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1.
Eduarda Barreira André Novo Josiana A. Vaz Ana M.G. Pereira 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(10):590-610
Objectives
Evaluate the effectiveness of the implementation of independently or combined dietary and physical activity programs on the blood glucose values and lipid profile in patients with type 2 diabetes, including participants aged 60 years and over.Design
Systematic review.Data source
PubMed/Medline database, with language restrictions. Papers published between 2010 and 2016 were included.Study selection
A total of 30 randomised controlled trials were included that focused on physical activity and dietary interventions in patients with type 2 diabetes mellitus and include participants aged 60 years and over.Results
The selected articles have shown that the implementation of physical activity programs (aerobic, resistance, flexibility and combined exercises), and programs based on a higher intake of vegetables, grains, legumes, fruits, unsaturated fatty acids, as well as consumption of foods with low glycaemic index, calorie restriction, intake of probiotics, vitamin D supplementation and educational sessions about diabetes improves blood glucose levels, as well as the lipid profile, in patients with type 2 diabetes.Conclusions
Physical activity and dietary programs are fundamental in the treatment and metabolic control of type 2 diabetes mellitus. 相似文献2.
Gabriel Jesús Rodríguez Juan Antonio Córdoba-Doña Antonio Escolar-Pujolar Manuel Aguilar-Diosdado Isabel Goicolea 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(10)
Aim
To examine the experience of diabetic care in patients undergoing lower limb amputation.Design
A qualitative study using the phenomenological approach.Setting
Cadiz Health District.Participants
A total of 16 patients (11 men and 5 women) diagnosed with diabetes mellitus type 2 and with non-traumatic lower limb amputation.Methods
Semi-structured interviews were performed, followed by a content analysis according Graneheim and Lundman.Results
Four categories were identified: 1. The family is the cornerstone for diabetic care. 2. The socio-economic and working conditions determine the quality of self-care. 3. The patient-health professional interaction facilitates patient care. 4. Limitations in the provision of health services.Conclusion
Family, economic and working conditions, along with health system-related factors are the most important elements in the care of patients with diabetes and amputations. Social, economic and working conditions determine diabetic complications. In order to enhance health care impact on the prevention of diabetes mellitus complications, health system policy makers must take these facts seriously into consideration and in a more personalised manner. 相似文献3.
A. Grateau M. Le Maréchal H. Labussière-Wallet S. Ducastelle-Leprêtre F.-E. Nicolini X. Thomas S. Morisset M. Michallet F. Ader 《Médecine et maladies infectieuses》2018,48(3):202-206
Objectives
To study the management of chronic disseminated candidiasis (CDC) in patients presenting with acute leukemia.Patients and methods
Single-center retrospective study of acute leukemia patients (2006–2015) to investigate three aspects of CDC: its impact on the time interval between diagnosis and hematopoietic stem cell transplantation, when required (non-parametric Wilcoxon-Mann-Whitney test); its impact on overall survival (Cox proportional hazard regression model); antifungal therapeutic strategies implemented.Results
A total of 639 patients presenting with acute leukemia were included; 144 were transplanted and 29 developed CDC. CDC did not significantly increase the time interval between diagnosis and transplantation, nor did it impact the overall survival of recipients. An improved overall survival was observed in non-transplanted acute leukemia patients presenting with CDC.Conclusion
CDC should not postpone transplantation if antifungal treatment is optimized. 相似文献4.
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María Julia Ajejas Bazán María Isab Jiménez Trujillo Julia Wärnberg Silvia Domínguez Fernández Ana López de Andrés Napoleón Pérez Farinós 《Gaceta sanitaria / S.E.S.P.A.S》2018,32(5):477-480
Objective
To examine relevant differences in the prevalence of overweight and obesity in children aged 2-15 years according to different sets of criteria (Orbegozo Foundation, International Obesity Task Force and World Health Organization), and how their use affects the trends in obesity recorded for both sexes between 1995 and 2011 in Spain.Method
Cross-sectional study, a population between 2 and 15 years. Three diagnosis criteria of overweight and obesity were be used.Results
The boys according to the three criteria, showed higher values of overweight and obesity compared to the girls. The lowest levels of overweight and obesity were observed using the Orbegozo tables.Discussion
The prevalence of overweight and obesity varies significantly according to the criteria used to define overweight and obesity. The percentiles of the Foundation Orbegozo gave the lowest estimates and the standards of growth of the World Health Organization were higher. 相似文献7.
Ana Molina-Barceló Rosana Peiró-Pérez Mercedes Vanaclocha Guillermo Vallés Laura Guaita Dolores Salas 《Gaceta sanitaria / S.E.S.P.A.S》2018,32(1):72-76
Objective
To examine the factors that influence informed participation in a Colorectal Cancer Screening Programme (CRCSP) from a gender perspective.Methods
Cross-sectional telephone survey directed to men and women invited to participate (2009-2010) in the Valencian Community CRCSP (Spain). Sample size: 785 subjects. Outcome variables: participation in CRCSP and being informed. Bivariate and multivariate analysis using logistic regression models (95% confidence interval [95%CI], p <0.05).Results
Being a woman (odds ratio [OR]: 1.52; 95%CI: 1.06-2.19), receiving information from a general practitioner (OR: 1.64; 95%CI: 1.05-2.55) and being informed (OR: 1.54; 95%CI: 1.08-2.21) are related to participation. Men are more likely to participate if they live with a partner (OR: 6.26; 95%CI: 1.82-21.49); and are more informed if they have family responsibilities (OR: 2.53; 95%CI: 1.39-4.63).Conclusion
Information about CRCSP, involving primary health care professionals and including specific actions directed at men and at women, could contribute to improve informed participation with a gender equity perspective. 相似文献8.
Belén Muñoz Díaz Antonio P. Arenas de Larriva Guillermo Molina-Recio Rafael Moreno-Rojas Jorge Martínez de la Iglesia 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(2):88-95
Objective
To analyse the nutritional status of patients older than 65 years included in the home care program (PAD).Design
Croos-sectional study.Emplacement
3 urban health centers.Participants
218 patients in the PAD.Method
Mini Nutritional Assessment questionnaire (MNA) was applied. Sociodemographic, anthropometric, dependency, emotional and cognitive status and analytical parameters: 57 variables were collected. Possible associations were analysed by applying the chi square and variance analysis. The level of significance was considered to be P < .05 was considered.Results
The mean age was 83.9 years (SD = 7.4); 34.9% were institutionalized and 80.7% were women; 21.2% of patients were malnourished and 40.1% were at risk of it. A significant association was established between poorer nutritional status and older age, lower BMI, greater dependence on basic and instrumental activities of daily living and greater cognitive impairment. The lowest mean hemoglobin, albumin, and iron levels were also associated with malnutrition and risk of malnutrition.Conclusions
More than half of PAD patients are malnourished or at risk for it, and a high proportion of them some laboratory abnormality susceptible to be corrected. Most cognitive impairment and functional dependence are closely related to malnutrition; so patients with these characteristics should receive more attention from the nutritional point of view. 相似文献9.
Ainhoa Coloma-Carmona José Luis Carballo Sonia Tirado-González 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(2):95-99
Objective
Due to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals’ health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers.Method
The participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire.Results
The main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals.Conclusions
Studies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care. 相似文献10.
Isabel Goicolea Paola Mosquera Erica Briones-Vozmediano Laura Otero-García Marta García-Quinto Carmen Vives-Cases 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(3):187-193
Objective
This study provides an overview of the perceptions of primary care professionals on how the current primary health care (PHC) attributes in Spain could influence health-related responses to intimate partner violence (IPV).Methods
A qualitative study was conducted using semi-structured interviews with 160 health professionals working in 16 PHC centres in Spain. Data were analysed using a qualitative content analysis.Results
Four categories emerged from the interview analysis: those committed to the PHC approach, but with difficulties implementing it; community work relying on voluntarism; multidisciplinary team work or professionals who work together?; and continuity of care hindered by heavy work load. Participants felt that person-centred care as well as other attributes of the PHC approach facilitated detecting IPV and a better response to the problem. However, they also pointed out that the current management of the health system (workload, weak supervision and little feedback, misdistribution of human and material resources, etc.) does not facilitate the sustainability of such an approach.Conclusion
There is a gap between the theoretical attributes of PHC and the “reality” of how these attributes are managed in everyday work, and how this influences IPV care. 相似文献11.
Alba Llop-Gironés Montse Vergara-Duarte Josep Anton Sánchez Gemma Tarafa Joan Benach 《Gaceta sanitaria / S.E.S.P.A.S》2018,32(4):369-372
Objective
To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain.Method
Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes.Results
The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01)Conclusions
The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible. 相似文献12.
Ingrid Solanes Ignasi Bolíbar Maria Antònia Llauger Meritxell Peiro Pepi Valverde Mar Fraga Casimira Medrano Teresa Bigorra Montserrat Freixas Iskra Ligüerre Maria Antònia Pou Leandra Domínguez Carles Valero Judit Solà Jordi Giner Vicente Plaza 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(3):184-196
Objective
To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD).Design
A study with a quasi-experimental design was used to evaluate the effectiveness of two interventions (I1, I2) for the care of patients with COPD after a mean follow-up of 31.2 months.Setting
Primary Care Centres in two Barcelona Health Areas and their referral hospitals.Participants
Patients with COPD selected by simple random sampling using any disease code corresponding to COPD.Interventions
I1: Integrated management program that was optimised and coordinated the resources. Training was given, as well as quality control of spirometry. I2: Isolated interventions like a call-centre. Care circuits and computerised clinical notes were shared.Main measurements
Variables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations.Results
Of the 393 patients evaluated at the beginning, 120 and 104 (I1 and I2, respectively) received the final evaluation. With I1, there was a reduction in patients who smoked (P = .034). Lung function and quality of life did not change significantly in either group, but shortness of breath was slightly worse. There was an increase in the correct use of inhalers, although it only reached 48% and 61% with interventions I1 and I2, respectively. The percentage of patients with exacerbations decreased with I1 compared to that of I2 (P < .001), and there were less hospital admissions due to exacerbations with I2 compared to I1 (P < .003]).Conclusions
Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD. 相似文献13.
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D. Vandroux N. Allou J. Jabot G. Li Pat Yuen E. Brottet B. Roquebert O. Martinet 《Médecine et maladies infectieuses》2018,48(2):141-144
Background
Coronavirus OC43 infection causes severe pneumonia in patients presenting with comorbidities, but clinical signs alone do not allow for viral identification.Objectives
To analyze acute manifestations of Coronavirus OC43 infections and outcomes of patients admitted to an intensive care unit (ICU).Patients and methods
Retrospective and monocentric study performed during a Coronavirus OC43 outbreak. We used multiplex PCR to detect an OC43 outbreak in Reunion Island during the 2016 Southern Hemisphere's winter: seven admissions to the ICU.Results
Mean age of patients was 71 [67;76] years, SAPS II was 42 [28;53], pneumonia severity index 159 [139;182] vs 73 [40.5;107] for patients in medical wards, and 43% required mechanical ventilation. Comorbidities were diabetes mellitus (87%), chronic respiratory failure (57%), and chronic renal failure (29%). One patient died from Haemophilus influenzae co-infection.Conclusion
As for MERS Co-V infections, underlying comorbidities impacted the clinical outcomes of OC43 infections. 相似文献18.
Cristina Blánquez Moreno Cristina Colungo Francia M. Carme Alvira Balada Belchin Kostov Luis González-de Paz Antoni Sisó-Almirall 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(9):539-546
Aim
To determine the impact of an educational program to improve the management of chronic obstructive pulmonary disease (COPD) that contributes to an increase of the quality of life, exercise capacity, level of dyspnoea, and clinical risk.Design
Intervention study without controls.Location
Primary Healthcare Centre.Participants
193 patients with COPD were invited, 73 accepted and 55 participated in the educational program.Interventions
Respiratory rehabilitation educational program with basic concepts of pulmonary and respiratory pathophysiology, respiratory physiotherapy exercises, practical workshop on the use of the most frequent inhalation devices, understanding of chronic disease and self-care measures in case of exacerbation.Main measurements
The quality of life (the COPD assessment test), exercise tolerance (the Six-Minute Walk Test), rating of perceived exertion (Borg Dyspnoea Score) and clinical risk (BODE index) were assessed by means of validated questionnaires in Spanish.Results
A total of 43 (78.2%) participants completed the program. An improvement in the quality of life by a mean of 3.3 points was observed (95%CI; 1.76-4.84). Just over half (53.5%) of the participants obtained a clinically relevant improvement. Participants also improved their physical exercise capacity at post-intervention by increasing the distance that they walked in 6 min by a mean of 20.76 m (95%CI; 2.57-38.95). Improvements in the level of dyspnoea and clinical risk were also observed.Conclusions
The educational program shows a statistically significant and clinically relevant improvement in the quality of life, fatigue, symptomatology, exercise capacity, level of dyspnoea, and clinical risk. The program is adaptable to the health care routine of healthcare centres. 相似文献19.
C. Vandererven A.-P. Bellanger J.-F. Faucher P. Marguet 《Médecine et maladies infectieuses》2017,47(4):261-265
Introduction
Tick bites, which may lead to Lyme disease, often prompt patients to consult their primary care physicians (PCPs). The aim of the present study was to assess how and how often PCPs in the Franche-Comté region of France manage tick bites.Material and methods
Standardized questionnaires were sent to a random sample of 400 PCPs in the Franche-Comté region, requesting their voluntary and anonymous participation. The questionnaires collected socio-demographic details and practice-related information about tick-bite prophylaxis, Lyme serology, and tick-borne encephalitis vaccination.Results
The crude response rate was 54.5% of the PCPs contacted. Tick-bite prophylaxis was prescribed as per current guidelines. However, Lyme serology seemed to be largely overprescribed for tick bites and in case of erythema migrans. A clear lack of knowledge about tick-borne encephalitis vaccination was also observed.Discussion
PCPs provide the first line of care for patients presenting with tick bites. This study showed that although PCPs of the Franche-Comté region manage tick bites as per current guidelines, they need further training on Lyme serology limitations and availability of tick-borne encephalitis vaccination. 相似文献20.
Maria Salvador-Piedrafita Davide Malmusi Carme Borrell 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(1):11-17