Modifiable risk factors associated with prediabetes in men and women: A cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes

Background: Prediabetes is a high-risk state for diabetes development, but little is known about the factors associated with this state. The aim of the study was to identify modifiable risk factors associated with the presence of prediabetes in men and women. Methods: Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS-Study) is a prospective study on a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects without glucose metabolism disorders. It is being conducted by 125 general practitioners in Spain. Data for this analysis were collected during the baseline stage in 2012. The modifiable risk factors included were: smoking habit, alcohol consumption, low physical activity, inadequate diet, hypertension, dyslipidemia, and obesity. To assess independent association between each factor and prediabetes, odds ratios (ORs) were estimated using logistic regression models. Results: Abdominal obesity, low plasma levels of high-density lipoprotein cholesterol (HDL-cholesterol), and hypertension were independently associated with the presence of prediabetes in both men and women. After adjusting for all factors, the respective ORs (95% Confidence Intervals) were 1.98 (1.41-2.79), 1.88 (1.23-2.88) and 1.86 (1.39-2.51) for men, and 1.89 (1.36-2.62), 1.58 (1.12-2.23) and 1.44 (1.07-1.92) for women. Also, general obesity was a risk factor in both sexes but did not reach statistical significance among men, after adjusting for all factors. Risky alcohol consumption was a risk factor for prediabetes in men, OR 1.49 (1.00-2.24). Conclusions: Obesity, low HDL-cholesterol levels, and hypertension were modifiable risk factors independently related to the presence of prediabetes in both sexes. The magnitudes of the associations were stronger for men than women. Abdominal obesity in both men and women displayed the strongest association with prediabetes. The findings suggest that there are some differences between men and women, which should be taken into account when implementing specific recommendations to prevent or delay the onset of diabetes in adult population

Instrumentos que miden la comunicación enfermera-paciente

Introduction: Given the importance which communication has in healthcare of quality, nurses have been concerned about the assessment of professional interactions with their patients. Objective: To identify instruments measuring the nurse-patient interactions in order to assess the quality of attention provided within an interpersonal dimension. Methodology: The related literature was reviewed by consulting the Scielo, Medline, Redalyc, BVS and CINHAL databases. 25 articles researching on the design, validation, application, and adaptation of instruments measuring nurse-patient communications in diverse services and levels of care were selected. Results: Selected articles were classified into three groups: a) application and validation of instruments; b) adaptation and validation of instruments; c) design and validation of instruments. Nine articles make reference to the application and validation of instruments, 10 make it to adaptation and validation, and 6 make it to the design and validation. Conclusions: Although diverse articles addressing the issue have been designed, validated, applied and adjusted, challenges in this research area still exist regarding new strategies which can diagnose and offer alternatives to improve the communication between the nurses and their patients in the daily nursing practice.Introdução: Pela importância que tem a comunicação para oferecer um cuidado de qualidade, as enfermeiras têm se preocupado pela avaliação da interação com seu paciente no exercício de sua prática profissional. Objetivo: Identificar instrumentos que medem a interação enfermeira paciente, pelo valor que pode envolver para a avaliação da qualidade da atenção na dimensão interpessoal. Metodologia: Revisou-se a literatura e consultaram as bases de Scielo, Medline, Redalyc, BVS e, CINHAL. Conforme no propósito enunciado selecionaram-se 25 artigos que pesquisam sobre o desenho, validação, aplicação e adaptação de instrumentos que medem a comunicação enfermeira-paciente em diversos serviços e níveis de saúde.                                                               Resultados: Os artigos selecionados classificaram-se em três grupos: a) aplicação e validação de instrumentos; b) adaptação e validação de instrumentos; c) desenho e validação de instrumentos. Nove fazem referência à aplicação e validação de instrumentos, 10 tanto na adaptação quanto na validação, por último, seis no desenho e validação. Conclusões: Ainda que se tenham desenhado, validado, aplicado e ajustado instrumentos, ainda existem desafios neste campo de pesquisa com o fim de oferecer novas estratégias que diagnostiquem e forneçam alternativas específicas, para melhorar a comunicação enfermeira-paciente na prática diária de enfermagem.Introducción: Por la importancia que tiene la comunicación al ofrecer un cuidado de calidad, las enfermeras se han preocupado por la evaluación de la interacción con su paciente en el ejercicio de su práctica profesional. Objetivo: Identificar instrumentos que midan la interacción enfermera paciente, por el valor que puede implicar para la evaluación de la calidad de la atención en la dimensión interpersonal. Metodología: Se revisó la literatura y consultaron las bases de Scielo, Medline, Redalyc, BVS y, CINHAL. De acuerdo con el propósito enunciado se seleccionaron 25 artículos que investigan sobre el diseño, validación, aplicación y adaptación de instrumentos que miden la comunicación enfermera-paciente en diversos servicios y niveles de salud.                    Resultados: Los artículos seleccionados se clasificaron en tres grupos: a) aplicación y validación de instrumentos; b) adaptación y validación de instrumentos; c) diseño y validación de instrumentos. Nueve hacen referencia a la aplicación y validación de instrumentos, 10 tanto a la adaptación como la validación, por último, seis al diseño y validación. Conclusiones: Aunque se han diseñado, validado, aplicado y ajustado instrumentos, aún existen retos en este campo de investigación, con el fin de ofrecer nuevas estrategias que diagnostiquen y brinden alternativas específicas, para mejorar la comunicación enfermera-paciente en la práctica diaria de enfermería

Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice : A multicentre cohort study

Background: The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods: Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014-2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen). Results: We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. Conclusions: EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads