Nivel de información médica sobre diabetes, actitud de los pacientes hacia la enfermedad y su asociación con el nivel de control glucémico

ObjetivoDeterminar el nivel de información y de actitud que sobre su enfermedad tienen pacientes con diabetes tipo 2 (DM2) y su asociación con el nivel de control glucémico.DiseñoEncuesta transversal survey.EmplazamientoDos unidades de medicina familiar.PacientesDoscientos sujetos con DM2.IntervencionesSe aplicaron 2 instrumentos validados para valorar nivel de conocimientos y actitud, y se midió el promedio de las últimas 6 glucemias.Mediciones y resultadosLa calificación global del instrumento de conocimientos fue 58,6 ± 17,9 (escala 0-100). Para el instrumento de actitud fue de 18,9 ± 2,1 (escala 0-35). La calificación de conocimientos del grupo controlado fue de 55,48 ± 16,8, y la del grupo descontrolado de 59,2 ± 18,1. La calificación sobre actitud del grupo controlado fue de 17,8 ± 2,3, y la del grupo descontrolado de 19,1 ± 2 (p = 0,001). El nivel de información proporcionado por el médico familiar fue del 42,9%, por el equipo de salud del 10,2% y por otras fuentes del 6,3%. En cuanto al análisis del grado de actitud y el nivel de información, hubo una mejor actitud cuando la información fue proporcionada por otras fuentes (p < 0,05). Por lo que respecta al porcentaje de información y el control glucémico, el nivel de control fue mejor cuando la información fue proporcionada por el equipo de salud (p < 0,01).ConclusionesEl nivel de información médica sobre diabetes proporcionada por el médico familiar y el equipo de salud es bajo, y sólo en este último caso se asocia a un mejor control glucémico. La actitud es mejor cuando se recibe información sobre diabetes de otras fuentes.ObjectiveTo determine the level of information and attitude that it has more than enough their illness has patient with diabetes type 2 (DM2), and their association with level of glucemic control.DesignCross-sectional.SettingTwo units of family medicine.Patient200 subject with DM2.InterventionsTwo instruments were applied validated to measure, level of knowledge and attitude was measured the average of the last 6 glucaemias.Measurements and resultsThe qualification average of the instrument of knowledge was 58.6 ± 17.9 (it scale 0–100). For the instrument of attitude it was of 18.9 ± 2.1 (it scale 0 at 35). The qualification of knowledge of the controlled group was of 55.48 ± 16.8, and of the uncontrolled group it was of 59.2 ± 18.1. The qualification has more than enough attitude of the controlled group it was of 17.8 ± 2.3, and of the uncontrolled group of 19.1 ± 2, p = 0.001. The proportionate level of information the family doctor was of 42.9%, of the team of health of 10.2% and of other sources of 6.3%. At the analysis of the degree of attitude and the level of information, there was a better attitude when the information was provided by other sources p < 0.05. In the percentage of information and the level of glucemic control, the control level was better when the information was for the team of health p < 0.01.ConclusionsThe level of medical information on diabetes provided by the family doctor and the team of health is low and it doesn't and only this last are associate to better glucemic control. The attitude is better when one receives information of other sources

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Ground-based validation of the Copernicus Sentinel-5P TROPOMI NO2 measurements with the NDACC ZSL-DOAS, MAX-DOAS and Pandonia global networks

This paper reports on consolidated ground-based validation results of the atmospheric NO2 data produced operationally since April 2018 by the TROPOspheric Monitoring Instrument (TROPOMI) on board of the ESA/EU Copernicus Sentinel-5 Precursor (S5P) satellite. Tropospheric, stratospheric, and total NO2 column data from S5P are compared to correlative measurements collected from, respectively, 19 Multi-Axis Differential Optical Absorption Spectroscopy (MAX-DOAS), 26 Network for the Detection of Atmospheric Composition Change (NDACC) Zenith-Scattered-Light DOAS (ZSL-DOAS), and 25 Pandonia Global Network (PGN)/Pandora instruments distributed globally. The validation methodology gives special care to minimizing mismatch errors due to imperfect spatio-temporal co-location of the satellite and correlative data, e.g. by using tailored observation operators to account for differences in smoothing and in sampling of atmospheric structures and variability and photochemical modelling to reduce diurnal cycle effects. Compared to the ground-based measurements, S5P data show, on average, (i) a negative bias for the tropospheric column data, of typically −23 % to −37 % in clean to slightly polluted conditions but reaching values as high as −51 % over highly polluted areas; (ii) a slight negative median difference for the stratospheric column data, of about −0.2 Pmolec cm−2, i.e. approx. −2 % in summer to −15 % in winter; and (iii) a bias ranging from zero to −50 % for the total column data, found to depend on the amplitude of the total NO2 column, with small to slightly positive bias values for columns below 6 Pmolec cm−2 and negative values above. The dispersion between S5P and correlative measurements contains mostly random components, which remain within mission requirements for the stratospheric column data (0.5 Pmolec cm−2) but exceed those for the tropospheric column data (0.7 Pmolec cm−2). While a part of the biases and dispersion may be due to representativeness differences such as different area averaging and measurement times, it is known that errors in the S5P tropospheric columns exist due to shortcomings in the (horizontally coarse) a priori profile representation in the TM5-MP chemical transport model used in the S5P retrieval and, to a lesser extent, to the treatment of cloud effects and aerosols. Although considerable differences (up to 2 Pmolec cm−2 and more) are observed at single ground-pixel level, the near-real-time (NRTI) and offline (OFFL) versions of the S5P NO2 operational data processor provide similar NO2 column values and validation results when globally averaged, with the NRTI values being on average 0.79 % larger than the OFFL values

Limits on point-like sources of ultra-high-energy neutrinos with the Pierre Auger Observatory

International audienceWith the Surface Detector array (SD) of the Pierre Auger Observatory we can detect neutrinos with energy between 1017 eV and 1020 eV from point-like sources across the sky, from close to the Southern Celestial Pole up to 60ˆ in declination, with peak sensitivities at declinations around ∼ −53ˆ and ∼+55ˆ, and an unmatched sensitivity for arrival directions in the Northern hemisphere. A search has been performed for highly-inclined air showers induced by neutrinos of all flavours with no candidate events found in data taken between 1 Jan 2004 and 31 Aug 2018. Upper limits on the neutrino flux from point-like steady sources have been derived as a function of source declination. An unrivaled sensitivity is achieved in searches for transient sources with emission lasting over an hour or less, if they occur within the field of view corresponding to the zenith angle range between 60ˆ and  95ˆ where the SD of the Pierre Auger Observatory is most sensitive to neutrinos

Techniques for measuring aerosol attenuation using the Central Laser Facility at the Pierre Auger Observatory

The Pierre Auger Observatory in Malargue, Argentina, is designed to study the properties of ultra-high energy cosmic rays with energies above 10^18 eV. It is a hybrid facility that employs a Fluorescence Detector to perform nearly calorimetric measurements of Extensive Air Shower energies. To obtain reliable calorimetric information from the FD, the atmospheric conditions at the observatory need to be continuously monitored during data acquisition. In particular, light attenuation due to aerosols is an important atmospheric correction. The aerosol concentration is highly variable, so that the aerosol attenuation needs to be evaluated hourly. We use light from the Central Laser Facility, located near the center of the observatory site, having an optical signature comparable to that of the highest energy showers detected by the FD. This paper presents two procedures developed to retrieve the aerosol attenuation of fluorescence light from CLF laser shots. Cross checks between the two methods demonstrate that results from both analyses are compatible, and that the uncertainties are well understood. The measurements of the aerosol attenuation provided by the two procedures are currently used at the Pierre Auger Observatory to reconstruct air shower data