Estrategia combinada de educación y cambios estructurales en CAPS

La calidad de atención brindada a personas con diabetes tipo 2 y factores de riesgo cardiovascular (DMT2 y FRCV}, en el nivel primario de atención, no alcanza metas de tratamiento capaces de prevenir el desarrollo y progresión de las complicaciones crónicas de la enfermedad.Área: Ciencias Sociales y Humana

Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America

Aims Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D. Methods This observational study utilized data from the QUALIDIAB database on 3,099 T2D patients seen in Diabetes Centers in Argentina, Chile, Colombia, Peru, and Venezuela. Data were grouped according to body mass index (BMI) as Normal (18.5BMI<25), Overweight (25BMI<30), and Obese (BMI30). Thereafter, we assessed clinical and metabolic data and cost of drug treatment in each category. Statistical analyses included group comparisons for continuous variables (parametric or non-parametric tests), Chi-square tests for differences between proportions, and multivariable regression analysis to assess the association between BMI and monthly cost of drug treatment. Results Although all groups showed comparable degree of glycometabolic control (FBG, HbA1c), we found significant differences in other metabolic control indicators. Total cost of drug treatment of hyperglycemia and associated cardiovascular risk factors (CVRF) increased significantly (p<0.001) with increment of BMI. Hyperglycemia treatment cost showed a significant increase concordant with BMI whereas hypertension and dyslipidemia did not. Despite different values and percentages of increase, this growing cost profile was reproduced in every participating country. BMI significantly and independently affected hyperglycemia treatment cost. Conclusions Our study shows for the first time that BMI significantly increases total expenditure on drugs for T2D and its associated CVRF treatment in Latin America.Fil: Elgart, Jorge Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Prestes, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Gonzalez, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Rucci, Enzo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America

Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D.Facultad de Ciencias MédicasCentro de Endocrinología Experimental y Aplicad

Self-administered structured food record for measuring individual energy and nutrient intake in large cohorts: Design and validation

Introduction: Several instruments developed to assess dietary intake of groups or populations have strengths and weaknesses that affect their specific application. No self-administered, closed-ended dietary survey was previously used in Argentina to assess current food and nutrient intake on a daily basis. Objective: To design and validate a self-administered, structured food record (NutriQuid, NQ) representative of the adult Argentine population’s food consumption pattern to measure indi- vidual energy and nutrient intake. Materials and methods: Records were loaded onto a database using software that checks a regional nutrition information system (SARA program), automatically quantifying energy and nutrient intake. NQ validation included two phases: (1) NQ construct validity comparing records kept simultaneously by healthy volunteers (45---75 years) and a nutritionist who provided meals (reference), and (2) verification of whether NQ reflected target population consumption (calo- ries and nutrients), week consumption differences, respondent acceptability, and ease of data entry/analysis. Data analysis included descriptive statistics, repeated measures ANOVA, intra- class correlation coefficient, nonparametric regression, and cross-classification into quintiles. Results: The first validation (study group vs. reference) showed an underestimation (10%) of carbohydrate, fat, and energy intake. Second validation: 109 volunteers (91% response) com- pleted the NQ for seven consecutive days. Record completion took about 9 min/day, and data entry 3---6 min. Mean calorie intake was 2240 ± 119 kcal/day (42% carbohydrates, 17% protein, and 41% fat). Intake significantly increased in the weekend. Conclusion: NQ is a simple and efficient tool to assess dietary intake in large samples.Facultad de Ciencias Médica

Self-administered structured food record for measuring individual energy and nutrient intake in large cohorts: Design and validation

Introduction: Several instruments developed to assess dietary intake of groups or populations have strengths and weaknesses that affect their specific application. No self-administered, closed-ended dietary survey was previously used in Argentina to assess current food and nutrient intake on a daily basis. Objective: To design and validate a self-administered, structured food record (NutriQuid, NQ) representative of the adult Argentine population’s food consumption pattern to measure indi- vidual energy and nutrient intake. Materials and methods: Records were loaded onto a database using software that checks a regional nutrition information system (SARA program), automatically quantifying energy and nutrient intake. NQ validation included two phases: (1) NQ construct validity comparing records kept simultaneously by healthy volunteers (45---75 years) and a nutritionist who provided meals (reference), and (2) verification of whether NQ reflected target population consumption (calo- ries and nutrients), week consumption differences, respondent acceptability, and ease of data entry/analysis. Data analysis included descriptive statistics, repeated measures ANOVA, intra- class correlation coefficient, nonparametric regression, and cross-classification into quintiles. Results: The first validation (study group vs. reference) showed an underestimation (10%) of carbohydrate, fat, and energy intake. Second validation: 109 volunteers (91% response) com- pleted the NQ for seven consecutive days. Record completion took about 9 min/day, and data entry 3---6 min. Mean calorie intake was 2240 ± 119 kcal/day (42% carbohydrates, 17% protein, and 41% fat). Intake significantly increased in the weekend. Conclusion: NQ is a simple and efficient tool to assess dietary intake in large samples.Facultad de Ciencias Médica

Improving diabetes care at primary care level with a multistrategic approach: results of the DIAPREM programme

Aim: To present results, 1 year postimplementation at primary care level, of an integrated diabetes care programme including systemic changes, education, registry (clinical, metabolic, and therapeutic indicators), and disease management (DIAPREM). Methods: We randomly selected and trained 15 physicians and 15 nurses from primary care units of La Matanza County (intervention—IG) and another 15 physicians/nurses to participate as controls (control—CG). Each physician– nurse team controlled and followed up 10 patients with type 2 diabetes for 1 year; both groups used structured medical records. Patients in IG had quarterly clinical appointments, whereas those in CG received traditional care. Statistical data analysis included parametric/ nonparametric tests according to data distribution profile and Chi-squared test for proportions. Results: After 12 months, the dropout rate was significantly lower in IG than in CG. Whereas in IG HbA1c, blood pressure and lipid profile levels significantly decreased, no changes were recorded in CG. Drug prescriptions showed no significant changes in IG except a decrease in oral monotherapy. Conclusions: DIAPREM is an expedient and simple multistrategic model to implement at the primary care level in order to decrease patient dropout and improve control and treatment adherence, and quality of care of people with diabetes.Centro de Endocrinología Experimental y AplicadaFacultad de Ciencias EconómicasInstituto de Investigación en InformáticaCentro Interdisciplinario Universitario para la Salu

Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America

Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D.Facultad de Ciencias MédicasCentro de Endocrinología Experimental y Aplicad

Dinâmica de Populações, Modelo de Lotka-Volterra e Tecnologias: Análise de um Projeto Interdisciplinar

Esta pesquisa teve por objetivo analisar um projeto interdisciplinarenvolvendo o uso do Facebook e do software Modellus como ferramentas de apoio ao ensino e aprendizagem nas áreas de Matemática e Biologia na disciplina de Matemática Aplicada da graduação em Matemática. A metodologia qualitativa aplicada envolveu quatro professores e seis alunos no estudo de modelos matemáticos sobre a dinâmica de populações no âmbito da ecologia. Percebe-se o impacto positivo do projeto, não somente nos alunos, mas na própria proposta da disciplina. A articulação entre a teoria e a prática, dada pela simulação a partir da busca de dados em artigos científicos para chegar aos parâmetros que foram construídos pelos alunos, proporcionou a compreensão do modelo em si, no caso específico, a relação presa/predador

Postoperative complications in appendectomies : comparative analysis between open and laparoscopic approaches

Introdução: A apendicectomia é o tratamento de escolha da apendicite aguda. Embora a preferência pelas técnicas minimamente invasivas seja tendência mundial, a cirurgia aberta ainda é realidade na maioria dos hospitais públicos. O índice de complicações pós-operatórias varia de acordo com a técnica cirúrgica empregada. O presente estudo objetiva comparar a incidência de complicações pós-operatórias entre a apendicectomia aberta e laparoscópica. Métodos: Coorte retrospectiva incluindo pacientes submetidos à apendicectomia no Hospital de Pronto Socorro de Porto Alegre entre novembro de 2015 a novembro de 2019. Foram avaliados dados demográficos, tempo de evolução dos sintomas, técnica cirúrgica, achados transoperatórios, necessidade de drenos ou ostomias, tempo cirúrgico, tempo de internação, experiência do cirurgião e desfechos. Resultados: Foram incluídos 358 pacientes, com idade de 32 ± 13,8 anos, e predomínio do sexo masculino (58,9%); 58,1% foram submetidos a cirurgia aberta, 41,9% a laparoscopia e 8% necessitaram conversão. As apendicites foram classificadas como complicadas em um terço dos casos. O tempo cirúrgico foi menor na cirurgia aberta (79,3 ± 38,8 vs. 104 ± 35,2 minutos; p < 0,001). O índice de complicações pós-operatórias foi de 21,2%, sendo significativamente maior na técnica aberta (26,4% vs. 13%; p = 0,003). O tempo de internação, a necessidade de reintervenção e mortalidade não apresentaram diferença entre as técnicas. Conclusão: Embora a apendicectomia aberta seja um procedimento seguro, com bons resultados e baixa morbimortalidade, a laparoscopia oferece potenciais vantagens em termos de evolução pós-operatória, inclusive em casos complicados. Deve ser indicada rotineiramente havendo disponibilidade de material e capacitação da equipe cirúrgica.Introduction: Appendectomy is the treatment of choice for acute appendicitis. Although the preference for minimally invasive techniques is a worldwide trend, open surgery remains a reality in most public hospitals. The rate of postoperative complications varies according to the surgical technique employed. The present study aimed to compare the incidence of postoperative complications between open and laparoscopic appendectomy. Methods: This retrospective cohort study included patients undergoing appendectomy at the Hospital de Pronto Socorro de Porto Alegre between November 2015 and November 2019. Demographic and clinical data, duration of symptoms, surgical technique, intraoperative findings, use of abdominal drains or stomas, operative time, length of stay, surgeon’s experience, and outcomes were assessed. Results: Three hundred and fifty-eight patients were included, predominantly male (58.9%), with a mean age of 32 ± 13.8 years; 58.1% underwent open surgery, 41.9% underwent laparoscopic surgery, and 8% required conversion. One third of the cases were classified as complicated. The mean operative time was shorter for open surgery (79.3 ± 38.8 vs. 104 ± 35.2 minutes; p < 0.001). The rate of postoperative complications was 21.2%, with a significantly higher incidence in the open technique (26.4% vs. 13%; p = 0.003). Length of stay, reoperation rate, and mortality did not differ between the techniques. Conclusions: Although open appendectomy is a safe and efficient procedure, associated with low morbidity and mortality rates, laparoscopy provides potential clinically beneficial advantages in terms of postoperative outcomes, even in complicated cases. Therefore, it should be routinely performed where laparoscopic equipment and skillful staff are available

Resultados de la implementación de una estrategia combinada de educación y gestión de pacientes en centros de atención primaria de Argentina

Objectivos: Evaluar el impacto de un programa de capacitación de médicos y enfermeras, asociado a cambios en el sistema de gestión de pacientes y registro sistemático de variables clínico-metabólicas y terapéuticas, implementado en el nivel primario de atención, sobre la calidad de atención brindada a personas con diabetes tipo 2 (DT2).Centro de Endocrinología Experimental y AplicadaInstituto de Investigación en InformáticaCentro Interdisciplinario Universitario para la Salu