RESUMEN
Importance: The universal call to action for healthier and more sustainable dietary choices is the framework of the United Nations's Sustainable Development Goals. The Atlantic diet, originating from the northwest of the Iberian Peninsula, represents an example of a traditional diet that aligns with these principles. Objective: To explore a 6-month intervention based on the Atlantic diet's effects on metabolic and environmental health, assessing metabolic syndrome (MetS) incidence and the carbon footprint. Design, Setting, and Participants: The Galician Atlantic Diet study was a 6-month randomized clinical trial designed to assess the effects of this regional traditional diet on families' eating habits. The study was conducted from March 3, 2014, to May 29, 2015, at a local primary health care center in the rural town of A Estrada in northwestern Spain and involved a multisectoral collaboration. Families were randomly selected from National Health System records and randomized 1:1 to an intervention or control group. This secondary analysis of the trial findings was performed between March 24, 2021, and November 7, 2023. Interventions: Over 6 months, families in the intervention group received educational sessions, cooking classes, written supporting material, and foods characteristic of the Atlantic diet, whereas those randomized to the control group continued with their habitual lifestyle. Main Outcomes and Measures: The main outcomes were MetS incidence, defined per National Cholesterol Education Program Adult Treatment Panel III guidelines, and carbon footprint emissions as an environmental metric using life cycle assessment with daily dietary intake as the functional unit. Results: Initially, 250 families were randomized (574 participants; mean [SD] age, 46.8 [15.7] years; 231 males [40.2%] and 343 females [59.8%]). The intervention group included 126 families (287 participants) and the control group, 124 families (287 participants). Ultimately, 231 families completed the trial. The intervention significantly reduced the risk of incident cases of MetS (rate ratio, 0.32; 95% CI, 0.13-0.79) and had fewer MetS components (proportional odds ratio, 0.58; 95% CI, 0.42-0.82) compared with the control condition. The intervention group did not have a significantly reduced environmental impact in terms of carbon footprint emissions compared with the control group (-0.17 [95% CI, -0.46 to 0.12] kg CO2 equivalents/person/d). Conclusions and Relevance: These findings provide important evidence that a family-focused dietary intervention based on a traditional diet can reduce the risk of incident MetS. Further research is needed to understand the underlying mechanisms and determine the generalizability to other populations, taking into account regional cultural and dietary variations. Trial Registration: ClinicalTrials.gov Identifier: NCT02391701.
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Culinaria , Dieta , Adulto , Femenino , Masculino , Humanos , Persona de Mediana Edad , Alimentos , Grupos Control , Huella de CarbonoRESUMEN
Unhealthy dietary patterns (DPs) can lead to cardiovascular and other chronic diseases. We assessed the effects of a community-focused intervention with a traditional Atlantic diet on changes in DPs in families and the associations of these changes with weight loss. The Galiat study is a randomized, controlled trial conducted in 250 families (720 adults and children) and performed at a primary care setting with the cooperation of multiple society sectors. Over 6 months, families randomized to the intervention group received educational sessions, cooking classes, written supporting material, and foods that form part of the Atlantic diet, whereas those randomized to the control group followed their habitual lifestyle. At baseline, five DPs that explained 30.1% of variance were identified: "Caloric", "Frieds", "Fruits, vegetables, and dairy products", "Alcohol", and "Fish and boiled meals." Compared to the controls, the intervention group showed significant improvements in "Fruits, vegetables, and dairy products" and "Fish and boiled meals" and reductions in the "Caloric" and "Frieds". Changes in bodyweight per unit increment of "Frieds" and "Fruits, vegetables, and dairy products" scores were 0.240 kg (95% CI, 0.050-0.429) and -0.184 kg (95% CI, -0.379-0.012), respectively. We found that a culturally appropriate diet improved DPs associated with weight loss.
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Dieta Saludable/métodos , Salud de la Familia , Conducta Alimentaria/psicología , Educación en Salud/métodos , Pérdida de Peso , Adulto , Servicios de Salud Comunitaria/métodos , Culinaria , Cultura , Productos Lácteos , Femenino , Frutas , Humanos , Análisis de Intención de Tratar , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Población Rural , Alimentos Marinos , España , VerdurasRESUMEN
The Atlantic diet, the traditional dietary pattern in northern Portugal and northwest Spain, has been related to metabolic health and low ischemic heart disease mortality. The Galiat Study is a randomized controlled trial aimed to assess the effects of the Atlantic diet on anthropometric variables, metabolic profile, and nutritional habits. The dietary intervention was conducted in 250 families (720 adults and children) and performed at a primary care center. Over six months, families randomized to the intervention group received educational sessions, cooking classes, written supporting material, and foods that form part of the Atlantic diet, whereas those randomized to the control group followed their habitual lifestyle. 213 families (92.4%) completed the trial. Adults in the intervention group lost weight as opposed to controls who gained weight (adjusted mean difference -1.1 kg, p < 0.001) and total serum cholesterol (adjusted mean difference -5.2 mg/dL, p = 0.004). Significant differences in favor of the intervention were found in other anthropometric variables and low-density lipoprotein cholesterol, but changes in triglycerides, high-density lipoprotein cholesterol, inflammation markers, blood pressure, and glucose metabolism were not observed. A family-based nutritional intervention based on the Atlantic diet showed beneficial effects on adiposity and the lipid profile.
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Terapia Conductista , Factores de Riesgo Cardiometabólico , Dieta Mediterránea , Características de la Residencia , Adulto , Peso Corporal , Estudios de Casos y Controles , Colesterol/sangre , Conducta Alimentaria , Femenino , Directrices para la Planificación en Salud , Humanos , Masculino , Cooperación del PacienteRESUMEN
El avance tecnológico en el campo del diagnóstico clínico ha generado una diversidad de pruebas de laboratorio aplicables en el lugar de asistencia al paciente (POCT), y ha permitido contar con una mayor calidad analítica de los procedimientos implementados. La elaboración de un cuadro de mando integral es una herramienta útil para el éxito en la gestión de un proceso trasversal, complejo e interdisciplinario, como es el de obtener resultados analíticos fiables, transferibles de forma inmediata mediante sistemas POCT. Para la elaboración de un cuadro de mando integral se deben considerar cuatro perspectivas: la de los clientes (pacientes, médicos, grupos de interés), la financiera (inversores privados o públicos), la de los procesos operativos internos (sistemas, procesos) y la de los profesionales (cultura organizativa). El objeto de este documento es establecer recomendaciones para la elaboración de un cuadro de mando integral para gestionar los sistemas POCT disponibles en una institución
Technological development of in vitro diagnostics has led to a diversity of new tests for point-of-care testing (POCT) and at the same time provides quality in the process. Construction of a balanced scorecard is a useful tool for the success in the management of a cross-sectional, complex and interdisciplinary process, as well as to obtain reliable analytical results for immediately use with POCT systems. In constructing a balanced scorecard, four perspectives should be considered: Customer (patients, doctors), Financial (private or public investors), Operating procedures (systems, processes), and Professionals (organisational culture). The aim of this document is to establish the recommendations for the development of an adequate balanced scorecard to manage a point-of-care network in a healthcare system
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Humanos , Sistemas de Atención de Punto/organización & administración , Pruebas en el Punto de Atención/organización & administración , Manejo de Especímenes/métodos , Métodos Analíticos de la Preparación de la Muestra/métodos , Técnicas de Laboratorio Clínico/métodos , Manejo de Atención al Paciente/métodos , 34002 , Técnicas de Apoyo para la Decisión , Seguridad del PacienteRESUMEN
BACKGROUND: The traditional diet of northwestern Spain and northern Portugal follows an 'Atlantic diet' pattern. Adherence to the Atlantic diet has been related to the good metabolic health and low coronary mortality recorded for these regions. METHODS: The GALIAT (Galicia Alimentación Atlántica [Galicia Atlantic Diet]) study is a randomised, controlled, dietary intervention clinical trial designed to examine the effect of the Atlantic diet on the lipid profile, glucose metabolism, inflammation makers and adiposity of the general population. The trial involved 250 randomly selected families (715 adults and children over 3 years of age) from a town in Spain's northwest, randomly allocated to follow either a control diet (C group) or the Atlantic diet (AD group) for a period of 6 months. The families of the AD group received educational sessions on food, diet and gastronomy and were provided written supporting material with nutritional recommendations and recipes for the preparation of menus. They also attended cooking classes. Throughout the study period, these families were provided a range of foods (free of charge) that form part of the traditional Atlantic diet. The C group families took part in none of the above activities, nor were they provided with any food. Lipid profile variables (primary variables), and anthropometric, inflammation marker and glucose metabolism status (secondary variables), were measured at baseline, three and six months. DISCUSSION: The GALIAT study is the first clinical trial to examine the effects of the Atlantic diet on metabolic and cardiovascular health and adiposity. If the study hypothesis is confirmed, this dietary pattern could be included in strategies to promote health. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02391701 on March 18, 2015.
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Dieta/métodos , Familia , Conducta Alimentaria/fisiología , Adulto , Antropometría , Glucemia/análisis , Niño , Preescolar , Culinaria/métodos , Femenino , Humanos , Mediadores de Inflamación/sangre , Lípidos/sangre , Masculino , EspañaRESUMEN
BACKGROUND AND GOALS: Predicting relapse in Inflammatory Bowel Disease (IBD) could allow for early changes of treatment. Close monitoring of fecal calprotectin (FC) could be useful to predict relapse in IBD. Aim of the study was to evaluate the predictive value of a rapid FC test to predict flares in patients with IBD under maintenance therapy with Infliximab. STUDY: A prospective observational cohort study was designed. IBD patients in clinical remission under maintenance Infliximab therapy were included. FC was measured using a rapid test on a stool sample obtained within 24 hours before Infliximab infusion. Clinical examination was performed 2 months after that infusion. RESULTS: Fifty-three patients were included (52.8% female). Thirty-three patients (62.3%) had Crohn's disease and 20 (37.7%) had ulcerative colitis. All patients were in remission at inclusion. After 2 months, 41 patients (77.4%) remained in clinical remission and 12 (22.6%) presented a relapse. FC (mean±SD) in relapsing and not-relapsing disease was 332±168 and 110±163 µg/g, respectively (P<0.005). A FC concentration>160 µg/g had a sensitivity of 91.7%, and specificity of 82.9% to predict relapse. CONCLUSIONS: In IBD patients under Infliximab maintenance therapy, high FC levels allow predicting relapse within the following 2 months. Long-term remission is associated with low calprotectin levels. Further studies are required to confirm these results.
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Antiinflamatorios/uso terapéutico , Colitis Ulcerosa/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Heces/química , Fármacos Gastrointestinales/uso terapéutico , Infliximab/uso terapéutico , Complejo de Antígeno L1 de Leucocito/metabolismo , Adolescente , Adulto , Anciano , Área Bajo la Curva , Biomarcadores/metabolismo , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/metabolismo , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/metabolismo , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Recurrencia , Inducción de Remisión , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia Arriba , Adulto JovenRESUMEN
INTRODUCTION: There is increasing awareness of the importance of transforming organisational culture in order to raise safety standards. This paper describes the results obtained from an evaluation of patient safety culture in a sample of clinical laboratories in public hospitals in the Spanish National Health System. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted among health workers employed in the clinical laboratories of 27 public hospitals in 2012. The participants were recruited by the heads of service at each of the participating centers. Stratified analyses were performed to assess the mean score, standardized to a base of 100, of the six survey factors, together with the overall patient safety score. RESULTS: 740 completed questionnaires were received (88% of the 840 issued). The highest standardized scores were obtained in Area 1 (individual, social and cultural) with a mean value of 77 (95%CI: 76-78), and the lowest ones, in Area 3 (equipment and resources), with a mean value of 58 (95%CI: 57-59). In all areas, a greater perception of patient safety was reported by the heads of service than by other staff. CONCLUSIONS: We present the first multicentre study to evaluate the culture of clinical safety in public hospital laboratories in Spain. The results obtained evidence a culture in which high regard is paid to safety, probably due to the pattern of continuous quality improvement. Nevertheless, much remains to be done, as reflected by the weaknesses detected, which identify areas and strategies for improvement.
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Hospitales Públicos/normas , Laboratorios de Hospital/normas , Programas Nacionales de Salud , Cultura Organizacional , Seguridad del Paciente/normas , Gestión de la Calidad Total , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Personal de Laboratorio , Masculino , Persona de Mediana Edad , Seguridad del Paciente/legislación & jurisprudencia , Personal de Hospital/educación , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , España , Encuestas y CuestionariosRESUMEN
Introducción. La importancia de la determinación de albúmina en orina ha sido claramente establecida; sin embargo, existe controversia sobre las recomendaciones a seguir para su uso en el diagnóstico de la nefropatía diabética. El objetivo de este trabajo es evaluar los resultados y los costes del programa de escrutinio de la nefropatía diabética en nuestra área sanitaria. Material y métodos. Se ha realizado un estudio descriptivo retrospectivo sobre la demanda de escrutinios para detección de la nefropatía diabética en el año 2006. Para ello, se ha analizado una muestra de 1.111 escrutinios solicitados por los médicos de Atención Primaria. Los pacientes se han clasificado en los distintos estadios de la nefropatía diabética de acuerdo a la excreción urinaria de albúmina. Resultados. Solo el 39,7% de los escrutinios cumplieron con todos los criterios de prescripción especificados en el programa. La frecuencia de resultados positivos fue distinta según el sexo y el grupo de edad considerado. El coste por resultado positivo fue de 29,61 para varones mientras que resultó de 71,17 para mujeres, para un intervalo de edad de 1270 años. Conclusiones. La adecuación de la demanda es necesaria para asegurar la eficiencia de la atención sanitaria (AU)
Introduction. The importance of measuring albumin in urine is well established; however, there is still controversy regarding the recommendations to be used for detecting early renal impairment in diabetic patients. The objective of this work is to evaluate the results and the costs of the screening program for diabetic nephropathy in our health area. Material and methods. A retrospective descriptive study was carried out on the requests for screening for diabetic nephropathy in 2006. We performed 1111 diabetic nephropathy screening tests requested by general practitioners. Patients were classified into different clinical nephropathy stages according to their albumin excretion rate. Results. Only 39.7% of the requests for diabetic nephropathy screening fulfilled all the prescription criteria specified in the program. The frequency of positive results was different in relation to sex and age groups. The cost per positive result was 29.61 for men, whereas it was 71.17 for women, in the 1270 years age group. Conclusions. The adjustment of the demand is necessary to ensure the efficiency of health care (AU)
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Nefropatías Diabéticas/diagnóstico , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud , Albuminuria/diagnóstico , Creatinina/análisis , Creatinina , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/epidemiología , Estudios Retrospectivos , Albuminuria/orina , Nefropatías Diabéticas/clasificaciónRESUMEN
Objectivo. Conocer los microorganismos causantes de las infecciones urinarias extrahospitalarias y sus resistencias antimicrobianas en nuestra área para facilitar el tratamiento antibiótico de forma empírica. Diseño. Se describen las infecciones del tracto urinario (ITU) identificadas a partir de la revisión sistemática de los resultados de urianálisis y urocultivo realizados en nuestro laboratorio. Pacientes y métodos. Urocultivos solicitados y remitidos a nuestro laboratorio entre los meses de abril a noviembre de 2003. Se identificó el tipo de germen y la sensibilidad antibiótica. Se analizaron un total de 4.874 urocultivos, de los cuales 1.310 (27 por ciento) fueron positivos. El germen más prevalente fue E. coli (48 por ciento) con mayor sensibilidad a fosfomicina, nitrofurantoína y amoxicilinaclavulánico, seguido de E. faecalis (14 por ciento), P. mirabilis (4 por ciento) y K. pneumoniae (3 por ciento). Conclusiones. E. coli fue el germen más frecuentemente aislado. Considerando una tasa de resistencia inferior al 20 por ciento para el empleo empírico de antibióticos en las ITU no complicadas, no se recomienda el uso de ampicilina, cotrimoxazol y quinolonas. En nuestro medio, los antibióticos de elección para el tratamiento de ITU serían amoxicilina-clavulánico y cefalosporinas de primera generación (AU)
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Infecciones Urinarias/diagnóstico , Infecciones Urinarias/etiología , Atención Primaria de Salud , Medios de Cultivo/aislamiento & purificación , Medios de Cultivo/análisis , Farmacorresistencia Microbiana , Fosfomicina/aislamiento & purificación , Fosfomicina/uso terapéutico , Nitrofurantoína/uso terapéutico , Amoxicilina/uso terapéutico , Estudios Retrospectivos , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/diagnóstico , Cistitis/diagnóstico , Cistitis/complicaciones , Pruebas de Sensibilidad Microbiana/métodos , Pruebas de Sensibilidad Microbiana , Pruebas de Sensibilidad Microbiana/clasificaciónRESUMEN
Fundamento. La determinación analítica de tirotropina puede proporcionar un diagnóstico correcto en la mayoría de pacientes con trastornos de la glándula tiroidea, pero si se emplea de forma inapropiada puede resultar ineficiente. El objetivo de este trabajo es estimar la prevalencia de hipotiroidismo clínico y de hipertiroidismo clínico en la población en general mediante el escrutinio de los trastornos de la glándula tiroidea realizado por los médicos de Atención Primaria. Métodos. Se ha realizado un estudio retrospectivo sobre el escrutinio para la detección de trastornos de la glándula tiroidea, desarrollado en el Área Norte de la isla de Tenerife y durante los años de 2000 a 2002. Para ello se ha analizado una muestra de 24.424 escrutinios. Resultados. La prevalencia de hipotiroidismo clínico en la población en general se ha estimado en el 1,22 por ciento. La prevalencia de hipertiroidismo clínico ha quedado establecida en el 0,50 por ciento. El porcentaje de pacientes con tiroxicosis por triidotironina frente aquellos con hipertiroidismo clínico fue del 8,73 por ciento. Los casos de hipotiroidismo clínico e hipertiroidismo clínico relacionados con enfermedades hipotalámicas-hipofisarias fueron muy infrecuentes. Conclusiones. La evidencia mediante estudios comunitarios es que el escrutinio sistemático de la población sólo detecta pocos pacientes con trastornos de la glándula tiroidea y, por tanto, están injustificados. En nuestro caso, se recomienda aplicar el escrutinio a los grupos de alto riesgo, como en mujeres con edades superiores a los 45 años y en varones con edades superiores a los 75 años (AU)