RESUMEN

INTRODUCTION: Diabetes mellitus (DM) is one of the most prevalent chronicdiseases and has a significant health and social impact. Strict control of blood glucose levels and other risk factors for vascular disease (VD) reduces complications and mortality and is related to the quality of care received. Although care should be interdisciplinary, based on the coordination of primary care (PC) and hospital care (HC), little information is available on the effectiveness of the different existing intervention models. OBJECTIVE: To assess, in a population with DM from a healthcare area, the impact on health, quality of care, and effectiveness in the use of resources of a specific model of shared management of patients with DM (Instrument for Evaluation of Models of Chronic Care in Diabetes Mellitus; IEMAC-DM). PATIENTS AND METHODS: A quasi-experimental before-after intervention study in patients with DM in the Cádiz-San Fernando Healthcare Area (Andalusia, Spain) that allows for identifying the capacity of the program to improve the quality indicators both in the whole population with DM and in that referred to HC. For this, a working group consisting of healthcare professionals of different profiles and care levels was set up. An initial self-assessment was done using the IEMAC-DM tool and, after analysis of the preliminary results, improvement strategies were established and implemented. Finally, the clinical and resource management results were assessed before and two years after the implementation of the model. RESULTS: During the study period, no significant changes were seen in process indicators related to laboratory practices or examinations in the health area. The proportion of patients with acceptable metabolic control [glycosylated hemoglobin (HbA1c) level < 8%] was 49% in 2015 and 45% in 2017. The number of admissions related to acute myocardial infarction (AMI) and stroke remained constant, but there was an increase in the standardized ratio of major lower limb amputations (1.5 vs. 1.9). Of the 295 patients referred from PC to HC, the proportion of adequate referrals increased from 40% in 2015 to 76% in 2017 (P = .001). In the referred patients, a significant improvement was seen in the mean difference in glycosylated hemoglobin levels (HbA1c; 1.14 ± 1.73%; 95% CI: 0.73-1.55; P = .0001) and cholesterol (11.28 ± 40 mg/dL; 95% CI: 2.07-20.48; P = .012). CONCLUSIONS: This study shows that an intervention based on a chronicity care model adapted to patients with DM improves certain aspects related to the quality of care and the degree of metabolic control. Improving health outcomes will require long-term evaluation and, probably, other additional interventions.

Asunto(s)

RESUMEN

INTRODUCTION: Diabetes mellitus (DM) is one of the most prevalent chronic diseases and has a significant health and social impact. Strict control of blood glucose levels and other risk factors for vascular disease reduces complications and mortality and is related to the quality of care received. Although care should be interdisciplinary, based on the coordination of primary care (PC) and hospital care (HC), little information is available on the effectiveness of the different existing intervention models. OBJECTIVE: To assess, in a population with DM from a healthcare area, the impact on health, quality of care, and effectiveness in the use of resources of a specific model of shared management of patients with DM (Instrument for Evaluation of Models of Chronic Care in Diabetes Mellitus; IEMAC-DM). PATIENTS AND METHODS: A quasi-experimental before-after intervention study in patients with DM in the Cádiz-San Fernando Healthcare Area (Andalusia, Spain) that allows for identifying the capacity of the program to improve the quality indicators both in the whole population with DM and in that referred to HC. For this, a working group consisting of healthcare professionals of different profiles and care levels was set up. An initial self-assessment was done using the IEMAC-DM tool and, after analysis of the preliminary results, improvement strategies were established and implemented. Finally, the clinical and resource management results were assessed before and two years after the implementation of the model. RESULTS: During the study period, no significant changes were seen in process indicators related to laboratory practices or examinations in the health area. The proportion of patients with acceptable metabolic control [glycosylated hemoglobin (HbA1c) level<8%] was 49% in 2015 and 45% in 2017. The number of admissions related to acute myocardial infarction and stroke remained constant, but there was an increase in the standardized ratio of major lower limb amputations (1.5 vs. 1.9). Of the 295 patients referred from PC to HC, the proportion of adequate referrals increased from 40% in 2015 to 76% in 2017 (p=0.001). In the referred patients, a significant improvement was seen in the mean difference in glycosylated hemoglobin levels (HbA1c; 1.14±1.73%; 95% CI: 0.73-1.55; p=0.0001) and cholesterol (11.28±40mg/dL; 95% CI: 2.07-20.48; p=0.012). CONCLUSIONS: This study shows that an intervention based on a chronicity care model adapted to patients with DM improves certain aspects related to the quality of care and the degree of metabolic control. Improving health outcomes will require long-term evaluation and, probably, other additional interventions.

RESUMEN

Objetivo: evaluar un programa de alimentación saludable para docentes y su transferencia educativa a través de un plan de acción a alumnos de 3º a 5º básico para mejorar sus hábitos alimentarios y habilidades culinarias. Metodología: estudio cuasi-experimental prospectivo de cuatro meses de duración, con mediciones cualitativas a profesores (n = 43) y cuantitativas pre- y postintervención en alumnos (n = 302) de tres colegios municipales, comparados con un grupo control de otros tres colegios (n = 265) en la comuna de La Reina, Santiago de Chile. Los profesores recibieron una capacitación on-line y al final del curso elaboraron un plan de acción que aplicaron en los colegios intervenidos. Resultados: en hábitos y consumo alimentarios, la mitad de los niños refirió que cenaba en la noche y un alto porcentaje desayunaba y almorzaba dos veces. Los que almorzaban dos veces disminuyeron a la mitad al final de la intervención. En el grupo intervenido aumentó significativamente la fruta como colación y en ambos grupos, la ingesta de agua. En habilidades culinarias, el grupo intervenido mejoró la preparación de sándwich. En ambos grupos disminuyó significativamente la obesidad. En los profesores mejoraron el consumo de agua y el hábito de comer tres veces al día y disminuyó la ingesta de comida rápida. Conclusión: la capacitación en alimentación saludable para profesores mejora sus hábitos alimentarios, los cuales se transfieren a sus alumnos. Para ello se debe contar con el apoyo de la dirección de la escuela y con equipos docentes interesados en organizar actividades de promoción de alimentación saludable

Objective: to evaluate a healthy food program for teachers and their educational transfer through an action plan for 3rd to 5th primary students, to improve their food habits and culinary skills. Methodology: a four months quasi-experimental prospective study was carried out, with qualitative measurements to teachers (n = 43) and pre- and post-intervention quantitative measurements for students (n = 302) in three public schools compared with a control group in other three schools (n = 265) in La Reina county, Santiago, Chile. The teachers received on-line training and at the end of the program they designed an action plan to be implemented at the three intervened schools. Results: half of the students reported that they had dinner at night. A high percentage had breakfast and lunch twice a day. At the end of the study, the number of students who had lunch twice a day was reduced to a half. Also, the group significantly increased the water and fruits consumption, instead of snacks. In culinary skills, they learned how to prepare healthy sandwiches. As a result, the level of obesity in both groups decreased significantly. The teachers increased water consumption, limited the number of meals to three per day, and decreased the fast food eating. Conclusion: the healthy food training improved the food habits of teachers and students. The support of the headmaster and the staff of the school is required to organize activities to promote healthy food

Asunto(s)

RESUMEN

La encefalitis es una entidad rara con manifestaciones clínicas variables. En los niños es usualmente leve y autolimitada. En 30 a 75% se desconoce la etiología y cuando el patógeno se identifica por PCR (reacción en cadena de la polimerasa), el 80% son enterovirus. En América Latina no están disponibles métodos específicos de diagnóstico. En nuestro país muy pocos centros realizan el examen y tampoco están disponibles estadísticas reales de su incidencia. Objetivo: correlacionar la etiología con los síntomas, resultados de laboratorio, imagen y electroencefalograma. Métodos: estudio transversal; de enero a diciembre de 2016 se revisaron las historias clínicas de 63 niños de 0 a 18 años hospitalizados con sospecha de encefalitis. Una vez identificado el enterovirus por PCR, se correlacionó con los hallazgos de los exámenes de laboratorio e imagen. Resultados: se confirmó encefalitis viral en 35 pacientes, enterovirus en 49%, predominio en la edad preescolar. Síntomas más comunes: fiebre, cefalea, signos meníngeos y síntomas digestivos, 24% alteraciones de la conciencia. Biometría hemática normal en 71%, proteina C reactiva alterada en 71%. De los pacientes con estudios de imagen, 6% tuvo resultado anormal y en aquellos con electroencefalograma 80% fue anormal. Se utilizó la U de Mann Whitney para el análisis estadístico, la relación entre enterovirus y alteración de estado de conciencia y síntomas digestivos fue significativa (p=0.029). Conclusión: en los pacientes con diagnóstico de encefalitis que presenten síntomas digestivos y alteración del estado de conciencia, se debe sospechar que el enterovirus es el agente etiológico.

Encephalitis is a rare entity with variable clinical manifestations. In children it is usually mild and self-limited. In 30-75% of cases, the etiology is unknown and when the pathogen is identified by PCR (polymerase chain reaction), 80% are enteroviruses. In Latin America specific diagnostic methods are not available. In our country very few centers carry out the specific test, real statistics of their incidence are not available Objective: To correlate etiology with symptoms, laboratory results, imaging and electroencephalogram. Methods: Cross-sectional study, clinical records of 63 children between 0 and 18 years hospitalized with suspected encephalitis from January to December 2016 were reviewed. Once Enterovirus was identified by PCR, it was correlated with the findings of laboratory and imaging tests. Results: Viral encephalitis was confirmed in 35 patients, Enterovirus in 49%, predominance in pre-school age. Most common symptoms: fever, headache, meningeal signs and digestive symptoms, 24% alterations of consciousness. Normal blood count in 71%, Protein C Reactive altered in 71%. In patients with imaging studies, 6% had an abnormal result and in those who underwent electroencephalography, 80% were abnormal. The Mann Whitney U was used for the statistical analysis, the relationship between enterovirus and alteration of consciousness and digestive symptoms was significant (p: 0.029) Conclution: In patients with a diagnosis of encephalitis presenting digestive symptoms and altered state of consciousness, Enterovirus should be suspected as an etiologic agent.

Asunto(s)

RESUMEN

RESUMEN Se describe el estado nutricional, consumo, hábitos alimentarios y habilidades culinarias en alumnos de tercero a quinto año básico de colegios municipales de la comuna de La Reina, Santiago, Chile, para proponer intervenciones que conduzcan hacia una alimentación saludable. El estudio es descriptivo, de corte transversal en 617 niños, 349 hombres y 268 mujeres de tercero (n=193), cuarto (n=202) y quinto básico (n=222). El 30,3% de los niños tenía obesidad, mayor que el 24,2% reportado por la Junta Nacional de Auxilio Escolar y Becas (JUNAEB) en primero básico el 2015. Al 66,2% de los niños les gusta cocinar, pero sólo un 20,0% mezcla y aliña verduras, hace sándwich y pela o pica fruta 4 a 5 días en la semana. Todos los niños (100%) toman once, pero sólo un 60,9% cena en la noche. Un 20,7% toma doble desayuno y un 35,7% come doble almuerzo. Casi todos (97%) llevaban dinero o colación de la casa. El 78,4% llevaba golosinas dulces, 60,0% fruta, 50,0% lácteos y 48,4% bebidas o jugos azucarados y un 45,0% lleva $500 a $1.000 por día al colegio. Existe la necesidad de educar en hábitos de alimentación saludable a los alumnos, incorporando padres con apoyo del Ministerio de Educación, para tener una política de Estado en prevención de la obesidad infantil.

ABSTRACT This article describes the nutritional status, food consumption, dietary behavior and culinary skills of third to fifth grade public school students from the La Reina neighborhood, Santiago de Chile, in order to propose healthy eating interventions. This is a cross-sectional, descriptive study in 617 children (349 males and 268 females) from third (n= 193), fourth (n= 202) and fifth grade (n= 222). Obesity prevalence was 30.3%, greater than the 24.2% reported by National Board of Scholarships and Grants in first grade in 2015. Most of the children reported liking cooking (66.2%), but just 20.0% cooked mixed or seasoned vegetables, made sandwiches, or peeled or cut 4 or 5 days per week. All children (100%) ate a late snack in the afternoon, but only 60.9% ate dinner at night. A second breakfast was eaten by 20.7% of the children and a second lunch by 35.7%. Almost all children (97%) brought money or a snack from home: 78.4% brought candies, 60.0% fruit, 50.0% dairy products and 48.4% soft drinks or juices with sugar, and 45.0% money (500 to 1000 Chilean pesos). It is necessary to educate children in healthy eating habits, with participation of parents and support from the Ministry of Education to prevent children obesity.

Asunto(s)