Fundamento: la población canaria sufre la mayor mortalidad
por diabetes tipo 2 (DM2) en España. El objetivo de este estudio es conocer el estilo de vida de las personas diabéticas del archipiélago y ...su adherencia al tratamiento, así como la DM2 desconocida.
Métodos: estudio transversal de 6.729 personas de la población
general participantes en la cohorte CDC de Canarias (edad 18-75 años). Se obtuvieron sus antecedentes médicos, dieta, actividad física, medicamentos consumidos, tabaco, etc.
Resultados: la prevalencia de DM2 fue 12% en varones y 10% en mujeres (p=0,005). El 22% de varones y 9% de mujeres
desconocían su enfermedad (p<0,001). Sumando DM2 desconocida, DM2 no tratada e incumplimiento terapéutico, el 48% de los hombres y 28% en mujeres no seguían tratamiento
correcto. Los varones diabéticos eran más obesos que los no diabéticos (45 versus 25%; p<0,001) pero no presentaban diferencias
en tabaquismo (28%; IC95%=23-33) o sedentarismo (62%; IC95%=56-68). Las mujeres diabéticas también eran más obesas (54 versus 27%; p<0,001) y, aunque fumaban menos (11 versus 22%; p<0,001), eran igual de sedentarias (75%; IC95%=70-79). La ingesta calórica era menor en quienes sufrían
DM2 (p<0,001), pero el 93% (IC95%=91-95) superaba el consumo recomendado de grasas saturadas y el 69% (IC95%=65-72) padecía síndrome metabólico.
Conclusiones: la población diabética en Canarias es sedentaria y obesa, muestra un consumo alto de grasas saturadas
y gran prevalencia de síndrome metabólico. El porcentaje que sigue tratamiento regular es muy bajo, sobretodo en varones,
que además mantienen el tabaquismo.
: Two hundred forty‐seven healthy newborns were investigated in a prospective cohort descriptive study. Information on phenotype and obstetric and parental history was collected. A positive ...association was found between erythema toxicum neonatorum and season of birth (spring and summer), whereas parental history of any skin disease was related to a lower frequency of this eruption.
Objective: The lower mortality from coronary ischemic disease in populations living at high altitude has been related to an increase of high‐density lipoprotein (HDL)‐cholesterol at altitude. Leptin ...has been proposed as a cardiovascular risk factor. We investigated whether leptin varies according to the altitude at which people live.
Research Methods and Procedures: This was a cross‐sectional study of the first 889 people enrolled in a cohort study in the Canary Islands, Spain. The relationship among serum leptin, altitude, obesity, and other cardiovascular risk factors was analyzed by bivariate and multivariate tests.
Results: Leptin levels showed an inverse correlation to altitude expressed in meters (r = −0.10). Obese subjects had this leptin‐altitude association (r = −0.19), but they also had a direct correlation of leptin to HDL‐cholesterol (r = 0.27) and an inverse correlation of leptin to the total cholesterol‐to‐HDL‐cholesterol ratio (r = −0.34), triglycerides (r = −0.29), apolipoprotein B (r = −0.21), and glycemia (r = −0.19). Nonobese subjects had only the leptin‐altitude association (r = −0.11). The final regression model included altitude as predictor. Other associated variables were gender, physical activity, BMI, age, smoking (reducing leptin independently of BMI), alcohol, heart rate, and income.
Discussion: Serum leptin level decreases when altitude increases, and this association could help to explain the lower cardiovascular mortality rate at high altitude. However, because in obese subjects there is a direct association of leptin with HDL‐cholesterol and an inverse association with the lipid atherogenic fractions, we suggest the hypothesis of different roles for bound and free leptin, with free leptin being a cardiovascular protective factor in obese people.
Summary Background Alpha-melanocyte-stimulating hormone receptor 1 (MC1R) has an important role in skin pigmentation and variants of the gene have been established as independent risk factors for ...susceptibility to cutaneous malignant melanoma. Objective To explore whether variants of the gene also influence the onset of the disease. Methods We analyzed 285 melanoma patients of European ancestry for common variation in codon 84 (D84E) of the α-MSH receptor 1 gene, which is known to have functional consequences in MC1R protein activity. Results The mean age difference at diagnosis between MC1R 84E carriers and non-carriers was 9 years (95% confidence interval CI: 2–17; p = 0.012), with 84E non-carrier patients being older. After adjusting for gender, Clark's level, phototype, eyes and hair colour, the risk for cutaneous malignant melanoma at any age was 2.07 times higher (95% CI: 1.21–3.52; p = 0.008) among MC1R 84E carriers. Enrolment criteria, geographical origin, Clark's levels and Breslow's indexes were similar between MC1R 84E carriers and non-carriers. Further analyses based on the Clark level and Breslow's index, both indicative for cancer invasion, reasonably supported an unbiased selection of patients during the study enrolment. Additional exon re-sequencing of the cyclin-dependent kinase inhibitor 2A ( CDKN2A ) gene in MC1R 84E carriers ruled out the presence of high penetrance mutations that have previously been associated with early onset of the disease. Conclusion Although our findings need to be confirmed by independent and larger studies we have described for the first time the association of D84E variant of the α-MSH receptor 1 gene as an independent risk factor for an earlier onset of cutaneous malignant melanoma.
Fundamento: Registrar los hábitos alimenticios exige de
un método válido y fiable. El objetivo del estudio es validar el
cuestionario de frecuencia de consumo de alimentos CDCFFQ,
que es una ...adaptación de otro cuestionario, para estudiar
la alimentación de la población adulta de Canarias.
Métodos: El cuestionario CDC-FFQ fue administrado a
1.067 personas de la población general (PG) y a 106 estudiantes
universitarios (EU), de 19 a 30 años. El segundo grupo fue
encuestado también sobre tres recordatorios de 24 horas. Se
comparan los nutrientes según CDC-FFQ en PG y EU. Se estiman
las correlaciones entre CDC-FFQ y los recordatorios para
nutrientes y grupos de alimentos, y la concordancia de consumos
de nutrientes y grupos de alimentos en los quintiles extremos,
para los estudiantes universitarios.
Resultados: Los valores medios entre nutrientes del
CDC-FFQ entre PG, EU y población general con estudios universitarios
no mostraron diferencias significativas excepto
para la vitamina B12 (p=0.004) y la vitamina D (p=0,005).
Entre el CDC-FFQ y la media de los tres recordatorios se obtuvieron
correlaciones en el rango de 0,202-0,601 entre nutrientes
ajustados por calorías consumidas para los estudiantes universitarios.
Por grupos de alimentos las correlaciones
oscilaron para CDC-FFQ y los recordatorios entre 0,243-
0,542. La concordancia de nutrientes osciló entre 39% y 100%
y para grupos de alimentos entre 41% y 100%.
Conclusiones: El cuestionario CDC-FFQ resulta válido
para clasificar a los sujetos en los rangos relativos de su nivel
de ingesta de alimentos y nutrientes, por lo que podría ser útil
en estudios epidemiológicos con valoración de dieta en población
canaria adulta.
RESUMEN La neuropatía periférica diabética (NPD) es una de las complicaciones más comunes y problemáticas de la diabetes mellitus puesto que supone la principal causa de úlceras y amputaciones en ...miembros inferiores. El objetivo del presente estudio es conocer cómo se lleva a cabo la valoración para la detección precoz de la NPD en Atención Primaria de Canarias. Tras llevar a cabo una búsqueda bibliográfica en las principales bases de datos no se recuperó documento alguno respecto a la valoración de la NPD por enfermeras. Con el fin de recabar información sobre la realización de estas exploraciones en Atención Primaria de Canarias, se diseñaron dos cuadernos de registro de datos: uno para enfermeras y otro para médicos que se distribuyeron entre profesionales sanitarios de centros de salud de las diferentes islas. La valoración de la NPD del paciente diabético en los centros de salud de Atención Primaria en Canarias puede mejorarse. Existe una relación directa entre la formación en neuropatía diabética y la realización de esta valoración con la asiduidad necesaria y los métodos y técnicas válidos para ello. Se requiere establecer estrategias para la formación continuada del personal sanitario de Atención Primaria en éste campo.
To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were ...associated with control of their disease.
Multicentric study of retrospective follow-up.
Seven health centers in Tenerife, Spain.
3543 patients with DM2.
Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables.
50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC.
The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.
The relationship of diurnal desaturations (oximetry-measured blood oxygen saturation S(pO(2)) < 90%) during activities of daily living and clinical aspects in patients with chronic obstructive ...pulmonary disease (COPD) and moderate hypoxemia has not been systematically evaluated.
We prospectively studied 88 patients with stable COPD (forced expiratory volume in the first second FEV(1) < 80% of predicted, ratio of FEV(1) to forced vital capacity < 70% of predicted, and P(aO(2)) 60-70 mm Hg) with 24 hours of ambulatory oximetry. Desaturators were defined as those who spent >/= 30% of the time with S(pO(2)) < 90%. Patients engaged in their usual activities of daily living. We correlated these desaturations with the following variables, measured immediately before the 24 hours of oximetry: body mass index, dyspnea (measured with the modified Medical Research Council dyspnea scale), gas exchange, pulmonary function, quality of life (measured with the Saint George's respiratory questionnaire), and comorbidity (measured with the Charlson index).
Thirty-three (38%) of the patients were desaturators: 50% nocturnal and 22% diurnal. We also measured daytime arterial blood gas values from arterial blood samples and found that the desaturators had higher P(aCO(2)) (p = 0.001) and lower P(aO(2)) (p = 0.007) than the nondesaturators. There were no differences in the other variables. The correlation between nocturnal and diurnal time with S(pO(2)) < 90% was r(2) = 0.67, and the concordance was low (Cohen's kappa 0.43, p < 0.001).
Patients with stable COPD and moderate hypoxemia have frequent and potentially important desaturations during activities of daily living and at night. In addition, there is a big difference in the profile and degree of nocturnal and diurnal desaturations. Twenty-four hours of oximetry provides valuable information for comprehensive evaluation of patients with COPD.
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