Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care.

BACKGROUND: In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. METHODS/DESIGN: The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. DISCUSSION: The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. TRIAL REGISTRATION: Clinical Trials U.S. National Institutes of Health, NCT01849731

Temporal and spatial variability of dissolved organic and inorganic phosphorus, and metrics of phosphorus bioavailability in an upwelling-dominated coastal system

Author Posting. © American Geophysical Union, 2005. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 110 (2005): C10S13, doi:10.1029/2004JC002837.High-frequency temporal and spatial shifts in the various dissolved P pools (total, inorganic, and organic) are linked to upwelling/relaxation events and to phytoplankton bloom dynamics in the upwelling-dominated Oregon coastal system. The presence and regulation of alkaline phosphatase activity (APA) is apparent in the bulk phytoplankton population and in studies of cell-specific APA using Enzyme Labeled Fluorescence (ELF®). Spatial and temporal variability are also evident in phytoplankton community composition and in APA. The spatial pattern of dissolved phosphorus and APA variability can be explained by bottom-controlled patterns of upwelling, and flushing times of different regions within the study area. The presence of APA in eukaryotic taxa indicates that dissolved organic phosphorus (DOP) may contribute to phytoplankton P nutrition in this system, highlighting the need for a more complete understanding of P cycling and bioavailability in the coastal ocean.KCR acknowledges WHOI for rapid-response funding that made possible participation on this first COAST cruise, and NSF-OCE grant 0119134 for support of subsequent work on these and other COAST samples

Use of the internet as a source of health information by Spanish adolescents

<p>Abstract</p> <p>Background</p> <p>The Internet is a fundamental part of the daily life of adolescents, they consider it as a safe and confidential source of information on health matters. The aims is to describe the experience of Spanish adolescents searching for health information on the Internet.</p> <p>Methods</p> <p>A cross-sectional study of 811 school-age adolescents in Granada was carried out. An adapted and piloted questionnaire was used which was controlled by trained personnel. Sociodemographic and health variables were included together with those concerning the conditions governing access to and use of information and communication technologies (ICT).</p> <p>Results</p> <p>811 adolescents were surveyed (99.38% response rate), mean age was 17 years old. Of these, 88% used the Internet; 57.5% used it on a daily or weekly basis and 38.7% used it occasionally. Nearly half the sample group (55.7%) stated that they used the Internet to search for health-related information. The main problems reported in the search for e-health were the ignorance of good web pages (54.8%) and the lack of confidence or search skills (23.2%).</p> <p>Conclusions</p> <p>In conclusion, it seems plausible to claim that websites designed and managed by health services should have a predominant position among interventions specifically addressed to young people.</p

Preconditioning with Physiological Levels of Ethanol Protect Kidney against Ischemia/Reperfusion Injury by Modulating Oxidative Stress

Oxidative stress due to excessive production of reactive oxygen species (ROS) and subsequent lipid peroxidation plays a critical role in renal ischemia/reperfusion (IR) injury. The purpose of current study is to demonstrate the effect of antecedent ethanol exposure on IR-induced renal injury by modulation of oxidative stress.Bilateral renal warm IR was induced in male C57BL/6 mice after ethanol or saline administration. Blood ethanol concentration, kidney function, histological damage, inflammatory infiltration, cytokine production, oxidative stress, antioxidant capacity and Aldehyde dehydrogenase (ALDH) enzymatic activity were assessed to evaluate the impact of antecedent ethanol exposure on IR-induced renal injury.After bilateral kidney ischemia, mice preconditioned with physiological levels of ethanol displayed significantly preserved renal function along with less histological tubular damage as manifested by the reduced inflammatory infiltration and cytokine production. Mechanistic studies revealed that precondition of mice with physiological levels of ethanol 3 h before IR induction enhanced antioxidant capacity characterized by significantly higher superoxidase dismutase (SOD) activities. Our studies further demonstrated that ethanol pretreatment specifically increased ALDH2 activity, which then suppressed lipid peroxidation by promoting the detoxification of Malondialdehyde (MDA) and 4-hydroxynonenal (HNE).Our results provide first line of evidence indicating that antecedent ethanol exposure can provide protection for kidneys against IR-induced injury by enhancing antioxidant capacity and preventing lipid peroxidation. Therefore, ethanol precondition and ectopic ALDH2 activation could be potential therapeutic approaches to prevent renal IR injury relevant to various clinical conditions

Alexandrium minutum growth controlled by phosphorus

Toxic algae are a worldwide problem threatening aquaculture public health and tourism Alexandrium a toxic dinoflagellate proliferates in Northwest France estuaries (i e the Penze estuary) causing Paralytic Shellfish Poisoning events Vegetative growth and in particular the role of nutrient uptake and growth rate are crucial parameters to understand toxic blooms With the goal of modelling in situ Alexandrium blooms related to environmental parameters we first try to calibrate a zero-dimensional box model of Alexandrium growth This work focuses on phosphorus nutrition Our objective is to calibrate Alexandrium minutum as well as Heterocapsa triquetra (a non-toxic dinoflagellate) growth under different rates of phosphorus supply other factors being optimal and constant Laboratory experiments are used to calibrate two growth models and three uptake models for each species Models are then used to simulate monospecific batch and semi continuous experiments as well as competition between the two algae (mixed cultures) Results show that the Droop growth model together with linear uptake versus quota can represent most of our observations although a power law uptake function can more accurately simulate our phosphorus uptake data We note that such models have limitations in non steady-state situations and cell quotas can depend on a variety of factors so care must be taken in extrapolating these results beyond the specific conditions studied (C) 2010 Elsevier BV All rights reserve

Prioritization of non-recommended clinical activities in Primary Care

Background: To prioritize non-recommended clinical activities in Primary Care (PC), from "Do not do" recommendations listed by the Sociedad Espanola de Medicina de Familia y Comunitaria (Semfyc), according to expert consensus (physicians, nurses and pharmacists).Methods. The consensus for the prioritization of non-recommended practices in PC was performed through an online procedure. We used as a base the list of "do not-do" recommendations of the SEMFYC. We asked the experts to prioritize practices that should be de-adopted in PC, based on four prioritization criteria: frequency of occurrence, cost of the activity, ease of disposal and damage caused, which were scored from one to five, according to their recommendation. Scores were summarized in median and quartile values. Two rounds were necessary to obtain a consensus. A modified e-Delphi technique was used.Results. 34 experts (62%) participated in the first consultation round and prioritized 19 recommendations with a score >= 3.5. These recommendations were again analyzed in a second round, in which 32 panelists agreed to prioritize 17 practices (13 related to prescription, three diagnostic tests, and one clinical analysis). The high priority list included seven practices with values >= 4.1) Prescription of a new drug in elderly patients without having reviewed the previous treatments; 2) Lipid-lowering drugs without calculating the overall cardiovascular risk; 3) Not systematically prescribing gastric protection with proton pump inhibitors to patients consuming Nonsteroidal anti-inflammatory drugs (NSAIDs); 4) Glucose self-analysis in non-insulinized type 2 diabetics; 5) Benzodiazepines in the long term; 6) Bisphosphonates in patients with low risk of fracture; and 7) Antibiotics in lower respiratory tract infections.Conclusion. This study provides information for the prioritization of 17 non-AP activities in which short-term de-adoption would significantly increase the efficiency of the public health system

Effect of P depletion on the functional pools of diatom carbohydrates, and their utilization by bacterial communities

Phosphorus (P) limitation of phytoplankton growth is known to affect the accumulation and release of carbohydrates (CHO) by micro-algae. However, relatively little is known about the fate of algal exudates, notably their bacterial degradation. The CHO chemical characterization is also not exhaustive, especially in ‘functional’ pools relevant for phytoplankton physiology (particulate reserve [R] or structural [S] CHO) and for bacterial degradation (dissolved mono- [MDCHO] and polysaccharides [P-DCHO]). In this study, we investigated how P depletion and repletion affect the CHO composition in diatomThalassiosira weissflogiicultures, and the shortterm response of free and diatom-attached bacteria in terms of abundance and potential βglucosidase activity (βGlc). The bacterial inoculum was composed of the bacterial consortiums of diatom precultures and a natural bacterial community from the Bay of Brest. P depletion favored CHO accumulation in diatom cells, mainly as R i.e. soluble CHO accumulated in cytoplasm, but also as S, polysaccharides linked to the cell wall. The R:S ratio was high in the present diatom cultures. The high M-DCHO observed in P-deplete cultures (twice that of P-replete cultures) when P-DCHO remained quite similar is explained both by active polysaccharide hydrolysis (very high potential βGlc of attached bacteria) and reduced uptake of M-DCHO by Pdepleted bacteria. P depletion of heterotrophic bacteria favors labile CHO accumulation, which may affect particle potential aggregation. However, the remarkably constant M-DCHO concentration over time for both conditions suggests tight coupling between phytoplankton accumulation, release, polymer hydrolysis and monomer uptake by bacteria.</jats:p