BackgroundDespite the existence of formal professional support services, informal support (mainly family members) continues to be the main source of eldercare, especially for those who are dependent or disabled. Professionals on the primary health care are the ideal choice to educate, provide psychological support, and help to mobilize social resources available to the informal caregiver.Controversy remains concerning the efficiency of multiple interventions, taking a holistic approach to both the patient and caregiver, and optimum utilization of the available community resources. .For this reason our goal is to assess whether an intervention designed to improve the social support for caregivers effectively decreases caregivers burden and improves their quality of life.Methods/designDesign: Controlled, multicentre, community intervention trial, with patients and their caregivers randomized to the intervention or control group according to their assigned Primary Health Care Team (PHCT).Study area: Primary Health Care network (9 PHCTs).Study participants: Primary informal caregivers of patients receiving home health care from participating PHCTs.Sample: Required sample size is 282 caregivers (141 from PHCTs randomized to the intervention group and 141 from PHCTs randomized to the control group.Intervention: a) PHCT professionals: standardized training to implement caregivers intervention. b) Caregivers: 1 individualized counselling session, 1 family session, and 4 educational group sessions conducted by participating PHCT professionals; in addition to usual home health care visits, periodic telephone follow-up contact and unlimited telephone support.Control: Caregivers and dependent patients: usual home health care, consisting of bimonthly scheduled visits, follow-up as needed, and additional attention upon request.Data analysisDependent variables: Caregiver burden (short-form Zarit test), caregivers’ social support (Medical Outcomes Study), and caregivers’ reported quality of life (SF-12)Independent variables: a) Caregiver: sociodemographic data, Goldberg Scale, Apgar family questionnaire, Holmes and Rahe Psychosocial Stress Scale, number of chronic diseases. b) Dependent patient: sociodemographic data, level of dependency (Barthel Index), cognitive impairment (Pfeiffer test).DiscussionIf the intervention intended to improve social and family support is effective in reducing the burden on primary informal caregivers of dependent patients, this model can be readily applied throughout usual PHCT clinical practice.Trial registrationClinical trials registrar: NCT02065427

BackgroundMany studies on diabetes have demonstrated that an intensive control of glycaemia and the main associated risk factors (hypertension, dislipidaemia, obesity and smoking) reduce cardiovascular morbi-mortality. Different scientific societies have proposed a multifactorial approach to type 2 diabetes.The objective of this study was to identify the degree of control of glycosylated haemoglobin (HbA1c) and of cardiovascular risk factors in type 2 diabetic patients, using the GedapS 2004 guidelines, and to analyse the type and intensity of drug treatment.MethodsThis cross-sectional, multicentre, epidemiological study was conducted in a primary care setting in Vallès Occidental South, Catalonia. Data were collected of 393 patients aged 18 and above who were diagnosed with diabetes mellitus type 2. Biodemographic and clinical data, cardiovascular risk factors, associated cardiovascular disease, and treatment were assessed. Descriptive and multivariable analysis with logistic regression was realized.ResultsA total of 392 patients with a mean age of 66.8 years (SD = 10.6) (45.4% male patients) were analyzed. The duration of diabetes was 8.4 years (SD = 7.6). The degree of multifactorial control of risk factors was only 2.6%, although in more than 50% individual cardiovascular risk factor was controlled, except for LDL cholesterol (40.6%) and systolic blood pressure (29.6%). Furthermore, only 13.0% of subjects had an optimal BMI, 27.5% an optimal waist circumference. Treatment for diabetes was prescribed in 82.7% of patients, for hypertension 70.7%, for dyslipidaemia 47.2% and 40.1% were taking antiplatelets.ConclusionOver 50% of type 2 diabetic patients presented optimal control of the majority of individual cardiovascular risk factors, although the degree of multifactorial control of diabetes was insufficient (2.6%) and should be improved. Drug treatment can be intensified using a larger number of combinations, particularly in patients with target organ damage and associated clinical cardiovascular disease.

Celiac disease (CD), an immune enteropathy caused by gluten-containing foods in genetically susceptible individuals, is usually diagnosed during childhood, but delayed diagnosis in adulthood is not uncommon (1 ). One-half of cases show atypical forms of the disease, e.g., irondeficient anemia unresponsive to iron or persistent hypertransaminasemia (2-4 ).Patients with CD often have high circulating concentrations of anti-endomysium antibodies (EMAs), the main disease marker (5 ), and anti-gliadin antibodies (AGAs), the most effective marker for children Ͻ3 years (6, 7 ). Tissue transglutaminase (tTG) has been identified as the autoantigen of CD (8 ).The first assays for tTG antibodies used antigen from guinea pigs (9 -15 ). Assays that used recombinant human tTg (rh-tTG) improved sensitivity and specificity (16 -21 ), but it is not well established in prospective studies whether the clinical effectiveness of rh-tTG is similar for children and adults.The aims of this study were (a) to evaluate the potential utility of rh-tTG IgA (rh-tTGA) compared with EMAs and AGAs for CD diagnosis in children and adults; (b) to analyze the concordance between rh-tTGA and small intestine biopsy (IB); and (c) to analyze the association of hypertransaminasemia and ferropenia with untreated CD.We prospectively selected 2570 patients with clinical suspicion of CD. Most patients (73.4%) were referred by the Pediatrics Department. From this cohort of patients we analyzed consecutively all patients fulfilling the inclusion and exclusion criteria. Inclusion criteria included histologic analysis of an IB and determination of serum markers for CD; the exclusion criterion was IgA deficiency. Both the IB and the immunologic markers were analyzed blindly and independently.The patients were classified into two groups. Group I consisted of 61 patients diagnosed with classic CD based on the results of the IB and obvious clinical and serologic response to a gluten-free diet. Group II contained 64 patients with clinical suspicion of CD but a normal IB and was considered the control group. The most common presentations in the control group were failure to thrive (29%) and gastrointestinal symptoms (27%).We also included 86 first-degree relatives of celiac patients, all asymptomatic. In this group we diagnosed six new cases of CD, who were then incorporated in group I.In our series 146 IBs were performed. Full-thickness jejunal biopsies were obtained by endoscopy or WatsonCrosby capsule (children). The histopathologic findings were classified according to internationally accepted criteria as normal mucosa, partial villous atrophy (slight, moderate, or severe), and subtotal villous atrophy (22 ). We considered all cases with at least a moderate villous atrophy as diseased, and biopsies showing slight atrophy or unspecific changes were considered as normal.rh-tTGA (expressed in the eukaryotic baculovirus system) was determined by enzyme immunoassay (Celikey; Pharmacia Diagnostics). The antibody concentration was expressed in arbitrary units (AU/mL)....

BackgroundSufficient iodine intake is needed during pregnancy to ensure proper fetal development. The iodine levels of women in their first trimester of pregnancy in Catalonia are currently unknown. This data would help to determine whether our public health services should establish recommendations or interventions in this line. The aim of this study was to investigate the iodine nutritional status, prevalence of urinary iodine <150 μg/L, and tobacco use in the first trimester of pregnancy in our setting.MethodsCross-sectional study. Data were collected during 2008–2009 from women in their first trimester at the primary care centers of the province of Barcelona (Spain). Pregnant women included in the study completed a questionnaire on eating habits and underwent urinary iodine concentration (UIC) assessment.ResultsNine hundred forty five women completed the dietary questionnaire and urinary iodine testing. Median UIC was 172 μg/L, with 407 participants (43.1%) showing levels <150 μg/L. On multivariate logistic regression analysis, intake of 1–2 glasses of milk per day, OR = 0.636 95% CI (0.45–0.90) or >2 glasses, OR = 0.593 95% CI (0.37–0.95); iodized salt consumption, OR = 0.678 95% CI (0.51–0. 90); and use of iodine supplementation, OR = 0.410 95% CI (0.31–0.54), protected against the risk of UIC <150 μg/L. Simultaneous consumption of iodized salt and milk (≥1 glass/day) showed a larger protective effect: OR = 0.427, 95% CI (0.31–0.54).ConclusionThe median UIC of the pregnant women surveyed indicated an acceptable iodine nutritional status according to the criteria established by the WHO and ICCIDD. The risk of urinary iodine <150 μg/L decreased with simultaneous consumption of milk and iodized salt, similar to the decrease seen with iodine supplementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1423-4) contains supplementary material, which is available to authorized users.

BackgroundA high percentage of cervical cancer cases have not undergone cytological tests within 10 years prior to diagnosis. Different population interventions could improve coverage in the public system, although costs will also increase. The aim of this study was to compare the effectiveness and the costs of three types of population interventions to increase the number of female participants in the screening programmes for cancer of the cervix carried out by Primary Care in four basic health care areas.Methods/DesignA cost-effectiveness analysis will be performed from the perspective of public health system including women from 30 to 70 years of age (n = 20,994) with incorrect screening criteria from four basic health care areas in the Valles Occidental, Barcelona, Spain. The patients will be randomly distributed into the control group and the three intervention groups (IG1: invitation letter to participate in the screening; IG2: invitation letter and informative leaflet; IG3: invitation letter, informative leaflet and a phone call reminder) and followed for three years. Clinical effectiveness will be measured by the number of HPV, epithelial lesions and cancer of cervix cases detected. The number of deaths avoided will be secondary measures of effectiveness. The temporal horizon of the analysis will be the life expectancy of the female population in the study. Costs and effectiveness will be discounted at 3%. In addition, univariate and multivariate sensitivity analysis will be carried out.DiscussionIG3 is expected to be more cost-effective intervention than IG1 and IG2, with greater detection of HPV infections, epithelial lesions and cancer than other strategies, albeit at a greater cost.Trial RegistrationClinical Trials.gov Identifier NCT01373723