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Fátima Méndez-López
Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain

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Journal article
Published: 28 May 2021 in International Journal of Environmental Research and Public Health
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Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45–75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions’ effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45–75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = −0.09 (95% CI: −0.29–0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: −0.32–0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01–0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64–1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55–1.73), no smoking OR = 0.61 (95% CI: 0.54–1.06), EVA adjusted mean difference = −1.26 (95% CI: −4.98–2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.

ACS Style

Francisco Represas-Carrera; Sabela Couso-Viana; Fátima Méndez-López; Bárbara Masluk; Rosa Magallón-Botaya; Jose Recio-Rodríguez; Haizea Pombo; Alfonso Leiva-Rus; Montserrat Gil-Girbau; Emma Motrico; Ruth Martí-Lluch; Francisco Gude; Ana Clavería. Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study). International Journal of Environmental Research and Public Health 2021, 18, 5788 .

AMA Style

Francisco Represas-Carrera, Sabela Couso-Viana, Fátima Méndez-López, Bárbara Masluk, Rosa Magallón-Botaya, Jose Recio-Rodríguez, Haizea Pombo, Alfonso Leiva-Rus, Montserrat Gil-Girbau, Emma Motrico, Ruth Martí-Lluch, Francisco Gude, Ana Clavería. Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study). International Journal of Environmental Research and Public Health. 2021; 18 (11):5788.

Chicago/Turabian Style

Francisco Represas-Carrera; Sabela Couso-Viana; Fátima Méndez-López; Bárbara Masluk; Rosa Magallón-Botaya; Jose Recio-Rodríguez; Haizea Pombo; Alfonso Leiva-Rus; Montserrat Gil-Girbau; Emma Motrico; Ruth Martí-Lluch; Francisco Gude; Ana Clavería. 2021. "Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study)." International Journal of Environmental Research and Public Health 18, no. 11: 5788.

Journal article
Published: 06 April 2021 in International Journal of Environmental Research and Public Health
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Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidities, and geographic variables. Methods: A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results: The multivariate Cox model showed that women had a better prognosis in any type of analysed prognosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions: Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols.

ACS Style

Rosa Magallón-Botaya; Bárbara Oliván-Blázquez; Karen Ramírez-Cervantes; Fátima Méndez-López-De-La-Manzanara; Isabel Aguilar-Palacio; Marc Casajuana-Closas; Eva Andrés-Esteban. Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care. International Journal of Environmental Research and Public Health 2021, 18, 3842 .

AMA Style

Rosa Magallón-Botaya, Bárbara Oliván-Blázquez, Karen Ramírez-Cervantes, Fátima Méndez-López-De-La-Manzanara, Isabel Aguilar-Palacio, Marc Casajuana-Closas, Eva Andrés-Esteban. Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care. International Journal of Environmental Research and Public Health. 2021; 18 (7):3842.

Chicago/Turabian Style

Rosa Magallón-Botaya; Bárbara Oliván-Blázquez; Karen Ramírez-Cervantes; Fátima Méndez-López-De-La-Manzanara; Isabel Aguilar-Palacio; Marc Casajuana-Closas; Eva Andrés-Esteban. 2021. "Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care." International Journal of Environmental Research and Public Health 18, no. 7: 3842.