XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017

This article presents an introduction to the Health Belief Model (HBM). The HBM states that the perception of a personal health behavior threat is influenced by at least three factors: general health values, interest and concern about health; specific beliefs about vulnerability to a particular health threat; and beliefs about the consequences of the health problem. Once an individual perceives a threat to his health and is simultaneously cued to action, if his perceived benefits outweighs his perceived costs, then the individual is most likely to undertake the recommended preventive health action. Key words: health promotion, health belief model, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy. Content available only in Romanian.

Health Belief Model

Estimates of global seasonal influenza-associated respiratory mortality: a modelling study

https://repositorio.insa.pt/bitstream/10400.18/3175/3/Relatorio_PNVG_2014-2015.pdf.pdf

Programa Nacional de Vigilância da Gripe: relatório da época 2014/2015

https://repositorio.insa.pt/bitstream/10400.18/5777/1/Moderate%20influenzza%20vaccine%20in%20a%20B%20mismatch%20season_2017_2018.pdf

Moderate influenza vaccine effectiveness in a B mismatch season: Preliminary results from the 2017/2018 season in Portugal

Análise da variação concelhia da mortalidade anual média por neoplasias malignas dos órgãos do aparelho respiratório e intra-torácicos em Portugal Continental

By employing a common protocol and data from electronic health registries in Denmark, Navarre (Spain), Norway and Portugal, we estimated vaccine effectiveness (VE) against hospitalisation due to COVID-19 in individuals aged ≥ 65 years old, without previous documented infection, between October 2021 and March 2022. VE was higher in 65–79-year-olds compared with ≥ 80-year-olds and in those who received a booster compared with those who were primary vaccinated. VE remained high (ca 80%) between ≥ 12 and < 24 weeks after the first booster administration, and after Omicron became dominant.

https://www.eurosurveillance.org/deliver/fulltext/eurosurveillance/27/30/eurosurv-27-30-1.pdf?containerItemId=content/eurosurveillance&itemId=/content/10.2807/1560-7917.ES.2022.27.30.2200551&mimeType=pdf

Estimation of COVID-19 vaccine effectiveness against hospitalisation in individuals aged ≥ 65 years using electronic health registries; a pilot study in four EU/EEA countries, October 2021 to March 2022

Hereditary hemochromatosis (HH) is a common autosomal recessive disorder of iron metabolism among Caucasian populations of Northern European descent [1]. The gene implicated in the disease (HFE) was discovered in 1996, and the C282Y mutation was identified as the main cause of the disease development [2]. H63D and S65C are other HFE missense mutations and are implicated in a mild form of HH [2, 3]. The high frequency of the C282Y mutation (5–10%) in Northern Europeans and its gradient towards the South (1– 5%) suggested that it had a Nordic origin [4]. On the other hand, the H63D mutation has a more general distribution, being spread worldwide [4–8]. The several haplotypes described associated with H63D in non-Caucasian populations disclose a multicentric origin for this mutation [4, 9, 10]. The geographical distribution of S65C has been less extensively analyzed than that of C282Y or H63D [7, 11, 12]. Studies regarding the prevalence of these HFE gene mutations in African populations are uncommon [4, 13–17]. Therefore, the main purpose of this study was to analyze the frequency of C282Y, H63D and S65C mutations in a group of 143 unrelated individuals (286 chromosomes), all with a Western sub-Saharan African origin (mainly from the ex-Portuguese colonies in Africa, Angola, Sao Tome and Principe, and Cape Verde). Moreover, these frequencies were compared with those described for populations from North Africa (Morocco and Algeria) and South Africa (Khoisan population). The origin of the positive H63D samples was investigated by HFE haplotype analysis. Total genomic DNAwas isolated from peripheral blood leukocytes by a salting-out procedure and HFE gene mutations (C282Y, H63D and S65C) were analyzed by a PCR restriction method (restriction fragment length polymorphism, RFLP). Fisher’s exact test was used to compare the allelic frequencies of the mutations, and the level of significance was set at 5%. The 95% confidence intervals for the allelic frequencies were calculated by the binomial exact method [18]. All statistical analyses were performed using the SPSS v11.0 software. The results obtained for the allelic frequencies of the C282Y, H63D and S65C mutations (and the respective 95% confidence intervals) are shown in Table 1. C282Y and S65C mutations were absent in all individuals studied, which resembles the results published for a South African population (Khoisan) [15]. Moreover, the frequency obtained for the C282Y mutation did not differ significantly from those described in the North African populations presented in Table 1 (p>0.05). The H63D allele was present in seven individuals, resulting in an overall allelic frequency of 2.45%. This frequency was significantly lower when compared with the North African population (p<0.05) [16]. The present study provides evidence that the HH-related mutations C282Y, H63D and S65C are extremely rare in the Western sub-Saharan African population. In prior studies, the C282Y mutation was not found in native individuals from Algeria (Mzab), Ethiopia, Kenya, Senegal, Gambia, Nigeria, Ghana, Zambia and South Africa [13–15, 19]. Similarly, in this study, the C282Y mutation was not found in individuals from Angola, Sao Tome and Principe, and Cape Verde. Therefore, its presence in people of North African ancestry [16] can be explained by the fact that these individuals have a different ethnic background than black African people or can be related to a European admixture. Curiously, the C282Y mutation was also found in R. Martins . I. Picanço . L. Romão . P. Faustino (*) Laboratório de Biologia Molecular, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Centro de Genética Humana, Lisbon, Portugal e-mail: paula.faustino@insa.min-saude.pt Tel.: +351-217519234 Fax: +351-217526410

Baltazar Nunes

Papers

Programa Nacional de Vigilância da Gripe: relatório da época 2014/2015

Moderate influenza vaccine effectiveness in a B mismatch season: Preliminary results from the 2017/2018 season in Portugal

Análise da variação concelhia da mortalidade anual média por neoplasias malignas dos órgãos do aparelho respiratório e intra-torácicos em Portugal Continental

Estimation of COVID-19 vaccine effectiveness against hospitalisation in individuals aged ≥ 65 years using electronic health registries; a pilot study in four EU/EEA countries, October 2021 to March 2022

HFE gene mutations are extremely rare in Western sub-Saharan Africa.