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/10400.18/687/1/Relatorio_Euroeva_Case_control_final_report_2009-10_PT_corrigido.pdf

Case control study for measuring influenza vaccine effectiveness in Portugal - Final report Season 2009-10

/pdf/cenarios-de-impacto-de-uma-eventual-pandemia-de-gripe-na-9lb5tbh9xj.pdf

Cenários de impacto de uma eventual pandemia de gripe na população portuguesa : morbilidade, mortalidade e necessidade de cuidados de saúde

Background Heatwaves can lead to increased mortality. In the Portuguese heat-health warning system (HHWS), ICARO, a daily report with heat-related mortality prediction is sent to heat-health action plan (HHAP) practitioners. HHAP practitioners assess risk and implement measures to prevent heatwave-related impact, but ICARO's use and understanding are unknown. We assessed ICARO's use and understanding by key HHAP practitioners. Methods We conducted semi-structured interviews with national/regional HHAP practitioners. Interviews were recorded, transcribed and analysed using thematic content analysis. To maximize credibility a validation process was implemented through researcher triangulation; a sample of 30 segments was recorded by independent researchers. Results We conducted six interviews with nine professionals (mean time 52 min) from five regions. We identified four categories: report's content and presentation, report's reception and communication, ICARO and risk assessment and other issues. Practitioners use ICARO and perceived it as relevant; they raised issues on its interpretation and felt these were not fully addressed, given researchers' use of statistical/epidemiological terms. We identified the need for improved communication and report's clarity. Conclusions Our study stresses the need for collaboration between experts within HHWS/HHAP. Despite ICARO's understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ICARO's interpretation. Practitioners' needs should be considered when developing/revising tools.

/pdf/assessing-the-use-and-understanding-of-the-portuguese-heat-31nlmlr0xj.pdf

Assessing the use and understanding of the Portuguese Heat–Health Warning System (ÍCARO)

Background: Head and neck cancer (HNC) has a considerable mortality and morbidity rate. Surgery is one of the most effective treatments; however, it may compromise the independence of patients after its performance. Early start rehabilitation is essential for the recovery of these patients, preventing functional capacity limitations. Objective: The objective of this study was to compare the independence between hospitalized patients who underwent rehabilitation nurse (RN) intervention versus general health care after HNC surgery. Methods: Patients submitted to different types of HNC surgery were divided into two groups intervention by the RN versus general health care, the outcome was the independence categorized as dichotomic to assess the patient independence at discharge and their differences calculated by statistical analysis. To analyze the effect of the RN intervention on independence, a Poisson regression model was used, adjusting the confounding factors initial Barthel Index and age in the variable Barthel Index independence. Results: Independence at discharge (p = 0.01) improved significantly in the RN intervention group compared to the general health care group. The intervention of the RN after surgery had a positive effect on the independence of the patients, after adjusting the confounding factors (RR: 1.47; 95% CI: [1.02; 2.12]). In the middle/late postoperative period, in the group with RN intervention (n = 79), the hospitalization time was reduced by 4.29 days versus general health care (n = 72). Conclusion: The RN intervention is an added value in the independence of the patient submitted to HNC surgery. It is an innovative study in patients after diagnosis of HNC, showing that the intervention of RN through rehabilitation programs allows independence after his surgery.

Rehabilitation Nursing Program in Oncological Surgery of the Head and Neck: A Retrospective Cohort Study

O INSEF beneficia de um apoio financeiro de cerca de 1.500.000€ concedido pela Islândia, Liechtenstein e Noruega atraves das EEA Grants

https://repositorio.insa.pt/bitstream/10400.18/3271/1/Poster_1CCQL_PLP.pdf

Baltazar Nunes

Papers

Case control study for measuring influenza vaccine effectiveness in Portugal - Final report Season 2009-10

Cenários de impacto de uma eventual pandemia de gripe na população portuguesa : morbilidade, mortalidade e necessidade de cuidados de saúde

Assessing the use and understanding of the Portuguese Heat–Health Warning System (ÍCARO)

Rehabilitation Nursing Program in Oncological Surgery of the Head and Neck: A Retrospective Cohort Study

Influência das condições pré-analíticas no índice de hemólise: resultados preliminares do 1º Inquérito Nacional de Saúde com Exame Físico