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

http://cardiologia.publicacionmedica.com/contenido/images/stemi_aha_2013.pdf

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

Angina/Non-ST-Elevation Myocardial Infarction : ACC/AHA 2007 Guidelines for the Management of Patients With Unstable ISSN: 1524-4539 Copyright © 2007 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online 72514 Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX doi: 10.1161/CIRCULATIONAHA.107.18194

https://cdr.lib.unc.edu/downloads/vd66w2108

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction)...

Three perspectives on the efficacy of social capital have been explored in the public health literature. A "social support" perspective argues that informal networks are central to objective and subjective welfare; an "inequality" thesis posits that widening economic disparities have eroded citizens' sense of social justice and inclusion, which in turn has led to heightened anxiety and compromised rising life expectancies; a "political economy" approach sees the primary determinant of poor health outcomes as the socially and politically mediated exclusion from material resources. A more comprehensive but grounded theory of social capital is presented that develops a distinction between bonding, bridging, and linking social capital. It is argued that this framework helps to reconcile these three perspectives, incorporating a broader reading of history, politics, and the empirical evidence regarding the mechanisms connecting types of network structure and state-society relations to public health outcomes.

/pdf/health-by-association-social-capital-social-theory-and-the-4jhmcns64n.pdf

Health by association? Social capital, social theory, and the political economy of public health

http://hwmaint.circ.ahajournals.org/cgi/reprint/110/9/e82.pdf

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

Objective: The aim of this study was to estimate, among college students ages 18-24, the numbers of alcohol-related unintentional injury deaths and other problems over the period from 1998 through 2005. Method: The analysis integrated data on 18- to 24-year-olds and college students from each of the following data sources: the National Highway Traffic Safety Administration Fatality Analysis Reporting System, Centers for Disease Control and Prevention Injury Mortality Data, National Coroner Studies, census and college enrollment data, the National Household Survey on Drug Use and Health, and the College Alcohol Study. Results: Among college students ages 18-24, alcohol-related unintentional injury deaths increased 3% per 100,000 from 1,440 in 1998 to 1,825 in 2005. From 1999 to 2005, the proportions of college students ages 18-24 who reported consuming five or more drinks on at least one occasion in the past month increased from 41.7% to 44.7%, and the proportions who drove under the influence of alcohol i...

/pdf/magnitude-of-and-trends-in-alcohol-related-mortality-and-2wauouq2w4.pdf

Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18-24, 1998-2005

Objective: To estimate the prevalence of alcohol abuse and dependence among U.S. college students, and to identify characteristics associated with these diagnoses. Method: More than 14,000 students at 119 4-year U.S. colleges completed a questionnaire that included items corresponding to DSM-IV diagnostic criteria for alcohol abuse and dependence. Frequencies were computed, and correlations used to identify demographic, drinking and other variables associated with these diagnoses. Results: 31% percent of students endorsed criteria for an alcohol abuse diagnosis and 6% for a dependence diagnosis in the past 12 months. More than two of every five students reported at least one symptom of abuse or dependence. Students who were heavy episodic drinkers were more likely than those who were not to have an alcohol disorder. Students who were frequent heavy episodic drinkers had 13 times greater odds for abuse and 19 times greater odds for dependence. One of every five heavy episodic drinkers was classified with d...

Alcohol abuse and dependence among U.S. college students

http://archive.sph.harvard.edu/cas/Documents/uptake/uptake1.pdf

Taking up binge drinking in college: the influences of person, social group, and environment

The purpose of this article was to describe patterns of poor mental health/depression (PMHD) in a national sample of college students and the relationships among PMHD, alcohol consumption, harm, and abuse Responses to mailed questionnaires completed by a random sample of 27,409 students at 119 colleges were analyzed using logistic regression Nationally, 48% of students reported PMHD The average college prevalence was 501% (range, 068% to 1323%) Students with PMHD were more likely than their peers to be female, nonwhite, and from low socioeconomic status families; less likely to report never drinking; as likely to report frequent, heavy, and heavy episodic drinking; and more likely to report drinking to get drunk Students with PMHD-especially females-were more likely to report drinking-related harms and alcohol abuse College is a critical context for studying youth mental health The interrelationship of mental health problems and their clustering by group and college are important considerations for prevention and treatment

Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college

http://archive.sph.harvard.edu/cas/Documents/GIS/GISstudy1-1.pdf

Elissa R. Weitzman

Papers

Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18-24, 1998-2005

Alcohol abuse and dependence among U.S. college students

Taking up binge drinking in college: the influences of person, social group, and environment

Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college

The relationship of alcohol outlet density to heavy and frequent drinking and drinking-related problems among college students at eight universities.