Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background\ud To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.\ud \ud Methods\ud This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).\ud \ud Results\ud Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).\ud \ud Conclusions\ud A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.We thank Mrs. Karianne Aroeira Davidson, Mrs. Anna Maria Ferreira, Mrs. Elisangela Santos and Sandro Sperandei for their technical assistance.This work was supported by grants from Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, the Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil

Avaliação dos conhecimentos teóricos dos diabéticos de um programa interdisciplinar Evaluación de los conocimientos teóricos de los diabéticos en un programa interdisciplinar Evaluation of diabetes carriers theoretical knowledge in an interdisciplinary program

Através de um instrumento de avaliação de conhecimentos, as autoras testaram a capacidade de compreensão e memorização de dez grupos de diabéticos atendidos por uma equipe multiprofissional que atua no ambulatório do Hospital Universitário Regional do Norte do Paraná. A avaliação incluiu temas diversos que faziam parte das atividades do programa educacional. Somente um grupo de pacientes apresentou índices de acerto considerados adequados. Analisados individualmente, diabéticos jovens, motivados e com bom nível de compreensão obtiveram melhores resultados. Conclui-se que a avaliação possibilitou identificar pacientes que necessitam de reforços nas diversas áreas de conhecimento permitindo a programação de atividades específicas para os mesmos.<br>A través de un instrumento de evaluación, los autores testaron la comprensión y memorización de diez grupos de diabéticos atendidos por un equipo multiprofesional con, respecto a temas diversos con ellos discutidos durante las actividades de un programa educacional. Solamente un grupo de pacientes obtuvo índices de acierto considerados adecuados. Analizados individualmente diabéticos jóvenes, motivados y con buen nivel de comprensión alcanzaron mejores resultados. Se concluye que la evaluación permitió seleccionar pacientes a los cuales los refuerzos en las diversas áreas de conocimiento testadas deben ser planeadas.<br>Using an instrument of evaluation of theoretical knowledge, the authors have assessed the capacity of understanding and memorizing often groups of diabetes' carriers that were being followed by a multiprofessional team from the ambulatory of the HURNP. The evaluation included the discussion of a variety of subjects which were part of the activities of an Educational Program. Only one group of patients showed a satisfactory performance. Individual analysis showed that young diabetes' carriers, that were motivated and had good level of understanding, had a better performance. It was concluded that the evaluation allows the selection of patients that need specific reinforcement and that a plan of activities can be elaborated according to the tested subjects

Enfermagem moderna: a ordem do cuidado Enfermería Moderna: el orden del cuidado Modern nursing: the order of care

Com o propósito de colocar em foco a enfermagem moderna, faço neste ensaio uma leitura das condições de possibilidade do surgimento do regime de práticas da enfermagem. Apoiada por textos de Michel Foucault e identificada com os Estudos Culturais resgato fragmentos da história da enfermagem para reconstituir a organização de seu regime de práticas, num determinado momento histórico e no ambiente hospitalar. Conto a história de algumas das personagens desse enredo mostrando que o passado pode ser um produto do presente, já que encerra uma escrita da história construída e moldada pela vontade de seus autores. Destaco a enfermagem moderna como uma prática de cuidados que se profissionaliza e constrói um saber próprio que pretende assegurar independência profissional.<br>Con el propósito de colocar en foco la enfermería moderna, hago en este ensayo una lectura de las condiciones de posibilidad del surgimiento del régimen de prácticas de la enfermería. Apoyada por textos de Michel Foucault e identificada con los Estudios Culturales rescato fragmentos de la historia de la enfermería para reconstituir la organización de su régimen de prácticas, en un determinado momento histórico y en el ambiente hospitalario. Cuento la historia de algunos de los personajes de ese enredo mostrando que el pasado puede ser un producto del presente, ya que termina una escritura de la historia construida y moldeada por las ganas de sus autores. Destaco la enfermería moderna como una práctica de cuidados que se profesionaliza y construye un saber propio que pretende asegurar independencia profesional.<br>With the purpose of placing modern nursing into focus, in this essay I go over the possible conditions for the emergence of nursing practice systems. Based on texts by Michel Foucault and identified with Cultural Studies, I reclaim fragments from nursing history in order to put back together the organization of its practice system at a given historical moment and in a hospital environment. I tell the story of some of this plot's characters in an effort to show that the past can become the product of the present, once it encompasses historical writings devised and set up by the will of its authors. I highlight modern nursing as a practice of care that becomes professional and builds its own knowledge intent on ensuring professional independence

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved