Primary care management of diabetes in a low/middle income country: A multi-method, qualitative study of barriers and facilitators to care

<p>Abstract</p> <p>Background</p> <p>The management of patients with diabetes mellitus is complex. Some research has been done in developed countries to attempt to determine the factors that influence quality of care of patients with diabetes: Factors thus far postulated are usually categorised into patient, clinician and organisational factors. Our study sought to discover the main barriers and facilitators to care in the management of diabetes in primary care in a low/middle income country.</p> <p>Methods</p> <p>A qualitative study, based on reflexive ethnography using participant observation, semi-structured interviews of clinicians (10) and group interviews with paramedical staff (4) and patients (12) in three purposively sampled health centres, along with informal observation and discussions at over 50 other health centres throughout Tunisia. A content analysis of the data was performed.</p> <p>Results</p> <p>Over 400 potential barriers or facilitators to care of patients with diabetes in primary care in Tunisia emerged. Overall, the most common cited factor was the availability of medication at the health centre. Other frequently observed organisational factors were the existence of chronic disease clinics and clinicians workload. The most commonly mentioned health professional factor was doctor motivation. Frequently cited patient factors were financial issues, patient education and compliance and attendance issues. There were notable differences in the priority given to the various factors by the researcher, physicians, paramedical staff and the patients.</p> <p>Conclusion</p> <p>We have discovered a large number of potential barriers and facilitators to care that may potentially be influencing the care of patients with diabetes within primary care in Tunisia, a low/middle income country. An appreciation and understanding of these factors is essential in order to develop culturally appropriate interventions to improve the care of people with diabetes.</p

An Empirical Analysis on Board Monitoring Role and Loan Portfolio Quality Measurement in Banks

This paper aims to analyze the effectiveness of the board monitoring role on specific loan portfolio quality measures in banks (default rate, recovery rate and provisioning rate). We use a sample comprises a totality of Italian-based banks, listed at Borsa Italiana SpA in 2006-2008 and a number of accounting proxies to express the loan portfolio quality of a bank. The results of the analysis show an overall weakness of the board role (expressed by Independents and Audit Committee on board) in monitoring loan portfolio quality of the bank, with the subsequent damage of the interests of stakeholders. A positive contribution of board monitoring, even if partial, is highlighted in two cases: Independents seems improve recovery rate, while the Audit committee enhances provisioning rate in banks. With reference to default rate, a total negative effect of board monitoring is reported. On the base of these results, some managerial implications are proposed

A Transition Net Formalism for Deductive Databases Efficiently Handling Quering and Integrity Constraints Aspects

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Exploring the probing capacities of MSA capped CdTe semiconductor quantum dots as optical chemsensors via analytical and isotherms modeling for selective Hg2+ detection

Abstract Heavy metal ions bioaccumulation can cause severe damage to environment and human health. Hence, the development of an effective detection assay of trace amounts of these ions is of great importance. Here, CdTe quantum dots (QDs) capped with mercaptosuccinic acid (MSA) ligands have been synthesized in aqueous solution with significant stability and good fluorescence properties. Photophysical characterization was performed using FTIR, XRD, HRTEM and UV–Vis. Absorption, PL and PLRT techniques, seeking their subsequent application as fluorescent probes for metal cations. CdTe-MSA QDs showed selective sensitivity toward Hg2+ ions by monitoring quantitative fluorescence quenching with increasing analyte content. Under optimal conditions, the linear range for the detection was 0.2–6 μM with a detection limit of 0.05 μM. According to the Stern–Volmer model, it can be inferred that a static quenching mechanism via Hg2+ selective binding to MSA carboxylate groups is operating with electron transfer process. Excess of mercuric ions further decreased and red shifted the fluorescence possibly due to competitive cation exchanges. To further explain the corresponding ligation mechanisms, adsorption behavior study was conducted via several isotherms as well as statistical physics models. The pseudo-first-order model can describe the adsorption kinetics of Hg2+ on CdTe-MSA QDs more accurately and the experimental data fitted well the Langmuir isotherm model of monolayer adsorption on homogeneous surface. Furthermore, this spontaneous process conforms to the Hill model as a physisorption with an adsorption energy of 32 kJ.mol−1 associated with the electrostatic interactions and hydrogen bonding. The developed system was assayed in the Hg2+ trace amount detection in real tap water and showed satisfactory accuracy performance meeting analytical requirements. The relevant results demonstrated that CdTe-MSA QDs could be deployed as promising Hg2+ fluorescent chemosensing system with high sensitivity and selectivity over wide linear detection range that have great potential for real water samples analysis

Stoichiometry-controlled cycloaddition of nitrilimines with unsymmetrical exocyclic dienones: Microwave-assisted synthesis of novel mono- and dispiropyrazoline derivatives

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