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

O impacto do desempenho das instituições de educação básica na qualidade do ensino superior El impacto del desempeño de las instituciones de educación básica en la calidad de la educación superior The impact of the performance of basic education institutions in the quality of higher education

Esta pesquisa analisou a eficiência educacional das Unidades Federativas (UF) do Brasil, relacionando o desempenho das instituições de Educação Básica com a qualidade alcançada pelas instituições do ensino superior. Além disso, investigou-se em qual nível da Educação Básica devem alocar-se esforços para melhoria da eficiência educacional de cada UF. A eficiência educacional foi medida considerando a relação entre o índice de qualidade do Ensino Superior (produto) e o desempenho da Educação Básica (insumos). O desempenho da educação básica levou em consideração o Índice de Desenvolvimento da Educação Básica (Ideb), já a qualidade do Ensino Superior foi determinada pelo Índice Geral de Cursos (IGC). Através de uma técnica denominada Data Envelopment Analysis, foram identificadas as UFs mais eficientes e as metas de melhoria para as menos eficientes. Os resultados indicaram ainda que, em geral, os anos iniciais do Ensino Fundamental merecem maior atenção por parte dos gestores e governantes.<br>Este estudio analizó la eficiencia educacional de las Unidades de la Federación (UF) en Brasil, relacionando el desempeño de las instituciones de la educación básica con la calidad de la educación superior. Además, se investigó en qué nivel de la educación básica se deben destinar los esfuerzos para mejorar la eficiencia educacional de cada estado. La eficiencia educacional se midió teniendo en cuenta la relación entre el índice de calidad de la enseñanza superior (producto) y el rendimiento de la educación básica (insumos). El desempeño de la educación básica tuvo en cuenta el Índice de Desarrollo de la Educación Básica (IDEB), ya que la calidad de la educación superior fue determinada por el Índice General de Cursos (IGC). La técnica conocida como Análisis Exploratorio de Datos (DEA) se utilizó para identificar la UF más eficiente y las metas de mejora para los menos eficientes. Los resultados también señalan que, en general, los primeros años de educación primaria merecen mayor atención por parte de los gestores y gobernantes.<br>This research analyzed the educational efficiency of the educational Federal Units (FU) in Brazil, linking the performance of institutions of Basic Education institutions with the quality achieved by Higher education institutions. Furthermore, this research also investigated at which level of Basic Education more efforts should be allocated more efforts to improve the educational efficiency of each FU. The educational efficiency was measured considering the relationship between the index of quality in Higher Education (product) and the performance of basic education (inputs). The performance of basic education considered the Index of Basic Education Development (Ideb) and the performance of Higher Education was determined by the General Index of Courses (IGC). A technique called Data Envelopment Analysis was used to identify the most efficient FUs and to set the goals of the least efficient. The results also indicated that, in general, the early years of Basic Education deserve greater attention by managers and political leaders

Efficacy of eugenol and the methanolic extract of condalia buxifolia during the transport of the silver catfish rhamdia quelen

This study evaluated extracts of Condalia buxifolia as anesthetics for the silver catfish Rhamdia quelen. The effectiveness of eugenol and of the methanolic extract (ME) of C. buxifolia during the transport of this species was also assessed. Fish of two different weights (1.50±0.02 g and 165.70±22.50 g) were transferred to aquaria containing water with the C. buxifolia ME or with fractions obtained from the ME, such as the n-hexane, dichloromethane, ethyl acetate, n-butane and aqueous fractions, at concentrations from 0-300 μL L-1. The C. buxifolia ME in the 0.5-120 μL L-1 range caused only light sedation, and the fractions did not have an effect on the fish. In the second experiment, another group of fish was transported for 12 h in 15 plastic bags. The fish were divided into five groups: control, 1 or 2.5 μL L-1 eugenol and 25 or 50 μL L-1 C. buxifolia ME. The non-ionized ammonia levels were lower at the end of transport in the groups with the compounds than in that with water alone. Moreover, both compounds decreased the Na+, Cl-, and K+ net effluxes; therefore, their addition to the water during transport is advisable because they reduce fish mortality and ion loss.Este estudo investigou extratos de Condalia buxifolia como anestésico para jundiá Rhamdia quelen, e também a eficiência do eugenol e do extrato metanólico (EM) de C. buxifolia para utilização durante o transporte dessa espécie. Peixes de dois diferentes pesos (1,50±0,02 g e 165,70±22,50 g) foram transferidos para aquários contendo água com o EM de C. buxifolia ou frações obtidas a partir do EM (n-hexano, acetato de diclorometano, etil n- butano e aquoso, em concentrações na faixa de 0 - 300 μL L-1. O EM de C. buxifolia em concentrações na faixa de 0,5 - 120 μL L-1 causou somente uma sedação leve e as frações não tiveram efeito. No segundo experimento outro grupo de peixes foi transportado por 12 h em 15 sacos plásticos divididos em cinco tratamentos: controle, 1 ou 2,5 μL L-1 de eugenol e 25 ou 50 μL L-1 de EM de C. buxifolia. Os níveis de amônia nãoionizada foram menores nos tratamentos com ambos compostos em relação à água (controle). Além disso, ambos compostos diminuíram os efluxos líquidos de Na+, Cl- e K+ e, portanto, sua adição na água de transporte é aconselhável, pois reduzem a mortalidade e a perda de íons dos peixes

Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil): study protocol for a multicenter randomized controlled trial

Background: Gestational diabetes mellitus (GDM), a hyperglycemic state detected during pregnancy, is an established risk factor for diabetes. However, treatment during pregnancy in and of itself is not able to eliminate this risk, and a considerable fraction of women with GDM will develop frank diabetes in the decade following pregnancy. Our aim is to conduct a multicenter randomized controlled trial to investigate the effectiveness of a lifestyle intervention program implemented after a pregnancy complicated by GDM in delaying or preventing the development of type 2 diabetes. Methods: Women aged 18 or older identified as having recent GDM are recruited and followed by telephone to assess eligibility for the trial. To be eligible, women must have used insulin during pregnancy or present intermediate hyperglycemia postpartum. Women are encouraged to enter the trial as early as 10 weeks, and are permitted to do so up to 2 years after a pregnancy with GDM. An estimated 740 women will be randomized to either conventional care or to coach-based interventions focused on breastfeeding, weight loss, healthy eating, and increased physical activity, and predominantly delivered by telephone. Women are followed annually to detect new onset diabetes, the primary outcome, and additional secondary outcomes which include reversion to normoglycemia, weight loss, physical activity and fitness, and insulin resistance. Discussion: Though previous studies have demonstrated that type 2 diabetes can be delayed or prevented, no study has yet demonstrated the feasibility and effectiveness of similar interventions implemented in the postpartum period for women with recent GDM. If shown to be successful, this approach could become an important means of preventing diabetes in primary care settings