Self-reported quality care for knee osteoarthritis: comparisons across Denmark, Norway, Portugal and the UK

Objectives: To assess and compare patient perceived quality of osteoarthritis (OA) management in primary healthcare in Denmark, Norway, Portugal and the UK. Methods: Participants consulting with clinical signs and symptoms of knee OA were identified in 30 general practices and invited to complete a cross-sectional survey including quality indicators (QI) for OA care. A QI was considered as eligible if the participant had checked 'Yes' or 'No', and as achieved if the participant had checked 'Yes' to the indicator. The median percentage (with IQR and range) of eligible QIs achieved by country was determined and compared in negative binominal regression analysis. Achievement of individual QIs by country was determined and compared using logistic regression analyses. Results: A total of 354 participants self-reported QI achievement. The median percentage of eligible QIs achieved (checked 'Yes') was 48% (IQR 28%, 64%; range 0-100%) for the total sample with relatively similar medians across three of four countries. Achievement rates on individual QIs showed a large variation ranging from 11% (referral to services for losing weight) to 67% (information about the importance of exercise) with significant differences in achievement rates between the countries. Conclusions: The results indicated a potential for improvement in OA care in all four countries, but for somewhat different aspects of OA care. By exploring these differences and comparing healthcare services, ideas may be generated on how the quality might be improved across nations. Larger studies are needed to confirm and further explore the findings.EULAR Health Professional Grant; Norwegian Fund through the FYSIOPRIM project; National Institute for Health Research (NIHR) [RP-PG-0407-10 386]; Arthritis Research UK Centre in Primary Care grant [18139]; National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands by a Knowledge Mobilisation Research Fellowship from the National Institute for Health Research; National Institute for Health Research (NIHR); Fundacao para a Ciencia e Tecnologia [PEst-OE/MAT/UI0006/2014]info:eu-repo/semantics/publishedVersio

Compliance with treatment and understanding of own disease in patients with severe and moderate haemophilia

It is well known that teenagers with chronic diseases have problems complying with their treatment. The aim of this study was to evaluate the patient's knowledge of haemophilia and his compliance to prophylactic treatment, and the age at which the patient took over the responsibility for his disease and to create educational material for teenagers and adolescents. This was a prospective multicentre study performed in Hemophilia Treatment Centres in Scandinavia. A total of 108 of 134 patients, between 13 and 25 years completed the questionnaire, a response rate of 80%. Eighty-three patients had a severe form of haemophilia, 24 patients in moderate form and one patient did not know the severity of his disease. Seventy-eight patients were on prophylactic treatment. The median age for starting prophylactic treatment was 3.0 years and the median age for the patient performing venepuncture was 11.6 years. Sixty-seven of 78 patients knew that the best time to give prophylactic treatment was in the morning. Even though the patients were on prophylactic treatment, 47 of 78 patients took additional treatment before sports activities. At a mean age of 14.1 years the patient himself had the responsibility for his disease and treatment. In the cohort of 108 patients, 73 were aware of their haemophilia heredity. This study shows a rather high degree of knowledge of haemophilia and compliance with treatment among the patients but it is of great importance for the nurse to continuously improve the patient's compliance and keep him aware of the benefit of regular treatment for his future well being

A internacionalização da marca aliança: ações graduais no mercado externo

Este caso para ensino descreve a trajetória da internacionalização da marca Aliança, uma marca de suco de uva integral e orgânico da Cooperativa Nova Aliança, localizada em Caxias do Sul (RS). O caso se desenvolve a partir do interesse da técnica da cooperativa Márcia e do cooperado Márcio em marcar uma reunião com o presidente da cooperativa para discutir a ampliação para novos mercados. É importante para a cooperativa a sua inserção no mercado internacional. O caso apresenta o processo da primeira exportação e traz uma discussão sobre decisões importantes que ocorreram na negociação internacional, para a inserção da marca no mercado líbio entre o importador Mr. Harmed, a coordenadora da cooperativa, Sra. Ana e o consultor da empresa júnior Lorran. O caso atende os seguintes objetivos de ensino: compreender como se dá o processo de internacionalização da marca na linha de sucos de uva da cooperativa, verificar os principais desafios encontrados para a consolidação do preço de exportação, identificar as principais exigências documentais e verificar a(s) estratégia(s) de internacionalização para a ampliação da marca no mercado internacional. O caso pode ser aplicado nas disciplinas de negociações internacionais, marketing internacional, estratégia de inserção internacional, logística, câmbio e sistemática de comércio exterior

Bioactive arabinogalactans from the leaves of Opilia celtidifolia Endl. ex Walp. (Opiliaceae)

The leaves of the tree Opilia celtidifolia have a long tradition for being used in Mali and other West African countries against various ailments such as for wound healing. Previous studies on polysaccharides from these leaves showed the presence of pectic-like polymers with an effect on the human complement system as well as the ability to activate macrophages. The present study shows that bioactive arabinogalactans isolated by water of 50°C could be separated into two acidic fractions, Oc50A1 and Oc50A2. The former could, by gel filtration on Sephacryl S-400, be separated into two fractions, which were further purified on a Superdex 200 column to give the fractions Oc50A1.I.pur and Oc50A1.II.pur. These fractions were subjected to chemical and biological studies. The polysaccharides consisted mainly of heavily branched type II arabinogalactans and minor amounts of rhamnogalacturonan I regions. The isolated polymers had a high human complement-fixating ability, as well as the ability to stimulate rat macrophages and dendritic cells (DCs) and to induce B cell proliferation. These effects were especially pronounced for the higher molecular weight fraction of Oc50A1.I.pur. The fractions Oc50A1.I.pur and Oc501.II.pur stimulated secretion of pro-inflammatory cytokines from purified B cells or DCs. Collectively, these results indicate that the arabinogalactan type II polymers present in the leaves of O. celtidifolia may be used to develop medical devices for regulating inflammatory processes. © 2010 The Author