Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels.

Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High-income countries can usually provide this, but the cost of this care is generally prohibitive for lower-income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower-income countries work toward establishing guidelines-based care, it is helpful to describe the levels of care that are potentially affordable, cost-effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: "minimal care," "intermediate care," and "comprehensive (guidelines-based) care." Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra-clinic mean HbA1c levels range from 12.0% to 14.0% (108-130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64-80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52-69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

Validación de apariencia, contenido y consistencia interna de la Escala de Apreciación de Agencia de Autocuidado (ASA) para Costa Rica, segunda versión en español / Validation of appearance, content and internal consistency of the scale Appraisal of Self-care Agency (ASA) to Costa Rica, second versión in Spanish

Resumen:Introducción:Este artículo presenta los resultados obtenidos del proceso de validación de apariencia, contenido y consistencia interna al que fue sometida la segunda versión en español de la escala ASA aplicada a población costarricense.Método:Este estudio es descriptivo, transversal, con un enfoque cuantitativo, con un diseño no experimental y psicométrico, realizado con una muestra de 211 personas en la etapa de la adultez temprana, intermedia y tardía, según su condición de salud conocidas como sanas o con diagnóstico de enfermedad crónica.Resultados:La investigación determinó que el análisis factorial con la aplicación de métodos estadísticos, la prueba de Kaiser-Meyer-Olkin (KMO) con resultado de 0,79, evidenció la viabilidad de la escala, en la que las variables miden factores comunes con una varianza total del 64,14%.Conclusión:El análisis factorial arrojó siete ejes factoriales y obtuvo valores adecuados que demuestran su validez.

Abstract:Introduction:This paper presents the results of the validation process of appearance, content and internal consistency that was submitted the second versión in Spanish of the ASA scale Costa Rican population.Method:It is a descriptive, cross-sectional non-experimental and psychometric study with a quantitative approach, design, conducted with a sample of 211 people at the stage of early, middle and late adulthood, according to your health condition and healthy known or diagnosed disease chronic.Results:The investigation determined that the factor analysis with the application of statistical methods, testing Kaiser-Meyer-Olkin (KMO) resulting in 0.79, showed the feasibility of the scale, which measured variables with a common variance factors Total 64.14%.Conclusion:Factor analysis showed seven factorial axes, appropriate values obtained demonstrate the validity of the same reflecting that is able to measure what it claims.

El sueño dorado / The gilding dream

Ciento setenta y uno pacientes (82 por ciento) de un total de 209 fueron estudiados utilizando los indicadores A.P.A.C.H.E.II, T.I.S.S. y el índice porcentual de mortalidad al ingreso y alta del paciente. La edad promedio fue de 52 (16-92) años, siendo 130 (76 por ciento) hombres y 41 (24 por ciento) mujeres; considerando la condición diagnóstica previa a admisión obtuvimos 139 (81 por ciento) pacientes "médicos" y 32 (19 por ciento) "post-quirúrgicos". La mortalidad real obtenida fue el doble de la mortalidad estimada y el 60 por ciento de los pacientes dados en alta alcanzaron por lo menos una recuperación parcial.

Effectiveness of a hospital-based cooperative care model on patients' functional status and utilization.

The primary objective of this study was to test the hypothesis that inpatient care which emphasized structured, patient education, self-care and social support from a care partner (the Cooperative Care Program) is a cost-effective alternative to the more expensive staff-intensive, traditional hospital care; and that such care can be substituted without resulting in poorer outcomes with regard to subsequent health status or use of services. The effects of this program on patient and physician acceptance, patient knowledge and treatment and health status, were evaluated by means of an experimental design with comparable groups of patients assigned to experimental (cooperative care) or control (usual hospitalization) group status. Follow-up analyses of both groups of patients for a 12-month time period concluded that there were comparable and equally positive post-hospitalization experiences, with greater than 90% of both groups of patients functioning well with respect to a series of measures of functional status. There was no evidence that Cooperative Care patients were re-hospitalized more often or needed more emergency, home care or other types of services. There was, on the other hand, evidence of the positive effect on patient understanding, adherence to treatment, satisfaction, and self-management.