Objective:to perform the translation, adaptation and validation of the Diabetes Attitudes Scale - third version instrument into Brazilian Portuguese. Methods:methodological study carried out in six stages: initial translation, synthesis of the initial translation, back-translation, evaluation of the translated version by the Committee of Judges (27 Linguists and 29 health professionals), pre-test and validation. The pre-test and validation (test-retest) steps included 22 and 120 health professionals, respectively. The Content Validity Index, the analyses of internal consistency and reproducibility were performed using the R statistical program. Results:in the content validation, the instrument presented good acceptance among the Judges with a mean Content Validity Index of 0.94. The scale presented acceptable internal consistency (Cronbach’s alpha = 0.60), while the correlation of the total score at the test and retest moments was considered high (Polychoric Correlation Coefficient = 0.86). The Intra-class Correlation Coefficient, for the total score, presented a value of 0.65. Conclusion:the Brazilian version of the instrument (Escala de Atitudes dos Profissionais em relação ao Diabetes Mellitus) was considered valid and reliable for application by health professionals in Brazil.
Objective: to translate, adapt and validate the contents of the Diabetes Medical Management Plan for the Brazilian context. This protocol was developed by the American Diabetes Association and guides the procedure of educators for the care of children and adolescents with diabetes in schools. Method: this methodological study was conducted in four stages: initial translation, synthesis of initial translation, back translation and content validation by an expert committee, composed of 94 specialists (29 applied linguists and 65 health professionals), for evaluation of the translated version through an online questionnaire. The concordance level of the judges was calculated based on the Content Validity Index. Data were exported into the R program for statistical analysis: Results: the evaluation of the instrument showed good concordance between the judges of the Health and Applied Linguistics areas, with a mean content validity index of 0.9 and 0.89, respectively, and slight variability of the index between groups (difference of less than 0.01). The items in the translated version, evaluated as unsatisfactory by the judges, were reformulated based on the considerations of the professionals of each group. Conclusion: a Brazilian version of Diabetes Medical Management Plan was constructed, called the Plano de Manejo do Diabetes na Escola.
Parafba State, Brazil is one of the poorest areas in that country; many of the hospitals are not high quality and medical training is not comparable to that of developed countries. Nevertheless, the rate of cesarean section delivery in urban hospitals has risen from 19.0 per cent in 1977 to 28.5 in 1981. Despite the larger volume of obstetric services in government hospitals, these hospitals had lower cesarean section rates than private hospitals, both profit and non-profit. (Am J Public Health 1988; 78:704-705.)
Urban private hospital discharges in Brazil increased enormously during the last decade. Several measures were taken in an effort to slow the rate of increase in hospital admissions and the escalation of hospital costs, which were out of control by the end of the last decade. The introduction of a new case-based reimbursement method, late in 1983, not only contributed to increased hospitalizations, but to changed hospital case mix, as private hospitals shifted from more costly to less costly patients. This occurred especially in the most developed areas of the country, where the concentration of profit-making hospitals is very high. The case-based prospective payment method can be seen as a good managerial tool for use in comparing hospital performance. However, it seems not to be a good mechanism for controlling health care expenditures, especially when profit-making hospitals dominate the provision of hospital care. Any decrease in hospitalization by private hospitals in Brazil has been caused by the severe economic recession, which hit the Brazilian economy hard, and by the shift in hospital admissions from private to public hospitals, not by the introduction of the new reimbursement method which has changed the unit of payment from 'patient day' to case or procedure.
Background: The effectiveness of remote follow-up of cancer patients through weekly medical questionnaires filled in on their smartphone has been reported in international studies. These studies demonstrated an improvement in quality of life (QoL) and survival of several months. The e-DomSanté study proposes the combined use of innovative technological tools for the improvement of patient care. Patients and methods: This 2-year pilot study was carried out with patients followed-up for metastatic breast cancer who lived far from their treatment center. They were offered, in addition to their usual follow-up, weekly medical questionnaires (10 items) on an interactive tablet and a connected watch that registered their falls, bedtime and their general activity. All this data arrived on a secure portal. In the event of an alert, telemedicine was organized by remote consultation with exchange on a secure platform, in parallel, between the center's carers and the treating physician, nurse, pharmacist or the Territorial Support Unit. The evaluation criteria used included telemedicine and patients' QoL (FACT-B questionnaires) as well as their satisfaction with their care. Results: The average age of the 15 patients included in the study was 65 years (range, 36-82 years) with one third of patients who had never used a computer or tablet. Those patients as well as elderly patients (≥ 75 years old) adapted very well to the technology simply with reinforced education and modification of the ergonomics of tablets and questionnaires. The requests for remote consultation were mainly due to 1) symptoms of deteriorating disease detected in advance, 2) toxicities relating to the treatment making it possible to adapt the therapy quickly, 3) the support oncological care (pain, depression or taken into terminal care at home) and 4) exhausted relatives. The QoL of all patients was stable or even improved despite progression of their metastatic disease in most cases. Practically all patients were satisfied (less fatigue due to less travel, high responsiveness of carers, security and confidence, less stress) with just a few criticisms (stress generated by the technology, no space for comments in the questionnaires and the restrictive nature of wearing the watch). Conclusions: The e-DomSanté study confirms the contribution of digital technology in improving cancer care. This system avoids unnecessary consultations that are tiring for the patient and costly for society (transportation and hospitalization). It also avoids acute admissions through the emergency room. This method leads to an improvement in the QoL of patients and their satisfaction with their care. A second, much larger, multicenter randomized trial assessing patients' survival, QoL of patients and their relatives and medico-economic assessment will commence soon. Citation Format: Quénel-Tueux N, Allam V, Desroches M, Duguey-Cachet O, Fillatreau C, Beaufrère P, Trézéguet V, Cassauba S, Portolan N, Caubet C, Rodrigues J, Saint-Upéry N, Gourgues A, Oukhemanou C, Savino F, Maurel M, Burbaud T, Jacques M, Lamurey D, Buyse P-E, Volpato-Coilier M, Michardière E, Hoppe S. E-DomSanté study on the improvement of care in oncology through digital technology [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-19.
A539of 16 criteria. Methods: 85 experts were interviewed to estimate the importance of each criterion in the decision-making on financing MT for rare diseases. We used 10-point scale, where 10 points mean major importance to the priority indicator, and 1point means minor importance. Mean estimates were calculated using descriptive statistics, then means were normalized. Results: Respondents were 41 years on average (ranging from 23 to 64 years), and included 20 public servants, 16 health administrators, 32 practitioners, and 14 researchers. 44 respondents had a scientific degree. The most important criteria were characteristics of treatment -"Effect of treatment on quality of life" and "Effect of treatment on life expectancy" with 1 points each. The least important criteria were both characteristics of the disease -"Cognitive disorders as manifestations of the disease and "Additional burden on the daily lives of care-givers" with 0.28 and 0.1 respectively. ConClusions: Characteristics of treatment turned out to be more important for respondents than characteristics of disease, therefore characteristics of treatment should be given consideration when evaluating rare diseases to determine priority financing.
Despite the absence of a family planning programme, the prevalence of sterilisation in Brazil has increased substantially, such that it is used by relatively young women in poor areas of the country. Sterilisation is influenced more by the characteristics of the health service than by socioeconomic characteristics of the population.
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