Countries were categorized according to the NCD Risk Factor Collaboration regions. 1 1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.
In healthcare settings, there is an emotional cost to caring which can result in compassion fatigue, burnout, secondary trauma, and compromised patient care. Innovative workplace interventions such as the Schwartz Rounds offer a group reflective practice forum for clinical and non-clinical professionals to reflect on the emotional aspects of working in health care. Whilst the Rounds are established in medical health practice, this study presents an evaluation of the Rounds offered to mental health services. The Rounds were piloted amongst 150 mental health professionals for 6 months and evaluated using a mixed-methods approach with standardized evaluation forms completed after each Round and a focus group (n = 9) at one-month follow-up. This paper also offers a unique six-year follow-up of the evaluation of the Rounds. Rounds were rated as helpful, insightful, and relevant, and at six years follow-up, Rounds were still rated as valuable and viewed as embedded. Focus groups indicated that Rounds were valued because of the opportunity to express emotions (in particular negative emotions towards patients that conflict with the professional care-role), share experiences, and feel validated and supported by colleagues. The findings indicate that Schwartz Rounds offer a positive application in mental healthcare settings. The study supports the use of interventions which provide an ongoing forum in which to discuss emotions, develop emotional literacy, provide peer support and set an intention for becoming a more compassionate organization in which to work.
Introduction: As diabetes increases in LMICs, there is a need for more evidence to guide health systems planning. We used a cascade of care approach to assess health system performance among adults (=15 years) in LMICs.
Methods: We pooled individual data from 25 nationally representative surveys. Diabetes was defined as FBG=126 mg/dL, RBG=200 mg/dL, HbA1c=6.5%, or on medication. Stages of the care cascade included: screening, diagnosis, lifestyle advice and/or medication (“treatment”), and control (HbA1c =8.0%). Linear probability models were used to evaluate predictors (age, sex, education, and wealth quintile) of (1) treatment and (2) control.
Results: Across all countries, the largest losses to care occur at screening (Table). While health service access increases with increasing country income group, rates of disease control are similar. Prediction models show that treatment is 31.1 percentage points (95% CI: 12.6-49.5) lower in the youngest age group compared to the oldest and that control is 3.9 percentage points (95% CI: 1.8-6.1) lower in men than women.
Conclusions: Diabetes prevalence is substantial across LMICs, particularly in Latin America and the Caribbean. Overall rates of screening are low and only 23% of those with diabetes achieve control, which is less than half of that in the U.S. (64%). Policy interventions that link adults with diabetes to care and improve disease control in LMICs are needed.
The diabetes cascade of care in 25 LMICS (N=92,141)RegionPrevalence (95% CI)Screened (95% CI)Diagnosed (95% CI)Completed (95% CI)Controlled (95% CI)Sub-Saharan Africa3.9 (3.0 - 5.0)53.1 (46.3 - 60.0)38.7 (32.9 - 45.0)36.0 (30.4 - 42.0)21.2 (16.7 - 26.3)Latin America & the Caribbean28.4 (23.7 - 33.7)79.8 (74.2 - 84.4)63.7 (57.9 - 69.3)48.9 (42.3 - 55.6)33.1 (26.8 - 40.1)South & Southeast Asia7.5 (7.1 - 7.9)57.5 (47.6 - 66.9)46.1 (36.9 - 55.6)45.2 (36.0 - 54.7)29.1 (22.0 - 37.5)Low-income group2.7 (2.1 - 3.5)39.9 (34.4 - 45.6)32.7 (27.2 - 38.5)31.4 (26.0 - 37.3)21.0 (16.0 - 27.1)Lower-middle income group7.7 (6.6 - 8.9)57.1 (46.0 - 67.6)38.2 (27.8 - 49.8)35.2 (25.0 - 47.0)23.9 (15.2 - 35.4)Upper-middle income group9.3 (5.5 - 15.3)68.9 (60.9 - 75.8)47.9 (40.3 - 55.5)41.7 (34.8 - 48.8)24.1 (19.1 - 30.0)Overall8.5 (5.9 - 12.0)57.9 (52.8 - 62.9)41.8 (37.1 - 46.6)37.6 (33.2 - 42.2)23.0 (19.5 - 27.0)
Disclosure
J. Manne-Goehler: None. P. Geldsetzer: None. D. Houinato: None. C. Houehanou: None. M.S. Gurung: None. G.M. Andall-Brereton: None. S. Crooks: None. K. Joseph: None. C. Wesseh: None. B. Norov: None. K.K. Aryal: None. K.B. Karki: None. P. Bovet: None. D. Labadarios: None. A. Stokes: None. M.T. Mayige: None. G.B. Kagaruki: None. D. Guwatudde: None. B.K. Silver: None. J.M. Jorgensen: None. S. Vollmer: None. J.I. Davies: None. T. Barnighausen: None. L.M. Jaacks: None.
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