Key words : Diabetes. Quality of life. Validation studies. Community pharmacy services. Palabras clave : Diabetes.
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Calidad de vida. Servicios de farmacia comunitaria. Lisbon Portugal.
Diabetes is a chronic condition with several implications in daily life of people diagnosed with this disease. Health-care professionals have the duty to monitor diabetic control to ensure prescribed treatment is effective to its full potential. Nonetheless, any therapeutic target established should be periodically evaluated to provide guidance on how practitioners can best target their interventions for the benefit of the patient. Physiological parameters traditionally controlled in diabetic patients include glycaemia, glicated haemoglobin, blood pressure, cholesterol and weight. When evaluating diabetes quality of life, it is most beneficial to use a diabetes-specific tool and, if comparing between different chronic conditions, a generic tool would be preferred.
Since the implementation of pharmacotherapy follow-up and pharmaceutical care programmes has been taking place in Portuguese community pharmacies. Demonstrating their added-value to the diabetic population, the Government started reimbursing providers in Future developments will need to include economic and humanistic outcomes so that the evaluation may be considered complete. The implementation of a patient monitoring programme should be preceded by a thorough review of the available measurement tools.
When this care is not taken, programme developers or evaluators may risk using inappropriate measures or developing previously existing ones. In Portugal, as in most non-English speaking countries, studies evaluating quality of life are still quite scarce. However, in recent years, the growth of instruments available in Portuguese has been exponential. There are currently several studies where well adapted and validated tools for the Portuguese culture have been used, mostly in the areas of anxiety and depression , but also in respiratory conditions 11 , amongst others.
Additionally, literature is abundant in criticisms to using unspecific scales in chronic conditions, as it is the case of diabetes.
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Alternatively, a diabetes-specific questionnaire that has been validated into Portuguese was searched in literature. Repeating the same search in a Portuguese database B-on Scielo resulted in 14 hints. Among them, 8 were from Brazil, which were equally inappropriate to use in Portugal for cultural reasons. Surprisingly, four of these manuscripts used the key-word quality of life but none of the questionnaires in fact measured this concept.
The Nottingham Health Profile, as the SF is a health-status measure, the Psychological General Well-being is a measure of well-being, also different from quality of life, and the Coping Responses Inventory explores coping processes developed by patients to deal with their illness which is an even more far apart concept from quality of life; the fifth one, although reporting work with diabetic patients, focused on the evaluation of depression and as such the Beck Depression Inventory was used, a scale which can be used for the overall population if the research focuses on depression.
In summary, despite being used in studies with diabetes, to our knowledge, none has been reported as a valid measure for diabetes. In a review of the measurement tools available in this area was published, where 13 quality of life questionnaires for use in diabetes were compared.
The latter has advantages when used in the elderly and in patients with low literacy levels, but also the disadvantage of comprising a considerably high number of items and a visual analogue scale, which can be difficult to read with visual impairments.
This tool comprised 13 items at the time of publication and was available in Portuguese for Brazil. Currently it comprises 18 items and is also now available for Portugal. This tool has the unique advantage of being individualised, allowing patients to complete only those items that are relevant to them and to rate the importance of the domain being assessed for their quality of life, as well as for the impact of diabetes on the domain. Furthermore, several studies attest the good psychometric properties of the questionnaire.
Once finalised, the produced version was to retain similar psychometric properties to the original. This paper describes the work carried out to verify the validity and reliability of the ADDQoL for Portugal, together with future work to validate and refine subsequent versions. A cross-sectional design was used and took place between June and July The estimated sample size of respondents for robust factor analysis is either or the number of items timed by five , whichever is greater.
Patient recruitment was undertaken in community pharmacies where access to ambulatory patients is high. The scales range from -3 to 3 for quality of life perceptions and from 0 to 3 in attributed importance, both being considered in order to obtain a weighted score ranging from -9 to 9. Statistical analyses were undertaken in SAS version 8.
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Age ranged from 18 to 89 years, with a mean age of The average number of diabetes specific prescribed drugs was 1. According to previous studies using the original ADDQoL, all items should load into one single factor using forced 1-factor analysis. The impact of each item for these two subgroups is illustrated in table 1 and figure 1.
Nonetheless, some specific psychometric properties need further exploration. Discriminatory power analyses revealed expected patterns: reduced statistical significance was partially attributable to sample size, which is less than previous studies. This issue should be further tackled by political decision makers. Indeed this item scored much more negatively in Portugal In the UK, institutions exist to provide additional support to diabetic patients in need, whilst in Portugal, the activity of such organisations is mostly centred around health promotion, stimulating self-monitoring, adoption of healthy life styles, and creating multidisciplinary teams to support the patients, but domiciliary care and even economic support available for these patients is still very limited, which may lead to insulin users needing e.
Alternatively, it may be that the wording for this item needs to be refined as these results may indicate the statement is being understood differently from the way originally intended, an issue to further explore on the cognitive debriefing during the development of the ADDQoL The trend to greater negative impact of diabetes on overall quality of life item II of insulin treated patients is consistent with previously published data. It is possible that the complications were present before diagnosis; a phenomenon commonly known as protopathic bias. It would be important to have this possibility in future studies as it is general knowledge that diabetes is on average diagnosed between 5 to 7 years after its onset in people with type 2 diabetes.
Again, special attention should be paid to the understanding of this item in the cognitive debriefing interviews held during the development of ADDQoL Let us give a clear signal from this House to Sir Brian Unwin: we are no longer prepared to listen to lies about how everything is perfect. PT tudo bem! Portugal, colloquial tudo bem? But it won't wipe out, you know, all life on Earth, so that 's fine. And we said, that 's fine ; let's meet; you'll bring us your business plan, which eventually they did. Similar translations Similar translations for "tudo bem" in English.
English as anything for everything in everything more importantly. English all everything everything that ….
English good very well benefit okay blessing OK favorably favourably nicely slam-bang sweetly pretty alright nicely slap bang smack. English property wealth possession mean. Context sentences Context sentences for "tudo bem" in English These sentences come from external sources and may not be accurate. Portuguese E eu pensei que eles provavelmente diriam, " Bem , tem tudo a ver com sexo.
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