Fitness coordinators' and fitness instructors' perspectives on implementing a task-oriented community exercise program within a healthcare-recreation partnership for people with balance and mobility limitations: a qualitative study.

Background: Healthcare organizations are partnering with recreation organizations to support the delivery of community-based exercise programs for people with balance and mobility limitations. The value and impact of support strategies provided by healthcare organizations, however, have not been examined.Objective: Study objectives were to explore fitness coordinators' and fitness instructors' experiences with implementing a task-oriented community-based exercise program for people with balance and mobility limitations within the context of a healthcare-recreation partnership.Methods: A qualitative descriptive study was conducted. Fitness coordinators and instructors involved with delivering a licensed, group, task-oriented community-based exercise program for people with balance and mobility limitations supported by a healthcare-recreation partnership were interviewed by telephone. Interviews were audio-recorded and transcribed verbatim. A thematic analysis was performed.Results: Eight fitness coordinators and 8 fitness instructors from 14 recreation centres were interviewed. Findings showed that healthcare-recreation partnerships help to optimize exercise program quality and safety through multiple strategies. Fitness coordinators and instructors still face challenges with program implementation at start-up and over time. Recommendations to address these challenges included increased training content related to adjusting exercises to accommodate participant abilities, 1-2 visits from a healthcare professional each program after initial program implementation, suggestions to increase exercise variety, and ongoing education.Conclusions: Findings clarify the role of healthcare organizations, ongoing challenges, and directions for improvement in this program delivery model.Implications for rehabilitationCommunity recreation centres can provide task-oriented exercise programs to help people with balance and mobility limitations safely engage in regular exerciseHealthcare organizations should provide specific supports to help increase the safety and quality of task-oriented exercise programs in recreation centresSupports include providing clear exercise guidelines, and a healthcare professional who trains fitness instructors, visits the program, answers questions between visits, promotes collaboration and information exchange between recreation centres, and provides ongoing education.

The cost of diabetes in Latin America and the Caribbean in 2015: Evidence for decision and policy makers.

BACKGROUND: The financial implications of the increase in the prevalence of diabetes in middle-income countries represents one of the main challenges to health system financing and to the society as a whole. The objective of this study was to estimate the economic cost of diabetes in Latin America and the Caribbean (LAC) in 2015. METHODS: The study used a prevalence-based approach to estimate the direct and indirect costs related to diabetes in 29 LAC countries in 2015. Direct costs included health care expenditures such as medications (insulin and oral hypoglycemic agents), tests, consultations, hospitalizations, emergency visits and treating complications. Two different scenarios (S1 and S2) were used to analyze direct cost. S1 assumed conservative estimates while S2 assumed broader coverage of medication and services. Indirect costs included lost resources due to premature mortality, temporary and permanent disabilities. RESULTS: In 2015 over 41 million adults (20 years of age and more) were estimated to have Diabetes Mellitus in LAC. The total indirect cost attributed to Diabetes was US$ 57.1 billion, of which US$ 27.5 billion was due to premature mortality, US$16.2 billion to permanent disability, and US$ 13.3 billion to temporary disability. The total direct cost was estimated between US$ 45 and US$ 66 billion, of which the highest estimated cost was due to treatment of complications (US$ 1 616 to US$ 26 billion). Other estimates indicated the cost of insulin between US$ 6 and US$ 11 billion; oral medication US$ 4 to US$ 6 billion; consultations between US$ 5 and US$ 6 billion; hospitalization US$ 10 billion; emergency visits US$ 1 billion; test and laboratory exams between US$ 1 and US$ 3 million. The total cost of diabetes in 2015 in LAC was estimated to be between US$ 102 and US$ 123 billion. On average, the annual cost of treating one case of diabetes mellitus (DM) in LAC was estimated between US$ 1088 and US$ 1818. Per capita National Health Expenditures averaged US$ 1061 in LAC. CONCLUSIONS: Diabetes represented a major economic burden to the countries of Latin America and the Caribbean in 2015. The estimates presented here are key information for decision-making that can be used in the formulation of policies and programs to achieve greater efficiency and effectiveness in the use of resources for diabetes prevention in the 29 countries of LAC.

A review of the quality of current diabetes clinical practice guidelines / Examen de la calidad de las directrices actuales de práctica clínica sobre la diabetes / Uma revisão da qualidade das diretrizes atuais para a prática clínica em casos de diabetes

Objective. To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods. Relevant guidelines were identified through a systematic search of MEDLINE/ PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results. Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%–100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions. Based on this study’s findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM.

Objetivo. Evaluar las directrices de práctica clínica sobre la diabetes mellitus de tipo 2 que se utilizan en la actualidad. Métodos. Se realizó una búsqueda sistemática en MEDLINE/PubMed con el fin de localizar las directrices pertinentes. Asimismo, se solicitó a las oficinas de la Organización Panamericana de la Salud (OPS) en los países que facilitaran las directrices nacionales sobre la diabetes utilizadas en cada país que no estuvieran accesibles ni publicadas en línea. Se obtuvieron 770 registros de trabajos publicados del 2008 al 2013 en MEDLINE/PubMed. Tras un tamizaje inicial, se localizaron 146 directrices relacionadas con la diabetes. Se aplicaron criterios de inclusión y exclusión para perfeccionar aún más la búsqueda y obtener un número viable de directrices para realizar la evaluación. La evaluación estuvo a cargo de profesionales de la salud, quienes utilizaron el instrumento AGREE II (Appraisal of Guidelines for Research and Evaluation), creado para abordar el problema de la variabilidad en cuanto a la calidad de las directrices, que evalúa el rigor metodológico y la transparencia del proceso de formulación. Se seleccionaron y evaluaron 17 directrices. Resultados. Diez directrices recibieron una puntuación ≥ 70% y siete directrices, ≥ 80%. El margen de las puntuaciones asignadas fue de 21-100 %. Se comparó la media de las puntuaciones asignadas a las directrices provenientes de países de América Latina y el Caribe (n = 6) con la media de aquellas provenientes de otros países (n = 11). Las directrices internacionales recibieron una puntuación notablemente mayor que las de América Latina y el Caribe en todos los criterios evaluados y en la calidad general. Conclusiones. Dados los resultados de este estudio, está claro que es preciso mejorar la formulación de directrices de práctica clínica sobre la diabetes mellitus de tipo 2, en particular con respecto a la participación de los interesados directos y la independencia editorial. Esta cuestión es sumamente evidente en las directrices de los países de América Latina y el Caribe, puesto que son necesarias mejoras considerables de la calidad en casi todos los aspectos de los criterios evaluados con el instrumento AGREE II. Es fundamental continuar con los esfuerzos destinados a formular directrices de excelente calidad y actualizarlas para mejorar el diagnóstico y el tratamiento de las enfermedades no transmisibles que son cada vez más prevalentes, como es el caso de la diabetes mellitus de tipo 2.

Objetivo. Avaliar as diretrizes atuais para a prática clínica em casos de diabetes mellitus do tipo 2 (DMT2). Métodos. Identificamos diretrizes relevantes por meio de uma pesquisa sistemática na base de dados MEDLINE/PubMed. As representações da Organização Pan- Americana da Saúde (OPAS) nos países também foram contatadas para que pudéssemos obter diretrizes para diabetes utilizadas nos países, mas não publicadas/disponíveis on-line. Ao todo, foram encontrados 770 resultados na MEDLINE/PubMed para citações publicadas entre 2008 e 2013. Depois de uma triagem inicial destes resultados, constatou-se que 146 eram diretrizes relacionadas ao diabetes. Utilizamos critérios de inclusão e exclusão para refinar ainda mais a pesquisa e obter um número viável de diretrizes a serem avaliadas. A avaliação das diretrizes foi feita por profissionais da saúde usando o instrumento AGREE II (Avaliação de Diretrizes para Pesquisa e Avaliação), desenvolvido para abordar a questão da variabilidade na qualidade de diretrizes e avaliar o rigor metodológico e a transparência no desenvolvimento de uma diretriz. No total, foram selecionadas e avaliadas17 diretrizes. Resultados. Dez diretrizes tiveram pontuação ≥70%, e sete diretrizes tiveram pontuação ≥80%. A variação foi de 21% a 100%. As pontuações médias das diretrizes de países da América Latina e Caribe (ALC) (n=6) foram comparadas às de países não pertencentes a esta região (n=11). As diretrizes internacionais tiveram pontuações consistentemente mais altas em todos os domínios e uma qualidade global mais elevada que as diretrizes da ALC. Conclusões. Com base nos resultados deste estudo, está claro que o desenvolvimento de diretrizes para a prática clínica em casos de DMT2 precisa ser aperfeiçoado, especialmente no que diz respeito à participação dos interessados diretos e à independência editorial. Este problema fica muito evidente no caso das diretrizes de países da ALC, cuja qualidade precisa melhorar muito em quase todos os aspectos dos critérios AGREE II. É preciso fazer esforços contínuos para desenvolver e atualizar diretrizes de alta qualidade a fim de melhorar a gestão de doenças não transmissíveis cada vez mais prevalentes, como o DMT2.

A review of the quality of current diabetes clinical practice guidelines.

OBJECTIVE: To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. METHODS: Relevant guidelines were identified through a systematic search of MEDLINE/PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. RESULTS: Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%-100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. CONCLUSIONS: Based on this study's findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM.

A review of the quality of current diabetes clinical practice guidelines / Examen de la calidad de las directrices actuales de práctica clínica sobre la diabetes / Uma revisão da qualidade das diretrizes atuais para a prática clínica em casos de diabetes

Objective To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods Relevant guidelines were identified through a systematic search of MEDLINE/PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%-100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions Based on this study's findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM.

RESUMEN Objetivo Evaluar las directrices de práctica clínica sobre la diabetes mellitus de tipo 2 que se utilizan en la actualidad. Métodos Se realizó una búsqueda sistemática en MEDLINE/PubMed con el fin de localizar las directrices pertinentes. Asimismo, se solicitó a las oficinas de la Organización Panamericana de la Salud (OPS) en los países que facilitaran las directrices nacionales sobre la diabetes utilizadas en cada país que no estuvieran accesibles ni publicadas en línea. Se obtuvieron 770 registros de trabajos publicados del 2008 al 2013 en MEDLINE/PubMed. Tras un tamizaje inicial, se localizaron 146 directrices relacionadas con la diabetes. Se aplicaron criterios de inclusión y exclusión para perfeccionar aún más la búsqueda y obtener un número viable de directrices para realizar la evaluación. La evaluación estuvo a cargo de profesionales de la salud, quienes utilizaron el instrumento AGREE II (Appraisal of Guidelines for Research and Evaluation), creado para abordar el problema de la variabilidad en cuanto a la calidad de las directrices, que evalúa el rigor metodológico y la transparencia del proceso de formulación. Se seleccionaron y evaluaron 17 directrices. Resultados Diez directrices recibieron una puntuación  70% y siete directrices,  80%. El margen de las puntuaciones asignadas fue de 21-100 %. Se comparó la media de las puntuaciones asignadas a las directrices provenientes de países de América Latina y el Caribe (n = 6) con la media de aquellas provenientes de otros países (n = 11). Las directrices internacionales recibieron una puntuación notablemente mayor que las de América Latina y el Caribe en todos los criterios evaluados y en la calidad general. Conclusiones Dados los resultados de este estudio, está claro que es preciso mejorar la formulación de directrices de práctica clínica sobre la diabetes mellitus de tipo 2, en particular con respecto a la participación de los interesados directos y la independencia editorial. Esta cuestión es sumamente evidente en las directrices de los países de América Latina y el Caribe, puesto que son necesarias mejoras considerables de la calidad en casi todos los aspectos de los criterios evaluados con el instrumento AGREE II. Es fundamental continuar con los esfuerzos destinados a formular directrices de excelente calidad y actualizarlas para mejorar el diagnóstico y el tratamiento de las enfermedades no transmisibles que son cada vez más prevalentes, como es el caso de la diabetes mellitus de tipo 2.

RESUMO Objetivo Avaliar as diretrizes atuais para a prática clínica em casos de diabetes mellitus do tipo 2 (DMT2). Métodos Identificamos diretrizes relevantes por meio de uma pesquisa sistemática na base de dados MEDLINE/PubMed. As representações da Organização Pan-Americana da Saúde (OPAS) nos países também foram contatadas para que pudéssemos obter diretrizes para diabetes utilizadas nos países, mas não publicadas/disponíveis on-line. Ao todo, foram encontrados 770 resultados na MEDLINE/PubMed para citações publicadas entre 2008 e 2013. Depois de uma triagem inicial destes resultados, constatou-se que 146 eram diretrizes relacionadas ao diabetes. Utilizamos critérios de inclusão e exclusão para refinar ainda mais a pesquisa e obter um número viável de diretrizes a serem avaliadas. A avaliação das diretrizes foi feita por profissionais da saúde usando o instrumento AGREE II (Avaliação de Diretrizes para Pesquisa e Avaliação), desenvolvido para abordar a questão da variabilidade na qualidade de diretrizes e avaliar o rigor metodológico e a transparência no desenvolvimento de uma diretriz. No total, foram selecionadas e avaliadas17 diretrizes. Resultados Dez diretrizes tiveram pontuação 70%, e sete diretrizes tiveram pontuação 80%. A variação foi de 21% a 100%. As pontuações médias das diretrizes de países da América Latina e Caribe (ALC) (n=6) foram comparadas às de países não pertencentes a esta região (n=11). As diretrizes internacionais tiveram pontuações consistentemente mais altas em todos os domínios e uma qualidade global mais elevada que as diretrizes da ALC. Conclusões Com base nos resultados deste estudo, está claro que o desenvolvimento de diretrizes para a prática clínica em casos de DMT2 precisa ser aperfeiçoado, especialmente no que diz respeito à participação dos interessados diretos e à independência editorial. Este problema fica muito evidente no caso das diretrizes de países da ALC, cuja qualidade precisa melhorar muito em quase todos os aspectos dos critérios AGREE II. É preciso fazer esforços contínuos para desenvolver e atualizar diretrizes de alta qualidade a fim de melhorar a gestão de doenças não transmissíveis cada vez mais prevalentes, como o DMT2.