Relationship between the users' contact time in educational programs on diabetes mellitus and self-care skills and knowledge

Abstract OBJECTIVE Check the relationship between the users' contact time in educational programs and self-care and knowledge variables in diabetes mellitus. METHOD A longitudinal study with a quantitative approach with the participation, in the initial phase, of 263 users linked to Basic Health Units in Belo Horizonte, Brazil during the years 2012 and 2013. The data were collected with respect to the total contact time of the users' participation in the educational program as regards knowledge and self-care in acquired diabetes mellitus. The data were analyzed using the Student t-test for comparison of means, considering a 0.05 significance level. RESULTS The final sample included 151 users. The analysis showed that the improvement in self-care scores was statistically higher during an educational intervention of eight hours or more (p-value <0.05). In relation to the scores for knowledge, there was a statistically significant improvement at the end of the educational program. It was not possible to identify a value for the contact time from which there was an increase in mean scores for the ability of knowledge. CONCLUSION To improve the effectiveness of the promotion of skills related to knowledge and self-care in diabetes mellitus, it is necessary to consider the contact time as a relevant factor of the educational program

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (&lt; 5 years, 5–10 years, 10–20 years, and &gt; 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (&lt; 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs &gt; 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (&lt; 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs &gt; 20 years: 0.62), and only surgeons with &gt; 20 years of experience did not have substantial reliability on assessment 2 (&lt; 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs &gt; 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

SYMPOSIUM ON B.S. CHIMNI, “CUSTOMARY INTERNATIONAL LAW: A THIRD WORLD PERSPECTIVE” “CUSTOMARY INTERNATIONAL LAW: A THIRD WORLD PERSPECTIVE”: REFLECTIONS IN LIGHT OF AN APPROACH TO CIL BASED ON FUNDAMENTAL ETHICAL PRINCIPLES

B.S. Chimni’s stimulating article makes an important contribution to the burgeoning literature on customary international law (CIL) by examining CIL from the perspective of developing states, a perspective underrepresented in this literature. His article articulates well many valid points about the sociohistorical biases of CIL. At the same time, there may be reasons for more optimism than Chimni appears to possess about the ability of CIL to serve global interests, including those of the ThirdWorld. Furthermore, some of Chimni’s proposals merit further refinement. In this essay I propose to evaluate the strengths and potential shortcomings of Chimni’s arguments in light of an approach to CIL that I have developed that is based on fundamental ethical principles recognized in international law. After laying out an alternative theory that still has many resonances with Chimni’s proposals, I discuss critically three of the key theses articulated by Chimni: First, that CIL is inherently colonialist and inconsistent with the values of Third World peoples; second, that even contemporary customary international human rights law (IHRL) is a means of furthering global capitalism to the detriment of Third World peoples; and third, that the remedy for CIL’s biases lies in the creation of a “postmodern” doctrine of CIL that incorporates reference to the “juridical conscience of humankind.

A Legalidade e a Ética de Medidas Especiais para Proteger Populações Vulneráveis sob o Direito Internacional

Atualmente, em muitos países do mundo, surge uma controvérsia sobre as medidas especiais implementadas por lei para promover o avanço social e econômico de membros de várias populações vulneráveis – medidas muitas vezes chamadas “ações afirmativas.” Essas medidas podem tomar a forma de cotas ou de preferências especiais buscando aumentar as oportunidades para membros dessas populações nas áreas de emprego ou educação, por exemplo, ao mesmo nível dos outros membros da sociedade. &#x0D; Esse artigo busca aprofundar as implicações jurídicas e éticas das normas no direito internacional pelas políticas nacionais concernentes às ações afirmativas. Antes de empreender essa exploração, ele revê alguns conceitos da igualdade ao nível conceitual. Depois, o artigo explora brevemente a história do tratamento de populações vulneráveis na sociedade e a abordagem adotada pelo direito internacional perante essa história. Ele averigua alguns conceitos fundamentais desenvolvidos no direito internacional contemporâneo relacionados à adoção de medidas especiais para proteger populações vulneráveis. Ao mesmo tempo, o artigo identifica algumas questões que não são resolvidas pelo direito internacional de acordo com uma interpretação tradicional. &#x0D; Em seguida, o artigo elabora uma teoria jurídica e ética sobre como interpretar essas normas do direito internacional e resolver essas questões restantes. Essa teoria é baseada no conceito de “unidade em diversidade,” que encontra apoio no direito internacional contemporâneo, bem como nas escrituras reverenciadas de muitas religiões e crenças mundiais. Finalmente, o artigo aplica essa teoria para alcançar algumas conclusões sobre a legalidade e a ética sob o direito internacional de medidas nacionais visando a proteção de populações vulneráveis. O artigo não pretende resolver a polêmico existente ao redor deste assunto, mas a esperança é que a abordagem que ele propõe possa ajudarmos a alcançar uma compreensão mais profunda do problema.</jats:p