PURPORSE¡GThis purpose of the study is to investigate the effectiveness of diabetes shared care model (DSCM)and the factors associated with extent of glycemic control. METHOD¡GWe analyzed 212 patients who completed the five shared care visits and 739 patients who completed the second follow-up visit. Patients are recruited from a department of Endocrinology of medical center located in southern part of Taiwan. Data used in this study were collected from the patients¡¦ medical records. To evaluate effectiveness of diabetes shared care model¡]dietary compliance, exercise behavior compliance, clinical indicators¡^and to examine the factors associated with the hemoglobulin A1c is the purpose of the study. RESULT¡G In 212 patients completing the 5 visits, the compliance of carbohydrate consumption was significantly improved, however, there was no significant improvement in those of calories and fat consumption. Further analysis in 739 patients who completed the second follow-up visit, we found that the compliance of calories and fat consumption was significantly improved. The compliance of carbohydrate was improved, but not reaching significant difference. Although the compliance of 212 patients¡¦ exercise behavior was not significantly improved, the compliance of 739 patients¡¦ exercise behavior was significantly improved. The improvement of clinical indicators following participating the DCSM are as followed¡G 1.The hemoglobulin A1c¡]before¡G8.1% vs after¡G7.9%¡AP=0.04¡^¡Bfasting plasma glucose¡]before¡G164.1mg/dL vs after¡G136.8 mg/dL¡AP<0.01¡^¡Btotal cholesterol ¡]before¡G200.9mg/dL vs after¡G187.3 mg/dL¡AP<0.01¡^¡Blow density lipoprotein¡]LDL¡^¡]before¡G121.0mg/dL vs posttest¡G113.1 mg/dL¡AP<0.01¡^¡Bhigh density lipoprotein¡]HDL¡^¡]before¡G42.6mg/dL vs posttest¡G46.2 mg/dL¡AP<0.01¡^of 212 patients were significantly improved. On the other hand, the triglyceride¡]pretest¡G159.9mg/dL vs after¡G152.2 mg/dL¡AP=0.71¡^¡Bsystolic blood pressure¡]before¡G132.5mmHg vs after¡G137.3 mmHg¡AP=0.34¡^and diastolic blood pressure¡]before¡G79.5 mmHg vs after¡G78.4 mmHg¡AP=0.09¡^of 212 patients were not significantly improved. 2.In 739 patients who only completing the second follow-up visit, the hemoglobulin A1c¡Bfasting plasma glucose¡Bdiastolic blood pressure were significantly improved but the systolic blood pressure was remain unchanged. Finally, multivariate regression modeling was used to investigate the factors associated with extent of glycemic control improvement (first visit HbA1c-annual visit HbA1c) in 212 patients competing the annual visit. After adjusting for age and sex, patients¡¦ sex, level of first visit hemoglobulin A1c and level of first visit triglyceride was associated with the extent of glycemic control.

Made available in DSpace on 2016-04-27T18:11:50Z (GMT). No. of bitstreams: 1 Fabia Regina Evangelista.pdf: 680450 bytes, checksum: 120707155b357e9fa62693c9e31cf0db (MD5) Previous issue date: 2011-02-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / INTRODUCTION: In the area of Speech-Language Pathology, studies that link clinical indicators and the constitution of the speaking subject are incipient, although researches about this theme could contribute to health promotion actions. To propose clinical indicators in the Speech-Language Pathology clinic, one must consider the peculiarities of this practice in its articulation among subjective aspects, noting that language symptoms are related to the effects of the relationship of the subject with the other/Other, the body, the language and the speech. OBJECTIVE: To propose preliminary clinical indicators for the constitution of the speaking subject. METHOD: The preliminary clinical indicators for the constitution of the speaking subject were based on pillars drawn up by Kupfer et al. (2003) for the constitution of the subject, by the model of the language symptoms approached by GOUVÊA (2007), and by the LEMOS (2002) proposal for language acquisition as a change in the position of the infans in relation to the other, language and speech. Analysis of Speech-Language academic reports from users who had been attended by the Speech-Language Pathology sector in the period from 2006 to 2009 in three Basic Health Units located in the Eastern Zone of São Paulo. Inclusion criteria: children between 2 and 6 years old, with speech evaluation and diagnosis of articulation disorders, stuttering or delayed speech. Exclusion criteria: children presenting speech and language disorders secondary to diseases of organic origin. Procedures: The data extracted from Speech-Language academic reports were organized in 2007 Excel spreadsheets in order to select the subjects of the research and avoiding duplicity. The analysis focused on parent s complaints and on their sayings reported in the interviews. Criteria for interpretation of data: Data interpretation focused on the parent s sayings about their child with speech and language symptoms, grouped by similarity, based on four pillars that support the constitution of the speaking subject: supposing/denying a speaking subject, recognition/denial of the speaking subject, recognition/denial of the significant and the responsiveness of the subject to the speech of the other. RESULTS AND CONCLUSIONS: The initial sample comprised 422 Speech-Language academic reports. From this sample, it was selected the ones related to the subjects whose characteristics matched the selection criteria, reaching 88 reports/subjects. From the parent s sayings about their complaints and those extracted from the interviews, 12 preliminary clinical indicators for the constitution of the speaking subject were established. These indicators point to a possibility of occurrence of speech and language disorders, allowing effective intervention in promoting the health of the speaker. The results suggest the importance of the actions of the speech therapist on basic health services before the symptoms emerge in speech and language / INTRODUÇÃO: No campo da Fonoaudiologia, trabalhos que façam articulação entre os indicadores clínicos e a constituição do sujeito falante são incipientes, embora pesquisas acerca deste tema possam contribuir com as ações de promoção de saúde. Para se propor indicadores clínicos fonoaudiológicos, deve-se considerar as peculiaridades desta práxis em sua lida com aspectos subjetivos, lembrando que o sintoma de linguagem está vinculado aos efeitos da relação sujeito e outro/Outro, sobre o corpo, a língua e a fala. OBJETIVO: Propor indicadores clínicos preliminares para a constituição do sujeito falante. MÉTODO: Os indicadores clínicos preliminares para a constituição do sujeito falante foram inspirados pelos eixos elaborados por KUPFER et al. (2003) para a constituição do sujeito, pelo modelo de funcionamento dos sintomas de linguagem abordado por GOUVÊA (2007) e pela proposta de LEMOS (2002) para a aquisição de linguagem enquanto mudança de posição do infans, em relação ao outro, à língua e à fala. Partiu da análise de relatórios fonoaudiológicos acadêmicos dos usuários que compareceram ao setor de Fonoaudiologia no período de 2006 a 2009 em três Unidades Básicas de Saúde localizadas na Zona Leste da cidade de São Paulo. Critérios de inclusão: Faixa etária entre 2 e 6 anos; ter avaliação fonoaudiológica; ter hipótese diagnóstica de distúrbio articulatório, gagueira, atraso ou retardo de linguagem oral. Critérios de exclusão: Apresentar perturbações de fala e/ou linguagem oral secundárias a alterações de fundo orgânico. Procedimentos: Os dados extraídos dos relatórios fonoaudiológicos acadêmicos foram organizados em planilhas Excel 2007, a fim de selecionar os sujeitos da coleta da pesquisa e evitar duplicidade. A análise incidiu sobre dizeres parentais que foram referidos durante a queixa e as entrevistas fonoaudiológicas. Critérios de interpretação dos dados: A interpretação dos dados incidiu sobre os dizeres parentais sobre a criança com sintomas de fala e linguagem, agrupados por relações de semelhança, a partir dos quatro eixos que sustentam a constituição do sujeito falante: supor/negar um sujeito falante, reconhecimento/negação do sujeito falante, reconhecimento/negação do significante e a responsividade do sujeito à fala do outro. RESULTADOS E CONCLUSÕES: A amostra inicial totalizou 422 relatórios fonoaudiológicos acadêmicos. Desta amostra, foram selecionados os que se referiam aos sujeitos cujas características atendiam aos critérios de seleção, chegando-se a 88 relatórios/sujeitos. Por meio dos dizeres parentais extraídos da queixa e da entrevista com os pais foi possível estabelecer 12 indicadores clínicos preliminares para a constituição do sujeito falante. Estes indicadores apontam para uma possibilidade de que o sujeito venha a apresentar perturbações de fala e linguagem, permitindo uma intervenção eficaz na promoção de saúde do falante. Os resultados permitem concluir a importância do fonoaudiólogo na atenção básica à saúde da população antes que emerjam os sintomas de fala e linguagem