The cardiovascular disease continuum begins with risk factors such as diabetes mellitus (DM), progresses to vasculopathy and myocardial dysfunction, and finally ends with cardiovascular death. Diabetes is associated with a 2- to 4-fold increased risk for heart failure (HF). Moreover, HF patients wit...h DM have a worse prognosis than those without DM. Diabetes can cause myocardial ischemia via micro- and macrovasculopathy and can directly exert deleterious effects on the myocardium. Hyperglycemia, hyperinsulinemia, and insulin resistance can cause alterations in vascular homeostasis. Then, reduced nitric oxide and increased reactive oxygen species levels favor inflammation leading to atherothrombotic progression and myocardial dysfunction. The classification, diagnosis, and treatment of HF for a patient with and without DM remain the same. Until now, drugs targeting neurohumoral and metabolic pathways improved mortality and morbidity in HF with reduced ejection fraction (HFrEF). Therefore, all HFrEF patients should receive guideline-directed medical therapy. By contrast, drugs modulating neurohumoral activity did not improve survival in HF with preserved ejection fraction (HFpEF) patients. Trials investigating whether sodium-glucose cotransporter-2 inhibitors are effective in HFpEF are on-going. This review will summarize the epidemiology, pathophysiology, and treatment of HF in diabetes.
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Este documento de orientação para elaboração de um plano nacional de operacionalização e vacinação (NDVP) apresenta um esquema que auxilia os países a: desenvolver e atualizar o respectivo NDVP para a introdução de vacinas contra a COVID-19; elaborar estratégias para a operacionalizaçã...o e o monitoramento da(s) vacina(s) contra a COVID-19 no país; garantir que o plano e o financiamento relacionado estejam bem alinhados a outros planos nacionais de suporte à recuperação e resposta à COVID-19, e que a implementação esteja totalmente integrada nos mecanismos nacionais de governança.Este documento de orientação baseia-se em documentos de orientação já existentes sobre a introdução de novas vacinas, elaborados anteriormente pela OMS mediante consulta com especialistas no assunto, e é embasado por materiais recentes sobre vacinas contra a COVID-19, endossados pelo SAGE OMS
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The document "Combating False Information on Vaccines: A Guide for Health Workers" is designed to help health workers address vaccine misinformation. It begins by defining misinformation and explaining why it spreads rapidly, often due to its emotional appeal and simplistic explanations. The guide i...dentifies common sources of vaccine misinformation, including influential individuals who profit from spreading false information. The document outlines strategies for combating misinformation, emphasizing the importance of health workers as trusted sources. It provides tips for identifying misinformation online, such as checking URLs, dates, and author credentials, and recognizing tactics like evoking strong emotions or pushing conspiracy theories. Two main approaches to fighting misinformation are discussed: prebunking and debunking. Prebunking involves warning individuals about potential misinformation before they encounter it, while debunking aims to correct false information after it has been consumed. The guide offers practical examples for both methods. Additionally, the document highlights the role of health workers in supporting peers and patients to trust immunization. It suggests being kind, nonjudgmental, and transparent when addressing concerns, and using motivational interviewing techniques to understand and respond to patients' doubts. Overall, the guide emphasizes the critical role of health workers in maintaining trust in vaccines and provides comprehensive strategies to identify, address, and prevent the spread of vaccine misinformation in clinical and community settings. The guide is a valuable resource for health workers to enhance their ability to combat vaccine misinformation, support informed decision-making, and promote trust in vaccines within their communities, and it addresses a pressing issue with practical solutions, supports trusted health workers, and ultimately aims to protect public health by promoting accurate information and trust in vaccines.
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The document "Combating False Information on Vaccines: A Guide for EPI Managers" is designed to help Expanded Program on Immunization (EPI) managers address vaccine misinformation. It begins by defining misinformation and explaining why it spreads rapidly, often due to its emotional appeal and simpl...istic explanations. The guide identifies common sources of vaccine misinformation, including influential individuals who profit from spreading false information. The document outlines strategies for combating misinformation, emphasizing the importance of EPI managers as trusted sources. It provides tips for identifying misinformation online, such as checking URLs, dates, and author credentials, and recognizing tactics like evoking strong emotions or pushing conspiracy theories. Two main approaches to fighting misinformation are discussed: prebunking and debunking. Prebunking involves warning individuals about potential misinformation before they encounter it, while debunking aims to correct false information after it has been consumed. The guide offers practical examples for both methods. Additionally, the document highlights the role of EPI managers in supporting health workers to trust immunization. It suggests being kind, nonjudgmental, and transparent when addressing concerns, and using motivational interviewing techniques to understand and respond to health workers' doubts. The guide also emphasizes the importance of creating a supportive environment for health workers, promoting pro-vaccine norms, and providing continuing education on vaccines. Overall, the guide aims to help EPI managers maintain trust in vaccines and provides comprehensive strategies to identify, address, and prevent the spread of vaccine misinformation in clinical and community settings. This document is necessary to equip EPI managers with the knowledge and tools to combat vaccine misinformation, support their teams, and promote trust in vaccines, ultimately protecting public health.
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This document describes the ethical values that are most important to the nursing profession in Ontario. It also provides scenarios of ethical situations in which there is a conflict of values. Nurses are encouraged to use these scenarios for reflection and discussion. No solutions are offered becau...se there is no one solution that is best in all situations. The behavioural directives are intended to help nurses work through ethical situations and provide information about the College of Nurses of Ontario’s (CNO’s) expectations for ethical conduct. These are taken into account when CNO Committees assess nurses’ practices. Nurses need to consider behavioural directives carefully when making decisions about ethical care as this process will strengthen their practice.
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