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Morales-Torres L, Vélez-Maldonado DA, Rosario-Maldonado FJ, Aguirre-Hernández JM, Motta-Pagán JL, Rodríguez-Torruella D, Castro-Figueroa E, Ramos-Lucca A, Rivera-Mateo E, Marzán-Rodríguez M, Jiménez-Chávez J. Empowering Underserved Communities in Southern Puerto Rico: A Formal Training Program in Community Health Promotion. J Community Health 2024; 49:887-899. [PMID: 38575835 PMCID: PMC11345324 DOI: 10.1007/s10900-024-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/06/2024]
Abstract
Community health promotion offers a potential solution to persistent healthcare challenges, with community health workers playing a pivotal role. The Community Training Institute for Health Disparities (CTIHD) implemented a problem-solving curriculum in Community Health Promotion, integrating a competency-based learning model through two courses: Introduction to Community Health Promotion and Design of an Action Plan for the Promotion of Community Health. Each course comprised ten three-hour sessions, featuring pre/post-tests, evaluations, and a cognitive debriefing. Knowledge change was assessed using pre/post-test scores among 27 community leaders from southern Puerto Rico. Cohort 1 and Cohort 2 demonstrated an overall retention rate of 62.6% and 96.7%, respectively. Although differences in knowledge gained between cohorts and courses weren't statistically significant, a trend toward increased knowledge was noted. Cohort 1 experienced a 22% knowledge increase in Course 1 and a 24% increase in Course 2. Cohort 2 demonstrated a 41% knowledge increase in Course 1 and a 25% increase in Course 2. The CTIHD's Community Health Promotion Program has made significant strides in elevating awareness and knowledge, marking a positive step toward reducing health disparities and fostering healthier, empowered communities in southern Puerto Rico.
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Affiliation(s)
- Luisa Morales-Torres
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico.
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico.
| | - David A Vélez-Maldonado
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Fernando J Rosario-Maldonado
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Jeannie M Aguirre-Hernández
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Jorge L Motta-Pagán
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | | | - Eida Castro-Figueroa
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Axel Ramos-Lucca
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Elizabeth Rivera-Mateo
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Melissa Marzán-Rodríguez
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Julio Jiménez-Chávez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
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Brant LCC, Miranda JJ, Carrillo-Larco RM, Flood D, Irazola V, Ribeiro ALP. Epidemiology of cardiometabolic health in Latin America and strategies to address disparities. Nat Rev Cardiol 2024:10.1038/s41569-024-01058-2. [PMID: 39054376 DOI: 10.1038/s41569-024-01058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/27/2024]
Abstract
In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.
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Affiliation(s)
- Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vilma Irazola
- Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Antonio Luiz P Ribeiro
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Dusi R, Trombini RRDSL, Pereira ALM, Funghetto SS, Ginani VC, Stival MM, Nakano EY, Zandonadi RP. Construction and Content Validation of Mobile Devices' Application Messages about Food and Nutrition for DM2 Older Adults. Nutrients 2024; 16:2306. [PMID: 39064750 PMCID: PMC11280354 DOI: 10.3390/nu16142306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Older adults face a decline in the quality of their diet, which affects their health. The prevalence of DM2 is increasing, as are the associated complications. Effective nutrition education and mobile health (mHealth) interventions offer a viable solution in the scenario of the widespread use of mobile devices. This study aimed to develop and validate messages for a mobile application aimed at older adult Brazilians with DM2 who receive care at the Brazilian Unified Health System (SUS). The educational messages on healthy eating for older adults with DM2 were created from 189 excerpts selected from Brazilian official documents. A total of 37 messages were created, categorized into 20 educational, 12 motivational, and 5 congratulatory, all up to 120 characters. Twenty-one experts validated the messages for clarity and relevance, and 11 messages had to be revised to meet the criteria. Subsequently, the 36 messages approved by the experts were tested on a sample of 57 older adults, guaranteeing clarity rates of over 80%. This study developed and validated 36 messages for a mobile health app aimed at older adults with type 2 diabetes mellitus in Brazil. Expert evaluation ensured clarity and relevance, confirmed by older adult participants who evaluated clarity. This research highlights the potential of mHealth to overcome barriers to accessing healthcare in the SUS, emphasizing personalized interventions for the effective management of older adults' health.
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Affiliation(s)
- Rafaella Dusi
- University of Brasília, Faculty of Health Sciences, Department of Nutrition, Campus Universitario Darcy Ribeiro, Brasilia 70910-900, Brazil;
| | - Raiza Rana de Souza Lima Trombini
- University of Brasília, Graduate Program in Health Sciences and Technologies, Campus Universitario Ceilândia, Brasília 72220-275, Brazil; (R.R.d.S.L.T.); (A.L.M.P.); (S.S.F.); (M.M.S.)
| | - Alayne Larissa Martins Pereira
- University of Brasília, Graduate Program in Health Sciences and Technologies, Campus Universitario Ceilândia, Brasília 72220-275, Brazil; (R.R.d.S.L.T.); (A.L.M.P.); (S.S.F.); (M.M.S.)
| | - Silvana Schwerz Funghetto
- University of Brasília, Graduate Program in Health Sciences and Technologies, Campus Universitario Ceilândia, Brasília 72220-275, Brazil; (R.R.d.S.L.T.); (A.L.M.P.); (S.S.F.); (M.M.S.)
| | - Verônica Cortez Ginani
- University of Brasília, Faculty of Health Sciences, Department of Nutrition, Campus Universitario Darcy Ribeiro, Brasilia 70910-900, Brazil;
| | - Marina Morato Stival
- University of Brasília, Graduate Program in Health Sciences and Technologies, Campus Universitario Ceilândia, Brasília 72220-275, Brazil; (R.R.d.S.L.T.); (A.L.M.P.); (S.S.F.); (M.M.S.)
| | - Eduardo Yoshio Nakano
- University of Brasília, Department of Statistics, Campus Universitario Darcy Ribeiro, Brasilia 70910-900, Brazil;
| | - Renata Puppin Zandonadi
- University of Brasília, Faculty of Health Sciences, Department of Nutrition, Campus Universitario Darcy Ribeiro, Brasilia 70910-900, Brazil;
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Mengesha EW, Tesfaye TD, Boltena MT, Birhanu Z, Sudhakar M, Hassen K, Kedir K, Mesfin F, Hailemeskel E, Dereje M, Hailegebrel EA, Howe R, Abebe F, Tadesse Y, Girma E, Wadilo F, Lake EA, Guta MT, Damtew B, Debebe A, Tariku Z, Amdisa D, Hiko D, Worku A, G/michael M, Abraha YG, Ababulgu SA, Fentahun N. Effectiveness of community-based interventions for prevention and control of hypertension in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003459. [PMID: 39012878 PMCID: PMC11251591 DOI: 10.1371/journal.pgph.0003459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 06/05/2024] [Indexed: 07/18/2024]
Abstract
Hypertension poses a significant public health challenge in sub-Saharan Africa due to various risk factors. Community-based intervention for prevention and control of hypertension is an effective strategy to minimize the negative health outcomes. However, comprehensive systematic review evidence to inform effective community-based interventions for prevention and control of hypertension in low resource settings is lacking. This study aimed to synthesize the effectiveness of community-based interventions on prevention and control of hypertension in sub-Saharan Africa. A comprehensive search for studies was carried out on PubMed, CINAHL, Web of Science Core Collection, Embase, Scopus, and Google scholar databases. The result of the review was reported according to PRISMA guidelines. Studies published in English language were included. Two independent reviewers conducted critical appraisal of included studies and extracted the data using predefined excel sheet. Experimental, quasi experimental, cohort and analytical cross-sectional studies conducted on adults who have received community-based interventions for prevention and controls of hypertension in sub-Saharan Africa were included. In this systematic review, a total of eight studies were included, comprising of two interventional studies, two quasi-experimental studies, three cohort studies, and one comparative cross-sectional study. The interventions included health education, health promotion, home-based screening and diagnosis, as well as referral and treatment of hypertensive patients. The sample sizes ranged from 236 to 13,412 in the intervention group and 346 to 6,398 in the control group. This systematic review shows the effect of community-based interventions on reduction of systolic and diastolic blood pressure. However, the existing evidence is inconsistence and not strong enough to synthesize the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Hence, further primary studies need on the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Systematic review registration number: PROSPERO CRD42022342823.
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Affiliation(s)
| | | | - Minyahil Tadesse Boltena
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Morankar Sudhakar
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kiya Kedir
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Firaol Mesfin
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Melat Dereje
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Rawleigh Howe
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Finina Abebe
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association, Addis Ababa, Ethiopia
| | - Yordanos Tadesse
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association, Addis Ababa, Ethiopia
| | - Fisseha Wadilo
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Eyasu Alem Lake
- College of Health Sciences and Medicine, Wolayita Sodo University, Sodo, Ethiopia
| | - Mistire Teshome Guta
- College of Health Sciences and Medicine, Wolayita Sodo University, Sodo, Ethiopia
| | - Bereket Damtew
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Adisalem Debebe
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zerihun Tariku
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Demuma Amdisa
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Desta Hiko
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Addisu Worku
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Yoseph Gebreyohannes Abraha
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Ethiopian Knowledge Translation Centre for Health, The Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Sabit Ababor Ababulgu
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Ethiopian Knowledge Translation Centre for Health, The Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Netsanet Fentahun
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Mensah P, Valdez K, Gyawali A, Snell-Bergeon J. Social and Structural Determinants of Cardiovascular Complications of Diabetes. Curr Diab Rep 2024; 24:147-157. [PMID: 38696042 DOI: 10.1007/s11892-024-01541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of mortality in people who have diabetes. Racial and ethnic minorities with diabetes have suboptimal management of cardiovascular risk factors, leading to higher mortality. Social and structural determinants of health are external factors that influence an individual's ability to choose positive health behaviors. In this review, we will discuss cardiovascular complications in people who have diabetes and their relationship to social determinants of health (SDOH). RECENT FINDINGS Recent innovations in diabetes treatment, including new devices and medications, have improved care and survival. However, disparities in the availability of these treatments to racial and ethnic minorities may contribute to continued inequities in CVD outcomes. Racial/ethnic disparities in CVD relate to inequities in economic opportunity, education and health literacy, neighborhoods and social cohesion, and health care access and quality driven by structural racism.
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Affiliation(s)
- Portia Mensah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Mail Stop F547, Aurora, CO, 80045, USA
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly Valdez
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Mail Stop F547, Aurora, CO, 80045, USA
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ankita Gyawali
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Mail Stop F547, Aurora, CO, 80045, USA
| | - Janet Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Mail Stop F547, Aurora, CO, 80045, USA.
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Fritz M, Grimm M, My Hanh HT, Koot JAR, Nguyen GH, Nguyen TPL, Probandari A, Widyaningsih V, Lensink R. Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study. BMJ Glob Health 2024; 9:e015053. [PMID: 38777393 PMCID: PMC11116884 DOI: 10.1136/bmjgh-2024-015053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades. Despite the escalating burden, screening for NCDs remains at very low levels, resulting in undetected cases, premature mortality and high public healthcare costs. We investigate whether community-based NCD prevention and management programmes are an effective solution. METHODS In Indonesia, we compare participants in the community-based NCD screening and management programme Pos Pembinaan Terpadu-Penyakit Tidak Menular with matched non-participants with respect to their uptake of screening activities, health-related behaviour and knowledge and metabolic risk factors. We use statistical matching to redress a possible selection bias (n=1669). In Viet Nam, we compare members of Intergenerational Self-Help Clubs, which were offered similar NCD health services, with members of other community groups, where such services were not offered. We can rely on two waves of data and use a double-difference approach to redress a possible selection bias and to measure the impacts of participation (n=1710). We discuss strengths and weaknesses of the two approaches in Indonesia and Viet Nam. RESULTS In Indonesia, participants have significantly higher uptake of screening for hypertension and diabetes (+13% from a control mean of 88% (95% CI 9% to 17%); +93% from a control mean of 48% (95% CI 79% to 108%)). In both countries, participants show a higher knowledge about risk factors, symptoms and complications of NCDs (Indonesia: +0.29 SD (0.13-0.45), Viet Nam: +0.17 SD (0.03-0.30)). Yet, the improved knowledge is only partly reflected in improved health behaviour (Viet Nam: fruit consumption +0.33 SD (0.15-0.51), vegetable consumption +0.27 SD (0.04-0.50)), body mass index (BMI) (Viet Nam: BMI -0.07 SD (-0.13 to -0.00)) or metabolic risk factors (Indonesia: systolic blood pressure: -0.13 SD (-0.26 to -0.00)). CONCLUSION Community-based NCD programmes are well suited to increase screening and to transmit health knowledge. Due to their extensive outreach within the community, they can serve as a valuable complement to the screening services provided at the primary healthcare level. Yet, limited coverage, insufficient resources and a high staff turnover remain a problem. TRIAL REGISTRATION NUMBER NCT05239572.
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Affiliation(s)
- Manuela Fritz
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
- School of Business, Economics and Information Systems, University of Passau, Passau, Germany
| | - Michael Grimm
- School of Business, Economics and Information Systems, University of Passau, Passau, Germany
- IZA Institute of Labor Economics, Bonn, Germany
| | | | - Jaap A R Koot
- Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Thi-Phuong-Lan Nguyen
- Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City, Viet Nam
| | - Ari Probandari
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia
| | - Vitri Widyaningsih
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia
| | - Robert Lensink
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
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Gafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW, Kengne AP. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens 2024:10.1038/s41371-024-00913-6. [PMID: 38698111 DOI: 10.1038/s41371-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa.
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa.
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | - Omotayo S Alaofin
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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Avezum Á, Drager LF, Reiker T, Bigoni A, Leonel LP, Abreu A, Bortolotto L, Palmeirim MS, Silveira M, Aquino B, Maggion RV, Baxter YC, Cobos Muñoz D, Dib KM, Amaral AZ, Saric J, Jarrett C, Boch J. An Intersectoral Approach to Hypertension Care: Solutions for Improving Blood Pressure Control in São Paulo, Brazil. Am J Hypertens 2024; 37:366-378. [PMID: 38214400 PMCID: PMC11016842 DOI: 10.1093/ajh/hpae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/01/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Hypertension is the leading risk factor for cardiovascular diseases (CVDs) and a major public health issue worldwide. In Brazil, it affects approximately 52.5% of the adult population. We describe the solutions package and the impact of a population health initiative in São Paulo city, following the CARDIO4Cities approach for the management of cardiovascular risk. METHODS Using a design thinking approach, interventions were developed with a coalition of local and international stakeholders to address needs of patients, healthcare professionals, and the health system. The resulting solution package was checked to comply with guidelines for non-communicable disease and hypertension management. Clinical impact was measured by extracting the hypertension cascade of care-monitored, diagnosis, treatment, and control-from medical records. RESULTS Under the leadership of the municipal health authorities, nine solutions were piloted and scaled across the city. Solutions conform with local and international best-practices. Between October 2017 and December 2021, 11,406 patient records were analyzed. Results showed a 40% increase in monitored patients (patients with at least one blood pressure, BP, measurement); reduced proportions of patients diagnosed among those with available BP measurements (72%-53%) and treated among diagnosed (93%-85%); and an improvement in controlled patients among those receiving treatment (16%-27%). CONCLUSIONS The solution package described in this study was correlated with increased BP control. The implementation methodology and results add to the body of real-world evidence supporting population health implementation science in Brazil and beyond.
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Affiliation(s)
- Álvaro Avezum
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
- Sociedade de Cardiologia do Estado de São Paulo (SOCESP), São Paulo, Brazil
| | - Luciano F Drager
- Sociedade de Cardiologia do Estado de São Paulo (SOCESP), São Paulo, Brazil
- Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Luiz Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Hipertensão, São Paulo, Brazil
| | - Marta Sólveig Palmeirim
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | - Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Karina Mauro Dib
- Secretaria Municipal da Saúde, Divisão de Cuidado às Doenças Crônicas, São Paulo, Brazil
| | - Amaury Zatorre Amaral
- Secretaria Municipal da Saúde, Divisão de Cuidado às Doenças Crônicas, São Paulo, Brazil
| | - Jasmina Saric
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Caitlin Jarrett
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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9
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Johnson C, Gerbers A, Staudt A, Cohrs J, Tutu P. Heart on hypertension: Improving hypertension control in the FQHC setting through a group visit program. J Natl Med Assoc 2024; 116:70-74. [PMID: 38199903 DOI: 10.1016/j.jnma.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Many solutions for increasing hypertension control rates have been proposed yet the social determinants of health create health disparities within the populations served by Federally Qualified Health Centers (FQHC) that can complicate reaching these goals. This study observes impact of a group visit program on hypertension control within the patient population served by an FQHC. METHODS Retrospective review and analysis of blood pressure data was performed for patients enrolled in the first 4 cohorts of the Heart on Hypertension Group Visit Program at the end of the program as well as 3 months, 6 months, and 12 months after the program ended. RESULTS AND DISCUSSION Twenty-two patients participated in the program. Seventeen patients achieved the goal with a statistically significant mean change in blood pressure at p > 0.001. Patients who completed the program had a statistically significant mean change in blood pressure at p > 0.001 and those who discontinued prior to completing the program had a statistically significant mean change in blood pressure at p = 0.001 systolic and p = 0.002 diastolic. Changes in patient blood pressure were sustained for 3-months (78%), 6-months (83%), and 12-months (83%). IMPLICATIONS Patients in the Heart on Hypertension program were successful in making significant changes in hypertension control in the FQHC setting. This method was useful in improving hypertension control metrics for patients facing increased influences by the Social Determinants of Health.
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Affiliation(s)
- Christen Johnson
- Director of Medical Education and Research and Family Physician, Heart of Ohio Family Health Centers, 5000 E. Main Street, Columbus, OH, 43213, United States.
| | - Abigail Gerbers
- Lead Clinical Dietitian, Heart of Ohio Family Health Centers, United States
| | - Anna Staudt
- Allied Health Manager and Lead Clinical Pharmacist, Heart of Ohio Family Health Centers, United States
| | - Janessa Cohrs
- RN Care Coordinator Supervisor and Clinical Pharmacist, Heart of Ohio Family Health Centers, United States
| | - Priscilla Tutu
- HIV Case Manager, Heart of Ohio Family Health Centers, United States
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Lubega M, Ogwok J, Nabunya B, Mbalinda SN. Role of community-based health clubs in promoting patients' health education for diabetes self-care management: an interventional qualitative study in a Ugandan urban setting. BMJ Open Qual 2023; 12:e002473. [PMID: 38135300 DOI: 10.1136/bmjoq-2023-002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Self-care management support is a core component of the Chronic Care Model that emphasises the need for empowering and preparing patients to manage their healthcare. In diabetes mellitus (DM) management, health education towards self-care empowers patients to make day-to-day decisions on their own disease and live with a healthy lifestyle. Although several strategies have been undertaken to improve the management of DM in Uganda, little has been done to empower patients to manage their own health. Community-based health clubs have been suggested as a novel way of improving diabetes management especially in settings with uneven distribution of healthcare facilities and inaccessibility to healthcare services that limit patients' awareness of the disease and self-care management. This interventional study was aimed at exploring the role of community-based health clubs in promoting patients' health education for diabetes self-care management. METHODS A cross-sectional qualitative study was conducted among 20 participants using focus group discussions with each having six to eight members. Only patients with diabetes who seek routine diabetes healthcare services at Wakiso Health Centre IV and had participated in the 8-week community-based health clubs' health education sessions were recruited for the study. The audio-recordings were transcribed verbatim and translated into English; thematic data analysis was conducted to generate codes and themes. Similar codes were merged and a group consensus was reached on coding discrepancies. RESULTS Three major themes on the role of health clubs in promoting patients' health education were merged from the study. These include promoting sharing of experiences among patients, improving awareness of healthy self-care practices and offering sufficient patient-health worker interaction time. CONCLUSIONS This is the first publication reporting on the role of community-based health clubs in promoting patients' health education towards diabetes self-care management in Uganda. The ability to share experiences among patients, improve patients' awareness on healthy living practices and the increased health worker-patient interaction time contribute heavily to the capacity-building for self-care among patients.
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Affiliation(s)
- Martin Lubega
- Department of Nursing, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Ogwok
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Brenda Nabunya
- Department of Nursing, Makerere University College of Health Sciences, Kampala, Uganda
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Fonseca SF, Ribeiro ALP, Cimini CCR, Soares TBDC, Delfino-Pereira P, Nogueira LT, Moura RMF, Motta-Santos D, Ribeiro LB, Camargos MCS, Paixão MC, Pires MC, Batchelor J, Marcolino MS. Scale up of implementation of a multidimensional intervention to enhance hypertension and diabetes care at the primary care setting: A protocol for a cluster-randomized study in Brazil. Am Heart J 2023; 262:119-130. [PMID: 37044364 DOI: 10.1016/j.ahj.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Hypertension and diabetes mellitus (DM) are highly prevalent in low and middle-income countries (LMICs), and the proportion of patients with uncontrolled diseases is higher than in high-income countries. Innovative strategies are required to surpass barriers of low sources, distance and quality of health care. Our aim is to assess the uptake and effectiveness of the implementation of an integrated multidimensional strategy in the primary care setting, for the management of people with hypertension and diabetes mellitus in Brazil. METHODS This scale up implementation study called Control of Hypertension and diAbetes in MINas Gerais (CHArMING) Project has mixed-methods, and comprehends 4 steps: (1) needs assessment, including a standardized structured questionnaire and focus groups with health care practitioners; (2) baseline period, 3 months before the implementation of the intervention; (3) cluster randomized controlled trial (RCT) with a 12-months follow-up period; and (4) a qualitative study after the end of follow-up. The cluster RCT will randomize 35 centers to intervention (n = 18) or usual care (n = 17). Patients ≥18 years old, with diagnosis of hypertension and/or DM, of 5 Brazilian cities in a resource-constrained area will be enrolled. The intervention consists of a multifaceted strategy, with a multidisciplinary approach, including telehealth tools (decision support systems, short message service, telediagnosis), continued education with an approach to issues related to the care of people with hypertension and diabetes in primary care, including pharmacological and non-pharmacological treatment and behavioral change. The project has actions focused on professionals and patients. CONCLUSIONS This study consists of a multidimensional strategy with multidisciplinary approach using digital health to improve the control of hypertension and/or DM in the primary health care setting. We expect to provide the basis for implementing an innovative management program for hypertension and DM in Brazil, aiming to reduce the present and future burden of these diseases in Brazil and other LMICs. CLINICAL TRIAL IDENTIFIER This study was registered in ClinicalTrials.gov. (NCT05660928).
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Affiliation(s)
- Sueli Ferreira Fonseca
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Cardiology Service, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil.; Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). Porto Alegre, Brazil
| | - Christiane Correa Rodrigues Cimini
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri. Teófilo Otoni, Brazil
| | | | - Polianna Delfino-Pereira
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). Porto Alegre, Brazil
| | - Lucas Tavares Nogueira
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - Regina Marcia Faria Moura
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - Daisy Motta-Santos
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - Leonardo Bonisson Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | | | - Maria Cristina Paixão
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - James Batchelor
- Clinical Informatics Research Unit, University of Southampton, Southampton United Kingdom
| | - Milena Soriano Marcolino
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). Porto Alegre, Brazil.
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Assessing the impact of community-based interventions on hypertension and diabetes management in three Minnesota communities: Findings from the prospective evaluation of US HealthRise programs. PLoS One 2023; 18:e0279230. [PMID: 36848352 PMCID: PMC9970068 DOI: 10.1371/journal.pone.0279230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/02/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Community-based health interventions are increasingly viewed as models of care that can bridge healthcare gaps experienced by underserved communities in the United States (US). With this study, we sought to assess the impact of such interventions, as implemented through the US HealthRise program, on hypertension and diabetes among underserved communities in Hennepin, Ramsey, and Rice Counties, Minnesota. METHODS AND FINDINGS HealthRise patient data from June 2016 to October 2018 were assessed relative to comparison patients in a difference-in-difference analysis, quantifying program impact on reducing systolic blood pressure (SBP) and hemoglobin A1c, as well as meeting clinical targets (< 140 mmHg for hypertension, < 8% Al1c for diabetes), beyond routine care. For hypertension, HealthRise participation was associated with SBP reductions in Rice (6.9 mmHg [95% confidence interval: 0.9-12.9]) and higher clinical target achievement in Hennepin (27.3 percentage-points [9.8-44.9]) and Rice (17.1 percentage-points [0.9 to 33.3]). For diabetes, HealthRise was associated with A1c decreases in Ramsey (1.3 [0.4-2.2]). Qualitative data showed the value of home visits alongside clinic-based services; however, challenges remained, including community health worker retention and program sustainability. CONCLUSIONS HealthRise participation had positive effects on improving hypertension and diabetes outcomes at some sites. While community-based health programs can help bridge healthcare gaps, they alone cannot fully address structural inequalities experienced by many underserved communities.
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Singh G, Sharma S, Bansal N, Sharma M, Chowdhury A, Sharma S, Bansal RK, Goraya JS, Setia RK, Paul BS, Sander JW. A cluster-randomized trial comparing home-based primary health care and usual clinic care for epilepsy in a resource-limited country. Epilepsia Open 2022; 7:781-791. [PMID: 36213959 PMCID: PMC9712458 DOI: 10.1002/epi4.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To ascertain whether home-based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic-based care in community samples of people with epilepsy in a resource-poor country. METHODS Participants included consenting individuals with active epilepsy identified in a population survey in impoverished communities. The intervention included antiseizure medication provision, adherence reinforcement and epilepsy self- and stigma management guidance provided by a primary health care-equivalent worker. We compared the intervention group to a routine clinic-based care group in a cluster-randomized trial lasting 24 months. The primary outcome was antiseizure medication adherence, appraised from monthly pill counts. Seizure outcomes were assessed by monthly seizure aggregates and time to first seizure and impact by the Personal Impact of Epilepsy scale. RESULTS Enrolment began on September 25, 2017 and was complete by July 24, 2018. Twenty-four clusters, each comprising ten people with epilepsy, were randomized to either home- or clinic-care. Home-care recipients were more likely to have used up their monthly-dispensed epilepsy medicine stock (regression coefficient: 0.585; 95% confidence intervals, 0.289-0.881; P = 0.001) and had fewer seizures (regression coefficient: -2.060; 95%CI, -3.335 to -0.785; P = 0.002). More people from clinic-care (n = 44; 37%) than home-care (n = 23; 19%) exited the trial (P = 0.003). The time to first seizure, adverse effects and the personal impact of epilepsy were similar in the two arms. SIGNIFICANCE Home care for epilepsy compared to clinic care in resource-limited communities improves medication adherence and seizure outcomes and reduces the secondary epilepsy treatment gap.
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Affiliation(s)
- Gagandeep Singh
- Research & Development UnitDayanand Medical CollegeLudhianaIndia,Department of NeurologyDayanand Medical CollegeLudhianaIndia,UCL Queen Square Institute of NeurologyLondon WC1N 3BGLondonUK
| | - Suman Sharma
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Namita Bansal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Meenakshi Sharma
- Non‐communicable Diseases DivisionIndian Council of Medical ResearchNew DelhiIndia
| | - Anurag Chowdhury
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | | | | | - Josemir W. Sander
- UCL Queen Square Institute of NeurologyLondon WC1N 3BGLondonUK,Chalfont Centre for EpilepsyChalfont St Peter SL9 0RJLondonUK,Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands,Neurology DepartmentWest of China Hospital, Sichuan UniversityChengduChina
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Fernández LG, Firima E, Robinson E, Ursprung F, Huber J, Amstutz A, Gupta R, Gerber F, Mokhohlane J, Lejone T, Ayakaka I, Xu H, Labhardt ND. Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: a literature scoping review and framework for designing chronic services. BMC Public Health 2022; 22:1126. [PMID: 35658850 PMCID: PMC9167524 DOI: 10.1186/s12889-022-13467-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background Arterial hypertension (aHT) is the leading cardiovascular disease (CVD) risk factor in sub-Saharan Africa; it remains, however, underdiagnosed, and undertreated. Community-based care services could potentially expand access to aHT diagnosis and treatment in underserved communities. In this scoping review, we catalogued, described, and appraised community-based care models for aHT in sub-Saharan Africa, considering their acceptability, engagement in care and clinical outcomes. Additionally, we developed a framework to design and describe service delivery models for long-term aHT care. Methods We searched relevant references in Embase Elsevier, MEDLINE Ovid, CINAHL EBSCOhost and Scopus. Included studies described models where substantial care occurred outside a formal health facility and reported on acceptability, blood pressure (BP) control, engagement in care, or end-organ damage. We summarized the interventions’ characteristics, effectiveness, and evaluated the quality of included studies. Considering the common integrating elements of aHT care services, we conceptualized a general framework to guide the design of service models for aHT. Results We identified 18,695 records, screened 4,954 and included twelve studies. Four types of aHT care models were identified: services provided at community pharmacies, out-of-facility, household services, and aHT treatment groups. Two studies reported on acceptability, eleven on BP control, ten on engagement in care and one on end-organ damage. Most studies reported significant reductions in BP values and improved access to comprehensive CVDs services through task-sharing. Major reported shortcomings included high attrition rates and their nature as parallel, non-integrated models of care. The overall quality of the studies was low, with high risk of bias, and most of the studies did not include comparisons with routine facility-based care. Conclusions The overall quality of available evidence on community-based aHT care is low. Published models of care are very heterogeneous and available evidence is insufficient to recommend or refute further scale up in sub-Sahara Africa. We propose that future projects and studies implementing and assessing community-based models for aHT care are designed and described according to six building blocks: providers, target groups, components, location, time of service delivery, and their use of information systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13467-4.
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Pitchalard K, Wimolphan P, Singkhorn O, Purkey E, Moonpanane K. Feasibility and Acceptability of the HOME Model to Promote Self-Management Among Ethnic Minority Elderly with Type 2 Diabetes Mellitus in Rural Thailand: A Pilot Study. Health Equity 2022; 6:629-637. [PMID: 36081879 PMCID: PMC9448522 DOI: 10.1089/heq.2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Ethnic minority elderly (EME) people are recognized as a vulnerable group who have higher prevalence of type 2 diabetes mellitus (T2DM) than the majority of the population. The aim of this study was to explore the feasibility, acceptability, and effect of the HOME model (Home intervention; Online monitoring; Multidisciplinary approach; and Equity and education) specifically for enhancing self-management activities, glycemic control, and satisfaction of EME with T2DM in rural areas in Thailand. Methods: In this quasi-experimental study, a single group used a pre-test and post-test, which were conducted as a pilot study to examine the effect of the HOME model. Results: Overall, 23 dyads of EME with T2DM and their family caregivers completed the 12-week intervention. They reported that the HOME model was helpful and motivating, and they reported satisfaction with the service provided. EME with T2DM showed significant reduction of blood glucose level, and significant improvement in self-management activities, happiness, and satisfaction compared with baseline. Family caregivers had also significant improvements in happiness and reported satisfaction with the HOME model. Conclusion: The primary evidence suggested that the HOME model was acceptable and feasible for EME with T2DM and their families in rural Thailand.
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Affiliation(s)
| | | | | | - Eva Purkey
- School of Medicine, Queen's University, Kingston, Ontario, Canada
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Zhu X, Xu Y, Lu L, Zou H. Telescreening satisfaction: disparities between individuals with diabetic retinopathy and community health center staff. BMC Health Serv Res 2022; 22:160. [PMID: 35130901 PMCID: PMC8822836 DOI: 10.1186/s12913-022-07500-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background The success of telescreening and the management of diabetic retinopathy (DR) in communities depends on stakeholder satisfaction, including both individuals with diabetes and community health center (CHC) staff. In this study, we investigated the satisfaction of both individuals with vision-threatening DR (VTDR) and CHC staff within the Shanghai Eye Disease Study (SEDS) comprehensive system for managing diabetic eye diseases at the primary care level. Methods The cross-sectional survey of patients receiving the service included 3,817 respondents with VTDR and focused on their satisfaction with the SEDS system, including the telescreening process, speed of feedback, interpretation of results, increased awareness of related diseases, and eye care services. The survey of the providers included 234 CHC staff respondents and focused on their satisfaction and the main barriers encountered during the implementation of the system. Sociodemographic characteristics and perceived barriers related to satisfaction were identified by conducting univariate and multivariate logistic regression analyses. Results The overall satisfaction of service recipients was 96.0%, and 75.8% of them were willing to undergo future telescreening for DR. The convenience of telescreening, organization of telescreening, and improvement in related disease awareness significantly correlated with satisfaction. Only 48.3% of the providers were satisfied with the SEDS system. The most frequently mentioned barriers to the development of the system were the inadequate levels of staffing (particularly technical staff), insufficient funding, and incomplete information transmission systems. Conclusions Disparities between high patient satisfaction and low provider satisfaction with the SEDS system were mainly related to the current weak level of ophthalmic expertise in the CHCs and the low awareness of screening for diabetic eye diseases among both patients and providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07500-w.
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Affiliation(s)
- Xiaofeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Yi Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Lu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Haidong Zou
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China. .,National Clinical Research Center for Eye Diseases, Shanghai, China. .,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.
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Oliveira GMMD, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, Souza MDFMD, Lorenzo ARD, Fagundes AADP, Schaan BD, Castilho FMD, Cesena FHY, Soares GP, Xavier GF, Barreto JAS, Passaglia LG, Pinto MM, Machline-Carrion MJ, Bittencourt MS, Pontes OM, Villela PB, Teixeira RA, Sampaio RO, Gaziano TA, Perel P, Roth GA, Ribeiro ALP. Estatística Cardiovascular – Brasil 2021. Arq Bras Cardiol 2022; 118:115-373. [PMID: 35195219 PMCID: PMC8959063 DOI: 10.36660/abc.20211012] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
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Macedo JCL, Soares DA, de Carvalho VCHDS, Cortes TBA, Mistro S, Kochergin CN, Rumel D, Oliveira MG. Self-Care in Patients with Non-Optimal Diabetes Management in Brazilian Rural Areas: A Mixed-Methods Study. Patient Prefer Adherence 2022; 16:1831-1842. [PMID: 35923656 PMCID: PMC9342662 DOI: 10.2147/ppa.s373302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study aims to assess self-care in patients with non-optimal diabetes management (HbA1c >7.0% for adults and >8.0 for those aged 60 or over) and the positive and negative experiences associated with it in the rural communities of a Brazilian municipality. PATIENT AND METHODS This is a cross-sectional mixed-methods study. The data were collected from participants with high HbA1c through focus group discussions, subsequently performing thematic analysis, and through structured questionnaires (socioeconomic characteristics and the Summary of Diabetes Self-Care Activities (SDSCA)). RESULTS The mean HbA1c of the 156 study participants was 9.94% (95% confidence interval: 9.70-10.19%) and most participants (86.54%) had negative self-care behaviors, with an overall SDSCA mean score of 3.55. This mean was not positive for any of the socioeconomic characteristics. The self-care activities with the most satisfactory performance concerned non-smoking and the use of prescribed medications, and the poorest results were observed for the practice of specific physical activities. The qualitative data indicated that the study participants face many difficulties regarding self-care practices, especially those related to an adequate diet. CONCLUSION The self-care assessment revealed unsatisfactory self-care behaviors as well as high HbA1c levels among the study participants and highlighted the various difficulties they encounter. This indicates the need for more attentive health teams to monitor patients, especially regarding actions focused on the non-pharmacological elements of self-care, such as lifestyle changes, which were found to be the dimensions with the most unsatisfactory results.
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Affiliation(s)
- Jessica Caline Lemos Macedo
- Master’s Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | - Daniela Arruda Soares
- Master’s Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | | | - Taciana Borges Andrade Cortes
- Master’s Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | - Sóstenes Mistro
- Master’s Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | | | - Davi Rumel
- Department of Community Health, School of Medicine of the Municipal University of São Caetano do Sul, São Caetano do Sul, São Paulo, Brazil
| | - Marcio Galvão Oliveira
- Master’s Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
- Correspondence: Marcio Galvão Oliveira, Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58 - Candeias, Vitória da Conquista - BA, Vitória da Conquista, Bahia, 45029-094, Brazil, Tel +55 77 988280954, Email
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Kaza S, Gupta P, Vaidya R, Nooyi S, Chaudhury N. Effect of COVID-19 lockdown on lifestyle habits and self-care practices of diabetic and hypertensive patients in rural Shimla and Udaipur – Findings from the HealthRise India program. Indian J Public Health 2022; 66:466-472. [PMID: 37039175 DOI: 10.4103/ijph.ijph_1908_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background COVID-19 pandemic has increased the risk of mortality among patients with noncommunicable diseases. Maintaining a good metabolic control, lifestyle modification along with improved self-care practices are not only associated with less severe COVID-19 infections but also with a high recovery rate. Objectives This research article explores the changes in lifestyle habits, self-care practices, and metabolic control among patients enrolled in the HealthRise program. The study compares behavioral changes, before COVID-19 pandemic and during COVID-19 pandemic, between intervention and control arms in Shimla and Udaipur. Methods A quasi-experimental study design was employed for program implementation in select villages of Shimla district, and Udaipur district. A total of 459 patients from Shimla and 309 patients from Udaipur with diabetes mellitus or hypertension or with both were enrolled and followed for 1 year. Results Metabolic control in Shimla intervention arm was 2.6 times higher than in control arm (P = 0.001) before COVID-19 pandemic. During COVID-19 pandemic, Odds of metabolic control in Shimla intervention was 1.5 times higher when compared with control arm (P = 0.03). In Udaipur, metabolic control before COVID-19 pandemic was comparable between control and intervention arms. During the pandemic, metabolic control in intervention arm of Udaipur was 5 times higher when compared to the control arm ((P = 0.001). Conclusion Participants exposed to support, appreciate, learn, and transfer-community life competence process (SALT-CLCP) intervention maintained metabolic control during the COVID-19 pandemic with improved behavioral and self-care practices. Community-based interventions such as SALT-CLCP method bring ownership and empower community in achieving the better health outcomes.
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Social Deprivation and Peripheral Artery Disease. Can J Cardiol 2021; 38:612-622. [PMID: 34971734 DOI: 10.1016/j.cjca.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
The link between peripheral artery disease and socioeconomic status is complex. The objective of this narrative review is to explore this relationship in detail, including how social factors impact the development, management, and outcomes of peripheral artery disease. Although the current literature on this topic is limited, some patterns do emerge. Populations of low socioeconomic status appear to be at increased risk for the development of peripheral artery disease, due to factors such as increased prevalence of cardiovascular risk factors (i.e. cigarette smoking) and decreased access to care. However, variables that are more difficult to quantify, such as chronic stress and health literacy, also likely play a significant role. Among those who are living with peripheral artery disease, socioeconomic status can also affect disease management. Secondary prevention strategies, such as medication use, smoking cessation, and exercise therapy, are underutilized in socially deprived populations. This underutilization of evidence-based management leads to adverse outcomes in these groups, including increased rates of amputation and decreased post-operative survival. The recognition of the importance of social factors in prognosis is an important first step towards addressing this health disparity. Moving forward, interventions that help to identify those who are at high risk and help to improve access to care in populations of low socioeconomic status, will be critical to improving outcomes.
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21
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Camargo MS, Passos LCS, Mistro S, Soares DA, Kochergin CN, de Carvalho VCHDS, Macedo JCL, Cortes TBA, de Souza AA, Rumel D, Oliveira MG. Improving Access to the Glycated Hemoglobin Test in Rural Communities With Point-of-Care Devices: An Application Study. Front Med (Lausanne) 2021; 8:734306. [PMID: 34881257 PMCID: PMC8645789 DOI: 10.3389/fmed.2021.734306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Living in a rural or remote area is frequently associated with impaired access to health services, which directly affects the possibility of early diagnosis and appropriate monitoring of diseases, mainly non-communicable ones, because of their asymptomatic onset and evolution. Point-of-care devices have emerged as useful technologies for improving access to several laboratory tests closely patients' beds or homes, which makes it possible to eliminate the distance barrier. Objective: To evaluate the application of point-of-care technology for glycated hemoglobin (HbA1c) estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality. Materials and Methods: We included individuals aged 18 years or older among rural communities in a Brazilian municipality. From September 2019 to February 2020, participants were assessed for anthropometrics, blood pressure, and capillary glycemia during routine primary care team activities at health fairs and in patient groups. Participants previously diagnosed with diabetes but without recent HbA1c test results or those without a previous diagnosis but with random capillary glycemia higher than 140 mg/dL were considered positive and were tested for HbA1c by using a point-of-care device. Results: At the end of the study, 913 individuals were accessed. Of these, 600 (65.7%) had no previous diagnosis of diabetes, 58/600 (9.7%) refused capillary glycemia screening and 542/600 (90.7%) were tested. Among tested individuals, 73/542 (13.5%) cases without a previous diagnosis of diabetes, were positive for capillary glycemia. Among positives, 31/73 (42.5%) had HbA1c levels that were considered indicative of prediabetes and 16/73 (21.9%) were newly diagnosed with diabetes. Among the participants, 313/913 (34.3%) were previously diagnosed with diabetes. Recent HbA1c results were unavailable for 210/313 (67.1%). These individuals were tested using point-of-care devices. Among them, 143/210 (68.1%) had HbA1c levels higher than target levels (>7% and >8% for adults and elderly individuals, respectively. Conclusion: The application of point-of-care devices for HbA1c level measurement improved the access to this test for people living in rural or remote areas. Thus, it was possible to include this technology in the routine activities of primary health care teams, which increased the rates of new diagnoses and identification of patients with uncontrolled glycemia.
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Affiliation(s)
| | | | - Sostenes Mistro
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Daniela Arruda Soares
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | | | - Jéssica Caline Lemos Macedo
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Taciana Borges Andrade Cortes
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Amós Alves de Souza
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Davi Rumel
- Department of Community Health, School of Medicine, Municipal University of São Caetano do sul, São Caetano Do Sul, Brazil
| | - Marcio Galvão Oliveira
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
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Cimini CCR, Maia JX, Pires MC, Ribeiro LB, Pinto VSDOEA, Batchelor J, Ribeiro ALP, Marcolino MS. Pandemic-related impairment in the monitoring of patients with hypertension and diabetes and the development of a digital solution for the community health worker: quasi-experimental and implementation study (Preprint). JMIR Med Inform 2021; 10:e35216. [PMID: 35191842 PMCID: PMC8966891 DOI: 10.2196/35216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/23/2022] [Accepted: 02/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background The restrictions imposed by the COVID-19 pandemic reduced health service access by patients with chronic diseases. The discontinuity of care is a cause of great concern, mainly in vulnerable regions. Objective This study aimed to assess the impact of the COVID-19 pandemic on people with hypertension and diabetes mellitus (DM) regarding the frequency of consultations and whether their disease was kept under control. The study also aimed to develop and implement a digital solution to improve monitoring at home. Methods This is a multimethodological study. A quasiexperimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary health care centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHWs) to identify and address at-risk patients with uncontrolled hypertension or DM. An expert panel assessment evaluated feasibility, usability, and utility of the software. Results Of 5070 patients, 4810 (94.87%) had hypertension, 1371 (27.04%) had DM, and 1111 (21.91%) had both diseases. There was a significant reduction in the weekly number of consultations (107, IQR 60.0-153.0 before vs 20.0, IQR 7.0-29.0 after social restriction; P<.001). Only 15.23% (772/5070) of all patients returned for a consultation during the pandemic. Individuals with hypertension had lower systolic (120.0, IQR 120.0-140.0 mm Hg) and diastolic (80.0, IQR 80.0-80.0 mm Hg) blood pressure than those who did not return (130.0, IQR 120.0-140.0 mm Hg and 80.0, IQR 80.0-90.0 mm Hg, respectively; P<.001). Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve treatment. Conclusions The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful, and easily incorporated into their routines.
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Affiliation(s)
| | - Junia Xavier Maia
- Telehealth Center, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Bonisson Ribeiro
- Telehealth Center, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - James Batchelor
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Antonio Luiz Pinho Ribeiro
- Telehealth Center and Cardiology Service, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Milena Soriano Marcolino
- Telehealth Center, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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González Fernández L, Firima E, Huber J, Raeber F, Amstutz A, Gupta R, Mokhohlane J, Belus JM, Labhardt ND. Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: A scoping review protocol. F1000Res 2021. [DOI: 10.12688/f1000research.51929.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Arterial hypertension (aHT) is the most important cardiovascular risk factor (CVRF) in adults living in sub-Saharan Africa (SSA), leading to an excess of cardiovascular disease (CVD) morbidity and mortality. Life-long aHT service delivery models in the region remain mostly anchored to health facilities and are provided by physicians or nurses, thus limiting access to care. Over the past years, decentralized community-based aHT care models have been piloted, aiming to improve access to prevention, diagnosis, and treatment. Although individual studies suggest that community-based care is well-received and potentially efficacious, a synthesized overview of such care models is missing. Hence, the aim of this scoping review is to map out and summarize existing interventions for community-based aHT diagnosis and care in non-pregnant adults in SSA. Additionally, we will describe outcomes in terms of acceptability, blood pressure control, patient engagement in care, and occurrence of aHT caused end-organ damage. Methods and analysis: We will apply the Arksey and O’Malley scoping review methodology and best practice, as outlined by Levac and the Joanna Briggs Institute scoping review guidelines. The research questions have been identified through a literature review and expert consultation. A systematic literature search will be conducted in four databases using a tailored search strategy, including a supplemental search through backward and forward citation. Abstracts and full text screening as well as the extraction of data will be conducted by two independent reviewers. Discrepancies will be resolved by a third reviewer. Information will be presented in both tabular and narrative form. Ethics and dissemination: This scoping review will summarize findings from existing publications, rather than primary data, and as such, does not require ethics review. Findings will be disseminated through stakeholder meetings, conference presentations, websites, and a peer-reviewed publication.
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Duodu PA, Agbadi P, Duah HO, Darkwah E, Nutor JJ. Correlates of blood pressure and blood glucose screenings in Cameroon: insights from the 2018 Demographic and Health Survey. Int Health 2021; 14:201-210. [PMID: 34118153 PMCID: PMC8890807 DOI: 10.1093/inthealth/ihab033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hypertension and diabetes, two major risk factors for cardiometabolic diseases, are associated with high morbidity and mortality rates. Early detection through screening can initiate early treatment to reduce adverse outcomes. The current study sought to investigate the correlates of blood pressure and blood glucose screenings in Cameroon. Methods We used secondary data from the 2018 Cameroon Demographic and Health Survey. Adjusting for a complex sample design, we performed multivariate prevalence ratio estimates of the blood pressure and blood glucose screenings. Results Approximately 60% and 30% of Cameroonians had undergone blood pressure and blood glucose screenings, respectively. More females (68%) had undergone blood pressure screenings compared with their male counterparts (44.1%). In the multivariate model, gender, age, education, marital status, household wealth index and region of residence were significantly associated with both blood pressure and blood glucose screenings in the full sample. Previous blood pressure screening was associated with an increased likelihood of blood glucose screening and vice versa. A modification effect of gender was observed in the association between the correlates and both outcomes. Conclusion Our findings uncovered individuals with a decreased likelihood for blood pressure and blood glucose screenings and this can inform policy decisions to ensure targeted screening aimed at early detection and management.
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Affiliation(s)
- Precious Adade Duodu
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Pascal Agbadi
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Ernest Darkwah
- Department of Psychology, University of Ghana, P. O. Box LG 84, Legon, Ghana
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA
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25
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Curado DDSP, Gomes DF, Silva TBC, Almeida PHRF, Tavares NUL, Areda CA, da Silva EN. Direct cost of systemic arterial hypertension and its complications in the circulatory system from the perspective of the Brazilian public health system in 2019. PLoS One 2021; 16:e0253063. [PMID: 34111216 PMCID: PMC8191920 DOI: 10.1371/journal.pone.0253063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Systemic arterial hypertension (SAH), a global public health problem and the primary risk factor for cardiovascular diseases, has a significant financial impact on health systems. In Brazil, the prevalence of SAH is 23.7%, which caused 203,000 deaths and 3.9 million DALYs in 2015. OBJECTIVE To estimate the cost of SAH and circulatory system diseases attributable to SAH from the perspective of the Brazilian public health system in 2019. METHODS A prevalence-based cost-of-illness was conducted using a top-down approach. The population attributable risk (PAR) was used to estimate the proportion of circulatory system diseases attributable to SAH. The direct medical costs were obtained from official Ministry of Health of Brazil records and literature parameters, including the three levels of care (primary, secondary, and tertiary). Deterministic univariate analyses were also conducted. RESULTS The total cost of SAH and the proportion of circulatory system diseases attributable to SAH was Int$ 581,135,374.73, varying between Int$ 501,553,022.21 and Int$ 776,183,338.06. In terms only of SAH costs at all healthcare levels (Int$ 493,776,445.89), 97.3% were incurred in primary care, especially for antihypertensive drugs provided free of charge by the Brazilian public health system (Int$ 363,888,540.14). Stroke accounted for the highest cost attributable to SAH and the third highest PAR, representing 47% of the total cost of circulatory diseases attributable to SAH. Prevalence was the parameter that most affected sensitivity analyses, accounting for 36% of all the cost variation. CONCLUSION Our results show that the main Brazilian strategy to combat SAH was implemented in primary care, namely access to free antihypertensive drugs and multiprofessional teams, acting jointly to promote care and prevent and control SAH.
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Affiliation(s)
| | - Dalila Fernandes Gomes
- Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
| | | | | | | | - Camila Alves Areda
- Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
| | - Everton Nunes da Silva
- Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
- Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
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Gender Differences in the Quality of Life of Formal Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115951. [PMID: 34206069 PMCID: PMC8199320 DOI: 10.3390/ijerph18115951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to assess the quality of life associated with gender inequalities in formal workers and to determine the effect of sociodemographic, clinical, and behavioral factors on the quality of life (QOL). METHODS This cross-sectional study involved 1270 workers. Quality of life was measured using the EUROHIS-QOL 8-Item and assessed in terms of psychological, environmental, social, and physical domains, while demographic, socioeconomic, behavioral, and clinical variables served as explanatory variables. Analyses were performed using an ordinal logistic regression model whose significance level was 5%. RESULTS Of the participants, 80.2% were men, and 19.8% were women; the mean age was 34 (standard deviation: ±10) and 32 (±9) years, respectively. In all prediction scenarios, men were more likely to have a higher quality of life, especially in the physical (odds ratio: 2.16; 95% confidence interval: 1.60-2.93) and psychological (odds ratio: 2.09; 95% confidence interval: 1.51-2.91) domains. CONCLUSIONS Men and women had significantly different levels of quality of life, and sociodemographic, clinical, and behavioral variables partially clarified these differences, which were possibly established by a socio-historical process of construction of the work role determined by gender issues.
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Lemos Macedo JC, de Carvalho VCHDS, Cortes TBA, Soares DA, Mistro S, Kochergin CN, Rumel D, Oliveira MG. Community-Based Interventions to Improve the Control of Non-Communicable Diseases in Underserved Rural Areas in Brazil: A Before-and-After Study. Front Pharmacol 2021; 12:644599. [PMID: 33935739 PMCID: PMC8080168 DOI: 10.3389/fphar.2021.644599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/10/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Hypertension and diabetes mellitus are the second and third highest leading causes of disability-adjusted life-years (DALY), respectively, in Brazil. The clinical outcomes of chronic diseases are influenced by various factors. Therefore, there is a need for multifaceted interventions to achieve a decrease in the rate of DALY, with a better control of these diseases. Objective: To verify whether sustainable long-term interventions, such as health worker training and provision of health education to the patients, contribute to health improvements in patients with hypertension and diabetes from rural communities. Methods: Over a 6 month period, educational and medical interventions were provided to optimize the treatment of hypertension and diabetes. Furthermore, blood pressure and glycated hemoglobin (HbA1c) measurements were taken at baseline and after the interventions. Results: The monitored hypertensive patients (n = 276) had a reduction of 13.4 mmHg (p = 0.021) and 5.8 mmHg (p < 0.001) in mean systolic and diastolic blood pressure, respectively. Diabetic patients who were followed-up (n = 71) achieved a 0.55% (p = 0.185) reduction in HbA1c level. The desired blood pressure level (<140/90 mmHg) was achieved in 38.8% of patients with hypertension, whereas the desired level of HbA1c (<7.0% for adults and <8.0% for the elderly) was achieved in 16.9% of patients with diabetes; in addition, 38.0% had a reduction of HbA1c of at least 1%. Conclusion: The results showed that the interventions improved the blood pressure and HbA1c levels in patients with hypertension and diabetes from rural communities in a municipality in Northeast Brazil.
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Affiliation(s)
- Jéssica Caline Lemos Macedo
- Master's Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | - Taciana Borges Andrade Cortes
- Master's Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Daniela Arruda Soares
- Master's Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Sóstenes Mistro
- Master's Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | - Davi Rumel
- Department of Community Health, School of Medicine of the Municipal University of São Caetano Do Sul, São Caetano Do Sul, Brazil
| | - Marcio Galvão Oliveira
- Master's Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil
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Lopes Cortes M, Andrade Louzado J, Galvão Oliveira M, Moraes Bezerra V, Mistro S, Souto Medeiros D, Arruda Soares D, Oliveira Silva K, Nicolaevna Kochergin C, Honorato dos Santos de Carvalho VC, Wildes Amorim W, Serrate Mengue S. Unhealthy Food and Psychological Stress: The Association between Ultra-Processed Food Consumption and Perceived Stress in Working-Class Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3863. [PMID: 33917015 PMCID: PMC8103503 DOI: 10.3390/ijerph18083863] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Ultra-processed foods are industrial formulations made from food extracts or constituents with little or no intact food and often containing additives that confer hyper-palatability. The consumption of these products increases the risk of chronic non-communicable diseases. Stressed people may engage in unhealthy eating as a way to cope. This study aimed to verify whether ultra-processed food consumption was associated with perceived stress levels in industrial and retail workers from Vitoria da Conquista, Brazil. METHODS This was a cross-sectional study carried out between July 2017 and August 2018. During the study period, 1270 participants completed a survey administered by an interviewer. Stress levels were assessed using the Perceived Stress Scale. Information regarding weekly ultra-processed food consumption was collected. Ultra-processed foods were classified into four groups: sugary drinks; sugary foods; fast foods; and canned foods, frozen foods, or processed meat. The Student's t-test or one-way analysis of variance was used to assess the differences in stress levels and ultra-processed food consumption. Ordinal regression was used to determine the association between the degrees of stress and ultra-processed food consumption levels. RESULTS Factors such as a young age, being unmarried, smoking, high-risk alcohol consumption, negative health perception, and high perceived stress level indicated higher rates of ultra-processed food consumption. Ordinal regression analysis showed that high stress levels were associated with increased odds of higher ultra-processed food consumption (odds ratio: 1.94; 95% CI: 1.54-2.45). CONCLUSIONS These findings could help identify appropriate target areas for interventions aimed at mental health promotion and healthier food consumption.
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Affiliation(s)
- Matheus Lopes Cortes
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - José Andrade Louzado
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Marcio Galvão Oliveira
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Vanessa Moraes Bezerra
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Sóstenes Mistro
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Danielle Souto Medeiros
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Daniela Arruda Soares
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Kelle Oliveira Silva
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Clávdia Nicolaevna Kochergin
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Vivian Carla Honorato dos Santos de Carvalho
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Bairro Candeias, Vitória da Conquista, 45029-094 Bahia, Brazil; (J.A.L.); (M.G.O.); (V.M.B.); (S.M.); (D.S.M.); (D.A.S.); (K.O.S.); (C.N.K.); (V.C.H.d.S.d.C.)
| | - Welma Wildes Amorim
- Department of Natural Sciences, State University of Southwest of Bahia, Estrada Bem Querer, Km-04, 3293, Bairro Candeias, Vitória da Conquista, 45083-900 Bahia, Brazil;
| | - Sotero Serrate Mengue
- Post-Graduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Bairro Santa Cecilia, 90035-002 Porto Alegre, Rio Grande do Sul, Brazil;
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Quality of Life and Associated Factors in Young Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042153. [PMID: 33672106 PMCID: PMC7926543 DOI: 10.3390/ijerph18042153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to identify the factors associated with the quality of life of young workers of a Social Work of Industry Unit. METHODS This was a cross-sectional study conducted on 1270 workers. Data were collected using a digital questionnaire built on the KoBoToolbox platform that included the EUROHIS-QOL eight-item index to assess quality of life. Demographic, socioeconomic, behavioral, and clinical variables were considered explanatory. The associations were analyzed using the ordinal logistic regression model at a 5% significance level. RESULTS Men and women had a mean quality of life of 31.1 and 29.4, respectively. Workers that rated their health as "very good" had an odds ratio of 7.4 (95% confidence interval (CI) = 5.17-10.81), and those who rated it as "good" had an odds ratio of 2.9 (95% CI = 2.31-3.77). Both these groups of workers were more likely to have higher levels of quality of life as compared to workers with "regular", "poor", or "very poor" self-rated health. Physically active individuals were 30% more likely to have higher levels of quality of life (odds ratio = 1.3; 95% CI = 1.08-1.65). After adjusting the model by gender, age group, marital status, socioeconomic class, self-rated health, nutritional status, and risky alcohol consumption, the odds ratio of active individuals remained stable (odds ratio = 1.3; 95% CI = 1.05-1.66). CONCLUSIONS In the present study, self-rated health, physical activity, and gender were associated with young workers' quality of life.
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Mangal S, Baig V, Gupta K, Mangal D, Panwar R, Gupta R. e Health initiatives for screening and management of hypertension in Rural Rajasthan. J Family Med Prim Care 2021; 10:4553-4557. [PMID: 35280647 PMCID: PMC8884285 DOI: 10.4103/jfmpc.jfmpc_848_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/23/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022] Open
Abstract
Context: Electronic health (e health) initiatives are being employed in various health programs for disease monitoring. Very few such studies have been conducted in India, so this study was planned. Aims: Assess feasibility and usefulness of e health interventions for health workers, ASHA (accredited social health activist) in screening and management of hypertension. Setting and Design: Prospective observational cohort study. ASHA's were recruited in two selected villages of Rajasthan and trained to use this technology. Methods and Material: A web-based application was developed for use on portable device (tablet) to screen and diagnose hypertension, provide health education focused on diet, physical exercise and promote adherence to therapies by repeated sessions of one-to-one health education. Statistical analysis was done by Excel. Results: With the use of e health initiatives, among population above 18yrs, we found 19.1% hypertensives (464/2430) with 46.5% new cases of hypertension and 38.9 % (945/2430) prehypertensive. Mean age of hypertensives was 52.6 yrs. ± 15.2 and 36.8 yrs. ± 14.2 for prehypertensive and highly significant (p < 0.001). Mean systolic blood pressure level of hypertensives decreased from 147.14 Hg ±13.86 to 133.3 Hg ±13.07 and for prehypertensive from 123.18 mm Hg ± 4.5 to 117.55 mm Hg ± 6.9 after follow up, the difference in change was highly significant (P < 0.001). Also, could start 27.4% hypertensives on treatment, while 50.2% were already on treatment. Conclusion: Training ASHA worker in e health technology is feasible and can assist in screening and management of diseases.
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Cortes ML, Louzado JA, Oliveira MG, Bezerra VM, Mistro S, Medeiros DS, Soares DA, Silva KO, Kochergin CN, Carvalho VCHS, Amorim WW, Mengue SS. Association between perceived stress and health-risk behaviours in workers. PSYCHOL HEALTH MED 2020; 27:746-760. [PMID: 33295792 DOI: 10.1080/13548506.2020.1859567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Individuals who experience stress can engage in health-risk behaviours that may decrease work performance. The aim of this study was to determine perceived stress levels in Brazilian workers and verify whether perceived stress was associated with health-risk behaviours. Stress levels of 1,270 workers (1,019 men, 251 women) were assessed using the Perceived Stress Scale. The health-risk behaviours investigated were low intake of vegetables and fruits, daily smoking, high-risk alcohol consumption, physical inactivity, and the presence of obesity. The Student's t-test or one-way analysis of variance was used to assess differences in stress levels. Ordinal regression was used to determine the association between the degrees of stress and health-risk behaviours. Women had higher perceived stress levels than men. In addition, perceived stress levels were higher in those who had low socioeconomic status, were unmarried, had a negative perception of their health, were smokers, or had obesity. Smoking and the presence of two or more health-risk behaviours were associated with 1.84 (95% CI: 1.24-2.73) times and 1.49 (95% CI: 1.18-1.89) times higher odds of experiencing higher degrees of stress, respectively. In women, such an association was observed with the presence of obesity (odds ratio: 2.0; 95% CI: 1.01-3.98).
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Affiliation(s)
- Matheus Lopes Cortes
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - J A Louzado
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - M G Oliveira
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - V M Bezerra
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - S Mistro
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - D S Medeiros
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - D A Soares
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - K O Silva
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - C N Kochergin
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - V C H S Carvalho
- Multidisciplinary Health Institute, Federal University of Bahia Vitória Da Conquista, Bahia, Brazil
| | - W W Amorim
- Department of Natural Sciences, State University of Southwest Bahia, Vitória da Conquista, Bahia, Brazil
| | - S S Mengue
- School of Medicine, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
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