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Taylor-Swanson LJ, Bell L, Tu W, Nelson AT, Geppelt C, Taylor B, Alvarez G, Garcia K. Volunteer Providers' Experience Referring Guatemalan Patients for Acupuncture Care in a Pilot, Integrated, Health Care Clinic. Med Acupunct 2024; 36:235-240. [PMID: 39309626 PMCID: PMC11411274 DOI: 10.1089/acu.2023.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Purpose The aim of this qualitative study was to explore the experience of volunteer providers referring Guatemalan patients for acupuncture care during a 1-day, pilot, integrated, health care clinic. Methods In a partnership among the University of Utah College of Nursing and Refuge International, the integrated, health care clinic occurred at hospital in San Raymundo. Before the clinic, nursing faculty offered providers an overview of acupuncture care. Providers referred 11 patients for acupuncture care. After the clinic, seven providers (one cardiologist, one certified nurse midwife, five student nurse midwives) were asked 10 questions in semi-structured interviews about their experience referring patients for acupuncture care. The interviews were audiotaped, transcribed, and analyzed to identify themes. Results Five themes emerged from analysis of the semi-structured interviews. Providers accurately recognized primarily pain, among other reasons, to refer patients for acupuncture care. Providers stated they lacked a comprehensive understanding of acupuncture care and wanted a more thorough education. Providers did not encounter barriers to referring patients for acupuncture care, and referrals did not hinder clinic flow. Providers were enthusiastically receptive to acupuncture care and endorsed expansion of integrated, health care clinics. Providers felt acupuncture care offered an important and culturally acceptable alternative to biomedicine, particularly for Guatemalan patients who are frequently marginalized and lack consistent access to health care. Discussion Results from this pilot study indicate promising potential for offering acupuncture care in an integrated, health care clinic, particularly for marginalized patients who lack consistent access to health care.
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Affiliation(s)
| | - Lisa Bell
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Wen Tu
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Cinnamon Geppelt
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Kimberly Garcia
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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Boccino J. Auricular Acupuncture for Lowering Blood Glucose in Type 2 Diabetes: A Pilot Study. Med Acupunct 2023; 35:186-194. [PMID: 37609549 PMCID: PMC10440671 DOI: 10.1089/acu.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Objective Although type 2 diabetes mellitus (T2DM) is a major health epidemic, little research on auricular acupuncture for reducing blood glucose levels has been published. In Guatemala, where this study was conducted, the prevalence of T2DM is high and access to care is limited. The purpose of this pilot study was to determine if an auricular acupuncture protocol could be a feasible, effective treatment for reducing blood glucose, thus offering another potential accessible treatment. Materials and Methods Utilizing a self-controlled design approach, 28 participants diagnosed with T2DM were recruited and received 2 weeks of treatment consisting of a set protocol of 5 points in each ear. Pre- and post-treatment surveys were used to assess patients' health status, treatment expectations, and quality of life. Paired t-tests were used to measure pre- to post-treatment glucose levels. Results Treatment produced significant reduction in the patients' fasting and postprandial blood glucose levels, averaging 45.35 (n = 19; P = 0.014) and 109.45 points (n = 10; P = 0.008), respectively. Surveys indicated that all participants would be interested in using the treatment again to help manage their blood glucose. Conclusions An auricular protocol may provide a low-cost, effective treatment for lowering blood glucose in patients with T2DM. The results of this study are promising, suggesting that further investigation is warranted.
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Affiliation(s)
- Joan Boccino
- Department of Bioscience, Pacific College of Health and Science–New York, New York, NY, USA
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Taylor-Swanson LJ, Tu W, Howell CS, Dillard MP, Bell L, Nelson AT, Geppelt C, Boccino JM, Taylor E, Alvarez G, Citkovitz C, Johnson K, Garcia K. Delivering Acupuncture Therapy in an Interdisciplinary Global Health Setting in Guatemala: Pilot Study and Lessons Learned. Med Acupunct 2023; 35:163-169. [PMID: 37609548 PMCID: PMC10440642 DOI: 10.1089/acu.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Objective Pain, stress, and diabetes mellitus (DM) are common complaints for Guatemalans seeking health care. Because acupuncture therapy (AT) is a low-cost, effective treatment for these concerns, it was offered to Guatemalans during a health care mission as an adjunct to primary care. The purpose of this study was to gather feedback about providing AT in this context and to describe the lessons that were learned. Materials and Methods A pretest single-arm exploratory study design was used, collecting demographic data and administering a pretest to patients referred for AT. Patients received AT according to presenting symptoms, except patients with DM, who were treated with a previously developed auricular AT protocol. After AT, all patients received adhesive seeds for self-administered auricular acupressure, along with a printed diagram, showing where and how to apply them, and a symptom-tracking form. Results AT was given to 11 patients (1 had DM; 10 did not). Most were female (9; 82%), older (average 59.27 years; range: 40-81 years), and had little education (average 4 years; range: 0-12 years). Complaints were pain (11; 100%), insomnia (6; 55%), anxiety (4; 36%), depression (7; 64%), and stress (3; 27%). More than 50% had seen health care providers (6; 55%). One person had AT previously and 3 people requested more information about AT before receiving it. Conclusions Reporting high symptom burdens, most patients were unfamiliar with AT. AT ceased when the licensed acupuncturist contracted COVID. Patients will be followed in 2023 and AT will be given to collect data on feasibility, satisfaction, and possible implementation.
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Affiliation(s)
| | - Wen Tu
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | | | - Lisa Bell
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | | | - Joan Maria Boccino
- Department of Bioscience, Pacific College of Health and Science–New York, New York, NY, USA
| | | | | | - Claudia Citkovitz
- College of Pharmacy and Health Sciences, New England School of Acupuncture, Worcester, MA, USA
| | | | - Kimberly Garcia
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Castañeda R, Cáceres A, Cruz SM, Aceituno JA, Marroquín ES, Barrios Sosa AC, Strangman WK, Williamson RT. Nephroprotective plant species used in traditional Mayan Medicine for renal-associated diseases. JOURNAL OF ETHNOPHARMACOLOGY 2023; 301:115755. [PMID: 36181985 DOI: 10.1016/j.jep.2022.115755] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/02/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The prevalence of kidney disease has increased rapidly in recent years and has emerged as one of the leading causes of mortality worldwide. Natural products have been suggested as valuable nephroprotective agents due to their multi-target and synergistic effects on modulating important proteins involved in kidney injury. There is a large number of plant species that have been used traditionally for kidney-related conditions in Mesoamerican medicine by different cultural groups that could provide a valuable source of nephroprotective therapeutic candidates and could lead to potential drug discovery. AIM OF REVIEW This review aims to provide an overview of the currently known efficacy of plant species used traditionally in Mesoamerica by Mayan groups to treat kidney-related conditions and to analyze the phytochemical, pharmacological, molecular, toxicological, and clinical evidence to contribute to public health efforts and for directing future research. METHODS Primary sources of plant use reports for traditional kidney-related disorders in Mesoamerica were searched systematically from library catalogs, theses, and scientific databases (PubMed, Google Scholar; and Science Direct), and were filtered according to usage frequency in Mayan groups and plant endemism. The database of traditional plants was further analyzed based on associations with published reports of the phytochemical, pharmacological, molecular, toxicological, and clinical evidence. RESULTS The most reported kidney-related conditions used traditionally in Mayan medicine involve reducing renal damage (a cultural interpretation that considers an inflammatory or infectious condition), cleaning or purifying the blood and kidney, reducing kidney pain, and eliminating kidney stones. A total of 208 plants used for kidney-related problems by 10 Mayan groups were found, representing 143 native species, where only 42 have reported pharmacological activity against kidney damage, mainly approached by in vitro and in vivo models of chemical- or drug-induced nephrotoxicity, diabetes nephropathy, and renal injury produced by hypertension. Nephroprotective effects are mainly mediated by reducing oxidative stress, inflammatory response, fibrosis mechanisms, and apoptosis in the kidney. The most common nephroprotective compounds associated with traditional Mayan medicine were flavonoids, terpenoids, and phenolic acids. The most widely studied traditional plants in terms of pharmacological evidence, bioactive compounds, and mechanisms of action, are Annona muricata L., Carica papaya L., Ipomoea batatas (L.) Lam., Lantana camara L., Sechium edule (Jacq.) Sw., Tagetes erecta L., and Zea mays L. Most of the plant species with reported pharmacological activity against kidney damage were considered safe in toxicological studies. CONCLUSION Available pharmacological reports suggest that several herbs used in traditional Mayan medicine for renal-associated diseases may have nephroprotective effects and consistent pharmacological evidence, nephroprotective compounds, and mechanisms of action in different models of kidney injury. However, more research is required to fully understand the potential of traditional Mayan medicine in drug discovery given the limited ethnobotanical studies and data available for most species with regards to identification on bioactive components, pharmacological mechanisms, and the scarce number of clinical studies.
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Affiliation(s)
- Rodrigo Castañeda
- School of Pharmacy, Faculty of Chemical Sciences and Pharmacy, University of San Carlos, Guatemala.
| | | | - Sully M Cruz
- School of Pharmacy, Faculty of Chemical Sciences and Pharmacy, University of San Carlos, Guatemala.
| | - J Agustín Aceituno
- School of Pharmacy, Faculty of Chemical Sciences and Pharmacy, University of San Carlos, Guatemala.
| | - E Sebastián Marroquín
- School of Pharmacy, Faculty of Chemical Sciences and Pharmacy, University of San Carlos, Guatemala.
| | - Ana C Barrios Sosa
- Department of Chemistry & Biochemistry, University of North Carolina Wilmington, USA.
| | - Wendy K Strangman
- Department of Chemistry & Biochemistry, University of North Carolina Wilmington, USA.
| | - R Thomas Williamson
- Department of Chemistry & Biochemistry, University of North Carolina Wilmington, USA.
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Chary AN, Nandi M, Flood D, Tschida S, Wilcox K, Kurschner S, Garcia P, Rohloff P. Qualitative study of pathways to care among adults with diabetes in rural Guatemala. BMJ Open 2023; 13:e056913. [PMID: 36609334 PMCID: PMC9827254 DOI: 10.1136/bmjopen-2021-056913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The burden of diabetes mellitus is increasing in low-income and middle-income countries (LMICs). Few studies have explored pathways to care among individuals with diabetes in LMICs. This study evaluates care trajectories among adults with diabetes in rural Guatemala. DESIGN A qualitative investigation was conducted as part of a population-based study assessing incidence and risk factors for chronic kidney disease in two rural sites in Guatemala. A random sample of 807 individuals had haemoglobin A1c (HbA1c) screening for diabetes in both sites. Based on results from the first 6 months of the population study, semistructured interviews were performed with 29 adults found to have an HbA1c≥6.5% and who reported a previous diagnosis of diabetes. Interviews explored pathways to and experiences of diabetes care. Detailed interview notes were coded using NVivo and used to construct diagrams depicting each participant's pathway to care and use of distinct healthcare sectors. RESULTS Participants experienced fragmented care across multiple health sectors (97%), including government, private and non-governmental sectors. The majority of participants sought care with multiple providers for diabetes (90%), at times simultaneously and at times sequentially, and did not have longitudinal continuity of care with a single provider. Many participants experienced financial burden from out-of-pocket costs associated with diabetes care (66%) despite availability of free government sector care. Participants perceived government diabetes care as low-quality due to resource limitations and poor communication with providers, leading some to seek care in other health sectors. CONCLUSIONS This study highlights the fragmented, discontinuous nature of diabetes care in Guatemala across public, private and non-governmental health sectors. Strategies to improve diabetes care access in Guatemala and other LMICs should be multisectorial and occur through strengthened government primary care and innovative private and non-governmental organisation care models.
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Affiliation(s)
- Anita Nandkumar Chary
- Medicine & Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Meghna Nandi
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Family Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - David Flood
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Tschida
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | - Katharine Wilcox
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Family Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Sophie Kurschner
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Pablo Garcia
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Peter Rohloff
- Center for Research on Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
- Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Robertson M, Parè G, Costa I, Alvarado B, Duhn L, Plazas PC. “I Could Have Stood a Little More Education Rather than Just: ‘Hey, you’re Diabetic Man, Make the Best out of It’”: Revisioning Diabetes Self-Management Education for Older Adults. Res Aging 2022:1640275221138968. [DOI: 10.1177/01640275221138968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: Providing diabetes self-management education (DSME) in an evidence-based format that is accessible and tailored to the population needs is crucial for individuals living with diabetes mellitus. Our qualitative study explores the experiences of older adults living with diabetes while residing in a rural setting. Methods: Adults aged 65 or older and residing in a rural area of Ontario completed a photovoice activity and semi-structured interviews to illustrate their experience of living with diabetes and accessing DSME. Results: Fourteen participants (11 males; mean age = 74 years) completed the photovoice activity and interview. Four main themes were identified pertaining to learning about diabetes education, the depth and breadth of learning, applying knowledge to daily life, and engaging older adults in DSME. Discussion: Diabetes self-management education should account for older adults’ preferences in learning about diabetes and self-management to promote access to evidence-based information, bolster knowledge and self-management efficacy, and improve disease control.
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Affiliation(s)
| | - Geneviéve Parè
- School of Nursing, Queen’s University, Kingston, ON, Canada
| | - Idevania Costa
- School of Nursing, Lakehead University, Thunder Bay, ON, Canada
| | - Beatriz Alvarado
- Department of Public Health Sciences, Queen’s University,Kingston, ON, Canada
| | - Lenora Duhn
- School of Nursing, Queen’s University, Kingston, ON, Canada
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Pseudoexfoliation and Cataract Syndrome Associated with Genetic and Epidemiological Factors in a Mayan Cohort of Guatemala. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147231. [PMID: 34299682 PMCID: PMC8303577 DOI: 10.3390/ijerph18147231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023]
Abstract
The Mayan population of Guatemala is understudied within eye and vision research. Studying an observational homogenous, geographically isolated population of individuals seeking eye care may identify unique clinical, demographic, environmental and genetic risk factors for blinding eye disease that can inform targeted and effective screening strategies to achieve better and improved health care distribution. This study served to: (a) identify the ocular health needs within this population; and (b) identify any possible modifiable risk factors contributing to disease pathophysiology within this population. We conducted a cross-sectional study with 126 participants. Each participant completed a comprehensive eye examination, provided a blood sample for genetic analysis, and received a structured core baseline interview for a standardized epidemiological questionnaire at the Salama Lions Club Eye Hospital in Salama, Guatemala. Interpreters were available for translation to the patients’ native dialect, to assist participants during their visit. We performed a genome-wide association study for ocular disease association on the blood samples using Illumina’s HumanOmni2.5-8 chip to examine single nucleotide polymorphism SNPs in this population. After implementing quality control measures, we performed adjusted logistic regression analysis to determine which genetic and epidemiological factors were associated with eye disease. We found that the most prevalent eye conditions were cataracts (54.8%) followed by pseudoexfoliation syndrome (PXF) (24.6%). The population with both conditions was 22.2%. In our epidemiological analysis, we found that eye disease was significantly associated with advanced age. Cataracts were significantly more common among those living in the 10 districts with the least resources. Furthermore, having cataracts was associated with a greater likelihood of PXF after adjusting for both age and sex. In our genetic analysis, the SNP most nominally significantly associated with PXF lay within the gene KSR2 (p < 1 × 10−5). Several SNPs were associated with cataracts at genome-wide significance after adjusting for covariates (p < 5 × 10−8). About seventy five percent of the 33 cataract-associated SNPs lie within 13 genes, with the majority of genes having only one significant SNP (5 × 10−8). Using bioinformatic tools including PhenGenI, the Ensembl genome browser and literature review, these SNPs and genes have not previously been associated with PXF or cataracts, separately or in combination. This study can aid in understanding the prevalence of eye conditions in this population to better help inform public health planning and the delivery of quality, accessible, and relevant health and preventative care within Salama, Guatemala.
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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10
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Blasco-Blasco M, Puig-García M, Piay N, Lumbreras B, Hernández-Aguado I, Parker LA. Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review. PLoS One 2020; 15:e0237542. [PMID: 32886663 PMCID: PMC7473520 DOI: 10.1371/journal.pone.0237542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Given that most evidence-based recommendations for managing type 2 diabetes mellitus (T2DM) are generated in high-income settings, significant challenges for their implementation exist in Latin America and the Caribbean region (LAC), where the rates of T2DM and related mortality are increasing. The aim of this study is to identify the facilitators and barriers to successful management of T2DM in LAC, from the perspectives of patients, their families or caregivers, healthcare professionals, and/or other stakeholders. METHODS We conducted a systematic review in MEDLINE, Web of Science, SciELO, and LILACS. We included studies of disease management, prevention of complications and risk factor management. We qualitatively synthesized the verbatim text referring to barriers and/or facilitators of diabetes management according to the Theoretical Domain Framework and described their relative frequencies. FINDINGS We included 60 studies from 1,595 records identified. 54 studies (90%) identified factors related to the environmental context and resources, highlighting the importance of questions related to health care access or lack of resources in the health system, and the environmental context and living conditions of the patients. Issues related to "social influences" (40 studies) and "social/professional role and identity" (37 studies) were also frequently addressed, indicating the negative impact of lack of support from family and friends and clinicians' paternalistic attitude. 25 studies identified patients beliefs as important barriers, identifying issues such as a lack of patients' trust in the effectiveness of the medication and/or the doctor's advice, or preferences for alternative therapies. CONCLUSIONS Successful diabetes management in LAC is highly dependent on factors that are beyond the control of the individual patients. Successful disease control will require emphasis on public policies to reinforce health care access and resources, the promotion of a patient-centred care approach, and health promoting infrastructures at environmental level.
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Affiliation(s)
- Mar Blasco-Blasco
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Marta Puig-García
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Nora Piay
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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