Community-based Care Program Research Articles

Improving Outcomes for Adolescents With Drug-Resistant Tuberculosis

As Moyo and colleagues’ research illustrated, we must improve outcomes for the estimated 655000 adolescents living with drug-resistant tuberculosis (DR-TB) (1). Several challenges, including those described by Moyo and colleagues, contribute to current abysmal outcomes, such as the treatment success rate of only 36% in this retrospective cohort. Understanding and addressing these challenges in both TB research and programming can ensure earlier detection, higher retention in care and better cure rates for adolescents with DR-TB, both with and without HIV infection. Community-based treatment support and care programs have been implemented to address issues of adherence to treatment and retention in care for adolescents living with HIV. In Zimbabwe, Africaid’s Zvandiri program, led by HIV-positive children and adolescents, works to ensure a robust continuum of care between clinic and community for adolescents and children living with HIV. The Zvandiri program operates in close collaboration with the ministry of health and child care and government and private clinics. Community adolescent treatment supporters (CATS) receive training to provide community based treatment adherence support and counseling for HIV-positive peers. Peer-led interventions provide continuous support to affected adolescents, which can help improve treatment adherence and reduce stigma associated with HIV and TB. Successful models of HIV treatment support should be adopted for adolescents undergoing treatment for DR-TB, which can last two years and result in significant side effects, some of which last beyond the end of treatment. Several factors believed to affect adolescent treatment success rates, including stigma and major life changes such as moving, finding work and developing significant relationships and long-term commitments, might be mitigated with the development of treatment regimens that are shorter, more effective and have fewer side effects. Two new drugs, bedaquiline and delamanid have been finally approved to treat DR-TB and several phase III DR-TB treatment-shortening studies are planned or already under way. Inclusion of adolescents in phase III treatment-shortening studies should be encouraged as there is no physiological basis for their exclusion. Adolescents achieve similar levels of drug exposures as adults, present with similar forms of TB disease and tolerate adult formulations. It is imperative that sponsors of new drugs and trials testing new combinations include adolescents in their studies. Both end TB (which plans to test five all-oral, nine-month regimens containing either bedaquiline or delamanid in people with multidrug-resistant TB) and NIX-TB (which is evaluating a six-to-ninemonth regimen of bedaquiline, new drug candidate pretomanid and linezolid in people with extensively drug-resistant TB) include adolescents down to 15 and 14 years old, respectively (2-4). Inclusion of adolescents in late-stage trials would help to expedite access to new, shorter and improved regimens for the large population of adolescents at increased risk of treatment failure and poor treatment outcomes under existing DR-TB therapies.

Methods and initial findings from the Durham Diabetes Coalition: Integrating geospatial health technology and community interventions to reduce death and disability

ObjectiveThe Durham Diabetes Coalition (DDC) was established in response to escalating rates of disability and death related to type 2 diabetes mellitus, particularly among racial/ethnic minorities and persons of low socioeconomic status in Durham County, North Carolina. We describe a community-based demonstration project, informed by a geographic health information system (GHIS), that aims to improve health and healthcare delivery for Durham County residents with diabetes. Materials and MethodsA prospective, population-based study is assessing a community intervention that leverages a GHIS to inform community-based diabetes care programs. The GHIS integrates clinical, social, and environmental data to identify, stratify by risk, and assist selection of interventions at the individual, neighborhood, and population levels. ResultsThe DDC is using a multifaceted approach facilitated by GHIS to identify the specific risk profiles of patients and neighborhoods across Durham County. A total of 22,982 patients with diabetes in Durham County were identified using a computable phenotype. These patients tended to be older, female, African American, and not covered by private health insurance, compared with the 166,041 persons without diabetes. Predictive models inform decision-making to facilitate care and track outcomes. Interventions include: 1) neighborhood interventions to improve the context of care; 2) intensive team-based care for persons in the top decile of risk for death or hospitalization within the coming year; 3) low-intensity telephone coaching to improve adherence to evidence-based treatments; 4) county-wide communication strategies; and 5) systematic quality improvement in clinical care. ConclusionsTo improve health outcomes and reduce costs associated with type 2 diabetes, the DDC is matching resources with the specific needs of individuals and communities based on their risk characteristics.

Willingness to pay for telecare programmes to support independent living: Results from a contingent valuation study

An ageing population provokes an economic interest in the resource allocation questions posed by long-term care and critically, the development of sustainable community-based health and social care models that support independent living. This paper explores Irish citizens preferences and willingness to pay (WTP) for a range of community-based care programmes, including different telecare programmes that support older people to continue living at home. The paper reports on a cross-sectional multi-good contingent valuation survey conducted between April and September 2009 with three representative samples of the Irish population (N = 1214) to identify rankings and preferences for different community care programmes including: family care programme, a state-provided care programme and three different telecare programmes. The survey design permits the identification of strength, direction and relative preferences of different forms of community care provision. We also investigate convergent validity between ranking and willingness to pay results. We find that while people place significant value on formal state care provision and on telecare programmes, willingness to pay (WTP) estimates continue to highlight the importance of family care, which remains the strongest preference of the Irish population for the provision of community-based care for older people in the country. Respondents weakened their ranking preferences in the WTP exercise. However, both the direction of ranking and WTP estimates confirm the importance of family care. While all telecare programmes generated some economic value, telecare associated with social connection had much stronger support than telecare used to support physical or cognitive care needs. This paper offers unique information on societal values for different forms of community care provision, and in particular, the direction of preferences for technology-based approaches.

Serum uric acid and disorders of glucose metabolism: the role of glycosuria

Hyperuricemia has been associated with hypertension, diabetes mellitus, and metabolic syndrome. We studied the association between hyperuricemia and glycemic status in a nonrandomized sample of primary care patients. This was a cross-sectional study of adults ≥20 years old who were members of a community-based health care program. Hyperuricemia was defined as a value >7.0 mg/dL for men and >6.0 mg/dL for women. The sample comprised 720 participants including controls (n=257) and patients who were hypertensive and euglycemic (n=118), prediabetic (n=222), or diabetic (n=123). The mean age was 42.4±12.5 years, 45% were male, and 30% were white. The prevalence of hyperuricemia increased from controls (3.9%) to euglycemic hypertension (7.6%) and prediabetic state (14.0%), with values in prediabetic patients being statistically different from controls. Overall, diabetic patients had an 11.4% prevalence of hyperuricemia, which was also statistically different from controls. Of note, diabetic subjects with glycosuria, who represented 24% of the diabetic participants, had a null prevalence of hyperuricemia, and statistically higher values for fractional excretion of uric acid, Na excretion index, and prevalence of microalbuminuria than those without glycosuria. Participants who were prediabetic or diabetic but without glycosuria had a similarly elevated prevalence of hyperuricemia. In contrast, diabetic patients with glycosuria had a null prevalence of hyperuricemia and excreted more uric acid and Na than diabetic subjects without glycosuria. The findings can be explained by enhanced proximal tubule reabsorption early in the course of dysglycemia that decreases with the ensuing glycosuria at the late stage of the disorder.

A Mixed Methods Study of Health Care Experience Among Asian Indians in the Southeastern United States.

The study explored health care experiences among Asian Indian immigrants living in the Southeastern United States. A concurrent triangulation mixed methods design was used with a purposive sample of 125 Asian Indian immigrants aged between 40 and 64 years in the survey and 10 participants in the focus group. The majority of the participants had health insurance and higher socioeconomic status. They had a moderate level of knowledge on the U.S. health care system and health insurance while presenting moderate satisfaction with the system. Barriers to health care services and needs in the health care system were identified from both quantitative and qualitative data. Some of the barriers were high costs, dissatisfaction with services, and inconvenience in accessing services. Participants called for self-management and community-based health programs as well as culturally tailored health care services. Findings congruent with prior studies further support the importance of comprehending Asian Indians' unique cultural background and experiences in the health care system. This study can be the foundation for culturally competent care to advance the body of transcultural nursing knowledge. Culturally congruent community-based health care programs are needed to provide better care for the ethnic minority to maintain and promote their health status.

Spouse and Child Availability for Newly Disabled Older Adults: Socioeconomic Differences and Potential Role of Residential Proximity

To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults. We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics. Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s. Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies.

Factors related to unmet oral health needs in older adults living in Chile

To assess the oral health status and treatment needs of an ambulant population of older adults, living in the Maule Region, Chile, and provide descriptive information on its distribution by selected socio-demographic characteristics. The source of primary data was the Regional Oral Health Survey. A stratified random sample of 438 older adults, aged 65–74 years, living independently in the community was orally examined, and underwent an oral health interview. The sample was largely a dentate one (74.9%); with a mean DMFT score of 25.7 (s.d. 6.5) and an average number of missing teeth of 22.4 (s.d. 5.8). Dentate participants had 41% of their restorative care needs unmet, and 68.4% needed oral hygiene instruction plus removal of calculus on their teeth. Almost 30.1% required complex periodontal therapy. 21% of those fully edentulous were in need of full dentures. Comparing these findings with existing data on the oral health of older adults in Chile, participants in this study appear to have lower missing teeth scores and less need for complex periodontal treatment. Inequities were apparent in the proportion of unmet restorative and prosthetics needs. Community-based preventive care programs specifically tailored to older adults are needed to address this challenge.

Factors associated with maternal health knowledge through community-based antenatal care program among pregnant women in rural Paraguay

Factors associated with maternal health knowledge through community-based antenatal care program among pregnant women in rural Paraguay

Proyecto Interconexiones : A Pilot Test of a Community-Based Depression Care Program for Latina Violence Survivors

Latina intimate partner violence (IPV) survivors often face great barriers to depression care. We sought to use a community-based participatory research (CBPR) approach to create and evaluate a community-based depression care program for Latina IPV survivors. We created a multifaceted, culturally tailored intervention, based on principles of chronic illness management. A promotora provided case management services and led 12 weekly group sessions. Participants completed surveys at baseline and 6 months and participated in open-ended exit interviews. Ten Spanish-speaking Latina women participated in the intervention. The program had excellent attendance, with 100% of women attending at least 10 group sessions, and high satisfaction. We found a large decrease in depression severity (Patient Health Questionnaire [PHQ]-9, 17.3-7.2; p = .001), as well as improvements in depression self-efficacy, self-esteem, and stress. This study offers promising preliminary data to support the use of community-based approaches to reducing depression disparities in Latina IPV survivors.

Effects of interferential care: a community-based care program for persons with severe problems on several life areas.

Background and aims:Interferential care differs from the current community-based care programs in that it targets a larger, heterogeneous group and combines brokerage and full service elements in a multi-organizational care team. The team provides all the services itself, but with the aim to prepare clients within a few months for referral to regular (ambulant) healthcare services. The aim of this study was to assess the effectiveness of interferential care.Methods:In a multisite, pretest–posttest design, 523 patients of three interferential care teams were followed. Quality of life, problem severity, problems with referral and engagement were assessed at baseline, at referral and again after 6 months. Analyses were performed using linear mixed modeling.Results:Interferential care showed moderate to strong effects on quality of life and problem severity. These effects persisted (quality of life) or further improved (problem severity) until follow-up 6 months after referral to regular services. There were also small effects on both engagement and problems with referral.Conclusion:Interferential care offers significant improvements in quality of life and problem severity in persons who have severe problems on several life areas and who are currently not reached by healthcare services. It is a promising community-based care program for healthcare systems in which regular care already contains many elements of home-based practice.

Contribution of community-based newborn health promotion to reducing inequities in healthy newborn care practices and knowledge: evidence of improvement from a three-district pilot program in Malawi

BackgroundInequities in both health status and coverage of health services are considered important barriers to achieving Millennium Development Goal 4. Community-based health promotion is a strategy that is believed to reduce inequities in rural low-income settings. This paper examines the contributions of community-based programming to improving the equity of newborn health in three districts in Malawi.MethodsThis study is a before-and-after evaluation of Malawi’s Community-Based Maternal and Newborn Care (CBMNC) program, a package of facility and community-based interventions to improve newborn health. Health Surveillance Assistants (HSAs) within the catchment area of 14 health facilities were trained to make pregnancy and postnatal home visits to promote healthy behaviors and assess women and newborns for danger signs requiring referral to a facility. “Core groups” of community volunteers were also trained to raise awareness about recommended newborn care practices. Baseline and endline household surveys measured the coverage of the intervention and targeted health behaviors for this before-and-after evaluation. Wealth indices were constructed using household asset data and concentration indices were compared between baseline and endline for each indicator.ResultsThe HSAs trained in the intervention reached 36.7% of women with a pregnancy home visit and 10.9% of women with a postnatal home visit within three days of delivery. Coverage of the intervention was slightly inequitable, with richer households more likely to receive one or two pregnancy home visits (concentration indices (CI) of 0.0786 and 0.0960), but not significantly more likely to receive a postnatal visit or know of a core group. Despite modest coverage levels for the intervention, health equity improved significantly over the study period for several indicators. Greater improvements in inequities were observed for knowledge indicators than for coverage of routine health services. At endline, a greater proportion of women from the poorest quintile knew three or more danger signs for pregnancy, delivery, and postpartum mothers than did women from the least poor quintile (change in CI: -0.1704, -0.2464, and -0.4166, respectively; p < 0.05). Equity also significantly improved for coverage of some health behaviors, including delivery at a health facility (change in CI: -0.0591), breastfeeding within the first hour (-0.0379), and delayed bathing (-0.0405).ConclusionsAlthough these results indicate promising improvements for newborn health in Malawi, the extent to which the CBMNC program contributed to these improvements in coverage and equity are not known. The strategies through which community-based programs are implemented likely play an important role in their ability to improve equity, and further research and program monitoring are needed to ensure that the poorest households are reached by community-based health programs.

Evaluation of a modified community based care transitions model to reduce costs and improve outcomes

BackgroundThe Affordable Care Act of 2010 proposed maximum penalty equal to 1% of regular Medicare reimbursements which prompted change in how hospitals regard 30-day readmissions. While several hospital to home transitional care models demonstrated a reduction in readmissions and cost savings, programs adapted to population needs and existing resources was essential.MethodsFocusing on process and outcomes evaluation, a retrospective analysis of a modified community based care transitions program was conducted.ResultsIn addition to high levels of patient satisfaction with the care transitions program, participants’ confidence with self care was significantly improved. Further, the program evaluation demonstrated a 73% reduction in readmissions and an actual Medicare cost savings during the 9-month study period of $214,192, excluding the cost to administer the program.ConclusionsWhile there are several transitional care programs in existence, a customized approach is desirable and often required as the most cost effective way to manage care transitions and employ evidence based policy making. This study established some of the pitfalls when implementing a community-based transitional care program and demonstrated encouraging outcomes.

Reaching Mothers and Babies with Early Postnatal Home Visits: The Implementation Realities of Achieving High Coverage in Large-Scale Programs

BackgroundNearly half of births in low-income countries occur without a skilled attendant, and even fewer mothers and babies have postnatal contact with providers who can deliver preventive or curative services that save lives. Community-based maternal and newborn care programs with postnatal home visits have been tested in Bangladesh, Malawi, and Nepal. This paper examines coverage and content of home visits in pilot areas and factors associated with receipt of postnatal visits.MethodsUsing data from cross-sectional surveys of women with live births (Bangladesh 398, Malawi: 900, Nepal: 615), generalized linear models were used to assess the strength of association between three factors - receipt of home visits during pregnancy, birth place, birth notification - and receipt of home visits within three days after birth. Meta-analytic techniques were used to generate pooled relative risks for each factor adjusting for other independent variables, maternal age, and education.FindingsThe proportion of mothers and newborns receiving home visits within three days after birth was 57% in Bangladesh, 11% in Malawi, and 50% in Nepal. Mothers and newborns were more likely to receive a postnatal home visit within three days if the mother received at least one home visit during pregnancy (OR2.18, CI1.46–3.25), the birth occurred outside a facility (OR1.48, CI1.28–1.73), and the mother reported a CHW was notified of the birth (OR2.66, CI1.40–5.08). Checking the cord was the most frequently reported action; most mothers reported at least one action for newborns.ConclusionsReaching mothers and babies with home visits during pregnancy and within three days after birth is achievable using existing community health systems if workers are available; linked to communities; and receive training, supplies, and supervision. In all settings, programs must evaluate what community delivery systems can handle and how to best utilize them to improve postnatal care access.

Prevalence of root caries among ambulant older adults living in central Chile

To assess the prevalence of root caries and the treatment needs in an ambulant population of older adults, living in the Maule Region, Chile. The source of primary data was the Regional Oral Health Survey. A random sample of 438 older adults, aged 65-74years, living independently in the community was orally examined, and underwent an oral health interview. This was a largely dentate population (74.9%). Dentate participants had 70.4% of their root surfaces with recession. Those with exposed root surfaces had an average of 29.8 root surfaces exposed. The root caries index (RCI) was 8.23%, and a mean of 0.21 and 0.55 root surfaces filled and decayed, respectively. Participants had better oral health status than previously reported. Consistent with studies conducted in independent-living older adults, root caries occurred in a lower frequency among Chilean ambulant older adults. The proportion of unmet restorative needs could be reduced. Community-based preventive care programmes specifically tailored to older adults are needed to address this challenge.

Exploring impacts of multi-year, community-based care programs for orphans and vulnerable children: A case study from Kenya

The Community-Based Care for Orphans and Vulnerable Children (CBCO) program operated in Kenya during 2006–2010. In Eastern Province, the program provided support to approximately 3000 orphans and vulnerable children (OVC) living in 1500 households. A primary focus of the program was to support savings and loan associations composed of OVC caregivers (typically elderly women) to improve household and OVC welfare. Cross-sectional data were collected in 2011 from 1500 randomly selected households from 3 populations: program participants (CBCO group, n=500), households in the same villages as program participants but not in the program (the local-community-group = Group L, n=300), and households living in nearby villages where the program did not operate (the adjacent-community-group, Group A, n=700). Primary welfare outcomes evaluated are household food security, as measured by the Household Food Insecurity Access instrument, and OVC educational attainment. We compared outcomes between the CBCO and the subset of Group L not meeting program eligibility criteria (L-N) to investigate disparities within local communities. We compared outcomes between the CBCO group and the subset of Group A meeting eligibility criteria (A-E) to consider program impact. We compared outcomes between households not eligible for the program in the local and adjacent community groups (L-N and A-N) to consider if the adjacent communities are similar to the local communities. In May–June 2011, at the end of the OVC program, the majority of CBCO households continued to be severely food insecure, with rates similar to other households living in nearby communities. Participation rates in primary school are high, reflecting free primary education. Among the 18–22 year olds who were “children” during the program years, relatively few children completed secondary school across all study groups. Although the CBCO program likely provided useful services and benefits to program participants, disparities continued to exist in food security and educational outcomes between program participants and their non-OVC peers in the local community. Outcomes for CBCO households were similar to those observed for OVC households in adjacent communities.

The needs of health promoters on a health promotion programme for families with adolescents orphaned by HIV and AIDS

The South African communities has shown to have a challenge in accessing health services especially in rural areas; hence the national strategic objective 1.7 aimed at strengthening community systems to expand access to services using the community-based care programmes (NSP 2012-2016). The programmes enhance access to health services whilst promoting health and educating the community to improve health knowledge and work towards attaining a healthy living (NSP 2012-2016). However, the health promoters from the rural Hammanskraal region in the North West Province of South Africa often found themselves rendering the health promotion services in their communities with limited resources. This study aimed at exploring and describing the challenges faced by health promoters in implementing health promotion programmes for families with adolescents orphaned by HIV and AIDS. The study followed a qualitative design. Data was collected using focus group interviews. Participants were purposely selected by the social worker and the health promotion coordinator working at Hammanskraal. The process of data analysis was adapted from the eight steps of Tesch method of data analysis where categories, sub-categories and themes were isolated. The following categories emerged as the needs of health promoters on health promotion programmes for families with adolescents orphaned by HIV and AIDS, (1) financial needs, (2) resources, (3) basic life needs, (4) educational needs and (5) health promoter's needs. It is therefore recommended that equal distribution of resources: including medicine, equipment and finances, should be maintained in order to ensure non-interrupted services.

The Interconnections Project: Development and Evaluation of a Community-Based Depression Program for African American Violence Survivors

Multi-faceted depression care programs based within the healthcare system have been found to be effective, but may not fully address the needs of African American Intimate Partner Violence (IPV) survivors, many of whom are not seeking depression care in healthcare settings. To develop and evaluate a multifaceted, community-based depression care program (the Interconnections Project) for African American women with a history of IPV. We used a community-based participatory research (CBPR) approach to develop, implement, and evaluate the intervention. Participants were African American women who had current depressive symptoms and a lifetime history of IPV. They participated in a 6-month intervention where a peer advocate provided education, skills training, and case management services, and used Motivational Interviewing to support self-management behaviors. We conducted pre-intervention and post-intervention assessments using quantitative and qualitative data. Fifty-nine women participated, with 92 % attending any sessions and 51 % attending at least 6 h of intervention activities. Intervention changes made to better accommodate participants' unpredictable schedules improved participation rates. Participants noted high levels of satisfaction with the program. There were significant improvements in depression severity (PHQ-9 13.9 to 7.9, p < 0.001), self-efficacy, self-management behaviors, and self-esteem (all p < 0.001), but no increase in use of antidepressants. Common themes related to why the program was helpful included that the program was by and for African American women, that it fostered trust, and that it taught self-management strategies with practical, lasting value. Culturally specific, community-based interventions led by peer advocates may be a promising way to help African American IPV survivors effectively address depression.

Critical determinants of the epilepsy treatment gap: A cross‐national analysis in resource‐limited settings

Epilepsy is one of the most common serious neurologic disorders worldwide. Our objective was to determine which economic, health care, neurology, and epilepsy-specific resources were associated with untreated epilepsy in resource-constrained settings. A systematic review of the literature identified community-based studies in resource-constrained settings that calculated the epilepsy treatment gap, the proportion with untreated epilepsy, from prevalent active epilepsy cases. Economic, health care, neurology, and epilepsy-specific resources were taken from existing datasets. Poisson regression models with jackknifed standard errors were used to create bivariate and multivariate models comparing the association between treatment status and economic and health resource indicators. Relative risks were reported. Forty-seven studies of 8,285 individuals from 24 countries met inclusion criteria. Bivariate analysis demonstrated that individuals residing in rural locations had significantly higher risks of untreated epilepsy (relative risk [RR] 1.63; 95% confidence interval [CI] 1.26-2.11). Significantly lower risks of untreated epilepsy were observed for higher physician density (RR 0.65, 95% CI 0.55-0.78), presence of a lay (RR 0.74, 95% CI 0.60-0.91) or professional association for epilepsy (RR 0.73, 95% CI 0.59-0.91), or postgraduate neurology training program (RR 0.67, 95% CI 0.55-0.82). In multivariate models, higher physician density maintained significant effects (RR 0.67; 95% CI 0.52-0.88). Even among resource-limited regions, people with epilepsy in countries with fewer economic, health care, neurology, and epilepsy-specific resources are more likely to have untreated epilepsy. Community-based epilepsy care programs have improved access to treatment, but in order to decrease the epilepsy-treatment gap, poverty and inequalities of health care, neurology, and epilepsy resources must be dealt with at the local, national, and global levels.

The effect of participatory community-based diabetes cares on the control of diabetes and its risk factors in western suburb of Yasouj, Iran

This study aimed to investigate whether a community-based participatory diabetes care program could efficiently improve diabetic care and reduce its risk factors. To induce a participatory approach, a local group was established in partnership with academics, local leaders, health providers and public representatives. The group conducted community needs assessment and priority setting process. Diabetes was identified as the first priority health problem in this area. A total of 2569 30- to 65-year-old residents were screened for diabetes and 405 of them took part in a 13-week nutrition education and physical exercise intervention. Out of 1336 high-risk individuals, 17% had fasting blood sugar (FBS) ≥126 mg/dl and 13.5% with FBS between 110 and 125 mg/dl. Percentages of participants with triglycerides (TG) ≥150 mg/dl and cholesterol ≥200 mg/dl were 33.8% and 23.5%, respectively. After completion of the intervention, the mean FBS, HbA1C, TG and cholesterol were decreased significantly. Although systolic and diastolic blood pressure and body mass index were decreased too, the differences were not statistically significant. The mean physical activity increased and consumption of fried foods and saturated oil decreased significantly. The results suggest that participatory community-based care could be a feasible model for control of diabetes and its risk factors.

Results from a community-based program evaluating the effect of changing smoking status on asthma symptom control

BackgroundCigarette smoking has been associated with accelerated decline in lung function, increased health services use and asthma severity in patients with asthma. Previous studies have provided insight into how smoking cessation improves lung function among asthma patients, however, fail to provide measurable asthma symptom-specific outcomes after smoking cessation. The objective of this study was to measure the effect of changing smoking status on asthma symptom control and health services use in adults with asthma.MethodsThe study was conducted in eight primary care practices across Ontario, Canada participating in a community-based, participatory, and evidence-based Asthma Care Program. Patients aged 18 to 55 identified with physician-diagnosed mild to moderate asthma were recruited. In addition to receiving clinical asthma care, participants were administered a questionnaire at baseline and 12-month follow-up visits to collect information on demographics, smoking status, asthma symptoms and routine health services use. The effect of changing smoking status on asthma symptom control was compared between smoking groups using Chi-square and Fisher’s exact tests where appropriate. Mixed effect models were used to measure the impact of the change in smoking status on asthma symptom and health services use while adjusting for covariates.ResultsThis study included 519 patients with asthma; 11% of baseline smokers quit smoking while 4% of baseline non-smokers started smoking by follow-up. Individuals who quit smoking had 80% lower odds of having tightness in the chest (Odds ratio (OR) = 0.21, 95% CI: 0.06, 0.82) and 76% lower odds of night-time symptoms (OR = 0.24, 95% CI: 0.07, 0.85) compared to smokers who continued to smoke. Compared to those who remained non-smokers, those who had not been smoking at baseline but self-reported as current smoker at follow-up had significantly higher odds of chest tightness (OR = 1.36, 95% CI: 1.10, 1.70), night-time symptoms (OR = 1.55, 95% CI: 1.09, 2.20), having an asthma attack in the last six months (OR = 1.43, 95% CI: 1.17, 1.75) and visiting a walk-in clinic for asthma (OR = 4.57, 95% CI: 1.44, 14.49).ConclusionsThis study provides practitioners measurable and clinically important findings that associate smoking cessation with improved asthma control. Health practitioners and asthma programs can use powerful education messages to emphasize the benefits of smoking cessation as a priority to current smokers.