Dataset Information

Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013.

ABSTRACT:

Introduction

Early detection and treatment for diabetes are essential for reducing disability and death from the disease. Finding effective screening and treatment for individuals living with diabetes in resource-limited countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, addressed this gap by utilizing a multi-pronged approach with community-based peer educators, access to laboratory procedures, local outpatient medical consultation, and a revolving drug fund. This study evaluated outcomes of MoPoTsyo's diabetes program in Takeo Province by assessing glycemic and blood pressure outcomes for individuals diagnosed with diabetes over a 24-month follow-up period between 2007-2013.

Methods

This is a retrospective cohort analysis of records without a comparison group. We calculated the mean fasting blood glucose (FBG) and blood pressure (BP) at regular intervals of follow-up. The proportion of patients reaching recommended treatment targets for FBG and BP was assessed.

Results

Of the 3411 patients enrolled in the program, 2230 were included in the study. The cohort was predominantly female (68.9%) with a median age of 54 years. Median follow-up time in the program was 16 months (4.9-38.4 months). Mean FBG decreased 63.9 mg/dl in mean FBG (95% CI 58.5 to 69.3) at one year of follow-up (p<0.001). After one year, 45% (321/708) of patients achieved goal FBG < 126. Of the 41.6% (927/2230) with elevated BP at enrollment, systolic and diastolic BP levels significantly decreased (p<0.001) by 16.9 mmHg (95% CI 1.2 to 22.9) and 10 mm Hg (95% CI 0.7 to 12.9) respectively between enrollment and one year of follow-up. At one year of follow-up, 51.1%% (183/355) of these patients reached the BP goal < 140/90.

Conclusion

The improved outcome indicators of diabetes care for MoPoTsyo's Takeo program evaluation showed promise. The program demonstrated a reasonable and practical approach to delivering effective diabetes care in a rural area and may serve as a model for other low-income communities. Future prospective evaluations with more complete data are necessary for longer-term outcomes.

SUBMITTER: Taniguchi D

PROVIDER: S-EPMC5612455 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013.

Taniguchi Dawn D LoGerfo James J van Pelt Maurits M Mielcarek Bessie B Huster Karin K Haider Mahri M Thomas Bernadette B

PloS one 20170925 9

<h4>Introduction</h4>Early detection and treatment for diabetes are essential for reducing disability and death from the disease. Finding effective screening and treatment for individuals living with diabetes in resource-limited countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, addressed this gap by utilizing a multi-pronged approach with community-based peer educators, access to laboratory procedures, local outpatient medical consultation, and a revolving drug fund. ...[more]

PMID: 28945753

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Project description:Abstract Objectives We sought to understand the feasibility, acceptability, and sustainability of using peer educators to deliver a worksite-based lifestyle intervention program to reduce cardiometabolic risk in India. Methods INtegrating DIAbetes prevention in WORKplaceS (INDIA-WORKS, Clinicaltrial.gov #NCT02813668) is an implementation study to evaluate a lifestyle intervention program targeting employees with prediabetes or newly diagnosed diabetes in ten worksites in India. Peer educators were recruited at each worksite and trained to teach lifestyle classes. We conducted in-depth interviews with managers (n = 16), peer educators (n = 29), and implementation team members (n = 8) and focus group discussions with employees participating in the program (n = 13) to evaluate program delivery, including use of peer educators in this setting. Interviews and focus groups were conducted in-person, audio-recorded, and transcribed verbatim. Data were analyzed using thematic analysis. Results Peer educators’ involvement in teaching classes varied across worksites. This variation was related to differences in the training peer educators received, degree of management support provided, and peer educators’ levels of confidence to teach classes (e.g., discuss nutrition topics). Most peer educators liked their role, as it allowed them to learn about lifestyle change and benefit other employees (e.g., by encouraging them to be physically active), themselves (e.g., by losing weight), and their families (e.g., by preparing and serving healthier meals at home). Many employees participating in the program were satisfied with the peer educators, though some preferred “experts” such as implementation team members to lead classes. For program sustainability, there remains a need to increase peer educators’ capacity to teach classes and maintain their motivation. Conclusions Findings indicate that while it may be feasible for peer educators to deliver worksite-based lifestyle programs in India, it is critical to ensure that they have confidence and training, management support, and motivation to carry out their role. Research is needed to understand the type of training and support necessary to develop a cadre of effective peer educators and strategies for sustaining their engagement in the program. Funding Sources NIH R01HL125442 NIH D43TW009337.

Project description:IntroductionCollege students face increased risk for a variety of mental health problems but experience barriers to treatment access. Prevention programs, including those implemented by peer educators, may decrease treatment needs and increase service access. We examined the implementation of an evidence-based eating disorder prevention program, Body Project, delivered by college peer educators at 63 colleges/universities, comparing three levels of implementation support: (1) Train-the-Trainer (TTT) training; (2) TTT plus a technical assistance workshop (TTT + TA); and (3) TTT + TA with one year of quality assurance calls (TTT + TA + QA). The present study tested the degree to which indicators proposed by the Consolidated Framework for Implementation Research (CFIR) were associated with core implementation outcomes.MethodWe tested whether indices of CFIR domains (i.e., perceived intervention characteristics, outer and inner setting factors, provider characteristics, and implementation process) were correlated with three implementation outcomes (program reach, fidelity, effectiveness) during a 1-year implementation period.ResultsGreater program reach was associated with implementation process, specifically the completion of more implementation activities (β = 0.46). Greater program fidelity was associated with higher positive (β = 0.44) and lower negative (β = - 0.43) perceptions of the Body Project characteristics, and greater reported general support for evidence-based practices (β = 0.41). Greater effectiveness was associated with lower negative perceptions of Body Project characteristics (d = 0.49).ConclusionsSeveral implementation determinants proposed by the CFIR model predicted outcomes, especially intervention fidelity. Across the outcomes of interest, implementation determinants related to peer educator and supervisor perceived characteristics of the specific intervention and general attitudes towards evidence-based practices emerged as robust predictors to inform future work investigating ongoing implementation and sustainability of programs in university settings.

Project description:Background and aimsThe new coronavirus disease (COVID-19) is a systemic disease. Mounting evidence depict signs and symptoms involving multiple organs, most of which supported by pathological data. A plausible link to these manifestations is vascular and endothelial dysfunction/damage. However, much of the current knowledge relies on opinion and incipient evidence. We aim to objectively appraise current evidence on the association between COVID-19 and vascular disease, specifically endotheliitis and vasculitis.MethodsTwo researchers independently entered the search terms COVID-19 OR SARS-CoV-2 AND vasculitis, endotheliitis OR endothelium in the following online platforms: MedRxiv and LitCovid (PubMed). The search period was set from November 1, 2019 to August 28, 2020. Manuscripts with unavailable full texts, not in English, mainly on pre-clinical data, presenting only study designs or not directly related to the topics of this review were excluded. Retrospective and prospective studies, especially longitudinal ones, were given priority to the purpose of this review. Since there was paucity of prospective controlled evidence, case reports/series were also considered.ResultsA total of 318 manuscripts were initially found. Sixty-seven (21%) were excluded: 59 (18.5%) met exclusion criteria and 8 (2.5%) were duplicates. One hundred and forty-two manuscripts (44,6%) did not provide original data and were also excluded: 35 (11%) were comments, 108 (33.9%) reviews; 1 (0.3%) position paper. One hundred and seven (33.6%) studies were considered for the present scoping review: 81 (25,5%) case reports/series; 18 (5.7%) prospective; 8 (2.5%) retrospective. Viral inclusions in endothelial cells, mononuclear cell infiltrates in the intima of small vessels and markers of endothelial cell apoptosis were demonstrated. Specificities of COVID-19 may lead to diverse vascular manifestations in different levels of the vascular bed.ConclusionsEvidence indicates that COVID-19 targets vasculature and endothelium. However, high quality data is still lacking and studies with prospective designs and appropriately matched controls are needed.

Dataset Information

Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013.

Introduction

Methods

Results

Conclusion

Publications

Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013.

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