RESUMO

Antecedentes: Las enfermedades no transmisibles siguen siendo un problema creciente en el mundo, sobre todo en los países de mediano y bajo ingresos. Los programas de intervención comunitaria se enfocan en su disminución mediante cambios en estilos de vida más saludables. Objetivos: Analizar la tendencia del programa de intervención en actividad física y nutrición, como estrategia para mejorar las dislipidemias y glucemia en los participantes del proyecto DemoMinga. Materiales y métodos: Estudio con enfoque cuantitativo. Diseño de investigación acción participativa, de carácter longitudinal, prospectivo. La población estuvo constituida por los participantes del Proyecto DemoMinga. Se determinó en cada participante: colesterol total, triglicéridos y glucemia en ayunas. Las muestras fueron procesadas en el Centro de Investigaciones Médicas de la FACISA-UNE. Se determinaron indicadores de tendencia central (mediana) de cada una de las variables. Resultados: Hubo mayor participación del sexo femenino, con predominio de personas con menos de 45 años. Las mediciones químicas arrojaron una tendencia de disminución a partir del quinto año de intervención, con talleres de cocina saludable incluyendo uso de aceite alto oleico, y actividad física. Sin embargo, la prueba no arrojó diferencias significativas de las mediciones entre la línea de base y el corte a los 6 años. Conclusión: El estudio resalta la importancia de los programas de intervención mediante terapias integrales para la promoción y prevención de las enfermedades cardiometabólicas a largo plazo.

Background: Non-communicable diseases remain a growing problem worldwide, especially in middle and low-income countries. Community intervention programs are focused on reducing their prevalence through promoting healthier lifestyle changes. Objectives: To analyze the trend of the physical activity and nutrition intervention program as a strategy to improve dyslipidemia and glycemia among participants of the DemoMinga project. Materials and methods: This study employed a quantitative approach with a participatory action research design, characterized as longitudinal and prospective. The population consisted of participants from the DemoMinga Project. For each participant, total cholesterol, triglycerides, and fasting glycemia were measured. Samples were processed at the Medical Research Center of FACISA-UNE. Indicators of central tendency (median) were determined for each of the variables. Results: There was a higher participation of females, with a predominance of individuals under the age of 45. Chemical measurements showed a decreasing trend starting from the fifth year of intervention, involving healthy cooking workshops that included the use of high oleic oil and physical activity. However, the test did not yield significant differences in measurements between the baseline and the 6-year cutoff. Conclusion: The study highlights the significance of intervention programs using comprehensive therapies for the long-term promotion and prevention of cardiometabolic diseases.

RESUMO

Antecedentes: Las enfermedades no transmisibles siguen siendo un problema creciente en el mundo, sobre todo en los países de mediano y bajo ingresos. Los programas de intervención comunitaria se enfocan en su disminución mediante cambios en estilos de vida más saludables. Objetivos: Analizar la tendencia del programa de intervención en actividad física y nutrición, como estrategia para mejorar las dislipidemias y glucemia en los participantes del proyecto DemoMinga. Materiales y métodos: Estudio con enfoque cuantitativo. Diseño de investigación acción participativa, de carácter longitudinal, prospectivo. La población estuvo constituida por los participantes del Proyecto DemoMinga. Se determinó en cada participante: colesterol total, triglicéridos y glucemia en ayunas. Las muestras fueron procesadas en el Centro de Investigaciones Médicas de la FACISA-UNE. Se determinaron indicadores de tendencia central (mediana) de cada una de las variables. Resultados: Hubo mayor participación del sexo femenino, con predominio de personas con menos de 45 años. Las mediciones químicas arrojaron una tendencia de disminución a partir del quinto año de intervención, con talleres de cocina saludable incluyendo uso de aceite alto oleico, y actividad física. Sin embargo, la prueba no arrojó diferencias significativas de las mediciones entre la línea de base y el corte a los 6 años. Conclusión: El estudio resalta la importancia de los programas de intervención mediante terapias integrales para la promoción y prevención de las enfermedades cardiometabólicas a largo plazo.

Background: Non-communicable diseases remain a growing problem worldwide, especially in middle and low-income countries. Community intervention programs are focused on reducing their prevalence through promoting healthier lifestyle changes. Objectives: To analyze the trend of the physical activity and nutrition intervention program as a strategy to improve dyslipidemia and glycemia among participants of the DemoMinga project. Materials and methods: This study employed a quantitative approach with a participatory action research design, characterized as longitudinal and prospective. The population consisted of participants from the DemoMinga Project. For each participant, total cholesterol, triglycerides, and fasting glycemia were measured. Samples were processed at the Medical Research Center of FACISA-UNE. Indicators of central tendency (median) were determined for each of the variables. Results: There was a higher participation of females, with a predominance of individuals under the age of 45. Chemical measurements showed a decreasing trend starting from the fifth year of intervention, involving healthy cooking workshops that included the use of high oleic oil and physical activity. However, the test did not yield significant differences in measurements between the baseline and the 6-year cutoff. Conclusion: The study highlights the significance of intervention programs using comprehensive therapies for the long-term promotion and prevention of cardiometabolic diseases.

RESUMO

Tuberculosis (TB) and depression is common and is associated with poor TB outcomes. The World Health Organization End TB Strategy explicitly calls for the integration of TB and mental health services. Interpersonal Counseling (IPC) is a brief evidence-based treatment for depression that can be delivered by non-mental health specialists with expert supervision. The goal of this study was to explore potential barriers and facilitators to training non-specialist providers to deliver IPC within the TB Control Program and primary care in Itaboraí, Rio de Janeiro state. Data collection consisted of six focus groups (n = 42) with health professionals (n = 29), program coordinators (n = 7), and persons with TB (n = 6). We used open coding to analyze the data, followed by deductive coding using the Chaudoir multi-level framework for implementation outcomes. The main structural barriers identified were poverty, limited access to treatment, political instability, violence, and social stigma. Organizational barriers included an overburdened and under-resourced health system with high staff turnover. Despite high levels of stress and burnout among health professionals, several provider-level facilitators emerged including a high receptivity to, and demand for, mental health training; strong community relationships through the community health workers; and overall acceptance of IPC delivered by any type of health provider. Patients were also receptive to IPC being delivered by any type of professional. No intervention-specific barriers or facilitators were identified. Despite many challenges, integrating depression treatment into primary care in Itaboraí using IPC was perceived as acceptable, feasible, and desirable.

RESUMO

The majority of U.S. adults are living with at least one chronic condition, and people of color bear a disproportionate burden of chronic disease. Prior research identifies community-clinical linkages (CCLs) as a strategy for improving health. CCLs traditionally use health care providers to connect patients to community-based self-management programs. The purpose of this study was to examine the effectiveness of a centralized CCL system on health indicators and health disparities. Administrative health data were merged with referral system data to conduct a quasi-experimental comparative time series study with a comparison group of nonreferred patients. Interrupted time-series comparisons within referred patients were also conducted. Of the 2,920 patients meeting inclusion criteria, 972 (33.3%) received a referral during the study period (January 2019-September 2021). Hemoglobin A1c levels, used to diagnose diabetes, declined significantly among referred patients, as did disparities among Hispanic/Latinx participants compared with non-Hispanic White participants. No changes were observed in body mass index (BMI). Blood pressure increased among both referred and nonreferred patients. CCLs with a centralized referral system can effectively reduce markers of diabetes and may contribute to the maintenance of BMI. The observed increase in blood pressure may have been affected by the COVID-19 pandemic and warrants further study. Practitioners can work with community partners to implement a centralized CCL model, either on its own or to enhance existing clinician or community health worker-based models.

Assuntos

RESUMO

INTRODUCTION: Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community-primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. METHODS: Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. RESULTS: Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community-primary care partnership. Lack of previous collaborations with the formal health system was common to both. CONCLUSION: The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability.

Assuntos

RESUMO

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) pandemic is a worldwide public health threat. Millions of people are at risk and older adults are more susceptible to developing the most serious manifestations of the disease, in part because of the effects of ageing on the immune system. Biomodulina T is an injectable immune modulator that has been licensed for use in Cuba for many years. OBJECTIVE: An open-label, uncontrolled trial was conducted to investigate whether or not it might be useful to prevent or modulate the serious effects of severe acute respiratory syndrome coronavirus 2 infections in older Cuban adults before the availability of vaccinations. METHODS: From April 12 to August 31, 2021, 1239 adults aged 60 years and older, unvaccinated against COVID-19 were recruited from the José Luis Dubrocq polyclinics, to receive Biomodulina T, 1 intramuscular 3 mL dose weekly for 6 weeks. Each person was visited at home weekly to be administered Biomodulina T. Once daily patients were seen by a medical student to collect information on any possible adverse events related to the medication as well as any symptoms of COVID-19. The possible usefulness of the intervention and its potential adverse events were assessed based on the number of older adults who became infected with COVID-19, and the severity of any symptoms reported or noted both during the 6-week treatment period and during an additional 6-week posttreatment observation period. RESULTS: Sixteen patients were diagnosed with symptomatic COVID-19 during the intervention using a specific reverse transcription polymerase chain reaction test. One patient died because of COVID-19. The most common preexisting diagnoses in treated patients included high blood pressure in 64.8%, diabetes mellitus in 19.85%, and ischemic cardiopathy in 13.88%. Biomodulina T was well tolerated. Only infrequent, mild, transient, and self-limited adverse events were identified. Both the incidence of COVID-19 infections and the overall mortality rate were lower in the treated patients than what was observed in the untreated general population of this Cuban province during the same time period. CONCLUSIONS: Although further, confirmatory, double-blind, controlled clinical trials are needed, Biomodulina T injections were well tolerated, and the results of this open, uncontrolled study suggest that it may have been useful to decrease the incidence and severity of symptomatic COVID-19 infection in these older Cuban adults. (Curr Ther Res Clin Exp. 2022; 82:XXX-XXX) © 2022 Elsevier HS Journals, Inc.

RESUMO

BACKGROUND: The Barbados Diabetes Remission Study-2 reported that a low-calorie diet for weight loss and diabetes remission implemented within the community and supported by trained community health advocates was both an acceptable implementation strategy and a clinically effective intervention. This study aimed to examine the adaptability of the face-to-face protocol into an online modality. METHODS: The Iterative Decision-making for Evaluation of Adaptations (IDEA) framework guides researchers in examining the necessity of the adaptation and the preservation of core intervention elements during the adaptation process. Adaptation outcomes were documented using the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS). Implementation outcome was determined by fidelity to core elements. Intervention effectiveness was determined from the analysis of clinical data. RESULTS: We decided that an adaptation was needed as COVID-19 control measures prohibited in-person interactions. The core elements-i.e. 12-week intervention duration, daily 840-kcal allowance, and weekly monitoring of weight and blood glucose-could be preserved during the adaptation process. Adaptations were made to the following: (1) the context in which data were collected-participants self-measured at home instead of following the original implementation strategy which involved being measured by community health advocates (CHA) at a community site; (2) the context in which data were entered-participants posted their measurements to a mobile application site which was accessible by CHAs. As with the original protocol, CHAs then entered the measurements into an online database; (3) the formulation of the low-calorie diet-participants substituted the liquid formulation for a solid meal plan of equivalent caloric content. There was non-inferiority in fidelity to attendance with the online format (97.5% visit rate), as compared to the face-to-face modality (95% visit rate). One participant deviated from the calorie allowances citing difficulty in estimating non-exact portion sizes and financial difficulty in procuring meals. Weight change ranged from - 14.3 to 0.4 kg over the 12-week period, and all group members achieved induction of diabetes remission as determined by a FBG of < 7mmol/l and an A1C of < 6.5%. CONCLUSION: The results suggest that this adapted online protocol-which includes changes to both the implementation strategy and the evidence-based practice-is clinically effective whilst maintaining fidelity to key elements. Utilization of the IDEA and FRAME-IS adaptation frameworks add scientific rigour to the research. TRIAL REGISTRATION: ClinicalTrials.gov NCT03536377 . Registered on 24 May 2018.

RESUMO

Despite evidence that chronic care management improves outcomes, a framework designed for low income, uninsured populations is still needed to improve health disparities and guide further replication. We describe the Innovative Care for Chronic Conditions framework implemented by a coalition of clinics and agencies to address chronic care management for Mexican Americans with Type 2 diabetes mellitus who have low income and primarily uninsured. The core elements of the framework are described by clinic, home and community settings with community health workers playing an essential role in the delivery of community-based services that address the social determinants of health. Promising results are described. This framework expands the understanding of chronic care management approaches and contributes to further replication of the framework in diverse settings.

Assuntos

RESUMO

OBJECTIVES: The aims of this feasibility study were to (1) examine the implementation of a community-based health advocate (CHA) training programme to develop the clinical skills needed to support a diabetes remission protocol based on a low-calorie diet (LCD) and (2) investigate if participant weight loss can be achieved and diabetes remission induced under these conditions. METHODS: This tripartite study followed a type 2 implementation-effectiveness design. Three faith-based organisations (FBOs) were purposively selected as study sites. Implementation outcomes were guided by the Consolidated Framework for Implementation Research. During the pre-implementation phase, site 'readiness' to facilitate the intervention was determined from a site visit and an interview with the FBOs' leadership. During the implementation phase, congregants could volunteer for the 10-week CHA training which included practical exercises in weight, glucose and blood pressure (BP) measurement, and a summative practical assessment. Acceptability and implementation effectiveness were assessed via survey. During the intervention phase, other congregants and community members with T2DM or pre-diabetes and overweight were invited to participate in the 12-week LCD. Anti-diabetic medication was discontinued on day 1 of the intervention. Clinical effectiveness was determined from the change in weight, fasting blood glucose (FBG) and BP which were monitored weekly at the FBO by the CHA. HbA1C was performed at weeks 1 and 12. RESULTS: The FBOs were found to be ready as determined by their adequate resources and engagement in health-related matters. Twenty-nine CHAs completed the training; all attained a passing grade at ≥1 clinical station, indicating implementation effectiveness. CHA feedback indicated that the programme structure was acceptable and provided sufficient access to intervention-related material. Thirty-one persons participated in the LCD (11 T2DM:20 pre-diabetes). Mean (95%CI) weight loss was 6.0 kg (3.7 to 8.2), 7.9 kg in males vs 5.7 kg in females; A1C (%) decreased from 6.6 to 6.1, with a greater reduction in those with T2DM when compared to pre-diabetes. FBG decreased from 6.4 to 6.0mmol/L. T2DM remission rates were 60% and 90% by A1C<6.5% and FBG<7mmol/L respectively. Pre-diabetes remission was 18% and 40% by A1C<5.7% and FBG<5.6 respectively. CONCLUSION: Implementation of a community-based diabetes remission protocol is both feasible and clinically effective. Its sustainability is to be determined. Adaptability to other disorders or other settings should be investigated. TRIAL REGISTRATION: NCT03536377 registered on 24 May 2018.

RESUMO

RESUMEN Objetivo: El artículo que se presenta aporta como resultado científico la descripción de la estructura conceptual de la competencia intervención comunitaria desde el paradigma emancipador de autodesarrollo para su formación en el contexto universitario. Métodos: Los métodos del nivel teórico empleados fueron el histórico-lógico, analítico-sintético, inductivo-deductivo, sistémico-estructural-funcional y del nivel empírico, el análisis de documentos. Resultado: A partir de la sistematización teórica realizada resultó posible develar las particularidades de la competencia objeto de análisis que apuntan hacia su identificación. Se determinaron los problemas contextuales a los que da solución, los ejes procesuales que de ella se derivan, los criterios de desempeño y las evidencias requeridas. Además se proponen niveles y patrones de logro que facilitan su formación y evaluación por cada uno de sus ejes procesuales, constituyendo un valioso instrumento para el trabajo metodológico. Conclusión: La investigación constituye un antecedente teórico necesario para sustentar un modelo pedagógico conducente a la formación de la competencia intervención comunitaria como expresión de la pertinencia social de la universidad y calidad del desempeño profesional en este ámbito.

ABSTRACT Objective: The article that is presented provides as a scientific result the description of the conceptual structure of community intervention competence from the emancipatory paradigm of self-development for its training in the university context. Method: The theoretical level methods used were the historical-logical, analytical-synthetic, inductive-deductive, systemic-structural-functional and the empirical level, the analysis of documents. Results: From the theoretical systematization carried out, it was possible to reveal the particularities of the competence under analysis that point towards its identification. The contextual problems to which it gives a solution, the procedural axes that derive from it, the performance criteria and the required evidence were determined. In addition, levels and patterns of achievement are proposed that facilitate their formation and evaluation for each of their process axes, constituting a valuable instrument for methodological work. Conclusion: The research constitutes a necessary theoretical background to support a pedagogical model conducive to the formation of community intervention competence as an expression of the social relevance of the university and the quality of professional performance in this field.

RESUMO

El dengue es una enfermedad febril producida por el virus DENV, transmitida principalmente por el mosquito Aedes aegypti, siendo uno de los problemas de Salud Pública de mayor presentación en países de América Latina, incluido Ecuador. Objetivo: Evaluar intervenciones comunitarias integradas en el manejo, control y prevención del dengue en el Cantón Durán de la provincia de Guayas-Ecuador 2020. Metodología: Investigación de tipo descriptiva, transversal, experimental con estudio de campo, muestra 304 jefes de familia, como instrumento de recolección de datos, se aplicó una encuesta estructurada y lista de cotejo para controla asistencia y participación. La encuesta se aplicó antes y después de la sesión educativa dictada referente al dengue, agente etiológico, síntomas, transmisión, control y prevención, los datos se transcribieron en Microsoft Excel y se uso el software libre EPIDAT 3.1 para calcular frecuencia e intervalos de confianza (IC) al 95%. Resultado: Después de la intervención comunitaria, a través de la sesión educativa dictada referente al dengue, 98,68% (300/304) conocían que la transmisión era por la picadura del mosquito hembra de Aedes aegypti, 98,03% conocían mucho sobre los síntomas del dengue, 99,01% (301/304) realizaban siempre la limpieza y eliminación de los criaderos, 92,43% (281/304) conocían de la enfermedad del dengue por charlas, reuniones y conferencias, evidenciando así, un cambio notable en la comunidad respecto a la información sobre el dengue y las actividades incluidas en el control y prevención de dicha enfermedad, Siendo los micros informativos con un 91,45% (278/304) los que dinamizaron la participación. Conclusión: La intervención comunitaria en el Cantón Durán de la Provincia de Guayas fue integral y dinámica contando con la participación activa(AU)

Dengue is a febrile disease produced by the DENV virus and transmitted by the Aedes aegypti, it is one of the most common Public Health problems in Latin American countries, including Ecuador. Objective. Evaluate integrated community interventions in the management, control and prevention of dengue in the Duran Canton of the Guayas Province-Ecuador 2020. Methodology: Descriptive, cross-sectional, experimental research with a field study with a sample of 304 household heads, such as Data collection instrument, a structured survey of 10 multiple-choice questions with alternative scales was applied before and after the educational session dictated regarding dengue, etiological agent, symptoms, transmission, control and prevention, the data were transcribed in Microsoft Excel and the free software EPIDAT 3.1 was used to calculate frequency and 95% confidence intervals (CI). Outcome. After the community intervention, through the educational session given regarding dengue, 98.68% (300/304) knew that the transmission was by the bite of the female Aedes aegypti, 98.03% knew a lot about the symptoms of dengue, 99.01% (301/304) always carried out the cleaning and elimination of the breeding sites, 92.43% (281/304) knew about the dengue disease through talks, meetings and conferences, thus evidencing a notable change in the community regarding information on dengue and the activities included in the control and prevention of said disease. Conclution. The community intervention in the Duran Canton of the Guayas Province was comprehensive and dynamic in which the subjects actively participated in the transformation of their reality, contributing significantly to the prevention and control of dengue(AU)

Assuntos

RESUMO

Resumen El presente estudio pretende explorar el estado de Inseguridad Alimentaria (IA) en cada país perteneciente a la comunidad sudamericana. Para ello y considerando que es un problema vigente y de carácter multifactorial, se analizaron sus cuatro pilares: disponibilidad, acceso, estabilidad y utilización de alimentos. Como resultado, se observa que la mala utilización de alimentos, es la causa más propensa a causar IA en la comunidad sudamericana, no obstante, la indisponibilidad e inaccesibilidad hacia los alimentos, causa gran preocupación en ciertos estados de la subregión. El origen más probable es la baja promoción de buenos hábitos alimenticios, además de políticas erradas que impiden la correcta producción y/o motivación de los campesinos a seguir ejerciendo sus actividades en el agro. Este problema debe ser mitigado lo antes posible, ya que, aunque empieza por no tener el dinero y/o los hábitos alimenticios necesarios, termina con graves problemas de salud hacia los pobladores. Consideramos importante fortalecer políticas para erradicar la IA sudamericana, iniciando con el apoyo hacia la producción de alimentos, para finalizar con intervenciones nutricionales que permitan mejorar los hábitos alimenticios de los habitantes.

Abstract The scope of this study is to examine the status of Food Insecurity (FI) in each country included in the South American community. To achieve this and considering that it is a current and multifactorial problem, its four pillars were analyzed: food availability, access, stability and use. As a result, it is observed that the misuse of food is the most likely cause of FI in the South American community, however, the lack of availability and inaccessibility of food causes great concern in certain states of the subregion. The most probable origin is the inadequate promotion of good eating habits, in addition to misguided policies that hinder the correct production and/or motivation of the peasants to continue carrying out their activities in agriculture. This problem needs to be addressed as soon as possible as, although it originates in not having the money and/or the necessary nutritional habits, it leads to serious health problems for the inhabitants. The consensus reached is that it is important to enhance policies to eradicate FI in South America, starting with support for food production, and following that up with nutritional interventions that improve the dietary habits of the inhabitants.

Assuntos

RESUMO

Globally, limited opportunities for women's political participation and decision-making reflect a widespread societal problem perpetuated through gender inequities that operate at numerous levels of society. Challenging and ending systemic gender-based power imbalances is critical to understanding the potential for women's political participation. The current study uses a liberation psychology approach to examine how a community intervention interrupts traditional gender ideology, enhances women's agency and political efficacy, and increases civic engagement and community leadership among women in rural Nicaragua. Research was conducted in partnership with a grassroots women's organization and data were taken from 261 surveys. Findings suggest that community-level interventions interrupt standard notions of women's political participation, resulting in greater agency and efficacy and thereby higher levels of decision-making and leadership. The findings illustrate the importance of assessing the psychosocial processes involved in transformative political spaces that facilitate women's meaningful citizen engagement, having important implications for women's political participation worldwide.

Assuntos

RESUMO

Introducción: La infertilidad por obstrucción tuboperitoneal, está relacionada con factores de riesgo de conducta sexual y enfermedades infecciosas ginecológicas prevenibles. Los adolescentes y adultos jóvenes, son un grupo poblacional en el cual la intervención comunitaria es primordial para la prevención. Las conductas sexuales de riesgo en esta etapa de la vida, contribuyen al desarrollo de este tipo de actividad. Objetivo: Determinar el impacto de la intervención comunitaria "Prevención de la infertilidad tuboperitoneal", en estudiantes de educación superior. Métodos: Se realizó un estudio de intervención comunitaria, mediante un programa de educación para la salud a estudiantes de educación superior. Un año después de la ejecución de la intervención se determinó su impacto en el nivel de conocimientos sobre infecciones de trasmisión sexual y aborto, así como la modificación de los factores de riesgo de infertilidad tuboperitoneal identificados en las estudiantes, antes de comenzar la investigación. Resultados: Las relaciones sexuales desprotegidas disminuyeron de 77,4 por ciento a 41,7 por ciento, la media de parejas sexuales de 2 a 1,23, la de abortos provocados de 0,85 a 0,18. Se produjo un índice de variación de 32,3 por ciento en el caso de la infección vaginal, 60,2 por ciento en la enfermedad inflamatoria pélvica, 13,8 por ciento en la infección de transmisión sexual y 32 por ciento en la infección postaborto. Conclusiones: La intervención comunitaria impactó en la disminución de las relaciones sexuales desprotegidas, el número de parejas sexuales, se confirmó la reducción del aborto provocado y las enfermedades infecciosas ginecológicas(AU)

ABSTRACT Introduction: Infections due to tuboperitoneal obstruction are related to risk factors of sexual behavior and preventable infectious gynecological diseases. Adolescents and young adults are a population group in which community intervention is paramount for prevention. Sexual risk behaviors in this stage of life contribute to the development of this type of activity. Objective: To determine the impact of community intervention "Prevention of tuboperitoneal infertility" in higher education students. Methods: A community intervention study was conducted through a health education program for higher education students. One year after the execution of the intervention, its impact on the level of knowledge about sexually transmitted infections and abortion was determined, as well as the modification of the risk factors for tuboperitoneal infertility identified in the students before beginning the investigation. Results: Unprotected sex decreased from 77.4 percent to 41.7 percent, the average of sexual partners from 2 to 1.23, that of induced abortions from 0.85 to 0.18. There was a variation rate of 32.3 percent in the case of the vaginal infection, 60.2 percent in the pelvic inflammatory disease, 13.8 percent in the sexually transmitted infection and 32 percent in the post abortion infection. Conclusions: The community intervention impacted on the reduction of unprotected sex, the number of sexual partners, the reduction of induced abortion and infectious gynecological diseases(AU)

Assuntos

RESUMO

Introducción: En la actualidad la tuberculosis pulmonar continúa siendo uno de los procesos infecciosos más observados en el mundo. Objetivo: Diseñar un programa de intervención comunitaria dirigido a pacientes con riesgo de tuberculosis pulmonar. Métodos: Se realizó un estudio de tipo descriptivo transversal en el consultorio 9 del Policlínico Docente Mario Antonio Pérez Mollinedo durante el periodo de noviembre de 2015 a marzo de 2017. Se seleccionó una muestra de 56 pacientes de una población de 125 dispensarizados con riesgo de tuberculosis. La estrategia de selección se basó en el muestreo no probabilístico intencional por criterios. Se aplicaron diferentes métodos y técnicas, como el análisis documental y cuestionarios. Para el procesamiento de la información se empleó la estadística descriptiva. Resultados: Los factores de riesgo a los que se encontraban expuestos los pacientes eran: el hábito de fumar (57,1 por ciento); el consumo de bebidas alcohólicas (46,4 por ciento); residir en condiciones de hacinamiento (44,6 por ciento); viviendas con malas condiciones (33,9 por ciento); estar expuestos a más de 2 factores de riesgo (58,9 por ciento); padecer de diabetes mellitus (14,2 por ciento), asma bronquial y enfermedad pulmonar obstructiva crónica (21,4 por ciento); y bajo nivel de conocimiento sobre la tuberculosis pulmonar (83,9 por ciento). Conclusiones: El programa de intervención comunitaria dirigido a pacientes con riesgo de tuberculosis pulmonar, según la evaluación de los especialistas, es pertinente y factible. En la actualidad se encuentra en fase de aplicación en el área de salud donde se realizó la investigación(AU)

Introduction: Nowadays, lung tuberculosis is still one of the most important infectious processes in the world. Objective: To design a project of community intervention directed to patients with risk of lung tuberculosis. Methods: It was carried out a descriptive cross-sectional's type study in the Family Doctor's Office #9 belonging to Mario Antonio Pérez Mollinedo Teaching Policlinic from November, 2015 to March, 2017. It was selected a sample of 56 patients from a population of 125 patients classified as with risk of Tuberculosis. The selection's strategy was based in an intentional non-probabilistic sampling by criteria. Different methods and techniques were applied as documentary analysis and questionnaires. Descriptive statistic and the analysis of qualitative data were used for processing information. Results: The risk factors that these patients were exposed were: smoking habit (57.1 percent); consumption of alcoholic beverages (46.4 percent); to live in overcrowding conditions (44.6 percent); housings with bad conditions (33.9 percent); to be exposed to more than 2 risk factors (58.9 percent); suffering Diabetes Mellitus (14.2 percent); bronchial asthma and COPD (21.4 percent); and low level of knowledge on lung tuberculosis (83.9%). Conclusions: The project of community intervention directed to patients with risk of Lung Tuberculosis, according to the specialists' assessment, it is pertinent and feasible. At the moment is in the application phase in the health area where it was carried out the investigation as part of a thesis of specialty(AU)

Assuntos

RESUMO

PURPOSE: To determine whether dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) reduces neuropathic pain symptoms in Mexican-Americans with type 2 diabetes. METHODS: Forty volunteers with type 2 diabetes enrolled in the "En Balance-PLUS" program, which provided weekly nutrition-diabetes education and daily supplementation with 1,000 mg docosahexaenoic acid (DHA)-200 mg eicosapentaenoic acid over 3 months. The study assessed self-reported neuropathic pain symptoms pre/postintervention using the short-form McGill Pain Questionnaire (SF-MPQ), monitored clinical laboratory values at baseline and 3 months, and performed baseline and 3-month metabolomic analysis of plasma samples. RESULTS: A total of 26 participants self-reported neuropathic pain symptoms at baseline. After 3 months of omega-3 PUFA supplementation, participants reported significant improvement in SF-MPQ scores (sensory, affective, and visual analogue scale; P<0.001, P=0.012, and P<0.001, respectively). Untargeted metabolomic analysis revealed that participants in the moderate-high SF-MPQ group had the highest relative plasma sphingosine levels at baseline compared to the low SF-MPQ group (P=0.0127) and the nonpain group (P=0.0444). Omega-3 PUFA supplementation increased plasma DHA and reduced plasma sphingosine levels in participants reporting neuropathic pain symptoms (P<0.001 and P<0.001, respectively). Increased plasma DHA levels significantly correlated with improved SF-MPQ sensory scores (r=0.425, P=0.030). Improved SF-MPQ scores, however, did not correlate with clinical/laboratory parameters. CONCLUSION: The data suggest that omega-3 PUFAs dietary supplementation may reduce neuropathic pain symptoms in individuals with type 2 diabetes and correlates with sphingosine levels in the plasma.

RESUMO

INTRODUCTION: Adults living in bateyes (i.e., sugarcane plantation villages) in the Dominican Republic have minimal access to health care services. Hypertension (HTN) is a serious and often unrecognized health problem among batey residents. The Jonas Batey Hypertension Program was built on existing social networks to address the detection and treatment of HTN. METHODS: An ongoing community-based participatory research endeavor involves a partnership among three organizations and collaboration with promotoras who engage their batey communities in a mobile HTN screening and treatment program. Adults are screened and, if indicated, are treated with antihypertensive medications. Data collection includes project documentation, participant observation, demographic data, blood pressure (BP) measurements, and pill counts. RESULTS: To date, 243 adults have received HTN treatment in four batey communities. A within-group, as-treated, repeated-measures, pre-/postanalysis showed that among participants who had been receiving antihypertensive treatment for 12 months ( n = 70), there was a significant decrease in BP ( p < .005). CONCLUSION: Results of an interim data analysis indicate that the program model has been implemented successfully and is making a positive impact on BP control. Evaluation is ongoing with regard to the long-term HTN-related health outcomes of batey residents. Ensuring program sustainability is an important consideration for the future.

Assuntos

RESUMO

Abstract Armed conflict has positioned Colombia as the country with the second highest internal displacement of citizens. This situation has forced government projects and international cooperation agencies to intervene to mitigate the impact of violence; however, the coping strategies implemented by the country's minorities are still unknown. The study objective is to describe the coping strategies and their relation with mental health within Afro-descendant culture in Colombia and the effects that armed conflict has on these coping mechanisms, through a phenomenological study involving focus groups and interviews with experts. Rituals and orality have a healing function that allow Afro-Colombian communities to express their pain and support each other, enabling them to cope with loss. Since the forced displacement, these traditions have been in jeopardy. Armed conflict prevents groups from mourning, generating a form of latent pain. Afro-Colombians require community interventions that create similar spaces for emotional support for the bereaved persons in the pre-conflict period. Thus, it is essential to understand the impact of this spiritual and ritualistic approach on mental health issues and the relevance of narrative and community interventions for survivors.

Resumo O conflito armado posiciona a Colômbia como o país com o segundo maior deslocamento interno em todo o mundo. Esta situação obrigou projetos do governo e agências de cooperação internacional a intervir; no entanto, as estratégias de enfrentamento implementadas por minorias do país ainda são desconhecidas. O objetivo do estudo é descrever as estratégias de enfrentamento e sua relação com a saúde mental dentro da cultura afro-descendente na Colômbia e os efeitos que o conflito armado tem sobre esses mecanismos de enfrentamento, por meio de um estudo fenomenológico envolvendo grupos focais e entrevistas com especialistas. Rituais e oralidade têm uma função de cura que permite que as comunidades afro-colombianas para expressar sua dor e apoiar uns aos outros, permitindo-lhes lidar com a perda. Em razão do deslocamento forçado, essas tradições têm estado em perigo; o conflito armado impede-os de realizar o luto, gerando uma forma de dor latente. Elas exigem intervenções comunitárias que criem espaços de apoio emocional para as pessoas enlutadas similares aos do período pré-conflito. Assim, é essencial compreender o impacto dessa abordagem ritualista em questões de saúde mental, bem como a pertinência das intervenções comunitárias e narrativa para os sobreviventes.

Assuntos

RESUMO

BACKGROUND: Recent literature on community intervention research stresses system change as a condition for durable impact. This involves highly participatory social processes leading to behavioural change. METHODS: Before launching the intervention in the Nicaraguan arm of Camino Verde, a cluster-randomised controlled trial to show that pesticide-free community mobilisation adds effectiveness to conventional dengue controls, we held structured discussions with leaders of intervention communities on costs of dengue illness and dengue control measures taken by both government and households. These discussions were the first step in an effort at Socialising Evidence for Participatory Action (SEPA), a community mobilisation method used successfully in other contexts. Theoretical grounding came from community psychology and behavioural economics. RESULTS: The leaders expressed surprise at how large and unexpected an economic burden dengue places on households. They also acknowledged that large investments of household and government resources to combat dengue have not had the expected results. Many were not ready to see community preventive measures as a substitute for chemical controls but all the leaders approved the formation of "brigades" to promote chemical-free household control efforts in their own communities. CONCLUSIONS: Discussions centred on household budget decisions provide a good entry point for researchers to engage with communities, especially when the evidence showed that current expenditures were providing a poor return. People became motivated not only to search for ways to reduce their costs but also to question the current response to the problem in question. This in turn helped create conditions favourable to community mobilisation for change. TRIAL REGISTRATION: ISRCTN27581154 .

Assuntos

RESUMO

We discuss two ethical issues raised by Camino Verde, a 2011-2012 cluster-randomised controlled trial in Mexico and Nicaragua, that reduced dengue risk though community mobilisation. The issues arise from the approach adopted by the intervention, one called Socialisation of Evidence for Participatory Action. Community volunteer teams informed householders of evidence about dengue, its costs and the life-cycle of Aedes aegypti mosquitoes, while showing them the mosquito larvae in their own water receptacles, without prescribing solutions. Each community responded in an informed manner but on its own terms. The approach involves partnerships with communities, presenting evidence in a way that brings conflicting views and interests to the surface and encourages communities themselves to deal with the resulting tensions.One such tension is that between individual and community rights. This tension can be resolved creatively in concrete day-to-day circumstances provided those seeking to persuade their neighbours to join in efforts to benefit community health do so in an atmosphere of dialogue and with respect for personal autonomy.A second tension arises between researchers' responsibilities for ethical conduct of research and community autonomy in the conduct of an intervention. An ethic of respect for individual and community autonomy must infuse community intervention research from its inception, because as researchers succeed in fostering community self-determination their direct influence in ethical matters diminishes. TRIAL REGISTRATION: ISRCTN 27581154.

Assuntos