Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru

Background Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders. Objective This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs). Methods Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up. Results The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings. Conclusions The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants’ depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings.

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Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru (Preprint)

10.2196/preprints.11698 ◽

2018 ◽

Author(s):

Paulo Menezes ◽

Julieta Quayle ◽

Heloísa Garcia Claro ◽

Simone da Silva ◽

Lena R Brandt ◽

...

Keyword(s):

Depressive Symptoms ◽

Pilot Study ◽

Mobile Phones ◽

Treatment Success ◽

Sao Paulo ◽

São Paulo ◽

Pilot Studies ◽

Middle Income ◽

Mhealth Intervention ◽

Physical Disorders

BACKGROUND Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders. OBJECTIVE This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs). METHODS Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up. RESULTS The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings. CONCLUSIONS The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants’ depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings.

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Recruitment, Training and Supervision of Nurses and Nurse Assistants for a taskshifting depression intervention in two RCTs in Brazil and Peru

10.21203/rs.3.rs-76085/v1 ◽

2020 ◽

Author(s):

Thais Izabel Ugeda Rocha ◽

Suzana Crismanis de Almeida Lopes Aschar ◽

Liliana Hidalgo ◽

Kate Daley ◽

Heloisa Garcia Claro ◽

...

Keyword(s):

Human Resources ◽

Task Shifting ◽

Sao Paulo ◽

São Paulo ◽

Middle Income ◽

Mhealth Intervention ◽

Middle Income Countries ◽

Technological Competence ◽

Training And Supervision ◽

Patients With Diabetes

Abstract Background: Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. Methods: We described and analyzed data related to the recruitment, training and supervision of 62 Nurse Assistants from the health system in Sao Paulo, Brazil and three hired Nurses in Lima, Peru. The data was collected from information provided by Nurses and Nurse Assistants, supervisor records from supervision meetings and the CONEMO platform database. Results: We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other’s experiences. Conclusion: Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings

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Recruitment, training and supervision of nurses and nurse assistants for a task-shifting depression intervention in two RCTs in Brazil and Peru

Human Resources for Health ◽

10.1186/s12960-021-00556-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Thais Izabel Ugeda Rocha ◽

Suzana Crismanis de Almeida Lopes Aschar ◽

Liliana Hidalgo-Padilla ◽

Kate Daley ◽

Heloísa Garcia Claro ◽

...

Keyword(s):

Human Resources ◽

Task Shifting ◽

Sao Paulo ◽

São Paulo ◽

Middle Income ◽

Mhealth Intervention ◽

Middle Income Countries ◽

Technological Competence ◽

Training And Supervision ◽

Patients With Diabetes

Abstract Background Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. Methods We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. Results We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other’s experiences. Conclusion Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).

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Use of doxycycline for leptospirosis after high-risk exposure in São Paulo, Brazil

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46651998000100012 ◽

1998 ◽

Vol 40 (1) ◽

pp. 59-61 ◽

Cited By ~ 39

Author(s):

Claudio R. GONSALEZ ◽

Jorge CASSEB ◽

Francisco G. V. MONTEIRO ◽

João B. PAULA-NETO ◽

Rufino B. FERNANDEZ ◽

...

Keyword(s):

Pilot Study ◽

Treated Group ◽

Sao Paulo ◽

Risk Exposure ◽

São Paulo ◽

High Exposure ◽

Igm Antibodies ◽

Igm Antibody ◽

Double Blinded ◽

Number Of Individuals

A clinical trial pilot study, double-blinded, randomized, and controlled with a placebo to assess the effectiveness of oral doxycycline (200 mg, single dose) in preventing leptospirosis after high exposure to potentially contamined water was performed in São Paulo, SP, Brazil. Confirmed cases were defined as those with leptospira IgM antibody and symptoms; asymptomatic cases were those presenting with IgM antibodies but no symptoms; and suspected cases were individuals with symptoms but no IgM antibody. Forty subjects were given doxycycline and 42 were given placebo. In the drug-treated group there were 2 confirmed cases, 11 asymptomatic cases, and 6 suspected cases. In the placebo group there were 5 confirmed, 6 symptomatic, and 5 suspected cases. Even though we found a protective association of doxycycline for confirmed leptospirosis cases (RR = 2.3) and seroconversion only (RR = 2.0), the association was not statistically significant because of the small number of individuals enrolled in this pilot study. We observed that the 22% of the volunteers already had IgM antibodies to leptospirosis at the first sampling. Finally, the attack rate to confirmed, asymptomatic, and suspected cases of Leptospirosis was 8.5%, 22%, and 13%, respectively, in this population.

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Aplicabilidade da classificação das intervenções e atividades de nutrição clínica em unidade hospitalar: estudo piloto/ Applicability of the clinical nutrition interventions classification and activities in a hospital unit: pilot study

Ciência Cuidado e Saúde ◽

10.4025/cienccuidsaude.v16i4.37263 ◽

2017 ◽

Vol 16 (4) ◽

Author(s):

Clotilde Oliveira ◽

Raquel Gaidzinski

Keyword(s):

Pilot Study ◽

Sao Paulo ◽

Clinical Nutrition ◽

São Paulo ◽

Nutrition Interventions ◽

Hospital Unit

Este estudo teve como objetivo avaliar a viabilidade do uso de uma classificação de intervenções/atividades executadas por nutricionistas no ambiente hospitalar e descrever o processo de trabalho destes profissionais. Pesquisa transversal, descritiva, observacional, realizada em um hospital público, no município de São Paulo. Participaram duas nutricionistas da unidade de internação cirúrgica. O instrumento aplicado contemplava o elenco de intervenções/atividades desenvolvidas pelos nutricionistas no Brasil. O tempo despendido pelos nutricionistas foi obtido pela observação direta e contínua das intervenções/atividades realizadas durante jornada de trabalho, por meio da técnica de tempo e movimento. Para análise dos dados, aplicou-se a estatística descritiva. O instrumento testado permitiu identificar todas as intervenções/atividades realizadas pelos nutricionistas, sem necessidade de alteração. Foram observadas 68,8% (22) intervenções/atividades. O tempo total observado correspondeu 1920 minutos. As nutricionistas despenderam a maior parte do tempo de trabalho em intervenções de cuidados diretos e indiretos (1406 minutos; 55,9%), espera (358 minutos; 18,6%), atividades pessoais (206,4 minutos; 10,8%) e deslocamento (205,4 minutos; 10,7%). O uso desse instrumento mostrou potencial para ser aplicado em unidades hospitalares brasileiras e forneceu dados preliminares sobre a prática profissional dos nutricionistas observados.

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Pilot study of a two-arm non-randomized controlled cluster trial of a psychosocial intervention to improve late life depression in socioeconomically deprived areas of São Paulo, Brazil (PROACTIVE): feasibility study of a psychosocial intervention for late life depression in São Paulo

BMC Public Health ◽

10.1186/s12889-019-7495-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Marcia Scazufca ◽

Maria Clara P. de Paula Couto ◽

Maiara Garcia Henrique ◽

Ana Vilela Mendes ◽

Alicia Matijasevich ◽

...

Keyword(s):

Pilot Study ◽

Feasibility Study ◽

Psychosocial Intervention ◽

Late Life ◽

Sao Paulo ◽

São Paulo ◽

Cluster Trial ◽

Late Life Depression ◽

Randomized Controlled ◽

Deprived Areas

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Salivary antibody detection in epidemiological surveys: a pilot study after a mass vaccination campaign against rubella in São Paulo, Brazil

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/0035-9203(95)90680-0 ◽

1995 ◽

Vol 89 (1) ◽

pp. 115-118 ◽

Cited By ~ 23

Author(s):

Raymundo Scares de Azevedo Neto ◽

Alison Richards ◽

David James Nokes ◽

Ana Silvia Barreiros Silveira ◽

Bernard John Cohen ◽

...

Keyword(s):

Pilot Study ◽

Vaccination Campaign ◽

Sao Paulo ◽

Mass Vaccination ◽

Antibody Detection ◽

São Paulo ◽

Mass Vaccination Campaign ◽

Epidemiological Surveys

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Patient-Perceived Barriers to Accessing Cleft Care at a Tertiary Referral Center in São Paulo, Brazil

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665618796018 ◽

2018 ◽

Vol 56 (5) ◽

pp. 639-645 ◽

Cited By ~ 1

Author(s):

Ananda Ise ◽

Camila Menezes ◽

Joao Batista Neto ◽

Saurab Saluja ◽

Julia R. Amundson ◽

...

Keyword(s):

Access To Care ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Sao Paulo ◽

Perceived Barriers ◽

Treatment Result ◽

São Paulo ◽

Orofacial Clefts ◽

Middle Income ◽

Referral Center

Background: In low- and middle-income countries, poor access to care can result in delayed surgical repair of orofacial clefts leading to poor functional outcomes. Even in Brazil, an upper middle-income country with free comprehensive cleft care, delayed repair of orofacial clefts commonly occurs. This study aims to assess patient-perceived barriers to cleft care at a referral center in São Paulo. Methods: A 29-item questionnaire assessing the barriers to care was administered to 101 consecutive patients (or their guardians) undergoing orofacial cleft surgery in the Plastic Surgery Department in Hospital das Clínicas, in São Paulo, Brazil, between February 2016 and January 2017. Results: A total of 54.4% of patients had their first surgery beyond the recommended time frame of 6 months for a cleft lip or cleft lip and palate and 18 months for a cleft palate. There was a greater proportion of isolated cleft palates in the delayed group (66.7% vs 33.3%). Almost all patients had a timely diagnosis, but delays occurred from diagnosis to repair. The mean number of barriers reported for each patient was 3.8. The most frequently cited barriers related to lack of access to care include (1) lack of hospitals available to perform the surgery (54%) and (2) lack of availability of doctors (51%). Conclusion: Delays from diagnosis to treatment result in patients receiving delayed primary repairs. The commonest patient-perceived barriers are related to a lack of access to cleft care, which may represent a lack of awareness of available services.

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Prevalence of Older Adult Disability and Primary Health Care Responsiveness in Low-Income Communities

Life ◽

10.3390/life10080133 ◽

2020 ◽

Vol 10 (8) ◽

pp. 133

Author(s):

Giovana Montoro Pazzini Watfe ◽

Lais Fajersztajn ◽

Euler Ribeiro ◽

Paulo Rossi Menezes ◽

Marcia Scazufca

Keyword(s):

Health Care ◽

Primary Health Care ◽

Family Physician ◽

Low Income ◽

Sao Paulo ◽

Individual Characteristics ◽

World Health ◽

São Paulo ◽

Middle Income ◽

Primary Health

In Brazil and in most low- and middle-income countries (LMICs), information about how prepared the health care system is for the rapid aging of the population is scarce. We investigated the prevalence of disability and areas of life affected by disability among elders of the public primary health care in São Paulo and Manaus, Brazil. We investigated whether people with disability visited a primary care professional more frequently, the individual characteristics associated with disability, and differences by city. We randomly selected participants aged ≥60 years (n = 1375). The main outcome was disability, evaluated with the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Exposure variables were consultation with a family physician, sociodemographic characteristics, health status, social support, and lifestyle. The prevalence of global disability was higher in Manaus (66.2% vs. 56.4% in São Paulo). In both cities, participation and mobility were the areas of life most affected by disability. The number of consultations with a family physician was not associated with disability. The high prevalence of disability and associated risk factors indicates that public primary health care is not meeting the needs of elders in both cities. It is warning because most elders in LMICs live in more underserved communities compared to Brazil.

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