Pandemic-related impairment in the monitoring of patients with hypertension and diabetes and the development of a digital solution for the community health worker: quasi-experimental and implementation study (Preprint)

BACKGROUND The restrictions imposed by the COVID-19 pandemic reduced the access of patients with chronic diseases to health services. The discontinuity of care is a cause of great concern, mainly in vulnerable regions. OBJECTIVE To assess the impact of the COVID-19 pandemic on the frequency of consultations and control of people with hypertension and diabetes (DM) and to develop and implement a digital solution to improve monitoring at home. METHODS This is a multi-methodological study. A quasi-experimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary healthcare centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHW) to identify and address patients with uncontrolled hypertension or DM at risk. An expert panel assessment evaluated feasibility, usability and utility of the software. RESULTS From 5070 patients, 4810 had hypertension (94.87%), 1371 had DM (27.4%) and 1111 (23.1%) had both diseases. There was a significant reduction in the weekly number of consultations (107 [IQR 60.0, 153.0] before vs 20.0 [IQR 7.0, 29.0] after social restriction, P<.001). Only 15.2% of all patients returned for consultation during the pandemic. Individuals with hypertension had lower systolic (120.0 [IQR 120.0-140.0] and diastolic blood pressure (80.0 [IQR 80.0-80]) than the ones that did not return (130.0 [IQR 120.0-140.0] and (80.0 [IQR 80.0-90.0]), P<.001. Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve the treatment. CONCLUSIONS The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful and easily incorporated into their routines.

Download Full-text

Implementation of the PIERS on the Move mHealth Application From the Perspective of Community Health Workers and Nurses in Rural Mozambique

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.659582 ◽

2021 ◽

Vol 2 ◽

Author(s):

Helena Boene ◽

Anifa Valá ◽

Mai-Lei Woo Kinshella ◽

Michelle La ◽

Sumedha Sharma ◽

...

Keyword(s):

Health Care ◽

At Risk ◽

Community Health ◽

Community Health Workers ◽

Health Care Workers ◽

Self Efficacy ◽

Health Workers ◽

Perceived Usefulness ◽

Care Workers ◽

The Impact

Background:mHealth is increasingly regarded as having the potential to support service delivery by health workers in low-resource settings. PIERS on the Move (POM) is a mobile health application developed to support community health workers identification and management of women at risk of adverse outcomes from pre-eclampsia. The objective of this study was to evaluate the impact of using POM in Mozambique on community health care workers' knowledge and self-efficacy related to caring for women with pre-eclampsia, and their perception of usefulness of the tool to inform implementation.Method: An evaluation was conducted for health care workers in the Mozambique Community Level Intervention for Pre-eclampsia (CLIP) cluster randomized trial from 2014 to 2016 in Maputo and Gaza provinces (NCT01911494). A structured survey was designed using themes from the Technology Acceptance Model, which describes the likelihood of adopting the technology based on perceived usefulness and perceived ease of use. Surveys were conducted in Portuguese and translated verbatim to English for analysis. Preliminary analysis of open-ended responses was conducted to develop a coding framework for full qualitative analysis, which was completed using NVivo12 (QSR International, Melbourne, Australia).Results: Overall, 118 community health workers (44 intervention; 74 control) and 55 nurses (23 intervention; 32 control) were surveyed regarding their experiences. Many community health workers found the POM app easy to use (80%; 35/44), useful in guiding their activities (68%; 30/44) and pregnant women received their counseling more seriously because of the POM app (75%; 33/44). Almost a third CHWs reported some challenges using the POM app (30%; 13/44), including battery depletion after a full day's activity. Community health workers reported increases in knowledge about pre-eclampsia and other pregnancy complications and increases in confidence, comfort and capacity to advise women on health conditions and deliver services. Nurses recognized the increased capacity of community health workers and were more confident in their clinical and technological skills to identify women at risk of obstetric complications.Conclusions: Many of the community health workers reported that POM improved knowledge, self-efficacy and strengthened relationships with the communities they serve and local nurses. This helped to strengthen the link between community and health facility. However, findings highlight the need to consider program and systematic challenges to implementation.

Download Full-text

Community Health Workers as a Strategy to Tackle Psychosocial Suffering Due to Physical Distancing: A Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063097 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3097

Author(s):

Dorien Vanden Bossche ◽

Susan Lagaert ◽

Sara Willems ◽

Peter Decat

Keyword(s):

Randomized Controlled Trial ◽

Community Health ◽

Health Workers ◽

Psychosocial Support ◽

Controlled Trial ◽

Intervention Group ◽

Psychosocial Health ◽

Control Group ◽

Randomized Controlled ◽

The Impact

Background: During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

Download Full-text

European Respiratory Society Statement on Sleep Apnoea, Sleepiness and Driving Risk

European Respiratory Journal ◽

10.1183/13993003.01272-2020 ◽

2020 ◽

pp. 2001272

Author(s):

Maria R Bonsignore ◽

Winfried Randerath ◽

Sofia Schiza ◽

Johan Verbraecken ◽

Mark W Elliott ◽

...

Keyword(s):

At Risk ◽

Motor Vehicle ◽

Task Force ◽

Present Report ◽

Sleep Apnoea ◽

Accident Risk ◽

European Respiratory Society ◽

Obstructive Sleep ◽

Patients At Risk ◽

The Impact

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure (CPAP) has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk for OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a Task Force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA, the mechanisms involved in this association, the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance, the impact of treatment on MVA risk in affected drivers, and highlights the evidence gaps regarding the identification of OSA patients at risk for MVA.

Download Full-text

The Effect of Music Therapy on Problem-Solving Skills

Journal of Sociological Research ◽

10.5296/jsr.v6i2.8979 ◽

2016 ◽

Vol 6 (2) ◽

pp. 169

Author(s):

Zeinab Sirous Jahedi ◽

Nasser Amini Khoi

Keyword(s):

Problem Solving ◽

Music Therapy ◽

Sampling Method ◽

Average Score ◽

Control Group ◽

Problem Solving Skills ◽

Statistical Population ◽

Quasi Experimental ◽

And Control ◽

The Impact

<p>The aim of the present research was study of the impact of music therapy on problem-solving skills of 4 to 6 years old children in Tehran. This research was a quasi-experimental study with pretest-posttest control group. The statistical population was all 4 to 6 years old children in region 2 of Tehran. Using the random sampling method, the study sample was chosen in two experiment (15 individuals) and control (15 individuals) groups. The experiment group received 12 sessions of music therapy and the control group was waiting for treatment meanwhile. To evaluate the problem-solving skill in children, the three subscales of Wechsler’s Preschool and Primary Scale of Intelligence (WPPSI) were used, including: mazes, cubes and arithmetic. Analysis of data obtained from the questionnaires was conducted in two parts of descriptive and inferential. The data analysis indicated the significant increase of problem-solving average score of the experiment group compared to the control group.</p>

Download Full-text

Community Health Workers as a Strategy to Tackle Psychosocial Suffering due to Physical Distancing: A Randomized Controlled Trial

10.20944/preprints202103.0097.v1 ◽

2021 ◽

Author(s):

Dorien Vanden Bossche ◽

Susan Lagaert ◽

Sara Willems ◽

Peter Decat

Keyword(s):

Randomized Controlled Trial ◽

Community Health ◽

Health Workers ◽

Psychosocial Support ◽

Controlled Trial ◽

Intervention Group ◽

Psychosocial Health ◽

Control Group ◽

Randomized Controlled ◽

The Impact

Background: During the COVID-19 pandemic some family physicians were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psycho-social support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW in-terventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

Download Full-text

The influence of the dynamics and the level of maturity of the cortical functions as a prerequisite for the development of speech in children

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh180510046d ◽

2019 ◽

Vol 147 (3-4) ◽

pp. 199-204

Author(s):

Maja Davidovic ◽

Jadranka Otasevic ◽

Nada Dobrota-Davidovic ◽

Ivana Petronic ◽

Dragomir Davidovic ◽

...

Keyword(s):

Motor Control ◽

Evoked Potentials ◽

Physiological Changes ◽

Articulation Disorder ◽

Significant Difference ◽

Cortical Responses ◽

Quasi Experimental ◽

Waveform Amplitude ◽

And Control ◽

The Impact

Introduction/Objective. The development of speech is the result of interaction of different systems of the cortex, which gradually acquires the ability of phonological presentation and motor control, in the presence of a series of physical and physiological changes in the morphology of the articulation system. The objective of the study was to examine the impact of laterality and cortical responses on the development of speech in children. Methods. Research is a quasi-experimental design with two groups. The sample covered 60 children from Belgrade, of both sexes, ages 5.5?7 years, divided into two groups, experimental (30) and control (30). We used the following instruments: test for assessing laterality and ascertaining evoked potentials. Results. On the visual lateralization subtest there was a statistically significant difference (?2 = 7.56, p < 0.05) between the observed groups. The visual evoked potentials on all measured parameters gave a statistically significant difference between the groups: waveform cortical responses ? left (?2 = 30.00, df = 1, p < 0.05); cortical responses ? right (?2 = 6.667, df = 1 , p < 0.05); waveform amplitude ? left (?2 = 13.469, df = 1, p < 0.05); amplitude ? right (?2 = 40.00, df = 1, p < 0.05), somatosensory potentials (?2 = 18.261, df = 1, p <0.05); waveform amplitude (?2 = 12.000, df = 1, p < 0.05); waveform latency (?2 = 5.455, df = 1, p < 0.05). Conclusion. Visual laterality, as well as visual and somatosensory cortical responses to stimuli is better in children without the present articulation disorder, which could be used for timely prevention planning.

Download Full-text

The Burden of COVID-19 Infection in a Rural Tamil Nadu Community

10.21203/rs.3.rs-289385/v1 ◽

2021 ◽

Author(s):

Rita Isaac ◽

Biswajit Paul ◽

Madelon Finkel ◽

Mahesh Moorthy ◽

Seshasailam Venkateswaran ◽

...

Keyword(s):

Community Health ◽

Tamil Nadu ◽

Health Workers ◽

Extended Family ◽

Community Health Center ◽

Vulnerable Groups ◽

Severe Illness ◽

Suspected Case ◽

Antibody Testing ◽

The Impact

Abstract Background: There are almost 11 million cases of COVID-19 in India. Transmission rates vary from region to region, and are influenced by many factors including population susceptibility, travel and uptake of preventive measures. To date there have been relatively few studies examining the impact of the pandemic in poor, rural regions of India. We report on a study examining COVID-19 burden in a rural community in Tamil Nadu.Methods: The study was undertaken in a population of approximately 130000 people, served by the Rural Unit of Health and Social Affairs (RUHSA), a community health center of CMC, Vellore. We established and evaluated a COVID-19 PCR-testing programme for symptomatic patients – testing was offered to 350 individuals, and household members of test-positive cases were offered antibody testing. We also undertook two COVID-19 seroprevalence surveys in the same community, amongst 701 randomly-selected individuals. Results: There were 182 positive tests in the symptomatic population (52.0%). Factors associated with test-positivity were older age, male gender, higher socioeconomic status (SES, as determined by occupation, education and housing), a history of diabetes, contact with a confirmed/suspected case and attending a gathering (such as a religious ceremony, festival or extended family gathering). Amongst test-positive cases, 3 (1.6%) died and 16 (8.8%) suffered a severe illness. Amongst 129 household contacts 40 (31.0 %) tested positive. The two seroprevalence surveys showed positivity rates of 2.2% (July/Aug 2020) and 22.0% (Nov 2020). 40 tested positive (31.0%, 95% CI: 23.02 -38.98). Our estimated infection-to-case ratio was 31.7.Conclusions: A simple approach using community health workers and a community-based testing clinic can readily identify significant numbers of COVID-19 infections in Indian rural population. There appear, however, to be low rates of death and severe illness, although vulnerable groups may be under-represented in our sample. It’s vital these poor, rural populations aren’t overlooked in ongoing pandemic monitoring and vaccine roll-out in India.

Download Full-text

Abstract 038: A Novel Histology Based Classification System to Identify Patients at Risk for Postoperative Atrial Fibrillation

Circulation Research ◽

10.1161/res.113.suppl_1.a038 ◽

2013 ◽

Vol 113 (suppl_1) ◽

Author(s):

Mahek Mirza ◽

Anton Strunets ◽

Ekhson Holmuhamedov ◽

Jasbir Sra ◽

Paul H Werner ◽

...

Keyword(s):

Atrial Fibrillation ◽

At Risk ◽

Classification System ◽

Area Under The Curve ◽

Postoperative Atrial Fibrillation ◽

Right Atrial ◽

Class Iii ◽

Atrial Fibrosis ◽

Patients At Risk ◽

The Impact

Postoperative atrial fibrillation (PoAF) is a common complication in up to 40% of patients after cardiac surgery, increasing morbidity, hospital stay and costs. The myocardial substrate underlying PoAF is not fully characterized. The objective was to assess the impact of atrial fibrosis on incident AF and define the fibrosis threshold level predictive of PoAF. Methods: Right atrial appendages removed from patients undergoing elective CABG with no history of AF or class III/IV heart failure were used to characterize the ratio of collagen to myocardium (Masson’s trichrome; NIH ImageJ software; Fig A), which was correlated with incident AF. Percentage burden of fibrosis predictive of PoAF with high sensitivity and specificity was determined by ROC curve. Results: Of 28 patients (67±10 years, 64% males), 15 had PoAF. There were no age, gender or comorbidity differences between groups. Compared to the group that remained in sinus rhythm, patients with PoAF had a significantly higher ratio of extracellular collagen to myocardium (45±16% vs. 5±4%, p <0.001; Fig B). A threshold ratio of 12.7% collagen to myocardium (ROC area under the curve 0.997; z statistic 137; P<0.0001) with 96% sensitivity and 97% specificity identified those with PoAF (Fig C). A classification system based on histological extent of atrial fibrosis is proposed for identifying patients at risk for PoAF (Fig D). Conclusion: Ongoing studies will confirm the predictive value of this new classification system for identifying the atrial substrate predisposing PoAF and correlate with preoperative cardiac imaging and circulatory serum biomarkers to provide a novel noninvasive tool to stratify patients at risk for PoAF.

Download Full-text

A nurse-led telephone triage for the prevention and control of COVID-19 spread in an oncology department.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13617 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13617-e13617

Author(s):

Lorenzo Calvetti ◽

Francesca Simionato ◽

Alessandro Cappetta ◽

Francesca La Russa ◽

Roberta Cimenton ◽

...

Keyword(s):

Medical Treatment ◽

Cancer Patients ◽

Health Workers ◽

Veneto Region ◽

Telephone Triage ◽

Period 2 ◽

Anticancer Treatment ◽

Hospital Acquired ◽

And Control ◽

The Impact

e13617 Background: After the results of the Nurse-led Telephone Triage (NTT) study ( Calvetti L, et al. ASCO 2020), the system has been implemented to prevent unnecessary hospitalizations of cancer patients. With the pandemic outbreak, a dedicated SARS-CoV-2 2019 (COVID-19) NTT protocol was added to monitor cancer patients (CPs) receiving active medical treatment. We report on the impact of NTT in limiting accesses and minimizing the risk of spread of the infection through the Department of Oncology. Methods: CPs on active medical treatment were educated to call the NTT in case of any symptoms suspected for COVID-19 infection to the Oncology Department of Vicenza, Italy, during the COVID-19 pandemic (February 22 2020 to January 31, 2021). Each event assessment was performed by trained oncology nurses with the supervision of a medical oncologist on duty and in case of suspected COVID-19 infection a testing pathway for COVID-19 was activated. Primary endpoint of this study was to compare incidence of COVID-19 and related deaths in both CPs on active medical treatment and health workers with the rate in the overall population of Veneto region. Results: From February 22 2020 to January 31, 2021 1,154 patients received systemic anticancer treatment (versus 1,022 patients in the same 2019 – 2020 period). Total consultations at NTT were 587; 97 patients reported symptoms suspected for COVID-19 infections. The COVID-19 testing pathway was launched in 60 CPs and a positive test was reported in 25 CPs (2.2% incidence compared to 6.5% in the overall Veneto region population). Two COVID-19 related deaths were reported (8% death rate). In the same period, 2/54 (3.7%) health workers tested positive for COVID-19. Patients who tested positive had a median treatment delay of 25 days. Conclusions: The NTT system in the clinical practice provided a useful tool for monitoring and limiting hospital-acquired COVID-19 infection among both CPs on active treatment and health workers.

Download Full-text

A mixed-methods evaluation of the impact of a person-centered family planning intervention for community health workers on family planning outcomes in India

BMC Health Services Research ◽

10.1186/s12913-020-05995-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nadia Diamond-Smith ◽

Claire McDonell ◽

Ananta Basudev Sahu ◽

Kali Prasad Roy ◽

Katie Giessler

Keyword(s):

Mixed Methods ◽

Family Planning ◽

Community Health ◽

San Francisco ◽

Health Workers ◽

Qualitative Interviews ◽

Centered Care ◽

The University ◽

Care Worker ◽

The Impact

Abstract Background Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention. Conclusions More research is needed on how to intervene to change behaviors related to person-centered family planning. Trial registration This study received IRB approval from the University of California, San Francisco (IRB # 15–25,950) and was retrospectively registered at clinicaltrials.gov (NCT04206527).

Download Full-text