Non-pharmacological intervention study of hypercholesterolemia among middle-aged people

Middle-aged people with a serum total cholesterol of more than 220 mg/dl at the latest health examination (n=197) at a chemical company were invited to join a health education program for 6 months. Participants meeting inclusion criteria were randomly assigned to an intervention (n=96) and a control group (n=92). Periodical interviews and blood tests were performed every 2 months for both groups. The intervention group was educated by health professionals in the factories through programs developed for hypercholesterolemia. After a 6-month intervention, the reduction of cholesterol levels and the differences between the groups were analysed. The mean total cholesterol (TCH) levels at the baseline measurement were 239.7 mg/dl in the intervention group and 236.5 mg/dl in the control group. During the intervention period, decreased levels of TCH were 27.1 mg/dl for the intervention group and 18.5 mg/dl for the control group. Declines in body weight, TCH and triglyceride levels in the intervention group were significantly larger than those in the control group. The decline of apoprotein-B was also significantly larger in the intervention group while high-density lipoprotein cholesterol levels essentially did not change. The health education by health professionals proved to be useful in reducing the risk factor levels for coronary heart disease. These results suggest that health education would also be useful against other major risk factors in cardiovascular diseases.     

Implementation of a Pilot School-site Cholesterol Reduction Intervention

A school-based cholesterol reduction intervention was offered to primary grade students in two New York City public schools. Subjects were participating in the "Know Your Body" school health program which includes an annual cholesterol screening for all students. Students with total serum cholesterol values greater than 170 mg/dl were eligible for a workshop designed to teach students to identify the amount and type of fat and fiber in various foods and to recognize the negative health consequences of eating a diet high in cholesterol and saturated fat as well as the benefits of eating a diet high in complex carbohydrate and fiber. Thirty-four students completed the five-session behavioral group intervention. Following the workshop, mean total cholesterol for the 34 intervention participants fell 9.0% from baseline (196.9 mg/dl to 179.1 mg/dl). Cholesterol levels decreased 6.6% for a matched sample of comparison subjects (n = 118) participating only in the "Know Your Body" program. While several methodological limitations existed in this pilot study, the results suggest school-site cholesterol reduction interventions for high-risk individuals are feasible, cost-effective, and potentially efficacious.     

Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention

We are pleased to present the European Guidelines on Cardiovascular Disease Prevention, translated and adapted by the Interdisciplinary Spanish Committee for Cardiovascular Disease Prevention. This guide is focused on the prevention of cardiovascular disease as a whole, recommending the SCORE model for risk assessment and placing priority on the care of patients and high-risk individuals. The objective is to prevent premature death due to CVD by means of dealing with its related risk factors in clinical practice. Hence, a maintained professional intervention is required in order to obtain an increase of physical activity and of healthy diets in patients high-risk individuals, and smoking cessation in smokers. The decision to start blood pressure treatment will depend upon the BP values, cardiovascular risk and possible damage to target organs. The treatment goal is to achieve BP < 140/90 mmHg, but among patients with diabetes, chronic kidney disease, a past history of ictus, coronary heart disease or heart failure, lower levels must be pursued. Serum cholesterol must be below 200 mg/dl and LDL cholesterol below 130 mg/dl, although among patients with CVD or diabetes, levels respectively below 175 mg/dl and 100 mg/dl must be pursued. Advice of a professional dietitian is always required in order to keep blood sugar levels controlled. Proper insulin therapy is required in Type I diabetes. Patients with Type II diabetes and those with metabolic syndrome must lose weight and increase their physical activity.,dngus beiln aiministered wherever applicable. Lastly, an appendix is included providing diet recommendations adapted to our environment and criteria related to referral or seeing a specialist for hypertensive or dyslipemic patients.     

Identifying gaps in the continuum of care for hypertension and diabetes in two Indian communities

Background

Non-communicable diseases (NCDs) represent the largest, and fastest growing, burden of disease in India. This study aimed to quantify levels of diagnosis, treatment, and control among hypertensive and diabetic patients, and to describe demand- and supply-side barriers to hypertension and diabetes diagnosis and care in two Indian districts, Shimla and Udaipur.

Methods

We conducted household and health facility surveys, as well as qualitative focus group discussions and interviews. The household survey randomly sampled individuals aged 15 and above in rural and urban areas in both districts. The survey included questions on NCD knowledge, history, and risk factors. Blood pressure, weight, height, and blood glucose measurements were obtained. The health facility survey was administered in 48 health care facilities, focusing on NCD diagnosis and treatment capacity, including staffing, equipment, and pharmaceuticals. Qualitative data was collected through semi-structured key informant interviews with health professionals and public health officials, as well as focus groups with patients and community members.

Results

Among 7181 individuals, 32% either reported a history of hypertension or were found to have a systolic blood pressure?≥?140 mmHg and/or diastolic ≥90 mmHg. Only 26% of those found to have elevated blood pressure reported a prior diagnosis, and just 42% of individuals with a prior diagnosis of hypertension were found to be normotensive. A history of diabetes or an elevated blood sugar (Random blood glucose (RBG) ≥200 mg/dl or fasting blood glucose (FBG) ≥126 mg/dl) was noted in 7% of the population. Among those with an elevated RBG/FBG, 59% had previously received a diagnosis of diabetes. Only 60% of diabetics on treatment were measured with a RBG <200 mg/dl. Lower-level health facilities were noted to have limited capacity to measure blood glucose as well as significant gaps in the availability of first-line pharmaceuticals for both hypertension and diabetes.

Conclusions

We found high rates of uncontrolled diabetes and undiagnosed and uncontrolled hypertension. Lower level health facilities were constrained by capacity to test, monitor and treat diabetes and hypertension. Interventions aimed at improving patient outcomes will need to focus on the expanding access to quality care in order to accommodate the growing demand for NCD services.

     

A Randomized-Controlled, Pilot Intervention on Diabetes Prevention and Healthy Lifestyles in the New York City Korean Community

Asian Americans experience diabetes at a higher rate than non-Hispanic whites. Diabetes prevention programs using lifestyle interventions have been shown to produce beneficial results, yet there have been no culturally-tailored programs for diabetes prevention in the Korean community. We explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve health behaviors and promote diabetes prevention among Korean Americans using a randomized controlled trial. Between 2011 and 2012, a total of 48 Korean Americans at risk for diabetes living in New York City (NYC) participated in the intervention. Participants were allocated to treatment or control groups. A community-based participatory research approach guided development of the intervention, which consisted of 6 workshops held by CHWs on diabetes prevention, nutrition, physical activity, diabetes complications, stress and family support, and access to health care. Changes over 6 months were examined for clinical measurements (weight, BMI, waist circumference, blood pressure, glucose, and cholesterol); health behaviors (physical activity, nutrition, food behaviors, diabetes knowledge, self-efficacy, and mental health); and health access (insurance and self-reported health). In this small pilot study, changes were seen in weight, waist circumference, diastolic blood pressure, physical activity nutrition, diabetes knowledge, and mental health. Qualitative findings provide additional contextual information that inform ways in which CHWs may influence health outcomes. These findings demonstrate that a diabetes prevention program can be successful among a Korean American population in NYC, and important insight is provided for ways that programs can be tailored to meet the needs of vulnerable populations.     

Effects of Physical Examination and Diet Consultation on Serum Cholesterol and Health-behavior in the Korean Pilots Employed in Commercial Airline

An objective of this study is to search how physical examination and diet consultation can influence those risk factors of cardiovascular disease. The subjects were 326 pilots of the “B” airline company in Korea whose total cholesterol values were over 220 mg/dl on their regular physical examinations from April 2006 to December 2008. They were divided into two groups, one who had diet consultation (an intervention group) and a control group. The physical examination components used to each group were body mass index (BMI), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL) and triglyceride (TG). The behavioral, anthropometric and biomedical measurements were collected at each visit. This study compares and investigates the changes of serum cholesterol and also the health-behavior at each physical examination. Within the intervention group significant improvements were observed for total cholesterol, BMI (body mass index) and HDL (high density lipoprotein). The normalizing rates for cholesterol level to decrease down to lower than 200 mg/dl were 17.7% in intervention group and 8.7% in control group, which is statistically significantly higher among the intervention group. The odds ratio of diet consultation was 2.80 (95% CI=1.35–5.79), which indicates that it is a significantly contributing factor to normalize the serum cholesterol value down to lower than 200 mg/dl. Based on result, it is recommended to have regular physical examination and intensive management with diet and exercise consultation.     

Pattern of coronary artery disease risk factors in population younger than 55 years and above 55 years: a population study of 31999 healthy individuals

More than eighty percent of patients with coronary heart diseases (CHD) have conventional risk factors. Prevalence of well known risk factors seems to show a different pattern in younger patients and individual above 55 years. To evaluate the pattern of conventional CHD risk factors in healthy individuals in two different age groups. A large scale population based survey of 31999 individuals from ten medical centers was designed. Screening of risk factors was performed upon these protocols: taking medical history, physical examination and blood tests of complete blood cell counts, fasting blood sugar, lipid profile, urinalysis and creatinine. Prevalence of the risk factors in healthy people aged above 55 years were: 8.1% for systolic blood pressure (SBP)>140 mmHg, 3.8% for diastolic blood pressure (DBP)>90 mmHg, 13.9% for fasting blood glucose (FBS)≥126 Mg/dl, 36.9% for total cholesterol>200 Mg/dl, 19.2% for triglyceride (TG)>200 Mg/dl, 67.8% for HDL-c<40 Mg/dl, 27.2% for LDL-c>130 Mg/dl, 4.72 for TC/HDL-c ratio, 2.88 for LDL-c/HDL/c ratio and 4.24 for TG/HDL-c ratio. Prevalence of risk factors in individuals younger than 55 years were: 1.7% for SBP>140 mmHg, 1.2% for DBP>90 mmHg, 5.2% for FBS≥126 Mg/dl, 31.3% for TC>200 Mg/dl, 21.5% for TG>200 Mg/dl, 69.4% for HDL-c<40 Mg/dl, 23.2% for LDL-c>130 Mg/dl, 4.7 for TC/HDL-c ratio, 2.83 for LDL-c/HDL-c ratio and 4.43 for TG/HDL-c ratio. In univariate model of analysis: prevalence of the risk factors were significantly higher in age above 55 years than in people younger than 55 years except for hypertriglyceridemia and HDL-c<40 Mg/dl. In a multivariate model of logistic regression, pattern of following CHD risk factors remained to demonstrate a statistically significance difference between two age groups: FBS≥126 Mg/dl P=0.006, TG>200 Mg/dl P= 0.002, HDL-c<40 Mg/dl P= 0.019, education status P=0.001, sex P=0.012, and SBP>140 mmHg P=0.001. Pattern of such a CHD risk factors of FBS≥126 Mg/dl, TG>200 Mg/dl, HDL-c<40 Mg/dl, education status, sex and SBP>140 mmHg demonstrated a statistically significant difference in the age above 55 years to the healthy people younger than 55 years. These results cab be implicated to set up prediction models for stratifying individuals at higher risk of CHD.     

Dietary intervention for cholesterol reduction in public clinic patients

Objectives: To test the feasibility and effectiveness of a diet intervention (consisting of interactive mailings, computer-generated phone calls, and classes) in hypercholesterolemic low-income public clinic patients.Methods: Clinic patients with serum cholesterol >200 mg/dl, referred by their primary care physician were randomized to a 6-month special intervention (SI) or usual care (UC). The intervention included mailings, computer phone calls, and four 1-hour classes. Serum total cholesterol (TC) was measured before and after intervention, and participation was monitored.Results: One hundred sixty-five of the 212 patients referred (77.8%) agreed to participate. A medical records review revealed 123 (74.5%) met eligibility criteria. Eligible subjects had a mean age of 56.7 years, 80.0% were African American, 74.8% were female, 33.6% were married, and 89.4% had a high school or lower education. Subjects were randomized with 80.5% (99) completing follow-up cholesterol measures. SI subjects were encouraged to use all three components, with 84.6% (55 of 65) actively participating in at least one component. Seventy-two percent (47 of 65) returned at least one mailing, 49.1% (28 of 57) of those with touch-tone phones accessed the computer system, and 43.1% (28 of 65) attended classes. The TC in SI decreased from 273.2 mg/dl to 265.0 mg/dl (P = 0.05) and in UC 272.4 mg/dl to 267.6 mg/dl (P = 0.32). The net reduction in SI compared with UC was 3.4 mg/dl (P = 0.58).Conclusions: (1) Low-income public clinic patients will participate in diet interventions, (2) computer-generated interactive phone calls are feasible in this population, and (3) clinically meaningful decreases in serum cholesterol are difficult to achieve with interventions of practical intensity.     

社区干预对我国2型糖尿病疗效影响的Meta分析

目的系统评价社区干预对2型糖尿病疗效的影响。方法检索万方数据库、维普资源信息系统、中国期刊全文数据库、中国生物医学文献数据库及Pubmed数据库中,2006年以来发表的有关社区干预对我国2型糖尿病疗效影响的相关文献。分析软件采用Stata 12.0。结果共纳入22篇文献,累计干预组患者1 723例,对照组患者1 674例。Meta分析结果显示,干预组空腹血糖（SMD=0.726,95%CI: 0.359～1.092）,餐后2 h血糖（SMD=0.798,95%CI: 0.407～1.127）、糖化血红蛋白（SMD=0.735,95%CI: 0.251～1.219）、总胆固醇（SMD=0.476,95%CI: 0.098～0.855）、甘油三酯（SMD=0.721,95%CI: 0.227～1.214）,均低于对照组,差异均有统计学意义（均P＜005）。结论社区干预对2型糖尿病病情控制效果显著,建议对2型糖尿病患者采取积极的社区干预措施。     

Diabetes risk factors, diabetes and diabetes care in a rural Australian community

OBJECTIVE: To comprehensively describe diabetes-related risk factors, quality of care and patient-perceived barriers to care in a rural community. DESIGN: Cross-sectional mail study, self-completed survey and retrospective chart review. SETTING: Community and health services in Corryong, rural Victoria, Australia. PARTICIPANTS: Ninety-seven patients with diabetes and 495 with other diseases in the mail study, 84 with diabetes in the self-completed survey and 101 diabetic patient chart reviews. MAIN OUTCOME MEASURES: Self-reported lifestyle activities, uptake of health checks, metabolic measures and uptake of medication, and self-reported barriers to diabetes care. RESULTS: Most residents without diabetes had recently had their blood pressure and cholesterol checked; 60.4% were trying to control their weight and 73.9% were exercising regularly (although only 30.7% to an adequate level). Those with diabetes reported a greater uptake of healthy living messages, and had a mean HbA1c of 7.3%, total cholesterol of 5.0 mmol L(-1); 12.9% had a diastolic blood pressure > or =85 mmHg. Foot checks were infrequent (18%). There was substantial room to increase antiplatelet, blood pressure, antihyperglycaemia and lipid-lowering therapy. Most patients reported psychological (84.5%) and educational (82.1%) barriers to care, with few perceiving physical barriers to care. CONCLUSION: Living in a rural area with predominantly GP care can be associated with comparatively good metabolic control, although psycho-educational barriers are frequently present. In the wider community, risk factors for diabetes remain common, and the majority have been screened for components of the metabolic syndrome in the previous year.     

Quality of diabetes care in primary care setting in egypt: an example of health sector reform in developing countries

The aim of this study was to evaluate the extent of provider adherence to evidence-based guidelines for diabetes care and the extent of glycemic, blood pressure, and lipid control in patients with diabetes in a developing country. A retrospective cohort study was carried out to evaluate diabetes care provided under Health Sector Reform Program (HSRP) in a major medical center in Alexandria, Egypt. Data on care provided for 137 patients were abstracted from medical records. Several process measures were studied including annual proportion of patients with measurements of blood glucose, blood pressure, and lipid levels. Patient outcomes on these measures were also examined. Logistic and poisson regressions were used to study factors related to having measurements done and number of measurements respectively. Multilevel analysis was then used to examine rate of change in patient outcomes and factors associated with this rate over one year of follow-up. For 137 patients with diabetes, annual testing was adequate for fasting blood glucose (FBG) (94.1%), blood pressure (100%), foot (92.7%), and fundus examination (86.6%) was adequate. On the other hand less attention was given to total cholesterol (60.6%), triglycerides (52.6%) and albuminuria (10.3%). At the end of 1 year follow-up, 89.2% did not meet the target level of fasting blood glucose of < 130 mg/dl. A total of 40.2% and 46.7% did not meet the goal of 130 mmHg for systolic and 80 mmHg for diastolic blood pressure. Fifty nine percent, and 76.4% did not meet the goal of total cholesterol level of <200 mg/dl, or triglycerides level of <150 mg /dl respectively. There was evidence of suboptimal treatment with insulin, antihypertensive drugs, and lipid- lowering drugs. This study demonstrates that diabetes care provided under HSRP is unsatisfactory. As a result more effort to increase compliance with evidence based guidelines in diabetes care is needed.     

Metabolic control in a nationally representative diabetic elderly sample in Costa Rica: patients at community health centers vs. patients at other health care settings

Background

Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM), especially among its elderly population. This article has two goals: (1) to assess the level of metabolic control among the diabetic population age ≥ 60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control.

Methods

Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions.

Results

Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin ≥ 7%; 78% have systolic blood pressure ≥ 130 mmHg; 66% have diastolic blood pressure ≥ 80 mmHg; 48% have triglycerides ≥ 150 mg/dl; 78% have LDL ≥ 100 mg/dl; 70% have HDL ≤ 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings.

Conclusion

Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to underserved and poor areas.     

The impact of the Guidelines for a Healthy Diet of The Netherlands Nutrition Council on total and high density lipoprotein cholesterol in hypercholesterolemic free-living men.

To study the impact of dietary intervention on the plasma total and high density lipoprotein cholesterol (HDL cholesterol) levels in hypercholesterolemic men, the authors selected 80 male participants in a monitoring risk factor project carried out in Amsterdam, The Netherlands. These men had plasma total cholesterol levels of between 6.5 and 10.0 mmol/liter (between 251 and 387 mg/dl) and were randomly assigned to either the intervention (n = 39) or the control (n = 41) group. At the start of the intervention period, after 5 weeks, and after 26 weeks, both the intervention and the control groups were examined. This examination consisted of a measurement of height, weight, plasma total and HDL cholesterol, and a dietary interview. The intervention program consisted of a personalized dietary advice to the respondent, based on the report of the Netherlands Nutrition Council. The study took place between September 1987 and November 1988. Because of this intervention program, the plasma total and HDL cholesterol levels decreased. The difference in change in plasma total cholesterol between the intervention and control groups was 0.47 mmol/liter (18 mg/dl) after 5 weeks and 0.30 mmol/liter (12 mg/dl) after 26 weeks. For HDL cholesterol, a significant difference in change after 5 weeks disappeared after 26 weeks. The public health implications of the decrease in plasma total cholesterol are discussed.     

常熟市成人血脂异常与糖尿病关系研究

目的 探讨常熟市成人血脂异常和糖尿病的关系,为预防和控制糖尿病的发生发展,制定防治策略和措施提供科学依据。方法 采用多阶段整群随机抽样方法,随机抽取常熟市6个乡镇/街道≥18岁的成人居民进行一对一面对面问卷调查并体检,分析血脂异常和糖尿病的关系。结果 共对11 809名居民进行了调查,男性4 776人,女性7 033人,平均年龄（59.46±11.93）岁;调查居民中有6 366人血脂异常,血脂异常率为53.91%,其中总胆固醇（TC）异常率为28.91%,总甘油三酯（TG）异常率为37.14%,高密度脂蛋白胆固醇（HDL-C）异常率为7.53%;成人居民中糖尿病患者1 416人,糖尿病患病率为11.99%。多因素Logistic回归分析结果显示血脂异常、TG异常和HDL-C异常者的糖尿病患病风险分别是正常人的1.351、1.320、1.629倍,TG每增加1个标准差,糖尿病风险增加21.9%,HDL-C每增加1个标准差,糖尿病患病风险降低22.0%。结论 常熟市成人血脂异常和糖尿病密切相关,应加强血脂的常规检测,预防及控制糖尿病的发生发展。     

Community cholesterol screenings: the impact of follow-up letters and incentives on retest rates and biometric changes in follow-up screenings

Abstract Total serum cholesterol was measured for 12,067 people as part of a community-based cholesterol screening program in New South Wales, Australia, in the fall of 1987. Forty-three percent had levels over 210 mg/dl and the average was 207 mg/dl. Those with levels over 210 mg/dl were counseled on how to reduce their cholesterol level and invited to take a second test in four to five months. Subjects were randomly allocated to one of three interventions: testing and counseling plus either 1) a reminder letter one month before the retest, 2) all of the above plus additional information on nutrition and exercise, or 3) all of the above plus a lottery ticket giving them a chance to win a microwave oven if they completed the retest. A total of 3,157 (60.8%) returned for the retest. There was no significant difference between the three intervention conditions in participation rates and a number of biometric measures. These results suggest that additional health information and prize incentives do not enhance rates of return for retest or changes in dietary and exercise behaviors within the context of a community screening program in Australia.     

Peer Reviewed: Using Resident Health Advocates to Improve Public Health Screening and Follow-Up Among Public Housing Residents,Boston, 2007-2008

Introduction

Promoting screening for hypertension, high cholesterol, diabetes, and dental disease, particularly among residents of public housing, is a key strategy for achieving the objectives of Healthy People 2010. This community-based participatory research study tested a resident health advocate (RHA) intervention in public housing to increase use of mobile screening and to assess postscreening follow-up care for people with positive screening results.

Methods

During the summers of 2007 and 2008, a mobile health unit screened residents at 4 housing developments for hypertension, high cholesterol, diabetes risk, and dental disease. In the first summer, at 2 intervention sites, RHAs used personal contacts and repeated flyers to recruit residents; 2 control sites received standard recruitment, which was to leave flyers with the development manager. In the second summer, the 2 control sites from the previous year became intervention sites. For both summers combined, we calculated the number of people at intervention and control sites who used the van and we examined rates of appointments made and kept for residents who had positive screening test results.

Results

Screening rates were higher in the intervention condition compared with the control condition (relative risk [RR], 1.55; 95% confidence interval [CI], 1.12-2.15). Approximately 65% of participants screened positive for at least 1 condition. The proportion of participants with screen-positive findings who had follow-up appointments increased from 15% in 2007 to 55% in 2008.

Conclusion

The use of RHAs increased participation in health screening among public housing residents and rates of follow-up medical visits for people with positive screening results.     

农村地区家庭医生团队干预脑卒中高危人群的效果研究*

目的探讨农村地区家庭医生团队管理对脑卒中高危人群的干预效果。方法选择在上海市浦东新区大团镇社区卫生服务中心慢性病登记管理在册的脑卒中高危患者280例,将其随机分为干预组和对照组,干预组在家庭医生团队的管理下采取社区综合健康教育措施和随访,对照组采取传统的健康教育方法,分析干预前后两组患者临床指标变化情况。结果干预组在干预前后自身比较,吸烟比例、饮酒比例均有所下降(P<0.05),血压正常比例和BMI正常比例均有提高(P<0.05);干预组与对照组比较,吸烟比例和饮酒比例下降更为明显(P<0.05);干预组干预后患者遵从医护计划、寻求健康促进行为和对疾病认识的比例比干预前有所提高,同时体育锻炼次数≥4次/周的比例从9.29%提高到54.29%(P<0.01),与对照组比较,干预组遵从医护计划、寻求健康促进行为和体育锻炼次数≥4次/周的比例更高(P<0.05);干预组患者干预后SBP、DBP、TC、TG、LDL-C和Hcy水平均有下降(P<0.01或P<0.05),HDL-C较干预前有所升高(P<0.01)。干预组患者干预后评分和10年卒中风险较干预前明显降低(P<0.01),干预组患者干预后评分和10年卒中风险低于对照组(P<0.01或P<0.05)。结论家庭医生团队对脑卒中高危人群采用社区综合健康教育干预改变了患者健康相关行为,促进了患者临床指标的改善。     

Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans

BACKGROUND: African Americans suffer disproportionately from diabetes complications, but little research has focused on how to improve diabetic control in this population. There are also few or no data on a combined primary care and community-based intervention approach. METHODS: We randomly assigned 186 urban African Americans with type 2 diabetes (76% female, mean A SD age 59 A 9 years) to 1 of 4 parallel arms: (1) usual care only; (2) usual care + nurse case manager (NCM); (3) usual care + community health worker (CHW); (4) usual care + nurse case manager/community health worker team. Using the framework of the Precede-Proceed behavioral model, interventions included patient counseling regarding self-care practices and physician reminders. RESULTS: The 2-year follow-up visit was completed by 149 individuals (84%). Compared to the Usual care group, the NCM group and the CHW group had modest declines in HbA(1c) over 2 years (0.3 and 0.3%, respectively), and the combined NCM/CHW group had a greater decline in HbA(1c) (0.8%. P = 0.137). After adjustment for baseline differences and/or follow-up time, the combined NCM/CHW group showed improvements in triglycerides (-35.5 mg/dl; P = 0.041) and diastolic blood pressure, compared to the usual care group (-5.6 mmHg; P = 0.042). CONCLUSIONS: Combined NCM/CHW interventions may improve diabetic control in urban African Americans with type 2 diabetes. Although results were clinically important, they did not reach statistical significance. This approach deserves further attention as a means to reduce the excess risk of diabetic complications in African Americans.     

A randomized study of the impact of home health aides on diabetic control and utilization patterns

Home health aides were offered to half of a group of 227 low-income diabetic clinic patients; in the group offered aides, fasting blood sugar (FBS) declined when compared to control group (10.1 mg/dl vs an increase of 5.1 mg/dl), and missed clinic appointments and emergency room use also decreased. The group of 44, who, upon offer of an aide actually accepted one, showed a significant increase in eye clinic appointments as well as the greatest decline in FBS (13.9 mg/dl).