Objective
To measure the effectiveness of implementing the chronic care model (CCM) in improving HIV clinical outcomes.Design
Multisite, prospective, interventional cohort study.Setting
Two urban community health centres in Vancouver and Prince George, BC.Participants
Two hundred sixty-nine HIV-positive patients (18 years of age or older) who received primary care at either of the study sites.Intervention
Systematic implementation of the CCM during an 18-month period.Main outcome measures
Documented pneumococcal vaccination, documented syphilis screening, documented tuberculosis screening, antiretroviral treatment (ART) status, ART status with undetectable viral load, CD4 cell count of less than 200 cells/mL, and CD4 cell count of less than 200 cells/mL while not taking ART compared during a 36-month period.Results
Overall, 35% of participants were women and 59% were aboriginal persons. The mean age was 45 years and most participants had a history of injection drug use that was the presumed route of HIV transmission. During the study follow-up period, 39 people died, and 11 transferred to alternate care providers. Compared with their baseline clinical status, study participants showed statistically significant (P < .001 for all) increases in pneumococcal immunization (54% vs 84%), syphilis screening (56% vs 91%), tuberculosis screening (23% vs 38%), and antiretroviral uptake (47% vs 77%), as well as increased viral load suppression rates among those receiving ART (72% vs 90%). Stable housing at baseline was associated with a 4-fold increased probability of survival. Aboriginal ethnicity was not associated with better or worse outcomes at baseline or at follow-up.Conclusion
Application of the CCM approach to HIV care in a marginalized, largely aboriginal patient population led to improved disease screening, immunization, ART uptake, and virologic suppression rates. In addition to addressing underlying social determinants of health, a paradigm shift away from an “infectious disease” approach to a “chronic disease management” approach to HIV care for marginalized populations is strongly recommended. 相似文献![点击此处可从《Nephrology (Carlton, Vic.)》网站下载免费的PDF全文](/ch/ext_images/free.gif)
OBJECTIVE
To assess the efficacy of curcumin in delaying development of type 2 diabetes mellitus (T2DM) in the prediabetic population.RESEARCH DESIGN AND METHODS
This randomized, double-blinded, placebo- controlled trial included subjects (n = 240) with criteria of prediabetes. All subjects were randomly assigned to receive either curcumin or placebo capsules for 9 months. To assess the T2DM progression after curcumin treatments and to determine the number of subjects progressing to T2DM, changes in β-cell functions (homeostasis model assessment [HOMA]-β, C-peptide, and proinsulin/insulin), insulin resistance (HOMA-IR), anti-inflammatory cytokine (adiponectin), and other parameters were monitored at the baseline and at 3-, 6-, and 9-month visits during the course of intervention.RESULTS
After 9 months of treatment, 16.4% of subjects in the placebo group were diagnosed with T2DM, whereas none were diagnosed with T2DM in the curcumin-treated group. In addition, the curcumin-treated group showed a better overall function of β-cells, with higher HOMA-β (61.58 vs. 48.72; P < 0.01) and lower C-peptide (1.7 vs. 2.17; P < 0.05). The curcumin-treated group showed a lower level of HOMA-IR (3.22 vs. 4.04; P < 0.001) and higher adiponectin (22.46 vs. 18.45; P < 0.05) when compared with the placebo group.CONCLUSIONS
A 9-month curcumin intervention in a prediabetic population significantly lowered the number of prediabetic individuals who eventually developed T2DM. In addition, the curcumin treatment appeared to improve overall function of β-cells, with very minor adverse effects. Therefore, this study demonstrated that the curcumin intervention in a prediabetic population may be beneficial.The impacts of type 2 diabetes mellitus (T2DM) on global health care and economy are enormous (1). According to the World Health Organization, there are ∼311 million people worldwide who live with T2DM. This number continues to rise, especially in the newly developing and poorer countries in Asia and elsewhere. Because T2DM is currently incurable, a common treatment approach is to try to control the disease with lifelong use of antidiabetes drugs. Limiting the number of newly developed T2DM cases should be one of the better key strategies to restrict the global impacts of T2DM (2). In order to limit the number of new T2DM cases, the lifestyle of the prediabetic population has to be changed. However, this has been shown to be challenging (3). One of the alternative approaches to prevent development of T2DM is to intervene with the prediabetic population before disease progresses into fully developed T2DM (3). The intervention approach is appealing. It relies on timely identification of prediabetic individuals and provision of preventive treatment before the disease fully progresses. The intervention represents a chance for the diabetes-prone population to halt the disease progression and maintain a normal and healthy life. In recent years, several effective T2DM intervention regimens have been developed, with encouraging results (3–5). However, these regimens are not usually economically accessible, and they are not well-tolerated because of treatment-related toxicities (4,5). The focus now is to identify new effective therapeutic agents, with relatively low cost and low toxicity, that can be used regularly to control a progression of T2DM in the prediabetic population.Curcumin is the principal curcuminoid found in turmeric (Curcuma longa Linn.), a popular spice in Asian cuisine. It is widely consumed and generally believed to be beneficial for human health (6). Curcumin extract from rhizomes of turmeric has been shown to contain anti-inflammation and antidiabetic properties (7–13). In addition, it could delay development of T2DM, improve β-cell functions, prevent β-cell death, and reduce insulin resistance in animals (8–16). This study aimed to determine the effectiveness of curcumin extract as an intervention agent to prevent T2DM development. We assessed T2DM progression and several indicative T2DM parameters in a large randomized, double-blinded, and placebo-controlled cohort. We found that curcumin extract effectively reduced the number of prediabetic individuals who progressed toward T2DM as well as improved functions of β-cells. 相似文献Approximately 5 billion people do not have access to safe, timely, and affordable surgical and anesthesia care, with this number disproportionately affecting those from low–middle-income countries (LMICs). Perioperative mortality rates (POMRs) have been identified by the World Health Organization as a potential health metric to monitor quality of surgical care provided. The purpose of this systematic review was to evaluate published reports of POMR and suggest recommendations for its appropriate use as a health metric.
MethodsThe protocol was registered a priori with PROSPERO. A peer-reviewed search strategy was developed adhering with the PRISMA guidelines. Relevant articles were identified through Medline, Embase, CENTRAL, CDSR, LILACS, PubMed, BIOSIS, Global Health, Africa-Wide Information, Scopus, and Web of Science databases. Two independent reviewers performed a primary screening analysis based on titles and abstracts, followed by a full-text screen. Studies describing POMRs of adult emergency abdominal surgeries in LMICs were included.
ResultsA total of 7787 articles were screened of which 7466 were excluded based on title and abstract. Three hundred and twenty-one articles entered full-text screen of which 70 articles met the inclusion criteria. Variables including timing of POMR reporting, intraoperative mortality, length of hospital stay, complication rates, and disease severity score were collected. Complication rates were reported in 83% of studies and postoperative stay in 46% of studies. 40% of papers did not report the specific timing of POMR collection. 7% of papers reported on intraoperative death. Additionally, 46% of papers used a POMR timing specific to the duration of their study. Vital signs were discussed in 24% of articles, with disease severity score only mentioned in 20% of studies.
ConclusionPOMR is an important health metric for quantifications of quality of care of surgical systems. Further validation and standardization are necessary to effectively use this health metric.
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