Community engagement interventions for communicable disease control in low- and lower- middle-income countries: evidence from a review of systematic reviews.

BACKGROUND: Community engagement (CE) interventions include a range of approaches to involve communities in the improvement of their health and wellbeing. Working with communities defined by location or some other shared interest, these interventions may be important in assisting equity and reach of communicable disease control (CDC) in low and lower-middle income countries (LLMIC). We conducted an umbrella review to identify approaches to CE in communicable disease control, effectiveness of these approaches, mechanisms and factors influencing success. METHODS: We included systematic reviews that: i) focussed on CE interventions; ii) involved adult community members; iii) included outcomes relevant to communicable diseases in LLMIC; iv) were written in English. Quantitative results were extracted and synthesised narratively. A qualitative synthesis process enabled identification of mechanisms of effect and influencing factors. We followed guidance from the Joanna Briggs Institute, assessed quality with the DARE tool and reported according to standard systematic review methodology. RESULTS: Thirteen systematic reviews of medium-to-high quality were identified between June and July 2017. Reviews covered the following outcomes: HIV and STIs (6); malaria (2); TB (1); child and maternal health (3) and mixed (1). Approaches included: CE through peer education and community health workers, community empowerment interventions and more general community participation or mobilisation. Techniques included sensitisation with the community and involvement in the identification of resources, intervention development and delivery. Evidence of effectiveness of CE on health outcomes was mixed and quality of primary studies variable. We found: i) significantly reduced neonatal mortality following women's participatory learning and action groups; ii) significant reductions in HIV and other STIs with empowerment and mobilisation interventions with marginalised groups; iii) significant reductions in malaria incidence or prevalence in a small number of primary studies; iv) significant reductions in infant diarrhoea following community health worker interventions. Mechanisms of impact commonly occurred through social and behavioural processes, particularly: changing social norms, increasing social cohesion and social capacity. Factors influencing effectiveness of CE interventions included extent of population coverage, shared leadership and community control over outcomes. CONCLUSION: Community engagement interventions may be effective in supporting CDC in LLMIC. Careful design of CE interventions appropriate to context, disease and community is vital.

Relationship between glycemic control and coronary artery disease severity, prevalence and plaque characteristics by computed tomography coronary angiography in asymptomatic type 2 diabetic patients.

Evaluate whether glycemic control in type 2 diabetes (DM2) asymptomatic for coronary artery disease (CAD) affects not only the presence and magnitude of CAD but also the characteristics of plaque vulnerability using multidetector row computed coronary tomography (MDCT). Acute coronary syndrome (ACS) is frequently observed in asymptomatic DM2 patients. Positive vessel remodeling (PR) and low-attenuation plaques (LAP) identified by MDCT have been demonstrated to be characteristics of subsequent culprit lesions of ACS. However, little is known regarding plaque characteristics in asymptomatic diabetic patients and their relationship with glycemic control. Ninety asymptomatic DM2 patients, aged 40-65 years old, underwent MDCT. The presence of atherosclerotic obstruction, defined as coronary stenosis ≥50 %, and plaque characteristics were compared between two groups of patients with A1c < 7 and A1c ≥ 7 %. Of the 90 patients, 38 (42.2 %) presented with coronary atherosclerotic plaques, 11 had A1c < 7 % and 27 had A1c ≥ 7 % (p = 0.0006). Fourteen patients had significant lumen obstruction higher than 50 %: 3 in the A1c < 7 % group and 11 in the A1c ≥ 7 % group (p = 0.02). Non-calcified plaque was more prevalent in the A1c ≥ 7 % group (p = 0.005). In eleven patients, the simultaneous presence of two vulnerability plaque characteristics (PR and LAP) were observed more frequently in the A1c ≥ 7 group (n = 8) than in the A1c < 7 group (n = 3) (p = 0.04). Asymptomatic DM2 patients with A1c ≥ 7 % have a higher frequency of CAD and a higher proportion of vulnerable atherosclerotic coronary plaque by MDCT compared to patients with DM2 with A1c < 7 in our study.

Evidence of association between GDF5 polymorphisms and congenital dislocation of the hip in a Caucasian population.

OBJECTIVE: Congenital dislocation of the hip (CDH) is a multifactorial disease which involves genetic factors that are still unidentified. Recently, a functional polymorphism (rs143383) of the 5'-untranslated region of GDF5 (Growth/Differentiation Factor 5) - previously reported to be associated with osteoarthritis - has been associated with CDH in a Chinese population. The aim of our study was to determine whether GDF5, known to be involved in bone, joint and cartilage morphogenesis, is also associated with CDH in Caucasians. DESIGN: We genotyped three tagSNPs (rs224334, rs143384, rs143383) in 239 cases and 239 controls from western Brittany (France) where CDH is frequent, and tested the association using both single-locus and haplotype-based approaches. RESULTS: The most significant association was observed with rs143384. The T allele of this SNP was overrepresented in cases (65.9% vs 55.9%, P=0.002). Under a recessive model, carriers of the TT genotype had a 1.71-fold higher risk of developing CDH than carriers of the other genotypes (OR(TT vs CT+CC)=1.71, 95% CI: [1.18-2.48], P=0.005). At a nominal level, the association was also significant with rs143383 (OR(TT vs CT+CC)=1.52, 95% CI: [1.05-2.19], P=0.026). The haplotype carrying the susceptibility alleles of these SNPs was also more frequent in cases (65.9% vs 55.9%, OR=1.53, 95% CI: [1.18-1.98], P=0.002). CONCLUSION: This study reports, for the first time, the association between GDF5 polymorphisms and CDH in Caucasians, and points out another polymorphism of interest that requires further investigation. Reduction in GDF5 expression might lead to developmental deficiency of ligaments and capsule in hip joint, and therefore contribute to CDH pathogenesis.

Do HOXB9 and COL1A1 genes play a role in congenital dislocation of the hip? Study in a Caucasian population.

OBJECTIVE: Congenital dislocation of the hip (CDH), which is one of the most common congenital skeletal disorders, corresponds to an abnormal seating of the femoral head in the acetabulum. It is commonly admitted that CDH presents a genetic component. However, little is known about the genetic factors involved. This study aimed to determine the role of two potential candidate genes on chromosome 17 in CDH: HOXB9 (involved in limb embryonic development) and COL1A1 (involved in joint laxity). METHOD: We set up a case-control association study (239 cases and 239 controls) in western Brittany (France) where CDH is particularly frequent. The set of informative single nucleotide polymorphisms (SNPs) in each gene was selected using Tagger and genotyped using the SNaPshot method (n=2 and n=10, respectively). The association was tested both through single-locus and haplotype-based analyses, using SAS and Haploview softwares. In addition, we carried out the transmission disequilibrium test (TDT) with the same polymorphisms from a sample of 81 trios (i.e., 81 patients included in the case-control study and their both parents). RESULTS: The case-control study revealed no significant association between CDH and the tagSNPs selected in both HOXB9 and COL1A1. Moreover, the TDT did not reveal distortion in allelic and haplotype transmission of the studied markers. CONCLUSION: Our study did not support an association between HOXB9 and COL1A1 and CDH in our population. These negative findings were obtained by population- and family-based designs. Analysis of the genetic component of CDH should focus on other candidate genes.

Efeitos da hidroterapia na recuperação do equilíbrio e prevenção de quedas em idosas / Effects of hydrotherapy in balance and prevention of falls among elderly women

CONTEXTO: A hidroterapia é utilizada para tratar doenças reumáticas, ortopédicas e neurológicas. Na atualidade, é alvo de investigações na recuperação do equilíbrio em idosos. OBJETIVO: Avaliar o efeito de um programa de hidroterapia no equilíbrio e no risco de quedas em idosas. MÉTODOS: Trata-se de um estudo quase-experimental antes/depois sem grupo controle. Foram avaliadas 25 idosas por meio de duas escalas, a Escala de Equilíbrio de Berg e Timed Up & Go. Posteriormente, foram submetidas a um programa de hidroterapia para equilíbrio, de baixa a moderada intensidade, que consistiu de três fases: fase de adaptação ao meio aquático, fase de alongamento e fase de exercícios estáticos e dinâmicos para equilíbrio. O programa foi aplicado durante 12 semanas, sendo duas sessões semanais com 40 minutos de duração cada sessão. As idosas foram reavaliadas após a sexta e a 12ª semanas do programa de hidroterapia. Os dados foram analisados estatisticamente pelo teste t, para amostras pareadas, e pelo teste de Wilcoxon. RESULTADOS: A hidroterapia promoveu aumento significativo do equilíbrio das idosas, avaliado por meio da Escala de Equilíbrio de Berg (p< 0,001) e teste Timed Up & Go (p< 0,001), e ainda, redução do risco de quedas (p< 0,001), de acordo com o modelo de Shumway-Cook et al. CONCLUSÕES: Pode-se sugerir que este programa de hidroterapia para equilíbrio aumentou o equilíbrio e reduziu o risco de quedas nas idosas.

BACKGROUND: Hydrotherapy is used to treat rheumatic, orthopedic and neurological disorders. It has been the subject of investigations regarding balance recovery in elderly people. OBJECTIVE: To evaluate the effect of a hydrotherapy program for balance, in relation to the risk of falls in elderly women. METHODS: This was a quasi-experimental before/after study without a control group. Twenty-five elderly women were evaluated using two scales: the Berg Balance Scale and Timed Up & Go. The subjects underwent, subsequently, a low to moderate intensity hydrotherapy program for balance, which consisted of three phases: a phase of adaptation to the aquatic environment, a stretching phase and a phase of static and dynamic balance exercises. The program was applied for 12 weeks, with two sessions per week, each session lasting 40 minutes. The elderly women were reassessed after the sixth and twelfth weeks of the hydrotherapy program. The data were analyzed statistically by means of Student's t test for paired samples and the Wilcoxon test. RESULTS: Hydrotherapy promoted significant increases in the elderly women's balance, as assessed using the Berg Balance Scale (p< 0.001) and the Timed Up & Go test (p< 0.001). There was also a reduction of the scores in a scale of risk of falls (p< 0.001), according to the model of Shumway-Cook et al. CONCLUSIONS: It can be suggested that this hydrotherapy program for balance gave rise to an increase in balance and a possible reduction in the risk of falls among these aged women.

[Rehabilitation of the first dorsal interosseous muscle by transfer of the extensor pollicis brevis tendon]. / Réanimation du muscle premier interosseux dorsal par transfert du tendon court extenseur du pouce: à propos de huit cas.

Weakness of the pinch grip between index finger and thumb, in ulnar nerve palsy, leads to severe loss of hand function. The first dorsal interosseous plays a major rôle as it abducts and flexes the index finger at its base and stabilizes the MP joint of this finger. Replacement of this muscle is therefore important. The authors report the results of eight clinical cases of replacement of the first dorsal interosseous by extensor pollicis brevis. They obtained good improvement of hand function, in terms of objective and subjective results, in all cases.