Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review.

BACKGROUND: Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS: Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS: 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION: Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.

[To improve body image with dance therapy]. / Améliorer l'image du corps avec la danse-thérapie.

Body image is a multidimentional organisation which participates in the construction of the identity. It stems from the body schema and changes throughout life. Dance therapy creates a link between the psychic and the physical self. It works on the cognitive, social and personal aspect of the personality. During forteen years, the Service of Therapeutic Education for Chronic Diseases of the University Hospital of Geneva developed a dance therapy program for obese patients.The effect of a dance therapy treatment on body image has been evaluated and compared to control groups. Our results show a great improvement on quality of life, self esteem and body self esteem and mental representations of oneself.

L'image du corps est une organisation multidimensionnelle, subjective qui participe à la construction de l'identité. Elle est issue des représentations du schéma corporel et se modifie au cours des ans. La danse-thérapie crée un lien entre le corps psychique et physique de la personne. Elle agit sur le plan cognitif, affectif et social. Pendant 14 ans, le service d'enseignement thérapeutique pour maladies chroniques, aux Hôpitaux Universitaires de Genève, a développé un programme de danse-thérapie pour les personnes souffrant d'obésité. L'effet de la danse-thérapie sur l'image du corps a été évalué. La comparaison avec des groupes de contrôle montre que la danse-thérapie permet d'améliorer significativement la qualité de vie, l'estime de soi et l'estime corporelle et les représentations mentales.

Dance therapy combined with patient education improves quality of life of persons with obesity: A pilot feasibility study for a randomised controlled trial.

OBJECTIVE: To assess the effect of dance therapy combined with patient education on quality of life, functional capacity (lower limb power and endurance) and physical activity level in obese individuals. METHODS: Thirty-three obese patients were randomised to a control group (structured patient education ambulatory program), and 34 to an intervention group (structured patient education ambulatory program combined with weekly sessions of dance therapy). Patients' quality of life, physical function and physical activity level were assessed at baseline and after 16 weeks. RESULTS: Almost only women were willing to enrol in the study. Participants of the intervention group significantly improved their quality of life (p=0.023), and particularly self-esteem (p=0.014). However, dance therapy added to a patient educational program did not produce statistically significant higher effects than a patient education program alone on functional capacities and patients' physical activity level. CONCLUSION: A 16 week structured patient educational program combined with dance therapy seems to have a positive effect on the quality of life of obese people, but no effect on functional capacities and physical activity. PRACTICE IMPLICATION: Dance therapy combined with structured patient education is an interesting approach to improve quality of life of obese people.

Effectiveness and efficacy of nutritional therapy: A systematic review following Cochrane methodology.

BACKGROUND & AIMS: Disease-related malnutrition has deleterious consequences on patients' outcome and healthcare costs. The demonstration of improved outcome by appropriate nutritional management is on occasion difficult. The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed the Nutrition Education Study Group (ESPEN-NESG) to increase recognition of nutritional knowledge and support in health services. METHODS: To obtain the best available evidence on the potential effects of malnutrition on morbidity, mortality and hospital stay; cost of malnutrition; effect of nutritional treatment on outcome parameters and pharmaco-economics of nutritional therapy, a systematic review of the literature was performed following Cochrane methodology, to answer the following key questions: Q1) Is malnutrition an independent predictive factor for readmission within 30 days from hospital discharge? Q2) Does nutritional therapy reduce the risk of readmission within 30 days from hospital discharge? Q3) Is nutritional therapy cost-effective/does it reduce costs in hospitalized patients? and Q4) Is nutritional therapy cost effective/does it reduce costs in outpatients? RESULTS: For Q1 six of 15 identified observational studies indicated that malnutrition was predictive of re-admissions, whereas the remainder did not. For Q2 nine randomized controlled trials and two meta-analyses gave non-conclusive results whether re-admissions could be reduced by nutritional therapy. Economic benefit and cost-effectiveness of nutritional therapy was consistently reported in 16 identified studies for hospitalized patients (Q3), whereas the heterogeneous and limited corresponding data on out-patients (Q4) indicated cost-benefits in some selected sub-groups. CONCLUSIONS: This result of this review supports the use of nutritional therapy to reduce healthcare costs, most evident from large, homogeneous studies. In general, reports are too heterogeneous and overall of limited quality for conclusions on impact of malnutrition and its treatment on readmissions.

[Oxytocin: metabolic effects and potential use for obesity treatment]. / Nutrition-obésité. Effets métaboliques de l'ocytocine et ses applications potentielles pour le traitement de l'obésité.

Oxytocin is a hormone known for a long time, mainly used in the field of gynecology. Apart from these well-defined effects, the role of oxytocin in controlling the stress response or behavior and the regulation of glucose/lipid metabolism seems to be very interesting, especially in obese patients. Several clinical studies are currently underway to assess the impact of oxytocin in the treatment of obesity. Taking these new data into consideration, the use of this hormone for weight loss in obese patients or as a complementary treatment in diabetic patients seems to be promising.

[Biofeedback: a new method for the prevention of amputations in patients with diabetes]. / Biofeedback: nouvelle méthode pour la prévention des amputations chez les patients diabétiques.

Lower limb amputations in patients with diabetes are still a huge public health problem. Despite of our knowledge and advanced technical tools, the incidence of amputations and they relapses remain very high and inacceptable. A key role in primary and secondary prevention of amputations is the foot off-loading. We dispose different off-loading devices and techniques which are efficient on short term. However, knowledge about its long term efficacy is missing. In this article, we review different methods of foot off-loading. We also describe a new method for diabetic foot off-loading based on the biofeedback technique we recently developed.

Dance therapy improves self-body image among obese patients.

OBJECTIVE: Obesity and disturbed eating behaviors are both associated with low self-esteem and distorted body images. The aim of this study was to assess the influence of a dance therapy program on the evolution of mental representations linked to body image among obese patients. Changes in body image were evaluated in terms of four parameters: physical, psychological, cognitive, and social. METHODS: In total, 18 obese patients were enrolled in a longitudinal dance therapy workshop (DTW) program lasting 36 weeks. Patients danced for 2h per week and were evaluated three times: at baseline, after 18 weeks, and at the end of the study (36 weeks). Evaluation was performed using questionnaires addressing health-related quality of life, sensorial-motor perception, and mental representations linked to body schema and self-body image. RESULTS: Obese patients enrolled in the DTW displayed a significant improvement in health-related quality of life (p<0.03), body consciousness (p<0.001), and mental representations linked to self body image (p<0.001). CONCLUSION: DTW allowed obese patients to reset both their somatic and psychic consciousness of their body image. PRACTICE IMPLICATIONS: Patients are usually reluctant to practice physical activity. Dance therapy improves not only body image, but also psycho-social aspects of their personality.

[The dilemma between the functional deficits of obese people and recommended physical activity: what part can dance therapy play?]. / Déficits fonctionnels des personnes obèses et rôle de la danse-thérapie.

Obese people may have trouble with walking and may present reduced postural control. Medical doctors or therapists should guide the patient to restart doing physical activities that are gentle and progressive. Exercise should take into account walking difficulties. Thus, the first challenge is to help obese individuals start exercising without risk, or excessive strain on the joints. The second stage should encourage individuals to persevere in the chosen activity. Enjoyment is a key factor for attaining these objectives. Dance therapy, with its psychological and physiological impact, could help individuals take on the challenge.

Biofeedback training for partial weight bearing in patients after total hip arthroplasty.

OBJECTIVE: To evaluate a new biofeedback training method based on visual delivery of information in patients after total hip arthroplasty (THA). DESIGN: Intervention study with prepost design. SETTING: Hospitalized care in a university referral center. PARTICIPANTS: Patients (N=11) (age 56.1+/-9.0 y) shortly after THA. INTERVENTION: A mobile system has been used for biofeedback training with the predefined partial weight bearing (PWB) threshold of 20 kg. After the learning period, 4 retention tests, consisting of 3 successive walking cycles without feedback, were recorded for each patient: (1) acquisition test, (2) early retention test (after 30 min), (3) the day after, and (4) after 2 days. MAIN OUTCOME MEASURE: The pressure error and the maximum pressure force at each step before and after biofeedback training. RESULTS: A significant difference of pressure errors between the beginning and the end of the learning period has been measured (42.5+/-22.5 N vs 3.7+/-11.4N, P<.001). However, there was no difference between the beginning of the learning period and different retention tests (after 30 minutes, after 1 day, after 2 days). In terms of maximal pressure force, there was a difference between the beginning and the end of learning (251 N vs 195 N, P<.05). The retention tests did not show significant differences compared with the baseline values. CONCLUSIONS: THA patients were able to use the defined PWB during a short period of time and shortly after stopping the training; both the pressure errors and the maximal pressure force attended the values before training. These results confirm the difficulties to achieve PWB in patients after THA.

[Nutrition-obesity. Rimonabant and cardiovascular risk factors]. / Nutrition-obésité. Rimonabant et facteurs de risque cardiovasculaire.

Cardiovascular mortality remains the first cause of death worldwide. This high mortality rate is directly associated with the increase of cardiovascular risk factors such as: obesity, hypertension, diabetes and hypercholesterolemia. Current tight management and new pharmacological treatment of cardiovascular risk factors decrease the cardiovascular mortality rate in general population. However, insulin resistance, hypo-adiponectinemia and inflammatory factors persist and are linked with atherosclerosis. Additional therapeutic solutions are needed. Rimonabant, a CB1-blocker brings novel perspective to manage several cardiovascular risk factors. Unfortunately, Rimonabant has been withdrawn from the market. Therefore, it has not been possible to assess in long term its efficacy on cardiovascular mortality.