The Challenges of Implementing a Text Message Intervention to Promote Behavioral Change in Primary Care Patients With Hypertension and Diabetes

Abstract Background Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions. Objective To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change. Methods A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes. Results Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%). Conclusion An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program's long-term effects on clinical outcomes.

Crescimento e marcadores bioquímicos de recém-nascidos prematuros até os seis meses de idade corrigida / Growth and biochemical markers of preterm newborns up to six months of corrected age

INTRODUCTION: Due to advances in recent decades in maternal-foetal and neonatal medicine, a greater survival of preterm infants with progressively smaller birth weight and gestational age is observed, increasing the risk of future morbidities on those infants. Among these morbidities, alterations in growth and metabolism are found. OBJECTIVE: To analyze the evolution of the growth and the metabolic profile of preterm infants' cohort from birth at six months of corrected age (CA) METHODS: A descriptive and prospective study with a sample of 107 mothers and 115 preterm infants at birth and 72 preterm infants and 68 mothers at the end of follow-up. Growth (body weight, height, cephalic perimeter) was evaluated at six time points. Plasma concentrations of cholesterol, triglycerides, glucose and insulin of premature infants were assessed during three periods, from birth to 6 months of CA. Comparative analysis of the initial sample and the sample that finished the follow-up was used in chi-square family tests. To Evaluate the growth over the 6-month period by using repeated measurements. RESULTS: Sociodemographic variables and maternal biochemical profile without statistical differences in the comparison of the mothers of the initial sample with those who completed the follow-up. Linear growth of preterm infants at six months of CA, however without recovery of growth. Plasma concentrations of triglycerides (birth = 48.1, 6 months = 151.1) and cholesterol (birth = 82.7, 6 months = 139.9) increased during the evaluations. Glycaemia remained stable (birth 80.4, 6 months = 83.3) and insulin decreased from 11.0 to 4.2. CONCLUSION: Growth of preterm infants, although linear, was lower than expected for age. Lipid profiles presented an ascending curve from birth onward. Therefore, this group is prone to delayed growth and to developing cardiovascular changes throughout life.

INTRODUÇÃO: Com os avanços nas últimas décadas na medicina materno-fetal e neonatal, observa-se maior sobrevida de crianças prematuras com peso de nascimento e idade gestacional progressivamente menores, elevando riscos de morbidades futuras. Dentre as quais, alterações do crescimento e no metabolismo dessas crianças. OBJETIVO: Analisar a evolução do crescimento e o perfil metabólico de uma coorte de prematuros do nascimento aos seis meses de idade corrigida. MÉTODO: Estudo de descritivo, prospectivo, amostra de 107 mães e 115 recém-nascidos prematuros, ao nascimento e 72 lactentes prematuros e 68 mães ao término do seguimento. Crescimento (peso corporal, estatura, perímetro cefálico) avaliado em seis momentos. Concentrações plasmáticas de colesterol, triglicerídeos, glicose e insulina dos prematuros avaliadas em três períodos, do nascimento aos seis meses de Idade Corrigida (IC). Análise da comparação da amostra inicial com amostra que finalizou o seguimento mediante testes da família qui quadrado. Para a avaliação do crescimento ao longo dos seis meses, a análise ocorreu por meio de delineamento de medidas repetidas. RESULTADOS: Variáveis sociodemográficas e perfil bioquímico materno sem diferenças estatísticas entre mães da amostra inicial e aquelas que finalizaram o seguimento. Crescimento linear dos prema turos da alta aos seis meses de IC, contudo sem recuperação do crescimento. Concentrações plasmáticas de triglicerídeos (nascimento=48,1; 6 meses=151,1) e colesterol (nascimento=82,7; 6 meses=139,9), aumentaram no decorrer das avaliações. Glicemia permaneceu estável (nascimento=80,4; 6 meses=83,3) e insulina reduziu de 11,0, para 4,2). CONCLUSÃO: O crescimento dos recém-nascidos prematuros, apesar de linear, inferior ao esperado para idade. Perfil lipídico apresentou curva ascendente desde o nascimento.