The effectiveness of community-based interventions in the control of hypertension: A systematic review and meta-analysis

Introduction@#Uncontrolled hypertension can lead to increased morbidity and mortality secondary to end-organ damage. Community-based health interventions promote health changes in a community setting and have been shown to promote better and more cost-effective healthcare. Existing meta-analyses on community-based interventions in hypertension control are confined to a certain country, have high risks of bias, and have shown heterogeneous results. A gap in the applicability of these conclusions necessitates the present study@*Objective@#Synthesize available evidence on the effectiveness of community-based interventions in addition to standard of care in the control of blood pressure among hypertensive adults.@*Methods@#A meta-analysis of randomized and non-randomized controlled trials among hypertensive adults was conducted. A literature search from various search engines and electronic databases such as PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, Google Scholar, Proquest, medRvix, and Grey literature was done by the investigators. Separate forest plots were generated for each desired outcome.@*Results@#Six studies were included. The pooled estimates showed a trend in favor of community-based interventions in the control of blood pressure [RR = 0.86, 95% CI 0.62 to 1.19, p = 0.37], reduction of systolic blood pressure, reduction of diastolic blood pressure [MD = -2.52, 95% CI -3.64 to -1.28, p < 0.001] and medication adherence [RR = 0.82, 95% CI 0.72 to 0.93, p = 0.0025]. However, there was high heterogeneity across studies. Subgroup analysis showed a favorable trend with lower heterogeneity in decreasing diastolic BP in particular, among community health worker-led interventions, and those involving health education and/or physical activity@*Conclusions/Recommendations@#Adherence to the current standard of care in the management of hypertension is still advised. There appears to be a trend towards control of blood pressure with community-based interventions; and a reduction of diastolic blood pressure with interventions that are led by community health workers involving health education and/or physical activity. There is a need to empower community health workers and conduct additional studies on the specific community-based interventions targeting communities as a whole whenever resources and current health restrictions allow

Effectiveness of community-based interventions among patients with Osteoarthritis in family and community practice: A meta-analysis

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Osteoarthritis (OA) is a debilitating disease that impedes activities of daily living and negatively impacts the quality of life of affected patients. With an increasing elderly population in the Philippines and across the globe, the incidence and prevalence of OA is expected to rise, and thus, will continue to pose a significant burden to patients, caregivers and the society in general. Community-based programs are practical, easily accessible and potentially sustainable and often involve educational programs aiming at lifestyle changes from which patients suffering from osteoarthritis may benefit.<br /></p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to determine the effectiveness of community-based interventions in the management of OA, specifically in terms of improving symptoms and physical functioning among patients who are diagnosed with this condition.<br /></p><p style="text-align: justify;"><strong>METHODS:</strong> This meta-analysis only included randomized, parallel clinical trials involving patients diagnosed to have osteoarthritis. The authors searched for studies in peer reviewed journals of PubMed, clinical trials registered in Cochrane Central Register of Controlled Trials and the grey literature. Clinical trials where the intervention described involved the community or labelled as 'community-based' delivered as face-to-face or web-based, were identified. The main categories of approaches considered were: 1) community screening; 2) health education and advocacy; 3) community exercises; and 4) monitoring of treatment by community health workers. standard care. The primary outcome considered was reported improvement of pain, stiffness and physical function based on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The authors also looked at the patients' quality of life as a secondary outcome. They used the RevMan 5.4 software in the analysis of their data. Assessment of bias, subgroup analysis and sensitivity analysis were done. The overall results were evaluated using GRADE.<br /></p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 543 studies were initially identified based on the inclusion criteria, from which 12 studies were eventually included in the review. Community interventions identified in the review included 3 publications on water-based exercises, 5 on strengthening exercises, 2 on behavioral intervention and 3 on physiotherapy. Two studies included QOL as part of the outcomes. Meta-analysis was done using the Revman 5 software and revealed that the studies were heterogeneous based on p values 50%. Subgroup analyses of specific variables were done to further assess the impact of the interventions. Results revealed that while there was no statistical difference between intervention and control, a positive trend in favor of strengthening exercises versus control in improving WOMAC pain scores, stiffness scores and physical function scores were noted. There was a statistically significant difference noted in favor of community-based intervention in the impact on quality of life, specifically for mental and social aspects based on SF-36<br /></p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Based on these findings, we conclude that community-based interventions, specifically strengthening exercises, physiotherapy and behavioral intervention are effective in the management of OA and may be implemented whenever feasible. These interventions will help address the burden of OA and serve as an adjunct to existing hospital or health institution-based management.</p>

Estratégia de Promoção à Saúde: Programa Academia da Cidade de Belo Horizonte / Health Promotion Strategy: Academia da Cidade Program of Belo Horizonte

O artigo tem o objetivo de descrever o histórico, o propósito e as ações de promoção saúde realizadas no polo piloto do Programa Academia da Cidade (PAC) de Belo Horizonte-MG. O PAC foi implantado em 2005 com a finalidade de promover modos saudáveis mediante intervenções interdisciplinares, prioritariamente coletivas, que ampliassem a autonomia dos sujeitos, respeitando a diversidade cultural da comunidade. O primeiro polo ofertava exercícios físicos e aconselhamento nutricional integrado às Unidades Básicas de Saúde. Atendia cerca de 400 pessoas que apresentavam baixo nível econômico, alimentação não saudável, excesso de peso e comorbidades. As ações propiciaram a prática regular de exercícios físicos, adoção de hábitos alimentares saudáveis e redução do peso. O PAC contribui para a promoção da saúde com equidade e justiça social.

The article aim to describe the history, purpose and health promotion action developed in the pilot Programa Academia da Cidade (PAC) in Belo Horizonte-MG. The PAC was implemented in 2005 to promote healthy ways of life through interdisciplinary interventions, mainly collective, which amplify the autonomy of individuals and to consider health demands of community, respecting cultural diversity. The first unit offering regular physical exercise and nutritional counseling integrated into basic health unit. The unit attends approximately 400 people who low income, unhealthy diet, excess of weight and comorbidities. The actions provided regular physical exercise, adopting healthier eating habits and weight reduction. The PAC contributes to health promotion with equity and social justice.

Projeto Comunidade em Movimento: a experiência multiprofissional na Atenção Primária à Saúde / Project Comunity in Motion: The multidisciplinary experience in Primary Health Care

O Projeto Comunidade em Movimento, vinculado ao Programa Pró-PetSaúde do Ministério da Saúde é um modelo de intervenção multiprofissional de base comunitária desenvolvido na Estratégia Saúde da Família de Cuiabá. Voltado à promoção da saúde e prevenção das doenças crônicas não transmissíveis em consonância com as diretrizes das políticas governamentais que enfatizam as práticas corporais e a alimentação saudável, o projeto oferece exercícios físicos supervisionados (2x/semana), educação em saúde, estruturação e estímulo dos conselhos gestores e outras atividades desenvolvidas por alunos, profissionais do serviço e docentes dos cursos de Educação Física, Enfermagem, Medicina, Nutrição, Saúde Coletiva e Serviço Social. Esperamos que intervenções como esta sirvam de modelo para os profissionais, gestores da saúde e universidades.

The "Community in Motion" Project, linked to the Pro-PetSaúde Program of the Ministry of Health, is a multiprofessional intervention model developed by the Health Family Strategy in community-based settings of Cuiabá. Aimed to the health promotion and prevention of chronic diseases, the project is aligned with government policies that emphasize the body practices and healthy eating, by offering supervised exercises (2x/week), health education activities, encouragement for the implementation of management councils and other activities developed by students, health professionals and faculty professors from Physical Education, Nursing, Medicine, Nutrition, Public Health and Social Service. We hope that interventions such as this can serve as a model for professionals, health managers and universities.