Effectiveness of a PMTCT programme in rural Western Kenya.

We assess the coverage of a Prevention of Mother-to-child Transmission (PMTCT) programme in Busia (Kenya) from 1 January 2006 to 31 December 2008 and estimate the risk of transmission of HIV. We also estimate the odds of HIV transmission according to pharmacological intervention received. Programme coverage was estimated as the proportion of mother-baby pairs receiving any antiretroviral (ARV) regimen among all HIV-positive women attending services. We estimated the mother-to-child transmission (MTCT) rate and their 95% confidence interval (95%CI) using the direct method of calculation (intermediate estimate). A case-control study was established among all children born to HIV-positive mothers with information on outcome (HIV status of the babies) and exposure (data on pharmacological intervention). Cases were all HIV-positive children and controls were the HIV-negative ones. Exposure was defined as: (1) complete protocol: ARV prescribed according World Health Organisation recommendations; (2) partial protocol: does not meet criteria for complete protocol; and (3) no intervention: ARVs were not prescribed to both mother and child. Babies were tested using DNA Polymerase Chain Reaction at six weeks of life and six weeks after breastfeeding ceased. In the study period, 22,566 women accepted testing, 1668 were HIV positive (7.4%; 95%CI 7.05-7.73); 1036 (62%) registered in the programme and 632 were lost. Programme coverage was 40.4% (95%CI 37.9-42.7). Out of the 767 newborns, 28 (3.6%) died, 148 (19.3%) defaulted, 282 (36.7%) were administratively censored and 309 (40.2%) babies completed the follow-up as per protocol; 49 were HIV positive and MTCT risk was 15.86% (95%CI 11.6-20.1). The odds of having an HIV-positive baby was 4.6 times higher among pairs receiving a partial protocol compared to those receiving a complete protocol and 43 times higher among those receiving no intervention. Our data show a good level of enrolment but low global coverage rate. It demonstrates that ARV regimens can be implemented in low resource rural settings with marked decreases of MTCT. Increasing the coverage of PMTCT programmes remains the main challenge.

Revisión sistemática de las intervenciones educativas grupales en pacientes diabéticos tipo 2 / Systematic review of group educational interventions in type-2 diabetes patients

Objetivo. Evaluar el efecto de las intervenciones educativas grupales en pacientes diabéticos tipo 2. Analizar qué tipo de intervención grupal produce mayores efectos a largo plazo. Diseño. Revisión sistemática. Fuente de datos. Revisión de bases electrónicas: CENTRAL, MEDLINE, EMBASE, CINAHL y PASCAL, así como de las citas bibliográficas de los estudios seleccionados. Contactos con expertos para localizar artículos no publicados. Selección de los estudios. Ensayos clínicos aleatorizados, controlados y estudios cuasiexperimentales que evalúen intervenciones educativas grupales dirigidas a pacientes diabéticos tipo 2, mayores de 18 años, de cualquier duración, realizada en cualquier ámbito, cuya meta sea mejorar la calidad de vida, el autocontrol o el control metabólico. El grupo de comparación incluye intervenciones educativas individuales y no intervenciones. Variables resultado. Calidad de vida, autocontrol y control diabético (HbA1c, colesterol, triglicéridos, presión arterial y consumo de tabaco). Métodos de revisión. Selección de los ensayos realizada por 3 grupos, con 3 investigadores cada uno, que de forma independiente revisan los títulos, abstracts y palabras clave de todos los ensayos identificados para decidir sobre su elegibilidad. La calidad de los ensayos se evalúa usando los criterios definidos por el Cochrane Metabolic and Endocrine Disorders Group. Los investigadores evalúan de forma independiente los artículos y las discrepancias se resuelven por discusión y consenso

Objectives. To evaluate the effect of group educational interventions in type-2 diabetes patients. To analyse what kind of group intervention has the best long-term effects. Design. Systematic review. Data sources. Review of electronic data bases: CENTRAL, MEDLINE, EMBASE, CINAHL, and PASCAL, and of the bibliographic references of the studies selected. Contacts with experts to locate non-published articles. Selection of studies. Randomised clinical studies with controls and quasi-experimental studies that evaluate group education interventions aimed at type-2 diabetes patients over 18 years old. These interventions were of any length and in any context, and their target was to improve quality of life, self-control, or metabolic control. The comparison group included individual educational interventions and non-interventions. Variables result. Quality of life, self-control, and diabetes control (HbA1c, cholesterol, triglycerides, blood pressure, and smoking). Review methods. Trial selection by 3 groups with 3 researchers in each, who independently reviewed headings, abstracts and key words of all the identified trials to decide on their eligibility. The quality of trials was evaluated by the criteria defined by the Cochrane Metabolic and Endocrine Disorders Group. Researchers assessed the articles independently; and discrepancies were resolved by discussion and consensus

[Systematic review of group educational interventions in type-2 diabetes patients]. / Revisión sistemática de las intervenciones educativas grupales en pacientes diabéticos tipo 2.

OBJECTIVES: To evaluate the effect of group educational interventions in type-2 diabetes patients. To analyse what kind of group intervention has the best long-term effects. DESIGN: Systematic review. DATA SOURCES: Review of electronic data bases: CENTRAL, MEDLINE, EMBASE, CINAHL, and PASCAL, and of the bibliographic references of the studies selected. Contacts with experts to locate non-published articles. Selection of studies. Randomised clinical studies with controls and quasi-experimental studies that evaluate group education interventions aimed at type-2 diabetes patients over 18 years old. These interventions were of any length and in any context, and their target was to improve quality of life, self-control, or metabolic control. The comparison group included individual educational interventions and non-interventions. VARIABLES RESULT: Quality of life, self-control, and diabetes control (HbA1c, cholesterol, triglycerides, blood pressure, and smoking). REVIEW METHODS: Trial selection by 3 groups with 3 researchers in each, who independently reviewed headings, abstracts and key words of all the identified trials to decide on their eligibility. The quality of trials was evaluated by the criteria defined by the Cochrane Metabolic and Endocrine Disorders Group. Researchers assessed the articles independently; and discrepancies were resolved by discussion and consensus.