Effect of telehealth on glycaemic control: analysis of patients with type 2 diabetes in the Whole Systems Demonstrator cluster randomised trial

Background: The Whole Systems Demonstrator was a large, pragmatic, cluster randomised trial that compared telehealth with usual care among 3,230 patients with long-term conditions in three areas of England. Telehealth involved the regular transmission of physiological information such as blood glucose to health professionals working remotely. We examined whether telehealth led to changes in glycosylated haemoglobin (HbA1c) among the subset of patients with type 2 diabetes. Methods: The general practice electronic medical record was used as the source of information on HbA1c. Effects on HbA1c were assessed using a repeated measures model that included all HbA1c readings recorded during the 12-month trial period, and adjusted for differences in HbA1c readings recorded before recruitment. Secondary analysis averaged multiple HbA1c readings recorded for each individual during the trial period. Results: 513 of the 3,230 participants were identified as having type 2 diabetes and thus were included in the study. Telehealth was associated with lower HbA1c than usual care during the trial period (difference 0.21% or 2.3 mmol/mol, 95% CI, 0.04% to 0.38%, p = 0.013). Among the 457 patients in the secondary analysis, mean HbA1c showed little change for controls following recruitment, but fell for intervention patients from 8.38% to 8.15% (68 to 66 mmol/mol). A higher proportion of intervention patients than controls had HbA1c below the 7.5% (58 mmol/mol) threshold that was targeted by general practices (30.4% vs. 38.0%). This difference, however, did not quite reach statistical significance (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053). Conclusions: Telehealth modestly improved glycaemic control in patients with type 2 diabetes over 12 months. The scale of the improvements is consistent with previous meta-analyses, but was relatively modest and seems unlikely to produce significant patient benefit

Promotion of breast-feeding, health, and growth among hospital-born neonates, and among infants of a rural area of Costa Rica

capítulo de libro -- Universidad de Costa Rica. Instituto de investigaciones en Salud, 1983. Publicado en Diarrhea and Malnutrition. Interactions, Mechanisms and Interventions. L.C. Chen & N.S. Scrimshaw, editors. Plenum Press, N.Y. pp. 177-202, 1983.decline in the incidence of breast-feeding in many developing nations \--as been recorded in recent years, often in conjunction with (a) rapid changes in way of life, (b) migration from rural to urban,- centers, (c) incorporation of women into the labor force (especially in industry), and (d) increase in stress, anxiety, and violence in transitional and modern societies. The marked decline in incidence and duration of breast-feeding throughout the world is a matter of international concern. The importance of breast-feeding, particularly in developing societies, stems from its health-promoting effect, as it provides the best food known for infants, protects the child against a variety of debilitating infectious processes, and encourages attachment between mother and infant.' Furthermore, successful breast-feeding indirectly reduces the ills of bottle- feeding, especially in developing nations, as epidemiological observation in many countries has revealed that early weaning is often associated with severe infant malnutrition, neglect, child abuse, abandonment, and premature deathUniversidad de Costa Rica.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Using satellite remote sensing and household survey data to assess human health and nutrition response to environmental change

Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices. This paper uses case studies to describe methods that make use of satellite remote sensing and Demographic and Health Survey data to better understand individual-level human health and nutrition outcomes. By bringing these diverse datasets together, the connection between environmental change and human health outcomes can be described through new research and analysis