The Experts below are selected from a list of 13917 Experts worldwide ranked by ideXlab platform
Nadia A Khan - One of the best experts on this subject based on the ideXlab platform.
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improving management of type 2 diabetes in south asian patients a systematic review of intervention studies
BMJ Open, 2016Co-Authors: N Bhurji, J Javer, Danijela Gasevic, Nadia A KhanAbstract:Objectives Optimal control of type 2 diabetes is challenging in many patient populations including in South Asian patients. We systematically reviewed studies on the effect of diabetes management interventions targeted at South Asian patients with type 2 diabetes on glycaemic control. Design Systematic review of MEDLINE, EMBASE and CINAHL databases for randomised controlled trials (RCTs) and pre-post-test studies (January 1990 to February 2014). Studies were stratified by where interventions were conducted (South Asia vs Western countries). Participants Patients originating from Pakistan, Bangladesh or India with type 2 diabetes. Primary outcome Change in glycated haemoglobin (HbA1c). Secondary end points included change in blood pressure, lipid levels, anthropomorphics and knowledge. Results 23 studies (15 RCTs) met criteria for analysis with 7 from Western countries (n=2532) and 16 from South Asia (n=1081). Interventions in Western countries included translated diabetes education, additional clinical care, written materials, visual aids, and Bilingual Community-based peers and/or health professionals. Interventions conducted in South Asia included yoga, meditation or exercise, Community-based peers, health professionals and dietary education (cooking exercises). Among RCTs in India (5 trials; n=390), 4 demonstrated significant reductions in HbA1c in the intervention group compared with usual care (yoga and exercise interventions). Among the 4 RCTs conducted in Europe (n=2161), only 1 study, an education intervention of 113 patients, reported a significant reduction in HbA1c with the intervention. Lipids, blood pressure and knowledge improved in both groups with studies from India more often reporting reductions in body mass index and waist circumference. Conclusions Overall, there was little improvement in HbA1c level in diabetes management interventions targeted at South Asians living in Europe compared with usual care, although other outcomes did improve. The smaller studies in India demonstrated significant improvements in glycaemic and other end points. Novel strategies are needed to improve glycaemic control in South Asians living outside of India.
Howard Bergman - One of the best experts on this subject based on the ideXlab platform.
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multilingualism but not always Bilingualism delays the onset of alzheimer disease evidence from a Bilingual Community
Alzheimer Disease & Associated Disorders, 2010Co-Authors: Howard Chertkow, Victor Whitehead, Natalie A Phillips, Christina Wolfson, Julie Atherton, Howard BergmanAbstract:A recent paper by Bialystok et al in Neuropsychologia (vol. 45, pgs. 459 to 464) suggested that early Bilingualism produced a statistically significant 4.1-year delay in onset of memory loss symptoms in older individuals with Alzheimer disease, possibly reflecting an increase in the cognitive reserve of these individuals. That study focused on multilingual elderly patients of whom 90% were immigrants. Our memory clinic, in Montreal Canada, has the advantage of having a large set of individuals who are either multilingual immigrants to Canada, or who are nonimmigrants but raised in both official languages of Canada— French and English. We thus attempted to replicate the above findings using a larger cohort in a different setting. We examined age at diagnosis of Alzheimer disease and age at symptom onset for all unilingual versus multilingual participants, and then for those who were nonimmigrant English/French Bilinguals. Overall, we found a small but significant protective effect of more than 2 languages spoken, but we found no significant benefit in Bilinguals overall in relation to age at diagnosis or age at symptom onset. However, in the immigrant group, the results mirrored those of Bialystok et al with 2 or more languages delaying the diagnosis of Alzheimer disease by almost 5 years. A trend toward the same effect was also seen in nonimmigrants whose first language was French. In contrast, in nonimmigrants whose first language was English, no such effect was found. These results are discussed in relation to the earlier findings and the theory of cognitive reserve.
N Bhurji - One of the best experts on this subject based on the ideXlab platform.
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improving management of type 2 diabetes in south asian patients a systematic review of intervention studies
BMJ Open, 2016Co-Authors: N Bhurji, J Javer, Danijela Gasevic, Nadia A KhanAbstract:Objectives Optimal control of type 2 diabetes is challenging in many patient populations including in South Asian patients. We systematically reviewed studies on the effect of diabetes management interventions targeted at South Asian patients with type 2 diabetes on glycaemic control. Design Systematic review of MEDLINE, EMBASE and CINAHL databases for randomised controlled trials (RCTs) and pre-post-test studies (January 1990 to February 2014). Studies were stratified by where interventions were conducted (South Asia vs Western countries). Participants Patients originating from Pakistan, Bangladesh or India with type 2 diabetes. Primary outcome Change in glycated haemoglobin (HbA1c). Secondary end points included change in blood pressure, lipid levels, anthropomorphics and knowledge. Results 23 studies (15 RCTs) met criteria for analysis with 7 from Western countries (n=2532) and 16 from South Asia (n=1081). Interventions in Western countries included translated diabetes education, additional clinical care, written materials, visual aids, and Bilingual Community-based peers and/or health professionals. Interventions conducted in South Asia included yoga, meditation or exercise, Community-based peers, health professionals and dietary education (cooking exercises). Among RCTs in India (5 trials; n=390), 4 demonstrated significant reductions in HbA1c in the intervention group compared with usual care (yoga and exercise interventions). Among the 4 RCTs conducted in Europe (n=2161), only 1 study, an education intervention of 113 patients, reported a significant reduction in HbA1c with the intervention. Lipids, blood pressure and knowledge improved in both groups with studies from India more often reporting reductions in body mass index and waist circumference. Conclusions Overall, there was little improvement in HbA1c level in diabetes management interventions targeted at South Asians living in Europe compared with usual care, although other outcomes did improve. The smaller studies in India demonstrated significant improvements in glycaemic and other end points. Novel strategies are needed to improve glycaemic control in South Asians living outside of India.
Sara Barker - One of the best experts on this subject based on the ideXlab platform.
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impact of a chronic care coordinator intervention on diabetes quality of care in a Community health center
Health Services Research, 2015Co-Authors: Rosa Solorio, Aasthaa Bansal, Bryan A. Comstock, Krista Ulatowski, Sara BarkerAbstract:The prevalence of type 2 diabetes in the U.S. Hispanic population is nearly double the rate in non-Hispanic whites (Mokdad et al. 2001). Hispanics are the fastest growing minority population in the United States (U.S. Census Bureau 2010), increasing the likelihood of more diabetes-related complications and health care costs. Despite the existing high expenditures for diabetes care, very few patients with diabetes are at goal for evidence-based recommendations, with only 7 percent of patients at goal for HbAIc, blood pressure, and LDL cholesterol (Saydah, Fradkin, and Cowie 2004). A systematic review of culturally competent interventions for Hispanic adults with type II diabetes (Whittemore 2007) indicates that the majority have been in specialized diabetes education programs provided over a period of time in the Community setting (i.e., church, Community center; Brown et al. 2005; Lorig, Ritter, and Gonzalez 2003; Lorig, Rittler, and Jacquez 2005; Rosal et al. 2005; Two Feathers et al. 2005). Other interventions have been provided in the clinic setting, typically a Community health center; among these, only one intervention provided individualized diabetes education assisted by a Bilingual Community health worker (CHW; Corkery et al. 1997); one used nurse case management combined with monthly education sessions with a CHW (Philis-Tsimikas et al. 2004) and other interventions provided a specialized diabetes education program over 1–3 months duration (Elshaw et al. 1994; Banister et al. 2004). According to the Centers for Disease Control (CDC), there is evidence demonstrating the value and impact of CHWs in preventing and managing a variety of chronic diseases, including diabetes (CDC 2011). CHWs typically work in Community settings; the specific characteristics of settings (i.e., Community vs. clinic setting) and infrastructure for effective CHW interventions has not yet been identified (Norris et al. 2006). The literature uses different names to refer to CHWs, including promotora (health promoter), patient navigator, case-manager, and chronic care coordinator (CCC). The purpose of this study is to evaluate the impact of a CCC intervention on quality of diabetes care within a Community Health Center's (CHC) serving predominantly low-income Hispanic and non-Hispanic white patients. We used a retrospective cohort study design with a 12-month pre- and 12-month post-intervention analysis to evaluate the effect of the CCC intervention on quality of care, outcomes, and health care utilization. Patients with diabetes who received the CCC intervention were compared to a propensity score adjusted comparison group who are not exposed to the CCC intervention. While previous studies have incorporated a CHW into the clinical setting (King et al. 2006; Joshu et al. 2007; Thompson, Horton, and Flores 2007), these studies' outcomes are limited to enrolled participants and have not used the EMR to evaluate outcomes; the methodology used to examine outcomes in this study contributes a novel approach because it provides data on all patients with diabetes within a network of CHCs. In addition, a previous qualitative study conducted at the Sea Mar Network evaluated provider and staff perceptions on the CCC role and indicates that the majority (92 percent) agreed or strongly agreed that care provided to patients with type 2 diabetes had improved (Shadish, Cook, and Campbell 2002). This study compliments this previous study by focusing on quantitative outcomes. We hypothesize that patients engaged by the CCC will be more likely to receive appropriate laboratory assessments of their diabetes and more likely to achieve control of their diabetes (HbA1C <7), blood pressure (BP <130/80), and lipids (LDL cholesterol <100) than those in the comparison group. We also hypothesize that patients engaged by a CCC will be more likely to exhibit appropriate health care utilization via increased visits to PCPs and ophthalmologists and fewer visits to endocrinologists than patients not engaged by the CCC.
Howard Chertkow - One of the best experts on this subject based on the ideXlab platform.
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multilingualism but not always Bilingualism delays the onset of alzheimer disease evidence from a Bilingual Community
Alzheimer Disease & Associated Disorders, 2010Co-Authors: Howard Chertkow, Victor Whitehead, Natalie A Phillips, Christina Wolfson, Julie Atherton, Howard BergmanAbstract:A recent paper by Bialystok et al in Neuropsychologia (vol. 45, pgs. 459 to 464) suggested that early Bilingualism produced a statistically significant 4.1-year delay in onset of memory loss symptoms in older individuals with Alzheimer disease, possibly reflecting an increase in the cognitive reserve of these individuals. That study focused on multilingual elderly patients of whom 90% were immigrants. Our memory clinic, in Montreal Canada, has the advantage of having a large set of individuals who are either multilingual immigrants to Canada, or who are nonimmigrants but raised in both official languages of Canada— French and English. We thus attempted to replicate the above findings using a larger cohort in a different setting. We examined age at diagnosis of Alzheimer disease and age at symptom onset for all unilingual versus multilingual participants, and then for those who were nonimmigrant English/French Bilinguals. Overall, we found a small but significant protective effect of more than 2 languages spoken, but we found no significant benefit in Bilinguals overall in relation to age at diagnosis or age at symptom onset. However, in the immigrant group, the results mirrored those of Bialystok et al with 2 or more languages delaying the diagnosis of Alzheimer disease by almost 5 years. A trend toward the same effect was also seen in nonimmigrants whose first language was French. In contrast, in nonimmigrants whose first language was English, no such effect was found. These results are discussed in relation to the earlier findings and the theory of cognitive reserve.