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      Evaluation of the Community-Based Chronic Disease Prevention Program Meta Salud in Northern Mexico, 2011–2012

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          Abstract

          Introduction

          Meta Salud is a community health worker–facilitated intervention in Hermosillo, Sonora, Mexico, and was adapted from Pasos Adelante, a similar evidence-based intervention developed for a Latino population in the United States–Mexico border region. The objective of this study was to examine outcomes for Meta Salud and compare them with outcomes for Pasos Adelante.

          Methods

          This pretest–posttest study took place during 13 weeks among low-income residents of an urban area. The program provided information on topics such as heart health, physical activity, nutrition, diabetes, healthy weight, community health, and emotional well-being; included individual and group activities aimed at motivating behavior change; and encouraged participants to engage in brisk physical activity.

          Results

          We found significant decreases from baseline to conclusion in body mass index, waist circumference, hip circumference, weight, triglycerides, and low-density lipoprotein (LDL) cholesterol. From baseline to 3-month follow-up, we found significant decreases in body mass index, waist circumference, weight, LDL cholesterol, and glucose, and an increase in high-density lipoprotein cholesterol. Outcomes for Meta Salud were similar to those found for Pasos Adelante.

          Conclusion

          The physiological improvements found among participants in Meta Salud and comparable changes among participants in Pasos Adelante suggest a scalable and effective behavioral intervention for regions of the United States and Mexico that share a common boundary or have similar cultural and linguistic characteristics.

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          Most cited references14

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          Practical and statistical issues in missing data for longitudinal patient-reported outcomes.

          Patient-reported outcomes are increasingly used in health research, including randomized controlled trials and observational studies. However, the validity of results in longitudinal studies can crucially hinge on the handling of missing data. This paper considers the issues of missing data at each stage of research. Practical strategies for minimizing missingness through careful study design and conduct are given. Statistical approaches that are commonly used, but should be avoided, are discussed, including how these methods can yield biased and misleading results. Methods that are valid for data which are missing at random are outlined, including maximum likelihood methods, multiple imputation and extensions to generalized estimating equations: weighted generalized estimating equations, generalized estimating equations with multiple imputation, and doubly robust generalized estimating equations. Finally, we discuss the importance of sensitivity analyses, including the role of missing not at random models, such as pattern mixture, selection, and shared parameter models. We demonstrate many of these concepts with data from a randomized controlled clinical trial on renal cancer patients, and show that the results are dependent on missingness assumptions and the statistical approach. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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            Priority setting for health interventions in Mexico's System of Social Protection in Health.

            Explicit priority setting presents Mexico with the opportunity to match the pressure and complexity of an advancing epidemiological transition with evidence-based policies driven by a fundamental concern for how to make the best use of scarce resources to improve population health. The Mexican priority-setting experience describes how standardised analytical approaches to decision making, mainly burden of disease and cost-effectiveness analyses, combine with other criteria--eg, being responsive to the legitimate non-health expectations of patients and ensuring fair financing across households--to design and implement a set of three differentiated health intervention packages. This process is a key element of a wider set of reform components aimed at extending health insurance, especially to the poor. The most relevant policy implications include lessons on the use of available and proven analytical tools to set national health priorities, the usefulness of priority-setting results to guide long-term capacity development, the importance of favouring an institutionalised approach to cost-effectiveness analysis, and the need for local technical capacity strengthening as an essential step to balance health-maximising arguments and other non-health criteria in a transparent and systematic process.
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              A Promotores de Salud Intervention to Reduce Cardiovascular Disease Risk in a High-Risk Hispanic Border Population, 2005-2008

              Introduction The high prevalence of cardiovascular disease (CVD) in the Hispanic population of the United States, together with low rates of health insurance coverage, suggest a potential cardiovascular health crisis. The objective of Project HEART (Health Education Awareness Research Team) was to promote behavior changes to decrease CVD risk factors in a high-risk Hispanic border population. Methods Project HEART took place from 2005 through 2008 as a randomized community trial with a community-based participatory research framework using promotores de salud (community health workers). A total of 328 participants with at least 1 CVD risk factor were selected by randomizing 10 US Census tracts in El Paso, Texas, to either the experimental or the control group. The experimental group (n = 192) was assigned to a series of 8 health classes using the Su Corazón, Su Vida curriculum. After 2 months of educational sessions, the group was followed for 2 months. The control group (n = 136) was given basic educational materials at baseline, and no other intervention was used. Main outcomes of interest included changes in health behaviors and clinical measures. Results Participants in the experimental group showed more awareness of CVD risk factors, more confidence in the control of these factors, and improved dietary habits (ie, lower salt and cholesterol intake, better weight-control practices) compared with the control group. Total cholesterol was 3% lower in the experimental than in the control participants, and non–high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were both 5% lower. Conclusion The HEART trial suggests that community health education using promotores de salud is a viable strategy for CVD risk reduction in a Hispanic border community.
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                Author and article information

                Journal
                Prev Chronic Dis
                Prev Chronic Dis
                PCD
                Preventing Chronic Disease
                Centers for Disease Control and Prevention
                1545-1151
                2014
                11 September 2014
                : 11
                : E154
                Affiliations
                [1]Author Affiliations: Cecilia Rosales, Melanie L. Bell, Tanyha Zepeda, Scott Carvajal, Jill Guernsey de Zapien, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Elsa Cornejo, Diana Munguía, El Colegio de Sonora, Hermosillo, Sonora, Mexico.
                Author notes
                Corresponding Author: Catalina A. Denman, PhD, MS, El Colegio de Sonora, Av Obregón #54, Colonia Centro, Hermosillo, Sonora, México 83000. Telephone: 52-662-259-5300, ext. 2223. E-mail: cdenman@ 123456colson.edu.mx .
                Article
                14_0218
                10.5888/pcd11.140218
                4164035
                25211502
                6cca3b8d-6a16-494a-ba83-516b825af234
                History
                Categories
                Original Research
                Peer Reviewed

                Health & Social care
                Health & Social care

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