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Is insulin the most effective injectable antihyperglycaemic therapy?. Diabetes Obes Metab. 2014 Oct 17

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IMS: The recent type 2 diabetes American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) position statement suggested insulin is the most effective glucose-lowering therapy, especially when glycated haemoglobin (HbA1c) is very high. However, randomized studies comparing glucagon-like peptide-1 receptor agonists (GLP-1RAs) exenatide once-weekly [OW; DURATION-3 (Diabetes therapy Utilization: Researching changes in A1c, weight, and other factors Through Intervention with exenatide ONce-Weekly)] and liraglutide once-daily [OD; LEAD-5 (Liraglutide Effect and Action in Diabetes)] with insulin glargine documented greater HbA1c reduction with GLP-1RAs, from baseline HbA1c approximately 8.3% (67 mmol/mol). This post hoc analysis of DURATION-3 and LEAD-5 examined changes in HbA1c, fasting glucose and weight with exenatide OW or liraglutide and glargine, by baseline HbA1c quartile.
METHODS: Descriptive statistics were provided for change in HbA1c, fasting glucose, weight, and insulin dose, and subjects (%) achieving HbA1c <7.0%, by baseline HbA1c quartile. Inferential statistical analysis on the effect of baseline HbA1c quartile was performed for change in HbA1c. An analysis of covariance (ANCOVA) model was used to evaluate similarity in change in HbA1c across HbA1c quartiles.
RESULTS: At 26 weeks, in both studies, HbA1c reduction, and proportion of subjects reaching HbA1c <7.0%, were similar or numerically greater with the GLP-1RAs than glargine for all baseline HbA1c quartiles. Fasting glucose reduction was similar or numerically greater with glargine. Weight decreased with both GLP-1RAs across all quartiles; subjects taking glargine gained weight, more at higher baseline HbA1c. Adverse events were uncommon although gastrointestinal events occurred more frequently with GLP-1RAs.
CONCLUSIONS: HbA1c reduction with the GLP-1RAs appears at least equivalent to that with basal insulin, irrespective of baseline HbA1c. This suggests that liraglutide and exenatide OW may be appropriate alternatives to basal insulin in type 2 diabetes, including when baseline HbA1c is very high (>/=9.0%). ….more

 

Distance courses on evidence-based practice

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The American International Health Alliance has provided free distance training courses on evidence-based practice for LMIC since 2004. Courses we have developed include ‘Introduction to evidence-based practice in healthcare,’ ‘Introduction to evidence-based practice in social work,’ and ‘Evidence-based patient information materials.’ Those courses are now provided in English for our partner organizations (hospitals, universities, nursing colleges) in Tanzania, Ethiopia, South Africa, Botswana and Zambia.

In addition to gaining knowledge and new skills, participants are NOW also interested in earning points towards their CE and acquiring a statement of accomplishment from globally reknowned programs.

As a part of our recent Knowledge Management strategy, we will investigate the following solutions:

– Certifying our courses with universities in the countries where AIHA is delivering its programs.

– Repackaging those courses for self-paced learning and posting them on reknown platforms geared towards distance training in health and related topics.

We would appreciate your ideas and recommendations for how to persue those possibilities.

For more information on evidence-based practice courses and AIHA Knowledge Management strategy, visit:

http://www.iss.it/binary/eahi/cont/38_Irina_Ibraghimova.pdf

http://www.iss.it/binary/eahi/cont/38_Ibraghimova_Irina_slides_EAHIL_2014.pdf

http://www.twinningagainstaids.org/documents/Tech_Brief_Knowledge_Management_06-17-14FINAL.pdf

Thanks,

Irina Ibraghimova, PhD

Library and Information Management Consultant

Thomas Achilles,

Administration & Communications Assistant

American International Health Alliance

1225 Eye Street, NW, Suite 250

Washington, DC 20005

Email: tachilles@aiha.com

Dilemmas faced by WHO in connection with the Ebola Emergency response

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Below are extracts from an article in the BMJ (with thanks to our sister forum HIFA-EVIPNet-French). The full text is available here:

http://www.bmj.com/content/349/bmj.g6255/rr-0

A linked article concludes: ‘[Member States] should support unequivocally the strengthening of WHO and its multilateral solutions and not favor solutions outside WHO’.

http://www.bmj.com/content/349/bmj.g7424/rr

Dilemmas faced by the World Health Organization in connection with the Ebola Emergency response

‘On January 25th a Special Session of the World Health Organization’s (WHO) Executive Board will be convened to discuss the Ebola emergency and the WHO response to the epidemic that has affected several countries in West Africa It is the third time in the history of WHO that the Executive Board organizes a Special Session. This is motivated by the multiple difficulties faced by the international response to the problem, resulting in ineffective and untimely action in countries lacking the adequate health infrastructure and sufficient health workforce…

‘The fight against Ebola has been full of mistakes and has lacked coordination…

‘In the weeks before the release of these two documents many worrisome ideas and opinions on the issues at stake floated in different media:

1) the idea of creating a new international agency for facing health emergency situations, relegating WHO to a role of producing technical norms and standards without any armed branches for orchestrating operational responses at country, regional or global level;

2) creating an international health emergency response fund outside WHO; and

3) creating an international corps of emergency health workers managed outside WHO and not linked neither to the structures established by the International Health Regulations approved in 2005 nor to the Health Cluster that is part of the International Humanitarian Response.

‘Evidently these absurd ideas have been triggered by the frustration resulting from the lack of an effective and timely response. However they point in the wrong direction fostering proposals that would only weaken the global health architecture and its current coordination mechanisms… It is time to halt this trend and make the necessary steps for rationalizing the huge dispersion of channels and mechanisms associated to the global health partnerships created during the last 20 years at a high cost for the effective coordination of international public health.’

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

The Effectiveness of Health Animations in Audiences With Different Health Literacy Levels: An Experimental Study

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Below is the citation and abstract of a new paper in the Journal of Medical Internet research. The full text is freely available here:

http://www.jmir.org/2015/1/e11/

The authors conclude that ‘spoken animation is the best way to communicate complex health information to people with low health literacy’. It should be noted, however, that the authors compared animations with static pictures and text, and did not look at other types of film/audiovisual material. It would be interesting to compare the impact of animated versus ‘real’ film in different contexts.

CITATION: Meppelink CS, van Weert JC, Haven CJ, Smit EG. The Effectiveness of Health Animations in Audiences With Different Health Literacy Levels: An Experimental Study. J Med Internet Res 2015;17(1):e11

DOI: 10.2196/jmir.3979

ABSTRACT

Background: Processing Web-based health information can be difficult, especially for people with low health literacy. Presenting health information in an audiovisual format, such as animation, is expected to improve understanding among low health literate audiences.

Objective: The aim of this paper is to investigate what features of spoken health animations improve information recall and attitudes and whether there are differences between health literacy groups.

Methods: We conducted an online experiment among 231 participants aged 55 years or older with either low or high health literacy. A 2 (spoken vs written text) x 2 (illustration vs animation) design was used. Participants were randomly exposed to one of the four experimental messages, all providing the same information on colorectal cancer screening.

Results: The results showed that, among people with low health literacy, spoken messages about colorectal cancer screening improved recall (P=.03) and attitudes (P=.02) compared to written messages. Animations alone did not improve recall, but when combined with spoken text, they significantly improved recall in this group (P=.02). When exposed to spoken animations, people with low health literacy recalled the same amount of information as their high health literate counterparts (P=.12), whereas in all other conditions people with high health literacy recalled more information compared to low health literate individuals. For people with low health literacy, positive attitudes mediated the relationship between spoken text and the intention to have a colorectal cancer screening (b=.12; 95% CI 0.02-0.25).

Conclusions: We conclude that spoken animation is the best way to communicate complex health information to people with low health literacy. This format can even bridge the information processing gap between audiences with low and high health literacy as the recall differences between the two groups are eliminated. As animations do not negatively influence high health literate audiences, it is concluded that information adapted to audiences with low health literacy suits people with high health literacy as well.

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

BJOG: The prevention and treatment of postpartum haemorrhage

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‘Postpartum haemorrhage (PPH) remains the most common cause of maternal mortality worldwide.[1] It is responsible for around 30% of maternal deaths, equivalent to 86 000 deaths per year annually or ten deaths every hour…’

Below is the citation and abstract of a review in the January 2015 issue of BJO – An International Journal of Obstetrics and Gynaecology. The full text is available here: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13098/full

I was particularly struck by the following statement, in the full text:

‘How best to deliver emergency care

In 2005 Hussein called for the development of ‘obstetric first aid’ skills and for its training in the community to be given as much priority as cardiopulmonary resuscitation.[57] Sadly, a decade later, little has progressed in achieving this aim and there is no agreed, coherent first-aid strategy for PPH…’

This suggests a serious failure of global health research translation and I would like to invite comment from HIFA members. As previously discussed on HIFA, the World Health Organization, among others, have provided guidance on emergency care for PPH: WHO recommendations for the prevention and treatment of postpartum haemorrhage (2012). http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502_eng.pdf  

Is this guidance not agreed and/or coherent?

CITATION: Weeks, A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next? BJOG: An International Journal of Obstetrics & Gynaecology. 2015. 122; 2: 202-210. http://dx.doi.org/10.1111/1471-0528.13098

ABSTRACT: Postpartum haemorrhage (PPH) remains a major cause of maternal deaths worldwide, and is estimated to cause the death of a woman every 10 minutes. This review presents the latest clinical advice, including new evidence on controlled cord traction, misoprostol, and oxytocin. The controversy around the diagnosis of PPH, the limitations of universal prophylaxis, and novel ways to provide obstetric first aid are also presented. It ends with a call to develop high-quality front-line obstetric services that can deal rapidly with unexpected haemorrhages as well as minimising blood loss at critical times: major abruption, placenta praevia, and caesarean for prolonged labour.

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

The global met need for emergency obstetric care: a systematic review

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Systematic Review: The global met need for emergency obstetric care: a systematic review

The January 2015 issue of BJOG – An International Journal of Obstetrics and Gynaecology – is a Special Issue on the theme of ‘Beyond 2015: The future of women’s health globally’. All the papers in this issue are freely available here:

http://onlinelibrary.wiley.com/doi/10.1111/bjo.2014.122.issue-2/issuetoc?utm_source=MHTF+Subscribers&utm_campaign=51df2c5448-MH_Buzz_January_13_2015&utm_medium=email&utm_term=0_8ac9c53ad4-51df2c5448-183741561

Below is the citation and abstract of one of the papers.

CITATION: Systematic Review: The global met need for emergency obstetric care: a systematic review

H Holmer, K Oyerinde, JG Meara1, R Gillies, J Liljestrand, and L Hagander

Article first published online: 26 DEC 2014

DOI: 10.1111/1471-0528.13230

ABSTRACT

Background: Of the 287 000 maternal deaths every year, 99% happen in low- and middle-income countries. The vast majority could be averted with timely access to appropriate emergency obstetric care (EmOC). The proportion of women with complications of pregnancy or childbirth who actually receive treatment is reported as ‘Met need for EmOC’.

Objective: To estimate the global met need for EmOC and to examine the correlation between met need, maternal mortality ratio and other indicators.

Search strategy: A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and Google Scholar.

Selection criteria: Studies containing data on met need in EmOC were selected.

Data collection and analysis: Analysis was performed with data extracted from 62 studies representing 51 countries. World Bank data were used for univariate and multiple linear regression.

Main results: Global met need for EmOC was 45% (IQR: 28–57%), with significant disparity between low- (21% [12–31%]), middle- (32% [15-56%]), and high-income countries (99% [99–99%]), (P = 0.041). This corresponds to 11.4 million (8.8–14.8) untreated complications yearly and 951 million (645–1174 million) women without access to EmOC. We found an inverse correlation between met need and maternal mortality ratio (r = -0.42, P < 0.001). Met need was significantly correlated with the proportion of births attended by skilled birth attendants (ß = 0.53 [95% CI 0.41–0.65], P < 0.001).

Authors’ conclusions: The results suggest a considerable inadequacy in global met need for EmOC, with vast disparities between countries of different income levels. Met need is a powerful indicator of the response to maternal mortality and strategies to improve EmOC act in synergy with the expansion of skilled birth attendance.

Best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Reviving rural towns would help drive to curb poverty

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One of the most bewildering things when driving through the Eastern Cape’s many rural towns is the state of disrepair of the roads, the decaying infrastructure, the hopelessness in the eyes of the many poor residents. Poverty is endemic and it seems to me every year we plunge to new depths of despair. Local town administrators are doing their best it seems but these areas won’t get out of the starting blocks without massive infrastructure investment…..more

Youth the Soweto looting instigators

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The youth are the instigators behind the looting of foreign-owned shops in Soweto, Gauteng police commissioner Lt-Gen Lesetja Mothiba said on Thursday…..more and more

Facts for Life

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Facts For Life, a ‘trusted resource that is written in easy-to-understand language [and] translated into 215 languages’ http://rehydrate.org/ffl/ . It is indeed urgent and vital that content such as Facts for Life – produced and ratified by reputable health organisations – is universally made available to citizens worldwide

After 10 years, few payoffs from Bill Gates’ ‘Grand Challenges’

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When he took the stage this fall to celebrate the 10th anniversary of his signature global health research initiative, Bill Gates used the word “naive” — four times — to describe himself and his charitable foundation. It was a surprising admission coming from the world’s richest man…..more

HealthPhone: Weekly news and social media on health and nutrition educational, instructional, tutorials and training videos

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HealthPhone is a curated video library of some of the world’s best producers of health and nutrition educational, instructional, tutorials and training content for personal computers, mobile phones and tablets. The videos are freely available for immediate viewing and download at our web site ( http://healthphone.org ) which houses a fast growing library of over 2,500 videos across 77 languages.

HealthPhone’s main objective is to facilitate the flow of knowledge to rural low- middle-income families and health workers that serve them; delivering information to educate, motivate, empower and inspire communities around better health and nutrition practices.

The topics covered are primarily in the area of nutrition, water, timing births, safe motherhood, newborn health, child development, early learning, breastfeeding, nutrition, growth, immunization, diarrhoea, coughs, colds, serious illnesses, hygiene, malaria, HIV, child protection, injury prevention, emergencies preparedness and response.

Videos are promoted daily on our Twitter ( https://twitter.com/HealthPhone ) and Facebook ( https://www.facebook.com/HealthPhone ) pages and also through the weekly on-line issue of HealthPhone News ( http://paper.li/HealthPhone/1372198680 ). Vist our web site, connect with us on social media and subscribe to our weekly news and YouTube channel ( https://www.youtube.com/user/HealthPhone ) for the latest in health and nutrition video content.

be well, nand

Nand Wadhwani

The Mother and Child Health and Education Trust

http://motherchildtrust.org  |  http://healthphone.org

Now that we can, we must!

WHO publishes systematic review of eLearning in health professional education

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WHO has just published eLearning for undergraduate health professional education – a systematic review informing a radical transformation of health workforce development.

You can download a copy of the report from: http://whoeducationguidelines.org/content/elearning-report

The World Health Organization (WHO) Department of Health Workforce in collaboration with the Department of Knowledge, Ethics and Research commissioned the Global eHealth Unit (GeHU) at Imperial College London to conduct a systematic review of the scientific literature to evaluate the effectiveness of eLearning for undergraduate health professional education. The review is based on a rigorous search, analysis and presentation of data that provides decision-makers with an up-to-date picture of current knowledge on eLearning for undergraduate professional education. It responds to a need at the country level for evidence to inform and guide health professional education as an important vehicle in preparing health professionals to be ‘fit-for-purpose’.

At a global level, it will assist in the implementation of the WHO’s global human resources for health strategy by providing the best evidence of how and where eLearning can best be used in country settings. The report also provides a foundation for the development of future WHO guidelines for pre-service training and the direction for  future research.

Kind regards,

Rebecca

Rebecca Bailey | Health Workforce Development Team Lead

IntraHealth International | Because Health Workers Save Lives.

6340 Quadrangle Drive, Suite 200 | Chapel Hill, NC 27517

m. +1 (919) 360-3339

rbailey@intrahealth.org

Webinar: Resources that support children who are hard of hearing

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I would like to announce an upcoming webinar titled “Resources for service providers, family, and caretakers of children who are hard of hearing”.

Join Audiologist Larrain Bratt, staff and parents from the Center for Early Intervention on Deafness, and Hesperian’s Executive Director Sarah Shannon for a webinar and discussion about Hesperian materials and resources that support anyone who works with or cares for children who are hard of hearing.

Learn about Hesperian’s print and digital resources in many languages and hear examples and stories of putting these resources into action in a variety of scenarios- from the clinic to the home.

When: Tuesday, January 27th

1:00 pm PST; 4:00 pm EST

Click to sign up for the webinar:

https://attendee.gotowebinar.com/register/4265772327572275970

Speakers:

Larrain Bratt, Audiologist with a focus on newborn hearing screening, infant diagnostics, and educational follow-up.

Helisa Katz, M.A. Teacher of the Deaf, Center for Early Intervention on Deafness

Melissa Lopez, Parent, Center for Early Intervention on Deafness

Sarah Shannon, Executive Director, Hesperian Health Guides

Special thanks to the California Communications Access Foundation for their support.

Warm Regards,

Libby Engles

Media and Communications Associate

libby@hesperian.org

510-845-1447 ext. 224

Physiopedia

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Physiopedia is run by volunteers for physiotherapists globally, and is accessible online. http://www.physio-pedia.com/

Strengthening Community Health Systems through CHWs and mHealth

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I was interested to see this new publication from the CORE Group, which ‘improves and expands community health practices for underserved populations, especially women and children, through collaborative action and learning’, with support from USAID. Below are some extracts of particular relevance to HIFA, for further discussion:

Strengthening Community Health Systems through CHWs and mHealth

http://www.coregroup.org/storage/documents/Fall_Conference_2014/Strengthening_Community_Health_Systems_through_CHWs_and_mHealth.pdf

‘Community health workers (CHWs) have been called the “world’s most promising health workforce resource” in terms of enabling health systems in resource-constrained settings.’

‘What seems like a straightforward health promotion and service delivery strategy, of recruiting, training and supporting local people to supplement health professionals at the community level, is in fact quite complex.’

‘Increasingly, there is a trend towards using mobile technology to train and support CHWs.’

‘Amref Health Africa looked at whether they could reduce face-to-face training time and still retain the quality of the CHW’s training using mLearning in Kenya. Before getting started, Amref tackled key questions such as, what type of phone to use, basic or smart; whether to develop a platform independently or build

partnerships; what curriculum to use; and what the guiding principles of their mLearning initiative should be. At the start of the initiative, 97% of CHWs in Kenya had mobile phones, with about 70% of CHWs having a basic phone. Thus, Amref decided to leverage current technology (basic phones) in the hands of CHWs for scalability and sustainability reasons. Additionally, Amref established partnerships with Accenture, Safaricom/Vodafone, Mezzanine, and the Kenyan Ministry of Health (MOH). With Amref taking the lead, they developed the Health Enablement and Learning Platform (HELP).’

Study links birth control to increased risk of HIV infection

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Women using the birth control shot known by the brand name Depo-Provera may have about a 30 percent higher risk of contracting HIV, according to new research. However, the link between hormonal contraception and HIV remains uncertain…..more

Strategy: Draft National Strategic Plan for HIV Prevention, Care and Treatment for Sex Workers

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Released by the South African National AIDS Council (SANAC) on 12 January, this 49-page preliminary document outlines plans to, for instance, increase HIV and tuberculosis (TB) prevention, care and treatment among sex workers and families….more

Child grants until age 23

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Talks are under way in government to possibly extend child grants for needy children from 18 years of age to 23. The proposal has been met with mixed reaction, with some roleplayers welcoming it and others questioning the timing of the move and saying that such a step will make people that much more dependent on government. “And it is taxpayers who will have to pay,” said Francois Stofberg, economist at the Efficient Group. ….more and more

Seven Gauteng schools kiss the chalkboard goodbye

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Seven schools in Tembisa in Ekurhuleni are stepping bravely into the digital future tomorrow morning. Briefing the media at Boitumelong Secondary School this afternoon Gauteng Education MEC Panyaza Lesufi said: “I’m signing the death warrant of the chalk, duster and chalkboard in Gauteng. We are moving on with the times and we are moving to better things.” ….more

Medical Aid Films – new films in 2015

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We at Medical Aid Films have new productions coming up in the next few months and would like to inform you of what is in production and will be available for your use in 2015. For those of you who do not know of our work you can access our freely available training and education films which we hope can complement your existing training materials here: http://medicalaidfilms.org/our-films/

For those of you already using our films please take the time to complete our short online survey (https://www.surveymonkey.com/s/JTLC6FQ) as this helps us to improve the films (10 minutes of your time), for those of you who have already done so and continue to provide feedback – thank you our expertise and understanding grows with every new piece of information and our films evolve for better use in your programs.

New films in 2015:

1. Kangaroo Mother Care – we are aware of some great existing materials by a few organisations and will be producing a film that is complementary to these.

2. Respectful Maternity Care Animation about respecting women’s basic human rights in childbirth. White Ribbon Alliance will use the film to train health workers and communities in Nigeria and Malawi, with the film available worldwide in the spring.

3. We are commencing a suite of Fistula Care training films for nurses. We will start with a pilot film, training nurses on pre and post-operative care for fistula surgery patients with Fistula Foundation. Once tested we hope to develop further films in this suite to complement further training.

4. Managing Obstructed Labour for nurse/midwife training will be developed thanks to Vitol Foundation later this year and will serve to complement the Fistula Care suite.

5. As part of 5 films identified for Reproductive Health we will be releasing the first pilot film for testing in February. Thanks so much to Pathfinder International who let us film with them in Nairobi and to so many other partners who gave us so much time and expertise to draft these films. We aim to have the five developed later in 2015 once we have tested the first film.

6. Ebola films for mobile devices – to complement the many training resources on Ebola we are planning two short animations on stigma and rebuilding trust in health systems.

Thank you to so many of you who have helped and supported our work, we make these films in the hope that they can support your training. Some amazing people have shared their stories, contributing to films that really put community members and health workers at the heart. We are hugely grateful to all our partners for their incredible work with us.

Finally, one last ask of HIFA members is that we are improving the look and accessibility of our website as a priority this year, so please let us know your thoughts on what you think works and doesn’t work and how you would like to access our materials by emailing josie@medicalaidfilms.org.  

Anyone particularly interested in any upcoming productions and would like to be involved or give advice please also get in touch with me directly: josie@medicalaidfilms.org

Best wishes from everyone at Medical Aid Films

HIFA profile: Josie Gallo is Content Co-ordinator for Medical Aid Films in the United Kingdom. Professional interests: Media for development.       josie AT medicalaidfilms.org

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To send a message to the HIFA forum, simply send an email to: HIFA2015@dgroups.org