Background Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities. Objectives This systematic review synthesized evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost effectiveness of such interventions in vulnerable populations with chronic, non-communicable conditions. Search methods Four electronic database searches, including PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane, and hand searches of reference collections were undertaken to identify randomized controlled trials published in English before August 2014. Selection A total of 934 unique citations were screened initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and six companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion. Data collection and analysis Data were extracted by 4 trained research assistants (RA) using a standardized data extraction form developed by the authors. Subsequently, an independent RA reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by two RAs who extracted relevant study information. Inter-rater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions. Main results All but 4 studies were conducted in the U.S. The two most common areas for CBHW interventions were cancer prevention (n=30) and cardiovascular disease risk reduction (n=26). The roles assumed by CBHWs included: health education (n=48), counseling (n=36), navigation assistance (n=21), case management (n=4), social services (n=7), and social support (n=18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n=9) and supervision procedures (n=24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n=21) and cardiovascular risk reduction (n=16). Eight articles documented cost effective analysis and found that integrating CBHWs into the healthcare delivery system was associated with cost-effective and sustainable care. Conclusions CBHW interventions appear to be effective when compared to alternatives and also cost-effective for certain health conditions particularly when partnering with low-income, underserved, and racial a...

The levels of several brain metabolites were investigated in the anterior (ACC) and posterior cingulate cortex (PCC) in 13 healthy controls (HC) and 13 patients with mild cognitive impairment (MCI) using single-voxel magnetic resonance spectroscopy (MRS) at 7T. Levels of γ-aminobutyric acid (GABA), glutamate (Glu), glutathione (GSH), N-acetylaspartylglutamate (NAAG), N-acetylaspartate (NAA), and myo-inositol (mI) were quantified relative to total creatine (tCr). The effect of diagnosis on metabolite levels, and relationships between metabolite levels and memory and executive function, correcting for age, were investigated. MCI patients showed significantly decreased GABA/tCr (ACC, PCC), Glu/tCr (PCC), and NAA/tCr (PCC), and significantly increased mI/tCr (ACC). In the combined group, worse episodic verbal memory performance was correlated with lower Glu/tCr (PCC), lower NAA/tCr (PCC), and higher mI/tCr (ACC, PCC). Worse verbal fluency performance was correlated with lower GSH/tCr (PCC). In summary, MCI is associated with decreased GABA and glutamate, most consistently in the PCC. Further studies in larger patient samples should be undertaken to determine the utility of 7T MRS in detecting MCI-related neurochemical changes.

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