Objective: Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries (LMICs). Mobile health technologies may improve noncommunicable disease outcomes, but LMICs lack resources to provide these services. We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure (BP) monitoring as a strategy for improving systolic BPs (SBPs) and other outcomes of hypertensive patients in two LMICs. Subjects and Methods: This was a randomized trial with a 6-week follow-up. Participants with high SBPs ( ‡140 mm Hg if nondiabetic and ‡130 mm Hg if diabetic) were enrolled from clinics in Honduras and Mexico. Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States, plus a home BP monitor. At baseline, control patients received BP results, hypertension information, and usual healthcare. The primary outcome, SBP, was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs. Secondary outcomes included perceived health status and medicationrelated problems. Results: Of the 200 patients recruited, 181 (90%) completed follow-up, and 117 of 181 had low literacy or high hypertension information needs. The median annual income was $2,900 USD, and average educational attainment was 6.5 years. At follow-up intervention patients' SBPs decreased 4.2 mm Hg relative to controls (95% confidence interval -9.1, 0.7; p = 0.09). In the subgroup with high information needs, intervention patients' average SBPs decreased 8.8 mm Hg ( -14.2, -3.4, p = 0.002). Compared with controls, intervention patients at follow-up reported fewer depressive symptoms (p = 0.004), fewer medication problems (p < 0.0001), better general health (p < 0.0001), and greater satisfaction with care (p £ 0.004). Conclusions: Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs. A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support.
Articles you may be interested inDirect comparative study on the energy level alignments in unoccupied/occupied states of organic semiconductor/electrode interface by constructing in-situ photoemission spectroscopy and Ar gas cluster ion beam sputtering integrated analysis system A molecular dynamics study of the transport coefficients of liquid transition and noble metals using effective pair potentials obtained from the embedded atom model Matrix isolation spectroscopy has been applied to quantitative sputtering studies by developing techniques for the codeposition of backsputtered metal atoms with a large excess of noble gas atoms, The electronic spectra of Au atoms, produced by bombardment of an Au target with 50 keY Ar+ ions, were studied in Ar, Kr, and Xe matrices. Energy level shifts of the Au resonance doublet due to matrix perturbations have been interpreted in terms of changes in the spin-orbit coupling interaction of the Au 6p electron. The values in the various matrices were found to be {x, = 2570 cm-I ; {K, = 2943 em-I; {A< = 3215 cm-I ({gas = 2543 cm-I ). The N 650 em-I splitting of the 2 P 3/2 state in the various matrices was interpreted in terms of an axial distortion of a dodecahedral substitutional site. Simultaneous diagonalization of spin-orbit and "crystal" field interactions was employed to obtain { and A 2 splitting parameters. Oscillator strengths for the resonance transitions were determined by developing an equation which relates the sputtering yield, integrated current, and a geometric factor based on a cosine law distribution of sputtered atoms to the integrated absorbance over an absorption band and the area sampled by the spectrometer beam. Oscillator strengths for the 2 P 112 and 2 P 3/2 transitions were found to be 0.132, 0.293 in Ar; 0.090, 0.200 in Kr; and 0.061, 0.145 in Xe. By comparison the gaseous atom values ("hook" method) are 0.19, 0.41. It is pointed out that the matrix isolation method can determine Au atom concentrations equivalent to 0.1 monolayer and is therefore among the more sensitive and rapid techniques for measuring sputtering yields.Very frequently, both atomic and molecular products are formed simultaneously in the sputtering process, ~ and in order to determine the relative yields of these products, oscillator strengths and infrared transition intensities in matrices have to be determined. For sput-
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