Medical Inspection – Health Blog

Although state and national health statistics ranked noninsulin-dependent diabetes mellitus as the most prevalent chronic disease among American adults—with African Americans disproportionately affected—and despite a community-based diabetes intervention effort that included mass screening and education initiated four years prior—none of the congregation leadership had ranked it as important at baseline. However, following an education providing the leadership with skills to prioritize health needs and plan health-promotion activities most beneficial to their congregations, diabetes was identified as the most serious health concern threatening the well-being of large- and medium-sized congregations. Moreover, most of the leaders had taken advantage of resources available, including Project DIRECT, within their own congregations and in the community to decrease the prevalence of known risk factors.

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At baseline, 21 of the 41 congregations identified agreed to participate, representing a variety of Christian and Muslim communities. These congregations served a total of about 9,600 persons, and congregation sizes ranged from 120 to 1,200 members. The follow-up period ranged from three-to-five years, although the median follow-up was four years.

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Project DIRECT

Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together), is a community-based demonstration project first funded by the Centers for Disease Control and Prevention in 1993. Its overarching goal was to reduce the burden of diabetes among African Americans in southeast Raleigh, NC. Recruitment and intervention methods for the parent project are detailed else-where. Briefly, community leaders from a predominantly middle- and upper-middle class African-American community in southeast Raleigh, NC, formed a committee to spearhead diabetes control activities in the community. Using the PRECEDE-PROCEDE model to plan the intervention, predisposing, reinforcing, and enabling factors related to chronic disease prevention were identified through formative focus group discussions. The resulting intervention focused on three main areas: a) primary prevention through community-based health promotion aimed at improving diet and physical activity; b) secondary prevention through outreach education to improve diabetes awareness, screening to detect undiagnosed diabetes, and case management to ensure that diabetics not receiving continual care were integrated into the healthcare system; and c) tertiary prevention through diabetes care and education aimed at physicians to improve the quality of diabetes care received within the healthcare system. These objectives were achieved through mass diabetes screenings, media campaigns, and community outreach activities in southeast Raleigh.

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INTRODUCTION

African Americans are at higher risk for diabetes, cardiovascular disease, and some cancer compared to their white counterparts. While some of the disparities can in part be attributed to nonmodifiable factors, such as age or genetic predisposition, some of this risk can be attributed to modifiable lifestyle factors, such as physical inactivity, tobacco use, obesity, diets high in fat and poor in some micronutrients, as well as under-utilization of preventive healthcare.

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Persons with HIV infection who subsequently develop an acute STD have an increased probability of transmitting HIV, as persons with acute STDs have increased probability of acquiring HIV. STDs, therefore, play an important role in the transmission of HIV Its prevention, thus, becomes important in the prevention of HIV.

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Two-hundred-thirty patients were informed about the purpose of the study, and 90 (39.1%) refused to be included in the study. A total of 140 women were therefore studied. The mean age was 31.1 ±6.9 years (range 18-50 years) with the majority (83.0%) in the 20-39-year age group. The mean parity was 1.76±2.1 (range 0-8), and more than one-third (39.3%) were nulliparous. One-hundred-fourteen (81.4%) of the patients were married, and 25 (18.9%) were single. Nine (6.4%) of the 140 patients gave a history of having more than one sexual partner. Table 1 shows the prevalence of the various isolates identified in the vaginal discharge of the 140 patients studied. In 31 patients (22.1%), Candida spp. (predominantly Candida albicans) were isolated. This was followed by Gardnerella vaginalis, 26 (18.8%). Staphylococcal spp. were isolated in 17 (12.1%). E. coli, Trichomonas vaginalis, and Neisseria gonococ-cus were in 7.9%, 4.3%, and 1.4%, respectively. In 40 (28.6%), no organisms were isolated. Four of the 140 patients were HIV seropositive, giving an HlV-sero-prevalence rate of 2.9%. Table 2 shows the sociode-mographic characteristics of the patients who were HIV seropositive. All the four of them were married. The mean age was 36.8±5.2 years (range 29-40 years) with a mean parity of 3.3±1.7 (range 1-5). All of them were petty traders. They were all sexually active, one of them admitting to having three sexual partners at a time. Their vaginal discharge was thick and white in color; nonoffensive and Candida albicans organism was isolated in all of them. They all had pruritus vulvae. Read More…

The study was carried out between April 2000 and August 2000 in the Cervical Cytology Clinic of the Lagos University Teaching Hospital. The clinic also takes care of patients from the gynecologic and family planning clinics who complain of vaginal discharge. The patients for the study were women in the reproductive age (15^9 years) that came to the clinic complaining of vaginal discharge. Pregnant women, postmenopausal women, and those with obvious benign or malignant lesions of the cervix were excluded from the study, which was approved by the Ethics and Research Committee of the Lagos University Teaching Hospital.

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