Archive for the ‘Diabet’ Category

Quality Care Improvement Program in a Community-Based Participatory Research Project: DISCUSSION

diabetes

This evaluation of Project DIRECT showed that at the end of the four-year study period, 40% of enrolled providers still participated in the program.

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Quality Care Improvement Program in a Community-Based Participatory Research Project: RESULTS

Provider Retention

Forty-seven healthcare providers practicing alone or in a group in 15 institutions were recruited to participate in the CQIP program (Table 1). All but two providers were physicians. These providers were a physician assistant affiliated with a practice that dropped out at the end of the first year and a nurse practitioner with a practice that stayed three years in the program. No new practice entered the project after it started. However, following expansion of one practice in 1999-2000, four new physicians were enrolled. The biggest drop-out occurred at the end of the first intervention year because of disbandment of three practices with 14 providers that were owned by the same group (the medical director for these practices left and the providers discontinued their participation) and withdrawal of one provider. Thereafter, the drop-out rate remained constant (12-14%), with about 40% of providers still participating at the end of the fourth year. On a year-to-year basis, however, the project objective of retaining 70% of providers was met (83%, 88%, and 82% the last three study years, respectively). It is of interest to note that single practitioners were more likely to stay in the program. The reasons for withdrawing varied. Only one single-practitioner practice truly declined CQIP participation; others left for migration out of Raleigh (n=2 practices with six providers), retirement (two providers in a practice that remained in the program), and practice disbandment or reorganization (n=6 practices with 21 providers).

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Quality Care Improvement Program in a Community-Based Participatory Research Project: OUTCOMES DEFINITION AND MEASUREMENT

Process Outcome

Retention plan. The plan was evaluated by the annual number of contacts with primary care providers recorded on DC practice records. These contacts were defined as a continuous variable and used to assess the objective’s implementation by the DIRECT staff. Overall attendance at education events was monitored, but attendance of specific CQIP providers was not transcribed.

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Quality Care Improvement Program in a Community-Based Participatory Research Project: METHODS

The CQIP used a one-group pre- and post-test design. The target population included African-American residents of southeast Raleigh, the historical center of Raleigh’s African-American community. The DC component was initiated in August 1996; the ongoing intervention is at its institutionalization phase. The North Carolina State University, Wake Forest University, and CDC Institutional Review Boards approved Project DIRECT protocols during the study.

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Quality Care Improvement Program in a Community-Based Participatory Research Project

diabetes tream

INTRODUCTION

The complex set of health status determinants, the disproportionate disease burden experienced in marginalized communities, and the limited effectiveness of traditional prevention research, particularly in minority communities, have increased the demand for more comprehensive and participatory approaches to public health research and practice. In 1985, the Secretary of Health and Human Services Task Force on Black and Minority Health identified diabetes as a major contributor to mortality among minorities in the United States. To respond to the excessive, unnecessary burden of diabetes among African Americans, the Centers for Disease Control and Prevention (CDC) led the development, implementation, and evaluation of Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together) in southeast Raleigh, NC.

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IDDM2 and the Polymorphism of the Human Tyrosine Hydroxylase: DISCUSSION

This report uses the microsatellite repeats (TCAT)n on chromosome 11 to investigate the tyrosine hydroxylase gene as IDDM2, the second major candidate gene for susceptibility to type-1 diabetes. No significant association was found either at the allele level or at the genotype level. This data is in contrast with findings in previous association studies that detected a significant association of hTH with type-1 diabetes in Caucasians. The data reported here for African Americans was consistent with findings reported by Field and coworker in a family study that failed to demonstrate significant evidence of linkage between type-1 and hTH, either by lod score or affected sibling pair linkage analysis. No association was found with hTH in another study that used restriction fragment polymorphism. The exact localization of the IDDM2 and the depiction of its effect on the expression of hTH, INS, and IGF2 may prove to be important in understanding the biological mechanisms that lead to the onset of type-1 diabetes and its complications. The study of microsatellite sequences has shown that they may have a function in recombination, in the generation of nucleosome positioning signals, and more subtle effects on expression. Previous studies have shown that hTH tetranucleotide repeat acts as a transcriptional enhancer in vitro. Moreover, these repeated sequences interact specifically and with high affinity with nuclear proteins.

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IDDM2 and the Polymorphism of the Human Tyrosine Hydroxylase: RESULTS

Five alleles were identified in this African-American population in the Washington, DC area labeled K5 (244 bp), K4 (248 bp), КЗ (252 bp), K2 (256 bp), and Kl (260 bp) (Table 2). The allele frequencies of the five alleles were estimated from 196 chromosomes of unrelated controls and 96 chromosomes of type-1 diabetes individuals. The heterozygosity of the TCAT marker was larger than 0.75. The most fre­quent allele of the hTH microsatellite repeats was K5 (248 bp), with a frequency 0.62 in controls and 0.66 in type-1 diabetes patients, which was not significantly different. The largest allele (260 bp) showed the greatest difference in allele frequency between patients and controls.

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