Browsing by Subject "Low-income"

Now showing 1 - 3 of 3
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    Conservative Kidney Management in the Middle East and North Africa: Attitudes, Practices, and Implementation Barriers
    (Elsevier, 2025-01-16) Koubar, Sahar H.; Hatab, Taha; Razzak, Farah Abdul; Helal, Imed; Ali, Ala; Shebani, Abdulhafid; Kaysi, Saleh; Gunderman, David; Al-Makki, Akram; Davison, Sara N.; Medicine, School of Medicine
    Introduction: Conservative kidney management (CKM) is poorly developed and not easily accessible globally, especially in middle- and low-income countries. This study aimed to understand the perspectives of nephrologists on CKM and the barriers to its implementation in the Middle East and North Africa (MENA) region. Methods: We conducted an online survey. Nephrologists were contacted through their local nephrology societies. Responses were divided into the following 3 groups as per the country's income classification by the World Bank: high-, middle-, and low-income. Results: A total of 336 surveys were analyzed (response rate: 34.28%). The mean age of participants was 43.3 ± 9.8 years; 50% were male, 91% practiced in urban settings, and 18% were affiliated with academic centers. Of the participants, 76% were from middle-income countries. Nearly 80% of the participants were aware of CKM, and 65% accepted CKM as a treatment modality for kidney failure. However, only 20% consistently offered CKM to their patients and only 16% had a formal CKM program at their institution. Among these, 12% had a multidisciplinary team and only 6% had formal CKM training. The major perceived barriers to CKM implementation were financial and resource constraints (37.7% and 32.7%, respectively). Cultural and religious barriers constituted 18.3% and 8.6%, respectively, and were similar among the 3 income groups. Conclusion: Despite the significant awareness of CKM in the MENA region, its implementation remains poor. Key barriers include financial limitations, resource shortages, and a lack of training. Regional and national research is required to address these challenges and guide policies to improve CKM accessibility and implementation.
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    Health Equity, Urban Congregations, and HIP
    (Indiana Minority Health Coalition, 2019-10) Craig, David M.; Hicks, Ivan Douglas; Green, Andrew; Meschi, Maria; Napier, Pamela; Patterson, Stephanie; Armstrong, George; Schicho, Fiona; Wilcox, Matthew
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    Program ACTIVE II: Design and Methods for a Multi-Center Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes
    (Hindawi, 2015-08) de Grogg, Mary; Shubrook, Jay; Schwartz, Frank; Hornsby Jr., W. Guyton; Pillay, Yegan; Saha, Chandan; Department of Medicine, IU School of Medicine
    OBJECTIVE: Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups. METHODS: The study is a 2-by-2 factorial randomized controlled trial consisting of 4 treatment groups: CBT alone, EXER alone, combination of CBT and EXER, and UC. Adults with T2DM for > 1 year and who meet DSM-IVTR criteria for Major Depressive Disorder (MDD) are eligible to participate at two rural Appalachian sites (southeastern Ohio and West Virginia) and one urban site (Indianapolis). This type II behavioral translation study uses a community-engaged research (CEnR) approach by incorporating community fitness centers and mental health practices as interventionists. CONCLUSIONS: This is the first study to evaluate the comparative effectiveness of combined CBT and exercise in the treatment of depression using community-based intervention delivery. This approach may serve as a national model for expanding depression treatment for patients with T2DM.