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Type 2 diabetes is reaching epidemic proportions in a low-/middle income country such as South Africa, where most patients are managed in the public health sector with limited resources. Poor knowledge, negative attitudes and unhealthy practices are common, highlighting the need for healthcare providers to adapt health communication strategies appropriately. The current study aimed to develop a health dialogue model by applying a multiple-methods design informed by the United Kingdom Medical Research Council’s guidelines for the development and evaluation of complex interventions. Guided by this framework, four separate but inter-related studies were conducted to establish the active components of health dialogue. Participants included patients with type 2 diabetes from a variety of public healthcare settings and healthcare providers who provide services to them. The findings from the four primary studies were then synthesised at a two-day workshop during which three focus areas emerged, including the community, the patient and the healthcare provider. Community awareness could be raised by delivering key messages in the native tongue of patients through combinations of traditional folk media such as drama and storytelling in the waiting rooms of health centres. Self-management of patients could be promoted by active participation of patients in tailored health communication using peer support and the use of mobile health devices. Finally, training platforms for healthcare providers should include in-service training through interactive workshops. Our culturally sensitive health dialogue model has the potential to improve adherence to treatment, leading to greater satisfaction and consequently improved health outcomes. Keywords: Complex intervention diabetes mellitus, Health dialogue model, Low/middle income countries

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Hace algunas jornadas, en medio de las iniciativas inimaginables que hemos debido poner en práctica desde el hogar madres y padres con niños pequeños en estos más de dos años de pandemia, cedí al reclamo de Hassancito de quedarse otro rato despierto algo que trato de hacer de manera excepcional bajo su argumentación de que al día siguiente no debía asistir a la escuela. El motivo de su demanda era ver qué película pondrían en Solo la verdad, rutina que despierta su interés en las noches de lunes, en que este espacio alterna con Historia del Cine, al igual que hace con el resto de la programación cinematográfica que nos llega por la parrilla elaborada cada semana.

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BACKGROUND:In patients with end stage kidney disease (ESKD) on dialysis, treatment non-adherence is common and results in poor health outcomes. However, the clinical benefits of interventions to improve adherence in dialysis patients are difficult to evaluate since trialled interventions and reported outcomes are highly diverse/ heterogeneous. This review summarizes existing literature on randomized controlled trials (RCTs) evaluating adherence interventions in ESKD patients focusing on the intervention category, outcome efficacy and persistence of benefit beyond the intervention. METHODS:We performed electronic database searches in Medline, Embase & Cochrane CENTRAL upto 1st July 2018 for RCTs evaluating interventions to improve diet, fluid, medication or dialysis adherence in ESKD patients. Study characteristics including category of interventions, outcomes, efficacy and follow-up were assessed. Meta-analysis was used to compute pooled estimates of the effects on the commonest reported outcome measures. RESULTS:From 1311 citations, we included 36 RCTs (13 cluster-randomized trials), recruiting a total of 3510 dialysis patients (mean age 55.1 ± 5.8 years, males 58.1%). Overall risk of bias was 'high' for 24 and of 'some concern' for 12 studies. Most interventions (33 trials, 92%) addressed patient related factors, and included educational/cognitive (N = 11), behavioural / counselling (N = 4), psychological/affective (N = 4) interventions or a combination (N = 14) of the above. A majority of (28/36) RCTs showed improvement in some reported outcomes. Surrogate measures like changes in phosphate (N = 19) and inter-dialytic weight gain (N = 15) were the most common reported outcomes and both showed significant improvement in the meta-analysis. Sixteen trials reported follow-up (1-12 months) beyond intervention and the benefits waned or were absent in nine trials within 12 months post-intervention. CONCLUSIONS:Interventions to improve treatment adherence result in modest short-term benefits in surrogate outcome measures in dialysis patients, but significant improvements in trial design and outcome reporting are warranted to identify strategies that would achieve meaningful and sustainable clinical benefits. LIMITATIONS:Poor methodological quality of trials. Frequent use of surrogate outcomes measures. Low certainly of evidence.

The objective of this work is to investigate the performance of chlorophyll sensitized solar cells (CSSCs) with gel electrolyte based on polyvinyl alcohol (PVA) with single iodide salt (potassium iodide (KI)) and double salt (KI and tetrapropylammonium iodide (TPAI)). Chlorophyll was extracted from the bryophyte Hyophila involuta. The CSSC with electrolyte containing only KI salt produced a short circuit current density (Jsc) of 4.59 mA cm−2, open circuit voltage (Voc) of 0.61 V, fill factor (FF) of 0.64, and efficiency (η) of 1.77%. However, the CSSC with double salt electrolyte exhibited Jsc of 5.96 mA cm−2, Voc of 0.58 V, fill factor FF of 0.58, and η of 2.00%. Since CSSC with double salt electrolyte showed better efficiency, other cells fabricated will use the double salt electrolyte. On addition of 0.7 M tetrabutyl pyridine (TBP) to the double salt electrolyte, the cell’s efficiency increased to 2.17%, Jsc=5.37 mA cm−2, Voc=0.55 V, and FF = 0.73. With 5 mM chenodeoxycholic acid (CDCA) added to the chlorophyll, the light to electricity efficiency increased to 2.62% with Jsc of 8.44 mA cm−2, Voc of 0.54 V, and FF of 0.58.