A Community-Based Intervention for Managing Hypertension in Rural South Asia.

Aged Antihypertensive Agents / therapeutic use Asia, Western Blood Pressure Blood Pressure Determination Checklist Community Health Workers Developing Countries Education, Medical, Continuing Female Health Care Costs / statistics & numerical data House Calls Humans Hypertension / diagnosis Male Middle Aged Patient Education as Topic Public Health Practice Rural Population

Journal

The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562

Informations de publication

Date de publication:
20 02 2020
Historique:
entrez: 20 2 2020
pubmed: 20 2 2020
medline: 7 3 2020
Statut: ppublish

Résumé

The burden of hypertension is escalating, and control rates are poor in low- and middle-income countries. Cardiovascular mortality is high in rural areas. We conducted a cluster-randomized, controlled trial in rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 communities were randomly assigned to either a multicomponent intervention (intervention group) or usual care (control group). The intervention involved home visits by trained government community health workers for blood-pressure monitoring and counseling, training of physicians, and care coordination in the public sector. A total of 2645 adults with hypertension were enrolled. The primary outcome was reduction in systolic blood pressure at 24 months. Follow-up at 24 months was completed for more than 90% of the participants. At baseline, the mean systolic blood pressure was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. At 24 months, the mean systolic blood pressure fell by 9.0 mm Hg in the intervention group and by 3.9 mm Hg in the control group; the mean reduction was 5.2 mm Hg greater with the intervention (95% confidence interval [CI], 3.2 to 7.1; P<0.001). The mean reduction in diastolic blood pressure was 2.8 mm Hg greater in the intervention group than in the control group (95% CI, 1.7 to 3.9). Blood-pressure control (<140/90 mm Hg) was achieved in 53.2% of the participants in the intervention group, as compared with 43.7% of those in the control group (relative risk, 1.22; 95% CI, 1.10 to 1.35). All-cause mortality was 2.9% in the intervention group and 4.3% in the control group. In rural communities in Bangladesh, Pakistan, and Sri Lanka, a multicomponent intervention that was centered on proactive home visits by trained government community health workers who were linked with existing public health care infrastructure led to a greater reduction in blood pressure than usual care among adults with hypertension. (Funded by the Joint Global Health Trials scheme; COBRA-BPS ClinicalTrials.gov number, NCT02657746.).

Sections du résumé

BACKGROUND
The burden of hypertension is escalating, and control rates are poor in low- and middle-income countries. Cardiovascular mortality is high in rural areas.
METHODS
We conducted a cluster-randomized, controlled trial in rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 communities were randomly assigned to either a multicomponent intervention (intervention group) or usual care (control group). The intervention involved home visits by trained government community health workers for blood-pressure monitoring and counseling, training of physicians, and care coordination in the public sector. A total of 2645 adults with hypertension were enrolled. The primary outcome was reduction in systolic blood pressure at 24 months. Follow-up at 24 months was completed for more than 90% of the participants.
RESULTS
At baseline, the mean systolic blood pressure was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. At 24 months, the mean systolic blood pressure fell by 9.0 mm Hg in the intervention group and by 3.9 mm Hg in the control group; the mean reduction was 5.2 mm Hg greater with the intervention (95% confidence interval [CI], 3.2 to 7.1; P<0.001). The mean reduction in diastolic blood pressure was 2.8 mm Hg greater in the intervention group than in the control group (95% CI, 1.7 to 3.9). Blood-pressure control (<140/90 mm Hg) was achieved in 53.2% of the participants in the intervention group, as compared with 43.7% of those in the control group (relative risk, 1.22; 95% CI, 1.10 to 1.35). All-cause mortality was 2.9% in the intervention group and 4.3% in the control group.
CONCLUSIONS
In rural communities in Bangladesh, Pakistan, and Sri Lanka, a multicomponent intervention that was centered on proactive home visits by trained government community health workers who were linked with existing public health care infrastructure led to a greater reduction in blood pressure than usual care among adults with hypertension. (Funded by the Joint Global Health Trials scheme; COBRA-BPS ClinicalTrials.gov number, NCT02657746.).

Identifiants

DOI: 10.1056/NEJMoa1911965 PMID: 32074419
pubmed: 32074419
doi: 10.1056/NEJMoa1911965
doi:

Substances chimiques

Antihypertensive Agents 0

Banques de données

ClinicalTrials.gov
['NCT02657746']

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

717-726

Subventions

Organisme : Medical Research Council
ID : MR/N006178/1
Pays : United Kingdom
Organisme : Wellcome Trust
ID : MR/N006178/1
Pays : United Kingdom
Organisme : United States
ID : MR/N006178/1
Pays : United States

Investigateurs

Tazeen H Jafar (TH)
Eric Finkelstein (E)
Helena Legido-Quigley (H)
Marcel Bilger (M)
Feng Liang (F)
Saeidah Tavajoh (S)
Lim Ching Wee (LC)
Anirudh Krishnan (A)
Cecille Lintag (C)
Mihir Gandhi (M)
Pryseley Nkouibert Assam (PN)
Rajesh Babu Moorakonda (RB)
Lin Xinyi (L)
Edwin Chan (E)
Zheng Yiheng (Z)
Aliya Naheed (A)
John D Clemens (JD)
Mohammad Hasnat (M)
Nantu Chakma (N)
Dewan Alam (D)
Sonia Pervin (S)
Ali Tanweer (A)
Rubhana Rajib (R)
Mohannad Tauhid Ul Islam (M)
Imtiaz Jehan (I)
Aamir Hameed (A)
Sahar Senan (S)
Hamid Farazdiq (H)
Gulshan Himani (G)
Samina Hirani (S)
Jehanzeb Khan (J)
Syed Omair Nadeem (SO)
Hunaina Shahab (H)
Ayesha Khan (A)
Asita de Silva (A)
Anurhadhani Kasuriratne (A)
Nathasha Luke (N)
Chamini de Silva (C)
Manuja Perera (M)
Channa Ranasinha (C)
Dileepa Ediriweera (D)
Shah Ebrahim (S)
Donald Morisky (D)
Elizabeth Turner (E)
Joep Perk (J)
Richard Smith (R)
Anne Mills (A)
Elizabeth Allen (E)
Kate Hunt (K)
Jill Jones (J)
Andrew Farmer (A)
Doris Young (D)
Bruce Neal (B)
Tan Say Beng (TS)

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2020 Massachusetts Medical Society.

Auteurs

Tazeen H Jafar (TH)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Mihir Gandhi (M)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

H Asita de Silva (HA)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Imtiaz Jehan (I)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Aliya Naheed (A)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Eric A Finkelstein (EA)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Elizabeth L Turner (EL)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Donald Morisky (D)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Anuradhani Kasturiratne (A)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Aamir H Khan (AH)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

John D Clemens (JD)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Shah Ebrahim (S)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Pryseley N Assam (PN)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

Liang Feng (L)

From the Program in Health Services and Systems Research (T.H.J., E.A.F., L.F.) and the Center for Quantitative Medicine (M.G.), Duke-NUS Medical School, the Department of Renal Medicine, Singapore General Hospital (T.H.J.), and the Department of Biostatistics, Singapore Clinical Research Institute (M.G., P.N.A.) - all in Singapore; the Duke Global Health Institute (T.H.J., E.A.F., E.L.T.) and the Department of Biostatistics and Bioinformatics, Duke University (E.L.T.) - both in Durham, NC; the Center for Child Health Research, Tampere University, Tampere, Finland (M.G.); the Clinical Trials Unit, Department of Pharmacology (H.A.S.), and the Department of Public Health (A.K.), Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; the Department of Community Health Sciences (I.J.) and the Section of Cardiology, Department of Medicine (A.H.K.), Aga Khan University, Karachi, Pakistan; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (A.N., J.D.C.); the UCLA Fielding School of Public Health, Department of Community Health Sciences, Los Angeles (D.M.); and the London School of Hygiene and Tropical Medicine, London (S.E.).

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › A Community-Based Intervention for Managing...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents cardiovasculaires › Antihypertenseurs › A Community-Based Intervention for Managing...
questionsmedicales.fr › Régions géographiques › Asie › Asie de l'Ouest › A Community-Based Intervention for Managing...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Hémodynamique › Pression sanguine › A Community-Based Intervention for Managing...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Examen physique › Mesure de la pression artérielle › A Community-Based Intervention for Managing...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Liste de contrôle › A Community-Based Intervention for Managing...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Auxiliaires de santé › Agents de santé communautaire › A Community-Based Intervention for Managing...
questionsmedicales.fr › Sciences sociales › Internationalité › Coopération internationale › Pays en voie de développement › A Community-Based Intervention for Managing...
questionsmedicales.fr › Éducation › Enseignement professionnel › Enseignement médical › Formation médicale continue comme sujet › A Community-Based Intervention for Managing...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Coûts des soins de santé › A Community-Based Intervention for Managing...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Pratique professionnelle › Visites à domicile › A Community-Based Intervention for Managing...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A Community-Based Intervention for Managing...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Hypertension artérielle › A Community-Based Intervention for Managing...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › A Community-Based Intervention for Managing...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services de médecine préventive › Éducation pour la santé › Éducation du patient comme sujet › A Community-Based Intervention for Managing...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › A Community-Based Intervention for Managing...
questionsmedicales.fr › Caractéristiques de la population › Population › Population rurale › A Community-Based Intervention for Managing...