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The COmmunity HEalth System InnovatiON (COHESION) project (2016–2019) was a 4-year collaboration between research teams from Mozambique, Nepal, Peru and Switzerland. It conducted formative health system research using tracer chronic conditions, non-communicable diseases (diabetes and hypertension) and one neglected tropical disease per country (schistosomiasis in Mozambique, leprosy in Nepal and neurocysticercosis in Peru).
Findings guided the co-creation of interventions to improve diagnosis and management through a participatory approach with communities, primary healthcare workers and regional health authorities.
As a continuation of this effort, the research team initiated the COHESION Implementation project (COHESION-I) with two objectives: (1) implement and evaluate the context-specific co-created interventions in Mozambique, Nepal and Peru (Component 1) and (2) adapt the COHESION approach to India, a country that did not benefit from a formative phase previously (Component 2). This protocol manuscript focuses on Component 1.
A mixed-methods, pre–post quasi-experimental design will be used, including quantitative, qualitative, economic and process evaluations. Each country will have three arms: (1) co-created and co-designed interventions; (2) only co-designed intervention and (3) the usual care arm. Data will be collected longitudinally over 18 months to assess the effect of the interventions. The main outcomes include patient satisfaction (Patient Satisfaction Questionnaire Short Form), health system responsiveness (WHO responsiveness domains) and quality of life (EuroQol 5 dimensions 5 levels). The qualitative evaluation will explore how satisfaction is perceived among service users with chronic conditions and healthcare workers. Other outcomes per type of evaluation will be considered such as perceived value of health services, cost estimation and acceptability of the intervention components, among others.
Approvals were obtained from Ethics Committees of Universidad Peruana Cayetano Heredia (Peru), Universidade Eduardo Mondale (Mozambique) and Nepal Health Research Council (Nepal). Results will be disseminated through peer-reviewed publications and scientific conferences.
by Martina Ferrari-Díaz, Ashuin Kammar-García, Juan Silva-Pereyra, Carmen García-Peña
Cognitive reserve (CR) refers to the adaptation of cognitive performance to endure brain pathology or the aging process. CR can be categorized into static (education and occupation) or dynamic (leisure and physical activities) proxies. Typically, longitudinal studies assess CR as a composite score at baseline and cognitive performance as a global score. This study aimed to compare the relationship between different CR proxies (static and dynamic) with 9-year domain-specific cognitive trajectories, and the risk of cognitive impairment in older adults. Data from the latest four waves of the Mexican Health and Aging Study (MHAS; n = 3102, baseline mean age = 66.62 years) were used. Mixed effects models were performed with CR as independent variables and cognitive trajectories (verbal memory encoding and retrieval, verbal fluency, constructional praxis, visual attention, and memory) as outcomes. Education and leisure activities were significant positive predictors of all cognitive domains. Physical activities were a positive predictor of verbal fluency and verbal memory encoding only. Occupation was a positive predictor of verbal fluency and visual attention. Logistic regression analysis was performed to assess the relationship between CR and the risk of cognitive impairment, where education (OR: 0.79, 95% CI: 0.76, 0.83), occupational complexity (OR: 0.85, 95% CI: 0.77, 0.95), and leisure activities (OR: 0.96, 95% CI: 0.95, 0.97) were significant protective factors. Increasing the years of education can serve as a preventive strategy to delay the clinical manifestation of cognitive impairment while implementing leisure activities can act as an intervention to promote cognition even in later years.
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