Community-level screening for type 2 diabetes risk in Mexicans living in Colorado

Introduction: Many Mexican immigrants to the US are medically underserved and have a higher risk for type 2 diabetes; early identifica-tion of risk factors can prompt referrals to lifestyle changes and primary care in this population. We used a cross-sectional study design to assess diabetes risk using an existing community partnership, a public health professional, and a lay health promoter model to identify individuals at high risk for diabetes without imposing tests that are difficult to perform or sustain in a community setting. Materials and Methods: Between January 1st, 2018, and December 31st, 2019, a community-based approach for type 2 diabetes-risk screening was conducted by lay health workers using a standard protocol including an educational component, the FINDRISC questionnaire, and capillary plasma glucose criteria. Basic descriptive statistics were obtained for demographic, lifestyle, and diabetes risk factors. Results:Our team screened 783 adult individuals (444 females and 339 males) for type 2 diabetes risk. 29% of participants (35.6% of females and 20.6% of males) were at high risk of type 2 diabetes because they had FINDRISC scores of 14 or higher. We also identified other risk factors, 79% of females and 86% of males were overweight or obese, and 39% had high blood pressure; consequently, we referred 427 patients to their PCP or a new medical home. Conclusions: The use of a community-based intervention using the FINDRISC type 2 diabetes risk assessment tool is a suitable, easy to perform intervention that can be applied in community settings by community lay health promoters.

Introducción: un gran número de mexicanos que viven en los Estados Unidos están medicamente desatendidos y tienen alto riesgo de desarrollar diabetes. La identificación oportuna de factores de riesgo puede iniciar el proceso de referencia a programas de mejora de estilo de vida y a primer nivel de atención. Presentamos un estudio transversal diseñado para evaluar el riesgo de diabetes utilizando alianzas comunitarias pre-existentes, un profesional en salud pública y un modelo de promotores comunitarios de salud para identificar personas con alto riesgo de diabetes sin usar estudios de laboratorio complejos. Material y métodos: entre enero de 2018 y diciembre de 2019 se aplicó un programa comunitario para detector riesgo de diabetes por miembros de la comunidad utilizando un protocolo estandarizado que incluyo un componente educativo, el cuestionario FINDRISC y criterios de glucosa capilar. Se hicieron estudios esta-disticos basicos en demografia, estilos de vida y factores de riesgo de diabetes. Resultados: 783 personas (444 mujeres y 339 hombres) fueron evaluados para determinar su riesgo de diabetes. 29% de los participantes (35.6% de las mujeres y 20,6% de los hombres) tuvieron un resultado mayor o igual a 14 en la escala FINDRISC lo que indica alto riesgo de desarrollar diabetes. Se identificaron otros factores de riesgo, 79% de las mujeres y 86% de los hombres tenían sobrepeso u obesidad. Se detectó hipertensión en 39% de la muestra. Como consecuencia de esta intervención se refirieron 427 personas a primer nivel de atención. Conclusiones: La detección de individuos de alto riesgo de diabetes a nivel comunitario utilizando la escala FINDRISC por miembros de la comunidad es factible y de fácil aplicación.

Curing Chronic Hepatitis C: A Cost Comparison of the Combination Simeprevir Plus Sofosbuvir vs. Protease-Inhibitor-Based Triple Therapy

ABSTRACT Introduction. Interferon-free, multi-direct acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection is highly effective and well tolerated, but costly. To gain perspective on the evolving economics of HCV therapy, we compared the cost per cure of a multi-DAA regimen with the prior standard of triple therapy. Material and methods. Patients infected with HCV genotype 1 who were treated through the University of Colorado Hepatology Clinic between May 2011 and December 2014 comprised the study population. The multi-DAA regimen of simeprevir plus sofosbuvir (SMV/SOF) was compared to the triple therapy regimen consisting of peginterferon and ribavirin, with either boceprevir or telaprevir (TT). Sustained-virologic response (SVR) rates, total costs per treatment and adverse events were recorded. Total cost per SVR were compared for the two treatments, controlling for patient demographics and clinical characteristics. Results. One hundred eighty-three patients received SMV/SOF (n = 70) or TT (n = 113). Patients receiving SMV/SOF were older, more treatment experienced, and had a higher stage of fibrosis. SVRs were 86% and 59%, average total costs per patient were $152,775 and $95,943, and average total costs per SVR were $178,237 vs. $161,813.49 for SMV/SOF and TT groups, respectively. Medication costs accounted for 98% of SMV/SOF and 85% of TT treatment costs. Conclusion. The high cure rate of multi-DAA treatment of HCV is offset by the high costs of the DAAs, such that the cost per cure from TT to multi-DAA therapy has been relatively constant. In order to cure more patients, either additional financial resources will need to be allocated to the treatment of HCV or drug costs will need to be reduced.

Prevalence of oral cancer self-examination among elderly people treated under Brazil's Unified Health System: household health survey / Prevalência de autoexame bucal é maior entre idosos assistidos no Sistema Único de Saúde: inquérito domiciliar

The aim of this study was to examine the prevalence of oral cancer self-examinationamong the elderly and confirm whether prevalence was higher among users of the dental services provided by Brazil's Unified Health System (SUS, acronym in Portuguese). A transversal study of elderly people aged between 65 and 74 years living in a large-sized Brazilian municipality was conducted using simple random sampling. Logistic regression was conducted and results were corrected for sample design and unequal weighting using the SPSS(r) software. The study assessed 740 individuals. A total of 492 met the inclusion criteria, of which 101 (22.4%) reported having performed an oral cancer self-examination. Prevalence was higher among users of the dental services provided by the SUS, higher-income individuals, people with higher levels of education, individuals that used a removable dental prosthesis, and people who had not experienced discomfort attributed to oral condition, and lower among people who sought regular and periodic dental treatment and individuals who did not have a drinking habit. This type of self-care should be encouraged by public health policies which respond to the needs of the elderly, with emphasis on users of private and philanthropic services, and other services outside the public health network.

Este estudo objetivou identificar a prevalência do autoexame bucal entre idosos e constatar se essa prevalência foi maior entre usuários de serviços odontológicos prestados pelo Sistema Único de Saúde (SUS). Estudo transversal conduzido a partir de amostragem probabilística complexa por conglomerados, entre idosos (65-74 anos) de um município brasileiro de grande porte populacional. Foi realizada regressão logística binária, as estimativas foram corrigidas pelo efeito de desenho e por ponderações, utilizando-se o SPSS(r). Dentre os 740 avaliados, atenderam aos critérios de inclusão 492 idosos e, destes, 101 (22,4%) relataram a prática do autoexame bucal. Esta prática foi maior entre idosos usuários dos serviços odontológicos prestados no SUS, entre aqueles com maior renda per capita, os com maior escolaridade, aqueles que utilizavam prótese dentária removível e entre os que não tiveram impactos decorrentes das desordens bucais; foi menor entre os que usaram serviços odontológicos por rotina e os que não possuíam hábito etilista. A prevalência do autoexame bucal entre idosos foi baixa e maior entre aqueles usuários do SUS. O estímulo à adesão a este autocuidado deve ser considerado nas políticas de saúde do idoso vigentes, especialmente entre usuários de serviços particulares, supletivos e filantrópicos.