Health care access and health-related quality of life among people with diabetes in the Southern Cone of Latin America-a cross-sectional analysis of data of the CESCAS I study.

PURPOSE: Little is known on the association of health care access and health-related quality of life (HRQoL) in people with diabetes in the Southern Cone of Latin America (SCLA). METHODS: We analyzed data of 1025 participants of CESCAS I. To determine HRQoL, we used the SF-12 physical (PCS-12) and mental component summary (MCS-12). We compared four groups regarding HRQoL: (a) insured people without self-reported barriers to health care, (b) uninsured people without self-reported barriers to health care, (c) insured people with self-reported barriers to health care, and (d) uninsured people with self-reported barriers to health care. We conducted linear regressions with PCS-12 and MCS-12 as outcome. We adjusted for sociodemographic and disease-related factors and having access to a primary physician. RESULTS: In the first group, there were 407, in the second 471, in the third 44, and in the fourth group 103 participants. Compared to the first group, PCS-12 was 1.9 points lower (95% Confidence Interval, CI: - 3.5, - 0.3) in the second, 4.5 points (95% CI: - 8.1, - 1) lower in the third, and 6.1 points lower (95% CI: - 8.7, - 3.6) in the fourth group. Compared to the first group, MCS-12 was 0.6 points lower (95% CI: - 2.7, 1.4) in the second, 4.8 points lower (95% CI: - 9.3, - 0.3) in the third, and 5.8 points lower (95% CI: - 9.1, - 2.5) in the fourth group. CONCLUSION: In the SCLA, impeded access to care is common in people with diabetes. Self-reported barriers to care may be more important than insurance status in determining HRQoL.

Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial.

BACKGROUND: Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country. METHODS: We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers and catalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy. RESULTS: Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics. Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was 5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups. CONCLUSIONS: An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina's primary care setting within the public healthcare system. TRIAL REGISTRATION NUMBER: NCT04293315.

Adaptación y confiabilidad inter-observador de un protocolo para evaluar la disponibilidad de alimentos en supermercados en Buenos Aires, Argentina.

Introducción: La Red Internacional para la Investigación, Monitoreo y Apoyo a la Acción para la Alimentación, Obesidad y Enfermedades No Transmisibles (INFORMAS por su sigla en inglés) ha desarrollado el Protocolo para evaluar la Disponibilidad de Alimentos en Supermercados. Objetivos: Describir el proceso de adaptación del protocolo para utilizarlo en la Ciudad de Buenos Aires (BA) y evaluar la variabilidad inter-observador al aplicarlo en supermercados de la ciudad. Metodología: El principal indicador del protocolo es la disponibilidad relativa de alimentos saludables (AS) vs. no saludables (ANS), calculado como el cociente entre la longitud (m) de estantes asignados a AS y ANS (longitudAS/ANS). Se adaptó la selección de alimentos a incluir en el indicador para utilizarlo en BA. Para explorar el funcionamiento del indicador se construyó una referencia, midiendo todos los alimentos y bebidas ofrecidos en 5 supermercados, que se clasificaron en AS y ANS según las guías alimentarias argentinas. El indicador se comparó con la disponibilidad relativa calculada a partir de la referencia. Para evaluar la confiabilidad inter-observador dos observadores realizaron mediciones en tres supermercados y se calculó el coeficiente de correlación intra-clase (CCI). Resultados: Según la referencia, el cociente longitudAS/ANS varió entre 0,16 y 0,61, con una media de 0,34 (DE 0,18). El indicador adaptado produjo resultados similares con una diferencia media de -0,05 (DE 0,04). El CCI entre la mediciones de ambos observadores resultó 0,92 (IC95% 0,86-0,98). Conclusión: Se adaptó el protocolo para aplicarlo en BA, con modificaciones en los alimentos a evaluar y una adecuada confiabilidad inter-observador.