Telemedicine screening of the prevalence of diabetic retinopathy among type 2 diabetic Filipinos in the community

Purpose@#To determine the feasibility of telemedicine screening for diabetic retinopathy in a community setting and to determine the prevalence of diabetic retinopathy among Filipino patients with type 2 diabetes in the community. @*Study Design@#Cross-sectional study among patients with type 2 diabetes in six community health centers in an urban city in the Philippines. @*Materials and methods@#Subjects were examined from November 2018 to December 2018. A three-field non-mydriatic 45’ fundus photographs were taken for each patient and photographs were uploaded in cloud storage and read by a retina specialist in a tertiary hospital for assessment of diabetic retinopathy and grading of the fundus photographs. The results were sent back to local health centers. @*Results@#A total of 387 eyes of 195 persons were examined. Overall, 288 out of 387 eyes (95.36%) had gradable quality fundus photo (grade 3 and higher) and did not need eye dilation. Prevalence of diabetic retinopathy among the respondents was 25.26% - 3.16% had mild diabetic retinopathy, 15.79% had moderate diabetic retinopathy, 3.68% had severe diabetic retinopathy, and 3.68% had proliferative diabetic retinopathy. Other fundus findings noted include hypertensive retinopathy glaucomatous optic nerve, age-related macular degeneration, posterior vitreous detachment, clinically significant macular edema, and epiretinal membrane.@*Conclusion@#Due to the significant number of patients with diabetic retinopathy among type 2 diabetics in the community, telemedicine screening was a feasible alternative to dilated fundus examination and may be considered as part of the local health program to prevent blindness due to diabetes.

Development of evaluation index system for community screening and referral procedure of patients with chronic heart failure / 中华全科医师杂志

Objective:To develop an evaluation index system for community screening and referral procedure of patients with chronic heart failure.Methods:Experts in fields of medical education, health administration and various clinical specialties were selected from Shanghai through the purpose sampling method. Two rounds of expert consultation with Delphi method were conducted during October 2020 to February 2021, the contents of consultation included the importance and availability of the index system. According to the consultation results, the index system for community screening and referral procedure of patients with chronic heart failure was developed.Results:A total of 16 experts participated in the consultation, among whom 15 held senior or associate senior titles and 14 had worked for 20 years. The recovery rates of valid questionnaires of two rounds expert of consultation were 16/16. The familiarity and judgment coefficient were 0.82 and 0.90 in the first round of expert consultation, and 0.86 and 0.90 in the second round. The expert consultation coordination coefficient of the importance in the community screening and referral procedure were 0.652 and 0.462 for the first consultation; 0.741 and 0.525 for the second consultation. In the final version of the evaluation index system there were 7 first-level indicators, 15 secondary indicators and 3 conditions for screening; and 2 first-level indicators, 5 secondary indicators and 1 condition for referral.Conclusion:In this study the positivity coefficient and authority degree of experts are high; the opinions are relatively concentrated. The consultation results have a high rationality and feasibility, which would be applicable for assessment of community screening and referral procedure of patients with chronic heart failure.

Study on performance comparison between Brain Health System's clinic digital memory assessment and previously used assessments in dementia risk screening / 中华老年医学杂志

Objective:To study on performance comparison between clinic digital memory assessment and previously used assessments in dementia risk screening.To compare the performance comparison between Beijing Aging Brain Rejuvenation Initiative(BABRI)Brain Health System's Clinic Digital Memory Detection as study and Alzheimer Disease-8(AD8)and the Brief Community Screening Instrument for Dementia(BCSID)as controls, We calculated and evaluated the accuracy, sensitivity and specificity of screening Mild cognitive impairment(MCI)among these tests.Furthermore, BABRI Brain Health System was used to conduct a large sample brain health examination and early dementia screening to test the validity, adaptability and stability of the evaluation results by BABRI Brain Health System'Clinic Digital Memory Detection.Methods:Dataset 1 contained 669 elderly subjects from five communities in Beijing were recruited according to inclusion and exclusion standard.The diagnosis of MCI was based on the full set of neuropsychological scale and Petersen standard.Dataset 1 was used to compare the discriminant effect of BABRI Brain Health System'Clinic Digital Memory Detection as study versus AD8 and BCSID as controls.The sensitivity, specificity, positive predictive value, negative predictive value and Youden index of each measurement tool were calculated.Then, the receiver operator characteristic(ROC)curve was prepared to compare the discrimination ability of MCI between each measurement tool.While the area under the curve(AUC)of different tools was compared by Wald χ2 test.Dataset 2 contained 284 103 subjects from 16 communities in Beijing, which were used to test the applicability of large sample screening in BABRI Brain Health System. Results:77 patients with MCI were found among 666 people, and incidence rate was 11.56% using the full set of neuropsychological scales in dataset 1.Compared with the results of other tests, the sensitivity of BABRI Brain Health System to correctly distinguish MCI was 0.753, which was close to BCSID, and better than AD8.In addition, BABRI Brain Health System's Youden's index was 0.741 and AUC was 0.905, which suggested that the specificity, positive predictive value, negative predictive value and cognitive domain coverage of MCI screening were generally better in BABRI Brain Health System than in AD8 and BCSID.Finally, the Brain Health Examination results of 284, 000 people in dataset 2 showed that the high-risk detection rate of MCI(8.65%)of the tool for people over 50 years old under a large sample was quite close to the results of dataset 1(8.67%), indicating that the BABRI Brain Health System had high stability.Conclusions:BABRI Brain Health System has not only high sensitivity and specificity, but also wide cognitive field coverage and high stability.BABRI Brain Health System is suitable for large-scale brain health examination and dementia risk screening in grass-roots communities, and is worthy of popularization.

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.

Dynamic alteration of risk factors for stroke in the population of Wanshoulu community of Beiijng Haidian district from 2011 to 2017 / 中国脑血管病杂志

Objective To evaluate the efficacy of stroke prevention project for screening community stroke population by analyzing the dynamic alteration of risk factors and the control levels for stroke in the Wanshoulu community from 2011 to 2017. Methods We retrospectively analyzed the database of the Wanshoulu community population of stroke screening in2011(n = 10 379),2013 (n = 2 364),2015 (n = 6 048) and 2017 (n = 3 497). The population in 2011 and 2013 were first screening population (covered rate reached 84. 7% in the population aged ≥40 years old), and the population in 2015 and 2017 were re-examination population. We analyzed the dynamic alteration in the proportion of eight risk factors of stroke (hypertension, diabetes, dyslipidemia, smoking, less physical exercise, atrial fibrillation, obesity, and family history), the awareness rate and the control rate of three risk factors(hypertension, diabetes, and dyslipidemia), and the risk categories of stroke from 2011 to 2017. Results Compared with the data in 2011 and 2013, the proportion of patients with six risk factors in 2015 and 2017, including hypertension(26.8% [1623/6 048], 27.2% [952/3 497] ta.30.9% [3 210/10 379], 33.7% [796/2 364]), atrial fibrillation (2.1% [124/6 048], 1.6% [57/3 497] vs. 6. 7% [691/10 379], 2.7% [64/2 364]), smoking (11.9% [718/6 048], 7. 7% [268/3 497] vs. 17. 8% [1 845/10 379], 14.5% [343/2 364]), dyslipidemia (15.3% [928/6 048], 15.0% [526/3 497] vs. 17. 5% [1814/10 379], 22.0[519/2 364]), less physical exercise (18.4% [1 112/6 048], 17. 1% [598/3 497] vs. 24. 1 % [2 497/10 379], 33.0% [780/2 364]), and obesity (12.7% [769/6 048], 5.4% [190/3 497] vs. 12.9% [1 337/10 379], 17.0% [403/2 364]), gradually decreased over the time(all P <0. 01). Meanwhile, the proportion of high-risk stroke population decreased (22. 9% [2 373/10 379], 19. 9% [470/2 364], 17. 9% [1 083/6 048], 17.0% [595/3 497]) in 2011, 2013, 2015 and 2017, respectively. χ2=158.331, P<0.01). Compared with that in 2011, the awareness rate and control rate of hypertension, diabetes mellitus, and dyslipidemia were all increased in 2017(all P<0.01). Conclusion Since the performance of stroke prevention project in 2011, the risk factors of stroke have been well controlled, and the proportion of high-risk stroke population has been decreasing.

Performance of mid-upper arm circumference to diagnose acute malnutrition in a cross-sectional community-based sample of children aged 6–24 months in Niger

BACKGROUND/OBJECTIVES: Accurate, early identification of acutely malnourished children has the potential to reduce related child morbidity and mortality. The current World Health Organisation (WHO) guidelines classify non-oedematous acute malnutrition among children under five using Mid-Upper Arm Circumference (MUAC) or Weight-for-Height Z-score (WHZ). However, there is ongoing debate regarding the use of current MUAC cut-offs. This study investigates the diagnostic performance of MUAC to identify children aged 6–24 months with global (GAM) or severe acute malnutrition (SAM). SUBJECTS/METHODS: Cross-sectional, secondary data from a community sample of children aged 6-24 months in Niger were used for this study. Children with complete weight, height and MUAC data and without clinical oedema were included. Using WHO guidelines for GAM (WHZ < −2, MUAC < 12.5 cm) and SAM (WHZ < −3, MUAC < 11.5 cm), the sensitivity (Se), specificity (Sp), predictive values, Youden Index and Receiver Operating Characteristic (ROC) curves were calculated for MUAC when compared with the WHZ reference criterion. RESULTS: Of 1161 children, 23.3% were diagnosed with GAM using WHZ, and 4.4% with SAM. Using current WHO cut-offs, the Se of MUAC to identify GAM was greater than for SAM (79 vs. 57%), yet the Sp was lower (84 vs. 97%). From inspection of the ROC curve and Youden Index, Se and Sp were maximised for MUAC < 12.5 cm to identify GAM (Se 79%, Sp 84%), and MUAC < 12.0 cm to identify SAM (Se 88%, Sp 81%). CONCLUSIONS: The current MUAC cut-off to identify GAM should continue to be used, but when screening for SAM, a higher cut-off could improve case identification. Community screening for SAM could use MUAC < 12.0 cm followed by appropriate treatment based on either MUAC < 11.5 cm or WHZ < −3, as in current practice. While the practicalities of implementation must be considered, the higher SAM MUAC cut-off would maximise early case-finding of high-risk acutely malnourished children.