Screening Colonoscopy among Uninsured and Underinsured Urban Minorities

BACKGROUND/AIMS: Uninsured individuals have lower rates of screening colonoscopy (SC), and little is known regarding the pathology results obtained when they undergo colonoscopies. Since 2004, we have participated in a program that offers SC to uninsured New Yorkers; herein, we report our findings. METHODS: Uninsured, average-risk patients who were at least 50 years of age underwent SC at our institution between April 2004 and June 2011. We analyzed polyp pathology, location, size, incidence of adenomas, and incidence of adenomas with advanced pathology (AAP) with respect to ethnicity, gender, and age. RESULTS: Out of 493 referrals, 222 patients completed the colonoscopies. Polyps were identified in 21.2% of all patients; 14% had adenomas, and 4.5% had AAP. The rates of adenomas among African-Americans, Hispanics, and Whites were 24.3%, 12.1%, and 11.6%, respectively, and the corresponding rates of AAP were 10.8%, 3.5%, and 2.3%. Differences in the polyp type, location, and AAP did not reach statistical significance with respect to ethnicity or gender. Patients aged 60 and older were found to have a higher rate of advanced adenomas compared with younger patients (8.6% vs 2.6%, p=0.047). CONCLUSIONS: Further efforts to fund screening colonoscopies for uninsured individuals will likely result in the identification of advanced lesions of the colon before they progress to colorectal cancer.

Síndrome metabólica em adulto e idosos de comunidades quilombolas do centro-sul do Piauí, Brasil / Metabolic syndrome in adults and elderly quilombolas from central - southern Piauí, Brazil

O objetivo deste trabalho consiste em estudar a prevalência da Síndrome Metabólica (SM) em grupos de quilombolas brasileiros da região Centro-Sul do Piauí. Este estudo transversal descritivo analítico foi realizado entre março e dezembro/2011, onde participaram 166 quilombolas adultos e idosos. A prevalência da SM foi determinada pelos critérios do NCEP-ATP III. Foram realizadas também medidas antropométricas, diário alimentar e hábitos de vida. A prevalência da SM foi de 55.4% nos quilombolas pesquisados, e mais prevalente no sexo feminino (p < 0,001). Portanto é necessário investir em políticas públicas de saúde preventiva para atender as demandas das comunidades quilombolas, tendo como base o contexto histórico e local onde vivem, bem como de doenças.

The purpose of this research is to study the prevalence of Metabolic Syndrome (MS) in Brazilian groups of Quilombolas from the Southcentral region of Piauí. This descriptive analytical cross-sectional study was conducted from March to December/2011, where 166 adult and elderly Quilombolas took part. The prevalence of MS was determined by the NCEP-ATP III. Anthropometric measurements, food journal and lifestyle habits were also performed. The prevalence of MS was 55.4% of the Quilombolas surveyed, and more prevalent on females (p < 0,001). However, it is required to invest in public politics of preventative health to fulfill the demands of maroon communities, based on the historical context and where they live, as well as diseases.

Anemia, malaria and hookworm infections in a Vietnamese ethnic minority.

The aim of this study was to determine the prevalence of anemia and evaluate the relationship of malaria and helminth infections on anemia status in Phan Tien village, a mountainous ethnic minority community in southern Vietnam. This longitudinal study was performed from April 1997 to 2000 by measuring the hemoglobin concentration of 2,767 people who participated in six annual surveys at the end of the rainy seasons. Ferritin concentration was measured in 2000 to evaluate the proportion of iron deficiency anemia. The relation between malaria and intestinal helminth infections with anemia was investigated. Anemia was always over 43% and mainly associated with iron deficiency (80.1%). Using generalized estimating equations, a small but significant decline of the anemia prevalence was detected (OR: 0.805; p < 0.0001). Malaria was significantly associated with anemia (OR: 2.408; p = 0.0006). There was no significant effect of the control of intestinal helminth infections on the time course of anemia (95% CI: -0.1548 to 0.1651).

Intestinal helminth infection in an ethnic minority commune in southern Vietnam.

A program to control intestinal helminth infections, based on stool surveys, mass treatment of children below 17 years, improvement of sanitation and health education was performed between 1997 and 1999 in Phan Tien, an ethnic minority community in mountainous southern Vietnam. Before intervention, 28.6% of children excreted eggs of at least one parasite, hookworm being the most common (23%), followed by Trichuris trichiura (1.9%), Hymenolepis nana (1.9%), Enterobius vermicularis (0.9%), Ascaris lumbricoides (0.5%), and multiple kinds of helminthes (0.5%). Strongyloides stercoralis was never detected. Poor sanitation and personal hygiene, and walking barefoot were considered the main risk factors for intestinal helminth infections. The success of 400 mg albendazole single dose mass treatment was initially frustrated by the poor quality of the drug formulation used, only containing half of the indicated amount of albendazole. Using another formulation quickly reduced the hookworm infection rate. Praziquantel was used to treat H. nana infections. After three years of intervention, intestinal helminth infections were reduced to 3.3% (p<0.0001). We conclude that interventions combining health education, improvement of sanitation and mass treatment effectively control intestinal helminth infections, but the quality of the drugs used is an important factor.