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.

Pinworm Infection at Salmon Ruins and Aztec Ruins: Relation to Pueblo III Regional Violence

The study of coprolites has been a theme of archaeology in the American Southwest. A feature of archaeoparasitology on the Colorado Plateau is the ubiquity of pinworm infection. As a crowd parasite, this ubiquity signals varying concentrations of populations. Our recent analysis of coprolite deposits from 2 sites revealed the highest prevalence of infection ever recorded for the region. For Salmon Ruins, the deposits date from AD 1140 to 1280. For Aztec Ruins, the samples can be dated by artifact association between AD 1182–1253. Both sites can be placed in the Ancestral Pueblo III occupation (AD 1100–1300), which included a period of cultural stress associated with warfare. Although neither of these sites show evidence of warfare, they are typical of large, defensible towns that survived this time of threat by virtue of large populations in stonewalled villages with easily accessible water. We hypothesize that the concentration of large numbers of people promoted pinworm infection and, therefore, explains the phenomenal levels of infection at these sites.

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.

Analgesic efficacy of oral firocoxib in ovariohysterectomized cats

The postoperative analgesic effects of firocoxib in ovariohysterectomized cats were observed. Twenty-four cats were divided into 3 groups: control (no medicine), firocoxib-1 (1 mg/kg/day) and firocoxib-3 (3 mg/kg/day). Colorado pain scale scores (CPSS), composite pain scores (CPS), and buccal mucosal bleeding times (BMBT) were recorded in blinded fashion before induction and 2, 5, 8, 24, 30, and 48 h post-operation. The average CPSS (mean ± SEM) over 2 to 48 h post-operation in firocoxib-3 (0.4 ± 0.1) was significantly lower than that of the control (0.7 ± 0.2; p = 0.004), but that of firocoxib-1 (0.5 ± 0.2) was not different from that of the control (p = 0.40). The mean CPS of firocoxib-3 was significantly lower than that of the control at 24 h post-operation (p = 0.04); nonetheless, there was no significant difference in mean CPS between firocoxib-1 and control groups at all intervals. BMBT and body temperature were within normal limits in all groups. However, reversible azotemia was identified in two firocoxib-3 cats at 72 h post-operation. One firocoxib-3 cat vomited once at 48 h post-operation. In conclusion, firocoxib-3 is helpful for postoperative pain control in cats; however, gastrointestinal irritation and renal function side effects may occur.

Colorado Potato Beetle (Leptinotarsa decemlineata Say) Control Potential of Essential Oil Isolated from Iranian Cymbopogon citratus Stapf

Colorado potato beetle is a most destructive insect pest of potato throughout the world. Although utilization of chemical insecticides is a main method for management of this pest, their negative side-effects such as threat to humans and the environmental pollution prompted researchers to search for natural alternatives. Recently plant essential oils with low or without side-effects against noun-targeted organisms and with high availability were considered as safe bio-pesticides. In the present study, toxicity of essential oil of Iranian lemongrass, Cymbopogon citratus Stapf, was evaluated against 3th instar larvae and adults of Colorado potato beetle by a leaf dipping method. Results displayed essential oil had notable toxicity against both larvae and adults after 24 and 48 h exposure times. Probit analysis revealed LC₅₀ values (lethal concentration to kill 50% of population) with 95% confidence limits were 10.32 (9.17 – 11.72) and 7.76 (6.80 – 8.74) µl/ml for larvae and 6.27 (4.82 – 8.15) and 4.35 (3.24 – 5.62) µl/ml for adults after 24 and 48 h, respectively. Based on regression analysis, a positive correlation between log concentration of essential oil and insect mortality was achieved. Results indicated C. citratus essential oil can be candidate as a natural alternative to the harmful chemical insecticides in the management of Colorado potato beetle.

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.

Efficacy of Colorado Needle in Lid Surgery

Eyelid has rare infection and good wound healing due to rich blood supply, but often lead to excessive bleeding during surgery. Thus, bleeding control in time of operation is very important to secure operation field and minimize subcutaneous hemorrhage and edema after operation. Retrospectively, we analized intra- and post-operative complications of 92 patients who had undergone eyelid surgeries by one operator using Colorado patients who had undergone eyelid surgeries by one operator using Colorado dissection needle attached to monopolar electrocautery from March to October 1997. there were 49 patients of epiblepharon or entropion, 16 patients of ptosis, 10 patients of dermatochalasis and 17 patients of blepharoplasty. In all 92 patients who had be used with Colorado needle neither complications nor side effects were developed. Therefore, we consider that the colorado needle monopolar electrocautery is an useful instrument in eyelid surgery.

Clinical Assessment of Gestational Age in the Newborn Infant by Ballard's Scoring System

In recent years, there has been a rapidly increasing interest; in babies whose birthweight is low because their intrauterine growth has been retarded and it has been recognized that the clinical problems of these 'small-for-dates' infants differ from those of true prematures. Although it is very difficult to differentiate 'small-for-dates' infants from true prematures, it can be made readily if the gestational age is known. So there is a need for a rapid, accurate method of clinically assessing gestational maturation and it needs to be reliable and capable of being fully performed regardless of the degree of illness or well-being of infant. Using the Ballard's scoring system which was based on 6 physical criteria and 6 neurogical criteria, the author estimated the gestational age of 265 newborn infants who were born at the Obstetric ward of the Seoul National University Hospital from April to August in 1980. And the author compared the estimated gestional age with the gestational age calculated from LMP. The results were as followings: 1) The age distribution of the 265 newborn infants showed predominance in the weeks of gestational age and there was no discrepancy between two sexes. 2) The weight distribution of the 265 newborn infants showed predominance in the 2,500g-3, 500 g of birthweight. 3) The numbers of babies whose weight was appropriate, small and large for gestational age were 233(88%), 19(7%), and 13(5%) respectively according to University of Colorado Medical Center Example. 4) The examination was performed between 6 hours and 72 hours after birth, and the average time required to complete the full examination ranged from 3 minutes and 25 second to 6 minutes and 50 seconds, averaging 5 minutes and 30 seconds. 5) The predictive values of 6 physical criteria, when compared with the gestational age calculated from LMP were as following: skin(0,855), breast(0.842), plantar creases(0.830), ears (0.823), lanugo (0.773) and genitals (M: 0.760, F: 0.703) . 6) The predictive values of 6 neurological criteria when compared with the gestational age calculated from LMP were as following: popliteal angle(0.752), heel to ear(0.727), scarf sign (0.715), square window(0.693), posture(0682) and arm recoil(0.633). 7) The correlation of the score from the total criteria was greater than that obtined from any of its individual criteria. 8) The correlation coefficiency between the estimated gestational age and that calculated from LMP was 0.745 and the regression formula for the latter(X) against the former(Y) was Y=0.83X+ 6.79. With the above results, the author could conclude that the clinical estimation of the gestational age with the Ballard's scoring system was highly correlated and it deserves to be recommended for clinical purpose if the problems of the maturity rating would be solved.

Clinical Assessment of Gestational Age in the Premature Infant

Recently the clinical estimation of gestational age has been of increasing concern particularly in premature babies because of its great aid in treament and expectation of future health. The clinical distinction between small-for-dates infants and premature babies offers great difficulty, but can be made readily if the gestational age is known. The author has investigated the clinical estimation of gestational age in 100 premature infants who were born at the Seoul National University Hospital, the Eul Ji Hospital and the So Wha Hospital from March to August in 1977, in order to evaluate the correlation between the gestationl age calculated from LMP and the clinically estimated gestaionl age using two charts designed by Brazie and Lubchenco, which were based on 16 physical criteria and 20 neurologic criteria with the following results. 1) The sex and age distribution of the 100 premature infants showed predominance in male and in the 34th336th weeks of gestional age. 2) The numbers of babies whose weight was appropriate, small and large for gestational age were 89, 9 and 2 respectively according to University of Colorado Medical Center Example, while they were 91, 4 and 5 according to the chart based on Rha's report in 1976 in Korea. 3) The correlation percentages between the gestational age determined by each of the 16 physical criteria and those calculated from LMP were as following; vernix (88%), skin and nail plates(88%), recoil-leg(75%), skin thickness appearance(73%), sole creases(68%), genitalia, testes and scrotum(67.5%) and so forth. 4) The correlation percentages between the gestational ages determined by each of the 20 neurologic criteria and those calculated from LMP were as following, pupillary reflex(94%), grasp reflex(90%), vertical positions(87%), head lag (83%), glabellar tap(81%), body extensors(80%), horizontal positions(80%), rooting reflex(80%), and so forth. 5) The correlation coefficiency between the clinically estimated gestational age using the above described two charts and that calculated from LMP was 0.98. And the regression formula for the latter (X) against the former (Y) was Y=0.786X+7.753. With the above results, the author could conclude that clinical estimation of the gestational age with the two charts of Brazie and Lubchenco was highly correlated and it deserves to be recommended for clinical purpose.