Cost-Effectiveness of Peer-Educator-Delivered Lifestyle Modification for Type 2 Diabetes Prevention in a Young Healthy Population in Sri Lanka: A Trial-Based Economic Evaluation and Economic Model.

BACKGROUND: This study evaluated the cost effectiveness of an intensive lifestyle modification (LSM) intervention delivered by peer educators for the prevention of type 2 diabetes mellitus in a young at-risk population in a low healthcare resource setting. OBJECTIVE: The aim of this study was to evaluate the short-term and long-term cost effectiveness of an intensive lifestyle modification intervention for type 2 diabetes prevention in a young urban at-risk population in Sri Lanka. METHODS: This was an economic evaluation using cost and outcome data from a randomized controlled trial. We randomized 3539 healthy individuals aged 5-40 years with risk factors for type 2 diabetes to either 3-monthly (P-LSM n = 1727) or 12-monthly (C-LSM n = 1812) peer-educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity. A cost-effectiveness analysis was conducted from a health system perspective with outcomes expressed as disability-adjusted life-years (DALYs). Intervention costs and outcomes were collected during a median clinical trial period of 3 years and extrapolated to a lifetime horizon using economic modelling. Uncertainty in the lifetime model was explored by structural and probabilistic sensitivity analyses. RESULTS: The costs of the more intensive peer support programme were partially offset by reduced costs of type 2 diabetes complications recorded over the trial period and completely offset by lifetime cost savings of 6000 LKR. The more intensive P-LSM also averted more DALYs, estimated at 0.456 DALYs over the lifetime of participants. CONCLUSIONS: In a young at-risk Sri Lanka population, an intensive LSM programme was cost effective, averting more DALYs at an acceptable additional cost than a much less intensive LSM programme. Early intervention in young at-risk people represents good value for money from the Sri Lankan health care payer perspective.

Analysing public sector institutional capacity for health workforce governance in the South-East Asia region of WHO.

BACKGROUND: In order to analyse the institutional capacity for health workforce policy development and implementation in countries in the South-East Asia region, the WHO facilitated a cross-sectional analysis of functions performed, structure, personnel, management and information systems of human resources for health (HRH) units in Ministries of Health. CASE PRESENTATION: A self-assessment survey on the characteristics and roles of HRH units was administered to relevant Government officials; the responses were validated through face-to-face workshops and by the WHO staff. Findings were tabulated to produce frequency distributions of the variables examined, and qualitative elements categorized according to a framework for capacity building in the health sector. Ten countries out of the 11 in the region responded to the survey. Seven out of 10 reported having an HRH unit, though their scope, roles, capacity and size displayed considerable variability. Some functions (such as planning and health workforce data management) were reportedly carried out in all countries, while others (inter-sectoral coordination, research, labour relations) were only performed in few. DISCUSSION AND CONCLUSIONS: The strengthening of the HRH governance capacity in countries should follow a logical hierarchy, identifying first and foremost the essential functions that the public sector is expected to perform to optimize HRH governance. The definition of expected roles and functions will in turn allow identifying the upstream system-wide factors and the downstream capacity requirements for the strengthening of the HRH units. The focus should ultimately be on ensuring that all the key strategic functions are performed to quality standards, irrespective of institutional arrangements.

Awareness of risk of cross-infection and infection-control measures among patients attending University Dental Hospital, Peradeniya, Sri Lanka.

AIM: The aim of the present study was to assess awareness of the risk of cross-infection and infection-control measures practiced in dental clinics for patients attending the outpatient dental department (OPD) at University Dental Hospital, Peradeniya, Sri Lanka. METHODS: A descriptive cross-sectional study was carried out among 427 patients who attended the OPD clinics at University Dental Hospital. An interviewer-administered questionnaire was used to collect data, and chi-squared-test of association was applied where appropriate. RESULTS: Most patients (75.2%) were aware that there was a chance of infection transmission during dental treatments, and nearly 72% stated that wearing gloves and masks by their dentists was important during dental treatment. Awareness was higher among patients with a higher educational level. Participants revealed their fear of potential transmission of blood-borne pathogens in the dental setting. Awareness of sterilization of dental instruments was poor. CONCLUSIONS: The public should be made aware of the possible risks of cross-infection and the importance of infection-control practices in dental clinics. Dental professionals should fill the information gap.

Mercury levels in hair samples of dentists: A comparative study in Sri Lanka.

AIM: Elemental mercury is widely used in dentistry as dental amalgam. Hair samples constitute preferred biomarkers to determine the index of mercury exposure. In the absence of any published studies, the aim of the present study was to ascertain the level of mercury in a selected sample of dentists and controls in Sri Lanka. METHODS: Hair samples (.7 g) from dentists working in and around the Colombo district in Sri Lanka (n = 50) and controls (n = 50) were digested with sulfuric acid-potassium permanganate solution, and reduced to metallic mercury with stannous chloride. Digested samples were analyzed for mercury using an atomic absorption spectrophotometer. RESULTS: The average mercury contents of the test and control samples (n = 50 each) were 5.36 ± 2.64 ppb and 3.1 ± 1.99 ppb, respectively. Based on the estimated ratio of mercury in hair to blood in humans as 250:1, the average content of mercury in the blood of the two groups could be .02 ppb and .01 ppb, respectively. The number of years in dentistry and number of amalgam restorations performed within 1 week were not correlated with the hair concentration of mercury. CONCLUSIONS: As the values of both groups were well below 10 ng/mL (10 ppb), within the concentrations considered as normal, mercury use was not considered an occupational hazard for dentists.