Initial impact and cost of a nationwide population screening campaign for diabetes in Brazil: A follow up study

<p>Abstract</p> <p>Background</p> <p>In 2001 Brazilian citizens aged 40 or older were invited to participate in a nationwide population screening program for diabetes. Capillary glucose screening tests and procedures for diagnostic confirmation were offered through the national healthcare system, diagnostic priority being given according to the severity of screening results. The objective of this study is to evaluate the initial impact of the program.</p> <p>Methods</p> <p>Positive testing was defined by a fasting capillary glucose ≥ 100 mg/dL or casual glucose ≥ 140 mg/dL. All test results were tabulated locally and aggregate data by gender and clinical categories were sent to the Ministry of Health. To analyze individual characteristics of screening tests performed, a stratified random sample of 90,106 tests was drawn. To describe the actions taken for positive screenees, a random sub-sample of 4,906 positive screenees was actively followed up through home interviews.</p> <p>Main outcome measures considered were the number of diabetes cases diagnosed and cost per case detected and incorporated into healthcare.</p> <p>Results</p> <p>Of 22,069,905 screening tests performed, we estimate that 3,417,106 (95% CI 3.1 – 3.7 million) were positive and that 346,168 (290,454 – 401,852) new cases were diagnosed (10.1% of positives), 319,157 (92.2%) of these being incorporated into healthcare. The number of screening tests needed to detect one case of diabetes was 64. As many cases of untreated but previously known diabetes were also linked to healthcare providers during the Campaign, the estimated number needed screen to incorporate one case into the healthcare system was 58. Total screening and diagnostic costs were US$26.19 million, the cost per diabetes case diagnosed being US$ 76. Results were especially sensitive to proportion of individuals returning for diagnostic confirmation.</p> <p>Conclusion</p> <p>This nationwide population-based screening program, conducted through primary healthcare services, demonstrates the feasibility, within the context of an organized national healthcare system, of screening campaigns for chronic diseases. Although overall costs were significant, cost per new case diagnosed was lower than previously reported. However, cost-effectiveness analysis based on more clinically significant outcomes needs to be conducted before this screening approach can be recommended in other settings.</p

Visuospatial Integration: Paleoanthropological and Archaeological Perspectives

The visuospatial system integrates inner and outer functional processes, organizing spatial, temporal, and social interactions between the brain, body, and environment. These processes involve sensorimotor networks like the eye–hand circuit, which is especially important to primates, given their reliance on vision and touch as primary sensory modalities and the use of the hands in social and environmental interactions. At the same time, visuospatial cognition is intimately connected with memory, self-awareness, and simulation capacity. In the present article, we review issues associated with investigating visuospatial integration in extinct human groups through the use of anatomical and behavioral data gleaned from the paleontological and archaeological records. In modern humans, paleoneurological analyses have demonstrated noticeable and unique morphological changes in the parietal cortex, a region crucial to visuospatial management. Archaeological data provides information on hand–tool interaction, the spatial behavior of past populations, and their interaction with the environment. Visuospatial integration may represent a critical bridge between extended cognition, self-awareness, and social perception. As such, visuospatial functions are relevant to the hypothesis that human evolution is characterized by changes in brain–body–environment interactions and relations, which enhance integration between internal and external cognitive components through neural plasticity and the development of a specialized embodiment capacity. We therefore advocate the investigation of visuospatial functions in past populations through the paleoneurological study of anatomical elements and archaeological analysis of visuospatial behaviors

Análise econômica de programa para rastreamento do diabetes mellitus no Brasil Economic analysis of a screening program for diabetes mellitus in Brazil

OBJETIVO: Diabetes mellitus é um problema de saúde pública com elevado ônus social e econômico, cujo diagnóstico é desconhecido em metade dos indivíduos portadores. Em 2001, o Ministério da Saúde realizou a Campanha Nacional para a Detecção do Diabetes Mellitus. Assim, o objetivo do estudo foi estimar o impacto econômico e o rendimento desse rastreamento populacional. MÉTODOS: Baseado no número de rastreados com resultados positivos (glicemia capilar em jejum >100 mg/dl ou fora do jejum >140 mg/dl), foram estimados os prováveis casos novos de diabetes mellitus e construído modelo de decisão analítico. Dados primários e secundários foram utilizados para estimar os custos (em Reais) e o rendimento (casos novos de diabetes mellitus detectados) do rastreamento com o pressuposto de pagador único. Análises de sensibilidade foram conduzidas para avaliar o efeito de alguns parâmetros nessas estimativas. RESULTADOS: Considerando-se a prevalência de diabetes mellitus não diagnosticado na população-alvo de 4,8%, o número provável de novos casos de diabetes mellitus diagnosticados foi de 518.579. Isso, pressupondo que um terço dos participantes com teste positivo procurou a confirmação (23 casos por 1.000 rastreados). O custo por novo caso de diabetes mellitus diagnosticado a partir desses pressupostos seria de R$89. Em análises de sensibilidade, os resultados foram sensíveis ao percentual dos testes confirmatórios. CONCLUSÕES: Apesar dos expressivos custos com a campanha de rastreamento no Brasil, o rendimento foi comparável a outras ações preventivas e, em termos absolutos, o custo por novo caso de diabetes mellitus detectado foi inferior ao relatado por outros países.<br>OBJECTIVE: Diabetes mellitus is a common disease and costly public health concern and an expressive number of affected individuals have undiagnosed diabetes mellitus. In 2001, the Brazilian Ministry of Health conducted a national diabetes screening campaign. The purpose of this study was to estimate the yield and economic impact of this screening strategy. METHODS: Based on positive screenees (fasting glucose >100 mg/dL or nonfasting >140 mg/dL) probable new cases of diabetes were estimated and a decision analytic model was built up. Primary and secondary data were used to estimate screening cost (in Brazilian Reais, R$) and yield (new cases of diabetes detected), assuming a single-payer-perspective. Sensitivity analyses were performed. RESULTS: Assuming a prevalence of undiagnosed diabetes mellitus of 4.8%, probable new cases of diabetes were 518,579 (23 new cases per 1,000 subjects screened), considering that 33% of positive-screening individuals underwent confirmatory glucose testing. The cost per new case of diabetes diagnosed would be R$89. The results were sensitive to percentage of confirmatory tests performed. CONCLUSIONS: The costs of nationwide community screening in Brazil were significant, however, in absolute terms lower than those described by other countries

Prevalência e gravidade de asma brônquica em adultos obesos com indicação de cirurgia bariátrica Prevalence and severity of asthma in obese adult candidates for bariatric surgery

OBJETIVO: Determinar a prevalência de asma em um grupo de adultos obesos, candidatos a cirurgia bariátrica e avaliar a gravidade da asma neste grupo de pacientes. MÉTODOS: Estudo transversal, envolvendo 363 pacientes obesos adultos (índice de massa corpórea > 35 kg/m²) avaliados por um médico pneumologista, utilizando a avaliação clínica como instrumento diagnóstico de asma. Todos os pacientes foram submetidos à avaliação clínica e espirometria e foram divididos em dois grupos (asma e controle). Os pacientes com asma foram classificados conforme a gravidade da doença. RESULTADOS: A prevalência de asma na população de obesos estudada foi de 18,5% (IC95%: 14,5-22,4). Essa prevalência nas mulheres e nos homens foi de 20,4% (IC95%: 16,2-24,5) e 13,7% (IC95%: 10,1-17,2), respectivamente. Havia sintomas de asma nos últimos doze meses em 8,0% (IC95%: 5,2-10,7), e houve manifestação inicial dos sintomas de asma na infância/adolescência em 17,4% (IC95%: 13,5-21,3). No grupo asma, asma intermitente estava presente em 29 pacientes (43,3%); asma persistente leve, em 7 (10,4%); asma moderada, em 25 (37,3%); e asma persistente grave, em 6 (9,0%). CONCLUSÕES: A prevalência de asma neste grupo de adultos obesos, utilizando-se a avaliação clínica como critério diagnóstico, mostrou-se elevada, com predomínio no sexo feminino e com manifestação inicial dos sintomas de asma na infância/adolescência. A gravidade da asma neste grupo de obesos adultos esteve entre os valores médios estimados para a população geral, com uma maior proporção de asma intermitente, asma persistente leve e asma persistente moderada<br>OBJECTIVE: To determine the prevalence of asthma in a group of obese adult candidates for bariatric surgery and to evaluate the severity of asthma in this group of patients. METHODS: This was a cross-sectional study involving 363 obese adults (body mass index > 35 kg/m²) evaluated by a pulmonologist, using clinical evaluation as a diagnostic tool for asthma. All patients underwent clinical evaluation and spirometry and were divided into two groups (asthma and control). The patients with asthma were stratified by the severity of asthma. RESULTS: The prevalence of asthma in the obese population studied was 18.5% (95% CI: 14.5-22.4). That prevalence was 20.4% (95% CI: 16.2-24.5) and 13.7% (95% CI: 10.1-17.2) in the women and the men, respectively. Asthma symptoms in the last twelve months were present in 8.0% (95% CI: 5.2-10.7), and the initial manifestation of asthma symptoms occurred during childhood/adolescence in 17.4% (95% CI: 13.5-21.3). In the asthma group, intermittent asthma was present in 29 patients (43.3%), mild persistent asthma in 7 (10.4%), moderate asthma in 25 patients (37.3%), and severe persistent asthma in 6 (9.0%). CONCLUSIONS: Using clinical evaluation as the diagnostic criterion, we found the prevalence of asthma to be high in this group of obese adults. Asthma was more common in females, and the initial manifestation of asthma symptoms more commonly occurred during childhood/adolescence. The severity of asthma in this group of obese adults was within the range of mean values predicted for the general population. Intermittent asthma, mild persistent asthma, and moderate persistent asthma predominate