Reaching individuals at risk for cardiovascular disease through community outreach in Colorado
ABSTRACT The aim of this program was to (1) increase awareness of individual cardiovascular disease (CVD) risk in underserved communities, (2) educate participants about lifestyle modifications to reduce CVD risk, and (3) link individuals at moderate to high risk with healthcare. Community health workers (CHWs) delivered the program in 14 urban, rural and frontier Colorado communities.
We analyzed data from CVD screenings of 17,995 individuals throughout Colorado between 2006 and 2009 in order to understand the reach and impact of the program on reaching target populations, identifying at-risk individuals and improving awareness of CVD risk.
In 3 years, 15 CHWs screened 17,995 clients for CVD risk, of which, almost 60% were racial and ethnic minorities and 42% were uninsured. Twenty-nine percent of participants had medium or high Framingham Risk Scores. Over three-quarters were overweight or obese, over one-fifth had mildly to severely high blood pressure, and 42% had borderline high or high cholesterol. Significantly, 82% had no knowledge of their CVD risk prior to screening.
This program is a replicable model for reaching minority and medically underserved populations who are at risk for CVD in urban, rural and frontier communities.
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ABSTRACT: Thymidylate synthase (TS) is a major target of 5-fluorouracil (5-FU) and dihydropyrimidine dehydrogenase (DPD) is a rate-limiting enzyme in the degradation of 5-FU. There are no studies investigating the comparison of TS and DPD mRNA expressions in oral tongue SCC (OSCC) and nontumor tissues obtained from the same patients. In addition, increased interest has been focused on the biological roles of TS and DPD as the independent prognostic factors as well as responsive determinants for cancer patients with 5-FU based therapy. We determined the expression levels of TS and DPD in tumor (T) and nontumor squamous epithelial tissues (N) of OSCC using real-time reverse transcription-polymerase chain reaction and evaluated whether the T/N ratio would correlate with clinicopathological factors. The mRNA expressions of TS and DPD were significantly higher in tumor areas than in nontumor areas. No correlation was found between the T/N ratio of each mRNA expression and gender, clinical stage, T classification, N classification or differentiation. The T/N ratio of TS in patients that died of disease was significantly higher than in patients with free of disease, whereas there were no relationships between The T/N ratio of DPD and disease status. Clinical follow-up data showed shorter overall survival periods for cases with high T/N ratio of TS than for cases with low T/N ratio of TS with the statistically significant. Our study showed that TS but not DPD seems to have prognostic value in OSCC. These findings suggest that the assessment of TS activity may be useful both in the management and in the treatment of OSCC.Archives of Oto-Rhino-Laryngology 09/2009; 267(4):581-6. DOI:10.1007/s00405-009-1062-0 · 1.61 Impact Factor
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ABSTRACT: Community-based diabetes screening programs can help sensitize the population and identify new cases. However, the impact of such programs is rarely assessed in high-income countries, where concurrent health information and screening opportunities are common place. A 2-week screening and awareness campaign was organized as part of a new diabetes program in the canton of Vaud (population of 697,000) in Switzerland. Screening was performed without appointment in 190 out of 244 pharmacies in the canton at the subsidized cost of 10 Swiss Francs per participant. Screening included questions on risk behaviors, measurement of body mass index, blood pressure, blood cholesterol, random blood glucose (RBG), and A1c if RBG was ≥7.0 mmol/L. A mass media campaign promoting physical activity and a healthy diet was channeled through several media, eg, 165 spots on radio, billboards in 250 public places, flyers in 360 public transport vehicles, and a dozen articles in several newspapers. A telephone survey in a representative sample of the population of the canton was performed after the campaign to evaluate the program. A total of 4222 participants (0.76% of all persons aged ≥18 years) underwent the screening program (median age: 53 years, 63% females). Among participants not treated for diabetes, 3.7% had RBG ≥ 7.8 mmol/L and 1.8% had both RBG ≥ 7.0 mmol/L and A1c ≥ 6.5. Untreated blood pressure ≥140/90 mmHg and/or untreated cholesterol ≥5.2 mmol/L were found in 50.5% of participants. One or several treated or untreated modifiable risk factors were found in 78% of participants. The telephone survey showed that 53% of all adults in the canton were sensitized by the campaign. Excluding fees paid by the participants, the program incurred a cost of CHF 330,600. A community-based screening program had low efficiency for detecting new cases of diabetes, but it identified large numbers of persons with elevated other cardiovascular risk factors. Our findings suggest the convenience of A1c for mass screening of diabetes, the usefulness of extending diabetes screening to other cardiovascular risk factors, and the importance of a robust background communication campaign.Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 06/2011; 4:213-23. DOI:10.2147/DMSO.S20649
- Preventive Medicine 01/2011; 52(1):1-2. DOI:10.1016/j.ypmed.2010.12.007 · 2.93 Impact Factor