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Gebreegziabher SB, Bjune GA, Yimer SA. Patients' and health system's delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study. BMC Infect Dis 2016; 16:673. [PMID: 27836012 PMCID: PMC5106835 DOI: 10.1186/s12879-016-1995-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/29/2016] [Indexed: 11/12/2022] Open
Abstract
Background Tuberculosis (TB) is a major public health concern in the developing world. Early diagnosis and prompt initiation of treatment is essential for effective TB control. The aim of this study was to determine the length and analyze associated factors of patients’ and health system’s delays in the diagnosis and treatment of new pulmonary TB (PTB) patients. Methods A cross-sectional study was conducted in 30 randomly selected public health facilities in West Gojjam Zone, Amhara Region, Ethiopia. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study. Patients’ delay (the time period from onset of TB symptoms to first presentation to a formal health provider) and health system’s delay (the time period from first presentation to a formal health provider to first start of TB treatment) were measured. Median patients’ and health system’s delays were calculated. Mixed effect logistic regression was used to analyze predictors of patients’ and health system’s delays. Results Seven hundred six patients were enrolled in the study. The median patients’ delay was 18 days (interquartile range [IQR]: 8–34 days) and the median health system’s delay was 22 days (IQR: 4–88 days). Poor knowledge of TB (adjusted odds ratio [AOR], 2.33; 95 % confidence interval [CI], 1.34–4.05), first visit to non-formal health provider (AOR, 47.56; 95 % CI, 26.31–85.99), self-treatment (AOR, 10.11; 95 % CI, 4.53–22.56) and patients’ age (≥45 years) (AOR, 2.99; 95 % CI, 1.14–7.81) were independent predictors of patients’ delay. Smear-negative TB (AOR, 1.88; 95 % CI, 1.32–2.68) and first visit to public health centers (AOR, 2.22; 95 % CI, 1.52–3.25) and health posts (AOR, 5.86; 95 % CI, 1.40–24.39) were found to be independent predictors of health system’s delay. Conclusions The health system’s delay in this study was long and contributed more than 50 % of the total delay. Better TB diagnostic tools to complement sputum smear microscopy are needed to early diagnose PTB cases at peripheral health facilities. In addition, due emphasis should be given to increase public awareness about symptoms and consequences of TB disease. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1995-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Senedu Bekele Gebreegziabher
- Amhara Regional State Health Bureau, Bahir Dar, Ethiopia. .,Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Gunnar Aksel Bjune
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Amhara Regional State Health Bureau, Bahir Dar, Ethiopia.,Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.,Oslo University Hospital, Oslo, Norway.,Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
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202
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Varela-Centelles P, López-Cedrún JL, Fernández-Sanromán J, Seoane-Romero JM, Santos de Melo N, Álvarez-Nóvoa P, Gómez I, Seoane J. Key points and time intervals for early diagnosis in symptomatic oral cancer: a systematic review. Int J Oral Maxillofac Surg 2016; 46:1-10. [PMID: 27751768 DOI: 10.1016/j.ijom.2016.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 09/11/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022]
Abstract
The aim of this study was to identify key points and time intervals in the patient pathway to the diagnosis of oral cancer, from the detection of a bodily change to the start of treatment. A systematic search of three databases was performed by two researchers independently. Articles reporting original data on patients with symptomatic primary oral or oropharyngeal squamous cell carcinoma that was pathologically confirmed were included. These articles had to include an outcome variable of 'diagnostic delay', 'time interval', or 'waiting time to diagnosis', or report time intervals from first symptom to treatment. Furthermore, the outcome variable had to have a clearly defined start point and end point, with the time measurement presented as a continuous or categorical variable. A total of 1175 reports were identified; 28 articles on oral cancer studies and 13 on oral and oropharyngeal cancer studies were finally included. These papers showed poor quality in terms of questionnaire validation, acknowledgement of biases influencing time-point measurements, and strategies for verification of patient self-reported data. They also showed great heterogeneity. The review findings allowed the definition of key points and time intervals within the Aarhus framework that may better suit the features of the diagnostic process of this neoplasm, particularly when assessing the impact of waiting time to diagnosis.
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Affiliation(s)
- P Varela-Centelles
- Galician Health Service, EOXI Lugo, Cervo e Monforte, Lugo, Spain; Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - J L López-Cedrún
- Service of Oral and Maxillofacial Surgery, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - J Fernández-Sanromán
- Service of Oral and Maxillofacial Surgery, Povisa Hospital, Vigo (Pontevedra), Spain
| | - J M Seoane-Romero
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - N Santos de Melo
- Departamento de Odontologia, Faculdade de Ciências da Saúde, Universidade de Brasília, Campus Universitário, Asa Norte, Brasília DF, Brazil
| | - P Álvarez-Nóvoa
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - I Gómez
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - J Seoane
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain.
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203
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Abstract
One of the reasons for high mortality of breast cancer is long delay in seeking medical care. This study was designed to measure the association of a wide range of socio-demographic and clinical factors with the diagnostic delay in breast cancer among Iranian patients.This study was conducted on 505 newly diagnosed patients with breast cancer from southern part of Iran. Medical files of the patients who were admitted to the hospital from November 2013 to May 2015 were examined and clinical and demographic information were extracted.According to the results, illiterate patients were diagnosed on average 87.42 days later compared with those with a college degree (95%CI: 29.68-145.16, P = 0.003) and those from rural area were diagnosed on average 72.48 days later (95%CI: 35.94-109.03, P = 0.001) compared with urban residences. Single women were diagnosed 65.99 days later (95%CI: 7.37-124.61, P = 0.02) compared with those married. Lobular or medullary types of cancer were diagnosed 65.19 days later (95%CI: 2.67-127.70, P = 0.04) compared with ductal type. On the other hand, those who were able to perform breast self-exam were diagnosed 49.07 days earlier compared with others (95%CI: 18.69-79.45, P = 0.002). Those felt lump as the initiating symptom were diagnosed 62.01 days earlier, (95%CI: 8.17-115.85, P = 0.02) compared with those with other initial symptoms. The only factor associated with doctors diagnosis delay was the place of residence as rural residences were diagnosed on average 87.42 days later compared with urban residences, (95%CI: 53.82-121.92, P = 0.001).Higher education, living in cities, ductal type of tumor, and noticing lump in breast were the most important demographic and clinical factors associated with shorter breast cancer diagnosis delay. Informing women and doctors, especially general physicians who are practicing in rural areas, of the common symptoms of breast cancer as well as training women to perform breast self-examination are effective measures in reducing breast cancer diagnosis delay. Providing accessible and effective diagnosis services to rural women reduces diagnosis delay in rural patients.
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Affiliation(s)
- Mostafa Dianatinasab
- Student Research Committee, Department of Epidemiology, School of Health
- HIV/AIDS Research Center
| | - Mohammad Fararouei
- HIV/AIDS Research Center
- Correspondence: Mohammad Fararouei HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran (e-mail: )
| | | | - Mohammad Zare-Bandamiri
- Department of Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
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204
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Magni C, Segrè C, Finzi C, Veneroni L, Clerici CA, Massimino M, Casanova M, Martinella V, Chiaravalli S, Ricci A, Biondi A, Ferrari A. Adolescents' Health Awareness and Understanding of Cancer and Tumor Prevention: When and Why an Adolescent Decides to Consult a Physician. Pediatr Blood Cancer 2016; 63:1357-61. [PMID: 27106760 DOI: 10.1002/pbc.25985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/04/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND A feature often seen in adolescent patients with cancer is a lengthy symptom interval, especially in comparison with children. It has been suggested that inadequate awareness of cancer risk among adolescents may play an important role in this study. METHODS The Società Italiana Adolescenti con Malattie Onco-ematologiche and the Fondazione Umberto Veronesi conducted a survey to investigate health awareness among healthy adolescents and their understanding of cancer and its signs and symptoms by commissioning a specialized agency (AstraRicerche). A questionnaire was administered to 500 Italian adolescents from the age group of 15 to 19 years using the computer-aided web interviewing method. RESULTS Approximately 80% of the adolescents interviewed claimed to be well informed about their own health, 85% said they were aware that some lifestyle habits could influence their health, and 80% reported that they know that cancer can develop in adolescence too. It was also noted that, while some adolescents were worried about a given symptom, 22% of them reportedly preferred a wait-and-see approach (either to avoid alarming their parents, or they hoped that the symptom would be temporary). CONCLUSIONS This study showed that a majority of adolescents are concerned about their own health, but sometimes prefer not to report their symptoms to anyone. Hence, it is important to develop information campaigns tailored to raise awareness among this age group and help them interpret their symptoms.
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Affiliation(s)
- Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | | | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.,Department of Biomolecular Sciences and Biotechnology, Psychology Section, Faculty of Medicine, University of Milan, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angelo Ricci
- Federazione Italiana Associazioni Genitori Oncoematologia Pediatrica, Modena, Italy
| | - Andrea Biondi
- Pediatric Hematology-Oncology Department and "Tettamanti" Research Centre, Milano-Bicocca University, "Fondazione MBBM", San Gerardo Hospital, Monza, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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205
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Nakao M, Sone K, Kagawa Y, Kurokawa R, Sato H, Kunieda T, Muramatsu H. Diagnostic delay of pulmonary tuberculosis in patients with acute respiratory distress syndrome associated with aspiration pneumonia: Two case reports and a mini-review from Japan. Exp Ther Med 2016; 12:835-839. [PMID: 27446284 DOI: 10.3892/etm.2016.3385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 01/08/2016] [Indexed: 11/06/2022] Open
Abstract
Diagnosing active tuberculosis in elderly patients presents problems due to nonspecific symptoms and complications such as aspiration pneumonia. The current study presents two cases of pulmonary tuberculosis with bilateral pulmonary infiltrates associated with aspiration pneumonia. The two elderly patients developed acute respiratory distress syndrome as a result of aspiration pneumonia. The diagnoses of pulmonary tuberculosis were delayed in both cases, as the patients were diagnosed with active tuberculosis following discharge from hospital. The sputum test for acid-fast bacillus at the time of administration was smear-negative/culture-positive in these patients. They were treated with isoniazid, rifampicin and ethambutol, and nosocomial transmission of tuberculosis from these patients was not reported. The number of elderly patients with aspiration pneumonia is predicted to increase rapidly, and aspiration pneumonia combined with pulmonary tuberculosis is a major medical and healthcare concern in Japan. The present study concludes that physicians should always consider the complication of pulmonary tuberculosis when treating pneumonia patients, in particular in treating elderly patients with pulmonary infiltrates.
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Affiliation(s)
- Makoto Nakao
- Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan
| | - Kazuki Sone
- Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan
| | - Yusuke Kagawa
- Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan
| | - Ryota Kurokawa
- Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan
| | - Hidefumi Sato
- Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan
| | - Takefumi Kunieda
- Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan
| | - Hideki Muramatsu
- Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan
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206
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Walen S, Damoiseaux RA, Uil SM, van den Berg JW. Diagnostic delay of pulmonary embolism in primary and secondary care: a retrospective cohort study. Br J Gen Pract 2016; 66:e444-50. [PMID: 27114207 DOI: 10.3399/bjgp16X685201] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/24/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Delayed diagnosis of pulmonary embolism (PE) is common because symptoms can be non-specific. The few studies that have investigated diagnostic delay have not taken into account the role of primary care physicians in the diagnostic process. AIM To document and quantify the stages of diagnostic delay of PE and to identify clinical factors associated with this delay. DESIGN AND SETTING A retrospective cohort study conducted in Zwolle and its surroundings in the Netherlands. METHOD Primary and secondary care records of all patients diagnosed with PE between January 2008 and December 2009 were reviewed for dates of symptom onset, date of presentation and diagnosis, and for clinical findings. Relationships between delay and clinical parameters were tested using multivariate regression analysis. RESULTS The 261 patients enrolled in the study had an average total delay of 8.6 days. Patient delay (4.2 days average) and delay in primary care (3.9 days) were the major contributors to this delay. Chest pain (odds ratio [OR] 0.51, 95% confidence interval [CI] = 0.28 to 0.92, P = 0.03) and symptoms of deep venous thrombosis (calf pain) (OR 0.49, 95% CI = 0.24 to 0.98, P = 0.05) were associated with an early diagnosis. Patient delay was shorter in patients with chest pain (OR 0.49, 95% CI = 0.25 to 0.95, P = 0.03) and longer in patients with dyspnoea (OR 2.95, 95% CI = 0.99 to 8.85, P = 0.05). In primary care, chest pain (OR 0.37, 95% CI = 0.17 to 0.84, P = 0.02) and rales (OR 0.22, 95% CI = 0.06 to 0.83, P = 0.03) were associated with an early referral, whereas comorbidity led to a delayed referral. CONCLUSION This study shows that the diagnostic delay of PE is substantial, especially patient delay and delay in primary care. There is room to reduce this delay by increasing the awareness of both patients and GPs. Further research is needed on clinical factors that raise suspicion of PE in primary care.
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207
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Alpern JD, Bahr NC, Vazquez-Benitez G, Boulware DR, Sellman JS, Sarosi GA. Diagnostic Delay and Antibiotic Overuse in Acute Pulmonary Blastomycosis. Open Forum Infect Dis 2016; 3:ofw078. [PMID: 27419155 PMCID: PMC4943562 DOI: 10.1093/ofid/ofw078] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/13/2016] [Indexed: 11/12/2022] Open
Abstract
The diagnosis of blastomycosis is often delayed. We identified 28 cases of pulmonary blastomycosis in a retrospective chart review. Most patients received multiple antibiotic courses before being diagnosed, and the sputum KOH smear was rarely used. Diagnostic delay can be decreased with higher suspicion for pulmonary blastomycosis and early use of the sputum KOH smear.
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Affiliation(s)
- Jonathan D Alpern
- Division of Infectious Disease & International Medicine, Department of Medicine,University of Minnesota, Minneapolis; Department of Medicine, Regions Hospital, St. Paul, Minnesota
| | - Nathan C Bahr
- Division of Infectious Disease & International Medicine, Department of Medicine,University of Minnesota, Minneapolis; Division of Infectious Diseases, Department of Medicine, University of Kansas
| | | | - David R Boulware
- Division of Infectious Disease & International Medicine, Department of Medicine, University of Minnesota , Minneapolis
| | - Jonathan S Sellman
- Division of Infectious Disease, Department of Medicine , Regions Hospital , St. Paul, Minnesota
| | - George A Sarosi
- Department of Medicine, University of Minnesota, Minneapolis; Department of Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
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208
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Rasmussen A, Radfar L, Lewis D, Grundahl K, Stone DU, Kaufman CE, Rhodus NL, Segal B, Wallace DJ, Weisman MH, Venuturupalli S, Kurien BT, Lessard CJ, Sivils KL, Scofield RH. Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus. Rheumatology (Oxford) 2016; 55:1195-201. [PMID: 26998859 DOI: 10.1093/rheumatology/kew023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The diagnosis of SS is often difficult and many patients are symptomatic for years with other diagnoses before confirmation of SS. Our aim was to determine whether overlapping clinical and serologic features with RA and SLE may in part drive the misdiagnoses. METHODS A total of 1175 sicca patients were evaluated in a multidisciplinary clinic and classified as having SS based on the American-European Consensus Group Criteria. They were interrogated for a past history of suspicion or diagnosis of RA, SLE or SSc. These diseases were confirmed or ruled out by applying the corresponding classification criteria if the patients responded affirmatively. RESULTS Of these, 524 (44.6%) subjects reported previous diagnosis or suspicion of RA, SLE or SSc, which was confirmed in 130 (24.8%) but excluded in 394 (75.2%) subjects. Of those previously diagnosed with another illness, 183 (34.9%) met the criteria for primary SS. RF was present in 70/191 patients with previous diagnosis of RA compared with 445/845 without a prior RA diagnosis (P = 3.38E-05), while 128/146 with a diagnosis of SLE had positive ANA compared with 622/881 without the diagnosis (P = 8.77E-06). Age also influenced former diagnoses: people with suspected RA were older than those without the diagnosis (P = 5.89E-06), while patients with SLE suspicion were younger (P = 0.0003). Interestingly, the previous diagnoses did not significantly delay a final classification of SS. CONCLUSION Among subjects classified as SS, the presence of a positive ANA or RF was associated with a previous, apparently erroneous diagnosis of SLE or RA, respectively.
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Affiliation(s)
- Astrid Rasmussen
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation
| | - Lida Radfar
- Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry
| | - David Lewis
- Department of Oral Pathology, University of Oklahoma College of Dentistry, Oklahoma City, OK
| | - Kiely Grundahl
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation
| | - Donald U Stone
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - C Erick Kaufman
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Nelson L Rhodus
- Department of Oral Surgery, University of Minnesota School of Dentistry
| | - Barbara Segal
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Daniel J Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Biji T Kurien
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation College of Medicine, Department of Medicine, Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center and
| | | | - Kathy L Sivils
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation
| | - R Hal Scofield
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation College of Medicine, Department of Medicine, Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center and Department of Medicine, The Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
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209
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Ferrari A, Lo Vullo S, Giardiello D, Veneroni L, Magni C, Clerici CA, Chiaravalli S, Casanova M, Luksch R, Terenziani M, Spreafico F, Meazza C, Catania S, Schiavello E, Biassoni V, Podda M, Bergamaschi L, Puma N, Massimino M, Mariani L. The Sooner the Better? How Symptom Interval Correlates With Outcome in Children and Adolescents With Solid Tumors: Regression Tree Analysis of the Findings of a Prospective Study. Pediatr Blood Cancer 2016; 63:479-85. [PMID: 26797893 DOI: 10.1002/pbc.25833] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND The potential impact of diagnostic delays on patients' outcomes is a debated issue in pediatric oncology and discordant results have been published so far. We attempted to tackle this issue by analyzing a prospective series of 351 consecutive children and adolescents with solid malignancies using innovative statistical tools. METHODS To address the nonlinear complexity of the association between symptom interval and overall survival (OS), a regression tree algorithm was constructed with sequential binary splitting rules and used to identify homogeneous patient groups vis-à-vis functional relationship between diagnostic delay and OS. RESULTS Three different groups were identified: group A, with localized disease and good prognosis (5-year OS 85.4%); group B, with locally or regionally advanced, or metastatic disease and intermediate prognosis (5-year OS 72.9%), including neuroblastoma, Wilms tumor, non-rhabdomyosarcoma soft tissue sarcoma, and germ cell tumor; and group C, with locally or regionally advanced, or metastatic disease and poor prognosis (5-year OS 45%), including brain tumors, rhabdomyosarcoma, and bone sarcoma. The functional relationship between symptom interval and mortality risk differed between the three subgroups, there being no association in group A (hazard ratio [HR]: 0.96), a positive linear association in group B (HR: 1.48), and a negative linear association in group C (HR: 0.61). CONCLUSIONS Our analysis suggests that at least a subset of patients can benefit from an earlier diagnosis in terms of survival. For others, intrinsic aggressiveness may mask the potential effect of diagnostic delays. Based on these findings, early diagnosis should remain a goal for pediatric cancer patients.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Daniele Giardiello
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Section of Psychology, Department of Biomolecular Sciences and Biotechnology, Faculty of School of Medicine, University of Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Serena Catania
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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210
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Lugo Reyes SO, Ramirez-Vazquez G, Cruz Hernández A, Medina-Torres EA, Ramirez-Lopez AB, España-Cabrera C, Hernandez-Lopez CA, Yamazaki-Nakashimada MA, Espinosa-Rosales FJ, Espinosa-Padilla SE, Murata C. Clinical Features, Non-Infectious Manifestations and Survival Analysis of 161 Children with Primary Immunodeficiency in Mexico: A Single Center Experience Over two Decades. J Clin Immunol 2015; 36:56-65. [PMID: 26707787 DOI: 10.1007/s10875-015-0226-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The hallmark of Primary immunodeficiencies (PID) is unusual infection, although other immunological non-infectious manifestations such as autoimmunity, allergy and cancer are often present. Most published reports focus on one disease or defect groups, so that a global prevalence of non-infectious manifestations of PID is hard to find. We aimed to describe the clinical features of our pediatric patients with PID, as well as the frequency and evolution of allergy, cancer and autoimmunity. METHODS We reviewed all the available charts of patients being followed for PID from 1991 to the spring of 2012 at the National Institute of Pediatrics, Mexico City, to describe their demographic, clinical and laboratory features. Their diagnoses were established by pediatric immunologists in accordance to ESID criteria, including routine immunological workup and specialized diagnostic assays. We divided patients by decade of diagnosis to analyze their survival curves. RESULTS There were 168 charts available, from which we excluded one duplicate and six equivocal diagnoses. We studied the charts of 161 PID patients (68% male, 86% alive), mostly from the center of the country, with a positive family history in 27% and known consanguinity in 11%. Eighty percent of the patients were diagnosed during the last decade. Current median age was 124 months; median age at onset of infections, 12 months; median age at diagnosis, 52 months; median age at death, 67.5 months. Severe infection and bleeding were the cause of 22 deaths. Eighty-six percent of all patients had at least one infection, while non-infectious manifestations had a global prevalence of 36%, namely: autoimmunity 19%, allergies 17%, and cancer 2.4%. Survival curves were not significantly different when compared by decade of diagnosis. CONCLUSIONS Compared to other registry reports, we found a lower prevalence of antibody defects, and of associated allergy and cancer. We could only locate two isolated IgA deficiencies and four cases of cancer among our PID patients. Although antibody defects are the most prevalent group (30%), the distribution we found is similar to that reported in Iran, Kuwait, Egypt and Taiwan, with a close 27% share for phagocyte defects, and 26% for the formerly called "well-defined" syndromes. Of note, autoimmune and inflammatory complications are high among our patients with chronic granulomatous disease, as has been reported in both the United States and Japan, but not in Europe.
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Affiliation(s)
| | | | - Alonso Cruz Hernández
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | - Edgar A Medina-Torres
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Corín España-Cabrera
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | | | | | - Francisco J Espinosa-Rosales
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Chiharu Murata
- Research Methodology Department, National Institute of Pediatrics, Mexico City, Mexico.
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Cicchiello M, Lin MJ, Pan Y, McLean C, Kelly JW. An assessment of clinical pathways and missed opportunities for the diagnosis of nodular melanoma versus superficial spreading melanoma. Australas J Dermatol 2015; 57:97-101. [PMID: 26563931 DOI: 10.1111/ajd.12416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 09/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Missed opportunities in the diagnosis of nodular melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus superficial spreading melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed. METHODS A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed. RESULTS Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found. CONCLUSIONS NM contributes disproportionately to melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated.
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Affiliation(s)
- Mark Cicchiello
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Matthew J Lin
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Yan Pan
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona McLean
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - John W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
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HeadSmart Be Brain Tumour Aware. A new clinical guideline from the Royal College of Paediatrics and Child Health with a national awareness campaign accelerates brain tumor diagnosis in UK children--"HeadSmart: Be Brain Tumour Aware". Neuro Oncol 2016; 18:445-54. [PMID: 26523066 DOI: 10.1093/neuonc/nov187] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/10/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A national survey in 2006 identified that UK referral practice for pediatric CNS tumors ranked poorly in international comparisons, which led to new National Health Service (NHS) Evidence accredited referral guidelines published in 2008 by the Royal College of Paediatrics and Child Health and a campaign to raise awareness of early features of CNS tumors and the need for timely imaging. METHODS The "HeadSmart: Be Brain Tumour Aware" campaign was launched in June 2011 across the UK as a quality improvement strategy directed at reducing the total diagnostic interval (TDI) from a pre-campaign (2006) median of 14 (mean, 35.4) weeks to a target of 5 weeks in order to equal the best reported internationally. Professional and public awareness was measured by questionnaire surveys. TDI was collected by clinical champions in 18 regional children's cancer centers and the public campaign was coordinated by a national charity, working with a network of community champions. RESULTS The guidelines and campaign raised awareness among pediatricians and were associated with reduction in TDI to a median of 6.7 (mean, 21.3) weeks by May 2013. This change in referral practice was most pronounced in the time from first medical contact to CNS imaging, for which the median was reduced from 3.3 to 1.4 weeks between January 2011 and May 2013 (P = .009). CONCLUSION This strategy to accelerate brain tumor diagnosis by the NHS using a public and professional awareness campaign is a "world first" in pediatric cancer and is being emulated internationally and acknowledged by a series of NHS and charity awards for excellence.
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Danese S, Fiorino G, Mary JY, Lakatos PL, D'Haens G, Moja L, D'Hoore A, Panes J, Reinisch W, Sandborn WJ, Travis SP, Vermeire S, Peyrin-Biroulet L, Colombel JF. Development of Red Flags Index for Early Referral of Adults with Symptoms and Signs Suggestive of Crohn's Disease: An IOIBD Initiative. J Crohns Colitis 2015; 9:601-6. [PMID: 25908718 DOI: 10.1093/ecco-jcc/jjv067] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Diagnostic delay is frequent in patients with Crohn's disease (CD). We developed a tool to predict early diagnosis. METHODS A systematic literature review and 12 CD specialists identified 'Red Flags', i.e. symptoms or signs suggestive of CD. A 21-item questionnaire was administered to 36 healthy subjects, 80 patients with irritable bowel syndrome (non-CD group) and 85 patients with recently diagnosed (<18 months) CD. Patients with CD were asked to recall symptoms and signs they experienced during the 12 months before diagnosis. Multiple logistic regression analyses selected and weighted independent items to construct the Red Flags index. A receiver operating characteristic curve was used to assess the threshold that discriminated CD from non-CD. Association with the Red Flags index relative to this threshold was expressed as the odds ratios (OR). RESULTS Two hundred and one subjects, CD and non-CD, answered the questionnaire. The multivariate analysis identified eight items independently associated with a diagnosis of CD. A minimum Red Flags index value of 8 was highly predictive of CD diagnosis with sensitivity and specificity bootstrap estimates of 0.94 (95% confidence interval 0.88-0.99) and 0.94 (0.90-0.97), respectively. Positive and negative likelihood ratios were 15.1 (9.3-33.6) and 0.066 (0.013-0.125), respectively. The association between CD diagnosis and a Red Flags index value of ≥8 corresponds to an OR of 290 (p < 0.0001). CONCLUSIONS The Red Flags index using early symptoms and signs has high predictive value for the diagnosis of CD. These results need prospective validation prior to introduction into clinical practice.
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Affiliation(s)
- Silvio Danese
- IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Geert D'Haens
- IBD Unit, Gastroenterology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | | | - Julian Panes
- Gastroenterology Department, Hospital Clinic of Barcelona, IDIPABS, CIBERehd, Barcelona, Spain
| | - Walter Reinisch
- Medizinische Universität Wien, Klinische Abt. Gastroenterologie & Hepatologie, AKH Wien, Austria
| | - William J Sandborn
- Division of Gastroenterology, UC San Diego Health System, La Jolla, CA, USA
| | - Simon P Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
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Seoane J, Alvarez-Novoa P, Gomez I, Takkouche B, Diz P, Warnakulasiruya S, Seoane-Romero JM, Varela-Centelles P. Early oral cancer diagnosis: The Aarhus statement perspective. A systematic review and meta-analysis. Head Neck 2015; 38 Suppl 1:E2182-9. [PMID: 25783770 DOI: 10.1002/hed.24050] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mortality is linked to diagnostic intervals in certain cancers. As symptom perception is conditioned by tumor site, a specific study on oral cancer is needed. METHODS This study's inclusion criteria were original data, symptomatic primary oral squamous cell carcinoma, and exposure of interest, diagnostic interval, or diagnostic delay. The outcome of interest was survival and disease stage. A meta-analysis was undertaken to investigate the relationship between intervals to diagnosis, TNM classification, and survival in oral cancer. RESULTS Regarding referral delay, the results present no heterogeneity and showed a risk increase in mortality of 2.48 (range = 1.39-4.42). The larger the diagnostic delay, the more advanced the stage at diagnosis. High quality studies reveal a higher risk increase than low quality studies (odds ratio [OR] = 2.44; 95% confidence interval [CI] = 1.36-4.36 vs OR = 1.53; 95% CI = 1.26-1.86). CONCLUSION A longer time interval from first symptom to referral for diagnosis is a risk factor for advanced stage and mortality of oral cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2182-E2189, 2016.
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Affiliation(s)
- Juan Seoane
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - Pablo Alvarez-Novoa
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - Iria Gomez
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - Bahi Takkouche
- Department of Preventive Medicine, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - Pedro Diz
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - Saman Warnakulasiruya
- Department of Oral Medicine, King's College, Dental Institute, London, United Kingdom
| | - Juan M Seoane-Romero
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - Pablo Varela-Centelles
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain.,Galician Health Service, EOXI Lugo, Cervo e Monforte de Lemos, Lugo, Spain
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Aloulou S, El Mahfoudi A, El Omrani A, Khouchani M. [Factors related to late diagnosis of breast cancer: experience of CHU Mohammed VI Marrakech]. Pan Afr Med J 2015; 21:162. [PMID: 26327999 PMCID: PMC4546774 DOI: 10.11604/pamj.2015.21.162.4363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 01/13/2015] [Indexed: 12/21/2022] Open
Abstract
Le cancer du sein est le premier cancer féminin en termes d'incidence et de mortalité. Au Maroc, il vient au premier rang des cancers de la femme avant celui du col utérin Il constitue un problème de santé publique. Son pronostic est étroitement lié au stade auquel le diagnostic est posé. Il s'agit d'une pathologie dont les moyens diagnostiques sont de nos jours développés, allant de la détection précoce à la mise en évidence de lésions infra-cliniques, ce qui a nettement amélioré le pronostic dans les pays développés. Ce travail que nous présentons a pour objectif d'identifier dans notre pratique quotidienne, les facteurs qui amènent les patientes à consulter à des stades tardifs. Une étude rétrospective a été menée de janvier 2012 à janvier 2013 portant sur 130 patientes porteuses d'un cancer du sein au sein du service d'onco-radiotherapie CHU Mohammed VI Marrakech. Un questionnaire a été élaboré et dument renseigné en ayant recours aux dossiers des malades. Ainsi 63,07% des patientes consultaient au-delà de six mois avec un délai moyen de consultation de 8,47 mois avec comme motif de consultation des lésions classées T4 dans 27,69%, et des tumeurs d'emblée métastatiques dans 13,84%. Les facteurs retrouvés à l'interrogatoire étaient le manque de moyens financiers 40%, l’éloignement des structures sanitaires dans 23%, les habitudes socioculturelles avec les traitements traditionnels en première intention 20%, et l'insuffisance de prise en charge thérapeutique 7%. Cependant, pris individuellement, aucune concordance significative n’était retrouvée entre ces facteurs et le long délai diagnostique. Dans notre pratique, c'est la conjonction de la triade ignorance, indigence et habitudes socioculturelles qui constituent le facteur essentiel du diagnostic tardif des cancers du sein.
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Affiliation(s)
- Sofia Aloulou
- Service d'Oncologie Radiothérapie, CHU Mohammed VI Marrakech, Maroc
| | - Amal El Mahfoudi
- Service d'Oncologie Radiothérapie, CHU Mohammed VI Marrakech, Maroc
| | | | - Mouna Khouchani
- Service d'Oncologie Radiothérapie, CHU Mohammed VI Marrakech, Maroc
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Gupta S, Gibson P, Pole JD, Sutradhar R, Sung L, Guttmann A. Predictors of diagnostic interval and associations with outcome in acute lymphoblastic leukemia. Pediatr Blood Cancer 2015; 62:957-63. [PMID: 25586065 DOI: 10.1002/pbc.25402] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/27/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about diagnostic interval lengths in childhood cancer, their predictors or impact upon survival. To date, studies have relied on questionnaires or chart abstraction. We aimed to construct and validate a diagnostic interval measure using health services data among children with acute lymphoblastic leukemia (ALL) in order to determine predictors of prolonged intervals and associations with event-free survival (EFS). PROCEDURE All children with ALL diagnosed 1995-2011 (N = 1,541) in Ontario, Canada were linked to population-based health administrative databases. Healthcare claims prior to diagnosis were used to define healthcare episodes. Diagnostic intervals (time between first episode with diagnostic code a priori classified as consistent with underlying ALL, and diagnosis) were validated by correlation with a chart abstraction-based measure. RESULTS Intervals were generally short (median 2 days, IQR 1-3). Predictors of longer intervals included having general primary care physicians versus pediatricians (odds ratio 1.60, 95%CI 1.04-2.47; P = 0.03). While prolonged diagnostic intervals were associated with superior EFS (hazard ratio 0.71, 95%CI 0.52-0.98; P = 0.04), this was explained by confounding by disease biology. CONCLUSIONS Health administrative data can be used to measure diagnostic intervals in ALL and potentially other pediatric malignant and non-malignant diseases. Diagnostic intervals were short and a marker of disease severity rather than independent predictors of outcome. These findings may be used to address caregiver guilt and caution against "early diagnosis" benchmarks not based in evidence. Future studies should examine the impact of diagnostic interval length in other conditions, but should account for potential confounding by disease severity.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
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Aggarwal A, Herz N, Campbell P, Arkush L, Short S, Rees J. Diagnostic delay and survival in high-grade gliomas - evidence of the 'waiting time paradox'? Br J Neurosurg 2015; 29:520-3. [PMID: 25738427 DOI: 10.3109/02688697.2015.1012050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We present a retrospective single-centre study to determine whether delays in diagnosis of high-grade glioma (HGG) impact on overall survival (OS). MATERIAL AND METHODS Consecutive patients diagnosed with HGG at a single neuroscience centre in 2011 were reviewed. Route of referral and time from initial presentation to diagnosis were analysed and correlated with OS. RESULTS 118 patients were studied - 92 patients with glioblastoma (GBM). Diagnosis of GBM in patients presenting to emergency services was quicker than that through outpatients (8 days vs. 26 days, p < 0.0001), but these patients had significantly worse OS (181 days vs. 386 days p = 0.0075). This trend was observed for the whole cohort (Grade III and GBM), with OS 278 days in patients presenting to emergency services compared with 423 days for patients presenting via outpatients (p = 0.0034). Patients presenting to outpatients were younger (median age: 54 years) compared with patients presenting to emergency services (median age: 62.5 years) (p = 0.0106). There were no other differences between the two groups with respect to the nature of presenting symptoms. CONCLUSION Earlier diagnosis is paradoxically associated with a worse OS in GBM. An 'aggressive' phenotype with rapid symptomatic deterioration and hence emergency presentation is a poor prognostic factor not influenced by earlier diagnosis.
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Affiliation(s)
- Ajay Aggarwal
- a National Hospital for Neurology and Neurosurgery , Queen Square, London , UK
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Sriskandarajah S, Aasarød K, Skrede S, Knoop T, Reisæter AV, Bjørneklett R. Improved prognosis in Norwegian patients with glomerulonephritis associated with anti-neutrophil cytoplasmic antibodies. Nephrol Dial Transplant 2015; 30 Suppl 1:i67-75. [PMID: 25694535 PMCID: PMC4371773 DOI: 10.1093/ndt/gfv008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Glomerulonephritis associated with anti-neutrophil cytoplasmic antibodies (ANCA) is associated with increased mortality and a high risk of end-stage renal disease (ESRD). Here, we investigated whether the prognosis has improved over the last 25 years. Methods Patients were identified in the Norwegian Kidney Biopsy Registry. We included all patients with pauci-immune crescentic glomerulonephritis and a positive ANCA test from 1988 to 2012. Deaths and ESRD in the cohort were identified through record linkage with the Norwegian Population Registry (deaths) and the Norwegian Renal Registry (ESRD). Outcomes of patients diagnosed in 1988–2002 were compared with outcomes of patients diagnosed in 2003–12. Results A cohort of 455 patients with ANCA-associated glomerulonephritis was identified. The mean follow-up was 6.0 years (range, 0.0–23.4). During the study period, 165 (36%) patients died and 124 (27%) progressed to ESRD. Compared with patients diagnosed in 1988–2002, those diagnosed in 2003–12 had higher mean initial estimated glomerular filtration rates (37 versus 27 mL/min/1.73 m2) and lower risk of ESRD (1-year risk: 13 versus 19%; 10-year risk: 26 versus 37%). The composite endpoint, ESRD or death within 0–1 year after diagnosis, was reduced from 34 to 25%. In patients over 60 years old, 1-year mortality fell from 33 to 20%. Conclusions In Norwegian patients with ANCA-associated glomerulonephritis, prognosis was significantly better in 2003–12 compared with 1988–2002. This improvement was probably partly due to a shorter diagnostic delay, and better therapeutic management in older patients.
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Affiliation(s)
| | - Knut Aasarød
- Department of Nephrology, St Olavs University Hospital, Trondheim, Norway Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Steinar Skrede
- Department of Medicine, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Knoop
- Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anna Varberg Reisæter
- Norwegian Renal Registry, Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Rune Bjørneklett
- Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Abstract
INTRODUCTION Long delays with the diagnosis of myeloma are common. So far there has not been a comprehensive study on this issue in Hungary. AIM The aim of the authors was to analyze the waiting time from their first symptoms to the diagnosis of myeloma. METHOD 193 myeloma patients treated in one large tertiary referral hematology centre in Hungary were included. RESULTS The median time was 4.1 months (0-35.4) until diagnosis, and 5.2 months (0-35.4) until treatment. The delay was longer in patients with better prognosis (early stage, low cytogenetic risk), in nonsecretory disease and in 5 patients with amyloidosis. There was no significant relationship between the delay and the survival. CONCLUSIONS Considering the results of the present study and earlier literature data, the authors look for possibilities to improve the diagnostic delay. They think that the key to an earlier diagnosis is in the hands of the primary care physicians as they see the patients first and decide whether it is necessary to refer them to further test and to which specialty. Helping them with diagnostic algorithms, clear referring pathways, fast tracking patients with urgent problems, and making serum electrophoresis universally available in the primary care could help to reduce the time that myeloma patients spend waiting.
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Affiliation(s)
- Gergely Varga
- Semmelweis Egyetem, Általános Orvostudományi Kar III. Belgyógyászati Klinika Budapest Kútvölgyi út 4. 1125
| | - Gábor Mikala
- Egyesített Szent István és Szent László Kórház-Rendelőintézet Hematológiai és Őssejt-transzplantációs Osztály Budapest
| | | | - Tamás Masszi
- Semmelweis Egyetem, Általános Orvostudományi Kar III. Belgyógyászati Klinika Budapest Kútvölgyi út 4. 1125 Egyesített Szent István és Szent László Kórház-Rendelőintézet Hematológiai és Őssejt-transzplantációs Osztály Budapest
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Abstract
OBJECTIVE Here, we investigated the factors associated with long diagnostic delay in celiac disease and the impact of the national Current Care Guidelines in reducing the delay. MATERIAL AND METHODS This population-based study involved 825 adult celiac disease patients. The diagnosis was considered delayed when the interval between first symptoms and diagnosis was >10 years. The patients were asked about the duration and type of symptoms before diagnosis, time and site (tertiary, secondary, or primary care) of the diagnosis, family history of the disease, and presence of significant comorbidities. Analysis was performed by binary logistic regression. RESULTS Altogether, 261 (32%) out of 825 participants reported a diagnostic delay of >10 years. Female gender, neurological or musculoskeletal disorders and presence of diarrhea, abdominal pain, and malabsorption were associated with prolonged delay. Male gender, diagnosis after the introduction of the first Current Care Guidelines in 1997, and being detected by serological screening, and family history of celiac disease were associated with a lower risk of delayed diagnosis. Factors not associated with the delay were site of diagnosis, age, and presence of dermatitis herpetiformis, type 1 diabetes, or thyroidal disease. CONCLUSION The number of long diagnostic delays in celiac disease has decreased over the past decades. The shift of diagnostics from secondary and tertiary care to primary care has not been detrimental. National guidelines together with increased awareness and active screening in at-risk groups of celiac disease are important in these circumstances.
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Affiliation(s)
- Valma Fuchs
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital , Tampere , Finland
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van Rhijn BD, Oors JM, Smout AJPM, Bredenoord AJ. Prevalence of esophageal motility abnormalities increases with longer disease duration in adult patients with eosinophilic esophagitis. Neurogastroenterol Motil 2014; 26:1349-55. [PMID: 25039642 DOI: 10.1111/nmo.12400] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/18/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND During the natural course of eosinophilic esophagitis (EoE), the risk for esophageal stricture formation increases. It remains unknown whether motility abnormalities in EoE also develop over time. We aimed to determine the relationship between disease duration, clinical characteristics, and manometric pattern of EoE patients. METHODS We compared esophageal high-resolution manometry (HRM) measurements of 31 adult EoE patients with HRM data from 31 GERD controls and 31 healthy controls. Subsequently, we assessed differences in disease duration and clinical characteristics between EoE patients with normal and those with abnormal esophageal motility. KEY RESULTS In EoE patients, peristaltic integrity was more frequently failed (12 vs 6%) or weak (27 vs 15%; p < 0.001) compared with healthy controls; however, this pattern was also seen in GERD controls (failed 14%, weak 27%). We found no differences regarding symptoms and signs of EoE between EoE patients with normal (42%) and abnormal motility (58%). However, disease duration was longer in EoE patients with abnormal motility than in those with normal motility (13 (6-18) years vs 4 (1-11) years; p < 0.05). In EoE, but not GERD, disease duration was identified as a risk factor for abnormal motility (OR for each year 1.142; 95% CI 1.004-1.299), and with longer disease duration, the prevalence of abnormal motility increased from 36% (duration 0-5 years) to 83% (duration ≥16 years; p < 0.05). CONCLUSIONS & INFERENCES Weak and failed peristaltic integrity are more often present in adult EoE patients than in healthy controls. The prevalence of manometric abnormalities in EoE patients increases with longer disease duration.
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Affiliation(s)
- Bram D van Rhijn
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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Nolan J, Renderos TB, Hynson J, Dai X, Chow W, Christie A, Mangione TW. Barriers to cervical cancer screening and follow-up care among Black Women in Massachusetts. J Obstet Gynecol Neonatal Nurs 2014; 43:580-588. [PMID: 25139164 DOI: 10.1111/1552-6909.12488] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To explore factors that might lead to delays in appropriate cervical cancer screening and diagnosis among Black women in Massachusetts. DESIGN Qualitative using focus groups. SETTING Hospitals, health centers, and community-based organizations in Boston, Massachusetts. PARTICIPANTS Sixty-four participants including Black, non-Hispanic women from the general population and cervical cancer survivors, community leaders in women's health, and health care providers. METHODS Six focus groups. Data were analyzed using methods based on grounded theory. RESULTS Findings from interviews revealed that inadequate information and education of providers and patients create barriers to appropriate screening and treatment practices for Black women. Fear, cultural beliefs, and compounding factors related to poverty, gender roles, and health system barriers create delays to screening and follow-up care. Also, unconscious bias, therapeutic delays, and miscommunication are important factors affecting continuity of care. CONCLUSION These results suggest a need for comprehensive, culturally specific cervical cancer prevention education initiatives and interventions for Black women and strategies to improve patient-provider relationships.
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Boufettal M, Azouz M, Rhanim A, Abouzahir M, Mahfoud M, Bardouni AE, Berrada MS, Yaacoubi ME. Schwannoma of the median nerve: diagnosis sometimes delayed. Clin Med Insights Case Rep 2014; 7:71-3. [PMID: 25125990 PMCID: PMC4125423 DOI: 10.4137/ccrep.s16686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/15/2014] [Accepted: 06/27/2014] [Indexed: 11/21/2022]
Abstract
Schwannoma is a tumor that develops from nerve sheath. The authors report an unusual case of schwannoma of the median nerve (MN) that remained asymptomatic for four years. The diagnosis was based on MRI (magnetic resonance imaging) and histopathological examination. Surgical removal is usually curative. The asymptomatic character of the tumor and its slow evolution remain an essential factor in diagnosis delays. This tumor has a good prognosis with a low recurrence rate and potential for malignant transformation.
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Affiliation(s)
- Monsef Boufettal
- Orthopedic Surgery Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco
| | - Mohamed Azouz
- Orthopedic Surgery Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco
| | - Abdelkarim Rhanim
- Orthopedic Surgery Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco
| | - Mohamed Abouzahir
- Orthopedic Surgery Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco
| | - Mustapha Mahfoud
- Orthopedic Surgery Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco
| | - Ahmed El Bardouni
- Orthopedic Surgery Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco
| | - Mohamed S Berrada
- Orthopedic Surgery Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco
| | - Moradh El Yaacoubi
- Orthopedic Surgery Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco
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Martínez-Orozco FJ, Vicario JL, Villalibre-Valderrey I, De Andrés C, Fernández-Arquero M, Peraita-Adrados R. Narcolepsy with cataplexy and comorbid immunopathological diseases. J Sleep Res 2014; 23:414-9. [PMID: 24645699 DOI: 10.1111/jsr.12143] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/18/2014] [Indexed: 01/08/2023]
Abstract
Evidence suggests that autoimmune diseases tend to co-occur so that patients with an autoimmune disorder are at higher risk of a second autoimmune disease. The association between allergic and autoimmune diseases is also of considerable interest. There are no reports on the association between sporadic or familial narcolepsy with cataplexy and other non-neurological immune-mediated diseases. This study reported on the comorbid immunopathological diseases associated with narcolepsy. One-hundred and fifty six narcoleptic patients with a mean age at diagnosis of 39.1 ± 17.8 years (range, 6-70 years) were assessed using the clinical history, physical and neurological examinations, sleep questionnaires, neuroimaging and human leucocyte antigen typing. Diagnosis was confirmed by polysomnography followed by a multiple sleep latency test or by measuring hypocretin-1 levels. Patients with immunopathological diseases were matched for gender and age at the onset of narcoleptic symptoms with narcoleptic patients without immunopathological diseases. Twenty-six patients (16.6%; 50% women; one familial, 25 sporadic) had one or more immunopathological diseases associated: autoimmune diseases, such as idiopathic thrombocytopenic purpura, multiple sclerosis, systemic lupus erythematosus, psoriasis, Crohn's disease, ulcerative colitis, autoimmune thyroid disease, Peyronie's disease and idiopathic recurrent facial palsy; other immunopathological diseases, like atopic dermatitis, allergic asthma and allergic rhinitis. Although not significant, the age at diagnosis of narcolepsy was 9.3 years earlier in patients with narcolepsy + immunopathological diseases. The results demonstrate that the prevalence of comorbid immunopathological diseases is high in narcolepsy, and cataplexy is significantly more severe in patients with narcolepsy + immunopathological diseases.
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Kuznetsov VN, Grjibovski AM, Mariandyshev AO, Johansson E, Bjune GA. A comparison between passive and active case finding in TB control in the Arkhangelsk region. Int J Circumpolar Health 2014; 73:23515. [PMID: 24563859 PMCID: PMC3927745 DOI: 10.3402/ijch.v73.23515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 11/28/2022] Open
Abstract
Background In Russia, active case finding (ACF) for certain population groups has been practiced uninterruptedly for many decades, but no studies comparing ACF and passive case finding (PCF) approaches in Russia have been published. Objective The aim of this study was to describe the main differences in symptoms and diagnostic delay between patients who come to TB services through PCF and ACF strategies. Methods A cross-sectional study was conducted among 453 new pulmonary tuberculosis (PTB) patients, who met criteria of TB diagnostic delay in Arkhangelsk. Results ACF patients used self-treatment more often than PCF patients (90.1% vs. 24.6%) and 36.3% of them were alcohol abusers (as opposed to only 26.2% of PCF patients). The median patient delay (PD) in PCF was 4 weeks, IQR (1–8 weeks), and less than 1 week in ACF. Twenty-three per cent of the PCF patients were seen by a medical provider within the first week of their illness onset. Conclusion Patients diagnosed through ACF tended to under-report their TB symptoms and showed low attention to their own health. However, ACF allowed for discovering TB patients earlier than PCF, and this was also the case for alcohol abusing patients. PCF systems should be supplemented with ACF strategies.
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Affiliation(s)
- Vladimir N Kuznetsov
- Institute of Health and Society, University of Oslo, Oslo, Norway ; Institute of Mental Medicine, Northern State Medical University, Arkhangelsk, Russia ; International School of Public Health, Northern State Medical University, Arkhangelsk, Russia
| | - Andrej M Grjibovski
- International School of Public Health, Northern State Medical University, Arkhangelsk, Russia ; Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Eva Johansson
- Karolinska Institute, Stockholm, Sweden ; Nordic School of Public Health, Gothenburg, Sweden
| | - Gunnar A Bjune
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Yimer SA, Holm-Hansen C, Storla DG, Bjune GA. Tuberculosis management time: an alternative parameter for measuring the tuberculosis infectious pool. Trop Med Int Health 2014; 19:313-320. [PMID: 24393123 DOI: 10.1111/tmi.12246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To demonstrate the application of TB management time as an alternative parameter to estimate the size of the tuberculosis infectious pool in West Gojjam Zone of Amhara Region, Ethiopia. METHODS In this study, we used the TB management time, i.e. the number of days from start of cough until start of treatment, to determine the infectious period. Patients with sputum smear-positive and smear-negative pulmonary TB, retreatment and an estimated number of undetected cases were included. The infectious pool was then estimated as the annual number of infectious person days in a defined population. RESULTS The TB management time of presently undiagnosed TB cases and sputum smear-positive patients contributed significantly to the infectious pool with 151,840 and 128,750 infectious person days per year, respectively. The total infectious pool including sputum smear-negative TB cases and retreatment patients in the study area was estimated at 325,410 person days or 15,447 person days per 100,000 population during the study year. CONCLUSION Recording TB management time may be used to estimate the infectious pool of TB and to monitor programme performance in the community.
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Affiliation(s)
- Solomon A Yimer
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway.,Amhara Regional State Health Bureau, Bahir Dar, Ethiopia.,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Carol Holm-Hansen
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Gunnar A Bjune
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Kishnani PS, Amartino HM, Lindberg C, Miller TM, Wilson A, Keutzer J. Timing of diagnosis of patients with Pompe disease: data from the Pompe registry. Am J Med Genet A 2013; 161A:2431-43. [PMID: 23997011 DOI: 10.1002/ajmg.a.36110] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/30/2013] [Indexed: 11/06/2022]
Abstract
Diagnostic delays in Pompe disease are common. The diagnostic gap (the time from the onset of symptoms to the diagnosis of Pompe disease) and factors associated with diagnostic delays were examined among Pompe Registry patients in three onset categories: Group A, onset ≤12 months of age with cardiomyopathy; Group B, onset ≤12 months without cardiomyopathy and onset >12 months to ≤12 years; and Group C, onset >12 years. Of 1,003 patients, 647 were available for analysis. In all groups, musculoskeletal signs and symptoms were among the most frequent presenting signs and symptoms, in addition to cardiomyopathy in Group A, which was part of the group's definition. Diagnostic gaps existed in all three groups. Patients presenting with respiratory and musculoskeletal signs and symptoms concurrently had the shortest diagnostic gap, while those presenting with neither respiratory nor musculoskeletal signs and symptoms had the longest. Independent factors influencing the probability of a long diagnostic gap included presenting signs and symptoms (all three groups) and year of diagnosis and age at symptom onset (Groups B and C). Group B, which represents the infantile patients without cardiomyopathy and juvenile Pompe cases, had the longest median gap (12.6 years). Diagnostic testing methods used also were reviewed. Despite the availability of blood-based assays that can be used to quickly and accurately diagnose Pompe disease, diagnostic gaps in Pompe patients across the disease spectrum continue.
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Affiliation(s)
- Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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Kansiime C, Kiwuwa SM, Levi M, Asiimwe BB, Katamba A. Health service delay among pulmonary tuberculosis patients presenting to a National Referral Hospital, Kampala, Uganda: a cross sectional study. Pan Afr Med J 2013; 15:84. [PMID: 24198882 PMCID: PMC3810284 DOI: 10.11604/pamj.2013.15.84.2692] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/18/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Delay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in Sub-Saharan Africa. Timely diagnosis of active tuberculosis is crucial in minimizing morbidity and mortality in the community as well as nosocomial transmission in health care facilities. This study aimed at determining factors associated with health service delay in the diagnosis and initiation of treatment among new PTB patients presenting to the National Referral Hospital-Mulago. METHODS This was a cross-sectional study among eligible new PTB patients presenting at the National referral TB treatment center Mulago hospital, between March to May 2009. The patients were consecutively recruited and interviewed using a semi-structured questionnaire to assess socio- demographic and health service factors. Multivariate logistic regression using odds ratios and 95% confidence intervals was done. RESULTS Two hundred and sixty six newly diagnosed PTB patients were enrolled, of which 65.4% experienced health systems delay. The median health service delay was 9days (IQR=8-19). Factors associated with health service delay were: 1n-patient (OR= 4.68, 95% CI: 1.91-11.45), secondary as highest level of education attained (OR= 3.56, 95% CI: 1.18-10.74), primary as highest level of education attained (OR= 6.70, 95% CI: 2.13-21.02), presence of fever (OR= 3.28, 95% CI: 1.05-10.79), and patient delay at health facility (OR= 5.01, 95% CI: 1.33-18.9). CONCLUSION The study found a significant proportion of Health service delay among pulmonary tuberculosis patients presenting at the referral hospital. Being an in-patient and having fever as a symptom of tuberculosis needs further attention in order to have timely diagnosis. There is need for awareness on TB especially that most of the TB symptoms present like other febrile illnesses such as malaria and needs consideration when patients present to a health facility.
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Affiliation(s)
- Catherine Kansiime
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P. O Box 7072, Kampala
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Ndour O, Alumeti DM, Fall M, Fall AF, Diouf C, Ndoye NA, Ngom G, Ndoye M. [Epidemiological, diagnostic and therapeutic aspects of osteosarcoma of the child at Aristide Le Dantec Teaching Hospital in Dakar: about 16 cases]. Pan Afr Med J 2013; 14:104. [PMID: 23720705 PMCID: PMC3665562 DOI: 10.11604/pamj.2013.14.104.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/18/2012] [Indexed: 11/11/2022] Open
Abstract
Le but de cette étude était de décrire les aspects épidémiologiques, diagnostiques et thérapeutiques des ostéosarcomes de l'enfant. Il s'agissait d'une étude rétrospective sur dix ans qui a colligé 16 dossiers d'ostéosarcome pris en charge au service de Chirurgie Pédiatrique de l'hôpital Aristide Le Dantec de Dakar. Les paramètres étudiés étaient le niveau d'instruction et le niveau socioprofessionnel des parents, l'origine géographique, l’âge, le sexe, les antécédents particuliers, le délai de consultation, les motifs de consultation, les signes physiques, les signes radiologiques, la biologie, les modalités thérapeutiques et l’évolution. Tous les patients avaient bénéficié d'un examen anatomopathologique qui a confirmé le diagnostic d'ostéosarcome. Pour la majeure partie de nos patients (58% des cas) les parents avaient un niveau d'instruction bas. L’âge moyen était de 11ans. Une prédominance masculine était retrouvée avec un sex-ratio de 3,25:1. Le délai de consultation moyen était de 16 mois. Le principal motif de consultation était la tuméfaction (10 cas). Huit patients avaient bénéficié d'un traitement traditionnel. La taille de la tumeur était supérieure à 10cm dans 14 cas. La localisation la plus fréquente était le genou (14 cas). La radiographie standard retrouvait dans 15 cas des images d'ostéolyse. Le bilan d'extension n'avait pas retrouvé de métastases. Les options thérapeutiques étaient dominées par l'amputation seule (43,75% des cas). La survie à 2 ans était de 17%. L'ostéosarcome atteint le plus souvent le garçon après l’âge de 10 ans. Sa prise en charge au Sénégal se heurte à d’énormes difficultés liées au retard diagnostique. La solution repose essentiellement sur une collaboration pluridisciplinaire.
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Affiliation(s)
- Oumar Ndour
- Service de Chirurgie Pédiatrique CHU Aristide Le Dantec, Dakar, Sénégal
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Murray EJ, Bond VA, Marais BJ, Godfrey-Faussett P, Ayles HM, Beyers N. High levels of vulnerability and anticipated stigma reduce the impetus for tuberculosis diagnosis in Cape Town, South Africa. Health Policy Plan 2012; 28:410-8. [PMID: 22945548 DOI: 10.1093/heapol/czs072] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Prolonged diagnostic and treatment delays, particularly in settings experiencing concomitant human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics, undermine global TB control efforts. Current TB control policy in South Africa, as organized through the National TB Control Programme (NTP), relies on the voluntary presentation of TB suspects to local clinics for diagnosis, i.e. passive case finding (PCF). In 2005 a participatory study suggested that popular interpretation and perception of TB within eight South African township sites in and around Cape Town, all carrying a high burden of HIV and undiagnosed TB, undermine PCF. Both people's association of TB with dirt and squalor, and the anticipation of HIV-related stigma, combine to impede TB diagnosis. Respondents conveyed TB as unavoidable; this perception is expressed in the context of vulnerability where so much-including dirt-is largely beyond the control of local residents. The lack of control has a disempowering effect, reducing the drive for seeking treatment. In addition, low confidence in patient confidentiality and anticipated HIV-related stigma act as direct deterrents to TB diagnosis and treatment. In conclusion, we wish to draw attention to high levels of disease stigma and vulnerability, and how these undermine PCF. Public health interventions that wish to improve case detection should aim to: (1) emphasize how early treatment improves outcome and can curb ongoing transmission; (2) combat a sense of communal vulnerability to TB; (3) address anticipated HIV-TB stigma; and (4) improve the quality of care provided at local diagnostic services, addressing low levels of patient confidentiality.
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Affiliation(s)
- Emma J Murray
- Desmond Tutu TB Centre, Stellenbosch University, South Africa.
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Abstract
BACKGROUND Many patients with lung cancer report delays in diagnosing their disease. This may contribute to advanced stage at diagnosis and poor long term survival. This study explores the delays experienced by patients referred to a regional cancer centre with lung cancer. METHODS A prospective cohort of patients referred with newly diagnosed lung cancer were surveyed over a 3 month period to assess delays in diagnosis. Patients were asked when they first experienced symptoms, saw their doctor, what tests were done, when they saw a specialist and when they started treatment. Descriptive statistics were used to summarize the different time intervals. RESULTS 56 of 73 patients consented (RR 77%). However only 52 patients (30M, 22F) were interviewed as 2 died before being interviewed and two could not be contacted. The mean age was 68yrs. Stage distribution was as follows (IB/IIA 10%, stage IIIA 20%, IIIB/IV 70%). Patients waited a median of 21 days (iqr 7-51d) before seeing a doctor and a further 22d (iqr 0-38d) to complete any investigations. The median time from presentation to specialist referral was 27d (iqr 12-49d) and a further 23.5d (iqr 10-56d) to complete investigations. The median wait to start treatment once patients were seen at the cancer centre was 10d (iqr 2-28d). The overall time from development of first symptoms to starting treatment was 138d (iqr 79-175d). CONCLUSIONS Lung cancer patients experience substantial delays from development of symptoms to first initiating treatment. There is a need to promote awareness of lung cancer symptoms and develop and evaluate rapid assessment clinics for patients with suspected lung cancers.
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Siminoff LA, Rogers HL, Thomson MD, Dumenci L, Harris-Haywood S. Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer. Patient Educ Couns 2011; 84:352-8. [PMID: 21621950 PMCID: PMC3159771 DOI: 10.1016/j.pec.2011.05.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 05/02/2011] [Accepted: 05/02/2011] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To examine the influence of patient and physician communication factors on diagnostic delay (DD). METHODS 242 patients diagnosed with colorectal cancer (CRC) in the past 6 months who experienced symptoms prior to diagnosis were administered a 2-h semi-structured qualitative interview to assess communication with health care provider and ease of access to care, among other factors. Patient-provided information was verified via review of medical records. RESULTS The factors associated with DD>2 months included lower income (OR=0.56, p=0.03), having regular physician prior to receiving a cancer diagnosis (OR=2.52, p=0.03), having a physician who used temporizing communication strategies during the consultation (OR=2.41, p=0.02), receiving an initial alternate diagnosis (OR=3.36, p=0.02), experiencing referral delay (OR=3.61, p=<0.001), and experiencing follow-up delay of any kind (OR=3.32, p=0.01). CONCLUSION Excellent communication skills that appropriately probe for relevant social and economic patient information, assist patients in distinguishing and elaborating on symptoms, and provide clear rationale and instructions for future steps, will speed along the diagnosis process and could be the difference between early and late stage CRC. PRACTICE IMPLICATIONS Increased understanding of physician communication and practice styles that contribute to DD could have a positive impact on decreasing the morbidity and mortality from this disease.
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Affiliation(s)
- Laura A Siminoff
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, USA.
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Mir TA, Ashraf M, Ahmed K, Chowdhary J, Rehana B, Ahmed J. Clinical profile, diagnostic delay, and genetic make-up of cystic fibrosis in Kashmir, India. Lung India 2011; 28:97-100. [PMID: 21712940 PMCID: PMC3109853 DOI: 10.4103/0970-2113.80318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This observational study was done to describe the clinical profile, and delays in diagnosing cystic fibrosis (CF) disease in Kashmir, India. MATERIALS AND METHODS A total of 6758 patients between the ages of 0 and 19 years were registered over a period of 1 year. Out of these, 150 patients suspected of having CF, on clinical grounds, were subjected to pilocarpine iontophoresis, and later on genetic evaluation. Apart from these specific tests, these patients were subjected to laboratory tests like blood counts, blood sugar, KFT, LFT, pancreatic function test, serum electrolytes, and chloride, urine, throat swab, blood culture, ABG analysis, chest and paranasal X-rays. In addition, sonographic evaluation of abdominal organs was carried out to know the status of internal organs. A polymerase chain reaction (PCR)-based test was used for the identification of CF mutation. RESULTS CF was diagnosed in three (0.8%) patients. Median age of presentation of CF was 78 months. Family history suggestive of CF was present in one (33.3%) and consanguinity in three (100%) patients. Common clinical manifestations at the time of presentation included recurrent pneumonia in three (100%), failure to thrive in three (100%), recurrent diarrhea in one (33.3%) patients. General physical examination showed pallor in three (100%), malnutrition in three (100%), and clubbing in two (66.7%) patients. Examination of respiratory tract revealed hyperinflation in two (66.7%), rhinitis in two (66.7%), and creptations in two (66.7%) patients. Sonography of abdominal organs revealed pancreatic cysts in one (33.3%), hyperechoeic and increased liver span in two (66.7%), and small gallbladder in one (33.3%). Staphylococcus aureus was cultured from sputum in one (33.3%), pseudomonas aeruginosa in one (33.3%) patients. Delta F508 mutation was present in one (33.3%) patient. CONCLUSION CF may be more common in Kashmir and other parts of Asia, than indicated by our study; diagnosis is often considerably delayed when the disease is identified solely on clinical grounds. It would be advisable to raise the index of suspicion about CF.
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Affiliation(s)
| | - Mohd Ashraf
- Department of Pediatrics, SKIMS Medical College, Srinagar, India
| | - Kaiser Ahmed
- Department of Pediatrics, GB Pant Hospital, GMC, Srinagar, India
| | - Javed Chowdhary
- Department of Pediatrics, GB Pant Hospital, GMC, Srinagar, India
| | - B Rehana
- Department of Pediatrics, GMC, Srinagar, Kashmir 190 001, India
| | - Javid Ahmed
- Department of Pediatrics, SKIMS Medical College, Srinagar, India
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Baldwin MR, Yori PP, Ford C, Moore DAJ, Gilman RH, Vidal C, Ticona E, Evans CA. Tuberculosis and nutrition: disease perceptions and health seeking behavior of household contacts in the Peruvian Amazon. Int J Tuberc Lung Dis 2004; 8:1484-91. [PMID: 15636496 PMCID: PMC2912521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
SETTING Households of TB patients in the Peruvian Amazon. OBJECTIVE To investigate how knowledge and beliefs of household contacts about TB affected health seeking behavior. DESIGN Interviews with 73 patients finishing treatment and 79 of their adult household contacts. RESULTS Contacts were knowledgeable about free screening and treatment, but contacts who noted weight loss, not cough, were more likely to be screened for TB (P = 0.03). Forty-two per cent reported that TB was prevented by nutrition, 28% by separating eating utensils, and only 19% by avoiding a coughing patient. Only one household contact reported being stigmatized. Stigma centered upon nutrition, and only 12% knew of the association between TB and HIV. Only 14% had a BMI < 20, yet 30% reported regularly going to sleep hungry. Free food packages were reported to be the most important reason for treatment adherence by 33% of patients. CONCLUSION Contacts misperceived TB as a nutritional disease and did not fear airborne transmission, which should be corrected by public health education. Weight loss, and not cough, led to screening. Stigma appeared to be minimized because risk was perceived as personal, through malnutrition, rather than exposure-based. Nutritional incentives that utilize these beliefs may reduce diagnostic delay and enhance treatment adherence.
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Affiliation(s)
- M R Baldwin
- Columbia University College of Physicians and Surgeons, New York, New York, USA
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235
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Demissie M, Lindtjorn B, Berhane Y. Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health 2002; 2:23. [PMID: 12296975 PMCID: PMC130033 DOI: 10.1186/1471-2458-2-23] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2002] [Accepted: 09/25/2002] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Delay in the diagnosis of tuberculosis may worsen the disease, increase the risk of death and enhance tuberculosis transmission in the community. This study aims to determine the length of delay between the onset of symptoms and patients first visit to health care (patient delay), and the length of delay between health care visit and the diagnosis of tuberculosis (health service delay). METHODS A cross sectional survey that included all the public health centres was conducted in Addis Ababa from August 1 to December 31 1998. Patients were interviewed on the same day of diagnosis using structured questionnaire. RESULTS 700 pulmonary TB patients were studied. The median patient delay was 60 days and mean 78.2 days. There was no significant difference in socio-demographic factors in those who delayed and came earlier among smear positives. However, there was a significant difference in distance from home to health institute and knowledge about TB treatment among the smear negatives. The health service delay was low (median 6 days; mean 9.5 days) delay was significantly lower in smear positives compared to smear negatives. Longer health service delay (delay more than 15 days) was associated with far distance. CONCLUSIONS The time before diagnosis in TB patients was long and appears to be associated with patient inadequate knowledge of TB treatment and distance to the health centre. Further decentralization of TB services, the use of some components of active case finding, and raising public awareness of the disease to increase service utilization are recommended.
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Affiliation(s)
- Meaza Demissie
- National Tuberculosis and Leprosy Control Programme, Addis Ababa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Bernt Lindtjorn
- National Tuberculosis and Leprosy Control Programme, Addis Ababa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Yemane Berhane
- Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia
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Arndt V, Stürmer T, Stegmaier C, Ziegler H, Dhom G, Brenner H. Patient delay and stage of diagnosis among breast cancer patients in Germany -- a population based study. Br J Cancer 2002; 86:1034-40. [PMID: 11953844 PMCID: PMC2364177 DOI: 10.1038/sj.bjc.6600209] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2001] [Revised: 12/27/2001] [Accepted: 01/22/2002] [Indexed: 02/07/2023] Open
Abstract
Early diagnosis is a tenet in oncology and should enable early treatment with the expectation of improved outcome. Extent and determinants of patient delay of diagnosis in breast cancer patients and its impact on stage of disease were examined in a population based study among female breast cancer patients in Germany. Two hundred and eighty-seven women, aged 18 to 80 years with newly diagnosed invasive symptomatic breast cancer, were interviewed with respect to the diagnostic process. Patient delay was defined as time from onset of first symptoms to first consultation of a doctor. Median patient delay was 16 days among symptomatic patients. Eighteen per cent of all breast cancer patients waited longer than 3 months before consulting a physician. Long patient delay was associated with old age, history of a benign mastopathy, obesity, and indices of health behaviour such as not knowing a gynaecologist for out-patient care and non-participation in general health screening examinations. A strong association between patient delay and stage at diagnosis was observed for poorly differentiated tumours. These results suggest that at risk groups for delaying consultation can be identified and that a substantial proportion of late stage diagnoses of poorly differentiated breast cancer cases could be avoided if all patients with breast cancer symptoms would present to a doctor within 1 month.
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Affiliation(s)
- V Arndt
- Department of Epidemiology, University of Ulm, D-89081 Ulm, Germany
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