The Durham Initiative for Stomach Health (DISH): a pilot community-based Helicobacter pylori education and screening study

The epidemiological study of family-based Helicobacter pylori screening and its benefits: a cross-sectional study

This study aimed to manage Helicobacter pylori (H. pylori) infection through a family-centered approach. It conducted a two-year follow-up on infected individuals' family members in Yichun, Jiangxi, China, to gain comprehensive insights into the transmission dynamics, treatment adherence, and associated risk factors of H. pylori within households. A retrospective analysis was performed on the data obtained from households in Yichun City that participated in the nationwide multicenter H. pylori prevalence study in 2021, along with the corresponding subsequent follow-up data. The collected information encompassed fundamental demographic details of the families, their lifestyle patterns, and the status of H. pylori infection. Among 514 households, 222 comprised two individuals, whereas 68 constituted larger families with five or more members. All member was infected in 9.34% of households. Larger family sizes (≥ 5 individuals) and higher generational counts were closely associated with H. pylori infection (e.g., family size > 6: OR 4.46, 95%CI 1.29 to 15.46). Adult age, marital status, and household members' infections were identified as primary risk factors (e.g., married individuals: OR 2.03, 95%CI 1.56 to 2.65). Students and previously uninfected individuals exhibited lower infection risks (e.g., tested as negative: OR 0.48, 95%CI 0.31 to 0.73). Maternal, paternal, or sibling infections were linked to increased risks of child infections (e.g., mother infected: OR 2.58 95%CI 1.37 to 4.87). Successful eradication in ≥ 2 individuals reduced the infection risk for other members (OR 0.25, 95%CI (0.07 to 0.89). H. pylori displayed noticeable clustering infection characteristics within families. This study lends support to family-based management strategies, but given suboptimal adherence to household management, there is a need to enhance education on the hazards of H. pylori before implementing screening programs.

A Screen-and-Treat Strategy for Eradication of Helicobacter pylori among Patients with Family History of Gastric Cancer in a Diverse US Population

BACKGROUND

Screening and eradication of Helicobacter pylori reduce the risk of gastric cancer in patients with a family history. We assessed patient perspectives on H. pylori screening and treatment within a diverse regional US population.

METHODS

Between July 2022 and August 2022, we conducted a cross-sectional study among patients with ≥1 first-degree relative(s) with gastric cancer. Eligible patients were between 18 and 75 years of age without history of H. pylori infection or gastric cancer. A survey assessed interest in testing and willingness to complete treatment for H. pylori. Interested patients were offered H. pylori testing and treatment. We examined interest and effectiveness of treatment by race and ethnicity.

RESULTS

We identified 15,255 eligible patients, and 1,500 patients were randomly selected for the survey; 280 (19%) patients, including two relatives not initially invited but asked to participate, responded following outreach. Respondents were 65% male and averaged 57 years (SD = 13) with 36% Hispanic, 36% non-Hispanic White, 15% Asian/Pacific Islander, and 9% non-Hispanic Black. Overall, 223 (80%) were interested in H. pylori screening; of these, 89% would take antibiotics as prescribed. Willingness to screen was consistent across racial and ethnic groups. Among 223 respondents interested in screening, 128 (57%) completed testing with 15 screen-detected cases; all 15 completed treatment, and 11 had confirmed eradication.

CONCLUSIONS

Patients with family history of gastric cancer had a high level of interest in H. pylori screening and successful eradication when detected.

IMPACT

A screen-and-treat strategy for H. pylori may be considered for patients with family history of gastric cancer.

Culturally safe community agency health promotion capacity for diverse equity-seeking women: a rapid theoretical review

Objectives

Immigrant and sexually/gender-diverse women (henceforth, women) face inequities in access to and quality of care. As a result, many seek health information from community agencies perceived as culturally safe. We aimed to generate knowledge on capacity needed for culturally safe community agency health promotion.

Design

Theoretical rapid review.

Data sources

Studies identified in MEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, Cochrane Library and the Joanna Briggs Institute Database of Systematic Reviews.

Eligibility criteria

Studies published in 2013 or later on health promotion for ethnoculturally, sexually and gender-diverse women led by community agencies (eg, settlement, cultural, support and faith).

Data extraction/synthesis

We extracted data on study characteristics, cultural tailoring, implementation with the Reach Effectiveness Adoption Implementation framework and health promotion capacity with the New South Wales framework.

Results

We included 19 studies published from 2017 to 2023. Most focused on health promotion to African or Latin American persons in faith-based organisations. Few studies focused solely on women, and no studies focused on or included 2SLGBTQ women. Few studies described cultural tailoring beyond the use of participants' first language. Training of community health workers (CHWs) to deliver health promotion education, and CHW in-person group training of health promotion participants on a wide range of topics resulted in improved knowledge, self-efficacy, intention to modify behaviour, behaviour change and health outcomes. A few studies yielded some insight into what community agencies need to enable health promotion: dedicated funding and personnel, training in healthcare issues, space and partnerships with academic and healthcare organisations.

Conclusions

This study confirmed and enhanced our understanding of the health promotion role of community agencies and identified gaps that can inform future research on how to achieve culturally safe community agency health promotion for diverse women.

Barriers to Community-Based Eradication of Helicobacter pylori Infection

Helicobacter pylori (HP) is a causative agent in gastric cancer (GC).1 In the United States, HP is more prevalent in racial and ethnic minorities, including African Americans, Asian Americans, Latinos, and immigrants, the same groups that are more likely to develop and die from GC.2 Although screening for HP is not presently performed in the United States, there are plausible benefits to doing so, because HP is considered a group 1 carcinogen by the World Health Organization, and its link to GC parallels that of human papilloma virus and cervical cancer.1 HP eradication as a means of preventing GC also fulfils the Wilson and Jungner criteria for a successful screening program, and literature has consistently demonstrated that HP eradication reduces GC risk and death from GC.3 In fact, in countries with a high burden of GC, HP eradication is considered primary prevention for GC. As such, targeted HP testing in the United States may reduce GC burden in high-risk groups.4 We evaluate the results of community-based HP testing in an at-risk, underserved population.

Advancing Equity in Cancer Research: Opportunities for Sponsors, Institutions, and Investigators

Numerous studies have documented patient-level barriers to research participation that are often connected to social determinants of health. As described in this paper, to significantly move the needle toward greater diversity and inclusion in cancer research, it will take a full commitment to integrating an equity lens across the cancer research ecosystem, specifically among sponsors, institutions, and investigators.

Evaluation of Different Strategies to Improve the Management of Helicobacter pylori Infection at the Primary Care Level: Training Sessions Increase Prescription Appropriateness of Treatment Regimens

Helicobacter pylori infection (H. pylori) is mainly managed at the primary care level. Our group previously performed a study demonstrating that providing specific counselling (SC) to primary care practitioners (PCPs) who requested a urea breath test (UBT) improved treatment management but not indications for H. pylori tests. SC was given in the form of a personal letter addressed to PCPs with UBT results which contained information about accepted UBT indications and a Helicobacter pylori treatment algorithm. The purpose of the present study was to evaluate the effect of training sessions (TS) on UBT indications, antibiotic prescriptions and eradication rates. This was a quasi-experimental study performed at primary care centres (PCCs). Phase I included 399 patients diagnosed with H. pylori infection after providing SC to PCPs. Phase II included 400 H. pylori-positive patients after giving TS to PCPs who had already received SC (100 from PCCs with TS and 300 from PCCs without TS). An improved trend in the appropriate indication of H. pylori diagnosis was observed between Phase I and PCCs with TS in Phase II (57.5% vs. 67%; p = 0.06). TS improved appropriate prescriptions in PCCs with TS compared to PCCs that only received SC in Phase I and II (94% vs. 75.3%, p = 0.01; 94% vs. 85.6%, p = 0.04, respectively). Eradication rates showed no differences between groups. In conclusion, training sessions after specific counselling improved antibiotic prescription appropriateness but not eradication rates.

Low compliance to post-screening recommendations in a family-based Helicobacter pylori screening and treatment program: A prospective cohort study

BACKGROUND

Intra-family transmission is an important Helicobacter pylori (H. pylori) infection route. Family-based screening and treatment of H. pylori is a promising strategy. However, limited data are available on patient compliance with post-screening recommendations for such a strategy.

MATERIALS AND METHODS

A prospective cohort study of families from six regions in Shandong, China, from July 2021 to February 2022 was conducted. Demographic characteristics, prior testing, and treatment for H. pylori, prior gastroscopy, symptoms, and family history were collected. Infection status of participants was determined using the ¹³ C-urea breath test. Infected participants were recommended to undergo eradication treatment, confirmation testing, and gastroscopy per expert consensus. Participants were monitored for 6 months to record recommendation compliance in a real-world setting. Logistic regression models were used to analyze the factors influencing compliance with the recommendations.

RESULTS

The study included 1173 individuals from 386 families with the overall infection rate of 36.7%. The recommendation compliance for eradication treatment, confirmation testing, and gastroscopy was 69.3% (271/391), 32.5% (88/271), and 6.1% (19/309), respectively. Factors that increased the risk of lower compliance were male sex (odds ratio [OR], 1.917, 95% confidence interval [CI], 1.233-2.981), and living in a non-urban area (OR, 1.954, 95% CI, 1.241-3.074), for treatment recommendations; having more than one infected family member (OR, 2.138, 95% CI, 1.237-3.698), and a lower family income (¥100,000-¥300,000 per year, OR, 7.247, 95% CI, 1.788-29.363; or <¥100,000 per year, OR, 7.294, 95% CI, 1.832-29.042), for confirmation testing recommendations; and being asymptomatic (OR, 3.009, 95% CI, 1.105-8.196), for gastroscopy recommendations.

CONCLUSIONS

Post-screening recommendation compliance for this family-based H. pylori screening and treatment program was unsatisfactory. Further studies focusing on pre-screening education are warranted to improve compliance.