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Jia L, Chen X, Feng Z, Tang S, Feng D. Factors affecting delays in seeking treatment among malaria patients during the pre-certification phase in China. Malar J 2024; 23:73. [PMID: 38468296 DOI: 10.1186/s12936-024-04892-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Delays in malaria treatment can not only lead to severe and even life-threatening complications, but also foster transmission, putting more people at risk of infection. This study aimed to investigate the factors influencing treatment delays among malaria patients and their health-seeking behaviour. METHODS The medical records of 494 patients diagnosed with malaria from 6 different malaria-endemic provinces in China were analysed. A bivariate and multivariable regression model was used to investigate the association between delays in seeking treatment and various factors. A Sankey diagram was used to visualize the trajectories of malaria patients seeking medical care. Total treatment delays were categorized as patient delays and doctor delays. RESULTS The incidence of total delays in seeking malaria treatment was 81.6%, of which 28.4% were delayed by patients alone and 34.8% by doctors alone. The median time from the onset of symptoms to the initial healthcare consultation was 1 day. The median time from the initial healthcare consultation to the conclusive diagnosis was 2 day. After being subjected to multiple logistic regression analysis, living in central China was less likely to experience patient delays (OR = 0.43, 95% CI 0.24-0.78). The factors significantly associated with the lower likelihood of doctor delays included: age between 30 to 49 (OR = 0.43, 95% CI 0.23-0.81), being single/divorce/separated (OR = 0.48, 95% CI 0.24-0.95), first visiting a county-level health institution (OR = 0.25, 95% CI 0.14-0.45), first visiting a prefectural health institution (OR = 0.06, 95% CI 0.03-0.12) and first visiting a provincial health institution (OR = 0.05, 95%CI 0.02-0.12). Conversely, individuals with mixed infections (OR = 2.04, 95% CI 1.02-4.08) and those experiencing periodic symptoms (OR = 1.71, 95% CI 1.00-2.92) might face increased doctor delays. Furthermore, higher financial burden and complications were found to be associated with patient delays. Doctor delays, in addition to incurring these two consequences, were associated with longer hospital stays. CONCLUSION There was a substantial delay in access to health care for malaria patients before China was certified malaria free. Region, marital status, periodic symptoms and the level of health institutions were factors contributing to delays in treatment-seeking among malaria patients.
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Affiliation(s)
- Lianyu Jia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xiaoyu Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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de Morais M, Sousa S, Marques J, Moniz M, Duarte R, Leite A, Soares P. Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal. BMC Public Health 2023; 23:2421. [PMID: 38053129 PMCID: PMC10696854 DOI: 10.1186/s12889-023-17319-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms. METHODS A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 - 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR). RESULTS The study included 75 patients. Median PD was 25 days (IQR 11.5-63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05-2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77-2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14-4.82)], while living in Oporto [PR 0.35 (95% CI 0.16-0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17-0.94)] were protective factors. CONCLUSIONS These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.
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Affiliation(s)
- Margarida de Morais
- NOVA National School of Public Health, Public Health Research Centre, NOVA University Lisbon, Lisbon, Portugal.
- Central Lisbon Public Health Unit, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal.
| | - Sofia Sousa
- Multidisciplinary Unit for Biomedical Research, Biomedical Sciences Institute Abel Salazar, University of Porto, Oporto, Portugal
| | - Jéssica Marques
- NOVA National School of Public Health, Public Health Research Centre, NOVA University Lisbon, Lisbon, Portugal
| | - Marta Moniz
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, NOVA University Lisbon, Lisbon, Portugal
| | - Raquel Duarte
- Epidemiological Investigation Unit, Public Health Institute, University of Porto, Oporto, Portugal
- Laboratory for Integrative and Translational Investigation in Populational Health, Oporto, Portugal
- Biomedical Sciences Institute Abel Salazar, University of Porto, Oporto, Portugal
- Clinical Investigation Unit, Regional Health Administration of the North, Oporto, Portugal
- Pneumology Service, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, NOVA University Lisbon, Lisbon, Portugal
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, NOVA University Lisbon, Lisbon, Portugal
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
- Centre for Vectors and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Águas de Moura, Portugal
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Zhang Y, Zhan B, Hao X, Wang W, Zhang X, Fang C, Wang M. Factors associated with diagnostic delay of pulmonary tuberculosis among children and adolescents in Quzhou, China: results from the surveillance data 2011-2021. BMC Infect Dis 2023; 23:541. [PMID: 37596514 PMCID: PMC10439644 DOI: 10.1186/s12879-023-08516-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Tuberculosis is a high-burden disease and a major health concern in China, especially among children and adolescents. The purpose of this study was to assess risk factors for diagnostic delay in students with pulmonary tuberculosis in Quzhou City in eastern China. PATIENTS AND METHODS Cases of PTB in students and relevant information in Quzhou from 2011 to 2021 were collected using the TB Management Information System. The outcome of interest was diagnostic delay (i.e. ≥ 28 days between symptom onset and treatment initiation). Risk factors for diagnostic delay were identified using multivariable logistic regression. RESULTS A total of 629 students in Quzhou were diagnosed with PTB during the study period, of whom 55.5% were male. The median diagnostic delay was 18 days (Inter Quartile Range, [IQR]: 8-38) and 38.0% of the students had a diagnostic delay. Living in a rural area (adjusted odds ratio, [AOR]: 1.56, 95% confidence interval [CI:] 1.11-2.19), developing PTB symptoms in the first quarter of the year (AOR: 2.18, 95% CI: 1.40-3.40), and no sputum smear result (AOR: 8.73, 95% CI: 1.68-45.30) were significantly associated with a diagnostic delay. Discovery through health examinations (AOR: 0.33, 95% CI: 0.17-0.63) was associated with reduced risk of diagnostic delay. CONCLUSION Schools in rural areas should pay special attention to increasing student awareness of the symptoms of tuberculosis and provide health education on tuberculosis prevention and control to students and staff.
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Affiliation(s)
- Yating Zhang
- School of Public Health, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Bingdong Zhan
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Xiaogang Hao
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Wei Wang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Xing Zhang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Chunfu Fang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Min Wang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China.
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Guo J, Feng YP, Liu ZD, Luo SR, Wu QY. Analysis of factors influencing patient delay by patients with pulmonary tuberculosis in Lishui City, Zhejiang Province. BMC Pulm Med 2023; 23:264. [PMID: 37464373 DOI: 10.1186/s12890-023-02554-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE The purpose of this study was to collect data on the current state of patient delay by patients with tuberculosis (TB) in Lishui City, Zhejiang Province who were under the care of a TB-designated hospital from 2011 to 2021 and to analyze the factors that contribute to this problem in order to provide a scientific basis for the prevention and control of TB. METHODS In this observational study, we collected data on patients with pulmonary TB that were reported to the Chinese government's disease prevention and control information system by the Traditional Chinese Medicine Hospital in Lishui City between 2011 and 2021. The data included demographics like age, gender, occupation, household registration, current address, date of symptoms, date of first visit, and etiology results. Multivariate logistic regression analysis was used to analyze the factors influencing patient delay by patients with pulmonary TB. RESULTS There were 3,190 cases of pulmonary TB treated in a TB-designated hospital in Lishui City, Zhejiang Province, between 2011 and 2021. Of these, 2,268 involved patient delay, with the delay rate of 71.10% and the median (Q25, Q75) days of patient delay being 36 (25, 72) days. Results of multivariate logistic regression analysis indicated the presence of risk factors-age > 60 years old (OR = 1.367, 95% CI: 1.144 ~ 1.632), pathogen positive (OR = 1.211, 95% CI: 1.033 ~ 1.419), and employed as peasants (OR = 1.353, 95% CI:1.144 ~ 1.601) for patient delay in patients with pulmonary TB. Patients with diabetes mellitus made up 64.94% of the pulmonary TB population, which was lower than the 71.58% of patients without diabetes mellitus (χ2 = 4.602, P = 0.032). Additionally, the presence of diabetes mellitus may be a protective factor in patient delay in patients with pulmonary TB (OR = 0.641, 95% CI: 0.481 ~ 0.856). CONCLUSION High rates of patient delay, age > 60 years old, a positive etiology, and being employed as peasants are all possible risk factors for pulmonary TB in Lishui City, Zhejiang Province.
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Affiliation(s)
- Jing Guo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, No. 800 Zhongshan Street, Liandu District, Lishui, 323000, China
| | - Yin-Ping Feng
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, No. 800 Zhongshan Street, Liandu District, Lishui, 323000, China
| | - Zhong-Da Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, No. 800 Zhongshan Street, Liandu District, Lishui, 323000, China
| | - Shui-Rong Luo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, No. 800 Zhongshan Street, Liandu District, Lishui, 323000, China
| | - Qian-Yu Wu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, No. 800 Zhongshan Street, Liandu District, Lishui, 323000, China.
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Wang X, Li Y, Fu Q, Zhou M. Trends of a decade in risk factors of patient delay among pulmonary tuberculosis patients during fast aging and urbanization - analysis of surveillance data from 2008 to 2017 in Wuhan, China. BMC Public Health 2023; 23:803. [PMID: 37131129 PMCID: PMC10155439 DOI: 10.1186/s12889-023-15707-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading infectious cause of morbidity and mortality worldwide. However, delay in health care seeking has remained unacceptably high. The aim of this study was to clarify the trend of patient delay and its associated risk factors during rapid aging and urbanization in Wuhan, China from 2008 to 2017. METHODS A total of 63,720 TB patients registered at Wuhan TB Information Management System from January 2008 to December 2017 were included. Long patient delay (LPD) was defined as patient delay longer than 14 days. Independent associations of area and household identity with LPD, as well their interaction effect, were tested by logistic regression models. RESULTS Among 63,720 pulmonary TB patients, 71.3% were males, the mean age was 45.5 ± 18.8 years. The median patient delay was 10 days (IQR, 3-28). A total of 26,360 (41.3%) patients delayed for more than 14 days. The proportion of LPD decreased from 44.8% in 2008 to 38.3% in 2017. Similar trends were observed in all the subgroups by gender, age and household, except for living area. The proportion of LPD decreased from 46.3 to 32.8% in patients living near downtown and increased from 43.2 to 45.2% in patients living far from downtown. Further interaction effect analysis showed that among patients living far from downtown, the risk of LPD for local patients increased with age, while decreased with age for migrant patients. CONCLUSION Although the overall LPD among pulmonary TB patients declined in the past decade, the extent of reduction varied in different subgroups. The elderly local and young migrant patients living far from downtown are the most vulnerable groups to LPD in Wuhan, China.
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Affiliation(s)
- Xiaojun Wang
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuehua Li
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China.
| | - Meilan Zhou
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
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Ma J, Luo Y, Yang S, Liu X, Peng Y, Wang H, Valimaki M, Gu C. Patient delay and related influencing factors in Chinese women under 35 years diagnosed with cervical cancer: A cross-sectional study. Asia Pac J Oncol Nurs 2023; 10:100165. [PMID: 36579173 DOI: 10.1016/j.apjon.2022.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Patient delay was defined as an interval between the discovery of the initial symptoms and diagnosis, which was longer than 90 days. This study aimed to determine the patient delay rate and related factors in women with cervical cancer in Hunan province, South-Central China. Methods A cross-sectional study was conducted among 140 women with cervical cancer aged <35 years from October, 2019 to March, 2021. Assumptions in Andersen Behavioral Model of Health Services Utilization were used to measure the factors influencing patient delay. Logistic regression models were used to identify factors associated with patient delay. A P-value of <5% was considered significant. Results A total of 57 (40.71%) young women with cervical cancer had patient delay, with an average delay time of 178.70 (307.90) days. Predisposing factors, such as religion, unemployment, health beliefs related to cancer screening, and a history of cervical cancer screening within 2 years or more (P < 0.05), were associated with patient delay. Enabling factors, such as distance to the nearest medical facility and type of the nearest medical facility, were associated with a reduced likelihood of patient delay. With the need-for-care factor, young women who experienced vaginal pain after or during intercourse had a higher risk (adjusted odds ratio, 33.48; 95% confidence interval, 3.22-348.68, P = 0.003) of patient delay. Conclusions These findings reinforce the need for programs to enhance knowledge and awareness about cervical cancer screening and the importance of early diagnosis in women to help eliminate cervical cancer in China by 2050.
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Zou H, Jiang DX, Zhao WY, Yang JH, Jia HH, Zhang LL. Factors associated with patient delay for older adults with benign prostatic hyperplasia: A descriptive qualitative study. Geriatr Nurs 2022; 46:178-183. [PMID: 35728300 DOI: 10.1016/j.gerinurse.2022.06.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
Based on the theory of planned behavior, the aim of this study was to describe the influencing factors of patient delay intentions and behaviors in benign prostatic hyperplasia (BPH) patients and to provide a reference for the development of a patient delay intention scale. This study was carried out over 4 months in 2021 in Daqing, Heilongjiang, China. The participants were 20 patients with BPH who were aged 60 to 82 years and experienced patient delay; participants were selected through a purposive sampling method. The data were collected via face-to-face semistructured interviews. Five main themes emerged from the interviews, including an insufficient understanding of symptoms, experiences of coping instead of seeking health care, negative attitudes toward care-seeking, the influence of others on decision-making for care-seeking, and obstacles to seeking health care. In conclusion, the patient delay intentions and behaviors of BPH patients are the result of a combination of many factors.
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Affiliation(s)
- Hao Zou
- Department of Nursing, Harbin Medical University, Daqing, 163319, China.
| | - Dong-Xu Jiang
- Department of Nursing, Harbin Medical University, Daqing, 163319, China.
| | - Wan-Yue Zhao
- Department of Nursing, Harbin Medical University, Daqing, 163319, China.
| | - Jin-Hong Yang
- Urology, People's Hospital in Hei Longjiang Province, Daqing, 163319, China.
| | - Hong-Hong Jia
- Department of Nursing, Harbin Medical University, Daqing, 163319, China.
| | - Lin-Lin Zhang
- Department of Nursing, School of Pharmacy, Changzhou University, Jiangsu, 213164, China.
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Sultana S, Salwa M, Towhid MII, Islam SS, Haque MA. Challenges for tuberculosis control at selected primary healthcare centers in Bangladesh: A mixed-method study. Indian J Tuberc 2022; 69:134-140. [PMID: 35379392 DOI: 10.1016/j.ijtb.2021.04.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The national tuberculosis control program in Bangladesh is progressing to end tuberculosis (TB) epidemic by 2035. Despite improved diagnostic and treatment facilities, the disease burden remains high. This mixed-method study aimed to identify existing challenges for successfully implementing the tuberculosis control program in primary healthcare centers (PHCs) of Bangladesh. METHODS Qualitative data were collected by observing six PHCs and interviewing TB patients (n = 12) and healthcare providers (n = 12). Quantitative data were collected by interviewing 94 TB patients. Data were integrated through a narrative approach. RESULTS Mean patient and health system delay were 99.0 (SD = 98.7) and 42.9 (SD = 79.9) days respectively. Patient delay was related to poor care-seeking behavior, unfamiliarity with tuberculosis symptoms, and unavailability of healthcare facilities. About 74 percent of patients sought initial treatment from village doctors or drug vendors. Health system delay was related to inadequate manpower, unskilled staff, and limited diagnostic facilities. Every second patient reported non-adherence to the directly observed treatment short-course (DOTS) guideline. DOTS provider's inaccessibility, inadequate incentive, and unreasonable patient demand lead to non-adherence. Insufficient administrative and structural facilities for infection control were observed at the selected facilities. CONCLUSIONS This study provides an insight into the recent challenges in TB control at PHCs in Bangladesh.
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Affiliation(s)
- Sarmin Sultana
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh.
| | - Marium Salwa
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Muhammad Ibrahim Ibne Towhid
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - M Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
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Matarredona-Quiles S, Martínez Ruíz de Apodaca P, Serrano Badía E, Ortega Beltrá N, Dalmau-Galofre J. Factors associated with diagnosis delay in head and neck cancer. Acta Otorrinolaringol Esp (Engl Ed) 2022; 73:19-26. [PMID: 35190084 DOI: 10.1016/j.otoeng.2020.10.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages. METHODS Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated. RESULTS Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p = .008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days. CONCLUSIONS Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays.
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Affiliation(s)
| | | | - Ester Serrano Badía
- Servicio de Otorrinolaringología, Hospital Francesc de Borja, Gandía, Valencia, Spain
| | - Noelia Ortega Beltrá
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - José Dalmau-Galofre
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, Spain
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Lidin M, Lyngå P, Kinch-Westerdahl A, Nymark C. Patient delay prior to care-seeking in acute myocardial infarction during the outbreak of the coronavirus SARS-CoV2 pandemic. Eur J Cardiovasc Nurs 2021; 20:752-759. [PMID: 34718511 DOI: 10.1093/eurjcn/zvab087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/02/2021] [Revised: 07/07/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023]
Abstract
AIMS To examine patient delay in seeking medical care when afflicted by an acute myocardial infarction during March-June 2020. METHODS AND RESULTS This was a cross-sectional study in a region in Sweden during the first wave of the COVID-19 pandemic examining patients selected from the national registry (SWEDEHEART). Eligible patients were those with acute myocardial infarction, and a total of 602 patients were invited. A self-administered psychometric evaluated questionnaire, 'Patients' appraisal, emotions, and action tendencies preceding care-seeking in acute myocardial infarction' (AMI), was sent to the patients, and questions regarding COVID-19 were added. A total of 326 patients answered the questionnaire. Of these, 19% hesitated to seek medical care because of the pandemic, which was related to a fear that the healthcare services were already overcrowded with patients with COVID-19, followed by a fear of becoming infected with COVID-19 in hospital. Characteristics of this cohort were significantly higher prevalences of women, immigrants, smokers, and patients with type 2 diabetes. CONCLUSIONS During the outbreak and first wave of the COVID-19 pandemic, women and immigrants delayed seeking medical care for AMI because of fears about overcrowded hospitals and about becoming infected themselves. Therefore, during the COVID-19 pandemic, it is especially important to convey information about how and when to seek medical care. A collaboration involving the healthcare professionals, patient organizations, and the media would be desirable.
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Affiliation(s)
- Matthias Lidin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Heart, Vascular and Neuro Theme, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education and Department of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | | | - Carolin Nymark
- Department of Neurobiology, Karolinska Institutet, Care sciences and Society, Division of Nursing Stockholm, Sweden
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Santos JA, Leite A, Soares P, Duarte R, Nunes C. Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal. BMC Public Health 2021; 21:2178. [PMID: 34837969 PMCID: PMC8627051 DOI: 10.1186/s12889-021-12245-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis. METHODS Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05. RESULTS Median patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19-71), 8 days (IQR: 1-32) and 62 days (IQR: 38-102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay. CONCLUSIONS Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.
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Affiliation(s)
- João Almeida Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
- National Health Institute Dr. Ricardo Jorge, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal.
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal
| | - Raquel Duarte
- Chest Disease Center, Vila Nova de Gaia, Rua Conselheiro Veloso da Cruz, 4400-092, Vila Nova de Gaia, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal
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Cao C, Li Y, Fu S, Zhang Y, Li N, Hou S, Fan H. Patient delay in a coronavirus disease 2019 (COVID-19) outbreak in Tianjin, China from January to February 2020. J Formos Med Assoc 2021; 121:1248-1256. [PMID: 34802833 PMCID: PMC8580809 DOI: 10.1016/j.jfma.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/05/2021] [Revised: 05/10/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022] Open
Abstract
Background Patient delay of COVID-19 patients occurs frequently, which poses a challenge to the overall epidemic situation. In this study, we aimed to evaluate the extent of patient delay, explore its factors, and investigate the effects of patient interval on epidemic situation. Methods A retrospective cohort study was conducted with 136 COVID-19 patients in Tianjin, China. Factors associated with patient delay were explored using logistic regression models. The relationship was investigated by spearman correlation analysis and mean absolute error between patient interval of lagging days and epidemic situation. Results The factors associated with patient delay of COVID-19 patients were mainly the imported cases, the first presentation to a tertiary hospital, close contacts and spatial accessibility to fever clinic. The longer the patient intervals of lagging days, the greater the number of new-onset and confirmed cases in 3–4 and 5–7 days after the first day symptoms, respectively. Conclusion Identification and quarantine of close contacts, promoting the spatial accessibility to fever clinics and creating public awareness are crucial to shortening patient delays to flat the curve for COVID-19.
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Affiliation(s)
- Chunxia Cao
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China
| | - Yue Li
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China
| | - Shaobo Fu
- General Courses Department, Army Military Transportation University of PLA, Tianjin 300161, PR China
| | - Yongzhong Zhang
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China
| | - Ning Li
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China
| | - Shike Hou
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China.
| | - Haojun Fan
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China.
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Almeida Santos J, Soares P, Leite A, Duarte R, Nunes C. Patient and healthcare delays in critical and non-critical pulmonary tuberculosis incidence areas in Portugal: are there differences? Public Health 2021; 201:41-47. [PMID: 34742116 DOI: 10.1016/j.puhe.2021.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/23/2021] [Revised: 08/08/2021] [Accepted: 09/26/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To characterize patient, healthcare, and total delay in diagnosing pulmonary tuberculosis (PTB) in critical (higher PTB incidence) and non-critical (lower PTB incidence) areas and their determinants considering clinical and sociodemographic factors. STUDY DESIGN Retrospective cohort study. METHODS Data was retrieved from the Portuguese National Tuberculosis Surveillance System (SVIG-TB). Were included in the study all active PTB patients (n = 11,762) notified between 2008 and 2017. Spatial analysis was used to define critical and non-critical areas. Kaplan-Meier estimator, logrank test, and Cox regression were conducted, stratified by area. RESULTS PTB cases in critical areas (n = 6594, 56.1%) presented longer patient median delay (41 vs 31days), shorter healthcare median delay (7 vs 10 days), and longer total median delay (63 vs 61days) t.han non-critical areas. Patient and total delay increased in both areas over time, while healthcare delay only increased in non-critical areas. Icn both areas, being from a high TB incidence country and alcohol abuse were associated with longer patient delays. Being female, older age, and oncologic diseases were associated with longer healthcare delays. Respiratory diseases were only associated with a longer healthcare delay in non-critical areas. Being female, older, and from a high TB incidence country were associated with a longer total delay in both areas. CONCLUSIONS Patient delay was significantly longer in critical areas, and healthcare delay was significantly longer in non-critical areas. Several factors associated with longer delays have been identified, most of which are shared by critical and non-critical areas. Differences in patient and healthcare delay, for example, by sex, age, or country of birth, highlight the need for targeted public health interventions to help reduce these differences.
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Affiliation(s)
- J Almeida Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; National Health Institute Dr. Ricardo Jorge, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal.
| | - P Soares
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal.
| | - A Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal.
| | - R Duarte
- Centro Hospitalar de Vila Nova de Gaia, Rua Conselheiro Veloso da Cruz, 4400-092 Vila Nova de Gaia, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal.
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Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 2021; 22:251. [PMID: 34556113 PMCID: PMC8459488 DOI: 10.1186/s12931-021-01841-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 02/21/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world's TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. METHODS We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. RESULTS This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were-patient delay (LIC/LMIC: 28 (95% CI 20-30); UMIC: 10 (95% CI 10-20), health system delay (LIC/LMIC: 14 (95% CI 2-28); UMIC: 4 (95% CI 2-4), and treatment delay (LIC/LMIC: 14 (95% CI 3-84); UMIC: 0 (95% CI 0-1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. CONCLUSIONS This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
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Küronya Z, Fröhlich G, Ladányi A, Martin T, Géczi L, Gyergyai F, Horváth O, Kiszner G, Kovács Á, Dienes T, Lénárt E, Nagyiványi K, Szarvas T, Szőnyi M, Tóth A, Biró K. Low socioeconomic position is a risk factor for delay to treatment and mortality of testicular cancer patients in Hungary, a prospective study. BMC Public Health 2021; 21:1707. [PMID: 34538241 PMCID: PMC8451119 DOI: 10.1186/s12889-021-11720-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/31/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background In Hungary, the mortality rate for testicular germ cell cancer (TGCC) is 0,9/100000 which is significantly higher than the EU average. We prospectively evaluated the effect of socioeconomic position on patient delay and therapy outcomes. Methods Questionnaires on subjective social status (MacArthur Subjective Status Scale), objective socioeconomic position (wealth, education, and housing data), and on patient’s delay were completed by newly diagnosed TGCC patients. Results Patients belonged to a relatively high socioeconomic class, a university degree was double the Hungarian average, Cancer-specific mortality in the highest social quartile was 1.56% while in the lowest social quartile 13.09% (p = 0.02). In terms of patient delay, 57.2% of deceased patients waited more than a year before seeking help, while this number for the surviving patients was 8.0% (p = 0.0000). Longer patient delay was associated with a more advanced stage in non-seminoma but not in seminoma, the correlation coefficient for non-seminoma was 0.321 (p < 0.001). For patient delay, the most important variables were the mother’s and patient’s education levels (r = − 0.21, p = 0.0003, and r = − 0.20, p = 0.0005), respectively. Since the patient delay was correlated with the social quartile and resulted in a more advanced stage in non-seminoma, the lower social quartile resulted in higher mortality in non-seminoma patients (p = 0.005) but not in seminoma patients (p = 0.36) where the patient delay was not associated with a more advanced stage. Conclusions Based on our result, we conclude that to improve survival, we should promote testicular cancer awareness, especially among the most deprived populations, and their health care providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11720-w.
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Affiliation(s)
- Zsófia Küronya
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary.
| | - Georgina Fröhlich
- Faculty of Science, Eötvös Loránd University, Budapest, Hungary.,Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Andrea Ladányi
- Department of Surgical and Molecular Pathology, National Institute of Oncology, Budapest, Hungary
| | - Tamás Martin
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Lajos Géczi
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Fruzsina Gyergyai
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Orsolya Horváth
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Gergő Kiszner
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Ágnes Kovács
- Boehringer Ingelheim RCV GmbH & Co. KG Branch Office Budapest, Budapest, Hungary
| | - Tamás Dienes
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Enikő Lénárt
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Krisztián Nagyiványi
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Tibor Szarvas
- Department of Urology, Semmelweis University Budapest, Budapest, Hungary
| | - Mihály Szőnyi
- Semmelweis University Faculty of Medicine, Budapest, Hungary
| | | | - Krisztina Biró
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
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Li B, Xia L, Yang J, Wen M, Yu M, Mou E, Liu S, Li H, Wang H. Enhancing social support and knowledge perception decreases patient delay in breast cancer. Gland Surg 2021; 10:2220-2231. [PMID: 34422593 PMCID: PMC8340337 DOI: 10.21037/gs-21-227] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patient delay commonly appears in breast cancer (BC), but the findings for influential factors may be contaminated by recall bias. The real factors in patient delay (divided into appraisal delay and utilization delay) for women with BC urgently need to be objectively analyzed for preventing the progression of this disease. METHODS Women meeting strict inclusion and exclusion criteria were asked to fill in a questionnaire, which included three sections of sociodemographic characteristics, medical history, and knowledge of BC. Later on, the outcomes were processed according to the verification of BC by pathological diagnosis. Then, multiple linear regression was conducted to analyze the potential factors of the delay and to explore their relations between these factors and BC. RESULTS Appraisal delay is the leading component of patient delay. Appraisal delay's time distribution of a higher percentage at delay time 0-29 and >360 days, while other delay time occupies lower percentage, which is highly consistent with that of patient delay, while utilization delay mainly occurs in the 0-29 days period. Concerning the influential factors for the different phases of delay, age (P=0.051, P=0.035 separately in appraisal and patient delay), residential address (P=0.036, P=0.010) and symptom disclosure to others (P=0.015, P=0.015) led to a decrease of appraisal and patient delay. However, reasons for first medical consultation (P=0.033, P=0.006) and knowledge of BC (P=0.027, P=0.002) would accelerate appraisal and patient delay. Many factors related to hospitals, such as hospital category for first medical consultation (P=0.030) and examinations for first medical consultation (P=0.055) would reduce utilization delay. CONCLUSIONS Obstacles in medical consultation for younger women should be removed, and early interventions are needed to avoid progression of BC.
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Affiliation(s)
- Baisen Li
- Department of Radiotherapy Center, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Xia
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Yang
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Wen
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Miao Yu
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Exian Mou
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shiwei Liu
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hui Li
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Wang
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Matarredona-Quiles S, Martínez Ruíz de Apodaca P, Serrano Badía E, Ortega Beltrá N, Dalmau-Galofre J. Factors associated with diagnosis delay in head and neck cancer. Acta Otorrinolaringol Esp (Engl Ed) 2021; 73:S0001-6519(20)30195-3. [PMID: 33714451 DOI: 10.1016/j.otorri.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/27/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVES Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages. METHODS Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated. RESULTS Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p=.008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days. CONCLUSIONS Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays.
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Affiliation(s)
| | | | - Ester Serrano Badía
- Servicio de Otorrinolaringología, Hospital Francesc de Borja, Gandía, Valencia, España
| | - Noelia Ortega Beltrá
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, España
| | - José Dalmau-Galofre
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, España
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Sebastian NM, Haveri SP, Nath AS. Delay in diagnosis of tuberculosis and related factors from a district in Kerala, India. Indian J Tuberc 2021; 68:59-64. [PMID: 33641852 DOI: 10.1016/j.ijtb.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/01/2019] [Accepted: 09/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early diagnosis and treatment of tuberculosis is of vital importance both to cure patients and to reduce transmission for effective control of tuberculosis, It is important to know whether tuberculosis is diagnosed in time and also what causes delay if any. OBJECTIVES The study was conducted with the objective of knowing the time taken to diagnose tuberculosis from the onset of symptoms and to identify the causes for delay if any. METHODS A study was conducted in the District of Malapppuram Kerala, South India among newly diagnosed smear positive tuberculosis patients. 489 patients were interviewed soon after diagnosis and their socio-demographic characteristics and details from onset of symptoms to diagnosis were collected using a structured format. RESULTS The mean time taken by the patient for consultation after onset was 36 days and the mean time for diagnosis was 42 days and total time until diagnosis was 78 days. 72.8% patients consult within 6 weeks of onset and 74.7% are diagnosed within 6 weeks of consultation. The delay for diagnosis was more with private institutions. Diagnosis took less time when government facilities are consulted and when cough was a prominent symptom. Socio demographic factors are seen not affecting the time. CONCLUSIONS There is delay in diagnosing tuberculosis especially with private health providers and more efforts are required to reduce the same.
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Affiliation(s)
- N M Sebastian
- Community Medicine, MES Medical College, Perinthalmanna, Kerala, India.
| | - Sheela P Haveri
- Community Medicine, MES Medical College, Perinthalmanna, Kerala, India
| | - Arya S Nath
- Biostatistics, Community Medicine, MES Medical College, Perinthalmanna, Kerala, India
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Caltabellotta T, Magne J, Salerno B, Pradel V, Petitcolin PB, Auzemery G, Virot P, Aboyans V. Characteristics associated with patient delay during the management of ST-segment elevated myocardial infarction, and the influence of awareness campaigns. Arch Cardiovasc Dis 2020; 114:305-315. [PMID: 33272857 DOI: 10.1016/j.acvd.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/10/2020] [Revised: 07/03/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The delay between the occurrence of symptoms and the call seeking medical assistance is an important component of the pain-to-balloon delay in patients with ST-segment elevation myocardial infarction (STEMI). Factors affecting this "patient delay" have been poorly studied, and campaigns to raise emergency call awareness have barely been evaluated. AIMS To evaluate the factors related to patient delay, and the effects of public awareness campaigns undertaken in our region. METHODS Data from the regional registry of STEMI in Limousin, France, were analysed, and we performed a survey to assess medical history, clinical signs, context, socioeconomic situation and perception and behaviour of the patient. "Late callers" (i.e. third tertile,>154minutes) were compared with "early callers" (i.e. first and second tertiles,≤154minutes) using univariate and multivariable statistical methods. The influence of public awareness campaigns was studied by comparing the patient delays before and after a regional campaign. RESULTS Among 481 patients, the median patient delay was 87minutes. "Late callers" were older (odds ratio [OR] 1.02 per year, 95% confidence interval [CI] 1.00 to 1.03), more often had symptom onset between 00:00 and 05:59 a.m. (OR 1.86, 95% CI 1.10 to 3.12) and more often sought assistance from a general practitioner (OR 2.58, 95% CI 1.66 to 4.04) or attended the emergency room (OR 4.10, 95% CI 2.04 to 8.32). Sweats and considering the situation to be severe were factors associated with a reduced delay. After awareness campaigns, there was no change in patient delay, but the proportion of patients calling the Emergency Medical Services increased from 55% to 62% (P<0.001). CONCLUSIONS Patient delay is multifactorial. The impact of previous campaigns is mixed. Psychological and behavioural aspects are determinant, and should be taken into consideration to develop awareness messages that target specific groups.
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Affiliation(s)
- Thibaut Caltabellotta
- Department of Medicine, Monts-et-Barrages Hospital, 87400 Saint-Léonard de Noblat, France
| | - Julien Magne
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France
| | - Baptiste Salerno
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | - Valerie Pradel
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | | | - Gilles Auzemery
- Agence Régionale de Santé-Nouvelle-Aquitaine, 33000 Bordeaux, France
| | - Patrice Virot
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France.
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Lestari BW, McAllister S, Hadisoemarto PF, Afifah N, Jani ID, Murray M, van Crevel R, Hill PC, Alisjahbana B. Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia. Lancet Reg Health West Pac 2020; 5:100059. [PMID: 34327397 DOI: 10.1016/j.lanwpc.2020.100059] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 11/22/2022]
Abstract
Background Understanding patient pathways can help align patient preferences and tuberculosis (TB) related services. We investigated patient pathways, and diagnostic and treatment delays among TB patients in Indonesia, which has one of the highest proportions of non-notified TB cases globally. Methods We conducted a study of TB patients recruited from Community Health Centers (CHCs), public and private hospitals, and private practitioners from 2017 to 2019 in Bandung City, regarding general characteristics and symptoms, and health-seeking, diagnostic and treatment pathways. Findings We recruited 414 TB patients: 138 (33%) in CHCs, 210 (51%) in hospitals, 66 (20%) in private practitioners. Most patients (74·6%) first sought care at an informal or private provider and experienced a complex pathway visiting both public and private providers to obtain a diagnosis. The median number of health provider visits pre-diagnosis was 6 (IQR 4–8). From start of symptoms, it took a median 30 days (IQR 14–61) to present to a health provider, 62 days (IQR 35–113) to reach a TB diagnosis, and 65 days (IQR 37–119) to start treatment. Patient delay was longer among male, lowly-educated and uninsured individuals. There were longer diagnostic delays among uninsured individuals, those who initially visited private providers, and those with multiple visits prior to diagnosis. Longer treatment delays were found in those with multiple pre-diagnosis visits or diagnosed by private practitioners. Interpretation Patient pathways in Indonesia are complex, involving the public and private sector, with multiple visits and long delays, especially to diagnosis. A widely available accurate diagnostic test for TB could have a dramatic effect on reducing delays, onward transmission and mortality. Funding This project was funded by the Partnership for Enhanced Engagement in Research (PEER) grant under Prime Agreement Number AID-OAA-A-11–00,012 by National Academy of Sciences (NAS); the United States Agency for International Development (USAID); University of Otago, New Zealand, and the Indonesian Endowment Fund for Education (LPDP).
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Zhao Y, Xiong J, Hou Y, Zhu M, Lu Y, Xu Y, Teliewubai J, Liu W, Xu X, Li X, Liu Z, Peng W, Zhao X, Zhang Y, Xu Y. Early detection of ST-segment elevated myocardial infarction by artificial intelligence with 12-lead electrocardiogram. Int J Cardiol 2020; 317:223-30. [PMID: 32376417 DOI: 10.1016/j.ijcard.2020.04.089] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/30/2020] [Indexed: 11/23/2022]
Abstract
Patient delay is a worldwide unsolved problem in ST-segment elevated myocardial infarction (STEMI). An accurate warning system based on electrocardiogram (ECG) may be a solution for this problem, and artificial intelligence (AI) may offer a path to improve its accuracy and efficiency. In the present study, an AI-based STEMI autodiagnosis algorithm was developed using a dataset of 667 STEMI ECGs and 7571 control ECGs. The algorithm for detecting STEMI proposed in the present study achieved an area under the receiver operating curve (AUC) of 0.9954 (95% CI, 0.9885 to 1) with sensitivity (recall), specificity, accuracy, precision and F1 scores of 96.75%, 99.20%, 99.01%, 90.86% and 0.9372 respectively, in the external evaluation. In a comparative test with cardiologists, the algorithm had an AUC of 0.9740 (95% CI, 0.9419 to 1), and its sensitivity (recall), specificity, accuracy, precision, and F1 score were 90%, 98% and 94%, 97.82% and 0.9375 respectively, while the medical doctors had sensitivity (recall), specificity, accuracy, precision and F1 score of 71.73%, 89.33%, 80.53%, 87.05% and 0.8817 respectively. This study developed an AI-based, cardiologist-level algorithm for identifying STEMI.
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Datiko DG, Jerene D, Suarez P. Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study. BMC Public Health 2020; 20:1126. [PMID: 32680489 PMCID: PMC7368783 DOI: 10.1186/s12889-020-08967-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Received: 01/25/2019] [Accepted: 05/20/2020] [Indexed: 01/16/2023] Open
Abstract
Background Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia. Methods This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. Results Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10–45), 4 (2–10) and 2 (1–3) days respectively. The median (IQR) of total delay was 33 (19–67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay. Conclusion TB patients’ delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.
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Affiliation(s)
- Daniel G Datiko
- Challenge TB Ethiopia /Management Sciences for Health Ethiopia, box 1157, code 1250, Addis Ababa, Ethiopia.
| | - Degu Jerene
- Challenge TB Ethiopia /Management Sciences for Health Ethiopia, box 1157, code 1250, Addis Ababa, Ethiopia
| | - Pedro Suarez
- Management Sciences for Health, Senior Director Infectious Disease Cluster, Arlington, USA
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Edo-Izquierdo S, Martínez-Blanquet LJ, Rovira T. Hierarchy of the main factors predicting the decision to go to the doctor in a general population sample: A factorial survey design. Patient Educ Couns 2020; 103:1407-1414. [PMID: 32044189 DOI: 10.1016/j.pec.2020.02.004] [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] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To obtain a hierarchy of the main factors that predict the decision to go to the doctor when symptoms are not yet linked to a specific disease. METHOD 64 representative vignettes, combinations of nine factors, were presented to 168 adults between 28-60 years of age. RESULTS Multilevel multiple regression models were used to rank the main factors predicting urgency to see a doctor in order of importance: the interference of symptoms in daily activities (B = -1.29; p < .001), fear (B = -0.96; p < .001), pain (B = -0.90; p < .001), access to medical care (B = -0.64; p < .001) and confidence in the doctor (B = -0.27; <.05). Moreover, gender (B = 0.56; p < .05) and educational level (B =-0.31; p < .05) explained part of the interindividual variation in the daily symptoms' interference. CONCLUSION When a specific disease has not yet been diagnosed, daily symptoms' interference is the factor that most strongly increases the urgency to visit a doctor, especially among men and among people with a higher level of education. PRACTICE IMPLICATIONS To reduce delay, generic health prevention campaigns should place more emphasis on possible interference in daily activities than on the meaning of symptoms for health.
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Affiliation(s)
| | | | - Tatiana Rovira
- Department of Basic Psychology, Autonomous University of Barcelona, Spain.
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Nieminen M, Atula T, Bäck L, Mäkitie A, Jouhi L, Aro K. Factors influencing patient and health care delays in Oropharyngeal Cancer. J Otolaryngol Head Neck Surg 2020; 49:22. [PMID: 32326977 PMCID: PMC7181590 DOI: 10.1186/s40463-020-00413-w] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing. Patients with HPV-associated and HPV-unassociated OPSCC differ in many aspects, which may also impact their diagnostic and management timelines. This study aims at studying the patient, primary health care (PHC) and specialist-care (SC) delays and possible differences between these two patient groups in seeking medical care. METHODS We reviewed all new patients with OPSCC treated between 2016 and 2018 at our institute, which covers a referral area of 1.6 million people. We collected data on patients' symptoms and factors influencing why they sought medical care using a patient-reported questionnaire and hospital records. We compared delays based on patient and tumor characteristics. RESULTS In our study population of 83 patients, the median patient delay was 30 days (range, 0-366), with a median PHC delay of 15 days (range, 0 days-2.5 years), and a median SC delay of 54 days (range, 12-231). The SC delay was further divided into diagnostic hospital delay and treatment delay, each with a median length of 16 days (range, 0-237) and 29 days (range, 0-73), respectively. Furthermore, we found that p16 status did not associate with delays. A longer patient delay associated with specific tumor factors, such as a larger primary tumor and a lower UICC 7th edition stage. Patients that had multiple visits or did not have a follow-up visit scheduled at the initial appointment had longer PHC delays. Treatment delay was significantly longer for patients scheduled for (chemo-)radiotherapy than for those undergoing surgery with or without (chemo-)radiotherapy. CONCLUSIONS Although delays remained short for the majority of OPSCC patients, long delays require further evaluation and improvement of management. Awareness of presenting symptoms among cancer risk patients and prompt referral practice or a follow-up visit at PHC represent key factors to shortening these delays. Ultimately, the causes for delays in SC appear multifactorial and require institutional quality control.
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Affiliation(s)
- Markus Nieminen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland.
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland
| | - Leif Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland.,Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland
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Chen JO, Qiu YB, Rueda ZV, Hou JL, Lu KY, Chen LP, Su WW, Huang L, Zhao F, Li T, Xu L. Role of community-based active case finding in screening tuberculosis in Yunnan province of China. Infect Dis Poverty 2019; 8:92. [PMID: 31661031 PMCID: PMC6819334 DOI: 10.1186/s40249-019-0602-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 01/23/2019] [Accepted: 10/09/2019] [Indexed: 02/02/2023] Open
Abstract
Background The barriers to access diagnosis and receive treatment, in addition to insufficient case identification and reporting, lead to tuberculosis (TB) spreads in communities, especially among hard-to-reach populations. This study evaluated a community-based active case finding (ACF) strategy for the detection of tuberculosis cases among high-risk groups and general population in China between 2013 and 2015. Methods This retrospective cohort study conducted an ACF in ten communities of Dongchuan County, located in northeast Yunnan Province between 2013 and 2015; and compared to 136 communities that had passive case finding (PCF). The algorithm for ACF was: 1) screen for TB symptoms among community enrolled residents by home visits, 2) those with positive symptoms along with defined high-risk groups underwent chest X-ray (CXR), followed by sputum microscopy confirmation. TB incidence proportion and the number needed to screen (NNS) to detect one case were calculated to evaluate the ACF strategy compared to PCF, chi-square test was applied to compare the incidence proportion of TB cases’ demography and the characteristics for detected cases under different strategies. Thereafter, the incidence rate ratio (IRR) and multiple Fisher’s exact test were applied to compare the incidence proportion between general population and high-risk groups. Patient and diagnostic delays for ACF and PCF were compared by Wilcoxon rank sum test. Results A total of 97 521 enrolled residents were visited with the ACF cumulatively, 12.3% were defined as high-risk groups or had TB symptoms. Sixty-six new TB patients were detected by ACF. There was no significant difference between the cumulative TB incidence proportion for ACF (67.7/100000 population) and the prevalence for PCF (62.6/100000 population) during 2013 to 2015, though the incidence proportion in ACF communities decreased after three rounds active screening, concurrent with the remained stable prevalence in PCF communities. The cumulative NNS were 34, 39 and 29 in HIV/AIDS infected individuals, people with positive TB symptoms and history of previous TB, respectively, compared to 1478 in the general population. The median patient delay under ACF was 1 day (Interquartile range, IQR: 0–27) compared to PCF with 30 days (IQR: 14–61). Conclusions This study confirmed that massive ACF was not effective in general population in a moderate TB prevalence setting. The priority should be the definition and targeting of high-risk groups in the community before the screening process is launched. The shorter time interval of ACF between TB symptoms onset and linkage to healthcare service may decrease the risk of TB community transmission. Furthermore, integrated ACF strategy in the National Project of Basic Public Health Service may have long term public health impact.
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Affiliation(s)
- Jin-Ou Chen
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yu-Bing Qiu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | | | - Jing-Long Hou
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Kun-Yun Lu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Liu-Ping Chen
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Wei-Wei Su
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Li Huang
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Fei Zhao
- Clinical trail and research center of Beijing hospital, Beijing, China
| | - Tao Li
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Xu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China.
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Wang XJ, Fu Q, Zhang ZB, Lu ZQ, Tian D, Nan J, Wang JJ, Li YH. [Delay on care-seeking and related influencing factors among tuberculosis patients in Wuhan, 2008-2017]. Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40:643-647. [PMID: 31238612 DOI: 10.3760/cma.j.issn.0254-6450.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the epidemiological characteristics, trend and related factors of tuberculosis patients that delayed for care, in Wuhan from 2008 to 2017. Methods: Data regarding tuberculosis (TB) patients was collected from the tuberculosis management information system (TMIS), a part of the China information system for disease control and prevention from 2008 to 2017. A total of 64 208 tuberculosis patients, aged 0 to 95 years were included for the analysis. Unconditional logistic regression method was used to estimate those factors that associated with this study. Results: Days of delay among TB patients appeared as M=10 (P(25)-P(75): 3-28) day, in Wuhan, 2008-2017. The prevalence of the delay was 52.5% (33 703/64 208), presenting a downward trend from 2008 to 2017 (trend χ(2)=10.64, P<0.001), but the proportions of women and ≥65 year-olds were gradually increasing. Results from the multivariate logistic regression analysis showed that factors as: patients living far away from the city vs. near the city (OR=1.29, 95%CI: 1.25-1.35), and age above 45 years vs. younger than 25 years (the age 45-64 years group vs. aged less than 25 years group, OR=1.22, 95%CI: 1.15-1.29; the age 65 or above group vs. aged less than 25 years group, the OR=1.30, 95%CI: 1.22-1.39) were under higher risk on the delay of seeking care. Occupation, way of case-finding and classification of tuberculosis patients also appeared as influencing factors on this issue. Conclusions: Prevalence on the delay of care was 52.5% among tuberculosis patients in Wuhan, 2008-2017, but with an annual decrease. Attention should be paid to female, wrinkly or elderly tuberculosis patients regarding the delay of care on TB, in Wuhan.
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Affiliation(s)
- X J Wang
- Tuberculosis Control and Management Office, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan 430030, China
| | - Q Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Z B Zhang
- Tuberculosis Control and Management Office, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan 430030, China
| | - Z Q Lu
- Tuberculosis Control and Management Office, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan 430030, China
| | - D Tian
- Tuberculosis Control and Management Office, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan 430030, China
| | - J Nan
- Tuberculosis Control and Management Office, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan 430030, China
| | - J J Wang
- Tuberculosis Control and Management Office, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan 430030, China
| | - Y H Li
- Tuberculosis Control and Management Office, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan 430030, China
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Dolmans LS, Hoes AW, Bartelink MLEL, Kappelle LJ, Rutten FH. Determinants of Patient Delay in Transient Ischemic Attack. Eur Neurol 2019; 81:139-144. [PMID: 31212275 DOI: 10.1159/000501077] [Citation(s) in RCA: 2] [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: 04/05/2019] [Accepted: 05/19/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Early diagnosis and stroke preventive treatment in patients with transient ischemic attack (TIA) are crucial, but hampered by delayed reporting of symptoms. Previous studies on causes of patient delay provided inconsistent results. We aimed to assess determinants of patient delay among patients with symptoms suggestive of TIA. METHODS We interviewed participants referred by their general practitioner to an outpatient TIA clinic within 72 h from symptom onset. We determined (i) the exact time from symptom onset to the first contact with a medical service (patient delay); (ii) demographic and clinical characteristics; (iii) patient's initial perception, and reaction to symptoms; and (iv) patient's knowledge about TIA. We used multivariable linear regression to identify determinants of patient delay. RESULTS We interviewed 202 suspected TIA patients (mean age 67.7 (SD 13.7) years, 111 (55.0%) male), of whom 123 (60.9%) received a definite diagnosis of TIA or minor stroke. Median patient delay was 1.5 (interquartile range 0.4-14.6) hours. Of all patients, 119 (58.9%) considered a TIA (or stroke) as the cause of their symptoms. Among them, 30 (25.2%) thought it was a medical emergency, while of the 83 not considering TIA as the cause of symptoms 38 (45.8%) thought of a medical emergency. Independently related to increased delay were (i) symptom onset out of hours, (ii) absence of dysarthria, (iii) being unaware that TIA requires urgent treatment, (iv) not considering the event an emergency, and (v) knowledge of TIA symptoms. Results for patients with a definite diagnosis of TIA/minor stroke were similar to those with alternative diagnoses. CONCLUSION Patients still tend to wait till office hours to report TIA symptoms. Speech difficulties, and specifically dysarthria, are related to shorter delay. To reduce patient delay, awareness of TIA symptoms should increase and more importantly lay people should be educated to consider a TIA an emergency.
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Affiliation(s)
- L Servaas Dolmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marie-Louise E L Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Asres A, Jerene D, Deressa W. Delays to anti-tuberculosis treatment intiation among cases on directly observed treatment short course in districts of southwestern Ethiopia: a cross sectional study. BMC Infect Dis 2019; 19:481. [PMID: 31142288 PMCID: PMC6542087 DOI: 10.1186/s12879-019-4089-x] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delayed tuberculosis (TB) diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. This study assessed patient and provider related delays to diagnosis and treatment of TB. METHODS A cross-sectional study was conducted among 735 new adult TB cases registered between January to December 2015 in 10 woredas equivalent to districts of southwestern Ethiopia. Data were collected through face-to-face interview of patients within the first 2 months of treatment initiation. Delay in days was tracked at three intervals: between onset of symptoms and self-presentation (Patient delay), Self-presentation to treatment initiation (Provider delay) and total delay. Days elapsed beyond median were used to define the delays. Bivariate and multiple logistic regression models were fit to identify predictors of delays and statistical significance was judged at p < 0.05. RESULT The median (inter-quartile range) of patient, provider and total delays were 25 (IQR;15-36), 22 (IQR:9-48) and 55 (IQR:32-100) days, respectively. More than half (54.6%) of the total delay was attributed to health system. Prior self-treatment [adjusted Odds Ratio (aOR)]: 1.72, 95% confidence interval [CI]:1.07-2.75), HIV co-infection (aOR:1.8, 95% CI: 1.05-3.10) and extra-pulmonary TB (aOR: 1.54,95% CI:1.03-2.29) were independently associated with increased odds of patient delay. On the other hand initial presentation to health posts or private clinics (aOR: 1.42, 95% CI: 1.01, 2.0) and patient delay (aOR: 1.81, 95% CI: 1.33-2.50) significantly predicted longer provider delay. Finally, having extra pulmonary TB (aOR: 1.6, 95% CI: 1.07-2.38), prior consultation of traditional healer (aOR: 3.72, 95% CI: 1.01-13.77) and use of holy water (aOR: 2.73, 95% CI: 1.11, 6.70) independently predicted longer total delay. CONCLUSION Tuberculosis patients waited too long time to initiate anti-TB treatment reflecting longer periods of morbidity and disease transmission. The delays are attributed to the patient, disease and health system related factors. Hence, improving community awareness, involving informal providers, health extension workers and TB treatment supporters can reduce the patient delay. Similarly, cough screening and improving diagnostic efficiencies of healthcare facilities should be in place to reduce the provider delays.
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Affiliation(s)
- Abyot Asres
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia. .,Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Degu Jerene
- Management Science for Health, Addis Ababa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Fu R, Li SD, Song CX, Yang JA, Xu HY, Gao XJ, Xu Y, Zeng JP, Li JN, Dou KF, Yang YJ. Clinical significance of diabetes on symptom and patient delay among patients with acute myocardial infarction-an analysis from China Acute Myocardial Infarction (CAMI) registry. J Geriatr Cardiol 2019; 16:395-400. [PMID: 31217792 DOI: 10.11909/j.issn.1671-5411.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Diabetes is frequently associated with poor prognosis among acute myocardial infarction (AMI) patients. Patients with these comorbidities often have atypical symptoms and subsequent delay in treatment. Few studies have reported detailed AMI symptoms in patients with diabetes. This study compared AMI symptoms and presentation characteristics between diabetics and non-diabetics. METHODS We included patients from the China AMI registry diagnosed with AMI between January 2013 and September 2014. Baseline characteristics, symptomology, and delay in treatment were compared between diabetics and non-diabetics. Multivariable logistic regression analysis was used to explore independent predictors of atypical symptoms. RESULTS A total of 4450 (20.2%) patients had diabetes. They were older, more often women, higher in body mass index, and more likely to have non-ST segment elevation myocardial infarction. Fewer diabetic patients presented with persistent precordial chest pain (63.1% vs. 68%, P < 0.0001), diaphoresis (60.1% vs. 65.6%, P < 0.0001), fatigue (16.7% vs. 18.3%, P = 0.0123), and incontinence (0.4% vs. 0.7%, P = 0.0093). Time to hospital presentation was longer among patients with diabetes than those without. In multivariable analysis, diabetes was identified as an independent predictor of atypical symptoms (OR: 1.112, 95% CI: 1.034-1.196). CONCLUSIONS Our study is the first large-scale study providing evidence that diabetics are less likely to present with typical chest pain and more likely to experience treatment delay when suffering from an AMI. Our results may increase clinician awareness of recognizing AMI patients rapidly to reduce diagnosis and treatment delay, particularly in the context of diabetes.
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Ahmed AE. Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems. J Infect Public Health 2019; 12:767-771. [PMID: 31006635 PMCID: PMC7102677 DOI: 10.1016/j.jiph.2019.04.002] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/25/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although Middle East respiratory syndrome coronavirus (MERS-CoV) diagnostic delays remain a major challenge in health systems, the source of delays has not been recognized in the literature. The aim of this study is to quantify patient and health-system delays and to identify their associated factors. METHODS The study of 266 patients was based on public source data from the World Health Organization (WHO) (January 2, 2017-May 16, 2018). The diagnostic delays, patient delays, and health-system delays were calculated and modelled using a Poisson regression analysis. RESULTS In 266 MERS-CoV patients reported during the study period, the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile [IQR] range: 3-8 days), 4 days (IQR range: 2-7 days), and 2 days (IQR range: 1-2 days), respectively. Both patient delay (r = 0.894, P = 0.001) and health-system delay (r = 0.163, P = 0.025) were positively correlated with diagnostic delay. Older age was associated with longer health-system delay (adjusted relative ratios (aRR), 1.011; 95% confidence intervals (CI), 1.004-1.017). Diagnostic delay (aRR, 1.137; 95% CI, 1.006-1.285) and health-system delays (aRR, 1.217; 95% CI, 1.003-1.476) were significantly longer in patients who died. CONCLUSION Delays in MERS-CoV diagnosis exist and may be attributable to patient delay and health-system delay as both were significantly correlated with longer diagnosis delay. Early MERS-CoV diagnosis may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system.
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Affiliation(s)
- Anwar E Ahmed
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
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Rathi P, Shringarpure K, Unnikrishnan B, Pandey A, Nair A. Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center. F1000Res 2019; 8:498. [PMID: 34035900 PMCID: PMC8112457 DOI: 10.12688/f1000research.17743.1] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/19/2023] Open
Abstract
Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 - April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however those visited public HCF diagnosed earlier as compared to others. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.
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Affiliation(s)
- Priya Rathi
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kalpita Shringarpure
- Department of Preventive and Social Medicine, Medical College Baroda, Baroda, Gujarat, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abhinav Pandey
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abhirami Nair
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Mhalu G, Weiss MG, Hella J, Mhimbira F, Mahongo E, Schindler C, Reither K, Fenner L, Zemp E, Merten S. Explaining patient delay in healthcare seeking and loss to diagnostic follow-up among patients with presumptive tuberculosis in Tanzania: a mixed-methods study. BMC Health Serv Res 2019; 19:217. [PMID: 30953502 PMCID: PMC6451234 DOI: 10.1186/s12913-019-4030-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/06/2018] [Accepted: 03/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania. METHODS In a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU. RESULTS Among 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08-7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16-0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98-2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62-8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01-2.17). CONCLUSION Delay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women's health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.
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Affiliation(s)
- Grace Mhalu
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mitchell G. Weiss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jerry Hella
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Francis Mhimbira
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Enos Mahongo
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Li YL, Qin YC, Tang LY, Liao YH, Zhang W, Xie XM, Liu Q, Lin Y, Ren ZF. Patient and Care Delays of Breast Cancer in China. Cancer Res Treat 2018; 51:1098-1106. [PMID: 30428639 PMCID: PMC6639234 DOI: 10.4143/crt.2018.386] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose This study differentiates patient and care delays of breast cancer and explores the related factors as well as the associations with the prognosis in Guangzhou, a southern city of China. Methods A cohort of female incident breast cancer patients (n=1,551) was recruited from October 2008 to March 2012 and followed up until January 1, 2016 (n=1,374) in the affiliated hospitals of Sun Yat-sen University. The factors associated with patient and care delays were analyzed with multivariable logistic models. Cox proportional hazards regression models were constructed to estimate the impacts of the delays on the prognosis. Results There were 40.4% patient delay (≥3 months) and 15.5% care delay (≥1 month). The patient delay, but not the care delay, was significantly related to the clinical stage and consequently worsened the prognosis of breast cancer (hazard ratio, 1.45; 95% confidence interval, 1.09 to 1.91 for progression-free survival). The factors related to an increased patient delay included premenopausal status, history of benign breast disease, and less physical examination. Conclusion Patient delay was the main type of delay in Guangzhou and resulted in higher clinical stage and poor prognosis of breast cancer. Screening for breast cancer among premenopausal women may be an effective way to reduce this delay.
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Affiliation(s)
- Yue-Lin Li
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ya-Chao Qin
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lu-Ying Tang
- Department of Pathology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Huang Liao
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wei Zhang
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiang Liu
- Breast Tumor Center, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Lin
- Department of Breast and Thyroid Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze-Fang Ren
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Li T, Zhang H, Shewade HD, Soe KT, Wang L, Du X. Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China. BMC Health Serv Res 2018; 18:786. [PMID: 30340489 PMCID: PMC6194607 DOI: 10.1186/s12913-018-3583-y] [Citation(s) in RCA: 12] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 09/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background Early diagnosis and treatment is vital for effective tuberculosis (TB) management especially among migrant populations who are a vulnerable group. We aimed to study factors associated with delay before registration at country level among registered migrant TB patients in China (2014–15) who were transferred out (during treatment) through web-based TB information management system (TBIMS). Methods This was a cross sectional study involving review of TBIMS data. Delays (in days) were classified as follows: patient delay (from symptom onset to first doctor visit), health system delay (from first doctor visit to treatment initiation, divided into health system diagnosis and treatment delay before and after date of diagnosis respectively), diagnosis delay (from symptom onset to diagnosis) and total delay (from symptom onset to treatment initiation). Linear regression was used to build a predictive model (forward stepwise) for the socio-demographic, clinical and health system related factors associated with delay: one model for each type of delay. Delays were log transformed and included in the model. Results The median (IQR) patient delay, health system delay and total delay was 16 (6, 34), two (0, 6) and 22 (11, 41) days respectively. Factors associated with long patient, diagnosis and total delay were: female gender, age ≥ 65 years, sputum smear positive pulmonary TB and registration at referral hospital. Treatment initiation delay was significantly higher among those registered in referral hospitals, unemployed and previously treated. Among migrant patients having permanent residence out of province, health system diagnosis delay was significantly higher while treatment initiation delay after diagnosis was significantly lower when compared to patients having permanent residence within the prefecture. Conclusion Among migrant population with TB, patient delay contributed to the total delay. The factors identified including the need for improved coordination between referral hospitals and national programme have to be addressed if China has to end TB. Electronic supplementary material The online version of this article (10.1186/s12913-018-3583-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Li
- National Center for Tuberculosis Control and Prevention, China CDC, No. 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, China CDC, No. 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asian Office, Delhi, India
| | - Kyaw Thu Soe
- Department of Medical Research (PyinOoLwin Branch), Ministry of Health and Sports, PyinOoLwin, Myanmar
| | - Lixia Wang
- National Center for Tuberculosis Control and Prevention, China CDC, No. 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Xin Du
- National Center for Tuberculosis Control and Prevention, China CDC, No. 155 Changbai Road, Changping District, Beijing, 102206, China.
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Dolmans LS, Hoes AW, Bartelink MLEL, Koenen NCT, Kappelle LJ, Rutten FH. Patient delay in TIA: a systematic review. J Neurol 2018; 266:1051-1058. [PMID: 30027321 PMCID: PMC6469675 DOI: 10.1007/s00415-018-8977-6] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/27/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
Background Patients who suffer a transient ischemic attack (TIA) have a high short-term risk of developing ischemic stroke, notably within the first 48 h. Timely diagnosis and urgent preventive treatment substantially reduce this risk. We conducted a systemic review to quantify patient delay in patients with (suspected) TIA, and assess determinants related to such delay. Methods A systematic review using MEDLINE and EMBASE databases up to March 2017 to identify studies reporting the time from onset of TIA symptoms to seeking medical help. Results We identified nine studies providing data on patient delay, published between 2006 and 2016, with 7/9 studies originating from the United Kingdom (UK). In total 1103 time-defined TIA patients (no remaining symptoms > 24 h), and 896 patients with a minor stroke (i.e., mild remaining symptoms > 24 h) were included (49.1% men, mean age 72.2 years). Patient’s delay of more than 24 h was reported in 33.1–44.4% of TIA patients, with comparable proportions for minor stroke patients. Delays were on average shorter in patients interviewed at the emergency department than among patients seen at TIA outpatient clinics. Univariably associated with a shorter delay were (1) a longer duration of symptoms, (2) motor symptoms, (3) a higher ABCD2 score, and (4) correct patient’s recognition as possible ischemic cerebrovascular event. Conclusions More than a third of patients experiencing a TIA delays medical attention for more than a day, thus critically extending the initiation of stroke preventive treatment. There still seems to be insufficient awareness among lay people that symptoms suggestive of TIA should be considered as an emergency. Additional data and multivariable analyses are needed to define main determinants of patient delay.
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Affiliation(s)
- L Servaas Dolmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marie-Louise E L Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niels C T Koenen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Wackers KJWM, Wassen MMLH, Zeegers B, Budé L, Nieuwenhuijze MJ. Effect of the use of a national information brochure about fetal movements on patient delay. Women Birth 2018; 32:131-136. [PMID: 30007853 DOI: 10.1016/j.wombi.2018.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/15/2018] [Revised: 05/25/2018] [Accepted: 06/26/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perinatal audits in the Netherlands showed that stillbirth was nearly always preceded by a period of reduced fetal movements. Patient or caregiver delay was identified as a substandard care factor. AIM To determine whether the use of a new information brochure for pregnant women on fetal movements results in less patient delay in contacting their maternity caregiver. METHODS A pre- and post-survey cohort study in the Netherlands, including 140 women in maternity care with a singleton pregnancy, expecting their first child. All participating women filled out a baseline questionnaire, Cambridge Worry Scale and pre-test questionnaire at the gestational age of 22-24 weeks. Subsequently, the intervention group received a newly developed information brochure on fetal movements. At a gestational age of 28 weeks, all women received the post-test questionnaire. Multiple regression analyses were used. FINDINGS Per-protocol analysis showed less patient delay in the intervention group compared to the control group (Odds Ratio 0.43; 95% Confidence Interval 0.17-0.86, p=0.02). A significant linear relation was observed between reading the information brochure and an increase of knowledge about fetal movements (B=1.2, 95% Confidence Interval 1.0-1.4, p<0.001). Maternal concerns did not affect patient delay to report reduced fetal movements. CONCLUSION Use of an information brochure regarding fetal movements has the potential to reduce patient delay and increase knowledge about reduced fetal movements. A national survey to determine the effect of an information brochure about reduced fetal movements on patient delay and stillbirth rates is needed.
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Affiliation(s)
- Karin J W M Wackers
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
| | - Martine M L H Wassen
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Bert Zeegers
- Research Centre for Midwifery Science, Maastricht, Zuyd University, P.O. Box 1256, 6201 BG Maastricht, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
| | - Luc Budé
- Research Centre for Midwifery Science, Maastricht, Zuyd University, P.O. Box 1256, 6201 BG Maastricht, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
| | - Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science, Maastricht, Zuyd University, P.O. Box 1256, 6201 BG Maastricht, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
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Fuge TG, Bawore SG, Solomon DW, Hegana TY. Patient delay in seeking tuberculosis diagnosis and associated factors in Hadiya Zone, Southern Ethiopia. BMC Res Notes 2018; 11:115. [PMID: 29426370 PMCID: PMC5809113 DOI: 10.1186/s13104-018-3215-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/19/2017] [Accepted: 01/31/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To assess patient delay in seeking tuberculosis diagnosis and associated factors in Hadiya Zone, Southern Ethiopia. Results The median patient delay in tuberculosis diagnosis in Hadiya Zone was found to be 30 days. Socioeconomic and perception related factors were identified as independent predictors for tuberculosis diagnosis delay. Socioeconomic characteristics like urban residence [OR 2.36; CI 1.64–3.40], religious views [OR 1.24; CI 1.73–7.0], low monthly income [OR 3.38; CI 2.01–5.66] were statistically significantly associated with patient delay in tuberculosis diagnosis. On the other hand, attitudinal determinants such as misconception about the time of TB treatment to be cured and lack of comfort with directly observed treatment short course service [OR 1.54; CI 1.02–2.30] were identified as independent predictors of patient delay in tuberculosis diagnosis. Thus, there is a need for more robust information dissemination strategy to ultimately change people’s views that tuberculosis can only be cured when diagnosed and treated promptly.
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Affiliation(s)
- Terefe Gone Fuge
- Department of Medical Laboratory Sciences, Hosanna College of Health Sciences, P.O. BOX 159, Hosanna, Ethiopia.
| | - Solomon Gebre Bawore
- Department of Medical Laboratory Sciences, Hosanna College of Health Sciences, P.O. BOX 159, Hosanna, Ethiopia
| | - Deneke Wolde Solomon
- Department of Medical Laboratory Sciences, Hosanna College of Health Sciences, P.O. BOX 159, Hosanna, Ethiopia
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Ebrahimi Kalan M, Yekrang Sis H, Kelkar V, Harrison SH, Goins GD, Asghari Jafarabadi M, Han J. The identification of risk factors associated with patient and healthcare system delays in the treatment of tuberculosis in Tabriz, Iran. BMC Public Health 2018; 18:174. [PMID: 29361918 PMCID: PMC5781292 DOI: 10.1186/s12889-018-5066-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/17/2017] [Accepted: 01/11/2018] [Indexed: 11/11/2022] Open
Abstract
Background Tuberculosis (TB) is a serious health concern, particularly in developing countries. Various delays, such as patient delay (PD) and healthcare system delay (HSD) in the TB process, are exacerbating the disease burden and increasing the rates of transmission and mortality in various global communities. Therefore, the aim of this study is to identify risk factors associated with PD and HSD in TB patients in Tabriz, Iran. Methods A cross-sectional study was conducted on 173 TB patients in Tabriz, Iran from 2012 to 2014. Patients were interviewed with a semi-structured questionnaire. Frequencies and percentages were reported for patient categories of sex, age, and education. The median and interquartile range (IQR) were reported for the time intervals of delays. Univariate and multivariate logistic regressions of delay in respect to socio-demographic and clinical variables were performed. Statistical significance was set at p < 0.05. Results The median values for delays were 53 days for HSD (IQR = 73) and 13 days for PD (IQR = 57). Odds ratios (OR) associated with PD were: employed vs. unemployed (OR = 5.86, 95% CI: 1.59 to 21.64); public hospitals vs. private hospitals (OR = 2.64, 95% CI: 1.01 to 6.85); ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 2.35, 95% CI: 1.08 to 5.11); and male vs. female (OR = 2.28, 95% CI: 1.29 to 4.39). The OR associated with HSD were: ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 9.44, 95% CI: 4.50 to 19.82), without vs. with access to TB diagnostic services (OR = 3.56, 95% CI: 1.85 to 6.83), and misdiagnosis as cold or viral infection vs. not (OR = 2.62, 95% CI: 1.40 to 4.91). Conclusions The results provide for an important understanding of the risk factors associated with PD and HSD. One of the major recommendations is to provide more TB diagnostic knowledge and tools to primary health providers and correct diagnoses for patients during their initial visit to the health care facilities. The knowledge generated from this study will be helpful for prioritizing and developing strategies for minimizing delays, initiating early treatment to TB patients, and improving TB-related training programs and healthcare systems in Tabriz, Iran.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Biology, North Carolina Agricultural and Technical State University, Greensboro, NC, 27411, USA
| | - Hassan Yekrang Sis
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences and Health Services, Tabriz, East Azerbaijan, Iran
| | - Vinaya Kelkar
- Department of Biology, North Carolina Agricultural and Technical State University, Greensboro, NC, 27411, USA
| | - Scott H Harrison
- Department of Biology, North Carolina Agricultural and Technical State University, Greensboro, NC, 27411, USA
| | - Gregory D Goins
- Department of Biology, North Carolina Agricultural and Technical State University, Greensboro, NC, 27411, USA
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences and Health Services, Tabriz, East Azerbaijan, Iran.,Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences and Health Services, Tabriz, East Azerbaijan, Iran
| | - Jian Han
- Department of Biology, North Carolina Agricultural and Technical State University, Greensboro, NC, 27411, USA.
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Getnet F, Demissie M, Assefa N, Mengistie B, Worku A. Delay in diagnosis of pulmonary tuberculosis in low-and middle-income settings: systematic review and meta-analysis. BMC Pulm Med 2017; 17:202. [PMID: 29237451 PMCID: PMC5729407 DOI: 10.1186/s12890-017-0551-y] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [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: 08/10/2017] [Accepted: 11/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Assessment of delays in seeking care and diagnosis of tuberculosis is essential to evaluate effectiveness of tuberculosis control programs, and identify programmatic impediments. Thus, this review of studies aimed to examine the extent of patient, health system, and total delays in diagnosis of pulmonary tuberculosis in low- and middle- income countries. Methods It was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic databases were searched to retrieve studies published from 2007 to 2015 including Pubmed central, Springer link, Hinari and Google scholar. Searching terms were pulmonary tuberculosis, health care seeking, health care seeking behavior, patient delay, diagnostic delay, health system delay, provider delay, and doctor delay. Retrieved studies were systematically reviewed and summarized using Comprehensive Meta-analysis software. Results Forty studies involving 18,975 patients qualified for systematic review, and 14 of them qualified for meta-analysis. The median diagnostic delay ranged from 30 to 366.5 days [IQR = 44–77.8], with a 4–199 days [IQR = 15–50] and 2–128.5 days [IQR = 12–34] due to patient and health system delays, respectively. The meta-analysis showed 42% of pulmonary tuberculosis patients delayed seeking care by a month or more; uneducated patients [pooled OR = 1.5, 95%CI = 1.1–1.9] and those who sought initial care from informal providers [pooled OR = 3, 95%CI = 2.3–3.9] had higher odds of patient delay. Conclusion Delay in diagnosis is still a major challenge of tuberculosis control and prevention programs in low- and middle- income settings. Efforts to develop new strategies for better case-finding using the existing systems and improving patients’ care seeking behavior need to be intensified.
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Affiliation(s)
- Fentabil Getnet
- Department of Public Health, College of Medicine and Health Sciences, Jigjiga University, PO Box = 1020, Jigjiga, Ethiopia.
| | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengistie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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40
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Ozaki A, Nomura S, Leppold C, Tsubokura M, Tanimoto T, Yokota T, Saji S, Sawano T, Tsukada M, Morita T, Ochi S, Kato S, Kami M, Nemoto T, Kanazawa Y, Ohira H. Breast cancer patient delay in Fukushima, Japan following the 2011 triple disaster: a long-term retrospective study. BMC Cancer 2017. [PMID: 28629330 PMCID: PMC5477136 DOI: 10.1186/s12885-017-3412-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 01/07/2023] Open
Abstract
Background Little information is available concerning how patient delay may be affected by mass disasters. The main objectives of the present study are to identify whether there was a post-disaster increase in the risk of experiencing patient delay among breast cancer patients in an area affected by the 2011 triple disaster in Fukushima, Japan, and to elucidate factors associated with post-disaster patient delay. Sociodemographic factors (age, employment status, cohabitant status and evacuation status), health characteristics, and health access- and disaster-related factors were specifically considered. Methods Records of symptomatic breast cancer patients diagnosed from 2005 to 2016 were retrospectively reviewed to calculate risk ratios (RRs) for patient delay in every year post-disaster compared with the pre-disaster baseline. Total and excessive patient delays were respectively defined as three months or more and twelve months or more from symptom recognition to first medical consultation. Logistic regression analysis was conducted for pre- and post-disaster patient delay in order to reveal any factors potentially associated with patient delay, and changes after the disaster. Results Two hundred nineteen breast cancer patients (122 pre-disaster and 97 post-disaster) were included. After adjustments for age, significant post-disaster increases in RRs of experiencing both total (RR: 1.66, 95% Confidence Interval (CI): 1.02–2.70, p < 0.05) and excessive patient delay (RR: 4.49, 95% CI: 1.73–11.65, p < 0.01) were observed. The RRs for total patient delay peaked in the fourth year post-disaster, and significant increases in the risk of excessive patient delay were observed in the second, fourth, and fifth years post-disaster, with more than five times the risk observed pre-disaster. A family history of any cancer was the only factor significantly associated with total patient delay post-disaster (odds ratio: 0.38, 95% CI: 0.15–0.95, p < 0.05), while there were no variables associated with delay pre-disaster. Conclusions The triple disaster in Fukushima appears to have led to an increased risk of patient delay among breast cancer patients, and this trend has continued for five years following the disaster. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3412-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan. .,Department of Epidemiology and Biostatistics, Teikyo University Graduate School of Public Health, Minamisoma, Tokyo, 173-8605, Japan.
| | - Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Minamisoma, Tokyo, 113-0033, Japan
| | - Claire Leppold
- Department of Research, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, 975-0033, Japan
| | - Masaharu Tsubokura
- Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, 975-0033, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, 972-8322, Japan
| | - Takeru Yokota
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan
| | - Manabu Tsukada
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan
| | - Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, 976-0016, Japan
| | - Sae Ochi
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, 976-0016, Japan
| | - Shigeaki Kato
- Research Institute of Innovative Medicine, Jyoban Hospital of Tokiwakai Group, Iwaki, Fukushima, 972-8322, Japan
| | - Masahiro Kami
- Medical Governance Research Institute, Minato-ku, Tokyo, 108-0074, Japan
| | - Tsuyoshi Nemoto
- Department of Home Medical Care, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, 975-0033, Japan
| | - Yukio Kanazawa
- Department of Gastroenterology, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, 975-0033, Japan
| | - Hiromichi Ohira
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan
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Ozaki A, Leppold C, Sawano T, Tsubokura M, Tsukada M, Tanimoto T, Kami M, Ohira H. Social isolation and cancer management - advanced rectal cancer with patient delay following the 2011 triple disaster in Fukushima, Japan: a case report. J Med Case Rep 2017; 11:138. [PMID: 28506309 PMCID: PMC5433021 DOI: 10.1186/s13256-017-1306-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/24/2017] [Accepted: 05/03/2017] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the effects of social isolation in the elderly on their process of gaining health information and seeking health care. Case presentation In March 2011, Fukushima, Japan experienced an earthquake, tsunami, and nuclear disaster, also known as Japan’s triple disaster. In June 2016, an 80-year-old Japanese man, who lived alone after divorce at the age of 42, presented to our hospital with bloody stools and dizziness. Although his bloody stools initially occurred in May 2015, a year earlier, he did not pursue the possibility of malignancy. He was diagnosed as having stage IIIA rectal cancer. Detailed history taking revealed that he experienced social isolation after the disaster, due to the evacuation of his friends, losing his regular opportunities for socialization. He additionally reported that the current diagnosis of rectal cancer made him feel he had lost his health in addition to his social relationships. Although radical surgery was attempted, it failed to resect the lesion completely, and thereafter his disease gradually progressed. As support from family or friends was not available, he was not able to receive palliative radiation therapy or home-based care in his end-of-life period. He died at a long-term care facility in February 2017. Conclusions This case suggests that intense social isolation after the Fukushima disaster was a likely contributor to the patient delay, poor treatment course, and poor outcome of an elderly patient with rectal cancer. Direct communication with family and friends may play an indispensable role in increasing health awareness and promoting health-seeking behaviors, and in the midst of social isolation, elderly patients with cancer may lose these opportunities and experience increased risk of patient delay. Although health care providers may be able to alleviate isolation-induced delay by promoting cancer knowledge and awareness widely among local residents, policy-led interventions at the community level may be essential to reducing social isolation and its health consequences.
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Affiliation(s)
- Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan.
| | - Claire Leppold
- Department of Research, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, 975-0033, Japan.,Global Public Health Unit, School of Social and Political Science, University of Edinburgh, EH8 9LD, Edinburgh, UK
| | - Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan
| | - Masaharu Tsubokura
- Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, 975-0033, Japan
| | - Manabu Tsukada
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, 972-8322, Japan
| | - Masahiro Kami
- Medical Governance Research Institute, Minato-ku, Tokyo, 108-0074, Japan
| | - Hiromichi Ohira
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan
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Yirgu R, Lemessa F, Hirpa S, Alemayehu A, Klinkenberg E. Determinants of delayed care seeking for TB suggestive symptoms in Seru district, Oromiya region, Ethiopia: a community based unmatched case-control study. BMC Infect Dis 2017; 17:292. [PMID: 28427367 PMCID: PMC5397811 DOI: 10.1186/s12879-017-2407-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 07/20/2016] [Accepted: 04/13/2017] [Indexed: 11/23/2022] Open
Abstract
Background Early tuberculosis (TB) case finding and adequate chemotherapy are essential for interrupting disease transmission and preventing complications due to delayed care seeking. This study was undertaken in order to provide insights into the magnitude and determinants of patient delay. Methods The study was conducted in rural Seru district, employing a population based unmatched case-control study design. The WHO standardized TB screening tool was used to identify presumptive TB cases among the district population ages > 15 years. Presumptive TB cases who sought care in a health facility more than 14 days after the onset of symptoms were considered cases while those who sought care within the first 14 days were classified as controls. A structured interview questionnaire was used to capture socio demographic characteristics and health care service utilization related data from the study participants. A multiple binary logistic regression model was used to identify any factor associated with patient care seeking delay. Result A total of 9,782 individuals were screened, of which 980 (10%, 95% CI; 9.4-10.5%) presumptive TB cases were identified. From these cases 358 (76%, 95% CI; 75.6%-76.4%) sought care within the first 14 days of the onset of symptoms with a median patient delay of 15 days, IQR (5-30 days). The most common TB suggestive symptom mentioned by the participants was night sweat 754 (76.4%) while the least common was a history of contact with a confirmed TB case in the past one year 207 (21.1%). Individuals in the 45-54 age range had lower odds of delay (AOR 0.31, 95%CI 0.15, 0.61) as compared to those 15-24 years old. First TB treatment episode (AOR16.2, 95% CI 9.94, 26.26) and limited access to either traditional or modern modes of transportation (AOR 2.62, 95% CI 1.25, 5.49) were independently associated with patient care delay. Conclusion Increasing community awareness about the risks of delayed care seeking and the importance of accessing health services close to the community can help decrease patient care delay.
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Affiliation(s)
- Robel Yirgu
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Firaol Lemessa
- Department of Public Health, College of Health Sciences, Arsi University, Rustavi, Georgia
| | - Selamawit Hirpa
- Department of Public Health, College of Health Sciences, Arsi University, Rustavi, Georgia
| | - Abraham Alemayehu
- Arsi Zone Health Bureau, Seru District Health Office, Seru Health Center., Seru, Ethiopia
| | - Eveline Klinkenberg
- KNCV Tuberculosis Foundation, The Hague, Netherlands.,Department of Global Health, Academic Medical Centre, Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
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Montagna G, Schneeberger AR, Rossi L, Bianchi Micheli G, Meani F, Imperiali M, Spitale A, Pagani O. Can we make a portrait of women with inoperable locally advanced breast cancer? Breast 2017; 33:83-90. [PMID: 28288387 DOI: 10.1016/j.breast.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/27/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Delay between clinical presentation and treatment of breast cancer (BC) can significantly impact mortality. We aimed at drawing a picture of women with locally advanced breast cancer (LABC) treated at our Breast Unit and at investigating factors associated with treatment delay. MATERIAL AND METHODS A retrospective descriptive analysis, using a specific 28-item semi-structured questionnaire, was conducted in 67 patients diagnosed with T4 BC. RESULTS Nearly a third of our patients had at least one known predisposing factor for LABC. 42% of patients did not perform routine medical breast checks, 49% reported indifference as the first feeling and 47% waited at least 3 months before seeking medical attention. The reasons for diagnostic delay were different in the various age groups. Doctor's delay in making the right diagnosis occurred in 60% of younger patients (≤40 years, n = 5), whereas among women aged 41-69years (n = 34) 50% suffered from psychiatric comorbidities. In patients ≥70 years (n = 28) social factors such as isolation, being widowed and living in a retirement home were present in most of the cases. Delay in seeking medical care was also associated with increasing age. Across all age groups, coping factors such as denial and indifference were also associated with an increase in the odds of delayed presentation, as opposed to fear. CONCLUSIONS Factors possibly explaining late medical consultation seem to differ according to age. Psychological factors are crucial in patients' delay whereas age and social factors are relevant in doctors' and system's delay.
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Affiliation(s)
- Giacomo Montagna
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale, Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland.
| | - Andres R Schneeberger
- Psychiatric University Hospital (UPK), University Basel, Basel, Switzerland; Psychiatric Services Grisons (PDGR), Chur, Switzerland; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences (AECOM), New York, NY, USA
| | - Lorenzo Rossi
- Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland; Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | | | - Francesco Meani
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale, Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland
| | - Mauro Imperiali
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Olivia Pagani
- Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland; Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
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Abstract
INTRODUCTION The Revised National Tuberculosis Control Programme's (RNTCP) passive case finding approach strongly influence the health seeking behaviour of patients and the timing of health seeking as well. AIM A systematic review was carried out to understand the health seeking behaviour, related delays and the knowledge and attitude regarding Tuberculosis (TB) and the health services linked with it. MATERIALS AND METHODS A manual search strategy was adopted using PUBMED and Google Scholar search engines to obtain research papers in the said subject. Of 113 articles obtained by the end of this search process 10 full text articles were finally selected for the purpose of this review. RESULTS Of the 10 studies identified, the results were delineated in 7 thematic areas such as: (1) Knowledge and perception of TB patients regarding TB and health services for TB; (2) Delays in seeking help; (3) Facility based health seeking behaviour; (4) Reasons for not seeking care/Delay in seeking care; (5) Geographical pattern (Rural-Urban) of health seeking; (6) Socio-cultural factors associated with health seeking; and (7) Gender based health seeking behaviour. CONCLUSION Health seeking behaviour and related delays are of utmost importance in TB care from two important perspectives; firstly TB requires timely treatment and secondly it requires protracted treatment. Required level of knowledge and positive health behaviour helps the patients in taking timely help from appropriate health facility.
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Affiliation(s)
- Janmejaya Samal
- Independent Public Health Researcher, Bhubaneswar, Odisha, India
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Maghous A, Rais F, Ahid S, Benhmidou N, Bellahamou K, Loughlimi H, Marnouche E, Elmajjaoui S, Elkacemi H, Kebdani T, Benjaafar N. Factors influencing diagnosis delay of advanced breast cancer in Moroccan women. BMC Cancer 2016. [PMID: 27268201 DOI: 10.1186/s12885-016-2394-y.pmid:27268201freepmc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Delay in the diagnosis of breast cancer in symptomatic women of 3 months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women. METHODS A group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay and system delay. Patient delay was defined as time from first symptoms until first medical consultation. System delay was defined as time from first presentation to a health care provider until definite diagnosis or treatment. Prospective information and clinical data were collected on a form during an interview with each patient and from medical records. RESULTS In all, 137 patients were interviewed. The mean age of women was 48.3 ± 10.4 years. The median of consultation time was 6[4,12] months and the median of diagnosis time was 1[1,3] months. Diagnosis delay was associated to a personal reason in 96 (70.1 %) patients and to a medical reason in 19 (13.9 %) patients. A number of factors predicted diagnosis delay: symptoms were not considered serious in 66 (55.9 %) patients; traditional therapy was applied in 15 (12.7 %) patients and fear of cancer diagnosis and/or treatment in 14 (11.9 %) patients. A use of traditional methods was significantly associated with rural residence and far away from basic health center (p = 0.000). Paradoxically, a family history of breast cancer was significantly higher in who report a fear of cancer diagnosis and/or treatment to diagnosis delay (p < 0.001). Also, a significantly higher risk of more than 6 months delay was found among rural women (P = 0.035) and women who live far away from specialized care center (P = 0.001). CONCLUSIONS Diagnosis delay is very serious problem in Morocco. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer information in our populations and training of general practitioners to reduce advanced breast cancer by promoting early detection.
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Affiliation(s)
- A Maghous
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
| | - F Rais
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - S Ahid
- Laboratory of epidemiology and clinical research, School of medicine and pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - N Benhmidou
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - K Bellahamou
- Department of Medical Oncology, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - H Loughlimi
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - E Marnouche
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - S Elmajjaoui
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - H Elkacemi
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - T Kebdani
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - N Benjaafar
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
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Maghous A, Rais F, Ahid S, Benhmidou N, Bellahamou K, Loughlimi H, Marnouche E, Elmajjaoui S, Elkacemi H, Kebdani T, Benjaafar N. Factors influencing diagnosis delay of advanced breast cancer in Moroccan women. BMC Cancer 2016; 16:356. [PMID: 27268201 PMCID: PMC4897875 DOI: 10.1186/s12885-016-2394-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 09/07/2015] [Accepted: 06/02/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Delay in the diagnosis of breast cancer in symptomatic women of 3 months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women. METHODS A group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay and system delay. Patient delay was defined as time from first symptoms until first medical consultation. System delay was defined as time from first presentation to a health care provider until definite diagnosis or treatment. Prospective information and clinical data were collected on a form during an interview with each patient and from medical records. RESULTS In all, 137 patients were interviewed. The mean age of women was 48.3 ± 10.4 years. The median of consultation time was 6[4,12] months and the median of diagnosis time was 1[1,3] months. Diagnosis delay was associated to a personal reason in 96 (70.1 %) patients and to a medical reason in 19 (13.9 %) patients. A number of factors predicted diagnosis delay: symptoms were not considered serious in 66 (55.9 %) patients; traditional therapy was applied in 15 (12.7 %) patients and fear of cancer diagnosis and/or treatment in 14 (11.9 %) patients. A use of traditional methods was significantly associated with rural residence and far away from basic health center (p = 0.000). Paradoxically, a family history of breast cancer was significantly higher in who report a fear of cancer diagnosis and/or treatment to diagnosis delay (p < 0.001). Also, a significantly higher risk of more than 6 months delay was found among rural women (P = 0.035) and women who live far away from specialized care center (P = 0.001). CONCLUSIONS Diagnosis delay is very serious problem in Morocco. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer information in our populations and training of general practitioners to reduce advanced breast cancer by promoting early detection.
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Affiliation(s)
- A Maghous
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
| | - F Rais
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - S Ahid
- Laboratory of epidemiology and clinical research, School of medicine and pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - N Benhmidou
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - K Bellahamou
- Department of Medical Oncology, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - H Loughlimi
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - E Marnouche
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - S Elmajjaoui
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - H Elkacemi
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - T Kebdani
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - N Benjaafar
- Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
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Ängerud KH, Thylén I, Sederholm Lawesson S, Eliasson M, Näslund U, Brulin C. Symptoms and delay times during myocardial infarction in 694 patients with and without diabetes; an explorative cross-sectional study. BMC Cardiovasc Disord 2016; 16:108. [PMID: 27386934 PMCID: PMC4937542 DOI: 10.1186/s12872-016-0282-7] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/14/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In myocardial infarction (MI) a short pre-hospital delay, prompt diagnosis and timely reperfusion treatment can improve the prognosis. Despite the importance of timely care seeking, many patients with MI symptoms delay seeking medical care. Previous research is inconclusive about differences in symptom presentation and pre-hospital delay between patients with and without diabetes during MI. The aim of this study was to describe symptoms and patient delay during MI in patients with and without diabetes. METHODS Swedish cross-sectional multicentre survey study enrolling MI patients in 5 centres within 24 h from admittance. RESULTS Chest pain was common in patients both with and without diabetes and did not differ after adjustment for age and sex. Patients with diabetes had higher risk for shoulder pain/discomfort, shortness of breath, and tiredness, but lower risk for cold sweat. The three most common symptoms reported by patients with diabetes were chest pain, pain in arms/hands and tiredness. In patients without diabetes the most common symptoms were chest pain, cold sweat and pain in arms/hands. Median patient delay time was 2 h, 24 min for patients with diabetes and 1 h, 15 min for patients without diabetes (p = 0.024). CONCLUSION Chest pain was common both in patients with and without diabetes. There were more similarities than differences in MI symptoms between patients with and without diabetes but patients with diabetes had considerably longer delay. This knowledge is important not only for health care personnel meeting patients with suspected MI, but also for the education of people with diabetes.
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Affiliation(s)
| | - Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Cardiology, Heart Centre, Umeå University, Umeå, Sweden
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Mahato RK, Laohasiriwong W, Vaeteewootacharn K, Koju R, Bhattarai R. Major Delays in the Diagnosis and Management of Tuberculosis Patients in Nepal. J Clin Diagn Res 2015; 9:LC05-9. [PMID: 26557545 DOI: 10.7860/jcdr/2015/16307.6633] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Early diagnosis is a determining factor for spread of tuberculosis. Delay in diagnosis and treatment of tuberculosis geometrically increases spread and infectivity of the disease and is associated with higher risk of mortality. AIM The present study aimed to investigate the length of delays in diagnosis and treatment among new pulmonary tuberculosis patients in central development region of Nepal. MATERIALS AND METHODS A cross-sectional study was conducted by administration of structured questionnaire interview and reviewing the medical records of the new sputum smear positive pulmonary tuberculosis cases during January-May 2015. Simple random sampling was applied to select samples from 5 districts of 19 districts comprising at least one each from 3 ecological regions of Nepal. RESULTS A total of 374 new sputum smear positive pulmonary tuberculosis cases were included in the study. The median patient delay, health system delay, and total delay were 32 days, 3 days and 39.5 days respectively. The unacceptable patients delay was 53.21% (95% CI: 48.12-58.29) of all new patients, whereas it was 26.74% (95% CI: 22.23-31.24) for the unacceptable health system delay and the unacceptable total delay was 62.83% (95% CI: 57.91-67.75). CONCLUSION TB diagnosis and treatment is still a significant problem of Nepal. Majority of unacceptable delays were from patients. Identifying factors influencing delays and developing evidence-based approaches to address those delays will help in advancing tuberculosis prevention and management in low-income settings.
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Affiliation(s)
- Roshan Kumar Mahato
- Faculty, Department of Public Health, MPH (International Health) Program, Khon Kaen University , Khon Kaen, Thailand
| | - Wongsa Laohasiriwong
- Associate Professor, Department of Public Health, Board Committee of Research and Training Centre for Enhancing Quality of Life of Working Age People (REQW), Faculty, Department of Public Health, Khon Kaen University , Khon Kaen, Thailand
| | | | - Rajendra Koju
- Professor, Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital , Nepal
| | - Ratna Bhattarai
- Senior Monitoring and Evaluation Officer, National TB Center , Thimi, Kathmandu, Nepal
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Mølbaek K, Hørslev-Petersen K, Primdahl J. Diagnostic Delay in Rheumatoid Arthritis: A Qualitative Study of Symptom Interpretation Before the First Visit to the Doctor. Musculoskeletal Care 2015; 14:26-36. [PMID: 26052985 DOI: 10.1002/msc.1108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND To prevent joint damage among patients with rheumatoid arthritis (RA), there is a need to minimize delays from the onset of symptoms until the initiation of appropriate therapy. The present study explored the factors that have an impact on the time it takes for Danish patients with RA to approach their general practitioner (GP) with joint pain, and also how GPs respond to patients' complaints. METHODS The study was based on qualitative data collected using 11 semi-structured individual interviews. RESULTS When symptoms were obvious to patients, there was a shorter delay between symptom onset and contacting their GP. In cases where symptoms gradually worsened or were difficult to interpret, there was a longer delay. Participants with a high degree of body awareness appeared to be good at detecting when something was not normal, and they responded quickly to their symptoms. For those who regarded the doctor as a resource to which they were entitled and who were not worried about getting a diagnosis there was a shorter delay. Diffuse symptoms seemed to confuse GPs and can contribute to physician delay in the investigation process. Similarly, the presence of other diseases can result in a prolonged period before referral to a rheumatologist. CONCLUSIONS The nature and severity of symptoms are the deciding factors in their interpretation, by both the GP and the patient. Both the patient's disease recognition and his/her subsequent interaction with the doctor is influenced by the patient's body awareness and general attitude towards going to the doctor. The results showed that the greater the patient's body awareness, the better the disease recognition, the fewer barriers to contacting the GP and the shorter the delay in doing so. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Karen Mølbaek
- King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark
| | - Kim Hørslev-Petersen
- Institute for Regional Health Research, University of Southern Denmark and King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark
| | - Jette Primdahl
- Institute for Regional Health Research, University of Southern Denmark and King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark
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Andersen RS, Vedsted P. Juggling efficiency. An ethnographic study exploring healthcare seeking practices and institutional logics in Danish primary care settings. Soc Sci Med 2015; 128:239-45. [PMID: 25625230 DOI: 10.1016/j.socscimed.2015.01.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the mutually constituting relationship between healthcare seeking practices and the socio-political context of clinical encounters. On the basis of ethnographic fieldwork carried out in the context of Danish primary care (general practice) and inspired by recent writings on institutional logics, we illustrate how a logic of efficiency organise and give shape to healthcare seeking practices as they manifest in local clinical settings. Overall, patient concerns are reconfigured to fit the local clinical setting and healthcare professionals and patients are required to juggle efficiency in order to deal with uncertainties and meet more complex or unpredictable needs. Lastly, building on the empirical case of cancer diagnostics, we discuss the implications of the pervasiveness of the logic of efficiency in the clinical setting and argue that provision of medical care in today's primary care settings requires careful balancing of increasing demands of efficiency, greater complexity of biomedical knowledge and consideration for individual patient needs.
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Affiliation(s)
- Rikke Sand Andersen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Denmark; Department of Culture and Society - Section for Anthropology, Faculty of Arts, Aarhus University, Denmark.
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Denmark.
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