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Rivers G, Hinchliff S, Thompson J. Transgender and non-binary peoples experiences of cervical cancer screening: A scoping review. J Clin Nurs 2024; 33:2112-2122. [PMID: 38334194 DOI: 10.1111/jocn.17023] [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: 09/22/2023] [Revised: 11/21/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
AIM(S) To synthesise the literature about transgender and non-binary people's experiences of cervical cancer screening and identify ways to improve screening. BACKGROUND Transgender people often face barriers to accessing health services including cervical screening, where transgender people have a lower uptake than cisgender women. DESIGN A scoping review was undertaken following the Arksey and O'Malley (2005) framework and the PRISMA-ScR checklist. Following database searching of Medline via PubMed, Web of Science, Scopus and CINHAL, 23 papers published between 2008 and 2003 were included. Papers were included if they shared trans and non-binary people's experiences of cervical screening and were written in English. There were no date or geographical data restrictions due to the paucity of research. RESULTS Transgender people experience barriers to cervical screening including gender dysphoria, a history of sexual trauma, and mistrust in health professionals or health services, which can result in having negative experiences of screening or avoiding screening. Health professionals can help to create a positive experience by informing themselves about best practices for trans+ health. CONCLUSION Changes are required to improve transgender people's experiences and uptake of cervical screening. Improving medical education about trans health and updating health systems would help to combat issues discussed. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Having an understanding of the reasons why accessing health services can be more difficult for transgender people will help health professionals to provide appropriate care for transgender patients. This paper details this in the context of cervical cancer screening and can be applied to other areas of healthcare. REPORTING METHOD We have adhered to relevant EQUATOR guidelines and used the PRISMA-ScR reporting method. No Patient or Public Contribution.
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Affiliation(s)
- Georgia Rivers
- Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Sharron Hinchliff
- Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Jill Thompson
- Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
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Turan G, Turan M, Ikiisik H, Yildirim ME, Cakir M, Maral I. Evaluation of the effectiveness of colorectal cancer screening intervention. Cancer Causes Control 2024; 35:761-769. [PMID: 38172469 DOI: 10.1007/s10552-023-01839-z] [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: 06/19/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The effectiveness of the Colorectal Cancer (CRC) screening program is assessed based on the reduction in CRC mortality and incidence rates over time. To accurately estimate the long-term impact, it is advisable to monitor additional indicators such as age and stage-specific incidence rates. Our objective is to evaluate the effectiveness of the National CRC Screening Program in Turkey and analyze its influence on disease stage at diagnosis and survival rates. METHODS The National CRC Screening Program was considered an intervention and the distribution of local, regional, and distant diseases, and survival estimates were assessed before and after the intervention to evaluate the effectiveness of the intervention. RESULTS 518 patients were included in the study. At the time of diagnosis, localized, regional, and distant disease in pre-intervention were 31.3%, 42.9%, 25.8%, while post-intervention were 42.8%, 33.3%, 23.9%, respectively (p = 0.020). The relative effectiveness of the intervention in males, females, and 50-70 ages were calculated as 1.2[95% CI 0.95-1.73], 1.5[95% CI 1.04-2.18], and 1.6[95% CI 1.21-2.28] in localized disease, 0.8[95% CI 0.67-1.18], 0.6[95% CI 0.43-0.90], and 0.6[95% CI 0.46-0.81] in regional diseases, 0.8[95% CI 0.57-1.20], 1.1[95% CI 0.66-1.84], and 1.0[95% CI 0.70-1.57] in distant disease, respectively. CONCLUSION A noticeable shift in the disease stage at the time of diagnosis was observed; however, this shift varied among gender and age groups. To effectively evaluate the impact of a cancer screening program on reducing the incidence and mortality rates of the disease, it is essential to monitor and analyze these indicators alongside 5-10-year survival estimates and stage changes at the time of diagnosis.
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Affiliation(s)
- Guven Turan
- Republic of Turkey Ministry of Health Aydın Efeler District Health Directorate, Aydın, Turkey.
| | - Merve Turan
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Hatice Ikiisik
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Emre Yildirim
- Department of Medical Oncology, Istanbul Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Cakir
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Isil Maral
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Dunn MR, Metwally EM, Vohra S, Hyslop T, Henderson LM, Reeder-Hayes K, Thompson CA, Lafata JE, Troester MA, Butler EN. Understanding mechanisms of racial disparities in breast cancer: an assessment of screening and regular care in the Carolina Breast Cancer Study. Cancer Causes Control 2024; 35:825-837. [PMID: 38217760 PMCID: PMC11045315 DOI: 10.1007/s10552-023-01833-5] [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: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Screening history influences stage at detection, but regular preventive care may also influence breast tumor diagnostic characteristics. Few studies have evaluated healthcare utilization (both screening and primary care) in racially diverse screening-eligible populations. METHODS This analysis included 2,058 women age 45-74 (49% Black) from the Carolina Breast Cancer Study, a population-based cohort of women diagnosed with invasive breast cancer between 2008 and 2013. Screening history (threshold 0.5 mammograms per year) and pre-diagnostic healthcare utilization (i.e. regular care, based on responses to "During the past ten years, who did you usually see when you were sick or needed advice about your health?") were assessed as binary exposures. The relationship between healthcare utilization and tumor characteristics were evaluated overall and race-stratified. RESULTS Among those lacking screening, Black participants had larger tumors (5 + cm) (frequency 19.6% vs 11.5%, relative frequency difference (RFD) = 8.1%, 95% CI 2.8-13.5), but race differences were attenuated among screening-adherent participants (10.2% vs 7.0%, RFD = 3.2%, 0.2-6.2). Similar trends were observed for tumor stage and mode of detection (mammogram vs lump). Among all participants, those lacking both screening and regular care had larger tumors (21% vs 8%, RR = 2.51, 1.76-3.56) and advanced (3B +) stage (19% vs 6%, RR = 3.15, 2.15-4.63) compared to the referent category (screening-adherent and regular care). Under-use of regular care and screening was more prevalent in socioeconomically disadvantaged areas of North Carolina. CONCLUSIONS Access to regular care is an important safeguard for earlier detection. Our data suggest that health equity interventions should prioritize both primary care and screening.
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Affiliation(s)
- Matthew R Dunn
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Eman M Metwally
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sanah Vohra
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Terry Hyslop
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Louise M Henderson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Pulmonary Disease and Critical Care Medicine, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Caroline A Thompson
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Eboneé N Butler
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Kongkamol C, Chintrakul A, Horsiritham K, Kiranantawat N, Nirattisaikul S, Sungsiri J, Sathirapanya P, Sathirapanya C, Boonma K, Chowwanapoonpohn T, Nuiman P, Supunthuchaikul J, Chokthamangoon N, Chintana C, Suktaneekul T, Watcharanimit C. The predictors of voluntary participation in pulmonary tuberculosis screening program: a study in a suburban community of southern Thailand. Front Public Health 2024; 12:1360986. [PMID: 38660360 PMCID: PMC11040456 DOI: 10.3389/fpubh.2024.1360986] [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: 12/24/2023] [Accepted: 03/14/2024] [Indexed: 04/26/2024] Open
Abstract
Background The health belief model (HBM), baseline health condition, and sociocultural factors impact the decision to participate in a tuberculosis screening program. Methods This cross-sectional and descriptive study was carried out among the "Kao Taew" community dwellers aged 18 years and above, who voluntarily underwent the provided pulmonary tuberculosis (PTB) screening by chest radiographs (CXRs). The level of individual HBM domain perception, attitudes toward PTB prevention, and regularity of PTB prevention practices by the participants were evaluated. The significantly associated or correlated factors such as demographic characteristics, individual HBM domain perception, and attitudes toward PTB prevention with the regularity of PTB prevention practices from the univariate analysis were further analyzed by multiple linear regression (p < 0.05) to determine the independent significant predictors of PTB prevention practices. Results Among 311 participants comprising 65% women, 57.9% aged ≥ 65 years and 67.2% had an underlying disease. The study participants had a high level of perception of HBM domains but a low level of perception of the barrier. In addition, a high level of attitudes toward PTB prevention and a high regularity of PTB prevention practices were found. A multiple linear regression analysis revealed that the perceived benefits of PTB screening [Beta = 0.20 (0.04, 0.36) p = 0.016] and acquiring underlying diseases [Beta = 1.06 (0.38, 1.73), p = 0.002] were significant predictors for PTB prevention practices, while belief in Islam was a reverse predictor [Beta = -0.84 (-1.47, -0.21), p = 0.010]. Conclusions The level of perception of the individual domain of HBM, health status, and religious belief significantly predicted voluntary participation in PTB screening programs. Careful consideration by integration of the relevant health psychology, physical, and sociocultural factors is crucial for planning a health screening program.
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Affiliation(s)
- Chanon Kongkamol
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Air Pollution and Health Effect Research Center, Prince of Songkla University, Songkhla, Thailand
| | - Apinya Chintrakul
- Health Sciences and Clinical Research, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kanakorn Horsiritham
- Division of Digital Innovation and Data Analytics (DIDA), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Nantaka Kiranantawat
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sitang Nirattisaikul
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jitpreedee Sungsiri
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pornchai Sathirapanya
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chutarat Sathirapanya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Koontidar Boonma
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tuck Chowwanapoonpohn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Paradon Nuiman
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jekita Supunthuchaikul
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Nuttartham Chokthamangoon
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chalanthon Chintana
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Trithep Suktaneekul
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chananyu Watcharanimit
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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van Oppen JD, Suzanne M. Frailty screening in the Emergency Department: why does it matter? Age Ageing 2024; 53:afae056. [PMID: 38655587 DOI: 10.1093/ageing/afae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- James David van Oppen
- Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK
| | - Mason Suzanne
- Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK
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Firnhaber C, Simoncini G, Mayer C, Armon C, Ewing AC, Tedaldi E, Battalora L, Carlson K, Chagaris K, Buchacz K, Li J. Mammogram and Pap Smear Uptake Among Women in the HIV Outpatient Study USA, 2010-2021. AIDS Patient Care STDS 2024; 38:151-154. [PMID: 38656216 DOI: 10.1089/apc.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- Cynthia Firnhaber
- Vivent Health, Department of Research, Denver, Colorado, USA
- University of Colorado, Department of Medicine, Division of Infectious Disease, Anschutz Medical Center, Aurora, Colorado, USA
| | - Gina Simoncini
- Department of Internal Medicine, AIDS Healthcare Foundation, Philadelphia, Pennsylvania, USA
| | - Cynthia Mayer
- Department of Internal Medicine, Division of Infectious Disease, St. Joseph's Comprehensive Research Institute, Tampa, Florida, USA
| | - Carl Armon
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Alexander C Ewing
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen Tedaldi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Linda Battalora
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
- Petroleum Engineering Department, Colorado School of Mines, Golden, Colorado, USA
| | - Kimberly Carlson
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Kalliope Chagaris
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Li
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Washington A, Smith L, Randall J, Anderson G. A Systematic Review of the Effectiveness of Cervical Cancer Screening and Prevention Interventions for African American Women: Implications for Promoting Health Equity. J Womens Health (Larchmt) 2024; 33:409-425. [PMID: 38394289 DOI: 10.1089/jwh.2023.0635] [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] [Indexed: 02/25/2024] Open
Abstract
African American women suffer under the burden of cervical cancer as they are first in mortality, diagnosed at later stages, and have a survivorship rate that is lower than the national average. The aim of our review is to evaluate the effectiveness of cervical cancer screening and prevention interventions for African American women living in the United States and to assess their commitment to health equity. A literature search was conducted using PubMed, Embase, CINAHL, and Scopus using MeSH terms related to cervical cancer, human papillomavirus (HPV), screening and prevention, and African Americans. This resulted in 1970 articles. Studies were included if they promoted cervical screening or prevention, sampled African American women aged 18 and over, and evaluated interventions. Among the 23 articles that met inclusion criteria, there were a wide variety of intervention strategies, that is, community health workers, patient navigation, patient reminders, self-sampling collection, and HPV vaccination. Health education interventions, when coupled with patient navigation or community health workers, were effective in promoting screening participation (odds ratio: 2.43, 95% confidence interval: 1.47-4.02). There were mixed results regarding the incorporation of health equity principles. This review supports the importance of incorporating health equity principles and community based methods in screening and prevention interventions. Future research and practice should incorporate African American women's perspectives in intervention development and implementation.
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Affiliation(s)
- Ariel Washington
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lisa Smith
- Grace Abbott School of Social Work, University of Nebraska Omaha, Omaha, Nebraska, USA
| | - Jill Randall
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Georgia Anderson
- College of Allied Health Sciences, School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA
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Vaid I, Blum E, Nwaise I. Women with Blood Pressure Improvement in the Well-Integrated Screening and Evaluation for Women Across the Nation Program by Race and Ethnicity, 2014-2018. J Womens Health (Larchmt) 2024; 33:467-472. [PMID: 38451720 DOI: 10.1089/jwh.2023.0612] [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] [Indexed: 03/09/2024] Open
Abstract
Background: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program aims to improve the cardiovascular health of women aged 40-64 years with low incomes, and who are uninsured or underinsured. The objective is to examine WISEWOMAN participants with hypertension who had high blood pressure (BP) improvement from January 2014 to June 2018, by race and ethnicity. Also examined was participation in WISEWOMAN Healthy Behavior Support Services (HBSS) and adherence to antihypertensive medication. Materials and Methods: WISEWOMAN data from January 2014 to June 2018 were analyzed by race and ethnicity. BP improvement was defined as at least a 5 mm Hg decrease in systolic or diastolic BP values from baseline screening to rescreening. The prevalence of HBSS participation and antihypertensive medication adherence were calculated among hypertensive women with BP improvement. Results: Approximately 64.2% (4,984) of WISEWOMAN participants with hypertension had at least a 5 mm Hg BP improvement. These improvements were consistent across each race and ethnicity (p = 0.56) in the study. Nearly 70% of women who had BP improvement attended at least one HBSS. Hispanic women (80.1%) had the highest HBSS attendance percentage compared to non-Hispanic Black women (64.1%) and non-Hispanic White women (63.8%; p < 0.001). About 80% of women with BP improvement reported being adherent to antihypertensive medication in the previous 7 days. Conclusions: The proportion of women achieving BP improvement in the WISEWOMAN program was consistent across race and ethnicity. In addition, women with BP improvement reported adherence to antihypertensive medication and participation in HBSS.
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Affiliation(s)
- Isam Vaid
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ethan Blum
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isaac Nwaise
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Smith NDW, Lewis KR, Feldman MA. Benefits of expanding behavioral health screening in a pediatric diabetes clinic to include anxiety and caregiver reports in youth 12 years and younger. Fam Syst Health 2024; 42:116-121. [PMID: 37589690 DOI: 10.1037/fsh0000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Depression and anxiety among youth with Type 1 diabetes (T1D) are associated with poor diabetes management. Further guidance regarding psychosocial screening measures would benefit pediatric integrated care clinics. The purpose of this exploratory study was to examine whether screening for anxiety, assessing caregiver reports, and screening children 12 years old and younger could identify a larger percentage of youth who may benefit from behavioral health support compared to the standard approach of only screening youth 13 and older for depression. METHOD Sixty-five youth 8-17 years old with T1D (N = 65; M = 13.2 years; 55.4% females) and their caregivers (75% mothers) completed validated self-report and proxy-report depression and anxiety screeners during routine clinic visits between 2019 and 2021. Twenty-seven youth aged 13-17 also completed a measure of diabetes-related distress. RESULTS The standard approach of screening youth aged 13-17 for depression via self-report identified 25.6% of participants, whereas screening youth ages 8-17 for depression and anxiety via self- and proxy-reports identified 47.7%. Screening for depression/anxiety identified unique portions of youth independent of diabetes distress. DISCUSSION Utilizing anxiety and proxy-report measures may identify youth likely to benefit from behavioral health support who are not identified when only a self-report depression measure is used in screening. Research should evaluate whether utilizing multiple measures and screening children under 13 years old improve detection and connection to care for youth experiencing difficulty managing diabetes. Early identification and intervention could subsequently mitigate the negative impacts of social-emotional difficulties on diabetes management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Nicholas David W Smith
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Health Morsani College of Medicine
| | - Kevin R Lewis
- Johns Hopkins All Children's Hospital Pediatric Endocrinology, Johns Hopkins School of Nursing
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Yu S, Jeong D, Kang HY, Kang YA, Lee GI, Choi H. A Quasi-experimental Study on the Effect of Pre-entry Tuberculosis Screening for Immigrants on Treatment Outcomes in South Korea: A Difference-in-Differences Analysis. J Epidemiol Glob Health 2024; 14:154-161. [PMID: 38261173 PMCID: PMC11043236 DOI: 10.1007/s44197-023-00181-6] [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: 09/30/2022] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE This study ascertains the effects of the pre-entry tuberculosis (TB) screening policy, which was implemented as a strategy for managing TB among immigrants, on the treatment outcomes of immigrants in South Korea. METHODS This study linked three different datasets from 2013 to 2018, namely (1) Korean National Tuberculosis Surveillance System; (2) National Health Information Database for patients diagnosed with TB with ICD code A15-A19, B90, or U84.3; and (3) Statistics Korea database related to cause of deaths. To identify the effect of the policy, cohorts comprising Korean and immigrant TB patients notified before (January 1, 2013-December 31, 2015) and after (September 1, 2016-December 31, 2018), the implementations of the policy were established. A difference-in-differences (DID) analysis of the treatment success and mortality rates was performed. RESULTS Data from 100,262 TB patients were included in the analysis (before policy implementation: 1240 immigrants and 65,723 Koreans; after policy implementation: 256 immigrants and 33,043 Koreans). The propensity score matching-DID analysis results showed that the difference in the treatment success rate between immigrants and Koreans decreased significantly, from 16% before to 6% after the policy implementation. The difference in the mortality rate between the two groups decreased from - 3% before to - 1% after the policy implementation; however, this difference was insignificant. CONCLUSION The treatment outcomes of immigrant TB patients in South Korea improved after the implementation of the pre-entry active TB screening policy. Future immigrant TB policies should consider establishing active patient support strategies and a healthcare collaboration system between countries.
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Affiliation(s)
- Sarah Yu
- School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Dawoon Jeong
- Department of Preventive Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hee-Yeon Kang
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyeong In Lee
- The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Hongjo Choi
- School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea.
- Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea.
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11
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Wu L, Chen GZ, Zeng ZR, Ji CW, Zhang AQ, Xia JH, Liu GC. Analysis of Breast Cancer Screening Results and Influencing Factors of Breast Cancer in Guangdong Province from 2017 to 2021. J Epidemiol Glob Health 2024; 14:131-141. [PMID: 38224387 PMCID: PMC11043295 DOI: 10.1007/s44197-023-00176-3] [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: 07/20/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUNDS Breast cancer screening plays an important role in the early detection, diagnosis and treatment of breast cancer. The aim of this study was to evaluate the screening results and explore the influencing factors of breast cancer detection rate in Guangdong. METHODS This cross-sectional study was conducted among 2,024,960 women aged 35-64 in Guangdong Province during 2017-2021. The data about breast cancer screening information were collected from the Guangdong maternal and child health information system. Descriptive statistical analysis was used to explain demographic characteristics and results of breast cancer screening. The generalized linear regression model was applied to analyze the related influencing factors of breast cancer detection rate. RESULTS The estimated detection rate of breast cancer in Guangdong Province is 70.32/105, with an early diagnosis rate of 82.06%. After adjusting covariates, those women with older age (45-55 [OR (95% CI) 2.174 (1.872, 2.526)], 55-65 [OR (95% CI) 2.162 (1.760, 2.657)]), education for high school ([OR (95% CI) 1.491 (1.254, 1.773)]) and older age at first birth ([OR (95% CI) 1.632 (1.445, 1.844)]) were more likely to have higher detection rate of breast cancer. No history of surgery or biopsy ([OR (95% CI) 0.527 (0.387, 0.718)]), no history of breast cancer check ([OR (95% CI) 0.873 (0.774, 0.985)]) and no family history of breast cancer ([OR (95% CI) 0.255 (0.151, 0.432)]) women were more likely to screen negative for breast cancer (P < 0.05). CONCLUSION The detection rate of breast cancer in screening showed an increasing trend year by year in Guangdong Province. Older age, education for high school and older age at first birth were risk factors for breast cancer detection rate, while no surgery or biopsy history, no family history of breast cancer and no history of breast cancer check were protective factors.
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Affiliation(s)
- Li Wu
- Guangdong Women and Children Hospital, Xingnan Road 521, Guangzhou, 511442, Guangdong, China
| | - Guo-Zhen Chen
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Zu-Rui Zeng
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Cun-Wei Ji
- Guangdong Women and Children Hospital, Xingnan Road 521, Guangzhou, 511442, Guangdong, China
| | - An-Qin Zhang
- Guangdong Women and Children Hospital, Xingnan Road 521, Guangzhou, 511442, Guangdong, China
| | - Jian-Hong Xia
- Guangdong Women and Children Hospital, Xingnan Road 521, Guangzhou, 511442, Guangdong, China.
| | - Guo-Cheng Liu
- Guangdong Women and Children Hospital, Xingnan Road 521, Guangzhou, 511442, Guangdong, China.
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Vaz-Pinto I, Ortega E, Chivite I, Butí M, Turnes-Vázquez J, Magno-Pereira V, Rocha M, Garrido J, Esteves-Santos C, Guimaraes M, Mourão T, Martínez Roma M, Guilera V, Llaneras-Artigues J, Barreira-Díaz A, Pérez Cachafeiro S, Daponte Angueira S, Xavier E, Vicente M, Garrido G, Heredia MT, Medina D, García Deltoro M. Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention. Front Public Health 2024; 11:1268888. [PMID: 38328544 PMCID: PMC10847218 DOI: 10.3389/fpubh.2023.1268888] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Background Around 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model. Methods The Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods. Intervention BBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI. Results Two years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period. Conclusions Implementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.
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Affiliation(s)
- Inês Vaz-Pinto
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Enrique Ortega
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
| | - Ivan Chivite
- Unidad de Enfermedades Infecciosas, Hospital Clínic i Provincial de Barcelona (HClinic), Barcelona, Spain
| | - María Butí
- Servicio de Hepatología, Hospital Universitari Vall d'Hebron (HVHEBRON), Barcelona, Spain
- CIBER Enfermedades Hepáticas y Digestivas del Instituto Carlos III, Madrid, Spain
| | | | - Vítor Magno-Pereira
- Serviço de Saúde da Região Autónoma da Madeira (SMADEIRA), Madeira, Portugal
- Universidade da Madeira, Madeira, Portugal
| | - Miguel Rocha
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | | | - Catarina Esteves-Santos
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Mafalda Guimaraes
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Tomás Mourão
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - María Martínez Roma
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
| | - Vanessa Guilera
- Unidad de Enfermedades Infecciosas, Hospital Clínic i Provincial de Barcelona (HClinic), Barcelona, Spain
| | | | - Ana Barreira-Díaz
- Servicio de Hepatología, Hospital Universitari Vall d'Hebron (HVHEBRON), Barcelona, Spain
| | | | | | - Elisa Xavier
- Serviço de Saúde da Região Autónoma da Madeira (SMADEIRA), Madeira, Portugal
| | | | | | | | - Diogo Medina
- Gilead Sciences, Madrid and Lisbon, Spain and Portugal
| | - Miguel García Deltoro
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
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Lambert JO, Falusi OO, Kaslow-Zieve E, Crawley S, Essel K. "It Can Be Confusing": Family Perspectives on Food Insecurity Screening in Urban Pediatric Primary Care Clinics. J Health Care Poor Underserved 2024; 35:65-78. [PMID: 38661860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Food insecurity, for which families are routinely screened at medical visits, has deleterious health consequences. This study sought to understand the lived experiences of families with lower incomes participating in food insecurity screening at two urban pediatric primary care clinics. Forty-three semi-structured interviews were performed in English and Spanish with families with public insurance after well visits where food insecurity screening was documented. Immersion-crystallization analysis was used to identify salient themes. Families reported discomfort with food insecurity screening, but nonetheless found screening acceptable when performed universally and privately. Families shared confusion about how their screening responses would be used and expected that resources would be available promptly for those who screen positive. Food insecurity screening may be improved for families through explanations of how responses will be used, allowing families to opt out, soliciting family preferences for resource referral, and offering promptly available resources for families with food insecurity.
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14
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Austin S, Ramamonjiarivelo Z, Comer-HaGans D, Zhang Y. Factors Associated with Early and Periodic Screening, Diagnostic, and Treatment Services in a Medicaid Managed Care Pediatric Population. J Health Care Poor Underserved 2024; 35:79-93. [PMID: 38661861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services is a Medicaid benefit for children that addresses their health problems before they become advanced, debilitating, and expensive. We conducted a retrospective cross-sectional analysis of pediatric beneficiaries (newborn to younger than 21 years) enrolled in a Medicaid managed care organization to examine the factors associated with EPSDT screening services completion. We obtained 2018 administrative claims data for beneficiaries continuously enrolled for a minimum of 90 days (n=156,108). Completion of EPSDT screening services among our Medicaid managed care beneficiaries was low. Those having more emergency department visits and hospitalizations, having family medicine practitioners as primary care physicians, belonging to the racial/ethnic group Asian/Pacific Islander/Hawaiian/Alaskan Native/Native American, and 18 to younger than 21 years age group were less likely than others to complete EPSDT services. Our results provide information on segments of pediatric beneficiaries that can be targeted to increase EPSDT screening services completion.
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Landy R, Gomez I, Caverly TJ, Kawamoto K, Rivera MP, Robbins HA, Young CD, Chaturvedi AK, Cheung LC, Katki HA. Methods for Using Race and Ethnicity in Prediction Models for Lung Cancer Screening Eligibility. JAMA Netw Open 2023; 6:e2331155. [PMID: 37721755 PMCID: PMC10507484 DOI: 10.1001/jamanetworkopen.2023.31155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/20/2023] [Indexed: 09/19/2023] Open
Abstract
Importance Using race and ethnicity in clinical prediction models can reduce or inadvertently increase racial and ethnic disparities in medical decisions. Objective To compare eligibility for lung cancer screening in a contemporary representative US population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity vs a counterfactual eligibility approach that recalculates life expectancy for racial and ethnic minority individuals using the same covariates but substitutes White race and uses the higher predicted life expectancy, ensuring that historically underserved groups are not penalized. Design, Setting, and Participants The 2 submodels composing LYFS-CT NoRace were refit and externally validated without race and ethnicity: the lung cancer death submodel in participants of a large clinical trial (recruited 1993-2001; followed up until December 31, 2009) who ever smoked (n = 39 180) and the all-cause mortality submodel in the National Health Interview Survey (NHIS) 1997-2001 participants aged 40 to 80 years who ever smoked (n = 74 842, followed up until December 31, 2006). Screening eligibility was examined in NHIS 2015-2018 participants aged 50 to 80 years who ever smoked. Data were analyzed from June 2021 to September 2022. Exposure Including and removing race and ethnicity (African American, Asian American, Hispanic American, White) in each LYFS-CT submodel. Main Outcomes and Measures By race and ethnicity: calibration of the LYFS-CT NoRace model and the counterfactual approach (ratio of expected to observed [E/O] outcomes), US individuals eligible for screening, predicted days of life gained from screening by LYFS-CT. Results The NHIS 2015-2018 included 25 601 individuals aged 50 to 80 years who ever smoked (2769 African American, 649 Asian American, 1855 Hispanic American, and 20 328 White individuals). Removing race and ethnicity from the submodels underestimated lung cancer death risk (expected/observed [E/O], 0.72; 95% CI, 0.52-1.00) and all-cause mortality (E/O, 0.90; 95% CI, 0.86-0.94) in African American individuals. It also overestimated mortality in Hispanic American (E/O, 1.08, 95% CI, 1.00-1.16) and Asian American individuals (E/O, 1.14, 95% CI, 1.01-1.30). Consequently, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while reducing African American eligibility by 39%. Using LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without reducing eligibility for Hispanic American and Asian American individuals. Conclusions and Relevance In this study, removing race and ethnicity miscalibrated LYFS-CT submodels and substantially reduced African American eligibility for lung cancer screening. Under counterfactual eligibility, no one became ineligible, and African American eligibility increased, demonstrating the potential for maintaining model accuracy while reducing disparities.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Isabel Gomez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
- Biostatistics Department, University of Michigan, Ann Arbor
| | - Tanner J. Caverly
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City
| | - M. Patricia Rivera
- Division of Pulmonary and Critical Care Medicine and Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Hilary A. Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Corey D. Young
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, Georgia
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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Atkinson-Briggs S, Jenkins A, Keech A, Ryan C, Brazionis L. Prevalence of diabetic retinopathy and reduced vision among indigenous Australians in the nurse-led integrated Diabetes Education and Eye Screening study in a regional primary care clinic. Intern Med J 2023; 53:1188-1195. [PMID: 34779559 DOI: 10.1111/imj.15625] [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: 10/07/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nationally, Indigenous Australians are more likely to have diabetes and diabetic retinopathy (DR) than non-Indigenous Australians. However, the prevalence of DR and impaired vision in regional primary care settings is unclear. AIM To describe the prevalence and severity of DR and presenting vision level among Indigenous Australian adults with diabetes attending an indigenous primary care clinic in regional Australia. METHODS Participants underwent nurse-led retinal imaging and DR screening with offsite retinal grading in the integrated Diabetes Education and Eye Screening (iDEES) project implemented at a regional indigenous primary healthcare setting between January 2018 and March 2020. RESULTS Of 172 eligible adults, 135 (79%) were recruited and screened for DR and vision level. The median age was 56 (46-67) years, 130 (96%) had type 2 diabetes of median (interquartile range) duration 6 (2-12) years and 48 (36%) were male. Images from 132 (97.8%) participants were gradable. DR was present in 38 (29%) participants: mild non-proliferative in 33 (25%); moderate-severe in three (2.5%); and sight-threatening two (1.5%). Subnormal presenting vision was present in 33%. CONCLUSIONS A nurse-led model of care integrating diabetes eye screening and education at a single visit was successful at recruiting Indigenous Australian adults with diabetes, screening their vision and acquiring a high rate of gradable images. Even for a short duration of known diabetes, DR was present in three out of 10 patients screened.
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Affiliation(s)
- Sharon Atkinson-Briggs
- Department of Medicine, University of Melbourne (St Vincent's Hospital), Melbourne, Victoria, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne (St Vincent's Hospital), Melbourne, Victoria, Australia
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17
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Thomsen MK, Jørgensen MD, Pedersen L, Erichsen R, Sørensen HT, Mikkelsen EM. Mental disorders, participation, and trajectories in the Danish colorectal cancer programme: a population-based cohort study. Lancet Psychiatry 2023; 10:518-527. [PMID: 37353263 DOI: 10.1016/s2215-0366(23)00179-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND People with mental disorders exhibit increased mortality due to colorectal cancer, despite having a similar incidence to the general population. We aimed to evaluate the extent to which people with mental disorders participate in organised colorectal cancer screening. METHODS We conducted a population-based cohort study of all Danish residents aged 50-74 years who were invited to undergo biennial faecal immunochemical testing between March 1, 2014, and Sept 30, 2018. We used national registry data from all first-time invitees. The primary endpoint was participation within 90 days of invitation. We calculated the proportion who participated and assessed their screening results and adherence to and completeness of follow-up colonoscopy according to their history of mental disorders, classified as none, mild or moderate, or severe. We computed crude and adjusted participation differences in percentage points and participation ratios using the pseudo-observations method. FINDINGS Of 2 036 704 people who were invited, we included 2 036 352 in the final cohort, of whom 1 008 045 (49·5%) were men and 1 028 307 (50·5%) were women, with a mean age of 60·7 years (SD 8·3, range 49-78). Data on ethnicity were not collected. Compared with people with no mental disorders, the adjusted analysis showed lower participation among people with mild or moderate mental disorders (men: participation difference -4·4 percentage points [95% CI -4·7 to -4·1]; women: -3·8 percentage points [-4·1 to -3·6]) and severe mental disorders (men: participation difference -13·8 percentage points [-14·3 to -13·3]; women: -15·4 percentage points [-15·8 to -14·9]). People with mental disorders had a higher proportion of positive faecal immunochemical test results, lower adherence to colonoscopy, and more incomplete colonoscopies than people without mental disorders. INTERPRETATION People with mental disorders were less likely to participate in colorectal cancer screening than those without these disorders. Patients with mental disorders could benefit from support or encouragement from their general practitioner or mental health-care facility to participate in cancer screening. Potential interventions should consider type of mental disorder, as needs might differ. FUNDING Danish Cancer Society, Danish Health Foundation.
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Affiliation(s)
- Mette Kielsholm Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; CASTLE - Cancer Survivorship and Treatment Late Effects, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Dahl Jørgensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
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Pace LE, Hagenimana M, Dusengimana JMV, Balinda JP, Benewe O, Rugema V, de Dieu Uwihaye J, Fata A, Shyirambere C, Shulman LN, Keating NL, Uwinkindi F. Implementation research: including breast examinations in a cervical cancer screening programme, Rwanda. Bull World Health Organ 2023; 101:478-486. [PMID: 37397178 PMCID: PMC10300777 DOI: 10.2471/blt.22.289599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To evaluate whether integrating breast and cervical cancer screening in Rwanda's Women's Cancer Early Detection Program led to early breast cancer diagnoses in asymptomatic women. Methods Launched in three districts in 2018-2019, the early detection programme offered clinical breast examination screening for all women receiving cervical cancer screening, and diagnostic breast examination for women with breast cancer symptoms. Women with abnormal breast examinations were referred to district hospitals and then to referral hospitals if needed. We examined how often clinics were held, patient volumes and number of referrals. We also examined intervals between referrals and visits to the next care level and, among women diagnosed with cancer, their initial reasons for seeking care. Findings Health centres held clinics > 68% of the weeks. Overall, 9763 women received cervical cancer screening and clinical breast examination and 7616 received breast examination alone. Of 585 women referred from health centres, 436 (74.5%) visited the district hospital after a median of 9 days (interquartile range, IQR: 3-19). Of 200 women referred to referral hospitals, 179 (89.5%) attended after a median of 11 days (IQR: 4-18). Of 29 women diagnosed with breast cancer, 19 were ≥ 50 years and 23 had stage III or stage IV disease. All women with breast cancer whose reasons for seeking care were known (23 women) had experienced breast cancer symptoms. Conclusion In the short-term, integrating clinical breast examination with cervical cancer screening was not associated with detection of early-stage breast cancer among asymptomatic women. Priority should be given to encouraging women to seek timely care for symptoms.
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Affiliation(s)
- Lydia E Pace
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA02115, United States of America (USA)
| | | | | | | | | | | | | | - Amanda Fata
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA02115, United States of America (USA)
| | | | | | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, USA
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Christensen EW, Pelzl CE, Patel BK, Carlos RC, Rula EY. Urbanicity, Income, and Mammography-Use Disparities Among American Indian Women. Am J Prev Med 2023; 64:611-620. [PMID: 37085244 DOI: 10.1016/j.amepre.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Reported breast cancer screening among American Indian women is consistently below that of White women. The last claims-based trends were from 1991 to 2001. This study updates mammography trends for American Indian women and examines the impact of race, urbanicity, and income on long-term mammography use. METHODS This was a multi-year (2005-2019), retrospective study of women aged 40-89 years using a 5% sample of Medicare fee-for-service beneficiaries residing in Arizona, California, New Mexico, Oklahoma, and Washington. This study used multivariable logistic regression to examine the impact of urbanicity and income on receiving mammography for American Indian women compared with that for White women. Analyses were conducted in 2022. RESULTS Overall, annual age-adjusted mammography use declined from 205 per 1,000 in 2005 to 165 per 1,000 in 2019. The slope of these declines was significantly steeper (difference = -2.41, p<0.001) for White women (-3.06) than for American Indian women (-0.65). Mammography-use odds across all urbanicity categories were less for American Indian women than for White women compared with those of their respective metropolitan counterparts (e.g., rural: 0.96, 95% CI=0.77, 1.20 for American Indian women and 1.47, 99% CI=1.39, 1.57 for White women). Although residing in higher-income communities was not associated with mammography use for American Indian women, it was 31% higher for White women (OR=1.31, 99% CI=1.28, 1.34). CONCLUSIONS The disparity in annual age-adjusted mammography use between American Indian and White women narrowed between 2005 and 2019. However, the association of urbanicity and community income on mammography use differs substantially between American Indian and White women. Policies to reduce disparities need to consider these differences.
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Affiliation(s)
- Eric W Christensen
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; Health Services Management, University of Minnesota, St Paul, Minesota.
| | - Casey E Pelzl
- Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Bhavika K Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Ruth C Carlos
- Division of Abdominal Radiology, University of Michigan, Ann Arbor, Michigan
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Gray TW, Podewils LJ, Rasulo RM, Weiss RP, Tomcho MM. Examining the Implementation of Health-Related Social Need (HRSN) Screenings at a Pediatric Community Health Center. J Prim Care Community Health 2023; 14:21501319231171519. [PMID: 37148221 PMCID: PMC10164847 DOI: 10.1177/21501319231171519] [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: 01/24/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDoH) influence health outcomes and screening for health-related social needs (HRSN) is a recommended pediatric practice. In 2018, Denver Health and Hospitals (DH) implemented the Accountable Health Communities (AHC) model under the Centers for Medicare and Medicaid Services (CMS) and began using the AHC HRSN screening tool during selected well child visits (WCVs) at a DH Federally Qualified Health Center (FQHC). The current evaluation aimed to examine the program implementation and identify key lessons learned to inform the expansion of HRSN screening and referral to other populations and health systems. METHODS Patients who completed a WCV between June 1, 2020 and December 31, 2021 (N = 13 750) were evaluated. Frequencies and proportions were used to describe patient characteristics of those that had a WCV, were screened, and received resource information. Multivariable logistic regression models with odds ratios (OR) and 95% confidence intervals (CI) were used to determine the association between patient characteristics and completing HRSN screening and provision of resource information. RESULTS The screening tool was completed by 80% (n = 11 004) of caregivers bringing children to a WCV at the DH Westside Clinic, with over one-third (34.8%; n = 3830) reporting >1 social need. Food insecurity was the most common concern (22.3%; n = 2458). Non-English, non-Spanish (NENS) speakers were less likely to be screened (OR 0.43, 95% CI 0.33, 0.57) and less likely to report a social need (OR 0.59, 95% CI 0.42, 0.82) than speakers of English, after adjusting for age, race/ethnicity, and health insurance. CONCLUSIONS A high rate of screening indicates feasibility of administering HRSN screenings for pediatric patients in a busy FQHC. More than a third of patients reported one or more social needs, underscoring the importance to identity these needs and the opportunity to offer personalized resources. Comparatively lower rates of screening and potential underreporting among NENS may be indicative of the availability and acceptability of current translation procedures as well as how the tool translates linguistically and culturally. Our experience highlights the need to partner with community organizations and involve patients and families to ensure SDoH screening and care navigation is part of culturally-appropriate patient-centered care.
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Affiliation(s)
| | - Laura J. Podewils
- Denver Health and Hospital Authority, Denver, CO, USA
- University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | | | | | - Margaret M. Tomcho
- Denver Health and Hospital Authority, Denver, CO, USA
- University of Colorado Anschutz Medical Campus, Denver, CO, USA
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Song SY, Lee YY, Shin HY, Park B, Suh M, Choi KS, Jun JK. Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey, 2005-2020. Epidemiol Health 2022; 44:e2022111. [PMID: 36470263 PMCID: PMC10396513 DOI: 10.4178/epih.e2022111] [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: 07/21/2022] [Accepted: 11/24/2022] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES Since 2002, the Korean government has provided breast cancer screening as part of the National Cancer Screening Program. This study reported trends in the screening rate among Korean women from 2005 to 2020, including organized and opportunistic screening for breast cancer. METHODS Data from the Korean National Cancer Screening Survey, an annual cross-sectional nationwide survey, were collected using a structured questionnaire between 2005 and 2020. The study population included 23,702 women aged 40-74 years with no history of cancer. We estimated the screening rate based on the current recommendation of biennial mammographic screening for breast cancer. In addition, a joinpoint trend analysis was performed for breast cancer screening rates among various subgroups. RESULTS In 2020, the breast cancer screening rate was 63.5%, reflecting an annual increase of 7.72% (95% confidence interval 5.53 to 9.95) between 2005 and 2012, followed by non-significant trends thereafter. In particular, a significant decrease in the breast cancer screening rate was observed in the subgroups aged 50-59 years old, with 12-15 years of education, and living in rural areas. CONCLUSIONS Although there has been substantial improvement in breast cancer screening rates in Korean women, the trend has flattened in recent years. Therefore, continual efforts are required to identify subgroups with unmet needs and solve barriers to the uptake of breast cancer screening.
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Affiliation(s)
- Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yun Yeong Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | | | - Bomi Park
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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22
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Bretthauer M, Løberg M, Wieszczy P, Kalager M, Emilsson L, Garborg K, Rupinski M, Dekker E, Spaander M, Bugajski M, Holme Ø, Zauber AG, Pilonis ND, Mroz A, Kuipers EJ, Shi J, Hernán MA, Adami HO, Regula J, Hoff G, Kaminski MF. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. N Engl J Med 2022; 387:1547-1556. [PMID: 36214590 DOI: 10.1056/nejmoa2208375] [Citation(s) in RCA: 175] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. METHODS We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. RESULTS Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04). CONCLUSIONS In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. (Funded by the Research Council of Norway and others; NordICC ClinicalTrials.gov number, NCT00883792.).
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Affiliation(s)
- Michael Bretthauer
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Magnus Løberg
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Paulina Wieszczy
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Mette Kalager
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Louise Emilsson
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Kjetil Garborg
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Maciej Rupinski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Evelien Dekker
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Manon Spaander
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Marek Bugajski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Øyvind Holme
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Ann G Zauber
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Nastazja D Pilonis
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Andrzej Mroz
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Ernst J Kuipers
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Joy Shi
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Miguel A Hernán
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Hans-Olov Adami
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Jaroslaw Regula
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Geir Hoff
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Michal F Kaminski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
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Shams T, Alhashemi H, Madkhali A, Noorelahi A, Allarakia S, Faden Y, Alhasani A, Alzahrani K, Alrefai A, Ghilan NA, Al-Sum H, Kurdi S, Al-Ansari Y, Alotaibi M. Comparing pregnancy outcomes between symptomatic and asymptomatic COVID-19 positive unvaccinated women- Multicenter study in Saudi Arabia. J Infect Public Health 2022; 15:845-852. [PMID: 35779468 PMCID: PMC9225930 DOI: 10.1016/j.jiph.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 12/26/2022] Open
Abstract
Introduction COVID-19 infection in pregnancy ranges from asymptomatic infection to severe disease. However, the maternal and pregnancy outcomes are primarily favorable. Acute Respiratory Illness (ARI) score is a Visual Triage Checklist for Acute Respiratory symptoms created by the ministry of health of Saudi Arabia 12 to screen the patient for acute respiratory infection with MERS-CoV. It has been used during the COVID-19 pandemic to identify suspected cases and place patients in isolation precautions if the score is≥ 4. Method This study is a cross-sectional study of all pregnant women who tested positive for COVID-19 in four medical centers located in four different cities in Saudi Arabia. The study period was from 1/3/2020 until 31/10/2020. Outcomes investigated were the prevalence of COVID infection in pregnant women at the time of delivery. Rate of asymptomatic disease, different maternal and pregnancy outcomes. Women were divided into symptomatic and asymptomatic groups according to the ARI score. The two groups were compared in maternal, perinatal, and neonatal outcomes. Furthermore, the cohort was divided according to maternal age into two groups: women of advanced maternal age ≥ 35 years and younger. The two groups were compared in maternal, perinatal, and neonatal outcomes Results During the study period, 9573 women gave birth at KAMCs, and 402 pregnant women were identified as COVID positive. Out of all COVID-positive women, only 394 women gave birth at KAMCs. The screening for COVID infection differed between the centers, but the testing was the same by the Nasopharyngeal polymerase chain reaction (PCR) swab. In Riyadh, screening was based on ARI scoring at the beginning of the pandemic. Then, it became universal. In Jeddah, the screening was based on ARI scoring. Any woman who scored four or more was labeled as suspected, and she was tested. Finally, in Madinah and Dammam, the screening was universal throughout the study. The prevalence of COVID-19 infection among women who gave birth at KAMCs was 4.2% (402/9573). (CI 3.8–4.6%). At the time of diagnosis, most women (62%) were asymptomatic. The most common symptoms were cough and shortness of breath. Twenty-two women (5.5%) had Pneumonia, and five women (1.3%) needed admission to Intensive care units (ICU). One woman died due to respiratory failure. When pregnancy outcomes were compared between symptomatic and asymptomatic women, pregnancy in symptomatic women was more likely to be complicated by Abortion (6 versus 2% p-value 0.00), fetal death (3 versus 1.3%), and cesarean delivery (30.8 versus 22.4%, p-value 0.001). COVID-positive pregnant women of advanced maternal age (AMA) were more likely to be symptomatic, have Abortion (5 versus 1%, p-value 0.01), and have Preterm delivery (17 versus 11% p-value 0.01) than younger women. In addition, neonatal death was more common in AMA COVID-positive women than younger (4 versus 0%), regardless of COVID-related symptoms. Conclusion Most of the COVID-infected pregnant women are asymptomatic. Therefore, the ARI scoring system does not help to triage patients. Symptomatic women, especially those older than 35, tend to have a higher maternal and pregnancy complication rate.
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Affiliation(s)
- Taghreed Shams
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia.
| | - Hashem Alhashemi
- Department of Medicine, Ministry of National Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia
| | - Azza Madkhali
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia
| | - Abdullah Noorelahi
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Jeddah, Saudi Arabia
| | - Sabah Allarakia
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia
| | - Yaser Faden
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia
| | - Amar Alhasani
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Al Madinah, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia
| | - Khalid Alzahrani
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Dammam, Saudi Arabia
| | - Alyaa Alrefai
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia
| | - Nadia Al Ghilan
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia
| | - Haitham Al-Sum
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia; King Abdullah International Research Center (KAIMRC), Saudi Arabia
| | - Saad Kurdi
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Riyadh, Saudi Arabia
| | - Yousif Al-Ansari
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Riyadh, Saudi Arabia
| | - Maha Alotaibi
- Department of Obstetrics and Gynecology, Ministry of National Health Affairs, Riyadh, Saudi Arabia
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Feltes BC, Vieira IA, Parraga-Alava J, Meza J, Portmann E, Terán L, Dorn M. Feature selection reveal peripheral blood parameter's changes between COVID-19 infections patients from Brazil and Ecuador. Infection, Genetics and Evolution 2022; 98:105228. [PMID: 35104680 PMCID: PMC8800568 DOI: 10.1016/j.meegid.2022.105228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
The investigation of conventional complete blood-count (CBC) data for classifying the SARS-CoV-2 infection status became a topic of interest, particularly as a complementary laboratory tool in developing and third-world countries that financially struggled to test their population. Although hematological parameters in COVID-19-affected individuals from Asian and USA populations are available, there are no descriptions of comparative analyses of CBC findings between COVID-19 positive and negative cases from Latin American countries. In this sense, machine learning techniques have been employed to examine CBC data and aid in screening patients suspected of SARS-CoV-2 infection. In this work, we used machine learning to compare CBC data between two highly genetically distinguished Latin American countries: Brazil and Ecuador. We notice a clear distribution pattern of positive and negative cases between the two countries. Interestingly, almost all red blood cell count parameters were divergent. For males, neutrophils and lymphocytes are distinct between Brazil and Ecuador, while eosinophils are distinguished for females. Finally, neutrophils, lymphocytes, and monocytes displayed a particular distribution for both genders. Therefore, our findings demonstrate that the same set of CBC features relevant to one population is unlikely to apply to another. This is the first study to compare CBC data from two genetically distinct Latin American countries.
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Affiliation(s)
- Bruno César Feltes
- Department of Genetics, Institute of Bioscience, and Department of Biophysics, Institute of Bioscience, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Igor Araújo Vieira
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Jorge Parraga-Alava
- Facultad de Ciencias Informaticas, Universidad Técnica de Manabí, Portoviejo, Manabí, Ecuador
| | - Jaime Meza
- Facultad de Ciencias Informaticas, Universidad Técnica de Manabí, Portoviejo, Manabí, Ecuador
| | - Edy Portmann
- Human-IST Institute, University of Fribourg, Fribourg, Switzerland
| | - Luis Terán
- Human-IST Institute, University of Fribourg, Fribourg, Switzerland
| | - Márcio Dorn
- Institute of Informatics, Center of Biotechnology, Federal University of Rio Grande do Sul, RS, Brazil; National Institute of Science and Technology - Forensic Science, Porto Alegre, RS, Brazil.
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Saboo K, Petrakov NV, Shamsaddini A, Fagan A, Gavis EA, Sikaroodi M, McGeorge S, Gillevet PM, Iyer RK, Bajaj JS. Stool microbiota are superior to saliva in distinguishing cirrhosis and hepatic encephalopathy using machine learning. J Hepatol 2022; 76:600-607. [PMID: 34793867 PMCID: PMC8858861 DOI: 10.1016/j.jhep.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Saliva and stool microbiota are altered in cirrhosis. Since stool is logistically difficult to collect compared to saliva, it is important to determine their relative diagnostic and prognostic capabilities. We aimed to determine the ability of stool vs. saliva microbiota to differentiate between groups based on disease severity using machine learning (ML). METHODS Controls and outpatients with cirrhosis underwent saliva and stool microbiome analysis. Controls vs. cirrhosis and within cirrhosis (based on hepatic encephalopathy [HE], proton pump inhibitor [PPI] and rifaximin use) were classified using 4 ML techniques (random forest [RF], support vector machine, logistic regression, and gradient boosting) with AUC comparisons for stool, saliva or both sample types. Individual microbial contributions were computed using feature importance of RF and Shapley additive explanations. Finally, thresholds for including microbiota were varied between 2.5% and 10%, and core microbiome (DESeq2) analysis was performed. RESULTS Two hundred and sixty-nine participants, including 87 controls and 182 patients with cirrhosis, of whom 57 had HE, 78 were on PPIs and 29 on rifaximin were included. Regardless of the ML model, stool microbiota had a significantly higher AUC in differentiating groups vs. saliva. Regarding individual microbiota: autochthonous taxa drove the difference between controls vs. patients with cirrhosis, oral-origin microbiota the difference between PPI users/non-users, and pathobionts and autochthonous taxa the difference between rifaximin users/non-users and patients with/without HE. These were consistent with the core microbiome analysis results. CONCLUSIONS On ML analysis, stool microbiota composition is significantly more informative in differentiating between controls and patients with cirrhosis, and those with varying cirrhosis severity, compared to saliva. Despite logistic challenges, stool should be preferred over saliva for microbiome analysis. LAY SUMMARY Since it is harder to collect stool than saliva, we wanted to test whether microbes from saliva were better than stool in differentiating between healthy people and those with cirrhosis and, among those with cirrhosis, those with more severe disease. Using machine learning, we found that microbes in stool were more accurate than saliva alone or in combination, therefore, stool should be preferred for analysis and collection wherever possible.
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Affiliation(s)
- Krishnakant Saboo
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nikita V Petrakov
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Andrew Fagan
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | - Edith A Gavis
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | | | - Sara McGeorge
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | | | - Ravishankar K Iyer
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA.
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Štotl I, Blagus R, Urbančič-Rovan V. Individualised screening of diabetic foot: creation of a prediction model based on penalised regression and assessment of theoretical efficacy. Diabetologia 2022; 65:291-300. [PMID: 34741637 DOI: 10.1007/s00125-021-05604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/23/2021] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS A large proportion of people with diabetes do not receive proper foot screening due to insufficiencies in healthcare systems. Introducing an effective risk prediction model into the screening protocol would potentially reduce the required screening frequency for those considered at low risk for diabetic foot complications. The main aim of the study was to investigate the value of individualised risk assignment for foot complications for optimisation of screening. METHODS From 2015 to 2020, 11,878 routine follow-up foot investigations were performed in the tertiary diabetes clinic. From these, 4282 screening investigations with complete data containing all of 18 designated variables collected at regular clinical and foot screening visits were selected for the study sample. Penalised logistic regression models for the prediction of loss of protective sensation (LOPS) and loss of peripheral pulses (LPP) were developed and evaluated. RESULTS Using leave-one-out cross validation (LOOCV), the penalised regression model showed an AUC of 0.84 (95% CI 0.82, 0.85) for prediction of LOPS and 0.80 (95% CI 0.78, 0.83) for prediction of LPP. Calibration analysis (based on LOOCV) presented consistent recall of probabilities, with a Brier score of 0.08 (intercept 0.01 [95% CI -0.09, 0.12], slope 1.00 [95% CI 0.92, 1.09]) for LOPS and a Brier score of 0.05 (intercept 0.01 [95% CI -0.12, 0.14], slope 1.09 [95% CI 0.95, 1.22]) for LPP. In a hypothetical follow-up period of 2 years, the regular screening interval was increased from 1 year to 2 years for individuals at low risk. In individuals with an International Working Group on the Diabetic Foot (IWGDF) risk 0, we could show a 40.5% reduction in the absolute number of screening examinations (3614 instead of 6074 screenings) when a 10% risk cut-off was used and a 26.5% reduction (4463 instead of 6074 screenings) when the risk cut-off was set to 5%. CONCLUSIONS/INTERPRETATION Enhancement of the protocol for diabetic foot screening by inclusion of a prediction model allows differentiation of individuals with diabetes based on the likelihood of complications. This could potentially reduce the number of screenings needed in those considered at low risk of diabetic foot complications. The proposed model requires further refinement and external validation, but it shows the potential for improving compliance with screening guidelines.
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Affiliation(s)
- Iztok Štotl
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sports, University of Ljubljana, Ljubljana, Slovenia
| | - Vilma Urbančič-Rovan
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Garofalo R, Adetunji A, Kuhns LM, Omigbodun O, Johnson AK, Kuti K, Awolude OA, Berzins B, Janulis P, Okonkwor O, Oladeji B, Muldoon AL, Amoo OP, Atunde H, Kapogiannis B, Taiwo BO. Evaluation of the iCARE Nigeria Pilot Intervention Using Social Media and Peer Navigation to Promote HIV Testing and Linkage to Care Among High-Risk Young Men: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e220148. [PMID: 35191969 PMCID: PMC8864509 DOI: 10.1001/jamanetworkopen.2022.0148] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Nigeria has the fourth-largest HIV epidemic globally, yet high levels of social stigma inhibit HIV testing among Nigerian youths and young men who have sex with men (MSM). OBJECTIVE To report pilot data from iCARE Nigeria (Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents), a combination intervention using social media and peer navigation to promote HIV testing and linkage to care among high-risk youths and young men (hereinafter referred to as young men), including predominantly young MSM. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled study assessed an organizational and community-level 12-month, preintervention-postintervention pilot trial of a combination intervention designed to increase HIV testing uptake, increase the rate of identified seropositive cases, and improve linkage to care among young men, including MSM, using social media outreach and peer navigation. Data were collected from June 1, 2019, to May 30, 2020. Participants were young men aged 15 to 24 years in the city of Ibadan, Nigeria, and surrounding areas. Frequencies and percentages were examined, and a Fisher exact test was used to evaluate outcomes compared with historical surveillance data. Linkage to care was defined as 2 clinic visits, including HIV confirmation, within 2 months of a positive rapid test result. INTERVENTION Four peer navigators conducted social media outreach promoting sexual health and guiding individuals to HIV counseling and rapid testing in clinical, community, or home-based settings. MAIN OUTCOMES AND MEASURES Primary outcomes included the number of young men tested for HIV at university-based iCARE catchment clinics or by iCARE peer navigators in the community, the postintervention HIV seroprevalence of these groups, and linkage to care of participants diagnosed with HIV infection. RESULTS A total of 339 participants underwent testing for HIV (mean [SD] age, 21.7 [1.9] years), with 283 (83.5%) referred through social media. The main referral sources for social media were WhatsApp (124 [43.8%]), Facebook (101 [35.7%]), and Grindr (57 [20.1%]). Regarding testing location, participants chose home (134 [39.5%]), community-based (202 [59.6%]), or clinic (3 [0.9%]) settings. Eighty-six participants reported no prior HIV testing. Thirty-six participants (10.6%) were confirmed as HIV seropositive; among those, 18 (50.0%) reported negative test results within the past year, and 31 (86.1%) were linked to care. In two 6-month follow-up periods, the intervention increased HIV testing by 42% and 31%, respectively, and seroprevalence increased compared with historical trends with odds ratios of 3.37 (95% CI, 1.43-8.02; P = .002) and 2.74 (95% CI, 1.10-7.11; P = .02), respectively. CONCLUSIONS AND RELEVANCE These findings suggest that use of iCARE Nigeria was associated with increased HIV testing and linkage to care in a high-risk, difficult-to-reach population, making it a promising combination intervention for young MSM. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN94590823.
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Affiliation(s)
- Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Olayinka Omigbodun
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Nigeria
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Amy K. Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Kehinde Kuti
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Olutosin A. Awolude
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois
| | - Bibilola Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abigail L. Muldoon
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Oluwaseun P. Amoo
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hannah Atunde
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Babafemi O. Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois
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Lock LJ, Banghart M, Channa R, Smith MA, Brennan MB, Torres Diaz A, Liu Y. Analysis of Health System Size and Variability in Diabetic Eye Disease Screening in Wisconsin. JAMA Netw Open 2022; 5:e2143937. [PMID: 35040971 PMCID: PMC8767430 DOI: 10.1001/jamanetworkopen.2021.43937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study uses statewide claims data to assess variability in diabetic eye disease screening across Wisconsin health systems and to examine the association between patient health system and screening receipt.
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Affiliation(s)
- Loren J. Lock
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Mark Banghart
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Maureen A. Smith
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Meghan B. Brennan
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Alejandra Torres Diaz
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
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Wood S, Min J, Tam V, Pickel J, Petsis D, Campbell K. Inequities in Chlamydia trachomatis Screening Between Black and White Adolescents in a Large Pediatric Primary Care Network, 2015-2019. Am J Public Health 2022; 112:135-143. [PMID: 34936422 PMCID: PMC8713640 DOI: 10.2105/ajph.2021.306498] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives. To identify associations between patient race and annual chlamydia screening among adolescent females. Methods. We performed a retrospective cohort study of females aged 15 to 19 years in a 31-clinic pediatric primary care network in Pennsylvania and New Jersey from 2015 through 2019. Using mixed-effect logistic regressions, we estimated associations between annual chlamydia screening and patient (race/ethnicity, age, previous chlamydia screening and infection, insurance type) and clinic (size, setting) characteristics. We decomposed potential effects of clinician's implicit racial bias and screening, using covariates measuring the proportion of Black patients in each clinician's practice. Results. There were 68 935 well visits among 37 817 females, who were 28.8% Black and 25.8% Medicaid insured. The mean annual chlamydia screening rate was 11.1%. Black females had higher odds of screening (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [CI] = 1.51, 1.84) than did White females. In the clinician characteristics model, individual clinicians were more likely to screen their Black versus non-Black patients (AOR = 1.88; 95% CI = 1.65, 2.15). Conclusions. Racial bias may affect screening practices and should be addressed in future interventions, given the critical need to increase population-level chlamydia screening.(Am J Public Health. 2022;112(1):135-143. https://doi.org/10.2105/AJPH.2021.306498).
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Affiliation(s)
- Sarah Wood
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Jungwon Min
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Vicky Tam
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Julia Pickel
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Danielle Petsis
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Kenisha Campbell
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
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Finney Rutten LJ, Parks PD, Weiser E, Fan C, Jacobson DJ, Jenkins GD, Zhu X, Griffin JM, Limburg PJ. Health Care Provider Characteristics Associated With Colorectal Cancer Screening Preferences and Use. Mayo Clin Proc 2022; 97:101-109. [PMID: 34920895 DOI: 10.1016/j.mayocp.2021.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess health care provider (HCP) preferences related to colorectal cancer (CRC) screening overall, and by HCP and patient characteristics. PARTICIPANTS AND METHODS We developed a survey based on the Theoretical Domains Framework to assess factors associated with CRC screening preferences in clinical practice. The survey was administered online November 6 through December 6, 2019, to a validated panel of HCPs drawn from US national databases and professional organizations. The final analysis sample included 779 primary care clinicians (PCCs) and 159 gastroenterologists (GIs). RESULTS HCPs chose colonoscopy as their preferred screening method for average-risk patients (96.9% (154/159) for GIs, 75.7% (590/779) for PCCs). Among PCCs, 12.2% (95/779) preferred multi-target stool DNA (mt-sDNA), followed by fecal immunochemical test (FIT), (7.3%; 57/779) and guaiac-based fecal occult blood test (gFOBT) (4.8%; 37/779). Preference among PCCs and GIs generally shifted toward noninvasive screening options for patients who were unable to undergo invasive procedures; concerned about taking time from work; unconvinced about need for screening; and refusing other screening recommendations. Among PCCs, preference for mt-sDNA over FIT and gFOBT was less frequent in larger compared with smaller clinical practices. Additionally, preference for mt-sDNA over FIT was more likely among PCCs with more years of clinical experience, higher patient volumes (> 25/day), and practice locations in suburban and rural settings (compared to urban). CONCLUSION Both PCCs and GIs preferred colonoscopy for CRC screening of average-risk patients, although PCCs did so less frequently and with approximately a quarter preferring stool-based tests (particularly mt-sDNA). PCCs' preference varied by provider and patient characteristics. Our findings underscore the importance of informed choice and shared decision-making about CRC screening options.
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Affiliation(s)
| | | | | | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Gregory D Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, rochester, MN, USA
| | - Paul J Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Abstract
BACKGROUND Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening. OBJECTIVE The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening. RESEARCH DESIGN A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk. SUBJECTS A total of 11,163 individuals at high risk for lung cancer just above and below age 65. MEASURE Self-reported use of low-dose computed tomography to screen for lung cancer in the past 12 months. RESULTS A total of 10,951 people at high lung cancer risk (45.7% women, response rate=98.1%) reported lung cancer screening information. Nearly universal access to Medicare increased lung cancer screening by 16.2 percentage points among men (95% confidence interval: 2.4%-30.0%, P=0.02), compared with a baseline screening rate of 11.1% just younger than age 65. Women had a baseline screening rate of 18.2% and experienced no statistically significant change in screening (1.6 percentage point increase, 95% confidence interval: -19.8% to 23.0%, P=0.88). CONCLUSIONS Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening.
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Affiliation(s)
- Jiren Sun
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Marcelo Coca Perraillon
- Department of Health, Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca Myerson
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Cullinen K, Hill M, Anderson T, Jones V, Nelson J, Halawani M, Zha P. Improving sexually transmitted infection screening, testing, and treatment among people with HIV: A mixed method needs assessment to inform a multi-site, multi-level intervention and evaluation plan. PLoS One 2021; 16:e0261824. [PMID: 34962965 PMCID: PMC8714108 DOI: 10.1371/journal.pone.0261824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022] Open
Abstract
Bacterial sexually transmitted infections (STIs) continue to be a worsening public health concern in the United States (US). Though the national incidence of HIV infection has decreased over recent years, that of chlamydia, gonorrhea, and syphilis have not. Despite national recommendations on prevention, screening, and treatment of these STIs, these practices have not been standardized. Nine Health Resources and Services Administration Ryan White HIV/AIDS Program funded clinics across 3 US jurisdictions (Florida, Louisiana, and Washington, DC), were selected as clinical demonstration sites to be evaluated in this mixed method needs assessment to inform a multi-site, multi-level intervention to evaluate evidence-based interventions to improve STI screening and testing of bacterial STIs among people with or at risk for HIV. These 3 US jurisdictions were selected due to having higher than national average incidence rates of HIV and bacterial STIs. Descriptive statistics and deductive analysis were used to assess quantitative and qualitative needs assessment data. Results indicate the following needs across participating sites: inconsistent and irregular comprehensive sexual behavior history taking within and among sites, limited routine bacterial STI testing (once/year and if symptomatic) not in accordance with CDC recommendations, limited extragenital site gonorrhea/chlamydia testing, limited annual training on STI-related topics including LGBTQ health and adolescent/young adult sexual health, and limited efforts for making high-STI incidence individuals feel welcome in the clinic (primarily LGBTQ individuals and adolescents/young adults). These findings were used to identify interventions to be used to increase routine screenings and testing for bacterial STIs.
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Affiliation(s)
- Kathleen Cullinen
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
- * E-mail:
| | - Macsu Hill
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Taylor Anderson
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Veronica Jones
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - John Nelson
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Mirna Halawani
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Peijia Zha
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
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Hortlund M, Mühr LSA, Lagheden C, Hjerpe A, Dillner J. Audit of laboratory sensitivity of human papillomavirus and cytology testing in a cervical screening program. Int J Cancer 2021; 149:2083-2090. [PMID: 34418082 DOI: 10.1002/ijc.33769] [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: 04/28/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/07/2022]
Abstract
The globally recommended public health policy for cervical screening is primary human papillomavirus (HPV) screening with cytology triaging of positives. To ensure optimal quality of laboratory services we have conducted regular audits of cervical smears taken before cervical cancer or cancer in situ (CIN3+) within an HPV-based screening program. The central cervical screening laboratory of Stockholm, Sweden, identified cases of CIN3+ who had had a previous cervical screening test up to 3 years before and randomly selected 300 cervical liquid-based cytology (LBC) samples for auditing. HPV testing with Roche Cobas was performed either at screening or with biobanked samples. HPV negative samples and subsequent biopsies were retrieved and tested with modified general primer HPV PCR and, if still HPV-negative, the LBCs and biopsies were whole genome sequenced. The Cobas 4800 detected HPV in 1020/1052 (97.0%) LBC samples taken before CIN3+. Further analyses found HPV in 28 samples, with nine of those containing HPV types not targeted by the Cobas 4800 test. There were 4 specimens (4/1052, 0.4%) where no HPV was detected. By comparison, the proportion of CIN3+ cases that were positive in a previous cytology were 91.6%. We find that the routine HPV screening test had a sensitivity in the real-life screening program of 97.0%. Regular laboratory audits of cervical samples taken before CIN3+ can be readily performed within a real-life screening program and provide assurance that the laboratory of the real-life program has the expected performance.
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Affiliation(s)
- Maria Hortlund
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Camilla Lagheden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjerpe
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Cervical Cancer Prevention, Department of Pathology & Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
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Castanon A, Kamineni A, Elfström KM, Lim AWW, Sasieni P. Exposure Definition in Case-Control Studies of Cervical Cancer Screening: A Systematic Literature Review. Cancer Epidemiol Biomarkers Prev 2021; 30:2154-2166. [PMID: 34526301 PMCID: PMC8643309 DOI: 10.1158/1055-9965.epi-21-0376] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 01/07/2023] Open
Abstract
The first step in evaluating the effectiveness of cervical screening is defining exposure to screening. Our aim was to describe the spectrum of screening exposure definitions used in studies of the effectiveness of cervical screening. This systematic review included case-control studies in a population-based screening setting. Outcome was incidence of cervical cancer. Three electronic databases were searched from January 1, 2012 to December 6, 2018. Articles prior to 2012 were identified from a previous review. The qualitative synthesis focused on describing screening exposure definitions reported in the literature and the methodologic differences that could have an impact on the association between screening and cervical cancer. Forty-one case-control studies were included. Six screening exposure definitions were identified. Cervical cancer risk on average decreased by 66% when screening exposure was defined as ever tested, by 77% by time since last negative test, and by 79% after two or more previous tests. Methodologic differences included composition of the reference group and whether diagnostic and/or symptomatic tests were excluded from the analysis. Consensus guidelines to standardize exposure definitions are needed to ensure evaluations of cervical cancer screening can accurately measure the impact of transitioning from cytology to human papillomavirus-based screening and to allow comparisons between programs.
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Affiliation(s)
- Alejandra Castanon
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, United Kingdom.
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - K Miriam Elfström
- Institutionen för Laboratoriemedicin, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anita W W Lim
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, United Kingdom
| | - Peter Sasieni
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, United Kingdom
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Ganesh A, Katipally R, Pasquinelli M, Feldman L, Spiotto M, Koshy M. Increased Disparities in Patients Diagnosed with Metastatic Lung Cancer Following Lung CT Screening in the United States. Clin Lung Cancer 2021; 23:151-158. [PMID: 34924304 DOI: 10.1016/j.cllc.2021.11.006] [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: 09/12/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We sought to determine if implementation of low dose computed tomography (LDCT) screening for lung cancer in the United States had led to changes in patients being diagnosed with metastatic lung cancer over time. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Result (SEER) database was utilized to determine the proportion of lung cancers diagnosed as stage I to III and stage IV from 2009-2018. Changes in lung cancer stage distribution were compared in the overall population and by race. RESULTS From 2009 to 2018, the proportion of stage I to III lung cancers increased from 52% (51.3%-53.2%) in 2009 to 56% (54.0%-55.8%) in 2018 (P < .001). Correspondingly, the proportion of lung cancers diagnosed in stage IV decreased from 48% (46.8%-48.7%) in 2009 to 45% (44.2%-46.0%) (P < .001) in 2018. For white patients, the proportion increased from 53% (51.6%-53.7%) to 56% (55.1%-57.1%) (P < .001). However, for black patients, no trend was present, with the proportion being 51% (47.9%-53.4%) in 2009 and 52% (49.0%-54.2%) in 2018 (P = .303). CONCLUSION Since the implementation of LDCT screening, the proportion of early-stage lung cancers increased in the general population. These changes in stage distribution were not present in black patients.
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Affiliation(s)
- Ashwin Ganesh
- College of Medicine, University of Illinois at Chicago, Chicago, IL.
| | - Rohan Katipally
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
| | - Mary Pasquinelli
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
| | - Lawrence Feldman
- Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Michael Spiotto
- Department of Radiation and Cellular Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Matthew Koshy
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL; Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL
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Abstract
The purpose of this study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on patients undergoing radiotherapy by comparing the patterns of unplanned radiotherapy interruption before and after the COVID-19 pandemic. We enrolled patients who received their first dose of radiotherapy for breast cancer between January 28 and July 31, 2019 and between January 28, 2020, and July 31, 2020. We compared the radiotherapy interruption patterns in 2019 with those in 2020 to analyze the impact of the COVID-19 pandemic on treatment interruption. Between January 28 and July 31, 2019, 287 patients with breast cancer received radiotherapy. Among them, 19 patients (6.6%) experienced treatment interruption; the reasons for treatment interruption were radiotherapy-related side effects (10 patients, 52.6%), other medical reasons (three patients, 15.8%), and personal reasons (six patients, 31.6%). Between January 28 and July 31, 2020, 279 patients with breast cancer received radiotherapy. Among them, 23 patients (8.2%) experienced treatment interruption; the reasons for treatment interruption were radiotherapy-related side effects (eight patients, 35%) and COVID-19 screening clinic-related reasons (six patients, 26.1%). Among the six patients with screening clinic-related causes of radiotherapy interruption, five had asymptomatic fever and one had mild cold-like symptoms. The duration of treatment interruption was longer in patients with screening clinic-related interruptions than in those with interruptions because of other causes (p = 0.019). Multivariate analysis showed that cancer stage and radiotherapy volume did not significantly affect treatment interruption. The radiotherapy of certain patients was suspended despite the lack of a confirmed COVID-19 diagnosis. Precise and systematic criteria for the management of patients with suspected COVID-19 are needed, and the opinion of radiation oncologist in charge of the patient must also be considered.
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Affiliation(s)
- Shiho Lee
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Choi UY, Jung SE, Kim MS, Oh HS, Kwon YM, Lee J, Choi JH. Analysis of a COVID-19 Prescreening Process in an Outpatient Clinic at a University Hospital during the COVID-19 Pandemic. J Korean Med Sci 2021; 36:e295. [PMID: 34725979 PMCID: PMC8560321 DOI: 10.3346/jkms.2021.36.e295] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital's address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied. METHODS All cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week. RESULTS During the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44-2.10] vs. 0.59 [CI, 0.52-0.65], respectively) (P < 0.001). CONCLUSION Fever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.
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Affiliation(s)
- Ui Yoon Choi
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Infection Control Department, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Eun Jung
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Mi Sook Kim
- Infection Control Department, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyang Sook Oh
- Infection Control Department, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Mi Kwon
- Department of Performance Improvement, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jehoon Lee
- Infection Control Department, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Hyun Choi
- Infection Control Department, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Infectious Disease, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gale N, McEwan M, Camacho OM, Hardie G, Proctor CJ, Murphy J. Changes in biomarkers after 180 days of tobacco heating product use: a randomised trial. Intern Emerg Med 2021; 16:2201-2212. [PMID: 34196886 PMCID: PMC8563516 DOI: 10.1007/s11739-021-02798-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/15/2021] [Indexed: 01/14/2023]
Abstract
The aim of this study was to investigate whether biomarkers of exposure (BoE) and potential harm (BoPH) are modified when smokers switch from smoking cigarettes to exclusive use of a tobacco heating product (THP) in an ambulatory setting. Participants in this randomised, controlled study were healthy volunteer smokers assigned either to continue smoking or switch to a THP, and a control group of smokers who abstained from cigarette smoking. Various BoE and BoPH related to oxidative stress, cardiovascular and respiratory diseases, and cancer were assessed at baseline and up to 180 days. In continuing smokers, BoE and BoPH remained stable between baseline and day 180, while THP users' levels of most BoE reduced significantly, becoming similar to those in controls abstaining from cigarette smoking. Also at 180 days, significant changes in numerous BoPH, including total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, 8-epi-prostaglandin F2α type III, fractional concentration of exhaled nitric oxide and white blood cell count, were directionally consistent with lessened health impact. Our findings support the notion that the deleterious health impacts of cigarette smoking may be reduced in smokers who completely switch to using THPs.
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Affiliation(s)
- Nathan Gale
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK.
| | - Michael McEwan
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK
| | - Oscar M Camacho
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK
| | - George Hardie
- British American Tobacco (Investments) Limited, Research and Development, Regents Park Road, Southampton, SO15 8TL, UK
| | | | - James Murphy
- R. J. Reynolds Tobacco Company, 401 N Main Street, Winston-Salem, NC27101, USA
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Balakrishna S, Salazar-Vizcaya L, Schmidt AJ, Kachalov V, Kusejko K, Thurnheer MC, Roth JA, Nicca D, Cavassini M, Battegay M, Schmid P, Bernasconi E, Günthard HF, Rauch A, Kouyos RD. Assessing the drivers of syphilis among men who have sex with men in Switzerland reveals a key impact of screening frequency: A modelling study. PLoS Comput Biol 2021; 17:e1009529. [PMID: 34699524 PMCID: PMC8570495 DOI: 10.1371/journal.pcbi.1009529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 11/05/2021] [Accepted: 10/05/2021] [Indexed: 01/06/2023] Open
Abstract
Over the last decade, syphilis diagnoses among men-who-have-sex-with-men (MSM) have strongly increased in Europe. Understanding the drivers of the ongoing epidemic may aid to curb transmissions. In order to identify the drivers of syphilis transmission in MSM in Switzerland between 2006 and 2017 as well as the effect of potential interventions, we set up an epidemiological model stratified by syphilis stage, HIV-diagnosis, and behavioral factors to account for syphilis infectiousness and risk for transmission. In the main model, we used ‘reported non-steady partners’ (nsP) as the main proxy for sexual risk. We parameterized the model using data from the Swiss HIV Cohort Study, Swiss Voluntary Counselling and Testing center, cross-sectional surveys among the Swiss MSM population, and published syphilis notifications from the Federal Office of Public Health. The main model reproduced the increase in syphilis diagnoses from 168 cases in 2006 to 418 cases in 2017. It estimated that between 2006 and 2017, MSM with HIV diagnosis had 45.9 times the median syphilis incidence of MSM without HIV diagnosis. Defining risk as condomless anal intercourse with nsP decreased model accuracy (sum of squared weighted residuals, 378.8 vs. 148.3). Counterfactual scenarios suggested that increasing screening of MSM without HIV diagnosis and with nsP from once every two years to twice per year may reduce syphilis incidence (at most 12.8% reduction by 2017). Whereas, increasing screening among MSM with HIV diagnosis and with nsP from once per year to twice per year may substantially reduce syphilis incidence over time (at least 63.5% reduction by 2017). The model suggests that reporting nsP regardless of condom use is suitable for risk stratification when modelling syphilis transmission. More frequent screening of MSM with HIV diagnosis, particularly those with nsP may aid to curb syphilis transmission. Syphilis, one of the most common sexually transmitted infections, remains a major public health problem. Over the last decade, a rising number of diagnoses especially in men-who-have-sex-with-men (MSM) was observed in Western Europe and Northern America. In Switzerland, the number of syphilis diagnoses in MSM tripled between 2006 and 2017. In this study, we used a mathematical model to assess the drivers of this increase among MSM in Switzerland. Our model could reproduce the increase in syphilis diagnoses in both MSM with and without HIV diagnosis between 2006 and 2017. Based on this model we found that MSM with HIV diagnosis have an over 45 times higher syphilis incidence than MSM without HIV diagnosis. Furthermore, we found that reported sex with non-steady partners is a useful proxy of behavioral risk. Considering counterfactual scenarios, we showed that increasing the screening frequency for syphilis among MSM with HIV diagnosis and with non-steady partners from once a year to twice per year can reduce syphilis incidence by 63.5% to 99.2%.
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Affiliation(s)
- Suraj Balakrishna
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Axel J. Schmidt
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Switzerland
- Sigma Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Viacheslav Kachalov
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Jan A. Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Division of Research and Analytical Services, Department of Informatics, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger D. Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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Morgan J, Mathew T, Azariah S. Eliminating congenital syphilis from Aotearoa New Zealand. N Z Med J 2021; 134:8-12. [PMID: 34695089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Jane Morgan
- Hamilton Sexual Health Service, Waikato District Health Board, Hamilton, New Zealand
| | - Teena Mathew
- MidCentral DHB Sexual Health Service, MidCentral District Health Board, Palmerston North, New Zealand
| | - Sunita Azariah
- Auckland Regional Sexual Health Service, Auckland District Health Board, Auckland, New Zealand
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Mazzitelli M, Ciccullo A, Baldin G, Cauda R, Rusconi S, Giacomelli A, Oreni L, Borghi V, Mussini C, Guaraldi G, Sterrantino G, Lagi F, Candelaresi B, Cirioni O, De Vito A, Rossetti B, Torti C, Di Giambenedetto S. Has COVID-19 changed the approach to HIV diagnosis?: A multicentric Italian experience. Medicine (Baltimore) 2021; 100:e27418. [PMID: 34731116 PMCID: PMC8519218 DOI: 10.1097/md.0000000000027418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
The occurrence of COVID-19 pandemic had a significant negative effect on health care systems over the last year. Health care providers were forced to focus mainly on COVID-19 patients, neglecting in many cases equally important diseases, both acute and chronic. Therefore, also screening and diagnostic strategies for HIV could have been significantly impaired.This retrospective, multicenter, observational study aimed at assessing the number and characteristics of new HIV/AIDS diagnoses during COVID-19 pandemic in Italy and compared characteristics of people living with HIV at diagnosis between pre- and post-COVID-19 era (2019 vs 2020).Our results showed a significant reduction of HIV diagnoses during pandemic. By contrast, people living with HIV during pandemic were older and were diagnosed in earlier stage of disease (considering CD4+ T cell count) compared to those who were diagnosed the year before. Moreover, there was a significant decrease of new HIV diagnoses among men who have sex with men, probably for the impact of social distancing and restriction applied by the Italian Government. Late presentation incidence, if numbers in 2020 were lower than those in 2019, is still an issue.Routinely performing HIV testing in patients with suspected SARS-CoV-2 infection is identifying and linking to care underdiagnosed people living with HIV earlier. Thus, combined tests (HIV and SARS-CoV-2) should be implemented in patients with SARS-CoV-2 symptoms overlapping HIV's ones. Lastly, our results lastly showed how urgent implementation of a national policy for HIV screening is necessary.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | | | | | - Roberto Cauda
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Stefano Rusconi
- III Infectious Diseases Unit, ASST FBF-Sacco, Milan, Italy
- UOC Malattie Infettive, Ospedale di Legnano, ASST Ovest Milanese, Italy
| | - Andrea Giacomelli
- III Infectious Diseases Unit, ASST FBF-Sacco, Milan, Italy
- DIBIC Luigi Sacco, Università degli Studi di Milano, Milan, Italy
| | - Letizia Oreni
- III Infectious Diseases Unit, ASST FBF-Sacco, Milan, Italy
- DIBIC Luigi Sacco, Università degli Studi di Milano, Milan, Italy
| | - Vanni Borghi
- Clinica Malattia Infettive, Università di Modena e Reggio Emilia
| | - Cristina Mussini
- Clinica Malattia Infettive, Università di Modena e Reggio Emilia
| | | | - Gaetana Sterrantino
- Dipartimento di Medicina clinica e Sperimentale presso l’Università degli studi di Firenze
| | - Filippo Lagi
- Dipartimento di Medicina clinica e Sperimentale presso l’Università degli studi di Firenze
| | - Bianca Candelaresi
- Clinica Malattie Infettive, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Oscar Cirioni
- Clinica Malattie Infettive, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Barbara Rossetti
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | - Simona Di Giambenedetto
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
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Ba DM, McCall-Hosenfeld JS, Ssentongo P, Chinchilli VM, Agbese E, Liu G, Leslie DL, Du P. Cervical cancer screening varies by HPV vaccination status among a National Cohort of privately insured young women in the United States 2006-2016. Medicine (Baltimore) 2021; 100:e27457. [PMID: 34731120 PMCID: PMC8519251 DOI: 10.1097/md.0000000000027457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/21/2021] [Indexed: 01/05/2023] Open
Abstract
Human papillomavirus (HPV) vaccination in young women is low. Women aged 21 to 65 years in the United States (U.S.) have not reached the Healthy People 2020 objective of 93% for cervical cancer screening. The main aim of this study was to investigate the association between HPV vaccination status and cervical cancer screening among privately insured women aged 21 to 26 years in the U.S.This was a retrospective cohort study using the IBM MarketScan database (2006-2016). The study population included 190,982 HPV-vaccinated women and 763,928 matched unvaccinated women. Adjusted incidence rate ratio (IRR) and the 95% confidence intervals (CIs) were obtained using the generalized estimating equations models with a Poisson distribution.Among a total of 954,910 women included in the analysis, age (mean [SD]) was 23.3 [1.6] years. During 967,317 person-years of follow-up, a total of 475,702 incidents of cervical cancer screening were identified. The incidence density rates of cervical cancer screening were 461 per 1000 person-years (PY) for unvaccinated women and 787 per 1000 PY for those who received 3 doses of the HPV vaccine. After adjusting for other covariates, the IRR of cervical cancer screening was 34% higher among HPV-vaccinated women with at least one vaccine dose than unvaccinated women (adjusted IRR = 1.34, 95% CI: 1.33-1.35; P < .0001). The IRR of cervical cancer screening varied by the dose of HPV vaccination. There was evidence of a linear dose-response relationship between the number of HPV vaccine doses and cervical cancer screening (P-trend < .0001). Compared with unvaccinated women, the IRR of cervical cancer screening were 14%, 39%, and 60% higher among those who received 1, 2, and 3 doses of the HPV vaccine, respectively.In this large retrospective cohort study of privately insured women, HPV-vaccinated women were more likely to be screened for cervical cancer compared with unvaccinated women.
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Affiliation(s)
- Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA
| | - Jennifer S. McCall-Hosenfeld
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Department of Medicine, Penn State College of Medicine, Hershey, PA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Department of Medicine, Penn State College of Medicine, Hershey, PA
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McPherson G, Parmar P, Payne D, Fairbairn-Dunlop TP. Which demographic factors influence Pacific women's attendance at colposcopy clinics in New Zealand? N Z Med J 2021; 134:69-78. [PMID: 34695078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM The aim of this study was to examine the demographic factors associated with attendance at colposcopy clinics among Pacific women following a high-grade cytology in New Zealand. METHODS A retrospective cohort study was undertaken of Pacific women following high-grade cytology between January 2010 and December 2015. Univariate and multivariate binary logistic regression was undertaken to assess whether socioeconomic deprivation, age and Pacific ethnicity were associated with colposcopy attendance. RESULTS Colposcopy attendance for Pacific women was 84.9% at 90 days and 93.5% at 180 days following referral. Pacific women residing in the most deprived areas were less likely to attend at both 90 days (OR=0.37 95% CI: 0.21-0.67) and 180 days (OR=0.19 95% CI: 0.60-0.63). Older women were more likely to attend their colposcopy appointment at 90 days when compared to the reference group aged <24-years-old. There was no association between Pacific ethnicity and attendance when adjusting for deprivation and age. CONCLUSIONS The overall attendance rates for Pacific women were higher than expected. Despite Pacific women engaging with cervical screening, Pacific women living in the most deprived areas were less likely to be seen by colposcopy services following a high-grade cytology. Targeted interventions are required to improve service utilisation and reduce health inequities.
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Affiliation(s)
- Georgina McPherson
- Nurse Practitioner / Clinical Lead, Colposcopy Clinic, Waitematā, District Health Board, Waitakere Hospital
| | - Priya Parmar
- Senior Lecturer / Deputy Head of Department, Department of Biostatistics and Epidemiology, Auckland University of Technology
| | - Deborah Payne
- Associate Professor, Centre for Midwifery & Women's Health Research, Faculty of Health and Environmental Sciences, Auckland University of Technology
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Ortiz AP, Gierbolini-Bermúdez A, Ramos-Cartagena JM, Colón-López V, Sonawane K, Deshmukh AA, Ortiz-Ortiz KJ. Cervical Cancer Screening Among Medicaid Patients During Natural Disasters and the COVID-19 Pandemic in Puerto Rico, 2016 to 2020. JAMA Netw Open 2021; 4:e2128806. [PMID: 34652451 PMCID: PMC8520125 DOI: 10.1001/jamanetworkopen.2021.28806] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cohort study examines rates of cervical cancer screening in Puerto Rico among women with Medicaid health coverage following the 2017 hurricanes, earthquakes in late 2019-2020, and the 2020 COVID-19 lockdown.
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Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Axel Gierbolini-Bermúdez
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Jeslie M. Ramos-Cartagena
- Department of University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, San Juan, Puerto Rico
| | - Vivian Colón-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Kalyani Sonawane
- Center for Health Services Research, Department of Management, Policy, and Community Health, University of Texas Health School of Public Health, Houston
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, University of Texas Health School of Public Health, Houston
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Dennison RA, Meek CL, Usher-Smith JA, Fox RA, Aiken CE, Griffin SJ. 'Oh, I've got an appointment': A qualitative interview study exploring how to support attendance at diabetes screening after gestational diabetes. Diabet Med 2021; 38:e14650. [PMID: 34268798 PMCID: PMC7614210 DOI: 10.1111/dme.14650] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/14/2021] [Indexed: 12/23/2022]
Abstract
AIMS To explore the views of women with a history of gestational diabetes mellitus (GDM) on suggested practical approaches to support diabetes screening attendance after GDM, which is recommended but poorly attended. METHODS We conducted semi-structured interviews with 20 participants in Cambridgeshire, UK who had been diagnosed with GDM and were 3-48 months postpartum. Interviews covered whether participants had been screened and why, plans for future screening and their views on potential interventions to facilitate attendance (at the first postpartum test and annual testing). Framework analysis was used to analyse the transcripts. The interview schedule, suggested interventions and thematic framework were based on a recent systematic review. RESULTS Sixteen participants had undergone screening since pregnancy, explaining that they had an appointment arranged and wanted reassurance that they did not have diabetes. The participants who had not been tested were not aware that it was recommended. Only 13 had planned to attend subsequent tests at the start of the interview. Eight themes to support future attendance were discussed. The majority of the participants agreed that changing the processes for arranging tests, offering choice in test location and combining appointments would facilitate attendance. Child-friendly clinics, more opportunities to understand GDM and the role of postpartum testing, stopping self-testing and increasing their GP's awareness of their pregnancy received inconsistent feedback. The nature of the test used did not appear to influence attendance. CONCLUSIONS The participants wanted to be screened for diabetes after GDM. We have identified interventions that could be relatively simply incorporated into routine practice to facilitate screening attendance, such as flexibility in the appointment location or time and sending invitations for tests.
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Affiliation(s)
- Rebecca A Dennison
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Claire L Meek
- Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
- Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, UK
- Wolfson Diabetes and Endocrinology Clinic, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rachel A Fox
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Catherine E Aiken
- University Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
- Department of Obstetrics and Gynaecology, Rosie Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Simon J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Read AJ, Waljee AK, Sussman JB, Singh H, Chen GY, Vijan S, Saini SD. Testing Practices, Interpretation, and Diagnostic Evaluation of Iron Deficiency Anemia by US Primary Care Physicians. JAMA Netw Open 2021; 4:e2127827. [PMID: 34596670 PMCID: PMC8486982 DOI: 10.1001/jamanetworkopen.2021.27827] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Recognition of iron deficiency anemia (IDA) is important to initiate timely evaluation for gastrointestinal tract cancer. Retrospective studies have reported delays in diagnostic evaluation of IDA as a common factor associated with delayed diagnosis of colorectal cancer. OBJECTIVE To assess how US primary care physicians (PCPs) approach testing for anemia, interpret iron laboratory studies, and refer patients with IDA for gastrointestinal endoscopy. DESIGN, SETTING, AND PARTICIPANTS This survey study, conducted in August 2019, included members of the American College of Physicians Internal Medicine Insiders Panel, a nationally representative group of American College of Physicians membership, who self-identified as PCPs. Participants completed a vignette-based survey to assess practices related to screening for anemia, interpretation of laboratory-based iron studies, and appropriate diagnostic evaluation of IDA. MAIN OUTCOMES AND MEASURES Descriptive statistics based on survey responses were evaluated for frequency of anemia screening, correct interpretation of iron laboratory studies, and proportion of patients with new-onset IDA referred for gastrointestinal tract evaluation. RESULTS Of 631 PCPs who received an invitation to participate in the survey, 356 (56.4%) responded and 31 (4.9%) were excluded, for an adjusted eligible sample size of 600, yielding 325 completed surveys (response rate, 54.2%). Of the 325 participants who completed surveys, 180 (55.4%) were men; age of participants was not assessed. The mean (SD) duration of clinical experience was 19.8 (11.2) years (range, 1.0-45.0 years). A total of 250 participants (76.9%) screened at least some patients for anemia. Interpretation of iron studies was least accurate in a scenario of a borderline low ferritin level (40 ng/mL) with low transferrin saturation (2%); 86 participants (26.5%) incorrectly responded that this scenario did not indicate IDA, and 239 (73.5%) correctly identified this scenario as IDA. Of 312 participants, 170 (54.5%) recommended bidirectional endoscopy (upper endoscopy and colonoscopy) for new IDA for women aged 65 years; of 305 respondents, 168 (55.1%) recommended bidirectional endoscopy for men aged 65 years. CONCLUSIONS AND RELEVANCE In this survey study, US PCPs' self-reported testing practices for anemia suggest overuse of screening laboratory tests, misinterpretation of iron studies, and underuse of bidirectional endoscopy for evaluation of new-onset IDA. Both misinterpretation of iron studies and underuse of bidirectional endoscopy can lead to delayed diagnosis of gastrointestinal tract cancers and warrant additional interventions.
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Affiliation(s)
- Andrew J. Read
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Akbar K. Waljee
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Health Services Research and Development, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Jeremy B. Sussman
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Health Services Research and Development, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Grace Y. Chen
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Sandeep Vijan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Health Services Research and Development, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Sameer D. Saini
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Health Services Research and Development, Center for Clinical Management Research, Ann Arbor, Michigan
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Bonnet E, Daures JP, Landais P. Determination of thresholds of risk in women at average risk of breast cancer to personalize the organized screening program. Sci Rep 2021; 11:19104. [PMID: 34580360 PMCID: PMC8476568 DOI: 10.1038/s41598-021-98604-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
In France, more than 10 million women at "average" risk of breast cancer (BC), are included in the organized BC screening. Existing predictive models of BC risk are not adapted to the French population. Thus, we set up a new score in the French Hérault region and looked for subgroups at a graded level of risk in women at "average" risk. We recruited a retrospective cohort of women, aged 50 to 60, who underwent the organized BC screening, and included 2241 non-cancer women and 527 who developed a BC during a 12-year follow-up period (2006-2018). The risk factors identified were high breast density (ACR BI-RADS grading)(B vs A: HR = 1.41, 95%CI [1.05; 1.9], p = 0.023; C vs A: HR = 1.65 [1.2; 2.27], p = 0.02 ; D vs A: HR = 2.11 [1.25;3.58], p = 0.006), a history of maternal breast cancer (HR = 1.61 [1.24; 2.09], p < 0.001), and socioeconomic difficulties (HR 1.23 [1.09; 1.55], p = 0.003). While early menopause (HR = 0.36 [0.13; 0.99], p = 0.003) and an age at menarche after 12 years (HR = 0.77 [0.63; 0.95], p = 0.047) were protective factors. We identified 3 groups at risk: lower, average, and higher, respectively. A low threshold was characterized at 1.9% of 12-year risk and a high threshold at 4.5% 12-year risk. Mean 12-year risks in the 3 groups of risk were 1.37%, 2.68%, and 5.84%, respectively. Thus, 12% of women presented a level of risk different from the average risk group, corresponding to 600,000 women involved in the French organized BC screening, enabling to propose a new strategy to personalize the national BC screening. On one hand, for women at lower risk, we proposed to reduce the frequency of mammograms and on the other hand, for women at higher risk, we suggested intensifying surveillance.
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Affiliation(s)
- Emmanuel Bonnet
- Montpellier University, EA2415, Institut Universitaire de recherche clinique, 34093, Montpellier Cedex 5, France.
- Languedoc Mutualité, Nouvelles Technologies, AESIO, Montpellier, France.
| | - Jean-Pierre Daures
- Montpellier University, EA2415, Institut Universitaire de recherche clinique, 34093, Montpellier Cedex 5, France
- Languedoc Mutualité, Nouvelles Technologies, AESIO, Montpellier, France
| | - Paul Landais
- Montpellier University, EA2415, Institut Universitaire de recherche clinique, 34093, Montpellier Cedex 5, France
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Gojnic-Dugalic M, Stefanovic K, Stefanovic A, Jotic A, Lalic N, Petronijevic-Vrzic S, Petronijevic M, Milicic T, Lukic L, Todorovic J, Dugalic S, Pantic I, Nesic D, Stoiljkovic M, Stanisavljevic D, Perovic M. Distribution of normal and pathological OGTTs among pregnant population and non-pregnant women with PCOS - the cross-sectional study. Medicine (Baltimore) 2021; 100:e27232. [PMID: 34664864 PMCID: PMC8448046 DOI: 10.1097/md.0000000000027232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/28/2021] [Indexed: 01/07/2023] Open
Abstract
Both pregnancy, as physiological, and polycystic ovary syndrome (PCOS), as a pathological condition, carry the risk for developing glucose metabolism abnormalities. In this retrospective cross-sectional study, we hypothesized that pregnancy as a physiological condition carries a higher likelihood for abnormal oral glucose tolerance test (OGTT) results than PCOS as a pathological condition.We have compared the prevalence and likelihood ratios for abnormal OGTT results between non-pregnant women with PCOS (Group A) and pregnant women at 24 to 28 weeks of gestation (Group B). Participants of both study groups underwent glucose tolerance testing with 75 g glucose OGTT. During the study period, 7411 women were tested, 3932 women encompassed Group A, and 3479 women comprised Group B.The numbers of yearly tested pregnant women and the corresponding proportion of tested women among all study participants have decreased during the study period, from 766 to 131 and 89.1% to 20.5%, respectively. Group A had a significantly lower prevalence (4.4%) of pathological OGTT results compared to Group B (8.1%). This has resulted in a 45.427 likelihood ratio (P < .001) for abnormal OGTT results in pregnant women compared to non-pregnant women with PCOS.We might conclude that pregnancy could have a more challenging influence on glucose metabolism and that carries higher risks for abnormal glucose metabolism than PCOS. The awareness of obstetricians regarding physiological changes during pregnancy that predisposes abnormal glucose metabolism is decreasing over time and the compliance concerning OGTT testing of pregnant women is decreasing too.
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Affiliation(s)
- Miroslava Gojnic-Dugalic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Katarina Stefanovic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandar Stefanovic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Jotic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Svetlana Petronijevic-Vrzic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Milos Petronijevic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Tanja Milicic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Ljiljana Lukic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Jovana Todorovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Serbia
| | - Stefan Dugalic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Igor Pantic
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Dejan Nesic
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Milica Stoiljkovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Dejana Stanisavljevic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Milan Perovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Gynaecology and Obstetrics “Narodni front,” Belgrade, Serbia
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Abstract
Mortality from colorectal cancer is reduced through screening and early detection; moreover, removal of neoplastic lesions can reduce cancer incidence. While understanding of the risk factors, pathogenesis, and precursor lesions of colorectal cancer has advanced, the cause of the recent increase in cancer among young adults is largely unknown. Multiple invasive, semi- and non-invasive screening modalities have emerged over the past decade. The current emphasis on quality of colonoscopy has improved the effectiveness of screening and prevention, and the role of new technologies in detection of neoplasia, such as artificial intelligence, is rapidly emerging. The overall screening rates in the US, however, are suboptimal, and few interventions have been shown to increase screening uptake. This review provides an overview of colorectal cancer, the current status of screening efforts, and the tools available to reduce mortality from colorectal cancer.
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Affiliation(s)
- Priyanka Kanth
- Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - John M Inadomi
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Zhu X, Wolfgruber TK, Leong L, Jensen M, Scott C, Winham S, Sadowski P, Vachon C, Kerlikowske K, Shepherd JA. Deep Learning Predicts Interval and Screening-detected Cancer from Screening Mammograms: A Case-Case-Control Study in 6369 Women. Radiology 2021; 301:550-558. [PMID: 34491131 PMCID: PMC8630596 DOI: 10.1148/radiol.2021203758] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The ability of deep learning (DL) models to classify women as at risk for either screening mammography-detected or interval cancer (not detected at mammography) has not yet been explored in the literature. Purpose To examine the ability of DL models to estimate the risk of interval and screening-detected breast cancers with and without clinical risk factors. Materials and Methods This study was performed on 25 096 digital screening mammograms obtained from January 2006 to December 2013. The mammograms were obtained in 6369 women without breast cancer, 1609 of whom developed screening-detected breast cancer and 351 of whom developed interval invasive breast cancer. A DL model was trained on the negative mammograms to classify women into those who did not develop cancer and those who developed screening-detected cancer or interval invasive cancer. Model effectiveness was evaluated as a matched concordance statistic (C statistic) in a held-out 26% (1669 of 6369) test set of the mammograms. Results The C statistics and odds ratios for comparing patients with screening-detected cancer versus matched controls were 0.66 (95% CI: 0.63, 0.69) and 1.25 (95% CI: 1.17, 1.33), respectively, for the DL model, 0.62 (95% CI: 0.59, 0.65) and 2.14 (95% CI: 1.32, 3.45) for the clinical risk factors with the Breast Imaging Reporting and Data System (BI-RADS) density model, and 0.66 (95% CI: 0.63, 0.69) and 1.21 (95% CI: 1.13, 1.30) for the combined DL and clinical risk factors model. For comparing patients with interval cancer versus controls, the C statistics and odds ratios were 0.64 (95% CI: 0.58, 0.71) and 1.26 (95% CI: 1.10, 1.45), respectively, for the DL model, 0.71 (95% CI: 0.65, 0.77) and 7.25 (95% CI: 2.94, 17.9) for the risk factors with BI-RADS density (b rated vs non-b rated) model, and 0.72 (95% CI: 0.66, 0.78) and 1.10 (95% CI: 0.94, 1.29) for the combined DL and clinical risk factors model. The P values between the DL, BI-RADS, and combined model's ability to detect screen and interval cancer were .99, .002, and .03, respectively. Conclusion The deep learning model outperformed in determining screening-detected cancer risk but underperformed for interval cancer risk when compared with clinical risk factors including breast density. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Bae and Kim in this issue.
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