Low Levels of Lifetime Pap Test Receipt Among Vulnerable Guatemalans.

Low and middle-income countries, such as Guatemala, shoulder a disproportionate share of cervical cancer, a preventable disease in high income countries. Tangible obstacles, such as lack of access to health care, cultural differences, and insufficient infrastructure, and facilitators, such as being Ladino, married, and educated, have been identified in the literature related to cervical cancer prevention. The aim of this survey was to explore barriers and facilitators to cervical cancer prevention, comparing rural Indigenous and urban Ladino populations. We surveyed 139 women in two health clinics. Participants answered questions about demographic information, cervical cancer knowledge, and health care behaviors. We analyzed survey data with four bivariate models. Our results suggest vulnerable populations, such as rural Indigenous women who are single, illiterate, and lack education, face higher cervical cancer risk. Partnerships should be formed with health promotors and lay midwives to educate and encourage vulnerable populations to prevent cervical cancer.

The burden of injury in China, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: A comprehensive evaluation of the burden of injury is an important foundation for selecting and formulating strategies of injury prevention. We present results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 of non-fatal and fatal outcomes of injury at the national and subnational level, and the changes in burden for key causes of injury over time in China. METHODS: Using the methods and results from GBD 2017, we describe the burden of total injury and the key causes of injury based on the rates of incidence, cause-specific mortality, and disability-adjusted life years (DALYs) in China estimated using DisMod-MR 2.1. We additionally evaluated these results at the provincial level for the 34 subnational locations of China in 2017, measured the change of injury burden from 1990 to 2017, and compared age-standardised DALYs due to injuries at the provincial level against the expected rates based on the Socio-demographic Index (SDI), a composite measure of development of income per capita, years of education, and total fertility rate. FINDINGS: In 2017, in China, there were 77·1 million (95% uncertainty interval [UI] 72·5-81·6) new cases of injury severe enough to warrant health care and 733 517 deaths (681 254-767 006) due to injuries. Injuries accounted for 7·0% (95% UI 6·6-7·2) of total deaths and 10·0% (9·5-10·5) of all-cause DALYs in China. In 2017, there was a three-times variation in age-standardised injury DALY rates between provinces of China, with the lowest value in Macao and the highest in Yunnan. Between 1990 and 2017, the age-standardised incidence rate of all injuries increased by 50·6% (95% UI 46·6-54·6) in China, whereas the age-standardised mortality and DALY rates decreased by 44·3% (41·1-48·9) and 48·1% (44·6-51·8), respectively. Between 1990 and 2017, all provinces of China experienced a substantial decline in DALY rates from all injuries ranging from 16·3% (3·1-28·6) in Shanghai and 60·4% (53·7-66·1) in Jiangxi. Age-standardised DALY rates for drowning; injuries from fire, heat and hot substances; adverse effects of medical treatments; animal contact; environmental heat and cold exposure; self-harm; and executions and police conflict each declined by more than 60% between 1990 and 2017. INTERPRETATION: Between 1990 and 2017, China experienced a decrease in the age-standardised DALY and mortality rates due to injury, despite an increase in the age-standardised incidence rate. These trends occurred in all provinces. The divergent trends in terms of incidence and mortality indicate that with rapid sociodemographic improvements, the case fatality of injuries has declined, which could be attributed to an improving health-care system but also to a decreasing severity of injuries over this time period. FUNDING: Bill & Melinda Gates Foundation.

Proton magnetic resonance spectroscopy in obsessive-compulsive disorder: a pilot investigation comparing treatment responders and non-responders.

Proton magnetic resonance spectroscopic imaging was performed to compare brain metabolism in patients with obsessive-compulsive OCD. Evaluation was done on responders and non-responders to pharmacotherapy and on healthy controls. The results showed significantly lower NAA/Cr ratios in the right basal ganglia in non-responders than in responders or in controls and higher Cho/Cr ratios in the right thalamus in non-responders than responders. Abnormal neuronal metabolism in the right basal ganglia and right thalamus may be indicating lack of response to treatment to selective serotonin reuptake inhibitor.

Adjustable, broadband, selective excitation with uniform phase.

An advance in the problem of achieving broadband, selective, and uniform-phase excitation in NMR spectroscopy of liquids is outlined. Broadband means that, neglecting relaxation, any frequency bandwidth may be excited even when the available radiofrequency (RF) field strength is strictly limited. Selective means that sharp transition edges can be created between pure-phase excitation and no excitation at all. Uniform phase means that, neglecting spin-spin coupling, all resonance lines have nearly the same phase. Conventional uniform-phase excitation pulses (e.g., E-BURP), mostly based on amplitude modulation of the RF field, are not broadband: they have an achievable bandwidth that is strictly limited by the peak power available. Other compensated pulses based on adiabatic half-passage, like BIR-4, are not selective. By contrast, inversion pulses based on adiabatic fast passage can be broadband (and selective) in the sense above. The advance outlined is a way to reformulate these frequency modulated (FM) pulses for excitation, rather than just inversion.

Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis.

BACKGROUND CONTEXT: Adjacent segment disease (ASD) after lumbar spinal fusion has been an important reason behind the development of nonfusion stabilization technology. However, the incidence, prevalence, and factors contributing to adjacent segment degeneration in the lumbar spine remain unclear. A range of prevalence rates for ASD have been reported in the lumbar spinal literature, but the annual incidence has not been widely studied in this region. Conflicting reports exist regarding risk factors, especially fusion length. PURPOSE: To determine the annual incidence and prevalence of further surgery for adjacent segment disease (SxASD) after posterior lumbar arthrodesis and examine possible risk factors. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Nine hundred twelve patients who underwent 1,000 consecutive posterior lumbar interbody fusion procedures, with mean follow-up duration of 63 months (range, 5 months-16 years). OUTCOME MEASURES: Further surgery for ASD or surgery-free survival. METHODS: A postal and telephone survey. Follow-up rate: 91% of patients. The annual incidence and prevalence of ASD requiring further surgery were determined using Kaplan-Meier survivorship analysis. Cox proportional-hazards (Cox) regression was used for multivariate analysis of possible risk factors. Significance was set at p<.05. RESULTS: Further surgery for ASD occurred following 130 of 1,000 or 13% of procedures at a mean time of 43 months (range, 2.3-162 months). The mean annual incidence of SxASD over the first 10 years, in all patients, was 2.5% (95% confidence interval [95% CI], 1.9-3.1) with prevalences of 13.6% and 22.2% at 5 and 10 years, respectively. Cox regression modeling found that the number of levels fused (p≤.0003), age of the patient, fusing to L5, and performing an additional laminectomy adjacent to a fusion all independently affect the risk of SxASD. The mean annual incidence figures in the first 10 years after a lumbar fusion were 1.7% (95% CI, 1.3-2.2) after fusion at single levels, 3.6% (2.1-5.2) after two levels, and 5.0% (3.3-6.7) after three and four levels. The 5- and 10-year prevalences were 9% and 16%, 17% and 31%, and 29% and 40% after single-, two-, and three-/four-level fusions, respectively. The risk of SxASD in patients younger than 45 years was one-quarter (95% CI, 10-64) the risk of patients older than 60 years (p=.003). A laminectomy adjacent to a fusion increases the relative risk by 2.4 times (95% CI, 1.1-5.2; p=.03). Stopping a fusion at L5 is associated with a 1.7-fold increased risk (95% CI, 1.2-2.4; p=.007) of SxASD compared with a fusion to S1, for fusions of the same length. CONCLUSION: The overall annual incidence and predicted 10-year prevalence of further surgery for ASD after lumbar arthrodesis were 2.5% and 22.2%, respectively. These rates varied widely depending on the identified risk factors. Although young patients who underwent single-level fusions were at low risk, patients who underwent fusion of three or four levels had a threefold increased risk of further surgery, compared with single-level fusions (p<.0001), and a predicted 10-year prevalence of 40%.

Quantitative SENSE-MRSI of the human brain.

PURPOSE: To develop a method for estimating metabolite concentrations using phased-array coils and sensitivity-encoded (SENSE) magnetic resonance spectroscopic images (MRSI) of the human brain. MATERIALS AND METHODS: The method is based on the phantom replacement technique and uses receive coil sensitivity maps and body-coil loading factors to account for receive B(1) inhomogeneity and variable coil loading, respectively. Corrections for cerebrospinal fluid content from the MRSI voxel were also applied, and the total protocol scan time was less than 15 min. The method was applied to 10 normal human volunteers using a multislice 2D-MRSI sequence at 3 T, and seven different brain regions were quantified. RESULTS: N-Acetyl aspartate (NAA) concentrations varied from 9.7 to 14.7 mM, creatine (Cr) varied from 6.6 to 10.6 mM and choline (Cho) varied from 1.6 to 3.0 mM, in good general agreement with prior literature values. CONCLUSIONS: Quantitative SENSE-MRSI of the human brain is routinely possible using an adapted phantom-replacement technique. The method may also be applied to other MRSI techniques, including conventional phase encoding, with phased-array receiver coils, provided that coil sensitivity profiles can be measured.

J-difference lactate editing at 3.0 Tesla in the presence of strong lipids.

PURPOSE: To implement in vivo detection of lactate in the presence of lipids by proton magnetic resonance spectroscopy at a 3 Tesla (T) field strength for potential applications in human tumors outside of the brain. MATERIALS AND METHODS: The BASING J-difference sequence was implemented in the presence of high lipid concentrations in phantoms and in vivo at 3 Tesla. RESULTS: The effectiveness of the lactate editing scheme is demonstrated in phantoms containing both lactate and lipids and in vivo in ischemic induced human muscle. CONCLUSION: The ability of the BASING J-difference technique to detect lactate in the presence of strong lipid signals outside the brain at 3T is feasible. This robust technique should permit noninvasive lactate measurements in human tumors to investigate its potential as a prognostic indicator.

Regional apparent metabolite concentrations in young adult brain measured by (1)H MR spectroscopy at 3 Tesla.

PURPOSE: To quantify and examine the distribution of brain metabolites in normal young adults using single voxel MR spectroscopy at 3 Tesla (T). MATERIALS AND METHODS: Short-echo time single-voxel PRESS technique was used to measure the apparent concentration of five metabolites at nine locations in the brains of young adults. Concentrations were estimated by means of an automated fitting method (LCModel) with reference to an unsuppressed water signal and were corrected for T(1) relaxation, T(2) relaxation, and cerebrospinal fluid partial volume. Analysis of variance with Tukey post hoc test was used to evaluate regional variations. RESULTS: Statistically significant differences in regional concentrations were detected for each of the metabolites. The number of significant differences was greatest for total choline, whereas myo-inositol and the sum of glutamine and glutamate had the fewest. Magnitude of variation was greatest for total choline and least for the sum of N-acetyl aspartate and N-acetylaspartylglutamate. CONCLUSION: In agreement with previous studies at other field strengths, we found heterogeneous distribution of the major spectroscopically measurable brain metabolites. Although the most distinct differences are between tissue types, there is appreciable variation within a tissue type at different locations. The spectra and metabolite concentrations presented should provide a useful reference for both clinical and research MR spectroscopy studies performed at 3T.

Proton MR spectroscopic imaging of the medulla and cervical spinal cord.

PURPOSE: To demonstrate the feasibility of quantitative, one-dimensional proton MR spectroscopic imaging (1D-MRSI) of the upper cervical spine and medulla at 3.0 Tesla. MATERIALS AND METHODS: A method was developed for 1D-point-resolved spectroscopy sequence (PRESS)-MRSI, exciting signal in five voxels extending from the pontomedullary junction to the level of the C3 vertebra, and performed in 10 healthy volunteers to generate control data. RESULTS: High-resolution 1D-MRSI data were obtained from all 10 subjects. Upper cervical spine concentrations of choline, creatine, and N-acetyl aspartate were estimated to be 2.8 +/- 0.5, 8.8 +/- 1.8, and 10.9 +/- 2.7 mM, respectively, while in the medulla they were 2.6 +/- 0.5, 9.1 +/- 1.7, and 10.8 +/- 0.9 mM. CONCLUSION: Quantitative 1D-MRSI of the upper cervical spine has been shown to be feasible at 3.0 Tesla.

Simultaneous water and lipid suppression for in vivo brain spectroscopy in humans.

A method to achieve simultaneous water and lipid suppression is described. The key feature of the new dual suppression technique is the use of the well-known hyperbolic secant (HS) waveform as a 90 degrees saturation pulse. Two HS pulses with opposite frequency offsets are employed either sequentially or simultaneously to saturate resonance frequencies corresponding to water and lipid, while leaving the target spins untouched. The excitation bandwidth is controlled by the frequency sweep and offset of each pulse, while varying the pulse length controls the transition bandwidth. An example of the use of the dual saturation method in in vivo magnetic resonance spectroscopic imaging of the human brain is presented.