Artificial intelligence for cervical cancer screening: Scoping review, 2009-2022.

BACKGROUND: The intersection of artificial intelligence (AI) with cancer research is increasing, and many of the advances have focused on the analysis of cancer images. OBJECTIVES: To describe and synthesize the literature on the diagnostic accuracy of AI in early imaging diagnosis of cervical cancer following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). SEARCH STRATEGY: Arksey and O'Malley methodology was used and PubMed, Scopus, and Google Scholar databases were searched using a combination of English and Spanish keywords. SELECTION CRITERIA: Identified titles and abstracts were screened to select original reports and cross-checked for overlap of cases. DATA COLLECTION AND ANALYSIS: A descriptive summary was organized by the AI algorithm used, total of images analyzed, data source, clinical comparison criteria, and diagnosis performance. MAIN RESULTS: We identified 32 studies published between 2009 and 2022. The primary sources of images were digital colposcopy, cervicography, and mobile devices. The machine learning/deep learning (DL) algorithms applied in the articles included support vector machine (SVM), random forest classifier, k-nearest neighbors, multilayer perceptron, C4.5, Naïve Bayes, AdaBoost, XGboots, conditional random fields, Bayes classifier, convolutional neural network (CNN; and variations), ResNet (several versions), YOLO+EfficientNetB0, and visual geometry group (VGG; several versions). SVM and DL methods (CNN, ResNet, VGG) showed the best diagnostic performances, with an accuracy of over 97%. CONCLUSION: We concluded that the use of AI for cervical cancer screening has increased over the years, and some results (mainly from DL) are very promising. However, further research is necessary to validate these findings.

Reevaluating the protective effect of smoking on preeclampsia risk through the lens of bias.

Preeclampsia is a hypertensive disorder that is usually diagnosed after 20 weeks' gestation. Despite the deleterious effect of smoking on cardiovascular disease, it has been frequently reported that smoking has a protective effect on preeclampsia risk and biological explanations have been proposed. However, in this manuscript, we present multiple sources of bias that could explain this association. First, key concepts in epidemiology are reviewed: confounder, collider, and mediator. Then, we describe how eligibility criteria, losses of women potentially at risk, misclassification, or performing incorrect adjustments can create bias. We provide examples to show that strategies to control for confounders may fail when they are applied to variables that are not confounders. Finally, we outline potential approaches to manage this controversial effect. We conclude that there is probably no single epidemiological explanation for this counterintuitive association.

Women's critical experiences with the pap smear for the development of cervical cancer screening devices.

Global cervical cancer incidence and mortality have remained a major public health problem. Depending on the quality and coverage of preventive programs, and the capacity of health care systems, different screening tests are used, with the Pap smear being the most widely implemented. Several difficulties have been reported in accessing timely detection, causing late cervical cancer diagnosis. Trying to close these gaps, new screening devices have been developed in recent years; however, there is a lack of knowledge about whether or not women perspective has been included in the design process and technological development of these devices. This scoping review aimed to describe and synthesize scientific literature on women's critical experiences with Pap smears to prospectively contribute to the design, development, and scale-up of cervical cancer screening devices. The electronic databases Web of Science, Scopus, PubMed, PsycINFO and SciELO were searched for relevant studies published between 2012 and 2021; finally, 18 qualitative studies were included. Experiences were classified into four categories: fear and embarrassment, speculum pain and discomfort, outcome distress and health service barriers. Critical experiences before, during, and after the test were analyzed in turn. In particular, during the test, women reported pain associated with the use of the speculum. The acceptability of new screening devices will largely depend on comfort during the test and timely delivery of results. This review provides a useful qualitative synthesis, not only to advance the design of novel devices but also for future implementation research in cervical screening services.

Multilevel analysis of birthplace effect on the proportion of C-Section in Colombia" / Análisis multinivel del efecto del lugar de nacimiento en la proporción de partos por cesárea en Colombia

Abstract Objectives: To determine the general contextual effect of the department in the variation of Cesarean section in Colombia in 2016, and their individual and contextual related factors. Methods: Cross-sectional study based on a birth cohort. We used the birth certificate database from January 1 to December 31, 2016. Three multilevel logistic models were constructed. Pregnant women were set at the first level and department at the second level. We fitted a null multilevel model followed by two multiple models, including individual and individual and department variables, respectively. Results: The overall prevalence of C-section was 45.5% (95% CI: 45.4-45.6), ranged from 5 to 76%. The variance partition coefficient was 15%. Individual factors did not explain the general contextual effect. However, the region to which these departments belong explained 71% of the variance. The Caribbean region was positively associated with C-section compared to the Andean region (OR:3.88, 95% CI: 2.65-5.67). Conclusions: Multilevel analysis of individual heterogeneity and discriminatory accuracy showed that the department plays an important role in the variation of C-sections in Colombia. Our results suggest that the proportional universalism approach should be applied to reduce the proportion of C-Section, focusing on departments with the highest risk and on the Caribbean and Insular region.

Resumen Objetivos: Determinar el efecto contextual de los límites político administrativo de los departamentos, en la posibilidad individual de cesárea en el año 2016 y, las características individuales y contextuales asociadas a la misma. Métodos: Estudio transversal de una cohorte de nacimientos. Se realizó un análisis multinivel utilizando como fuente la base de datos de los certificados de nacimientos de Colombia desde el 1 de enero al 31 de diciembre de 2016. Se elaboraron tres modelos logísticos multinivel, con las gestantes en el primer nivel y el departamento como segundo nivel. El primer modelo incluyó solo el departamento como efecto aleatorio, seguido de otro con variables individuales y el último incluyó también las variables de contexto. Resultados: La proporción de cesáreas fue de 45.5% (IC 95%: 45.4-45.6), con un rango de 5% al 76%. El coeficiente de partición de varianza fue de 15%, indicando la existencia de una considerable desigualdad geográfica en la posibilidad del parto por cesárea. La región a la que pertenecen los departamentos explicó 71 % de la varianza entre departamentos. En particular, la región Caribe se asoció de manera positiva con la posibilidad de cesáreas comparado con la región Andina (OR:3.88, IC 95%: 2.65-5.67). Conclusiones: El análisis multinivel de la heterogeneidad individual mostró que el departamento juega un papel importante en la posibilidad de partos por cesáreas. Nuestros resultados sugieren que intervenciones con enfoque de universalismo proporcional son necesarias para reducir el parto por cesárea con énfasis en los departamentos de mayor riesgo y en la región Caribe e Insular

Exercise Capacity in Young Adults Born Small for Gestational Age.

Importance: Being born small for gestational age (SGA), approximately 10% of all births, is associated with increased risk of cardiovascular mortality in adulthood, but mechanistic pathways are unclear. Cardiac remodeling and dysfunction occur in fetuses SGA and children born SGA, but it is uncertain whether and how these changes persist into adulthood. Objective: To evaluate baseline cardiac function and structure and exercise capacity in young adults born SGA. Design, Setting, and Participants: This cohort study conducted from January 2015 to January 2018 assessed a perinatal cohort born at a tertiary university hospital in Spain between 1975 and 1995. Participants included 158 randomly selected young adults aged 20 to 40 years born SGA (birth weight below the 10th centile) or with intrauterine growth within standard reference ranges (controls). Participants provided their medical history, filled out questionnaires regarding smoking and physical activity habits, and underwent incremental cardiopulmonary exercise stress testing, cardiac magnetic resonance imaging, and a physical examination, with blood pressure, glucose level, and lipid profile data collected. Exposure: Being born SGA. Main Outcomes and Measures: Cardiac structure and function assessed by cardiac magnetic resonance imaging, including biventricular end-diastolic shape analysis. Exercise capacity assessed by incremental exercise stress testing. Results: This cohort study included 81 adults born SGA (median age at study, 34.4 years [IQR, 30.8-36.7 years]; 43 women [53%]) and 77 control participants (median age at study, 33.7 years [interquartile range (IQR), 31.0-37.1 years]; 33 women [43%]). All participants were of White race/ethnicity and underwent imaging, whereas 127 participants (80% of the cohort; 66 control participants and 61 adults born SGA) completed the exercise test. Cardiac shape analysis showed minor changes at rest in right ventricular geometry (DeLong test z, 2.2098; P = .02) with preserved cardiac function in individuals born SGA. However, compared with controls, adults born SGA had lower exercise capacity, with decreased maximal workload (mean [SD], 180 [62] W vs 214 [60] W; P = .006) and oxygen consumption (median, 26.0 mL/min/kg [IQR, 21.5-33.5 mL/min/kg vs 29.5 mL/min/kg [IQR, 24.0-36.0 mL/min/kg]; P = .02). Exercise capacity was significantly correlated with left ventricular mass (ρ = 0.7934; P < .001). Conclusions and Relevance: This cohort of young adults born SGA had markedly reduced exercise capacity. These results support further research to clarify the causes of impaired exercise capacity and the potential association with increased cardiovascular mortality among adults born SGA.

Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction.

BACKGROUND: Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. We evaluated whether prenatal cardiovascular changes previously demonstrated in FGR persist into preadolescence. METHODS AND RESULTS: A cohort study of 58 FGR (defined as birth weight below 10th centile) and 94 normally grown fetuses identified in utero and followed-up into preadolescence (8-12 years of age) by echocardiography and 3-dimensional shape computational analysis. Compared with controls, FGR preadolescents had a different cardiac shape, with more spherical and smaller hearts. Left ventricular ejection fraction was similar among groups, whereas FGR had decreased longitudinal motion (decreased mitral annular systolic peak velocities: control median, 0.11 m/s [interquartile range, 0.09-0.12] versus FGR median 0.09 m/s [interquartile range, 0.09-0.10]; P<0.01) and impaired relaxation (isovolumic relaxation time: control, 0.21 ms [interquartile range, 0.12-0.35] versus FGR, 0.35 ms [interquartile range, 0.20-0.46]; P=0.04). Global longitudinal strain was decreased (control mean, -22.4% [SD, 1.37] versus FGR mean, -21.5% [SD, 1.16]; P<0.001) compensated by an increased circumferential strain and with a higher prevalence of postsystolic shortening in FGR as compared with controls. These differences persisted after adjustment for parental ethnicity and smoking, prenatal glucocorticoid administration, preeclampsia, gestational age at delivery, days in intensive care unit, sex, age, and body surface area at evaluation. CONCLUSIONS: This study provides evidence that cardiac remodeling induced by FGR persists until preadolescence with findings similar to those reported in their prenatal life and childhood. The findings support the hypothesis of primary cardiac programming in FGR for explaining the association between low birth weight and cardiovascular risk in adulthood.

Perfil del paciente hiperfrecuentador y su asociación con el trastorno ansioso depresivo en servicios de atención primaria de Cali, Colombia / Profiles of high-frequency users of primary care services and associations with depressive anxiety disorders in Cali, Colombia

RESUMEN Objetivos. Determinar el perfil de los pacientes hiperfrecuentadores en servicios de atención primaria y su asociación con el trastorno ansioso depresivo en Cali, Colombia. Materiales y métodos. Estudio de casos y controles. Se definió como caso hiperfrecuentador a aquellos pacientes con un percentil >75 en la frecuencia de uso de consulta externa por demanda espontánea en los últimos 12 meses y como controles a aquellos con percentil <25. Se utilizó el análisis de correspondencias múltiples para describir los perfiles de los pacientes y mediante regresión logística se determinó la influencia de la depresión y ansiedad en la hiperfrecuentación. Resultados. Participaron 780 pacientes; las diferencia en los perfiles entre los hiperfrecuentadores y controles se observaron en los factores de predisposición: sexo, edad, escolaridad; de capacidad: tiempo en acudir a la institución y el medio de transporte que utilizan; y de necesidad: percepción de salud, apoyo social, función familiar, y la presencia de trastornos ansiosos o depresivos. Tener depresión o ansiedad se asoció con la hiperfrecuentación (ORa 1,99; IC 95%: 1,19-3,31) así como tener un sistema de referencias (ORa 1,61; IC 95%: 1,01-2,76), la disfunción familiar leve o buena se asoció de manera negativa (ORa: 0,79; IC 95%: 0,48-0,88) después de ajustar por edad, sexo, etnia e institución prestadora de servicios de salud. Conclusiones. Los pacientes hiperfrecuentadores tienen diferentes perfiles de capacidad, necesidad y predisposición que los controles, los últimos se asociaron de manera independiente a la hiperfrecuentación. En particular, lo trastornos ansioso depresivos duplicaron el riesgo de hiperfrecuentar en atención primaria.

ABSTRACT Objectives. To determine the profiles of highly frequent users of primary care services and the associations of these profiles with depressive anxiety disorders in Cali, Colombia. Materials and Methods. A case-control study, high-frequency cases were defined as those involving patients with a percentile >75 with regard to the frequency of spontaneous use of outpatient facilities in the last 12 months; controls were defined as those with a percentile <25. A multiple correspondence analysis was used to describe patient profiles, and the influences of depression and anxiety on frequent attendance was determined via logistic regression. Results. Among the 780 participating patients, differences in the profiles among frequent users and controls were related to predisposing factors such as sex, age, and education, capacity factors such as the time required to visit the institution and the means of transport used, and need factors such as health perceptions, social support, family function, and the presence of anxiety or depressive disorders. A depression or anxiety disorder was found to associate positively with frequent attendance (adjusted odds ratio [aOR]: 1.99, 95% confidence interval [CI]: 1.19-3.31) and a referral system (aOR: 1.61, 95% CI: 1.01-2.76), but negatively with mild or no family dysfunction (aOR: 0.79; 95% CI: 0.48-0.88) after adjusting for age, sex, ethnicity, and health service-providing institutions. Conclusions. The profiles of high-frequency patients differ from control patients with respect to factors related to capacity, need, and willingness; in particular, the latter were independently associated with frequent attendance. Notably, the presence of an anxious or depressive disorder doubled the risk of highfrequency attendance at a primary care facility.

Prevalencia y factores asociados a la adherencia al tratamiento no farmacológico en pacientes con hipertensión y diabetes en servicios de baja complejidad / Prevalence and factors associated with adherence to non-pharmacological treatment of hypertensive and diabetic patients at low complexity services / Prevalência e fatores associados à aderência ao tratamento não-farmacológico em pacientes com hipertensão e diabete em serviços de baixa complexidade

OBJETIVO: determinar la prevalencia y los factores relacionados con la adherencia no farmacológica en pacientes con hipertensión arterial (HTA) y diabetes mellitus (DM). METODOLOGIA: estudio observacional transversal en pacientes adultos mayores de 35 años con diagnóstico de HTA o DM, atendidos en un programa de Renoprotección en cuidado primario en Cali, Colombia. Se excluyeron aquellos pacientes con enfermedad renal crónica en estadío KDOQI 4-5, los que presentaran comorbilidades adicionales que deterioraran la función renal o con trastornos neuropsiquiátricos diagnosticados previamente. La adherencia no farmacológica se determinó mediante un cuestionario de autoreporte y los factores asociados a la misma se determinaron mediante regresión de Poisson con varianza robusta. RESULTADOS : la prevalencia de la adherencia no farmacológica fue de 9,4%. La inactividad física estuvo presente en 75% de los pacientes, y más del 19% de la población consumía sal frecuentemente. Entre los diabéticos, 18% consumía carbohidratos con frecuencia. Los hombres mostraron ser menos adherentes que las mujeres (RP: 0,21; p = 0,002). Los factores asociados positivamente con la adherencia no farmacológica fueron: estar estudiando, desempleado o pensionado (RP: 4,42; p = 0,019), recibir apoyo del equipo de salud (RP: 3,17; p = 0,032), tener diagnóstico de diabetes (RP: 7,79; p = 0,000) y la función renal en KDOQI-3 (RP: 5,14; p = 0,008). CONCLUSION: la adherencia no farmacológica fue muy baja en la población de estudio, en particular en relación con la inactividad física. Los factores asociados positivamente a la adherencia fueron el sexo femenino, tener una ocupación diferente al hogar, diagnostico de diabetes, enfermedad renal en KDOQI-3 y contar con apoyo del equipo de salud.

OBJECTIVE: To determine the prevalence and factors associated with adherence to non-pharmacological treatment in patients with high blood pressure (HBP) and diabetes mellitus (DM). METHODOLOGY: A cross-sectional and observational study conducted with adult patients older than 35, diagnosed with HBP or DM and receiving health care in a primary care renal protection program in Cali, Colombia. Patients with chronic kidney disease at the KDOQI 4-5 stage, additional comorbidities which impair the renal function or with previously diagnosed neuropsychiatric disorders were excluded. Adherence to non-pharmacological treatment was determined using a self-report questionnaire. Factors associated with adherence were obtained through a Poisson regression with robust variance. RESULTS : The prevalence of patient adherence was 9.4%.Physical inactivity was present in 75% of the patients and 19% of the population often consumed salt. Among the diabetics, 18% often consumed carbohydrates. Men showed less adherence than women (RP: 0.21; p = 0.002). Factors positively associated with adherence to non-pharmacological treatment were: being a student, unemployed or retired(RP: 4.42; p = 0.019), getting help from the health care team (RP: 3.17; p = 0.032), being diagnosed with diabetes (RP: 7.79; p = 0.000) and having the renal function in the KDOQI-3 stage (RP: 5.14; p = 0.008). CONCLUSION: Adherence to non-pharmacological treatment was very low in the studied population, particularly in relation to physical inactivity. The factors positively associated with treatment adherence were being female, not being a housewife, having diabetes, having a renal disease at the KDOQI-3 stage and having the support of a health care team.

OBJETIVO: Determinar a prevalência e os fatores ligados à aderência não-farmacológica em pacientes com hipertensão arterial (HTA) e diabetes mellitus (DM). METODOLOGIA: Estudo observacional transversal em pacientes adultos maiores de 35 anos com diagnóstico de HTA ou DM, atendidos em um programa de Renoproteção em cuidado primário em Cali, Colômbia.Foram excluídos aqueles pacientes com doença renal crônica em etapa KSOQI 4-5, aqueles com comorbilidades adicionais que deterioram a função renal ou com transtornos neuropsiquiátricos diagnosticados previamente.A aderência não farmacológica foi determinada por meio de um questionário de auto-relato e os fatores associados a ela foram determinados por meio de regressão de poisson com variância robusta. RESULTADOS: A prevalência da aderência não farmacológica foi de 9.4%.A inatividade física esteve presente em 75% dos pacientes e mais de 19% da população consumia sal frequentemente.Entre os diabéticos 18% consumia frequentemente carboidratos. Os homens mostraram ser menos aderentes do que as mulheres (RP: 0,21; p = 0,002). Os fatores associados positivamente à aderência não farmacológica foram os fatos de estarem estudando, desempregados ou aposentados(RP: 4,42; p = 0,019), receber apoio da equipe de saúde (RP: 3,17; p = 0,032), ter diagnóstico de diabetes (RP: 7,79; p = 0,000) e a função renal em KDOQI-3 (RP: 5,14; p = 0,008). CONCLUSÃO: Aderência não farmacológica foi muito baixa na população analisada, em particular em relação com a atividade física.Os fatores associados positivamente à aderência foram o gênero feminino, ter uma ocupação diferente do lar, diagnóstico de diabetes, doença renal em KDOQI-3 e contar com apoio da equipe de saúde.

Abordaje del paciente hiperfrecuentador de servicios en atención primaria: un acercamiento desde la teoría / Addressing frequent attender in primary health care: an approach from theory / Abordagem do paciente hiperfrecuentador aos serviços na atenção primária: uma aproximação desde a teoria

Este artículo hace una revisión de la literatura sobre la hiperfrecuentación de servicios de salud, con el objetivo de analizar la magnitud del problema para para el paciente, las familias y elsistema de salud, así como sus posibles factores asociados. Se realizó una búsqueda en revistas nacionales e internacionales para proponer una definición que permita estandarizar criterios para su detección, así como analizar posibles factores que puedan generar o perpetuar dicha conducta en el contexto nacional, con base en el modelo teórico de Aday y Andersen. También se sugieren algunas estrategias de intervención en servicios de baja complejidad. Se propone el uso de percentiles en la definición de los casos y a los trastornos mentales comunes como posibles contribuyentes de este comportamiento en salud. Con este artículo se espera contribuir a la generación de conocimiento del uso de servicios cuando las barreras de acceso han sido superadas...

This article is a literature review on frequent-attenders in health services. The current study objective was to analyze the problem for patients, families and health system and its potential related factors. A search in national and international journals was conducted to find a definition criteria for detection and to analyze the factors that may generate or perpetuate such behavior in the national context, based on the theoretical model of Aday and Andersen. It also suggests some intervention strategies in low-complexity services. We propose the use of percentiles for case definition and common mental disorders as potential contributors to this health behavior.This article hopes to contribute to understanding the use of services when access barriers are overcome...

O artigo faz revisão da literatura acerca da hiperfrequentação dos serviços de saúde, a fim de analisar a magnitude do problema para pacientes, familiares e do sistema de saúde e seus fatoresassociados possíveis. Procurou-se em revistas nacionais e internacionais visando propor uma definição que permitisse critérios padronizados para detecção, mesmo analisar possíveis fatores que puderem causar ou perpetuar esse tipo de comportamento no contexto nacional, com baseno modelo teórico de Aday e Andersen. Sugere, também, algumas estrategias de intervenção nos serviços de baixa complexidade. Propoe-se o uso de percentis nas definições dos casos etranstornos mentais comuns como potenciais contribuintes para este comportamento de saúde. Este artigo pretende contribuir para a geração de conhecimento sobre o uso de serviços onde as barreiras de acesso são superadas...