A descriptive study on diagnostic timelines, and factors influencing delayed diagnosis among adult head and neck cancer patients at Uganda cancer institute.

BACKGROUND: Many patients with head and neck cancer (HNC) often present with advanced disease. This may result from delay in deciding to seek care, delay in reaching the healthcare facility and or delay in accessing care in the healthcare facility. We therefore set out to determine the time to definitive diagnosis and factors associated with delayed diagnosis among patients with HNC at the Uganda Cancer Institute (UCI). METHODS: A cross-sectional study was conducted at UCI, patients with HNC were recruited. An interviewer administered questionnaire was used to collect data on sociodemographic factors and clinical characteristics, including timelines in months, from symptom onset to deciding to seek care, to reaching the health care facility and to definitive diagnosis. Multivariate Poisson regression analysis was used to calculate odds ratios (ORs) for the factors of association with delayed diagnosis. RESULTS: We recruited 160 HNC patients, and 134 patients were analyzed. The median age was 49.5 years (IQR 26.5), 70% (94 of 134) were male, 48% (69 of 134) had below secondary school education, 49% (65 of 134) had a household income < 54 USD. 56% (76 of 134) were sole bread winners, 67% (89 of 134) had good access road condition to the nearest health unit and 70% (91 of 134) presented with tumor stage 4. Median time from onset of symptoms to definitive diagnosis was 8.1 months (IQR 15.1) and 65% (87 of 134) of patients had delayed diagnosis. Good access roads (aOR: 0.26, p = 0.006), secondary school education (aOR: 0.17, p = 0.038), and household income > 136 USD (aOR: 0.27, p = 0.043) were associated with lower odds of delayed diagnosis. Being the sole bread winner (aOR: 2.15, p = 0.050) increased the odds of delayed diagnosis. CONCLUSION: Most of HNC patients (65%) at UCI had delayed diagnosis. A national care pathway for individuals with suspected HNC should be established and consider rotation of Ear, Nose and Throat surgeons to underserved regions, to mitigate diagnostic delay.

Appendicitis Hospitalization Care Costs Among Patients With Delayed Diagnosis of Appendicitis.

Importance: Delayed appendicitis diagnosis is associated with worse outcomes. Appendicitis hospital care costs associated with delayed diagnosis are unknown. Objective: To determine whether delayed appendicitis diagnosis was associated with increased appendicitis hospital care costs. Design, Setting, and Participants: This cohort study used data from patients receiving an appendectomy aged 18 to 64 years in 5 states (Florida, Maryland, Massachusetts, New York, Wisconsin) that were captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department databases for the years 2016 and 2017 with no additional follow-up. Data were analyzed January through April 2023. Exposures: Delayed diagnosis was defined as a previous emergency department or inpatient hospital encounter with an abdominal diagnosis other than appendicitis, and no intervention 7 days prior to appendectomy encounter. Main Outcomes and Measures: The main outcome was appendicitis hospital care costs. This was calculated from aggregated charges of encounters 7 days prior to appendectomy, the appendectomy encounter, and 30 days postoperatively. Cost-to-charge ratios were applied to charges to obtain costs, which were then adjusted for wage index, inflation to 2022 US dollar, and with extreme outliers winsorized. A multivariable Poisson regression estimated appendicitis hospital care costs associated with a delayed diagnosis while controlling for age, sex, race and ethnicity, insurance status, care discontinuity, income quartile, hospital size, teaching status, medical school affiliation, percentage of Black and Hispanic patient discharges, core-based statistical area, and state. Results: There were 76 183 patients (38 939 female [51.1%]; 2192 Asian or Pacific Islander [2.9%], 14 132 Hispanic [18.5%], 8195 non-Hispanic Black [10.8%], 46 949 non-Hispanic White [61.6%]) underwent appendectomy, and 2045 (2.7%) had a delayed diagnosis. Delayed diagnosis patients had median (IQR) unadjusted cost of $11 099 ($6752-$17 740) compared with $9177 ($5575-$14 481) for nondelayed (P < .001). Patients with delayed diagnosis had 1.23 times (95% CI, 1.16-1.28 times) adjusted increased appendicitis hospital care costs. The mean marginal cost of delayed diagnosis was $2712 (95% CI, $2083-$3342). Even controlling for delayed diagnosis, non-Hispanic Black patients had 1.22 times (95% CI, 1.17-1.28 times) the adjusted increased appendicitis hospital care costs compared with non-Hispanic White patients. Conclusions and Relevance: In this cohort study, delayed diagnosis of appendicitis was associated with increased hospital care costs.

Diagnosing and characterizing inflammatory myopathies at an Australian tertiary public hospital: Resource utilization and direct healthcare costs.

AIM: To determine the direct health service costs and resource utilization associated with diagnosing and characterizing idiopathic inflammatory myopathies (IIMs), and to assess for limitations and diagnostic delay in current practice. METHODS: A retrospective, single-center cohort analysis of all patients diagnosed with IIMs between January 2012 and December 2021 in a large tertiary public hospital was conducted. Demographics, resource utilization and costs associated with diagnosing IIM and characterizing disease manifestations were identified using the hospital's electronic medical record and Health Intelligence Unit, and the Medicare Benefits Schedule. RESULTS: Thirty-eight IIM patients were identified. IIM subtypes included dermatomyositis (34.2%), inclusion body myositis (18.4%), immune-mediated necrotizing myopathy (18.4%), polymyositis (15.8%), and anti-synthetase syndrome (13.2%). The median time from symptom onset to diagnosis was 212 days (IQR: 118-722), while the median time from hospital presentation to diagnosis was 30 days (8-120). Seventy-six percent of patients required emergent hospitalization during their diagnosis, with a median length of stay of 8 days (4-15). The average total cost of diagnosing IIM was $15 618 AUD (STD: 11331) per patient. Fifty percent of patients underwent both MRI and EMG to identify affected muscles, 10% underwent both pan-CT and PET-CT for malignancy detection, and 5% underwent both open surgical and percutaneous muscle biopsies. Autoimmune serology was unnecessarily repeated in 37% of patients. CONCLUSION: The diagnosis of IIMs requires substantial and costly resource use; however, our study has identified potential limitations in current practice and highlighted the need for streamlined diagnostic algorithms to improve patient outcomes and reduce healthcare-related economic burden.

Malpractice Claims Following Major Liver and Pancreatic Surgeries: What Can we Learn?

INTRODUCTION: General surgery is a highly litigious specialty. Lawsuits can be a source of emotional distress and burnout for surgeons. Major hepatic and pancreatic surgeries are technically challenging general surgical oncology procedures associated with an increased risk of complications and mortality. It is unclear whether these operations are associated with an increased risk of lawsuits. The objective of the present study was to summarize the medical malpractice claims surrounding pancreatic and hepatic surgeries from publicly available court records. METHODS: The Westlaw legal database was searched and analyzed for relevant malpractice claims from the last two decades. RESULTS: Of 165 search results, 30 (18.2%) cases were eligible for inclusion. Appellant cases comprised 53.3% of them. Half involved a patient death. Including co-defendants, a majority (n = 21, 70%) named surgeons as defendants, whereas several claims (n = 13, 43%) also named non-surgeons. The most common cause of alleged malpractice was a delay in diagnosis (n = 12, 40%). In eight of these, surgery could not be performed. The second most common were claims alleging the follow-up surgery was due to negligence (n = 6). Collectively, 20 claims were found in favor of the defendant. Seven verdicts (23.3%) returned in favor of the plaintiff, two of which resulted in monetary awards (totaling $1,608,325 and $424,933.85). Three cases went to trial or delayed motion for summary judgment. There were no settlements. CONCLUSIONS: A defendant verdict was reached in two-thirds of malpractice cases involving major hepatic or pancreatic surgery. A delay in diagnosis was the most cited claim in hepatopancreaticobiliary lawsuits, and defendants may often practice in nonsurgical specialties. While rulings favoring plaintiffs are less frequent, the payouts may be substantial.

Site-specific patterns of early-stage cancer diagnosis during the COVID-19 pandemic.

The COVID-19 pandemic caused widespread disruptions in cancer care. We hypothesized that the greatest disruptions in diagnosis occurred in screen-detected cancers. We identified patients (≥18 years of age) with newly diagnosed cancer from 2019 to 2020 in the US National Cancer Database and calculated the change in proportion of early-stage to late-stage cancers using a weighted linear regression. Disruptions in early-stage diagnosis were greater than in late-stage diagnosis (17% vs 12.5%). Melanoma demonstrated the greatest relative decrease in early-stage vs late-stage diagnosis (22.9% vs 9.2%), whereas the decrease was similar for pancreatic cancer. Compared with breast cancer, cervical, melanoma, prostate, colorectal, and lung cancers showed the greatest disruptions in early-stage diagnosis. Uninsured patients experienced greater disruptions than privately insured patients. Disruptions in cancer diagnosis in 2020 had a larger impact on early-stage disease, particularly screen-detected cancers. Our study supports emerging evidence that primary care visits may play a critical role in early melanoma detection.

Epidemiology, Characteristics of Disease, and Unmet Needs of Patients with Generalized Pustular Psoriasis: A Large Italian Delphi Consensus.

INTRODUCTION: Generalized pustular psoriasis (GPP) is a rare and chronic, debilitating skin condition characterized, in its acute flare phase, by clinically severe and potentially life-threatening systemic manifestations. Data on GPP are still scanty, particularly in Europe and at a national level. The aim of this study was to provide expert indications on several disease-related and patient-related aspects of GPP, with specific focus to the Italian context. METHODS: We conducted an iterative eDelphi study following the recommended criteria for reporting methods and results. After a thorough bibliographic review aimed to identify unknown or controversial issues in GPP, the following areas were investigated through a few specific questions/statements for each area: (1) disease epidemiology; (2) disease characteristics, with specific interest toward GPP flares; (3) diagnosis and diagnostic delay; (4) GPP treatment; (5) GPP patient journey and use of healthcare resources in Italy; (6) unmet needs and quality of life. An Executive Board of 9 principal investigators revised and approved the topics to be examined and overviewed the whole project. A total of 35 experts from different Italian areas, including 34 board-certified Italian dermatologists and 1 representative of patients' associations, took part in the study. RESULTS: A high agreement in responses from Italian experts emerged during two eDelphi iterations on - among several other aspects - GPP prevalence and incidence in Italy, use of European Rare and Severe Psoriasis Expert Network diagnostic criteria, flare frequency and duration, best diagnostic and care pathway, and main unmet needs of Italian patients. On the other hand, a broad spectrum of treatments (of different drug classes) was reported both in the acute and chronic phases of GPP, and no consensus on the issue was thus achieved. CONCLUSIONS: Consensus findings from this Delphi study of GPP experts may be useful to fill gaps of knowledge and improve awareness of this rare disease, as well as to help clinical and public health management of GPP in Italy.

Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers.

BACKGROUND: Previous studies have examined disparities in dementia care that affect the U.S. Hispanic/Latino population, including clinician bias, lack of cultural responsiveness, and less access to health care. However, there is limited research that specifically investigates the impact of language barriers to health disparities in dementia diagnosis. METHODS: In this retrospective cross-sectional study, 12,080 English- or Spanish- speaking patients who received an initial diagnosis of mild cognitive impairment (MCI) or dementia between July 2017 and June 2019 were identified in the Yale New Haven Health (YNHH) electronic medical record. To evaluate the timeliness of diagnosis, an initial diagnosis of MCI was classified as "timely", while an initial diagnosis of dementia was considered "delayed." Comprehensiveness of diagnosis was assessed by measuring the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis. Binomial logistic regressions were calculated with and without adjustment for age, legal sex, ethnicity, neighborhood disadvantage, and medical comorbidities. RESULTS: Spanish speakers were less likely to receive a timely diagnosis when compared with English speakers both before (unadjusted OR, 0.65; 95% CI, 0.53-0.80, p <0.0001) and after adjusting for covariates (adjusted OR, 0.55; 95% CI, 0.40-0.75, p = 0.0001). Diagnostic services were provided equally between groups, except for referrals to geriatrics, which were more frequent among Spanish-speaking patients. A subgroup analysis revealed that Spanish-speaking Hispanic/Latino patients were less likely to receive a timely diagnosis compared to English-speaking Hispanic/Latino patients (adjusted OR, 0.53; 95% CI, 0.38-0.73, p = 0.0001). CONCLUSIONS: Non-English language preference is likely to be a contributing factor to timely diagnosis of cognitive impairment. In this study, Spanish language preference rather than Hispanic/Latino ethnicity was a significant predictor of a less timely diagnosis of cognitive impairment. Policy changes are needed to reduce barriers in cognitive disorders care for Spanish-speaking patients.

Access to Federally Qualified Health Centers and HIV Outcomes in the U.S. South.

INTRODUCTION: Federally Qualified Health Centers may increase access to HIV prevention, care, and treatment for at-risk populations. METHODS: A pooled cross section of ZIP Code Tabulation Areas from cites in the U.S. South with high HIV diagnoses were used to examine Federally Qualified Health Center density and indicators of HIV epidemic control. The explanatory variable was Federally Qualified Health Center density-number of Federally Qualified Health Centers in a ZIP Code Tabulation Areas' Primary Care Service Area per low-income population-high versus medium/low (2019). Outcomes were 5-year (2015-2019 or 2014-2018) (1) number of new HIV diagnoses, (2) percentage late diagnosis, (3) percentage linked to care, and (4) percentage virally suppressed, which was assessed over 1 year (2018 or 2019). Multiple linear regression was used to examine the relationship, including ZIP Code Tabulation Area-level sociodemographic and city-level HIV funding variables, with state-fixed effects, and data analysis was completed in 2022-2023. Sensitivity analyses included (1) examining ZIP Code Tabulation Areas with fewer non-Federally Qualified Health Center primary care providers, (2) controlling for county-level primary care provider density, (3) excluding the highest HIV prevalence ZIP Code Tabulation Areas, and (4) excluding Florida ZIP Code Tabulation Areas. RESULTS: High-density ZIP Code Tabulation Areas had a lower percentage of late diagnosis and virally suppressed, a higher percentage linked to care, and no differences in new HIV diagnoses (p<0.05). In adjusted analysis, high density was associated with a greater number of new diagnoses (number or percentage=5.65; 95% CI=2.81, 8.49), lower percentage of late diagnosis (-3.71%; 95% CI= -5.99, -1.42), higher percentage linked to care (2.13%; 95% CI=0.20, 4.06), and higher percentage virally suppressed (1.87%; 95% CI=0.53, 2.74) than medium/low density. CONCLUSIONS: Results suggest that access to Federally Qualified Health Centers may benefit community-level HIV epidemic indicators.

Health care resource use, diagnostic delay and disease burden in transthyretin amyloid cardiomyopathy in Sweden.

AIMS: To estimate healthcare resource use and direct healthcare costs of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in Sweden over 12 months across severity stages as defined by the New York Heart Association (NYHA). Secondary to investigate the current diagnostic trajectory for patients with ATTR-CM in Sweden. METHODS: A stratified inclusion of patients with a confirmed diagnosis of ATTR-CM in different NYHA classes. Data was extracted from medical records in two cardiology clinics in Sweden. Healthcare resource use data were retrospectively collected for 12 months. RESULTS: 38 patients were included, of whom 7 were in NYHA class II, 20 in class III and 4 in class IV. The total cost of health care per patient increased from SEK 69,000 (€6800) in NYHA stage II, SEK 219,000 (€21,500) in NYHA stage III, to SEK 638,000 (€62,900) in stage IV, mainly due to an increase in inpatient stays. Mean time (standard deviation, SD) from any cardiac related diagnosis prior to ATTR-CM diagnosis was 3.5 (3.1) years. CONCLUSIONS: Advanced ATTR-CM stages are associated with significant healthcare costs, as patients more often require resource-intensive inpatient care. The current diagnostic trajectory of ATTR-CM in this study was characterized by a diagnostic delay of several years.

This study shows that both healthcare resource use and healthcare costs increased considerably with a higher degree of ATTR-CM severity.The diagnostic trajectory of ATTR-CM in this study was characterized by a diagnostic delay of several years.Greater disease awareness and a lower threshold for screening risk groups for TTR-amyloidosis is prompted to establish an earlier diagnosis.

Nusinersena para tratamento da Atrofia Muscular Espinhal 5q tipo II e III (início tardio): (maio 2021) / Nusinersen for the treatment of Spinal Muscular Atrophy 5q type II and III (late onset): (May 2021)

INTRODUÇÃO: A AME 5q é uma doença neuromuscular hereditária, caracterizada pela degeneração dos neurônios motores na medula espinhal e tronco encefálico, que resulta em fraqueza muscular, geralmente simétrica, e atrofia atribuídas à disfunção e perda do neurônio motor. O diagnóstico é confirmado por meio de testes genéticos e moleculares. Clinicamente, a AME 5q é classificada em diferentes subtipos, com base na gravidade, no número de cópias SMN2 (e teoricamente com o nível de proteína de SMN, fornecendo uma base molecular para a classificação) e na idade de início dos sintomas, sendo então dividida em início precoce e tardio. A forma mais comum da doença é a AME 5q tipo I, caracterizada pelo início precoce da doença, antes dos seis meses de idade. A AME 5q de início tardio, classificada como tipos II a IV, apresenta, de uma forma geral, melhor prognóstico quando comparada à AME 5q tipo I. A AME 5q tipo II é caracterizada por ser sintomática, em geral, entre 6 e 18 meses de idade, a capacidade de sentar é geralmente alcançada por volta dos nove meses e os pacientes normalmente não ficam de pé ou andam independentemente. Embora a expectativa de vida seja reduzida nestes pacientes, a maioria chega à idade adulta. Os pacientes com AME 5q tipo III, com início do aparecimento dos sintomas entre as idades de 18 meses e a idade a

Impacto psicosocial y económico de la uveítis en México / Psychosocial and economic impact of uveitis in Mexico

Resumen Objetivo: Conocer el impacto psicosocial y económico quede la uveítis en México. Métodos: Encuesta en pacientes diagnosticados con uveítis. Se registraron datos demográficos y nivel socioeconómico. Se identificaron síntomas, tiempo al diagnóstico, tratamiento, comportamiento, actitudes y sentimientos ante la enfermedad. Resultados: Se realizaron 100 encuestas a pacientes con uveítis, con edad media de 45 ± 17.08 años, nivel socioeconómico ≤ D; 54 eran mujeres. El diagnóstico se realizó al 1.87 ± 2.73 años. Acuden anualmente a cita 2.1 ± 2.14 mes, más de 1 a urgencias y son hospitalizados 3.7 días. Utilizan tratamiento sistémico con antiinflamatorios esteroideos (53 %), inmunosupresor (31 %), terapia biológica (7 %), tratamiento tópico con lubricantes (44 %), esteroides (26 %) y cirugías (39 %). Comorbilidades observadas: hipertensión arterial, diabetes mellitus, artritis reumatoide (18 %), síndrome de Sjögren, lupus y colitis ulcerativa crónica inespecífica. Complicaciones: deterioro visual, cataratas y ceguera. La uveítis afecta su vida en el 83 % de los casos, en el 41 % a diario y el 49 % necesitan cuidados de otra persona. El 79 % reciben atención privada, el 43 % cuenta con seguridad social, gastando mensualmente $3,590 ± $2,730.65 pesos en medicamentos, transporte, consulta médicas y estudios. Anualmente con ausentismo laboral de 8.5 ± 14.56 días, más 7.0 días de incapacidad u hospitalización. El 51 % refieren falta de apoyo para conocer la enfermedad. Conclusiones: Se trata del primer estudio nacional que escenifica la condición de los pacientes con uveítis y las insuficiencias por las que atraviesan, incluyendo el ámbito económico y biopsicosocial.

Abstract Objective: Determine the psychosocial and economic impact suffered by patients diagnosed with uveitis in Mexico. Methods: Survey in uveitis-diagnosed patients. Demographic data and socioeconomic level were recorded. Symptoms, time to diagnosis, type of treatment, behavior, attitudes and feelings towards the disease were identified. Results: One hundred surveys were conducted in patients with uveitis, who had a mean age of 45 ± 17.08 years, and socioeconomic level ≤ D; 54 were females. Diagnostic delay was 1.87 ± 2.73 years. Annually, patients attend 2.1 ± 2.14 appointments per month, and are admitted once to the emergency department and remain hospitalized for 3.7 days. Patients use systemic treatment with steroidal anti-inflammatory drugs (53 %), immunosuppressant agents (31 %), biological therapy (7 %), topical treatment with lubricants (44 %) or steroids (26 %) and undergo surgery (39 %). Observed comorbidities include hypertension, diabetes mellitus, rheumatoid arthritis (18 %), Sjögren’s syndrome, systemic lupus erythematosus, and nonspecific chronic ulcerative colitis. Complications: visual impairment, cataracts and blindness. Uveitis affects their life in 83 % of cases, in 41 % does it daily, and 49 % need care from another person. Seventy-nine percent receive private care and 43 % have social security, with $ 3,590 ± $ 2,730.65 pesos being spent monthly on medicines, transportation, medical appointments and studies. Annually, work absenteeism is 8.5 ± 14.56 days, plus 7.0 days of disability or hospitalization; 51% refer lack of support to learn about the disease. Conclusions: This is the first national study to portray the condition of patients with uveitis and the shortcomings they go through, including the economic and biopsychosocial fields.

Diagnostic and treatment delays in breast cancer in association with multiple factors in Pakistan

Background: Breast cancer has the highest incidence rate among all types of cancer worldwide. There is strong evidence that delay in presentation to an oncologist may lead to a decrease in survival.Aims: This study explores factors causing diagnostic and treatment delays among the breast cancer patients enrolled in Jinnah Hospital, Lahore, from 2016 to 2018.Methods: Data from 372 patients were collected, including tumour characteristics, first symptoms, knowledge and experience of breast cancer, first visit to a doctor, etc. We calculated the patient, physician, treatment, system and total delay intervals.Results: Breast cancer cases showed longer mean patient delay in older women (> 50 years) in comparison with younger women. Women with painless lump as the initial symptom showed the longest delay with median total delay 280 days (25th and 75th percentiles 140 and 410 days respectively). Initial symptoms were correlated with total delay (P = 0.036). Educated women showed shorter delay in treatment compared with illiterate women (P = 0.068). Rural residence showed significant delay (P = 0.007). Lump size showed correlation with delay (P = 0.039). Patients with low household income (< Rs 10 000) had greater delay in diagnosis (P = 0.027) and actively employed women showed shorter delay (P < 0.0001). Unmarried women were diagnosed earlier than married (P < 0.001).Conclusions: Women showed delay in presentation due to lack of resources and lack of awareness about the disease. They presented late due to fear of surgery and chemotherapy. Using traditional treatment methods leads to diagnosis of the disease at more advanced stages.

Prevalencia de diabetes y descontrol glucémico en México: resultados de la Ensanut 2016 / Prevalence of diabetes and poor glycemic control in Mexico: results from Ensanut 2016

Resumen: Objetivo: Estimar la prevalencia de diabetes (total, diagnosticada y no diagnosticada), de descontrol glucémico en México y sus factores asociados. Material y métodos: Se analizaron 3 700 adultos participantes en la Encuesta Nacional de Salud y Nutrición de 2016. Se estimaron las prevalencias con ponderadores poblacionales y los factores asociados con diabetes total y descontrol glucémico con modelos de regresión de Poisson. Resultados: La prevalencia total de diabetes fue de 13.7% (9.5% diagnosticada, 4.1% no diagnosticada); 68.2% de los diagnosticados presentó descontrol glucémico. Mayor tiempo de diagnóstico, vivir en el centro/sur del país y ser atendido en farmacias se asoció con descontrol glucémico, mientras que ser atendido en los servicios de seguridad social se asoció con mejor control glucémico. Conclusión: Se requieren esfuerzos multisectoriales para fortalecer el tamizaje, diagnóstico oportuno y control de la enfermedad, considerando las diferencias por región y tipo de servicio de salud.

Abstract: Objective: To estimate the prevalence of total, diagnosed and undiagnosed diabetes, and the prevalence of poor glycemic control in Mexico, and its associated factors. Materials and methods: Data from 3 700 adult participants were analysed in the 2016 National Health and Nutrition Survey. Diabetes prevalences were estimated with population weights, and the factors associated with total diabetes and poor glycemic control with Poisson regression models. Results: The total prevalence of diabetes was 13.7% (9.5% diagnosed, 4.1% undiagnosed); 68.2% of people with diagnosed diabetes presented poor glycemic control. Longer disease duration, living in the centre or south of the country and being treated in pharmacies were associated with poor glycemic control. Being treated in a social security system was associated with better glycemic control. Conclusion: Multisectoral efforts are needed to strengthen screening, timely diagnosis and disease control, considering differences by region and type of health service.

Late diagnosis of Human Immunodeficiency Virus infection and associated factors / Diagnóstico tardio de infecção pelo Vírus da Imunodeficiência Humana e fatores associados / Diagnóstico tardío de infección por el virus de la inmunodeficiencia humana y factores asociados

Objective: to analyze the occurrence of late diagnosis of infection by the Human Immunodeficiency Virus and its associated factors. Method: this is an epidemiological, cross-sectional and analytical study, carried out with 369 people followed-up by Specialized Assistance Services, undergoing anti-retroviral treatment, and interviewed by means of a questionnaire. Univariate analysis was performed using Pearson's chi-square test or Fisher's exact test and Kruskall-Wallis test, and multivariate analysis using the ordinal logistic regression model of proportional odds. Results: the occurrence of 59.1% for late diagnosis of the infection was observed; the probability of later diagnosis is greater among people who have a steady partnership, when compared to those who do not; with increasing age, particularly above 35 years old; among those with lower schooling; for those who seek the health services to have an HIV test when they feel sick; and for those who test HIV less often or never do it after sex without a condom with a steady partner. Conclusion: the knowledge on the high proportion of late diagnosis and its associated factors verified in this study make the planning and implementation of new policies and strategies aimed at the timely diagnosis of the infection imperative.

Objetivo: analisar a ocorrência de diagnóstico tardio de infecção pelo Vírus da Imunodeficiência Humana e seus fatores associados. Método: trata-se de estudo epidemiológico, transversal e analítico, realizado com 369 pessoas acompanhadas por Serviços de Assistência Especializada, em tratamento antirretroviral, entrevistadas por meio de questionário. Realizou-se análise univariada, utilizando-se os testes Qui-quadrado de Pearson ou exato de Fisher e o teste de Kruskall-Wallis, e análise multivariada, pelo modelo de regressão logística ordinal de chances proporcionais. Resultados: observou-se a ocorrência de 59,1% de diagnóstico tardio da infecção; a probabilidade de diagnóstico mais tardio é maior entre pessoas que têm parceria fixa, quando comparadas aos que não têm; com o aumento da idade, particularmente, acima dos 35 anos; entre os que possuem menor escolaridade; para os que buscam os serviços de saúde para realizar o teste de HIV quando se sentem doentes; para aqueles que fazem o teste de HIV com menor frequência ou nunca o fazem após relação sexual sem preservativo com parceria fixa. Conclusão: o conhecimento da elevada proporção de diagnóstico tardio e de seus fatores associados verificados neste estudo tornam imperiosos o planejamento e a implementação de novas políticas e estratégias que visem ao diagnóstico oportuno da infecção.

Objetivo: analizar la ocurrencia del diagnóstico tardío de infección por el Virus de Inmunodeficiencia Humana y sus factores asociados. Método: estudio epidemiológico, transversal y analítico, realizado con 369 personas que utilizan Servicios de Asistencia Especializada, en tratamiento antirretroviral, entrevistados a través de un cuestionario. El análisis univariado se realizó por medio de la prueba de chi-cuadrado de Pearson o la prueba exacta de Fisher y la prueba de Kruskall-Wallis, mientras que para el análisis multivariado se utilizó el modelo de regresión logística ordinal de probabilidades proporcionales. Resultados: se observó la ocurrencia de 59,1% de diagnóstico tardío de la infección; la probabilidad de un diagnóstico posterior es mayor entre las personas que tienen una pareja estable, en comparación con quienes no la tienen; con el aumento de la edad, particularmente, por encima de los 35 años; entre aquellos con índice más bajo de escolaridad; para aquellos que buscan servicios de salud para hacerse una prueba de VIH cuando se sienten enfermos; para quienes se realizan la prueba del VIH con menor frecuencia o nunca lo hacen después de tener relaciones sexuales sin condón con una pareja estable. Conclusión: el conocimiento de la alta proporción de diagnósticos tardíos y sus factores asociados verificados en este estudio hacen que la planificación e implementación de nuevas políticas y estrategias dirigidas al diagnóstico oportuno de la infección sea imperativa.

Características clínicas y administrativas que se relacionan con el retraso en el diagnóstico y tratamiento de los pacientes con cáncer de cabeza y cuello / Clinical and administrative characteristics related to the delay in the diagnosis and treatment of patients with head and neck cancer

Introducción. En Colombia, el diagnóstico de los tumores de cabeza y cuello es tardío, lo cual aumenta la mor-talidad, las secuelas estéticas y funcionales, y los costos para el sistema de salud. Actualmente, hay poca información sobre los factores que retrasan el diagnóstico y tratamiento de los pacientes con cáncer de cabeza y cuello. Métodos. Se trata un estudio transversal y analítico. Como referencia, se utilizó el cálculo de muestras para una población finita con un nivel de confianza del 95 % y un margen de error del 5 %, para un total de 159 pacientes con diagnóstico de cáncer de cabeza y cuello atendidos en la Clínica Vida de Medellín, entre los años 2016 y 2017. Resultados. Se evaluaron 146 pacientes. Los síntomas más frecuentes por los que consultaron fueron masa cervical y disfonía. Solo el 53,4 % de los pacientes buscó atención médica inmediata ante la presencia del síntoma. De aque-llos que no la buscaron, la causa más frecuente fue la creencia de que el síntoma desaparecería espontáneamente. Discusión. Con base en los resultados obtenidos, se puede concluir que el síntoma de presentación juega un papel importante para que el paciente decida buscar o no buscar atención médica inmediata. El síntoma de presentación y el vivir en el área rural, retrasan el tiempo transcurrido entre la aparición del síntoma y la primera valoración por un médico de atención primaria. Los factores que se asociaron al retraso entre el diagnóstico y el inicio del tratamiento, fueron la seguridad social y el haber presentado tos como síntoma inicial

Introduction: In Colombia the diagnosis of head and neck tumors is late, which represents an increase in mor-tality, aesthetic and functional sequelae and costs for the health system. Currently, there is little information on the factors that delay the diagnosis and treatment of patients with head and neck cancer.Methods: It is a cross-sectional and analytical study. As a reference, the calculation of samples was used for a finite population with a confidence level of 95% and a margin of error of 5%, for a total of 159 patients diagnosed with head and neck cancer treated between 2016 and 2017.Results: A total of 146 patients were evaluated. The most frequent symptoms for those who consulted were neck mass and dysphonia. Only 53.4% of the patients sought immediate medical attention in the presence of the symptom. Of those who did not seek for it, the most frequent cause was the belief that the symptom would spontaneously disappear.Discussion: Based on the results obtained, it can be concluded that the presentation symptom plays an important role for the patient to decide whether or not to seek immediate medical attention. The presentation symptom and living in rural areas delay the time elapsed between the appearance of the symptom and the first assessment by a primary care physician. The factors that were associated with the delay between diagnosis and the start of treatment were social security and having presented cough as an initial symptom