Impact of Primary Care Providers and Health Insurance Type on Colorectal Cancer Screening in the United States.

INTRODUCTION: Colorectal cancer (CRC) is a major cause of cancer deaths. We evaluated the effect of health insurance type and primary care provider (PCP) access on CRC screening. METHODS: HINTS data were used to analyze CRC screening. RESULTS: Individuals aged 50 to 65 years had comparable screening rates across all insurance types. Beyond 65 years, individuals with Medicare or Medicare with private insurance were more likely to undergo screening than private insurance users. PCP access increased CRC screening rates. Among PCP users, Medicare, income, and smoking status influenced screening. DISCUSSION: Medicare and PCP access influence CRC screening. All individuals should be linked with PCPs.

Prevalence and predictors of colorectal cancer screening in the United States: evidence from the HINTS database 2018 to 2020.

BACKGROUND: The incidence of colorectal cancer (CRC) and CRC-related mortality among young adults (< 50 years) has been on the rise. The American Cancer Society (ACS) reduced the CRC screening age to 45 in 2018. Few studies have examined the barriers to CRC screening among young adults. METHODS: Analyses were conducted using data from 7,505 adults aged 45-75 years who completed the 2018 to 2020 Health Information National Trends Survey. We examined the sociodemographic characteristics associated with CRC screening overall and by age group using separate multivariable logistic regression models. RESULTS: 76% of eligible adults had received screening for CRC. Increasing age, Black racial group [OR 1.45; 95% CI (1.07, 1.97)], having some college experience, a college degree or higher [OR 1.69; 95% CI (1.24, 2.29)], health insurance coverage [OR 4.48; 95% CI (2.96, 6.76)], primary care provider access [OR 2.48; 95% CI (1.91, 3.22)] and presence of a comorbid illness [OR 1.39; 95% CI (1.12, 1.73)] were independent predictors of CRC screening. Current smokers were less likely to undergo CRC screening [OR 0.59; 95% CI (0.40, 0.87)]. Among adults aged 50-64 years, being of Hispanic origin [OR 0.60; 95% CI (0.39, 0.92)] was associated with a lower likelihood of CRC screening. CONCLUSION: CRC screening rates among adults 45-49 years are low but are increasing steadily. Odds of CRC screening among Blacks is high which is encouraging while the odds among current smokers is low and concerning given their increased risk of developing CRC.

A Curious Case of Vanishing Hepatocellular Carcinoma (HCC).

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. Spontaneous regression of HCC is rare with few documented cases in literature. The mechanism of this phenomenon is unknown, but tumor hypoxia and systemic inflammatory response have been suggested as possible etiologies. This article aims to shed more light on this rare phenomenon and provides an opportunity to review the proposed pathophysiology of spontaneous HCC regression. In this case report, we describe an interesting case of a 39-year-old male with HCC who underwent spontaneous regression.

Hospitalization Trends and Outcomes of Eosinophilic Esophagitis in the United States: A Decade-Long Nationwide Analysis.

Background Eosinophilic esophagitis (EoE) is a chronic antigen-mediated esophageal disease characterized by infiltration of the esophageal mucosa by eosinophils. The prevalence of EoE continues to rise worldwide. However, certain aspects of the epidemiology and pathogenesis remain unclear. Methods This study examined the hospitalization trends of EoE using an extensive inpatient database in the United States, the National (Nationwide) Inpatient Sample (NIS), to identify hospitalizations between 2010 and 2019. We assessed patient demographics as well as hospital-specific variables using the NIS. We obtained the prevalence rate of EoE for each year and used joinpoint regression analysis to obtain trends after adjusting the rate for age and gender. We also sought to characterize the outcomes of these hospitalizations by obtaining the mortality rate, length of stay (LOS), and total hospital charges (THC). Results Of 305 million hospitalizations included in the study, 33,878 were for EoE. The prevalence rate per 100,000 hospitalizations of EoE increased from 6.6 in 2010 to 15.5 in 2019. The annual percentage change obtained from the joinpoint regression analysis was 13.3% from 2010 to 2014 and 7.2% from 2014 to 2019. Most of the hospitalizations were among the male gender and young adults. Almost 95% of hospitalizations across the study period were seen in urban hospitals. We did not notice any significant trend in the mortality rates or length of stay over the study period. The THC increased significantly across the study period. Conclusion There has been an upward trend in the average prevalence rate of EoE over the decade from 2010 to 2019 which almost parallels that of inflammatory bowel disease. This represents a significant burden of disease for a condition that was initially recognized in the late 20th century.

Cannabis Use and Associated Gastrointestinal Disorders: A Literature Review.

Cannabis, commonly known as marijuana, is used by at least 18% of the United States (US) population, which makes it the most commonly used federally illegal drug in the United States. It is widely used for recreational purposes, while its therapeutic benefits have been extensively explored in the US. For several years, cannabis has been used for the treatment of diverse health conditions, including pain management, anti-inflammatory effects, and spasticity associated with multiple sclerosis and other neurodegenerative diseases. However, cannabis use has been associated with some acute and chronic adverse effects. This review sheds light on gastrointestinal disorders, gastroesophageal reflux disease, pancreatitis, and peptic ulcer disease that have been associated with cannabis use.

Association between Financial Barriers to Healthcare Access and Mental Health Outcomes in Tennessee.

OBJECTIVES: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. METHODS: We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables. RESULTS: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001). CONCLUSIONS: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.

Barriers Encountered Toward Pursuing a Neurosurgical Career: A Cross-Sectional Study Among Medical Students, Interns, and Junior Doctors in Africa.

BACKGROUND: Africa has an increased burden of neurosurgical diseases with an estimate of 1,986,392 neurosurgical cases, 108,824 neurosurgical case capacity, and 1,877,568 case deficits yearly. Literature suggests that about 8420 neurosurgeons are needed to fill this vast gap. The main objective of this study is to elucidate barriers encountered in pursuing neurosurgery training in the African context. METHODS: A cross-sectional electronic survey, developed in English and subsequently translated into French, was utilized. This was disseminated among medical students, medical interns, and junior doctors in all 5 African regions. RESULTS: A total of 491 responses were received from the following 5 African regions: West Africa (30.5%), East Africa (30.3%), Central Africa (18.1%), North Africa (11.8%), and Southern Africa (9.2%). Of the participants, 55.2% were men and 44.8% were women. Seventy-six percent of respondents were aware of the neurosurgery deficit in Africa. Barriers to pursuing neurosurgery included discouragement from others over lack of an "ideal personality" trait, culture/cultural beliefs as related to gender roles, lack of mentorship, inadequate neurosurgical training opportunities, poor health infrastructure for neurosurgical practice in Africa, poor patient outcomes, and challenges with work/life balance were some of the barriers highlighted to pursuing neurosurgical career on the continent. CONCLUSION: Even with its robust population growth, Africa is not producing enough neurosurgeons to meet the demands of the population due to several barriers. Delineating these challenges and barriers represents an important step in developing sustainable mechanisms for recruitment, training, mentorship, and support of burgeoning African neurosurgeons.

COVID-19 vaccine acceptance among health care workers in Africa: A systematic review and meta-analysis.

INTRODUCTION: Coronavirus Disease (COVID-19) vaccine acceptance, and hesitancy amongst Health Care Workers (HCWs) on the African continent have been examined through observational studies. However, there are currently no comprehensive reviews among these cadre of population in Africa. Hence, we aimed to review the acceptance rate and possible reasons for COVID-19 vaccine non-acceptance/hesitancy amongst HCWs in Africa. METHODS: We searched Medline/PubMed, Google Scholar, and Africa Journal Online from January, 2020 to September, 2021. The Newcastle-Ottawa Quality Assessment tool adapted for cross-sectional studies was used to assess the quality of the retrieved studies. DerSimonian and Laird random-effects model was used to pool the COVID-19 vaccine acceptance rate. Sub-group and sensitivity analyses were performed. Reasons for COVID-19 vaccine hesitancy were also systematically analyzed. RESULTS: Twenty-one (21) studies were found to be eligible for review out of the 513 initial records. The estimated pooled COVID-19 vaccine acceptance rate was 46% [95% CI: 37%-54%]. The pooled estimated COVID-19 vaccine acceptance rate was 37% [95% CI: 27%-47%] in North Africa, 28% [95% CI: 20%-36%] in Central Africa, 48% [CI: 38%-58%] in West Africa, 49% [95% CI: 30%-69%] in East Africa, and 90% [CI: 85%-96%] in Southern Africa. The estimated pooled vaccine acceptance was 48% [95% CI:38%-57%] for healthcare workers, and 34% [95% CI:29%-39%] for the healthcare students. Major drivers and reasons were the side effects of the vaccine, vaccine's safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust. CONCLUSION: The data revealed generally low acceptance of the vaccine amongst HCWs across Africa. The side effects of the vaccine, vaccine's safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust were the major reasons for COVID-19 hesitancy in Africa. The misconceptions and barriers to COVID-19 vaccine acceptance amongst HCWs must be addressed as soon as possible in the continent to boost COVID-19 vaccination rates in Africa.