Cervical cancer screening decentralized policy adaptation: an African rural-context-specific systematic literature review.

BACKGROUND: Worldwide, nearly 570,000 women are diagnosed with cervical cancer each year, with 85% of new cases in low- and middle-income countries. The African continent is home to 35 of 40 countries with the highest cervical cancer mortality rates. In 2014, a partnership involving a rural region of Senegal, West Africa, was facing cervical cancer screening service sustainability barriers and began adapting regional-level policy to address implementation challenges. OBJECTIVE: This manuscript reports the findings of a systematic literature review describing the implementation of decentralized cervical cancer prevention services in Africa, relevant in context to the Senegal partnership. We report barriers and policy-relevant recommendations through Levesque's Patient-Centered Access to Healthcare Framework and discuss the impact of this information on the partnership's approach to shaping Senegal's regional cervical cancer screening policy. METHODS: The systematic review search strategy comprised two complementary sub-searches. We conducted an initial search identifying 4272 articles, then applied inclusion criteria, and ultimately 19 studies were included. Data abstraction focused on implementation barriers categorized with the Levesque framework and by policy relevance. RESULTS: Our findings identified specific demand-side (clients and community) and supply-side (health service-level) barriers to implementation of cervical cancer screening services. We identify the most commonly reported demand- and supply-side barriers and summarize salient policy recommendations discussed within the reviewed literature. CONCLUSIONS: Overall, there is a paucity of published literature regarding barriers to and best practices in implementation of cervical cancer screening services in rural Africa. Many articles in this literature review did describe findings with notable policy implications. The Senegal partnership has consulted this literature when faced with various similar barriers and has developed two principal initiatives to address contextual challenges. Other initiatives implementing cervical cancer visual screening services in decentralized areas may find this contextual reporting of a literature review helpful as a construct for identifying evidence for the purpose of guiding ongoing health service policy adaptation.

Persistent and aggressive interactions with the police: potential mental health implications.

AIMS: Little is known about the potential health impact of police encounters despite a ubiquitous police presence in many disadvantaged urban environments. In this paper, we assess whether persistent or aggressive interactions with the police are associated with poor mental health outcomes in a sample of primarily low-income communities of colour in Chicago. METHODS: Between March 2015 and September 2016, we surveyed 1543 adults in ten diverse Chicago communities using a multistage probability design. The survey had over 350 questions on health and social factors, including police exposure and mental health status. We use sex-stratified logistic regression to examine associations between persistent police exposure (defined as a high number of lifetime police stops) or aggressive police exposure (defined as threat or use of police force during the respondent's most recent police stop) and the presence of post-traumatic stress disorder (PTSD) or depressive symptoms. RESULTS: Men reporting a high number of lifetime police stops have three times greater odds of current PTSD symptoms compared with men who did not report high lifetime police stops (OR 3.1, 95% CI 1.3-7.6), after adjusting for respondent age, race/ethnicity, education, history of homelessness, prior diagnosis of PTSD and neighbourhood violent crime rate. Women reporting a high number of lifetime police stops have two times greater odds of current PTSD symptoms, although the results are not statistically significant after adjustment (OR 2.0, 95% CI 0.9-4.2). Neither persistent nor aggressive police exposure is significantly associated with current depressive symptoms in our sample. CONCLUSIONS: Our findings support existing preliminary evidence of an association between high lifetime police stops and PTSD symptoms. If future research can confirm as causal, these results have considerable public health implications given the frequent interaction between police and residents in disadvantaged communities in large urban areas.

Why are teenagers in the United States less likely to breast-feed than older women?

Teenage mothers are much less likely than older mothers to breastfeed their infants. The lower breastfeeding rate among teenagers aged 16-19, compared with women aged 20-29, is due almost entirely to the fact that teenage mothers tend to have characteristics associated with a lower likelihood of breastfeeding among all women, such as lower educational level, lower income, and being unmarried. Even so, nearly 40% of the difference between teenage mothers aged 15 or less and mothers aged 20-29 remains unexplained by these factors and may be due to developmental aspects of adolescence, such as greater egocentricity and greater concern about body image.

Anaplastic thyroid carcinoma: cytomorphology and clinical implications of fine-needle aspiration.

Four cases of anaplastic carcinoma of the thyroid were diagnosed in 1,519 thyroid aspirates. All patients had unilateral or diffuse nodular enlargement of the thyroid. One patient had a concurrent grade 1 mucinous carcinoma of the ovary. Cytologically, the neoplasms were characterized by pleomorphic giant or spindle cells with multilobulated, single or multiple nuclei. The chromatin pattern was clumped with prominent parachromatin clearing, and there were multiple prominent nucleoli. Associated papillary and follicular structures were recognized in two aspirates. All cytologic preparations were considered diagnostic of malignancy. Examination of histologic material revealed the same elements identified cytologically on the aspiration smears. Three patients died shortly after diagnosis due to massive local tumor growth in the neck. One patient, who received radiation therapy, had a prolonged survival of 30 mo, but died then of local neck recurrence. The cytologic features of anaplastic carcinoma parallel their histologic appearance. Histologic confirmation of cytologically diagnosed anaplastic carcinoma is not necessary.

Marketing a practical health care policy for the United States.

A policy for universal health care in the United States has been proposed by leading health planners. All citizens of the United States should be entitled to basic health care of adequate quality. Basic care should include physicians, hospitals, and clinic services, emergency and preventive care, and certain other treatments and services. Key to this practical health care policy is the method by which it will be financed. This policy combines several widely discussed financial methods such as Medical Individual Retirement Accounts, catastrophic health insurance, and the combination of what is now known as Medicare and Medicaid into one umbrella package. Active competition within the health care delivery system is essential. To prepare the health care consumer for this competitive environment, an active marketing program by providers, corporations, and all levels of government is basic. For such a policy to be implemented, it must be marketed to the legislature, professional organizations within the health and insurance fields, to educators and to the public.

Current concepts of warfarin therapy.

Oral anticoagulants are used extensively, although their risks are not always fully recognized. The prophylaxis of venous thrombosis after hip surgery, the prevention of deep venous thrombosis and pulmonary emboli after an acute episode of these, the prevention of arterial emboli from the heart in patients at risk, and the prophylaxis of thrombosis in patients with congenital deficiency of antithrombin III, protein C, or protein S are some of the indications for oral anticoagulant use. Warfarin sodium is contraindicated in pregnancy, however. The recommended prothrombin time is 1 1/2 to two times control, lower than previously. The major risk of oral anticoagulant therapy, bleeding, is treated with vitamin K or plasma, depending on its severity. Warfarin necrosis and the "purple-toe" syndrome are seen more frequently than realized.

Media-dependent subculture of nutritionally variant streptococci.

A case of infective endocarditis due to a strain of Streptococcus that demonstrated unusual nutritional requirements is reported. This strain was recognized as a nutritional variant because it could not be subcultured on certain routine primary plating and subculture media. The media-dependent recovery of this nutritionally variant Streptococcus is stressed, since media used routinely in some laboratories would result in this organism's being missed. Variability of routine media in supporting the growth of this isolate is also demonstrated.