U.S. Women with Invasive Cervical Cancer: Characteristics and Potential Barriers to Prevention.

Objectives: Although invasive cervical cancer (ICC) rates have declined since the advent of screening, the annual age-adjusted ICC rate in the United States remains 7.5 per 100,000 women. Failure of recommended screening and management often precedes ICC diagnoses. The study aimed to evaluate characteristics of women with incident ICC, including potential barriers to accessing preventive care. Materials and Methods: We abstracted medical records for patients with ICC identified during 2008-2020 in five U.S. population-based surveillance sites covering 1.5 million women. We identified evidence of adverse social and medical conditions, including uninsured/underinsured, language barrier, substance use disorder, incarceration, serious mental illness, severe obesity, or pregnancy at diagnosis. We calculated descriptive frequencies and compared potential barriers by race/ethnicity, and among women with and without symptoms at diagnosis using chi-square tests. Results: Among 1,606 women with ICC (median age: 49 years; non-White: 47.4%; stage I: 54.7%), the majority (68.8%) presented with symptoms. Forty-six percent of women had at least one identified potential barrier; 15% had multiple barriers. The most common potential barriers among all women were being underinsured/uninsured (17.3%), and language (17.1%). Presence of any potential barrier was more frequent among non-White women and women with than without symptoms (p < 0.05). Conclusions: In this population-based descriptive study of women with ICC, we identified adverse circumstances that might have prevented women from seeking screening and treatment to prevent cancer. Interventions to increase appropriate cervical cancer screening and management are critical for reducing cervical cancer rates.

Impact of prior underinsurance on cervical cancer screening among Davidson County, Tennessee, women diagnosed with invasive cervical cancer, 2008-2018.

INTRODUCTION: We sought to investigate the association between insurance coverage history and cervical cancer screening among Davidson County, Tennessee, women diagnosed with incident cervical cancer. METHODS: We reviewed medical records of women diagnosed with invasive cervical cancer from 2008 through 2018 identified via the state's cancer registry and by active surveillance of diagnostic pathology reports for the HPV-IMPACT project. Per 2012 United States Preventive Services Task Force recommended cervical cancer screening guidelines, women were characterized into three screening history categories: "no screening", "no follow-up" and "test/screening failure". Multivariable logistic regression measured the association of prior inadequate insurance (underinsurance) and screening history ("no screening/no follow-up" compared to "test/screening failure"). RESULTS: Of 212 women, most (77%) had not undergone recommended cervical cancer screening or follow-up prior to cancer diagnosis. Overall, 28% of women had history of underinsurance in 5 years prior to diagnosis. In adjusted analyses, underinsured women were more likely to have a "no screening/no follow-up" prior to cancer diagnosis (aOR 4.26; 95% CI 1.15-15.80) compared to "test/screening failure" history. Non-white race (aOR 2.73; 95% CI 0.98-7.61), older age (aOR 1.03 per year; 95% CI 1.00-1.07), and history of smoking (aOR 4.07; 95% CI 1.54-10.74) were also associated with increased likelihood of "no screening/no follow-up". CONCLUSIONS: Previous underinsurance was independently associated with non-adherence to cervical cancer screening and follow-up guidelines among women with incident cervical cancer. Further study of factors contributing to inadequate cervical cancer screening and interventions to increase cervical cancer screening in high-risk populations is needed.

High Incidence of Moderately Reduced Renal Function and Lead Bioaccumulation in Agricultural Workers in Assin South District, Ghana: A Community-Based Case-Control Study.

BACKGROUND: The quest to enhance agricultural productivity and crop yields has led to increased use of agrochemicals on a global scale. Long-term use of these agrochemicals may be associated with adverse health implications. OBJECTIVE: To assess haematological indices, renal function, heavy metal bioaccumulation in farmers and sprayers, and their use of personal protective equipment (PPE). MATERIALS AND METHODS: This community-based case-control study was conducted from January 2018 to June 2018 in the Assin South District, Central Region, Ghana. A total of 144 participants were conveniently sampled: 83 agricultural workers (cases) and 61 indigenes with no direct exposure to agrochemicals (controls). Structured questionnaire was used to obtain demographic data as well as agricultural work practices followed by cases. Venous blood samples were drawn from participants and used for estimating full blood count and renal function (serum creatinine (CRE), blood-urea nitrogen (BUN), BUN : CRE ratio, and estimated GFR (eGFR)). Serum lead, arsenic, and cadmium levels were estimated using the Varian AA 240FS atomic spectrometer in an acetylene-air flame. RESULTS: The median RBC (4.49 vs. 4.92 × 1012/L), haemoglobin (12.50 vs. 13.70 g/dL), and platelet (220.00 vs. 268.00) counts were significantly lower in cases. A significantly higher proportion of cases were classified as anaemic or having microcytic cells compared to controls. Also, serum urea (4.08 vs. 3.41; p=0.0009), creatinine (108.10 vs. 101.10; p=0.0286), and BUN : CRE ratio (19.75 vs. 17.84) were significantly higher in cases. Additionally, 18.1% of cases were classified as having moderately reduced renal function compared to only 6.6% of controls. Moreover, a significantly higher proportion of cases had detectable serum lead (55.6% vs. 16.4%) and arsenic (53.1% vs. 9.8%) levels compared to controls. However, on average, 80% of agricultural workers did not use personal protective equipment (PPE) when applying agrochemicals; 84.3% of used agrochemical containments were discarded near the river/canal. CONCLUSION: Neglect of the use of PPE may be predisposing the agrochemical workers and community to lead and arsenic bioaccumulation with a consequent reduced haematological and renal function.

Intellectual property approaches to the protection of traditional knowledge in the African Region

Traditional knowledge has played a significant role in the healthcare systems in countries of the African Region for centuries. Traditional medicines are presently used by nearly 80of the population. Owing to the global resurgence in the use of natural products and the advent of the biotechnological industry; traditional knowledge is increasingly becoming a source of modern drug development and biotechnological inventions. Despite the important role of traditional knowledge; traditional communities are unable to protect their knowledge through the existing intellectual property system owing to the failure of the knowledge to satisfy the requirements for intellectual property protection; incompatibility in most cases between the traditional knowledge concepts and intellectual property as well as the prohibitive costs involved in patent registration. Studies conducted recently and the outcomes of global debates have suggested some policy and legal approaches that can be used to effectively protect traditional knowledge; including traditional medicine. This paper discusses conceptsof traditional knowledge and provides policy and legal measures that have been developed at the international and regional levels for the protection and utilization of traditional knowledge for the benefit of the knowledge holders and society at large