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1.
Med. oral patol. oral cir. bucal (Internet) ; 25(6): e769-e774, nov. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-197185

RESUMO

BACKGROUND: The aim was to examine the interval since first symptoms until final diagnosis of squamous cell carcinoma (SCC) in the head and neck region in southern Brazil. MATERIAL AND METHODS: The individuals were prospectively selected and underwent anamnesis, physical examination and interview in the first medical consultation at a Cancer Hospital from south of Brazil. RESULTS: From 488 patients who underwent clinical examination, 105 were included in the study with diagnosis of SCC. Patients average interval from first symptoms to final diagnosis was 152 days (median 86; max: 1105; min: 1), the average professional interval was 108 days (median: 97; max: 525; min: 1), and the average total period interval was 258 days (median: 186; max: 1177; min: 45). Factors statistically associated with patient and diagnosis itinerary intervals were smoking and poorly adapted dentures and distance from home to hospital, respectively. CONCLUSIONS: The identification of the itinerary characteristics of this specific population may reflect in more effective public policies, such as primary and secondary prevention programs, aiming to increase the survival of oncological patient. Furthermore, the knowledge of the variables that influence the late diagnosis minimizes patient's journey in search of care to cancer centers through health programs


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Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Estudos Transversais , Tempo para o Tratamento , Fatores de Tempo , Fatores de Risco , Brasil
2.
J Cardiovasc Med (Hagerstown) ; 21(11): 869-873, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009170

RESUMO

AIMS: The purpose of this study was to verify the impact on the number and characteristics of coronary invasive procedures for acute coronary syndrome (ACS) of two hub centers with cardiac catheterization facilities, during the first month of lockdown following the COVID-19 pandemic. MATERIALS AND METHODS: Procedural data of ACS patients admitted between 10 March and 10 April 2020 were compared with those of the same period of 2019. RESULTS: We observed a 23.4% reduction in ACS admissions during 2020, with a decrease for both ST-elevation myocardial infarction (STEMI) (-5.6%) and non-ST-elevation myocardial infarction (-34.5%), albeit not statistically significant (P = 0.2). During the first 15 days of the examined periods, the reduction in ACS admissions reached 52.5% (-25% for STEMI and -70.3% for non-ST-elevation myocardial infarction, P = 0.04). Among STEMI patients, the rate of those with a time delay from symptoms onset longer than 180 min was significantly higher during the lockdown period (P = 0.01). Radiograph exposure (P = 0.01) was higher in STEMI patients treated in 2020 with a slightly higher amount of contrast medium (P = 0.1) and number of stents implanted (P = 0.1), whereas the number of treated vessels was reduced (P = 0.03). Percutaneous coronary intervention procedural success and in-hospital mortality were not different between the two groups and in STEMI patients (P NS for all). CONCLUSION: During the early phase, the COVID-19 outbreak was associated with a lower rate of admissions for ACS, with a substantial impact on the time delay presentation of STEMI patients, but apparently without affecting the in-hospital outcomes.


Assuntos
Síndrome Coronariana Aguda , Infecções por Coronavirus , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio , Pandemias , Intervenção Coronária Percutânea , Pneumonia Viral , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Controle de Infecções/métodos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Tempo para o Tratamento/estatística & dados numéricos
3.
Ann Emerg Med ; 76(3S): S56-S63, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32928463

RESUMO

STUDY OBJECTIVE: Individuals living with sickle cell disease (SCD) often require urgent care; however, some patients hesitate to present to the emergency department (ED), which may increase the risk of serious clinical complications. Our study aims to examine psychosocial, clinical, and demographic factors associated with delaying ED care. METHODS: This was a cross-sectional study of 267 adults with SCD from the national INSIGHTS Study. The binary outcome variable asked whether, in the past 12 months, participants had delayed going to an ED when they thought they needed care. Logistic regression was performed with clinical, demographic, and psychosocial measures. RESULTS: Approximately 67% of the participants reported delaying ED care. Individuals who delayed care were more likely to have reported higher stigma experiences (odds ratio [OR]=1.09; 95% confidence interval [CI] 1.03 to 1.16), more frequent pain episodes (OR=1.15; 95% CI 1.01 to 1.32), lower health care satisfaction (OR= 0.74; 95% CI 0.59 to 0.94), and more frequent ED visits (OR=6.07; 95% CI 1.18 to 31.19). Disease severity and demographics, including sex, age, and health insurance status, were not significantly associated with delay in care. CONCLUSION: Psychosocial factors, including disease stigma and previous negative health care experiences, are associated with delay of ED care in this SCD cohort. There is a need to further investigate the influence of psychosocial factors on the health care-seeking behaviors of SCD patients, as well as the downstream consequences of these behaviors on morbidity and mortality. The resulting knowledge can contribute to efforts to improve health care experiences and patient-provider relationships in the SCD community.


Assuntos
Anemia Falciforme/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Anemia Falciforme/psicologia , Estudos Transversais , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente/estatística & dados numéricos , Psicologia , Estigma Social , Adulto Jovem
4.
J Fr Ophtalmol ; 43(8): 774-778, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32800414

RESUMO

INTRODUCTION: In an environment where strabismus is poorly understood and management centers rare, we studied the epidemiological, clinical and therapeutic aspects of neglected childhood strabismus. MATERIALS AND METHODS: This was a retrospective study carried out from March 1st, 2013 to September 30, 2018. Neglected childhood strabismus was defined as strabismus occurring in the first 5 years of life, for which the patient was over 7-years-old at the time of first consultation. The variables studied were age at first consultation, gender, age of onset, type of strabismus, etiology of strabismus, angle of deviation and rate of surgery. RESULTS: We found 113 cases of neglected childhood strabismus among the 430 cases of strabismus seen during the study period. There were more females (n=64) than males. The mean age was 17.7±10.5 years. There were 73 exotropias (64.6 %). The mean angle of deviation was 41.2±12.2PD. Strabismus was early in 70.8 % of cases. Innervational strabismus accounted for 86.7 % of cases. The most frequent refractive error was hyperopic astigmatism (55.3 %). Of the 45 patients who were seen again after full-time wear of their full cycloplegic correction, 2 were orthotropic. Surgery was performed in 60.5 % of cases. The average postoperative angle of deviation was 6.6±9.4PD. CONCLUSION: Management of neglected childhood strabismus provides good results and should therefore be encouraged in order to improve the quality of life of affected patients.


Assuntos
Diagnóstico Tardio , Estrabismo/diagnóstico , Estrabismo/epidemiologia , Estrabismo/terapia , Adolescente , Adulto , Idade de Início , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Estudos Transversais , Diagnóstico Tardio/estatística & dados numéricos , Esotropia/diagnóstico , Esotropia/epidemiologia , Esotropia/terapia , Exotropia/diagnóstico , Exotropia/epidemiologia , Exotropia/terapia , Feminino , Humanos , Perda de Seguimento , Masculino , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Qualidade de Vida , Estudos Retrospectivos , Adulto Jovem
5.
Epidemiol Health ; 42: e2020058, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32777881

RESUMO

OBJECTIVES: Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis. METHODS: An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas. RESULTS: The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables. CONCLUSIONS: The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.


Assuntos
Brucelose/epidemiologia , Diagnóstico Tardio/prevenção & controle , Vigilância da População , Brucelose/diagnóstico , Cidades/epidemiologia , Análise por Conglomerados , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Análise Espacial
6.
Diabetes Care ; 43(11): 2870-2872, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32778554

RESUMO

OBJECTIVE: To evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Italy. RESEARCH DESIGN AND METHODS: This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetic ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between 20 February and 14 April in 2019 and 2020. RESULTS: Fifty-three of 68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared with 2019. Among those newly diagnosed patients who presented in a state of DKA, the proportion with severe DKA was 44.3% in 2020 vs. 36.1% in 2019 (P = 0.03). There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed severe acute respiratory syndrome coronavirus 2. CONCLUSIONS: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any "second wave" requires strategies to educate and reassure parents about timely emergency department attendance for non-COVID-19 symptoms.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Diabetes Mellitus Tipo 1/diagnóstico , Cetoacidose Diabética/diagnóstico , Pneumonia Viral/diagnóstico , Adolescente , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/virologia , Cetoacidose Diabética/epidemiologia , Cetoacidose Diabética/virologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
7.
J Fr Ophtalmol ; 43(7): 598-603, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32631694

RESUMO

INTRODUCTION: Neuromyelitis optica spectrum disorder (NMO-SD) has been recognized for the past decade. Biomarkers such as anti-Aquaporin 4 antibodies (AQP4) and anti-Myelin Oligodendrocyte Glycoprotein (MOG) have been able to classify NMO-SD into several groups. METHODS: A retrospective study was performed in the Strasbourg University Medical Center among patients with AQP4+, MOG+ and double-seronegative NMO to compare their clinical, epidemiological and paraclinical features. RESULTS: Thirty-two patients with NMO were included. The AQP4+ NMO patients had a median of age of 45 years, with associated myelitis in 62.5% of cases and other autoantibodies in 37.5% of cases. The mean number of relapses by clinical history was 3. The mean initial visual acuity during an exacerbation was 0.3 LogMAR, and the visual acuity after an exacerbation was 0.1 LogMAR. MOG+NMO patients had a median age of 23 years, with severely impaired initial visual acuity (0.6 LogMAR) but better recovery (0 LogMAR); optic disc edema was present in 80% of cases; the mean number of relapses on clinical history was 1. AQP4-/MOG- NMO's were more common in women (70%) and were bilateral in 40% of cases. CONCLUSION: The diagnostic characteristics of NMO-SD are becoming increasingly differentiated, with a positive impact on functional prognosis and long-term progression. Other biomarkers have yet to be identified to improve the diagnosis and treatment of these disorders.


Assuntos
Neuromielite Óptica/diagnóstico , Neuromielite Óptica/epidemiologia , Adulto , Diagnóstico Tardio/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuromielite Óptica/terapia , Estudos Retrospectivos , Acuidade Visual/fisiologia , Adulto Jovem
8.
AIDS Patient Care STDS ; 34(7): 303-315, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639210

RESUMO

Despite successful implementation of anonymous voluntary human immunodeficiency virus (HIV) counseling and testing (aVCT) in Taiwan, the trend of late HIV presentation in sexually active populations has remained unchanged in Taiwan over the past decade. We evaluated the effect and acceptance of an aVCT cascade program among Taiwanese individuals by surveying 572 participants (mean age: 29.6 years; 99.3% men; and 79.5% same-sex sexual contact) diagnosed with HIV/acquired immune deficiency syndrome (AIDS) from 2015 to 2019. We designed a five-stage continuum based on acceptance of the program before HIV diagnosis: at high risk of HIV infection (Stage 1), heard of aVCT (Stage 2), wants to receive aVCT (Stage 3), has received aVCT (Stage 4), and regularly receives aVCT (Stage 5). Four domains established from exploratory factor analysis described reasons for inability to reach the next aVCT stage: low perceived HIV risk, fear of testing positive because of discrimination/stigmatization, and structural barriers to aVCT. Regular aVCT (vs. never receiving aVCT) protected against AIDS on diagnosis (p < 0.001). There were no significant differences in program acceptance across 2015-2019. However, uptake reduced markedly across the program; the largest reduction (37.4.0-61.0%) occurred from Stage 4 to Stage 5. Fear of testing positive because of discrimination/stigmatization was the main reason for not proceeding to the next aVCT stage. Although the findings indicate the benefits of regular aVCT for early HIV diagnosis, additional strategies to reduce fear of negative social consequences of HIV infection are prioritized to optimize aVCT in Taiwan.


Assuntos
Aconselhamento/métodos , Diagnóstico Tardio/estatística & dados numéricos , Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Estigma Social , Síndrome de Imunodeficiência Adquirida , Adulto , Atitude do Pessoal de Saúde , Aconselhamento/estatística & dados numéricos , Discriminação Psicológica , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Comportamento Sexual , Taiwan/epidemiologia
9.
Ital J Pediatr ; 46(1): 87, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600464

RESUMO

Since the outbreak of COVID-19 pandemic, the number of cases registered worldwide has risen to over 3 million. While COVID-19 per se does not seem to represent a significant threat to the pediatric population, which generally presents a benign course and a low lethality, the current emergency might negatively affect the care of pediatric patients and overall children welfare. In particular, the fear of contracting COVID-19 may determine a delayed access to pediatric emergency facilities. Present report focuses on the experience of The Children Hospital in Alessandria (northern Italy). The authors document a drop in the number of admissions to the emergency department (A&E) during the lock-down. They will also focus on four emblematic cases of pediatric patients who were seen to our A&E in severe conditions. All these cases share a significant diagnostic delay caused by the parents' reluctance to seek medical attention, seen as a potential risk factor for COVID-19 contagion. None was found positive to all COVID-19 swab or immunologic testing. All in all, our data strongly support the importance of promoting a direct and timely interaction between patients and medical staff, to prevent the fear of COVID-19 from causing more harm than the virus itself.


Assuntos
Infecções por Coronavirus/epidemiologia , Diagnóstico Tardio/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Controle de Infecções/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Criança , Bem-Estar da Criança , Infecções por Coronavirus/prevenção & controle , Emergências/epidemiologia , Feminino , Hospitais Pediátricos , Humanos , Itália/epidemiologia , Masculino , Pandemias/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Pediatria/organização & administração , Pneumonia Viral/prevenção & controle , Desenvolvimento de Programas , Medição de Risco
12.
BMC Public Health ; 20(1): 1126, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680489

RESUMO

BACKGROUND: Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia. METHODS: This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. RESULTS: Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10-45), 4 (2-10) and 2 (1-3) days respectively. The median (IQR) of total delay was 33 (19-67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay. CONCLUSION: TB patients' delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/terapia , Adolescente , Adulto , Análise por Conglomerados , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estigma Social , Fatores de Tempo , Adulto Jovem
13.
Postgrad Med J ; 96(1137): 392-398, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32522844

RESUMO

Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diagnóstico Tardio/prevenção & controle , Erros de Diagnóstico/prevenção & controle , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/fisiopatologia , Síndrome da Liberação de Citocina/virologia , Diagnóstico Tardio/estatística & dados numéricos , Diagnóstico Diferencial , Erros de Diagnóstico/estatística & dados numéricos , Diarreia/virologia , Disgeusia/virologia , Humanos , Doenças do Sistema Nervoso/virologia , Transtornos do Olfato/virologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Replicação Viral
14.
Actas Dermosifiliogr ; 111(8): 629-638, 2020 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-32513393

RESUMO

Background and objectives: Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma. Material and methods: Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points. Results: Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter >4cm or thickness >6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (>6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five- and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months. Conclusions: In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect to see to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays.


Assuntos
Betacoronavirus , Carcinoma de Células Escamosas/patologia , Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Melanoma/patologia , Pneumonia Viral/epidemiologia , Neoplasias Cutâneas/patologia , Carga Tumoral , Fatores Etários , Algoritmos , Carcinoma de Células Escamosas/mortalidade , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Acesso aos Serviços de Saúde , Humanos , Masculino , Melanoma/mortalidade , Pandemias , Vigilância em Saúde Pública/métodos , Quarentena , Estudos Retrospectivos , Fatores Sexuais , Neoplasias Cutâneas/mortalidade , Espanha/epidemiologia , Fatores de Tempo , Tempo para o Tratamento
16.
Ann Epidemiol ; 46: 14-19, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32532368

RESUMO

BACKGROUND: Lung cancer remains a major cause of death worldwide. While in the past it was considered to primarily afflict males, in recent decades the number of female patients has risen, such that rates among females are similar to those among males. Nevertheless, it has been found previously (e.g., in cardiovascular disease) that when there is a sex-specific stereotype to a disease, it may remain entrenched in medical diagnostic processes, so as to cause belated diagnosis among the other sex. Gender-based differences in incidence and diagnosis are likely to exist with respect to lung cancer because of smoking habits and stereotypes, geographic and socioeconomic differences, and past epidemiologic differences between the sexes. Here we aim to characterize the effects of gender on lung cancer diagnosis and whether such effects have changed over time. METHODS: The SEER (Statistics, Epidemiology, and End Results) database was used to check for sex-based differences by tumor type and stage at diagnosis and to investigate whether these patterns have changed with time by comparing staging data in different age cohorts over time. Results were stratified by location and analyzed with data regarding possible confounders such as smoking and socioeconomic factors. RESULTS: We examined 458,132 cases of lung cancer from the years 2004-2012; 243,021 (53%) in males and 215,111 (47%) in females. Lung cancer rates were 73.8 (73.5-74.1) per 100k in males and 51.6 (51.4-51.8) per 100k in females. Of these, 400,800 had the stage listed, 214,479 (54%) in males, and 186,321 (46%) in females. Total lung cancer rates were higher in males than females at all disease stages. Male patients were more likely than female patients to be diagnosed at stage 3-4, consistent across lung cancer types, cancer registries, smoking, and socioeconomic backgrounds. The difference between the percentage of males versus females diagnosed in stages 3-4 correlated negatively with increased female ever-smokers and with squamous and small cell carcinoma and were not correlated with the rate of cancer in females, or the difference between male and female cancer rates. CONCLUSIONS: Our study showed that there is no belated diagnosis of lung cancer in females. Results appear to point to the fact that smoking females are more likely to be diagnosed at later stages, which is consistent with the current literature.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Neoplasias Pulmonares/patologia , Fatores Sexuais , Fumar/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Incidência , Neoplasias Pulmonares/classificação , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Sistema de Registros , Programa de SEER , Fatores Socioeconômicos , Estados Unidos/epidemiologia
17.
South Med J ; 113(5): 224-231, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358617

RESUMO

OBJECTIVES: This study aimed to identify small geographic areas where the childhood cancer yearly incidence and late-stage diagnosis rates were disproportionately higher among racial/ethnic minorities (Hispanics and non-Hispanic African Americans) in Texas. METHODS: The study examined childhood cancer disparities in Texas from 2005 to 2014, based on geographic location and race/ethnicity. Relative (risk ratio) and absolute (risk difference) measures were used to investigate racial disparities of childhood cancer late-stage diagnosis in small geographic areas (census tracts). The study investigated childhood cancer yearly incidence- and late-stage diagnosis rates for three racial groups combined. The study also analyzed the temporal change of childhood cancer late-stage diagnosis rates based on the data from census tracts where disparities existed for Hispanics and non-Hispanic African Americans compared with a non-Hispanic white reference group. RESULTS: A total of 54% of the cases in the study cohort were diagnosed in the late stage. Although there were fewer non-Hispanic African Americans cases compared with non-Hispanic white and Hispanic cases, they showed significant geographic variation in racial/ethnic disparities compared with the non-Hispanic white reference group. The study also revealed that 58 census tracts for non-Hispanic African Americans and 47 census tracts for Hispanics (of 5265) had significantly higher late-stage diagnosis rates compared with non-Hispanic whites. The findings also demonstrated consistent increases in incidence and late-stage diagnosis from 2005 to 2014 for all cases combined. CONCLUSIONS: Most of the significant census tracts with a higher late-stage diagnosis rate for Hispanics were located on the outskirts of the Dallas-Fort Worth, Houston, and San Antonio areas. In contrast, geographic disparities of childhood cancer late-stage diagnosis for non-Hispanic African Americans were found inside the large metropolitan areas of Houston and Dallas-Fort Worth. The findings of this study will help prioritize the geographical allocation of resources, which, in turn, will help to facilitate preventive healthcare services and alleviate the disease burden in children.


Assuntos
Afro-Americanos/estatística & dados numéricos , Diagnóstico Tardio/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Neoplasias/etnologia , Adolescente , Criança , Pré-Escolar , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Geografia , Disparidades nos Níveis de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estadiamento de Neoplasias , Neoplasias/patologia , População Suburbana , Texas , População Urbana , Adulto Jovem
18.
Infect Dis Poverty ; 9(1): 49, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381122

RESUMO

BACKGROUND: Cambodia is among the 30 countries in the world with the highest burden of tuberculosis (TB), and it is estimated that 40% of people with TB remain undiagnosed. In this study, we aimed to investigate the determinants of delayed diagnosis and treatment of TB in Cambodia. METHODS: This mixed-method explanatory sequential study was conducted between February and September 2019 in 12 operational districts in Cambodia. It comprised of a retrospective cohort study of 721 people with TB, followed by a series of in-depth interviews. We assessed factors associated with time to TB diagnosis and treatment initiation using Cox proportional hazards model. Subsequently, we conducted in-depth interviews with 31 people with TB purposively selected based on the time taken to reach TB diagnosis, sex, and residence. Transcripts were coded, and thematic analyses were performed. RESULTS: The median time from the onset of symptoms to TB diagnosis was 49 days (Interquartile range [IQR]: 21-112). We found that longer time to diagnosis was significantly associated with living in rural area (Adjusted hazards ratio [aHR] = 1.25; 95% confidence interval [CI]: 1.06-1.48); TB symptoms-cough (aHR: 1.52; 95% CI: 1.18-1.94), hemoptysis (aHR 1.32; 95% CI: 1.07-1.63), and night sweats (aHR: 1.24; 95% CI: 1.05-1.46); seeking private health care/self-medication (aHR: 1.23; 95% CI: 1.04-1.45); and higher self-stigma (aHR: 1.02; 95% CI: 1.01-1.03). Participants who received education level above the primary level were inversely associated with longer time to diagnosis (aHR: 0.78; 95% CI: 0.62-0.97). The median time from TB diagnosis to the initiation of treatment was two days (IQR: 1-3). The use of smear microscopy for TB diagnosis (aHR: 1.50; 95% CI: 1.16-1.95) was associated with longer time to treatment initiation. Seeking private health care and self-medication before TB diagnosis, lack of perceived risk, threat, susceptibility, and stigma derived qualitatively further explained the quantitative findings. CONCLUSIONS: TB diagnostic delay was substantial. Increasing public awareness about TB and consciousness regarding stigma, engaging the private healthcare providers, and tailoring approaches targeting the rural areas could further improve early detection of TB and narrowing the gap of missing cases in Cambodia.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Camboja , Estudos de Coortes , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
BMC Public Health ; 20(1): 572, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345256

RESUMO

BACKGROUND: Early diagnosis and treatment of malaria symptoms reduces the risk of severe complication and malaria transmission. However, delay in malaria diagnosis and treatment is a major public health problem in India. The primary aim of the study was to determine cut-off for the delay in seeking treatment of fever, and the secondary aim was to identify the factors associated with delay in malaria-endemic areas of Assam, Northeast India. METHODS: The present study analysed data from two prior cross-sectional surveys (community- and hospital-based) that was conducted to study the health-seeking behaviour of people residing in high malaria-endemic areas of Assam, Northeast India. The hospital-based survey data were used to determine optimal cut-off for the delay in reporting, and further, used to identify the factors associated with delay using community-based data. RESULTS: Mean age of fever cases was similar in both community- and hospital-based surveys (23.1 years vs 24.2 years, p = 0.229). Delay in reporting fever was significantly higher among hospital inpatients compared to community-based fever cases (3.6 ± 2.1 vs 4.0 ± 2.6 days; p = 0.006). Delay of > 2 days showed higher predictive ability (sensitivity: 96.4%, and ROC area: 67.5%) compared to other cut-off values (> 3, > 4, and > 5 days). Multivariable logistic regression analysis revealed that the adjusted odds ratio (aOR) of delay was significantly higher for people living in rural areas (1.52, 95%CI: 1.11-2.09), distance (> 5 km) to health facility (1.93, 95%CI: 1.44-2.61), engaged in agriculture work (2.58, 95%CI: 1.97-3.37), and interaction effect of adult male aged 20-40 years (1.71, 95%CI: 1.06-2.75). CONCLUSION: The delay (> 2 days) in seeking treatment was likely to be twice among those who live in rural areas and travel > 5 km to assess health care facility. The findings of the study are useful in designing effective intervention programmes for early treatment of febrile illness to control malaria.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Febre/diagnóstico , Malária/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Instalações de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valores de Referência , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
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