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1.
Medicina (B Aires) ; 79(5): 349-357, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671384

RESUMO

In Argentina, mortality from childhood cancer is higher than in more developed countries, with late diagnosis being one of the possible causes. Our objective was to determine the frequency of barriers to diagnosis faced by families assisted by a Non-Governmental Organization, and some associated demographic, institutional and medical factors. A retrospective observational and quantitative analysis of the diagnosis pathway of children with cancer assisted by the N.D. Flexer Foundation, Argentina, between 1/1/2011 and 12/31/2015 was carried out. The primary outcome was the presence of barriers to diagnosis. It was considered that there was a barrier when there were consultations without diagnostic suspicion, family delay, institutional delay, self-derivation and/or more than 30 days between the onset of symptoms and diagnosis. The frequency of barriers within each category was contrasted by the y2 test. A multivariate logistic regression was used to examine its association with relevant variables. Among the 1818 families included, 63.5% faced delays/ barriers to diagnosis. Negative modulators were diagnosis at age younger than 1-year, renal tumor and first attention at a public hospital of the City of Buenos Aires or a provincial capital hospital (all p < 0.0001). Positive modulators were the diagnosis of bone tumor (p = 0.009) and first attention at a primary healthcare center (p< 0.0001) or private doctor's office (p = 0.001). The main non-biological factor associated with the possibility of facing barriers to diagnosis was the type of first contact-health institution.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Neoplasias/diagnóstico , Adolescente , Fatores Etários , Argentina/epidemiologia , Criança , Pré-Escolar , Detecção Precoce de Câncer , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Tempo
2.
Am Surg ; 85(10): 1179-1183, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657320

RESUMO

Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.


Assuntos
Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Diagnóstico Tardio/efeitos adversos , Perfuração Espontânea/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Doença Aguda , Adulto , Apendicectomia/estatística & dados numéricos , Apendicite/complicações , Tratamento Conservador/efeitos adversos , Tratamento Conservador/estatística & dados numéricos , Diagnóstico Tardio/estatística & dados numéricos , Diagnóstico Precoce , Feminino , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Análise de Regressão , Perfuração Espontânea/complicações , Perfuração Espontânea/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Breast Cancer Res Treat ; 177(1): 67-75, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31154578

RESUMO

BACKGROUND: Triple-negative breast cancer (TNBC) includes mostly aggressive types of breast cancer with poor prognosis. Due to its growth pattern, misinterpretation in clinical imaging is more frequent than in non-TNBC. As the group of TNBC contains heterogeneous types of tumors, marker expression-based subtypes have recently been established. We analyzed clinical features and false-negative imaging findings that could potentially lead to diagnostic delay within the subtypes. METHODS: An exploratory analysis compared the imaging features across the a priori defined subtypes and related these findings to molecular subtype, disease stage, potential diagnostic delay, and patient outcome. RESULTS: TNBC cases were categorized into basal-like (BL; 38.6%), mesenchymal-like (ML; 19.9%), luminal androgen receptor (LAR; 28.3%), and immunomodulatory (IM; 13.3%) subtype. In almost every third patient, malignant classification was missed in at least one imaging method. Misclassification in mammogram was more frequent in ML, while benign ultrasound features were reported more often in the BL subtype. Diagnostic delay due to misclassification in imaging led to tumor growth and/or upgrading of the tumor stage in 8.9% of BL tumors, which had the lowest overall survivals. Despite misclassification rate was higher in the ML subtype it showed better outcomes. Misdiagnosis of axillary lymph node metastasis was higher in LAR; however, this subtype showed a higher percentage of affected axillary lymph nodes. CONCLUSION: TNBC subtypes have different clinical features, benign appearances, and diagnostic delay, which can lead to tumor stage upgrade. Future clinical studies on TNBC outcomes might consider the confounder of clinical delay in the subtypes.


Assuntos
Diagnóstico Tardio , Erros de Diagnóstico , Neoplasias de Mama Triplo Negativas/diagnóstico , Adulto , Idoso , Biomarcadores Tumorais , Terapia Combinada , Diagnóstico Tardio/estatística & dados numéricos , Erros de Diagnóstico/estatística & dados numéricos , Diagnóstico por Imagem/métodos , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Estadiamento de Neoplasias , Razão de Chances , Resultado do Tratamento , Neoplasias de Mama Triplo Negativas/etiologia , Neoplasias de Mama Triplo Negativas/mortalidade , Neoplasias de Mama Triplo Negativas/terapia
4.
BMC Infect Dis ; 19(1): 489, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151423

RESUMO

BACKGROUND: A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia. METHODS: An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p-value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay. RESULTS: The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3-37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48-8.98], Culture [AOR = 5.15; 95% CI: 2.53-10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41-3.19] were associated with treatment delays. CONCLUSION: Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/diagnóstico , Adulto , Estudos Transversais , Diagnóstico Tardio/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
5.
N Z Med J ; 132(1496): 31-38, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170131

RESUMO

AIMS: Outpatient endoscopy non-attendance leads to diagnostic delay and increasing wait times. We aimed to analyse endoscopy non-attendance rates and factors associated with it at the Canterbury and Auckland District Health Boards during a five-year period. METHODS: Consecutive appointments between April 2012 and March 2017 were assessed. The following procedures were included: gastroscopy, colonoscopy and endoscopic retrograde cholangiopancreatography. Predictors of non-attendance were assessed using univariate and multivariate binary logistic regression. RESULTS: A total of 58,434 appointments were offered (Canterbury-33,697, Auckland-24,737), of which 2,694 (4.6%) were not attended. Maori (OR 3.0, 95%CI 2.63-3.42) and Pacific Peoples (OR 3.1, 95%CI 2.7-3.55) were significantly more likely to miss appointments compared with Europeans. Patients from socioeconomically most deprived areas (NZDep10) had higher rates of non-attendance (OR 2.13, 95%CI 1.72-2.63) compared with NZDep1. Males (OR 1.43, 95%CI 1.32-1.56) and the Auckland District Health Board patients (OR 2.28, 95%CI 2.08-2.50) had higher non-attendance rates. CONCLUSION: Overall, 4.6% patients did not attend endoscopy appointments. Maori, Pacific Peoples and patients from socioeconomically deprived areas had higher non-attendance rates. Targeted interventions for at-risk groups would potentially lessen health inequalities and optimise utilisation of endoscopy resources.


Assuntos
Agendamento de Consultas , Diagnóstico Tardio/estatística & dados numéricos , Endoscopia do Sistema Digestório/métodos , Cooperação do Paciente/estatística & dados numéricos , Adulto , Assistência Ambulatorial/organização & administração , Análise de Variância , Endoscopia do Sistema Digestório/estatística & dados numéricos , Grupos Étnicos , Feminino , Hospitais Públicos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nova Zelândia , Pacientes Ambulatoriais/estatística & dados numéricos , Sistemas de Alerta , Estudos Retrospectivos , Medição de Risco , Fatores Socioeconômicos
6.
Aust N Z J Public Health ; 43(5): 413-418, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31180616

RESUMO

OBJECTIVE: To develop an HIV response suited to women and to inform appropriate services, we describe the characteristics of women diagnosed and living with HIV using 22 years of high-quality surveillance data. METHODS: Data on women newly diagnosed with HIV between 1994 and 2016 and women living with diagnosed HIV in Victoria at 31 December 2016 were extracted from the Victorian Public Health Surveillance System. Descriptive analysis by place of birth was performed and Poisson regression used to assess trends over time. RESULTS: There were 465 new diagnoses among women in Victoria between 1994 and 2016 and 613 women living with HIV in 2016. Women were diagnosed late, and frequently reported no HIV testing history, AIDS-defining illness or other symptoms of HIV at diagnosis. These indicators of delayed diagnosis were even greater for non-Australian-born women. Conclusions and implications for public health: For Victoria to reach the ambitious targets for diagnosis, treatment and viral suppression in 95% of people living with HIV, prevention programs and efforts to increase early diagnosis as well as support services must consider the epidemiology and diversity of women.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Disparidades em Assistência à Saúde/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Vigilância da População/métodos , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Humanos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Vitória/epidemiologia , Adulto Jovem
7.
Asian Pac J Cancer Prev ; 20(6): 1717-1726, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31244292

RESUMO

Objective: Interval breast cancer (IC) is a limitation of breast cancer screening. We investigated data from a large scaled breast cancer dataset of patients with breast cancer who underwent breast cancer screening in order to recapitulate the overall survival (OS) of patients with ICs compared to those with non-ICs. Methods: A total of 27,141 patients in the Korean breast cancer registry with breast cancer who had ever participated in biannual national breast cancer screening programs between 2009 and 2013 were enrolled. We compared the social, pregnancy-associated, and pathologic characteristics between the IC and non-IC groups and identified the significant prognostic factors for OS. Results: The proportion of ICs was 1.3% (370/27,141) in this study population. ICs were correlated with age 45-55 years at diagnosis, higher levels of education, early menopause (<50 years), hormone replacement therapy, specific provinces (Kangwon, Kyungnam, Jeju, and Dae-jeon), and family history of breast cancer. Low-to-intermediate nuclear grade, early stage (stage 0-I), and low Ki-67 level were also correlated with IC proportion. Non-ICs were associated with an increased risk of five-year mortality (hazard ratio [HR] 7.4; 95% confidence interval [CI]:1.85-29.66; p = 0.005) compared to ICs. Lymph node metastasis, residence (Kyung-nam province), low education status, high histologic grade, and asymptomatic cancers increased the HR of five-year OS. Conclusion: ICs occurred unequally in specific province and relatively high-educated women in Korea. They were also diagnosed with early-stage breast cancer with a favorable recurrence risk, and their outcome was better than those of patients with other breast cancers in breast cancer screening.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Diagnóstico Tardio/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adulto , Neoplasias da Mama/epidemiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , República da Coreia/epidemiologia , Fatores de Risco , Taxa de Sobrevida
8.
PLoS Negl Trop Dis ; 13(6): e0007495, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31247040

RESUMO

INTRODUCTION: A high proportion of grade 2 disability (visible deformity) is indicative of delay in detection of leprosy and leprosy is one of the major causes of preventable disability. We conducted this study to determine the risk factors associated with disability (G2D and G1D) among adult new leprosy cases and to measure their strength of association. METHODS: A multi-centric case-control study was undertaken in five states of India i.e. Andhra Pradesh, Delhi, Gujarat, Maharashtra and West Bengal). Among new adult patients, cases were defined as those with disability (G2D and G1D) at the time of diagnosis and controls were defined as those without any disability (G0D). Delays were quantified based on patient recall across a timeline. Patient delay defined as the time period between first noticed symptom by the patient and the first visit to any health care provider (HCP); HCP delay defined as the time period between patient's first visit to any HCP and the confirmation of diagnosis of leprosy; and total delay defined as the sum of both patient and HCP delays. RESULTS: A total of 1400 new leprosy patients (700 G2D/G1D and 700 G0D) across five states were interviewed. Among G2D/G1D, the median patient delay was 8 months compared with 4 months among G0D. The median HCP delay was 2 months for G2D/G1D and 1 month for G0D. The median total delay was 14 months for G2D/G1D and 6.2 months for G0D; observed median difference between groups was statistically significant (p<0.001). When patient delay was more than 3 months, odds of G2D/G1D at diagnosis were 1.6 times higher compared to when patient delay was less than 3 months. When the HCP delay was more than one month, the odds of G2D/G1D were 1.4 times higher compared to when the HCP delay was less than one month. When the patient had multi-bacillary type leprosy the odds of G2D/G1D at the time of diagnosis was nine times higher compared to pauci-bacillary type leprosy. CONCLUSION: Patient delay is the major reason for risk of disability (G2D/G1D) among adult leprosy patients. A patient delay of more than 3 months from the notice of first symptom is a significant indicator for the disabilities among adult leprosy patients. Early case detection campaigns like active surveys in endemic spots should be done periodically as this can reduce delays and promote early diagnosis. Additionally, the program should lay greater emphasis on raising community awareness regarding the disease. Also, health care provider delay of more than 1 month have been significant risk factors for disability among adult leprosy cases. Hence, periodical capacitation of all HCPs including private practitioners would significantly contribute to reduce diagnostic delay and promote timely referral and early detection.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Hanseníase/complicações , Hanseníase/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Índia/epidemiologia , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
9.
Indian J Public Health ; 63(2): 94-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219056

RESUMO

Background: Timely treatment of tuberculosis is imperative for its control. This can get delayed due to delay in care seeking, diagnosis or treatment initiation. Objectives: The study aims to find out the magnitude of delays in care seeking, diagnosis or treatment initiation, and understand the reasons behind these delays in Wardha district of Maharashtra, India. Methods: A mixed methods study was conducted among 275 patients selected from those enrolled under Revised National Tuberculosis Control Programme in 2014. We collected information regarding the duration of delays and generated a free list of reasons for delays in care seeking and diagnosis. The free list items were then subjected to pile sorting. Two-dimensional scaling and hierarchical clustering analysis were performed to identify the various domains of reasons for delays. Results: The median delay in initial care seeking and diagnosis was 10 days each, and that for treatment initiation was 2 days. The domains identified for delay in care seeking were negligence toward health, health conditions, facility-related issues, and household and social reasons. The domains identified for delay in diagnosis were system-related reasons; and patient-related reasons, each of them further having two subdomains. Conclusions: Interventions for reducing the knowledge gap and stigma, increasing the accessibility of services, active case finding; capacity building of providers, quality assured sputum microscopy, and communication skills will help reduce these delays.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Tuberculose Pulmonar/prevenção & controle , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Humanos , Índia/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Tempo , Tuberculose Pulmonar/psicologia
10.
Ren Fail ; 41(1): 384-392, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31106687

RESUMO

BACKGROUND: Late presentation (LP) of chronic kidney disease (CKD) patients to nephrologist is a serious problem worldwide with persistent high prevalence despite known benefits of early nephrology care. OBJECTIVE: Determine the prevalence and factors associated with LP of CKD patients to nephrologists in Cameroon. METHODS: A cross-sectional study from October 2015 to May 2016 at the nephrology units of the Douala General and Laquintinie hospitals, including all consenting incident CKD patients. Data collected were: socio-demographic, search of CKD diagnostic criteria during prior follow up, therapeutic itinerary, clinical and biological parameters at presentation, knowledge on CKD and attitude towards dialysis. LP was defined as eGFR < 30 ml/min/1.73 m2. It was physician-related whenever no CKD screening was done in the presence of risk factor or no referral to nephrologists at early stages; patient-related whenever patients did not have recourse to hospital care while symptomatic or disrespected a referral decision. p value <.05. RESULTS: We included 130 patients, mean age 53.10 ± 14.66 years, 60.77% males, 58.70% were referred by internal medicine physicians and 10% had recourse to complementary and alternative medicine (CAM). At presentation, 70.80% were symptomatic, 53% had CKD stage five, 86.12% were poorly graded on knowledge and 49% had a negative attitude towards dialysis. The prevalence of LP was 73.90%, 50% was physician-related, 44.79% patient-related and 5.21% both. Being accompanied (p = .038), a low level of education (p = .025) and recourse to CAM (p = .008) were associated with LP. CONCLUSION: LP is high in Cameroon, attributed to physician's practical attitudes and patient's socio-cultural behaviors and economic conditions.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Nefrologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Insuficiência Renal Crônica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Camarões/epidemiologia , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/patologia , Fatores Socioeconômicos , Fatores de Tempo
11.
J Cutan Med Surg ; 23(4): 421-427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31081374

RESUMO

BACKGROUND: When diagnosed at stage 0-I, melanoma has a 5-year survival rate of 92% to 100% in comparison with stage IV, which has a 5-year survival rate of 15% to 20%. OBJECTIVE: The objective of this article is to identify what socioeconomic and demographic factors were associated with increased odds in receiving a delayed melanoma diagnosis. METHODS: This study analyzed the odds of 108,628 patients from the National Cancer Database who were diagnosed between 2004 and 2012 with American Joint Committee on Cancer stage 0-I and stage IV based on race, sex, insurance type, income, facility type, and education. RESULTS: We identified significantly (P < .05) increased odds of stage IV primary melanoma diagnosis in those who had nonprivate insurance, including Medicare (odds ratio [OR] = 1.31, 95% confidence interval [CI]: 1.19-1.45), other government insurance (OR = 2.19, 95% CI: 1.61-2.98), Medicaid (OR = 6.97, 95% CI: 5.98-8.13), or no insurance (OR = 5.10, 95% CI: 4.41-5.91). Increased odds of late-stage melanoma were also associated with male sex (OR = 1.46, 95% CI: 1.36-1.57), race and ethnicity other than non-Hispanic white such as Hispanic whites (OR = 1.49, 95% CI: 1.15-1.92) or African Americans (OR=4.81, 95% CI: 3.75-6.18), and who had decreased education (OR = 1.19, 95% CI: 1.09-1.30). There was not a significant increase in odds of late-stage melanoma in patients from areas with the lowest levels of income compared with areas of highest income. CONCLUSIONS: Certain socioeconomic and demographic factors are associated with odds of a later-stage melanoma diagnosis.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Afro-Americanos/estatística & dados numéricos , Idoso , Bases de Dados Factuais , Escolaridade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Renda , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Melanoma/secundário , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fatores Sexuais , Neoplasias Cutâneas/patologia , Estados Unidos
12.
PLoS One ; 14(5): e0216940, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112572

RESUMO

Many adults with IgG subclass deficiency (IgGSD) experience long intervals of frequent/severe respiratory tract infection before IgGSD diagnosis, but reasons for delays in IgGSD diagnoses are incompletely understood. We performed a retrospective study of 300 white adults (ages ≥18 y) with IgGSD including frequency analyses of age at IgGSD diagnosis, duration of frequent/severe respiratory tract infection before IgGSD diagnosis, and age at onset of frequent/severe infection (calculated). We performed multivariable regressions on age at diagnosis, infection duration, and age at infection onset using these variables, as appropriate: sex; age at diagnosis; diabetes; autoimmune condition(s); atopy; allergy; corticosteroid use; body mass index; serum immunoglobulin isotype levels; blood lymphocyte subsets; three IgGSD-associated human leukocyte antigen-A and -B haplotypes; and referring physician specialties. Mean age at diagnosis was 50 ± 12 (standard deviation) y (median 50 y (range 19-79)). There were 247 women (82.3%). Mean infection duration at IgGSD diagnosis was 12 ± 13 y (median 7 y (range 1-66)). Mean age at infection onset was 38 ± 16 y (median 38 y (range 4, 76)). Age at infection onset was ≥18 y in 95.7% of subjects. Regressions on age at diagnosis and infection duration revealed no significant associations. Regression on age at infection onset revealed one positive association: age at diagnosis (p <0.0001). We conclude that the median duration of frequent/severe respiratory tract infection in adults before IgGSD diagnosis was 7 y. Older adults may be diagnosed to have IgGSD after longer intervals of infection than younger adults. Duration of frequent/severe respiratory tract infection before IgGSD diagnosis was not significantly associated with routine clinical and laboratory variables, including referring physician specialties.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Deficiência de IgG/diagnóstico , Isotipos de Imunoglobulinas/classificação , Infecções Respiratórias/diagnóstico , Adulto , Fatores Etários , Idade de Início , Idoso , Índice de Massa Corporal , Feminino , Expressão Gênica , Antígenos HLA-A/classificação , Antígenos HLA-A/genética , Antígenos HLA-A/imunologia , Antígenos HLA-B/classificação , Antígenos HLA-B/genética , Antígenos HLA-B/imunologia , Haplótipos , Humanos , Deficiência de IgG/sangue , Deficiência de IgG/imunologia , Deficiência de IgG/fisiopatologia , Isotipos de Imunoglobulinas/sangue , Subpopulações de Linfócitos/classificação , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/sangue , Infecções Respiratórias/imunologia , Infecções Respiratórias/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo
13.
Rev Med Chil ; 147(2): 153-160, 2019 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-31095162

RESUMO

BACKGROUND: Physical activity may improve quality of life in patients with chronic kidney disease. AIM: To assess the relationship between physical activity and quality of life in patients with Chronic Kidney Disease. MATERIAL AND METHODS: The Kidney Disease Quality of Life-36 (KDQOL-36) and the International Physical Activity questionnaire were answered by 130 patients with chronic kidney disease (74 women, 80 receiving renal substitution therapy). Sociodemographic variables were recorded. RESULTS: Patients on renal substitution therapy with a time lapse since diagnosis of 0 to 6 months had higher levels of physical activity than those with longer time lapses (51.4 ± 12.5 and 34.6 ± 8.1 minutes respectively). Disease burden scores were lower among patients with renal substitution therapy. There was a direct correlation between levels of vigorous and moderate physical activity and the physical functioning dimension in the quality of life questionnaire for patients with more than 19 months of disease. The dimension general physical health was significantly associated with physical activity in women and patients with 7 to 18 months of diagnosis. The dimension disease burden was associated with physical activity in women, patients not receiving substitution therapy and those with 7 to 18 months of diagnosis. CONCLUSIONS: Moderate and vigorous physical activity is directly related to the dimensions physical functioning, the general perception of physical health and inversely related with the dimension burden of disease.


Assuntos
Exercício/psicologia , Qualidade de Vida/psicologia , Insuficiência Renal Crônica/psicologia , Adulto , Estudos Transversais , Diagnóstico Tardio/estatística & dados numéricos , Substituição de Medicamentos/estatística & dados numéricos , Exercício/fisiologia , Feminino , Humanos , Masculino , Insuficiência Renal Crônica/terapia , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários
15.
BMC Health Serv Res ; 19(1): 217, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953502

RESUMO

BACKGROUND: Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania. METHODS: In a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU. RESULTS: Among 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08-7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16-0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98-2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62-8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01-2.17). CONCLUSION: Delay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women's health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tuberculose/terapia , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Conscientização , Diagnóstico Tardio/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Farmácias/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Distribuição por Sexo , Tanzânia/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/psicologia , Adulto Jovem
16.
Rev Epidemiol Sante Publique ; 67(3): 143-147, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30981595

RESUMO

AIMS: In France, guidelines for cervical cancer screening recommend that women between the ages of 25-65 have a smear test performed once every three years. However, some women are screened significantly more frequently. In this study, we used a data-driven approach as opposed to a traditional hypothesis-driven approach to characterise the population of women who are screened more frequently than advised. METHODS: Data came from an organised cervical cancer screening programme of a French department in the Alps (Isère). We retrospectively selected women aged between 25 to 65 years old who had at least two smear tests during the follow up period (2011-2015). We used a data-driven clustering approach to compare the population of over-screened women with other populations. We then performed a descriptive analysis of the over-screened population using univariate (Chi2 test) and multivariate (logistic regression) methods. RESULTS: A total of 10,000 patients were randomly chosen from a population of 54,073. In our univariate analysis, women in the over-screened population were significantly younger, participated less in organised screening, were more likely to be followed by a gynaecologist and had more smear test results showing inflammation than the other populations. Patient location (urban v.s. rural area) was not significant for this population. The multivariate analysis confirmed these results. CONCLUSION: This data-driven approach based on an unsupervised learning method enables us to more accurately characterise the over-screened population. These data invite to improve communication with the youngest women and the gynecologists to recall the benefit of an interval between two normal smears complying with the recommendations. This approach could help to improve the prevention and have a real impact on this Public Health issue.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal , Adulto , Idoso , Diagnóstico Tardio/estatística & dados numéricos , Detecção Precoce de Câncer/normas , Feminino , França/epidemiologia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Esfregaço Vaginal/métodos , Esfregaço Vaginal/estatística & dados numéricos
17.
BMC Health Serv Res ; 19(1): 225, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975142

RESUMO

BACKGROUND: Maternal and neonatal mortality remain high in southern Tanzania despite an increasing number of births occurring in health facilities. In search for reasons for the persistently high mortality rates, we explored illness recognition, decision-making and care-seeking for cases of maternal and neonatal illness and death. METHODS: We conducted 48 in-depth interviews (16 participants who experienced maternal illnesses, 16 mothers whose newborns experienced illness, eight mothers whose newborns died, and eight family members of a household with a maternal death), and five focus group discussions with community leaders in two districts of Mtwara region. Thematic analysis was used for interpretation of findings. RESULTS: Our data indicated relatively timely illness recognition and decision-making for maternal complications. In contrast, families reported difficulties interpreting newborn illnesses. Decisions on care-seeking involved both the mother and her partner or other family members. Delays in care-seeking were therefore also reported in absence of the husband, or at night. Primary-level facilities were first consulted. Most respondents had to consult more than one facility and described difficulties accessing and receiving appropriate care. Definitive treatment for maternal and newborn complications was largely only available in hospitals. CONCLUSIONS: Delays in reaching a facility that can provide appropriate care is influenced by multiple referrals from one facility to another. Referral and care-seeking advice should include direct care-seeking at hospitals in case of severe complications and primary facilities should facilitate prompt referral.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Doenças do Recém-Nascido/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações na Gravidez/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Tomada de Decisões , Família , Feminino , Grupos Focais , Instalações de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Masculino , Mortalidade Materna , Mães/estatística & dados numéricos , Gravidez , Complicações na Gravidez/mortalidade , Pesquisa Qualitativa , Tanzânia/epidemiologia
18.
Acta Oncol ; 58(7): 1056-1061, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30938249

RESUMO

Background: Rapid diagnostics and treatment approaches have been applied in many countries to enhance patient satisfaction, but it is unknown whether this leads to improvements in survival. Material and methods: Symptoms initiation, referral, and investigations and their timing, and survival were retrospectively collected from all the patients diagnosed for lung cancer at Oulu University Hospital 2015-2016 (n = 221). Correlation of treatment delays to survival was evaluated in different categories and by tumor stages. Results: Survival analysis showed no statistical difference between patients having below or above median time for the whole clinical pathway (from symptoms to treatment). Subsection analysis of the clinical pathway and division of patients by stage showed improved survival for patients having longer than median times in referral to diagnosis (p = .03) and diagnosis to treatment (p < .0001) for the whole population and in the latter for the stage IV patients as well (p < .0001). In multivariate analysis, long diagnosis to treatment time associated with improved survival while statistical difference was lost in the referral to diagnosis interval. Conclusion: Longer time on diagnostic work-up of lung cancer does not worsen the survival suggesting that fast-track approaches might not improve lung cancer outcomes.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias Pulmonares/diagnóstico , Idoso , Institutos de Câncer/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo
19.
J Neurooncol ; 143(2): 297-304, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30929127

RESUMO

INTRODUCTION: For children with central nervous system (CNS) tumors, survival rates remain significantly lower than other childhood malignancies with a substantial increase in disability of survivors. Given this, it is imperative that these children are identified at the earliest sign of symptom onset. Our institution aimed to identify diagnostic delays, morbidity and mortality, and specific barriers that may exist within our specific healthcare system that result in diagnostic delay. METHODS: A retrospective chart review was performed of newly diagnosed CNS tumors between January 1, 2008 and December 31, 2017. RESULTS: 235 patient cases were reviewed, 34 (14.5%) of which had an associated tumor predisposition syndrome. Median age at the time of diagnosis was 9 years (range 1 day to 25 years), with median number of days from symptom onset to definitive diagnosis of 42 days (interquartile range 14-120 days). Delays longer than 60 days occurred in 95 (47.5%) patients. The 10 year relative survival rate for all tumors was 86.8%. CONCLUSIONS: Our institution had a shorter interval from symptom onset to diagnosis than currently reported in the literature, as well as a decrease in associated morbidity. In addition, for those with longer delays, we were able to characterize the etiology and barriers leading to these delays. With these identified, we are able to utilize this knowledge to further improve education and awareness in community members and healthcare professionals to continue to improve the time to diagnosis in the future.


Assuntos
Neoplasias do Sistema Nervoso Central/diagnóstico , Neoplasias do Sistema Nervoso Central/mortalidade , Diagnóstico Tardio/estatística & dados numéricos , Assistência à Saúde , Hospitais Pediátricos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Neoplasias do Sistema Nervoso Central/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Morbidade , Ohio/epidemiologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
20.
S Afr Med J ; 109(3): 159-163, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30834871

RESUMO

BACKGROUND: Breast cancer is the most common cancer in women in many low- and middle-income countries, and often presents at an advanced stage that affects prognosis irrespective of the care available. Although patient-related delay is commonly cited, the reasons for delay and the relationship of delay to stage are still poorly documented, especially in Africa. OBJECTIVES: To identify where patient-related socioeconomic delays occur and how these relate to stage at presentation. METHODS: Consecutive women with a new breast cancer diagnosis were prospectively invited to complete a questionnaire on their socioeconomic characteristics and ability to access care. Clinical stage at presentation was documented. RESULTS: Over 14 months, 252 women completed the questionnaire (response rate 71.6%). Their median age was 55 years (interquartile range 44 - 65), with 26.5% aged <45 years. Stage at presentation was stage 1 in 15.5% of patients, stage 2 in 28.5% and stage 3 in 56.0%. Almost a third of the patients (30.4%) presented with a T4 tumour (6.1% inflammatory). Total delay in presenting to the breast clinic was significantly associated with locally advanced stage at presentation (p=0.021). Average delay differed between early stage (1.5 months) and locally advanced (2.5 months), and most delay occurred between acknowledging a breast symptom and seeking care. The least delay was between attending a health service and presenting at the open-access breast clinic, with 75.0% presenting within 1 month. Factors associated with delay were difficulties with transport, low level of education and fear of missing appointments due to work. CONCLUSIONS: Most women delayed in seeking breast care. Facilitating direct access to specialist breast clinics may reduce delays in presentation and improve time to diagnosis and care.


Assuntos
Neoplasias da Mama/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Diagnóstico Tardio/psicologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estudos Prospectivos , Fatores Socioeconômicos , África do Sul , Serviços Urbanos de Saúde
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