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1.
AIDS Care ; 34(2): 227-231, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33625933

RESUMO

HIV-associated functional impairment may cause cognitive impairment secondary to the viral infection, hence, associations between cognitive impairment and functional impairment in youth living with HIV are important to assess. We sought to determine whether cognitive impairment is associated with functional impairment and if it carries higher risk for also having functional impairment. We collected parent-rated information regarding youth functional impairment on four different measures and administered a cognitive battery to youth to determine cognitive impairment, 203 HIV-infected youth and 44 HIV-uninfected controls. Degree of cognitive impairment correlated strongly with decreased function: CBCL, r = -.17, p = .01; VABS2, r = -.28, p < .001; repeated-grades, r = .26, p < .001. Presence of cognitive impairment was associated with increased risk of functional impairment: 3.47 (CIS); 1.71 (CBCL); 2.17 (VABS2); 2.97 (repeated-grades). Repeated-grades strongly associated with cognitive impairment and functional impairment. We found strong associations between HIV-infected youth functional impairment on CBCL, VABS2 and repeated-grades with degree of cognitive impairment; and that when cognitive impairment was present youth had higher risk of experiencing functional impairment as well. Asking whether youth have repeated a grade at school could be a helpful screening question for assessing potential functional impairment and provide clinicians with an indication as to whether a further in-depth assessment is required.


Assuntos
Disfunção Cognitiva , Infecções por HIV , Adolescente , Disfunção Cognitiva/complicações , Infecções por HIV/psicologia , Humanos , Programas de Rastreamento
2.
J. Health Biol. Sci. (Online) ; 10(1): 1-9, 01/jan./2022. tab
Artigo em Português | LILACS | ID: biblio-1378520

RESUMO

Objetivos: avaliar a cobertura e os fatores associados à não realização do exame citopatológico do colo do útero entre mulheres de 18 a 39 anos no Brasil. Métodos: estudo transversal, de base populacional, com dados de inquérito domiciliar com 2.002 mulheres alfabetizadas de áreas urbanas, selecionadas por amostragem aleatória por conglomerados em 2016. Foram avaliados a prática do exame nos três anos anteriores e os fatores associados à não realização, com cálculo de razão de prevalência ajustada (RPaj) e intervalos de confiança de 95% (IC95%) por regressão de Poisson. Resultados: a cobertura do exame entre mulheres de 18-39 anos foi de 66,5%, sendo mais elevada naquelas de 35-39 anos (76,8%). Mulheres com renda familiar até 1 salário-mínimo (RPaj=2,08;IC95% 1,72-2,54), que estudaram até a 4a série (RPaj=2,30;IC95% 1,22-2,67), residentes na região Nordeste (RPaj=1,79;IC95% 1,34-2,09) e em municípios com até 20.000 habitantes (RPaj=3,15;IC95% 2,33-3,96) apresentaram maior prevalência de não realização do exame. Conclusão: a cobertura do exame citopatológico esteve abaixo do recomendado, com disparidades socioeconômicas e geográficas. Os dados sugerem necessidade de oportunizar o rastreamento entre mulheres jovens de maior risco para o câncer do colo do útero.


Objectives: to evaluate the coverage and factors associated with non-performing Pap smear test among women aged 18-39 years in Brazil. Methods: cross-sectional, population-based study with household survey data with 2,002 literate women from urban areas, selected by random sampling by clusters in 2016. The practice of Pap test in the previous three years and associated factors with non-participation were evaluated, with calculation of adjusted prevalence ratio (PRad) and 95% confidence intervals (95%CI) by Poisson regression. Results: coverage of Pap tests among women 18-39 years was 66.5%, being higher in those aged 35-39 years (76.8%). Women with a family income up to 01 minimum wage (PRad=2.08; 95%CI 1.72-2.54), who studied up to 4th grade (PRad=2.30; 95%CI 1.22-2.67) and residents in the Northeast region (PRad=1.79; 95%CI 1.34-2.09) and in municipalities up to 20,000 inhabitants (PRad=3.15; 95%CI 2.33-3.96) had a higher prevalence of non-participation in screening. Conclusions: the coverage of the Pap smear test was below recommended, with socioeconomic and geographical disparities. The data suggest the need to provide screening among young women at higher risk for cervical cancer.


Assuntos
Teste de Papanicolaou , Mulheres , Neoplasias do Colo do Útero , Colo do Útero , Programas de Rastreamento , Inquéritos Epidemiológicos
3.
J. Health Biol. Sci. (Online) ; 10(1): 1-12, 01/jan./2022. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1378476

RESUMO

Objective: Analyze lysosomotropic agents and their action on COVID-19 targets using the molecular docking technique. Methods: Molecular docking analyses of these lysosomotropic agents were performed, namely of fluoxetine, imipramine, chloroquine, verapamil, tamoxifen, amitriptyline, and chlorpromazine against important targets for the pathogenesis of SARS-CoV-2. Results: The results revealed that the inhibitors bind to distinct regions of Mpro COVID-19, with variations in RMSD values from 1.325 to 1.962 Å and binding free energy of -5.2 to -4.3 kcal/mol. Furthermore, the analysis of the second target showed that all inhibitors bonded at the same site as the enzyme, and the interaction resulted in an RMSD variation of 0.735 to 1.562 Å and binding free energy ranging from -6.0 to -8.7 kcal/mol. Conclusion: Therefore, this study allows proposing the use of these lysosomotropic compounds. However, these computer simulations are just an initial step toward conceiving new projects for the development of antiviral molecules.


Objetivo: aAnalisar agentes lisossomotrópicos e sua ação em alvos de COVID-19 usando a técnica de docking molecular. Métodos: Foram realizadas análises de docagem molecular destes agentes lisossomotrópicos, nomeadamente de fluoxetina, imipramina, cloroquina, verapamil, tamoxifeno, amitriptilina e clorpromazina contra alvos importantes para a patogenia do SARS-CoV-2. Resultados: Os resultados revelaram que os inibidores se ligam a regiões distintas do Mpro COVID-19, com variações nos valores de RMSD de 1.325 a 1.962 Å e energia livre de ligação de -5,2 a -4,3 kcal/mol. Além disso, a análise do segundo alvo mostrou que todos os inibidores se ligaram no mesmo sítio da enzima, e a interação resultante em uma variação de RMSD de 0,735 a 1.562 Å e energia livre de ligação variando de -6,0 a -8,7 kcal/mol. Conclusão: Portanto, este estudo permite propor o uso desses compostos lisossomotrópicos. No entanto, essas simulações em computador são apenas um passo inicial para a concepção de novos projetos para o desenvolvimento de moléculas antivirais.


Assuntos
SARS-CoV-2 , COVID-19 , Antivirais , Cloroquina , Programas de Rastreamento , Fluoxetina , Amitriptilina , Imipramina
4.
Cancer Epidemiol Biomarkers Prev ; 31(8): 1517-1520, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35916602

RESUMO

The effectiveness and efficiency of cancer screening in real-world settings depend on many factors, including test sensitivity and specificity. Outside of select experimental studies, not everyone receives a gold standard test that can serve as a comparator in estimating screening test accuracy. Thus, many studies of screening test accuracy use the passage of time to infer whether or not cancer was present at the time of the screening test, particularly for patients with a negative screening test. We define the accuracy assessment interval as the period of time after a screening test that is used to estimate the test's accuracy. We describe how the length of this interval may bias sensitivity and specificity estimates. We call for future research to quantify bias and uncertainty in accuracy estimates and to provide guidance on setting accuracy assessment interval lengths for different cancers and screening modalities.


Assuntos
Detecção Precoce de Câncer , Neoplasias , Viés , Humanos , Programas de Rastreamento , Neoplasias/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde , Sensibilidade e Especificidade
5.
Trials ; 23(1): 635, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35932062

RESUMO

BACKGROUND: Approximately 7% of all reported tuberculosis (TB) cases each year are recurrent, occurring among people who have had TB in the recent or distant past. TB recurrence is particularly common in India, which has the largest TB burden worldwide. Although patients recently treated for TB are at high risk of developing TB again, evidence around effective active case finding (ACF) strategies in this population is scarce. We will conduct a hybrid type I effectiveness-implementation non-inferiority randomized trial to compare the effectiveness, cost-effectiveness, and feasibility of two ACF strategies among individuals who have completed TB treatment and their household contacts (HHCs). METHODS: We will enroll 1076 adults (≥ 18 years) who have completed TB treatment at a public TB unit (TU) in Pune, India, along with their HHCs (averaging two per patient, n = 2152). Participants will undergo symptom-based ACF by existing healthcare workers (HCWs) at 6-month intervals and will be randomized to either home-based ACF (HACF) or telephonic ACF (TACF). Symptomatic participants will undergo microbiologic testing through the program. Asymptomatic HHCs will be referred for TB preventive treatment (TPT) per national guidelines. The primary outcome is rate per 100 person-years of people diagnosed with new or recurrent TB by study arm, within 12 months following treatment completion. The secondary outcome is proportion of HHCs < 6 years, by study arm, initiated on TPT after ruling out TB disease. Study staff will collect socio-demographic and clinical data to identify risk factors for TB recurrence and will measure post-TB lung impairment. In both arms, an 18-month "mop-up" visit will be conducted to ascertain outcomes. We will use the RE-AIM framework to characterize implementation processes and explore acceptability through in-depth interviews with index patients, HHCs and HCWs (n = 100). Cost-effectiveness will be assessed by calculating the incremental cost per TB case detected within 12 months and projected for disability-adjusted life years averted based on modeled estimates of morbidity, mortality, and time with infectious TB. DISCUSSION: This novel trial will guide India's scale-up of post-treatment ACF and provide an evidence base for designing strategies to detect recurrent and new TB in other high burden settings. TRIAL REGISTRATION: NCT04333485 , registered April 3, 2020. CTRI/2020/05/025059 [Clinical Trials Registry of India], registered May 6 2020.


Assuntos
Programas de Rastreamento , Tuberculose , Adulto , Análise Custo-Benefício , Pessoal de Saúde , Humanos , Índia , Programas de Rastreamento/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico
6.
Ann Saudi Med ; 42(4): 252-261, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35933610

RESUMO

BACKGROUND: Colorectal cancer (CRC) is mainly a disease of the elderly in the Western world, but its characteristics are changing globally. Iraq does not have a well established CRC screening program. Understanding trends of CRC incidence, fatality and the clinical features of CRC patients is vital to the design of effective public health measures; public awareness, screening, diagnosis and treatment strategies to meet the future demands. OBJECTIVES: Determine trends in demography, incidence proportion, mortality, topography (primary tumor site) and morphology (histology) over two decades. DESIGN: Registry-based study SETTING: Iraqi National Cancer Registry (INCR) database PATIENTS AND METHODS: We collected and analyzed data from CRC patients obtained from the INCR to calculate incidence and mortality proportion per 100 000 population for the period from 2000 to 2019. In addition to estimation, data were examined by anatomic location and morphological type. MAIN OUTCOME MEASURES: Change in the incidence and mortality proportion, topography and morphology of CRC over 20 years. SAMPLE SIZE: 20 880 CRC patients ranging in age from 14-80 years. RESULTS: The overall (males and females) CRC incidence proportion (CIP) increased from 2.28 to 6.18 per 100 000 population in 2000 and 2019, respectively, with an annual percentage change (APC) of 5.11%. The incidence proportion (IP) of CRC in patients from 20 to <50 years rose from 1.46 in 2000 to 4.36 per 100 000 population in 2019, which is an APC of 5.6%. The IP in patients older than 50 years rose from 12.7 to 40.59 per 100 000 population in 2000 and 2019, respectively, with an APC of 5.98%. The percentage of all CRC cases to all total malignancies in Iraq grew from 3.69% in 2000 to 6.5% in 2019. The CRC mortality proportion increased from 1.25 to 1.77 per 100 000 populations in 2010 and 2019, respectively, reflecting an APC of 3.54%. Anatomically, colon (C18) tumor represented 59.2% and 65.7% in 2000 and 2019, respectively. Rectal (C20) tumors were 37.2% in 2000 down to 31.4% in 2019, while rectosigmoid junction tumor (C19) were 3.6% in 2000 dropping to 2% in 2019. CONCLUSIONS: CRC in Iraq is still a disease of the elderly and is rising in incidence and mortality in all age groups. This necessitates reconsidering health policy regarding CRC; public awareness, screening and management strategies to accommodate for these alarming changes. LIMITATIONS: Data about stages, grades and molecular characterisations are not available in the INCR. CONFLICT OF INTEREST: None.


Assuntos
Neoplasias Colorretais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Iraque/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Sistema de Registros , Adulto Jovem
7.
Geriatr Psychol Neuropsychiatr Vieil ; 20(2): 182-189, 2022 06 01.
Artigo em Francês | MEDLINE | ID: mdl-35929385

RESUMO

Organized breast cancer screening in France is recommended for women up to 74 years of age, while the frequency and severity of this cancer increases after 75 years. The aim of this work is to assess the potential benefits of extending organized screening. Methodology: Retrospective study of a continuous monocentric series of women over 75 having undergone surgery for breast cancer. The following variables were studied: addressing after screening or not, age at diagnosis, UICC stage and therapeutic measures (surgery by lumpectomy or mastectomy, lymph node dissection, adjuvant treatment with chemotherapy, radiotherapy or hormone therapy). Results: 185 women aged 82.8 ± 5.2 years [extreme ages 75 to 95] were included in the study. 136 (73.5%) breast cancers were discovered after palpation and 49 (26.5%) after screening mammography. The distribution by stage was: I - 38.8%, II - 39.5%, III - 15.1% and stage IV - 7%. 164 (87.7%), patients received surgical treatment: 115 lumpectomies (61.2%) and 49 mastectomies (26.5%). 51 (27.6%) patients underwent lymph node dissection. The distribution of adjuvant treatments was: chemotherapy 21.1%, radiotherapy 68.6%, or hormone therapy (79.5%), sometimes combined. Women not screened are older than women screened (84 ± 5.3 versus 79.5 ± 3.6 years; p < 0.0001). Cancers are diagnosed at a more advanced stage in non-screened patients compared to screened patients (p < 0.0001). While there is a higher proportion of stage I among screened patients (75.5%), stage II is the most frequent in women not screened (47%). Stage I and II are the majority in the latter (72%). In multivariate analysis with adjustment for age, screening made it possible to make a diagnosis at a less advanced stage (stage I-II vs II-IV: OR = 5.593; 95% CI [1.575­19.866]; p = 0.0078) and to have conservative surgery more often (lumpectomy vs mastectomy: OR = 2.645; 95% CI [1.079­6.493]; p = 0.0333) without more recourse to surgery (OR = 1.856 95% CI [0.207­16.612]; p = 0.58). After adjusting for age and stage, screening was no longer a determining factor in the choice of type of surgery (OR = 1.934; 95% CI [0.753­4.975]; p = 0.170). Conclusion: At the age when organized breast cancer screening in France stopped, there was a decrease in survival, a diagnosis at a higher stage and an increase in co-morbidities. Our study shows a change in management with heavier treatment, more complications and a greater loss of autonomy without screening. This pleads for a continuation beyond 75 years of the practice of mammography screening for breast cancer in elderly women.


Le dépistage du cancer du sein par mammographie est recommandé jusqu'à 74 ans alors que fréquence et gravité de ce cancer augmentent après 75 ans. Le but de ce travail est d'évaluer les bénéfices potentiels de l'extension du dépistage individuel par mammographie. Méthodologie: Étude rétrospective d'une série continue monocentrique de femmes de plus de 75 ans ayant consulté pour cancer du sein. Résultats: Cent-quatre-vingt-cinq femmes âgées (82,8 ± 5,2 ans [75-95]) ont été inclues. Cent-soixante-quatre (87,7 %) patientes ont bénéficié d'une chirurgie (115 tumorectomies (61,2 %), 49 mastectomies (26,5 %) et 51 curages ganglionnaires (27,6 %) avec traitement adjuvant (chimiothérapie 21,1 % ; radiothérapie 68,6 % ; ou hormonothérapie 79,5 %). Quarante-neuf cancers du sein ont été découverts après dépistage individuel par mammographie (26,5 %) chez des femmes moins âgées (79,5 ± 3,6 vs 84 ± 5,3 ans ; p < 0,0001), à un stade moins avancé (stade I-II vs III-IV : OR = 5,6 [1,5­19,8] ; p = 0,0078) avec une chirurgie plus conservatrice (tumorectomie vs mastectomie : OR = 2,6 [1,1­6,5] ; p = 0,0333). Conclusion: Le dépistage individuel du cancer du sein par mammographie permet une prise en charge moins lourde, à un stade moins avancé et devrait être poursuivi après 75 ans.


Assuntos
Neoplasias da Mama , Mamografia , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Detecção Precoce de Câncer , Feminino , Hormônios , Humanos , Programas de Rastreamento , Mastectomia , Estudos Retrospectivos
9.
BMC Med ; 20(1): 247, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35915501

RESUMO

Chronic kidney disease (CKD) in people with diabetes is becoming an increasing major public health concern, disproportionately burdening low- and middle-income countries (LMICs). This rising burden is due to various factors, including the lack of disease awareness that results in late referral and the cost of screening and consequent treatment of the comorbid conditions, as well as other factors endemic to LMICs relating to inadequate management of risk factors. We critically assessed the extant literature, by performing searches of Medline via PubMed, EBSCOhost, Scopus, and Web of Science, for studies pertaining to screening, diagnosis, and prediction of CKD amongst adults with diabetes in LMICs, using relevant key terms. The relevant studies were summarized through key themes derived from the Wilson and Jungner criteria. We found that screening for CKD in people with diabetes is generally infrequent in LMICs. Also, LMICs are ill-equipped to appropriately manage diabetes-associated CKD, especially its late stages, in which supportive care and kidney replacement therapy (KRT) might be required. There are acceptable and relatively simple tools that can aid diabetes-associated CKD screening in these countries; however, these tools come with limitations. Thus, effective implementation of diabetes-associated CKD screening in LMICs remains a challenge, and the cost-effectiveness of such an undertaking largely remains to be explored. In conclusion, for many compelling reasons, screening for CKD in people with diabetes should be a high policy priority in LMICs, as the huge cost associated with higher mortality and morbidity in this group and the cost of KRT offers a compelling economic incentive for improving early detection of diabetes in CKD.


Assuntos
Diabetes Mellitus , Insuficiência Renal Crônica , Adulto , Países em Desenvolvimento , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diagnóstico Precoce , Humanos , Programas de Rastreamento/métodos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia
11.
S Afr Fam Pract (2004) ; 64(1): e1-e11, 2022 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-35924619

RESUMO

BACKGROUND:  The high burden of tuberculosis (TB) in South Africa (SA) is associated with uncontrolled transmission in communities and delayed diagnosis of active cases. Active surveillance for TB is provided by community-based services (CBS). Research is required to understand key factors influencing TB screening services in the CBS. This study explored the implementation of active surveillance for TB where community-oriented primary care (COPC) had been successfully implemented to identify these factors. METHODS:  This was a qualitative study of four established COPC sites across two provinces in SA where active surveillance for TB is implemented. Semi-structured interviews were conducted with purposively selected healthcare workers in the CBS and citizens in these communities. The recorded interviews were transcribed for data analysis using ATLAS.ti software. RESULTS:  The factors influencing active surveillance for TB were directly related to the major players in the delivery of CBS. These factors interacted in a complex network influencing implementation of active surveillance for TB. Building effective relationships across stakeholder platforms by community health workers (CHWs) was directly influenced by the training, capacity building afforded these CHWs by the district health services; and acceptability of CBS. Each factor interplayed with others to influence active surveillance for TB. CONCLUSION:  Community health workers were central to the success of active surveillance for TB. The complex interactions of the social determinants of health and TB transmission in communities required CHWs to develop trusting relationships that responded to these issues that have impact on TB disease and linked clients to healthcare.


Assuntos
Tuberculose , Conduta Expectante , Agentes Comunitários de Saúde , Humanos , Programas de Rastreamento , África do Sul/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
12.
BMC Med ; 20(1): 264, 2022 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-35922801

RESUMO

BACKGROUND: Prostate cancer is an epidemic of the modern age, and despite efforts to improve awareness, it remains the case that mortality has hardly altered over the decades, driven largely by late presentation. There is a strong public perception that male urinary symptoms is one of the key indicators of prostate cancer, and this continues to be part of messaging from national guidelines and media health campaigns. This narrative, however, is not based on evidence and may be seriously hampering efforts to encourage early presentation. DISCUSSION: Anatomically, prostate cancer most often arises in the peripheral zone, while urinary symptoms result from compression of the urethra by prostatic enlargement more centrally. Biopsy studies show that mean prostate volume is actually lower in men found to have (early) prostate cancer compared to those with benign biopsies. This inverse relationship between prostate size and the probability of cancer is so strong that PSA density (PSA corrected for prostate volume) is known to be significantly more accurate in predicting a positive biopsy than PSA alone. Thus, this disconnect between scientific evidence and the current perception is very striking. There is also evidence that using symptoms for investigating possible cancer may lead to higher proportions of men presenting with locally advanced or metastatic disease compared to PSA testing or screening programmes. Concerns about overwhelming health care services if men are encouraged to get tested without symptoms may also be overstated, with recent newer approaches to reduce over-investigation and treatment. In this article, we explore the link between urinary symptoms and prostate cancer and propose that public and professional messaging needs to change. CONCLUSION: If rates of earlier diagnosis are to improve, we call for strong clear messaging that prostate cancer is a silent disease especially in the curable stages and men should come forward for testing regardless of whether or not they have symptoms. This should be done in parallel with other ongoing efforts to raise awareness including targeting men at highest risk due to racial ancestry or family history. While the current resurgence in interest and debate about prostate cancer screening is timely, change of this message by guideline bodies, charities and the media can be a first simple step to improving earlier presentation and hence cures rates.


Assuntos
Neoplasias da Próstata , Biópsia , Detecção Precoce de Câncer , Humanos , Masculino , Programas de Rastreamento , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/prevenção & controle
13.
BMC Med ; 20(1): 239, 2022 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-35922814

RESUMO

BACKGROUND: Early detection of breast cancer (BC) through mammography screening (MAM) is known to reduce mortality. We examined the differential effect that mammography has on BC characteristics and overall survival and the sociodemographic determinants of MAM utilization in a multi-ethnic Asian population. METHODS: This study included 3739 BC patients from the Singapore Breast Cancer Cohort (2010-2018). Self-reported sociodemographic characteristics were collected using a structured questionnaire. Clinical data were obtained through medical records. Patients were classified as screeners (last screening mammogram ≤ 2 years before diagnosis), non-screeners (aware but did not attend or last screen > 2years), and those unaware of MAM. Associations between MAM behaviour (MB) and sociodemographic factors and MB and tumour characteristics were examined using multinomial regression. Ten-year overall survival was modelled using Cox regression. RESULTS: Patients unaware of screening were more likely diagnosed with late stage (ORstage III vs stage I (Ref) [95% CI]: 4.94 [3.45-7.07], p < 0.001), high grade (ORpoorly vs well-differentiated (reference): 1.53 [1.06-2.20], p = 0.022), nodal-positive, large size (OR>5cm vs ≤2cm (reference): 5.06 [3.10-8.25], p < 0.001), and HER2-positive tumours (ORHER2-negative vs HER2-positive (reference): 0.72 [0.53-0.97], p = 0.028). Similar trends were observed between screeners and non-screeners with smaller effect sizes. Overall survival was significantly shorter than screeners in the both groups (HRnon-screeners: 1.89 [1.22-2.94], p = 0.005; HRunaware: 2.90 [1.69-4.98], p < 0.001). Non-screeners and those unaware were less health conscious, older, of Malay ethnicity, less highly educated, of lower socioeconomic status, more frequently ever smokers, and less physically active. Among screeners, there were more reported personal histories of benign breast surgeries or gynaecological conditions and positive family history of breast cancer. CONCLUSIONS: Mammography attendance is associated with more favourable BC characteristics and overall survival. Disparities in the utility of MAM services suggest that different strategies may be needed to improve MAM uptake.


Assuntos
Neoplasias da Mama , Detecção Precoce de Câncer , Neoplasias da Mama/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Mamografia , Programas de Rastreamento
15.
BMC Womens Health ; 22(1): 338, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941606

RESUMO

BACKGROUND: Most women undergoing screening examinations in the U.S. do not receive immediate results and for many this results in increased stress, inconvenience, delayed diagnosis, and potential loss to follow-up. OBJECTIVE: To study the impact of same appointment mammogram results on breast cancer screening experience and patient satisfaction. MATERIALS AND METHODS: A 6-question survey with questions focused on breast cancer screening experience with our new service of same appointment mammogram results was distributed to 200 patients, with 185 patients returning their responses. Patients evaluated their current experience on receiving their screening results during the same appointment with their prior breast cancer screening experience. Patients who did not respond to their satisfaction score either before or after same appointment results were excluded from the patient cohort analyzing satisfaction score. Remaining questions were analyzed separately as additional satisfaction assessment tools. RESULTS: About 48% of the patients indicated an improvement in their screening experience with same appointment mammography results service, while 47% of the patients reported no significant difference in their experience. CONCLUSION: Although not statistically significant, same appointment mammogram results were able to make a positive impact on breast cancer screening experience among 48% of the patients. Further research elucidating barriers to screening and other ways to improve patient satisfaction will be required to increase breast cancer screening compliance.


Assuntos
Neoplasias da Mama , Detecção Precoce de Câncer , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Mamografia , Programas de Rastreamento , Satisfação Pessoal , Melhoria de Qualidade
16.
BMJ Open Qual ; 11(3)2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35944933

RESUMO

BACKGROUND: Spine pain is one of the most common conditions seen in primary care and is often treated with ineffective, aggressive interventions, such as prescription pain medications, imagery and referrals to surgery. Aggressive treatments are associated with negative side effects and high costs while conservative care has lower risks and costs and equivalent or better outcomes. Despite multiple well-publicised treatment guidelines and educational efforts recommending conservative care, primary care clinicians (PCCs) widely continue to prescribe aggressive, low-value care for spine pain. METHODS: In this qualitative study semistructured interviews were conducted with PCCs treating spine pain patients to learn what prevents clinicians from following guidelines and what tools or support could promote conservative care. Interviews were conducted by telephone, transcribed and coded for thematic analysis. RESULTS: Forty PCCs in academic and private practice were interviewed. Key reflections included that while familiar with guidelines recommending conservative treatment, they did not find guidelines useful or relevant to care decisions for individual patients. They believed that there is an insufficient body of real-world evidence supporting positive outcomes for conservative care and guidance recommendations. They indicated that spine pain patients frequently request aggressive care. These requests, combined with the PCCs' commitment to reaching shared treatment decisions with patients, formed a key reason for pursuing aggressive care. PCCs reported not being familiar with risk-screening tools for spine patients but indicated that such screens might increase their confidence to recommend conservative care to low-risk patients. CONCLUSIONS: PCCs may be more willing to give conservative, guideline-consistent care for spine pain if they had tools to assist in making patient-specific evaluations and in countering requests for unneeded aggressive care. Such tools would include both patient risk screens and shared decision-making aids that include elements for resolving patient demands for inappropriate care.


Assuntos
Dor , Encaminhamento e Consulta , Humanos , Programas de Rastreamento , Atenção Primária à Saúde , Pesquisa Qualitativa
18.
Arq Neuropsiquiatr ; 80(6): 570-579, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35946705

RESUMO

BACKGROUND: Reaction time is affected under different neurological conditions but has not been much investigated considering all types of mild cognitive impairment (MCI). OBJECTIVE: This study investigated the diagnostic accuracy of CompCog, a computerized cognitive screening battery focusing on reaction time measurements. METHODS: A sample of 52 older adults underwent neuropsychological assessments, including CompCog, and medical appointments, to be classified as a control group or be diagnosed with MCI. The accuracy of CompCog for distinguishing between the two groups was calculated. RESULTS: The results from diagnostic accuracy analyses showed that the AUCs of ROC curves were as high as 0.915 (CI 0.837-0.993). The subtest with the highest sensitivity and specificity (choice reaction time subtest) had 91.7% sensitivity and 89.3% specificity. The logistic regression final model correctly classified 92.3% of individuals, with 92.9% specificity and 91.7% sensitivity, and included only four variables from different subtests. CONCLUSIONS: In summary, the study showed that reaction time assessed through CompCog is a good screening measure to differentiate between normal aging and MCI. Reaction time measurements in milliseconds were more accurate than correct answers. This test can form part of routine clinical tests to achieve the objectives of screening for MCI, indicating further procedures for investigation and diagnosis and planning interventions.


Assuntos
Disfunção Cognitiva , Idoso , Disfunção Cognitiva/diagnóstico , Humanos , Programas de Rastreamento , Testes Neuropsicológicos , Tempo de Reação , Sensibilidade e Especificidade
19.
BMC Public Health ; 22(1): 1511, 2022 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-35941579

RESUMO

BACKGROUND: Health screens are the cornerstones for health promotion and preventive interventions at a community level. This study investigated the barriers and facilitators to the uptake of diabetes health screening in the general population of Singapore. METHODS: In this mixed methods study, participants without diabetes were recruited from the general population. The quantitative phase (n = 2459) included face to face survey of participants selected through disproportionate stratified random sampling. Those who participated in the quantitative survey were then randomly chosen for a one-to-one semi-structured interview (n = 30). RESULTS: Among the survey respondents, 73.09% (n = 1777) had attended a diabetes health screening in their lifetime whilst 42.36% (n = 1090) and 57.64% (n = 1328, p < 0.0001) attended the health screens regularly (every 12 months) and irregularly, respectively. A significantly higher proportion of older adults (≥ 40 years) attended regular diabetes health screening compared to younger adults (less than 40 years; 55.59% vs 24.90%, p < 0.001). The top 3 reasons for attending regular health screens were to detect diabetes early, to make lifestyle changes in case of a diagnosis and being health conscious. Qualitative interviews identified similar issues and complex nuances that influenced the uptake of regular diabetes health screening. Several personal factors (laziness, self-reliance, psychological factors, etc.), competing priorities, fatalistic beliefs, affordability, misconceptions about the screens, and appointment related factors (inconvenient location, time, etc.) were identified as barriers, while affordable screens, sense of personal responsibility, perception of susceptibility /risk, role of healthcare team (e.g. reminders and prescheduled appointments) and personal factors (e.g. age, family, etc.) were facilitators. Age, household income, ethnicity and educational level were associated with the uptake of regular diabetes health screening. CONCLUSION: The uptake of regular diabetes health screening can be improved. Several barriers and enablers to the uptake of diabetes health screening were identified which should be addressed by the policy makers to alleviate misconceptions and create greater awareness of the importance of the programme that will improve participation.


Assuntos
Diabetes Mellitus , Programas de Rastreamento , Idoso , Agendamento de Consultas , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/prevenção & controle , Humanos , Singapura , Inquéritos e Questionários
20.
J Med Internet Res ; 24(8): e37368, 2022 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-35943786

RESUMO

BACKGROUND: Patients with cancer undergoing cytotoxic chemotherapy face an elevated risk of developing serious infection as a consequence of their treatment, which lowers their white blood cell count and, more specifically, their absolute neutrophil count. This condition is known as neutropenia. Neutropenia accompanied by a fever is referred to as febrile neutropenia, a common side effect of chemotherapy with a high mortality rate. The timely detection of severe neutropenia (<500 absolute neutrophil count/µL) is critical in detecting and managing febrile neutropenia. Current methods rely on blood draws, which limit them to clinical settings and do not allow frequent or portable monitoring. In this study, we demonstrated the usability of PointCheck, a noninvasive device for neutropenia screening, in a simulated home environment without clinical supervision. PointCheck automatically performs microscopy through the skin of the finger to image the blood flowing through superficial microcapillaries and enables the remote monitoring of neutropenia status, without requiring venipuncture. OBJECTIVE: This study aimed to evaluate the usability of PointCheck, a noninvasive optical technology for screening severe neutropenia, with the goal of identifying potential user interface, functionality, and design issues from the perspective of untrained users. METHODS: We conducted a multicenter study using quantitative and qualitative approaches to evaluate the usability of PointCheck across 154 untrained participants. We used a mixed method approach to gather usability data through user testing observations, a short-answer qualitative questionnaire, and a standardized quantitative System Usability Scale (SUS) survey to assess perceived usability and satisfaction. RESULTS: Of the 154 participants, we found that 108 (70.1%) scored above 80.8 on the SUS across all sites, with a mean SUS score of 86.1 across all sites. Furthermore, the SUS results indicated that, out of the 151 users who completed the SUS survey, 145 (96%) found that they learned how to use PointCheck very quickly, and 141 (93.4%) felt very confident when using the device. CONCLUSIONS: We have shown that PointCheck, a novel technology for noninvasive, home-based neutropenia detection, can be safely and effectively operated by first-time users. In a simulated home environment, these users found it easy to use, with a mean SUS score of 86.1, indicating an excellent perception of usability and placing this device within the top tenth percentile of systems evaluated for usability by the SUS. TRIAL REGISTRATION: ClinicalTrials.gov NCT04448314; https://clinicaltrials.gov/ct2/show/NCT04448314 (Hospital Universitario 12 de Octubre registration) and NCT04448301; https://clinicaltrials.gov/ct2/show/NCT04448301 (Boston Medical Center registration).


Assuntos
Neutropenia Febril , Neoplasias , Detecção Precoce de Câncer , Humanos , Programas de Rastreamento , Neoplasias/tratamento farmacológico , Inquéritos e Questionários
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