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Portero de la Cruz S, Béjar LM, Cebrino J. Temporal Evolution and Associated Factors of Adherence to Mammography Screening among Women in Spain: Results from Two National Health Surveys (2017-2020). Healthcare (Basel) 2023; 11:2934. [PMID: 37998426 PMCID: PMC10671473 DOI: 10.3390/healthcare11222934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Ensuring equity in cancer screening is recommended by the European Commission. Despite the fact that breast cancer screening is a free population-based program in Spain, there remains considerable variation in the adherence to screening rate among population groups. This study was designed to describe the adherence of breast cancer screening in women in Spain, to evaluate the evolution in the period from 2017 to 2020, and to determine the variables that influence choosing to undergo breast cancer screening. A nationwide cross-sectional study with 7220 females aged 50-69 years from the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain was performed. We investigated mammography uptake rates, with socio-demographic factors, lifestyle habits, and health-related characteristics as independent variables. Multivariable logistic regression was used to identify the associated factors of mammography adherence. Of the women, 78% had undergone mammography in the previous two years, and there was a significant decrease in the uptake rate for breast cancer screening from 2017 (81.23%) to 2020 (74.68%) (p < 0.001). Educational level, marital status, residential location, nationality, smoking status, alcohol consumption, and leisure-time physical activity were all associated factors of mammography uptake.
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Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal, S/N, 14071 Córdoba, Spain
- Research Group GE10 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain
| | - Luis M. Béjar
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
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2
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Zapata-Moya AR, Freese J, Bracke P. Mechanism substitution in preventive innovations: Dissecting the reproduction of health inequalities in the United States. Soc Sci Med 2023; 337:116262. [PMID: 37898013 DOI: 10.1016/j.socscimed.2023.116262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/30/2023]
Abstract
In the last three decades, numerous studies in different countries have corroborated the main postulates of the Fundamental Cause Theory (FCT), providing evidence showing how health inequalities are reproduced as society increases its capacity to control disease and/or avoid its consequences through preventive innovations. However, documenting the reproductive logic proposed by the theory requires the development of a dynamic analytical approach to consider socioeconomic disparities in the incorporation of multiple preventive innovations over time, which could act as mediating mechanisms of the durable relationship between socioeconomic status and health/mortality. This study draws on data from different waves of the National Health Interview Survey and the National Health and Nutrition Examination Survey to analyze the diffusion processes of various innovations in the U.S. The results of the study show that educational inequalities emerge, are amplified, and are reduced by the continuous diffusion of preventive innovations, supporting the meta-hypothesis of substitution of mediating mechanisms according to the interconnections of FCT and Diffusion of Innovation Theory.
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Affiliation(s)
- Angel R Zapata-Moya
- Universidad Pablo de Olavide, Department of Anthropology, Basic Psychology and Public Health, Seville, Spain; Centre for Sociology and Urban Policies - The Urban Governance Lab, Universidad Pablo de Olavide, Seville, Spain.
| | - Jeremy Freese
- Stanford University, Department of Sociology, United States.
| | - Piet Bracke
- Ghent University, Department of Sociology, Health and Demographic Research, Ghent, Belgium.
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3
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Sinopoli A, Baccolini V, Di Rosa E. Killing Two Birds with One Stone: Is the COVID-19 Vaccination Campaign an Opportunity to Improve Adherence to Cancer Screening Programmes? The Challenge of a Pilot Project in a Large Local Health Authority in Rome. Vaccines (Basel) 2023; 11:vaccines11030523. [PMID: 36992105 DOI: 10.3390/vaccines11030523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The COVID-19 pandemic has affected health services worldwide. The suspension of cancer screening programs during the lockdown period, coupled with the other measures taken to limit the SARS-CoV-2 spread, contributed to the idea that cancer preventive interventions are deferrable. In this opinion paper, we present some data on cancer screening coverage in one of the largest Local Health Authorities in Italy in recent years. Within this context, we introduce the benefits of a pilot project in which we took advantage of the great attention on the COVID-19 vaccination campaign to improve screening uptake. In this project, we offered men and women eligible for cancer screening the opportunity to book appointments while waiting to be vaccinated. In addition, trained healthcare personnel were available on-site to discuss any barriers to participation with the attendees. Despite the project having only just started, preliminary results are encouraging, with positive feedback from the attendees. In conclusion, we advocate for the need to adopt a comprehensive approach when it comes to population health, and we use this project as an example to discuss how it is possible to contribute to minimizing the long-term impact of the COVID-19 pandemic with resources already in place.
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Affiliation(s)
- Alessandra Sinopoli
- Department of Prevention, Local Health Authority Roma 1, 00193 Rome, Italy
- Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Enrico Di Rosa
- Department of Prevention, Local Health Authority Roma 1, 00193 Rome, Italy
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4
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Laza-Vásquez C, Hernández-Leal MJ, Carles-Lavila M, Pérez-Lacasta MJ, Cruz-Esteve I, Rué M. Barriers and Facilitators to the Implementation of a Personalized Breast Cancer Screening Program: Views of Spanish Health Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031406. [PMID: 35162427 PMCID: PMC8835407 DOI: 10.3390/ijerph19031406] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 02/01/2023]
Abstract
This study explored the barriers and facilitators to the implementation of a risk-based breast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 via a web-based survey and included the advantages and disadvantages of risk-based screening and barriers and facilitators for the implementation of the program. Descriptive statistics and Likert scale responses analyzed as category-ordered data were obtained. The risk-based screening was considered important or very important to reduce breast cancer mortality and promote a more proactive role for women in breast cancer prevention, to increase coverage for women under 50 years, to promote a breast cancer prevention strategy for women at high risk, and to increase efficiency and effectiveness. Switching to a risk-based program from an age-based program was rated as important or very important by 85% of participants. As barriers for implementation, risk communication, the workload of health professionals, and limited human and financial resources were mentioned. Despite the barriers, there is good acceptance, and it seems feasible, from the perspective of health professionals, to implement a risk-based breast cancer screening program in Spain. However, this poses a number of organizational and resource challenges.
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Affiliation(s)
- Celmira Laza-Vásquez
- Health Care Research Group (GRECS), Department of Nursing and Physiotherapy, University of Lleida-IRBLleida, 25198 Lleida, Spain;
| | - María José Hernández-Leal
- Research Centre on Economics and Sustainability (ECO-SOS), Department of Economics, Rovira i Virgili University (URV), 43003 Tarragona, Spain; (M.J.H.-L.); (M.C.-L.); (M.J.P.-L.)
- Research Group in Statistical and Economic Analysis in Health (GRAEES), 43204 Reus, Spain
| | - Misericòrdia Carles-Lavila
- Research Centre on Economics and Sustainability (ECO-SOS), Department of Economics, Rovira i Virgili University (URV), 43003 Tarragona, Spain; (M.J.H.-L.); (M.C.-L.); (M.J.P.-L.)
- Research Group in Statistical and Economic Analysis in Health (GRAEES), 43204 Reus, Spain
| | - Maria José Pérez-Lacasta
- Research Centre on Economics and Sustainability (ECO-SOS), Department of Economics, Rovira i Virgili University (URV), 43003 Tarragona, Spain; (M.J.H.-L.); (M.C.-L.); (M.J.P.-L.)
- Research Group in Statistical and Economic Analysis in Health (GRAEES), 43204 Reus, Spain
| | - Inés Cruz-Esteve
- Primer de Maig Basic Health Area, Catalan Health Institute (ICS), 25003 Lleida, Spain;
| | - Montserrat Rué
- Research Group in Statistical and Economic Analysis in Health (GRAEES), 43204 Reus, Spain
- Department of Basic Medical Sciences, University of Lleida-IRBLleida, 25198 Lleida, Spain
- Correspondence:
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De Prez V, Jolidon V, Willems B, Cullati S, Burton-Jeangros C, Bracke P. Cervical cancer screening programs and their context-dependent effect on inequalities in screening uptake: a dynamic interplay between public health policy and welfare state redistribution. Int J Equity Health 2021; 20:211. [PMID: 34560888 PMCID: PMC8464130 DOI: 10.1186/s12939-021-01548-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels of inequality in CCS uptake. AIM This study assesses how the screening strategy (as a score based on the availability of organized population-based CCS programs), accessibility of the healthcare system (as an index of out-of-pocket expenditure as a proportion of total healthcare costs, public health expenditure as a percentage of total GDP, and general practitioner (GP) density per 10'000 inhabitants) and social protection (as a decommodification index), impact education- and income-based inequalities in CCS uptake. METHODS A two-level design with 25-64-year-old women (N = 96'883), eligible for Pap smear screening, nested in 28 European countries, was used to analyze data from the European Health Interview Survey's second wave, using multilevel logistic regression modelling. RESULTS Clear educational and income gradients in CCS uptake were found, which were smaller in countries with organized CCS programs, higher accessibility of the healthcare system and a higher level of decommodification. Furthermore, three-way interaction terms revealed that these gradients were smaller when organized CCS programs were implemented in countries with better accessibility of the healthcare system or a high level of decommodification. CONCLUSION This study indicates that the combination of organized screening and high accessibility of the healthcare system or social protection is essential for having lower levels of inequality in CCS uptake. In such countries, the structural threshold for poorer and lower educated women to engage in CCS is lower. This may be explained by them having a better interaction with their GP, who may convince them of the screening test, lower out-of-pocket payments, and financial support to buffer against a disadvantageous position on the labor market.
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Affiliation(s)
- Vincent De Prez
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium.
| | - Vladimir Jolidon
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland
| | - Barbara Willems
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Stéphane Cullati
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland.,Population Health Laboratory, Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Ch. du Musée 8, CH-1700, Fribourg, Switzerland
| | - Claudine Burton-Jeangros
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland
| | - Piet Bracke
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
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6
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Weisband YL, Torres L, Paltiel O, Sagy YW, Calderon-Margalit R, Manor O. Socioeconomic Disparity Trends in Cancer Screening Among Women After Introduction of National Quality Indicators. Ann Fam Med 2021; 19:396-404. [PMID: 34546946 PMCID: PMC8437575 DOI: 10.1370/afm.2715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Primary care physicians have an important role in encouraging adequate cancer screening. Disparities in cancer screening by socioeconomic status (SES) may affect presentation stage and cancer survival. This study aimed to examine whether breast, colorectal, and cervical cancer screening rates in women differed by SES and age, and whether screening rates and SES disparities changed after introduction of a primary care-based national quality indicator program. METHODS This repeated cross-sectional study spanning 2002-2017 included all female Israeli residents in age ranges appropriate for each cancer screening assessed. SES was measured both as an individual-level variable based on exemption from copayments and as an area-level variable using census data. RESULTS In 2017, the most recent year in the study period, screening rates among 1,529,233 women were highest for breast cancer (70.5%), followed by colorectal cancer (64.3%) and cervical cancer (49.6%). Women in the highest area-level SES were more likely to undergo cervical cancer screening compared with those in the lowest (odds ratio = 3.56; 99.9% CI, 3.47-3.65). Temporal trends showed that after introduction of quality indicators for breast and colorectal cancer screening in 2004 and 2005, respectively, rates of screening for these cancers increased, with greater reductions in disparities for the former. The quality indicator for cervical cancer screening was introduced in 2015, and no substantial changes have occurred yet for this screening. CONCLUSIONS We found increased uptake and reduced socioeconomic disparities after introduction of cancer screening indicators. Recent introduction of a cervical cancer screening indicator may increase participation and reduce disparities, as has occurred for breast and colorectal cancer screening. These findings related to Israel's quality indicators program highlight the importance of primary care clinicians in increasing cancer screening rates to improve outcomes and reduce disparities.
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Affiliation(s)
| | - Luz Torres
- Research Department, Cardioinfantil Foundation-Cardiology Institute, Bogotá, Colombia
| | - Ora Paltiel
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Yael Wolff Sagy
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
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7
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Mwenda V, Bor JP, Gitungo H, Kirika L, Njoroge R, Mugi B, Ojuka D, Nyangasi M. Breast health awareness campaign and screening pilot in a Kenyan County: Findings and lessons. Cancer Rep (Hoboken) 2021; 5:e1480. [PMID: 34235881 PMCID: PMC8955074 DOI: 10.1002/cnr2.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/16/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIM Breast cancer is the leading cancer in terms of incidence in Kenya. We conducted a breast cancer awareness and screening pilot to assess feasibility of rolling out a national screening program in Kenya. METHODS Conducted in Nyeri County during October-November 2019, the pilot had three phases; awareness creation, screening (clinical breast examination and/or imaging) and final evaluation (post-screening exit interviews and retrospective screening data review). Descriptive statistics on awareness, screening process and outputs were derived. RESULTS During the pilot, 1813 CBE, 217 breast ultrasounds and 600 mammograms were performed. Mammography equipment utilization increased from 11% to 83%. Of 49 women with suspicious lesions on mammography, only 22 (44.9%) had been linked to care 4 months after the campaign. Of 532 exit interview respondents; 95% (505/532) were ≥35 years of age; 80% (426/532) had been reached by the awareness campaign. Majority (75% [399/532]) had received information from community health volunteers; 68% through social groups. Majority (79% [420/532]) felt the campaign had changed their behavior on breast health. Although 77% (407/532) had knowledge on self breast examination (SBE); only 13% practiced monthly SBE. More than half (58% [306/532]) had previously undertaken a CBE. Approximately 70% (375/528) were unaware of mammography before the pilot; 86% (459/532) had never previously undertaken a mammogram. Fifty-five percent (293/532) of respondents had screening waiting times of >120 min. CONCLUSION Community health workers can create breast cancer screening demand sustainably. Adequate personnel and effective follow-up are crucial before national roll-out of a breast cancer screening program.
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Affiliation(s)
- Valerian Mwenda
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Joan-Paula Bor
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Hannah Gitungo
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Lydia Kirika
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Richard Njoroge
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Beatrice Mugi
- Radiology and Diagnostic Imaging Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Ojuka
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | - Mary Nyangasi
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
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8
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Hasson RM, Fay KA, Phillips JD, Millington TM, Finley DJ. Rural barriers to early lung cancer detection: Exploring access to lung cancer screening programs in New Hampshire and Vermont. Am J Surg 2021; 221:725-730. [PMID: 32829909 PMCID: PMC10750228 DOI: 10.1016/j.amjsurg.2020.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rural populations face many health disadvantages compared to urban areas. There is a critical need to better understand the current lung cancer screening landscape in these communities to identify targeted areas to improve the impact of this proven tool. METHODS Data from the County Health Rankings of New Hampshire and Vermont was reviewed for population density, distribution of adult smokers, and level of education compared to the distribution of Lung Cancer Screening Facilities throughout these two states. RESULTS Screening programs in southern counties of Vermont with lower levels of education have decreased access. In New Hampshire, there are no programs within 30 miles of the areas with the largest distribution of smokers, and decreased access in some areas with the lowest levels of education. CONCLUSIONS Improving equitable access to high-quality screening services in rural regions and the creation of targeted interventions to address decreased access in areas of high tobacco use and low education is vital to decreasing the incidence of latestage presentations of lung cancer within these populations.
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Affiliation(s)
- Rian M Hasson
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Kayla A Fay
- The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Joseph D Phillips
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Timothy M Millington
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
| | - David J Finley
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
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9
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Finneran C, Johnson Peretz J, Blemur D, Palefsky J, Flowers L. "That's Only for Women": The Importance of Educating HIV-Positive Sexual Minority Men on HPV and High Resolution Anoscopy (HRA). J Int Assoc Provid AIDS Care 2021; 20:23259582211016134. [PMID: 34056930 PMCID: PMC8170352 DOI: 10.1177/23259582211016134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 01/22/2023] Open
Abstract
Gay, bisexual, and other men who have sex with men (MSM) experience disproportionately high burdens of Human Papilloma Virus (HPV)-associated anal cancers. Recent focus has shifted to anorectal cancer prevention through high-resolution anoscopy (HRA); however, little is known about sexual minority men's perceptions, attitudes, or beliefs regarding HRA. We conducted 4 qualitative Focus Group Discussions (FGDs) (n = 15) with sexual minority men, focusing on their beliefs, attitudes, and perceptions of undergoing HRA. Participants discussed their experiences of HPV/HRA as influenced by both their gender and sexuality, including unawareness of HPV disease as a male health issue, challenges relating to female-oriented HPV/HRA language, conception of HPV/HRA as related to prostate health, and connecting their sexual behavior identification as "bottoms" to their need for HRA. As efforts to improve HRA knowledge, access, and uptake among sexual and gender minority communities increase, special attention should be paid to language and messaging choices around HRA.
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Affiliation(s)
- Catherine Finneran
- Department of Internal Medicine, Washington University School of Medicine
in St. Louis, St. Louis, MO, USA
| | - Jason Johnson Peretz
- Global Health and Clinical Science, University of California San
Francisco, San Francisco, CA, USA
| | - Danielle Blemur
- Department of Gynecology and Obstetrics; Emory University School of
Medicine, Atlanta, GA, USA
| | - Joel Palefsky
- Department of Infectious Disease; University of California San
Francisco, San Francisco, CA, USA
| | - Lisa Flowers
- Department of Gynecology and Obstetrics; Emory University School of
Medicine, Atlanta, GA, USA
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10
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Kjeldgaard AH, Hørslev-Petersen K, Wehberg S, Soendergaard J, Primdahl J. Does socioeconomic status make a difference? A register-based study on the extent to which cardiovascular screening in patients with inflammatory arthritis leads to recommended follow-up in general practice. RMD Open 2020; 6:rmdopen-2019-000940. [PMID: 32868450 PMCID: PMC7507734 DOI: 10.1136/rmdopen-2019-000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/07/2019] [Accepted: 07/29/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate to what extent patients with inflammatory arthritis (IA) follow recommendations given in a secondary care nurse-led cardiovascular (CV) risk screening consultation to consult their general practitioner (GP) to reduce their CV risk and whether their socioeconomic status (SES) affects adherence. METHODS Adults with IA who had participated in a secondary care screening consultation from July 2012 to July 2015, based on the EULAR recommendations, were identified. Patients were considered to have high CV risk if they had risk Systematic COronary Risk Evaluation (SCORE) ≥5%, according to the European SCORE model or systolic blood pressure ≥145 mmHg, total cholesterol ≥8 mmol/L, LDL cholesterol ≥5 mmol/L, HbA1c ≥42 mmol/mol or fasting glucose ≥6 mmol/L. The primary outcome was a consultation with their GP and at least one action focusing on CV risk factors within 6 weeks after the screening consultation. RESULTS The study comprised 1265 patients, aged 18-85 years. Of these, 336/447 (75%) of the high-risk patients and 580/819 (71%) of the low-risk patients had a GP consultation. 127/336 (38%) of high-risk patients and 160/580 (28%) of low-risk patients received relevant actions related to their CV risk, for example, blood pressure home measurement or prescription for statins, antihypertensives or antidiabetics. Education ≥10 years increased the odds for non-adherence (OR 0.58, 95% CI 0.0.37 to 0.92, p=0.02). CONCLUSIONS 75% of the high-risk patients consulted their GP after the secondary care CV risk screening, and 38% of these received an action relevant for their CV risk. Higher education decreased adherence.
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Affiliation(s)
| | - Kim Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg 6400, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense 5000, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense 5000, Denmark
| | - Jens Soendergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense 5000, Denmark
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg 6400, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense 5000, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa 6200, Denmark
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