Understanding the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos: A qualitative study

Introduction

Rates of lung cancer screening among Latinos remain low. The purpose of the study was to understand the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos.

Methods

Participants (N=20) were recruited using community-based recruitment strategies. Eligibility criteria included: 1) self-identified as Hispanic/Latino, 2) spoke English and/or Spanish, and 3) met the USA Preventive Services Task Force eligibility criteria for lung cancer screening. Interviews were conducted in Spanish and English, audio recorded, and transcribed verbatim. Using the health belief model, a qualitative theoretical analysis was used to analyze the interviews.

Results

Participants' mean age was 58.3 years old (SD=5.8), half of the participants were female, 55% had completed high school or lower educational level, and 55% reported speaking more Spanish than English. All participants were currently smoking. Fourteen participants (70%) were unaware of lung cancer screening, and eighteen (90%) did not know they were eligible for lung cancer screening. Regarding lung cancer screening, participants reported multiple perceived benefits (e.g., smoking cessation, early detection of lung cancer, increased survivorship) and barriers (e.g., fear of outcomes, cost, lung cancer screening not being recommended by their clinician). Lastly, multiple cues to actions for lung cancer screening were identified (e.g., family as a cue to action for getting screened).

Conclusions

Most Latinos who were eligible for lung cancer screening were unaware of it and, when informed, they reported multiple perceived benefits, barriers, and cues to action. These factors provide concrete operational strategies to address lung cancer screening among Latinos.

Tubo-ovarian abscess in virginal adolescent females: a case report and review of the literature

BACKGROUND

A tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease (PID), predominantly polymicrobial and present in sexually active women. TOA in virginal adolescent females are extremely rare but have serious and lifelong consequences.

CASE

A 13 y.o. virginal female presented to the Emergency Room of a tertiary care pediatric hospital with abdominal pain and vomiting. Imaging suggested bowel compromise with potential perforation. An exploratory laparotomy revealed TOA which grew Escherichia Coli. This is the first reported case of Escherichia Coli TOA due to suspected bowel translocation.

CONCLUSION

Review of the literature identified 8 cases of TOA in virginal adolescents. Given the severity of outcomes following TOA, this pathology should be considered in the differential diagnosis of virginal adolescents who present with fever and abdominal pain. If suspected, a prompt gynecology consult should be initiated, followed by a first line antibiotic therapy and when indicated, surgical drainage.

How has the 'two-week wait' rule affected the presentation of colorectal cancer?

OBJECTIVE

To assess the impact of the 'two-week wait' rule on the presentation of colorectal cancer.

METHODS

A retrospective study of all patients referred to a fast-track clinic in a colorectal cancer centre over an 18-month period, documenting outcome, especially colorectal cancer diagnosis. Comparison was made with patients diagnosed with colorectal cancer presenting via other routes in the same time period.

RESULTS

Over an 18-month period, 462 patients were seen in the fast-track clinic and 64 (13.8%) were diagnosed with colorectal cancer. A further 131 patients with colorectal cancer presented to the department in the same time period through other means; 66 via standard out-patient letters, 26 from other departments and 39 (20%) as emergency admissions. Median (range) time to first clinic was 12 (2-28) days for fast-track and 24 (1-118) days for standard referrals (P < 0.0001); median time to first treatment was a further 36 (9-134) and 36.5 (1-226) days, respectively. The fast-track cohort had more advanced staging than those referred by standard letter. There were 19 Dukes' B, 22 Dukes' C and 14 Dukes' D cancers in the fast-track group compared with 28 Dukes' B, 25 Dukes' C and 6 Dukes' D in the standard referral group. After patient interview, only 337 (73%) of 462 fast-track patients appeared to fulfil the referral criteria but of the 64 diagnosed with cancer, 59 (92%) satisfied the criteria. Of the 66 patients with cancer referred by standard letter, 61 (92%) fulfilled the criteria.

CONCLUSION

Patients referred to the fast-track clinic were seen quicker than those referred by standard letter, but they tended to have more advanced disease. The fast-track referral criteria were fulfilled by most patients with cancer (whether or not they were referred to the fast track clinic), confirming their validity. After detailed interview in the clinic, a quarter of fast-track referrals were found not to satisfy referral criteria, suggesting that prioritization in primary care could be improved.

Optimal thresholds of the lecithin/sphingomyelin ratio and lamellar body count for the prediction of the presence of phosphatidyl glycerol in diabetic women

OBJECTIVE

To assess the optimal thresholds of the lecithin/sphingomyelin (L/S) ratio and lamellar body count for the prediction of the presence of phosphatidyl glycerol (PG) in diabetic pregnant women.

METHODS

We accessed a database of clear amniotic fluid specimens obtained by transabdominal amniocentesis in diabetic women with singleton non-malformed fetuses. PG results were classified as 'absent' or 'present'. Receiver operating characteristic (ROC) curve analysis was constructed of different L/S ratios and lamellar body counts to identify the optimal threshold for prediction of the presence of PG. Sensitivity was defined as the rate of L/S ratio and lamellar body count above specific thresholds among cases with present PG. The false-positive rate was that of L/S ratios or lamellar body counts above specific thresholds among cases with absent PG. Statistical analysis included one-way analysis of variance with post-hoc analysis, with p < 0.05 considered significant.

RESULTS

A total of 76 consecutive women were included in the analysis, 74% (n = 56) using insulin and the remainder treated by diet alone. L/S and PG results were both available in 72 women. PG was reported as 'present' in 70% (51/73) of specimens. As expected, there was a significant relationship between L/S ratios and presence of PG (area under the curve = 0.932, p < 0.001). An L/S ratio of > or = 3.0 represented the optimal trade-off between sensitivity (68%) and false-positive rate (6%) in the prediction of present PG. Similarly, there was a significant relationship between lamellar body count values and presence of PG (area under the curve = 0.976, p < 0.001). A lamellar body count of > or = 50 000 represented the optimal trade-off between sensitivity (92%) and false-positive rate (0%) in the prediction of present PG.

CONCLUSION

In diabetic pregnant patients, the presence of PG in the amniotic fluid more closely corresponded to an L/S ratio of > or = 3.0 or to a lamellar body count of > or = 50,000.

Is bipolar disorder still underdiagnosed? Are antidepressants overutilized?

BACKGROUND

Previous studies have suggested that bipolar disorder may be underdiagnosed, and that antidepressants may be over-utilized in its treatment.

METHODS

Consecutively admitted patients (n =48) diagnosed with DSM-IV bipolar disorder, type I, (n = 44) or schizoaffective disorder, bipolar type, (n = 4) were interviewed systematically and their charts were reviewed to confirm diagnosis before admission. They were then treated according to systematic structured interview diagnoses. These data reflect the changes in diagnoses and treatment.

RESULTS

40% (19/48) were identified with previously undiagnosed bipolar disorder, all previously diagnosed with unipolar major depressive disorder. A period of 7.5+/-9.8 years elapsed in this group before bipolar diagnosis was made. Antidepressant use was high on admission (38%) and was reduced with acceptable treatment response rates. The adjunctive use of risperidone appeared to be a good treatment alternative.

LIMITATIONS

While diagnoses were made prospectively, treatment response was assessed retrospectively, and was based on non-randomized, naturalistic therapy.

CONCLUSIONS

Systematic application of DSM-IV criteria identified previously undiagnosed bipolar disorder in 40% of a referred population of patients with mood disorders, all previously misdiagnosed as unipolar major depressive disorder. Antidepressants appeared overutilized and risperidone was an effective alternative adjunctive therapy agent.

An insight into patient satisfaction. Evaluation of a stoma care service

Stoma care nursing aims to put patient needs first. A questionnaire was devised by a stoma care nurse to assess her patients' satisfaction with the service provided, enabling changes to be made according to users' specified needs.

Sitting a transverse colostomy

Traditional teaching suggests that a transverse colostomy should be sited in the right upper quadrant. This study of 67 colostomies (26 right upper quadrant and 41 right iliac fossa) indicates that they should be placed in the optimum position for each patient, which is usually the right iliac fossa.

Benylin dependence, metabolic acidosis and hyperglycaemia

We describe a patient who had consumed large quantities of a proprietary cough mixture containing diphenhydramine, ammonium chloride and sodium citrate (Benylin expectorant) daily for several months and subsequently presented with confusion, marked metabolic acidosis and non-ketotic hyperglycaemia.

Characterisation of sodium-dependent uptake of 5-hydroxytryptamine into guinea-pig brain

The uptake of 5-hydroxytryptamine (5-HT) was studied using isolated nerve endings (synaptosomes) prepared from the corpus striatum of the guinea pig. Analysis of temperature-dependent uptake revealed that two processes were involved, a sodium-dependent and sodium-independent mechanism. Kinetic studies indicated that the affinity of 5-HT (Ku) and the transport capacity (Vu) of the uptake process were dependent upon the external concentration of sodium. The transport capacity increased linearly with increasing concentrations of sodium up to 140 mmol/l, whereas the affinity for 5-HT was enhanced at concentrations of sodium up to 100 mmol/l, but reduced at 130 mmol/l sodium. The findings of this study suggest that uptake of 5-HT occurs as a result of a mobile carrier transport system which, depending upon the external concentration of sodium proceeds by a single or double displacement mechanism.

Use of repeated matings to estimate environmental and genetic trends and effects of relaxing selection in a selected strain of Leghorn chickens

Response from index selection for egg production traits in a Leghorn strain over 7 years was partitioned into estimates of total (delta T), temporary (delta R), and net genetic (delta G) response, by producing progeny from selected (A) and unselected (D) first year breeders and from second year breeders (B) and first year full-sisters of previous years A breeders (C). In A, B, C, and D populations, average yearly number of full-sib families was 121, 47, 37, and about 50 and of birds with complete records was 824, 287, 258, and 298. Restricting A to repeated B families added positive bias in delta G for viability, age at first egg, and rate of lay. Estimates of delta G and delta R from B and C populations were similar. Yearly environmental change (delta E) was over three times the phenotypic change (delta P) for egg numbers, emphasizing necessity for intra-year estimates of delta G and delta R. Temporary response (delta R) approached or exceeded total response (delta T) for mortality and accounted for 40% of delta T for rate of lay and 60% for economic index, suggesting adverse maternal environmental effects from relaxing selection (D). Net yearly genetic change (delta G) was 1.5% for rate of lay, $.18 per bird, and in desired direction for most traits. Estimated net yearly response for rate of lay exceeded that predicted from .64 sigma male and .92 sigma female index selection differentials and sire-component genetic parameters (.6%) but agreed ($.16) for economic index. Efficiency and bias for the repeat-mating design are handicapped by mortality and health-related maternal effects.

Eradication of subgroups A and B lymphoid leukosis virus from commercial poultry breeding flocks

A specific-pathogen-free pedigreed breeding population of White Leghorns was determined to be free of lymphoid leukosis subgroups (LL-A and LL-B) on the basis of the standard resistance-inducing factor (RIF) test of sera of individual birds. The fourth pedigreed generation (G-4) was the first to test free of viruses of both sub-groups. In three subsequent pedigreed generations (G-5 through G-7) no viremic birds were found. The RIF test of sera was also used to detect carriers infected with LL-A and LL-B in sample populations of commercial broiler, brown-egg layer, and other White Leghorn breeding lines. When only known nonviremic dams were used for reproduction, in only one instance were viremic birds detected in samples of their progeny in succeeding generations. Some implications for a virus-free breeding program are discussed.

Autosensitivity of Pseudomonas aeruginosa to its own pyocin

Sensitivity of smooth and mucoid Pseudomonas aeruginosa strains from the same patient to their own pyocins was found to be greater at 20 than at 35 C.