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Ge R, Zhu G, Tian M, Hou Z, Pan W, Feng H, Liu K, Xiao Q, Chen Z. Analysis on time delay of tuberculosis among adolescents and young adults in Eastern China. Front Public Health 2024; 12:1376404. [PMID: 38651131 PMCID: PMC11033351 DOI: 10.3389/fpubh.2024.1376404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Background Tuberculosis (TB) is recognized as a significant global public health concern. Still, there remains a dearth of comprehensive evaluation regarding the specific indicators and their influencing factors of delay for adolescents and young adults. Methods All notified pulmonary TB (PTB) patients in Jiaxing City were collected between 2005 and 2022 from China's TB Information Management System. Logistic regression models were conducted to ascertain the factors that influenced patient and health system delays for PTB cases, respectively. Furthermore, the impact of the COVID-19 pandemic on local delays has been explored. Results From January 1, 2005 to December 31, 2022, a total of 5,282 PTB cases were notified in Jiaxing City, including 1,678 adolescents and 3,604 young adults. For patient delay, female (AOR: 1.18, 95%CI: 1.05-1.32), PTB complicated with extra-pulmonary TB (AOR: 1.70, 95% CI: 1.28-2.26), passive case finding (AOR: 1.46, 95% CI: 1.07-1.98) and retreatment (AOR: 1.52, 95% CI: 1.11-2.09) showed a higher risk of delay. For health system delay, minorities (AOR: 0.69, 95% CI: 0.53-0.90) and non-students (AOR: 0.83, 95% CI: 0.71-0.98) experienced a lower delay. Referral (AOR: 1.46, 95% CI: 1.29-1.65) had a higher health system delay compared with clinical consultation. Furthermore, county hospitals (AOR: 1.47, 95% CI: 1.32-1.65) and etiological positive results (AOR: 1.46, 95% CI: 1.30-1.63) were associated with comparatively high odds of patient delay. Contrarily, county hospitals (AOR: 0.88, 95% CI: 0.78-1.00) and etiological positive results (AOR: 0.67, 95% CI: 0.59-0.74) experienced a lower health system delay. Besides, the median of patient delay, health system delay, and total delay during the COVID-19 pandemic were significantly lower than that before. Conclusion In general, there has been a noteworthy decline in the notification rate of PTB among adolescents and young adults in Jiaxing City while the declining trend was not obvious in patient delay, health system delay, and total delay, respectively. It also found factors such as gender, case-finding method, and the hospital level might influence the times of seeking health care and diagnosis in health agencies. These findings will provide valuable insights for refining preventive and treatment strategies for TB among adolescents and young adults.
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Affiliation(s)
- Rui Ge
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Guoying Zhu
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Min Tian
- Nanhu Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Zhigang Hou
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Weizhe Pan
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Hao Feng
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qinfeng Xiao
- The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Zhongwen Chen
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
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Ko Y, Park JS, Min J, Kim HW, Koo HK, Oh JY, Jeong YJ, Lee E, Yang B, Kim JS, Lee SS, Kwon Y, Yang J, Han JY, Jang YJ, Kim J. Timely Pulmonary Tuberculosis Diagnosis Based on the Epidemiological Disease Spectrum: Population-Based Prospective Cohort Study in the Republic of Korea. JMIR Public Health Surveill 2024; 10:e47422. [PMID: 38557939 PMCID: PMC11019417 DOI: 10.2196/47422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/01/2023] [Accepted: 01/31/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Timely pulmonary tuberculosis (PTB) diagnosis is a global health priority for interrupting transmission and optimizing treatment outcomes. The traditional dichotomous time-divided approach for addressing time delays in diagnosis has limited clinical application because the time delay significantly varies depending on each community in question. OBJECTIVE We aimed to reevaluate the diagnosis time delay based on the PTB disease spectrum using a novel scoring system that was applied at the national level in the Republic of Korea. METHODS The Pulmonary Tuberculosis Spectrum Score (PTBSS) was developed based on previously published proposals related to the disease spectrum, and its validity was assessed by examining both all-cause and PTB-related mortality. In our analysis, we integrated the PTBSS into the Korea Tuberculosis Cohort Registry. We evaluated various time delays, including patient, health care, and overall delays, and their system-associated variables in line with each PTBSS. Furthermore, we reclassified the scores into distinct categories of mild (PTBSS=0-1), moderate (PBTBSS=2-3), and severe (PBTBSS=4-6) using a multivariate regression approach. RESULTS Among the 14,031 Korean patients with active PTB whose data were analyzed from 2018 to 2020, 37% (n=5191), 38% (n=5328), and 25% (n=3512) were classified as having a mild, moderate, and severe disease status, respectively, according to the PTBSS. This classification can therefore reflect the disease spectrum of PTB by considering the correlation of the score with mortality. The time delay patterns differed according to the PTBSS. In health care delays according to the PTBSS, greater PTB disease progression was associated with a shorter diagnosis period, since the condition is microbiologically easy to diagnose. However, with respect to patient delays, the change in elapsed time showed a U-shaped pattern as PTB progressed. This means that a remarkable patient delay in the real-world setting might occur at both apical ends of the spectrum (ie, in both mild and severe cases of PTB). Independent risk factors for a severe PTB pattern were age (adjusted odds ratio 1.014) and male sex (adjusted odds ratio 1.422), whereas no significant risk factor was found for mild PTB. CONCLUSIONS Timely PTB diagnosis should be accomplished. This can be improved with use of the PTBSS, a simple and intuitive scoring system, which can be more helpful in clinical and public health applications compared to the traditional dichotomous time-only approach.
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Affiliation(s)
- Yousang Ko
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Republic of Korea
| | - Jee Youn Oh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Yun-Jeong Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Eunhye Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-Ju, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Republic of Korea
| | - Yunhyung Kwon
- Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency, Osong, Republic of Korea
| | - Jiyeon Yang
- Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency, Osong, Republic of Korea
| | - Ji Yeon Han
- Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency, Osong, Republic of Korea
| | - You Jin Jang
- Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency, Osong, Republic of Korea
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Lastunen KS, Leppäniemi AK, Mentula PJ. Pre-hospital management and patient-related factors affecting access to the surgical care of appendicitis - a survey study. Scand J Prim Health Care 2024:1-9. [PMID: 38497923 DOI: 10.1080/02813432.2024.2329214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND AND AIMS Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay. METHODS A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed. RESULTS The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p < .001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40-64 years (OR 1.63 (95% CI 1.06-2.52); compared to age 18-39), age more than 64 years (OR 2.84 (95% CI 1.18-6.80); compared to age 18-39), loss of appetite (OR 2.86 (95% CI 1.64-4.98)), fever (OR 1.66 (95% CI 1.08-2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15-3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32-3.53)). Age 40-64 years (OR 2.41 (95% CI 1.50-3.88)), age more than 64 years (OR 8.79 (95% CI 2.19-35.36)), fever (OR 1.83 (95% CI 1.15-2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14-3.14)) were also risk factors for complicated appendicitis. CONCLUSIONS Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis.
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Affiliation(s)
- Kirsi Serenella Lastunen
- Department of Gastrointestinal Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Ari Kalevi Leppäniemi
- Department of Gastrointestinal Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Panu Juhani Mentula
- Department of Gastrointestinal Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
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Sun R, Wu Z, Zhang H, Huang J, Liu Y, Chen M, Lv Y, Zhao F, Zhang Y, Li M, Yan J, Jiang H, Zhan Y, Xu J, Xu Y, Yuan J, Zhao Y, Shen X, Yang C. Corrigendum: Assessing heterogeneity of patient and health system delay among TB in a population with internal migrants in China. Front Public Health 2024; 12:1391181. [PMID: 38504683 PMCID: PMC10949983 DOI: 10.3389/fpubh.2024.1391181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2024.1354515.].
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Affiliation(s)
- Ruoyao Sun
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Zheyuan Wu
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Hongyin Zhang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jinrong Huang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yueting Liu
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Meiru Chen
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yixiao Lv
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, China
| | - Yangyi Zhang
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Minjuan Li
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jiaqi Yan
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Hongbing Jiang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yiqiang Zhan
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jimin Xu
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yanzi Xu
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Jianhui Yuan
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Yang Zhao
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Xin Shen
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Chongguang Yang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Zhu S, Wang Y, Chu T, Jin X, Wei F, Hu N. Patient delay of patients with pulmonary tuberculosis in Yantai, China, 2013 to 2022: Analysis of a case series. Medicine (Baltimore) 2024; 103:e37188. [PMID: 38428857 PMCID: PMC10906614 DOI: 10.1097/md.0000000000037188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/17/2024] [Indexed: 03/03/2024] Open
Abstract
Patient delay increases the morbidity and mortality due to tuberculosis (TB). This study aimed to assess patient delay among patients with pulmonary tuberculosis in Yantai from 2013 to 2022, and to analyze factors related to patient delay. Data of patients with pulmonary tuberculosis in Yantai City from 2013 to 2022 were obtained from the Tuberculosis Management Information System of the Chinese Disease Prevention and Control System. Statistical analyses were performed using the SPSS.26.0 software. The trend in patient delay rate was tested using the chi-square trend test. Univariate analyses were performed using the chi-square test, and factors with statistically significant differences in the univariate analysis were included in the binary logistic regression analysis to identify the factors affecting patient delay. Patient delay was defined as an interval of more than 14 days between the onset of clinical symptoms and the patient first visit to a healthcare facility. From 2013 to 2022, the median delay time for patients with pulmonary tuberculosis in Yantai was 28 ± 52 days and the patient delay rate was 69.5%. There was an overall increasing trend in the rate of patient delay as the number of years increased. Univariate analyses revealed statistically significant differences in patient delay in terms of age, occupation, patient source, domicile, pathogenetic results, and the presence of comorbidities (all P < .05). The results of logistic regression analysis showed that the age was 20 to 39, 40 to 59, and ≥ 60 years (OR = 1.365, 95%CI: 1.156-1.612; OR = 1.978, 95%CI: 1.660-2.356; OR = 1.767, 95%CI: 1.480-2.110), occupation was domestic and un-employed (OR = 1.188, 95%CI: 1.071-1.317), domicile as mobile population (OR = 1.212, 95%CI: 1.099-1.337), and positive pathogenic results (OR = 1.242, 95%CI: 1.015-1.520) were risk factors for patient delay. Patient delays were serious among pulmonary tuberculosis patients in Yantai City, 2013 to 2022, and patient delay was related to factors such as age, occupation, domicile, patient source, and pathogenetic results.
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Affiliation(s)
- Sijin Zhu
- School of Public Health, Binzhou Medical University, Yantai City, Shandong Province, China
| | - Yuelei Wang
- Yantai Centre for Disease Control and Prevention, Yantai City, Shandong Province, China
| | - Tianci Chu
- School of Public Health, Binzhou Medical University, Yantai City, Shandong Province, China
| | - Xiaoxiang Jin
- School of Public Health, Binzhou Medical University, Yantai City, Shandong Province, China
| | - Fei Wei
- School of Public Health, Binzhou Medical University, Yantai City, Shandong Province, China
| | - Naibao Hu
- School of Public Health, Binzhou Medical University, Yantai City, Shandong Province, China
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Animut Y, Godno AB, Nigatu SG, Abiy SA. Delay in seeking treatment and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel zone, Benishangul Gumuz region, Western Ethiopia. Front Public Health 2024; 12:1356770. [PMID: 38476481 PMCID: PMC10929009 DOI: 10.3389/fpubh.2024.1356770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/29/2024] [Indexed: 03/14/2024] Open
Abstract
Background Tuberculosis is a major global public health problem and a leading cause of morbidity and mortality in Ethiopia. TB prevention and control in low-income countries, such as Ethiopia, face significant challenges, including late detection and treatment initiation. A delay in the initiation of tuberculosis treatment increases the morbidity and mortality of patients and community transmission. Therefore, this study aimed to assess patient delay and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel Zone, Benishangul Gumuz Region, Western Ethiopia. Methods An institution-based cross-sectional study was conducted from March to August 2020 among newly diagnosed pulmonary tuberculosis patients. All pulmonary tuberculosis patients (416) who came to all public health facilities of the Metekel zone for treatment during the period were included. Data were collected through face-to-face interviews using a structured and pretested questionnaire. A multivariable logistic regression was fitted to identify independent factors for delay in seeking treatment among PTB patients. Adjusted odds ratios with 95% CIs were determined, and variables with p values <0.05 were considered statistically significant. Results Nearly three-fourths 302 (72.6, 95% CI: 68.5, 76.7) of the patients were delayed in seeking medical advice, with a median patient delay of 27 days (IQR: 21-31). Age of the patients [above 54 years (AOR = 2.65, 95% CI: 1.30, 5.40), 36-54 years (AOR = 1.86, 95% CI: 1.14,3.02)], family size of 5 members and above (AOR = 1.62, 95% CI: 1.10-3.14), travel time above 60 min (AOR = 3.65, 95% CI: 1.55, 8.60), history of visits to informal care providers (AOR = 1.74, 95% CI: 1.11, 3.14), and poor knowledge about PTB (AOR = 1.64, 95% CI: 1.04-2.44) were statistically significant factors associated with delays in seeking treatment among PTB patients. Conclusion Most pulmonary tuberculosis patients delay seeking medical advice for their illnesses. Delays in seeking treatment were associated with older age, large household size, longer travel time to reach the nearby health facility, visiting informal care providers, and poor knowledge about pulmonary tuberculosis. Hence, it is crucial to consider community screening programs, enhance public awareness, and ensure the accessibility of TB diagnostic and treatment services.
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Affiliation(s)
- Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abera Birhanu Godno
- Public Health Emergency Management Directorate, Benishangul Gumuz Regional Health Bureau, Assosa, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Saron Abeje Abiy
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Zheng J, Guo AH, Xue BW, Wu SY, Wang XX, Jing YJ, Zhai LJ, Liu R. Exploring patient delay in people with chronic kidney disease: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37077. [PMID: 38363926 PMCID: PMC10869059 DOI: 10.1097/md.0000000000037077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
To examine the factors that contribute to patient delays among individuals with chronic kidney disease (CKD) and offer insights to help develop specific risk management strategies. Conducted as a cross-sectional study between September 2021 and April 2022, this study used a convenient sampling technique to select 245 individuals diagnosed with CKD from a Grade 3 Class A hospital located in Shanxi Province. These individuals were chosen as the subjects of the study. The research participants underwent an investigation using several assessment tools, including socio-demographic information questionnaire, medical behavior, the social support rating scale, the simplified coping style questionnaire, and the General Self-efficacy Scale. The study revealed that 35.4% of individuals with CKD experienced patient delay (the interval between the initial onset and the time of seeking medical attention being longer than or equal to 3 months). Through a multifactorial logistic regression analysis, it was determined that various factors independently influenced patient delay in patients with CKD. These factors included the level of knowledge about CKD, educational level, frequency of attending physical examinations, severity of initial symptoms, social support, self-efficacy, positive coping, and negative coping. Numerous factors contribute to the Patient Delay. To effectively enhance awareness and coping abilities regarding CKD in high-risk groups, it is essential to implement focused and continuous interventions throughout the medical seeking process.
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Affiliation(s)
- Jie Zheng
- Nursing College of Shanxi Medical University, Shanxi, China
| | - Ao-Han Guo
- Nursing College of Shanxi Medical University, Shanxi, China
| | - Bo-Wen Xue
- Nursing College, Hangzhou Normal University, Hangzhou, China
| | - Shu-Yan Wu
- Nursing College of Shanxi Medical University, Shanxi, China
| | | | - Yue-Juan Jing
- The Second Hospital of Shanxi Medicine University, Shanxi, China
| | - Lin-Jun Zhai
- Nursing College of Shanxi Medical University, Shanxi, China
| | - Rong Liu
- Nursing College of Shanxi Medical University, Shanxi, China
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Sun R, Wu Z, Zhang H, Huang J, Liu Y, Chen M, Lv Y, Zhao F, Zhang Y, Li M, Yan J, Jiang H, Zhan Y, Xu J, Xu Y, Yuan J, Zhao Y, Shen X, Yang C. Assessing heterogeneity of patient and health system delay among TB in a population with internal migrants in China. Front Public Health 2024; 12:1354515. [PMID: 38371243 PMCID: PMC10869454 DOI: 10.3389/fpubh.2024.1354515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Backgrounds The diagnostic delay of tuberculosis (TB) contributes to further transmission and impedes the implementation of the End TB Strategy. Therefore, we aimed to describe the characteristics of patient delay, health system delay, and total delay among TB patients in Shanghai, identify areas at high risk for delay, and explore the potential factors of long delay at individual and spatial levels. Method The study included TB patients among migrants and residents in Shanghai between January 2010 and December 2018. Patient and health system delays exceeding 14 days and total delays exceeding 28 days were defined as long delays. Time trends of long delays were evaluated by Joinpoint regression. Multivariable logistic regression analysis was employed to analyze influencing factors of long delays. Spatial analysis of delays was conducted using ArcGIS, and the hierarchical Bayesian spatial model was utilized to explore associated spatial factors. Results Overall, 61,050 TB patients were notified during the study period. Median patient, health system, and total delays were 12 days (IQR: 3-26), 9 days (IQR: 4-18), and 27 days (IQR: 15-43), respectively. Migrants, females, older adults, symptomatic visits to TB-designated facilities, and pathogen-positive were associated with longer patient delays, while pathogen-negative, active case findings and symptomatic visits to non-TB-designated facilities were associated with long health system delays (LHD). Spatial analysis revealed Chongming Island was a hotspot for patient delay, while western areas of Shanghai, with a high proportion of internal migrants and industrial parks, were at high risk for LHD. The application of rapid molecular diagnostic methods was associated with reduced health system delays. Conclusion Despite a relatively shorter diagnostic delay of TB than in the other regions in China, there was vital social-demographic and spatial heterogeneity in the occurrence of long delays in Shanghai. While the active case finding and rapid molecular diagnosis reduced the delay, novel targeted interventions are still required to address the challenges of TB diagnosis among both migrants and residents in this urban setting.
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Affiliation(s)
- Ruoyao Sun
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Zheyuan Wu
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Hongyin Zhang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jinrong Huang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yueting Liu
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Meiru Chen
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yixiao Lv
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, China
| | - Yangyi Zhang
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Minjuan Li
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jiaqi Yan
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Hongbing Jiang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yiqiang Zhan
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jimin Xu
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yanzi Xu
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Jianhui Yuan
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Yang Zhao
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Xin Shen
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Chongguang Yang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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9
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Supehia S, Singh M, Bahurupi Y, Aggarwal P, Chandra R, Sharma N. The Extent of Delay in Diagnosis, Treatment and their Associated Factors among Tuberculosis Patients Attending Government Hospitals of Rishikesh, Uttarakhand: A Cross-Sectional Study. Recent Adv Antiinfect Drug Discov 2024; 19:137-147. [PMID: 37198982 DOI: 10.2174/2772434418666230517151828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND "Tuberculosis (TB) remains a major public health problem" worldwide, affecting almost all age groups. "Early diagnosis and prompt treatment are essential to significantly reducing the TB burden." However, a significant proportion of cases remain undiagnosed and untreated, which plays a vital role in the transmission of the disease and severity of the illness in the community in most developing countries. AIMS & OBJECTIVES This study aimed to assess "the extent of delay in diagnosis and treatment of TB patients" and to identify the major factors associated with such delays (whether patient or health system-related) among TB patients in Rishikesh. METHODS This descriptive cross-sectional study was conducted in Rishikesh Town, Dehradun District, Uttara khand, India. Total of 130 newly diagnosed TB patients were recruited as study participants who attended the government hospitals of Rishikesh, All India Institute of Medical Sciences, Rishikesh and S P S Government Hospital, Rishikesh. A universal sampling technique was used in this study. RESULTS The mean age of the study participant was 36.75 (Standard Deviation (SD), 17.6), and the median age was 34 years. Of the patients, 64.6% were men, and 35.4% were women. The extent of various delays, such as patient delay (median 16 days), diagnostic delay (median 78.5 days), treatment delay (median 4 days), health system delay (43 days), and total delay (median 81 days). CONCLUSION The misconception of any chronic disease may lead to a false diagnosis or long treatment for symptomatic relief; the absence of proper diagnostic tests and doctor shopping could be the reasons for the prolonged diagnostic delay. Therefore, by strengthening the collaboration between private and public practitioners in order to meet the expectations of the Government of India to achieve the goals of the "National Strategic Plan for ending TB" in India by providing good quality care for all patients.
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Affiliation(s)
- Sakshi Supehia
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Mahendra Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Pradeep Aggarwal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Rishita Chandra
- School of Medicine, University of Tasmania, Tasmania, Australia
| | - Nandita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
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10
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Zheng J, Xue BW, Guo AH, Feng SY, Gao R, Wu SY, Liu R, Zhai LJ. Patient delay in chronic kidney disease: A qualitative study. Medicine (Baltimore) 2023; 102:e36428. [PMID: 38050199 PMCID: PMC10695617 DOI: 10.1097/md.0000000000036428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
This study aimed to investigate the reasons for patient delay in chronic kidney disease (CKD) and provide a scientific basis for implementing effective interventions. With the adoption of the phenomenological method in qualitative research, semi-structured, face-to-face interviews were conducted with 14 cases, and the Colaizzi seven-step analysis method was used to analyze the interview data and refine the themes. A total of 4 themes were obtained, namely, a cognitive explanation of illness, negative psychological emotions, socioeconomic levels, and limited medical resources. The current status of patient delay in chronic kidney disease is serious, and there are various reasons for it. Health management departments and healthcare providers at all levels should pay attention to this situation and provide targeted supportive interventions and health education to help patients establish the correct awareness of medical consultation and effectively improve their quality of survival.
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Affiliation(s)
- Jie Zheng
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Bo-Wen Xue
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Ao-Han Guo
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Sheng-Ya Feng
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Rong Gao
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Shu-Yan Wu
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Rong Liu
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Lin-Jun Zhai
- School of Nursing, Shanxi Medical University, Shanxi, China
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11
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Dános K, Horváth A, Halász J, Tamás L, Polony G. Patient delay and its clinical significance among head and neck cancer patients in Hungary. Pathol Oncol Res 2023; 29:1611206. [PMID: 37674645 PMCID: PMC10477355 DOI: 10.3389/pore.2023.1611206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
Abstract
Introduction: Head and neck cancers represent a major health problem in Hungary. With their high incidence and mortality rates, Hungary is one of the world leaders in these indicators. The length of patient delay, defined as time from onset of symptoms to first medical consultation, is unknown in Hungarian patients with head and neck cancer. We aimed to use a representative sample of the Hungarian head and neck cancer patient population to determine patient delay according to disease localization and stage and to identify correlations with other clinical parameters. Methods: In our retrospective study, we reviewed patient documentation. For the inclusion, the patients had to be diagnosed with malignant tumors of the oral cavity, oropharynx, hypopharynx or larynx at the Department Head and Neck Surgery of Semmelweis University between 2012 and 2017. Results: We identified 236 patients who met the inclusion criteria. The median delay was 9.5 weeks (range 0-209 weeks) and the mean delay of patients was 17.57 weeks (SD 23.67). There was a significant difference in patient delay data by location. Among glottic cancers, the most common diagnosis was an early stage (67%), compared with other localizations, including most commonly the oropharynx (81%) and hypopharynx (80%), where a locoregionally advanced stage was more frequent. Discussion: Compared to data from different countries, the delay of Hungarian patients with head and neck cancer is significantly longer, which may contribute to the high mortality in Hungary. Screening and patient education in high-risk groups could contribute to earlier diagnosis and thus improve prognosis.
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Affiliation(s)
- Kornél Dános
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Angéla Horváth
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Halász
- Department of Pathology, Forensic and Insurance Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - László Tamás
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Polony
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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12
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Wang J, Zhen X, Coyte PC, Shao D, Zhao N, Chang L, Feng Y, Sun X. Association Between Online Health Information-Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China. J Med Internet Res 2023; 25:e46953. [PMID: 37585244 PMCID: PMC10468701 DOI: 10.2196/46953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information-seeking (OHIS) behaviors by caregivers. OBJECTIVE This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. METHODS This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children's health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. RESULTS A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers' OHIS behaviors impacted the cancer care pathway by influencing caregivers' symptom appraisal before the first medical contact and caregivers' acceptance of health care providers' diagnostic and treatment decisions. CONCLUSIONS Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers' cancer symptom appraisal before the first medical contact.
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Affiliation(s)
- Jiamin Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xuemei Zhen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Di Shao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Ni Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Lele Chang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
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13
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Istamov K, Beglaryan M, Goncharova O, Sakmamatov K, Kyrbashov B, Mamytova M, Zairova I, Alumkylova G, Nair D. Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants? Trop Med Infect Dis 2023; 8:412. [PMID: 37624350 PMCID: PMC10458606 DOI: 10.3390/tropicalmed8080412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Migrants are at increased risk of developing tuberculosis (TB) and have poor treatment outcomes. The National TB program (NTP) of the Kyrgyz Republic recognizes two types of migrants: internal (intra-country) and external (inter-country) migrants. This cohort study compared the characteristics, timeliness of diagnosis and treatment initiation, and treatment outcomes of TB patients (internal migrant vs. external migrant vs. non-migrant) identified during treatment in the country in 2021. The TB treatment register and treatment cards of 5114 patients (156 internal, 430 external, and 4528 non-migrants) were reviewed. Risk factors (unemployment, smoking, alcohol use, and homelessness) were higher (p-value < 0.001) in internal (84%) than in external migrants (66%) and non-migrants (43%). The median delay in seeking care post-symptom onset was longer (p-value= 0.03) in external (30 days) than in internal migrants (21 days) and non-migrants (25 days). Successful treatment outcomes for drug-sensitive TB were higher in internal (89%, p-value = 0.012) and external migrants (86%, p-value = 0.001) than in non-migrants (78%). Internal and external migrants should be separately considered with respect to TB care and monitoring under the NTP. Success rates seem to be high in migrants, but our findings may be biased, as migrants with poor healthcare access may remain undetected and untreated and have undocumented poor outcomes.
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Affiliation(s)
- Kylychbek Istamov
- School of Medicine, Osh State University, Osh City 723500, Kyrgyzstan
| | - Mher Beglaryan
- Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia
| | - Olga Goncharova
- National Center for Phthisiology, Bishkek 720000, Kyrgyzstan
| | - Konushbek Sakmamatov
- Faculty of Medicine, Ala-Too International University, Bishkek 720000, Kyrgyzstan
| | - Bolot Kyrbashov
- National Center for Phthisiology, Bishkek 720000, Kyrgyzstan
| | - Mukadas Mamytova
- School of Medicine, Osh State University, Osh City 723500, Kyrgyzstan
| | - Indira Zairova
- School of Medicine, Osh State University, Osh City 723500, Kyrgyzstan
| | | | - Divya Nair
- International Union Against TB and Lung Disease (The Union), 75001 Paris, France
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14
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Sari NM, Devansyah S, Modjaningrat I, Suryawan N, Susanah S, Rakhmillah L, Wahyudi K, Kaspers GJL. Type of cancer and complementary and alternative medicine are determinant factors for the patient delay experienced by children with cancer: A study in West Java, Indonesia. Pediatr Blood Cancer 2023; 70:e30192. [PMID: 36636790 DOI: 10.1002/pbc.30192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/27/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Most pediatric cancer patients in developing countries present at an advanced stage due to delayed diagnosis, being an important barrier to effective care. The objective of this study was to evaluate the associated factor of patient delay and explore significant parental practice-associated risk factor to patient delay. METHODS This was a sequential mixed methodology, utilizing data from the Indonesian Pediatric Cancer Registry for clinical variables and completed interviews with parents using structured questionnaires to obtain their sociodemographic data. A binary logistic regression analysis model was fitted to identify factors associated with patient delay. Additional semi-structured interviews related to parental practice of using complementary and alternative medicine (CAM) were administered to 30 parents. Thematic framework analysis was performed on qualitative data to explore determinant factors of parental practice of using CAM. RESULTS We interviewed 356 parents with children with cancer. The median patient delay was 14 days (interquartile range [IQR]: 6-46.5 days). The most extended delay was in patients with malignant bone tumors (median 66, IQR: 14-126). In multivariable logistic regression analysis, solid cancer (odds ratio [OR] = 5.22, 95% confidence interval [CI]: 2.79-9.77, p < .001) and use of CAM (OR = 1.86, 95% CI: 1.13-3.08, p = .015) were associated with patient delay. Qualitative interviews highlighted key issues relative to determinant parental factors using CAM, including vague initial childhood cancer symptoms, parental health-seeking behavior, CAM availability and accessibility, also barriers of healthcare facilities. CONCLUSION Type of cancer and use of CAM are essential factors that cause patient delay. It should be addressed in the future childhood cancer awareness and childhood cancer diagnosis pathway.
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Affiliation(s)
- Nur Melani Sari
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Sultan Devansyah
- Universitas Padjadjaran, Faculty of Medicine, Bandung, Indonesia
| | | | - Nur Suryawan
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Susi Susanah
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Lulu Rakhmillah
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Kurnia Wahyudi
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Gertjan J L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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15
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Atula M, Aro K, Irjala H, Halme E, Jouppila-Mättö A, Koivunen P, Wilkman T, Blomster H, Mäkitie A, Atula T. Patient and health care delays in large (class T3-T4) oral, oropharyngeal, and laryngeal carcinomas. Head Neck 2023; 45:1215-1225. [PMID: 36880833 DOI: 10.1002/hed.27335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/16/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Head and neck cancers (HNCs) are often diagnosed at an advanced stage. We investigated the lengths and factors associated with patient, primary health care (PHC), and specialist care (SC) delays in T3-T4 oral, oropharyngeal, and laryngeal cancer. METHODS A nationwide prospective questionnaire-based study (n = 203) with the 3-year long data collection period. RESULTS The median patient, PHC and SC delays were 58, 13, and 43 days, respectively. Lower level of education, heavy alcohol use, hoarseness, difficulties breathing, and eventual palliative treatment associated with a longer patient delay. A lump on the neck or facial swelling associated with a shorter PHC delay. Conversely, if symptoms were treated as an infection, PHC delay was longer. The treatment modality and tumor site affected SC delay. CONCLUSIONS Patient delay stands as the most notable factor contributing to delays before treatment. HNC symptom awareness thus remains especially important among HNC risk groups.
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Affiliation(s)
- Markus Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Elina Halme
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Anna Jouppila-Mättö
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology - Head and Neck Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Henry Blomster
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Clinical Sciences, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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16
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Chaychoowong K, Watson R, Barrett DI. Perceptions of stigma among pulmonary tuberculosis patients in Thailand, and the links to delays in accessing healthcare. J Infect Prev 2023; 24:77-82. [PMID: 36815061 PMCID: PMC9940242 DOI: 10.1177/17571774231152720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Background Delay in seeking care increases the morbidity and mortality in tuberculosis (TB) patients and leads to increased likelihood of transmission within the community. Stigmatisation is one of the influencing factors causing delay in accessing healthcare when experiencing symptoms of TB. Objective This study aimed to explore the relationship between TB stigmatisation and patient delay among pulmonary tuberculosis (PTB) patients. Methods A mixed methods study was undertaken among 300 randomly sampled participants who completed questionnaire surveys, supplemented by 25 in-depth interviews with purposively-sampled participants identified as delaying access to healthcare. Results Participants reporting higher perceived levels of TB stigmatisation demonstrated a longer duration of patient delay (p < 0.001). Qualitative data reinforced the view that perceptions of TB as being a disease carrying with it a stigma contributed to a delay in seeking healthcare. This was also exacerbated in patients with HIV-positive. Given that HIV-positive status is still subject to stigma in some parts of society, patients demonstrated additional reluctance to seek out healthcare if they were known to be HIV-positive whilst also experiencing symptoms of TB. Discussion The study highlights that accurate and objective information about TB is required to reduce societal stigmatisation related to the disease, thereby reducing the reluctance of patients to access healthcare.
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Affiliation(s)
| | - Roger Watson
- Faculty of Health Sciences, University of Hull, Hull, UK
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17
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Farquharson B, Johnston M, Williams B, Smith K, Dombrowski S, Jones C, Treweek S, Dougall N, Grindle M, Savinc J, Abyhankar P. Reducing patient delay in acute coronary syndrome: Randomized controlled trial testing effect of behaviour change intervention on intentions to seek help. Br J Health Psychol 2023; 28:188-207. [PMID: 35942523 PMCID: PMC10086951 DOI: 10.1111/bjhp.12619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of a behaviour change intervention to reduce patient delay with symptoms of acute coronary syndrome. DESIGN A 3-arm web-based, parallel randomized controlled trial. METHODS The intervention comprised 12 behaviour change techniques (BCTs) embedded in a text-only or text+visual narrative (the techniques were systematically identified through systematic review and a consensus exercise). Between February and November 2017, n = 145 people who had recently experienced acute coronary syndrome were randomly allocated to intervention ('text+visual' or 'text-only') or control. Intentions to phone an ambulance immediately for acute coronary syndrome symptoms were assessed before and after the intervention using symptom scenarios, and the change in intention was compared across the three groups. RESULTS Significant increases in intention to phone an ambulance immediately for ACS symptoms were seen following the 'text+visual' intervention but not following 'text-only' or control. However, the study was underpowered to detect any significant changes in intention between the 3 groups. There were no unintended effects on intentions for non-urgent symptoms. CONCLUSIONS A 'text+visual' BCT-based intervention may significantly increase intention to phone an ambulance with symptoms of ACS. Further testing of the effect of the intervention on actual behaviour is required.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mark Grindle
- University of Highlands and Islands, Inverness, UK
| | - Jan Savinc
- Edinburgh Napier University, Edinburgh, UK
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18
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Govindarajulu S, Muthuvel T, Lal V, Rajendran KP, Seshayyan S. Determinants of patients' delay with disability in the diagnosed leprosy cases in the three major states of India: A case-control study. Indian J Dermatol Venereol Leprol 2023; 89:35-40. [PMID: 35389017 DOI: 10.25259/ijdvl_1172_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/01/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Skin lesions are the most common early symptoms of leprosy, often ignored by patients at an early stage and misdiagnosed as other dermatological diseases by healthcare personnel, leading to delay in diagnosis and treatment of leprosy precipitating permanent neurological deficit, deformities and serious disabilities. AIMS The objective is to evaluate the duration of delay and factors responsible for the delay in reporting of patients, among the newly detected leprosy cases (Grade 1 and Grade 2 disability patients). METHODS A case-control study was conducted during 2014-2016 in three major states of India (Delhi, Gujarat and West Bengal) in 140 randomly recruited newly registered adult leprosy patients (aged 18 years and above) with Grade 2/1 disabilities (cases) and 140 Grade 0 disability patients (controls) in each of these Indian states. RESULTS It is established that the major contributors for the delay in the early diagnosis of leprosy have been patient-related factors. The median patient delay in the three states of Delhi, Gujarat and West Bengal were five months (0.7-1.8), 2.8 months (2-14) and 12 months (2-24), respectively. LIMITATIONS The study design is case-control and has an inbuilt reporting bias due to the retrospective nature of data collection but the data collection was carried with caution to reduce the recall bias. As the study is carried out in three states, generalisation of interpretation was cautiously executed. The matching ratio of cases and controls was 1:1 in this study, but we could not increase the controls due to operational feasibility during the conduct of the study. CONCLUSION Patient delay is a crucial factor responsible for the disability among new leprosy cases. A higher patient delay in these three states reflects that the community is not aware about the signs and symptoms of leprosy. Reducing patient delay is very important for reducing disabilities in the newly diagnosed cases.
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Affiliation(s)
- Srinivas Govindarajulu
- Professor and Head, Department of Epidemiology, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
| | | | - Vivek Lal
- Sasakawa-India Leprosy Foundation, New Delhi, India
| | - Karthikeyan P Rajendran
- Postgraduate Student, Department of Epidemiology, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
| | - Sudha Seshayyan
- Vice Chancellor, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
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Zhang H, Liang C, Zhang X, Yu H, Yan X, Wang L, Tong T, Zhang H, Dai H, Tong H. Factors influencing patient delay in individuals with obstructive sleep apnoea: a study based on an integrated model. Ann Med 2022; 54:2828-2840. [PMID: 36259469 PMCID: PMC9586697 DOI: 10.1080/07853890.2022.2132417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder, yet it remains undiagnosed in a large proportion of adults. OBJECTIVE This study aims to investigate the status of patient delay and provider delay in OSA patients and examine related factors affecting patient delay in OSA individuals in China. METHODS A cross-sectional design was conducted on a sample of 309 OSA patients (aged from 18 to 76, median age of 47 years, 84.8% male) in Northeast China. Participants were required to complete the sociodemographic questionnaire, the symptom characteristics questionnaire, the help-seeking attitude scale (HSAS), the social support rating scale and the chronic disease self-efficacy scales (CDSES) to test the hypothesis. Binary logistic regression analysis was conducted to explore factors that account for the patient delay. RESULTS The median patient delay among OAS patients in this study was 22 months, the median provider delay was one month, and the median total delay was 26 months. As shown by multivariate analysis results, patients who have snored for over 6 years (OR = 3.377, 95%CI: 1.175-9.702) were more likely to experience prolonged patient delays. Per capita monthly family income above 3000 RMB (OR = 0.172, 95%CI: 0.052-0.571), taking up residence in cities or towns (OR = 0.484, 95%CI: 0.248-0.946), higher self-recognition of the disease (OR = 0.793, 95%CI: 0.647-0.972), higher objective support (OR = 0.825, 95%CI: 0.739-0.921) and stronger self-efficacy (OR = 0.674, 95%CI: 0.525-0.867) were significantly associated with shorter patient delays. CONCLUSION Patient delay is common in Chinese OSA patients. The upstream factors affecting the patient delay in individuals with OSA include income, place of residence, and objective support; midstream factors include self-recognition of the disease and self-efficacy; downstream factors include years of snoring.KEY MESSAGESDespite being a high-prevalence disease, many obstructive sleep apnoea (OSA) patients are not clearly diagnosed and treated.The factors affecting the delay in seeking medical treatment in individuals with OSA included income, place of residence, objective support, self-recognition of the disease, self-efficacy and years of snoring.Investigations into OSA patients' care-seeking behaviours can better reflect the secondary prevention of OSA, and it is crucial to pay attention to the delayed phase of patients.
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Affiliation(s)
- Hui Zhang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Chunguang Liang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Xin Zhang
- Department of Respiratory Medicine, Zibo Central Hospital, Zibo, PR China
| | - Haitao Yu
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Xiangru Yan
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Liying Wang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Tong Tong
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Huiying Zhang
- Department of Otolaryngology Head & Neck Surgery, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China
| | - Hongliang Dai
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Huijuan Tong
- Department of Nursing, Shenyang Medical College, Shenyang, PR China
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20
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Ke X, Wu T, Gao G, Yang S, Lin W, Xiao Y, Shen M, Chen M, Chen X, Zhao S, Su J. Delay in Seeking Medical Attention and Diagnosis in Chinese Melanoma Patients: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:14916. [PMID: 36429635 PMCID: PMC9690906 DOI: 10.3390/ijerph192214916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Melanoma is a highly malignant skin tumor, and prolonged delay in seeking medical attention (DSMA) and delay in diagnosis (DD) may result in poor prognoses. Through a web-based questionnaire, we explored the related factors affecting the DSMA and DD of melanoma in a Chinese population. A total of 112 valid answer sheets were received. After obtaining the relevant information, we analyzed the factors associated with DSMA and DD. The median time of DSMA was 8.0 (quartiles: 1.0, 29.3) months, and the median of patients' DD was 1.0 (quartiles: 1.0, 8.3) month. The subsequent analysis showed that DSMA and DD were positively correlated to age and negatively correlated to education background and annual household income. Patients with a history of tumors or previous health-seeking behavior because of other skin lesions had significantly longer DSMA than those without. Patients who sought medical help at general tertiary hospitals for the first time had a significantly shorter DD than those who chose other hospitals. Our study found that DSMA and DD are associated with factors such as age, education, income, and patients' histories. Secondary prevention of Chinese melanoma should be strengthened to reduce DSMA and DD to improve patients' prognoses.
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Affiliation(s)
- Xinchen Ke
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Tianhao Wu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guiyun Gao
- Department of Dermatology, Hunan Aerospace Hospital, Changsha 410205, China
| | - Songchun Yang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wenrui Lin
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
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Mauceri R, Bazzano M, Coppini M, Tozzo P, Panzarella V, Campisi G. Diagnostic delay of oral squamous cell carcinoma and the fear of diagnosis: A scoping review. Front Psychol 2022; 13:1009080. [PMID: 36405204 PMCID: PMC9669962 DOI: 10.3389/fpsyg.2022.1009080] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 07/25/2023] Open
Abstract
The mortality rate of patients affected with oral squamous cell carcinoma (OSCC) has been stable in recent decades due to several factors, especially diagnostic delay, which is often associated with a late stage diagnosis and poor prognosis. The aims of this paper were to: analyze diagnostic delay in OSCC and to discuss the various psychological factors of patients with OSCC, with particular attention to the patient's fear of receiving news regarding their health; and the professional dynamics related to the decision-making processes in cases of suspected OSCC. A preliminary review of literature focusing on OSCC diagnostic delay was performed. Seven articles were included with the diagnostic delay ranging from 45 days to approximately 6 months. Patients' fears and, to a lesser degree, the concerns of dentists, were found to be still poorly investigated. On the basis of the authors' professional experience, the development of oral lesions of unknown origin may generate different behaviors in the decision-making processes by patients and clinicians, and fear may play a key role in the distinct steps of this process. It is crucial to increase awareness and inform patients about the onset of OSCC, and contemporaneously encourage experimental studies on patients' fear and professional behaviors with respect to communication regarding OSCC.
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Affiliation(s)
- Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Monica Bazzano
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Martina Coppini
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Pietro Tozzo
- U.O.C. of Stomatology, A.O.O.R., Villa Sofia-Cervello of Palermo, Palermo, Italy
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Giuseppina Campisi
- Unit of Oral Medicine and Dentistry for Fragile Patients, Department of Rehabilitation, Fragility and Continuity of Care, University Hospital Palermo, Palermo, Italy
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22
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Chaychoowong K, Watson R, Barrett DI. Predictors of patient delay among pulmonary tuberculosis patients in Northeast Thailand. J Infect Prev 2022; 23:222-227. [PMID: 36003128 PMCID: PMC9393596 DOI: 10.1177/17571774221094164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/22/2022] [Indexed: 09/03/2023] Open
Abstract
Background Pulmonary tuberculosis (PTB) is a major health problem in Thailand. Delay in getting treatment is an important factor which may worsen the disease and increase TB transmission. Objective This study aimed to investigate the duration and predictors of patient delay among PTB patients in Northeast Thailand. Methods A cross-sectional study was undertaken using a structured questionnaire in nine districts in Nakhon Ratchasima Province from July to September 2018. The duration between the first symptom onset and the first visit to a health facility was determined, with a period of greater than 30 days defined as patient delay. Multiple logistic regression was used to identify predictors of the delay. Results 300 PTB patients participated in the survey, with patient delay identified in 39% of respondents. The median duration of the delay was 35 days among participants overall. Through multivariate analysis, primary education, upper secondary education, previous TB knowledge, TB recognition, TB stigmatisation, weight loss, self-treatment, the number of visits with health providers and using a motorcycle to travel to the hospital were significant predictors of patient delay. Discussion Knowledge needs to be provided to people to increase their recognition and minimise stigmatisation of TB. Education about TB screening needs to be revised and delivered to health providers to increase and improve TB detection processes.
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O’Connor CT, Ibrahim A, Buckley A, Maguire C, Kumar R, Kumar J, Arnous S, Kiernan TJ. Total ischaemic time in STEMI: factors influencing systemic delay. Br J Cardiol 2022; 29:17. [PMID: 36212786 PMCID: PMC9534116 DOI: 10.5837/bjc.2022.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Total ischaemic time in ST-elevation myocardial infarction (STEMI) has been shown to be a predictor of mortality. The aim of this study was to assess the total ischaemic time of STEMIs in an Irish primary percutaneous coronary intervention (pPCI) centre. A single-centre prospective observational study was conducted of all STEMIs referred for pPCI from October 2017 until January 2019. There were 213 patients with a mean age 63.9 years (range 29-96 years). The mean ischaemic time was 387 ± 451.7 mins. The mean time before call for help (patient delay) was 207.02 ± 396.8 mins, comprising the majority of total ischaemic time. Following diagnostic electrocardiogram (ECG), 46.5% of patients had ECG-to-wire cross under 90 mins as per guidelines; 73.9% were within 120 mins and 93.4% were within 180 mins. Increasing age correlated with longer patient delay (Pearson's r=0.2181, p=0.0066). Women exhibited longer ischaemic time compared with men (508.96 vs. 363.33 mins, respectively, p=0.03515), driven by a longer time from first medical contact (FMC) to ECG (104 vs. 34 mins, p=0.0021). The majority of total ischaemic time is due to patient delay, and this increases as age increases. Women had longer ischaemic time compared with men and longer wait from FMC until diagnostic ECG. This study suggests that improved awareness for patients and healthcare staff will be paramount in reducing ischaemic time.
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Affiliation(s)
| | - Abdallah Ibrahim
- Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Anthony Buckley
- Interventional Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Caoimhe Maguire
- Medical Registrar Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Rajesh Kumar
- Interventional Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Jatinder Kumar
- Interventional Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Samer Arnous
- Consultant Cardiologist Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Thomas J Kiernan
- Associate Professor of Medicine Department of Cardiology, University Hospital Limerick, Limerick, IrelandXS
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Batbayar B, Kariya T, Boldoo T, Purevdorj E, Dambaa N, Saw YM, Yamamoto E, Hamajima N. Patient delay and health system delay of patients with newly diagnosed pulmonary tuberculosis in Mongolia, 2016-2017. Nagoya J Med Sci 2022; 84:339-351. [PMID: 35967952 PMCID: PMC9350575 DOI: 10.18999/nagjms.84.2.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
Although diagnosis and treatment of tuberculosis (TB) have been improved in many countries, delays in the diagnosis and treatment remain problematic in resource-limited countries. This study aimed to identify factors affecting delays in TB care in Mongolia. Data on TB cases registered from January 2016 to December 2017 were obtained from the national registry of TB at the Department of TB Surveillance and Research in National Center for Communicable Disease. The total number of TB cases registered in these two years was 8,166, including 3,267 cases of newly diagnosed pulmonary TB. Pulmonary TB cases (1,836 males and 1,431 females) were analyzed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Patient delays longer than the median (28 days) were significantly associated with patient age >32 years (aOR=1.31, 95%CI: 1.14-1.51), residence in areas other than Ulaanbaatar (aimags) (aOR=1.38, 95%CI: 1.20-1.59), and smear-negative (aOR=0.57, 95%CI: 0.47-0.69). Health system delays longer than the median (7 days) were significantly associated with patient age >32 years (aOR=1.16, 95%CI: 1.00-1.33), residence in aimags (aOR=0.82, 95%CI: 0.71-0.95), special facilities including a prison hospital (aOR=4.40, 95%CI: 2.42-7.83), registration in 2017 relative to 2016 (aOR=0.83, 95%CI: 0.71-0.95), and smear-negative (aOR=1.72, 95%CI: 1.42-2.07). Total delays longer than the median (45 days) were significantly associated with patient age >32 years (aOR=1.39, 95%CI: 1.21-1.60), residence in aimags (aOR=1.27, 95%CI: 1.11-1.47), and smear-negative (aOR=0.74, 95%CI: 0.62-0.90). To shorten the total delay, improvement of the access to medical facilities in aimags is necessary.
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Affiliation(s)
- Batmunkh Batbayar
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Tsolmon Boldoo
- National Center for Communicable Diseases, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Enkhtamir Purevdorj
- National Center for Communicable Diseases, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Naranzul Dambaa
- National Center for Communicable Diseases, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Shafaee MN, Silva LR, Ramalho S, Doria MT, De Andrade Natal R, Cabello V, Cons L, Pavanello M, Zeferino LC, Mano MS, Linck RDM, Batista LS, Pedro EP, De Paula BH, Zuca-Matthes G, Podany E, Makawita S, Ann Stewart K, Tsavachidis S, Tamimi R, Bondy M, Debord L, Ellis M, Bines J, Cabello C. Breast Cancer Treatment Delay in SafetyNet Health Systems, Houston Versus Southeast Brazil. Oncologist 2022; 27:344-351. [PMID: 35348756 PMCID: PMC9074991 DOI: 10.1093/oncolo/oyac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer outcomes among patients who use safety-net hospitals in the highly populated Harris County, Texas and Southeast Brazil are poor. It is unknown whether treatment delay contributes to these outcomes. Methods We conducted a retrospective cohort analysis of patients with non-metastatic breast cancer diagnosed between January 1, 2009 and December 31, 2011 at Harris Health Texas and Unicamp’s Women’s Hospital, Barretos Hospital, and Brazilian National Institute of Cancer, Brazil. We used Cox proportional hazards regression to evaluate association of time to treatment and risk of recurrence (ROR) or death. Results One thousand one hundred ninety-one patients were included. Women in Brazil were more frequently diagnosed with stage III disease (32.3% vs. 21.1% Texas; P = .002). Majority of patients in both populations had symptom-detected disease (63% in Brazil vs. 59% in Texas). Recurrence within 5 years from diagnosis was similar 21% versus 23%. Median time from diagnosis to first treatment defined as either systemic therapy (chemotherapy or endocrine therapy) or surgery, were comparable, 9.9 weeks versus 9.4 weeks. Treatment delay was not associated with increased ROR or death. Higher stage at diagnosis was associated with both increased ROR and death. Conclusion Time from symptoms to treatment was considerably long in both populations. Treatment delay did not affect outcomes. Impact Access to timely screening and diagnosis of breast cancer are priorities in these populations.
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Affiliation(s)
| | - Leonardo Roberto Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Susana Ramalho
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Maira Teixeira Doria
- Department of Obstetrics and Gynecology, Clinical Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Rodrigo De Andrade Natal
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Victor Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Livia Cons
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marina Pavanello
- School of Women's and Children's Health, Lowy Cancer Research Centre, University of New South Wales, Sydney, Australia
| | - Luiz Carlos Zeferino
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Max S Mano
- Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Kelsey Ann Stewart
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | | | - Rull Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | - Melissa Bondy
- Center for Population Health Sciences, Stanford Cancer Institute, Stanford, CA, USA
| | - Logan Debord
- Department of Dermatology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | | | - Jose Bines
- Instituto Nacional Do Câncer (INCA - HCIII), Rio de Janeiro, Brazil
| | - Cesar Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Lai AYK, Sit SMM, Wu SYD, Wang MP, Wong BYM, Ho SY, Lam TH. Associations of Delay in Doctor Consultation With COVID-19 Related Fear, Attention to Information, and Fact-Checking. Front Public Health 2021; 9:797814. [PMID: 34966717 PMCID: PMC8710678 DOI: 10.3389/fpubh.2021.797814] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Delaying doctor consultation is harmful. Fear of COVID-19 leads to delays in seeking medical care at a time when pandemic information overflows. However, little is known about the role of COVID-19 related fear, attention to information, and fact-checking in such delay. Objective: Under the Hong Kong Jockey Club SMART Family-Link Project, we examined the associations of delay in doctor consultation amidst the pandemic with sociodemographic characteristics, COVID-19 related fear, attention to information, and fact-checking. Methods: We conducted a population-based online cross-sectional survey in May 2020 on Hong Kong Chinese adults. Respondents reported whether the pandemic caused any delay in doctor consultation (yes/no), level of COVID-19 related fear, attention to information and fact-checking (all on a scale of 0 to 10 and recoded into tertiles of low, moderate, high). Regression analyses were used to examine the associations of delay and fear with sociodemographic characteristics, attention and fact-checking, adjusting for covariates. Data were weighted by sex, age and education level of the population. Results: Of 4,551 respondents (46.5% male, 59.7% aged over 45 years), 10.1% reported delay in doctor consultation. The mean score was 6.4 for fear, 8.0 for attention and 7.4 for fact-checking. Delay was more common in males and increased with age and fear. High vs. low level of fear was associated with delay [adjusted odd ratios (AOR) 2.68, 95% confidence interval (CI) 2.08, 3.47]. Moderate level of fact-checking was negatively associated with delay (AOR 0.72, 95% CI 0.56, 0.92). Females reported greater fear and fear decreased with age. Fear increased with attention to information and decreased with fact-checking. Fear substantially mediated the association of delay with attention (96%) and fact-checking (30%). Conclusions: We have first shown that delay in doctor consultation increased with fear of COVID-19 and decreased with fact-checking amidst the pandemic. Fear also increased with attention to COVID-19 related information and decreased with fact-checking. Understanding these associations can help policymakers develop targeted communication and support to the public to reduce delayed doctor consultations and the associated COVID-19-related or unrelated morbidity and mortality in the community.
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Affiliation(s)
- Agnes Yuen-Kwan Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shirley Man-Man Sit
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.,School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Socrates Yong-Da Wu
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Man-Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Bonny Yee-Man Wong
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai-Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Xiao W, Chen B, Huang D, Chan O, Wei X, Zhou L, Zou G. Comparison of Delay in Tuberculosis Diagnosis Between Migrants and Local Residents in an Eastern County of China: An Analysis of the Electronic Data Between 2015 and 2019. Front Public Health 2021; 9:758335. [PMID: 34869174 PMCID: PMC8637117 DOI: 10.3389/fpubh.2021.758335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: China continues to rank among one of the countries with the highest number of tuberculosis (TB) cases globally. Migrants are a particularly at-risk subgroup for TB and pose a challenge for case management in contemporary China. The early diagnosis and treatment of patients with TB are pivotal for effective TB control. This study investigates the delay in the TB diagnosis of migrants as compared with residents, to provide an evidence base for improved case detection and the better management of migrant patients with TB. Materials and Methods: The data was collected from the Tuberculosis Information Management System (TBIMS) (2015-2019) in an eastern county of China. The total diagnostic delay, consisting of patient delay and health system delay, is defined as the interval between the onset of TB symptoms and the confirmation of TB diagnosis in the designated TB hospital. The comparison of the delay in the TB diagnosis between migrants and residents was conducted using a Mann-Whitney U-test and chi-square test. The difference in the delay curves between these two groups was examined using a log-rank test. Results: Of 2,487 patients with TB, 539 (22%) were migrants. The migrants tended to be younger, presented with less severe conditions, received an initial diagnosis at prefectural and above-level hospitals. Compared with the local patients with TB, the migrant patients with TB had a longer median total diagnostic delay (30 vs. 9, P = 0.000) and a higher proportion of patients with this delay >28 days (52 vs. 13%, P = 0.000). Similarly, the migrant patients with TB also had a longer median patient delay (13 vs. 9, P = 0.000) and a higher proportion of patients with this delay >14 days (47 vs. 30%, P = 0.000), longer median health system delay (9 vs. 0, P = 0.000), and a higher proportion of patients with this delay >14 days (42 vs. 0.5%, P = 0.000) than the local patients with TB. The survival curves of delay showed that the longer the time interval was, the more likely the migrant patients with TB were to be diagnosed (P < 0.05). Conclusions: Diagnosis is significantly delayed among migrant patients with TB. Our study highlights the importance of early screening and diagnosis for TB especially among migrants, to improve access and ensure better management for all patients with TB.
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Affiliation(s)
- Wenhui Xiao
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Dajiang Huang
- Center for Disease Control and Prevention, Cangnan County, Wenzhou, China
| | - Olivia Chan
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Xiaolin Wei
- Division of Clinical Epidemiology & Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lin Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
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Norsa'adah B, Rampal KG, Mohd Amin R. Time Taken for Symptom Recognition, First Consultation, Diagnosis and First Definitive Treatment and Its Associated Factors among Women with Breast Cancer. Asian Pac J Cancer Prev 2021; 22:3623-3631. [PMID: 34837921 PMCID: PMC9068193 DOI: 10.31557/apjcp.2021.22.11.3623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Breast cancer patients in Malaysia often present late, delaying diagnosis and treatment. Decisions on health-seeking behaviour are influenced by a complex interplay of several factors. Early detection and subsequent successful treatment are the main goal in order to reduce breast cancer mortality. The aims of this study were to identify the time taken by women with breast cancer for consultation, diagnosis and first definitive treatment and the factors associated with the initiation of definitive treatment. METHODS In this cohort study, we interviewed 328 women with histologically confirmed breast cancer at five medical centres in Malaysia. Times were measured from recognition of symptoms to first consultation to diagnosis and to the first definitive treatment. The event was initiation of definitive treatment. Data was analysed using multivariable Cox proportional hazards regression. RESULTS The mean age was 47.9 (standard deviation 9.4) years and 79.9% were ethnic Malays. The median follow-up time was 6.9 months. The median times for first doctor consultation, diagnosis and initiation of treatment were 2 months, 5.5 months and 2.4 weeks, respectively. The percentage of consultation delay more than a month was 66.8%, diagnosis delay more than three months was 73.2% and treatment delay more than one month was 11.6%. Factors associated with not initiating the definitive treatment were pregnancy (adjusted hazard ratio (AHR) 1.75; 95% Confidence Interval (CI): 1.07, 2.88), taking complementary alternative medicine (AHR 1.45; 95% CI: 1.15, 1.83), initial refusal of mastectomy (AHR 3.49; 95% CI: 2.38, 5.13) and undergoing lumpectomy prior to definitive treatment (AHR 1.62; 95% CI: 1.16, 2.28). CONCLUSIONS Delays in diagnosis and consultation were more serious than treatment delays. Most respondents would accept treatment immediately after diagnosis. Respondents themselves were responsible for a large proportion of the delays. This study was successful in understanding the process of breast cancer patients' experience, from symptoms recognition to consultation, diagnosis and treatment.
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Affiliation(s)
- Bachok Norsa'adah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Krishna Gopal Rampal
- Centre for Graduate Studies, Cyberjaya University College of Medical Sciences, Persiaran Bestari, Cyber 11, Cyberjaya, Selangor, Malaysia
| | - Rahmah Mohd Amin
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, Kuala Terengganu, Terengganu, Malaysia
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Philip PM, Kannan S. Patient Interval and Associated Factors in the Diagnostic Journey of Oral Cancer: A Hospital-Based Cross-Sectional Study from Kerala, India. Asian Pac J Cancer Prev 2021; 22:3143-3149. [PMID: 34710990 PMCID: PMC8858242 DOI: 10.31557/apjcp.2021.22.10.3143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background: The incidence of oral cancer is increasing in south-central Asia. Though it can be detected early, most cases were reported in late stages, resulting in a poor prognosis. Reducing the patient interval will facilitate early diagnosis and better disease survival. The paucity of research on the patient interval in oral cancer has limited our ability to design and evaluate programs for early diagnosis. Methods: The study was conducted to identify the duration of patient interval and associated factors in oral cancer. Patients with oral cancer reporting at a tertiary cancer center during the study period were interviewed using validated data collection tools. The ‘Aarhus statement’ guidelines were followed in designing and reporting the study. Results: Among the 261 participants, 54% reported a patient interval of more than 90 days. The median (IQR) patient interval was 92 (38-168) days. In the multivariate binary logistic regression model, those who approached healthcare facilities due to pain (OR, 8.3, 95% CI, 2.9 to 23.4) were more likely to have a patient interval of more than 90 days over those who came due to insistence by family. Smoking status (Current smoker vs. never smoker) at the time of diagnosis (OR, 2.518, 95% CI, 1.3 to 4.7), Stage of cancer (late vs. early) of participants (OR, 2.62, 95% CI, 1.3 to 5.2), and time of travel (>30 minutes vs. ≤ 10 minutes) to health care facility (OR 5.8, 95% CI, 1.6 to 21.7) were the other significant predictors for the patient interval of more than 90 days. Conclusion: Patient interval in oral cancer can be reduced by improving symptom awareness, abstinence from tobacco use, and facilitating access to health care facilities. The double burden of tobacco use in oral cancer, as it increases the risk of disease occurrence and delays symptom presentation, needs serious policy considerations in the context of cancer prevention.
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Affiliation(s)
- Phinse Mappalakayi Philip
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Srinivasan Kannan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Lauritzen BB, Jensen JS, Grønhøj C, Wessel I, von Buchwald C. Impact of delay in diagnosis and treatment-initiation on disease stage and survival in oral cavity cancer: a systematic review. Acta Oncol 2021; 60:1083-1090. [PMID: 34043480 DOI: 10.1080/0284186x.2021.1931712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM/OBJECTIVES This study aimed to systematically review the literature on the impact of delay in diagnosis and treatment of oral cavity cancer. METHODS PubMed and Embase were systematically searched for articles reporting impact of delay in diagnosis and treatment on cancer-stage and survival of oral cavity cancer. Studies comprising at least ten patients, and published since the year 2000, were included. RESULTS Sixteen studies (n = 45,001, range: 62-18,677 per study, 83% men), from Australia, Asia, Europe, North America and South America, met the inclusion criteria. Eleven studies (n = 1,460) examined delay in diagnosis, while five studies (n = 43,541) reported delay in treatment. Eight of the eleven studies, examining delay in diagnosis (n = 1,220), analyzed the correlation between delay in diagnosis and tumor stage at diagnosis. Three studies found a significant correlation between patient delay and advanced stage at diagnosis (p < 0.05), whereas three other studies did not. The studies reporting a significant correlation were from Asian countries, whereas the three studies that did not find a correlation were from other continents. Studies reporting on professional delay and total diagnostic delay, generally, did not find a significant correlation with advanced cancer at diagnosis. Time to treatment (TTI), defined as time from diagnosis to treatment, was found significantly correlated with survival in three studies (p < 0.01, p < 0.001, p < 0.05), and nonsignificant in two studies. CONCLUSION A significant correlation between patient delay and advanced stage cancer was reported in Asian studies only, while professional delay and total diagnostic delay were generally found to be non-correlated with advanced stage cancer at diagnosis. TTI was in some studies reported to be correlated with poorer outcome, while other studies did not report a correlation. One study presented that there was no clear advantage in overall survival (OS) for patients treated within 30 days, compared to patients treated between 30 and 44 days.
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Affiliation(s)
- Benedicte Bitsch Lauritzen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Schmidt Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Legrand A, Quintard B, Garrouteigt C, Beylot-Barry M, Broc G. From neglect to earlier diagnosis: a qualitative meta-synthesis of psycho-social factors associated with consultation delay in advanced basal cell carcinoma. PSYCHOL HEALTH MED 2021; 27:1793-1804. [PMID: 34251919 DOI: 10.1080/13548506.2021.1952281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Local malignant potential of basal cell carcinoma (BCC) can lead at advanced stages to the destruction of underlying tissues and significant morbidity. The primary risk factor for progression of advanced basal cell carcinoma (aBCC) is the long duration of the tumour, which results from delay in seeking medical care. To assess the implication of psycho-social factors in the delay before the first medical consultation among patients with aBCC, in order to identify potentially targetable factors enabling earlier diagnosis. Three-step qualitative meta-synthesis: (1) systematic review of the literature; (2) structured qualitative analysis of these documents; (3) construction of a logical model. After screening, 81 articles were included. Self-neglect and denial in patients are roundly put forward as the main obstacles to consultation. We found that avoidance behaviour, mistaken interpretation and banalisation of symptoms, and fear of treatment all played a role. The strongest motivation to seek help comes from the realisation that new symptoms may be dangerous; the role of interpersonal surroundings is highlighted as helpful. Patient delay has multifactorial origins in aBCC, especially self-neglect ranging from denial of tumours to conscious refusal of treatment.
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Affiliation(s)
- A Legrand
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - B Quintard
- INSERM U1219, Bordeaux Population Health Research Centre, Team: Handicap, Activity, Cognition, Health, Bordeaux, France
| | - C Garrouteigt
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - M Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France.,INSERM U1053, UMR Bariton, Oncogenesis of Cutaneous Lymphoma, University of Bordeaux, Bordeaux, France
| | - G Broc
- Department of Psychology, Paul Valéry Montpellier 3, University of Montpellier, Montpellier, France
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Baymler Lundberg AS, Esbensen BA, Jensen MB, Hauge EM, de Thurah A. Facilitators and barriers in diagnosing rheumatoid arthritis as described by general practitioners: a Danish study based on focus group interviews. Scand J Prim Health Care 2021; 39:222-229. [PMID: 33905289 PMCID: PMC8293939 DOI: 10.1080/02813432.2021.1913925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the perspectives of general practitioners (GPs) on facilitators and barriers in diagnosing rheumatoid arthritis (RA). DESIGN Qualitative study based on focus group interviews, and using latent thematic analysis. SETTING General practices from Central Region Denmark. SUBJECTS Eleven GPs participated in three different focus groups. Forty percent were female, the mean age was 53 years (range 37-64), and the mean since medical licensing was 16 years (range 5-23). Sixty percent of the GPs worked in an area served by a university hospital, and 40% were served by a regional hospital. MAIN OUTCOME MEASURE Themes describing experiences and reflections about facilitators and barriers in diagnosing Rheumatoid Arthritis. RESULTS Four themes emerged: (A) If the patient is not a textbook example, (B) The importance of maintaining the gatekeeper function, (C) Difficulties in referral of patients to the rheumatologist, and (D) Laboratory tests-can they be trusted? Barriers were identified in all themes, but facilitators only in A, C, and D. The overarching theme was Like finding a needle in a haystack. CONCLUSION The GPs found several barriers for diagnosing RA (symptom awareness, GP's gatekeeper function, suboptimal collaboration with rheumatologists and limitations in laboratory tests). They identified education, more specific tests and better access to rheumatologists as possible facilitators for diagnosing RA. To facilitate earlier referral of suspected RA in general practice and strengthen mutual information and collaboration, future research should focus on these facilitators and barriers.KeypointsEarly diagnosis is essential for the prognosis of RA, and the diagnostic process begins in general practice.Suggested facilitators: training courses in interpretation of laboratory tests and the clinical manifestation of RA, and videos on joint examinations.Suggested barriers: compliance with the gatekeeper function, suboptimal collaboration with rheumatologists, limitations of laboratory tests, and diversity of clinical manifestations.
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Affiliation(s)
- Anne Sofie Baymler Lundberg
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- Research Unit for General Practice, Department of Public Health, Aarhus University,Aarhus, Denmark
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Ellen Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- CONTACT Annette de Thurah Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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Černíková Anna K, Kráčmarová Klůzová L, Pešoutová M, Tavel P. Patient delay in presenting symptoms of breast cancer in women in the Czech Republic. Klin Onkol 2021; 34:40-48. [PMID: 33657818 DOI: 10.48095/ccko202140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Presenting breast cancer symptoms and seeking medical help is a key element in the dia-gnosis and treatment of this disease. Early presentation of symptoms increases the likelihood of recovery. However, some women do not seek medical attention as soon as they find a symptom and delay a visit to the physician. MATERIAL AND METHODS This study is part of a project based on DIPEx qualitative methodology focused on experience of women with breast cancer. The aim of this article is to explore reasons for the delay of the presentation of breast cancer symptoms to a physician. Fifty-three interviews with women were collected across the Czech Republic. Aiming for maximum variation of the sample, the women represent different age groups, education level, marital status, stages of illness and types of treatment. The DIPEx qualitative methodology was used. The first part of the interview is narrative, followed by a semi-structured part. The interviews were verbatim transcribed for the analysis. The data were analysed using NVivo10 software. Open coding was applied from which the categories were constructed and the themes emerged. We used the OSOP (one sheet of paper) method for a thematic analysis. RESULTS Delay in presenting symptoms to a physician is mainly caused by wrong symptom interpretation, and not considering symptom as serious. In some cases, defence mechanisms are activated and women tend to downplay the symptom. Cognitive distortion is triggered in some women who have experience with such a symptom. Other women tend to prioritize various life events over seeing a physician. Screening tests were perceived positively. CONCLUSIONS Bearing the results in mind, we recommend aiming educational campaigns not only at symptom recognition and the importance of seeking medical help, but also the subsequent steps that need to be taken.
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Alrawashdeh A, Nehme Z, Williams B, Smith K, Stephenson M, Bernard S, Bray J, Stub D. Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction. Eur J Cardiovasc Nurs 2021; 20:243–251. [PMID: 33611404 DOI: 10.1177/1474515120953737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction. METHODS This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011-January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression. RESULTS The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range=17-176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10-11.83; and 8.02; 3.65-17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours. CONCLUSION Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient's decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.
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Affiliation(s)
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Monash University, Australia
| | - Karen Smith
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Michael Stephenson
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia.,Baker IDI Heart and Diabetes Institute, Australia
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Nguyen TTM, Kruyt ND, Pierik JGJ, Doggen CJM, van der Lugt P, Ramessersing SAV, Wijers NT, Brouwers PJAM, Wermer MJH, den Hertog HM. Stroke patient's alarm choice: General practitioner or emergency medical services. Acta Neurol Scand 2021; 143:164-170. [PMID: 32885417 PMCID: PMC7821309 DOI: 10.1111/ane.13341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Objectives Stroke patients should be treated as soon as possible since the benefit of reperfusion therapies is highly time‐dependent. The proportion of patients eligible for reperfusion therapy is still limited, as many patients do not immediately alarm healthcare providers. The choice of healthcare system entrance influences the time of arrival in the hospital. Therefore, we assessed differences in these choices to obtain insight for strategies to reduce time delays in acute stroke patients. Materials and Methods Patients with suspected acute stroke admitted to the participating hospitals received a questionnaire. We assessed differences between patients who initially alarmed the general practitioner (GP) and patients who directly alarmed the emergency medical services (EMS). Additionally, we assessed regional differences and patient trajectories after medical help was sought. Results We included 163 patients. Most patients alarmed the GP as primary healthcare provider (n = 104; 64%), and median onset‐to‐door times were longer in these patients (466 minutes [IQR 149–1586]) compared to patients directly alarming the EMS (n = 59; 36%) (90 minutes [IQR 45–286]). This was even more pronounced in less densely populated areas. Patients who alarmed the GP first, more often had patient delay >15 minutes, hesitated to burden healthcare providers and underestimated symptomatology. Conclusions Our results showed that patients who alarmed the GP first instead of the EMS differed in several factors that are potentially modifiable. Strategies to achieve reduction of vital prehospital time delays and to improve patient outcome are optimizing public awareness campaigns and GP triage along with adjusting current guidelines by enabling and focusing on immediate involvement of the EMS once acute stroke is suspected.
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Affiliation(s)
- T. Truc My Nguyen
- Department of Neurology Leiden University Medical Centre Leiden The Netherlands
| | - Nyika D. Kruyt
- Department of Neurology Leiden University Medical Centre Leiden The Netherlands
| | - Jorien G. J. Pierik
- Department of Transmural Care Medisch Spectrum Twente Enschede The Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology & Services Research and Faculty of Behavioral, Management and Social Sciences Technical Medical Centre Enschede the Netherlands
- Department of Science Rijnstate Arnhem Arnhem The Netherlands
| | | | | | - Naomi T. Wijers
- Department of Neurology Leiden University Medical Centre Leiden The Netherlands
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Tesfaw A, Demis S, Munye T, Ashuro Z. Patient Delay and Contributing Factors Among Breast Cancer Patients at Two Cancer Referral Centres in Ethiopia: A Cross-Sectional Study. J Multidiscip Healthc 2020; 13:1391-1401. [PMID: 33173301 PMCID: PMC7646382 DOI: 10.2147/jmdh.s275157] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background Unlike developed countries, there is high mortality of breast cancer in low- and middle-income countries associated with prolonged patient delays and advanced stage presentations. However, evidence-based information about patient delay in presentation and contributing factors to diagnosis of breast cancer in Ethiopia is scarce. Methods Institution-based cross-sectional study was conducted at oncology units of the University of Gondar and Felege Hiwot specialized hospitals. A total of 371 female breast cancer patients who were newly diagnosed from September 2019 to April 30, 2020 were included. Data were entered using EPI info version 7.2 and analyzed in SPSS version 23. Descriptive statistics was used to summarize socio-demographic and clinical characteristic of the patients. Multivariable logistic regression at a P-value<0.05 significance level was used to identify predictors of patient delay. Results A total of 281 (75.7%) patients had long patient delay of ≥90 days (3 months) with the average patient delay time of 8 months, and advanced stage diagnosis was found on 264 (71.2%) of patients. The median age of patients was 40 years. Rural residence (AOR=3.72; 95% CI=1.82–7.61), illiterate (AOR=3.8; 95% CI=1.71–8.64), having a painless wound (AOR=3.32; 95% CI=1.93, 5.72), travel distance ≥5 km (AOR=1.66; 95% CI=1.09–3.00), having no lump/swelling in the armpit (AOR=6.16; 95% CI=2.80–13.54), and no history of any breast problem before (AOR=2.46; 95% CI=(1.43–4.22) were predictors for long patient delay. Conclusion Long patient delay and advanced stage diagnosis of breast cancer are higher in our study. Travel distance ≥5 km, rural residence, no history of any breast problem before, having no lump/swelling in the arm pit, a painless lump in the breast, and being illiterate were important predictors for patient delay. Therefore, public awareness programs about breast cancer should be designed to prevent patient delay in presentation and to promote early detection of cases before advancement.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Pediatrics and neonatal Nursing, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Comprehensive Nursing, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Zemachu Ashuro
- Dilla University, College of Health Sciences, Dilla, Southern Ethiopia
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Türkkani MH, Özdemir T, Özdilekcan Ç. Determination of related factors about diagnostic and treatment delays in patients with smear-positive pulmonary tuberculosis in Turkey. Turk J Med Sci 2020; 50:1371-1379. [PMID: 32421283 PMCID: PMC7491262 DOI: 10.3906/sag-2001-89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background/aim This study aimed to analyze delays in diagnosis and treatment by defining the related demographic and clinical factors, to reveal obstacles, and to develop essential attempts to help reduce treatment delays. Materials and methods We created a questionnaire on the subject of delays in diagnosis and treatment in tuberculosis (TB) control to be administered to the patients. The forms were distributed to dispensaries across the country by the General Directorate of Public Health via an official letter. Results The study included 853 new patients with smear-positive pulmonary TB. The mean patient delay was 18.06 ± 22.27 days, the mean diagnosis delay was 35.63 ± 34.86 days, and the mean treatment delay was 0.90 ± 2.39 days. We found no association between sex, age, literacy, residential location, the presence of chronic respiratory diseases, and patient delay. It was determined that patient delay was shorter for patients with hemoptysis, fever, dyspnoea, and chest pain. In women, the diagnosis delay was longer than in men. Conclusion In the diagnosis process of patients with tuberculosis, it was determined that there was an improvement in the patient delay; however, the improvement in the diagnosis delay was still not acceptable as an ideal duration.
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Affiliation(s)
| | - Tarkan Özdemir
- Department of Chest Diseases, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Çiğdem Özdilekcan
- Department of Chest Diseases, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Abstract
Introduction The severe acute respiratory syndrome coronavirus 2 (SARS2-CoV-2) induced pandemic (COVID-19 pandemic) has affected healthcare in all aspects, including stroke care. We sought to investigate this effect with analysis of our hospital’s stroke treatment protocols as well as stroke volume on state, regional, and national levels. Methods This was a retrospective review of prospectively collected data from our stroke registry to assess the impact of the SARS2-CoV-2 induced pandemic on the volume of stroke patients presenting to our facility. Demographics collected included age, sex, race, National Institute of Health Stroke Scale (NIHSS) on admission, discharge modified Rankin Score (mRS), type of stroke (ischemic, hemorrhagic, or transient ischemic attack), time of symptom onset, and time to initial imaging. Data were also stratified by date and comparison was made between the intra-COVID-period (March and April 2020), pre-COVID period (March and April 2019), and peri-COVID period (January and February 2020). To determine stroke trends on a national level, we utilized the Get with the Guidelines (GWTG) stroke database to compare stroke volumes in the pre-COVID, peri-COVID, and intra-COVID periods between our hospital, all California hospitals, and the West and Pacific regions. Results There was a significant increase in last known well time (LKWT) to arrival to the emergency department (ED) (LKWT to door) as well as time from arrival to the ED to obtaining a computed tomography (CT) of the head (door to CT) in March 2020 compared to 2019 (p=0.0220 and p=0.0475, respectively). There were significantly fewer transient ischemic attacks (TIAs) in California hospitals as well as in March and April 2020 in comparison to January and February 2020 (p=0.0417). Similarly, there were significantly fewer TIAs in March and April 2019 compared to March and April 2020 (p=0.0360). The decrease in TIAs was also seen at our hospital in both time frame comparisons as well as in West Regional Hospitals in March and April 2020 compared to March and April 2019 (p=0.0111, p=0.0215, and p=0.0414, respectively). Conclusion Stroke care has been disrupted by the COVID-19 pandemic worldwide. We identified a delay in LKWT to door as well as time from door to CT in March 2020 compared to March 2019 at our institution. There was a statistically significant decrease in final diagnosis of TIA at our hospital, all California hospitals, and all West Regional hospitals during the March-April 2020 window, suggesting that some patients with minor stroke symptoms may not be presenting to the hospital in the midst of the pandemic. Strategies to minimize delays in care and maximize functional recovery must continue to evolve as new challenges are met during the COVID-19 pandemic.
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Affiliation(s)
- Hammad Ghanchi
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Ariel Takayanagi
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Paras Savla
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Omid R Hariri
- Neurosurgery, Kaiser Permanente-Orange County, Anaheim, USA
| | - Emilio C Tayag
- Neurology and Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Michael Schiraldi
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.,Neurosurgery, Redlands Community Hospital, Redlands, USA
| | - Lucille Jorgensen
- Stroke Program Coordinator, Arrowhead Regional Medical Center, Colton, USA
| | - Dan E Miulli
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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Getnet F, Demissie M, Worku A, Gobena T, Tschopp R, Seyoum B. Longer Delays in Diagnosis and Treatment of Pulmonary Tuberculosis in Pastoralist Setting, Eastern Ethiopia. Risk Manag Healthc Policy 2020; 13:583-594. [PMID: 32607026 PMCID: PMC7306477 DOI: 10.2147/rmhp.s258186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose This study aimed to assess the extent of patient, health system and total delays in diagnosis and treatment of pulmonary tuberculosis (TB) in Somali pastoralist setting, Ethiopia. Patients and Methods A cross-sectional study among 444 confirmed new pulmonary TB patients aged ≥15 years in 5 TB care units was conducted between December 2017 and October 2018. Data were collected using a structured questionnaire and record review. We measured delays from symptom onset to provider visit, provider visit to diagnosis and diagnosis to treatment initiation. Delays were summarized using median days. Mann–Whitney and Kruskal–Wallis tests were used to compare delays between categories of explanatory variables. The Log-binomial regression model was used to reveal factors associated with health system delay ≥15 days, presented in adjusted prevalence ratio (APR) with 95% confidence interval (CI). Results The median age of patients was 30 years, ranged from 15 to 82. The majority (62.4%) were male, and nearly half (46.4%) were pastoralists. The median patient, health system and total delays were 30 (19–48.5), 14 (4.5–29.5) and 50 (35–73.5) days, respectively. The median patient delay (35.5 days) and total delay (58.5 days) among pastoralists were substantially higher than the equivalent delays among non-pastoralists [p<0.001]. Of all, 3.8% of patients (16 of 18 were pastoralists) delayed longer than 6 months without initiating treatment. Factors associated with health system delay ≥15 days were mild symptoms [APR (95% CI) = 1.4 (1.1–1.7)], smear-negativity [APR (95% CI) = 1.2 (1.01–1.5)], first visit to health centers [APR (95% CI) = 1.6 (1.3–2.0)] and multiple provider contacts [APR (95% CI) = 5.8 (3.5–9.6)]. Conclusion Delay in diagnosis and treatment remains a major challenge of tuberculosis control targets in pastoralist settings of Ethiopia. Efforts to expand services tailored to transhumance patterns and diagnostic capacity of primary healthcare units need to be prioritized.
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Affiliation(s)
- Fentabil Getnet
- College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia.,School of Public Health, Haramaya University, Harar, Ethiopia
| | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- School of Public Health, Haramaya University, Harar, Ethiopia
| | - Rea Tschopp
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Jánosi A, Csató G, Pach FP, Guti S, Pápai G, Erdős G, Fontos G, Andréka P. [Emergency care of patients with myocardial infarction: from the onset of symptoms until opening the vessel]. Orv Hetil 2020; 161:458-467. [PMID: 32172587 DOI: 10.1556/650.2020.31679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction and aim: The authors analyse emergency care data for 6878 patients treated for acute myocardial infarction (AMI) using data from the Hungarian Myocardial Infarction Registry (HUMIR) and the National Ambulance Service (NAS). Method: Patients received treatment between 01/01/2017 and 31/12/2018, and all patients underwent percutaneous coronary intervention (PCI): 47.5% of patients had ST-elevation myocardial infarction (STEMI) and 3614 patients (52.5%) had non-ST-elevation myocardial infarction. The time between the beginning of the complaint and notification of NAS was regarded as the patient delay (PD). The time from the notification of NAS until arrival on the scene (M1), that of the on-site care (M2) and of the transport from the scene to the hospital (M3) were recorded. In-hospital care was evaluated from admission until opening the vessel ("door to balloon time"). The results were also broken down by counties. The median values and the quartiles (Q1, Q3) were given when the time was reported. Results: Patient delay in both types of infarction was unfavourably long: 101 minutes for STEMI and 687 minutes for NSTEMI. Immediate ambulance action was recorded in 58.7% for STEMI patients and 43.7% for NSTEMI patients. In both types of myocardial infarction, the median M1 time was 13 minutes, on-site care (M2) was 23 minutes, and M3 time was 30 minutes. In patients treated for STEMI, the time from hospital admission until opening the infarct-related artery was 37 minutes, and the total ischemic time was 243 minutes. In 9.5% of STEMI patients, the infarct-related artery was opened within 2 hours, in 49.1% within 4 hours, and in 88.1% within 12 hours. Significant differences were found between the counties for each of the periods examined. Conclusions: The PD is currently the biggest problem in providing optimal care timely for myocardial infarction patients. There are significant regional differences in rescue times, and further analysis is needed to investigate the causes. Orv Hetil. 2020; 161(12): 458-467.
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Affiliation(s)
- András Jánosi
- Nemzeti Szívinfarktus Regiszter,Gottsegen György Országos Kardiológiai IntézetBudapest, Haller u. 29., 1096
| | | | | | | | | | | | - Géza Fontos
- Nemzeti Szívinfarktus Regiszter,Gottsegen György Országos Kardiológiai IntézetBudapest, Haller u. 29., 1096
| | - Péter Andréka
- Nemzeti Szívinfarktus Regiszter,Gottsegen György Országos Kardiológiai IntézetBudapest, Haller u. 29., 1096
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Deolia SG, Kela KS, Sawhney IM, Sonavane PA, Nimbulkar G, Reche A. Evaluation of oral health care seeking behavior in rural population of central India. J Family Med Prim Care 2020; 9:886-891. [PMID: 32318440 PMCID: PMC7114035 DOI: 10.4103/jfmpc.jfmpc_990_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives To study the perception regarding common oral diseases and health seeking behaviour related to those diseases among rural population of central India. Methods A cross sectional study was conducted in the rural areas of Wardha, Maharashtra on a population between the age group of 18 and above. Data was recorded by a self administered, structured questionnaire in this study. Questionnaire was based on oral health literacy and health seeking behaviour of participants. Results Study included 700 participants, 343 males and 347 females. Dental problem was reported by 68% of participants. Toothache was the most common dental problem reported. Government hospitals were chosen by 19% of participants as treatment centre. Fear 24.3% was found to be the major reason for not visiting the dentist. Conclusion Healthcare seeking behaviour among rural population towards oral diseases was poor. So efforts must be made to bring a change in this scenario.
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Affiliation(s)
- Shravani G Deolia
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
| | - Koyal S Kela
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
| | - Ishita M Sawhney
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
| | - Priyanka A Sonavane
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
| | - Gargi Nimbulkar
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
| | - Amit Reche
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
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Pakka J, Holm J, Börjesson AM, Halldin CB, Paoli J. Neglected Basal Cell Carcinoma With Fatal Outcome. Dermatol Pract Concept 2019; 9:295-296. [PMID: 31723464 DOI: 10.5826/dpc.0904a09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 10/31/2022] Open
Affiliation(s)
- Jenna Pakka
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joanna Holm
- Department of Dermatology and Venereology, Uddevalla Hospital, Uddevalla, Sweden
| | - Annika M Börjesson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina B Halldin
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Getnet F, Demissie M, Worku A, Gobena T, Seyoum B, Tschopp R, Andersen CT. Determinants of Patient Delay in Diagnosis of Pulmonary Tuberculosis in Somali Pastoralist Setting of Ethiopia: A Matched Case-Control Study. Int J Environ Res Public Health 2019; 16:E3391. [PMID: 31547479 DOI: 10.3390/ijerph16183391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
Abstract
Background: Healthcare-seeking behavior is the basis to ensure early diagnosis and treatment of tuberculosis (TB) in settings where most cases are diagnosed upon self-presentation to health facilities. Yet, many patients seek delayed healthcare. Thus, we aimed to identify the determinants of patient delay in diagnosis of pulmonary TB in Somali pastoralist area, Ethiopia. Methods: A matched case-control study was conducted between December 2017 and October 2018. Cases were self-presented and newly diagnosed pulmonary TB patients aged ≥ 15 years who delayed > 30 days without healthcare provider consultation, and controls were patients with similar inclusion criteria but who consulted a healthcare provider within 30 days of illness; 216 cases sex-matched with 226 controls were interviewed using a pre-tested questionnaire. Hierarchical analysis was done using conditional logistic regression. Results: After multilevel analysis, pastoralism, rural residence, poor knowledge of TB symptoms and expectation of self-healing were individual-related determinants. Mild-disease and manifesting a single symptom were disease-related, and >1 h walking distance to nearest facility and care-seeking from traditional/religious healers were health system-related determinants of patient delay > 30 days [p < 0.05]. Conclusion: Expansion of TB services, mobile screening services, and arming community figures to identify and link presumptive cases can be effective strategies to improve case detection in pastoral settings.
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Nymark C, Henriksson P, Mattiasson AC, Saboonchi F, Kiessling A. Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction. Eur J Cardiovasc Nurs 2019; 18:512-520. [PMID: 31132880 DOI: 10.1177/1474515119844654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking. AIM To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay. METHODS A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis. RESULTS The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay (P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour. CONCLUSION Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.
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Affiliation(s)
- Carolin Nymark
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
| | - Peter Henriksson
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
| | | | - Fredrik Saboonchi
- 3 Karolinska Institutet, Department of Clinical Neuroscience, Sweden.,4 The Red Cross University College, Stockholm, Sweden
| | - Anna Kiessling
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
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Duan W, Zhang W, Wu C, Wang Q, Yu Y, Lin H, Liu Y, Hu D. Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study. BMJ Open 2019; 9:e026638. [PMID: 30975682 PMCID: PMC6500361 DOI: 10.1136/bmjopen-2018-026638] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the extent and associations of patient/diagnostic delay and other potential factors with catastrophic health expenditure (CHE) for tuberculosis (TB) care in Chongqing municipality, China. DESIGN A cross-sectional study. SETTING Four counties of Chongqing municipality, China. PARTICIPANTS A total of 1199 patients with active pulmonary TB beyond 16 years and without mental disorders were consecutively recruited in the four counties' designated TB medical institutions. OUTCOME MEASURES The incidence and intensity of CHE for TB care were described. The association between patients' 'sociodemographic and clinical characteristics such as patient delay, diagnostic delay, forms of TB, health insurance status and hospitalisation and CHE were analysed using univariate and multivariate logistic regression. RESULTS The incidence of CHE was 52.8% and out-of-pocket (OOP) payments were 93% of the total costs for TB care. Compared with patients without delay, the incidence and intensity of CHE were higher in patients who had patient delay or diagnostic delay. Patients who experienced patient delay or diagnostic delay, who was a male, elderly (≥60 years), an inhabitant, a peasant, divorced/widow, the New Cooperative Medical Scheme membership had greater risks of incurring CHE for TB care. Having a higher educational level appeared to be a protective factor. However, hospitalisation was not associated with CHE after controlling for other variables. CONCLUSION The incidence and intensity of CHE for TB care are high, which provides baseline data about catastrophic costs that TB-related households faced in Chongqing of China. Variety of determinants of CHE implicate that it is essential to take effective measures to promote early seeking care and early diagnosis, improve the actual reimbursement rates of health insurance, especially for outpatients, and need more fine-tuned interventions such as precise poverty alleviation to reduce catastrophic costs of the vulnerable population.
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Affiliation(s)
- Weixia Duan
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
- The center of Laboratory Medicine, Chongqing Occupational Diseases Prevention Hospital, Chongqing, China
| | - Wen Zhang
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Chengguo Wu
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Qingya Wang
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Ya Yu
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Hui Lin
- Department of Epidemiology, The Third Military Medical University, Chongqing, China
| | - Ying Liu
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Daiyu Hu
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
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Abstract
While the prognosis for early-stage oral cavity cancer is relatively good; the majority of patients are still diagnosed with advanced-stage disease on presentation with an associated poorer prognosis. The aims of this review are to summarize our current understanding of delays in oral cavity cancer and their impact on stage at diagnosis and survival. The delays pathway can be subdivided into three components: patient, professional, and treatment delays. Patient delay represents the longest interval in the delays pathway usually lasting between 2 and 5 months and being most influenced by cognitive and psychosocial factors. Professional and treatment delays are shorter in most studies, but highly variable depending on the respective healthcare system. Most studies indicate that advanced stage at diagnosis, primary treatment with radiotherapy, treatment at an academic center, and transitions in care are associated with an increased treatment delay. Based on our current understanding, a delay between definitive diagnosis and treatment of 4-6 weeks seems acceptable from an oncologic perspective. Further studies are needed to better define what a 'safe' waiting time is and to understand the psychological impact of delays for patients.
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Affiliation(s)
- J Gigliotti
- Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Madathil
- Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - N Makhoul
- Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
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Stack RJ, Nightingale P, Jinks C, Shaw K, Herron-Marx S, Horne R, Deighton C, Kiely P, Mallen C, Raza K. Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. BMJ Open 2019; 9:e024361. [PMID: 30837252 PMCID: PMC6429945 DOI: 10.1136/bmjopen-2018-024361] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis. METHODS Newly presenting adults with either RA or unclassified arthritis were recruited from rheumatology clinics. Data on the length of time between symptom onset and first seeing a GP (patient delay), between first seeing a general practitioner (GP) and being referred to a rheumatologist (general practitioner delay) and being seen by a rheumatologist following referral (hospital delay) were captured. RESULTS 822 patients participated (563 female, mean age 55 years). The median time between symptom onset and seeing a rheumatologist was 27.2 weeks (IQR 14.1-66 weeks); only 20% of patients were seen within the first 3 months following symptom onset. The median patient delay was 5.4 weeks (IQR 1.4-26.3 weeks). Patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not. In addition, those with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset. The median general practitioner delay was 6.9 weeks (IQR 2.3-20.3 weeks). Patients made a mean of 4 GP visits before being referred. The median hospital delay was 4.7 weeks (IQR 2.9-7.5 weeks). CONCLUSION This study identified delays at all levels in the pathway towards assessment by a rheumatologist. However, delays in primary care were particularly long. Patient delay was driven by the nature of symptom onset. Complex multi-faceted interventions to promote rapid help seeking and to facilitate prompt onward referral from primary care should be developed.
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Affiliation(s)
| | - Peter Nightingale
- Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Karen Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Rob Horne
- UCL School of Pharmacy, UCL, London, UK
| | - Chris Deighton
- Department of Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Patrick Kiely
- Department of Rheumatology, St Georges University Hospital NHS Foundation Trust, London, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Shi Y, Yang D, Chen S, Wang S, Li H, Ying J, Zhang M, Li Y, Xing Z, Sun J. Factors influencing patient delay in individuals with haemorrhoids: A study based on theory of planned behavior and common sense model. J Adv Nurs 2018; 75:1018-1028. [PMID: 30375030 DOI: 10.1111/jan.13900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/31/2018] [Accepted: 10/02/2018] [Indexed: 01/21/2023]
Abstract
AIMS This study aimed to describe the status of patient delay and examine related factors affecting patient delay in individuals with haemorrhoids in mainland China, based on theory of planned behaviour and common sense model. BACKGROUND Studies on patient delay have mainly focused on cancer, tuberculosis and myocardial infarction, but studies on patient delay in individuals with haemorrhoids have yet to be conducted. Compared with other diseases, haemorrhoids are initially considered benign. However, if patients with haemorrhoids seek delayed medical assistance, they pay a large cost for worse symptoms because they fail to seek timely treatments compared with those who receive appropriate treatments at early stages. DESIGN A cross-sectional study design was used. METHODS The current study was performed on 306 patients with haemorrhoids from June - October 2017. Data were collected via a self-administered pencil-and-paper survey that consisted of a multi-item questionnaire. Stepwise logistic regression analysis was conducted to explore the factors of patient delay. RESULTS Middle-aged participants were more than twice more likely to report patient delay than participants in other age groups. A high level of perceived self-efficacy, a high level of illness perceptions and perceived social impact were associated with prolonged delay. CONCLUSION This study showed that patient delay is common among patients with haemorrhoids in China. The influencing factors of patient delay were middle-aged, illness perceptions, perceived self-efficacy, and perceived social impact.
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Affiliation(s)
- Ying Shi
- School of Nursing, Jilin University, Changchun, People's Republic of China.,Hubei University of Medicine, Shiyan, People's Republic of China
| | - Dongliang Yang
- Cangzhou Medical College, Cangzhou, People's Republic of China
| | - Si Chen
- The First Bethune Hospital of Jilin University, Changchun, People's Republic of China
| | - Shouqi Wang
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Huanhuan Li
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Jie Ying
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Meiling Zhang
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Yuan Li
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Zhuangjie Xing
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, People's Republic of China
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Abstract
OBJECTIVE For many individuals with Lyme disease, prompt treatment leads to rapid resolution of infection. However, severe complications can occur if treatment is delayed. Our objective was to identify themes around belated diagnosis or treatment of Lyme disease using the General Model of Total Patient Delay (GMTPD). DESIGN We conducted a qualitative interview study using indepth telephone interviews. SETTING Participants were patients from a large, integrated health system in the state of Pennsylvania, USA. PARTICIPANTS There were 26 participants. Participants had to have a diagnosis of Lyme disease between 2014 and 2017 and a positive IgG western blot. We used a stratified purposeful sampling design to identify patients with and without late Lyme disease manifestations. To ensure variation in care experiences, we oversampled patients diagnosed outside of primary care. OUTCOME MEASURES We asked participants about their experience from first Lyme disease symptoms to treatment. We applied an iterative coding process to identify key themes and then synthesised codes into higher order codes representing the GMTPD stages: appraisal delay (symptom to recognition of illness); illness delay (inferring illness to deciding to seek help); behavioural delay (deciding to seek help to the act of seeking help); scheduling delay (seeking help to attending an appointment); and treatment delay (attending appointment to treatment). RESULTS Appraisal delay themes included symptom misattribution, intermittent symptoms and misperceptions about the necessity of a bull's-eye rash. Health insurance status was a driver of illness and behavioural delays. Scheduling delay was not noted by participants, in part, because 10 of the 26 patients went to urgent care or emergency department settings. Misdiagnoses were more common in these settings, contributing to treatment delay. CONCLUSION Our study identified potentially modifiable risk factors for belated treatment. Targeting these risk factors may minimise time to treatment and reduce the occurrence of preventable complications.
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Affiliation(s)
- Annemarie G Hirsch
- Department of Epidemiology and Health Services Research, Geisinger, Danville, Pennsylvania, USA
| | | | - Alison Rebman
- Department of Medicine, Division of Rheumatology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John Aucott
- Department of Medicine, Division of Rheumatology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Christopher Heaney
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian S Schwartz
- Department of Epidemiology and Health Services Research, Geisinger, Danville, Pennsylvania, USA
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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50
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Yonemoto N, Kada A, Yokoyama H, Nonogi H. Public awareness of the need to call emergency medical services following the onset of acute myocardial infarction and associated factors in Japan. J Int Med Res 2018; 46:1747-1755. [PMID: 29490526 PMCID: PMC5991256 DOI: 10.1177/0300060518757639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Early recognition of acute myocardial infarction (AMI) and early activation of emergency medical services (EMS) are essential to reduce delays in patient care. We investigated public awareness of the need to call EMS at onset of AMI and evaluated associated factors. Methods In January 2008, a nationwide population-based survey using quota sampling was conducted in Japan. The primary outcome measure was responsiveness to promptly calling EMS at AMI onset, subdivided by on-time (daytime) and off-time (nights and holidays) hours. Results In total, 1200 participants were surveyed. Their mean age was 46.3 years (standard deviation, 17.4), and 50.3% (n=604) were women. A total of 11.6% (n=139) answered that they would call EMS during on-time hours, and 27.5% (n=330) stated that they would call during off-time hours. Multivariable analysis showed that the participants’ age, female sex, education level, and self-confidence regarding their understanding of AMI were significant associated factors. The associated factors were almost identical during the off-time hours; only sex was no longer significant. Conclusions Public awareness of the need to call EMS at AMI onset in Japan was low. Previous intervention studies that were not effective may not have targeted groups with significant risk factors.
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Affiliation(s)
- Naohiro Yonemoto
- 1 Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Akiko Kada
- 2 Department of Clinical Trial and Research, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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