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Dickson-Swift V, Adams J, Spelten E, Blackberry I, Wilson C, Yuen E. Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review. BMC Womens Health 2024; 24:256. [PMID: 38658945 PMCID: PMC11040767 DOI: 10.1186/s12905-024-03094-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available. METHODS All original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners). The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken. RESULTS A total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making. CONCLUSION The results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.
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Affiliation(s)
- Virginia Dickson-Swift
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia
| | - Joanne Adams
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia.
| | - Evelien Spelten
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia
| | - Irene Blackberry
- Care Economy Research Institute, La Trobe University, Wodonga, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
- Melbourne School of Population and Global Health, Melbourne University, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Eva Yuen
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
- Institute for Health Transformation, Deakin University, Burwood, Australia
- Centre for Quality and Patient Safety, Monash Health Partnership, Monash Health, Clayton, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Bongaerts THG, Büchner FL, Nierkens V, Crone MR, Guicherit OR, Numans ME. Perceptions and beliefs of general practitioners on their role in the cancer screening programmes in the Netherlands: a mixed-methods study. BMC Prim Care 2024; 25:129. [PMID: 38658815 PMCID: PMC11040810 DOI: 10.1186/s12875-024-02394-5] [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: 08/18/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND In the Netherlands, population-based cancer screening programmes (CSPs) are organized aiming at cervical, breast and colorectal cancer. For a CSP to be effective, high participation rates are essential; however, there is an alarming downward trend, including wide regional variation in screening uptake. General practitioner (GP) involvement can have a stimulating effect on screening participation. Current GP involvement is however, limited, varies between the programmes and has changed over time. Unexplored is what GPs think of their role(s) in the CSPs. The aim of this study was therefore to map the perceptions and beliefs of GPs regarding their current and future role in the Dutch CSPs. METHODS A mixed-methods sequential explanatory study was conducted in the Leiden/The Hague area of the Netherlands, between the end of 2021 and 2022. A questionnaire was developed and distributed among 110 GPs. The aggregated results obtained from the questionnaires served as starting points for conducting semi-structured interviews, with purposefully selected GPs. With this sequential approach we aimed to further enhance the understanding of the questionnaire data, and delved into the topics that emerged from the questionnaire responses. RESULTS In total, 46 GPs completed the online questionnaire (response rate 42%). Subsequent five semi-structured comprehensive interviews were conducted. GPs indicated that they frequently encounter the CSP in their daily practice and consider it important. They also emphasised it is important that GPs remain closely involved with the CSPs in the future. Nevertheless, GPs also repeatedly mentioned that they are not eager to take on more logistical/organizational tasks. They are however willing to empower CSPs in a positive manner. CONCLUSION GPs were generally positive about the CSPs and their current role within these programmes. Nevertheless, several options have been proposed to improve the CSPs, especially to increase screening uptake for populations in a socioeconomically disadvantaged position. Since it is of utmost importance to screen those who are most at risk of developing the screening-specific tumours, efforts should be made to achieve this goal.
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Affiliation(s)
- Thomas H G Bongaerts
- Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Frederike L Büchner
- Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Matty R Crone
- Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Onno R Guicherit
- University Cancer Center Leiden - The Hague, Haaglanden Medical Center, The Hague, the Netherlands
| | - Mattijs E Numans
- Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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O'Donnell N, Waller J, Marlow L, Anderson NC, McBride E. "Knowing that I had HPV, I literally just shut down": A qualitative exploration of the psychosocial impact of human papillomavirus (HPV) in women living with mental health conditions. Br J Health Psychol 2024; 29:80-94. [PMID: 37658582 DOI: 10.1111/bjhp.12688] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/09/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Psychological distress after testing positive for human papillomavirus (HPV) at cervical cancer screening is well documented in the general population. However, little is known about the impact of an HPV-positive result on those with pre-existing mental health conditions, who may be at higher risk of experiencing clinically significant distress. This study explored the psychosocial impact of HPV in women with co-morbid mental health conditions, as well as their experience of cervical screening during the COVID-19 pandemic. METHODS Semi-structured telephone interviews were conducted with 22 women aged 27-54 who had tested positive for HPV at routine cervical screening in England, and who reported having at least one mental health condition. Data were analysed using thematic analysis. RESULTS Being informed of an HPV-positive result increased distress and heightened pre-existing psychological challenges. Psychosocial response and duration of HPV-related distress appeared to be influenced by the ability to regulate emotions, number of consecutive HPV-positive results, interactions with health care professionals, and other life stressors. The experience added further complexity to many women's perceptions of self and self-esteem. Women who had received psychological treatment for their mental health condition were best able to self-manage HPV-related distress by applying learned coping skills. CONCLUSIONS Receiving an HPV-positive result at cervical screening appears to be a distressing experience for women with co-morbid mental health conditions. Future hypothesis-driven research is needed to confirm findings and develop effective interventions to reduce psychosocial burden.
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Affiliation(s)
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London (KCL), London, UK
| | - Laura Marlow
- School of Cancer and Pharmaceutical Sciences, King's College London (KCL), London, UK
| | | | - Emily McBride
- Institute of Psychology, Psychiatry and Neuroscience (IoPPN), King's College London (KCL), London, UK
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Abdi HI, Nagler RH, Fowler EF, Gollust SE. Effects of exposure to media messages about limiting breast cancer screening: A qualitative experimental study. Patient Educ Couns 2023; 117:107988. [PMID: 37778162 DOI: 10.1016/j.pec.2023.107988] [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: 12/07/2022] [Revised: 05/31/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Examine how women aged 35-50 respond to messages about limiting cancer screening. METHODS A national sample of women aged 35-50 (n = 983) were randomly assigned to read one of four media vignettes: three provided information about potential harms of mammograms using evidence, norms, or an anecdote strategy, and one provided no such information. Participants listed thoughts they had about the message, and after coding these themes, we tested for associations between the themes evoked, message exposure, and mammogram history. RESULTS Thematic categories included emotions (8 %); behavioral intentions (14 %); and cognitions, attitudes, and beliefs (67 %). Pro-screening attitudes, questioning, and cues to get screened were most prevalent. The anecdote message often elicited pro-screening attitudes, while the evidence message often elicited negative emotions and anger, as well as questioning or skeptical responses. Those with a history of mammograms expressed more pro-screening attitudes and disagreed with the message more often. CONCLUSIONS Media messaging about guideline-supported care, especially when it involves reducing a clinical service that is routine and valued by patients, may evoke counterarguing, skepticism, and other negative responses. PRACTICE IMPLICATIONS Clinicians should recognize the role of the media in potentially shaping women's attitudes, beliefs, and intentions when it comes to breast cancer screening.
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Affiliation(s)
- Hamdi I Abdi
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Rebekah H Nagler
- Hubbard School of Journalism and Mass Communication, University of Minnesota College of Liberal Arts, 206 Church St SE, Minneapolis, MN 55455, USA
| | - Erika Franklin Fowler
- Department of Government, Wesleyan University, 318 High Street, Middletown, CT 06459, USA
| | - Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN 55455, USA
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Harris E. Many Older People Disagree With Life Expectancy-Based Cancer Screening. JAMA 2023; 330:1612. [PMID: 37851483 DOI: 10.1001/jama.2023.19803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
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Mantula F, Toefy Y. Women and health providers' perspectives on male support for cervical cancer screening in Gwanda district, Zimbabwe. PLoS One 2023; 18:e0282931. [PMID: 37824479 PMCID: PMC10569579 DOI: 10.1371/journal.pone.0282931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/05/2023] [Indexed: 10/14/2023] Open
Abstract
Several studies have shown that male involvement increases the uptake of sexual and reproductive health programmes for improved family health outcomes. The role of men in reducing the burden of cervical cancer has however not been researched in Zimbabwe. It is for this reason that this study explores male support for cervical cancer screening programmes from the perspective of women and health providers in the Gwanda district of Zimbabwe. A qualitative approach that engaged thirty-six women aged 25-50 years in focus group discussions, and twenty-five health providers with different roles in the cervical cancer screening programme in in-depth interviews was used to determine their perspectives on male support for cervical cancer screening. Data were analysed thematically using ATLAS.ti Computer Assisted Qualitative data analysis software. Key findings reflected that men lacked knowledge on cervical cancer and its risk factors and prevention. Subsequently, they engaged in sexual behaviours that increased their partners' risk of acquiring Human Papillomavirus infection, the virtually necessary cause of cervical cancer. Furthermore, men did not provide the necessary emotional and financial support for their women to access screening and treatment. Participants were optimistic that innovative awareness creation strategies and intense, sustained cervical cancer education efforts targeting men could increase male partner support. Involvement of community leaders was seen as crucial in the facilitation of male involvement for programme acceptance and improved uptake of cervical cancer screening. Male involvement is seen as an integral component of the cervical cancer prevention and control programme that has to be implemented in Gwanda district to minimise male partner-related barriers to cervical cancer screening. Further research focusing on men is required to identify specific knowledge gaps that would enable development of appropriate strategies that best involve men in cervical cancer prevention and control interventions.
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Affiliation(s)
- Fennie Mantula
- Department of Global Health, Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
- Department of Nursing and Midwifery, Faculty of Medicine, National University of Science and Technology, Bulawayo, Zimbabwe
| | - Yoesrie Toefy
- Department of Global Health, Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
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Bea VJ, An A, Gordon AM, Antoine FS, Wiggins PY, Hyman D, Robles-Rodriguez E. Mammography screening beliefs and barriers through the lens of Black women during the COVID-19 pandemic. Cancer 2023; 129:3102-3113. [PMID: 37691521 DOI: 10.1002/cncr.34644] [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: 08/05/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 09/12/2023]
Abstract
BACKGROUND Mammography is an effective screening tool that leads to decreased breast cancer mortality, yet minority women continue to experience barriers. The coronavirus disease 2019 (COVID-19) pandemic has been proven to have negatively affected minority communities, yet its effect on mammography screening habits in Black women is uncertain. The purpose of this study was to evaluate breast cancer mammography screening habits and barriers for Black women in two northeast communities amid the COVID-19 pandemic. METHODS The study participants were Black women aged 40 years or older who were recruited from community outreach initiatives. Study coordinators conducted telephone surveys to determine mammography screening behaviors, perceptions, and psychosocial factors. RESULTS Two hundred seventy-seven surveys were completed. Two hundred fifty-six patients who reported ever having a mammogram became the study population of interest. One hundred seventy-four of these patients (68%) reported having a mammogram within the past year (nondelayed), and 82 (32%) had a mammogram more than a year ago (delayed). Only thirty-one of the delayed participants (37.8%) had private insurance. There was a significant difference in the mean score for mammography screening perceived barriers for nondelayed participants (mean = 9.9, standard deviation [SD] = 3.6) versus delayed participants (mean = 11.2, SD = 4.3, p = .03). There was also a significant difference in the mean score when they were asked, "How likely is it that 'other health problems would keep you from having a mammogram'?" (p = .002). CONCLUSIONS Barriers to mammography screening for Black women during the COVID-19 era include insurance, competing health issues, and perceptions of screening. Community outreach efforts should concentrate on building trust and collaborating with organizations to improve screening despite the COVID-19 pandemic.
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Affiliation(s)
- Vivian J Bea
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Anjile An
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Ashley M Gordon
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Francesse S Antoine
- Division of General Internal Medicine, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | | | - Diane Hyman
- MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA
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Thomsen MK, Jørgensen MD, Pedersen L, Erichsen R, Sørensen HT, Mikkelsen EM. Mental disorders, participation, and trajectories in the Danish colorectal cancer programme: a population-based cohort study. Lancet Psychiatry 2023; 10:518-527. [PMID: 37353263 DOI: 10.1016/s2215-0366(23)00179-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND People with mental disorders exhibit increased mortality due to colorectal cancer, despite having a similar incidence to the general population. We aimed to evaluate the extent to which people with mental disorders participate in organised colorectal cancer screening. METHODS We conducted a population-based cohort study of all Danish residents aged 50-74 years who were invited to undergo biennial faecal immunochemical testing between March 1, 2014, and Sept 30, 2018. We used national registry data from all first-time invitees. The primary endpoint was participation within 90 days of invitation. We calculated the proportion who participated and assessed their screening results and adherence to and completeness of follow-up colonoscopy according to their history of mental disorders, classified as none, mild or moderate, or severe. We computed crude and adjusted participation differences in percentage points and participation ratios using the pseudo-observations method. FINDINGS Of 2 036 704 people who were invited, we included 2 036 352 in the final cohort, of whom 1 008 045 (49·5%) were men and 1 028 307 (50·5%) were women, with a mean age of 60·7 years (SD 8·3, range 49-78). Data on ethnicity were not collected. Compared with people with no mental disorders, the adjusted analysis showed lower participation among people with mild or moderate mental disorders (men: participation difference -4·4 percentage points [95% CI -4·7 to -4·1]; women: -3·8 percentage points [-4·1 to -3·6]) and severe mental disorders (men: participation difference -13·8 percentage points [-14·3 to -13·3]; women: -15·4 percentage points [-15·8 to -14·9]). People with mental disorders had a higher proportion of positive faecal immunochemical test results, lower adherence to colonoscopy, and more incomplete colonoscopies than people without mental disorders. INTERPRETATION People with mental disorders were less likely to participate in colorectal cancer screening than those without these disorders. Patients with mental disorders could benefit from support or encouragement from their general practitioner or mental health-care facility to participate in cancer screening. Potential interventions should consider type of mental disorder, as needs might differ. FUNDING Danish Cancer Society, Danish Health Foundation.
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Affiliation(s)
- Mette Kielsholm Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; CASTLE - Cancer Survivorship and Treatment Late Effects, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Dahl Jørgensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
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Matovu JKB, Wagner GJ, Juncker M, Namisango E, Bouskill K, Nakami S, Beyeza-Kashesya J, Luyirika E, Wanyenze RK. Mediators and moderators of the effect of the game changers for cervical cancer prevention intervention on cervical cancer screening among previously unscreened social network members in Uganda. BMC Cancer 2023; 23:428. [PMID: 37170099 PMCID: PMC10173559 DOI: 10.1186/s12885-023-10924-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/06/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Cervical cancer (CC) rates are high in Uganda, yet CC screening rates are very low. Our peer advocacy group intervention, Game Changers for Cervical Cancer Prevention (GC-CCP), was shown to increase CC screening uptake among social network members. In this secondary analysis, we examined mediators and moderators of this effect to better understand how and for whom the intervention was most successful in promoting CC screening. METHODS We conducted a pilot randomized controlled trial of GC-CCP in Namayingo district, Eastern Uganda between September 2021 and April 2022. Forty adult women who had screened for CC in the past year (index participants) enrolled at baseline: 20 were randomized to receive the 7-session intervention to empower women to engage in CC prevention advocacy, and 20 were assigned to the waitlist control; from these index participants, 103 unscreened social network members (alters) also enrolled. All participants were assessed at baseline and month 6 follow-up. Change in cognitive and behavioral CC-related constructs from baseline to month 6 were examined as mediators, using multivariate linear regression analysis. Index and alter demographics and index CC treatment status were examined as moderators. RESULTS Increased alter engagement in CC prevention advocacy fully mediated the intervention effect on alter uptake of CC screening, and was associated with an increased likelihood of alter CC screening. CC treatment status of the index participant was the sole moderator of the intervention effect, as those in the intervention group who had screened positive and received treatment for pre-cancerous lesions were more likely to have alters who got screened for CC by month 6. CONCLUSION The effect of GC-CCP on alter CC screening is greater when the alter reports increased engagement in her own advocacy for CC prevention with others. The intervention effects on increased engagement in CC prevention advocacy among both index and alter participants suggest a diffusion of advocacy, which bodes well for dissemination of knowledge and screening activation throughout a network and the larger community.
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Affiliation(s)
- Joseph KB Matovu
- School of Public Health, Makerere University, Kampala, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | | | | | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | | | | | - Jolly Beyeza-Kashesya
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
- School of Medicine, Makerere University, Kampala, Uganda
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Mangione CM, Barry MJ, Nicholson WK, Cabana M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Stevermer J, Wong JB. Serologic Screening for Genital Herpes Infection: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA 2023; 329:502-507. [PMID: 36786784 DOI: 10.1001/jama.2023.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
IMPORTANCE Genital herpes is a common sexually transmitted infection caused by 2 related viruses, herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2). Infection is lifelong; currently, there is no cure for HSV infection. Antiviral medications may provide clinical benefits to symptomatic persons. Transmission of HSV from a pregnant person to their infant can occur, most commonly during delivery; when genital lesions or prodromal symptoms are present, cesarean delivery can reduce the risk of transmission. Neonatal herpes infection is uncommon yet can result in substantial morbidity and mortality. OBJECTIVE To reaffirm its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update on targeted key questions to systematically evaluate the evidence on accuracy, benefits, and harms of routine serologic screening for HSV-2 infection in asymptomatic adolescents, adults, and pregnant persons. POPULATION Adolescents and adults, including pregnant persons, without known history, signs, or symptoms of genital HSV infection. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that the harms outweigh the benefits for population-based screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons. RECOMMENDATION The USPSTF recommends against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons. (D recommendation).
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Affiliation(s)
| | | | | | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Chan Medical School, Worcester
| | | | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Shin HY, Kang P, Song SY, Jun JK. Understanding of Cervical Screening Adoption among Female University Students Based on the Precaution Adoption Process Model and Health-Belief Model. Int J Environ Res Public Health 2022; 20:700. [PMID: 36613020 PMCID: PMC9819152 DOI: 10.3390/ijerph20010700] [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] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to identify the decisional stages for cervical screening and corresponding cognitive factors in female university students. A cross-sectional study was conducted among Korean female university students aged 20-29 years through an online survey. The main outcome was the decisional stage of cervical screening adoption using the precaution adoption process model. The stages were classified into pre-adoption (the unawareness, unengaged, and undecided stages), adoption (the decided to act and acting stages), and refusal (the decided not to act stage). The cognitive factors in each stage were analyzed using the key concepts of the health-belief model. Cervical screening was defined as a clinical Papanicolaou (Pap) smear performed by a physician in a clinic. The final analysis included 1024 students. Approximately 89.0%, 1.0%, and 10.2% were classified as the pre-adoption, refusal, and adoption stages, respectively. Compared to the pre-adoption stage group, the adoption stage group was more likely to be older and have higher self-efficacy and knowledge. Most participants belonged to the pre-adoption stage-those unaware of cervical screening. Furthermore, most had a low level of knowledge and perception of cervical cancer and its screening. Therefore, our study highlighted the need for education to increase awareness and knowledge of cervical screening in this population.
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Affiliation(s)
- Hye Young Shin
- Department of Nursing, Gangseo University, Seoul 07661, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea
| | - Purum Kang
- College of Nursing, Woosuk University, Wanju 55338, Republic of Korea
| | - Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Republic of Korea
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Optimizing the implementation of lung cancer screening in Scotland: Focus group participant perspectives in the LUNGSCOT study. Health Expect 2022; 25:3246-3258. [PMID: 36263948 PMCID: PMC9700133 DOI: 10.1111/hex.13632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Targeted lung cancer screening is effective in reducing lung cancer and all-cause mortality according to major trials in the United Kingdom and Europe. However, the best ways of implementing screening in local communities requires an understanding of the population the programme will serve. We undertook a study to explore the views of those potentially eligible for, and to identify potential barriers and facilitators to taking part in, lung screening, to inform the development of a feasibility study. METHODS Men and women aged 45-70, living in urban and rural Scotland, and either self-reported people who smoke or who recently quit, were invited to take part in the study via research agency Taylor McKenzie. Eleven men and 14 women took part in three virtual focus groups exploring their views on lung screening. Focus group transcripts were transcribed and analysed using thematic analysis, assisted by QSR NVivo. FINDINGS Three overarching themes were identified: (1) Knowledge, awareness and acceptability of lung screening, (2) Barriers and facilitators to screening and (3) Promoting screening and implementation ideas. Participants were largely supportive of lung screening in principle and described the importance of the early detection of cancer. Emotional and psychological concerns as well as system-level and practical issues were discussed as posing barriers and facilitators to lung screening. CONCLUSIONS Understanding the views of people potentially eligible for a lung health check can usefully inform the development of a further study to test the feasibility and acceptability of lung screening in Scotland. PATIENT OR PUBLIC CONTRIBUTION The LUNGSCOT study has convened a patient advisory group to advise on all aspects of study development and implementation. Patient representatives commented on the focus group study design, study materials and ethics application, and two representatives read the focus group transcripts.
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Affiliation(s)
- Debbie Cavers
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Mia Nelson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Jasmin Rostron
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
- Present address:
The National Institute of Economic and Social Research2 Dean Trench Street, London NW1P 3HEUK
| | - Kathryn A. Robb
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Christine Campbell
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Ahsan R. Akram
- Centre for Inflammation Research and Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Graeme Dickie
- Care of the Usher InstituteUniversity of Edinburgh, EdinburghEdinburghUK
| | | | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | | | - Robert J. Steele
- School of Medicine, Ninewells HospitalUniversity of DundeeDundeeUK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - David Weller
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
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Olson RE, Goldsmith L, Winter S, Spaulding E, Dunn N, Mander S, Ryan A, Smith A, Marshall HM. Emotions and lung cancer screening: Prioritising a humanistic approach to care. Health Soc Care Community 2022; 30:e5259-e5269. [PMID: 35894098 PMCID: PMC10947369 DOI: 10.1111/hsc.13945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 06/12/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Low-dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long-term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality-especially for female smokers-limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening.
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Affiliation(s)
- Rebecca E. Olson
- School of Social ScienceThe University of QueenslandSt LuciaQueenslandAustralia
| | | | - Sara Winter
- School of Applied PsychologyGriffith UniversityMt GravattQueenslandAustralia
| | | | - Nicola Dunn
- The Prince Charles HospitalChermsideQueenslandAustralia
| | - Sarah Mander
- Psychology DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Alyssa Ryan
- Cancer Care ServicesThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Alexandra Smith
- School of Social ScienceThe University of QueenslandSt LuciaQueenslandAustralia
| | - Henry M. Marshall
- University of Queensland Thoracic Research Centre and Department of Thoracic MedicineThe Prince Charles HospitalChermsideQueenslandAustralia
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Fawns-Ritchie C, Miller CB, van der Pol M, Douglas E, Bell D, O'Carroll RE, Deary IJ. Psychological correlates of free colorectal cancer screening uptake in a Scottish sample: a cross-sectional observational study. BMJ Open 2022; 12:e042210. [PMID: 35105557 PMCID: PMC8808413 DOI: 10.1136/bmjopen-2020-042210] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Colorectal cancer (CRC) screening uptake in Scotland is 56%. This study examined whether psychological factors were associated with CRC screening uptake. DESIGN Cross-sectional observational study. SETTING This study used data from the Healthy AGeing In Scotland (HAGIS) pilot study, a study designed to be representative of Scottish adults aged 50 years and older. PARTICIPANTS 908 (505 female) Scottish adults aged 50-80 years (mean age=65.85, SD=8.23), who took part in the HAGIS study (2016-2017). PRIMARY AND SECONDARY OUTCOME MEASURES Self-reported participation in CRC screening was the outcome measure. Logistic regression was used to test whether scores on measures of health literacy, cognitive ability, risk aversion, time preference (eg, present oriented or future oriented) and personality were associated with CRC screening when these psychological factors were entered individually and simultaneously in the same model. RESULTS Controlling for age, age-squared, sex, living arrangement, and sex*living arrangement, a one-point increase in risk aversion (OR=0.66, 95% CI 0.51 to 0.85) and present orientation (OR=0.86, 95% CI 0.80 to 0.94) was associated with reduced odds of screening. Higher scores on health literacy (OR per one-point increase=1.20, 95% CI 1.09 to 1.31), cognitive ability (OR per SD increase=1.51, 95% CI 1.25 to 1.81) and the intellect personality trait (OR per one-point increase=1.05, 95% CI 1.01 to 1.09) were associated with increased odds of screening. Higher risk aversion was the only psychological variable that was associated with CRC screening participation when all psychological variables were entered in the same model and remained associated with CRC screening when additionally adjusting for deprivation and education. A backward elimination model retained two psychological variables as correlates of CRC screening: risk aversion and cognitive ability. CONCLUSION Individuals who are more risk averse are less likely to participate in free, home CRC screening.
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Affiliation(s)
| | | | | | - Elaine Douglas
- Division of Economics, University of Stirling, Stirling, UK
| | - David Bell
- Division of Economics, University of Stirling, Stirling, UK
| | | | - Ian J Deary
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
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15
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Htay MNN, Dahlui M, Schliemann D, Cardwell CR, Loh SY, Ibrahim Tamin NSB, Somasundaram S, Donnelly M, Su TT. Changing Health Beliefs about Breast Cancer Screening among Women in Multi-Ethnic Malaysia. Int J Environ Res Public Health 2022; 19:1618. [PMID: 35162641 PMCID: PMC8835215 DOI: 10.3390/ijerph19031618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023]
Abstract
This study evaluated the impact of the 'Be Cancer Alert' mass media campaign for breast cancer (BCAC-BC) in terms of changes to women's health beliefs regarding BC susceptibility and the benefits and barriers of breast cancer screening in Malaysia. Pre- and post-campaign surveys evaluated changes in health beliefs among women aged 40 years and above (n = 676). The perceived susceptibility to breast cancer was significantly higher at follow-up (mean ± SD: 7.30 ± 2.77 vs. 7.63 ± 2.58, p = 0.008) whereas the mean score for the perceived benefits of undertaking screening was high at baseline and follow-up (16.34 ± 2.36 vs. 15.95 ± 2.07, p = 0.001). The perceptions or beliefs about barriers to screening did not change significantly (31.70 ± 8.26 vs. 31.77 ± 7.63, p = 0.841). Regression analyses indicated that mean scores for the barriers subscale were significantly lower among Chinese women (-2.61, 95% CI -4.67, -0.55, p = 0.013) compared to Malay, and among single compared to married women (-2.40, 95% CI -4.60, -0.21, p = 0.032) after adjustment for other demographic variables and past screening history. Malaysian women appeared to already have positive perceptions before the BCAC-BC mass media campaign about the benefits of BC screening. However, the campaign appeared to be linked to both an increased awareness of the susceptibility to breast cancer and to positive beliefs that countered emotional barriers to screening, particularly among single women and Chinese-Malay women.
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Affiliation(s)
- Mila Nu Nu Htay
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Department of Community Medicine, Manipal University College Malaysia, Manipal Academy of Higher Education (MAHE), Melaka 75150, Malaysia
| | - Maznah Dahlui
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Désirée Schliemann
- Centre for Public Health and UKCRC, Centre of Excellence for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK; (D.S.); (C.R.C.); (M.D.)
| | - Christopher R. Cardwell
- Centre for Public Health and UKCRC, Centre of Excellence for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK; (D.S.); (C.R.C.); (M.D.)
| | - Siew Yim Loh
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | | | | | - Michael Donnelly
- Centre for Public Health and UKCRC, Centre of Excellence for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK; (D.S.); (C.R.C.); (M.D.)
| | - Tin Tin Su
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- South East Asia Community Observatory (SEACO) and Global Public Health, Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia
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Dagan M, Dinh DT, Stehli J, Zaman S, Brennan A, Tan C, Liew D, Reid CM, Stub D, Kaye DM, Lefkovits J, Duffy SJ. Impact of Age and Sex on Treatment and Outcomes Following Myocardial Infarction. J Am Coll Cardiol 2021; 78:1934-1936. [PMID: 34736569 DOI: 10.1016/j.jacc.2021.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
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O'Shea R, Rankin NM, Kentwell M, Gleeson M, Tucker KM, Hampel H, Taylor N, Lewis S. Stakeholders' views of integrating universal tumour screening and genetic testing for colorectal and endometrial cancer into routine oncology. Eur J Hum Genet 2021; 29:1634-1644. [PMID: 33811254 PMCID: PMC8560784 DOI: 10.1038/s41431-021-00871-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022] Open
Abstract
Mainstream genetic testing in routine oncology care requires implementation research to inform intervention design. In Australia, funding is available for oncology health professionals (OHP) to organise genetic testing (GT) for eligible colorectal and endometrial cancer patients as part of their routine care. To assess the health system ability to incorporate this practice change, we conducted an implementation survey using the Consolidated Framework for Implementation Research (CFIR). The online survey was available from April to September 2020 to OHP and genetic health professional (GHP). In total, 198 respondents attempted the survey, with 158 completed and 27 partial responses: 26% were GHP, 66% OHP and 8% pathologists. Of all responders, 50% were female, mainly practicing in public hospital settings (57%) in an urban location (80%) and with an 18-60 years plus age range. The majority of respondents saw the relative advantage of aligning GT to abnormal universal tumour screening (UTS) results, with 77% of GHP and 78% of OHP agreeing it would streamline care for patients. There was disagreement across healthcare professional groups about knowledge and self-efficacy, with 45% of GHP not viewing oncologists as 'feeling confident' to use genetic test results for treatment management decisions, while 62% of OHP felt confident in their ability. Both OHP and GHP's indicated embedding a genetic counsellor in oncology or having a genetics point of contact to support integrating of GT through UTS as favourable interventions. Implementation research findings allow for the design of targeted interventions and a model for GT integration into oncology.
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Affiliation(s)
- Rosie O'Shea
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Nicole M Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Maira Kentwell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Oncology, Royal Women's Hospital Parkville, Melbourne, VIC, Australia
| | | | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Heather Hampel
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Natalie Taylor
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Research Division, Cancer Council, Sydney, NSW, Australia
| | - Sarah Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Smith J, Dodd RH, Gainey KM, Naganathan V, Cvejic E, Jansen J, McCaffery KJ. Patient-Reported Factors Associated With Older Adults' Cancer Screening Decision-making: A Systematic Review. JAMA Netw Open 2021; 4:e2133406. [PMID: 34748004 PMCID: PMC8576581 DOI: 10.1001/jamanetworkopen.2021.33406] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Decisions for older adults (aged ≥65 years) and their clinicians about whether to continue to screen for cancer are not easy. Many older adults who are frail or have limited life expectancy or comorbidities continue to be screened for cancer despite guidelines suggesting they should not; furthermore, many older adults have limited knowledge of the potential harms of continuing to be screened. OBJECTIVE To summarize the patient-reported factors associated with older adults' decisions regarding screening for breast, prostate, colorectal, and cervical cancer. EVIDENCE REVIEW Studies were identified by searching databases from January 2000 to June 2020 and were independently assessed for inclusion by 2 authors. Data extraction and risk of bias assessment were independently conducted by 2 authors, and then all decisions were cross-checked and discussed where necessary. Data analysis was performed from September to December 2020. FINDINGS The search yielded 2475 records, of which 21 unique studies were included. Nine studies were quantitative, 8 were qualitative, and 4 used mixed method designs. Of the 21 studies, 17 were conducted in the US, and 10 of 21 assessed breast cancer screening decisions only. Factors associated with decision-making were synthesized into 5 categories: demographic, health and clinical, psychological, physician, and social and system. Commonly identified factors associated with the decision to undergo screening included personal or family history of cancer, positive screening attitudes, routine or habit, to gain knowledge, friends, and a physician's recommendation. Factors associated with the decision to forgo screening included being older, negative screening attitudes, and desire not to know about cancer. Some factors had varying associations, including insurance coverage, living in a nursing home, prior screening experience, health problems, limited life expectancy, perceived cancer risk, risks of screening, family, and a physician's recommendation to stop. CONCLUSIONS AND RELEVANCE Although guidelines suggest incorporating life expectancy and health status to inform older adults' cancer screening decisions, older adults' ingrained beliefs about screening may run counter to these concepts. Communication strategies are needed that support older adults to make informed cancer screening decisions by addressing underlying screening beliefs in context with their perceived and actual risk of developing cancer.
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Affiliation(s)
- Jenna Smith
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael H. Dodd
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Karen M. Gainey
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kirsten J. McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Kue J, Szalacha LA, Rechenberg K, Nolan TS, Menon U. Communication Among Southeast Asian Mothers and Daughters About Cervical Cancer Prevention. Nurs Res 2021; 70:S73-S83. [PMID: 34173374 PMCID: PMC8527390 DOI: 10.1097/nnr.0000000000000531] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Southeast Asian women have high rates of cervical cancer and yet are among the least likely to be screened. There is sparse literature on communication patterns among Southeast Asian women, specifically related to cervical cancer and Pap test uptake. Little is known about the influence of Southeast Asian mothers and daughters on each other's cervical cancer beliefs and screening behaviors. OBJECTIVES We examined the perceptions of and barriers to cervical cancer screening among Cambodian and Lao mothers and daughters and explored how they converse about women's health issues, specifically cervical cancer and Pap testing. METHODS We conducted in-depth interviews with Cambodian and Lao mother-daughter dyads, aged 18 years and older, living in a large Midwestern city between February and September of 2015. Descriptive statistics were calculated to summarize the sample demographic characteristics. Bivariate tests (contingency table analyses, independent t-tests, and Pearson correlations) were conducted to test for differences between the mothers and daughters in demographic characteristics and measures of health status and beliefs. Qualitative data were analyzed using content analysis. RESULTS In-depth interviews were conducted with three Cambodian and eight Lao mother-daughter dyads. The daughters were significantly more acculturated to English, had greater education, and were mostly employed full time. The mothers and daughters evaluated their health status much the same, their medical mistrust equally, and all of the mothers and nine of the daughters were Buddhist. Themes in mother-daughter communication included what mothers and daughters do and do not talk about with regard to sexual health, refugee experiences, what hinders mother-daughter communication, and relationship dynamics. The mothers were embarrassed and uncomfortable discussing cervical cancer, Pap testing, and other women's health issues with their daughters. Although mothers did not influence women's health promotion or cervical cancer prevention with their daughters, daughters did influence their mothers' health and healthcare decisions. Daughters were critical in navigating healthcare systems, engaging with providers, and making medical decisions on behalf of their mothers. DISCUSSION By leveraging the unique and dynamic intergenerational bond that mothers and daughters who identify as Southeast Asian have, we can develop strategies to influence the cultural dialogue related to cervical cancer and early detection.
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Gopalan HS, Haque I, Ahmad S, Gaur A, Misra A. Education and screening for obesity, hypertension, and diabetes (including gestational diabetes) "at the doorstep" of women from nine underprivileged urban areas in Delhi National Capital Region. Diabetes Metab Syndr 2021; 15:102209. [PMID: 34314922 DOI: 10.1016/j.dsx.2021.102209] [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] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Women in underprivileged urban areas have poor access to health and education, making them vulnerable to non-communicable diseases (NCDs), specifically diabetes. The current project has sought to focus on this group, to educate and screen this population to prevent and manage obesity and diabetes. METHODS The project was conducted in 9 underprivileged areas of Delhi NCR using a mobile van unit. Women from these areas were invited for health education (this included talks, lectures and distribution of Information, Education & Communication material), screening {anthropometric, blood glucose and blood pressure (BP) measurements} diet counselling sessions and referral of subjects with uncontrolled blood glucose. RESULTS Baseline survey on knowledge of diabetes and nutrition showed low awareness. Health education sessions (n, 46) included face-to-face discussion and problem solving and distribution of simple pictorial leaflets (n, 3000). The health education sessions were well accepted. In total, 4% women (n,3175/91000- total population, 3056 non-pregnant, 119 pregnant) participated in the research trial. Among non-pregnant women, an average weight gain of 11.8 kg between the ages of 20-40 years was observed. The average BMI and waist circumference (WC) was 26.8 ± 5.3 kg/m2 and 91.1 ± 13.2 cm, respectively in non-pregnant women. Further, 75.3.0% (2207/2928) and 96.7% (2875/2971) of the non-pregnant women had overweight/obesity and abdominal obesity, respectively. In the non-pregnant women, 21.7% had known diabetes. Further, 7.4% non-pregnant women and 2.5% pregnant women were identified as having hyperglycaemic state. Hypertension was observed in 11.9% pregnant women and 49.9% of non-pregnant women. CONCLUSION Extremely high prevalence of obesity, along with diabetes and hypertension in underprivileged urban women requires intensive individualised and group health education, screening, and counselling "at the doorsteps", as has been shown in our model.
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Affiliation(s)
- Hema S Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India
| | - Intazaamul Haque
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India
| | - Shamshad Ahmad
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India
| | - Ashok Gaur
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India
| | - Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India; Diabetes Foundation (India), New Delhi, 110016, India; Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B 16, Chirag Enclave, New Delhi, India.
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Osuagwu UL, Sharma S, Silva D, Saunders J, Pillay J, Piya MK, Simmons D. Assessment of diabetes knowledge, screening and uptake of community diabetes programs in a peri-urban region in Australia. Diabetes Metab Syndr 2021; 15:102257. [PMID: 34425557 DOI: 10.1016/j.dsx.2021.102257] [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: 03/16/2021] [Revised: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
AIMS The Wollondilly Diabetes Program (WDP) is testing ways to improve uptake of diabetes prevention services. This project evaluated the reach of WDP in diabetes promotion while assessing diabetes knowledge and risk among residents. METHODS A WDP member travelled in the DW weekly to community events including outreach programs between October 2016 and June 2019. Data from diabetes knowledge questionnaire (DKQ), the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), HbA1c and Random Blood Glucose (RBG) measurements obtained from participants who attended community events and road shows. RESULTS Over the 32 months period, WDP attended 32 community events reaching 1415 people (∼3% of the Wollondilly adult population). DKQ was completed by 154 people (52.9% females, 78% Australian born, median age 69 years), 39% had diabetes and their mean score (25.0 ± 3.1, maximum possible score = 31) was similar to those without diabetes (24.0 ± 4.6, p = 0.093). AUSDRISK assessment was completed by 166 people with 85% at intermediate or high risk of diabetes. There were 65% results above range for RBG (≥5.5 mmol/l) and/or HbA1c (≥5.7%,39 mmol/mol). CONCLUSION A community outreach team set up in partnership with local stakeholders that offers opportunistic diabetes screening, is an effective way of engaging with the community to increase diabetes awareness and knowledge.
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Affiliation(s)
- Uchechukwu Levi Osuagwu
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560 Australia.
| | - Suryansh Sharma
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Dilan Silva
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - James Saunders
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Jayeshwari Pillay
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Milan K Piya
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Campbelltown Hospital, Campbelltown, NSW, 2560, Australia.
| | - David Simmons
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Campbelltown Hospital, Campbelltown, NSW, 2560, Australia.
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Harper DM, Tariq M, Alhawli A, Syed N, Patel M, Resnicow K. Cancer risk perception and physician communication behaviors on cervical cancer and colorectal cancer screening. eLife 2021; 10:e70003. [PMID: 34427182 PMCID: PMC8384416 DOI: 10.7554/elife.70003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Women 50-65 years of age have the lowest cervical and colorectal cancer (CRC) screening rates among ages recommended for screening. The primary aim of this work is to determine how cancer risk perceptions and provider communication behaviors, in addition to known demographic factors, influence the uptake of both cervical and CRC screening or a single screen among women in southeast Michigan. Methods Fourteen health services and communication behavior questions were adapted from the Health Information National Trends Survey (HINTS) and administered to a multiethnic sample of adults in southeast Michigan. The outcome variable was self-reported up-to-date cervical cancer and/or CRC screening as defined by the United States Preventive Services Task Force (USPSTF). Demographic and cancer risk/communication behavior responses of the four screening populations (both tests, one test, no tests) were analyzed with multinomial regression for all comparisons. Results Of the 394 respondents, 54% were up to date for both cervical and CRC screening, 21% were up to date with only cervical cancer screening and 12% were up to date for only CRC screening. Of the 14 risk perception and communication behavior questions, only 'Did your primary care physician (PCP) involve you in the decisions about your health care as much as you wanted?' was significantly associated with women having both screens compared to only cervical cancer screening (aOR 1.67; 95% CI: 1.08, 2.57). The multivariate model showed age, and Middle East and North African (MENA) ethnicity and Black race, in addition to PCP-patient dyad decision-making to be associated with the cancer screenings women completed. Conclusions Optimizing PCP-patient decision-making in health care may increase opportunities for both cervical cancer and CRC screening either in the office or by self-sampling. Understanding the effects of age and the different interventional strategies needed for MENA women compared to Black women will inform future intervention trials aimed to increase both cancer screenings. Funding This work was supported by NIH through the Michigan Institute for Clinical and Health Research UL1TR002240 and by NCI through The University of Michigan Rogel Cancer Center P30CA046592-29-S4 grants.
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Affiliation(s)
- Diane M Harper
- Department of Family Medicine, University of Michigan School of MedicineAnn ArborUnited States
- Department of Obstetrics & Gynecology, University of Michigan School of MedicineAnn ArborUnited States
- Department of Women’s Studies, University of Michigan, College of Literature, Science and the ArtsAnn ArborUnited States
| | - Madiha Tariq
- Arab Community Center for Economic and Social Services (ACCESS)DearbornUnited States
| | - Asraa Alhawli
- Arab Community Center for Economic and Social Services (ACCESS)DearbornUnited States
| | - Nadia Syed
- Arab Community Center for Economic and Social Services (ACCESS)DearbornUnited States
| | - Minal Patel
- Department of Health Behavior & Health Education, University of Michigan School of PublicAnn ArborUnited States
- Outreach and Health Disparities Research, University of Michigan Rogel Cancer CenterAnn ArborUnited States
| | - Ken Resnicow
- Outreach and Health Disparities Research, University of Michigan Rogel Cancer CenterAnn ArborUnited States
- Center for Health Communications Research, University of Michigan, School of Public HealthAnn ArborUnited States
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Facciorusso A, Demb J, Mohan BP, Gupta S, Singh S. Addition of Financial Incentives to Mailed Outreach for Promoting Colorectal Cancer Screening: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2122581. [PMID: 34432010 PMCID: PMC8387849 DOI: 10.1001/jamanetworkopen.2021.22581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Although screening decreases incidence of and mortality from colorectal cancer (CRC), screening rates are low. Health-promoting financial incentives may increase uptake of cancer screening. OBJECTIVE To evaluate the relative and absolute benefit associated with adding financial incentives to the uptake of CRC screening. DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to July 31, 2020. Keywords and Medical Subject Headings terms were used to identify published studies on the topic. The search strategy identified 835 studies. STUDY SELECTION Randomized clinical trials (RCTs) were selected that involved adults older than 50 years who were eligible for CRC screening, who received either various forms of financial incentives along with mailed outreach or no financial incentives but mailed outreach and reminders alone, and who reported screening completion by using recommended tests at different time points. Observational or nonrandomized studies and a few RCTs were excluded. DATA EXTRACTION AND SYNTHESIS The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Data were abstracted and risk of bias was assessed by 2 independent reviewers. Random-effects meta-analysis was conducted, heterogeneity was examined through subgroup analysis and metaregression, and quality of evidence was appraised. MAIN OUTCOMES AND MEASURES The primary outcome was CRC screening completion within 12 months of receiving the intervention. RESULTS A total of 8 RCTs that were conducted in the United States and reported between January 1, 2014, and December 31, 2020, were included. The trials involved 110 644 participants, of whom 53 444 (48.3%) were randomized to the intervention group (received financial incentives) and 57 200 (51.7%) were randomized to the control group (received no financial incentives). Participants were predominantly male, with 59 113 men (53.4%). Low-quality evidence (rated down for risk of bias and heterogeneity) suggested that adding financial incentives may be associated with a small benefit of increasing CRC screening vs no financial incentives (odds ratio [OR], 1.25; 95% CI, 1.05-1.49). With mailed outreach having a 30% estimated CRC screening completion rate, adding financial incentives may increase the rate to 33.5% (95% CI, 30.8%-36.2%). On metaregression, the magnitude of benefit decreased as the proportion of participants with low income and/or from racial/ethnic minority groups increased. No significant differences were observed by type of behavioral economic intervention (fixed amount: OR, 1.26 [95% CI, 1.05-1.52] vs lottery: OR, 1.06 [95% CI, 0.80-1.40]; P = .32), amount of incentive (≤$5: OR, 1.09 [95% CI, 1.01-1.18] vs >$5: OR, 1.25 [95% CI, 1.02-1.54]; P = .22), or screening modality (stool-based test: OR, 1.14 [95% CI, 0.92-1.41] vs colonoscopy: OR, 1.63 [95% CI, 1.01-2.64]; P = .18). CONCLUSIONS AND RELEVANCE Adding financial incentives appeared to be associated with a small benefit of increasing CRC screening uptake, with marginal benefits in underserved populations with adverse social determinants of health. Alternative approaches to enhancing CRC screening uptake are warranted.
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Affiliation(s)
| | - Joshua Demb
- Moores Cancer Center, University of California at San Diego, La Jolla
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City
| | - Samir Gupta
- Moores Cancer Center, University of California at San Diego, La Jolla
- Section of Gastroenterology, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Gastroenterology, University of California at San Diego, La Jolla
| | - Siddharth Singh
- Division of Gastroenterology, University of California at San Diego, La Jolla
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Pentecost R, Schmidt K, Grassley JS. Health Care Providers' Perceived Barriers to Screening for Substance Use During Pregnancy. Nurs Womens Health 2021; 25:272-277. [PMID: 34146524 DOI: 10.1016/j.nwh.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/07/2021] [Accepted: 05/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore health care providers' perceived barriers to conducting standardized screening processes for substance use during pregnancy. DESIGN Descriptive survey. SETTING/LOCAL PROBLEM A health system in the northwestern United States where there was a lack of consistent substance use screening in prenatal clinics. PARTICIPANTS A convenience sample of 12 women's health care providers from two hospitals in the health system, including obstetricians/gynecologists, women's health nurse practitioners, women's health physician assistants, and certified nurse-midwives. INTERVENTION/MEASUREMENTS We created a 16-item questionnaire that identified potential barriers to screening, such as education/resources for providers, screening tools, referral processes, legal implications, patient relations, and infrastructure. RESULTS A majority (n = 8, 66.7%) of participants indicated they had received adequate training regarding substance use during pregnancy and felt comfortable asking pregnant women about their substance use. All (n = 12, 100%) providers indicated that women would feel safe disclosing their substance use but might feel offended if their provider asked them about it. Although most reported screening women for substance use, they did not use a consistent screening tool or process. Participants identified lack of time, legal concerns, and lack of access to resources for referrals as other barriers to screening. CONCLUSION Clinicians perceive barriers to screening for substance use during pregnancy, and they may be unaware of legal implications for patients related to perinatal substance use. Identifying barriers to universal screening may facilitate development of best practices related to counseling patients about substance use during pregnancy.
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Ng DY, Tudor Car L, Ng MJM, Lu J, Leung J, Goo TT, Chia CLK. Identifying barriers to early presentation in patients with locally advanced breast cancer (LABC) in Northern Singapore: Qualitative study. PLoS One 2021; 16:e0252008. [PMID: 34032802 PMCID: PMC8148318 DOI: 10.1371/journal.pone.0252008] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/07/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Breast cancer is the leading cause of death in Singaporean women, with advanced stage rendering a poorer prognosis. This study aims to explore the barriers to early presentation, information needs and sources in patients with locally advanced breast cancer (LABC). MATERIALS & METHODS A convenience sample of patients who presented with locally advanced breast cancer to the Department of General Surgery in a teaching tertiary hospital were recruited for the study. We conducted semi-structured interviews face to face with the recruited patients. We recorded the interviews, transcribed them verbatim and analysed using thematic content analysis. RESULTS Twenty-three participants were recruited of which 12 were Chinese and 11 were Malay women. Mean age was 60 years (± 13 SD). The most common knowledge barrier resulting in delay was the misconception that a breast lump must be painful to be malignant. Other knowledge barriers include the lack of knowledge and misinformation from the internet or other social media platforms. Some perceived barriers include fear of diagnosis, fear of treatment and fear of imposing financial burden on family members. A significant proportion of participants were also not aware of a national breast screening programme. CONCLUSIONS Our study has found that barriers to early presentation of women with locally advanced breast cancer remain similar and have persisted over the years despite targeted efforts. There is a need for a rethink of existing strategies and to develop new innovative ways to reach out to this group of patients.
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Affiliation(s)
- Ding Yi Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorraine Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Marcus Jia Ming Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Junde Lu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Joelle Leung
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Tiong Thye Goo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
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Mehta SJ, Day SC, Norris AH, Sung J, Reitz C, Wollack C, Snider CK, Shaw PA, Asch DA. Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial. BMJ 2021; 373:n1022. [PMID: 34006604 PMCID: PMC8129827 DOI: 10.1136/bmj.n1022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965. DESIGN Pragmatic randomized controlled trial. SETTING 43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020. PARTICIPANTS Patients born between 1945 and 1965 with no history of screening and at least two primary care visits in the two years before the enrollment period. INTERVENTIONS This multilevel trial was divided into two studies. Substudy A included 1656 eligible patients of 17 primary care clinicians who were randomized in a 1:1 ratio to a mailed letter about HCV screening (letter only), or a similar letter with a laboratory order for HCV screening (letter+order). Substudy B included the remaining 19 837 eligible patients followed by 417 clinicians. Active electronic patient portal users were randomized 1:5 to receive a mailed letter about HCV screening (letter), or an electronic patient portal message with similar content (patient portal); inactive patient portal users were mailed a letter. In a factorial design, patients in substudy B were also randomized 1:1 to receive standard content (usual care), or content based on principles of social norming, anticipated regret, reciprocity, and commitment (behavioral content). MAIN OUTCOME MEASURES Proportion of patients who completed HCV testing within four months. RESULTS 21 303 patients were included in the intention-to-treat analysis. Among the 1642 patients in substudy A, 19.2% (95% confidence interval 16.5% to 21.9%) completed screening in the letter only arm and 43.1% (39.7% to 46.4%) in the letter+order arm (P<0.001). Among the 19 661 patients in substudy B, 14.6% (13.9% to 15.3%) completed screening with usual care content and 13.6% (13.0% to 14.3%) with behavioral science content (P=0.06). Among active patient portal users, 17.8% (16.0% to 19.5%) completed screening after receiving a letter and 13.8% (13.1% to 14.5%) after receiving a patient portal message (P<0.001). CONCLUSIONS Opt out framing and effort reduction by including a signed laboratory order with outreach increased screening for HCV. Behavioral science messaging content did not increase uptake, and mailed letters achieved a greater response rate than patient portal messages. TRIAL REGISTRATION ClinicalTrials.gov NCT03712553.
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Affiliation(s)
- Shivan J Mehta
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan C Day
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne H Norris
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica Sung
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Reitz
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin Wollack
- Information Services, Penn Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher K Snider
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela A Shaw
- Department of Clinical Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA
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Malih N, Sohrabi MR, Abadi A, Arshi S. Determinants of Adherence to Diabetes Screening in Iranian Adults With a Positive Family History of Diabetes. J Prev Med Public Health 2021; 54:190-198. [PMID: 34092065 PMCID: PMC8190546 DOI: 10.3961/jpmph.20.496] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/14/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Insufficient evidence exists regarding factors that affect screening adherence among people with a family history of diabetes, who comprise roughly half of all patients with diabetes. Therefore, we aimed to identify the determinants of diabetes screening adherence in adults with a family history of diabetes who had not yet been diagnosed with diabetes. METHODS This cross-sectional study was conducted at selected urban primary healthcare facilities in Tehran, Iran. The study population was clinically non-diabetic adults above 20 years of age with a family history of diabetes in at least 1 first-degree relative. All eligible people identified on randomly-selected days of the month were invited to join the study. RESULTS Among 408 participants, 128 (31.4%) had received a fasting blood glucose check during the last year. Using binary logistic regression, the independent predictors of screening adherence were knowledge of adverse effects of diabetes such as sexual disorders (odds ratio [OR], 3.05) and renal failure (OR, 2.73), the impact of family members' advice on receiving diabetes screening (OR, 2.03), recommendation from a healthcare provider to have a fasting blood glucose check (OR, 2.61), and intention to have a fasting blood glucose check within the next 6 months (OR, 2.85). Other variables that predicted screening adherence were age (OR, 1.05), job (being a housekeeper; OR, 3.39), and having a college degree (OR, 3.55). CONCLUSIONS Knowledge of the adverse effects of diabetes, physicians' and healthcare providers' advice about the benefits of early disease detection, and family members' advice were independent predictors of screening adherence.
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Affiliation(s)
- Narges Malih
- Social Determinants of Health Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Sohrabi
- Social Determinants of Health Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abadi
- Social Determinants of Health Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahnam Arshi
- Social Determinants of Health Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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28
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Ohanyan A, Noack J, Hümmelgen M, Löwe B, Kohlmann S. Investigating patients´ views on screening for depression in cardiac practice: A qualitative interview study. J Psychosom Res 2021; 144:110419. [PMID: 33765518 DOI: 10.1016/j.jpsychores.2021.110419] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Recommendations on screening for depression in patients with coronary heart disease (CHD) are highly debated. While recent research has prioritized efficacy studies, little is known about what is potentially required for screening to be efficacious. Expanding our knowledge of how patients with CHD view screening is likely to pose a first step towards addressing this gap. We aimed to investigate patients ́ views on routine screening for depression in cardiac practice. METHODS This exploratory, qualitative study was conducted among 12 patients with CHD, who completed semi-structured interviews. We used a purposive sampling strategy to include patients within a range of ages, gender and self-reported depression. Thematic analysis was carried out. RESULTS We identified four main themes: Acceptance, utility, barriers and expectations. Patients in this sample appeared to be in favor of standardized routine screening for depression in cardiac practice, if the rationale was disclosed. Patients reported that standardized screening addresses holistic care demands, promotes validation of individual symptom burden and legitimizes the display of psychological distress in cardiac practice. Yet, skepticism towards the validity of screening instruments and perceived stigmatization could pose a main barrier to screening efficacy. Patients expected to receive feedback on results and consecutive recommendations. CONCLUSION We found that depression screening is endorsed by patients with CHD in this study sample. Standardized routine screening procedures could serve as a useful tool to combat stigmatization, and encourage patients to display symptoms of depression towards cardiologists. The efficacy of depression screening could potentially be enhanced by tailoring the screening process towards patients´ needs.
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Affiliation(s)
- Ani Ohanyan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Jan Noack
- Cardiologicum Hamburg, Hamburg, Germany
| | | | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Sebastian Kohlmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
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29
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Devine K, Mitchell AL. Cervical screening in women with classic congenital adrenal hyperplasia: uptake and barriers. BMJ Sex Reprod Health 2021; 47:153-154. [PMID: 33229400 DOI: 10.1136/bmjsrh-2020-200868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kerri Devine
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anna L Mitchell
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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30
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van Allen Z, Dogba MJ, Brent MH, Bach C, Grimshaw JM, Ivers NM, Wang X, McCleary N, Asad S, Chorghay Z, Hakim H, Sutakovic O, Drescher O, Légaré F, Witteman HO, Zettl M, Squires J, Tremblay MC, Randhawa A, Lopez G, Ben Guiza A, Presseau J. Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups. Diabet Med 2021; 38:e14429. [PMID: 33068305 DOI: 10.1111/dme.14429] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
AIM To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes. METHODS Using a patient-oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French-speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development. RESULTS We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group-specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine. CONCLUSION Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.
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Affiliation(s)
- Zack van Allen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Catherine Bach
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Xiaoqin Wang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Evidence-based Medicine Centre, Lanzhou University, Lanzhou, China
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sarah Asad
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Zahraa Chorghay
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Mary Zettl
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Janet Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Marie-Claude Tremblay
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | | | | | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Langwenya N, Todd CS, Jones HE, Hoover DR, Hu NC, Ronan A, Myer L. Risk-based screening to identify reproductive tract infection among HIV-infected women desiring use of intrauterine contraceptives. BMJ Sex Reprod Health 2021; 47:137-143. [PMID: 32611546 PMCID: PMC8020848 DOI: 10.1136/bmjsrh-2019-200494] [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] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Reproductive tract infections (RTIs) are a major cause of morbidity and mortality, yet RTI testing remains limited in resource-constrained settings. We assessed performance of an existing RTI risk assessment screening tool among women living with HIV (WLHIV) considering intrauterine contraceptive (IUC) use. METHODS We conducted a cross-sectional analysis among WLHIV screened for participation in an IUC trial in Cape Town, South Africa (NCT01721798). RTI testing included Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis. Tool scoring was based on five separately scored criteria: (1) age under 25 years, (2) cohabitation with a partner, (3) secondary education, (4) self-reported intermenstrual bleeding and (5) number of current sexual partners and condom use frequency (score 0-5). We assessed tool performance in detecting RTI at 0 vs 1-5, 0-1 vs 2-5 and 0-2 vs 3-5 score thresholds. RESULTS Of 303 women, 52% (n=157) reported antiretroviral therapy use and median age was 31 years. The prevalence of any RTI was 38% (gonorrhoea=7%, chlamydia=11%, trichomoniasis=12% and bacterial vaginosis=18%) and 8% of women had multiple RTIs. Overall, 4%, 27% and 69% of women had screening tool scores of 0, 1 or 2+, respectively. At a threshold of at least one scored criterion, the tool demonstrated high sensitivities (95%-97%) but low specificities (3%-4%) for detecting any RTI. Increasing the score threshold and/or inclusion of abnormal vaginal discharge marginally improved specificity. CONCLUSION The prevalence of RTIs observed in this population was high, and the screening tool had no discriminatory power to detect prevalent RTIs.
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Affiliation(s)
- Nontokozo Langwenya
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Catherine S Todd
- Global Health, Population, and Nutrition Department, FHI 360, Durham, North Carolina, USA
| | - Heidi E Jones
- Department of Epidemiology & Biostatistics, City University of New York, New York, New York, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, New Brunswick, New Jersey, USA
| | - Nai-Chung Hu
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Agnes Ronan
- Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa
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Biermann O, Klüppelberg R, Lönnroth K, Viney K, Caws M, Atkins S. 'A double-edged sword': Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities-A qualitative study based on expert interviews. PLoS One 2021; 16:e0247568. [PMID: 33705422 PMCID: PMC7951804 DOI: 10.1371/journal.pone.0247568] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Active case-finding (ACF), also referred to as community-based tuberculosis screening, is a component of the World Health Organization's End TB Strategy. ACF has potential benefits but also harms, which need to be carefully assessed when developing and implementing ACF policies. While empirical evidence on the benefits of ACF is still weak, evidence on the harms is even weaker. This study aimed to explore experts' views on the benefits and harms of ACF for people with presumptive TB and communities. METHODS This was an exploratory study. Semi-structured interviews were conducted with a purposive sample of 39 experts from international, non-governmental/non-profit organizations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide. Framework analysis was applied. RESULTS Findings elaborated perceived benefits of ACF, including reaching vulnerable populations, reducing patient costs, helping raise awareness for tuberculosis among individuals and engaging communities, and reducing tuberculosis transmission. Perceived harms included increasing stigma and discrimination, causing false-positive diagnoses, as well as triggering other unintended consequences related to screening for tuberculosis patients, such as deportation of migrants once confirmed to have tuberculosis. Most of the perceived benefits of ACF could be linked to its objective of finding and treating persons with tuberculosis early (theme 1), while ACF was also perceived as a "double-edged sword" and could cause harms, if inappropriately designed and implemented (theme 2). The analysis underlined the importance of considering the benefits and harms of ACF throughout the screening pathway. The study provides new insights into the perceived benefits and harms of ACF from the perspectives of experts in the field. CONCLUSION This study highlights gaps in the evidence base surrounding ACF and can stimulate further research, debate and analysis regarding the benefits and harms of ACF to inform contextual optimization of design and implementation of ACF strategies.
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Affiliation(s)
- Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Raina Klüppelberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
| | - Salla Atkins
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- New Social Research and Global Health and Development, Faculty of Social Sciences, Tampere University, Tampere, Finland
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Usher-Smith JA, Mills KM, Riedinger C, Saunders CL, Helsingen LM, Lytvyn L, Buskermolen M, Lansdorp-Vogelaar I, Bretthauer M, Guyatt G, Griffin SJ. The impact of information about different absolute benefits and harms on intention to participate in colorectal cancer screening: A think-aloud study and online randomised experiment. PLoS One 2021; 16:e0246991. [PMID: 33592037 PMCID: PMC7886213 DOI: 10.1371/journal.pone.0246991] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/30/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is considerable heterogeneity in individuals' risk of disease and thus the absolute benefits and harms of population-wide screening programmes. Using colorectal cancer (CRC) screening as an exemplar, we explored how people make decisions about screening when presented with information about absolute benefits and harms, and how those preferences vary with baseline risk, between screening tests and between individuals. METHOD We conducted two linked studies with members of the public: a think-aloud study exploring decision making in-depth and an online randomised experiment quantifying preferences. In both, participants completed a web-based survey including information about three screening tests (colonoscopy, sigmoidoscopy, and faecal immunochemical testing) and then up to nine scenarios comparing screening to no screening for three levels of baseline risk (1%, 3% and 5% over 15 years) and the three screening tests. Participants reported, after each scenario, whether they would opt for screening (yes/no). RESULTS Of the 20 participants in the think-aloud study 13 did not consider absolute benefits or harms when making decisions concerning CRC screening. In the online experiment (n = 978), 60% expressed intention to attend at 1% risk of CRC, 70% at 3% and 77% at 5%, with no differences between screening tests. At an individual level, 535 (54.7%) would attend at all three risk levels and 178 (18.2%) at none. The 27% whose intention varied by baseline risk were more likely to be younger, without a family history of CRC, and without a prior history of screening. CONCLUSIONS Most people in our population were not influenced by the range of absolute benefits and harms associated with CRC screening presented. For an appreciable minority, however, magnitude of benefit was important.
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Affiliation(s)
- Juliet A. Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Katie M. Mills
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Christiane Riedinger
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Catherine L. Saunders
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Lise M. Helsingen
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Maaike Buskermolen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Simon J. Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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Martin K, Olaru ID, Buwu N, Bandason T, Marks M, Dauya E, Muzangwa J, Mabey D, Dziva Chikwari C, Francis SC, Tembo M, Mavodza C, Simms V, Mackworth-Young CRS, Machiha A, Kranzer K, Ferrand RA. Uptake of and factors associated with testing for sexually transmitted infections in community-based settings among youth in Zimbabwe: a mixed-methods study. Lancet Child Adolesc Health 2021; 5:122-132. [PMID: 33417838 PMCID: PMC7818532 DOI: 10.1016/s2352-4642(20)30335-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The prevalence of sexually transmitted infections (STIs) among youth is high in sub-Saharan Africa. We investigated the uptake of testing for and prevalence of Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhoea) infections among youth in community-based settings in Zimbabwe, and explored the facilitators and barriers to testing. METHODS This study was nested within a cluster randomised trial of community-based delivery of integrated HIV and sexual and reproductive health services for youth aged 16-24 years. Chlamydia and gonorrhoea testing via urine samples using the Xpert CT/NG test was offered in the four intervention clusters in Harare, Zimbabwe. Factors associated with testing uptake were investigated in a subset of participants (n=257) using hierarchical multivariate logistic regression. In-depth interviews with a separate purposively selected sample (n=26) explored facilitators and barriers to STI testing and partner notification and were analysed using thematic analysis. FINDINGS Between June 1, 2019, and Jan 31, 2020, there were 6200 attendances by 4440 participants (78·2% women, 21·8% men) median age 20·3 (IQR 17·9-22·8) years. 1478 participants had 1501 tests done, and 248 tests were positive and 1253 tests were negative for chlamydia or gonorrhoea, or both. STI test uptake was 33·3% (95% CI 31·9-34·7), increasing from 11·7% in June, 2019, to 37·1% in January, 2020. The prevalence of chlamydia or gonorrhoea, or both, was 16·5% (95% CI 14·7-18·5; 248 of 1501), with only seven participants (3%) showing symptoms. The overall yield of testing was 4·0% (95% CI 3·5-4·5; 248 of 6200). Uptake was associated with having symptoms (adjusted odds ratio [OR] 14·8, 95% CI 1·66-132·07) and negatively associated with being single (adjusted OR 0·33, 95% CI 0·13-0·84) or having a boyfriend or girlfriend (adjusted OR 0·19, 95% CI 0·087-0·43) compared with being married, and being a student compared with being employed (adjusted OR 0·26, 95% CI 0·10-0·68). Perceived risk and symptoms of STIs were motivators for testing whereas misinformation, anticipated stigma, and concern about confidentiality were barriers. INTERPRETATION The prevalence of chlamydia or gonorrhoea, or both, was high among youth but only a minority were symptomatic. Therefore most infections would remain untreated without access to STI testing. Provision of education, counselling, and confidentiality are essential to improve uptake and acceptability of STI testing. FUNDING Wellcome Trust.
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Affiliation(s)
- Kevin Martin
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ioana D Olaru
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nyasha Buwu
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Joice Muzangwa
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - David Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Chido Dziva Chikwari
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Suzanna C Francis
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mandikudza Tembo
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Zimbabwe
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe; Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
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Bhandari D, Shibanuma A, Kiriya J, Hirachan S, Ong KIC, Jimba M. Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal. PLoS One 2021; 16:e0245856. [PMID: 33481894 PMCID: PMC7822561 DOI: 10.1371/journal.pone.0245856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/10/2021] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer burden is increasing in low-income countries (LICs). Increasing incidence and delayed presentation of breast cancer are mainly responsible for this burden. Many women do not participate in breast cancer screening despite its effectiveness. Moreover, studies are limited on the barriers associated with low utilization of breast cancer screening in LICs. This study identified breast cancer screening behavior and factors associated with breast cancer screening intention among women in Kathmandu Valley, Nepal. Methods A cross-sectional study was conducted among 500 women living in five municipalities of Kathmandu Valley, Nepal. Data were collected from July to September 2018, using a structured questionnaire. Interviews were conducted among women selected through proportionate random household sampling. This study was conceptualized using the theory of planned behavior, fatalism, perceived susceptibility, and perceived severity. The outcome variables included: the intention to have mammography (MMG) biennially, the intention to have clinical breast examination (CBE) annually, and the intention to perform breast self-examination (BSE) monthly. Analysis was conducted separately for each outcome variable using partial proportional odds model. Results Out of 500 women, 3.4% had undergone MMG biennially, 7.2% CBE annually, and 14.4% BSE monthly. Women with a positive attitude, high subjective norms, and high perceived behavioral control were more likely to have the intention to undergo all three screening methods. Similarly, women were more likely to have intention to undergo CBE and MMG when they perceived themselves susceptible to breast cancer. Conversely, women were less likely to have intention to undergo CBE when they had high fatalistic beliefs towards breast cancer. Conclusion Women in this study had poor screening behavior. The practice of breast self-examination was comparatively higher than clinical breast examination and mammography. Multidimensional culturally sensitive interventions are needed to enhance screening intentions. Efforts should be directed to improve attitude, family support, and fatalistic belief towards cancer. Furthermore, the proper availability of screening methods should be ensured while encouraging women to screen before the appearance of symptoms.
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Affiliation(s)
- Divya Bhandari
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Junko Kiriya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | | | - Ken Ing Cherng Ong
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
- * E-mail:
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
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Devkota HR, Sijali TR, Bogati R, Clarke A, Adhikary P, Karkee R. How Does Public Knowledge, Attitudes, and Behaviors Correlate in Relation to COVID-19? A Community-Based Cross-Sectional Study in Nepal. Front Public Health 2021; 8:589372. [PMID: 33520911 PMCID: PMC7842277 DOI: 10.3389/fpubh.2020.589372] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The COVID-19 pandemic has created a global health emergency requiring an effective public health response including citizen's roles in preventing spread and controlling the pandemic. Little is known about public knowledge, beliefs and behaviors in-relation to the pandemic in Nepal. This study aims to assess knowledge, attitude and practices (KAP) toward COVID-19 among the general public and to identify associated factors. Methods: A cross-sectional survey was conducted between May-June 2020 with a sample of 645, recruited from 26 hospitals across Nepal. We conducted telephone interviews using a semi-structured questionnaire related to KAP regarding COVID-19. T-test and one-way ANOVA was conducted to determine group differences for socio-demographic variables. Linear regression and correlational analysis were performed to identify associated factors and measure strength and direction of relationships. Results: Overall mean scores for knowledge, attitude and practice were 11.6 (SD 4.5), 2.7 (SD 1.8), and 9.9 (SD 1.93) respectively, but differed by socio-demographic characteristics. Positive but weak linear correlations were observed between knowledge-practice (r = 0.19, p < 0.01) and attitude-practice (r = 0.08, p < 0.05). The relationship between knowledge and education was fairly strong (r = 0.34, p < 0.01). Province, place of residence, ecological area, age, gender and caste/ethnicity were also significantly associated with KAP score of participants. Conclusion: The study found varying degrees of correlation between Knowledge, Attitude and Practice that may increase as the pandemic evolves in Nepal. Knowledge and level of education had positive associations with attitude and adherence to precautionary measures. The findings suggest a need for targeted community awareness interventions for the most vulnerable populations, men, those with no school education, the elderly and people living in rural areas.
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Affiliation(s)
| | - Tula Ram Sijali
- Community Support Association of Nepal (COSAN), Kathmandu, Nepal
| | - Ramji Bogati
- Community Support Association of Nepal (COSAN), Kathmandu, Nepal
| | - Andrew Clarke
- Save the Children UK, London and Lancaster University, Lancaster, United Kingdom
| | - Pratik Adhikary
- UC Berkeley/Institute for Social and Environmental Research, Chitwan, Nepal
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Malmqvist J, Siersma V, Bang CW, Brodersen J. Consequences of screening in colorectal cancer (COS-CRC): development and dimensionality of a questionnaire. BMC Psychol 2021; 9:7. [PMID: 33413695 PMCID: PMC7792180 DOI: 10.1186/s40359-020-00504-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Harms of colorectal cancer (CRC) screening include psychosocial consequences. We have not identified studies using a participant-relevant questionnaire with adequate measurement properties to investigate these harms. However, Brodersen et al. have previously developed a core questionnaire consequences of screening (COS) for use in screening for life-threatening diseases. Therefore, the objectives were: (1) To investigate content validity of COS in a CRC screening setting and in case of gaps in content coverage (2) generate new items and themes and (3) test the possibly extended version of COS for dimensionality and differential item functioning (DIF) using Rasch Models. METHODS We performed two-part-focus-groups with CRC screenees. Screenees were recruited by strategic sampling. In the first part 16 screenees with false-positive results (n = 7) and low-risk polyps (n = 9) were interviewed about their CRC screening experiences and in the second part COS was examined for content validity. When new information was developed in the focus groups, new items covering this topic were generated. Subsequently, new items were, together with COS, tested in the subsequent interviews. A random subsample (n = 410) from a longitudinal questionnaire study, not yet published, was used to form the data for this paper. We analysed multidimensionality and uniform DIF with Andersen's conditional likelihood ratio test. We assessed individual item fit to the model. We also analysed Local Dependence (LD) and DIF by partial gamma coefficients using Rasch Models. RESULTS COS was found relevant in a CRC screening setting. However, new information was discovered in the focus groups, covered by 18 new CRC screening-specific items. The Rasch analyses only revealed minor problems in the COS-scales. The 18 new items were distributed on four new CRC screening-specific dimensions and one single item. CONCLUSION An extended version of COS specifically for use in a CRC screening setting has been developed. The extended part encompasses four new scales and one new single item. The original COS with the CRC-screening specific extension is called consequences of screening in colorectal cancer (COS-CRC). COS-CRC possessed reliability, unidimensionality and invariant measurement.
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Affiliation(s)
- Jessica Malmqvist
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1514 Copenhagen, Denmark
- Primary Healthcare Research Unit, Region Zealand, Alléen 15, 4180 Soroe, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1514 Copenhagen, Denmark
| | - Christine Winther Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1514 Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1514 Copenhagen, Denmark
- Primary Healthcare Research Unit, Region Zealand, Alléen 15, 4180 Soroe, Denmark
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Raets L, Vandewinkel M, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, Roggen N, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Devlieger R, Mathieu C, Benhalima K. Preference of Women for Gestational Diabetes Screening Method According to Tolerance of Tests and Population Characteristics. Front Endocrinol (Lausanne) 2021; 12:781384. [PMID: 34858350 PMCID: PMC8630544 DOI: 10.3389/fendo.2021.781384] [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] [Received: 09/22/2021] [Accepted: 10/22/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS To determine the preferred method of screening for gestational diabetes mellitus (GDM). METHODS 1804 women from a prospective study (NCT02036619) received a glucose challenge test (GCT) and 75g oral glucose tolerance test (OGTT) between 24-28 weeks. Tolerance of screening tests and preference for screening strategy (two-step screening strategy with GCT compared to one-step screening strategy with OGTT) were evaluated by a self-designed questionnaire at the time of the GCT and OGTT. RESULTS Compared to women who preferred one-step screening [26.2% (472)], women who preferred two-step screening [46.3% (834)] were less often from a minor ethnic background [6.0% (50) vs. 10.7% (50), p=0.003], had less often a previous history of GDM [7.3% (29) vs. 13.8% (32), p=0.008], were less often overweight or obese [respectively 23.1% (50) vs. 24.8% (116), p<0.001 and 7.9% (66) vs. 18.2% (85), p<0.001], were less insulin resistant in early pregnancy (HOMA-IR 8.9 (6.4-12.3) vs. 9.9 (7.2-14.2), p<0.001], and pregnancy outcomes were similar except for fewer labor inductions and emergency cesarean sections [respectively 26.6% (198) vs. 32.5% (137), p=0.031 and 8.2% (68) vs. 13.0% (61), p=0.005]. Women who preferred two-step screening had more often complaints of the OGTT compared to women who preferred one-step screening [50.4% (420) vs. 40.3% (190), p<0.001]. CONCLUSIONS A two-step GDM screening involving a GCT and subsequent OGTT is the preferred GDM screening strategy. Women with a more adverse metabolic profile preferred one-step screening with OGTT while women preferring two-step screening had a better metabolic profile and more discomfort of the OGTT. The preference for the GDM screening method is in line with the recommended Flemish modified two-step screening method, in which women at higher risk for GDM are recommended a one-step screening strategy with an OGTT, while women without these risk factors, are offered a two-step screening strategy with GCT. CLINICAL TRIAL REGISTRATION NCT02036619 https://clinicaltrials.gov/ct2/show/NCT02036619.
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Affiliation(s)
- Lore Raets
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
- *Correspondence: Lore Raets,
| | | | - Paul Van Crombrugge
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics & Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics & Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Nele Roggen
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics & Gynecology, Antwerp University Hospital, Edegem, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan Brussel, Brussel, Belgium
| | - Katrien De Clippel
- Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Brussel, Belgium
| | | | - Anne Loccufier
- Department of Obstetrics & Gynecology, AZ St Jan Brugge, Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical bioinformatics, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Apers H, Nöstlinger C, Van Beckhoven D, Deblonde J, Apers L, Verheyen K, Loos J. Identifying key elements to inform HIV-testing interventions for primary care in Belgium. Health Promot Int 2020; 35:301-311. [PMID: 31056680 PMCID: PMC7250498 DOI: 10.1093/heapro/daz037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
General practitioners (GPs) play a key role in reducing the hidden HIV-epidemic, but many diagnostic opportunities are missed in primary care. This study aimed at informing the development of an HIV-testing intervention for GPs in Flanders (Belgium) using formative research with a participatory approach. Through the active involvement of an advisory board and 16 group discussions with 122 Flemish GPs, GPs’ current HIV-testing practices and perceived practical relevance of 2 distinct HIV-testing strategies (i.e. provider-initiated testing of key populations and indicator condition-based testing) were explored in terms of their relevance and feasibility in routine primary care. Self-reported HIV-testing practices revealed that most tests performed were patient-initiated, pretest counseling was rarely done, and post-test counseling was offered mainly for patients with an HIV-diagnosis. GPs reported multiple barriers to provider-initiated HIV-testing, i.e. personal discomfort, fear of offending their patient, limited knowledge of benefits of early HIV-diagnosis, misconceptions about HIV-risks, lack of guidelines and time. Difficulties to identify patient’s sexual orientation or ethical concerns were mentioned as barriers for target group-based HIV testing. GPs assessed the current list of 64 indicator conditions as too difficult to integrate in routine care, deeming a reduced list of GP-relevant conditions as more feasible. Combined strategies (i.e. target group- and indicator-based testing) supported by official screening recommendations were perceived as successful strategies for provider-initiated HIV-testing in primary care. This formative research delivered qualitative evidence for the development of an HIV-testing intervention for primary care settings.
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Affiliation(s)
- Hanne Apers
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Corresponding author. E-mail:
| | - Christiana Nöstlinger
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dominique Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Sciensano - Belgian Scientific Institute of Public Health, Ixelles, Belgium
| | - Jessika Deblonde
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Sciensano - Belgian Scientific Institute of Public Health, Ixelles, Belgium
| | - Ludwig Apers
- HIV/STI clinic, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Katleen Verheyen
- General Practitioner, Opglabbeek, Belgium
- ELIZA - Center for General Practice, Department of Primary & Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - Jasna Loos
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Kummer S, Waller J, Ruparel M, Duffy SW, Janes SM, Quaife SL. Psychological outcomes of low-dose CT lung cancer screening in a multisite demonstration screening pilot: the Lung Screen Uptake Trial (LSUT). Thorax 2020; 75:1065-1073. [PMID: 33087548 PMCID: PMC7677470 DOI: 10.1136/thoraxjnl-2020-215054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies of psychological burden in low-dose CT (LDCT) lung cancer screening trials may lack generalisability due to participation bias and control arms having elevated distress. METHODS Current and former smokers (n=787, aged 60-75) within a real-world screening demonstration pilot completed measures of lung cancer worry at three time points (T0: appointment, T1: next day, T2: 3 months) and anxiety and depression at two time points (T0 and T2). A 'screening unaware' community sample (n=383) with the same age and smoking characteristics completed these measures once (T0). Mean scores were compared by sample type and LDCT result. RESULTS Compared with the community sample (T0), mean scores were higher in the screening sample, and statistically significantly increased in adjusted analyses, for lung cancer worry at T0 and T2 (mean (M): 9.32; 95% CI 8.96 to 9.69 vs M: 11.34; 11.09 to 11.59 and M: 11.88; 11.49 to 12.27), for anxiety at T0 and T2 (M: 3.32; 2.94 to 3.70 vs M: 4.73; 4.42 to 5.04 and M: 5.78; 5.33 to 6.23) and depression at T2 (M: 3.85; 3.44 to 4.27 vs M: 4.15; 3.76 to 4.55). Scores were highest for those with indeterminate (eg, T2 anxiety M: 6.93; 5.65 to 8.21) and incidental findings (primary care follow-up M: 5.34; 4.67 to 6.02) and those ineligible for screening (M: 6.51; 5.25 to 7.77). Being female, younger, not in paid employment, not married/cohabiting with a partner and lower education predicted poorer psychological outcomes at T0, but not T2 after adjusting for baseline scores. Mean scores remained within 'normal' clinical ranges. CONCLUSION Psychological distress was raised among high-risk individuals undergoing LDCT screening in a real-world setting, but overall differences were unlikely to be clinically meaningful. It will be critical to monitor the psychological impact of services longitudinally across diverse settings, including subgroups vulnerable to clinically elevated distress. TRIAL REGISTRATION The Lung Screen Uptake Trial was registered prospectively with the International Standard Registered Clinical/soCial sTudy (ISRCTN) (Number: ISRCTN21774741) on 23 September 2015 and the National Institutes of Health ClinicalTrials.gov database (NCT02558101) on 22 September 2015.
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Affiliation(s)
- Sonja Kummer
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
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Long MM, Cramer RJ, Bennington L, Morgan FG, Wilkes CA, Fontanares AJ, Sadr N, Bertolino SM, Paulson JF. Perinatal depression screening rates, correlates, and treatment recommendations in an obstetric population. Fam Syst Health 2020; 38:369-379. [PMID: 33119369 DOI: 10.1037/fsh0000531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
INTRODUCTION The current study aimed to assess perinatal depression (PD) screening and treatment practices of obstetrical health care providers. METHOD Retrospective record reviews (n = 557) evaluated the PD screening, referral, and treatment practices at an Obstetrician/Gynecology practice. This study assessed the frequency of screening for PD, rates of elevated Edinburgh Postnatal Depression Scale (EPDS) scores, treatment recommendations, demographic correlates, and predictors of elevated EPDS scores. RESULTS PD screening completion rates were: 60.1% (intake), 35% (glucola test), and 85.5% (6-week follow-up). Rates of clinically elevated EPDS scores were: 18.21% (intake), 17.43% (glucola test), and 13.00% (6-week follow-up). Correlates of clinically elevated EPDS scores at intake and 6-week follow-up were history of depression, history of anxiety, and young age. History of depression and anxiety were associated with an increased likelihood of having a clinically significant EPDS score at intake. Intake EPDS score and history of depression were associated with an increased likelihood of having a clinically significant EPDS score at 6-week follow-up. DISCUSSION Obstetric/gynecology providers should screen for perinatal depression at every obstetrical appointment. It is important to thoroughly assess history of depression and anxiety. Education and training for health care providers and perinatal women may improve the mental health experience of perinatal women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte
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Weng R, Hong F, Zhang C, Wen L, Chen X, Cai Y. Associated factors of willingness to undergo routine chlamydia trachomatis screening among hospital-based patients in Shenzhen, China: a cross-sectional study. BMC Public Health 2020; 20:1720. [PMID: 33198730 PMCID: PMC7670722 DOI: 10.1186/s12889-020-09828-6] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) is a common sexually transmitted infection (STI) with significant morbidity. The study aimed to explore the willingness to undergo routine CT screening and its associated factors among hospital-based patients in Shenzhen. METHODS We used data from the Shenzhen Gonorrhea and Chlamydia Intervention Programme. Participants were recruited with a stratified purposeful sampling design from 1 April 2018 to 16 May 2018. A structured questionnaire was used to obtain data on baseline characteristics and CT-related participant information. RESULTS Of the 16,546 participants, 64.79% were women, with a mean age of 31.85 ± 7.31 of all participants. Of the participants, 88.78% were willing to undergo routine CT screening. According to multivariate logistic regression analyses, willingness to undergo routine CT screening was associated with the following (P < 0.05): being a woman (AOR = 1.53, 95% CI = 1.34-1.75), one year or more residency in Shenzhen (AOR = 1.64, 95% CI = 1.37-1.95), any secondary education (AOR = 2.46, 95% CI = 1.92-3.15), monthly income ≥ RMB 10,000 (AOR = 1.24, 95% CI = 1.01-1.51), having forgotten CT diagnosis history (AOR = 1.42, 95% CI = 1.12-1.79), without current STI-related symptoms (AOR = 1.24, 95% CI = 1.10-1.41), and having correct understanding of the sequelae of CT infection (AOR = 1.68, 95% CI = 1.39-2.03). CONCLUSION This study reported high willingness to undergo routine CT screening among hospital-based patients in Shenzhen, and provided evidence for the promotion and the implementation of strategies and recommendations on routine CT screening in China.
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Affiliation(s)
- Rongxing Weng
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China
| | - Fuchang Hong
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China
| | - Chunlai Zhang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China
| | - Lizhang Wen
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China
| | - Xiangsheng Chen
- Peking Union Medical College Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China
- National Center for Sexually Transmitted Disease Control, Nanjing, China
| | - Yumao Cai
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China.
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Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for Hypertension in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 324:1884-1895. [PMID: 33170247 DOI: 10.1001/jama.2020.11119] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Childhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks. OBJECTIVE To update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force. DATA SOURCES PubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020. STUDY SELECTION Fair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions. DATA EXTRACTION AND SYNTHESIS Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments. RESULTS Forty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were -4.38 mm Hg (95% CI, -7.27 to -2.16) for angiotensin-converting enzyme inhibitors and -3.07 mm Hg (95% CI, -4.99 to -1.44) for angiotensin receptor blockers. Candesartan reduced SBP by -6.56 mm Hg (P < .001; n = 240). β-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (-4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (-2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (-7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure. CONCLUSIONS AND RELEVANCE Observational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.
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Affiliation(s)
- Gerald Gartlehner
- Evidence-Based Practice Center, RTI International-University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- RTI International, Research Triangle Park, North Carolina
- Department for Evidence-Based Medicine and Evaluation, Danube University, Krems, Austria
| | - Emily B Vander Schaaf
- Evidence-Based Practice Center, RTI International-University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Colin Orr
- Evidence-Based Practice Center, RTI International-University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sara M Kennedy
- Evidence-Based Practice Center, RTI International-University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- RTI International, Research Triangle Park, North Carolina
| | - Rachel Clark
- Evidence-Based Practice Center, RTI International-University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Meera Viswanathan
- Evidence-Based Practice Center, RTI International-University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- RTI International, Research Triangle Park, North Carolina
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Abstract
This cohort study explores whether clinician specialty and patient familiarity with the attending clinician are associated with rates of low-dose computerized tomographic lung cancer screening after shared decision-making visits.
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Affiliation(s)
- James S. Goodwin
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch at Galveston
| | - Shuang Li
- Sealy Center on Aging, University of Texas Medical Branch at Galveston
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Her M. How Is COVID-19 Affecting South Korea? What Is Our Current Strategy? Disaster Med Public Health Prep 2020; 14:684-686. [PMID: 32241325 PMCID: PMC7160162 DOI: 10.1017/dmp.2020.69] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 01/09/2023]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) caused by the virus SARS-CoV-2 is expanding globally. South Korea is one of the countries most affected by COVID-19 from the very early stages of this pandemic. Explosive outbreaks occurred across South Korea in the first two months, and efforts to control this new virus have involved everyone across the country. To curb the transmission of the virus, health-care professionals, committees, and governments have combined many approaches, such as extensive COVID-19 screening, effective patient triage, the transparent provision of information, and the use of information technology. This experience could provide some valuable ideas and lessons to others who are fighting against COVID-19.
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Affiliation(s)
- Minyoung Her
- Department of Internal Medicine, Pyeongtaek Good morning Hospital, Pyeongtaek, South Korea
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Abstract
OBJECTIVES Adolescents who seek care in emergency departments (EDs) are often at high risk for sexually transmitted infections (STIs). The objective of this study was to assess adolescent attitudes toward ED-based STI screening. METHODS We conducted a secondary analysis of a cross-sectional study that evaluated STI screening acceptability and prevalence when STI testing was universally offered to asymptomatic adolescents presenting to the ED for care. Adolescents 14 to 21 years old completed a computerized survey and answered questions regarding attitudes toward ED-based STI screening and sexual behavior. We performed multivariable logistic regression to compare differences in attitudes toward ED-based STI screening among patients who agreed versus declined STI testing. RESULTS Of 553 adolescents, 326 (59.0%) agreed to be tested for STIs. Most (72.1%) believed the ED was an appropriate place for STI screening. Patients who agreed to be tested for STIs were more likely to positively endorse ED-based STI screening than those who declined STI testing [77.0% vs 64.8%; adjusted odds ratios, 1.6; 95% confidence interval (CI), 1.1-2.4]. Most (82.6%) patients stated they would feel comfortable getting tested for STIs in the ED. There was no difference in the comfort level of ED-based STI testing between those who agreed and declined STI testing (83.5% vs 81.4%; adjusted odds ratios, 1.1; 95% CI, 0.7-1.8). CONCLUSION Our results suggest that adolescents view the ED as an acceptable location for STI screening. Therefore, the ED may serve a role in increasing the accessibility of STI detection and prevention resources for adolescents.
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Affiliation(s)
| | | | - Monika K. Goyal
- Children’s National Health System, Washington, DC
- Departments of Pediatrics and Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Abstract
Introduction: Prostate cancer is the most common malignancy among men in the United States and the second most common cancer in Turkey. The incidence of prostate cancer is increasing in industrialized countries.Aim: The aim of the study was to assess the knowledge about prostate cancer, its diagnosis, and treatment among patients with lower urinary tract symptoms.Methods: This study was performed from January to April 2015 with the patients applied to our clinic. A questionnaire that includes 10 questions was administered to the participants.Results: One hundred fifty-nine participants were included in this study. The participants' ages were between 40 and 82 with a mean age of 61.5 ± 7.9 years. Patient awareness of prostate biopsy and prostate cancer were 21.37 and 71.06%. The main origin awareness of PSA testing is family and friends. On the other hand, if the doctor advises acout prostate biopsy, 47.16% of the patients would accept and 11.31% of them would refuse this invasive procedure.Conclusion: Prostate cancer is one of the important health-related problem among men in the world. Additional researches are needed to investigate the knowledge of prostate cancer among men and the Ministry of Health may take preventive methods to increase the cancer knowledge level of people.
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Affiliation(s)
- Mustafa Sungur
- Department of Urology, Hitit University Erol Olcok Education and Research Hospital, Corum, Turkey
| | - Selahattin Caliskan
- Department of Urology, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey
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Bilger M, Özdemir S, Finkelstein EA. Demand for Cancer Screening Services: Results From Randomized Controlled Discrete Choice Experiments. Value Health 2020; 23:1246-1255. [PMID: 32940243 DOI: 10.1016/j.jval.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/24/2020] [Revised: 05/25/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Low uptake of cancer screening services is a global concern. Our aim was to understand factors that influence the screening decision, including screening and treatment subsidies and a gain-frame message designed to present screening as a win-win. METHODS We analyzed preferences for mammography and Pap smear among women in Singapore by means of discrete choice experiments while randomly exposing half of respondents to a gain-framed public health message promoting the benefits of screening. RESULTS Results showed that the message did not influence stated uptake, and given the levels shown, respondents were influenced more by treatment attributes, including effectiveness and out-of-pocket cost should they test positive, than by screening attributes, including the offer of a monetary incentive for screening. Respondents also underestimated the survival chances of screen-detected breast and cervical cancers. CONCLUSIONS Combined, these findings suggest that correcting misconceptions about screen-detected cancer prognosis or providing greater financial protection for those who test positive could be more effective and more cost-effective than subsidizing screening directly in increasing screening uptakes.
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Affiliation(s)
- Marcel Bilger
- Health Economics and Policy, Vienna University of Economics and Business, Vienna, Austria; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Semra Özdemir
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Eric A Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Duke Global Health Institute, Duke University, Durham, NC, USA
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Miller DB, Hamler TC, Qin W. Prostate cancer screening in Black men: Screening intention, knowledge, attitudes, and reasons for participation. Soc Work Health Care 2020; 59:543-556. [PMID: 32804046 DOI: 10.1080/00981389.2020.1808149] [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] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
The objective of the present study is to capture the prostate cancer screening intention, knowledge levels, attitudes, and reasons for participation in screening among African American men. African American men aged from 35 to 65 in Georgia, North Carolina, and Ohio were recruited for study (N = 168). Questionnaires were administered using validated instruments. Findings suggest critical needs for community-based social workers to communicate the importance of prostate cancer screening and risk factors among African American men. Increasing the use of culturally relevant community health education might benefit underserved minority men at risk of having prostate cancer.
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Affiliation(s)
- David B Miller
- Jack,Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University , Cleveland, Ohio, USA
| | - Tyrone C Hamler
- Jack,Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University , Cleveland, Ohio, USA
| | - Weidi Qin
- Jack,Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University , Cleveland, Ohio, USA
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Abstract
The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of personal autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA.
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Affiliation(s)
- Kasoka Kasoka
- School of Law, Birkbeck, University of London, London, UK.
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