The Effectiveness and Cost to Improve Colorectal Cancer Screening in a Federally Qualified Homeless Clinic in Eastern Kentucky

The objective of this study was to analyze the effectiveness and cost of patient incentives, together with patient navigation and patient reminders, to increase fecal immunochemical test (FIT) kit return rates and colorectal cancer screening uptake in one federally qualified health center (FQHC) in Appalachia. This FQHC is a designated homeless clinic, as 79.7% of its patient population are homeless. We collected process, outcome, and cost data from the FQHC for two time periods: usual care (September 2016-August 2017) and implementation (September 2017-September 2018). We reported the FIT kit return rate, the increase in return rate, and the additional number of individual screens. We also calculated the incremental cost per additional screen. The patient incentive program, with patient navigation and patient reminders, increased the number of FIT kits returned from the usual care period to the implementation period. The return rate increased by 25.9 percentage points (from 21.7% to 47.6%) with an additional 91 people screened at an incremental cost of $134.61 per screen. A patient incentive program, together with the assistance of patient navigators and supplemented with patient reminders, can help improve CRC screening uptake among vulnerable and homeless populations.

[Pregnancy in women with spinal cord injuries: State of knowledge]

OBJECTIVES

Updating knowledge of health professionals about pregnant women with spinal cord injuries. Development of maternity hospitals to make them accessible to spinal cord injured pregnant women to improve their care in pre-, per- and post-partum.

METHODS

Cross-sectional declarative study based on a questionnaire distributed to health professionals in the maternity hospital of the University Hospital of Nantes and liberal midwives of Nantes conurbation, based on their knowledge, their difficulties and their expectations for obstetrical care for spinal cord injured women. An inventory was carried out in parallel at the maternity hospital of the University Hospital of Nantes.

RESULTS

Seventy-two percent of health professionals surveyed rated their level of knowledge on spinal cord injuries insufficient or even non-existent. Among the professionals, 84.8% said they encountered difficulties to take care of spinal cord injured women. The main cited difficulty relates to unsuitable equipment or premises, obstacle indeed found during the inventory made on the maternity hospital.

CONCLUSION

Several proposals are being considered, including specific trainings, the execution of a management protocol for spinal cord injured women, the establishment of a situation's form of handicap, the layout of the maternity hospitals premises, and finally, the creation of reference's centers in the region to optimize the follow-up of these patients.

Reconstruction of a scalar-tensor theory of gravity in an accelerating universe

The present acceleration of the Universe strongly indicated by recent observational data can be modeled in the scope of a scalar-tensor theory of gravity. We show that it is possible to determine the structure of this theory along with the present density of dustlike matter from two observable cosmological functions: the luminosity distance and the linear density perturbation in the dustlike matter component as functions of redshift. Explicit results are presented in the first order in the small inverse Brans-Dicke parameter omega(-1).

Reconstruction of a scalar-tensor theory of gravity in an accelerating universe

The present acceleration of the Universe strongly indicated by recent observational data can be modeled in the scope of a scalar-tensor theory of gravity. We show that it is possible to determine the structure of this theory along with the present density of dustlike matter from two observable cosmological functions: the luminosity distance and the linear density perturbation in the dustlike matter component as functions of redshift. Explicit results are presented in the first order in the small inverse Brans-Dicke parameter omega(-1).