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International Journal For Equity in... Sep 2023Mobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on...
BACKGROUND
Mobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on investment and impact on chronic disease management outcomes in the Mid-Atlantic and East Coast regions of the United States, little is known about the characteristics and clinical outcomes of adults who receive care aboard mobile clinics on the West Coast region. Guided by the Anderson Behavioral Model, this study describes the predisposing, enabling, and need factors associated with mobile medical clinic use among mobile medical clinic patients in Southern California and examines the relationship between mobile clinic utilization and presence and control of diabetes and hypertension.
METHODS
We conducted a retrospective cohort study of 411 adults who received care in four mobile clinic locations in Southern California from January 1, 2018, to December 31, 2019. Data were collected from patient charts on predisposing (e.g., sex, race, age), enabling (e.g., insurance and housing status), and need (e.g., chronic illness) factors based on Andersen's Behavioral Model. Zero-truncated negative binomial regression was used to examine the association of chronic illness (hypertension and diabetes) with number of clinic visits, accounting for potential confounding factors.
RESULTS
Over the course of the 2-year study period, 411 patients made 1790 visits to the mobile medical clinic. The majority of patients were female (68%), Hispanic (78%), married (47%), with a mean age of 50 (SD = 11). Forty-four percent had hypertension and 29% had diabetes. Frequency of mobile clinic utilization was significantly associated with chronic illness. Patients with hypertension and diabetes had 1.22 and 1.61 times the rate of mobile medical clinic visit than those without those conditions, respectively (IRR = 1.61, 95% CI, 1.36-1.92; 1.22, 95% CI, 1.02-1.45).
CONCLUSIONS
Mobile clinics serve as an important system of health care delivery, especially for adults with uncontrolled diabetes and hypertension.
Topics: Adult; Humans; Female; Male; Middle Aged; Mobile Health Units; Retrospective Studies; Ambulatory Care Facilities; Ambulatory Care; Hypertension
PubMed: 37749529
DOI: 10.1186/s12939-023-02004-3 -
Orphanet Journal of Rare Diseases Jul 2023Among the various numbers of different autoinflammatory diseases (AIDs), the absolute majority of them remains rare, with a single representative in large populations....
BACKGROUND
Among the various numbers of different autoinflammatory diseases (AIDs), the absolute majority of them remains rare, with a single representative in large populations. This project, endorsed by PRES, supported by the EMERGE fellowship program, and performed in line with the Metadata registry for the ERN RITA (MeRITA), has the objective of performing a data synchronization attempt of the most relevant research questions regarding clinical features, diagnostic strategies, and optimal management of autoinflammatory diseases.
RESULTS
An analysis of three large European registries: Eurofever, JIR-cohort and AID-Net, with a total coverage of 7825 patients from 278 participating centers from different countries, was performed in the context of epidemiological and clinical data merging. The data collected and evaluated in the registries does not cover only pediatric patients, but also adults with newly diagnosed AIDs. General aspects of the existing epidemiological data have been discussed in the context of patient global distribution, potential diagnostic delays, access to genetic testing, and the availability of the treatment.
CONCLUSIONS
In general, the results indicate a great potential for upcoming collaborative work using existing data in cohorts that enhance the quality of medical care performed for patients with autoinflammatory diseases.
Topics: Adult; Child; Humans; Genetic Testing; Hereditary Autoinflammatory Diseases; Registries
PubMed: 37461074
DOI: 10.1186/s13023-023-02812-4 -
La Radiologia Medica Mar 2024Lung cancer screening (LCS) by low-dose computed tomography (LDCT) demonstrated a 20-40% reduction in lung cancer mortality. National stakeholders and international...
PURPOSE
Lung cancer screening (LCS) by low-dose computed tomography (LDCT) demonstrated a 20-40% reduction in lung cancer mortality. National stakeholders and international scientific societies are increasingly endorsing LCS programs, but translating their benefits into practice is rather challenging. The "Model for Optimized Implementation of Early Lung Cancer Detection: Prospective Evaluation Of Preventive Lung HEalth" (PEOPLHE) is an Italian multicentric LCS program aiming at testing LCS feasibility and implementation within the national healthcare system. PEOPLHE is intended to assess (i) strategies to optimize LCS workflow, (ii) radiological quality assurance, and (iii) the need for dedicated resources, including smoking cessation facilities.
METHODS
PEOPLHE aims to recruit 1.500 high-risk individuals across three tertiary general hospitals in three different Italian regions that provide comprehensive services to large populations to explore geographic, demographic, and socioeconomic diversities. Screening by LDCT will target current or former (quitting < 10 years) smokers (> 15 cigarettes/day for > 25 years, or > 10 cigarettes/day for > 30 years) aged 50-75 years. Lung nodules will be volumetric measured and classified by a modified PEOPLHE Lung-RADS 1.1 system. Current smokers will be offered smoking cessation support.
CONCLUSION
The PEOPLHE program will provide information on strategies for screening enrollment and smoking cessation interventions; administrative, organizational, and radiological needs for performing a state-of-the-art LCS; collateral and incidental findings (both pulmonary and extrapulmonary), contributing to the LCS implementation within national healthcare systems.
Topics: Humans; Early Detection of Cancer; Lung; Lung Neoplasms; Mass Screening; Smoking Cessation; Tomography, X-Ray Computed; Middle Aged; Aged
PubMed: 38319494
DOI: 10.1007/s11547-024-01764-4 -
Medical Decision Making : An... 2023Overdiagnosis is a concept central to making informed breast cancer screening decisions, and yet some people may react to overdiagnosis with doubt and skepticism. The...
Assessing and Understanding Reactance, Self-Exemption, Disbelief, Source Derogation and Information Conflict in Reaction to Overdiagnosis in Mammography Screening: Scale Development and Preliminary Validation.
PURPOSE
Overdiagnosis is a concept central to making informed breast cancer screening decisions, and yet some people may react to overdiagnosis with doubt and skepticism. The present research assessed 4 related reactions to overdiagnosis: reactance, self-exemption, disbelief, and source derogation (REDS). The degree to which the concept of overdiagnosis conflicts with participants' prior beliefs and health messages (information conflict) was also assessed as a potential antecedent of REDS. We developed a scale to assess these reactions, evaluated how those reactions are related, and identified their potential implications for screening decision making.
METHODS
Female participants aged 39 to 49 years read information about overdiagnosis in mammography screening and completed survey questions assessing their reactions to that information. We used a multidimensional theoretical framework to assess dimensionality and overall domain-specific internal consistency of the REDS and Information Conflict questions. Exploratory and confirmatory factor analyses were performed using data randomly split into a training set and test set. Correlations between REDS, screening intentions, and other outcomes were evaluated.
RESULTS
Five-hundred twenty-five participants completed an online survey. Exploratory and confirmatory factor analyses identified that Reactance, Self Exemption, Disbelief, Source Derogation, and Information Conflict represent unique constructs. A reduced 20-item scale was created by selecting 4 items per construct, which showed good model fit. Reactance, Disbelief, and Source Derogation were associated with lower intent to use information about overdiagnosis in decision making and the belief that informing people about overdiagnosis is unimportant.
CONCLUSIONS
REDS and Information Conflict are distinct but correlated constructs that are common reactions to overdiagnosis. Some of these reactions may have negative implications for making informed screening decisions.
HIGHLIGHTS
Overdiagnosis is a concept central to making informed breast cancer screening decisions, and yet when provided information about overdiagnosis, some people are skeptical.This research developed a measure that assessed different ways in which people might express skepticism about overdiagnosis (reactance, self-exemption, disbelief, source derogation) and also the perception that overdiagnosis conflicts with prior knowledge and health messages (information conflict).These different reactions are distinct but correlated and are common reactions when people learn about overdiagnosis.Reactance, disbelief, and source derogation are associated with lower intent to use information about overdiagnosis in decision making as well as the belief that informing people about overdiagnosis is unimportant.
Topics: Humans; Female; Decision Making; Overdiagnosis; Mammography; Breast Neoplasms; Early Detection of Cancer; Mass Screening
PubMed: 37705500
DOI: 10.1177/0272989X231195603 -
Tidsskrift For Den Norske Laegeforening... Sep 2023
Topics: Humans; Pharmacogenomic Testing
PubMed: 37753760
DOI: 10.4045/tidsskr.23.0496 -
The Journal of Clinical Investigation Mar 2024Mammalian preimplantation embryos often contain chromosomal defects that arose in the first divisions after fertilization and affect a subpopulation of cells - an event...
Mammalian preimplantation embryos often contain chromosomal defects that arose in the first divisions after fertilization and affect a subpopulation of cells - an event known as mosaic aneuploidy. In this issue of the JCI, Chavli et al. report single-cell genomic sequencing data for rigorous evaluation of the incidence and degree of mosaic aneuploidy in healthy human in vitro fertilization (IVF) embryos. Remarkably, mosaic aneuploidy occurred in at least 80% of human blastocyst-stage embryos, with often less than 20% of cells showing defects. These findings confirm that mosaic aneuploidy is prevalent in human embryos, indicating that the process is a widespread event that rarely has clinical consequences. There are major implications for preimplantation genetic testing of aneuploidy (PGT-A), a test commonly used to screen and select IVF embryos for transfer. The application and benefit of this technology is controversial, and the findings provide more cause for caution on its use.
Topics: Pregnancy; Female; Humans; Preimplantation Diagnosis; High-Throughput Nucleotide Sequencing; Genetic Testing; Aneuploidy; Fertilization in Vitro; Mosaicism
PubMed: 38488008
DOI: 10.1172/JCI179134 -
International Journal of Environmental... Nov 2023The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world....
The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers serving Alaska Native people in rural/remote communities. A total of 28 provider (physicians, advanced practice, and Community Health Aides/Practitioners) interviews were held from 1 February to 30 November 2021. Colonoscopy provider-level barrier themes included time, competing priorities, and staffing, while system-level barriers included travel costs, weather, and the COVID-19 pandemic. Multi-target stool DNA (mt-sDNA) barrier themes included test viability and unfamiliarity, and previous stool tests experiences. For both tests, limited medical record reminders was a major barrier. Facilitator themes for both tests included community outreach, cultural competency and patient navigation, and clinic/system improvements. In-depth interviews with tribal health providers showed that adding mt-sDNA testing may help address system-level colonoscopy barriers such as waitlists and travel costs, but other barriers remain. Further research is needed into patient barriers and facilitators, as well as the effectiveness of integrating mt-sDNA into a geographically dispersed tribal health system to reduce cancer disparities and build equity in CRC prevention among Alaska Native people.
Topics: Humans; Pandemics; Early Detection of Cancer; DNA; Colorectal Neoplasms; Colonoscopy; Mass Screening
PubMed: 37998261
DOI: 10.3390/ijerph20227030 -
BMC Public Health Dec 2023Access to hygiene facilities is essential for health and well-being, and in many countries, employers are legally obliged to ensure that hygiene facilities are readily... (Review)
Review
BACKGROUND
Access to hygiene facilities is essential for health and well-being, and in many countries, employers are legally obliged to ensure that hygiene facilities are readily available. This interview study considers how being on the move impacts the ability of mobile workers (such as community care workers, police, delivery drivers, gardeners, cleaners, utility workers) to access hygiene facilities, and the challenges they face.
METHODS
Using a qualitative exploratory research design, we investigate through semi-structured interviews with 22 United Kingdom (UK) mobile workers (1) what influences their access to hygiene facilities, (2) their hygiene needs, and (3) where mobile workers are accessing hygiene facilities. The interview data was analysed qualitatively using a coding framework developed from a literature review of hand hygiene in fixed workplaces.
RESULTS
Mobile workers' access to hygiene facilities is influenced by the wider cultural environment, the biological environment, the organisational environment, the physical environment, the facility owner, the worker's role, and the individual themselves, all underpinned by social norms. Our participants needed hygiene facilities so they could use the toilet, clean themselves, and do their work, and for First Aid. Access to facilities is challenging, and our participants needed to access facilities where they were working, travel to find them, or use hygiene kits. The quality of facilities is frequently poor, and mobile workers must often seek permission and may incur financial costs. Our participants often had to rely on the goodwill of people in private homes. In the absence of facilities, workers often resort to strategies that may affect their health (such as restricting drinking and eating, and ignoring urges) or their dignity (such as relieving themselves outdoors or even soiling their clothes).
CONCLUSIONS
The lack of hygiene facilities available to mobile workers is a serious health and well-being concern. Given that there are many occupations where workers are mobile at least some of the time, the scale of the problem needs to be recognised. This study adds to our understanding of hygiene in workplaces and highlights the inadequacy of current legislation, which appears to serve primarily those working in fixed workplaces such as offices. Recommendations are made to policy makers and organisations.
Topics: Humans; Hygiene; Qualitative Research; United Kingdom; Mobile Health Units
PubMed: 38102613
DOI: 10.1186/s12889-023-17465-y -
Journal of Autism and Developmental... Aug 2023Prior studies suggest autism-specific and general developmental screens are complementary for identifying both autism and developmental delay (DD). Parents completed...
Prior studies suggest autism-specific and general developmental screens are complementary for identifying both autism and developmental delay (DD). Parents completed autism and developmental screens before 18-month visits. Children with failed screens for autism (n = 167) and age, gender, and practice-matched children passing screens (n = 241) completed diagnostic evaluations for autism and developmental delay. When referral for autism and/or DD was considered, overall false positives from the autism screens were less frequent than for referral for autism alone. Presence of a failed communication subscale in the developmental screen was a red flag for autism and/or DD. An ordinally-scored autism screen had more favorable characteristics when considering autism and/or DD, yet none of the screens achieved recommended standards at 18 months, reinforcing the need for recurrent screening as autism emerges in early development.
Topics: Child; Humans; Infant; Autistic Disorder; Autism Spectrum Disorder; Surveys and Questionnaires; Parents; Mass Screening
PubMed: 35579791
DOI: 10.1007/s10803-022-05541-y -
BMC Women's Health Mar 2024Breast cancer is a significant public health concern in Jordan. It is the most common cancer among Jordanian women. Despite its high incidence and advanced stage at time...
INTRODUCTION
Breast cancer is a significant public health concern in Jordan. It is the most common cancer among Jordanian women. Despite its high incidence and advanced stage at time of diagnosis, the uptake of breast cancer screening in Jordan is low. This study aims to compare clinical outcomes of both screening and diagnostic mammogram among women in Jordan.
METHODS
A retrospective cohort of 1005 women who underwent mammography in breast imaging unit in a tertiary hospital in Jordan. It aimed to investigate outcomes of screening and diagnostic mammography. recall rates, clinical manifestations and cancer rates were investigated.
RESULTS
A total of 1005 participants were involved and divided into screening group (n = 634) and diagnostic group (n = 371). Women in the diagnostic group were more likely to be younger, premenopausal, smokers with higher BMI. Among the screening group, 22.3% were labeled with abnormal mammogram, 26% recalled for ultrasound, 46 patients underwent tissue biopsy and a total of 12 patients had a diagnosis of breast carcinoma. Among the diagnostic group, the most commonly reported symptoms were a feeling of breast mass, mastalgia and nipple discharge. Abnormal mammogram was reported in 50.4% of women, a complementary ultrasound was performed for 205 patients. A diagnostic Tru-cut biopsy for 144 patients and diagnostic excisional biopsy for 17 patients were performed. A total of 131 had a diagnosis of carcinoma.
CONCLUSION
With the high possibility of identifying a carcinoma in mammography among symptomatic women and low uptake of screening mammogram, efforts to increase awareness and improve access to screening services are crucial in reducing the burden of breast cancer in Jordan.
Topics: Humans; Female; Retrospective Studies; Mammography; Breast Neoplasms; Delivery of Health Care; Carcinoma; Mass Screening; Early Detection of Cancer
PubMed: 38515093
DOI: 10.1186/s12905-024-03007-0