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Annals of Emergency Medicine Jan 2021There has been increasing attention to screening for health-related social needs. However, little is known about the screening practices of emergency departments (EDs)....
STUDY OBJECTIVE
There has been increasing attention to screening for health-related social needs. However, little is known about the screening practices of emergency departments (EDs). Within New England, we seek to identify the prevalence of ED screening for health-related social needs, understand the factors associated with screening, and understand how screening patterns for health-related social needs differ from those for violence, substance use, and mental health needs.
METHODS
We analyzed data from the 2018 National Emergency Department Inventory-New England survey, which was administered to all 194 New England EDs during 2019. We used descriptive statistics to compare ED characteristics by screening practices, and multivariable logistic regression models to identify factors associated with screening.
RESULTS
Among the 166 (86%) responding EDs, 64 (39%) reported screening for at least one health-related social need, 160 (96%) for violence (including intimate partner violence or other violent exposures), 148 (89%) for substance use disorder, and 159 (96%) for mental health needs. EDs reported a wide range of social work resources to address identified needs, with 155 (93%) reporting any social worker availability and 41 (27%) reporting continuous availability.
CONCLUSION
New England EDs are screening for health-related social needs at a markedly lower rate than for violence, substance use, and mental health needs. EDs have relatively limited resources available to address health-related social needs. We encourage research on the development of scalable solutions for identifying and addressing health-related social needs in the ED.
Topics: Cross-Sectional Studies; Domestic Violence; Emergency Service, Hospital; Humans; Mass Screening; Needs Assessment; New England; Social Work; Substance-Related Disorders
PubMed: 33160720
DOI: 10.1016/j.annemergmed.2020.08.010 -
The American Journal of the Medical... Oct 2021Exposure to cadmium and lead is widespread, and is related to environmental contamination, occupational sources, food, tobacco and other consumer products. Lower... (Review)
Review
Exposure to cadmium and lead is widespread, and is related to environmental contamination, occupational sources, food, tobacco and other consumer products. Lower socioeconomic status increases the risk of heavy metal exposure and the diseases associated with cadmium and lead toxicity. Concurrent toxicity with both cadmium and lead is likely but has not often been assessed. There is now substantial evidence linking cadmium and lead to many diseases including hypertension, diabetes mellitus, obesity, cancer, coronary artery disease, chronic kidney disease (CKD) and lung disease. Both chronic renal failure and ischemic heart disease patients have been treated separately in recent studies with calcium disodium ethylenediaminetetraacetic acid (Ca EDTA) chelation therapy. In patients with CKD, serum creatinine 1.5-4.0 mg/dL, and increased body lead burden, weekly low dose chelation with Ca EDTA slowed the rate of decline in renal function in diabetics and non-diabetics. In patients with a history of myocardial infarction, the Trial to Assess Chelation Therapy (TACT) study showed that Ca EDTA chelation decreased the likelihood of cardiovascular events, particularly in diabetics. Ca EDTA chelation administered carefully at lower dosage (<50 mg/kg per week) is generally safe. In the past, acute renal failure associated with much higher dosage was reported. We suggest that the preponderance of the evidence favors a more activist approach towards diagnosis and possible intervention in heavy metal toxicity.
Topics: Cadmium Poisoning; Humans; Lead Poisoning; Mass Screening
PubMed: 34048724
DOI: 10.1016/j.amjms.2021.05.019 -
Journal of Clinical Nursing Jun 2024To synthesise the literature about transgender and non-binary people's experiences of cervical cancer screening and identify ways to improve screening. (Review)
Review
AIM(S)
To synthesise the literature about transgender and non-binary people's experiences of cervical cancer screening and identify ways to improve screening.
BACKGROUND
Transgender people often face barriers to accessing health services including cervical screening, where transgender people have a lower uptake than cisgender women.
DESIGN
A scoping review was undertaken following the Arksey and O'Malley (2005) framework and the PRISMA-ScR checklist. Following database searching of Medline via PubMed, Web of Science, Scopus and CINHAL, 23 papers published between 2008 and 2003 were included. Papers were included if they shared trans and non-binary people's experiences of cervical screening and were written in English. There were no date or geographical data restrictions due to the paucity of research.
RESULTS
Transgender people experience barriers to cervical screening including gender dysphoria, a history of sexual trauma, and mistrust in health professionals or health services, which can result in having negative experiences of screening or avoiding screening. Health professionals can help to create a positive experience by informing themselves about best practices for trans+ health.
CONCLUSION
Changes are required to improve transgender people's experiences and uptake of cervical screening. Improving medical education about trans health and updating health systems would help to combat issues discussed.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
Having an understanding of the reasons why accessing health services can be more difficult for transgender people will help health professionals to provide appropriate care for transgender patients. This paper details this in the context of cervical cancer screening and can be applied to other areas of healthcare.
REPORTING METHOD
We have adhered to relevant EQUATOR guidelines and used the PRISMA-ScR reporting method. No Patient or Public Contribution.
Topics: Adult; Female; Humans; Male; Middle Aged; Early Detection of Cancer; Health Services Accessibility; Mass Screening; Transgender Persons; Uterine Cervical Neoplasms
PubMed: 38334194
DOI: 10.1111/jocn.17023 -
Public Health Research & Practice Jul 2019
Topics: Adult; Aged; Aged, 80 and over; Australia; Breast Neoplasms; Colorectal Neoplasms; Early Detection of Cancer; Female; Forecasting; Humans; Male; Mass Screening; Middle Aged; Uterine Cervical Neoplasms
PubMed: 31384882
DOI: 10.17061/phrp2921909 -
Pediatric Annals Oct 2019Development is a core part of the care we provide to our pediatric patients. It should be monitored and evaluated at every visit. Whether it is performing a risk...
Development is a core part of the care we provide to our pediatric patients. It should be monitored and evaluated at every visit. Whether it is performing a risk assessment, longitudinal surveillance, or a formal developmental screen, this important element of pediatric medicine is a part of every interaction that we have with our patients and their families. Identifying developmental delays early and helping families to access appropriate interventions is key to providing successful outcomes for these patients. To detect delays, we must commit to using standardized screening tools and become comfortable with their interpretation. The more opportunities we have to interact with our young patients, the more opportunities we have to assess and intervene when developmental differences are noted. This ensures the best possible outcomes for our pediatric patients. [Pediatr Ann. 2019;48(10):e381-e384.].
Topics: Child, Preschool; Developmental Disabilities; Early Diagnosis; Humans; Infant; Mass Screening; Primary Health Care
PubMed: 31609994
DOI: 10.3928/19382359-20190918-02 -
Public Health Feb 2020The prevention of colorectal cancer (CRC) attainable from introducing once-in-a-lifetime flexible sigmoidoscopy (FSIG) screening was assessed. (Review)
Review
OBJECTIVES
The prevention of colorectal cancer (CRC) attainable from introducing once-in-a-lifetime flexible sigmoidoscopy (FSIG) screening was assessed.
STUDY DESIGN
This is a review of relevant available information for the assessment of the impact and resource demands of FSIG in New Zealand.
METHODS
The reduction in bowel cancer incidence achievable by one-off FSIG screening from 50 to 59 years of age, an age group for which bowel screening is not currently offered, was reviewed. The prevention of CRC attainable from an offer of screening at 55 years of age in New Zealand was also estimated. The number and cost of the FSIG screening procedures required and referrals for colonoscopies and the savings in treatment were calculated.
RESULTS
Annually, about 27,500 FSIG screening procedures would be required if 50% of those turning 55 years of age accepted an offer of once-in-a-lifetime FSIG screening. This would result in three-four-fold fewer people being referred for colonoscopy than in the national 2-yearly faecal immunochemical test (FIT) screening programme and subsequently reduce demand for colonoscopy from a false-positive FIT. The number of CRC cases prevented would increase over 17 years to more than 300 per year by 2033. After 10-15 years of screening, the annual savings in health service costs, primarily from CRC prevented, were sufficient to completely fund the FSIG screening.
CONCLUSIONS
Inclusion of FSIG screening in the national bowel screening programme would significantly reduce both the incidence and mortality of CRC in New Zealand, reduce the colonoscopy demand of current bowel screening and reduce long-term health service costs.
Topics: Colorectal Neoplasms; Costs and Cost Analysis; Early Detection of Cancer; Female; Humans; Male; Mass Screening; Middle Aged; New Zealand; Sigmoidoscopy
PubMed: 31726398
DOI: 10.1016/j.puhe.2019.09.021 -
The Journal of Prevention of... 2020
Topics: Alzheimer Disease; Cognitive Dysfunction; Early Diagnosis; Humans; Mass Screening; Mental Status and Dementia Tests; Primary Health Care
PubMed: 32463065
DOI: 10.14283/jpad.2020.16 -
PloS One 2022We sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin.
OBJECTIVES
We sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin.
DESIGN
Mixed-methods, cross-sectional study with a cost assessment.
SETTING
Eight participating health facilities in Cotonou, Benin.
PARTICIPANTS
Consecutive pregnant women presenting for antenatal care at any participating site who were not in labor or currently being treated for TB from April 2017 to April 2018.
INTERVENTIONS
Screening for the presence of TB symptoms by midwives and Xpert MTB/RIF for those with cough for at least two weeks. Semi-structured interviews with 14 midwives and 16 pregnant women about experiences with TB screening.
PRIMARY AND SECONDARY OUTCOME MEASURES
Proportion of pregnant women with cough of at least two weeks and/or microbiologically confirmed TB. The cost per pregnant woman screened and per TB case diagnosed in 2019 USD from the health system perspective.
RESULTS
Out of 4,070 pregnant women enrolled in the study, 94 (2.3%) had a cough for at least two weeks at the time of screening. The average (standard deviation) age of symptomatic women was 26 ± 5 years and 5 (5.3%) had HIV. Among the 94 symptomatic women, 2 (2.3%) had microbiologically confirmed TB for a TB prevalence of 49 per 100,000 (95% CI: 6 to 177 per 100,000) among pregnant women enrolled in the study. The average cost to screen one pregnant woman for TB was $1.12 USD and the cost per TB case diagnosed was $2271 USD. Thematic analysis suggested knowledge of TB complications in pregnancy was low, but that routine TB screening was acceptable to both midwives and pregnant women.
CONCLUSION
Enhanced screening for TB among pregnant women is feasible, acceptable, and inexpensive per woman screened, however in this setting has suboptimal yield even if it can contribute to enhance TB case finding.
Topics: Adolescent; Adult; Benin; Costs and Cost Analysis; Female; Humans; Mass Screening; Middle Aged; Pregnancy; Pregnancy Complications; Pregnant Women; Prevalence; Tuberculosis, Pulmonary
PubMed: 35192665
DOI: 10.1371/journal.pone.0264206 -
Infectious Disease Clinics of North... Sep 2019Profound changes in technology have revolutionized laboratory testing for human immunodeficiency virus (HIV) since the first laboratory enzyme immunoassays that detected... (Review)
Review
Profound changes in technology have revolutionized laboratory testing for human immunodeficiency virus (HIV) since the first laboratory enzyme immunoassays that detected only immunoglobulin G (IgG) antibodies. Instrumented fourth-generation random-access chemiluminescent assays are now recommended for initial screening because they become reactive in as little as 2 weeks after infection. Using HIV-1 RNA viral load assays after a reactive initial test could confirm infection and provide useful clinical information. Early initiation of antiretroviral therapy and use of preexposure prophylaxis can alter the evolution of biomarkers and assay reactivity, leading to ambiguous test results.
Topics: Diagnostic Tests, Routine; HIV Infections; Humans; Immunoassay; Mass Screening; Molecular Diagnostic Techniques
PubMed: 31239094
DOI: 10.1016/j.idc.2019.04.001 -
Journal of Gastrointestinal Cancer Mar 2021Colorectal cancer is one of the most sprayed cancers; the gold standard of diagnostic is a colonoscopy. The quality of this examination is depended on many factors,...
INTRODUCTION
Colorectal cancer is one of the most sprayed cancers; the gold standard of diagnostic is a colonoscopy. The quality of this examination is depended on many factors, which includes doctors' experience.
PURPOSE
The purpose of this study is to establish the main factors affecting the completeness of colonoscopy in colorectal cancer screening.
MATERIALS AND METHODS
Endoscopists were questioned; descriptive statistics methods and logistic regression were used.
RESULTS AND DISCUSSION
The main factors that influence the quality of screening colonoscopy were identified: experience in colonoscopy, theoretical training, participation in the screening program, and number of annual colonoscopies. The calculated odds ratio for the selected dependent variable is calculated.
CONCLUSIONS
The experience for more than 5 years (p = 0.017) and at least 200 colonoscopies per year (p = 0.004) are the main factors that allow to perform complete colonoscopy in 90% or more of cases.
Topics: Clinical Competence; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Humans; Mass Screening; Quality Improvement; Surgeons; Surveys and Questionnaires
PubMed: 32303997
DOI: 10.1007/s12029-020-00402-2