Date Of First Symptoms Research Articles

Do Behavioral Characteristics Influence the Breast Cancer Diagnosis Delay? Evidence From French Retrospective Data

ObjectivesThis study aimed to analyze the behavioral determinants of breast cancer (BC) diagnosis delays in France. To do so, we investigated whether time discounting, risk tolerance, and personality traits influenced the BC diagnosis delay of patients. MethodsWe used original retrospective data collected on 2 large online patient networks from 402 women diagnosed of BC. The BC diagnosis delay was measured by the difference between the date of diagnosis and the date of first symptoms. Time discounting and risk tolerance are measured with both self-reported questions and hypothetical lotteries. Personality traits are measured with the 10-item Big Five indicator. Ordinary least square and probit models were used to analyze whether these behavioral characteristics influenced the BC diagnosis delay. ResultsResults showed that risk tolerance and time discounting were not significantly associated with the BC diagnosis delay. However, we found a longer diagnosis delay for women with a neuroticism personality trait (standardized coefficients ranged from 0.104 [P-value = .036] to 0.090 [P-value = .065]). ConclusionsOverall, our findings underline the need for an increased consideration of cancer screening public health policy for women with mental vulnerabilities since such vulnerabilities were found to be highly correlated with a neuroticism personality trait.

Self-collected gargle fluids and nasopharyngeal swabs as a strategy for molecular diagnostics of respiratory viruses

Diagnosis of respiratory viruses traditionally relies on deep oropharynx or nasopharynx swabs collected by healthcare workers (HCW). However, outpatients must make an appointment, and the procedure can cause discomfort in patients. Self-collecting has the potential as a strategy to improve participants’ willingness to participate in diagnostics, surveillance, or studies.We compared self-collected gargle fluids and nasopharyngeal swabs as a strategy for molecular diagnostics of respiratory viruses and compared the average cycle threshold (Ct)-values with those of samples collected by HCW. The study was conducted among technicians of the Laboratory of Clinical Microbiology and Infectious Diseases, Zwolle, the Netherlands, and their family members, between April 2019 and March 2020. It included a questionnaire regarding the severity and date of first symptoms and an assessment of the sampling experience. The primary outcome was the mean Ct of positive PCRs. Similar mean Ct values were obtained using self- or HCW-collected swabs. In addition, gargle fluids and self-swabbed specimens had comparable detection rates of respiratory viruses. Notably, most participants preferred gargling over self-swabbing. Interestingly, but not surprisingly, the time between the onset of symptoms and sampling was shorter in PCR-positive compared to PCR-negative participants.Though this study was abrogated by the SARS-CoV-2 pandemic, the results indicate that both self-swabs and gargle fluids are acceptable for diagnosing common respiratory viruses in the outpatient population, including influenza virus, rhinovirus, adenovirus, SARS-CoV-2 and endemic human coronaviruses. Gargling could be considered an alternative sampling strategy and may enhance willingness to participate in screenings or diagnostics for respiratory viruses.

361 Carotid Endarterectomy Pathway at a Hub Site – the Impact of COVID-19

Abstract Aim NICE Guidelines recommend that all patients who suffer from a TIA or non-disabling stroke are rapidly assessed and imaged. Patients suspected of having symptomatic carotid stenosis should be referred to a Vascular Centre for consideration of urgent carotid endarterectomy (CEA) within two weeks. Our aim was to assess the current referral-to-treatment timeline for carotid surgery in our Vascular Centre against these standards and explore the impact of the COVID-19 Pandemic on this. Method We retrospectively interrogated the National Vascular Registry to identify patients undergoing CEA “pre-pandemic” (Jan – Dec 2019) and in a “contemporary period” (Jan – Sept 2021) Results A total of 129 patients underwent CEA in the defined periods, including pre-Pandemic (80 patients) and contemporary (49 patients) periods. One patient had to be excluded due to inability to identify date of first symptoms. 2019 Data: The times (median) from symptoms to surgery were 10 days (interquartile range (IQR) 23 days), from imaging-to-referral, one day and from vascular review to surgery, two days. 2021 Data: The times (median) from symptoms to surgery were 10 days (IQR 12 days), from imaging-to-referral, two days and from vascular review to surgery, one day. Conclusions The median time from symptoms to surgery has remained the same from pre-Pandemic data, though there is a decrease in IQR in current practice. We recommend creating a CEA Pathway to optimise the carotid service.

041 Determinants of prolonged time to diagnosis in relapsing-remitting multiple sclerosis in Scotland

BackgroundThere is increasing emphasis on earlier diagnosis in patients with relapsing remitting multiple sclerosis (RRMS) as evidence is accumulating that earlier treatment reduces long-term disability accumu- lation. Much inter-individual variability in time to diagnosis remains unexplained.ObjectivesTo examine factors associated with longer time to diagnosis in a cohort of adult patients diagnosed with RRMS in Scotland between January 2016 and February 2019.MethodsClinical and demographic features were collected as part of an incidence cohort study. Time to diagnosis was defined as interval between date of first symptom to date of diagnosis and considered prolonged if it was greater than the median value. Age at onset, sex, weight, smoking status, employ- ment status, socioeconomic status and onset symptom type were examined for association with time to diagnosis using logistic regression.ResultsWe recruited 440 patients. Median time to diagnosis was 1.75 years. Current employment (OR2.016 [1.186–3.428] p=0.010) was associated with longer time to diagnosis. We found no association with other variables measured.ConclusionsTime to diagnosis in RRMS in Scotland is employment status-dependent. A considerable proportion of variance in time to diagnosis remains unexplained in RRMS.fraser@tonnard.co.uk

MO495: A Comparative Study of Patient Mortality During First and Second Waves of Covid-19 Pandemic in Dialysis Patients and Kidney Transplant Recipients

Abstract BACKGROUND AND AIMS Patients on kidney replacement therapy (KRT) are at a particularly high risk of mortality from COVID-19. In this study, we investigated COVID-19 mortality in KRT patients in the first and second waves of the pandemic and potential reasons for any difference in mortality between the two waves. METHOD Data from the European Renal Association COVID-19 Database (ERACODA) of KRT patients who presented between 1 March 2020 and 28 February 2021 with COVID-19 were analyzed. The cut-off for dividing the first and second waves was set for 1 August 2020. The primary study outcome was 28-day mortality. Multivariable Cox proportional-hazards regression analysis was used to examine the relationship between the pandemic waves and mortality with follow-up time starting at the date of presentation. Dialysis patients and kidney transplant recipients were analyzed separately. RESULTS Among 3004 dialysis patients (1253 in the first and 1751 in the second wave), the 28-day mortality was 24.3% in the first wave and 19.6% in the second wave (P = .002). Compared with the first wave, in the second wave, identification of patients with limited to no symptoms was higher (14.3% versus 24.8%; P < .001), hospitalization was lower (71.3% versus 44.3%; P < .001), but in-hospital mortality was similar (30.4% versus 30.7%; P = .92) (Fig. 1). Crude hazard ratio (HR) for 28-day mortality in the second wave was 0.77 (95% CI: 0.66, 0.89). However, in a fully adjusted model, when correcting for differences in patient and disease characteristics, including the reason for COVID-19 screening and disease severity, the HR for mortality in the second wave was 0.93 [95% confidence interval (95% CI): 0.79–1.10]. When follow-up was chosen to start at the date of first symptoms to account for possible lead-time bias, crude HR for 28-day mortality in the second wave was 0.90 (95% CI: 0.75–1.07) and the fully adjusted HR was 0.98 (95% CI: 0.81–1.18). Among 1035 kidney transplant recipients (475 in the first and 560 in the second wave), results were essentially similar except that patients in the second wave were younger (55.6 years versus 58.2 years; P = .002), and crude HR for 28-day mortality from the date of first symptoms was 0.66 (95% CI: 0.47–0.93), whereas the fully adjusted HR was 1.02 (95% CI: 0.70–1.49). CONCLUSION Among patients on KRT with COVID-19, 28-day mortality rates were lower in the second wave compared with the first wave. However, a greater proportion of patients with minimal symptoms, lead-time bias in dialysis patients, and younger age in kidney transplant recipients possibly explain the lower mortality during the second wave. Any improvement in patient management during the second wave may not be the main reason for lower mortality.

AB1085 ASSESSMENT OF DIAGNOSTIC DELAY IN PATIENTS AFFECTED BY ENTEROPATHIC SPONDYLOARTHRITIS: A CROSS-SECTIONAL STUDY

Background:Diagnostic delay of spondyloarthritis (SpA) has been established even in combination with inflammatory bowel disease and may contribute to radiographic progression and disability.Objectives:We aimed to evaluate diagnostic delay in enteropathic SpA (eSpA) and explore associated demographic, clinical, and radiographic characteristics.Methods:We analysed consecutive eSpA patients referred to the combined gastro-rheumatologic clinic of the University of Rome Tor Vergata. Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Conventional radiography (CR) and magnetic resonance images (MRI) of sacroiliac (SI) joints and spine were performed in axial (ax)SpA patient and examined by two independent radiologists. MRI were assessed for the presence of active/chronic inflammatory lesions, disease activity by ASDAS and inflammatory markers. Statistical analyses were performed using Mann-Whitney, chi square/Fisher tests and covariance analysis (SPSS software).Results:190 eSpA patients (124 female, mean age 47.5±12.8 years, disease duration 72±67.4 months, 73 UC/117 CD; 118 peripheral SpA, 72 axSpA including 44 non radiographic (nr)-axSpA) were evaluated. Axial eSpA patients had a higher prevalence of men sex (p<0.0001), HLA-B27 positivity (p=0.004), uveitis (p=0.01) and pancolitis (p<0.006) compared with peripheral eSpA. AxeSpA patients displayed higher ESR, ASDAS, and VAS pain compared with peripheral ESpA (p=0.0006, p=0.001, p=0.019, respectively). A higher prevalence of csDMARDs was detected in peripheral eSpA compared with axSpA (p=0.002) while treatment with cs and bDMARDs was similar in rad-axSpA and nr-axSpA patients.Median diagnostic delay in eSpA was 48 months (IQR 6-77) with no difference between axial and peripheral patients. Rad-ax-SpA patients displayed a higher diagnostic delay compared with nr-axSpA (median/IQR 36/17-129 vs 31/10-57 months, p=0.03). Patients with rad-axSpA were older and with longer disease duration than patients with nr-axSpA (p=0.005 and p=0.019). Low education status and high rate of employment were found in rad-axSpA compared with nr-axSpA (p=0.003 and p=0.03, respectively).Rad-axSpA patients with sclerosis, syndesmophytes and bridge at CR had a higher diagnostic delay than those without lesions (p=0.03, p=0.043, p<0.0001, Fig. 1A-C). Men showed a higher prevalence of spine damage lesions than women as sclerosis (p=0.02), squaring (p=0.0006), syndesmophytes (p=0.0028) and bridges (p=0.007). Longer disease duration was detected in patients with radiographic damage as bridge (p<0.0001) and sacroiliitis grade 3 (p=0.04). On MRI, SI bone oedema was associated with reduced diagnostic delay (p=0.04) while bone erosions was associated with higher diagnostic delay (p=0.002) compared with that in patients without these lesions (Fig. 1D-E). Rad-axSpA women had a higher prevalence of SI damage lesions at MRI than men (p=0.001). Patients with psoriasis displayed a higher diagnostic delay compared to those without skin involvement (p=0.004).Figure 1.Conclusion:Demographic and clinical factors differentiate axSpA from nr-axSpA patients. Diagnostic delay was higher in rad-axSpA compared with nr-axSpA despite the same treatment. Some lesions of spine/SI at CR and MRI, and psoriasis, were mostly associated with diagnostic delay and sex.Disclosure of Interests:None declared

Spatial and temporal analysis of Hepatitis A cases in fier district, Albania, 1986–2016

Purpose: To document long term changes in the prevalence of Hepatitis A and its use as an indicator of sanitary standards and public health capacity. Methods & Materials: Registers of infectious disease cases maintained by Public Health authorities in Fier District, Albania for the years 1986 – 2016 inclusive were scanned and digitised as part of national project to quantify the burden of such diseases in the population. In total over 21,000 individual records covering 29 separate diseases were computerized of which Hepatitis A was the most common diagnosis with nearly 9,000 recorded cases over the 31-year period. For each case, demographic and biographic details of the patient, as well as key dates such as onset of symptoms, first visit to doctor or clinic, diagnosis, recovery and reporting to PH authorities were recorded. Spatial and temporal analysis of the data were carried out to identify long term trends and geographical distribution of cases. Results: Overall, there was a significant decrease in the number of cases of Hepatitis A from nearly 1300 per year 1986 to less than 100 cases annually from 2003 onwards. In the 4 years 2010 to 2014, a total of 18 cases were recorded. The following year, however, the number of reported cases rose to 92, of which 50 were recorded in a single commune. This outbreak was the subject of substantial media coverage and a detailed investigation by public health authorities which identified a number of contributing factors. Throughout the time series, outbreaks of Hepatitis A occurred at intervals of roughly 4-6 years, the periodicity possibly reflecting waning levels of immunity in the paediatric population. There was also a progressive reduction in the duration of clinical cases (date of first symptoms to date of recovery) attributed to more effective therapeutic options and better overall standards of health care. Conclusion: Using Hepatitis A as a proxy for water borne infectious diseases, the study demonstrated the effects of improvements in water and sewage infrastructure over three decades on the health of the population of Fier District. Continued sporadic cases and localised outbreaks could be used to identify communities where further investment was needed.

Validation of an Algorithm Identifying Incident Primary Immune Thrombocytopenia in the French National Health Insurance Database

Introduction: Population-based studies using health insurance databases are very useful for epidemiological studies, notably for rare diseases such as immune thrombocytopenia (ITP). French health insurance databases, called SNIIRAM (Système d’Information Inter-Régimes de l’Assurance Maladie) cover the entire French population (66 million inhabitants).We developed an algorithm that identifies incident primary ITP cases in the SNIIRAM. The aim of this study was to evaluate the positive predictive value (PPV) of this algorithm.Methods: The SNIIRAM is an electronic database prospectively recording demographic, hospitalization, long term disabling disease (LTD) and out-hospital drugs dispensing as well as other healthcare data.The algorithm used to identify newly diagnosed primary ITP patients follows several steps: 1) extraction of patients with at least one ITP code (D69.3 code of the International Classification of Disease, version 10 -ICD-10) as primary diagnosis during a hospital stay or as LTD; 2) exclusion of patients with ambiguous or contradictory codes, i.e.other D69 ICD-10 codes as LTD or hospital diagnosis between 12 months before and 6 months after the first ITP code, except D69.6 (thrombocytopenia, unspecified) and D69.9 (hemorrhagic condition, unspecified); 3) refining of the presumed date of diagnosis searching ITP drug dispensing in the six-month period before the first ITP code. A six-month wash out period is used to define incident ITP; 4) lastly, secondary ITPs are defined by a LTD or a hospitalization with codes corresponding to hematological malignancies, chronic viral infections and connective tissue diseases between 12 months before and 6 months after the presumed date of diagnosis.For the present validation study, we applied this algorithm to regional SNIIRAM data of the Midi-Pyrénées region (South of France, 3 million inhabitants) to identify incident ITP patients between July 1, 2012 and June 30, 2014. Medical charts were independently reviewed by two investigators.We calculated the PPVs of: 1) the diagnosis of ITP; 2) the fact that ITP was incident or not (compared with the true date of diagnosis and the true date of first ITP symptoms); 3) the identification of secondary ITPs.Results: We identified 200 incident ITP patients in the Midi-Pyrénées regional SNIIRAM during the study period. We could assess by medical chart review 168 cases. At ITP diagnosis, 70.4% of the patients were adults (≥18 years). Median age was 2.8 years in children and 63.0 years in adults. The male:female sex-ratio was 0.83. Overall, 66.6% of the patients had bleeding symptoms. The median platelet count was 10 x 109/L.After medical chart review, 161 cases were true ITP yielding a PPV of 95.8% (95% confidence interval - 95% CI: 92.8-98.8). Among them, 128 were incident according to the date of symptom onset and 134 were incident according to the true diagnosis date yielding PPVs of 79.5% (95% CI: 73.2-85.7) and 83.2% (95% CI: 77.4-89.0), respectively. As expected, the PPV for newly diagnosed ITP was significantly lower in case of low platelet count as first symptom compared tobleeding revealing ITP (respectively, 65.4%, 95% CI: 52.5-78.3 and 92%, 95% CI 86.9-97.0, p=0.08). The median time from the date of first symptoms and the estimated date of ITP onset by the algorithm was 3 days (interquartile range - IQR: 0 to 20). The median time from the true date of diagnosis and the estimated date of ITP diagnosis by the algorithm was 0 days (IQR: 0 to 15).Ten patients were identified as having a secondary ITP using the algorithm: 4 lymphoid neoplasms (2 B-cell lymphoma, 1 Hodgkin lymphoma and 1 chronic lymphoid leukemia), 4 connective tissue diseases (sarcoidosis, rheumatoid arthritis, systemic sclerosis and Sjögren syndrome, 1 case each) and 2 chronic infections (HIV and HCV). There was no misclassification after medical chart review. On the contrary, 7 secondary ITPs identified by medical chart review were not detected by the algorithm: 3 CMV and 1 EBV infections, 1 Waldenström disease, 1 plasmocytoma and 1 myelodysplastic syndrome.Conclusions: This algorithm showed good PPV in identifying incident primary ITP patients and could be extended to other similar databases. The estimated date of ITP onset may be delayed in case of isolated chronic thrombocytopenia because platelet count results are not recorded in the database. The SNIIRAM is not a useful database to detect virus-associated secondary ITP. DisclosuresNo relevant conflicts of interest to declare.

Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients

ObjectivesThe diagnostic delay of axial spondyloarthritis (axSpA) is usually reported to be more than seven years but may have decreased recently. The objective was to quantify the diagnostic delay in patients with axSpA in France and to explore its associated factors. MethodsTwo cross-sectional observational studies included consecutively patients with axSpA (according to both ASAS criteria and rheumatologist expert opinion). Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Potential predictive factors of diagnostic delay analyzed by multiple linear regression were demographic factors, HLA B27 status, year of diagnosis, clinical presentation and sacroiliitis on MRI or radiography. ResultsIn all, 432 patients were analyzed: the mean age at diagnosis was 34.2 (standard deviation, 12.5) years, the mean disease duration at the time of the assessment was 11.4 (10.4) years. In all, 66.7% were HLA B27 positive, and 70.2% had radiographic sacroiliitis. The mean diagnostic delay was 4.9 (6.3) years, with a median of 2.0 years (interquartile range, 1–7; range: 0–43). In multivariable analysis, factors independently associated with a longer diagnostic delay were: higher age at diagnosis (beta=0.13; P<0.001), less frequent peripheral arthritis or dactylitis (beta=−1.69; P=0.005), and more frequent entheseal pain (beta=1.46; P=0.015). ConclusionThe median diagnostic delay was 2 years indicating diagnostic delay may be for most patients shorter than previously reported. A more “typical” SpA clinical presentation was associated with a shorter diagnostic delay, whereas sacroiliitis and HLA B27 positivity were not associated with this delay.

Hereditary angioedema due to C1 - inhibitor deficiency in Switzerland: clinical characteristics and therapeutic modalities within a cohort study.

BackgroundRegistration of trigger factors, prodromal symptoms, swelling localization, therapeutic behavior and gender-specific differences of the largest cohort of patients with hereditary angioedema due to C1-Inhibitor deficiency (C1-INH-HAE) in Switzerland.MethodsQuestionnaire survey within a cohort study: Consenting eligible patients with diagnosed HAE according to clinical history, physical examination and laboratory results, including plasma values for C1-INH and C4 were selected. To each participant we sent a questionnaire assessing patients’ birthday, sex, date of first symptoms and diagnosis, trigger factors, prodromal symptoms, frequency and localization of angioedema, medication use and co-morbidities. Clinical information was collected in each center and then transmitted to the cohort database. Frequencies and distributions were summarized. Associations between gender and trigger factors or prodromal symptoms or localization of angioedema were assessed in multivariate analyses correcting for patients’ age.ResultsOf 135 patients, data from 104 patients (77 %) were available for analysis. Fifty- four percent were female, mean age at diagnosis was 19.5 years (SD 14.1), Mean age when completing the questionnaire was 44.0 (SD 19.8). More women than men were symptomatic (44/57 vs. 36/47; p = 0.005). This association remained when correcting for age at diagnosis (16.10. 95%CI (5.17 to 26.70); p = 0.004). Swelling episodes ranged between 1 and 136 episodes/year. Swelling was more common among female than among male (-13.15 (95 % CI; -23.10 to -3.22), p = 0.010). Age at diagnosis was inversely associated with the total number of attacks 0.50 (-0.88 to -.011); p = 0.012). One third of patients were on danazol prophylaxis.ConclusionWe found large differences of HAE in male and female both in terms of symptom number and swelling episodes. Women are more affected by intensity and frequency of angioedema episodes than men. Danazol treatment remains widely used as effective prophylaxis despite its side effects. New therapies which selectively influence the hormonal estrogen balance could open new therapeutic options mainly for women and maybe also for men.

Prevalence and Risk Factors for Patient Delay Among Women With Breast Cancer in Rural India.

Delay in seeking health care by women with breast cancer increases mortality risk. This study was conducted in rural India to identify risk factors associated with patient delay. A total of 212 women with primary breast cancer diagnosed between 2010 and 2012 were interviewed. Sociodemographic characteristics, time interval between seeking medical attention and appearance of symptoms, and reasons for delay were inquired. Patient delay was defined as more than 3 months between date of first symptoms and medical consultation. Logistic regression was applied to assess associations between potential risk factors and patient delay. Almost half the women with breast cancer experienced patient delay. Age more than 60 years (odds ratio = 4.9, 95% confidence interval = 1.3-18.0) was significantly associated with patient delay. Only 6.6% of patients had heard about breast self-examination. Significantly higher number of patients with delay presented with advanced clinical stage (P = .000). Health education programs should be introduced with specific strategies to shorten patient delay.

AB0297 Does Delay of Therapy Affect Outcomes of Early RA in A T2T Clinic?

BackgroundVery early referral/start of therapy within 3-4 months vs. delayed referral has been shown beneficial for short- and long-term outcomes in rheumatoid arthritis (RA). However, treatment strategy in these studies...

Tuberculosis management time: an alternative parameter for measuring the tuberculosis infectious pool

To demonstrate the application of TB management time as an alternative parameter to estimate the size of the tuberculosis infectious pool in West Gojjam Zone of Amhara Region, Ethiopia. In this study, we used the TB management time, i.e. the number of days from start of cough until start of treatment, to determine the infectious period. Patients with sputum smear-positive and smear-negative pulmonary TB, retreatment and an estimated number of undetected cases were included. The infectious pool was then estimated as the annual number of infectious person days in a defined population. The TB management time of presently undiagnosed TB cases and sputum smear-positive patients contributed significantly to the infectious pool with 151,840 and 128,750 infectious person days per year, respectively. The total infectious pool including sputum smear-negative TB cases and retreatment patients in the study area was estimated at 325,410 person days or 15,447 person days per 100,000 population during the study year. Recording TB management time may be used to estimate the infectious pool of TB and to monitor programme performance in the community.

Agreement between patient-reported and doctor-reported patient intervals and date of first symptom presentation in cancer diagnosis – A population-based questionnaire study

Background: The concept of delay in cancer diagnosis has been a scientific issue for decades, and there is still no standardised and validated way to measure the time intervals. One of the intervals that are difficult to measure is the patient interval (i.e. the period from the patient's first symptom until the first presentation to the health care system) because dates of symptom onset and first presentation are difficult to establish precisely. Further, since patients may have another experience of the diagnostic pathway than e.g. the general practitioner (GP), a reasonable question remains whether patients and GPs agree on these important milestones. The objective of this study was to analyse the agreement between patient-reported and GP-reported patient intervals and date of first presentation of cancer-related symptom(s) to the GP. Methods: On the basis of a cohort study, we included incident cancer patients from the former Aarhus County from 1 September, 2004 to 31 August, 2005. Both patients and GPs reported the length of the patient interval and the date of the first presentation to the GP with a cancer-related symptom measured by self-administered questionnaires. Agreement was measured using agreement-survival plots and Lin's concordance correlation coefficient (CCC). Results: There was full agreement between GP- and patient-reported patient intervals in 21.0% of all the cancer cases. In 50.1% of cases, patients and GPs agreed about the patient interval within a margin of one month. There was full agreement between GP- and patient-reported date of first presentation in 37.5% of the cancer cases and within one week in 52.0% of all the cancer cases. Overall, the agreement on the length of the patient interval was poor (CCC=0.513), but better for patients presenting with alarm symptoms. The agreement was moderate between GP- and patient-reported dates of first presentation (CCC=0.924). Conclusion: We found that GPs systematically reported a longer patient interval than patients did. We found moderate agreement on reported date of first presentation of symptoms to the GP, meaning that the disagreement in reported patient interval is related to date of first symptom rather than date of first presentation to the GP.

Diagnostic and treatment delay, quality of life and satisfaction with care in colorectal cancer patients: a study protocol

BackgroundDue to recent improvements in colorectal cancer survival, patient-reported outcomes, including health-related quality of life and satisfaction with care, have become well-established endpoints to determine the impact of the disease on the lives of patients.The aim of this study is to determine prospectively, in a cohort of colorectal cancer incident cases: a) health-related quality of life, b) satisfaction with hospital-based care, and c) functional status. A secondary objective is to determine whether diagnostic/therapeutic delay influence quality of life or patients’ satisfaction levels.Methods/designSingle-centre prospective follow-up study of colorectal cancer patients diagnosed during the period 2011–2012 (n = 375).This project was approved by the corresponding ethics review board, and informed consent is obtained from each patient. After diagnosis, patients are interviewed by a trained nurse, obtaining information on sociodemographic characteristics, family history of cancer, first symptoms, symptom perception and reaction to early symptoms. Quality of life is assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires, and patients’ satisfaction with care is determined using the EORTC IN-PATSAT32. Functional status is measured with the Karnofsky Performance Status Scale.Clinical records are also reviewed to collect information on comorbidity, tumour characteristics, treatment, hospital consultations and exploratory procedures.Symptoms-to-diagnosis interval is defined as the time from the date of first symptoms until the cytohistological confirmation of cancer. Treatment delay is defined as the time between diagnosis and surgical treatment.All the patients will be followed-up for a maximum of 2 years. For survivors, assessments will be re-evaluated at one and two years after the diagnosis.Multiple linear/logistic regression models will be used to identify variables associated with the patients’ functional status, quality of life and satisfaction with care score. Changes in quality of life over time will be analysed with linear mixed-effects regression models.DiscussionThe results will provide a deeper understanding of the impact of colorectal cancer from a more patient-centred approach, allowing us to identify groups of patients in need of additional attention, as well as areas for improvement. Special attention will be given to the relationship between diagnostic/therapeutic delay and patients’ quality of life and satisfaction with the care received.

Population-Based Surveillance for Neonatal Herpes in New York City, April 2006–September 2010

Population-based data for neonatal herpes simplex virus (HSV) infection are needed to describe disease burden and to develop and evaluate prevention strategies. From April 2006 to September 2010, routine population-based surveillance was conducted using mandated provider and laboratory reports of neonatal HSV diagnoses and test results for New York City resident infants aged ≤60 days. Case investigations, including provider interviews and review of infant and maternal medical charts and vital records, were performed. Hospital discharge data were analyzed and compared with surveillance data findings. Between April 2006 and September 2010, New York City neonatal HSV surveillance detected 76 cases, for an average incidence of 13.3/100,000 (1/7519) live births. Median annual incidence of neonatal HSV estimated from administrative data for 1997 to 2008 was 11.8/100,000. Among surveillance cases, 90.8% (69/76) were laboratory confirmed. Among these, 40.6% (28/69) were HSV-1; 39.1% (27/69) were HSV-2; and 20.3% (14/69) were untyped. The overall case-fatality rate was 17.1% (13/76). Five cases were detected among infants aged >42 days. In all, 80% (20/25) of the case-infants delivered by cesarean section were known to have obstetric interventions that could have increased risk of neonatal HSV transmission to the infant before delivery. Over half (68%, or 52/76) of all cases lacked timely or ideal diagnostics or treatment. Administrative data may be an adequate and relatively inexpensive source for assessing neonatal HSV burden, although they lack the detail and timeliness of surveillance. Prevention strategies should address HSV-1. Incubation periods might be longer than expected for neonatal HSV. Cesarean delivery might not be protective if preceded by invasive procedures. Provider education is needed to raise awareness of neonatal HSV and to assure appropriate testing and treatment.

Survival of head and neck cancer in Greenland

Objectives. Head and neck cancer is frequent in the Inuit population of Greenland and is characterized by a very high incidence of Epstein-Barr virus associated nasopharyngeal carcinoma (NPC). However, information on the treatment and survival of Inuit head and neck cancer patients is practically non-existent. The aim of this study, therefore, was to analyse the epidemiological pattern, time course and survival of head and neck cancer patients in Greenland.Study design. Retrospective register-based study.Methods. The Danish Civil Registration System, the Danish Cancer Registry and hospital-based registries were used to identify all patients resident in Greenland diagnosed with head and neck cancer during the period 1994–2003. Data were analysed with regard to clinical characteristics, treatment delay and survival.Results. A total of 125 patients were identified. The age-standardized incidence rate for all head and neck cancer cases was 28/100,000 for males and 19/100,000 for females. High incidence rates were found for NPC and oral cancers. Of all cancers, 47% were stage IV at the time of diagnosis, while 61% of all NPC’s were stage IV. The median delay from date of first symptom to treatment was 248 days for all cancers. The overall crude 5-year survival rate for all sites together was 35% and for NPC 20%.Conclusion. Survival of head and neck cancer in Greenland is very low. Delays in treatment and inadequate follow-up on treatment complications are probable causes. The improvements in treatment for NPC and other head and neck cancer cases over the last decades are yet to be seen in this Inuit population.

Pediatric Sialendoscopy

To evaluate the outcome of our experience in the treatment of salivary gland disorders in children undergoing sialendoscopy and to assess the evolution of the technique. Retrospective medical record review. Tertiary care university hospital. Thirty-eight children with salivary gland disorders undergoing diagnostic and interventional sialendoscopy between January 1, 2003, and November 30, 2008. Diagnostic and interventional sialendoscopy using general anesthesia. Demographic, clinical, and surgical variables, including age, sex, date of first symptoms, parotid or submandibular location of disease, preoperative ultrasonographic results, sialendoscopy technique, sialendoscopy observations, and complications. Pediatric sialendoscopy was performed on the parotid gland in 23 patients (61%) and on the submandibular gland in 15 patients (39%). The most frequent indication for sialendoscopy was recurrent salivary gland swelling. Thirty-two of 38 procedures (84%) were performed endoscopically, whereas a combined intervention was necessary for 3 patients and a submandibular gland excision for another 3 patients. Sialendoscopy allowed the diagnosis of 12 patients with salivary duct lithiasis, 21 with salivary duct stenosis, and 2 with both submandibular lithiasis and stenosis, and findings from 3 sialendoscopies were normal. Preoperative ultrasonographic results were confirmed by sialendoscopy in only 7 patients. Of the 10 patients with lithiasis found using sialendoscopy, only 4 had been detected using preoperative ultrasonography. Sialendoscopy is a pertinent technique for the diagnosis and treatment of salivary gland disorders in children. It also allows the most conservative treatment of sialolithiasis and juvenile recurrent parotitis.

Vigilância epidemiológica do sarampo e da rubéola no Município de Campinas (SP), Brasil: confiabilidade dos dados

To evaluate and validate the information concerning measles and rubella from the Brazilian National Disease Notification System (BNDNS) (Sistema Nacional de Informação de Agravos de Notificação, or SINAN) for Campinas, a large city in the state of São Paulo, Brazil, using as a reference the data from a control system, the Syndromic Surveillance System for Fever and Exanthem (SSSFE) (Sistema de Vigilância Sindrômica de Febre e Exantema, or VigiFEx), which operated from May 2003 through June 2004. In our study we compared: (1) annual data from BNDNS for the years 1999 through 2003 and (2) data from BNDNS and data from SSSFE for the period of June 2003 through May 2004. We analyzed the rate of completion for key fields (record number, date of notification, and city of notification) as well as for name of disease, date of first symptoms, name of patient, birth date and age, sex, city of residence, date of investigation, immunization history, presence of exanthem, date at start of exanthem, presence of fever, suspected cases among pregnant women, signs and symptoms, date of collection of first sample, results with the sample, virus isolation, final classification, criteria for confirmation/exclusion of cases, diagnosis of excluded patients, development of the case, and date of closure. The level of agreement between the recorded cases in the two data banks was also analyzed. From June 2003 through May 2004, 211 suspected cases of measles or rubella were identified in SSSFE and 275 in BNDNS. All the records had complete information concerning the three key fields. The rate of completion was also 100% for patient name, disease, and city of residence. The completion rate was higher than 95% for date of investigation, measles vaccine, measles and rubella vaccine, and rubella vaccine. A lower completion rate was found for other vaccination variables (number of doses and date of last dose) and for exanthem, fever, and date of start of exanthem. The two information systems were not completely consistent, particularly in terms of variables related to epidemiologic background, clinical data, and case closure. The quality of the SSSFE data was higher. Epidemiologic surveillance, immunization, and laboratory information systems need to undergo routine evaluation to ensure that the data are reliable and can support the planning of public health efforts.

Recent Use of Oral Contraceptives and the Risk of Multiple Sclerosis

Exogenous estrogens affect the onset and clinical course of experimental allergic encephalomyelitis. Oral contraceptives, a frequent source of exogenous estrogens in humans, could have a role in the development of multiple sclerosis (MS). To examine whether recent oral contraceptive use and pregnancy history are associated with the risk of MS. A case-control study nested in the General Practice Research Database. This database contains prospective health information (drug prescriptions and clinical diagnoses) on more than 3 million Britons who are enrolled with selected general practitioners. One hundred six female incident cases of MS, younger than 50 years, with at least 3 years of continuous recording in the General Practice Research Database before the date of first symptoms (index date), identified between January 1, 1993, and December 31, 2000, and 1001 controls matched on age, practice, and date of joining the practice. Main Outcome Measure Incidence of first symptoms of MS, confirmed through medical records. The incidence of MS was 40% lower (odds ratio, 0.6; 95% confidence interval, 0.4-1.0) in oral contraceptive users compared with nonusers during the previous 3 years. The risk of MS increased in the 6 months after pregnancy (odds ratio, 2.9, 95% confidence interval, 1.2-6.6), but it was not otherwise related to parity. The hormonal changes that occur during oral contraceptive use and pregnancy may be associated with a short-term reduction in the risk of MS, and the postpartum period may be associated with a short-term increase in the risk of MS.