Preventive Screening Research Articles

Interest in Lung Screening among a Sample of Adult Muslims in the United States

Objectives. Muslims in the United States exhibit high rates of tobacco use, which make them highly vulnerable to lung cancer. Lung cancer could be avoided by regularly undergoing preventive lung screening. This study investigated the associations between Social Cognitive Theory factors and being interested in preventive lung screening in a sample of adult US Muslims. Methods. We examined a convenience sample of adult US Muslims. A cross-sectional online survey was used to collect data. Binomial logistic regression analyses were conducted to identify the factors related to interest in preventive lung screening. Key Findings. Two hundred seventy-one eligible participants (≥18 years old Muslim individuals who live in the US) from 30 states completed the questionnaire. Individuals were more likely to express an interest in lung cancer screening if they had 1) more positive attitudes about lung screening, 2) a higher perceived value of screening, and 3) greater self-efficacy regarding the ability to undergo lung screening. Conclusion. Addressing attitudes, perceived value, and self-efficacy in future interventions could increase interest in preventive lung screening amongst adult US Muslims.

Prevalence and predictors of colon and prostate cancer screening among volunteer firefighters: The United States Firefighter Cancer Assessment and Prevention Study.

Although firefighters have increased risk for colon and prostate cancer, limited information exists on screening practices for these cancers in volunteer firefighters who compose two-thirds of the US fire service. We estimated the prevalence of colon and prostate cancer screening among volunteer firefighters using eligibility criteria from 4 evidence-based screening recommendations and evaluated factors influencing screening. We evaluated colon (n = 569) and prostate (n = 498) cancer screening prevalence in a sample of US volunteer firefighters using eligibility criteria from the US Preventive Services Taskforce (USPSTF), National Fire Protection Association, American Cancer Society, and National Comprehensive Cancer Network. We assessed associations with fire service experience, demographics, and cancer risk perception based on USPSTF guidelines. For those eligible based on USPSTF guidelines, colon and prostate cancer screening prevalence was 51.7% (95% CI: 45.7, 57.8) and 48.8% (95% CI: 40.0, 57.6), respectively. Higher odds of colon and prostate cancer screening were observed with older age and with some college education compared to those with less education. Fire service experience and cancer risk perception were not associated with screening practices. This is the first large study to assess colon and prostate cancer screening among US volunteer firefighters based on different screening guidelines. Our findings suggest gaps in cancer prevention efforts in the US volunteer fire service. Promoting cancer screening education and opportunities for volunteer firefighters by their fire departments, healthcare professionals, and public health practitioners, may help to address the gaps.

Significance of HIV status in cervical cancer patients receiving curative chemoradiation therapy, definitive radiation alone, or palliative radiation in Botswana.

Cervical cancer associated with human papillomavirus has the highest cancer incidence and mortality for women in Botswana because of a high HIV prevalence and limited screening. This study investigates the significance of HIV on the overall survival (OS) of patients with locally advanced cervical cancer by various treatment categories (curative chemoradiation, definitive radiation [RT] alone, or palliative RT alone). This study included patients diagnosed with cervical cancer between 2013 and 2020, prospectively enrolled in the Botswana Prospective Cancer Cohort. OS based on HIV status and completion of planned treatment regimen was estimated by the Kaplan-Meier method. Comparisons of 2-year OS by HIV status was performed by the log-rank test, univariate and multivariable Cox analyses adjusting for cancer stage, RT dose, number of chemotherapy cycles, and baseline hemoglobin levels. Of 1131 patients diagnosed with stage IB-IVB cervical cancer, 69.8% were women living with HIV (n=789). For patients receiving curative chemoradiation, HIV status was not significantly associated with OS in unadjusted (p=.987) and adjusted (p=.578) analyses. For RT only treatment and definitive (high-dose) RT alone, HIV status was significantly associated with OS in unadjusted analysis (HR=1.77, p=.002; HR=1.95, p=.014), but not in adjusted analysis (p=.227, p=.73). For patients receiving palliative (low-dose) RT, HIV status was not associated with OS in unadjusted (p=.835) or adjusted analysis (p=.359). In Botswana, a resource-limited setting, HIV status had no significant effect on 2-year OS in patients with cervical cancer with well-managed HIV receiving chemoradiation, RT alone, or palliative RT. This demonstrates that patients living with HIV receiving antiretroviral treatment can receive clinically appropriate treatment with no evidence that HIV may lead to poorer outcomes.

Therapeutic Effect Analysis of Cervical Cancer Vaccine

Cervical cancer is a very widespread carcinogenic condition that poses a significant threat to women's health. The primary cause of this condition is mostly linked to persistent infection with high-risk strains of human papillomavirus (HPV), which are recognized for their ability to promote the development of cancer. Due to HPV infection, both therapeutic and preventative HPV vaccinations have been developed. Therapeutic vaccines can eradicate viruses and virus-infected cells by stimulating cellular immunity. Notwithstanding the availability of preventive HPV vaccinations, HPV screening, surgery, radiotherapy, and chemotherapy, the therapeutic effect on cervical cancer patients is limited. Therefore, therapeutic vaccines have emerged as a new treatment option. The cancer-causing proteins E6 and E7, which are consistently detected in cervical cancer and precancerous lesions, are crucial in the progression and sustenance of cervical cancer. Consequently, these cancer-causing proteins present an encouraging opportunity for the research and creation of therapeutic cervical cancer vaccines. The multiple therapeutic vaccines against cervical cancer will be briefly discussed in this article, including their mechanisms, development methods, and clinical effects.

Abstract 4858: Examining state- and race-specific five-year prostate cancer mortality rates (2016-2020) and their association with prostate-specific antigen screening

Abstract Background: In 2023, 34,000 US men will die from prostate cancer. The impact of prostate cancer mortality varies greatly across states. Racial differences in state populations may explain some but not all of this variability. This study examined prostate cancer mortality rates by state and race and their associations with state-level prostate-specific antigen (PSA) screening prevalence. Methods: We obtained race-specific, state level five-year average age-standardized prostate cancer mortality rates from 2016-2020 from the NCI State Cancer Profiles. Data on race-specific, state level PSA screening prevalence in 2010 were obtained from the Behavioral Risk Factor Surveillance System. We compared mortality rate ratios (RR, 95% confidence intervals [CI]) of state level prostate cancer mortality rates of Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Native men to White men. We generated descriptive statistics (median and range) on state level mortality rates to quantify the variability within racial/ethnic groups. We fit univariable Poisson regression models to explore associations between prostate cancer mortality rates and PSA screening prevalence, for White, Black, and Hispanic men, but omitted Asian and American Indian men due to sparse data. Results: Mortality data were available for 50 states and the District of Columbia (D.C.) for White, 40 states and D.C. for Black, 36 states for Hispanic, 24 states for Asian, and 11 states for American Indian men. The US average prostate cancer mortality rate was 18.8 deaths per 100,000 per year. As expected, rates were higher among Black than White men (RR 2.07; 1.90, 2.24), while rates among Hispanic (RR 0.75; 0.68, 0.84) and Asian (RR 0.48; 0.41, 0.56) men were lower. Rates among American Indian men were slightly higher than White men (RR 1.12; 0.96, 1.29). Variability of state-level mortality rates within each race was quite high, with largest ranges for Black and American Indian men. Black men had a median (range) state-level prostate cancer mortality rate of 37.9 (23.9 to 49.2), and American Indian men had a median rate of 20.4 (7.7 to 28.9). Median (range) rates were 17.7 (11.3 to 22.3) for White, 8.3 (4.3 to 17.4) for Asian, and 13.5 (8.9 to 22.5) for Hispanic men. Associations between a 5-percentage point increase in PSA screening prevalence and prostate cancer mortality rates were RR 0.92 (95% CI: 0.84, 0.99) in White, RR 0.96 (0.88, 1.05) in Black, and 0.98 (0.90, 1.07) in Hispanic men. Conclusion: There is considerable variability in prostate cancer mortality rates across states, both between and within racial/ethnic groups, highlighting complexity of racial disparities. PSA screening may weakly contribute to this variability, but other factors such as health care access, social determinants, and lifestyle factors that vary between states should be considered in future studies. Citation Format: Hannah E. Guard, Jane B. Vaselkiv, Ethan Ecsedy, Florian Kuechen, Nareg Minassian, James Dun Rappaport, Zhiyu Qian, Michelle O. Sodipo, Kathryn L. Penney, Konrad H. Stopsack, Lorelei A. Mucci. Examining state- and race-specific five-year prostate cancer mortality rates (2016-2020) and their association with prostate-specific antigen screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4858.

Abstract 7475: The contribution of the oral bacteriome and mycobiome in cancer risk in people with HIV in Puerto Rico

Abstract Although under highly effective antiretroviral therapy, people with HIV (PWH) still experience an increased risk of developing cancer compared to people without HIV (PWOH). Dysbiosis of the oral microbiota in PWH can contribute to persistent inflammation and cancer risk. We previously showed higher levels of inflammation in saliva of PWH measured by TGF-β1 and IL-2. In addition, microbial products such as short-chain fatty acids (SCFA) can regulate the transcription of immune-related genes, particularly those necessary for the innate immune response to pathogens. In this study, we characterized the composition of the oral bacteriome and mycobiome in saliva of Puerto Rican PWH and PWOH, and analyzed these data in relation to markers of inflammation and cancer risk in saliva. Saliva, sociodemographic, and clinical data from 100 adults were collected (50 PWH and 50 PWOH). PWH were virally suppressed (<50 copies/mL) and had a median CD4 count of 699.8 cells/µL. We sequenced the 16S rDNA and the ITS in extracted DNA from saliva to characterize and quantify the bacterial and fungal communities, respectively. Furthermore, measurement of inflammatory markers (TGF-β1, IL-2, and IL-8) in saliva was performed using quantitative immunoassays. Microbiome data was processed using Qiime2, and statistical analysis was carried out using R-statistical software. Biological pathways associated to changes in the microbiome were inferred using PiCRUST2. PWH showed lower alpha diversity in the oral bacteriome (Observed OTUs: p=0.02, Faith: p=0.03) and oral mycobiome (Shannon: p=0.02) when compared to PWOH. In a multivariate analysis, lower alpha diversity in the bacteriome was associated with biological sex and HIV status. Lower alpha diversity in the oral bacteriome was associated with higher levels of acetate (r=-0.38, p<0.001) and lower levels of IL-8 (r= 0.21, p= 0.056) in saliva independent of HIV status. Taxonomic analyses showed PWH had a significantly lower abundance of Porphyromonas, Peptostreptococcus, Oribacterium, Parvimonas, Leptotrichia, Fusobacterium, Eubacterium, Dialister, and Alkalibacter genera of bacteria but there not significant changes in taxonomy in the oral mycobiome. Biological processes significantly affected by dysbiosis of the oral mycobiome include cytosolic and mitochondrial NADPH production, amino acid and sugar degradation, and phospholipid remodeling. Dysbiosis of both the oral bacteriome and mycobiome occur in HIV infection, which can contribute to chronic inflammation. However, the bacteriome and mycobiome may have different biological mechanisms, which suggest different roles in increasing cancer risk in Puerto Rican PWH. These findings provide more information regarding the oral health in people with HIV and may contribute to innovative cancer prevention strategies and screening guidelines for this high-risk population. Citation Format: Veronica Sofia Sanchez Gonzalez, Yakshi N. Ortiz-Maldonado, Gabriel Borges-Vélez, Tanner L. Shull, Jeannette L. Salgado-Montilla, Josué Pérez-Santiago1. The contribution of the oral bacteriome and mycobiome in cancer risk in people with HIV in Puerto Rico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7475.

Abstract 254: Triggering head and neck cancer cell cornification leads to mucosa-like differentiation, chromatin remodeling, and loss of cell malignancy

Abstract Head and neck squamous cell carcinoma (HNSCC) is the 6th most common tumor disease worldwide with a death rate of about 50%. As mortality and morbidity of affected patients were not substantially improved in recent decades, new treatment options are urgently needed. HNSCCs that are negative for the human papillomavirus are characterized by areas of differentiated keratinized tissue. Dissecting the mechanisms regulating this terminal differentiation of HNSCC cells may unravel targets with high potential for anti-tumor therapy. Using primary tumor-initiating spheroid cells, we established a model of HNSCC cell differentiation by cornification and observed a deprivation of cell malignancy leading to the adhesion of spheroid cells, loss of single-cell cloning capacity, and diminished tumor-initiating potential in immunodeficient mice. Analysis of our differentiation model employing ATAC-seq, RNA-seq, and proteomics showed an increased accessibility of small promoter regions despite overall genome closure, activation of a wound healing-associated signaling program, and upregulation of the stress keratin 17 (KRT17) as well as cornification markers including SPRR3. These results suggest that the differentiation of HNSCC cells resembles the differentiation process in other stem cell-maintained tissue systems. Multi-marker immunofluorescence analysis of human tissue revealed a reversion of the role of KRT17 from a basal stem-cell marker in normal mucosa to an early differentiation marker in HNSCC tissue and dysplastic mucosa preceding cornification. This proposes KRT17 as potential biomarker for HNSCC prevention screening. Human tissue analysis identified distinct cell differentiation states shared between HNSCC tissue and normal mucosa that were detected in higher and lower differentiated tumor tissue of distinct anatomical sub-locations. Cornification was observed to be induced at the interface between vital tumor tissue and necrotic, immune-infiltrated areas in human HNSCCs, suggesting a promoting influence of pro-inflammatory stimuli on cell differentiation. Treatment of tumor spheroids with inflammatory mediators resulted in cell attachment and cornification, indicating a potential strategy to stop the self-renewal of HNSCC cells. Our study thus reveals that the targeted differentiation of HNSCC tumor-initiating cells could be used as a future therapy approach against squamous cell carcinomas of the head and neck and other tissues. Citation Format: Felix Oppel, Sarah Gendreizig, Laura Martinez-Ruiz, Javier Florido, Alba López-Rodríguez, Harkiren Pabla, Lakshna Loganathan, Leonie Hose, Philipp Kühnel, Pascal Schmidt, Matthias Schürmann, Judith M. Neumann, Flavian Viyof Ful, Lars Uwe Scholtz, Ingo Todt, Ligum Dina, Frank Brasch, Niehaus Karsten, Germaine Escames, Tobias Busche, Jörn Kalinowski, Peter Goon, Holger Sudhoff. Triggering head and neck cancer cell cornification leads to mucosa-like differentiation, chromatin remodeling, and loss of cell malignancy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 254.

Prevalence of Lung Cancer Screening in the US, 2022

This cross-sectional study compares lung cancer screening prevalence in 2022 among individuals eligible by 2021 vs 2013 criteria by sociodemographics and state.

Abstract P507: Adherence to Pediatric Screening Guidelines for Cardiovascular Risk Factors in a Diverse Cohort of Children in Chicago

Background: Preventive screenings in children and adolescents encourage maintenance of optimal cardiovascular health (CVH) early in life, but there may be a gap between recommendations and clinical practice. We evaluated adherence to pediatric guidelines for universal age-based and risk-based screening for body mass index (BMI), blood pressure (BP), lipids, and blood glucose. Methods: We used 2010-2018 ambulatory visit data from children aged 2-12y within CAPriCORN, an electronic health record network from major healthcare systems in Chicago. For each child who attended a well-child visit and met age and/or risk-based criteria, receipt of BMI, BP, lipids, and/or HbA1c or fasting blood glucose measurements were assessed. For each metric, proportion adherence was calculated via generalized estimating equations with an exchangeable correlation structure and was stratified by age, sex, race/ethnicity, and insurance status. Results: This study included 87,549 children who attended 197,559 well-child encounters. Across all encounters, children were 51.5% male and mean (SD) age 6.4 (3.3) years. Universal age-based screening prevalence (95% CI) per 100 eligible children was 77.1 (76.8, 77.3) for BMI, 33.4 (33.1, 33.7) for BP, and 9.6 (9.3, 9.9) for lipids. Risk-based screening prevalence (95% CI) per 100 eligible children was 13.9 (12.2, 15.9) for BP, 6.9 (6.4, 7.5) for lipids, and 13.3 (12.6, 14.1) for blood glucose. Conclusions: Early screening of CVH risk factors could lead to earlier interventions, which could alter CVH trajectories across the lifetime. Low levels of adherence to universal age-based and risk-based CVH screening highlight the gap between recommendations and clinical practice, emphasizing the need to understand and address barriers to screening in pediatric populations.

Abstract P171: Patient and Interdisciplinary HIV Care Experts Illness Representations on HIV Comorbidities and Usability of a Virtual Environment as Heart Disease Prevention Education in Ethnic and Racial Sexual Minority Men With HIV

Background: Black and Latinx sexual minority men with HIV are at increased risk of CVD and have been underrepresented in clinical trials. The American Heart Association has called for an increase in interventions that focus on enhancing cardiovascular health in underserved communities by addressing social determinants and modifiable risk factors of CVD. Objective: To explore patient and HIV care experts’ perceptions about HIV comorbidities and assess usability of a virtual environment as CVD prevention education in Black and Latinx sexual minority men with HIV. Methods: This two-phase study is part of a pilot behavioral clinical trial informed by the American Heart Association’s metrics for cardiovascular health. Qualitative Phase 1 data were collected June 2021 to May 2022. Phase 2 data were collected August 2022 to October 2022. Using convenience sampling, we recruited a) Black and Latinx sexual minority men with HIV, and b) interdisciplinary HIV care experts. Eligibility criteria for non-HIV care experts were: 1) self-identify as gay or bisexual; 2) HIV serostatus positive; 3) ages 30 to 65; 4) access to a laptop or desktop. We explored HIV comorbidities of concern and conducted usability testing of the virtual environment. Eighty-four pages of interview data were analyzed using NVivo 12. Results: Phase 1 themes included: Mixed Perceptions about Health, High Risk for Comorbidities, and Virtual Environment Features. CVD risk factors were consistently expressed in relation to HIV, including hypertension, heart attack, stroke, and diabetes. Additionally, kidney, and liver disease were identified as important. Cancer was a common concern and so were the development of mental health conditions. All participants in Phase 2 completed the usability checklist with favorable feedback. Conclusions: We identified hypertension, diabetes, asthma, and cancer were comorbidities of concern. These findings carry significant implications for mitigating barriers to preventative health screenings in Black and Latinx sexual minority men with HIV, given shared risk factors between HIV, CVD, and cancer. We also found that usability of a virtual environment as CVD prevention education was promising as it offered anonymity and access to reliable health information that traverses geography. A virtual environment may serve as a novel modality for extending the reach of prevention education and clinical trials into the hands of ethnic and racial, sexual minoritized individuals that have been underrepresented in advancements in health equity.

Pretransplant Screening for Prevention of Hyperacute Graft Loss in Pig-to-primate Kidney Xenotransplantation.

Xenotransplantation using pig organs is now a clinical reality. However, the process for xenograft recipient screening lacks clarity and scientific rigor: no established thresholds exist to determine which levels of preformed antipig natural antibodies (Nabs) will be safe for clinical xenograft transplantation, and hyperacute rejection (HAR) or acute humoral xenograft rejection (AHXR), which still impacts pig-to-primate kidney xenograft survivals, may impede broader application of pig-to-human clinical xenograft transplantation. We retrospectively examined 28 cases of pig-to-baboon kidney xenotransplantation using GalTKO±human complement regulatory protein (hCRP)-transgenic (Tg) pig donors, as well as 6 cases of triple-KO multi-Tg (10GE) pig donors, and developed screening algorithms to predict risk of HAR/AHXR based on recipient antipig Nab levels. Preformed Nabs were evaluated using both complement-dependent cytotoxicity and antibody (IgM and IgG) binding flow-cytometry assays. High complement-dependent cytotoxicity was associated with HAR/AHXR as expected. However, we also found that high levels of IgG were independently associated with HAR/AHXR, and we developed 2 indices to interpret and predict the risk of IgG-mediated HAR/AHXR. Based on the data in this study, we have established a new 2-step screening, which will be used for future clinical kidney xenotransplantation trials.

The Gail Model and Its Use in Preventive Screening: A Comparison of the Corbelli Study.

Background This study aims to determine the usage of the Gail model in screening for breast cancer during physical examinations of women by sampling primary care physicians in two regions of Texas - Hidalgo County and Johnson County.A Gail score of 1.66% or higher indicates increased breast cancer risk.Three specialties are surveyed: internal medicine (IM), family medicine (FM), and gynecology (GYN). The null hypothesis for this study is that primary care physicians do not use the Gail model in screening for breast cancer during physical examinations of women. Methods A survey was distributed to 100 physicians with specialties in IM, FM, and GYNfrom May 2022 to July 2022.The survey assessed the physician's frequency of use of the Gail model and chemoprevention.Data were collected by distributing survey questionnaires to physicians in person.Descriptive statistics were used for response distributions. Fisher's exact probability test was used for comparisons across specialties. Results The response rate was 34% (34/100).Thirty-eight percent of the physicians surveyed reported using the Gail model in their practice (IM 46%, FM 23%, and GYN 31%).All 13 of the physicians using the Gail model were open to using chemoprevention. Conclusions Only 38% of the physicians surveyed responded that they use the Gail model in their practice. The study concluded that a minority of primary care physicians used the Gail modelto decrease breast cancer risk.Further research would help to define better the Gail model and its use in preventing breast cancer in women.The Gail model appears to be beneficial to breast cancer risk reduction; however, risk reduction medication side effects need to be minimized.

Risk assessment of airborne agricultural pesticide exposure in humans in rural China.

Continuous exposure to airborne pesticides causes their gradual accumulation in the human body, eventually posing a threat to human health. To the best of our knowledge, risk assessment study of pesticide non-occupational exposure to residents in agricultural areas has not been conducted in China. In this study, air samples (gas and dust) were collected from inside and outside residences of seven households and an area near the field in a grain-growing area (wheat and maize rotation) for eight months, and the pesticides present were examined both qualitatively and quantitatively. Using a 95% confidence interval, 9 out of 16 pesticides were detected, namely acetamiprid, acetochlor, atrazine, flucarbazone-sodium, imidacloprid, methyldisulfuron-methyl, nicosulfuron-methyl, pendimethalin, and beta-cyhalothrin, and their safety was subsequently evaluated. The results showed that the inhalation exposure of households to beta-cyhalothrin exceeded the acceptable range in the first residential, and the excess lifetime cancer risk of acetochlor inhalation exposure in six households and area around the field exceeds 1E-6, which highlights the need to strengthen preventive screening for cancer risk.

Cervical cancer screening and its associated factors among women of reproductive age in Kenya: further analysis of Kenyan demographic and health survey 2022

IntroductionAlthough cervical cancer screening is one of the most effective strategies to reduce the incidence and mortality of cervical cancer, the percentage of cervical cancer screening in low- and middle-income counties is low. In Kenya, the current nationwide prevalence and associated factors for the detection of cervical cancer is unknown. Therefore, this study aimed to assess the prevalence and associated factors for the detection of cervical cancer screening among women of reproductive age in Kenya using the Kenyan Demographic and Health Survey 2022.MethodsThis study used the most recent Kenyan Demographic and Health Survey data (2022) with a total weighted sample of 16,901 women. A mixed effects logistic regression analysis was performed and in the multivariable analysis, variables with a p-value below 0.05 were considered statistically significant. The strength of the association was evaluated using adjusted odds ratios along with their corresponding 95% confidence intervals.ResultsThe prevalence of cervical cancer screening in Kenya was 16.81%(95% CI: 16.24, 17.38%). Having a history of abortion (AOR = 1.33, 95% CI: 1.171.50, 1.43), using modern contraceptive methods (AOR = 1.57, 95% CI: 1.25, 1.95), media exposure (AOR = 1.31, 95%CI: 1.03, 1.65), primary education (AOR = 1.56, 95%CI: 1.09, 2.22), secondary education (AOR = 21.99, 95% CI: 1.1.38, 2.87), higher education (AOR = 2..50, 95% CI: 1.71, 3.65), visiting health facility within the past 12 months (AOR = 1.61, 95%CI: 1.46, 1.79), positive HIV status (AOR: 3.50, 95% CI: 2.69, 4.57), being from a community with a higher proportion of educated individuals (AOR = 1.37, 95%CI: 1.13, 1.65) and being from a community with high proportion of poor individuals (AOR = 0.72, 9 5%CI: 0.60–0.87)) were significantly associated with cervical cancer screening.ConclusionIn Kenya, the prevalence of cervical cancer screening was found to be low. A history of abortion, use of modern contraceptives, exposure to the media, visits to health facilities in the past 12 months, HIV status, level of education, community educational level, and community wealth were identified as significant associated factors for cervical cancer screening. Therefore, it is recommended to implement targeted public health interventions that focus on these identified factors to improve the adoption of cervical cancer screening in Kenya.

Mendelian randomization supports genetic liability to hospitalization for COVID-19 as a risk factor of pre-eclampsia.

Pre-eclampsia and eclampsia are among the major threats to pregnant women and fetuses, but they can be mitigated by prevention and early screening. Existing observational research presents conflicting evidence regarding the causal effects of coronavirus disease 2019 (COVID-19) on pre-eclampsia risk. Through Mendelian randomization (MR), this study aims to investigate the causal effect of three COVID-19 severity phenotypes on the risk of pre-eclampsia and eclampsia to provide more rigorous evidence. Two-sample MR was utilized to examine causal effects. Summary-level data from genome-wide association studies (GWAS) of individuals of European ancestry were acquired from the GWAS catalog and FinnGen databases. Single-nucleotide polymorphisms associated with COVID-19 traits at p < 5 × -8 were obtained and pruned for linkage disequilibrium to generate instrumental variables for COVID-19. Inverse variance weighted estimates were used as the primary MR results, with weighted median and MR-Egger as auxiliary analyses. The robustness of the MR findings was also evaluated through sensitivity analyses. Bonferroni correction was applied to primary results, with a p < 0.0083 considered significant evidence and a p within 0.083-0.05 considered suggestive evidence. Critical ill COVID-19 [defined as hospitalization for COVID-19 with either a death outcome or respiratory support, OR (95% CI): 1.17 (1.03-1.33), p = 0.020] and hospitalized COVID-19 [defined as hospitalization for COVID-19, OR (95% CI): 1.10 (1.01-1.19), p = 0.026] demonstrated suggestive causal effects on pre-eclampsia, while general severe acute respiratory syndrome coronavirus 2 infection did not exhibit a significant causal effect on pre-eclampsia. None of the three COVID-19 severity phenotypes exhibited a significant causal effect on eclampsia. Our investigation demonstrates a suggestive causal effect of genetic susceptibility to critical ill COVID-19 and hospitalized COVID-19 on pre-eclampsia. The COVID-19 severity exhibited a suggestive positive dose-response relationship with the risk of pre-eclampsia. Augmented attention should be paid to pregnant women hospitalized for COVID-19, especially those needing respiratory support.

Identify risk factors affecting participation of Turkish women in mammography screening for breast cancer prevention

PurposeCancer screening is a public health intervention aiming to reduce cancer-caused deaths. This study aims to determine the factors affecting the mammography screening time among women aged 40–69.MethodsThe micro dataset obtained from the Türkiye Health Survey conducted by the Turkish Statistical Institute (TurkStat) in 2019 and 2022 was used in the present study. Stereotype logistic regression was used to determine the variables affecting mammography screening and period for breast cancer prevention in women in Türkiye.ResultsGiven the results achieved from the analysis, it was found that factors such as age, marital status, general health condition, comorbidity, receiving psychosocial support, high blood lipid levels, and performing breast self-examinations affected women’s adherence to cancer screening programs.ConclusionSince adherence to mammography increases with age, it is recommended to pay importance to education for women approaching the age of mammography screening. Educated individuals are expected to have access to multiple sources of information as to cancer and to access this information more easily. In order to gain more insight into the recommended preventive measures and outcomes related to cancer, it is suggested to review policies, which will increase the educational level of women, and provide privileges in the field of education.

Breast cancer screening among Medicare Advantage enrollees with dementia

BackgroundThe decision to screen for breast cancer among older adults with dementia is complex and must often be individualized, as these individuals have an elevated risk of harm from over-screening. Medicare beneficiaries with dementia are increasingly enrolling in Medicare Advantage plans, which typically promote receipt of preventive cancer screening among their enrollees. This study examined the utilization of breast cancer screening among Medicare enrollees with dementia, in Medicare Advantage and in fee-for-service Medicare.MethodsWe conducted a pooled cross-sectional study of women with Alzheimer’s disease and related dementias or cognitive impairment who were eligible for mammogram screening. We used Medicare Current Beneficiary Survey data to identify utilization of biennial mammogram screening between 2012 and 2019. Poisson regression models were used to estimate prevalence ratios of mammogram utilization and to calculate adjusted mammogram rates for Medicare Advantage and fee-for-service Medicare enrollees with dementia, and further stratified by rurality and by dual eligibility for Medicare and Medicaid.ResultsMammogram utilization was 16% higher (Prevalence Ratio [PR] 1.16; 95% CI: 1.05, 1.29) among Medicare Advantage enrollees with dementia, compared to their counterparts in fee-for-service Medicare. Rural enrollees experienced no significant difference (PR 0.99; 95% CI: 0.72, 1.37) in mammogram use between Medicare Advantage and fee-for-service Medicare enrollees. Among urban enrollees, Medicare Advantage enrollment was associated with a 21% higher mammogram rate (PR 1.21; 95% CI: 1.09, 1.35). Dual-eligible Medicare Advantage enrollees had a 34% higher mammogram rate (PR 1.34; 95% CI: 1.10, 1.63) than dual-eligible fee-for-service Medicare enrollees. Among non-dual-eligible enrollees, adjusted mammogram rates were not significantly different (PR 1.11; 95% CI: 0.99, 1.24) between Medicare Advantage and fee-for-service Medicare enrollees.ConclusionsMedicare beneficiaries age 65–74 with Alzheimer’s disease and related dementias or cognitive impairment had a higher mammogram use rate when they were enrolled in Medicare Advantage plans compared to fee-for-service Medicare, especially when they were dual-eligible or lived in urban areas. However, some Medicare Advantage enrollees with Alzheimer’s disease and related dementias or cognitive impairment may have experienced over-screening for breast cancer.

Estimating the economic burden of stroke in China: a cost-of-illness study

ObjectivesStroke imposes a heavy economic burden and loss of productivity on individuals and society. This study assessed a range of crucial factors, including direct costs and indirect costs, to gauge...

The impact of electronic health records on patient care and outcomes: A comprehensive review

Electronic Health Records (EHRs) have revolutionized healthcare delivery, offering numerous benefits for patient care and outcomes. This comprehensive review examines the impact of EHRs on patient care and outcomes, highlighting key findings from existing literature. EHRs have significantly improved patient care by enhancing accessibility and accuracy of patient information. With EHRs, healthcare providers can easily access patient records, including medical history, medications, and lab results, leading to more informed decision-making and improved coordination of care. EHRs also facilitate communication among healthcare providers, enabling better care coordination and reducing medical errors. Moreover, EHRs have been shown to improve patient outcomes by supporting evidence-based practices and clinical decision-making. EHRs can provide alerts and reminders for preventive care and screenings, helping healthcare providers adhere to best practices and guidelines. Additionally, EHRs enable real-time monitoring of patient data, allowing for early detection of potential health issues and timely interventions. Despite these benefits, challenges remain in the implementation and use of EHRs. Issues such as interoperability, data security, and provider burnout need to be addressed to fully realize the potential of EHRs in improving patient care and outcomes. In conclusion, EHRs have had a transformative impact on patient care and outcomes, improving accessibility, accuracy, and coordination of care. However, ongoing efforts are needed to address challenges and ensure the effective use of EHRs in healthcare delivery.

Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19

Introduction: Early in the COVID-19 pandemic, routine sexually transmitted infection (STI) screenings decreased, and test positivity rates increased due to limited screening appointments, national-level STI testing supply shortages, and social distancing mandates. It is unclear if adolescent preventive STI screening has returned to pre-pandemic levels and if pre-existing disparities worsened in late-pandemic. Methods: This cross-sectional study examined 22,974 primary care visits by 13-19-year-olds in the Philadelphia metropolitan area undergoing screening for gonorrhea and chlamydia in a 31-clinic pediatric primary care network during 2018-2022. Using interrupted-time-series analysis and logistic regression, pandemic-related changes in the asymptomatic STI screening rate and test positivity were tracked across patient demographics. Neighborhood moderation was investigated by census-tract-level Child Opportunity Index in 2023. Results: The asymptomatic STI screening rate dropped by 27.8 percentage points (pp) and 13.5pp when the pandemic and national STI test supply shortage began, respectively, but returned to pre-pandemic levels after supply availability was restored in early 2021. Non-Hispanic-Black adolescents had a significant pandemic drop in STI screening rate, and it did not return to pre-pandemic levels (-3.6 pp in the late-pandemic period, p< 0.01). This decrease was more pronounced in socioeconomically and educationally disadvantaged neighborhoods (7.5 pp and 9.9 pp lower, respectively) than in advantaged neighborhoods (both p< .001), controlling for sex, age, insurance type and clinic characteristics. Conclusions: Neighborhood socioeconomic and educational disadvantage amplified racial-ethnic disparities in STI screening during the pandemic. Future interventions should focus on improving primary care utilization of non-Hispanic-Black adolescents to increase routine STI screening and preventive care utilization.