Preventive Screening Research Articles

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.

Community Health Navigators for Cancer Screening Among Deaf, Deafblind, and Hard of Hearing Adults Who Use American Sign Language

Deaf, deafblind, and hard of hearing (DDBHH) individuals experience barriers to accessing cancer screening, including ineffective patient-physician communication when discussing screening recommendations. For other underserved communities, culturally and linguistically aligned community health navigators (CHNs) have been shown to improve cancer screening and care. A needs assessment study was conducted to identify barriers and gather recommendations for CHN training resources. A community-based participatory needs assessment was conducted from May 2022 to June 2022 using three focus groups. Eight were cancer survivors, six advocates/navigators, and three clinicians. All questions were semi-structured and covered screening barriers, observations or personal experiences, perceived usefulness of having a CHN to promote cancer screening adherence, and training resources that may be useful to American Sign Language (ASL)–proficient CHNs, who are also culturally and linguistically aligned. Out of 20 focus group participants, seven self-identified as persons of color. Data highlighted systemic, attitudinal, communication, and personal-level barriers as recurrent themes. The most frequently cited barrier was access to training that supports the role and competencies of CHNs, followed by cultural considerations, access to cancer guidelines in ASL, dialect diversity in sign language, and the health system itself. Unaddressed barriers can contribute to health disparities, such as lower preventive cancer screening rates amongst DDBHH individuals. The next step is to translate recommendations into actionable tasks for DDBHH CHN training programs. As a result, CHNs will be well-equipped to help DDBHH individuals navigate and overcome their unique barriers to cancer screening and healthcare access.

Mental health disorder symptoms among serving Royal Canadian Mounted Police

ABSTRACT The Royal Canadian Mounted Police (RCMP) experience extraordinary exposures to diverse occupational stressors, potentially exacerbated by systemic stressors (e.g., public calls for pervasive organizational changes, the COVID-19 pandemic, natural disasters). The current study was designed to assess the mental health of currently serving RCMP (n = 1348) who completed an online survey from June 2022 to February 2023. The positive screening prevalence for any mental health disorder was higher (ps<.05) for current participants (64.7%) than previously reported for RCMP members (50.2%), diverse public safety personnel (44.5%), and the general population diagnostic prevalence (10.1%). Women were less likely (ps<.05) to screen positive for posttraumatic stress disorder and alcohol use disorder than men participants. RCMP participants evidenced substantially more mental health challenges than previous assessments, underscoring urgent and growing needs for proactive, ongoing, evidence-based supports for RCMP mental health, at the individual, organizational, and structural levels.

PASS to End TB in Europe: Accelerated efforts on prevention and systematic screening to end tuberculosis in the WHO European Region by 2030

ObjectivesOutline the objectives, methods, and initial stages of the Prevention and Systematic Screening (PASS) initiative, a complimentary element of the innovative new approach of technical assistance mechanisms of WHO and its partners to countries aligned to the Regional TB Action Plan to End TB in the European Region by 2030. DesignTo provide an objective and critical overview of the existing landscape on TB epidemic in the WHO European Region (the European Region) and ii) identify the strategic significance of proactive measures aimed at approaching TB pre-elimination in the Region. ResultsInterventions primarily include systematic screening for TB disease and treatment for TB infection (TBI). ConclusionsPASS to End TB is an exemplary initiative of how technical and funding partners are joining hands to support national health programmes to work towards global commitments to curb major public health challenges like TB.

Metabolic-associated fatty liver disease and hepatocellular carcinoma: a prospective study of characteristics and response to therapy.

The rising incidence of hepatocellular carcinoma (HCC) in Australia is related to increasing rates of metabolic-associated fatty liver disease (MAFLD). This study aimed to prospectively characterize the metabolic profile, lifestyle, biometric features, and response to treatment of HCC patients in an Australian population. Multicenter prospective cohort analysis of newly diagnosed HCC patients at six multidisciplinary team meetings over a 2-year period. Three hundred and thirteen (313) newly diagnosed HCC patients with MAFLD (n=77), MAFLD plus other liver disease (n=57) (the "mixed" group), and non-MAFLD (n=179) were included in the study. Alcohol-associated liver disease (ALD) (43%) and MAFLD (43%) were the most common underlying liver diseases. MAFLD-HCC patients were older (73years vs 67years vs 63years), more likely to be female (40% vs 14% vs 20%), less likely to have cirrhosis (69% vs 88% vs 85%), showed higher ECOG, and were less likely to be identified by screening (29% vs 53% vs 45%). Metabolic syndrome was more prevalent in the MAFLD and mixed groups. The severity of underlying liver disease and HCC characteristics were the same across groups. While the MAFLD population self-reported more sedentary lifestyles, reported dietary patterns were no different across the groups. Dyslipidemia was associated with tumor size, and those taking statins had a lower recurrence rate. Equal to ALD, MAFLD is now the most common underlying liver disease seen in HCC patients in Australia. Future HCC prevention screening and treatment strategies need to take this important group of patients into consideration.

Resilient back-propagation machine learning-based classification on fundus images for retinal microaneurysm detection.

The timely diagnosis of medical conditions, particularly diabetic retinopathy, relies on the identification of retinal microaneurysms. However, the commonly used retinography method poses a challenge due to the diminutive dimensions and limited differentiation of microaneurysms in images. Automated identification of microaneurysms becomes crucial, necessitating the use of comprehensive ad-hoc processing techniques. Although fluorescein angiography enhances detectability, its invasiveness limits its suitability for routine preventative screening. This study proposes a novel approach for detecting retinal microaneurysms using a fundus scan, leveraging circular reference-based shape features (CR-SF) and radial gradient-based texture features (RG-TF). The proposed technique involves extracting CR-SF and RG-TF for each candidate microaneurysm, employing a robust back-propagation machine learning method for training. During testing, extracted features from test images are compared with training features to categorize microaneurysm presence. The experimental assessment utilized four datasets (MESSIDOR, Diaretdb1, e-ophtha-MA, and ROC), employing various measures. The proposed approach demonstrated high accuracy (98.01%), sensitivity (98.74%), specificity (97.12%), and area under the curve (91.72%). The presented approach showcases a successful method for detecting retinal microaneurysms using a fundus scan, providing promising accuracy and sensitivity. This non-invasive technique holds potential for effective screening in diabetic retinopathy and other related medical conditions.

Knowledge, Attitudes, and Prevalence of Cervical Cancer Screening Among Women in Garissa County

Background: Globally, cancer is a leading cause of death, with cervical cancer being particularlyprevalent in sub-Saharan Africa, including Kenya. Despite being preventable, cervical cancer remains asignificant health burden due to low screening awareness and socioeconomic disparities. In Kenya, it isthe second most frequent cancer among women. This is exacerbated by high HPV infection rates,underscoring the critical need for effective screening strategies. This study assessed the knowledge,attitudes, and prevalence of cervical cancer screening among women in Garissa County.Methods: A descriptive cross-sectional study involving 480 women was conducted in Savannah RoyalHospital, Garissa from January 31st to February 4th, 2023. The study employed questionnaires toassess the knowledge and attitudes of women toward cervical cancer screening, alongside visualinspection with acetic acid (VIA) to determine the prevalence of cervical cancer. Participants wereselected through convenience sampling after a public awareness drive, and informed consent wasobtained from all participants.Results: Of 480 women screened, 96% (462) and 4% (18) tested negative and positive for cervicalcancer, respectively. Notably, 66% (315) were unaware of cervical cancer screening prior to the study,with 82.1% citing lack of awareness as the reason for not being previously screened. Regardingattitudes, 65.1% reported no discomfort during screening, 71.9% rated the experience positively, and50% felt no embarrassment in seeking a repeat VIA or Papanicolaou smear. Most women (72%)preferred receiving the results in person, and 97% were willing to undergo follow-up tests if the screeningresults were positive.Conclusion: The study highlights a significant lack of awareness of cervical cancer screening amongwomen in Garissa County, yet reveals positive attitudes toward screening. This suggests that enhancingawareness could lead to higher screening participation. The 4% positivity rate emphasizes the necessityof ongoing screening initiatives.

TRACKING OF COMMON MENTAL DISORDER IN CARERS OF ADULTS AND ELDERLY INSTITUTIONALIZED IN SOUTHEAST GOIANO

Objective: To characterize caregivers of institutionalized elderly people in terms of sociodemographic, health, employment profile and common mental suffering. Method: Cross-sectional study carried out with caregivers of institutionalized residents in cities in Southeast Goiás, from September to December 2021. Results: 14 caregivers participated in the study, the majority of whom were female (92.9%), at least 24 years old and maximum age of 56 years (average of 37.93 years), time working as a caregiver, up to 1 year (42.9%). Regarding common mental disorder (CMD), there was positive screening for CMD in six caregivers (42.9%). The questions that scored the most in the positive screening scores for CMD were: “gets scared easily” and “feels nervous, tense or worried” (8.43%). Suicidal ideation was revealed in 2 caregivers (14%), who were already being monitored. Conclusion: It is concluded that the majority of women play the role of caregiver, with a length of service of up to five years in the LTCFs investigated. The prevalence of positive screening for CMD was almost half of the caregivers.

Perceptions of HIV-Related Comorbidities and Usability of a Virtual Environment for Cardiovascular Disease Prevention Education in Sexual Minority Men With HIV: Formative Phases of a Pilot Randomized Controlled Trial.

Sexual minority men with HIV are at an increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and clinical trials. This study aims to explore perceptions of HIV-related comorbidities and assess the interest in and usability of a virtual environment for CVD prevention education in Black and Latinx sexual minority men with HIV. This is a 3-phase pilot behavioral randomized controlled trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with a total of 25 individuals. In phase 1, a total of 15 participants completed interviews exploring HIV-related illnesses of concern that would be used to tailor the virtual environment. In phase 2, usability testing and beta testing were conducted with 10 participants to assess interest, features, and content. In phase 1, we found that CVD risk factors included high blood pressure, myocardial infarction, stroke, and diabetes. Cancer (prostate, colon, and others) was a common concern, as were mental health conditions. In phase 2, all participants completed the 12-item usability checklist with favorable feedback within 30 to 60 minutes. Beta-testing interviews suggested (1) mixed perceptions of health and HIV, (2) high risk for comorbid conditions, (3) virtual environment features were promising, and (4) the need for diverse avatar representations. We identified several comorbid conditions of concern, and findings carry significant implications for mitigating barriers to preventive health screenings, given the shared risk factors between HIV and related comorbidities. Highly rated aspects of the virtual environment were anonymity; meeting others with HIV who identify as gay or bisexual; validating lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) images and content; and accessibility to CVD prevention education. Critical end-user feedback from beta testing suggested more options for avatar customization in skin, hair, and body representation. Our next phase will test the virtual environment as a new approach to advancing cardiovascular health equity in ethnic and racial sexual minority men with HIV. ClinicalTrials.gov NCT04061915; https://clinicaltrials.gov/study/NCT05242952. RR2-10.2196/38348.

Public and dental teams' views about weight management interventions in dental health settings: Systematic review and meta-analysis.

Collaborative approaches across healthcare to address obesity are needed but intervention in dental settings is not widely implemented. Here we systematically synthesized the views of both the public and dental teams about delivering weight management interventions in dental settings and identified potential barriers to implementation. A systematic review of five databases from inception to April 3, 2023 was completed. Proportional meta-analyses were performed with quantitative data and thematic analysis of qualitative data. A total of 7851 studies were screened and 33 included in the review. The prevalence of height and weight screening in dental settings varied (4%-87%) with an average of 29% undertaking screening (p = <0.01; 95% CI: 14%-46%). A significant proportion of the public were supportive of weight screening in dental settings (83%; p = <0.01; 95% CI:76%-88%). Significant barriers to providing weight screening and/or intervention included fear of offending patients (57%; 95% CI: 45%-68%) and a lack of time (48%; 95% CI: 30%-66%). Qualitative data revealed further barriers including stigmatizing views of dental teams toward people living with overweight/obesity. Enablers of weight discussion included associating weight with oral health. Overall, whilst some barriers were identified, there is potential for weight management interventions to be used more routinely in dental settings.

Deep Learning-based Ensemble Approach for Conventional Pap Smear Image Classification

Cervical cancer screening allows the early signs of precancerous abnormalities in the cervix before they develop into invasive cancer. The Pap Smear is a widely used screening for early detection and prevention of cervical cancer. In many remote areas, the number of cytologists available to interpret pap smear screening tests is insufficient. This lack of personnel makes the test interpretation very time-consuming. To address this, deep learning techniques have been employed to detect cervical cancer cells and support cytologists. Therefore, an integrative approach with deep learning models and the ensemble techniques such as the maximum occurrence and the maximum probability score of cervical cells was proposed. The multi-cell assessment of the Pap smear slide allowed aggregate predictions of single cervical cell images using the proposed method. The classification results between pre-trained deep learning models and the proposed method were compared. In the experimental results, the proposed method can achieve an accuracy score of more than 97%, while the best pre-trained deep learning model can attain an accuracy score of more than 85%. Hence, the proposed method may have the potential to assist physicians or cytologists in the classification of cervical cell types for Pap Smear images.

Patterns of Cancer-Related Healthcare Access across Pennsylvania: Analysis of Novel Census Tract-Level Indicators of Persistent Poverty.

Persistent poverty census tracts have had ≥20% of the population living below the federal poverty line for 30+ years. We assessed the relationship between persistent poverty and cancer-related healthcare access across census tracts in Pennsylvania. We gathered publicly available census tract-level data on persistent poverty, rurality, and sociodemographic variables, as well as potential access to healthcare (i.e., prevalence of health insurance, last-year check-up), realized access to healthcare (i.e., prevalence of screening for cervical, breast, and colorectal cancers), and self-reported cancer diagnosis. We used multivariable spatial regression models to assess the relationships between persistent poverty and each healthcare access indicator. Among Pennsylvania's census tracts, 2,789 (89.8%) were classified as non-persistent poverty, and 316 (10.2%) were classified as persistent poverty (113 did not have valid data on persistent poverty). Persistent poverty tracts had lower prevalence of health insurance [estimate = -1.70, standard error (SE) = 0.10], screening for cervical cancer (estimate = -4.00, SE = 0.17) and colorectal cancer (estimate = -3.13, SE = 0.20), and cancer diagnosis (estimate = -0.34, SE = 0.05), compared with non-persistent poverty tracts (all P < 0.001). However, persistent poverty tracts had higher prevalence of last-year check-up (estimate = 0.22, SE = 0.08) and screening for breast cancer (estimate = 0.56, SE = 0.15; both P < 0.01). Relationships between persistent poverty and cancer-related healthcare access outcomes differed in direction and magnitude. Health promotion interventions should leverage data at fine-grained geographic units (e.g., census tracts) to motivate focus on communities or outcomes. Future studies should extend these analyses to other states and outcomes to inform public health research and interventions to reduce geographic disparities.

Temporal Trends in Practice Patterns After Introduction of Pediatric Hypertension Guidelines in Canada

In 2016 and 2017, respectively, new Canadian and US guidelines for diagnosis and management of pediatric hypertension (HTN) were published. Six years after their publication, it is unknown whether the recommendations have led to changes in primary care practice patterns. To determine whether HTN guidelines are associated with changes in practice patterns among primary care clinicians. This retrospective, multicenter, population-based cohort study was conducted across 3 phases: January 1, 2011, to December 31, 2015 (era 1), January 1, 2016, to December 31, 2017 (washout period), and January 1, 2018, to December 31, 2019 (era 2). Data were collected from 7 Canadian provinces using the Canadian Primary Care Sentinel Surveillance Network Electronic Medical Record database. Eligible participants included children and adolescents (aged ≥3 to <18 years) with 1 or more encounters in the database. Data analysis was conducted from February 2022 to February 2023. Implementation of the 2016 Hypertension Canada and 2017 American Academy of Pediatrics guidelines. The primary outcomes were annual BP screening documentation, high BP follow-up documentation at 6 months and 1-year, HTN prevalence, laboratory testing rates, and medication prescription rates. Interrupted time series analysis was used to assess the association of the introduction of the Canadian and US guidelines with outcomes. The study included 343 191 children and adolescents (mean [SD] age at first encounter, 6.7 (4.6) years; 173 290 female [50.5%]; 169 901 male [49.5%]), including 235 094 patients in era 1 and 193 473 patients in era 2. In era 1, 55 550 patients (23.6%) had at least 1 BP measurement, and in era 2, 45 006 patients (23.3%) had at least 1 BP measurement. There was a significant increase in BP screening in era 2 from 26 876 of 148 554 screenings (18.1%) to 28 556 of 141 192 screenings (20.2%; β = 0.202; 95% CI, 0.009 to 0.390; P = .04), and the increasing trend was sustained. There was a significant decrease in the trend of follow-up of high BP measurement at 6 months (1265 of 4941 patients with BP measurements [25.6%] to 1718 of 7321 patients with BP measurements [23.5%]; β = -0.490; 95% CI, -0.758 to -0.223; P = .001) and 1 year (1974 of 4941 measurements [40.0%] to 2314 of 7321 measurements [31.6%]; β = -1.392; 95% CI, -1.573 to -1.212; P < .001) in era 2. The proportion of patients meeting HTN criteria significantly increased from 2540 of 55 550 patients (4.6%) in era 1 to 5690 of 45 006 patients (12.6%) in era 2 (β = 0.0210; 95% CI, 0.0021 to 0.0410; P = .03). There was no significant change in the trend of laboratory testing rates in era 2 (949 of 4941 patients tested [19.2%] to 1149 of 7321 patients tested [15.7%]; β = -0.159; 95% CI, -0.364 to 0.046; P = .12). The trend in prescribing of medications to patients with HTN also decreased in era 2 (1305 of 4941 patients prescribed medication [26.4%] to 1415 of 7321 patients prescribed medication [19.3%]; β = -0.605; 95% CI, -0.830 to -0.358; P < .001). The findings of this cohort study within the Canadian primary care setting suggest that there was a significant increase in BP screening and HTN prevalence after the publication of national and international HTN guidelines; however, the follow-up of high BP was still suboptimal. Increasing rates of pediatric HTN emphasize the need for better adherence to pediatric HTN guidelines to improve care and outcomes.