Regular Mail Research Articles

Bladder Cancer detection by urinary methylation markers GHSR/MAL: a validation study

PurposeAlthough cystoscopy is a reliable tool for detecting bladder cancer, it poses a high burden on patients and entails high costs. This highlights the need for non-invasive and cost-effective alternatives. This study aimed to validate a previously developed urinary methylation marker panel containing GHSR and MAL.MethodsWe enrolled 134 patients who underwent cystoscopy because of hematuria, including 63 individuals with primary bladder cancer and 71 with non-malignant findings. Urine samples were self-collected at home and sent via regular mail. Subsequently, DNA was extracted and the hypermethylation of GHSR and MAL was evaluated using quantitative methylation-specific polymerase chain reaction. The performance of methylation markers was assessed using area-under-the-curve (AUC) analysis and sensitivity and specificity based on pre-established cut-off values.ResultsValidation of the marker panel GHSR/MAL resulted in an AUC of 0.87 at 79% sensitivity and 80% specificity. Sensitivity was comparable to the previous investigation (P > 0.9), though specificity was significantly lower (P = 0.026). Sensitivity was higher for high-grade tumors compared to low-grade tumors (94% vs. 60%, P = 0.002).ConclusionValidation of the GHSR/MAL methylation marker panel on at home collected urine samples confirms its robust performance for bladder cancer detection in a hematuria population, and underscores the diagnostic potential for future clinical application.

HPV self-sampling in organized cervical cancer screening program: A randomized pilot study in Estonia in 2021.

Cervical cancer incidence in Estonia ranks among the highest in Europe, but screening attendance has remained low. This randomized study aimed to evaluate the impact of opt-in and opt-out human papillomavirus (HPV) self-sampling options on participation in organized screening. A random sample of 25,591 women were drawn from the cervical cancer screening target population who were due to receive a reminder in autumn 2021 and thereafter randomly allocated to two equally sized intervention arms (opt-out and opt-in) receiving a choice between HPV self-sampling or clinician sampling. In the opt-out arm, a self-sampler was sent to home address by regular mail; the opt-in arm received an e-mail containing a link to order a self-sampler online. The remaining 30,102 women in the control group received a standard reminder for conventional screening. Participation by intervention arm, age and region of residence was calculated; a questionnaire was used to assess self-sampling user experience. A significant difference in participation was seen between opt-out (41.7%) (19.8% chose self-sampling and 21.9% clinician sampling), opt-in (34.1%) (7.9% self-sampling, 26.2% clinician sampling) and control group (29.0%, clinician sampling only). All age groups and regions in the intervention arms showed higher participation compared to the control group, but the size of the effect varied. Among self-sampling users, 99% agreed that the device was easy to use and only 3.5% preferred future testing at the clinic. Providing women with a choice between self-sampling and clinician sampling significantly increased participation in cervical cancer screening. Opt-in and opt-out options had a different effect across age groups, suggesting the need to adapt strategies.

Participation and engagement in online cognitive testing

Web-based testing of cognitive abilities allows for large-scale assessments without geographical constraints. Yet, the extent to which it can reach populations beyond the typical demographic groups recruited for cognitive studies is unclear. This study focused on comparing the characteristics of individuals from a general population study (HUNT4) who chose to participate in a cognitive study (HUNT4-Hjernetrim) with those who did not. Additionally, we investigated participants' engagement and user experience. We obtained data on socio-demographics, health conditions (both physical and mental), self-reported cognitive or learning difficulties, and lifestyle factors of Hjernetrim participants and non-participants from the HUNT4 database. Hjernetrim involved 13 cognitive tests, administered through the online platform Memoro. We used logistic regressions to assess participation biases and linear regressions to assess participants’ engagement and user experience. Of 65,851 HUNT4 participants invited via regular mail to Hjernetrim, 5634 (9.4%, aged 13–97, 54% women) participated. The best represented in the sample were 50–79-year-olds, women, tertiary educated, living alone, from urban areas, not occupationally active, and reporting memory complaints. Individuals who were aged 80+, had motor or vision impairments, and teenagers with learning disabilities, were underrepresented. Participants were more likely to have mental health problems, have or survived cancer and less likely to have cardiovascular disease. Participants logged on mainly during weekdays, the preferred time of day varied by age. On average, participants used 42 min and completed 78% of the tasks. Using PCs provided the most complete data. In terms of user experiences, 65% were positive while 14% were negative or reported technical difficulties. Overall, the study demonstrated that web-based methodology allowed for a relatively well-represented sample that included groups typically difficult to reach. The presence of somatic and mental diseases had a variable influence on participation. Participants finished most tests and reported positive experiences overall.

Efficient Generation of Pancreatic Progenitor Cells from Induced Pluripotent Stem Cells Derived from a Non-Invasive and Accessible Tissue Source-The Plucked Hair Follicle.

The advent of induced pluripotent stem cell (iPSC) technology has brought about transformative advancements in regenerative medicine, offering novel avenues for disease modeling, drug testing, and cell-based therapies. Patient-specific iPSC-based treatments hold the promise of mitigating immune rejection risks. However, the intricacies and costs of producing autologous therapies present commercial challenges. The hair follicle is a multi-germ layered versatile cell source that can be harvested at any age. It is a rich source of keratinocytes, fibroblasts, multipotent stromal cells, and the newly defined Hair Follicle-Associated Pluripotent Stem Cells (HAP). It can also be obtained non-invasively and transported via regular mail channels, making it the ideal starting material for an autologous biobank. In this study, cryopreserved hair follicle-derived iPSC lines (HF-iPS) were established through integration-free vectors, encompassing a diverse cohort. These genetically stable lines exhibited robust expression of pluripotency markers, and showcased tri-lineage differentiation potential. The HF-iPSCs effectively differentiated into double-positive cKIT+/CXCR4+ definitive endoderm cells and NKX6.1+/PDX1+ pancreatic progenitor cells, affirming their pluripotent attributes. We anticipate that the use of plucked hair follicles as an accessible, non-invasive cell source to obtain patient cells, in conjunction with the use of episomal vectors for reprogramming, will improve the future generation of clinically applicable pancreatic progenitor cells for the treatment of Type I Diabetes.

To Remind or Not to Remind During Recruitment? An Analysis of an Online Panel in Germany.

Objective: To explore the role of reminders in recruiting and maintaining participation in an online panel. Methods: 50,045 individuals from five German federal states were invited by regular mail to participate in the online study "Health-Related Beliefs and Healthcare Experiences in Germany." Those who did not respond to the first attempt received a postal reminder. Comparisons of sociodemographic characteristics and responses were made between first-attempt respondents and those who enrolled after the second letter. Results: After the initial letter, 2,216 (4.4%, 95%CI: 4.3%-4.6%) registered for the study; after a reminder 1,130 (2.5%, 2.3%-2.6% of those reminded) enrolled. Minor sociodemographic differences were observed between the groups and the content of the responses did not differ. Second-attempt respondents were less likely to participate in subsequent questionnaires: 67.3% of first-attempt vs. 43.3% of second-attempt respondents participated in their fourth survey. Recruitment costs were 79% higher for second-attempt respondents. Conclusion: While reminders increased the number of participants, lower cost-effectiveness and higher attrition of second-attempt respondents support the use of single invitation only for studies with a similar design to ours when the overall participation is low.

Pengalihan Hak Atas Tagihan Atas Nama atau Cessie yang Berkepastian Hukum

Debt and credit transactions are common occurrences in business activities. Often, debtors are unable or have not yet fulfilled their obligations, while creditors need immediate funds even before the due date of their receivables. In such cases, Civil Law provides a solution through the institution of "cessie," which is the Transfer of Rights to a Claim. However, the legislation governing cessie is still limited, as it is only addressed in Article 613 of the Civil Code (KUHPerdata), and even that does not comprehensively regulate the matter, leading to disputes that may escalate to court. Article 613 of the Civil Code lacks sufficient provisions for the implementation of cessie, as it only states that the transfer of cessie must be done through an authentic deed or a private document and will only be legally effective against the debtor if it has been notified to them. However, it does not specify who should make the notification, when it should be made, and how it should be done, resulting in legal uncertainty. This research adopts the Juridical Normative method, utilizing two approaches: the Statute Approach, which examines all relevant laws, and the Conceptual Approach, which involves studying legal doctrines and opinions from experts in law. The Transfer of Rights to a Claim (Cessie) transaction has not provided legal certainty for all parties involved, including the cessus (debtor), cedent (transferor), and cessionaris (transferee). This is evident from court decisions in various cases that show inconsistency in how notification is made to cessus. Whether of whether notification is sufficient when done by the cedent or the cessionaris, whether through regular mail or the Court Bailiff's writ, remains unsettled.

The response rates to surveys among breast cancer patients using different manners of distribution: A prospective study of integrated rehabilitation.

138 Background: Communication with breast cancer patients is crucial within individualised integrated rehabilitation, where the patients are at the centre of the provided health care services. Anonymous surveys could be used as one of the tools to check the needs of patients, the effectiveness of various aspects of the interventions offered and to obtain valuable feedback from patients. Our aim was to determine which manner of conducting anonymous surveying among breast cancer patients would be most suitable for improving the health service of individualized integrated rehabilitation. Methods: The subjects of our prospective study were 600 females (29-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients receiving treatment at Institute of Oncology Ljubljana in 2019-2022. Questionnaires of implemented surveys were anonymous with different manners of distribution and on three different topics. The first survey was conducted via standard post sending questionnaires on papers to the patients to inquire about their satisfaction with the provided services after the conclusion of their treatment. The second survey was conceded via email, sending online questionnaires to inquire about appropriateness of interventions and patients' opinions about spa treatment. The third survey was conducted half via email and half via text message on mobile phone (SMS) to inquire about the most suitable terms of the regular physical activity during oncological treatment. The survey response rate was calculated as the number of valid surveys received (numerator) divided by the number of surveys distributed (denominator). If all questions were not answered, the survey was invalid. Results: There was a significant difference in the response rate of the patients to the anonymous surveys, depending on the manner of distribution of the survey. The response rate of patients who got questionnaires by regular mail were 51%, 28% and 13% if received by e-mail and 27% if sent via SMS. The difference in the response rate in the survey on physical activity, received by email or by SMS, was statistically significant (p= 0,0026). Conclusions: The highest response rate of breast cancer patients was received by sending the questionnaires via regular post. Clinical trial information: V3-1906. [Table: see text]

Retrieval of HCV patients lost to follow-up as a strategy for Hepatitis C Microelimination: results of a Brazilian multicentre study

BackgroundSeveral HCV patients in Brazil were lost to follow-up (LTFU) in the last two decades before achievement of sustained virological response (SVR). Strategies to recall those diagnosed but untreated patients have been used elsewhere with different success rates.AimTo identify and retrieve LTFU patients in order to offer them the treatment with the current highly effective direct acting antiviral agents (DAAs).MethodsRegistries ofall HCV patients from three large reference centers in Brazil were retrospectively reviewed to identify those with no registry of SVR. Reasons for non-achievement of SVR were elicited in HCV-RNA + patients. All patients who were not treated or cured were contacted to offer the therapy with DAAs.Results10,289 HCV patients (50% males, mean age 52 ± 11 years) were identified. Only 4,293 (41.7%) had been successfully treated previously. From the remaining 5,996 most were LTFU (59%), were not treated for other reasons (14.7%) or were non-responders (26.3%). After revision of the charts 3,559 were considered eligible to be retrieved. The callback success of phone calls was 18%, 13% to cellphone messages (SMS or WhatsApp) and 7% to regular mail. Five-hundred sixty patients had been already treatedor were on treatment and 234 were reported to be dead or transplanted. Finally, 201 had made an appointment and initiated antiviral treatment.ConclusionEven considering the low callback rate, retrieval of LTFU patients was shown to be an important strategy forhepatitis C micro-elimination in Brazil.

Cross-sectional analysis of relationship between strategic orientation, structural arrangements and size of enterprises in Croatia

Objective: To investigate the relationship between the two basic constructs of organizational design, strategic orienta-tion, and structural arrangements, as well as to re-examine the role of enterprise size in the variations of both con-structs.Methods: A cross-sectional study was carried out by regu-lar mail in the first half of 2019, using already existing and empirically validated measurement instruments for the constructs of strategic orientation and organizational struc-ture characteristics. Management board representatives or managing directors of the contacted enterprises were asked for their views on the situation in their enterprise in rela-tion to the researched constructs. Descriptive and bivariate statistical analyses were performed.Results: On the sample of 37 enterprises, the strategic orien-tation ‘analyzer enterprise’ was predominant. In addition, organic organizational structure characteristics slightly prevailed over mechanistic characteristics. A regression analysis was carried out, establishing a positive relation-ship between strategic orientation and organizational structure characteristics (R2=0.160; P=0.014), especially with communication as a characteristic of mentioned organiza-tional structure (R2=0.239; P=0.002). T-tests confirmed the significance of the role of enterprise size for organizational structure characteristics (P=0.067). In other words, larger enterprises tend to foster mechanistic organizational struc-ture characteristics. Variations in the types of strategic ori-entation of enterprises were not related to the size of those enterprises (P=0.296).Conclusion: The design and adaptation of organizational and structural arrangements of enterprises are related to their selected strategic orientation. An increase in enter-prise size inevitably leads to more rigid mechanistic struc-tural arrangements, while the status of a small enterprise does not automatically imply the ‘prospector’ strategic ori-entation or the successful development and implementa-tion of innovations.

Clinical sensitivity and specificity of a high-throughput microfluidic nano-immunoassay combined with capillary blood microsampling for the identification of anti-SARS-CoV-2 Spike IgG serostatus.

We evaluate the diagnostic performance of dried blood microsampling combined with a high-throughput microfluidic nano-immunoassay (NIA) for the identification of anti-SARS-CoV-2 Spike IgG seropositivity. We conducted a serological study among 192 individuals with documented prior SARS-CoV-2 infection and 44 SARS-CoV-2 negative individuals. Participants with prior SARS-CoV-2 infection had a long interval of 11 months since their qRT-PCR positive test. Serum was obtained after venipuncture and tested with an automated electrochemiluminescence anti-SARS-CoV-2 S total Ig reference assay, a commercial ELISA anti-S1 IgG assay, and the index test NIA. In addition, 109 participants from the positive cohort and 44 participants from the negative cohort participated in capillary blood collection using three microsampling devices: Mitra, repurposed glucose test strips, and HemaXis. Samples were dried, shipped by regular mail, extracted, and measured with NIA. Using serum samples, we achieve a clinical sensitivity of 98·33% and specificity of 97·62% on NIA, affirming the high performance of NIA in participants 11 months post infection. Combining microsampling with NIA, we obtain a clinical sensitivity of 95·05% using Mitra, 61·11% using glucose test strips, 83·16% using HemaXis, and 91·49% for HemaXis after automated extraction, without any drop in specificity. High sensitivity and specificity was demonstrated when testing micro-volume capillary dried blood samples using NIA, which is expected to facilitate its use in large-scale studies using home-based sampling or samples collected in the field.

A Preliminary Analysis of Thyrotropin Measurement from Finger Stick Dried Blood Spot with an Automated High-Throughput Immunoassay Analyzer.

Background: Hyper- and hypothyroidism are prevalent in Western countries and often go unnoticed for long periods. Thyrotropin (TSH) as a biomarker of thyroid dysfunction is regularly measured in venous plasma/serum. In newborn screening for congenital hypothyroidism, TSH is measured from dried blood spots (DBSs). DBS enables minimally invasive (at-home) sampling of a small blood volume that can be sent to diagnostic laboratories by regular mail. Methods: In this study, we included 109 patients who presented to the outpatient clinic of the University Medical Center Utrecht. Capillary finger stick was used to spot blood on a filter paper card and was dried. After extraction of TSH from DBS, method comparison with venous TSH was performed on an automated high-throughput immunoassay analyzer. Additional validation steps regarding stability, effect of hematocrit (Hct), precision, and limits of blank and quantitation were conducted according to corresponding Clinical and Laboratory Standards Institute evaluation protocol. Results: Method comparison of TSH from venous plasma versus finger stick DBSs showed an R2 [95% confidence interval] = 0.988 [0.986-0.990]. This enabled correct diagnosis of hypothyrotropinemia and hypothyroidism in 12 of 14 and 6 of 7 cases, respectively, with no false positives. Furthermore, TSH from DBS was stable for at least 4 days at temperatures between -20°C and +30°C, and the maximum decrease of eluate TSH was 1.13% for 1% increase in Hct. Conclusions: TSH from DBS may be accurately measured on an automated high-throughput immunoassay analyzer and could be used to diagnose hypothyroidism and, for the first time, hypothyrotropinemia. This method, when confirmed in larger field studies, may enable individuals to engage in (at-home) sampling of blood on DBSs for telediagnostics, screening programs, patient follow-up, and medication management.

Analysis of C-reactive protein from finger stick dried blood spot to predict high risk of cardiovascular disease

C-reactive protein (CRP) is an acute-phase protein involved in inflammation. Furthermore, CRP is an important biomarker used in diagnostics to predict risk of cardiovascular disease (CVD) in addition to monitoring bacterial and viral infections. To measure plasma CRP, venipuncture is still necessitated and has to be performed by trained phlebotomists. As a solution, dried blood spots (DBS) are used for minimally invasive at-home sampling of blood and can be send to diagnostic laboratories by regular mail. In this study, we included 53 patients that presented to the outpatient clinic of the University Medical Center Utrecht. Capillary finger stick was used to spot blood on a filter paper card and allowed to dry. After extraction of DBS, CRP was analyzed on an automated high-throughput chemistry analyzer. Additional validation steps regarding stability, effect of hematocrit, precision, and limits of blank and quantitation were conducted according to corresponding Clinical and Laboratory Standards Institute standards. An excellent regression analysis of R2 (95% confidence interval) = 0.986 (0.982–0.989) was found. This enabled correct classification for high CVD risk of all 25 cases with sensitivity (95% CI) of 1.00 (1.00–1.00) and specificity (95% CI) of 0.96 (0.89–1.03) and correct diagnosis of inflammation of 12/13 cases with sensitivity (95% CI) of 0.92 (0.77–1.07) and specificity (95% CI) of 1.00 (1.00–1.00). Furthermore, CRP was found to be stable for 31 days and observed hematocrit variation amongst patients was clinically acceptable. CRP from DBS can be accurately measured on an automated high-throughput chemistry analyzer and used to diagnose inflammation and classify high CVD risk. This method enables individuals to engage in at-home sampling of blood on DBS for (tele)diagnostics, screening programs, patient follow-up, and medication management.

Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission-A structural equation model.

The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge. Correlational design based on cross-sectional data from a multicentre survey study. People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling. In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA=0.06, 90% CI, 0.05-0.06; CFI=0.90; TLI=0.90. Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care. This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes. People and healthcare personnel evaluated content validity and were included in selecting items for the short version.

Сучасний підхід під час проведення практичних занять із фітнесу в умовах воєнного часу

The article highlights the problem of distance education in wartime conditions, defines the place and role of information and communication technologies in the process of distance education in fitness, focuses on the interactive approach to conducting lectures and practical classes on the educational components of the “Fitness” specialization, suggests the expediency of software delivery methods lecture and practical material for students of higher education. It was determined that to ensure effective interaction during distance learning in the academy, a whole range of means is used: interactive computer programs for determining physical condition during fitness classes, various Internet services, e-mail, telephone, fax, regular mail. Also, the Zoom web platform and Google services fully met the specified distance learning requirements: Blogger, Google Classroom; Google Forms web application; the Google Chrome tool, which were chosen as the main tools for conducting lectures and practical classes on educational components in the specialty 017 Physical culture and sports. The main advantages of certain web services that help with distance learning are considered. It was determined that distance learning technologies allow for the qualitative formation of professional competences when studying the organization of the educational process in fitness. The teacher’s task is to choose the most optimal software products and use a variety of tools that allow to implement the principles of education and achieve the desired result as much as possible.

Enhanced passive safety surveillance of Influvac® and Influvac® Tetra: Results from seven consecutive seasons.

In 2014, the European Medicines Agency (EMA) set out requirements for an enhanced safety surveillance for seasonal influenza vaccines. This paper presents data from the yearly Enhanced Passive Safety Surveillance (EPSS) implemented for Influvac® since season 2014/15 and continued for Influvac® Tetra from season 2018/19 onwards. In seven consecutive seasons, an EPSS, aiming for at least 1,000 vaccinees (additional target of 100 vaccinees per five predefined age groups), was conducted in Germany, where market characteristics were expected to allow for a quick generation of representative data. Reactogenicity data in terms of reporting rates, severity and duration of pre-specified local and systemic adverse events of interest (AEI) were collected using response cards, which were completed by vaccinees and returned seven days after vaccination via regular mail. In addition, response cards contained a call center number to enhance reporting of other than pre-specified adverse events. The primary target of at least 1,000 vaccinees was surpassed in all seasons, as was the additional target of 100 adults and elderly. Reactogenicity data were in line with known safety profile of Influvac® and Influvac® Tetra. In children, the target was mostly met in seasons when the EPSS was conducted for Influvac®, but not in seasons when it was conducted for Influvac® Tetra. Although the data for Influvac® Tetra are based on a low number of paediatric vaccinees, they do not indicate a different reactogenicity profile of Influvac® Tetra compared with Influvac®. No signals were identified. The EPSS set up for Influvac® and Influvac® Tetra proved a robust and effective methodology to comply with the objectives of EMÁ's guidance on enhanced safety surveillance of seasonal influenza vaccines. Safety data from seven consecutive seasons confirmed the favourable safety profile of both vaccines.

An improved public key infrastructure-based digital signature authentication service for higher key storage system

In general, we quickly forget about boxes with paper archives, and there is not even a single sheet of paper on the desktop. If a paper document is sent to the institution through regular mail, the artifact is immediately scanned and digitized. In fact, it turned out to be quite the opposite. The more a company uses computers for digital workflows, the more it documents and prints. Above all, every document must be authenticated. A document without a signature is only a draft or an information note. To get the signature, the documents are printed and then often scanned, and the original documents are kept on file. It is now clear that the (paperless) workflow cannot be implemented without electronic digital signatures. In this study, an improved public key infrastructure-based Digital Signature Authentication Service is proposed for higher key storage system. In this method, the CAs included in the list provide certificate-based digital identifiers and time stamping services that comply with global regulations, such as the eIDAS standard. Electronic digital signatures are already supported for most popular office document formats. Timestamps are supported, including multi-person document signatures.

Interval Methods in Knowledge Representation

Please send your abstracts (or copies of papers that you want to see reviewed here) to vladik@utep.edu, or by regular mail to Vladik Kreinovich, Department of Computer Science, University of Texas at El Paso, El Paso, TX 79968, USA…

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Self-care in migrants with type 2 diabetes, during the COVID-19 pandemic.

Type 2 diabetes is increasing globally and particularly affects vulnerable groups in society, such as migrants. Research shows that type 2 diabetes is a risk factor for severe illness when infected with COVID-19. Diabetes-related complications can be prevented with good glycaemic control. In addition, good glycaemic control has been shown to be an important cornerstone for preventing severe illness in individuals infected with COVID-19. In order to maintain good glycaemic control, self-care is needed. The purpose of this article is to describe self-care maintenance and possible changes in self-care maintenance and to explore factors related to unchanged self-care maintenance in migrant patients with type 2 diabetes during the COVID-19 pandemic. The second aim is to describe well-being, social support, and the need for support from healthcare services during the COVID-19 pandemic in migrant patients with type 2 diabetes. A triangulation design with cross-sectional data collection was used. Both quantitative and qualitative data were collected and interpreted together in a triangulation design. Patients were selected by a diabetes nurse from a computer system at a health center in south-eastern Sweden and invited to participate in the study. A questionnaire was translated into the languages most commonly used at the clinic and sent out to 332 migrant patients who had been diagnosed with type 2 diabetes and treated in primary care. This questionnaire assessed self-care maintenance for diabetes (questions inspired by the Self-Care of Diabetes Inventory), with questions added to every item to assess changes during the pandemic. When changes occurred, we asked the participants to elaborate. Open-ended questions asked the participants how they would like to receive information when there are changes in their healthcare. Descriptive statistical analyses were used for the quantitative data and qualitative data was analyzed using a directed approach to content analysis. In total, 79 participants answered the questionnaire (mean age 69 ± 11, 51% male, 47% born in the Middle East). Of these, 76% stated a change in self-care. More than half (58%) stated changes in maintaining an active lifestyle, 40% had changed their physical exercise, and 38% had changed their behavior to avoid getting sick. Participants said that this change was due to staying at home or canceling social activities because they feared meeting people during the pandemic. Others were more physically active than before on a regular basis during the pandemic due to taking walks to get fit, as a precaution related to COVID-19, and having greater awareness about how to avoid getting sick. Approximately one-quarter of the participants experienced a change in contact with healthcare due to poorer access to care, with fewer doctors' appointments and care being postponed during the pandemic. More than half (58%) would like to receive information about healthcare changes by a letter in the regular mail. Social support had changed for 35% of the participants, with less support from family and friends due to the risk of being infected with COVID-19. The COVID-19 pandemic led to societal restrictions that changed the way of life for many individuals. Migrant patients with type 2 diabetes, who are already a vulnerable group regarding self-care, had difficulties in maintaining good living habits during the pandemic. During crises such as COVID-19, support with self-care, such as closer contact with healthcare providers, is vital. Knowledge about how the COVID-19 pandemic has affected migrants with type 2 diabetes can be used to support healthcare providers in identifying individuals who are at high risk of suffering from the consequences of their diabetes associated with the pandemic.

HPV self-sampling as an additional option in cervical cancer screening: a pilot study in Estonia

Abstract Background Cervical cancer incidence and mortality rates remain high in Estonia and participation in organized cervical cancer screening program is low. The aim of this pilot study was to estimate the impact of offering an HPV self-sampling option on screening uptake. Methods A randomized intervention study was conducted within Estonian organized cervical cancer screening program in 2021. Among target group women who had not participated in screening by August 2021, 26,000 women were randomly selected and allocated to two equally sized intervention arms offering a choice between attending a clinic or taking a self-sample. The opt-out group received a Qvintip sampler by regular mail to home address, the opt-in group received by e-mail a link to order the sampler from a web-site. A control group of 32,000 women received the usual reminder to attend screening at a clinic. Participation rates were calculated and data on user experience were collected with a questionnaire. Results Significant difference in participation rates was observed between opt-out (41%) (among them 20% chose self-sampling, 21% chose clinic attendance), opt-in (34%) (8% self-sampling, 26% clinic) and control group (28%). Intervention arms showed higher screening uptake in all age-groups and regions, but the largest effect was seen at ages 60 and 65 years and in regions showing the lowest screening participation rates. Among self-sampling users, 99% agreed that self-sampling was easy and only 3% prefer testing at a clinic. Conclusions Offering women a choice between HPV self-sampling or attending a clinic significantly increased cervical cancer screening uptake. Sending an HPV self-sampling kit to home address was the most effective approach. Majority of women who chose HPV self-sampling want to use this option in the future. HPV self-sampling should be integrated in the cervical cancer screening program in Estonia. Key messages