Uptake Of Diagnostic Testing Research Articles

The Role of Preprocedure Genetic Counseling in Pregnancies Interrupted for Fetal Abnormalities.

Congenital birth defects affect 3 to 5% of pregnancies. Genetic counseling can help patients navigate the testing process and understand results. The study objective was to identify predictors and utility of genetic counseling at the time of pregnancy termination. Additionally, we aimed to see what proportion of patients would benefit from additional testing based on the results of the genetic testing. This was a retrospective cohort review of all terminations performed for fetal anomalies by an academic center from July 2016 to May 2020. Indications were stratified by abnormal serum screening or types of abnormal ultrasound findings. Data were abstracted regarding uptake of genetic counseling and testing results. Abnormal results that warranted additional testing regarding recurrence risks were noted. Multivariable logistic regression was performed to identify predictors of receipt of genetic counseling and testing. Of 387 patients, 57% (n = 220) received preprocedure genetic counseling and 43% (n = 167) did not. Among patients who received diagnostic testing, 62% (n = 194) had genetic counseling compared with 38% (n = 121) without counseling (adjusted odds ratio 2.46, 95% confidence interval [1.41-4.29], p < 0.001). Among the entire cohort, 38% (n = 148) had suspected aneuploidy based on serum screening. Of these, 89% (n = 132/148) had definitive testing, 92% (n = 122/132) confirming the aneuploidy. Among the other 68% (n = 239) with structural anomalies, 76% (n = 183) had diagnostic testing with 29% (n = 53) yielding an abnormal result. Among those fetuses with structural anomalies, 36% (n = 19/53) of genetic diagnoses warranted additional parental testing because of risk of recurrence compared with only 2% (n = 2/122) of patients with abnormal serum screening results alone. Genetic counseling was associated with increased uptake of diagnostic testing, which yielded useful information and prompted additional testing. This is important for determining etiology and recurrence risk and should be offered to patients presenting for termination for fetal indications, as well as providing diagnostic closure for patients. · Genetic counseling increases the uptake of diagnostic testing in patients with fetal anomalies.. · Patients with ultrasound anomalies received less diagnostic testing despite actionable results 36% of the time.. · Genetic testing is invaluable for recurrence risk counseling even if patients chose to terminate..

Prosocial Interventions and Health Outcomes

Prosocial interventions encourage voluntary actions that benefit others. Community solidarity in response to the COVID-19 pandemic, expanding mutual aid programs, and health workforce issues have accelerated prosocial health interventions. To investigate the association of prosocial interventions with health outcomes in clinical trials and observational studies. In this systematic review and meta-analysis informed by the Cochrane Handbook for Systematic Reviews of Interventions, 5 databases (MEDLINE [via PubMed], Embase, CINAHL, PsycInfo, and Scopus) were searched from database inception through February 23, 2023. The search included terms for altruism and prosocial behaviors, health outcomes, and study type. Included studies, determined by multiple reviewers, compared health outcomes in a prosocial intervention group with a nonintervention group. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline, data extraction and synthesis captured quantitative and qualitative data. To pool data from quantitative studies, random-effects meta-analyses were used to estimate the impact of prosocial interventions. To combine data from quantitative and qualitive studies, data were transformed into qualitative narratives using meta-aggregation. The main outcome was whether prosocial interventions were associated with improved health outcomes. Barriers to and facilitators of implementation of these interventions were assessed. The search identified 5229 citations; 30 studies were included in the synthesis. Studies indicated that prosocial interventions were associated with positive health outcomes for givers (17 studies [56.7]) and recipients (8 [26.7%]). Prosocial interventions included acts of kindness (12 studies [40.0%]), cash gifts (7 [23.3%]), pay-it-forward approaches (6 [20.0%]), and expressions of kindness (5 [16.7%]). Improvements were reported in depression, testing for sexually transmitted diseases, vaccine uptake, physical activity, and individual biomarkers. Data from 6 studies (20.0%) demonstrated that pay-it-forward approaches were associated with increased uptake of diagnostic tests or vaccines among vulnerable groups (moderate certainty of evidence). Data from 14 studies (46.7%) suggested that community connectedness facilitated prosocial interventions. Shared vulnerabilities among groups (eg, sexual minority individuals, older adults) may provide a context for collective mobilization to improve health in local communities. This systematic review and meta-analysis found that prosocial interventions were associated with improved health outcomes among vulnerable groups and have been useful for addressing health disparities. Further research is needed to develop and evaluate prosocial interventions.

Mobility restrictions during the COVID-19 pandemic and reduced outpatient HIV and syphilis testing in Brazil.

In the initial phases of the COVID-19 pandemic, strategies adopted to reduce the dissemination of SARS-CoV-2 relied on non-pharmacological interventions, including physical distancing. Mobility restrictions affected the availability and quality of care for many health conditions, including sexually transmitted infections. To investigate the impact of the COVID-19 pandemic mobility restriction on syphilis and HIV testing in outpatient settings. In this study, we collected the weekly number of syphilis and HIV tests performed in a referent laboratory in São Paulo, Brazil, as well as the percentage of positive tests between January 2019 and December 2021. We also retrieved data on retail and recreation mobility in São Paulo city using Google COVID-19 Community Mobility Reports. We explored the association between populational mobility and the number of weekly tests and the association between the number of weekly tests and the percentage of positive results during the pandemic period. The analyses were conducted separately for syphilis and HIV tests. We found that mobility restrictions during the COVID-19 pandemic have been associated with a significant decrease in both syphilis and HIV tests performed in outpatient settings. We also observed that the number of tests performed was inversely associated with the percentage of positive results for syphilis; this association was also apparent for HIV tests in the first wave of the pandemic in the graphic analysis. Taken together, our findings suggest an indirect impact of COVID-19 pandemic-related mobility restrictions on the uptake of diagnostic tests for HIV and syphilis and the potential adoption of targeted-testing strategies. Understanding the extent and complexity of COVID-19 aftermaths on specific conditions and communities is essential to build strategies to mitigate the long-term consequences of COVID-19.

Prenatal diagnostic testing decisions in twin pregnancies in the era of cell-free DNA screening

Rates of diagnostic procedures in singleton pregnancies have declined since cell-free DNA (cfDNA) became commercially available. However, the impact of cfDNA on the uptake of diagnostic testing in twin gestations is unclear. We aimed to describe the rate of invasive diagnostic procedures in twin pregnancies after cfDNA screening with and without fetal structural abnormalities. This is a secondary analysis of data from a multicenter retrospective cohort study from 12/2011- 02/2020 that aimed to evaluate cfDNA screening performance in twin pregnancies. For this analysis, we excluded cases with a vanishing twin. cfDNA results were reported as positive, negative, or non-reportable. Structural abnormalities were defined as a major or minor anomaly, including an increased nuchal translucency >3mm. Rates of diagnostic testing were analyzed via chi-squared with odds ratio calculated by logistic regression. A total of 112 (6.6%) of 1,696 patients with twin pregnancies had cfDNA results and diagnostic procedures performed: 82 amniocenteses and 29 chorionic villus samplings (CVS). Diagnostic procedures were more frequent in patients that were older, had private insurance and conceived via IVF (Table 1). Patients with diagnostic testing were more likely to have positive or non-reportable cfDNA results compared to those without diagnostic testing. As noted in Figure 1A, 50% of positive cfDNA, 4.8% of negative cfDNA and 20% of non-reportable cfDNA ultimately had diagnostic testing. Figure 1B details the frequency of diagnostic procedures performed for each combination of cfDNA result and the presence of a structural abnormality. Diagnostic testing was more common if a structural abnormality was present (15.0% vs 4.5%, aOR 4.30 95% CI 2.71-6.83) and if there was an abnormal cfDNA result (32.8% vs 4.7%, aOR 8.72 95% CI 5.16-14.74), when adjusted for demographic factors. Cell-free DNA results and the presence of structural abnormalities greatly impact the decision to pursue diagnostic testing in patients with twin gestations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

P16.40: Physicians’ Opinions Regarding Low-Level Epstein-Barr Virus DNA Levels From PCR Testing

Introduction: Epstein Barr virus (EBV) DNA measurement supports diagnosis and management of EBV-associated complications in transplant recipients. Laboratory-developed EBV DNA tests can be variable between laboratories and relatively insensitive. The availability of more sensitive, consistent and accurate tests, with results that are traceable to the WHO International Standard and are reported IU/mL of plasma, raises questions regarding the clinical importance of results in lower titer ranges that are newly detectable. Commercially available EBV DNA tests now exhibit sensitivity and even linearity near or below 100 IU/mL in plasma. With the advancement of more sensitive diagnostics, the clinical significance of low-level EBV DNA test results should be considered, however, no clear clinical consensus is currently available to help interpret these results, and it is unclear what actions clinicians may take when presented with them. We undertook a survey of practicing adult and pediatric transplantation clinicians in order to characterize their likely therapeutic and diagnostic decisions in response to theoretical scenarios involving low-level EBV DNA test results. Methods: Fifty-one clinicians who manage transplant recipients in the US, UK and Australia responded to a questionnaire presenting two hypothetical clinical scenarios involving low-level EBV DNA test results in adult and pediatric transplant patients. Scenario 1 included a detectable DNA level that was below the limit of quantitation. Scenario 2 involved low-level DNA results (150 vs. 400 IU/mL of plasma) from two different laboratories. Results: Almost a quarter (24%) of clinicians would change treatment based on a single detectable EBV DNA result as presented in scenario 1 (Figure 1). Before changing treatment or ordering imaging studies in anticipation of possible core biopsy, the overwhelming majority would repeat EBV testing, mostly on a weekly basis. Most clinicians (59%) were likely to act based on the apparent increase in EBV DNA in scenario 2, with most intending to confirm the results through repeat testing to confirm the trend in viral load (Figure 2). Conclusions: Adequate use and uptake of diagnostic testing in clinical medicine is often suboptimal leading to misinterpretation by clinicians and unnecessary diagnostic errors. Our findings reveal the impact that low-level EBV DNA plasma results may have on potential patient management approaches. In addition, the survey also showed marked differences in how clinicians would interpret and act on these results. This highlights that, in our theoretical clinical scenarios, there is no clear consensus regarding these potential and diverse interventions based on the different diagnostic and therapeutic approaches triggered by low EBV DNA plasma levels. These observed differences underline the need for more interpretive guidance to support the wider availability of more accurate, sensitive and standardized EBV DNA level monitoring assays.

Factors associated with US and Canadian genetic counselors' testing decisions during pregnancy.

Decision-making regarding prenatal screening and diagnostic testing has become more complex as the number of options has increased, with pregnant patients having access to more information about their pregnancies than ever before. Genetic counselors have extensive training in prenatal genetic screening and testing options, but personal decision-making in this well-informed population remains largely unstudied. This study describes the prenatal testing decisions genetic counselors made during their own pregnancies, and the factors identified as important when making those decisions. A web-based, mixed-methods survey was distributed to members of multiple professional societies for genetic counselors. A total of 318 genetic counselors across numerous specialties in the United States and Canada participated in this study. The satisfaction with decision scale was modified and applied to measure participants' decisional satisfaction. In their most recent pregnancies, most genetic counselors pursued carrier screening (77%) and aneuploidy and/or open neural tube defect screening (88%). A minority of genetic counselors (15%) utilized diagnostic testing. Common factors considered when making testing decisions included wanting information that could impact future decisions, test specifics (e.g., accuracy, methodology, and content), and knowledge gained from participants' genetic counseling background. The uptake of diagnostic testing among prenatal genetic counselors was significantly greater (p < 0.05) than the uptake among genetic counselors in other specialties. This informed study population largely self-directed their own prenatal care, leading to high satisfaction with their decisions. Data in this study provide evidence for promoting participation in prenatal screening and testing decision-making to maximize decisional satisfaction.

EP450: Effectiveness and utility of noninvasive prenatal screening (NIPS) for sex chromosome aneuploidies

Noninvasive prenatal screening (NIPS) has high sensitivity and specificity for the common autosomal aneuploidies. However, compared to these autosomal trisomies, the few studies assessing NIPS for detecting sex chromosome aneuploidy (SCA) have shown higher false positive rates; particularly for monosomy X. The primary goal of this study was to determine the effectiveness and utility of NIPS as a tool for recognizing SCA; we also discuss uptake of diagnostic testing. Over 39 months (August 2018-October 2021), we performed NIPS for 1438 specimens. Overall, the proportion of specimens with any high-risk result was 2.6% (37/1438). Of those, autosomal aneuploidy was prognosticated in 2.09% (30/1438), while SCA was suspected in 0.49% (7/1438) of patients, with similar frequencies of abnormal results being published among other laboratories performing this test. Of the seven pregnancies at high risk for SCA, three were high risk for Turner syndrome (45,X); three for Klinefelter syndrome (47,XXY); and one for Triple X (47,XXX). None of the patients with high-risk results for SCA elected to have additional prenatal diagnostic testing. Also, no patients elected to terminate pregnancies based on NIPS SCA results. Follow-up karyotype analysis was available for four of these seven cases: three newborns and one product of conception (POC) specimen. Of the three pregnancies at high risk for monosomy X, two resulted in miscarriage; with one having follow-up genetic testing that confirmed monosomy X (true positive). The third high-risk monosomy X case resulted in a liveborn. Subsequent testing of the newborn including FISH, karyotype and microarray yielded results consistent with a normal female complement (false positive). Of the three pregnancies at high risk for 47,XXY, all resulted in live births, with two confirmed as true positives in the newborns (the third did not pursue testing). The case at high risk for 47,XXX was reported as phenotypically normal but no diagnostic testing was performed. Seven patients received high-risk results for SCA; however, none elected to pursue diagnostic testing prenatally via amniocentesis or CVS. Follow-up testing was available in four of the seven cases. Three were true positive (two 47,XXY and one 45,X) and one was a false positive (45,X). Calculation of the test specifications (sensitivity, specificity, PPV, NPV) for SCAs is limited due to lack of confirmatory genetic testing and limited phenotypes observed in the newborn period (and beyond) for some conditions. NIPS allows for earlier diagnosis of SCA, which could aid in behavioral interventions or fertility concerns/management for people with SCAs.

The role of counselling in tuberculosis diagnostic evaluation and contact tracing: scoping review and stakeholder consultation of knowledge and research gaps

BackgroundTuberculosis (TB) care cascade analyses show large gaps at early stages, including care-seeking and diagnostic evaluation, where promising interventions to decrease attrition are urgently needed. Person-centered care is prioritized in the World Health Organization’s End TB strategy; yet little is known about how it is delivered and can be optimized. Recommendations for counselling, a core component of person-centered care, are largely limited to its role in improving TB treatment adherence. The role of counselling to close key diagnostic gaps in the care cascade is poorly understood.MethodsWe conducted a scoping review to identify evidence on the use of counselling at TB diagnosis, for both people with presumptive TB and index patients to promote patient retention and contact tracing. Using search terms for TB, diagnosis and counselling, we systematically searched PubMed, EMBASE and Web of Science. Two independent reviewers screened all abstracts, full-texts, extracted data and conducted a quality assessment. We used thematic analysis to identify key themes.ResultsAfter screening 1785 articles, we extracted data from 15 studies and determined that the major themes best corresponded to the following gaps in the TB care cascade: care-seeking, pre-diagnosis, and pre-treatment. Studies were conducted across varied settings including pharmacies, primary health centres, and clinics, primarily in high TB incidence countries. No study directly evaluated the impact of counselling on outcomes such as treatment initiation or retention in care. Included studies suggested counselling may play an important role in improving the uptake of diagnostic testing and contact tracing. Barriers to counselling included time and personnel requirements. Stakeholder consultation emphasized the importance of high-quality counselling as a core tenet of TB care.ConclusionData on the impact of counselling to improve TB case detection are absent from the literature. The shift towards person-centred care for TB presents an opportunity to incorporate counselling during earlier stages of the TB care cascade; however, evidence-based approaches are needed. Implementation research is needed to operationalize and evaluate counselling to strengthen high-quality TB care delivery.

Diagnostic tests and treatment procedures performed prior to cardiovascular death in individuals with severe mental illness.

ObjectiveTo examine whether severe mental illnesses (i.e., schizophrenia or bipolar disorder) affected diagnostic testing and treatment for cardiovascular diseases in primary and specialized health care.MethodsWe performed a nationwide study of 72 385 individuals who died from cardiovascular disease, of whom 1487 had been diagnosed with severe mental illnesses. Log‐binomial regression analysis was applied to study the impact of severe mental illnesses on the uptake of diagnostic tests (e.g., 24‐h blood pressure, glucose/HbA1c measurements, electrocardiography, echocardiography, coronary angiography, and ultrasound of peripheral vessels) and invasive cardiovascular treatments (i.e., revascularization, arrhythmia treatment, and vascular surgery).ResultsPatients with and without severe mental illnesses had similar prevalences of cardiovascular diagnostic tests performed in primary care, but patients with schizophrenia had lower prevalences of specialized cardiovascular examinations (prevalence ratio (PR) 0.78; 95% CI 0.73–0.85). Subjects with severe mental illnesses had lower prevalences of invasive cardiovascular treatments (schizophrenia, PR 0.58; 95% CI 0.49–0.70, bipolar disorder, PR 0.78; 95% CI 0.66–0.92). The prevalence of invasive cardiovascular treatments was similar in patients with and without severe mental illnesses when cardiovascular disease was diagnosed before death.ConclusionBetter access to specialized cardiovascular examinations is important to ensure equal cardiovascular treatments among individuals with severe mental illnesses.

Uptake of Diagnostic Tests by Livestock Farmers: A Stochastic Game Theory Approach.

Game theory examines strategic decision-making in situations of conflict, cooperation, and coordination. It has become an established tool in economics, psychology and political science, and more recently has been applied to disease control. Used to examine vaccination uptake in human medicine, game theory shows that when vaccination is voluntary some individuals will choose to “free-ride” on the protection provided by others, resulting in insufficient coverage for control of a vaccine-preventable disease. Here, we use game theory to examine farmer uptake of a new diagnostic ELISA test for sheep scab—a highly infectious disease with an estimated cost exceeding £8M per year to the UK industry. The stochastic game models decisions made by neighboring farmers when deciding whether to adopt the newly available test, which can detect subclinical infestation. A key element of the stochastic game framework is that it allows multiple states. Depending on infestation status and test adoption decisions in the previous year, a farm may be at high, medium or low risk of infestation this year—a status which influences the decision the farmer makes and the farmer payoffs. Ultimately, each farmer's decision depends on the costs of using the diagnostic test vs. the benefits of enhanced disease control, which may only accrue in the longer term. The extent to which a farmer values short-term over long-term benefits reflects external factors such as inflation or individual characteristics such as patience. Our results show that when using realistic parameters and with a test cost around 50% more than the current clinical diagnosis, the test will be adopted in the high-risk state, but not in the low-risk state. For the medium risk state, test adoption will depend on whether the farmer takes a long-term or short-term view. We show that these outcomes are relatively robust to change in test costs and, moreover, that whilst the farmers adopting the test would not expect to see large gains in profitability, substantial reduction in sheep scab (and associated welfare implications) could be achieved in a cost-neutral way to the industry.

Comparative Diagnostic Testing Uptake and Confirmation Rates After High-Risk cffDNA for Trisomy 21, 18, and 13 [32N

INTRODUCTION: There is increasing concern that high-risk cffDNA screening results are not always confirmed by diagnostic testing. We hypothesized that the poorer prognosis of trisomy 18 (T18) or trisomy 13 (T13) compared to trisomy 21 (T21) differentially affects the uptake of confirmatory diagnostic testing after a high-risk cffDNA result for these aneuploidies. METHODS: A retrospective study of singleton gestations with abnormal cffDNA screening for trisomies 21, 18 and 13 between 10/2012 and 3/2016. We excluded multiple gestations, any unreportable and any other positive cffDNA results. Based on cffDNA results, 3 cohorts were compared: high risk for T21, T18 and T13. Diagnostic testing was offered to all study subjects. Primary outcome was uptake rate of diagnostic testing in the 3 groups. A P-value of &lt; 0.05 was considered significant. RESULTS: 278 women met inclusion criteria. Demographics were similar in the 3 groups, except for higher rate of AMA in T21 group compared to T18 and T13 (P=.04). The uptake of diagnostic testing was similar in the 3 groups (P=.79). The confirmation of diagnosis by karyotype or CMA was significantly higher for T21 group compared to T18 and T13 (P=.0001). The rate of false positive cffDNA result was significantly higher in T13 group compared to T18 and T21 (P=.0001). CONCLUSION: There is no difference in uptake of diagnostic testing in women with a cffDNA screening result indicating high risk for Trisomy 21, 18 or 13. Diagnostic testing is more likely to confirm diagnosis of T21 and T18 compared to T13 in women with abnormal cffDNA screening.

Diagnostic Testing Uptake After High-Risk cffDNA Screening [6B

INTRODUCTION: Introduction of cffDNA screening has decreased the rate of diagnostic testing and serum screening. We hypothesized that the uptake of diagnostic testing after abnormal cffDNA depends on the type of chromosomal aneuploidy suspected. Our aim was to evaluate the uptake of diagnostic testing in women with abnormal cffDNA screening. METHODS: A retrospective study of singleton gestations and any abnormal cffDNA results between 10/1/2012 and 3/31/2016. We compared 3 cohorts based on high-risk cffDNA results for (1) trisomies 21, 18, 13, (2) sex chromosome aneuploidies (SCA) and (3) other (no call, unreportable). Diagnostic testing was offered to all study subjects. Primary outcome was uptake of diagnostic testing by abnormal cffDNA results. P-value &lt; .05 was considered significant. RESULTS: 443 women met inclusion criteria. Mean age, rate of AMA and abnormal ultrasound were higher in trisomy group compared to SCA and other category. Uptake of diagnostic testing after a positive cffDNA result in this cohort was 31.6%. Women at high-risk cffDNA for trisomies were more likely to undergo diagnostic testing compared to SCA or other category (P=.02). Similarly, women with high-risk cffDNA for trisomies were more likely to be confirmed with diagnostic testing compared to SCA and other category (P &lt; .0001). Diagnostic testing results in the last group were more likely to be normal or discordant from screen result. CONCLUSION: Diagnostic testing uptake is low overall but is higher in women with cffDNA screening results indicating high-risk for trisomy compared to sex chromosome aneuploidies or other category. High-risk screens for trisomies are more likely to be confirmed.

Diagnostic Testing Uptake After High-Risk cffDNA Results for Sex Chromosome Aneuploidy [11B

INTRODUCTION: The phenotype of sex chromosome aneuploidy (SCA) is typically mild, except in fetuses with cystic hygroma/hydrops. We hypothesize that because the phenotype of SCA is variable, the uptake of diagnostic testing after positive cffDNA screening varies between different SCA. Our study aim was to describe the uptake of diagnostic testing after a positive cffDNA screen for SCA. METHODS: A retrospective study of singleton gestations and abnormal cffDNA results for 45,X, 47,XXY or other SCA from 10/2012 to 3/2016. Any unreportable and other positive cffDNA results were excluded. Based on cffDNA results, 3 cohorts were defined: high-risk for 45,X, 47,XXY or other SCA. Diagnostic testing was offered to all study subjects. Primary outcome was uptake rate of diagnostic testing by abnormal cffDNA SCA results in 3 groups. P-value of &lt; .05 was considered significant. RESULTS: 109 women met inclusion criteria. Demographics were similar in the 3 groups. The overall uptake of diagnostic testing after abnormal cffDNA for SCA was 22.9%. It was higher in 45,X cohort (36.7%) compared to 47,XXY (14.3%); none of the patients in “other SCA” cohort accepted diagnostic testing (P=.0004). The false positive and confirmation rate of suspected chromosomal abnormality was similar in 45,X and 47,XXY group (P=.68). CONCLUSION: Only 23% of women with positive cffDNA for SCA proceed with diagnostic testing. Of all SCA, the uptake is noted to be highest for 45,X. The increased uptake in 45,X may be due to a higher likelihood of abnormal ultrasound findings such as cystic hygroma. Further analysis of this observation is indicated.

A quantitative analysis of attitudes and behaviours concerning sustainable parasite control practices from Scottish sheep farmers

Nematode control in sheep, by strategic use of anthelmintics, is threatened by the emergence of roundworms populations that are resistant to one or more of the currently available drugs. In response to growing concerns of Anthelmintic Resistance (AR) development in UK sheep flocks, the Sustainable Control of Parasites in Sheep (SCOPS) initiative was set up in 2003 in order to promote practical guidelines for producers and advisors. To facilitate the uptake of ‘best practice’ approaches to nematode management, a comprehensive understanding of the various factors influencing sheep farmers’ adoption of the SCOPS principles is required.A telephone survey of 400 Scottish sheep farmers was conducted to elicit attitudes regarding roundworm control, AR and ‘best practice’ recommendations. A quantitative statistical analysis approach using structural equation modelling was chosen to test the relationships between both observed and latent variables relating to general roundworm control beliefs. A model framework was developed to test the influence of socio-psychological factors on the uptake of sustainable (SCOPS) and known unsustainable (AR selective) roundworm control practices. The analysis identified eleven factors with significant influences on the adoption of SCOPS recommended practices and AR selective practices. Two models established a good fit with the observed data with each model explaining 54% and 47% of the variance in SCOPS and AR selective behaviours, respectively. The key influences toward the adoption of best practice parasite management, as well as demonstrating negative influences on employing AR selective practices were farmer’s base line understanding about roundworm control and confirmation about lack of anthelmintic efficacy in a flock. The findings suggest that improving farmers’ acceptance and uptake of diagnostic testing and improving underlying knowledge and awareness about nematode control may influence adoption of best practice behaviour.

Risk of HIV and Hepatitis B and C Over Time Among Men Who Inject Image and Performance Enhancing Drugs in England and Wales: Results From Cross-Sectional Prevalence Surveys, 1992-2013.

Infection risks among people who inject drugs (PWID) are widely recognized, but few studies have focused on image and performance enhancing drugs (IPEDs). Globally, concern about IPED injection has increased and, in the United Kingdom, IPED injectors have become the largest group using Needle and Syringe Programmes. Blood-borne virus prevalence trends among IPED injectors are explored. Data from 2 surveys of IPED injectors (2010-2011; 2012-2013) and the national bio-behavioral surveillance system for PWID (1992-1997; 1998-2003; 2004-2009) were merged. Psychoactive drug injectors and women were excluded. Logistic regression analyses explored temporal changes. Between 1992 and 2009, median age increased from 25 to 29 years (N = 1296), years injecting from 2 to 4. There were 53 men who had sex with men (MSM). Overall, 0.93% had HIV, 4.4% ever had hepatitis B (HBV), and 3.9% hepatitis C (HCV, from 1998, N = 1083). In multivariable analyses, HIV increased in 2004-2009 [adjusted odds ratio (AOR) = 10 (95% confidence interval (CI): 0.94 to 106) vs. 1992-2003], and remained elevated (AOR = 4.12, 95% CI: 0.31 to 54, 2012-2013); HBV also increased in 2004-2009 (AOR = 3.98, 95% CI: 1.59 to 9.97). HCV prevalence increase was only borderline significant (AOR = 2.47, 95% CI: 0.90 to 6.77, 2010-2011). HIV and HBV were associated with MSM and HCV with sharing needles/syringes. Uptake of diagnostic testing for HIV and HCV, and HBV vaccination increased (to 43%, 32% and 44% respectively). Condom use was consistently poor; needle/syringe sharing occurred. Blood-borne virus prevalences among IPED injectors have increased and for HIV, is now similar to that among psychoactive drug injectors. Targeted interventions to reduce risks are indicated.

Socioeconomic disparities in diagnostic testing after positive aneuploidy screening.

The objective of this study was to investigate the association between type of health insurance (Medicaid vs. private) and uptake of diagnostic testing for fetal aneuploidy after a positive screening test result. We performed a retrospective cohort study of pregnant women who underwent aneuploidy screening in the first and/or second trimesters of pregnancy and received positive results. The characteristics of and outcomes for women with Medicaid were compared with those of women with private insurance in both univariable and multivariable analyses. In this study, 75 women with Medicaid and 75 with private insurance were analyzed. Those with Medicaid were younger (33.8 vs. 36.9 years, p < 0.01), and more likely to be of non-white race/ethnicity (88 vs. 27%, p < 0.01), unmarried (65 vs. 19%, p < 0.01), non-English speaking (12 vs. 0%, p < 0.01), and multiparous (76 vs. 59%, p = 0.02). They also were less likely to undergo diagnostic testing after a positive aneuploidy screen (35 vs. 57%, p < 0.01). In multivariable analysis, those with Medicaid remained significantly less likely to undergo diagnostic testing (odds ratio, 0.26; 95% confidence interval, 0.09-0.80). Women with Medicaid are less likely than women with private insurance to undergo diagnostic testing after positive screening for aneuploidy. These results emphasize the potential importance of improved counseling for low-income women.

A qualitative study of staff perspectives of patient non-attendance in a regional primary healthcare setting.

Non-attendance at health appointments reduces health service efficiency, is costly to services, and can risk patient health. Reminder systems are widely used to overcome forgetfulness, the most common reason for non-attendance; however, other factors, such as patient demographics and service accessibility, may also affect attendance rates. There is limited primary research on the reasons for patient non-attendance in the Australian healthcare setting, although the success of preventative health initiatives requires ongoing monitoring of patients. This study aims to improve our understanding of the Australian experience by examining staff perspectives. This qualitative study explored staff perspectives of the reasons for non-attendance in a large, regional general practice super clinic, which has a low socioeconomic catchment, and serves a large Aboriginal population. The practical barriers to attendance of travel, cost, and waiting times had largely been overcome with transport provision, free medical care and responsive appointment times, but paradoxically, these were seen to devalue allocated appointments and reinforce the expectations of "on-demand" health care. For Aboriginal patients specifically, a distrust of authority, combined with poor health literacy was perceived to impact negatively on the uptake of diagnostic tests, filling of prescriptions, health monitoring, and adherence to medication. The results suggest a complex interplay between poor health literacy and low patient self-worth; a funding system that encourages "five-minute medicine and prevents doctors getting to the root cause of patient problems or having the ability to provide health education.

PFM.60 Down’s Syndrome Screening and counselling: the unseen workload of a Fetal Medicine Midwife

Introduction1st trimester Down’s syndrome screening has been offered to all antenatal women since 2011 and our unit has made changes to improve the delivery of this service locally. FASP recommends...

Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study

ObjectiveTo describe drug use, sexual risks and the prevalence of blood-borne viral infections among men who inject image and performance enhancing drugs (IPEDs).DesignA voluntary unlinked-anonymous cross-sectional biobehavioural survey.Setting19 needle and...

Case management of malaria fever in Cambodia: results from national anti-malarial outlet and household surveys

BackgroundContinued progress towards global reduction in morbidity and mortality due to malaria requires scale-up of effective case management with artemisinin-combination therapy (ACT). The first case of artemisinin resistance in Plasmodium falciparum was documented in western Cambodia. Spread of artemisinin resistance would threaten recent gains in global malaria control. As such, the anti-malarial market and malaria case management practices in Cambodia have global significance.MethodsNationally-representative household and outlet surveys were conducted in 2009 among areas in Cambodia with malaria risk. An anti-malarial audit was conducted among all public and private outlets with the potential to sell anti-malarials. Indicators on availability, price and relative volumes sold/distributed were calculated across types of anti-malarials and outlets. The household survey collected information about management of recent "malaria fevers." Case management in the public versus private sector, and anti-malarial treatment based on malaria diagnostic testing were examined.ResultsMost public outlets (85%) and nearly half of private pharmacies, clinics and drug stores stock ACT. Oral artemisinin monotherapy was found in pharmacies/clinics (9%), drug stores (14%), mobile providers (4%) and grocery stores (2%). Among total anti-malarial volumes sold/distributed nationally, 6% are artemisinin monotherapies and 72% are ACT. Only 45% of people with recent "malaria fever" reportedly receive a diagnostic test, and the most common treatment acquired is a drug cocktail containing no identifiable anti-malarial. A self-reported positive diagnostic test, particularly when received in the public sector, improves likelihood of receiving anti-malarial treatment. Nonetheless, anti-malarial treatment of reportedly positive cases is low among people who seek treatment exclusively in the public (61%) and private (42%) sectors.ConclusionsWhile data on the anti-malarial market shows favourable progress towards replacing artemisinin monotherapies with ACT, the widespread use of drug cocktails to treat malaria is a barrier to effective case management. Significant achievements have been made in availability of diagnostic testing and effective treatment in the public and private sectors. However, interventions to improve case management are urgently required, particularly in the private sector. Evidence-based interventions that target provider and consumer behaviour are needed to support uptake of diagnostic testing and treatment with full-course first-line anti-malarials.