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Adherence to colorectal cancer screening guidelines in Canada
Maida J Sewitch, Caroline Fournier, Antonio Ciampi, Alina Dyachenko
BMC Gastroenterology , 2007, DOI: 10.1186/1471-230x-7-39
Abstract: 2003 Canadian Community Health Survey Cycle 2.1 respondents who were at least 50 years old, without past or present CRC and living in Ontario, Newfoundland, Saskatchewan, and British Columbia were included. Outcomes, defined according to current CRC screening guidelines, included adherence to: i) fecal occult blood test (FOBT) (in prior 2 years), ii) endoscopy (colonoscopy/sigmoidoscopy) (prior 10 years), and iii) adherence to CRC screening guidelines, defined as either (i) or (ii). Generalized estimating equations regression was employed to identify correlates of the study outcomes.Of the 17,498 respondents, 70% were non-adherent CRC screening to guidelines. Specifically, 85% and 79% were non-adherent to FOBT and endoscopy, respectively. Correlates for all outcomes were: having a regular physician (OR = (i) 2.68; (ii) 1.91; (iii) 2.39), getting a flu shot (OR = (i) 1.59; (ii) 1.51; (iii) 1.55), and having a chronic condition (OR = (i) 1.32; (ii) 1.48; (iii) 1.43). Greater physical activity, higher consumption of fruits and vegetables and smoking cessation were each associated with at least 1 outcome. Self-perceived stress was modestly associated with increased odds of adherence to endoscopy and to CRC screening guidelines (OR = (ii) 1.07; (iii) 1.06, respectively).Healthy lifestyle behaviors and factors that motivate people to seek health care were associated with adherence, implying that invitations for CRC screening should come from sources that are independent of physicians, such as the government, in order to reduce disparities in CRC screening.In Canada, colorectal cancer (CRC) is the third most commonly diagnosed cancer in men and women and the second leading cause of cancer deaths [1]. According to the 2006 Canadian Cancer statistics, an estimated 1 in 14 men and 1 in 16 women will develop CRC in their lifetimes and 1 in 28 men and 1 in 31 women will die from CRC. CRC screening reduces both CRC incidence through removal of premalignant polyps and CRC deaths
The Impact of Adherence to Screening Guidelines and of Diabetes Clinics Referral on Morbidity and Mortality in Diabetes  [PDF]
Carlo Giorda, Roberta Picariello, Elisa Nada, Barbara Tartaglino, Lisa Marafetti, Giuseppe Costa, Roberto Gnavi
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033839
Abstract: Despite the heightened awareness of diabetes as a major health problem, evidence on the impact of assistance and organizational factors, as well as of adherence to recommended care guidelines, on morbidity and mortality in diabetes is scanty. We identified diabetic residents in Torino, Italy, as of 1st January 2002, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations to compare primary versus specialty care management of diabetes and the fulfillment of a quality-of-care indicator based on existing screening guidelines (GCI). Then, we performed regression analyses to identify associations of these factors with mortality and cardiovascular morbidity over a 4 year- follow-up. Patients with the lowest degree of quality of care (i.e. only cared for by primary care and with no fulfillment of GCI) had worse RRs for all-cause (1.72 [95% CI 1.57–1.89]), cardiovascular (1.74 [95% CI 1.50–2.01]) and cancer (1.35 [95% CI 1.14–1.61]) mortality, compared with those with the highest quality of care. They also showed increased RRs for incidence of major cardiovascular events up to 2.03 (95% CI 1.26–3.28) for lower extremity amputations. Receiving specialist care itself increased survival, but was far more effective when combined with the fulfillment of GCI. Throughout the whole set of analysis, implementation of guidelines emerged as a strong modifier of prognosis. We conclude that management of diabetic patients with a pathway based on both primary and specialist care is associated with a favorable impact on all-cause mortality and CV incidence, provided that guidelines are implemented.
Screening for alcohol use disorders in HIV patients
C Ward,S Ahmad
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18160
Abstract: Many chronic health conditions have been linked to alcohol consumption, as well as excess morbidity, mortality and an increased financial burden on the National Health Service (NHS). The British HIV Association (BHIVA) recommends that HIV patients be asked about alcohol due to its effect on adherence to antiretroviral therapy. National Institute of Health and Clinical Excellence (NICE) guidelines recommend screening for alcohol use disorders in patients attending genitourinary medicine (GUM) clinics. In this study we looked at the use of a screening tool for alcohol use disorders in HIV patients in a metropolitan city. We assessed HIV patients over a 6-month period for alcohol use disorders using the AUDIT-C questionnaire. Patients with a score >4 were identified as higher risk and provided with brief advice about alcohol and offered written information and support. Demographic data was collected along with hepatitis B and C status, information on sexually transmitted infection (STI) testing and diagnosis. 352 patients were reviewed with a mean age of 41. 297 (84.4%) patients were male, 235 (66.8%) were white British and 251 (71.3%) were men who have sex with men (MSM). 277 (78.7%) patients were on antiretroviral therapy with 254 (91.7%) of these having an undetectable viral load. Alcohol use disorders were assessed using the AUDIT-C score in 332 (94.3%) patients with no patient declining assessment. 166 (50%) patients had an AUDIT-C score >4 signifying higher risk. Alcohol advice was provided to 161 (97%) of these patients and a Drink Smart guide offering advice on alcohol self help offered to 103 (64%) patients and accepted by 45 (43.7%). An opportunistic STI screen was offered to 258 (73.3%) patients on that visit in line with best practice guidelines and was accepted by 83 (32.2%). 25 infections were found in 20 patients, of which 13 (65%) had AUDIT-C scores >4. There were 8 active hepatitis C co-infected patients of which 3 had an AUDIT-C score >4 and 12 chronic hepatitis B co-infected patients with 3 having an AUDIT-C score >4. Our results show that screening for alcohol use disorders using the AUDIT-C questionnaire has high acceptability among HIV patients; however the data is biased to Caucasian MSM. Alcohol use has been shown to exacerbate liver damage in patients with chronic hepatitis, increase the likelihood of STI acquisition and compromise immunity. It is therefore important to screen for and quantify alcohol use as part of routine HIV clinical practice.
Adherence to cancer screening guidelines across Canadian provinces: an observational study
Erin C Strumpf, Zhijin Chai, Srikanth Kadiyala
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-304
Abstract: We calculated age-cancer-specific screening rates for ages 40-60 using the Canadian Community Health Survey (2003 and 2005), a cross-sectional, nationally representative survey of health status, health care utilization and health determinants in the Canadian population. We estimated the degree of compliance using logistic regression to measure the change in adjusted screening rates at the guideline-recommended initiation age for each province in the sample.For breast cancer, after adjusting for age trends and other covariates, being above age 50 in Quebec increased the probability of being screened by 19 percentage points, from an average screening rate of 24% among 40-49 year olds. None of the other regions exhibited a statistically significant change in screening rates at age 50. Additional analyses indicated that these patterns reflect asymptomatic screening and that Quebec's breast cancer screening program enhanced the degree of guideline compliance in that province. Colorectal cancer screening practice was consistent with guidelines only in Saskatchewan, as screening rates increased at age 50 by 12 percentage points, from an average rate of 6% among 40-49 year olds. For prostate cancer, the regions examined here are not compliant with Canadian guidelines since screening rates were quite high, and there was not a discrete increase at any particular age.Screening practice for breast, colorectal and prostate cancer was generally not consistent with Canadian clinical guidelines. Quebec (breast) and Saskatchewan (colorectal) were exceptions to this, and the impact of Quebec's breast cancer screening program suggests a role for policy in improving screening guideline compliance.Clinical guidelines codify and transmit existing knowledge regarding best practice and aid physicians and patients in choosing optimal treatment. The extent to which Canadian patients and physicians follow, or comply with, such guidelines for cancer screening remains largely unknown. Studies t
Physician adherence to guidelines for tuberculosis and HIV care in Rio de Janeiro, Brazil
Saraceni, Valeria;Pacheco, Antonio Guilherme;Golub, Jonathan E;Vellozo, Vitoria;King, Bonnie S;Cavalcante, Solange C;Eldred, Lois;Chaisson, Richard E;Durovni, Betina;
Brazilian Journal of Infectious Diseases , 2011, DOI: 10.1590/S1413-86702011000300012
Abstract: background: tuberculosis is the most common opportunistic infection among hiv-infected patients in brazil. brazil's national policy for hiv care recommends screening for latent tuberculosis (tb) and implementing isoniazid preventive therapy (ipt). objectives: we compared physician adherence to tb screening and other prevention and care policies among hiv primary care clinics in rio de janeiro city. methods: data on performance of cd4 counts, viral load testing, tuberculin skin testing (tst) and ipt were abstracted from patient charts at 29 hiv clinics in rio de janeiro as part of the tb/hiv in rio (thrio) study. data on use of pneumocystis jiroveci pneumonia (pcp) prophylaxis were also abstracted from a convenience sample of 150 patient charts at 10 hiv clinics. comparisons were made between rates of adherence to tb guidelines and other hiv care guidelines. results: among the subset of 150 patients with confirmed hiv infection in 2003, 96% had at least one reported cd4 counts result; 93% had at least one viral load result reported; and, pcp prophylaxis was prescribed for 97% of patients with cd4 counts < 200 cells/mm3 or when clinically indicated. in contrast, 67 patients (45%) had a tst performed (all eligible); and only 11% (17) of eligible patients started ipt. among 12,027 thrio cohort participants between 2003 and 2005, the mean number of cd4 counts and viral load counts was 2.5 and 1.9, respectively, per patient per year. in contrast, 49% of 8,703 eligible patients in thrio had a tst ever performed and only 53% of eligible patients started ipt. conclusion: physicians are substantially more compliant with hiv monitoring and pcp prophylaxis than with tb prophylaxis guidelines. efforts to improve tb control in hiv patients are badly needed.
Hepatitis B and C infection and liver disease trends among human immunodeficiency virus-infected individuals  [cached]
Susan E Buskin, Elizabeth A Barash, John D Scott, David M Aboulafia, Robert W Wood
World Journal of Gastroenterology , 2011,
Abstract: AIM: To examine trends in and correlates of liver disease and viral hepatitis in an human immunodeficiency virus (HIV)-infected cohort.METHODS: The multi-site adult/adolescent spectrum of HIV-related diseases (ASD) followed 29 490 HIV-infected individuals receiving medical care in 11 U.S. metropolitan areas for an average of 2.4 years, and a total of 69 487 person-years, between 1998 and 2004. ASD collected data on the presentation, treatment, and outcomes of HIV, including liver disease, hepatitis screening, and hepatitis diagnoses.RESULTS: Incident liver disease, chronic hepatitis B virus (HBV), and hepatitis C virus (HCV) were diagnosed in 0.9, 1.8, and 4.7 per 100 person-years. HBV and HCV screening increased from fewer than 20% to over 60% during this period of observation (P < 0.001). Deaths occurred in 57% of those diagnosed with liver disease relative to 15% overall (P < 0.001). Overall 10% of deaths occurred among individuals with a diagnosis of liver disease. Despite care guidelines promoting screening and vaccination for HBV and screening for HCV, screening and vaccination were not universally conducted or, if conducted, not documented.CONCLUSION: Due to high rates of incident liver disease, viral hepatitis screening, vaccination, and treatment among HIV-infected individuals should be a priority.
Viral Hepatitis and Rapid Diagnostic Test Based Screening for HBsAg in HIV-infected Patients in Rural Tanzania  [PDF]
Fabian C. Franzeck, Ramadhani Ngwale, Bernadeta Msongole, Marian Hamisi, Omary Abdul, Lars Henning, Emilio Letang, Geoffrey Mwaigomole, Manuel Battegay, Christoph Hatz, Marcel Tanner
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058468
Abstract: Background Co-infection with hepatitis B virus (HBV) is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg) before initiation of combination antiretroviral therapy (cART) is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV) infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania. Methods Prospectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-na?ve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO) in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA. Results Samples of 272 patients were included. Median age was 38 years (interquartile range [IQR] 32–47), 169/272 (63%) subjects were females and median CD4+ count was 250 cells/μL (IQR 97–439). HBsAg was detected in 25/272 (9.2%, 95% confidence interval [CI] 6.2–13.0%) subjects. Of these, 7/25 (28%) were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8–99.6%) and specificity at 100% (95% CI, 98.9–100%). Antibodies to HCV (anti-HCV) were found in 10/272 (3.7%, 95% CI 2.0–6.4%) of patients. Conclusion This study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa.
Adherence to the screening program for HBV infection in pregnant women delivering in Greece
Vassiliki Papaevangelou, Christos Hadjichristodoulou, Dimitrios Cassimos, Maria Theodoridou
BMC Infectious Diseases , 2006, DOI: 10.1186/1471-2334-6-84
Abstract: Perinatal transmission can be prevented with the identification of HBsAg(+) women and administration of immunoprophylaxis to their newborns. A national prevention programme for HBV with universal screening of pregnant women and vaccination of infants is in effect since 1998 in Greece.To evaluate adherence to the national guidelines, all women delivering in Greece between 17–30/03/03 were included in the study. Trained health professionals completed a questionnaire on demographic data, prenatal or perinatal screening for HBsAg and the implementation of appropriate immunoprophylaxis.During the study period 3,760 women delivered. Prenatal screening for HBsAg was documented in 91.3%. Greek women were more likely to have had prenatal testing. HBsAg prevalence was 2.89% (95%CI 2.3–3.4%). Higher prevalence of HBV-infection was noted in immigrant women, especially those born in Albania (9.8%). Other risk factors associated with maternal HBsAg (+) included young maternal age and absence of prenatal testing. No prenatal or perinatal HBsAg testing was performed in 3.2% women. Delivering in public hospital and illiteracy were identifiable risk factors for never being tested. All newborns of identified HBsAg (+) mothers received appropriate immunoprophylaxis.The prevalence of HBsAg in Greek pregnant women is low and comparable to other European countries. However, immigrant women composing almost 20% of our childbearing population, have significant higher prevalence rates. There are still women who never get tested. Universal vaccination against HBV at birth and reinforcement of perinatal testing of all women not prenatally tested should be discussed with Public Health Authorities.Hepatitis B infection (HBV) is a major Public Health Problem. It is estimated that more than 350 million people are chronic HBV carriers worldwide. About one forth of them will develop chronic hepatitis and cirrhosis and could develop hepatocellular carcinoma eventually [1]. The probability of becoming
Screening for hepatitis C among HIV positive patients at Mulago Hospital in Uganda
V Walusansa, M Kagimu
African Health Sciences , 2009,
Abstract: Background: In industrialized countries with more resources, it is recommended that HIV infected patients should be screened for hepatitis C virus (HCV) on entry into the health care system. Implementation of these guidelines in a country like Uganda with limited resources requires some modification after taking into account the prevailing circumstances. These include the prevalence of HCV in HIV positive patients and the cost of HCV testing. Objective: The objective of the study was to estimate the prevalence of HCV in HIV positive patients. Methods: This was a cross sectional study among HIV positive outpatients in Mulago hospital. HCV screening was done using anti-HCV Enzyme Immuno Assay (Roche Diagnostics) Results: Between October 2003 and February 2004, one hundred and twenty two HIV positive patients were enrolled into the study with a mean age of 33.9 years. There were more females 81 (66.4%) than males. Only 4 patients had anti-HCV, giving an estimated HCV prevalence of 3.3%. Conclusion: In view of the low HCV prevalence found in our study and similar studies and considering the high cost of HCV screening, routine HCV testing cannot be recommended among all HIV positive patients in our health care settings with limited resources. We recommend that HCV screening be limited to investigating HIV positive patients with features suggestive of liver disease in order to identify HCV as a possible cause. African Health Sciences 2009; 9(3): 143-146
Seroprevalence of hepatitis B and C viral co-infections among children infected with human immunodeficiency virus attending the paediatric HIV care and treatment center at Muhimbili National Hospital in Dar-es-Salaam, Tanzania
Safila P Telatela, Mecky I Matee, Emmanuel K Munubhi
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-338
Abstract: Investigations included; interviews, physical examination and serology for HBsAg, IgG antibodies to HCV and alanine aminotransferase (ALT) levels. HIV serostatus and CD4 counts were obtained from patient records.167 HIV infected children, 88(52.7%) males and 79(47.3%) females were enrolled. The overall prevalence of hepatitis co-infection was 15%, with the seroprevalence of HBV and HCV being 1.2% and 13.8%, respectively. Hepatitis virus co-infection was not associated with any of the investigated risk factors and there was no association between HBV and HCV. Elevated ALT was associated with hepatitis viral co-infection but not with ART usage or immune status.The high seroprevalence (15%) of hepatitis co-infection in HIV infected children attending the Paediatrics HIV CTC at the MNH calls for routine screening of hepatitis viral co-infection and modification in the management of HIV infected children.With more than 1.4 million women estimated to give birth annually and 8.2% HIV prevalence rate at antenatal clinics (ANC), approximately 122,000 HIV-infected women deliver annually in Tanzania. Assuming a 40% transmission rate in the absence of any intervention, an estimated 48,000 children will become HIV-infected each year. In 2003, the number of children (0–15 years) living with HIV/AIDS in Tanzania was estimated to be between 85,000 and 230,000[1,2]. A large number of infected children have been associated with significant increase in morbidity, hospitalization and mortality [2].With increased access to antibiotics and antifungal agents hepatitis viruses, especially hepatitis B and C, are emerging as the leading causes of morbidity and mortality among children on ART [3].Relatively little is known regarding HCV or HBV co-infection in HIV infected children in Tanzania. Thus, not surprisingly the current national guidelines for management of HIV disease in children do not include screening and management of hepatitis viral co-infection.We conducted this study to determ
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