新发涂阳肺结核病人延误诊断影响因素分析

目的 探讨涂阳肺结核病人延误诊断治疗的影响因素,为早期控制传染源提供科学依据.方法 以2007年4～10月就诊于湖南省郴州市北湖区、桂阳、宜章、永兴、安仁5县(区)结防机构新发涂阳肺结核患者为研究对象,利用调查表收集相关资料,应用COX比例风险模型进行延误诊断治疗的影响因素分析.结果 患者延误、确诊延误、治疗延误、医疗机构延误及总延误时间中位数分别21,29,3,16,62 d.患者延误的独立危险因素为不知晓结核病相关知识和首次症状有非肺结核主要症状;确诊延误的独立危险因素为首次就诊未进行痰涂片、X线电子计算机断层扫描(CT)和摄胸片检查;治疗延误的独立危险因素为农村户籍和首次就诊未进行痰涂片检查.医疗机构延误的独立危险因素为首次检查未进行痰涂片、摄胸片和CT检查、首诊医疗机构在村级或乡级医疗机构及首次无咯血症状;总延误的独立危险因素为男性、首次检查未进行胸透或CT检查.结论 患者延误诊断、治疗与患者肺结核知识、户口所在地、首诊时间、未进行痰涂片和X线检查有关.     

上海松江户籍人口结核病就诊延误及影响因素分析

目的了解上海市松江区户籍人口结核病就诊延误情况,分析人口学、社会经济和症状等因素对结核病患者就诊延误的影响。方法对松江区新确诊的826例结核病患者,用回顾性队列研究法了解患者就诊延误,分析其影响因素。结果患者延误时间的中位数为10d,女性、重体力劳动者、初治病人和菌阳病人发生就诊延误的危险性高。性别、职业和初复治等影响患者延误时间的长短。结论应根据危险因素积极采取相关措施,减少结核病各种诊断延误。     

北京市不同职业女性乳腺癌影响因素分析

为了解北京市不同职业女性乳腺癌危险因素，2019年7月—2020年1月采用1：1病例对照研究方法选取在北京市6家医疗机构就诊的患者为研究对象，以该时间段首次就诊的乳腺癌患者为病例组，以同医疗机构该时间段就诊 的非乳腺癌患者为对照组，采用统一编制的问卷进行人口学基本特征、生理生育和职业病危害因素三方面调查和分析。结果显示，女性乳腺癌的高危因素包括职业、年龄、体重指数（BMI）、文化程度以及绝经状态，体力劳动者较脑力劳动者发生乳腺癌的风险增加。提示，超重和肥胖、绝经后女性体力劳动者更应通过改变生活方式、合理饮食、加强体育锻炼等降低乳腺癌的发生率。     

广州市海珠区肺结核患者就诊延误影响因素的研究

目的 分析广州市海珠区肺结核患者就诊延误情况及其影响因素,为制定减少就诊延误发生的干预措施提供科学依据。方法 采取随机抽样调查方法,应用编制的问卷对2014年1月1日~2014年12月31日登记发现的150例广州市海珠区肺结核患者进行面对面的问卷调查,并收集患者病历资料,分别从基本情况、经济因素及临床因素分析就诊延误的影响因素。结果 150例肺结核患者就诊延误率为52.0%（78/150）。多因素分析结果表明转诊（OR=0.121,95% CI:0.028~0.513）、咯血（OR=0.291,95% CI:0.098~0.860）是减少就诊延误的因素;就诊交通费支出≥50 元/月（OR=7.334,95% CI:1.729~31.113）、因症就诊（OR=3.225,95% CI:1.337~7.775）是增加就诊延误的因素。结论 广州市海珠区肺结核患者存在一定的就诊延误,提高人群结核病相关知识的知晓水平,加强转诊,改善结核病定点医疗机构服务的可及性和便利性,增强人群健康体检意识,从而减少肺结核患者就诊延误。     

2015—2020年广州市番禺区学生肺结核患者就诊延迟影响因素分析

目的 探索番禺区学生结核病临床特征,为制定干预措施提供理论依据。方法 以2015—2020年番禺区学校的479例初治肺结核患者为研究对象,采用回顾性研究方法从中国结核病管理信息系统收集病案数据,采用单因素χ2检验及多因素logistic回归分析方法,分析学校肺结核患者的就诊延误的影响因素。结果 2015—2020年番禺区学生肺结核患者病原学阳性率为45.93%,从出现症状到就诊的中位数(四分位数)为8.0(1.0,28.0)d,就诊延迟率为39.67%,多因素logistic回归分析结果显示,以病原学阴性为对照,病原学阳性学生肺结核患者就诊延误的风险低[OR(95%CI)=0.679(0.468～0.986)];以接触者检查为对照,被动发现学生肺结核患者的就诊延误的风险低[OR(95%CI)=0.334(0.134～0.832)];以高中/中专为对照,大学学生肺结核患者的就诊延误的风险高[OR(95%CI)=2.705(1.098～6.665)]。结论 番禺区学生肺结核患者的就诊延迟较为普遍,对就诊延迟的影响因素要加强干预,重点关注学校定期健康体检制度等学校相关因素的干预,减少延误的发生。     

农村老年肺结核病例发现延误的影响因素研究

目的了解农村老年肺结核病例发现延误状况,探讨发现延误的影响因素。方法采取横断面调查方法,运用自制的调查表,对2007—2009年到湖州市结核病定点医院接受诊治的农村老年新发涂阳肺结核患者进行面对面调查。结果 237例痰涂片阳性的肺结核患者,从症状出现到被确诊为肺结核的发现延迟时间中位数为49 d（0-1164 d）;有157例（66.24%）患者存在发现延误。发现延误的影响因素有：居住地距离最近医疗卫生机构的距离、就诊前是否接受过结防宣教、首发症状咯血、首诊胸片检查、首诊未做任何检查、确诊前就诊医疗机构的次数和是否服用民间偏方行为。结论农村地区老年结核病普遍存在发现延误的现象,发现延迟时间较长。需采取综合性干预措施,减少农村老年结核病患者的发现延误。     

2010-2015年广西青少年新发涂阳肺结核发现延误及对预后的影响

目的 研究广西青少年出现新发涂阳肺结核发现延误（就诊和确诊延误）情况及对疗效的影响,分析发现延误（就诊和确诊延误）的影响因素。方法 收集2010-2015年广西登记管理的10~19岁新发涂阳肺结核,对患者人口学特征、临床特点、不同延误水平指标、预后结果进行描述性分析和多因素Logistic回归分析。结果 共收集到2 196例青少年新发涂阳肺结核患者,就诊延误时间中位数为36 d,确诊延误时间中位数为1 d。治愈2 122例,治愈率为96.6%。多因素分析结果显示,男性患者比女性患者就诊延误时间短,学生发生就诊延误时间较长的风险小于非学生患者。肺部有空洞患者就诊延误时间较长（OR=1.31,95% CI:1.10~1.57,P=0.002）。少数民族外地人口患者来源为转诊和追踪到位和肺部有空洞的患者发生确诊延误时间较长。治疗管理方式为全程督导和服药满6个月的患者治愈率更高。结论 广西青少年新发涂阳肺结核发现延误时间低于普通人群,治愈率高于国家规划指标要求。就诊延误与患者职业、肺部空洞有关,确诊延误与民族、患者来源及肺部空洞有关。     

胜利油田地区结核病人就诊延误影响因素研究

目的:探讨胜利油田地区结核病人就诊延误影响因素。方法:采用结构式结核病人调查表对2006年1月—2007年4月就诊于胜利石油管理局结防所的114例胜利油田和100例地方结核病人进行问卷调查。结果:东营地方病人发生就诊延误的危险性低于油田病人(OR=0.287,95%CI:0.120～0.684);个人月收入大于1500元的三个组发生就诊延误的危险性低于个人无收入者(OR值分别为0.073、0.346、0.234);有咯血症状者比无咯血症状者发生就诊延误的危险性低(OR=0.267,95%CI:0.122～0.940);肺外结核发生就诊延误的危险性大于初治肺结核(OR=2.235,95%CI:1.094～4.564)。结论:油田地方、有无咯血、个人月收入是就诊延误的影响因素。     

苏北农村地区县级医院门诊慢性咳嗽患者就医行为和医疗可及性的影响因素探讨

目的 评价社会经济因素和人口学因素对于慢性咳嗽患者(潜在结核病患者)就医行为的影响。方法 描述慢性咳嗽患者从开始咳嗽至就诊的首诊延误以及从开始咳嗽至正规医疗机构就诊的正式就诊延误情况,通过x~2检验、Kaplan-Meier生存分析、Cox回归和logistic多元回归等方法分析影响患者就诊延误的因素,并对患者的首诊医疗机构选择和痰检情况进行分析。结果 结核病控制项目县和非项目县在慢性咳嗽患者延误时间上存在差异,职业,医疗制度是影响患者就医行为的主要因素,其中未成年人与农民相比到医疗机构(RR=1.66,95％CI:1.16～2.38)尤其是乡以上医院就诊的机会多(RR=1.90,95％CI:1.27～2.84);未成年人相对农民多选择乡及乡以上医院作为首诊机构(RR=2.06,95％CI:1.12～3.80);公费比自费患者有更多的机会去乡及乡以上医院就诊(RR=1.64,95％CI:1.35～2.10)。在综合医院就诊的咳嗽满2周的患者中仅有约2.5％获得痰检建议。结论 职业和医疗保险是影响慢性咳嗽患者就医行为和医疗可及性的重要因素。无论是在结核病控制项目县还是非项目县,慢性咳嗽尚未成为综合医院医生诊断结核病的一个重要警示症状。     

性传播疾病患者就诊延误的影响因素分析

目的探索影响性传播性疾病患者就诊延误的主要因素，为减少性传播疾病包括艾滋病的扩散和蔓延提供依据。方法以诸暨市2002-2003年报告的性传播疾病病例作为研究对象，采用统一的调查表，以入户调查的方式收集患者的性别、年龄、婚姻状况、文化程度、职业、发病地点、传染来源、病种等，采用单因素分类资料和多因素分析方法分析患者就诊延误的影响因素。结果除患者的性别、发病地点、文化程度外，年龄、婚姻状况、职业、传染来源、病种与就诊延误有关，其中以病种和传染来源影响较大。结论性传播疾病作为一种比较特殊的传染病，其就诊及时性受到多种因素的影响，针对可能导致延误就诊的因素，采取相应的应对措施，将有助于缩短患者发病到就诊的时间，提高及时就诊率，对防止性传播疾病的扩散和蔓延有一定的意义。     

Delay in breast cancer: a review of the literature.

Delay in seeking medical attention for breast cancer symptoms, as well as delay in the diagnosing of and delivery of effective treatments for breast cancer may result in advanced states of disease, thereby contributing to breast cancer mortality. Our knowledge of the scope and characteristics of delay in breast cancer is limited. Delay can be divided into two components, patient and system delay. Patient delay is the time it takes for a women to seek help once she has discovered a breast symptom. System delay is the time it takes for a woman to be evaluated, diagnosed, and treated once she has sought help. Most of the studies have dealt with patient delay, with few studies being performed on system delay, especially in the United States. It is evident that patient and system delays of 2-3 months apiece do occur in a small percentage of cases. However, there is not a clear picture of the factors associated with these long delays. Studies have had conflicting results and have often been difficult to compare because of inconsistent definitions of delay. This review critically examines the available literature on delay in breast cancer. Given the lack of a complete understanding regarding the factors associated with long delay, and the fact that the earlier a breast cancer is diagnosed and treated, the greater the likelihood of long-term survival, it is especially important to do further work to determine the factors associated with long delay so that interventions can be designed to minimize delay and thus permit earlier diagnoses and treatments of breast cancers.     

Patient- and system-related diagnostic delay in breast cancer

Background: Breast cancer patients in developing countries usuallyseek treatment at a more advanced-stage of disease. This workwas aimed at evaluating the avoidable risk factors related todiagnostic delay of breast cancer (patient- and system-related)in Alexandria, Egypt. Methods: Data were collected from 565incidents, histologically confirmed cases of breast cancer,recruited from nine hospitals in Alexandria, reflecting differentpatterns of health care delivery during the period July 1997–June1998. Results: Patient-related delay (interval between firstsymptom and first medical consultation > three months) wasfound in 38.1%, while system-related delay (interval betweenfirst medical consultation and final diagnosis > four weeks)was found in 12.9% of cases. A significant association betweendelay in seeking medical advice and late stage at diagnosiswas detected; in fact, while 26.3% of women with less than threemonths delay were at stage III and IV, the corresponding proportionamong women with more than three months delay was 72.1% (²1=109.6,p<0.0001). Regarding patient-related delay, age >40 years,lower educational level and not conducting breast self examinationwere independent risk factors associated with diagnostic delay.As for the system-related factors, place of first visit (generalpractitioner), absence of a palpable lump and lack of healthinsurance were significant predictors for delay. Conclusion:The patient's role in diagnostic delay of breast cancer is veryimportant in Egypt. Also, Interactive training directed to generalpractitioners to rationalise their approach to cases with breastlumps should be promoted to reduce system-related delay.     

Factors Associated With Delayed Diagnosis of Breast Cancer in Northeast Thailand

Background

We identified factors associated with delayed first consultation for breast symptoms (patient delay), delayed diagnosis after first consultation (doctor delay), and advanced pathologic stage at presentation among 180 women with breast cancer in Thailand.

Methods

In this cross-sectional study 180 patients with invasive breast cancer were interviewed about potential risk factors and markers of delayed presentation. Patient delay was defined as time from onset of symptoms to first consultation with a health care provider, and doctor delay was defined as time from first consultation with a health care provider to diagnosis of breast cancer. Linear regression and logistic regression were used for the data analyses.

Results

Among the 180 patients, 17% delayed seeking consultation for longer than 3 months, and 42% reported a doctor delay of longer than 3 months. In multivariate linear analysis, a significant increase in patient delay was associated with higher family income and smoking; factors associated with increased doctor delay were previous breast symptoms, self-treatment, and travel time to the hospital. In multiple logistic regression, doctor delay was related to age at first birth (P = 0.003), previous breast symptoms (P = 0.01), and number of consultations with a surgeon before diagnosis (P = 0.007). Regarding stage of breast cancer, there were significant associations with age at diagnosis (P for trend = 0.04), education (P for trend = 0.01), family income (P for trend = 0.02), time to referral (P = 0.01), and number of consultations with a surgeon before diagnosis (P < 0.01).

Conclusions

Hospital referral from a health care provider was a major contributor to delayed diagnosis. Breast cancer awareness campaigns in Thailand should target individuals in low- and high-income groups, as well as practitioners.Key words: delayed diagnosis, advanced stage, breast cancer, Thailand     

Delay in the presentation of breast symptoms for consultant investigation

Summary Women referred to hospital outpatients with breast symptoms were interviewed to ascertain the interval between first noticing a breast symptom and first consulting a doctor (patient delay). Later, the hospital notes of each patient were examined to determine the intervals between this first consultation and referral by a doctor (doctor delay) and between referral and outpatient attendance (hospital delay), as well as the diagnosis (benign or malignant). The study found that the largest component of delay between noticing symptoms and outpatient attendance was patient delay, with 20 per cent of the women delaying for more than 12 weeks. Analysis of this group revealed that long delays were related to both age and subsequent diagnosis, but that these two variables were not independent of each other. The findings that there were longer delays in older women and that symptoms other than lumps, which could indicate breast cancer, were associated with long delays, have implications for health education. Generally, doctors in the community distinguished between benign and malignant cases, with 86 per cent of the latter referred within a week. Most women waited 2 weeks or less for an outpatient appointment, with none of those subsequently found to have breast cancer waiting more than 4 weeks. This study was supported by a grant from the Department of Health and Social Security through the Wessex Regional Cancer Organisation.     

Delay versus help seeking for breast cancer symptoms: A critical review of the literature on patient and provider delay

Patient delay in seeking help for breast cancer symptoms and provider delay in treating those symptoms combine to decrease a woman's potential for breast cancer survival. This paper reviews the literature on patient and provider delay published since 1975. Meta-analysis of 12 studies using common definitions of patient delay estimates that 34% of women with breast cancer symptoms delay help seeking for 3 or more months. Provider delay appears to be both under researched and underestimated. This review identifies the factors that have been advanced as contributing to patient and provider delay, evaluating the support for each of these reported findings. Theory-based hypotheses emerging from the reviewed studies highlight foci for future investigations.     

Race and ethnicity are associated with delays in breast cancer treatment (2003-2006)

Access to timely treatment may be one contributing factor to survival differences by race/ethnicity among breast cancer patients. In this study, we examined the relationship between race and treatment delay among breast cancer patients diagnosed between 2003 and 2006 with Stage I-III breast cancer from the National Cancer Database (n=250,007). We evaluated factors associated with receipt of initial treatment more than 30, 60, and 90 days after biopsy using multivariable log binomial models to estimate risk ratios (RR) and 95% confidence intervals (CI). The average time to treatment was 34.30 days (±31.77). Independent of health insurance, stage at diagnosis, and age, Black and Hispanic patients had higher risks of 30, 60, and 90-day treatment delay compared with White patients. Further studies are needed to define the role of structural, health system, physician, clinical and patient factors in treatment delay among Black and Hispanic women and appropriate interventions.     

Use of CAM results in delay in seeking medical advice for breast cancer

Cancer patients in developing countries often delay seeking medical advice. It can adversely influence the clinicopathological behavior and outcome of the disease process. This study was undertaken to obtain information about initial perceptions of patients presenting with breast lump, subsequent efforts to seek medical advice, frequency and reasons for delay in seeking medical advice and its possible impact on clinicopathological characteristics. We prospectively gathered data from 138 recently diagnosed (3 months) breast cancer patients who had initially presented with a breast lump and were referred to the medical oncology service for further treatment. Delay in seeking medical advice was defined as time period of 1 month between initial perception of lump and first physician visit. The study was conducted at the National Cancer Institute, Karachi, Pakistan. Most (85%) patients discovered the lump accidentally. In other cases, lump was discovered by the family physician or by the patient as part of regular self-examination. Etiologic perceptions included malignancy (17%), benign growth (26%), milk clot (19%), trauma (23%) and infection (10%). On average, patients took 8.7 weeks to inform the family and 17.2 weeks to first physician visit. Fifty three percent delayed seeking medical advice. Common reasons were; antecedent use of complimentary/alternative therapies (34%), lack of significance attached to the lump (23%), fear of surgery (22%), conflicting personal commitments (7%), fear of cancer (5%), and others (8%). Twenty nine percent practiced CAM before visiting any physician. Common methods used were homeopathy (70%), spiritual therapy (15%) and Ayurvedic medicine (13%). CAM use was associated with delay in seeking medical advice (OR: 5.6; 95% CI: 2.3, 13.3) and presentation at an advanced stage of disease (OR: 2.2; 95% CI: 1.01, 4.6). Patients who delayed seeking medical advice more often had positive axillary nodes and stage III/IV disease. Breast cancer patients in Pakistan frequently (53%) delay seeking medical advice. Antecedent practice of CAM is widespread and a common underlying reason. The delay results in significant worsening of the disease process.     

The relationship of symptoms and psychological factors to delay in seeking medical care for breast symptoms

BACKGROUND: The psychological processes involved in the delay between noticing breast symptoms and seeking medical care are not well understood. METHODS: We evaluated 85 women referred to a specialist breast clinic prior to their clinic appointment. We assessed the relationship between delay and the type of breast symptom, immediate emotional response to the symptom, perceived risk of breast cancer, fear of breast cancer treatment, and disclosure of the breast symptom to others. RESULTS: Delay was unrelated to demographic factors but was related to the type of breast symptom; women who had a breast lump waited a significantly shorter time period before visiting the doctor than those without a breast lump. Initial symptom distress on the discovery of the breast symptom was also significantly related to delay. Knowledge of a friend or family member with breast cancer, perceived risk of breast cancer and fear of breast cancer treatment, and disclosure of the symptom to a partner or other person were all unrelated to delay. CONCLUSIONS: The results show the importance of the type of symptom and initial emotional distress in delay and highlight the importance of widening public perceptions of breast symptoms other than breast lumps in order to reduce delay times.     

Health disparity: time delay in the treatment of breast cancer in Louisiana

Previous studies have suggested that breast cancer patients with a delay of three months or more in initiating radiotherapy after breast conservative surgery, have increased recurrence and lower survival than those without treatment delay. In this study, the inequalities in receiving radiation on time after surgery were identified in five areas--patient's age at diagnosis, race, size of the facility where the patient received treatment, teaching status of the facilities and geographical location where the patient received treatment. All patients studied were female patients. Women younger than 50 years of age, of the black race, receiving treatment in a teaching hospital, and who were treated by surgeons in southeast and central Louisiana were more likely to experience delay in receiving radiotherapy after breast conservative surgery than their counterparts. Patient's insurance status, marital status and SES did not have any influence on treatment delay. Also, the surgeon's practice age at diagnosis, the surgeon's medical school, facility ownership status and Commission on Cancer approval status did not show significant effect.