妇科门诊患者宫颈癌筛查认知程度及其影响因素

 目的 探讨妇科门诊患者宫颈癌筛查的认知程度及其相关影响因素。方法 选取840例妇科门诊就诊的患者进行问卷调查,分析就诊患者宫颈癌筛查的知晓率,采用单因素χ²检验和多因素Logistic回归法分别筛选认知程度的影响因素。结果 840例妇科门诊患者宫颈癌筛查的知晓率为52.38%(440/840);影响宫颈癌筛查认知程度的因素包括文化程度(OR=2.022,95%CI 1.251~3.268)、家族妇科肿瘤史(OR=2.918,95%CI 1.689~5.042)、宫颈癌筛查史(OR=4.031,95%CI 2.124~7.652)、“两癌筛查”社区宣教(OR=5.043,95%CI 2.757~9.223)、接受生殖健康信息(OR=3.337,95%CI 1.482~7.512)、社会支持程度(OR=2.593,95%CI 1.291~5.211)。结论 妇科门诊患者宫颈癌筛查的认知程度仍然较低,且影响认知程度的因素较多,应针对其特点及其影响因素,早期采取对策和措施,提高认知程度,降低宫颈癌的发生率。     

缺血性脑卒中患者抗血小板药物服药依从性及影响因素分析

目的:对缺血性脑卒中患者抗血小板药物服药依从行为的现状进行调查,探讨药物依从性的影响因素.方法:选取2017年6月至12月期间在本院住院的缺血性脑卒中患者585例,根据服药依从性情况,将研究对象分为依从性好的患者280例,依从性差的患者305例,通过Logistic回归分析影响缺血性脑卒中患者抗血小板药物服药依从性的影响因素.结果:A组患者的文化程度、家庭收入、有医保、居住在城市、合并糖尿病、合并高血脂症复诊的比例均显著高于B组,多因素Logistic回归结果显示,患者抗血小板药物服药依从性的影响因素有年龄、文化程度、家庭年收入、医保、合并糖尿病、合并高脂血症、复诊(P＜0.05).结论:缺血性脑卒中患者服用抗血小板药物的服药依从性有待进一步提高,应重点针对低年龄、文化程度不高、无医保、无合并其他慢性病的人群进行个性化干预,加强宣传缺血性脑卒中患者的二级预防,提高患者的服药依从性.     

缺血性脑卒中患者抗血小板药物服药依从性及影响因素

目的:对缺血性脑卒中患者抗血小板药物服药依从行为的现状进行调查,探讨药物依从性的影响因素.方法 选取2017年6月至12月期间在本院住院的缺血性脑卒中患者585例,根据服药依从性情况,将研究对象分为依从性好的患者280例,依从性差的患者305例,通过Logistic回归分析影响缺血性脑卒中患者抗血小板药物服药依从性的影响因素.结果 A组患者的文化程度、家庭收入、有医保、居住在城市、合并糖尿病、合并高血脂症复诊的比例均显著高于B组,多因素Logistic回归结果显示,患者抗血小板药物服药依从性的影响因素有年龄、文化程度、家庭年收入、医保、合并糖尿病、合并高脂血症、复诊(P＜0.05).结论 缺血性脑卒中患者服用抗血小板药物的服药依从性有待进一步提高,应重点针对低年龄、文化程度不高、无医保、无合并其他慢性病的人群进行个性化干预,加强宣传缺血性脑卒中患者的二级预防,提高患者的服药依从性.     

慢性支气管炎社区干预治疗的效果评价

目的:观察社区干预对慢性支气管炎患者的作用效果.方法:对社区内200名慢性支气管炎患者进行干预,主要方式为健康宣教,行为干预,随访干预,预防性治疗,定期观察治疗依从性、危险因素及并发症情况.结果:干预后患者对慢性支气管炎的认知度明显提高,降低了住院率提高了生活质量.患者对社区内开展卡介菌素多糖核酸(斯奇康)等预防性治疗表示满意,危险因素及并发症显著减少.结论:社区干预是控制慢性支气管炎的有效方法,适合社区内推广和发展.     

影响宫颈癌根治性放射治疗患者预后的临床因素分析

目的探讨宫颈癌患者根治性放射治疗的远期疗效、预后影响因素及放疗并发症。方法将兰州军区兰州总医院肿瘤中心和解放军总医院肿瘤中心2002年1月—2012年12月间收治的855例原发性宫颈癌患者作为研究对象,对其临床资料进行回顾性研究。上述患者均完成根治性放射治疗:盒式四野照射30~44 Gy后进行双侧宫旁推量至46~58 Gy,平均剂量A点36.3 Gy,B点52.7 Gy;外照射疗程中同步行宫颈腔内近距离放疗(6~7)Gy/次×5~6次,平均剂量(A点)32.6 Gy。132例患者接受子宫动脉介入灌注化疗栓塞术(介入治疗)。大部分患者接受最多4周期的全身化疗。结果全组患者的2、5、10年总生存率分别为87.6%、57.5%、32.2%。Cox多因素回归分析显示影响宫颈癌根治性放射治疗生存率的独立预后因素为年龄、介入治疗、临床分期、血红蛋白水平、全身化疗、A点总剂量。年龄、A点总剂量、B点总剂量是迟发性直肠损伤的危险因素;临床分期及B点总剂量是迟发性小肠损伤的危险因素;介入治疗为迟发性膀胱损伤发生的唯一危险因素。结论患者发病年龄、血红蛋白水平、全身化疗、A点总剂量是影响宫颈癌患者根治性放射治疗预后的积极因素;临床分期、介入治疗是消极因素。     

早期宫颈癌术后淋巴结阳性患者放疗后疗效及预后分析

目的 回顾性分析早期（Ⅰ _B~Ⅱ _A期）宫颈癌术后淋巴结阳性患者调强放疗（IMRT）后的预后及淋巴结转移的相关危险因素。方法 选取2016年1月至2018年12月宁夏医科大学总医院放疗科收治的292例早期宫颈癌术后存在高危因素和/或中危因素且行盆腹腔调强放疗±同步化疗的患者进行回顾性分析,分为盆腔淋巴结阴性组239例、淋巴结阳性组53例,对淋巴结转移的相关危险因素及两组患者的预后进行分析。结果 早期宫颈癌术后淋巴结转移影响因素的单因素及多因素分析显示,病变≥4 cm、深间质侵犯、危险因素个数是盆腔淋巴结转移的独立影响因素（χ²=7.11、9.05、90.08,P<0.05）;盆腔淋巴结阴性及阳性患者放疗后3、5年总生存（OS）差异无统计学意义（P>0.05）,3、5年无疾病生存（DFS）两组分别为87.6%、84.5%;72.5%、69.3%（χ²=8.59,P=0.003）。在失败模式上,淋巴结阳性组以远处转移为主,淋巴结阴性组以局部复发为主（χ²=9.40,P<0.05）。对53例淋巴结阳性患者放疗后影响DFS的单因素分析,深间质侵犯明显影响患者的DFS,差异有统计学意义（χ²=7.25,P<0.05）;多因素分析提示病变>4 cm、残端阳性和深间质侵犯显著影响DFS （χ²=4.37、4.69、4.39,P<0.05）。结论 早期宫颈癌术后病变大小、侵犯深度、危险因素个数是淋巴结转移的独立影响因素,盆腔淋巴结阳性患者放疗后DFS显著低于淋巴结阴性患者,淋巴结阳性患者的主要复发模式为远处转移,深间质侵犯是早期宫颈癌术后淋巴结阳性患者放疗后DFS的独立影响因素。     

扩散加权成像及临床病理特性对宫颈癌同步放化疗复发的诊断价值

目的 回顾性分析扩散加权成像(DWI)技术及临床病理特性预测宫颈癌同步放化疗复发的价值.方法 选取于放化疗前及放化疗后4周行DWI扫描的宫颈癌患者72例,其中放化疗后复发患者14例.比较放化疗前后及复发组与未复发组肿瘤表观扩散系数(ADC)值、ADC改变量及肿瘤临床病理的差异,回归分析宫颈癌复发的危险因素.结果 同步放...     

某部40岁以上1208例体检人群大肠癌筛查结果分析

 目的 探索与体检相结合的大肠癌筛查工作的可行性。方法 选择某部40岁以上人群1208例,通过宣传手段使其了解大肠癌的危险因素,发放便潜血标本收集器,对便潜血试验阳性和有危险因素的高危人群进行肠镜检查。结果 在1208例筛查人员中,同时行便潜血检查和参加危险因素调查者1045例,筛查的总应答率86.5%,肠镜检查的应答率72.7%,均高于国内几次大型筛查的应答率（P＜0.05）。潜血阳性组行肠镜检查21例,危险因素调查阳性组行肠镜检查83例;两组的肠镜检查应答率、肠镜检查阳性率、癌的检出率、伴不典型增生的检出率相比差异无统计学意义,潜血阳性组绒毛状腺瘤、多发管状腺瘤的检出率高于危险因素调查阳性组（P＜0.05）,危险因素调查阳性组单发管状腺瘤的检出率高于潜血阳性组（P＜0.05）。结论 与单位体检相结合的大肠癌筛查方案人群应答率高,危险因素调查是大肠癌筛查的有效手段。     

超声造影技术评估宫颈癌预后应用价值研究

目的探讨超声造影(CEUS)技术评估宫颈癌预后的应用价值。方法选取2010年12月至2016年4月收治的宫颈癌患者40例,根据是否存在风险预后因素分为中-高风险组(15例)与低风险组(25例)。比较两组患者的CEUS表现与时间-强度曲线(TIC)参数,绘制受试者工作特征曲线(ROC)并计算增强强度(EI)最佳诊断阈值。结果宫颈癌CEUS表现以非均匀性高增强为主,两组增强水平与增强分布比较,差异无统计学意义(P>0.05);中-高风险组灌注缺损多于低风险组,差异有统计学意义(P<0.05)。两组增强时间(AT)与达峰时间(TTP)差异无统计学意义(P>0.05);中-高风险组峰值强度(PI)与增强强度(EI)高于低风险组,差异有统计学意义(P<0.05)。EI在最佳诊断阈值25.75 d B时,评估宫颈癌存在中-高风险预后因素的敏感度为93.3%、特异度为74.0%、准确度为77.5%。结论 CEUS技术在评估宫颈癌预后中具有一定的临床应用价值。     

老年胃溃疡出血患者再发出血的危险因素分析

【摘要】 目的 探讨分析老年胃溃疡出血患者再发出血的相关危险因素。方法 选取 2020 年3月至2022年3月许昌市中心医院收治的 140 例老年胃溃疡出血患者作为研究对象, 收集患者性别、年龄、发病部位、胃溃疡长径、出血活动度、是否为胃溃疡 A1 期、是否合并幽门螺杆菌 (Hp) 感染、有无吸烟史、有无饮酒史、合并其他慢性疾病种类 (≤2 种、>2 种)、是否进行消化内镜治疗、是否长期使用非甾体抗炎药 (NSAIDs) 等资料,并根据患者止血成功后 1 个月内是否再发出血将患者分为发生组与未发生组? 多因素 Logistic 回归分析老年胃溃疡出血患者再发出血的危险因素。结果 140 例老年胃溃疡出血患者均于止血成功后随访 1 个月, 随访过程中 21例 (15.0%) 患者再发出血, 设为发生组; 119 例 (85.0%) 患者未再发出血, 设为未发生组。单因素分析结果显示, 发生组胃溃疡 A1 期、Hp 感染、未进行消化内镜治疗、长期使用 NSAIDs 的患者比例均明显高于未发生组(χ2 = 4.269、7.381、7.580、11.836, P= 0.039、0.007、0.006、0.001); 多因素 Logistic 回归分析结果显示, 胃溃疡 A1 期、Hp 感染、未进行消化内镜治疗、长期使用 NSAIDs 是老年胃溃疡出血患者再发出血的独立危险因素(95%CI 为 1.039~ 9.660、1.909~ 58.707、0.059~ 0.585、1.880~ 18.559, P= 0.043、0.007、0.004、0.002)。 结论 胃溃疡 A1 期、Hp 感染、未进行消化内镜治疗、长期使用 NSAIDs 是老年胃溃疡出血患者再发出血的独立危险因素, 临床应根据患者具体情况制定针对性干预措施, 以降低再出血发生风险。     

Modifiers of Cancer Screening Prevention Among Sexual and Gender Minorities in the Behavioral Risk Factor Surveillance System

PurposeIncreasing social acceptance of sexual and gender minorities may not translate to parity in health care access and health outcomes. Sexual orientation and gender identity (SOGI) may continue to contribute to differences in preventive health behavior including cancer screening. Our purpose was to estimate the independent effect of SOGI on breast, cervical, and colorectal cancer screening adherence.MethodsWe used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System. We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force guidelines. All survey data were self-reported including demographic and medical information. We calculated the prevalence of screening by sexual orientation (straight, lesbian or gay, bisexual) and gender identity (cisgender, transgender). The term “sexual and gender minorities” in our study refers to lesbian or gay, bisexual, and transgender individuals. Logistic regression models assessed independent effect of SOGI on screening adherence.ResultsPrevalence of breast, cervical, and colorectal cancer screening varied significantly by SOGI. After adjusting for other variables, bisexual persons had significantly lower odds (odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38-0.93) of breast cancer screening adherence. Lesbian or gay persons had significantly decreased likelihood (OR = 0.53, 95% CI = 0.29-0.95) of cervical cancer screening adherence. Although rate of colorectal cancer screening adherence varied significantly by SOGI, we did not find an independent effect of SOGI and colorectal cancer screening adherence after adjusting for other variables. No independent effect of gender identity categories on breast, cervical, and colorectal cancer screening adherence was detected. Social determinants of health, such as health care access and insurance, that disproportionately disadvantaged bisexual individuals independently influenced screening adherence.ConclusionsSOGI can affect cancer screening adherence. Bisexual individuals had worse health care access and socioeconomic hardships among sexual and gender minorities. Given the independent effects of social determinants of health on cancer screening adherence, more attention needs to be paid to sexual and gender minorities, especially bisexual population.     

Implementation and Uptake of Rural Lung Cancer Screening

ObjectiveGiven the higher rates of tobacco use along with increased mortality specific to lung cancer in rural settings, low-dose CT (LDCT)-based lung cancer screening could be particularly beneficial to such populations. However, limited radiology facilities and increased geographical distance, combined with lower income and education along with reduced patient engagement, present heightened barriers to screening initiation and adherence.MethodsIn collaboration with community leaders and stakeholders, we developed and implemented a community-based lung cancer screening program, including telephone-based navigation and tobacco cessation counseling support, serving 18 North Texas counties. Funding was available to support clinical services costs where needed. We collected data on LDCT referrals, orders, and completion.ResultsTo raise awareness for lung cancer screening, we leveraged our established collaborative network of more than 700 community partners. In the first year of operation, 107 medical providers referred 570 patients for lung cancer screening, of whom 488 (86%) were eligible for LDCT. The most common reasons for ineligibility were age (43%) and insufficient tobacco history (20%). Of 381 ordered LDCTs, 334 (88%) were completed. Among screened patients, 61% were current smokers and 36% had insurance coverage for the procedure. The program cost per patient was $430.DiscussionImplementation, uptake, and completion of LDCT-based lung cancer screening is feasible in rural settings. Community outreach, health promotion, and algorithm-based navigation may support such efforts. Given low lung cancer screening rates nationally and heightened lung cancer risk in rural populations, similar programs in other regions may be particularly impactful.     

Colorectal cancer screening in women: an underutilized lifesaver

OBJECTIVE: Colorectal cancer (CRC) represents the third most common cancer diagnosed and a major cause of cancer-related deaths in women. Despite strong evidence that early screening decreases colorectal cancer incidence and mortality rates, colorectal cancer screening rates in women still lag significantly behind screening rates for breast and cervical cancers. Additionally, women have been found to be less likely than men to undergo CRC screening. This is despite the fact that the overall lifetime risk for the development of colorectal carcinoma is similar in both sexes. Barriers to screening have been found to be different for women compared with men. Screening adherence in women also appears to be associated with various social and demographic factors. CONCLUSION: CT colonography (CTC) is an accurate, minimally invasive, and well-tolerated examination that is newly endorsed by the American Cancer Society, U.S. Multisociety Task Force, and the American College of Radiology. Improved screening compliance may occur in women with further dissemination of CTC.     

Predictors of Lung Cancer Screening Utilization in a Population-Based Survey

PurposeAnnual low-dose CT (LDCT) screening in high-risk individuals has been recommended to detect lung cancer earlier and reduce mortality. The objective of this study was to identify demographic, financial, and health care factors associated with screening uptake in a population-based survey.MethodsData from the Lung Cancer Screening Module and core modules of the 2017 Behavioral Risk Factor Surveillance System, a population-based survey administered via cell phone and landline, were analyzed to examine demographic, health, and financial factors associated with screening uptake among the 10 states that administered the screening module. Weighted frequencies and confidence intervals (CIs) were produced, and weighted Wald χ² tests were used to compare differences in screening utilization by patient characteristics. A multivariate logistic mixed-effects model was constructed, in which participant clustering by state was accounted for with a random intercept.ResultsThe uninsured were less likely to undergo LDCT screening (odds ratio [OR], 0.28; 95% CI, 0.12-0.65). LDCT screening uptake was higher for participants with chronic respiratory conditions (OR, 4.14; 95% CI, 2.33-7.35); those who were divorced, separated, widowed, or refused to answer (OR, 1.41; 95% CI, 1.05-1.86); those who had previous cancer diagnoses (OR, 1.90; 95% CI, 1.40-2.56); and those aged 65 to 69 years (OR, 1.23; 95% CI, 1.06-1.44) or 70 to 74 years (OR, 1.17; 95% CI, 1.00-1.37). Utilization also varied significantly across states.ConclusionsHaving a related health condition whereby participants were sensitized to the benefits of early screening (ie, another cancer diagnosis, presence of chronic respiratory conditions) and having insurance coverage were associated with higher LDCT screening uptake. Providers should engage LDCT-eligible patients through informed and shared decision making to increase preference-sensitive screening decisions.     

人乳头瘤病毒检测在宫颈疾病诊断中的意义

目的探讨人乳头瘤病毒(HPV)检测在宫颈疾病诊断中的应用及临床意义。方法选取2009年5月—2010年11月520例在大连医科大学附属一院三部妇科就诊妇女为研究对象,取宫颈脱落细胞采用导流杂交基因芯片(HybriMax)法行HPV检测,同时结合组织病理学检查进行分析,明确HPV感染与宫颈疾病的关系及宫颈癌的发生、发展过程。结果 HPV总感染率为48.8%,30～39岁年龄组HPV感染率最高为54.5%;组织病理学诊断慢性宫颈炎症、低级别病变(CINⅠ)、高级别病变(CINⅡ～Ⅲ)、宫颈原位癌或浸润癌中高危HPV感染检出率以42.2%、65.8%、95.4%、100.0%依次递增。结论宫颈疾病与高危型HPV感染有着十分密切的关系,引起宫颈肿瘤的最主要原因是高危型HPV感染,高危型HPV检测可作为宫颈癌的一种重要筛查手段。     

Identifying disparities in brachytherapy delivery for locally advanced cervical cancer

IntroductionThe standard of care for locally advanced cervical cancer is concurrent chemotherapy and external beam radiation therapy (EBRT) followed by a brachytherapy boost. Some studies show a decreased usage of brachytherapy in cervical cancer patients despite the standard of care and known survival advantage. This study aims to characterize the utilization of brachytherapy in Oregon and identify where disparities in treatment may exist.MethodsThe Oregon State Cancer Registry database was used to identify patients diagnosed with FIGO Stage IB2-IVB cervical cancer between 2007 and 2016. Patients who received initial EBRT were categorized by whether they received brachytherapy boost or not. Age at diagnosis, county of patient residence, rural-urban status of the county, race/ethnicity, and insurance payer were studied using multivariable logistic regression to identify possible underserved populations. Survival data was compared using a Cox proportional hazard survival model.Results401 patients who received primary EBRT for FIGO stage IB2-IVB cervical cancer were identified in the 10-year span. Breakdown by stage is: 16% stage IB2, 23.9% stage II, 37.4% stage III, and 22.7% stage IV. Of those, 154 (38.4%) received brachytherapy boost treatment, 75 (18.7%) received a different boost modality, and 42.9% received no boost. Stage IV (p = 0.001) and uninsured patients (p = 0.04) were significantly less likely to receive brachytherapy. Older age was also associated with decreased brachytherapy usage, as each additional year of life decreased brachytherapy receipt by 1.8% (p = 0.04). Native American and Pacific Islander patients were the only group significantly more likely to receive brachytherapy (p=0.003). There was no significant difference in the rate of brachytherapy boost identified based on urban/rural status of the county (p = 0.63 to 0.69), other racial/ethnic categories (p = 0.66 to 0.80), or among the other stages (p=0.45 to 0.63). In Cox proportional hazard survival analysis, patients that received brachytherapy showed a 42% reduction in risk of cancer specific mortality, though this did not reach the predetermined level of statistical significance (p = 0.057).ConclusionsThe brachytherapy boost rate among locally advanced cervical cancer patients was 38.4%. The data also indicated a likely reduction in cancer specific mortality in patients receiving brachytherapy. Older patients, stage IV patients, and uninsured patients were less likely to receive brachytherapy. Given the low overall brachytherapy usage, these data indicate access and delivery of brachytherapy care needs to be improved across the state. The increased brachytherapy use in the American Indian and Pacific Islander patient population should be further studied to identify facilitators to treatment completion and potentially extrapolate to other groups.     

Completion of colorectal cancer screening in women attending screening mammography

RATIONALE AND OBJECTIVES: The American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) recommend colorectal cancer (CRC) screening to begin at age 50 in individuals at average risk for CRC. To estimate rate at which women eligible for CRC screening at the time of screening mammography attendance later completed in CRC screening, we retrospectively evaluated CRC screening utilization in women who underwent screening mammography at our institution. MATERIALS AND METHODS: We retrospectively identified 3357 women between the ages of 50 to 75 who received screening mammography in 1998 at a single academic medical center using the institution's Radiology Information System (RIS). Additional information collected from the institution's Health System Data Warehouse and the Radiology department's mammography quality assurance data included mammography results, Breast Imaging Reporting and Database System (BI-RADS) classification of mammography findings, recommendation for screening mammography follow-up, insurance status, and CRC screening utilization after screening mammography. After excluding women who were current with CRC screening at the time of mammography, we determined the proportion of eligible women who completed CRC screening after mammography. Age, insurance type, BI-RADS code, and recommendation code were evaluated as potential predictors of CRC screening completion in eligible women. RESULTS: Of the 3357 women between the ages of 50 and 75 who received screening mammography in 1998, only 414 (12.3%) were current with CRC screening at the time of screening mammography. Of the remaining 2943 women who were eligible for CRC screening at the time of screening mammography, 142 (4.8%) subsequently completed CRC screening. Average time to completion of CRC screening after screening mammography is 35.4 months (range, 0.27-64.9). Managed care insurance was the only significant predictor of CRC screening completion after screening mammography in eligible women after adjusting for other variables (adjusted OR 1.73, 95% CI 1.21-2.47, P < .0001). Neither BI-RADS classification nor postmammography recommendations were significantly associated with CRC screening completion. CONCLUSIONS: Prevalence studies have demonstrated that women who were compliant with screening mammography were more compliant with CRC screening. Our data suggest that despite this increased compliance, overall incidence of CRC screening is low in the screening mammography population.