The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors.

OBJECTIVES: This study described factors related to colorectal cancer stage at diagnosis. METHODS: Logistic regression analyses were used on data from the New York State Tumor Registry and US Census area-level social class indicators. RESULTS: After the effects of other predictors were controlled for, the odds of late-stage cancer increased as age decreased; women and African Americans were significantly more likely to have late stage than men and Whites; and individuals living in areas of low socioeconomic status (SES) were significantly more likely to be diagnosed at late stage than those living in higher SES areas. Stratified analyses showed that living in a low SES area was the most important determinant of stage for all age, race, gender and source-of-care groups. CONCLUSIONS: While all populations would benefit from the systematic use of screening socioeconomically disadvantaged groups may also benefit from targeted screening.     

The importance of place of residence in predicting late-stage diagnosis of breast or cervical cancer

We tested whether inner-city women were at significantly increased risk of late-stage cancer diagnosis because they resided in extremely poor and socially isolated neighborhoods or in neighborhoods meeting the federal definition of a medically underserved area (MUA). Cancer registry data on women in three American cities were matched to Census data. Using logistic regression we found that residence in economically and socially distressed or medically underserved neighborhoods tended to increase the likelihood of late-stage cancer diagnoses. Further, we found that not all areas that are economically and socially distressed receive the federal MUA designation. Consequently, we argue that economically and socially distressed neighborhoods should be automatically designated as MUA.     

The social and demographic characteristics of women dying from cervical cancer in Nottingham

Cervical cancer accounted for 57 deaths to women in Nottingham District in 1986 and 1987. 28% were women aged under 50 years of age. Using age specific death rates, the greatest risk was among women aged 60-69 years. However, when expressed as a proportion of all deaths, cervical cancer represents 8.5% of deaths in women aged 25-45, but only 0.6% of deaths to women over 46. There was no significant difference in relative risk between the five social classes, even when social class V was compared to aggregated data for social classes I-IV. This supports other evidence that the social class gradient in cervical cancer mortality is lessening. There was no excess risk shown to women resident in the inner city or in areas of social deprivation. This finding is in contrast to the work of others who have shown an increased incidence in areas of social deprivation. The evidence from this study would support those who suggested over 20 years ago that it is not social deprivation or occupation that constitute an increased risk to women, but sexual behaviour and other habits such as smoking.     

Social and demographic predictors of parental consultation for child psychological difficulties

BACKGROUND: Results from previous studies examining determinants of parental consultation for child mental health provide inconsistent evidence concerning socio-demographic predictors. The aim of this study is to identify the sociodemographic predictors of parental consultation for child psychological difficulties. METHOD: An epidemiological cross-sectional analysis was carried out using a sample of 5,913 children aged between 4 and 15 years from the Health Survey for England. The Strengths and Difficulties Questionnaire (SDQ) was the measure of child psychological morbidity. RESULTS: Parents of children with psychological difficulties were less likely to seek a consultation if their child was a girl, as household income decreased or if the head of household came from manual social class. In contrast, parents were more likely to seek a consultation if they were in receipt of a benefit than if they were not in receipt of a benefit. Age of child and family type did not predict parental consultation. CONCLUSIONS: The results of this analysis confirm that a substantial proportion of children with mental health difficulties in the general population (42 per cent) have not been seen by a professional, and these are likely to be girls and children in low-income families, indicating a significant unmet need for services across the nation. These results suggest that parents and health professionals should be made more aware of the symptoms of psychological problems in girls and that services need to be planned in a way that improves uptake by low-income parents.     

Risk of late-stage breast cancer after a childbirth

A pregnancy may lead to hormone-induced growth of breast tumors. The authors investigated whether women in the first years after childbirth had a higher incidence of breast cancer and, in particular, a higher incidence of late-stage tumors (i.e., a large tumor, nodal involvement, or histologic grading II + III). The study was based on a population-based cohort of 1.5 million Danish women born between 1935 and 1978. Between 1978 and 1994, 10,790 incident cases of breast cancer were identified in a nationwide cancer registry. Overall, uniparous and biparous mothers experienced a transient increased risk that did not appear to be attributable to delayed cancer diagnosis. The risk of being diagnosed with a tumor whose diameter was larger than 5 cm was, on average, 53% higher during the first 10 years after birth compared with later. The risk of tumors of less than 2 cm was not significantly associated with time since the latest birth. In conclusion, after a childbirth, mothers experience a transient increased risk of breast cancer and, in particular, a relatively high risk of late-stage disease. This finding suggests that pregnancy-related factors transiently induce a high growth rate in cells that are already malignant and stimulate new tumor growth.     

Breast and cervical cancer screening: sociodemographic predictors among White,Black, and Hispanic women

OBJECTIVES: We evaluated the relationship between breast and cervical cancer screening and a variety of variables across race/ethnicity groups. METHODS: Using logistic regression models, we analyzed data from the 1998 National Health Interview Survey to assess the relative importance of the independent variables in predicting use of cancer screening services. RESULTS: Having a usual source of care was the most important predictor of cancer screening use for all race/ethnicity groups. Health insurance was associated with an increased likelihood of cancer screening. Smoking was associated with a decreased likelihood of cancer screening. CONCLUSIONS: Regardless of race/ethnicity, most women follow mammography and cervical cancer screening guidelines. The identification of specific factors associated with adherence to cancer screening guidelines may help inform screening campaigns.     

Relationships among and demographic predictors of dentists' self-reported adherence to national guidelines.

How dentists learn about and integrate new procedures and techniques into dental practice are major concerns in innovation research in dentistry. The purposes of this study were to: (1) develop reliable measures of self-reported adherence to different national guidelines; (2) to examine the relationships among the different measures; and (3) to determine if predictors of these adherence behaviours exist. One thousand U.S. general dentists were asked to complete a survey of adherence behaviours to established guidelines in infection control, radiation protection, and antibiotic prophylaxis. Thirty-five percent responded to the mailed survey. Reliable scales were developed in infection control and antibiotic prophylaxis behaviors. Step-wise multiple regression analysis produced several weak predictors of adherence to guidelines in these two areas. Characteristics of early adopters such as office complexity, membership in professional associations, and year of graduation, were consistent with other dental innovation literature. Significant correlations were found between adherence behaviors in infection control and antibiotic prophylaxis. These correlations do support the findings that practitioners who are early adopters of innovation are likely to do so in more than one area.     

宫颈癌新辅助化疗临床研究

目的:观察新辅助化疗治疗宫颈癌的疗效并探讨其临床意义。方法:对34例宫颈癌患者进行新辅助化疗,然后再进行手术治疗。结果:34例患者经过两个疗程的化疗后,完全缓解4例,部分缓解12例,稳定10例,进展8例,总治愈率76.47%。对患者进行术后的病理检查,发生淋巴结转移4例。结论:运用新辅助化疗对宫颈癌进行治疗是安全有效的,其作为一种新的治疗宫颈癌的手段,临床意义显著。     

血清SCCAG在宫颈癌及癌前病变中的临床意义

目的:研究鳞状细胞癌抗原(SCCAg)在宫颈癌及癌前病变中的表达和意义。方法:分析宫颈上皮内瘤变(CIN)组368例、宫颈癌组84例的SCCAg值与患者不同临床分期、分化程度等病理参数之间的关系。结果:SCCAg在宫颈癌前病变及宫颈癌早期已有变化,与临床FIGO分期、分化程度、肿瘤体积的增大及淋巴结转移呈正相关。结论:SCCAg是宫颈癌的重要临床肿瘤标志物,较高的血清SCCAg值可能意味着肿瘤恶性程度越高,为患者的辅助诊断、病情估计提供全面的指导信息。     

人乳头瘤病毒多重感染与宫颈癌的临床特征

目的探讨人乳头瘤病毒(Human papilloma virus,HPV)多重感染与宫颈癌的关系。方法选择2007年1月-2016年12月医院收治的宫颈癌患者350例为宫颈癌组,宫颈正常女性100例为对照组,所有患者均行HPV分型检测。结果宫颈癌组HPV感染率为84.6%,对照组HPV感染率为9.0%;宫颈癌组HPV单一感染率和HPV多重感染率均高于对照组(P<0.05);宫颈癌HPV多重感染以二重感染为主,只有3例三重感染,HPV二重感染以HPV16+HPV18占29.8%、HPV16+HPV68占14.9%、HPV16+HPV58占12.8%为主;HPV多重感染的发生与宫颈癌患者的年龄有关(P<0.05)。结论宫颈癌的发生与HPV多重感染有关,HPV多重感染与宫颈癌患者的年龄有关,HPV与宫颈癌分期、病理分型、组织分化和淋巴结转移无显著关系。     

培美曲塞联合奥沙利铂一线治疗老年晚期肺腺癌临床观察

目的观察培美曲塞（pemetrexed）联合奥沙利铂（Oxaliplatin）一线治疗老年晚期肺腺癌的临床疗效及毒副反应。方法病理学或组织学确诊的老年晚期肺腺癌患者共15例,采用培美曲塞联合奥沙利铂方案：培美曲塞500 mg/m~2第1d;奥沙利铂120 mg/m~2第2d,每3周为1个周期重复,每2个周期后评估疗效及不良反应。结果 15例患者均可评价疗效,1例获完全缓解（CR）,4例获部分缓解（PR）,4例稳定（SD）,6例疾病进展（PD）,总有效率为33.3%（5/15）,疾病控制率60.0%（9/15）,中位疾病进展时间（TTP）为4.9个月,中位生存期（OS）10.7个月（4～19个月）,1年生存率为53.3%（8/15）。毒性反应主要有骨髓抑制、发热、恶心、呕吐和腹泻等。但患者多为Ⅰ、Ⅱ度反应,耐受性较好。结论培美曲塞联合奥沙利铂方案对老年晚期肺腺癌疗效确切,临床使用安全性较好。     

放化疗同步治疗晚期宫颈癌的临床观察

目的：观察放化疗同步治疗对晚期宫颈癌的临床治疗效果。方法对2008年5月至2012年7月广东省深圳市蛇口人民医院收治的晚期宫颈癌患者,随机分为对照组及实验组,均进行放射治疗,而实验组患者再配合化学辅助治疗,观察两组治疗效果。结果治疗后实验组肿瘤最大径线小于对照组,且差异具有统计学意义（t＝4．321,P＜0．05）。实验组患者有效率高于对照组,差异具有统计学意义（χ2＝4．71,P＜0．05）。实验组骨髓抑制和消化道反应比例均高于对照组,且差异具有统计学意义（χ2值分别为7．38和7．66,均P＜0．05）。两组患者生存率逐年递减,实验组1年、3年、5年生存率高于对照组,且差异具有统计学意义（χ2值分别为6．543,6．542,6．541,均P＜0．05）。结论采用放化疗同步治疗患者晚期宫颈癌效果显著。     

Cervical cancer risk factors and predictors of cervical dysplasia among women in south‐west Nigeria

Aim: This study identified predictors of cervical dysplasia and assessed the prevalence of risk factors for cervical cancer among women of different socioeconomic classes in Ogun State, Nigeria. Method: In a two‐phase study, self‐reported information on cervical cancer awareness, risk factors and cervical cancer screening practices was obtained from 278 randomly selected working women. A random subset was screened for dysplasia using visual inspection with acetic acid (VIA). Results: Of the 278 women, 126 (45.3%) were semi‐skilled while 152 (54.7%) were skilled and professional workers. Median age at first sexual intercourse was 19 years (range 13–29) and lower than the median age at first marriage (25 years). Gonorrhoea and genital warts were the commonest reported sexually transmitted infections. Only 12.2% of the women used male condoms as their primary method of birth control and 4.7% of the women had ever had a Papanicolaou smear, a practice that was significantly higher among the professional/skilled compared with semi‐skilled workers (P = 0.031). Of the 125 screened, 20 (16%) had positive VIA. Young age at first sex (≤17 years) (OR = 3.7 (95% CI, 1.07–12.8)) and early first marriage (<25 years) (3.3 (1.00–10.9)) were associated with a positive VIA. Women with lower parity (0–3) had borderline significantly increased risk of having a positive VIA (3.1 (0.9–10.6)). Women currently over 34 years and those without a history of sexually transmitted infections had lower risk of positive VIA (P > 0.05). Conclusions: Acceptable screening services and cervical cancer awareness campaigns that address modifiable risk factors are urgently needed in this community.     

宫颈癌住院患者临床特点及影响因素

目的宫颈癌严重威胁女性生命健康,本研究旨在探讨宫颈癌住院患者的临床特点及影响因素。方法选择大连市妇幼保健院2014-05-10-2019-05-20收治的500例宫颈癌患者作为病例组,另选取同期行体检的500名非宫颈癌检查者作为对照组。通过问卷调查收集年龄、孕次、产次、吸烟、避孕方法、家族相关遗传病史和首次性行为时间等资料,并进行分析。结果 500例宫颈癌患者中,临床分期:Ⅰ期209例,ⅡA期291例;病理类型:鳞癌412例,腺癌88例;肿瘤直径:<2cm 221例,≥2cm 279例;脉管累及:有162例,无338例;淋巴转移332例。单因素分析结果显示,两组在孕次(χ~2=38.440,P<0.001)、吸烟(χ~2=58.080,P<0.001)、避孕方法(χ~2=69.370,P<0.001)、家族相关遗传病史(χ~2=82.850,P<0.001)和首次性行为年龄(χ~2=97.320,P<0.001)等方面比较,差异有统计学意义。多因素分析结果显示,宫颈癌的危险因素为吸烟史(OR=1.725,95%CI为1.161～2.562,P=0.007)、服用避孕药(OR=2.255,95%CI为1.275～3.988,P=0.005)、有家族相关遗传病史(OR=2.782,95%CI为1.597～4.844,P<0.001)、孕次≥3次(OR=1.958,95%CI为1.360～2.820,P<0.001)和首次性行为年龄≤20岁(OR=3.370,95%CI为1.566～7.253,P=0.002)。结论宫颈癌患者的病理特点为临床分期较晚,鳞癌比例较高,多无脉管累及,且淋巴结转移率较高;孕次、吸烟、避孕方法、家族相关遗传病史和首次性行为年龄为主要影响因素。     

Geographic disparities in late-stage breast cancer diagnosis in California

Using cancer registry data for the population of California women aged 67+ with breast cancers, we estimated random intercept logistic models to examine how two socio-ecological predictors (residential isolation and poverty) were associated with probability of late-stage diagnosis for breast cancer. Using the multilevel modeling results, we calculated fully adjusted predicted probabilities associated with women in each Medical Service Study Area (MSSA) in California and classified the areas into two distinct groups: MSSAs with predicted rates below the 25th percentile (presumably the better outcome areas) and MSSAs with predicted rates above the 75th percentile (presumably the worse outcome areas) for two minority groups. Some areas had better outcomes for one group but worse outcomes for the other, suggesting that interventions to improve outcomes need different strategies for different groups in the same areas. Using information from geographic risk factors and multilevel modeling, this study informs interventions designed to reduce disparities in breast cancer outcomes.     

宫颈癌患者治疗后性功能状况的临床观察

目的分析经过临床治疗的子宫颈癌患者与性功能障碍的关系。方法采用女性性功能指数(FSFI)自评量表对170例治疗前、后的子宫颈癌患者进行性功能状况的调查。结果 170例子宫颈癌患者在临床治疗后有78.5%出现不同程度的性功能障碍;宫颈癌患者的年龄、临床分期及围绝经期综合征病情程度等与其治疗后的性功能恢复相关。结论宫颈癌患者在临床治疗后可能出现不同程度的性功能障碍,故在提高宫颈癌治愈率和患者生存率的同时,不仅要降低性功能障碍的发生率和提高患者的生存质量,还应注重宫颈癌患者治疗后的性功能康复治疗。     

Infant,maternal and demographic predictors of delayed vaccination: A population-based cohort study

BackgroundReceiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity.MethodsPerinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000–11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children.ResultsEach dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region.ConclusionThe sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.