Factors involved in the diagnosis of oral squamous cell carcinoma in Malaysia

The delay in the diagnosis of oral cancer has been variously reported as being contributed by the clinicians, patients or both. The purpose of this study was to evaluate the referral pattern of 65 patients eventually diagnosed as having oral squamous cell carcinoma. The results showed that 50% of the patients delayed seeking professional help for more than 3 months after being aware of the lesion. The majority of the patients consulted medical practitioners as the first source of help. The mean clinicians' and patients' delay were 10.3 weeks and 28.9 weeks respectively. Dental practitioners showed a tendency to refer more advanced lesions compared to the medical practitioners. The findings raise the concern that lack of patients' awareness, misdiagnosis by clinicians and late detection by dental practitioners prevail thus calling for urgent measures towards early detection of the disease.     

孤独症谱系障碍早期诊断的影响因素分析

目的 研究孤独症谱系障碍(ASD)早期诊断的影响因素,为相关政策及研究提供科学依据。方法 对207例于深圳市妇幼保健院确诊的6岁以下ASD儿童的带养人进行现场或电话调查。依据诊断月龄分为早期诊断组(n=48,23.19%)和非早期诊断组(n=159,76.81%),采用调查表、盖瑟尔发育诊断量表(GDDS)、婴儿-初中学生社会生活能力量表(S-M)进行评估,运用单因素分析和逐步Logistic回归探讨影响因素。结果 两组的早期筛查、主要带养人等11个变量有统计学差异(P<0.05)。进行早期筛查有利于早期诊断(OR=4.296,95%CI:1.959~9.423);生活能力水平(OR=0.380,95%CI:0.207~0.698)、粗大运动水平(OR=0.323,95%CI:0.185~0.564)越低,越不利于早期诊断。结论 早期筛查对早期诊断至关重要,应完善当前的ASD早期筛查程序。     

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。     

Factors associated with speed of diagnosis, referral, and treatment in colorectal cancer.

Delay in the presentation of symptoms and in referral of patients for surgical opinion remains an important problem in colorectal cancer. Factors influencing patients to consult early include advice from close family or other associates and abdominal pain or vomiting, or both, as one of the early symptoms. More localised rectal symptoms and loss of weight are often associated with long delay. The "classic" symptom pictures are not often seen in the early stages of the disease. Few identifiable factors were associated with delay in referral for surgical opinion. Doctors who examine their patients (rectally or otherwise) refer them sooner. In the districts studied delay in instituting definitive treatment after consultant referral does not seem to be a major problem. There is some evidence that delay is associated with stage of the disease at presentation.     

Factors associated with time to breast cancer diagnosis and treatment in unscreened women in Portugal

Delays in detection, diagnosis and treatment may lead to poorer prognosis in women with breast cancer. We quantified time intervals from first detection (FD) to diagnosis (D) and first treatment (FT) and identified associated factors. We studied 282 patients diagnosed with breast cancer during 2012 at the Breast Clinic of the Portuguese Institute of Oncology in Porto, Portugal using face-to-face interview and medical records. Associations of sociodemographic and clinical characteristics with time intervals was computed using adjusted percentage differences (adjPD) after logarithmic transformation, odds ratios (adjOR) for comparing the highest and lowest thirds of the distribution and 95 percent confidence intervals (CI) for both measures, using linear and logistic regression, respectively. The median times between FD and D and FT were 31 and 44 days, respectively. Significantly longer periods between FD and D were found in symptomatic women (adjPD = 99.5, 95 percent CI: 37.1, 190.0; adjOR = 3.16, 95 percent CI: 1.57, 6.33). More advanced stage was associated with shorter intervals between D and FT (adjPD = ?33.8, 95 percent CI: ?44.2, ?21.5; adjOR = 0.14, 95 percent CI: 0.05, 0.34). Although some differences according to clinical characteristics were observed, they did not seem to translate into inequities in access to public healthcare in this group of women.     

Factors influencing finger systolic blood pressure test for diagnosis of vibration-induced white finger

Finger systolic blood pressure (FSBP) measurement during finger cooling is a feasible method for the diagnosis of vibration-induced white finger (VWF). The standardization of the FSBP test is required. The final draft of an international standard for the measurement and evaluation of FSBP (ISO/DIS 14835-2) has been proposed in 2004. The aim of this review is to overview factors influencing the FSBP test and discuss some issues in the final draft. The FSBP test is a method of diagnosing VWF with reasonable sensitivity and specificity, although the sensitivity was relatively low in studies of mild VWF. The test results depend on cold provocation procedures including finger cooling, body cooling, room temperature and other factors such clothing and smoking. There are some versions of procedures for cold provocation and the tested fingers in the final draft. These may cause a low sensitivity of the FSBP test. To determine how the methodological difference influence the results of the FSBP test, further studies are needed. Although there are issues in the draft, the international standard of the FSBP test is extremely useful for the diagnosis, treatment and compensation of VWF.     

腮腺肿瘤的CT诊断价值

目的提高对腮腺肿瘤的CT诊断及鉴别诊断水平。方法回顾性分析65例腮腺肿瘤的CT表现和病理结果。结果混合瘤37例,乳头状囊腺瘤15例,管状腺瘤1例,基底细胞腺瘤2例,嗜酸细胞腺瘤1例,淋巴上皮囊肿2例,脂肪瘤2例,癌5例。混合瘤平扫多数为低密度或等密度,增强后轻中度强化或明显强化,行多期增强扫描病例表现为渐进性的强化;乳头状囊腺瘤平扫呈略低密度或等密度,增强后强化较为显著,行多期增强扫描病例无渐进性强化;管状腺瘤平扫可见囊变区,增强后实性部分及囊壁明显强化;基底细胞腺瘤平扫呈等密度不易发现,增强后呈明显不均匀强化;嗜酸性细胞腺瘤平扫为稍高密度,周围脂肪间隙略模糊,增强后呈环形强化;淋巴上皮囊肿平扫成囊样低密度,增强后囊壁强化明显,较为均匀;脂肪瘤平扫呈典型的脂肪密度,增强后无明显强化;腮腺癌平扫呈等密度,增强后明显不均匀强化,3例颈部可见肿大淋巴结。良性肿瘤包膜一般较完整,与正常腮腺组织分界清,恶性肿瘤侵犯周围组织,并可有相应区域淋巴结肿大。结论 CT可清楚显示腮腺区肿瘤的存在及定位,一定程度上可鉴别良恶性肿瘤,增强扫描有助于鉴别诊断。     

Factors affecting delays in tuberculosis diagnosis in rural China: a case study in four counties in Shandong Province

Improving case detection is an urgent and serious challenge for tuberculosis (TB) control in China. We investigated the extent to which TB patients delayed seeking TB care and health services delayed reaching a diagnosis, and socio-economic factors associated with the delays. Standard questionnaires were administered to 190 new smear-positive TB patients who had completed treatment at TB dispensaries in four counties of Shandong Province in 2001. Multivariate analysis using Cox Regression showed that old age, lack of education and distance from home to a township health centre were significantly associated with delay in seeking care from service providers. In examining the delay between first contact with a service provider and diagnosis, we found that women experienced longer delays than men, and that the higher the level of facility patients first visited, the less time was needed to achieve a diagnosis. These two factors were statistically significant in multivariate Cox Regression analysis. We concluded that the elderly, the less educated, women, and those living far from health facilities face the longest delays in reaching TB services and achieving diagnosis.     

Factors leading to self-disclosure of a positive HIV diagnosis in Nairobi, Kenya: people living with HIV/AIDS in the Sub-Sahara

Understanding why, how, and to whom people living with HIV/AIDS disclose their diagnosis to others is a critical issue for HIV prevention and care efforts, but previous investigations of those issues in sub-Saharan Africa have been limited to one or two questions included in quantitative studies of social support or stigma. Instruments and findings on serostatus disclosure based on U.S. populations are likely to be at best only partially relevant because of Africa's primarily heterosexual transmission vectors and highly communalistic social structures. This qualitative analysis of two male and two female focus groups comprised of persons living with HIV/AIDS (PLWHAs) in Nairobi, Kenya, revealed several HIVstatus disclosure patterns that appear distinctive to Africa. These include (a) intermediaries as vehicles for disclosure to family, (b) indirectness as a communication strategy, and (c) church pastors as common targets for disclosure.     

Delay in the diagnosis of tuberculosis

In five patients, a 46-year-old Surinamese man, a 45-year-old Dutch barkeeper, a 41-year-old woman from Eritrea, and an 18-year-old Afghan woman and her 43-year-old mother, tuberculosis was diagnosed and treated after a considerable delay. Such a late diagnosis and subsequent treatment is not uncommon for tuberculosis as the symptoms, physical examination, laboratory tests, imaging techniques and bacteriological results are often not very specific. However under certain circumstances, tuberculosis (including the extrapulmonary manifestations) should be considered at an earlier stage, especially among certain risk groups such as the homeless, drug addicts, immigrants and asylum seekers. In the five patients discussed the causes of delay were identified as: delay caused by the asymptomatic phase of the disease, the patient's delay in presenting, a delay on the part of the physician, a delay in diagnostic confirmation and a delay in the treatment.