scholarly journals FACTORS ASSOCIATED WITH DELAY IN CANCER DIAGNOSIS AND TREATMENT IN CHILDREN, A STUDY FROM NORTHERN PAKISTAN.

2019 ◽  
Vol 26 (07) ◽  
pp. 1156-1161
Author(s):  
Tanveer Ashraf ◽  
Shoaib Ahmed ◽  
Saman Tanveer
Keyword(s):  
Time Lag ◽  
Healthcare Facility ◽  
Treatment Delay ◽  
Patient Delay ◽  
Definitive Treatment ◽  
Military Hospital ◽  
Malignant Diseases ◽  
Total Delay ◽  
Cross Sectional ◽  
Factors Associated

Objectives: This study explores various factors responsible for delay in management of Pakistani children having malignant diseases. Study Design: Cross-sectional, observational study. Setting: Pediatric Oncology Unit of Combined Military Hospital Rawalpindi. Period: 1st March 2017 to 31st August 2017. Material and Methods: A total of 147 children, up to 15 years of age, being managed for malignant diseases were enrolled. Data was collected by reviewing the medical record and face-to-face interviews of the parents. Time lag from onset of symptoms to start of treatment was divided in three categories, patient delay, physician delay and treatment delay. Various factors associated with delay were analyzed. Results: Out of 147 patients, 114 were male and 33 were female. Mean age was 5.76 (±SD 3.15) years. Mean patient delay was 13.36 (+ SD 27.21) days. Mean physician delay was 66.22 (+ SD 87.66) days and mean treatment delay was 17.61 (+ SD 46.20) days. In 34% of patients total delay was > 90 days. Important factors associated with delay were age of patient, type of malignancy, financial problems, distance from healthcare facility, parents’ education status, their perception about usefulness of treatment and use of alternative therapies. Patients’ gender was not significantly associated with delayed management. Discussion & Conclusion: One third of our patients had to wait for three months or more for definitive treatment to start. Physician delay was more than patient or treatment delay. It signifies that our health care system is not well equipped to promptly handle malignant diseases in children. Better training of medical professionals and improvement in diagnostic facilities can result in reduced time lag before definite treatment.

scholarly journals Factors associated with renal dysfunction in hepatitis C-related cirrhosis and its correlation with Child-Pugh score

2019 ◽  
Vol 6 (1) ◽  
pp. e000286 ◽  
Author(s):  
Hamza Waqar Bhatti ◽  
Umama Tahir ◽  
Noman Ahmed Chaudhary ◽  
Sania Bhatti ◽  
Muhammad Hafeez ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatitis C ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Cross Sectional ◽  
Disease Epidemiology ◽  
Factors Associated ◽  
Level Of Significance

ObjectivesTo assess factors associated with renal dysfunction (RD) in hepatitis C virus (HCV) cirrhosis, correlate renal parameters with Child-Pugh score (CPS) and find a cut-off value of CPS to determine RD.Materials and methodsIt was a cross-sectional study that included 70 cases of liver cirrhosis secondary to HCV from a period of 6 months at Combined Military Hospital, Multan. Diagnosis of HCV was confirmed by serological assay and liver cirrhosis by ultrasonography. CPS was determined and lab reports were taken. Patients were divided into two groups as not having RD (serum creatinine≤1.5 mg/dL) and having RD (serum creatinine≥1.5 mg/dL). Estimated glomerular filtration rate (eGFR) was calculated by chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Data were analyzed using SPSS V.23.0. χ2, Kruskal-Wallis test and Pearson coefficient of correlation were applied. ROC curve was drawn to evaluate cut-off value of CPS for the presence of RD. Level of significance was set at p<0.05.ResultsPatients with CP grade B or C develop RD as compared to patients with CP grade A (p=0.000). Mean age, urea, creatinine and eGFR varies significantly among patients who develop RD and patients who do not (p=0.02, p=0.000, p=0.000 and p=0.000, respectively). eGFR negatively correlates with CPS (r=−0.359, p=0.002). Creatinine, urea and ALBI score positively correlates with CPS (r=+0.417, p=0.000; r=+0.757, p=0.000; r=+0.362, p=0.002, respectively).ConclusionAscites and encephalopathy are associated with RD in HCV cirrhosis.

scholarly journals Factors Associated with Migration in Individuals Affected by Leprosy, Maranhão, Brazil: An Exploratory Cross-Sectional Study

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
C. Murto ◽  
C. Kaplan ◽  
L. Ariza ◽  
K. Schwarz ◽  
C. H. Alencar ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Health Sector ◽  
Healthcare Facility ◽  
Cross Sectional Study ◽  
Future Research ◽  
Newly Diagnosed ◽  
Sectional Study ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Factors Associated

In Brazil, leprosy is endemic and concentrated in high-risk clusters. Internal migration is common in the country and may influence leprosy transmission and hamper control efforts. We performed a cross-sectional study with two separate analyses evaluating factors associated with migration in Brazil’s Northeast: one among individuals newly diagnosed with leprosy and the other among a clinically unapparent population with no symptoms of leprosy for comparison. We included 394 individuals newly diagnosed with leprosy and 391 from the clinically unapparent population. Of those with leprosy, 258 (65.5%) were birth migrants, 105 (26.6%) were past five-year migrants, and 43 (10.9%) were circular migrants. In multivariate logistic regression, three independent factors were found to be significantly associated with migration among those with leprosy: (1) alcohol consumption, (2) separation from family/friends, and (3) difficulty reaching the healthcare facility. Separation from family/friends was also associated with migration in the clinically unapparent population. The health sector may consider adapting services to meet the needs of migrating populations. Future research is needed to explore risks associated with leprosy susceptibility from life stressors, such as separation from family and friends, access to healthcare facilities, and alcohol consumption to establish causal relationships.

scholarly journals Patient delay and associated factors among tuberculosis patients in Gamo zone public health facilities, Southern Ethiopia: An institution-based cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255327
Author(s):  
Asrat Arja ◽  
Wanzahun Godana ◽  
Hadiya Hassen ◽  
Biruk Bogale
Keyword(s):  
Cross Sectional Study ◽  
Health Facilities ◽  
Patient Delay ◽  
Southern Ethiopia ◽  
Public Healthcare ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tuberculosis Patients ◽  
Factors Associated ◽  
Presenting Symptoms

Background Delayed tuberculosis diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. Early diagnosis and initiation of treatment are essential for effective TB control. Therefore, the main objective of this study was to assess the magnitude and factors associated with patient delay among tuberculosis patients in Gamo Zone, Southern Ethiopia. Methods A cross-sectional study was conducted in Gamo Zone, Southern Ethiopia from February to April 2019. Fifteen health facilities of the study area were selected randomly and 255 TB patients who were ≥18 years of age were included. Data were collected using a questionnaire through face-to-face interviews and analyzed using SPSS version 20.0. Patient delay was analyzed using the median as the cut-off value. Multivariable logistic regression analysis was fitted to identify factors associated with patient delay. A p-value of ≤ 0.05 with 95% CI was considered to declare a statistically significant association. Results The median (inter-quartile range) of the patient delay was 30 (15–60) days. About 56.9% of patients had prolonged patients’ delay. Patient whose first contact were informal provider (adjusted odds ratio [AOR]: 2.24; 95% confidence interval [CI] 1.29, 3.86), presenting with weight loss (AOR: 2.53; 95%CI: 1.35, 4.74) and fatigue (AOR: 2.38; 95%CI: 1.36, 4.17) and body mass index (BMI) categories of underweight (AOR: 1.74; 95%CI: 1.01, 3.00) were independently associated with increased odds of patient delay. However, having good knowledge about TB (AOR: 0.44; 95% CI: 0.26, 0.76) significantly reduce patients’ delay. Conclusion In this study, a significant proportion of patients experienced more than the acceptable level for the patient delay. Knowledge about TB, the first action to illness, presenting symptoms, and BMI status were identified factors associated with patient delay. Hence, raising public awareness, regular training, and re-training of private and public healthcare providers, involving informal providers, and maintenance of a high index of suspicion for tuberculosis in the vulnerable population could reduce long delays in the management of TB.

scholarly journals Delays in diagnosis and treatment of pulmonary tuberculosis in patients seeking care at a regional referral hospital, Uganda: a cross sectional study

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Winters Muttamba ◽  
Samuel Kyobe ◽  
Alimah Komuhangi ◽  
James Lakony ◽  
Esther Buregyeya ◽  
...  
Keyword(s):  
Health Facility ◽  
Cross Sectional Study ◽  
Patient Delay ◽  
Referral Hospital ◽  
Cross Sectional Survey ◽  
Total Delay ◽  
Cross Sectional ◽  
Treatment Unit ◽  
Regional Referral Hospital ◽  
Tb Treatment

Abstract Objective A cross-sectional survey involving 134 pulmonary TB patients started on TB treatment at the TB Treatment Unit of the regional referral hospital was conducted to ascertain the prevalence of individual and health facility delays and associated factors. Prolonged health facility delay was taken as delay of more than 1 week and prolonged patient delay as delay of more than 3 weeks. A logistic regression model was done using STATA version 12 to determine the delays. Results There was a median total delay of 13 weeks and 110 (82.1%) of the respondents had delay of more than 4 weeks. Patient delay was the most frequent and greatest contributor of total delay and exceeded 3 weeks in 95 (71.6%) respondents. At multivariate analysis, factors that influenced delay included poor patient knowledge on TB (adjOR 6.904, 95% CI 1.648–28.921; p = 0.04) and being unemployed (adjOR 3.947, 95% CI 1.382–11.274; p = 0.010) while being female was found protective of delay; adjOR 0.231, 95% CI 0.08–0.67; p = 0.007). Patient delay was the most significant, frequent and greatest contributor to total delay, and factors associated with delay included being unemployed, low knowledge on TB while being female was found protective of delay.

Abstract P48: Factors Associated With Delay to Treatment of Aneurysmal Subarachnoid Hemorrhage (aSAH) - A Systematic Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Thuy Phuong Nguyen ◽  
Sabah Rehman ◽  
Christine Stirling ◽  
Ronil V Chandra ◽  
Linda Nichols ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Delay ◽  
Definitive Treatment ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Time Duration ◽  
Time Intervals ◽  
Time To Treatment ◽  
Factors Associated ◽  
Hospital Factors ◽  
Delay In Treatment

Background: Delay in treatment of aneurysmal subarachnoid haemorrhage (aSAH) appears to be common, contributing to the poor outcomes of patients. We currently have limited understanding of the causes of these delays. The aim of this systematic review was to identify delays in treatment of patients with aSAH, and to identify factors associated with treatment delay. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. We searched four electronic databases (MEDLINE, EMBASE, Web of Science, and Google Scholar) for manuscripts published from January 1998 to 2020 using pre-designated search terms and search strategy. Main outcomes were duration of delays of any time intervals from onset of aSAH to definitive treatment and/or factors related to delays. Results: A total of 64 studies met study entry criteria. We identified 16 different time intervals in the pathway of aSAH patients and 17 groups of predictors to delay in treatment. Most studies measured time intervals between four major time points including time of onset, hospital admission, diagnosis, and receiving coiling or clipping. Methods to measure delay in treatment varied largely between studies, using cut-off timepoints or measured absolute time duration using mean or median. Demographic factors (age, sex, race, or socioeconomic status) were not associated with time to treatment. More severe aSAH reduced treatment delay in most studies. Pre-hospital delays (patients delay, late referral, late arrival of ambulance, being transferred between hospitals or arriving at the hospital outside of office hours) were associated with treatment delay. In-hospital factors (complication, having other procedures before definitive treatment, and type of treatment) had two-way association with treatment delay - both increasing and decreasing time to treatment. Conclusions: This review provides the first comprehensive understanding of types and predictors of delays in treatment of aSAH. There is significant opportunity to increase the comparability of aSAH time to treatment data, and to identify pre-hospital and in-hospital factors that currently delay treatment.

Time and predictors of time to treatment for aneurysmal subarachnoid haemorrhage (aSAH): a systematic review

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Thuy Phuong nguyen ◽  
Sabah Rehman ◽  
Christine Stirling ◽  
Ronil Chandra ◽  
Seana Gall
Keyword(s):  
Systematic Review ◽  
Subarachnoid Haemorrhage ◽  
Meta Analysis ◽  
Treatment Delay ◽  
Definitive Treatment ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Time Intervals ◽  
Time To Treatment ◽  
Factors Associated ◽  
Modifiable Factors

Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH) is a serious form of stroke, for which rapid access to specialist neurocritical care is associated with better outcomes. Delays in the treatment of aSAH appear to be common and may contribute to poor outcomes. We have a limited understanding of the extent and causes of these delays, which hinders the development of interventions to reduce delays and improve outcomes. The aim of this systematic review was to quantify and identify factors associated with time to treatment in aSAH. Methods This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and was registered in PROSPERO (Reg. No. CRD42019132748). We searched four electronic databases (MEDLINE, EMBASE, Web of Science and Google Scholar) for manuscripts published from January 1998 using pre-designated search terms and search strategy. Main outcomes were duration of delays of time intervals from onset of aSAH to definitive treatment and/or factors related to time to treatment. Results A total of 64 studies with 16 different time intervals in the pathway of aSAH patients were identified. Measures of time to treatment varied between studies (e.g. cut-off timepoints or absolute mean/median duration). Factors associated with time to treatment fell into two categories—individual (n = 9 factors, e.g. age, sex and clinical characteristics) and health system (n = 8 factors, e.g. pre-hospital delay or presentation out-of-hours). Demographic factors were not associated with time to treatment. More severe aSAH reduced treatment delay in most studies. Pre-hospital delays (patients delay, late referral, late arrival of ambulance, being transferred between hospitals or arriving at the hospital outside of office hours) were associated with treatment delay. In-hospital factors (patients with complications, procedure before definitive treatment, slow work-up and type of treatment) were less associated with treatment delay. Conclusions The pathway from onset to definitive treatment of patients with aSAH consists of multiple stages with multiple influencing factors. This review provides the first comprehensive understanding of extent and factors associated with time to treatment of aSAH. There is an opportunity to target modifiable factors to reduce time to treatment, but further research considering more factors are needed.

scholarly journals Treatment delay of cancer patients in Indonesia: a reflection from a national referral hospital

2021 ◽  
Vol 30 (2) ◽  
pp. 129-37
Author(s):  
Soehartati Gondhowiardjo ◽  
Sugandi Hartanto ◽  
Sigit Wirawan ◽  
Vito Filbert Jayalie ◽  
Ida Ayu Putri Astiti ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Alternative Treatment ◽  
Complex Disease ◽  
Treatment Delay ◽  
Cross Sectional Study ◽  
Patient Delay ◽  
Cross Sectional ◽  
Treatment Delays ◽  
System Diagnosis ◽  
History Of

BACKGROUND Cancer is a complex disease requiring a multidisciplinary approach in establishing prompt diagnosis and treatment. Treatment in a timely manner is crucial for the outcomes. Hence, this study aimed to provide information on treatment delay including patient and provider delays and its associated factors. METHODS Cancer patients were recruited conveniently in the outpatient clinic of Department of Radiation Oncology, Cipto Mangunkusumo Hospital, Indonesia between May and August 2015. All patients were asked to fill a questionnaire and interviewed in this cross-sectional study. Treatment delay was explored and categorized into patient delay and provider delay. Patient delay could be happened before (patient-delay-1) or after (patient-delay-2) the patient was diagnosed with cancer. Provider delay could be due to physician, system-diagnosis, and system-treatment delays. RESULTS Among 294 patients, 86% patient had treatment delay. Patient delay was observed in 153 patients, and 43% of them had a history of alternative treatment. An older age (p = 0.047), lower educational level (p = 0.047), and history of alternative treatment (p<0.001) were associated with patient delay. Meanwhile, 214 patients had provider delay, and 9%, 36%, and 80% of them experienced physician, system-diagnosis, and system-treatment delays, respectively. All types of provider delay were associated with patient delay (p<0.001). CONCLUSIONS Most of the patient had treatment delay caused by either patient or provider.

scholarly journals Tuberculosis’ Total Health care system and patient side diagnosis and Treatment Delay and Associated Factors Among Pulmonary Tuberculosis Patients At Hadiya Zone Public Health Facilities, Southern Ethiopia.

2019 ◽  
Vol 9 (1-s) ◽  
pp. 214-228
Author(s):  
Gedeyon Getahun ◽  
Tilahun Beyene ◽  
Lakew Abebe
Keyword(s):  
Health Care ◽  
Health System ◽  
Treatment Delay ◽  
Health Facilities ◽  
Patient Delay ◽  
System Delay ◽  
Total Delay ◽  
Health System Delay ◽  
Tb Treatment ◽  
Hadiya Zone

Background: Delay in TB treatment is significant to both disease prognoses at the individual level and within the community. Even though studies conducted in TB treatment delay there is result inconsistencies due to differences in culture, environment and infrastructure. Objective: the aim of the study is to assess the tuberculosis treatment Delay and associated factor among pulmonary tuberculosis patients. Method: Facility based cross sectional study triangulated by Qualitative study was employed on 340 PTB patients in Hadiya zone public health facilities. Three woredas and health facilities were selected by Simple random sampling method. DOTS user at the beginning of data collection was consecutively recruited in to the study until the intended sample size was fulfilled. Multivariable binary Logistic regression was used. A P-value < 0.05 at 95 % CI was considered statistical significance between dependent and predictors variables. Result: Among 340 PTB patients enrolled in the study, of which 49.1% experienced patient delay, 30% health system delay and 49.8% total delay. Unable to read and write, Poor knowledge of TB (AOR 3.96, 95% CI (2.28   6.86), self-treatment (AOR: 2, 95% CI (1.14, 3.93), financial constraint (AOR: 2.092, 95% CI (1.11, 3.945) , Visiting two or more health care providers (AOR: 3.40, 95% CI (1.910 – 6.07), prolonged referral (AOR: 3.004, 95% CI (1.59, 5.67) were independent predictors of delay. Conclusion: Nearly half of the total delay was contributed by patient delay. Unable to read and write, Poor knowledge of TB, self-treatment, financial constraints, prolonged referral, several visit of health care provider of two or more and ever used other drugs rather than Anti-TB drugs were found to have association with patient delay and health system delay. Keywords: Tuberculosis treatment delay, PTB, patient delay and health system delay, Hadiya zone, Ethiopia.

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