Assessing Concordance to an Intensified Upendo Ward Wilms Tumor Treatment Protocol in Tanzania: An Institutional Review

2020 ◽  
Vol 31 (2) ◽  
pp. 11-21
Author(s):  
Sarah Nyagabona ◽  
Godfrey Sama ◽  
Evelyne Mkuchika ◽  
Nazima Dharsee ◽  
Patricia Scanlan
Keyword(s):  
High Risk ◽  
Low Income ◽  
Wilms Tumor ◽  
Clinical Stage ◽  
Treatment Protocol ◽  
Retrospective Chart Review ◽  
Late Presentation ◽  
Small Female ◽  
Cross Sectional ◽  
Number Of Patients

Background: In Tanzania Wilms tumor (WT) ranks second among the most frequently diagnosed childhood cancer. Due to late presentation an intensified treatment protocol was established aiming for tumor reduction before surgery for achieving better surgical outcomes. We used two indicators for measuring the protocol concordance. First indicator was assessing the number of patients that received radiotherapy and second was number of patients treated with the high-risk regimen as per the protocol indications.Methodology: This was a cross sectional study. Data was collected using a retrospective chart review of all children with WT at Muhimbili National Hospital Pediatric Oncology Unit for a period between April 2016 to May 2017 who were treated using the intensified treatment protocol (combination of two WT protocols with neoadjuvant as per SIOP-PODC and adjuvant as per modified SIOP International). Analysis was conducted using excel sheet and SPSS v20.Results: A total of 74 children were eligible. The median age was 3 years ranging from 6 months to 17 years with small female predisposition of 57% (n=42). On clinical presentation all patients presented with history of abdominal swelling. In terms of clinical stage; 45% (n= 33) and 43% (n= 32) presented with stage 4 and 3 disease, respectively. Radiotherapy treatment was administered to 30% (n=22). As per protocol stage III and IV disease require radiotherapy thus only 34% of eligible candidates received radiotherapy. On histology report; 34% (n = 25) reports were never found and 66% (n=49) were available. High-risk cases were 27% (n = 20). We noted high-risk regimen was given to 12% (n=9) of study participants; thus only 45% of eligible candidates received high-risk regimen. All patient had intention to treat on admission with noted 19% (n = 14) default rate.Conclusion: Measuring concordance with guidelines allows for identification of best practices, which in turn inform on quality improvements. This snapshot identified opportunities for improvement in protocol uptake in our unit. Key words: Wilms Tumor, low income country, pediatric malignancy.

scholarly journals HPV self-sampling acceptability in rural and indigenous communities in Guatemala: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029158 ◽  
Author(s):  
Audrey R. Murchland ◽  
Anna Gottschlich ◽  
Kristin Bevilacqua ◽  
Andres Pineda ◽  
Berner Andrée Sandoval-Ramírez ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Low Income ◽  
Prevalence Ratio ◽  
Indigenous Communities ◽  
Cross Sectional Study ◽  
Indigenous Community ◽  
Hpv Testing ◽  
Cross Sectional ◽  
High Risk Hpv

IntroductionCervical cancer disproportionately burdens low-income and middle-income countries (LMICs) such as Guatemala. Self-collection testing for human papillomavirus (HPV) has been suggested as a form of cervical cancer screening to facilitate access in LMICs. This study assessed and compared the acceptability of self-collection HPV testing in two rural, indigenous and ethnically distinct communities in Guatemala: Santiago Atitlán, Sololá and Livingston, Izabal.MethodsAll participants, women between the ages of 18 and 60, completed a questionnaire. Eligible participants were also asked to self-collect a vaginal sample and complete a questionnaire regarding comfort and acceptability. Self-collected samples were tested for high-risk HPV using the real-time PCR Hybribio kit.ResultsIn the indigenous community of Santiago Atitlán, of 438 age-eligible participants, 94% completed self-collection. Of those, 81% found it comfortable and 98% were willing to use it as a form of screening. In the multiethnic (Afro-Caribbean, indigenous) community of Livingston, of 322 age-eligible participants, 53% chose to self-collect. Among those who took the test, 83% found it comfortable and 95% were willing to use it as a form of screening. In Livingston, literacy (can read and/or write vs cannot read or write) was higher in women who chose to self-collect (prevalence ratio 2.25; 95% CI 1.38 to 3.68). Ethnicity, history of screening and reproductive history were not associated with willingness to self-collect in Livingston. Women in Santiago reported less prior use of healthcare than women in Livingston. Overall, 19% (106/549) of samples tested positive for high-risk HPV.ConclusionAmong women willing to self-collect in rural and indigenous communities in Guatemala, self-collection for HPV testing is highly acceptable. However, willingness to try self-collection might vary across communities and settings. Women from a community that used less healthcare were more likely to choose self-collection. Further research is necessary to determine what factors influence a woman’s choice to self-collect.

scholarly journals Challenge of Gastro-Intestinal Stromal Tumor Management in Low-Income Countries : Example of Benin

2021 ◽  
Author(s):  
Dansou Gaspard GBESSI ◽  
Freddy Houéhanou Rodrigue GNANGNON ◽  
Aboudou Raïmi KPOSSOU ◽  
Prudent Pacifique GBETCHEDJI ◽  
Falilatou Seidou ◽  
...  
Keyword(s):  
High Risk ◽  
Low Income ◽  
Locally Advanced ◽  
Stromal Tumor ◽  
Low Income Countries ◽  
Care Seeking ◽  
Mesenchymal Tumors ◽  
Cross Sectional ◽  
Risk Of Recurrence ◽  
Rare Tumors

Abstract Background: GISTs are rare tumors but the most frequent mesenchymal tumors of the digestive tract. Diagnosis and treatment are challenging in low-income countries due to relatively poor access to immunohistochemistry and targeted therapy. In Africa there are few studies about it. This study described the diagnosis and therapeutic management of GIST in Cotonou, Benin.Methods: This was a descriptive cross-sectional study, with retrospective data collection over a 10-year period from 2010 to 2020, focused on patients with histological confirmed gastro-intestinal stromal tumor (GIST). Data analysis was performed with Epidata Analysis software version 3.0.0.1.Results: Fifteen GISTs were identified during the study period. The median age was 52 and the sex ratio was 2. The most frequent symptom was abdominal pain (n = 12). Delay in care seeking after onset of symptoms ranged from 24 hours to 15 years. The most common site for GISTs was the stomach (n = 8). The median tumor size was 11 cm and the majority (n=10) was metastatic or locally advanced at the time of diagnosis. The tumors were often spindle-shaped at histology (n = 13) and the majority expressed KIT (n = 14). Most of the tumors (n = 12) were at high risk of recurrence according to the Joensuu scoring system. The availability of imatinib have improved the outcome of GIST with response in all cases it was used in neoadjuvant setting (n = 7).Conclusion: GISTs are rare tumors and preferentially affect the stomach in Cotonou. Most of the tumors were large, unresectable at the time of diagnosis and at high risk of recurrence. Access to imatinib has revolutionized the management of those tumors in our country.

scholarly journals Spatial Distribution of COVID-19 in Shahroud, Iran Using GIS

2020 ◽  
Author(s):  
Marjan Ghanbarian ◽  
Sepideh Mahdavi ◽  
Mostafa Enayatrad ◽  
Fariba Zare ◽  
Mostafa MajidNia ◽  
...  
Keyword(s):  
Spatial Distribution ◽  
High Risk ◽  
Geographical Distribution ◽  
Cross Sectional Study ◽  
Disease Spread ◽  
Eastern Region ◽  
Risk Of Infection ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Gis Software

Abstract Background: The highest incidence rate of covid-19 in Iran was reported from Shahroud County. This study was conducted by geographic information systems (GIS) to determine the geographical distribution of Covid-19 in 60 days. Study design: A cross-sectional study Methods: This study was conducted in counties covered by Shahroud University of Medical Sciences, namely Shahroud and Mayami, from February 20, 2020 to April 18, 2020. The GIS can better show the spread of epidemics. This software indicates geographical distribution of disease spread and is very helpful in controlling the epidemics. Therefore, maps of spatial distribution and risk of infection to COVID-19 were prepared in different regions of Shahroud county using Arc-GIS software to better implement health policies. Results: During this sixty-day period, 529 confirmed cases were detected, of which 51% were men and the average age was 55 years. The maps showed high-risk to risk-free regions. Shahroud and Bastam cities were known as the coronavirus hot spots. The eastern region of Shahroud has the highest number of cases but some high risk areas are spread throughout the Shahroud city due to high infectivity of virus. Risk-based time maps indicated a reduction in the risk of infection at the end of the research period due to some mitigation and suppression strategies. Conclusions: Shahroud and Bastam are the most dangerous cities that, the number of patients and dissemination has decreased over time because of tracking definite patients and people in contact with them and implementation of preventive care.

scholarly journals Prevalence of childhood Cancer among children attending referral hospitals of outpatient Department in Ethiopia

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aklilu Endalamaw ◽  
Nega Tezera Assimamaw ◽  
Tadesse Awoke Ayele ◽  
Achenef Asmamaw Muche ◽  
Ejigu Gebeye Zeleke ◽  
...  
Keyword(s):  
Developing Countries ◽  
Childhood Cancer ◽  
Hodgkin Lymphoma ◽  
Low Income ◽  
Wilms Tumor ◽  
Sampling Technique ◽  
Lymphocytic Leukemia ◽  
Outpatient Department ◽  
Treatment Center ◽  
Cross Sectional

Abstract Introduction Childhood cancer is one of the leading causes of morbidity and mortality in the pediatrics age group. The problem affects both developed and developing countries. A high mortality rate has been observed in low-income counties. Despite its high fatality rate, less attention has been paid to the problem in developing countries, including Ethiopia. For this reason, childhood cancer is not well documented in the study setting. Therefore, we assessed the prevalence of childhood cancer in Ethiopia. Methods Institution based cross-sectional study design from January 1, 2019, to March 30, 2019, was conducted in the pediatrics treatment center. A systematic random sampling technique has used to select 1270 children in the pediatric outpatient department. The data were entered using Epi info version 7 and exported to SPSS version 20 for analysis. We checked model fitness for the advanced statistical methods, but it was difficult to proceed with logistic regression model to see the association between dependent and explanatory variables because of the unmet x2 assumption. We presented the results by using tables and figures. Results From the total 1270 study participants, 1257 were included in the final analysis provided that a 98.97% response rate. Out of these, 10(0.8%) children were diagnosed with cancer. Regarding its types, two each, Acute Lymphocytic Leukemia, Wilms tumor, Hodgkin lymphoma, and one each non-Hodgkin lymphoma, Parotid cancer, Retinoblastoma, and Breast cancer were reported. The prevalence of childhood cancer was 0.9 and 0.7% among male and female children, respectively. Conclusions Eight children diagnosed with cancer per 1000 children who visited the pediatric outpatient department. Even though childhood cancers have little attention from policymakers, the prevalence of childhood cancer remains prevalent. Therefore, researchers and policymakers shall give special emphasis to childhood cancer.

Genetic counseling and testing of an underserved population at a large city hospital.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 38-38
Author(s):  
Kathie-Ann P. Joseph ◽  
Shubhada Dhage ◽  
Kenneth Rifkind
Keyword(s):  
Genetic Counseling ◽  
High Risk ◽  
Low Income ◽  
Breast Surgery ◽  
Personal History ◽  
Counseling And Testing ◽  
Number Of Patients ◽  
Risk Patients ◽  
History Of ◽  
Racial Ethnic

38 Background: Genetic counseling and testing for hereditary breast and ovarian cancer is underutilized in low-income and racial/ethnic women. We examine the number of patients referred for genetic counseling over from 2011-2012, clinic referral pattern, and number of patients tested in a population of largely underserved, immigrant patient population. Methods: The study was conducted in Bellevue Hospital. A retrospective review of patients referred to this institution’s high-risk clinic was analyzed. Demographics, insurance status, BRCA status, if tested, and source of referral were collected. Results: Between 2011-2012, 196 patients were referred for genetic counselling. The majority of the referrals came from specialty clinics: Breast Surgery (42%), Medical Oncology (24%) and Gyn (8.7%). 17.5% were classified as other. One percent of consults came from internal medicine, 0.5% from women’s clinic, 4% were referred from family members. Of those patients counseled, 83 were tested. Breast surgery had the highest yield with 49% of the patients tested, followed by med onc (33%). One patient refused testing. Forty-seven of our patients were able to receive genetic testing through Myriad hardship, thirty-three through Medicaid, two paid by Bellevue Hospital, and one by private insurance. Five patients were BRCA1 positive, five patients were BRCA2 positive (12% of patients tested); An additional five patients were BRCA2 MUS. Racial/ethnic breakdown of the BRCA positive patients were 40% Asian, 20% Latina, 30% African American, 10% White. Four patients had a personal history of BrCa, two patients personal history of OvCa, one patient personal history of BCa/OvCa, and three patients FHBCa/OvCa. Conclusions: Genetic testing for HBOC can be underutilized in low-income and racial/ethnic women due to lack of insurance and lack of education. It is possible to get many high-risk women tested and most patients are receptive to testing when the benefits of testing are clearly explained. Our results indicate that while cancer specialists are referring high-risk patients, there may be room for education on the part of primary care specialists to refer more unaffected high risk patients. This may afford patients the opportunity to make better informed screening and treatment decisions.

scholarly journals Job Satisfaction Among Dentists According to Workplace in Tehran

2021 ◽  
Author(s):  
Reza Emrani ◽  
Katayoun Sargeran ◽  
Ahmad Reza Shamshiri ◽  
Hossein Hessari
Keyword(s):  
Job Satisfaction ◽  
Marital Status ◽  
Low Income ◽  
Work Experience ◽  
Cross Sectional Study ◽  
Working Environment ◽  
Cross Sectional ◽  
Number Of Children ◽  
Number Of Patients ◽  
The Mean

Objectives: The purpose of the present study was to assess the level of job satisfaction among dentists in Tehran, according to background determinants, working environment elements, and type of workplace in 2018. Materials and Methods: In this cross-sectional study, 350 dentists, selected by convenience sampling, completed a validated Persian job satisfaction questionnaire in a dental congress (with about 1100 participants) in Tehran, and in 59 dental clinics. The questionnaire included 39 structured questions (in 12 domains) on job satisfaction, reporting the satisfaction level according to a 5-point Likert scale. The level of satisfaction was measured by summing the weighted scores of each domain. The mean job satisfaction score (out of 100) was reported according to demographic factors (age, gender, level of income, years of experience, marital status, and number of children), working environment elements (number of assistants, number of colleagues, type of workplace), and stress score (8 questions). Linear regression was applied for statistical analysis. Results: The mean score of job satisfaction was 70±10. The analysis showed that women, dentists with a low income, those working in the public sector, and those with higher stress scores had lower job satisfaction scores (P<0.05). The number of dental assistants, number of colleagues, age, work experience, marital status, number of children, and monthly number of patients had no significant correlation with job satisfaction (P>0.05). Conclusion: The level of job satisfaction was mainly related to individual determinants. Improving job satisfaction can foster the whole dental care system and working environment elements.

The role of postoperative PET-CT in the evaluation of patients with high-risk stage III colorectal cancer (CRC).

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 566-566
Author(s):  
O. Purim ◽  
Y. Asman ◽  
S. Bard ◽  
Y. Kundel ◽  
N. Wasserberg ◽  
...  
Keyword(s):  
High Risk ◽  
Lymph Nodes ◽  
Systemic Disease ◽  
Treatment Protocol ◽  
Retrospective Chart Review ◽  
Clinicopathological Characteristics ◽  
Stage Iii ◽  
Pet Ct ◽  
Ca 19.9

566 Background: Routine PET-CT evaluation is still not indicated for stage III CRC patients; however accumulating data suggest that it may modify these patients' staging and treatment. We hence evaluated the role of PET-CT in high risk stage III CRC patients and to characterize positive predictors. Methods: Retrospective chart review of stage III CRC patients who underwent PET-CT for being at high risk for systemic disease attributable to: early T stage (T < 3), grade > 3, < 12 lymph-nodes examined, > 3 involved lymph-nodes, elevated postoperative CEA and/or CA-19.9. The demographic and clinicopathological characteristics of patients found to have metastatic disease were compared to those who were negative. Results: Seventy-three patients (33 males [45%], median age 67 years [range: 29-88 years]) were included. Pathologic FDG-uptake was observed in 33 (45%) patients. Of them, 16 (22%) were upstaged with altered treatment protocol, 13 (18%) required further work-up and 4 (5%) were found to have post operative changes. Elevated post-operative CEA and CA-19.9 levels correlated with positive PET-CT (p = 0.002 and p = 0.015, respectively). None of the other examined parameters differed between the groups. With a median follow-up of 26 months (range:1-63 months), overall survival was 88% in patients with positive PET-CT and 92% in patients with negative PET-CT. Eight patients in the positive group were disease free following metastectomy, five were alive with disease, two patients died of disease and one patient died of other cause. Conclusions: Selective postoperative PET-CT influenced staging/therapy in 22% of high risk stage III CRC patients. Postoperative CEA and CA-19.9 levels may play a role in selecting eligible patients. Failure to identify other parameters may be related to the preexisting selection bias and the small cohort. No significant financial relationships to disclose.

scholarly journals An estimation of patients at potential risk for drug-induced sexual dysfunction using pharmacy dispensing data

2020 ◽  
Author(s):  
Rineke Gordijn ◽  
Melianthe P J Nicolai ◽  
Henk W Elzevier ◽  
Henk-Jan Guchelaar ◽  
Martina Teichert
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Sexual Dysfunction ◽  
The Netherlands ◽  
Sexual Functioning ◽  
Cross Sectional Study ◽  
Additional Risk Factor ◽  
Drug Induced ◽  
Cross Sectional ◽  
Number Of Patients

Abstract Background and Objectives Adverse drug reactions on sexual functioning (sADRs) may seriously decrease a person’s quality of life. A multitude of diseases and drugs are known risk factors for sexual dysfunction. To inform patients better about these potential effects, more insight is needed on the estimated number of patients at high risk for sADRs and their characteristics. Methods This cross-sectional study estimated the number of patients in the Netherlands who were dispensed drugs with a potential very high risk (&gt;10%) or high risk (1–10%) for sADRs as registered in the Summary of Product Characteristics, the official drug information text in Europe. Results In April 2019, 2.06% of the inhabitants of the Netherlands received drugs with &gt;10% risk for sADRs and 7.76% with 1–10% risk. The majority of these patients had at least one additional risk factor for decreased sexual function such as high age or depression. Almost half of the patients were identified with two or more morbidities influencing sexual functioning. Paroxetine, sertraline and spironolactone were the most dispensed drugs with a potential &gt;10% risk for sADRs. One-third of their first dispenses were not followed by a second dispense, with a higher risk of discontinuation for a decreasing number of morbidities. Conclusion About 1 in 11 inhabitants of the Netherlands was dispensed a drug with a potential high risk for sADRs, often with other risk factors for sexual complaints. Further research is needed whether these users actually experience sADRs, to understand its impact on multimorbid patients and to provide alternatives if needed.

scholarly journals Evaluation of Administration Time and Adherence Rates of Morning vs. Bedtime Dosing of Antihypertensive Medications

2019 ◽  
Vol 66 (1) ◽  
pp. 11-16
Author(s):  
Laura Perry ◽  
Suzanne Surowiec ◽  
Danielle Danso ◽  
Omuwa Kerobo ◽  
Ashley Anugwom ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Retrospective Chart Review ◽  
Cross Sectional Study ◽  
Time Of Day ◽  
Primary Objective ◽  
Single Center ◽  
Antihypertensive Medications ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Reported Data

Purpose The primary objective of this study was to evaluate the time of day patients administer antihypertensive medications. Secondary objectives were to evaluate medication adherence rates between morning and bedtime dosing and possible barriers to bedtime administration. Methods A single-center, cross-sectional study using a mixed-methods model containing a retrospective chart review and telephone survey was administered to hypertensive patients at a multidisciplinary, private practice clinic. Patients above the age of 18 with a diagnosis of hypertension were eligible for inclusion. The primary endpoint was the number of patients administering one or more antihypertensive medications at bedtime. Secondary endpoints were medication adherence and potential barriers of adherence to bedtime dosing. Results A total of 139 responses were collected. Most patients (75.5%) administered all antihypertensive medications in the morning, with only 24.5% of patients administering at least one antihypertensive medication at bedtime. Adherence was higher for medications administered in the morning compared to medications administered at bedtime, 87.8% and 79.4%, respectively. Limitations to this study include the single-center design and potential for patient recall and reporting bias when using self-reported data. Conclusion Results of this study suggest that the prevalence of bedtime administration of antihypertensive medications is low. Although self-reported adherence rates were higher with morning dosing compared to bedtime dosing, adherence rates for bedtime dosing were still promising. Future studies should be conducted to expand on existing morbidity and mortality evidence as well as prevalence of and adherence to bedtime dosing of antihypertensive medications.

scholarly journals Impacts of Smoking and Alcohol Consumption on Workplace Presenteeism: A Cross-Sectional Study

2020 ◽  
Author(s):  
So Young Lee ◽  
Jinhwa Lee ◽  
Min Kwon
Keyword(s):  
High Risk ◽  
Alcohol Consumption ◽  
Low Income ◽  
Alcohol Drinking ◽  
Occupational Injuries ◽  
Limited Attention ◽  
Drinking Alcohol ◽  
Cross Sectional ◽  
Heavy Smoking ◽  
The Impact

Abstract Background: Presenteeism refers to the practice of going to work despite poor health, resulting in subpar performance. The problems caused by smoking and drinking alcohol while on company premises have received limited attention despite their health hazards, which are linked to sick leave, occupational injuries, and reduced productivity. This study aimed to investigate the effects of smoking and alcohol drinking on presenteeism. Methods: The study participants were 60,051 wage workers from the database of the second and third Korean Working Conditions Surveys (KWCS) in 2010 and 2011 , respectively. A total of 41,672 workers aged 19 and over who had worked for at least one hour in the previous week answered the survey questions. Chi-squared tests and multiple logistic regression analyses were conducted using SPSS 18.0 to determine the impacts of smoking and drinking alcohol on presenteeism. Results: Of the 41,672 Korean workers, 8565 (20.6%) had experienced presenteeism in the past 12 months. Presenteeism was higher among women; the elderly; people with low educational status; people with low income; people with 5-11 days absenteeism; people with more working time; people with health problems; heavy smokers; and high-risk alcohol drinkers than other participants. Based on the results of multiple regression analysis, heavy smoking (AOR = 2.10, 95% CI [1.56, 2.82]) and high-risk drinking of alcohol (AOR = 1.20, 95% CI [1.10, 1.31]) were significantly related to presenteeism among workers.Conclusions: Smoking and alcohol drinking are associated with and potentially influence presenteeism; therefore, interventions for employees, and for the general public, may improve workplace productivity and reduce accidents. Companies that encourage employees to receive treatments for reduction of smoking or alcohol consumption may benefit from greater productivity. Hence, we should consider the impact of smoking and alcohol in the workplace and build appropriate strategies and implementation programs to help reduce heavy smoking and high-risk alcohol drinking behaviors.

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