Preventive medicine
-
Preventive medicine · Aug 2022
Emergency health services use and medically-treated suicidal behaviors following depression screening among adolescents: A longitudinal cohort study.
The primary goal of depression screening is to reduce adverse psychiatric outcomes, which may have downstream implications for reducing avoidable health services use. The objective of this study was to examine the association of depression screening with emergency health services use and medically-treated suicidal behaviors among adolescents in the U. S. ⋯ Associations were similar in magnitude among male and female adolescents. The results of this study suggest that depression screening, as it is currently practiced in the U. S., may not deter avoidable health services use among adolescents.
-
Preventive medicine · Aug 2022
A first look at breast cancer screening in over 1000 community health centers in the United States.
Community Health Centers (CHCs) primarily serve low-income and vulnerable patients. Breast cancer screening recently became a quality-of-care metric in the annual Uniform Data System (UDS) report, and this study examines the first year of breast cancer screening data among 1375 CHCs in the United States. Clinics with available screening data (n = 1070) were categorized based on US region, state expansion of Medicaid to low-income adults under the Affordable Care Act, ranked terciles of race/ethnic composition (non-Hispanic Black, non-Hispanic Asian, and Hispanic/Latino patients), and proportion uninsured. ⋯ In conclusion, our findings show that only half of women eligible who received care within CHCs were screened for breast cancer. Disparities in breast cancer screening rates are seen for clinics with high proportions of Black and uninsured patients, along with clinics outside the northeast and clinics in non-Medicaid expansion states. Targeted solutions centered around reducing cost, improving quality, and reducing structural disparities are needed to address low rates of breast cancer screening in low-income women who visited CHCs and already experience healthcare inequities.
-
Preventive medicine · Aug 2022
Hepatitis C virus (HCV) seroprevalence, RNA detection, and genotype distribution across Florida, 2015-2018.
Chronic hepatitis C virus (HCV) infection is a leading cause of hepatocellular carcinoma (HCC) in the U. S. Due to high rates of HCV among baby boomers (born 1945-1965), it was recommended they receive universal screening. ⋯ A similar age/race pattern was observed for active HCV infection. There was a higher prevalence of genotype 1A and 3 and lower prevalence of 1B in younger adults. Patterns of HCV seroprevalence and active HCV infection identified in our study support the recent shift from age and risk-based screening guidelines to universal adult screening.
-
Preventive medicine · Aug 2022
Cervical cancer screening by visual inspection and HPV testing in Eswatini.
In 2009, visual inspection with acetic acid (VIA) followed by cryotherapy (VIA-and-cryotherapy), was introduced into the Eswatini cervical cancer prevention programme. We present screening results of 654 women attending VIA-and-cryotherapy who participated in a sexually transmitted infections prevalence study, at which samples for HPV DNA testing and liquid-based cytology (LBC) were also collected. VIA positives (VIA+) ineligible for cryotherapy, suspected cancers and women with high-grade squamous intraepithelial or worse lesions (HSIL+) on LBC were referred for diagnosis and treatment. ⋯ The ineligibility rates for cryotherapy were 38% (24 of 63 VIA+), and 46% among HIV positives (18 of 39 VIA+). HPV testing was substantially more sensitive than VIA, thus, HPV followed by ablative treatment may be more effective. However, the high ineligibility for cryotherapy highlights the need for improving the assessment of eligibility for ablative treatment and for strengthening colposcopy, particularly in populations with high HIV prevalence.
-
Preventive medicine · Aug 2022
Review Meta AnalysisShould we abandon annual physical examination? - A meta-analysis of annual physical examination and all-cause mortality in adults based on observational studies.
Several meta-analyses based on randomized clinical trials data have failed to find an association between the annual physical examination (APE) and reduced mortality; however, no comparable meta-analysis based on observational data exists. We conducted a meta-analysis of observational studies comparing APE versus non-APE in adults for all-cause mortality. English-language searches of four databases (PubMed, CINAHL, EMBASE, and Google Scholar) between the years 2000 to 2019 yielded seven observational studies that investigated APE versus non-APE in healthy adults in relation to all-cause mortality. ⋯ APE was significantly associated with a 45% lower hazard of all-cause mortality, with pooled hazard ratio of 0.55 (95% CI 0.48 to 0.64, P < 0.01) for all participants. This meta-analysis of seven observational studies in the past 20 years provides evidence of an association between APE and a lower hazard of all-cause mortality, a finding that contrasts with findings based on meta-analyses of randomized clinical trials data. Nonetheless, at present the evidence available about the effectiveness or ineffectiveness of APE on all-cause mortality still needs further study.