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Breast Cancer Screening in Sarawak, Borneo: 10 Years’ Community Outreach Program
No full textBackground
Sarawak isthe largest state in Malaysia, with a population of 2.9 millionwith 45% living more than 100 km from urban cities. These communities face the risk of delayed breast cancer diagnosis due to limited access to healthcare services. Sarawak has only four government hospitals with diagnostic mammogram facilities.
Objective
Sarawak Breast Cancer Support Group (SBCSG) has spearheaded breast cancer education and early screening outreach since 2012, with a special focus on rural communities. This paper describes the results from our 10‐year program.
Methods
These programs were organized or co‐organized by SBCSG from 2013 to 2023, involving local organizers and the Ministry of Health Malaysia. Women aged 18 years and above were invited to participate in clinical breast examination, and those with abnormal findings were referred to the nearest clinic or hospital for further management.
Results
We screened 2050 women, with 7.1% exhibiting abnormal breast findings. Urban screening sites reported higher abnormal findings in (9% [85/949] vs. 5% [61/1101]; p = 0.003), Malays demonstrated the highest percentage of abnormal breast findings (9.5%, 28/296). Women with fewer than three children were more likely to exhibit abnormal findings (8.3% [85/1021] vs. 5.9% [61/1029]; p = 0.003). Subjects screened at urban sites and between the ages of 30–59 were 1.6 and 2.3 times more likely to exhibit abnormal findings, respectively.
Conclusion
Screening site was the strongest independent variable for detecting breast abnormality, which could be linked to reproductive health, as women in rural areas tend to have more children, a trend that can be attributed to socioeconomic and cultural norms
Left ventricular morphology and geometry in élite athletes characterised by extreme anthropometry
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The aim of the study was to explore the individual impact of BMI and height on LV size and geometry in a cohort of healthy athletes.
Methods
From a total cohort of 1857 healthy élite athletes (21 ± 5 years, males 70%) investigated with ECG and echocardiogram, we considered three groups: Group 1 n = 50: BMI ≥ 30 and height < 1.90 m; Group 2 n = 87: height ≥ 1.95 m and BMI < 30; control Group 3 n = 243: height < 1.90 m and BMI = 20–29.
Results
BSA was ≤2.3 m2 in 52% of athletes in group 1 and 47% of athletes in group 2. Athletes in group 1 and in group 2 showed an enlarged LV end-diastolic diameter (LVEDD) (57 ± 6 vs 57 ± 4 vs 53 ± 4 mm in Group 3); 50% of athletes in group 1 and 38% of athletes in group 2 exhibited a LVEDD > 57 mm (p = 0.23). LV wall thickness was higher in group 1 (11 ± 1 vs 10 ± 2 mm in Group 2, p = 0.001). Concentric hypertrophy or concentric remodelling was found in 20% of athletes in group 1 vs 7% of athletes in group 2 (p = 0.04). Athletes of group 1 with BSA ≤ 2.3 m2 showed lower LVEDD (53 ± 5 vs 60 ± 5 mm, p 2.3 m2.
Conclusion
Athletes with high BMI have similar LV dimensions but greater wall thickness and higher prevalence of concentric remodelling compared to very tall athletes. Athletes with high BMI and large BSA have the widest LV dimensions
The co-occurrence of functional neurological disorder and autism spectrum disorder: a systematic literature review and meta-analysis
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Recent studies reveal increasing interest in the link between Autism Spectrum Disorder (ASD) and Functional Neurological Disorder (FND), prompting a systematic review and meta-analysis of their co-occurrence.
Method
The review covered a comprehensive literature search across multiple databases up to November 2024, focusing on peer-reviewed studies of ASD and FND co-occurrence. Twenty-four studies qualified for inclusion.
Results
The study included 11,324 participants, predominantly female (73.4%). It estimated the proportion of ASD in FND populations to be 0.10 (95% CI: 0.07–0.15), with significant heterogeneity (I² = 97%, p < 0.01). Subgroup analysis showed variation among different age groups and diagnoses. The proportion of ASD was 0.09 in adults and 0.10 in children with FND, 0.15 in adults and 0.19 in children with Functional Tic-Like Behaviours (FTLB), and 0.07 in children with Functional Seizures (FS).
Conclusion
Many studies have reported the co-occurrence of ASD in FND, suggesting a higher-than-expected rate of 10%. Emerging themes exploring the overlapping determinants of FND and ASD, are discussed. However, the significance of this correlation and the overlapping determinants that might explain it, require further research due to the heterogeneity in methodologies, settings, conditions studied and findings. The presence of publication bias warrants cautious interpretation of the results
Pilot Study to Evaluate Patients’ Understanding of Key Terms and Aspects of Antimicrobial Use in a Rural Province in South Africa Findings and Implications
Get PDFIntroduction:
Antimicrobial resistance (AMR) is a global concern, necessitating the understanding of utilisation patterns and their rationale. Pilot studies have been conducted in a rural province in South Africa to determine the extent of self-purchasing of antibiotics by patients from independent and chain pharmacies. It is imperative to understand the extent of knowledge and concerns of patients regarding the key aspects of antibiotic use and AMR, and potential language barriers, when pharmacists and their assistants are discussing the key aspects with patients. Consequently, the aim was to pre-test a patient questionnaire translated in three native languages building on the findings from the English language pilot.
Materials and Methods:
The English patient questionnaire (Parts 1 and 2) was translated to Sepedi, Tshivenda and Xitsonga. In total 30 patients were interviewed (5/language for Part 1 and Part 2 respectively) when leaving 10 chain and independent pharmacies. This was followed by interviews with patients to evaluate their understanding of questions and key concepts.
Results:
Eleven of 15 patients interviewed for Part 1 received antibiotics, including 8 without a prescription. Only independent pharmacies (8/10) dispensed antibiotics without prescriptions. Interviews revealed concerns about antibiotic knowledge and AMR and that certain terms including ‘antibiotic’ and ‘AMR’ posed challenges with patient understanding of the purpose of antibiotics. For instance, one patient self-purchased antibiotics for ‘cleansing’ of sexually transmitted infections. The questionnaires in the native languages were subsequently revised so that explanations for terms, including ‘antibiotic’ and ‘AMR’ will be provided in the main study.
Conclusion:
Similar to the previous pilot studies, self-purchasing of antibiotics was observed among independent pharmacies, although at varying rates, with similar indications. Continued health literacy education for pharmacists and patients, especially with native language communication, are needed to address current challenges and will be explored in the main study
Diagnosis of carbon monoxide exposure in clinical research and practice: A scoping review.
Get PDFOBJECTIVE: To undertake a scoping review to identify methods and diagnostic levels used in determining unintentional, non-fire related carbon monoxide exposure. DESIGN: Online databases and grey literature were searched from 1946 to 2023 identifying 80 papers where carbon monoxide levels were reported. RESULTS: 80 papers were included; 71 research studies and 9 clinical guidelines. Four methods were described: blood carboxyhaemoglobin (arterial or venous blood analysis), carbon monoxide oximetry (SpO2), expired carbon monoxide, and ambient carbon monoxide sampling. Blood analysis methods predominated (60.0% of the papers). Multiple methods of measurement were used in 26 (32.5%) of the papers. Diagnostic levels for carboxyhaemoglobin were described in 54 (67.5%) papers, ranging between 2% and 15%. 26 (32.5%) papers reported diagnostic levels that were adjusted for the smoking status of the patient. CONCLUSIONS: Four methods were found for use in different settings. Variability in diagnostic thresholds impairs diagnostic accuracy. Agreement on standardised diagnostic levels is required to enable consistent diagnosis of unintentional, non-fire related carbon monoxide exposure
Comparison of glycosylated fibronectin versus soluble fms-like tyrosine kinase/placental growth factor ratio testing for the assessment of pre-eclampsia: protocol for a multicentre diagnostic test accuracy study.
Get PDFINTRODUCTION: Pre-eclampsia is a condition associated with significant maternal and neonatal morbidity and mortality. The prediction of pre-eclampsia in high-risk populations using angiogenic markers, such as serum placental growth factor (PlGF) assessment, has been shown to improve maternal outcomes and is recommended by the National Institute for Health and Care Excellence (NICE). However, such tests are not yet available at the point of care (POC). Glycosylated fibronectin (GlyFn) level for the prediction of pre-eclampsia development is available as a POC test (Lumella) and has the potential to aid rapid clinical decision making. This study aimed to test the hypothesis that the sensitivity of the GlyFn test is not inferior to that of the current gold standard of soluble fms-like tyrosine kinase (sFlt)/PlGF-based laboratory testing for pre-eclampsia. METHODS AND ANALYSIS: This is a multicentre prospective study. Women at risk for pre-eclampsia based on predefined clinical and/or obstetric risk factors will be invited to participate in the study. The recruitment target is 400 participants. Consenting participants will have paired samples for sFlt/PlGF together with POC GlyFn testing. Two follow-up visits are planned at 2 and 4 weeks after the initial recruitment where repeat testing with both tests will be performed. The clinical team will be blinded to the results of the GlyFn test but not that of the sFlt/PlGF test. Clinical care will be based on established protocols incorporating maternal/fetal evaluation and the results of sFlt/PlGF levels. Maternal and neonatal outcome data will be collected to compare the sensitivity and specificity of the tests, with the primary outcome being delivery for pre-eclampsia within 4 weeks. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Health Research Authority and Health and Care Research Wales Ethics Committee. The results of this study will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER: ISRCTN13430018
PINNing cerebral blood flow: analysis of perfusion MRI in infants using physics-informed neural networks
Get PDFArterial spin labelling (ASL) magnetic resonance imaging (MRI) enables cerebral perfusion measurement, which is crucial in detecting and managing neurological issues in infants born prematurely or after perinatal complications. However, cerebral blood flow (CBF) estimation in infants using ASL remains challenging due to the complex interplay of network physiology, involving dynamic interactions between cardiac output and cerebral perfusion, as well as issues with parameter uncertainty and data noise. We propose a new spatial uncertainty-based physics-informed neural network (PINN), SUPINN, to estimate CBF and other parameters from infant ASL data. SUPINN employs a multi-branch architecture to concurrently estimate regional and global model parameters across multiple voxels. It computes regional spatial uncertainties to weigh the signal. SUPINN can reliably estimate CBF (relative error −0.3±71.7), bolus arrival time (AT) (30.5±257.8), and blood longitudinal relaxation time (T1b) (−4.4 ± 28.9), surpassing parameter estimates performed using least squares or standard PINNs. Furthermore, SUPINN produces physiologically plausible spatially smooth CBF and AT maps. Our study demonstrates the successful modification of PINNs for accurate multi-parameter perfusion estimation from noisy and limited ASL data in infants. Frameworks like SUPINN have the potential to advance our understanding of the complex cardio-brain network physiology, aiding in the detection and management of diseases. Source code is provided at: https://github.com/cgalaz01/supinn
Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study.
Get PDFOBJECTIVE: In the UK and worldwide, there are substantial ethnic inequalities in maternal and perinatal care and outcomes. We aim to assess the impact of the unprecedented change in care provision during the COVID-19 pandemic on inequalities in adverse maternity outcomes. DESIGN: Retrospective cohort study using structured electronic health record data. SETTING: English hospital trusts providing maternity care. PARTICIPANTS: Women giving birth and babies born in the National Health Service (NHS) in England between 1 April 2018 and 31 March 2021, in three time groups: prepandemic, the first pandemic wave (26 March 2020 to 30 June 2020) and second pandemic wave (1 July 2020 to 31 March 2021). Self-reported ethnicity was grouped into White, South-Asian, Black, Mixed and Other. MAIN OUTCOME MEASURES: Composite and component measures of maternal (emergency caesarean section, obstetric anal sphincter injury, hysterectomy, sepsis, anaesthetic complications and prolonged hospital stay) and perinatal (stillbirth, neonatal death, preterm birth, brain injury, small for gestational age and prolonged hospital stay). Poisson regression was used to compare relative risks between different ethnic groups. FINDINGS: 1.54 million maternal and 1.43 million neonatal records were included. The overall incidence of adverse outcomes per 1000 births initially decreased maternal: from 308.0 (95% CI 307.0 to 309.0) to 291.0 (95% CI 311.4 to 314.9) (p<0.001); perinatal: from 133.0 (95% CI 132.3 to 133.7) to 111.9 (95% CI 110.1 to 113.7) (p<0.001)), but then increased in the second pandemic period (maternal: 313.2 (95% CI 311.4 to 314.9) (p<0.001); perinatal 118.9 (95% CI 117.7 to 120.0) (p<0.001)). The risk of adverse outcomes was higher in women and babies from all ethnic minority groups compared with White women in both pandemic periods. Black and South-Asian women and babies were approximately 25% more likely to sustain adverse outcomes. While similar overall changes in adverse outcomes were seen in all groups, existing inequalities were sustained throughout the pandemic periods. INTERPRETATION: Existing inequalities in adverse maternal and perinatal/neonatal outcomes were maintained, not tempered, during the pandemic, despite substantial changes to maternity services and care. Further research on possible interventions to reduce inequality is needed
Treatment patterns for chronic obstructive pulmonary disease under the tiered medical system.
Get PDFChina has implemented the "tiered medical services" policy since 2015, while there is a paucity of data evaluating the the current status of chronic obstructive pulmonary disease (COPD) management under the system. Characteristics and treatments from 11,905 COPD patients in 88 hospitals across different tiers in China were included and analyzed. We assessed the statistical significance of differences by one way analysis of variance (ANOVA) for continuous variables and with the chi-squared test for categorical variables. Patients in primary hospitals (Tier1) exhibited heightened exposure to risk factors including smoking, household biofuel, and family history of respiratory diseases, and displayed elevated COPD assessment test (CAT) and modified Medical Research Council (mMRC) dyspnea scale scores, and worse lung function, in comparison to tertiary (Tier3) hospitals (P < 0.001). However, the utilization of inhaled maintenance treatments in Tier1 hospitals is markedly lower than that in Tier3 hospitals (54.8% vs. 81.3%, P < 0.001). At odds with the patients with more severer symptoms (as indicated by CAT ≥ 10 or mMRC ≥ 2), a higher proportion relied exclusively on single bronchodilators in Tier1 hospitals was observed compared to secondary (Tier2) and Tier3 hospitals (37.7% vs. 32.1% vs. 26.3%, 40.0% vs. 29.8% vs. 25.6%, P<0.001). Dual bronchodilators (long-acting β2-agonists /long-acting muscarinic antagonist, LABA/LAMA) represented the least common medication regimen across all tiers of hospitals, albeit their usage rates increased in tandem with hospital tier (0.7% vs. 7.2% vs. 10.4%, P < 0.001). In addition, the use of inhalation therapies containing inhaled corticosteroids (ICS) in China's primary care is notably lower (16.9%) than the United States, the United Kingdom, and other middle-to-high-income countries (29.5-57.0%). There was compelling evidence pointing to greater disease severity in Tier1 hospitals, attributable to the lower and inappropriate utilization of inhaled maintenance treatments. This underscores the necessity for enhanced availability of medications and educational initiatives aimed at both physicians and patients within Tier1 hospitals
Differences by ethnicity in the association between unpaid caring and health trajectories over 10 years in the UK Household Longitudinal Study.
Get PDFBACKGROUND: Unpaid carers deliver critical social care. We aimed to examine differences by ethnicity in (1) profiles of unpaid caring and (2) associations between caring and physical and mental health trajectories. METHODS: We used 10 waves of data from 47 015 participants from the UK Household Longitudinal Study (2009-2020). Our outcomes were 12-item Short Form Health Survey physical and mental component scores. We performed bivariate comparison of profiles of caring by ethnicity. We used multilevel linear mixed effects models to estimate associations between caring and health trajectories and assess for heterogeneity by ethnicity. RESULTS: We found that caring profiles differed by ethnicity. The proportion caring for someone within their household ranged from 39.7% of White carers to 70.1% of Pakistani and 74.8% of Bangladeshi carers. The proportion providing 20+ hours/week of care ranged from 26.9% of White carers to 40.6% of Pakistani and 43.3% of Black African carers. Ethnicity moderated associations between caring and physical but not mental health trajectories (test for interaction: p=0.038, p=0.75). Carers showed worse physical health compared with non-carers among Black African (-1.93; -3.52, -0.34), Bangladeshi (-2.01; -3.25, -0.78), Indian (-1.30; -2.33, -0.27) and Pakistani carers (-1.16; -2.25, -0.08); Bangladeshi carers' trajectories converged with non-carers over time (0.24; -0.02, 0.51). White carers showed better baseline physical health than non-carers (0.35; 0.10, 0.60), followed by worsening trajectories versus non-carers (-0.14; -0.18, -0.10). CONCLUSIONS: There are differences by ethnicity in profiles of caring and associations between caring and physical health trajectories. Future research should account for ethnicity to ensure applicability across groups
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