Purpose: Non-adherence to recommended follow-up visits after an abnormal cytological finding is associated with poorer outcomes and higher health care costs. The purpose of this paper is to describe the challenges whe...Purpose: Non-adherence to recommended follow-up visits after an abnormal cytological finding is associated with poorer outcomes and higher health care costs. The purpose of this paper is to describe the challenges when examining reasons for non-adherence to cervical cancer screening follow-up and to discuss the recommendations to overcome those challenges. Methods: We conducted a telephone survey with two subgroups of women: 1) those which adhered to recommended follow-up care after an abnormal Pap test, and 2) those which did not adhere. Results: The follow-up accrual among non-adherent women lagged behind that of adherers. We were able to contact and conduct a survey with 51% of the adherers and 26% of the non-adherers. The challenges in studying non-adherent women were related to several distinct factors: 1) the definition of non-adherence, 2) the availability of alternate contact information, 3) the amount and type of financial incentives, and 4) the availability of staffing. We describe strategies employed to increase the accrual of non-adherent women. Discussion: This paper describes four recommendations that may play a role in understanding and reducing non-adherence to follow-up gynecological care.展开更多
Between 2005 to 2010 in a Tanzanian referral hospital, the Cesarean section rate ranged from 29.9% to 35.5%. The leading indication was previous Cesarean.
Sexual dysfunction and prostate cancer are common among older men. Few studies explored the association between these two illnesses. We examined whether sexual function is associated with prostate cancer risk among ol...Sexual dysfunction and prostate cancer are common among older men. Few studies explored the association between these two illnesses. We examined whether sexual function is associated with prostate cancer risk among older men. Among 448 men undergoing prostate biopsy at the Durham Veterans Affairs Hospital, sexual function was ascertained from the Expanded Prostate Cancer Index Composite sexual assessment. We tested the link between sexual function and prostate cancer risk adjusting for multiple demographic and clinical characteristics using logistic regression. Multinomial logistic regression was used to test the associations with risk of low-grade （Gleason 〈6） and high-grade （Gleason 〉7 or 〉4 ＋ 3） disease versus no cancer. Of 448 men, 209 （47%） had a positive biopsy; these men were less likely to be white （43% vs 55%, P=0.013）, had higher prostate-specific antigen （PSA） （6.0 vs 5.4 ng ml-1, P 〈 0.001）, but with lower mean sexual function score （47 vs 54, P = 0.007）. There was no difference in age, BMI, pack years smoked, history of heart disease and/or diabetes. After adjusting for baseline differences, sexual function was linked with a decreased risk of overall prostate cancer risk （OR. 0.91 per lO-point change in sexual function, P= 0.004） and high-grade disease whether defined as Gleason ≥7 （OR： 0.86, P= 0.001） or 〉4 ＋ 3 （OR： 0.85, P= 0.009）. Sexual function was unrelated to low-grade prostate cancer （OR： 0.94, P = 0.13）. Thus, among men undergoing prostate biopsy, higher sexual function was associated with a decreased risk of overall and high-grade prostate cancer. Confirmatory studies are needed.展开更多
文摘Purpose: Non-adherence to recommended follow-up visits after an abnormal cytological finding is associated with poorer outcomes and higher health care costs. The purpose of this paper is to describe the challenges when examining reasons for non-adherence to cervical cancer screening follow-up and to discuss the recommendations to overcome those challenges. Methods: We conducted a telephone survey with two subgroups of women: 1) those which adhered to recommended follow-up care after an abnormal Pap test, and 2) those which did not adhere. Results: The follow-up accrual among non-adherent women lagged behind that of adherers. We were able to contact and conduct a survey with 51% of the adherers and 26% of the non-adherers. The challenges in studying non-adherent women were related to several distinct factors: 1) the definition of non-adherence, 2) the availability of alternate contact information, 3) the amount and type of financial incentives, and 4) the availability of staffing. We describe strategies employed to increase the accrual of non-adherent women. Discussion: This paper describes four recommendations that may play a role in understanding and reducing non-adherence to follow-up gynecological care.
文摘Between 2005 to 2010 in a Tanzanian referral hospital, the Cesarean section rate ranged from 29.9% to 35.5%. The leading indication was previous Cesarean.
文摘Sexual dysfunction and prostate cancer are common among older men. Few studies explored the association between these two illnesses. We examined whether sexual function is associated with prostate cancer risk among older men. Among 448 men undergoing prostate biopsy at the Durham Veterans Affairs Hospital, sexual function was ascertained from the Expanded Prostate Cancer Index Composite sexual assessment. We tested the link between sexual function and prostate cancer risk adjusting for multiple demographic and clinical characteristics using logistic regression. Multinomial logistic regression was used to test the associations with risk of low-grade （Gleason 〈6） and high-grade （Gleason 〉7 or 〉4 ＋ 3） disease versus no cancer. Of 448 men, 209 （47%） had a positive biopsy; these men were less likely to be white （43% vs 55%, P=0.013）, had higher prostate-specific antigen （PSA） （6.0 vs 5.4 ng ml-1, P 〈 0.001）, but with lower mean sexual function score （47 vs 54, P = 0.007）. There was no difference in age, BMI, pack years smoked, history of heart disease and/or diabetes. After adjusting for baseline differences, sexual function was linked with a decreased risk of overall prostate cancer risk （OR. 0.91 per lO-point change in sexual function, P= 0.004） and high-grade disease whether defined as Gleason ≥7 （OR： 0.86, P= 0.001） or 〉4 ＋ 3 （OR： 0.85, P= 0.009）. Sexual function was unrelated to low-grade prostate cancer （OR： 0.94, P = 0.13）. Thus, among men undergoing prostate biopsy, higher sexual function was associated with a decreased risk of overall and high-grade prostate cancer. Confirmatory studies are needed.
