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To identify patient factors associated with whether women who screened positive for high-risk human papillomavirus (hrHPV) successfully accessed treatment in a cervical cancer prevention program in Kenya. A prospective cohort study was conducted as part of a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya from January 2018 to February 2019. In this larger trial, women underwent hrHPV testing during community health campaigns (CHCs), and hrHPV+ women were referred to government facilities for cryotherapy. For this analysis, we looked at rates of and predictors of presenting for treatment and presenting within 30 days of receiving positive hrHPV results (\"timely\" presentation). Data came from questionnaires completed at the time of screening and treatment. Multivariable logistic regression was used to identify factors associated with each outcome. Of the 505 hrHPV+ women, 266 (53%) presented for treatment. Cryotherapy was performed in 236 (89%) of the women who presented, while 30 (11%) were not treated: 15 (6%) due to gas outage, six (2%) due to pregnancy, five (2%) due to concern for cervical cancer, and four (2%) due to an unknown or other reason. After adjusting for other factors in the multivariable analysis, higher education level and missing work to come to the CHC were associated with presenting for treatment. Variables that were associated with increased likelihood of timely presentation were missing work to come to the CHC, absence of depressive symptoms, told by someone important to come to the CHC, and shorter distance to the treatment site. The majority of hrHPV+ women who did not get treated were lost at the stage of decision-making or accessing treatment, with a small number encountering barriers at the treatment sites. Patient education and financial support are potential areas for intervention to increase rates of hrHPV+ women seeking treatment.

ObjectiveAcute myocardial infarction (AMI) is the leading cause of death and disability globally. There is increasing evidence from observational studies that influenza infection is associated with AMI. In patients with known coronary disease, influenza vaccination is associated with a lower risk of cardiovascular events. However, the effect of influenza vaccination on incident AMI across the entire population is less well established.MethodThe purpose of our systematic review of case–control studies is twofold: (1) to estimate the association between influenza infection and AMI and (2) to estimate the association between influenza vaccination and AMI. Cases included those conducted with first-time AMI or any AMI cases. Studies were appraised for quality and meta-analyses using random effects models for the influenza exposures of infection, and vaccination were conducted.Results16 studies (8 on influenza vaccination, 10 on influenza infection and AMI) met the eligibility criteria, and were included in the review and meta-analysis. Recent influenza infection, influenza-like illness or respiratory tract infection was significantly more likely in AMI cases, with a pooled OR 2.01 (95% CI 1.47 to 2.76). Influenza vaccination was significantly associated with AMI, with a pooled OR of 0.71 (95% CI 0.56 to 0.91), equating to an estimated vaccine effectiveness of 29% (95% CI 9% to 44%) against AMI.ConclusionsOur meta-analysis of case–control studies found a significant association between recent respiratory infection and AMI. The estimated vaccine effectiveness against AMI was comparable with the efficacy of currently accepted therapies for secondary prevention of AMI from clinical trial data. A large-scale randomised controlled trial is needed to provide robust evidence of the protective effect of influenza vaccination on AMI, including as primary prevention.

Background Despite the growing number of people with migrant background in Germany, a systematic review about their utilization of health care and differences to the non-migrant population is lacking. By covering various sectors of health care and migrant populations, the review aimed at giving a general overview and identifying special areas of potential intervention. Methods A systematic review was conducted in PubMed database including records that were published until 1st of June 2017. Further criteria for eligibility were a publication in a peer-reviewed journal written in English or German language. The studies have to report quantitative and original data of a population residing in Germany. The appropriateness of the studies was judged by both authors. Studies were excluded if native controls were not originated from the same sample. Moreover, indicators of health care utilization have to assess individual behaviour like consultation or participation rates. 63 studies met the inclusion criteria for a qualitative synthesis of the findings. Results The overall findings indicate a lower utilization among migrants, although the results vary in terms of health care sector, indicator of health care utilization and migrant population. For specialist care, medication use, therapist consultations and counselling, rehabilitation as well as disease prevention (early cancer detection, prevention programs for children and oral health check-ups) a lower utilization among people with migrant background was found. The lower usage was particularly shown for migrants of the 1st generation, people with two-sided migrant background, children/adolescents and women. Due to the methodological heterogeneity a meta-analysis was not feasible. As most of the studies were cross-sectional, no causal interpretations could be drawn. Conclusions The inequalities in utilization could not substantially be explained by differences in the socioeconomic status. Other reasons of lower utilization could be due to differences in need, preferences, information, language and formal access barriers (e.g. charges, waiting times, travel distances or lost wages). Different migrant-specific and migrant-sensitive strategies are relevant to address the problem for certain health care sectors and migrant populations. Trial registration The review protocol was registered on PROSPERO ( CRD42014015162 ).

Emerging infectious diseases (EIDs), including the latest COVID-19 pandemic, have emerged and raised global public health crises in recent decades. Without existing protective immunity, an EID may spread rapidly and cause mass casualties in a very short time. Therefore, it is imperative to identify cases with risk of disease progression for the optimized allocation of medical resources in case medical facilities are overwhelmed with a flood of patients. This study has aimed to cope with this challenge from the aspect of preventive medicine by exploiting machine learning technologies. The study has been based on 83,227 hospital admissions with influenza-like illness and we analysed the risk effects of 19 comorbidities along with age and gender for severe illness or mortality risk. The experimental results revealed that the decision rules derived from the machine learning based prediction models can provide valuable guidelines for the healthcare policy makers to develop an effective vaccination strategy. Furthermore, in case the healthcare facilities are overwhelmed by patients with EID, which frequently occurred in the recent COVID-19 pandemic, the frontline physicians can incorporate the proposed prediction models to triage patients suffering minor symptoms without laboratory tests, which may become scarce during an EID disaster. In conclusion, our study has demonstrated an effective approach to exploit machine learning technologies to cope with the challenges faced during the outbreak of an EID.

COVID-19 is a novel respiratory disease associated with severe morbidity and high mortality in the elderly population and people with comorbidities. Studies have suggested that pregnant women are more susceptible to COVID-19 compared to non-pregnant women. However, it's unclear whether pregnant women in Ghana are knowledgeable about COVID-19 and practice preventive measures against it. This study sought to assess the knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana. A cross-sectional study was conducted using a structured questionnaire in the Nabdam district in Ghana. A total of 527 pregnant women were randomly sampled from health facilities offering antenatal care services in the district. Multivariable logistic regression analysis was used to assess the association between the predictors and outcome variables. The prevalence of adequate knowledge and good COVID-19 preventive practices were 85.6%, (95% CI: 82.57, 88.59) and 46.6%, (95% CI: 42.41, 50.95) respectively. Having at least a primary education, residing in an urban area, and receiving COVID-19 education at a health facility were positively associated with adequate knowledge on COVID-19. Factors positively associated with good COVID-19 preventive practices were older age, having at least a primary education, pregnant women with a chronic disease, and living in an urban area. Multiparity was negatively associated with good COVID-19 preventive practices. Although majority of women had adequate knowledge of COVID-19, less than half of them were engaged in good COVID-19 preventive practices. Education of pregnant women on COVID-19 preventive practices should be intensified at health facilities while improving upon the water, sanitation and hygiene need particularly in rural communities.

Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers' adoption of PrEP into clinical practice. This qualitative study explored PrEP providers' firsthand experiences relative to six commonly-cited barriers to prescription-financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)-as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or Southern (22%) U.S. Nearly all (94%) were medical doctors (MDs), most of whom self-identified as infectious disease specialists. Prior experience prescribing PrEP ranged from 2 to 325 patients. Overall, providers reported favorable experiences with PrEP implementation and indicated that commonly anticipated problems were minimal or manageable. PrEP was covered via insurance or other programs for most patients; however, pre-authorization requirements, laboratory/service provision costs, and high deductibles sometimes presented challenges. Various models of PrEP care and coordination with other providers were utilized, with several providers highlighting the value of clinical staff support. Eligibility was determined through joint decision-making with patients; CDC guidelines were commonly referenced but not considered absolute. Patient adherence was variable, with particularly strong adherence noted among patients who had actively sought PrEP (self-referred). Providers observed minimal adverse effects or increases in risk behavior. However, they identified several barriers with respect to accessing and engaging PrEP candidates. Providers offered a wide range of suggestions regarding content, strategy, and logistics surrounding PrEP training, highlighting sexual history-taking and sexual minority competence as areas to prioritize. These insights from early-adopting PrEP providers may facilitate adoption of PrEP into clinical practice by PrEP-inexperienced providers, thereby improving access for individuals at risk for HIV.

Supplemental Digital Content is available in the text. Introduction:The Medicare Annual Wellness Visit (AWV) is a preventive care visit introduced in 2011 as part of the Affordable Care Act provided without cost to beneficiaries. The AWV is associated with higher preventive services utilization. Although AWV utilization increased during 2011-2013, utilization was lower among ethnoracial minority beneficiaries who may benefit the most.Objectives:To determine if AWV utilization disparities have persisted using the most recent data available.Research Design:The authors analyzed AWV utilization in 2011-2013 and 2015-2016 by beneficiary-reported race and ethnicity, adjusting for potential confounders.Subjects:Weighted sample of 78,639,501 fee-for-service Medicare beneficiaries aged 66 years and older who participated in the Medicare Current Beneficiary Survey 2011-2013 or 2015-2016.Measures:AWV utilization was identified using Medicare claims.Results:AWV utilization increased from 8.1% to 23.0% of all beneficiaries between 2011 and 2016. Compared with non-Hispanic white beneficiaries, utilization was significantly lower among non-Hispanic Black and non-Hispanic other race beneficiaries in both the minimally and fully-adjusted models. Hispanic/Latino beneficiaries had lower utilization in the minimally adjusted model, but not in the fully-adjusted model. In 2016, compared with non-Hispanic white beneficiaries, AWV utilization was 10.2 points lower for non-Hispanic black, 11.6 points lower for Hispanic/Latino, and 8.6 points lower for non-Hispanic other race beneficiaries, and these differences were attenuated after adjusting for all covariates to 6.8 points lower, 9.4 points lower, and 7.2 points lower, respectively.Conclusions:The AWV has the potential to increase the use of preventive care, improve health, and reduce ethnoracial disparities among Medicare beneficiaries, but realizing these goals will require increasing utilization by minority groups. If ethnoracial minority beneficiaries had used the AWV at the same rate as non-Hispanic white beneficiaries during the study period, then ~1.6 million additional AWVs would have been used.

Background Preventive medicine is one of the core elements of primary care physicians’ (PCPs) work. This includes screening for cancer (such as Mammography and fecal occult blood test (FOBT) for breast and colon cancer) and also screening for chronic conditions (like bone density scans (DEXA scans) for osteoporosis). In recent years, especially since the COVID-19 pandemic, the use of telemedicine increased dramatically. This study aimed to identify the rate of preventative medicine referrals and performance in individuals who mostly had face-to-face encounters compared to those who mostly had remote encounters. Methods This retrospective cohort study is based on the electronic medical records of one healthcare maintenance organization (HMO) in Israel. We followed all individuals eligible for at least one of the screening tests in 2020 and 2021 and evaluated whether they received referrals to screening tests (mammography, FOBT, and DEXA scans) and performed them. Each individual was assigned to the face-to-face group (more than 60% of their encounters were face-to-face), the remote group (more than 60% of their encounters were remote), and the mixed group , which included the rest of the cohort. Results For mammographies and FOBT, the referral rates were lower in the face-to-face group compared to remote and mixed groups (mammographies: 27.3% vs. 29.8% and 32.9%, p-value < 0.001; FOBT: 55.6% vs. 60.3% and 58.7%, p-value < 0.001, respectively). However, for all three tests, the performance rates were the lowest in the remote group compared to face-to-face and mixed (for mammographies, 68.2% vs. 76.3% vs. 78.1; for FOBT, 44% vs. 56.8% vs. 54.3%; for DEXA 9.2% vs. 22.9% vs. 20.7%, respectively). A referral from the PCP increased the odds of performing the test for mammographies OR-1.55, 95% CI 1.52–1.58, and for FOBT OR-1.96, 95% CI 1.93–1.99. Conclusion Although PCPs referred their patients to screening tests in remote visits, the performance rate of individuals who mainly used telemedicine was lower than those who mostly had face-to-face visits. A referral for a screening test from the PCP increased the odds of performing it. Understanding individuals’ health behaviors using telemedicine is crucial to maintaining adherence to preventing medicine.

PurposePatients receiving palliative care make avoidable emergency department visits (AvED), which may increase economic and social costs. However, the proportion of AvED among all patients, including cancer patients after curation, and the resulting costs are unknown in Asia. This study aimed to investigate the proportion, characteristics, and costs regarding factors associated with AvED among cancer patients.MethodsThis retrospective cohort study analyzed the medical records of patients who visited the emergency department (ED) at a tertiary care hospital in Korea in 2016. Data regarding patients’ demographic, cancer-related, and clinical characteristics were collected.ResultsED visits by a total of 4346 patients were included in the analysis, of which 2420 visits (55.7%) were avoidable. In the multivariate logistic model, the following main factors were associated with AvED: stay in ED (odds ratio [OR] 0.998, 95% confidence interval [CI] 0.997–0.999, P < 0.001), distance to the home from the ED (OR 0.998, 95% CI 0.997–0.999, P < 0.001), multiple ED visits in 1 year (OR 1.204, 95% CI 1.156–1.255, P < 0.001), primary progression (vs. after curation) (OR 0.748, 95% CI 0.627–0.892, P = 0.001), and chief complaint being a gastrointestinal symptom (vs. pain) (OR 1.871, 95% CI 1.188–2.946, P = 0.007). The average cost per visit in the AvED group was $369.80, and the annual total cost for all AvEDs was $894,877.ConclusionsOur study showed that 55.7% of all ED visits by cancer patients visiting the ED of a tertiary care hospital were avoidable, and several factors were associated with AvED.

Background: Increasing patient-provider sex and race/ethnicity concordance has been proposed to improve healthcare and help mitigate health disparities, but the relationship between concordance and health outcomes remains unclear. Objective: To examine associations of patient-provider sex, race/ethnicity, and dual concordance with healthcare measures. Research Design and Participants: Analyses of data from adult respondents indicating a usual source of healthcare (N=22,440) in the 2002 to 2007 Medical Expenditure Panel Surveys (each a 2-year panel). Measures: Year 1 provider communication, sex-neutral (colorectal cancer screening, influenza vaccination) and sex-specific (mammography, Papanicolaou smear, prostate-specific antigen) prevention; and year 2 health status (SF-12). Analyses adjusted for patient sociodemographics and health variables, and healthcare provider (usual source of care) sex and race/ethnicity. Results: Of 24 concordance assessments, 3 were statistically significant. Women with female providers were more likely to report mammography adherence [average adjusted marginal effect=3.9%, 95% confidence interval (CI): 1.6%, 6.2%; P<0.01]. Respondents reporting dual concordance were less likely to rate provider communication in the highest quartile (average adjusted marginal effect = —4.2%, 95% CI: —8.1%, —0.2%; P=0.04), but dual concordance was associated with higher adjusted SF-12 Physical Component Summary scores (0.58 points, 95% CI: 0.00, 1.15; P=0.05). Conclusions: Little evidence of clinical benefit resulting from sex or race/ethnicity concordance was found. Greater matching of patients and providers by sex and race/ethnicity is unlikely to mitigate health disparities.