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Instruction: Is language a barrier to the use of preventive services?
Abstracts:
abstract_id: PUBMED:9276652
Is language a barrier to the use of preventive services? Objective: To isolate the effect of spoken language from financial barriers to care, we examined the relation of language to use of preventive services in a system with universal access.
Design: Cross-sectional survey.
Setting: Household population of women living in Ontario, Canada, in 1990.
Participants: Subjects were 22,448 women completing the 1990 Ontario Health Survey, a population-based random sample of households.
Measurements And Main Results: We defined language as the language spoken in the home and assessed self-reported receipt of breast examination, mammogram and Pap testing. We used logistic regression to calculate odds ratios for each service adjusting for potential sources of confounding: socio-economic characteristics, contact with the health care system, and measures reflecting culture. Ten percent of the women spoke a non-English language at home (4% French, 6% other). After adjustment, compared with English speakers, French-speaking women were significantly less likely to receive breast exams or mammography, and other language speakers were less likely to receive Pap testing.
Conclusions: Women whose main spoken language was not English were less likely to receive important preventive services. Improving communication with patients with limited English may enhance participation in screening programs.
abstract_id: PUBMED:27606643
Validation of the Spanish-language version of the Rapid Assessment for Adolescent Preventive Services among Colombian adolescents. Seventy percent of adolescent morbidity and mortality is related to six risky behaviors. The Rapid Assessment for Adolescent Preventive Services is a screening questionnaire consisting of 21 questions but there is not a validated Spanish-language version. The obj ective of this study was to validate the Spanish-language version of the Rapid Assessment for Adolescent Preventive Services in two Colombian cities: Bucaramanga and Medellin. The questionnaire was administered to 270 randomly selected adolescent students aged between 11 and 19 years old. Its internal consistency measured using Cronbach's alpha was 0.7207. The factor analysis showed that two factors accounted for 84.5% of variance, but factor loading indicates that only one of these is valid in Colombia: substance use (tobacco, alcohol, narcotics, and psychoactive substances).
abstract_id: PUBMED:21665066
Impact of communication on preventive services among deaf American Sign Language users. Background: Deaf American Sign Language (ASL) users face communication and language barriers that limit healthcare communication with their providers. Prior research has not examined preventive services with ASL-skilled clinicians.
Purpose: The goal of this study was to determine whether provider language concordance is associated with improved receipt of preventive services among deaf respondents.
Methods: This cross-sectional study included 89 deaf respondents aged 50-75 years from the Deaf Health Survey (2008), a Behavioral Risk Factor Surveillance System survey adapted for use with deaf ASL users. Association between the respondent's communication method with the provider (i.e., categorized as either concordant-doctor signs or discordant-other) and preventive services use was assessed using logistic regression adjusting for race, gender, income, health status, health insurance, and education. Analyses were conducted in 2010.
Results: Deaf respondents who reported having a concordant provider were more likely to report a greater number of preventive services (OR=3.42, 95% CI=1.31, 8.93, p=0.0122) when compared to deaf respondents who reported having a discordant provider even after adjusting for race, gender, income, health status, health insurance, and education. In unadjusted analyses, deaf respondents who reported having a concordant provider were more likely to receive an influenza vaccination in the past year (OR=4.55, p=0.016) when compared to respondents who had a discordant provider.
Conclusions: Language-concordant patient-provider communication is associated with higher appropriate use of preventive services by deaf ASL users.
abstract_id: PUBMED:25729102
Patient-physician language concordance and use of preventive care services among limited English proficient Latinos and Asians. Objectives: Patient-physician language concordance among limited English proficient (LEP) patients is associated with better outcomes for specific clinical conditions. Whether or not language concordance contributes to use of specific preventive care services is unclear.
Methods: We pooled data from the 2007 and 2009 California Health Interview Surveys to examine mammography, colorectal cancer (CRC) screening, and influenza vaccination use among self-identified LEP Latino and Asian (i.e., Chinese, Korean, and Vietnamese) immigrants. We defined language concordance by respondents reporting that their physician spoke their non-English language. Analyses were completed in 2013-2014.
Results: Language concordance did not appear to facilitate mammography use among Latinas (adjusted odds ratio [AOR] = 1.02, 95% confidence interval [CI] 0.72, 1.45). Among Asian women, we could not definitively exclude a negative association of language concordance with mammography (AOR=0.55, 95% CI 0.27, 1.09). Patient-physician language concordance was associated with lower odds of CRC screening among Asians but not Latinos (Asian AOR=0.50, 95% CI 0.29, 0.86; Latino AOR=0.85, 95% CI 0.56, 1.28). Influenza vaccination did not differ by physician language use among either Latinos or Asians.
Conclusions: Patient-physician language concordance was not associated with higher use of mammography, CRC screening, or influenza vaccination. Language concordance was negatively associated with CRC screening among Asians for reasons that require further research. Future research should isolate the impact of language concordance on the use of preventive care services from health system factors.
abstract_id: PUBMED:9187576
Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84. Use of preventive health services (physical, dental, and eye examinations, Pap smear and breast examinations) among Mexican American, Cuban American, and Puerto Rican adults (ages 20-74) was investigated with data from the HHANES. Analyses focused on the relative importance of two predictors of recency of screening: access to services (health insurance coverage, having a routine place for care, type of facility used, having a regular provider, travel time) and acculturation (spoken and written language, ethnic identification). Regression analyses controlling for age, education, and income indicated that utilization of the preventive services was predicted more strongly by access to care than by acculturation. For each Hispanic group, having a routine place for health care, health insurance coverage, and a regular provider were each significantly associated with greater recency of screening. Type of facility used and travel time produced less consistent effects. These results replicate past studies that have demonstrated the important link between institutional access and use of health services. Of the acculturation variables, language but not ethnic identification (which was measured only for the Mexican Americans) predicted use. This latter finding, which has been demonstrated in other studies as well, suggests that the effect of language on screening practices should not be interpreted as a cultural factor, but as an access factor, i.e. use of English favors access to services.
abstract_id: PUBMED:18799780
Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Objectives: We examined self-reported health status, health behaviors, access to care, and use of preventive services of the US Hispanic adult population to identify language-associated disparities.
Methods: We analyzed 2003 to 2005 Behavioral Risk Factor Surveillance System data from 45 076 Hispanic adults in 23 states, who represented 90% of the US Hispanic population, and compared 25 health indicators between Spanish-speaking Hispanics and English-speaking Hispanics.
Results: Physical activity and rates of chronic disease, obesity, and smoking were significantly lower among Spanish-speaking Hispanics than among English-speaking Hispanics. Spanish-speaking Hispanics reported far worse health status and access to care than did English-speaking Hispanics (39% vs 17% in fair or poor health, 55% vs 23% uninsured, and 58% vs 29% without a personal doctor) and received less preventive care. Adjustment for demographic and socioeconomic factors did not mitigate the influence of language on these health indicators.
Conclusions: Spanish-language preference marks a particularly vulnerable subpopulation of US Hispanics who have less access to care and use of preventive services. Priority areas for Spanish-speaking adults include maintenance of healthy behaviors, promotion of physical activity and preventive health care, and increased access to care.
abstract_id: PUBMED:31318468
Factors associated with the intention to use adult preventive health services in Taiwan. Objective: This research aimed to examine the factors associated with the intention to use adult preventive health services in Taiwan.
Design And Sample: Using Andersen's behavioral model, we employed a cross-sectional descriptive design to investigate 500 samples from four communities in southern Taiwan.
Measures: We used a self-reported survey to assess participants' intention to use adult preventive health services, and the predisposing, enabling, and need factors influencing their intention.
Results: Intention to use adult preventive health services was more significantly explained by predisposing and enabling factors than by need factors. In addition, a lack of fixed medical facilities (enabling factor) and Taiwanese origin (predisposing factor) were associated with decreased odds of intention to use adult preventive health services. An educational level of high school or below (predisposing factor), higher amounts of exercise (predisposing factor), and lower barriers to use preventive health services (predisposing factor) were associated with increased odds of intention to use adult preventive health services.
Conclusion: The findings can assist public health nurses in identifying high-risk groups with lower intentions of using adult preventive health services. Additionally, community-based health education program can be developed to increase people's intention to use adult preventive health services.
abstract_id: PUBMED:27778218
Preventive services use among female survivors of adolescent and young adult cancer. Purpose: Examine preventive services utilization among female survivors of adolescent and young adult (AYA) cancer compared with women without cancer in the USA.
Methods: A total of 1017 women diagnosed with cancer at AYA ages (15-39 years) who were at least 5 years since diagnosis were identified from 2008 to 2012 Medical Expenditure Panel Surveys. A comparison group without cancer was matched on age and other characteristics. General preventive services included dental, medical, blood pressure, and cholesterol checkups, and flu shots in the previous year. Cancer-related services included pap smear and mammography. Preventive services and covariates (demographics, socioeconomics, and health status) were compared between groups using χ 2 tests. Ordinal logistic regression identified covariates associated with general preventive services use.
Results: Female survivors reported dental checkups less often (57.8 vs. 72.4 %, p < 0.001) than the comparison group and checked their blood pressure (90 vs. 86.7 %, p = 0.045) and cholesterol (67.5 vs. 61.7 %, p = 0.045) more often. No differences were found in flu shots, medical checkups, and cancer-related services. Survivors without insurance were less likely to use general preventive services (odds ratio [OR] = 0.2, 95 % confidence interval [CI] 0.12-0.35, p < 0.001). Older survivors (OR = 3.09, 95 % CI 1.69-5.62, p < 0.001) and those who speak Spanish or other languages at home (OR = 3.19, 95 % CI 1.33-7.67, p = 0.01) were more likely to use general prevention than their counterparts.
Conclusion: Overall, female survivors were as likely as the comparison group to use preventive services, except dental services, blood pressure, and cholesterol checks.
Implications For Cancer Survivors: Survivors may require support to use recommended preventive services more effectively, especially the younger and uninsured who may be at greater risk for underuse.
abstract_id: PUBMED:34433384
Receipt of preventive health services and current cannabis users. Substance use is associated with greater barriers and reduced access to care. Little research, however, has examined the relationship between cannabis use and receipt of preventive health services. Using data from the 2017 Behavioral Risk Factor Surveillance System, we examined the association between current cannabis use and receipt of 12 preventive health services, adjusting for sociodemographic characteristics and access to care. In analyses that adjusted for sociodemographic factors and access to care, participants with current cannabis use had lower odds of being vaccinated for influenza (AOR = 0.67, 95% CI = 0.54-0.83) and higher odds of ever receiving HPV vaccination (AOR = 1.77, 95% CI = 1.06-2.96) and HIV screening (AOR = 2.34, 95% CI = 1.88-2.92) compared with those without cannabis use. Among the 12 preventive services examined, we found three differences in receipt of preventive services by cannabis use status. Cannabis use does not appear to be associated with significant underuse of preventive services.
abstract_id: PUBMED:15191136
Utilization of preventive dental services by recent immigrants in Quebec Objectives: Studies conducted in Canada show that recent immigrants tend to under-utilize preventive services provided by the health care system. The objective of our study was to learn whether this phenomenon also applies to dental care.
Methods: Our sample was composed of 5,795 women who live in Quebec and are between 30 and 44 years old. These women filled out a self-administered questionnaire regarding their immigration status and their habits concerning dental visits. In our analyses, we compared the use of dental services of recent immigrants (10 years or less in Canada), long-term immigrants (more than 10 years), and non-immigrants (Canadians of origin).
Results: 55% of recent immigrants are preventive service users compared to 69% of long-term immigrants and 76% of non-immigrants. The financial barrier partly explains this result: immigrants often have a modest income and rarely benefit from dental coverage. However, having private dental insurance does not in itself explain the gap between these groups. This suggests that there is a cultural barrier in dental services access.
Conclusions: Under-use of preventive services by immigrants is not limited to the medical field, it extends to dental services as well. In order to facilitate immigrants' adaptation to the health system, we recommend that the government provide them with free dental services that respect their culture.
Answer: Yes, language appears to be a barrier to the use of preventive services. Studies have shown that individuals who do not speak the dominant language of the country they reside in are less likely to receive important preventive services. For instance, in Ontario, Canada, women whose main spoken language was not English were less likely to receive breast exams, mammography, or Pap testing compared to English speakers (PUBMED:9276652). Similarly, deaf American Sign Language (ASL) users had better receipt of preventive services when they had language-concordant providers, indicating that communication barriers can limit access to preventive care (PUBMED:21665066).
Furthermore, among limited English proficient (LEP) Latinos and Asians in California, patient-physician language concordance did not necessarily lead to higher use of mammography, colorectal cancer screening, or influenza vaccination, and was negatively associated with colorectal cancer screening among Asians (PUBMED:25729102). This suggests that language concordance alone may not be sufficient to improve the use of preventive services and that other factors may also play a role.
Hispanics in the US who preferred speaking Spanish reported worse health status, access to care, and received less preventive care compared to their English-speaking counterparts (PUBMED:18799780). Additionally, language barriers have been shown to affect the use of preventive dental services by recent immigrants in Quebec, indicating that under-utilization of preventive services extends beyond medical care to dental services as well (PUBMED:15191136).
Overall, these findings suggest that language barriers contribute to disparities in the use of preventive health services, and improving communication between healthcare providers and patients with limited proficiency in the dominant language may enhance participation in screening programs and access to preventive care. |
Instruction: Aging, health, and depressive symptoms: are women and men different?
Abstracts:
abstract_id: PUBMED:24533913
Comprehensive evaluation of androgen replacement therapy in aging Japanese men with late-onset hypogonadism. Objective: This study assessed the efficacy and safety of testosterone replacement therapy (TRT) in aging Japanese men with late-onset hypogonadism (LOH).
Methods: This study included 50 (median age: 57.7 years) Japanese men with LOH, who were consecutively enrolled and treated with TRT for at least six months at our institution. We evaluated the following measurements before and after six months of treatment with TRT as follows: blood tests, prostate volume, residual urine volume, self-ratings for International Index of Erectile Function 5 (IIEF-5), International Prostate Symptom Score (IPSS), Self-Rating Depression Scale (SDS), Aging Male Symptom (AMS) and the Medical Outcomes Study 8-item Short-Form health survey (SF-8).
Results: Following six months of TRT, the levels of testosterone, red blood cells, hemoglobin and hematocrit were significantly increased from baseline, while total cholesterol level was significantly decreased from baseline. Furthermore, TRT led to a significant increase in IIEF-5 score and a significant decrease in IPSS score. Of 30 men who were diagnosed with depression at baseline, only 11 men (36.7%) were still suffering from depression after TRT, and SDS scores were significantly decreased from baseline at month six. Treatment with TRT led to a significant decrease in all scores of the AMS scale as well as a significant improvement in all scores of the SF-8 survey, with the exception of the bodily pain score.
Conclusion: These findings suggest that TRT is an effective and safe treatment for aging Japanese men with LOH. TRT improved depressive symptoms as well as health-related quality of life.
abstract_id: PUBMED:28067548
The association between negative attitudes toward aging and mental health among middle-aged and older gay and heterosexual men in Israel. Objectives: The association between negative attitudes toward aging and mental health (indicated by depressive symptoms, neuroticism, and happiness) was explored among Israeli middle-aged and older gay and heterosexual men.
Method: In a community-dwelling sample, 152 middle-aged and older gay men and 120 middle-aged and older heterosexual men at the age range of 50-87 (M = 59.3, SD = 7.5) completed measures of negative attitudes toward aging, depressive symptoms, neuroticism, and happiness.
Results: After controlling for socio-demographic characteristics, the association between negative attitudes toward aging and mental health was moderated by sexual orientation, demonstrating that negative attitudes toward aging were more strongly associated with adverse mental health concomitants among middle-aged and older gay men compared to middle-aged and older heterosexual men.
Conclusions: The findings suggest vulnerability of middle-aged and older gay men to risks of aging, as their mental health is markedly linked with their negative attitudes toward aging. This vulnerability should be addressed by clinicians and counselors who work with middle-aged and older gay men.
abstract_id: PUBMED:33217248
Benefits and Risks of Testosterone Treatment in Men with Age-Related Decline in Testosterone. The substantial increase in life expectancy of men has focused growing attention on quality-of-life issues associated with reproductive aging. Serum total and free testosterone levels in men, after reaching a peak in the second and third decade of life, decline gradually with advancing age. The trajectory of age-related decline is affected by comorbid conditions, adiposity, medications, and genetic factors. Testosterone treatment of older men with low testosterone levels improves overall sexual activity, sexual desire, and erectile function; improves areal and volumetric bone density, as well as estimated bone strength in the spine and the hip; corrects unexplained anemia of aging; increases skeletal muscle mass, strength and power, self-reported mobility, and some measures of physical function; and modestly improves depressive symptoms. The long-term effects of testosterone on major cardiovascular events and prostate cancer risk remain unclear. The Endocrine Society recommends against testosterone therapy of all older men with low testosterone levels but suggests consideration of treatment on an individualized basis in men who have consistently low testosterone levels and symptoms or conditions suggestive of testosterone deficiency.
abstract_id: PUBMED:26071237
Depressive Symptom Trajectories, Aging-Related Stress, and Sexual Minority Stress Among Midlife and Older Gay Men: Linking Past and Present. We concatenate 28 years of historical depressive symptoms data from a longitudinal cohort study of U.S. gay men who are now midlife and older (n = 312), with newly collected survey data to analyze trajectories of depressive symptomatology over time and their impact on associations between current stress and depressive symptoms. Symptoms are high over time, on average, and follow multiple trajectories. Aging-related stress, persistent life-course sexual minority stress, and increasing sexual minority stress are positively associated with depressive symptoms, net of symptom trajectories. Men who had experienced elevated and increasing trajectories of depressive symptoms are less susceptible to the damaging effects of aging-related stress than those who experienced a decrease in symptoms over time. Intervention efforts aimed at assisting gay men as they age should take into account life-course depressive symptom histories to appropriately contextualize the health effects of current social stressors.
abstract_id: PUBMED:35935592
The Effect of Discrimination and Resilience on Depressive Symptoms among Middle-Aged and Older Men who have Sex with Men. This study investigated if homophobic and racist discrimination increased depressive symptoms among 960 middle-aged and older men who have sex with men (MSM) and how resilience moderated these relationships. We used five waves of longitudinal data from the Healthy Aging sub-study of the Multicenter AIDS Cohort Study (MACS). We used linear regression analyses to model depressive symptoms as a function of discrimination. We used linear mixed analyses to model changes in mean resilience scores across visits. We used linear regression analyses to model depressive symptoms as a function of changes in resilience and to test the moderation effects of resilience on the relationship between discrimination and depressive symptoms. The models accounted for repeated measures of resilience. Men who experienced external and internal homophobia had greater depressive symptoms (β: 2.08; 95% Confidence Interval: 0.65, 3.51; β: 1.60; 95% Confidence Interval: 0.76, 2.44). Men experienced significant changes in mean resilience levels across visits (F = 2.84, p = 0.02). Men with a greater positive change in resilience had lower depressive symptoms (β: -0.95; 95% Confidence Interval: -1.47, -0.43). Men with higher average resilience levels had lower depressive symptoms (β: -5.08; 95% Confidence Interval: -5.68, -4.49). Men's resilience did not moderate the relationship between homophobia and depressive symptoms. Significant associations of external and internal homophobia with greater depressive symptoms present targets for future research and interventions among middle-aged and older MSM. Significant associations of average and positive changes in resilience with lower depressive symptoms provide aims for future research and interventions with this population.
abstract_id: PUBMED:22378711
Grandfather Involvement and aging men's mental health. The mental health of aging men is an understudied social issue. Although it is widely accepted that meaningful family relationships are associated with fewer depressive symptoms and greater positive affect, scholars have largely overlooked relationships between grandfathers and grandchildren as being beneficial to men's mental health. This study investigates the differences in the depressive symptoms and positive affect of 351 grandfathers. Using a cluster analytic technique, participants were categorized as involved, passive, and disengaged based on their frequency of contact, level of commitment, and participation in activities with grandchildren. Comparative analyses indicate that involved grandfathers had fewer depressive symptoms than disengaged grandfathers. Involved grandfathers had significantly higher scores on positive affect than disengaged grandfathers, and passive grandfathers had significantly higher scores on positive affect than disengaged grandfathers. This study provides evidence that grandfather-grandchild relationships influence aging men's mental health. Implications for practitioners working with aging men are discussed.
abstract_id: PUBMED:26061865
Men's Sheds and the experience of depression in older Australian men. Background/aim: Men's Sheds are community spaces where, usually, older men can socialise as they participate in a range of woodwork and other activities. There is currently little research evidence supporting the anecdotally reported mental health and wellbeing benefits of Men's Sheds. This research project investigated how older men with self-reported symptoms of depression experience their participation in Men's Sheds.
Methods: This study included in-depth interviews and administration of the Beck Depression Inventory-II with 12 men from 3 Men's Sheds, triangulated with observation of the different shed environments. Interviews explored how participation in the Men's Shed, living in a regional area, and retirement intersected with experiences of depression. Participants had either self-reported symptoms of depression or a diagnosis of depression.
Results: The findings from this study support the notion that participation at Men's Sheds decreases self-reported symptoms of depression. Beck Depression Inventory-II scores showed that most participants were currently experiencing minimal depression. The Men's Sheds environment promoted a sense of purpose through relationships and in the sharing of skills, new routines, motivation, and enjoyment for its members. The shed encouraged increased physical activity and use of cognitive skills. Finally, participants reported feelings of pride and achievement which had an impact on their sense of self-worth.
Conclusion: Men's Sheds provide an opportunity to promote health and wellbeing among retired men. The shed's activity and social focus offers a way to help men rediscover purpose and self. Further research is required to measure symptoms of depression before and after participation in Men's Sheds.
abstract_id: PUBMED:28070358
Cholesterol and depressive symptoms in older men across time. This study aimed to examine reciprocal relations between cholesterol and depression. We assessed cholesterol and depressive symptoms twice over a 3-year interval, using 842 men from the Veterans Affairs Normative Aging Study (M = 64, standard deviation = 8). Because depressive symptoms were skewed, we used zero-inflated Poisson analyses. Cross-lagged models showed that cholesterol levels at T1 predicted the existence of depressive symptoms at T2, covarying T1 depressive symptoms, age, smoking status, body mass index, and medications. Depressive symptoms at T1 did not predict cholesterol at T2. Low cholesterol levels may be risk factors for development of depressive symptoms in late life.
abstract_id: PUBMED:26337662
Relationships between nutritional status, depression and pleasure of eating in aging men and women. Nutritional health is an essential component of quality of life among older adults. The aim of this study was to identify the predictors of nutritional status in order to identify both common and sex specific predictive pathways in an aging population. A questionnaire was administered to 464 people living at home aged 65 years and above. Part of the questionnaire contained questions about nutritional status (MNA), depression (GDS), pleasure of eating and demographic characteristics. Structural equation modeling was used to examine relationships between the variables. For both sexes, results indicate that depression and pleasure of eating are related to nutritional status. In addition, different pathways were found between men and women. In particular, while pleasure of eating is affected by depression among aging women this is not the case for men. The implications of the findings for nutrition communication are discussed.
abstract_id: PUBMED:26398001
Discrimination, mental health, and leukocyte telomere length among African American men. African American men in the US experience disparities across multiple health outcomes. A common mechanism underlying premature declines in health may be accelerated biological aging, as reflected by leukocyte telomere length (LTL). Racial discrimination, a qualitatively unique source of social stress reported by African American men, in tandem with poor mental health, may negatively impact LTL in this population. The current study examined cross-sectional associations between LTL, self-reported racial discrimination, and symptoms of depression and anxiety among 92 African American men 30-50 years of age. LTL was measured in kilobase pairs using quantitative polymerase chain reaction assay. Controlling for sociodemographic factors, greater anxiety symptoms were associated with shorter LTL (b=-0.029, standard error [SE]=0.014; p<0.05). There were no main effects of racial discrimination or depressive symptoms on LTL, but we found evidence for a significant interaction between the two (b=0.011, SE=0.005; p<0.05). Racial discrimination was associated with shorter LTL among those with lower levels of depressive symptoms. Findings from this study highlight the role of social stressors and individual-level psychological factors for physiologic deterioration among African American men. Consistent with research on other populations, greater anxiety may reflect elevated stress associated with shorter LTL. Racial discrimination may represent an additional source of social stress among African American men that has detrimental consequences for cellular aging among those with lower levels of depression.
Answer: The abstracts provided offer insights into the relationship between aging, health, and depressive symptoms, with some focusing specifically on men. The studies suggest that there are indeed differences in how aging and health issues impact depressive symptoms in men and women, as well as within subgroups of men.
For instance, one study found that testosterone replacement therapy (TRT) improved depressive symptoms and health-related quality of life in aging Japanese men with late-onset hypogonadism (LOH) (PUBMED:24533913). Another study highlighted that negative attitudes toward aging were more strongly associated with adverse mental health outcomes among middle-aged and older gay men compared to their heterosexual counterparts (PUBMED:28067548). This suggests that sexual orientation can influence the relationship between aging perceptions and mental health in men.
In the context of sexual minority stress, one study showed that homophobic and racist discrimination increased depressive symptoms among middle-aged and older men who have sex with men (MSM), and resilience played a role in moderating these symptoms (PUBMED:35935592). Another study on gay men linked past depressive symptom trajectories with current stress and depressive symptoms, indicating that life-course experiences and historical stressors can impact current mental health (PUBMED:26071237).
Regarding the role of social engagement, one study found that involved grandfathers had fewer depressive symptoms and higher positive affect compared to disengaged grandfathers (PUBMED:22378711). Similarly, participation in Men's Sheds, which are social spaces for older men, was associated with decreased self-reported symptoms of depression (PUBMED:26061865).
In terms of physiological factors, one study suggested that low cholesterol levels might be a risk factor for the development of depressive symptoms in older men (PUBMED:28070358). Another study found that depression and pleasure of eating were related to nutritional status in both aging men and women, but the pathways differed by sex (PUBMED:26337662).
Lastly, a study on African American men indicated that anxiety symptoms were associated with shorter leukocyte telomere length (LTL), a marker of biological aging, and that racial discrimination in tandem with depressive symptoms could impact LTL (PUBMED:26398001).
In summary, the abstracts suggest that there are sex-specific pathways and factors that influence the relationship between aging, health, and depressive symptoms. These include hormonal changes, sexual orientation, discrimination, social engagement, nutritional status, and biological aging markers. Men may experience unique stressors such as discrimination and sexual minority stress that can exacerbate depressive symptoms, and social engagement through family relationships or community spaces like Men's Sheds can have a positive impact on their mental health. Additionally, physiological factors such as testosterone levels and cholesterol may play a role in the mental health of aging men. For women, while not directly addressed in these abstracts, it is implied that there may be different predictors of nutritional status and pleasure of eating that affect their mental health as they age (PUBMED:26337662). Overall, these findings underscore the importance of considering gender and other demographic factors when examining the interplay between aging, health, and depressive symptoms. |
Instruction: Advanced pediatric myelodysplastic syndromes: can immunophenotypic characterization of blast cells be a diagnostic and prognostic tool?
Abstracts:
abstract_id: PUBMED:19061215
Advanced pediatric myelodysplastic syndromes: can immunophenotypic characterization of blast cells be a diagnostic and prognostic tool? Background: The diagnosis of myelodysplastic syndromes (MDS) is mainly based on morphology and cytogenetic analysis. Several efforts to analyze MDS by flow cytometry have been reported in adults. These studies have focused on the identification of abnormalities in the maturation pathway of antigen expression of myelo-monocytic cells, and characterization of blast populations. Therefore, phenotype has been proposed as a diagnostic and prognostic criterion tool for adult MDS. The current article provides data concerning the blast phenotype in pediatric MDS.
Procedure: We evaluated by multiparameter flow cytometry 26 MDS pediatric patients with more than 2% of blast cells at bone marrow morphological examination (17 de novo MDS and 9 secondary MDS) and 145 pediatric de novo acute myeloid leukemia (AML) cases (M3 excluded). As control group, 12 healthy age-matched donors for allogenic bone marrow transplantation (BMD) and 6 regenerating bone marrow samples, collected from children with acute lymphoblastic leukemia (ALL) in remission after induction chemotherapy, were studied.
Results: We identified a blast immunophenotype typically expressed in most MDS cases and a strong correlation between CD7 expression and poor outcome. CD34+ compartment in MDS bone marrow was also analyzed: a significant decrease of B-cell precursors was detected in MDS patients independent of age.
Conclusions: Our data suggest that the blasts phenotypic features can constitute a diagnostic and prognostic tool also for pediatric MDS.
abstract_id: PUBMED:12525519
Additional prognostic value of bone marrow histology in patients subclassified according to the International Prognostic Scoring System for myelodysplastic syndromes. Purpose: The most recent and powerful prognostic instrument established for myelodysplastic syndromes (MDS) is the International Prognostic Scoring System (IPSS), which is primarily based on medullary blast cell count, number of cytopenias, and cytogenetics. Although this prognostic system has substantial predictive power in MDS, further refinement is necessary, especially as far as lower-risk patients are concerned. Histologic parameters, which have long proved to be associated with outcome, are promising candidates to improve the prognostic accuracy of the IPSS. Therefore, we assessed the additional predictive power of the presence of abnormally localized immature precursors (ALIPs) and CD34 immunoreactivity in bone marrow (BM) biopsies of MDS patients.
Patients And Methods: Cytogenetic, morphologic, and clinical data of 184 MDS patients, all from a single institution, were collected, with special emphasis on the determinants of the IPSS score. BM biopsies of 173 patients were analyzed for the presence of ALIP, and CD34 immunoreactivity was assessable in 119 patients. Forty-nine patients received intensive therapy.
Results: The presence of ALIP and CD34 immunoreactivity significantly improved the prognostic value of the IPSS, with respect to overall as well as leukemia-free survival, in particular within the lower-risk categories. In contrast to the IPSS, both histologic parameters also were predictive of outcome within the group of intensively treated MDS patients.
Conclusion: Our data confirm the importance of histopathologic evaluation in MDS and indicate that determining the presence of ALIP and an increase in CD34 immunostaining in addition to the IPSS score could lead to an improved prognostic subcategorization of MDS patients.
abstract_id: PUBMED:1732678
Prognostic factors in myelodysplastic syndromes. The extreme variability in prognosis among patients with myelodysplastic syndromes (MDS) complicates decision-making regarding their therapy. Several studies carried out in recent years have recognized the prognostic value of some clinical and biological characteristics. The percentage of blast cells in bone marrow, cytopenias, age and chromosome abnormalities are the most relevant factors affecting outcome. More importantly, some of these studies have resulted in the development of prognostic regression formulas and scoring systems for accurately estimating the individual prognosis of patients. The major aim of this review is to offer the clinician useful tools for treating MDS patients on a risk-fitted strategy.
abstract_id: PUBMED:12111649
The myelodysplastic syndromes: analysis of prognostic factors and comparison of prognostic systems in 128 Chinese patients from a single institution. Introduction: Although retrospective analysis were frequently undertaken, and many prognostic systems for myelodysplastic syndromes (MDS) have been proposed worldwide, few such studies have been performed and the effectiveness of different scoring systems have not yet been verified in independent patient populations in China. The aim of this single center study was to evaluate the prognostic factors and compare the prognostic scoring systems in Chinese patients with MDS.
Materials And Methods: One hundred and twenty-eight patients diagnosed as primary MDS in our Institution were studied retrospectively to identify significant prognostic factors and to assess the predictive value of 11 previously described prognostic systems, including French-American-British (FAB) classification, World Health Organization (WHO) classification, Mufti, Sanz, Morra, Aul, Oguma, Toyama, Morel and international prognostic scoring system (IPSS).
Results: The median age of the patients was 50 years (range 13-82). The 2- and 5-year survival rate of the patients were 55.22+/-4.90% and 26.09+/-6.36% respectively, with a median survival of 31 months (range 1-127 months). Fifty patients (39.1%) had progressed to acute leukemia (AL) with a median time of 8 months (range 1-43 months). Major independent variables indicated by multivariate analysis were the percentage of bone marrow (BM) blast cells and complex karyotype aberrations for survival (P=0.042 and 0.042, respectively) and only the percentage of BM blast cells for AL transformation (P=0.023). All the systems except Mufti scores successfully discriminated risk groups concerning both survival and AL evolution, especially in the high risk group, ranging from 10 to 20 months and from 4 to 7 months, respectively. The FAB and WHO classification, as well as Sanz, Oguma, Morel and IPSS possessed lower P value (P<0.0001) than that of the rest scoring systems.
Conclusion: The patients in our study were younger than these of the Western population, whereas the survival and AL transformation ratio were comparable to these previous studies. The BM blast proportion and complex chromosomal defects were highly significant for predicting outcome in MDS patients. Most investigated systems effectively stratified patients into groups with different life expectancies and identified a subset of patients with poor clinical outcome. The FAB, WHO classification, as well as Sanz, Oguma, Morel and IPSS scoring systems were more applicable for predicting survival and leukemia progression.
abstract_id: PUBMED:24507815
Chronic myelomonocytic leukemia: myelodysplastic or myeloproliferative? Chronic myelomonocytic leukemia (CMML) is a clonal disease of the hematopoietic stem cell that provokes a stable increase in peripheral blood monocyte count. The World Health Organisation classification appropriately underlines that the disease combines dysplastic and proliferative features. The percentage of blast cells in the blood and bone marrow distinguishes CMML-1 from CMML-2. The disease is usually diagnosed after the age of 50, with a strong male predominance. Inconstant and non-specific cytogenetic aberrations have a negative prognostic impact. Recurrent gene mutations affect mainly the TET2, SRSF2, and ASXL1 genes. Median survival is 3 years, with patients dying from progression to AML (20-30%) or from cytopenias. ASXL1 is the only gene whose mutation predicts outcome and can be included within a prognostic score. Allogeneic stem cell transplantation is possibly curative but rarely feasible. Hydroxyurea, which is the conventional cytoreductive agent, is used in myeloproliferative forms, and demethylating agents could be efficient in the most aggressive forms of the disease.
abstract_id: PUBMED:12931223
Is FISH a relevant prognostic tool in myelodysplastic syndromes with a normal chromosome pattern on conventional cytogenetics? A study on 57 patients. Conventional cytogenetics (CC) at clinical diagnosis shows a normal karyotype in 40-60% of de novo myelodysplastic syndromes (MDSs). Fluorescence in situ hybridization (FISH) might detect occult aberrations in these patients. Therefore, we have used FISH to check 57 MDS patients who were karyo-typically normal on CC. At clinical diagnosis, FISH revealed a clonal abnormality in 18-28% interphase cells from nine patients, five of whom also presented the same defect on metaphase FISH. In five out of nine patients, the occult defect effected a change in the international prognostic scoring system (IPSS). An abnormal FISH pattern was significantly correlated with marrow blast cell percentage (P<10(-3)) and IPSS (P<10(-3)). Patients with an occult abnormality showed an overall survival and event-free survival significantly inferior in comparison to those of patients with normal FISH (P<10(-3), P<10(-3)). Death and AML progression were 15- and eight-fold more frequent in FISH abnormal patients. In conclusion, occult defects (1) are revealed in about 15% of CC normal MDS patients, (2) are overlooked by CC either because of the poor quality of metaphases or their submicroscopic nature, (3) are clinically relevant as they may cause a change in the IPSS category and may identify a fraction of CC normal patients with an unfavorable clinical outcome.
abstract_id: PUBMED:21139142
Prognostic markers for myeloid neoplasms: a comparative review of the literature and goals for future investigation. Myeloid neoplasms include cancers associated with both rapid (acute myeloid leukemias) and gradual (myelodysplastic syndromes and myeloproliferative neoplasms) disease progression. Percentage of blast cells in marrow is used to separate acute (rapid) from chronic (gradual) and is the most consistently applied prognostic marker in veterinary medicine. However, since there is marked variation in tumor progression within groups, there is a need for more complex schemes to stratify animals into specific risk groups. In people with acute myeloid leukemia (AML), pretreatment karyotyping and molecular genetic analysis have greater utility as prognostic markers than morphologic and immunologic phenotypes. Karyotyping is not available as a prognostic marker for AML in dogs and cats, but progress in molecular genetics has created optimism about the eventual ability of veterinarians to discern conditions potentially responsive to medical intervention. In people with myelodysplastic syndromes (MDS), detailed prognostic scoring systems have been devised that use various combinations of blast cell percentage, hematocrit, platelet counts, unilineal versus multilineal cytopenias and dysplasia, karyotype, gender, age, immunophenotype, transfusion dependence, and colony-forming assays. Predictors of outcome for animals with MDS have been limited to blast cell percentage, anemia versus multilineal cytopenias, and morphologic phenotype. Prognostic markers for myeloproliferative neoplasms (eg, polycythemia vera, essential thrombocythemia) include clinical and hematological factors and in people also include cytogenetics and molecular genetics. Validation of prognostic markers for myeloid neoplasms in animals has been thwarted by the lack of a large case series that requires cooperation across institutions and veterinary specialties. Future progress requires overcoming these barriers.
abstract_id: PUBMED:8251411
The prognostic significance of auer rods in myelodysplasia. The category of refractory anaemia with excess blasts in transformation (RAEBt) of the French-American-British (FAB) classification system comprises a heterogeneous group of patients: those with any combination of 5% or more blood blast cells, more than 20% but no more than 30% marrow blast cells, or the presence of auer rods and 30% or less marrow blast cells. To determine the prognostic significance of auer rods in RAEBt, we classified the 208 patients with RAEBt seen between 1973 and 1992 as (1) those having RAEBt solely on the basis of auer rods (RAEBta, n = 29), (2) those meeting blood or marrow blast criteria for RAEBt and also having auer rods (RAEBtpos, n = 40) or (3) those meeting blood or marrow blast criteria for RAEBt without having auer rods (RAEBtneg, n = 139). The RAEBta group had a higher survival probability than either of the other two groups. Within RAEBta, those patients who, without auer rods, would be considered RAEB by the FAB system (n = 19) had a higher probability of survival than patients with RAEB as conventionally defined. Furthermore, patients with RAEBtpos were more likely to live longer than those with RAEBtneg. The RAEBta, RAEBtpos and RAEBtneg groups were similar with regard to the usual haematologic parameters. However, patients with auer rods were more likely to have a normal karyotype and less likely to have prognostically unfavourable cytogenetic abnormalities. When analysis was performed within cytogenetic groups, the favourable prognostic impact of auer rods was still evident. Similarly, the favourable prognostic significance of auer rods was discernible both among patients who did not receive intensive therapy and those who received induction chemotherapy. The complete remission rate in auer rod positive patients was 77%, compared to 27% in those without auer rods. There were no differences in remission duration. Our results suggest that: (1) patients with auer rods without blood or bone marrow blast criteria for RAEBt should not be grouped with those patients with such criteria, and (2) patients with auer rods and other criteria for RAEBt have a higher complete remission rate following induction therapy of the type frequently reserved for patients with acute myeloid leukaemia.
abstract_id: PUBMED:32337851
Identification of a metabolic gene panel to predict the prognosis of myelodysplastic syndrome. Myelodysplastic syndrome (MDS) is clonal disease featured by ineffective haematopoiesis and potential progression into acute myeloid leukaemia (AML). At present, the risk stratification and prognosis of MDS need to be further optimized. A prognostic model was constructed by the least absolute shrinkage and selection operator (LASSO) regression analysis for MDS patients based on the identified metabolic gene panel in training cohort, followed by external validation in an independent cohort. The patients with lower risk had better prognosis than patients with higher risk. The constructed model was verified as an independent prognostic factor for MDS patients with hazard ratios of 3.721 (1.814-7.630) and 2.047 (1.013-4.138) in the training cohort and validation cohort, respectively. The AUC of 3-year overall survival was 0.846 and 0.743 in the training cohort and validation cohort, respectively. The high-risk score was significantly related to other clinical prognostic characteristics, including higher bone marrow blast cells and lower absolute neutrophil count. Moreover, gene set enrichment analyses (GSEA) showed several significantly enriched pathways, with potential indication of the pathogenesis. In this study, we identified a novel stable metabolic panel, which might not only reveal the dysregulated metabolic microenvironment, but can be used to predict the prognosis of MDS.
abstract_id: PUBMED:1283545
The prognostic significance of the CD34 antigen in acute myeloid leukaemia. The prognostic value of CD34 expression on leukaemic blast cells was assessed in 38 patients with acute myeloid leukaemia. Nineteen patients had more than 10% CD34 positive blast cells. Median survival for the CD34 positive patients was 125 days and for the CD34 negative patients the median survival has not yet been reached at day 575 (p = 0.06). Of those patients who received intensive chemotherapy, CD34 positive patients (n = 13) had a median survival of 150 days while for CD34 negative patients (n = 14) the median survival has not yet been reached (p = 0.01). Adjustment for age and pre-existing myelodysplastic syndrome did not affect the correlation of CD34 positivity with survival (p = 0.02). Over the period of observation (median 10 months, range 2-19 months) the relative risk of death was 5 times greater for the CD34 positive patients. This study suggests that CD34 expression is an adverse prognostic marker, independent of age and pre-existing myelodysplasia.
Answer: Yes, immunophenotypic characterization of blast cells can be a diagnostic and prognostic tool in advanced pediatric myelodysplastic syndromes (MDS). The study by PUBMED:19061215 evaluated 26 pediatric MDS patients and found that a specific blast immunophenotype was typically expressed in most MDS cases. Additionally, there was a strong correlation between CD7 expression and poor outcome, suggesting that the phenotypic features of blasts can serve as both diagnostic and prognostic indicators in pediatric MDS. The study also noted a significant decrease in B-cell precursors in the CD34+ compartment of MDS bone marrow, which was independent of age. This supports the idea that flow cytometry and the analysis of blast cell immunophenotype can provide valuable information for the diagnosis and prognosis of pediatric MDS. |
Instruction: Does a myelomeningocele sac compared to no sac result in decreased postnatal leg function following maternal fetal surgery for spina bifida aperta?
Abstracts:
abstract_id: PUBMED:17556822
Does a myelomeningocele sac compared to no sac result in decreased postnatal leg function following maternal fetal surgery for spina bifida aperta? Objective: A fetus with large sac S1 myelomeningocele (MMC) but bilateral talipes prompted the question, 'Does the presence or size of an MMC sac affect postnatal leg function?'
Study Design: An MMC database with prenatal, birth, and a minimum of 1-year follow-up evaluation was reviewed. All fetuses had in-utero MMC repair at 20 + 0 to 25 + 6 weeks at a single institution. Fifty-four fetuses had prenatal evaluation, with 48 children completing a birth and a 1-year evaluation of leg function.
Results: An MMC sac was present in 38/54 (70%) of fetuses evaluated in-utero and had been present in 35/48 (73%) of children evaluated at 1 year of age. Although leg function evaluated at 1 year was better than expected in the 'no sac' group (p = 0.059), this did not reach statistical significance.
Conclusion: The presence of an MMC sac may increase postnatal lower limb morbidity.
abstract_id: PUBMED:37970655
Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational-age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function. Objectives: To determine if the lower-extremity neurological motor function level in fetuses with open spina bifida deteriorates within the 4-week interval between a first prenatal motor assessment at around 22 weeks of gestation and a second evaluation, prior to 'late' prenatal surgery, defined as surgery at 26-28 weeks and, in certain situations, up to 30 weeks, and to assess the association between prenatal presurgical motor-function level, anatomical level of the lesion and postnatal motor-function level.
Methods: This was a two-center cohort study of 94 singleton fetuses with open spina bifida which underwent percutaneous repair using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique between December 2016 and January 2022. All women underwent two prenatal systematic ultrasound evaluations, approximately 4 weeks apart, with the second one being performed less than 1 week before surgery, and one postnatal evaluation via physical examination within 2 months of birth. Motor-function classification was from spinal level T12 to S1, according to key muscle function. Each leg was analyzed separately; in case of discrepancy between the two legs, the worst motor-function level was considered for analysis. Motor-function-level evaluations were compared with each other and with the anatomical level as observed on ultrasound. Independent predictors of a postnatal reduction in motor-function level were assessed using a logistic regression model.
Results: Prenatal motor-function level was assessed at a median gestational age of 22.5 (interquartile range (IQR), 20.7-24.3) and 26.7 (IQR, 25.4-27.3) weeks, with a median interval of 4.0 (IQR, 2.4-6.0) weeks. The median gestational age at surgery was 27.0 (IQR, 25.9-27.6) weeks and the postnatal examination was at median age of 0.8 (IQR, 0.3-5.4) months. There was no significant difference in motor-function level between the two prenatal evaluations (P = 0.861). We therefore decided to use the second prenatal evaluation for comparison with postnatal motor function and anatomical level. Overall, prenatal and postnatal motor function evaluations were significantly different from the anatomical level (preoperative assessment, P = 0.0015; postnatal assessment, P = 0.0333). Comparing prenatal with postnatal motor-function level, we found that 87.2% of babies had similar or improved motor function compared with that prior to prenatal surgery. On logistic regression analysis, lower anatomical level of defect and greater difference between anatomical level and prenatal motor-function level were identified as independent predictors of postnatal motor function (odds ratio, 0.237 (95% CI, 0.095-0.588) (P = 0.002) and 3.44 (95% CI, 1.738-6.813) (P < 0.001), respectively).
Conclusions: During a 4-week interval between first ultrasound evaluation and late fetal surgical repair of open spina bifida, motor function does not change significantly, suggesting that late repair, ≥ 26 weeks, does not impact negatively on motor-function outcome. Compared with the anatomical level of the lesion, preoperative neurological motor-function assessment via ultrasound is more predictive of postnatal motor function, and should be included in preoperative counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
abstract_id: PUBMED:28536839
Maternal-fetal surgery for myelomeningocele: some thoughts on ethical, legal, and psychological issues in a Western European situation. Background: The results of the Management of Myelomeningocele Study (MOMS) randomized controlled trial have demonstrated that maternal-fetal surgery (MFS) for myelomeningocele (MMC) compared to postnatal MMC repair has clear neurological benefits for the child at 12 and 30 months of age. Level I evidence nevertheless does not provide answers to many questions in this delicate field. Since the beginning of 2012, our fetal center has been offering MFS for spina bifida aperta (SBA) to patients from different European and non-European countries, in a societal context where termination of pregnancy is the option chosen by most patients when being informed of this diagnosis.
Methods: We aim to explore in this text some of the ethical, legal, and psychological issues that we have encountered.
Results: For many of these questions, we do not have definite answers. A pregnant patient when diagnosed with a MMC fetus is a vulnerable subject. She needs to be referred to a highly specialized center with sufficient expertise in diagnosis and in all therapeutic options. Objective but compassionate counseling is of paramount importance. It is required that a multidisciplinary professional team obtains full voluntary consent from the mother after providing an appropriate information including diagnosis, short-, medium-, and long-term prognosis as well as benefits and harms of the fetal surgery.
Conclusion: The latter should be offered with full respect for maternal choice and individual assessment and perception of potential risks taking into consideration legislation in the fetal center and the parents' country legislation.
abstract_id: PUBMED:24582882
Maternal-fetal surgery for spina bifida: future perspectives Open spina bifida or myelomeningocele (MMC) is a frequent congenital abnormality (450 cases per year in France) associated with high morbidity. Immediate postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, treating hydrocephalus with a ventricular shunt. MMC surgical techniques haven't achieved any major progress in the past decades. Numerous experimental and clinical studies have demonstrated the MMC "two-hit" hypothetic pathogenesis: a primary embryonic congenital abnormality of the nervous system due to a failure in the closure of the developing neural tube, followed by secondary damages of spinal cord and nerves caused by long-term exposure to amniotic fluid. This malformation frequently develops cranial consequences, i.e. hydrocephalus and Chiari II malformation, due to leakage of cerebrospinal fluid. After 30 years of research, a randomized trial published in February 2011 proved open maternal-fetal surgery (OMFS) for MMC to be a real therapeutic option. Comparing prenatal to postnatal surgery, it confirmed better outcomes of MMC children after a follow up of 2.5 years: enhancement of lower limb motor function, decrease of the degree of hindbrain herniation associated with the Chiari II malformation and the need for shunting. At 5 years of age, MMC children operated prenatally seems to have better neurocognitive, motor and bladder-sphincter outcomes than those operated postnatally. However, risks of OMFS exist: prematurity for the fetus and a double hysterotomy at approximately 3-month interval for the mother. Nowadays, it seems crucial to inform parents of MMC patients about OMFS and to offer it in France. Future research will improve our understanding of MMC pathophysiology and evaluate long-term outcomes of OMFS. Tomorrow's prenatal surgery will be less invasive and more premature using endoscopic, robotic or percutaneous techniques. Beforehand, Achilles' heel of maternal-fetal surgery, i.e. preterm premature rupture of membranes, preterm labor and preterm birth, must be solved.
abstract_id: PUBMED:34523765
Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida. Objectives: Open spina bifida is a common cause of hydrocephalus in the postnatal period. In-utero closure of the fetal spinal defect decreases the need for postnatal cerebrospinal fluid (CSF) diversion surgery. Good prenatal predictors of the need for postnatal CSF diversion surgery are currently lacking. In this study, we aimed to assess the association of fetal ventriculomegaly and its progression over the course of pregnancy with the rate of postnatal hydrocephalus requiring intervention.
Methods: In this retrospective study, fetuses with a prenatal diagnosis of open spina bifida were assessed longitudinally. Ventricular diameter, as well as other potential predictors of the need for postnatal CSF diversion surgery, were compared between fetuses undergoing prenatal closure and those undergoing postnatal repair.
Results: The diameter of the lateral ventricle increased significantly throughout gestation in both groups, but there was no difference in maximum ventricular diameter at first or last assessment between fetuses undergoing prenatal closure and those undergoing postnatal repair. There was no significant difference in the rate of progression of ventriculomegaly between the two groups, with a mean progression rate of 0.83 ± 0.5 mm/week in the prenatal-repair group and 0.6 ± 0.6 mm/week in the postnatal-repair group (P = 0.098). Fetal repair of open spina bifida was associated with a lower rate of postnatal CSF diversion surgery (P < 0.001). In all subjects, regardless of whether they had prenatal or postnatal surgery, the severity of ventriculomegaly at first and last assessments was associated independently with the need for postnatal CSF diversion surgery (P = 0.005 and P = 0.001, respectively), with a greater need for surgery in fetuses with larger ventricular size, even after controlling for gestational age at assessment.
Conclusions: In fetuses with open spina bifida, fetal ventricular size increases regardless of whether spina bifida closure is performed prenatally or postnatally, but the need for CSF diversion surgery is significantly lower in those undergoing prenatal repair. Ventriculomegaly is associated independently with the need for postnatal CSF diversion in fetuses with open spina bifida, irrespective of timing of closure. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
abstract_id: PUBMED:15286226
Neonatal loss of motor function in human spina bifida aperta. Objective: In neonates with spina bifida aperta (SBA), leg movements innervated by spinal segments located caudal to the meningomyelocele are transiently present. This study in neonates with SBA aimed to determine whether the presence of leg movements indicates functional integrity of neuronal innervation and whether these leg movements disappear as a result of dysfunction of upper motor neurons (axons originating cranial to the meningomyelocele) and/or of lower motor neurons (located caudal to the meningomyelocele).
Methods: Leg movements were investigated in neonates with SBA at postnatal day 1 (n = 18) and day 7 (n = 10). Upper and lower motor neuron dysfunction was assessed by neurologic examination (n = 18; disinhibition or inhibition of reflexes, respectively) and by electromyography (n = 12; absence or presence of denervation potentials, respectively).
Results: Movements, related to spinal segments caudal to the meningomyelocele, were present in all neonates at postnatal day 1. At day 1, leg movements were associated with signs of both upper (10 of 18) and lower (17 of 18) motor neuron dysfunction caudal to the meningomyelocele. In 7 of 10 neonates restudied after the first postnatal week, leg movements had disappeared. The absence of leg movements coincided with loss of relevant reflexes, which had been present at day 1, indicating progression of lower motor neuron dysfunction.
Conclusions: We conclude that the presence of neonatal leg movements does not indicate integrity of functional lower motor neuron innervation by spinal segments caudal to the meningomyelocele. Present observations could explain why fetal surgery at the level of the meningomyelocele does not prevent loss of leg movements.
abstract_id: PUBMED:19540177
Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention. Myelomeningocele (MMC) is a common birth defect that is associated with significant lifelong morbidity. Little progress has been made in the postnatal surgical management of the child with spina bifida. Postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, and treating hydrocephalus with a ventricular shunt. In-utero repair of open spina bifida is now performed in selected patients and presents an additional therapeutic alternative for expectant mothers carrying a fetus with MMC. It is estimated that about 400 fetal operations have now been performed for MMC worldwide. Despite this large experience, the technique remains of unproven benefit. Preliminary results suggest that fetal surgery results in reversal of hindbrain herniation (the Chiari II malformation), a decrease in shunt-dependent hydrocephalus, and possibly improvement in leg function, but these findings might be explained by selection bias and changing management indications. A randomized prospective trial (the MOMS trial) is currently being conducted by three centers in the USA, and is estimated to be completed in 2010. Further research is needed to better understand the pathophysiology of MMC, the ideal timing and technique of repair, and the long-term impact of in-utero intervention.
abstract_id: PUBMED:32003478
Maternal low body mass index is a risk factor for fetal ductal constriction following indomethacin use among women undergoing fetal repair of spina bifida. Objectives: The objectives were to determine the prevalence of and to identify risk factors associated with constriction of the fetal ductus arteriosus (DA) following perioperative indomethacin use for fetal myelomeningocele (MMC) repair. Study design A retrospective chart review study included 100 consecutive fetuses who underwent fetal MMC repair between 2011 and 2018. All patients had fetal echocardiography (FE) on postoperative day (POD)#1 and 2 to detect constriction of the DA. All patients received indomethacin for tocolysis using a standardized protocol. Multivariate regression analysis was carried out to identify the predictors for fetal ductal constriction.
Results: Eighty patients met our study eligibility criteria. Median gestational age at time of surgery was 25 (24-25) weeks. Constriction of the DA was detected in 14 fetuses (17.5%). In five fetuses, this was observed on POD# 1, in seven on POD# 2, and in two on both days. The only independent risk factor for predicting DA constriction was maternal body mass index (BMI) <25 kg/m2 (P = .002).
Conclusion: Indomethacin therapy following fetal MMC surgery requires careful daily FE surveillance. The association of DA constriction and low BMI suggests that BMI-based dosing of indomethacin may be recommended for perioperative tocolysis in fetal MMC surgery.
abstract_id: PUBMED:22126123
Fetal endoscopic myelomeningocele closure preserves segmental neurological function. Aim: Our aim was to compare the effect of prenatal endoscopic with postnatal myelomeningocele closure (fetally operated spina bifida aperta [fSBA]) versus neonatally operated spina bifida aperta [nSBA]) on segmental neurological leg condition.
Method: Between 2003 and 2009, the fetal surgical team (Department of Obstetrics, University of Bonn, Germany) performed 19 fetal endoscopic procedures. Three procedures resulted in fetal death, three procedures were interrupted by iatrogenic hemorrhages and 13 procedures were successful. We matched each successfully treated fSBA infant with another nSBA infant of the same age and level of lesion, resulting in 13 matched pairs (mean age 14 mo; SD 16 mo; f/m=1.6; female-16, male-10). Matched fSBA and nSBA pairs were compared in terms of segmental neurological function and leg muscle ultrasound density (MUD). We also determined intraindividual difference in MUD (dMUD) between myotomes caudal and cranial to the myelomeningocele (reflecting neuromuscular damage by the myelomeningocele) and compared dMUD between fSBA and nSBA infants. Finally, we correlated dMUD with segmental neurological function.
Results: We found that, on average, the fSBA group were born at a lower gestational age than the nSBA group (median 32 wks [range 25-34 wks] vs 39 wks [34-41 wks]; p=0.001) and experienced more complications (chorioamnionitis, premature rupture of the amniotic membranes, oligohydramnios, and infant respiratory distress syndrome necessitating intermittent positive-pressure ventilation). Neurological function was better preserved after fSBA than after nSBA (median motor and sensory gain of two segments; better preserved knee-jerk [p=0.006] and anal [p=0.032] reflexes). The dMUD was smaller in fSBA than in nSBA infants (mean difference 24, 95% confidence interval [CI] 15-33; p<0.05), which was associated with better preserved segmental muscle function.
Interpretation: Fetal endoscopic surgery is associated with spinal segmental neuroprotection, but it results in more complications. Before considering clinical implementation of fetal endoscopic myelomeningocele closure as standard care, the frequency of complications should be appropriately reduced and results assessed in larger groups over a longer period of time.
abstract_id: PUBMED:26138563
Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part III: neurosurgical intervention in the first postnatal year. Objective: To evaluate the need for postnatal neurosurgical intervention after fetoscopic patch coverage of spina bifida aperta (SBA).
Methods: This was a retrospective analysis of a cohort of 71 fetuses which underwent minimally invasive fetoscopic patch coverage of SBA between 21 + 0 and 29 + 1 weeks of gestation. Postnatal neurosurgical procedures were classified into two types: re-coverage of the SBA within the first 3 months following birth, and shunt placement as treatment of associated hydrocephalus within the first year.
Results: Location of the SBA was lumbosacral in 59 cases, lumbar in seven, thoracic in three and sacral in two. In total, 20/71 (28%) patients underwent early postnatal neurosurgical intervention by means of re-coverage of the SBA. This was performed because of cerebrospinal fluid leakage in seven (35%), adhesions with functional deterioration in three (15%), incomplete coverage in five (25%) and skin defect in five (25%) cases. Ventriculoperitoneal shunt placement within 1 year was required in 32 (45%) cases and was preceded by ventriculostomy in two. Three (4%) infants needed Chiari decompression surgery in the first 12 months following birth, because of syringomyelia or gait disturbance.
Conclusions: Fetoscopic patch coverage of SBA may require postnatal re-coverage in some cases. In most cases, conservative wound treatment shows good results, without requiring neurosurgical intervention. The low 1-year-shunt rate is comparable to data of the Management of Myelomeningocele Study and lower compared with published data of patients with postnatal only coverage of SBA.
Answer: The presence of a myelomeningocele (MMC) sac may be associated with increased postnatal lower limb morbidity, as suggested by a study that found leg function evaluated at 1 year was better than expected in the 'no sac' group, although this did not reach statistical significance (PUBMED:17556822). This indicates that while there is a trend towards better leg function in the absence of an MMC sac, the evidence is not strong enough to conclusively state that a sac leads to decreased postnatal leg function. Further research would be needed to establish a definitive relationship between the presence of an MMC sac and postnatal leg function outcomes. |
Instruction: Does race influence age of diagnosis for children with developmental delay?
Abstracts:
abstract_id: PUBMED:21122725
Does race influence age of diagnosis for children with developmental delay? Background: Early identification of developmental delay is important for ensuring that children receive the early intervention services they need. Racial disparities exist for a number of childhood conditions, but it is not known whether there are racial disparities in the age of diagnosis with developmental delay.
Objective/hypothesis: This study aimed to determine the mean age of diagnosis with developmental delay for children ensured by South Carolina Medicaid. We hypothesized that African American children would be diagnosed later than white children.
Methods: A retrospective cohort study design explored South Carolina Medicaid claim records to determine the age when 5358 children with developmental delay (DD) were first diagnosed and whether there were racial disparities in age of diagnosis.
Results: The mean age at diagnosis was 4.08 years for African American children and 4.27 years for white children. For children diagnosed with DD and mental retardation, the average age of first diagnosis was 2.6 years, and for children with DD plus cerebral palsy, the average age was 2.1 years. African American race was significantly associated with younger diagnosis with DD in a multivariable model, but the overall model explained little of the variation in age at diagnosis.
Conclusions: There were no clinically significant racial differences in the mean age of diagnosis with developmental delay. However, in general the age of diagnosis was undesirably late for both groups. Additional efforts are needed to ensure that children with DD, living in South Carolina, are identified near the beginning of early intervention services.
abstract_id: PUBMED:36606184
Age of Diagnosis and Demographic Factors Associated with Autism Spectrum Disorders in Chinese Children: A Multi-Center Survey. Purpose: The present study investigated the age of diagnosis, treatment and demographic factors of Chinese children with autism spectrum disorders (ASD), to provide a scientific basis for the early detection, diagnosis, and intervention of ASD.
Patients And Methods: A total of 1500 ASD children aged 2-7 years old from 13 cities in China were administered questionnaires to examine their diagnosis, treatment, and basic family information. The Childhood Autism Rating Scale (CARS) was used to measure the symptoms and severity of ASD children, and the Children Neuropsychological and Behavior Scale-Revision 2016 (CNBS-R2016) was utilized to measure neurodevelopmental levels of ASD children.
Results: We found that for children with ASD, the median (p25, p75) age for the initial detection of social behavioral developmental delay was 24 (18, 30) months, while the age for the initial diagnosis was 29 (24, 36) months and the age for the beginning of intervention was 33 (27, 42) months. Multiple linear regression (MLR) analysis suggested that in children with ASD whose parents were divorced, separated, or widowed, or whose mothers were engaged in physical work, the initial detection of social behavioral developmental delay happened later. For the children with ASD who lived in urban areas, had higher levels of ASD symptom severity or whose parents were not divorced or separated, the age for the initial diagnosis was earlier. For the children with ASD who lived in urban areas or whose mothers had received higher level of education, the earlier age for the beginning of intervention was observed, while for those with ASD whose mothers were engaged in physical work, the age for the beginning of training was later.
Conclusion: It is recommended to actively carry out health education of ASD and strengthen the support for ASD families to enhance their rehabilitation level.
abstract_id: PUBMED:17261988
Diagnosis of severe developmental disorders in children under three years of age. Background: Autism, intellectual disability, and specific language impairment (SLI) constitute three important forms of developmental disability that are often mistaken for each other, especially in very young children (under age 4). Diagnostic problems are caused by the fact that a fundamental problem in cognition, language, or behavior has secondary effects on the remaining areas, which makes it difficult to separate cause from effect. A wrong or absent diagnosis can be a major hindrance in providing properly targeted therapy for developmentally disabled children.
Material/methods: From a population of 667 children referred to a specialized outpatient clinic for developmentally disabled children, we identified 35 children in whom the fundamental diagnosis of autism, intellectual disability, or SLI was unambiguous, and then analyzed these children's scores on 7 subtests from the Munich Functional Developmental Diagnosis, in order to identify specific features of each of the three syndromes.
Results: The most reliable differentiating factor in our research group proved to be the MFDD subtest for self-reliance. A model was constructed to assist in analyzing the complex interactions of symptoms, which frequently overlap.
Conclusions: Cognitive and communicative limitations resulting from underlying perceptual dysfunctions can lead to inappropriate adaptive behavior in children with developmental disorders, such as autism, intellectual disability, and specific language impairment. Each of these syndromes has a specific profile in respect to measures of cognitive function, social skills, and verbal communication.
abstract_id: PUBMED:17683451
Variability in outcome for children with an ASD diagnosis at age 2. Background: Few studies have examined the variability in outcomes of children diagnosed with autism spectrum disorder (ASD) at age 2. Research is needed to understand the children whose symptoms - or diagnoses - change over time. The objectives of this study were to examine the behavioral and diagnostic outcomes of a carefully defined sample of 2-year-old children with ASD, and to identify child and environmental factors that contribute to variability in outcomes at age 4.
Methods: Forty-eight children diagnosed with autism or pervasive developmental disorder not otherwise specified (PDDNOS) at age 2 were followed to age 4. Diagnostic measures included the Autism Diagnostic Observation Schedule - Generic (ADOS-G) and clinical diagnosis at ages 2 and 4, and the ADI-R at age 4.
Results: Diagnostic stability for an ASD diagnosis (autism or PDDNOS) was 63%, and for an autism diagnosis was 68%. Children who failed to meet diagnostic criteria for ASD at follow-up were more likely to: 1) be 30 months or younger at initial evaluation; 2) have milder symptoms of autism, particularly in the social domain; and 3) have higher cognitive scores at age 2. No differences between children with stable and unstable diagnoses were found for amount of intervention services received. Among the children with unstable diagnoses, all but one continued to have developmental disorders, most commonly in the area of language.
Conclusions: The stability of ASD was lower in the present study than has been reported previously, a finding largely attributable to children who were diagnosed at 30 months or younger. Implications for clinical practice are discussed.
abstract_id: PUBMED:28857799
Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis. Background: Animals exposed to anesthetics during specific age periods of brain development experience neurotoxicity, with neurodevelopmental changes subsequently observed during adulthood. The corresponding vulnerable age in children, however, is unknown.
Methods: An observational cohort study was performed using a longitudinal dataset constructed by linking individual-level Medicaid claims from Texas and New York from 1999 to 2010. This dataset was evaluated to determine whether the timing of exposure to anesthesia ≤5 years of age for a single common procedure (pyloromyotomy, inguinal hernia, circumcision outside the perinatal period, or tonsillectomy and/or adenoidectomy) is associated with increased subsequent risk of diagnoses for any mental disorder, or specifically developmental delay (DD) such as reading and language disorders, and attention deficit hyperactivity disorder (ADHD). Exposure to anesthesia and surgery was evaluated in 11 separate age at exposure categories: ≤28 days old, >28 days and ≤6 months, >6 months and ≤1 year, and 6-month age intervals between >1 year old and ≤5 years old. For each exposed child, 5 children matched on propensity score calculated using sociodemographic and clinical covariates were selected for comparison. Cox proportional hazards models were used to measure the hazard ratio of a mental disorder diagnosis associated with exposure to surgery and anesthesia.
Results: A total of 38,493 children with a single exposure and 192,465 propensity score-matched children unexposed before 5 years of age were included in the analysis. Increased risk of mental disorder diagnosis was observed at all ages at exposure with an overall hazard ratio of 1.26 (95% confidence interval [CI], 1.22-1.30), which did not vary significantly with the timing of exposure. Analysis of DD and ADHD showed similar results, with elevated hazard ratios distributed evenly across all ages, and overall hazard ratios of 1.26 (95% CI, 1.20-1.32) for DD and 1.31 (95% CI, 1.25-1.37) for ADHD.
Conclusions: Children who undergo minor surgery requiring anesthesia under age 5 have a small but statistically significant increased risk of mental disorder diagnoses and DD and ADHD diagnoses, but the timing of the surgical procedure does not alter the elevated risks. Based on these findings, there is little support for the concept of delaying a minor procedure to reduce long-term neurodevelopmental risks of anesthesia in children. In evaluating the influence of age at exposure, the types of procedures included may need to be considered, as some procedures are associated with specific comorbid conditions and are only performed at certain ages.
abstract_id: PUBMED:2195972
Autism in infants and young children. The value of early diagnosis Clinical studies of early symptoms are among the most significant advances achieved during recent years in the field of autism. The first descriptions of early symptoms were retrospective and lacked precision. Autistic children are now being seen increasingly early and new insight is being gained into the initial manifestations and differences in clinical patterns. Similarly, differential diagnosis problems (borderline forms) are changing as clinicians evaluate children at younger ages. Although a definitive diagnosis is neither possible nor even desirable before the age of 18 to 24 months, detailed clinical data should be collected early. This data forms the basis for differential diagnosis and will be needed later for differentiating various clinical patterns of developmental disorders, establishing a prognosis, and monitoring therapeutic effects. In prospective longitudinal studies of autistic children, comparison of recent observations with detailed early data is essential. Early initial evaluation includes videotape recordings, assessment of cognitive functions and communication skills, and use of a scale for autistic symptoms. Using the results of evaluations of very young children, a specific semiology (communication disorders) can be developed. Several symptoms probably denote neurophysiologic and/or perceptive disorders. Primary symptoms are now being better distinguished from secondary anomalies (behavior disorders) that may be avoidable or treatable.
abstract_id: PUBMED:38481459
Autism spectrum disorder: Comorbidity and demographics in a clinical sample. Objective: To determine the demographic and clinical characteristics of children followed up with the diagnosis of autism spectrum disorder (ASD) at a tertiary center in Southeeast Turkey. Methods: Children followed up with the diagnosis of ASD at a university hospital child psychiatry clinic between June 2016 and June 2021 were evaluated retrospectively for comorbidities, intellectual functioning and age at diagnosis. Results: In the preschool group, females displayed significantly more frequent cognitive developmental delay. Median age at diagnosis was 36 months (IQR= 22) regardless of gender. Approximately three-fourth (73.7%) of the cases had at least one psychiatric comorbid disorder while 22.8% had at least one medical diagnosis. Psychiatric comorbidity was found to be associated with later diagnosis. Conclusion: Although the age at first diagnosis in this study is relatively earlier than the studies in the literature, most of the children with ASD are still diagnosed very late. Psychiatric comorbidities may lead to later diagnosis due to overshadowing. Training of educational and primary healthcare workers on symptoms of ASD may enable earlier diagnosis.
abstract_id: PUBMED:19581269
No change in the age of diagnosis for fragile x syndrome: findings from a national parent survey. Objective: To determine recent trends in the diagnosis of children with fragile X syndrome (FXS) and identify factors associated with the timing of diagnosis.
Methods: More than 1000 families of children with FXS participated in a national survey. Of these, 249 had their first child (213 boys, 36 girls) diagnosed between 2001 and 2007 and did not know about FXS in their family before diagnosis. These parents answered questions about the average age of first concerns, developmental delays, early intervention, and the FXS diagnosis. They also provided other information about their child and family, reported who made the diagnosis, and described ramifications for other children and extended family members.
Results: The average age of FXS diagnosis of boys remained relatively stable across the 7-year period at approximately 35 to 37 months. The 36 girls with full mutation were given the diagnosis at an average age of 41.6 months. A trend was noted in earlier diagnosis of developmental delay for boys in more recent years. Approximately 25% of the families of male children had a second child with the full mutation before the diagnosis was given to the first child; 14 (39%) of the 36 families of female children had a second child with the full mutation before the diagnosis.
Conclusions: Despite patient advocacy, professional recommendations regarding prompt referral for genetic testing, and increased exposure to information about FXS in the pediatric literature, no changes were detected in the age of diagnosis of FXS during the time period studied. Earlier identification in the absence of systematic screening will likely continue to be a challenge.
abstract_id: PUBMED:31318778
Children with Tourette Syndrome in the United States: Parent-Reported Diagnosis, Co-Occurring Disorders, Severity, and Influence of Activities on Tics. Objective: Describe the diagnostic process for Tourette syndrome (TS) based on parent report, as well as TS severity and associated impairment; the influence of common daily activities on tics; and the presence of co-occurring mental, behavioral, and developmental disorders among children in the United States.
Methods: Parent-report data from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome on 115 children ever diagnosed with TS were analyzed. Descriptive, unweighted analyses included frequencies and percentages, and means and standard deviations. Fisher's exact test and t-tests were calculated to determine statistically significant differences.
Results: The mean age that tics were first noticed was 6.3 years, and, on average, TS was diagnosed at 7.7 years. The time from initially noticing tics to TS diagnosis averaged 1.7 years. The mean age when TS symptoms were most severe was 9.3 years. Tic severity was associated with impaired child functioning but not tic noticeability. Almost 70% of parents reported that fatigue and major transitions made their child's tics worse. Children with ever-diagnosed TS had a mean of 3.2 ever-diagnosed co-occurring mental, behavioral, or developmental disorders; a quarter (26.9%) had 5 or more co-occurring disorders.
Discussion: In this sample of children with TS, the time to diagnosis averaged less than 2 years from when tics were initially noticed. More severe TS was associated with greater functional impairment, and co-occurring disorders were common among children with TS. This study provides insight into the current experiences of children with TS in the United States and their families.
abstract_id: PUBMED:33392868
Factors Associated with a Delayed Autism Spectrum Disorder Diagnosis in Children Previously Assessed on Suspicion of Autism. This study aimed to investigate factors associated with a delayed autism spectrum (ASD) diagnosis when compared to children with either no or early ASD diagnosis. Among 893 children assessed for ASD before age 8, 39% had no ASD at baseline, of which 21% received a later ASD diagnosis. Autism symptoms, diagnostic history of other developmental disorders, cognitive ability, and socioeconomic factors were associated with delayed ASD. Autism Diagnostic Observation Schedule (ADOS) scores in delayed ASD fell between early and no ASD. Other developmental disorders, time and clinical trends like ADOS use and low parental education distinguished delayed and early ASD, whereas higher frequency of IQ < 70 at baseline and a diagnosis of emotional disorders during follow-up distinguished delayed and no ASD.
Answer: Based on the information provided in the abstracts, there is evidence that race may influence the age of diagnosis for children with developmental delay, but the findings are not consistent across all studies. In a study examining children insured by South Carolina Medicaid, African American children were diagnosed with developmental delay (DD) at a slightly younger age than white children, with a mean age at diagnosis of 4.08 years for African American children and 4.27 years for white children (PUBMED:21122725). However, the study concluded that there were no clinically significant racial differences in the mean age of diagnosis with developmental delay, although the age of diagnosis was generally late for both groups.
In contrast, another study investigating autism spectrum disorders (ASD) in Chinese children found that demographic factors, including living in urban areas and parental education levels, influenced the age of initial diagnosis, with no specific mention of race as a factor (PUBMED:36606184). Similarly, other studies focused on the diagnosis of developmental disorders such as autism, intellectual disability, and specific language impairment (PUBMED:17261988), the variability in outcomes for children diagnosed with ASD at age 2 (PUBMED:17683451), and the association between exposure to surgery and anesthesia with mental disorder diagnosis (PUBMED:28857799), but did not specifically address the influence of race on the age of diagnosis.
A study on autism spectrum disorder in Southeast Turkey found that psychiatric comorbidity was associated with later diagnosis, but did not specifically mention race as a factor (PUBMED:38481459). Another study on fragile X syndrome (FXS) did not detect changes in the age of diagnosis over a 7-year period and did not report on the influence of race (PUBMED:19581269). Lastly, a study on Tourette syndrome in the United States did not find a significant influence of race on the age of diagnosis (PUBMED:31318778).
In summary, while one study (PUBMED:21122725) found a slight difference in the age of diagnosis between African American and white children, it did not find this difference to be clinically significant. Other studies did not specifically address race as a factor influencing the age of diagnosis for developmental delays. Therefore, based on the provided abstracts, it is not possible to conclusively state that race influences the age of diagnosis for children with developmental delay. |
Instruction: A 50-g glucose challenge test: is there any diagnostic cut-off?
Abstracts:
abstract_id: PUBMED:29694252
The Effect of the 50 g Glucose Challenge Test on The Thiol/Disulfide Homeostasis in Pregnancy. Aim: A 50 g glucose challenge test (GCT) is recommended for screening all pregnant women for gestational diabetes mellitus. In this study, the effect of GCT on the thiol/disulfide balance was investigated.
Methods: One-hundred women that underwent a 50 g GCT at 24-28 weeks of gestation (63 positive and 37 negative results) were evaluated in terms of thiol/disulfide in serum samples at test hours 0 and 1.
Results: Compared to the baseline values (hour 0), after the glucose load (hour 1), the thiol and native thiol/total thiol (p < 0.0001) of the GCT-positive women were reduced whereas the values of glucose, disulfide, disulfide/native thiol, disulfide/total thiol (p < 0.0001) and total thiol increased (p = 0.018).
Conclusion: In GCT-positive pregnant individuals, the glucose load increases oxidative stress by changing the thiol/disulfide homeostasis. Such an effect is not observed in healthy pregnancies.
abstract_id: PUBMED:27651570
50 Grams Oral Glucose Challenge Test: Is It an Effective Screening Test for Gestational Diabetes Mellitus? Aim: To find out whether 50 g oral glucose challenge test (OGCT) is an effective screening test for all pregnant women between 24 and 28 weeks gestation.
Method: A 50 g OGCT test was administered to 307 unselected women at 24-28 weeks of gestation. When venous plasma glucose (VPG) concentration after 1 h was >7.8 mmol/l, OGCT was positive. Women with a positive OGCT underwent 2 h 75 grams oral glucose tolerance test (OGTT) as a confirmatory diagnosis of GDM. When fasting and 2 h post 75 g OGTT values were >5.5 mmol/I and >8 mmol/l, respectively, women were considered diabetic.
Results: We screened 307 women for GDM by OGCT. Total number of women with positive OGCT was 83 (27.03 %). In the low-risk group, total number of women with GDM was 9/168 (5.35 %) while the total number of women with GDM in the high-risk group was 14/139 (10.07 %). There was no significant difference with respect to the total number of women with GDM in the groups.
Conclusions: A 50 g OGCT seems to be an effective screening test for both groups. More cases of GDM can be discovered when universal rather than risk-related screening is applied.
abstract_id: PUBMED:33350460
Different pre-analytical techniques and the results of 50 g oral glucose challenge tests. Objective: We aimed to analyse the pre-analytical process and its effect of 50 g of oral glucose challenge test results for screening gestational diabetes mellitus.
Research Design And Methods: The 50 g oral glucose challenge test was performed to 30 pregnant women, and the blood was collected as two samples for three tubes containing; serum separating jell (SSJ), sodium fluoride-potassium oxalate (NaF - KOx) and sodium citrate-containing tube. The first samples of the three tubes were centrifuged within 30 minutes, and second samples were centrifuged after 60 minutes and were analysed. One sample in SSJ tube and was analysed in the same day according to hospitals routine practice. The results were compared.
Results: Among the 30 samples, the mean decrease in glucose levels was highest in the SSJ tube (0.38 mmol/L), followed by 0.16 mmol/L in Na citrate tube and 0.14 mmol/L in NaF-KOx tube. The hospital routine assessment with SSJ was 6.36 ± 1.90 mmol/L. The <30 and >60 minutes glucose results were 6.80 ± 1.88 mmol/L vs 6.42 ± 1.97 mmol/L for SSJ, 5.95 ± 1.60 mmol/L vs 5.78 ± 1.51 mmol/L for Na Citrate and 6.90 ± 1.86 mmol/L vs 6.75 ± 1.90 mmol/L for NaF-KOx mg/dL groups, respectively, and both the changes within time and the results between the tubes showed a statistically significant difference (P < .001).
Conclusion: In cases with longer assessment time and with different blood sample tubes, the clinician should also keep in mind that, especially with results under but close to the cut-off levels, an underdiagnosed gestational diabetes might be present.
abstract_id: PUBMED:35261106
Relationship of anthropometric measurements with glycated hemoglobin and 1-h blood glucose after 50 g glucose challenge test in pregnant women: A longitudinal cohort study in Southern Thailand. Aims: To assess correlations of anthropometric measurements with glycated hemoglobin (HbA1c) and 1-h blood glucose after a 50 g glucose challenge test during the first and late second trimesters and explore their relationships of anthropometric measurements with neonatal birth weight.
Methods: A longitudinal study was conducted among pregnant Thai women with gestational age ≤14 weeks. Anthropometric measurements, using body mass index, body compositions, and circumferences, and skinfold thickness, were measured at four-time points: ≤14, 18-22, 24-28, and 30-34 weeks of gestation. HbA1c and 1-h blood glucose were examined at ≤14 and 24-28 weeks. Neonatal birth weight was recorded.
Results: Of 312 women, HbA1c was more correlated with anthropometric measurements during pregnancy than 1-h blood glucose. At 24-28 weeks, women with high/very high body fat percentage were more likely to have higher HbA1c. Women with high subscapular skinfold thickness were more likely to have higher 1-h blood glucose at ≤14 and 24-28 weeks. High hip circumference significantly increased neonatal birth weights.
Conclusion: Anthropometric measurements were longitudinally correlated with HbA1c and 1-h blood glucose, higher in the late second than first trimesters, as well as neonatal birth weight. The mechanisms to explain the relationship of different anthropometric measurements are required to be further studied.
abstract_id: PUBMED:29323608
The Association Between Low 50 g Glucose Challenge Test Values and Adverse Pregnancy Outcomes. Background: The implications of low values on the 50 g glucose challenge test (GCT) in pregnancy are not clearly defined. Few studies have evaluated the influence of maternal low GCT values on obstetrical outcomes. This study aimed to compare pregnancy outcomes between women with low 50 g GCT values and those with normal values.
Materials And Methods: Women undergoing gestational diabetes mellitus screening at 24-28 weeks of gestational age between January 2010 and December 2016 were retrospectively evaluated. Women with multifetal pregnancies, prepregnancy type I or II diabetes, GCT performed before 24 or after 28 weeks of gestational age, and women undergoing multiple GCTs in the same pregnancy were excluded. Low GCT values and normal GCT values were defined as ≤85 mg/dL and 86-130 mg/dL, respectively.
Results: Of 3875 screened subjects, 519 (13.4%) women were included in the low GCT group and 3356 (86.6%) in the normal GCT group. Low GCT women had a significantly higher rate of small for gestational age (SGA) infants than normal GCT women (10.8% vs. 7.9%, p = 0.02). Cesarean section and postpartum hemorrhage (PPH) were less frequent in low GCT women than in normal women (32.6% vs. 42.8%, p < 0.01 and 0.2% vs. 1.2%, p = 0.03, respectively). Low GCT women had a 1.38-fold increased risk of bearing SGA infants (95% confidence intervals: 1.01-1.88, p = 0.04).
Conclusions: Rate of SGA infants was significantly higher and cesarean delivery and PPH rates were significantly lower in women with low GCT values. Low GCT values were independently associated with an increased risk of SGA.
abstract_id: PUBMED:33150244
A Retrospective Multicenter Study on the Usefulness of 50 g Glucose Challenge Test in Gestational Diabetes Mellitus Screening. Introduction: To clarify the usefulness of glucose challenge test (GCT), the rate of gestational diabetes mellitus (GDM) detection and perinatal outcomes were compared between the groups of random blood glucose level (RBG) and 50 g GCT in this study.
Methods: The first survey was conducted at 255 institutions registered by the Kanto Society of Obstetrics and Gynecology and clinical training institutions in the Kanto Area, followed by a second survey. The included women were broadly classified into the RBG and GCT groups, according to the mid-trimester blood glucose screening method, and the perinatal outcomes of the two groups were retrospectively compared. The primary outcomes were the proportion of infants weighing 3,500 g or more and birth weight ≥90th-percentile infants.
Results: The rate of GDM diagnosis was significantly higher in the GCT group (7.6%) than that in the RBG group (4.8%). However, no significant differences were observed in perinatal outcomes, i.e., the proportion of infants weighing 3,500 g or more or birth weight ≥90th percentile.
Conclusions: GCT is not superior for predicting infants weighing 3,500 g or more and birth weight ≥90th percentile, as compared with RBG.
abstract_id: PUBMED:30091446
Maternal hypoglycaemia on the 50 g oral glucose challenge test - evaluation of obstetric and neonatal outcomes. Objectives: To discuss obstetric and neonatal outcomes of maternal hypoglycaemia observed after the 50 g oral glucose challenge test.
Material And Methods: A retrospective evaluation was made of the results of patients at 24-28 weeks gestation of a live singleton pregnancy who underwent a 50 g OGCT at the Health Sciences University Gazi Yaşargil Training and Research Hos-pital, between September 2016 and August 2017. In the 50 g OGCT, 1-hour blood glucose results were divided into Low OGCT (< 90 mg/dL) and Normal OGCT (90-139 mg/dL). The groups were compared in respect of obstetrics and neonatal outcomes.
Results: Of 2623 pregnant patients applied with the 50 g OGCT, blood glucose was < 140 mg/dL in 77.16% (n = 2024), with 11.9% (n = 312) in the Low OGCT group, and the remaining 65.26% (n = 1712) in the Normal OGCT group. Based on the comparison of the groups, the SGA rate was 7% in the Low OGCT group and 4% in the Normal OGCT group; the 5th minute APGAR score was < 7 in 2% of the Low OGCT group and in 1% of the Normal OGCT group, while caesarean section rates were 25% and 32% respectively (p < 0.05).
Conclusions: The results of the study showed a significant association between maternal hypoglycaemia and increased SGA rate, decreased 5-minute APGAR scores and reduced caesarean section rates, and this relationship should be confirmed with further comprehensive studies.
abstract_id: PUBMED:35931097
Screening Accuracy of the 50 g-Glucose Challenge Test in Twin Compared With Singleton Pregnancies. Context: The optimal 50 g-glucose challenge test (GCT) cutoff for the diagnosis of gestational diabetes mellitus (GDM) in twin pregnancies is unknown.
Objective: This work aimed to explore the screening accuracy of the 50 g-GCT and its correlation with the risk of large for gestational age (LGA) newborn in twin compared to singleton pregnancies. A population-based retrospective cohort study (2007-2017) was conducted in Ontario, Canada. Participants included patients with a singleton (n = 546 892 [98.4%]) or twin (n = 8832 [1.6%]) birth who underwent screening for GDM using the 50 g-GCT.
Methods: We compared the screening accuracy, risk of GDM, and risk of LGA between twin and singleton pregnancies using various 50 g-GCT cutoffs.
Results: For any given 50 g-GCT result, the probability of GDM was higher (P = .0.007), whereas the probability of LGA was considerably lower in the twin compared with the singleton group, even when a twin-specific growth chart was used to diagnose LGA in the twin group (P < .001). The estimated false-positive rate (FPR) for GDM was higher in twin compared with singleton pregnancies irrespective of the 50 g-GCT cutoff used. The cutoff of 8.2 mmol/L (148 mg/dL) in twin pregnancies was associated with an estimated FPR (10.7%-11.1%) that was similar to the FPR associated with the cutoff of 7.8 mmol/L (140 mg/dL) in singleton pregnancies (10.8%).
Conclusion: The screening performance of the 50 g-GCT for GDM and its correlation with LGA differ between twin and singleton pregnancies.
abstract_id: PUBMED:29637552
Use of the 50-g glucose challenge test to predict excess delivery weight. Objective: To identify a cut-off value for the 50-g glucose challenge test (GCT) that predicts excess delivery weight.
Methods: A retrospective study was conducted among pregnant women who undertook a 50-g GCT at Hacettepe University Hospital, Ankara, Turkey, between January 1, 2000, and December 31, 2016. Patients with singleton pregnancies who delivered live neonates after 28 weeks of pregnancy were included. Patients were classified according to their 50-g GCT values into group 1 (<7.770 mmol/L); group 2 (7.770 to <8.880 mmol/L, group 3 (8.880-9.990 mmol/L); or group 4 (>9.990 mmol/L). Classification and regression tree data mining was performed to identify the 50-g GCT cut-off value corresponding to a substantial increase in delivery weight.
, Results: Median delivery weight were 3100 g in group 1 (n=352), 3200 g in group 2 (n=165), 3720 g in group 3 (n=47), and 3865 g in group 4 (n=20). Gravidity, 50-g GCT value, and pregnancy duration at delivery explained 30.6% of the observed variance in delivery weight. The cut-off required for maternal blood glucose level to predict excessive delivery weight was 8.741 mmol/L.
Conclusion: The 50-g GCT can be used to identify women at risk of delivering offspring with excessive delivery weight.
abstract_id: PUBMED:27512415
Response to fifty grams oral glucose challenge test and pattern of preceding fasting plasma glucose in normal pregnant Nigerians. Background: Diabetes mellitus in pregnancy has profound implications for the baby and mother and thus active screening for this is desirable.
Method: Fifty grams oral glucose challenge test was administered after obtaining consent to 222 women in good health with singleton pregnancies without diabetes mellitus at 24 to 28 weeks gestation after an overnight fast. Venous blood sample was obtained before and 1 hour after the glucose load. A diagnostic 3-hour 100 g oral glucose tolerance test was subsequently performed in all.
Results: Two hundred and ten women had a normal response to oral glucose tolerance test i.e. venous plasma glucose below these cut-off levels: fasting 95 mg/dl (5.3 mmol/l), 1 hour 180 mg/dl (10.0 mmol/l), 2 hours 155 mg/dl (8.6 mmol/l) and 3 hours 140 mg/dl (7.8 mmol/l), while 12 were found to have gestational diabetes mellitus and were subsequently excluded from the study. They were appropriately managed. The mean maternal age was 30.9 ± 4.1 years (range 19 to 45 years) and the mean parity was 1.2 ± 1.1 (range 0 to 5). The mean fasting plasma glucose was 74.5 ± 11.5 mg/dl (range 42 to 117 mg/dl), while the mean plasma glucose 1 hour after 50 g glucose challenge test was 115.3 ± 19.1 mg/dl (range 56 to 180 mg/dl).
Conclusions: The mean fasting plasma glucose in normal pregnant Nigerians was 74.5 ± 11.5 mg/dl (range 42 to 117 mg/dl). There is a need to re-appraise and possibly review downwards the World Health Organization fasting plasma glucose diagnostic criteria in pregnant Nigerians for better detection of gestational diabetes mellitus. Pregnant women with venous plasma glucose greater than 153.5 mg/dl (8.5 mmol/l) 1 hour after 50 g glucose challenge test are strongly recommended for diagnostic test of gestational diabetes mellitus.
Answer: The 50 g glucose challenge test (GCT) is a screening test for gestational diabetes mellitus (GDM) and is typically administered to pregnant women between 24 and 28 weeks of gestation. According to the abstracts provided, there are indeed diagnostic cutoff values used to interpret the results of the GCT.
In one study, a venous plasma glucose (VPG) concentration greater than 7.8 mmol/L (140 mg/dL) one hour after the glucose load was considered a positive GCT result, prompting further testing with a 75 g oral glucose tolerance test (OGTT) for a confirmatory diagnosis of GDM (PUBMED:27651570). Another study mentioned that a cutoff of 8.2 mmol/L (148 mg/dL) in twin pregnancies was associated with an estimated false-positive rate (FPR) similar to the FPR associated with the cutoff of 7.8 mmol/L (140 mg/dL) in singleton pregnancies (PUBMED:35931097).
Additionally, one study aimed to identify a cutoff value for the 50-g GCT that predicts excess delivery weight and found that a maternal blood glucose level of 8.741 mmol/L was the cutoff required to predict excessive delivery weight (PUBMED:29637552).
It is important to note that the cutoff values can vary depending on the population being studied and the specific outcomes being considered. For instance, the study conducted in Nigeria suggested that there might be a need to review the fasting plasma glucose diagnostic criteria downwards for better detection of GDM in that population (PUBMED:27512415).
In summary, while there are established cutoff values for the 50 g GCT, these values can vary, and further testing with an OGTT is often required for a definitive diagnosis of GDM. |
Instruction: Maternal mortality: only 42 days?
Abstracts:
abstract_id: PUBMED:26279311
Review of the importance of nutrition during the first 1000 days: maternal nutritional status and its associations with fetal growth and birth, neonatal and infant outcomes among African women. Maternal nutritional status (MNS) is a strong predictor of growth and development in the first 1000 days of life and may influence susceptibility to non-communicable diseases in adulthood. However, the role of nutrition during this window of developmental plasticity in Africa is unclear. This paper reviews published data to address whether maternal nutrition during the first 1000 days is important for Africa, with a focus on MNS and its associations with fetal growth and birth, neonatal and infant outcomes. A systematic approach was used to search the following databases: Medline, EMBASE, Web of Science, Google Scholar, ScienceDirect, SciSearch and Cochrane Library. In all, 26 studies met the inclusion criteria for the specific objectives. MNS in Africa showed features typical of the epidemiological transition: higher prevalences of maternal overweight and obesity and lower underweight, poor diet quality 1 and high anaemia prevalence. Maternal body mass index and greater gestational weight gain (GWG) were positively associated with birth weight; however, maternal overweight and obesity were associated with increased risk of macrosomia and intrauterine growth restriction. Maternal anaemia was associated with lower birth weight. Macro- and micronutrient supplementation during pregnancy were associated with improvements in GWG, birth weight and mortality risk. Data suggest poor MNS in Africa and confirms the importance of the first 1000 days as a critical period for nutritional intervention to improve growth, birth outcomes and potential future health risk. However, there is a lack of data beyond birth and a need for longitudinal data through infancy to 2 years of age.
abstract_id: PUBMED:36381799
Importance of Maternal Nutrition in the First 1,000 Days of Life and Its Effects on Child Development: A Narrative Review. Maternal nutrition needs to be addressed during pregnancy for the child's first 1,000 days of life, or roughly between conception and a child's second birthday. The infant requires just breast milk for the first six months of life. The production of breastmilk and its nutritional value is essentially unaffected by maternal privation. The child's health suffers when the mother's diet and health are impaired. This review aims to discuss the importance of pregnant women's nutrition and how it impacts the development and expansion of a child during this critical period of development, which is supported by the most recent literature. Throughout the child's growth in the mother's womb and outside, four distinct stages have been identified: (1) nine months to zero months: pregnancy; (2) zero to six months: breastfeeding; (3) six to 12 months: introduction of solid food; and (4) >12 months: transition to family diet, appreciation of nutritious food offered within each period for the child's development. Moreover, there is a strong link between nutrition, well-being, and learning. The nutritional intake of infants, children, and adolescents maintains the body weight and is sufficient to sustain their normal growth and development. One of the crucial factors influencing a child's development is nutrition. Rapid growth occurs during infancy. Compared to other growth phases, this phase has the largest relative energy and food needs for body size.
abstract_id: PUBMED:33023698
The missing focus on women's health in the First 1,000 days approach to nutrition. The First 1,000 Days approach highlights the time between conception and a child's second birthday as a critical period where adequate nutrition is essential for adequate development and growth throughout the child's life and potentially onto their own offspring. Based on a review of relevant literature, this commentary explores the First 1,000 Days approach with a maternal lens. While the primary objective of the First 1,000 Days approach to nutrition is to reduce child malnutrition rates, particularly chronic undernutrition in the form of stunting, interventions are facilitated through mothers in terms of promoting healthy behaviours such as exclusive breast-feeding and attention to her nutritional status during pregnancy and lactation. Though these interventions were facilitated through women, women's health indicators are rarely tracked and measured, which we argue represents a missed opportunity to strengthen the evidence base for associations between maternal nutrition and women's health outcomes. Limited evidence on the effects of dietary interventions with pregnant and lactating mothers on women's health outcomes hinders advocacy efforts, which then contributes to lower prioritisation and less research.
abstract_id: PUBMED:34143504
Does neonatal manipulation on continuous or alternate days change maternal behavior? Maternal separation and neonatal manipulation of pups produce changes in maternal behavior after the dam-pup reunion. Here, we examined whether continuous versus alternating days of neonatal manipulation during the first 8 postnatal days produces differential changes in maternal and non-maternal behaviors in rats. We found that both maternal separation protocols increased anogenital licking after dam-pup reunion, reflecting increased maternal care of pups.
abstract_id: PUBMED:34077076
Policy dialogue to support maternal newborn child health evidence use in policymaking: The lessons learnt from the Nigeria research days first edition. The use of evidence in decision-making and practice can be improved through diverse interventions, including policy dialogue. The Department of Family Health, Federal Ministry of Health of Nigeria initiated and organized the Nigeria Research Days (NRD), to serve as a platform for exchange between researchers and policymakers for improving maternal, new-born and child health. The study reports on the conceptualization, organization and lessons learned from the first edition. A cross-sectional study was designed to assess the effectiveness of a policy dialogue during the NRDs. Data were collected from the feasibility and workshop evaluation surveys. A descriptive analysis of data was performed. As a result, the Nigeria Research Days meets all the criteria for a successful policy dialogue. The participants positively rated the content and format of the meeting and made suggestions for improvement. They were willing to implement the recommendations of the final communiqué. The lessons learned from this first edition will be used to improve future editions.
abstract_id: PUBMED:38468697
Maternal periconception food insecurity and postpartum parenting stress and bonding outcomes. Food insecurity during pregnancy is associated with various adverse pregnancy outcomes for the mother and infant, but less is known about the role of periconception food insecurity and its links to maternal and child wellbeing in the postpartum period. In a sample of 115 diverse (41% white) and predominately low-income mothers, results of hierarchical regression analyses showed that periconception food insecurity was positively associated with parenting stress at 2 months postpartum. A negative association between food insecurity and maternal-infant bonding at 6 months postpartum was mediated after controlling for prenatal depression, social support, and demographic factors. Findings highlight the need for maternal linkage to effective food security programs, such as United States-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for women during their childbearing years due to the critical importance of food security for maternal and infant well-being.
abstract_id: PUBMED:34408995
"The First Thousand Days" Define a Fetal/Neonatal Neurology Program. Gene-environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.
abstract_id: PUBMED:34067735
Stakeholder Perspectives on Barriers and Facilitators on the Implementation of the 1000 Days Plus Nutrition Policy Activities in Ghana. Optimizing nutrition in the preconception and 1000 days periods have long-term benefits such as higher economic productivity, reduced risk of related non-communicable diseases and increased health and well-being. Despite Ghana's recent progress in reducing malnutrition, the situation is far from optimal. This qualitative study analyzed the maternal and child health nutrition policy framework in Ghana to identify the current barriers and facilitators to the implementation of nutrition policies and programs relating to the first 1000 days plus. Data analyzed included in-depth interviews and focus group discussions conducted in Ghana between March and April 2019. Participants were composed of experts from government agencies, civil society organizations, community-based organizations and international partners at national and subnational levels. Seven critical areas were identified: planning policy implementation, resources, leadership and stakeholders' engagement, implementation guidance and ongoing communication, organizational culture, accountability and governance and coverage. The study showed that, to eradicate malnutrition in Ghana, priorities of individual stakeholders have to be merged and aligned into a single 1000 days plus nutrition policy framework. Furthermore, this study may support stakeholders in implementing successfully the 1000 days plus nutrition policy activities in Ghana.
abstract_id: PUBMED:14592584
Maternal mortality: only 42 days? Objective: A maternal death is defined by WHO as 'the death of a woman while pregnant or within 42 days of termination of pregnancy em leader '. The origin of the 42 days is no longer clear. In developing countries, the burden imposed by pregnancy and birth on a woman's body may extend beyond 42 days as pregnancy-related anaemia can persist for longer and vaginal haemorrhaging and risk of infections are not necessarily over after six weeks. We therefore examined duration of excess mortality after delivery in rural Guinea-Bissau.
Design: In a prospective cohort study, we followed 15,844 women of childbearing age with biannual visits over a period of six years, resulting in a total of 60,192 person-years-at-risk. To establish cause and timing in relation to termination of pregnancy, verbal autopsy was carried out for all deaths. Mortality rates were calculated for short time intervals after each delivery or miscarriage.
Results: During the observation period we registered 14,257 pregnancies and 350 deaths. One hundred and ninety-four deaths followed termination of a registered pregnancy and thus were eligible for the analysis. Eighty-two deaths occurred during the first 42 days after delivery/miscarriage. A further 16 women died in the period from 43 to 91 days after parturition, 16 between 92 and 182 days and 18 between 183 and 365 days after delivery. Compared with baseline mortality 7-12 months after delivery, women who had recently delivered had 15.9 times higher mortality (95% CI 9.8-27.4). From days 43 to 91 the mortality was still significantly elevated (RR = 2.8 [1.4-5.4]).
Conclusion: Where living conditions are harsh, pregnancy and delivery affect the health of the woman for more than 42 days. Using the WHO definition may result in an under-estimation of the pregnancy-related part of the reproductive age mortality. Extending the definition of maternal death to include all deaths within three months of delivery may increase current estimates of maternal mortality by 10-15%.
abstract_id: PUBMED:36552046
A Bio-Social Model during the First 1000 Days Optimizes Healthcare for Children with Developmental Disabilities. Most children with developmental disabilities (DD) live in resource-limited countries (LMIC) or high-income country medical deserts (HICMD). A social contract between healthcare providers and families advocates for accurate diagnoses and effective interventions to treat diseases and toxic stressors. This bio-social model emphasizes reproductive health of women with trimester-specific maternal and pediatric healthcare interactions. Lifelong neuronal connectivity is more likely established across 80% of brain circuitries during the first 1000 days. Maladaptive gene-environment (G x E) interactions begin before conception later presenting as maternal-placental-fetal (MPF) triad, neonatal, or childhood neurologic disorders. Synergy between obstetrical and pediatric healthcare providers can reduce neurologic morbidities. Partnerships between healthcare providers and families should begin during the first 1000 days to address diseases more effectively to moderate maternal and childhood adverse effects. This bio-social model lowers the incidence and lessens the severity of sequalae such as DD. Access to genetic-metabolomic, neurophysiologic and neuroimaging evaluations enhances clinical decision-making for more effective interventions before full expression of neurologic dysfunction. Diagnostic accuracy facilitates developmental interventions for effective preschool planning. A description of a mother-child pair in a HIC emphasizes the time-sensitive importance for early interventions that influenced brain health throughout childhood. Partnership by her parents with healthcare providers and educators provided effective healthcare and lessened adverse effects. Effective educational interventions were later offered through her high school graduation. Healthcare disparities in LMIC and HICMD require that this bio-social model of care begin before the first 1000 days to effectively treat the most vulnerable women and children. Prioritizing family planning followed by prenatal, neonatal and child healthcare improves wellness and brain health. Familiarity with educational neuroscience for teachers applies neurologic diagnoses for effective individual educational plans. Integrating diversity and inclusion into medical and educational services cross socioeconomic, ethnic, racial, and cultural barriers with life-course benefits. Families require knowledge to recognize risks for their children and motivation to sustain relationships with providers and educators for optimal outcomes. The WHO sustainable development goals promote brain health before conception through the first 1000 days. Improved education, employment, and social engagement for all persons will have intergenerational and transgenerational benefits for communities and nations.
Answer: The concept of maternal mortality traditionally encompasses the death of a woman while pregnant or within 42 days of termination of pregnancy, as defined by the World Health Organization (WHO) (PUBMED:14592584). However, the origin of the 42-day period is not entirely clear, and there is evidence suggesting that the burden imposed by pregnancy and birth on a woman's body may extend beyond this timeframe. In a study conducted in rural Guinea-Bissau, researchers found that women who had recently delivered experienced significantly elevated mortality rates not only during the first 42 days after delivery/miscarriage but also from 43 to 91 days and even up to 365 days postpartum (PUBMED:14592584). The study revealed that compared with baseline mortality 7-12 months after delivery, women had 15.9 times higher mortality in the first 42 days, and mortality remained significantly elevated (RR = 2.8) from days 43 to 91 (PUBMED:14592584). These findings suggest that in harsh living conditions, the health effects related to pregnancy and delivery can affect women for more than the 42-day period recognized by the WHO. Consequently, using the WHO definition may result in an underestimation of the pregnancy-related component of reproductive age mortality. The study proposes that extending the definition of maternal death to include all deaths within three months of delivery could increase current estimates of maternal mortality by 10-15% (PUBMED:14592584). |
Instruction: Can patients with brain herniation on cranial computed tomography have a normal neurologic exam?
Abstracts:
abstract_id: PUBMED:19076104
Can patients with brain herniation on cranial computed tomography have a normal neurologic exam? Objectives: Herniation of the brain outside of its normal intracranial spaces is assumed to be accompanied by clinically apparent neurologic dysfunction. The authors sought to determine if some patients with brain herniation or significant brain shift diagnosed by cranial computed tomography (CT) might have a normal neurologic examination.
Methods: This is a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) II cranial CT database compiled from a multicenter, prospective, observational study of all patients for whom cranial CT scanning was ordered in the emergency department (ED). Clinical information including neurologic examination was prospectively collected on all patients prior to CT scanning. Using the final cranial CT radiology reports from participating centers, all CT scans were classified into three categories: frank herniation, significant shift without frank herniation, and minimal or no shift, based on predetermined explicit criteria. These reports were concatenated with clinical information to form the final study database.
Results: A total of 161 patients had CT-diagnosed frank herniation; 3 (1.9%) had no neurologic deficit. Of 91 patients with significant brain shift but no herniation, 4 (4.4%) had no neurologic deficit.
Conclusions: A small number of patients may have normal neurologic status while harboring significant brain shift or brain herniation on cranial CT.
abstract_id: PUBMED:20370782
Prevalence of herniation and intracranial shift on cranial tomography in patients with subarachnoid hemorrhage and a normal neurologic examination. Objectives: Patients frequently present to the emergency department (ED) with headache. Those with sudden severe headache are often evaluated for spontaneous subarachnoid hemorrhage (SAH) with noncontrast cranial computed tomography (CT) followed by lumbar puncture (LP). The authors postulated that in patients without neurologic symptoms or signs, physicians could forgo noncontrast cranial CT and proceed directly to LP. The authors sought to define the safety of this option by having senior neuroradiologists rereview all cranial CTs in a group of such patients for evidence of brain herniation or midline shift.
Methods: This was a retrospective study that included all patients with a normal neurologic examination and nontraumatic SAH diagnosed by CT presenting to a tertiary care medical center from August 1, 2001, to December 31, 2004. Two neuroradiologists, blinded to clinical information and outcomes, rereviewed the initial ED head CT for evidence of herniation or midline shift.
Results: Of the 172 patients who presented to the ED with spontaneous SAH diagnoses by cranial CT, 78 had normal neurologic examinations. Of these, 73 had initial ED CTs available for review. Four of the 73 (5%; 95% confidence interval [CI] = 2% to 13%) had evidence of brain herniation or midline shift, including three (4%; 95% CI = 1% to 12%) with herniation. In only one of these patients was herniation or shift noted on the initial radiology report.
Conclusions: Awake and alert patients with a normal neurologic examination and SAH may have brain herniation and/or midline shift. Therefore, cranial CT should be obtained before LP in all patients with suspected SAH.
abstract_id: PUBMED:11742046
Computed tomography of the head before lumbar puncture in adults with suspected meningitis. Background: In adults with suspected meningitis clinicians routinely order computed tomography (CT) of the head before performing a lumbar puncture.
Methods: We prospectively studied 301 adults with suspected meningitis to determine whether clinical characteristics that were present before CT of the head was performed could be used to identify patients who were unlikely to have abnormalities on CT. The Modified National Institutes of Health Stroke Scale was used to identify neurologic abnormalities.
Results: Of the 301 patients with suspected meningitis, 235 (78 percent) underwent CT of the head before undergoing lumbar puncture. In 56 of the 235 patients (24 percent), the results of CT were abnormal; 11 patients (5 percent) had evidence of a mass effect. The clinical features at base line that were associated with an abnormal finding on CT of the head were an age of at least 60 years, immunocompromise, a history of central nervous system disease, and a history of seizure within one week before presentation, as well as the following neurologic abnormalities: an abnormal level of consciousness, an inability to answer two consecutive questions correctly or to follow two consecutive commands, gaze palsy, abnormal visual fields, facial palsy, arm drift, leg drift, and abnormal language (e.g., aphasia). None of these features were present at base line in 96 of the 235 patients who underwent CT scanning of the head (41 percent). The CT scan was normal in 93 of these 96 patients, yielding a negative predictive value of 97 percent. Of the three misclassified patients, only one had a mild mass effect on CT, and all three subsequently underwent lumbar puncture, with no evidence of brain herniation one week later.
Conclusions: In adults with suspected meningitis, clinical features can be used to identify those who are unlikely to have abnormal findings on CT of the head.
abstract_id: PUBMED:7775236
Glioma in a goat. An adult goat was examined because of behavioral changes and circling. Results of neurologic examination, CSF analysis, hematologic evaluation, and computed tomography of the brain were suggestive of an intra-axial mass. The goat was euthanatized because of worsening neurologic condition and poor prognosis. Necropsy revealed a large mass in the right cerebral hemisphere and caudal brain herniation through the foramen magnum. The mass was diagnosed as a glioma, with oligodendrocyte differentiation. Results of immunohistochemical evaluation were compatible with a malignant, poorly differentiated tumor.
abstract_id: PUBMED:33482817
The diagnostic value of intravenous contrast computed tomography in addition to plain computed tomography in dogs with head trauma. Background: The aim of this study is to evaluate additional findings which can be detected by post-contrast computed tomography (CCT) in relation to plain CT (PCT) findings in patients presented with head trauma. Medical records of canine patients with the history of head trauma from three institutions were reviewed. PCT- and CCT-anonymized images were evaluated by a veterinary radiologist separately. From the categorized findings the following conclusions were drawn as: abnormalities were identified on (A) PCT but missed on CCT, (B) CCT but missed on PCT, (C) both PCT and CCT.
Results: Thirty-two patients were included. The results showed that findings identified on CCT or PCT (category A and B) but missed on the other series were limited to mild soft tissue and sinus changes. Overall, 61 different fracture areas, 6 injuries of the temporomandibular joint (TMJ), 4 orbital injuries, 14 nasal cavities with soft tissue density filling, 13 areas of emphysema, 4 symphysis separations, 12 intracranial hemorrhages, 6 cerebral edema, 5 cerebral midline shifts, 3 intracranial aeroceles, 3 brain herniations and 6 intraparenchymal foreign bodies (defined as an abnormal structure located within the brain: e.g. bony fragments, bullet, teeth,..) were identified on both PCT and CCT separately (category C). Severity grading was different in 50% (3/6) of the reported cerebral edema using PCT and CCT images.
Conclusion: The results showed that PCT is valuable to identify the presence of intracranial traumatic injuries and CCT is not always essential to evaluate vital traumatic changes.
abstract_id: PUBMED:12148847
Three-layer reconstruction for large defects of the anterior skull base. Objectives: To evaluate and discuss a three-layer rigid reconstruction technique for large anterior skull base defects.
Study Design: Prospective, nonrandomized, non-blinded.
Setting: Tertiary teaching medical center.
Methods: Twenty consecutive patients underwent craniofacial resection for a variety of pathology. All patients had large anterior cranial base defects involving the cribriform plate, fovea ethmoidalis, and medial portion of the roof of the orbit at least on one side. A few patients had more extensive defects involving both roof of the orbits, planum sphenoidale, and bones of the upper third of the face. The defects were reconstructed with a three-layer technique. A watertight seal was obtained with a pericranial flap separating the neurocranium from the viscerocranium. Rigid support was provided by bone grafts fixed to a titanium mesh, anchored laterally to the orbital roofs. All patients had a computed tomography scan of the skull on the first or second postoperative day. Patients were observed for immediate and long-term postoperative complications after such reconstruction.
Results: Postoperative computed tomography scans showed small pneumocephalus in all patients. It resolved spontaneously and did not produce neurologic deficits in any patient. There was no cerebrospinal fluid leak, hematoma, or infection. On long-term follow-up, exposures of bone graft or mesh, brain herniation, or transmission of brain pulsation to the eyes were not observed in any patient.
Conclusions: Three-layer reconstruction using bone grafts, titanium mesh, and pericranial flap provides an alternative technique for repair of large anterior cranial base defects. It is safe and effective, and provides rigid protection to the brain.
abstract_id: PUBMED:36751360
Brain herniation on computed tomography is a poor predictor of whether patients with a devastating brain injury can be confirmed dead using neurological criteria. Background: It is unclear if the presence of compartmental brain herniation on neuroimaging should be a prerequisite to the clinical confirmation of death using neurological criteria. The World Brain Death Project has posed this as a research question.
Methods: The final computed tomography of the head scans before death of 164 consecutive patients confirmed dead using neurological criteria and 41 patients with devastating brain injury who died following withdrawal of life sustaining treatment were assessed by a neuroradiologist to compare the incidence of herniation and other features of cerebral swelling.
Results: There was no difference in the incidence of herniation in patients confirmed dead using neurological criteria and those with devastating brain injury (79% vs 76%, OR 1.23 95%, CI 0.56-2.67). The sensitivity and specificity of brain herniation in patients confirmed dead using neurological criteria was 79% and 24%, respectively. The positive and negative predictive value was 81% and 23%, respectively. The most sensitive computed tomography of the head findings for death using neurological criteria were diffuse sulcal effacement (93%) and basal cistern effacement (91%) and the most specific finding was loss of grey-white differentiation (80%). The only features with a significantly different incidence between the death using neurological criteria group and the devastating brain injury group were loss of grey-white differentiation (46 vs 20%, OR 3.56, 95% CI 1.55-8.17) and presence of contralateral ventricular dilatation (24 vs 44%, OR 0.41, 95% CI 0.20-0.84).
Conclusions: Neuroimaging is essential in establishing the cause of death using neurological criteria. However, the presence of brain herniation or other signs of cerebral swelling are poor predictors of whether a patient will satisfy the clinical criteria for death using neurological criteria or not. The decision to test must remain a clinical one.
abstract_id: PUBMED:17663954
Prognostic capacity of brain herniation signs in patients with structural neurological injury Objective: To determine whether the usual mortality prediction systems (APACHE and SAPS) can be complemented by cranial computed tomography (CT) brain herniation findings in patients with structural neurological involvement.
Design: Prospective cohort study.
Setting: Trauma ICU in university hospital.
Patients: One hundred and fifty five patients admitted to ICU in 2003 with cranial trauma or acute stroke.
Main Variables Of Interest: Data were collected on age, diagnosis, mortality, admission cranial CT findings and on APACHE II, APACHE III and SAPS II scores.
Results: Mean age was 47.8 +/- 19.4 years; APACHE II, 17.1 +/- 7.2 points; SAPS II, 43.7 +/- 17.7 points; and APACHE III, 55.8 +/- 29.7 points. Hospital mortality was 36% and mortality predicted by SAPS II was 38%, by APACHE II 30% and by APACHE III 36%. The 56 non-survivors showed greater midline shift on cranial CT scan versus survivors (4.2 +/- 5.5 vs. 1.6 +/- 3.22 mm, p = 0.002) and higher severity as assessed by SAPS II, APACHE II and APACHE III. The mortality rate was significantly higher in patients with subfalcial herniation (61% vs. 30%, p < 0.001). In the multivariate logistic regression analysis, hospital mortality was associated with the likelihood of death according to APACHE III (OR 1.07; 95% CI: 1.05-1.09) and with presence of subfalcial herniation (OR 3.15; 95% CI: 1.07-9.25).
Conclusions: In critical care patients with structural neurological involvement, cranial CT signs of subfalcial herniation complement the prognostic information given by the usual severity indexes.
abstract_id: PUBMED:28965126
Low-Dose CCT to Exclude Contraindications to Lumbar Puncture : Benefits and Limitations. Background: Low-dose cranial computed tomography (LD-CCT) based on iterative reconstruction has been shown to have sufficient image quality to assess cerebrospinal fluid spaces (CSF) and midline structures but not to exclude subtle parenchymal pathologies. Patients without focal neurological deficits often undergo CCT before lumbar puncture (LP) to exclude contraindications to LP including brain herniation or increased CSF pressure. We performed LD-CCT to assess if image quality is appropriate for this indication.
Methods: A total of 58 LD-CCT (220 mA/120 kV) of patients before LP were retrospectively evaluated and compared to 79 normal standard dose cranial computed tomography (SD-CCT) (350 mA/120 kV). Iterative reconstruction used for both dose levels was increased by one factor for LD-CCT. We assessed the signal-to-noise (SNR) and contrast-to-noise ratio (CNR), the dose estimates and scored diagnostic image quality by two raters independently. Significance level was set at p < 0.05.
Results: The inner and outer CSF spaces except the sulci were equally well depicted by the LD-CCT and SD-CCT; however, depiction of the subtle density differences of the brain parenchyma and the sulci was significantly worse in the LD-CCT (p < 0.0001). The SNR in the gray matter (9.35 vs. 10.61, p < 0.05) and white matter (7.23 vs. 8.15, p < 0.001) were significantly lower in LD-CCT than in SD-CCT with significantly lower dose estimates (1.04 vs. 1.69 mSv, respectively p < 0.0001).
Conclusion: The use of LD-CCT with a dose reduction of almost 50% is sufficient to exclude contraindications to LP; however, LD-CCT cannot exclude subtle parenchymal pathologies. Therefore, in patients with suspected parenchymal pathology, SD-CCT is still the method of choice.
abstract_id: PUBMED:37577024
The impact of oral anticoagulants on the characteristics of subdural hematomas and other brain lesions in patients with traumatic brain injury. Background And Aim: The aim of the study was to determine the impact of prior anticoagulant treatment on the characteristics of intracranial hematomas.
Methods: We included in this retrospective study 135 patients who were diagnosed with subdural hematoma in the context of traumatic brain injury. We recorded the demographic and clinical data, the paraclinical examinations and the characteristics of subdural hematoma evidenced by preoperative computed tomography (CT). We also reported the other brain injuries, entailed by primary and secondary lesions, as described by CT.
Results: The anticoagulation therapy was recorded in 35 patients, at the moment of diagnosis. Acute subdural hematoma was recorded in 89 (65.9%) patients, 21 (60%) of these had anticoagulation therapy on admission. There were 46 (34.1%) patients with chronic subdural hematoma, 14 (40%) of these were on anticoagulant therapy. The midline shift was significantly moved in patients with anticoagulation therapy. The thickness of the subdural hematoma was significantly higher in patients with anticoagulation. We did not find any significant association of the other brain lesions (cranial fracture, extradural hematoma, intraparenchymal hematoma, nor intracranial hypertension, brain herniation, brain swelling), and the presence of anticoagulation therapy.
Conclusion: The study showed that anticoagulants significantly influence some neuroimaging aspects of the SDH in head trauma.
Answer: Yes, patients with brain herniation on cranial computed tomography (CT) can have a normal neurologic exam. A study analyzing the National Emergency X-Radiography Utilization Study (NEXUS) II cranial CT database found that out of 161 patients with CT-diagnosed frank herniation, 3 (1.9%) had no neurologic deficit. Additionally, among 91 patients with significant brain shift but no herniation, 4 (4.4%) had no neurologic deficit (PUBMED:19076104). Another study focusing on patients with subarachnoid hemorrhage (SAH) and a normal neurologic examination found that 4 out of 73 (5%) had evidence of brain herniation or midline shift on cranial CT, including three (4%) with herniation (PUBMED:20370782). These findings suggest that a small number of patients may present with significant brain shift or brain herniation on cranial CT while maintaining a normal neurologic status. |
Instruction: Does patient health and hysterectomy status influence cervical cancer screening in older women?
Abstracts:
abstract_id: PUBMED:18784967
Does patient health and hysterectomy status influence cervical cancer screening in older women? Background: Decisions to screen older patients for cancer are complicated by the fact that aging populations are heterogeneous with respect to life expectancy.
Objective: To examine national trends in the association between cervical cancer screening and age, health and hysterectomy status.
Design And Participants: Cross-sectional data from the 1993, 1998, 2000, and 2005 National Health Interview Surveys (NHIS) were used to examine trends in screening for women age 35-64 and 65+ years of age. We investigated whether health is associated with Pap testing among older women using the 2005 NHIS (N = 3,073). We excluded women with a history of cervical cancer or who had their last Pap because of a problem.
Measurements: The dependent variable was having a Pap test within the past 3 years. Independent variables included three measures of respondent health (the Charlson comorbidity index (CCI), general health status and having a chronic disability), hysterectomy status and sociodemographic factors.
Main Results: NHIS data showed a consistent pattern of lower Pap use among older women (65+) compared to younger women regardless of hysterectomy status. Screening also was lower among older women who reported being in fair/poor health, having a chronic disability, or a higher CCI score (4+). Multivariate models showed that over 50% of older women reporting poor health status or a chronic disability and 47% with a hysterectomy still had a recent Pap.
Conclusions: Though age, health and hysterectomy status appear to influence Pap test use, current national data suggest that there still may be overutilization and inappropriate screening of older women.
abstract_id: PUBMED:32155360
Prevalence of Inadequate Cervical Cancer Screening in Low-Income Older Women. Objective: At age 65 years, cervical cancer screening is not recommended in women with an adequate history of negative screening tests in the previous 10 years if they do not have other high-risk factors for cervical cancer. The purpose of this study was to assess the proportion of older low-income women at a safety net urban hospital system without other risk factors for cervical cancer who should have cervical cancer screening because of an inadequate screening history, and to evaluate if they were triaged appropriately. Materials and Methods: Medical records from 200 women 65 years and older at the Gynecology clinic of John H. Stroger Hospital of Cook County were evaluated for adequate cervical cancer screening or hysterectomy to see if they could stop screening. Charts were reviewed to see if a screen was performed, and the results of that test and associated biopsies. Data using cytology alone and the cytology/human papillomavirus cotest were compared. Chi-square test was used. Results: Of 200 women included, the median age was 68.5 years, range 65-93 years. Of these women, 81 (40.5%) did not need testing because of adequate screening or hysterectomy for benign indications. There were 119 (59.5%) women who needed to continue testing because of inadequate screening. Of these women, 46 (38.7%) did not have appropriate testing carried out. Of 73 correctly screened women, 16 (21.9%) required biopsies, of which 11 demonstrated high-grade lesions or cancers. Conclusions: Many older women, especially low-income women, need to continue screening for cervical cancer because of inadequate screening histories. This is a group at increased risk for cervical cancer, and it is imperative that clinicians evaluate previous test results before exiting a woman from screening at age 65 years.
abstract_id: PUBMED:31678587
Three large scale surveys highlight the complexity of cervical cancer under-screening among women 45-65years of age in the United States. Background: Large scale United States (US) surveys guide efforts to maximize the health of its population. Cervical cancer screening is an effective preventive measure with a consistent question format among surveys. The aim of this study is to describe the predictors of cervical cancer screening in older women as reported by three national surveys.
Methods: The Behavioral Risk Factor Surveillance System (BRFSS 2016), the Health Information National Trends Survey (HINTS 2017), and the Health Center Patient Survey (HCPS 2014) were analyzed with univariate and multivariate analyses. We defined the cohort as women, without hysterectomy, who were 45-65years old. The primary outcome was cytology within the last 3years.
Results: Overall, Pap screening rates were 71% (BRFSS), 79% (HINTS) and 66% (HCPS), among 41,657, 740 and 1571 women, respectively. BRFSS showed that women 60-64years old (aPR=0.88, 95% CI: 0.85, 0.91), and in rural locations (aPR=0.95, 95% CI: 0.92, 0.98) were significantly less likely to report cervical cancer screening than women 45-49-years old or in urban locations. Compared to less than high school, women with more education reported more screening (aPR=1.20, 95% CI: 1.13, 1.28), and those with insurance had higher screening rates than the uninsured (aPR=1.47, 95% CI: 1.33, 1.62). HINTS and HCPS also showed these trends.
Conclusions: All three surveys show that cervical cancer screening rates in women 45-65years are insufficient to reduce cervical cancer incidence. Insurance is the major positive predictor of screening, followed by younger age and more education. Race/ethnicity are variable predictors depending on the survey.
abstract_id: PUBMED:15226035
Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey. Background: Cervical cancer screening is not fully utilized among all groups of women in the United States, especially women without access to health care and older women.
Methods: Papanicolaou (Pap) test use among U.S. women age 18 and older is examined using data from the 2000 National Health Interview Survey (NHIS).
Results: Among women who had not had a hysterectomy (n = 13,745), 83% reported having had a Pap test within the past 3 years. Logistic regression analyses showed that women with no contact with a primary care provider in the past year were very unlikely to have reported a recent Pap test. Other characteristics associated with lower rates of Pap test use included lacking a usual source of care, low family income, low educational attainment, and being unmarried. Having no health insurance coverage was associated with lower Pap test use among women under 65. Despite higher insurance coverage, being age 65 and older was associated with low use. Rates of recent Pap test were higher among African-American women.
Conclusions: Policies to generalize insurance coverage and a usual source of health care would likely increase use of Pap testing. Also needed are health system changes such as automated reminders to assist health care providers implement appropriate screening. Renewed efforts by physicians and targeted public health messages are needed to improve screening among older women without a prior Pap test.
abstract_id: PUBMED:9275270
Cervical screening of Arabic-speaking women in Australian general practice. Objective: To determine recency and predictors of cervical screening among Arabic-speaking women in Sydney, Australia.
Method: A consecutive sample of Arabic-speaking women, attending 20 Arabic-speaking general practitioners, was asked to complete a self administered health risk questionnaire available in Arabic or English which included three questions about cervical screening knowledge and behaviour.
Results: Of 756 eligible women, 526 (70%) returned completed questionnaires. Of these, 69 (13%) did not know what a cervical smear was. Sixteen per cent of overseas-born compared with 2% of Australian-born women at risk had not heard of a cervical smear. Women were defined as being at risk of cervical cancer if they had both been married and not had a hysterectomy. Of 318 women at risk for cervical cancer who knew what a cervical smear was, 66% had had a smear in the last two years, a further 7% were attending for one that day while 11% had not had a smear for at least two years, 9% had never had one and 7% did not answer/could not remember. Religion, age, and residence in Australia for more than 10 years were significant and independent predictors of screening after adjustment for other variables in simultaneous logistic regression model (P = 0.002, P = 0.002, and P = 0.040 respectively). Muslim women and older women were more likely to be underscreened, and women with more than 10 years' residence in Australia were more likely to have been screened in the last two years. Acculturation, smoking status, health status, duration of relationship with participating doctor, and chronic disease were not significant predictors of a recent smear.
Conclusion: As only 73% of women at risk had been screened in the last two years, including women attending on the day and 9% had never been screened, Arabic-speaking women should be a priority for public campaigns, particularly Muslim and older women. Studies to evaluate the effectiveness and acceptability of reminders by ethnic general practitioners are recommended.
abstract_id: PUBMED:23317023
Health maintenance in women. The health maintenance examination is an opportunity to focus on disease prevention and health promotion. The patient history should include screening for tobacco use, alcohol misuse, intimate partner violence, and depression. Premenopausal women should receive preconception counseling and contraception as needed, and all women planning or capable of pregnancy should take 400 to 800 mcg of folic acid per day. High-risk sexually active women should be counseled on reducing the risk of sexually transmitted infections, and screened for chlamydia, gonorrhea, and syphilis. All women should be screened for human immunodeficiency virus. Adults should be screened for obesity and elevated blood pressure. Women 20 years and older should be screened for dyslipidemia if they are at increased risk of coronary heart disease. Those with sustained blood pressure greater than 135/80 mm Hg should be screened for type 2 diabetes mellitus. Women 55 to 79 years of age should take 75 mg of aspirin per day when the benefits of stroke reduction outweigh the increased risk of gastrointestinal hemorrhage. Women should begin cervical cancer screening by Papanicolaou test at 21 years of age, and if results have been normal, screening may be discontinued at 65 years of age or after total hysterectomy. Breast cancer screening with mammography may be considered in women 40 to 49 years of age based on patients' values, and potential benefits and harms. Mammography is recommended biennially in women 50 to 74 years of age. Women should be screened for colorectal cancer from 50 to 75 years of age. Osteoporosis screening is recommended in women 65 years and older, and in younger women with a similar risk of fracture. Adults should be immunized at recommended intervals according to guidelines from the Centers for Disease Control and Prevention.
abstract_id: PUBMED:11817921
Breast and cervical cancer screening practices among Hispanic women in the United States and Puerto Rico, 1998-1999. Background: Results from recent studies suggest that Hispanic women in the United States may underuse cancer screening tests and face important barriers to screening.
Methods: We examined the breast and cervical cancer screening practices of Hispanic women in 50 states, the District of Columbia, and Puerto Rico from 1998 through 1999 by using data from the Behavioral Risk Factor Surveillance System.
Results: About 68.2% (95% confidence interval [CI] = 66.3 to 70.1%) of 7,253 women in this sample aged 40 years or older had received a mammogram in the past 2 years. About 81.4% (95% CI = 80.3 to 82.5%) of 12,350 women aged 18 years or older who had not undergone a hysterectomy had received a Papanicolaou test in the past 3 years. Women with lower incomes and those with less education were less likely to be screened. Women who had seen a physician in the past year and those with health insurance coverage were much more likely to have been screened. For example, among those Hispanic women aged 40 years or older who had any health insurance coverage (n = 6,063), 72.7% (95% CI 70.7-74.6%) had had a mammogram in the past 2 years compared with only 54.8% (95% CI 48.7-61.0%) of women without health insurance coverage (n = 1,184).
Conclusions: These results underscore the need for continued efforts to ensure that Hispanic women who are medically underserved have access to cancer screening services.
abstract_id: PUBMED:24447699
Predictors of non-participation in cervical screening in Denmark. Purpose: The aims of this study were to identify demographic and socio-economic predictors of non-participation in cervical screening in Denmark, and to evaluate the influence of health care use on screening participation.
Methods: A population based register study was undertaken using data from the Central Population Register, the national Patobank, and Statistics Denmark. The study included women aged 25-54 years on 1st of January 2002, living in Denmark during the next 5 years, and without a history of total hysterectomy, N=1,052,447. Independent variables included age, civil status, nationality, level of education, and use of health care. Associations with non-participation in screening were determined with logistic regression.
Results: Main predictors of non-participation were limited or no contact with dental services (odds ratio (OR)=2.36), general practitioners (OR=1.75), and high age (OR=1.98). Other important factors for non-participation were primary school education only (OR=1.53), not being married (OR=1.49), and foreign nationality (OR=1.32).
Conclusion: A 2-1.5-fold difference in non-participation in cervical screening in Denmark was found across various population sub-groups. Increased screening compliance among women with primary school education only, and limited or no use of primary health care services in general could potentially diminish the current social inequalities in cervical cancer incidence, and thus decrease the overall high incidence of this disease in Denmark.
abstract_id: PUBMED:34019928
Impact of screening between the ages of 60 and 64 on cumulative rates of cervical cancer to age 84y by screening history at ages 50 to 59: A population-based case-control study. There is little empirical data on the absolute benefit of cervical screening between ages 60-64y on subsequent cancer risk. We estimate the incidence of cervical cancer up to age 84y in women with and without a cervical cytology test at age 60-64y, by screening histories aged 50-59y. The current study is a population based case-control study of women born between 1928 and 1956 and aged 60-84y between 2007 and 2018. We included all such women diagnosed with cervical cancer in England and an aged-matched random sample without cancer. Women with a hysterectomy were excluded. Exposure was cervical cytology between ages 50-64y. The main outcome was 25y cumulative risk of cervical cancer between ages 60-84y. We found that eight in every 1000 (8.40, 95%CI: 7.78 to 9.07) women without a screening test between age 50-64y develop cervical cancer between the ages of 60-84y. The risk is half: 3.46 per 1000 (95%CI: 2.75 to 4.36) among women with a test between age 60-64y but no cervical screening test at age 50-59y. The absolute difference in risk is equivalent to one fewer cancer for every 202 such women screened. The highest risk (10.01, 95%CI:6.70 to 14.95) was among women with abnormal screening at ages 50-59y and no tests 60-64y. 25y risk among women with a screening test every five years between age 50-64y was just under two in a 1000 (1.59, 95%CI:1.42 to 1.78). Results suggest the upper age of screening should be dependent on previous screening participation and results.
abstract_id: PUBMED:33323276
Differences in cervical cancer screening and follow-up for black and white women in the United States. Objective: To study differences in screening adherence and follow-up after an abnormal Pap test in Non-Hispanic Black (Black) and Non-Hispanic White (White) women.
Methods: An observational cohort study using 2010 National Health Interview Survey cancer module to examine HPV knowledge, screening behavior, and follow-up to abnormal Pap test in Black and White women 18 years of age or older without a hysterectomy. We fit logistic regression models to examine associations between race and primary outcome variables including: HPV awareness, Pap test in the last three years, provider recommended Pap test, received Pap test results, had an abnormal Pap test, recommended follow-up, and adhered to the recommendation for follow-up.
Results: Analyzing data for 7509 women, Black women had lower odds ratios [OR] for: 1) HPV awareness (71% vs 83%; OR = 0.42; 95% CI = 0.36-0.49); 2) reporting Pap screening was recommended (59% vs 64%; OR = 0.76; 95% CI = 0.66-0.88), and 3) acknowledging receipt of Pap results (92% vs 94%; OR = 0.64; 95% CI = 0.49-0.83). Group differences persisted after covariates adjustment. In adjusted models, Black women had higher odds of reporting recent Pap screening (84% vs 77%; OR = 1.7; 95% CI = 1.42-2.03), but reported lower odds of receiving a follow-up recommendation subsequent to abnormal test (78% vs 87%; OR = 0.54; 95% CI = 0.31-0.95).
Conclusion: Black women reported higher cervical cancer screening adherence but lower rates of being informed of an abnormal Pap test and contacted for follow-up treatment. We recommend a multilevel approach to deliver culturally appropriate education and communication for patients, physicians, clinicians in training, and clinic level ancillary staff.
Answer: Yes, patient health and hysterectomy status do influence cervical cancer screening in older women. National Health Interview Surveys data showed a consistent pattern of lower Pap test use among older women (65+) compared to younger women regardless of hysterectomy status. Screening was also lower among older women who reported being in fair/poor health, having a chronic disability, or a higher Charlson comorbidity index (CCI) score. Despite this, over 50% of older women reporting poor health status or a chronic disability and 47% with a hysterectomy still had a recent Pap test, suggesting potential overutilization and inappropriate screening of older women (PUBMED:18784967).
Additionally, many older women, especially those with low income, need to continue screening for cervical cancer due to inadequate screening histories. This is a group at increased risk for cervical cancer, and it is imperative that clinicians evaluate previous test results before exiting a woman from screening at age 65 years (PUBMED:32155360).
Moreover, large scale surveys in the United States have highlighted the complexity of cervical cancer under-screening among women aged 45-65 years. Factors such as insurance, younger age, and more education were major positive predictors of screening, while race/ethnicity were variable predictors depending on the survey (PUBMED:31678587).
In summary, both health status and hysterectomy status are associated with the likelihood of older women receiving cervical cancer screening, with a trend towards lower screening rates among those with poorer health or those who have had a hysterectomy. However, there is also evidence of continued screening in some older women with poor health or post-hysterectomy, which may not always be appropriate according to guidelines. |
Instruction: Does breast size modify the association between mammographic density and breast cancer risk?
Abstracts:
abstract_id: PUBMED:18349279
Does breast size modify the association between mammographic density and breast cancer risk? Background: Both the absolute and the percent of mammographic density are strong and independent risk factors for breast cancer. Previously, we showed that the association between mammographic density and breast cancer risk tended to be weaker in African American than in White U.S. women. Because African American women have a larger breast size, we assessed whether the association between mammographic density and breast cancer was less apparent in large than in small breasts.
Methods: We assessed mammographic density on mammograms from 348 African American and 507 White women, 479 breast cancer patients and 376 control subjects, from a case-control study conducted in Los Angeles County. We estimated odds ratios (OR) for breast cancer with increasing mammographic density, and the analyses were stratified by mammographic breast area.
Results: Median breast size was 168.4 cm2 in African American women and 121.7 cm2 in White women (P for difference <0.001). For absolute density, adjusted ORs (95% confidence intervals) per increase of 10 cm2 were 1.32 (1.13-1.54), 1.14 (1.03-1.26), and 1.02 (0.98-1.07) in the first, second, and third tertiles of breast area, respectively (P for effect modification by breast area = 0.005). The results for percent density were similar although weaker; adjusted ORs per 10% increase (absolute value) in percent density were 1.22 (1.05-1.40), 1.22 (1.06-1.41), and 1.03 (0.90-1.18 P for effect modification by breast area = 0.34).
Conclusion: Our results indicate that the association between mammographic density and breast cancer may be weaker in women with larger breasts.
abstract_id: PUBMED:32643449
Mammographic density and breast cancer screening. Mammographic density, which is determined by the relative amounts of fibroglandular tissue and fat in the breast, varies between women. Mammographic density is associated with a range of factors, including age and body mass index. The description of mammographic density has been transformed by the digitalization of mammography, which has allowed automation of the assessment of mammographic density, rather than using visual inspection by a radiologist. High mammographic density is important because it is associated with reduced sensitivity for the detection of breast cancer at the time of mammographic screening. High mammographic density is also associated with an elevated risk of developing breast cancer. Mammographic density appears to be on the causal pathway for some breast cancer risk factors, but not others. Mammographic density needs to be considered in the context of a woman's background risk of breast cancer. There is intense debate about the use of supplementary imaging for women with high mammographic density. Should supplementary imaging be used in women with high mammographic density and a clear mammogram? If so, what modalities of imaging should be used and in which women? Trials are underway to address the risks and benefits of supplementary imaging.
abstract_id: PUBMED:30977028
The association between mammographic density and breast cancer risk in Western Australian Aboriginal women. Purpose: Mammographic density is an established breast cancer risk factor within many ethnically different populations. The distribution of mammographic density has been shown to be significantly lower in Western Australian Aboriginal women compared to age- and screening location-matched non-Aboriginal women. Whether mammographic density is a predictor of breast cancer risk in Aboriginal women is unknown.
Methods: We measured mammographic density from 103 Aboriginal breast cancer cases and 327 Aboriginal controls, 341 non-Aboriginal cases, and 333 non-Aboriginal controls selected from the BreastScreen Western Australia database using the Cumulus software program. Logistic regression was used to examine the associations of percentage dense area and absolute dense area with breast cancer risk for Aboriginal and non-Aboriginal women separately, adjusting for covariates.
Results: Both percentage density and absolute dense area were strongly predictive of risk in Aboriginal women with odds per adjusted standard deviation (OPERAS) of 1.36 (95% CI 1.09, 1.69) and 1.36 (95% CI 1.08, 1.71), respectively. For non-Aboriginal women, the OPERAS were 1.22 (95% CI 1.03, 1.46) and 1.26 (95% CI 1.05, 1.50), respectively.
Conclusions: Whilst mean mammographic density for Aboriginal women is lower than non-Aboriginal women, density measures are still higher in Aboriginal women with breast cancer compared to Aboriginal women without breast cancer. Thus, mammographic density strongly predicts breast cancer risk in Aboriginal women. Future efforts to predict breast cancer risk using mammographic density or standardize risk-associated mammographic density measures should take into account Aboriginal status when applicable.
abstract_id: PUBMED:35836268
The association of age at menarche and adult height with mammographic density in the International Consortium of Mammographic Density. Background: Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk.
Methods: Participants were 10,681 breast-cancer-free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemiologic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi-level linear regression models estimated changes in square-root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult height in pooled analyses and population-specific meta-analyses. Models were adjusted for age at mammogram, body mass index, menopausal status, hormone therapy use, mammography view and type, mammographic density assessor, parity and height/age at menarche.
Results: In pooled analyses, later age at menarche was associated with higher per cent density (β√PD = 0.023 SE = 0.008, P = 0.003) and larger dense area (β√DA = 0.032 SE = 0.010, P = 0.002). Taller women had larger dense area (β√DA = 0.069 SE = 0.028, P = 0.012) and higher per cent density (β√PD = 0.044, SE = 0.023, P = 0.054), although the observed effect on per cent density depended upon the adjustment used for body size. Similar overall effect estimates were observed in meta-analyses across population groups.
Conclusions: In one of the largest international studies to date, later age at menarche was positively associated with mammographic density. This is in contrast to its association with breast cancer risk, providing little evidence of mediation. Increased height was also positively associated with mammographic density, particularly dense area. These results suggest a complex relationship between growth and development, mammographic density and breast cancer risk. Future studies should evaluate the potential mediation of the breast cancer effects of taller stature through absolute breast density.
abstract_id: PUBMED:36183671
Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis. Objectives: Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature.
Methods: Medline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I2 statistic, stratified and sensitivity analyses.
Results: Nine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84-2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52-2.21) increased. Both results were statistically significant and homogenous.
Conclusions: Mammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.
abstract_id: PUBMED:33312342
Mammographic density: intersection of advocacy, science, and clinical practice. Purpose: Here we aim to review the association between mammographic density, collagen structure and breast cancer risk.
Findings: While mammographic density is a strong predictor of breast cancer risk in populations, studies by Boyd show that mammographic density does not predict breast cancer risk in individuals. Mammographic density is affected by age, parity, menopausal status, race/ethnicity, and body mass index (BMI).New studies normalize mammographic density to BMI may provide a more accurate way to compare mammographic density in women of diverse race and ethnicity. Preclinical and tissue-based studies have investigated the role collagen composition and structure in predicting breast cancer risk. There is emerging evidence that collagen structure may activate signaling pathways associated with aggressive breast cancer biology.
Summary: Measurement of film mammographic density does not adequately capture the complex signaling that occurs in women with at-risk collagen. New ways to measure at-risk collagen potentially can provide a more accurate view of risk.
abstract_id: PUBMED:37558417
Risk Analysis of Breast Cancer by Using Bilateral Mammographic Density Differences: A Case-Control Study. The identification of risk factors helps radiologists assess the risk of breast cancer. Quantitative factors such as age and mammographic density are established risk factors for breast cancer. Asymmetric breast findings are frequently encountered during diagnostic mammography. The asymmetric area may indicate a developing mass in the early stage, causing a difference in mammographic density between the left and right sides. Therefore, this paper aims to propose a quantitative parameter named bilateral mammographic density difference (BMDD) for the quantification of breast asymmetry and to verify BMDD as a risk factor for breast cancer. To quantitatively evaluate breast asymmetry, we developed a semi-automatic method to estimate mammographic densities and calculate BMDD as the absolute difference between the left and right mammographic densities. And then, a retrospective case-control study, covering the period from July 2006 to October 2014, was conducted to analyse breast cancer risk in association with BMDD. The study included 364 women diagnosed with breast cancer and 364 matched control patients. As a result, a significant difference in BMDD was found between cases and controls (P < 0.001) and the case-control study demonstrated that women with BMDD > 10% had a 2.4-fold higher risk of breast cancer (odds ratio, 2.4; 95% confidence interval, 1.3-4.5) than women with BMDD ≤ 10%. In addition, we also demonstrated the positive association between BMDD and breast cancer risk among the subgroups with different ages and the Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories. This study demonstrated that BMDD could be a potential risk factor for breast cancer.
abstract_id: PUBMED:34771552
Biological Mechanisms and Therapeutic Opportunities in Mammographic Density and Breast Cancer Risk. Mammographic density is an important risk factor for breast cancer; women with extremely dense breasts have a four to six fold increased risk of breast cancer compared to women with mostly fatty breasts, when matched with age and body mass index. High mammographic density is characterised by high proportions of stroma, containing fibroblasts, collagen and immune cells that suggest a pro-tumour inflammatory microenvironment. However, the biological mechanisms that drive increased mammographic density and the associated increased risk of breast cancer are not yet understood. Inflammatory factors such as monocyte chemotactic protein 1, peroxidase enzymes, transforming growth factor beta, and tumour necrosis factor alpha have been implicated in breast development as well as breast cancer risk, and also influence functions of stromal fibroblasts. Here, the current knowledge and understanding of the underlying biological mechanisms that lead to high mammographic density and the associated increased risk of breast cancer are reviewed, with particular consideration to potential immune factors that may contribute to this process.
abstract_id: PUBMED:28697417
Tumor characteristics and family history in relation to mammographic density and breast cancer: The French E3N cohort. Background: Mammographic density is a known heritable risk factor for breast cancer, but reports how tumor characteristics and family history may modify this association are inconsistent.
Methods: Dense and total breast areas were assessed using Cumulus™ from pre-diagnostic mammograms for 820 invasive breast cancer cases and 820 matched controls nested within the French E3N cohort study. To allow comparisons across models, percent mammographic density (PMD) was standardized to the distribution of the controls. Odds ratios (OR) and 95% confidence intervals (CI) of breast cancer risk for mammographic density were estimated by conditional logistic regression while adjusting for age and body mass index. Heterogeneity according to tumor characteristic and family history was assessed using stratified analyses.
Results: Overall, the OR per 1 SD for PMD was 1.50 (95% CI, 1.33-1.69). No evidence for significant heterogeneity by tumor size, lymph node status, grade, and hormone receptor status (estrogen, progesterone, and HER2) was detected. However, the association of PMD was stronger for women reporting a family history of breast cancer (OR1SD=2.25; 95% CI, 1.67-3.04) than in women reporting none (OR1SD=1.41; 95% CI, 1.24-1.60; pheterogeneity=0.002). Similarly, effect modification by FHBC was observed using categories of PMD (pheterogeneity=0.02) with respective ORs of 15.16 (95% CI, 4.23-54.28) vs. 3.14 (95% CI, 1.89-5.22) for ≥50% vs. <10% PMD.
Conclusions: The stronger association between mammographic density and breast cancer risk with a family history supports the hypothesis of shared genetic factors responsible for familial aggregation of breast cancer and the heritable component of mammographic density.
abstract_id: PUBMED:25258465
Percent Mammographic Density and Dense Area as Risk Factors for Breast Cancer. Purpose: Mammographic characteristics are known to be correlated to breast cancer risk. Percent mammographic density (PMD), as assessed by computer-assisted methods, is an established risk factor for breast cancer. Along with this assessment the absolute dense area (DA) of the breast is reported as well. Aim of this study was to assess the predictive value of DA concerning breast cancer risk in addition to other risk factors and in addition to PMD. Methods: We conducted a case control study with hospital-based patients with a diagnosis of invasive breast cancer and healthy women as controls. A total of 561 patients and 376 controls with available mammographic density were included into this study. We describe the differences concerning the common risk factors BMI, parital status, use of hormone replacement therapy (HRT) and menopause between cases and controls and estimate the odds ratios for PMD and DA, adjusted for the mentioned risk factors. Furthermore we compare the prediction models with each other to find out whether the addition of DA improves the model. Results: Mammographic density and DA were highly correlated with each other. Both variables were as well correlated to the commonly known risk factors with an expected direction and strength, however PMD (ρ = -0.56) was stronger correlated to BMI than DA (ρ = -0.11). The group of women within the highest quartil of PMD had an OR of 2.12 (95 % CI: 1.25-3.62). This could not be seen for the fourth quartile concerning DA. However the assessment of breast cancer risk could be improved by including DA in a prediction model in addition to common risk factors and PMD. Conclusions: The inclusion of the parameter DA into a prediction model for breast cancer in addition to established risk factors and PMD could improve the breast cancer risk assessment. As DA is measured together with PMD in the process of computer-assisted assessment of PMD it might be considered to include it as one additional breast cancer risk factor that is obtained from breast imaging.
Answer: Yes, breast size does modify the association between mammographic density and breast cancer risk. A study assessing mammographic density in African American and White women found that the association between mammographic density and breast cancer risk may be weaker in women with larger breasts. Specifically, the odds ratios for breast cancer with increasing mammographic density decreased across tertiles of breast area, indicating that the association was less apparent in larger breasts (PUBMED:18349279).
This finding is consistent with the understanding that mammographic density is a strong and independent risk factor for breast cancer, but its association with breast cancer risk can be influenced by various factors, including breast size. The study's results suggest that when assessing mammographic density as a risk factor for breast cancer, breast size should be taken into account, as the risk association may not be uniform across different breast sizes. |
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The PQAref dataset is a dataset for fine-tuning large language models for referenced question-answering in biomedical domain.
The dataset contains 3 components:
- Instruction - question that is supposed to be answered
- Abstracts - set of 10 relevant abstracts retrieved from PubMed by an IR system. They contain the PubMed id, abstract title and the content of the abstract
- Answer - expected answer, with references in the form of PubMed IDs.
The dataset was created semi-automatically, utilizing questions available from PubMedQA dataset.
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