Socioeconomic Disparities across Ethnicities: An Application to Cervical Cancer Screening

Objectives: Our aim is to investigate socioeconomic disparities in cervical cancer screening utilization among and between ethnic groups in the United States. Study Design: Observational study. Methods: Data on 26,338 women aged 21 to 64 years were obtained from the 2007 to 2011 years of the Medical Expenditure Panel Survey. Data on cervical cancer screening utilization in the preceding 12 months and 3 years, and a range of sociodemographic characteristics were included. Analyses were undertaken for all women and across racial/ethnic grouping (ie, white, black, Hispanic, and other). Concentration indices were used to measure the socioeconomic gradient across ethnic groups. Probit regression analyses were used to examine variations in utilization related to socioeconomic factors across ethnic groups controlling for a range of pertinent characteristics. Results: Annual utilization rates are high in the United States (60.15%) and greatest among black women (66.25%). Disparities, as measured by concentration indices (CIs), are large in the United States, with the largest being for white women (CI, 0.179) relative to black (CI, 0.103) and Hispanic (CI, 0.081) women. Screening differences across income, education and insurance status are also greater amongst white women. Conclusions: Uptake of cervical cancer screening is common in the United States, with large socioeconomic disparities also evident. Those from lower socioeconomic or uninsured groups who are most likely to have, and to die from, cervical cancer, are least likely to use preventive screening. Disparities differ across ethnic groups and are greatest amongst white women. Incorporating organized screening may serve to improve both the systems efficiency and address disparities between and within groups

The solubility and oxidation state of nickel in silicate melt at low oxygen fugacities: Results using a mechanically assisted equilibration technique

The solubility of Ni in a silicate melt has been measured using a new, mechanically assisted equilibration technique over a wide range of controlled ƒO2 values. The melt composition corresponds to the 1 atm eutectic in the system CaAl2Si2O8-CaMgSi2O6 + 10 wt% CaO. The experiments were performed at 1300°C and over an ƒO2 range of 10−8.5 to 10−13.75, and over a temperature range of 1270 to 1390°C at a constant gas mixing ratio ( ). The experiment consists of a sample of melt contained within a crucible of Ni metal and held in a 1 atm gas mixing furnace. A Ni spindle is entered into the sample from above and continuously rotated at a constant angular velocity using a viscometer head. The stirring of the sample serves to accelerate the approach to equilibrium between the liquid sample and the metal crucible (and spindle). This arrangement allows relatively rapid equilibration of Ni content following changes to higher or lower ƒO2 values. Samples of the melt may be taken at any time for analysis and thus the equilibrium solubility of Ni in the silicate melt may be determined from unambiguous experimental reversals. The Ni contents of samples, analysed both by INAA and by ICP-AES, range from 25 to 5300 ppm. The data presented in this paper indicate that the oxidation state of Ni in the investigated melt is Ni2+ over the entire range of ƒO2 investigated. This conclusion contrasts with recent reports in the literature of an inflection in the ƒO2 dependence of Ni solubility, which has been interpreted as solution of neutral Ni at low ƒO2 (Morse et al., 1991; Colson, 1992; Ehlers et al., 1992). We also present data for the temperature dependence of Ni solubility in the investigated melt. The solubility decreases with increasing temperature at constant ƒO2. The present results are in good agreement with the metal-loop-equilibration experiments reported by Holzheid et al. (1994)

Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels

BACKGROUND: Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients' adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3). METHODS: We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients' adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3). RESULTS: Eight TDF domains were perceived to influence patients' and HCPs' behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in secondary care. Efficacy should be measured using pulmonary exacerbations, hospital admissions and quality of life (Stage 3). CONCLUSIONS: Twelve BCTs form the intervention content. An individualised selection from these 12 BCTs will be delivered to all patients over several face-to-face visits in secondary care. Future research should focus on developing physical materials to aid delivery of the intervention prior to feasibility and pilot testing. If effective, this intervention may improve adherence and health outcomes for those with bronchiectasis in the future

Active cloaking of finite defects for flexural waves in elastic plates

We present a new method to create an active cloak for a rigid inclusion in a thin plate, and analyse flexural waves within such a plate governed by the Kirchhoff plate equation. We consider scattering of both a plane wave and a cylindrical wave by a single clamped inclusion of circular shape. In order to cloak the inclusion, we place control sources at small distances from the scatterer and choose their intensities to eliminate propagating orders of the scattered wave, thus reconstructing the respective incident wave. We then vary the number and position of the control sources to obtain the most effective configuration for cloaking the circular inclusion. Finally, we successfully cloak an arbitrarily shaped scatterer in a thin plate by deriving a semi-analytical, asymptotic algorithm.Comment: 19 pages, 14 figures, 1 tabl

Approaches to canine health surveillance

Effective canine health surveillance systems can be used to monitor disease in the general population, prioritise disorders for strategic control and focus clinical research, and to evaluate the success of these measures. The key attributes for optimal data collection systems that support canine disease surveillance are representativeness of the general population, validity of disorder data and sustainability. Limitations in these areas present as selection bias, misclassification bias and discontinuation of the system respectively. Canine health data sources are reviewed to identify their strengths and weaknesses for supporting effective canine health surveillance. Insurance data benefit from large and well-defined denominator populations but are limited by selection bias relating to the clinical events claimed and animals covered. Veterinary referral clinical data offer good reliability for diagnoses but are limited by referral bias for the disorders and animals included. Primary-care practice data have the advantage of excellent representation of the general dog population and recording at the point of care by veterinary professionals but may encounter misclassification problems and technical difficulties related to management and analysis of large datasets. Questionnaire surveys offer speed and low cost but may suffer from low response rates, poor data validation, recall bias and ill-defined denominator population information. Canine health scheme data benefit from well-characterised disorder and animal data but reflect selection bias during the voluntary submissions process. Formal UK passive surveillance systems are limited by chronic under-reporting and selection bias. It is concluded that active collection systems using secondary health data provide the optimal resource for canine health surveillance

Longevity and mortality of owned dogs in England

Improved understanding of longevity represents a significant welfare opportunity for the domestic dog, given its unparalleled morphological diversity. Epidemiological research using electronic patient records (EPRs) collected from primary veterinary practices overcomes many inherent limitations of referral clinic, owner questionnaire and pet insurance data. Clinical health data from 102,609 owned dogs attending first opinion veterinary practices (n = 86) in central and southeast England were analysed, focusing on 5095 confirmed deaths. Of deceased dogs with information available, 3961 (77.9%) were purebred, 2386 (47.0%) were female, 2528 (49.8%) were neutered and 1105 (21.7%) were insured. The overall median longevity was 12.0 years (IQR 8.9–14.2). The longest-lived breeds were the Miniature poodle, Bearded collie, Border collie and Miniature dachshund, while the shortest-lived were the Dogue de Bordeaux and Great Dane. The most frequently attributed causes of death were neoplastic, musculoskeletal and neurological disorders. The results of multivariable modelling indicated that longevity in crossbred dogs exceeded purebred dogs by 1.2 years (95% confidence interval 0.9–1.4; P < 0.001) and that increasing bodyweight was negatively correlated with longevity. The current findings highlight major breed differences for longevity and support the concept of hybrid vigour in dogs

Decomposing socioeconomic inequality in child vaccination: Results from Ireland

Background There is limited knowledge of the extent of or factors underlying inequalities in uptake of childhood vaccination in Ireland. This paper aims to measure and decompose socioeconomic inequalities in childhood vaccination in the Republic of Ireland. Methods The analysis was performed using data from the first wave of the Growing Up in Ireland survey, a nationally representative survey of the carers of over 11,000 nine-month old babies collected in 2008 and 2009. Multivariate analysis was conducted to explore the child and parental factors, including socioeconomic factors that were associated with non-vaccination of children. A concentration index was calculated to measure inequality in childhood vaccination. Subsequent decomposition analysis identified key factors underpinning observed inequalities. Results Overall the results confirm a strong socioeconomic gradient in childhood vaccination in the Republic of Ireland. Concentration indices of vaccination (CI = −0.19) show a substantial pro-rich gradient. Results from the decomposition analysis suggest that a substantial proportion of the inequality is explained by household level variables such as socioeconomic status, household structure, income and entitlement to publicly funded care (29.9%, 24% 30.6% and 12.9% respectively). Substantial differences are also observed between children of Irish mothers and immigrant mothers from developing countries. Conclusions Vaccination was less likely in lower than in higher income households. Access to publicly funded services was an important factor in explaining inequalities

The importance of socio-economic variables in cancer screening participation: A comparison between population-based and opportunistic screening in the EU-15

Objectives To investigate differences in participation with breast and cervical cancer screening related to individual socio-economic characteristics, across population-based versus opportunistic screening programmes. Methods Data from Eurobarometer 66.2 “Health in the European Union” 2006 on self-reported breast and cervical cancer screening participation in the preceding 12 months within the EU 15 was obtained The sample was restricted to those eligible for screening based on the screening age within each country. Observations for 2214 and 5025 individuals respectively for breast and cervical cancer screening were available. Data on marital status, self-reported health, socio-economic group and years of education were also available. Screening programmes were categorised as population-based or opportunistic and logistic regression analysis used to examine the relationship between participation, individual characteristics and programme type. Results Differences in participation related to socio-economic status were observed in opportunistic screening programmes for breast cancer (OR = 0.63* and OR = 0.51**) and cervical cancer (OR = 0.75** and OR = 0.64**). Differences related to socio-economic characteristics were not found with respect to participation in population-based programmes. Conclusions In opportunistic programmes, differences in participation across socio-economic groups are evident in respect of both breast and cervical cancer screening. These differences may have implications for treatment and outcomes across socio-economic groups. Such differences were not evident in population-based programmes