Lung Cancer Screening in a Community Setting: Characteristics, Motivations, and Attitudes of Individuals Being Screened

We describe the characteristics of individuals being screened in community settings including factors influencing screening decisions and the level of information sought prior to screening. Individuals from two community-based radiology clinics (N = 27) were surveyed after screening. Screening efficacy and salience were the most important factors in screening decisions, whereas healthcare provider recommendations were rated not important. Half of participants reported no or little conversation about screening with their primary care provider, and 61.5 percent had not sought any information on screening. Individuals being screened in a community setting are unlikely to have sufficient information for an informed decision about screening

Evaluation of Multi-Level Barriers and Facilitators in a Large Diabetic Retinopathy Screening Program in Federally Qualified Health Centers: A Qualitative Study

BACKGROUND: Recommended annual diabetic retinopathy (DR) screening for people with diabetes has low rates in the USA, especially in underserved populations. Telemedicine DR screening (TDRS) in primary care clinics could expand access and increase adherence. Despite this potential, studies have observed high variability in TDRS rates among clinics and over time, highlighting the need for implementation supports. Previous studies of determinants of TDRS focus on patients\u27 perspectives, with few studies targeting upstream multi-level barriers and facilitators. Addressing this gap, this qualitative study aimed to identify and evaluate multi-level perceived determinants of TDRS in Federally Qualified Health Centers (FQHCs), to inform the development of targeted implementation strategies. METHODS: We developed a theory-based semi-structured interview tool based on the Consolidated Framework for Implementation Research (CFIR). We conducted 22 key informant interviews with professionals involved in TDRS (administrators, clinicians, staff). The interviews were audio-recorded and transcribed verbatim. Reported barriers and facilitators were organized into emergent themes and classified according to CFIR constructs. Constructs influencing TDRS implementation were rated for each study site and compared across sites by the investigators. RESULTS: Professionals identified 21 main barriers and facilitators under twelve constructs of the five CFIR domains. Several identified themes were novel, whereas others corroborated previous findings in the literature (e.g., lack of time and human resources, presence of a champion). Of the 21 identified themes, 13 were classified under the CFIR’s Inner Setting domain, specifically under the constructs Compatibility and Available Resources. Themes under the Outer Setting domain (constructs External Incentives and Cost) were primarily perceived by administrators, whereas themes in other domains were perceived across all professional categories. Two Inner Setting (Leadership Engagement, Goals and Feedback) and two Process (Champion, Engaging) constructs were found to strongly distinguish sites with high versus low TDRS performance. CONCLUSIONS: This study classified barriers and facilitators to TDRS as perceived by administrators, clinicians, and staff in FQHCs, then identified CFIR constructs that distinguished high- and low-performance clinics. Implementation strategies such as academic detailing and collection and communication of program data and successes to leadership; engaging of stakeholders through involvement in implementation planning; and appointment of intervention champions may therefore improve TDRS implementation and sustainment in resource-constrained settings

Buprenorphine Physician Supply: Relationship with State-Level Prescription Opioid Mortality

Background: Buprenorphine is an effective treatment for opioid use disorder but the supply of buprenorphine physicians is currently inadequate to address the nation’s prescription opioid crisis. Perception of need due to rising opioid overdose rates is one possible reason for physicians to adopt buprenorphine. This study examined associations between rates of growth in buprenorphine physicians and prescription opioid overdose mortality rates in US states. Methods: The total buprenorphine physician supply and number of physicians approved to treat 100 patients (per 100,000 population) were measured from June 2013 to January 2016. States were divided into two groups: those with rates of prescription opioid overdose mortality in 2013 at or above the median (\u3e 5.5 deaths per 100,000 population) and those with rates below the median. State-level growth curves were estimated using mixed-effects regression to compare rates of growth between high and low overdose states. Results: The total supply and the supply of 100-patient buprenorphine physicians grew significantly (total supply from 7.7 to 9.9 per 100,000 population, p \u3c 0.001; 100-patient supply from 2.2 to 3.4 per 100,000 population, p \u3c 0.001). Rates of growth were significantly greater in high overdose states when compared to low overdose states (total supply b = 0.033, p \u3c 0.01; 100-patient b = 0.022, p \u3c 0.01). Conclusions: The magnitude of the US prescription opioid crisis, as measured by the rate of prescription opioid overdose mortality, is associated with growth in the number of buprenorphine physicians. Because this observational design cannot establish causality, further research is needed to elucidate the factors influencing physicians’ decisions to begin prescribing buprenorphine

High Trait Shame Undermines the Protective Effects of Prevalence Knowledge on State Shame Following HPV/CIN Diagnosis in Women

Human papillomavirus (HPV), and the related, cervical intraepithelial neoplasia (CIN), are common yet poorly understood physical conditions. The diagnosis of HPV often elicits shame and guilt, which in turn may undermine psychological and physical health. The current study compared shame and guilt responses to diagnosis among two groups: women diagnosed with HPV/CIN and women diagnosed with Epstein–Barr Virus (EBV/IM). Eighty women recently diagnosed with HPV/CIN or EBV/IM completed measures of shame- and guilt-proneness, shame and guilt following diagnosis, and disease knowledge including prevalence estimates (HPV and EBV, respectively). HPV/CIN (vs. EBV/IM) predicted more diagnosis-related shame and guilt. Estimates of high prevalence interacted with diagnosis and shame-proneness to predict diagnosis-related shame. Simple slope analyses indicated that in women with HPV/CIN reporting low-to-average shame-proneness, high prevalence estimates reduced diagnosis-related shame; however, women high in shame-proneness experienced high diagnosis-related shame regardless of more accurate prevalence estimates. Women high in shame-proneness appear to be particularly vulnerable to HPV-related shame even when they are aware that it is very common

Morphometric characteristics of pyloric gastric glands at experimental acute gastritis and after administration of ‘Platex-Placental’ medication on the background of experimental acute gastritis

В роботі встановлена динаміка змін середніх метричних показників воротарних залоз шлунка при гострому експериментальному гастриті, після введення препарату «Платекс-плацентарний» (кріоконсервована тканина плаценти) та після введення препарату «Платекс-плацентарний» на тлі гострого експериментального гастриту. Виявлена позитивна динаміка дії препарату «Платекс-плацентарний» на швидкість перебігу та перебудову захисних властивостей воротарних залоз у відповідь на гострий запальний процес.; В работе установлена динамика изменений средних показателей привратниковых желез желудка при остром экспериментальном гастрите, после введения препарата «Платекс-плацентарный» (криоконсервированная ткань плаценты) и после введения препарата «Платекс-плацентарный» на фоне острого экспериментального гастрита. Выявлена положительная динамика действия препарата «Платекс-плацентарный» на скорость протекания и перестройку защитных свойств привратниковых желез в ответ на острый воспалительный процесс.; The study descrides the dynamics of changes in average indices of pyloric gastric glands at experimental acute gastritis, after administration of ‘Platex-Placental’ medication, and after administration of ‘Platex-Placental’ medication on a background of experimental acute gastritis. The positive outcomes were found after administration of ‘Platex-Placental’ medication in terms of inflammation course as well as reorganization of defence peculiarities of pyloric glands as a response to an acute inflammation

Terminate Lung Cancer (TLC) Study—A Mixed-Methods Population Approach to Increase Lung Cancer Screening Awareness and Low-Dose Computed Tomography in Eastern Kentucky

For low dose CT lung cancer screening to be effective in curbing disease mortality, efforts are needed to overcome barriers to awareness and facilitate uptake of the current evidence-based screening guidelines. A sequential mixed-methods approach was employed to design a screening campaign utilizing messages developed from community focus groups, followed by implementation of the outreach campaign intervention in two high-risk Kentucky regions. This study reports on rates of awareness and screening in intervention regions, as compared to a control region

Using User-Centered Design to Facilitate Adherence to Annual Lung Cancer Screening: Protocol for a Mixed Methods Study for Intervention Development

BackgroundLung cancer is the leading cause of cancer-related death in the United States, with the majority of lung cancer occurrence diagnosed after the disease has already metastasized. Lung cancer screening (LCS) with low-dose computed tomography can diagnose early-stage disease, especially when eligible individuals participate in screening on a yearly basis. Unfortunately, annual adherence has emerged as a challenge for academic and community screening programs, endangering the individual and population health benefits of LCS. Reminder messages have effectively increased adherence rates in breast, colorectal, and cervical cancer screenings but have not been tested with LCS participants who experience unique barriers to screening associated with the stigma of smoking and social determinants of health. ObjectiveThis research aims to use a theory-informed, multiphase, and mixed methods approach with LCS experts and participants to develop a set of clear and engaging reminder messages to support LCS annual adherence. MethodsIn aim 1, survey data informed by the Cognitive-Social Health Information Processing model will be collected to assess how LCS participants process health information aimed at health protective behavior to develop content for reminder messages and pinpoint options for message targeting and tailoring. Aim 2 focuses on identifying themes for message imagery through a modified photovoice activity that asks participants to identify 3 images that represent LCS and then participate in an interview about the selection, likes, and dislikes of each photo. A pool of candidate messages for multiple delivery platforms will be developed in aim 3, using results from aim 1 for message content and aim 2 for imagery selection. The refinement of message content and imagery combinations will be completed through iterative feedback from LCS experts and participants. ResultsData collection began in July 2022 and will be completed by May 2023. The final reminder message candidates are expected to be completed by June 2023. ConclusionsThis project proposes a novel approach to facilitate adherence to annual LCS through the development of reminder messages that embrace content and imagery representative of the target population directly in the design process. Developing effective strategies to increase LCS adherence is instrumental in achieving optimal LCS outcomes at individual and population health levels. International Registered Report Identifier (IRRID)DERR1-10.2196/4665

Fatigue and Fatigue-Related Symptoms in an Orofacial Pain Population

Objectives The aims of this study were to investigate the presence and magnitude of self-reported fatigue and fatigue-related symptoms and to determine whether fatigue can be distinguished as a unique clinical symptom in a sample of patients diagnosed with chronic temporomandibular joint or masticatory muscle pain. Study design Fifty-five chronic TMD patients and 55 age-, sex-, and education-matched healthy volunteers completed a battery of 4 different fatigue measures as well as the SCL90-R, MPI, and PSQI. Results Fatigue and fatigue-related symptoms were reported significantly more often by chronic TMD patients than by healthy volunteers. MANCOVAs with somatization, depression, anxiety, general activity level, and sleep disturbances as covariates eliminated the differences between patients and controls. Stepwise regression showed that fatigue and fatigue-related symptoms did not appear to be a unique clinical symptom of TMD patients, but merely emerged as somatic symptoms accounted for by somatization and depression. Conclusion Fatigue and fatigue related symptoms may be symptoms of somatization and depression in this sample of chronic TMD patients

Individual decision making about lung cancer screening: A conjoint analysis of perspectives among a high‐risk national sample

Objectives Lung cancer screening (LCS) is effective in reducing lung cancer mortality, but there is limited information available regarding preferences among high-risk individuals concerning LCS. In this study, we use a conjoint valuation analysis (CVA) to better understand which LCS attributes most affect LCS preferences. Materials and Methods We implemented a web-based nationally representative survey that included a full-profile CVA exercise. Participants were over the age of 45, had at least a 20 pack-year smoking history, and no history of lung cancer. The CVA instrument included five LCS attributes, and additional survey items collected demographic and psychosocial information. Results Participants (n = 210) had a mean age of 61 (SD 8.5) years, approximately half were female (51.9%), and were racially/ethnically diverse. Average relative importance of the LCS program attributes was (from high to low): out of pocket costs (27.3 +/- 17.7); provider recommendation (24.8 +/- 13.4); mortality reduction (17.2 +/- 8.9); false-positive rate (15.8 +/- 10.4); and ease of access (14.8 +/- 7.3). There was large variation among individuals, but few significant associations of propensity to screen with individual demographic characteristics. Average screening propensity across individuals (1-9 scale) was 3.63 +/- 1.6, and average rates of individual scenarios ranged from 2.60 +/- 2.00 to 5.57 +/- 2.13, indicating low inclination for screening. Conclusions We found that overall propensity for screening is low in a high-risk population, and that out of pocket costs were of greater importance to potential screeners than mortality reduction or false-positive rates. Thus, individuals considering or eligible for LCS need additional education and support regarding the LCS landscape in order to achieve informed decision making