El difícil camino al diagnóstico del paciente con atrofia muscular espinal / The difficult path to diagnosis of the patient with spinal muscular atrophy

Introducción. Con las nuevas terapias, el diagnóstico temprano de la atrofia muscular espinal (AME) es esencial. El objetivo de este estudio es analizar los distintos componentes que influyen en el retraso diagnóstico. Población y métodos. Se incluyeron pacientes con un diagnóstico molecular de AME tipo I, II y III. Se estudiaron varios parámetros, como la edad al momento de la aparición del primer signo, qué signo fue y el intervalo entre este y el diagnóstico confirmado. Neurólogos especialistas realizaron entrevistas que se complementaron con la revisión de historias clínicas cuando fue necesario. Resultados. Se entrevistaron 112 pacientes. AME I n = 40, AME II n = 48, AME III n = 24. La mediana de edad en meses al momento del reporte del primer signo fue AME I: 1,5 (R 0-7), AME II: 9 (R 2-20), AME III: 18 (R 8-180). Los primeros signos fueron reconocidos por los padres en el 75 % al 85 % de las veces en todos los subtipos. La mediana del tiempo transcurrido entre el primer signo y la primera consulta médica fue menor a un mes en los tres tipos. La mediana de tiempo transcurrido en meses entre el primer signo y el diagnóstico molecular confirmado fue en AME I: 2 (R 0-11), en AME II: 10 (3-46) y en AME III: 31,5 (R 4-288). Conclusiones. Existe un significativo retraso en el diagnóstico de la AME relacionado fundamentalmente a la falta de sospecha clínica. La demora es menor en AME I y mayor en AME III. Otros factores incluyen deficiencias en el sistema de salud.

Introduction. News treatments, make early diagnosis of spinal muscular atrophy (SMA) critical. The objective of this study is to analyze the different factors that influence delay in diagnosis. Population and methods. Patients with a molecular diagnosis of types I, II, and III SMA were included. Several parameters were studied, such as age at onset of first sign, what sign it was, and the time from recognition of first sign to confirmed diagnosis. Neurologists specialized in SMA conducted interviews, supported by the review of medical records when deemed necessary. Results. A total of 112 patients were interviewed. SMA I n = 40, SMA II n = 48, SMA III n = 24. The median age in months at the time of reporting the first sign was SMA I: 1.5 (R: 0­7), SMA II: 9 (R: 2­20), SMA III: 18 (R: 8­180). In all subtypes, first signs were identified by parents from 75% to 85% of the times. The median time from first sign to first medical consultation was less than a month in all 3 types. The median time in months, from first sign to confirmed molecular diagnosis in SMA I was: 2 (R: 0­11), in SMA II: 10 (R: 3­46), in SMA III: 31.5 (R: 4­288). Conclusions. There is a significant delay in SMA diagnosis mainly related to the absence of clinical suspicion. The delay is shorter in SMA I and longer in SMA III. Other factors include deficiencies in the health care system.

Late diagnosis of HIV infection and its associated factors in Jiading District of Shanghai between 1998 and 2022 / 上海预防医学

ObjectiveTo investigate the late diagnosis of HIV infection and associated factors in Jiading District between 1998 and 2022， and to provide the information for the development of AIDS prevention and control strategy. MethodsInformation of newly reported HIV/AIDS cases in Jiading District between 1998 and 2022 were obtained from the National Information System for Comprehensive AIDS Prevention and Control. Logistic regression was used to explore the associated factors of late diagnosis of HIV infection. ResultsIn total， 809 HIV/AIDS cases was newly reported， 324 of which were late diagnosis with the overall rate of late diagnosis of 40.1%. Despite an increased tendency from 2016 to 2018， the rate of late diagnosis showed a downward trend from 1998 to 2015. The late diagnosis rate was 29.5% in 2015. From 2016 to 2022， the average rate was 34.9%. The average age of cases with a late diagnosis was 44.8±14.6 years old. Age groups over 50 had the highest risk，at 57.7%， accounting for 35.8% of all cases of late diagnosis. All age groups older than 30（OR=1.37‒3.50） had a higher rate of late diagnosis than the group between age 21 and 30. In comparison to patients at VCT clinic， the rate of late diagnosis among sexually transmitted disease （STD） outpatients （OR=2.23， 95%CI：1.42‒3.49） and other clinical patients （OR=2.75， 95%CI：1.88‒4.01） was higher. ConclusionThe late diagnosis rate of HIV infection is relatively high in Jiading District. AIDS education and prevention activities should be strengthened among people aged over 50 years. For early detection of HIV infection， VCT clinic platform’s function should be fully utilized. Medical institutions should pay attention to HIV testing in patients.

Diagnóstico tardio do Vírus da Imunodeficiência Humana e da Síndrome da Imunodeficiência Adquirida em Idosos: protocolo scoping review / Late diagnosis of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in the Elderly: scoping review protocol

As pessoas idosas, diagnosticadas tardiamente, tem maior risco de desenvolver AIDS. Com a contagem de CD4 inferior a 200 células/ml3, elas apresentam em média mais chances de morrer no primeiro ano após o diagnóstico. O objetivo desta revisão de escopo é mapear evidências relativas aos fatores associados e de risco do diagnóstico tardio de HIV/AIDS em pessoas idosas, mas especificamente, esta revisão quer dar resposta às seguintes questões: Quais são os fatores associados do diagnóstico tardio de HIV/AIDS em pessoas idosas? Quais são os fatores de riscos do diagnóstico tardio de HIV/AIDS em pessoas idosas? Que contexto o diagnóstico tardio de HIV/AIDS em pessoas idosas foi realizado? Esta revisão será orientada pela metodologia do Joanna Briggs Institute, que assentará na estratégia de definição dos participantes, conceito e contexto. Os resultados serão apresentados pelo resumo lógico e descritivo, apresentados, como um mapa de dados extraídos dos artigos e alinhado com o objetivo e as perguntas da revisão de escopo. Espera-se que esta revisão de escopo contribua para a análise compreensiva das práticas de cuidados à saúde das pessoas idosas.

Elderly people, diagnosed late, have a higher risk of developing AIDS. With a CD4 count of less than 200 cells / ml3, they are on average more likely to die in the first year after diagnosis. The purpose of this scope review is to map evidence regarding the associated risk factors of late diagnosis of HIV / AIDS in older people, but specifically, this review aims to address the following questions: What are the associated factors of late diagnosis of HIV / AIDS in elderly people? What are the risk factors for late diagnosis of HIV / AIDS in elderly people? In what context was the late diagnosis of HIV / AIDS in elderly people given? This review will be guided by the methodology of the Joanna Briggs Institute, which will be based on participant definition strategy, concept and context. Results will be presented by the logical and descriptive summary, presented as a map of data extracted from the articles and aligned with the objective and scope review questions. This scope review is expected to contribute to a comprehensive analysis of the health care practices of elderly people.

Las personas mayores, diagnosticadas tardíamente, tienen un mayor riesgo de desarrollar SIDA. Con un recuento de CD4 de menos de 200 células/ml3, tienen en promedio más probabilidades de morir en el primer año después del diagnóstico. El objetivo de esta revisión de alcance es mapear las evidencias relacionadas con los factores asociados y de riesgo del diagnóstico tardío del VIH/SIDA en personas mayores, pero específicamente esta revisión tiene como objetivo responder a las siguientes preguntas: ¿Cuáles son los factores asociados con el diagnóstico tardío del VIH/SIDA en las personas mayores? ¿Cuáles son los factores de riesgo para el diagnóstico tardío del VIH/SIDA en las personas mayores? ¿Cuál es el contexto del diagnóstico tardío del VIH/SIDA en las personas mayores? Esta revisión se guiará por la metodología del Joanna Briggs Institute, que se basará en la estrategia de definición, concepto y contexto de los participantes. Los resultados se presentarán mediante un resumen lógico y descriptivo, presentado como un mapa de los datos extraídos de los artículos y alineados con el objetivo y las preguntas de la revisión del alcance. Se espera que esta revisión del alcance contribuya al análisis exhaustivo de las prácticas de atención de la salud de los ancianos.

Prevalence and factors associated with late diagnosis of the HIV infection in a municipality of São Paulo / Prevalencia y factores asociados al diagnóstico tardío de la infección ocasionada por el VIH en un municipio de São Pauloo / Prevalência e fatores associados ao diagnóstico tardio da infecção pelo hiv em um município paulista

ABSTRACT Objective: to identify the prevalence and factors associated with late diagnosis of the infection by the Human Immunodeficiency Virus (HIV), in a municipality of São Paulo. Method: an epidemiological, analytical and retrospective study that analyzed the HIV and AIDS cases notified by the health services in the period from 2015 to 2017 using data from the notifications of the Information System for Notifiable Diseases (SINAN Net) corresponding to the users recently diagnosed with HIV/AIDS infection in the municipality of Ribeirão Preto/SP, Brazil. Data collection was in May 2018. The chi-square test was performed, as well as binary logistic regression, where the dependent variable was the AIDS criterion at the moment of notifying infection by HIV. A p-value<0.05 was considered for the association between the variables studied in relation to late diagnosis. Results: of the 829 (100%) new HIV cases, 290 (35.0%) were diagnosed in the condition of AIDS. Most of the population was male and aged between 15 and 34 years old. Oral candidiasis and weight loss greater than 10% were the main symptoms associated with AIDS. It was observed that people with lower schooling levels and older were more prone to late diagnoses. Conclusion: it is necessary to devise strategies that favor timely diagnosis in the municipality under study, particularly among the individuals aged over 45 years old and with lower schooling levels.

RESUMEN Objetivo: identificar la prevalencia y los factores asociados al diagnóstico tardío de la infección ocasionada por el Virus de Inmunodeficiencia Humana (HIV) en un municipio del interior de Brasil. Método: estudio epidemiológico, analítico y retrospectivo que analizó los casos de VIH y SIDA notificados por los servicios de salud entre 2015 y 2017 por medio de los datos de las notificaciones del Sistema de Información de Problemas de Salud pasibles de Notificación (SINAN Net) referentes a los usuarios recién diagnosticados con la infección ocasionada por el VIH/SIDA en el municipio de Ribeirão Preto/SP, Brasil. La recolección de datos fue en mayo de 2018. Se realizaron tanto una prueba de chi-cuadrado como un análisis de regresión logística binaria, en la cual la variable dependiente fue el criterio de SIDA al momento de notificar la infección ocasionada por el HIV. Se consideró un valor de p<0,05 para la asociación entre las variables estudiadas en relación con el diagnóstico tardío. Resultados: entre los 829 (100%) casos nuevos de HIV, 290 (35,0%) fueron diagnosticados en la condición de SIDA. La mayoría de la población era del sexo masculino y pertenecía al grupo etario de 15 a 34 años. Candidiasis oral y pérdida de peso superior al 10% fueron los principales síntomas asociados al SIDA. Se observó que las personas con niveles de educación más bajos y de mayor edad fueron más propensas a ser diagnosticadas tardíamente. Conclusión: es necesario elaborar estrategias que favorezcan el diagnóstico oportuno en el municipio estudiado, particularmente entre las personas de más de 45 años de edad y con niveles de educación más bajos.

RESUMO Objetivo: identificar a prevalência e os fatores associados ao diagnóstico tardio da infecção pelo vírus da imunodeficiência humana (HIV), em um município do interior paulista. Método: estudo epidemiológico, analítico e retrospectivo que analisou os casos de HIV e AIDS notificados pelos serviços de saúde no período de 2015 a 2017 por meio dos dados das notificações do Sistema de Informação de Agravos de Notificação (Sinan Net) dos usuários recém-diagnosticados para a infecção pelo HIV/AIDS no município de Ribeirão Preto/SP, Brasil. A coleta de dados ocorreu em maio de 2018. Foi realizado o teste qui-quadrado e regressão logística binária, no qual a variável dependente foi o critério de AIDS no momento da notificação da infecção pelo HIV. Foi considerado o valor de p<0,05 para a associação entre as variáveis estudadas com relação ao diagnóstico tardio. Resultados: dentre os 829 (100%) casos novos de HIV, 290 (35,0%) foram diagnosticados na condição de AIDS. A maioria da população pertencia ao sexo masculino e na faixa etária dos 15 aos 34 anos. A candidose oral e a perda de peso acima de 10% foram os principais sintomas associados à AIDS. Observou-se que pessoas com menor escolaridade e com o aumento da idade eram mais propensas a serem diagnosticadas tardiamente. Conclusão: estratégias que favoreçam o diagnóstico oportuno no município estudado são necessárias, particularmente entre os indivíduos com idade acima de 45 anos e com menor escolaridade.

Características clínico-epidemiológicas de mujeres con Virus de Inmunodeficiencia Humana. Boyeros. 1986-2016 / Clinical and epidemiological characteristics of women with Human Immunodeficiency Virus. Boyeros. 1986-2016

Introducción: En los últimos años las mujeres constituyen uno de los grupos más vulnerables y afectados por el VIH. Objetivo: Determinar características clínico-epidemiológicas de mujeres con VIH, residentes en el municipio Boyeros. Material y métodos: investigación descriptiva, retrospectiva de pacientes femeninas con VIH, diagnosticadas y residentes en el municipio Boyeros, desde 1986 hasta el 31 de diciembre del 2016. Se incluyeron solo las pacientes mayores de 14 años, vivas, diagnosticadas y residentes en el municipio. La muestra estuvo constituida por 99 casos. La fuente de información se obtuvo de las historias clínicas de la Consulta Municipal especializada para la atención a pacientes con VIH/sida del municipio Boyeros. Resultados: Las tasas de incidencia muestran tendencia ascendente. El 49,5 por ciento se diagnostican con edades entre 15 y 29 años. Predominan las mujeres blancas en 40 por ciento, con nivel de escolaridad secundaria básica (43 por ciento). Un 19 por ciento se hizo el diagnostico como gestante y más de 50 por ciento no declararon vínculo laboral estable. El diagnóstico tardío se presentó en 43 por ciento y a edades mayores. El último conteo de T-CD4 fue mayor de 350 células/mm3 en más de 50 por ciento. El 92,9 por ciento de los casos tienen indicado TARV. Conclusiones: La población femenina con VIH del municipio Boyeros es predominantemente joven, con nivel de escolaridad básica y sin vínculo laboral. Se mantienen casos de diagnóstico tardío y las cifras de T-CD4 muestran valores adecuados en la mayoría de los casos(AU)

Introduction: Women are one of the most vulnerable groups affected by HIV during the last years. Objective: To determine the clinical and epidemiological characteristics of women with HIV in Boyeros municipality. Material and Methods: A descriptive retrospective research was conducted in female HIV patients in Boyeros municipality from 1986 to December 31, 2016. Only alive women older than 14 years living in the aforementioned municipality who were previously diagnosed with HIV were included in the study. The sample was composed of 99 cases. The information was obtained from the clinical records of the Municipal Consultation where specialized care is given to patients with HIV/AIDS. Results: The incidence rates of HIV infection in women showed a rising trend. Also, 49,5 percent of women infected with HIV were between 15 and 29 years of age. There was a prevalence of whites (40 percent) as well as women with secondary levels of education (43 percent). The diagnosis was also made in pregnant women, representing the 19 percent. More than 50 percent of them declared not to have steady jobs. Late diagnosis was identified in 43 percent of women in older ages. The latest T-CD4 count was higher than 350 cells/mm3 in more than 50 percent of them. ART was indicated in 92,9 percent of the cases. Conclusions: The female population infected with HIV in Boyeros municipality is mainly young; a lot of them have basic educational levels and do not have an employment contract. Late diagnosis of HIV infection continues to be identified. T-CD4 cell counts show adequate values in most of the cases(AU)

O diagnóstico tardio na perspectiva do itinerário terapêutico: grau 2 de incapacidade física na hanseníase / El diagnóstico tardío desde la perspectiva del itinerario terapéutico: grado 2 de discapacidad física en la enfermedad de Hansen / Late diagnosis under the perspective of therapeutic itineraries: level 2 physical disabilities in Hansen's disease

Destacam-se casos novos de hanseníase com grau de incapacidade física 2 (GIF 2) que demonstram a ineficiente detecção oportuna. O artigo é um relato de casos e propõe analisar o diagnóstico tardio sob a perspectiva do itinerário terapêutico (IT), com base em um estudo qualitativo. O cenário foram dois municípios da Região Metropolitana da Baixada Santista: Praia Grande e São Vicente. Realizou-se análise documental e entrevista em profundidade com quatro participantes. O material foi submetido à análise de conteúdo e definiram-se as categorias temáticas: cuidado em saúde; corpo na hanseníase; incapacidades na hanseníase; e diagnóstico tardio. Revelaram-se intrincados itinerários terapêuticos, marcados pela fragilidade do cuidado com erro e atraso no diagnóstico, que potencializaram os riscos individuais e coletivos e impactaram negativamente o cotidiano dos sujeitos. (AU)

Se subrayan casos nuevos de enfermedad de Hansen (lepra) con grado de discapacidad física 2 (GIF 2), que demuestran la ineficiente detección oportuna. El artículo es un relato de casos y propone analizar el diagnóstico tardío bajo la perspectiva del itinerario terapéutico (IT), con base en un estudio cualitativo. El escenario fueron dos municipios de la Región Metropolitana de la Baixada Santista: Praia Grande y São Vicente. Se realizó el análisis documental y entrevista en profundidad con cuatro participantes. El material se sometió a análisis de contenido y se definieron las categorías temáticas: cuidado de salud, cuerpo en la enfermedad de Hansen; discapacidades en la enfermedad de Hansen y diagnóstico tardío. Se revelaron intricados itinerarios terapéuticos, señalados por la fragilidad del cuidado, con error y atraso en el diagnóstico, que potencializaron los riesgos individuales y colectivos e impactaron negativamente el cotidiano de los sujetos. (AU)

There are remarkable numbers of new leprosy cases with 2 (GIF 2) degree of physical disability, demonstrating the inefficient timely detection. This article presents case reports, based on a qualitative study, regarding four patients with Hansen's disease and a GIF 2 level at the time of diagnosis, analyzing the late diagnosis from the perspective of therapeutic itineraries (TI). The cases came from two municipalities in the Metropolitan Region of Baixada Santista: Praia Grande and São Vicente. Three men and one woman participated, between 45 and 61 years old. The researcher performed documentary analysis and in-depth interviews. Resulting data was submitted to content analysis and four thematic categories were identified: health care; body in leprosy; disabilities in leprosy; late diagnosis. The results reveal intricate therapeutic itineraries with obstacles for reaching a diagnosis. Lack of information about Hansen's disease and professional inability to diagnose increased both individual and collective risks, in addition to the negative impact on the subjects' daily lives. Thus, a late diagnosis due to the frailty of care strongly concurs to keep Hansen's disease as a stigmatizing and disabling disease. (AU)

Association between delayed diagnosis and breast cancer in advanced clinical stage at the time of consultation in four oncology centers in Medellin- Colombia, 2017. Cross-sectional study / Asociación entre retraso en el diagnóstico y estadio clínico avanzado de cáncer de mama al momento de la consulta en cuatro centros oncológicos de medellín, colombia, 2017. estudio de corte transversal

RESUMEN Objetivo: establecer la asociación entre el retraso en el diagnóstico de cáncer de mama con un estadio clínico avanzado y explorar factores que influyen en dicho retraso. Materiales y métodos: estudio de corte transversal con mujeres mayores de 18 años con cáncer de mama que consultaron en cuatro centros oncológicos de Medellín, Colombia, en 2017. Se usó el Breast Cancer Delay Questionnaire que incluye variables sociodemográficas, clínicas y de tiempos de atención. Se estimó el odds ratio (OR) crudo y ajustado por medio de una regresión logística con el estadio clínico avanzado como desenlace y el retraso diagnóstico como exposición. Resultados: se incluyeron 242 pacientes. La mediana del tiempo entre identificar el problema y la biopsia diagnóstica fue 104,5 días; entre identificar el problema y la primera consulta médica, 20 días, y de la primera consulta a la biopsia diagnóstica fue de 53 días. El 52,1 % se diagnosticó en estadio avanzado. Hubo asociación del retraso diagnóstico con estadio clínico avanzado (OR = 2,15; IC 95 %: 1,21-3,79). Se encontró que la edad mayor a 40 años es un factor protector contra una lesión avanzada (OR = 0,35; IC 95 %: 0,14-0,83). El retraso diagnóstico se asoció con estar afiliada al régimen subsidiado por el Estado (OR = 9,67; IC 95 %: 2,76-33,9) y tener edad mayor a 40 años (OR = 2,75; IC 95 %: 1,16-6,53). Conclusión: se requieren intervenciones educativas en las pacientes para adherir a los programas de tamización temprana o la consulta oportuna al identificar un signo o síntoma, para lograr un diagnóstico en estadios tempranos de la enfermedad. Además, se requieren estudios prospectivos para determinar los factores relacionados con la demora en recibir el tratamiento una vez diagnosticado el cáncer de seno y evaluar las intervenciones destinadas a disminuir las dilaciones en la atención de este cáncer.

ABSTRACT Objective: To determine the association between delayed diagnosis and advanced clinical stage breast cancer, and to explore the factors that influence this delay. Materials and methods: Cross-sectional study of women over 18 years of age with breast cancer who attended 4 oncology centers in Medellín, Colombia, in 2017. The "Breast Cancer Delay Questionnaire" which includes sociodemographic and clinical variables as well as time intervals was used. Crude and adjusted odds ratio (OR) were estimated, using advanced clinical stage as outcome and delayed diagnosis as exposure. Results: 242 patients were included. The median time interval between the identification of the problem and the diagnostic biopsy was 104.5 days; between the identification of the problem and the first medical visit, 20 days; and between the first visit and the diagnostic biopsy, 53 days. Of all the cases, 52.1 % were diagnosed at an advanced stage. An association was found between delayed diagnosis and advanced clinical stage (OR = 2.15 95 % CI 1.21-3.79). Age above 40 was found to be a protective factor against having an advanced-stage lesion (OR = 0.35; 95 % CI: 0.14-0.83). Delayed diagnosis was associated with affiliation to the government subsidized health system (OR = 9.67; 95 % CI 2.76- 33.9) and age over 40 years (OR = 2.75; 95 % CI: 1.16-6.53). Conclusion: Patient education is required in order to ensure adherence to early screening programs or timely consultation whenever a sign or symptom is identified, thus allowing diagnosis at an early stage of the disease. Moreover, prospective studies are needed in order to identify factors associated with delays in treatment after the diagnosis of breast cancer, and to assess interventions designed to reduce delays in the care of this form of cancer.

Diagnóstico tardio de HIV na terceira idade: uma análise de reportagens veiculadas na mídia / Late HIV diagnosis in third age: an analysis of news articles in media

Esse artigo apresenta resultados de uma pesquisa qualitativa exploratória, que buscou analisar a visão das mídias em relação ao sexo na terceira idade. Foram utilizadas cinco reportagens sobre a forma que as mídias auxiliam como ferramenta informativa sobre HIV na terceira idade. Os motivos dos idosos serem vulneráveis às IST (infecções sexualmente transmissíveis) a partir de dados midiáticos são diagnóstico tardio da doença pelos profissionais de saúde, que ao terem acesso as demandas dos pacientes, a priori, atribuem qualquer outro diagnóstico ao idoso, não considerando a possibilidade de ser um quadro clínico de HIV positivo; preconceitos, estereótipos e discriminações sociais perante a atividade sexual na terceira idade, pela crença social de vida sexual inativa da pessoa idosa. Diante destas problemáticas, se faz necessário trabalhar nas políticas públicas questões sobre soropositividade das pessoas na terceira idade, intervenções através da criação de campanhas, cartilhas e outras sobre a importância do uso do preservativo, importância do olhar humanizado do profissional de saúde voltado para a população idosa, e olhar mais minucioso e sensível aos sinais e sintomas da doença para que o tratamento possa ser praticado na fase inicial da infecção.

This article shows exploratory qualitative research outcomes that analyze how social media touch upon the theme of the sexual relations among elderly people. It was utilized five news reports published on newspapers that talk about how social media works as an informative tool about HIV among elderly people. The reasons to elderly people are vulnerable to sexually transmitted diseases, according to social media datas, can be the late diagnosis; prejudice, stereotypes and, social discrimination in relation to the sexual relations among elderly people, as a result of social representation that affirms there is not sexual practices in old age. As as result of this problem, it is necessary to work on public policies on issues of seropositivity in the old age, as well as interventions through the creation of campaigns, booklets and others approaches on the importance of condom use. The importance of the humanized approach of work of health professionals focused on older population, and a more refined look at the signs and symptoms of the HIV disease, so that treatment can be practiced in the early stages of infection.

HIV/AIDS case detection and influencing factors for late diagnosisin Hangzhou from 2013 to 2018 / 预防医学

Objective@#To analyze current situation of HIV/AIDS case detection and factors associated with late diagnosis among the newly diagnosed cases from 2013 to 2018 in Hangzhou, so as to provide basis for improving the detection capacity of HIV. @*Methods@#The data of HIV testing and newly diagnosed HIV/AIDS cases in Hangzhou from 2013 to 2018 were collected through the China AIDS Prevention and Control Information System. The proportion of HIV antibody detection and positive cases in different regions, detection ways and high-risk groups were analyzed. The influencing factors for late diagnosis were analyzed by multivariate logistic regression model. @*Results@#The proportions of cases with HIV detected, HIV positive and late diagnosis increased from 2013 to 2018, and the annual ones were 24.99%, 6.95 per ten thousand and 30.07%, respectively. The results of the multivariate logistic regression analysis showed that people who were male ( OR=1.656, 95%CI: 1.351-2.030 ) and aged older ( OR: 1.912-5.117, 95%CI: 1.250-7.904 ) had higher risks of late diagnosis; who detected HIV through pre-test of receiving blood ( OR=4.429, 95%CI:2.217-9.225 ) , other inpatient detection ( OR=2.137, 95%CI: 1.615-2.826 ) , preoperative testing ( OR=2.137, 95%CI: 1.615-2.826 ) and testing of STD clinic attendants ( OR=1.359, 95%CI: 1.007-1.834 ) had higher risks of late diagnosis compared to those diagnosed at VCT clinics; who diagnosed at CDCs ( OR=0.714,95%CI: 0.558-0.915 ) and community health centers ( OR=0.645, 95%CI: 0.441-0.943 ) had lower risks of late diagnosis than those diagnosed in hospitals; who were infected by heterosexual contact ( OR=1.299, 95%CI: 1.130-1.493 ) had a higher risk of late diagnosis than MSM; who had history of STD ( OR=0.818, 95%CI: 0.706-0.948 ) had a lower risk of late diagnosis than who did not.@*Conclusions@# HIV testing and case detection had been expanded, but late diagnosis had not been improved in Hangzhou from 2013 to 2018. Age, sex, route and institution of diagnosis, transmission route and history of STD were influencing factors of late diagnosis.

Proporção de pessoas soropositivas ao HIV diagnosticadas em ambiente hospitalar / Proportion of seropositive people diagnosed with HIV in a hospital setting

Introdução: A aids é uma manifestação clínica decorrente da infecção pelo vírus da imudeficiência humana. No Brasil de 1980 a junho 2019 foram notificados 966.058 casos de aids, com média de 39 mil novos casos nos últimos cinco anos. A maior incidência concentra- se nos indivíduos de 25 a 39 anos, de ambos os sexos, porém nota-se envelhecimento da população e aumento do diagnóstico tardio. A apresentação tardia leva ao atraso no tratamento, ao aumento da mortalidade e da transmissão do vírus. Objetivo: Analisar a proporção e percepções de pacientes hospitalizados diagnosticados em fases tardias da infecção pelo HIV. Materiais e Métodos: Estudo misto, analítico e descritivo. Desenvolvido em um serviço de atendimento hospitalar, composto por pacientes que tiveram o diagnóstico em fases tardias da infecção pelo HIV durante internação no período de janeiro de 2014 a agosto de 2019. Foram analisados prontuários, fichas de notificações e realizado entrevistas com os recém-diagnosticado. Aprovado pelo Comitê de Ética e Pesquisa através do número CAAE 03221272.0.0000.5438. Resultados: Compuseram a amostra 136 pacientes diagnosticados em fases tardias da infecção pelo HIV com faixa etária entre 20 e 76 anos e média de 44,2 anos. 68,4% eram do sexo masculino, 63,2% brancos, 64,7% solteiros, 40,4% possuíam o ensino fundamental incompleto, 54,4% eram tabagistas e 48,5% etilistas. O período de internação variou de 1 a 69 dias, com média de 13,4 dias e 39,7% evoluíram a óbito. A principal causa de internação foi febre 19,1% e o diagnóstico de internação foi pneumocistose (14,7%). Houve associação significante entre as variáveis: situação conjugal e sexo (p=0,001), diagnóstico de internação e mortalidade (p=0,004), número de dias internados e óbito (p<0,001) e número de dias internados e diagnóstico de internação (p<0,001). O acompanhamento da infecção pelo HIV nos serviços de saúde é visto como benefício adquirido. As barreiras ou dificuldades estão relacionadas ao abandono e/ou afastamento de amigos e companheiros, a autoestima, a depressão e ao preconceito tanto no âmbito familiar, social e trabalhista. Em quase todas as falas há o relato quanto à falta de informação na sociedade ocasionando o preconceito. Poucos consideraram a transmissão como um fator de risco. Considerações finais: 60,7% foram diagnosticados em fase tardia da infecção pelo HIV durante internação hospitalar. A maior lacuna permanece em aumentar o conhecimento sorológico das pessoas vivendo com HIV. Apesar das inúmeras estratégias e dos avanços na comunidade científica quanto à infecção a vulnerabilidade social e o preconceito permitem o avanço da epidemia, é necessário investimento em diagnóstico precoce, prevenção, intervenções e inovações nos programas que causem maior impacto. É indispensável à realização de novos estudos em pequenos centros populacionais que abordem o diagnóstico em fase tarda da infecção.

Introduction: SIDA is clinical manifestation resulting from HIV infection. In Brazil from 1980 to June of 2019 have been notified 966.058 cases of SIDA, with an average of 39 thousand new cases in the last five years. The highest incidence is concentrates in individuals aged 25 to 39 years old, of both genders, however there is an aging of the population and an increase in late diagnosis. Late presentation leads to delayed treatment, increased mortality and virus transmission. Objective: To analyze the proportion of seropositive people diagnosed in a hospital setting. Materials e Methods: Mixed study, analytical and descriptive. Developed in a hospital care service, composed of patients who were diagnosed with HIV/SIDA seropositivity during hospitalization from January 2014 to August 2019. Medical records and notification forms were analyzed and interviews. Approved by CEP through number CAAE 03221272.0.0000.5438. Results: A sample comprised 136 HIV seropositive patients aged between 20 and 76 years old and an averaged of 44,2 years old. 68,4% were male, 63,2% were White, 64,7% were single, 40,4% had incomplete primary school, 54,4% were smokers and 48,5% were alcoholics. The hospitalization period ranged from 1 to 69 days, with an average of 13,4 days and 39,7% evolved to death. The main cause of hospitalization was fever 19,1% and the diagnosis of hospitalization was pneumocystosis (14,7%). There was a significant association between the variables: marital status and gender (p=0,001), diagnosis of hospitalization and mortality (p=0,004), number of days hospitalized and death (p<0,001). Monitoring HIV infection in health services is seen as an acquired benefit. Barriers or difficulties are related to abandonment and/or withdrawal from friends and companions, the self-esteem, depression, and prejudice in both families, social and labour area. In almost all speeches there is a report about the lack of information in society causing prejudice. Few considered transmission as a risk factor. Final considerations: 60,7 % were diagnosed in a hospital, the biggest gap remains in increasing the serological knowledge of HIV/SIDA patients. Despite the innumerable strategies and advances in the scientific community as for infection, social vulnerability and prejudice allows the epidemic to advance, investment in early diagnosis, prevention, interventions and innovations in programs that have the greates impact is necessary. It is essential to carry out new studies in small population centers that address late presentation in a hospital environment, as well as using the MCS in this population.

Evaluation of delays in diagnosis and treatment of breast cancer in a reference center: a retrospective analysis / Avaliação do atraso no diagnóstico e tratamento do câncer de mama em um centro de referência: uma análise retrospectiva

Objectives: To evaluate possible causes of delay in the diagnosis and treatment of breast cancer in a population treated exclusively by the Brazilian Unified Health System (SUS) of Brazil. Methods: A retrospective analysis of the medical patient charts of 173 patients treated at IMIP, between January 2011 and December 2017. Time intervals (biopsy and treatment intervals) were associated with sociodemographic and clinical variables utilizing statistical analysis. Results: The mean age was 56.36 years, 116 (67.1%) were from Recife's metropolitan region and the majority were illiterate or had up to 8 years of schooling. The biopsy interval ranged between 0 and 826 days (41.42; med 12.50) while the treatment interval ranged from 0 and 460 days (94.6; med 69.0). There was no statistically significant association of these intervals with clinical variables such as origin, educational level, age, tumor staging, type of treatment and clinical situation of the patients at the end of the study. Conclusions: Although the early diagnosis and treatment of breast cancer are fundamental, the data of this present investigation showed that median delays of 3 months for starting treatment in a public hospital were not associated with worsening of prognosis or survival of the patients.

Objetivos: Avaliar possíveis causas de atraso no diagnóstico e tratamento do carcinoma mamário em uma população atendida exclusivamente pelo Sistema Único de Saúde (SUS) do Brasil. Métodos: Foi realizada uma análise retrospectiva dos prontuários de 173 pacientes tratadas no Instituto Materno Infantil Prof. Fernando Figueira (IMIP), entre janeiro de 2011 e dezembro de 2017. Intervalos de tempo (intervalo de biópsia e de tratamento) foram relacionados com variáveis sociodemográficas e clínicas por meio de análise estatística. Resultados: A média de idade foi 56,36 anos, 116 mulheres (67,1%) eram da região metropolitana do Recife e a maioria era analfabeta ou tinha até 8 anos de escolaridade. O intervalo de biópsia variou entre 0 e 826 dias (41,42; med 12,50), enquanto o intervalo de tratamento variou entre 0 e 460 dias (94,6; med 69,0). Não houve associação estatisticamente significante desses intervalos com variáveis clínicas como procedência, nível educacional, idade, estadiamento, tipo de tratamento e situação clínica das pacientes ao final do estudo. Conclusões: Embora o diagnóstico e tratamento precoces do câncer de mama sejam fundamentais, os dados da presente investigação mostraram que atrasos medianos de três meses para início do tratamento em hospital público não foram associados com piora do prognóstico ou sobrevida das pacientes.

Diagnóstico tardío de VIH/sida en pacientes rurales dado por baja sospecha diagnostica en la comunidad médica. Reportes de caso / Late diagnosis of HIV/AIDS in rural patients due to low diagnostic suspicion among the medical community. Case reports

Resumen Introducción. La prevalencia de la infección por el virus de inmunodeficiencia humana (VIH) en Latinoamérica no ha sido estudiada de forma adecuada, pero se calcula que en Chile la mitad de los pacientes que están infectados no han sido diagnosticados y no están bajo control ni tratamiento. Presentación de los casos. Se presentan dos casos clínicos de pacientes masculinos de 22 y 33 años, sin antecedentes mórbidos, con múltiples consultas en diversos servicios clínicos. El diagnóstico se hizo en etapa sida (síndrome de inmunodeficiencia adquirida), con las complicaciones que se asocian cuando se diagnostica de manera tardía. Conclusiones. El VIH es una patología subdiagnosticada, en su mayoría por falta de sospecha y por los prejuicios de la población respecto a la realización del test de VIH. El cuerpo médico debe tomar la responsabilidad de pesquisar los casos de manera temprana para disminuir el impacto de la enfermedad, en especial en lugares con población vulnerable.

Abstract Introduction: The prevalence of the human immunodeficiency virus (HIV) infection in Latin America has not been adequately studied, but it is estimated that in Chile half of the patients who are infected have not been diagnosed and are not controlled or receiving treatment. Case presentation: This paper presents two clinical cases of male patients aged 22 and 33, without a medical history, and with multiple consultations for different reasons in various clinical services. The diagnosis was made at the AIDS stage (acquired immunodeficiency syndrome), with the complications associated with late diagnosis. Conclusions: HIV is an underdiagnosed pathology, mostly due to lack of suspicion and prejudiced attitudes towards HIV testing. The medical staff should take responsibility for the early study of these cases to reduce the impact of the disease, especially in places where vulnerable populations live.

Aspectos clínicos y de laboratorio en pacientes con diagnóstico tardío de SIDA / Clinical and laboratory findings in patients with late diagnosis of AIDS

RESUMEN Introducción: El retraso diagnóstico de la infección por SIDA constituye un problema de gran magnitud con importantes repercusiones para los propios infectados y para la sociedad en general. Objetivos: Caracterizar a los pacientes con diagnóstico tardío de infección por VIH y su evolución a los 6 meses del diagnóstico. Material y Métodos: Se realizó un estudio longitudinal de corte prospectivo que incluyó 248 casos con diagnóstico positivo de infección por VIH durante su ingreso o en la consulta de infectología del Instituto de Medicina Tropical "Pedro Kourí" desde enero de 2015 hasta diciembre de 2016, los que se dividieron en dos grupos de comparación, según diagnóstico tardío (n=79) o no (n=169) de la enfermedad. Resultados: La edad avanzada y el sexo masculino fueron factores relacionados con el diagnóstico tardío de la infección por VIH. La fiebre (31,7%) y los síntomas respiratorios (20,3%) fueron las formas más frecuentes de presentación, mientras que la neumonía por Pneumocystis jirovecii fue la enfermedad con más incidencia en el momento del diagnóstico. La mitad de los pacientes se encontraban con inmunodepresión severa en el momento del diagnóstico. Los pacientes con diagnóstico tardío mostraron una supervivencia significativamente menor a los 6 meses del diagnóstico en comparación con los pacientes con diagnóstico precoz. La carga viral y el nivel de linfocitos CD4 fueron parámetros de laboratorio con un alto valor predictivo de mortalidad. Conclusiones: El diagnóstico tardío de infección por VIH conlleva un alto riesgo de mortalidad, mayor en aquellos con afectación de la carga viral y el nivel de linfocitos T CD4+.

ABSTRACT Introduction: Late diagnosis of HIV is a major problem with important consequences for the people infected with this virus and the society in general. Objectives: To characterize patients with late diagnosis of HIV infection and their evolution six months after diagnosis. Material and Methods: We conducted a prospective longitudinal study which included 248 cases with positive diagnosis of HIV infection during admission at the Pedro Kourí Tropical Medicine Institute between January 2015 and December 2016. They were divided into two comparison groups which included patients with late diagnosis (n=79) and those with no late diagnosis (n=169) of the disease. Results: Advanced age and male sex were factors related to the late diagnosis of HIV infection. Fever (31.7%) and respiratory symptoms (20.3%) were the most frequent forms of presentation, whereas Pneumocystis jirovecii pneumonia was the disease with the highest incidence at the time of diagnosis. Half of the patients were found to have severe immunosuppression at the time of diagnosis. Patients with late diagnosis showed a significantly diminished survival six months after being diagnosed compared with those patients with early diagnosis. Viral load and CD4+ T count were laboratory parameters with a high predictive value of mortality. Conclusions: Late diagnosis of HIV leads to a high risk of mortality, which is higher in those with affectation of the viral load and low CD4+ T cell count.

Características clínicas de pacientes con Virus de Inmunodeficiencia Humana. Hospital General Docente "Enrique Cabrera" / Clinical characteristics of patients with Human Immunodeficiency Virus. Enrique Cabrera General Teaching Hospital

RESUMEN Introducción: La atención de pacientes con VIH se realiza actualmente en Cuba de forma descentralizada; cada vez es mayor el número de casos ingresados en hospitales generales. Objetivo: Determinar características clínicas de pacientes con VIH ingresados en el Hospital General Docente "Enrique Cabrera". Material y Métodos: Se realizó una investigación descriptiva retrospectiva de pacientes con VIH ingresados en el Hospital General Docente "Enrique Cabrera" en el período comprendido del 1RO de enero de 2007 hasta 31 de diciembre de 2013. La muestra estuvo constituida por 86 casos. Resultados: El número de pacientes se incrementó por años, los casos masculinos constituyeron 79%, los grupos de edad más frecuentes 21 a 30 y 41 a 50 años. Las adenopatías generalizadas fue el hallazgo al examen físico más frecuente. Predominó el conteo de T CD4 menor de 200 células/mm3. Las patologías respiratorias constituyeron 25% de las causas de ingreso. Se realizó el diagnostico hospitalario en 36% de los casos de los cuales el 77% eran diagnósticos tardíos de la enfermedad. Conclusiones: Los pacientes con VIH constituyen una población joven que ingresa cada vez más a nivel secundario hospitalario, con características propias de esta enfermedad y patologías que ponen en riesgo su vida.

ABSTRACT Introduction: The care of patients with Human Immunodeficiency Virus is currently carried out in a decentralized way in Cuba. The number of patients with HIV admitted to general hospitals is increasing. Objective: To determine the clinical characteristics of patients with HIV admitted to Enrique Cabrera General Teaching Hospital. Material and Methods: A descriptive retrospective study was carried out in patients with HIV admitted to Enrique Cabrera General Teaching Hospital from January 1st, 2007 to December 31st, 2013. The sample consisted of 86 cases. Results: The number of patients increased per year, male cases constituted 79 %, the most frequent age groups were from 21 to 30 years and from 41 to 50 years. Generalized adenopathies were the most frequent findings on physical examination. CD4 T- cell counts below 200 cells/mm3 predominated in the study. Respiratory pathologies constituted 25 % of the causes of admission. Hospital diagnosis was carried out in 36 % of the cases, 77 % of which had late diagnoses of HIV. Conclusions: HIV patients constitute a young population that is admitted more and more to secondary level hospitals. They present own characteristics of the disease and pathologies that put their lives at risk.

Analysis of late diagnosis and its influencing factors of newly reported HIV/AIDS in Guizhou Province from 2014 to 2018 / 中华疾病控制杂志

Objective To find late diagnosis and its influencing factors of newly reported HIV/AIDS in Guizhou Province from 2014 to 2018. Methods Through the Chinese National Comprehensive HIV/AIDS Prevention and Care Information System,all newly reported HIV/AIDS cases from 2014 to 2018 in Guizhou Province were analyzed and related factors of late diagnosis were analyzed using binary Logistic regression model. Results From 2014 to 2018, there were 33 611 newly reported HIV/AIDS cases in Guizhou Province, and the late diagnosis rates of newly reported cases were 35.46%, 34.49%, 38.35%, 39.74% and 38.80% respectively. The analysis showed that the proportion of late diagnosis cases from medical institutions increased year by year ( 2=64.603,P<0.001). By analyzing the late diagnosis rate of cases from different sample sources, medical institutions was significantly higher than that reported by voluntary counseling and testing, positive spouses or sexual partners( 2=276.033,P<0.001). Multivariate analysis showed that gender, marital status, route of transmission, occupation, ethnicity and source of samples were associated with the late diagnosis of newly reported cases (all P<0.05). Conclusions It shows a slow upward trend of late diagnosis rate among HIV/AIDS reported in Guizhou Province from 2014 to 2018.On the one hand, it is of great significance to continue to strengthen the publicity and education of the whole population in Guizhou , in order to improve the awareness of HIV active detection. On the other hand, we should continue to expand HIV testing in Guizhou Province to improve the early detection level of HIV/AIDS.

Issue in late diagnosis of gastric cancer / Монголын Анагаах Ухаан

Introduction@#Gastric cancer is still one of the most leading causes of mortality in the world. The highest mortality rate of gastric cancer is estimated in Mongolia. South Korea and Japan, where leading the incidence of gastric cancer, mortality rates are observed in 51th and 31nd rank respectively. In Mongolia, gastric cancer is the second leading site, after liver cancer.@*Goal@#We aimed to determine the cause of late diagnosis of gastric cancer and to evaluate supply of upper endoscopy devices and human resource for gastric cancer in the general hospital of provinces and districts. @*Materials and Methods@#In this study, 84 patients suffering from gastric cancer (42 patients in III, IV TNM stage; 42 patients in I, II TNM stage)were investigated in National Cancer Center, Mongolia. A survey questionnaire which included age, gender, education, income, risk factors and clinical questions was detected from all patients. And we conducted study of supply of upper endoscopy devices and human resource for gastric cancer in general hospitals of from 21 provinces and general hospitals of 6 districts by questionnaire. @*Results@#Seventy three(86.9%) patients were over 50 years old and the highest rates of gastric cancer were in group of 61-70 years (40.5%). From the results, the reason to visiting hospital was significantly different between two groups. 55.1% of patients suffering from early-stage gastric cancer were voluntarily diagnosed by upper endoscopy. In contrary, 55.8% of patients suffering from late-stage gastric cancer have visited the hospital due to worsening symptoms or dysphagia and vomiting. Factors such as age, gender, education, employment status and income had no significant effect on late diagnosis of gastric cancer. In totally 24(89%)general hospitals out of 27 had upper endoscopy devices and 22 (81.5%) hospitals had endoscopist. Although 75% of total general hospitals conduct annual cancer screening, 64% of them do not perform the endoscopy in annual screening.@*Conclusion@#In our country, late diagnosis of gastric cancer is related to the attitudes of patients for preventing and screening disease. Therefore, it is important to improve the health education of the population and to develop healthy, right attitudes and practices. And the study revealed that general hospitals have insufficient for upper endoscopy devices and human resource.

Narrativas autobiográficas de mulheres com endometriose: que fenômenos permeiam os atrasos no diagnóstico? / Autobiographic narratives of women with endometriosis: which phenomena permeate the delays in diagnosis?

Resumo Este artigo objetiva compreender a rede de significados construídos intersubjetivamente que caracterizam o fenômeno da endometriose na vida das mulheres acometidas, equilibrando perspectivas micro e macrossociais. Trata-se de uma pesquisa qualitativa ancorada na técnica de narrativa autobiográfica do sociólogo Fritz Schütze, que explorou a experiência de 29 mulheres com endometriose. A análise foi realizada de acordo com o método reconstrutivo proposto por Schütze. Para além da estrutura esquemática baseada nos dados indexados, emergiam duas teorias: negligência estrutural legitimada por questões de gênero e barreiras e atalhos na rede de assistência. As narrativas revelam a institucionalização de questões de gênero nos serviços de saúde como reflexo de relações embutidas na estrutura social. Negligência, psiquiatrização do sofrimento feminino, centralidade das ações na função reprodutiva e medicalização precoce do corpo feminino foram fenômenos sociais identificados nas narrativas. Esses aspectos estruturais, legitimados pela violência cultural, relacionam-se de forma simbiótica a lapsos na rede de assistência. O enfrentamento a esse fenômeno demanda mais do que a reorganização das linhas de cuidado segundo o paradigma da integralidade, embora esta emerja como uma possiblidade. É crucial a compreensão das microestruturas relacionadas ao gênero que fundamentam os arranjos sociais e a organização assistencial, produzindo violências institucionais e múltiplos sofrimentos.

Abstract This article aims to understand the network of intersubjectively constructed meanings that characterize the phenomenon of endometriosis in the lives of affected women, balancing micro and macrosocial perspectives. This is a qualitative research based on the autobiographical narrative technique of sociologist Fritz Schütze, who explored the experience of 29 women with endometriosis. The analysis was performed according to the reconstructive method proposed by Schütze. Beyond the schematic structure based on indexed data, two theories emerged: structural neglect legitimized by gender issues and barriers and shortcuts in the care network. The narratives reveal the institutionalization of gender issues in health services as a reflection of relationships embedded in the social structure. Neglect, psychiatrization of female suffering, centrality of actions in reproductive function and early medicalization of the female body were social phenomena identified in the narratives. These structural aspects, legitimized by cultural violence, are symbiotically related to lapses in the care network. Coping with this phenomenon demands more than the reorganization of care lines according to the integrality paradigm, although it emerges as a possibility. Understanding the gender-related microstructures that underlie social arrangements and care organization, producing institutional violence and multiple sufferings, is crucial.

Correlation between blood routine indicators and CD4+ T cell count in AIDS patients without antiviral therapy / 中国基层医药

Objective@#To study the correlation between the blood routine indicators and CD4+ T, CD8+ T lymphocytes in AIDS patients without antiviral treatment, and to find a simple, cheap and effective monitoring indicator.@*Methods@#A study of 333 AIDS patients without antiviral treatment was performed.The methods of regression analysis and other statistical methods were applied to research the correlation between WBC, W-SCC and CD4+ T, CD8+ T cell count among HIV/AIDS.@*Results@#The rate of routine blood abnormalities among 333 HIV/AIDS patients was very high, the main test indicators within the reference range only accounted for 30.63%.The proportion of late diagnosis infected with HIV among women was higher than that of males.Significant correlations were observed between CD4+ Tcell count and WBC, W-SCC, W-LCC, RBC, HGB, PLT(r=0.408, 0.541, 0.157, 0.337, 0.338, 0.166). The equation between W-SCC (x) and CD4+ cell count (y) was y=120.913x+ 90.339.@*Conclusion@#There is a strong correlation between CD4+ T lymphocyte count and lymphocyte count in AIDS patients without antiviral treatment.It can be used as an important indicator of immune status in patients with AIDS.At the same time, we should strengthen the propaganda of AIDS prevention, promote AIDS early detection, early treatment, and improve the quality of life of AIDS patients.

Analysis on late HIV diagnosis among newly reported human immunodeficiency virus/acquired immunodeficiency syndrome cases between 2009 and 2017 in medical institutions / 中华预防医学杂志

Objective@#To analyze the proportion of late HIV diagnosis and the factors associated with late HIV diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) cases newly reported by medical institutions in China from 2009 to 2017.@*Methods@#Data of adult HIV/AIDS cases newly reported by medical institutions in China from 2009 to 2017 were downloaded from the AIDS prevention and control information system of China′s disease prevention and control information system. The basic information, sample source, transmission route, flow of HIV/AIDS patients and the first CD4+ T lymphocyte count were analyzed in 293 187 cases who had been tested for CD4+ T lymphocyte count within 91 days of diagnosis. The multivariate logistic regression was used to analyze the late HIV diagnosis relevant factors.@*Results@#A total of 293 187 newly reported HIV/AIDS cases in medical institutions were analyzed, and the mean age was (44.7±15.6) years. The proportion of late diagnosis in all cases was 68.4% (200 503 cases). From 2009 to 2017, the proportions of late diagnosis were 71.7% (6 263/8 737), 69.5% (8 283/11 917), 69.2% (13 230/19 116), 67.0% (17 186/25 669), 66.5% (21 833/32 834), 66.4% (26 541/39 944), 67.2% (31 257/46 536), 69.6% (35 920/51 646) and 70.4% (39 990/56 789) respectively. Compare with female cases, the OR (95%CI) of male cases with late diagnosis was 1.18 (1.15-1.20). Compared with the 18 to 29 years old group, the 30 to 39 years, 40 to 49 years, 50 to 59 years and 60 years old and over groups have higher risk of late diagnosis with OR (95%CI) values about 1.65 (1.61-1.69), 2.13 (2.08-2.19), 2.25 (2.18-2.31) and 2.33 (2.26-2.39) respectively. Compared with the college education level and above group, OR (95% CI) values of junior middle school and below group was 1.11 (1.08-1.14); and OR (95%CI) values of senior high school and equal level education group was 1.08 (1.04-1.11). Compared with the migrant population, the resident population has higher risk of late diagnosis (OR=1.06, 95%CI: 1.04-1.08). Compared with other national minorities, Han nationality has higher risk of late diagnosis (OR=1.33, 95%CI: 1.30-1.36). Compared with divorce, widowed and other marital status, married spouse have higher risk of late diagnosis (OR=1.08, 95%CI: 1.06-1.10). Compared with patients receiving other testing services, the OR (95%CI) values of examination before blood transfusion or blood products, pregnancy and childbirth examination, STD clinic and preoperative examination were 1.16 (1.08-1.25), 0.52 (0.50-0.54), 0.63 (0.61-0.64), 0.66 (0.65-0.68) respectively.@*Conclusion@#The proportion of late HIV diagnosis of newly reported HIV/AIDS cases in medical institutions in China was relatively high from 2009 to 2017 and the factors associated with late HIV diagnosis included male, Han nationality, old age group, low educational level, married spouse, other testing services and resident population.

Analysis of the influential factors of late diagnosis among newly identified HIV/AIDS cases in Anhui Province, 2011-2015 / 中华预防医学杂志

Objective@#To analyze the base situation and influential factors of late diagnosis among newly identified HIV/AIDS cases in Anhui Province from 2011 to 2015.@*Methods@#Database information of the newly identified HIV/AIDS cases in Anhui Province from 2011 to 2015 were downloaded from the National HIV/AIDS Comprehensive Information System of China's disease prevention and control information system. To analyze the data including basic information, sample source, route of HIV transmission, population mobility, venereal disease, death and first CD4 count; and the number of 7 073 cases were classified according to late diagnosis and non-late diagnosis criteria. The Chi-square test and logistic regression analysis were used to analyze the influential factors of HIV late diagnosis.@*Results@#A total of 7 073 newly identified HIV/AIDS cases were analyzed, and the mean age was (38.5±15.0) years. The proportion of late diagnosis in all counted cases was 41.7% (2 949/7 073); from 2011 to 2015, the proportions of late diagnosis were 59.7% (485/812), 46.5% (531/1 141), 42.7% (587/1 376), 36.1% (609/1 686), and 35.8% (737/2 058), respectively. Compared with the 0 to 19 years group, the 40 to 59 years group and over 60 years old group have higher risk of late diagnosis (OR=2.68, 95%CI: 1.94-3.71; OR=2.18, 95%CI: 1.53-3.10, respectively). Compared with the high education group, the illiterate and primary school education group have higher risk of late diagnosis (OR=1.74, 95%CI: 1.36-2.22; OR=1.64, 95%CI: 1.34-2.01, respectively). Compared with other sample sources, medical institutions have higher risk of late diagnosis (OR=2.64, 95%CI: 2.28-3.05). Compared with migrant population, the resident population have higher risk of late diagnosis (OR=1.80, 95%CI: 1.53-2.11).@*Conclusion@#The proportion of late diagnosis among newly identified HIV/AIDS cases in Anhui province was relatively high from 2011 to 2015. The main risk factors of late diagnosis included cases reported by medical institutions, resident population, over 40 years old age group and low education level.