Racial and Ethnic Disparities in Cervical Cancer Screening From Three U.S. Healthcare Settings.

INTRODUCTION: This study sought to characterize racial and ethnic disparities in cervical cancer screening and follow-up of abnormal findings across 3 U.S. healthcare settings. METHODS: Data were from 2016 to 2019 and were analyzed in 2022, reflecting sites within the Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations Research Center, part of the Population-based Research to Optimize the Screening Process consortium, including a safety-net system in the southwestern U.S., a northwestern mixed-model system, and a northeastern integrated healthcare system. Screening uptake was evaluated among average-risk patients (i.e., no previous abnormalities) by race and ethnicity as captured in the electronic health record, using chi-square tests. Among patients with abnormal findings requiring follow-up, the proportion receiving colposcopy or biopsy within 6 months was reported. Multivariable regression was conducted to assess how clinical, socioeconomic, and structural characteristics mediate observed differences. RESULTS: Among 188,415 eligible patients, 62.8% received cervical cancer screening during the 3-year study period. Screening use was lower among non-Hispanic Black patients (53.2%) and higher among Hispanic (65.4%,) and Asian/Pacific Islander (66.5%) than among non-Hispanic White patients (63.5%, all p<0.001). Most differences were explained by the distribution of patients across sites and differences in insurance. Hispanic patients remained more likely to screen after controlling for a variety of clinical and sociodemographic factors (risk ratio=1.14, CI=1.12, 1.16). Among those receiving any screening test, Black and Hispanic patients were more likely to receive Pap-only testing (versus receiving co-testing). Follow-up from abnormal results was low for all groups (72.5%) but highest among Hispanic participants (78.8%, p<0.001). CONCLUSIONS: In a large cohort receiving care across 3 diverse healthcare settings, cervical cancer screening and follow-up were below 80% coverage targets. Lower screening for Black patients was attenuated by controlling for insurance and site of care, underscoring the role of systemic inequity. In addition, it is crucial to improve follow-up after abnormalities are identified, which was low for all populations.

A single physical education session improves subsequent academic performance in rural school students / Uma única aula de educação física melhora o desempenho acadêmico subsequente em estudantes de escola rural / Una única clase de educación física mejora el posterior desempeño académico en alumnos de escuela rural

ABSTRACT Introduction: Activity breaks or physical exercise interventions in schools are linked to better cognitive function in adolescents. However, few studies have evaluated the relationship between physical exercise and cognition in rural schools, where drop-out levels tend to be higher and academic achievement lower. Objective: To analyze the effects of a physical exercise class (PE) on subsequent academic performance of students, and how they felt during mathematics (MATH) and Portuguese language (PL) tests. Methods: Thirty-six students (14.9 ± 1.5 years) randomly carried out 30 min of PE, performed at 74.3 ± 11.8%HRmax, while a control group (CON) remained seated watching a movie, prior to the tests (PE-MATH; PE-PL; CON-MATH; CON-PL). Results: The PE-MATH group presented higher scores (5.3 ± 2.2) than the CON-MATH group (4.0 ± 2.2). The tests were completed more quickly in PE-PL (7.8 ± 3.3 minutes) than in CON-PL (10.5 ± 4.2 minutes). The number of correct answer per minute was higher in PE-MATH and PE-PL (0.52 ± 0.25; 0.64 ± 0.51) than in CON-MATH and CON-PL (0.35 ± 0.19; 0.41 ± 0.41). Furthermore, 38.9% of PE-MATH felt more focused during the test, while only 16.7% of CON-MATH felt more focused. During the Portuguese language test, 27.8% of CON-PL complained of greater apprehensiveness, compared to 8.3% for PE-PL. Also, 36.1% reported feeling fatigued during PL after PE, compared to 8.3% in the CON-PL group. Conclusions: PE improved the adolescents' academic performance. Despite feeling fatigue, more students who performed physical exercise felt less apprehensive and more focused during the tests after PE. Level of evidence I; STARD: studies of diagnostic accuracy.

RESUMO Introdução: Os intervalos com atividade ou as intervenções com programas de exercícios na escola estão relacionados com a melhora da função cognitiva em adolescentes. Contudo, poucos estudos avaliaram a relação entre exercício físico e cognição em escolas de zonas rurais, onde os níveis de evasão são altos e o rendimento acadêmico é baixo. Objetivo: Analisar os efeitos de uma aula de exercício físico (EF) sobre o desempenho acadêmico subsequente dos alunos e o que sentem durante os testes de matemática (MAT) e de língua portuguesa (PO). Métodos: Trinta e seis estudantes (14,9 ± 1,5 anos) foram divididos randomicamente em dois grupos: um com 30 minutos de EF realizados a 74,3 ± 11,8% da FCmáx e um controle (CON), que permaneceram sentados assistindo a um filme antes dos testes (EF-MAT; EF-PO; CON-MAT; CON-PO). Resultados: O EF-MAT apresentou maior escore (5,3 ± 2,2) que o CON-MAT (4,0 ± 2,2). Os testes foram concluídos mais rapidamente no EF-PO (7,8 ± 3,3) do que no CON-PO (10,5 ± 4,2). O número de respostas corretas por minuto foi maior no EF-MAT e no EF-PO (0,52 ± 0,25; 0,64 ± 0,51) do que no CON-MAT e no CON-PO (0,35 ± 0,19; 0,41 ± 0,41). Além disso, 38,9% do EF-MAT sentiram que estavam mais concentrados durante o teste, em comparação com apenas 16,7% do CON-MAT que se sentiram mais concentrados. Durante o a prova de português, 27,8% dos CON-PO reclamaram de maior apreensão quando comparados com 8,3% do EF-PO. Ainda, 36,1% relataram cansaço durante o teste de PO depois de EF, comparados com 8,3% do grupo CON-PO. Conclusão: A aula de EF melhorou o desempenho acadêmico dos adolescentes. Apesar da sensação de cansaço, mais estudantes sentiram menos apreensão e estavam mais concentrados durante os testes depois de EF. Nível de evidência I; Estudos de acurácia diagnóstica (STARD).

RESUMEN Introducción: Los intervalos con actividad o las intervenciones con programas de ejercicios en la escuela están relacionados con la mejora de la función cognitiva en adolescentes. Sin embargo, pocos estudios evaluaron la relación entre ejercicio físico y cognición en escuelas de zonas rurales, en donde los niveles de evasión son altos y el rendimiento académico es bajo. Objetivo: Analizar los efectos de una clase de ejercicio físico (EF) sobre el desempeño académico subsiguiente de los alumnos y lo que sienten durante los tests de matemática (MAT) y de idioma portugués (PO). Métodos: Treinta y seis estudiantes (14,9 ± 1,5 años) fueron divididos aleatoriamente en dos grupos: uno con 30 minutos de EF realizados a 74,3 ± 11,8% de la FCmáx y un control (CON), que permanecieron sentados viendo una película antes de los tests (EF-MAT; EF-PO; CON-MAT; CON-PO). Resultados: El EF-MAT presentó mayor puntuación (5,3 ± 2,2) que el CON-MAT (4,0 ± 2,2). Los tests fueron concluidos más rápidamente en el EF-PO (7,8 ± 3,3) que en el CON-PO (10,5 ± 4,2). El número de respuestas correctas por minuto fue mayor en el EF-MAT y en el EF-PO (0,52 ± 0,25,0,64 ± 0,51) que en el CON-MAT y en el CON-PO (0,35 ± 0,19, 0,41 ± 0,41). Además, 38,9% del EF-MAT sintió que estaba más concentrado durante el test, en comparación con sólo 16,7% del CON-MAT que se sintió más concentrado. Durante la prueba de portugués, 27,8% de los CON-PO reclamó de mayor aprehensión cuando comparado con 8,3% del EF-PO. Además, 36,1% relató cansancio durante el test de PO después del EF, comparado con el 8,3% del grupo CON-PO. Conclusión: La clase de EF mejoró el desempeño académico de los adolescentes. A pesar de la sensación de cansancio, más estudiantes sintieron menos aprehensión y estaban más concentrados durante los tests después de EF. Nivel de evidencia I; Estudios de precisión diagnóstica (STARD).

The rehabilitation enhancing aging through connected health (REACH) study: study protocol for a quasi-experimental clinical trial.

BACKGROUND: Mobility limitations among older adults increase the risk for disability and healthcare utilization. Rehabilitative care is identified as the most efficacious treatment for maintaining physical function. However, there is insufficient evidence identifying a healthcare model that targets prevention of mobility decline among older adults. The objective of this study is to evaluate the preliminary effectiveness of a physical therapy program, augmented with mobile tele-health technology, on mobility function and healthcare utilization among older adults. METHODS: This is a quasi-experimental 12-month clinical trial conducted within a metropolitan-based healthcare system in the northeastern United States. It is in parallel with an existing longitudinal cohort study evaluating mobility decline among community-dwelling older adult primary care patients over one year. Seventy-five older adults (≥ 65-95 years) are being recruited using identical inclusion/exclusion criteria to the cohort study. Three aims will be evaluated: the effect of our program on 1) physical function, 2) healthcare utilization, and 3) healthcare costs. Changes in patient-reported function over 1 year in those receiving the intervention (aim 1) will be compared to propensity score matched controls (N = 150) from the cohort study. For aims 2 and 3, propensity scores, derived from logistic regression model that includes demographic and diagnostic information available through claims and enrollment information, will be used to match treatment and control patients in a ratio of 1:2 or 1:3 from a Medicare Claims Registry derived from the same geographic region. The intervention consists of a one-year physical therapy program that is divided between a combination of outpatient and home visits (6-10 total visits) and is augmented on a computerized tablet using of a commercially available application to deliver a progressive home-based exercise program emphasizing lower-extremity function and a walking program. DISCUSSION: Incorporating mobile health into current healthcare models of rehabilitative care has the potential to decrease hospital visits and provide a longer duration of care. If the hypotheses are supported and demonstrate improved mobility and reduced healthcare utilization, this innovative care model would be applicable for optimizing the maintenance of functional independence among community-dwelling older adults. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT02580409 (Date of registration October 14, 2015).

Defining patient complexity from the primary care physician's perspective: a cohort study.

BACKGROUND: Patients with complex health needs are increasingly the focus of health system redesign. OBJECTIVE: To characterize complex patients, as defined by their primary care physicians (PCPs), and to compare this definition with other commonly used algorithms. DESIGN: Cohort study. SETTING: 1 hospital-based practice, 4 community health centers, and 7 private practices in a primary care network in the United States. PARTICIPANTS: 40 physicians who reviewed a random sample of 120 of their own patients. MEASUREMENTS: After excluding patients for whom they were not directly responsible, PCPs indicated which of their patients they considered complex. These patients were characterized, independent predictors of complexity were identified, and PCP-defined complexity was compared with 3 comorbidity-based methods (Charlson score, Higashi score, and a proprietary Centers for Medicare & Medicaid Services algorithm). RESULTS: Physicians identified 1126 of their 4302 eligible patients (26.2%) as complex and assigned a mean of 2.2 domains of complexity per patient (median, 2.0 [interquartile range, 1 to 3]). Mental health and substance use were identified as major issues in younger complex patients, whereas medical decision making and care coordination predominated in older patients (P<0.001 for trends by decade). Major independent predictors of PCP-defined complexity (P<0.001) included age (probability of complexity increased from 14.8% to 19.8% with age increasing from 55 to 65 years), poorly controlled diabetes (from 12.7% to 47.6% if hemoglobin A1c level≥9%), use of antipsychotics (from 12.7% to 31.8%), alcohol-related diagnoses (from 12.9% to 27.4%), and inadequate insurance (from 12.5% to 19.2%). Classification agreement for complex patients ranged from 26.2% to 56.0% when PCP assignment was compared with each of the other methods. LIMITATION: Results may not be generalizable to other primary care settings. CONCLUSION: Primary care physicians identified approximately one quarter of their patients as complex. Medical, social, and behavioral factors all contributed to PCP-defined complexity. Physician-defined complexity had only modest agreement with 3 comorbidity-based algorithms. PRIMARY FUNDING SOURCE: Partners Community Healthcare, Inc.

Variation in eligibility criteria from studies of radiculopathy due to a herniated disc and of neurogenic claudication due to lumbar spinal stenosis: a structured literature review.

STUDY DESIGN: A structured literature review. SUMMARY OF THE BACKGROUND DATA: Widely recognized classification criteria for rheumatologic disorders have resulted in well-defined patient populations for clinical investigation. OBJECTIVE: We sought to determine whether similar criteria were needed for back pain disorders by examining variability in eligibility criteria in published studies. METHODS: Studies involving radiculopathy due to lumbar herniated disc (HD) and for neurogenic claudication due to lumbar spinal stenosis (LSS) were identified. Randomized controlled trials published between January 1, 2006 and October 1, 2008 in select peer reviewed journals were retrieved, their eligibility criteria were identified and categorized. RESULTS: Twelve eligible HD studies were identified. Thirteen unique categories of eligibility criteria were identified with a mean of 3.9 (+/-2.0) and a range from 0 to 8 categories per study. More categories were present for studies that included nonsurgical (5.6 +/- 2.5) treatment for studies with only surgical treatment (2.6 +/- 1.7) P = 0.04). Seven LSS studies met eligibility criteria, and 9 unique categories were identified. A mean of 5.0 (+/-2.2) categories with a range from 2 to 7 was used per study. CONCLUSION: Wide variation in the number and type of eligibility criteria from randomized clinical trials of well defined back pain syndromes was identified. These results support the need for developing and disseminating international classification criteria for these clinical conditions.