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Several comorbidities have been shown to be associated with coronavirus disease 2019 (COVID-19) related severity and mortality. However, considerable variation in the prevalence estimates of comorbidities and their effects on COVID-19 morbidity and mortality have been observed in prior studies. This systematic review and meta-analysis aimed to determine geographical, age, and gender related differences in the prevalence of comorbidities and associated severity and mortality rates among COVID-19 patients. We conducted a search using PubMed, Scopus, and EMBASE to include all COVID-19 studies published between January 1st, 2020 to July 24th, 2020 reporting comorbidities with severity or mortality. We included studies reporting the confirmed diagnosis of COVID-19 on human patients that also provided information on comorbidities or disease outcomes. We used DerSimonian and Laird random effects method for calculating estimates. Of 120 studies with 125,446 patients, the most prevalent comorbidity was hypertension (32%), obesity (25%), diabetes (18%), and cardiovascular disease (16%) while chronic kidney or other renal diseases (51%, 44%), cerebrovascular accident (43%, 44%), and cardiovascular disease (44%, 40%) patients had more COVID-19 severity and mortality respectively. Considerable variation in the prevalence of comorbidities and associated disease severity and mortality in different geographic regions was observed. The highest mortality was observed in studies with Latin American and European patients with any medical condition, mostly older adults (≥ 65 years), and predominantly male patients. Although the US studies observed the highest prevalence of comorbidities in COVID-19 patients, the severity of COVID-19 among each comorbid condition was highest in Asian studies whereas the mortality was highest in the European and Latin American countries. Risk stratification and effective control strategies for the COVID-19 should be done according to comorbidities, age, and gender differences specific to geographical location.

Background Cervical cancer is the most incident cancer and the leading cause of cancer mortality in women in Ghana. Currently little is known about Ghanaian women's knowledge and beliefs about cervical cancer screening, yet this information is essential to the success of cervical cancer screening programs. The purpose of this study, therefore, was to describe the knowledge and beliefs of women university college students in Ghana. Methods A cross sectional survey among college women in a university in Ghana elicited information about sociodemographics, knowledge and beliefs and acceptability of cervical cancer screening, screening history, and sexual history. Bivariate analyses were conducted to identify factors associated with screening. Results 140 females were recruited; the age range was 20-35 years. The prior pap screening rate was 12.0%; Women were unaware of local screening initiatives and only 7.9% were aware of the link between HPV and cervical cancer. The most prevalent barriers were lack of awareness that the purpose of pap screening is to diagnose cancer, concerns about what others may think, and lack of information about how to obtain screening services. Although women perceived the benefits of screening, only about half perceived themselves to be at risk. Women received few screening cues. Three barriers were negatively associated with screening in bivariate analyses: lack of belief that cervical screening diagnoses cancer, belief that pap test is painful and belief that the test will take away virginity. Conclusion New screening programs in Ghana should address these barriers and increase screening cues to the public.

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Introduction: Racial/ethnic differences in colorectal cancer (CRC) screening rates are thought to account, in part, for the racial/ethnic differences in CRC disease burden. The purpose of this study was to examine which factors mediate racial/ethnic differences in CRC screening.Methods: Five hundred sixty participants attending a primary care clinic, aged 50 to 80 years, and of African-American, Hispanic, or non-Hispanic white race/ethnicity were interviewed. The goal was to assess the contribution of sociodemographic characteristics, knowledge, beliefs about CRC, and the health care experience with their primary care doctor to racial/ethnic differences in CRC screening. The outcome variable was self-reported screening. All analyses were weighted; bivariate testing and multivariate logistic regression was conducted.Results: The response rate was 55.7%, with no sociodemographic differences noted between respondents and nonrespondents. Respondents were African-American (n ‫؍‬ 194), Hispanic (n ‫؍‬ 162), and non-Hispanic white (n ‫؍‬ 204); 64.5% were aged 50 to 64 years; 63.1% were women; 96.9% were insured; and over half reported a total annual income of less than $25,000. Overall 62.5% were current with CRC screening: 67.5% of non-Hispanic whites, 54.3% of African-Americans, and 48.6% of Hispanics (P < .001). A doctor's recommendation (odds ratio, 3.86); awareness of screening (odds ratio, 3.32); older age (odds ratio, 2.88); greater education (odds ratio, 2.02); and perceived susceptibility (odds ratio, 1.74) contributed to racial/ethnic differences in CRC screening.Conclusions: Interventions to address CRC screening disparities among racial/ethnic groups should focus on the health care setting and patient education about CRC screening; differences in attitudes and beliefs seem to be less important.

The weight loss information that people were likely to access online was often of substandard quality because most comprehensive and quality Web sites ranked too low in search results.

PURPOSE We wanted to better understand patient preferences and decision making about options for colorectal cancer screening. Consistency in patient preferences could improve patient-clinician communication about tests by simplifying and focusing discussions. METHODSIn a cross-sectional sample of primary care patients, cognitive ranking tasks were used to estimate patient preferences for fecal occult blood testing, fl exible sigmoidoscopy, colonoscopy, and double-contrast barium enema before and after consideration of 13 test attributes, such as accuracy and scientifi c evidence. Patients also ranked the 13 test attributes and attribute descriptions in terms of importance. Friedman's nonparametric test was used to measure overall discrimination among items, and the average Pearson correlation coeffi cient (r ) among participants was used to measure the degree of consistency in choices.RESULTS Participants (n = 168) averaged 62.1 years of age, and 64.3% were of minority racial ethnicity. For test-specifi c attributes, preferences were for high test accuracy (r = 0.63, P <.001), amount of colon examined (r = 0.64, P <.001), strong scientifi c evidence for effi cacy (r = 0.59, P <.001), minimum discomfort (r = 0.50, P <.001), and low risk of complications (r = 0.38, P <.001). When all 13 attributes were considered together, agreement dropped (r = 0.13, P <.001), but attributes considered most important for decision making were test accuracy, scientifi c evidence for effi cacy, amount of colon examined, and need for sedation. Test preferences showed moderate agreement (r = 0.20, P <.001), and choices were fairly consistent before and after exposure to test-specifi c attributes (κ = 0.17, P = .007). Initially the modal choice was fecal occult blood testing (59%); however, after exposure to test specifi c attributes, the modal choice was colonoscopy (54%).CONCLUSION Participants were clear about the attributes that they prefer, but no single test has those attributes. Preferences were varied across participants and were not predictable; clinicians should discuss the full range of recommended tests for colorectal cancer with all patients. 2 Professional organizations have widely endorsed screening for colorectal cancer 3-5 because of evidence of its effectiveness [6][7][8][9][10][11] and because screening could prevent 18,800 deaths per year.12 Screening remains underutilized, [13][14][15][16][17][18] however, with the lowest rates in African Americans and Hispanics. [19][20][21][22] Discussing colorectal cancer screening is challenging because multiple tests are recommended for screening, the tests are quite different and 142 INF OR MED DECISION M A K ING A ND T ES T PR EFER ENC EScomplex, patients lack familiarity with them, physicians have limited time to explain all the tests, and physicians have misconceptions about patient preferences regarding the tests and their attributes. [23][24][25][26] These problems have further been compounded by the continuing evolution of guidelines for colorectal cancer scree...

Objective. Sickle cell disease (SCD) is a disease that requires a significant degree of medical intervention, and family physicians are one potential provider of care for patients who do not have access to specialists. The extent to which family physicians are comfortable with the treatment of and concerned about potential complications of SCD among their patients is unclear. Our purpose was to examine family physician's attitudes toward SCD management. Methods. Data was collected as part of the Council of Academic Family Medicine Educational Research Alliance (CERA) survey in the United States and Canada that targeted family physicians who were members of CERA-affiliated organizations. We examined attitudes regarding management of SCD. Results. Overall, 20.4% of respondents felt comfortable with treatment of SCD. There were significant differences in comfort level for treatment of SCD patients depending on whether or not physicians had patients who had SCD, as well as physicians who had more than 10% African American patients. Physicians also felt that clinical decision support (CDS) tools would be useful for treatment (69.4%) and avoiding complications (72.6%) in managing SCD patients. Conclusions. Family physicians are generally uncomfortable with managing SCD patients and recognize the utility of CDS tools in managing patients.