BACKGROUND: National guidelines endorse colonoscopy as the only colorectal cancer (CRC) screening test which prevents CRC and evaluates the entire large bowel. However, little is known regarding patient compliance with a screening program that exclusively uses colonoscopy, particularly in an underserved population. The Connecticut Department of Public Health provided funds for the total cost of colonoscopies, patient navigators and education of staff and primary care providers. With cost and provider barriers removed, we were able to examine patient related factors influencing compliance with colonoscopy in an ethnically diverse sample of underinsured adults. OBJECTIVE: To determine what patient related factors are predictors of compliance with screening colonoscopy. DESIGN: Cross sectional retrospective study. PARTICIPANTS: Underinsured patients (50-64 years) visiting nine Connecticut community health centers (CHCs) were evaluated for medical eligibility for screening; eligible patients were offered a free colonoscopy. MAIN MEASURES: Patients were deemed non-compliant if they refused, canceled or did not show for the colonoscopy. Obesity (Body Mass Index≥30), educational attainment, gender, race, ethnicity, previous screening and social ties were examined as primary risk factors for compliance. KEY RESULTS: Of 424 uninsured patients (62% female, 21% White, 26% Black, 53% Hispanic), 354 were eligible for colonoscopy. Among eligible patients, 263 (74.3%) were compliant. Obese patients were more likely than non-obese patients to be noncompliant with colonoscopy (adjusted odds ratio= 2.16; 95% Confidence interval= 1.20-3.89). A high school education was positively correlated with increased compliance social ties such as having a spouse, significant other, family or friend also increased compliance. CONCLUSIONS: In an ethnically diverse, uninsured population, obese patients and patients with lower educational attainment were less likely to comply with free colonoscopy. These patients require special attention in colonoscopy-based CRC screening efforts.
BackgroundCachexia augments cancer-related mortality and has devastating effects on quality of life. Pre-clinical studies indicate that systemic inflammation-induced loss of muscle oxidative phenotype (OXPHEN) stimulates cancer-induced muscle wasting. The aim of the current proof of concept study is to validate the presence of muscle OXPHEN loss in newly diagnosed patients with lung cancer, especially in those with cachexia.MethodsQuadriceps muscle biopsies of comprehensively phenotyped pre-cachectic (n = 10) and cachectic (n = 16) patients with non-small cell lung cancer prior to treatment were compared with healthy age-matched controls (n = 22). OXPHEN was determined by assessing muscle fibre type distribution (immunohistochemistry), enzyme activity (spectrophotometry), and protein expression levels of mitochondrial complexes (western blot) as well as transcript levels of (regulatory) oxidative genes (quantitative real-time PCR). Additionally, muscle fibre cross-sectional area (immunohistochemistry) and systemic inflammation (multiplex analysis) were assessed.ResultsMuscle fibre cross-sectional area was smaller, and plasma levels of interleukin 6 were significantly higher in cachectic patients compared with non-cachectic patients and healthy controls. No differences in muscle fibre type distribution or oxidative and glycolytic enzyme activities were observed between the groups. Mitochondrial protein expression and gene expression levels of their regulators were also not different.ConclusionMuscle OXPHEN is preserved in newly diagnosed non-small cell lung cancer and therefore not a primary trigger of cachexia in these patients.
Objective. To describe core principles and processes in the implementation of a navigated care program to improve specialty care access for the uninsured. Study Setting. Academic researchers, safety-net providers, and specialty physicians, partnered with hospitals and advocates for the underserved to establish Project AccessNew Haven (PA-NH). PA-NH expands access to specialty care for the uninsured and coordinates care through patient navigation. Study Design. Case study to describe elements of implementation that may be relevant for other communities seeking to improve access for vulnerable populations. Principal Findings. Implementation relied on the application of core principles from community-based participatory research (CBPR). Effective partnerships were achieved by involving all stakeholders and by addressing barriers in each phase of development, including (1) assessment of the problem; (2) development of goals; (3) engagement of key stakeholders; (4) establishment of the research agenda; and (5) dissemination of research findings. Conclusions. Including safety-net providers, specialty physicians, hospitals, and community stakeholders in all steps of development allowed us to respond to potential barriers and implement a navigated care model for the uninsured. This process, whereby we integrated principles from CBPR, may be relevant for future capacity-building efforts to accommodate the specialty care needs of other vulnerable populations. Key Words. Uninsured/safety-net providers, integrated delivery system, communitybased participatory research, demonstration project, access to careCare for the uninsured and underinsured is largely provided by our nation's health care safety-net system comprised of providers who care for patients regardless of their ability to pay (Institute of Medicine 2000). Nevertheless, uninsured and underinsured adults have inadequate access to care, receiving fewer health screening, preventive, and specialty care services than privately insured patients (Ayanian et al.
COVID-19 in long-term care facilities (Box 1). Th is blueprint can serve as a guide for clinicians, administrators, and payers seeking to reduce the harm from COVID-19 in LTCFs. Stakeholder EngagementComprehensive testing for COVID-19 in LTCFs likely requires a partnership among clinical, laboratory, and public health organizations. Long-term care facilities uncom-
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