Factors associated with advanced stage at diagnosis of cervical cancer in Addis Ababa, Ethiopia: a population-based study

ObjectiveTo describe the patterns and factors associated with advanced stage at diagnosis of cervical cancer among Addis Ababa residents, Ethiopia.DesignA population-based cross-sectional study.SettingSeven major hospitals or diagnostic facilities in Addis Ababa, Ethiopia.ParticipantsAll histopathology-confirmed patients with incident cervical cancer diagnosed from 1 January 2017 to 30 June 2018 among Addis Ababa residents.Outcome measuresThe proportion of patients with cervical cancer diagnosed at early stage (stage I/II) and advanced stage (stage III/IV) of the disease according to International Federation of Gynaecology and Obstetrics staging criteria, and adjusted prevalence ratio (APR) for factors associated with advanced-stage diagnosis using a Poisson regression with robust variance model.ResultsThe mean age of the study participants was 52.9 (±13.3) years. Nearly two-thirds (60.4%, 95% CI: 53.8% to 66.5%) of patients with cervical cancer were diagnosed at an advanced stage. Advanced stage at diagnosis was significantly associated with paying medical bill out of pocket (APR=1.44, 95% CI: 1.08 to 1.91), diagnostic interval >90 days (APR=1.31, 95% CI: 1.04 to 1.71), practicing religion as a remedy or not taking immediate action following symptom recognition (APR=1.25, 95% CI: 1.08 to 1.91) and visiting more than three different health facilities prior to diagnostic confirmation (APR=1.24, 95% CI: 1.07 to 1.51).ConclusionsOur findings of the high proportion of advanced-stage diagnosis of cervical cancer in Addis Ababa and its strong associations with out-of-pocket medical bill, seeking care out of conventional medicine settings and multiple visits to healthcare facilities before diagnostic confirmations underscore the need for public policies to improve the affordability of cancer care and enhance community awareness about the severity of the disease and referral system, in addition to expanding cervical cancer screening.

What States Can Do to Address Out-of-Network Air Ambulance Bills

Out-of-network air ambulance bills are a pernicious and financially devastating type of surprise medical bill. Courts have broadly interpreted the Airline Deregulation Act to preempt most state attempts to regulate air ambulance billing abuses, so a federal solution is ultimately needed. However, in the absence of a federal fix, states have experimented with a variety of approaches that may survive preemption and provide some protections for their citizens

Abstract 16776: Can We Rely on Patients to Report Rehospitalizations After Acute Myocardial Infarction? Implications for the Design of Future Practical Clinical Studies

Background: Few studies have described the accuracy of patient-reported hospitalizations and characterized patients who either under- or over-report hospitalizations. Methods: At scheduled interviews 6 weeks, 6 and 12 months after discharge, acute MI patients in the TRANSLATE-ACS study were asked to report any rehospitalizations. Bills from hospitals in the patient’s geographic area and from 12-month queries at the discharging institution were obtained to confirm reported and screen for unreported hospitalizations. We assessed the accuracy of patient-reported hospitalizations with bill validation as the reference. We also examined the characteristics of patients who accurately, over-, or under-reported the number of hospitalizations. Results: Among 12,302 acute MI patients, 5,668 patients (46%) reported 8,716 rehospitalizations within the 1 year post-discharge. Only 59% of patient-reported hospitalizations were confirmed by medical bill data (Table). Among the total number of hospital bills collected, 34% were never reported by the patient. Among 5,688 patients confirmed to be rehospitalized, 41% accurately reported the number of hospitalizations, 37% over-reported by a range of 1-12 hospitalizations (median 1) and 22% under-reported by 1-19 hospitalizations (median 1). Compared with accurate reporters, under-reporters were more likely to be female (36% vs. 31%), non-white race (17% vs. 12%), unemployed (67% vs. 54%), non-high school graduate (19% vs. 12%) or to have lower functional status (median EQ5D VAS score 65 vs. 75, p<0.01 for all). Characteristics of over-reporters were more similar to accurate reporters. Clinical risk, as summarized by the ACTION mortality risk score, was not substantially different between groups. Conclusions: In a large community-based study, the accuracy of patient-reported hospitalizations was low when compared with validation by medical bills, with patients both under- and over-reporting events.

The LDS RCS(Eng): 150 years on and still going strong

The Licence in Dental Surgery (LDS) originated in the 19th century and is the oldest continuously existing dental qualification in the UK. Records show that a letter sent to the Lancet in 1855 by a Mr Rymer of Croydon suggested that the Royal College of Surgeons should 'appoint a properly constituted board of examiners whose duties should be to hold periodical examinations of such candidates as were desirous of obtaining such a distinction, for instance as might be termed “licentiates in dentistry”. 'Sir John Tomes worked with the College and the Odontological Society and was instrumental in proposing a clause to be added to the Medical Bill of 1958 'to grant the Royal College of Surgeons of England power to institute and hold examinations for the purpose of testing the fitness of persons to practise as dentists, who may be desirous of being so examined, and to grant certificates of such fitness.'