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Article ; Online: Screening and Surveillance Bias in Cancer

Stefano Tancredi / Stéphane Cullati / Arnaud Chiolero

Epidemiologia, Vol 4, Iss 12, Pp 117-

2023 Volume 120

Abstract: Surveillance bias arises when differences in the frequency of a condition are due to changes in the modality of detection rather than to a difference in the actual risk of the condition. This bias hampers the surveillance of scrutiny-dependent cancers, ... ...

Abstract	Surveillance bias arises when differences in the frequency of a condition are due to changes in the modality of detection rather than to a difference in the actual risk of the condition. This bias hampers the surveillance of scrutiny-dependent cancers, leading to misinterpretations of cancer trends, risk factor identification, and, consequently, to the wrong public health actions.
Keywords	surveillance bias ; cancer ; cancer risk factors ; cancer surveillance ; Internal medicine ; RC31-1245
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: General and Vulnerable Population’s Satisfaction With the Healthcare System in Urban and Rural Areas

Lorenzo Righi / Stéphane Cullati / Pierre Chopard / Delphine S. Courvoisier

International Journal of Public Health, Vol

Findings From the European Social Survey

2022 Volume 67

Abstract: Introduction: Access to the healthcare system when patients are vulnerable and living outside metropolitan areas can be challenging. Our objective was to explore healthcare system satisfaction of urban and rural inhabitants depending on financial and ... ...

Abstract	Introduction: Access to the healthcare system when patients are vulnerable and living outside metropolitan areas can be challenging. Our objective was to explore healthcare system satisfaction of urban and rural inhabitants depending on financial and health vulnerabilities.Methods: Repeated cross-sectional data from 353,523 European citizens (2002–2016). Multivariable associations between rural areas, vulnerability factors and satisfaction with the healthcare system were assessed with linear mixed regressions and adjusted with sociodemographic and control factors.Results: In unadjusted analysis, the people who lived in houses in the countryside and those who lived in the suburbs were the most satisfied with the healthcare system. In the adjusted model, residents living in big cities had the highest satisfaction. Financial and health vulnerabilities were associated with less satisfaction with the healthcare system, with a different effect according to the area of residence: the presence of health vulnerability was more negatively correlated with the healthcare system satisfaction of big city inhabitants, whereas financial vulnerability was more negatively correlated with the satisfaction of those living in countryside homes.Conclusion: Vulnerable residents, depending on their area of residence, may require special attention to increase their satisfaction with the healthcare system.
Keywords	healthcare system ; vulnerability ; satisfaction ; urban ; rural ; Europe ; Public aspects of medicine ; RA1-1270
Subject code	910
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Physicians’ perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission

Stéphane Cullati / Monica Escher / Mathieu R Nendaz / Patricia Hudelson

BMJ Open, Vol 11, Iss

a qualitative study

2021 Volume 5

Abstract: Objective The use of intensive care at the end of life can be high, leading to inappropriate healthcare utilisation, and prolonged suffering for patients and families. The objective of the study was to determine which factors influence physicians’ ... ...

Abstract	Objective The use of intensive care at the end of life can be high, leading to inappropriate healthcare utilisation, and prolonged suffering for patients and families. The objective of the study was to determine which factors influence physicians’ admission decisions in situations of potentially non-beneficial intensive care.Design This is a secondary analysis of a qualitative study exploring the triage process. In-depth interviews were analysed using an inductive approach to thematic content analysis.Setting Data were collected in a Swiss tertiary care centre between March and June 2013.Participants 12 intensive care unit (ICU) physicians and 12 internists routinely involved in ICU admission decisions.Results Physicians struggled to understand the request for intensive care for patients with advanced disease and full code status. Physicians considered patients’ long-term vital and functional prognosis, but they also resorted to shortcuts, that is, a priori consensus about reasons for admitting a patient. Family pressure and unexpected critical events were determinants of admission to the ICU. Patient preferences, ICU physician’s expertise and collaborative decision making facilitated refusal. Physicians were willing to admit a patient with advanced disease for a limited amount of time to fulfil a personal need.Conclusions In situations of potentially non-beneficial intensive care, the influence of shortcuts or context-related factors suggests that practice variations and inappropriate admission decisions are likely to occur. Institutional guidelines and timely goals of care discussions with patients with advanced disease and their families could contribute to ensuring appropriate levels of care.
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Intergenerational educational trajectories and premature mortality from chronic diseases

Daniela Anker / Stéphane Cullati / Naja Hulvej Rod / Arnaud Chiolero / Cristian Carmeli

SSM: Population Health, Vol 20, Iss , Pp 101282- (2022)

A registry population-based study

2022

Abstract: The tracking of educational gradients in mortality across generations could create a long shadow of social inequality, but it remains understudied. We aimed to assess whether intergenerational educational trajectories shape inequalities in early ... ...

Abstract	The tracking of educational gradients in mortality across generations could create a long shadow of social inequality, but it remains understudied. We aimed to assess whether intergenerational educational trajectories shape inequalities in early premature mortality from chronic diseases. The study included 544 743 participants of the Swiss National Cohort, a registry population-based study. Individuals were born 1971–1980 and aged 10–19 at the start of the study (1990). Mortality follow-up was until 2018. Educational trajectories were High–High (reference), High–Low, Low–High, Low–Low, corresponding to the sequence of parental-individual attained education. Examined deaths were related to cardiovascular diseases (CVD), cancers, and substance use. Sex-specific inequalities in mortality were quantified via standardized cumulative risk differences/ratios between age 20 and 45. We triangulated findings with a negative outcome control. For women, inequalities were negligible. For men, while inequalities in cancers deaths were negligible, inequalities in CVD mortality were associated to low individual education regardless of parental education. Excess CVD deaths for Low–High were negligible while High–Low provided 234 (95% confidence intervals: 100 to 391) and Low–Low 185 (115 to 251) additional CVD deaths per 100 000 men compared to High–High. That corresponded to risk ratios of 2.7 (1.6 to 4.5) and 2.3 (1.6 to 3.4), respectively. Gradients in substance use mortality were observed only when education changed across parent-offspring. Excess substance use deaths for Low–Low were negligible while High–Low provided 225 (88 to 341) additional and Low–High 80 (23 to 151) fewer substance use deaths per 100 000 men compared to High–High. That corresponded to risk ratios of 1.8 (1.3 to 2.5) and 0.7 (0.5 to 0.9), respectively. Inequalities in premature mortality were driven by individual education and by parental education for some chronic diseases. This could justify the development of intergenerational prevention strategies.
Keywords	Public aspects of medicine ; RA1-1270 ; Social sciences (General) ; H1-99
Subject code	310
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Women carry the weight of deprivation on physical inactivity

Silvio Maltagliati / Ilyes Saoudi / Philippe Sarrazin / Stéphane Cullati / Stefan Sieber / Aïna Chalabaev / Boris Cheval

SSM: Population Health, Vol 20, Iss , Pp 101272- (2022)

Moderated mediation analyses in a European sample of adults over 50 Years of age

2022

Abstract: Deprived people are less physically active than privileged individuals. However, pathways underlying the association between deprivation and physical activity remain overlooked. We examined whether the association between deprivation and physical ... ...

Abstract	Deprived people are less physically active than privileged individuals. However, pathways underlying the association between deprivation and physical activity remain overlooked. We examined whether the association between deprivation and physical activity was mediated by body mass index (BMI). Consistent with an intersectional perspective (how the combination of belongingness to vulnerable social categories widens inequalities), we tested whether gender moderated this mediating pathway and hypothesized that the mediating effect of BMI would be stronger among women (vs men). Large-scale longitudinal data from 20,961 adults 50 years of age or older (57% women) from the Survey of Health, Ageing and Retirement in Europe were used. Social and material deprivation were measured by questionnaire, BMI and physical activity were reported from two to six years later. Simple mediation models showed that BMI partly mediated the association of material (total effect c = -0.14, proportion of mediated effect = 8%) and of social deprivation (c = -0.24, proportion of mediated effect = 4%) with physical activity. Moderated mediation models revealed that this mediating pathway was moderated by gender. The effect of deprivation on BMI was stronger among women (vs men), with BMI mediating 18% and 7% of the association of material and social deprivation with physical activity among women (vs 4% and 2% among men). Lower levels of physical activity observed among deprived older adults could be partly attributed to a higher BMI. Critically, this mechanism was exacerbated among women, reinforcing the need to understand how deprivation and gender interact to predict health behaviors.
Keywords	Physical activity ; Deprivation ; Body mass index ; Gender ; Intersectional approach ; Public aspects of medicine ; RA1-1270 ; Social sciences (General) ; H1-99
Subject code	796
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Revisiting the Effects of Organized Mammography Programs on Inequalities in Breast Screening Uptake

Vladimir Jolidon / Vincent De Prez / Piet Bracke / Andrew Bell / Claudine Burton-Jeangros / Stéphane Cullati

Frontiers in Public Health, Vol

A Multilevel Analysis of Nationwide Data From 1997 to 2017

2022 Volume 10

Abstract: This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an ... ...

Abstract	This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an opportunity to perform an ecological quasi-experimental study. We examine absolute income and marital status inequalities in mammography uptake, and whether the cantons' implementation of mammography programs moderate these inequalities, as previous research has devoted little attention to this. We use five waves of the Swiss Health Interview Survey covering the 1997–2017 period and comprising data on 14,267 women aged 50–70. Both up-to-date and ever-screening outcomes are analyzed with multilevel models which assess the mammography programs' within-canton effect. Findings show that higher income women and married women (compared to unmarried women) had significantly higher mammography uptake probabilities. Mammography programs did not moderate absolute income differences in up-to-date screening; however, they were associated with smaller absolute income differences in ever-screening uptake. Mammography programs related to higher screening uptake for married women, more than for unmarried women. In conclusion, we showed absolute income inequalities in mammography uptake which were not revealed by previous studies using relative inequality measures. Mammography programs may have contributed to reducing income inequalities in ever-screening, yet this was not observed for up-to-date screening. This study has implication for preventive health interventions—e.g., cancer screening promotion should pay attention to women's marital status since screening programs may widen the screening gap between married and unmarried women.
Keywords	socioeconomic inequalities ; Switzerland ; breast cancer screening ; marital status ; multilevel analysis ; organized population-based screening programs ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Neighbourhood socio-economic vulnerability and access to COVID-19 healthcare during the first two waves of the pandemic in Geneva, Switzerland

Denis Mongin / Stéphane Cullati / Michelle Kelly-Irving / Maevane Rosselet / Simon Regard / Delphine S. Courvoisier

EClinicalMedicine, Vol 46, Iss , Pp 101352- (2022)

A gender perspective

2022

Abstract: Summary: Background: Neighbourhood socio-economic inequities have been shown to affect COVID-19 incidence and mortality, as well as access to tests. This article aimed to study how associations of inequities and COVID-19 outcomes varied between the first ...

Abstract	Summary: Background: Neighbourhood socio-economic inequities have been shown to affect COVID-19 incidence and mortality, as well as access to tests. This article aimed to study how associations of inequities and COVID-19 outcomes varied between the first two pandemic waves from a gender perspective. Methods: We performed an ecological study based on the COVID-19 database of Geneva between Feb 26, 2020, and June 1, 2021. Outcomes were the number of tests per person, the incidence of COVID-19 cases, the incidence of COVID-19 deaths, the positivity rate, and the delay between symptoms and test. Outcomes were described by neighbourhood socio-economic levels and stratified by gender and epidemic waves (first wave, second wave), adjusting for the proportion of inhabitants older than 65 years. Findings: Low neighbourhood socio-economic levels were associated with a lower number of tests per person (incidence rate ratio [IRR] of 0.88, 0.85 and 0.83 for low, moderate, and highly vulnerable neighbourhood respectively), a higher incidence of COVID-19 cases and of COVID-19 deaths (IRR 2.3 for slightly vulnerable, 1.9 for highly vulnerable). The association between socio-economic inequities and incidence of COVID-19 deaths was mainly present during the first wave of the pandemic, and was stronger amongst women. The increase in COVID-19 cases amongst vulnerable populations appeared mainly during the second wave, and originated from a lower access to tests for men, and a higher number of COVID-19 cases for women. Interpretation: The COVID-19 pandemic affected people differently depending on their socio-economic level. Because of their employment and higher prevalence of COVID-19 risk factors, people living in neighbourhoods of lower socio-economic levels, especially women, were more exposed to COVID-19 consequences. Funding: This research was supported by the research project SELFISH, financed by the Swiss National Science Foundation, grant number 51NF40–160590 (LIVES centre international research project call).
Keywords	Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2022-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: How to improve hospital admission screening for patients at risk of multidrug-resistant organism carriage

Stéphane Cullati / Pierre Chopard / Damien Grauser / Aimad Ourahmoune / Pascal Briot / Dominique Joubert / Lorenzo Righi

BMJ Open Quality, Vol 11, Iss

a before-and-after interventional study and cost-effectiveness analysis

2022 Volume 2

Keywords	Medicine (General) ; R5-920
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Physicians’ Views and Agreement about Patient- and Context-Related Factors Influencing ICU Admission Decisions

Stéphane Cullati / Thomas V. Perneger / Fabienne Scherer / Mathieu Nendaz / Monica Escher

Journal of Clinical Medicine, Vol 10, Iss 3068, p

A Prospective Study

2021 Volume 3068

Abstract: Background: Single patient- and context-related factors have been associated with admission decisions to intensive care. How physicians weigh various factors and integrate them into the decision-making process is not well known. Objectives: First, to ... ...

Abstract	Background: Single patient- and context-related factors have been associated with admission decisions to intensive care. How physicians weigh various factors and integrate them into the decision-making process is not well known. Objectives: First, to determine which patient- and context-related factors influence admission decisions according to physicians, and their agreement about these determinants; and second, to examine whether there are differences for patients with and without advanced disease. Method: This study was conducted in one tertiary hospital. Consecutive ICU consultations for medical inpatients were prospectively included. Involved physicians, i.e., internists and intensivists, rated the importance of 13 factors for each decision on a Likert scale (1 = negligible to 5 = predominant). We cross-tabulated these factors by presence or absence of advanced disease and examined the degree of agreement between internists and intensivists using the kappa statistic. Results: Of 201 evaluated patients, 105 (52.2%) had an advanced disease, and 140 (69.7%) were admitted to intensive care. The mean number of important factors per decision was 3.5 (SD 2.4) for intensivists and 4.4 (SD 2.1) for internists. Patient’s comorbidities, quality of life, preferences, and code status were most often mentioned. Inter-rater agreement was low for the whole population and after stratifying for patients with and without advanced disease. Kappa values ranged from 0.02 to 0.34 for all the patients, from −0.05 to 0.42 for patients with advanced disease, and from −0.08 to 0.32 for patients without advanced disease. The best agreement was found for family preferences. Conclusion: Poor agreement between physicians about patient- and context-related determinants of ICU admission suggests a lack of explicitness during the decision-making process. The potential consequences are increased variability and inequity regarding which patients are admitted. Timely advance care planning involving families could help physicians make the ...
Keywords	decision making ; intensive care ; admission ; palliative care ; triage ; quality of care ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cervical cancer screening programs and their context-dependent effect on inequalities in screening uptake

Vincent De Prez / Vladimir Jolidon / Barbara Willems / Stéphane Cullati / Claudine Burton-Jeangros / Piet Bracke

International Journal for Equity in Health, Vol 20, Iss 1, Pp 1-

a dynamic interplay between public health policy and welfare state redistribution

2021 Volume 14

Abstract: Abstract Background While organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels ...

Abstract	Abstract Background While organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels of inequality in CCS uptake. Aim This study assesses how the screening strategy (as a score based on the availability of organized population-based CCS programs), accessibility of the healthcare system (as an index of out-of-pocket expenditure as a proportion of total healthcare costs, public health expenditure as a percentage of total GDP, and general practitioner (GP) density per 10′000 inhabitants) and social protection (as a decommodification index), impact education- and income-based inequalities in CCS uptake. Methods A two-level design with 25–64-year-old women (N = 96′883), eligible for Pap smear screening, nested in 28 European countries, was used to analyze data from the European Health Interview Survey’s second wave, using multilevel logistic regression modelling. Results Clear educational and income gradients in CCS uptake were found, which were smaller in countries with organized CCS programs, higher accessibility of the healthcare system and a higher level of decommodification. Furthermore, three-way interaction terms revealed that these gradients were smaller when organized CCS programs were implemented in countries with better accessibility of the healthcare system or a high level of decommodification. Conclusion This study indicates that the combination of organized screening and high accessibility of the healthcare system or social protection is essential for having lower levels of inequality in CCS uptake. In such countries, the structural threshold for poorer and lower educated women to engage in CCS is lower. This may be explained by them having a better interaction with their GP, who may convince them of the screening test, lower out-of-pocket payments, and financial support to buffer against a disadvantageous position on the labor market.
Keywords	Cancer screening participation ; Education gradient ; Income gradient ; Screening strategy ; Access to healthcare ; Decommodification ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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