Ayten Ozkirac Kirsal, Gul Kahveci
Using varied technological agents-assisted simultaneous prompting for teaching discrete skills to children with developmental disabilities
International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience
urgent need improve breast cancer survival subsaharan africa geospatial barriers delay diagnosis treatment effect survival settings well understood examined geospatial disparities 4year survival african breast cancerdisparities outcomes cohort prospective cohort study women aged 18 years newly diagnosed breast cancer recruited eight hospitals namibia nigeria south africa uganda zambia reported sociodemographic information intervieweradministered questionnaires clinical treatment data collected medical records vital status ascertained contacting participants next kin every 3 months primary outcome allcause mortality relation rural versus urban residence straightline distance modelled travel time hospital analysed using restricted mean survival time cox proportional hazards flexible parametric survival models 2228 women breast cancer recruited sept 8 2014 dec 31 2017 127 excluded analysis 58 potentially recurrent cancer previously received treatment followup 14 minority ethnic groups small sample sizes 55 missing geocoded home addresses among 2101 women included analysis 928 44 lived rural area 1042 patients died within 4 years diagnosis 4year survival 39 95 ci 3642 women rural areas versus 49 4652 urban areas unadjusted hazard ratio hr 124 95 ci 109140 among 734 women living 1 h hospital crude 4year survival 37 95 ci 3242 women rural areas versus 54 4662 women urban areas hr 135 95 ci 107171 adjustment age stage treatment status among women rural areas mortality rates increased distance adjusted hr per 50 km 104 101107 travel time adjusted hr per h 106 102110 among women earlystage breast cancer receiving treatment women rural areas strong survival disadvantage overall hr 154 114207 adjusted age stage 1 h distance adjusted hr 214 121378 geospatial barriers reduce survival patients breast cancer subsaharan africa specific attention needed support patients earlystage breast cancer living rural areas far cancer treatment facilities us national institutes health national cancer institute susan g komen cure international agency research cancer