Search

Background: Cervical cancer (CC) is preventable. CC screening decreases CC mortality. Emergency department (ED) patients are at disproportionately high risk for nonadherence with CC screening recommendations. The ED, therefore, is a target-rich environment for interventions to promote CC screening., Methods: We conducted a randomized clinical trial to test and compare the efficacies of (1) basic referral for CC screening and (2) basic referral plus a text messaging intervention, grounded in behavioral change theory, to promote uptake of CC screening among ED patients. Participants aged 21-65, identified as in need of CC screening, were randomized to study arms and followed up at 150 days to assess interval CC screening uptake (primary outcome) and analyze methods-related moderators of intervention effects. Participants were recruited from a large, urban ED and a small, rural ED within the same health care system. Intervention arms were compared to historical controls., Results: A total of 4035 patients were surveyed, with 1089 identified as requiring CC screening and subsequently randomized. Upon 150-day follow-up, 20% of individuals in the basic referral arm and 23% of individuals in the basic referral plus text messaging arm had obtained screening. Screening uptake in the historical control group was found to be 10% over a 150-day period. The overall difference between prospective arms was not significant (p = 0.219). However, moderation analysis found that women ≥40 years old demonstrated greater uptake of screening after the higher intensity intervention compared to the lower (p = 0.032). The differences in screening uptake between both interventions, individually and combined, when compared to controls was significant (p ≤ 0.001)., Conclusions: This study demonstrates that both of the evaluated low-intensity ED-based interventions significantly increase subsequent CC screening uptake compared to historical controls. The higher intensity intervention significantly increased screening uptake compared to the lower intensity intervention among women ≥40 years old., (© 2025 Society for Academic Emergency Medicine.)

Objectives: Pica is a non-nutritive eating behavior. The potential impact of pica on oral health and the association between pica and anemia are understudied. We examined the current evidence on the relationship between pica practices, anemia, and oral health outcomes., Methods: We used Population, Intervention, Control, and Outcomes (PICO) terms to create MeSH terms to assess 1) the relationship between pica and iron deficiency anemia (IDA), 2) the relationship between IDA and oral health, and 3) the relationship between pica, anemia, and oral health outcomes. The review was registered on Prospero [CRD42022349022]. We searched databases including PubMed, Embase, Web of Science, Cochrane Library, and, clinicaltrials.gov in June 2022., Results: From 4,159 searched articles, 89 met the inclusion criteria. Studies were published between 1959 and 2022 from 33 countries. Nearly half of these studies (55.1%, n = 49) were case reports. The most common picas included geophagia (soil/dirt) (44.9%, n = 40 papers), pagophagia (ice) (22.5%, n = 20), amylophagia (starch) (15.7%, n = 14), paint/metal (5.6%, n = 5), paper (5.6%, n = 5) and others such as pica for foam and hair. Fifteen case reports and one intervention study showed the effects of pica practice on oral health, such as tooth abrasion, dental caries, and de-papillated tongue. Furthermore, 81% of the papers reported the co-occurrence of pica with anemia and 15 papers reported a significant association (p < 0.05) between pica and low hemoglobin levels ranging from < 12.0 to 2.7g/dL among all age groups, including among pregnant and postpartum women. Pica practices were strongly associated with IDA (serum ferritin < 15.0 - 4.3 mcg/ml) but showed a non-statistically significant trend of association with oral health outcomes., Conclusion: Pica was strongly associated with anemia and IDA. Tooth abrasion and dental caries were observed among pica users. Future studies could define the strength of the pica-oral health association, and the potential mediators, such as anemia., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval and consent of participants were addressed in the published papers included in the study. Consent for publication: Not Applicable Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)