Guidelines For Early Detection Research Articles

Evidence-Based Infant Assessment for Cerebral Palsy: Diagnosis Timelines and Intervention Access in a Newborn Follow-up Setting.

Evidence-based assessment pathways inform early detection of cerebral palsy and access to intervention. This study investigated the relationships between early evidence-based assessments, diagnosis timeline, and rehabilitation intervention access in a population of children with cerebral palsy who were seen between 2010 and 2022 at the University of Wisconsin Waisman Center Newborn Follow Up Clinic. Cerebral palsy-specific assessments were increasingly integrated after the publication of early detection guidelines by Novak et al. in 2017. Age at cerebral palsy first mention (high risk for cerebral palsy) decreased over time, although age at diagnosis remained similar. Infants who received multiple evidence-based assessments were diagnosed at a younger age. Ninety-nine percent of children were referred to rehabilitation therapies before diagnosis. Infant age at referral to outpatient therapies decreased over time. This study provides novel clinical data on diagnosis timelines and identifies remaining gaps related to implementation feasibility toward improved early diagnosis and intervention access.

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Introduction and objectives: Eating disorders are a growing problem in our society, especially among young people. The aim of this study is to know which are the individual and social factors that support and perpetuate the danger of suffering from eating disorders, and their possible consequences on the sports and academic performance of individuals. Material and method: The sample consisted of 395 athletes between 12 and 16 years of age (M = 14.07; SD = 1.35), of whom 142 (35.9%) were female and 253 (64.1%) male. A questionnaire was administered to collect information on sociodemographic data, body image, use of social networks, social relationships, sports practice, risk of eating disorders, and academic and sports performance. In the analysis, firstly, cross-tabulations were carried out to observe the body distortion of the respondents according to body mass index; secondly, a linear regression was performed to analyze the factors influencing the risk of eating disorders. In addition, correlations were performed to find out the relationship between risk of manifesting eating disorders and academic and sports performance. Results: The main result shows that there is a high risk of eating disorders among young athletes, due to a high distortion of body image, which becomes the main determinant factor. In addition, relationships with family and friends have a significant influence on this danger. On the other hand, behaviors related to eating disorders cause academic and sports performance to decrease. Conclusión: Due to these data, it is necessary to generate and promote prevention and early detection guidelines during adolescence.

Successful Screening of Undiagnosed Psoriatic Arthritis in Primary Care Utilising Digital Interventions Within a Quality Improvement Programme

Background: Despite the advancements in the management of psoriasis (PsO) and psoriatic arthritis (PsA), there remains a significant delay to diagnosis of PsA. National guidelines recommend regular screening of patients with PsO for PsA. The aim of this study was to increase the screening of patients with PsO, and reduce the delay to diagnosis in PsA. Methods: A retrospective baseline audit was conducted in patients with PsO attending a large general practice (Brookside Group Practice, Reading, UK) between November 2022–April 2023. In the follow-up stage between May–November 2023, a digital Egton Medical Information System (EMIS; Emis Health, Rawdon, Leeds, UK) web template, using the Psoriasis Epidemiology Screening Tool (PEST) questionnaire was implemented. The number of patients with PsO screened for PsA, and the number of newly diagnosed PsA cases, were recorded. Results: At baseline, 15 patients with PsO were identified, and none had PsA screening done. In the follow-up phase, 28 patients coded for PsO were identified. There was an increase in the number of patients screened for PsO from 15 to 28, representing an increase of 87% from baseline. From the follow-up group, 12 (43%) patients were screened for PsA. These patients were referred to the specialist clinic, and seven (58%) had confirmed PsA. This represented a population of patients with previously undiagnosed PsA within the general practitioner (GP) surgery. Conclusions: The authors have successfully implemented an integrated and interactive digital screening tool for PsA within the GP system. This has led to an increase in the detection of patients with PsA. This practical and effective approach is in line with national guidelines for early detection, to prevent long-term damage and disability from PsA.

Successful Screening of Undiagnosed Psoriatic Arthritis in Primary Care Utilising Digital Interventions Within a Quality Improvement Programme

Background: Despite the advancements in the management of psoriasis (PsO) and psoriatic arthritis (PsA), there remains a significant delay to diagnosis of PsA. National guidelines recommend regular screening of patients with PsO for PsA. The aim of this study was to increase the screening of patients with PsO, and reduce the delay to diagnosis in PsA. Methods: A retrospective baseline audit was conducted in patients with PsO attending a large general practice (Brookside Group Practice, Reading, UK) between November 2022–April 2023. In the follow-up stage between May–November 2023, a digital Egton Medical Information System (EMIS; Emis Health, Rawdon, Leeds, UK) web template, using the Psoriasis Epidemiology Screening Tool (PEST) questionnaire was implemented. The number of patients with PsO screened for PsA, and the number of newly diagnosed PsA cases, were recorded. Results: At baseline, 15 patients with PsO were identified, and none had PsA screening done. In the follow-up phase, 28 patients coded for PsO were identified. There was an increase in the number of patients screened for PsO from 15 to 28, representing an increase of 87% from baseline. From the follow-up group, 12 (43%) patients were screened for PsA. These patients were referred to the specialist clinic, and seven (58%) had confirmed PsA. This represented a population of patients with previously undiagnosed PsA within the general practitioner (GP) surgery. Conclusions: The authors have successfully implemented an integrated and interactive digital screening tool for PsA within the GP system. This has led to an increase in the detection of patients with PsA. This practical and effective approach is in line with national guidelines for early detection, to prevent long-term damage and disability from PsA.

Identifying Opportunities for Early Detection of Cerebral Palsy.

This study aimed to evaluate assessment and referral practices for the early detection and diagnosis of children at risk for or with cerebral palsy (CP) by health care and education providers in Maryland and Delaware. A secondary aim was to identify barriers for using early detection tools and identify opportunities for change to support early diagnosis and improve care. Seventy-two participants answered ≥ 50% of the survey questions. Most were occupational or physical therapists (86%) working in early intervention (61%). Eighty-eight percent indicated awareness that CP can be diagnosed by 12 months. Though 86% stated they typically suspect a diagnosis of CP between 0 and 12 months, only 19% reported that their patients received a CP diagnosis < 12 months. The Developmental Assessment of Young Children (73%) and the Peabody Developmental Motor Scales-2 (59%) were used most. Many respondents indicated never using magnetic resonance imaging (70%), the General Movements Assessment (87%), or the Hammersmith Infant Neurological Exam (69%). Participants identified clinical signs and symptoms prompting a referral for the diagnostic assessment of CP, most commonly stiffness in legs (95%), excessive head lag (93%), and persistent fisting (92%). Policy and organizational change, clinician education, and training are needed to support the implementation of CP early detection guidelines.

Allogeneic stem cell transplant recipients surviving at least 2 years without relapse: outcome and risk factors.

Outcomes of 2-year survivours undergoing allo-haematopoietic stem cell transplantation at Oslo University Hospital were retrospectively assessed with the objectives of identification of risk factors for late death as possible means for precautionary measures and interventions to improve long-term survival. 421 patients with haematological malignancy, transplanted between 2005 and 2019, alive and free of disease after 2 years were included with data reported from The OUS-HSCT registry. Median follow-up was 6.2 years (2.016.1), and 232 patients (55%) were observed for minimum 5 years. The probability of being alive 5 and 10 years after HSCT was 86% and 76%. Primary risk factors for late death included initial diagnosis of age ≥ 60 years, chronic lymphocytic leukaemia (CLL), previous blood stream- or invasive fungal infection (BSI, IFI), and chronic graft-versus-host disease (cGVHD). Transplant-related mortality (TRM) and relapse at 5 years were 9.0% and 7.7%, respectively. Two factors were associated with the latter: cytomegalovirus (CMV) seronegative donor and CLL. Compared with the age- and gender-matched Norwegian general population, life expectancy was lower for each disease, except for CML. The prospect for the long-term survival is good for 2-year survivors of the allogeneic hematopoietic stem cell transplantation. However, life expectancy remains inferior to the age- and gender-matched general population. Optimising prophylaxis and treatment for chronic GVHD, BSI and IFI are needed along with the improved adherence to guidelines for early detection of secondary malignancies. Measures to improve immune reconstitution, possibly the microbiota, and the use of CMV seropositive donors regardless of recipient sero-status may be warranted and should be addressed in further studies.

Pathological Manifestations of Gluten-Related Neuro-Psychiatric Disorders and the Impact of Gluten-Free Diet in a Pediatric Age Group: A Systematic Review.

Gluten, as a term, causes unease amonga vast majority of the population. The reason is the body's inability to process gluten, causing various pathological manifestations. While celiac disease is predominantly a gastrointestinal disease, it also has various extra-intestinal manifestations. Many children receive diagnoses of idiopathic neuropsychiatric symptoms such as epilepsy, attention-deficit hyperactivity disorder (ADHD), restless leg syndrome (RLS), and peripheral neuropathy without ever finding the root cause. A majority of these cases may be associated with celiac disease if only their antibody titers and other appropriate investigations were conducted. The treatment of these manifestations may be eliminated or at least controllable with dietary modification to a gluten-free diet (GFD). In this paper, we will discuss the pathology of celiac disease and the impact of GFD on the neuropsychiatric aspects of this disease, which is of higher prevalence in the pediatric population. A comprehensive literature search was conducted in prominent databases, namely PubMed and Google Scholar, to include studies that provided individual-level data on the neuropathological manifestations and the impact of a GFD on extra-intestinal manifestations of celiac disease. The research protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) with the registration ID: CRD42023415100. Based on the inclusion and exclusion criteria, we included prospective studies, observational studies, and case reports on pediatric patients with biopsy-proven celiac disease, serologically positive celiac disease, celiac disease with neuropsychiatric manifestations, and studies reporting the impact of GFD. After a rigorous quality assessment to remove the risk of bias, we finally included 20 studies to be discussed. In 6 (30%) studies, patients with neuropsychiatric manifestations had positive serology findings and a relatively higher grade of biopsy results. Seven studies discussed the positive impact of GFD. Five of these seven studies reported statistically significant results (p ≤ 0.001).Our study suggests that gluten plays a role in the severity of neuropsychiatric manifestations of celiac disease. Considering the results of our study, we can see that GFD does impact the prognosis of the disease. Neuropsychiatric findings without gastrointestinal manifestations are more common in the pediatric age group. We have clear evidence that several neurological conditions (neuropathy, ADHD, epilepsy, and RLS) have not only a significant association with gluten but can also potentially benefit from GFD. Thus, screening, with a combination of serological, biopsy, and imaging techniques, must be adapted into the guidelines for early detection and induction of GFD. Furthermore, studies should aim at introducing GFD in the pediatric population as a mode of primary prevention. In conclusion, our review underscores the importance of gluten while dealing with idiopathic neurological conditions in children and hopes to shed light on this commonly misdiagnosed and easily manageable disease.

Social and Individual Factors Associated with Eating Disorders in Young Athletes: Effects on Concentration and Fatigue.

Eating disorders are a growing societal problem, especially among young people. This study aims to determine the individual and social factors that support and perpetuate the risk of eating disorders (ED) and their possible consequences on an individual's athletic and academic performances. The sample consisted of 395 athletes between 12 and 16 years of age (M = 14.07; SD = 1.35), of whom 142 (35.9%) were female, and 253 (64.1%) were male. A questionnaire was administered to collect information on sociodemographic data, body image, use of social networks, social relationships, sports practice, risk of developing ED, and academic and sports performance. In the resulting analysis, an initial cross-tabulation was carried out to observe the body distortion of the respondents as a function of BMI, followed by a linear regression to analyze the factors influencing the risk of suffering from ED. In addition, correlations were made to determine the relationship between the risk of manifesting ED and academic and sports performance. The main results show that 77.7% of the young athletes present a risk of ED (M = 13.3; DT = 3.33) due to a high body image distortion, which becomes the determining factor. In addition, relationships with family and friends have a significant influence on this. On the other hand, behaviors related with eating disorders affect concentration (r = -0.122; p = 0.01) and fatigue (r = -0.376; p < 0.01). For all these reasons, generating and promoting prevention and early detection guidelines during adolescence is necessary.

Cardiac dysfunction (CD) among breast cancer survivors (BCS): Role of cardiotoxic therapy and cardiovascular risk factors.

12078 Background: CD is the leading cause of mortality in BCS. Limited information regarding the long-term risk of CD after exposure to cardiotoxic agents (anthracyclines, trastuzumab/pertuzumab and left breast/chest wall radiation) and additional factors that place BCS at highest risk has precluded development of surveillance guidelines for early detection of CD in BCS. Methods: Patients, who survived ≥1y after BC and received potentially cardiotoxic therapy, underwent q2y echocardiographic (echo) screening at a single center. All echos from BC diagnosis to CD or last follow-up were processed in Python via automated text analysis. New-onset CD was defined as left ventricular ejection fraction (LVEF) &lt;50% or fractional shortening (FS) &lt;28%. Treatment exposures, demographics and cardiovascular risk factors (CVRFs: diabetes, hypertension, dyslipidemia, obesity, smoking) were abstracted from medical records. Cumulative incidence of CD described the magnitude of risk in the entire cohort and among those who received anthracyclines (±radiation), trastuzumab/pertuzumab (±radiation), and radiation alone (without anthracyclines/trastuzumab/pertuzumab). Cox proportional hazards models estimated hazard ratios (HRs) and 95%CIs of associations between CD and treatment, adjusting for CVRFs (time varying) and demographics. Longitudinal echocardiographic analyses (adjusted for covariates) estimated trends in cardiac function prior to CD. Results: We evaluated 2,540 echos in 847 BCS exposed to potentially cardiotoxic therapy (median age at BC: 54.4y; median follow-up: 7.6y). Overall, 39% of BCS received anthracyclines, 17% received trastuzumab/pertuzumab, 5% received anthracyclines + trastuzumab/pertuzumab, and 39% received radiation alone. The cumulative incidence of CD in the entire cohort was 12.3% at 2y, increasing to 29.7% by 10y after BC. Multivariable analysis revealed the following to be independently associated with CD: treatment (anthracyclines: HR=2.72, 95%CI=1.9-3.9; trastuzumab/pertuzumab: HR=1.92, 95%CI=1.1-3.2; ref: radiation alone), presence of CVRFs before CD diagnosis (hypertension: HR=1.77, 95%CI=1.3-2.4; obesity: HR=1.82, 95%CI=1.4-2.4; and dyslipidemia: HR=1.63, 95%CI=1.3-2.1). Adjusted longitudinal echo analyses revealed a statistically significant decline in SF over 20y from BC diagnosis (but prior to CD onset) for the entire cohort (p=0.0007), trastuzumab/pertuzumab (p=0.006), anthracyclines (p=0.037), and radiation alone (p=0.01). Conclusions: In this large cohort of BCS followed longitudinally for an extended period, exposure to potentially cardiotoxic therapy results in a substantial burden of CD; the risk increases over time, and with CVRFs. These results provide evidence for close surveillance of BC survivors at increased risk of CD for extended periods, and aggressive management of CVRFs before, during and after BC.

Abstract B060: Increasing breast and cervical cancer knowledge in the COVID-19 pandemic in the health system

Abstract The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) reported that for the month of In April 2020, screening tests for breast cancer decreased by 87% and for cervical cancer by 84% compared to the previous 5-year averages for that month. In response to this finding, the Puerto Rico Breast and Cervical Cancer Prevention and Early Detection Program (PR-BCCPEDP) in collaboration with the insurer Triple S-Salud, implemented a virtual educational intervention and/or face-to-face for breast and cervical cancer in the health centers where Triple-S Salud insurer provides services. The purpose of this initiative was aimed at strengthen knowledge in the early detection of breast and cervical cancer, increase the use of screening tests in the population of interest, and increase the reach of women who do not have health insurance who can qualify for the Program. Methodology: The PR-BCCPEDP entered into a collaborative agreement with the insurer Triple-S Salud to implement an educational intervention for breast and cervical cancer in 12 primary health centers around the island. In the period from October to December 2020, 12 health educators from the Triple-S Salud insurer carried out 131 educational activities with the participation of 875 participants. The educational activities were carried out in person through educational flip charts and virtually using an educational PowerPoint on both types of cancer. The educational materials included topics related to breast and cervical cancer such as: statistics, risk factors, signs and symptoms, early detection guidelines, myths and facts, and barriers to not having early detection tests. Results: The educational intervention in breast and cervical cancer obtained the following results: A total of 875 participated in the intervention, where 100% were women, with an average age of 50 years and the majority (97%) had coverage from the government health plan. The towns with the most registered participants were Bayamón with 18% and Mayagüez with 16% respectively. The virtual form was the most used by the participants (58%) compared to the face-to-face form. Regarding screening tests for breast and cervical cancer, of 75 women who had overdue the breast cancer guidelines, 20% had a mammogram after the intervention. Similarly, 142 women had overdue the cervical cancer guidelines, and 22.6% were carried out the tests after the intervention. Other hand, of the women, referred to the PR-BCCPEDP, 3% indicated not having health insurance, of which 29.6% were recruited and cared for by the Program. Conclusion: Despite security restrictions as a result of the pandemic, collaborations with a health system helped reach a greater number of women to provide education and awareness about breast and cervical cancer. In addition, it can be inferred that the virtual form allowed for increasing the scope of participation in times of pandemic. Lastly, I also helped reach women without health insurance who were recruited into the Program. Citation Format: Omayra Salgado-Cruz, Nelybeth Santiago-Yance, Mirza Rivera-Lugo, Guillermo Tortolero-Luna. Increasing breast and cervical cancer knowledge in the COVID-19 pandemic in the health system [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B060.

From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service

ObjectivesTo report on knowledge translation strategies and outcomes from the implementation of the early detection guidelines for cerebral palsy (CP) in a state-wide tertiary early intervention (EI) service and investigate...

Neuroanatomical regions associated with non-progressive dysarthria post-stroke: a systematic review

BackgroundDysarthria is a common and persisting sequela to stroke. It can have a negative influence on psychological wellbeing, and quality of life. This systematic review aimed to describe and identify the neuroanatomical regions associated with non-progressive dysarthria following stroke.MethodsA systematic search of PubMed, Ovid Medline, CINAHL, Cochrane, Scopus, and ScienceDirect was conducted to identify all relevant articles published in peer-reviewed journals up to December 2021. Following data extraction, the National Institutes of Health (NIH) quality assessment tools were used to evaluate the methodological quality of the included studies.ResultsOut of 2186 papers found in the literature related to dysarthria post-stroke, 24 met the inclusion criteria. Eligible articles assessed 1150 post-stroke subjects. Out of them, 420 subjects had dysarthria from isolated lesions. Regarding dysarthric subjects with ischemic strokes, 153 sustained supratentorial infarctions, while 267 had infratentorial infarctions. The majority had pontine infarctions (n = 142), followed by infarctions in the corona radiata (n = 104), and the cerebellum (n = 64).ConclusionThis systematic review is the first step toward establishing a neuroanatomical model of dysarthria throughout the whole brain. Our findings have many implications for clinical practice and provide a framework for implementing guidelines for early detection and management of dysarthria post-stroke.

Early atherosclerotic cardiovascular disease in high-risk women with polycystic ovary syndrome

Background and Aims: Polycystic Ovary Syndrome (PCOS) is associated with increased cardiometabolic risk factors and cardiovascular disease (CVD). Currently, there is a need to assess early CVD in high-risk women with and without PCOS to effectively prevent morbidity from CVD. Objective: The aim of this study was to provide evidence-based research to aid assessment guidelines for early detection of dyslipidaemia, cardiac dysfunction and subclinical atherosclerosis in women with and without PCOS.

Endocrine Late Effects in Childhood Cancer Survivors.

Simple SummaryRecent advances in cancer treatment have led to improved survival, with an exponential increase in sequelae among survivors. Around 50% of survivors will experience at least one hormonal disorder, with radiotherapy, hematopoietic stem cell transplantation, and alkylating chemotherapy being the most frequently related. Therefore, lifelong monitoring of childhood cancer survivors at risk is paramount. With this review, we describe in detail the most prevalent endocrine sequelae, considering new approaches such as proton beam therapy and immune-related endocrinopathies with the advent of precision oncology treatment. We hope to encourage oncologists and endocrinologists to develop early detection guidelines that minimize sequelae and have a positive impact on their quality of life.Childhood cancer management has improved considerably over the years, leading to a significant improvement in survival of up to 80%. However, childhood cancer survivors are at the highest risk of developing sequelae resulting from treatment, with endocrine complications being frequently observed among survivors. Multiple predisposing factors for endocrine sequelae have been identified, including age at diagnosis, treatment received, radiation, tumor type, and genetic polymorphisms, which could explain the individual predisposition to develop drug toxicity. Novel agents targeting tumor growth and immune checkpoint inhibitors have recently become the cornerstone for the treatment of different cancers, triggering a myriad of immune-related endocrinopathies. Endocrine sequelae of cancer therapy will have an impact on not only childhood but also on the survival and quality of life of these highly complex patients. Therefore, lifelong monitoring of childhood cancer survivors at risk of endocrine diseases is paramount. Encouraging oncologists and endocrinologists to develop new follow-up and early detection guidelines that minimize sequelae among these patients has become a priority, promoting integration between pediatric and adult units since many sequelae may manifest only after years to decades of follow-up.

Il modello di gestione del bambino sovrappeso e obeso in Regione Emilia-Romagna: primi risultati

Child and adolescent obesity is a complex, multifactorial but also largely preventable disease; as a consequence its management needs a multilevel and integrated approach to be successful. This article describes the Preventive Diagnostic Therapeutic Assistance Pathways (PPDTA) for children with overweight and obesity delivered by trained multidisciplinary teams in the Emilia-Romagna Region. The regional “Guidelines for early detection, assessment and treatment of childhood obesity” were launched in 2013 (DGR 783/2013) and in 2017 WHO/Europe mentioned them as good practice and Country example. Training in childhood obesity prevention and management was delivered for all the primary care paediatricians (PCPs) and the members of the multidisciplinary teams. The PPDTA is based on three progressive levels: Level 1: PCPs. Level 2: a multidisciplinary team consisting of paediatricians, sports medicine doctors, exercise specialists, dieticians and psychologists experienced in paediatric obesity defines the clinical condition of children referred by the PCPs and runs the lifestyle change multi-component interventions. Level 3: is carried out by specialized clinicians in the hospital setting on a multidisciplinary basis for children with more severe and complicated obesity. In case of therapeutic failure, the PCP refers the child to the second-level multidisciplinary team. The second-level assessment and intervention are conducted at public health departments or at public health centres. During treatment, each team member uses the same tools, such as motivational interviewing for encouraging behaviour change. A standard evaluation framework is in place to assess the quality and effectiveness of the weight multidisciplinary management services, with three types of regional evaluation indicators: anthropometrics, lifestyle changes (eating habits, sedentary and physical activity) and equity. An improvement in weight status was observed in both children and adolescents with overweight and obesity. Interventions targeting at specific behaviours, such as increasing fruit and vegetable intake, habitually eating a balanced breakfast and reducing sedentary behaviour have been found effective as well.

Colorectal Cancer Screening in China: Status, Challenges, and Prospects - China, 2022.

Colorectal cancer (CRC) ranks third among the most commonly diagnosed cancers in China. Despite proof that screening can decrease CRC incidence and mortality, there are still gaps remaining between CRC screening objectives and reality in China. In this review, we provided an overview of the status of CRC screening in China. First, we summarized the current CRC screening programs and strategies in China. Second, we reviewed the authoritative CRC screening and early detection guidelines in China to orient future evidence-based guideline development. Finally, we identified current challenges and further provided some suggestions to improve the implementation of CRC screening programs. To maximize the effectiveness of CRC screening, further research on risk prediction models including polygenic risk scores and prior screening outcomes, novel biomarkers and artificial intelligence, and personalized screening strategies are recommended. Both cohort study and microsimulation techniques are recommended for long-term evaluations of the effectiveness of CRC screening strategies.

Abstract PO-065: Increasing breast and cervical cancer knowledge during COVID-19 pandemic in collaboration with Cooperative Extension Program

Abstract Introduction: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) reported that in April 2020, screening tests for breast cancer decreased by 87% and 84% for cervical cancer, compared to the averages of the previous 5-year for the same month. In response to this finding, the Puerto Rico Breast and Cervical Cancer Prevention and Early Detection Program (PR-BCCPEDP), in collaboration with the Cooperative Extension Program (CEP), implemented an educational intervention of breast and cervical cancer in the northeast region of the island. The intervention aimed to reinforce knowledge in the early detection of breast and cervical cancer, increase screening tests, and reach out to women without health insurance who may qualify for the Program. Methodology: Since 2017, the PR-BCCPEDP agreed with the CEP to implement educational interventions for breast and cervical cancer in 4 of CEP's regions throughout the island. From February to May 2021, seven CEP Family and Consumer Educators (EFC) carried out 8 educational activities with 182 participants in the island's northeast region. We collected age, town of residence, level of education, health insurance, breast and cervical cancer screening history, and the reasons for not having performed screening tests according to the recommended guidelines. The educational activities were performed virtually through an educational PowerPoint and face-to-face using flip charts. The topics included breast and cervical cancer statistics, risk factors, symptoms, early detection guidelines, myths and facts, and barriers to not having screening tests. Participants that didn't have the screening tests according to the recommended guidelines had follow-up calls. Results: A total of 182 women participated in the intervention, with an average age of 47 years; most participants had a high school degree (42%), and 59% had the government's health plan. Regarding screening tests, 35.1% reported that they had not had a mammogram in the last two years, 73.4% authorized to be contacted after the intervention. Similarly, Pap tests, 30.7% reported that they had not had a Pap test in the last three years, of which 87.5% authorized to be contacted. Of the participants who had not had a mammogram (35.1%) or Pap test (30.7%), the main reason was the COVID-19 Pandemic (22.9% and 21.8%, respectively). Regarding the participants referred to the PR-BCCPEDP, 3.6% of the women without health insurance were referred to the Program and of these, 50% were recruited. Conclusion: Despite security, restrictions from the Pandemic, collaborations with community-based programs helped to reach a greater number of women to provide education and awareness about breast and cervical cancer. In terms of breast and cervical cancer screening, more than a third of the participants had not had their mammogram or Pap done due to the Pandemic. Women were recruited for the Program; however, additional efforts are necessary in order to reach a higher number of uninsured women. Citation Format: Omayra Salgado, Ircha Martinez, Nelybeth Santiago, Mirza Rivera, Taina De La Torre, Guillermo Tortolero. Increasing breast and cervical cancer knowledge during COVID-19 pandemic in collaboration with Cooperative Extension Program [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-065.

Leveraging Clinical Informatics Tools to Extract Cumulative Anthracycline Exposure, Measure Cardiovascular Outcomes, and Assess Guideline Adherence for Children With Cancer.

Cardiovascular disease is a significant cause of late morbidity and mortality in survivors of childhood cancer. Clinical informatics tools could enhance provider adherence to echocardiogram guidelines for early detection of late-onset cardiomyopathy. Cancer registry data were linked to electronic health record data. Structured query language facilitated the construction of anthracycline-exposed cohorts at a single institution. Primary outcomes included the data quality from automatic anthracycline extraction, sensitivity of International Classification of Disease coding for heart failure, and adherence to echocardiogram guideline recommendations. The final analytic cohort included 385 pediatric oncology patients diagnosed between July 1, 2013, and December 31, 2018, among whom 194 were classified as no anthracycline exposure, 143 had low anthracycline exposure (< 250 mg/m2), and 48 had high anthracycline exposure (≥ 250 mg/m2). Manual review of anthracycline exposure was highly concordant (95%) with the automatic extraction. Among the unexposed group, 15% had an anthracycline administered at an outside institution not captured by standard query language coding. Manual review of echocardiogram parameters and clinic notes yielded a sensitivity of 75%, specificity of 98%, and positive predictive value of 68% for International Classification of Disease coding of heart failure. For patients with anthracycline exposure, 78.5% (n = 62) were adherent to guideline recommendations for echocardiogram surveillance. There were significant association with provider adherence and race and ethnicity (P = .047), and 50% of patients with Spanish as their primary language were adherent compared with 90% of patients with English as their primary language (P = .003). Extraction of treatment exposures from the electronic health record through clinical informatics and integration with cancer registry data represents a feasible approach to assess cardiovascular disease outcomes and adherence to guideline recommendations for survivors.

National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: a population-based analysis.

In some countries, breast cancer age-standardised mortality rates have decreased by 2-4% per year since the 1990s, but others have yet to achieve this outcome. In this study, we aimed to characterise the associations between national health system characteristics and breast cancer age-standardised mortality rate, and the degree of breast cancer downstaging correlating with national age-standardised mortality rate reductions. In this population-based study, national age-standardised mortality rate estimates for women aged 69 years or younger obtained from GLOBOCAN 2020 were correlated with a broad panel of standardised national health system data as reported in the WHO Cancer Country Profiles 2020. These health system characteristics include health expenditure, the Universal Health Coverage Service Coverage Index (UHC Index), dedicated funding for early detection programmes, breast cancer early detection guidelines, referral systems, cancer plans, number of dedicated public and private cancer centres per 10 000 patients with cancer, and pathology services. We tested for differences between continuous variables using the non-parametric Kruskal-Wallis test, and for categorical variables using the Pearson χ2 test. Simple and multiple linear regression analyses were fitted to identify associations between health system characteristics and age-standardised breast cancer mortality rates. Data on TNM stage at diagnosis were obtained from national or subnational cancer registries, supplemented by a literature review of PubMed from 2010 to 2020. Mortality trends from 1950 to 2016 were assessed using the WHO Cancer Mortality Database. The threshold for significance was set at a p value of 0·05 or less. 148 countries had complete health system data. The following variables were significantly higher in high-income countries than in low-income countries in unadjusted analyses: health expenditure (p=0·0002), UHC Index (p<0·0001), dedicated funding for early detection programmes (p=0·0020), breast cancer early detection guidelines (p<0·0001), breast cancer referral systems (p=0·0030), national cancer plans (p=0·014), cervical cancer early detection programmes (p=0·0010), number of dedicated public (p<0·0001) and private (p=0·027) cancer centres per 10 000 patients with cancer, and pathology services (p<0·0001). In adjusted multivariable regression analyses in 141 countries, two health system characteristics were significantly associated with lower age-standardised mortality rates: higher UHC Index levels (β=-0·12, 95% CI -0·16 to -0·08) and increasing numbers of public cancer centres (β=-0·23, -0·36 to -0·10). These findings indicate that each unit increase in the UHC Index was associated with a 0·12-unit decline in age-standardised mortality rates, and each additional public cancer centre per 10 000 patients with cancer was associated with a 0·23-unit decline in age-standardised mortality rate. Among 35 countries with available breast cancer TNM staging data, all 20 that achieved sustained mean reductions in age-standardised mortality rate of 2% or more per year for at least 3 consecutive years since 1990 had at least 60% of patients with invasive breast cancer presenting as stage I or II disease. Some countries achieved this reduction without most women having access to population-based mammographic screening. Countries with low breast cancer mortality rates are characterised by increased levels of coverage of essential health services and higher numbers of public cancer centres. Among countries achieving sustained mortality reductions, the majority of breast cancers are diagnosed at an early stage, reinforcing the value of clinical early diagnosis programmes for improving breast cancer outcomes. None.

Association between male infertility and prostate cancer: a systematic review and meta-analysis.

Male infertility has been shown to be associated with different maladies. The present systematic review and meta-analysis aimed to summarize the available evidence on the association between male infertility or childlessness and prostate cancer. The PubMed, Web of Science, and Scopus databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Studies were deemed eligible if they compared males with known infertility or childlessness to the control group including fertile males with regards to the diagnosis of prostate cancer. Overall, ten studies met our eligibility criteria. Three studies found that infertility was associated with higher risk of prostate cancer, four studies - with a reduced risk of prostate cancer, and three studies found no association. The forest plot revealed that infertility was not associated with prostate cancer (odds ratio [OR]: 1.26, 95% confidence interval [CI] 0.63-2.54; P = 0.5). Infertility was not associated with high (OR: 1.44, 95% CI 0.54-3.83; P = 0.5) or low (OR: 0.99, 95% CI 0.43-2.27; P = 0.9) grade prostate cancer. Infertility or childlessness were not associated with the risk of prostate cancer. The significant heterogeneity between the included studies supports the need for more granular research to guide/fine tune early detection guidelines based on fertility.