Health Care Screening Research Articles

Cardiopulmonary assessment prior to returning to high-hazard occupations post-symptomatic COVID-19 infection: a position statement of the Aviation and Occupational Cardiology Task Force of the European Association of Preventive Cardiology.

This article provides an overview of the recommendations of the Aviation and Occupational Cardiology Task Force of the European Association of Preventive Cardiology on returning individuals to work in high-hazard occupations (such as flying, diving, and workplaces that are remote from healthcare facilities) following symptomatic Coronavirus Disease 2019 (COVID-19) infection. This process requires exclusion of significant underlying cardiopulmonary disease and this consensus statement (from experts across the field) outlines the appropriate screening and investigative processes that should be undertaken. The recommended response is based on simple screening in primary healthcare to determine those at risk, followed by first line investigations, including an exercise capacity assessment, to identify the small proportion of individuals who may have circulatory, pulmonary, or mixed disease. These individuals can then receive more advanced, targeted investigations. This statement provides a pragmatic, evidence-based approach for those (in all occupations) to assess employee health and capacity prior to a return to work following severe disease, or while continuing to experience significant post-COVID-19 symptoms (so-called ‘long-COVID’ or post-COVID-19 syndrome).

Patient Navigation Based Care-delivery to Reduce Inequities in Cancer Care Among Immigrants and Refugees: A Commentary on the Successes and the Unmet Needs.

As immigrant and refugee populations continue to enter American shores, multiple factors such as lack of health and healthcare knowledge, cultural and linguistic barriers, and obstacles related to the social determinants of health (SDOH) limit the timely uptake of healthcare screenings, particularly cancer screening. Although acculturation experiences are unique to immigrants and refugees, similar to several other minority communities, these groups also face financial and other access-related challenges to cancer screening and treatment. Furthermore, the ongoing COVID-19 pandemic has likely exacerbated these issues. Therefore, exploring novel methods to reduce cancer related inequities among these populations is critical. Accordingly, in this article, we describe the importance of culturally tailored educational tools and patient navigation to reduce cancer-related disparities. Specifically, this article examines historical aspects of patient navigation, highlights experiences and studies using patient navigation to promote cancer screening and treatment within immigrant and refugee populations and discusses the unmet needs and future directions for patient navigator models along the cancer care continuum.

Provider opinions of the acceptability of Ask Suicide-Screening Questions (ASQ) Tool and the ASQ Brief Suicide Safety Assessment (BSSA) for universal suicide risk screening in community healthcare: Potential barriers and necessary elements for future implementation.

A convenience sample of community health care providers (N = 19) was asked to preview and rate the acceptability of the Ask Suicide-Screening Questions (ASQ) tool and the ASQ Brief Suicide Safety Assessment (BSSA) guide. Providers were also asked about potential barriers to implementation. The majority of participants stated they would be comfortable screening for suicide with the ASQ tool (78.9%; N = 15), that they would recommend the ASQ tool and the BSSA to colleagues (84.2%; N = 16), and that they were "satisfied" or "highly satisfied" with the ASQ and BSSA (88.2%; N = 13). Barriers to implementation reported included a lack of knowledge regarding suicide risk screening and lack of access to behavioral health resources. Education regarding the ASQ, the BSSA, and suicide risk screening are highlighted as crucial elements for future implementation.

Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis.

Metastases to the kidney are rare and were historically described in autopsy series, and the incidence ranged between 2.36% and 12.6%. However, in the contemporary literature with the improvements in imaging modalities (computed tomography scan and magnetic resonance imaging) and other health care screening services, metastatic tumors to the kidney are being diagnosed more frequently in surgical specimens. The utility of needle core biopsies in the primary evaluation of renal masses has also increased the number of sampled metastases, and as a result, only limited histologic material is available for evaluation in some cases and may potentially lead to diagnostic pitfalls. In the last decade, a few large clinical series have been published. In these series, the majority of metastatic tumors to the kidney are carcinomas, with the lung being the most common primary site. A significant number of the various tumor types with metastasis to the kidney are also associated with widespread metastases to other organs, and the renal metastasis may present several years after diagnosis of the primary tumor. The majority of secondary tumors of the kidney are asymptomatic, incidentally discovered, and solitary. There should be a high index of suspicion of metastasis to the kidney in patients with an associated enlarging renal lesion with minimal to no enhancement on imaging and tumor progression of a known high-grade nonrenal malignancy. Secondary tumors of the kidney can be accurately diagnosed by correlating histopathologic features with clinical and radiographic findings and the judicious use of ancillary studies.

Professional views on priorities for cervical cancer policy in Uganda: a qualitative study

BackgroundCervical cancer incidence in Uganda is three-times that of the global average, and is a leading cause of mortality for women. The main cause is human papillomavirus (HPV). Women living with HIV have a greater risk of acquiring HPV and need better cervical cancer care than their HIV-negative counterparts. Although funding and infrastructure exist for HIV control, they are not in place for cervical cancer. We aimed to assess Ugandan health professionals' knowledge of and perspectives regarding cervical cancer among women with HIV to identify perceived barriers and facilitators, and to guide potential interventions to reduce the burden of cervical cancer. MethodsWe used qualitative interviews to obtain primary data from professionals working in the HIV field in Uganda, identified through purposive and snowball sampling, and through consultation with colleagues at The AIDS Support Organisation (TASO) and Makerere University in Kampala. Inclusion criteria required the respondent to be a provider, researcher, community health worker, or other authority on cervical cancer and HPV and to be conversant in English. Exclusion criteria included being younger than 18 years. Written and verbal informed consent were obtained in accordance with the Medical College of Wisconsin and Makerere University human subjects protection protocols. Virtual, 1 h-long interviews were conducted and recorded. Interviews consisted of open-ended questions exploring perspectives on, knowledge about, and practices surrounding HPV and cervical cancer among women with HIV in Uganda. Institutional review board approval was obtained from TASO, the Uganda National Council for Science and Technology, and Medical College of Wisconsin. Transcripts were analysed and coded via MaxQDA software for common themes; emerging codes were generated from meaningful quotes as used in specific interviewee contexts of facilitators and barriers to HPV vaccination, cervical cancer screening, and treatment. FindingsTo date, we have conducted 50 interviews of health professionals with experience across Uganda. Common themes regarding barriers to cervical cancer control include misconceptions about treatment cost and effectiveness, scarce access to and distance to cervical cancer services, transient funding for cervical cancer screening and treatment supplies, and fears of social exclusion and death. Potential solutions offered by participants include decentralising care through integration with existing health programmes, and prioritising education that targets misconceptions surrounding cervical cancer. InterpretationProfessionals indicated numerous misconceptions and fears held by women with HIV and inaccessibility of care due to lack of funding and integration of services. Priorities should include increasing mass media campaigns that target misconceptions, decentralising care through integration with existing health-care infrastructure and HIV screening and treatment programmes, and training more professionals in rural areas. FundingMedical College of Wisconsin Cancer Center and Dr Elaine Kohler Global Health Research.

Include, Affirm, and Empower: A Paradigm Shift in Cancer Clinical Trials for Sexual and Gender Diverse Populations

Sexual and gender diverse (SGD) individuals have unique lived experiences across the lifespan that contribute to health disparities and influence cancer risk and outcomes. Biopsychosocial factors contribute to trauma and medical mistrust with suboptimal engagement with healthcare and cancer-preventive screenings. These factors contribute to cancer disparities among SGD people. A lack of inclusive and affirming practices within cancer clinical trials also contributes to this problem. Dismantling exclusionary research practices requires strategic action. We advocate for sexual orientation and gender identity (SOGI) data collection as well as thoughtful design and conduct of clinical trials that consider the role of intersectionality and minority stress. Exploring SGD cancer patients’ lived experiences and medical histories in a sensitive and affirming manner will help us learn about factors influencing treatment adherence and prognosis. The current manuscript outlines a paradigm shift in the conduct of clinical trials from early conceptualization through dissemination and implementation in order toinclude, affirm, and empowerSGD people with cancer. We provide an overview of culturally responsive practices that should be implemented at each phase of the research process. These enhancements to conventional trial procedures will promote the long-term goal of improving the safety and efficacy of cancer treatments for SGD patients. We also discuss methods for SGD community engagement, research personnel training, and considerations for working with SGD people in industry-funded clinical trials. Advancing clinical and research competencies along these guidelines are fundamental to promoting the inherent value of SGD patients’ lives and more equitable outcomes across the cancer care continuum.

Identifying patient profiles and mapping the patient journey across three countries in a large-scale, fully digital survey of patients with prostate cancer.

16 Background: A survey of patients with prostate cancer (PCa) was conducted to map their experiences, expectations and attitudes, and to identify challenges and unmet needs in diagnosis, therapy patterns, care teams, quality of life (QoL), patient organizations and resources. Here, we describe the initial survey results and explore differences in diagnosis and therapy patterns between 3 countries. Methods: Don’tBePatient Intelligence conducted a large survey in patients with non-metastatic (M−) and metastatic (M+) PCa in Germany (DE), the UK and the US from Feb 9–Apr 10, 2021 in collaboration with patient organizations and medical experts. Recruitment was through social media advertising and patient organizations. Data were evaluated using descriptive and advanced statistics. Results: Of 33,882 survey starters, 15,824 completed, split 50.1%/49.9% in rural/urban areas. In DE/US, diagnosis through healthcare screening was more frequent than in the UK (M−/M+: DE 77%/58%; UK 42%/21%; US 77%/63%) where a higher percentage of symptomatic diagnosis was recorded (M−/M+: DE 18%/39%; UK 49%/75%; US 12%/31%). Prostatectomy was the predominant therapy in M− PCa in DE/US (71%/57%). In the UK, radiotherapy was slightly more frequent than prostatectomy (48% vs. 41%) and active surveillance was more common than in DE/US (14% vs. 6%/9%). Hormone therapy was the most common therapy in M+ PCa in all countries (DE 65%; UK 77%; US 73%). Chemotherapy was received by < 2% of patients with M− PCa in all countries but was more frequent in M+ PCa in the UK than DE/US (38% vs. 21%/27%; table). Satisfaction levels were generally high (> 80%) for all therapies in all countries. Conclusions: To our knowledge this is the largest digital survey conducted in patients with PCa, allowing identification of unmet needs in the patient journey. Preliminary data suggest that rates of screening are lower in the UK than DE/US; this may correlate with the higher rate of symptomatic and potentially later-stage diagnosis, highlighting the role of routine screening. Relatively low active surveillance rates in DE/US may reflect a lower likelihood of men with M− versus M+ PCa to respond to the survey. Further analyses will include impact of differences in patient journey, trust in healthcare professionals, access to information, involvement with patient advocacy groups and QoL. [Table: see text]

Impact of COVID-19 on the incidence of prostate cancer among White and Black Veterans.

29 Background: Early-stage prostate cancer (PCa) is typically detected on prostate-specific antigen (PSA) screening and subsequent prostate biopsy, healthcare interventions that are considered routine elective procedures. The COVID-19 pandemic disrupted routine healthcare screenings and interventions. We sought to determine whether delayed screening and diagnostic workup of PCa was associated with increased rates of incident PCa, high-grade Gleason, and metastatic disease at diagnosis. Methods: We used the Corporate Data Warehouse of the Veterans Health Administration to collect PSA, prostate biopsy, PCa diagnosis, Gleason score, and metastasis information of White and Black Veterans aged 40 years or older newly diagnosed with PCa from January 2019 through June 2021. For each month, we calculated rates of PSA, prostate biopsy, and incident PCa per 100,000 men and plotted monthly rates by race. We performed descriptive analyses to compare age at first PSA, age at diagnosis, baseline PSA, Gleason scores, and metastasis pre- and post-January 2020, the month in which the U.S. declared COVID-19 a public health emergency. Results: The decrease in the rate of PSA screening immediately after January 2020 was similar in both White and Black Veterans (7% vs. 6%). However, the magnitude of reduction in the rate of prostate biopsy and the rate diagnosis of incident PCa were five times larger among Black Veterans compared to White Veterans (11% vs. 2% for both biopsy and diagnosis rates). Among the 17,771 White and 9,610 Black Veterans with incident PCa, the rate of Gleason of 4+3 or greater and the rate of metastatic disease at diagnosis increased three months after the pandemic in both race groups with comparable magnitude (2-3% increase in high-grade Gleason, 1% increase in metastatic disease). Conclusions: Utilization patterns indicated that while the decrease in PSA screening after the pandemic was similar in White and Black Veterans, reductions in prostate biopsy and diagnosis of incident PCa were five times greater in Blacks than Whites. Further research including risk-adjusted modeling is needed to determine whether Black Veterans were disproportionately affected by the pandemic-related disruptions in PSA screening and diagnostic workup of prostate cancer.[Table: see text]

Implementing traumatic brain injury screening in behavioral healthcare: protocol for a prospective mixed methods study

BackgroundCharacteristics of both individuals and innovations are foundational determinants to the adoption of evidenced-based practices (EBPs). However, our understanding about what drives EBP adoption is limited by few studies examining relationships among implementation determinants and implementation outcomes through theory-driven hypothesis testing. Therefore, drawing on the Theory of Planned Behavior and Diffusion of Innovations Theory, this study will disentangle relationships between provider characteristics and innovation factors on the early adoption of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) in behavioral health settings.MethodsThis study will utilize an explanatory sequential mixed methods design. In Phase I (quantitative), Time 1, we will investigate behavioral health providers (N = 200) attitudes, perceived behavioral control, subjective norms, and intentions to screen for TBI upon completion of a video module introducing the OSU TBI-ID. At Time 2, we will examine the number of TBI screens conducted over the previous month, as well as the feasibility, appropriateness, and acceptability of using the OSU TBI-ID in practice. Structural equation modeling will be used to determine whether provider characteristics predict TBI screening intentions, and whether intentions mediate actual TBI screening behaviors. We will then test whether feasibility, appropriateness, and acceptability of the OSU TBI-ID moderates the relationship between intentions and TBI screening behaviors. In Phase II (qualitative), we will develop an interview guide using results from Phase I and will conduct semi-structured interviews with providers (N = 20) to assess contextual determinants of TBI screening adoption. Qualitative data will be thematically analyzed using sensitizing concepts from the Consolidated Framework for Implementation Research and integrated with the quantitative results using a joint display.DiscussionThis mixed methods study capitalizes on two theory-driven hypotheses bridging proximal (e.g., screening intent) to distal (actual behaviors) implementation outcomes and will contextualize these results qualitatively to advance our understanding about why TBI screening adoption has failed to translate to the behavioral healthcare context. Results of this study will offer insights into what is driving TBI screening adoption so that implementation strategies can be selected with greater precision to improve the adoption, sustainment, and scale-up of TBI screening in behavioral healthcare.

Impact of COVID-19 on Primary Care Quality Measures in an Academic Integrated Health System.

BackgroundAccess to primary care was hindered by the coronavirus disease 2019 (COVID-19) pandemic.ObjectiveEvaluate changes in health screening rates before and during the pandemic.DesignRetrospective analysis of health maintenance and disease management screening rates among primary care patients before and during the pandemic.ParticipantsOver 150,000 patients of a large, academic health system.Main MeasuresSix quality measures were analyzed: colon cancer, breast cancer, cervical cancer, diabetes Hgb A1C, diabetes eye, and diabetes nephropathy monitoring. Based on US Preventative Services Task Force screening guidelines, we determined which patients were due for at least one of the quality measures. We tracked completion rates during three time periods: pre-pandemic (January 1–March 3, 2020), stay-at-home (March 4–May 8, 2020), and phased reopening (May 9–July 8, 2020). Differences in quality measure completion rates were evaluated using mixed-effects logistic regression models.Key ResultsCompared to pre-pandemic rates, completion of all health screenings declined during the stay-at-home period: mammograms (OR: 0.34; 95% CI: 0.31–0.37), cervical cancer (OR: 0.83; 95% CI: 0.76–0.91), colorectal cancer (OR: 0.25; 95% CI: 0.23–0.28), diabetes eye (OR: 0.34; 95% CI: 0.29–0.41), diabetes Hgb A1c (OR: 0.41; 95% CI: 0.37–0.46), and diabetes nephropathy (OR: 0.46, 95% CI: 0.41–0.53). During phased reopening, completion of all quality measures increased compared to the stay-at-home period, except for cervical cancer screening (OR: 0.83; 95% CI: 0.76–0.92). There was a persistent reduction in completion of all quality measures, except for diabetic nephropathy monitoring (OR: 0.99; 95% CI: 0.89–1.09), during phased reopening compared to pre-pandemic.ConclusionsHealthcare screening rates were reduced during the early part of the COVID-19 pandemic and did not fully recover to pre-pandemic rates by July 2020. Future research should aim to clarify the long-term impacts of delayed health screenings. New interventions should be considered for expanding remote preventative health services.

Firearm ownership, attitudes, and safe storage practices among a nationally representative sample of older U.S. adults age 50 to 80

Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019–12/23/2019) of 2048 older adults (age 50–80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%–28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9–73.1]) and safety counseling (63.2% [95%CI = 58.8–67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1–82.3]), comprehensive background checks (85.0% [95%CI = 81.5–87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9–90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8–84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's < 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.

Russian-Language Mobile Apps for Reducing Alcohol Use: Systematic Search and Evaluation.

BackgroundPersonalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated.ObjectiveThis study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia.MethodsA systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS).ResultsWe identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing.ConclusionsRussian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458

Validation for measurements of skeletal muscle areas using low-dose chest computed tomography

Various methods were suggested to measure skeletal muscle areas (SMAs) using chest low-dose computed tomography (chest LDCT) as a substitute for SMA at 3rd lumbar vertebra level (L3-SMA). In this study, four SMAs (L1-SMA, T12-erector spinae muscle areas, chest wall muscle area at carina level, pectoralis muscle area at aortic arch level) were segmented semi-automatically in 780 individuals taking concurrent chest and abdomen LDCT for healthcare screening. Four SMAs were compared to L3-SMA and annual changes were calculated from individuals with multiple examinations (n = 101). Skeletal muscle index (SMI; SMA/height2) cut-off for sarcopenia was determined by lower 5th percentile of young individuals (age ≤ 40 years). L1-SMA showed the greatest correlation to L3-SMA (men, R2 = 0.7920; women, R2 = 0.7396), and the smallest annual changes (0.3300 ± 4.7365%) among four SMAs. L1-SMI cut-offs for determining sarcopenia were 39.2cm2/m2 in men, and 27.5cm2/m2 in women. Forty-six men (9.5%) and ten women (3.4%) were found to have sarcopenia using L1-SMI cut-offs. In conclusion, L1-SMA could be a reasonable substitute for L3-SMA in chest LDCT. Suggested L1-SMI cut-offs for sarcopenia were 39.2cm2/m2 for men and 27.5cm2/m2 for women in Asian.

Psychological differences in adults with and without a COVID-19 diagnosis

Background Substantial evidence is emerging regarding the broad societal and psychological impacts of the COVID-19 pandemic, but little is known about whether infected individuals are differently affected. Aim We evaluated psychological differences between individuals who do vs. do not report testing positive for COVID-19. Methods An online survey was offered to adults (≥18 years) who were diagnosed with COVID-19 by a provider within a large integrated-delivery healthcare system, enrolled in COVID-19-related clinical trials at the healthcare system, or responded to targeted local distribution. Measures assessed included the 8-item Patient Health Questionnaire depression scale, Generalized Anxiety Disorder 7-item Scale, and Posttraumatic Diagnostic Scale for DSM-5. Results Of 487 respondents, 43% reported testing positive for COVID-19, including 11% requiring hospitalization. Overall rates of general anxiety disorder and posttraumatic stress were 34% and 16%, respectively, with no significant differences between groups. Prevalence of depression was higher among respondents reporting a positive COVID-19 test (52% vs. 31%). This difference persisted after controlling for respondent characteristics (odds ratio = 3.7, p < 0.01). Conclusions People who report testing positive for COVID-19, even those not requiring hospitalization, have increased risk for depression. Mental health care screening and services should be offered to individuals testing positive, facilitating early intervention.

Abstract PO-036: Healthcare and colorectal cancer screening needs among older adults in a cancer center catchment area

Abstract Background and objective Cancer centers and healthcare systems play a pivotal role in identifying and responding appropriately to the population's cancer burden and health needs in their catchment area to reduce health inequities. Community health needs assessment (CHNA) is an integral instrument in identifying individuals' fundamental health needs in a given community. This study utilizes data from a pilot CHNA collected by a Cancer Center at community engagement events to examine cancer screening status, cancer screening education, having a primary care doctor, and barriers to healthcare among older participants. We hypothesize that screening and healthcare needs will differ by racial/ethnic groups. Methods The initial CHNA comprises data from eligible participants aged 18 years and older who attended 13 cultural and health events in Chicago from August to December 2019. The study analysis focused on Hispanic, Non-Hispanic Black (NHB), and Non-Hispanic White (NHW) participants aged 50 years and older. We examined colorectal cancer (CRC) screening and education interest questions as emblematic for both sexes in this age group based on the U.S. Preventive Services Task Force recommendations in 2019. Participants responded to (1) having received colon/rectal cancer screening with stool test (FOBT/FIT) or colonoscopy within the past ten years and (2) interests in learning more about the screening tests. We conducted descriptive bivariate analyses to examine CRC screening status and interests, having primary care, and barriers to care by race/ethnicity and used the Chi-square test of association to compare differences for the descriptive analyses. Results The study consisted of 308 men and women aged 50 years and older. Of these, 25% were Hispanic, 59% were NHB, and 16% were NHW. Compared to NHW participants, a smaller proportion of Hispanics (59.2% vs 78.4%; p=0.02) reported receiving CRC screening while no differences were observed for NHB participants (73.5% vs 78.4%; p=0.47). Compared to NHW participants, more Hispanics (31.6% vs 11.8%; p=0.01) and NHB (27.6% vs 11.8%; p=0.02) participants expressed interest in receiving education on CRC screening. Likewise, more Hispanic participants reported not having a primary care doctor (86.8% vs 94.1%; p=0.02), while no differences were observed for NHB vs NHW participants (92.3% vs 94.1%; p=0.08). Furthermore, compared to NHWs, more Hispanics and NHB participants reported barriers to screening such as transportation (NHW=0% vs Hispanics=7.9% vs NHB=16%), knowledge of screening services (NHW=1.96% vs Hispanics=7.9% vs NHB=20.4%), and lack of provider trust (NHW=3.9% vs Hispanics=11.8% vs NHB=14.3%). Conclusion The study findings show differences in CRC screening status and education interests, having primary care, and barriers to care by race/ethnicity. Minority groups reported higher screening education interests and barriers to care. This study demonstrates a means of identifying the population's healthcare needs and interests within a catchment area using a community engagement model. Citation Format: Ifeanyi B. Chukwudozie, Chibuzor Abasilim, Jessica M. Madrigal, Vida A. Henderson, Erica Martinez, Alana A. Aziz-Bradley, Jeanette Santana Gonzalez, Nasima Mannan, Ahlam Al-Kodmany, Karriem S Watson. Healthcare and colorectal cancer screening needs among older adults in a cancer center catchment area [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-036.

Universal thyroid screening in maternal health care in India: The need of the hour

Universal thyroid screening in maternal health care in India: The need of the hour

Training primary health care providers in Colombia, Mexico and Peru to increase alcohol screening: Mixed-methods process evaluation of implementation strategy.

Initial results from the SCALA study demonstrated that training primary health care providers is an effective implementation strategy to increase alcohol screening in Colombia, Mexico and Peru, but did not show evidence of superior performance for the standard compared to the shorter training arm. This paper elaborates on those outcomes by examining the relationship of training-related process evaluation indicators with the alcohol screening practice. A mix of convergent and exploratory mixed-methods design was employed. Data sources included training documentation, post-training questionnaires, observation forms, self-report forms and interviews. Available quantitative data were compared on outcome measure - providers' alcohol screening. Training reach was high: three hundred fifty-two providers (72.3% of all eligible) participated in one or more training or booster sessions. Country differences in session length reflected adaptation to previous topic knowledge and experience of the providers. Overall, 49% of attendees conducted alcohol screening in practice. A higher dose received was positively associated with screening, but there was no difference between standard and short training arms. Although the training sessions were well received by participants, satisfaction with training and perceived utility for practice were not associated with screening. Profession, but not age or gender, was associated with screening: in Colombia and Mexico, doctors and psychologists were more likely to screen (although the latter represented only a small proportion of the sample) and in Peru, only psychologists. The SCALA training programme was well received by the participants and led to half of the participating providers conducting alcohol screening in their primary health care practice. The dose received and the professional role were the key factors associated with conducting the alcohol screening in practice.Plain Language Summary: Primary health care providers can play an important role in detecting heavy drinkers among their consulting patients, and training can be an effective implementation strategy to increase alcohol screening and detection. Existing training literature predominantly focuses on evaluating trainings in high-income countries, or evaluating their effectiveness rather than implementation. As part of SCALA (Scale-up of Prevention and Management of Alcohol Use Disorders in Latin America) study, we evaluated training as implementation strategy to increase alcohol screening in primary health care in a middle-income context. Overall, 72.3% of eligible providers attended the training and 49% of training attendees conducted alcohol screening in practice after attending the training. Our process evaluation suggests that simple intervention with sufficient time to practice, adapted to limited provider availability, is optimal to balance training feasibility and effectiveness; that booster sessions are especially important in context with lower organizational or structural support; and that ongoing training refinement during the implementation period is necessary.

Abstract PO-260: Screening of Brazilian underserved workers exposed to asbestos in loco with a mobile low dose computed tomography

Abstract Occupational exposure to asbestos is strongly associated with pleural and pulmonary fibrosis, lung cancer, and malignant mesothelioma. Although many countries, including Brazil, have recently banned the extraction and usage of asbestos, cases of pulmonary fibrosis and asbestos-related malignancy are still expected to increase, due to the long latency period of disease development. A proper response to this scenario primarily requires awareness and structured surveillance, but also access to screening and diagnostic methods in healthcare, restrict and unequally available in Brazil. Recent evidence suggests that Low Dose Computed Tomography (LDCT) may be an effective tool to screen malignancy in asbestos-exposed workers. Here we describe an initiative to improve screening with a mobile LDCT unit in an underserved population of workers of a former asbestos manufacture factory at Pedro Leopoldo, city, Minas Gerais state, Brazil. In partnership with ABREA (Associação Brasileira dos Expostos ao Amianto) workers with a history of direct or indirect asbestos exposure were included in September 2019, regardless of the exposure duration or respiratory symptoms, to whom an LDCT examination was offered. Thoracic radiologists searched for pleural plaques or nodules, pleural effusion, fibrosis-related findings, and lung nodules, and a structured report was filled in. Pulmonary nodules were managed according to Lung-Rads-1.1. Necessary supplementary investigations were referred to a tertiary oncological center, in which the malignancies were also to be treated. Two hundred and three men and twenty women underwent LDCT screening, the median age of 57 years, 89% directly engaged in asbestos manufacturing. Pleural plaques or nodules were identified in 19% of individuals, with a median exposure time of 13,5 years. Five individuals had moderate or marked signs of pulmonary fibrosis, and one was diagnosed with low-stage pulmonary adenocarcinoma, none of which were suspected under usual care. Although political interference had precluded full attendance of participants, proper treatment was guaranteed with the aid of the Labor Prosecutor Office. The mobile LDCT unit was successful in enhancing screening and awareness of this exposed and underserved population. Citation Format: Rodrigo Sampaio, Leonardo Almeida, Larissa Ferreira, Maraisa Costa, Ana Oliveira, Bruna Carvalho, Mauro Cardoso, Fabiana Vazquez, Henrique Silveira, Laércio Castilho-Neto, Fernanda Giannasi Fernanda Giannasi, Rui Reis. Screening of Brazilian underserved workers exposed to asbestos in loco with a mobile low dose computed tomography [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-260.

Abstract PO-017: The association of COVID-19 and cancer screening inquiries among Spanish speakers: An examination of NCI Cancer Information Service data

Abstract The disruption of routine cancer screening during the COVID-19 pandemic is a public health priority given documented delays in the diagnosis and treatment of screening-eligible cancers, and future impacts on cancer mortality. Furthermore, COVID-19 has disproportionately affected historically underrepresented populations such as the Hispanic community, who already experience lower cancer screening rates compared to non-Hispanic whites. The purpose of this study was to examine inquiries about cancer screening among Spanish-speaking general public users before and during COVID-19, using data from the National Cancer Institute's Cancer Information Service (CIS). For this analysis, we examined cancer screening inquiries before (February 2019-March 2020) and during (March 2020-January 2021) COVID-19 among Spanish-speaking general public users. We analyzed CIS point of access (email, LiveHelp, social media, telephone), subjects of interaction, and referrals. Cancer sites with low cell sizes (e.g., lung) were combined into the category “other.” We conducted Chi-squared tests to compare counts for cancer screening inquiries before and during COVID-19 across these variables. There were 47.3% (n=691) cancer screening inquiries among English-speaking users before COVID-19 and 52.7% (n=770) during COVID-19. In comparison, among the 300 cancer screening inquiries from Spanish speakers, there were 57% (n=171) before COVID-19 compared to 43% (n=129) during COVID-19. There was a significant difference in patterns between these two groups (p&amp;lt;.002). Cancer site inquiries among Spanish speakers included breast (n=66), general (n=108), and 17 other cancers combined (n=126). The proportion of breast and general cancer inquiries from Spanish speakers increased during COVID-19 compared to pre-COVID (p&amp;lt;.001), whereas other cancer inquiries decreased. Additionally, Spanish-speaking telephone-based inquiries increased during COVID-19 whereas all other points of access decreased (p&amp;lt;.001); subjects of interaction regarding general cancer questions increased, but those on finding healthcare services, screening tests, and other subjects decreased (p&amp;lt;.01); and there was an increase in referrals to national/community organizations and to the CDC National Breast and Cervical Cancer Early Detection Program, although referrals to healthcare providers and other sources decreased during COVID-19 (p&amp;lt;.001). We found that COVID-19 was associated with a significant decrease in cancer screening inquiries among Spanish speakers compared to English speakers using the CIS, with changes in point of access, referrals, subject of interaction, and cancer site for Spanish-speaking CIS users. It is critical to evaluate how these changes in information-seeking may affect screening behaviors post-COVID in Hispanic communities and may potentially widen existing disparities that have worsened during COVID-19. Despite overall inquiry reductions, there was an increase in some cancer screening referrals, hopefully resulting in increased screening behavior among Spanish-speaking CIS users. Citation Format: Heather N. Platter, Adaora Ezeani, Travis Hyams, Grace C. Huang, Robin C. Vanderpool, William M.P. Klein. The association of COVID-19 and cancer screening inquiries among Spanish speakers: An examination of NCI Cancer Information Service data [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-017.

Telemedicine Consultation: Geriatric Patients’ Attitude at Primary Care Clinics in Security Forces Hospital in Riyadh, Saudi Arabia

Background: Telemedicine has been adopted to deliver healthcare services around the world in response to the COVID-19 pandemic. Telemedicine was widely used due to its safety in providing healthcare services and screening for COVID-19 symptoms. Objectives: To assess telemedicine consultations during the COVID-19 pandemic at primary care clinics for follow-up geriatric patients. Materials and methods: A cross-sectional survey-dependent study was conducted at Security Forces Hospital in Riyadh, Saudi Arabia, from July to August 2021. Participants were selected using a non-randomized voluntary response sampling technique. Data were collected over telephonic interviews and analyzed using SPSS program version 23. Results: A total of 518 respondents were included in the study. We found 90.73% of the participants thought that first time they have been consulted as a patient on the Telephone. And 91.89% of the participants thought that the majority agreed that it made healthcare services easier during the COVID-19 pandemic. their desire to in the future to have telephone Consultation (71.62%). Showed that the average attitude toward Telephone consultingsatisfaction score of respondents was 6.5 ± 1.0, demonstrating that most participants revealed a good level of Attitude toward telephonic consultations during the pandemic. Satisfaction scores, gender, age and nationality of participants did not differ significantly. Conclusion: The study concluded that geriatric patients had an excellent attitude toward telemedicine consultation during the pandemic at the Hospital’s primary care clinic. Further studies are needed to address factors associated with attitudes toward telemedicine. Keywords: Attitude, Telemedicine, Riyadh, geriatric patients, COVID-19