Implementation Of Screening Program Research Articles

An artificial intelligence-enabled consumables tracking system for medical laboratories

Abstract The medical laboratory plays a crucial role within a hospital setting and is responsible for the examination and analysis of patient specimens to accurately diagnose various ailments. The burden on medical laboratory personnel has significantly increased, particularly in the context of the ongoing global COVID-19 pandemic. Worldwide, the implementation of comprehensive and extended COVID-19 screening programs has placed a significant strain on healthcare professionals. This burden has led to exhaustion among medical employees, limiting their ability to effectively track laboratory resources, such as medical equipment and consumables. Therefore, this study proposed an artificial intelligence (AI)-based solution that contributes to a more efficient and less labor-intensive workflow for medical workers in laboratory settings. With the ultimate goal to reduce the burden on healthcare providers by streamlining the process of monitoring and managing these resources, the objective of this study is to design and develop an AI-based system for consumables tracking in medical laboratories. In this work, the effectiveness of two object detection models, namely, YOLOv5x6 and YOLOv8l, for the administration of consumables in medical laboratories was evaluated and analyzed. A total of 570 photographs were used to create the dataset, capturing the objects in a variety of settings. The findings indicate that both detection models demonstrate a notable capability to achieve a high mean average precision. This underscores the effectiveness of computer vision in the context of consumable goods detection scenarios and provides a reference for the application of real-time detection models in tracking systems within medical laboratories.

Implementation of clinical breast examination screening programme as part of primary care in Vietnam: An analysis of contextual factors

Implementation of clinical breast examination screening programme as part of primary care in Vietnam: An analysis of contextual factors

Prostate-specific antigen, digital rectal examination, and prostate cancer detection: A study based on more than 7000 transrectal ultrasound-guided prostate biopsies in Ghana

Purpose of the studyThis study aims to determine the role of serum prostate-specific antigen (PSA) levels and digital rectal examination (DRE) in predicting the histological outcomes of prostate biopsies by analyzing a database of over 7000 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsies. MethodsWe conducted a retrospective analysis of men who underwent TRUS-guided prostate biopsies at Korle Bu Teaching Hospital, a tertiary referral center in Accra, Ghana, from July 2005 to December 2022. The biopsies, which included 10 to 12 core samples, were prompted by PSA levels greater than 4.0 ng/mL, abnormal DRE findings, or both. We then correlated histopathology results with PSA and DRE findings. ResultsOut of 7,338 patients who presented for biopsy, 76.3% were between the ages of 60 and 79. Histology reports were available for 5,289 patients, of whom 2,564 (48.5%) were diagnosed with prostate cancer. Cancer detection rates based on PSA levels were as follows: 21.6% for PSA <4 ng/mL, 21.7% for PSA 4-10 ng/mL, 32.7% for PSA 10-20 ng/mL, 53.0% for PSA 20-50 ng/mL, 71.5% for PSA 50-100 ng/mL, and 92.0% for PSA >100 ng/mL. When DRE findings were classified according to the 2016 TNM System (AJCC 8th Edition) as T1, T2, T3, and T4, cancer detection rates were 26.8%, 51.8%, 87.6%, and 95.7%, respectively. The overall cancer detection rate was significantly higher with abnormal DRE findings (64.6% vs. 26.7%, p < 0.001). Additionally, 78.2% of the detected cancers were high-grade (Gleason score of 7 or more). ConclusionThis extensive study of Ghanaian men undergoing TRUS biopsies reveals a high prostate cancer detection rate, with nearly 80% of the detected cancers being high-grade. These findings underscore the importance of PSA and DRE in the early detection of prostate cancer and should be considered in patient counseling and discussions regarding the implementation of prostate cancer screening programs in this population.

Preferences of parents from diverse backgrounds on genomic screening of apparently healthy newborns.

Genomic sequencing has been proposed as a strategy to expand newborn screening. Perspectives on genomic newborn screening from parents of diverse racial, ethnic, and socioeconomic backgrounds are needed to shape equitable implementation of this modality. We conducted 20 semi-structured interviews (15 English, 5 Spanish) and seven focus groups (4 English, 3 Spanish) with parents from diverse backgrounds to assess their perspectives regarding which disorders and variants might be screened, data privacy, and barriers to pursuing specialized care. Parents felt that genomic newborn screening would provide them with improved understanding of their children's health and had the potential to yield health and personal benefits. Themes that became evident included: interest in childhood and family health risks, the value of emotional preparation and personal planning, understanding of uncertain and low-risk results, concerns regarding data privacy, and concerns about support following the receipt of a positive newborn screening result. The expected benefits and concerns expressed by parents of diverse backgrounds regarding genomic newborn screening should guide future policy decisions. Their preferences should be considered prior to the implementation of large-scale genomic newborn screening programs.

Colorectal screening program implementation in primary health care, in Loures-Odivelas, Portugal

Abstract Problem In 2020, Portugal had the highest cumulative incidence of colorectal cancer (CRC) in the European Union (103 new cases/100,000 inhabitants). The Colorectal Cancer Screening Program (CRCS) is based on fecal occult blood testing (FOBT) as the primary screening method. With the delivery of the stool sample collection device; instruction on its use is provided by the Primary Health Care team. The sample is processed at the Clinical Pathology laboratory of the Hospital Center (HC). In case of a positive result, the general practitioner communicates the result and refers the individual to the Follow-up and Treatment Center. Description The general objective of this project was to implement the CRCS in the 19 Family Health Units (FHU) of Loures-Odivelas Health Center Group, between September 2022 and April 2023. The following activities were carried out: 1. Sessions to present the patient pathway, record platform, and stool sample collection device; 2. Application of a checklist of essential points for the start of screening; 3. Preparation and dissemination of monitoring reports to the FHU; 4. Follow-up visits to clarify doubts. Results By March 2023, CRCS had been implemented in 15 of the 19 FHU (79%). Between September 2022 and March 2023, 1,430 devices were delivered and 959 FOBT samples were received (67%). Among the devices received with biological samples, it was not possible to issue a result for 5%. Lessons The activities carried out allowed for the initiation of CRCS in most FHU. The involvement of professionals in these activities contributes to increased patient adherence and proper collection technique, reducing inconclusive FOBT results. It is necessary to continue this strategy of personalized support for the FHU to consolidate the implementation of CRCS in LO HCG. Ensuring that the necessary materials are available and that result issuance and referral deadlines are met are important factors for maintaining professional motivation. Key messages • The objective was to implement the Colorectal Cancer Screening Program (CRCS) in 19 Family Health Units (FHU) in Loures-Odivelas. By March 2023, CRCS had been implemented in 15 of 19 FHU (79%). • It is important to continue these activities in order to put into operation the CRCS in all FHU and to tackle the problem of colorectal cancer.

Effects of screening coverage and screening quality assurance on cervical cancer mortality: Implication for integrated framework to monitor global implementation of cervical cancer screening programmes.

Cervical cancer is a global health threat and a manifestation of inequality, and screening is an effective intervention. However, little is known about how screening coverage and quality assurance, influence cervical cancer mortality. We aimed to investigate the association between screening coverage, screening quality assurance and cervical cancer mortality among women from countries at different developmental levels. We obtained data on age-standardised mortality from cervical cancer from the GLOBOCAN 2020 database; coverage of cervical cancer screening from World Health Organization (WHO) Global Health Observatory; and cervical screening programme settings and quality assurance from the Cancer Screening in Five Continents (CanScreen5) database. We assessed the dependency of cervical cancer age-standardised mortality on screening coverage and quality assurance by simple and multiple regression models. We also used linear regression models to identify factors that improved the screening coverage. The study included data from 53 countries. Reduced mortality was associated with increased screening programme quality assurance in 22 high-development countries. In 31 low-development countries, screening coverage in women aged 30-49 years was inversely associated with cervical cancer mortality. Political commitment (documentation of the cervical cancer screening policy as law) and financial support (treatment services provided free of charge) positively associated with screening coverage. Screening programmes need strengthening commensurate with local resources and context. Priority should be given to improving screening coverage through stronger political commitment and financial support in low-development countries, and to ensuring good performance at all levels in high-development countries.

10 Optimizing implementation and continuous monitoring of a newborn screening program for severe combined immunodeficiency

Abstract Background Severe Combined Immunodeficiency (SCID) is an inborn error of immunity characterized by severely low T cell levels and function. Early diagnosis is essential to prevent serious infections and improve outcomes. Newborn screening (NBS) for SCID provides a way to detect SCID and other conditions associated with T cell lymphopenia in the neonatal period. Objectives 1) Optimize the implementation of a NBS program for SCID in British Columbia (BC), Canada; and 2) create a systematic method for monitoring the diagnoses and outcomes of infants with a positive screen to facilitate continuous improvement of the NBS program. Design/Methods An interdisciplinary working group comprised of immunologists, biochemical geneticists, and hematopathologists met at regular intervals prior to and after implementing NBS for SCID in BC. We developed an algorithm for the evaluation and initial management of infants with an abnormal NBS for SCID based on literature review and local expert consensus. Using a REDCap database, we tracked the prevalence, evaluation, diagnoses and outcomes of infants with a positive NBS. The database also monitored diagnoses and outcomes of children referred to Immunology outside of the NBS program. Plan-do-study-act cycles included creation of clinical and educational guidelines on SCID, optimization of abnormal NBS cut-off values, and reflex chromosomal microarray (CMA) testing of infants with confirmed T cell lymphopenia. Results Between October 3, 2022 and June 16, 2023, 28,816 initial samples were tested, and 30 infants had a positive screen for SCID. Of the 30 infants, 10 were ultimately diagnosed with conditions associated with T cell lymphopenia. Diagnosis led to avoidance of live viral vaccines and implementation of infection precaution measures. No infants experienced complications related to live viral vaccine administration, compared to 1 case in the preceding 12 months prior to NBS implementation. In February 2023, the threshold for an abnormal NBS was adjusted to achieve the goal positive screen frequency of 0.1%. Performing reflex CMA testing on infants with confirmed T cell lymphopenia led to rapid diagnosis of chromosomal microdeletion syndromes, avoiding unnecessary second tier testing. Since implementing NBS for SCID in BC, there have been no cases of SCID diagnosed outside of the NBS program. Conclusion Establishing an interdisciplinary working group and clinical database facilitated the smooth integration and continuous improvement of NBS for SCID in BC. This model can be applied to other healthcare systems to support teams and ensure the best possible outcomes for affected patients.

No Ear Left Behind: Wireless Earbuds for Low-Cost Hearing Screening

Hearing loss is particularly harmful for language acquisition and neuro-development if it is left undetected in early childhood. Newborn hearing screening technologies using otoacoustic emissions (OAE) rely on detecting soft sounds generated by a healthy cochlea. High-income countries like the United States frequently implement hearing screening programs for every child at birth. However, such universal hearing screening is significantly less common in low- and middle-income countries, partly due to the conventional wisdom that the test requires sensitive and expensive acoustic hardware that costs thousands of dollars. In our MobiSys paper[1], we present the first wireless earbud design for low-cost hearing screening. Our hardware-software system reliably performs hearing screening using low-cost acoustic hardware, while being in the form-factor of a wireless earbud (Figure. 1a,b). The earbud hardware is designed to work across a large age range from newborns to adults. By developing low-cost and open-source wearable technology, our work may help address global health inequities in hearing screening by democratizing these medical devices.

Mood temperaments in adult patients with attention-deficit/hyperactivity disorder

BackgroundThe incidence of various mood disorders and temperaments in ADHD patients is well-documented, irrespective of age. These temperamental differences cause emotional and behavioral instability, impacting individual and social functioning, and overall quality of life. This study evaluates different temperaments in adults with ADHD compared to those without ADHD.MethodsThis case–control study was performed on 75 adult ADHD patients as the case group and 75 adults without ADHD as the control group. A demographic questionnaire and a shortened Persian version of the TEMPS-A questionnaire were given and completed to the people included in the study to assess different mood temperaments.ResultsComparing different components of mood temperaments between the patients with and without ADHD showed significantly higher mean scores for irritable, anxious, depressed, and cyclothymic temperaments in those with ADHD as compared to a control group. In the group suffering from ADHD, women had significantly higher mean scores for dysthymic and anxious temperaments as compared to men, while the mean score for cyclothymic temperaments was significantly higher in men than in women. A high academic degree was associated with lower scores for mood temperaments, while mood temperaments were independent of patients’ age.ConclusionsThe higher score of various mood temperaments in patients with ADHD compared to people without this disorder is completely predictable, and this score can potentially affect the gender of the patients as well as their education level. Given the higher scores of temperamental traits in patients with adult ADHD, implementing screening programs aimed at identifying temperamental disorders in these patients is highly emphasized.

Implementation of a Lung Cancer Screening Program in a Community Setting

Implementation of a Lung Cancer Screening Program in a Community Setting

Synthesized economic evidence on the cost-effectiveness of screening familial hypercholesterolemia

BackgroundFamilial hypercholesterolemia (FH) is a prevalent genetic disorder with global implications for severe cardiovascular diseases. Motivated by the growing recognition of the need for early diagnosis and treatment of FH to mitigate its severe consequences, alongside the gaps in understanding the economic implications and equity impacts of FH screening, this study aims to synthesize the economic evidence on the cost-effectiveness of FH screening and to analyze the impact of FH screening on health inequality.MethodsWe conducted a systematic review on the economic evaluations of FH screening and extracted information from the included studies using a pre-determined form for evidence synthesis. We synthesized the cost-effectiveness components involving the calculation of synthesized incremental cost-effectiveness ratios (ICERs) and net health benefit (NHB) of different FH screening strategies. Additionally, we applied an aggregate distributional cost-effectiveness analysis (DCEA) to assess the impact of FH screening on health inequality.ResultsAmong the 19 studies included, over half utilized Markov models, and 84% concluded that FH screening was potentially cost-effective. Based on the synthesized evidence, cascade screening was likely to be cost-effective, with an ICER of $49,630 per quality-adjusted life year (QALY). The ICER for universal screening was $20,860 per QALY as per evidence synthesis. The aggregate DCEA for six eligible studies presented that the incremental equally distributed equivalent health (EDEH) exceeded the NHB. The difference between EDEH and NHB across the six studies were 325, 137, 556, 36, 50, and 31 QALYs, respectively, with an average positive difference of 189 QALYs.ConclusionsOur research offered valuable insights into the economic evaluations of FH screening strategies, highlighting significant heterogeneity in methods and outcomes across different contexts. Most studies indicated that FH screening is cost-effective and contributes to improving overall population health while potentially reducing health inequality. These findings offer implications that policies should promote the implementation of FH screening programs, particularly among younger population. Optimizing screening strategies based on economic evidence can help identify the most effective measures for improving health outcomes and maximizing cost-effectiveness.

Awareness of Colorectal Cancer Preventive Measures Among Residents of Riyadh.

Background Colorectal cancer (CRC) poses a significant challenge to healthcare providers. Spreading awareness, providing preventive measures, and implementing screening programs are essential for detecting and halting the progression of the disease and decreasing the mortality associated with this type of malignancy. This study aimed to assess public knowledge and awareness of colorectal cancer preventive measures and screening programs among residents of Riyadh, Saudi Arabia, and also to design better healthcare interventions or policy development. Methods This cross-sectional study was carried out among residents in Riyadh, Saudi Arabia. A self-administered questionnaire was sent to participants using a Google survey. The questionnaire consisted of socio-demographic characteristics (age, gender, marital status, and occupation), a general understanding of CRC and its prevention, risk factors for developing CRC, barriers to undergoing CRC screening, and a 21-item questionnaire to assess awareness of CRC preventive measures. Results Of the 420 respondents, 301 (71.7%) were female, and 134 (31.9%) were between 18 and 29 years old. The overall mean awareness score was 12.5 (SD 3.05) out of 21 points. Accordingly, 240 (57.1%) were categorized as having moderate awareness, 70 (16.7%) as good, and 110 (26.2%) had poor awareness levels. Being younger, being unmarried, having heard of CRC and screening tests that detect colon cancer, and being aware of the CRC early detection campaign in Saudi Arabia were the factors associated with increased awareness. Conclusion There was modest awareness of CRC preventive measures among residents living in Riyadh. Significant predictors of increased awareness include younger age, being unmarried, having heard of CRC, having heard of screening tests to detect CRC, and awareness of the CRC early-detection campaigns in Saudi Arabia. Healthcare providers have a vital role in increasing awareness of CRC's preventive measures.

Developmental screening of neurodevelopmental disorders before age 6: a nationwide health screening program.

We aimed to investigate the association between developmental screening before 24 months of age and neurodevelopmental disorders (NDDs) at 4-6 years of age. We included 922,899 newborn born between 2014 and 2016 registered in National Health Insurance Service (NHIS). Developmental screening was administered at 9-12 and 18-24 months old with the Korean Developmental Screening Test for Infants & Children (K-DST). Diagnoses of NDDs was based on the World Health Organization's International Classification of Diseases, Tenth Revision (ICD-10), provided by the NHIS database. Among 637,277 individuals who underwent screening at 9-12 and 18-24 months, Screen-positivity (defined as summed score < -2 standard deviation) for gross motor domain at 9-12 months was significantly associated with the incidence of autism spectrum disorder (aHR, 2.24; 95% CI, 1.80-2.80) and cerebral palsy (aHR, 4.81; 95% CI, 3.62-6.38). Screening positive at language domain at 18-24 months old was associated with autism spectrum disorder (aHR 5.50; 95% CI, 4.31- 7.02) and developmental language disorder (aHR 8.67; 95% CI, 7.27-10.33) at 4-6 years of age. Widespread nationwide implementation of screening programs before 24 months was effective in identifying NDDs at 4-6 years of age. Further strategies integrating with referral and intervention systems should be established. We investigated the screening effect of nationwide developmental screening program on neurodevelopmental disorders using nationwide data. Gross motor delay during infancy was significant predictor of later neurodevelopmental disorders. Language, cognitive, and social delay before 24 months of age was associated with later autism spectrum disorders and developmental language disorders. Widespread nationwide implementation of screening programs before 24 months was effective in identifying NDDs at 4-6 years of age and should be encouraged.

Population screening for cirrhosis.

In response to the growing health crisis of liver-related morbidity and mortality, screening for liver cirrhosis has emerged as a promising strategy for early detection and timely intervention. By identifying individuals with severe fibrosis or compensated cirrhosis, screening holds the promise of enhancing treatment outcomes, delaying disease progression, and ultimately improving the quality of life of affected individuals. Clinical practice guidelines from international scientific societies currently recommend targeted screening strategies, investigating high-risk populations with known risk factors of liver disease. While there is good evidence that screening increases case finding in the population, and a growing number of studies indicate that screening may motivate beneficial lifestyle changes in patients with steatotic liver disease, there are major gaps in knowledge in need of clarification before screening programs of cirrhosis are implemented. Foremost, randomized trials are needed to ensure that screening leads to improved liver-related morbidity and mortality. If not, screening for cirrhosis could be unethical due to overdiagnosis, overtreatment, increased health care costs, negative psychological consequences of screening, and futile invasive investigations. Moreover, the tests used for screening need to be optimized toward lower false positive rates than the currently used FIB-4 while retaining few false negatives. Finally, barriers to adherence to screening and implementation of screening programs need to be elucidated. This review provides a comprehensive overview of the current landscape of screening strategies for liver cirrhosis and the promises and pitfalls of current methods for early cirrhosis detection.

Emerging Trends in Lung Cancer Presentation at a Leading Tertiary Oncology Center and the Need for Lung Cancer Screening in Pakistan.

Background Lung cancer is a significant global health concern, with Pakistan lacking a national cancer registry. Methods A retrospective study analyzed 345 lung cancer patients at Shifa International Hospital from 2018 to 2020. Demographics, symptoms, cancer stage, site, and histological types were assessed using descriptive statistics and Pearson'schi-square test. Results Most patients were male (267, 77.4%) with a mean age of 45-75 years. Common symptoms included patients with cough (168, 49%), blood in sputum (114, 33%), and chest pain (120, 35%). Most cases presented at advanced stages (81% at stage 4). Adenocarcinoma (131, 38%) was the most common histological type, with significant differences noted between smokers and non-smokers. Conclusion Gender disparities exist in lung cancer incidence, with a higher proportion of male patients. Both smokers and non-smokers are affected, emphasizing the need for comprehensive screening. Early detection and intervention strategies are crucial, especially considering the advanced stage of presentation. Tailored approaches considering histological types are essential for effective management. This study underscores the urgency of implementing screening programs and raising awareness to mitigate the burden of lung cancer in Pakistan.

Feasibility of implementing a school entry hearing screening programme in the South-East District, Botswana

Objective To assess the feasibility of implementing a school entry hearing screening programme in the South-East District, Botswana. Design A feasibility study design was used. Trained screeners conducted smartphone-based pure tone audiometry screening at 25 dB HL, at 1, 2, and 4 kHz using calibrated headphones. Learners with “refer” results after an immediate rescreen were referred and scheduled for diagnostic hearing assessment at the local hospital. Attendance at diagnostic appointments was encouraged through multiple contacts with the families. Study sample The study participants were 403 Grade 1 learners from eight public primary schools. Results The overall referral rate for diagnostic hearing assessment was 4.7%, with a referral uptake rate of 90%. The sensitivity and specificity of the hearing screening protocol were 93.3% and 86.4%, respectively. The positive and negative predictive values were 82.4% and 95%, respectively. The average cost per learner screened was US$ 10.75. Conclusions School entry hearing screening programmes can be successfully implemented in the South-East District, Botswana. Lessons learnt from this study can potentially guide phased implementation of school hearing screening programmes in other districts.

Radiofrequency as a method of localizing impalpable breast lesions

BackgroundThe incidence of early stage breast cancer has risen as a result of increased detection of non-palpable tumors through the implementation of screening programs and greater public awareness. Performing breast-conserving surgery can be challenging due to the need for accurate localization of non-palpable breast lesions, particularly given the logistical difficulties associated with wire localization. After implementing a new technique for localizing non-palpable breast lesions (LOCalizerTM Radiofrequency identification TAG-Hologic®), a radiofrequency identification tag localization device manufactured by Hologic, Inc. in Marlborough, MA, was launched in 2017, our objective was to investigate its impact on surgical outcomes, whether there was an increase in re-excision rates for positive margins and whether the attainment of clear margins was dependent on the exact positioning of the RFID device. MethodA single-center single-arm interventional study, data were gathered both in a forward-looking manner for 1 year (prospectively) and by looking back at past records for 1 year (retrospectively) for a total period of two years. Individuals who were diagnosed with non-palpable breast lesions, as confirmed by histological analysis, or invasive breast cancer and who were scheduled to undergo breast-conserving surgery were eligible for inclusion in the study. The RFID (Radiofrequency Identification) method was used to localize the lesions prior to surgery. Either with a mammogram or ultrasound scan position of the Tag was recorded, including the distance of the lesion from the center of the lesion and the lesion depth from the skin in millimeters. The rate of re-excision was documented and examined in relation to the parameters mentioned above. ResultsTwo hundred and twenty RFID Tags were inserted in two hundred and seventeen (three patient had bilateral tags insertion), patients aged between 30 and 85 had a localizer Tag inserted between Oct 2020 and Oct 2022. Three patients had non-palpable breast lesions in both breasts. Fourteen were inserted under stereotactic guidance and two hundred and six under ultrasound guidance. Ten patients subsequently had wire insertion also due to Tag position. Of 210 procedures, RFIF Tags within the lesion was seen in hundred and sixty patients (76.19 %). An additional 50 procedures were performed using the RFID Tag system, which were not directly related to the lesion but were deemed appropriate to proceed with.Out of a total of 220 procedures, positive margins were observed in 38 cases (17.27 %). Among these cases, eleven (28.94 %) involved the use of the RFID Tag system, not within the lesion but adjacent to it (within 15 mm surrounding the lesion). ConclusionRFID is a good alternative to wire localization of non-palpable breast lesions. Re-excision rates are higher in patients with Tag outside the lesion compared to those with Tag within the lesion.

Imaging for Early Detection of Pancreatic Ductal Adenocarcinoma: Updates and Challenges in the Implementation of Screening and Surveillance Programs.

Pancreatic ductal adenocarcinoma (PDA) is one of the most aggressive cancers. It has a poor 5-year survival rate of 12%, partly because most cases are diagnosed at advanced stages, precluding curative surgical resection. Early-stage PDA has significantly better prognoses due to increased potential for curative interventions, making early detection of PDA critically important to improved patient outcomes. We examine current and evolving early detection concepts, screening strategies, diagnostic yields among high-risk individuals, controversies, and limitations of standard-of-care imaging.

Interventions to improve equity in emergency departments for Indigenous people: A scoping review.

Disparities in health outcomes, including increased chronic disease prevalence and decreased life expectancy for Indigenous people, have been shown across settings affected by white settler colonialism including Canada, the United States, Australia, and New Zealand. Emergency departments (EDs) represent a unique setting in which urgent patient need and provider strain interact to amplify inequities within society. The aim of this scoping review was to map the ED-based interventions aimed at improving equity in care for Indigenous patients in EDs. This scoping review was conducted using the procedures outlined by Arksey and O'Malley and guidance on conducting scoping reviews from the Joanna Briggs Institute. A systematic search of MEDLINE, CINAHL, SCOPUS, and EMBASE was conducted. A total of 3636 articles were screened by title and abstract, of which 32 were screened in full-text review and nine articles describing seven interventions were included in this review. Three intervention approaches were identified: the introduction of novel clinical roles, implementation of chronic disease screening programs in EDs, and systems/organizational-level interventions. Relatively few interventions for improving equity in care were identified. We found that a minority of interventions are aimed at creating organizational-level change and suggest that future interventions could benefit from targeting system-level changes as opposed to or in addition to incorporating new roles in EDs.

Prevalence of sexually transmitted infections and human papillomavirus in cervical samples from incarcerated women in São Paulo, Brazil: a retrospective single-center study.

Sexually transmitted infections (STIs) cause considerable morbidity worldwide and, depending on the specific pathogen, may lead to serious complications in the female reproductive tract. Incarcerated women are particularly vulnerable to health problems with a disproportionate high rate of STIs, including infections with human papillomavirus (HPV). Here, cervical swab samples collected from 299 women (18 to 64 years) living in one of the women's prisons of São Paulo, Brazil were submitted for liquid-based cytology to determine the prevalence of precancerous lesions. Furthermore, direct detection of 30 genital HPV genotypes (18 high-risk and 12 low-risk types) and 11 additional STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Haemophilus ducreyi, Mycoplasma genitalium and hominis, Treponema pallidum, Trichomonas vaginalis, Ureaplasma parvum and urealyticum) were performed by molecular typing using two PCR-based DNA microarray systems, i.e., EUROArray HPV and EUROArray STI (EUROIMMUN), respectively. The overall prevalence of cytological abnormalities was 5.8%, including five women with low-grade and five women with high-grade squamous intraepithelial lesions. The overall prevalence of HPV was 62.2, and 87.1% of the HPV-positive women were infected with oncogenic high-risk (HR) HPV types. HPV types 16 (24.1%), 33 and 52 (both 10.4%) were the most frequently detected. The prevalence of the other STIs was 72.8%. Up to four different pathogens were found in the infected women, the most frequent being Ureaplasma parvum (45.3%), Mycoplasma hominis (36.2%) and Trichomonas vaginalis (24.8%). The high number of HR-HPV infections and other STIs described here highlights the fact that the Brazilian female prison population requires more attention in the country's health policies. The implementation of screening programs and treatment measures might contribute to a decrease in the incidence of STIs and cervical cancer in this vulnerable population. However, for such measures to be effective, further studies are needed to investigate the best practice to get more women to engage in in-prison prevention programs, e.g., through offering further sexual health education and self-sampling.