Provision Of Screening Services Research Articles

Estimation of haemoglobin using non-invasive portable device with spectroscopic signal application

An estimated 52% of non-pregnant women of reproductive age in India are estimated to be affected by anaemia, which is categorised as a chronic condition. In 2019–2021, the National Family Health Survey–5 (NFHS–5) which was undertaken revealed the following statistics about the prevalence of anaemia in the state of Karnataka. To estimate haemoglobin levels using non-invasive portable device among nursing students. A cross sectional study was done among students of Nursing college in central Karnataka for a period of 3 months. Total of 140 students were included in the study. EzeCheck haemoglobin estimation was done twice and was recorded in the same Google form. The frequency and percentage of variation of results between Haematology Analyzer and EzeCheck devices was presented with a range of difference such as 0, less than 1, 1.0 to 1.9, 2.0 to 2.9, 3.0 to 3.9, and 4.0 and above. The total prevalence of anaemia among nursing students was 57.8% and most of the students had moderate degree of anaemia (28.6%). Two readings of haemoglobin were taken and difference of readings were calculated and majority of the students had difference of < 0.5 gm/dl (61.4%) and only 1.4% of the students had difference of > 2 gm/dl. The mean difference of haemoglobin of two readings was 0.5 ± 0.5 gm/dl. The technology employed in this study bridges the gap between patients and anaemia diagnosis by providing screening services. The device provides the diagnosis via a non-invasive, IoT-enabled service at a low cost.

Knowledge, attitudes and practices of Zimbabwean men relating to prostate cancer.

Prostate cancer is one of the leading causes of death in Zimbabwe. However, screening for prostate cancer is opportunistic as population-based screening is not available. This study aimed to describe the knowledge, attitudes and practices of men living in Harare, Zimbabwe relating to prostate cancer. A door-to-door survey took place in Mufakose, Harare. Each household was included, and men, 40 years and older, were convenience sampled until realisation of the calculated sample size of 269 (n = 269). A researcher-administered questionnaire collected the data, analysis was performed with descriptive statistics, and Chi-square tested statistically significant differences between the variables. The majority of the sample (53.2; n = 143) was between 40 years old and 49 years old. Most (74.5%; n = 201) did not know what prostate cancer was, but the total sample (100%; n = 269) indicated that prostate cancer could lead to death. Only 50.6% (n = 136) were of the opinion that men should be screened; most (87.7%; n = 236) had never been screened. A Chi-square test of independence found a statistically significant difference between educational level and having had prostate cancer screening, χ2 (1) = 47.881, p 0.000. As confirmed by other studies, the respondents had limited knowledge of prostate cancer, but had a positive attitude towards the disease, as most were willing to go for screening. There had been only a small percentage screened previously, and less than half returned to learn the results.Contribution: The study emphasises the role of primary health clinics as it could be an ideal setting to teach men about prostate cancer and its screening, and provide screening services in Zimbabwe.

Factor Analysis Of Characteristics Of Respondents With Pregnancy Depression At The Bojong Rawalumbu Community Health Center, Bekasi City

Background: Pregnancy is one of the things expected by women in the process of life. However, many women experience difficulties due to physical, social, and psychological changes during pregnancy, there are even some mothers who suffer from psychological disorders such as depression. Perinatal depression occurs in 10-15% of women. One of the causes is a lack of knowledge about the process of pregnancy until the postpartum period which results in birth complications and disrupts the baby's growth and development. Purpose: This study aimed to identify the characteristic factors of respondents associated with prenatal depression. Methods: This research is a quantitative research that uses a cross-sectional design. The sample in this study was 85 respondents of pregnant women using the Edinburgh Postnatal Depression Scale (EPDS) screening tool. Results: The results of this study showed that the factors associated with the incidence of depression in pregnant women were education (p = 0.011), income (P = 0.046), history of domestic violence (p = 0.028), and pregnancy complications (p = 0.043) while the unrelated factors were age (P = 0.098), occupation (P = 0.829) and parity (p = 0.139) with α = 0.05. Conclusion: Education, income, history of domestic violence and history of pregnancy complications affect the incidence of depression in pregnant women. Recommendations: It is expected that the team of health workers, especially midwives and nurses, will not only focus on physical health but mental health also needs attention, and is expected to provide screening services and pregnancy psychology services to identify patients at risk of depression. Keywords: Depression, pregnancy, domestic violence, prenatal.

Cervical cancer screening aided by artificial intelligence, China.

To implement and evaluate a large-scale online cervical cancer screening programme in Hubei Province, China, supported by artificial intelligence and delivered by trained health workers. The screening programme, which started in 2017, used four types of health worker: sampling health workers, slide preparation technicians, diagnostic health workers and cytopathologists. Sampling health workers took samples from the women on site; slide preparation technicians prepared slides for liquid-based cytology; diagnostic health workers identified negative samples and classified positive samples based on the Bethesda System after cytological assessment using online artificial intelligence; and cytopathologists reviewed positive samples and signed reports of the results online. The programme used fully automated scanners, online artificial intelligence, an online screening management platform, and mobile telephone devices to provide screening services. We evaluated the sustainability, performance and cost of the programme. From 2017 to 2021, 1 518 972 women in 16 cities in Hubei Province participated in the programme, of whom 1 474 788 (97.09%) had valid samples for the screening. Of the 86 648 women whose samples were positive, 30 486 required a biopsy but only 19 495 had one. The biopsy showed that 2785 women had precancerous lesions and 191 had invasive cancers. The cost of screening was 6.31 United States dollars (US$) per woman for the public payer: US$1.03 administrative costs and US$ 5.28 online screening costs. Cervical cancer screening using artificial intelligence in Hubei Province provided a low-cost, accessible and effective service, which will contribute to achieving universal cervical cancer screening coverage in China.

Aotearoa New Zealand Deaf women's perspectives on breast and cervical cancer screening.

Since the introduction of both cervical and breast screening programmes in Aotearoa New Zealand, mortality rates have dropped. Both screening programmes track women's engagement, but neither capture the level of engagement of Deaf women who are New Zealand Sign Language users or their experiences in these screening programmes. Our paper addresses this knowledge deficit and provides insights that will benefit health practitioners when providing screening services to Deaf women. We used qualitative interpretive descriptive methodology to investigate the experiences of Deaf women who are New Zealand Sign Language users. A total of 18 self-identified Deaf women were recruited to the study through advertisements in key Auckland Deaf organisations. The focus group interviews were audiotaped and transcribed. The data was then analysed using thematic analysis. Our analysis indicated that a woman's first screening experience may be made more comfortable when staff are Deaf aware and a New Zealand Sign Language interpreter is used. Our findings also showed that when an interpreter is present, extra time is required for effective communication, and that the woman's privacy needs to be ensured. This paper provides insights, as well as some communication guidelines and strategies, which may be useful to health providers when engaging with Deaf women who use New Zealand Sign Language to communicate. The use of New Zealand Sign Language interpreters in health settings is regarded as best practice, however their presence needs to be negotiated with each woman.

A qualitative study to explore healthcare providers' perspectives on barriers and enablers to early detection of breast and cervical cancers among women attending primary healthcare clinics in Johannesburg, South Africa.

Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.

Abstract PO-257: Prevalence and correlates of false-positive results in screening mammography among uninsured women in a community outreach program

Abstract Introduction: False-positive mammographic screening results are one of the most important harms of breast cancer screening, and their prevalence in the insured population range from 8.7% to 16.3% during the first screening encounter. However, false-positive results have been rarely investigated among uninsured minority women screened through community outreach programs. For this study, we analyzed data from the Breast Screening and Patient Navigation (BSPAN) program participants with an aim to report prevalence and assess correlates of false-positive results in screening mammograms, stratified by age. Methods: BSPAN, created by Moncrief Cancer Institute, contracts with the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and uses a hub-and-spoke model to provide patient navigation and no-cost breast cancer screening and diagnostic services to under- and uninsured predominantly minority women in North Texas. We defined false-positive result as a positive screening mammogram (BI-RADS 0, 3, 4 or 5) followed by a negative diagnostic mammogram (BI-RADS 1, 2 or 3) or a negative biopsy within 9 months of the screen. We used multivariable logistic regression to assess associations of demographic and clinical covariates with false positive results for each age group (40-49 years and 50-64 years, which coincides with age eligibility for NBCCEDP). Results: BSPAN provided screening services to 21,022 women between 2012 and 2019. Prevalence of false-positive results in these women was 11.8% in the 40-49 age group and 9.6% in the 50-64 age group. Multivariable logistic regression demonstrated that, in the 40-49 age group, women who were non-menopausal, did not use hormone replacement therapy, and had prior mammograms had higher odds of false-positive results than those who were menopausal, used hormone replacement therapy and had no prior mammograms, respectively. In the 50-64 age group, women with a prior diagnostic mammogram had higher odds of false-positive results than those without a prior diagnostic mammogram. Discussion: This study establishes contemporary evidence regarding prevalence and correlates of false-positive rates in the unique BSPAN population, where women were predominantly Hispanic, under- and uninsured receiving no-cost screening and diagnostic services through a real-world outreach program. Our findings demonstrate that uninsured women who receive no-cost mammograms are similar to insured women in two aspects: prevalence of false-positive rates in our study is comparable to those among insured population, and we found higher false positive rates among younger women, compared to older women. Impact: Equitable screening outcomes in underserved population emphasizes the need for efforts to reduce false-positive screening rates among uninsured women served through community outreach programs. Citation Format: Rasmi G. Nair, Simon J. Craddock Lee, Hong Zhu, Firouzeh K. Arjmandi, Emily Berry, Keith E. Argenbright, Jasmin A. Tiro, Celette S Skinner. Prevalence and correlates of false-positive results in screening mammography among uninsured women in a community outreach 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-257.

Surveying and mapping breast cancer services in Ghana: a cross-sectional pilot study in the Eastern Region

ObjectivesDefine the services available for the care of breast cancer at hospitals in the Eastern Region of Ghana, identify areas of the region with limited access to care through geospatial...

Abstract 63: Barriers and Facilitators of Cervical Cancer Screening Access in Belize: A Qualitative Analysis of Stakeholder Perspectives

Abstract Purpose: Cervical cancer is the fourth most common cancer among women worldwide. Belize has among the highest cervical cancer incidence and mortality rates of Latin American and Caribbean countries despite current programs to increase access to secondary prevention services. This study evaluates the perspectives of key stakeholders in the cervical cancer screening system in Belize to elucidate barriers and facilitators of cervical cancer screening services. Methods: In 2018, semi-structured interviews discussing challenges and successes in cervical cancer screening were conducted with key stakeholders across the 6 districts of Belize. Interviews were transcribed and coded using thematic content analysis to identify salient themes. Themes were organized by levels of the Tappan model. Results: A total of 47 interviews were conducted with healthcare providers (45%), administrators (17%), government officials (25%), and other stakeholders (13%). 78% of interviews were conducted in the public sector. Perceived barriers to cervical cancer screening were identified across 5 levels: (1) Individual (expectation of delay in Pap smear results and fear of a cancer diagnosis, reduces participation in screening); (2) Provider (responsibilities beyond the provision of screening service prevents clinics from offering services daily); (3) Organizational (insufficient space and training engenders diagnostic delays and possible misdiagnoses); (4) Community (screening limitations are more pronounced in rural vs. urban areas); and (5) Policy (limited budget allocated to equipment and staff restricts screening coverage). Salient facilitators were identified at the community and policy levels. At the community level, facilitators included resource-sharing between public and private sectors and the designation of personnel for rural outreach. Facilitators at the policy level included government coverage of screening costs and establishment of population-based screening targets. Conclusion: Despite no-cost cervical cancer screening in Belize, barriers still exist. Overloaded provider responsibilities, geographic inaccessibility, and insufficient funding are insights that serve as potential areas for system strengthening. Citation Format: Avni Mittal, Shane Neibart, Abha Kulkarni, Taylor Anderson, Jennifer Tsui, Shawna Hudson, Mark Einstein, Natalia Largaespada Beer, Racquel E. Kohler. Barriers and Facilitators of Cervical Cancer Screening Access in Belize: A Qualitative Analysis of Stakeholder Perspectives [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 63.

Colorectal cancer screening and the COVID-19 pandemic – Lessons learnt

• COVID-19 pandemic interrupted most national CRC screening programs • Clinical impact of interrupted screening services is substantial • Most programs provided screening services during 2nd & 3rd waves • Learnt lessons, forward planning, redesigned robust systems will minimise future impact

Mechanisms Linking Periodontal Disease and Cardiovascular Disease: A Review and Update

Aim: To present review of current literature regarding association between periodontal and cardiovascular diseases and the mechanisms involved in the association. Materials and Methods: Thorough search was carried out on PUBMED, MEDLINE databases and Google on the association between periodontal disease and cardiovascular diseases and the mechanisms involved selected literature included review articles, observational studies, case control studies, randomized control trials and meta-analysis. Priority was placed on papers published within last 10 years. Brief description of periodontal disease and atherosclerosis underlying pathophysiology has also been included. Results and Conclusion: Preponderance of data appears to support the concept that a potential link does exist between periodontal disease and CVD independent of confounding factors. Interventional trials have shown that periodontal therapy is associated with reduction in surrogate markers of atherosclerotic cardiovascular disease. Prospective interventional studies are required to determine the exact link between PD and CVD as well as to evaluate whether periodontal treatment may reduce the risk of developing CVD. Clinical Significance Pre assessment of developing cardiovascular disease using biomarkers can help in diagnosis of developing or worsening periodontal diseases at earlier stages and can aid in providing screening services and advice to seek immediate dental care. Keywords: Coronary Artery Disease, Chronic Periodontitis, Interrelationship, Periodontal disease, Systemic conditions.

Cervical Cancer Screening Uptake and Associated Factors among HIV-Positive Women in Ethiopia: A Systematic Review and Meta-Analysis.

Background Women living with human immunodeficiency virus (HIV) are more likely to develop an increased risk of invasive cervical cancer. Morbidity and mortality due to cervical cancer could be reduced with early detection through cervical screening. Though uptake of cervical screening was investigated in Ethiopia, inconsistent findings were reported. Therefore, this systematic review and meta-analysis was designed to estimate the pooled prevalence of cervical cancer screening uptake among HIV-positive women and its associated factors in Ethiopia. Methods A comprehensive search of PubMed/MEDLINE, Scopus, EMBASE, CINAHL, Google Scholar, Science Direct, and Cochrane Library was conducted. The data were extracted using a standardized data extraction format. Statistical analysis was done using the STATA, version 14, software. The heterogeneity of the studies was assessed using the I2 test. Funnel plots and Egger's test were used to check publication bias. A random effects model was computed to estimate the pooled prevalence of cervical cancer screening uptake. Moreover, pooled odds ratios with 95% confidence intervals were used to determine the association of identified determinant factors with cervical cancer screening uptake. Results A total of 10358 studies were retrieved, and 7 studies were included in the meta-analysis. The pooled prevalence of cervical cancer screening uptake among HIV-positive women in Ethiopia was 18.17% (95% CI : 11.23, 25.10) with exhibited heterogeneity (I2 = 96.6%; p < 0.001). Educational status of women (AOR = 3.50; 95% CI : 1.85, 6.07), knowledge of women on cervical cancer (AOR = 3.26; 95% CI : 2.50, 4.43), and perceived susceptibility (AOR = 3.26; 95% CI : 2.26, 4.26) were significantly associated with cervical cancer screening uptake among HIV-positive women. Conclusion The uptake of cervical cancer screening among HIV-positive women in Ethiopia was low. The findings of this study suggest the need to improve the existing national strategies of cervical cancer screening so as to strengthen reproductive health education and promotion, in addition to providing screening services. Furthermore, cervical screening service should be integrated to the routine care and treatment, so that HIV-positive women can get counseling services in every clinical contact.

Pharmacists' experiences and views on providing screening services: An international comparison.

The PHARMASCREEN study, adapted from the Australian Cardiovascular Absolute Risk Screening study (CARS), tested the first community pharmacist-delivered screening model for diabetes and cardiovascular disease (CVD) in the UAE. Both PHARMASCREEN and CARS screening models successfully identified at-risk individuals despite differences in healthcare systems, infrastructure, and scope of practice. Comparing pharmacists' experiences of screening delivery in different health systems will help to understand key contextual factors that affect future implementation. To explore and compare the views and experiences of pharmacists participating in the UAE PHARMACSCREEN trial, with those of community pharmacists who participated in the Australian CARS trial. In-depth, face-to-face interviews were conducted with pharmacists who delivered the screening programs in Australia (n=10) and UAE (n=12) to explore their views and experiences. The interview guide was similar in both studies to ensure consistency and comparability of collected data. Interviews were transcribed verbatim and thematically analyzed. Two common themes emerged: pharmacists' experiences with the screening program, and barriers and facilitators to service delivery. Both groups held very positive views about the screening intervention, particularly referencing the professional satisfaction it generated and broad participant satisfaction with pharmacy-based screening. Despite country and health system differences, pharmacists reported many similar barriers (e.g., staffing levels, pharmacy coordination) and enablers (e.g., implementation support, adequate staffing, point-of-care tests, no cost to patient) to implementation. The context for screening delivery emerged as a key theme for UAE interviews only, where issues such as local population needs, regulatory factors, pharmacist roles and expectations, and training needs were quite prominent. Pharmacists' positive experiences with the screening programs is a testimony to the strong emerging evidence supporting pharmacists-delivered screening. Despite differences in health care systems, similar enablers and barriers were identified. The adaptation and successful implementation of international screening models requires a country-specific adaptation process.

Mainstreaming the private health sector in the response to COVID-19: facility readinessassessment for screening services in Edo State, Nigeria.

IntroductionThe COVID-19 pandemic presents an opportunity for the Nigerian health system to harness the potentials available in the private sector to augment the capacity within the public health system. This survey was carried out to assess private facility readiness in providing screening services in Edo State.MethodsThis was a descriptive cross-sectional study carried out among private facilities in Edo state. Facilities were selected using stratified sampling technique. Data was collected using adapted questionnaires and an observational checklist. Facility readiness was assessed using the Nigeria Centre for Disease Control recommendations for screening. Parameters were scored and overall scores were converted to proportions. Facilities that scored 70% and above were adjudged to be ready while facilities that scored 69% and below were adjudged to be not ready.ResultsA total of 252 health facilities were assessed, comprising 149 (59.1%) hospitals/clinics, 62 (24.6%) pharmacies and 41 (16.3%) laboratories. One hundred and forty-two (95.3%), 60 (96.8%) and 41 (100.0%) hospitals/clinics, pharmacies and laboratories, respectively had hand hygiene facilities. However, overall facility readiness assessment scores for screening services were low with only 51 (34.2%) hospitals/clinics, 2 (3.2%) pharmacies and 2 (4.9%) laboratories achieving high enough scores to be adjudged ready for screening services.ConclusionOverall facility readiness of the private health sector to provide screening services in Edo State was assessed to be low. The government and facility owners will need to ensure that screening services are improved in all facilities to help mitigate community spread of COVID-19.

Knowledge, Perception, and Prevention Practices Related to Human Papillomavirus-based Cervical Cancer and Its Socioeconomic Correlates Among Women in Karachi, Pakistan.

BackgroundCervical carcinoma is a widespread disease of the female genital tract, for which human papillomavirus (HPV) is an utmost risk factor. Of the total global burden, the majority is endured by the developing nations of the world, mainly due to inadequate knowledge regarding the disease and ineffective measures taken for its prevention, early detection, and screening. Hence, our study aimed to determine the level of knowledge, general attitudes and perception, and prevention practices related to HPV-based cervical cancer and its socioeconomic correlates among women in Karachi, Pakistan.MethodsA cross-sectional, questionnaire-based study was conducted by approaching 450 females in the out-patient department (OPD) of a tertiary care hospital in Karachi, Pakistan from June 2019 to November 2019. The modified Kuppuswamy socioeconomic scale 2018 was deployed to assess the socioeconomic status of participants, while the knowledge score of the participants was determined based on the original Bloom's cut off point. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 24.0 (IBM Corp., Armonk, NY). Descriptive statistics were used to present the knowledge, attitude, and practice level of respondents. The respondents’ knowledge, attitude, and practice scores were compared across socioeconomic and demographic variables using the chi-square test.ResultsOf the 388 females interviewed, 199 (51.3%) were aware of the term cervical cancer, and 68 (34.2%) knew about Pap smear as a screening test; only 80 (40.2%) women were familiar with HPV vaccination as prophylaxis against cervical cancer. The practice of screening and prevention was found to be remarkably low (2.1% and 1.8% respectively). Socioeconomic status and education level had a significant association with knowledge of cervical cancer. Although around 64% of participants had poor knowledge, 308 (79.4%) demonstrated a favorable attitude as they were willing to know more about screening and preventive practices regarding cervical carcinoma.ConclusionThe majority of the participants had insufficient overall knowledge about cervical cancer, HPV, Pap smear test, and HPV vaccination, highlighting the need for mass education through health professionals and media. In addition, the government authorities should provide screening services and vaccination against HPV free of cost to promote early detection of lesions and prophylaxis against this deadly disease.

Using Telehealth to address disparities in cognitive, language, and emotion regulation problems in young children: A case illustration using the INvesT model.

Over the past decade, there has been a rise in the prevalence of developmental disabilities. Early diagnosis and access to healthcare services are essential for children with developmental delays to optimize development. For families living in poverty, accessing specialized assessment/intervention services for children with developmental disabilities is often a formidable task. In this study, we provide preliminary evidence for the implementation of a developmental risk assessment screening questionnaire using a telehealth format to address the gap in access to services in a community clinic serving a low-income urban neighborhood. Ninety-seven caregivers of children between 12 months and 7 years of age participated in this study. Caregivers completed the risk assessment screening questionnaire using an iPad that was available to them at the clinic. Results showed that while only 11% of caregivers indicated they were initially concerned about their child's overall development, completion of the focused risk assessment resulted in a completely different picture. Fifty percent of caregivers reported that their child had three or more concerns in at least one area of development that would warrant further evaluation. Alerting both families and professionals to these concerns as early as possible may position the family and child to receive the much-needed services that have the potential to mitigate more serious developmental problems. This article discusses the promising role that Telehealth can play in providing screening services for all families, but especially low-income urban households.

Tailoring Therapies: Improving the Outcome of Breast Cancer in a Comprehensive Cancer Center in West Africa—The University of Nigeria Teaching Hospital Experience

Background and context: Early detection and improved treatments are associated with a reduction in breast cancer mortality and morbidity. UNTH is a leading comprehensive cancer center in Nigeria with referrals from the entire southeast and south south regions. Our goal is to offer high quality comprehensive cancer care services across the cancer care continuum from public health awareness campaigns and provision of screening services all the way to palliative care and survivorship. This is the first attempt by any institution in the country to standardize and harmonize available treatment options for breast cancer. Aim: To optimize, standardize and harmonize treatment options and management strategies for breast cancer using a multidisciplinary approach by developing guidelines adapted to our peculiar infrastructure and health system. Strategy/Tactics: The practice guideline was specifically developed for UNTH using a multidisciplinary approach and taking into consideration circumstances peculiar to UNTH, including the following: UNTH's specific patient population; UNTH's services and structure; and UNTH's clinical information. Program/Policy process: The process used recognized methods that are robust, objective, scientifically valid, consistent and adaptable to UNTH and engaged all identified multisectoral and multidisciplinary stakeholders involved in the care of patients with breast cancer. Outcomes: We reviewed substantial evidence on documented and proven strategies for community screening and prevention, less expensive and only marginally less effective diagnostic tools, locoregional and systemic therapies for the management of breast cancer. The team also recommended all patients receive psycho-oncology support through a dedicated team and through the breast cancer support group. It was agreed that palliative care be incorporated within the first 8 weeks of commencing treatment in line with the current ASCO guidelines and receive consultation from the exercise immunology unit. What was learned: Institutionalized care offers better management strategies and standardized treatment in line with best global practices of care for patients with breast cancer across the cancer care continuum which will ultimately translate to better treatment outcomes.

Willingness of potential service suppliers to provide cancer screening in urban China

Objective: Based on the investment for potential suppliers of cancer screening services, we assessed the reasons that affecting their participation motivation related to the long-term sustainability of cancer screening in China. Methods: Hospitals that had never been involved in any national level cancer screening project were selected by using the convenient sampling method within the 16 project cities of Cancer Screening Program in Urban China (CanSPUC) with 1 or 2 hospitals for each city. All the managers from the institutional/department level and professional staff working and providing screening services in these hospitals, were interviewed by paper-based questionnaire. SAS 9.4 was used for logical verification and data analysis. Results: A total of 31 hospitals (18 hospitals at the third level and, 13 hospitals at the second level) and 2 201 staff (508 hospital and clinic unit managers, 1 693 professional staff) completed the interview. All the hospitals guaranteed their potential capacity in service providing. 92.5% hospital managers showed strong willingness in providing cancer screening services, while 68.3% of them declared that the project fund-raising function was the responsibility of the government. For professional staff, their prospect gains from providing screening service would include development on professional skills (72.4%) and material rewards (46.8%). Their main worries would include extra work for CanSPUC might interfere their routine work (42.1%) plus inadequate compensation (41.8%). Medians of the prospect compensation for extra work ran between 20 to 90 Chinese Yuan per screening item respectively. For all the screening items, workers from the third-level hospitals expected their compensation to be twice as much of those working at the second level hospitals. Conclusion: Professional capacity building and feasible material incentive seemed to be the two key factors that influenced the sustainability and development of the programs.

Willingness and preferences of actual service suppliers regarding cancer screening programs: a multi-center survey in urban China

Objective: From the perspective of actual service suppliers regarding cancer screening, this study aimed to assess the long-term sustainability of cancer screening programs in China. Methods: Based on a Cancer Screening Program in Urban China (CanSPUC), our survey focused on all the hospitals, centers for disease control and prevention (CDC) and community service centers across 16 provinces in China which participated in the programs between 2013 and 2015. All the managers (institutional/department level) and professional staff involved in the program were interviewed using either paper-based questionnaire or online approach. Results: A total of 4 626 participants completed the interview. It showed that the main gains from providing screening service emphasized promotion in social value (63.6%), local reputation (35.9%), and professional skills (30.6%), whereas difficulties encountered included inadequate compensation (30.9%) and discordance among information systems (28.3%). When the service remuneration amounts to about 50 Chinese Yuan per screening item, those professional staff self-reported that they would like to work overtime. More than half (63.7%) of the staff expressed willingness to provide routine screening service, the main expectations were to promote their reputation to the local residents (48.7%) and to promote professional skills (43.1%). Those who were not willing to provide screening services were worried about the potential heavy workload (59.8%) or being interfered with their routine work (49.8%). Further detailed results regarding the different organization types and program roles were presented in the following detailed report. Conclusions: Findings of gains and difficulties showed that if cancer screening is expected to become a long-term running, incentive mechanism from the program, external promotion and advocacy as well as capacity building should be strengthened; furthermore, rewards to staff's screening services should be raised according to the local situations. Results regarding the "willingness to provide service" showed that management of the program should also be strengthened, including information system building and inter-agency and inter-department coordination at the government levels.

The mental health community: An underserved and undertreated population: Students call for increased efforts to reduce mental health stigma

The mental health community: An underserved and undertreated population: Students call for increased efforts to reduce mental health stigma