Health Care Screening Research Articles

Screening for Nasal Carriage of Mupirocin Resistant Staphylococcus aureus among health care workers in a tertiary care hospital

Introduction: The aim is to isolate and to identify Staphylococcus aureus from the nasal swabs of the health care workers and screen for the mupirocin resistance among the isolated Staphylococcus strains. Materials and Methods: Present study is a prospective type of study. A total of 100 nasal swabs were collected from health care workers. All the nasal swabs were cultured on MacConkey and Blood agar. Isolated organisms were subjected for antibiotic susceptibility testing by Kirby-Bauer disk diffusion method. Results: Among the 100 nasal swabs, Staphylococcus spp. was isolated in 100 (100%) samples which comprised of 13 (13%) Staphylococcus aureus isolates and 87(87%) were Coagulase negative Staphylococcus. Of 13 Staphylococcus aureus isolates, 7 (53.84%) and 6 (46.15%) were detected as Methicillin Resistant Staphylococcus aureus and Methicillin Sensitive Staphylococcus aureus respectively. None of S.aureus isolates was resistant to mupirocin. Low level mupirocin resistant (MupL) was seen in 10 (30%) of Methicillin Resistant Coagulase negative Staphylococcus and 5 (14.7%) in Methicillin Sensitive Coagulase negative Staphylococcus isolates, respectively. High level mupirocin resistant (MupH) was seen in 4 (12%) of Methicillin Resistant Coagulase negative Staphylococcus and 4 (12%) of MRCoNS and MSCoNS isolates, respectively. Conclusion: Mupirocin is a potent antibiotic to treat the nasal carriage of S. aureus. As resistance to mupirocin both low and high level is on rise, it is a matter of great concern. Policies and guidelines should be framed to create awareness among the health care workers regarding the screening methods for the detection and treatment of nasal carriage. Keywords: MRSA- Methicillin resistant Staphylococcus aureus, MSSA- Methicillin sensitive Staphylococcus aureus, Mupirocin resistance

Screening for Problematic Alcohol Consumption - A Survey on Guideline Implementation in Transdisciplinary Health Care of a Model Region

Recording the frequency of screenings for problematic alcohol consumption by professionals involved in the health care of respective patients. The German S3-guideline "screening, diagnosis and treatment of alcohol-related disorders" recommends the use of questionnaire-based screenings for all patients in all settings. Cross-sectional survey on screening frequency among general practitioners, gynecologists, psychiatrists, child- and adolescent therapists, psychotherapists, social workers and midwives. Logistic regression was used to explore how healthcare professionals' attributes were associated with the implementation of screenings. With response rates of about 20%, health care professionals reported using screening instruments for an average of 6.9% of all patients during the previous four weeks. Most of the time, custom-made questions were used instead of the recommended instruments (AUDIT, AUDIT-C). Higher screening rates were reported for patients with newly diagnosed hypertension (21.2%), alcohol-related disorders (43.3%) and mental disorders (39.3%). Knowledge of the guideline was associated with implementation of screenings (OR=4.67; 95% KI 1.94-11.25, p<0.001). Comprehensive screening for problematic alcohol use with questionnaire-based instruments in accordance with guidelines is far from being routinely implemented in the studied health care settings. Measures to increase the knowledge of the guidelines are necessary in order to increase the frequency of alcohol screening in health care.

Health promotion and preventive health care service guidelines for the care of people with spina bifida.

Individuals with Spina Bifida (SB) have unique lifelong medical and social needs. Thus, when considering how to promote health and offer preventive care, providers must adapt general healthcare screening and counseling recommendations to their patients’ physical and cognitive impairments along with discerning how to monitor secondary or chronic conditions common to the population. This article provides an update on the health promotion and preventive health care guidelines developed as part of the Spina Bifida Association’s fourth edition of the Guidelines for the Care of People with Spina Bifida. The guidelines highlight accommodations needed to promote general preventive health, common secondary/chronic conditions such as obesity, metabolic syndrome, hypertension, musculoskeletal pain, and considerations for preventing acute care utilization for the SB population throughout the lifespan. Further research is needed to understand the effectiveness of preventive care interventions in promoting positive health outcomes and mitigating potentially preventable acute care utilization.

Secondary Impact of Social Media via Text Message Screening for Type 2 Diabetes Risk in Kuwait: Survey Study.

BackgroundType 2 diabetes mellitus (T2DM) is an international problem of alarming epidemic proportions. T2DM can develop due to multiple factors, and it usually begins with prediabetes. Fortunately, this disease can be prevented by following a healthy lifestyle. However, many health care systems fail to properly educate the public on disease prevention and to offer support in embracing behavioral interventions to prevent diabetes. SMS messaging has been combined with cost-effective ways to reach out to the population at risk for medical comorbidities. To our knowledge, the use of nationwide SMS messaging in the Middle East as a screening tool to identify individuals who might be at risk of developing T2DM has not been reported in the literature.ObjectiveThe primary aim of this study was to assess the feasibility of conducting a series of SMS messaging campaigns directed at random smartphone users in Kuwait for the detection and prevention of T2DM. It was predicted that 1% of those receiving the text message would find it relevant and participate in the study. The secondary aim of this study was to assess the incidence of participation of those who were forwarded the initial text message by family members and friends.MethodsIn this study, 5 separate text message screening campaigns were launched inviting recipients to answer 6 questions to determine the risk of developing T2DM. If subjects agreed to participate, a link to the prediabetes screening test devised by the Centers for Disease Control and Prevention was automatically transmitted to their mobile devices. Those identified as high risk were invited to participate in a diabetes prevention program.ResultsA total of 180,000 SMSs were sent to approximately 6% of the adult population in Kuwait. Of these, 0.14% (260/180,000) of the individuals who received the SMS agreed to participate, of whom 58.8% (153/260) completed the screening. Surprisingly, additional surveys were completed by 367 individuals who were invited via circulated SMS messages forwarded by family members and friends. Altogether, 23.3% (121/520) qualified and agreed to participate in a diabetes prevention program. The majority of those who chose to participate in the prevention program were overweight, aged 45-65 years, and reported being less physically active than those who chose not to participate (χ22=42.1, P<.001).ConclusionsAlthough health care screening via text messaging was found to have limited effectiveness by itself, it exhibited increased reach through shared second-party social media messaging. Despite the fact a subpopulation at possible risk of developing T2DM could be reached via text messaging, most responders were informed about the screening campaign by family and friends. Future research should be designed to tap into the benefits of social media use in health risk campaigns.

Using Social Cognitive Theory to Predict Preventive Health Screening Behaviors Among Type 2 Diabetics

Preventive health screening behaviors are vital for preventing complications among diabetics. The purpose of this study was to examine the extent to which constructs of the social cognitive theory (SCT) predict preventive health care screenings in type 2 diabetics. Adults with type 2 diabetes (n=148) were recruited from medical clinics to complete a 41-item valid and reliable instrument. Data were analyzed using logistic and multiple linear regression. The constructs self-efficacy and self-control, along with the variables education and diabetes education status, accounted for 16.2% of the variance. Overall, constructs from social cognitive theory were not strong predictors in this study.

Evaluation of sarcopenia in long-lived elderly patients: comparison between the muscle mass index and the calf circumference

Introduction: With population aging, many elderly citizens have been achieving extreme longevity (≥ 90 years). Sarcopenia is related to several adverse outcomes, such as disability, falls, hospitalization and death; hence, its early identification is important. Several methods can be used for its evaluation, with dual-energy x-ray absorptiometry (DXA) being the most accurate. Nevertheless, due to low availability and high cost, other methods are routinely adopted for screening in Primary Health Care (PHC), such as the evaluation of the Muscle Mass Index (MMI) and the Calf Circumference (CC).Objective: To evaluate sarcopenia in elderly people with extreme longevity, and then compare it by means of MMI and CC.Methodology: Cross-sectional and quantitative study, performed in 2019/2020, with n = 69 individuals aged ≥ 90 years, of both genders, users of the Unified Health System in the town of Três Lagoas – MS. We collected sociodemographic and anthropometric data in triplicate. For CC, we used a cutoff score ≤ 31 centimeters as a sign of sarcopenia. We determined MMI based on the calculation of skeletal muscle mass, using the formula of Lee and collaborators, which considers height, body mass, gender, age and ethnicity. The classification of sarcopenia adopted was that of Janssen and collaborators (women: ≤ 5.75 kg/m2 = severe sarcopenia; 5.76 – 6.75 kg/m2 = moderate sarcopenia; and ≥ 6.76 kg/m2 = normal muscle mass. Men: ≤ 8.50 kg/m2 = severe sarcopenia; 8.51 – 10.75 kg/m2 = moderate sarcopenia; and ≥ 10.76 kg/ m2 = normal muscle mass). In order to relate the variables, we applied the Spearman’s correlation test. Results: A total of 52.2% of the participants were women, with an average age of 93.5 years old and 1.3 years of schooling. The average CC was 31.2 centimeters, with 46.1% being considered sarcopenic patients according to this parameter. The average MMI was 5.1 kg/m2, with 100% of the elderly patients being considered sarcopenic through this method. There was no relationship between CC and MMI (p = 0.213).Discussion: We found a high prevalence of sarcopenia in the long-lived elderly patients, mainly using MMI. This data is worrying, since these elderly people may have several limitations due to sarcopenia. The absence of a relationship between the CC and MMI variables highlights the need to use more reliable methods to evaluate sarcopenia in long-lived elderly people, since the identification from CC, despite being easy and fast, may not be sensitive in this age group. Conclusion: We should highlight the need for personalization of public policies and evaluation recommendations for elderly people with extreme longevity in PHC, as they constitute a group that has unique characteristics.

Nursing and Allied Health Research Priorities in the Care of Patients With Thoracic Malignancies: An International Cross-Sectional Survey.

BackgroundThere is currently no evidence of research priorities from nurses and allied health professionals working in the field of thoracic malignancies, which could provide strategic directions for funders, policy makers, and researchers.ObjectiveThe aim of this study is to identify the priorities for lung cancer and other thoracic malignancies research and practice in nurses and allied health professionals.MethodsDescriptive cross-sectional web-based international survey conducted through international societies’ membership lists.ResultsParticipants included 152 nurses and allied health professionals. Key priority categories were related to developing and evaluation interventions; symptom management interventions; health care system issues; treatment-related research (immunotherapy; targeted therapies); persistent/late effects management (fatigue; pulmonary toxicity); risk reduction, and screening research. The specific topic with the highest endorsement (80.9%) was the development of interventions to improve quality of life. Symptom management interventions, particularly for pain, dyspnea, and fatigue, were also highly endorsed. Health care system topics were related to delivery of care and included nurse-/allied health-led care (67.5%), working with the multidisciplinary team (67.5%), continuity of care (69.2%), and access to care (67.5%). Topics around screening/early detection research were highly endorsed too.ConclusionA clear focus (and need) for research in interventions to improve quality of life and symptom management, particularly for pain, dyspnea, and fatigue was also established, alongside healthcare system issues and screening research.Implications for practiceInternational societies and funding bodies could consider these topics in their funding decisions and in shaping their strategic directions in the care of patients with thoracic malignancies.

Corrigendum

Journal of Evaluation in Clinical PracticeVolume 27, Issue 1 p. 204-204 CORRIGENDUMFree Access Corrigendum This article corrects the following: Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C J. Palacio-Vieira PhD, L. Segura MSc, P. Anderson MD, MPH, PhD, FRCP, A. Wolstenholme MA(Hons) MPH, C. Drummond PhD, P. Bendtsen PhD, M. Wojnar PhD, E. Kaner PhD, HonFRCP, HonMFPH, M.N. Keurhorst PhD, B. Steenkiste PhD, K. Kłoda PhD, A. Mierzecki PhD, K. Parkinson PhD, D. Newbury-Birch PhD, K. Okulicz-Kozaryn MD, P. Deluca PhD, J. Colom MSc, A. Gual PhD, Volume 24Issue 2Journal of Evaluation in Clinical Practice pages: 369-374 First Published online: December 1, 2017 First published: 22 October 2020 https://doi.org/10.1111/jep.13505AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In article Palacio-Vieira J et al1 , an acknowledgement section was missed and should have read: Acknowledgements Segura L. Performs this work in the context of the Interuniversity Doctoral Study Program in Psychology of Communication and Change. Autonomous University of Barcelona (UAB) and University of Barcelona (UB). The authors wish to apologize for the oversight. References 1Palacio-Vieira J, Segura L, Anderson P, et al. Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C. J Eval Clin Pract. 2018; 24(2): 369- 374. Volume27, Issue1February 2021Pages 204-204 ReferencesRelatedInformation

Occupational safety in nurses working in a tertiary care hospital in Turkey.

To determine the occupational safety of nurses working in a tertiary care hospital. The cross-sectional and descriptive study was conducted at a tertiary care hospital at Kocaeli University, Turkey, from January to March 2016, and comprised nurses working at the hospital. A questionnaire and the occupational safety scale were used to collect data. The Occupational Safety Scale has seven subscales. Frequencies, percentages, mean values and standard deviations were calculated during data analysis. Of the 200 nurses, 180(90%) were female and 88(44%) had 6-11 years of professional experience. The overall mean score of the scale was 2.593±0.770. Nurses working in daytime had better score on the healthcare screening and registry systems subscale compared to nurses working in shifts (p=0.020). There were no differences between the other subscales and work patterns (p>0.05). The nurses were found to have poor occupational safety.

“Coming out” against cancer: How local outreach to the LGBT community can reduce cancer disparities.

131 Background: Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals make up an estimated 4% of the population, qualifying them as a sexual minority. LGBT individuals are also more likely to be a racial or gender minority, to live in poverty, and to have less social support than their heterosexual peers. LGBT populations are disproportionately affected by mental health issues such as depression, which are correlated not only with behavioral risk factors, but with less likelihood to comply with healthcare screening or treatment. Approximately 30% of LGBT adults do not seek health care services or lack a regular health care provider, compared with 10% of heterosexuals. Research studies demonstrate that knowledge about increased risks and need for screening is low in LGBT populations. Sub-populations are less likely to have had a recent mammogram, anal or cervical Pap, or a prostate exam. Methods: We implemented a population-oriented program into our community outreach team in 2019 to address LGBT cancer disparities. A program manager partnered with community resources and leaders, including the Cleveland LGBT Community Center, Plexus LGBT Chamber of Commerce, and Trans Ohio. First year programming included a mammogram clinic for sexual/gender minority (SGM) women, “Cancer is a DRAG” show, and a tobacco-free campaign for LGBT pride month. Results: Creating meaningful partnerships was extremely important to community leaders and organizations. Strategic plans include direct community input and engagement through a community council, in conjunction with the LGBT Community Center, a breast cancer awareness campaign, in conjunction with local entertainers, and a tobacco cessation program, through our Center for LGBT Care. We educated over 150 people and screened over 85 within the first year. Conclusions: When our healthcare institution met local LGBT people within their community, the result was quite impactful. This pilot program proved successful at educating members of the community about their increased cancer risk, which resulted in higher cancer screening rates for LGBT people. More programs tailored to LGBT-specific health concerns are important to continue reaching these populations and eventually decrease health disparities in the community.

Normative reference values for estimated cardiorespiratory fitness in apparently healthy British men and women.

ObjectivesTo develop normative reference standards for estimated cardiorespiratory fitness (eCRF) measured from treadmill-based incremental exercise testing in ~12 000 British men and women.MethodsCross-sectional study using retrospectively collected eCRF data from five preventative health screening clinics in the United Kingdom. Reference centiles were developed using a parametric approach by fitting fractional polynomials. We selected the ‘best’ powers by considering both the smallest deviance, and clinical knowledge from the following set of a priori decided powers (-2,-1,-0.5, 0, 0.5,1,2,3). A series of fractional polynomials (FPs) were investigated with three-parameters (median, standard deviation and skewness). The following reference centiles were plotted (3, 5, 10, 25, 50, 75, 90, 95, 97).ResultsWe included 9 204 males (median [25th,75th centiles] age 48 [44, 53] years; BMI 27 {25, 29] kg∙m-2; peak VO2 36.9 [30.5, 44.7] ml∙kg-1∙min-1) and 2 687 females (age 48, [41, 51] years; BMI 24 {22, 27] kg∙m-2; peak VO2 36.5 [30.1, 44.8] ml∙kg-1∙min-1) in our analysis to develop the normative values.ConclusionReference values and nomograms for eCRF were derived from a relatively large cohort of preventative health care screening examinations of apparently healthy British men and women. Age- and sex-specific eCRF percentiles were similar to data from international cohort studies. The adoption of submaximal exercise testing protocols reduces individual risk when exercise history is unknown and testing is conducted in a community-based setting. Our findings can be used by health professionals to help guide clinical decision making.

Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol

BackgroundSuicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention in two settings where individuals at risk for suicide are especially likely to present: primary care and specialty mental health care. We will leverage methods from behavioral economics, which involves understanding the many factors that influence human decision making, to inform strategy development.MethodsWe will identify key mechanisms that limit implementation of evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health through contextual inquiry involving behavioral health and primary care clinicians. Second, we will use contextual inquiry results to systematically design a menu of behavioral economics-informed implementation strategies that cut across settings, in collaboration with an advisory board composed of key stakeholders (i.e., behavioral economists, clinicians, implementation scientists, and suicide prevention experts). Finally, we will conduct rapid-cycle trials to test and refine the menu of implementation strategies. Primary outcomes include clinician-reported feasibility and acceptability of the implementation strategies.DiscussionFindings will elucidate ways to address common and unique barriers to evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health care. Results will yield refined, pragmatically tested strategies that can inform larger confirmatory trials to combat the growing public health crisis of suicide.

Improving Cervical Screening in Trans and Gender-Diverse People.

Trans and gender-diverse people with a cervix experience difficulties accessing cervical cancer screening because of structural, interpersonal, and individual barriers. The aim of this study was to explore issues with cervical cancer screening participation, awareness, and healthcare provider recommendation for trans and gender-diverse people. A national Australian survey was conducted in 2018 to 2019. Participants included 196 trans and gender-diverse people with a cervix. Data were analyzed using descriptive and multiple regression analyses. Two awareness items related to cervical cancer screening, healthcare provider recommendation, and cervical cancer screening participation were assessed. Four variables associated with cervical cancer screening were included in the regression: age, healthcare provider recommendation, like for body, and gender. The sample was young; half (52.6%) were aged 20 to 24 years. Almost half (44.6%) had never had a healthcare provider recommend cervical cancer screening to them. Around half (48.0%) had never participated, with 21.9% reporting that they are regular screeners. More than a quarter (27.5%) of people who had screening had an abnormal result. The most common reasons for not participating in screening were that it is emotionally traumatic for them (55.3%) and inability to find a healthcare provider with whom they are comfortable (38.3%). Trans and gender-diverse Australians with a cervix are unlikely to be regular participants in cervical cancer screening. To continue reducing cervical cancer rates, healthcare providers must address underscreening in this community. Gender diversity training needs to be provided to healthcare providers. In addition, healthcare providers need to promote participation in cervical screening in this trans and gender-diverse community.

Early Detection and Control of Methicillin resistant Staphylococcus aureus Outbreak in an Intensive Care Unit.

Although Methicillin resistant Staphylococcus aureus (MRSA) is one of the major pathogens of healthcare associated infections, we had only sporadic cases in our intensive care unit (ICU) for years. To investigate the sudden increase in the number of MRSA cases in ICU. Descriptive study. From the 5th December 2016 to 26th January 2017, we detected 11 new MRSA cases in ICU. Screening of 73 ICU healthcare workers (HCWs) and screening of 13 patients was performed for outbreak investigation. Nine clinical isolates available in stocks and eight screening MRSA isolates were included in molecular studies. PFGE, spa-mecA-mecC-PVL in-house multiplex PCR assay and spa typing, SCCmec typing were performed for all isolates. Sequence type of the representative strain was determined by Multi-Locus Sequence typing (MLST). All strains were mecA positive, PVL negative, and have the same antimicrobial susceptibility pattern except for two strains. All clinical, two patient screening and three nasal isolates of HCWs showed the same pulsotype, named clone A. The spa type of outbreak isolates is t030 and the SCCmec type is SCCmecIII; the MLST type of representative strain is ST239 (PFGE pulsotype A, ST239-SCCmecIII-t030). Unrelated three isolates had PFGE pulsotype B-SCCmecI-t030, PFGE pulsotype C-SCCmecIII-t459, PFGE pulsotype D-SCCmecIII. Molecular typing techniques are the cornerstones for the investigation of outbreaks. Infection control measures, such as enhancing cleaning procedures, promoting hand hygiene, should be enforced in the ICU unit. All patients, including those who have already been discharged to other departments, must be put on contact isolation. HCWs carrying the MRSA strains could be offered decolonization.

Factors associated with improvement in depressive symptoms among older persons after hospitalisation - a prospective design with two follow-ups.

Depression is a common disorder in old age and increases with hospitalisation. The aim was to investigate whether improvement in depressive symptoms after hospitalisation is associated with education level, age, gender, living situation, self-efficacy, activities in daily living and quality of life by (1) examining the prevalence of depressive symptoms at baseline and at 1st and 2nd follow-up (2) examining different factors' association with depressive symptoms at baseline and (3) examining different factors' association with improvement in depressive symptoms at baseline and at 1st and 2nd follow-up. The study consisted of 145 patients, 65years and older. Data were collected between February 2015 and September 2016 through interviews conducted using structured protocols. The instrument used was Katz index of ADL, Geriatric Depression Scale-20, Life Satisfaction Questionnaire and the General Self-Efficacy Scale. The participants were interviewed before discharge from hospital, after 1.5month and after 3months. The prevalence of depressive symptoms in older persons was high after hospitalisation. Factors associated with improvement of depressive symptoms after hospitalisation were higher educational level, improvement in activities in daily living and quality of life. Non-significant results were found for improvement of depressive symptoms and gender, age, living situation or self-efficacy. Depression is a common health problem in older persons, especially after hospitalisation. It is therefore important that healthcare staff screen older persons for depression during hospitalisation, as this allows identification of those in need and a possibility to help them in an appropriate manner. Persons with lower educational level and depressive symptoms need special attention.

Gaps in Alcohol Screening and Intervention Practices in Surgical Healthcare: A Qualitative Study.

Risky alcohol use before surgery is associated with an increased risk of postoperative complications and longer hospital stays. Preoperative alcohol interventions can improve surgical outcomes but are not commonly integrated into routine care. This study sought to better understand patient's and provider's perceptions of alcohol-related surgical health and healthcare practices and illuminate gaps in care and how they could be improved. This study used a descriptive qualitative research design. Data were collected between July 2017 and March 2018. One-on-one interviews assessed domains related to knowledge, gaps in alcohol-related screening and intervention, and interest in enhancing alcohol-related care. Key themes emerged from a process of iterative coding and thematic analysis. Participants included elective surgical patients who met alcohol screening criteria (n = 20) and surgical healthcare providers (n = 9). Participants had modest or low awareness of alcohol-related surgical health risks. Basic alcohol screening was a routine part of care, but results were often discounted or overlooked. Providers did not routinely initiate preoperative alcohol education or intervention. Providers viewed improving alcohol-related clinical practices as a low priority. Patients were interested in receiving alcohol interventions before surgery if they were delivered in a nonjudgement style and focused on surgical health optimization. This study highlights potential gaps in alcohol-related knowledge and care, and found providers place a low priority on alcohol interventions in the perioperative context. Given the high complication rate associated with preoperative alcohol use, these topics are worthy of future research. To be successful strategies to overcome specific barriers to alcohol screening and intervention must address the needs of patients and providers.

Barriers and facilitators towards colonoscopy: a qualitative systematic review.

Colonoscopy is integral in the early detection of colorectal cancer (CRC), be it for screening, diagnostic or therapeutic intentions. Despite the presence of multiple screening modalities, colonoscopy remains integral in providing a definitive CRC diagnosis. However, uptake rates remain low worldwide with minimal understanding towards stakeholders' perspectives. This systematic review is the first to outline the barriers and facilitators faced by providers and patients in receiving colonoscopy specifically. Using PRISMA guidelines, our systematic review consolidates findings from Medline, Embase, CINAHL, PsycINFO and Web of Science Core collection. All perceptions of healthcare providers and screening participants aged 45 and above towards colonoscopy were included. Forty-five articles were included in our review. Five major analytical themes were identified - procedural perceptions, personal experiences, thoughts and concerns, societal influences, doctor-patient relationship and healthcare system. The discrepancies in knowledge between patients and providers have evidently reduced in the present decade, potentially attributable to the rising influence of social media. The sharing of providers' personal experiences, involvement of patients' family in colonoscopy recommendations and propagation of patients' positive recounts were also more apparent in the past compared to the present decade, highlighting the need to reevaluate the balance between medical confidentiality and personal touch. Additionally, Asian patients were reportedly more apathetic towards CRC diagnosis due to their strong belief in destiny, a crucial association consistent with present studies. This study highlights pertinent gaps in our healthcare system, providing crucial groundwork for interventions to be enacted in engendering higher colonoscopy uptake rates.

Discovery of potent thrombin inhibitors from a protease-focused DNA-encoded chemical library

DNA-encoded chemical libraries are collections of compounds individually coupled to unique DNA tags serving as amplifiable identification barcodes. By bridging split-and-pool combinatorial synthesis with the ligation of unique encoding DNA oligomers, million- to billion-member libraries can be synthesized for use in hundreds of healthcare target screens. Although structural diversity and desirable molecular property ranges generally guide DNA-encoded chemical library design, recent reports have highlighted the utility of focused DNA-encoded chemical libraries that are structurally biased for a class of protein targets. Herein, a protease-focused DNA-encoded chemical library was designed that utilizes chemotypes known to engage conserved catalytic protease residues. The three-cycle library features functional moieties such as guanidine, which interacts strongly with aspartate of the protease catalytic triad, as well as mild electrophiles such as sulfonamide, urea, and carbamate. We developed a DNA-compatible method for guanidinylation of amines and reduction of nitriles. Employing these optimized reactions, we constructed a 9.8-million-membered DNA-encoded chemical library. Affinity selection of the library with thrombin, a common protease, revealed a number of enriched features which ultimately led to the discovery of a 1 nM inhibitor of thrombin. Thus, structurally focused DNA-encoded chemical libraries have tremendous potential to find clinically useful high-affinity hits for the rapid discovery of drugs for targets (e.g., proteases) with essential functions in infectious diseases (e.g., severe acute respiratory syndrome coronavirus 2) and relevant healthcare conditions (e.g., male contraception).

Assessment and screening of positive childhood experiences along with childhood adversity in research, practice, and policy

Despite empirical evidence documenting the role of positive childhood experiences in predicting adaptation over the lifespan and across generations, this research has not yet been fully integrated into public health and policy efforts. We argue that adults' benevolent childhood experiences (BCEs) should be measured in large-scale data collection efforts, such as statewide surveys, alongside more routinely collected adverse childhood experiences (ACEs). We also outline several recommended strategies in which the assessment and screening of positive childhood experiences could be implemented as a counterpart to community health and primary care screening for childhood adversity in adults, with short- and long-term benefits. Pediatric physicians should screen children and adolescents for their current positive childhood experiences as well. The assessment of positive childhood experiences is essential to empirically identifying resilience resources linked with better long-term adaptation, understanding how positive experiences may counteract the long-term effects of childhood adversity in underserved and traumatized individuals, informing medical providers' knowledge about patients' strengths in addition to challenges, and instilling hope in individuals and families experiencing stress.

Abstract C105: Exploring cancer health disparities among formerly incarcerated African Americans

Abstract African Americans are disproportionately impacted by cancer rates, prevalence, incidents, morbidity and mortality. The National Cancer Institute, Division of Cancer Control and Population Sciences (2016), identified incarcerated persons as an understudied population for cancer risks and incidents. Further the availability of high quality data about cancer prevalence, incidence and mortality among people who experience incarceration is lacking. African American persons with a history of incarceration are at particular risk for chronic health diseases, cancer risks and health disparities due to their experience of incarceration; discrimination and stigma post-incarceration; personal lifestyle factors; socioeconomic status and, environmental barriers to cancer prevention and control resources. Despite these risk factors scant research has been conducted on risks for cancer health disparities among formerly incarcerated African Americans. This qualitative pilot study explored cancer health disparities among African American men and women (n=25) who were formerly incarcerated in an Illinois prison or the Cook County Jail. Four qualitative focus groups were conducted in Chicago to collect preliminary data on barriers to cancer health care access, screening, and treatment, post-release. The Integrative Model of Behavioral Prediction guided the study. An iterative process of content analysis was used to identify facilitators and barriers to cancer early detection, screening and treatment among the target population. Preliminary analysis revealed five central themes: (1) Increased access to health care through the Affordable Care Act, Medicaid, and County Care motivated active participation in health maintenance routines and cancer early detection, prevention and treatment services; (2) Long wait times for appointments with primary care physicians increased reliance on emergency room visits; (3) Significant insurance and community resource, gaps occur at release and community reentry; (4) Costs for care (co-pays and deductibles, pre and post release) are barriers to routine care and delay urgent care-seeking; and, (5) Cancer health literacy and cancer awareness messages specifically designed for persons who experience incarceration is lacking. Study findings will inform the development of a pilot community health worker training and navigation intervention aimed at increasing access to cancer health care and decreasing cancer health disparities among formerly incarcerated African Americans in Chicago. Citation Format: Vickii Coffey, Carolyn Rodgers, Shirley Spencer, Joseph Strickland, Mary Muse, Phoenix Alicia Matthews, Catherine Balthazar. Exploring cancer health disparities among formerly incarcerated African Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C105.