Secondary Prevention Services Research Articles

Feasibility of the interdisciplinary multimodal assessment-The team perspective

Secondary preventive outpatient diagnostic services for patients with pain and risk factors for chronification have not yet been sufficiently established. In the PAIN2020 project (Innovation Fund, 01NVF17049) an outpatient interdisciplinary multimodal assessment (IMA) was introduced for the first time early in the course of the disease. For the implementation of the IMA procedures for team cooperation and decision criteria were developed, which were implemented by ateam of medical, physiotherapeutic and psychological therapists. These procedures and decision criteria are to be discussed against the background of clinical experience and examined with respect to their feasibility (qualitative). In PAIN2020 aworkshop on IMA was held in September 2021 to jointly reflect on the findings and experiences gained in the process so far through monitoring and structuring documentation in the implementation with staff or teams of PAIN2020 centers on the feasibility of implementing astructured interdisciplinary multimodal assessment. In three work phases, occupational group-specific and cross-occupational group topics were addressed. In the decision-making processes of the occupational groups, in addition to profession-specific focal points within the framework of the assessment of findings (somatic, functional or psychosocial core criteria), overarching core criteria within the professions as well as complementary patient-related aspects are evident, which are included in the integrative team process. With respect to team collaboration, the implementation of the team meeting and the final discussion can be used to identify structural and process parameters that promote or inhibit implementation, which are also accompanied by interactional factors. For the implementation of the IMA, there were (1)adaptations of the IMA, which is currently implemented as A‑IMA in the selective agreement with BARMER and (2)new dimensions or task fields and ideas for evidence-based concepts for the content design of integrative diagnostics as well as for the feedback of the results to the patients, which should be discussed in the future.

Underlying motivations hampering Flemish primary care physicians from overcoming the barriers in osteoporosis care: an EMR-facilitated clinical reasoning study

BackgroundOver half of the European population aged minimum 65 years presents with at least two chronic diseases. Attention towards these diseases exhibits disparities, with limited primary care physician (PCP) attention for osteoporosis. This was confirmed in a previous integrated osteoporosis care (IOC) project in which notable difficulties to enlist PCPs arose. Consequently, this study was initiated in Flemish PCPs for in-depth analysis of underlying mechanisms hampering PCPs to fully commit to osteoporosis care.MethodsA qualitative Electronic Medical Record (EMR)-facilitated clinical reasoning study was conducted. A semi-structured interview guide was employed to guide PCPs from reflections on their own patients to broader views regarding osteoporosis care. An inductive thematic analysis was performed using NVivo 12.ResultsThirteen PCPs were interviewed. They stated that osteoporosis patients often had complex (medical) profiles. PCPs emphasised the ongoing necessity for prioritisation within this context. This leads to a competition for PCP attention during consultations at three levels: i. between acute versus preventive care; ii. between primary fracture prevention and other preventive services and iii. between secondary fracture prevention and other preventive services; spanning eight areas of competition: disease significance, perceived impact, PCP awareness, the patient agenda, PCP competence, PCP support, perceived patient burden, and efficiency of care provision. Applicability of these areas of competition differed between levels.ConclusionThe intricate context in which PCPs operate, creates a competition for PCP attention leading to a lack of attention for fracture prevention. To preserve efforts in fracture prevention, areas of competition should be systematically addressed.Trial registrationApproval for the study has been provided by the Ghent University Hospital Ethics Committee (BC-09797).

Understanding integrated HPV testing and treatment of pre-cancerous cervical cancer in Burkina Faso, Cote d’Ivoire, Guatemala and Philippines: study protocol

BackgroundMany low- and-middle-income countries are disproportionately burdened by cervical cancer, resulting in high morbidity and mortality. HPV-DNA testing coupled with treatment with thermal ablation is a recommended screening and precancer treatment strategy, but not enough is known about how this can be effectively implemented in the context of integrated services. The (Scale Up Cervical Cancer Elimination by Secondary prevention Strategy, (SUCCESS) project is conducting a study to understand this approach, integrated into existing women’s health services in Burkina Faso, Cote d’Ivoire, Guatemala, and the Philippines (2020–2024).MethodsA hybrid effectiveness-implementation type III mixed-methods observational study design is used to assess feasibility, acceptability, and costs of integrated service delivery in 10 sites per country, selected considering urban/rural location, facility level, onsite/offsite laboratories, and health services type. In each country, a sample size of 2227 women aged 25–49 years will be enrolled with about 20% being women living with HIV. The primary outcome is proportion of HPV positive women completing precancer treatment, if eligible, within three months of screening. Data collection and analysis includes; facility and client exit surveys, key informant and client interviews, registries and project records extractions, and costing data analysis. Analysis includes descriptive statistics, context description, thematic analysis, and document analysis. Quantitative analyses will be stratified by participant’s HIV status.DiscussionRecruitment of study participants started in April 2022 (Burkina Faso and Côte d’Ivoire) and August 2022 (Guatemala and the Philippines). Enrolment targets for women screened, client exit, in-depth and key informant interviews conducted were reached in Burkina Faso and Cote d’Ivoire in November 2022. Guatemala and Philippines are expected to complete enrolment by June 2023. Follow-up of study Participants 12-months post-treatment is ongoing and is expected to be completed for all countries by August 2024. In LMICs, integrating cervical cancer secondary prevention services into other health services will likely require specific rather than incidental recruitment of women for screening. Reconfiguration of laboratory infrastructure and planning for sample management must be made well in advance to meet induced demand for screening.Trail Registration ClinicalTrials.Gov ID: NCT05133661 (24/11/2021).

Secondary risk reduction service acceptability amongst Irish breast cancer survivors and clinicians

Abstract Background Many patients (>75%) diagnosed with breast cancer in Ireland today will be cured and are at risk of dying from other cancers and non-communicable diseases. Breast cancer diagnosis provides a pivotal time point for education on modifiable risk factors and engagement with secondary risk reduction services. Our study set out to establish the level of awareness and acceptability of these areas, respectively. Methods A survey was developed for breast cancer survivors and oncology clinicians using previously validated questionnaires; the ‘Mitchelstown Cohort Survey’ and the ‘International Physical Activity Questionnaire'. IBM SPSS software (Version 28.0) was used for data analysis. Results Between September and December 2021, 322 patients and 29 clinicians attending the South Infirmary Victoria and Cork University Hospitals, completed the survey. Over 80% of patients and clinicians were aware of modifiable cancer risk factors. Only 1 in 5 clinicians had training in secondary risk reduction however 90% were willing to refer to services. Education had an impact on the likelihood of patient engagement with weight management, dietary, and exercise education (Pearson chi-squared test; p = 0.009, 0.039, 0.139 respectively). Patients who smoked, had increased alcohol intake, or gained weight since diagnosis were more likely to engage with services (p = <0.001, p = <0.001, p = 0.015 respectively). Patients who made changes to activity levels since diagnosis were more likely to engage with exercise education (p = 0.015). Conclusions This study identified that over 4 in 5 breast cancer survivors and oncology clinicians were aware of the importance of modifiable lifestyle risk factors. While 9 in 10 clinicians were willing to refer to secondary prevention services if available, the likelihood of patient engagement was associated with their at-risk behaviours and education level. Our study highlights the challenges of implementing health promotion programs in this cohort. Key messages • High level of intended engagement with secondary risk reduction services amongst breast cancer survivors and oncology clinicians. • Likelihood of patient engagement was associated with their at-risk behaviours and education level.

Preventing the next fragility fracture: a cross-sectional survey of secondary fragility fracture prevention services worldwide

BackgroundThere has been an increasing awareness of the public health impact of fragility fractures due to osteoporosis and the imperative of addressing this health burden with well-designed secondary fragility fracture...

Efektifitas Pemberian Rebusan Daun Salam dengan Senam Hipertensi Pada Lansia Hipertensi untuk Menurunkan Tekanan Darah

Older adults are someone who is over 60 years old, which is the final stage of the development of human life, or someone who is starting to enter the stage of the aging process. This study aimed to determine the difference in effectiveness of giving bay leaf decoction with hypertension exercise to older adults with hypertension to reduce blood pressure in Karangayu, Semarang Barat, before and after the intervention. This research method used quasi-experimental pre-and post-tests for two intervention groups, 1 and 2. The sampling technique used was non-probability sampling on 74 respondents, using pre-test and post-test observation sheets with SOP for boiled bay leaves and SOP for hypertension exercises. This study showed that the average blood pressure before being given the bay leaf decoction intervention in group 1 was 89.2% with severe pain. In contrast, the average blood pressure after being given bay leaf decoction intervention was 86.5%, with mild blood pressure. For group 2, the average blood pressure before being given the hypertension exercise intervention was 94.6% with severe pain. Meanwhile, the average blood pressure after the hypertension exercise intervention was 75.7% with mild blood pressure. The results of the marginal homogeneity test obtained a P value of 0.001 (<0.05), meaning that there was a significant difference in mean between the pre-test and post-test, which affected the effect of giving bay leaf decoction with hypertension exercise on blood pressure in the older adults. Advice to health services, such as Posbindu (Pos Pembinaan Terpadu), on how to provide non-drug treatment with bay leaf decoction and hypertension gymnastics, which means physical exercise and traditional medicine, as part of training for Posbindu officers in secondary prevention services for high blood pressure in older adults.

Estimating induced abortion incidence and the use of non-recommended abortion methods and sources in two provinces of the Democratic Republic of the Congo (Kinshasa and Kongo Central) in 2021: results from population-based, cross-sectional surveys of reproductive-aged women

The changing abortion legal and practice landscape in the DRC in recent years calls for a re-examining of induced abortion experiences. The current study provides population-level estimates of induced abortion incidence and safety by women’s characteristics in two provinces using direct and indirect approaches to assess indirect method performance. We use representative survey data on women aged 15–49 in Kinshasa and Kongo Central collected from December 2021 to April 2022. The survey had questions on respondents’ and their closest friends’ experience with induced abortion, including methods and sources used. We estimated one-year abortion incidence and proportion using non-recommended methods and sources overall and by background characteristics for each province separately for respondents and friends. The fully adjusted one-year friend abortion rate was 105.3 per 1000 women of reproductive age in Kinshasa and 44.3 per 1000 in Kongo Central in 2021; these were substantially higher than corresponding respondent estimates. Women earlier in their reproductive lifespan were more likely to have had a recent abortion. Approximately 17.0% of abortions in Kinshasa and one-third of abortions in Kongo Central involved non-recommended methods and sources according to respondent and friend estimates. The more accurate friend abortion incidence estimates indicate that women in the DRC often rely on abortion to regulate their fertility. Many use non-recommended means and sources to terminate, thus, significant work remains to actualise the commitments made in the Maputo Protocol to provide comprehensive reproductive health services that combine primary and secondary prevention services to reduce unsafe abortion and its consequences.

European Cancer Summit 2022 Submission for Prevention, Early Detection and Screening NetworkCancer prevention and care for people experiencing homelessness: barriers and facilitators at system, provider, and individual level in four European countries

BackgroundPeople experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the general population, including a higher burden of cancer and cancer-specific mortality (Thomas, 2012). These outcomes are associated with several etiological factors and may lead to significant barriers to accessing primary and secondary prevention and community health services. The CANCERLESS project (EU Horizon 2020) aims to enable PEH in Europe to access cancer prevention measures at an early stage by developing a novel care model, the Health Navigator Model (HNM). Implementing this co-designed person-centered and community-based intervention may be a way to address the growing health and social disparities in PEH and promote their timely access to cancer prevention services. MethodsTo qualitatively adapt the HNM to structural conditions in four European healthcare systems, we collected data through 69 semi-structured interviews between August and October 2021 with PEH, both with and without direct experiences of cancer, as well as with health and social care professionals. Interviews conducted by partners in Austria, Greece, Spain, and the United Kingdom were transcribed verbatim and thematically analyzed utilizing the approach set out by Saldaña (2021). ResultsWe derived the two overarching themes (1) Experiences and understanding of cancer prevention and treatment, and (2) Considerations for program intervention. While cancer was a major source of worry, participants’ responses indicated that PEH generally had very limited knowledge and understanding of cancer symptoms and cancer prevention. Across all settings, programs and activities for cancer prevention geared towards PEH were described as effectively non-existent, and very few participants experiencing homelessness recalled being invited to a screening appointment. As a result, health and social care professionals in some settings indicated that cancer in people experiencing homelessness was often missed in the early stages, and instead only picked up when the severity of symptoms intensified. ConclusionsAs cancer-specific knowledge among PEH is limited, engagement on educational and awareness-building levels in this population is needed. To achieve this, communication around cancer should be multilingual, accessible, and simple, while medical staff should be trained to provide more inclusive health services (Hauff & Secor-Turner, 2014).

Availability and nature of cardiac rehabilitation by province in Iran: A 2018 update of ICCPR's global audit

Background: Cardiac rehabilitation (CR) is scantly available in Iran, although it is the cost-benefit strategy in cardiac patients, It has not been established how CR is delivered within Iran. This study aimed to determine: (a) availability, density and unmet need for CR, and (b) nature of CR services in Iran by province. Materials and Methods: In this cross-sectional sub-study of the global CR audit, program availability was determined through cardiovascular networks. An online survey was then disseminated to these programs in June 2016–2017 which assessed capacity and characteristics; a paper-based survey was disseminated in 2018 to nonresponding and any new programs. CR density and need was computed based on annual incidence of acute myocardial infarction (AMI) in each province. Results: Of the 31 provinces, 12 (38.7%) had CR services. There were 30 programs nationally, all in capital cities; of these, programs in 9 (75.0%) provinces, specifically 22 (73.3%) programs, participated. The national CR density is 1 spot per 7 incident AMI patients/year. Unmet need is greatest in Khuzestan, Tehran and west Azerbaijan, with 44,816 more spots needed/year. Most programs assessed cardiovascular risk factors, and offered comprehensive services, delivered by a multi-disciplinary team, comprised chiefly of nurses, dietitians and cardiologists. Median dose is 14 sessions/program in supervised programs. A third of programs offered home-based services. Conclusion: Where programs do exist in IRAN, they are generally delivered in accordance with guidelines. Therefore, we must increase capacity in CR services in all provinces to improve secondary prevention services.

The feasibility and effectiveness of telecare consultations in nurse-led post-acute stroke clinics: A study protocol.

Globally, nurse-led post-acute stroke clinics have been developed to provide secondary care services to stroke survivors. Although synthesized evidence supports the idea that the secondary prevention services delivered by nurses in these clinics can improve the functional ability of stroke survivors and reduce their readmission rates, long travel and waiting times, high costs, and the pandemic have limited the utilization of such clinics. Telecare consultations are a new modality for expanding public access to healthcare services, although how it can be applied in nurse-led clinics has not been reported. The aim of this study is to determine the feasibility and effects of telecare consultations in nurse-led post-acute stroke clinics. The study adopts a quasi-experimental design. The participants will receive three secondary stroke care consultations in 3 months provided via telecare by experienced advanced practice nurses. The outcome measures include feasibility (reasons for refusing to participate and for dropping-out, the attitudes and satisfaction of both the advanced practice nurses and their patients towards the programme), and preliminary effectiveness (degree of disability after stroke, activities of daily living, instrumental activities of daily living, health-related quality of life, depression) outcomes. Data will be collected at pre-(T1) and post-(T2) intervention. The findings of this study may help facilitate the implementation of telecare consultations in a nurse-led post-acute stroke clinic, which may benefit the stroke survivors who are having mobility restrictions from accessing customary healthcare services and may protect them from being exposed to the infectious risk.

High levels of risk factors and poor secondary prevention for coronary heart disease patients in public hospitals: A descriptive repeated measures study.

Secondary prevention is a priority after coronary revascularization for effective long-term cardiovascular care. Coronary Heart Disease is a major health problem in Jordan, but little is known about the current provision of secondary prevention. The aim of this study was to evaluate risk factors and explore the current provision of secondary Coronary Heart Disease prevention among patients presenting with first-time Coronary Heart Disease at two time points: during hospitalization (Time 1) and 6 months later (Time 2), in multicentre settings in Jordan. A descriptive, repeated measures research study design was applied to a consecutive sample of 180 patients with first-time Coronary Heart Disease. Demographic and clinical details were recorded from medical files. Self-administered questionnaires developed by the researchers were used to measure secondary prevention information related to Coronary Heart Disease, including secondary prevention services, lifestyle advice received and medical advice topics. A short form of the International Physical Activity Questionnaire was used to measure physical activity. Participants were assessed at Times 1 and 2. Unstructured lifestyle advice given to the patients at Times 1 and 2 most frequently related to medications, smoking, diet and blood lipids control advice topics, with no statistically significant improvement in cardiovascular risk factors among patients between Times 1 and 2. Despite an extremely high prevalence of risk factors in this population, the provision of secondary prevention is poor in Jordan, which requires urgent improvement, and the contribution of nurses' to secondary prevention should be enhanced.

Qualitative study of the views of people living with cardiovascular disease, and healthcare professionals, towards the use of a digital platform to support cardiovascular disease self-management

ObjectivesThis paper focuses on formative research as part of a broader study to develop and evaluate an innovative digital health platform for the self-management of cardiovascular disease (CVD). The primary...

Secondary Prevention after Myocardial Infarction: What to Do and Where to Do It.

Acute myocardial infarction is a manifestation of atherosclerosis which may be fatal. In-hospital and short-term mortality rates after an acute myocardial infarction have declined in the past few decades. However, although long-term mortality has decreased, it remains unacceptably high. This review paper summarises the non-pharmacological interventions (smoking cessation, physical activity, nutrition, and psychosocial intervention) and pharmacological approaches (antiplatelet and lipid-lowering therapy, renin-angiotensin-aldosterone system inhibitors, beta-blockers, and glucose-lowering drugs) to secondary prevention after a myocardial infarction. The provision of secondary prevention services is established through cardiac rehabilitation, which consists of several discussed components. Finally, we discuss the quality indicators for long-term care after an acute myocardial infarction.

Bridging the gaps in secondary fracture prevention at a single center in Pakistan—compliance with the IOF best practice framework

The International Osteoporosis Foundation (IOF) formulated a set of best practice framework as an international benchmark for secondary fracture prevention (SFP) and fracture liaison services (FLS), delineating essential elements of service delivery. The aim of this audit was to assess compliance with the IOF standards for patients ≥ 50years presenting with fragility hip fractures at a tertiary care center in Pakistan. A retrospective sample of hip fracture cases from Jan 2019 to Dec 2019, treated at the section of Orthopedic Surgery, Aga Khan University, Karachi, was conducted. After excluding high energy trauma cases and patients younger than 50years of age, medical records were audited, using a pre-structured Performa based on IOF standards. Compliance level of 0, 1, 2, and 3 was recorded as defined by IOF. Microsoft excel was used for data analysis. A compliance level of 3 was recorded for patient identification and fall prevention services, whereas level 1 was attained for database maintenance for 25 (100%) cases. For medication initiation, level 0 was recorded for all the cases; however, 8 (32%) cases were prescribed calcium and vitamin D supplements. For the standards, including post-fracture assessment timing, evaluation of secondary causes of osteoporosis, multifaceted assessment, medication review, communication strategy, and long-term management, a level 0 was noted for 25 (100%) cases. Moreover, no recommended assessment guidelines were followed uniformly. The care gaps identified require substantial efforts to ensure adequate implementation of the overall best practice standards for SFP, necessitating the need for FLS initiation and establishment of fracture care pathway.

Covid-19 given opportunity to use ultrasound in the plaster room to continue secondary fracture prevention care: A retrospective Fracture Liaison Service study

IntroductionFracture Liaison Service (FLS) managed secondary fracture prevention services have been hampered during the COVID-19 pandemic. A challenging opportunity is to use pulse-echo ultrasound (P-EU) in the plaster room. The study had two objectives: can P-EU help our decision to justly avoid DXA/VFA scans in plaster treated women (50–70 years) after fracture and whether its use can encourage or nudge all plaster treated patients (>50 years) who need DXA/VFA scans. Patients and methods1307 patients (cohort: pre-COVID-19) and 1056 patients (cohort: peri-COVID-19), each of them ≥ 50 years after recent fracture, were studied. Only in women aged 50–70 years, we used a P-EU decision threshold (DI) >= 0.896 g/cm2 to rule out further analysis by means of DXA/VFA. All other plaster patients received P-EU as part of patient information. Peri-Covid-19, all performed DXA/VFA scans were counted until three months post-study closure. By then each patient still waiting for a DXA/VFA had received a scan. ResultsPeri-COVID-19, 69 out of 191 plaster-treated women aged 50–70 years were ruled out (36%), for plaster and not in-plaster treated women aged 50–70 years, it was 27%. Comparing all peri-to pre-COVID-19 plaster-treated women and men, a significant P-EU nudging effect was found (difference in proportions: 8.8%) P = .001. ConclusionThe combination of patient information and P-EU in the plaster room is effective to reduce DXA/VFA scans and allow extra patients to undergo DXA/VFA. After all, more than a quarter of 50–70 years old women in plaster did not need to be scanned.

A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting.

Poland has recently intensified its health promotion in an effort to extend healthy life expectancy and reduce health inequalities. Our aim was to reach a deprived rural population, increase its health literacy, and explore its use of and barriers to cancer screening and public health care. A CBPR study was conducted in one of the poorest districts in Wielkopolska region, Poland, among 122 beneficiaries of health education workshops. A self-developed questionnaire was used. The reported barriers to participation in cancer screening included: lack of time, lack of need, or feeling healthy (32.8%); long waiting times (17.2%); fear of costs (9%). Physicians seldom recommended screening to their patients. Only 7.4% of respondents had ever received dermatoscopy. Among women, 18.2% did not perform any breast exams and 25% had never had smear tests. Diagnostics was often financed out of pocket (thyroid ultrasound = 58.1%; smear test = 48.5%; breast ultrasound = 36.8%). The health system needs mentioned by participants included better access to physicians (65.6%), promotion of free screening tests (54.9%), and access to public health programmes (22.1%). There is an urgent need to translate national strategies into action. Health promotion and better access to care must become priorities in deprived areas, while primary care providers should become key figures in delivering these services.

First results of the register of patients with osteoporosis included in the secondary fracture prevention services

Background. To reduce the number of osteoporotic fractures in the world in recent years, — Fracture Liaison Service has been created. Since 2019, the development of a register of patients included in the Secondary Fracture Prevention named «Prometheus» has begun in Russia.Materials and methods. An information system for storing, searching and processing information has been created, and a registration card has been developed. Six FLS participate in the register management. As of 10.03.2021, data on 387 patients were introduced in the register.Results. Among the included patients, 46.25% received a fracture of the proximal femur, 20.41% — of the vertebral bodies and 16.80% of the proximal humerus, the rest had fractures of other localizations. The risk of fractures was assessed in all patients. A high risk of major osteoporotic fractures according to FRAX was determined in 160 (43.24%) people. Two-energy X-ray absorptiometry (DXA) was performed in 152 (39.28%) patients, and osteoporosis was detected in 103 (67.76%), osteopenia — in 42 (27.63%) patients. The risk of falls was assessed in 100% of the included patients, and the risk of falls was determined to be high in 343 (88.63%) patients. Evaluation of various laboratory parameters to find the causes of secondary osteoporosis was performed in most patients. After consultation with the FLS doctor, anti-osteoporotic drugs were prescribed to 241 (64.27%) people. Among the rest, 70 (52.24%) patients had contra-indications and 31 (23.13%) people needed further examination.Conclusions. Thus, the use of the register allows you to evaluate all the main sections of the organization of assistance within the FLS and compare them with international standards to identify «gaps» and improve the work of the service.

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.

Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020.

The 2020 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for the Secondary Prevention of Stroke includes current evidence-based recommendations and expert opinions intended for use by clinicians across a broad range of settings. They provide guidance for the prevention of ischemic stroke recurrence through the identification and management of modifiable vascular risk factors. Recommendations address triage, diagnostic testing, lifestyle behaviors, vaping, hypertension, hyperlipidemia, diabetes, atrial fibrillation, other cardiac conditions, antiplatelet and anticoagulant therapies, and carotid and vertebral artery disease. This update of the previous 2017 guideline contains several new or revised recommendations. Recommendations regarding triage and initial assessment of acute transient ischemic attack (TIA) and minor stroke have been simplified, and selected aspects of the etiological stroke workup are revised. Updated treatment recommendations based on new evidence have been made for dual antiplatelet therapy for TIA and minor stroke; anticoagulant therapy for atrial fibrillation; embolic strokes of undetermined source; low-density lipoprotein lowering; hypertriglyceridemia; diabetes treatment; and patent foramen ovale management. A new section has been added to provide practical guidance regarding temporary interruption of antithrombotic therapy for surgical procedures. Cancer-associated ischemic stroke is addressed. A section on virtual care delivery of secondary stroke prevention services in included to highlight a shifting paradigm of care delivery made more urgent by the global pandemic. In addition, where appropriate, sex differences as they pertain to treatments have been addressed. The CSBPR include supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.

Assessing the Amenability of Rural MSM to Using Telemedicine for Medical and Mental Healthcare

Rural men who have sex with men (MSM) experience numerous barriers to healthcare, including stigma, which impedes medical and mental healthcare engagement. Given this, rural MSM are less likely to be engaged in routine healthcare compared to their urban counterparts. Telemedicine has been advocated for to address these disparities in care access; however, no known studies have explored the amenability of telemedicine for both medical and mental healthcare among rural MSM. In-depth interviews were conducted with a sample of MSM (n = 23) residing in rural Oklahoma and Arkansas. Respondents described a willingness to use telemedicine to engage with medical and mental health providers as it presented a mechanism to overcome identified barriers to care. Removing barriers, notably lack of access to knowledgeable and affirming providers, is one potential method for increasing engagement in routine care which provides opportunities for rural MSM to engage in primary and secondary prevention services.