Early Detection Services Research Articles

Qualitative service evaluation of a multimodal pilot service for early detection of liver disease in high-risk groups: ‘Alright My Liver?’

ObjectiveLiver disease is a growing cause of premature death in the UK. The National Health Service in England (NHS England) has funded regional early detection programmes through Community Liver Health Check pilots. ‘Alright My Liver?’ is Bristol and Severn’s pilot service offering early detection of liver disease through screening events serving populations at risk, including people with a history of drug or alcohol use, type 2 diabetes and obesity. The service offers point-of-care testing for liver disease and a supported follow-up process.MethodsSemistructured interviews were conducted with 14 service users and six service providers over a 6-month period using diversity sampling. Topic guides encouraged discussion of experiences of the service as well as barriers and facilitators to accessing the service. Data were analysed using thematic analysis, and positive and negative comments pertaining to the service were collated in a ‘table of changes’ to inform optimisation.ResultsThree main themes were identified: (1) motivations for engagement, (2) experience of the service and (3) health impacts. Key motivations for engagement were screening as a novel opportunity, a response to immediate health concerns or as reassurance. Service users commented on its convenience and that staff interactions were warm and informative. Some felt that follow-up could be more intensive. Impacts varied depending on perceived risk factors and screening results but generally involved stating a commitment to healthy lifestyle changes, including reducing alcohol use.ConclusionTargeted screening for liver disease in high-risk groups through this pilot service was deemed an appropriate and accessible intervention, with important optimisations identified.

Development, Validity, and Reliability of the Primary Eye Care Questionnaire (PECQ) Among Optometrists in Malaysia.

Visual impairment and vision loss are preventable or treatable if there is access to eyecare services for early detection and if proper interventions are given.Optometristsplay a vital role in the early detection of eye and visual-related issues.As healthcare professionals, optometrists are trained to provide comprehensive eye and vision care encompassing dispensing and refraction, detection of abnormalities in the vision and eye, and the rehabilitation of conditions of the visual system, as suggested by the World Council of Optometry.In the current practice of primary eye care, optometrists are not fully utilized and are mostly restricted to refractive correction. Therefore, the optometrists' practice level, scope, and challenges to practice primary eye care must be identified before strengthening optometrists' role in the community. The present study aimed to develop and validate a questionnaireto determine the contributing factors and challenges to the practice of primary eye care by optometrists in Malaysia. The Primary Eye Care Questionnaire (PECQ) was developed through an extensive literature search to identify the domains and to construct the items. The items were then scrutinized further through focus group discussions with experts (n = 10) from various sectors of eye care. Content validation was conducted with ophthalmologists and optometrists as panels (n = 10), followed by face validation (n = 10) by optometrists from the public and private sectors. Construct validation was performed with exploratory factor analysis and reliability was evaluated by using Cronbach's alpha coefficient and the test-retest reliability. In total, the PECQ questionnaire was constructed with 123 itemsunder three main domains: contributing factors, challenges, and continuous education. The content validity index (CVI) for each item (I-CVI) score ranged from 0.9 to 1.0 for each item and the CVI for average scale (S-CVI/Ave) was above 0.8 for each domain, with internal consistency of 0.948 and Cronbach's alpha coefficient of 0.971. The PECQ is a valid and reliable tool for assessing the optometrists' scope of practice, challenges, and contributing factors to the practice of primary eye care.

Discovering down's syndrome: An account from A low middle income country.

This study aims to establish the frequency of Down's syndrome which will enhance the knowledge of our local population as well to understand our genotypic patterns and variations. Electronic Medical Records of inborn babies at the Department of Neonatology, Sheikh Saeed Memorial Campus of The Indus Hospital Karachi during the study period from 1st January 2021 to 31st December 2022 were retrieved. Chromosomal karyotyping was done for all babies with suspicious clinical features identified on routine new born examination by consultant neonatologists, trainee doctors and experienced nurses. There was a total of 7,433 live births during the study period, out of which 14 babies had features suggestive of DS. repetition of sentence. What about karyotyping result?? The frequency of DS in our study is slightly higher than the incidence reported within South East Asia. It is high time to perform effective antenatal screening and efficient prenatal diagnostic services for early detection of chromosomal numerical aberration such as Down syndrome for better management of upcoming pregnancies.

Individualized pretest risk estimates to guide treatment decisions in patients with clinical high risk for psychotic disorders

IntroductionClinical high risk for psychosis (CHR) states are associated with an increased risk of transition to psychosis. However, the predictive value of CHR screening interviews is dependent on pretest risk enrichment in referred patients. This poses a major obstacle to CHR outreach campaigns since they invariably lead to risk dilution through enhanced awareness. A potential compensatory strategy is to use estimates of individual pretest risk as a ‘gatekeeper’ for specialized assessment. We aimed to test a risk stratification model previously developed in London, UK (OASIS) and to train a new predictive model for the Swiss population. MethodThe sample was composed of 513 individuals referred for CHR assessment from six Swiss early psychosis detection services. Sociodemographic variables available at referral were used as predictors whereas the outcome variable was transition to psychosis. ResultsReplication of the risk stratification model developed in OASIS resulted in poor performance (Harrel's c=0.51). Retraining resulted in moderate discrimination (Harrel's c=0.67) which significantly differentiated between different risk groups. The lowest risk group had a cumulative transition incidence of 6.4% (CI: 0–23.1%) over two years. ConclusionFailure to replicate the OASIS risk stratification model might reflect differences in the public health care systems and referral structures between Switzerland and London. Retraining resulted in a model with adequate discrimination performance. The developed model in combination with CHR assessment result, might be useful for identifying individuals with high pretest risk, who might benefit most from specialized intervention.

Community Pharmacists' Readiness for Breast Cancer Mammogram Promotion: A National Survey from Jordan.

Mammography is the gold standard screening technique for early detection of breast cancer. This study aimed to assess the knowledge of community pharmacists of different aspects emphasized by the JBCP programs. This study also identifies the attitudes and barriers towards promoting early detection services. This study was a cross-sectional survey of community pharmacists in Jordan. Pharmacists were randomly selected and asked to complete an electronic questionnaire. Inclusion criteria: a pharmacist with a bachelor's degree or higher and registered at the JPA working in a community pharmacy. The questionnaire included demographic and socioeconomic information, knowledge, attitudes towards breast cancer screening mammography services, and barriers towards participation in the promotion of these services. A total of 1,088 community pharmacists were approached, 1,000 (91.8%) completed the questionnaire. Participants had an average age of 34 years ± 10.8 and average experience of 9.1 ± 9.5 years. Only 48 (37.8%) of the female pharmacists aged 40 years or older underwent a mammogram. Knowledge of symptoms of breast cancer was the highest with a score of 755, followed by knowledge of risk factors (670) and finally early detection of breast cancer (540). Many barriers were reported by the community pharmacists including lack of educational materials and time constraints. Pharmacists with higher educational levels (p<0.001), of female gender (p<0.001), attended continuous cancer-related education (p<0.001), encountered a higher percentage of female customers (p<0.001), in a certain geographic location (p=0.003), underwent mammography (p=0.014), and encountered high frequency of inquiries on mammogram by the customers (p<0.001) were all associated with higher knowledge scores. Despite the reported barriers and insufficient knowledge in certain aspects of early detection of breast cancer, community pharmacists have positive attitudes and can be a valuable asset for awareness-raising efforts.

Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries.

The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.

Factors Related to The Utilization of Integration Health Program (Posbindu) Among Older Adults in Indonesia: A Scoping Review.

Indonesia is experiencing an increase in the elderly population, which is a challenge for health services. One of the health programs specifically designed for older people is the integration health program, known as "Posbindu". Posbindu is a community-based health service that provides health promotion, disease prevention, and early detection services for the elderly. However, its utilization has not been maximized, so a study was conducted to analyze the factors related to the utilization of Posbindu in Indonesia. The research design used a scoping review and data analysis narrative approach. The researcher searched articles using the PCC framework, with the elderly as the population (including pre-elderly), the factors as concept, and the context as utilization of Posbindu. It used Indonesian and English keywords in the Google Scholar, Pubmed, ProQuest, and Researchgate databases. Then, the article selection process used the PRISMA-ScR flow chart, and 201 articles were obtained that matched the inclusion criteria, 192 articles, and the final result was nine articles were analyzed. The results of the article analysis showed that the average value of older people's participation in Posbindu was 47.51%, which means it did not reach the target. Factors related to this are predisposition factors found in eight articles (intentions, knowledge, attitudes, education, traditions, beliefs, and control over actions), enabling factors in five articles (distance to Posbindu, access to information, and quality of Posbindu for older people), and reinforcing factors in seven articles (family support and health voluntary support). From all p-values for these factors, the most strongly related to Posbindu for the elderly was reinforcing elements, with a p-value of less than 0.03 in all analyzed articles. So, it can be concluded that the reinforcing factor is the most related to the utilization of the elderly Posbindu. So, it is crucial to involve all sector to increase the participation of older people in Posbindu program.

Risk Factors of Chronic Kidney Disease Among Patients Attending at Dessie Comprehensive Specialized Hospital, Dessie, Amhara Region, Northeastern Ethiopia: Unmatched Case–Control Study

Introduction: The incidence of chronic kidney disease is rising, primarily due to its asymptomatic nature of the disease and poor access to early detection and management services. In Ethiopia, little is known about the context-specific risk factors. This study aimed to identify the risk factors of chronic kidney diseases in Northeast Ethiopia, focusing on patients attending Dessie Comprehensive Specialized Hospital, in 2022. Methods: A hospital-based unmatched case-control study was employed among chronic kidney disease patients at Dessie Comprehensive Specialized Hospital, from May 10 to July 15/2022. Cases were all patients who were diagnosed with chronic kidney diseases at Dessie Comprehensive Specialized Hospital while controls were patients without chronic kidney diseases. For each case, two controls were selected using a systematic random sampling technique. A semi-structured interviewer-administered questionnaire with the support of a document review was used to collect the data. The data were entered into Epi data version 4.6 and exported to Stata version 14 software for analysis. During bivariable logistic regression analysis, variables having p-value &lt;0.2 were entered and analyzed by multivariable logistic regression analysis to identify risk factors associated with chronic kidney diseases. Statistical differences were considered at P &lt; 0.05, and the strength of association was assessed by adjusted odds ratio and respective confidence intervals. Results: A total of 78 cases and 156 controls were included in this study. This study revealed that factors such as being male [AOR: 2.54, 95%CI (1.125- 5.754)], the presence of hypertension [AOR: 5.33, 95%CI (2.107-13.489)], diabetic-mellitus [AOR: 3.64,95%CI (1.530- 8.671)], kidney stone [AOR: 3.91,95%CI (1.492- 10.257)], and underground water source usage [AOR: 2.63,95%CI (1.108-6.262] were statistically significantly associated factors with chronic kidney diseases. Conclusion: In our study, being male, the presence of hypertension, diabetic mellitus, diagnosis of a kidney stone, and underground water usage were independent risk factors for chronic kidney diseases. Therefore, policymakers, healthcare providers, and other stakeholders should emphasize the aforementioned factors to forestall the development and progression of the disease. Furthermore, routine urinalysis and glomerular filtration rates for all hospitalized patients with hypertension and diabetes-mellitus could help to detect chronic kidney diseases at an early stage.

Healthcare professionals’ perspectives on the key considerations for digital technology aiding the early detection of dementia-causing diseases: a qualitative approach

Abstract Introduction Digital health technologies (DHTs) can assist with the early detection of dementia-causing diseases.(1) Previous research has highlighted the benefits of involving health care professionals (HCPs) in their design and development.(2) Aim Explore HCPs’ perspectives on the key considerations when using DHTs for the early detection of dementia-causing diseases in healthcare settings. Methods HCPs in the National Health Service with a patient-facing role (independent of speciality or experience) were recruited using online clinical networks. Semi-structured interviews were conducted remotely (over Zoom) exploring their acceptance of DHTs and providing an early detection service, the optimal location for the service, and the challenges surrounding implementation. With the aid of NVivo, we applied an inductive framework approach using the ‘constant comparison’ to identify recurring themes in the data. Results Primary care (general practitioners [n=11]) and secondary care staff (mental health nurses [n=3], dementia specialist nurse [n=1], psychiatrist [n=1], community psychiatric nurse [n=1], care coordinator [n=1]) were interviewed. Three key themes were generated relating to healthcare service users, healthcare professionals, and DHTs (Table 1). HCPs stressed the importance of defining a target healthcare service user group to avoid wasting resources and avoiding contributing towards health inequities in terms of access to the service and post-detection care. Brain Health Centres, which use a combination of clinical and research methods for early detection, were favoured over traditional primary or secondary care settings, due to workload concerns. HCPs suggested training be provided to help interpret results and provide appropriate interventions post detection. Many HCPs were excited about the benefit of collecting longitudinal real-time data that could monitor patients over time but raised concerns around the accuracy of current digital tools. Conclusion Results highlighted important considerations for HCPs when developing and implementing DHTs to aid the early detection of dementia-causing diseases in clinical settings. Participants had an interest in older people’s health, dementia, mild cognitive impairment or digital health, which may have influenced their perspectives; however, our work shows DHTs should not contribute towards health inequities. Future work is needed to explore the perspectives of groups experiencing health inequities within the design, development and implementation of DHTs.

Pathways to care in youth and young adults at clinical high risk for psychosis in Switzerland: Current situation and clinical implementation of the PsyYoung project.

We aim to give an insight into the current situation in Switzerland concerning the pathways to care of young people with clinical high risk of psychosis. In a second step we propose a procedure of optimizing pathways to care developed within the project PsyYoung. A qualitative survey derived and adapted from Kotlicka-Antczak et al. (2020) was conducted in large early detection services of three Swiss cantons (Geneva, Basel-Stadt, Vaud) focusing on pathways to care. More specifically, using questionnaires delivered to the heads of participating services, information was collected on referral sources, on activities to implement outreach campaigns and on the use of a pre-screening tool. Main results on referral source indicated that sources were variable but seemed to come primarily from the medical sector and more so from the psychiatric sector. Very few referrals came from non-medical sectors. Outreach activities included the contact to other clinics as well as through brochures and posters. All services but one used the Prodromal Questionnaire - 16 as pre-screening tool. All in all, the results indicate a referral and care pathway system implemented mostly within the medical and particularly mental health sector. Accordingly, the PsyYoung project proposes a procedure for pathways to care which could help overcome the obstacle of referrals being restrained to a narrow field of mental health and to harmonize the referral process within services dedicated to the same aim of helping young people at high risk of developing a psychosis.

Lessons From the Design and Rollout of an Electronic Medical Record System for Cervical Cancer Screening in Rwanda.

In its commitment to delivering comprehensive women's cancer early detection services, the Rwanda Ministry of Health rolled out a new cervical cancer screening program. The paper-based medical record system that tracked clients at different points in the continuum of cervical cancer care had challenges with storing data, accessing client information for follow-up visits, and fragmenting information on individual clients. To support the rollout of the new cervical cancer screening program, a new electronic medical record system was designed and implemented to ensure clients were followed along the complete continuum of care. We document the development and implementation of the electronic medical record system and highlight challenges and lessons learned during implementation. Implementation took a participatory approach to ensure that the electronic medical record system was efficient in tracking clients along the continuum of care. At every stage, a wide range of stakeholders were engaged, including clinicians, program managers, and software developers. Health facility visits and conversations were conducted with health care providers and data managers to review the existing system and ensure that the design and development of the electronic record system were suitable for the context in which it would be used. Cervical cancer screening sites are currently using the electronic medical record system to document client information and track women along the continuum of care to reduce loss to follow-up. The system has been rolled out to all newly activated screening sites as part of national scale-up. Planning, collaboration, and adaptability were the key factors in this system's successful rollout and should be the foundation of future data systems development.

Influence of Clinical and Demographic Variables 0n the Quality of Life in Patients with Cervical Cancer

Background: Cervical cancer remains a significant public health issue, particularly in low- and middle-income countries, where it disproportionately affects women's quality of life (QoL). Understanding the impact of clinical and demographic variables on the QoL of patients with cervical cancer is crucial for improving care and support strategies. Objective: This study aims to assess how clinical and demographic factors influence the QoL of Pakistani women diagnosed with cervical cancer, comparing these findings against established benchmarks for both healthy individuals and those with malignancies. Methods: Conducted at a leading cancer centre in Pakistan from April to September 2022, this cross-sectional study involved 186 women with histopathologically confirmed cervical cancer, identified through a population-based cancer database. QoL was evaluated using the Organization for Research and Treatment of Cancer QLQ-C30 (Version 3.0) questionnaire, encompassing functional scales, symptom scales, single-item scales, and a global health status score. Data analysis was performed using SPSS version 25, applying logistic regression to identify factors significantly associated with QoL outcomes. Results: The median global health status score for enrolled patients was 50.0 [interquartile range (IQR) 33.3 - 66.7], significantly lower than the reference values for healthy females (58.0 [IQR 41.3 - 82.7]) and those with any malignancy (71.0 at age 55). Functional scale scores indicated compromised physical (65.7 [IQR 60.0 - 75.0]) and social (67.7 [IQR 56.0 - 100]) functioning. Symptom scale scores revealed high levels of pain (84.3 [IQR 65.7 - 84.3]) and fatigue (78.8 [IQR 55.7 - 88.7]). Regression analysis highlighted age and education level as significant predictors of physical health outcomes. Conclusion: The study underscores the profound impact of cervical cancer on the QoL of Pakistani women, with age and education level emerging as key determinants. These findings call for tailored interventions to address the specific needs of this patient population, emphasizing the need for early detection and comprehensive support services.

Research Implementation of Special Detection Elementary School Service For Children with Special Needs in Banjarmasin

In order to shape the abilities and character of children with special needs, it is essential to provide early detection services in public elementary schools. This study, conducted in Banjarmasin, Kalimantan, examined six inclusive elementary schools with 102 children with special needs and 82 special assistant teachers. Using a descriptive qualitative approach with additional quantitative data collection through observations, interviews, and documentation, the study found that some public schools have implemented detection services for children with special needs. Special assistant teachers and coordinators were provided to supervise and support the activities of these children at school. The study concluded that detecting and providing services for children with special needs at an early stage is crucial as elementary school is the foundation for personality development. This is in line with the universal values and religious perspectives that every child has the right to equal education

The role of clinical breast examination and fine needle aspiration cytology in early detection of breast cancer: A cross-sectional study nested in a cohort in a low-resource setting.

Breast cancer is prevalent worldwide, with disparities in screening, diagnosis, treatment outcomes, and survival. In Africa, the majority of women are diagnosed at advanced stages, affecting treatment outcomes. Screening is one of the best strategies to reduce mortality rates caused by this cancer. Yet in a resource-constrained setting, there is limited access to screening and early detection services, which are available only at a few referral hospitals. We aimed to evaluate the prevalence and screening results of breast cancer using clinical breast examination coupled with fine needle aspiration cytology in a resource-constraint setting. A combined cross-sectional and cohort study. Women at risk of developing breast cancer in the Kilimanjaro region of Tanzania were invited, through public announcements, to their primary healthcare facilities. A questionnaire was used to assess the participants' characteristics. The women received a clinical breast examination, and detectable lesions were subjected to a confirmatory fine needle aspiration cytology or an excisional biopsy. Preliminary data from this ongoing breast cancer control program were extracted and analyzed for this study. A total of 3577 women were screened for breast cancer; their mean age was 47 ± 7.53 years. About a third of them (1145, 32%) were practicing self-breast examination at least once a month. Of 200 (5.6%) with abnormal clinical breast examination, 18 (9%) were confirmed to be breast cancer, making the prevalence to be 0.5%. The vast majority of participants with breast cancer (13, 72.2%) had early disease stages, and infiltrating ductal carcinoma, no special type, was the most common (15, 83.3%) histopathology subtype. Hormonal receptor status determination results indicated that 11 (61.1%), 7 (38.9%), and 5 (27.8%) of the tumors overexpressed estrogen receptor, progesterone receptor, and human epidermal receptor-2, respectively. Our study demonstrates 5.6% of Tanzanian women have abnormal clinical breast examination findings, with 9% having breast cancer. Nearly three-quarters (72.2%) of breast cancer screened for early disease were detected in the early disease stages. This finding suggests that organized screening with clinical breast examination coupled with fine needle aspiration cytology, which is a simple and cost-effective screening method, has the potential to improve early detection and outcomes for breast cancer patients in a resource-constraint setting.

Prevalence, Etiology, and Impact of Hearing Loss in Pediatric Populations: A Multicenter Study in Rural Sub-Saharan Africa

This multicenter study delves into the prevalence, etiology, and impact of hearing loss among pediatric populations in rural Sub-Saharan Africa over recent decades. Drawing on a diverse array of healthcare facilities, the research incorporates a comprehensive methodology, including diagnostic tools, genetic testing, and interviews, to unravel the complexities of this often-overlooked health concern. The findings reveal a substantial prevalence of pediatric hearing loss, with infants and toddlers being particularly vulnerable. Genetic factors, infectious diseases, and environmental influences emerge as significant contributors, underlining the intricate interplay of genetic predispositions and external factors. The impact of hearing loss on affected children is profound, affecting psychosocial, educational, and developmental domains. The study emphasizes the urgent need for targeted interventions, early detection, and community-based support services. This research not only advances our understanding of pediatric hearing loss in rural Sub-Saharan Africa but also advocates for the development of context-specific interventions to improve the lives of affected children and their families.

P195: The evolution of a community mental health team in Singapore: Community Psychogeriatric Programme

Mental health issues in the elderly were often overlooked in the past, with mental illness often being underdiagnosed, undiagnosed or misdiagnosed. As such, mental healthcare in the elderly was often insufficient, leading to significant adverse outcomes in individuals and caregivers, as well as an added burden to the healthcare system.The Community Psychogeriatric Programme (CPGP) was set up in Changi General Hospital in 2007 to serve the Eastern Region in Singapore. CPGP comprises of a multidisciplinary team of psychiatrists, psychologists, nurses, medical social workers, occupational therapists, a physiotherapist and administrative executives. The programme objective is to provide community mental health services for early detection and treatment of psychogeriatric disorders and to allow aging-in-place within the community. This is achieved through collaborating with social and healthcare agencies, as well as caregivers, to meet the needs of the elderly to maintain them in the community for as long as possible.Over the past 16 years, the proportion of Singapore’s population aged 65 and above have grown, mental health literacy in Singapore has improved, and community mental healthcare providers have increased. CPGP’s community partnerships multiplied, including social eldercare agencies such as dementia daycare centres, general medical practitioners in Primary Care Clinics and Community Hospitals, and residential facilities such a sheltered homes and nursing homes. The CPGP team pivoted to focus more heavily on networking with community partners, training and upskilling them with knowledge of geriatric mental healthcare and empowering them to provide care and support in the community setting. The goal was to right-site care, promoting early detection and intervention in the community. Home based consultations or nursing home consultations, including telepsychiatry, were reserved for elderly patients who really could not access specialist psychogeriatric outpatient services in the hospital.Looking back on the work CPGP has done, this is a reflection of our journey, reviewing the strategies we have employed to improve community psychogeriatric care, our achievements thus far, and the challenges we have been faced with as the healthcare landscape evolved in Singapore.

Investigating the levels of depression, anxiety, sexual disorders, and other influencing factors in breast cancer patients: Turkish radiation oncology integrative group study (12-05).

The fear of death associated with cancer and the side effects of its treatments can have a detrimental psychological impact on breast cancer patients. Early detection and support services play a crucial role in alleviating the expected symptoms of depression, anxiety, and sexual dysfunction. The objective of our study is to assess the levels of depression, anxiety, and sexual dysfunction in breast cancer patients, as well as identify the factors that influence these conditions. The study involved 329 voluntarily participating breast cancer patients who had undergone surgery and were in the follow-up stage. Data were collected from 8 different centers after obtaining ethical approval. The assessment utilized tools such as the Sociodemographic Information Form, Beck Depression and Anxiety Scale, and Arizona Sexual Experiences Scale. Data analysis was performed using SPSS 20. The study included 329 breast cancer patients in the follow-up stage post-surgery. Their average age was 52.7 years (range: 27-83). Results indicated that 33.1% experienced moderate to severe depression, 18.2% reported severe anxiety, and 82.7% scored above 11 on the sexual scale. Factors linked to higher scores were mastectomy, surgical dissatisfaction, insufficient information on sexual side effects, and comorbidities like smoking and diabetes. The study emphasizes the importance of closely monitoring anxiety, depression levels, and sexual side effects in breast cancer treatment. It underscores the need to focus not only on reducing mortality rates but also on supporting patients' psychological and sexual well-being, ultimately improving their overall quality of life.

Students Health Services in Israel from the Parents’ Point of View: Mixed-Methods Study

Abstract Background Student Health Services (SHS) are provided by school nurses to 1st to 9th-grade pupils in Israel. The nurse's role is to provide early detection and prevention services. SHS is provided by the Ministry of Health (MOH) or through outsourcing. Aim To examine parents’ knowledge, attitudes, and satisfaction with SHS; and the differences in these measures when the services are provided by the MOH vs. outsourced organizations. Methods This study combines mixed methods, including a quantitative cross-sectional study among 506 parents and a qualitative study that included interviews with ten parents (upon reaching saturation). The research questionnaires were distributed via social media as well as through the National Parents’ Leadership organization. The interviewees were recruited from among the quantitative study participants. Findings The findings of the quantitative and qualitative studies support each other. Sixty-five percent of the parents responded that there is no school nurse or that they do not know whether or not there is one. Only 13.4% believe that the school nurse is available to answer their questions. The parents’ knowledge level regarding the school nurse's role was intermediate (an average of 4.44 on a scale of 0-9). However, their attitudes support the importance of the nurse's role. Age, socio-economic status, and trust significantly predict parents’ satisfaction. The older the parents and the higher their socio-economic status is, the lower their chance of being satisfied with the school nurse's role. In addition, the higher the parents’ level of trust in the nurse, the higher the chance they will be satisfied. No significant differences were found when comparing the MOH and outsourced organizations. Conclusions Many parents are unaware of the nurse's existence and are insufficiently informed regarding her role or how to contact her. However, many feel the role is essential, necessary, and should be improved. Key messages • It is important to promote a public participatory process of parents, pupils, school staff and healthcare professionals in order to improve SHS and the way it's provided. • Parents-nurse-students relationship and communication must be improved in order to ensure parents’ cooperation and pupils’ health.

EHDI Services should be accessible! caregivers’ expectations of EHDI services in South Africa

ABSTRACT Progress of Early Hearing Detection and Intervention (EHDI) services within the South African context lags behind that made by high-income countries internationally. Implementation of EHDI services in this context faces many challenges that underscore the need to ensure contextualized intervention approaches that meet the needs of South Africa’s linguistically and culturally diverse population. The aim of the current study was to describe caregivers’ expectations of EHDI services, and to evaluate the success and/or failure of the EHDI services in relation to these expectations. To achieve this aim, in-person, telephonic and videoconferencing narrative interviews were conducted with nine caregivers of children who are Deaf-or-Hard-of-Hearing (DHH), and analysed through reflexive thematic analysis. The following themes and sub-themes emerged from the narrative interviews: (1) expectations of the EHDI process (‘early detection of hearing loss and ‘EHDI should be accessible’), and (2) expectations for the outcomes of EHDI services (‘age-appropriate acquisition of spoken language’, ‘mainstream education’, and ‘further education and independence’). These themes speak to concerns with the entire EHDI process from detection to intervention, including continuity of care. In order to ensure effective and sustainable EHDI services within the South African context; caregivers’ expectations should be used to inform service provision and to guide best practice. Furthermore, these findings suggest a need to implement wide spread, integrated, and inter-disciplinary EHDI services that are linguistically and culturally responsive and relevant; with caregivers and families forming a crucial part of the programmes.

Head and neck cancer burden in India: an analysis from published data of 37 population-based cancer registries.

Head and neck cancer (HNC) is a major public health problem in India. This article presents the HNC burden in different regions of India. The published population-based cancer registries (PBCRs) data from the National Cancer Registry Programme, Bengaluru, and the Tata Memorial Centre, Mumbai, India, were utilised. The 37 PBCRs were divided into six regions including central, east, north, northeast, west and south. The age-standardised incidence rate of HNC was 25.9 (95% CI 25.7-26.1) and 8.0 (95% CI 7.9-8.1) per 100,000 population, respectively, in males and females. HNC accounted for about 26% of all cancer cases in males and 8% in females. The risk of developing HNC was 1 in 33 for males and 1 in 107 for females. The northeastern registries reported the highest incidence rate 31.7 per 100,000 population in males followed by northern (28.5), central (28.3), western (24.4), southern (23.9) and eastern (18.3). In females, the incidence was in the range of 6.2-10.1 per 100,000 population. For all PBCRs together, the HNC burden was two to three times higher in the age group 60+ as compared to 20-39 years. The HNC burden in India is higher than in the USA, UK, Australia, Africa and Brazil. The PBCRs from the south-east Asia region such as the Colombo district, Sri Lanka, as well as Siraha, Saptari, Dhanusha and Mohattari - Nepal have also reported a high burden of HNC. All regions reported mouth as a leading cancer site followed by tongue, larynx, hypopharynx and tonsil except the northeastern region registries where hypopharynx was the top leading cancer. The burden of other sites of HNC is low. Raising awareness of the disease and associated risk factors, providing early detection services, as well as easy access to diagnosis and treatment are required. The government should focus on building the infrastructure and capacity building to control this disease.