Health Disparity in Effective Cervical Cancer Screening: Findings from a National Survey of U.S.

Background: Cervical cancer is one of the most common causes of cancer death for women, but it can often be detected early and sometimes even prevented entirely by having regular tests. An effective way to prevent cervical cancer is to have screening tests. Even though cervical cancer screening programs are implemented in many countries and regions especially in developed countries, cervical cancer incidence has not been effectively controlled and there is still certain health disparity in the population. Inappropriate screening frequency may be the cause of the health disparity. Methods: Drawing on the data from the 2017 Health Information National Trends Survey (Cycle5.1), a national survey conducted by the National Cancer Institute (NCI), we characterized cervical cancer screening (CCS) as two dimensions by the item of screening frequency, namely, active screening and effective screening. We compared the differences between these two screening behavior applying ordered logistic regression and binary logistic regression, and explored the mechanisms of effective screening. Results: The impact factors differed between active screening and effective screening based on theory. Only self-efficacy (β=0.16, p=0.023) had a positively significant association with active screening behavior and both online health information seeking (β=-0.102, p<0.001) and social media participation (β=-0.466, p=0.001) negatively and significantly influenced effective screening behavior. Second, a theory-based mechanism of effective screening behavior found that traditional health perception factors no longer influence effective screening behavior, while environmental factors (social media) significantly reduce women's effective screening. In addition, the higher the level of education, the less inclined to conduct effective screening, but the more inclined to active screening for cervical cancer. Conclusions: Our results indicate that while the Internet has become the main channel through which women acquire health resources, and social media has become a main platform for people to obtain health information, online information cannot guide people to engage in appropriate healthy behaviors. Overloading of online health information and digital divide may cause excessive screening or screening avoidance. Consequently, we must pay attention to the health disparity caused by unreasonable health behaviors caused by factors such as environmental factors and the divide in the use of IT.

107 Improving Frailty Screening and Accuracy in the Emergency Department (Ed) of A Busy District General Hospital

Background Over 20,000 75+ years attendances annually in ED with frailty screening in introduced in ED in 2016. Early recognition of frailty is recommended. Accurate estimation of frailty level is important as it contributes to clinical pathway and management. Introduction Screening rates had fallen and there were concerns about the accuracy.. Our aim was increased frequency and accuracy of screening at triage. Method Frailty screening rates for patients aged 75+ years attending the ED (routine measure) reviewed with ED Frailty Lead. Stakeholder engagement with ED staff and Frailty and Interface Team (FIT). Frailty screening tool revised. Data review March 2020 focused on CFS accuracy (CFS at triage v CFS by FIT in routine assessment). Sampling approach to CFS accuracy during June 2020. Interventions Small group sessions with ED nursing staff (Jan 2020). Revised electronic screening tool introduced (February 2020). Education sessions (x2) for ED nursing staff (June 2020) focused on CFS. Results Frailty screening increased significantly following revised screening tool introduction from 60% to &gt;80%. In March 2020 agreement of CFS at triage and FIT review in 22% (76/341). The CFS reliability for 10 consecutive patients per day was measured in June 2020 before and following 2 education sessions held on CFS. The reliability of CFS was 0.23 prior to teaching in June and rose to an average of 0.31 following the teaching intervention. Conclusions Frailty screening frequency and the reliability of the CFS improved following teaching interventions but remains low. Work is continuing to focus on improving this further. Although CFS has been found to be reliable between raters in other hospitals we have found this difficult to replicate. It is not known if this is due to local factors or to more common challenges that others may face in CFS estimation by ED staff.

Women’s Views on Multifactorial Breast Cancer Risk Assessment and Risk-Stratified Screening: A Population-Based Survey from Four Provinces in Canada

Risk-stratified screening for breast cancer (BC) is increasingly considered as a promising approach. However, its implementation is challenging and needs to be acceptable to women. We examined Canadian women’s attitudes towards, comfort level about, and willingness to take part in BC risk-stratified screening. We conducted an online survey in women aged 30 to 69 years in four Canadian provinces. In total, 4293 women completed the questionnaire (response rate of 63%). The majority of women (63.5% to 72.8%) expressed favorable attitudes towards BC risk-stratified screening. Most women reported that they would be comfortable providing personal and genetic information for BC risk assessment (61.5% to 67.4%) and showed a willingness to have their BC risk assessed if offered (74.8%). Most women (85.9%) would also accept an increase in screening frequency if they were at higher risk, but fewer (49.3%) would accept a reduction in screening frequency if they were at lower risk. There were few differences by province; however, outcomes varied by age, education level, marital status, income, perceived risk, history of BC, prior mammography, and history of genetic test for BC (all p ≤ 0.01). Risk-based BC screening using multifactorial risk assessment appears to be acceptable to most women. This suggests that the implementation of this approach is likely to be well-supported by Canadian women.

Breast cancer and breast self-examination awareness among undergraduate students of the University of Bamenda, Cameroon

Background: Breast self-examination (BSE) is an individual check-up to identify any health problem in the breast, especially breast cancer. However, though the university is the place of high education, the level of the student knowledge about breast cancer and BSE remains not quite known. This study aimed to identify awareness on breast cancer and BSE among the student population of The University of Bamenda, Cameroon.Methods: A well designed descriptive study was carried out using a structured questionnaire to look at the awareness about breast cancer, its possible risk factors, signs and symptoms as well as the awareness on BSE among the students.Results: Out of the studied population of 255 participants who completed the questionnaire, a good portion (91.76%) of the respondents have heard about breast cancer. Only 38.43% respondents knew some signs and symptoms of breast cancer while 44.31% had an idea of the treatment. The population pointed alcohol consumption and smoking, use of contraceptives and exposure to pesticides as possible risk factors of breast cancer. BSE was practiced by only 23.92% and only 20.39% of the participants suggested a monthly screening frequency. Across age ranges, 20 to 24 years old and 25-29 years old participants had almost 5 times more chances to have heard about BSE than younger people.Conclusions: Summarily, the present study demonstrated that the general had poor knowledge of the signs and symptoms of breast cancer and the BSE practice, though the population aged 20-29 years old has relatively heard about breast cancer and BSE.

Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?

Background A consensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of CRE bloodstream infection (BSI). Methods We retrospectively studied the clinical data of 395 consecutive HSCT patients from September 2017 to April 2019. From September 2017 to June 2018 (period 1), 200 patients received single CRE screening before transplantation. From July 2018 to April 2019 (period 2), 195 patients received continuous weekly CRE screening after admission. For patients colonized with CRE, targeted managements were received: (1) contact precautions and (2) preemptive CRE-targeted treatment if necessary. Results During period 1, 3 patients with CRE colonization were detected (1.5%). The CRE BSI rate was 2.0% (4 patients), and the related 30-day mortality was 50.0% (2 out of 4 patients). During period 2, 21 patients with CRE colonization were detected, and the detection rate was significantly higher than that in period 1 (P<0.001). Of the 21 colonized patients, 4 (19.0%) patients were identified as positive for CRE at the first screening, 5 (23.8%) were identified at the second screening, and the remaining 12 (57.1%) were identified at the third or later screening. The CRE BSI rate decreased to 0.5% (1/195), and there were no CRE-related death. Fifteen colonized patients developed neutropenic fever. Thirteen colonizers were preemptively treated with tigecycline within 24 hours of fever onset, and they achieved rapid temperature control. One colonizer received tigecycline later than 48 hours after fever onset and ultimately survived due to the addition of polymyxin. The other received tigecycline later than 72 hours after fever onset and died of septic shock. Conclusion The increase in screening frequency contributed to the detection of patients with CRE colonization. Targeted managements for these colonized patients may contribute to reducing the incidence and mortality of CRE BSI, therefore improving the prognosis of patients.

Different screening frequency of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?

BackgroundConsensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of severe CRE infection. However, there is no standard for effective screening and relevant studies has been fewer reported, especially for hematopoietic stem cell transplantation (HSCT) population. Methods We retrospectively studied the clinical data of 395 consecutive HSCT patients admitted in our center from September 2017 to April 2019 during two periods, single screening and continuous screening. During period 1 (September 2017 to June 2018), 200 patients received single stool CRE screening within one week before transplantation. During period 2 (July 2018 to April 2019), we implemented continuous weekly stool CRE screening after admission. For patients colonized with CRE, target management were received:(1) contact precaution;(2) preemptive CRE-targeted treatment if necessary. Results During period 1 , three patients with CRE colonization were detected (1.5%). The BSI percent of CRE was 2.0% (4 patients) and related 30-day mortality was 50.0% (2 out of 4 patients). During period 2, twenty-one patients with CRE colonization were detected and the detection rate was significantly higher than that in period 1(P<0.001). The CRE BSIs rate decreased to 0.5% (1/195) and there was no CRE-related mortality. Conclusion The increase of screening frequency contributed to the detection of patients with CRE colonization. Targeted management for these colonized patients may contribute to reduce the incidence and related mortality of CRE bloodstream infection, therefore improving the prognosis of HSCT patients.

Frequency of Screening and SBT Technique Trial - North American Weaning Collaboration (FAST-NAWC): a protocol for a multicenter, factorial randomized trial

Rationale In critically ill patients receiving invasive mechanical ventilation (MV), research supports the use of daily screening to identify patients who are ready to undergo a spontaneous breathing trial (SBT) followed by conduct of an SBT. However, once daily (OD) screening is poorly aligned with the continuous care provided in most intensive care units (ICUs) and the best SBT technique for clinicians to use remains controversial. Objectives To identify the optimal screening frequency and SBT technique to wean critically ill adults in the ICU. Methods We aim to conduct a multicenter, factorial design randomized controlled trial with concealed allocation, comparing the effect of both screening frequency (once versus at least twice daily [ALTD]) and SBT technique (Pressure Support [PS] + Positive End-Expiratory Pressure [PEEP] vs T-piece) on the time to successful extubation (primary outcome) in 760 critically ill adults who are invasively ventilated for at least 24 h in 20 North American ICUs. In the OD arm, respiratory therapists (RTs) will screen study patients between 06:00 and 08:00 h. In the ALTD arm, patients will be screened at least twice daily between 06:00 and 08:00 h and between 13:00 and 15:00 h with additional screens permitted at the clinician’s discretion. When the SBT screen is passed, an SBT will be conducted using the assigned technique (PS + PEEP or T-piece). We will follow patients until successful extubation, death, ICU discharge, or until day 60 after randomization. We will contact patients or their surrogates six months after randomization to assess health-related quality of life and functional status. Relevance The around-the-clock availability of RTs in North American ICUs presents an important opportunity to identify the optimal SBT screening frequency and SBT technique to minimize patients’ exposure to invasive ventilation and ventilator-related complications. Trial registration Clinical Trials.gov, NCT02399267. Registered on Nov 21, 2016 first registered.

Atrial fibrillation screening with photo-plethysmography through a smartphone camera

Aims This cross-sectional study was set up to assess the feasibility of mass screening for atrial fibrillation (AF) with only the use of a smartphone. Methods and results A local newspaper published an article, allowing to subscribe for a 7-day screening period to detect AF. Screening was performed through an application that uses photo-plethysmography (PPG) technology by exploiting a smartphone camera. Participants received instructions on how to perform correct measurements twice daily, with notifications pushed through the application’s software. In case of heart rhythm irregularities, raw PPG signals underwent secondary offline analysis to confirm a final diagnosis. From 12 328 readers who voluntarily signed up for screening (49 ± 14 years; 58% men), 120 446 unique PPG traces were obtained. Photo-plethysmography signal quality was adequate for analysis in 92% of cases. Possible AF was detected in 136 individuals (1.1%). They were older (P < 0.001), more frequently men (P < 0.001), and had higher body mass index (P = 0.004). In addition, participants who strictly adhered to the recommended screening frequency (i.e. twice daily) were more often diagnosed with possible AF (1.9% vs. 1.0% in individuals who did not adhere; P = 0.008). Symptoms of palpitations, confusion, and shortness of breath were more frequent in case of AF (P < 0.001). The cumulative diagnostic yield for possible AF increased from 0.4% with a single heart rhythm assessment to 1.4% with screening during the entire 7-day screening period. Conclusion Mass screening for AF using only a smartphone with dedicated application based on PPG technology is feasible and attractive because of its low cost and logistic requirements.