bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of occupational therapy on comprehensive care in pediatric oncology.
Authors: Hsueh Hui-Yun 
Published: June 2023

e22018 Background: Children with cancer can experience difficulties in performing and engaging in their usual activities and the families can also experience interruptions to their daily routines as well as family dynamics. Yet, current cancer rehabilitation tends to focus more on the aspect of bodily repair and functional restoration. This study intends to illustrate the impact of occupational therapy approaches that were identified to have positive influence on the children with cancer and their family. Methods: Three cases of children with brain tumor of age 1, 4 and 16 were reviewed and their caregivers were interviewed. Family education on disease progression, caregiver burden, unhealthy caregiving style, and activity participation facilitation, and coping strategies for the teenaged survivor were included in the regular occupational therapy sessions. Results: Of the three cases, two families of the younger clients who later deceased, reported being supported with the occupational therapy service from emotional support to facilitating activity participation. The other case was reported to have resumed activity participation both in the hospital and at home following a client-centered occupational therapy approach. Conclusions: Although it is important to facilitate functional restoration or preservation, it does not facilitate activity participation on children with cancer if psychological and/or contextual factors are not taken into consideration. It is equally important to meet children’s developmental needs and educate their caregiver/family to provide the proper care they need. Coping is required for both child survivor and their caregiver/family. Client-centered approach that is used in occupational therapy can provide comprehensive care to both children and their family in meeting the needs of the child and family and facilitating activity participation.
A multi-component educational intervention for oncologists to improve tobacco cessation treatment among patients with cancer who smoke.
Authors: Jose Thulasee , Ohde Joshua , Warner David O 
Published: June 2023

e22500 Background: Oncologists are change agents to improve tobacco cessation among patients. As part of the National Cancer Institute Cancer Center Cessation Initiative, we established an electronic health record (EHR, Epic)-based "opt-out" approach to refer patients to tobacco treatment specialist without active involvement by oncologists. However, the role of oncologists in contributing to the “opt-out” approach to patients has not been explored. We tested the hypothesis that a multi-component educational program for oncologists would increase the proportion of patients who completed tobacco treatment appointments. Methods: As a quality improvement initiative, oncology providers at the Rochester Mayo Clinic Cancer Center were educated using a multimodal academic detailing approach with group and individual educational sessions. Its effectiveness was tested using a modified step-wedge implementation design. The primary outcomes were patient behaviors that could plausibly be changed by conversations with their provider: the rate at which cancer patients identified as current tobacco users scheduled an appointment in the Nicotine Dependence Center (NDC) (which required active patient involvement), and the rate at which patients scheduled for a NDC appointment completed their appointment. Comparisons were made before, during, and after the education period (from July through Dec 2019) and with a separate group of providers who did not complete education (results examined over a similar time period). Results: Education did not improve outcomes in providers who received education; indeed, the rate of appointment scheduling decreased, although this may reflect other concurrent changes in the referral process (Table). Outcomes were similar between providers who did and did not receive education. Conclusions: Tobacco cessation efforts should be routinely integrated into cancer care to improve outcomes. The “opt-out” program resulted in approximately 1 in 5 cancer patients being seen for tobacco use, but an academic detailing approach designed to equip oncology providers to encourage their patients to complete appointments was not effective. Other approaches are needed to increase the uptake of tobacco treatment in these patients. [Table: see text]
The effect of an ultraviolet photography educational exercise on sunscreen application.
Authors: Young Jade N , Poplausky Dina , Owji Shayan , Lavin Leore , Tai Hansen , Ungar Benjamin , Gulati Nicholas , Ungar Jonathan 
Published: June 2023

e22506 Background: Sun exposure is a known risk factor for skin cancer development. Sun protection factor (SPF) is based on an application of 2 mg/cm2 of facial surface area (FSA). Studies demonstrate that most people do not apply a sufficient volume to achieve the intended SPF, thus overestimating their sun protection. Ultraviolet photography (UVP) is easily performed by placing an inexpensive UV filter over a digital camera lens. Chemical and physical sunscreen appear metallic black and blue, respectively, under UV light, thus helping to visualize sunscreen application. We sought to determine if visualizing application with UVP increases the volume of sunscreen applied and to investigate the effect of demographic factors and sunscreen type (physical and chemical) on the results of the intervention. Methods: Participants were recruited from June to August 2022. Subjects were randomized to either physical or chemical sunscreen for the first round of sunscreen application. Using a mirror, subjects applied sunscreen as they normally would. Subjects were then shown a UV photo that helped visualize the extent of sunscreen application. With a clean face, the process was repeated with the other sunscreen type (physical or chemical), such that each subject applied both types by the end of the study (round 2). Sunscreen bottles were weighed before and after applications to calculate the volume of sunscreen applied. Statistics were performed in RStudio version 1.4.1717, a language and environment for statistical computing. Results: 30 subjects (ages 18 to 88, Fitzpatrick skin type I-V) were enrolled. A greater percentage of participants applied > 2mg/cm2 from round 1 to round 2 (23% vs 36%). Mean application volume significantly increased from round 1 to round 2 (1.46 SD = 0.936 to 2.15 SD = 1.91, p = 0.0256). Subjects in the “chemical first” group applied a greater amount in round 2 (p< 0.001), however the same was not true in the “physical first” group. Mean sunscreen applied did not significantly differ between chemical and physical in round 1 (p = 0.187). There were no significant differences observed in sunscreen application across race, gender, skin type, and age. Conclusions: The volume of application increased during round 2, indicating that UVP may be an effective intervention to increase the volume of sunscreen application. Differences between the chemical first and physical first groups indicate the intervention may be more suited to teach the application of chemical sunscreen, which appears darker on UVP. Lack of difference between sunscreen types in round 1 suggests there was negligible pre-intervention bias in application behaviors. Overall, most subjects applied less than the recommended amount of sunscreen in both rounds, suggesting that additional counseling is paramount to ensuring proper sunscreen utilization among the public to prevent skin malignancy.
A flexible quantitative framework to assess the potential contribution of early cancer detection to improved cancer survival.
Authors: Yu Menggang , Tyson Christopher , Limburg Paul J. , Beer Tomasz M. 
Published: June 2023

e22508 Background: Public health goals often articulate aspirations to improve cancer survival by some pre-specified percentage. Such survival improvements may be achieved through a combination of medical interventions and lifestyle change. Early detection of cancer can contribute to cancer survival improvements. Impact of early detection programs is realized both through innovation driving advances in screening technologies and increased access and adherence with screening tests. We develop a quantitative approach to characterize the magnitude of early detection across multiple cancer types that corresponds to a specified percent improvement in survival. Methods: A matrix equation is developed relating survival and stage shift. The percent of survival improvement is defined a priori as 20% in this case but can be set to other percentages. We populate the matrix equation with incidence and cause-specific survival for 15 cancers by stage at diagnosis from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. We then use linear programming to solve the matrix for all specified cancers simultaneously given a set of constraints formulated to steer the solution towards the least stage shift required to achieve the objective and to partially compensate for length-time bias. Results: Based on our target survival improvement of 20%, three common trends emerged across 14 of the 15 cancer types: first, we see that the bulk of survival improvement can be achieved by detecting most disease prior to stage 4; second, that the remaining survival improvement can be achieved by detecting most cancers just one stage earlier; and third, that stage 1 diagnosis is generally not necessary to achieve reasonable survival improvement goals. The solution revealed lung cancer as the one type that required more aggressive earlier detection than others, an expected result given that lung cancer has both very high incidence and very poor survival. Conclusions: The mathematical framework we develop is very flexible and can be helpful for public health officials and innovators to characterize the contribution that earlier cancer detection can make towards improved cancer survival. Our results suggest that detecting cancer prior to the development of distant metastases, even after progression beyond stage 1, has potential for significant public health benefit. This approach may also be extended to assess the impact that emerging treatment landscapes, coupled with early cancer detection, may have on improved cancer survival.
Mammography in women with sickle cell disease.
Authors: Farooqui Marwah Wafa , Hussain Faiz , Zhang Xu , Haqqani Rayyan , Sung Kaitlin , Saraf Santosh L. 
Published: June 2023

e22509 Background: Sickle cell disease (SCD) is an inherited blood disorder affecting 100,000 people in the US with a median life expectancy of 54 years. As this population ages, it is important to focus on wellness screenings. Literature review has mixed results on the prevalence of malignancies in SCD. Initiation of BC screening is recommended between age 40-50. Patients with SCD have risk factors for breast cancer (BC) including radiation exposure, nulliparity/decreased parity, dense breasts, African American race, lack of physical activity, and use of allogenic Hematopoietic Stem Cell Transplant with total body irradiation and alkylating agent conditioning regimens. This study's purpose is to determine if these patients are being adequately screened and if guidelines for the general population are appropriate for SCD patients given their potential increased risk. Methods: This is a single center retrospective study of women with SCD who are >40 with an encounter between 2018-2022. Data collection included: screening age, recent mammogram date, American College of Radiology (ACR) category for breast density (BD), family history of cancer, type of SCD, menopausal status, and Body Mass Index (BMI). Ordinal logistical regression model was used for statistical analysis. Results: A total of 156 patients were identified and 71% screened for BC; however only 56% had screening in the last 2 years. With a binomial test, the difference between CDC 2019 African American women and SCD regarding screen is not significant (P=1). The average age for screening was 44. Over half of our patients (53%) have dense breasts. Younger age at screen and lower BMI are both related to a higher density score (Table). Conclusions: As per guidelines, breast awareness (age 25) and mammography (age 40) should be offered to ensure early detection in the general population. The question arises if there should be earlier screening with an alternative imaging modality in SCD patients given increased breast density, potential risk factors, and lower life expectancy. However, it is important to consider the risks versus benefits of early screening. Screening can provide better outcomes, as SCD patients might not tolerate standard treatments for advanced disease. Our findings present a new challenge regarding BD. Increased BD decreases the accuracy of mammograms and requires additional imaging. Higher BD is found in younger women with lower BMI, but here fertility may be an additional factor as it differs in patients with SCD. The limitation of our study is that it is a retrospective, single institution study during a pandemic. Future studies are needed to closely examine if SCD patients are at increased risk given density findings and if there is a need for earlier or alternative modality of screening other than mammography. [Table: see text]
Inclusive innovation: World health organization (WHO) task-shifting principles in community health workers living with disabilities through women’s cancer screening in the EMPOWER Program.
Authors: Kanari Catherine , Nyongo Dorothy Ogada , Wambua Jacqueline , Muhanji Raymond 
Published: June 2023

e22512 Background: The W.H.O estimates that people with disabilities make up 15% of the world’s population. In the Horn of Africa (Djibouti, Kenya, Ethiopia & Uganda) there have been several disability inclusion programs in Education, livelihoods and empowerment through the Development Response to Displacement Impacts Project (DRDIP). In Kenya, the Government has continued to leverage on the private sector to accelerate progress towards inclusion. A strategic partnership with Safaricom enabled provision of Assistive devices and medical cover exceptional approval to a tune of USD 223,000 to Persons with Disabilities in the formal and informal economy in Kenya. Women CHVs were selected to reduce cultural barriers because many women in the communities are more comfortable being screened by a fellow woman. Objectives: To identify and deploy women living with disabilities as community health volunteers in the county EMPOWER Clinics; To build capacity of women living with disabilities and enable them to accurately screen for breast and cervical cancer. Methods: A total of 25 women living with disabilities and 7 able-bodied women from Meru and Kisumu counties were selected for the training program through county disability coordinators. The training program consisted of a basic community health volunteer (CHV) module and focused on Breast and cervical cancer awareness topics. The CHVs were equipped with mobile phones with assistive technology (AT) features such as braille keyboards, magnifiers, and text-to-speech technology. The training was delivered through Amref Health Innovations' (AHI) LEAP platform in collaboration with 5 county community health assistants. The CHVs' understanding of the material was evaluated through performance tracking on the LEAP platform. The CHVs were also given regular feedback on their progress, and any areas of difficulty were addressed through additional support and guidance. Results: The trained CHVs demonstrated an increased understanding of breast and cervical cancer screening, as well as the skills necessary to perform medical tactile breast exams. The trained CHVs were then commissioned to be integrated into the community health workforce, with a focus on breast and cervical cancer screening and awareness. Conclusions: The deployment of inclusion-centered learning for women Community Health Volunteers (CHVs) living with disabilities is a promising approach for improving access to health services for this marginalized group. This program provides a model for promoting disability inclusion in health services and underscores the need for continued investment in disability-inclusive programs. The findings of this program can inform the development of similar programs in other regions and contribute to the achievement of universal health coverage and health for all.
Cervical cancer risk factors, knowledge and attitudes towards HPV vaccine among coastal Kenyan women: A prospective cross-sectional survey.
Authors: Omar Abeid Mohamed Athman , Ahmed Zahra Mohamed , Sheikh Raiham , Mohamed Abdurahman Abud , Amoody Fatma Omar 
Published: June 2023

e22515 Background: Cervical cancer is the leading cause of death among women in Sub-Saharan Africa (SSA) despite being a preventable disease. Currently, there is a global rolling out of the human papillomavirus (HPV) vaccine among young girls. However, the knowledge and attitude of Cervical Cancer and the HPV vaccine remain unknown among women in SSA. Methods: We conducted a voluntary cross-sectional survey among adult women attending the cervical and breast cancer screening during Breast Cancer Awareness month in October 2022 at the Coast General Teaching Referral Hospital Regional Cancer Center, Kenya. The demographic, cervical cancer risk factors, knowledge, and attitudes to the HPV vaccine data were collected and analyzed using descriptive analysis. Results: Two hundred and fifty women participated in the survey, of which 48% were native coastal people. Their mean age was 39.3 ±12.4, and the majority (61%) of the participants were married. The most common age onset of sexual intercourse was 21-30 years (50%), followed by 16-20 years (41%), while 7% were virgins, and a quarter (n = 67) reported having multiple sexual partners. Most (90%) of the participants knew screening and early detection of cervical cancer are associated with better survival. Nevertheless, only a third had been screened previously for cervical cancer. Concerning the cause of cervical cancer, half of the patients (n = 126) knew cervical cancer is caused by HPV, and only 45% (n = 111) were aware of the free national HPV vaccination program, with only 5 participants having been vaccinated against HPV. The most commonly sighted reason for not being vaccinated was lack of knowledge of the HPV vaccine's existence (50%), a third was afraid of the vaccine’s side effects, 10% was due to lack of access, and 3%- were due to the vaccine’s age limit. With regards to the willingness to be vaccinated if they had qualified and the HPV vaccine is available for free, only two-thirds were willing to be vaccinated. However, most (90%) would recommend it to young girls. The few who would not recommend the vaccine to young girls were due to fear and lack of knowledge about the vaccine (73%). Conclusions: There is an unmet need for awareness and understanding of the HPV vaccine, and sensitization is needed to improve its uptake. In addition, it will be worth reviewing the age limit of HPV vaccination among Kenyan women as most women are sexually active after 20 years.
Real-world data on survival outcomes and characteristics of lung cancer patients in northern serbia.
Authors: Bokan Darijo , Zaric Bojan , Kovacevic Tomi , Stojanovic Goran , Djekic Malbasa Jelena 
Published: June 2023

e22528 Background: Serbia is the one of the countries with the highest incidence and mortality of lung cancer in Europe and survival rates are very low. Despite that fact, there is no recent data published on the incidence, mortality, survival time or the most significant patient characteristics for the Northern Serbian Province of Vojvodina. Methods: For the purpose of this retrospective study data for the period 2010 to 2022 were collected from Institute for Pulmonary Diseases of Vojvodina Hospital Information System and the Lung Cancer Registry. Also, we collected data from seven Public Health Institutes, one for each district to analyze incidence and mortality rates. The primary objective of the study was to determine the impact of demographic and clinical pathological characteristics of patients on overall survival. The secondary objective was to analyze the incidence and mortality of lung cancer in the region of Vojvodina. Incidence and mortality rates were directly age-standardized to the World and Europe Standard Population. Results: A total of 15072 patients were eligible for the analysis, 10413 (69.1%) males and 4659 (30.9%) females. The most of the patients were current smokers (62.9% males vs 63.3% females), stage IV (47.7% males vs 46.9% females), ECOG performance status 1 (78.5% males vs 79.0% females). One-year survival rate for the patients with stage IV squamous carcinoma was 20.5% males vs 27.2% females, adenocarcinoma 18.0% males vs 22.9% females and small-cell carcinoma 10.6% males vs 17.8% females. Three-year survival rate for all stages of squamous carcinoma was 12.7%, adenocarcinoma 11.8% and small-cell carcinoma 2.9%. Five-year survival rate for all stages of squamous carcinoma was 7.4%, adenocarcinoma 6.8% and small-cell carcinoma 1.9%. There was statistically significant difference in survival time by gender in subtypes of adenocarcinoma (p = 0.000), squamous cell carcinoma (p = 0.000) and small-cell carcinoma (p = 0.001). Analysis showed significant difference in survival by age (p = 0.000), cancer type (p = 0.000), stage of the disease (p = 0.000), ECOG performance status (p = 0.000) and smoking status (p = 0.001). Incidence (ASR-W) was 65.4/100000 for males and 21.7/100000 for females. Mortality (ASR-W) was 67.8/100000 for males and 20.9/100000 for females. Conclusions: Northern Serbian Province of Vojvodina is one of the regions with the highest incidence and mortality of lung cancer and overall survival is low. Determining the impact of the most important demographic and tumor characteristics on lung cancer patients’ survival, as well as incidence and mortality rates define the parameters necessary for adequate planning of activities and strategies for improving the prevention, diagnosis and treatment of patients in Vojvodina.