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Barriers to Colorectal Cancer Screening in People Obtaining Care From Community Mental Health Agencies by Kelly Gardiner MSN, Wayne State University, 1997 BSN, Wayne State University, 1988 Dissertation Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Despite being highly treatable with early intervention and preventative screenings, the overall mortality rate of colorectal cancer is substantially higher in participants with a preexisting mental disorder. Variables affecting the likelihood of completing screening for those with mental illnesses were unknown in people who obtain services from a Community Mental Health agency. Using the Health Belief Model, the proposed study investigated the effects of access to transportation, referral to screening, physical ability to complete the colonoscopy prep, type of procedure, awareness of the purpose of screening, anxiety, embarrassment, gender, race, and age to determine which affect completion of colorectal cancer screening. Significant relationships existed between embarrassment, fear of pain, fear of cancer, anxiety, physical ability to do testing, awareness of screening at age 50, FOBT vs Scope procedures, age of first screening, being told to get screening, knowing someone who had screening, and completion of colorectal cancer screening. In the binary logistic model Anxiety was negatively correlated and being told to get screening was positively correlated to completion of colorectal cancer screening and those choosing Scope were more likely to complete than those choosing FOBT. The results of this study may effect positive social change by providing healthcare providers with an increased understanding of variables that influence colorectal cancer screening completion among persons with a diagnosed mental illness, resulting in a changing agenda for effective mental and physical health care in this population.

Indiana University-Purdue University Indianapolis (IUPUI) / Human papillomavirus (HPV) infection results in serious health issues including cervical, anal, vulvar, penile and oropharyngeal cancers. There are three vaccines against HPV but vaccination rates in the United States remain low. One barrier to uptake is a concern that individuals who are vaccinated may increase their risky sexual behaviors or decrease their use of cervical cancer screenings, an adjustment in perceived level of risk for HPV that can be studied using risk compensation theory. Methods Three distinct studies examined risk compensation after HPV vaccination. A systematic review examined literature from January 1, 2008-June 30, 2015, using three databases. A qualitative study using semi-structured interviews of 22 healthcare providers that assessed their beliefs regarding sexual disinhibition and cervical cancer screening following vaccination. A cross-sectional survey that assessed cervical cancer screening practices, awareness and comfort with recommendations, and knowledge regarding the purpose of a Papanicolaou (Pap) test. Results Twenty articles were included in the systematic review. None of the studies of sexual behaviors and/or biological outcomes found evidence of riskier behaviors after HPV vaccination. Instead, the studies found vaccinated individuals were less likely to report risky sexual behaviors, sexually transmitted infections (STIs), and pregnancy. Qualitative interviews found no healthcare providers believed the HPV vaccine would result in increased risky sexual behavior or decreased cervical cancer screening, and these concerns would not influence their vaccination recommendations. The survey included 291 women 21-35 years old; 62% were non-Hispanic black, 84% had a Pap test in the last three years, and 33% had at least one HPV vaccine. Logistic regression showed that vaccinated women did not have greater odds of having a Pap test in the past three years (OR=1.32; 95% CI=0.66-2.65; p=0.427). However, this odds ratio was significant when controlling for age and race (AOR=3.06; 95% CI=1.37-6.83; p=0.006). Conclusion These studies found no evidence of increased risky sexual behaviors or decreased cervical cancer screening rates after HPV vaccination. Furthermore, vaccinated women showed less evidence of risk compensation. These results should alleviate concerns about administering the HPV vaccination among parents and providers.

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[ES] Encontrar un método no invasivo de clasificación fiable para distinguir entre pacientes con cancer de próstata e hiperplasia benigna de próstata no es una tarea trivial. El antígeno prostático específico mas utilizado presenta un au- mento en otras situaciones como la retención de orina o la eyaculación. Los productos metabólicos celulares como los compuestos volatiles en forma de bio-fluidos presentan una oportunidad para estudiarlos con la tecnología de semiconductores de óxido de metal. Una nariz electrónica diseñada para estos biofiuidos podría convertirse en una prueba ambulatoria clave para disminuir el número de biopsias. El diseño 3D, la creación de circuitos electrónicos, neumáticos, la adecuación de las muestras, la creación de una base de datos estandarizada para narices electrónicas, la definición de una interfaz de usuario amigable para el profesional sanitario, un sistema securizado para la comunicación con un servidor de almacenamiento de datos y todo el software necesario para hacer viable la democratización de las narices electrónicas en atención hospitalaria configuran la estrategia del trabajo. Además, el método empleado para conseguir aumentar el número de datos ha resultado determinante para hacer mas sencillo el entrenamiento de la red neuronal con la que se ha logrado una precisión del 87% en la clasificación entre pacientes de cancer de próstata e hiperplasia benigna de próstata. Se ha escogido un formato libro donde recoger todos los aspectos significativos de la realización del estudio. El primer capítulo se centra en el proyecto de tesis a financiar, la problemática a resolver, los objetivos y el plan de trabajo. En el segundo capítulo se definen los conceptos, el sentido del olfato, la vejiga, la próstata, los sensores utilizados, indicadores de cancer y otros elementos como la nariz electrónica. Es con una nariz electrónica de donde se obtienen las señales que se tratan en el capítulo tercero. En este capítulo se muestran las características de las señales provenientes de pacientes con cancer de próstata y pacientes con hiperplasia benigna de próstata, su tratamiento, filtrado, comparación y uso para la clasificación de pacientes. Asimismo, se muestran dos métodos distintos de clasificación y estudio de los algoritmos para automatizar la misma. El capítulo cuarto se centra en la construcción de un prototipo. Se ha abordado este capítulo como un manual de construcción que permita al lector conocer el proceso realizado, la toma de decisiones y la técnica utilizada para la realización del hardware, software y el modelo 3D. Dado que la diversidad de especialidades que confluyen en el mismo proyecto puede imposibilitar el dominio de alguno de los campos tratados, incluso dentro del mismo campo de especialización, se ha preparado este capítulo con diagramas y código fu- ente que acompaña a las explicaciones de forma detallada. El propósito de este capítulo es permitir a investigadores de diversas areas de conocimiento su construcción sin necesidad de profundizar en otros campos. Además, en este capítulo se detallan los procedimientos a fin de favorecer la democratización de la nariz electrónica como instrumento científico y con la esperanza de proporcionar la base para futuras implementaciones en la comunidad científica. Para el autor, la tesis no es sólo un documento, es un período de evolución personal. Ha estado condicionada por factores diversos, una pandemia, el planteamiento inicial, la financiación, el grupo de acogida, la línea de investigación, el desarrollo socio-económico del autor y el propio autoaprendizaje en el proceso de ejecución. Es por ello que se ha plasmado en el capítulo quinto lo que ha guiado de una u otra manera, pero de forma significativa, la toma de decisiones. Este capítulo versa sobre el trabajo futuro y tres proyectos, COST y H2020, DE1-SoC ADC e-Nose y Detección de tumores, que han ejercido influencia en el desarrollo de la tesis. Las conclusiones se recogen en el capítulo sexto. No obstante, cada capítulo dispone de un apartado llamado "Reflexiones" donde se anotan aquellas ideas y conclusiones concretas sobre el mismo. De esta forma se proporciona al lector un instrumento de lectura rápida que permita su consulta como si se tratara de un manual, sin necesidad de leer la totalidad del documento. En resumen, en este estudio se detallan los métodos y procedimientos de la investigación realizada con pacientes de cáncer de próstata e hiperplasia benigna de próstata con el propósito de conseguir un prototipo de una nariz electrónica para la clasificación de pacientes haciendo uso de orina como biofluido. Se ha tratado de escribir una referencia desde la que seguir construyendo conocimiento en torno a las narices electrónicas aplicadas a la clasificación de pacientes. / [CA] Trobar una mètode no invasiu de classificació fiable per a distingir entre pacients amb càncer de pròstata i hiperplàsia benigna de pròstata no és una tasca trivial. L'antigen prostàtic específic més utilitzat presenta un augment en altres situacions com la retenció d'orina o l'ejaculació. Els productes metabòlics cel·lulars com els compostos volàtils en forma de bio-fluids presenten una oportunitat per tal d'estudiar-los amb la tecnologia de semiconductors d'òxid de metall. Un nas electrònic dissenyat per a aquestos bio-fluids podria convertir-se en una prova ambulatòria clau per tal de disminuir el nombre de biòpsies. El disseny 3D, la creació de circuits electrònics, pneumàtics, l'adequació de les mostres, la creació d'una base de dades estandarditzada per a nassos electrònics, la definició d'una interfície d'usuari amigable per al professional sanitari, un sistema securitzat per a la comunicació amb un servidor d'emmagatzemament de dades i tot el software necessari per tal de fer viable la democratització dels nassos electrònics en atenció hospitalària configuren l'estratègia del treball. A més, el mètode emprat per a aconseguir augmentar el nombre de dades ha resultat determinant per fer més senzill l'entrenament de la xarxa neuronal amb la qual s'ha aconseguit una precisió del 87% a la classificació entre pacients de càncer de pròstata i hiperplàsia benigna de pròstata. S'ha escollit un format llibre on recollir tots els indrets significatius de la realització de l'estudi. El primer capítol es centra en el projecte de tesi a finançar, la problemàtica a resoldre, els objectius i el pla de treball. Al segon capítol es defineixen els conceptes, el sentit de l'olfacte, la bufeta, la próstata, els sensors utilitzats, indicadors de càncer i altres elements com el nas electrònic. És amb un nas electrònic d'on s'obtenen les senyals que es tracten al capítol tercer. En aquest capítol es mostren les característiques dels senyals provinents de pacients amb càncer de pròstata i pacients amb hiperplàsia benigna de próstata, el seu tractament, filtrat, comparació i ús per a la classificació de pacients. Així mateix, es mostren dos mètodes diferents de classificació i estudi dels algorismes per a automatitzar la mateixa. El capítol quart es centra en la construcció d'un prototip. S'ha abordat aquest capítol com un manual de construcció que permeta al lector conéixer el procés realitzat, la presa de decisions i la tècnica emprada pera la realització tant del hardware, els software i com el model 3D. Com que la diversitat d'especialitats que conflueixen en el mateix projecte pot impossibilitar el domini d'algun dels camps tractats, inclòs dins del mateix camp d'especialització, s'ha preparat aquest capítol amb diagrames i codi font que acompanya les explicacions de forma detallada. El propòsit d'aquest capítol és permetre a investigadors de diverses àrees de coneixement la seva construcció sense necessitat d'aprofundir en altres camps. A més, en aquest capítol es detallen els procediments per tal d'afavorir la democratització del nas electrònic com a instrument científic i amb la esperança de proporcionar la base per a futures implementacions en la comunitat científica. Per a l'autor, la tesi no és sols un document, és un període d'evolució personal. Ha estat condicionada per factors diversos, una pandèmia, el plantejament inicial, el finançament, el grup d'acollida, la línia d'investigació, el desenvolupament socio-econòmic de l'autor i el propi autoaprenentatge al procés d'execució. És per això que s'ha plasmat al capítol cinqué allò que ha guiat d'una manera o d'altra, però de forma significativa, la presa de decisions. Aquest capítol versa sobre el treball futur i tres projectes, COST i H2020, DE1-SoC ADC e-Nose i Detecció de tumors, que han exercit influència al desenvolupament de la tesi. És un exercici de reflexió al voltant dels mateixos i són una mostra de la capacitat investigadora de l'autor. Les conclusions es recullen al capítol sisé. No obstant això, cada capítol disposa d'un apartat anomenat "Reflexions" on s'anoten aquelles idees i conclusions concretes sobre el mateix. D'aquesta manera es proporciona al lector un instrument de lectura ràpida que permeta la seva consulta com si es tractés d'un manual, sense necessitat de llegir la totalitat del document. En resum, en aquest estudi es detallen els mètodes i procediments de la investigació realitzada amb pacients de càncer de pròstata i hiperplàsia benigna de pròstata amb el propòsit d'aconseguir un prototip d'un nas electrònic per a la classificació de pacients fent ús d'orina com a bio-fluid. S'ha tractat d'escriure una referència des d'on seguir construint coneixement al voltant dels nassos electrònics aplicats a la classificació de pacients. / [EN] Finding a reliable non-invasive classification method to distinguish between patients with prostate cancer and benign prostatic hyperplasia is not a trivial task. The most commonly used specific prostate antigen shows an increase in other situations such as urinary retention or ejaculation. Cellular metabolic products, such as volatile compounds in the form of bio- fiuids, present an opportunity to study them by using metal oxide semiconduc- tor technology. An electronic nose designed for these bio-fiuids could become a key ambulatory test in order to decrease the number of biopsies. The strategy of the work is configured in diferent fields. Design a 3D set to enclose the electronics and penumatic circuits. The suitability of the samples it has to be studied furthermore the creation of a standardized database for electronic noses to store these samples. The definition of a friendly user interface for the health professional besides a system secured for communication with a data storage server. To sum up, all the software and hardware necessary to make viable the democratization of electronic noses in hospital care. In addition, the method be inployed to increase the number of data has been decisive to simplify the training of the neural network with which an accuracy of 87% has been achieved in the classification between prostate cancer patients and benign prostatic hyperplasia. A book format has been chosen to collect all the significant points of the study. The first chapter focuses on the thesis project to be financed, the problem to be solved, the objectives and the work plan. The second chapter defines the concepts, the sense of smell, the bladder, the prostate, the sensors used, cancer indicators and other elements such as the electronic nose. It is with an electronic nose that the signals discussed in chapter three are obtained. This chapter shows the characteristics of signals from patients with prostate cancer and patients with benign prostatic hyper- plasia, their treatment, filtering, comparison and use for patient classification. Likewise, two different methods of classification and study of the algorithms to automate the same are shown. The fourth chapter focuses on the construction of a prototype. This chapter has been approached as a construction manual that allows the reader to know the process carried out, the decision-making and the technique used to make both the hardware, the software and the 3D. Since the diversity of specialties that converge in the same project can make it impossible to master any of the fields discussed, including within the same field of specialization, this chapter has been prepared with diagrams and source code that accompanies the explanations of form detailed. The purpose of this chapter is to allow researchers from various areas of knowledge to construct it without the need to delve into other fields. In addition, this chapter details the procedures to promote the democratization of the electronic nose as a scientific instrument and with the hope of providing the basis for future implementations in the scientific community. For the author, the thesis is not just a document, it is a period of personal evolution. It has been conditioned by various factors, a pandemic, the initial approach, the funding, the host group, the line of research, the socioof the author and the self-learning in the execution process. That is why what has been shaped in the fifth has guided in one way or another, but in a significant way, the decision-making. This chapter deals with future work and three projects, COST and H2020, DE1-SoC ADC eNose and Tumor Detection, which have influenced the development of the thesis. It is an exercise in reflection about them and they are a sample of the author's research capacity. The conclusions are collected in chapter six. However, each chapter has a section called "Reflections" where those specific ideas and conclusions about the same are noted. / Talens Felis, JB. (2022). Anàlisi, disseny i implementació d'instrumentació no invasiva per a la detecció de càncer de pròstata i bufeta mitjançant tecnologia MOS [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/190835

The thesis provides a comprehensive overview of key issues affecting practice, policy and patients, in current efforts for colorectal cancer (CRC) disease control. The global burden of CRC is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. CRC incidence and mortality rates vary up to 10-fold worldwide, which is thought to reflect variation in lifestyles, especially diet. Better primary prevention, and more effective early detection, in screening and surveillance, are needed to reduce the number of patients with CRC in future1. The risk factors for CRC development include genetic, behavioural, environmental and socio-economic factors. Changes to surveillance, which offer non-invasive testing and provide primary prevention interventions represent promising opportunities to improve outcomes and personalise care in those at risk of CRC. By systematic review of the literature, I highlight the gaps in comparative effectiveness analyses of post-polypectomy surveillance. Using micro-simulation methods I assess the role of non-invasive, faecal immunochemical testing in surveillance programmes, to optimise post-polypectomy surveillance programmes, and in an accompanying sub-study, I explore the value of adding an adjunct diet and lifestyle intervention. The acceptability of such revisions is exposed to patient preference evaluation by discrete choice experiment methods. These preferences are accompanied by evidence generated from the prospective evaluation of the health literacy, numeracy, sedentary behaviour levels, body mass index (BMI) and information provision about cancer risk factors, to highlight the potential opportunities for personalisation and optimisation of surveillance. Additional analysis examines the optimisation of a screening programme facing colonoscopy constraints, highlighting the attendant potential to reduce costs and save lives within current capacity.

Les travaux réalisés dans le cadre de cette thèse avaient pour objectifs :- déterminer les facteurs socio-économiques individuels et collectifs influençant la participation des femmes au dépistage organisé du cancer du sein, - étudier les facteurs individuels influençant l’adéquation du rythme de suivi des femmes selon leur niveau de risque, - analyser l’importance du dépistage et du suivi médical sur le stade de découverte des tumeurs. Les résultats des travaux ont montré que les femmes qui habitaient dans des zones économiquement défavorisées ou dans des zones rurales, celles affiliées au Régime Social des Indépendants ainsi que celles habitant à plus de 15 minutes d’un cabinet de radiologie participaient moins au dépistage organisé du cancer du sein. Les femmes qui avaient un suivi gynécologique régulier ainsi que celles qui avaient une activité professionnelle faisaient plus souvent des mammographies à titre individuel ou cumulaient les deux types de dépistage. Les résultats de nos travaux ont également montré qu’un dépistage et un suivi médical régulier permettaient la découverte de cancers du sein à des stades précoces, le recours plus fréquent à des traitements par chirurgie et radiothérapie et à moins de traitement par chimiothérapie néo-adjuvante. Les femmes suivies dans le cadre du dépistage organisé du cancer du sein et celles qui avaient un suivi gynécologique régulier avaient plus de chances d’avoir un rythme de dépistage conforme aux recommandations. Afin de tirer un maximum de profit du dépistage organisé du cancer du sein peut-être faudrait-il impliquer beaucoup plus les médecins dans le programme de dépistage. / Mammography screening allowed breast tumors detection in early stage while treatments are less aggressive. Despite the fact that organized mammography screening has been free of charge for the target population since 2004 in France, the participation rate to the programme remains low.The aim of the studies was to investigate individual and area-level socioeconomic factors explaining low breast cancer screening attendance, individual factors influencing mammography screening round adequacy and to assess the evidence of screening round adequacy in the discovery of breast tumors.The results showed that women living in most deprived areas or rural areas, those covered by self-employed insurance scheme and those living at more than 15 minutes from an accredited screening centre were less likely to attend organized breast cancer screening. Women with a regular screening and medical follow-up were more likely to be diagnosed with an early stage tumor.Attendance to mammography screening and regular medical follow up lead to have tumors discovered at an early stage, to be treated by surgery and radiotherapy and to receive less neoadjuvant chemotherapy. This supposes to be screened in the organized mammography screening programme and to have regular gynecological follow-up.

Utilizing a mixed methods approach in assessing cities and metropolitan areas with the highest rates of breast cancer disparities in African-American communities, this study presents the Affiliate perspective of the Susan G. Komen non-profit organization in combination with available socioeconomic data and academic literature. Analyzed through an anthropological lens, qualitative and quantitative data illuminate the lived experiences and dynamic circumstances in which breast cancer disparities are disproportionately experienced in 21 of the nation’s populations of African-Americans. Two main recommendations arose from this research: prioritization of granting to activities such as patient navigation, usage of patient narrative messaging, community-based participatory research methods of program development and implementation, mobile mammography delivery, usage of lay health educators, and self-advocacy education to alleviate barriers to healthcare and supplementation of the current educational activities of the Komen Affiliates through program sharing and leverage of current assets with consideration of current Affiliate capacity. These recommendations may help in alleviating breast cancer disparities present in African-American communities with the highest levels of disparities in the nation.

Indiana University-Purdue University Indianapolis (IUPUI) / A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations.