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Introduction Detecting upper gastrointestinal (GI) cancers in primary care is challenging, as cancer symptoms are common, often non-specific, and most patients presenting with these symptoms will not have cancer. Substantial investment has been made to develop biomarkers for cancer detection, but few have reached routine clinical practice. We aimed to identify novel biomarkers for upper GI cancers which have been sufficiently validated to be ready for evaluation in low-prevalence populations. Methods We systematically searched MEDLINE, Embase, Emcare, and Web of Science for studies published in English from January 2000 to October 2019 (PROSPERO registration CRD42020165005). Reference lists of included studies were assessed. Studies had to report on second measures of diagnostic performance (beyond discovery phase) for biomarkers (single or in panels) used to detect pancreatic, oesophageal, gastric, and biliary tract cancers. We included all designs and excluded studies with less than 50 cases/controls. Data were extracted on types of biomarkers, populations and outcomes. Heterogeneity prevented pooling of outcomes. Results We identified 149 eligible studies, involving 22,264 cancer cases and 49,474 controls. A total of 431 biomarkers were identified (183 microRNAs and other RNAs, 79 autoantibodies and other immunological markers, 119 other proteins, 36 metabolic markers, 6 circulating tumour DNA and 8 other). Over half (n = 231) were reported in pancreatic cancer studies. Only 35 biomarkers had been investigated in at least two studies, with reported outcomes for that individual marker for the same tumour type. Apolipoproteins (apoAII-AT and apoAII-ATQ), and pepsinogens (PGI and PGII) were the most promising biomarkers for pancreatic and gastric cancer, respectively. Conclusion Most novel biomarkers for the early detection of upper GI cancers are still at an early stage of matureness. Further evidence is needed on biomarker performance in low-prevalence populations, in addition to implementation and health economic studies, before extensive adoption into clinical practice can be recommended. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01571-z) contains supplementary material, which is available to authorized users.

BACKGROUND Almost 30% of Chilean women report cigarette smoking with important repercussions on their health. OBJECTIVE Design and test a mobile phone intervention for smoking cessation in young women. STUDY DESIGN A mobile application (app) was created using the best available evidence and consumer input. Its effectiveness was assessed through a randomized clinical trial. STUDY PARTICIPANTS Women 18 to 44 years old from middle-class neighborhoods in Santiago, Chile. Inclusion criteria were intention to quit cigarette smoking in the following month and having a smartphone cell phone. Women with positive screening for risky alcohol consumption were excluded. INTERVENTION App with content to support cigarette smoking cessation over 6 months. The control arm included an app that delivered general messages to promote permanence in the study. Telephone follow-up was performed at 6 weeks, and at 3 and 6 months after randomization. MAIN OUTCOME MEASURE No smoking in the past 7 days at 6 weeks from enrolment. Intention-to-treat analysis was carried out using SPSS 17.0 with a significance level set at .05. RESULTS 309 women entered the study. Mean number of cigarettes smoked in a day was 8.8. 58.6% of the participants (n = 181) completed the follow-up for the primary outcome. With intention-to-treat analysis, 9.7% of participants in the intervention group reported not having smoked any cigarettes in the last 7 days vs 3.2% in the control group (RR 2.98 CI 95% 1.11-8.0, P = .022). Additionally, 12.3% vs 1.9% of the participants in the intervention group and control group reported continuous abstinence at 6 weeks, respectively (RR 6.29 95% CI 1.9-20.8, P < .001). Continuous abstinence was also significant at 6 months ( P-value of .036). CONCLUSIONS The “Appagalo” app is an effective tool to support smoking cessation in young women. It is a simple mHealth alternative for smoking cessation that can contribute to improving women's health in the Americas and worldwide.

Background Australian guidelines recommend that all people aged 50–70 years old actively consider taking daily low-dose aspirin (100–300 mg per day) for 2.5 to 5 years to reduce their risk of colorectal cancer (CRC). Despite the change of national CRC prevention guidelines, there has been no active implementation of the guidelines into clinical practice. We aim to test the efficacy of a health consultation and decision aid, using a novel expected frequency tree (EFT) to present the benefits and harms of low dose aspirin prior to a general practice consultation with patients aged 50–70 years, on informed decision-making and uptake of aspirin. Methods Approximately five to seven general practices in Victoria, Australia, will be recruited to participate. Patients 50–70 years old, attending an appointment with their general practitioner (GP) for any reason, will be invited to participate in the trial. Two hundred fifty-eight eligible participants will be randomly allocated 1:1 to intervention or active control arms using a computer-generated allocation sequence stratified by general practice, sex, and mode of trial delivery (face-to-face or teletrial). There are two co-primary outcomes: informed decision-making at 1-month post randomisation, measured by the Multi-dimensional Measure of Informed Choice (MMIC), and self-reported daily use of aspirin at 6 months. Secondary outcomes include decisional conflict at 1-month and other behavioural changes to reduce CRC risk at both time points. Discussion This trial will test the efficacy of novel methods for implementing national guidelines to support informed decision-making about taking aspirin in 50–70-year-olds to reduce the risk of CRC and other chronic diseases. Trial registration The Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001003965. Registered on 10 October 2020.

Cancer is one of the most common and serious medical conditions, with significant challenges in the detection of cancer originating from the non-specific nature of symptoms and very low prevalence. For general practitioners (GPs), this can be particularly important, as they are the primary contact for patients for most medical conditions. This places high significance on using the data available to a GP to design decision support tools that will aid GPs in detecting cancer as early as possible. With pathology data being one of the datasets available in the GP electronic medical record (EMR), our work targets this type of data in an attempt to incorporate an early cancer detection tool in existing GP practices. We focus on utilizing full blood count pathology results to design features that can be used in an early cancer detection model 3 to 6 months ahead of standard diagnosis. This research focuses initially on lung cancer but can be extended to other types of cancer. Additional challenges are present in this type of data due to the irregular and infrequent nature of doing pathology tests, which are also considered in designing the AI solution. Our findings demonstrate that hematological measures from pathology data are a suitable choice for a cancer detection tool that can deliver early cancer diagnosis up to 6 months ahead for up to 8 out of 10 patients, in a way that is easily incorporated in current GP practice.

Introduction Lower gastrointestinal (GI) cancers are a major cause of cancer deaths worldwide. Prognosis improves with earlier diagnosis, and non-invasive biomarkers have the potential to aid with early detection. Substantial investment has been made into the development of biomarkers; however, studies are often carried out in specialist settings and few have been evaluated for low-prevalence populations. Methods We aimed to identify novel biomarkers for the detection of lower GI cancers that have the potential to be evaluated for use in primary care. MEDLINE, Embase, Emcare and Web of Science were systematically searched for studies published in English from January 2000 to October 2019. Reference lists of included studies were also assessed. Studies had to report on measures of diagnostic performance for biomarkers (single or in panels) used to detect colorectal or anal cancers. We included all designs and excluded studies with fewer than 50 cases/controls. Data were extracted from published studies on types of biomarkers, populations and outcomes. Narrative synthesis was used, and measures of specificity and sensitivity were meta-analysed where possible. Results We identified 142 studies reporting on biomarkers for lower GI cancers, for 24,844 cases and 45,374 controls. A total of 378 unique biomarkers were identified. Heterogeneity of study design, population type and sample source precluded meta-analysis for all markers except methylated septin 9 (mSEPT9) and pyruvate kinase type tumour M2 (TuM2-PK). The estimated sensitivity and specificity of mSEPT9 was 80.6% (95% CI 76.6–84.0%) and 88.0% (95% CI 79.1–93.4%) respectively; TuM2-PK had an estimated sensitivity of 81.6% (95% CI 75.2–86.6%) and specificity of 80.1% (95% CI 76.7–83.0%). Conclusion Two novel biomarkers (mSEPT9 and TuM2-PK) were identified from the literature with potential for use in lower-prevalence populations. Further research is needed to validate these biomarkers in primary care for screening and assessment of symptomatic patients. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01645-6.

Adrenal incidentalomas are common with a prevalence of 3-10% and in up to 30% of cases may have probable autonomous cortisol secretion. Hypercortisolism is associated with substantial cardiometabolic morbimortality and can physiologically decrease ACTH levels. Objective: To determine the sensitivity, specificity, and positive and negative predictive values of ACTH levels in evaluating autonomous cortisol secretion in a prospective cohort of incidentally discovered adrenal adenomas. Methods: We prospectively evaluated 224 consecutive adult subjects with incidentally discovered adrenal masses on computed tomography. Finally, 168 participants with radiographic adenoma criteria underwent systematic hormonal assessment, including measurements of morning cortisol and ACTH on day 1, and a 1 mg dexamethasone suppression test (DST) on day 2. Hypercortisolism was excluded if the DST was < 1.8 mcg/dL. Autonomous cortisol secretion was defined as a DST > 5.0 mcg/dL and DST levels of 1.8-5.0 mcg/dL were considered to be possibly autonomous hypercortisolism. We evaluated the correlation of ACTH levels with clinical, radiographic, and endocrine variables. In order to identify the most sensitive threshold value for diagnosing autonomous cortisol secretion, we determined ROC curves and negative likelihood ratio (NLR). Concordance of repeated ACTH was assessed using Bland Altman analysis. Results: The characteristics of the cohort were mean age 56 (+/- 11.8) years, 76% female, adenoma size 19 (+/- 7) mm, and 13% bilateral adenomas. Mean ACTH was 15 (+/- 11) pg/ml (range 5-72) and the mean DST was 2.2 (+/- 3.0) ug/dL (range 0.4-25.9). Fifty-four (32%) participants had a DST ≥1.8mcg/dL and 13 (8%) a DST≥5.0 mcg/dL. We found no correlation between ACTH levels and age, gender or body mass index. ACTH was inversely associated with adrenal adenoma diameter (r=-3.3 p=0.002) and volume (r=-2.9 p=0.008). There was an inverse association between ACTH and DST values (r=-3.1 p=0.01). In the subgroup of patients with a second ACTH measurement we found high concordance, with mean difference of 0.16+/-3.6 pg/ml (p=0.83). ROC analysis showed that an ACTH ≥20 pg/ml had a sensitivity of 98% to exclude hypercortisolism, with a negative predictive value of 97% and a negative likelihood ratio of 0.06. The only case with DST≥1.8 and ACTH≥20 had Cushing′s phenotype with both an adrenal adenoma and a pituitary ACTH-producing adenoma. Systematic evaluation of morning cortisol and ACTH allowed the detection of 5 cases of false negative low DST values due to the use of non-oral corticosteroids. Conclusion: In this cohort, an ACTH ≥20pg/ml excluded autonomous cortisol secretion with excellent sensitivity and negative predictive value, providing strong reassurance that there is no clinically relevant hypercortisolism. Therefore, subjects with a normal DST and ACTH ≥20pg/ml should be candidates for relaxed surveillance.

Se entiende el temperamento como el conjunto de diferencias individuales en reactividad y autorregulación, manteniéndose relativamente estable a través del tiempo, y siendo influenciado por la herencia, la maduración biológica y el contacto con el ambiente. En el presente estudio se buscó establecer si se dan diferencias en las dimensiones de temperamento de extraversión, afecto negativo y autorregulación según nivel socioeconómico, en niños chilenos asistentes a sala cuna. Se evaluaron 103 niños de ambos sexos, a los 12 y a los 30 meses de edad, con los cuestionarios IBQ-R-VSF y ECBQ-VSF, los cuales respondieron los padres. Los resultados mostraron que entre los 12 y 30 meses la extraversión se mantuvo constante, mientras que las dimensiones de afecto negativo y autorregulación disminuyeron de manera significativa. A los 12 meses los niños de NSE alto mostraron una mayor autorregulación, mientras que a los 30 meses los niños de NSE bajo evidenciaron un mayor afecto negativo. Se discuten los resultados en base a la evidencia encontrada sobre las diferentes realidades en los distintos niveles socioeconómicos.

Background In Chile, more than 500 women die every year from cervical cancer, and a majority of Chilean women are not up-to-date with their Papanicolau (Pap) test. Mobile health has great potential in many health areas, particularly in health promotion and prevention. There are no randomized controlled trials in Latin America assessing its use in cervical cancer screening. The ‘Development of Mobile Technologies for the Prevention of Cervical Cancer in Santiago, Chile’ study aims to determine the efficacy of a text-message intervention on Pap test adherence among Chilean women in the metropolitan region of Santiago. Methods/design This study is a parallel randomized-controlled trial of 400 Chilean women aged 25–64 who are non-adherent with current recommendations for Pap test screening. Participants will be randomly assigned to (1) a control arm (usual care) or (2) an intervention arm, where text and voice messages containing information and encouragement to undergo screening will be sent to the women. The primary endpoint is completion of a Pap test within 6 months of baseline assessment, as determined by medical record review at community-based clinics. Medical record reviewers will be blinded to randomization arms. The secondary endpoint is an evaluation of the implementation and usability of the text message intervention as a strategy to improve screening adherence. Discussion This intervention using mobile technology intends to raise cervical cancer screening adherence and compliance among a Chilean population of low and middle-low socioeconomic status. If successful, this strategy may reduce the incidence of cervical cancer. Trial registration Clinicaltrials.gov NCT02376023 Registered 2/17/2015. First participant enrolled Feb 22nd 2016. Electronic supplementary material The online version of this article (10.1186/s12885-017-3870-8) contains supplementary material, which is available to authorized users.

Introduccion: El tabaco es la primera causa de morbimortalidad prevenible en el mundo. En Chile la prevalencia de consumo es 40,6%, la mayor a nivel continental. El consejo breve o consejeria breve (CB) es una intervencion simple, efectiva y de bajo costo para el cese de consumo de tabaco, que Atencion Primaria en Salud (APS) ha demostrado disminuir la prevalencia de tabaquismo. Existe escasa informacion sobre la utilizacion de CB en APS en Chile. Metodos: Estudio transversal de metodologia cuantitativa. Se encuesto a 604 pacientes pertenecientes a 2 centros APS de Santiago, tras haber recibido atencion clinica. Los datos fueron analizados con SPSS 21 y calculadora web Graph Pad. Resultados: La prevalencia de tabaquismo entre los encuestados fue 32,5%, de ellos el 78,9% reporto deseo de dejar de fumar. Al 43,7% de los encuestados se le pregunto respecto a consumo de tabaco en la atencion reciente, y del total de fumadores a 37,1% se les aconsejo dejar de fumar. Los pacientes fumadores calificaron la recepcion de CB como “indeferente”, “agradable” o “muy agradable” en un 94,9% y en un 90,5% entre aquellos que no desean dejar de fumar. Conclusiones: El tabaquismo es un problema escasamente abordado en las atenciones clinicas APS, lo que contrasta con la alta prevalencia de consumo nacional y de los pacientes consultantes. La mayoria de los fumadores desea dejar de fumar y la minoria considera “desagradable” o “muy desagradable” ser aconsejada para cesar el consumo, aun en aquellos fumadores que no quieren dejar de fumar.

BACKGROUND In Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations. OBJECTIVE The objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates. METHODS We conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)–based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis. RESULTS Focus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates. CONCLUSIONS This study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations.

Objective:The detection of adrenal incidentalomas is increasing. Current European guidelines suggest that all adrenal incidentalomas (AI) should be screened for excess cortisol and cathecolamines, but excess aldosterone only in the presence of hypertension and/or hypokalemia. Consistently, the repor

INTRODUCTION Breast cancer is the most commonly diagnosed cancer and the leading cause of death in Latin American women [1]. Although differences in incidence exist, mortality rates remain proportionally higher (approximately 10%) in Latin America compared with the mortality rates in United States and Canada. Late stage detection in these countries is believed to be a major contributing factor to decreased survival [2]. Globally, increasing adherence to screening mammography guidelines has led to a significant improvement in early detection. Mammography screening compliance rates throughout Latin America are estimated around 8% to 34% [3]. Alternatively, compliance is estimated at an average of 66% in the United States, though it varies from 38% to 75%, dependent on various cultural and socioeconomic factors [4]. Many lowand middle-income Latin American countries struggle to implement screening programs because of limited resources. In many cases, mammographic exams remain opportunistic rather than compulsory. For example, the

BACKGROUND Latinas have the highest rates of cervical cancer in the United States and the second highest rate of cervical cancer mortality. One factor in the disparity is the relatively low rate of screening for cervical cancer in this population. METHODS Eligible women who were out of adherence with cervical cancer screening (>3 years since their last Papanicolaou [Pap] test) were identified via medical record review by a federally qualified local health center. The effects of a low-intensity intervention (video delivered to participants' homes; n = 150) and a high-intensity intervention (video plus a home-based educational session; n = 146) on cervical cancer screening uptake in comparison with a control arm (usual care; n = 147) were investigated. A cost-effectiveness analysis of the interventions was conducted: all intervention costs were calculated, and the incremental cost-effectiveness ratio was computed. Finally, women with positive Pap tests were provided navigation by a community health educator to ensure that they received follow-up care. RESULTS A total of 443 Latinas participated. Seven months after randomization, significantly more women in the high-intensity arm received a Pap test (53.4%) in comparison with the low-intensity arm (38.7%; P

Background: Breast cancer is the most frequently diagnosed malignancy among Chilean women and an increasingly significant public health threat. This study assessed the accuracy of breast cancer risk perception among underserved, Chilean women. Methods: Women aged 50 to 70 years, with no mammogram during the last 2 years, were randomly selected from a community clinic registry in Santiago, Chile (n = 500). Perceived risk was measured using three methods: absolute risk, comparative risk, and numerical risk. Risk comprehension was measured by comparing women's perceived and objective risk estimates. Multivariate logistic regression was used to assess overestimation of perceived risk. Results: Women at high risk of breast cancer were more likely than average risk women to perceive themselves at high or higher risk, using absolute and comparative risk approaches (P < 0.001). The majority of participants (67%) overestimated their breast cancer risk, on the basis of risk comprehension; although, participants achieved higher accuracy with comparative risk (40%) and absolute risk (31.6%) methods. [Age, breast cancer knowledge and Breast Cancer Risk Assessment Tool (BCRAT) 5-year risk were significantly associated (P < 0.01) with accuracy of perceived risk]. Conclusion: Chilean women residing in an underserved community may not accurately assess their breast cancer risk, although risk perception and level of accuracy differed between perceived risk measures. Comparative and absolute risk methods may better reflect women's interpretation and accuracy of risk perception. Impact: Improving our understanding of Chilean women's perceptions of developing breast cancer may lead to the development of culturally relevant efforts to reduce the breast cancer burden in this population. Cancer Epidemiol Biomarkers Prev; 21(10); 1716–21. ©2012 AACR.

BackgroundIn Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations. ObjectiveThe objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates. MethodsWe conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)–based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis. ResultsFocus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates. ConclusionsThis study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations.

Colorectal cancer (CRC) is a common cancer worldwide. In Chile it is the third leading cause of cancer mortality. Its incidence rate is about 14 per 100,000 inhabitants. It is known that there is an inverse relationship between GDP per capita and CRC mortality. In Chile it is estimated that for every 3 people with CRC two deaths occur, while in the United States this number is one death per 6 people diagnosed. The Chilean Health care system is a dual one; the public sector serves >70% of the population with 50% of the resources. The private sector serves Methods: Retrospective cohort study in 3 PCC. Collection of data was made through electronic medical records (EMR). We selected and reviewed all EMR with diagnosis of CRC from 2010 to march 2017. Demographic data, initial symptoms, secondary referrals, and place of diagnosis were extracted. With these data incidence, characterization of patients with CRC and estimation of waiting times were determined. Results: We reviewed 60,783 EMR from eligible men and women. We found 22 people with confirmed CRC with an incidence of 4,4 per 100,000 inhabitants. The average age at diagnosis was 64.3 years; 45% (10) were men and 55% (12) women. 50% (11) of them had their diagnosis made in the private system. There were records of early symptoms in 63% (14) of patients. 43% (6) had weight loss, 36% (5) hematochezia, 21% (3) abdominal pain, 14% (2) anemia, 14% (2) diarrhea, 14% (2) change in bowel habit, 14% (2) palpable mass, and 13% (2) had been diagnosed due to an acute complication. Regarding waiting times, 4 people had a recorded time from symptoms to first consultation, which was 4.7 months on average. In one patient the time from symptoms to diagnosis was 9 months. 8 people had the time from referral to specialist evaluation on their EMR, which was 23.5 days on average. 7 of these patients were referred with a diagnosis already made. Conclusion: There is a severe lack of information regarding CRC diagnosis. Data obtained through this pilot study were scarce and insufficient to estimate the waiting times between the symptoms and the diagnosis of CRC. One of the reasons for this lack of diagnosis might be that information systems in primary, secondary, and tertiary care are not connected, thus making it impossible to access patient information that might have been diagnosed in the hospitals and stayed there for the whole durations of their treatment. Through these results we might also infer that a large percentage of our patients were diagnosed outside the public network, probably because of the long waiting times for a colonoscopy in the public sector. This could explain the low incidence of CRC. It is necessary to carry out more studies that include secondary-level data as well as qualitative data to determine the diagnostic process of CRC more accurately. Citation Format: Viviana Rodríguez, María Jesús Valdivieso, Felipe Quezada, Maria Elisa Herrera, Javiera Martínez-Gutiérrez. Diagnosing CRC in 3 vulnerable health centers in Santiago, Chile. Not an easy task [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C75.

Introduction: Cervical cancer is a serious public health problem. An estimated 270,000 women die every year from cervical cancer and more than 85% of these deaths take place in developing countries. Chile´s national cervical cancer program was created in 1987. Since then, and with the systematic implementation of cervical cancer screening through Papanicolau (Pap) smears, cervical cancer mortality rates have dropped significantly. Cancer screening rates, however, have stabilized in the last 10 years at approximately 59%. Additionally, most late-stage cervical cancers are diagnosed in low-socioeconomic-status (SES) Latinas. Mobile technologies may have use in improving health disparities due to their widespread availability. In Chile, more than 80% of low-SES people own a cell phone. Nevertheless, developing an effective mHealth intervention may require tailoring and adjusting of available technology in developing countries. The aim of this study was to describe key aspects of an mHealth intervention to be used in Latinas from an underserved area of Santiago, Chile. Methods: We held 9 focus groups at three health care centers with Latinas between 25-64 years old and midwives. Focus groups were recorded, and transcribed verbatim. We analyzed and coded the data grouping findings into relevant themes. With these findings, we developed a customized mHealth intervention that is now being tested using a randomized controlled trial (RCT) in a vulnerable area of Santiago, Chile. Results: Development: The results of our study revealed key aspects to consider for the final intervention: We asked about mode of delivery, content, frequency, and duration of the ideal intervention. Mode of delivery: Although younger women preferred texting and other “indirect” modes of communication, older women were not as savvy with reading texts--their preferred method of contact was a phone call. Content: Women agreed that messages needed to be clear and written in simple language. They would like the messages to have information about cervical cancer, as well as Pap smear availability at their health care centers. Frequency and duration of the intervention: Women mentioned the messages should be sent every week and no more than two times a week. They would like the messages to alternate being sent during weekends and weekday evenings to allow for sufficient time to read them. Previous studies had shown that a duration of 6 months would be effective to promote change in screening behavior. The final intervention was designed with the following characteristics: 1. Four months of text messages and two months of automated phone calls; 2. Twice a week on Wednesday and Sunday evenings; 3. Two types of messages: Information about cervical cancer and clinic hours, scheduling procedures, etc. Implementation: We planned to deliver the text and phone messages using a custom web platform connected to a generic SMS gateway provider. Lack of close relations between two such providers and Chilean mobile carriers generated profound disruptions in the reliability with which messages were sent during testing. After an iterative trial-and-error we settled for our current provider, which is delivering messages for our clinical trial without major issues. Conclusions: Developing and implementing an effective mHealth intervention requires tailoring according to cultural, socioeconomic, and educational characteristics of the population as well as knowledge of the technology available in every country. Transferring technologies proven easy to implement in developed countries is not as straightforward as it may seem. Our intervention is currently being tested through a RCT in a vulnerable population of Santiago, Chile. We hope to learn more about the implementation of such technologies in vulnerable populations, thus improving cancer screening rates across the country. Citation Format: Javiera Martinez Gutierrez, Daniel Capurro, Francis Ciampi, Mauricio Soto, Mackenzie C. Momany, Emilia Cea, Tania Mergudich, Klaus Puschel. Developing and implementing an mHealth intervention for cervical cancer prevention in Santiago, Chile [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C74.

Background In a rapidly changing culture like ours, with emphasis on productivity, there is a strong need to find the meaning of health care work using learning instances that privilege reflection and face to face contact with others. The Diploma in Health and Humanization (DSH), was developed as an interdisciplinary space for training on issues related to humanization. Aim To analyze the experience of DSH aiming to identify the elements that students considered key factors for the success of the program. Material and methods We conducted a focus group with DSH graduates, identifying factors associated with satisfaction. Transcripts were coded and analyzed by two independent reviewers. Results DSH graduates valued a safe space, personal interaction, dialogue and respect as learning tools of the DSH. They also appreciates the opportunity to have emotional interactions among students and between them and the teacher as well as the opportunity to share personal stories and their own search for meaning. Discussion DSH is a learning experience in which their graduates value the ability to think about their vocation and the affective interaction with peers and teachers. We hope to contribute to the development of face to face courses in the area of humanization. Face to face methodology is an excellent teaching technique for contents related to the meaning of work, and more specifically, to a group of learners that require affective communication and a personal connection of their work with their own values and beliefs.

Each phase of the cancer experience profoundly affects patients' lives. Much of the literature has focused on negative consequences of cancer; however, the study of resilience may enable providers to promote more positive psychosocial outcomes before, during, and after the cancer experience. The current review describes the ways in which elements of resilience have been defined and studied at each phase of the cancer continuum. Extensive literature searches were conducted to find studies assessing resilience during one or more stages of the adult cancer continuum. For all phases of the cancer continuum, resilience descriptions included preexisting or baseline characteristics, such as demographics and personal attributes (e.g., optimism, social support), mechanisms of adaptation, such as coping and medical experiences (e.g., positive provider communication), as well as psychosocial outcomes, such as growth and quality of life. Promoting resilience is a critical element of patient psychosocial care. Nurses may enable resilience by recognizing and promoting certain baseline characteristics and optimizing mechanisms of adaptation.

Background: Mobile technology uptake has increased exponentially in the past years; in 2009, mobile telephones could be found in more than 90% of Chilean homes and are widely distributed across all socioeconomic levels. Because of this technological explosion, mobile health (mHealth), or medical and public health practice supported by mobile devices, has gained potential in many health areas such as cancer prevention. Chile has a very well organized Cervical Cancer Prevention Program, with universal coverage, and a centralized registry. Despite all efforts, more than 500 Chilean women die of cervical cancer each year and Papanicolau (Pap) adherence is lower than 60%. Like many other cancers sites, cervical cancer affects the most vulnerable and under-served women. An intervention based on mobile health might be able to narrow this gap by increasing cervical cancer screening in vulnerable Latinas. The aim of this study is to assess mobile use and barriers, facilitators and acceptability to an intervention based on text messaging to increase cervical cancer-screening rates in three health care centers of Santiago Chile. Methods: We held 9 focus groups at 3 under-served health care centers in Santiago Chile; 6 focus groups among 27 women between 25-64 years old and 3 among 11 midwifes working at the health care centers. Focus groups were conducted in Spanish, recorded, and transcribed verbatim. Our research team analyzed and coded the data grouping findings into relevant themes. Results: Regarding mobile use, older women (44 to 65 years) in our study used their phones mainly to keep in touch and receive news from family and friends. Most women did not call or send messages for two main reasons: a. Most women owned prepaid phones and did not have the money to be able perform such tasks. b. Some women did not know how to check or answer a text message. Younger women (25 to 44 years) were more prone to use cell phones for different tasks such as navigating the Internet, using chat apps and making calls through Wi-Fi if they did not have the money to pay for their calls. Acceptability: Most women mentioned liking the idea of receiving messages regarding their health. They mentioned they would have to be written in simple language and the content be general enough to respect confidentiality. They would like the messages to have information regarding cervical cancer and days and hours for them to be able to get the Pap at their health care centers. They would also like to receive reminders of their scheduled Pap appointments. Older women mentioned they preferred to get phone calls from their provider or even automated calls rather than text messages. Providers were also very prone to the idea of a text message intervention since it would increase cervical cancer screening rates and would make their jobs easier. Facilitators to the implementation of a strategy based on text messages were easy access to the technology and better communication with the health care team. Potentials barriers were: Switching cell phone number rather frequently. They find it easier to buy prepaid cell phones each time rather than keep their number and get a cell phone plan. Also, male providers and the need to schedule an appointment for their Pap rather than getting it instantly whenever they arrive at the health care center were mentioned as organizational barriers. Conclusions: Cell phone use is widely spread in the Chilean population. An intervention based on text messaging might help increase cervical cancer-screening rates in Santiago, Chile. Women and providers were prone to accept an intervention using mHealth. Facilitators and barriers described such as availability of cell phones, difficulty to operate messages and use of prepaid phones need to be considered when planning an mHealth intervention for cancer prevention. Citation Format: Javiera Martinez-Gutierrez, Mauricio Soto, McKenzie Momany, Francis Ciampi, Daniel Capurro, Emilia Cea, Klaus Puschel. “Messages for your health”: Mobile use and cancer prevention for underserved Latinas in Santiago, Chile. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B77.

Federally Qualified Health Centers (FQHCs) serve uninsured and minority populations, who have low cancer screening rates. The patient-centered medical home (PCMH) model aims to provide comprehensive preventive services, including cancer screening, to these populations. Little is known about organizational factors influencing the delivery of cancer screening in this context. We conducted 18 semi-structured interviews with clinic personnel at four FQHC clinics in Washington State. All interviews were recorded and transcribed verbatim and analyzed by two bilingual coders to identify salient themes. We found that screening on-site, scheduling separate visits for preventive care, and having non-provider staff recommend and schedule screening services facilitated the delivery of cancer screening. We found work overload to be a barrier to screening. To successfully implement screening strategies within the PCMH model, FQHCs must enhance facilitators and address organizational gaps in their cancer screening processes.