Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated (CLARO PARTE) for Latin America and the Caribbean Countries.

PURPOSE: This study aimed to identify, evaluate, and rank suitable safety innovations developed during the COVID-19 pandemic in Latin American and Caribbean (LAC) radiation oncology centers. METHODS: We conducted a multimodal participatory engagement collaboration with the Latin-American and Caribbean Society of Medical Oncology. The study consisted of four phases. Innovations were collected from a panel of radiotherapy experts representing a diverse group of 11 countries from LAC (Phase I). Next, a medical scientific team compared the innovations against international standards regarding their potential impact on risk of infection, clinical operation, and continuity of quality cancer care (Phase II). Their findings were supplied to the country representatives who rated the innovations for acceptability in their cancer centers (Phase III), resulting in a final report of the panel's recommendations (Phase IV). RESULTS: A total of 81 innovations were reported by the country representatives and merged by the medical scientific team into 24 innovations that combined similar innovations. The 24 innovations were grouped into six categories including practices aimed at (1) reducing clinic crowding (n = 3), (2) increasing screening and vaccinations for COVID-19 disease (n = 5), (3) implementing social distancing (n = 6), (4) strengthening personal infection equipment and disinfection (n = 6), (5) avoiding delaying or shortening treatment protocols (n = 2), and (6) mixed procedures (n = 2). The medical scientific team found nearly all innovations were supported by international recommendations and rated as safe, efficient, and acceptable. CONCLUSION: By using the lessons learned from the Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated study, a manual of scalable practices in radiation oncology clinics may be developed to guide actions during future large-scale public health crises in low- and middle-income countries of LAC.

High-Risk HPV Screening Initiative in Kosovo-A Way to Optimize HPV Vaccination for Cervical Cancer.

Nearly all cervical cancers are caused by persistent high-risk human papillomavirus (hrHPV) infection. There are 14 recognized hrHPV genotypes (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), and hrHPV genotypes 16 and 18 comprise approximately 66% of all cases worldwide. An additional 15% of cervical cancers are caused by hrHPV genotypes 31, 33, 45, 52, and 58. Screening patients for hrHPV as a mechanism for implementation of early treatment is a proven strategy for decreasing the incidence of HPV-related neoplasia, cervical cancer in particular. Here, we present population data from an HPV screening initiative in Kosovo designed to better understand the prevalence of the country's HPV burden and local incidence of cervical cancer by hrHPV genotype. Nearly 2000 women were screened for hrHPV using a real-time polymerase chain reaction (real-time PCR) assay followed by melt curve analysis to establish the prevalence of hrHPV in Kosovo. Additionally, DNA was extracted from 200 formalin-fixed, paraffin embedded cervical tumors and tested for hrHPV using the same method. Cervical screening samples revealed a high prevalence of hrHPV genotypes 16 and 51, while cervical cancer specimens predominantly harbored genotypes 16, 18, and 45. This is the first comprehensive screening study for evaluating the prevalence of hrHPV genotypes in Kosovo on screening cervical brush samples and cervical neoplasms. Given the geographic distribution of hrHPV genotypes and the WHO's global initiative to eliminate cervical cancer, this study can support and direct vaccination efforts to cover highly prevalent hrHPV genotypes in Kosovo's at-risk population.

Providing Diagnostic Pathology Services in Low and Middle-Income Countries.

Diagnostic pathology services in low and middle-income countries are often hindered by lack of expertise, equipment, and reagents. However, there are also educational, cultural, and political decisions, which must be addressed in order to provide these services successfully. In this review, we describe some of the infrastructure barriers that must be overcome and provide 3 examples of implementing molecular testing in Rwanda and Honduras despite initial lack of resources.

Approaches for Measuring Inclusive Demographics Across Youth Enjoy Science Cancer Research Training Programs.

The National Cancer Institute's (NCI) Youth Enjoy Science Program (YES) funds initiatives to support the cancer research training and career ambitions of middle school through undergraduate students from populations underrepresented in the biomedical sciences. The program has funded 16 institutions nationally as of January 2022. Given the program's focus on increasing diversity within the cancer research workforce, demographic characteristics of YES trainees provide essential information about the populations being served and program effectiveness. Six programs formed an interest group focused on trainee demographics and surveyed all YES grantees about their demographic data practices. Fifteen programs (94%) completed the survey. Survey data were analyzed through descriptive statistics and thematic coding. Findings revealed considerable variability in programs' approach to demographic data, including which demographics were measured, how they were operationalized, and when and how the data were collected. Half of YES programs (53%) could report underrepresented populations in biomedical research among trainees using consistent definitions. Most programs described efforts to improve their demographic data practices; however, challenges remained for the vast majority. In consideration of these findings, we offer recommendations for inclusive demographic data practices to better define and retain underrepresented populations in biomedical sciences.

Reducing dermal exposure to agrochemical carcinogens using a fluorescent dye-based intervention among subsistence farmers in rural Honduras.

BACKGROUND: Occupational exposure to agrochemicals, some of which are known or suspected carcinogens, is a major health hazard for subsistence agricultural workers and their families. These impacts are more prevalent in low-and-middle income countries (LMIC) due to weak regulations, lack of awareness of the risks of contamination, predominant use of handheld backpack style spraying equipment, general lack of personal protective equipment (PPE), and low literacy about proper agrochemical application techniques. Reducing exposure to agrochemicals was identified as a paramount concern by rural Hondurans working with a community-engaged research initiative. Fluorescent tracer dyes have been described as a means of visualizing and quantifying dermal exposure to agricultural chemicals, and exposure models adapted for LMIC have been developed previously. Tracer dyes have also been used in educational simulations to promote pesticide safety. However, studies evaluating the effectiveness of these educational dye interventions in reducing future exposure have been lacking. AIM: To evaluate whether observing one's own chemical contamination after applying agrochemicals changed the amount of occupational dermal exposure during a subsequent chemical application. METHODS: We employed a multi-modal community intervention in a rural village in Honduras that incorporated chemical safety education and use of a fluorescent tracer dye during pesticide application on two consecutive occasions, and compared dermal exposure between the intervention group (previous dye experience and safety education, n = 6) and the control group (safety education only, n = 7). RESULTS: Mean total visual score (TVS) of the tracer dye, which accounts for both extent and intensity of whole-body contamination, was lower among those who had previously experienced the dye intervention (mean TVS = 41.3) than among participants who were dye-naïve (mean TVS = 78.4), with a difference between means of -37.10 (95% CI [-66.26, -7.95], p = 0.02). Stratifying by body part, contamination was significantly lower for the anterior left lower extremity and bilateral feet for the dye-experienced group vs. dye-naïve, with most other segments showing a trend toward decreased contamination as well. CONCLUSION: Participants who had previously experienced the dye intervention were significantly less contaminated than the dye-naïve control group during a subsequent spraying event. The findings of this small pilot study suggest that a multi-modal, community-based approach that utilizes fluorescence-augmented contamination for individualized learning (FACIL) may be effective in reducing dermal exposure to carcinogenic agrochemicals among subsistence farmers in Honduras and other LMIC.

Feasibility of Brigade-Style, Multiphasic Cancer Screening in Rural Honduras.

PURPOSE: To evaluate the feasibility of brigade-style, multiphasic cancer screening in Honduras, exploring data from 3 screening events that each tested for multiple cancers on single occasions. METHODS: This series of 3 studies each used a single-arm, post-test-only design to explore the feasibility of implementing multiphasic, community-based cancer screening at the same rural location in 2013, 2016, and 2017. The 2013 event for women screened for 2 cancers (breast and cervix), and the 2016 event for women screened for 3 cancers (breast, cervix, and thyroid). The 2017 event for men screened for 5 cancers (skin, prostate, colorectal, oropharynx, and testes). RESULTS: Totals of 473 and 401 women participated in the 2013 and 2016 events, respectively, and 301 men participated in the 2017 event. Staffing for each event varied from 33 to 44 people and relied primarily on in-country medical students and local community members. High rates (mean, 88%) of compliance with referral for follow-up testing at clinics and primary care facilities were observed after the screening events. CONCLUSION: The multiphasic, community-based approach proved feasible for both women and men and resulted in high rates of compliance with follow-up testing. This approach appears highly replicable: it was conducted multiple times across the years with different screening targets, which could be further scaled elsewhere using the same technique.

Screening for Human Papillomavirus in a Low- and Middle-Income Country.

PURPOSE: Low- and middle-income countries have high incidences of cervical cancer linked to human papillomavirus (HPV), and without resources for cancer screenings these countries bear 85% of all cervical cancer cases. To address some of these needs, brigade-style screening combined with sensitive polymerase chain reaction-based HPV testing to detect common high-risk HPV genotypes may be necessary. METHODS: We deployed an inexpensive DNA extraction technique and a real-time polymerase chain reaction-based HPV genotyping assay, as well as Papanicolaou testing, in a factory in San Pedro Sula, Honduras, where 1,732 women were screened for cervical cancer. RESULTS: We found that 28% of participants were positive for high-risk HPV, with 26% of HPV-positive participants having more than one HPV infection. Moreover, the most common HPV genotypes detected were different than those routinely found in the United States. CONCLUSION: This work demonstrates a deployable protocol for HPV screening in low- and middle-income countries with limited resources to perform cytopathology assessment of Pap smears.

Feasibility of a Symptom Management Intervention for Honduran Adults Undergoing Chemotherapy.

Evidence-based interventions often need to be adapted to maximize their implementation potential in low-to middle-income countries. A single-arm feasibility study was conducted to determine the feasibility and acceptability of a telephone-delivered, nurse-led, symptom management intervention for adults undergoing chemotherapy in Honduras. Over the course of 6 months, nurses engaged 25 patients undergoing chemotherapy in the intervention. Each participant received an average of 16.2 attempts to contact them for telephone sessions (SD = 8.0, range = 2-28). Collectively, the participants discussed 24 different types of symptoms. The most commonly discussed symptoms were pain (12%), nausea (7%), and constipation (5%). Qualitative and quantitative data were used to identify treatment manual modifications (i.e., adding content about different symptoms and addressing scheduling of treatment) and workplace modifications (i.e., dedicated nurse time and space) that are needed to optimize implementation of the intervention.

Implementation of Multicolor Melt Curve Analysis for High-Risk Human Papilloma Virus Detection in Low- and Middle-Income Countries: A Pilot Study for Expanded Cervical Cancer Screening in Honduras.

PURPOSE: Cervical cancer is a leading cause of cancer-related mortality in low- and middle-income countries (LMICs) and screening in LMICs is extremely limited. We aimed to implement on-site high-risk human papillomavirus (hrHPV) DNA testing in cohorts of women from an urban factory and from a rural village. METHODS: A total of 802 women were recruited for this study in partnership with La Liga Contra el Cancer through the establishment of women's health resource fairs at two locations in Honduras: a textile factory (n = 401) in the city of San Pedro Sula and the rural village of El Rosario (n = 401) in Yoro. Participants received a routine cervical examination during which three sterile cytobrushes were used to collect cervical samples for testing. hrHPV genotyping was performed using a hrHPV genotyping assay and a real-time polymerase chain reaction instrument. RESULTS: hrHPV status across all participants at both sites was 13% hrHPV positive and 67% hrHPV negative. When hrHPV status was compared across all three testing sites, hrHPV-positive rates were approximately equal among the factory (13%), village (12%), and confirmatory testing at Dartmouth-Hitchcock Medical Center (Lebanon, NH; 14%). hrHPV genotype was compared across sites, with HPV16 showing the highest infection rate (15%), followed by HPV59 (12%), and HPV68 (11%). There was a low prevalence of HPV18 observed in both populations compared with the hrHPV-positive population in the United States. CONCLUSION: In collaboration with oncologists and pathologists from La Liga Contra el Cancer, we were able to provide a continuum of care once health-fair testing was performed. We established a method and implementation plan for hrHPV testing that is sustainable in LMICs.

Rural distribution of human papilloma virus in low- and middle-income countries.

Cervical cancer rates in low- and middle-income countries (LMICs) are higher than in developed countries and account for 80% of an estimated 500,000 new cases annually. Factors that contribute to this are that diagnostic and prevention strategies designed for developed countries suffer from the combination of low vaccination rates and limitations due to lack of consistent access to both healthcare and supplies. Here we: 1) improve upon our LMIC deployable HPV test and 2) determine both the high and low-risk HPV genotype prevalence in an isolated Honduran population. We found an unexpected HPV distribution with an abundance of HPV 52 and HPV 72 infections. In this context, molecular testing using a LMIC deployable approach for the detection of HPV can aid in both the triage of HPV positive cytology-based follow up and provide information regarding HPV genotype distribution in support of vaccination strategies.

Opportunistic Breast Cancer Education and Screening in Rural Honduras.

PURPOSE: In Honduras, the breast cancer burden is high, and access to women's health services is low. This project tested the connection of community-based breast cancer detection with clinical diagnosis and treatment in a tightly linked and quickly facilitated format. METHODS: The Norris Cotton Cancer Center at Dartmouth College partnered with the Honduran cancer hospital La Liga Contra el Cancer to expand a cervical cancer screening program, which included self-breast exam (SBE) education and clinical breast exams (CBEs), to assess patient attitudes about and uptake of breast cancer education and screening services. The cervical cancer screening event was held in Honduras in 2013; 476 women from 31 villages attended. RESULTS: Half of the women attending elected to receive a CBE; most had concerns about lactation. Clinicians referred 12 women with abnormal CBEs to La Liga Contra el Cancer for additional evaluation at no cost. All referred patients were compliant with the recommendation and received follow-up care. One abnormal follow-up mammogram/ultrasound result was negative on biopsy. One woman with an aggressive phyllodes tumor had a mastectomy within 60 days. Multimodal education about breast cancer screening maximized delivery of women's health services in a low-tech rural setting. CONCLUSION: The addition of opportunistic breast cancer education and screening to a cervical cancer screening event resulted in high uptake of services at low additional cost to program sponsors. Such novel strategies to maximize delivery of women's health services in low-resource settings, where there is no access to mammography, may result in earlier detection of breast cancer. Close follow-up of positive results with referral to appropriate treatment is essential.

Impact and outcomes of a rural Personal Helpers and Mentors service.

OBJECTIVE: To describe impacts and outcomes associated with the Personal Helpers and Mentor's (PHaMs) service in a rural Australian town. DESIGN: A descriptive analysis of longitudinal data, uncontrolled pre-test and post-test caseworker ratings, and retrospective pre-test/post-test self-ratings and feedback comments were collected from convenience samples. SETTING: A community-based mental health recovery service. PARTICIPANTS: n=76 mental health consumers; mean age=37.78 years; 45% male; 63% Aboriginal; primary diagnoses=41% psychotic disorder and 61% mood disorder; co-morbid diagnosis=45% substance use disorder. INTERVENTIONS: Individual recovery plan (IRP), personal goal setting, caseworker mentoring and support. MAIN OUTCOME MEASURES: Gains towards goals, the Role Functioning Scale (RFS), self-ratings and feedback comments. RESULTS: The most frequently addressed goals were: attend mental health treatment services, acquire suitable accommodation and be more involved in the community. IRP completers (n=19) showed a significant improvement in caseworker-rated adaptive functioning which was adequate at case closure (t(18)=-4.38, P<0.001). Participant (n=19) ratings of the service and its key performance indicators suggested global satisfaction and gains in the management of everyday tasks, use of medications and community engagement. Good rapport was reported with the locally trained and predominantly Aboriginal (56%) staff. CONCLUSIONS: PHaMs shows promise for assisting rural people with mental illness to improve their everyday functioning, medication management and community involvement. Recruitment and capacity-building of Aboriginal staff appears to facilitate Aboriginal consumer participation.

Confirmatory factor analysis of the Injustice Experience Questionnaire in an Australian compensable population.

PURPOSE: This study examined the factor structure of the Injustice Experience Questionnaire (IEQ; Sullivan et al. in J Occup Rehabil 18:249-261, 2008) using confirmatory factor analysis (CFA). Two models were proposed for analysis: a single factor and a two-factor model. METHODS: A total of 150 participants (81 males and 69 females, mean age = 45.48 years, SD = 10.71), with a chronic work-related musculoskeletal disorder (53 % back condition), and a mean duration of work disability of 4.34 years (SD = 5.14), completed the IEQ and measures of depression and anger. CFA was performed on the IEQ data using the maximum likelihood estimation method. RESULTS: Neither proposed model provided an acceptable fit; however, a good fitting model with two highly correlated factors and one error covariance was derived through post hoc model fitting. The two-factors were differentially correlated to depression and duration of work disability, but not anger. CONCLUSIONS: The IEQ appears to be a useful tool to support the comprehensive psychosocial assessment of injured workers with long-term disability secondary to a musculoskeletal disorder. In addition to identifying perceived injustice, the IEQ may also be used to inform the choice of psychological interventions. The IEQ has construct validity and generalizability across different populations of injured workers.

Experience-induced changes in sugar taste discrimination.

An apparent plasticity in glucose sensitivity was first noted while studying human taste variants, but the experimental design did not rule out regression to the mean. Since then, a human taste induction hypothesis that sensitivity for a taste stimulus increases with repeated exposure to it has been supported first by experience-induced changes in taste identification of monosodium glutamate and, subsequently, in sensory detection of glutaraldehyde, as well as in psychophysical and functional magnetic resonance imaging responses to novel taste stimuli. Yet, whether such plasticity occurs for the highly familiar taste of sugar remained unconfirmed. Therefore, we tested the taste induction hypothesis for sugar using a counterbalanced design, consisting of 3 pretreatment and 2 treatment conditions. The effects over time also were followed with an additional group of participants. The results showed that 1) experience with fructose significantly increases sensitivity for the taste of a sugar, glucose; 2) there are no significant differences in the sugar sensitivity between groups of randomly assigned participants before treatments; 3) a single session of 5 brief tastings of glucose has an effect on glucose sensitivity when tested 11 or 12 days later; and 4) without continued treatment, the increased sensitivity reverses within 33 or 34 days.

Experience-induced changes in taste identification of monosodium glutamate (MSG) are reversible.

A few studies have reported experience-inducible changes in human taste and olfactory sensitivities. However, no study thus far has systematically characterized the stability of the enhanced sensitivities. In our previous study, we found increases in taste identification ability for monosodium glutamate (MSG) in subjects who had been briefly exposed to MSG in food for 10 days. Here, we tested the temporal stability of the enhanced taste identification ability. First, we exposed a group of 20 subjects to MSG in food and then compared their sensitivities to MSG with those of a control group. When tested on day 11 or 12, the mean MSG taste identification ability of the MSG-exposed group was significantly higher than the control group. Next, 11 of the subjects who were exposed to MSG in food initially, and then stopped being exposed performed significantly poorer in identifying MSG after 10 days of the nonexposure than they did 10 days before. In contrast, nine subjects who were exposed to MSG initially and continued being exposed maintained their high identification levels. These results support earlier finding of the plasticity in the taste identification of MSG and show that the enhanced identification ability can be reversed rapidly when MSG exposure is not sustained.

Experience-induced changes in taste identification of monosodium glutamate.

Taste sensitivity for a given subject generally has been thought to be genetically determined and not plastic. Yet experience-inducible changes in human taste and olfactory sensitivities have been reported. To test a taste induction hypothesis, we exposed 17 Americans/Europeans to monosodium glutamate (MSG) in food and then compared their ability to identify MSG taste with that of 2 control groups (18 Americans/Europeans without MSG exposure and 18 Japanese). When tested on Day 11 or 12, the Americans/Europeans exposed to MSG were able to identify MSG at significantly lower concentrations than the Americans/Europeans without MSG exposure. Moreover, Japanese subjects who had prior extensive experience with MSG in Japanese food were able to identify MSG at significantly lower concentrations than the two American/European groups. The differences in identification ability between the two American/European groups challenge the notion of taste sensitivity as stable over time and support the hypothesis of an experience-inducible component in human taste.