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Introduction: Women constitute about one-half of the workforces in most countries and spend a significant proportion of their time at the workplace, contributing to a lot of physical and mental stress. The health-care professional in the workforce was the most affected during the COVID-19 pandemic. COVID-19 and noncommunicable diseases (NCDs) and associated risk factors have a substantial correlation. According to numerous studies from around the world, people who already have established risk factors such as diabetes, hypertension, obesity, or other vascular risk factors, are more likely to contract COVID-19 and experience complications or even pass away from it. Objectives: The objective is to assess the health status of working women in a tertiary health-care center in Kerala during the COVID-19 pandemic. Methodology: The study was done in a tertiary health-care center in Kozhikode district, Kerala, South India. This center comprises medical, paramedical and nursing institutes. A total of 262 women were included in the study, and data were collected using a semi-structured questionnaire. Results: This study demonstrated that working women's stress was prevalent. It reveals that 94 (99.4%) women experience stress, 60.7% experience depression, 72.5% do not engage in daily physical activity and 80.8% of women were at risk of having NCDs. Conclusion: This study was an attempt to explore the health status of the women's working health status during COVID-19 time. It found that some women are hypertensive, depressed and have stress-related disorders such as anxiety and worries. Mental health is directly linked with physical activity. The stress levels were controlled for those who were involved in physical activity on regular basis. Hence, we should work on this area to help improve these conditions. [ABSTRACT FROM AUTHOR]

Introduction: India has experienced many phases of the rise and fall of Coronavirus Disease-2019 (COVID-19) cases from the first quarter of 2020 to the present date. It is important to periodically assess the clinicoepidemiology and local factors affecting the pandemic in each geographical area. Emerging Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) variants {Variants of Concern (VOC) and Variants of Interest (VOI)} are contributing to ongoing unprecedented outbreaks, posing new challenges. Continuous surveillance is essential to keep track of currently circulating lineages. Aim: To study the clinicoepidemiological trends of COVID-19 disease in patients. Materials and Methods: A cross-sectional descriptive study was conducted on 53,311 suspected COVID-19 patients attending Jaipur National University of Medical Sciences and Research (JNUIMSRC), Jaipur, Rajasthan, India. Sociodemographic variables, clinical signs and symptoms, details of hospitalisation, and mortality data were collected between May 2020 and April 2022. All patients with Influenza-like illness and suspected COVID-19 were included in the study. Ribonucleic Acid (RNA) extraction and Polymerase Chain Reaction (PCR) were performed using Indian Council of Medical Research (ICMR) approved kits. Mean, median, and “p-values” were calculated using Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 21.0 software. Results: A total of 15.77% (8410/53,311) of patients tested positive for SARS-CoV-2 by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The median age of the patient population was 43±18.44 years, with a male-to-female ratio of 1.86, 33.21% (2793/8410) of patients were asymptomatic. Cough (56.74%; 4772/8410) was the most common symptom, followed by fever (56.48%; 4750/8410) and sore throat (50.31%; 4231/8410). The surge in the number of COVID-19 positive cases varied month-wise during the study period. The case fatality rate was 3.19%. Conclusion: Asymptomatic cases have contributed to the widespread distribution of COVID-19 disease. Periodic remodeling of testing and mitigation strategies is required, given the early detection of asymptomatic infections in comorbid and elderly patients for the management of the COVID19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Breast cancer awareness and early detection are critical for reducing the global burden of the disease. This study assessed breast cancer awareness among women in a high-altitude sub-Himalayan region of North India. Materials and Methods: A cross-sectional survey was conducted among women attending the gynecology outpatient clinic in a district hospital. A structured questionnaire was used to collect data on breast cancer knowledge, attitudes, and practices. Participants received posttest health education and counseling on breast cancer prevention strategies. Result: The study included 188 participants with a mean age of 31.0 ± 8.8 years. The findings revealed inadequate knowledge about breast cancer among a significant portion of the cohort. Misconceptions about risk factors, such as breastfeeding, oral contraceptive use, and past wrongdoings, were observed. Only half of the participants believed early-stage breast cancer could be effectively treated. Limited awareness of screening methods, including self-breast examination and mammography, was noted. Barriers to breast self-examination (BSE) included considering it unnecessary and lacking knowledge about its execution. Conclusion: This study highlights insufficient breast cancer awareness in the high-altitude sub-Himalayan region. Targeted interventions, including health campaigns and electronic media, should be prioritized to improve knowledge and promote early detection practices. [ABSTRACT FROM AUTHOR]

Cardiovascular Disease (CVD) remains a significant health concern, especially in regions like India, where its prevalence is on the rise. In response to this, we present a groundbreaking approach to CVD recognition using Convolutional Neural Networks (CNN) applied to an audio dataset containing heartbeats. Our study's primary objective was to detect CVD, with a particular focus on distinguishing between five distinct classes: normal, murmur, extra heart sound, artifact, and extrasystole. Our CNN model achieved an impressive 70% accuracy in classifying these heartbeat sounds. Importantly, for abnormal heartbeats, the model can accurately identify the type of anomaly and provide essential information on symptoms, treatments, and the urgency of seeking medical attention. In India, CVD poses a pressing health issue, with a high incidence of undiagnosed cases due to the limitations of traditional diagnostic methods, including their cost and time consumption. This study addresses the need for accessible, accurate, and rapid CVD diagnosis through an innovative approach. We employed a CNN architecture to process and classify audio heartbeat data from the Dangerous Heartbeat Dataset (DHD), implementing techniques such as data augmentation and cross-validation to optimize performance. The CNN model successfully classified heartbeat sounds into their respective categories and provided valuable insights for abnormal heartbeats, including symptom identification, treatment recommendations, and advice on seeking medical attention. This research has the potential to revolutionize CVD diagnosis by offering a non-invasive, cost-effective, and time-efficient method that can be widely accessible. The model's accuracy and ability to provide symptom and treatment guidance have the potential to reduce the burden on healthcare systems, leading to earlier interventions and improved patient outcomes. Future research in this field should focus on expanding the dataset and improving model generalization. Practical applications include integrating this technology into portable devices for early screening and enhancing telemedicine capabilities for rural and underserved areas. In conclusion, this study demonstrates that CNN-based audio analysis can provide an accurate, accessible, and informative method for CVD detection, with the potential to transform the landscape of cardiovascular healthcare in India and beyond. [ABSTRACT FROM AUTHOR]

The total or partial impairment of auditory sense is one of the most prevalent sensory deficits. It causes an immense impact on a person's daily activities, social, economic, and overall being. Out of every one thousand infants being born, about five to six suffer from hearing loss. Unfortunately, in our Indian scenario, they go undiagnosed immediately after birth. By the time the parents recognize the problem, the children have already crossed two years of age, and the most important time for development of speech and language has passed. The only way to counter this problem is to screen all newborns universally, right after their birth. Trained healthcare personnel can be equipped to screen the infants. The National Program for Prevention and Control of Deafness, India advocated this Universal Newborn Hearing Screening. The only way forward is to diagnose these children with hearing impairment early and give them appropriate means of rehabilitation, to reduce our burden of deafness in society. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of breast cancer is increasing in India, making it the most common cancer among women. Early detection of breast cancer is crucial for reducing morbidity, mortality, and improving the quality of life for patients. However, breast cancer mortality rates are higher in India compared to other parts of the world, possibly due to late-stage diagnosis. Regular screening is key to early detection, but population screening is not feasible in India due to limited resources. Therefore, high-risk screening is a more practical approach. Assessing individual risk using a breast cancer risk calculator can help identify asymptomatic women at high-risk and motivate them to undergo regular screening, leading to early detection. Aim: To assess the risk of developing breast cancer among women in Kerala using a breast cancer risk calculator and to describe their screening practices. Materials and Methods: A cross-sectional survey was conducted among 1861 women aged over 30 years in Thiruvananthapuram, Kerala, India. Personal details of the participants, major known risk factors of breast cancer, and information about breast cancer screening practices were collected using a questionnaire. Breast cancer risk stratification was performed using the Snehita breast cancer risk calculator. Results: According to the breast cancer risk calculator, 12.74% of the women were classified as high-risk and 65.18% had a normal risk of developing breast cancer. Among the participants, 82.64% stated that they had never undergone any breast cancer screening procedures. Conclusion: Despite Kerala being a state with high female literacy rate, the screening practices for breast cancer were found to be very low (17.36%). Additionally, 12.74% of the women were identified as being at high-risk of developing breast cancer. Breast cancer risk calculators can serve as a motivational tool to encourage women to undergo regular screening. [ABSTRACT FROM AUTHOR]

Background: Currently, oral cancer in India ranks among the top three types of cancer affecting mainly the elderly population. However, recent years have witnessed a marked increase in the younger people less than 45 years of age being affected by oral squamous cell carcinoma (OSCC). Thus, its early detection and treatment are of utmost importance and this responsibility lies with the healthcare providers. Therefore, we planned this study to assess the knowledge, attitude and practices of oral cancer among undergraduate dental and medical students. The objective was to suggest strategies to improve awareness on oral cancer. Methods: A pretested questionnaire comprising nineteen questions were distributed among 193 undergraduate dental and 218 undergraduate medical students of our university. Fundamental questions were included in the clinical examination, risk factors and need for information lectures on oral cancer. Chi-square and ANOVA tests were used to analyse the data. Results: The response rate of the study was good with 91.7% (177/193) of the dental and 88% (191/218) of the medical undergraduates participating in the survey. Though dental students had sufficient knowledge regarding the prevention and detection of oral cancer, however, medical students were less aware of the investigative methods of oral cancer. Conclusion: Though the mean knowledge of the dental students was good, they were not confident of diagnosing the early clinical symptoms of oral cancer. Practices on detection of oral cancer have to be reinforced among medical students so that they can contribute to its prevention. [ABSTRACT FROM AUTHOR]

It has been 46 years since the launch of cancer control programs in India and yet the recent National Family Health Survey (fifth round, 2019–2021) has reported that just 1.9% of women aged 30–49 years have ever undergone cervical cancer screening. The cost of delayed diagnosis of cervical cancer and its treatment is overwhelming, and the rural population takes the worst hit. It is the need of the hour that the Indian health system and policymakers identify the barriers and facilitators for cervical cancer early detection and provide pragmatic solutions so that the targets of cervical cancer elimination can be achieved in a timely manner. Nationwide implementation of early detection of cervical cancer, as envisioned in the Operational Guidelines formulated by the Government of India for the prevention and control of common cancers, requires monumental efforts. The authors discuss various factors that act as deterrents to population‐based cervical cancer screening in India and the factors that can facilitate the early detection of cervical cancer. [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer (BC) presents a major public health challenge world-over including India. While several risk-factors, early signs and symptoms of BC are known, the knowledge and awareness of this disease remains poor among the population. The present study aimed to determine the extent of knowledge and awareness of BC, its risk factors, early signs and symptoms and breast self-examination (BSE) practice as an early detection method among Indian college-going female students. Design/methodology/approach: The authors conducted a cross-sectional survey at a University in Delhi-NCR. Data on socio-demographic, knowledge and awareness of BC including BSE was collected using a pretested questionnaire. Chi-square test and logistic regression analysis was performed. All tests were two-sided and significance was set at p < 0.05. Findings: A total of 866 female students participated in the study with mean age of 22.32 (±0.146) years having mean body mass index (BMI) of 21.22 (±3.52). As high as 82.1% of the participants had heard of BC but while 74.8% thought early detection is possible, 70.7% believed BC cannot be prevented. Gene mutations (60.2%) were identified as a significant risk factor, while breast pain (61.4%) was commonly recognized as a sign of BC. Only 29.8% of students ever performed BSE. Increased odds of performing BSE (OR = 3.4) was found among students who recognized gene mutations as an important BC risk factor. Research limitations/implications: Knowledge and awareness of BC including BSE among female college students were found to be below average. It is suggested that there is an urgent need for increasing BC awareness among young girls through workshops and mobile-health interventions. Practical implications: This study provides new information on the level of knowledge and awareness of BC risk factors, sign and symptoms and self-examination practice among young college girls. Moreover, this study advocates the need for design and implementation of a sustainable digital health model for active population BC screening, which is not being done currently. Social implications: BC is a highly aggressive disease, which is now one of the leading causes of morbidity and mortality in India and world over. Although the knowledge of BC risk factors and its signs and symptoms have increased, the awareness of these elements among the general population at large is low and/or missing, especially in India. Furthermore, as a consequence of unorganized screening programs in the country, majority of women are presenting young with locally advanced disease. Understanding the existing level of knowledge and educating school, college and University students of the pertinent factors and screening practices such as BSE could drastically help in improving the self-screening and/or clinical examination rates. This could potentially lead to early detection and improved prognosis, thus ameliorating disease burden. Originality/value: This study is one of the few studies conducted in India among young female college students belonging to non-medical backgrounds, delineating the level of knowledge and awareness of BC risk factors and signs and symptoms along with practice of early detection method such as BSE. The study has a considerable sample size and provides valuable evidence for a need to implement programs incorporating digital health models for accelerating awareness and screening of young girls in both rural and urban settings. [ABSTRACT FROM AUTHOR]

Justification: When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited guidelines for its screening. Process: A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance guidelines for DDH. Objectives: To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH. Recommendations: Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal. [ABSTRACT FROM AUTHOR]

Background: Low participation in screening and poor follow-up are major challenges in implementing population based screening in developing countries. Determinants of participation in a community-based organized cervical cancer screening program are discussed here. Objectives: The objectives were to study factors determining compliance of women for cervical cancer screening in an urban low socioeconomic setting. Methodology: Community-based service program was conducted for screening uterine cervix cancers with a visual inspection of the cervix on the application of 5% acetic acid by trained primary health workers. The process involved the selection of clusters, household surveys, health education, and screening of eligible women for uterine cervix cancer. Logistic regression analysis was conducted to identify determinants of participation in cervical cancer screening. Results: A total of 138,383 population were surveyed, of which 21,422 eligible women were contacted and 16,424 (82.50%) complied for screening. According to the results of univariate and multivariate analysis, women belonging to the age group of 30–39 (80.69%), literate women with school level or education up to Senior College (78.97% and 80.86%) (odds ratio [OR], 1.323; P ≤ 0.001) and (OR, 1.402; P ≤ 0.001), belonging to Hindu religion (77.20%), speaking Marathi (77.07%), and with a family history of cancer (81.93%) had higher participation for screening, while women belonging to the Muslim community (73.95%) (OR, 0.743; P ≤ 0.001), speaking other than Marathi and Hindi language (73%) (OR, 0.872; P = 0.017), illiterate women (70.71%), and graduate women (70.78%) had lower participation. Conclusion: High compliance can be achieved by providing good-quality health education and setting up of screening clinics in vicinity of participating women. [ABSTRACT FROM AUTHOR]

Objectives: The present study focusses on cytomorphological evaluation of the scrapings and cytological appearance of a spectrum of lesions of the oral cavity, Morphometric nuclear and cytoplasmic parameters were used to distinguish between benign, premalignant and malignant lesions. Material and Methods: The samples were obtained by scraping the lesion firmly till tiny pin point bleeding points were seen to ensure adequate sampling. Adequate sampling was defined as 50 cells consisting of transepithelial cytology specimen (superficial, intermediate and basal cells). Results: A total of 80 patients were evaluated with predominance in males and mean age of presentation was 45.05± 12.8 years. Cytomorphomteric analysis revealed an increasing trend in nuclear parameters as the spectrum of oral lesion moved from benign to malignant category while a decline was observed in cellular parameters. A significant p value of <0.0001 was found between cytomorphometrical parameters and histopathological subtypes. Sensitivity and specificity of conventional exfoliative cytology in conjunction with cytomorphometry was 100% and 94.74% respectively. Negative predictive value and positive predictive value of cytology for malignant lesions was 100% and 93.75% respectively. Diagnostic accuracy of cytology in predicting malignancy taking histopathology as gold standard was 97.0. Conclusion: Grading and scoring of oral cytosmears according to morphology showed a positive correlation with histopathological diagnosis. In addition, cytomorphometry increases the diagnostic accuracy of oral conventional exfoliative cytology and hence is seen to have an impact on early detection of cellular alterations and prompt treatment. Therefore, it is a sensitive and useful adjunct to monitor the cellular transformation. [ABSTRACT FROM AUTHOR]

Cervical cancer is a major public health challenge that can be cured with early diagnosis and timely treatment. This challenge formed the rationale behind our design and development of an intelligent and robust image analysis and diagnostic tool/scale, namely "OM—The OncoMeter", for which we used R (version-3.6.3) and Linux (Ubuntu-20.04) to tag and triage patients in order of their disease severity. The socio-demographic profiles and cervigrams of 398 patients evaluated at OPDs of Batra Hospital & Medical Research Centre, New Delhi, India, and Delhi State Cancer Institute (East), New Delhi, India, were acquired during the course of this study. Tested on 398 India-specific women's cervigrams, the scale yielded significant achievements, with 80.15% accuracy, a sensitivity of 84.79%, and a specificity of 66.66%. The statistical analysis of sociodemographic profiles showed significant associations of age, education, annual income, occupation, and menstrual health with the health of the cervix, where a p-value less than (<) 0.05 was considered statistically significant. The deployment of cervical cancer screening tools such as "OM—The OncoMeter" in live clinical settings of resource-limited healthcare infrastructure will facilitate early diagnosis in a non-invasive manner, leading to a timely clinical intervention for infected patients upon detection even during primary healthcare (PHC). [ABSTRACT FROM AUTHOR]

Background: Breast cancer remains a pervasive threat to women worldwide, with increasing incidence rates necessitating effective screening strategies. Timely detection with mammography has emerged as the primary tool for mass screening. This retrospective study, which is part of the Chiraiya Project, aimed to evaluate breast lesion patients identified during opportunistic mammography screening camps in Jammu Province, India., Methods: A total of 1505 women aged 40 years and older were screened using a mobile mammographic unit over a five-year period, excluding 2020 and 2021 due to the COVID-19 pandemic. The inclusion criterion was women in the specified age group, while the exclusion criterion was women with open breast wounds, history of breast cancer or a history of breast surgery. The screening process involved comprehensive data collection using a detailed Proforma, followed by mammographic assessments conducted within strategically stationed mobile units. Radiological interpretations utilizing the BI-RADS system were performed, accompanied by meticulous documentation of patient demographics, habits, literacy, medical history, and breastfeeding practices. Participants were recruited through collaborations with NGOs, army camps, village panchayats, and urban cooperatives. Screening camps were scheduled periodically, with each camp accommodating 90 patients or fewer., Results: Among the 1505 patients, most were aged 45-50 years. The number of screenings increased yearly, peaking at 441 in 2022. The BI-RADS II was the most common finding (48.77%), indicating the presence of benign lesions, while the BI-RADS 0 (32.96%) required further evaluation. Higher-risk categories (BI-RADS III, IV, V) were less common, with BI-RADS V being the rarest. Follow-up adherence was highest in the BI-RADS III, IV, and V categories, with BI-RADS V achieving 100% follow-up. However, only 320 of 496 BI-RADS 0 patients were followed up, indicating a gap in continuity of care. The overall follow-up rate was 66.89%. Compared to urban areas, rural areas demonstrated greater screening uptake but lower follow-up rates, highlighting the need for tailored interventions to improve follow-up care access, especially in rural contexts., Conclusion: This study underscores the efficacy of a mobile mammographic unit in reaching marginalized populations. Adherence to screening protocols has emerged as a linchpin for early detection, improved prognosis, and holistic public health enhancement. Addressing misconceptions surrounding mammographic screenings, especially in rural settings, is crucial. These findings call for intensified efforts in advocacy and education to promote the benefits of breast cancer screening initiatives. Future interventions should prioritize improving access to follow-up care and addressing screening to enhance breast cancer management in Jammu Province., (© 2024. The Author(s).)

Cervical cancer continues to be a major public health concern in India and other low- and middle-income countries. Tata Memorial Centre, India, has been at the forefront in providing treatment, developing best practice guidelines for low-cost efficacious interventions, conducting practice-changing randomized trials and engaging in regional and international collaborations for education and research in cervical cancer. This review summarizes how cervical cancer research and clinical care has evolved over the past two decades at the Tata Memorial Centre, right from testing low-cost public health screening of cervical cancers to the incorporation of the latest technological advancements and providing high-quality evidence for therapeutic management of cervical cancer. The various ongoing strategies for improving survival, toxicity reduction, translational research studies, educational activities and teaching programmes initiated by the Tata Memorial Centre at both national and international levels are discussed. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common cancer among women. Totally 14%of the breast cancer accounts among Indian women. It is reported that with every four minutes, an Indian woman is diagnosed with breast cancer. Women can self-diagnose their condition and know of the presence of lumps or masses that suggest cancerous outgrowths. The very reason for a low breast cancer survival rate of women in India accounts from its lack of awareness and poor early screening and diagnosis rates. Therefore, it is highly important for the public to be educated on breast cancer and to know the steps to detect it early as soon as possible. Self-structured questionnaire consisting of 15 close-ended questions was circulated through an online survey planet application among randomly selected 100 participants to Female College students in Chennai. The data obtained were subjected to statistical analysis. This survey shows that 66.5% of the female students in Chennai have Knowledge and awareness towards Breast self Examination. Female College students who practiced breast self-examination had significantly higher knowledge level than those who had not. The respondents had a high knowledge level of breast self-examination and also they were aware of the symptoms of breast cancer. The present study indicated that most of the female participants are aware of Breast self Examination. The findings from this survey imply that proper training, continuing education programs, and short-term courses about Breast Self Examination are required. Therefore it would be useful to obtain enough knowledge, attitude and behavior of Breast self Examination in order to understand how much this is affecting the awareness and uptake of screening among college women, as well as facilitate in the identification of areas for potential improvement. [ABSTRACT FROM AUTHOR]

Background: The three most commonly occurring cancers in India are those of the breast, uterine cervix, and lip or oral cavity, together accounting for approximately 34% of all cancers. All the three cancers are amenable to prevention, early detection, and treatment through which the morbidity and mortality due to these cancers can be reduced. This pilot study was conducted to assess the operational feasibility of the national cancer screening guidelines. Method: This study was conducted in the Dibrugarh district of Assam in seven tea garden hospitals which serve as the primary health centers for the tea estate population in the Northeast region of India. The study intervention was a three-day training package designed to train primary care physicians in population-based screening for oral, breast, and cervical cancers. Knowledge evaluation and skill assessment were performed with a validated questionnaire and checklist, respectively. Results: Pre and posttraining knowledge assessment showed significant gain in the knowledge levels of the participants in all topics. The greatest knowledge increase was seen in breast cancer (96.3%), followed by cervical cancer (57.5%), oral cancer (35.5%) and general cancer-related information (16.7%). The skill assessment done for each participant individually at the end of the training indicated a need for retraining all participants in breast cancer screening. Conclusion: The learnings from this study will be of great help in scaling up the capacity building programme for cancer screening when the nation-wide population-based cancer screening programme will be rolled out in the country. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer among women in India. Jhpiego, a not-for-profit health organization, is providing technical assistance for developing an evidence-based model of breast health care in the states of Uttar Pradesh and Jharkhand in India.Methods: A situational assessment of breast health care services using validated tools was conducted in the 2 states.Results: Findings of the assessment were presented to the Breast Health Technical Advisory Committee comprised of subject experts and government functionaries. The committee, guided by Breast Health Global Initiative resource-stratified guidelines, developed a conceptual framework for integration of breast health services into the existing health system. This conceptual framework was presented to the Technical Advisory Groups (TAGs) of the respective state governments. Each TAG then developed an operationally feasible, contextually appropriate implementation plan in alignment with the national guidelines for noncommunicable diseases. This implementation plan guided the rollout of the breast health care program in the Lucknow (Uttar Pradesh) and Ranchi (Jharkhand) districts.Conclusions: Early results from the implementation suggest that it is feasible to integrate the breast health care pathway with the ongoing National Cancer Control Program of India. [ABSTRACT FROM AUTHOR]

Background: Globally and in India, breast cancer is a prevalent malignancy. India saw 178,361 new cases and 90,000 deaths in 2020. Timely detection is vital, highlighting the importance of Breast Self-Examination (BSE), especially in low-income settings. Strengthening BSE in awareness and screening efforts is urgent. Despite awareness, practical application lags due to women's reluctance. Effective execution demands partnerships, a multi-sectoral strategy, and training grassroots workers., Objective: To address these challenges, the present study aims to strengthen the breast cancer screening program using BSE strategy and adopting a referral mechanism for the diagnosis and treatment of suspect cases., Methods: A community-based study occurred in specific districts of Rajasthan (2017-2022), enhancing breast cancer screening for women aged 30-65. It involved healthcare providers and local women, utilizing tools like the MT-DM-GP6620 Breast Inspection Model, educational booklets, and semi-structured schedules. The strategy encompassed knowledge assessment, capacity building for healthcare providers, BSE training, increasing women's breast cancer awareness, suspect case referrals, and phone-based follow-up., Results: Our study encompassed 157,225 women aged 30-65 in Jodhpur, Jalore, and Pali districts. Initial breast self-examination (BSE) awareness was below 1%. BSE training reached 218,978 women using booklets and demonstrations, with 72% aged 30-65 and the rest 15-30. Follow-ups reinforced BSE, leading to 745 identified suspect breast cancer cases, mostly due to painless lumps (332 cases). Capacity-building workshops involving 824 medical and paramedical staff strengthened early breast cancer detection in Jodhpur and Jalore, in collaboration with the district health department., Conclusion: The study model's success suggests its applicability in other Rajasthan districts, Indian states, and global breast cancer prevention programs. While positive outcomes were evident, challenges related to culture, cost, and benefits warrant consideration. The approach prioritized early detection through community engagement, reducing patient and government burdens. Community involvement and healthcare engagement were pivotal, with breast self-examination proving effective for enhancing awareness and early detection. Promoting BSE education can significantly enhance breast cancer awareness and early detection., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer SG declared a shared parent affiliation with the author AS to the handling editor at the time of review., (Copyright © 2023 Sangwan, Huda, Panigrahi, Toteja, Sharma, Thakor and Kumar.)

The study aims to develop and validate a video-based screening instrument for autism spectrum disorder that parents may use. Purposive sampling was used in all stages of this study to select distinct groups of participants in various stages such as development, judgement quantifying, pretest with sentences, and pretest with videos. Parents in India can use the Nayak Autism Screening Instrument which consists of 24 2-dimensional animated videos on a scale of 1-4 and one descriptive item to identify behavioural indications of ASD in children between the ages of 3 and 10., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest, (Copyright © 2023 Elsevier B.V. All rights reserved.)

With unprecedented surge in the incidence and prevalence of cancer in India, it has become imperative to strengthen the workforce for all the domains of cancer care. A large proportion of the activity required for prevention as well as for palliation, lie outside of tertiary institutions, in the community. Palliative care (PC) as a field is expanding exponentially across the country and the service providers often engage and work actively within the local community in their region. This article describes the scope for reducing the cancer burden in the community, through capacity building of community based PC healthcare functionaries in the domains of Prevention, and Early detection of common cancers along with Palliative care – the PEP domains. It suggests aligning and enhancing the workforce already active within the community for PC, for screening, and if feasible, for early detection of common cancers. The article describes possibilities of initiating PEP activities and offers a set of screening questionnaire that may be used when engaged with family/ community setting. The aim is to integrate the activities done, to detect the need for palliative care in a family / community, with that required to detect need for evaluation of most common cancers- oral, breast and cervix. The PEP concept may be adapted to different levels, based on the team presence in the communities, degree of engagement, and availability of trainers and healthcare personnel. [ABSTRACT FROM AUTHOR]

Objective: In India, usually, oral cancer is mostly identified at a progressive stage of malignancy. Hence, we are motivated to identify oral cancer in its early stages, which helps to increase the lifetime of the patient, but this early detection is also more challenging., Methods: The proposed research work uses a probabilistic neural network (PNN) for the prediction of oral malignancy. The recommended work uses PNN along with the discrete wavelet transform to predict the cancer cells accurately. The classification accuracy of the PNN model is 80%, and hence this technique is best for the prediction of oral cancer., Result: Due to heterogeneity in the appearance of oral lesions, it is difficult to identify the cancer region. This research work explores the different computer vision techniques that help in the prediction of oral cancer., Conclusion: Oral screening is important in making a decision about oral lesions and also in avoiding delayed referrals, which reduces mortality rates.

Introduction: Recurrence is a frequent phenomenon of the natural history of epithelial Ovarian Cancer (OC). Early detection of recurrence is important. Clinical examination combined with Carbohydrate Antigen 125 (CA125) and imaging are used for the follow-up of these patients. Human Epididymis Protein 4 (HE4) is a recent marker which is found to have elevated in OC. Aim: To study the role of HE4 in detection of OC recurrence. Materials and Methods: This prospective study was conducted at Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India. Patients were enrolled from January 2014 to January 2016 after informed written consent. Total 65 patients of carcinoma ovary were prospectively followed up after completion of their primary treatment. 19 patients had clinical evidence of recurrence as detected by radiological imaging and subsequently proved by pathological examination. Timing and levels of rise in tumour marker were studied and correlated with timing of clinical evidence of disease. Results: HE4 and CA125 detected recurrence in 19 (100%) and 14 (73.7%) patients respectively. Among these 5 (26.3%) recurrence were detected by HE4 alone. In 10 (52.6%) patients, simultaneous rise in both of these markers were noticed and in 4 (21.1%) patients HE4 started rising before CA125 with a lead time of 3.25 months. CA125 was found to be in normal range in all mucinous carcinoma and two out of 16 serous carcinoma. Conclusion: HE4 is a potential useful serum marker to detect OC recurrence timely and better as compared to traditional utilised CA125. Future studies based on recurrence detection by HE4 may provide evidence on its role on survival. [ABSTRACT FROM AUTHOR]

This editorial discusses the prevailing situation in India as regards early detection of Developmental Dysplasia of the Hip (DDH) and proposes the reasons why this is necessary and what could be the best modalities to apply for this complex situation in a developing country like India. The present time is the best time to develop a National Screening Program for early detection of DDH. [ABSTRACT FROM AUTHOR]

Background: Cancers of the uterine cervix, breast, and oral cavity accounted for 134,420, 115,251, and 24,375 cases, respectively, and were responsible for 52.8% of the total cancers among women in India in 2008.Aim: The major objectives were to create awareness regarding common cancers among women, to detect pre-cancers of the uterine cervix and oral cavity, and early cancers of the breast, uterine cervix, and oral cavity, by conducting screening with simple, low-cost technology, within the community, and to facilitate confirmation of diagnosis among the screen positives and treatment and follow-up among the diagnosed cases.Settings and Methods: This is a community-based screening program for early detection of breast, uterine cervix, and oral cancers, being implemented among the socioeconomically disadvantaged women in Mumbai, India. The process involves selection of clusters, household surveys, health education, and screening the eligible women for breast, uterine cervix, and oral cancers, by primary healthcare workers, at a temporarily set-up clinic within the community. The program is planned to cover a 125,000 disadvantaged population in five years.Results: Twenty-one thousand and fifteen people, with 4009 eligible women, have been covered to date. The compliance for screening for breast, cervix, and oral cavity has been 85, 70, and 88% and the screen positivity rates are 3.9, 14.9, and 3.9%, respectively. Twenty-seven oral pre-cancers, 25 cervix pre-cancers, one invasive cancer of the breast, two of the cervix, and one oral cavity cancer have been diagnosed among the screened women and all of them have complied with the treatment.Conclusions: The program is raising awareness about the common cancers and harms of tobacco among the disadvantaged women population in Mumbai. It is also helping in detecting pre-cancers and cancers among asymptomatic women and is assisting them in receiving treatment. [ABSTRACT FROM AUTHOR]

Summary: Objectives: We studied oral cancer incidence and mortality and the impact of compliance to repeat screening rounds during a 15-year follow-up in a cluster-randomized controlled trial in Trivandrum district, Kerala, India. Methods: Healthy individuals aged 35 and above in seven clusters randomized to the intervention arm received four rounds of oral visual inspection by trained health workers at 3-year intervals, and those in six clusters randomized to the control arm received routine care during 1996–2005 and one round of visual screening during 2006–2009. Screen-positive persons were referred for diagnosis and treatment. Oral cancer incidence and mortality were compared between the study arms by intention to treat analysis. Results: Of the 96,517 eligible subjects in the intervention arm, 25,144 (26.1%) had one, 22,382 (23.2%) had two, 22,008 (22.8%) had three and 19,288 (20.0%) had four rounds of screening. Of the 95,356 eligible subjects in the control group 43,992 (46.1%) received one round of screening. Although the 12% reduction in oral cancer mortality in all individuals did not reach statistical significance, there was a 24% reduction in oral cancer mortality (95% CI 3–40%) in users of tobacco and/or alcohol in the intervention arm after 4-rounds of screening; there was 38% reduction in oral cancer incidence (95% CI 8–59%) and 81% reduction in oral cancer mortality (95% CI 69–89%) in tobacco and/or alcohol users adhering to four screening rounds. Conclusion: Sustained reduction in oral cancer mortality during the 15-year follow-up, with larger reductions in those adhering to repeated screening rounds support the introduction of population-based screening programs targeting users of smoking or chewing tobacco or alcohol or both in high-incidence countries. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the utility of cytology and HPV testing in women from Mumbai, India, suspected of having cervical intraepithelial neoplasia (CIN) on visual inspection with acetic acid (VIA), Lugol''s iodine (VILI), or both. Method: The sensitivity, specificity, and predictive values of these tests for the detection of CIN 2 and/or 3 were evaluated in this cross-sectional study with 756 women suspected of having CIN on visual inspection. Results: There were 25 women with CIN 2, 20 with CIN 3, and 21 with invasive cancer. The sensitivity to detect CIN 3 lesions was 85.0% (95% CI, 62.1–96.8) and 70.0% (95% CI, 45.7–88.1) for cytology testing at the ASCUS and LSIL thresholds, respectively, and it was 89.5% (95% CI, 66.9–98.7) for HPV testing. The specificity to detect CIN 3 lesions was 94.5% (95% CI, 92.5–96.1) and 96.1% (95% CI, 94.4–97.5) for cytology testing at the ASCUS and LSIL thresholds, and it was 91.1% (95% CI, 88.5–93.2) for HPV testing. Conclusion: Cytology and HPV testing were both found to be accurate triaging methods for women suspected of having CIN on visual inspection, especially for those with CIN 3 lesions. [Copyright &y& Elsevier]

Objective: To assess the accuracy of cervical screening with visual inspection and cytology testing, and the cure rate of cervical intraepithelial neoplasia (CIN) after treatment, in a rural population in North India.Methods: A cross-sectional study evaluated the detection rates of CIN 2 and CIN 3 lesions by cytology testing and by visual inspection of the cervix following the application of 5% acetic acid (VIA) or Lugol's iodine (VILI). It also evaluated the cure rates following treatment of CIN.Results: Of 5050 women approached in 17 villages, 3000 (59.4%) participated (range, 41%-91%). Of these, 14.2% were positive by VIA, 15.6% by VILI, and 5.4% by cytology testing at ASCUS threshold, and 37 women were diagnosed as having CIN 1 and 20 as having CIN 2 or CIN 3. Detection rates of CIN 2 or 3 using VIA, VILI, and cytologic findings of ASCUS and LSIL were 3.7, 3.3, 4.5, and 4.2 per 1000 women, respectively, and 91.4% of the treated women were cured.Conclusion: Both VIA and VILI were found to be accurate screening tests and the cure rates for CIN were satisfactory. [ABSTRACT FROM AUTHOR]

The incidence of breast cancer is low in India, but rising. Breast cancer is the commonest cancer of urban Indian women and the second commonest in the rural women. Owing to the lack of awareness of this disease and in absence of a breast cancer screening program, the majority of breast cancers are diagnosed at a relatively advanced stage. The quality of care available for breast cancer patients varies widely according to where the patient is treated. Although there are some centers of excellence providing multimodality protocol-based treatment at par with the best anywhere in the world, the vast majority of breast cancer patients undergo inadequate and inappropriate treatment due to lack of high-quality infrastructure and sometimes skills, and above all financial resources. The recent emphasis on health education, early diagnosis of cancers, and more public facilities for cancer treatment are expected to bring about the much needed improvement in breast cancer care in India. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Several studies have investigated the accuracy of naked eye visual inspection with acetic acid (VIA) in the early detection of cervical neoplasia. It is not clear whether low-level (2–4×) magnification (VIAM) can improve the sensitivity and specificity of VIA. The accuracy of both VIA and VIAM, provided by independent health workers, were evaluated in three cross-sectional studies involving 18,675 women aged 25–65 years in Kolkata and Mumbai in India. All screened women were investigated with colposcopy and biopsies were obtained based on colposcopy findings. The final disease status was based on the reference standard of histology (if biopsies had been taken) or colposcopy. Data from the studies were pooled to calculate the test characteristics for the detection of high-grade squamous intraepithelial lesions (HSIL). 14.1% and 14.2% were positive on testing with VIA and VIAM respectively. Two hundred twenty-nine were diagnosed with HSIL and 68 with invasive cancer. The pooled sensitivity, specificity, positive and negative predictive values for VIA in detecting high-grade squamous intraepithelial lesions (HSIL) were 60.3% (95% CI: 53.6–66.7), 86.8% (95% CI: 86.3–87.3), 5.9% (95% CI: 5.0–7.0), and 99.4% (95% CI: 99.2–99.5), respectively. The values were 64.2% (95% CI: 57.6–70.4), 86.8% (95% CI: 86.2–87.3), 6.3% (95% CI: 5.3–7.3) and 99.4% (95% CI: 99.3–99.6), respectively, for VIAM. Low-level magnification did not improve the test performance of naked eye visualization of acetic acid impregnated uterine cervix. [Copyright &y& Elsevier]

The efficacy of a single round of screening of visual inspection with acetic acid (VIA) on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in south India. Women aged 30–59 years in 113 clusters in Dindigul District were randomized to VIA screening by nurses (57 clusters, 48,225 eligible women) and to a control group (56 clusters, 30,167 women). 30,577 (63.4%) eligible women participated in screening. Younger, educated, married, multiparous, low-income women and those who have had tubal sterilization had a higher compliance with screening. Of the 2069 women diagnosed with CIN and invasive cancer, 1498 (72.4%) received treatment. Young women, those who practiced contraception and women with high-grade precursor lesions and invasive cancers were more likely to comply with treatment. In summary, our study indicates that women accept screening with VIA by nurses and a moderate level of compliance with screening and treatment can be reached through appropriate service delivery systems including health education activities, personal invitations, clinics in proximity to the target women, and testing and treatment in the same session. Our results imply that integration of screening activities with primary health services seems to have the potential to replicate most of these service delivery conditions in routine programs. [Copyright &y& Elsevier]

A cluster randomized controlled oral cancer screening trial is on-going in the Trivandrum district, India, to evaluate the efficacy of screening in reducing oral cancer mortality. Subjects, aged 35 years and above, in 13 clusters in the Trivandrum district, India, were randomized to the intervention (screening) group (7 clusters, 78,969 subjects) to receive three rounds of screening by oral visual inspection by trained health workers at 3-year intervals or to a control group (6 clusters, 74,739 subjects). Two rounds of screening were completed between 1995 and 2002 during which 69,896 (88.5%) subjects were screened at least once, and 59.7% of the 4408 screen-positive subjects were further investigated. In the intervention group, 344,404 person-years were accrued and 329,326 person-years were in the control group. In the intervention group, 149 incident oral cancer cases and 65 deaths from oral cancer were observed, and 106 incident cases and 62 deaths from oral cancer were observed in the control group. The programme sensitivity for detection of oral precancerous lesions and cancer was 81.5% and the programme specificity was 84.8%; the programme positive predictive value was 39.6%. In the intervention group 37.6% of the cases were in stages I–II, as opposed to 18.9% in the control group. The 3 year survival rate was 57.5% in the intervention and 38.8% in the control group (P<0.05). The age standardized oral cancer mortality rates were 21.2/100,000 person-years in the intervention and 21.3/100,000 in the control group. After completing two rounds of screening, oral cancer mortality rates were similar in both study groups. [Copyright &y& Elsevier]

Background: The Breast Health Initiative (BHI) was launched to demonstrate a scalable model to improve access to early diagnosis and treatment of breast cancer., Methods: A package of evidence-based interventions was codesigned and implemented with the stakeholders, as part of the national noncommunicable disease program, through the existing primary health care system. Data from the first 18 months of the BHI are presented., Results: A total of 108,112 women received breast health education; 48% visited the health facilities for clinical breast examination (CBE), 3% had a positive CBE result, and 41% were referred to a diagnostic facility. The concordance of CBE findings between health care providers and adherence to follow-up care improved considerably, with more women visiting the diagnostic facilities and completing diagnostic evaluation within 1 month from initial screening, and with only 9% lost to follow-up. The authors observed a clinically meaningful decrease in time to complete diagnostic evaluation with biopsy, from 37 to 9 days., Conclusions: The results demonstrate the feasibility and effectiveness of implementing a large-scale, decentralized breast cancer early detection program delivered through the existing primary health care system in India., (© 2022 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Among the emerging economies Brazil, Russia, India, China and South Africa (together known as the BRICS countries) share collectively approximately 40 per cent of the global population and contribute to 25 per cent of the world gross domestic products. All these countries are facing the formidable challenge of rising incidence of breast cancer and significant number of premature deaths from the disease. A multidimensional approach involving prevention, early detection and improved treatment is required to counteract the growing burden of breast cancer. A growing trend in the prevalence of major preventable risk factors of breast cancer such as obesity, western dietary habits, lack of physical activity, consumption of alcohol and smoking is contributing significantly to the rising burden of the disease in BRICS nations. Specific interventions are needed at the individual and population levels to mitigate these risk factors, preferably within the broader framework of non-communicable disease control programme. Population-based quality assured mammography-based screening of the 50-69 yr old women can reduce breast cancer mortality at least by 20 per cent. However, none of the BRICS countries have been able to implement population-based organized screening programme. Large scale opportunistic screening with mammography targeting predominantly the younger women is causing harms to the women and wasting precious healthcare resources. There are recent national recommendations to screen women with mammography in Brazil and Russia and with clinical breast examination in China (along with ultrasound) and India. Given the challenges of implementing systematic screening of the population, the BRICS countries should prioritize the early diagnosis approach and invest in educating the women about the breast cancer symptoms, training the frontline health providers to clinically detect breast cancers and appropriately refer for diagnostic confirmation, and creating improved access to good quality diagnostic and treatment facilities for breast cancer. The early diagnosis approach has been proved to achieve downstaging and improve survival at a fraction of the resources needed for population screening. The countries also need to focus on improving the services and capacity for multidisciplinary treatment of breast cancer, histopathology and immunohistochemistry, safe administration of chemotherapy and palliative care., Competing Interests: None

Objectives: We examined the level of awareness about Rheumatic Heart Disease (RHD) among school-aged children in a rural district of India and evaluated the effects of a questionnaire-based survey in improving the level of awareness., Methods: The study involved 8,646 students aged 10-16 years from 20 schools in West Midnapore, India which was conducted in August 2017. We examined changes in the level of awareness of RHD using a 29-point scoring system in seven domains. The baseline questionnaire survey assessed students' knowledge and was followed by a multimedia presentation about RHD and a post-intervention survey using the same questionnaire. The questionnaire included 9 questions on different aspects of RHD including prevalence, nature of disease, symptoms, determinants, treatment options, impact of the disease and diagnosis., Results: The mean age of the study population was 13 years and 46% were boys. At baseline, the mean level of knowledge about RHD was 42% (12.2 out of 29 points). After the school-based presentation, the score improved to a mean of 55% (15.9 points on the 29-point scale), a 31% relative improvement. Improvement in students' knowledge was noted across all seven domains, individually and combined (p < 0.001)., Conclusions: Awareness among children in rural India about RHD is modest. A school-based intervention could help in improving awareness about this chronic condition and may promote secondary prophylaxis to reduce the morbidity and mortality from RHD., Competing Interests: Conflicts of interest Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Level Ex, Medscape Cardiology, PhaseBio, PLx Pharma, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, CSI, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, Takeda. All other authors have none to declare relevant to this study., (Copyright © 2020. Published by Elsevier B.V.)

Background: Opportunistic screening for individuals aged ≥30 years at all levels of healthcare for early detection of diabetes mellitus (DM) and hypertension (HTN) is an integral strategy under the national program to control non-communicable diseases. There has been no systematic assessment of the screening process in primary care settings since its launch. The objective was to determine the number and proportion eligible for screening, number screened, diagnosed and treated for DM and HTN among persons aged ≥30 years in two selected primary health centres (PHCs) in Dakshina Kannada district, Karnataka, India during March-May 2019 and to explore the enablers and barriers in the implementation of screening from the perspective of the health care providers (HCPs) and beneficiaries . Methods: This was a sequential explanatory mixed-methods study with a quantitative (cohort design) and a descriptive qualitative component (in-depth interviews and focus group discussions) with HCPs and persons seeking care. Those that were not known DM/HTN and not screened for DM/HTN in one year were used to estimate persons eligible for screening. Results: Of 2697 persons, 512 (19%) were eligible for DM screening, 401 (78%) were screened; 88/401 (22%) were diagnosed and 67/88 (76%) were initiated on treatment. Of 2697, 337 (13%) were eligible for HTN screening, 327 (97%) were screened, 55 (17%) were diagnosed with HTN; of those diagnosed, 44/55 (80%) were initiated on treatment.  The documentation changes helped in identifying the eligible population. Patient willingness to undergo screening and recognition of relevance of screening were screening enablers.  Overworked staff, logistical and documentation issues, inadequate training were the barriers. Conclusion: Nearly 19% were eligible for DM screening and 13% were eligible for HTN screening. The yield of screening was high. We noted several enablers and barriers. The barriers require urgent attention to reduce the gaps in delivery and uptake of services., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Raghuveer P et al.)

Indian women with breast cancer are usually diagnosed in advanced stages leading to poor survival. Improving breast awareness and increasing access to early diagnosis and adequate treatment has been advocated for breast cancer control. We implemented a program to increase awareness on breast cancer and access to its early detection in an occupational health care scheme in Mumbai, India. Breast awareness brochures were mailed annually between June 2013 and June 2016 to a cohort of 22,500 eligible women aged 30-69 years old receiving universal health care from an occupational health care scheme comprising of primary health centres and a referral secondary care hospital in Mumbai. Women with suspected breast cancers were provided with diagnostic investigations and treatment. Socio-demographic information and tumour characteristics were compared between the breast awareness pre-intervention period (Jan 2005-May 2013) and the breast awareness intervention period after four rounds of mailers (June 2013-June 2016). The proportion of women with early tumours and axillary lymph node negative cancers increased from 74% to 81% and 46% to 53% respectively, between the two periods. While the proportion of patients receiving breast conserving surgery increased from 39% to 51%, the proportion receiving chemotherapy decreased from 84% to 56%. Interim results following efforts to improve breast awareness and access to care in a cohort of women in an occupational health care scheme indicate early detection and more conservative treatment of breast cancers. Creating awareness and improving access to care may result in cancer down-staging., (Copyright © 2016 Elsevier Ltd. All rights reserved.)