Training Primary Health Professionals in Breast Cancer Prevention: Evidence and Experience from Mexico

Designing a virtual breast cancer prevention program for Iranian women: A study protocol

BACKGROUND

The growing number of breast cancer patients in Iran, following the lower referrals of women to screening centers after the outbreak of the COVID-19, suggests the need for designing virtual educational interventions to teach self-care methods to women. The aim of this study is to design a virtual training program for the prevention of breast cancer in women based on the steps of the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) educational design model.

MATERIALS AND METHODS

This developmental study will be conducted based on the steps of the ADDIE model. In the first step (analysis), a qualitative study, literature review, and a panel of experts will be conducted to analyze the situation (learners, content, platforms, and media for the electronic presentation of the program). In the design step, the learning objectives, educational strategies, and the way of program's implementation and evaluation will be specified. In the third step, not only are the content, storyboard, and educational program developed, but the pilot study is also conducted and formative assessment is performed. In the fourth step, the program will be provided to the audience and will be implemented as a preliminary program. In the final step, the final virtual education program for the prevention of breast cancer in women will be presented based on the results of the evaluation.

CONCLUSIONS

Using a comprehensive and systematic educational design model can be a step toward making changes and encouraging innovations in breast cancer prevention education programs in women based on virtual education. Given the existing needs and conditions, this program can promote cancer preventive behaviors as much as possible, reduce the costs imposed on the family and healthcare systems, and lower the complications and mortality rate caused by the delayed diagnosis of the disease.

Proposed methodology for designing and developing MOOCs for the deaf community

Massive Open Online Courses (MOOCs) have become important resources in educational environments worldwide because they have a positive impact on teaching and learning processes. Nevertheless, the way they are designed is crucial to properly address the requirements of special needs people in educational processes. Thus, this paper proposes a methodology for designing and developing MOOCs for Deaf or hard-of-hearing individuals. This exploratory and descriptive study adopted an inclusive education approach based on a literature review and expert consultation. The results highlight the importance of four aspects in MOOC development for these special needs individuals: (i) designing and incorporating elements that meet the needs of Deaf or hard-of-hearing people so that they can use MOOCs effectively; (ii) combining different methodologies and resources; (iii) properly planning and sequencing the design stages; and (iv) using appropriate tools, contents, and times for the process. The findings show that MOOCs should be adequately designed to address the demands of the Deaf community by considering their characteristics and requirements and incorporating current tools, practices, and resources.

Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework)

Preventable risk factors are responsible of at least 40% of cases and almost 45% of all cancer deaths worldwide. Cancer is already the leading cause of death in almost half of the Latin American and the Caribbean countries constituting a public health problem. Cost-effective measures to reduce exposures through primary prevention and screening of certain types of cancers are critical in the fight against cancer but need to be tailored to the local needs and scenarios. The Latin America and the Caribbean (LAC) Code Against Cancer, 1st edition, consists of 17 evidence-based recommendations for the general public, based on the most recent solid evidence on lifestyle, environmental, occupational, and infectious risk factors, and medical interventions. Each recommendation is accompanied by recommendations for policymakers to guide governments establishing the infrastructure needed to enable the public adopting the recommendations. The LAC Code Against Cancer has been developed in a collaborative effort by a large number of experts from the region, under the umbrella strategy and authoritative methodology of the World Code Against Cancer Framework. The Code is a structured instrument ideal for cancer prevention and control that aims to raise awareness and educate the public, while building capacity and competencies to policymakers, health professionals, stakeholders, to contribute to reduce the burden of cancer in LAC.

Cancer Prevention Literacy among Different Population Subgroups: Challenges and Enabling Factors for Adopting and Complying with Cancer Prevention Recommendations

It is estimated that 40% of the cancer cases in Europe could be prevented if people had better information and tools to make healthier choices and thereby reduce some of the most important cancer risk factors. The aim of this study is to gain knowledge and understanding about cancer prevention literacy among people with intellectual disabilities, immigrants, young people and young cancer survivors. In this qualitative study, we conducted six online focus-group interviews, including forty participants, to explore the cancer prevention literacy of four population subgroups and determine how cancer prevention recommendations according to the European Code Against Cancer (ECAC) were perceived. The analysis resulted in the following main categories: current health beliefs and their impacts on how the ECAC recommendations were perceived, communication strategies and sources benefiting or hindering cancer prevention information from reaching out, and how vulnerabilities in these subgroups impact cancer prevention literacy. To improve cancer prevention literacy in Europe, more attention is needed this topic to overcome barriers among different population subgroups. Recommendations include improved and adapted cancer prevention information, support to individuals, as well as societal support, such as easy-access screening and vaccination programmes and regulations related to tobacco, alcohol, and diet.

Behavioral interventions towards knowledge and awareness of reproductive cancer care: A study on select Indians using an online survey

BACKGROUND

The behavioral aspects of human beings influence the incidences of cancer cases directly and indirectly. The factors like positive thinking and motivation were found to change the behavior toward knowledge and awareness of cancer. The main objective of the study is to assess the knowledge and awareness of select Indians about reproductive cancer.

MATERIALS AND METHODS

The online survey method assessed various components of knowledge and awareness about reproductive cancer. A Google Form has been distributed through social media platforms such as e-mail, Instagram, Facebook, and WhatsApp. The coded data has been computed in SPSS (version 25) by IBM (USA) for the analysis. Univariate and bivariate data analysis has been drawn to justify the objective.

RESULTS

Nearly 68 percent of the respondents were aware of reproductive cancer. Among them, 17 percent know about cervical cancer, and 12.5 percent have awareness about breast cancer. Electronic and print media (41.2 percent) were major sources of information about reproductive cancer. Nearly 48 percent of respondents reported that multiple sexual partners and poor sexual hygiene were risk factors for reproductive cancer. Around 57 percent of respondents reported reproductive cancer is preventable, 59 percent knew about cancer screening, and 63.5 percent knew the treatment process. The gender of the respondents was associated (p-value = 0.002) with awareness of reproductive cancer. It has been found that there is a significant association between knowledge of screening tests and the treatment process of reproductive cancer. The marital status of respondents is strongly associated (p-value = 0.000) with the awareness of reproductive cancer.

CONCLUSION

The factors like knowledge of reproductive cancer and awareness proceed as an important role in cancer prevention. A gender-neutral cancer awareness program is needed to increase cancer awareness irrespective of marital status.

Learning Design Strategies in MOOCs for Physicians' Training: A Scoping Review

In recent years, there has been an increased implementation of massive open online courses (MOOCs). This teaching model plays a pivotal role in online education because it can provide high-quality learning resources to numerous students with great feasibility, shaping training courses according to their different learning requirements. Although the widespread adoption of MOOCs in medical education has led to numerous benefits for undergraduate and graduate doctors, their role remains unclear, suggesting the need to analyze the key factors of such a learning method in this field. To achieve this aim, a scoping review, in line with the PRISMA method for qualitative synthesis, was performed by considering studies published from 2016 to 2021, written in English, and including the physician population. Through this literature analysis, the following main areas of interest came to light: (1) pedagogical approaches, (2) MOOC structure-related variables, (3) participant-related variables, and (4) MOOCs vs. traditional courses. The review provides valuable evidence on factors underlying MOOCs effectiveness, which might be helpful for academic and healthcare organizations in designing effective training courses for physicians.

Massive Open Online Courses for Health Worker Education in Low- and Middle-Income Countries: A Scoping Review

Background

Massive Open Online Courses (MOOCs) have the potential to improve access to quality education for health care workers (HCWs) globally. Although studies have reported on the use of MOOCs in low- and middle-income countries (LMICs), our understanding of the scope of their utilization or access barriers and facilitators for this cohort is limited. We conducted a scoping review to map published peer-reviewed literature on MOOCs for HCW education in LMICs. We systematically searched four academic databases (Scopus, Web of Science, PubMed, ERIC) and Google Scholar, and undertook a two-stage screening process. The analysis included studies that reported on MOOCs relevant to HCWs' education accessed by HCWs based in LMICs.

Results

The search identified 1,317 studies with 39 studies included in the analysis, representing 40 MOOCs accessed in over 90 LMICs. We found that MOOCs covered a wide range of HCWs' including nurses, midwives, physicians, dentists, psychologists, and other workers from the broader health care sector, mainly at a post-graduate level. Dominant topics covered by the MOOCs included infectious diseases and epidemic response, treatment and prevention of non-communicable diseases, communication techniques and patient interaction, as well as research practice. Time contribution and internet connection were recognized barriers to MOOC completion, whilst deadlines, email reminders, graphical design of the MOOC, and blended learning modes facilitated uptake and completion. MOOCs were predominantly taught in English (20%), French (12.5%), Spanish (7.5%) and Portuguese (7.5%). Overall, evaluation outcomes were positive and focused on completion rate, learner gain, and student satisfaction.

Conclusion

We conclude that MOOCs can be an adequate tool to support HCWs' education in LMICs and may be particularly suited for supporting knowledge and understanding. Heterogeneous reporting of MOOC characteristics and lack of cohort-specific reporting limits our ability to evaluate MOOCs at a broader scale; we make suggestions on how standardized reporting may offset this problem. Further research should focus on the impact of learning through MOOCs, as well as on the work of HCWs and the apparent lack of courses covering the key causes of diseases in LMICs. This will result in increased understanding of the extent to which MOOCs can be utilized in this context.

Literature Review on MOOCs on Sensory (Olfactory) Learning

Massive Open Online Courses (MOOCs) have been described as a “next development of networked learning”, and they have the potential to mediate sensory learning. To understand this phenomenon, the present systematic review examines the research techniques, subjects, and trends of MOOC research on sensory learning, in order to provide a thorough understanding of the MOOC relevant to sensory (olfactory) learning phenomena by evaluating 65 (four studies are about multisensorial learning and 61 are about multisensorial empirical MOOCs researches) empirical MOOC studies published between 2008 and 2021 by searching through databases: PubMed, Scopus, Web of Science, and Google Scholar. The results indicated that most studies were based on quantitative research methods followed by mixed research methods and the qualitative research approaches; most of the studies were surveys, followed by platform databases and interviews; almost half of the studies were conducted using at least two methods for data collection: survey and interviews; most were replicated. The most highlighted subjects included student retention, learning experience, social learning, and engagement. Implications and studies into the future have been considered in order to obtain a more evolved understanding of the acquisition of knowledge through the senses.

Public Policies and Programs for the Prevention and Control of Breast Cancer in Latin American Women: A Scoping Review (Preprint)

Background

Breast cancer has positioned itself worldwide as one of the main public health problems, especially in Latin America. In some countries, several programs for the prevention and control of breast cancer in women have been developed and implemented on a permanent basis, but there are no public reports on the policies that originated such programs.

Objective

A scoping review of scientific publications that identify the type, extent, and scope of policies and programs for the prevention and control of breast cancer in Latin American women was performed, and the main results were presented in this paper.

Methods

This scoping review was carried out according to the method by Arksey and O’Malley based on 3 fundamental questions about breast cancer prevention and control policies in Latin America: their type, extent and scope, and reference framework. The search period was from 2000 to 2019, and the search was carried out in the following databases: MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost), ISI Web of Science (Science Citation Index), and Scopus in English, Spanish, and Portuguese, and Scielo, Cochrane, and MEDES-MEDicina in Spanish and Portuguese. Of the 743 studies found, 20 (2.7%) were selected, which were analyzed using descriptive statistics and qualitative content analysis.

Results

The selected studies identified several Latin American countries that have generated policies and programs to prevent and control breast cancer in women, focusing mainly on risk communication, prevention and timely detection, effective access to health services, improvement of the screening process, and evaluation of screening programs. Evaluation criteria and greater participation of civil society in policy design and program execution are still lacking. This could undoubtedly help eliminate existing barriers to effective action.

Conclusions

Although several Latin American countries have generated public policies and action programs for the prevention and control of breast cancer, a pending issue is the evaluation of the results to analyze the effectiveness and impact of their implementation given the magnitude of the public health problem it represents and because women and civil society play an important role in its prevention and control.

International Registered Report Identifier (IRRID)

RR2-10.2196/12624

Harvesting Health Knowledge: Breast Cancer Perceptions in the South Florida Latinx Farmworker Community

South Florida agricultural regions, home to Latinx immigrant farmworkers, report higher rates of late-stage breast cancer diagnosis than national, state, and county-level averages. We conducted a community-based qualitative study on the needs, health knowledge gaps, barriers to breast cancer screening, and the role of community health workers (CHWs) in supporting the community's access to early detection services. We conducted three CHW focus groups (FGs) (n = 25) and in-depth interviews (n = 15), two FGs (n = 18) and in-depth interviews (n = 3) with farmworker community members, and informal interviews with cancer clinicians (n = 7). Using a grounded theory approach, five core themes regarding the community's barriers to accessing health care services emerged: (a) lack of information; (b) social and economic barriers; (c) cultural factors; (d) fears and mistrust; and (e) psychosocial concerns. Findings yield implications for community health practice, the potential impact of CHWs, and the production of breast cancer education to improve health equity along with the care continuum.

Massive open online courses for nurses' and healthcare professionals' continuous education: a scoping review

AIM

To map the main characteristics of massive open online courses, and their effectiveness, facilitators and barriers in continuing education among nurses and other healthcare professionals.

BACKGROUND

Online continuous education attracted new attention among educators and managers with regard to how to best design, implement it and evaluate its effectiveness.

INTRODUCTION

No studies to date have mapped the state of research on massive open online courses and the facilitators promoting their effectiveness in continuing education.

METHODS

A scoping review performed in 2020 by following the Preferred Reporting Items for Systematic reviews and Meta-analysis extension-Scoping Reviews. Electronic databases were searched for primary and secondary studies, written in English. Identified barriers/facilitators were categorized using a content analysis.

RESULTS

Of the 1149 studies, 31 were included, and the majority had an explorative research design. Massive open online courses documented to date are characterized by their (a) developers' countries and providers, mainly the United Stated and universities, respectively; (b) variety of teaching methods and contents, including infectious diseases; (c) using both qualitative and quantitative assessment methods; and (d) multidisciplinary target audience ranging from 40 to 83 000 participants, including nurses. Facilitators of and barriers to effectiveness depend on their pedagogical background, appropriate course design, delivery and implementation as well as on the learners' profile.

DISCUSSION

Studies available to date are mainly based on experiential projects. A variety of strategies promoting massive online courses' effectiveness have emerged.

CONCLUSION

Some public health issues may benefit from massive education, as a unique system promoting a quick and effective continuous education.

IMPLICATIONS FOR NURSING/HEALTH/SOCIAL POLICY

Clinical nurses, nurse managers and educators should consider available evidence on massive online courses' when making decisions on which strategy to use to maintain competencies. Moreover, as a public health tool, massive online courses should be derived from a strong cooperation between political, scientific and professional bodies.

What knowledge is available on massive open online courses in nursing and academic healthcare sciences education? A rapid review

BACKGROUND

With the recent challenges due to the Coronavirus 2019 outbreak, distance learning has been largely introduced in healthcare sciences curricula, and universities have been called upon to share learning opportunities with each other to ensure continuity of education and delivery of new graduates to the health system. However, decisions about its introduction should be supported by up-to-date evidence capable of providing an overview of available knowledge.

OBJECTIVES

To map the (a) state of research on massive open online courses in undergraduate and postgraduate health sciences education, (b) evaluation methods and tools used to measure learning outcomes, and (c) factors increasing their effectiveness as documented to date.

DESIGN

A rapid review following the preferred reporting items for systematic reviews and meta-analysis guidelines.

METHODS

PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane, Scopus, PsycInfo and Medline (via Ovid) were searched. Primary studies reporting one or more massive open online course (1) devoted to undergraduate and/or postgraduate students in nursing and healthcare sciences (2), written in English (3) with abstract available (4) and published up to February 18th, 2020 were all included. After having assessed the need for a review and the topic itself (a), the literature search was performed (b), studies were screened and selected (c), data was extracted (d), and the findings were summarised (e).

RESULTS

Thirty-six studies emerged with mainly an explorative/descriptive or case study design. The courses have been developed mainly by universities alone or in collaboration with institutions mainly in US, Sweden and the UK. Their delivery has been performed at multi-national levels, mainly in English, and with a number of participants ranging from 45 to >23,000. The duration spanned from two weeks to six months on clinical topics (e.g., emergency medicine) to methods (e.g., statistics). The target audience has been mainly mixed, including students, healthcare professionals, and lay citizens. Evaluation methods and tools have been described in 28 studies, and multiple-choice questions were most frequently adopted. Factors affecting the effectiveness of massive open online courses have been identified analysing the courses themselves and the participants.

CONCLUSION

Massive open online courses have recently started to be studied in healthcare sciences: these can be useful to educate students, mainly as elective courses, and to educate a massive audience, thus embodying the third mission of the university. The complexity of factors increasing effectiveness suggests the need for a multidisciplinary approach both in their design and implementation.

Capacity building for cancer prevention and early detection in the Ugandan primary healthcare facilities: Working toward reducing the unmet needs of cancer control services

Background

In 2018, approximately 60,000 Ugandans were estimated to be suffering from cancer. It was also reported that only 5% of cancer patients access cancer care and 77% present with late‐stage cancer coupled with low level of cancer health literacy in the population despite a wide coverage of primary healthcare facilities in Uganda. We aimed to contribute to reducing the unmet needs of cancer prevention and early detection services in Uganda through capacity building.

Methods

In 2017, we conducted two national and six regional cancer control stakeholders’ consultative meetings. In 2017 and 2018, we trained district primary healthcare teams on cancer prevention and early detection. We also developed cancer information materials for health workers and communities and conducted a follow‐up after the training.

Results

A total of 488 primary healthcare workers from 118 districts were trained. Forty‐six health workers in the pilot East‐central subregion were further trained in cervical, breast, and prostate cancer early detection (screening and early diagnosis) techniques. A total of 32,800 cancer information, education and communication materials; breast, cervical, prostate childhood and general cancer information booklets; health education guide, community cancer information flipcharts for village health teams and referral guidelines for suspected cancer were developed and distributed to 122 districts. Also, 16 public and private‐not‐for‐profit regional hospitals, and one training institution received these materials. Audiovisual clips on breast, cervical, and prostate cancer were developed for mass and social media dissemination. A follow‐up after six months to one year indicated that 75% of the districts had implemented at least one of the agreed actions proposed during the training.

Conclusions

In Uganda, the unmet needs for cancer control services are enormous. However, building the capacity of primary healthcare workers to integrate prevention and early detection of cancer into primary health care based on low‐cost options for low‐income countries could contribute to reducing the unmet needs of cancer prevention and early detection in Uganda.

In Uganda, the unmet needs for cancer control services are enormous. We engaged district leaders and healthcare managers, developed cancer information materials, and trained the district PHC workers to integrate prevention and early detection of cancer into the primary healthcare system. This could contribute to reducing the unmet needs of cancer control services in Uganda.

Community-based participatory design of a community health worker breast cancer training intervention for South Florida Latinx farmworkers

OBJECTIVE

Community health worker (CHW)-led education is an important strategy to increase awareness and access to breast cancer screening in medically-underserved communities. This study aimed to develop a context-specific, culturally-appropriate training intervention for South Florida CHWs to educate Latinx immigrant farmworkers on breast cancer and early detection.

METHODS

A community-based participatory research (CBPR) study, conducted 2017-2019, informed the design of a training curriculum for CHWs and educational dissemination materials. Twenty-two CHWs were trained and knowledge gains were measuring using a one-group pre-and post-test design. Triangulated evaluation consisted of field observations of CHW-client interactions, CHW self-reports, and rapid assessment surveys of community members.

RESULTS

A community stakeholder-informed breast cancer training curriculum resulted in significant, sustained breast cancer knowledge gains among CHWs when comparing pre-, post-, and 4-6 month post-training follow-up test scores. Field observations of educational material dissemination, CHW self-reported evaluations, and community rapid assessment surveys at three health fairs demonstrated this was an effective strategy to engage female Latinx farmworkers in breast cancer education.

CONCLUSIONS

Community and key stakeholder participation in the development of a breast cancer educational intervention allowed for tailored design priorities around knowledge-based content, comprehensiveness, relevance, appropriateness, and ease of dissemination to community members. This model of participatory CHW training intervention design can enable future train-the-trainer approaches to disseminate and scale-up evidence-based health education interventions.

Factors associated with late-stage diagnosis of breast cancer among women in Addis Ababa, Ethiopia

PURPOSE

Stage at diagnosis is a key determinant of breast cancer prognosis. In this study, we characterize stage at diagnosis and determine factors associated with advanced stage at diagnosis among women diagnosed with invasive breast cancer in Addis Ababa, capital city of Ethiopia.

METHODS

Stage information was collected from medical records of 441 women with invasive breast cancer seen in seven major health facilities in Addis Ababa, from January 2017 to June 2018; these seven facilities capture 90% of all incident breast cancer cases in the city. We used multivariable Poisson regression model with robust variance to determine factors associated with advanced stage at diagnosis.

RESULTS

The predominant tumor histology was ductal carcinoma (83.7%). More than half of the tumors' grade was moderately or poorly differentiated. The median tumor size at presentation was 4 cm. Sixty-four percent of the patients were diagnosed at advanced stage of the disease (44% stage III and 20% stage IV), with 36% of the patients diagnosed at early-stage (5% stage I and 31% stage II). The prevalence of advanced stage disease was significantly higher among women who used traditional medicine before diagnostic confirmation (adjusted prevalence ratio [aPR] = 1.31; p = 0.001), had patient delay of >  3 months (aPR = 1.16; p = 0.042) and diagnosis delay of > 2 months (aPR = 1.24; p = 0.004). But it was lower among women who had history of breast self-examination (aPR = 0.77; p = 0.021).

CONCLUSIONS

Advanced stage at diagnosis of breast cancer among women in Addis Ababa is strongly associated with use of traditional medicine and with prolonged time interval between symptom recognition and disease confirmation. Community- and health systems-level interventions are needed to enhance knowledge about breast cancer and facilitate timely diagnoses.

Terapia cognitivo-conductual grupal sobre la sintomatología depresiva-ansiosa y temperatura nasal en mujeres con cáncer de mama: Estudio piloto

Objetivo. Evaluar el efecto de una intervención cognitivo-conductual grupal sobre la sintomatología ansiosa-depresiva y el funcionamiento autonómico afectivo en mujeres con cáncer de mama. Método. Estudio pre-experimental con una muestra de 17 mujeres mexicanas con un nivel de depresión de moderada-severa y diagnóstico de cáncer de mama. Los instrumentos de evaluación fueron el Inventario de Depresión de Beck y la Escala de ansiedad de Hamilton; además de una evaluación del funcionamiento autonómico mediante el registro intra-sesión de la temperatura periférica nasal. Resultados. Se observó una reducción de los síntomas de depresión (Z=-3.182, p=0.001), ansiedad (Z=-2.697, p=0.007) y un incremento de la temperatura al finalizar el tratamiento (Z=-2.669, p=008) que se mantuvo por seis meses (Z=-3.266, p=0.001). Conclusión. La terapia cognitivo conductual grupal fue eficaz para la reducción de la sintomatología ansiosa-depresiva y la regulación autonómica en el grupo de mujeres con cáncer de mama.

Equipping Learners to Evaluate Online Health Care Resources: Longitudinal Study of Learning Design Strategies in a Health Care Massive Open Online Course

BACKGROUND

The digital revolution has led to a boom in the number of available online health care resources. To navigate these resources successfully, digital literacy education is required. Learners who can evaluate the reliability and validity of online health care information are likely to be more effective at avoiding potentially dangerous misinformation. In addition to providing health care education, massive open online courses (MOOCs) are well positioned to play a role in providing digital literacy education in this context.

OBJECTIVE

This study focused on learners enrolled in a MOOC on cancer genomics. The aim of this study was to evaluate the efficacy of a series of digital literacy-related activities within this course. This was an iterative study, with changes made to digital literacy-related activities in 4 of the 8 runs of the course.

METHODS

This mixed methods study focused on learner engagement with the digital literacy-related activities, including the final course written assignment. Quantitative data including the number of references listed in each written assignment were compared between successive runs. Qualitative data in the form of learner comments on discussion forums for digital literacy-related tasks were evaluated to determine the impact of these educational activities.

RESULTS

Using the number of references included for each final course assignment as an indicator of digital literacy skills, the digital literacy-related activities in the final 2 runs were judged to be the most successful. We found a statistically significant increase in the number of references cited by learners in their final written assignments. The average number of references cited in Run 8 was significantly higher (3.5) than in Run 1 (1.8) of the MOOC (P=.001). Learner comments in Runs 7 and 8 showed that a poll in which learners were asked to select which of 4 online resources was reliable was effective in stimulating learner discussion about how to evaluate resource reliability.

CONCLUSIONS

Similar to many health care MOOCs, the course studied here had a heterogeneous group of learners, including patients (and their families), the public, health care students, and practitioners. Carefully designing a range of digital literacy-related activities that would be beneficial to this heterogenous group of learners enabled learners to become more effective at evaluating and citing appropriate online resources within their written assignments.

Educación en Colombia para la detección temprana del cáncer de mama

Introducción. El cáncer de mama representa un problema de salud pública cada vez mayor en Colombia. La mayoría de los estudiantes de medicina y de los profesionales de la salud no reciben capacitación para la detección temprana del cáncer de mama. Objetivo. Describir el proceso llevado a cabo por el Instituto Nacional de Cancerología de Colombia, para capacitar a los profesionales de la salud (médicos generales, ginecólogos, médicos familiares y enfermeras) en la detección temprana del cáncer de mama, mediante cursos presenciales y virtuales. Resultados. Con las dos modalidades de cursos, 1.875 profesionales de la salud han sido capacitados, la mayoría de ellos mediante el curso virtual (n=1.294; 73,0 %). Asimismo, los médicos generales han sido los profesionales que más se han certificado mediante alguna de las dos modalidades del curso (n=919; 49,0 %). Los dos cursos generan gran satisfacción en los participantes, con una tasa de certificación del 100 % en la modalidad presencial y del 73,0 % en la virtual. Conclusiones. Es difícil medir el impacto de la capacitación profesional en el diagnóstico precoz del cáncer de mama, porque la mayoría de las regiones de Colombia no tienen registros de cáncer. Es probable que, con un tiempo mayor de seguimiento, se logre medir el impacto real de los cursos en la detección temprana del cáncer de mama y, por ende, en la mortalidad debida a la enfermedad.

These may not be the courses you are seeking: a systematic review of open online courses in health professions education

INTRODUCTION

Open Online Courses (OOCs) are increasingly presented as a possible solution to the many challenges of higher education. However, there is currently little evidence available to support decisions around the use of OOCs in health professions education. The aim of this systematic review was to summarise the available evidence describing the features of OOCs in health professions education and to analyse their utility for decision-making using a self-developed framework consisting of point scores around effectiveness, learner experiences, feasibility, pedagogy and economics.

METHODS

Electronic searches of PubMed, Medline, Embase, PsychInfo and CINAHL were made up to April 2019 using keywords related to OOC variants and health professions. We accepted any type of full text English publication with no exclusions made on the basis of study quality. Data were extracted using a custom-developed, a priori critical analysis framework comprising themes relating to effectiveness, economics, pedagogy, acceptability and learner experience.

RESULTS

54 articles were included in the review and 46 were of the lowest levels of evidence, and most were offered by institutions based in the United States (n = 11) and United Kingdom (n = 6). Most studies provided insufficient course detail to make any confident claims about participant learning, although studies published from 2016 were more likely to include information around course aims and participant evaluation. In terms of the five categories identified for analysis, few studies provided sufficiently robust evidence to be used in formal decision making in undergraduate or postgraduate curricula.

CONCLUSION

This review highlights a poor state of evidence to support or refute claims regarding the effectiveness of OOCs in health professions education. Health professions educators interested in developing courses of this nature should adopt a critical and cautious position regarding their adoption.

Perspectives of patients, family members, and health care providers on late diagnosis of breast cancer in Ethiopia: A qualitative study

Background

Most women with breast cancer in Ethiopia are diagnosed at an advanced stage of the disease, but the reasons for this have not been systematically investigated. This study, therefore, aimed to explore the main reasons for diagnosis of advanced stage breast cancer from the perspective of patients, family members, and health care providers.

Methods

A qualitative study with in-depth interviews was conducted with 23 selected participants at Tikur Anbessa Specialized Hospital, Oncology Clinic using a semi-structured interview guide. These participants were 13 breast cancer patients, 5 family members, and 5 health care providers. Data were transcribed into English, coded and analyzed using thematic analysis.

Results

Awareness about the causes, risk, initial symptoms, early detection methods, and treatment of breast cancer were uncommon, and misconceptions about the disease prevailed among breast cancer patients and family members. There was a sense of hopelessness and uncertainty about the effectiveness of conventional medicine amongst patients and family members. Consequently, performing spiritual acts (using holy water) or seeking care from traditional healers recurred amongst the interviewees. Not taking initial symptoms of breast cancer seriously by the patients, reliance on traditional medicines, competing priorities, financial hardship, older age, fear of diagnosis of cancer, and weak health systems (e.g., delay in referral and long waiting period for consultation) were noted as the main contributors to late diagnosis. In contrast, persuasion by family members and friends, higher educational attainment, and prior experience of neighboring women with breast cancer were mentioned to be facilitators of early diagnosis of breast cancer.

Conclusions

The causes of late diagnosis of breast cancer in Ethiopia are multi-factorial and include individual, cultural, and health system factors. Interventions targeting these factors could alleviate the misconceptions and knowledge gap about breast cancer in the community, and shorten waiting time between symptom recognition and diagnosis of breast cancer.

Sociocultural Barriers Related to Late-Stage Presentation of Breast Cancer in Morocco

Breast cancer is the most prevalent cancer affecting women globally and in Morocco, where more than one fourth of patients are diagnosed at advanced stages. This study aimed to investigate sociocultural barriers that contribute to delayed presentation and diagnosis of breast cancer among women in Marrakesh, Morocco. Qualitative interviews were conducted with 25 breast cancer patients who received care at the CHU Mohammed VI Hospital in Marrakesh to elicit barriers to diagnosis and treatment and ease of access to care. Interviews with breast cancer patients revealed several themes regarding structural and sociocultural barriers to initial diagnosis and treatment. Structural barriers included high treatment-associated costs for patients and their families, burden of transportation to central treatment centers, and limited access to appropriate health care resources. Sociocultural barriers included perceived attack on one's identity associated with breast cancer diagnosis and treatment, influence of the local community, and ideas of faith, spirituality, and conception of death. Findings from this study can help identify areas for improved access and education of patients in order to improve breast cancer diagnostic and treatment efforts and enhance opportunities for early detection.

Using Citation Context to Improve the Retrieval of Research Article from Cancer Research Journals

Objective:

In recent years, citation analysis tools provide many devices for finding or computing the citation score or impact factor for journals. It is important for the researchers to identify good journals for collecting research ideas discussed. A journal with a good impact factor value is preferably referred to by many researchers. In this research work, the author proposes a system for ranking journals on the basis of ideas and results cited in other papers.

Methods:

The work involves the cited content extractor for extracting the descriptive features mentioned about the cited paper. The cited content refers to the content in the article written by a citing paper and relating to the cited paper. The ranking system uses a citation score estimator for computing the overall weight of the descriptive cited content relating to a specific paper in the citing papers. The journal ranking system performs classification of the citation content with the evaluation of a citation score. The work that involves the citation content is classified under different categories as positively cited, negatively cited or neutral and unrelated.

Results:

Then the computed citation score is used for ranking the dealing with research on cancer research journals. The results of the ranking journals indicate that the particular ranked journal has been cited in the literature of many journals with a good descriptive content. Journal ranking system can be considered as a well-organized tool for ranking the cancer research scientific journal based on citation content and citation counting.

Conclusion:

This experimental cancer journal ranking method increases accuracy and effectiveness by using the citation content when compared with PageRank and HITS.

The comparison of teaching efficiency between massive open online courses and traditional courses in medicine education: a systematic review and meta-analysis

Background

This systematic review and meta-analysis aimed to investigate and compare the passing rates of Massive Open Online Courses (MOOCs) with Traditional Courses to indicate how to improve the teaching efficiency in Medicine Education.

Methods

A systematic search of relevant published literature was conducted to collect relevant retrospective cohort studies that compared the teaching efficiency of MOOCs and Traditional Courses.

Results

There are three retrospective cohort studies included in the final meta-analysis. There were no significant differences in the passing rates of MOOCs and Traditional Courses.

Conclusions

it is necessary for universities to invest in online education to promote the development of MOOCs, which will probably have an advantage over Traditional Courses for postgraduate medical education in the near future.