BACKGROUND:Periodic universal screening for anxiety and for intimate partner violence (IPV) for women and adolescent girls are national clinical practice recommendations. However, screening rates in primary care settings are low. This study aimed to increase awareness and adoption of screening for anxiety and for IPV in women and adolescent girls by identifying screening barriers and facilitators to inform clinical resource development. METHODS:Two-phase, qualitative study using semistructured interviews to identify screening barriers and facilitators; thematic analysis of interview data using a rapid evaluation approach. RESULTS:Twenty-seven clinicians and staff members were interviewed in 12 clinics in 2 primary care networks in Oregon. All participants recognized the importance of screening in primary care settings but were generally unaware of screening recommendations and insurance coverage and were unsure of their clinic's policies and practices, citing a lack of protocols for referrals for positive screens. Barriers to both anxiety and IPV screening included screening fatigue, lack of metrics, uncertain documentation and reporting, and unclear referral and follow-up procedures. For IPV screening specifically, barriers included discomfort with screening, privacy concerns, and perceived low occurrence. Facilitators for both services included leveraging existing screening practices and electronic health record tools, and clear recommendations for universal screening best practices. CONCLUSION:Implementation of routine screening for anxiety and IPV in women and adolescents in primary care is low but may improve with targeted clinician resources and education. Workflow diagrams and resource guides responsive to identified screening barriers and facilitators, including clarification of insurance coverage for preventive services, and resources to support implementation of protocols of screening methods, clinical documentation, and referrals for anxiety and IPV in primary care settings, could improve screening practices.

The Women's Preventive Services Initiative (WPSI) expanded its previous cervical cancer screening recommendation for average-risk women by including patient-collected high-risk human papillomavirus (hrHPV) screening tests and additional follow-up testing needed to complete the screening process. To update the previous recommendation, the WPSI identified new evidence demonstrating that primary hrHPV screening increases detection of precancerous lesions compared with cytology screening. New studies indicate that patient-collected hrHPV testing has similar test accuracy for precancer detection compared with clinician-collected samples and may reduce barriers to screening. Consistent with the previous recommendation, the WPSI recommends cervical cancer screening for average-risk women aged 21–65 years. For women aged 21–29 years, screening using cervical cytology (Pap test) every 3 years is recommended; co-testing with cytology and hrHPV testing is not recommended for those younger than 30 years. For women aged 30–65 years, primary hrHPV testing (preferred method) or co-testing (cytology with hrHPV) every 5 years is recommended; if hrHPV testing cannot be performed, cytology every 3 years is acceptable. Women at average risk should not be screened more than once every 3 years. Patient-collected hrHPV is an appropriate screening method for average-risk women aged 30–65 years. The new recommendation—including additional testing to follow up on findings on the initial screening—was recently approved by the Health Resources & Services Administration, U.S. Department of Health and Human Services, for coverage without co-pay or deductible charges for most eligible women beginning in 2027.

The Women's Preventive Services Initiative (WPSI) expanded its previous cervical cancer screening recommendation for average-risk women by including patient-collected high-risk human papillomavirus (hrHPV) screening tests and additional follow-up testing needed to complete the screening process. To update the previous recommendation, the WPSI identified new evidence demonstrating that primary hrHPV screening increases detection of precancerous lesions compared with cytology screening. New studies indicate that patient-collected hrHPV testing has similar test accuracy for precancer detection compared with clinician-collected samples and may reduce barriers to screening. Consistent with the previous recommendation, the WPSI recommends cervical cancer screening for average-risk women aged 21-65 years. For women aged 21-29 years, screening using cervical cytology (Pap test) every 3 years is recommended; co-testing with cytology and hrHPV testing is not recommended for those younger than 30 years. For women aged 30-65 years, primary hrHPV testing (preferred method) or co-testing (cytology with hrHPV) every 5 years is recommended; if hrHPV testing cannot be performed, cytology every 3 years is acceptable. Women at average risk should not be screened more than once every 3 years. Patient-collected hrHPV is an appropriate screening method for average-risk women aged 30-65 years. The new recommendation-including additional testing to follow up on findings on the initial screening-was recently approved by the Health Resources & Services Administration, U.S. Department of Health and Human Services, for coverage without co-pay or deductible charges for most eligible women beginning in 2027.

Background:Ensuring patient safety (PS) and implementing quality improvement (QI) are well-recognized functions of healthcare delivery systems and fall within physicians' scope of practice. How to effectively introduce equity-centered PS and QI concepts into an already overloaded undergraduate medical education curriculum is a challenge. Methods:This report describes our experiences at the Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM), a new medical school, and how we have developed our Quality Improvement and Patient Safety curriculum within a larger institutional environment where equity and social justice are highly valued. Results:Integrating health systems science into undergraduate medical education and concepts related to health equity requires intentional curricular design and ongoing adaptation. Lessons learned include: (1) importance of using the Basic Improvement Framework as an educational anchor; (2) understanding the value of integration across curricular phases; and (3) creating a dedicated space for curricular refinement over time. Conclusions:Medical schools and health systems aiming to strengthen their health systems science curricula may find value in implementing structured approaches-such as the Basic Improvement Framework utilized at KPSOM-to promote early and meaningful engagement with systems-based concepts, especially health equity, throughout learners' training.

This Viewpoint discusses new Women’s Preventive Services Initiative breast cancer screening recommendations encompassing the entire clinical pathway from screening to diagnosis.

Importance:Screening and follow-up rates for breast and cervical cancer vary across socioeconomic and demographic groups. While patient navigation services can help patients overcome barriers to health care, they are not commonly used in cancer screening. Objective:To determine the effectiveness and harms of patient navigation services to increase screening and follow-up rates for breast and cervical cancer. Data Sources:A search of the MEDLINE, Scopus, CENTRAL, and Cochrane Database of Systematic Reviews was conducted for English-language articles published between January 1, 2000, and September 19, 2024. A manual review of article references supplemented the search. Study Selection:Eligible articles were randomized clinical trials comparing the effectiveness of patient navigation services in participants eligible for breast or cervical cancer screening with usual care or control groups, as well as observational studies for harm. Investigators independently dual-reviewed abstracts and full-text articles to identify studies meeting prespecified eligibility criteria. Disagreements were resolved by consensus with a third reviewer. Of all abstracts and full-text articles reviewed, 2.9% were selected for analysis. Data Extraction and Synthesis:This report followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A single investigator extracted data from each study. A second investigator reviewed the data for accuracy. Investigators independently dual-rated individual study quality as good, fair, or poor. Discordant quality ratings were resolved with a third reviewer. Data were combined using a profile likelihood random-effects model. Main Outcomes and Measures:The main outcomes were breast and cervical cancer screening rates within 1 year of the intervention, follow-up rates within 2 years, and any harm. Results:A total of 42 randomized clinical trials with 39 111 participants assessing the effectiveness of patient navigation services to increase screening and follow-up rates for breast and cervical cancer were included in the meta-analysis; no studies described harms. For breast cancer, patient navigation resulted in higher rates of screening (risk ratio [RR], 1.50; 95% CI, 1.30-1.75; I2 = 88.0%; 30 trials; n = 34 744 participants) and follow-up (RR, 1.23; 95% CI, 1.15-1.41; I2 = 12.6%; 3 trials; n = 1008 participants) compared with comparison groups. For cervical cancer, patient navigation also resulted in higher rates of screening (RR, 1.62; 95% CI, 1.28-2.09; I2 = 89.6%; 20 trials; n = 11 820 participants) and follow-up (RR, 1.63; 95% CI, 0.86-2.65; I2 = 69.0%; 2 trials; n = 401 participants). Sensitivity analyses demonstrated higher screening rates with patient navigation vs comparison groups for general populations and populations based on race, ethnicity, low-income status, and other characteristics. Predicted 1-year absolute rates following patient navigation were 13.8% higher for breast cancer screening and 15.6% higher for cervical cancer screening than for comparison groups. Conclusions and Relevance:The results of this systematic review and meta-analysis suggest that patient navigation services can increase breast and cervical cancer screening and follow-up. Reducing barriers with patient navigation services could improve access and engage patients in more effective and equitable cancer preventive care.

The Women's Preventive Services Initiative (WPSI) expanded its previous breast cancer screening recommendation-initiate annual or biennial mammography screening for women at average risk of breast cancer between the ages of 40 and 50 years-by including additional imaging and pathology evaluation as part of the screening process if needed. Consistent with the previous recommendation, screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening. To increase utilization of screening recommendations, the WPSI also issued a new recommendation to provide patient navigation services for breast and cervical cancer screening. To update its 2016 breast cancer screening recommendation, the WPSI found no new evidence of benefits and harms of screening. However, additional studies reported that gaps in insurance coverage contributed to incomplete follow-up after an initial abnormal mammogram for many women. For its new patient navigation recommendation, the WPSI evaluated 42 randomized controlled trials of patient navigation services for breast and cervical cancer screening and follow-up that showed increased rates compared with usual care. Patient navigation services involve person-to-person contact and are individualized to the patient's specific needs. Services include but are not limited to person-centered assessment and planning, health care access and health system navigation, referrals to support services, and patient education. The new recommendations are intended to expand breast cancer screening follow-up and to improve access and equity for cancer screening. Beginning in 2026, under the Affordable Care Act, these services will be covered without copay or deductible charges for most eligible women.

Importance:In young-onset breast cancer (YOBC), a diagnosis within 5 to 10 years of childbirth is associated with increased mortality. Women with germline BRCA1/2 pathogenic variants (PVs) are more likely to be diagnosed with BC at younger ages, but the impact of childbirth on mortality is unknown. Objective:To determine whether time between most recent childbirth and BC diagnosis is associated with mortality among patients with YOBC and germline BRCA1/2 PVs. Design, Setting, and Participants:This prospective cohort study included women with germline BRCA1/2 PVs diagnosed with stage I to III BC at age 45 years or younger between 1950 and 2021 in the United Kingdom, who were followed up until November 2021. Data were analyzed from December 3, 2021, to November 29, 2023. Exposure:Time between most recent childbirth and subsequent BC diagnosis, with recent childbirth defined as 0 to less than 10 years, further delineated to 0 to less than 5 years and 5 to less than 10 years. Main Outcomes and Measures:The primary outcome was all-cause mortality, censored at 20 years after YOBC diagnosis. Mortality of nulliparous women was compared with the recent post partum groups and the 10 or more years post partum group. Cox proportional hazards regression analyses were adjusted for age, tumor stage, and further stratified by tumor estrogen receptor (ER) and BRCA gene status. Results:Among 903 women with BRCA PVs (mean [SD] age at diagnosis, 34.7 [6.1] years; mean [SD] follow-up, 10.8 [9.8] years), 419 received a BC diagnosis 0 to less than 10 years after childbirth, including 228 women diagnosed less than 5 years after childbirth and 191 women diagnosed 5 to less than 10 years after childbirth. Increased all-cause mortality was observed in women diagnosed within 5 to less than 10 years post partum (hazard ratio [HR], 1.56 [95% CI, 1.05-2.30]) compared with nulliparous women and women diagnosed 10 or more years after childbirth, suggesting a transient duration of postpartum risk. Risk of mortality was greater for women with ER-positive BC in the less than 5 years post partum group (HR, 2.35 [95% CI, 1.02-5.42]) and ER-negative BC in the 5 to less than 10 years post partum group (HR, 3.12 [95% CI, 1.22-7.97]) compared with the nulliparous group. Delineated by BRCA1 or BRCA2, mortality in the 5 to less than 10 years post partum group was significantly increased, but only for BRCA1 carriers (HR, 2.03 [95% CI, 1.15-3.58]). Conclusions and Relevance:These findings suggest that YOBC with germline BRCA PVs was associated with increased risk for all-cause mortality if diagnosed within 10 years after last childbirth, with risk highest for ER-positive BC diagnosed less than 5 years post partum, and for ER-negative BC diagnosed 5 to less than 10 years post partum. BRCA1 carriers were at highest risk for poor prognosis when diagnosed at 5 to less than 10 years post partum. No such associations were observed for BRCA2 carriers. These results should inform genetic counseling, prevention, and treatment strategies for BRCA PV carriers.

Importance Prior reports demonstrated that patients with cancer experienced worse outcomes from pandemic-related stressors and COVID-19 infection. Patients with certain malignant neoplasms, such as high-risk gastrointestinal (HRGI) cancers, may have been particularly affected. Objective To evaluate disruptions in care and outcomes among patients with HRGI cancers during the COVID-19 pandemic, assessing for signs of long-term changes in populations and survival. Design, Setting, and Participants This retrospective cohort study used data from the National Cancer Database to identify patients with HRGI cancer (esophageal, gastric, primary liver, or pancreatic) diagnosed between January 1, 2018, and December 31, 2020. Data were analyzed between August 23 and September 4, 2023. Main Outcome and Measures Trends in monthly new cases and proportions by stage in 2020 were compared with the prior 2 years. Kaplan-Meier curves and Cox regression were used to assess 1-year mortality in 2020 compared with 2018 to 2019. Proportional monthly trends and multivariable logistic regression were used to evaluate 30-day and 90-day mortality in 2020 compared with prior years. Results Of the 156 937 patients included in this study, 54 994 (35.0%) were aged 60 to 69 years and 100 050 (63.8%) were men. There was a substantial decrease in newly diagnosed HRGI cancers in March to May 2020, which returned to prepandemic levels by July 2020. For stage, there was a proportional decrease in the diagnosis of stage I (-3.9%) and stage II (-2.3%) disease, with an increase in stage IV disease (7.1%) during the early months of the pandemic. Despite a slight decrease in 1-year survival rates in 2020 (50.7% in 2018 and 2019 vs 47.4% in 2020), survival curves remained unchanged between years (all P > .05). After adjusting for confounders, diagnosis in 2020 was not associated with increased 1-year mortality compared with 2018 to 2019 (hazard ratio, 0.99; 95% CI, 0.97-1.01). The rates of 30-day (2.1% in 2018, 2.0% in 2019, and 2.1% in 2020) and 90-day (4.3% in 2018, 4.4% in 2019, and 4.6% in 2020) operative mortality also remained similar. Conclusions and Relevance In this retrospective cohort study, a period of under diagnosis and increase in stage IV disease was observed for HRGI cancers during the pandemic; however, there was no change in 1-year survival or operative mortality. These results demonstrate the risks associated with gaps in care and the tremendous efforts of the cancer community to ensure quality care delivery during the pandemic. Future research should investigate long-term survival changes among all cancer types as additional follow-up data are accrued.

Telehealth delivery of preventive health services may improve access to care; however, its effectiveness and adverse effects are unknown. We conducted a comparative effectiveness review on the effectiveness and harms of telehealth interventions for women’s reproductive health and intimate partner violence (IPV) services. We searched MEDLINE, Cochrane Library, CINAHL, and Scopus for English-language studies (July 2016 to May 2022) for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women’s reproductive health and IPV versus usual care. Two investigators identified studies and abstracted data using a predefined protocol. Study quality was assessed using study design-specific standardized methods; disagreements were resolved through consensus. Eight RCTs, 1 nonrandomized trial, and 7 observational studies (n=10 731) were included (7 studies of contraceptive care and 9 of IPV services). Telehealth interventions to supplement contraceptive care demonstrated similar rates as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]); evidence on abortion was insufficient. Outcomes were also similar between telehealth interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). In these studies, telehealth barriers included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Strategies to ensure safety increased telehealth use for IPV services. Evidence on access, health equity, or harms was lacking. Telehealth interventions for contraceptive care and IPV services demonstrate equivalent clinical and patient-reported outcomes versus in-person care, although few studies are available. Effective approaches for delivering these services and how to best mobilize telehealth, particularly for women facing barriers to care remain uncertain. PROSPERO CRD42021282298.

AbstractIMPORTANCEIn young-onset breast cancer, a diagnosis within 5-10 years of childbirth associates with increased mortality. Women with germlineBRCA1/2pathogenic variants (PVs) are more likely to be diagnosed with breast cancer at younger ages, but the impact of childbirth on mortality is unknown.OBJECTIVEDetermine whether time between recent childbirth and breast cancer diagnosis impacts mortality among young-onset breast cancer patients with germlineBRCA1/2PVs.DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study includes 903 women with germlineBRCA1/2PVs diagnosed with stage I-III breast cancer at ≤45 years of age, between 1950-2021 in the UK.MAIN OUTCOMES AND MEASURESThe primary outcome is all-cause mortality, censored at 20 years post-diagnosis. The primary exposure is time between most recent childbirth and breast cancer diagnosis, with recent childbirth defined as >0-<10 years post childbirth (n=419)], further delineated to >0-<5 years (n=228) and 5-<10 years (n=191). Mortality of nulliparous cases (n=224) was compared to the recent postpartum groups and the ≥10 years postpartum (n=260) group. Cox proportional hazards regression analyses were adjusted for patient age, tumor stage, further stratified by tumor estrogen receptor (ER) andBRCAgene status.RESULTSFor allBRCAPV carriers, increased all-cause mortality was observed in women diagnosed >0-<10 years postpartum, compared to nulliparous and ≥10 years groups, demonstrating the transient duration of postpartum risk. Risk of mortality was greater for ER-positive cases in the >0-<5 group [HR=2.35 (95% CI, 1.02-5.42)] and ER-negative cases in the 5-<10 group [HR=3.12 (95% CI, 1.22-7.97)] compared to the nulliparous group. Delineated byBRCA1orBRCA2, mortality in the 5-<10 group was significantly increased, but only forBRCA1carriers [HR=2.03 (95% CI, 1.15-3.58)].CONCLUSIONS AND RELEVANCEYoung-onset breast cancer with germlineBRCAPVs confers increased risk for all-cause mortality if diagnosed within 10 years of childbirth, with risk highest for ER+ cases at >0-<5 years postpartum, and for ER-cases at 5-<10 years postpartum.BRCA1carriers are at highest risk for poor prognosis when diagnosed at 5-10 years postpartum. No such associations were observed forBRCA2carriers. These results should inform genetic counseling, prevention, and treatment strategies forBRCAPV carriers.Key PointsQuestionIs a postpartum diagnosis an independent risk factor for mortality among young-onset breast cancer patients with germlineBRCA1/2PVs?FindingsA diagnosis <10 years postpartum associates with higher risk of mortality compared to nulliparous and ≥10 years postpartum cases. Peak risk after childbirth varies for ER-positive (>0-<5 years) vs. ER-negative cases (5-<10 years).BRCA1carriers had peak risk of mortality 5-10 years postpartum, with no associations observed forBRCA2carriers.MeaningA breast cancer diagnosis within 10 years of childbirth independently associates with increased risk for mortality in patients with germlineBRCA1/2PVs, especially for carriers ofBRCA1PVs.

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( JAMA . 2022;328:1714–1729) Unintended pregnancy is a common occurrence in the United States and has been associated with adverse outcomes for both mothers and infants. This systematic review and meta-analysis aimed to understand the relationships between unintended pregnancy and health outcomes during pregnancy and postpartum among current US populations to better inform clinical practice and health policy and improve outcomes.

Description: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient advocacy representatives, developed a recommendation for counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI; 18.5 to 29.9 kg/m(2)) to maintain weight or limit weight gain to prevent obesity with the long-term goals of optimizing health, function, and well-being. This recommendation is intended to guide clinical practice and coverage of clinical preventive health services for the Health Resources and Services Administration and other stakeholders. Clinicians providing preventive health care to women in primary care settings are the target audience for this recommendation. Methods: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness and harms of interventions to prevent weight gain and obesity in women aged 40 to 60 years without obesity. Seven randomized clinical trials including 51 638 participants and using various counseling and behavioral interventions were included. Trials indicated favorable weight changes with interventions that were statistically significantly different from control groups in 4 of 5 trials of counseling, but not in 2 trials of exercise. Few harms were reported. Recommendation: The WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight BMI (18.5 to 29.9 kg/m(2)) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity.

Importance:Unintended pregnancy is common in the US and is associated with adverse maternal and infant health outcomes; however, estimates of these associations specific to current US populations are lacking. Objective:To evaluate associations of unintended pregnancy with maternal and infant health outcomes during pregnancy and post partum with studies relevant to current clinical practice and public health in the US. Data Sources:Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE databases (January 1, 2000, to June 15, 2022) and manual review of reference lists. Study Selection:Epidemiologic studies relevant to US populations that compared key maternal and infant health outcomes for unintended vs intended pregnancies and met prespecified eligibility criteria were included after investigators' independent dual review of abstracts and full-text articles. Data Extraction and Synthesis:Investigators abstracted data from publications on study methods, participant characteristics, settings, pregnancy intention, comparators, confounders, and outcomes; data were validated by a second investigator. Risk of bias was independently dual rated by investigators using criteria developed by the US Preventive Services Task Force. Results of studies controlling for confounders were combined by using a profile likelihood random-effects model. Main Outcomes and Measures:Prenatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth, and infant low birth weight. Results:Thirty-six studies (N = 524 522 participants) were included (14 cohort studies rated good or fair quality; 22 cross-sectional studies); 12 studies used large population-based data sources. Compared with intended pregnancy, unintended pregnancy was significantly associated with higher odds of depression during pregnancy (23.3% vs 13.9%; adjusted odds ratio [aOR], 1.59 [95% CI, 1.35-1.92]; I2 = 85.0%; 15 studies [n = 41 054]) and post partum (15.7% vs 9.6%; aOR, 1.51 [95% CI, 1.40-1.70]; I2 = 7.1%; 10 studies [n = 82 673]), interpersonal violence (14.6% vs 5.5%; aOR, 2.22 [95% CI, 1.41-2.91]; I2 = 64.1%; 5 studies [n = 42 306]), preterm birth (9.4% vs 7.7%; aOR, 1.21 [95% CI, 1.12-1.31]; I2 = 1.7%; 10 studies [n = 94 351]), and infant low birth weight (7.3% vs 5.2%; aOR, 1.09 [95% CI, 1.02-1.21]; I2 = 0.0%; 8 studies [n = 87 547]). Results were similar in sensitivity analyses based on controlling for history of depression for prenatal and postpartum depression and on study design and definition of unintended pregnancy for relevant outcomes. Studies provided limited sociodemographic data and measurement of confounders and outcomes varied. Conclusions and Relevance:In this systematic review and meta-analysis of epidemiologic observational studies relevant to US populations, unintended pregnancy, compared with intended pregnancy, was significantly associated with adverse maternal and infant outcomes. Trial Registration:PROSPERO Identifier: CRD42020192981.

Objectives. To evaluate the effectiveness, use, and implementation of telehealth for women’s preventive services for reproductive healthcare and interpersonal violence (IPV), and to evaluate patient preferences and engagement for telehealth, particularly in the context of the coronavirus (COVID-19) pandemic. Data sources. Ovid MEDLINE®, CINAHL®, Embase®, and Cochrane CENTRAL databases (July 1, 2016, to March 4, 2022); manual review of reference lists; suggestions from stakeholders; and responses to a Federal Register Notice. Review methods. Eligible abstracts and full-text articles of telehealth interventions were independently dual reviewed for inclusion using predefined criteria. Dual review was used for data abstraction, study-level risk of bias assessment, and strength of evidence (SOE) rating using established methods. Meta-analysis was not conducted due to heterogeneity of studies and limited available data. Results. Searches identified 5,704 unique records. Eight randomized controlled trials, one nonrandomized trial, and seven observational studies, involving 10,731 participants, met inclusion criteria. Of these, nine evaluated IPV services and seven evaluated contraceptive care, the only reproductive health service studied. Risk of bias was low in one study, moderate in nine trials and five observational studies, and high in one study. Telehealth interventions were intended to replace usual care in 14 studies and supplement care in 2 studies. Delivery modes included telephone (5 studies), online modules (5 studies), and mobile applications (1 study), and was unclear or undefined in five studies. There were no differences between telehealth interventions to supplement contraceptive care and comparators for rates of contraceptive use, sexually transmitted infection, and pregnancy (low SOE); evidence was insufficient for abortion rates. There were no differences between telehealth IPV services versus comparators for outcomes measuring repeat IPV, depression, post-traumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). The COVID-19 pandemic increased telehealth utilization. Barriers to telehealth interventions included limited internet access and digital literacy among English-speaking IPV survivors, and technical challenges and confidentiality concerns for contraceptive care. Telehealth use was facilitated by strategies to ensure safety of individuals who receive IPV services. Evidence was insufficient to evaluate access, health equity, or harms outcomes. Conclusions. Limited evidence suggests that telehealth interventions for contraceptive care and IPV services result in equivalent clinical and patient-reported outcomes as in-person care. Uncertainty remains regarding the most effective approaches for delivering these services, and how to best mobilize telehealth, particularly for women facing barriers to healthcare.

BACKGROUND:Cancer-related deaths over the next decade are expected to increase due to cancer screening deficits associated with the coronavirus disease 2019 (COVID-19) pandemic. Although national deficits have been quantified, a structured response to identifying and addressing local deficits has not been widely available. The objectives of this report are to share preliminary data on monthly screening deficits in breast, colorectal, lung, and cervical cancers across diverse settings and to provide online materials from a national quality improvement (QI) study to help other institutions to address local screening deficits.METHODS:This prospective, national QI study on Return-to-Screening enrolled 748 accredited cancer programs in the United States from April through June 2021. Local prepandemic and pandemic monthly screening test volumes (MTVs) were used to calculate the relative percent change in MTV to describe the monthly screening gap.RESULTS:The majority of facilities reported monthly screening deficits (colorectal cancer, 80.6% [n = 104/129]; cervical cancer, 69.0% [n = 20/29]; breast cancer, 55.3% [n = 241/436]; lung cancer, 44.6% [n = 98/220]). Overall, the median relative percent change in MTV ranged from -17.7% for colorectal cancer (interquartile range [IQR], -33.6% to -2.8%), -6.8% for cervical cancer (IQR, -29.4% to 1.7%), -1.6% for breast cancer (IQR, -9.6% to 7.0%), and 1.2% for lung cancer (IQR, -16.9% to 19.0%). Geographic differences were not observed. There were statistically significant differences in the percent change in MTV between institution types for colorectal cancer screening (P = .02).CONCLUSION:Cancer screening is still in need of urgent attention, and the screening resources made available online may help facilities to close critical gaps and address screenings missed in 2020.LAY SUMMARY:Question: How can the effects of the coronavirus disease 2019 pandemic on cancer screening be mitigated?FINDINGS:When national resources were provided, including methods to calculate local screening deficits, 748 cancer programs promptly enrolled in a national Return-to-Screening study, and the majority identified local screening deficits, most notably in colorectal cancer. Using these results, 814 quality improvement projects were initiated with the potential to add 70,000 screening tests in 2021. Meaning: Cancer screening is still in need of urgent attention, and the online resources that we provide may help to close critical screening deficits.

BACKGROUNDDespite high prevalence rates of obesity in the United States, no clinical guidelines exist for obesity prevention in midlife women who commonly experience weight gain.PURPOSETo evaluate evidence on the effectiveness and harms of behavioral interventions to reduce weight gain and improve health outcomes for women aged 40 to 60 years without obesity.DATA SOURCESEnglish-language searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (inception to 26 October 2021); ClinicalTrials.gov (October 2021); and reference lists of studies and reviews.STUDY SELECTIONRandomized controlled trials (RCTs) enrolling predominantly midlife women comparing behavioral interventions to prevent weight gain with control groups and reporting health outcomes and potential harms.DATA EXTRACTIONDual extraction and quality assessment of individual studies.DATA SYNTHESISSeven RCTs in 12 publications (n = 51 638) were included. Four RCTs showed statistically significant favorable differences in weight change for counseling interventions versus control groups (mean difference of weight change, -0.87 to -2.5 kg), whereas 1 trial of counseling and 2 trials of exercise showed no differences; 1 of 2 RCTs reported improved quality-of-life measures. Interventions did not increase measures of depression or stress in 1 trial; self-reported falls (37% vs. 29%; P < 0.001) and injuries (19% vs. 14%; P = 0.03) were higher with exercise counseling in 1 trial.LIMITATIONTrials were generally small, heterogeneous, and lacked data on harms, long-term health outcomes, and specific patient populations.CONCLUSIONCounseling interventions to prevent weight gain in women during midlife may result in modest differences in weight change without causing important harms. More research is needed to determine optimal content, frequency, length, and number of sessions required and should include additional patient populations.PRIMARY FUNDING SOURCEHealth Resources and Services Administration.