Progress in Lung Cancer Screening Adoption

The National Lung Screening Trial, a landmark randomized clinical trial that demonstrated the efficacy of lung cancer screening with low-dose computed tomography (LDCT), was published more than a decade ago. In the interim, the US Preventive Services Task Force has endorsed lung cancer screening in certain adults, insurance coverage of LDCT has expanded, and a second large randomized clinical trial, the NELSON trial, demonstrated that LDCT can reduce lung cancer mortality. Importantly, annual LDCT screening also carries risks. In a recent observational study, approximately 32% of those screened underwent additional imaging, 3% had invasive testing, and 31% of those who received invasive testing had a complication.

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Agosto 2024

Long-term cost-effectiveness of case-finding and mass-screening for coeliac disease in children

Celiac disease (CD) is a common yet underdiagnosed autoimmune disease with substantial long-term consequences. High-accuracy point-of-care tests (POCTs) for CD antibodies conducted at youth primary healthcare centers (YHCCs) may enable earlier identification of CD, but evidence about the cost-effectiveness of such strategies is lacking. We estimated the long-term cost-effectiveness of active case-finding and mass-screening compared to clinical detection in the Netherlands.

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Luglio 2024

Examining the availability and readiness of health facilities to provide cervical cancer screening services in Nepal: a cross-sectional study using data from the Nepal Health Facility Survey

Objective
We assessed the availability and readiness of health facilities to provide cervical cancer screening services in Nepal.

Design
Cross-sectional study.

Setting
We used secondary data from a nationally representative 2021 Nepal Health Facility Survey, specifically focusing on the facilities offering cervical cancer screening services.

Outcome measures
We defined the readiness of health facilities to provide cervical cancer screening services using the standard WHO service availability and readiness assessment manual.

Results
The overall readiness score was 59.1% (95% CI 55.4% to 62.8%), with more equipment and diagnostic tests available than staff and guidelines. Public hospitals (67.4%, 95% CI 63.0% to 71.7%) had the highest readiness levels. Compared with urban areas, health facilities in rural areas had lower readiness. The Sudurpashchim, Bagmati and Gandaki provinces had higher readiness levels (69.1%, 95% CI 57.7% to 80.5%; 60.1%, 95% CI 53.4% to 66.8%; and 62.5%, 95% CI 56.5% to 68.5%, respectively). Around 17% of facilities had trained providers and specific guidelines to follow while providing cervical cancer screening services. The basic healthcare centres (BHCCs) had lower readiness than private hospitals. Facility types, province and staff management meetings had heterogeneous associations with three conditional quantile scores.

Conclusion
The availability of cervical cancer screening services is limited in Nepal, necessitating urgent action to expand coverage. Our findings suggest that efforts should focus on improving the readiness of existing facilities by providing training to healthcare workers and increasing access to guidelines. BHCCs and healthcare facilities in rural areas and Karnali province should be given priority to enhance their readiness.

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Luglio 2024