Risultati per: Screening del cancro del colon-retto

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.

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.

Le forme più gravi aumentano ancora di più il pericolo

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Introduction
Lung cancer is the most common cause of cancer death globally. In 2022 the UK National Screening Committee recommended the implementation of a national targeted lung cancer screening programme, aiming to improve early diagnosis and survival rates. Research studies and services internationally consistently observe socioeconomic and smoking-related inequalities in screening uptake. Pathway navigation (PN) is a process through which a trained pathway navigator guides people to overcome barriers to accessing healthcare services, including screening. This nested randomised controlled trial aims to determine whether a PN intervention results in more individuals participating in lung cancer screening compared with the usual written invitation within a previous non-responder population as part of the Yorkshire Lung Screening Trial (YLST).

Methods and analysis
A two-arm randomised controlled trial and process evaluation nested within the YLST. Participants aged 55–80 (inclusive) who have not responded to previous postal invitations to screening will be randomised by household to receive PN or usual care (a further postal invitation to contact the screening service for a lung health check) between March 2023 and October 2024. The PN intervention includes a postal appointment notification and prearranged telephone appointment, during which a pathway navigator telephones the participant, following a four-step protocol to introduce the offer and conduct an initial risk assessment. If eligible, participants are invited to book a low-dose CT (LDCT) lung cancer screening scan. All pathway navigators receive training from behavioural psychologists on motivational interviewing and communication techniques to elicit barriers to screening attendance and offer solutions.

Coprimary outcomes
The number undergoing initial telephone assessment of lung cancer risk. The number undergoing an LDCT screening scan.
Secondary outcomes include demographic, clinical and risk parameters of people undergoing telephone risk assessment; the number of people eligible for screening following telephone risk assessment; the number of screen-detected cancers diagnosed; costs and a mixed-methods process evaluation.
Descriptive analyses will be used to present numbers, proportions and quantitative components of the process evaluation. Primary comparisons of differences between groups will be made using logistic regression. Applied thematic analysis will be used to interpret qualitative data within a conceptual framework based on the COM-B framework. A health economic analysis of the PN intervention will also be conducted.

Ethics and dissemination
The study is approved by the Greater Manchester West Research Ethics Committee (18-NW-0012) and the Health Research Authority following the Confidentiality Advisory Group review. Results will be shared through peer-reviewed scientific journals, conference presentations and on the YLST website.

Trial registration numbers
ISRCTN42704678 and NCT03750110.

Most colorectal cancers (CRCs) develop via the adenoma-carcinoma sequence, a stepwise process characterized by mutations in healthy tissue that accumulate in the progression from adenomatous polyps to cancer. First coined the polyp-cancer sequence nearly a century ago, it is widely believed that the contemporary concept was first used by Jackman and Mayo in 1951. Even before more modern sequencing technology facilitated the elucidation of the underlying molecular mechanisms, it was well understood that this process is typically slow, generally taking approximately 10 years. This time frame is the empirical basis for most current colorectal cancer screening guidelines that endorse a 10-year interval after a colonoscopy with no abnormal findings.

In Reply We appreciate the perspective from Boulestreau and Couffinhal on our recent initiative to enhance screening for primary aldosteronism (PA) by leveraging electronic health records capabilities. We designed and implemented an advisory that identifies PA screening candidates and assists clinicians with test ordering and interpretation. Boulestreau and Couffinhal suggest empirical use of mineralocorticoid receptor antagonists (MRA) to treat patients with possible PA as a more pragmatic alternative to PA screening.

This report of 2 randomized clinical trials evaluates whether bulk ordering, text messaging, and clinician endorsement increase breast cancer screening rates.

To the Editor Patients with hypertension and primary aldosteronism (PA) face a grim prognosis in the absence of specific therapy; they must be promptly identified and managed. Charoensri et al reported on an enhanced effective screening rate for this population, reaching up to 9.9%, through an artificial intelligence−based best practice advisories system that identifies patients who are at high-risk for PA for clinicians. Although this is an improvement compared with the commonly reported 2% to 4% rate, screening remained infrequent even in this study context, with 90.1% of patients who were identified as being at high risk not undergoing screening. Some may perceive this as a failure, but we believe a critical outcome is absent, hindering a proper evaluation of the intervention’s effectiveness.

In Lombardia uno studio pilota promosso da Telethon coinvolgerà 100mila neonati. Obiettivo: validare il test per la diagnosi di leucodistrofia metacromatica

Circulation, Ahead of Print. Background: This trial aimed to assess the efficacy, acceptability and safety of a first-trimester screen-and-prevent strategy for preterm preeclampsia (PE) in Asia.Methods: Between 1stAugust 2019 and 28thFebruary 2022, this multicenter stepped wedge cluster randomized trial included maternity/diagnostic units from ten regions in Asia. The trial started with a period where all recruiting centers provided routine antenatal care without study-related intervention. At regular six-week intervals, one cluster was randomized to transit from non-intervention phase to intervention phase. In the intervention phase, women underwent first-trimester screening for preterm PE using a Bayes theorem-based triple-test. High-risk women, with adjusted risk for preterm PE ≥ 1 in 100, received low-dose aspirin from