Risultati per: Nuovo test per distinguere tra infezioni virali e batteriche

Studio pubblicato su Frontiers in Immunology

Objectives
To perform a budget impact analysis of the HepClink test-and-treat strategy in which community health agents offer hepatitis C virus (HCV) testing, diagnosis and treatment to the Pakistani population living in Catalonia compared with the current practice of the Catalan health system (without targeted screening programmes).

Methods
We estimated the population of adult Pakistani migrants registered at the primary care centres in Catalonia by means of the Information System for the Development of Research in Primary Care (n=37 972 in 2019, Barcelona health area). This cohort was followed for a time period of 10 years after HCV diagnosis (2019–2028). The statistical significance of the differences observed in the anti-HCV positivity rate between screened and non-screened was confirmed (α=0.05). The budget impact was calculated from the perspective of the Catalan Department of Health. Sensitivity analyses included different levels of participation in HepClink: pessimistic, optimistic and maximum.

Results
The HepClink scenario screened a higher percentage of individuals (69.8%) compared with the current scenario of HCV care (39.7%). Viraemia was lower in the HepClink scenario compared with the current scenario (1.7% vs 2.5%, respectively). The budget impact of the HepClink scenario was 884 244.42 in 10 years.

Conclusions
Scaling up the HepClink strategy to the whole Catalan territory infers a high budget impact for the Department of Health and allows increasing the detection of viraemia (+17.8%) among Pakistani migrants ≥18 years. To achieve a sustainable elimination of HCV by improving screening and treatment rates, there is room for improvement at two levels. First, taking advantage of the fact that 68.08% of the Pakistani population had visited their primary care physicians to reinforce targeted screening in primary care. Second, to use HepClink at the community level to reach individuals with reluctance to use healthcare services.

New England Journal of Medicine, Ahead of Print.

Objectives
This pilot study assessed whether a peer-supported, WhatsApp-assisted lifestyle modification intervention for weight reduction is feasible to execute a definitive trial.

Design
A mixed-methods, single group, pretest and post-test, quasi-experimental study.

Setting
Azam Basti, an urban slum in Karachi, Pakistan.

Participants
Fifty participants (males and females aged 20–60) with a body mass index of >23 kg/m2, along with their nominated peers from the same family.

Intervention
Using motivational interviewing techniques, a trained nutritionist delivered the lifestyle modification intervention to the participants and peers for 3 days after the baseline assessment and then once monthly for 1 year. The intervention was delivered in groups using WhatsApp voice calls. The education sessions mainly focused on dietary modifications, physical activity advice and peer-support assignments to achieve a 5% wt loss from the participant’s initial body weight.

Outcomes
The feasibility measures included screening, recruitment, retention and monthly interview response rates. At 1 year, in-depth interviews (IDIs) with participants and peers were conducted to explore the facilitators, barriers, acceptability and experiences of the intervention. Changes in weight, calorie intake/day and calorie expenditure/day were also assessed.

Results
The recruitment and retention rates were 32% (n=50/156) and 78% (n=39/50), respectively, while the response rate for monthly interviews ranged between 66% (n=33) and 94% (n=47). The mean weight loss at 1 year was 2.2 kg, and the reduction in mean calorie intake was 386 kcal/day. There were no changes in the mean calorie expenditure. During the IDIs, participants and peers reported intervention via WhatsApp and peer support as convenient, flexible and supportive.

Conclusions
The quantitative and qualitative findings of the current pilot study support the scale-up of this work with minor modifications to the screening method as well as close monitoring and motivational interviewing to improve adherence in terms of physical activity.

Trial registration number
NCT05928338.

In Reply We thank Pacheco and colleagues for their interest in our article. Most of the prevalence estimates we report in our systematic review and meta-analysis were derived from screening tools applied to large populations (most commonly the Edinburgh Postnatal Depression Scale). They present a subanalysis, recalculating the prevalence for depression where they account for the presumed screening performance of the Edinburgh Postnatal Depression Scale (ie, sensitivity and specificity), and they include a bayesian adjustment.

To the Editor The systematic review and meta-analysis conducted by Roddy Mitchell et al provides new evidence on the epidemiology of perinatal depression (PD) in low- and middle-income countries. The pooled prevalence of PD in this study was 24.7%. However, rates were higher in studies that used self-report screening tools (25.3%) compared with diagnostic interviews (17.8%). More than 90% of the studies used a self-report screening instrument, predominantly the Edinburgh Postnatal Depression Scale (EPDS), but none of them adjusted apparent prevalence estimates (the ones derived by applying thresholds of screening instruments) to true prevalence estimates (the ones incorporating uncertainty of the screening instruments). We have reanalyzed the results of this study by applying bayesian adjustment to correct apparent to true prevalence estimates.

Miglioramenti nel comportamento degli animali

Miglioramenti nel comportamento degli animali

Possono causare infezioni croniche e gravi problemi al fegato. Più di un milione di persone muore ogni anno per le conseguenze derivanti da queste malattie

Introduction
Multi-cancer early detection (MCED) blood tests look for cancer signals in cell-free deoxyribonucleic acid. These tests have the potential to detect cancers at an earlier (asymptomatic) stage, improving cancer outcomes. Any screening method needs careful consideration of the psychological harms prior to implementation. The aim of this research is to explore the psychological impact of having a cancer signal detected following an MCED blood test.

Methods and analysis
The project is embedded in the NHS-Galleri trial (ISRCTN91431511; NCT05611632), a large clinical trial in eight Cancer Alliances in England. In the trial, over 140 000 members of the general population aged 50–77 have been randomised 1:1 to either the intervention (blood tested with MCED test) or control (blood stored) arm. The proposed project focuses on participants in the intervention arm, who have a cancer signal detected. All participants who have a cancer signal detected (expected to be around 700 assuming a 1% test positive rate) will be sent a questionnaire at three timepoints: soon after receiving their result, 6 months and approximately 12 months later. The primary outcome is anxiety, assessed using the short-form 6-item Spielberger State Trait Anxiety Inventory. We will also assess the psychological consequences of screening (using the Psychological Consequences of Screening Questionnaire), reassurance/concern about the test result, understanding of results and help/health-seeking behaviour. A subsample of 40 participants (20 with a cancer diagnosis and 20 for whom no cancer was found) will be invited to take part in a one-to-one semistructured interview.

Ethics and dissemination
Ethical approval for this work has been granted by the Wales Research Ethics Committee as part of the NHS-Galleri trial (Ref 21/WA/0141). Consent to be sent questionnaires is collected as part of the main trial. A separate consent form will be required for interview. Results will be disseminated via peer-reviewed publication and conference presentations.

Introduction
Two blood brain-derived biomarkers, glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), can rule out intracranial lesions in patients with mild traumatic brain injury (mTBI) when assessed within the first 12 hours. Most elderly patients were excluded from previous studies due to comorbidities. Biomarker use in elderly population could be affected by increased basal levels. This study will assess the performance of an automated test for measuring serum GFAP and UCH-L1 in elderly patients to predict the absence of intracranial lesions on head CT scans after mTBI, and determine both biomarkers reference values in a non-TBI elderly population.

Methods and analysis
This is a prospective multicentre observational study on elderly patients (≥65 years) that will be performed in Spain, France and Germany. Two patient groups will be included in two independent substudies. (1) A cohort of 2370 elderly patients (1185

Quasi 300mila sanitari coinvolti entro il 2026

Quasi 300mila sanitari coinvolti entro il 2026

Starting in July 2024, the US Centers for Medicare & Medicaid Services (CMS) will begin piloting the Making Care Primary Model at organizations in 8 states—Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. In addition to improving care coordination, helping primary care clinicians connect with specialists, and strengthening connections with community-based organizations, the approach will likely reduce health care costs, the agency said in a statement.