Risultati per: Cancro al seno: Screening e diagnosi

Studio pubblicato nella rivista Nature Communications

Background
Cervical cancer (CC) is preventable through regular screening and vaccination against human papillomavirus (HPV). However, CC remains a significant public health issue in low-income and middle-income countries (LMICs) like Vietnam, where financial constraints hinder the widespread implementation of HPV vaccination and screening programmes. Currently, Vietnam lacks both a national CC screening intervention and an HPV vaccination programme for women and girls. To date, cost-effectiveness studies evaluating CC screening methods in Vietnam remain limited.

Objectives
To evaluate the cost-effectiveness of two CC screening strategies for Vietnamese women aged 25–55 years: (1) cotesting combining cytology and HPV testing conducted three times at 5 year intervals (intervention) and (2) cytology-based screening conducted five times at 2 year intervals (comparator). The objective is to provide evidence to inform policy and clinical practice in Vietnam.

Design
Cost-effectiveness analysis using a Markov model with 1 year cycles to simulate the natural progression of CC.

Setting
The Vietnamese healthcare system, modelled from the provider’s perspective, with parameters adapted to the local context through expert consultations.

Participants
A simulated cohort of Vietnamese women aged 25–55 years.

Interventions
The intervention involved cotesting (cytology and HPV testing) three times at 5 year intervals. The comparator was cytology-based screening conducted five times at 2 year intervals.

Primary and secondary outcome measures
The primary outcome measure was quality-adjusted life years (QALYs). Costs and cost-effectiveness ratios were assessed using Vietnam’s gross domestic product (GDP) per capita as the cost-effectiveness threshold (1–3 times GDP per capita). Sensitivity analyses (one-way deterministic and probabilistic) were conducted to account for uncertainties.

Results
The cotesting strategy was less effective and more costly than cytology-based screening across all age groups. Cotesting resulted in higher costs and fewer QALYs than the comparator. Probabilistic sensitivity analyses confirmed that cotesting was not cost-effective under current conditions in Vietnam.

Conclusions
Cytology-based screening conducted five times at 2 year intervals is a more cost-effective option for CC screening in Vietnamese women aged 25–55 years. The cotesting strategy cannot be recommended due to its higher cost and lower effectiveness.

Studio della Karolinska Institutet con l’Università Milano-Bicocca

IncontraDonna, grazie al teatro benefici mentali e relazionali

This multisite, single-group, prospective, observational study examines the feasibility and potential impact of genomic newborn screening using dried blood spots in a racially and ethnically diverse population from New York State.

Today’s genomic technology introduces a multitude of assays that could be deployed in health care: diagnostic testing of patients with suspected monogenic conditions, polygenic risk prediction for common diseases, pharmacogenomic analysis for drug-gene interactions, analysis of tumors for targetable somatic sequence variations, and noninvasive screening for prenatal chromosomal disorders or occult cancer. Alongside these approaches we must also grapple with screening of the ostensibly healthy population for monogenic diseases of newborns, children, and adults with either targeted or genome-scale sequencing.

Il 25 Airc celebra 60 anni d’impegno, 141 milioni alla ricerca

Purpose
There is limited research on individuals undergoing self-initiated health examinations, and the Werlabs cohort will be a base for such research.

Participants
All individuals aged 18 or older who had undertaken a self-initiated health examination at Werlabs AB with at least one recorded value of creatinine or cholesterol in Sweden (from 1 January 2015 through 31 December 2023) was included. Medical history and anthropometric measurements were self-reported through an online questionnaire. We describe cohort baseline characteristics, demographic variables and cardiometabolic risk factors.

Findings to date
The study population includes 149 556 individuals who provided at least one health screening. The median (IQR) age was 43 (33–54) years and 54% were women. The most common self-reported chronic disease was hypertension (4.5%), followed by cardiovascular disease (0.9%) and 12.6% reported values of obesity. The prevalence was 2.1% for diabetes, 1.2% for kidney disease (including an estimated glomerular filtration rate of 3.0 mmol/L and 4.1% for anaemia (haemoglobin

Introduction
The annual prevalence of elder mistreatment (EM) in cognitively intact older adults is estimated to be 11%, yet the annual prevalence in older adults with Alzheimer’s disease and related dementias (AD/ADRD) is estimated to be as high as 75%. Associated with a decrease in quality of life and increase in risk of mortality, EM represents a significant public health burden. Home-based primary care (HBPC) providers are uniquely positioned to address the critical need for robust EM screening and reporting, especially among individuals with AD/ADRD. This protocol seeks to adapt the Detection of Elder mistreatment Through Emergency Care Technicians (DETECT) screening tool, previously used by emergency medical technicians, for use by HBPC providers.

Methods and analysis
The protocol consists of two main phases which include four substudies. Substudy 1 uses a qualitative approach to understand the current barriers to clinician identification and reporting of EM in HBPC, including what adaptations need to be made to DETECT for use in HBPC. Substudy 2 is a cluster randomised controlled trial evaluating the impact of Detection of Elder Abuse Through Emergency Care Technicians Screening Tool Revision for Home-Based Primary Care (DETECT-RPC) on clinician identification of older adult patients with increased risk of EM and referring their concerns to the appropriate authorities and service providers. Substudies 3 and 4 apply a mixed-methods approach to postscreening interviews with clinicians and caregiver/care recipient dyads, respectively. These substudies aim to evaluate DETECT-RPC’s impact on barriers to EM identification and reporting as well as the harms and benefits of using the screening tool from the perspective of patients and their caregivers.

Ethics and dissemination
All components of this study are conducted with the approval of the Institutional Review Board of the University of Texas Health Science Center at Houston (HSC-SPH-22-0732, HSC-SPH-23-0105, HSC-SPH-23-0965, HSC-SPH-24-0123). The results of this study will be disseminated through a peer-reviewed journal as well as through presentations at professional conferences, invited talks and other standard channels.

Trial registration number
NCT05958654 (ClinicalTrials.gov).

Annals of Internal Medicine, Ahead of Print.

Iss,adesione 43% indagini su seno, 41% su cervice e 27% su colon

Introduction
Dementia is one of the most relevant widespread diseases, with a prevalence of currently 55 million people with dementia worldwide. However, about 60–75% of people with dementia have not yet received a formal diagnosis. Asymptomatic screening of cognitive impairments using neuropsychiatric tests has been proven to efficiently enhance diagnosis rates. Digital screening tools, in particular, provide the advantage of being accessible without spatial or time restrictions. The study aims to validate a digital cognitive screening test (digiDEM-SCREEN) as an app in the German language.

Methods and analysis
This is a multicentre study in Bavaria. Participants are people with mild cognitive impairment, people with dementia in an early stage and cognitively healthy people. Recruitment will take place in specialised diagnostic facilities (memory outpatient clinics). 135 participants are aimed based on a power analysis. Sociodemographic data, diagnosis and results of neuropsychiatric tests (Consortium to Establish a Registry for Alzheimer’s Disease, Montreal Cognitive Assessment, digiDEM-SCREEN) will be collected at one point per person via electronic data capturing. The sensitivity, specificity and corresponding cut-off values will be determined based on receiver-operating-characteristic curves. The correlation of the digiDEM-SCREEN test with existing cognitive screening/testing procedures will be analysed.

Ethics and dissemination
The study obtained ethical approval from the Ethics Committee of the Julius-Maximilians-Universität of Würzburg (JMU) (application number: 177/23-sc). The test will give feedback about the current cognitive status and possible cognitive impairments that should lead to the users seeking further diagnostic measures by medical professionals. It will be accessible free of charge in established app stores. The results of the validation study will be published in peer-reviewed journals.

This retrospective study demonstrated that qSepsis had better predictive performance in terms of AUROC and area under the precision–recall curve (AUPRC) compared to existing assessment scores. It has the potential to be used in pre-hospital settings with limited access to laboratory tests and in the ED for quick screening of patients with sepsis. However, due to its low positive predictive value (PPV), the false alarms may increase in actual clinical practice.

Oncologi, la preservazione della fertilità tra le nuove problematiche