Risultati per: Importanza dell’ecografa nel setting della medicina generale. Introduzione con survey

Bartoletti,attenzione a sottobosco professionisti ‘improvvisati’

Objective
The aim of this study was to assess the prevalence of diabetic retinopathy (DR) and retina screening coverage among people with diabetes in the catchment area of a high-volume eye care organisation in north India.

Design
A population-based cross-sectional study using Rapid Assessment of Avoidable Blindness survey, including the DR module.

Setting
A customised rural district in the catchment of Dr Shroff’s Charity Eye Hospital in Uttar Pradesh in north India.

Participants
4095 people of age 50 years and above were enrolled using a two-staged cluster sampling, 3867 (94.4%) participated; 2167 (52.9%) were women. 3803 of 4095 (92.9%) participants were assessed for diabetes. People with already diagnosed diabetes and anyone with a random blood glucose ≥200 mg/dL were offered dilated fundus examination.

Primary and secondary outcomes
Primary and secondary outcomes were the prevalence of DR and screening coverage for DR, respectively.

Results
The prevalence of diabetes was 7.0% (95% CI 5.9% to 8.0%). 50.2% of all people with diabetes were newly detected. The prevalence of any DR among people with diabetes who consented to dilated pupillary examination was 22.8% (51 of 224), (95% CI 18.2% to 27.3%). 5.8% (13/224) of people with diabetes were found to have sight-threatening DR and only 15.4% (2/13) had received treatment. 84.8% of people with previously diagnosed diabetes had never had their eyes tested for DR; this was significantly higher in women (90.2% vs 76.0%, respectively, p

Background
The use of new biological medicines as standard treatment is expected to increase substantially and cover new therapeutic indications in the near future. Interchange of biological medicines in pharmacies increases the need for patient guidance.

Objectives
The study aims to gain a patient perspective on biological medicine users’ needs and wishes regarding patient guidance by exploring what kind of information patients wish to receive and to further investigate the potential differences in needs between originator biological medicine users and biosimilar users.

Design
A cross-sectional patient survey.

Setting
Anonymous electronic patient survey was conducted in 88 community pharmacies and via two patient organisations in Finland in 2022.

Participants
Users of originators and biosimilars of adalimumab, etanercept, filgrastim and pegfilgrastim.

Results
The majority of the 199 respondents had received instructions from a nurse or a public health nurse on how to use their self-injected medicine. According to the patients, the main factors affecting treatment persistence, apart from treatment effectiveness, were few adverse effects, access to treatment support and an easy-to-use administration device. At treatment initiation, the optimal types of guidance were face-to-face instruction, hands-on practice with injecting the medicine, using the administration device and information on adverse effects. Even though 79% of respondents indicated that they would not have wanted more instruction on using their self-injected medicine, these respondents also expressed that, at the time of treatment initiation, additional information or help would have been needed concerning adverse effects, biosimilars, and biological medicines in general. In general, biosimilar users were more concerned about adverse effects than users of originator products.

Conclusion
Patients consider information about adverse effects an important part of patient guidance when starting and maintaining self-administered biological therapy. The results highlight the importance of ensuring that up-to-date evidence-based information is readily available to patients from reliable sources.

Objectives
To identify, measure and value the economic burden of musculoskeletal (MSK) disorders in the Kilimanjaro region, Tanzania.

Design
Community-based cross-sectional survey (undertaken between January and September 2021).

Setting
Hai district, Kilimanjaro, Tanzania.

Participants
Households resident in the Hai district.

Methods
A two-stage cluster sampling was used to select a representative sample of all Hai district residents. Clinical screening tools were used to identify and measure MSK disorders through a tiered approach. An economic questionnaire measuring healthcare costs, out-of-pocket costs, absenteeism, presenteeism and work productivity loss was administered to those with likely MSK disorders and selected controls (individuals without MSK disorders, matched by age and gender). Resource use was valued using country-specific costs. Two-part model regressions were fitted. A descriptive analysis of catastrophic expenditure was also conducted.

Main outcome measure
Healthcare costs, productivity costs and total costs.

Results
Annual average productivity and healthcare costs were, respectively, 3.5 and 3 times higher for those with likely MSK disorders than controls. Productivity costs of individuals with MSK disorders were Int$487 vs Int$132 in the control group (difference: Int$355, 95% CI Int$222 to Int$488). Healthcare costs in those with MSK were Int$269 vs Int$88 in the control group (difference: Int$181, 95% CI Int$34 to Int$327). The difference in terms of out-of-pocket expenses was economically substantial in magnitude, although not statistically significant.

Conclusion
The evidence will be used to inform policies addressing MSK disorders, by promoting the design of interventions, service provision, health promotion and awareness activities at local, regional and national level.

Objective
To examine the public’s stance on physician-assisted dying (PAD) in Taiwan across different PAD scenarios and identify demographic and psychosocial factors associated with the levels of support.

Design
Cross-sectional survey design. Independent variables included individual sociodemographic characteristics, healthcare professionals, perceived quality of life, formal caregiver experience, Patient Right to Autonomy Act (PRAA) awareness and advance care planning (ACP) preparedness.

Setting
An online survey of the general population in Taiwan was conducted in 2022.

Participants
A total of 3922 Taiwanese adults who completed all survey questions.

Outcome measures
Agreement levels with PAD in three scenarios: terminal illnesses, unbearable non-terminal pain and severe cognitive impairments. Multivariate logistic regression was used to examine agreement with each PAD scenario as separate dependent variables in the first three models and overall agreement across all scenarios as the dependent variable in the fourth model.

Results
High levels of public support for PAD were observed, with 86.2% supporting PAD for terminal illnesses, 79.2% for unbearable non-terminal pain and 72.6% for severe cognitive impairments. Support for PAD was associated with factors including younger age, male gender, lack of religious affiliation, a non-healthcare professional background, employment as a formal caregiver, lack of awareness of PRAA and higher preparedness in ACP.

Conclusions
The results indicate a potential cultural shift in Taiwan towards greater emphasis on individual autonomy in end-of-life decisions. There appears to be significant public support for developing legal frameworks in favour of PAD, carefully considering the psychosocial factors that highlight the importance of individual rights in end-of-life care.

Objectives
Sedentary behaviour (SB) is associated with increased risks of breast, colorectal, endometrial, ovarian and rectal cancers. However, the number of cancer cases attributable to SB in Germany and the associated costs are unknown.

Setting
Numbers and proportions (population-attributable fractions, PAF) of new cancer cases attributable to SB with published risk estimates for Germany for the years 2024, 2030 and 2040.

Participants
Sex-specific and age-specific population projections, national cancer incidence and exposure data. Primary and secondary outcome measures: new cancer cases attributable to SB and healthcare costs associated with cancer cases attributable to SB in Germany for the year 2024.

Results
Estimated numbers of cancers attributable to SB are projected to be up to 7612 cases (6% of total cancer cases) in 2024, up to 7899 cases (6%) in 2030 and up to 8245 cases (6%) in 2040. The PAF attributable to SB in women is 3% for breast cancer, 8% for colon cancer, 9% for both endometrial and ovarian cancers and 2% for rectal cancer. In men, the PAF is 9% for colon cancer and 3% for rectal cancer. In 2024, the estimated costs of SB-attributable cancers are 270 million for colon cancer, 51 million for rectal cancer, 234 million for breast cancer and 242 million for female genital cancers.

Conclusions
A considerable number of cancer cases can be attributed to SB, which also imposes a large health economic burden. Implementing effective prevention measures, such as workplace, school or commuting interventions, is needed to reduce the incidence of cancer attributable to this modifiable risk factor.

Introduction
There is a lack of consensus on the optimal surgical strategy for differentiated thyroid cancer (DTC), partly due to inconsistent reporting of outcomes. This limits the ability to compare study results, hindering the ability to draw conclusions regarding novel treatment strategies. The development of a core outcome set (COS) reduces heterogeneity in the selection and reporting of clinical trial outcomes. Currently, there is no COS for the surgical treatment of DTC. We aim to reach a global consensus among patients and physicians on the COS for the surgical treatment for patients with DTC of all ages.

Methods and analysis
The DTC-COS development will consist of three phases: first, an extensive literature review will be performed to identify reported outcomes in studies regarding surgical treatment for DTC in patients of all ages. Second, a 2-step or 3-step Delphi procedure will be performed to identify a final set of core outcomes out of the selected outcomes from the literature review. For this Delphi survey, both healthcare professionals and patients will be invited. Third, an (online) expert meeting with participants from every stakeholder group is organised to ratify the final core outcome set. The final COS will be reported in accordance with the COS-Standards for Reporting statement.

Ethics and dissemination
The medical research ethics committee of the Amsterdam UMC confirmed that the Dutch Medical Research Involving Human Subjects Act (WMO) does not apply to this study and that full approval by the committee is not required. The study is registered in the COMET initiative database (registration number 2597). Results will be presented in peer-reviewed academic journals and at (international) conferences.

Trial registration number
COMET initiative database 2597

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.

Objective
During the COVID-19 pandemic, many parents faced heightened stress, anxiety and depression due to the local and global COVID-19 mitigation measures and lockdowns.

Design
This is a cross-sectional study.

Setting
This study used stratified whole-cluster sampling to randomly select three elementary schools within Ezhou City.

Participants
An online survey was administered to the parents of students in one or two classes in grades 1–6, respectively, of each school. Among them, males account for 30.4% and females account for 69.6%. The inclusion criteria included (1) the parent or legal guardian of a primary school student or a person directly responsible for the child’s education and (2) the ability to operate a computer or smartphone to complete the survey. Only one representative from each family was allowed to participate, and surveys with incomplete data were considered invalid and thus excluded.

Results
A total of 764 participants completed the online survey. Overall, 90.4% of the participants were concerned about their children’s mental health and learning during the pandemic. Additionally, 97.0% were aware of the typical symptoms of COVID-19. Only 48.0% of the participants felt the pandemic negatively impacted their lives. The average psychological status score among parents was 87.79±8.91, with 51.6% showing signs of high psychological distress. Significant differences in psychological status were linked to age, education, professional background, sleep status, personal views on the pandemic’s impact and concern for children’s learning (p

Dall’anno accademico 2025/26, esclusivamente in lingua inglese

Objectives
To understand the current state of maternal, newborn and child health (MNCH) among internally displaced persons (IDPs), returnees and host communities in remote counties of Jonglei state.

Design
Cross-sectional, randomly sampled, mixed-methods, population-based household study.

Setting
Ayod, Nyirol, Fangak and Pigi counties of Jonglei, South Sudan.

Participants
859 households, including 586 adult females and 273 adult males.

Primary and secondary outcome measures
Knowledge, attitudes and practices of MNCH. Secondary: contraception, pregnancies, pregnancy outcomes, use or non-use of antenatal care (ANC)/postnatal care (PNC), use of skilled birth attendants, breastfeeding, knowledge of warning or danger signs of pregnancy, gender-based violence (GBV) and MNCH attitudes/cultural norms.

Results
A total of 859 households consented to the study (586 females and 273 males) with a response rate of 96% among females and 94% among males. The ability to list at least three warning/danger signs or essentials of care for different MNCH categories among respondents was low (range, 37·0%–47·1%). 1% of females and 3% of males use contraception. ANC and PNC are suboptimal and largely provided by unskilled providers. 26% of women exclusively breastfed for up to 6 months. For respondents with children

Objectives
This study aimed to determine doctors’ level of adherence to the natriuretic peptide testing guideline and to identify the factors influencing their adherence.

Design
Cross-sectional study.

Setting
Web-based survey.

Participants
Full-time doctors involved in heart failure (HF) treatment in Vietnam.

Primary and secondary outcome measures
Doctors using natriuretic peptide testing for diagnosis, differential diagnosis, treatment assessment and prognosis of patients with HF were classified as adhering to the guidelines. We assessed the practice of natriuretic peptide testing and stratified the doctors based on their professional qualifications. Univariate and multivariate logistic regression analyses were used to estimate the Odds Ratio (ORs) and 95% CIs for associations between guideline adherence and selected covariates.

Results
Over half of the participants adhered to the natriuretic peptide testing guidelines (57.4%). Cardiologists adhered more closely to the guidelines than other professionals; they had approximately four times higher odds of adherence than other doctors (univariate model, OR: 3.88, 95% CI: 2.56 to 5.89, p

In Reply In September 2024, a US appeals court struck down California’s prohibition on firearms in health care settings, citing the Supreme Court’s new requirement that modern gun laws be evaluated based on whether they are consistent with historical tradition rather than their ability to address the threat and reality of gun violence. Under this “originalist” approach, whether hospitals qualify as “sensitive places” where guns can be prohibited turns on whether judges believe hospitals to be sufficiently similar to places where guns have historically been prohibited.

To the Editor In their article, Mr Romero and colleagues discussed the consequences of recent Supreme Court decisions on the possession of firearms, especially the possibility that declaring hospitals a firearm-free domain breaches Second Amendment rights. If that is true, then it applies to hospital staff as well as patients and their relatives. How will patients feel about their physician having an AR-15 on their desk during an examination?

Objectives
To determine the prevalence of hospital discharge communication problems with older adults, compare them across countries and determine factors associated with those problems.

Design
Secondary analysis of cross-sectional survey data.

Setting
2021 Commonwealth Fund International Health Policy (IHP) Survey of Older Adults conducted across 11 high-income countries, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.

Participants
4501 respondents aged 60 and older in the USA and 65 and older in all other included countries who were hospitalised at least once in the past 2 years before the survey and answered discharge communication-related questions.

Primary outcome measure
Our primary outcome measure is poor discharge communication (PDC), a composite variable of three IHP questions related to written information, doctor follow-up and medicines discussed.

Results
Overall PDC rate was 19.2% (864/4501), although rates varied by nation. PDC was highest in Norway (31.5%) and lowest in the USA (7.5%). Gender, education, income and the presence of at least one chronic disease were not statistically associated with PDC.

Conclusions
Given the high rate of PDC observed, hospital discharge teams and leadership should carefully examine communication during the hospital discharge process to ensure minimisation of care gaps, particularly regarding medication, since this was the most reported problem.

Introduction
Mental health problems are the most significant cause of disability and have high annual economic costs; hence, they are a priority for the government, service providers and policymakers. Consisting of largely coastal and rural communities, the populations of Norfolk and Suffolk, UK, have elevated burdens of mental health problems, areas with high levels of deprivation and an increasing migrant population. However, these communities are underserved by research and areas with the greatest mental health needs are not represented or engaged in research. This National Institute of Health and Care Research-funded project aims to bring together key stakeholders to conduct extensive scoping work to identify mental health needs and priorities as a basis for conducting larger research to address the identified priorities over the next 5 years.

Methods and analysis
This 12-month mixed-methods research-priority-setting project consists of five phases. It is being conducted in Norfolk and Suffolk counties in the East of England, UK. Underpinned by Delphi methodology, it will adopt the James Lind Alliance approach to identify priorities for mental health research for the populations of Norfolk and Suffolk. The project will use multiple methods, including mapping and identification of stakeholders, online questionnaires, face-to-face focus groups and interviews, and consensus meetings with experts and mental health stakeholders. Key evidence-informed priorities will be collaboratively ranked and documented, and a final top 10 research priorities will be identified to inform future research, policy and service provision.

Ethics and dissemination
This study was approved by the University of East Anglia’s Faculty of Medicine and Health Research Ethics Committee (reference: ETH2324-2542), Norwich, UK. Research findings will be disseminated through workshops with stakeholders and collaborators and via peer-reviewed scientific publications, presentations at academic societies, blogs and social media.