Risultati per: Le campagne di screening come strumento di prevenzione oncologica tra dubbi e certezze

This JAMA Patient Page describes osteoporosis and the US Preventive Services Task Force recommendations for screening for osteoporosis.

This 2025 Recommendation Statement from the US Preventive Services Task Force recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older (B recommendation) and postmenopausal women younger than 65 years at increased risk for an osteoporotic fracture (B recommendation) and concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men (I statement).

At first glance, the updated US Preventive Services Task Force (USPSTF) Recommendation Statement on osteoporosis screening appears nearly identical to the previous 2018 statement, especially regarding the recommendation for universal screening in women 65 years or older and insufficient evidence to support a recommendation for or against screening in men. However, subtle revisions to the 2018 recommendation may result in substantive changes in screening of younger postmenopausal women in clinical practice. While a B recommendation for higher-risk postmenopausal women younger than 65 years is common to both statements, the 2018 statement recommended assessing risk of osteoporosis in these women using a formal clinical risk assessment tool, whereas the 2024 Recommendation Statement recommends screening those at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. Additionally, the screening test for both younger and older postmenopausal women in the 2018 recommendation is specified broadly as bone measurement testing. By contrast, the 2024 statement is more specific and defines screening as central (hip or lumbar spine) dual-energy x-ray absorptiometry (DXA) bone mineral density (BMD) testing with or without fracture risk assessment.

Objectives
Alzheimer’s disease (AD) poses a significant challenge for individuals aged 65 and older, being the most prevalent form of dementia. Although existing AD risk prediction tools demonstrate high accuracy, their complexity and limited accessibility restrict practical application. This study aimed to develop a convenience, efficient prediction model for AD risk using machine learning techniques.

Design and setting
We conducted a cross-sectional study with participants aged 60 and older from the National Alzheimer’s Coordinating Center. We selected personal characteristics, clinical data and psychosocial factors as baseline predictors for AD (March 2015 to December 2021). The study utilised Random Forest and Extreme Gradient Boosting (XGBoost) algorithms alongside traditional logistic regression for modelling. An oversampling method was applied to balance the data set.

Interventions
This study has no interventions.

Participants
The study included 2379 participants, of whom 507 were diagnosed with AD.

Primary and secondary outcome measures
Including accuracy, precision, recall, F1 score, etc.

Results
11 variables were critical in the training phase, including educational level, depression, insomnia, age, Body Mass Index (BMI), medication count, gender, stenting, systolic blood pressure (sbp), neurosis and rapid eye movement. The XGBoost model exhibited superior performance compared with other models, achieving area under the curve of 0.915, sensitivity of 76.2% and specificity of 92.9%. The most influential predictors were educational level, total medication count, age, sbp and BMI.

Conclusions
The proposed classifier can help guide preclinical screening of AD in the elderly population.

Objective
This study aims to map the literature on screening, diagnosis, treatment and outcomes of developmental dysplasia of the hip (DDH) in the Brazilian population aged 0–18 years, to describe regional variations in its presentation and management.

Design
Scoping review.

Data sources
PubMed/MEDLINE, Web of Science, Scopus, “Biblioteca Virtual em Saúde” and “Biblioteca Digital Brasileira de Teses e Dissertacões”. The journals, Revista Brasileira Ortopedia and Acta Ortopédica Brasileira, were manually searched for non-indexed issues. Databases were searched from their inception to February 2024.

Eligibility criteria
This scoping review included studies on Brazilian patients aged 0–18 years diagnosed with or being assessed for DDH. No language or date restrictions were applied.

Data extraction and synthesis
Studies were assessed based on title, authors, publication year, study design, sample size, level of evidence, region of Brazil and healthcare setting (public or private). The articles were then analysed across four categories: screening, diagnosis, treatment and outcomes.

Results
52 studies, published between 1951 and 2023, were included. Reported prevalence rates ranged from 0.75 to 56.4 cases per 1000 children. No study examined the effectiveness of specific screening programmes or compared their outcomes. The most common diagnostic methods were the Ortolani manoeuvre and ultrasonography using the Graf method. Of the 27 articles on treatment, 17 focused exclusively on surgical interventions, with the Salter osteotomy being the most frequent procedure.

Conclusions
There should be a greater focus on understanding the prevalence of DDH in Brazil, the availability of ultrasound devices and trained operators, and the follow-up of conservative treatments. More information on DDH in Brazil is essential for designing and implementing effective screening and treatment programmes. Future research should be done to understand the prevalence of the disease, optimal forms of screening and early treatment.

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Objectives
There is increasing interest in guiding atrial fibrillation (AF) screening by risk rather than age. The perceptions of healthcare professionals (HCPs) towards the implementation of risk prediction models to target AF screening are unknown. We aimed to explore HCP perceptions about using risk prediction models for this purpose, and how models could be implemented.

Design
Semistructured interviews with HCPs engaged in the Future Innovations in Novel Detection of AF (FIND-AF) study. Data were thematically analysed and synthesised to understand barriers and facilitators to AF screening and guiding screening using risk assessment.

Setting
Five primary care practices in England taking part in the FIND-AF study.

Participants
15 HCPs (doctors, nurses/nurse practitioners, healthcare assistants, receptionists and practice managers).

Results
Participants knew the health implications of AF and were supportive of the risk prediction models for AF screening. Four main themes developed: (1) health implications of AF, (2) positives and negatives of risk prediction in AF screening, (3) strategies to implement a risk prediction model and (4) barriers and facilitators to risk-guided AF screening. HCPs thought risk-guided AF screening would improve patient outcomes by reducing AF-related stroke, and this outweighed concerns over health anxiety and the impact on workload. Pop-up notifications and practice worklists were the main suggestions for risk-guided screening implementation and for this to be predominantly run by administrative staff. Many recommended the need for educating staff on AF and the prediction models to help aid the implementation of a clear protocol for longitudinal follow-up of high-risk patients and communication of risk.

Conclusions
Overall, HCPs participating in the FIND-AF study were supportive of using risk prediction to guide AF screening and willing to take on extra workload to facilitate risk-guided AF screening. The best pathway design and the method of how risk is communicated to patients require further consideration.

Trial registration number
NCT05898165.

Al via l’edizione 2025

In the US, cancer prevention and screening have saved more lives from 5 types of cancer combined than treatment advances over the past 45 years, according to a modeling study published in JAMA Oncology. An estimated 5.9 million breast, cervical, colorectal, lung, and prostate cancer deaths were avoided from 1975 to 2020 due to prevention, screening, and treatment efforts, but prevention and screening alone were responsible for averting about 4.8 million—4 out of 5—of those deaths.

Introduction
Only 30%–50% of people referred to clinics during community-based eye screening are able to access care in Botswana, India, Kenya and Nepal. The access rate is even lower for certain population groups. This platform trial aims to test multiple, iterative, low-risk public health interventions and simple service modifications with a series of individual randomised controlled trials (RCT) conducted in each country, with the aim of increasing the proportion of people attending.

Methods and analysis
We will set up a platform trial in each country to govern the running of a series of pragmatic, adaptive, embedded, parallel, multiarm, superiority RCTs to test a series of service modifications suggested by intended service users. The aim is to identify serial marginal gains that cumulatively result in large improvements to equity and access. The primary outcome will be the probability of accessing treatment among the population group with the worst access at baseline. We will calculate Bayesian posterior probabilities of clinic attendance in each arm every 72 hours. Each RCT will continually recruit participants until the following default stopping rules have been met: >95% probability that one arm is best; >95% probability that the difference between the best arm and the arms remaining in the trial is

This model-based study using population-level cancer mortality data evaluates the association of prevention, screening, and treatment interventions with cumulative number of cancer deaths averted from 1975 to 2020 for breast, cervical, colorectal, lung, and prostate cancers.

This Teachable Moment describes a man in his 30s who presented with a right diabetic foot ulcer and hyperglycemia and was assumed to have type 2 diabetes and was subsequently diagnosed with latent autoimmune diabetes in adults.

This Viewpoint proposes applying a systematic curriculum for early management of traumatically injured patients as a framework for suicide risk screening after overdose.

Objective
To evaluate the knowledge, attitude and practice (KAP) regarding screening and managing diabetic microvascular complications, encompassing diabetic retinopathy (DR), diabetic kidney disease (DKD) and diabetic neuropathy (DN), among general practitioners (GPs).

Design
Cross-sectional study.

Setting
The online questionnaire survey was conducted between April and July 2023.

Participants
GPs from community health centres (CHCs) in all 16 districts of Shanghai were recruited.

Primary and secondary outcome measures
The data of sociodemographic characteristics, KAP scales, training experience and screening instruments for community screening and managing diabetic microvascular complications were collected. Multiple stepwise linear regression was used to explore the influencing factors of KAP. Restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to determine the association between KAP score and duration of general practice.

Results
A total of 1243 questionnaires were included in the analysis. The total KAP score was 66.6±8.8/100, and the knowledge, attitude and practice scores were 64.7±8.7, 83.5±10.5 and 51.6+17.8, respectively. Male (β=–2.419, p=0.012), shorter practice duration (β=–1.033, p=0.031), practice in rural area (β=3.230, p=0.001), not attending training in diabetic microvascular complications (β=–6.346, p

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