Risultati per: Indicazioni per gli screening oncologici

New England Journal of Medicine, Volume 389, Issue 1, Page 92-94, July 2023.

Sicge, efficacia al pari esami di prevenzione per alcuni tumori

Sicge, efficacia al pari esami di prevenzione per alcuni tumori

This case series study examines significant incidental findings reported in the low-dose computed tomography arm of the National Lung Screening Trial.

The evidence was insufficient to recommend screening for anxiety in older adults or screening for suicide risk in anyone.

Introduction
Progress towards leprosy elimination is threatened by increasing incidence in ‘hot-spot’ areas where more effective control strategies are urgently required. In these areas, active case finding and leprosy prevention limited to known contacts is insufficient for control. Population-wide active case-finding together with universal prevention through mass drug administration (MDA) has been shown to be effective in ‘hot-spot’ areas, but is logistically challenging and expensive. Combining leprosy screening and MDA with other population-wide screening activities such as for tuberculosis may increase programme efficiency. There has been limited evaluation of the feasibility and effectiveness of combined screening and MDA interventions. The COMBINE study aims to bridge this knowledge gap.

Methods and analysis
This implementation study will assess the feasibility and effectiveness of active leprosy case-finding and treatment, combined with MDA using either single-dose rifampicin or rifamycin-containing tuberculosis preventive or curative treatment, for reducing leprosy incidence in Kiribati. The leprosy programme will run over 2022–2025 in concert with population-wide tuberculosis screening-and-treatment in South Tarawa. The primary research question is to what extent the intervention reduces the annual leprosy new case detection rate (NCDR) in adults and children compared with routine screening and postexposure prophylaxis (PEP) among close contacts (baseline leprosy control activities). Comparisons will be made with (1) the preintervention NCDR separably among adults and children in South Tarawa (before–after study) and (2) the corresponding NCDRs in the rest of the country. Additionally, the postintervention prevalence of leprosy obtained from a survey of a ‘hot-spot’ sub-population will be compared with prevalence documented during the intervention. The intervention will be implemented in collaboration with the Kiribati National Leprosy Programme.

Ethics and dissemination
Approval has been obtained from the Kiribati Ministry of Health and Medical Services (MHMS), the University of Otago (H22/111) and the University of Sydney (2021/127) Human Research Ethics Committees. Findings will be shared with the MHMS, local communities and internationally through publication.

Molte più Tac all’Icot di Latina, ma mancano i fondi

This JAMA Patient Page describes the pros and cons of screening for anxiety disorders in adults.

This systematic review to support the 2023 US Preventive Services Task Force Recommendation Statement on anxiety screening summarizes published evidence on the benefits and harms of screening for, and treatment of, anxiety among primary care patients.

This 2023 Recommendation Statement from the US Preventive Services Task Force recommends screening for anxiety disorders in adults, including pregnant and postpartum persons (B recommendation), and concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults (I statement).

Mental disorders are a leading cause of disease burden worldwide, with anxiety disorders being the second most influential contributor, after depressive disorders, to global disability-adjusted life-years. Anxiety disorders are characterized by anxious mood and, often, phobic avoidance, which result in extreme distress, functional impairment, or both. The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) recognizes the following types of anxiety disorders likely to be seen in adults: generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, specific phobias, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition. The latter 2 instances of anxiety are caused by identifiable and, mostly, treatable sources and should be considered “rule-outs” before concluding that one of the other anxiety disorders is present.

Attese circa 9mila diagnosi precoci ogni anno

Objectives
Throughout Europe, many countries offer population-based cancer screening programmes (CSPs). In the Netherlands, two implemented CSPs are targeting people of 50 years and older, aiming at breast cancer (BC) and colorectal cancer (CRC). In order for a CSP to be (cost-)effective, high participation rates and outreach to the populations at risk are essential. People living in highly urbanised areas and big cities are known to participate less in CSPs. The aim of this study was to gain further insight into the participation patterns of a screening-eligible population of 50 years and over, living in a highly urbanised region, over a longer time period.

Design
A retrospective observational study.

Setting
Participation data of the regional screening organisation, linked to the cancer incidence data derived from the Netherlands Cancer Registry, concerning the city of The Hague, between 2005 and 2019. Attendance groups were defined as attenders (attending >50% of the invitations) and non-attenders (attending ≤50% of the invitations), and were mutually compared.

Results
The databases contained 106 377 unique individuals on the BC screening programme (SP) and 73 669 on the CRC-SP. Non-attendance at both CSPs was associated with living in a lower socioeconomic status (SES) neighbourhood and as a counter effect, also associated with a more unfavourable, relatively late-stage, tumour diagnosis. When combining the results of the two CSPs, our results imply high screening adherence over time. Women who did not participate in both CSPs were older, and more often lived in neighbourhoods with a lower SES score.

Conclusions
Since low screening uptake is one of the factors that contribute to increasing inequalities in cancer survival, future outreach strategies should be focused on engaging specific non-attending subgroups.

Objective
To assess the feasibility of the family paediatrician’s (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being.

Design, setting and participants
Data for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60–90 days after childbirth). Moreover, on the third visit (5–7 months after childbirth) the FP was asked to answer ‘yes’ or ‘no’ to a question on the parental postpartum depression, based on his knowledge and on the acquired information.

Results
In 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as ‘likely depressed’. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69).

Conclusions
The findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care.

Trial registration number
NCT03894566; Pre-results.