Risultati per: Screening della retinopatia diabetica

Introduction
The elevated rates of neurodevelopmental disorders (NDDs) among siblings of children with autism spectrum disorder (ASD) raise concerns about their developmental monitoring and development. The main aim of this study is to assess the feasibility and acceptability of a standardised screening process on a large sample of siblings.

Methods and analysis
This prospective study will assess the feasibility of a selective and multi-stage screening process for NDD performed on 384 siblings of children with confirmed ASD. Stage 1 will consist of the screening of NDD performed using online parental questionnaires (Social Responsiveness Scale, IdentiDys scale, DCDQ, parental concerns) through a web platform. In cases of a positive result, the second stage, consisting of a clinical semi-structured interview with a psychologist, will be proposed to the sibling before referral for diagnosis and treatment, if necessary. Approximately 12 months after stage 2, parents will be contacted by telephone to collect the diagnosis established following the referrals and their level of satisfaction concerning the screening process. Based on an expected participation rate of 50%, to estimate this rate with an accuracy of 5%, it is necessary to screen 384 subjects.

Ethics and dissemination
The Ethics Committee on the Research of Human Subjects of Paris (Ile de France VII) approved this study in March 2022 (number: 2021-A02241-40). Express consent is required from all participants. Findings from the cohort study will be disseminated by publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with associated teams.

Trial registration number
NCT05512637.

Objective
To describe the thyroid function test among children with abdominal distention and to follow up the treatment received by children with abnormal thyroid function.

Design
Cross-sectional study.

Setting and participants
A total of 1089 children (median age:30 days (IQR=21–60 days) with abdominal distension were included in this single centre study in Nanjing, China.

Result
Thyroid dysfunction was found in 43 of 148 Hirschsprung’s disease (HSCR) cases, with 3 (2.03%) having hypothyroidism, 3 (2.03%) having subclinical hypothyroidism and 3 (2.03%) having subclinical hyperthyroidism. Thyroid dysfunction was found in 206 of 941 functional abdominal distension cases, with 4 (0.43%) having hypothyroidism, 23 (2.4%) having subclinical hypothyroidism, 28 (2.9%) having subclinical hyperthyroidism and 1 (0.11%) having hyperthyroidism. Among total 65 cases (9 from HSCR, 56 from functional abdominal distension) diagnosed with thyroid diseases, 12 were treated with levothyroxine (LT-4), of which 9 were discontinued treatment at about 2 years old, and 3 were still receiving LT-4. Thirty-two cases received no treatment and thyroid function returned to normal in about 1 month. Twenty-one cases were lost during the follow-up.

Conclusion
The paediatrician should be vigilant for hypothyroidism when dealing with children with abdominal distension. Thyroid function should be followed up rather than simply administering a short-term levothyroxine treatment.

New England Journal of Medicine, Volume 388, Issue 4, Page 376-379, January 2023.

Prevalence of advanced neoplasm was much lower at repeat screening colonoscopies than at all screening colonoscopies.

Background
In elite football, periodic health examination (PHE) may be useful for injury risk prediction.

Objective
To explore whether PHE-derived variables are prognostic factors for indirect muscle injuries (IMIs) in elite players.

Design
Retrospective cohort study.

Setting
An English Premier League football club.

Participants
134 outfield elite male players, over 5 seasons (1 July 2013–19 May 2018).

Outcome and analysis
The outcome was any time-loss, lower extremity index IMI (I-IMI). Prognostic associations were estimated using odds ratios (ORs) and corresponding statistical significance for 36 variables, derived from univariable and multivariable logistic regression models. Missing data were handled using multiple imputation. Non-linear associations were explored using fractional polynomials.

Results
During 317 participant-seasons, 138 I-IMIs were recorded. Univariable associations were determined for previous calf IMI frequency (OR 1.80, 95% CI 1.09 to 2.97), hamstring IMI frequency (OR 1.56, 95% CI 1.17 to 2.09), if the most recent hamstring IMI occurred >12 months but 12 months but 12 months but

Obiettivo progetto internazionale con ricercatori italiani

Objectives
A cross-sectional and a policy document review study was performed to investigate perceived acceptability and feasibility to implementing different integration measures for tuberculosis (TB) and diabetes mellitus (DM) healthcare among healthcare workers (HCWs) and health managers, and to describe policy influence through a policy documents review in Malawi.

Setting
The survey was performed at eight hospitals, ministry of health offices and 10 non-governmental organisations. We collected data in March and April 2021.

Participants
Of 95 HCWs and health managers invited; 92 participated. 21/92 (23%) were female, and 17/92 (18%) participants were from clinics that piloted the integrated care for TB and DM.

Outcome measures
We described awareness levels on TB/DM comorbidity, perceptions and experiences in TB/DM care. Furthermore, development processes and contents of included documents were analysed.

Results
16/17 (94%) of HCWs from clinics piloting integrated care and 65/75 (86%) HCWs from hospitals that do not use integrated care for TB and DM responded that integrated care was acceptable and feasible. In qualitative data, shortage of resources, inadequate information sharing were common themes. We included seven relevant documents for the analysis. On development process and content, six of seven documents were scored ≥70%. In these documents, DM is a recognised risk factor for TB, and integration of healthcare services for infectious diseases and non-communicable diseases is recommended, however, these documents lacked information specifically on integrated care for TB and DM.

Conclusion
In this study, we identified inadequate information sharing, and lack of resources as major factors impeding implementation of integration of services, however, awareness on TB/DM comorbidity was high.

Objective
The Surviving Sepsis Campaign guidelines recommend the implementation of systematic screening for sepsis. We aimed to validate a paediatric sepsis screening tool and derive a simplified screening tool.

Design
Prospective multicentre study conducted between August 2018 and December 2019. We assessed the performance of the paediatric sepsis screening tool using stepwise multiple logistic regression analyses with 10-fold cross-validation and evaluated the final model at defined risk thresholds.

Setting
Twelve emergency departments (EDs) in Queensland, Australia.

Participants
3473 children screened for sepsis, of which 523 (15.1%) were diagnosed with sepsis.

Interventions
A 32-item paediatric sepsis screening tool including rapidly available information from triage, risk factors and targeted physical examination.

Primary outcome measure
Senior medical officer-diagnosed sepsis combined with the administration of intravenous antibiotics in the ED.

Results
The 32-item paediatric sepsis screening tool had good predictive performance (area under the receiver operating characteristic curve (AUC) 0.80, 95% CI 0.78 to 0.82). A simplified tool containing 16 of 32 criteria had comparable performance and retained an AUC of 0.80 (95% CI 0.78 to 0.82). To reach a sensitivity of 90% (95% CI 87% to 92%), the final model achieved a specificity of 51% (95% CI 49% to 53%). Sensitivity analyses using the outcomes of sepsis-associated organ dysfunction (AUC 0.84, 95% CI 0.81 to 0.87) and septic shock (AUC 0.84, 95% CI 0.81 to 0.88) confirmed the main results.

Conclusions
A simplified paediatric sepsis screening tool performed well to identify children with sepsis in the ED. Implementation of sepsis screening tools may improve the timely recognition and treatment of sepsis.

Entrance surveillance screenings have been widely implemented in health care settings during the COVID-19 pandemic. These measures, which are required by the US Department of Labor, rely on self-reported factors such as symptoms or exposure history and are intended to reduce risk to patients and health care workers. In this issue of JAMA Internal Medicine, Roberts and colleagues examine the usefulness of entrance surveillance screenings at a single academic medical center. They find that during the first wave of the pandemic, about 1 in every 38 people screened positive. However, during later periods, the catch rate was considerably lower, closer to 1 in every 3000 people. This lower rate was constant regardless of community incidence of disease. It cannot be known from their findings if the screening requirement itself acted as a deterrent to those who might have otherwise sought entry to the health care center. Awareness of the screening procedure or of the nature of COVID-19 symptoms may have increased over the course of time.

This quality improvement study analyzes the rate of failures in entrance screening for COVID-19 among individuals entering a large academic medical center.

This economic evaluation study of Swedish men compares the cost-effectiveness of magnetic resonance imaging–aided screening for prostate cancer with strategies using no screening or prostate-specific antigen alone.

Solid organ transplant recipients (SOTRs) are at an increased risk for developing skin cancers compared with the general population. The increased risk of skin cancer among SOTRs is 65-fold greater for cutaneous squamous cell carcinoma (cSCC), 10-fold greater for basal cell carcinoma (BCC), and 3-fold greater for malignant melanoma (MM). The risk of posttransplant skin cancer increases gradually over time after transplantation; however, a subset of SOTRs may present with earlier-onset skin cancer based on various risk factors, requiring timely evaluation and treatment by a dermatologist. With more than 400 000 living transplant recipients and more than 30 000 transplant procedures performed annually in the US, it is not feasible for all SOTRs to receive annual skin cancer screening. Risk-based screening considers the feasibility of access to dermatologic care in a resource-limited setting and helps define which patients need more urgent referral to dermatology.

This cross-sectional study analyzes patterns in the rates of routine screening and diagnosis for breast, cervical, and colorectal cancer before and after the COVID-19 pandemic.

This cross-sectional study examines annual use trends in cervical cancer screening–associated services in Medicare fee-for-service beneficiaries and estimates expenditures for services.

Sars-Cov-2 fa meno paura ma crescono carenza medici e zoonosi

Introduction
Cancer screening guidelines should be based on the best available evidence, presenting both the benefits and harms of screening in a manner applicable to stakeholders. How the potential benefits and harms of screening are presented determine the intent of guideline developers and the delivery of recommendations. Therefore, we will systematically review the cancer screening guidelines for Koreans to evaluate the presentation and detailed ways of the benefits and harms of the recommended cancer screening practices.

Methods and analysis
To identify cancer screening guidelines for Koreans, we will search international electronic databases, including MEDLINE, Embase and domestic literature databases (Korean Studies Information Service System, Research Information Sharing Service, KoreaMED, Korean Medical Database, National Assembly Library and Korea Institute of Science and Technology Information) as well as guideline databases (Guideline International Network, National Institute for Health and Care Excellence, Turning Research Into Practice medical database, WHO guidelines and Korean Medical Guideline Information Center), from inception to November 2022. We will include cancer screening guidelines for healthcare practitioners and patients. Furthermore, we will focus on the most updated guidelines when multiple versions of guidelines are available for a specific intervention and cancer pairs from the same development group. Two reviewers will independently and in duplicate conduct reference screening and data extraction. Data will be extracted based on recommendations from each guideline and how their benefits and harms are presented. The general characteristics of cancer screening guidelines, including cancer type, recommended screening methods, certainty of evidence, direction and strength of recommendation, will be collected. In addition, we will obtain key information on the presentation of the benefits and harms of screening interventions, including quantification of their relative and absolute effects of screening interventions. Finally, our findings will be presented descriptively, and a summary of the results will be provided.

Ethics and dissemination
Ethics approval is not required as we will only use published materials. We will disseminate our findings through publication in peer-reviewed journals.