Search Results for: Le campagne di screening come strumento di prevenzione oncologica tra dubbi e certezze

Objective
To examine the feasibility of implementing remote atrial fibrillation (AF) self-screening among older people supported by a remote central monitoring system.

Design
Process evaluation of the Mass AF randomised clinical trial (ACTRN12621000184875) with one-to-one semistructured interviews using interview guides underpinned by the Critical Realism approach and coded using the UK Medical Research Council Guidance of Process Evaluation Framework.

Setting and participants
Community-dwelling people aged ≥75 years from both genders (ratio 1:1) and urban/rural (ratio 2:1) in Australia.

Interventions
Participants were provided handheld single-lead electrocardiogram (ECG) devices and trained to self-record ECGs once daily on weekdays for at least 6 months. A remote central team notified participants and general practitioners (GPs) of AF.

Primary feasibility outcomes
The strengths, weaknesses, opportunities and threats (SWOT) analysis examined enablers (ie, strengths and opportunities) and barriers (ie, weaknesses and threats).

Results
Overall, 200 participants; 98.5% completed the 6-month programme, 96% reported being satisfied with screening and 48 were interviewed: mean age 79 years, 54% male and 71% urban. 11 GPs were interviewed: 55% female and 64% urban. Programme participants trusted the remote monitoring system that supported the screening programme and provided follow-up pathways where required. GPs saw opportunities to introduce this self-screening programme to at-risk patients and improve patients’ risk profiles. Programme participants reported that after being trained to use the device, they felt empowered to do self-screening and found it convenient. GPs saw empowerment could enhance the doctor–patient relationship. Participants and GPs valued screening in diagnosing AF that would otherwise be missed in usual care, but the uncertainty of effective screening duration could be a barrier.

Conclusions
This screening programme was feasible with the reinforcement of the underpinning enablers. Several implementation strategies were identified using SWOT analysis, including leveraging the opportunity for GPs to introduce this screening programme to at-risk patients.

Trial registration number
ACTRN12621000184875.

Introduction
Temporomandibular disorders (TMDs) are musculoskeletal disorders characterised by jaw pain and typically temporomandibular joint limitations. Resistance training (RT) has been shown to be effective at reducing pain and improving function for different musculoskeletal conditions (eg, neck pain, low back pain); however, the effectiveness of RT for patients with TMDs remains unclear. This systematic review will evaluate the effectiveness of RT on pain and temporomandibular joint range of motion in people with TMDs.

Methods and analysis
The report of this protocol aligns with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The search strategy will be conducted from 1 March 2024 to 31 March 2024 via the following electronic databases: MEDLINE (OVID interface), EMBASE (OVID interface), SCOPUS, Web of Science, PubMed and Cochrane Central Register of Controlled Trials. Any randomised controlled trials or non-randomised studies of interventions in adults with TMD that examine RT targeting the masticatory muscles, compared to other interventions not including RT, will be included. Primary outcomes will be jaw pain intensity and maximal mouth opening. Secondary outcomes will include measures of neuromuscular performance and pressure pain thresholds. Two independent reviewers will conduct the screening of articles for inclusion, data extraction, risk-of-bias assessment using the revised Cochrane risk-of-bias tool for included studies and will evaluate the overall quality of evidence following the Grading of Recommendations Assessment, Development and Evaluation framework. A meta-analysis will be performed where applicable. Alternately, a narrative synthesis will be performed by adhering to the synthesis without meta-analysis guidelines. Data will be summarised according to the outcome measures or, when this is not possible, according to other pertinent variables such as TMD type (ie, temporomandibular joint disorders, masticatory muscle disorders and mixed disorders).

Ethics and dissemination
Ethical approval is not necessary, since this study does not involve the collection of primary data. The results will be disseminated through presentations at scientific conferences and publication in a peer-reviewed journal.

PROSPERO registration number
CRD42023476269.

Saltamartini: “Tra le prime regioni per tecnologie innovative”

Objectives
We aimed to determine the prevalence and factors affecting antenatal anxiety (AA) among Sri Lankan women.

Design
We conducted a cross-sectional analysis of first trimester data from a population-based cohort of antenatal women.

Setting
Field antenatal clinics of four field health areas in Colombo District, Sri Lanka.

Participants
Antenatal women (n=535) in the first trimester of pregnancy and aged ≥18 years were sequentially recruited when they attended antenatal clinics selected using random cluster sampling. Those with hearing difficulty, visual and speaking problems or currently on treatment for mental disorders were excluded.

Measures
We used an interviewer-administered questionnaire to collect data. The AA was identified using the validated Sinhala version of Perinatal Anxiety Screening Scale (PASS-S). Self-reported demographic and pregnancy-related information were verified against health records. Psychosocial risk factors were self-reported. We investigated the associations between potential risk factors and AA using regression models that included confounders identified through a directed acyclic graph and reported using adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

Results
The prevalence of AA during the first trimester of pregnancy, identified using a PASS threshold of ≥20, was 34.4% (n=184). We found several novel risk factors for AA, namely, physical (OR 2.1; 95% CI 1.4 to 3.2) and mental health problems of self (OR 2.3; 95% CI 1.2 to 4.4), physical (OR 2.1; 95% CI 1.4 to 3.4) and mental health problems of parents/spouse (OR 6.7; 95% CI 2.8 to 16.2), traumatic life situations (OR 2.7; 95% CI 1.5 to 4.8), substance abuse by the spouse (OR 3.5; 95% CI 1.9 to 6.6) and the spouse being away (OR 2.0; 95% CI 1.1 to 3.7). The other risk factors that we identified included domestic violence among family members (OR 6.4; 95% CI 1.3 to 31.0), loss of family support (OR 2.2; 95% CI 1.0 to 5.2), financial hardships (OR 1.7; 95% CI 1.0 to 2.8), accommodation-related issues (OR 2.2; 95% CI 1.0 to 4.9), unplanned pregnancy (OR 3.7; 95% CI 1.9 to 7.3), difficulties due to pregnancy (OR 2.0; 95% CI 1.1 to 3.4), changed or stopped education (OR 2.9; 95% CI 1.7 to 5.1), recent loss of employment (OR 2.9; 95% CI 1.2 to 7.0), recent death of a loved one (OR 3.5; 95% CI 2.0 to 5.9) and sleep problems during pregnancy (OR 1.6; 95% CI 1.1 to 2.3).

Conclusions
The prevalence of antenatal anxiety is high in Sri Lanka and is associated with several risk factors, not previously described, which are potentially modifiable.

Background
China’s plasmapheresis donation policy differs from that of Western countries. The association between regular plasmapheresis donation and donor health in China is still unknown.

Objectives
To investigate the association of regular plasmapheresis donation with serum protein and electrolyte levels and provide scientific evidence for policy improvement.

Design
Multicentre cross-sectional study.

Setting and participants
A total of 767 regular and 726 new donors from the provinces of Sichuan, Hunan, Henan and Yunnan were recruited from September 2021 to October 2022.

Primary and secondary outcome measures
Our primary outcome focused on measuring the levels of serum protein and electrolyte levels, including total serum protein (TSP), IgG, albumin (Alb), haemoglobin (Hb), calcium, potassium (K+) and magnesium (Mg2+). The secondary outcome assessed their abnormal rates.

Results
Male and female donors in the high donation frequency group ( >16 donations per year) exhibited lower IgG levels compared with new donors (p=0.008 for male donors and p=0.007 for female donors). Additionally, female donors with high donation frequency and a high total number of lifetime donations ( >100 donations) had significantly lower Hb concentrations than new donors. However, no significant changes were observed in TSP, Alb, calcium, K+ and Mg2+ levels. There were also no statistically significant differences in the rates of abnormal protein and electrolyte values below the respective threshold levels between new and regular donors.

Conclusions
Plasmapheresis donation is not associated with an increased risk of abnormalities in the analysed parameters. However, the results provide preliminary evidence supporting the routine inclusion of IgG screening for donors, as plasmapheresis donation is associated with a decrease in IgG levels. Particular attention should be paid to the Hb levels of female donors, especially those who donate frequently. Testing of TSP at each donation may not be necessary.

Introduction
Globally, it is estimated that dietary habits contribute to 22% of adult deaths and 15% of disability-adjusted life years, highlighting the critical role of dietary behaviour in public health. Despite the known benefits of healthy eating, many individuals find it challenging to change their diet for disease prevention. eHealth and mHealth interventions using behaviour change techniques (BCTs) have emerged as promising strategies to address this issue. However, the specific BCTs that are most effective in promoting dietary behaviour are not well established. This systematic review and component network meta-analysis (CNMA) aims to estimate the effect size of each BCT on fostering healthy eating.

Methods and analysis
We will include randomised controlled trials that assess the effects of eHealth and mHealth interventions on promoting changes in dietary behaviours among healthy adults. Studies with a minimum follow-up period of 3 weeks will be considered. Searches will be conducted in MEDLINE [PubMed], Embase [Dialogue], Cochrane Central Register of Controlled Trials, PsycInfo [Dialogue], ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and the University Hospital Medical Information Network Clinical Trials Registry on 27 January 2024. Two independent reviewers will conduct title and abstract screening followed by a full-text review. Disagreements will be resolved through discussion or consultation with a third reviewer. The primary outcome is dietary behaviour, as measured by changes in the diet quality score and the intake of a specific food. Our data synthesis will apply a frequentist random-effects model for pairwise meta-analysis, network meta-analysis and an additive CNMA model to compute the effect size of each BCT. This methodological approach will reveal the positive and negative effects of each BCT and provide a ranking of these techniques, considering both direct and indirect evidence.

Ethics and dissemination
Ethical approval is not required for this systematic review because it uses existing published data. These results will be submitted for publication in a peer-reviewed journal. The current protocol was submitted to PROSPERO on 16 January 2024 (CRD 42024502217).

Objectives
The objectives are to investigate the status of knowledge, attitudes and practices (KAP) and to identify factors related to KAP towards breast and cervical cancer screening among rural Chinese women aged 40–65 years.

Design and setting
This cross-sectional study was conducted from July to September 2020 in rural areas of eastern China.

Participants
This study involved 301 rural women aged 40–65 years.

Variables and outcomes
The questionnaire included demographic information and the KAP related to breast and cervical cancer screening. Multivariate linear regression analysis was used for the multifactor analysis.

Results
A total of 301 rural women aged 40–65 years participated in the survey. The overall score of KAP was (62.41±11.24), and the scores of each KAP domain relating to screening for breast and cervical cancer among participants in rural areas were (1.82±0.97), (44.52±7.20) and (16.06±4.56), respectively. The following factors were significantly associated with the total KAP Score relating to breast and cervical cancer screening among rural women aged 40–65 years, explaining 35% of the variance (p

Introduction
Developmental dysplasia of the hip (DDH) includes a spectrum of clinical and imaging findings at birth or early infancy. The circumstances in which this condition is detected and managed may be heterogeneous in Brazil owing to its large territory and regional socio-economic differences. Mapping DDH perspectives in a country is fundamental for designing guidelines and strategies for public policy. This scoping review aims to map the available literature related to screening, diagnosis, treatment and outcomes of DDH in the Brazilian population to provide an overview of this condition and to describe regional variations in presentation and management across the country.

Methods and analysis
This study will follow the methods outlined in the Joanna Briggs Institute Reviewers manual for conducting a scoping review. Relevant publications will be first searched in PubMed/MEDLINE, Scientific Electronic Library Online, Web of Science, Scopus, “Biblioteca virtual em saúde” and “Biblioteca Digital Brasileira de Teses e Dissertacões” using search terms developed from a brief preliminary search of those databases. There were no language or date range limitations for study inclusion. Databases will be searched from their inception until February 2024. Titles and abstracts will be analysed by two or more independent reviewers to assess them against the inclusion criteria for the review. The search results and study inclusion process will be reported in full in the final version of the scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flowchart. The resulting data will be recorded and organised to present the key information contained in all examined articles.

Ethics and dissemination
This review will include existing available studies and does not require a specific ethical review or approval. The final study will be submitted for presentation at conferences that focus on Brazilian healthcare and publication in peer-reviewed journals. This scoping review protocol was registered in the Open Science Framework. DOI registration (https://doi.org/10.17605/OSF.IO/V3AYH).

Introduction
Nerve sheath tumours arise from both the central and peripheral nervous systems. In particular, cases of spinal or paraspinal origins are scarce and poorly covered in the literature. This systematic review aims to summarise the body of evidence regarding spinal nerve sheath tumours and assess its quality, to provide the current knowledge on epidemiology, tumour characteristics, diagnostics, treatment strategies and outcomes.

Methods and analysis
Databases including PubMed, Web of Science and Embase will be searched using keywords such as “spinal”, “nerve sheath”, “neurofibroma”, “schwannoma”, “neurinoma” and “neurilemoma”. The search will be limited to studies published no earlier than 2000 without language restrictions. Case reports, editorials, letters and reviews will be excluded. Reference lists of identified studies will be searched to find possible additional relevant records. Identified studies will be screened for inclusion, by one reviewer at first and then two independent ones in the next step to increase the external validity. The Rayyan platform will be used for the screening and inclusion process. Data extraction within several predetermined areas of interest will proceed. Subjects of interest include epidemiology, histopathology, radiological diagnostics, surgery, complications, non-surgical treatment alternatives, disease outcomes and predictors of outcome, and recurrence rates. On satisfactory amount of homogenous data, a meta-analysis of key outcomes such as recurrence risk or postoperative neurological improvement will be performed. This systematic review will primarily serve as a reference guide to aid in diagnosis and treatment of patients with spinal schwannomas, while also spotlighting the knowledge gaps in the literature to help guide future research initiatives.

Ethics and dissemination
Ethics approval is not required for the protocol or review as both are based on existing publications. For dissemination, the final manuscript will be submitted to a peer-reviewed journal.

Both Cologuard Plus and Shield were approved in 2024.

Background
Worldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants. Recommendations in current clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants, and there are concerns regarding the quality of guidance in these CPGs.

Objectives
This study aimed to identify and evaluate the quality of published CPGs addressing vitD and immigrants’ health using the Appraisal of Guidelines for Research and Evaluation-II (AGREE II) tool and clarify the recommendations pertaining to vitD and immigrant populations in these CPGs.

Methods
We performed a systematic search to identify the most recent CPGs across various databases (Ovid MEDLINE ALL, Embase and Turning Research Into Practice), guideline repositories and grey literature. Two reviewers independently conducted study selection and data abstraction and evaluated the quality of the included guidelines using the AGREE II tool.

Results
We identified 25 relevant CPGs; 21 focused on vitD and 4 covered immigrants’ health. Around one-quarter of the included CPGs were high quality (≥60% in at least four of the six domains, including ‘rigour of development’). The highest mean scores among the six AGREE II domains were for ‘clarity of presentation’ and ‘scope and purpose’. About 4.8% (1/21) of the CPGs on vitD had immigrant-related recommendations. VitD recommendations were emphasised in one out of the four immigrant health CPGs (25%). CPGs covering immigrants’ health and vitD were inadequately systematically appraised. Moreover, recommendations regarding vitD were insufficient to address the growing epidemic of vitD deficiency among immigrant populations.

Conclusion
The insufficient recommendations for vitD fail to address the rising vitD deficiency among immigrants, highlighting a critical gap in healthcare provisions. Urgent national and international efforts are needed to develop comprehensive CPGs, bridging research, policy and practice disparities. Future guidelines must prioritise routine vitD screening, supplementation protocols for vulnerable immigrant groups, and culturally appropriate interventions to improve health outcomes for immigrants globally.

PROSPERO registration number
CRD42021240562.

Objectives
There is an increasing trend of pre-diabetes and diabetes mellitus (DM) among adolescents, and sub-Saharan Africa is no exception. However, few published data on pre-diabetes among adolescents in Sudan exist. We aimed to investigate the prevalence of and factors associated with pre-diabetes among adolescents in Eastern Sudan.

Design
A community-based cross-sectional study was conducted from August to October 2023.

Settings
This community-based study was conducted in Gadarif city, the capital of Gadarif state, Eastern Sudan.

Participants
Adolescents (within the ages of 10–19 years).

Main outcome measures
A questionnaire was used to collect socio-demographic information. Anthropometric and glycated haemoglobin (HbA1c) measurements were performed in accordance with standard procedures. Multivariate logistic regression analysis was performed.

Results
Of the 387 enrolled adolescents, 207 (53.5%) were female and 180 (46.5%) were male. The median (IQR) age was 14.0 (12.0–16.0) years. 39.5% of the participants’ fathers were employed. The median (IQR) HbA1c was 5.5% (5.2%–5.8%). One-third (32.6%) of the adolescents had pre-diabetes or DM. Of the participants, 67.4%, 30.0% and 2.6% had no DM, pre-diabetes or type 2 DM, respectively. In the univariate analysis, the father’s employment (OR=1.60, 95% CI=1.03 to 2.50) was associated with increased odds of pre-diabetes; age, sex, parents’ education, the mother’s occupation, body mass index z-score, cigarette smoking and a family history of DM were not associated with pre-diabetes. In the multivariate analysis, the father’s employment (adjusted OR=1.70, 95% CI=1.03 to 2.50) was associated with increased odds of pre-diabetes.

Conclusion
Pre-diabetes is a significant public health problem among adolescents in Eastern Sudan. The introduction of early screening programmes for pre-diabetes at the community level is recommended to halt the progression of pre-diabetes to DM and to deal with existing DM among adolescents.

Introduction
The National Early Warning Score (NEWS/2) system was developed to enable the detection and early intervention of patients at risk of clinical deterioration. It has demonstrated good accuracy in identifying imminent critical outcomes but has limitations in its applicability to various patient types and its ability to predict upcoming deterioration beyond 24 hours. Various studies have attempted to improve its predictive accuracy and clinical utility by modifying or adding variables to the standard NEWS/2 system. The purpose of this scoping review is to identify modifications to the NEWS and NEWS2 systems (eg, the inclusion of additional patient demographic, physiological or other characteristics) and how those modifications influence predictive accuracy to provide an evidence base for subsequent improvement of the system.

Methods and analysis
The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and the Population, Intervention, Comparator, Outcome, and Study frameworks. Six databases (PubMed, ScienceDirect, Embase, CINAHL, Web of Science and Cochrane Library) will be searched in April 2024 for articles published in English. Article screening and data extraction will be conducted by two independent reviewers, with any conflicts resolved by discussion. The analysis will be descriptive to provide a summary of modifications identified and their influence on the predictive accuracy of NEWS/NEWS 2.

Ethics and dissemination
Ethical approval is not required as data will be obtained from already published sources. Findings from this study will be disseminated via publication in a peer-reviewed journal.

Treni regionale tra Ancona e Pescara per prevenzione tumore seno

Introduction
Pilot or feasibility trials examine the feasibility, viability and recruitment potential of larger, main trials. Specifically, a pilot trial can be instrumental in identifying methodological issues essential to the development of an effective research protocol. However, numerous studies published as pilot or feasibility studies have demonstrated notable inconsistencies in the nature of information reported, resulting in poor-quality and incomplete reporting. It is unclear whether such low quality or incompleteness of reporting is also prevalent in arthroplasty pilot trials.

Methods and analysis
This protocol outlines a methodological survey examining the completeness of reporting among hip and knee arthroplasty pilot trials in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 extension to pilot trials. Secondary objectives include: (1) determining the prevalence of ‘spin’ practices, defined as: (a) placing a focus on statistical significance rather than feasibility, (b) presenting results that show the trial to be non-feasible as feasible or (c) emphasising the effectiveness or potential intervention benefits rather than feasibility; (2) determining factors associated with incomplete reporting, and ‘spin’. A search of PubMed will be conducted for pilot trials in hip or knee arthroplasty published between 01 January 2017 and 31 December 2023. Following screening, appropriate data will be extracted from eligible publications and reported as descriptive statistics, encompassing elements of the CONSORT checklist associated with completeness of reporting. Logistic regression analysis and Poisson regression will be used to analyse factors associated with completeness of reporting and spin.

Ethics and dissemination
This methodological review does not require formal ethical approval, as it will solely involve the use of published and publicly reported literature. The results of this study will be disseminated through submission to peer-reviewed journals and academic conference presentations. Study details will be sent to McMaster University’s media coordinators to be shared through the institution’s research-focused platforms.

Objective
Despite extensive exploration of potential biomarkers of cardiovascular diseases (CVDs) derived from retinal images, it remains unclear how retinal images contribute to CVD risk profiling and how the results can inform lifestyle modifications. Therefore, we aimed to determine the performance of cardiovascular risk prediction model from retinal images via explicitly estimating 10 traditional CVD risk factors and compared with the model based on actual risk measurements.

Design
A prospective cohort study design.

Setting
The UK Biobank (UKBB), a prospective cohort study, following the health conditions including CVD outcomes of adults recruited between 2006 and 2010.

Participants
A subset of data from the UKBB which contains 52 297 entries with retinal images and 5-year cumulative incidence of major adverse cardiovascular events (MACE) was used. Our dataset is split into 3:1:1 as training set (n=31 403), validation set (n=10 420) and testing set (n=10 474). We developed a deep learning (DL) model to predict 5-year MACE using a two-stage DL neural network.

Primary and secondary outcome measures
We computed accuracy, area under the receiver operating characteristic curve (AUC) and compared variations in the risk prediction models combining CVD risk factors and retinal images.

Results
The first-stage DL model demonstrated that the 10 CVD risk factors can be estimated from a given retinal image with an accuracy ranging between 65.2% and 89.8% (overall AUC of 0.738 with 95% CI: 0.710 to 0.766). In MACE prediction, our model outperformed the traditional score-based models, with 8.2% higher AUC than Systematic COronary Risk Evaluation (SCORE), 3.5% for SCORE 2 and 7.1% for the Framingham Risk Score (with p value