Risultati per: Screening del cancro ai polmoni

Objectives
Despite global research on early detection of age-related macular degeneration (AMD), not enough is being done for large-scale screening. Automated analysis of retinal images captured via smartphone presents a potential solution; however, to our knowledge, such an artificial intelligence (AI) system has not been evaluated. The study aimed to assess the performance of an AI algorithm in detecting referable AMD on images captured on a portable fundus camera.

Design, setting
A retrospective image database from the Age-Related Eye Disease Study (AREDS) and target device was used.

Participants
The algorithm was trained on two distinct data sets with macula-centric images: initially on 108,251 images (55% referable AMD) from AREDS and then fine-tuned on 1108 images (33% referable AMD) captured on Asian eyes using the target device. The model was designed to indicate the presence of referable AMD (intermediate and advanced AMD). Following the first training step, the test set consisted of 909 images (49% referable AMD). For the fine-tuning step, the test set consisted of 238 (34% referable AMD) images. The reference standard for the AREDS data set was fundus image grading by the central reading centre, and for the target device, it was consensus image grading by specialists.

Outcome measures
Area under receiver operating curve (AUC), sensitivity and specificity of algorithm.

Results
Before fine-tuning, the deep learning (DL) algorithm exhibited a test set (from AREDS) sensitivity of 93.48% (95% CI: 90.8% to 95.6%), specificity of 82.33% (95% CI: 78.6% to 85.7%) and AUC of 0.965 (95% CI:0.95 to 0.98). After fine-tuning, the DL algorithm displayed a test set (from the target device) sensitivity of 91.25% (95% CI: 82.8% to 96.4%), specificity of 84.18% (95% CI: 77.5% to 89.5%) and AUC 0.947 (95% CI: 0.911 to 0.982).

Conclusion
The DL algorithm shows promising results in detecting referable AMD from a portable smartphone-based imaging system. This approach can potentially bring effective and affordable AMD screening to underserved areas.

Lo ribadisce il più grande studio condotto, incaricato dall’Oms

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Circulation, Ahead of Print. Background:Guidelines have suggested screening for atrial fibrillation to enable early treatment and avoid downstream negative clinical events. We aimed to determine if atrial fibrillation screening potentially enhanced by NT-proBNP would reduce stroke or systemic embolism incidence as compared to in a control group and to determine if it was safe for those with low NT-proBNP concentrations to forfeit prolonged screening.Methods:In this randomized controlled trial all 75/76-year-old individuals in Stockholm Region, Sweden were randomized 1:1 to be invited to screening or serve as a control group. NT-proBNP concentration were measured and a single-lead-ECG registered only once if NT-proBNP

This cohort study examines the use of routine electrocardiogram (ECG) screening in identifying individuals at risk for cardiovascular disease.

In their article on routine electrocardiogram (ECG) screening and cardiovascular disease (CVD) events Yagi and colleagues report findings from a nationwide cohort study on screening electrocardiography in Japan between January 2015 and December 2021. Since 1989, an annual screening ECG has been mandatory for working-age people in Japan aged 35 years and older. The authors assessed claims and annual health screening data from the Japan Health Insurance Association that included 3 698 429 individuals registered in the database and who had a screening ECG in 2016. Electrocardiograms were classified as having 1 minor abnormality, 2 or more minor abnormalities, or major abnormalities. Using multivariable Cox proportional hazards models and adjusting for multiple clinical covariates, the authors found a greater risk of the composite outcome of overall death or hospital admission for CVD in people with 1 minor abnormality (hazard ratio [HR], 1.19; 95% CI, 1.18-1.20), 2 or more minor abnormalities (HR, 1.37; 95% CI, 1.34-1.39), and major ECG abnormalities (HR, 1.96; 95% CI, 1.92-2.02) compared with people with a normal ECG result. Cardiovascular events were observed across subgroups by age, sex, and low vs moderate to high CVD risk groups. The authors concluded that “further studies are needed to elucidate the role of routine ECG screening for early prevention of CVD events, along with optimal follow-up strategies for both major and minor ECG abnormalities.”

Background
Occupational diseases are one of the most important health problems related to employment However, in Malaysia, there are few epidemiological studies discussing these issues, especially among workers in the industry. For that, this study aimed to screen workers from high-risk industrial sectors, identify hazards in the workplace and recommend improvement measures in the workplace to prevent occupational diseases.

Methods and analysis
This is a 3-year project in which a survey of 100 000 workers from all 13 states in Malaysia will be conducted using a web-based screening tool that is comprised of two parts: occupational disease screening tool and hazard identification, risk assessment and risk control method. Data will be collected using a multistage stratified sampling method from 500 companies, including seven critical industrial sectors. The independent variables will be sociodemographic characteristics, comorbidities, previous medical history, high-risk behaviour and workplace profile. The dependent variable will be the types of occupational diseases (noise-induced hearing loss, respiratory, musculoskeletal, neurotoxic, skin and mental disorders). Subsequently, suggestions of referral for medium and high-risk workers to occupational health clinics will be attained. The approved occupational health service clinics/providers will make a confirmatory diagnosis of each case as deemed necessary. Subsequently, a walk-through survey to identify workplace hazards and recommend workplace improvement measures to prevent these occupational diseases will be achieved. Both descriptive and inferential statistics will be used in this study. Simple and adjusted binary regression will be used to find the determinants of occupational diseases.

Ethics and dissemination
This study has been approved by the MARA University of Technology Research Ethics Board. Informed, written consent will be obtained from all study participants. Findings will be disseminated to the Department of Occupational Health and Safety, involved industries, and through peer-reviewed publications.

In April 2024, the US Preventive Services Task Force (USPSTF) recommended that women aged 40 to 74 years with an average risk of breast cancer undergo mammography screening every 2 years. This updated the USPSTF’s prior suggestion that women aged 40 to 49 years engage in shared decision-making with their clinician before deciding whether to be screened.

Annals of Internal Medicine, Volume 177, Issue 9, Page 1222-1232, September 2024.

Annals of Internal Medicine, Ahead of Print.

Objectives
Investigating men’s perceived lifetime risk of prostate cancer.

Design
Survey-based study to men invited for prostate-specific antigen (PSA) screening in the GÖTEBORG-2 trial between September 2015 and June 2020.

Setting
38 775 men in the Gothenburg area, Sweden, were invited for PSA-testing and participated in a survey.

Participants
17 980 men participated in PSA-testing, of whom 13 189 completed the survey. In addition, 1264 men answered the survey only.

Interventions
Before having the PSA-test, men answered an electronic survey and estimated their lifetime risk of receiving a prostate cancer diagnosis on a visual analogue scale from 0% to 100%.

Main outcome measures
The primary outcome was the median lifetime risk estimation, which was compared with Wilcoxon test to an anticipated lifetime risk of 20% (based on GÖTEBORG-1 trial). The secondary outcome was to determine factors associated with risk estimation in a multivariable linear regression model: previous prostate examination, family history, physical exercise, healthy diet, comorbidity, alcohol consumption, smoking, education level, marital status, urinary symptoms and erectile dysfunction.

Results
Among PSA-tested men, the median estimated lifetime risk of prostate cancer was 30% (IQR 19% to 50%), corresponding to a 10 percentage-points higher estimation compared with the anticipated risk (p5 percentage-points higher risk estimation. Similar results were obtained for non-PSA-tested men.

Conclusions
Most men overestimated their prostate cancer risk which underscores the importance of providing them accurate information about prostate cancer.

Trial registration number
ISRCTN94604465.