Risultati per: Screening del cancro alla prostata

To the Editor In a secondary analysis of the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP), the secondary end point of prostate cancer–specific mortality was significantly reduced, with a rate ratio of 0.92 (95% CI, 0.85-0.99; P = .03) after a median follow-up of 15 years. I agree with the authors that this result is modest, yet it is important to note that both nonattendance (ie, individuals randomized to the intervention group who did not have a prostate-specific antigen [PSA] test) and contamination (ie, individuals randomized to the standard group who had at least 1 PSA test) can affect the magnitude of the rate ratio for prostate cancer–specific mortality. Specifically, as the authors noted in their CAP article from 2018, the contamination rate was estimated at 10% to 15%, meaning at least 10% of participants in the standard group received at least 1 PSA test. In the current article, the authors noted that the nonattendance rate in the intervention group was 60% and an additional 6% of participants did not have a valid PSA test result. Therefore, in the best-case scenario, the difference in the PSA testing between the 2 randomized groups would be 30% (40% minus 10%). Specifically, 40% in the intervention group was derived from the 60% nonattendance rate and 10% in the standard group was due to contamination. Ideally, to assess the value of a single PSA test on prostate cancer–specific mortality, the difference in PSA testing between the 2 randomized groups should be 100%. As a result, the effect of a single PSA screen on the end point of prostate cancer–specific mortality is likely to be greater than the reported 8% reduction, as reflected in the rate ratio of 0.92. Therefore, it is important to recognize that the results of the CAP study may have underestimated the true effect of a single PSA screen on prostate cancer–specific mortality.

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

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.”

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

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.