Showing papers on "Mass screening published in 2012"
TL;DR: The USPSTF recommends against PSA-based screening for prostate cancer (grade D recommendation), which applies to men in the general U.S. population, regardless of age.
Abstract: This USPSTF recommendation on screening for prostate cancer considers evidence on the benefits and harms of prostate-specific antigen (PSA)–based screening for prostate cancer, as well as those of ...
2,137 citations
TL;DR: It is concluded that screening reduces breast cancer mortality but that some overdiagnosis occurs, and results from observational studies support the occurrence of over Diagnosis, but estimates of its magnitude are unreliable.
1,451 citations
TL;DR: In this paper, a systematic review and meta-analysis of studies that used receiver operating characteristics (ROC) curves for assessing the discriminatory power of anthropometric indices in distinguishing adults with hypertension, type-2 diabetes, dyslipidaemia, metabolic syndrome and general cardiovascular outcomes (CVD).
Abstract: Our aim was to differentiate the screening potential of waist-to-height ratio (WHtR) and waist circumference (WC) for adult cardiometabolic risk in people of different nationalities and to compare both with body mass index (BMI) We undertook a systematic review and meta-analysis of studies that used receiver operating characteristics (ROC) curves for assessing the discriminatory power of anthropometric indices in distinguishing adults with hypertension, type-2 diabetes, dyslipidaemia, metabolic syndrome and general cardiovascular outcomes (CVD) Thirty one papers met the inclusion criteria Using data on all outcomes, averaged within study group, WHtR had significantly greater discriminatory power compared with BMI Compared with BMI, WC improved discrimination of adverse outcomes by 3% (P < 005) and WHtR improved discrimination by 4-5% over BMI (P < 001) Most importantly, statistical analysis of the within-study difference in AUC showed WHtR to be significantly better than WC for diabetes, hypertension, CVD and all outcomes (P < 0005) in men and women For the first time, robust statistical evidence from studies involving more than 300 000 adults in several ethnic groups, shows the superiority of WHtR over WC and BMI for detecting cardiometabolic risk factors in both sexes Waist-to-height ratio should therefore be considered as a screening tool
1,229 citations
TL;DR: The management strategies discussed here apply to lupus nephritis in adults, particularly to those receiving care in the United States of America, and include interventions that were available in theUnited States as of April 2011.
Abstract: In the United States, approximately 35% of adults with Systemic Lupus Erythematosus (SLE) have clinical evidence of nephritis at the time of diagnosis; with an estimated total of 50–60% developing nephritis during the first 10 years of disease [1–4]. The prevalence of nephritis is significantly higher in African Americans and Hispanics than in Caucasians, and is higher in men than in women. Renal damage is more likely to develop in non-Caucasian groups [2–4]. Overall survival in patients with SLE is approximately 95% at 5 years after diagnosis and 92% at 10 years [5, 6]. The presence of lupus nephritis significantly reduces survival, to approximately 88% at 10 years, with even lower survival in African Americans [5, 6].
The American College of Rheumatology (ACR) last published guidelines for management of systemic lupus erythematosus (SLE) in 1999 [7]. That publication was designed primarily for education of primary care physicians and recommended therapeutic and management approaches for many manifestations of SLE. Recommendations for management of lupus nephritis (LN) consisted of pulse glucocorticoids followed by high dose daily glucocorticoids in addition to an immunosuppressive medication, with cyclophosphamide viewed as the most effective immunosuppressive medication for diffuse proliferative glomerulonephritis. Mycophenolate mofetil was not yet in use for lupus nephritis and was not mentioned. Since that time, many clinical trials of glucocorticoids-plus-immunosuppressive interventions have been published, some of which are high quality prospective trials, and some not only prospective but also randomized. Thus, the ACR determined that a new set of management recommendations was in order. A combination of extensive literature review and the opinions of highly qualified experts, including rheumatologists, nephrologists and pathologists, has been used to reach the recommendations. The management strategies discussed here apply to lupus nephritis in adults, particularly to those receiving care in the United States of America, and include interventions that were available in the United States as of April 2011.
While these recommendations were developed using rigorous methodology, guidelines do have inherent limitations in informing individual patient care; hence the selection of the term “recommendations.” While they should not supplant clinical judgment or limit clinical judgment, they do provide expert advice to the practicing physician managing patients with lupus nephritis.
1,128 citations
Washington University in St. Louis1, University of Colorado Denver2, University of Utah3, University of California, Los Angeles4, University of Alabama at Birmingham5, Georgetown University6, Henry Ford Health System7, Marshfield Clinic8, University of Pittsburgh9, Westat10, National Institutes of Health11, University of Toronto12
TL;DR: There was no evidence of a mortality benefit for organized annual screening in the PLCO trial compared with opportunistic screening, which forms part of usual care, and there was no apparent interaction with age, baseline comorbidity, or pretrial PSA testing.
Abstract: Results Approximately 92% of the study participants were followed to 10 years and 57% to 13 years. At 13 years, 4250 participants had been diagnosed with prostate cancer in the intervention arm compared with 3815 in the control arm. Cumulative incidence rates for prostate cancer in the intervention and control arms were 108.4 and 97.1 per 10 000 person-years, respectively, resulting in a relative increase of 12% in the intervention arm (RR = 1.12, 95% CI = 1.07 to 1.17). After 13 years of follow-up, the cumulative mortality rates from prostate cancer in the intervention and control arms were 3.7 and 3.4 deaths per 10 000 person-years, respectively, resulting in a nonstatistically significant difference between the two arms (RR = 1.09, 95% CI = 0.87 to 1.36). No statistically significant interactions with respect to prostate cancer mortality were observed between trial arm and age (Pinteraction
1,029 citations
University of Cambridge1, Medical Research Council2, University of Glasgow3, Pasteur Institute4, University of Groningen5, The Heart Research Institute6, University of California, San Diego7, Boston University8, University of Gothenburg9, German Cancer Research Center10, University College London11, University of Oxford12, Ludwig Maximilian University of Munich13, University of Vermont14, University of Bristol15, VU University Amsterdam16, Lund University17, University of Minnesota18, University of Edinburgh19, Cardiff University20, Harvard University21, Istituto Superiore di Sanità22, Centers for Disease Control and Prevention23, Erasmus University Rotterdam24, Memorial Hospital of South Bend25, Karolinska Institutet26, Osaka University27, University of Copenhagen28, Innsbruck Medical University29, Kyushu University30, University of Ulm31, Wageningen University and Research Centre32, University of Pittsburgh33, University of London34, National Institute for Health and Welfare35, Istanbul University36, Harokopio University37, University of Washington38, University of Hawaii at Manoa39, University of Eastern Finland40, Analytical Services41, Columbia University42, Maastricht University43, University of Oulu44, Merck & Co.45, Yeshiva University46, Umeå University47, Leiden University48, St George's, University of London49, University of Sydney50, University of Iceland51
TL;DR: It is estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened.
Abstract: Background There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. Methods We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. Results The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P = 20%) (P = 20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years. Conclusions In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.)
938 citations
17 Aug 2012
TL;DR: Targeted testing and linkage to care for infected persons in this birth cohort is expected to reduce HCV-related morbidity and mortality and help halt disease progression and provide a virologic cure.
Abstract: Hepatitis C virus (HCV) is an increasing cause of morbidity and mortality in the United States. Many of the 2.7-3.9 million persons living with HCV infection are unaware they are infected and do not receive care (e.g., education, counseling, and medical monitoring) and treatment. CDC estimates that although persons born during 1945-1965 comprise an estimated 27% of the population, they account for approximately three fourths of all HCV infections in the United States, 73% of HCV-associated mortality, and are at greatest risk for hepatocellular carcinoma and other HCV-related liver disease. With the advent of new therapies that can halt disease progression and provide a virologic cure (i.e., sustained viral clearance following completion of treatment) in most persons, targeted testing and linkage to care for infected persons in this birth cohort is expected to reduce HCV-related morbidity and mortality. CDC is augmenting previous recommendations for HCV testing (CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47[No. RR-19]) to recommend one-time testing without prior ascertainment of HCV risk for persons born during 1945-1965, a population with a disproportionately high prevalence of HCV infection and related disease. Persons identified as having HCV infection should receive a brief screening for alcohol use and intervention as clinically indicated, followed by referral to appropriate care for HCV infection and related conditions. These recommendations do not replace previous guidelines for HCV testing that are based on known risk factors and clinical indications. Rather, they define an additional target population for testing: persons born during 1945-1965. CDC developed these recommendations with the assistance of a work group representing diverse expertise and perspectives. The recommendations are informed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, an approach that provides guidance and tools to define the research questions, conduct the systematic review, assess the overall quality of the evidence, and determine strength of the recommendations. This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the development, implementation, and evaluation of prevention and clinical services. These recommendations will be reviewed every 5 years and updated to include advances in the published evidence.
934 citations
TL;DR: New evidence on the comparative test performance of liquid-based cytology and the benefits and harms of human papillomavirus testing as a stand-alone test or in combination with cytology is reviewed.
Abstract: This recommendation on cervical cancer screening from the U.S. Preventive Services Task Force considers evidence on liquid cytology, human papillomavirus testing, and a computer model of optimal sc...
903 citations
TL;DR: In the surgical population, a STOP-Bang score of 5–8 identified patients with high probability of moderate/severe OSA and can help the healthcare team to stratify patients for unrecognized OSA, practice perioperative precautions, or triage patients for diagnosis and treatment.
Abstract: Background The STOP-Bang questionnaire is used to screen patients for obstructive sleep apnoea (OSA). We evaluated the association between STOP-Bang scores and the probability of OSA. Methods After Institutional Review Board approval, patients who visited the preoperative clinics for a scheduled inpatient surgery were approached for informed consent. Patients answered STOP questionnaire and underwent either laboratory or portable polysomnography (PSG). PSG recordings were scored manually. The BMI, age, neck circumference, and gender (Bang) were documented. Over 4 yr, 6369 patients were approached and 1312 (20.6%) consented. Of them, 930 completed PSG, and 746 patients with complete data on PSG and STOP-Bang questionnaire were included for data analysis. Results The median age of 746 patients was 60 yr, 49% males, BMI 30 kg m−2, and neck circumference 39 cm. OSA was present in 68.4% with 29.9% mild, 20.5% moderate, and 18.0% severe OSA. For a STOP-Bang score of 5, the odds ratio (OR) for moderate/severe and severe OSA was 4.8 and 10.4, respectively. For STOP-Bang 6, the OR for moderate/severe and severe OSA was 6.3 and 11.6, respectively. For STOP-Bang 7 and 8, the OR for moderate/severe and severe OSA was 6.9 and 14.9, respectively. The predicted probabilities for moderate/severe OSA increased from 0.36 to 0.60 as the STOP-Bang score increased from 3 to 7 and 8. Conclusions In the surgical population, a STOP-Bang score of 5–8 identified patients with high probability of moderate/severe OSA. The STOP-Bang score can help the healthcare team to stratify patients for unrecognized OSA, practice perioperative precautions, or triage patients for diagnosis and treatment.
724 citations
American Cancer Society1, National Institutes of Health2, Emory University3, Memorial Sloan Kettering Cancer Center4, University of Minnesota5, University of Massachusetts Medical School6, University of Arizona7, University of New Mexico8, Harvard University9, Cornell University10, University of California, San Francisco11, McGill University12, University of Virginia13, American Society for Clinical Pathology14, Duke University15
TL;DR: The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up of women after screening, and screening strategies for women vaccinated against HPV16/18 infections.
Abstract: An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections. CA Cancer J Clin 2012;62:147-172. V C
659 citations
Boston Children's Hospital1, Royal Children's Hospital2, Amrita Institute of Medical Sciences and Research Centre3, Stellenbosch University4, James Cook University5, Universidade Federal de Minas Gerais6, All India Institute of Medical Sciences7, Johns Hopkins University8, Sri Jayadeva Institute of Cardiovascular Sciences and Research9, University of Cape Town10
TL;DR: The standardized criteria for RHD aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs.
Abstract: Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.
TL;DR: The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities, and results suggest that patient preferences should be considered when making CRC screening recommendations.
Abstract: Background Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence. Methods We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening. Results A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P Conclusions The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations. Trial Registration clinicaltrials.gov Identifier: NCT00705731
TL;DR: The USPSTF reviewed new evidence on the benefits and harms of screening and primary care–feasible or referable nonsurgical weight-loss interventions and recommended screening all adults for obesity.
Abstract: This USPSTF recommendation on screening for and management of obesity in adults updates its 2003 recommendation. The Task Force's recommendation: Clinicians should screen adults for obesity and off...
National Marrow Donor Program1, Center for International Blood and Marrow Transplant Research2, Fred Hutchinson Cancer Research Center3, Nagoya University4, Federal University of Paraná5, University of Minnesota6, Cincinnati Children's Hospital Medical Center7, Keio University8, Federal University of São Paulo9, Royal Melbourne Hospital10, University of Florida11, University Hospital of Basel12
TL;DR: In this article, the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic hematopoietic cell transplantation (HCT) were provided.
American Cancer Society1, National Institutes of Health2, Emory University3, Memorial Sloan Kettering Cancer Center4, University of Minnesota5, University of Massachusetts Medical School6, University of Arizona7, University of New Mexico8, Harvard University9, Cornell University10, University of California, San Francisco11, McGill University12, University of Virginia13, American Society for Clinical Pathology14, Duke University15
TL;DR: The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, and screening strategies for women vaccinated against HPV16 and HPV18 infections.
Abstract: An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections.
TL;DR: In innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR, the leading cause of blindness in working-age populations.
Abstract: Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world's health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.
01 Jan 2012
TL;DR: An overview of plant drought stress, its effects on plants’ resistance mechanisms and management strategies to cope with drought stress is provided.
Abstract: Drought is one of the major constraints limiting crop production worldwide. Crop growth models predict that this issue will be more severe in future. Drought impairs normal growth, disturbs water relations, and reduces water use efficiency in plants. Plants, however, have a variety of physiological and biochemical responses at cellular and whole organism levels, making it a more complex phenomenon. The rate of photosynthesis is reduced mainly by stomatal closure, membrane damage, and disturbed activity of various enzymes, especially those involved in ATP synthesis. Plants display a range of mechanisms to withstand drought, such as reduced water loss by increased diffusive resistance, increased water uptake with prolific and deep root systems, and smaller and succulent leaves to reduce transpirational loss. Low-molecular-weight osmolytes, including glycinebetaine, proline and other amino acids, organic acids, and polyols also play vital roles in sustaining cellular functions under drought. Plant growth substances such as salicylic acid, auxins, gibberellins, cytokinins, and abscisic acid modulate plant responses toward drought. Polyamines, citrulline, and several enzymes act as antioxidants and reduce adverse effects of water deficit. Plant drought stress can be managed by adopting strategies such as mass screening and breeding, marker-assisted selection, and exogenous application of hormones and osmoprotectants to seeds or growing plants, as well as engineering for drought resistance. Here, we provide an overview of plant drought stress, its effects on plants’ resistance mechanisms and management strategies to cope with drought stress.
TL;DR: The benefit of PSA screening was diminished by loss of QALYs owing to postdiagnosis long-term effects, and longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made.
Abstract: Background After 11 years of follow-up, the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% reduction in prostate-cancer mortality among men who underwent screening for prostate-specific antigen (PSA) levels. However, the extent to which harms to quality of life resulting from overdiagnosis and treatment counterbalance this benefit is uncertain. Methods On the basis of ERSPC follow-up data, we used Microsimulation Screening Analysis (MISCAN) to predict the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening. Various screening strategies, efficacies, and quality-of-life assumptions were modeled. Results Per 1000 men of all ages who were followed for their entire life span, we predicted that annual screening of men between the ages of 55 and 69 years would result in nine fewer deaths from prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and a total o...
TL;DR: It is necessary to better understand the potential role of other risk factors such as apolipoproteins and genetic predisposition to shape public health programs to preserve vision in individuals with diabetes.
Abstract: With increasing global prevalence of diabetes, diabetic retinopathy (DR) is set to be the principle cause of vision impairment in many countries. DR affects a third of people with diabetes and the prevalence increases with duration of diabetes, hyperglycemia, and hypertension—the major risk factors for the onset and progression of DR. There are now increasing data on the epidemiology of diabetic macular edema (DME), an advanced complication of DR, with studies suggesting DME may affect up to 7 % of people with diabetes. The risk factors for DME are largely similar to DR, but dyslipidemia appears to play a more significant role. Early detection of DR and DME through screening programs and appropriate referral for therapy is important to preserve vision in individuals with diabetes. Future research is necessary to better understand the potential role of other risk factors such as apolipoproteins and genetic predisposition to shape public health programs.
TL;DR: The principles of evidence assessment and methods for reaching recommendations are presented here to promote international discussion and collaboration by making the principles and methods used in developing the guidelines known to a wider professional and scientific community.
Abstract: Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The principles of evidence assessment and methods for reaching recommendations are presented here to promote international discussion and collaboration by making the principles and methods used in developing the guidelines known to a wider professional and scientific community. Following this methodology in the future updating of the guidelines has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of the screening process, including multidisciplinary diagnosis and management of the disease.
TL;DR: The challenges inherent in conducting accurate, clinically effective, and cost-effective cardiac evaluations among transplantation candidates relate to the large size of the target population, the prevalence of disease, the limited number of donated organs, and the often extended waiting periods.
TL;DR: Screening women for IPV can provide benefits that vary by population, while potential adverse effects have minimal effect on most women, and screening instruments accurately identify women experiencing IPV.
Abstract: The U.S. Preventive Services Task Force commissioned this systematic review to inform the upcoming update of its recommendation on intimate partner violence (IPV). The review focused on the effecti...
TL;DR: Birth-cohort screening for HCV in primary care settings was cost-effective and was most sensitive to sustained viral response of antiviral treatment, the cost of therapy, the discount rate, and the QALY losses assigned to disease states.
Abstract: Hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and most of them are currently undiagnosed. Whether screening based on birth cohort is more cost-effect...
TL;DR: These evidence-based recommendations to increase the proportion of hepatitis C virus-infected persons who know their status and are linked to appropriate care and treatment and address brief alcohol screening, as alcohol accelerates progression of liver disease among HCV- Infected individuals.
Abstract: The Centers for Disease Control and Prevention developed these evidence-based recommendations to increase the proportion of hepatitis C virus (HCV)–infected persons who know their status and are li...
TL;DR: The prevalence of PA increases with the severity of hypertension and the inclusion of current study results did not alter the mean prevalences of elevated ARRs and PA in primary care and referred patients.
Abstract: There is an ongoing controversy on the prevalence of primary aldosteronism (PA). We aimed to update a meta-analysis published in 2008, that compiled studies reporting the prevalence of positive ARR screening tests and PA. We therefore reviewed original studies published in 2008 or later to examine whether current reports provide similar, higher or lower prevalences of elevated ARRs or PA than reports included in the original meta-analysis. A systematic review of English articles using PubMed was conducted. Search and extraction of articles were performed by one review author; the second review author checked all extracted data. We identified 11 eligible studies. The updated, weighted mean prevalences of elevated ARRs and PA in primary care (prevalence of high ARRs 16.5%; prevalence of PA 4.3%) and referred patients (prevalence of high ARRs 19.6%; prevalence of PA 9.5%) were only marginally different from the mean values obtained in the original meta-analysis. Among the current studies the maximum values for the prevalence of elevated ARRs and PA were substantially lower than among the older studies. Our results confirm the main conclusions from the original meta-analysis. The prevalence of PA increases with the severity of hypertension and the inclusion of current study results did not alter the mean prevalences of elevated ARRs and PA in primary care and referred patients. Additionally, we found that current studies focus increasingly on patients in referral centers or special subgroups, while the prevalence of PA in the general hypertensive population is yet unknown.
TL;DR: Although the reduction in CRC mortality was sustained, further follow-up of the screened population has not shown a significant reduction in the CRC incidence, which was independent of sex and site of the tumour.
Abstract: Background Three large randomised trials have shown that screening for colorectal cancer (CRC) using the faecal occult blood test (FOBt) can reduce the mortality from this disease. The largest of these trials, conducted in Nottingham since 1981, randomised 152 850 individuals between the ages of 45 and 74 years to an intervention arm receiving biennial Haemoccult (FOB) test kit or to a control arm. In 2006, the National Bowel Cancer Screening Programme was launched in England using the FOBt, with the expectation that it will reduce CRC mortality. Aims To compare the CRC mortality and incidence in the intervention arm with the control arm after long-term follow-up. Methods The 152 850 randomised individuals were followed up through local health records and central flagging (Office for National Statistics). Results At a median follow-up of 19.5 years there was a 13% reduction in CRC mortality (95% CI 3% to 22%) in the intervention arm despite an uptake at first invitation of approximately 57%. The CRC mortality reduction in those accepting the first screening test, adjusted for the rate of non-compliers, was 18%. There was no significant difference in mortality from causes other than CRC between the intervention and control arms. Despite removing 615 adenomas >10 mm in size from the intervention arm, there was no significant difference in CRC incidence between the two arms. Conclusions Although the reduction in CRC mortality was sustained, further follow-up of the screened population has not shown a significant reduction in the CRC incidence. Moreover, despite the removal of many large adenomas there was no reduction in the incidence of invasive cancer which was independent of sex and site of the tumour.
TL;DR: This work automatically classified five types of ECG beats of MIT-BIH arrhythmia database using feed forward neural network and Least Square-Support Vector Machine and obtained the highest accuracy using the first approach using principal components of segmentedECG beats.
Abstract: Electrocardiogram (ECG) is the P, QRS, T wave indicating the electrical activity of the heart. The subtle changes in amplitude and duration of ECG cannot be deciphered precisely by the naked eye, hence imposing the need for a computer assisted diagnosis tool. In this paper we have automatically classified five types of ECG beats of MIT-BIH arrhythmia database. The five types of beats are Normal (N), Right Bundle Branch Block (RBBB), Left Bundle Branch Block (LBBB), Atrial Premature Contraction (APC) and Ventricular Premature Contraction (VPC). In this work, we have compared the performances of three approaches. The first approach uses principal components of segmented ECG beats, the second approach uses principal components of error signals of linear prediction model, whereas the third approach uses principal components of Discrete Wavelet Transform (DWT) coefficients as features. These features from three approaches were independently classified using feed forward neural network (NN) and Least Square-Support Vector Machine (LS-SVM). We have obtained the highest accuracy using the first approach using principal components of segmented ECG beats with average sensitivity of 99.90%, specificity of 99.10%, PPV of 99.61% and classification accuracy of 98.11%. The system developed is clinically ready to deploy for mass screening programs.
TL;DR: CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease and should be considered for comprehensive cardiac assessment, which may include CMR.
Abstract: Purpose To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. Patients and Methods Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. Results In this survivor population, 14% (n = 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2...
TL;DR: A nationwide colonoscopy screening program that uses highly qualified endoscopists can detect a significant number of adenomas and early-stage carcinomas.
TL;DR: What is known about help‐seeking behavior for mental health problems in college populations is reviewed and suggestions for the next steps that could be undertaken to improve knowledge and practice are offered.
Abstract: This article reviews what is known about help-seeking behavior for mental health problems in college populations and offers suggestions for the next steps that could be undertaken to improve knowledge and practice in this area. Our review suggests that traditional barriers, such as stigma, can only partially explain the high prevalence of untreated disorders. We discuss the conclusions and limitations of research on campus-based intervention strategies, including anti-stigma campaigns, screening programs, and gatekeeper trainings. In proposing new directions for research and practice, we consider insights from research on other health behaviors (e.g., diet and exercise) as well as innovative ideas from behavioral economics and cognitive psychology regarding behavior change.