What is the effectiveness of systematic population-level screening programmes for reducing the burden of cardiovascular diseases? Second edition

Cardiovascular disease (CVD) remains the main cause of death in the WHO European Region. This review of systematic screening programmes for CVD risk factors and preclinical CVD across general populations is a second edition of a report published in 2021. It includes an updated literature search and a more comprehensive investigation of country-level specific screening programmes. This updated review includes final results from two studies which were ongoing in 2021. It also identified 10 new studies, but none of these met the inclusion criteria. It shows that screening for CVD risk factors does not lower CVD morbidity and mortality or health-care expenses. Screening for preclinical CVD slightly reduces mortality and negative outcomes related to abdominal aortic aneurysm; however, the results may be outdated owing to a decline in smoking and improved treatment. Screening for atrial fibrillation or screening for a mixture of risk factors and preclinical CVD has a marginal effect on morbidity and mortality. Serious adverse effects are observed, probably due to overdiagnosis and overtreatment. Most studies were conducted in western European countries. Future research could investigate possible benefits of screening in countries that have not yet been studied. Few countries have national screening programmes for CVD risk factors and preclinical CVD.

Krótki poradnik na temat badań przesiewowych w kierunku nowotworów złośliwych: zwiększenie skuteczności, maksymalizacja korzyści i minimalizacja szkód

Celem badań przesiewowych w kierunku nowotworów złośliwych jest wykrycie stanu przednowotworowego lub nowotworu we wczesnym stadium u osób, które nie mają objawów, tak aby można było zaoferować wczesną diagnostykę i szybkie podjęcie leczenia, które u niektórych osób może przynieść lepsze wyniki. Celem programu badań przesiewowych w kierunku nowotworów złośliwych jest ograniczenie umieralności i chorobowości w populacji dzięki wczesnemu wykrywaniu i leczeniu nowotworów złośliwych (na przykład badania przesiewowe w kierunku raka piersi), albo zmniejszenie zachorowalności poprzez identyfikację i leczenie prekursorów nowotworów złośliwych (np. badania przesiewowe w kierunku raka szyjki macicy i jelita grubego). Ten krótki poradnik stanowi źródło najważniejszych informacji na temat badań przesiewowych w kierunku nowotworów złośliwych. Czytelnicy powinni zapoznać się z innymi publikacjami zawierającymi kompleksowe omówienie i szczegółowe wytyczne dotyczące programów badań przesiewowych w kierunku nowotworów złośliwych.

Factors related to good death in the Eastern Mediterranean Region: a systematic review

Background: Considerations for palliative care and quality of death has significantly increased over the past 10 years in the Eastern Mediterranean Region (EMR). Recent trends in ageing and increasing chronic disease burden have drawn attention to the need to pay attention to the concept of good death and related factors from the perspective of the local population. Aims: To assess the factors related to good death in the EMR. Methods: We searched PubMed, Embase, Scopus, Web of Science, and ProQuest on 22 October 2021 for English language articles, with no time limit, using keywords “quality of death”, “good death”, “quality of dying”, “good dying”, “Middle Eastern”, and countries in the Region. The quality of articles was evaluated using the Hawker criterion and based on the PRISMA guidelines. From the thematic analysis, the factors influencing good death were extracted. EndNote X8 software was used for data management. Results: The search yielded 55 articles, and 14 were included in the study, with a total of 3589 participants. Factors related to good death were classified into 2 main categories: patient preferences and end-of-life care. The former was divided into 4 groups: symptom management, psychological support, social support, and spiritual care. The second category included 2 subcategories: death control and patient autonomy, and end-of-life care. Conclusion: Although patients’ beliefs about good death are personal, unique, and different, perception about good death in the EMR depends on the extent to which patients’ preferences are met and end-of-life care is provided. More research on good death is recommended in the context of Islamic countries in EMR, and to empower patients and their families to better manage the dying process and create educational programmes.

A short guide to cancer screening: increase effectiveness, maximize benefits and minimize harm

The purpose of cancer screening tests is to detect pre-cancer or early-stage cancer in asymptomaticindividuals so that timely diagnosis and early treatment can be offered, where this treatment can leadto better outcomes for some people. The aim of a cancer screening programme is either to reducemortality and morbidity in a population by early detection and early treatment of a cancer (forexample, breast screening) or to reduce the incidence of a cancer by identifying and treating itsprecursors (such as cervical and colorectal screening). This short guide is designed to be a quickreference that contains the important ideas about cancer screening. Readers should refer to otherpublications for comprehensive discussion and detailed guidance on cancer screening programmes.

Apport de la dixième révision de la Classification internationale des maladies dans le codage de la mortalité médico-légale

Contexte : les rapports de mortalité en Tunisie n’incluent pas les causes de décès médico-légaux. Objectif : établir les statistiques sur les causes de décès médico-légaux au nord de la Tunisie en 2015 en se basant sur la Dixième Révision de la Classification internationale des maladies (CIM-10). Méthodes : il s’agissait d’une étude transversale et descriptive portant sur tous les décès autopsiés au nord de la Tunisie en 2015. Les caractéristiques socio-démographiques ont été identifiées, ainsi que les formes médico-légales et les causes de décès. Celles-ci ont été codées selon la CIM-10. Résultats : notre échantillon était composé de 1957 cas. Il y avait une prédominance masculine avec un sex ratio de 3,5. L’âge moyen était de 47,2 ( écart type [ET] 20,6 ) ans. Les morts violentes ont représenté 57,4 % de la mortalité globale, suivies du groupe des maladies de l’appareil circulatoire (24,5 %) et de celui des maladies de l’appareil respiratoire (6,5 %). Les causes de décès les plus fréquentes étaient les accidents de transport terrestre (33,7 %) et les cardiopathies ischémiques (17,9 %). Les accidents de la voie publique étaient à l’origine de 56,1 % des morts accidentelles. La pendaison était le mode suicidaire le plus fréquent (51,5 %). Les homicides étaient le plus souvent secondaires à des plaies par arme blanche (35,8 %). Conclusion : la CIM-10 a permis de mettre en avant la part de la mort violente et ses caractéristiques dans la mortalité médico-légale au nord de la Tunisie, ce qui témoigne de son efficacité dans la standardisation des conclusions des rapports d’autopsie.

Trends in premature mortality in the Islamic Republic of Iran: probability of dying between ages 30 and 70 years

Background: The burden of noncommunicable diseases (NCDs) is a major challenge facing the whole world. Around 15 million premature deaths due to NCDs occur in people aged 30–70 years annually.Aims: Mortality data based on death registration systems and population data were used to estimate proposed mortality statistics in the Islamic Republic of Iran.Methods: Various criteria and methods were used to assess the quality of mortality data. The probability of dying among those aged 30–70 years for all causes and for NCDs was calculated using the life table method.Results: The mortality rate in the population aged 30–69 years was 343.12 (per 100 000 persons) in 2006 and decreased to 240.62 in 2016 in both sexes. The probability of dying due to NCDs was 21.36% in 2006 and declined to 14.95% in 2016 for both sexes.Conclusions: The number of premature deaths due to NCDs have decreased over the last decade. We predict that this reduction will continue and the country will meet the targets of the WHO NCD action plan by 2025 and also the targets of the Sustainable Development Goals for reducing premature deaths by 2030. However, the morbidity and burden of NCDs are still public health concerns in the country. Due to advancements in health care technologies and also the aging population, these concerns will impose greater costs on the health system. Hence, prevention programmes for NCDs should be an urgent priority for Iranian health policy.

Second meeting of the Regional Director's Advisory Council on Innovation for Noncommunicable Diseases

Noncommunicable diseases (NCDs) are responsible for nearly 90% of deaths and 84% of years lived with disability in the WHO European Region. As a result of the deadly interplay between NCDs and infectious diseases, the high prevalence of NCDs and their risk factors has exacerbated the burden of COVID-19 in the WHO European Region, while the pandemic is further exacerbating the burden of NCDs in the Region. Efforts to prevent and control NCDs are at the heart of the new WHO European Programme of Work 2020–2025 (EPW), entitled “United Action for Better Health in Europe”. As part of this, in 2020 the WHO Regional Director for Europe established an NCD Advisory Council on Innovation for Noncommunicable Diseases (NCD Advisory Council), which brings together renowned experts on NCDs and representatives of special interest groups. At the inaugural meeting in December 2020, it was agreed to develop a new energized roadmap centred on Signature Initiatives to accelerate progress towards – and ideally beyond – the NCD targets. The second Advisory Council meeting took place on 5 March 2021 and Council members provided feedback on a draft concept note for a roadmap for reducing NCDs in the WHO European Region, including a proposed set of six Signature Initiatives, and discussed next steps for taking the work on these Signature Initiatives forward.