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2.
BMC Infect Dis ; 22(1): 28, 2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-34983434

RESUMEN

INTRODUCTION: There are efforts in low and middle-income countries (LMICs) to integrate Tuberculosis (TB) and Diabetes mellitus (DM) healthcare services, as encouraged by WHO and other international health organizations. However, evidence on actual effect of different integration measures on bidirectional screening coverages and or treatment outcomes for both diseases in LMICs is scarce. OBJECTIVES AND METHODS: Retrospective chart review analysis was conducted to determine effects of integrated care on bidirectional screening and treatment outcomes for both TB patients and people with DM (PWD) recruited in eight Malawian hospitals. Data of ≥ 15 years old patients registered between 2016 to August 2019 were collected and analysed. RESULTS: 557 PWDs (mean age 54) and 987 TB patients (mean age 41) were recruited. 64/557 (11.5%) PWDs and 105/987 (10.6%) of TB patients were from an integrating hospital. 36/64 (56.3%) PWDs were screened for TB in integrated healthcare as compared to 5/493 (1.0%) in non-integrated care; Risk Difference (RD) 55.2%, (95%CI 43.0, 67.4), P < 0.001, while 10/105 (9.5%) TB patients were screened for DM in integrated healthcare as compared to 43/882 (4.9%) in non-integrated care; RD 4.6%, (95%CI - 1.1, 10.4), P = 0.065. Of the PWDs screened, 5/41 (12.2%) were diagnosed with TB, while 5/53 (9.4%) TB patients were diagnosed with DM. On TB treatment outcomes, 71/508 (14.8%) were lost to follow up in non-integrated care and none in integrated care were lost to follow-up; RD - 14.0%, (95%CI: - 17.0,-11.0), p < 0.001. Among PWDs, 40/493 (8.1%) in non-integrated care and 2/64 (3.1%) were lost to follow up in integrated care; RD - 5.0%, (95%CI:-10.0, - 0.0); P = 0.046. After ≥ 2 years of follow up, 62.5% PWDs in integrated and 41.8% PWDs in non-integrated care were retained in care, RD 20.7, (95%CI: 8.1, 33.4), P = 0.001. CONCLUSION: We found higher bidirectional screening coverage and less loss to follow-up in one centre that made more efforts to implement integrated measures for TB and DM care than in 7 others that did not make these efforts. Decisions on local programs to integrate TB/DM care should be taken considering currently rather weak evidence and barriers faced in the local context as well as existing guidelines.


Asunto(s)
Diabetes Mellitus , Tuberculosis , Adolescente , Adulto , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Hospitales , Humanos , Malaui/epidemiología , Tamizaje Masivo , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis/complicaciones , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico
3.
Pediatr Emerg Care ; 38(1): 9-12, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34986577

RESUMEN

OBJECTIVES: Adolescents with psychiatric conditions more commonly engage in high-risk sexual behaviors and are at increased risk of sexually transmitted infections (STIs) and when presenting to pediatric emergency departments (PEDs) may be an important population in which to target screening efforts. This study aimed to determine frequency of physician-documented sexual history and STI screening in adolescents presenting to a PED with mental health-related complaints. METHODS: Retrospective study of patients aged 14 to 18 years presenting to a PED February 2015 to September 2016. Electronic records were reviewed for demographics, chief complaint, sexual history documentation, STI screening, resident involvement in patient care, and disposition. Proportions were calculated for frequencies, whereas χ2 and Fisher exact tests evaluated factors associated with documentation of sexual history and STI screening. RESULTS: Two hundred eighty-five patient encounters were identified. Age range was 15 to 18 years with an average of 16 years, and 58% were girls. The most common chief complaint was "intentional ingestion/overdose" (169 encounters, 59%) followed by "suicidal/attempted suicide" (59, 21%). Seventy-seven patients (27%) had sexual history documented. Girls were more likely to have sexual history documented (75% vs 52%, P = 0.0004). Forty-five (59%) patients were noted to be sexually active, and 17 (38%) of these were screened for STI. There was no relationship between screening and race, sex, or involvement of a resident in patient care. CONCLUSIONS: In a high-risk PED population, physicians documented sexual history only 27% of the time. Female patients were more likely to have a sexual history documented. In patients with sexual history indicating risk for STI, less than half were screened.


Asunto(s)
Salud Mental , Enfermedades de Transmisión Sexual , Adolescente , Niño , Documentación , Servicio de Urgencia en Hospital , Femenino , Humanos , Tamizaje Masivo , Estudios Retrospectivos , Conducta Sexual , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología
4.
Artículo en Inglés | MEDLINE | ID: mdl-34991183

RESUMEN

Eating disorders are prevalent in adulthood and have high rates of morbidity and mortality. In many cases, primary care physicians (PCPs) are the first and/or only medical professionals to interact with individuals with eating disorders. However, PCPs often do not receive adequate training to confidently and appropriately care for these patients. This review includes up-to-date screening and treatment guidelines and relevant studies concerning the care of adult patients with eating disorders and provides concise guidance for PCPs regarding the outpatient management of these patients in primary care. Three case reports are also included to provide real-life examples of patients with eating disorders that PCPs may encounter. Although eating disorders can have grave consequences, recovery is possible and common, even after patients have been ill for many years. PCPs can play an integral role in promoting recovery by following evidence-based guidelines, by identifying when medical or psychiatric hospitalization is indicated, by monitoring for medical complications, and by referring early to evidenced-based therapies.


Asunto(s)
Trastornos de Alimentación y de la Ingestión de Alimentos , Médicos de Atención Primaria , Adulto , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Personal de Salud , Humanos , Tamizaje Masivo , Atención Primaria de Salud
5.
Health Res Policy Syst ; 20(1): 7, 2022 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-35012561

RESUMEN

BACKGROUND: Tuberculosis case-finding interventions often involve several activities to enhance patient pathways, and it is unclear which activity defines the type of case-finding intervention. When conducting studies to identify the most effective case-finding intervention it is important to have a clear understanding of these interventions for meaningful comparisons. This review aimed to construct a systems-based logic model of all pathways to tuberculosis case detection through a synthesis of intervention designs. METHODS: We identified an existing systematic review on the effectiveness of interventions to increase tuberculosis case detection and updated the search from December 2016 to October 2020. We included randomized controlled trials, as these designs encourage detailed description of interventions. Taking each study in turn, intervention descriptions were read in detail. The texts were analysed qualitatively by constantly comparing emerging codes to construct patient journeys, visualized as logical chains. Actions taken as part of interventions were positioned along patient journeys to theorize the sequence of outcomes. Patient journeys formed the basis of the model, which was refined through discussion. RESULTS: Based on intervention descriptions from 17 randomized controlled trials, our model distinguishes two care-seeking pathways and four screening pathways. An open invitation to people with tuberculosis symptoms creates care-seeking pathways. On care-seeking pathways, systematic screening can be conducted at general health services, but not at specific TB care services. People invited to tuberculosis services regardless of symptoms follow tuberculosis screening pathways and may be identified with presumptive tuberculosis even if they do not seek care for tuberculosis symptoms. Tuberculosis screening pathways include screening offered to all people accessing care at general health services, screening at a mobile clinic or health facility with open invitation to a whole population or tuberculosis contacts, screening personally offered to a whole population or tuberculosis contacts at home, work or school, and screening offered to people receiving care for human immunodeficiency virus or other clinical risk-group care. CONCLUSION: This systems-based logic model of tuberculosis case-finding pathways may support standardized terminology, consistency, transparency and improved communication among researchers, policy-makers, health workers and community members when implementing and evaluating interventions to improve tuberculosis case detection.


Asunto(s)
Infecciones por VIH , Tuberculosis , Personal de Salud , Humanos , Tamizaje Masivo , Aceptación de la Atención de Salud
6.
JAMA ; 327(1): 41-49, 2022 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-34982119

RESUMEN

Importance: Implementation of guideline-recommended depression screening in medical oncology remains challenging. Evidence suggests that multicomponent care pathways with algorithm-based referral and management are effective, yet implementation of sustainable programs remains limited and implementation-science guided approaches are understudied. Objective: To evaluate the effectiveness of an implementation-strategy guided depression screening program for patients with breast cancer in a community setting. Design, Setting, and Participants: A pragmatic cluster randomized clinical trial conducted within Kaiser Permanente Southern California (KPSC). The trial included 6 medical centers and 1436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018. Patients were followed up through study end date of May 31, 2019. Interventions: Six medical centers in Southern California participated and were randomized 1:1 to tailored implementation strategies (intervention, 3 sites, n = 744 patients) or education-only (control, 3 sites, n = 692 patients) groups. The program consisted of screening with the 9-item Patient Health Questionnaire (PHQ-9) and algorithm-based scoring and referral to behavioral health services based on low, moderate, or high score. Clinical teams at tailored intervention sites received program education, audit, and feedback of performance data and implementation facilitation, and clinical workflows were adapted to suit local context. Education-only controls sites received program education. Main Outcomes and Measures: The primary outcome was percent of eligible patients screened and referred (based on PHQ-9 score) at intervention vs control groups measured at the patient level. Secondary outcomes included outpatient health care utilization for behavioral health, primary care, oncology, urgent care, and emergency department. Results: All 1436 eligible patients were randomized at the center level (mean age, 61.5 years; 99% women; 18% Asian, 17% Black, 26% Hispanic, and 37% White) and were followed up to the end of the study, insurance disenrollment, or death. Groups were similar in demographic and tumor characteristics. For the primary outcome, 7.9% (59 of 744) of patients at tailored sites were referred compared with 0.1% (1 of 692) at education-only sites (difference, 7.8%; 95% CI, 5.8%-9.8%). Referrals to a behavioral health clinician were completed by 44 of 59 patients treated at the intervention sites (75%) intervention sites vs 1 of 1 patient at the education-only sites (100%). In adjusted models patients at tailored sites had significantly fewer outpatient visits in medical oncology (rate ratio, 0.86; 95% CI, 0.86-0.89; P = .001), and no significant difference in utilization of primary care, urgent care, and emergency department visits. Conclusions and Relevance: Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program. Trial Registration: ClinicalTrials.gov Identifier: NCT02941614.


Asunto(s)
Neoplasias de la Mama/psicología , Servicios de Salud Comunitaria , Depresión/diagnóstico , Tamizaje Masivo , Derivación y Consulta/estadística & datos numéricos , Femenino , Humanos , Masculino , Oncología Médica , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Educación del Paciente como Asunto , Encuestas y Cuestionarios
7.
BMC Infect Dis ; 22(1): 49, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35022023

RESUMEN

BACKGROUND: In Australia, demand for specialist infectious diseases services exceeds capacity to provide timely management of latent tuberculosis infection (LTBI) in areas of high refugee and asylum seeker settlement. A model for treating LTBI patients in primary care has been developed and piloted in a refugee-focused primary health service (Monash Health Refugee Health and Wellbeing [MHRHW]) and a universal primary care clinic. This study reports on the development and evaluation of the model, focusing on the model feasibility, and barriers and enablers to its success. METHODS: A convergent mix-methods design was used to evaluate the model for treating LTBI patients in primary care, where a prospective cohort study of patients commencing treatment either at MHRHW or the universal primary care clinic determined the model feasibility, while focus groups with clinicians directly involved in treating these patients explored barriers and enablers to sustainability and success of the model. RESULTS: From January 2017 to April 2018, 65 patients with confirmed LTBI presented at participating clinics. Treatment was accepted by 31 (48%) patients, of whom 15(48%) were treated at MHRHW and 16 (52%) at the universal primary care clinic. The 6-months' treatment completion rate was higher at MHRHW compared to the universal primary care clinic (14 (93%) compared to 9 (56%) respectively, p = 0.0373). Reasons for non-completion included adverse reaction, opting out and relocation. At the completion of the pilot, 15 clinicians participated in two focus groups. Clinicians identified barriers and enablers for successful LTBI management at patient, provider, organisational and clinical levels. While barriers for treatment completion and adherence were consistent across the two pilot sites, enablers, such as resources to facilitate patient education and follow-up, were available only at MHRHW. CONCLUSION: Screening and management of LTBI patients can be achieved within the primary care setting, considerate of barriers and enablers at patient, provider, organisational and clinical levels. Upscaling of a primary care response to the management of LTBI will require supporting primary care clinics with resources to employ dedicated clinical staff for patient education, follow-up communication and monitoring medication adherence.


Asunto(s)
Tuberculosis Latente , Refugiados , Antituberculosos/uso terapéutico , Humanos , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/tratamiento farmacológico , Tamizaje Masivo , Atención Primaria de Salud , Estudios Prospectivos
8.
Trials ; 23(1): 31, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35022080

RESUMEN

BACKGROUND: Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently, only 44% of Australians aged 50-74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice. METHODS: We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narrative messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with a two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to the control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to 12 months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit. DISCUSSION: This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620001020976 . Registered on 17 October 2020.


Asunto(s)
Neoplasias Colorrectales , Detección Precoz del Cáncer , Neoplasias Colorrectales/diagnóstico , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Sangre Oculta , Victoria
9.
Rheum Dis Clin North Am ; 48(1): 67-90, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34798960

RESUMEN

Mental health problems are more common in children with pediatric rheumatologic diseases (PRDs) than healthy peers. Mental health problems affect disease-related outcomes and health-related quality of life (HRQOL), so addressing these problems can improve clinical and psychosocial outcomes. Mental health screening tools are available, and there are resources available to aid in integrating mental health care into the clinical setting. By implementing these tools, mental health problems can be recognized and addressed.


Asunto(s)
Reumatología , Niño , Estado de Salud , Humanos , Tamizaje Masivo , Salud Mental , Calidad de Vida
10.
Med Clin North Am ; 106(1): 13-28, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34823726

RESUMEN

Unhealthy alcohol and drug use are among the top 10 causes of preventable death in the United States, but they are infrequently identified and addressed in medical settings. Guidelines recommend screening adult primary care patients for alcohol and drug use, and routine screening should be a component of high-quality clinical care. Brief, validated screening tools accurately detect unhealthy alcohol and drug use, and their thoughtful implementation can facilitate adoption and optimize the quality of screening results. Recommendations for implementation include patient self-administered screening tools, integration with electronic health records, and screening during routine primary care visits.


Asunto(s)
Tamizaje Masivo/métodos , Atención Primaria de Salud/métodos , Trastornos Relacionados con Sustancias/diagnóstico , Adulto , Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Registros Electrónicos de Salud , Femenino , Implementación de Plan de Salud/métodos , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Autoevaluación (Psicología) , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/mortalidad , Estados Unidos/epidemiología
11.
Emerg Infect Dis ; 28(1): 219-223, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34932935

RESUMEN

We report a transfusion-transmitted hepatitis A virus infection in an immunocompromised patient in France, detected shortly after a transfusion of pathogen-reduced pooled platelets. This case raises questions about the efficacy of donor screening methods. Additional safety measures, such as routine donation screening, should be considered.


Asunto(s)
Virus de la Hepatitis A , Torque teno virus , Donantes de Sangre , Transfusión Sanguínea , Virus de la Hepatitis A/genética , Humanos , Huésped Inmunocomprometido , Tamizaje Masivo
12.
Clin Imaging ; 82: 224-227, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34896935

RESUMEN

Disparities in screening mammography and barriers to accessing breast cancer screening are most prevalent among racial/ethnic minority and low-income women. The significant breast cancer mortality rates experienced in both Hispanic and African American populations are found to be connected to delayed screening. For these women to follow the screening guidelines outlined by the American College of Radiology and Society of Breast Imaging, they must successfully navigate existing barriers to screening. These barriers include differential access to care, language barriers, and lack of medical insurance. The COVID-19 Pandemic has worsened the barriers to breast cancer screening faced by these groups of women. These barriers need to be addressed or they may further exacerbate disparities.


Asunto(s)
Neoplasias de la Mama , COVID-19 , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/epidemiología , Detección Precoz del Cáncer , Femenino , Humanos , Mamografía , Tamizaje Masivo , Grupos Minoritarios , Pandemias , SARS-CoV-2
13.
Lancet Glob Health ; 10(1): e52-e62, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34919856

RESUMEN

BACKGROUND: To address the growing prevalence of hearing loss, WHO has identified a compendium of key evidence-based ear and hearing care interventions to be included within countries' universal health coverage packages. To assess the cost-effectiveness of these interventions and their budgetary effect for countries, we aimed to analyse the investment required to scale up services from baseline to recommended levels, and the return to society for every US$1 invested in the compendium. METHODS: We did a modelling study using the proposed set of WHO interventions (summarised under the acronym HEAR: hearing screening and intervention for newborn babies and infants, pre-school and school-age children, older adults, and adults at higher risk of hearing loss; ear disease prevention and management; access to technologies such as hearing aids, cochlear implants, or hearing assistive technologies; and rehabilitation service provision), which span the life course and include screening and management of hearing loss and related ear diseases, costs and benefits for the national population cohorts of 172 countries. The return on investment was analysed for the period between 2020 and 2030 using three scenarios: a business-as-usual scenario, a progress scenario with a scale-up to 50% of recommended coverage, and an ambitious scenario with scale-up to 90% of recommended coverage. Using data for hearing loss burden from the Global Burden of Disease Study 2019, a transition model with three states (general population, diagnosed, and those who have died) was developed to model the national populations in countries. For the return-on-investment analysis, the monetary value of disability-adjusted life-years (DALYs) averted in addition to productivity gains were compared against the investment required in each scenario. FINDINGS: Scaling up ear and hearing care interventions to 90% requires an overall global investment of US$238·8 billion over 10 years. Over a 10-year period, this investment promises substantial health gains with more than 130 million DALYs averted. These gains translate to a monetary value of more than US$1·3 trillion. In addition, investment in hearing care will result in productivity benefits of more than US$2 trillion at the global level by 2030. Together, these benefits correspond to a return of nearly US$15 for every US$1 invested. INTERPRETATION: This is the first-ever global investment case for integrating ear and hearing care interventions in countries' universal health coverage services. The findings show the economic benefits of investing in this compendium and provide the basis for facilitating the increase of country's health budget for strengthening ear and hearing care services. FUNDING: None.


Asunto(s)
Pérdida Auditiva/prevención & control , Pérdida Auditiva/terapia , Atención de Salud Universal , Organización Mundial de la Salud/organización & administración , Análisis Costo-Beneficio , Países en Desarrollo , Enfermedades del Oído/economía , Enfermedades del Oído/prevención & control , Enfermedades del Oído/terapia , Accesibilidad a los Servicios de Salud/economía , Audífonos/economía , Pérdida Auditiva/economía , Humanos , Tamizaje Masivo/economía , Modelos Econométricos , Organización Mundial de la Salud/economía
14.
Lancet Glob Health ; 10(1): e96-e104, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34919862

RESUMEN

BACKGROUND: Universal testing and treatment for HIV has shown promise as an approach to reduce mortality and lower HIV incidence. Evidence on the economic effects of this approach on individuals and households in low-resource settings is scarce. We aimed to examine the effect of universal HIV testing and treatment on a range of economic outcomes. METHODS: We collected data in household surveys done over a 3-year period in a sample of HIV-positive and HIV-negative adults participating in a cluster-randomised trial of universal HIV testing and treatment in 32 rural communities in Kenya and Uganda. Communities of approximately 10 000 people were pair-matched on the basis of geographical and population characteristics, with the best-matching 16 pairs randomly assigned (1:1) to intervention or control groups. Participants in intervention communities received annual HIV and multidisease testing, universal antiretroviral therapy (ART) eligibility, and patient-centred care. Participants in control communities received baseline testing and medical care according to national guidelines. We analysed employment and health-care utilisation outcomes for working-age adults (age 18-65 years) and education outcomes for school-age children (6-17 years) using data from 3 years after the intervention. This trial is now complete, and is registered with ClinicalTrials.gov, NCT01864603. FINDINGS: Between July 9, 2013, and June 15, 2017, we collected survey data on 8198 working-age adults and 6755 school-age children. Compared with adults living with HIV in control communities, adults living with HIV in intervention communities were more likely to be employed (difference 9·7% [95% CI 2·1 to 18·3]), less likely to seek health care (-10·3% [-22·0 to 0·1]), and less likely to spend money on health care (-12·7% [-22·4 to 0·6]) 3 years after the intervention. We found no significant differences in outcomes between HIV-negative adults in intervention and control communities. Among children in households with HIV-positive adults, the intervention led to a 7·3% (95% CI 1·0 to 15·1) increase in primary school completion after 3 years in intervention communities compared with control communities. INTERPRETATION: Universal HIV testing and treatment improved employment outcomes and other indicators of socioeconomic wellbeing for HIV-positive adults and children in their households, but had no effect on HIV-negative adults. Our findings suggest that the considerable investments needed to expand ART access might have substantial short-term and long-term economic returns. FUNDING: National Institutes of Health.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Tamizaje Masivo/organización & administración , Población Rural , Adolescente , Adulto , Anciano , Antirretrovirales/administración & dosificación , Niño , Escolaridad , Femenino , Prueba de VIH , Servicios de Salud/estadística & datos numéricos , Humanos , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Uganda/epidemiología , Carga Viral , Adulto Joven
15.
Emerg Infect Dis ; 28(1): 247-250, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34932453

RESUMEN

We sequenced ≈50% of coronavirus disease cases imported to Hong Kong during March-July 2021 and identified 70 cases caused by Delta variants of severe acute respiratory syndrome coronavirus 2. The genomic diversity detected in Hong Kong was similar to global diversity, suggesting travel hubs can play a substantial role in surveillance.


Asunto(s)
COVID-19 , SARS-CoV-2 , COVID-19/diagnóstico , COVID-19/epidemiología , Genómica , Hong Kong/epidemiología , Humanos , Tamizaje Masivo , SARS-CoV-2/aislamiento & purificación , Viaje
16.
Eur Radiol ; 32(1): 602-612, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34117912

RESUMEN

OBJECTIVES: In breast cancer screening, two readers separately examine each woman's mammograms for signs of cancer. We examined whether preventing the two readers from seeing each other's decisions (blinding) affects behaviour and outcomes. METHODS: This cohort study used data from the CO-OPS breast-screening trial (1,119,191 women from 43 screening centres in England) where all discrepant readings were arbitrated. Multilevel models were fitted using Markov chain Monte Carlo to measure whether reader 2 conformed to the decisions of reader 1 when they were not blinded, and the effect of blinding on overall rates of recall for further tests and cancer detection. Differences in positive predictive value (PPV) were assessed using Pearson's chi-squared test. RESULTS: When reader 1 recalls, the probability of reader 2 also recalling was higher when not blinded than when blinded, suggesting readers may be influenced by the other's decision. Overall, women were less likely to be recalled when reader 2 was blinded (OR 0.923; 95% credible interval 0.864, 0.986), with no clear pattern in cancer detection rate (OR 1.029; 95% credible interval 0.970, 1.089; Bayesian p value 0.832). PPV was 22.1% for blinded versus 20.6% for not blinded (p < 0.001). CONCLUSIONS: Our results suggest that when not blinded, reader 2 is influenced by reader 1's decisions to recall (alliterative bias) which would result in bypassing arbitration and negate some of the benefits of double-reading. We found a relationship between blinding the second reader and slightly higher PPV of breast cancer screening, although this analysis may be confounded by other centre characteristics. KEY POINTS: • In Europe, it is recommended that breast screening mammograms are analysed by two readers but there is little evidence on the effect of 'blinding' the readers so they cannot see each other's decisions. • We found evidence that when the second reader is not blinded, they are more likely to agree with a recall decision from the first reader and less likely to make an independent judgement (alliterative error). This may reduce overall accuracy through bypassing arbitration. • This observational study suggests an association between blinding the second reader and higher positive predictive value of screening, but this may be confounded by centre characteristics.


Asunto(s)
Neoplasias de la Mama , Detección Precoz del Cáncer , Teorema de Bayes , Neoplasias de la Mama/diagnóstico por imagen , Estudios de Cohortes , Femenino , Humanos , Mamografía , Tamizaje Masivo , Variaciones Dependientes del Observador
18.
Pediatr Clin North Am ; 69(1): 153-170, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34794672

RESUMEN

Immigrant children are a diverse group and include refugees, asylees, and internationally adopted children. They have various infectious disease risk factors, depending on conditions within their country of origin, journey, and current living conditions. Infectious disease screening should take place within the framework of a comprehensive medical evaluation in the medical home. Some screening is recommended for all immigrant children including hepatitis B, syphilis, HIV, tuberculosis, and intestinal parasites; other diseases can be tested for based on individual risks. Although guidelines and resources are available, there is limited evidence supporting much of the care of immigrant children and youth.


Asunto(s)
Niño Adoptado , Enfermedades Transmisibles/diagnóstico , Enfermedades Transmisibles/terapia , Emigrantes e Inmigrantes , Refugiados , Adolescente , COVID-19/diagnóstico , Niño , Preescolar , Control de Enfermedades Transmisibles/métodos , Femenino , Infecciones por VIH/diagnóstico , Hepatitis Viral Humana/diagnóstico , Humanos , Inmunización/métodos , Lactante , Masculino , Tamizaje Masivo/métodos , Enfermedades Parasitarias/diagnóstico , Pediatría/métodos , Guías de Práctica Clínica como Asunto , Sífilis/diagnóstico , Tuberculosis/diagnóstico
20.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 39(1): 16-20, 2022 Jan 10.
Artículo en Chino | MEDLINE | ID: mdl-34964959

RESUMEN

OBJECTIVE: To assess the application value of combined detection of HbA2 and HbF for the screening of thalassemia among a population of childbearing age in Quanzhou, Fujian, and determine the optimal cut-off values for the region. METHODS: Capillary hemoglobin electrophoresis and genetic testing for α and ß globin gene mutations were simultaneously carried out on 11 428 patients with suspected thalassemia. Statistical methods were used to analyze the distribution of various types of thalassemia and compare the performance of HbA2 and HbF measurement for the screening of various types of thalassemia. The optimal cut-off values for HbA2 and HbF were determined with the ROC curves. RESULTS: 4591 patients with α, ß, and αß compound thalassemia were identified by genetic testing. The most common genotypes for α and ß thalassemia included --SEA/αα and ß654/ßN, ß41-42/ßN, and ß17/ßN. The ROC curves were drawn to compare the performance of HbA2 screening for α-, ß-, αß-compound, static α-, mild α-, and intermediate α-thalassemia, and the maximum area under the curves was 0.674, 0.984, 0.936, 0.499, 0.731, 0.956, and the optimal cut-off values for HbA2 were 2.45%, 3.25%, 3.65%, 2.95%, 2.55%, 1.75%, respectively. CONCLUSION: HbA2 is an efficient indicator for identifying intermediate types of α-, ß-, and αß compound thalassemia. The combination of HbA2 and HbF measurement can effectively detect carriers for ß-thalassemia mutations.


Asunto(s)
Talasemia alfa , Talasemia beta , Genotipo , Hemoglobina A2/análisis , Hemoglobina A2/genética , Heterocigoto , Humanos , Tamizaje Masivo , Mutación , Talasemia beta/diagnóstico , Talasemia beta/genética
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