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1.
Orv Hetil ; 161(10): 374-381, 2020 Mar.
Artículo en Húngaro | MEDLINE | ID: mdl-32115991

RESUMEN

Introduction: Pregnancy is usually desired, yet it has its own difficulties that can be overwhelming, thus depression might occur. The prevalence of this is 6.58-26.7% in the international literature and 6.5-17.9% in Hungarian studies. Aim: The aim was to analyze the data of the perinatal depression screening program of Békéscsaba which started in 2014. We wanted to study the pathological rate and the connection between demographic data and depression symptoms. Method: Until august 2019, 1708 women took part in the program. The screening is done by perinatal nurses: they explain the aims and hand over the Edinburgh Postnatal Depression Scale three times during pregnancy and once postpartum. They also suggest women in need to attend the psychological intervention as part of the screening. Results: The prevalence of the pathological questionnaires were 15.31%, 14.29%, 11.87%, and 12.68% at the four measuring occasions. In the whole sample, 18.27% of women had pathological score at least once. The depression scores of the four measurements correlated significantly with each other. Women who did not plan their pregnancies had higher level of depression in all four measurements. In the first trimester, women who were under 21 years old and/or were single had higher depression scores. In the second trimester, multipara women tended to have higher scores. Conclusion: The high prevalence and the constant level of depression emphasize the importance of the screening and psychological intervention, as previous studies found connection between depression and some perinatal complications. Some demographic factors can indicate more vulnerable women. Orv Hetil. 2020; 161(10): 374-381.


Asunto(s)
Depresión Posparto/psicología , Depresión/diagnóstico , Tamizaje Masivo/métodos , Complicaciones del Embarazo/psicología , Atención Prenatal/métodos , Adulto , Depresión/epidemiología , Depresión/psicología , Depresión Posparto/diagnóstico , Depresión Posparto/epidemiología , Femenino , Humanos , Hungría/epidemiología , Edad Materna , Atención Perinatal , Embarazo , Atención Prenatal/estadística & datos numéricos , Prevalencia , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Adulto Joven
2.
J Korean Med Sci ; 35(11): e123, 2020 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-32193904

RESUMEN

As the coronavirus disease 2019 (COVID-19) outbreak is ongoing, the number of individuals to be tested for COVID-19 is rapidly increasing. For safe and efficient screening for COVID-19, drive-through (DT) screening centers have been designed and implemented in Korea. Herein, we present the overall concept, advantages, and limitations of the COVID-19 DT screening centers. The steps of the DT centers include registration, examination, specimen collection, and instructions. The entire service takes about 10 minutes for one testee without leaving his or her cars. Increased testing capacity over 100 tests per day and prevention of cross-infection between testees in the waiting space are the major advantages, while protection of staff from the outdoor atmosphere is challenging. It could be implemented in other countries to cope with the global COVID-19 outbreak and transformed according to their own situations.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/diagnóstico , Tamizaje Masivo/métodos , Neumonía Viral/diagnóstico , Automóviles , Betacoronavirus , Humanos , República de Corea
3.
Euro Surveill ; 25(5)2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32046816

RESUMEN

We evaluated effectiveness of thermal passenger screening for 2019-nCoV infection at airport exit and entry to inform public health decision-making. In our baseline scenario, we estimated that 46% (95% confidence interval: 36 to 58) of infected travellers would not be detected, depending on incubation period, sensitivity of exit and entry screening, and proportion of asymptomatic cases. Airport screening is unlikely to detect a sufficient proportion of 2019-nCoV infected travellers to avoid entry of infected travellers.


Asunto(s)
Viaje en Avión , Temperatura Corporal , Infecciones por Coronavirus/diagnóstico , Fiebre/diagnóstico , Tamizaje Masivo , Neumonía Viral/diagnóstico , Enfermedades Transmisibles Emergentes , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Toma de Decisiones , Humanos , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Modelos Teóricos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Vigilancia de la Población , Salud Pública
4.
Lancet ; 395(10224): 575-590, 2020 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-32007141

RESUMEN

BACKGROUND: The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. METHODS: The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions. FINDINGS: Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4-19·8) to 2·1 (2·0-2·6) cases per 100 000 women-years over the next century (89·4% [86·2-90·1] reduction), and to avert 61·0 million (60·5-63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 (0·6-1·6) cases per 100 000 women-years (96·7% [91·3-96·7] reduction) and averted an extra 12·1 million (9·5-13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58-65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89-100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37-99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71-100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11-31 years. Long-term vaccine protection was required for elimination. INTERPRETATION: Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden. FUNDING: WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec-Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.


Asunto(s)
Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino/prevención & control , Adulto , Países en Desarrollo , Detección Precóz del Cáncer/métodos , Estudios de Factibilidad , Femenino , Humanos , Incidencia , Renta , Tamizaje Masivo/métodos , Modelos Biológicos , Infecciones por Papillomavirus/complicaciones , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Vacunación
5.
Lancet ; 395(10224): 591-603, 2020 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-32007142

RESUMEN

BACKGROUND: WHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus (HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90-70-90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals (SDGs)-a one-third reduction in premature mortality from non-communicable diseases by 2030. METHODS: The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries (LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10-14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median (range) of model predictions. FINDINGS: In 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 (range 12·9-14·1) per 100 000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% (0·1-0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% (23·3-37·8), averting 300 000 (300 000-400 000) deaths by 2030 (with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% (61·4-66·1), averting 4·8 million (4·1-4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% (84·0-89·3), averting 13·3 million (13·1-13·6) deaths (with once-lifetime screening), or by 92·3% (88·4-93·0), averting 14·6 million (14·1-14·6) deaths (with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% (86·6-89·9), averting 45·8 million (44·7-46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% (95·0-98·0), averting 60·8 million (60·2-61·2) deaths (with once-lifetime screening), or by 98·6% (96·5-98·6), averting 62·6 million (62·1-62·8) deaths (with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half (48% [45-55]) of deaths averted would be in sub-Saharan Africa and almost a third (32% [29-34]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths (age 30-69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% (24·4-37·9) by 2030, 96·2% (94·3-96·8) by 2070, and 98·6% (96·9-98·8) by 2120. INTERPRETATION: These findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives. FUNDING: WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Germany Federal Ministry of Health, National Health and Medical Research Council Australia, Centre for Research Excellence in Cervical Cancer Control, Canadian Institute of Health Research, Compute Canada, and Fonds de recherche du Québec-Santé.


Asunto(s)
Neoplasias del Cuello Uterino/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Países en Desarrollo , Detección Precóz del Cáncer/métodos , Femenino , Humanos , Renta , Lactante , Recién Nacido , Tamizaje Masivo/métodos , Persona de Mediana Edad , Modelos Biológicos , Mortalidad/tendencias , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Vacunación/métodos , Organización Mundial de la Salud , Adulto Joven
6.
Elife ; 92020 02 24.
Artículo en Inglés | MEDLINE | ID: mdl-32091395

RESUMEN

Traveller screening is being used to limit further spread of COVID-19 following its recent emergence, and symptom screening has become a ubiquitous tool in the global response. Previously, we developed a mathematical model to understand factors governing the effectiveness of traveller screening to prevent spread of emerging pathogens (Gostic et al., 2015). Here, we estimate the impact of different screening programs given current knowledge of key COVID-19 life history and epidemiological parameters. Even under best-case assumptions, we estimate that screening will miss more than half of infected people. Breaking down the factors leading to screening successes and failures, we find that most cases missed by screening are fundamentally undetectable, because they have not yet developed symptoms and are unaware they were exposed. Our work underscores the need for measures to limit transmission by individuals who become ill after being missed by a screening program. These findings can support evidence-based policy to combat the spread of COVID-19, and prospective planning to mitigate future emerging pathogens.


Asunto(s)
Infecciones Asintomáticas , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Tamizaje Masivo , Neumonía Viral/diagnóstico , Viaje , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades , Humanos , Control de Infecciones , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Medición de Riesgo
7.
Anticancer Res ; 40(2): 575-581, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32014898

RESUMEN

Previous randomized studies suggest that fecal occult blood test (FOBT) screening can reduce mortality from colorectal cancer (CRC). Our aim was to review the current status of FOBTs in CRC screening. FOB is measured using either the traditional guaiac-based tests or more recently introduced fecal immunochemical tests (FITs). FITs have several advantages over guaiac-based FOBTs, including higher sensitivity and specificity, resulting in improved clinical performance and higher efficiency. Another advantage in population screening according to European Guidelines for quality assurance in CRC screening is that FITs can be automated and user can adjust the cut-off at which a positive result is reported. In population-based screening, all those testing positively with any FOBT should be referred for colonoscopy. Conclusion: Although a plethora of FOBTs are available on the market, relatively few have been extensively tested for clinical sensitivity and specificity in CRC screening. Current data imply that new FITs have superior test characteristics as compared with guaiac-based FOBTs. The latest development in the field is represented by the proteomic-based tests that may further reduce false-negative rates in CRC screening. Simple stool sample preservation and automatic analysis are other important issues in population-based screening for CRC.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Heces/citología , Inmunoquímica/métodos , Tamizaje Masivo/métodos , Detección Precóz del Cáncer , Humanos , Sangre Oculta
9.
Epidemiol Psychiatr Sci ; 29: e85, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31915097

RESUMEN

Given the high prevalence (30-35%) of psychosocial and psychiatric morbidity amongst cancer patients in any phase of the disease trajectory, screening for emotional problems and disorders has become mandatory in oncology. As a process, screening begins at the entry to the cancer care system and continues at clinically meaningful times, periodically during active cancer care, or when clinically indicated. The goal is to facilitate proper referral to psychosocial oncology specialists for more specific assessment and care, as well as treatment and evaluation of the response, according to the implementation of distress management guidelines. In this editorial, we will provide a non-exhaustive overview of relevant protocols, with particular reference to the National Comprehensive Cancer Network (NCCN) Distress Management in Oncology Guidelines, and review the challenges and the problems in implementing screening, and the assessment and management of psychosocial and psychiatric problems in cancer centres and community care.


Asunto(s)
Tamizaje Masivo/métodos , Neoplasias/psicología , Estrés Psicológico/diagnóstico , Humanos , Salud Mental , Neoplasias/complicaciones , Guías de Práctica Clínica como Asunto , Calidad de Vida/psicología , Estrés Psicológico/etiología , Estrés Psicológico/terapia
10.
Z Gastroenterol ; 58(1): 30-38, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31931538

RESUMEN

BACKGROUND: In order to reduce alcohol relapse after liver transplantation (LT), the German national guidelines for waiting-list maintenance and organ allocation demand a minimum 6-month period of alcohol abstinence pre-LT, confirmed by measuring urinary ethyl glucuronide (uEtG). METHODS: Between January 2015 and June 2016, uEtG was measured at least once in 339 cirrhotic patients with an indication for LT at the University Medical Center Mainz. uEtG was measured with an enzyme-linked immunosorbent assay (ELISA) screening test (cutoff value: 500 µg/L). For uEtG values ≥ 500 µg/L, liquid chromatography-mass spectrometry (LC-MS/MS) was performed as a confirmatory assay. Data were collected prospectively in a transplant database. RESULTS: Of the 339 potential liver transplant candidates, uEtG was negative in 86.4 %. Most patients were male (64.3 %), with an average age of 56.42 ±â€Š10.1 years. In the multivariate analysis, mean corpuscular volume (p = 0.001), urinary creatinine (p = 0.001), gamma-glutamyl transferase (p = 0.001), and hemoglobin (p = 0.003) were significantly associated with a positive uEtG test result. The sensitivity of the ELISA screening test was 100 % for uEtG values > 2000 µg/L, as confirmed by LC-MS/MS. CONCLUSION: uEtG is an effective parameter to reveal alcohol consumption by patients on the waiting list for LT. The sensitivity of the ELISA is excellent for uEtG values > 2000 µg/L, for which LC-MS/MS confirmation could be omitted.


Asunto(s)
Consumo de Bebidas Alcohólicas , Glucuronatos/orina , Cirrosis Hepática Alcohólica/cirugía , Cirrosis Hepática Alcohólica/orina , Trasplante de Hígado , Tamizaje Masivo/métodos , Anciano , Biomarcadores/orina , Cromatografía Liquida , Estudios de Cohortes , Ensayo de Inmunoadsorción Enzimática , Etanol/sangre , Etanol/orina , Femenino , Humanos , Cirrosis Hepática Alcohólica/diagnóstico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Espectrometría de Masas en Tándem , Listas de Espera
13.
Medicine (Baltimore) ; 99(2): e18525, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914025

RESUMEN

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.


Asunto(s)
Epidemias/prevención & control , Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Tamizaje Masivo/métodos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Encuestas de Atención de la Salud/métodos , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Consultorios Médicos/estadística & datos numéricos , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
14.
Medicine (Baltimore) ; 99(2): e18741, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914092

RESUMEN

Inappropriate care for patients with cognitive dysfunction in the hospital could worsen quality of care and medical service satisfaction.All elderly participants were recruited from acute wards of 5 departments in an university hospital. They were administered the Chinese version of Ascertain Dementia 8 (AD8) at admission and the Nursing Service Satisfaction Questionnaire before discharge.A total of 345 participants completed the study. There were 91 (26.4%) participants with AD8 ≥ 2, the cut-off value of high risk of dementia. The prevalence was much higher than prior community-based reports. The Nursing Service Satisfaction Score was significantly lower in AD8 ≥ 2 than in AD8 < 2 (56.99 ±â€Š0.94 vs 60.55 ±â€Š0.48, P < .01).Using AD8 in hospital-based screening might be more efficient than in the community in terms of cost-effectiveness due to higher positive rate and easier approach to diagnostic facilities. AD8 ≥ 2 is also an indicator to identify care dissatisfaction among inpatients. By identifying patients with cognitive dysfunction, such as its related communication barriers, care systems could be tailored for more friendly services.


Asunto(s)
Demencia/diagnóstico , Demencia/enfermería , Tamizaje Masivo/métodos , Satisfacción del Paciente , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Demencia/epidemiología , Femenino , Humanos , Masculino , Tamizaje Masivo/economía , Tamizaje Masivo/normas , Persona de Mediana Edad , Calidad de la Atención de Salud/normas , Reproducibilidad de los Resultados
15.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31995677

RESUMEN

OBJECTIVE: A nominal group process followed by a modified Delphi method was used to survey expert opinions on best practices for tardive dyskinesia (TD) screening, diagnosis, and treatment and to identify areas lacking in clinical evidence. PARTICIPANTS: A steering committee of 11 TD experts met in nominal group format to prioritize questions to be addressed and identify core bibliographic materials and criteria for survey panelists. Of 60 invited experts, 29 (23 psychiatrists and 6 neurologists) agreed to participate. EVIDENCE: A targeted literature search of PubMed (search term: tardive dyskinesia) and recommendations of the steering committee were used to generate core bibliographic material. Inclusion criteria were as follows: (1) review articles, meta-analyses, guidelines, or clinical trials; (2) publication in English between 2007 and 2017; (3) > 3 pages in length; and (4) publication in key clinical journals with impact factors ≥ 2.0. Of 29 references that met these criteria, 18 achieved a score ≥ 5 (calculated as the number of steering committee votes multiplied by journal impact factor and number of citations divided by years since publication) and were included. CONSENSUS PROCESS: Two survey rounds were conducted anonymously through electronic media from November 2017 to January 2018; responses were collected, collated, and analyzed. Respondent agreement was defined a priori as unanimous (100%), consensus (75%-99%), or majority (50%-74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥ 4 ("agree completely" or "agree"). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with < 25% agreement and > 75% agreement (unless feedback suggested further investigation). CONCLUSIONS: Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential.


Asunto(s)
Antipsicóticos , Antagonistas Colinérgicos , Tamizaje Masivo/métodos , Administración del Tratamiento Farmacológico/normas , Examen Neurológico/métodos , Discinesia Tardía , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Antagonistas Colinérgicos/administración & dosificación , Antagonistas Colinérgicos/efectos adversos , Consenso , Técnica Delfos , Monitoreo de Drogas/métodos , Monitoreo de Drogas/normas , Humanos , Guías de Práctica Clínica como Asunto , Medición de Riesgo/métodos , Discinesia Tardía/inducido químicamente , Discinesia Tardía/diagnóstico , Discinesia Tardía/terapia , Proteínas de Transporte Vesicular de Monoaminas/antagonistas & inhibidores
16.
Klin Padiatr ; 232(1): 20-28, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31569262

RESUMEN

OBJECTIVE: The prevalence and follow-up of the clinical real-world data focussing on existing or risk of malnutrition in a tertiary hospital general paediatric ward including 4 months of follow-up was assessed. METHODS: Measurements included anthropometric measurements, a nutrition interview and an extended version of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP). R Studio 3.4.2 was used for statistical analysis and diagnosing malnutrition by calculating height-for-age (HfAz)-, weight-for-age (WfAz)- weight-for-height (WfHz)-, body mass index-for-age (BMIz) and mid-upper-arm circumference (MUACz)-z-scores with the childsds package with KIGGS and WHO for reference. RESULTS: The median age of the 68 participants was 8.00 (4.00-13.00) years. The main reasons for hospitalisation in the tertiary centre were gastrointestinal diseases, diabetes mellitus and rheumatic diseases. At admission 39.71%, at the second examination 36.00% and at the third examination 45.90% were malnourished. 68% of inpatients lost weight during their clinical stay, of which 35.29% lost more than 3% of their initial weight. However, changes were not significantly different. CONCLUSION: A significant share of patients was diagnosed to be malnourished at admission, the majority of patients lost weight during their hospital stay and the 4 months after admission. Due to the far reaching consequences for patients, doctors, health insurance and politics, the early diagnosis and treatment of malnutrition should take greater account in the future.


Asunto(s)
Desnutrición/diagnóstico , Tamizaje Masivo/métodos , Hipernutrición/diagnóstico , Pediatría , Adolescente , Índice de Masa Corporal , Peso Corporal , Niño , Estudios de Seguimiento , Humanos , Desnutrición/epidemiología , Hipernutrición/epidemiología , Prevalencia
17.
Gastroenterology ; 158(2): 322-340, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31586566

RESUMEN

Researchers have discovered associations between elements of the intestinal microbiome (including specific microbes, signaling pathways, and microbiota-related metabolites) and risk of colorectal cancer (CRC). However, it is unclear whether changes in the intestinal microbiome contribute to the development of sporadic CRC or result from it. Changes in the intestinal microbiome can mediate or modify the effects of environmental factors on risk of CRC. Factors that affect risk of CRC also affect the intestinal microbiome, including overweight and obesity; physical activity; and dietary intake of fiber, whole grains, and red and processed meat. These factors alter microbiome structure and function, along with the metabolic and immune pathways that mediate CRC development. We review epidemiologic and laboratory evidence for the influence of the microbiome, diet, and environmental factors on CRC incidence and outcomes. Based on these data, features of the intestinal microbiome might be used for CRC screening and modified for chemoprevention and treatment. Integrated prospective studies are urgently needed to investigate these strategies.


Asunto(s)
Neoplasias Colorrectales/epidemiología , Ejercicio/fisiología , Conducta Alimentaria/fisiología , Microbioma Gastrointestinal/fisiología , Bacterias/aislamiento & purificación , Colon/microbiología , Colon/patología , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etiología , Neoplasias Colorrectales/prevención & control , Detección Precóz del Cáncer/métodos , Humanos , Incidencia , Mucosa Intestinal/microbiología , Mucosa Intestinal/patología , Tamizaje Masivo/métodos , Factores de Riesgo
18.
J Surg Res ; 246: 160-169, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31586890

RESUMEN

BACKGROUND: A major roadblock to reducing the mortality of colorectal cancer (CRC) is prompt detection and treatment, and a simple blood test is likely to have higher compliance than all of the current methods. The purpose of this report is to examine the utility of a mass spectrometry-based blood serum protein biomarker test for detection of CRC. MATERIALS AND METHODS: Blood was drawn from individuals (n = 213) before colonoscopy or from patients with nonmetastatic CRC (n = 50) before surgery. Proteins were isolated from the serum of patients using targeted liquid chromatography-tandem mass spectrometry. We designed a machine-learning statistical model to assess these proteins. RESULTS: When considered individually, over 70% of the selected biomarkers showed significance by Mann-Whitney testing for distinguishing cancer-bearing cases from cancer-free cases. Using machine-learning methods, peptides derived from epidermal growth factor receptor and leucine-rich alpha-2-glycoprotein 1 were consistently identified as highly predictive for detecting CRC from cancer-free cases. A five-marker panel consisting of leucine-rich alpha-2-glycoprotein 1, epidermal growth factor receptor, inter-alpha-trypsin inhibitor heavy-chain family member 4, hemopexin, and superoxide dismutase 3 performed the best with 70% specificity at over 89% sensitivity (area under the curve = 0.86) in the validation set. For distinguishing regional from localized cancers, cross-validation within the training set showed that a panel of four proteins consisting of CD44 molecule, GC-vitamin D-binding protein, C-reactive protein, and inter-alpha-trypsin inhibitor heavy-chain family member 3 yielded the highest performance (area under the curve = 0.75). CONCLUSIONS: The minimally invasive blood biomarker panels identified here could serve as screening/detection alternatives for CRC in a human population and potentially useful for staging of existing cancer.


Asunto(s)
Biomarcadores de Tumor/sangre , Neoplasias Colorrectales/diagnóstico , Detección Precóz del Cáncer/métodos , Metástasis Linfática/diagnóstico , Tamizaje Masivo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Colectomía , Colonoscopía , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Estudios Transversales , Estudios de Factibilidad , Femenino , Humanos , Metástasis Linfática/patología , Masculino , Espectrometría de Masas/métodos , Persona de Mediana Edad , Estadificación de Neoplasias , Proyectos Piloto , Estudios Prospectivos , Curva ROC
19.
Int J Cancer ; 146(6): 1503-1513, 2020 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-31162856

RESUMEN

In 2011, the U.S. National Lung Cancer Screening Trial (NLST) reported a 20% reduction of lung cancer mortality after regular screening by low-dose computed tomography (LDCT), as compared to X-ray screening. The introduction of lung cancer screening programs in Europe awaits confirmation of these first findings from European trials that started in parallel with the NLST. The German Lung cancer Screening Intervention (LUSI) is a randomized trial among 4,052 long-term smokers, 50-69 years of age, recruited from the general population, comparing five annual rounds of LDCT screening (screening arm; n = 2,029 participants) with a control arm (n = 2,023) followed by annual postal questionnaire inquiries. Data on lung cancer incidence and mortality and vital status were collected from hospitals or office-based physicians, cancer registries, population registers and health offices. Over an average observation time of 8.8 years after randomization, the hazard ratio for lung cancer mortality was 0.74 (95% CI: 0.46-1.19; p = 0.21) among men and women combined. Modeling by sex, however showed a statistically significant reduction in lung cancer mortality among women (HR = 0.31 [95% CI: 0.10-0.96], p = 0.04), but not among men (HR = 0.94 [95% CI: 0.54-1.61], p = 0.81) screened by LDCT (pheterogeneity = 0.09). Findings from LUSI are in line with those from other trials, including NLST, that suggest a stronger reduction of lung cancer mortality after LDCT screening among women as compared to men. This heterogeneity could be the result of different relative counts of lung tumor subtypes occurring in men and women.


Asunto(s)
Detección Precóz del Cáncer/métodos , Neoplasias Pulmonares/epidemiología , Tamizaje Masivo/métodos , Mortalidad/tendencias , Tomografía Computarizada por Rayos X , Anciano , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Incidencia , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores Sexuales , Fumar/efectos adversos , Análisis de Supervivencia
20.
Gut ; 69(2): 311-316, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31040168

RESUMEN

OBJECTIVE: The impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists' sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence. DESIGN: We defined the 'rate of advanced adenoma on the target population' (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50-69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50-74 year old subjects and the cumulative AA-TAP. RESULTS: In 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013-2014 and those in 2003-2004 (p=0.009). CONCLUSION: The AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Adenoma/diagnóstico , Adenoma/epidemiología , Anciano , Colonoscopía , Detección Precóz del Cáncer/métodos , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Sangre Oculta , Cooperación del Paciente/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos
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