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2.
PLoS Comput Biol ; 17(3): e1008688, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33690626

RESUMEN

Outbreaks of SARS-CoV-2 are threatening the health care systems of several countries around the world. The initial control of SARS-CoV-2 epidemics relied on non-pharmaceutical interventions, such as social distancing, teleworking, mouth masks and contact tracing. However, as pre-symptomatic transmission remains an important driver of the epidemic, contact tracing efforts struggle to fully control SARS-CoV-2 epidemics. Therefore, in this work, we investigate to what extent the use of universal testing, i.e., an approach in which we screen the entire population, can be utilized to mitigate this epidemic. To this end, we rely on PCR test pooling of individuals that belong to the same households, to allow for a universal testing procedure that is feasible with the limited testing capacity. We evaluate two isolation strategies: on the one hand pool isolation, where we isolate all individuals that belong to a positive PCR test pool, and on the other hand individual isolation, where we determine which of the individuals that belong to the positive PCR pool are positive, through an additional testing step. We evaluate this universal testing approach in the STRIDE individual-based epidemiological model in the context of the Belgian COVID-19 epidemic. As the organisation of universal testing will be challenging, we discuss the different aspects related to sample extraction and PCR testing, to demonstrate the feasibility of universal testing when a decentralized testing approach is used. We show through simulation, that weekly universal testing is able to control the epidemic, even when many of the contact reductions are relieved. Finally, our model shows that the use of universal testing in combination with stringent contact reductions could be considered as a strategy to eradicate the virus.


Asunto(s)
/métodos , /prevención & control , Epidemias/prevención & control , Bélgica/epidemiología , /estadística & datos numéricos , Biología Computacional , Simulación por Computador , Trazado de Contacto/métodos , Trazado de Contacto/estadística & datos numéricos , Trazado de Contacto/tendencias , Reacciones Falso Negativas , Composición Familiar , Estudios de Factibilidad , Humanos , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/tendencias , Modelos Estadísticos , Cuarentena/métodos , Cuarentena/estadística & datos numéricos , Cuarentena/tendencias , Viaje
3.
Diabetes Metab Syndr ; 15(1): 407-413, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33581594

RESUMEN

BACKGROUND AND AIMS: Diabetes and coronavirus disease 2019 (COVID-19) share a bidirectional relationship. Hyperglycemia occurring in the setting of either previously diagnosed or undiagnosed diabetes is known to be associated with poor outcomes. Here, we aim to provide a simple and practical guidance on the diagnosis and management of hyperglycemia in admitted patients with COVID-19. METHODS: The guidance is formulated based on experience of authors and relevant literature on the subject searched using Pubmed. RESULTS: Every patient admitted to a COVID care facility should be investigated for hyperglycemia using a combination of tests including capillary blood glucose, fasting plasma glucose and HbA1c. Oral glucose lowering drugs can be considered in patients with mild COVID illness who have mild hyperglycemia [pre-meal blood glucose of <180 mg/dl (10 mmol/L) and post-meal blood glucose of <250 mg/dl (13.9 mmol/L)] and no contraindication to the use of these agents.. All patients with moderate-severe disease and/or hyperglycemia of greater severity should be initiated on insulin therapy. Hyperglycemia should be aggressively screened for and managed in patients receiving systemic glucocorticoids. CONCLUSION: This document provides a broad overview on the diagnosis and management of hyperglycemia at COVID care facilities and should be useful to a wide range of healthcare personnel involved in care of patients with COVID-19.


Asunto(s)
/diagnóstico , Hospitalización/tendencias , Hiperglucemia/diagnóstico , Hiperglucemia/epidemiología , Tamizaje Masivo/tendencias , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Manejo de la Enfermedad , Humanos , Hiperglucemia/terapia , Hipoglucemiantes/farmacología , Hipoglucemiantes/uso terapéutico , India/epidemiología , Tamizaje Masivo/normas
4.
BMC Med ; 19(1): 50, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33596902

RESUMEN

BACKGROUND: Following implementation of strong containment measures, several countries and regions have low detectable community transmission of COVID-19. We developed an efficient, rapid, and scalable surveillance strategy to detect remaining COVID-19 community cases through exhaustive identification of every active transmission chain. We identified measures to enable early detection and effective management of any reintroduction of transmission once containment measures are lifted to ensure strong containment measures do not require reinstatement. METHODS: We compared efficiency and sensitivity to detect community transmission chains through testing of the following: hospital cases; fever, cough and/or ARI testing at community/primary care; and asymptomatic testing; using surveillance evaluation methods and mathematical modelling, varying testing capacities, reproductive number (R) and weekly cumulative incidence of COVID-19 and non-COVID-19 respiratory symptoms using data from Australia. We assessed system requirements to identify all transmission chains and follow up all cases and primary contacts within each chain, per million population. RESULTS: Assuming 20% of cases are asymptomatic and 30% of symptomatic COVID-19 cases present for testing, with R = 2.2, a median of 14 unrecognised community cases (8 infectious) occur when a transmission chain is identified through hospital surveillance versus 7 unrecognised cases (4 infectious) through community-based surveillance. The 7 unrecognised community upstream cases are estimated to generate a further 55-77 primary contacts requiring follow-up. The unrecognised community cases rise to 10 if 50% of cases are asymptomatic. Screening asymptomatic community members cannot exhaustively identify all cases under any of the scenarios assessed. The most important determinant of testing requirements for symptomatic screening is levels of non-COVID-19 respiratory illness. If 4% of the community have respiratory symptoms, and 1% of those with symptoms have COVID-19, exhaustive symptomatic screening requires approximately 11,600 tests/million population using 1/4 pooling, with 98% of cases detected (2% missed), given 99.9% sensitivity. Even with a drop in sensitivity to 70%, pooling was more effective at detecting cases than individual testing under all scenarios examined. CONCLUSIONS: Screening all acute respiratory disease in the community, in combination with exhaustive and meticulous case and contact identification and management, enables appropriate early detection and elimination of COVID-19 community transmission. An important component is identification, testing, and management of all contacts, including upstream contacts (i.e. potential sources of infection for identified cases, and their related transmission chains). Pooling allows increased case detection when testing capacity is limited, even given reduced test sensitivity. Critical to the effectiveness of all aspects of surveillance is appropriate community engagement, messaging to optimise testing uptake and compliance with other measures.


Asunto(s)
/epidemiología , Vida Independiente/tendencias , Modelos Teóricos , Vigilancia de la Población/métodos , Australia/epidemiología , Número Básico de Reproducción/prevención & control , Diagnóstico Precoz , Estudios de Factibilidad , Hospitalización/tendencias , Humanos , Estudios Longitudinales , Tamizaje Masivo/métodos , Tamizaje Masivo/tendencias
6.
Res Dev Disabil ; 109: 103852, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33465590

RESUMEN

BACKGROUND: Screening and diagnostic assessments tools for autism spectrum disorder (ASD) are important to administer during childhood to facilitate timely entry into intervention services that can promote developmental outcomes across the lifespan. However, assessment services are not always readily available to families, as they require significant time and resources. Currently, in-person screening and diagnostic assessments for ASD are limited due to the COVID-19 pandemic and will continue to be a concern for situations that limit in-person contact. Thus, it is important to expand the modalities in which child assessments are provided, including the use of technology. AIMS: This systematic review aims to identify technologies that screen or assess for ASD in 0-12 year-old children, summarizing the current state of the field and suggesting future directions. METHODS: An electronic database search was conducted to gather relevant articles to synthesize for this review. OUTCOMES AND RESULTS: 16 studies reported use of novel technology to assess children suspected of ASD. CONCLUSIONS AND IMPLICATIONS: Results strongly supported live-video evaluations, video observations, and online or phone methods, but there is a need for research targeting the feasibility of these methods as it applies to the stay-at-home orders required by the pandemic, and other situations that limit clients from seeing providers in-person.


Asunto(s)
Trastorno del Espectro Autista/diagnóstico , Control de Enfermedades Transmisibles/métodos , Tamizaje Masivo , Telemedicina/métodos , /epidemiología , Niño , Humanos , Invenciones , Tamizaje Masivo/métodos , Tamizaje Masivo/tendencias
8.
Arch Osteoporos ; 15(1): 162, 2020 10 16.
Artículo en Inglés | MEDLINE | ID: mdl-33067691

RESUMEN

We examine whether new government criteria designed to reduce overuse of vitamin D testing changed testing rates in Australian women. Although testing initially declined, the reduction was not sustained. Women who had more doctor visits and who had been tested previously were more likely to have vitamin D testing. PURPOSE: Vitamin D testing increased substantially in the 2000s in many countries, particularly in women. Because of concerns about potential over-testing, in 2014, the Australian criteria for subsidised testing were restricted to those at high risk of vitamin D deficiency. We aimed to describe vitamin D testing trends in Australian women (1996 to 2019) and investigate sociodemographic and health factors associated with testing under the new criteria. METHODS: We used joinpoint regression to assess changes in national testing trends in Australian women (aged 15+ years) using universal health insurance system data. Additionally, we investigated the factors associated with vitamin D testing through Poisson regression with robust error variance using survey and linked insurance system data from participants born 1946-51 in the Australian Longitudinal Study on Women's Health (ALSWH). RESULTS: Between 1996 and 2013, vitamin D testing rates increased in all age groups. Rates declined between 2013 and 2016, but increased again between 2016 and 2019. In the ALSWH cohort, a higher likelihood of testing under the new criteria was associated with 12 or more doctor visits per year compared to two or fewer visits per year (relative risk (RR) 1.85; 95% CI 1.61-2.12), and women who had two or more vitamin D tests between 2012 and 2014 compared to no test (RR 1.55; 95% CI 1.48-1.62). CONCLUSION: The introduction of new criteria has not led to sustained declines in testing. High testing rates and repeated testing suggest that over-testing for vitamin D deficiency in Australian women is still occurring.


Asunto(s)
Guías como Asunto , Tamizaje Masivo , Deficiencia de Vitamina D/diagnóstico , Vitamina D , Adolescente , Australia/epidemiología , Femenino , Humanos , Estudios Longitudinales , Tamizaje Masivo/normas , Tamizaje Masivo/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Embarazo , Vitamina D/sangre , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/etiología , Vitaminas
9.
J Diabetes Res ; 2020: 9036847, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33123599

RESUMEN

Recently, telemedicine has become remarkably important, due to increased deployment and development of digital technologies. National and international guidelines should consider its inclusion in their updates. During the COVID-19 pandemic, mandatory social distancing and the lack of effective treatments has made telemedicine the safest interactive system between patients, both infected and uninfected, and clinicians. A few potential evidence-based scenarios for the application of telemedicine have been hypothesized. In particular, its use in diabetes and complication monitoring has been remarkably increasing, due to the high risk of poor prognosis. New evidence and technological improvements in telemedicine application in diabetic retinopathy (DR) have demonstrated efficacy and usefulness in screening. Moreover, despite an initial increase for devices and training costs, teleophthalmology demonstrated a good cost-to-efficacy ratio; however, no national screening program has yet focused on DR prevention and diagnosis. Lack of data during the COVID-19 pandemic strongly limits the possibility of tracing the real management of the disease, which is only conceivable from past evidence in normal conditions. The pandemic further stressed the importance of remote monitoring. However, the deployment of device and digital application used to increase screening of individuals and monitor progression of retinal disease needs to be easily accessible to general practitioners.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/terapia , Pandemias , Neumonía Viral/epidemiología , Telemedicina , Betacoronavirus/fisiología , Análisis Costo-Beneficio , Retinopatía Diabética/epidemiología , Humanos , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Tamizaje Masivo/organización & administración , Tamizaje Masivo/tendencias , Oftalmología/economía , Oftalmología/métodos , Oftalmología/organización & administración , Oftalmología/tendencias , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/normas , Telemedicina/tendencias
10.
In Vivo ; 34(5): 3047-3053, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32871851

RESUMEN

BACKGROUND/AIM: Coronavirus disease is spreading worldwide. Due to fast transmission and high fatality rate drastic emergency restrictions were issued. During the lockdown, only urgent medical services are guaranteed. All non-urgent services, as breast cancer (BC) screening, are temporarily suspended. The potential of breast cancer screening programs in increasing the survival rate and decreasing the mortality rate has been widely confirmed. Suspension could lead to worse outcomes for breast cancer patients. Our study aimed to analyse the data and provide estimates regarding the temporary BC screening suspension. PATIENTS AND METHODS: Data regarding breast cancer and respective screening programs were achieved through literature research and analysis. RESULTS: Considering three different scenarios with respect to the lockdown's impact on breast cancer screening, we estimate that approximately 10,000 patients could have a missed diagnosis during these 3 months. Considering a 6-month period, as suggested by the Imperial college model, the number of patients who will not receive a diagnosis will rise to 16,000. CONCLUSION: Breast cancer screening should be resumed as soon as possible in order to avoid further breast cancer missed diagnosis and reduce the impact of delayed diagnosis.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Infecciones por Coronavirus/epidemiología , Detección Precoz del Cáncer , Tamizaje Masivo/tendencias , Neumonía Viral/epidemiología , Anciano , Betacoronavirus/patogenicidad , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Femenino , Humanos , Mamografía , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/virología
12.
PLoS Med ; 17(8): e1003233, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32797047

RESUMEN

BACKGROUND: Protecting the health of refugees and other migrant populations in the United States is key to ensuring successful resettlement. Therefore, to identify and address health concerns early, the US Centers for Disease Control and Prevention (CDC) recommends a domestic medical examination (screening for infectious and noninfectious diseases/conditions) shortly after arrival in the US. However, because refugee/migrant populations often have differing health patterns from one another and the US population, the collection and analysis of health information is key to developing population-specific clinical guidelines to guide the care of resettled individuals. Yet little is known regarding the health status of Cubans resettling in the US. Among the tens of thousands of Cuban migrants who have resettled in the US, some applied as refugees in Cuba, some applied for parole (a term used to indicate temporary US admission status for urgent humanitarian reasons or reasons of public benefit under US immigration law) in Cuba, and others applied for parole status after crossing the border. These groups were eligible for US government benefits to help them resettle, including a domestic medical examination. We reviewed health differences found in these examinations of those who were determined to be refugees or parolees in Cuba and those who were given parole status after arrival. METHODS AND FINDINGS: We conducted a retrospective cross-sectional analysis of the Texas Department of State Health Services database. Cubans who arrived from 2010 to 2015 and received a domestic medical examination in Texas were included. Those granted refugee/parolee status in Cuba were listed in federal databases for US-bound refugees/parolees; those who were paroled after arrival were not listed. Overall, 2,189 (20%) obtained either refugee or parolee status in Cuba, and 8,709 (80%) received parolee status after arrival. Approximately 62% of those who received parolee status after arrival at the border were male, compared with 49% of those who obtained prior refugee/parolee status in Cuba. Approximately one-half (45%) of those paroled after arrival were 19-34 years old (versus 26% among those who obtained refugee/parolee status in Cuba). Separate models were created for each screening indicator as the outcome, with entry route as the main exposure variable. Crude and adjusted prevalence ratios were estimated using PROC GENMOD procedures in SAS 9.4. Individuals paroled after arrival were less likely to screen positive for parasitic infections (9.6% versus 12.2%; adjusted prevalence ratio: 0.79, 0.71-0.88) and elevated blood lead levels (children ≤16 years old, 5.2% versus 12.3%; adjusted prevalence ratio: 0.42, 0.28-0.63). Limitations include potential disease misclassification, missing clinical information, and cross-sectional nature. CONCLUSIONS: Within-country variations in health status are often not examined in refugee populations, yet they are critical to understand granular health trends. Results suggests that the health profiles of Cuban Americans in Texas differed by entry route. This information could assist in developing targeted screenings and health interventions.


Asunto(s)
Estado de Salud , Hispanoamericanos , Tamizaje Masivo/tendencias , Migrantes , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Texas/epidemiología , Adulto Joven
13.
Neurology ; 95(3): e239-e246, 2020 07 21.
Artículo en Inglés | MEDLINE | ID: mdl-32601123

RESUMEN

OBJECTIVE: To determine whether systematic screening for adverse effects of antiepileptic drugs (AEDs) reduces toxicity burden and improves health-related quality of life in patients with epilepsy. METHODS: Consecutive patients with uncontrolled seizures aged ≥16 years and a high Adverse Event Profile (AEP) score were randomized to 2 groups and followed up for 18 months at 11 referral centers. AEP scores were made available to treating physicians at all visits in the intervention group, but not in the control group. Co-primary endpoints were changes in AEP scores and Quality of Life Inventory for Epilepsy-31 (QOLIE-31) scores. RESULTS: Of 809 enrolled patients able to complete the AEP questionnaire, 222 had AEP scores ≥45 and were randomized to the intervention (n = 111) or control group (n = 111). A total of 206 patients completed the 18-month follow-up. Compared with baseline, AEP scores decreased on average by 7.2% at 6 months, 12.1% at 12 months, and 13.8% at 18 months in the intervention group (p < 0.0001), and by 7.7% at 6 months, 9.2% at 12 months, and 12.0% at 18 months in controls (p < 0.0001). QOLIE-31 scores also improved from baseline to final visit, with a mean 20.7% increase in the intervention group and a mean 24.9% increase in the control group (p < 0.0001). However, there were no statistically significant differences in outcomes between groups for the 2 co-primary variables. CONCLUSIONS: Contrary to findings from a previous study, systematic screening for adverse effects of AEDs using AEP scores did not lead to a reduced burden of toxicity over usual physician treatment. ITALIAN MEDICINES AGENCY AIFA IDENTIFIER: FARM52K2WM_003. CLINICALTRIALSGOV IDENTIFIER: NCT03939507 (registered retrospectively in 2019; the study was conducted during the 2006-2009 period and registration of clinical trials was not a widely established practice when this study was initiated). CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that the additional collection of formal questionnaires regarding adverse effects of AEDs does not reduce toxicity burden over usual physician treatment.


Asunto(s)
Anticonvulsivantes/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Epilepsia/tratamiento farmacológico , Tamizaje Masivo/métodos , Adolescente , Adulto , Anciano , Epilepsia/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Tamizaje Masivo/tendencias , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
14.
Adv Respir Med ; 88(3): 173-175, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32706099

RESUMEN

As of May 10, 2020, the United States of America (USA) has 1,367,079 cases of SARS CoV-2 and 80,773 deaths associated with the disease. New York alone has more than 333,000 cases and nearly 21,271 deaths. As we are trying to reopen our economies, the biggest risk we face is a surge in the immediate cases of new infections. The second wave of infection in the fall has also been predicted. As per the Center for Disease Control and Prevention's (CDC) latest data set, among the dead from SARS COV-2 in the USA, 80% were 65 years or older. Despite lower percentages of people living in nursing homes and the fact that they represented only 11% of total cases of SARS CoV-2 cases, the maximum death rate has been seen there. A staggering 27,700 people died in long-term facilities in the USA as per the database by the New York Times. These deaths accounted for one-third of the deaths related to SARS CoV-2, making it the most intensively hurt group of al. lThe ground reality is that unfortunately, even now, most of these facilities do not have enough tests that can stop the outbreak. We suggest special targeting of residents of long-term care facilities, and the HCPs involved in these facilities to stop the spread of SARS CoV-2. Extreme measures including the highest testing numbers should be allocated to these facilities and rigorous Infection control measures should be undertaken so that the SARS-CoV-2 virus does not enter and infect the patients in these facilities and if it does, it is limited to the facility.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Tamizaje Masivo/tendencias , Neumonía Viral/epidemiología , Prevención Primaria/tendencias , Adulto , Anciano , Centers for Disease Control and Prevention, U.S. , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Guías de Práctica Clínica como Asunto , Estados Unidos
15.
Public Health Rep ; 135(4): 501-510, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32579861

RESUMEN

OBJECTIVES: HIV testing identifies persons living with HIV and can lead to treatment, decreased risk behaviors, and reduced transmission. The objective of our study was to describe state-level trends in HIV testing in the general US adult population aged 18-64 years, for both ever tested for HIV and tested for HIV in the previous 12 months. METHODS: Using 2011-2017 Behavioral Risk Factor Surveillance System data, we estimated the percentage of the state population, plus the District of Columbia, aged 18-64 years ever tested for HIV and tested for HIV in the previous 12 months. The 50 states and the District of Columbia were grouped according to the estimated prevalence of HIV in 2011. We used orthogonal contrasts to calculate P values for linear trends. RESULTS: The percentage of the population ever tested for HIV increased significantly in 23 states during 2011-2017, whereas the percentage tested for HIV in the previous 12 months increased significantly in 8 states. In 2017, the mean percentage ever tested for HIV in states with a high prevalence of HIV was 8.6 percentage points higher than the mean percentage in states with a low prevalence of HIV (48.5% vs 39.9%); the mean increase in the percentage ever tested was highest (11.4%) in states with a low prevalence of HIV. CONCLUSION: Enhanced efforts by states to make HIV testing simple, accessible, and routine are needed to reduce the number of persons who are not aware of their infection.


Asunto(s)
Sistema de Vigilancia de Factor de Riesgo Conductual , Infecciones por VIH/epidemiología , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/tendencias , Adolescente , Adulto , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
16.
MMWR Morb Mortal Wkly Rep ; 69(25): 776-780, 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32584800

RESUMEN

In 2019, the U.S. Department of Health and Human Services launched the Ending the HIV Epidemic: A Plan for America (EHE) initiative to end the U.S. human immunodeficiency virus (HIV) epidemic by 2030. A critical component of the EHE initiative involves early diagnosis of HIV infection, along with prevention of new transmissions, treatment of infections, and response to HIV outbreaks (1). HIV testing is the first step in identifying persons with HIV infection who need to be engaged in treatment and care as well as persons with a negative HIV test result and who are at high risk for infection and can benefit from HIV preexposure prophylaxis (PrEP) and other prevention services. These opportunities are often missed for persons receiving clinical services in ambulatory care settings (2). Data from the 2009-2016 National Ambulatory Medical Care Survey (NAMCS) and 2009-2017 National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed to estimate trends in HIV testing at visits by males and nonpregnant females to physician offices, community health centers (CHCs), and emergency departments (EDs) in the United States. HIV tests were performed at 0.63% of 516 million visits to physician offices, 2.65% of 37 million visits to CHCs, and 0.55% of 87 million visits to EDs. The percentage of visits with an HIV test did not increase at visits to physician offices during 2009-2016, increased at visits to CHC physicians during 2009-2014, and increased slightly at visits to EDs during 2009-2017. All adolescents and adults should have at least one HIV test in their lifetime (3). Strategies that reduce clinical barriers to HIV testing (e.g., clinical decision supports that use information in electronic health records [EHRs] to order an HIV test for persons who require one or standing orders for routine opt-out testing) are needed to increase HIV testing at ambulatory care visits.


Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Infecciones por VIH/prevención & control , Tamizaje Masivo/tendencias , Consultorios Médicos/estadística & datos numéricos , Adolescente , Adulto , Femenino , Infecciones por VIH/epidemiología , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
18.
BMC Infect Dis ; 20(1): 338, 2020 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-32398032

RESUMEN

BACKGROUND: Peer education has become a strategy for health promotion among high-risk groups for HIV infection worldwide. However, the extent to which peer education could have an impact on HIV prevention or the long-term effect of this impact is still unknown. This study thus quantifies the impact of peer education over time among high-risk HIV groups globally. METHOD: Following the PRISMA guidelines, a systematic review and meta-analysis was used to assess the effects and duration of peer education. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on high-risk HIV groups were reviewed. Pooled effects were calculated and the sources of heterogeneity were explored using meta-regression and subgroup analysis. RESULTS: A total of 60 articles with 96,484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among overall high risk groups (OR: 0.64; 95%CI: 0.47-0.87). Peer education can promote HIV testing (OR = 3.19; 95%CI:2.13,4.79) and condom use (OR = 2.66, 95% CI: 2.11-3.36) while reduce equipment sharing (OR = 0.50; 95%CI:0.33,0.75) and unprotected sex (OR = 0.82; 95%CI: 0.72-0.94). Time trend analysis revealed that peer education had a consistent effect on behavior change for over 24 months and the different follow-up times were a source of heterogeneity. CONCLUSION: Our study shows that peer education is an effective tool with long-term impact for behavior change among high-risk HIV groups worldwide. Low and middle-income countries are encouraged to conduct large-scale peer education.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/psicología , Promoción de la Salud/métodos , Grupo Paritario , Adolescente , Adulto , Condones , Femenino , Humanos , Masculino , Tamizaje Masivo/tendencias , Asunción de Riesgos , Sexo Inseguro/prevención & control , Adulto Joven
19.
PLoS One ; 15(5): e0232883, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32407342

RESUMEN

BACKGROUND: HIV testing contributes to the prevention and control of the HIV epidemic in the general population. South Africa has made strides to improve HIV testing towards reaching the first of the UNAIDS 90-90-90 targets by 2020. However, to date no nationally representative analysis has examined temporal trends and factors associated with HIV testing among youth and adults in the country. AIM: This study aimed to examine the trends and associations with ever having tested for HIV among youth and adults aged 15 years and older in South Africa using the 2005, 2008, 2012 and 2017 nationally representative population-based household surveys. METHODS: The analysis of the data collected used multi-stage stratified cluster randomised cross-sectional design. P-trend chi-squared test was used to identify any significant changes over the four study periods. Bivariate and multivariate logistic regression analysis was conducted to determine factors associated with HIV testing in each of the survey periods. RESULTS: Ever having tested for HIV increased substantially from 2005 (30.6%, n = 16 112), 2008 (50.4%, n = 13 084), 2012 (65.5%, n = 26 381), to 2017 (75.2%, n = 23 190). Those aged 50 years and older were significantly less likely to ever have tested for HIV than those aged 25-49 years. Those residing in rural areas were significantly less likely to have tested for HIV as compared to people from urban areas. There was a change in HIV testing among race groups with Whites, Coloureds and Indian/Asians testing more in 2005 and 2008 and Black Africans in 2017. Marriage, education and employment were significantly associated with increased likelihood of ever testing for HIV. Those who provided a blood specimen for laboratory HIV testing in the survey rounds and were found to have tested positive were more likely to have ever tested for HIV previously. CONCLUSION: The results show that overall there has been an increase in ever having an HIV test in the South African population over time. The findings also suggest that for South Africa to close the testing gap and reach the first of the UNAIDS 90-90-90 targets by 2020, targeted programmes aimed at increasing access and utilization of HIV testing in young people, males, those not married, the less educated, unemployed and those residing in rural areas of South Africa should be prioritised.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , VIH/aislamiento & purificación , Conductas Relacionadas con la Salud , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/tendencias , Adolescente , Adulto , Conducta , Estudios Transversales , Composición Familiar , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Incidencia , Masculino , Tamizaje Masivo/psicología , Persona de Mediana Edad , Aceptación de la Atención de Salud , Prevalencia , Factores Socioeconómicos , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Adulto Joven
20.
BMJ ; 369: m1570, 2020 05 27.
Artículo en Inglés | MEDLINE | ID: mdl-32461218

RESUMEN

OBJECTIVE: To evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening. DESIGN: Population based observational cohort study. SETTING: Data from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service. PARTICIPANTS: All 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014. MAIN OUTCOME MEASURES: Incident invasive breast cancer and death from breast cancer. RESULTS: By December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer. CONCLUSIONS: To date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.


Asunto(s)
Neoplasias de la Mama/mortalidad , Carcinoma Intraductal no Infiltrante/patología , Tamizaje Masivo/estadística & datos numéricos , Anciano , Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/epidemiología , Carcinoma Intraductal no Infiltrante/radioterapia , Carcinoma Intraductal no Infiltrante/terapia , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Mamografía/métodos , Márgenes de Escisión , Tamizaje Masivo/tendencias , Mastectomía/métodos , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Mortalidad/tendencias , Riesgo
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