Methods for Using Race and Ethnicity in Prediction Models for Lung Cancer Screening Eligibility.

Importance: Using race and ethnicity in clinical prediction models can reduce or inadvertently increase racial and ethnic disparities in medical decisions. Objective: To compare eligibility for lung cancer screening in a contemporary representative US population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity vs a counterfactual eligibility approach that recalculates life expectancy for racial and ethnic minority individuals using the same covariates but substitutes White race and uses the higher predicted life expectancy, ensuring that historically underserved groups are not penalized. Design, Setting, and Participants: The 2 submodels composing LYFS-CT NoRace were refit and externally validated without race and ethnicity: the lung cancer death submodel in participants of a large clinical trial (recruited 1993-2001; followed up until December 31, 2009) who ever smoked (n = 39 180) and the all-cause mortality submodel in the National Health Interview Survey (NHIS) 1997-2001 participants aged 40 to 80 years who ever smoked (n = 74 842, followed up until December 31, 2006). Screening eligibility was examined in NHIS 2015-2018 participants aged 50 to 80 years who ever smoked. Data were analyzed from June 2021 to September 2022. Exposure: Including and removing race and ethnicity (African American, Asian American, Hispanic American, White) in each LYFS-CT submodel. Main Outcomes and Measures: By race and ethnicity: calibration of the LYFS-CT NoRace model and the counterfactual approach (ratio of expected to observed [E/O] outcomes), US individuals eligible for screening, predicted days of life gained from screening by LYFS-CT. Results: The NHIS 2015-2018 included 25 601 individuals aged 50 to 80 years who ever smoked (2769 African American, 649 Asian American, 1855 Hispanic American, and 20 328 White individuals). Removing race and ethnicity from the submodels underestimated lung cancer death risk (expected/observed [E/O], 0.72; 95% CI, 0.52-1.00) and all-cause mortality (E/O, 0.90; 95% CI, 0.86-0.94) in African American individuals. It also overestimated mortality in Hispanic American (E/O, 1.08, 95% CI, 1.00-1.16) and Asian American individuals (E/O, 1.14, 95% CI, 1.01-1.30). Consequently, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while reducing African American eligibility by 39%. Using LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without reducing eligibility for Hispanic American and Asian American individuals. Conclusions and Relevance: In this study, removing race and ethnicity miscalibrated LYFS-CT submodels and substantially reduced African American eligibility for lung cancer screening. Under counterfactual eligibility, no one became ineligible, and African American eligibility increased, demonstrating the potential for maintaining model accuracy while reducing disparities.

Mental disorders, participation, and trajectories in the Danish colorectal cancer programme: a population-based cohort study.

BACKGROUND: People with mental disorders exhibit increased mortality due to colorectal cancer, despite having a similar incidence to the general population. We aimed to evaluate the extent to which people with mental disorders participate in organised colorectal cancer screening. METHODS: We conducted a population-based cohort study of all Danish residents aged 50-74 years who were invited to undergo biennial faecal immunochemical testing between March 1, 2014, and Sept 30, 2018. We used national registry data from all first-time invitees. The primary endpoint was participation within 90 days of invitation. We calculated the proportion who participated and assessed their screening results and adherence to and completeness of follow-up colonoscopy according to their history of mental disorders, classified as none, mild or moderate, or severe. We computed crude and adjusted participation differences in percentage points and participation ratios using the pseudo-observations method. FINDINGS: Of 2 036 704 people who were invited, we included 2 036 352 in the final cohort, of whom 1 008 045 (49·5%) were men and 1 028 307 (50·5%) were women, with a mean age of 60·7 years (SD 8·3, range 49-78). Data on ethnicity were not collected. Compared with people with no mental disorders, the adjusted analysis showed lower participation among people with mild or moderate mental disorders (men: participation difference -4·4 percentage points [95% CI -4·7 to -4·1]; women: -3·8 percentage points [-4·1 to -3·6]) and severe mental disorders (men: participation difference -13·8 percentage points [-14·3 to -13·3]; women: -15·4 percentage points [-15·8 to -14·9]). People with mental disorders had a higher proportion of positive faecal immunochemical test results, lower adherence to colonoscopy, and more incomplete colonoscopies than people without mental disorders. INTERPRETATION: People with mental disorders were less likely to participate in colorectal cancer screening than those without these disorders. Patients with mental disorders could benefit from support or encouragement from their general practitioner or mental health-care facility to participate in cancer screening. Potential interventions should consider type of mental disorder, as needs might differ. FUNDING: Danish Cancer Society, Danish Health Foundation.

Examining the Implementation of Health-Related Social Need (HRSN) Screenings at a Pediatric Community Health Center.

INTRODUCTION: Social determinants of health (SDoH) influence health outcomes and screening for health-related social needs (HRSN) is a recommended pediatric practice. In 2018, Denver Health and Hospitals (DH) implemented the Accountable Health Communities (AHC) model under the Centers for Medicare and Medicaid Services (CMS) and began using the AHC HRSN screening tool during selected well child visits (WCVs) at a DH Federally Qualified Health Center (FQHC). The current evaluation aimed to examine the program implementation and identify key lessons learned to inform the expansion of HRSN screening and referral to other populations and health systems. METHODS: Patients who completed a WCV between June 1, 2020 and December 31, 2021 (N = 13 750) were evaluated. Frequencies and proportions were used to describe patient characteristics of those that had a WCV, were screened, and received resource information. Multivariable logistic regression models with odds ratios (OR) and 95% confidence intervals (CI) were used to determine the association between patient characteristics and completing HRSN screening and provision of resource information. RESULTS: The screening tool was completed by 80% (n = 11 004) of caregivers bringing children to a WCV at the DH Westside Clinic, with over one-third (34.8%; n = 3830) reporting >1 social need. Food insecurity was the most common concern (22.3%; n = 2458). Non-English, non-Spanish (NENS) speakers were less likely to be screened (OR 0.43, 95% CI 0.33, 0.57) and less likely to report a social need (OR 0.59, 95% CI 0.42, 0.82) than speakers of English, after adjusting for age, race/ethnicity, and health insurance. CONCLUSIONS: A high rate of screening indicates feasibility of administering HRSN screenings for pediatric patients in a busy FQHC. More than a third of patients reported one or more social needs, underscoring the importance to identity these needs and the opportunity to offer personalized resources. Comparatively lower rates of screening and potential underreporting among NENS may be indicative of the availability and acceptability of current translation procedures as well as how the tool translates linguistically and culturally. Our experience highlights the need to partner with community organizations and involve patients and families to ensure SDoH screening and care navigation is part of culturally-appropriate patient-centered care.

Urbanicity, Income, and Mammography-Use Disparities Among American Indian Women.

INTRODUCTION: Reported breast cancer screening among American Indian women is consistently below that of White women. The last claims-based trends were from 1991 to 2001. This study updates mammography trends for American Indian women and examines the impact of race, urbanicity, and income on long-term mammography use. METHODS: This was a multi-year (2005-2019), retrospective study of women aged 40-89 years using a 5% sample of Medicare fee-for-service beneficiaries residing in Arizona, California, New Mexico, Oklahoma, and Washington. This study used multivariable logistic regression to examine the impact of urbanicity and income on receiving mammography for American Indian women compared with that for White women. Analyses were conducted in 2022. RESULTS: Overall, annual age-adjusted mammography use declined from 205 per 1,000 in 2005 to 165 per 1,000 in 2019. The slope of these declines was significantly steeper (difference = -2.41, p<0.001) for White women (-3.06) than for American Indian women (-0.65). Mammography-use odds across all urbanicity categories were less for American Indian women than for White women compared with those of their respective metropolitan counterparts (e.g., rural: 0.96, 95% CI=0.77, 1.20 for American Indian women and 1.47, 99% CI=1.39, 1.57 for White women). Although residing in higher-income communities was not associated with mammography use for American Indian women, it was 31% higher for White women (OR=1.31, 99% CI=1.28, 1.34). CONCLUSIONS: The disparity in annual age-adjusted mammography use between American Indian and White women narrowed between 2005 and 2019. However, the association of urbanicity and community income on mammography use differs substantially between American Indian and White women. Policies to reduce disparities need to consider these differences.

Podcast POEMs (BVS APS): Testes de rastreamento e tuberculose pulmonar em crianças. Epidemio: Estudos transversais

Iniciando dezembro com mais um episódio do Podcast POEMS da BVS APS, vou falar para vocês sobre uma revisão sistemática da Cochrane avaliando a qualidade de alguns testes de rastreio para detecção da tuberculose ativa em crianças. Como a revisão se utilizou de estudos transversais e coortes, vou falar um pouco sobre aqueles primeiros, já que sobre coortes eu já dei uma pincelada no episódio nove da primeira temporada.

Understanding the role of access in Hispanic cancer screening disparities.

BACKGROUND: Hispanic populations in the United States experience numerous barriers to care access. It is unclear how cancer screening disparities between Hispanic and non-Hispanic White individuals are explained by access to care, including having a usual source of care and health insurance coverage. METHODS: A secondary analysis of the 2019 National Health Interview Survey was conducted and included respondents who were sex- and age-eligible for cervical (n = 8316), breast (n = 6025), or colorectal cancer screening (n = 11,313). The proportion of ever screened and up to date for each screening type was compared.  Regression models evaluated whether controlling for reporting a usual source of care and type of health insurance (public, private, none) attenuated disparities between Hispanics and non-Hispanic White individuals. RESULTS: Hispanic individuals were less likely than non-Hispanic White individuals to be up to date with cervical cancer screening (71.6% vs. 74.6%) and colorectal cancer screening (52.9% vs. 70.3%), but up-to-date screening was similar for breast cancer (78.8% vs. 76.3%). Hispanic individuals (vs. non-Hispanic White) were less likely to have a usual source of care (77.9% vs. 86.0%) and more likely to be uninsured (23.6% vs. 7.1%). In regressions, insurance fully attenuated cervical cancer disparities. Controlling for both usual source of care and insurance type explained approximately half of the colorectal cancer screening disparities (adjusted risk difference: -8.3 [-11.2 to -4.8]). CONCLUSION: Addressing the high rate of uninsurance among Hispanic individuals could mitigate cancer screening disparities. Future research should build on the relative successes of breast cancer screening and investigate additional barriers for colorectal cancer screening. PLAIN LANGUAGE SUMMARY: This study uses data from a national survey to compare cancer screening use those who identify as Hispanic with those who identify as non-Hispanic White. Those who identify as Hispanic are much less likely to be up to date with colorectal cancer screening than those who identify as non-Hispanic White, slightly less likely to be up to date on cervical cancer screening, and similarly likely to receive breast cancer screening. Improving insurance coverage is important for health equity, as is further exploring what drives higher use of breast cancer screening and lower use of colorectal cancer screening.

Improving domestic violence screening practices in the emergency department: an Australian perspective.

INTRODUCTION: Domestic violence (DV) is a major cause of morbidity worldwide. The ED is a location recommended for opportunistic screening. However, screening within EDs remains irregular. OBJECTIVE: To examine intrinsic and extrinsic barriers to routine screening in Australian EDs, while describing actions taken after identification of DV. METHODS: Emergency clinicians at nine public hospitals participated in an anonymous online survey. Factor analysis was performed to identify principal components around attitudes and beliefs towards screening. RESULTS: In total, 496 emergency clinicians participated. Universal screening was uncommon; less than 2% of respondents reported screening all adults or all women. Although willing, nearly half (45%) reported not knowing how to screen. High patient load and no single rooms were 'very or severely limiting' for 88% of respondents, respectively, while 24/7 social work and interpreter services, and online/written DV protocols were top enablers. Factor analysis identified four distinct intrinsic belief components: (1) screening is not futile and could be done in ED, (2) screening will not cause harm, (3) there is a duty to screen and (4) I am willing to screen. CONCLUSION: This study describes a culture of Queensland ED clinicians that believe DV screening in ED is important and interventions are effective. Most ED clinicians are willing to screen. In this setting, availability of social work and interpreter services are important mitigating resources. Clinician education focusing on duty to screen, coupled with a built-in screening tool, and e-links to a local management protocol may improve the uptake of screening and subsequently increase detection.

Prevalence of diabetic retinopathy and reduced vision among indigenous Australians in the nurse-led integrated Diabetes Education and Eye Screening study in a regional primary care clinic.

BACKGROUND: Nationally, Indigenous Australians are more likely to have diabetes and diabetic retinopathy (DR) than non-Indigenous Australians. However, the prevalence of DR and impaired vision in regional primary care settings is unclear. AIM: To describe the prevalence and severity of DR and presenting vision level among Indigenous Australian adults with diabetes attending an indigenous primary care clinic in regional Australia. METHODS: Participants underwent nurse-led retinal imaging and DR screening with offsite retinal grading in the integrated Diabetes Education and Eye Screening (iDEES) project implemented at a regional indigenous primary healthcare setting between January 2018 and March 2020. RESULTS: Of 172 eligible adults, 135 (79%) were recruited and screened for DR and vision level. The median age was 56 (46-67) years, 130 (96%) had type 2 diabetes of median (interquartile range) duration 6 (2-12) years and 48 (36%) were male. Images from 132 (97.8%) participants were gradable. DR was present in 38 (29%) participants: mild non-proliferative in 33 (25%); moderate-severe in three (2.5%); and sight-threatening two (1.5%). Subnormal presenting vision was present in 33%. CONCLUSIONS: A nurse-led model of care integrating diabetes eye screening and education at a single visit was successful at recruiting Indigenous Australian adults with diabetes, screening their vision and acquiring a high rate of gradable images. Even for a short duration of known diabetes, DR was present in three out of 10 patients screened.

Avaliação de indicadores de monitoramento do rastreamento do câncer de mama na população do sexo feminino atendida no Sistema Único de Saúde, Brasil, 2018-2019: estudo descritivo / Evaluación de indicadores del tamizaje de cáncer de mama en la población femenina atendida en el Sistema Único de Salud, Brasil, 2018-2019: estudio descriptivo / Evaluation of breast cancer screening indicators in the female population using the National Health System, Brazil, 2018-2019: a descriptive study

Objetivo: analisar indicadores de monitoramento do rastreamento do câncer de mama na população feminina usuária do Sistema Único de Saúde, Brasil, no período 2018-2019. Métodos: estudo descritivo, a partir do Sistema de Informação do Câncer; foram calculados indicadores de rastreamento após relacionamento determinístico das bases de dados de mamografia e histopatologia. Resultados: em 2018, 807.430 mulheres na faixa etária de 50-69 anos foram rastreadas, e dessas, 91% apresentaram resultado benigno, 1,8% provavelmente benigno, 6,7% inconclusivo e 0,5% sugestivo de câncer; a taxa de mamografia positiva foi de 9,0%; estimou- -se indicação de biópsia para 1,6% das mulheres, resultado maligno para 33,9% delas, e taxa de confirmação de câncer de 5,4 por 1 mil mulheres. Conclusão: identificou-se elevada perda de seguimento das lesões benignas; a taxa de mamografias positivas foi inferior ao parâmetro internacional; contudo, a taxa de detecção de câncer foi adequada, e o percentual de mamografias inconclusivas, aceitável.

Objetivo: analizar indicadores del tamizaje de cáncer de mama en población femenina atendida por Sistema Único de Salud Brasileño, de 2018-2019. Métodos: estudio descriptivo basado en Sistema de Información del Cáncer (Siscan). Los indicadores de detección se calcularon después de vinculación determinista de bases de datos de mamografía e histopatología. Resultados: en 2018, 807.430 mujeres de 50-69 años examinaram cáncer de mama. De estos, 91% tuvo resultado benigno, 1,8% probablemente benigno, 6,7% resultado no concluyente y 0,5% sugestivo de cáncer. La tasa de mamografías positivas fue 9,0%. Se estimó indicación de biopsia en 1,6% de las mujeres, resultado maligno en 33,9% y tasa de confirmación de cáncer de 5,4 por 1.000 mujeres. Conclusión: se identificó alta pérdida de seguimiento de las lesiones benignas. La tasa de mamografías positivas fue inferior al parámetro internacional, pero la tasa de detección de cáncer fue adecuada y el porcentaje de mamografías no concluyentes aceptable.

Objetive: to analyze breast cancer screening monitoring indicators in the female population using the Brazilian National Health System, from 2018 to 2019. Methods: this was a descriptive study based on Cancer Information System (SISCAN) data; screening indicators were calculated following deterministic linkage of the mammography and histopathology databases. Results: in 2018, 807,430 women aged 50 to 69 years were screened for breast cancer, 91% of whom had a benign result, 1.8% probably benign, 6.7% inconclusive results and 0.5% results suggestive of cancer; the positive mammogram rate was 9.0%; biopsy was estimated to be indicated for 1.6% of the women, 33.9% of whom had a malignant result, and the cancer confirmation rate was 5.4 per 1,000 women. Conclusion: high benign lesion loss to follow-up was identified; the positive mammogram rate was lower than the international parameter, but the cancer detection rate was adequate and the percentage of inconclusive mammograms was acceptable.

Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention.

Background: Around 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model. Methods: The Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods. Intervention: BBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI. Results: Two years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period. Conclusions: Implementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.

Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey, 2005-2020.

OBJECTIVES: Since 2002, the Korean government has provided breast cancer screening as part of the National Cancer Screening Program. This study reported trends in the screening rate among Korean women from 2005 to 2020, including organized and opportunistic screening for breast cancer. METHODS: Data from the Korean National Cancer Screening Survey, an annual cross-sectional nationwide survey, were collected using a structured questionnaire between 2005 and 2020. The study population included 23,702 women aged 40-74 years with no history of cancer. We estimated the screening rate based on the current recommendation of biennial mammographic screening for breast cancer. In addition, a joinpoint trend analysis was performed for breast cancer screening rates among various subgroups. RESULTS: In 2020, the breast cancer screening rate was 63.5%, reflecting an annual increase of 7.72% (95% confidence interval 5.53 to 9.95) between 2005 and 2012, followed by non-significant trends thereafter. In particular, a significant decrease in the breast cancer screening rate was observed in the subgroups aged 50-59 years old, with 12-15 years of education, and living in rural areas. CONCLUSIONS: Although there has been substantial improvement in breast cancer screening rates in Korean women, the trend has flattened in recent years. Therefore, continual efforts are required to identify subgroups with unmet needs and solve barriers to the uptake of breast cancer screening.

Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death.

BACKGROUND: Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. METHODS: We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. RESULTS: Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04). CONCLUSIONS: In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. (Funded by the Research Council of Norway and others; NordICC ClinicalTrials.gov number, NCT00883792.).

Dados do programa do câncer do colo do útero na pandemia Covid-19 / Data from the cervical cancer program in the Covid-19 pandemic / Datos del programa de cáncer cervical sobre la pandemia Covid-19

O câncer do colo do útero é considerado um dos cânceres mais comuns entre mulheres, representando um grande problema de saúde global, sendo a quarta causa mais frequente de morte por câncer na população feminina. Mediante a um estudo quantitativo e retrospectivo de dados pré- analíticos e analíticos das requisições do exame citopatológico do colo do útero, objetivou-se avaliar os resultados de exames citopatológicos de mulheres usuárias do SUS de um município do oeste do Paraná, realizados no período antes da pandemia COVID-19, de março de 2019 a fevereiro de 2020 e durante a pandemia COVID-19, de março de 2020 a fevereiro de 2021, dos exames citopatológicos alterados. Foram utilizadas as requisições de exames citopatológicos do Programa Nacional de Controle do CCU e o sistema eletrônico SISCAN como ferramentas de busca. Dentre os resultados, totalizaram-se 20.425 amostras processadas no período antes da pandemia, sendo 19.908 consideradas satisfatórias para análise oncótica, onde 1.148 (5,76%) amostras apresentaram alteração citológica. No período da pandemia, totalizaram-se 11.315 amostras processadas, sendo 11.149 amostras satisfatórias para análise oncótica, das quais 721 (6,47%) apresentaram alteração citológica. No período da pandemia, o estudo demostra que metade da população de mulheres usuárias do SUS em um município do oeste do Paraná encontra-se na faixa etária da população-alvo preconizada pelo MS, sendo que a maioria delas realizou seu exame citopatológico por motivo de rastreamento. Contudo, mesmo com a interrupção dos atendimentos eletivos, as mulheres continuaram realizando seus exames citopatológicos, sendo elucidado um discreto aumento de 0,71% das alterações citológicas no período da pandemia, quando comparado ao período anterior, demonstrando o cenário deste programa na pandemia COVID-19.

Cervical cancer is considered one of the most common cancers among women, representing a major global health problem, being the fourth most frequent cause of cancer death in the female population. Through a quantitative and retrospective study of pre-analytical and analytical data of requests for cervical cytopathological examination, the objective was to evaluate the results of cytopathological examinations of women using the SUS in a city in western Paraná, carried out in the period before during the COVID-19 pandemic, from March 2019 to February 2020, and during the COVID-19 pandemic, from March 2020 to February 2021, from the altered cytopathological exams. Requests for cytopathological exams from the National Control Program of the CCU and the SISCAN electronic system were used as search tools. Among the results, a total of 20.425 samples were processed in the period before the pandemic, 19.908 of which were considered satisfactory for oncotic analysis, where 1.148 (5,76%) samples showed cytological alterations. During the pandemic period, a total of 11.315 samples were processed, of which 11.149 were satisfactory for oncotic analysis, of which 721 (6,47%) showed cytological alterations. During the pandemic period, the study shows that half of the population of women using the SUS in a municipality in western Paraná is in the target population age group recommended by the MS, and most of them underwent their cytopathological examination due to tracking. However, even with the interruption of elective care, women continued to perform their cytopathological exams, with a slight increase of 0,71% in cytological changes during the pandemic period, when compared to the previous period, demonstrating the scenario of this program in the COVID-19 pandemic.

El cáncer de cuello uterino se considera uno de los cánceres más comunes entre las mujeres, representando un importante problema de salud mundial, siendo la cuarta causa más frecuente de muerte por cáncer en la población femenina. Mediante el estudio cuantitativo y retrospectivo de los datos preanalíticos y analíticos de los requisitos del examen citopatológico del útero, se evaluaron los resultados de los exámenes citopatológicos de las usuarias del SUS de un municipio del oeste de Paraná, realizados en el período anterior a la pandemia COVID-19, de marzo de 2019 a febrero de 2020, y durante la pandemia COVID-19, de marzo de 2020 a febrero de 2021, de los exámenes citopatológicos alterados. Se utilizaron como herramientas de búsqueda las requisiciones de exámenes citopatológicos del Programa Nacional de Control de UCC y el sistema electrónico SISCAN. Entre los resultados, un total de 20.425 muestras fueron procesadas en el período anterior a la pandemia, de las cuales 19.908 fueron consideradas satisfactorias para el análisis oncológico, donde 1.148 (5,76%) muestras presentaron alteración citológica. En el periodo de la pandemia, se procesaron un total de 11.315 muestras, de las cuales 11.149 fueron satisfactorias para el análisis oncológico, y 721 (6,47%) presentaron alteraciones citológicas. En el período de la pandemia, el estudio demuestra que la mitad de la población de mujeres usuarias del SUS en una ciudad del oeste de Paraná está en la franja de edad de la población objetivo recomendada por el MS, y la mayoría de ellas se sometió a un examen citopatológico con fines de cribado. Sin embargo, aún con la interrupción de la atención electiva, las mujeres continuaron realizando sus exámenes citopatológicos, siendo dilucidado un leve aumento de 0,71% de alteraciones citológicas en el período pandémico, cuando comparado con el período anterior, demostrando el escenario de este programa en la pandemia COVID-19.

Adherencia a las recomendaciones de prevención de la sepsis neonatal temprana asociada a la colonización por Streptococcus agalactiae en una institución de referencia en Bogotá, Colombia, 2019 / Adherence to recommendations for preventing early neonatal sepsis associated with Streptococcus agalactiae colonization in a referral center in Bogotá, Colombia, 2019

RESUMEN Objetivos: Evaluar la adherencia a las recomendaciones de tamización para la prevención de la sepsis neonatal, describir la prevalencia de colonización por estreptococo del grupo B y los desenlaces perinatales asociados a la colonización por esta bacteria. Materiales y métodos: Estudio de cohorte retrospectiva que incluyó gestantes a término y sus recién nacidos, en una clínica universitaria privada de alta complejidad en Bogotá, entre el 1 de julio y el 31 de diciembre de 2019. Se evaluó la adherencia a la tamización y a la profilaxis antibiótica intraparto para las gestantes colonizadas con EGB, la prevalencia de colonización y los desenlaces perinatales adversos tempranos. Resultados: Se incluyeron 1.928 mujeres. La adherencia a la tamización fue de 68,0 % (IC 95 %: 66-70,1), a la administración de antibióticos intraparto de 87,9 % (IC 95 %: 87,8 -88), pero hubo uso no indicado de antibióticos en 14,7 % de mujeres para una adherencia final a profilaxis antibiótica de 86,3 %. La prevalencia de colonización por EGB fue 12,5 % (IC 95 %: 10,7-14,3), la incidencia de hospitalización neonatal fue de 27,5 % (IC 95 %: 16,3-33,7); no hubo casos de mortalidad ni sepsis neonatal temprana atribuibles al estado de tamización, colonización o profilaxis antibiótica para EGB. Conclusiones: Se requieren nuevos estudios en otras instituciones para determinar la adherencia a esta guía, en especial en aquellas regiones que atienden usuarias adscritas al régimen subsidiado, con cobertura a la población más vulnerable, así como nuevos estudios poblacionales de prevalencia de EGB y costo-efectividad de la estrategia de tamización universal en comparación con la profilaxis antibiótica basada en factores de riesgo.

ABSTRACT Objectives: To assess adherence to screening recommendations for the prevention of neonatal sepsis, and describe the prevalence of colonization by Group B streptococcus (GBS) as well as the perinatal outcomes associated with colonization by this bacterium. Material and methods: Retrospective cohort study that included pregnant women at term and their newborns, seen at a private high-complexity clinic in Bogota, between July 1 and December 31, 2019. Adherence to screening and intrapartum antibiotic prophylaxis in pregnant women colonized with group B streptococcus, as well as the prevalence of colonization and early adverse perinatal outcomes were assessed. Results: Overall, 1928 women were included. Adherence to screening was 68.0 % (95 % CI: 66-70.1) and 87.9 % to intrapartum antibiotic administration (95 % CI: 87.8-88); non-indicated use of antibiotics occurred in 14.7 % of the women, for 86.3 % final adherence to antibiotic prophylaxis. The prevalence of GBS colonization was 12.5 % (95 % CI: 10.7-14.3); the incidence of neonatal hospitalization was 27.5 % (95 % CI: 16.3-33.7). There were no cases of mortality or early neonatal sepsis attributable to screening status, colonization or prophylactic antibiotics for GBS. Conclusions: Additional studies in other centers are required in order to determine adherence to this guideline, particularly in those that receive users affiliated to the subsidized regime which covers the most vulnerable population. Also, new population studies of GBS prevalence and cost-effectiveness of universal screening compared to risk factor-based antibiotic prophylaxis are needed.

Producción científica sobre validación y adaptación de instrumentos de tamizaje de la depresión en población peruana / Scientific output on validation and adaptation of depression screening instruments in peruvian population

RESUMEN: El objetivo de la investigación fue describir la producción científica sobre estudios psicométricos de instrumentos de tamizaje para la depresión en población peruana. Para ello, se realizó un estudio descriptivo de la literatura científica en Scopus, Web of Science, PubMed y SciELO, con descriptores para depresión, propiedades psicométricas y Perú. Luego del proceso de revisión se incluyeron 22 estudios. Se encontraron validaciones de instrumentos de tamizaje en adultos mayores, adultos, adultos con depresión, mujeres adultas, mujeres embarazadas, profesionales de salud, estudiantes universitarios, estudiantes de secundaria y niños. El Patient Health Questionnaire (PHQ-9) fue el instrumento más estudiado. A pesar de que los estudios psicométricos cubren la mayoría de las poblaciones, quedan pendientes los pueblos originarios y poblaciones clínicas. El PHQ-9, por sus características, podría implementarse en las políticas de salud mental del Perú.

ABSTRACT The aim of the research was to describe the scientific output of psychometric studies on screening instruments for depression in the Peruvian population. We carried out a descriptive study of the scientific literature in Scopus, Web of Science, PubMed and SciELO, with descriptors for depression, psychometric properties, and Peru. After the review process, we included 22 studies. We found validations of screening instruments for older adults, adults, adults with depression, adult women, pregnant women, health professionals, university students, high school students and children. The Patient Health Questionnaire (PHQ-9) was the most widely used instrument. Psychometric studies cover most populations; however, native people and clinical populations remain to be studied. The PHQ-9, due to its characteristics, could be implemented in mental health policies in Peru.

Comparing pregnancy outcomes between symptomatic and asymptomatic COVID-19 positive unvaccinated women: Multicenter study in Saudi Arabia.

INTRODUCTION: COVID-19 infection in pregnancy ranges from asymptomatic infection to severe disease. However, the maternal and pregnancy outcomes are primarily favorable. Acute Respiratory Illness (ARI) score is a Visual Triage Checklist for Acute Respiratory symptoms created by the ministry of health of Saudi Arabia 12 to screen the patient for acute respiratory infection with MERS-CoV. It has been used during the COVID-19 pandemic to identify suspected cases and place patients in isolation precautions if the score is≥ 4. METHOD: This study is a cross-sectional study of all pregnant women who tested positive for COVID-19 in four medical centers located in four different cities in Saudi Arabia. The study period was from 1/3/2020 until 31/10/2020. Outcomes investigated were the prevalence of COVID infection in pregnant women at the time of delivery. Rate of asymptomatic disease, different maternal and pregnancy outcomes. Women were divided into symptomatic and asymptomatic groups according to the ARI score. The two groups were compared in maternal, perinatal, and neonatal outcomes. Furthermore, the cohort was divided according to maternal age into two groups: women of advanced maternal age ≥ 35 years and younger. The two groups were compared in maternal, perinatal, and neonatal outcomes RESULTS: During the study period, 9573 women gave birth at KAMCs, and 402 pregnant women were identified as COVID positive. Out of all COVID-positive women, only 394 women gave birth at KAMCs. The screening for COVID infection differed between the centers, but the testing was the same by the Nasopharyngeal polymerase chain reaction (PCR) swab. In Riyadh, screening was based on ARI scoring at the beginning of the pandemic. Then, it became universal. In Jeddah, the screening was based on ARI scoring. Any woman who scored four or more was labeled as suspected, and she was tested. Finally, in Madinah and Dammam, the screening was universal throughout the study. The prevalence of COVID-19 infection among women who gave birth at KAMCs was 4.2% (402/9573). (CI 3.8-4.6%). At the time of diagnosis, most women (62%) were asymptomatic. The most common symptoms were cough and shortness of breath. Twenty-two women (5.5%) had Pneumonia, and five women (1.3%) needed admission to Intensive care units (ICU). One woman died due to respiratory failure. When pregnancy outcomes were compared between symptomatic and asymptomatic women, pregnancy in symptomatic women was more likely to be complicated by Abortion (6 versus 2% p-value 0.00), fetal death (3 versus 1.3%), and cesarean delivery (30.8 versus 22.4%, p-value 0.001). COVID-positive pregnant women of advanced maternal age (AMA) were more likely to be symptomatic, have Abortion (5 versus 1%, p-value 0.01), and have Preterm delivery (17 versus 11% p-value 0.01) than younger women. In addition, neonatal death was more common in AMA COVID-positive women than younger (4 versus 0%), regardless of COVID-related symptoms. CONCLUSION: Most of the COVID-infected pregnant women are asymptomatic. Therefore, the ARI scoring system does not help to triage patients. Symptomatic women, especially those older than 35, tend to have a higher maternal and pregnancy complication rate.

Feature selection reveal peripheral blood parameter's changes between COVID-19 infections patients from Brazil and Ecuador.

The investigation of conventional complete blood-count (CBC) data for classifying the SARS-CoV-2 infection status became a topic of interest, particularly as a complementary laboratory tool in developing and third-world countries that financially struggled to test their population. Although hematological parameters in COVID-19-affected individuals from Asian and USA populations are available, there are no descriptions of comparative analyses of CBC findings between COVID-19 positive and negative cases from Latin American countries. In this sense, machine learning techniques have been employed to examine CBC data and aid in screening patients suspected of SARS-CoV-2 infection. In this work, we used machine learning to compare CBC data between two highly genetically distinguished Latin American countries: Brazil and Ecuador. We notice a clear distribution pattern of positive and negative cases between the two countries. Interestingly, almost all red blood cell count parameters were divergent. For males, neutrophils and lymphocytes are distinct between Brazil and Ecuador, while eosinophils are distinguished for females. Finally, neutrophils, lymphocytes, and monocytes displayed a particular distribution for both genders. Therefore, our findings demonstrate that the same set of CBC features relevant to one population is unlikely to apply to another. This is the first study to compare CBC data from two genetically distinct Latin American countries.

Evaluation of the iCARE Nigeria Pilot Intervention Using Social Media and Peer Navigation to Promote HIV Testing and Linkage to Care Among High-Risk Young Men: A Nonrandomized Controlled Trial.

Importance: Nigeria has the fourth-largest HIV epidemic globally, yet high levels of social stigma inhibit HIV testing among Nigerian youths and young men who have sex with men (MSM). Objective: To report pilot data from iCARE Nigeria (Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents), a combination intervention using social media and peer navigation to promote HIV testing and linkage to care among high-risk youths and young men (hereinafter referred to as young men), including predominantly young MSM. Design, Setting, and Participants: This nonrandomized controlled study assessed an organizational and community-level 12-month, preintervention-postintervention pilot trial of a combination intervention designed to increase HIV testing uptake, increase the rate of identified seropositive cases, and improve linkage to care among young men, including MSM, using social media outreach and peer navigation. Data were collected from June 1, 2019, to May 30, 2020. Participants were young men aged 15 to 24 years in the city of Ibadan, Nigeria, and surrounding areas. Frequencies and percentages were examined, and a Fisher exact test was used to evaluate outcomes compared with historical surveillance data. Linkage to care was defined as 2 clinic visits, including HIV confirmation, within 2 months of a positive rapid test result. Intervention: Four peer navigators conducted social media outreach promoting sexual health and guiding individuals to HIV counseling and rapid testing in clinical, community, or home-based settings. Main Outcomes and Measures: Primary outcomes included the number of young men tested for HIV at university-based iCARE catchment clinics or by iCARE peer navigators in the community, the postintervention HIV seroprevalence of these groups, and linkage to care of participants diagnosed with HIV infection. Results: A total of 339 participants underwent testing for HIV (mean [SD] age, 21.7 [1.9] years), with 283 (83.5%) referred through social media. The main referral sources for social media were WhatsApp (124 [43.8%]), Facebook (101 [35.7%]), and Grindr (57 [20.1%]). Regarding testing location, participants chose home (134 [39.5%]), community-based (202 [59.6%]), or clinic (3 [0.9%]) settings. Eighty-six participants reported no prior HIV testing. Thirty-six participants (10.6%) were confirmed as HIV seropositive; among those, 18 (50.0%) reported negative test results within the past year, and 31 (86.1%) were linked to care. In two 6-month follow-up periods, the intervention increased HIV testing by 42% and 31%, respectively, and seroprevalence increased compared with historical trends with odds ratios of 3.37 (95% CI, 1.43-8.02; P = .002) and 2.74 (95% CI, 1.10-7.11; P = .02), respectively. Conclusions and Relevance: These findings suggest that use of iCARE Nigeria was associated with increased HIV testing and linkage to care in a high-risk, difficult-to-reach population, making it a promising combination intervention for young MSM. Trial Registration: isrctn.org Identifier: ISRCTN94590823.

Testing the Accuracy of a Bedside Screening Tool Framework to Clinical Records for Identification of Patients at Risk of Malnutrition in a Rural Setting: An Exploratory Study.

This study aimed to explore the diagnostic accuracy of the Patient-Generated Subjective Global Assessment (PG-SGA) malnutrition risk screening tool when used to score patients based on their electronic medical records (EMR), compared to bedside screening interviews. In-patients at a rural health service were screened at the bedside (n = 50) using the PG-SGA, generating a bedside score. Clinical notes within EMRs were then independently screened by blinded researchers. The accuracy of the EMR score was assessed against the bedside score using area under the receiver operating curve (AUC), sensitivity, and specificity. Participants were 62% female and 32% had conditions associated with malnutrition, with a mean age of 70.6 years (SD 14.9). The EMR score had moderate diagnostic accuracy relative to PG-SGA bedside screen, AUC 0.74 (95% CI: 0.59-0.89). The accuracy, specificity and sensitivity of the EMR score was highest for patients with a score of 7, indicating EMR screen is more likely to detect patients at risk of malnutrition. This exploratory study showed that applying the PG-SGA screening tool to EMRs had enough sensitivity and specificity for identifying patients at risk of malnutrition to warrant further exploration in low-resource settings.

Pattern of breast cancer presentation during the COVID-19 pandemic: results from a cohort study in the UK.

Background: This study aimed to explore the hypothesis that the stage of breast cancer at initial diagnosis in 2020 is more advanced compared with 2019. Methods: Tumor, node, metastasis and Union for International Cancer Control (UICC) stages of new breast cancer diagnoses at the Bucks Breast Unit from May 2019 to October 2020 were reviewed. A p < 0.05 was considered significant. Results: Average UICC stage increased from 1a in 2019 to 2a in 2020 (p < 0.01). Excluding cancers detected through screening, UICC stage still increased from 1b in 2019 to 2a in 2020 (p = 0.0184). There was a significant increase in the percentage of node-positive patients (p = 0.0063) and patients with metastatic disease (p = 0.0295) on initial presentation. Conclusion: Overall, patients presented with higher UICC stages and more node-positive and metastatic disease on initial diagnosis in 2020 compared with 2019.

Plain language summary During the coronavirus disease 2019 pandemic, breast cancer screening services were halted across the UK. Patients were also encouraged to stay home and to seek medical attention only in an emergency. The authors hypothesized that this might have led to delays in presentation to breast cancer clinics or missed cancer diagnoses. While patients are at home with undiagnosed breast cancer, the cancer can grow and spread. The authors evaluated whether these delays in presentation led to patients presenting with more advanced breast cancers when they finally presented to a breast cancer clinic. The authors collected data on breast cancer stages for a patient group in 2020 (during the height of the pandemic) and compared them with a patient group in 2019. The authors' results did indeed show that patients presented, on average, with more advanced breast cancers in 2020 compared with 2019.