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1.
MMWR Morb Mortal Wkly Rep ; 69(4): 97-102, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31999684

RESUMO

Identifying persons with human immunodeficiency virus (HIV) infection who are unaware of their status and linking them to care are critical steps in achieving viral suppression and reducing the risk for transmitting HIV (1). In 2017, 43% of new diagnoses of HIV infection were among persons who self-identify as blacks or African Americans (blacks) (2), who represent 13% of the U.S. population (3). Fewer blacks, compared with whites, were linked to HIV medical care within 90 days of diagnosis, retained in care, or virally suppressed (4). Ending the HIV Epidemic (EHE) is an initiative intended to reduce new HIV infections by 90% from 2020 to 2030 (5). EHE's Phase 1 is focused on 50 jurisdictions* that accounted for >50% of new diagnoses during 2016-2017 and seven states† with disproportionate HIV prevalence in rural areas (5). The purpose of this analysis was to examine HIV testing outcomes among blacks in high prevalence EHE jurisdictions, using CDC's 2017 National HIV Prevention Program Monitoring and Evaluation data. Blacks accounted for 43.2% of CDC-funded tests and 49.1% of new diagnoses of HIV infection. Seventy-nine percent of blacks with newly diagnosed HIV infection were linked to HIV medical care within 90 days (below the 2010 National HIV/AIDS Strategy goal of 85%), 71.4% interviewed for partner services, and 81.8% referred to prevention services. To achieve the goals of EHE, HIV prevention programs should focus on locally tailored evidence-based§ testing strategies to enhance and overcome barriers for linkage to and retention in care and reduce onward HIV transmission and HIV-related disparities.


Assuntos
Afro-Americanos/estatística & dados numéricos , Infecções por HIV/etnologia , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Saúde da População Rural/etnologia , Saúde da População Rural/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
2.
Medicine (Baltimore) ; 99(2): e18525, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914025

RESUMO

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.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/epidemiologia , HIV/isolamento & purificação , Programas de Rastreamento/métodos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Pesquisas sobre Serviços de Saúde/métodos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Consultórios Médicos/estatística & dados numéricos , Testes Sorológicos/métodos , Testes Sorológicos/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
3.
Int J Cancer ; 146(3): 810-818, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30980692

RESUMO

Primary prevention through the use of human papillomavirus (HPV) vaccination is expected to impact both cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS). While CIN is well described, less is known about the epidemiology of AIS, a rare cervical precancer. We identified AIS and CIN grade 3 (CIN3) cases through population-based surveillance, and analyzed data on HPV types and incidence trends overall, and among women screened for cervical cancer. From 2008 to 2015, 470 AIS and 6,587 CIN3 cases were identified. The median age of women with AIS was older than those with CIN3 (35 vs. 31 years; p < 0.01). HPV16 was the most frequently detected type in both AIS and CIN3 (57% in AIS; 58% in CIN3), whereas HPV18 was the second most common type in AIS and less common in CIN3 (38% vs. 5%; p < 0.01). AIS lesions were more likely than CIN3 lesions to be positive for high-risk types targeted by the bivalent and quadrivalent vaccines (HPV16/18, 92% vs. 63%; p < 0.01), and 9-valent vaccine (HPV16/18/31/33/45/52/58, 95% vs. 87%; p < 0.01). AIS incidence rates decreased significantly in the 21-24 year age group (annual percent change [APC] overall: -22.1%, 95% CI: -33.9 to -8.2; APC among screened: -16.1%, 95% CI: -28.8 to -1.2), but did not decrease significantly in any older age group. This report on the largest number of genotyped AIS cases to date suggests an important opportunity for vaccine prevention of AIS, and is the first to document a decline in AIS incidence rates among young women during the vaccine era.


Assuntos
Adenocarcinoma in Situ/epidemiologia , Neoplasia Intraepitelial Cervical/epidemiologia , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Adenocarcinoma in Situ/prevenção & controle , Adenocarcinoma in Situ/virologia , Adolescente , Adulto , Fatores Etários , Neoplasia Intraepitelial Cervical/prevenção & controle , Neoplasia Intraepitelial Cervical/virologia , DNA Viral/isolamento & purificação , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Incidência , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/uso terapêutico , Lesões Pré-Cancerosas/prevenção & controle , Lesões Pré-Cancerosas/virologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Adulto Jovem
4.
BMC Infect Dis ; 19(1): 1019, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791253

RESUMO

BACKGROUND: Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany. METHODS: We used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates. RESULTS: Total number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening). CONCLUSIONS: Screening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.


Assuntos
Erradicação de Doenças , Hepatite C/prevenção & controle , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Adulto , Antivirais/economia , Antivirais/uso terapêutico , Estudos de Coortes , Análise Custo-Benefício , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/estatística & dados numéricos , Erradicação de Doenças/economia , Erradicação de Doenças/métodos , Erradicação de Doenças/estatística & dados numéricos , Usuários de Drogas/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Custos de Cuidados de Saúde , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Hepatite C/economia , Hepatite C/epidemiologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Vigilância da População/métodos , Anos de Vida Ajustados por Qualidade de Vida , Minorias Sexuais e de Gênero/estatística & dados numéricos
5.
MMWR Morb Mortal Wkly Rep ; 68(48): 1117-1123, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31805031

RESUMO

BACKGROUND: Approximately 38,000 new human immunodeficiency virus (HIV) infections occur in the United States each year; these infections can be prevented. A proposed national initiative, Ending the HIV Epidemic: A Plan for America, incorporates three strategies (diagnose, treat, and prevent HIV infection) and seeks to leverage testing, treatment, and preexposure prophylaxis (PrEP) to reduce new HIV infections in the United States by at least 90% by 2030. Targets to reach this goal include that at least 95% of persons with HIV receive a diagnosis, 95% of persons with diagnosed HIV infection have a suppressed viral load, and 50% of those at increased risk for acquiring HIV are prescribed PrEP. Using surveillance, pharmacy, and other data, CDC determined the current status of these three initiative strategies. METHODS: CDC analyzed HIV surveillance data to estimate annual number of new HIV infections (2013-2017); estimate the percentage of infections that were diagnosed (2017); and determine the percentage of persons with diagnosed HIV infection with viral load suppression (2017). CDC analyzed surveillance, pharmacy, and other data to estimate PrEP coverage, reported as a percentage and calculated as the number of persons who were prescribed PrEP divided by the estimated number of persons with indications for PrEP. RESULTS: The number of new HIV infections remained stable from 2013 (38,500) to 2017 (37,500) (p = 0.448). In 2017, an estimated 85.8% of infections were diagnosed. Among 854,206 persons with diagnosed HIV infection in 42 jurisdictions with complete reporting of laboratory data, 62.7% had a suppressed viral load. Among an estimated 1.2 million persons with indications for use of PrEP, 18.1% had been prescribed PrEP in 2018. CONCLUSION: Accelerated efforts to diagnose, treat, and prevent HIV infection are needed to achieve the U.S. goal of at least 90% reduction in the number of new HIV infections by 2030.


Assuntos
Infecções por HIV/prevenção & controle , Programas de Rastreamento/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Carga Viral/estatística & dados numéricos , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
6.
Orv Hetil ; 160(49): 1948-1956, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31786940

RESUMO

Introduction: The organized breast and cervical screening programs were implemented in the framework of public health program in Hungary in order to reduce breast cancer mortality by 30% and cervical cancer mortality by 60% in given age groups within 10 years by 2012. Aim: The aim of our study was to conduct a retrospective analysis of mortality and morbidity data and to evaluate the effectiveness of the implemented screening programs. Method: Descriptive statistical analysis was performed by age-standardized mortality and morbidity data between 1980 and 2015 with special regard to the period of 2002-2012. Results: Breast cancer mortality of women aged 45-64 reduced by 28.3%, the incidence reduced by 23.6% and the incidence of in situ carcinoma increased by 242% between 2002 and 2012. Cervical cancer mortality of women aged 25-64 years reduced by 25.5%, the incidence reduced by 21.2%, and the incidence of in situ carcinoma increased by 13.3% during 2002-2012. Conclusion: Although both breast cancer and cervical cancer mortality substantially decreased in Hungary, the decrease in cervical cancer did not reach the target value. Orv Hetil. 2019; 160(49): 1948-1956.


Assuntos
Neoplasias da Mama/mortalidade , Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Hungria/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias do Colo do Útero/diagnóstico
7.
BMC Infect Dis ; 19(1): 1076, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864297

RESUMO

BACKGROUND: HIV voluntary counseling and testing (VCT) is a crucial gateway to all strategies related to care, prevention and treatment of human immunodeficiency virus (HIV) infection. Nevertheless, utilization of voluntary counselling and testing (VCT) service among adults is very low in Ethiopia. The objective of this study is to identify determinants associated with VCT utilization among adult women aged 15-49 in Ethiopia. METHODS: A cross-sectional study was conducted based on data taken from the Ethiopian Demographic Health Survey (EDHS) 2016. Using cluster sampling, 14,369 women aged 15-49 years were selected from all the nine administrative regions and two city administrations. Logistic regression was used to analyze factors associated with HIV VCT utilization. RESULTS: Overall prevalence of ever tested for HIV was 53% (95% CI, 52, 54). Aged 20-44, ever married, being at higher socio economic position (SEP) and having risky sexual behavior were factors which are positively associated with VCT utilization. Being Muslims in urban and protestants in rural were factors significantly and negatively associated with VCT utilization. Those who had stigmatizing attitude both in urban and rural and who had comprehensive knowledge in rural were less likely to utilize VCT service. CONCLUSION: VCT utilization among women in Ethiopia is demonstrating better improvement in recent years. However, stigmatizing attitude continued to be among the major factors, which are negatively affecting VCT uptake among women in Ethiopia. Concerted efforts should be made by all stakeholders to mitigate stigma, improve socio economic inequities and increase awareness on the benefit of VCT in controlling HIV in the society. In this aspect, the role of religious leader, schools, health extension workers and community leaders should not be undermined.


Assuntos
Aconselhamento/estatística & dados numéricos , Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estigma Social , Fatores Socioeconômicos , Adulto Jovem
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1058-1063, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770837

RESUMO

Objective: To explore the screening efficiency of colorectal cancer in urban residents of Kunming, China. Methods: Using the method of cluster sampling, from October 2014 to October 2017, residents of the three jurisdictions of Xishan, Guandu and Chenggong Districts of Kunming city were investigated. The inclusion criteria: (1) resident (for more than 3 years) population of Kunming city aged 40-74 years old; (2) voluntarily participating and receiving colonoscopy; (3) signing informed consent. Based on the Harvard Cancer Risk Index, the questionnaire was built on the consensus of more than 20 years of common cancer epidemiology in China. Through the consensus reached by the multidisciplinary expert panel discussion, a comprehensive evaluation system for cancer risk in China was designed. The high-risk group of colorectal cancer was determined by preliminary screening of the questionnaire, and a free colonoscopy was performed for the appointment to the gastrointestinal endoscopy department of the Yunnan Cancer Hospital. All polypoid lesions and ulcers found by colonoscopy must be biopsied to confirm the diagnosis. χ(2) test or Fisher exact probability method was used to compare the detection of colorectal cancer in 4 groups of 40-49 years old, 50-59 years old, 60-69 years old, and ≥70-years old. Detection of colonoscopy, compliance, pathological examination, pathological diagnosis, and morbidity of colorectal cancer were analyzed. Results: A total of 127 960 people from 40 to 74 years old of urban residents in Kunming city participated in the preliminary screening of the questionnaire, including 59 748 (46.7%) males and 68 212 females (53.3%) with mean age of (53.6±8.6) years old. The 40-49 years old group had the largest number of participants (48 044, 37.5%), followed by the groups of 50-59 years old (42 473, 33.2%), 60-69 years old (34 111, 26.7%), and ≥70 years old (3332, 2.6%). Till October 2017, a total of 14 971 people were screened as at high risk of colorectal cancer, with the high-risk detection rate of 11.7%, and the high-risk detection rate of women was significantly higher than that of men [13.4% (9 109/68 212) vs. 9.8% (5 862/59 748), χ(2)=386.947, P<0.001]. The highest high-risk detection rate was in the 50-59 years group in both gender [men: 11.1% (2202/19 831), women: 15.3% (3034/22 642)]. A total of 3449 people among the high-risk population received colonoscopy examination. The compliance rate of colonoscopy was 23.0% (3449/14 971), and the male compliance rate was 19.8% (1162/5862), which was significantly lower than that of females [25.1% (2287/9109), χ(2)=56.175, P<0.001]. The highest compliance was observed in the 50-59 years group [25.4% (1438/5668)], followed by 40-49 years and 60-69 year group [22.1%(1091/4931) and 22.0%(891/4048), respectively], and the compliance of ≥70 years old group was the lowest [9.0% (29/324)]. Colonoscopy examination revealed 606 cases with lesions, the detection rate of lesions was 17.6%, and the male detection rate was significantly higher than that of females [26.9% (313/1162) vs. 12.8% (293/2287), χ(2)=106.140, P<0.001]. The detection rate of lesions increased with age [40-49, 50-59, 60-69, ≥70: 10.9% (119/1091), 17.5% (252/1438), 25.0% (223/891) and 41.4% (12/29), respectively, χ(2)=79.010, P<0.001]. A total of 584 cases underwent endoscopic excision and pathological diagnosis, and 465 cases (13.5%) of precancerous lesions were detected. The prevalence of precancerous lesions in men was higher than that in women [21.3% (247/1162) vs. 9.5% (218/2287), χ(2)=90.801, P<0.001], the precancerous lesion detection rate increased with age [40-49, 50-59, 60-69, ≥70: 8.0% (87/1091), 14.3% (206/1438), 18.1% (161/891) and 37.9% (11/29); χ(2)=58.109, P<0.001]. A total of 4 patients with colorectal cancer were detected, including 3 males and 1 female. The detection rate of male colorectal cancer was 258.2/100 000, and the female was 43.7/100 000, whose difference was not statistically significant (χ(2)=1.488, P=0.223). There was no significant difference in the detection rate of colorectal cancer among 4 age groups [40-49, 50-59, 60-69, ≥70: 91.7/100 000 (1/1091), 69.5/100 000 (1/1438), 224.5/100 000 (2/891) and 0, respectively, P=0.696]. Conclusions: Screening for colorectal cancer is an important measure to control the onset and death of colorectal cancer. Through the questionnaire risk assessment plus colonoscopy, two-step screening method can improve the screening efficiency and greatly reduce the screening cost.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Adulto , Idoso , China/epidemiologia , Colonoscopia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Medição de Risco , População Urbana
9.
Acta Chir Orthop Traumatol Cech ; 86(5): 324-329, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748106

RESUMO

PURPOSE OF THE STUDY In the Czech Republic a systematic neonatal hip screening has been performed for many decades. Its aim is to prevent, by means of early treatment of hip dysplasia in the newborn period, the development of hip deformities leading to the onset of degenerative hip changes during the adulthood. The study aims to prove the effects of paediatric hip care based on the data analysis of the Czech National Register of Joint Replacement. MATERIAL AND METHODS The National Register of Joint Replacement comprises information on implantation of hip arthroplasties performed over the period of last 15 years, while the screening has been carried out for almost 60 years. An analysis of the patients' data from the register was conducted; the data was sorted by the diagnosis leading to surgery in individual age categories and individual years. The obtained data was correlated with the systems of newborn hip screening at the time when the treated generations of patients were born. RESULTS According to the National Register of Joint Replacement, in the period 2003-2017 a total of 174,515 primary hip joint replacements were performed, 345 total hip arthroplasties (0.19 %) were implanted for complete hip dislocation in dysplasia, 14,139 replacements (8.10%) were performed for postdysplastic hip degeneration. By comparing the periods 2005-2007 and 2015-2017 a decrease almost to a half of the number of implanted endoprostheses for hip dislocation was identified. Moreover, only 8 of 345 dislocated hips in the Register were managed by joint replacement in patients who were born during the systematic screening period. The percentage of endoprostheses implanted for postdysplastic degeneration decreased respectively; in 2005-2007 period 2,692 of 28,525 hip endoprotheses (9.44%) were implanted, whereas in 2015-2017 period 3,285 of 46,228 hips (7.11%) were operated on. This decline is statistically significant (p < 0.001, OR 1.34). DISCUSSION The efficiency and success rate of sonography resulted in Central Europe in such a rapid expansion of neonatal ultrasound hip screening that no comparative studies were carried out to confirm this concept (as is currently requested by evidencebased-medicine). This has later become the source of misunderstanding and subject to criticism primarily in the overseas literature. Those who focus on ultrasound screening feel that conducting prospective randomised studies on (non)treatment in ultrasound detected pathologies is ethically unacceptable today. When seeking another way of confirming the efficiency of universal screening, a detailed analysis of data from the hip joint replacement registry has proven successful. CONCLUSIONS A low number of arthroplasties implanted for hip dislocation in the Czech population is recorded in the National Register of Joint Replacement. This confirms the success of the existing system of neonatal hip screening; the results show that the treatment of hip dislocation in children is successful. The ongoing decline in the share of patients in the population treated by total hip replacement in postdysplastic degeneration has been confirmed. Data evolution will be subject to further research in the upcoming decades, with a positive effect of ultrasound monitoring of treatment to be foreseen. Key words: developmental dysplasia of the hip, screening, register of joint replacements.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Luxação Congênita de Quadril/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adulto , Criança , República Tcheca/epidemiologia , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Humanos , Recém-Nascido , Programas de Rastreamento/estatística & dados numéricos , Estudos Prospectivos , Ultrassonografia
10.
BMC Health Serv Res ; 19(1): 799, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690299

RESUMO

INTRODUCTION: Female Sex workers (FSW) and their clients accounted for 18% of the new HIV infections in 2015/2016. Special community-based HIV testing service delivery models (static facilities, outreaches, and peer to peer mechanism) were designed in 2012 under the Most At Risk Populations Frame work and implemented to increase access and utilization of HIV care services for key populations like female sex workers. However, to date there is no study that has been done to access the preference and uptake of different community-based HIV testing service delivery models used to reach FSW. We assessed preference and uptake of the current community-based HIV testing services delivery models that are used to reach FSW and identified challenges faced during the implementation of the models. METHODS: We conducted a cross-sectional study design using quantitative (interview with the health workers in facilities providing services to female sex workers and interviews with FSWs) and qualitative (interviews with Ministry of Health staff, health workers, district health team members, program staff at different levels involved in delivery of HIV care services, FSWs and political leaders to assess for the enabling environment created to deliver the different community-based HIV testing services to FSWs along the Malaba-Kampala highway. Malaba - Kampala high way is one of the major high ways with many different hot spots where the actual buying and selling of sex takes place. We defined FSWs as any female, who undertakes sexual activity after consenting with a man for money or other items/benefits as an occupation or as a primary source of livelihood irrespective of site of operation within the past six months. We assessed the preference and uptake of different community based HIV testing services delivery model among FSWs based on two indicators, i.e., the proportion of FSWs who had an HIV Counseling and Testing (HCT) in the last 12 months and the proportion of FSWs who were positive and linked to care. RESULTS: Overall, 86% (390/456) of the FSWs had taken an HIV test in the last 12 months. Of the 390 FSWs, 72% (279/390) had used static facilities, 25% (98/390) had used outreaches, and 3.3% (13/390) used peer to peer mechanisms to have an HIV test. Overall, 35% (159/390) of the FSWs who had taken an HIV test were HIV positive. Of the 159, 83% (132/159) were successfully linked into care. Ninety one percent (120/132) reported to have been linked into care by static facilities. Challenges experienced included; lack of trust in the results given during outreaches, failure to offer other testing services including hepatitis B and syphilis during outreaches, inconsistent supply of testing kits, condoms, STI drugs, and unfriendly health services due to the infrastructure and non-trained health workers delivering KP HIV testing services. CONCLUSIONS: Most of the FSWs had HCT services and were linked to care through static facilities. Community-based HIV testing service delivery models are challenged with inconsistent supply of HIV testing commodities and unfriendly services.. We recommended strengthening of all HIV testing community-based HIV testing service deliverymodels by ensuring constant supply of HIV testing/AIDS care commoditiesoffering FSW friendly services, and provision of comprehensive HIV/AIDS health care package.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Profissionais do Sexo/psicologia , Adolescente , Adulto , Serviços de Saúde Comunitária/organização & administração , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Profissionais do Sexo/estatística & dados numéricos , Uganda , Adulto Jovem
11.
Pan Afr Med J ; 33: 213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692660

RESUMO

Introduction: HIV self-testing could add a new approach to scaling up HIV testing with potential of being high impact, low cost, confidential, and empowering for users. Methods: Pregnant women attending antenatal clinics (ANC) and their male partners were recruited in 14 clinics in the eastern and central regions of Kenya and randomly allocated to intervention or control arms at a ratio of 1:1:1. Arm 1 received the standard of care, which involved invitation of the male partner to the clinic through word of mouth, arm 2 received an improved invitation letter, and arm 3 received the same improved letter and, two self-testing kits. Analysis was done using adjusted odds ratios (aOR) at 95% confidence intervals (CI) to calculate and determine effects of HIV self-testing in increasing uptake of male partner testing. Results: A total of 1410 women and 1033 men were recruited; 86% (1217) women and 79% (1107) couples were followed up. In arm 3, over 80% (327) of male partners took HIV test, compared to only 37% (133) in arm 2 and 28% (106) in arm one. There was a statistical significance between arm one and two (p-value=0.01) while arm three was statistically significant compared to arm two (p-value<0.001). Men in arm three were twelve times more likely to test compared to arm one (aOR 12.45 (95% CI 7.35, 21.08)). Conclusion: Giving ANC mothers test kits and improved male invitation letter increased the likelihood of male partner testing by twelve times. These results demonstrate that HIV self-test kits could complement routine HIV testing methods in the general population.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Cuidado Pré-Natal/métodos , Parceiros Sexuais , Adolescente , Adulto , Testes Diagnósticos de Rotina , Feminino , Humanos , Quênia , Masculino , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Adulto Jovem
12.
BMC Public Health ; 19(1): 1441, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31676001

RESUMO

BACKGROUND: Home-based HIV testing and counselling (HB-HTC) is frequently used to increase awareness of HIV status in sub-Saharan Africa. Whereas acceptance of HB-HTC is usually high, testing coverage may remain low due to household members being absent during the home visits. This study assessed whether two consecutive visits, one during the week, one on the weekend, increase coverage. METHODS: The study was a predefined nested-study of the CASCADE-trial protocol and conducted in 62 randomly selected villages and 17 urban areas in Butha-Buthe district, Lesotho. HB-HTC teams visited each village/urban area twice: first during a weekday, followed by a weekend visit to catch-up for household members absent during the week. Primary outcome was HTC coverage after first and second visit. Coverage was defined as all individuals who knew their HIV status out of all household members (present and absent). RESULTS: HB-HTC teams visited 6665 households with 18,286 household members. At first visit, 69.2 and 75.4% of household members were encountered in rural and urban households respectively (p < 0.001) and acceptance for testing was 88.5% in rural and 79.5% in urban areas (p < 0.001), resulting in a coverage of 61.8 and 61.5%, respectively. After catch-up visit, the HTC coverage increased to 71.9% in rural and 69.4% in urban areas. The number of first time testers was higher at the second visit (47% versus 35%, p < 0.001). Direct cost per person tested and per person tested HIV positive were lower during weekdays (10.50 and 335 USD) than during weekends (20 and 1056 USD). CONCLUSIONS: A catch-up visit on weekends increased the proportion of persons knowing their HIV status from 62 to 71% and reached more first-time testers. However, cost per person tested during catch-up visits was nearly twice the cost during first visit. TRIAL REGISTRATION: NCT02692027 (prospectively registered on February 21, 2016).


Assuntos
Infecções por HIV/diagnóstico , Visita Domiciliar , Programas de Rastreamento/estatística & dados numéricos , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Visita Domiciliar/economia , Humanos , Lesoto , Masculino , Estudos Prospectivos
14.
Adv Clin Exp Med ; 28(10): 1377-1383, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31638746

RESUMO

BACKGROUND: Poland is considered among the European countries with an average incidence of cervical cancer (CC; about 3,000-3,500/year) and at the same time with high mortality (5-year survival rate - 55.2%). For this reason, in 2006 Poland introduced a Population-Based Cervical Cancer Prevention and Early Detection Program addressed to women aged 25-59 years, in which a cytological test is carried out every 3 years. OBJECTIVES: The aim of the study was to assess the changes in the curability of CC patients brought by the introduction of the Screening Program in the Lower Silesian voivodeship and to identify the subpopulation of women for whom activities aimed at increasing adherence rates must be intensified. MATERIAL AND METHODS: The 5-year relative survival in 3,586 CC patients from 2000-2010 registered in the Lower Silesian Cancer Registry was analyzed. RESULTS: In the Lower Silesian voivodeship, a 55.1% 5-year survival rate was recorded in 2000-2004 and 70.5% in 2010. The highest increase in 5-year relative survival rates was found in rural communities (from 53.1% in 2000-2004 to 77.7% in 2010) and in Wroclaw (56.8% and 74.2%, respectively). In the study group, the number of patients with invasive CC (C53) detected in the local stage of the disease increased systematically from 61.5% in 2000-2004 to 74.3% in 2010. CONCLUSIONS: The introduction of the population-based screening program improved the curability rate in CC patients in the Lower Silesian voivodeship. In order to maintain the recent positive trends, further education should be continued, and activities aimed at increasing adherence to screening tests should be intensified, especially in urban-rural communities.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cooperação do Paciente/psicologia , Polônia/epidemiologia , Vigilância da População , Avaliação de Programas e Projetos de Saúde , Taxa de Sobrevida/tendências , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
15.
BMC Public Health ; 19(1): 1326, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640639

RESUMO

BACKGROUND: It is well documented that Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world. The recent development of highly effective direct acting antiviral drugs (DAAs), has opened the possibility of treating and curing HCV infection in the Egyptian population on a large scale. METHODS: A screening demonstration project was implemented in southern Egypt in and around the city of Luxor. Free screening and if indicated, treatment, was offered to those 16 years or older for anti-HCV antibodies (anti-HCV) and hepatitis B surface antigen (HBsAg) using third generation enzyme immunoassays (Enzygnost® Anti-HCV and HbsAg). Statistical methods included estimation of odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: There was a large turnout of 67,042 persons who were screened in a 12-month period starting in June 2016. Thirty-one thousand nine hundred sixty-four males (47.7%) and 35,074 females (52.3%) were screened with a mean age of 43.6 ± 14.3 years. Nine thousand seven hundred one patients (14.5%) were positive for anti-HCV and 2950 (4.4%) for HBsAg. Prevalence of anti-HCV was significantly higher in males than females (19.67% vs.9.73% OR = 2.27; CI 2.2 to 2.4; p < 0.001) and the same for HBsAg (6.2% vs. 2.8% OR = 2.3; CI 2.2 to 2.5; p < 0.001). The prevalence of anti-HCV was significantly associated with age (p < 0.001), ranging from between 1 and 4% in individuals below the age of 40 years, then increased steadily to 42% at age 60 followed by a precipitous decline in age specific prevalence. CONCLUSIONS: The results showed unanticipated patterns in the Luxor area of anti-HCV and HBsAg by age and gender in contrast to previous reports on this unique HCV epidemic in Egypt. Moreover, the level and rate of turnout, cost, and other logistical issues, provided essential information for effective planning, design, and evaluation methods for larger national mass screening and treatment programs.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Egito/epidemiologia , Feminino , Hepacivirus/isolamento & purificação , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B/sangue , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos
16.
BMC Health Serv Res ; 19(1): 765, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660966

RESUMO

BACKGROUND: Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. METHODS: Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). RESULTS: Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). CONCLUSION: Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.


Assuntos
Antivirais/uso terapêutico , Serviços de Saúde Comunitária/estatística & dados numéricos , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Programas de Rastreamento/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
BMJ ; 367: l5383, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578177

RESUMO

OBJECTIVE: To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk. DESIGN: Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon). SETTING: A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures. POPULATION: Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%). COMPARISONS: Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence. MAIN OUTCOME MEASURES: Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach. RESULTS: Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates. CONCLUSIONS: Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Programas de Rastreamento/normas , Modelos Estatísticos , Idoso , Colonoscopia/efeitos adversos , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega/epidemiologia , Sangue Oculto , Guias de Prática Clínica como Assunto , Sigmoidoscopia/efeitos adversos , Sigmoidoscopia/normas , Sigmoidoscopia/estatística & dados numéricos , Análise de Sobrevida
18.
BMJ ; 367: l5515, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578196

RESUMO

CLINICAL QUESTION: Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?" CURRENT PRACTICE: Numerous guidelines recommend screening, but vary on recommended test, age and screening frequency. This guideline looks at the evidence and makes recommendations on screening for four screening options: faecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy. RECOMMENDATIONS: These recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids. HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, content experts and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. A linked systematic review of colorectal cancer screening trials and microsimulation modelling were performed to inform the panel of 15-year screening benefits and harms. The panel also reviewed each screening option's practical issues and burdens. Based on their own experience, the panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform their recommendations. THE EVIDENCE: Overall there was substantial uncertainty (low certainty evidence) regarding the 15-year benefits, burdens and harms of screening. Best estimates suggested that all four screening options resulted in similar colorectal cancer mortality reductions. FIT every two years may have little or no effect on cancer incidence over 15 years, while FIT every year, sigmoidoscopy, and colonoscopy may reduce cancer incidence, although for FIT the incidence reduction is small compared with sigmoidoscopy and colonoscopy. Screening related serious gastrointestinal and cardiovascular adverse events are rare. The magnitude of the benefits is dependent on the individual risk, while harms and burdens are less strongly associated with cancer risk. UNDERSTANDING THE RECOMMENDATION: Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Programas de Rastreamento/normas , Sangue Oculto , Sigmoidoscopia/estatística & dados numéricos , Idoso , Colonoscopia/normas , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sigmoidoscopia/normas , Fatores de Tempo
19.
BMC Public Health ; 19(1): 1190, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31554513

RESUMO

BACKGROUND: Due to the high prevalence of diabetes risk factors in rural areas, it is important to identify whether differences in diabetes screening rates between rural and urban areas exist. Thus, the purpose of this study is to examine if living in a rural area, rurality, has any influence on diabetes screening across the US. METHODS: Participants from the 2011, 2013, 2015, and 2017 nationally representative Behavioral Risk Factor Surveillance System (BRFSS) surveys who responded to a question on diabetes screening were included in the study (n = 1,889,712). Two types of marginal probabilities, average adjusted predictions (AAPs) and average marginal effects (AMEs), were estimated at the national level using this data. AAPs and AMEs allow for the assessment of the independent role of rurality on diabetes screening while controlling for important covariates. RESULTS: People who lived in urban, suburban, and rural areas all had comparable odds (Urban compared to Rural Odds Ratio (OR): 1.01, Suburbans compared to Rural OR: 0.95, 0.94) and probabilities of diabetes screening (Urban AAP: 70.47%, Suburban AAPs: 69.31 and 69.05%, Rural AAP: 70.27%). Statistically significant differences in probability of diabetes screening were observed between residents in suburban areas and rural residents (AMEs: - 0.96% and - 1.22%) but not between urban and rural residents (AME: 0.20%). CONCLUSIONS: While similar levels of diabetes screening were found in urban, suburban, and rural areas, there is arguably a need for increased diabetes screening in rural areas where the prevalence of diabetes risk factors is higher than in urban areas.


Assuntos
Diabetes Mellitus/epidemiologia , Programas de Rastreamento/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
20.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31562252

RESUMO

BACKGROUND: Universal screening is recommended to reduce the age of diagnosis for autism spectrum disorder (ASD). However, there are insufficient data on children who screen negative and no study of outcomes from truly universal screening. With this study, we filled these gaps by examining the accuracy of universal screening with systematic follow-up through 4 to 8 years. METHODS: Universal, primary care-based screening was conducted using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F) and supported by electronic administration and integration into electronic health records. All children with a well-child visit (1) between 16 and 26 months, (2) at a Children's Hospital of Philadelphia site after universal electronic screening was initiated, and (3) between January 2011 and July 2015 were included (N = 25 999). RESULTS: Nearly universal screening was achieved (91%), and ASD prevalence was 2.2%. Overall, the M-CHAT/F's sensitivity was 38.8%, and its positive predictive value (PPV) was 14.6%. Sensitivity was higher in older toddlers and with repeated screenings, whereas PPV was lower in girls. Finally, the M-CHAT/F's specificity and PPV were lower in children of color and those from lower-income households. CONCLUSIONS: Universal screening in primary care is possible when supported by electronic administration. In this "real-world" cohort that was systematically followed, the M-CHAT/F was less accurate in detecting ASD than in previous studies. Disparities in screening rates and accuracy were evident in traditionally underrepresented groups. Future research should focus on the development of new methods that detect a greater proportion of children with ASD and reduce disparities in the screening process.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Lista de Checagem , Programas de Rastreamento/normas , Pediatria/normas , Fatores Etários , Transtorno do Espectro Autista/epidemiologia , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Lactente , Masculino , Programas de Rastreamento/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Philadelphia/epidemiologia , Valor Preditivo dos Testes , Prevalência , Sensibilidade e Especificidade , Fatores Sexuais , Fatores Socioeconômicos
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