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1.
Public Health Res Pract ; 30(4)2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33294902

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to many aspects of life in Australia and globally. This includes actual and potential future impacts on Australia's three national screening programs for breast, bowel and cervical cancer. These programs aim to improve cancer outcomes through an organised approach to the early detection of cancer and precancer in asymptomatic populations. The design of each program varies according to biological differences in the three cancers, the available screening technology, the target population, and variations in their administration of Australia's federal, state and territory jurisdictions. The observed and potential impacts of COVID-19 on these programs, and on related activities such as the current national enquiry into lung cancer screening feasibility, therefore vary significantly. This article focuses on observed short-term impacts, adaptations and the longer-term outlook for cancer screening in relation to COVID-19. It summarises potential responses to minimise the harms of disruptions caused by COVID-19, and highlights research and policy opportunities in the pandemic response and recovery which could inform and accelerate optimisation of cancer screening in the long term.


Assuntos
/epidemiologia , Detecção Precoce de Câncer/métodos , Neoplasias/diagnóstico , Adulto , Idoso , Austrália , Neoplasias da Mama/diagnóstico , Colonoscopia , Detecção Precoce de Câncer/tendências , Feminino , Humanos , Neoplasias Intestinais/diagnóstico , Neoplasias Pulmonares/diagnóstico , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Pandemias , Neoplasias do Colo do Útero/diagnóstico
2.
Euro Surveill ; 25(47)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33243354

RESUMO

We present preliminary results of a coronavirus disease (COVID-19) impact assessment on testing for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region. We analyse 98 responses from secondary care (n = 36), community testing sites (n = 52) and national level (n = 10). Compared to pre-COVID-19, 95% of respondents report decreased testing volumes during March-May and 58% during June-August 2020. Reasons for decreases and mitigation measures were analysed.


Assuntos
Serviços de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus , Coronavirus , Assistência à Saúde/estatística & dados numéricos , Avaliação do Impacto na Saúde , Programas de Rastreamento/estatística & dados numéricos , Serviços de Laboratório Clínico/tendências , Assistência à Saúde/tendências , Europa (Continente) , Infecções por HIV/diagnóstico , Hepatite C/diagnóstico , Hepatite Viral Humana/diagnóstico , Humanos , Masculino , Programas de Rastreamento/tendências , Pandemias , Organização Mundial da Saúde
3.
PLoS One ; 15(11): e0242491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33201934

RESUMO

We formulate a sex-structured deterministic model to study the effects of varying HIV testing rates, condom use rates and ART adherence rates among Adolescent Girls and Young Women (AGYW) and, Adolescent Boys and Young Men (ABYM) populations in Kenya. Attitudes influencing the Kenyan youth HIV/AIDS control measures both positively and negatively were considered. Using the 2012 Kenya AIDS Indicator Survey (KAIS) microdata we constructed our model, which we fitted to the UNAIDS-Kenya youth prevalence estimates to understand factors influencing Kenyan youth HIV/AIDS prevalence trends. While highly efficacious combination control approach significantly reduces HIV/AIDS prevalence rates among the youth, the disease remains endemic provided infected unaware sexual interactions persist. Disproportional gender-wise attitudes towards HIV/AIDS control measures play a key role in reducing the Kenyan youth HIV/AIDS prevalence trends. The female youth HIV/AIDS prevalence trend seems to be directly linked to increased male infectivity with decreased female infectivity while the male youth prevalence trend seems to be directly associated with increased female infectivity and reduced male infectivity.


Assuntos
Infecções por HIV/epidemiologia , Adesão à Medicação/psicologia , Cooperação do Paciente/psicologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Atitude Frente a Saúde , Criança , Feminino , HIV/patogenicidade , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia/epidemiologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Adesão à Medicação/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Prevalência , Fatores de Risco , Sexo Seguro/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
4.
PLoS Med ; 17(10): e1003370, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33119589

RESUMO

BACKGROUND: Reactive malaria strategies are predicated on the assumption that individuals infected with malaria are clustered within households or neighbourhoods. Despite the widespread programmatic implementation of reactive strategies, little empirical evidence exists as to whether such strategies are appropriate and, if so, how they should be most effectively implemented. METHODS AND FINDINGS: We collated 2 different datasets to assess clustering of malaria infections within households: (i) demographic health survey (DHS) data, integrating household information and patent malaria infection, recent fever, and recent treatment status in children; and (ii) data from cross-sectional and reactive detection studies containing information on the household and malaria infection status (patent and subpatent) of all-aged individuals. Both datasets were used to assess the odds of infections clustering within index households, where index households were defined based on whether they contained infections detectable through one of 3 programmatic strategies: (a) Reactive Case Detection (RACD) classifed by confirmed clinical cases, (b) Mass Screen and Treat (MSAT) classifed by febrile, symptomatic infections, and (c) Mass Test and Treat (MTAT) classifed by infections detectable using routine diagnostics. Data included 59,050 infections in 208,140 children under 7 years old (median age = 2 years, minimum = 2, maximum = 7) by microscopy/rapid diagnostic test (RDT) from 57 DHSs conducted between November 2006 and December 2018 from 23 African countries. Data representing 11,349 infections across all ages (median age = 22 years, minimum = 0.5, maximum = 100) detected by molecular tools in 132,590 individuals in 43 studies published between April 2006 and May 2019 in 20 African, American, Asian, and Middle Eastern countries were obtained from the published literature. Extensive clustering was observed-overall, there was a 20.40 greater (95% credible interval [CrI] 0.35-20.45; P < 0.001) odds of patent infections (according to the DHS data) and 5.13 greater odds (95% CI 3.85-6.84; P < 0.001) of molecularly detected infections (from the published literature) detected within households in which a programmatically detectable infection resides. The strongest degree of clustering identified by polymerase chain reaction (PCR)/ loop mediated isothermal amplification (LAMP) was observed using the MTAT strategy (odds ratio [OR] = 6.79, 95% CI 4.42-10.43) but was not significantly different when compared to MSAT (OR = 5.2, 95% CI 3.22-8.37; P-difference = 0.883) and RACD (OR = 4.08, 95% CI 2.55-6.53; P-difference = 0.29). Across both datasets, clustering became more prominent when transmission was low. However, limitations to our analysis include not accounting for any malaria control interventions in place, malaria seasonality, or the likely heterogeneity of transmission within study sites. Clustering may thus have been underestimated. CONCLUSIONS: In areas where malaria transmission is peri-domestic, there are programmatic options for identifying households where residual infections are likely to be found. Combining these detection strategies with presumptively treating residents of index households over a sustained time period could contribute to malaria elimination efforts.


Assuntos
Testes Diagnósticos de Rotina/tendências , Malária Falciparum/diagnóstico , Malária Falciparum/epidemiologia , África/epidemiologia , Criança , Pré-Escolar , Análise por Conglomerados , Estudos Transversais , Testes Diagnósticos de Rotina/métodos , Características da Família , Feminino , Humanos , Lactente , Recém-Nascido , Malária Falciparum/tratamento farmacológico , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Microscopia/métodos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , Plasmodium falciparum/patogenicidade , Reação em Cadeia da Polimerase/métodos
5.
J Diabetes Res ; 2020: 9036847, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33123599

RESUMO

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


Assuntos
Infecções por Coronavirus/epidemiologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/terapia , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina , Betacoronavirus/fisiologia , Análise Custo-Benefício , Retinopatia Diabética/epidemiologia , Humanos , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Programas de Rastreamento/tendências , Oftalmologia/economia , Oftalmologia/métodos , Oftalmologia/organização & administração , Oftalmologia/tendências , Telemedicina/economia , Telemedicina/organização & administração , Telemedicina/normas , Telemedicina/tendências
6.
JAMA Netw Open ; 3(10): e2022874, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33119106

RESUMO

Importance: Genomic screening for hereditary breast and ovarian cancer (HBOC) in unselected women offers an opportunity to prevent cancer morbidity and mortality, but the potential clinical impact and cost-effectiveness of such screening have not been well studied. Objective: To estimate the lifetime incremental incidence of HBOC and the quality-adjusted life-years (QALYs), costs, and cost-effectiveness of HBOC genomic screening in an unselected population vs family history-based testing. Design, Setting, and Participants: In this study conducted from October 27, 2017, to May 3, 2020, a decision analytic Markov model was developed that included health states for precancer, for risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO), for earlier- and later-stage HBOC, after cancer, and for death. A complimentary cascade testing module was also developed to estimate outcomes in first-degree relatives. Age-specific RRM and RRSO uptake probabilities were estimated from the Geisinger MyCode Community Health Initiative and published sources. Parameters including RRM and RRSO effectiveness, variant-specific cancer risk, costs, and utilities were derived from published sources. Sensitivity and scenario analyses were conducted to evaluate model assumptions and uncertainty. Main Outcomes and Measures: Lifetime cancer incidence, QALYs, life-years, and direct medical costs for genomic screening in an unselected population vs family history-based testing only were calculated. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in cost between strategies divided by the difference in QALYs between strategies. Earlier-stage and later-stage cancer cases prevented and total cancer cases prevented were also calculated. Results: The model found that population screening of 30-year-old women was associated with 75 (95% credible range [CR], 60-90) fewer overall cancer cases and 288 QALYs (95% CR, 212-373 QALYs) gained per 100 000 women screened, at an incremental cost of $25 million (95% CR, $21 millon to $30 million) vs family history-based testing; the ICER was $87 700 (78% probability of being cost-effective at a threshold of $100 000 per QALY). In contrast, population screening of 45-year-old women was associated with 24 (95% CR, 18-29) fewer cancer cases and 97 QALYs (95% CR, 66-130 QALYs) gained per 100 000 women screened, at an incremental cost of $26 million (95% CR, $22 million to $30 million); the ICER was $268 200 (0% probability of being cost-effective at a threshold of $100 000 per QALY). A scenario analysis without cascade testing increased the ICER to $92 600 for 30-year-old women and $354 500 for 45-year-old women. A scenario analysis assuming a 5% absolute decrease in mammography screening in women without a variant was associated with the potential for net harm (-90 QALYs per 100 000 women screened; 95% CR, -180 to 10 QALYs). Conclusions and Relevance: The results of this study suggest that population HBOC screening may be cost-effective among younger women but not among older women. Cascade testing of first-degree relatives added a modest improvement in clinical and economic value. The potential for harm conferred by inappropriate reduction in mammography among noncarriers should be quantified.


Assuntos
Neoplasias da Mama/diagnóstico , Análise Custo-Benefício/métodos , Programas de Rastreamento/economia , Neoplasias Ovarianas/diagnóstico , Adulto , Análise Custo-Benefício/tendências , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos
7.
Klin Padiatr ; 232(6): 314-320, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33063311

RESUMO

OBJECTIVE: of the study is to research the epidemiological aspects of maternal alloimmunization against erythrocyte antigens of fetuses (AB0, Rhesus, Lewis, Kell, Duffy and others) and to identify the most common types of hemolytic disease of the newborn (HDN) in the West Herzegovina region. STUDY DESIGN: The 20-year retrospective epidemiological study includes all pregnant women who had been immunologically tested and newborn treated for HDN. RESULTS: The indirect antiglobulin (IAT) detected antibodies against antigens in 545 (1.8%) pregnant women of the 29 663 who were tested at the Department of Transfusion Medicine. During the 20-year-long study 310 (1.0%) newborn with HDN were treated. Our results indicate that 42% (230/545) of the pregnant women had AB0 immunization. The most common form of HDN is AB0 HDN 64% (199/310), whereas RhD HDN was treated in 19% (59/310) of the newborn infants. ETR was performed on 29 (19%) infants, 21 (72.4%) with AB0 HDN, and 7 (26%) with RhD HDN. CONCLUSION: This 20-year-long study concludes that, even though there has been significant progress in the prevention of immunization and proactive treatment of HDN, precautionary measures are still required as is the need for gynecologists and obstetricians to be active. The reasons for this are the non-existence of preventive measures for non-RhD immunization, the irregular immunological screening of RhD positive women in pregnancy in the region encompassed by the study in the past few years. The above raises new questions and recommends further research and monitoring of immunization and HDN treatment worldwide.


Assuntos
Teste de Coombs , Eritroblastose Fetal , Eritroblastose Fetal/diagnóstico , Eritroblastose Fetal/terapia , Feminino , Seguimentos , Humanos , Recém-Nascido , Programas de Rastreamento/tendências , Gravidez , Estudos Retrospectivos
8.
Arch Osteoporos ; 15(1): 162, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067691

RESUMO

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


Assuntos
Guias como Assunto , Programas de Rastreamento , Deficiência de Vitamina D/diagnóstico , Vitamina D , Adolescente , Austrália/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento/normas , Programas de Rastreamento/tendências , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/etiologia , Vitaminas
10.
In Vivo ; 34(5): 3047-3053, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32871851

RESUMO

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


Assuntos
Neoplasias da Mama/diagnóstico , Infecções por Coronavirus/epidemiologia , Detecção Precoce de Câncer , Programas de Rastreamento/tendências , Pneumonia Viral/epidemiologia , Idoso , Betacoronavirus/patogenicidade , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia
12.
PLoS Med ; 17(8): e1003233, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32797047

RESUMO

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


Assuntos
Nível de Saúde , Hispano-Americanos , Programas de Rastreamento/tendências , Migrantes , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Texas/epidemiologia , Adulto Jovem
13.
Adv Respir Med ; 88(3): 173-175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706099

RESUMO

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


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Programas de Rastreamento/tendências , Pneumonia Viral/epidemiologia , Prevenção Primária/tendências , Adulto , Idoso , Centers for Disease Control and Prevention, U.S. , Infecções por Coronavirus/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Guias de Prática Clínica como Assunto , Estados Unidos
14.
Neurology ; 95(3): e239-e246, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32601123

RESUMO

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


Assuntos
Anticonvulsivantes/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Epilepsia/tratamento farmacológico , Programas de Rastreamento/métodos , Adolescente , Adulto , Idoso , Epilepsia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Psychiatry Res ; 291: 113250, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32622170

RESUMO

Depression rates are increasing among minors. Internet is central to the lives of many minors, and many of them look online for depression information. This report describes minors who attempted to screen themselves for depression in a worldwide online study. Google Ads were used to recruit individuals to a multilingual depression screening study that was meant to target and recruit adults. Of 158,170 individuals accessing the site, 30,396 (19.22%) were minors from 190 countries. Proportions of minors varied considerably between different cultures. Given youth's interest in depression information, online services to ethically and effectively address youth depression are needed.


Assuntos
Depressão/diagnóstico , Depressão/epidemiologia , Saúde Global/tendências , Internet/tendências , Programas de Rastreamento/tendências , Adolescente , Criança , Depressão/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos
16.
JAMA Netw Open ; 3(7): e2011645, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716514

RESUMO

Importance: National guidelines balance risks and benefits of population-level cancer screening among adults with average risk. Older adults are not recommended to receive routine screening, but many continue to be screened (ie, are overscreened). Objective: To assess the prevalence of overscreening for colorectal, cervical, and breast cancers among older adults as well as differences in overscreening by metropolitan status. Design, Setting, and Participants: The cross-sectional study examined responses to a telephone survey of 176 348 community-dwelling adults. Participants were included if they met age and sex criteria, and they were excluded from each cancer-specific subsample if they had a history of that cancer. Data came from the 2018 Behavioral Risk Factor Surveillance System, administered by the US Centers for Disease Control and Prevention. Exposures: Metropolitan status, according to whether participants lived in a metropolitan statistical area. Main Outcomes and Measures: Overscreening was assessed using US Preventive Services Task Force definitions, ie, whether participants self-reported having a screening after the recommended upper age limit for colorectal (75 years), cervical (65 years), or breast (74 years) cancer. Results: Of 176 348 participants (155 411 [88.1%] women; mean [SE] age, 75.0 [0.04] years; 150 871 [85.6%] non-Hispanic white; 60 456 [34.3%] with nonmetropolitan residence) the cancer-specific subsamples contained 20 937 [11.9%] men and 34 244 [19.4%] women for colorectal cancer, 82 811 [47.0%] women for cervical cancer, and 38 356 [21.8%] women for breast cancer. Overall, 9461 men (59.3%; 95% CI, 57.6%-61.1%) were overscreened for colorectal cancer; 14 463 women (56.2%; 95% CI, 54.7%-57.6%), for colorectal cancer; 31 988 women (45.8%; 95% CI, 44.9%-46.7%), for cervical cancer; and 26 198 women (74.1%; 95% CI, 73.0%-75.3%), for breast cancer. Overscreening was more common in metropolitan than nonmetropolitan areas for colorectal cancer among women (adjusted odds ratio [aOR], 1.23; 95% CI, 1.08-1.39), cervical cancer (aOR, 1.20; 95% CI, 1.11-1.29), and breast cancer (aOR, 1.36; 95% CI, 1.17-1.57). Overscreening for cervical and breast cancers was also associated with having a usual source of care compared with not (eg, cervical cancer: aOR, 1.87; 95% CI, 1.56-2.25; breast cancer: aOR, 2.08; 95% CI, 1.58-2.76), good, very good, or excellent self-reported health compared with fair or poor self-reported health (eg, cervical cancer: aOR, 1.21; 95% CI, 1.11-1.32; breast cancer: aOR, 1.47; 95% CI, 1.28-1.69), an educational attainment greater than a high school diploma compared with a high school diploma or less (eg, cervical cancer: aOR, 1.14; 95% CI, 1.06-1.23; breast cancer: aOR, 1.30; 95% CI, 1.16-1.46), and being married or living as married compared with other marital status (eg, cervical cancer: OR, 1.36; 95% CI, 1.26-1.46; breast cancer: OR, 1.54; 95% CI, 1.34-1.77). Conclusions and Relevance: In this study, overscreening for cancer among older adults was high, particularly for women living in metropolitan areas. Overscreening could be associated with health care access and patient-clinician relationships. Additional research on why overscreening persists and how to reduce overscreening is needed to minimize risks associated with cancer screening among older adults.


Assuntos
Mapeamento Geográfico , Programas de Rastreamento/normas , Sobremedicalização/tendências , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias Colorretais/diagnóstico , Estudos Transversais , Feminino , Geriatria/métodos , Geriatria/tendências , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Fatores de Risco , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico
17.
Psychiatry Res ; 291: 113223, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32563747

RESUMO

The Spielberger State-Trait Anxiety Inventory (STAI) has been widely used to measure the state and trait components of anxiety. We sought to develop a short, yet reliable and valid form of these scales for use in circumstances where the full-form is not feasible. We abbreviated the scales using item response theory analyses to retain the items that could discriminate the best among participants. One sample (N = 922) completed the state scale, a second sample (N = 2227) completed the trait scale, while a third sample (N = 250) completed the short forms. Our participants completed the Hungarian version of STAI alongside other measures to observe external validity. We calculated cut-off scores for the state (>9.5,) and trait (>13.5) scales. A total of 19.5% and 20.1% of the respondents reached the cut-off scores. The five-item short forms of STAI had sound psychometric properties that are comparable to those obtained on the full-form. The external validity of the scales is also demonstrated. We report detailed descriptive statistics that could be used in further studies as standards. The short scales are reliable measures that could be used in clinical screening and behavioural research; especially where practical considerations preclude the use of a longer questionnaire.


Assuntos
Ansiedade/diagnóstico , Ansiedade/psicologia , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Autorrelato/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Psicometria/métodos , Psicometria/tendências , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas , Adulto Jovem
18.
Aust N Z J Public Health ; 44(4): 301-306, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32510784

RESUMO

OBJECTIVES: To report rates of perinatal mental health screening from 2000 to 2017 and investigate factors associated with not being screened both antenatally and postnatally more recently (2013-2017). METHODS: A longitudinal community-based study of self-reported perinatal mental health screening with a national sample of 7,566 mothers from the Australian Longitudinal Study on Women's Health reporting on 9,384 children. The main outcome measure was whether mothers were asked about their emotional wellbeing by a health professional, including completing a questionnaire. RESULTS: From 2000 to 2017, the percentage of women not screened decreased from 40.6% to 1.7%. The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3%. From 2013 to 2017, women who were older (aOR, 0.65; 95%CI, 0.52-0.81) or had reported emotional distress (aOR, 0.77; 95%CI, 0.60-0.99) were less likely to have been screened both antenatally and postnatally. CONCLUSIONS: Despite improvements, perinatal mental health screening is not yet universal. One-in-five women are not screened both antenatally and postnatally, including women in high-risk populations such as those who have reported emotional distress. Implications for public health: Women are in regular contact with health professionals in the perinatal period. This opportunity to detect women at risk of perinatal mental health issues is too important to be missed.


Assuntos
Depressão Pós-Parto/epidemiologia , Depressão/epidemiologia , Programas de Rastreamento/tendências , Transtornos Mentais/diagnóstico , Saúde Mental/estatística & dados numéricos , Mães/psicologia , Assistência Perinatal/métodos , Adulto , Austrália/epidemiologia , Depressão/diagnóstico , Depressão/psicologia , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento/estatística & dados numéricos , Serviços de Saúde Materna/tendências , Saúde Mental/tendências , Parto , Assistência Perinatal/estatística & dados numéricos , Gravidez , Complicações na Gravidez , Angústia Psicológica , Inquéritos e Questionários , Adulto Jovem
19.
MMWR Morb Mortal Wkly Rep ; 69(25): 776-780, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32584800

RESUMO

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


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Programas de Rastreamento/tendências , Consultórios Médicos/estatística & dados numéricos , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
20.
Public Health Rep ; 135(4): 501-510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579861

RESUMO

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


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Infecções por HIV/epidemiologia , Programas de Rastreamento/estatística & dados numéricos , Programas de Rastreamento/tendências , Adolescente , Adulto , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
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