Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.451
Filtrar
1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1084-1087, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683391

RESUMO

The screening, early diagnosis and early treatment project of the upper gastrointestinal cancer had achieved good results since its launch. However, from a national perspective, the endoscopic screening of upper gastrointestinal cancer was still not optimistic, such as the poor rate of the early diagnosis, the low rate of 5-year survival in rural areas, and the disparity of the standardized screening and diagnosis in different areas. Therefore, the situation of upper gastrointestinal cancer prevention and treatment is still severe. Under the guidance of the "Healthy China 2030" plan, based on the international experience and domestic actual circumstance, it is suggested that the screening of high-risk population in high-risk areas should be changed into the opportunistic screening in primary medical institutions. The opportunistic screening could expand the coverage of the screening, early diagnosis and early treatment project of the upper gastrointestinal cancer, and increase the early diagnosis rate in rural areas and primary medical institutions, which could improve the 5-year survival rate of patients with the upper gastrointestinal cancer, and then achieve the sustainable development of the cancer prevention and treatment in China.


Assuntos
Detecção Precoce de Câncer , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Programas de Rastreamento/métodos , China , Endoscopia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/etnologia , Humanos , Programas de Rastreamento/tendências , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/etnologia
3.
BMC Public Health ; 19(1): 959, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319826

RESUMO

BACKGROUND: In Brazil, 70% of the population depends on the public healthcare system. Since early detection is considered crucial, this study aimed to evaluate temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service (SUS) according to the different regions of the country between 2008 and 2017. METHODS: This ecological study analyzed data on breast cancer screening within the SUS for women aged 50-69 years. Coverage was calculated from the ratio between the number of screening tests conducted and the expected number for the target population. Joinpoint regression analysis was used to calculate annual percent changes (APC) in coverage. RESULTS: Around 19 million mammograms were performed in 50-69-year old women within the SUS between 2008 and 2016. The estimated APC indicates that breast cancer screening coverage increased by 14.5% annually in Brazil between 2008 and 2012 (p < 0.01), with figures stabilizing between 2012 and 2017 as shown by an APC of - 0.4% (p = 0.3). In the five geographic regions of the country, the APC initially increased, then stabilized in the north, northeast and southeast and decreased in the south and Midwest. Of the 26 states, coverage increased in seven and remained stable in six. In the other 13, there was an initial increase followed by stabilization in 11, and a reduction in coverage in two. In the Federal District, coverage remained stable throughout the study period. CONCLUSION: Evaluation of the temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service revealed an initial increase, confirming that public policies were effective, although insufficient to ensure organized screening. There appears to be a lack of uniformity between the different regions and states and this situation is highlighted in the final 5-year period, with the APC reflecting stabilization of breast cancer screening coverage.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/tendências , Mamografia/tendências , Programas de Rastreamento/tendências , Programas Nacionais de Saúde/estatística & dados numéricos , Idoso , Brasil/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo
4.
World J Gastroenterol ; 25(21): 2565-2580, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31210710

RESUMO

Colorectal cancer incidence and mortality in patients younger than 50 years are increasing, but screening before the age of 50 is not offered in Europe. Advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age are increasing. This is not a detection-bias effect; it is a real issue affecting the entire population. Three independent computational models indicate that screening from 45 years of age would yield a better balance of benefits and risks than the current start at 50 years of age. Experimental data support these predictions in a sex- and race-independent manner. Earlier screening is seemingly affordable, with minimal impediments to providing younger adults with colonoscopy. Indeed, the American Cancer Society has already started to recommend screening from 45 years of age in the United States. Implementing early screening is a societal and public health problem. The three independent computational models that suggested earlier screening were criticized for assuming perfect compliance. Guidelines and recommendations should be derived from well-collected and reproducible data, and not from mathematical predictions. In the era of personalized medicine, screening decisions might not be based solely on age, and sophisticated prediction software may better guide screening. Moreover, early screening might divert resources away from older individuals with greater biological risks. Finally, it is still unknown whether early colorectal cancer is part of a continuum of disease or a biologically distinct disease and, as such, it might not benefit from screening at all. The increase in early-onset colorectal cancer incidence and mortality demonstrates an obligation to take actions. Earlier screening would save lives, and starting at the age of 45 years may be a robust screening option.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Fidelidade a Diretrizes , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Fatores Etários , Tomada de Decisão Clínica/métodos , Colonoscopia/normas , Neoplasias Colorretais/epidemiologia , Sistemas de Apoio a Decisões Clínicas , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/tendências , Europa (Continente) , Gastroenterologia/normas , Humanos , Incidência , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Oncologia/normas , Pessoa de Meia-Idade , Mortalidade/tendências , Sociedades Médicas/normas , Software , Estados Unidos
5.
Acta Diabetol ; 56(9): 981-994, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203437

RESUMO

Various imaging modalities are of significant utility in the screening, grading, treatment, and follow-up of the different stages of diabetic retinopathy (DR) and diabetic macular edema. Color stereographic photography, fluorescein angiography, and optical coherence tomography (OCT) have been the gold standard for DR imaging for years. Besides these tools, newer technologies are gaining validation and popularity, such as fundus autofluorescence and OCT angiography. Furthermore, widefield retinography and ultra-widefield retinography have been introduced for a more comprehensive evaluation of the medium-far and very-far retinal peripheries, which is crucial for the assessment of the diverse manifestations of the disease. The aim of this review is to illustrate the recent advancements of the imaging systems for diagnosing DR, with a focus on the newest and noninvasive diagnostic tools.


Assuntos
Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico/tendências , Invenções/tendências , Angiofluoresceinografia , Fundo de Olho , Humanos , Edema Macular/diagnóstico , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Fotografação , Retina/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos
6.
Cleve Clin J Med ; 86(6): 400-406, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31204979

RESUMO

This review summarizes evidence that may enhance and influence clinical practice of women's health. Supporting articles were identified by reviewing high-impact medical and women's health journals published in 2017 and 2018. The chosen articles are pertinent to osteoporosis screening, hormonal contraceptive interactions with antibiotics, hormone replacement therapy in BRCA1 mutation carriers, breast cancer diagnosis using digital tomosynthesis, and risks of hormonal contraception.


Assuntos
Neoplasias da Mama , Anticoncepção/tendências , Terapia de Reposição Hormonal/tendências , Programas de Rastreamento/tendências , Osteoporose , Saúde da Mulher/tendências , Feminino , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-31207996

RESUMO

A cross-sectional study with 27,821 records of non-institutionalized people in Spain aged between 50-69 years old (59.94 ± 5.8 years), who participated in the European Health Survey in Spain (2009, 2014) and National Health Survey (2011/12, 2017). Fecal occult testing, the reason for performing the test, age, sex, nationality, social status, marital status, education level, body mass index (BMI), and place of residence. Overall, 54% were women, 93.9% were Spanish, 47.8% had a secondary study, and 66.4% were married. Across the years, the rate of the fecal occult blood test (FOBT) increased significantly (p < 0.001). This increase can be accounted for a letter campaign advising testing (45%, p < 0.001). FOBT was associated with more age (odds ratio-OR 1.04, 95% confidence interval-CI 1.04-1.05, p < 0.001), Spanish nationality (OR 1.91, 95% CI 1.25-2.93, p = 0.003), being married (OR 1.13, 95% CI 1.02-1.25, p = 0.025), having a higher level of education (OR 2.46, 95% CI 2.17-2.81, p < 0.001), belonging to high social classes (OR 1.35, 95% CI 1.12-1.64, p = 0.001), and BMI <25 (OR 1.72, 95% CI 1.25-2.37). Frequency of FOBT has increased in recent years. Performing FOBT is associated with age, nationality, marital status, higher education level, and social class.


Assuntos
Neoplasias Colorretais/diagnóstico , Programas de Rastreamento/tendências , Sangue Oculto , Idoso , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Espanha
9.
Fam Syst Health ; 37(2): 131-149, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31058525

RESUMO

INTRODUCTION: Whereas universal depression screening has potential to increase identification of mental health concerns among college students, the prevalence of universal screening in college health centers is unknown. This study provides an estimate of the prevalence of universal depression screening at public, 4-year universities in the United States. It also documents systems-level facilitators and correlates of universal screening, as well as reasons for not screening. METHOD: Online cross-sectional survey of college health center directors and student health personnel of public 4-year universities. RESULTS: There were 131 participants who responded to the survey (25% response): 64.2% (54-74%; 95% confidence interval [CI]) of respondents reported that their clinics use universal depression screening. Characteristics associated with universal depression screening use clustered around systems-level resources, including larger student populations and health care staff, greater perceived financial resources, and shorter estimates of time required for screening. Universal screening use was also associated with respondents' awareness of the U.S. Preventive Services Task Force (USPSTF) recommendation, agreement with the evidence base supporting universal depression screening, and beliefs that codified standards support effective care. Leading reasons for not screening included: lack of mental health professionals, provider reluctance, liability concerns, and lack of clinic space. DISCUSSION: Universal depression screening is reasonably common among college health centers. Care planner discussions regarding depression screening initiatives should address resource concerns, awareness of the USPSTF recommendation and evidence base, and information about the average time it takes to screen. Future research should examine functional outcomes and implementation experiences of college health centers that have adopted universal depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Depressão/diagnóstico , Programas de Rastreamento/métodos , Serviços de Saúde para Estudantes/métodos , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/normas , Programas de Rastreamento/tendências , Prevalência , Serviços de Saúde para Estudantes/normas , Estudantes/psicologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Universidades/organização & administração , Universidades/estatística & dados numéricos , Adulto Jovem
10.
Crit Care ; 23(1): 170, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088542

RESUMO

BACKGROUND: Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are disseminating worldwide leading to increased hospital length of stay and mortality in intensive care units (ICU). ESBL-E dissemination was first due to outbreaks in hospital settings which led to the implementation of systematic fecal carriage screening to improve hygiene procedures by contact precautions. ESBLs have since spread in the community, and the relevance of contact precautions is questioned. ESBL-E dissemination led to an overuse of carbapenems triggering the emergence of carbapenem-resistant Enterobacteriaceae. Empirical antimicrobial therapy based on ESBL-E fecal carriage has been proposed but is debated as it could increase the consumption of carbapenems among ESBL-E carriers without any clinical benefit. Finally, selective decontamination among ESBL-E fecal carriers is evoked to decrease the risk for subsequent ESBL-E infection, but its efficacy remains debated. We propose to systematically review the evidence to recommend or not such systematic ESBL-E fecal carriage screening in adult ICU. METHODS: Every article focusing on ESBL-E and ICU available on the MEDLINE database was assessed. Articles were included if focusing on cross-transmission, efficacy of hygiene procedures, link between ESBL-E colonization and infection or guidance of empirical therapy or selective decontamination efficacy. RESULTS: Among 330 articles referenced on PubMed, 39 abstracts were selected for full-text assessment and 25 studies were included. Systematic screening of ESBL-E fecal carriage to guide contact precautions do not seem to decrease the rate of ESBL-E cross-transmission. It has a very good negative predictive value for subsequent ESBL-E infections but a positive predictive value between 40 and 50% and so does not help to spare carbapenems. Cessation of ESBL-E carriage systematic screening could decrease the use of carbapenems in ICU without any clinical harm. Nevertheless, further studies are needed to validate these results from monocentric before-after study. Selective decontamination strategy applied to ESBL-E fecal carriers could be helpful, but available data are conflicting. CONCLUSION: Current knowledge lacks of high-quality evidence to strongly recommend in favor of or against a systematic ESBL-E fecal carriage screening policy for ICU patients in a non-outbreak situation. Further evaluation of selective decontamination or fecal microbiota transplantation among ESBL-E fecal carriers is needed.


Assuntos
Portador Sadio/diagnóstico , Fezes/microbiologia , Programas de Rastreamento/métodos , beta-Lactamases/análise , Adulto , Portador Sadio/fisiopatologia , Infecção Hospitalar/prevenção & controle , Enterobacteriaceae/metabolismo , Enterobacteriaceae/patogenicidade , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/fisiopatologia , Infecções por Enterobacteriaceae/prevenção & controle , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Programas de Rastreamento/tendências , Testes de Sensibilidade Microbiana/métodos , beta-Lactamases/efeitos adversos , beta-Lactamases/metabolismo
11.
Gynecol Oncol ; 154(1): 3-7, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30995961

RESUMO

George Papanicolaou, a Greek immigrant and cytopathologist, was responsible for what is now colloquially known as the "Pap smear"-undoubtedly one of the greatest advances in medicine and public health of the last century. However, his landmark research on the development of cervical cytology for the detection of precancerous lesions of the cervix ("New Cancer Diagnosis," 1928) made a rather inauspicious debut in an unlikely venue: John Harvey Kellogg's Third Race Betterment Conference-a meeting devoted to the furtherance of the concept and implementation of eugenics. Herein, we discuss the stark juxtaposition of Papanicolaou's landmark discovery amid the pseudoscience of the third Race Betterment Conference. We discuss the latency of Papnicolaou's discovery-its potential implications unrealized-until co-publication with Herbert Traut, which catapulted Papanicolaou's research to the scientific foreground. This gave rise to public health initiatives aimed at establishing the Pap smear as a screening tool. We further delineate the progress made in recent decades with the identification of HPV as the etiological agent for cervical cancer, and the subsequent development of the HPV vaccine, and discuss ongoing research in the present day. In this way, we hope to provide a background and historical context for the development of the Pap smear.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Teste de Papanicolaou/história , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/história , Neoplasia Intraepitelial Cervical/patologia , Neoplasia Intraepitelial Cervical/virologia , Colo do Útero/patologia , Colo do Útero/virologia , Feminino , História do Século XX , História do Século XXI , Humanos , Programas de Rastreamento/história , Programas de Rastreamento/tendências , Teste de Papanicolaou/tendências , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Estados Unidos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/tendências
12.
J Perinat Neonatal Nurs ; 33(2): 136-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31021939

RESUMO

The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines.


Assuntos
Diabetes Gestacional/diagnóstico , Disparidades em Assistência à Saúde/economia , Hipertensão Induzida pela Gravidez/diagnóstico , Programas de Rastreamento/normas , Morte Materna/prevenção & controle , Cuidado Pós-Natal/métodos , Diabetes Gestacional/mortalidade , Diabetes Gestacional/terapia , Feminino , Seguimentos , Disparidades em Assistência à Saúde/etnologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/terapia , Programas de Rastreamento/tendências , Período Pós-Parto , Gravidez , Resultado da Gravidez , Gravidez de Alto Risco , Medição de Risco
13.
Workplace Health Saf ; 67(5): 209-217, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31023191

RESUMO

Asian Americans have a higher prevalence of developing type 2 diabetes mellitus (T2DM) compared with White Americans. A two-phase evidence-based project developed specifically for Chinese American employees at an urban catering company worksite was led by a registered nurse/certified diabetes educator. The purpose of this project was to (a) identify Chinese employees at risk for T2DM, and (b) develop and implement a customized diabetes prevention program in Chinese. In Phase 1, Chinese employees were screened for T2DM risk factors using a Chinese version of the Canadian Diabetes Risk Assessment Questionnaire (CANRISK). Thirty-five people, who represented 58% of the Chinese employees, were screened; two were newly diagnosed with T2DM, and two were newly diagnosed with prediabetes based on the screening scores, nonfasting blood glucose, and hemoglobin (Hb) A1c tests. In Phase 2, 23 Chinese employees were interviewed and their remarks were used to modify the National Diabetes Prevention Program (DPP). Six Chinese employees participated and completed the DPP. Risk scores, nonfasting blood glucose, and HbA1c were obtained and pre- and postprogram data were compared. Upon completion of the program, participants showed an average reduction of nonfasting blood glucose of 30 mg/dL (1.7 mmol/L), and a reduction of HbA1c by 0.32 points (3 mmol/mol). This evidence-based project emphasizes the importance of screening for diabetes in the worksite setting and using linguistically sensitive materials.


Assuntos
Americanos Asiáticos/psicologia , Diabetes Mellitus Tipo 2/diagnóstico , Programas de Rastreamento/métodos , Educação de Pacientes como Assunto/métodos , Adulto , Glicemia/análise , Feminino , Serviços de Alimentação , Hemoglobina A Glicada/análise , Promoção da Saúde/métodos , Humanos , Masculino , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Educação de Pacientes como Assunto/tendências , Inquéritos e Questionários
14.
Health Rep ; 30(4): 12-17, 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30994922

RESUMO

BACKGROUND: Prostate cancer is the most common type of cancer in Canadian men. Screening recommendations have changed substantially over the last 25 years. Since 2011 (United States) and 2014 (Canada), taskforce guidelines have recommended against screening using the prostate-specific antigen (PSA) test in low-risk men of all ages. This work reports on trends in prostate cancer incidence, mortality, and stage at diagnosis in Canada from 1992 to 2015. DATA AND METHODS: Prostate cancer incidence, mortality, and stage at diagnosis were retrieved from Statistics Canada's Canadian Cancer Registry and Canadian Vital Statistics - Death Database. Joinpoint analysis was used to examine trends over time. RESULTS: The age-standardized incidence rate (ASIR) of prostate cancer peaked in 1993 and 2001, and declined thereafter. From 2011 to 2015, the ASIR declined by 9.3% per year. The age-standardized mortality rate (ASMR) decreased continuously from 1992 to 2015, but fell most rapidly (2.9% per year) after 2001. Data from two provinces show that, from 2005 to 2015, the rate of Stage I and Stage II cancers decreased by 3.2% per year, while the rate of Stage III and Stage IV cancers remained relatively stable. DISCUSSION: Incidence of prostate cancer has declined substantially in recent years. Most of the decline seems to be in localized cases (Stage I and Stage II). Changes in incidence have mirrored changes to PSA screening recommendations. Future work should continue to monitor trends over time at the national level, especially as they relate to screening recommendations.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Neoplasias da Próstata/epidemiologia , Sistema de Registros/estatística & dados numéricos , Distribuição por Idade , Idoso , Canadá/epidemiologia , Humanos , Incidência , Masculino , Programas de Rastreamento/normas , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Neoplasias da Próstata/mortalidade
15.
Worldviews Evid Based Nurs ; 16(3): 204-210, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31012540

RESUMO

BACKGROUND: Intimate partner violence (IPV) is a significant public health issue. Healthcare providers (e.g., nurses, advanced practice nurses, physicians, social workers) have a unique opportunity to prevent and reduce IPV through screening and referral. The objective of this project was to determine the impact of education and a brief screening tool integrated into the electronic medical record (EMR) on readiness to screen for IPV. METHODS: An intervention was implemented that included the EMR integration of a screening tool, creation of an automated resource telephone system and healthcare provider IPV screening and response education. Readiness for screening was evaluated pre- and postintervention using the Domestic Violence Health Care Provider Survey Scale (DVHCPSS), which is scored cumulatively and by each of six domains. An unpaired Student's t test was performed. RESULTS: Mean age (31-40 years of age) and years of clinical practice (11-15 years) was the same for pre- (n = 96) and postintervention (n = 83) survey respondents. There was an overall significant increase in screening readiness (p = .003) with significant improvement in "professional role resistance/fear of offending the patient" (p < .0001), "blame victim items" (p = .0029), "perceived self-efficacy" (p = .0064), and "victim/provider safety" (p = .003). LINKING EVIDENCE TO ACTION: Adopting and integrating a validated IPV screening tool into the EMR combined with education was associated with an improvement in overall readiness for IPV screening. Reducing and preventing IPV through universal screening and referral can be accomplished by embedding a standardized readily accessible validated IPV screening tool in the EMR.


Assuntos
Pessoal de Saúde/psicologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Programas de Rastreamento/normas , Adulto , Atitude do Pessoal de Saúde , Feminino , Pessoal de Saúde/normas , Humanos , Violência por Parceiro Íntimo/psicologia , Masculino , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Inquéritos e Questionários
16.
J Urol ; 202(3): 469-474, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30835631

RESUMO

PURPOSE: Current trends in renal transplantation, such as improved allograft/recipient survival and expanded organ transplantation eligibility criteria in older recipients, are concomitant with increasingly detected low risk prostate cancer in candidates for or recipients of renal transplantation. We reviewed the evidence regarding prostate cancer screening, diagnosis and management in renal transplant candidates and recipients. We focused on published reports of prostate cancer incidence and diagnosis in patients with end stage renal disease, pretransplant screening recommendations, and recommendations regarding waiting time between treatment and active wait listing after the prostate cancer diagnosis in renal transplant candidates. In addition, we examined the natural history of prostate cancer development after renal transplantation in the setting of standard immunosuppression. MATERIALS AND METHODS: We reviewed the English language literature using search terms including prostate cancer, end stage renal disease, renal transplantation, prostate cancer screening, prostate specific antigen, prostate cancer treatment and active surveillance in various combinations. RESULTS: Prostate cancer screening is still widely done in almost all patients with end stage renal disease before and after transplantation. Active treatment of any patients with prostate cancer and a 5-year waiting period before transplantation can negatively affect the collective pool of participants and the overall survival of patients on dialysis. Several groups have proposed a shorter waiting time to kidney transplantation in patients with low risk prostate cancer. CONCLUSIONS: There are no standardized guidelines for screening and management of prostate cancer before and after transplantation. In the era of low risk prostate cancer end stage renal disease is a significant competing mortality risk factor. The role of active surveillance in these complex cases has yet to be well investigated. Further studies and nomograms are urged to integrate risk stratified screening and treatment protocols before and after renal transplantation.


Assuntos
Detecção Precoce de Câncer/normas , Programas de Rastreamento/normas , Neoplasias da Próstata/diagnóstico , Conduta Expectante/estatística & dados numéricos , Fatores Etários , Idoso , Detecção Precoce de Câncer/estatística & dados numéricos , Detecção Precoce de Câncer/tendências , Humanos , Incidência , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim/normas , Transplante de Rim/estatística & dados numéricos , Transplante de Rim/tendências , Masculino , Programas de Rastreamento/estatística & dados numéricos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/complicações , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/terapia , Medição de Risco , Conduta Expectante/normas , Conduta Expectante/tendências
17.
Psychiatry Res ; 272: 790-796, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30832200

RESUMO

Depressive symptoms are common in children and adolescents. The prevalence of depressive symptoms in children and adolescents in China vary significantly across studies. A meta-analysis of the prevalence of depressive symptoms in children and adolescents in China was conducted. Literature search was performed in both English (PubMed, PsycINFO and EMBASE) and Chinese (China National Knowledge Internet, WANFANG Data and SinoMed) databases. Random-effects model was used to synthesize the prevalence of depressive symptoms. Eighteen studies covering 29,626 participants were identified and analyzed. All these studies used the same measurement to identify depressive symptoms. The reported point prevalence of depressive symptoms ranged between 4% and 41% in the studies; the pooled prevalence of depressive symptoms was 19.85% (95% confidence interval: 14.75%-24.96%). In the subgroup analyses the prevalence of depressive symptoms was significantly associated with the region where the study was conducted: 17.8% in eastern, 23.7% in central, 22.7% in western, and 14.5% in northeast regions of China (P < 0.001). Considering the adverse impact of depressive symptoms on health outcomes, regular screening and effective interventions should be implemented in this population.


Assuntos
Depressão/epidemiologia , Depressão/psicologia , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/psicologia , Adolescente , Criança , China/epidemiologia , Bases de Dados Factuais/tendências , Depressão/diagnóstico , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Transtornos do Neurodesenvolvimento/diagnóstico , Estudos Observacionais como Assunto/métodos , Prevalência
18.
Am J Med ; 132(8): 926-930, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30853473

RESUMO

The expansive scope of general internal medicine makes it difficult to identify practice-changing medical literature. Clinical updates can be facilitated by synthesizing relevant articles and implications for practice. Six internal medicine physicians reviewed the titles and abstracts in the 7 general internal medicine clinical outpatient journals with the highest impact factor and relevance to the internal medicine outpatient physician: New England Journal of Medicine (NEJM), Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA-Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine. The following collections of article synopses and databases were also reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus on articles based on clinical relevance to outpatient Internal Medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, 7 practice-changing articles were included.


Assuntos
Assistência Ambulatorial/métodos , Medicina Baseada em Evidências/tendências , Programas de Rastreamento/métodos , Adulto , Idoso , Feminino , Humanos , Medicina Interna/métodos , Medicina Interna/normas , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/fisiopatologia , Neoplasias do Colo do Útero/diagnóstico
20.
J Autism Dev Disord ; 49(6): 2304-2319, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30726534

RESUMO

U.S. guidelines for detecting autism emphasize screening and also incorporate clinical judgment. However, most research focuses on the former. Among 1,654 children participating in a multi-stage screening protocol for autism, we used mixed methods to evaluate: (1) the effectiveness of a clinical decision rule that encouraged further assessment based not only on positive screening results, but also on parent or provider concern, and (2) the influence of shared decision-making on screening administration. Referrals based on concern alone were cost-effective in the current study, and reported concerns were stronger predictors than positive screens of time-to-complete referrals. Qualitative analyses suggest a dynamic relationship between parents' concerns, providers' concerns, and screening results that is central to facilitating shared decision-making and influencing diagnostic assessment.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Tomada de Decisão Clínica/métodos , Tomada de Decisões , Programas de Rastreamento/métodos , Transtorno do Espectro Autista/psicologia , Criança , Pré-Escolar , Assistência à Saúde/métodos , Assistência à Saúde/tendências , Feminino , Humanos , Masculino , Programas de Rastreamento/tendências , Pais/psicologia , Encaminhamento e Consulta/tendências
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA