RESUMO
Abdominal aortic aneurysm (AAA) is a significant vascular disease found in 4% to 8% of the screening population. If ruptured, its mortality rate is between 75% and 90%, and it accounts for up to 5% of sudden deaths in the United States. Therefore, screening of AAA while asymptomatic has been a crucial portion of preventive health care worldwide. Ultrasound of the abdominal aorta is the primary imaging modality for screening of AAA recommended for asymptomatic adults regardless of their family history or smoking history. Alternatively, duplex ultrasound and CT abdomen and pelvis without contrast may be appropriate for screening. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation
Assuntos
Humanos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Doenças Assintomáticas , Programas de Triagem Diagnóstica , UltrassonografiaRESUMO
The American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus, in addition to the development of Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than to dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.
Assuntos
Humanos , Polipose Adenomatosa do Colo/diagnóstico , Programas de Triagem Diagnóstica , MutaçãoAssuntos
Surtos de Doenças , Pandemias , Doença pelo Vírus Ebola , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , COVID-19 , Infecções Respiratórias , Peste , Programas de Triagem Diagnóstica , Temperatura , Migrantes , Vigilância da População , Viagem , Emigração e Imigração , Revisão Sistemática , Seguimentos , Regulamento Sanitário Internacional , Saúde Pública , PolíticasRESUMO
This document aims to provide national and subnational authorities involved in prison health andprison health-care services with practical principles and actions for addressing five managementphases: prepare, prevent, detect and respond to infectious diseases, further strengthened bybuilding connectedness of prisons with wider health systems. This document also aims to enhancecapacity to tackle social determinants of health and to accelerate progress towards achieving thesustainable development goals, including universal health coverage. The document was developedthrough evidence review, remote expert consultation and interaction with experts during a dedicatedinternational conference. The evidence review focused on the five management phases applied tothe prison setting, leading to a draft collating the evidence, which was then used to identify keyquestions to be addressed and discussed during an international conference of stakeholders inprison health and global experts in infectious diseases in June 2023. A second evidence review wasconducted during which identified evidence gaps were further searched. Although this documentis primarily intended for policy-makers and policy-makers, it is expected that the document isalso useful for the health-care workforce in prisons and other places of detention. Thus, all coreprinciples presented are supported by recommendations for implementation.
Assuntos
Prisões , Doenças Transmissíveis , Epidemias , Mycobacterium tuberculosis , Hepatite , Programas de Triagem Diagnóstica , Doenças Preveníveis por VacinaRESUMO
Fundamentos: El programa de cribado de cáncer colorrectal (CCR) mediante el test de sangre oculta en heces (SOH) ha alcanzado una implementación elevada en España, aunque la participación sigue sin encontrarse en cifras óptimas. A su vez, los datosdisponibles ofrecen diferencias de participación significativas, tanto entre CC. AA. como entre distintos grupos sociodemográficos, loque plantea diferentes problemas de equidad. Este estudio buscó realizar un análisis exploratorio, desde una perspectiva cualitativa,sobre las actitudes, percepciones e imágenes sociales que la población objeto del cribado de cáncer colorrectal tenía sobre el mismo,así como las barreras y elementos de mejora a partir de estas. Métodos: Este estudio se diseñó mediante un enfoque de investigación cualitativa a partir de la realización de cuatro grupos dediscusión, durante el mes de mayo de 2022, a un total de veintiséis personas (igual número de hombres y mujeres) con edades decincuenta a sesenta y nueve años, residentes en la Comunidad de Madrid, Cataluña, Andalucía y País Vasco (en grandes y pequeñasciudades), con diferentes niveles formativos y distintas experiencias previas de participación en el programa de cribado de CCR. Resultados: Se detectaron distintas conceptualizaciones de la prevención, pero ninguna que englobe el cáncer (y especialmente el colorrectal) como elemento a incorporar en las prácticas cotidianas, ya que su aparición se asocia fundamentalmente al azar.Sumado al desconocimiento del CCR frente a otros tipos (mama o próstata), se percibieron diferentes barreras de carácter actitudinala la participación en un programa de cribado de CCR, como fueron el rechazo a formar parte del colectivo de más edad (diana de laprueba), el miedo a la espera por los resultados, la falta de fiabilidad o la sensación de poder postergar el momento...(AU)
Backgorund: The screening for colorectal cancer (CRC) through the fecal occult blood test (FOBT) has achieved high implementation in Spain, although participation rates are still not optimal. At the same time, available data show significant differencesin participation both among autonomous communities and among different sociodemographic groups, which raises various equityissues. This study aimed to conduct an exploratory analysis from a qualitative perspective on the attitudes, perceptions, and socialimages that the target population for colorectal cancer screenings holded regarding them, as well as the barriers and areas forimprovement identified through these. Methods: This study was designed using a qualitative research approach, through the conduct of four focus groups in May 2022, witha total of twenty-six participants (equal number of men and women) aged fifty to sixty-nine years. The participants were residents of theCommunity of Madrid, Catalonia, Andalusia, and the Basque Country (in both large and small cities), with varying educational levels anddifferent previous experiences of participation in the CRC screening program. Results: Different conceptualizations of prevention were identified, but none that encompassed cancer (especially colorectalcancer) as an element to be incorporated into daily practices since its occurrence is primarily associated with chance. In addition tothe lack of knowledge about CRC compared to other types of cancer (such as breast or prostate cancer), various attitudinal barriersto participation in the CRC screening program were perceived. These included the rejection of being part of the older age group(targeted by the test), fear of waiting for the results, lack of reliability, or the sense of being able to postpone the moment...(AU)
Assuntos
Humanos , Neoplasias Colorretais/sangue , Neoplasias Colorretais/microbiologia , Programas de Triagem Diagnóstica , Prevenção de Doenças , Detecção Precoce de Câncer , Sangue Oculto , Saúde Pública , Pesquisa Qualitativa , Espanha , Serviços Preventivos de SaúdeRESUMO
La pandemia por COVID-19 en Navarra ha impactado tanto en la atención de los pacientes infectados por SARS-CoV-2 como en la cantidad de servicios de salud provistos y en la manera de proveerlos, incluyendo la prevención, tratamiento y seguimiento de los pacientes con cáncer. En Navarra, la situación de los programas de detección precoz de cáncer de mama (PDPCM) y colorrectal (PDPCCR) se vio comprometida durante 2020. Durante el periodo de confinamiento se suspendieron ambos (la realización de mamografías y el envío de kits, respectivamente), para evitar un riesgo adicional de las personas invitadas a participar y de los profesionales, además de la necesidad de dedicar muchos de los recursos asistenciales, profesionales y físicos a la atención de la COVID-19. Durante 2020 la cobertura por invitación del PDPCM se redujo casi a la mitad y la del PDPCCR l a una cuarta parte, sin que la participación en ambos programas se viese afectada. El programa de detección precoz de cáncer de cuello de útero (PDPCCU), que estaba en fase de diseño antes de la pandemia, se interrumpió debido a la necesidad de destinar todos los recursos informáticos a la pandemia. Tras la desescalada, aunque con mucho esfuerzo, se fue progresivamente recuperando la actividad de los programas anteriormente en funcionamiento, y se retomó el diseño del PDPCCU.(AU)
Assuntos
Humanos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pandemias , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/prevenção & controle , Espanha , Saúde Pública , Sistemas de Saúde , Serviços de Saúde , Neoplasias/prevenção & controle , Detecção Precoce de Câncer , Programas de Triagem DiagnósticaAssuntos
Humanos , Hepatopatias , Hepatite , Infecções , Programas de Triagem Diagnóstica , Estratégias de eSaúde , Gastroenterologia , Sistemas de Saúde , ConsensoRESUMO
Introducción. Las pruebas diagnósticas de tamizaje son aquellas pruebas que son capaces de identificar un factor de riesgo o mutaciones genéticas que predicen el inicio ulterior de la enfermedad, así como también las pruebas que ponen de manifiesto alteraciones estructurales de la enfermedad antes que la enfermedad progrese y se vuelva sintomática. Métodos. Se hizo una revisión de la literatura para establecer los fundamentos teóricos científicos que sustentan a las pruebas de diagnóstico de tamizaje y las condiciones y requisitos que se deben cumplir para introducirlas en el ámbito clínico o como programas de salud pública. Resultados. Se estableció la diferencia conceptual entre la detección precoz y el diagnóstico temprano y la diferencia entre tamizaje de prevalencia y tamizaje de incidencia. Se dieron a conocer las indicaciones y criterios científicos para la realización de las pruebas de tamizaje. Se puntualizó la importancia de la duración del tiempo de adelanto en la eficacia de las pruebas diagnósticas de detección precoz. Se argumentaron las razones por las cuales era necesario la realización de experimentos clínicos aleatorizados para evaluar la eficacia de las pruebas diagnósticas de detección precoz en la prevención secundaria de la enfermedad. Conclusiones. Las pruebas diagnósticas de tamizaje hacen posible la introducción de intervenciones en el ámbito de la prevención primaria, como también en el escenario de la prevención secundaria de las enfermedades.
Introduction. Screening diagnostic tests are those tests that help to identify a risk factor or genetic mutations that predict the subsequent onset of the disease, as well as tests that reveal structural alterations of the disease before the disease progresses and becomes symptomatic. Methods. A literature review was performed to establish the scientific theoretical fundamentals that support diagnostic screening tests and the conditions and requirements that must be met to introduce them in the clinical setting or as public health programs. Results. The conceptual difference between early detection and early diagnosis and the difference between prevalence screening and incidence screening was established. Indications and scientific criteria for conducting screening tests were presented. The importance of the duration of the lead time in the efficacy of early detection diagnostic tests was pointed out. The reasons why it was necessary to carry out a randomized clinical experiment to evaluate the efficacy of early detection diagnostic tests for early diagnosis in the secondary prevention of the disease were confronted. Conclusions. Screening diagnostic tests make it possible to introduce interventions in the field of primary prevention, as well as in the setting of secondary prevention of diseases.
Assuntos
Humanos , Programas de Rastreamento , Valor Preditivo dos Testes , Programas de Triagem Diagnóstica , Técnicas e Procedimentos Diagnósticos , Diagnóstico PrecoceRESUMO
[EXTRACT]. The articles in this special issue on HEARTS in the Americas illustrate a wide range of important research on implementing the comprehensive HEARTS model throughout the Americas. Results show that this approach works in countries with differ- ing social and political environments and can be scaled up to serve large populations. Public health programs work best when they focus on specific, measurable, ambitious, achievable targets. In hypertension con- trol, this means focusing on steadily increasing the proportion of all people with estimated hypertension who are adequately treated.
Assuntos
Doenças Cardiovasculares , Hipertensão , Programas de Triagem Diagnóstica , AméricaRESUMO
[ABSTRACT]. Hypertension remains the leading cause of cardiovascular disease globally despite the availability of safe and effective treatments. Unfortunately, many barriers exist to controlling hypertension, including a lack of effective screening and awareness, an inability to access treatment and challenges with its management when it is treated. Addressing these barriers is complex and requires engaging in a systematic and sustained approach across communities over time. This analysis aims to describe the key elements needed to create an effective delivery system for hypertension control. A successful system requires political will and supportive leadership at all levels of an organization, including at the point of care delivery (office or clinic), in the health care system, and at regional, state and national levels. Effective screening and outreach systems are necessary to identify individuals not previously diagnosed with hypertension, and a system for follow up and tracking is needed after people are diagnosed. Implementing simple protocols for treating hypertension can reduce confusion among providers and increase treatment efficiency. Ensuring easy access to safe, effective and affordable medica- tions can increase blood pressure control and potentially decrease health care system costs. Task-sharing among members of the health care team can expand the services that are delivered. Finally, monitoring of and reporting on the performance of the health care team are needed to learn from those who are doing well, disseminate ideas to those in need of improvement and identify individual patients who need outreach or additional care. Successful large-scale hypertension programs in different settings share many of these key elements and serve as examples to improve systems of hypertension care delivery throughout the world.
[RESUMEN]. A pesar de la disponibilidad de tratamientos seguros y efectivos, la hipertensión sigue siendo la principal causa de enfermedad cardiovascular a nivel mundial. Lamentablemente, el control de la hipertensión enfrenta muchos obstáculos, como la falta de detección y concientización efectivas, la incapacidad de acceder al tratamiento y los retos que plantea su manejo cuando se recibe tratamiento. Resulta complejo abordar estos obstáculos; se debe adoptar un enfoque sistemático y sostenido en todas las comunidades a lo largo del tiempo. El presente análisis tiene como objetivo describir los elementos clave necesarios para crear un sistema de atención eficaz para el control de la hipertensión. Un sistema adecuado precisa voluntad política y un liderazgo que brinde apoyo en todos los niveles de una organización, incluido el punto donde se presta la atención (consultorio o clínica), el sistema de atención de salud y a nivel regional, estatal y nacional. Se necesitan sistemas efectivos de detección y de alcance comunitario para encontrar a las personas sin diag- nóstico previo de hipertensión, así como un sistema para el seguimiento y la localización una vez han sido diagnosticadas. La aplicación de protocolos simples para tratar la hipertensión puede reducir la confusión entre los proveedores y aumentar la eficiencia del tratamiento. Garantizar un acceso fácil a medicamentos seguros, efectivos y asequibles puede aumentar el control de la presión arterial y potencialmente disminuir los costos para el sistema de atención de salud. La distribución de tareas entre los miembros del equipo de atención de salud permite expandir los servicios que se prestan. Finalmente, es necesario dar seguimiento al desempeño del equipo de atención de salud y presentar información al respecto, a fin de aprender de las buenas prácticas, difundir ideas entre quienes necesitan mejorar y determinar a cuáles pacientes se debe llegar y cuáles necesitan atención adicional. Los programas de hipertensión a gran escala con buenos resultados en diferentes entornos comparten muchos de estos elementos clave y sirven como ejemplos para mejorar la atención de la hipertensión en todo el mundo.
[RESUMO]. A hipertensão continua sendo a principal causa de doenças cardiovasculares no mundo, apesar da dis- ponibilidade de tratamentos seguros e eficazes. Infelizmente, existem muitas barreiras para o controle da hipertensão, incluindo a falta de rastreamento e a conscientização eficazes, a incapacidade de acesso ao tratamento e desafios de conduta clínica quando ela é tratada. A abordagem dessas barreiras é complexa e requer um enfoque sistemático e sustentado em diferentes comunidades ao longo do tempo. Esta análise tem como objetivo descrever os elementos-chave necessários para criar um sistema eficaz de prestação de intervenções para o controle da hipertensão. Um sistema de sucesso requer vontade política e liderança que o apoie em todos os níveis de uma organização, inclusive no ponto da prestação de cuidados (consultório ou clínica), no sistema de saúde e nos níveis regional, estadual e nacional. Sistemas eficazes de triagem e acolhida são necessários para identificar indivíduos com hipertensão não diagnosticada, e um sistema de acompanhamento e rastreamento após o diagnóstico se faz igualmente necessário. A implementação de protocolos simples para o tratamento da hipertensão pode reduzir a confusão entre os profissionais de saúde e aumentar a eficiência do tratamento. Garantir o fácil acesso a medicamentos seguros, eficazes e acessíveis pode aumentar o controle da pressão arterial e potencialmente diminuir os custos do sistema de saúde. A divisão de tarefas entre os integrantes da equipe de saúde pode expandir os serviços prestados. Finalmente, é necessário monitorar e informar acerca do desempenho da equipe de saúde para aprender com aqueles que estão indo bem, disseminar ideias para aqueles que precisam melhorar e identificar pacientes individuais que precisam de ajuda ou cuidados adicionais. Programas bem-sucedidos de controle da hipertensão em larga escala em diferentes ambientes compartilham muitos desses elementos-chave e servem como exem- plos para melhorar os sistemas de atenção à hipertensão em todo o mundo.
Assuntos
Hipertensão , Equipe de Assistência ao Paciente , Melhoria de Qualidade , Saúde da População , Gestão da Saúde da População , Protocolos Clínicos , Programas de Triagem Diagnóstica , Anti-Hipertensivos , Hipertensão , Equipe de Assistência ao Paciente , Melhoria de Qualidade , Saúde da População , Gestão da Saúde da População , Protocolos Clínicos , Programas de Triagem Diagnóstica , Anti-Hipertensivos , Hipertensão , Equipe de Assistência ao Paciente , Melhoria de Qualidade , Saúde da População , Gestão da Saúde da População , Programas de Triagem Diagnóstica , Anti-HipertensivosRESUMO
Background & aims: Colorectal (CRC) screening programs represent a large volume of procedures that need a follow-up endoscopy. A knowledge-based clinical decision support system (K-CDSS) is a technology which contains clinical rules and associations of compiled data that assist with clinical decision-making tasks. We develop a K-CDSS for management of patients included in CRC screening and surveillance of colorectal polyps. Methods: We collected information on 48 variables from hospital colonoscopy records. Using DILEMMA Solutions Platform © (https://www.dilemasolution.com) we designed a prototype K-CDSS (PoliCare CDSS), to provide tailored recommendations by combining patients data and current guidelines recommendations. The accuracy of rules was verified using four scenarios (normal colonoscopy, lesions different than polyps, non-advanced adenomas and advanced adenomas). We studied the degree of agreement between the clinical assessments made by expert doctors and nurses equipped with PoliCare CDSS. Two experts confirmed a correlation between guidelines and PoliCare recommendations. Results: 56 consecutive endoscopy cases from colorectal screening program were included (62.8 years; range 53-71). Colonoscopy results were: absence of colon lesions (n=7, 12.5%), lesions in the colon that are not polyps (n=3, 5.4%) and resected colonic polyps (n=46, 82.1%; 100% R0 resection). Patients with resected polyps presented non-advanced adenoma (n=21, 45.6%) or advanced lesions (n=25, 54.4%). There were no differences in erroneous orders with PoliCare CDSS (Kappa value 1.0). Conclusions: PoliCare CDSS can easily be integrated into the workflow for improving the overall efficiency and better adherence to evidence-based guidelines.(AU)
Antecedentes & objetivos: Los programas de cribado de cáncer colorrectal (CCR) generan un gran número de colonoscopias de seguimiento. Un sistema de soporte a la decisión clínica basado en el conocimiento (K-CDSS) es una tecnología que contiene reglas clínicas y asociaciones de datos que ayudan en la tarea de toma de decisiones clínicas. El objetivo fue desarrollar un K-CDSS para el manejo de los pacientes de cribado de CCR, y evaluar su eficacia. Métodos: Recolectamos información de 48 variables de registros de colonoscopia. Mediante el software DILEMMA (https://www.dilemasolution.com) diseñamos un prototipo de K-CDSS (PoliCare CDSS), para proporcionar recomendaciones personalizadas, combinando los datos de los pacientes y las recomendaciones de las guías actuales. La exactitud de las reglas se verificó mediante cuatro escenarios (colonoscopia normal, lesiones diferentes a pólipos, adenomas no avanzados y adenomas avanzados). Se estudió el grado de concordancia entre las valoraciones clínicas realizadas por médicos expertos y enfermeros equipados con PoliCare CDSS. Dos expertos confirmaron una correlación entre las pautas y las recomendaciones de PoliCare. Resultados: Se incluyeron 56 casos consecutivos del programa de cribado (62,8 años; rango 53-71). Los resultados de la colonoscopia fueron: ausencia de lesiones de colon (n = 7, 12,5%), lesiones en el colon que no son pólipos (n = 3, 5,4%) y pólipos de colon resecados (n = 46, 82,1%; resección R0 del 100%). Los pacientes con pólipos resecados presentaron adenoma no avanzado (n = 21, 45,6%) o lesiones avanzadas (n = 25, 54,4%). No hubo diferencias en recomendaciones erróneas con PoliCare CDSS (valor Kappa 1.0). Conclusiones: PoliCare CDSS se puede integrar fácilmente en el flujo de trabajo de una unidad de endoscopia digestiva.(AU)
Assuntos
Programas de Triagem Diagnóstica , Neoplasias Colorretais , Colonoscopia , Sistemas de Apoio a Decisões Clínicas , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Estudos Retrospectivos , Gastroenterologia , Prontuários MédicosRESUMO
Objetivo: El consenso de Baveno VI para el cribado endoscópico de varices esofagogástricas recomienda evitar la endoscopia en algunos pacientes. Bajo esta estrategia, podrían pasar desapercibidas lesiones no relacionadas con hipertensión portal, algunas de ellas potencialmente graves. El objetivo de este estudio es determinar la prevalencia de dichas lesiones e identificar los factores clínicos asociados a las mismas. Pacientes y métodos: Estudio transversal unicéntrico sobre una cohorte consecutiva de pacientes cirróticos sometidos a endoscopia digestiva alta en el contexto de un programa de cribado de varices esofagogástricas entre noviembre del 2013 y noviembre del 2018. Se analizaron los factores de riesgo para la presencia de lesiones no relacionadas con hipertensión portal mediante regresión logística uni y multivariante. Resultados: Se incluyó a 379 pacientes. La etiología mayoritaria de la cirrosis fue etílica (n=229; 60,4%). La prevalencia de lesiones endoscópicas no relacionadas con hipertensión portal fue del 39,6% (n=150). Entre los 96 pacientes con enfermedad péptica (25,3%) se tomó test de ureasa en 54 (56,2%), siendo positiva en 24 (44,4%). La presencia de lesiones endoscópicas no relacionadas con hipertensión portal no estuvo influida por la edad (p=1), el género (p=0,28), la función hepática (MELD p=0,20, Child-Pugh p=0,77) o la presencia de datos ecográficos de hipertensión portal (p=0,14). Los pacientes fumadores presentaron tendencia a mayor prevalencia de lesiones endoscópicas no relacionadas con la hipertensión portal (43,2% vs. 34,6%; p=0,09), particularmente úlcera péptica (6,4% vs. 0,6%; p=0,05) y duodenitis péptica (17,3% vs. 6,3%; p=0,002). El tabaquismo activo fue el único factor predictivo independiente de ulcus o duodenitis péptica (odds ratio=2,56; intervalo de confianza del 95%: 1,18-5,56; p=0,017).(AU)
Aim: To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis. Patients and methods: Cross-sectional study including a consecutive cohort of patients with liver cirrhosis enrolled in a screening program of oesophageal varices who underwent an upper gastrointestinal endoscopy from November, 2013, to November, 2018. Clinical predictors of endoscopic lesions unrelated to portal hypertension were analyzed by univariate and multivariate logistic regression. Results: A total of 379 patients were included. The most frequent aetiology of liver disease was alcohol consumption (60.4%). The prevalence of endoscopic lesions unrelated with portal hypertension was 39.6% (n=150). Among 96 patients with peptic lesions, urease was obtained in 56.2% of patients (positive in 44.4% of them). The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. Smokers had a trend to increased prevalence of endoscopic lesions unrelated to portal hypertension (43.2% vs. 34.6%; p=0.09), particularly peptic ulcer (6.4% vs. 0.6%; p=0.05) and peptic duodenitis (17.3% vs. 6.3%; p=0.002). Active smoking was the only independent predictor of peptic ulcer or duodenitis (OR=2.56; p=0.017). Conclusion: Active smoking is a risk factor for endoscopic lesions unrelated to portal hypertension. This finding should be further investigated to reassess endoscopic screening programs in cirrhotic smokers.(AU)
Assuntos
Humanos , Hipertensão , Cirrose Hepática , Programas de Rastreamento , Programas de Triagem Diagnóstica , Varizes , Hipertensão Portal , Endoscopia do Sistema Digestório , Duodenite/complicações , Estudos Transversais , GastroenterologiaRESUMO
BACKGROUND: Abnormal levels of maternal biochemical markers used in multiple marker aneuploidy screening have been associated with adverse pregnancy outcomes. This study aims to assess if a combination of maternal characteristics and biochemical markers in the first and second trimesters can be used to screen for preeclampsia (PE). The secondary aim was to assess this combination in identifying pregnancies at risk for gestational hypertension and preterm birth. METHODS: This case-control study used information on maternal characteristics and residual blood samples from pregnant women who have undergone multiple marker aneuploidy screening. The median multiple of the median (MoM) of first and second trimester biochemical markers in cases (women with PE, gestational hypertension and preterm birth) and controls were compared. Biochemical markers included pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), human chorionic gonadotropin (hCG), alpha feto-protein (AFP), unconjugated estriol (uE3) and Inhibin A. Logistic regression analysis was used to estimate screening performance using different marker combinations. Screening performance was defined as detection rate (DR) and false positive rate (FPR). Preterm and early-onset preeclampsia PE were defined as women with PE who delivered at < 37 and < 34 weeks of gestation, respectively. RESULTS: There were 147 pregnancies with PE (81 term, 49 preterm and 17 early-onset), 295 with gestational hypertension, and 166 preterm birth. Compared to controls, PE cases had significantly lower median MoM of PAPP-A (0.77 vs 1.10, p < 0.0001), PlGF (0.76 vs 1.01, p < 0.0001) and free-ß hCG (0.81 vs. 0.98, p < 0.001) in the first trimester along with PAPP-A (0.82 vs 0.99, p < 0.01) and PlGF (0.75 vs 1.02, p < 0.0001) in the second trimester. The lowest first trimester PAPP-A, PlGF and free ß-hCG were seen in those with preterm and early-onset PE. At a 20% FPR, 67% of preterm and 76% of early-onset PE cases can be predicted using a combination of maternal characteristics with PAPP-A and PlGF in the first trimester. The corresponding DR was 58% for gestational hypertension and 36% for preterm birth cases. CONCLUSIONS: Maternal characteristics with first trimester PAPP-A and PlGF measured for aneuploidy screening provided reasonable accuracy in identifying women at risk of developing early onset PE, allowing triage of high-risk women for further investigation and risk-reducing therapy. This combination was less accurate in predicting women who have gestational hypertension or preterm birth.
Assuntos
Aneuploidia , Biomarcadores/sangue , Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico , Proteína Plasmática A Associada à Gravidez , Adulto , Estudos de Casos e Controles , Programas de Triagem Diagnóstica , Feminino , Humanos , Hipertensão Induzida pela Gravidez/sangue , Hipertensão Induzida pela Gravidez/diagnóstico , Modelos Logísticos , Ontário/epidemiologia , Gravidez , Trimestres da Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/diagnóstico , Curva ROC , Estudos RetrospectivosRESUMO
Programas de saúde auditiva estão voltados predominantemente para crianças entre 0 e 3 anos de idade ou para os maiores de 7. As crianças entre estas duas faixas etárias não estão em nenhum destes programas, porém é neste grupo que mais ocorrem problemas de orelha média, e, é, neste grupo, possível detectar as perdas auditivas mínimas, leves ou unilaterais que não foram identificadas nos programas de triagem auditiva neonatal. Objetivo: Identificar alterações auditivas em crianças pré-escolares por meio de um programa de triagem auditiva. Método: Trata-se de estudo descritivo, transversal e observacional realizado em duas escolas municipais do município de Mauá. A amostra foi composta por crianças de cinco e seis anos de idade. O programa de triagem auditiva foi composto: a. otoscopia; b. timpanometria, e c. registro das emissões otoacústicas transiente (EOAT) e produto de distorção (EOAPD). Em vista da pandemia iniciada em março de 2020, não foi possível avaliar as crianças de três e quatro anos. Resultados: 28,44% (n= 31) de crianças falharam na otoscopia. Das 78 (71,55%) crianças que passaram na otoscopia, 30,8% falharam na timpanometria; 16,7% nas Emissões Otoacústicas Produto de Distorção (DPOAE) e 19,2% nas Emissões Otoacústicas por estímulo Transiente (TPOAE); 30,76% (n= 24) das crianças falharam em pelo menos um dos três procedimentos. Conclusão: foram identificadas 30,76% de crianças com risco de alteração auditiva que devem ser encaminhadas para avaliação médica e audiológica.
Hearing health programs are predominantly aimed at children between 0 and 3 years of age or those older than 7. Children between these two age groups are not in any of these programs, but it is in this group that the most middle ear problems occur, and, it is in this group, possible to detect minimal, mild, or unilateral hearing loss that was not identified in neonatal hearing screening programs. Objective: To identify hearing alterations in preschool children through a hearing screening program. Method: This is a descriptive, cross-sectional, and observational study conducted in two municipal schools in the municipality of Mauá. The sample consisted of children aged five and six years. The hearing screening program was composed of a. otoscopy; b. tympanometry and, c. recording of transient otoacoustic emissions (TOAE) and distortion product (DPOAE). In view of the pandemic that began in March 2020, it was not possible to evaluate the three and four-year-old children. Results: 28.44% (n= 31) of the children failed otoscopy. Of the 78 (71.55%) children who underwent otoscopy, 30.8% failed tympanometry: 16.7% in Distortion Product Otoacoustic Emissions (DPOAE) and 19.2% in Transient Stimulus Otoacoustic Emissions (TPOAE); 30.76% (n= 24) of the children failed at least one of the three procedures. Conclusion: 30.76% of children at risk of hearing impairment were identified and should be referred for medical and audiological evaluation.
Los programas de salud auditiva están dirigidos principalmente a niños entre 0 y 3 años o mayores de 7 años. Los niños entre estos dos grupos de edad no están en ninguno de estos programas, pero es en este grupo que ocurren la mayoría de los problemas del oído medio, y, es en este grupo, posible detectar la pérdida de audición mínima, leve o unilateral que no se identificó en los programas de cribado auditivo neonatal. Objetivo: Identificar las alteraciones auditivas en niños en edad preescolar a través de un programa de detección auditiva. Método: Se trata de un estudio descriptivo, transversal y observacional realizado en dos colegios municipales del municipio de Mauá. La muestra estuvo constituida por niños de cinco y seis años y sus padres/tutores. El programa de detección de audición estuvo compuesto por: a. Cuestionario para padres/tutores sobre la historia de la salud auditiva de los niños; b. otoscopia; c. timpanometria y, d. Registro de emisiones otoacústicas transitorias (EOT) y producto de distorsión (DPOAE). Ante la pandemia que comenzó en marzo de 2020, no fue posible realizar los reexámenes ni evaluar a los niños de tres y cuatro años. Resultados: 28,44% (n= 31) de los niños no pasaron la otoscopia. De los 78 (71,55%) niños que se sometieron a otoscopia, 30,8% fallaron la timpanometria; 16,7% en emisiones otoacústicas de productos de distorsión (DPOAE) y 19,2% en emisiones otoacústicas de estímulo transitorio (TPOAE); 30,76% (n= 24) de los niños fallaron por lo menos uno de los tres procedimientos. Conclusión: 30,76% de los niños con riesgo de deficiencia auditiva fueron identificados y deben ser referidos para evaluación médica y audiológica.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Pré-Escolar , Programas de Triagem Diagnóstica , Audição , Estudos Transversais , Perda Auditiva/diagnósticoRESUMO
Introducción: La supervivencia del cáncer colorrectal es del 57% a los 5 años, en parte debido a un diagnóstico tardío por una baja participación en los programas de cribado. Son necesarios instrumentos que analicen las causas de participación.Objetivo: Comprobar la validez y consistencia interna de la versión en castellano del cuestionario de Rawl para el cribado de cáncer colorrectal con sangre oculta en heces.Tipo de estudio: Metodología de validación de cuestionarios.Localización: Tres centros de salud de Valencia.Variables: Edad, sexo, estado civil, nivel de estudios, clase social, consumo de tabaco, alcohol, índice de masa corporal, antecedentes personales y familiares de cáncer.Resultados: Se estudiaron 408 individuos (237 casos y 171 controles). La edad media fue de 59,45 (DE 5,17) años. La consistencia interna de todas las variables alcanzó una alfa de Cronbach de 0,796. El alfa de Cronbach de la dimensión beneficios del cribado fue de de 0,871 y para la dimensión barreras al cribado fue de 0,817. Los coeficientes de correlación intraclase del test-retest para la dimensión de los beneficios del cribado fue de 0,809 (IC 95% 0,606-0,913) y de 0,499 (IC 95% 0,126-0,750) para las barreras.Conclusión: La versión en castellano del cuestionario Rawl es válido, fiable y reproducible. Con lo que disponemos de un elemento validado en España con el que objetivar barreras y beneficios percibidos en un programa de cribado poblacional.
Introduction: Colorectal cancer 5-years-survival is 57%, partway due to a low rate of participation in screening programmes. Instruments analyzing causes of low adherence are needed.Objective: To evaluate the validity and internal consistency of the Spanish version of Rawl's Questionnaire for the screening of colorectal cancer by faecal occult blood testing.Type of study: Questionnaire validation methodology.Location: Three Primary Care Centres in Valencia.Variables: Age, sex, civil status, educational level, social class, smoking, alcohol consumption, body mass index, personal and family history of cancer.Results: We analyzed 408 individuals (237 cases and 171 controls). Mean age was 59.45 years (SD 5.17). Internal consistency of all variables reached a Cronbach's alfa of 0.796. The Cronbach's alfa benefit dimension of the screening was 0.871 and for the barrier dimension of the screening it was 0.817. Intraclass correlation coefficients of the test-retest for the benefit dimension of the screening was 0.809 (CI 95% 0.606-0.913) and 0.499 (CI 95% 0.126-0.750) for the barrier dimension.Conclusion: The Spanish version of Rawl's Questionnaire is valid, reliable and reproducible, so we have this validated instrument with which to identify barriers and benefits in a colorectal screening programme in Spain.
Assuntos
Humanos , Adulto , Neoplasias Colorretais , Fezes , Programas de Triagem Diagnóstica , Neoplasias Colorretais/diagnóstico , Análise Multivariada , Interpretação Estatística de Dados , Estudos de Casos e Controles , Gastroenterologia , Fatores Etários , EspanhaRESUMO
INTRODUCTION: Even if now we have available the weapon of vaccination against SARS-CoV-2, the patients with cancer remains a very frail population in which frequently the immunologic response to vaccination may be impaired. In this setting, the SARS-CoV-2 infection screening retains a great value. However, there are still limited data on the feasibility and efficacy of combined screening procedures to assess the prevalence of SARS-CoV-2 infection (including asymptomatic cases) in cancer outpatients undergoing antineoplastic therapy. PATIENTS AND RESULTS: From May 1, 2020, to June 15, 2020, during the first wave of SARS-CoV-2 pandemic, 860 consecutive patients, undergoing active anticancer therapy, were evaluated and tested for SARS-CoV-2 with a combined screening procedure, including a self-report questionnaire, a molecular nasopharyngeal swab (NPS) and a rapid serological immunoassay (for anti-SARS-CoV-2 IgG/IgM antibodies). The primary endpoint of the study was to estimate the prevalence of SARS-CoV-2 infection (including asymptomatic cases) in consecutive and unselected cancer outpatients by a combined screening modality. A total of 2955 SARS-CoV-2 NPS and 860 serological tests, in 475 patients with hematologic cancers and in 386 with solid tumors, were performed. A total of 112 (13%) patients self-reported symptoms potentially COVID-19 related. In 1/860 cases (< 1%) SARS-CoV-2 NPS was positive and in 14 cases (1.62%) the specific serological test was positive (overall prevalence of SARS-CoV-2 infection 1.62%). Of the 112 cases who declared symptoms potentially COVID-19-related, only 2.7% (3/112) were found SARS-CoV-2 positive. CONCLUSIONS: This is the largest study reporting the feasibility of a combined screening procedure (including triage, NPS and serologic test) to evaluate the prevalence of SARS-CoV-2 infection in cancer patients receiving active therapy, during the first epidemic wave and under the restrictive lockdown measures, in one of the active areas of the SARS-CoV-2 circulation. Lacking specific recommendations for the detection of asymptomatic SARS-CoV-2 cases, a combined diagnostic screening might be more effective to detect the exact prevalence of SARS-CoV-2 in neoplastic patient population. The prevalence can obviously change according to the territorial context, the entity of the restrictive measures adopted and the phase of the epidemic curve. However, its exact and real-time knowledge could be important to balance risks/benefits of oncologic treatments, avoiding (if the prevalence is low) the reduction of dose intensity or the selection of less intensive (but also less effective) anti-cancer therapies.