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Best Practice & Research. Clinical... 2021Gastric cancer (GC) is a significant global health problem, with Helicobacter pylori infection estimated to be responsible for 89% of non-cardiac GC cases, or 78% of all... (Review)
Review
Gastric cancer (GC) is a significant global health problem, with Helicobacter pylori infection estimated to be responsible for 89% of non-cardiac GC cases, or 78% of all GC cases. The International Agency for Research on Cancer has called for Helicobacter pylori test-and-treat strategies in countries with high rates of GC. However, for countries with low rates of GC, such as most Western countries, the balance between benefits, harms and costs of screening is less clear-cut. GC is a disease with a well-characterized precancerous process, providing the basis for primary and secondary prevention efforts. However, rigorous data assessing the impact of such interventions in Western countries are lacking. In the absence of clinical trials, modelling offers a unique approach to evaluate the potential impact of various screening and surveillance interventions. In this paper, we provide an overview of modelling studies evaluating the cost-effectiveness of GC screening and surveillance in Western countries.
Topics: Cost-Benefit Analysis; Early Detection of Cancer; Humans; Mass Screening; Stomach Neoplasms
PubMed: 33975689
DOI: 10.1016/j.bpg.2021.101735 -
Biostatistics (Oxford, England) Jul 2020Group testing involves pooling individual specimens (e.g., blood, urine, swabs, etc.) and testing the pools for the presence of disease. When the proportion of diseased...
Group testing involves pooling individual specimens (e.g., blood, urine, swabs, etc.) and testing the pools for the presence of disease. When the proportion of diseased individuals is small, group testing can greatly reduce the number of tests needed to screen a population. Statistical research in group testing has traditionally focused on applications for a single disease. However, blood service organizations and large-scale disease surveillance programs are increasingly moving towards the use of multiplex assays, which measure multiple disease biomarkers at once. Tebbs and others (2013, Two-stage hierarchical group testing for multiple infections with application to the Infertility Prevention Project. Biometrics69, 1064-1073) and Hou and others (2017, Hierarchical group testing for multiple infections. Biometrics73, 656-665) were the first to examine hierarchical group testing case identification procedures for multiple diseases. In this article, we propose new non-hierarchical procedures which utilize two-dimensional arrays. We derive closed-form expressions for the expected number of tests per individual and classification accuracy probabilities and show that array testing can be more efficient than hierarchical procedures when screening individuals for multiple diseases at once. We illustrate the potential of using array testing in the detection of chlamydia and gonorrhea for a statewide screening program in Iowa. Finally, we describe an R/Shiny application that will help practitioners identify the best multiple-disease case identification algorithm.
Topics: Algorithms; Biological Assay; Chlamydia Infections; Communicable Diseases; Gonorrhea; Humans; Iowa; Mass Screening; Models, Theoretical
PubMed: 30371749
DOI: 10.1093/biostatistics/kxy058 -
Missouri Medicine 2019Opioid use disorder risk assessment tools cannot be used in isolation. In combination with standardized clinical examination, and, when indicated, urine drug screening,... (Review)
Review
Opioid use disorder risk assessment tools cannot be used in isolation. In combination with standardized clinical examination, and, when indicated, urine drug screening, a validated risk assessment tool, improves the ability to detect opioid misuse. Even though no single tool has been shown to have both high interobserver reliability and high sensitivity, the standardized approach has still been shown to be superior to subjective care giver assessment. This article will provide a global approach to risk assessment in addition to reviewing the available tools.
Topics: Humans; Mass Screening; Opioid-Related Disorders; Risk Assessment
PubMed: 31527982
DOI: No ID Found -
Journal of Transcultural Nursing :... Jul 2022This narrative review identifies barriers and facilitators influencing breast cancer screening among Arab Muslim immigrants and refugees. Low participation rates create... (Review)
Review
INTRODUCTION
This narrative review identifies barriers and facilitators influencing breast cancer screening among Arab Muslim immigrants and refugees. Low participation rates create health inequities in breast cancer screening among this population.
METHOD
A systematic search of peer-reviewed empirical articles was performed. PRISMA, CASP, and MMAT checklists were used to appraise the studies.
RESULTS
Results include 3 themes: individual, health care system and health providers, and cultural factors.
DISCUSSION
Lack of fluency in the new country's language, lack of knowledge, and poor exposure to breast cancer screening may contribute to the Arab Muslim women's vulnerability to undiagnosed or delayed breast cancer diagnosis.
Topics: Arabs; Breast Neoplasms; Early Detection of Cancer; Emigrants and Immigrants; Female; Humans; Islam; Mass Screening; Refugees
PubMed: 35473467
DOI: 10.1177/10436596221085301 -
Missouri Medicine 2020Malignant colon and rectal disorders must be identified and treated. Timing and indication for diagnostic and screening colonoscopy are extremely important. A high index... (Review)
Review
Malignant colon and rectal disorders must be identified and treated. Timing and indication for diagnostic and screening colonoscopy are extremely important. A high index of suspicion to exclude malignancy is imperative. This paper will focus on the screening for and treatment of colorectal and anal cancers.
Topics: Colonoscopy; Digestive System Surgical Procedures; Early Detection of Cancer; Humans; Mass Screening; Primary Health Care
PubMed: 32848278
DOI: No ID Found -
JNCI Cancer Spectrum Aug 2021The cost-effectiveness of mammography screening among Chinese women remains contentious. Here, we characterized breast cancer (BC) epidemiology in Hong Kong and...
BACKGROUND
The cost-effectiveness of mammography screening among Chinese women remains contentious. Here, we characterized breast cancer (BC) epidemiology in Hong Kong and evaluated the cost-effectiveness of personalized risk-based screening.
METHODS
We used the Hong Kong Breast Cancer Study (a case-control study with 3501 cases and 3610 controls) and Hong Kong Cancer Registry to develop a risk stratification model based on well-documented risk factors. We used the Shanghai Breast Cancer Study to validate the model. We considered risk-based programs with different screening age ranges and risk thresholds under which women were eligible to join if their remaining BC risk at the starting age exceeded the threshold.
RESULTS
The lifetime risk (15-99 years) of BC ranged from 1.8% to 26.6% with a mean of 6.8%. Biennial screening was most cost-effective when the starting age was 44 years, and screening from age 44 to 69 years would reduce breast cancer mortality by 25.4% (95% credible interval [CrI] = 20.5%-29.4%) for all risk strata. If the risk threshold for this screening program was 8.4% (the average remaining BC risk among US women at their recommended starting age of 50 years), the coverage was 25.8%, and the incremental cost-effectiveness ratio (ICER) was US$18 151 (95% CrI = $10 408-$27 663) per quality-of-life-year (QALY) compared with no screening. The ICER of universal screening was $34 953 (95% CrI = $22 820-$50 268) and $48 303 (95% CrI = $32 210-$68 000) per QALY compared with no screening and risk-based screening with 8.4% threshold, respectively.
CONCLUSION
Organized BC screening in Chinese women should commence as risk-based programs. Outcome data (e.g., QALY loss because of false-positive mammograms) should be systemically collected for optimizing the risk threshold.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Breast Neoplasms; Case-Control Studies; China; Cost-Benefit Analysis; Female; Hong Kong; Humans; Mammography; Mass Screening; Middle Aged; Proportional Hazards Models; Quality-Adjusted Life Years; Registries; Risk Assessment; Risk Factors; Young Adult
PubMed: 34377936
DOI: 10.1093/jncics/pkab060 -
Sexually Transmitted Infections Mar 2022Women and girls are relatively under-represented across the HIV treatment cascade. Two conditions unique to women, pregnancy and cervical cancer/dysplasia, share a... (Review)
Review
BACKGROUND
Women and girls are relatively under-represented across the HIV treatment cascade. Two conditions unique to women, pregnancy and cervical cancer/dysplasia, share a common acquisition mode with HIV. This scoping review aimed to explore HIV testing practices in voluntary termination of pregnancy (TOP) and colposcopy services.
METHODS
The scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched articles published up to 20 December 2020 using three electronic databases (PubMed/Medline, Embase, Google Scholar) and including the keywords "HIV Testing", "Abortion, Induced", "Colposcopy", "HIV screen*" and "termination of pregnancy".
RESULTS
A total of 1496 articles were identified, of which 55 met the inclusion criteria. We included studies providing background HIV prevalence in addition to prevalence in the study population and studies of women seeking TOP rather than presenting with TOP complications. This limited our review to high-income, low HIV prevalence settings. We observed two study phases: studies pre-antiretroviral therapy (ART) using unlinked anonymous testing data and examining HIV risk factors associated with positive HIV tests and studies post-ART using routine testing data and exploring HIV testing uptake. HIV prevalence was estimated at >0.2% in most TOP settings and >1% (range 1.7%-11.4%) in colposcopy services. Many TOP providers did not have local HIV testing policies and HIV testing was not mentioned in many specialist guidelines. Testing uptake was 49%-96% in TOP and 23%-75% in colposcopy services.
CONCLUSION
Given the estimated HIV prevalence of >0.1% among women attending TOP and colposcopy services, HIV testing would be economically feasible to perform in high-income settings. Explicit testing policies are frequently lacking in these two settings, both at the local level and in specialist guidelines. Offering HIV testing regardless of risk factors could normalise testing, reduce late HIV presentation and create an opportunity for preventive counselling.
Topics: Abortion, Induced; Colposcopy; Female; HIV Infections; HIV Testing; Humans; Mass Screening; Pregnancy
PubMed: 34544889
DOI: 10.1136/sextrans-2021-055111 -
Clinical Pediatrics Mar 2022Universal lipid screening (ULS) is recommended for all 9- to 11-year-old children. We investigated ULS outcomes and long-term pediatrician management of children with...
Universal lipid screening (ULS) is recommended for all 9- to 11-year-old children. We investigated ULS outcomes and long-term pediatrician management of children with dyslipidemia using a retrospective chart review of well-child visits between 2014 and 2016. Descriptive statistics summarized demographics, ULS results, and follow-up visits/testing. Pearson χ test examined differences between those with and without an abnormal screen. A total of 1039 children aged 9 to 11 years were seen for a well-child visit; only 33.3% (343/1039) completed screening. Of children screened, 18.1% (62/343) had abnormal screen results and were more likely to have an elevated body mass index ( < .001), though 30.1% (19/62) had no risk factors. A total of 10.2% (35/343) had dyslipidemia. A total of 77.1% of children with dyslipidemia received nutrition/exercise counseling and 57.1% received dietitian referrals; only 68.6% had a follow-up visit and 31.4% had repeat lipid testing. Pediatricians would benefit from more practical strategies for universal testing such as point-of-care testing and long-term management to ensure ULS is an effective screening tool.
Topics: California; Chi-Square Distribution; Child; Disease Management; Female; Humans; Hypercholesterolemia; Lipids; Male; Mass Screening; Retrospective Studies
PubMed: 35090369
DOI: 10.1177/00099228221075409 -
BMC Health Services Research Nov 2022Unmet social risks such as housing, food insecurity and safety concerns are associated with adverse health outcomes in adults and children. Experimentation with social...
BACKGROUND
Unmet social risks such as housing, food insecurity and safety concerns are associated with adverse health outcomes in adults and children. Experimentation with social needs screening in primary care is currently underway throughout the United States. Pediatric primary care practices are well-positioned to amplify the effects of social needs screening and referral programs because all members of the household have the potential to benefit from connection to needed social services; however, more research is needed to determine effective implementation strategies.
METHODS
To describe common implementation barriers and facilitators, we conducted 48 in-depth qualitative interviews with leadership, providers and staff between November 2018 and June 2019 as part of a multiple case study of social needs screening and referral programs based out of four pediatric ambulatory care clinics in New York City. Interviews were recorded, transcribed and coded using a protocol-driven, template-based rapid analysis approach designed for pragmatic health services research. In addition to analyzing content for our study, we delivered timely findings to each site individually in order to facilitate quality improvement changes in close-to-real time.
RESULTS
Effective implementation strategies included tailoring screening tools to meet the needs of families seen at the clinic and reflect the resources available in the community, hiring dedicated staff to manage the program, building strong and lasting partnerships with community-based organizations, establishing shared communication methods between partners, and utilizing technology for efficient tracking of screening data. Respondents were enthusiastic about the value of their programs and the impact on families, but remained concerned about long-term sustainability after the grant period.
CONCLUSION
Implementation of social needs screening and referral interventions is dependent on contextual factors including the nature of family needs and the availability of intraorganizational and community resources to address those needs. Additional research is needed to prospectively test promising implementation strategies that were found to be effective across sites in this study. Sustainability of programs is challenging, and future research should also explore measurable outcomes and payment structures to support such interventions in pediatric settings, as well as aim to better understand caregiver perspectives to improve engagement.
Topics: Adult; Child; Humans; United States; Referral and Consultation; Mass Screening; Social Welfare; New York City; Primary Health Care
PubMed: 36397075
DOI: 10.1186/s12913-022-08692-x -
World Journal of Gastroenterology May 2024The screening of colorectal cancer (CRC) is pivotal for both the prevention and treatment of this disease, significantly improving early-stage tumor detection rates.... (Review)
Review
The screening of colorectal cancer (CRC) is pivotal for both the prevention and treatment of this disease, significantly improving early-stage tumor detection rates. This advancement not only boosts survival rates and quality of life for patients but also reduces the costs associated with treatment. However, the adoption of CRC screening methods faces numerous challenges, including the technical limitations of both noninvasive and invasive methods in terms of sensitivity and specificity. Moreover, socioeconomic factors such as regional disparities, economic conditions, and varying levels of awareness affect screening uptake. The coronavirus disease 2019 pandemic further intensified these cha-llenges, leading to reduced screening participation and increased waiting periods. Additionally, the growing prevalence of early-onset CRC necessitates innovative screening approaches. In response, research into new methodologies, including artificial intelligence-based systems, aims to improve the precision and accessibility of screening. Proactive measures by governments and health organizations to enhance CRC screening efforts are underway, including increased advocacy, improved service delivery, and international cooperation. The role of technological innovation and global health collaboration in advancing CRC screening is undeniable. Technologies such as artificial intelligence and gene sequencing are set to revolutionize CRC screening, making a significant impact on the fight against this disease. Given the rise in early-onset CRC, it is crucial for screening strategies to continually evolve, ensuring their effectiveness and applicability.
Topics: Humans; Colorectal Neoplasms; Early Detection of Cancer; COVID-19; Artificial Intelligence; Mass Screening; SARS-CoV-2; Quality of Life; Colonoscopy
PubMed: 38855153
DOI: 10.3748/wjg.v30.i20.2726