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Aim Methods Results Conclusions This study aimed to analyse perceptions, knowledge and ways of incorporating screening tools for mental disorders (MDs) into the daily practice of physicians working in primary health care (PHC) in the Brazilian public health system.This is a descriptive qualitative study with a sample of 24 physicians. The data collected in the semi‐structured interviews were subjected to reflective thematic analysis.The use of screening tools was low, not only due to lack of knowledge, but also due to reasoned criticism of this strategy developed by physicians trained in PHC. Physicians also presented a scenario of chaos, work overload and the fragility of the psychosocial care network as barriers to effective care of patients with MDs and to the incorporation of innovations in this care.Interventions aimed at improving the quality of mental health care should include training on the topic, (re)organizing work processes, strengthening the health care network and producing robust scientific evidence on interventions aimed at qualifying professionals in mental health in PHC. [ABSTRACT FROM AUTHOR]

Background: The intersection of artificial intelligence (AI) with cancer research is increasing, and many of the advances have focused on the analysis of cancer images. Objectives: To describe and synthesize the literature on the diagnostic accuracy of AI in early imaging diagnosis of cervical cancer following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ScR). Search Strategy: Arksey and O'Malley methodology was used and PubMed, Scopus, and Google Scholar databases were searched using a combination of English and Spanish keywords. Selection Criteria: Identified titles and abstracts were screened to select original reports and cross‐checked for overlap of cases. Data Collection and Analysis: A descriptive summary was organized by the AI algorithm used, total of images analyzed, data source, clinical comparison criteria, and diagnosis performance. Main Results: We identified 32 studies published between 2009 and 2022. The primary sources of images were digital colposcopy, cervicography, and mobile devices. The machine learning/deep learning (DL) algorithms applied in the articles included support vector machine (SVM), random forest classifier, k‐nearest neighbors, multilayer perceptron, C4.5, Naïve Bayes, AdaBoost, XGboots, conditional random fields, Bayes classifier, convolutional neural network (CNN; and variations), ResNet (several versions), YOLO+EfficientNetB0, and visual geometry group (VGG; several versions). SVM and DL methods (CNN, ResNet, VGG) showed the best diagnostic performances, with an accuracy of over 97%. Conclusion: We concluded that the use of AI for cervical cancer screening has increased over the years, and some results (mainly from DL) are very promising. However, further research is necessary to validate these findings. Synopsis: The role of artificial intelligence in cervical cancer screening has grown, showing promising results, particularly in deep learning. However, further research is required to validate these findings. [ABSTRACT FROM AUTHOR]

• The survival benefit from screening for bladder cancer (BC) may be due to the "lead time" (LT) bias. • LT is the interval between the detection of BC in asymptomatic and symptomatic persons. • LT may be derived from the ratio between the prevalence of pre-symptomatic BC and its incidence. • These ratios are 3.3 to 12.1 years if derived from screening for microhematuria. • LT may, therefore, account for the survival benefit from early treatment of BC. • The benefit of screening for BC should be confirmed by randomized trials. Some studies have suggested a survival benefit from early treatment of bladder cancer (BC). This benefit may be due in part to a "lead-time" bias (LT), i.e., the time interval between the detection of BC in asymptomatic individuals and the development of symptoms ("backward prolongation of survival"). To estimate the LT of BC, it was assumed that LT corresponds to the ratio between the prevalence of pre-symptomatic BC and the incidence of symptomatic BC. Data on the prevalence of pre-symptomatic BC were derived from published screening studies. Data on the annual incidence of symptomatic BC at the age and gender of the study populations were derived from national registries in the countries in the years in which the screening studies were conducted. The ratios of the prevalence of presymptomatic BC to the incidence of symptomatic BC ranged from 3.3 to 12.1 years when derived from screening for microhematuria, and from 1.8 to 5.3 years when derived from screening for urine cytology and cell markers. The estimates of the LT of BC derived from the ratios between its prevalence in asymptomatic persons and its incidence in the corresponding population were consistent with those previously reported in retrospective and prospective cohort studies. Since these estimates may account for the survival benefit from early treatment of BC, the gain of screening for BC remains uncertain and should be confirmed by controlled randomized trials. [ABSTRACT FROM AUTHOR]

Purpose: Lung cancer is the leading cause of cancer deaths in Canada, and because early cancers are often asymptomatic screening aims to prevent mortality by detecting cancer earlier when treatment is more likely to be curative. These reviews will inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening for lung cancer. Methods: We will update the review on the benefits and harms of screening with CT conducted for the task force in 2015 and perform de novo reviews on the comparative effects between (i) trial-based selection criteria and use of risk prediction models and (ii) trial-based nodule classification and different nodule classification systems and on patients' values and preferences. We will search Medline, Embase, and Cochrane Central (for questions on benefits and harms from 2015; comparative effects from 2012) and Medline, Scopus, and EconLit (for values and preferences from 2012) via peer-reviewed search strategies, clinical trial registries, and the reference lists of included studies and reviews. Two reviewers will screen all citations (including those in the previous review) and base inclusion decisions on consensus or arbitration by another reviewer. For benefits (i.e., all-cause and cancer-specific mortality and health-related quality of life) and harms (i.e., overdiagnosis, false positives, incidental findings, psychosocial harms from screening, and major complications and mortality from invasive procedures as a result of screening), we will include studies of adults in whom lung cancer is not suspected. We will include randomized controlled trials comparing CT screening with no screening or alternative screening modalities (e.g., chest radiography) or strategies (e.g., CT using different screening intervals, classification systems, and/or patient selection via risk models or biomarkers); non-randomized studies, including modeling studies, will be included for the comparative effects between trial-based and other selection criteria or nodule classification methods. For harms (except overdiagnosis) we will also include non-randomized and uncontrolled studies. For values and preferences, the study design may be any quantitative design that either directly or indirectly measures outcome preferences on outcomes pertaining to lung cancer screening. We will only include studies conducted in Very High Human Development Countries and having full texts in English or French. Data will be extracted by one reviewer with verification by another, with the exception of result data on mortality and cancer incidence (for calculating overdiagnosis) where duplicate extraction will occur. If two or more studies report on the same comparison and it is deemed suitable, we will pool continuous data using a mean difference or standardized mean difference, as applicable, and binary data using relative risks and a DerSimonian and Laird model unless events are rare (< 1%) where we will pool odds ratios using Peto's method or (if zero events) the reciprocal of the opposite treatment arm size correction. For pooling proportions, we will apply suitable transformation (logit or arcsine) depending on the proportions of events. If meta-analysis is not undertaken we will synthesize the data descriptively, considering clinical and methodological differences. For each outcome, two reviewers will independently assess within- and across-study risk of bias and rate the certainty of the evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation), and reach consensus. Discussion: Since 2015, additional trials and longer follow-ups or additional data (e.g., harms, specific patient populations) from previously published trials have been published that will improve our understanding of the benefits and harms of screening. The systematic review of values and preferences will allow fulsome insights that will inform the balance of benefits and harms. Systematic review registration: PROSPERO CRD42022378858 [ABSTRACT FROM AUTHOR]

Introduction. Abdominal aortic aneurysm (AAA) is a dilation of the abdominal aorta greater than 1.5 times the expected diameter. Its prevalence is variable, with reported rates of up to 12.5%. It is considered the cause of death of more than 10,000 people a year in the United States. The objective of this literature review was to describe risk factors and screening tools for AAA. Methods. A literature search was conducted using two equations in electronic databases, using terms selected from "Medical Subject Heading" (MeSH) and "Descriptors in Health Sciences" (DeCS). The quality of the studies was evaluated with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool. Results. Forty articles were collected and from them the review text was constructed, identifying the risk factors associated with the development of AAA, such as male sex, smoking, high blood pressure, family history and obesity, among others. Diabetes mellitus seems to act as a protective factor. Among the screening instruments, abdominal ultrasound is one of the most used. Conclusion. AAA is a multifactorial pathology. Currently, aortic ultrasonography is the method of choice for screening, allowing early detection. Screening for AAA with non-invasive methods, such as ultrasound, is useful especially in areas with a high prevalence of this pathology and in patients with certain risk factors. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between trypsin‐like protease (TLP) activity in the oral cavity as an indicator of periodontal health status and kidney function in Japanese workers. Materials and Methods: This cross‐sectional study included 1117 Japanese workers (mean age = 43.8 years). Tongue‐swab TLP activity was quantified as a* value (the redness intensity of the matrix disc of the TLP activity assessment kit; a larger value indicates more intense enzymatic activity in the samples and poorer periodontal health status). Kidney function was assessed using the estimated glomerular filtration rate (eGFR; a lower value indicates poorer kidney function). We performed ordinal logistic regression analyses to assess the association of the a* value with three eGFR categories: ≥90, 60–89 and <60 mL/min/1.73 m2. Results: The prevalence for each eGFR category was as follows: ≥90 (31.6%), 60–89 (63.8%) and <60 mL/min/1.73 m2 (4.6%). After adjusting for potential confounders, the a* value was found to be significantly associated with reduced kidney function. The multivariable‐adjusted odds ratio (95% confidence interval) for reduced kidney function was 1.12 (1.02–1.22) per unit increase in the a* value. Conclusions: Higher TLP activity was associated with reduced kidney function in Japanese workers. [ABSTRACT FROM AUTHOR]

Lower-limb strength measures can enhance falls risk assessment but due to the lack of clinically applicable methods, such measures are not included in current screening. The enhanced paper grip test (EPGT) is a simple-to-use and cost-effective test that could fill this gap. However, its outcome measure (EPGT force) has not yet been directly linked to the risk of falling. Is the EPGT a good candidate for falls risk screening in older people in the community? Seventy-one older people living independently in the community were recruited for this prospective observational study (median age 69 y, range 65y-79y). Lower-limb and whole-body strength were assessed at baseline using the EPGT and a standardised hand-grip method respectively. Incident falls were recorded monthly for a year through follow-up telephone conversations. The capacity of individual strength measures to predict falls and to enhance an established falls risk assessment tool (FRAT) commonly used by UK's national health service (NHS) was assessed using binomial logistic regression. The analysis was repeated for the subset of participants without history of falling at baseline (prediction of first-ever falls). Increased EPGT force and increased symmetry in strength between limbs were significantly associated with reduced risk of falling. Compared to the NHS-FRAT, the EPGT correctly classified more people (73% vs 69%), it achieved higher sensitivity (56% vs 26%) and higher negative predictive value (76% vs 68%). Complementing the NHS-FRAT with the EPGT produced a more comprehensive model that correctly classified 91% of participants and achieved 98% specificity, 81% sensitivity, 89% negative and 96% positive predictive value. Replacing the EPGT with hand-grip strength consistently undermined prediction accuracy. The EPGT remained highly accurate when focused on the prediction of first-ever falls. The EPGT can substantially enhance falls screening in the community. These results can also inform effective personalised strength exercise interventions. • The enhanced paper grip test (EPGT) accurately predicted the risk of falling. • The EPGT can enhance community screening for falls (recurrent and first-ever). • Higher EPGT force is significantly associated with reduced risk of falling. • Higher strength asymmetry between limbs also decreases the risk of falling. • These results can guide effective personalised strength exercise interventions. [ABSTRACT FROM AUTHOR]

Background: Cancer is a major global health concern. Unfortunately, Indigenous populations such as Greenlanders living in Denmark, face significant disparities in cancer risk, incidence, diagnosis, care quality, and outcomes. In Denmark, vulnerable Greenlanders face challenges accessing cancer screening. The aim of this study was to explore their perceptions of cancer, barriers to participation in cancer screening, and potential for developing a tailored intervention. Methods: This qualitative study was based on participant observations and qualitative interviews. The sample comprised 46 participants from four distinct drop-in centres. Of these, 28 were vulnerable Greenlanders (19 women and 9 men), 9 were staff members (6 women and 3 men), and 6 were relatives (4 women and 2 men). The data were analysed through inductive content analysis. Results: Vulnerable Greenlanders in Denmark believed they were responsible for their own health and were generally satisfied with the healthcare system. However, they found it challenging to manage their own health and many depended on support from others. Fear of cancer and death shaped their attitudes towards screening. Conclusion: For vulnerable Greenlanders in Denmark participation in cancer screening programmes was positively viewed for most but could be challenging. Different intervention ideas raised by the vulnerable Greenlanders, relatives and staff members could guide the development of strategies to increase participation rates. [ABSTRACT FROM AUTHOR]

Background: Childhood dyslipidemia is a common condition that can lead to atherosclerotic cardiovascular disease in adulthood. It is usually multifactorial. Screening for cholesterol disorders in children varies based on risk factors, with some guidelines recommending cascade screening for children with a clear family history of familial hypercholesterolemia, targeted screening for those with specific risk factors, and universal screening. Point-of-care testing (POCT) cholesterol tests offer potential advantages, including ease of use, portability, increased patient access, low cost, fewer medical or laboratory visits, and instant results. This study aimed to evaluate the effect of POCT cholesterol screening on the diagnosis of hypercholesterolemia in children in a family practice setting. Methods: We used a POCT cholesterol analyzer to perform two different (universal and targeted) screening approaches for dyslipidemia in children. We used the NCEP guidelines for the classification of the results. Results: We screened 183 children, 105 in the universal screening group and 78 in the targeted screening group. Eight patients in the targeted screening group had elevated cholesterol levels (p = 0.02). Conclusions: All participants received instant feedback and recommendations. Using a targeted screening approach, POCT could be a practical and effective tool for identifying at-risk children with hypercholesterolemia. [ABSTRACT FROM AUTHOR]

Background. Despite the imminent change and controversy around screening mammography, many women are still screened beyond the recommended age. Objectives. This study aims to characterise these women and to identify factors associated with this decision. Material and methods. A cross-sectional study including women who attended a Portuguese primary health care centre and who performed at least one mammography after turning 70 from March 2007 until July 2019. Data was collected by accessing the electronic health records. Results. Among all women who underwent mammography after the age of 50, 5.5% were 70 years of age and older. The main risk factor for breast cancer (BC) identified was the presence of other breast abnormalities (46.3%). Most requests in the screening group were for women under 75 years of age (79.2%) and were performed by the family physician (76.9%). Adherence to the BC national screening programme was lower in the screening group (73.3% vs 84.8%). After logistic regression, age at the time of request (OR = 0.815, 95% CI: 0.720-0.922, p = 0.001) and initiative of the request (OR = 0.176, 95% CI: 0.044-0.707, p = 0.014) of the last mammography added significantly to the model. Conclusions. Only a small proportion of screening mammographs were performed on women beyond the recommended age limit, which complied with the National Cancer Plan currently implemented in Portugal. Patients' age, presence of arterial hypertension or osteoporosis or hip fracture, number of comorbidities and the initiative of the request may have contributed to the decision to continue screening. Our study provides important clues for understanding factors associated with prolonging BC screening. However, further research is still needed. [ABSTRACT FROM AUTHOR]

Purpose Smoking cessation intervention is one of the key components of successful lung cancer screening program. We investigated the effectiveness and related factors of smoking cessation services provided to the participants in a population-based lung cancer screening trial. Materials and Methods The Korean Lung Cancer Screening Project (K-LUCAS) is a nationwide, multi-center lung cancer screening trial that evaluates the feasibility of implementing population-based lung cancer screening. All 5,144 current smokers who participated in the K-LUCAS received a mandatory smoking cessation counseling. Changes in smoking status were followed up using a telephone survey in 6 months after lung cancer screening participation. The lung cancer screening's impact on smoking cessation is analyzed by variations in the smoking cessation interventions provided in screening units. Results Among 4,136 survey responders, participant's motivation to quit smoking increased by 9.4% on average after lung cancer screening. After 6 months from the initial screening, 24.3% of participants stopped smoking, and 10.6% of participants had not smoked continuously for at least 6 months after screening. Over 80% of quitters stated that participation in lung cancer screening motivated them to quit smoking. Low-cost public smoking cessation program combined with lung cancer screening increased the abstinence rates. The smokers were three times more likely to quit smoking when the smoking cessation counseling was provided simultaneously with low-dose computed tomography screening results than when provided separately. Conclusion A mandatory smoking cessation intervention integrated with screening result counselling by a physician after participation in lung cancer screening could be effective for increasing smoking cessation attempts. [ABSTRACT FROM AUTHOR]

Hearing loss is commonly encountered by general practitioners. We aimed to evaluate the screening benefit of air conduction pure-tone audiometry over visual analogue scale (VAS) scores for hearing loss. Moreover, we intended to perform the first cross-sectional study in Greece to assess hearing loss with pure-tone audiometry in young adults of the general population. We evaluated Greeks between 15 and 40 years old in a high school in Karditsa, Greece, and a primary health care unit in a nearby community. Subjects filled out a VAS score sheet and underwent pure-tone audiometry in a room without sound isolation, with air conduction only. We named the latter procedure modified pure-tone audiometry (mPTA). Subjects with pathologic results were examined via otoscopy and standardized pure-tone audiometry (sPTA). Of the 286 subjects evaluated, the VAS score revealed 5 subjects (1.7%) with hearing loss. mPTA (100 s duration) doubled this percentage (in total 3.8%; Pearson Chi-Square test; p < 0.001). Based on sPTA, the sensitivity and positive predictive value of the VAS score were 40% and 13%, respectively. For mPTA, they were 100% and 37%, respectively. mPTA filtered out pathologic cases in a proper, rapid, cheap and simple way and may be considered a proper screening method for hearing loss in primary health care. [ABSTRACT FROM AUTHOR]

The aim of this review is to appraise and assimilate evidence from studies that have reported on the cost-effectiveness of screening programs for chronic kidney disease (CKD). The study protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO). The final search was conducted on 18 January 2023 using 7 databases. Screening of articles, data extraction, and quality assessment was performed by 2 independent reviewers. The ISPOR-AMCP-NPC checklist was used to assess the credibility of the included studies. From 4948 retrieved studies, a final total of 20 studies were included in the qualitative synthesis. Studies found that screening in diabetic populations was cost-effective (n = 8, 57%) or even cost-saving (n = 6, 43%). Four studies (67%) found that screening in hypertensive populations was also cost-effective. For the general population, findings were inconsistent across studies in which many found screening to be cost-effective (n = 11, 69%), some cost-saving (n = 2, 12%), and others not cost-effective (n = 3, 19%). The most influential parameters identified were prevalence of CKD and cost of screening. Screening for CKD in patients with diabetes or hypertension is recommended from a cost-effectiveness point of view. For the general population, despite some inconsistent findings, the majority of studies demonstrated that screening in this population is cost-effective, depending mainly on the prevalence and the costs of screening. Healthcare decision makers need to consider the prevalence, stratification strategies, and advocate for lower screening costs to reduce the burden on healthcare budgets and to make screening even more favorable from the health-economic perspective. • Although chronic kidney disease (CKD) screening has been found cost-effective in high-risk categories, such as diabetic populations, screening in the general population has shown conflicting results across studies. Therefore, assessing the cost-effectiveness of screening in the general population is crucial because only half of the CKD and end-stage kidney disease cases can be attributed to elevated risk. • Screening for CKD in patients with diabetes or hypertension is recommended from a cost-effectiveness point of view. Despite some inconsistencies, the majority of studies have demonstrated that screening in the general population is cost-effective, depending mainly on the prevalence of CKD and the costs of screening. • Our study's findings suggest that healthcare decision makers need to consider the prevalence of CKD and advocate for lower screening costs to reduce the burden on healthcare budgets; the latter will make screening for the general population even more favorable from a health-economic perspective. Moreover, stratification based on CKD risk score, ethnicity, or age can be used to ensure that favorable cost-effectiveness of screening in the general population is further enhanced. [ABSTRACT FROM AUTHOR]

Background: Excessive weight gain during childhood is a strong predictor for adult overweight, but it remains unknown which growth measures in infancy (0–2 years of age), besides predictors known at birth, are the strongest predictors for excessive weight gain between 2 and 5–7 years of age. Methods: The Amsterdam Born Children and their Development (ABCD) study formed the derivation cohort, and the Groningen Expert Center for Kids with Obesity (GECKO) Drenthe study formed the validation cohort. Change (Δ) in body mass index (BMI) z-score between 2 and 5–7 years was the outcome of interest. The growth measures considered were weight, weight-for-length (WfL), and body mass index (BMI). Formats considered for each growth measure were values at 1, 6, 12, and 24 months, at the BMI peak, the change between aforementioned ages, and prepeak velocity. 10 model structures combining different variable formats and including predictors at birth were derived for each growth measure, resulting in 30 linear regression models. A Parsimonious Model considering all growth measures and a Birth Model considering none were also derived. Results: The derivation cohort consisted of 3139 infants of which 373 (11.9%) had excessive gain in BMI z-score (> 0.67). The validation cohort contained 2201 infants of which 592 (26.9%) had excessive gain. Across the 3 growth measures, 5 model structures which included measures related to the BMI peak and prepeak velocity (derivation cohort area under the curve [AUC] range = 0.765–0.855) achieved more accurate estimates than 3 model structures which included growth measure change over time (0.706–0.795). All model structures which used BMI were superior to those using weight or WfL. The AUC across all models was on average 0.126 lower in the validation cohort. The Parsimonious Model's AUCs in the derivation and validation cohorts were 0.856 and 0.766, respectively, compared to 0.690 and 0.491, respectively, for the Birth Model. The respective false positive rates were 28.2% and 20.1% for the Parsimonious Model and 70.0% and 74.6% for the Birth Model. Conclusion: Models' performances varied significantly across model structures and growth measures. Developing the optimal model requires extensive testing of the many possibilities. [ABSTRACT FROM AUTHOR]

Endometrial cancer is one of the three major gynecological cancers, and the proportion of endometrial cancer among women of childbearing age is increasing yearly. How to achieve effective, safe and economical prevention and control of endometrial cancer through early diagnosis and screening has become a major topic. At present, there are still huge challenges in the early diagnosis and screening of endometrial cancer, including inadequate methods and programs, uncertain screening objects, and lack of efficient and minimally or non-invasive methods. In recent years, the molecular and imaging protocols are gradually alleviating these difficulties, which are expected to become efficient and safe screening programs for endometrial cancer. This article is aimed to review the current status of endometrial cancer screening and the research progress of emerging molecular and imaging regimens of early screening and diagnosis of endometrial cancer, and explore the implementation of future screening strategies. [ABSTRACT FROM AUTHOR]

The recent increase in the number of people with diabetes and the high incidence of complications carry a significant socioeconomic burden in addition to the disease burden and impact on personal health. Therefore, the Korean Diabetes Association and the Korean government have been making efforts to prevent the progression from pre-diabetes to diabetes through screening tests and to reduce diabetes complications and associated mortality in diabetic patients. Several studies in Korea have shown that glycated hemoglobin (HbA1c) provides complementary information to fasting plasma glucose (FPG) and improves clinical utility for diabetes screening. We hope that this consensus meeting will serve as an opportunity to identify additional diabetic patients who have not been diagnosed through a combination of FPG and HbA1c during a medical check-up. Our study is aimed to significantly reduce the lead time between diabetes onset and clinical diagnosis and initiation of diabetes treatment. [ABSTRACT FROM AUTHOR]

Purpose: There is a rising prevalence in undetected perinatal depression in many countries, more effort in screening and early identification of perinatal depression is needed. While the Whooley questionnaire is the recommended case-finding strategy for perinatal depression, there is no validated Chinese version. The aim was to evaluate the diagnostic accuracy and stability of the translated Chinese Whooley questionnaire against gold standard measurement during and early after pregnancy. Materials and Methods: This observational study recruited 131 pregnant women from an antenatal clinic in Hong Kong from September 2019 to May 2020. We translated the Whooley questionnaire in Chinese and evaluated self-reported responses against an interviewer-assessed diagnostic standard (DSM-IV criteria) in 107 women at 26–28 gestational weeks. We calculated sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio, with DSM-IV diagnosis as the gold standard. Results: The Chinese Whooley questions had a sensitivity of 79% (95% CI 54.4–93.9), a specificity of 97% (95% CI 90.4–99.3), a positive likelihood ratio of 23.2 (95% CI 7.4–72.1) and a negative likelihood ratio of 0.2 (95% CI 0.1–0.5) in identifying perinatal depression. Conclusion: The translated Chinese Whooley questionnaire has an acceptable diagnostic accuracy in identifying perinatal depression. It can be implemented in health services among Cantonesespeaking Chinese population. [ABSTRACT FROM AUTHOR]

Despite some evidence of an increased risk of neurologic symptoms following viral vector COVID-19 vaccine administration, it is unclear whether SARS-CoV-2 infection is associated with Bell's palsy (BP), especially over a long enough follow-up period. The study population of this nationwide population-based study was derived from the South Korean population, including 11 593 365 and 36 565 099 participants with and without COVID-19, respectively. The Fine and Gray's regression model was utilized to calculate the adjusted subdistribution hazard ratio (aSHR), considering death as a competing risk, to assess the association between SARS-CoV-2 infection and the risk of BP. All participants were followed up from 1 December 2021, until the incident BP, SARS-CoV-2 infection, death, or 31 March 2022. Subgroup analyses were conducted based on participants' vaccination status (completion of the primary series vs. unvaccinated). COVID-19 was associated with an increased risk of BP in all participants (aSHR, 1.24; CI, 1.19–1.29). However, the size of the COVID-19–related BP risk was significantly lower among those who completed the primary series of the COVID-19 vaccine (aSHR, 1.20; 95% CI, 1.15–1.25) compared to those who were unvaccinated (aSHR, 1.84; 95% CI, 1.59–2.12; p for interaction: <0.001). The severity of COVID-19 exhibited a gradual escalation in BP risk for both vaccinated and unvaccinated individuals. While both unvaccinated individuals and those who completed the primary series of the COVID-19 vaccine may be at an increased risk of developing BP due to COVID-19, the risk appears to be lower among those who completed the vaccination. [ABSTRACT FROM AUTHOR]

Background: Due to the COVID-19 pandemic, elective colonoscopies were postponed in Ohio from 3/17/2020 to 5/1/2020. When the ban was lifted, canceled patients determined whether to reschedule their colonoscopy in the midst of the ongoing pandemic. Aims: We aim to determine whether demographic, colorectal cancer (CRC) risk, and COVID-19 morbidity and mortality risk factors are associated with rescheduling of colonoscopies canceled by the COVID-19 pandemic. Methods: A medical record review of 420 participants ages 40–74 at a midwestern academic health system with elective colonoscopies canceled from 3/17/2020 to 5/1/2020 due to the COVID-19 pandemic was performed. Results: More than half of participants (71.0%) rescheduled their colonoscopy within the next 8 months. Indication for colonoscopy being 'surveillance following adenoma', colonoscopy ordered by primary care provider rather than gastroenterologist, and dyslipidemia were independently associated with rescheduling colonoscopy. Higher body mass index, indication for colonoscopy being simply 'screening for CRC,' and stool testing were associated with not rescheduling. Diagnoses associated with colorectal cancer risk such as adenomas, personal or family history of colorectal cancer, and inflammatory bowel disease were not associated with rescheduling, nor were other comorbidities associated with increased COVID-19 severity. 4.5% (19/420) opted for stool fecal immunochemical test or Cologuard testing. Conclusions: Most patients rescheduled their colonoscopy despite the risk of virus exposure, suggesting that concern of missed colorectal cancer diagnosis outweighed coronavirus concerns. Patient trust in referring providers may be important for rescheduling, and colonoscopy indications were independently associated with rescheduling status. [ABSTRACT FROM AUTHOR]

Objectives: Cervical cancer elimination requires high-performance screening tests and high treatment rates, and thus high screening program performance is essential; however, Latin America lacks organized screening and quality assurance (QA) guidelines. We aimed to develop a core set of QA indicators suitable to the region. Methods: We reviewed QA guidelines from countries/regions with highly organized screening programs and selected 49 indicators for screening intensity, test performance, follow-up, screening outcomes and system capacity. A regional expert consensus using the Delphi method in two rounds was implemented to identify basic indicators actionable within the regional context. The panel was integrated by recognized Latin American scientists and public health experts. They voted for the indicators blinded to each other based on feasibility and relevance. The correlation between both attributes was analyzed. Results: In the first round 33 indicators reached consensus for feasibility but only 9 for relevance, without full coincidence. In the second round 9 indicators met the criteria for both (2 screening intensity, 1 test performance, 2 follow-up, 3 outcomes, 1 system capacity). A significant positive correlation was observed for test performance and outcomes indicators between the two attributes assessed (p < 0.05). Conclusions: Cervical cancer control requires realistic goals supported by proper programs and QA systems. We identified a set of indicators suitable to improve cervical cancer screening performance in Latin America. The assessment by an expert panel with a joint vision from science and public health practice represents a significant progress towards real and feasible QA guidelines for countries in the region. [ABSTRACT FROM AUTHOR]

Background: Pathological maxillary sinus would affect implant treatment and even result in failure of maxillary sinus lift and implant surgery. However, the maxillary sinus abnormalities are challenging to be diagnosed through CBCT images, especially for young dentists or dentists in grassroots medical institutions without systematical education of general medicine. Objectives: To develop a deep‐learning‐based screening model incorporating object detection and 'straight‐forward' classification strategy to screen out maxillary sinus abnormalities on CBCT images. Methods: The large area of background noise outside maxillary sinus would affect the generalisation and prediction accuracy of the model, and the diversity and imbalanced distribution of imaging manifestations may bring challenges to intellectualization. Thus we adopted an object detection to limit model's observation zone and 'straight‐forward' classification strategy with various tuning methods to adapt to dental clinical need and extract typical features of diverse manifestations so that turn the task into a 'normal‐or‐not' classification. Results: We successfully constructed a deep‐learning model consist of well‐trained detector and diagnostor module. This model achieved ideal AUROC and AUPRC of 0.953 and 0.887, reaching more than 90% accuracy at optimal cut‐off. McNemar and Kappa test verified no statistical difference and high consistency between the prediction and ground truth. Dentist‐model comparison test showed the model's statistically higher diagnostic performance than dental students. Visualisation method confirmed the model's effectiveness in region recognition and feature extraction. Conclusion: The deep‐learning model incorporating object detection and straightforward classification strategy could achieve satisfying predictive performance for screening maxillary sinus abnormalities on CBCT images. [ABSTRACT FROM AUTHOR]

Background Mass tuberculosis (TB) screening has been recommended in certain high-risk populations. However, population-based screening interventions have rarely been implemented. Whether mass screening improves health equity is unknown. Methods We implemented a mass TB screening intervention among elderly persons (>60 years old) in Lanxi County, China. Standardized questionnaires, physical examinations, and chest radiographs (CXRs) were administered to all participants. Systematic testing with computed tomography, smear, culture, or Xpert was performed among persons with an abnormal CXR. We assessed TB prevalence per 100 000 persons and constructed multivariable regression models among subgroups that were and were not screened. Medical insurance was categorized as participation in either a basic program with limited coverage or a more comprehensive coverage program. Results In total, 49 339 individuals (32% of the elderly population in Lanxi) participated in the screening. One hundred fifteen screened persons were diagnosed with TB (233 cases per 100 000 persons), significantly higher than persons not screened (168 cases among 103 979 person-years; prevalence-to-case notification ratio, 1.44 [95% confidence interval {CI}, 1.14–1.83]). This increase was largely driven by diagnosis of asymptomatic disease during mass screening (n = 57 [50% of participants with TB]). Participants with basic medical insurance were much more likely to be diagnosed through mass screening than by passive detection (adjusted odds ratio, 4.52 [95% CI, 1.35–21.28]). Conclusions In a population-based, mass TB screening intervention encompassing >30% of the elderly population in a county in rural China, case finding was 44% higher than background detection, driven by diagnosis of TB without recognized symptoms. Importantly, mass screening identified TB in people with limited healthcare options who were less likely to be found through background case detection. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the total number of false-positive recalls, including radiographic appearances and false-positive biopsies, in the Malmö Breast Tomosynthesis Screening Trial (MBTST). Methods: The prospective, population-based MBTST, with 14,848 participating women, was designed to compare one-view digital breast tomosynthesis (DBT) to two-view digital mammography (DM) in breast cancer screening. False-positive recall rates, radiographic appearances, and biopsy rates were analyzed. Comparisons were made between DBT, DM, and DBT + DM, both in total and in trial year 1 compared to trial years 2 to 5, with numbers, percentages, and 95% confidence intervals (CI). Results: The false-positive recall rate was higher with DBT, 1.6% (95% CI 1.4; 1.8), compared to screening with DM, 0.8% (95% CI 0.7; 1.0). The proportion of the radiographic appearance of stellate distortion was 37.3% (91/244) with DBT, compared to 24.0% (29/121) with DM. The false-positive recall rate with DBT during trial year 1 was 2.6% (95% CI 1.8; 3.5), then stabilized at 1.5% (95% CI 1.3; 1.8) during trial years 2 to 5. The percentage of stellate distortion with DBT was 50% (19/38) trial year 1 compared to 35.0% (72/206) trial years 2 to 5. Conclusions: The higher false-positive recall rate with DBT compared to DM was mainly due to an increased detection of stellate findings. The proportion of these findings, as well as the DBT false-positive recall rate, was reduced after the first trial year. Clinical relevance statement: Assessment of false-positive recalls gives information on potential benefits and side effects in DBT screening. Key Points: • The false-positive recall rate in a prospective digital breast tomosynthesis screening trial was higher compared to digital mammography, but still low compared to other trials. • The higher false-positive recall rate with digital breast tomosynthesis was mainly due to an increased detection of stellate findings; the proportion of these findings was reduced after the first trial year. [ABSTRACT FROM AUTHOR]

In the fight against COVID-19; It is extremely important to detect and subsequently isolate people infected with the disease. For this purpose, the diagnostic tests used around the world differ in terms of diversity and application criteria. In this review, from a public health perspective; The tests used for the diagnosis of COVID-19, for whom and how they are used, as well as approaches to test use are discussed. Polymerase chain reaction (PCR) based tests are considered the gold standard due to their high sensitivity and specificity. Although comparisons are made for different sampling methods, the general view is in the direction of nasopharyngeal swab. Although it is accepted as the gold standard diagnostic method, it has some disadvantages. The most important thing is that it takes a long time to result and high cost. In order to reduce the cost, it may be preferable to evaluate several samples as a single sample, that is, to pool them. As an alternative to these disadvantages, rapid antigen tests can be considered. There are many different market forms of rapid antigen tests. There are many studies on the specificity and sensitivity of these tests and there are different values. In general, it has been determined that their specificity is high and their sensitivity is lower. Community screening may be a solution for the difficulty of symptomatic diagnosis of the disease and the problems that some people do not show symptoms even though they are contagious. With the emergence of new variants, changes in testing policies and different approaches have been observed around the world. Efforts were made to make the tests available to the general public or for community screening in order to conduct more comprehensive screening. However, due to the increasing PCR test load, testing policies such as limiting the people to be tested or the additional use of alternative test methods such as rapid antigen tests had to be implemented in some countries. [ABSTRACT FROM AUTHOR]

Background/Aims: The impact of coronavirus disease 2019 (COVID-19) on the management of colorectal cancer (CRC) may worse in elderly population, as almost all COVID-19 deaths occurred in the elderly patients. This study aimed to evaluate the impact of COVID-19 on CRC management in the elderly population. Methods: The numbers of patients who underwent colonoscopy, who visited hospitals or operated for CRC in 2020 and 2021 (COVID-19 era) were compared with those in 2019, according to 3 age groups (≥ 70 years, 50-69 years, and ≤ 49 years), based on the nationwide, population-based database (2019-2021) in South Korea. Results: The annual volumes of colonoscopy and hospital visits for CRC in 2020 were more significantly declined in the old age group than in the young age group (both P< 0.001). In addition, the annual volume of patients operated for CRC numerically more declined in old age group than in young age group. During the first surge of COVID-19 (March and April 2020), old age patients showed statistically significant declines for the monthly number of colonoscopies (-46.5% vs. -39.3%, P<0.001), hospital visits (-15.4% vs. -7.9%, P<0.001), CRC operations (-33.8% vs. -0.7%, P<0.05), and colonoscopic polypectomies (-41.8% vs. -38.0%, P< 0.001) than young age patients, compared with those of same months in 2019. Conclusions: Elderly population are more vulnerable for the management of CRC during the COVID-19 pandemic. Therefore, the elderly population are more carefully cared for in the management of CRC during the next pandemic. [ABSTRACT FROM AUTHOR]

As the uptake of population screening expands, assessment of medical and psychosocial outcomes is needed. Through the Alabama Genomic Health Initiative (AGHI), a state‐funded genomic research program, individuals received screening for pathogenic or likely pathogenic variants in 59 actionable genes via genotyping. Of the 3874 eligible participants that received screening results, 858 (22%) responded to an outcomes survey. The most commonly reported motivation for seeking testing through AGHI was contribution to genetic research (64%). Participants with positive results reported a higher median number of planned actions (median = 5) due to AGHI results as compared to negative results (median = 3). Interviews were conducted with survey participants with positive screening results. As determined by certified genetic counselors, 50% of interviewees took appropriate medical action based on their result. There were no negative or harmful actions taken. These findings indicate population genomic screening of an unselected adult population is feasible, is not harmful, and may have positive outcomes on participants now and in the future; however, further research is needed in order to assess clinical utility. [ABSTRACT FROM AUTHOR]

Aim: To compare the incidence, clinical features and timing of initial treatment of early‐ and later‐presenting developmental dysplasia of the hip (DDH) in infancy in the context of a risk‐based selective ultrasound screening programme. Methods: We conducted a retrospective observational study of infants born at a tertiary perinatal centre in Melbourne, Australia, between July 2016 and June 2020 and treated for DDH up to 18 months of age at a tertiary paediatric centre. The incidence of DDH was calculated for early‐ and later‐presenting cases. Clinical features and ultrasound indications were analysed using multivariate logistic regression. Results: There were 192 infants with DDH requiring treatment, 100 (52%) of which were not detected by universal neonatal hip examination and selective ultrasound screening based on risk factors (overall incidence 6.3 per 1000 livebirths). The median age at which treatment was commenced was delayed by 8 weeks for the later‐presenting group compared to those detected through screening (16.7 vs. 7.9 weeks, P < 0.001). Skin crease asymmetry was associated with later presentation (adjusted odds ratio (aOR) 44.03, 95% confidence interval (CI) 9.99–333), whilst breech presentation (aOR 0.08, 95% CI 0.02–0.26) and Barlow/Ortolani test positivity (aOR 0.06, 95% CI 0.01–0.25) were associated with early presentation. Only 39 (1.45%) infants receiving a screening ultrasound had DDH. Conclusion: Approximately half of all infants with DDH were not detected by combining risk‐based selective ultrasound screening with neonatal clinical findings, highlighting the failure of this screening method to reliably detect a significant proportion of dysplastic infant hips. [ABSTRACT FROM AUTHOR]

Introduction: Current research estimates that over 24 million individuals experience human trafficking worldwide. There is a growing prevalence of sex trafficking in the United States. An estimated 87% of trafficked persons visit the emergency department during their captivity. Emergency departments across the United States use differing screening methods for sex trafficking. Current screening tools return a high rate of false negatives, and the appropriate use of tools or standardised lists remains unclear. Aims: To explore best practices for identifying sex trafficking among adults who visit emergency departments. We sought to answer the practice question: How does the implementation of a multifaceted screening model for sex trafficking, versus the use of a list of standardised screening questions, improve the detection of trafficked persons? Methods: We conducted an integrative review of articles published after 2016 in PubMed, CINAHL, Embase, SCOPUS, and Web of Science databases. PRISMA checklist and guidelines were used. Whittemore and Knafl's method was used to review the literature. Results: A final selection of 11 articles were reviewed and appraised using the Johns Hopkins nursing evidence‐based practice model. The synthesis of evidence yielded four themes: (1) Provider and personnel education; (2) Protocol establishment; (3) Legal consultation; and (4) Multidisciplinary teamwork. Conclusion: Through this process, we learned the importance of using multifaceted screening tools for identifying persons who are experiencing sex trafficking. In addition to using multifaceted screening tools, detection is improved when all emergency department personnel receive training on sex trafficking. There is a recognised lack of education on sex trafficking recognition nationwide. Relevance to Clinical Practice: Notably, emergency department nurses play an essential role in sex trafficking identification due to their maximised interaction with patients and the increased perception of trust that patients have with nurses. Steps include the development of an education program to improve recognition. No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this integrative review. [ABSTRACT FROM AUTHOR]

Many factors need to be considered when planning and managing a screening programme for the early detection of cervical cancer (CC). A non-systematic international review of the organisation of CC screening using high-risk human papillomavirus (HPV-HR) testing, aimed at identifying the organisational methods of these programmes, was conducted with a view to supporting the future of the French system in the context of the transition to HPV-HR testing. In countries where HPV testing has been implemented or planned, the initial reflection process has provided an opportunity to rethink the previous (cytological) screening organisation. Despite considerable differences between countries, a nationally or regionally centralised organisational model appears to be the preferred option in most countries. This model is based on a national/regional structure tasked with all invitations, reminders, follow-up and coordination, centralised laboratories integrating both biology and pathology laboratories, and a unified information system integrated with routine health management tools used by health practitioners and nurses. Besides quality considerations, grouped purchasing makes it possible to implement a public procurement policy that includes price negotiations with suppliers. Discussions around the introduction of HPV testing have resulted in most countries reviewing or creating information systems and quality assurance processes. While the WHO seems to recommend the systematic use of vaginal self-sampling, very few countries have considered this option. More and more countries are planning to implement vaginal self-sampling, but no clear organisational model has emerged from the countries where it has been implemented to date. [ABSTRACT FROM AUTHOR]

• Negative neurocognitive response to infant signals of distress during pregnancy predicts postpartum depression and depressive symptom severity after birth. • Early integrated screening for risk factors may lead to better prevention of postpartum depression. • The low number of participants who completed the full screening indicates a need for a shorter tool to screen for postpartum depression risk. Postpartum depression (PPD) is a severe mental illness affecting 10–15% of mothers. Emerging evidence indicates that negative neurocognitive bias in response to infant distress during pregnancy marks an increased risk of PPD. This proof-of-concept study aimed to investigate the association between negatively biased neurocognitive processing of infant distress during pregnancy and subsequent PPD and to explore the feasibility of an online risk screening tool. In the second or third trimester of pregnancy, 87 participants underwent two online tests of reactivity to and evaluation of infant distress and completed questionnaires regarding psychosocial risk factors. After birth, participants rated their depressive symptoms online and underwent a diagnostic telephone interview concerning PPD. Irrespective of depressive symptoms during pregnancy, negative reactivity to and evaluation of infant distress predicted PPD (reactivity: Exp(B)=1.33, p = 0.04) and depressive symptoms after birth (reactivity: B = 0.04, p = 0.048; evaluation: B = 0.10, p = 0.04). The negative reactivity toward infant distress showed high sensitivity and moderate specificity (89% and 77%, respectively), while the evaluation of infant distressed cries showed lower sensitivity and specificity (67% and 66%, respectively). The relatively small sample size prevented the inclusion of additional risk variables in the regression models. The replication of an association between negative neurocognitive bias during pregnancy with PPD risk is noteworthy and has clinical implications in terms of early prevention. However, the low response rate indicates that this tool is not feasible in its current form. Future larger-scale studies are needed to further investigate candidate risk factors in a brief online screening tool. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features and gene variation characteristics of short/ branched acyl-coA dehydrogenase deficiency (SBCADD) in Fujian province. Methods From August 2016 to March 2022, the Neonatal Disease Screening Center of the hospital used tandem mass spectrometry technology to screen 111 547 newborns for genetic metabolic diseases. A total of 11 children with elevated C5 were found in the center for diagnosis, treatment and follow-up, among which eight cases were diagnosed with SBCADD (estimated prevalence rate was 1/13 943), and three children were diagnosed with IVA (estimated prevalence was 1/37 182). The clinical features, biochemical data and gene sequencing results of the eight children with SBCADD were analyzed retrospectively. Results Among the eight children with SBCADD, one was male and seven were female; seven were Han nationality and one was Miao nationality. Isovaleryl carnitine was increased in all eight cases, the highest was 1.04 µmol/L. Urinary 2-methyl-butylglycine levels increased in all eight cases. The growth and development of the eight cases were generally normal with no clinical symptoms. A toatl of six ACADSB gene variants were detected in the eight patients. All of these children had two alleles, of which three were homozygous and five were complex heterozygous. A toatl of three gene variants have been reported in literature [c. 1165A>G (p. M389V), c. 275C>G (p. S92 * ) and c. 923G>A (p. C308Y)]. A toatl of three variants were not reported [c. 1232C>T (p. T411M), c. 421A>C(p. 1141L) and c. 919G>A(p.G307R)]. The most common gene variation in the eight patients was c. 275C>G [56. 25% (9/16)]. Conclusion Most patients with SBCADD are asymptomatic, but clinical monitoring is necessary, especially in stressful situations. Longitudinal clinical and biochemical follow-up is recommended for both symptomatic and asymptomatic patients with SBCADD. In this study, a new gene variant was found, which has extended the ACADSB gene variant spectrum. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Guidelines suggest 1-time screening with esophagogastroduodenoscopy (EGD) for Barrett's esophagus (BE) in individuals at an increased risk of esophageal adenocarcinoma (EAC). We aimed to estimate the yield of repeat EGD performed at prolonged intervals after a normal index EGD. METHODS: We conducted a national retrospective analysis within the U S Veterans Health Administration, identifying patients with a normal index EGD between 2003 and 2009 who subsequently had a repeat EGD. We tabulated the proportion with a new diagnosis of BE, EAC, or esophagogastric junction adenocarcinoma (EGJAC) and conducted manual chart review of a sample. We fitted logistic regression models for the odds of a new diagnosis of BE/EAC/EGJAC. RESULTS: We identified 71,216 individuals who had a repeat EGD between 1 and 16 years after an index EGD without billing or cancer registry codes for BE/EAC/EGJAC. Of them, 4,088 had a new billing or cancer registry code for BE/EAC/EGJAC after the repeat EGD. On manual review of a stratified sample, most did not truly have new BE/EAC/EGJAC. A longer duration betweenEGDwas associated with greater odds of a new diagnosis (adjusted odds ratio [aOR] for each 5 years 1.31; 95% confidence interval [CI] 1.19-1.44), particularly among those who were younger during the index EGD (ages 19-29 years: aOR 3.92; 95% CI 1.24-12.4; ages 60-69 years: aOR 1.19; 95% CI 1.01-1.40). DISCUSSION: The yield of repeat EGD for BE/EAC/EGJAC seems to increase with time after a normal index EGD, particularly for younger individuals. Prospective studies are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: The Korea National Cancer Screening Program (KNCSP) offers upper endoscopy or upper gastrointestinal series (UGIS) biannually for people aged ≥ 40 years. This study aimed to assess the effect of negative screening results on the incidence of and mortality from upper gastrointestinal (GI) cancer. Methods: A population-based retrospective cohort of 15,850,288 men and women was constructed using data from 3 national databases. The participants were followed until the end of 2017 for data on cancer incidence and in 2019 for data on the vital status. Cox proportional hazard model with time-varying exposure was used to assess the association. Results: By the end of the follow-up period, 230,783 upper GI cancer cases and 99,348 upper GI cancer deaths were recorded. Negative gastric cancer screening was significantly associated with a lower risk of upper GI cancer in both UGIS (adjusted hazard ratio [aHR] = 0.81, 95% CI = 0.80–0.82) and upper endoscopy (aHR = 0.67, 95% CI = 0.67–0.68) groups. The HRs for upper GI mortality were 0.55 (95% CI = 0.54–0.56) and 0.21 (95% CI = 0.21–0.22) for the UGIS and upper endoscopy groups, respectively. The most significant reductions in the risk of upper GI cancer (UGIS: aHR = 0.76, 95% CI = 0.74–0.77; upper endoscopy: aHR = 0.60, 95% CI = 0.59–0.61) and death (UGIS: aHR = 0.54, 95% CI = 0.52–0.55; upper endoscopy: aHR = 0.19, 95% CI = 0.19–0.20) were observed among individual aged 60–69 years. Conclusion: Negative screening cases, especially in upper endoscopy of the KNCSP, were associated with an overall reduction in the risk of and mortality from upper GI cancer. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is a public health problem due to its incidence and mortality, with the possibility of prevention and early detection and consequent improvement of the prognosis through the actions of the Family Health Strategy (FHS). Objective: Investigate the knowledge, attitudes, and practices (CAP) of FHS professionals on actions to control BC recommended by the Ministry of Health and their association with sociodemographic and training characteristics. Method: Cross-sectional study with doctors and nurses from the FHS of Juiz de for a (MG, Brazil), using a self-administered structured questionnaire, in 2019. The data were analyzed using descriptive statistics, the chi-square test, and Fisher's exact test, with a significance level of 5%. Results: A total of 170 professionals (93.0%) were surveyed, with a predominance of females (74.1%), aged 30 to 49 years (47.9%), and undergraduates older than 20 years (45.8%). Adequate CAP was 75.6%, 61.8%, and 78.4%, respectively. They had more adequate knowledge, younger professionals with better practices, and professionals with more time since graduation. Conclusion: The study found important gaps in the process of continuing education for FHS professionals, resulting in a possible obstacle to better control of CM. The evaluation enables targeted health actions and better planning to face the CM. [ABSTRACT FROM AUTHOR]

Background: Research suggests NT-proBNP (N-terminal pro-B-type natriuretic peptide) to be a strong predictor of incident atrial fibrillation (AF) and stroke. However, its utility in AF screening remains unknown. The aim of this study was to investigate NT-proBNP as a potential marker for screening efficacy with respect to AF yield and stroke prevention. Methods: In the LOOP Study (Atrial Fibrillation Detected by Continuous ECG Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-Risk Individuals), 6004 AF-naïve individuals at least 70 years old and with additional stroke risk factors were randomized 1:3 to either screening with an implantable loop recorder (ILR) and initiation of anticoagulation upon detection of AF episodes lasting ≥6 minutes or usual care (control). This post hoc analysis included study participants with available NT-proBNP measurement at baseline. Results: A total of 5819 participants (96.9% of the trial population) were included. The mean age was 74.7 years (SD, 4.1 years) and 47.5% were female. The median NT-proBNP level was 15 pmol/L (interquartile range, 9–28 pmol/L) corresponding to 125 pg/mL (interquartile range, 76–233 pg/mL). NT-proBNP above median was associated with an increased risk of AF diagnosis both in the ILR group (hazard ratio, 1.84 [95% CI, 1.51–2.25]) and the control group (hazard ratio, 2.79 [95% CI, 2.30–3.40]). Participants with NT-proBNP above the median were also at higher risk of clinical events compared with those having lower levels (hazard ratio, 1.21 [95% CI, 0.96–1.54] for stroke or systemic embolism [SE], 1.60 [95% CI, 1.32–1.95] for stroke/SE/cardiovascular death, and 1.91 [95% CI, 1.61–2.26] for all-cause death). Compared with usual care, ILR screening was associated with significant reductions in stroke/SE and stroke/SE/cardiovascular death among participants with NT-proBNP above median (hazard ratio, 0.60 [95% CI, 0.40–0.90] and 0.70 [95% CI, 0.53–0.94], respectively) but not among those with lower levels (P interaction=0.029 for stroke/SE and 0.045 for stroke/SE/cardiovascular death). No risk reduction in all-cause death was observed in either NT-proBNP subgroup for ILR versus control (P interaction=0.68). Analyzing NT-proBNP as a continuous variable yielded similar findings. Conclusions: In an older population with additional stroke risk factors, ILR screening for AF was associated with a significant reduction in stroke risk among individuals with higher NT-proBNP levels but not among those with lower levels. These findings should be considered hypothesis generating and warrant further study before clinical implementation. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02036450. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) recommends targeted screening for latent tuberculosis infection (LTBI) among high‐risk populations. Recent studies that evaluate targeted school‐based programmes in low burden settings are scarce. Aims: To evaluate a school screening programme for recently arrived migrant students from moderate and high tuberculosis (TB) burden countries and estimate (1) the number of cases of active TB that were prevented and (2) the cost per case of active TB prevented. Methods: Students were screened with tuberculin skin tests (TST) at schools with a high migrant population intake. Those with positive results were referred for specialist evaluation. Outcomes were retrospectively assessed using 5 years of prospectively collected data. Cost data were collected. Main outcomes measured were the number of children were diagnosed with LTBI who completed treatment, and programme costs. Results: Of 4728 student screened, 295 (6.2%) were diagnosed with LTBI. Of these, 273 (92.5%) were offered preventive therapy, 242 (82.0%) commenced and 204 (69.2%) completed therapy. The number needed to screen (NNS) was 23 per completed course of preventive treatment for LTBI. Assuming a 10% lifetime risk of reactivation, the NNS was 386 per case of TB disease notification avoided. The cost of screening was A$23 932 per case of TB disease avoided. Conclusions: This TB strategy is supported by the high rate of TB infection in the student group, the treatment uptake and completion rates. Cost–benefit is linked with lifetime risk of TB reactivation. Targeted school screening programmes represent an important opportunity for TB control in low‐burden settings. [ABSTRACT FROM AUTHOR]

Objectives: To compare results of selected performance measures in mammographic screening for an artificial intelligence (AI) system versus independent double reading by radiologists. Methods: In this retrospective study, we analyzed data from 949 screen-detected breast cancers, 305 interval cancers, and 13,646 negative examinations performed in BreastScreen Norway during the period from 2010 to 2018. An AI system scored the examinations from 1 to 10, based on the risk of malignancy. Results from the AI system were compared to screening results after independent double reading. AI score 10 was set as the threshold. The results were stratified by mammographic density. Results: A total of 92.7% of the screen-detected and 40.0% of the interval cancers had an AI score of 10. Among women with a negative screening outcome, 9.1% had an AI score of 10. For women with the highest breast density, the AI system scored 100% of the screen-detected cancers and 48.6% of the interval cancers with an AI score of 10, which resulted in a sensitivity of 80.9% for women with the highest breast density for the AI system, compared to 62.8% for independent double reading. For women with screen-detected cancers who had prior mammograms available, 41.9% had an AI score of 10 at the prior screening round. Conclusions: The high proportion of cancers with an AI score of 10 indicates a promising performance of the AI system, particularly for women with dense breasts. Results on prior mammograms with AI score 10 illustrate the potential for earlier detection of breast cancers by using AI in screen-reading. Key Points: • The AI system scored 93% of the screen-detected cancers and 40% of the interval cancers with AI score 10. • The AI system scored all screen-detected cancers and almost 50% of interval cancers among women with the highest breast density with AI score 10. • About 40% of the screen-detected cancers had an AI score of 10 on the prior mammograms, indicating a potential for earlier detection by using AI in screen-reading. [ABSTRACT FROM AUTHOR]

Background: The national skin cancer screening (SCS) was introduced in Germany in 2008. However, public awareness and participation rates remain low. There are no campaigns or target group‐specific invitation strategies for SCS yet. Thus, our aim was to derive potential suggestions on how to best inform German residents about the possibility of SCS. Methods: Semi‐structured, individual interviews with male and female German residents aged ≥35 years were conducted in Erlangen (Germany) to explore opportunities on raising awareness of SCS. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. Results: Overall, 39 persons were interviewed. About 79.5% (31/39) had already undergone at least one SCS. Numerous opportunities to raise awareness of the possibility of SCS were suggested which were categorized into three main topics: the role of public promotion, health‐related caregivers, and health insurance. Similar themes were identified for inviting entitled persons to undergo SCS after 2 years. Furthermore, age‐dependent communication approaches were proposed, that is, younger persons should be approached electronically, while the older generation should be targeted with traditional media like mail. Conclusions: The results of this project will inform stakeholders to take appropriate actions. The findings may contribute to increase participation rates in SCS and thus lead to earlier detection of skin cancer. [ABSTRACT FROM AUTHOR]

Purpose To investigate the incidence, outcomes, and imaging characteristics of clustered microcysts detected on breast US in asymptomatic women, and suggest appropriate management guidelines. Materials and Methods We identified and reviewed the lesions recorded as "clustered microcysts" on breast US performed in asymptomatic women between August 2014 and December 2019. The final diagnosis was based on pathology and imaging follow-up results for at least 12 months. Results The incidence was 1.5% and 100 patients with 117 lesions were included. Among 117 lesions, 3 (2.6%), 2 (1.7%), and 112 (95.7%) were malignant, high-risk benign, and benign lesions, respectively. The malignant lesions included two cases of ductal carcinoma in situ and one invasive ductal carcinoma. Two of them were assessed as category 4, showing mammographic suspicious microcalcifications and internal vascularity on Doppler US. The remainder was a false negative case and showed echo pattern change on the 12-month follow-up US. Conclusion The incidence of clustered microcysts on breast US in asymptomatic women was 1.5% and malignancy rate was 2.6% (3 of 117). Knowledge of outcomes and imaging features of benign and malignant clustered microcysts may be helpful for radiologists, thereby aiding categorization and management recommendations. [ABSTRACT FROM AUTHOR]

The exponential increase in higher education students and the new university profile that incorporates more vulnerable social groups are associated with an increase in mental health problems in this population. Likewise, the complex stage of the life cycle in which these young people find themselves and the stress of the transition between adolescence and adulthood are other risk factors for the development of mental health problems. The emergence of mental health problems in this group could then be due to a confluence of factors, also facilitating risk behaviors. National and international researches have reported the worrying rates of mental health disorders in university students, mainly in relation to the presence of depression, anxiety, stress, alcohol or drug use, eating disorders, and suicidal ideation. These disorders tend to be aggravated, because the university population is prone not to seek help. The stigma of presenting mental health problems, skepticism about treatments, not wanting to worry the closest family and the few economic resources or not having a health plan, lead to not seeking help or do this late. Studies have found that more than half of students who need mental health and support services are not receiving them. On the other hand, a high percentage seeks help late, which implies that the disorders are accentuated or become chronic, which makes subsequent treatment and improvement difficult, even becoming a public health problem due to the high economic and professional demand that these treatments require. Given these antecedents and the exponential increase in these high rates of mental health, it was proposed to carry out a complete process of Mental Health Problems Screening, feedback, and follow-up in a large sample of university students, in order to determine both the prevalence of mental health symptoms, such as the impact of the use of information technologies on feedback and guidance in seeking help. To do this, a battery of questionnaires aimed at investigating hopelessness and suicide risk, depressive symptoms, anxiety, stress, eating disorders and perceived social support were applied through the university online platform to 1 707 students. Once the instruments were answered, the students received feedback about their levels of symptoms and information about networks and establishments to seek help and receive care in the required cases. In the middle of the following year, a follow-up survey was conducted with 577 of the students who had previously answered all the questionnaires. The results of the battery of questionnaires applied indicate high rates of mental health symptoms, with statistically significant differences according to sex, with women having the highest prevalence. These results are consistent with various studies that show high percentages of mental health problems in university students and various associations. In turn, the subsequent follow-up showed that the feedback provided triggered the search for help, with positive correlations between feeling better and having sought mental health treatment or having asked friends or family for help. In addition, the most of the young people surveyed consider that the use of computer platforms are useful to obtain help on mental health issues and that they are useful to better understand what is happening to them and learn about mental health problems. Both the increase in the university population and the high prevalence of morbidity have led to the need to implement various resources that make mental health more accessible to young people. The use of information technologies in mental health research and prevention would have a positive outreach, being a useful, accessible and close tool for young people. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to analyse results on early screening outcomes, including recall and cancer rates, and histopathological tumour characteristics among non-immigrants and immigrants invited to BreastScreen Norway. Methods: We included information about 2, 763,230 invitations and 2,087,222 screening examinations from 805,543 women aged 50–69 years who were invited to BreastScreen Norway between 2010 and 2019. Women were stratified into three groups based on their birth country: non-immigrants, immigrants born in Western countries and immigrants born in non-Western countries. Age-adjusted regression models were used to analyse early screening outcomes. A random intercept effect was included in models where women underwent several screening examinations. Results: The overall attendance was 77.5% for non-immigrants, 68% for immigrants from Western countries and 51.5% for immigrants from non-Western countries. The rate of screen-detected cancers was 5.9/1000 screening examinations for non-immigrants, 6.3/1000 for immigrants from Western countries and 5.1/1000 for immigrants from non-Western countries. Adjusted for age, the rate did not differ statistically between the groups (p =0.091). The interval cancer rate was 1.7/1000 screening examinations for non-immigrants, 2.4/1000 for immigrants from Western countries and 1.6/1000 for non-Western countries (p <0.001). Histological grade was less favourable for screen-detected cancers, and subtype was less favourable for interval cancers among immigrants from non-Western countries versus non-immigrants. Conclusions: There were no differences in age-adjusted rate of screen-detected cancer among non-immigrants and immigrants from Western countries or non-Western countries among women attending BreastScreen Norway between 2010 and 2019. Small but clinically relevant differences in histopathological tumour characteristics were observed between the three groups. [ABSTRACT FROM AUTHOR]

Background: In Pakistan, Breast Cancer is the most common cancer affecting females and becomes more aggressive as it usually presents in 3rd and 4th stages. Screening practices like breast self-examination, clinical breast examination and mammography can decrease the burden of disease. The objective of this study was to assess the awareness about breast self-examination and the screening practices regarding breast cancer. Materials & Methods: A community based cross sectional study was done from November 01, 2020 to January 30, 2021 in rural and urban areas of Islamabad organized by Community Medicine Department Islamabad Medical and Dental College. Sample size was 310, all females above 25 years and less than 70 years whether married or unmarried were included in the study. The data collection tool was six section based proforma. Analysis was done by using SPSS version 23. Chi-square test was used to calculate the p-value, and p-value of <0.05 was set as significant. Results: Out of 310 females, with a mean age of 32 year, 50% of the participants never heard of breast selfexamination (BSE) while 40% of the participants heard about that but had never practiced it and 10% practiced it occasionally with significant p-value of 0.001. Knowledge association with demographic variables like literacy rate, marital status and living area was also assessed and the difference was found significant, having p-valve less than 0.05. Conclusion: Knowledge regarding BSE was there in community however, screening practices were deficient and it needs special attention. [ABSTRACT FROM AUTHOR]

Testicular cancer (TCa) commonly presents as a painless scrotal mass. It has been suggested that testicular self-examination (TSE) can help in early detection and thus potentially improve treatment outcomes and prognosis. While TSE is more well established in guideline recommendations for patients with a known history of TCa, its role in healthy young men is less established and controversial. In this paper, we review contemporary data to provide an updated recommendation. [ABSTRACT FROM AUTHOR]

Limited access to screening and evaluation for autism spectrum disorder in children is a major barrier to improving outcomes for marginalized families. To identify and evaluate available digital autism spectrum disorder screening resources, we simulated web and mobile app searches by a parent concerned about their child's likelihood of autism spectrum disorder. Included digital autism spectrum disorder screening tools (a) were on Internet or mobile app; (b) were in English; (c) had a parent user inputting data; (d) assigned likelihood category to child <9 years; and (e) screened for autism spectrum disorder. Ten search terms, developed using Google Search and parent panel recommendations, were used to search web and app tools in the United States, the United Kingdom, India, Australia, and Canada using Virtual Private Networks. Results were examined for attributes likely to benefit parents in marginalized communities, such as ease of searching, language versions, and reading level. The four terms most likely to identify any tools were "autism quiz," "autism screening tool," "does my child have autism," and "autism toddler." Three out of five searches contained autism spectrum disorder screening tools, as did one of 10 links or apps. Searches identified a total of 1475 websites and 919 apps, which yielded 23 unique tools. Most tools required continuous Internet access or offered only English, and many had high reading levels. In conclusion, screening tools are available, but they are not easily found. Barriers include inaccessibility to parents with limited literacy or limited English proficiency, and frequent encounters with games, advertisements, and user fees. Many parents wonder if their child might have autism. Many parents use their smartphones to answer health questions. We asked, "How easy or hard is it for parents to use their smartphones to find 'tools' to test their child for signs of autism?" After doing pretend parent searches, we found that only one in 10 search results were tools to test children for autism. These tools were not designed for parents who have low income or other challenges such as low literacy skills, low English proficiency, or not being tech-savvy. [ABSTRACT FROM AUTHOR]

Aims: Diabetes is associated with a higher risk of colorectal cancer (CRC) and inferior survival after CRC. Screening may enable the early detection of CRC. We aimed to assess the impact of diabetes on cancer detection and disease stage during the prevalence round of a national CRC screening program. Methods: We performed a register‐based cohort study based on the randomized procedure for inviting Danish residents aged 50–74 years to the prevalence round of national CRC screening program in 2014–2017. By comparing the random half of the population who had been invited by 1 May 2016 with the not yet invited half, the effect of screening was assessed by the detection of CRC and disease stage among individuals with and without diabetes. Further, the impact of diabetes on the screening participation rate was calculated. Results: By randomisation, 504,673 individuals had been invited to the CRC screening by 1 May 2016, and 549,359 individuals had not yet been invited. The diabetes prevalence was 10% in both groups. When comparing those not yet invited to those invited, the effect of screening on the number of detected cancers per 100,000 individuals was higher in those with diabetes (from 207 to 494 cancers) than in those without diabetes (from 147 to 364 cancers), and screening resulted in overall higher proportions of stage I cancer. Among those invited to screening, the participation rate was 9.1% lower (95% CI: 8.7%–9.5%) in individuals with versus without diabetes. Conclusions: Despite a lower participation rate, the effect of CRC screening was higher in individuals with diabetes. [ABSTRACT FROM AUTHOR]

Serology has significantly revolutionized the knowledge of celiac disease (CD), leading to the identification of unsuspected patients in at-risk CD groups, thereby increasing the number of CD diagnoses compared to the pre-screening era. Several markers for CD with a progressive diagnostic accuracy have been identified over the years, but only three of them, i.e. anti-tissue transglutaminase (antitTG), anti-endomysial (EmA) and anti-deamidated gliadin antibodies (DGP) are currently assessed in the daily clinical practice. A thorough review of the literature identified 44 original studies published between 1998 to 2022 for a total of 5098 pediatric and adult CD patients (without selective IgA deficiency) and 11930 disease controls. The results highlighted that anti-tTG IgA exhibited a higher sensitivity for CD (93.4%) than EmA IgA (92.8%), DGP IgG (81.8%) and DGP IgA (83.8%). The specificity of EmA IgA (99%) resulted to be higher than those of anti-tTG IgA (95.8%), DGP IgG (96.4%) and DGP IgA (92.1%). In patients with selective IgA deficiency, a condition closely related to CD, serological screening should include one of the three antibodies of IgG class, since anti-tTG, DGP and EmA have a very similar diagnostic accuracy in this clinical setting. According to age, there are two main diagnostic strategies for CD detection. In children, the revised ESPGHAN 2020 guidelines established that CD could be diagnosed in both symptomatic and asymptomatic children by high anti-tTG IgA titers (>10 times the cut-off) and EmA positivity with no need to obtain duodenal biopsy and HLA typing. In adult patients, although high tTG IgA titers (confirmed by EmA IgA positivity) correlate with villous atrophy, an intestinal biopsy is still considered mandatory for confirming CD diagnosis. Currently, a case finding approach in at-risk groups is preferred to mass screening for CD detection. [ABSTRACT FROM AUTHOR]

Hepatitis E caused by hepatitis E virus (HEV) infection is an acute /chronic infectious disease with significant morbidity and mortality, which has become an important global health issue. Our understanding of HEV has changed completely over the past decade. Every year 20 million people are infected with HEV, among whom hepatitis E occur in 3.3 million cases and 70 thousands die from HEV infection-related diseases globally. However, a majority of HEV infections, especially fulminant or chronic hepatitis E, are missed diagnosed or misdiagnosed in China. According the goal of eliminating viral hepatitis as a public health threat by 2030 set by the World Health Organization and based on the fact that medical institutions are the main facilities for diagnosis and treatment of Hepatitis E in China, we developed the Expert Consensus on the process of in-hospital screening and management of viral hepatitis E in China. The consensus intends to promote multi-disciplinary and multi-departmental collaboration in health care institutions, including hospital administration, infection control division, clinical departments and laboratory, to strengthen the screen, diagnosis, consultation, referral and treatment of patients with hepatitis E. Meanwhile, the consensus also intends to raise the awareness of hepatitis E among non-infectious and non-hepatic specialists, which would be conducive to timely detection and early diagnosis of hepatitis E. [ABSTRACT FROM AUTHOR]

Objective: To evaluate HPV‐negative cervical high‐grade precancerous lesions or cancer in China. Methods: Histologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were searched in a multicentric clinical study. All patients underwent cobas HPV testing, liquid‐based cytology, DNA ploidy analysis, and colposcopy‐guided biopsy. According to clinical practice, patients underwent p16ink4a staining and cone biopsy. Comparisons were made between HPV‐negative and ‐positive patients for clinical characteristics. Results: The study found 61 cases of cobas HPV‐negative CIN2+ among 797 cases of histologically confirmed CIN2+, including 38 CIN2, 20 CIN3, and 3 invasive cancers. The prevalence of HPV‐negative CIN2+ and CIN3+ was 7.7% (95% confidence interval [CI] 5.8–9.5) and 5.7% (95% CI 3.5–8.0), respectively. Among 24 cases with p16 staining, 20 showed p16 positivity. The proportions of normal or minor abnormalities in terms of colposcopy, cytology, and DNA ploidy were higher in HPV‐negative cases than in HPV‐positive cases. When adding cytology to the screening of symptomatic or previously HPV‐positive women, the prevalence of HPV‐negative CIN2+ or CIN3 would decrease by approximately 50%. Conclusion: Less than one‐tenth of CIN2+ are missed by HPV‐only screening, and they have smaller lesions than HPV‐positive cases. Colposcopy should be considered for symptomatic or previously HPV‐positive women with HPV‐negative results. Synopsis: Less than one‐tenth of CIN2+ are missed by HPV‐only screening in China, and colposcopy should be considered for women who are symptomatic but negative for HPV. [ABSTRACT FROM AUTHOR]

Background: High-density lipoprotein cholesterol's (HDL-C) long-held status as a cardiovascular disease (CVD) preventative has been called into question. Most of the evidence, however, focused on either the risk of death from CVD, or on single time point level of HDL-C. This study aimed to determine the association between changes in HDL-C levels and incident CVD in individuals with high baseline HDL-C levels (≥ 60 mg/dL). Methods: 77,134 people from the Korea National Health Insurance Service-Health Screening Cohort were followed for 517,515 person-years. Cox proportional hazards regression was used to evaluate the association between change in HDL-C levels and the risk of incident CVD. All participants were followed up until 31 December 2019, CVD, or death. Results: Participants with the greatest increase in their HDL-C levels had higher risks of CVD (adjusted hazard ratio [aHR], 1.15; 95% confidence interval [CI], 1.05–1.25) and CHD (aHR 1.27, CI 1.11–1.46) after adjusting for age, sex, household income, body mass index, hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol consumption, moderate-to-vigorous physical activity, Charlson comorbidity index, and total cholesterol than those with the lowest increase in HDL-C levels. Such association remained significant even among participants with decreased low-density lipoprotein cholesterol (LDL-C) levels for CHD (aHR 1.26, CI 1.03–1.53). Conclusions: In people with already high HDL-C levels, additional increases in HDL-C levels may be associated with an increased risk of CVD. This finding held true irrespective of the change in their LDL-C levels. Increasing HDL-C levels may lead to unintentionally elevated risk of CVD. [ABSTRACT FROM AUTHOR]

STATISTICAL ANALYSIS We computed the proportion HBsAg completion among at-risk patients at baseline and the proportion HBsAg completion at the end of the pilot study in the intervention clinic and control clinic. The use of surname lists to identify Asians for health screenings has previously been validated.[7] Patients who already had a hepatitis B surface antigen (HBsAg) completed were automatically excluded. Keywords: electronics; health care delivery; hepatitis B; mass screening; registries EN electronics health care delivery hepatitis B mass screening registries 228 231 4 02/17/23 20230301 NES 230301 Abbreviations CHB chronic hepatitis B HBcAb hepatitis B core antibody total HBsAb hepatitis B surface antibody HBsAg hepatitis B surface antigen HBV hepatitis B virus PCP primary care provider INTRODUCTION Chronic hepatitis B (CHB) affects up to 2.4 million persons in the United States and is the leading cause of cirrhosis and liver cancer worldwide.[1] Thus, the Centers for Disease Control and Prevention, United States Preventive Services Task Force and American Association for the Study of Liver Diseases have recommended CHB screening all persons born in countries with endemicity >=2%. [Extracted from the article]