Case-finding Methods Research Articles

Informing community pharmacists on COPD case-finding methods: A scoping review

Background: Early detection of chronic obstructive pulmonary disease (COPD) is a strategy to address the increasing human and economic costs of this condition. This study aimed to inform pharmacists’ case-finding strategies by providing an overview of case-finding approaches by health care practitioners. Methods: A scoping review was conducted based on the Joanna Briggs Institute and the PRISMA Extension for Scoping Reviews (PRISMA ScR) guidelines. Included studies were analyzed under the following themes: population characteristics, inclusion and exclusion criteria, setting, case-finding strategies and yield, health care practitioners involved, interprofessional collaboration and the provision of preventive services. Studies were then characterized by highest yields (the weighted average of each approach expressed as a percentage of the total number of new COPD cases divided by the total number of patients screened using the same approach). Results: The screening process produced 170 eligible studies. Twenty case-finding approaches with average yields of new COPD cases ranging from 3.8% to 29% were identified. The approach with the highest yield involved the use of a questionnaire, peak flow meter and pre–post spirometry. In 14 of these approaches, the process was initiated with the use of questionnaires. In many of the studies, case-finding was targeted at high-risk and/or symptomatic patients. Characteristics of studies with the highest case-finding yields included provider education/training, patient education, active screening, multistep approaches to case-finding, provider engagement, diagnostic criteria by guidelines and engagement of other health care practitioners. Conclusion: In our scoping review of case-finding methods for patients with COPD, we found the greatest yield from pre–post spirometry following initial screening with a peak flow meter and questionnaire. Pharmacists and health researchers can use these approaches to identify high-risk patients for interventions.

The role of the World Guidelines for Falls Prevention and Management's risk stratification algorithm in predicting falls: a retrospective analysis of the Osteoarthritis Initiative.

Recurrent falls are observed frequently among older people, and they are responsible for significant morbidity and mortality. The aim of the present study was to verify sensitivity, specificity and accuracy of World Guidelines for Falls Prevention and Management (WGFPM) falls risk stratification algorithm using data from the Osteoarthritis Initiative (OAI). Participants aged between 40 and 80years were stratified as 'low risk', 'intermediate risk' or 'high risk' as per WGFPM stratification. Data from the OAI cohort study were used, a multi-centre, longitudinal, observational study focusing primarily on knee osteoarthritis. The assessment of the outcome was carried out at baseline and during the follow-up visit at 24months. Data about sensitivity, specificity and accuracy were reported. Totally, 4796 participants were initially included. Participants were aged a mean of 61.4years (SD = 9.1) and were predominantly women (58.0%). The population was divided into three groups: low risk (n = 3266; 82%), intermediate risk (n = 25; 0.6%) and high risk (n = 690; 17.3%). WGFPM algorithm applied to OAI, excluding the intermediate-risk group, produced a sensitivity score of 33.7% and specificity of 89.9% for predicting one or more falls, with an accuracy of 72.4%. In our study, WGFPM risk assessment algorithm successfully distinguished older people at greater risk of falling using the opportunistic case finding method with a good specificity, but limited sensitivity, of WGFPM falls risk stratification algorithm.

Exploring Active Case Detection Approaches for Leprosy Diagnosis in Varied Endemic Settings: A Comprehensive Scoping Review.

(1) Background: The global burden of leprosy is not shared equally; with the majority of cases being diagnosed in Brazil, India, and Indonesia. Understanding the methods of active case detection (ACD) used in high and low endemic regions is vital for the development of future screening programs. (2) Methods: A systematic search of three databases, PubMed, Embase and Web of Science, was conducted for English language papers, published since the year 2000, which discussed the use of active case detection methods for leprosy screening. The paper utilised the Integrated Screening Action Model (I-SAM) as a tool for the analysis of these methods. (3) Results: 23 papers were identified from 11 different countries. The papers identified 6 different methods of active case detection: Household contact/social contact identification; door-to-door case detection; screening questionnaire distribution; rapid village surveys; school-based screening; and prison-based screening. 15 were located in high endemic regions and 8 of these were located in low endemic regions. (4) Conclusions: For selecting the appropriate methods of active case finding, the leprosy endemicity must be taken into consideration. The findings contribute to policy decision making allowing for more successful future leprosy case detection programs to be designed, ultimately reducing the global burden of the disease, and achieving the WHO's aim of zero leprosy.

Early Diagnosis and Treatment of COPD and Asthma — A Randomized, Controlled Trial

BackgroundMany persons with chronic obstructive pulmonary disease (COPD) or asthma have not received a diagnosis, so their respiratory symptoms remain largely untreated.MethodsWe used a case-finding method to identify adults in the community with respiratory symptoms without diagnosed lung disease. Participants who were found to have undiagnosed COPD or asthma on spirometry were enrolled in a multicenter, randomized, controlled trial to determine whether early diagnosis and treatment reduces health care utilization for respiratory illness and improves health outcomes. Participants were assigned to receive the intervention (evaluation by a pulmonologist and an asthma–COPD educator who were instructed to initiate guideline-based care) or usual care by their primary care practitioner. The primary outcome was the annualized rate of participant-initiated health care utilization for respiratory illness. Secondary outcomes included changes from baseline to 1 year in disease-specific quality of life, as assessed with the St. George Respiratory Questionnaire (SGRQ; scores range from 0 to 100, with lower scores indicating better health status); symptom burden, as assessed with the COPD Assessment Test (CAT; scores range from 0 to 40, with lower scores indicating better health status); and forced expiratory volume in 1 second (FEV1).ResultsOf 38,353 persons interviewed, 595 were found to have undiagnosed COPD or asthma and 508 underwent randomization: 253 were assigned to the intervention group and 255 to the usual-care group. The annualized rate of a primary-outcome event was lower in the intervention group than in the usual-care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% confidence interval [CI], 0.36 to 0.63; P<0.001). At 12 months, the SGRQ score was lower than the baseline score by 10.2 points in the intervention group and by 6.8 points in the usual-care group (difference, −3.5 points; 95% CI, −6.0 to −0.9), and the CAT score was lower than the baseline score by 3.8 points and 2.6 points, respectively (difference, −1.3 points; 95% CI, −2.4 to −0.1). The FEV1 increased by 119 ml in the intervention group and by 22 ml in the usual-care group (difference, 94 ml; 95% CI, 50 to 138). The incidence of adverse events was similar in the trial groups.ConclusionsIn this trial in which a strategy was used to identify adults in the community with undiagnosed asthma or COPD, those who received pulmonologist-directed treatment had less subsequent health care utilization for respiratory illness than those who received usual care. (Funded by Canadian Institutes of Health Research; UCAP ClinicalTrials.gov number, NCT03148210.)

Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review

IntroductionPolypharmacy and multimorbidity pose escalating challenges. Despite numerous attempts, interventions have yet to show consistent improvements in health outcomes. A key factor may be varied approaches to targeting patients for...

Inflammation, muscle health and aging: Calf circumference as a cost-effective diagnostic indicator of Sarcopenia

BackgroundThis study aims to investigate the levels of interleukin6(IL6), interleukin 10(IL10), the IL6:IL10 ratio, and various anthropometric measurements in different stages of sarcopenia among older individuals. MethodologyConducted as a one-year cross-sectional study using purposive sampling, involving individuals aged 58–85 years, screened for sarcopenia based on the AWGS-2019 criteria. Case-finding methods included the SARCCalF questionnaire, handgrip strength(HGS), and chair-stand tests(CST). Anthropometric measurementswere recorded for all participants, allowing for the calculation of body mass index(BMI), waist-to-hip ratio(WHR), and appendicular skeletal muscle mass index(ASMI). Additionally, IL6 and IL10levels were estimated using Sandwich-ELISA. ResultsAmong the 130participants, 33 were free from sarcopenia, 35 exhibited pre-sarcopenia, 29 had sarcopenia, and 33 presented severe-sarcopenia. A majority (63 %) of the participants were male, and a substantial portion (77 %) had both diabetes and sarcopenia. The study's findings revealed that the SARCCalF questionnaire demonstrated a lower mean score in the non-sarcopenia group, with an increasing trend from pre-sarcopenia to severe-sarcopenia groups. HGS, CST results, and ASMI exhibited a reverse trend. Post-Hoc Tukey's tests revealed that IL6, IL10, IL6:IL10, and Calf Circumference(CC) exhibited significant differences between the study groups. Furthermore, ROC analysis demonstrated that IL6, IL10, IL6:IL10, and CC possessed an AUC ranging between 0.7 and 0.9, showcasing good sensitivity and specificity in distinguishing between non-sarcopenia and pre-sarcopenia. ConclusionThis study highlights the utility of IL6, IL10, IL6:IL10, and CC in the early identification of pre-sarcopenia among older individuals, offering valuable insights for clinicians to intervene promptly and enhance their quality of life.

Analysis on time delay of tuberculosis among adolescents and young adults in Eastern China.

Tuberculosis (TB) is recognized as a significant global public health concern. Still, there remains a dearth of comprehensive evaluation regarding the specific indicators and their influencing factors of delay for adolescents and young adults. All notified pulmonary TB (PTB) patients in Jiaxing City were collected between 2005 and 2022 from China's TB Information Management System. Logistic regression models were conducted to ascertain the factors that influenced patient and health system delays for PTB cases, respectively. Furthermore, the impact of the COVID-19 pandemic on local delays has been explored. From January 1, 2005 to December 31, 2022, a total of 5,282 PTB cases were notified in Jiaxing City, including 1,678 adolescents and 3,604 young adults. For patient delay, female (AOR: 1.18, 95%CI: 1.05-1.32), PTB complicated with extra-pulmonary TB (AOR: 1.70, 95% CI: 1.28-2.26), passive case finding (AOR: 1.46, 95% CI: 1.07-1.98) and retreatment (AOR: 1.52, 95% CI: 1.11-2.09) showed a higher risk of delay. For health system delay, minorities (AOR: 0.69, 95% CI: 0.53-0.90) and non-students (AOR: 0.83, 95% CI: 0.71-0.98) experienced a lower delay. Referral (AOR: 1.46, 95% CI: 1.29-1.65) had a higher health system delay compared with clinical consultation. Furthermore, county hospitals (AOR: 1.47, 95% CI: 1.32-1.65) and etiological positive results (AOR: 1.46, 95% CI: 1.30-1.63) were associated with comparatively high odds of patient delay. Contrarily, county hospitals (AOR: 0.88, 95% CI: 0.78-1.00) and etiological positive results (AOR: 0.67, 95% CI: 0.59-0.74) experienced a lower health system delay. Besides, the median of patient delay, health system delay, and total delay during the COVID-19 pandemic were significantly lower than that before. In general, there has been a noteworthy decline in the notification rate of PTB among adolescents and young adults in Jiaxing City while the declining trend was not obvious in patient delay, health system delay, and total delay, respectively. It also found factors such as gender, case-finding method, and the hospital level might influence the times of seeking health care and diagnosis in health agencies. These findings will provide valuable insights for refining preventive and treatment strategies for TB among adolescents and young adults.

Pooled sputum testing by Xpert® MTB/RIF Ultra for active tuberculosis case finding among high-risk groups in a low-incidence area: a prospective study

Background Early detection and treatment of tuberculosis (TB) are of great importance to stop its spread. However, optimising the active case findingstrategy is critical to improving its feasibility in regions where TB is epidemic. Method The different pooled ratios between TB-positive and TB-negative sputum specimens were evaluated and a pooling ratio of 5:1 was used for the active case finding screening by Xpert MTB/RIF Ultra among high-risk groups in Beijing. Results The sensitivity of pooling ratio at 5:1 was 97.5% (39/40). Between October 2022 and March 2023, among 17,681 participants, 1729 metthe active case finding criteria and were screened by 350 5:1 sputum pools by Xpert MTB/RIF Ultra. Four pools (1.1%) tested positive and were further confirmed as definite active TB cases. In our study population with high TB incidence (231/100,000), the cost for detection of individual patients was reduced by 77.4% at a 5:1 pooling ratio. Conclusions pooled sputum testing at a suitable ratio using Xpert MTB/RIF Ultra provides a rapid, efficient, and cost-effective method for active TB case finding among high-risk groups in a low-incidence area.

A case study in applying artificial intelligence-based named entity recognition to develop an automated ophthalmic disease registry

PurposeAdvances in artificial intelligence (AI)-based named entity extraction (NER) have improved the ability to extract diagnostic entities from unstructured, narrative, free-text data in electronic health records. However, there is a lack of ready-to-use tools and workflows to encourage the use among clinicians who often lack experience and training in AI. We sought to demonstrate a case study for developing an automated registry of ophthalmic diseases accompanied by a ready-to-use low-code tool for clinicians.MethodsWe extracted deidentified electronic clinical records from a single centre’s adult outpatient ophthalmology clinic from November 2019 to May 2022. We used a low-code annotation software tool (Prodigy) to annotate diagnoses and train a bespoke spaCy NER model to extract diagnoses and create an ophthalmic disease registry.ResultsA total of 123,194 diagnostic entities were extracted from 33,455 clinical records. After decapitalisation and removal of non-alphanumeric characters, there were 5070 distinct extracted diagnostic entities. The NER model achieved a precision of 0.8157, recall of 0.8099, and F score of 0.8128.ConclusionWe presented a case study using low-code artificial intelligence-based NLP tools to produce an automated ophthalmic disease registry. The workflow created a NER model with a moderate overall ability to extract diagnoses from free-text electronic clinical records. We have produced a ready-to-use tool for clinicians to implement this low-code workflow in their institutions and encourage the uptake of artificial intelligence methods for case finding in electronic health records.

Patient, Diagnosis, and Treatment Delays Among Tuberculosis Patients Before and During COVID-19 Epidemic - China, 2018-2022.

The coronavirus disease (COVID-19) pandemic could have a damaging impact on access to tuberculosis (TB) diagnosis and treatment. The overall delay experienced by TB patients during the COVID-19 pandemic has shown a modest decrease in comparison to the period before the pandemic. Notably, higher patient delays were observed among agricultural workers and those identified through passive case-finding methods. Furthermore, the patient delay in eastern regions was shorter compared to western and central regions. The observed increase in patient delay in 2022 should be of concern for ongoing TB control efforts. Health education and active screening initiatives must be enhanced and broadened among high-risk populations and regions characterized by extended patient delays.

Strong and consistent associations of precedent chronic rhinosinusitis with risk of non–cystic fibrosis bronchiectasis

Chronic rhinosinusitis (CRS) and bronchiectasis commonly co-occur, but most prior studies were not designed to evaluate temporality and causality. In a sample representing the general population in 37 counties in Pennsylvania, and thus the full spectrum of sinonasal and relevant lung diseases, we aimed to evaluate the temporality and strength of associations of CRS with non-cystic fibrosis bronchiectasis. We completed case-control analyses for each of 3 primary bronchiectasis case finding methods. We used electronic health records to identify CRS and bronchiectasis with diagnoses, procedure orders, and/or specific text in sinus or chest computerized tomography scan radiology reports. The controls never had any indication of bronchiectasis and were frequency-matched to the 3 bronchiectasis groups on the basis of age, sex, and encounter year. There were 5,329 unique persons with bronchiectasis and 33,363 without bronchiectasis in the 3 analyses. Important co-occurring conditions were identified with diagnoses, medication orders, and encounter types. Logistic regression was used to evaluate associations (odds ratios [ORs] and 95% CIs) of CRS with bronchiectasis while adjusting for confounding variables. In adjusted analyses, CRS was consistently and strongly associated with all 3 bronchiectasis definitions. The strongest associations for CRS (ORs and 95% CIs) were those that were based on the text of sinus computerized tomography scan reports; the associations were generally stronger for CRS without nasal polyps (eg, OR= 4.46 [95% CI= 2.09-9.51] for diagnosis-based bronchiectasis). On average, CRS was identified more than 6 years before bronchiectasis. Precedent CRS was strongly and consistently associated with increased risk of bronchiectasis.

Global prevalence of autism: A systematic review update.

Prevalence estimates of autism are essential for informing public policy, raising awareness, and developing research priorities. Using a systematic review, we synthesized estimates of the prevalence of autism worldwide. We examined factors accounting for variability in estimates and critically reviewed evidence relevant for hypotheses about biological or social determinants (viz., biological sex, sociodemographic status, ethnicity/race, and nativity) potentially modifying prevalence estimates of autism. We performed the search in November 2021 within Medline for studies estimating autism prevalence, published since our last systematic review in 2012. Data were extracted by two independent researchers. Since 2012, 99 estimates from 71 studies were published indicating a global autism prevalence that ranges within and across regions, with a median prevalence of 100/10,000 (range: 1.09/10,000 to 436.0/10,000). The median male‐to‐female ratio was 4.2. The median percentage of autism cases with co‐occurring intellectual disability was 33.0%. Estimates varied, likely reflecting complex and dynamic interactions between patterns of community awareness, service capacity, help seeking, and sociodemographic factors. A limitation of this review is that synthesizing methodological features precludes a quality appraisal of studies. Our findings reveal an increase in measured autism prevalence globally, reflecting the combined effects of multiple factors including the increase in community awareness and public health response globally, progress in case identification and definition, and an increase in community capacity. Hypotheses linking factors that increase the likelihood of developing autism with variations in prevalence will require research with large, representative samples and comparable autism diagnostic criteria and case‐finding methods in diverse world regions over time.Lay SummaryWe reviewed studies of the prevalence of autism worldwide, considering the impact of geographic, ethnic, and socioeconomic factors on prevalence estimates. Approximately 1/100 children are diagnosed with autism spectrum disorder around the world. Prevalence estimates increased over time and varied greatly within and across sociodemographic groups. These findings reflect changes in the definition of autism and differences in the methodology and contexts of prevalence studies.

Effective High Grade Cervical Intraepithelial Neoplasia Case Finding in Low Resource Settings.

Background: Visual Inspection with Acetic Acid (VIA) is an inexpensive option for cervical cancer screening. In this study, we evaluated the role of the VIA as well as of the clinical symptoms/signs to find the best case-finding method for Cervical Intraepithelial Neoplasia (CIN) 2+. Methods: In a cross-sectional study, we extracted from records the demographic characteristics, clinical symptoms/signs, and indications for colposcopy referral of patients with CIN 2+ in pathology. Patients were divided into 1- Abnormal Pap smear, 2- Positive VIA, 3- abnormal Pap smear with clinical symptoms/signs, 4-VIA positive with clinical symptoms/signs, 5- only clinical symptoms/signs. The sensitivity of each method was studied to determine their effectiveness as a screening method. Results: Out of 146 patients who underwent colposcopy, 38 patients had it due to abnormal Pap smears, 37 due to positive VIA, 21 due to abnormality of both these tests, and 50 due to clinical symptoms/signs despite having normal screening tests. The sensitivity for VIA and Pap smear was 73.39% (17.48%-83.31%) and 40.41% (32.47%-48.86%) respectively. Presence of at least one of the three clinical symptoms/signs and a positive VIA found 78.8% of CIN 2+ cases. Presence of at least one of the three clinical symptoms/signs and abnormal Pap smear identified 84.2% of the cases. Conclusion: To find high-grade CIN, focused attention to the clinical symptoms/signs, even in the presence of normal Pap smear, can increase the sensitivity of Pap smear and VIA. In low resource settings, a simple, highly sensitive method like VIA can be used in addition to or as an alternative to other means.

Evaluation of the Completeness of ALS Case Ascertainment in the US National ALS Registry: Application of the Capture-Recapture Method

Introduction: The Centers for Disease Control and Prevention (CDC) National Amyotrophic Lateral Sclerosis (ALS) Registry is the first national registry for a chronic neurologic disease in the USA and uses a combination of case-finding methods including administrative healthcare data and patient self-registration. Methods: We applied capture-recapture methodology to estimate the completeness of the Registry for ascertaining patients with ALS for the first full year and the fourth year of the Registry (2011, 2014). The Registry uses the combination of two national administrative claims databases (Medicare and Veterans Affairs) with a self-register option at the registry portal. We conducted descriptive analyses of the demographic and clinical characteristics of the ALS cases identified by each of the sources and estimated the completeness of case ascertainment for each of the three ALS Registry sources individually, pairwise, and in all combinations. Results: Case-finding completeness was 54% in 2011 and improved to 56% in 2014. A smaller proportion of ALS patients under age 65 were ascertained than those 65 or older, and ascertainment was also lower for nonwhite than white patients. The uncorrected ALS prevalence was 4.3/100,000 in 2011 (in 2014, 5.0/100,000), but after correction for underascertainment, annual prevalence in 2011 was 7.9/100,000 (95% CI: 7.6–8.2) (in 2014 was 8.9/100,000 [95% CI: 8.7–9.2]). Discussion/Conclusion: Our findings indicate that administrative healthcare databases are a very efficient method for identifying the majority of ALS prevalent cases in the National ALS Registry and that the inclusion of a web registry portal for patients to self-register is important to ensure a more representative population for estimating ALS prevalence. Nonetheless, more than 40% of ALS cases were not ascertained by the Registry, with individuals younger than age 65 and people of color underrepresented. Recommendations are provided for additional methods that can be considered to improve the completeness of case ascertainment.

Online respondent-driven detection for enhanced contact tracing of COVID-19

Abstract Background Contact tracing (CT) is a core intervention in the global COVID-19 response, but it is a laborious task for the public health professionals (PHPs) who execute CT. In many countries, the workload associated with CT of COVID-19 exceeded available resources for CT. Online respondent-driven detection (RDD) is an innovative method for case finding that can enhance CT efficiency, through active involvement of index cases and contacts in the execution of CT. This can accelerate CT and decrease PHPs' workload. However, it is unclear if and why (not) PHPs want to apply RDD for CT of COVID-19 and what they need to this purpose. Methods This mixed methods study is undertaken in the Netherlands and Germany. We developed an interview guide based on the ‘reasoned action approach' to elicit factors that influence PHPs' intention to apply RDD for CT of COVID-19 and their needs. We conducted 17 semi-structured interviews with Dutch PHPs - and will conduct 6-10 interviews with German PHPs involved in CT of COVID-19. Based on the interviews, an online questionnaire is developed to validate the qualitative findings in a larger population of PHPs. Preliminary results Dutch PHPs believe that RDD facilitates autonomous participation of index cases and contacts and, conversely, less control of PHPs in CT. PHPs anticipated that this could impact the quality and efficiency of CT, and the delivery of - and compliance with - control measures. Several factors, e.g. the available CT-capacity and the anticipated skills and willingness of index cases and contacts to participate in RDD, influenced PHPs' intention to apply RDD for CT of COVID-19. PHPs expressed a need to retain opportunities to support and guide index cases and contacts in CT and to maintain oversight over the CT-process. Conclusions RDD can support PHPs and enhance CT during the ongoing COVID-19 pandemic and future large scale outbreaks of infectious diseases. In order to be properly applied, PHPs' needs should be addressed.

99Increasing prevalence of primary biliary cholangitis in Victoria, Australia

Abstract Background The prevalence of primary biliary cholangitis (PBC) reported in different countries varies significantly and in some parts of the world appears to be increasing. The aim of this study was to determine the 2013 prevalence of PBC in Victoria, Australia, and to determine the time trend by comparing it with previous studies undertaken in 1991 and 2002. Methods Four case-finding methods were used to identify cases of PBC in Victoria: (1) physicians’ survey; (2) tertiary hospital search; (3) liver transplant database search; and (4) private pathology antimitochondrial antibody search. Results The prevalence of PBC in Victoria, Australia, is 189.0 per million using all four methods. The average annual increase in prevalence from 1991 to 2013 was 7.7 per million per year. Using the same case-finding methods as the 1991 Victorian prevalence study (methods 1 and 2), the prevalence of PBC increased from 19.1 per million in 1991 to 49.4 per million in 2002 (P &amp;lt; 0.001) and to 80.7 per million in 2013 (P &amp;lt; 0.001). Conclusions The current prevalence of PBC in Victoria is significantly higher than previously reported. The use of private pathology-based case-finding methods is important in identifying the maximum number of PBC cases. Key messages PBC prevalence in Victoria increased significantly since previous surveys, to 189 per million persons. Including pathology-based case ascertainment yields improved identification of cases.

Substandard and Falsified Medicines: Proposed Methods for Case Finding and Sentinel Surveillance.

The World Health Organization and others warn that substandard and falsified medicines harm health and waste money, especially in low- and middle-income countries. However, no country has measured the market-wide extent of the problem, and no standardized methods exist to estimate the prevalence of either substandard or falsified medicines. This is, in part, because the task seems overwhelming; medicine markets are huge and diverse, and testing medicines is expensive. Many countries do operate some form of postmarket surveillance of medicine, but their methods and goals differ. There is currently no clear guidance on which surveillance method is most appropriate to meet specific public health goals. In this viewpoint, we aimed to discuss the utility of both case finding and risk-based sentinel surveillance for substandard and falsified medicines, linking each to specific public health goals. We posit that choosing the system most appropriate to the goal, as well as implementing it with a clear understanding of the factors driving the production and sale of substandard and falsified medicines, will allow for surveillance resources to be concentrated most efficiently. We adapted principles used for disease outbreak responses to suggest a case-finding system that uses secondary data to flag poor-quality medicines, proposing risk-based indicators that differ for substandard and falsified medicines. This system potentially offers a cost-effective way of identifying “cases” for market withdrawal, enhanced oversight, or another immediate response. We further proposed a risk-based sentinel surveillance system that concentrates resources on measuring the prevalence of substandard and falsified medicines in the risk clusters where they are most likely to be found. The sentinel surveillance system provides base data for a transparent, spreadsheet-based model for estimating the national prevalence of substandard and falsified medicines. The methods we proposed are based on ongoing work in Indonesia, a large and diverse middle-income country currently aiming to achieve universal health coverage. Both the case finding and the sentinel surveillance system are designed to be adaptable to other resource-constrained settings.

Online respondent-driven detection for enhanced contact tracing of close-contact infectious diseases: benefits and barriers for public health practice

BackgroundOnline respondent-driven detection (RDD) is a novel method of case finding that can enhance contact tracing (CT). However, the advantages and challenges of RDD for CT have not yet been investigated from the perspective of public health professionals (PHPs). Therefore, it remains unclear if, and under what circumstances, PHPs are willing to apply RDD for CT.MethodsBetween March and April 2019, we conducted semi-structured interviews with Dutch PHPs responsible for CT in practice. Questions were derived from the ‘diffusion of innovations’ theory. Between May and June 2019, we distributed an online questionnaire among 260 Dutch PHPs to quantify the main qualitative findings. Using different hypothetical scenarios, we assessed anticipated advantages and challenges of RDD, and PHPs’ intention to apply RDD for CT.ResultsTwelve interviews were held, and 70 PHPs completed the online questionnaire. A majority of questionnaire respondents (71%) had a positive intention towards using RDD for CT. Anticipated advantages of RDD were ‘accommodating easy and autonomous participation in CT of index cases and contact persons’, and ‘reaching contact persons more efficiently’. Anticipated challenges were ‘limited opportunities for PHPs to support, motivate, and coordinate the execution of CT’, ‘not being able to adequately convey measures to index cases and contact persons’, and ‘anticipated unrest among index cases and contact persons’. Circumstances under which PHPs anticipated RDD applicable for CT included index cases and contact persons being reluctant to share information directly with PHPs, digitally skilled and literate persons being involved, and large scale CT. Circumstances under which PHPs anticipated RDD less applicable for CT included severe consequences of missing information or contact persons for individual or public health, involvement of complex or impactful measures for index cases and contact persons, and a disease being perceived as severe or sensitive by index cases and their contact persons.ConclusionsPHPs generally perceived RDD as a potentially beneficial method for public health practice, that may help overcome challenges present in traditional CT, and could be used during outbreaks of infectious diseases that spread via close contact. The circumstances under which CT is performed, appear to strongly influence PHPs’ intention to use RDD for CT.

Study to evaluate the effectiveness and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among residents (≥40 years) in four cities in China: protocol for a multicentre cross-sectional study on behalf of the Breathe Well group

IntroductionThe latest chronic obstructive pulmonary disease (COPD) epidemiology survey in China estimated that there were 99 million potential COPD patients in the country, the majority of whom are undiagnosed. Screening...

Impact of COPD case finding on clinical care: a prospective analysis of the TargetCOPD trial

ObjectivesTo investigate the impact of chronic obstructive pulmonary disease (COPD) case finding on clinical care.DesignWe conducted a prospective observational analysis of data from a pragmatic cluster randomised controlled trial in...