Changes In Screening Practices Research Articles

The impact of recreational cannabinoid legalization on utilization in a pregnant population.

Marijuana potency and utilization both continue to increase across the United States. While the overall prevalence of cannabinoid utilization during pregnancy has been surveyed in various studies, the direct impact of changing governmental policies on pregnancy use is less characterized. Thus, we aimed to investigate how the legalization of recreational cannabinoid products impacted use during pregnancy in the state of New Mexico. Participants who had a live birth during two study epochs were included: pre-legalization (Epoch 1: 1 January 2019-31 March 2021) and post-legalization (Epoch 2: 1 November 2021-30 November 2022). Participants were further divided into case group [prenatal cannabinoid exposure (PCE)] vs. control (no PCE), with cases being identified by documented self-report or a positive laboratory toxicology test for cannabinoid use during pregnancy. A total of 1,191 maternal/infant dyads were included in Epoch 1, and 378 maternal/infant dyads were included in Epoch 2. In Epoch 1, 788 dyads were controls with 403 cases, while Epoch 2 had 292 controls and 86 cases. Interestingly there was a significant decrease in self-report or positive laboratory toxicology tests in Epoch 2 compared to Epoch 1. Infants born following PCE in both Epoch groups were more commonly born via Cesarean section, had significantly smaller birth weight, length, and head circumference as well as significantly lower Apgar scores at 1 and 5 min. The finding of decreased reported cannabinoid use in the post-legalization group is contradictory to previous studies which have shown increased rates of cannabinoid use after legalization. This could be due to multiple factors including changes in screening practices, the COVID-19 pandemic, and lack of commercialization of THC products. Additional studies are needed to further characterize how changing governmental policies impacts utilization during pregnancy.

Unmet needs in Barret's esophagus diagnosis and treatment: a narrative review.

This narrative review discusses Barrett's esophagus management in the context of perceived deficiencies or controversies. Barrett's adenocarcinoma incidence has not clearly been impacted by Barrett's screening and surveillance. The following report was derived from articles using PubMed and Google searches. The search was concentrated on Barrett's esophagus screening and management guidelines. Comprehensive literature searches that highlight potential deficiencies or controversies regarding the current approach to Barrett's esophagus were employed. Esophageal adenocarcinoma incidence is rapidly increasing and this malignancy usually presents in an advanced and unresectable state. This is despite the significant expenditure of resources and time in endoscopic screening for and surveillance of Barrett's esophagus. Thus, more widespread screening for Barrett's esophagus may be considered. In addition, there are apparent inefficiencies and precision lack in the performance of endoscopic surveillance. This relates mainly to the lack of endoscopic cues for dysplasia. On the other hand, relatively low-risk subjects have frequent screening or surveillance procedures increasing cost. Lastly, endoscopic ablation for Barrett's with dysplasia has moderately good efficacy, especially for eradication of dysplasia, but mandates intensive post-therapy endoscopic surveillance. There is some concern for subsurface development of advanced Barrett's lesions. Fortunately, there is intense research in improving Barrett's esophagus diagnosis and treatment. Our narrative review will delineate deficiencies and potential measures to remedy them. In conclusion, screening for Barrett's esophagus and surveillance in Barrett's subjects have minimal established benefits, but proposed changes in screening practices and innovations in Barrett's esophagus endoscopic surveillance and dysplasia therapy have great promise.

The effect of changing screening practices and demographics on the incidence of gestational diabetes in British Columbia, 2005-2019.

Rates of gestational diabetes are reported to be increasing in many jurisdictions, but the reasons for this are poorly understood. We sought to evaluate the relative contribution of screening practices for gestational diabetes (including completion and methods of screening) and population characteristics to risk of gestational diabetes in British Columbia, Canada, from 2005 to 2019. We used a population-based cohort from a provincial registry of perinatal data, linked to laboratory billing records. We used data on screening completion, screening method (1-step 75-g glucose test or 2-step approach of 50-g glucose screening test, followed by a diagnostic test for patients who screen positive) and demographic risk factors. We modelled predicted annual risk for gestational diabetes, sequentially adjusted for screening completion, screening method and risk factors. We included 551 457 pregnancies in the study cohort. The incidence of gestational diabetes more than doubled over the study period, from 7.2% in 2005 to 14.7% in 2019. Screening completion increased from 87.2% in 2005 to 95.5% in 2019. Use of 1-step screening methods increased from 0.0% in 2005 to 39.5% in 2019 among those who were screened. Unadjusted models estimated a 2.04 (95% confidence interval [CI] 1.94-2.13) increased risk of gestational diabetes in 2019 (v. 2005). This increase was 1.89 (95% CI 1.81-1.98) after accounting for the rise in screening completion and 1.34 (95% CI 1.28-1.40) after accounting for changes in screening methods. Further accounting for demographic risk factors (e.g., age, body mass index, prenatal care) had a small impact (increase of 1.25, 95% CI 1.19-1.31). Most of the observed increase in the incidence of gestational diabetes was attributable to changes in screening practices (primarily changes in screening methods) rather than changing population factors. Our findings highlight the importance of understanding variation in screening practices when monitoring incidence rates for gestational diabetes.

Cervical cytology and HPV in cervical cancer screening

Cervical cancer remains a health burden in our country and is the 2nd most common cancer in Indian women. Effective screening can reduce the incidence as well as the morbidity and mortality of this disease. Cervical cytology and the more recent human papilloma virus (HPV) DNA test are the two main pillars of screening. Liquid based cytology has improved the cytological preparations and has shown certain advantages while advancements in molecular techniques for detection of high-risk HPV DNA/RNA has opened up new frontiers. These technological advancements have led to the changes in screening practices and paradigms and are evolving at a rapid pace. This article gives an overview of the screening modalities currently available, the technological advancements, recent updates of the screening guidelines and the future directions.

Trends in Incidence of Metastatic Prostate Cancer in the US

The US Preventive Services Task Force (USPSTF) has recommended against routine prostate-specific antigen (PSA)-based prostate cancer (PCa) screening, initially for men older than 75 years in 2008, and then for all men in 2012. Concern has been raised that, by recommending against screening, and thus early detection, the USPSTF recommendations may be associated with an increase in the incidence of metastatic PCa (mPCa). To explore the incidence of mPCa before and after the USPSTF recommendations against routine PCa screening. This population-based cohort study used the recently released Surveillance, Epidemiology, and End Results (SEER) 18 registry incidence data to identify men aged 45 years and older with a diagnosis of invasive PCa from 2004 through 2018. Data were analyzed from January 1, 2004 to December 31, 2018. Outcomes were assessed before vs after the USPSTF recommendations against routine screening. Annual age-adjusted incidence rates per 100 000 population of mPCa (defined using SEER Summary Stage and American Joint Committee on Cancer [AJCC] staging systems), with adjustments for age structure and reporting delay from 2004 to 2011, according to race and age were examined. Annual percentage changes (APCs) were calculated to quantify changes in the annual incidence rates. From 2004 to 2018, a total of 836 282 patients with PCa were recorded in the SEER database; 26 642 (56.5%) distant mPCa cases were reported in men aged 45 to 74 years, and 20 507 (43.5%) cases were reported in men aged 75 years or older. Among men aged 45 to 74 years, the incidence rate of distant mPCa (SEER Summary staging) remained stable during 2004 to 2010 (APC, -0.4%; 95% CI, -1.7% to 1.1%; P = .60), then increased significantly during 2010 to 2018 (APC, 5.3%; 95% CI, 4.5% to 6.0%; P < .001). In men aged 75 years or older, the incidence rate of distant mPCa decreased from 2004 to 2011 (APC, -1.5%; 95% CI, -3.0% to 0%; P = .046), and then increased from 2011 to 2018 (APC, 6.5%; 95% CI, 5.1% to 7.8%; P < .001). Similar trends were also seen for M1 mPCa defined per the AJCC staging system. These increased trends in mPCa incidence were particularly significant in non-Hispanic White men (2010-2018 APC, 6.9%; 95% CI, 5.4% to 8.4%; P < .001). Analysis of the emerging trends from the most recently released SEER data set (2004-2018) suggests that the incidence rates of mPCa have increased significantly and coincide temporally with the USPSTF recommendations against PCa screening across races and age groups. These mPCa trends are associated with reported changes in screening practices following the USPSTF recommendations.

A Growing Concern: The Emergence and Dissemination of Carbapenemase-producing Enterobacterales (CPE) in Canada

Background: Carbapenemase-producing Enterobacterales (CPE) have rapidly become a global health concern and are associated with substantial morbidity and mortality due to limited treatment options. Travel to endemic areas, especially healthcare exposure in these areas, is an important risk factor for acquisition. We describe the evolving epidemiology, molecular features, and outcomes of CPE in Canada through surveillance by the Canadian Nosocomial Infection Surveillance Program (CNISP). Methods: CNISP has conducted surveillance for CPE among inpatients and outpatients of all ages since 2010. Participating acute-care facilities submit eligible specimens to the National Microbiology Laboratory for detection of carbapenemase production, and epidemiological data are collected. Incidence rates per 10,000 patient days are calculated based on inpatient data. Results: In total, 59 CNISP hospitals in 10 Canadian provinces representing 21,789 beds and 6,785,013 patient days participated in this surveillance. From 2010 to 2018, 118 (26%) CPE-infected and 547 (74%) CPE-colonized patients were identified. Few pediatric cases were identified (n = 18). Infection incidence rates remain low and stable (0.02 per 10,000 patient days in 2010 to 0.03 per 10,000 patient days in 2018), and colonization incidence rates have increased by 89% over the surveillance period. Overall, 92% of cases were acquired in a healthcare facility: 61% (n = 278) in a Canadian healthcare facility and 31% (n = 142) in a healthcare facility outside Canada. Of the 8% of cases not acquired in a healthcare facility, 50% (16 of 32) reported travel outside of Canada in the 12 months prior to positive culture. The distribution of carbapenemases varied by region; New Delhi metallo-B-lactamase (NDM) was dominant (59%) in western Canada and Klebsiella pneumoniae carbapenemase (KPC) (66%) in central Canada. NDM and class D carbapenemase OXA-48 were more commonly identified among those who traveled outside of Canada, whereas KPC was more commonly identified among patients without travel. In addition, 30-day all-cause mortality was 14% (25 of 181) among CPE infected patients and 32% (14 of 44) among those with bacteremia. Conclusions: CPE rates remain low in Canada; however, national surveillance data suggest that the increase in CPE in Canada is now being driven by local nosocomial transmission as well as travel and healthcare within endemic areas. Changes in screening practices may have contributed to the increase in colonizations; however, these data are currently lacking and will be collected moving forward. These data highlight the need to intensify surveillance and coordinate infection control measures to prevent further spread of CPE in Canadian acute-care hospitals.Funding: NoneDisclosures: Susy Hota reports contracted research for Finch Therapeutics. Allison McGeer reports funds to her institution for projects for which she is the principal investigator from Pfizer and Merck, as well as consulting fees from the following companies: Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

Abrogation of survival disparity between Black and White individuals after the USPSTF's 2012 prostate-specific antigen-based prostate cancer screening recommendation.

In May 2012, the US Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA)-based screening for prostate cancer (PCa), assigning it a grade D. This decision then was modified in 2018 to a grade C for men aged 55 to 69 years. The authors hypothesized that changes in screening practices would reduce survival outcomes for both Black and White men but maintain racial discrepancies in outcomes. Using the Surveillance, Epidemiology, and End Results database, the authors examined PCa-specific survival based on race and year of diagnosis. The period between January 2010 and December 2012 was categorized as the pre-USPSTF era, whereas the period between January 2014 and December 2016 was classified as the post-USPSTF era. The year 2013 was considered the transition year and was excluded from the analysis. A total of 49,388 men were identified in the pre-USPSTF era who were diagnosed with PCa, approximately 83.7% of whom were White and 16.3% of whom were Black. In the post-USPSTF era, a total of 41,829 men were diagnosed with PCa, approximately 82.7% of whom were White and 17.3% of whom were Black. When compared with the pre-USPSTF era, men diagnosed in the post-USPSTF era were found to have more adverse clinical features. In the pre-USPSTF era, White men were less likely to die of PCa than Black men. This survival disparity between White and Black men was no longer observed in the post-USPSTF era. In men diagnosed with PCa between 2014 and 2016, a survival disparity between White and Black men was not observed due to a decrease in survival among White men while the survival of Black men remained steady.

Erratum. Changes in Screening Practices for Prediabetes and Diabetes Since the Recommendation for Hemoglobin A1c Testing. Diabetes Care 2019;42:576-584.

Acknowledgment of funding support was inadvertently omitted from the above-mentioned article. The following information is added: Funding. …

Determinants of new onset cardiometabolic risk among normal weight children

ObjectiveTo identify determinants for the development of “normal weight metabolically unhealthy” (NWMU) profiles among previously metabolically healthy normal weight children.MethodsThe QUALITY cohort comprises youth 8–10 years of age with a parental history of obesity (n = 630). Of these, normal weight children with no metabolic risk factors were identified and followed up 2 years later (n = 193). Children were classified as NWMU if they remained normal weight but developed at least one cardiometabolic risk factor. They were classified as normal weight metabolically healthy otherwise. Multivariable logistic regression models were used to identify whether adiposity (anthropometrics and DXA), lifestyle habits (physical activity, screen time, vegetables, and fruit- and sugar-sweetened beverages intake), fitness, and family history of cardiometabolic disease were associated with new onset NWMU.ResultsOf the 193 normal weight and metabolically healthy children at baseline, 45 (23%) became NWMU 2 years later (i.e., 48% had elevated HDL cholesterol, 13% had elevated triglycerides, and 4% had impaired fasting glucose). Changes in adiposity between baseline and follow-up were associated with an increased risk of NWMU for all adiposity measures examined (e.g., for ∆zBMI OR = 3.95; 95% CI: 1.76, 8.83). Similarly, a 2-year change in screen time was associated with incident NWMU status (OR = 1.24; 95% CI 1.04, 1.49).ConclusionsChildren who increase their adiposity levels as they enter puberty, despite remaining normal weight, are at risk of developing cardiometabolic risk factors. Studies examining long-term consequences of NWMU profiles in pediatrics are needed to determine whether changes in screening practice are warranted.

250 Has Endoscopic Screening for Colon and Rectal Cancer Reached an Inflection Point?

INTRODUCTION: There are six currently approved screening modalities for colorectal cancer (CRC) as of 2016 United States Preventative Services Task Force guidelines. We sought to model what changes in current screening practice regarding choice between endoscopic and non-endoscopic testing would have to occur to drive a significant (10%) decrease in population-wide endoscopic procedures done as a result of CRC screening. METHODS: Published models of endoscopic procedural rates for all six approved screening methods were integrated with National Health Interview Survey data on screening compliance and reported utilization rates of currently approved screening modalities. A simulated population of 1000 screening-naïve patients was modeled over the guideline recommended period of 25 years (age 50–75). Individuals within the model could choose endoscopic or non-endoscopic screening, but were not allowed crossover between the two groups. Positive non-endoscopic screens were referred for endoscopy and continued on endoscopic screening thereafter. Population-wide total predicted endoscopic procedures were calculated using variables reflecting current screening practices. Choice of endoscopic and non-endoscopic screening within the population was then modified to estimate the increased adoption of non-endoscopic screening that would be necessary to drive an overall 10% reduction in total CRC screening related endoscopic screening procedures. RESULTS: For a simulated population of 1,000 screening-eligible and screening-naïve adults, screening activity mirroring recent compliance rates and choice of modality type generates approximately 2,612 endoscopic procedures over the population's screening lifetime. If 20% more screened patients choose non-endoscopic screening relative to current rates and overall rates of screening compliance remain stable then the number of total endoscopic procedures done for CRC screening drops by 10% (2,348). CONCLUSION: Currently, non-endoscopic approaches to CRC screening represent &lt;10% of screened patients. Our data shows that if a relatively small increase in utilization of non-endoscopic screening strategies occurs then a significant reduction in the number of endoscopic procedures performed for screening purposes are likely. Such a change in screening practices might be an avenue towards reducing population screening costs, justifying initial screening at a younger age, and improving access to care.

Cervical cancer case-control audit: Results from routine evaluation of a nationwide cervical screening program.

Our study used a refined case–control cervical cancer Audit framework to investigate effectiveness of cervical screening, with measures of three screening failures: irregular‐participation, cervical cancer developed after cytological abnormalities and after normal screening results. The register‐based study included 4,254 cervical cancer cases diagnosed in Sweden during 2002–2011, and 30 population‐based controls per case. We used conditional logistic regression models to examine relative risks of cervical cancer in relation to screening participation and screening results in the past two screening rounds from 6 months before cancer diagnosis. We found that women unscreened in past two screening rounds showed four times increased risk of cervical cancer compared to women screened in time (OR = 4.1, 95% CI = 3.8–4.5), and women unscreened in the previous round but screened in the most recent round also showed a statistically significantly elevated risk (OR = 1.6, 95% CI = 1.5–1.8). Women having abnormality in previous two rounds exhibited higher risk of cervical cancer compared to women screened with normal results, while having normal results in the subsequent round after the abnormality also yielded an increased risk (OR = 4.0, 95% CI = 3.2–5.1). Being screened with only normal results was associated with 89% risk reduction for squamous cell cancer, compared to women unscreened, but only 60% reduction for adenocarcinoma. Our findings emphasize the importance of routine participation in cervical screening and suggest that management of abnormalities, as well as sensitivity of the test, warrants improvement especially for preventing cervical adenocarcinoma. The Audit framework serves as routine evaluation model and the findings benchmark for future evaluation of changes in screening practice.

Changes in Screening Practices for Prediabetes and Diabetes Since the Recommendation for Hemoglobin A1c Testing

Screening involves the presumptive identification of asymptomatic individuals at increased risk for unrecognized disease. We examined changes in screening practices for prediabetes and diabetes since January 2010, when HbA1c was first recommended as an option for screening and diagnosis. We studied members without diabetes of an HMO ≥45 years of age continuously enrolled for ≥3 years and assigned to primary care clinicians affiliated with a large academic health system. We defined screening as the first oral glucose tolerance test, HbA1c, or glucose test performed between 2010 and 2014. Of 12,772 eligible patients, 9,941 (78%) were screened at least once over 3 years. HbA1c was the initial screening test 14% of the time and glucose 86% of the time. Of those screened with HbA1c, 63% had abnormal results defined as HbA1c ≥5.7% (≥39 mmol/mol). Of those tested with glucose, 30% had abnormal results defined as glucose ≥100 mg/dL, and 5% had abnormal results defined as glucose ≥126 mg/dL. Patients with abnormal HbA1c levels and those with glucose levels ≥126 mg/dL were equally likely to be scheduled for follow-up appointments (41% vs. 39%), but those with abnormal HbA1c levels were more likely to be diagnosed with prediabetes or diabetes (36% vs. 26%). As we observed in 2004, rates of screening are high. HbA1c is still used less frequently than glucose for screening but is more likely to result in a clinical diagnosis. Evidence to support guidelines to define the role of random glucose screening, including definition of appropriate cut points and follow-up, is needed.

Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend

BackgroundDue to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1) collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2) explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination.MethodsA systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies.ResultsA total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness.ConclusionsThis review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.

European shortage of purified protein derivative and its impact on tuberculosis screening practices.

In June 2014, we became aware that shortages of purified protein derivative (PPD), the test substance used for the tuberculin skin test (TST), had occurred in several European health care institutions providing care for children with tuberculosis (TB). To establish the extent of the shortage, a survey was performed. Survey conducted over a 1-month period (June-July 2014) among members of the Paediatric Tuberculosis Network European Trials Group (ptbnet). Thirty-five physicians from 23 European countries contributed data. The most commonly used PPD product was RT23 (Statens Serum Institut; n = 22, 63%). Twenty-one (60%) participants reported that their institution was experiencing a PPD shortage. The majority (n = 17, 81%) of those reporting a shortage were using RT23. Thirteen (37%) participants reported changes in screening practices resulting from the shortage, including sourcing PPD from alternative manufacturers, restricting remaining supplies to patients at greatest risk or replacing TST by an interferon-gamma release assay. The data show that a PPD shortage occurred in 2014, affecting multiple European countries. The shortage resulted in changes in TB screening capabilities and practices, potentially compromising both patient care as well as public health efforts. Appropriate actions to prevent future PPD shortages should be explored urgently by public health agencies and key stakeholders.

Abstract P3-02-07: Rates of Cancer Detection and Abnormal Results among Clients Recruited for Mammography through Outreach and Education Supported by the Avon Breast Health Outreach Program

Abstract Background: The Avon Breast Health Outreach Program (BHOP) supports community-based organizations and safety-net providers in conducting outreach and education to recruit underserved, low-income and uninsured women for breast cancer screening mammography. Funded organizations report mammography outcomes as part of routine program monitoring. NCI Breast Cancer Consortium data for 2009 reported a cancer detection rate of 3.92 per 1,000 for screening mammograms and 33.21 per 1,000 for diagnostic mammograms. In CY2009, CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) reported 14 percent of mammograms had abnormal results requiring further investigation, with an overall cancer detection rate of 10.2 per 1,000 mammograms. Objective: To describe reported breast cancer detection rates and rates of abnormal mammography findings among Avon BHOP-funded programs. Methods: We reviewed routinely reported program outcomes data for 98 organizations funded continuously through the Avon BHOP for a three-year period from 2009 to 2011. Data for 17,839 mammograms were available in aggregate by year by grantee agency including the number of mammograms reported, number with a preliminary abnormal finding, and number of confirmed cancer diagnoses. Results: Agencies reported an average of 981 mammogram outcomes per year over 3 years (range 108 to 5,946 by agency). The average agency-specific rate of abnormal findings across 3 years was 13.2% (median 11.2%; range 0.49% to 51.0%). The average agency-specific cancer detection rate was 8.1 per 1,000 (median 6.4 per 1,000; range zero to 31.7 per 1,000). 28 organizations had 3-year average cancer detection rates in excess of 10 per 1,000, and 6 had rates exceeding 20 per 1,000. Large fluctuations in the proportion of mammogram outcomes reported as abnormal by a given agency year-over-year were common. Conclusion: Avon BHOP agencies reported overall abnormal and cancer detection rates similar to those of the NBCCEDP, but higher than the general population. Fluctuations in year-over-year rates were common, and may indicate changes in the way program data were reported over time, changes in screening practices (e.g. new clinical providers or new equipment), and/or differences in breast cancer risk among clients recruited for screening over time. High rates of abnormal screening results could indicate delays in obtaining results from follow-up diagnostic testing, problems with the calibration of equipment, or other quality issues. Discussion: Grantees with unusually high or low rates of abnormal or cancer outcomes or significant year-over-year rate fluctuations would benefit from technical assistance to identify and explain the underlying causes of these trends. Ensuring that all clients recruited for breast cancer screening receive high quality mammography services – including accurate imaging and reliable interpretation by experienced radiologists – is critical to minimize client anxiety and to ensure that screening results in improved health outcomes. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-07.

Developmental and Autism Screening

The American Academy of Pediatrics (AAP) recommends screening children for developmental delay and autism. Studies of current screening practice to date have been limited in scope and primarily focused on small, local samples. This study is designed to determine compliance with AAP screening recommendations: (1) developmental screening at 9, 18, and 24 or 30 months; (2) screening when concerns are raised at a surveillance visit; and (3) autism screening at 18 and 24 months and to examine pediatrician and practice characteristics associated with compliance. Pediatricians from 6 states completed a 38-item web-based questionnaire (N = 406) regarding compliance with recommendations, screening implementation, changes in screening practice since the publication of guidelines, and pediatrician and practice demographics. Overall, 17.8% of pediatricians were compliant with all 3 screening recommendations. A total of 41.6% of pediatricians screened for development at the 9-month visit, 58% at the 18-month visit, and 52% at the 24- or 30-month visit. A total of 59.8% of physicians screened for autism at the 18-month visit and 50.2% at 24-month visit. As compared with 5 years ago, 44.8% of pediatricians currently screen for development more often and 72.2% screen for autism more often. Pediatricians with 10%–50% of patients of non-White race/ethnicity in their practice were significantly less likely to screen for developmental delay than pediatricians with more than 50% of patients (odds ratio [OR] = 0.30; 95% confidence interval [CI] = 0.13, 0.69; p = .004). Similarly, pediatricians with 10%–30% of Medicaid-insured patients were less likely to screen for developmental delay than pediatricians with more than 30% of patients (OR = 0.45; 95% CI = 0.25, 0.80; p = .0007). In contrast, pediatricians with 10%–30% of Medicaid-insured patients were significantly more likely to screen patients for autism than pediatricians with more than 30% of patients (OR = 2.46; 95% CI = 1.38, 4.40; p = .0002). Increasing numbers of pediatricians are screening children for developmental delays and autism. Economically disadvantaged children are significantly more likely to be screened for developmental delay but less likely to be screened for autism than do less disadvantaged children.

Highlights of This Issue

Disparities in colorectal cancer (CRC) incidence and mortality rates between blacks and whites in the United States are considerable. How many of these disparities can be explained by differences in CRC screening practices? Using the MISCAN-Colon microsimulation model, Lansdorp-Vogelaar and colleagues simulated life histories from birth to death to estimate CRC progression in the absence of screening. They report that differences in screening practices between white and black U.S. residents are responsible for a substantial proportion of black/white disparities in CRC incidence and mortality rates. The authors suggest that enabling blacks to achieve equal access to health care could reduce these disparities.In the United States, mammography use and breast cancer rates have both declined over the past decade. Are these declines due to a reduction in hormone therapy use as well as changes in screening practices of hormone therapy users? To address this question, Buist and colleagues tracked hormone therapy use, mammography screening, and breast cancer rates in the same cohort of 163,490 women between 1994 and 2009. They report that differential screening mammography rates by hormone therapy use do not explain the decline in invasive breast cancer rates. The authors recommend that future breast cancer surveillance should focus on age-specific incidence, histologic subtypes, tumor characteristics, and outcomes following diagnosis.Obesity is an established risk factor for endometrial cancer in postmenopausal women; however, it is not clear if weight cycling (repeated cycles of weight loss and regain) is also a risk factor. Stevens and colleagues evaluated the endometrial cancer risk of weight cycling in women in the Cancer Prevention Study II Cohort. They report that weight cycling was not positively associated with endometrial cancer incidence after adjustment for body mass index. These results encourage women to strive for weight loss as a means to lower their risk of endometrial cancer.Guo and colleagues examined risk factors for esophageal squamous cell carcinoma (ESCC) in high-incidence areas of China. The presence of human papilloma virus (HPV) DNA and HPV-16–specific antibodies was assessed in ESCC cases and controls. The study revealed that the presence of HPV-16 was particularly associated with ESCC and that antibodies against HPV-16 E7 protein were found in higher proportions in cases versus controls. These results support a significant role for HPV infection in ESCC development in high-incidence areas of China.

Increased detection of cystic-fibrosis-related diabetes in Australia

ObjectivesTo estimate the incidence of cystic-fibrosis-related diabetes (CFRD) in youth from New South Wales (NSW) and the Australian Capital Territory (ACT), Australia and to examine demographic/clinical features at diagnosis.MethodsIncident cases...

Calibrating Longitudinal Models to Cross-Sectional Data: The Effect of Temporal Changes in Health Practices

ObjectivesTo assess the impact of simulating temporal changes in health-care practice patterns when calibrating longitudinal models to cross-sectional data. MethodsA Markov model of cervical cancer was calibrated to recent age-specific US data on the prevalence of cervical abnormalities, cervical cancer incidence, and related mortality. The impact of failing to account for temporal changes in screening practices was assessed by comparing results from 1) a conventional calibration that incorrectly assumed that all women had been exposed to current screening practices in the past and 2) an historically accurate calibration that reflected the fact that US women 65 years of age and older had not received currently available screening practices at younger ages. ResultsThe parameter set derived from conventional calibration produced a cervical cancer incidence rate of 13.4 per 100,000 among women aged 65 years and older, which is equal to the target end point. However, when this parameter set was used in the model to simulate the effects of historically correct screening, cervical incidence and related mortality in the 65 years and older age group were overestimated by 18% and 47%, respectively. Finally, when the parameter set was correctly calibrated by assuming historical changes in screening in the calibration process, excellent calibration to both incidence and mortality was obtained. ConclusionsCalibrating longitudinal models to cross-sectional data without accounting for temporal changes in clinical practice may result in a parameter set that is not as optimized as it appears and may lead to bias in evaluating the effectiveness of interventions.

Diagnostic prénatal et prévalence de la trisomie 21 en population parisienne, 2001–2005

ObjectivesTo assess recent trends in the prevalence of Down syndrome and the proportion of cases with a prenatal diagnosis in the Parisian population. Patients and methodsFour hundred and ninety-nine cases of Down syndrome were registered by the Paris Registry of Congenital Anomalies during the period 2001–2005. All cases with prenatal diagnosis were confirmed by cytogenetic examination. We analyzed trends in the total and live birth prevalence, the proportion of cases with a prenatal diagnosis and those with a pregnancy termination, as well as gestational age at diagnosis and termination. Analyses were stratified by maternal age and trends were tested by the Cochran-Armitage test and Anova. ResultsTotal prevalence of Down syndrome remained high (37.6 per 10,000 births, 95%CI 34.2–40.9) during this period because of advanced maternal age in Paris. The proportion of cases with a prenatal diagnosis (overall average 85.5%, 95% CI 81.8–88.1), and live birth prevalence of Down syndrome (7.1 per 10,000 live births, 95%CI 5.7–8.6) have remained fairly stable over time. The great majority of women (95% CI 95% 92.7–96.9) opted for a pregnancy termination following a prenatal diagnosis of Down syndrome. A trend towards an earlier gestational age at prenatal diagnosis was noted among women less than 30 years of age. Discussion and conclusionIt is important to continue to evaluate changes in the prenatal diagnosis of Down syndrome, notably in view of potential changes in screening practices and policies, and particularly if a first trimester strategy is adopted following recent recommendation by the “Haute Autorité de santé”.