Community-based Screening Program Research Articles

An evaluation of a community dementia screening program in rural Kenya: DEM-SKY.

This study describes the implementation outcomes and evaluation of DEM-SKY, a community-based dementia screening program developed in rural Kenya with the support of community health care workers (CHWs). DEM-SKY was delivered to 3546 older adults in Makueni County, Kenya, over a 6-month period. Using a mixed-methods design, we explored implementation outcomes with stakeholders through surveys and interviews. The program demonstrated good acceptability, adoption, and fidelity and was effective in instigating behavior change. Individuals who screened positive for dementia were 28.7 times more likely to intend to speak to a doctor. Qualitative data showed that participants valued the program but indicated scope for improvement, particularly further down the diagnostic pathway. DEM-SKY was successful across several implementation metrics. Although the program demonstrates that community-based screening can be conducted effectively with minimal resources, future research needs to explore the long-term benefits of dementia screening in Kenya. Community-based dementia screening is feasible in rural Africa. Involving community health workers strengthens trust in health care systems. Empowering community health workers enhances the community capacity to address dementia Screening promotes proactive health seeking among older adults.

Impact of sending vouchers for a community-based oral screening program on dental service usage promotion among adults: a difference-in-difference analysis

BackgroundCommunity- and evidence-based approaches are essential for improving dental public health. We evaluated the effectiveness of sending vouchers in a community-based oral screening program to encourage dental visits and improve oral health among adults.MethodsWe analyzed the data from April 2014 to March 2019 obtained from administrative claims and screening program databases in Tsukuba City, Japan. This longitudinal observational study utilized the difference-in-difference approach to evaluate the impact of the screening program on dental service use. The exposure group, which comprised residents aged 30, 40, 50, 60, and 70 years who were eligible for the screening program and had received dental check-up vouchers, was compared with an age-matched control group, which comprised individuals aged ± 2 years. Dental service use was evaluated in terms of (1) whether monthly dental visits occurred, (2) the number of dental visits per person, and (3) the total monthly dental expenditure.ResultsData were obtained from 43,438 residents (14,392 and 29,046 in the exposure and control groups, respectively). The program positively affected the likelihood of attending a dental visit (adjusted risk ratio, 1.04; 95% confidence interval [CI], 1.00–1.07) and the overall monthly expenditure on dental services (adjusted mean ratio, 1.03; 95% CI, 1.03–1.03).ConclusionsThe oral screening program slightly increased dental service use among adults in Japan. The findings enable evidence-based policy-making on the improvement of the population-level oral health status.

Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia: The ANRS 12384 CAM-C Cluster Randomized Controlled Trial-Protocol for a Mixed Methods Study.

In Cambodia, hepatitis C constitutes a significant public health challenge, particularly among older adults (>45 years) for whom prevalence is estimated to be 5%. To facilitate the elimination of hepatitis C among the general population, enhancing access to screening and treatment is imperative. In this regard, the evaluation of community-based screening programs emerges as a crucial step toward improving health care accessibility. This study aims to assess the comparative efficacy of a community-based versus a facility-based approach in enhancing the uptake of hepatitis C antibody testing among the general population older than 40 years of age in Cambodia. The CAM-C (Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia) study uses a cluster-randomized controlled trial design across two Cambodian provinces to compare community-based and facility-based hepatitis testing interventions. Sampling involves a multistage cluster approach, targeting individuals older than 40 years of age due to their higher prevalence and risk of chronic hepatitis complications. This study incorporates a qualitative analysis of acceptability and a cost-effectiveness comparison. Interventions include facility-based testing with subsequent referral and community-based testing with direct in-home assessments. Follow-up for positive cases involves comprehensive management and potential direct-acting antiviral treatment. This study aims to identify a significant increase in testing uptake, requiring the screening of 6000 individuals older than 40 years of age, facilitated by a structured sampling and intervention approach to minimize contamination risks. The final protocol including the quantitative, qualitative, and cost-effectiveness part of the study was registered and was approved in 2019 by the National Ethical Cambodian for Health Research. Inclusions were completed by mid-2024, with analyses starting in May 2024. Using a mixed methods approach that combines a robust methodology (cluster-randomized controlled trial) with a cost-effectiveness analysis and qualitative research, such a study should provide invaluable information to guide the Ministry of Health in its hepatitis C virus screening strategy and move toward elimination. ClinicalTrials.gov NCT03992313; https://clinicaltrials.gov/study/NCT03992313. DERR1-10.2196/63376.

The serum uric acid/high-density lipoprotein cholesterol ratio: a novel predictor for the presence of abdominal aortic aneurysm.

Robust evidence has demonstrated that inflammation plays an important role in the occurrence and development of abdominal aortic aneurysms (AAA). The serum uric acid (UA)/high-density lipoprotein cholesterol (HDL-C) ratio (UHR) has recently been recognized as a new biomarker for evaluating inflammatory and anti-inflammatory interactions. However, whether UHR is associated with AAA remains unclear. This study aimed to explore the association between UHR and presence of AAA. We prospectively performed a hospital-based and community-based AAA screening program using ultrasonography in 9,064 individuals at Guangdong Provincial People's Hospital and two communities in China. Logistic regression analysis was used to explore the association between UHR and presence of AAA. In addition, the restricted cubic spline (RCS) regression method was used to visually investigate the dose-response relationship between UHR and the presence of AAA. Propensity score matching (PSM) analysis was conducted to adjust for baseline variations and diminish selection bias, and subgroup analysis was performed to investigate the consistency of the conclusions. The prevalence of AAA was 2.45% (222/9,064) in the present study. The optimal cut-off value of UHR was 17.0%, which was selected according to the receiver operator characteristic curve. The prevalence of AAA was 3.96% in the high-UHR group (UHR ≥ 17%) and 1.54% in the low-UHR group (UHR < 17%) (P < 0.001). After adjusting for other relevant clinical covariates, UHR was independently associated with the presence of AAA, either as a continuous variable (odds ratio [OR] 1.03, 95% confidence intervals [CI] 1.01-1.05, P < 0.001) or as a categorical variable (OR 1.63, 95% CI 1.18-2.26, P = 0.003). The RCS curve showed a nonlinear dose-response relationship between UHR and the presence of AAA. Moreover, the positive correlation between UHR and the presence of AAA remained significant after PSM and subgroup analyses. UHR was positively associated with the presence of AAA, and there was a non-linear dose-response relationship between them. Thus, UHR may serve as a novel and reliable predictor of AAA.

Improving health outcomes among older adults in India: effectiveness and implementability of a novel comprehensive geriatric assessment based intervention.

There is significant evidence on the benefits of comprehensive assessment in older adults. But this evidence is primarily from western countries and in secondary care settings. National policies in India recognize this need and envision community-based screening and facility-based assessment programs integrated into the care pathways for the elderly. However, this is yet to translate into specific interventions, primarily due to lack of complex interventions necessary and evidence of their effectiveness. This study aims to design and pilot an integrated (Community + Facility) Elderly Health Status Assessment and Screening (EHSAS) intervention to improve health outcomes of older adults and assess its feasibility for implementation in Indian rural settings. We propose a hybrid design where we will build the complex intervention, develop and validate the tools needed, pilot it using an exploratory cluster randomized trial and evaluate its implementatbility using the Exploration-Preparation-Implementation-Sustainment (EPIS) framework. This study will fill critical gaps in evidence regarding the effectiveness of geriatric screening and assessment in community and primary care settings in low-middle income countries and provide validated tools and implementation models for adoption into national programs. CTRI/2023/07/055661.

Role of artificial intelligence-enabled hand-held fundus camera for community-based diabetic retinopathy screening

BackgroundThis study aimed to assess the diagnostic accuracy of an artificial intelligence (AI) system integrated with a portable handheld fundus camera for the detection of diabetic retinopathy (DR) in a community-based screening program. MethodsA DR screening camp was organized at a tertiary care hospital in India. A cohort of 261 patients with diabetes was screened using a nonmydriatic handheld fundus camera. Retinal images were graded by specialists and compared with the AI system's output. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC-ROC) were calculated. Subgroup analyses based on image quality was performed. ResultsOf the 261 patients screened, 253 had available retinal images, and 243 had gradable images. The AI system achieved a sensitivity of 85.29%, specificity of 99.04%, PPV of 93.55%, and NPV of 97.64% for detecting referable DR. The AUC-ROC was 0.93. The AI system's performance remained robust across all image-quality categories. The AI system showed strong agreement with human graders (κ = 0.86). However, it failed to identify certain non-DR pathologies detected by human graders. ConclusionsThe AI system integrated with a portable handheld fundus camera demonstrated high diagnostic accuracy for referable DR detection in a community-based screening setting. This technology shows promise for expanding DR-screening coverage in resource-limited settings.

Hypertensive myocardial disease screening in low-income settings using smartphone-based technologies: a prospective multicenter trial

Abstract Background Mobile health technologies are revolutionizing cardiovascular (CV) medicine. However, more than 80% of heart disease related deaths occur in low-income settings, that are unable to take advantage of such technologies for healthcare awareness and prevention. Purpose To assess the feasibility of a pilot telemedicine-based CV screening campaign with D-Heart, a validated low-cost 8-lead smartphone portable ECG, coupled with blood-pressure (BP) monitoring in three regions of Africa. Methods A total of 950 patients (60%) men, age 29±21) were enrolled at 5 African rural dispensaries, 2 in Kenya, 2 in Senegal and at a hospital (Uganda). ECGs recording were obtained by community health workers with D- Heart smartphone ECG; BP was measured with a validated smartphone BP recorder. Global burden of ECG abnormalities was defined by a semi-quantitative score based on the sum of 9 criteria, identifying four classes of increasing severity. ECGs that were moderately and severely abnormal and from patients with severe hypertension, were sent for consultation via smartphone to D-Heart tele-cardiology centre: an advice on how to manage the patient was sent back to the community health worker’s smartphone within 15 minutes. If referral was needed, patients were sent to the local hospital. Results Mean BMI was 26.2 ± 8.5 (men 22.3±1.5 vs women 27.2±1.1, p&amp;lt;0.01). Active/recent history of smoking and alcohol intake were 327 (45%, 298 men) and 232/590 (40%, 198 men) respectively. A total of 142 (15%) patients had been previously diagnosed with diabetes, 199(25%) had known hypertension of whom 95/199 on treatment), whereas 43(4%) had a previous myocardial infarction. A total of 487 (51%) patients never had their blood pressure measured, whereas 798(91%) never received an ECG. Mean SBP/DBP were 138±31/71±12 mmHg respectively. Patients with normal BP were 304(32%), whereas 380(40%) were mildly-moderately hypertensive (SBP/DBP 148±7/91±5 mmHg) and 130 (29%) with severe hypertension (SBP/DBP 162±8/99±6 mmHg). D-Heart ECGs tracings were respectively classified as: normal: 361(38%); mildly abnormal: 332(35%); moderately abnormal: 199 (21%) and severely abnormal 58(6%). Most common ECG abnormality was a positive Romhilt-Estes index in 361, 38%. For 174(18%) patients smartphone tele-report advised referral to the local hospital, but only 121 69%) presented to the visit: 9 (8%) were found to have normal hearts, 57(47%) with hypertensive heart disease, 35 (29%) with rheumatic heart disease, 20 (16%) with HFrEF. Visit time was 8±2 minutes; cost of screening per patient was 1.10€: 0,30€ for consumable electrodes, 0.80€ for the community health worker visit time. Conclusions D-Heart ECG screening combined with smartphone BP measurement proved feasible and cost-effective. This should encourage to develop and extend low-cost/high-technology community-based CV screening programs in low-income settings.

Risk Factors of Hepatitis Associated With Time to Adopting a New Cancer Screening Model Under Diffusion of Innovation Theory-A 10-Year Cohort Study in Taiwan.

Hepatitis is a serious global health issue. To reduce mortality, early screening for liver disease has been recommended in community health policies, particularly for asymptomatic individuals. This study explored the link between liver function biomarkers and how quickly people adopt a new multiple cancer screening program, using the diffusion of innovation (DOI) Theory. The study included 57,939 participants from a community-based screening program in Keelung, Taiwan, between January 1, 2001, and December 31, 2010. Data on demographics and lifestyle habits were collected through questionnaires, and blood samples were analyzed to measure biomarkers related to liver function. On average, participants took 3.48 years to accept the new screening program. People with healthier lifestyles, such as those who drank alcohol less often, were more likely to adopt the screening early. Additionally, those with higher levels of liver-related biomarkers like albumin, total protein, and ALT joined even sooner. In conclusion, using DOI theory, the study found that personal lifestyle and liver function play a role in how quickly individuals adopt a new screening system. These insights can help healthcare providers improve early screening efforts, particularly for people at risk of hepatitis and liver cancer, potentially reducing related deaths.

Innovative Biomedical Interventions for Cardiovascular Risk Reduction and Health Promotion: A Review Study

Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide, with increasing prevalence in both developed and developing regions. The complexity of CVD necessitates innovative approaches that combine biomedical research with clinical practice for effective prevention, diagnosis, and treatment. This chapter explores cutting-edge biomedical interventions to reduce cardiovascular risk and promote heart health. It focuses on recent advancements in biomarker identification, gene therapy, nanotechnology, and regenerative medicine, offering new strategies for early detection and targeted treatment of cardiovascular conditions. Additionally, the chapter highlights the role of precision medicine and personalized healthcare approaches in managing individual risk factors, including hypertension, dyslipidemia, and diabetes, while addressing lifestyle influences like nutrition and physical activity. Public health initiatives are also discussed, examining how biomedical research has contributed to the development of population-level interventions, such as community-based screening programs and digital health tools for monitoring cardiovascular health. By integrating biomedical innovation with preventive healthcare strategies, this chapter provides a comprehensive overview of the future directions in cardiovascular risk reduction, underscoring the importance of a multi-disciplinary approach for enhancing patient outcomes and promoting long-term cardiovascular wellness.

Significance of Incidental Thyroid Findings in a Large Community-based Lung Cancer Screening Cohort.

Investigate incidental findings of neck pathology on lung cancer screening computer tomography scans and determine clinical relevance in a population of heavy smokers. A retrospective chart review was conducted utilizing a database of patients who underwent a chest computed tomography (CT) through a robust community-based hospital lung cancer screening program in 2019 and 2020. Demographics, medical history, imaging reports, and any pathology results were analyzed. A total of 1738 patients received a lung screening scan during the study period. The median age of the patient population was 64 (range: 50-79), 886 (51%) were male, and 1599 (92%) were Caucasian. Ninety-four (5.4%) were found to have neck findings on their CT report, including thyroid nodules, calcifications, heterogeneity or enlargements, pathologic appearing lymph nodes, or parathyroids. Forty-two patients had evidence of follow-up for their thyroid findings, and three of these ultimately underwent surgical intervention. The results of our study demonstrate that lung cancer screening chest scans can discover clinically relevant findings in the neck. The risks and benefits of screening needs to be thoroughly evaluated. Given the relatively low incidence of findings in this population, a prospective study in conjunction with screening questionnaire for symptoms may increase the yield of incidental findings. 3 Laryngoscope, 135:964-968, 2025.

Community-Based Intervention for Hearing Loss: Impact of Hearing Screening Programme in Ondo West Local Government Area

Introduction: The spectrum of hearing loss as a public health condition has continued to increase globally both in its pathological as well as demographic status. Consequently, a vast majority of people especially in Nigeria and other low income countries suffer from one psychological, economic, social and cognitive disadvantage of hearing loss to another. Aim: The aim of this study was to investigate the impact of hearing screening programmes as a means of Community-based intervention for hearing loss. Methods: Subjects in the study are patients who submitted for a free hearing screening programme within the months of March and May 2022, organized by the department of Ear, Nose and Throat, University of Medical Sciences Teaching Hospital, Ondo State, Nigeria. The hearing screening was carried out by Otorhinolaryngologist, Audiologists and Speech Therapists using, Otoscope, Tuning Forks, HearWHO mobile app, a well-structured questionnaire etc. Results: Of 356 patients who were screened, 80 presented with hearing related disorders such as hearing loss, tinnitus, canal blockage, polyps, otitis media and otitis externa. Interventions were administered accordingly, on either free or subsidized scale to patients. It was deduced that the majority of these patients would not have presented for hearing screening if it was not a free Community-based programme. Conclusion: Community-based hearing screening programmes enhance early identification of hearing disorders and commencement of hearing healthcare interventions especially in low income countries.

Glycemic status and effect on mortality: Multifactorial prevention programme for cardiovascular disease in Finnish primary care

AimsTo compare 13-year mortality rates in normoglycemic, prediabetic and diabetic subjects attending a community-based screening and intervention programme. MethodsPopulation survey identified 2569 cardiovascular disease (CVD) white risk subjects aged 45–70 years and without manifested CVD or diabetes. Oral glucose tolerance test was performed, and multifactorial intervention was provided. Effect of glycemic status on mortality was estimated in models adjusted for age, gender, education years, smoking, body mass index, mean arterial pressure, total cholesterol, and physical activity. ResultsOf the subjects, 2055 (77 %) were normoglycemic, 380 (14 %) had prediabetes and 224 (9 %) diabetes. Compared to the normoglycemic group, the fully adjusted hazard ratios (HR) for all-cause mortality were 1.34 (95 % CI: 0.98–1.83) in the prediabetes group and 2.31 (95 % CI: 1.62–3.31) in the diabetes group. Standardized mortality rates were 0.63 (95 % CI: 0.54–0.73), 0.91 (95 % CI: 0.69–1.18), and 1.55 (95 % CI: 1.19–2.02) in the normoglycemic, prediabetes, and diabetes groups, respectively. The most common cause of death was cancer (42 % of all deaths), followed by CVD (28 %). Conclusions/interpretationScreen-detected diabetes carries a substantial risk of death even after primary care intervention. The pattern of excess mortality has shifted towards cancer deaths.

DIABETES AND PERIODONTAL DISEASE: INTERCONNECTED PATHOPHYSIOLOGY AND CLINICAL IMPLICATIONS: A COMPREHENSIVE REVIEW

The bidirectional relationship between diabetes mellitus (DM) and periodontal disease is well-documented, with poor glycemic control exacerbating periodontal inflammation and vice versa. Novel therapies, including anti-inflammatory agents, antioxidants, and biologics, show promise in reducing systemic inflammation and improving glycemic control. Advances in identifying salivary biomarkers such as miRNAs 146a/b and 155, IL-1β, MMP8, and IL-6 have improved early detection of periodontitis in diabetic patients. Additionally, innovative imaging techniques like Raman spectroscopy and multiplex hand-held biosensors have enhanced diagnostic accuracy. Longitudinal studies and clinical trials remain essential to validate the long-term benefits and safety of new biomarkers and therapies. Recent studies highlight the importance of integrated care and interdisciplinary collaboration between dental and medical professionals to effectively manage these interrelated conditions. Future research should focus on understanding the biological pathways linking DM and periodontal disease, with a particular emphasis on the roles of inflammatory cytokines, oxidative stress, and the microbiome. Public health initiatives should aim to increase awareness of the bidirectional relationship between DM and periodontal disease through educational campaigns and community-based screening programs. Policy recommendations should encourage integrated health services and interdisciplinary training programs. The integration of artificial intelligence and machine learning in diagnostic tools offers potential for early detection and personalized treatment plans, further improving patient outcomes. Addressing these research gaps through continued investigation and technological innovation is crucial for enhancing the prevention, diagnosis, and management of diabetes and periodontal disease. These efforts will ultimately lead to better health outcomes and quality of life for affected individuals.

Study on the application value of fecal SDC2 gene methylation detection in colorectal cancer screening of urban residents in Zengcheng District in Guangzhou City

Objective: To investigate the application value of fecal Syndecan-2 (SDC2) gene methylated SDC2 (mSDC2) detection in colorectal cancer (CRC) screening among urban residents in Guangzhou City. Methods: A cross-sectional study was conducted in Shitan Town, Zengcheng District, Guangzhou City from July to December 2022. A community-based screening program for CRC was conducted among residents aged 40-74 years old. mSDC2 detection was employed in the participants, and those with positive results should be recommended to receive colonoscopy examination. The positive rate of mSDC2 detection, colonoscopy compliance rate, detection rate of intestinal lesions and clinicopathological characteristics were observed. The relationship between cycle threshold (CT) value of mSDC2 and intestinal lesions was explored. Further, the cost-effectiveness of screening was evaluated. Results: A total of 8 189 fecal samples were collected from 8 877 participants with the recovery rate of 92.25%. 8 048 qualified samples were enrolled in this study, consisted of 3 182 males (39.54%) and 4 866 females (60.46%), with the average age of 56 years old (40-74 years). The positive rate of mSDC2 detection was 7.99% (643/8 048), and the compliance rate of colonoscopy was 73.10% (470/643). 20 cases (4.25%) of colorectal cancer, 109 cases (23.19%) of advanced adenoma, 145 cases (30.85%) of non-advanced adenoma, 79 cases (16.81%) of polyps were detected. The detection rate of intestinal lesions was 75.11% and indicated significant differences in gender and age. 20 CRCs included 15 of stage 0-I, 4 of stage Ⅱ-Ⅲ and 1 of unknown stage. The CT value of mSDC2 was negatively correlated with the proportion of advanced colorectal neoplasms (χ2=16.063, P<0.001). The total cost of the screening was 4.339 5 million yuan, the screening benefit was 28.506 2 million yuan, and the benefit-cost ratio was 6.57. Conclusion: The CRC screening strategy of fecal mSDC2 detection combined with colonoscopy has high colonoscopy compliance and detection rate of intestinal lesions, which is conducive to the detection of early CRCs, and has good cost-effectiveness. This study suggests that this method may be applied to the general CRC screening in China and contribute to the prevention of CRC. The CT value of mSDC2 may have a certain suggestion on the malignant degree of intestinal tumors.

Acceptability of adding a non-contrast abdominal CT scan to screen for kidney cancer and other abdominal pathology within a community-based CT screening programme for lung cancer: A qualitative study.

The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding non-contrast abdominal CT scanning to screen for kidney cancer and other abdominal malignancies to community-based CT screening for lung cancer within the Yorkshire Lung Screening Trial (YLST). This study explored the acceptability of the combined screening approach to participants and healthcare professionals (HCPs) involved in the trial. We conducted semi-structured interviews with eight HCPs and 25 participants returning for the second round of scanning within YLST, 20 who had taken up the offer of the additional abdominal CT scan and five who had declined. Transcripts were analysed using thematic analysis, guided by the Theoretical Framework of Acceptability. Overall, combining the offer of a non-contrast abdominal CT scan alongside the low-dose thoracic CT was considered acceptable to participants, including those who had declined the abdominal scan. The offer of the additional scan made sense and fitted well within the process, and participants could see benefits in terms of efficiency, cost and convenience both for themselves as individuals and also more widely for the NHS. Almost all participants made an instant decision at the point of initial invitation based more on trust and emotions than the information provided. Despite this, there was a clear desire for more time to decide whether to accept the scan or not. HCPs also raised concerns about the burden on the study team and wider healthcare system arising from additional workload both within the screening process and downstream following findings on the abdominal CT scan. Adding a non-contrast abdominal CT scan to community-based CT screening for lung cancer is acceptable to both participants and healthcare professionals. Giving potential participants prior notice and having clear pathways for downstream management of findings will be important if it is to be offered more widely.

Costs of Community-Based Viral Hepatitis Screening in Cameroon Using Point-of-Care Technologies.

This cost analysis of a community-based viral hepatitis screening program in Cameroon found an investment of $3.52 per person screened, $50.63 per new diagnosis of hepatitis B, $159.45 per new diagnosis of hepatitis C, and $47.97 per new diagnosis of either hepatitis B or C.

Autism spectrum disorder: evaluation of community-based screening program.

This study was conducted to evaluate the results of autism spectrum disorder (ASD) screenings conducted in a region of İstanbul between 2018 and 2023. This descriptive study was conducted between April 2018 and February 2023 among 25,839 children aged between 18-36 months who had been screened for autism spectrum disorder in Sultanbeyli, İstanbul. Children between 18-36 months are examined and a form consisting of 5 questions and typical symptoms of ASD is filled. Each question is answered as yes or no. Answering yes to at least one of the questions is sufficient to direct them to child psychiatry. Between 2018 and 2023, a total of 25,839 children were screened for autism spectrum disorders, 1449 children were found to be at risk, and 88 were diagnosed with autism spectrum disorder. According to the sex distribution of the children, the male:female ratio is 3.6:1. The 5-year prevalence was found to be 0.9%. With the effect of the pandemic between 2020 and 2021, screening rates have decreased and the number of diagnoses has decreased. The most common symptom among those diagnosed is delay in speaking, and the second is inability to make eye contact. Autism spectrum disorder is a developmental disorder whose prevalence is increasing globally and for which early diagnosis is important. To recognize this disease, it is necessary to increase screening and raise awareness among families. This study will also shed light on future studies on this subject.

Simultaneous alleviation of verification and reference standard biases in a community-based tuberculosis screening study using Bayesian latent class analysis.

Estimation of prevalence and diagnostic test accuracy in tuberculosis (TB) prevalence surveys suffer from reference standard and verification biases. The former is attributed to the imperfect reference test used to bacteriologically confirm TB disease. The latter occurs when only the participants screening positive for any TB-compatible symptom or chest X-ray abnormality are selected for bacteriological testing (verification). Bayesian latent class analysis (LCA) alleviates the reference standard bias but suffers verification bias in TB prevalence surveys. This work aims to identify best-practice approaches to simultaneously alleviate the reference standard and verification biases in the estimates of pulmonary TB prevalence and diagnostic test performance in TB prevalence surveys. We performed a secondary analysis of 9869 participants aged ≥15 years from a community-based multimorbidity screening study in a rural district of KwaZulu-Natal, South Africa (Vukuzazi study). Participants were eligible for bacteriological testing using Xpert Ultra and culture if they reported any cardinal TB symptom or had an abnormal chest X-ray finding. We conducted Bayesian LCA in five ways to handle the unverified individuals: (i) complete-case analysis, (ii) analysis assuming the unverified individuals would be negative if bacteriologically tested, (iii) analysis of multiply-imputed datasets with imputation of the missing bacteriological test results for the unverified individuals using multivariate imputation via chained equations (MICE), and simultaneous imputation of the missing bacteriological test results in the analysis model assuming the missing bacteriological test results were (iv) missing at random (MAR), and (v) missing not at random (MNAR). We compared the results of (i)-(iii) to the analysis based on a composite reference standard (CRS) of Xpert Ultra and culture. Through simulation with an overall true prevalence of 2.0%, we evaluated the ability of the models to alleviate both biases simultaneously. Based on simulation, Bayesian LCA with simultaneous imputation of the missing bacteriological test results under the assumption that the missing data are MAR and MNAR alleviate the reference standard and verification biases. CRS-based analysis and Bayesian LCA assuming the unverified are negative for TB alleviate the biases only when the true overall prevalence is <3.0%. Complete-case analysis produced biased estimates. In the Vukuzazi study, Bayesian LCA with simultaneous imputation of the missing bacteriological test results under the MAR and MNAR assumptions produced overall PTB prevalence of 0.9% (95% Credible Interval (CrI): 0.6-1.9) and 0.7% (95% CrI: 0.5-1.1) respectively alongside realistic estimates of overall diagnostic test sensitivity and specificity with substantially overlapping 95% CrI. The CRS-based analysis and Bayesian LCA assuming the unverified were negative for TB produced 0.7% (95% CrI: 0.5-0.9) and 0.7% (95% CrI: 0.5-1.2) overall PTB prevalence respectively with realistic estimates of overall diagnostic test sensitivity and specificity. Unlike CRS-based analysis, Bayesian LCA of multiply-imputed data using MICE mitigates both biases. The findings demonstrate the efficacy of these advanced techniques in alleviating the reference standard and verification biases, enhancing the robustness of community-based screening programs. Imputing missing values as negative for bacteriological tests is plausible under realistic assumptions.

Advances and Challenges in Intellectual Disability in Rural India: A Comprehensive Review of Recent Trends

Intellectual disability (ID) presents a significant public health challenge in rural India, characterized by disparities in access to healthcare, stigma, and socio-economic barriers. This comprehensive review examines recent advances and persistent challenges in understanding, diagnosing, and supporting individuals with ID in rural communities in India. Advancements in diagnosing and intervening in intellectual disability in rural India have been achieved through various approaches, including community-based screening programs, culturally tailored assessment tools, telemedicine, and mobile health solutions. These initiatives prioritize widening access to healthcare services and early intervention, with the overarching goal of enhancing outcomes for individuals with intellectual disabilities. However, formidable challenges persist. Limited access to specialized services, pervasive stigma, socio-economic disparities, and inadequate awareness hinder progress in addressing the needs of individuals with ID in rural India. These challenges necessitate a multi-faceted approach involving policymakers, healthcare providers, educators, and community leaders. Addressing these challenges requires prioritizing the needs of individuals with ID, promoting awareness and advocacy, investing in capacity building, and implementing policy reforms. Collaborative efforts are essential to overcome barriers and ensure that individuals with ID in rural India receive the support and opportunities they deserve. Moving forward, it's essential to prioritize on-going research, expand service provision, and nurture a culture of acceptance and inclusion. These endeavors are critical for shaping a future where individuals with intellectual disabilities in rural India can not only thrive but also actively contribute to their communities. While strides have been made, significant challenges persist in addressing intellectual disability in these areas. Acknowledging these hurdles and collectively working to overcome them is vital for building a more inclusive and equitable society that values the unique contributions of all individuals, regardless of their abilities. In conclusion, the author concluded that while progress has been made, significant challenges remain in addressing intellectual disability in rural India. By acknowledging these challenges and working together to overcome them, we can build a more inclusive and equitable society for all individuals, regardless of their abilities.

Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study

IntroductionNon-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades....