Nationwide Program Research Articles

Experience of Living with Disability of University Students in Saudi Arabia

Individuals with disability experience challenges that can be burdens for society members. In Saudi Arabia, the living experience of individuals with disability has been given little attention. Thus, this study was conducted to understand the challenges and expectations of university students with disabilities to improve their living experience. This study recruited 18 students with visual, physical, or hearing impairments to explore their experience using semi-structured interviews. Their responses were thematically analyzed and revealed three major issues: challenges in living with disability, perception toward their impairments, and optimism toward the future. The students faced physical, communicational, and emotional barriers to meeting their needs. Despite limited academic programs for students with disabilities, many students were self-motivated to pursue their education and earn academic degrees. Additionally, they were optimistic about career opportunities, individuals’ rights, and society’s perception of disability. Disability-related barriers have hindered the students from living independently and enjoying social and academic life. To enhance their living experience, physical and social adjustments are highly recommended by enforcing construction and design regulations and community-based interventions. Additionally, nationwide programs to support such individuals’ success in both academic and professional life must be provided.

Knowledge and Power in Indonesian Traditional Music: A Genealogical Approach on the Transformation of the Meaning of Karawitan

The term Karawitan is generally known to mean gamelan music, more specifically Javanese, Balinese, and Sundanese gamelan music tuned to slendro and pelog scales. However, the term is discursive and has meaning in wider contexts as well. The term karawitan first appeared during the colonial period in royal courts on Java to indicate Javanese gamelan music. However, through its nation-wide university karawitan programs, the Indonesian government and art academics use the term to refer to all Indonesian traditional music practices (Musik Nusantara).Thisarticle gives a postcolonial account of the discourse surrounding the term karawitan to trace the transformation of its meaning. It employs Michel Foucault's theory of discourse and genealogical research methods to explore colonial-era and post-colonial literature using the term karawitan. By reviewing various discourses about karawitan, authors provide a more nuanced understanding about how power operates in the context of traditional music in Indonesia. We illustrate how the meaning of “karawitan” has been re-defined and contested through discursive practices. In general, these transformations demonstrate a shift from colonial power to national power

DEVELOPING AND IMPLEMENTING A NATIONWIDE CURRICULUM FOR AGING STUDIES. WHAT ARE THE KEY CONSIDERATIONS FOR GHANA?

Abstract In 2019, Ghana reported the implementation of a Geriatric Medicine Fellowship Program within the Faculty of Family Medicine at the Ghana College of Physicians and Surgeons (GCPS). Though this is a laudable effort to address the specialized workforce shortage the country is facing, the GCPS program is meant to provide an in-country specialization path for physicians desiring to become geriatricians. There are currently no national standardized aging studies, training programs or curricula available to other students in disciplines such as nursing, psychology, public health, and social work. Students in the public, government-owned tertiary institutions are offered isolated courses related to aging and the needs of older adults. To effectively address the workforce shortage issue and improve the overall health and wellbeing of older adults in Ghana, it is imperative to train students in diverse fields and disciplines with the needed knowledge and skills to provide the various specialized services for the aging population. This presentation highlights a proposal to the government of Ghana to consider some key issues and recommendations related to developing and implementing a nation-wide aging studies programs in the public higher institutions. Five key evidence-based areas are extensively discussed: (1) Aging studies in Ghana should be culturally relevant. (2) Aging studies in Ghana should address the needs of older Ghanaians. (3) Aging studies in Ghana should be competency-based. (4) Aging studies in Ghana should be implemented and evaluated by expert-educators. (5) Aging studies in Ghana should be attractive to potential service providers.

Treatment-Resistant Depression in Colombia: Results From a Longitudinal Analysis of the TRAL Study

ObjectivesThis manuscript reports on the clinical outcomes (response, remission and relapse) in TRD patients in Colombia under Standard-of-Care (SOC), and patient reported outcomes (PROs) – QoL, disability, depression severity – over a 1-year follow-up. Materials and methodsFrom a sample of 162 MDD patients from 4 centres in Colombia, 52 had a formal diagnosis of TRD and were included in the 1-year follow-up. Exclusion criteria were patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial. Clinical outcomes were measured with MADRS and PHQ-9, while PROs included EQ-5D (QoL) and Sheehan Disability Scale (SDS – disability). ResultsPatients’ mean age was 41.88 years, 80.8% of which were female, 37.3% were married or on consensual union and 42.3% had at least 13 years of formal education. Half of the sample achieved clinical response after 1-year of follow-up, while remission was not achieved by 57.9% of the participants (MADRS). Over 60% of the patients had mild to severe depression at the end of study (PHQ-9), while 57.9% reported feeling anxious/depressed (EQ-5D). Over three-quarters of the sample reported disruption in work/school, social life/leisure and family/home responsibilities (SDS). ConclusionsPresent results for Colombia underline the burden of TRD in most aspects of daily living. Current SOC fails to deliver the necessary clinical outcomes and patient centric approach, which suggests the need to improve treatment protocols, while increasing access to specialists, foster earlier diagnosis and the implementation on a nationwide programme for mental health.

Impact of a National Follow-Up Program on the Age at Diagnosis for Cerebral Palsy

BackgroundThe Danish National Cerebral Palsy Follow-up Program (CPOP) is a nationwide program offering standardized treatment to all children with cerebral palsy (CP) since 2004. We aimed to establish if its implementation had a positive impact on the diagnostic age of CP. MethodsChildren with validated CP diagnoses were identified from the Danish Cerebral Palsy Registry and the CPOP. We then compared the age at diagnosis and the clinical features of children with CP born in 2000 to 2003 with those born in 2010 to 2013. Differences in time to diagnosis were compared using log-rank test. ResultsThe age at diagnosis was not different in the two periods (P = 0.23), with identical overall median diagnostic ages at 13.0 months. The number of children with severe motor disability decreased markedly from 47.5% in 2000 to 2003 to 32.0% in 2010 to 2013 (P < 0.001). There was increased usage of cerebral magnetic resonance imaging; however, this was not associated with lower diagnostic age. ConclusionsThe diagnostic age of CP did not change after the implementation of a nationwide follow-up program, offering standardized and early assessments. However, central clinical aspects also changed significantly between the periods compared, which possibly affected the diagnostic age.

Is universal early childhood education and care an equalizer? A systematic review and meta-analysis of evidence

Studies have shown that early investments improve outcomes for disadvantaged children. Targeted early childhood interventions aimed at vulnerable children have lasting positive impacts throughout the participants' life course, consequently reducing inequalities. However, results from targeted programs cannot be generalized to universal Early Childhood Education and Care (ECEC). Universal ECEC, available to all children, may increase inequalities given stratification in access to nationwide programs. In order to analyze whether universal ECEC has the same equalizing effects as the targeted programs, this study uses a systematic review and meta-analysis of quasi-experimental evidence to examine the impact of universal ECEC on children's outcomes throughout their lives, focusing on how it affects children from different socioeconomic statuses (SES). The findings indicate that universal ECEC is an effective policy strategy for equalization, as it reduces inequalities by benefiting more children from disadvantaged families. Low SES children benefit more in the non-cognitive domain than high SES children. Starting ECEC before age three improves the chances of better outcomes for disadvantaged children. The results demonstrate significant variability across regions, with European programs standing out in delivering positive outcomes for children from vulnerable backgrounds. The study emphasizes the importance of equitable access to universal ECEC to reduce inequalities and foster long-lasting positive impacts on children's development and life chances.

Quasi-experimental evaluation of a nationwide diabetes prevention programme.

Diabetes is a leading cause of morbidity, mortality and cost of illness1,2. Health behaviours, particularly those related to nutrition and physical activity, play a key role in the development of type 2 diabetes mellitus3. Whereas behaviour change programmes (also known as lifestyle interventions or similar) have been found efficacious in controlled clinical trials4,5, there remains controversy about whether targeting health behaviours at the individual level is an effective preventive strategy for type 2 diabetes mellitus6 and doubt among clinicians that lifestyle advice and counselling provided in the routine health system can achieve improvements in health7-9. Here we show that being referred to the largest behaviour change programme for prediabetes globally (the English Diabetes Prevention Programme) is effective in improving key cardiovascular risk factors, including glycated haemoglobin (HbA1c), excess body weight and serum lipid levels. We do so by using a regression discontinuity design10, which uses the eligibility threshold in HbA1c for referral to the behaviour change programme, in electronic health data from about one-fifth of all primary care practices in England. We confirm our main finding, the improvement of HbA1c, using two other quasi-experimental approaches: difference-in-differences analysis exploiting the phased roll-out of the programme and instrumental variable estimation exploiting regional variation in programme coverage. This analysis provides causal, rather than associational, evidence that lifestyle advice and counselling implemented at scale in a national health system can achieve important health improvements.

Analyzing the Effectiveness of Access to Information (a2i) Program in Promoting Women Empowerment in Selected Areas of Bangladesh: A Case Study of Shimulia Union Parishad and Muksudpur Union Parishad, Dhaka District

Access to Information (a2i) is a Government led nationwide program with 4,547 Union Digital Centers (UDCs) at every Union with two (one female and one male) entrepreneurships. With the aim of investigating to what extent ‘a2i’ is effective in promoting women empowerment through women entrepreneurship, this paper analyzed primary data collected from Shimulia Union Parishad (UP) and Muksudpur UP, Dhaka, Bangladesh. This paper indicates that the socioeconomic barriers are causing a2i program to have a less profound impact on promoting women empowerment through women entrepreneurship. With different recommendations from program level and policy level, this paper proposes that the design, redesign, and implementation of the a2i program should have a flexible characteristic so that it can address the socioeconomic challenges from within the scope of the program.

Malaria surveillance reveals parasite relatedness, signatures of selection, and correlates of transmission across Senegal

We here analyze data from the first year of an ongoing nationwide program of genetic surveillance of Plasmodium falciparum parasites in Senegal. The analysis is based on 1097 samples collected at health facilities during passive malaria case detection in 2019; it provides a baseline for analyzing parasite genetic metrics as they vary over time and geographic space. The study’s goal was to identify genetic metrics that were informative about transmission intensity and other aspects of transmission dynamics, focusing on measures of genetic relatedness between parasites. We found the best genetic proxy for local malaria incidence to be the proportion of polygenomic infections (those with multiple genetically distinct parasites), although this relationship broke down at low incidence. The proportion of related parasites was less correlated with incidence while local genetic diversity was uninformative. The type of relatedness could discriminate local transmission patterns: two nearby areas had similarly high fractions of relatives, but one was dominated by clones and the other by outcrossed relatives. Throughout Senegal, 58% of related parasites belonged to a single network of relatives, within which parasites were enriched for shared haplotypes at known and suspected drug resistance loci and at one novel locus, reflective of ongoing selection pressure.

The aortic root in young adults

Abstract Background Aortic size varies between individuals and is influenced by age, gender, body size and blood pressure. There are numerous studies aimed at defining normative aortic root measurements, but the vast majority of these are in older adults, or limited by a small sample size. Purpose To screen a large number of young individuals (≤35 years) to understand the rate of aortic growth, validate current guideline cut-offs for aortic root measurements in this age group and compare findings in males versus females. Methods Individuals ≥ 16 years old who attended a voluntary, nationwide cardiac screening programme for young individuals (aged 14-35) were offered and consented for an additional focused transthoracic echocardiogram of the aorta. Individuals with a known cardiac abnormality or genetic syndrome (for example Marfan’s) were excluded. Images were obtained in the parasternal long axis view with measurements of the sinus of Valsalva (SOV), sinotubular junction (STJ) and ascending aorta (AA) at end-diastole from inner-edge to inner-edge in line with British Society of Echocardiography (BSE) guidance[1]. Measurements were indexed to height (in metres). Mean SOV, STJ and AA measurements were plotted against age and comparisons were made between males and females. Results 1153 patients were recruited. 11 were excluded to a bicuspid aortic valve (BAV), leaving 1142 subjects in the final analysis. 88% (1004) were Caucasian. The aortic measurements are shown in table 1. Males had a significantly larger SOV, STJ and AA than females (p&amp;lt;0.001). However, when indexed to height, only the SOV was significantly larger. All mean aortic root measurements fell within the normative range for each gender as specified by current BSE guidance[1]. Mean aortic root measurements at each year of age are shown in figure 1. There was a weakly positive correlation coefficient between age and aortic diameter (r=0.33 at SOV, r=0.31 at STJ, r=0.39 at AA) which, coupled with the lines of best-fit in figure 1, suggest there is slow but continual aortic growth from the age of 16. Conclusion Despite adult height being reached by the age of 16 in most individuals, the aorta continues to grow beyond this age. This study further highlights the importance of indexing aortic measurements to height, and validates that the current BSE guideline cut-offs for aortic root measurements can be applied to young individuals.

PCR standard curve quantification in an extensive wastewater surveillance program: results from the Dutch SARS-CoV-2 wastewater surveillance.

Since the start of the COVID-19 pandemic in 2020, wastewater surveillance programs were established, or upscaled, in many countries around the world and have proven to be a cost-effective way of monitoring infectious disease pathogens. Many of these programs use RT-qPCR, and quantify the viral concentrations in samples based on standard curves, by including preparations of a reference material with known nucleic acid or virus concentrations in the RT-qPCR analyses. In high-throughput monitoring programs it is possible to combine data from multiple previous runs, circumventing the need for duplication and resulting in decreased costs and prolonged periods during which the reference material is obtained from the same batch. However, over time, systematic shifts in standard curves are likely to occur. This would affect the reliability and usefulness of wastewater surveillance as a whole. We aim to find an optimal combination of standard curve data to compensate for run-to-run measurement variance while ensuring enough flexibility to capture systematic longitudinal shifts. Based on more than 4000 observations obtained with the CDC N1 and N2 assays, taken as a part of the National Sewage Surveillance program at the Dutch National Institute for Public Health and the Environment, we show that seasonal and long-term shifts in RT-qPCR efficiency and sensitivity occur. We find that in our setting, using five days of standard-curve data to quantify, results in the least error prone curve or best approximation. This results in differences up to 100% in quantified viral loads when averaged out over a nationwide program of >300 treatment plants. Results show that combining standard curves from a limited set of runs can be a valid approach to quantification without obscuring the trends in the viral load of interest.

Risk of financial stressors in patients diagnosed with cancer: Lessons from a nation-wide financial navigation program.

204 Background: Financial toxicity associated with a cancer diagnosis can lead to poor outcomes in both non-medical and medical domains. Family Reach, a US-based nonprofit, is dedicated to removing financial barriers between cancer patients and their treatment through comprehensive financial navigation. In this study, we sought to understand the prevalence of medical and non-medical financial stressors in a cohort of patients receiving financial navigation. Methods: Patient application data (provided by patients, caregivers, or case workers) from the Family Reach program from March 2020 - June 2022 were analyzed. Data included patient demographics; clinical and financial attributes; and medical &amp; non-medical financial stressors. Associations between stressors and patient characteristics were assessed using descriptive statistics, multivariable, and univariate tests using SPSS. Results: 10,558 applications from 50 states and D.C. were processed in the study period: 92% had annual household income &lt;$70,000 (US median -$70,784 in 2021).Data were stratified by type of cancer (55% solid vs. 38% hematologic); age (32% pediatric, 32% Adolescents and Young Adults, &amp; 36% adult, defined by NCI as pediatric - 0-14 years, AYA - 15-39 years, and adult – 40+ ); and race/ethnicity [41% non-Hispanic White (W), 22% non-Hispanic Black (B), 16% Hispanic/Latinx (H/L)]. Other race categories (20%) were not analyzed due to small sample sizes (0.9% AI/AN, 4% Asian American, 8% two or more races) Race/ethnicity: 85% B and 84% H/L patients had an annual household income &lt;$50,000, compared to 65% W patients (X2 p&lt;0.05). B and H/L respondents were more likely to belong to single-parent households (59% B, 40% H/L, 30% W, X2 p&lt;0.05). Both groups were at a higher risk of food insecurity (B vs. W, OR=1.8, H/L vs. W, OR=1.9), utility shut-off (B vs. W, OR=1.9, H/L vs. W, OR=1.4), phone shut-off (B vs. W, OR=2.0, H/L vs. W, OR=1.2) and houselessness (B vs. W, OR=1.8, H/L vs. W, OR=1.7), after adjustment for geography. Age of cancer onset: No income differences were observed between pediatric, AYA, &amp; adult patients. Adult (OR=3.2, p&lt;0.05) &amp; AYA (OR=1.9, p&lt;0.05) patients had a higher risk of unpaid medical expenses, as compared to pediatric patients, after adjustment for income &amp; geography. While no significant differences were seen between solid and heme cancers, lung patients were at a higher risk of financial distress from non-medical expenses (e.g., risk of homelessness OR = 1.4, p&lt;0.05) as compared to breast, colon, and prostate combined, after adjustment for income &amp; geography. Conclusions: To our knowledge, this is the first analysis of financial stressors in a national cohort of cancer patients receiving financial navigation. The higher prevalence of financial stressors in patients of color in this self-selected group indicates that interventions addressing cancer need to integrate social determinants of health.

Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control

BackgroundOut-of-hospital cardiac arrest (OHCA) and life-threatening bleeding from trauma are leading causes of preventable mortality globally. Early intervention from bystanders can play a pivotal role in increasing the survival rate...

Sex Disparities in Management and Outcomes Among Patients With Acute Coronary Syndrome

Sex disparities in the management and outcomes of acute coronary syndrome (ACS) have received increasing attention. To evaluate the association of a quality improvement program with sex disparities among patients with ACS. The National Chest Pain Centers Program (NCPCP) is an ongoing nationwide program for the improvement of quality of care in patients with ACS in China, with CPC accreditation as a core intervention. In this longitudinal analysis of annual (January 1, 2016, to December 31, 2020) cross-sectional data of 1 095 899 patients with ACS, the association of the NCPCP with sex-related disparities in the care of these patients was evaluated using generalized linear mixed models and interaction analysis. The robustness of the results was assessed by sensitivity analyses with inverse probability of treatment weighting. Data were analyzed from September 1, 2021, to June 30, 2022. Hospital participation in the NCPCP. Differences in treatment and outcomes between men and women with ACS. Prehospital indicators included time from onset to first medical contact (onset-FMC), time from onset to calling an emergency medical service (onset-EMS), and length of hospital stay without receiving a percutaneous coronary intervention (non-PCI). In-hospital quality indicators included non-PCI, use of statin at arrival, discharge with statin, discharge with dual antiplatelet therapy, direct PCI for ST-segment elevation myocardial infarction (STEMI), PCI for higher-risk non-ST-segment elevation ACS, time from door to catheterization activation, and time from door to balloon. Patient outcome indicators included in-hospital mortality and in-hospital new-onset heart failure. Data for 1 095 899 patients with ACS (346 638 women [31.6%] and 749 261 men [68.4%]; mean [SD] age, 63.9 [12.4] years) from 989 hospitals were collected. Women had longer times for onset-FMC and onset-EMS; lower rates of PCI, statin use at arrival, and discharge with medication; longer in-hospital delays; and higher rates of in-hospital heart failure and mortality. The NCPCP was associated with less onset-FMC time, more direct PCI rate for STEMI, lower rate of in-hospital heart failure, more drug use, and fewer in-hospital delays for both men and women with ACS. Sex-related differences in the onset-FMC time (β = -0.03 [95% CI, -0.04 to -0.01), rate of direct PCI for STEMI (odds ratio, 1.11 [95% CI, 1.06-1.17]), time from hospital door to balloon (β = -1.38 [95% CI, -2.74 to -0.001]), and rate of in-hospital heart failure (odds ratio, 0.90 [95% CI, 0.86-0.94]) were significantly less after accreditation. In this longitudinal cross-sectional study of patients with ACS from hospitals participating in the NCPCP in China, sex-related disparities in management and outcomes were smaller in some aspects by regionalization between prehospital emergency and in-hospital treatment systems and standardized treatment procedures. The NCPCP should emphasize sex disparities to cardiologists; highlight compliance with clinical guidelines, particularly for female patients; and include the reduction of sex disparities as a performance appraisal indicator.

Fifteen Years of Iodine Prophylaxis in Italy: Results of a Nationwide Surveillance (Period 2015-2019).

In 2005, a nationwide program of iodine prophylaxis on a voluntary basis was implemented in Italy by law. However, recent data on iodine status are lacking. The aim of this study was to evaluate efficiency, effectiveness, and possible adverse effects (increased occurrence of thyroid autoimmunity and hyperthyroidism) of the Italian iodine prophylaxis program. From 2015 to 2019, a nationwide survey was performed. The use of iodized salt was evaluated in a sample of 164 593 adults and in 998 school canteens. A sample of 4233 schoolchildren (aged 11-13 years) was recruited to assess urinary iodine concentration, prevalence of goiter, and thyroid hypoechogenicity on ultrasound, with the latter being an indirect indicator of thyroid autoimmunity. Neonatal TSH values of 197 677 infants screened in regions representative of Northern, Central, and Southern Italy were analyzed to investigate the percentage of TSH values >5.0 mIU/L. Data on methimazole prescriptions were analyzed as indirect indicators of new cases of hyperthyroidism. The prevalence of the use of iodized salt was 71.5% in adult population and 78% in school canteens. A median urinary iodine concentration of 124 μg/L, a prevalence of goiter of 2.2%, and a prevalence of thyroid hypoechogenicity of 5.7% were observed in schoolchildren. The percentage of neonatal TSH values >5.0 mIU/L resulted still higher (5.1%) than the World Health Organization threshold of 3.0%, whereas the prescriptions of methimazole showed a reduction of 13.5%. Fifteen years of iodine prophylaxis have led to iodine sufficiency in Italy, although there still is concern about iodine nutritional status during pregnancy.

What does protection sound like? A modern approach to understanding New Zealand’s underwater soundscapes and acoustic anthropogenic pressures

Global marine ecosystems have experienced degradation and loss of biodiversity as a result of human impacts and climate change. Monitoring of ecologically significant areas is vital in understanding these effects and their subsequent management. Soundscapes offer a unique opportunity for examining organisms and habitats in a way that eliminate many potential weaknesses of traditional monitoring techniques. This fundamental property of every environment is being increasingly influenced by the presence of human activities but is not yet recognized for the breadth of information it holds, and as a key indicator of change in an ecosystem. A nation-wide program, focusing on several high-priority protection sites, utilize passive acoustic monitoring (PAM) creating baseline datasets. With the emphasis on characterizing the ambient soundscapes and acoustic signatures of significant species, identifying key acoustic parameters that reflect ecosystem health and biodiversity, and in locations where human use will potentially contribute to negative acoustic exposures. Here, spatiotemporal trends in the underwater soundscapes at sites within Fiordland National Park are reported, illustrating diel, lunar, and seasonal patterns in sound pressure levels, identifying biotic, abiotic, and anthropogenetic sound sources where possible. PAM is an increasingly useful tool in understanding anthropogenic presence and ecosystem status, and offers an effective, minimally invasive, and less labor-intensive way of monitoring marine ecosystems.

Stakeholders’ perspectives about national target programme for new rural development in Vietnam

The new rural development in Vietnam is a large-scale, nationwide programme that involves many stakeholders. The perspectives of these stakeholders, whether they exhibit differences or homogeneity, will significantly shape the programme’s outcomes and results. This study assessed the perspectives of stakeholders and classified them into four categories: (1) the significance of the new rural programme, (2) the role of stakeholders, (3) levels of stakeholders’ participation, and (4) stakeholders’ expectations. The findings indicate that the stakeholders strongly agreed on and appreciated the significance of the new rural programme in improving people’s livelihoods. However, the distinguishing viewpoints focused mainly on the roles and the levels of participation of the stakeholders. Bridging the perceived gap among stakeholders and strengthening the key role of the people are the decisive factors of the programme’s success, contribute to poverty reduction, social justice, and the long-term sustainability of the national target programme for new rural development in Vietnam.

BEAT-IT: A de-novo cardiac screening programme in Maltese adolescents

AimsSudden cardiac death (SCD) in young individuals is often unexpected, provoking substantial emotional stress for family and friends of the deceased. Cardiac screening may identify individuals who harbour disorders linked to SCD. The feasibility and diagnostic yield of a nationwide cardiac screening programme in adolescents has never been explored. MethodsAll individuals eligible for cardiac screening (students aged 15 years) were systematically invited to enrol. Students were provided with a health questionnaire. ECGs were acquired at school. A physician led consultation was carried out on site. Participants with an abnormal screen were then referred for secondary evaluation to the nation’s tertiary centre. Feasibility criteria included a) participation rate >60%, b) adherence to secondary evaluation >80%, and c) cost per individual screened equating to <€100. The diagnostic yield was also evaluated. ResultsAt the end of enrolment, 2708 students gave consent (mean 15 years, 50.4% male), equating to 67.9% of the eligible cohort. Overall, 109 participants (4.0%) were referred for further evaluation. An abnormal electrocardiogram (ECG) was the most common reason for referral (3.7%). Fifteen individuals (0.6%) were diagnosed with a cardiac condition. Nine (0.3%) had a condition linked to SCD (n = 1 Long-QT syndrome, n = 1 Hypertrophic Cardiomyopathy, n = 5 Wolff-Parkinson White, n = 2 coronary anomalies). The yield was similar in athletes and non-athletes (p = 0.324). The cost per cardiac individual screened equated to €51.15. ConclusionA nationwide systematic cardiac screening programme for adolescent athletes and non-athletes is feasible and cost-efficient, provided that responsible centres have the appropriate infrastructure.

Influence of mammographic density and compressed breast thickness on true mammographic sensitivity: a cohort study

Understanding the detectability of breast cancer using mammography is important when considering nation-wide screening programmes. Although the role of imaging settings on image quality has been studied extensively, their role in detectability of cancer at a population level is less well studied. We wish to quantify the association between mammographic screening sensitivity and various imaging parameters. Using a novel approach applied to a population-based breast cancer screening cohort, we specifically focus on sensitivity as defined in the classical diagnostic testing literature, as opposed to the screen-detected cancer rate, which is often used as a measure of sensitivity for monitoring and evaluating breast cancer screening. We use a natural history approach to model the presence and size of latent tumors at risk of detection at mammography screening, and the screening sensitivity is modeled as a logistic function of tumor size. With this approach we study the influence of compressed breast thickness, x-ray exposure, and compression pressure, in addition to (percent) breast density, on the screening test sensitivity. When adjusting for all screening parameters in addition to latent tumor size, we find that percent breast density and compressed breast thickness are statistically significant factors for the detectability of breast cancer. A change in breast density from 6.6 to 33.5% (the inter-quartile range) reduced the odds of detection by 61% (95% CI 48–71). Similarly, a change in compressed breast thickness from 46 to 66 mm reduced the odds by 42% (95% CI 21–57). The true sensitivity of mammography, defined as the probability that an examination leads to a positive result if a tumour is present in the breast, is associated with compressed breast thickness after accounting for mammographic density and tumour size. This can be used to guide studies of setups aimed at improving lesion detection. Compressed breast thickness—in addition to breast density—should be considered when assigning complementary screening modalities and personalized screening intervals.

How Electoral Cycles Shape the Implementation of Public Works Programs: Evidence From India

Why do public works programs in developing democracies often experience implementation failures at the local level? Building on the literature on political business cycles, our study sheds light on a key explanation. We argue that electoral cycles undermine the completion of public works projects because of incumbents’ difficulties in reaping electoral rewards for following through on projects proposed just prior to an election. Analyses based on project-level data from a nation-wide public program in India supports the argument. We find that projects proposed close to an upcoming election are less likely to be eventually completed than projects proposed at other times. We further find that incumbent turnover exacerbates the effect of electoral cycles and that this modifying effect is plausibly causal. The results suggest that new incumbents have reduced incentives to follow through on projects proposed by their predecessors due to the difficulties involved with claiming credit for such projects.