National Screening Policy Research Articles

Comparing the cost-benefit of breast cancer screening programs in rural and urban areas across four economic zones in China: a Markov modeling analysis

BackgroundThis study assessed the effectiveness and cost-effectiveness of breast cancer screening across rural and urban regions in China’s four economic zones.MethodsUsing a decision-analytic Markov model, we evaluated 5,280 scenarios involving different ages and screening technologies. The model followed individuals from birth through 100 yearly cycles in eight settings. Model parameters, such as incidence, transition rate, attendance and compliance rate, screening accuracy, utility, and mortality, were based on Chinese research and international data. Screening costs were calculated using median medical costs in the respective zones. The main outcome measured was incremental net benefit (INB) and incremental cost-effectiveness ratio (ICER), with sensitivity analyses to assess uncertainty.ResultsUsing a willingness-to-pay threshold of three times the local per capita Gross domestic product (GDP), the recommended strategies varied across regions. However, annual screening of individuals aged 30–70 years with a combination of mammography (MAM) and computed tomography laser mammography (CTL) was the most cost-effective strategy for most regions. The incremental cost-effectiveness ratios (ICERs) of the most cost-effective strategies, compared to no intervention and status quo in China, ranged from US$5,173.31/QALY to US$18,551.27/QALY, and from US$-3,872.28 to US$17,804.59, respectively. Except for the rural central region, where the cost-effective strategy had suboptimal outcomes compared to status quo, the recommended strategies in the other seven regions could prevent 41.12–58.80% and 8.08–35.39% of advanced breast cancer cases, and 18.83–29.27% and 2.71–14.06% of breast cancer deaths, when compared to no screening and status quo, respectively. Sensitivity analysis indicated that the results were robust.ConclusionOur study identified cost-effective breast cancer screening strategies suitable for the rural and urban areas in China’s four major economic zones. These findings highlight the necessity of universal screening and the importance of optimizing strategies based on regional economic development and epidemiological characteristics. These insights are crucial for improving national breast cancer screening policies.

Comparative Analysis of HPV Detection Efficiency: Evaluating Cobas 8800 Performance in Vaginal Self-Sampling versus Clinician-Collected Samples at a Regional Thai Hospital

Background: This study, conducted at a regional Thai hospital, assesses the comparative efficacy of self-collected versus clinician-collected samples for HPV detection using the Cobas 8800 system among Thai women aged 30–60. Methods: Our methodology involved analyzing 1541 self-collected and 1398 clinician-collected samples. Results: The results show a statistically significant mean difference in cycle threshold (Ct) values favoring clinician-collected samples (1.53; 95% CI: 1.18–1.87, p < 0.0001). This pattern was consistent across various age groups, with the most pronounced differences noted in the oldest cohort (50–59 years), suggesting higher detection efficiency in clinician-collected samples. The study further explored the correlation of Ct values with cytological and histological outcomes, where clinician-collected samples demonstrated superior diagnostic performance, particularly in identifying LSIL and HSIL conditions, evidenced by AUC values of 0.793 and 0.866, respectively. While self-sampling remains a viable method, with sensitivity reaching up to 48.84% for LSIL and 46.15% for HSIL, clinician collection proved more accurate, likely influencing future national screening policies. Conclusions: This work underscores the need for robust sample collection methods and the importance of ongoing enhancements to self-sampling assays and techniques to ensure their efficacy in cervical cancer screening programs.

Socioeconomic inequalities in uptake of outreach mammography before and after accessibility improvement of Taiwan’s national universal breast cancer screening policy

BackgroundTaiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005–2009) and post-CAQIP (2010–2014).MethodWe conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values.ResultsUtilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was − 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively.ConclusionsOur study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.

The Staging of Newly Diagnosed Hepatocellular Carcinoma in Romania. A National Multicentric Study.

Hepatocellular carcinoma (HCC) is a significant public health issue, with an increasing incidence and prevalence and a high incidence-to-mortality ratio. The prognosis of HCC depends on two competing factors, tumor burden and underlying liver disease severity, encompassed in the Barcelona Clinic Liver Cancer (BCLC) classification. To assess HCC staging and the way staging affects eligibility for treatment at the time of the first diagnosis in Romania in the setting of opportunistic diagnosis, in the absence of a national HCC screening policy. Data regarding HCC staging, underlying liver disease, and eligibility for treatment at the time of diagnosis was analyzed using a prospectively maintained multicentric database, which included patients from the five largest tertiary care hepatology units in the country between June 2016 and February 2020. A consecutive series of 477 patients was included. The distribution within BCLC classes was as follows: very early (0) 7.1%, early (A) 34.3%, intermediate (B) 19.4%, advanced (C) 14.2%, terminal (D) 24.7%. At the time of the diagnosis, 198 (41.5%) were eligible for a curative intent treatment, while 359 (75.2%) were eligible for a disease-modifying therapy. 228 patients (47.8%) had decompensated liver disease at the time of diagnosis, the most common decompensating event being ascites (78.1%). A large proportion of HCC cases are diagnosed at the time of a decompensating event, severely restricting the therapeutic potential. Proactive diagnostic strategies should be implemented to improve the rate of actionable diagnosis.

Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island

BackgroundRéunion Island is a French overseas territory located in the southern Indian Ocean, with a challenging socioeconomic and multicultural context. Compared to mainland France, Réunion has an overincidence and overmortality of cervical cancer. In order to investigate these two issues, it is important to evaluate the barriers and potential levers to Pap smear screening among female inhabitants of the island. We aimed to identify the specific socio-demographic factors, cultural factors, and living conditions associated with Pap smear screening in Réunion, with a view to increasing uptake.MethodsWe conducted a Knowledge Attitude Behavior and Practices (KABP) survey on cervical cancer screening practices among women aged between 25 and 65 years old living in Réunion Island, selected using random digit dialing sampling. Data were collected using Computer Assistant Telephone Interviews. Weighted chi-squared tests and Student’s t-tests were used to compare women who had up-to-date Pap smear screening with women who did not. Weighted logistic models were used to identify the factors associated with not having up-to-date screening.ResultsA total of 1000 women were included in the study. Of these, 88.1% had a Pap smear test during the previous three years. Factors independently associated with not being up to date were as follows: aged over 55 (AOR 2.3 [1.2–4.3]), no children (AOR 2.5 [1.4–4.3]), having free universal health coverage (AOR 1.7 [1.1–2.7]), an income per unit consumption lower than 1500€ per month (AOR 2.0 [1.1–3.7]), low health literacy (AOR 2.7 [1.7–4.1]), not consulting a general practitioner in the prior 12 months (AOR 3.6 [2.0-6.5]), and a BMI > 30 (AOR 2.6 [1.5–4.4]).ConclusionsThis is the first large-scale survey focusing on recommended Pap smear screening uptake in Réunion Island. Although self-reported screening incidence was higher than in mainland France, national screening policies must take into account the island’s diverse social and cultural characteristics (e.g., an ageing population, low health literacy), while implementing actions to fight against poverty and increase general access to healthcare.

Novel educational training of para medical professionals in cervical cancer screening

BackgroundCervical cancer is a public health problem in India due to weak national screening policy compounded by lack of resources including scarcity of trained personnel to carry out community-based screening program. Para medical professionals (PMPs) are closely related to women in local communities. Hence, training PMPs by incorporating novel technology and reduced time duration to achieve adequate competence in screening is an area underutilized and needs to be explored. Materials and methodsA pilot cross sectional analytical study was conducted at a tertiary referral cancer center using a shorter version of educational intervention of 2 weeks duration (EI2W) involving PMPs. Pre- and post-training assessment of knowledge, attitude, and practice (KAP) was done using questionnaires consisting of 5 domains viz. awareness of cervical cancer, awareness of cervical pre-cancer, practical screening methodology (practice oriented), data management and aspects of human papilloma virus (HPV). Wilcoxon signed-rank test was used for comparison and the degree of change was measured using analysis of covariance (ANCOVA). A p value of <0.05 was considered significant. Results118 PMPs were included. There was a significant improvement in scores of all domains (except cervical pre-cancer domain), following introduction of EI2W. Knowledge scores, post EI2W was better in Auxiliary Nurse Midwives (ANMs) than other participants. Awareness regarding cervical cancer was higher with more years of experience. The KAP analysis showed excellent interrater reliability in the practice 0.726 (0.649–0.792) followed by knowledge domain 0.711 (0.626–0.783). ConclusionEI2W was effective in significantly improving the competence of PMPs, thus reducing human resource constraints in cervical cancer prevention and elimination.

Naïve no more: Foreign direct investment screening in the European Union

AbstractThis paper asks what explains the creation and comparative features of national Investment Screening Mechanisms (ISMs) in Europe. After providing a brief history and definition of ISMs, we provide descriptive patterns about the similarities and differences in the investment screening features of national ISMs in EU member states. We then explain differences in national screening policies by focusing on the role of public debt, Chinese investment, R&amp;D expenditures and various geographic groupings. Finally, we make three policy arguments about the rise of ISMs in Europe: (1) ISMs have not been designed as protectionist instruments, (2) the politics of inward investment screening reflects a shift from economic to security logic in addressing the fundamental tension between the benefits and vulnerabilities of open markets and (3) the EU can use the ‘commercialisation’ of security to extend its own competence in the security sphere. We conclude by considering how the rapid expansion of investment screening in Europe could affect economic openness, as well as the role of the EU as a global actor.

The Global Expansion of LTBI Screening and Treatment Programs: Exploring Gaps in the Supporting Economic Evidence.

The global burden of latent TB infection (LTBI) and the progression of LTBI to active TB disease are important drivers of ongoing TB incidence. Addressing LTBI through screening and TB preventive treatment (TPT) is critical in order to end the TB epidemic by 2035. Given the limited resources available to health ministries around the world in the fight against TB, we must consider economic evidence for LTBI screening and treatment strategies to ensure that limited resources are used to achieve the biggest health impact. In this narrative review, we explore key economic evidence around LTBI screening and TPT strategies in different populations to summarize our current understanding and highlight gaps in existing knowledge. When considering economic evidence supporting LTBI screening or evaluating different testing approaches, a disproportionate number of economic studies have been conducted in high-income countries (HICs), despite the vast majority of TB burden being borne in low- and middle-income countries (LMICs). Recent years have seen a temporal shift, with increasing data from low- and middle-income countries (LMICs), particularly with regard to targeting high-risk groups for TB prevention. While LTBI screening and prevention programs can come with extensive costs, targeting LTBI screening among high-risk populations, such as people living with HIV (PLHIV), children, household contacts (HHC) and immigrants from high-TB-burden countries, has been shown to consistently improve the cost effectiveness of screening programs. Further, the cost effectiveness of different LTBI screening algorithms and diagnostic approaches varies widely across settings, leading to different national TB screening policies. Novel shortened regimens for TPT have also consistently been shown to be cost effective across a range of settings. These economic evaluations highlight key implementation considerations such as the critical nature of ensuring high rates of adherence and completion, despite the costs associated with adherence programs not being routinely assessed and included. Digital and other adherence support approaches are now being assessed for their utility and cost effectiveness in conjunction with novel shortened TPT regimens, but more economic evidence is needed to understand the potential cost savings, particularly in settings where directly observed preventive therapy (DOPT) is routinely conducted. Despite the growth of the economic evidence base for LTBI screening and TPT recently, there are still significant gaps in the economic evidence around the scale-up and implementation of expanded LTBI screening and treatment programs, particularly among traditionally hard-to-reach populations.

“Here it was waiting for me:” Diabetes Diagnosis Pathways and Implications for Health Policy

AbstractDiabetes in older adults is a growing public health concern with nearly 30% of Americans 65 and older having diabetes. This includes 2.6 million older adults with undiagnosed diabetes who are at high risk of microvascular and cardiovascular complications (Centers for Disease Control and Prevention, 2022). The majority of cases are Type‐2 diabetes. The past decade has witnessed an expansion in screening recommendations in an effort to reduce rates of undiagnosed older adults. Drawing on the sociology of diagnosis, we suggest further attention to the social factors that shape the diagnosis process is needed. We examine the diabetes diagnosis process from the perspective of older adults with type 2 diabetes. The data derive from diabetes illness narrative interviews with non‐Hispanic White and African American older adult men and women (age ≥50) with type 2 diabetes (N=83). Our thematic analysis reveals four pathways to diagnosis: 1. Annual wellness exam, 2. Workplace screening, 3. Community‐based opportunities, and 4. Health event or alarm. Diabetes' early symptoms are often normalized within daily life, with health insurance gaps, providers' dismissal of symptoms, and nonprescription medications reinforcing efforts to address initial symptoms within the home. Wellness visits, as well as worksite and community‐based screening, critically intercede in the unfolding of symptoms. In contrast, diagnosis in connection with a health event or alarm carries an additional toll on social and emotional well‐being. These findings have implications for national screening policies and local diabetes control efforts.

Awareness of HLA-B* 15:02 screening in trigeminal neuralgia and the gene screening policy among dentists in Southern Thailand.

To determine the factors associated with public hospital dentists' awareness of HLA-B*15:02 screening in trigeminal neuralgia (TN) and the national gene screening policy in Thailand. Cross-sectional study. A validated questionnaire was distributed to public hospital dentists with at least 1 year of practice in Southern Thailand (n =760) to assess their knowledge of TN, carbamazepine (CBZ) use, awareness of HLA-B*15:02 screening, and the gene screening policy. A total of 385 dentists participated (50.7% response rate); 81.3% of respondents were aware of HLA-B*15:02 screening. However, 18.7% of dentists were not aware of the importance of gene testing. Furthermore, dentists who were aware of gene screening had significantly better knowledge of TN diagnosis and CBZ use than "unaware" dentists. Awareness of HLA-B*15:02 screening was also significantly associated with dental specialty. Moreover, 80.5% of respondents were not aware of the gene screening policy. The primary problems related to the policy were its inefficient publication, poor implementation, and lack of clinical practice guidelines (CPGs) to encourage dentists to follow the policy and prescribe gene tests. While most hospital dentists were aware of the necessity of HLA-B*15:02 screening prior to prescribing CBZ in TN, the majority were unaware of the national gene screening policy. Dental specialty and knowledge were associated with awareness of HLA-B*15:02 screening.

Epidemiological and diagnostic characteristics of scoliosis in children in a single tertiary centre in Abidjan.

Introduction:Scoliosis is the most frequent spine deformity in children. Epidemiological data are available in Western countries due to the systematic screening policies implemented at school. Unfortunately, in our country, there are neither national data nor screening policy for scoliosis. Are the epidemiological and diagnostic characteristics of scoliosis in our practice similar to the data in the literature?Patients and Methods:We retrospectively reviewed 106 medical records of patients under 19 years old between 2010 and 2019 at the 'Vivre Debout' Centre for structural scoliosis confirmed by spine X-ray with a Cobb angle ≥10°. The epidemiological and diagnostic characteristics were noted. The data were treated with Excel 2010.Results:The mean frequency of scoliosis was 10 cases/year. The male-to-female sex ratio was 1:1.3. The mean age at diagnosis was 11.2 ± 2.13 years. There was a family history of scoliosis in two cases (1.8%). Twenty-four girls (39.3%) out of 61 had had menarche at the time of diagnosis. The mean time from noticing deformity to consultation was 17.9 ± 21.9 months. Lateral deviation of the spine (n = 77; 72.6%), hump (n = 12; 11.3%) and pain (n = 3; 2.8%) were the main complaints for consultation. In 14 cases (13.2%), the discovery was fortuitous during a medical examination for another complaint. The curvature was single in 88 cases (83%) and double in 18 (17%). The convexity was right in 69 cases (65.1%) and left in 37 (34.9%). Curvatures were thoracic (n = 57; 53.8%), lumbar (n = 10; 9.4%) and thoracolumbar (n = 39; 36.8%). The average Cobb angle was 35.2° ±10.71° (range: 11°–90°). Curvatures were moderate (20°–40°) in 49 cases (46.2) and severe (>40°) in 18 (17%). The aetiologies were predominated by idiopathic causes (n = 79; 74.5%), followed by congenital (n = 16; 15.1%) and neuromuscular (n = 11; 10.4%) causes.Conclusion:Scoliosis is uncommon in our practice. It is characterised by single curvature. The predominance of moderate and severe curvatures was due to delayed consultation.

Comparative analysis between self-collected and clinician-collected samples for HPV testing in public health facilities in Zimbabwe.

Cervical cancer screening programs that use visual inspection with acetic acid to identify women with pre-cancerous lesions in Zimbabwe have had limited success due to challenges with human resource constraints and patient acceptability. Nucleic acid amplification tests for human papillomavirus (HPV) have been endorsed by the World Health Organization for cervical cancer screening, along with self-collection of samples. As evidence shows self-collected sampling to be acceptable and preferable, Zimbabwe's Ministry of Health and Child Care (MOHCC) required a comparative analysis on the agreement between self- and clinician-collected samples for testing with Hologic Aptima HPV mRNA assay, to determine if self-collected samples could be used as another method to increase coverage of cervical cancer screening programs. In four public health facilities in Zimbabwe from July to August 2020, self- and clinician-collected HPV samples were obtained from HIV-positive women aged 30-49 years for HPV testing. A total of 280 self- and clinician-collected samples were tested and results were found to have good agreement (κ: 0.75, 95% CI: 0.66-0.82). HPV prevalence was 43.0% (95% CI: 37.0%-49.3%) for self-samples and 48.0% (95% CI: 41.0%-54.2%) for clinician-samples. Self-collected sampling had good agreement with clinician-collected and its inclusion in the national cervical cancer screening policy by Zimbabwe's MOHCC is expected to increase testing coverage, especially among underserved communities such as women living with HIV, as well as decentralize access to cervical cancer screening services for lower-level facilities and increase the geographical scope of where HPV testing can be offered through the country.

Predicting patient-level new-onset atrial fibrillation from population-based nationwide electronic health records: protocol of FIND-AF for developing a precision medicine prediction model using artificial intelligence

IntroductionAtrial fibrillation (AF) is a major cardiovascular health problem: it is common, chronic and incurs substantial healthcare expenditure because of stroke. Oral anticoagulation reduces the risk of thromboembolic stroke in...

Modelling the impact of prevention strategies on cervical cancer incidence in South Africa.

In 2020, the World Health Organisation (WHO) published a strategy to eliminate cervical cancer as a public health concern. In South Africa, despite having a national screening policy in place since 2000, diagnosed cervical cancer incidence has shown no signs of decline. We extend a previously developed individual-based model for human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection to include progression to cervical cancer. The model accounts for future reductions in HIV incidence and prevalence and includes a detailed cervical cancer screening algorithm, based on individual-level data from the public health sector. We estimate the impact of the current prevention programme and alternative screening scenarios on cervical cancer incidence. The South African screening programme prevented 8600 (95%CI 4700-12 300) cervical cancer cases between 2000 and 2019. At current levels of prevention (status quo vaccination, screening, and treatment), age-standardised cervical cancer incidence will reduce from 49.4 per 100 000 women (95%CI 36.6-67.2) in 2020, to 12.0 per 100 000 women (95%CI 8.0-17.2) in 2120. Reaching WHO's prevention targets by 2030 could help South Africa reach elimination (at the 10/100 000 threshold) by 2077 (94% probability of elimination by 2120). Using new screening technologies could reduce incidence to 4.7 per 100 000 women (95%CI 2.8-6.7) in 2120 (44% probability of elimination at the 4/100 000 threshold). HPV vaccination and decreasing HIV prevalence will substantially reduce cervical cancer incidence in the long term, but improvements to South Africa's current screening strategy will be required to prevent cases in the short term. Switching to new screening technologies will have the greatest impact.

Effect of accessibility improvement in a national population-based breast cancer screening policy on mammography utilization among women with comorbid conditions in Taiwan

In Taiwan, a Cancer Screening Quality Improvement Program (CAQIP), implemented in 2010, provides financial support to qualified hospitals to improve accessibility. This study aimed to examine the effect of CAQIP on mammography participation among women aged 50–69 years at various health statuses. A natural experimental study design before and after CAQIP implementation in 2010 was conducted. Phase 1 included 437,875 screened and 1,490,453 non-screened women, and 830,348 and 1,03,454 in Phase 2. Compared with women with no comorbidity, women with severe chronic conditions were less likely to participate in mammography screening. CAQIP was positively associated with the likelihood of mammography participation (OR 3.899, 95% CI 3.878–3.920); the magnitude of the effect was smaller for women with comorbid conditions. The findings provide evidences and economic theorical perspectives of potential benefits of health policy interventions to improve accessibility and mammography participation among women aged 50–69 years with comorbid conditions.

National and Subnational Incidence, Mortality, and Years of Life Lost Due to Breast Cancer in Iran: Trends and Age-Period-Cohort Analysis Since 1990.

Breast cancer is the most common cancer among women, causing considerable burden and mortality. Demographic and lifestyle transitions in low and low-middle income countries have given rise to its increased incidence. The successful management of cancer relies on evidence-based policies taking into account national epidemiologic settings. We aimed to report the national and subnational trends of breast cancer incidence, mortality, years of life lost (YLL) and mortality to incidence ratio (MIR) since 1990. As part of the National and Subnational Burden of Diseases project, we estimated incidence, mortality and YLL of breast cancer by sex, age, province, and year using a two-stage spatio-temporal model, based on the primary dataset of national cancer and death registry. MIR was calculated as a quality of care indicator. Age-period-cohort analysis was used to distinguish the effects of these three collinear factors. A significant threefold increase in age-specific incidence at national and subnational levels along with a twofold extension of provincial disparity was observed. Although mortality has slightly decreased since 2000, a positive mortality annual percent change was detected in patients aged 25–34 years, leading to raised YLLs. A significant declining pattern of MIR and lower provincial MIR disparity was observed. We observed a secular increase of breast cancer incidence. Further evaluation of risk factors and developing national screening policies is recommended. A descending pattern of mortality, YLL and MIR at national and subnational levels reflects improved quality of care, even though mortality among younger age groups should be specifically addressed.

An analysis of fertility, maternal age and Down syndrome in Romania: why does a national pregnancy registry matter?

Down syndrome (DS; trisomy 21) is the most common viable chromosomal anomaly to be diagnosed during pregnancy. The cases of trisomy 21 raise medical, familial and social consequences due to their development impact and associated malformations. The objective of this article is to analyze fertility, maternal age and the cases diagnosed with Down syndrome at birth in Romania, for a better understanding of the need of an effective national preventive healthcare system. Materials and method. We used a retrospective descriptive tabulation of data reported by the Romanian National Institute of Statistics and Eurostat. Results. In 2018, the average age at birth was 28 years old in Romania, compared to 30.58 years old in the European Union. The total number of pregnancies declined with an average annual rate of 3%, but the number of birth in women above 30 years old registered a steady growth. A decrease of DS cases at one million children between 2010 and 2015 (annual averages of 5.3%) for Romania was associated with a decrease in birth for women under 30 years old. Discussion. The number of DS cases at birth has decreased in the last decades, raising the question if the increasing costs led to an improvement in the prenatal screening diagnosis. New and often expensive tests have become available and widely prescribed. Understanding the impact of a national screening policy for Down syndrome in Romania is useful for rationale population-wide testing strategies. Nevertheless, a national pregnancy and birth registry, including pregnancy outcome and child surveillance corroborated with regular audit control, may contribute to allocate funds based on real needs.

Knowledge, Attitudes, and Behaviors on Utilizing Mobile Health Technology for TB in Indonesia: A Qualitative Pilot Study.

Tuberculosis (TB) infections remain a global health burden with a high incidence rate in South-East Asia, including Indonesia. TB control strategy is founded on early case detection and complete treatment to minimize transmission and prevent the emergence of drug resistance. However, many patients face challenges to comply with daily medication, causing many to adhere inconsistently or stop prematurely. Technological solutions could enhance adherence to treatment and support national screening and follow-up policies. These include telephone video communication, enabling health professionals to watch patients take their medication, address patients' concerns, and provide advice and support. This manuscript describes the outcome of a qualitative pilot study, based on a series of focus group discussions to assess the knowledge, attitudes, and behaviors, on the potential utilization of mobile technology for health purposes with a particular focus on TB treatment follow-up. The findings illustrate that general knowledge of mobile health technologies, of their legal framework of operations, and of their exact potential within the healthcare system is incomplete or poor. The novel findings are as follows: (a) the willingness of participants to learn about these technologies, (b) the open and welcoming attitude toward receiving such information even within frontline community settings, and (c) the willingness to back a government-supported, healthcare-driven set of such initiatives. Potential implementation barriers have also been highlighted. This study is an important first step toward understanding the attitudes and behaviors on utilizing mobile health technology for TB in Indonesia.

Fine-tuning of routine combined first- trimester screening: The ratio of serum-free- beta-human chorionic gonadotropin (fβ-hCG) to pregnancy-associated plasma protein-A (PAPP-A) could improve performance of Down syndrome screening program, a retrospective cohort study in Iran.

To evaluate the performance of the current national screening policy for Down syndrome (DS) in Iran and suggest a more efficient protocol with a wealth of a large series of first-trimester screening (FTS) data obtained from Nilou medical laboratory. To fulfill this aim, detection rate (DR), positive screening rate (PSR), false negative rate (FNR) and odds of being affected given a positive results (OAPR) were calculated at different cutoff risk. In the latest update of DS screening program in Iran, there is no place for intermediate group to be further investigated. Next, we proposed a novel parameter namely the ratio of fβ-hCG multiple of the median (MoM) value to PAPP-A MoM value to delicately categorize FTS results in a way that reduce FNR without imposing unnecessary anxious and extra money on most families. The present investigation was conducted retrospectively on 197,210 pregnancies undergoing FTS for aneuploidies in Nilou medical laboratory, Tehran, Iran, from March 2015 to February 2016. Intermediate risk group is important as 23 out of 45 FN fell in the range 1:250 to 1:1100. By applying the proposed index, the ratio of fβ-hCG MoM to PAPP-A MoM and subsequent decision about NIPT, 8 out of 23 FN cases in intermediate group could be detected. Compared with the current policy, our novel proposed approach had better performance and could be applied by the Iran National Health Service to improve the screening program guideline.

Potential Unintended Consequences of National Infectious Disease Screening Strategies in Deceased Donor Kidney Transplantation: A Cost-Effectiveness Analysis.

In order to counter the lack of sufficient kidney donors, there has been interest in expanding the utilization of organs from increased infectious-risk donors. Negative nucleic acid testing of increased infectious-risk organs has been shown to increase their use as compared to only enzyme-linked immunosorbent assay negativity. However, it is not known how the expanded use of nucleic acid testing on a national scale might affect total donor utilization. The objective of this paper was to determine if a national screening policy requiring the use of nucleic acid testing in both increased infectious-risk and non-increased infectious-risk renal transplant donors would increase the donor organ pool. This study used decision-tree analysis to determine the cost-effectiveness of four US national screening policies based on an increasingly expansive use of nucleic acid testing for increased infectious-risk and non-increased infectious-risk kidneys. Parameters were taken from the literature. All costs were reported in 2020 US dollars using a Medicare payer perspective and a life-time horizon. The use of nucleic acid screening solely for increased infectious-risk organs was the dominant strategy. Our results were robust to deterministic and probabilistic sensitivity analyses. One of the main driving factors of cost-effectiveness was the false-positive rate of nucleic acid testing. Before implementing nucleic acid screening outside of increased infectious-risk organs, its false-positivity rate should be directly studied to ensure that its use does not detrimentally affect transplantation numbers, quality-adjusted life-years, and costs.