National Screening Program Research Articles

Affected brother as the highest risk factor of type 1 diabetes development in children and adolescents: One center data before implementing type 1 diabetes national screening.

There is an increased risk for childhood type 1 diabetes (T1D) when T1D and type 2 diabetes (T2D) are reported in relatives. Our objective was to evaluate current family risk factors for T1D development before implementing a national screening program for T1D. A population of 879 Caucasian children and adolescents with T1D and 286 healthy controls were enrolled in the study. All participants completed the same questionnaire, which collected information about family history of diabetes over 3 generations. In statistical analyses, frequency tables and χ2 tests evaluated possible multicollinearity among risk factors that were significantly associated with the outcomes. Family history of diabetes was more frequent in controls (n = 75, 26.2%) than in patients with T1D (n = 146, 16.6%, odds ratio (OR) = 1.785, 95% confidence interval (95% CI): 1.299-2.452, degrees of freedom (df) = 12.976, p = 0.004), especially with a family history of T2D (n = 62, 21.7% compared to n = 79, 9.0%, respectively, OR = 2.803, 95% CI: 1.948-4.034, df = 32.669, p < 0.001). Also, there was a tendency for the nuclear family of T1D patients to be more frequently affected by T1D (n = 74, 8.4%) than the controls (n = 15, 5.2%, OR = 1.605, 95% CI: 0.937-2.751, df = 3.081, p = 0.079). The risk of T1D was associated with the closest family members being affected and accelerated over generations. Indeed, it was highest in siblings, especially brothers (OR = 12.985, 95% CI: 0.782-215.743, Fisher's test: p < 0.001). A positive family history of T2D burden among second-degree relatives was 2.728 times more frequent in the control group than in the T1D group (OR = 2.728; 95% Cl: 1.880-3.962, p < 0.001). Furthermore, a positive family history of T1D among first-degree relatives was less frequent in the controls than in the T1D group (OR = 0.124; 95% Cl: 0.030-0.516, p = 0.004). A family history of T1D, but not T2D, is a significant risk factor for T1D development. Indeed, the priority in screening for T1D should be given to first-degree relatives of T1D patients, starting from siblings.

Spatial variability in socio-demographic factors affecting participation in the Australian national bowel cancer screening program

ObjectivesThe objective of this paper is to analyse the socio-demographic and spatial patterns associated with bowel cancer screening in Australia. Despite the importance of screening in reducing mortality via early intervention, it remains the case that overall screening rates are uneven between different socio-demographic groups and geographic regions. Notwithstanding this, there is limited knowledge in Australia regarding the interplay between socio-demographics and geography in relation to bowel cancer screening. Thus, this paper explores the socio-demographic and spatial patterns of screening participation across Australian regions to better inform public health policy and programs. Study designThis is a nationwide ecological study based on aggregate spatial data. MethodsAn ecological study is conducted using bowel cancer screening rates and selected socio-demographic data measured at the Statistical Area 3 level. Geographically weighted regression software is used to conduct global and spatial regression analysis. ResultsThe global regression results show that higher rates of screening participation were associated with employment/education disengagement and volunteering while in contrast, lower rates of participation were associated with higher rates of indigenous populations, people with chronic health conditions, and people with poor English skills. Considering the spatial analysis, the analysis shows that once the spatial non-stationarity in the data is considered the influence of the variables shown to be significant in the global model, has significant spatial variability. ConclusionFrom a public health perspective, addressing shortfalls in bowel cancer screening participation is an important priority. In order to understand differences in participation rates it is important to consider both socio-demographic factors as well as the geographic or spatial distribution of these factors.

Preventing Dementia-A Cross-Sectional Study of Outpatients in a Tertiary Internal Medicine Department.

Dementia is a significant health problem worldwide, being the seventh leading cause of death (2,382,000 deaths worldwide in 2016). Recent data suggest there are several modifiable risk factors that, if addressed, can decrease dementia risk. Several national dementia screening programs exist; however, limited-income countries do not have the means to implement such measures. We performed a prospective cross-sectional study in an outpatient department to identify individuals at risk for dementia. Patients with no known cognitive dysfunction seeking a medical consult were screened for dementia risk by means of the cardiovascular risk factors, ageing, and dementia (CAIDE) and modified CAIDE tests. Additionally, we collected demographic and clinical data and assessed each participant for depression, mental state, and ability to perform daily activities. Of the 169 patients enrolled, 63.3% were identified as being in the intermediate-risk or high-risk group, scoring more than seven points on the mCAIDE test. Over 40% of the elderly individuals in the study were assessed as "somewhat depressed" or "depressed" on the geriatric depression scale. Almost 10% of the study population was diagnosed de novo with cognitive dysfunction. In conclusion, using a simple questionnaire such as the mCAIDE in a predefined high-risk population is easy and does not represent a major financial burden. At-risk individuals can subsequently benefit from personalized interventions that are more likely to be successful. Limited-resource countries can implement such screening tools in outpatient clinics.

The application of artificial intelligence in diabetic retinopathy screening: a Saudi Arabian perspective

IntroductionDiabetic retinopathy (DR) is the leading cause of preventable blindness in Saudi Arabia. With a prevalence of up to 40% of patients with diabetes, DR constitutes a significant public health burden on the country. Saudi Arabia has not yet established a national screening program for DR. Mounting evidence shows that Artificial intelligence (AI)-based DR screening programs are slowly becoming superior to traditional screening, with the COVID-19 pandemic accelerating research into this topic as well as changing the outlook of the public toward it. The main objective of this study is to evaluate the perception and acceptance of AI in DR screening among eye care professionals in Saudi Arabia.MethodsA cross-sectional study using a self-administered online-based questionnaire was distributed by email through the registry of the Saudi Commission For Health Specialties (SCFHS). 309 ophthalmologists and physicians involved in diabetic eye care in Saudi Arabia participated in the study. Data analysis was done by SPSS, and a value of p &amp;lt; 0.05 was considered significant for statistical purposes.Results54% of participants rated their level of AI knowledge as above average and 63% believed that AI and telemedicine are interchangeable. 66% believed that AI would decrease the workforce of physicians. 79% expected clinical efficiency to increase with AI. Around 50% of participants expected AI to be implemented in the next 5 years.DiscussionMost participants reported good knowledge about AI. Physicians with more clinical experience and those who used e-health apps in clinical practice regarded their AI knowledge as higher than their peers. Perceived knowledge was strongly related to acceptance of the benefits of AI-based DR screening. In general, there was a positive attitude toward AI-based DR screening. However, concerns related to the labor market and data confidentiality were evident. There should be further education and awareness about the topic.

Mammography-based deep learning model for coronary artery calcification.

Mammography, commonly used for breast cancer screening in women, can also predict cardiovascular disease. We developed mammography-based deep learning models for predicting coronary artery calcium (CAC) scores, an established predictor of coronary events. We evaluated a subset of Korean adults who underwent image mammography and CAC computed tomography and randomly selected approximately 80% of the participants as the training dataset, used to develop a convolutional neural network (CNN) to predict detectable CAC. The sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and overall accuracy of the model's performance were evaluated. The training and validation datasets included 5235 and 1208 women, respectively [mean age, 52.6 (±10.2) years], including non-zero cases (46.8%). The CNN-based deep learning prediction model based on the Resnet18 model showed the best performance. The model was further improved using contrastive learning strategies based on positive and negative samples: sensitivity, 0.764 (95% CI, 0.667-0.830); specificity, 0.652 (95% CI, 0.614-0.710); AUROC, 0.761 (95% CI, 0.742-0.780); and accuracy, 70.8% (95% CI, 68.8-72.4). Moreover, including age and menopausal status in the model further improved its performance (AUROC, 0.776; 95% CI, 0.762-0.790). The Framingham risk score yielded an AUROC of 0.736 (95% CI, 0.712-0.761). Mammography-based deep learning models showed promising results for predicting CAC, performing comparably to conventional risk models. This indicates mammography's potential for dual-risk assessment in breast cancer and cardiovascular disease. Further research is necessary to validate these findings in diverse populations, with a particular focus on representation from national breast screening programmes.

Differences in mammography screening attendance among non-Western immigrants in Denmark, Finland, Iceland and Norway

Several studies have shown that attendance rates are lower among non-Western immigrants than among natives. As the Nordic countries have quite similar health systems and populations but also differences in the organisation of their organised mammography screening programmes, differences in attendance rates could highlight organisational factors that might increase the attendance rates. Mammography screening is offered free of charge in Denmark and Finland, but not in Iceland and Norway. Contrarily to the other countries, Iceland do not send out pre-booked appointment.The study population included natives and non-Western immigrants aged 50–69 years, who had at least one invitation to the national mammography screening programmes in Denmark (2008–2017), Finland (2001–2017), Iceland (2001–2020) or Norway (2001–2015). Relative risks (RRs) of attendance were estimated and adjusted for age group and calendar period.The study population included 116.033 non-Western immigrants and more than 2 million natives. The attendance rates were significantly lower among non-Western immigrants than among natives, with an adjusted relative risk of 0.81/0.80 in Denmark and Finland, 0.62 in Norway, and 0.40 in Iceland. The lower attendance rates among immigrants in Norway and Iceland did not seem to be due to differences in birth country, immigration age, or educational level, but might be explained by organisational factors.Offering free-of-charge mammography screening in Norway and Iceland and/or including a pre-booked appointment in the invitation letters in Iceland might increase the attendance rate among non-Western immigrants.

Premarital hemoglobinopathy screening program results of a province in the Black Sea region of Turkey: three years’ experience

ABSTRACT Objectives Hemoglobinopathies are a global public health problem with high mortality and morbidity and very expensive treatment. Disease can be reduced and prevented with hemoglobinopathy screening tests. It is possible to identify carriers with the hemoglobinopathy screening program applied in many countries of the world and in Turkey. This study aims to evaluate the results of the national premarital hemoglobinopathy screening program carried out in primary healthcare institutions. Methods The research is of epidemiological and cross-sectional type. Electrophoresis results examined within the scope of the premarital hemoglobinopathy screening program in Samsun between 1 January 2019 and 31 December 2021 were evaluated retrospectively. Age, gender, year of screening, and hemoglobinopathy screening results were obtained from the records. In the statistical analysis of the data, p < 0.05 was accepted. Results The median age of 52,338 people screened under the hemoglobinopathy screening program was 29.0 (16.0–86.0) years. About 54.1% (n = 28,309) of those who were screened were female, and it was found that the least screening was done in 2020 (n = 15,765 (30.1%)). As a result of the screening, the frequency of the β-thalassemia (β-thal) trait was 1.37% (n = 676), the frequency of the abnormal HbS was 0.04% (n = 20). The frequency of β-thal trait was statistically significantly higher in 2020 (1.5%) compared to other years (p = 0.029). When the results were analyzed by gender, the rate of women with abnormal HbS (3.7%) was significantly higher than the others (p = 0.017). Conclusions This study presents the results of the national hemoglobinopathy screening program in Northern Turkey and the β-thal and the abnormal HbS rates were found to be low. The data obtained will be useful in monitoring hemoglobinopathy disorders and evaluating the current program’s effectiveness in the future. It will allow decision-makers to implement policy changes and prioritize new programs.

Assessing, updating and utilising primary care smoking records for lung cancer screening

BackgroundLung cancer screening with low-dose computed tomography for high-risk populations is being implemented in the UK. However, inclusive identification and invitation of the high-risk population is a major challenge for equitable lung screening implementation. Primary care electronic health records (EHRs) can be used to identify lung screening-eligible individuals based on age and smoking history, but the quality of EHR smoking data is limited. This study piloted a novel strategy for ascertaining smoking status in primary care and tested EHR search combinations to identify those potentially eligible for lung cancer screening.MethodsSeven primary care General Practices in South Wales, UK were included. Practice-level data on missing tobacco codes in EHRs were obtained. To update patient EHRs with no tobacco code, we developed and tested an algorithm that sent a text message request to patients via their GP practice to update their smoking status. The patient’s response automatically updated their EHR with the relevant tobacco code. Four search strategies using different combinations of tobacco codes for the age range 55-74+ 364 were tested to estimate the likely impact on the potential lung screening-eligible population in Wales. Search strategies included: BROAD (wide range of ever smoking codes); VOLUME (wide range of ever-smoking codes excluding “trivial” former smoking); FOCUSED (cigarette-related tobacco codes only), and RECENT (current smoking within the last 20 years).ResultsTobacco codes were not recorded for 3.3% of patients (n = 724/21,956). Of those with no tobacco code and a validated mobile telephone number (n = 333), 55% (n = 183) responded via text message with their smoking status. Of the 183 patients who responded, 43.2% (n = 79) had a history of smoking and were potentially eligible for lung cancer screening. Applying the BROAD search strategy was projected to result in an additional 148,522 patients eligible to receive an invitation for lung cancer screening when compared to the RECENT strategy.ConclusionAn automated text message system could be used to improve the completeness of primary care EHR smoking data in preparation for rolling out a national lung cancer screening programme. Varying the search strategy for tobacco codes may have profound implications for the size of the population eligible for lung-screening invitation.

Smoking history and all-cause, ischaemic heart disease and lung cancer mortality: follow-up study of 358 551 men and women aged 40–43 years

AimsWe studied the health consequences of quitting smoking before age 43 by time since quitting, number of years smoked and cigarettes smoked per day. The outcomes were all-cause, ischaemic heart...

Prevalence and sociodemographic predictors of high-risk vaginal human papillomavirus infection: findings from a public cervical cancer screening registry

IntroductionHigh-risk human papillomavirus (HPV) screening is vital for early cervical cancer detection and treatment. With the introduction of the national cervical cancer screening programme and screening registry in Malaysia, there is a need to monitor population-based HPV screening uptake and high-risk HPV prevalence as part of cervical cancer surveillance.ObjectiveTo determine the prevalence and sociodemographic factors predicting high-risk HPV infection in Malaysia based on a public, community-based cervical cancer screening registry targeting women at risk of getting HPV infection.MethodsThe study used data from the Malaysian cervical cancer screening registry established by the Family Health Development Division from 2019 to 2021. The registry recorded sociodemographic data, HPV test details and results of eligible women who underwent HPV screening at public primary healthcare facilities. A vaginal sample (via self-sampling or assisted by a healthcare provider) was used for DNA extraction for HPV detection and genotyping. Registry data were extracted and analysed to determine prevalence estimates of high-risk HPV infection. Multifactorial logistic regression analysis was conducted to determine predictors of high-risk HPV infection. All analyses were performed using Stata version 14.ResultsThe programme screened a total of 36,738 women during the study period. Women who attended the screening programme were mainly from urban areas, aged 30–39 years, and of Malay ethnicity. The prevalence of high-risk HPV infection was 4.53% among women screened, with the yearly prevalence ranging from 4.27 to 4.80%. A higher prevalence was observed among urban settling women, those aged 30–49 years, those of Indian ethnicity, and those without children. The results from logistic regression showed that women from urban areas, lower age groups, of Indian or Chinese ethnicity, and who are self-employed were more likely to be infected with high-risk HPV.ConclusionTargeted and robust strategies to reach identified high-risk groups are needed in Malaysia. In addition, the registry has the potential to be expanded for an improved cervical cancer elimination plan.Trial registrationTrial registration number: NMRR ID-22-00187-DJU.

Inferior T wave inversion in young individuals: should we be worried

Abstract Introduction Cardiac screening in young individuals may identify individuals at risk of sudden cardiac death (SCD). The ECG is crucial to identify individuals who harbour pre-clinical/clinical phenotypes. T wave inversion (TWI) are often found at screening. Outcomes and clinical implications of individuals with TWI are dependent on demographic variables and territory involved. However, the implications of inferior TWI in young individuals are poorly understood. Aim This study was carried out to ascertain prevalence and outcomes of adolescent individuals with inferior TWI. Methodology Cardiac screening (questionnaire/ECG) was carried out in 2672 students (14-17 years) attending year 11 classes during the 2017/2018 scholastic year (3991 eligible citizens) as part of a national cardiac screening program (BEAT-IT). Cases with contiguous TWI in ≥2 leads in the inferior (II/III/aVF) leads were included (isolated and those extending into the lateral leads). ECGs with inferior TWI were repeated (in shallow breathing) to ensure appropriate lead placement. An athlete was defined as an individual who participated in organized sport and/or engaged in &amp;gt;4 hours of physical activity weekly. Results 2672 adolescents gave consent (mean, 50.4% were female). 1042 (39.0%) were athletes. Most were of Caucasian ethnicity (95.8%). Inferior TWI were present in 15 (0.6%), all were Caucasian and 9 of these were non-athletic individuals. 4 had symptoms (26.7%) and 1 (6.7%) had a positive family history [HCM]. Inferior TWI (n=15) was more frequent in females (n=13 [1.0%] vs n=2 [0.2%] vs 0.2%, p=0.037). The prevalence was similar in athletes and non-athletes (n=6 [0.6%] vs n=9 [0.6%], p=0.858). 11 (0.4%) had isolated inferior TWI. Only 1 (9.1%) had TWI involving all three inferior leads. Another 4 (0.1%) had inferior TWI extending into the lateral leads. Borderline/other pathological ECG patterns were as likely in both groups (p=0.770). Two participants with inferior TWI (22.2%) had other abnormal ECG patterns (P mitrale [n=1] and ST segment depression [n=2]). One participant (24.0%) from the inferolateral TWI group had ST segment depression. Two patients (13.3% of all participants with inferior TWI) were given a clinical diagnosis (one HCM [inferolateral TWI] and one MVP [inferior TWI]). Both were asymptomatic. The yield was similar for inferolateral (25.0%) and isolated inferior (11.1%) TWI [2 leads] (p=0.523). Most participants with isolated inferior TWI (n=5, 55.6%) were discharged after referral vs 0% in those with inferolateral TWI. Some (n=6) are under surveillance (mean±SD 1897±9 days). Two refused further evaluation. Conclusion Inferior TWI is an infrequent finding in young individuals and may be a marker of pathology in a small group of subjects. The number of leads with TWI (inferior [2 leads], inferior [3 leads] and inferolateral TWI) did not influence the diagnostic yield. Further evaluation is warranted in such cases.

Abstract 16924: Lateral T Wave Inversion in Adolescent Individuals: The Beat-It Cardiac Screening Program

Introduction: Cardiac screening is mandated by most sporting organisations. A resting 12-lead ECG may identify individuals who harbour cardiac disorders who may be at risk of sudden cardiac death (SCD). Lateral wave inversion (TWI) may identify subjects with cardiac phenotypes that are linked to SCD. Aim: The aim of this study was to ascertain the prevalence of lateral TWI in adolescent individuals as part of a systematic nationwide cardiac screening. The yield of family screening in these probands was also evaluated. Methodology: A national cardiac screening program (BEAT-IT) was set up in the 2017/2018 scholastic year for students attending year 11 classes. 2672 students (14-17 years) and their legal guardians gave consent. Screening protocol consisted of a questionnaire/ECG at school. ECGs were reported as per the ‘International Recommendations for ECG interpretation’ (2017). Those with contiguous TWI in ≥2 lateral leads were evaluated. An athlete was defined as an individual who participated in organized sport and/or engaged in &gt;4 hours of physical activity weekly. Results: 2672 adolescents gave consent (mean age 15 years, 50.4% female, 95.8% Caucasian, 39.0% athletes). 6 (0.22%) had lateral TWI, extending into the inferior (n=4, 0.15%) or anterior (n=2 (0.07%) leads. The prevalence was the same in both genders (p=0.477) and athletic status (p=0.580). 2 (0.07%) had symptoms, 4 (0.15%) were female, all were Caucasian, 3 (0.11%) were athletes. 4 (0.15%) had borderline or other pathological ECG changes (n=2 LAE, n=1 RAE, n=1 ST depression). 4 (0.15%) had deep TWI (≥2mm). One patient was diagnosed with HCM (0.04%). All subjects are under surveillance. Family screening in relatives (n=27) identified two (7.4%) with cardiomyopathy (n=1 HCM, n=1 DCM). Another 5 (18.5%) had an abnormal ECG requiring surveillance. These findings suggest that some of the participants identified at screening may harbour pre-clinical phenotypes. Conclusion: Lateral TWI is an infrequent finding in young individuals and requires surveillance as it may be a manifestation of heart disease. Family screening may help increase the degree of suspicion of pre-clinical disease in peripubertal individuals.

The shifting patterns of childhood obesity: Insights from national school screening data

BackgroundRecent reports indicated an increasing prevalence of obesity among children and adolescents in Saudi Arabia, making it an impending national epidemic. However, obesity prevalence data in children and adolescents in Saudi Arabia are largely inconsistent. ObjectivesThis study analyzed and compared the prevalence of obesity among a national sample of children and adolescents across sexes, school grades, regions, and city types in Saudi Arabia using the Growth Charts for Saudi Children and Adolescents. MethodsWeight, height, and body mass index (BMI) data from 1 134 317 children in first, fourth, seventh, and tenth school grades who participated in the national school screening program were analyzed cross-sectionally. BMI values were classified using the Growth Charts for Saudi Children and Adolescents. ResultsNearly 10.4% of students were overweight, 10.7 % were obese, and 4.50% were severely obese. Male students had a higher prevalence of overweight and obesity than their female counterparts. The prevalence of overweight and obesity was the highest among students in intermediate school, the Central region, and administrative capitals. ConclusionManaging childhood obesity is challenging due to its multifaceted nature Therefore, utilizing clinical and community-based participatory approaches is essential to develop nationwide obesity prevention and management program that is effective and sustainable. This program must utilize dynamic BMI surveillance systems using ethnically representative growth references, conduct national pediatric obesity research with careful consideration for demographic and regional differences, lead targeted pediatric obesity awareness campaigns, provide obesity management interventions in a pediatric multi-disciplinary clinic, and evaluate the program outcomes periodically.

Effect of Smoking Cessation on the Risk of Subarachnoid Hemorrhage: A Nested Case-Control Study in Korean Men.

Smoking is a well-established risk factor for subarachnoid hemorrhage (SAH), and current smokers have an increased risk of SAH. However, there are insufficient data on whether smoking cessation in current smokers reduces the risk of SAH. A nested case-control study was conducted based on the National Health Insurance Service-National Health Screening Cohort, which comprises nationwide health claims data and a national health screening program in Korea (2002-2019). We constructed a cohort of current male smokers without a history of stroke at the baseline health screening (2002-2003). From this cohort, cases were defined as individuals who experienced a nontraumatic SAH during the follow-up period up to 2019. Five controls were matched to each case using incidence density sampling. Smoking status (continuation or cessation) before the occurrence of SAH was evaluated using the repeated national health screening program. We conducted a multivariable conditional logistic regression analysis, adjusting for alcohol consumption, physical activity, body mass index, systolic blood pressure, and fasting blood glucose levels, to evaluate the association between SAH risk and smoking cessation. At baseline, there were 112 142 current male smokers. After excluding individuals with prior stroke or insufficient data, the cohort consisted of 105 223 eligible participants (mean age, 50.3±8.5 years). Among them, we identified 318 cases of SAH and 1590 matched controls. Those who quit smoking had a significantly lower risk of SAH compared with current smokers (adjusted odds ratio, 0.55 [95% CI, 0.41-0.73]). The risk of SAH decreased with a longer period of smoking cessation. The risk reduction with smoking cessation was consistent even among prior heavy smokers. Smoking cessation in current male smokers reduced the risk of SAH, and the risk reduction was greater as the cessation period increased. These findings warrant intensive efforts to encourage smokers, even heavy smokers, to quit.

459P Association between national health screening program and undertreatment of dyslipidemia in cancer survivors: A cross-sectional study

459P Association between national health screening program and undertreatment of dyslipidemia in cancer survivors: A cross-sectional study

Approach of Female Patients to Screening Tests in the Prevention of HPV-Related Cervical Cancer and the Effect of Physician's Recommendation

The aim of our study was to evaluate the cervical cancer screening test status of female patients between the ages of 30-65 who applied to the family medicine outpatient clinic for any reason. If they have not had the screening test, it is aimed to provide information and relevant education to the patients about the test, and then to include the patient in the national cervical cancer screening program by improving the patient's knowledge and awareness and also to contribute to preventive health care, which is our principle of family medicine specialty. Our study was prospective observational research in which evaluating the status of having a cervical cancer screening test after appropriate information. Patients were asked about their cervical cancer screening test status, and all participants were informed about this issue, and the patients who did not get tested were contacted again by phone one month later to evaluate the status of taking the test. A unique structured questionnaire form was used for the study. A total of 146 women who agree to participate voluntarily were included in the study. The mean age of the patients was 44.39±9.26 years and 64.4% had not gone through menopause. Of the patients, 87% were married, 48.6% were university graduates, and 49.3% were not employed. 66.4% of patients had had a cervical cancer screening test at least once, while 28.9% of them had been tested more than five years ago, 2.1% did not remember when they had the test. Of those who had the screening test, 57.7% had the test for health check-up, 73.5% of those who did not get tested they did not have a test because they did not need or had any complaints. 73.3% of the patients had not received training on the screening tests. 51.3% of those receiving training stated that they received training from the hospital and 28.2% from the family health center. After being informed about the cervical cancer screening test, 58.9% (n=86) of the patients considered having the test. It was determined that 26.6% of the patients (n=79) who did not have the screening test in accordance with the screening program and who never tested, had the screening test done after being informed. Consider the average age of the patients, it was determined that their participation in the cervical cancer screening program was quite low. The fact that more than half of the participants considered having a screening test after the physician's recommendation and training, and the fact that one quarter of the participants who were due to have the screening test after one month had the screening test, shows the importance of the physician's recommendation and education.

Screening for haemoglobin disorders: One size may not fit all.

Accurate laboratory screening for sickle cell disease and other haemoglobin disorders is expanding worldwide. Two new reports describe different methods and strategies for screening in Mali and Denmark, respectively, and their encouraging results suggest that countries should tailor their screening programmes according to local needs, resources and opportunities. Commentary on: Guindo et al. Potential for a large-scale newborn screening strategy for sickle cell disease in Mali: a comparative diagnostic performance study of two rapid diagnostic tests (SickleScan® and HemotypeSC®) on cord blood. Br J Haematol 2024;204:337-345 and Gravholt et al. The Danish national haemoglobinopathy screening programme: report from 16 years of screening in a low-prevalence, non-endemic region. Br J Haematol 2024;204:329-336.

A role of National Cancer Control Programme during COVID-19 pandemics - experience from Slovenia

Abstract Issue Cancer is a major public health issue. Countries should tackle it with setting up National Cancer Control Programmes (NCCP), which are especially important during extreme circumstances. In Slovenia, during the COVID-19 pandemic, we managed to follow the direction set out in the NCCP. Description of the problem Slovenia has had a NCCP since 2010. The program's activities are already yielding results at a national level. During the COVID-19 pandemic, oncology services in Slovenia were designated as an exception that should not be interrupted. However, the functioning of primary care level has been modified due to COVID-19 management. This reflected in the drop of new cancer diagnoses and temporary stop of cancer screening programmes. Results During pandemics timely monitoring of cancer care has been set up by Slovenian Cancer Registry. During the first wave more than 30% drop in new cancer diagnoses has been observed. The results have been presented to policy makers and general public. Appeals to the policy makers to resume cancer screening as soon as possible, communication campaigns urging people to see a doctor, if they notice any signs of cancer, and support for all providers to maintain cancer care uninterrupted have been initiated by the NCCP. These activities resulted in only 3 months stop of the three national cancer screening programmes, and enhanced activities after their restart; the cancer awareness was raised in the next COVID-19 waves, since the drop in the new cancer diagnoses during following waves (autumn 2020- spring 2021) reached to “only” 10%. And institutions related to cancer care have remained dedicated to cancer throughout the whole pandemic period. Lessons Coordinated national cancer strategy can have important influence on policy makers and general population, raising awareness and preventing major disruptions. Coordinated support for cancer care was crucial to avoid worse long-term cancer outcomes. Key messages • Strategic framework of activities through NCCP have important impacts on the provision of cancer care, especially during extreme circumstances, such was COVID-19, which diminish health care delivery. • Strategic framework of activities through NCCP have important impacts on the provision of cancer care, especially during extreme circumstances, such was COVID-19, which diminish health care delivery.

Evaluation of the Community's Awareness of Developmental Dysplasia of the Hip: A Cross-Sectional Study in Jordan.

Developmental dysplasia of the hip (DDH) is a condition where there is an abnormal relationship between the femoral head and acetabulum. DDH is prevalent in Jordan, where late presentations of complicated cases are common due to the absence of a national screening program and cultural behaviors that can exacerbate DDH progression. The study aims to prove that the absence of a nationwide screening program and low awareness of the population about DDH are the primary reasons for the high incidence of late-presenting DDH in Jordan. The study highlights the need for addressing modifiable risk factors like swaddling and correcting common misconceptions such as using multiple diapers as a treatment option. The cross-sectional study evaluated the awareness level of DDH among Jordan residents above the age of 18. An online questionnaire was used, containing two sections. The Chi-square test was used to analyze the level of awareness scores according to demographic variables and cultural norms such as tight swaddling and using multiple diapers. The sample was categorized into three groups based on their scores: low awareness (0-4), moderate awareness (5-8), and high awareness (9-12). The study included 1013 participants. The results indicated that 48.9% had moderate awareness, 37.8% had low awareness, and 13.3% had high awareness of DDH. Gender and place of residence had no significant relationship with the level of awareness. However, the majority of participants with high and moderate levels of awareness were in the 25-40 years age group, and healthcare workers had the highest levels of awareness. The study showed that 33.9% of participants gained their knowledge from either relatives or self-experience, while awareness campaigns were the least assessed source of information with only 2.9% of participants getting their information from them. The study also revealed misconceptions regarding DDH, such as the belief that tight swaddling and wearing many diapers reduced the risk of developing DDH. Additionally, about half of the participants were unaware of the presence of screening guidelines for DDH. The study underscores the urgent need to establish a national screening program and awareness campaigns to increase knowledge about DDH and prevent late presentations of complicated cases in Jordan. The study findings provide essential information for the development of future DDH campaigns and screening protocols.

Motoric Cognitive Risk and Incident Dementia in Older Adults

Motoric cognitive risk (MCR) is a novel predementia syndrome; however, whether it can estimate dementia in a nationwide population or has additive estimation validity over cognitive or motoric components alone remains unknown. To examine whether modified MCR, which incorporates the timed-up-and-go and one-leg-standing tests, improves estimation validity for incident dementia over using cognitive or motoric components alone. This nationwide cohort study evaluated data from individuals aged 66 years who participated in the National Screening Program for Transitional Ages in Korea from January 1, 2009, to December 31, 2013, and examined the association between MCR and incident dementia using Cox proportional hazards regression analysis. Data were collected from the index date (the date on which the participant had the screening) until dementia onset, death, or the end of the follow-up period, whichever came first. The 2 subtypes were defined as subjective cognitive declines with timed-up-and-go impairment or one-leg-standing impairment. The data set was generated with permission from the Korean National Health Insurance Service, and data analysis was conducted from August 2, 2021, to January 31, 2022. Individuals diagnosed with dementia or psychotic disorders or those who had a documented history of dementia medication use before the index date were excluded. The main outcome was incidence of dementia, defined as an individual receiving their first dementia medication with the relevant International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes after the index date. Among the 1 137 530 participants (53.7% women), 15 380 (1.4%) met the MCR criteria for the timed-up-and-go subtype, and 32 910 (2.9%) met the criteria for the one-leg-standing subtype. The mean (SD) follow-up period was 7.02 (1.38) years. Participants with MCR demonstrated an approximately 2-fold higher risk of incident dementia than those without MCR (timed-up-and-go subtype, adjusted hazard ratio, 2.03; 95% CI, 1.94-2.13; one-leg-standing subtype, adjusted hazard ratio, 2.05; 95% CI, 1.98-2.12). In this cohort study of participants aged 66 years of the National Screening Program for Transitional Ages, modified motoric cognitive risk had higher adjusted hazard ratios of incident dementia than individual cognitive or motoric components. Motoric cognitive risk may be a practical screening tool for estimating dementia among individuals in their mid-60s ; however, further investigation of the clinical and neurobiological aspects is necessary.