Screening Group Research Articles

Prevention and treatment of drug-induced liver injury in patients with breast cancer and ovarian cancer

Introduction: Drug-induced liver injury is one of the most serious problems in hepatology. In most cases the abolition of the “causative” drug is a sufficient condition for the reverse development of pathological changes. However, in the case of chemotherapy for cancer patients, the abolition of hepatotoxic drug is impossible without creating an immediate or delayed threat to the patient’s life. Objective: To develop optimal schemes for the prevention and treatment of drug-induced liver injury by studying of its characteristics of with various chemotherapy regimens in patients with breast cancer and ovarian cancer. Material and methods: The screening group included 291 patients who underwent chemotherapy courses for breast cancer and ovarian cancer. The diagnosis and type of drug-induced liver injury was based on laboratory data (alanine aminotransferase and/or alkaline phosphatase increased above 2 norms) and the exclusion of other etiologies of liver diseases. Chemotherapy hepatotoxicity was assessed using the Shaposhnikov scale. The degree of hepatic encephalopathy was determined using a critical flicker frequency test. Depending on chemotherapy mode, groups of the patients were divided into subgroups: cyclophosphamide + Methotrexate+ Fluorouracil, Doxorubici + Cyclophosphamide, Epirubicin + Cyclophosphamide + 5-fluorouracil, Paclitaxel + Cisplatin, Carboplatin + Cyclophosphamide. According to the type of drug-induced liver injury, patients with cholestatic type received preparations, with cytolytic type – S-adenosylmethionine for 8 weeks. Results and its discussion: It was found that the most common side effect of chemotherapy is leukopenia, anemia and increase in level of alanine aminotransferase and alkaline phosphatase. The use of ursodeoxycholic acid and S-adenosylmethionine as an accompanying therapy significantly reduces the level of alanine aminotransferase and alkaline phosphatase degree of hepatotoxicity and hepatic encephalopathy, clinical improves the quality of life of patients and contributes to a more rapid elimination of symptoms of astheno-vegetative, dyspeptic and pain syndromes. Conclusion: It has been proven that the use of a differentiated approach to the choice of a hepatoprotector: S-adenosylmethionine in hepatocellular type, ursodeoxycholic acid - in cholestatic type of drug-induced liver injury for 8 weeks in patients with oncological profile allowed to carry out the planned therapy without deviations from the protocol.

Effect of fertility health awareness strategies on fertility knowledge and childbearing in young married couples (FertStart): study protocol for an effectiveness-implementation hybrid type I multicentre three-arm parallel group open-label randomised clinical trial

IntroductionBirth rates have been declining in many advanced societies including Singapore. We designed two interventions with vastly different resource requirements, which include fertility education, personalised fertility information and a behavioural...

Colorectal Sessile Serrated Lesion and Synchronous Neoplasm or Polyps: An Update and Critical Assessment;Analysis of 167 Consecutive Cases Undergoing Total Colonoscopy and Found 343 Polyps

Aim: Sessile serrated lesions (SSL) have the potential for malignant transformation into colorectal carcinoma (CRC), which develops via the serrated pathway of carcinogenesis. Material and Methods: Based on colonoscopy and pathology reports, all sessile serrated lesions or polyps in the risk screening group were studied at an urban medical research center between July 2018 and July 2022. We prospectively included consecutive colorectal polyps classified as a hyperplastic polyp (HP), sessile serrated lesion (SSL), traditional serrated adenoma (TSA), unclassified serrated adenoma, and synchronous neoplasm or polyp. Results: During the 48-month study period, 167 cases of sessile serrated lesions or polyps were diagnosed. In the study, 97 (58.1%) of the patients were male, 70 were female (41.9%), and the mean age was 59.74 (± 11.1). Hematoxylin-eosin preparations were available for complete analysis for 226 SSL, and 117 had synchronous adenomatous polyps or carcinomas. Approximately 88.1% of all polyps were ≤10 mm or less in diameter. There was a significant correlation between polyp size (≤10 mm) and epithelial polyps (p=0.000). In particular, polyps detected in the sigmoid colon with the rectum were relatively larger than in other locations. The sigmoid colon and rectum were the most common locations for sessile serrated lesions in our study. There was a significant association between epithelial polyps and anatomical locations (p=0.000). The distribution of all epithelial polyps was as follows; HP was the most frequently observed epithelial polyp with 57.7% (194 polyps), SSL was 6.8% (23 polyps), and TSA was 2.1% (7 polyps), unclassified serrated adenoma was 0.6% (2 cases), synchronous conventional were seen in 31% (104 polyps) of SSL or polyps, and carcinoma with polyps was detected in three (0.9%) cases Conclusions: Hyperplastic polyps are the most common sessile serrated lesions, and synchronous conventional tubular adenomas were most commonly accompanied by hyperplastic polyps. HPs were most commonly observed in the distal colon, particularly in the sigmoid colon and rectum. Future prospective studies using uniform diagnostic criteria and considering clinical outcomes are needed to make accurate decisions regarding surveillance and treatment of patients with serrated lesions.

Perinatal Outcomes in Obese Women with One Abnormal Value on 3-Hour Oral Glucose Tolerance Test.

This study aimed to determine if one abnormal value of four on the diagnostic 3-hour oral glucose tolerance test (OGTT) is associated with adverse perinatal outcomes in obese women. This is a secondary analysis of a prospective study of nulliparous women in eight geographic regions. Women with body mass index <30 kg/m2 and pregestational diabetes mellitus (GDM) were excluded. Four groups were compared: (1) normal 50-g 1-hour glucose screen, (2) elevated 1-hour glucose screen with normal 100-g 3-hour diagnostic OGTT, (3) elevated 1-hour glucose screen and one of four abnormal values on 3-hour OGTT, and (4) GDM. Using multivariable logistic regression adjusting for covariates, the women in the groups with dysglycemia were compared with those in the normal screen group for maternal and neonatal outcomes. Among 1,713 obese women, 1,418 (82.8%) had a normal 1-hour glucose screen, 125 (7.3%) had a normal 3-hour diagnostic OGTT, 72 (4.2%) had one abnormal value on their diagnostic OGTT, and 98 (5.7%) were diagnosed with GDM. The one abnormal value group had increased risk of large for gestational age (LGA) neonates (adjusted odds ratio [aOR] = 2.24, 95% confidence interval [CI]: 1.31-3.82), cesarean delivery (aOR = 2.19, 95% CI: 1.34-3.58), and hypertensive disorders of pregnancy (aOR = 2.19, 95% CI: 1.32-3.63) compared with normal screens. The one abnormal value group also had an increased risk of preterm birth <37 weeks (aOR = 2.63, 95% CI: 1.43-4.84), neonatal respiratory support (aOR = 2.38, 95% CI: 1.23-4.60), and neonatal hyperbilirubinemia (aOR = 2.00, 95% CI: 1.08-3.71). There was no association between one abnormal value with shoulder dystocia and neonatal hypoglycemia. For obese women, one abnormal value on the 3-hour OGTT confers increased perinatal adverse outcomes. These women should be studied further to determine if nutrition counseling and closer fetal monitoring improve outcomes even in the absence of a diagnosis of GDM. · Study of obese women with one abnormal value on OGTT.. · Adverse maternal and neonatal outcomes were found, including more LGA neonates.. · Neonates were not at increased risk of hypoglycemia..

PSYHOLOGICAL CORRECTION OF AGGRESSIVE BEHAVIOR IN ADOLESCENTS WITH MILD MENTAL RETARDATION

The article is devoted to the formulation of an actual problem of modern psychology, which consist of necessary realizing psychological correctional work with adolescents with a mental retardation diagnosis and aggressive behavior. Aggressive behavior manifests in negativism related with the educational process, emotional disorders. Consequently, the development and implementation of a program of corrective actions to reduce the manifestation of aggression obtain the particular relevance. The program of psychological corrections was developed in accordance with formulated purposes and appointments, psychological functional meeting the requirements of the research standards was selected. According to the conducted statistical analysis the main positions of the checklist aggression by A.Bass and A.Darki was described. The aggression index and animosity index in screening group have a high activity that correspond to expressed manifestation of aggression directed against concrete people. There is a downward trend pronounced aggression manifestation in experimental group. Significant changes in a result of verbal aggression, physical aggression and indirect aggression towards reduction of objective manifestations aggression behavior were relieved. A special practical role is acquired in realization psycho corrective program in a condition children neuropsychiatric boarding school. In the issue of psychological research was made a significant conclusion that reducing the level of aggressive manifestations program has an important efficiency in establishment of social and ethical norms in interaction with external environment

The value of computer aided detection system FOR mammography in the breast cancer screening: single-center, prospective, randomized clinical trial

Purpose. To assess the influence of mammography mapping with the help of computer-aided detection system (CAD) MammCheck II of our own design on the relapse-free survival (RFS) in breast cancer (BC) patients detected during the combined (mammographic and ultrasound [US]) screening. Materials and methods. 10732 women aged 40-87 years old (mean age: 52.20±8.63) who performed mammography were randomized to the standard screening group (mammography → US of the dense breasts) or to the group of CAD-assisted screening (mammography → CAD → targeted US of suspicious CAD markings, as well as the standard US of the dense breasts; CAD group). The primary endpoint was the 3-years RFS. Results. Totally, in the standard screening group we identified 230 BCs (4.29%), in the CAD group — 248 BCs (4.62%; p&gt;0.05), including 49 (21.20%) и 88 (35.48%) 0-I stage BCs, respectively (p&lt;0.05). Median of the primary tumor size was significantly lower in the CAD group (18 mm) compared to the standard screening group (25 mm; р&lt;0.05). 3-years RFS was significantly higher (87.90%) in the CAD group compared to the standard screening group (81.20%; р&lt;0.05). Conclusion. Breast US after the previous mammography CAD mapping significantly increases the 3-years RFS of women with combined screening-detected BC.

Atrial fibrillation screening: feasible approaches and implementation challenges across Europe

Abstract Background Atrial fibrillation (AF) screening has the potential to increase early detection and possibly reduce complications of AF. Guidelines recommend screening, but the most appropriate approaches are unknown. Purpose We aimed to explore the views of stakeholders across Europe about the opportunities and challenges of implementing four different AF screening scenarios. Method This qualitative study included 21 semi-structured interviews with healthcare professionals and regulators potentially involved in AF screening implementation in nine European countries. Data were analysed using thematic analysis. Results Three themes evolved. 1) Current approaches to screening: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity by the reach of screening programmes being limited to those who access healthcare services. 2) Feasibility of screening approaches: single time point opportunistic screening in primary care using single lead ECG devices was considered the most feasible approach and AF screening may be possible in previously unexplored settings such as dentists and podiatrists. Software algorithms may aid identification of patients suitable for screening and telehealth services have the potential to support diagnosis. However, there is a need for advocacy to encourage the use of telehealth to aid AF diagnosis, and training for screening familiarisation and troubleshooting. 3) Implementation requirements: sufficient evidence of benefit is required. National rather than pan-European screening processes must be developed due to different payment mechanisms and health service regulations. There is concern that the rapid spread of wearable devices for heart rate monitoring may increase workload due to false positives in low risk populations for AF. Data security and inclusivity for those without access to primary care or personal devices must be addressed. Conclusions There is an overall awareness of AF screening. Opportunistic screening appears to be most feasible across Europe. Challenges that need to be addressed concern health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit, and a tailored approach adapted to national realities. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020 Screening ScenariosGraphical abstract

Evaluation of Genoprotective Activity of Indigofera tinctoria using Allium cepa Root

The principle reason for the examination article is to assess the genoprotective action of the herbal source leaves extract of Indigofera tinctoria against insecticidal such as transfluthrin using Allium cepa as a biomarker. Indigofera tinctoria has the potential secondary metabolites, inorganic elements in phytochemical screening and different functional groups also. So that It possesses excellent anticancer, anti-inflammatory, anti-oxidant, antifungal, antibacterial, antitumor, anti mycobacterial, mosquitocidal, immunostimulatory properties. Normally for mutation, chemotherapy and radiation treatments are used. Here we used herbal remedy as Indigofera tinctoria against transfluthrin by using Allium cepa as a biomarker and the mitotic record and DNA discontinuity likewise determined. It contains high amount of secondary metabolites, inorganic elements and functional groups. The mitotic index remains exactly same at before and after treatment by calculating the number of roots and its length in segments like dividing and non-dividing cells. We concluded that Indigofera tinctoria repaired the mutation act against insecticidal transfluthrin. So it acts as an excellent mutant repair mechanism against insecticidal.

Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines.

There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.

The Preventive Effect of Dysphagia Screening on Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis.

(1) Background: Dysphagia is common in acute stroke patients and is a major risk factor for aspiration pneumonia. We investigated whether the early detection of dysphagia in stroke patients through screening could prevent the development of pneumonia and reduce mortality; (2) Methods: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published up to November 2021. We included studies that performed dysphagia screening in acute stroke patients and evaluated whether it could prevent pneumonia and reduce mortality rates. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions tool, and publication bias was evaluated by the funnel plot and Egger’s test; (3) Results: Of the 6593 identified studies, six studies met the inclusion criteria for analysis. The screening group had a significantly lower incidence of pneumonia than the nonscreening group did (odds ratio (OR), 0.60; 95% confidence interval (CI), 0.42 to 0.84; p = 0.003; I2, 66%). There was no significant difference in mortality rate between the two groups (OR, 0.61; 95% CI, 0.33 to 1.13; p = 0.11; I2, 93%); (4) Conclusions: Early screening for dysphagia in acute stroke patients can prevent the development of pneumonia.

Worldwide prevalence of inadequate work ability among hospital nursing personnel: A systematic review and meta-analysis.

To estimate the worldwide pooled prevalence of inadequate work ability among hospital nursing personnel using the Work Ability Index (WAI). Systematic review and meta-analysis. A systematic search was conducted on Medline/PubMed, Scopus, Web of Science, Scielo, PsychInfo, CINAHL, Nursing and Allied Health, LILACS, and Google Scholar from inception to July 2021 to identify observational studies on work ability among hospital nursing personnel using the WAI. Two researchers independently completed the study selection, quality assessments, and data extraction on the prevalence of inadequate work ability that was pooled using the random effects model. Finally, subgroup analyses were performed to explore sources of heterogeneity. A total of 42 studies were included, consisting of 24,728 subjects worldwide from 14 countries. Of these, 35 studies were included in the meta-analytical analyses. The worldwide pooled prevalence of inadequate work ability among hospital nursing personnel was 24.7% (95% CI=20.2%-29.4%). High levels of heterogeneity were detected in all studies. Prevalence was higher in studies where samples were composed of nurses and nursing assistive personnel (26.8%; 95% CI=22.4%-31.5%) than in those of nurses alone (22.2%; 95% CI=13.1%-32.9%) and in studies where the sample was over 40 (28.1%; 95% CI=19.5%-37.5%) than in those with a sample under that age (22.4%; 95% CI=15.8%-29.7%). Almost one in four members of hospital nursing staff in the world has inadequate work ability and therefore are at risk of several negative outcomes during their working life. These prevalence data correspond to the pre-pandemic period, so new studies should also be especially useful in quantifying the impact of the COVID-19 pandemic on work ability in the hospital nursing workforce. The above findings justify the launch of initiatives that include annual assessment for the early identification of inadequate work ability, offering the possibility of anticipated corrective measures. Nursing workforce older than 40years and those belonging to the professional category of nursing assistive personnel should be priority target groups for screening and intervention to improve work ability.

Determinants of Hepatitis C Virus Prevalence in People With Serious Mental Illness: A Systematic Review and Meta-Analysis.

Objective: To perform a meta-analysis of hepatitis C virus (HCV) prevalence in people with serious mental illness (SMI) and to systematically review barriers to care with the contention that both individual complications and HCV community transmission can be reduced with enhanced health care strategies.Data Sources: PubMed, Scopus, Embase, CINAHL, and Web of Science were searched for articles published in English between April 21, 1989, and July 1, 2020. The terms Hepatitis C Virus, HCV, HCV seroprevalence, and HCV prevalence were cross-referenced with serious mental illness, severe mental illness, psychiatric illness, mental illness, and psychiatric patients.Study Selection: We identified 230 titles after removing duplicates. The final analysis included 36 publications drawn from prospective and large retrospective cohort studies that cross-sectionally screened for HCV in people with SMI ≥ 18 years of age.Data Extraction: Pooled HCV prevalence was analyzed, with random effects modeling due to significant attributable study heterogeneity. Demographic data and HCV risk factors were subanalyzed. Qualitative and semiqualitative data relating to control cohort prevalence and the HCV care cascade were also extracted.Results: The pooled HCV prevalence was 8.0% (95% CI, 6.0%-9.0%). Subanalysis of prospective studies (n = 9,015 individuals) demonstrated a similar prevalence, 8.0% (CI, 5.0%-11.0%), to retrospective studies (n = 289,247), 8.0% (CI, 6.0%-10.0%). HCV was 3.0- to 11.3-fold higher in people with SMI relative to controls. Semiqualitative analysis of seropositive cases showed that (1) 20.0%-58.1% did not have an identified HCV risk factor; (2) 12.5%-100% of cases were not previously known to have HCV; and (3) the majority, 57.0%-96.6%, of people with SMI were receptive to HCV screening.Conclusions: People with SMI have high HCV seroprevalence and should be recognized as a priority group for HCV screening and health care access.

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

Prostate-specific antigen (PSA) screening for prostate cancer has resulted in a slight reduction in prostate cancer mortality but also a concomitant overdiagnosis of low-risk tumors. Prostate-specific antigen levels are affected by use of cholesterol-lowering statin drugs, but the association of statin use with PSA screening performance is unknown. To investigate whether statin use was associated with outcomes of a randomized PSA-based prostate cancer screening intervention. This post hoc subgroup analysis of a cohort from a population-based randomized clinical trial used data from the population-based Finnish Randomized Study of Prostate Cancer Screening, which randomized men to PSA screening or routine care from March 1, 1996, to December 31, 1999, with follow-up continuing until December 31, 2015. The population included all men aged 55 to 67 years at baseline and residing in the Tampere or Helsinki districts of Finland. Information on statin purchases from 1996 to 2009 was obtained from a national prescription registry. Eligible men were identified from the population registry of Finland. Prevalent prostate cancer cases at baseline were excluded. Data were analyzed from January 1, 2019 to March 31, 2021. Three invitations for PSA screening at 4-year intervals from 1996 to 2007 vs routine care. Risk for prostate cancer overall, high-risk disease, and prostate cancer mortality in the screening group vs the control group as an intention-to-treat analysis. The analysis was stratified by statin use. The study comprised 78 606 men (median age, 59 years [range, 55-67 years]) with statin purchase data available. Although PSA screening was associated with increased prostate cancer incidence among statin nonusers (screening vs control, 11.2 vs 8.6 per 1000 person-years); rate ratio [RR], 1.31; 95% CI, 1.24-1.38), no similar increase in incidence was observed among statin users (6.9 vs 5.9 per 1000 person-years; RR, 1.02; 95% CI, 0.95-1.10; P < .001 for interaction). Incidence of low-risk (Gleason score 6) and localized tumors was lower among statin users, whereas detection of tumors with a Gleason score of 8 to 10 was similar. Screening was associated with a lower incidence of metastatic tumors regardless of statin use. In this post hoc subgroup analysis of a cohort from a population-based randomized clinical trial, PSA screening among statin users was associated with a decreased incidence of advanced prostate cancer that was similar among statin nonusers, but with less increase in detection of low-grade localized tumors in statin users than in nonusers. These findings suggest that statin use does not materially compromise benefits of PSA-based screening.

Abstract 13823: Clinical Presentation Rather Than Imaging Findings Determine Outcomes in Cardiac Sarcoidosis

Background: Cardiac PET and MRI have facilitated increased diagnosis of Cardiac Sarcoidosis (CS). Varied clinical presentations such as advanced heart block, ventricular arrhythmias and heart failure (HF) are initiating this diagnostic pathway but it is unclear if prognosis is dictated by clinical presentation or imaging findings. In our quaternary care center, we conducted a retrospective review of patients diagnosed with CS by cardiac MRI/PET and examined outcomes in relation to imaging findings and clinical presentation. Methods: 223 patients underwent evaluation for suspected CS by cardiac MRI/PET between 2016-2019 and 62 were identified as having CS based on clinical and imaging criteria. We divided this cohort based on their primary clinical indication for imaging- arrhythmia, HF or screening due to history of pulmonary sarcoidosis. Outcome defined as MACE included death, ICD-shock or admission for HF. Results: Study population was predominantly male (65%), Caucasian (79%) with mean age 60±10 years, Referral diagnosis was HF in 37 (59%), arrhythmia (defined as high grade AV block/ventricular arrhythmias) in 15 (25%) and screening in 10 (16%). While there were no differences in the CMRI LGE findings or degree of inflammation by FDG-PET, there was a higher incidence of resting anteroseptal perfusion on PET, with a higher summed rest score in the arrhythmia group (mean 2 vs 0 in other groups; p&lt;0.05). Based on imaging findings, 39% were treated with steroids, 25% with immunosuppressant, 10% were on combination. Over mean follow-up of 3.5 years, there were 26 events- 6 deaths, 10 ICD shocks 10 heart failure admissions. Event-free survival was 53%, 76% and 80% in the arrhythmia, HF and screening groups respectively. In multivariable analysis, a model that included VT presentation (OR 11; p&lt;0.05) and global hypokinesis on PET images (OR 10; p&lt;0.05) had a sensitivity of 86% and specificity of 63% for MACE prediction. Compared to the model, neither Inflammation on FDG-PET or LGE (MRI) predicted outcomes and treatment with steroids and/or immunosuppressant did not alter prognosis. Conclusions: In this single center study of CS, a primary diagnosis of ventricular arrhythmia and global LV systolic dysfunction, regardless of LVEF, had the worst prognosis.

Abstract 9176: Quarterly versus Annual ECG Screening for Atrial Fibrillation in Older Chinese (AF-CATCH): A Prospective, Randomised, Controlled Trial

Introduction: Screening for atrial fibrillation before symptoms manifested and subsequent initiation of oral anticoagulants (OACs), could prevent stroke and death. The most cost-effective strategy to screen atrial fibrillation in high-risk population aged 65 and over remains unknown. Methods: We performed a randomised controlled trial that compares different screening frequencies of 30-second single-lead ECG (AliveCor® Heart Monitor) in the detection of atrial fibrillation in Chinese residents (≥65 years old) in 5 community health centres in Shanghai. Only participants without atrial fibrillation history and atrial fibrillation rhythm at baseline were eligible for inclusion in the trial. Participants were randomised in a 1:1 ratio into annual (G1) and quarterly screening (G2) groups: the quarterly screening group was further randomised in a 3:1 ratio into subgroups of quarterly screening (G2-1) and quarterly screening PLUS (G2-2, ECG weekly for 1-month then quarterly). The primary outcome was the detection rate of atrial fibrillation. The intention-to-treat analysis was performed for all randomised patients who had at least one ECG recording during follow-up. This trial was registered at ClinicalTrials.gov, number NCT02990741. Results: Between April 17, 2017, and June 26, 2018, a total of 8240 participants were randomised into G1 (n=4120), G2-1 (n=3090) and G2-2 (n=1030), with a mean of 1.6, 3.5 and 5.2 ECG records respectively during a median of 2.1 years follow-up (13,284 person-years). 73 incident cases of atrial fibrillation occurred: 26 in G1 (4.1/1000 person-years) and 47 in G2 (6.7/1000 person-years; hazard ratio with G1, 1.71; 95% confidence interval [CI] 1.06-2.76; P =0.03). 40 incident cases were detected in G2-1 (7.2/1000 person-years; hazard ratio with G1, 1.83; 95% CI 1.12-3.00; P =0.02) and 7 in G2-2 (4.8/1000 person-years; hazard ratio with G1, 1.24; 95% CI 0.54-2.86; P =0.61). No significant difference was noted between G2-1 and G2-2 (hazard ratio with G2-1, 0.68; 95% CI 0.30-1.52; P =0.35). Conclusions: Quarterly 30-second single-lead ECG screening significantly increased the detection rate of incident atrial fibrillation, additional weekly screening in the first month did not yield added predictive value.

Cost Analysis of Screening for IgA Nephropathy Using Novel Biomarkers

ObjectivesIgA nephropathy (IgAN) is the most common primary chronic glomerulonephritis and a major cause of end-stage kidney disease worldwide. Novel biomarkers, including the aberrantly glycosylated IgA1 and glycan-specific antibodies, could be useful in the diagnosis of IgAN. The aim of this study was to assess the cost analysis of IgAN screening using novel biomarkers in addition to the conventional screening compared with conventional screening alone. MethodsTo estimate the medical expense of each strategy related to renal disease for 40 years, we developed an analytical decision model. The decision tree started at “40 years of age with first-time hematuria.” It simulated 2 clinical strategies: IgAN screening using the novel biomarkers (group N) and conventional screening (group C). The analysis results were presented as medical expenses from a societal perspective. Discounting was not conducted. ResultsThe expected medical expense per person for 40 years was ¥31.2 million (~$291 000) in group N and ¥33.4 million (~$312 000) in group C; hence, expense in group N was lower by ¥2.2 million (~$21 000). In group N, the expected value of IgAN increased by 5.67% points (N 48.44%, C 42.77%) and that of dialysis introduction decreased by 0.85% points (N 19.06%, C 19.91%). In the sensitivity analysis, expenses could be reduced in almost all cases except when renal biopsy using conventional screening was performed at the rate of 73% or higher. ConclusionScreening for IgAN using novel biomarkers would reduce renal disease–related expenses.

An Economic Evaluation of Australia's Newborn Hearing Screening Program: A Within-Study Cost-Effectiveness Analysis.

Hearing loss is one of the most prevalent congenital disorders among children. Many countries have implemented universal newborn hearing screening (UNHS) for the early diagnosis and treatment of hearing loss. Despite widespread implementation, the value for money of UNHS is unclear due to lack of cost and outcomes data from rigorous study designs. The objective of this research is to conduct a within-study cost-effectiveness analysis of UNHS compared with targeted screening (targeting children with risk factors of hearing loss) from the Australian healthcare system perspective. This evaluation is the first economic evaluation to assess the cost-effectiveness of UNHS compared to targeted screening using real-world data from a natural experiment. The evaluation assumed the Australian healthcare system perspective and considered a time horizon of 5 years. Utilities were estimated using responses to the Health Utilities Index Mark III. Screening costs were estimated based on the Victorian Infant Hearing Screening Program. Ongoing costs were estimated based on administrative data, while external data sources were used to estimate costs related to hearing services. Missing data were handled using the multiple imputation method. Outcome measures included quality-adjusted life years (QALYs) and four language and communication-related outcomes: Peabody Picture Vocabulary Test, Wechsler Nonverbal Scale of Ability, Progressive Achievement Test, and comprehensive, expressive, and total language scores based on the Preschool Language Scale. On average, the UNHS cost an extra Australian dollar (A$)22,000 per diagnosed child and was associated with 0.45 more QALYs per diagnosed child compared with targeted screening to 5 years, resulting in an incremental cost-effectiveness ratio (ICER) of A$48,000 per QALY gained. The ICERs for language outcomes lay between A$3,900 (for expressive language score) and A$83,500 per one-point improvement in language score (for Wechsler Nonverbal Scale of Ability). UNHS had a 69% probability of being more cost-effective compared to targeted screening at a willingness to pay threshold of A$60,000 per QALY gained. ICERs were most sensitive to the screening costs. The evaluation demonstrated the usefulness of a within-study economic evaluation to understand the value for money of the UNHS program in the Australian context. Findings from this evaluation suggested that screening costs were the key driver of cost-effectiveness results. Most outcomes were not significantly different between UNHS and targeted screening groups. The ICER may be overestimated due to the short follow-up period. Further research is warranted to include long-term resource use and outcome data, late diagnosis, transition and remission between severity levels, and timing of diagnosis and treatment.

Long-Term Follow-up of the Italian Flexible Sigmoidoscopy Screening Trial.

Recent reports showed that the protective effect of flexible sigmoidoscopy (FS) screening was maintained up to17 years, although differences were reported by sex. To assess long-term reduction of colorectal cancer (CRC) incidence and mortality after a single FS screening. Parallel randomized controlled trial. (ISRCTN registry number: 27814061). 6 centers in Italy. Persons aged 55 to 64 years expressing interest in having FS screening if invited, recruited from 1995 to 1999 and followed until 2012 (incidence) and 2014 to 2016 (mortality). Eligible persons were randomly assigned (1:1 ratio) to either the once-only FS screening group or control (usual care) group. Incidence and mortality rate ratios (RRs) and rate differences. A total of 34272 persons (17136 in each group) were included in the analysis; 9911 participants had screening in the intervention group. Median follow-up was 15.4 years for incidence and 18.8 years for mortality. Incidence of CRC was reduced by 19% (RR, 0.81 [95% CI, 0.71 to 0.93]) in the intention-to-treat (ITT) analysis, comparing the intervention with the control group, and by 33% (RR, 0.67 [CI, 0.56 to 0.81]) in the per protocol (PP) analysis, comparing participants screened in the intervention group with the control persons. Colorectal cancer mortality was reduced by 22% (RR, 0.78 [CI, 0.61 to 0.98]) in the ITT analysis and by 39% (RR, 0.61 [CI, 0.44 to 0.84]) in the PP analysis. Incidence of CRC was statistically significantly reduced among both men and women. Colorectal cancer mortality was statistically significantly reduced among men (ITT RR, 0.73 [CI, 0.54 to 0.97]) but not among women (ITT RR, 0.90 [CI, 0.59 to 1.37]). Self-selection of volunteers from the general population sample targeted for recruitment may limit generalizability. The strong protective effect of a single FS screening for CRC incidence and mortality was maintained up to 15 and 19 years, respectively. Italian Association for Cancer Research, Italian National Research Council, Istituto Oncologico Romagnolo, Fondo "E. Tempia," University of Milan, and Local Health Unit ASL-Torino.

Screening for Coronavirus Disease 2019 (COVID-19) at the Pediatric Emergency Department During Different Pandemic Phases.

The wide spectrum of COVID-19 symptoms complicates the selection of target groups for screening. We aimed to compare data of children screened for COVID-19 at the pediatric emergency department in Vilnius between different phases throughout 1 year (Phase I: March–May, 2020; Phase II: June–September, 2020; and Phase III: October, 2020–February, 2021) and to evaluate the possible predictors of the disease. SARS-CoV-2 PCR tests were positive for 2.7% of tested children (248/9,238), significantly higher during the Phase III (5.5%) compared with the Phase I (0.6%, p = 0.000) and Phase II (0.3%, p = 0.000). Infants and teenagers (12–17 years) accounted for a larger proportion of COVID-19 patients (24.6 and 26.2%, respectively) compared to other age groups: 1–2 years (18.9%), 3–6 years (14.9%), and 7–11 years (15.3%). There were more COVID-19 cases among children with a known SARS-CoV-2 exposure compared to those who did not declare any contact (18.2 vs. 1.1%, p = 0000). When symptoms were adjusted for age, gender and known exposure to SARS-CoV-2, we found that fever (OR 2.66; 95% CI 1.89–3.81), pharyngitis (OR 1.35; 95% CI 1.01–1.80), headache (OR 1.81; 95% CI 1.09–2.90), and anosmia/ageusia (OR 6.47; 95% CI 1.61–22.47) were the most significant predictors.Conclusion: Although high numbers of testing were maintained throughout the year, the positive test results were significantly higher during the Phase III. Age (<1 year, 12–17 years), a history of exposure to SARS-CoV-2 and some symptoms, such as fever, pharyngitis, headache and anosmia/ageusia could aid in targeting groups for screening for COVID-19 in children.

Advances in Neurocardiology: Focus on Atrial Fibrillation.

Advances in Neurocardiology: Focus on Atrial Fibrillation.