Population Screening Research Articles

Multigeographic clinical assessment of a molecular diagnostic assay for detection of key codons to predict decreased susceptibility or resistance to cephalosporins in Neisseria gonorrhoeae.

Cephalosporin resistance in Neisseria gonorrhoeae has severely compromised the efficacy of World Health Organization (WHO)-recommended therapies. This study aimed to methodologically evaluate the optimized Six-CodonPlus assay, and additionally conducted a multicenter evaluation to assess its clinical application, especially for predicting antimicrobial resistance (AMR). For methodological evaluation, 397 sequence-known N. gonorrhoeae isolates were evaluated for specificity, 17 nongonococcal isolates were assessed for cross-reactivity, 159 uncultured urogenital swabs and urine samples were evaluated for sensitivity at the clinical level. For multicenter evaluation, 773 isolates with confirmed phenotypic data and 718 clinical urogenital swabs collected from four geographical cities were, respectively, utilized for the evaluation of AMR-prediction strategies and the clinical application of the assay. The assay accurately identified specific single-nucleotide polymorphisms in resistance-associated genes, the detection limits dropped to 10 copies/reaction for individual targets. The specificity reached 100% and no cross-reactivity occurred with double-target confirmation. The assay could be directly applied to clinical samples containing over 20 copies/reaction. Multicenter evaluation formulated two optimal strategies for decreased susceptibility prediction in specific scenarios, and one tactic for prediction of resistance and identification of FC428-like strains. High sensitivity of 86.84% (95% CI, 71.11-95.05) and specificity of 99.59% (95% CI, 98.71-99.89) for resistance prediction were demonstrated for ceftriaxone (CRO). Regarding N. gonorrhoeae identification among multicenter swabs, specificity reached 97.53% (95% CI, 95.49-98.69), and sensitivity reached 93.77% (95% CI, 90.04-96.22). The Six-CodonPlus assay exhibited excellent detection performance and formulated optimal AMR-related prediction strategy with regional adaptability, providing critical information for population screening and clinical treatment.

Implementation of polygenic risk scores in secondary prevention of (breast) cancer

Abstract Utilizing polygenic risk scores to inform secondary prevention of breast cancer via population screening programs is one of the pioneering applications of genomics in public health applications. Over the last decade, polygenic risk scores for breast cancer have been developed and validated in various European populations (AUC ± 0.63, OR per Z unit ± 1.6, depending on the population). In some countries, the polygenic risk score has been integrated with decision modeling tools, such as CanRisk in the Netherlands, and low-level implementation into health and care systems has started. Implementation strategies vary, but generally consider initial implementation into high-risk populations, such as breast cancer families, in specialized clinical setting, such as academic medical centres, or specialized cancer clinics, referring relatives of patients to population screening based on comprehensive risk modelling, including polygenic risk scores. This route may be followed by other disease fields as well. The presentations outlines the current evidence and considerations on breast cancer genetic risk modelling, clinical pilot studies and the outline of step-wise implementation of such models to benefit secondary prevention programs. We start from the perspective of a single hospital, to the needed steps to upscale to national populations, both in diversity of these populations, as the throughput of genetic testing and counselling, until the harmonization and recalibration of various European healthcare models. We draw from examples of the Genotyping on all patients (GOALL), building cancer health platforms (CanHeal) and Genome of Europe (GoE) consortia.

The future of screening and early detection in the Netherlands: a foresight study to support new screening policy strategies

Abstract The Dutch government provides several population screening programmes intended for early detection of diseases so that prompt treatment can be provided. These include population screenings for various forms of cancer and screenings for specific diseases in unborn and newborn children. The future provision of these screenings is influenced by various developments, including the ageing population, economic fluctuations and technological advancements. To understand these developments and their potential impacts on the future of screening and early detection, RIVM has conducted a foresight study based upon a systematic six-step approach. Important steps in this process are building a conceptual framework, identifying important developments via horizon scanning, selecting scenario logics and making scenarios in order to select important challenges and opportunities for the future. The final output of the foresight study consists of a broad horizon scan, two simple future scenarios and four societal perspectives on screening and early detection. In this foresight study, there was special attention for the role of different societal perspectives and the variation in desirable futures that these perspectives entail. These perspectives were presented to the Ministry and other important stakeholders in the future strategy planning, by playing a serious role game. The results of the foresight study and the experience of looking to the future through various perspectives forms the input for the Dutch Ministry of Health, Welfare and Sport in formulating a strategy for the future of screening and early detection and making informed decisions about potential actions. The presentation will focus on how the foresight process was done and how this has informed the Ministry of Health in order for them to follow the next steps in setting future goals and ambitions and planning for a future policy strategy.

Treated obstructive sleep apnoea and incident arrhythmias

Abstract Background Obstructive sleep apnoea (OSA) is prevalent in approximately 15% of western populations. Cardiovascular disease and arrhythmia are extremely common in this group with significant morbidity overlap. Whilst treatment of OSA with continuous positive airways pressure (CPAP) appears to reduce hypertension, bradycardia and recurrence of atrial fibrillation (AF), large randomised control trials and meta-analyses do not demonstrate a significant reduction of incident tachyarrhythmias such as atrial fibrillation or sudden cardiac death. Some smaller studies suggest that AF may have up to 20% incidence. Analysis of these studies suggest that there may be significant heterogeneity in both CPAP usage and OSA phenotype, confounding the results. Furthermore, standard arrhythmia detection often underestimates paroxysmal arrhythmias. This on-going trial investigates a treated OSA population using CPAP monitoring and implantable loop recorders (ILR). Purpose This study aims to identify the incidence of arrhythmia in a treated OSA population with comprehensive arrhythmia monitoring and CPAP usage. It also explores the mechanisms linking OSA and arrhythmia such as heart rate variability and turbulence and cardiac biomarkers in order to identify at risk sub populations. Methods Continuous moderate-to-severe OSA patients were recruited from a major UK sleep centre after ECG and medical history confirmed the absence of arrhythmia. Each patient was then randomised to receive either standard-care or standard-care with an ILR with 24-hour heart rate variability/turbulence measurements, echocardiography (where possible) and cardiac biomarkers at baseline and 12 months. All patients had remote CPAP usage monitoring (where possible). The trial ended at 36 months after enrolment. Results 200 patients were recruited to the trial. Current mean average follow-up is 28 months in this on-going trial. Mean age and apnoea hypopnea index at enrolment was 53 years and 43.8 respectively. To date we have diagnosed atrial fibrillation in 15% of the ILR group compared to 2% in the standard care group. Other arrhythmias detected in the ILR group include two with supraventricular tachycardia and 2 with significant pauses but not requiring further treatment. Final analysis of arrhythmia incidence with CPAP usage and heart rate variability/turbulence, and cardiac biomarkers is ongoing with final results due by the time of final submission. Conclusion Arrhythmias, particularly AF, are highly incident in OSA despite CPAP treatment. This study may determine if heterogenous CPAP usage confounds the above observation and whether there may be predictors of arrhythmia that may indicate a need for arrhythmia screening in the OSA population.

Referral and disease patterns of patients treated at the Nicosia General Hospital Breast Centre

Abstract Background Cyprus has one of the lowest mortality rates from breast cancer in Europe. The reasons behind this have not been investigated but it is speculated that the ease of access to Breast Centers in combination with an increased public awareness play a role. The aim of this study was to investigate referral and disease presentation patterns of patients treated at the Nicosia General Hospital (NGH) Breast Centre and define opportunities for effective public health interventions. Methods A retrospective study of all patients (585) with in situ or invasive breast cancer treated at the NGH Breast Centre between February 2017 and November 2023 was conducted. Data on referral sources, symptoms, and cancer stage at the time of diagnosis were analyzed using Stata 18. Results Most patients were referrals from the national population screening program (42.2%), followed by self-referrals (40.6%), and General Practitioner (GP)/or other specialist referrals (17.2%). Half of the patients (50.3%) were asymptomatic at diagnosis. In addition, 8% of the patients diagnosed with invasive breast cancer were Stage I, 65% Stage II, and 27% Stage III. Conclusions Our study provides important insights forming the basis of public health activities for the early detection of breast cancer based on the fact that 20% of newly diagnosed breast cancer cases in Cyprus receive treatment in NGH Breast Center. Although adherence to the national population screening program does not meet desired expectations, a significant proportion of breast cancers were detected via this program highlighting its effectiveness in early detection of asymptomatic cancers. A large proportion of patients were self-referred underlining the high degree of breast cancer awareness in Cyprus but also the media-induced anxiety which leads to early investigations. Key messages • Screening program and breast cancer awareness campaigns are effective in detecting breast cancers early. • These activities should be sustained to further reduce breast cancer mortality rate.

Prevecardio: a single-visit population screening model for detection and prevention of 10-year cardiovascular risk

Abstract Introduction Cardiovascular diseases (CVDs) are a major contributor to global mortality. The early detection of cardiovascular risk factors, coupled with timely intervention strategies, is essential for CVD prevention. PreveCardio was developed as an innovative, single-visit population screening model designed to facilitate the early identification and management of cardiovascular risk factors within a population of 1 million in a European capital city region totaling 6 million inhabitants. Purpose This study aimed to ascertain the prevalence of cardiovascular risk factors within the general population and to evaluate the effectiveness of the PreveCardio model in estimating 10-year cardiovascular risks and promoting preventive interventions. Methods In this cross-sectional prevalence study, individuals aged 50 to 75 from a health network were randomly selected and invited to participate in a comprehensive health check. The 30-minute screening consisted of lifestyle evaluations, anthropometric measurements, and blood tests for lipid profiles and glycated haemoglobin. The methodology was designed to provide participants with immediate feedback on their results, cardiovascular health and practical guidance for risk management. Results From the 8,492 individuals solicited, 3,546 took part in the screening: 56,83% were female, mean age 61,17 ± 7,33 y.o. Picture 1 shows the population's percentages with various modifiable cardiovascular risk factors, including 20% with active smoking, 30% with sedentarism, 16% with risky alcohol consumption, 49% with non-adherence to the Mediterranean diet, 40% with overweight, and 30% with obesity. The screening revealed new diagnoses of LDL-hypercholesterolemia in 47% participants, high levels of blood pressure in hypertension range in 49%, prediabetes in 30% and diabetes in 2% (Picture 2). After use SCORE2 and SCORE-OP risk prediction algorithms, PreveCardio is estimated to potentially prevent between 39 to 202 fatal and non-fatal cardiovascular events over 10 years. Predictive modelling based on PreveCardio data projected that expanding the screening across the capital region could prevent at least 26,260 cardiovascular events over 10 years. Conclusion(s) PreveCardio has established itself as a viable and effective model for the early detection of cardiovascular risk factors in a general population. It holds significant promise for public health impact by potentially reducing the incidence of CVD through comprehensive screening and proactive intervention.

The usefulness of QT interval measurement as a screening tool for cascade testing in asymptomatic patients at risk of long QT syndrome

Abstract Background Long QT syndrome (LQTS), an inherited arrhythmic syndrome, remains a public health concern with up to 3000 unexpected deaths in the US annually. A simple 12-lead ECG is the most easily accessible tool for initial screening. Purpose To describe the diagnostic utility of the standard QT correction techniques in 12-Lead ECGs, in a screening population of first-degree relatives of persons with LQTS of known genotype. Methods In this single centre study, data were included on consecutive patients undergoing cascade clinical and genetic testing for LQTS, who had a first degree relative with genotype-positive LQTS, from the years 2019 to 2022. Patient demographics, baseline ECG and genetic results were obtained. The QT interval was manually calculated between three independent readers using the tangent method and corrected using the 4 most commonly used formulae: Bazett (BQTc), Fridericia (FreQTc), Framingham (FraQTc) and Hodges (HQTc). The Mean QT was calculated by taking the average of four consecutive QT measurements in lead II or V5. The QT dispersion (QTd), was also calculated by using the formula: QTd = QT max – QT min. Results Data was available on 97 patients from 14 families. The mean age at screening was 44 years, and 51.5% were males. Two-thirds of patients were asymptomatic (n = 74, 76.3%). Fifteen patients had syncopal events. 72.2% (n = 70) of patients had a family history of arrhythmic death. After clinical screening and genotyping, 46.4% (n = 45) patients were gene positive for either KCNQ1 (75.5%) or KCNH2 (24.5%). Patients with prior syncope were more likely to be gene positive (72.7% vs 39.2%, p = 0.005). The 12-Lead ECG derived QTc result is listed in Table 1, with all correction modalities showing a higher corrected QT in the genotype-positive group (p <0.001). The diagnostic performance of BQTc was similar to that of the newer formulae (FreQTc, FraQTc and HQTc) when correcting for heart rate within the range of 60 – 100bpm as listed in Table 2. At a cut-off value of 440ms, BQTc formula had a sensitivity of 51% and a specificity of 84% for predicting genotype pathogenicity as listed in Table 3. The QT dispersion was higher in patients with KCNH2 compared to those with KCNQ1 (122msec, SD 30.5 vs 74.2 msec, SD 30.4, p value <0.001). Patients with KCNH2 were more likely to require an ICD (83.3% vs 16.7%, p <0.001). The mean Schwartz score in gene positive patient was 2.6 compared to 1.9 (p <0.003). Conclusion Formula correction of QT interval to heart rate had good overall diagnostic performance. Both FreQT and FraQT had high AUROC across different heart rates, though there was no statistically significant difference seen between correction formulae. The ECG remains a good preliminary screening tool method for identifying patients with increased risk LQTS in this population. Larger studies are needed to power for comparisons between QT correction methods.

Adherence to Pediatric Screening.

Preventive screenings in children encourage maintenance of optimal cardiovascular health, but gaps may exist between recommendations and clinical practice. We evaluated adherence to pediatric guidelines for universal age-based and risk-based screening for body mass index, blood pressure, lipids, and blood glucose. We used 2010 to 2018 ambulatory visit data from children aged 2 to 12 years within CAPRICORN (Chicago Area Patient-Centered Outcomes Research Network), an electronic health record network in Chicago. This study included 87 549 children who attended 197 559 well-child encounters. Across all encounters, children were 51.5% male and mean (SD) age 6.4 (3.3) years. For each child who attended a well-child visit and met age and/or risk-based criteria, receipt of body mass index, blood pressure, lipids, and/or hemoglobin A1c or fasting blood glucose measurements were assessed. We used generalized estimating equations to calculate proportion adherence for each metric overall and stratified by age, sex, race and ethnicity, and insurance status. Universal age-based screening prevalence (95% CI) per 100 eligible visits was 77.1 (76.8-77.3) for body mass index, 33.4 (33.1-33.7) for blood pressure, and 9.6 (9.3-9.9) for lipids. Risk-based screening prevalence (95% CI) per 100 eligible visits was 13.9 (12.2-15.9) for blood pressure, 6.9 (6.4-7.5) for lipids, and 13.3 (12.6-14.1) for blood glucose. Early screening of cardiovascular health risk factors could lead to earlier interventions, which could alter cardiovascular health trajectories across the lifetime. Low-to-moderate levels of adherence to universal age-based and risk-based cardiovascular health screening highlight the gap between recommendations and clinical practice, emphasizing the need to understand and address barriers to screening in pediatric populations.

Clinical utility of expanded carrier screening in the preconception and prenatal population: A Chinese cohort study

ObjectivesTo evaluate the clinical utility of expanded carrier screening (ECS) in Chinese preconception and prenatal populations, focusing on carrier frequency and the impact on at-risk couples (ARCs). MethodsData from 6,298 Chinese individuals from 4,420 families who underwent a 149-gene ECS panel at a single center were analyzed. The prevalence of positive carriers and ARCs was determined, with follow-up on reproductive decisions and pregnancy outcomes for ARCs. ResultsOf the individuals screened, 2,673 (42.4 %) were carriers of at least one pathogenic or likely pathogenic variant, and 98 (2.22 %) ARCs were identified. GJB2-related deafness and Duchenne muscular dystrophy were the most common autosomal recessive (AR) and X-linked disorders. Screening the top 11 (gene carrier rate [GCR] ≥ 1/100), 22 (GCR ≥ 1/200), and 41 (GCR ≥ 1/331) AR genes could identify 53.5 %, 67.9 %, and 81.3 % of variants, respectively. The corresponding ratios for identified ARCs were 90.4 %, 94.0 %, and 100 %. Follow-up data from 80 ARCs indicated that 75.0 % (60/80) took significant action based on the ECS results. Additionally, four families (3.5 %, 4/115) were identified at risk for a second disease unrelated to their initial family monogenic history. ConclusionsThis study, representing the largest cohort of a moderate-sized ECS panel test in the Chinese population, demonstrates the clinical utility of ECS in both healthy individuals and those with a family history of monogenic disorders. The data obtained provide valuable insights for developing a Chinese-specific ECS panel. Tailored approaches are critical for wider adoption and successful routine application of ECS.

Emerging concepts and success stories in type 1 diabetes research: a roadmap for a bright future.

Type 1 diabetes treatment stands at a crucial and exciting crossroad since the 2022 U.S. Food and Drug Administration (FDA) approval of teplizumab to delay disease development. In this Perspective article, we discuss four major conceptual and practical issues that emerged as key to further advance type 1 diabetes research and therapies. First, collaborative networks leveraging the synergy between the type 1 diabetes research and care community members are key to fostering innovation, know-how and translation into the clinical arena worldwide. Second, recent clinical trials in presymptomatic stage 2 and recent-onset stage 3 disease have shown the promise, and potential pitfalls, of using immunomodulatory and/or beta-cell protective agents to achieve sustained remission or prevention. Third, the increasingly appreciated heterogeneity of clinical, immunological, and metabolic phenotypes and disease trajectories is of critical importance to advance the decision-making process for tailored type 1 diabetes care and therapy. Fourth, the clinical benefits of early diagnosis of beta-cell autoimmunity warrant consideration of general population screening for islet autoantibodies, which requires further efforts to address the technical, organizational and ethical challenges inherent to a sustainable program. Efforts are underway to integrate these four concepts into the future directions of type 1 diabetes research and therapy.

Prostate Specific Antigen (PSA) testing in a general practice 2009-2019.

Prostate-specific antigen (PSA) testing is not recommended as a population screening measure for prostate cancer. PSA testing is nevertheless widespread and is associated with harm due to false-positive test results, overdiagnosis and economic costs. This study sought to document the exposure of patients to PSA testing over a decade in a general medical practice setting. Laboratory results for each year were extracted from the clinical record. A chart review was undertaken for cases of prostate cancer. We report 13,743 PSA results in 3313 men. In any year, 18% of all men and 33% of men aged over 50years had at least one PSA test. Between 4.8 and 21% of first tests exceeded age normal values depending on age. There were 113 incident cancers in the study interval of which 84 (74%) were screen detected. Mortality was lower in screen-detected than symptomatic cancers. Men at our practice are significantly exposed to PSA testing. We found evidence of possible overdiagnosis.

Results of the cancer screening program in urban areas in Shaanxi province of China, 2019-2020

Objective: Analyze the cancer screening status of the cancer screening program in urban areas in Shaanxi province in 2019-2020. Methods: The early diagnosis and early treatment project for urban cancers carried out high-risk population screening for 5 types of high-incidence malignant tumors (breast cancer, lung cancer, upper gastrointestinal cancer, liver cancer, and colorectal cancer) in urban areas. Three prefecture-level cities in Shaanxi province with a population of over 1 million (Xi'an, Baoji, and Shangluo) were selected, and 4 communities with a relatively good working foundation were selected in each city. The general population aged 45-74 years was surveyed on the principles of informed consent and voluntariness, and high-risk groups identified through the questionnaire were further subjected to free endoscopy, ultrasound, CT, and other clinical screenings. The high-risk rates, screening compliance rates, and positive detection rates of the above 5 types of malignant tumors were analyzed. Results: A total of 19 632 people completed the survey effectively, with the proportion of male participants (40.0%) lower than that of females (60.0%). A total of 10 102 high-risk groups were identified, with an initial screening high-risk rate of 51.5%, and the high-risk rates for the 5 types of cancers were 24.1% for breast cancer, 28.6% for lung cancer, 9.1% for upper gastrointestinal cancer, 4.0% for liver cancer, and 20.0% for colorectal cancer. Among the 14 960 person-time initially assessed as high-risk, 5 129 person-time received clinical screening, with a screening compliance rate of 34.3%. The number of people receiving clinical screening and the screening compliance rates for the 5 types of cancers were 1 192 (41.9%) for breast cancer, 2 081 (37.1%) for lung cancer, 574 (32.0%) for upper gastrointestinal cancer, 404 (51.3%) for liver cancer, and 878 (22.3%) for colorectal cancer, with positive detection numbers and rates of 179 (15.0%) for breast, 289 (13.9%) for lung, 9 (1.6%) for upper gastrointestinal, 14 (3.5%) for suspected liver, and 67 (7.6%) for colorectal, respectively. Conclusion: The cancer screening status of the cancer screening program in urban areas in Shaanxi province is beneficial for the detection of precancerous lesions and early cancer patients, and improving the early diagnosis and treatment rate of patients, but the public participation rate is not high, and the project management model and technical plan need to be further improved.

Influence of COVID-19 pandemic on prevalence and genotype distribution of HPV in cervical cancer screening population

BackgroundHuman Papillomavirus (HPV) DNA screening was a crucial element in the fight against cervical cancer and had been adopted in many countries, including China. However, the onset of the COVID-19 pandemic in March 2020 disrupted this program significantly.MethodsThe aim of this study is to investigate the prevalence and distribution of HPV genotypes among the population undergoing cervical cancer screening during the pandemic period. From January 2017 to December 2022, Peking Union Medical College Hospital gathered 45,496 cervical swabs from individuals undergoing cervical cancer screening. These samples were analyzed to detect fifteen high-risk HPV (HR-HPV) DNA types and a combination of two low-risk HPV (LR-HPV) types.ResultsThe study revealed an overall infection rate of 11.24% (5,114/45,496), with 11.06% (5,032/45,496) of individuals infected with HR-HPV. The number of HPV screening patients and the infection rates of HPV, HR-HPV, LR-HPV, multiple genotype HPV (M-HPV), and single genotype HPV (S-HPV) during the pandemic were lower than those observed before the pandemic. Moreover, the age group with the highest percentage of infected individuals was under 45–49 years, with HPV52, HPV58, HPV16, and HPV51 being the most prevalent genotypes. Notably, HPV66 emerged as the fifth most commonly detected genotype during the pandemic. Additionally, among the eleven age groups examined, women under 25 exhibited the highest detection rate, with HPV52 and HPV16 infection rates exceeding those observed in the pre-pandemic period.ConclusionsThe findings of this study offer significant insights for shaping HPV prevention strategies and enhancing cervical cancer screening initiatives in China following the epidemic.

Differences in setting of initial dementia diagnosis among fee-for-service Medicare beneficiaries.

Accurate and timely diagnosis of dementia is necessary to allow affected individuals to make informed decisions and access appropriate resources. When dementia goes undetected until a hospitalization or nursing home stay, this could reflect delayed diagnosis or misdiagnosis, and may reflect underlying disparities in healthcare access. In this retrospective cohort study, we used 2012-2020 Medicare claims and other administrative data to examine variation in setting of dementia diagnosis among fee-for-service Medicare beneficiaries with an initial claims-based dementia diagnosis in 2016. We used multinomial logistic regression to evaluate the association of person and geographic factors with diagnosis location, and Cox proportional hazards regression to examine 4-year survival relative to diagnosis location. Among 754,204 Medicare beneficiaries newly diagnosed with dementia in 2016, 60.3% were diagnosed in the community, 17.2% in hospitals, and 22.5% in nursing homes. Adjusted 4-year survival rates were significantly lower among those diagnosed in hospitals [-16.1 percentage points (95% CI: -17.0, -15.1)] and nursing homes [-16.8 percentage points (95% CI: -17.7, -15.9)], compared to those diagnosed in the community. Community-diagnosed beneficiaries were more often female, younger, Asian or Pacific Islander, Native American or Alaskan Native, Hispanic, had fewer baseline hospitalizations and higher homecare use, and resided in wealthier ZIP codes. Rural beneficiaries were more likely to be diagnosed in hospitals. Many older adults are diagnosed with dementia in a hospital or nursing home. These individuals have significantly lower survival than those diagnosed in the community, which may indicate diagnosis during an acute illness or care transition, or at a later disease stage, all of which are suboptimal. These results highlight the need for improved dementia screening in the general population, particularly for individuals in rural areas and communities with higher social deprivation.

Healthy Life Awareness, Blood Pressure Awareness and Insight Among Adult Individuals: A Population-Based Cross-Sectional Study.

To measure healthy life awareness, blood pressure awareness and insight levels, along with their predisposing factors among adult individuals. A population-based cross-sectional study. The population consisted of adult individuals in a rural district of a city in Türkiye. Voluntary individuals who visited the population screening, organized as the May Measurement Month activity, were invited to the study (n=290). The data were collected by a questionnaire, the Healthy Life Awareness Scale (HeLAS), and the Blood Pressure Awareness and Insight Scale (BASIS). Descriptive statistics, Pearson Correlation, and multiple linear regression were used to analyze the data. The mean scores of the HeLAS and the BASIS were 49.62±8.30 and 2.89±1.43, respectively. Income level, regular physical activity habits, and formerly being diagnosed with hypertension were positively associated with ahealthy life awareness level. Former diagnosis of hypertension, regular medication usage, and being unemployed were the significant predisposing factors of blood pressure awareness and insight level. Most adult individuals displayed a moderate level of healthy life awareness and a low level of blood pressure awareness and insight. Nurses could take on the leading role in developing healthy lifestyle habits among individuals, ensure medication treatment adherence, and prevent hypertension prevalence.

Feasibility study of opportunistic osteoporosis screening on chest CT using a multi-feature fusion DCNN model

SummaryA multi-feature fusion DCNN model for automated evaluation of lumbar vertebrae L1 on chest combined with clinical information and radiomics permits estimation of volumetric bone mineral density for evaluation of osteoporosis.PurposeTo develop a multi-feature deep learning model based on chest CT, combined with clinical information and radiomics to explore the feasibility in screening for osteoporosis based on estimation of volumetric bone mineral density.MethodsThe chest CT images of 1048 health check subjects were retrospectively collected as the master dataset, and the images of 637 subjects obtained from a different CT scanner were used for the external validation cohort. The subjects were divided into three categories according to the quantitative CT (QCT) examination, namely, normal group, osteopenia group, and osteoporosis group. Firstly, a deep learning–based segmentation model was constructed. Then, classification models were established and selected, and then, an optimal model to build bone density value prediction regression model was chosen.ResultsThe DSC value was 0.951 ± 0.030 in the testing dataset and 0.947 ± 0.060 in the external validation cohort. The multi-feature fusion model based on the lumbar 1 vertebra had the best performance in the diagnosis. The area under the curve (AUC) of diagnosing normal, osteopenia, and osteoporosis was 0.992, 0.973, and 0.989. The mean absolute errors (MAEs) of the bone density prediction regression model in the test set and external testing dataset are 8.20 mg/cm3 and 9.23 mg/cm3, respectively, and the root mean square errors (RMSEs) are 10.25 mg/cm3 and 11.91 mg/cm3, respectively. The R-squared values are 0.942 and 0.923, respectively. The Pearson correlation coefficients are 0.972 and 0.965.ConclusionThe multi-feature fusion DCNN model based on only the lumbar 1 vertebrae and clinical variables can perform bone density three-classification diagnosis and estimate volumetric bone mineral density. If confirmed in independent populations, this automated opportunistic chest CT evaluation can help clinical screening of large-sample populations to identify subjects at high risk of osteoporotic fracture.

Bridging Innovation and Education: IJMS Volume 12 Issue 3 and the 2024 World Conference on Medical Student Research (WCMSR)

The International Journal of Medical Students (IJMS) is proud to present Volume 12, Issue 3, highlighting innovative research across various medical disciplines. This issue underscores the journal's commitment to fostering medical education and advancing healthcare. Featured articles explore critical areas, including narrative medicine's role in reducing burnout, stress management among medical students, and the long-term impacts of the COVID-19 pandemic on cancer referrals and treatment decisions. Public health concerns such as antimicrobial resistance and access to syphilis screening in vulnerable populations are also examined. Additionally, this edition includes insightful reviews on pediatric allergy consultations and the utility of ultrasound in anatomical dissection courses. Case reports on rare medical conditions, reflections on global surgical electives, and personal experiences in overcoming research challenges further enrich the content. To complement this issue, the IJMS announces the 2024 World Conference on Medical Student Research (WCMSR), taking place on October 26, 2024, with participants from over 40 countries. This event promises to be a valuable platform for showcasing the best global research, fostering discussion, and inspiring the next generation of medical professionals.

CURRENT STATUS OF DIAGNOSTIC INFECTIONS CAUSED BY HELICOBACTER PYLORI

The article is devoted to the review of the latest scientific research related to methods of diagnosis of infections caused by Helicobacter pylori (H. pylori) bacteria. Based on the review of research in the field of diagnosis of infections caused by Helicobacter pylori, modern approaches used in global medical practice were analysed. In modern times, diagnosing H. pylori is a significant problem given the variety of methods and their effectiveness, and there is no single universal approach for detecting this pathogenic bacterium. Infection caused by the bacterium Helicobacter pylori is one of the world's most common stomach and intestinal infections. More than half of the world's population is infected with this bacterium, which often leads to severe diseases such as stomach and duodenal ulcers, as well as stomach cancer. Modern medicine develops every day, providing new methods of diagnosis and treatment. Significant scientific and technological changes are taking place in Helicobacter pylori diagnostics, which open up new perspectives and opportunities. One of the leading prospects is the search for more accurate, fast and convenient diagnostic methods that would be less invasive and more accessible to patients. The development of molecular and genetic methods, in particular polymerase chain reaction (PCR), opens up opportunities for accurate and rapid detection of H. pylori and the determination of its virulent properties. Another perspective is the development of accurate biomarkers and prognostic methods that will predict the risk of developing complications due to H. pylori infection. This will help plan and individualise treatment strategies for patients with this infection. The search for new drugs to eradicate H. pylori is also a critical prospect, especially considering the growing problem of antibiotic resistance. The article compares invasive and non-invasive methods of disease research, highlighting their advantages and limitations. Therefore, leading scientists and practitioners in the field of gastroenterology are recommended to use two or more methods, in particular, to combine invasive and non-invasive approaches, to use a serological method for population screening, to control and eradicate H. pylori mainly by non-invasive methods, using PCR as the most accurate method for diagnosing H. pylori, as well as to determine the molecular and genetic characteristics of the microorganism and assess its virulence to form an idea of the further course and prognosis of the disease. The purpose of the work is to systematically review modern methods of diagnosing infections caused by the bacterium Helicobacter pylori (H. pylori) to evaluate their effectiveness, advantages and limitations. An overview of the state of the art in diagnosing Helicobacter pylori infections is presented, focusing on the various detection methods, their advantages and disadvantages, and their role in the course of the disease and the treatment of this infection. A variety of diagnostic methods are reviewed, including both invasive and non-invasive approaches, including endoscopy, histology, urea breath test (UBT), polymerase chain reaction (PCR)-based methods, next-generation sequencing (NGS), biosensors, and MALDI-TOF MS . The advantages and limitations of each of the methods, as well as their effectiveness in the diagnosis of H. pylori infections, are discussed. Studies have shown the importance of developing new approaches and their application in practice to improve the diagnosis and treatment of this infection.

BREATH TEST TO DETECT WOMEN AT LOW RISK FOR BREAST CANCER: POTENTIAL CLINICAL AND ECONOMIC BENEFITS.

A breath test for volatile organic compounds has identified biomarkers associated with breast cancer. We evaluated the potential clinical and economic benefits of a breath test to detect women at low risk for breast cancer by comparing its negative predictive value (NPV) to the NPV of screening mammography. Sensitivity and specificity values for screening mammography were obtained from the Food & Drug Administration Mammography Quality Standards Act; Amendments to Part 900 Regulations Docket No. FDA-2013-N-0134. The high values were sensitivity = 79.0%, specificity = 88.9% and the low values were sensitivity = 66.0%, specificity = 88.9%. In two previous studies of 771 women undergoing mammography, breath testing identified breast cancer with sensitivity=84% and specificity = 68.6% in 178 asymptomatic women, and sensitivity=82% and specificity = 77% in 593 who were symptomatic. These values were projected to a hypothetical screening population of 100,000 asymptomatic women with average breast cancer prevalence of 450/100,000, in order to estimate the NPV and PPV (positive predictive value) for breath testing and screening mammography respectively. Breath test in asymptomatic women: NPV = 99.895% and PPV = 1.19%; in symptomatic women: NPV = 99.895% and PPV = 1.59%. For screening mammography, NPV = 99.83% and PPV = 2.82% (low values), increasing to NPV= 99.89% and PPV = 3.12% (high values). A negative breath test identified 68.3% of the screening population as having low risk of breast cancer, with NPV similar to mammography. Based on Medicare reimbursement rates, elimination of mammography in women with a negative breath test could reduce the annual cost of breast cancer screening by 38.9. In a hypothetical screening population, a negative breath test ruled out breast cancer with the same accuracy as a negative mammogram. A screening breath test could potentially eliminate the need for two thirds of all mammograms and reduce the costs of screening without increasing the risk of false-negative findings. If applied in clinical practice, this approach could potentially reduce the costs and burdens of breast cancer screening services, and benefit women by lessening the discomfort, anxiety, radiation exposure, and costs associated with mammography.

Effectiveness of Risk-Adapted Upper Gastrointestinal Cancer Screening in China: Prospective Cohort Study.

Previous studies have proved the effectiveness of endoscopic screening in rural areas; however, long-term, high-quality evidence regarding the effectiveness of risk-adapted upper gastrointestinal cancer (UGC) sequential screening strategies in resource-rich regions is currently lacking. The objectives were to validate the effectiveness of risk-adapted sequential screening strategies in UGC prevention and control and assess the potential of sequential screening to lower mortality rates. Based on the Cancer Screening Program in Urban China, a prospective, large-scale cohort study based on population was conducted to recruit individuals from 4 cities in China from 2013-2019. Those identified as having a high risk of UGC according to a validated risk-score model were advised to undergo endoscopy tests. Follow-up outcomes were tracked until June 2021. Incidence of UGC, UGC-related mortality, and all-cause mortality were evaluated between the screened and nonscreened cohorts. The study included 153,079 participants at baseline. In total, 113,916 (74.42%) of the participants were designated as low risk of UGC. The remaining 39,163 (25.68%) participants were deemed to be at high risk of UGC and were offered gastroscopy tests. Among the high-risk participants, 9627 (compliance rate 24.6%) adhered to the gastroscopy tests. Over a median follow-up of 6.05 (IQR 3.06-7.06) years, 622 UGC cases, 180 UGC deaths, and 1958 all-cause death cases were traced. The screened cohort exhibited the highest cumulative incidence of UGC (119.2 per 100,000 person-years), followed by the nonscreened and low-risk cohorts. Obvious reductions in both all-cause mortality and UGC mortality were observed between those who undertook screening (153.7 and 4.7 per 100,000 person-years, respectively) and the nonscreened group (245.3 and 27 per 100,000 person-years, respectively). The screening population showed a significant 36% and 82% reduction in both all-cause mortality (hazard ratio [HR] 0.64, 95% CI 0.49-0.83, P<.001) and UGC mortality (HR 0.18, 95% CI 0.04-0.74, P=.02), respectively, compared to the nonscreened group. Reductions of 35% in all-cause mortality (HR 0.65, 95% CI 0.49-0.86, P=.003) and 81% in UGC mortality (HR 0.19, 95% CI 0.05-0.80, P=.02) were observed in participants aged older than 55 years in the screened group compared to the nonscreened group. The reductions in all-cause mortality and UGC mortality were statistically significant in males (all-cause mortality: HR 0.64, 95% CI 0.47-0.88, P=.005; UGC mortality: HR 0.10, 95% CI 0.01-0.72, P=.02), but significant reductions were not observed in females (all P values were >.05). Our study suggests the significance of one-off risk-adapted UGC screening in reducing both all-cause mortality and UGC mortality, particularly among high-risk individuals, indicating its effectiveness in UGC prevention and management.