Screening Test Research Articles

Performance of a blood-based test for colorectal cancer screening adjusted to the US census age and sex distribution.

18 Background: Despite availability of various screening options, nearly 40% of eligible U.S. adults were not up to date with the colorectal cancer (CRC) screening. Blood-based testing offers a promising complementary approach and may enhance patient adherence among unscreened individuals. In the PREEMPT CRC study, we evaluated clinical performance of an investigational blood-based screening test for detecting molecular signals of advanced colorectal neoplasia (ACN) in an average-risk population. Freenome blood-based CRC screening test met all primary endpoints demonstrating 79.2% sensitivity for CRC, 91.5% specificity for ACN, 90.8% negative predictive value (NPV) for ACN and 15.5% positive predictive value (PPV) for ACN. Sensitivity for advanced precancerous lesions (APLs) was 12.5%. To evaluate how the test would perform in the standard U.S. population, an analysis of test performance weighted to the U.S. census sex and age distribution was prespecified and performed. Methods: Between May 2020 and April 2022, the study enrolled participants aged 45-85 at average risk for CRC. Enrolled participants had a blood drawn before the bowel preparation for the standard of care screening colonoscopy (CS). CS and applicable histopathology reports underwent central pathologist review. Blood samples were processed blind to clinical findings. Primary endpoints included sensitivity for CRC, specificity for ACN, NPV for ACN and PPV for ACN. A secondary endpoint was sensitivity for APLs. Results: A subset of 32,731 sequentially enrolled participants were included in the clinical validation cohort. Out of those, 27,010 (82.5%) had evaluable blood samples and CS. The median age of the evaluable participants was 57.0 years, and 55.8% were women versus 50.5% in the U.S. Census. Age distribution included 11.0% participants in the 45-49 age group versus 15.3% in the U.S. Census, 33.0% in the 50-54 age group versus 15.6%, and 32.3% in the 55-64 age group versus 32.3%, 20.8% in the 65-74 age group versus 24.3%, 3.0% participants aged 75 or older versus 12.5%. After performance was weighted to match U.S. Census sex and age distributions, sensitivity for CRC was 81.1% (95% CI 71.3%-88.1%), specificity for those without ACN was 90.4% (95% CI 90.0%-90.7%), NPV for those without ACN was 90.5% (95% CI 90.5%-90.7%), and PPV for ACN was 15.5% (95% CI 13.8%-16.2%). Sensitivity for APL was 13.7% (95% CI 12.4%-15.0%). Conclusions: PREEMPT CRC is the largest study evaluating a CRC screening blood-based test to date. The study successfully met all primary endpoints, demonstrating acceptable clinical performance of the investigational blood-based test. The U.S. census sex-age adjusted clinical performance estimates showed improvement in CRC and APL sensitivity. This blood-based test may provide a convenient and effective option for CRC screening in the average-risk U.S. population. Clinical trial information: NCT04369053 .

Impact of COVID-19 on colorectal cancer screening using Medicare Centers for Medicare and Medicaid Services (CMS) claims data.

91 Background: When COVID-19 pandemic started in 2020 in the US, the Centers for Medicare and Medicaid Services (CMS) recommended that all non-urgent procedures, including screening colonoscopies, be delayed until pandemic stabilization. This was done to prevent the spread of the virus via colonoscopy since the presence of the virus in fecal samples has been reported in infected patients. Little is known of the impact of COVID-19 on the number of colorectal cancer (CRC) screening performed in the US. Methods: We utilized the Centers for Medicare & Medicaid Services Database which provides Medicare claims data for 2013-2022. We searched “Medicare Physician & Other Practitioners - by Geography and Service” using CPT code for colonoscopy(G0121, G0105), fecal occult blood test (FOBT; G0328, 82270), stool-based gene analysis (81528), sigmoidoscopy (G0104), and barium enema (G0120) and collected the number of CRC screening claims at national level and calculated the year-over-year (YOY) change. Results: The number of CRC screening claims in the US from 2013 to 2022 is listed (Table). The total number of CRC screening claims increased an average of 0.5% YOY from 2014 to 2019 then decreased 23.4% in 2020. From 2014 to 2019, the average YOY change in colonoscopy, FOBT, stool-based gene analysis, sigmoidoscopy, and barium enema claims were -0.5%, -6.0%, 58.7%, 8.1%, and -6.0%, respectively whereas in 2020, the rates were -27.5%, -25.0%, -14.4%, -25.3%, and -1.7%, respectively. The total number of CRC screening claims in year 2021 and 2022 increased from 2020, however, was still lower than 2019. Conclusions: CRC screening claims decreased in the US in 2020 likely due to COVID-19 and not yet returned to pre-pandemic levels. Number of CRC screening claims in the US from 2013 to 2022. Screening test 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Colonoscopy 759,883 736,400 743,873 765,974 767,063 755,806 736,247 533,972 685,439 707,672 FOBT 1,307,054 1,263,602 1,161,214 1,130,130 1,085,777 996,016 897,993 673,614 646,550 556,950 Stool-Based Gene analysis 123,748 231,765 335,459 482,761 413,224 497,748 536,348 Sigmoidoscopy 2,666 2,316 3,254 3,390 3,835 3,784 3,975 2,968 3,893 3,680 Barium enema 107 93 80 116 128 97 58 57 44 65 Total CRC screening 2,069,710 2,002,411 1,908,421 2,023,358 2,088,568 2,091,162 2,121,034 1,623,835 1,833,674 1,804,715 Data are expressed in numbers (N). CRC; colorectal cancer; FOBT; fecal occult blood test.

Colorectal Cancer Screening Participation and Health Belief Levels of Public Hospital Patients in Türkiye.

Colorectal cancer can be diagnosed early with screening tests; therefore, patients' beliefs regarding colorectal cancer screening are closely related to clinical and pathological disease stages at the time of diagnosis. This study aimed to determine participation in colorectal cancer screening programs and health beliefs related to protection from colorectal cancer among patients aged 40-70years and evaluate factors affecting their participation in such screening programs. This descriptive study was conducted in a state hospital in Türkiye between May 2021 and December 2021 with the participation of 1,016 patients. Study data were collected through face-to-face interviews using a questionnaire consisting of an "Introductory Information Form" and the "Health Belief Model Scale for Prevention of Colorectal Cancer." Signed voluntary consent was obtained from all participants, as well as ethics committee approval and institutional permission from the hospital. The mean age of the participants was 50.12±9.29years, 54% were 40-50years old, 55.5% were female, 87.3% were married, 6.8% had a primary education or below, and 39.3% were employed. The internal consistency was low for the health motivation subscale and relatively high for other subscales of the Health Belief Model Scale for Prevention of Colorectal Cancer.

Cervical screening with self-sampling for postmenopausal women with molecular triage using extended genotyping and methylation.

With the transition from cytology to human papilloma virus (HPV) testing in cervical cancer screening, it is possible to use self-sampling instead of professionally collected samples. Most studies have included women between 20 and 60years age. Here we aimed to study postmenopausal women and investigate whether vaginal self-sampling is equally effective as professional sampling for detection of HSIL and the possibility to use a method for molecular triage directly on the screening sample. Postmenopausal women in Örebro county, Sweden, were invited (n=7835) during 2018-2020 to participate in the study including both professional and self-sampling. In total 2258 women returned both sample types, that were analyzed for HPV followed by triage for cytology, HPV genotyping and methylation and clinical follow-up according to national guidelines. The prevalence of HPV was 3.4% in the professionally collected samples and 12.6% in the self-collected. All women with high-grade squamous intraepithelial lesion (HSIL) were HPV-positive in both professionally and self-collected samples. For self-collected samples, we compared different triage strategies. Cytology was the most efficient strategy. Among the molecular triage methods, the combination of methylation and genotyping was most efficient but resulted in twice as many colposcopy referrals as cytology. In conclusion, HPV self-sampling with molecular triage detects HSIL to the same extent as professional screening with cytological triage. The specificity of molecular triage is, however, unacceptably low, and to avoid overtreatment other triage methods following primary self-sampling need to be developed.

Multi-target stool-DNA test for colorectal cancer screening and effects on health and economic outcomes compared to blood-based tests: Influence of adherence.

88 Background: There are an estimated 60 million individuals in the US who are not up-to-date with average-risk colorectal cancer (CRC) screening, as screening rates and adherence have remained stubbornly below the national target of 80%. Efforts are ongoing to improve CRC screening performance and participation, including the development of new blood-based tests. Despite high expectations for these tests, performance remains lower than other guideline-recommended strategies, particularly with respect to advanced precancerous lesion (APL) sensitivity. We conducted a simulation study of estimated clinical and economical outcomes for CRC screening with a blood-based test (at perfect adherence) compared to the multi-target stool-DNA (mt-sDNA) test (at published adherence rates). Methods: Utilizing CRC-AIM, a calibrated and validated microsimulation model, CRC screening outcomes were calculated for 1 million average-risk individuals screened between ages 45-75 years with triennial blood-based versus mt-sDNA testing. CRC and APL sensitivity and specificity inputs were derived from two large clinical validation studies for these screening modalities: ECLIPSE (NCT04136002) and DeeP-C (NCT01397747), respectively. To demonstrate the maximum benefits and burdens of blood-based screening, adherence to initial screening and follow-up colonoscopy after a positive blood test was modeled at 100%, while real-world adherence estimates of 65.6% were used for the mt-sDNA test. Outcomes of interest included life years-gained (LYG) and CRC cases missed by the blood-based test compared to the stool-based test, additional treatment costs imposed by theblood-based test, and additional CRC-related deaths per 1 million screened. Results: Compared to triennial screening with mt-sDNA at real-world adherence, blood-based screening at perfect adherence resulted in a higher number of incident (n=18,464) and fatal (n=6,483) CRC cases that would been avoided with the mt-sDNA test. Over a lifetime, screening with blood-based tests required 1,276,310 more tests (21% more) and 52,942 additional follow-up colonoscopies (7% more) compared to mt-sDNA screening. This increased testing burden did not generate additional benefits and instead reduced life-years gained by 67,645 per 1 million screened, resulting in an additional $1.6 billion in treatment costs compared to the mt-sDNA strategy. Conclusions: Data from this CRC-AIM modeling study show that even with perfect adherence, blood-based screening yields inferior clinical and economic benefits compared to mt-sDNA screening, due to suboptimal APL detection with the former test.

Evaluation of stability and potential interference on alpha-thalassaemia early eluting peak and immunochromatographic strip test for alpha thalassaemia screening

Evaluation of stability and potential interference on alpha-thalassaemia early eluting peak and immunochromatographic strip test for alpha thalassaemia screening

Cost-effectiveness of blood-based colorectal cancer screening: A simulation model incorporating real-world longitudinal adherence.

93 Background: Colorectal cancer (CRC) is a predominant cause of cancer-related mortality worldwide. Regular screening improves outcomes. However, despite there being many U.S. Preventive Services Task Force (USPSTF) recommended CRC screening options, many people elect not to use any of them. Most cost-effectiveness models assume perfect (100%) adherence initially and over time (longitudinally), which is implausible as approximately one-third of eligible individuals are not up to date with CRC screening. Our study evaluates the cost-effectiveness of Shield, an FDA-approved blood-based CRC test, while incorporating real-world adherence. Methods: The CAN-SCREEN (Colorectal cANcer SCReening Economics and adherENce) model is a validated, discrete-event simulation model designed to evaluate the clinical and economic outcomes of CRC screening strategies under real-world adherence scenarios. We simulated individual lifetime outcomes for a cohort of 10,000 people beginning screening at age 45, running 4,000 trials per cohort. We conducted a cost-effectiveness analysis using the CAN-SCREEN model, and compared the Shield blood-based test administered every three years to no screening. Costs were calculated from a healthcare perspective and adjusted to 2023 US dollars. Shield was considered cost-effective if the incremental cost-effectiveness ratio (ICER) was below $100,000 per quality-adjusted life-year (QALY) gained. The analysis also assessed the maximum price Shield could maintain while remaining cost-effective. Results: Compared to no screening, Shield increased the number of QALYs by 154 per 1,000 individuals and raised costs by $7.5 million per 1,000 individuals at its commercial test cost. With an incremental cost of $48,662 per QALY gained, Shield was found to be cost-effective relative to no screening at $100,000 cost per QALY willingness-to-pay threshold. Furthermore, the unit cost of Shield can be as high as $3,241 and $4,942 to be considered cost-effective at $100,000 and $150,000 per QALY gained, respectively. Conclusions: This study used the CAN-SCREEN model to compare Shield, an FDA-approved blood-based CRC screening test, against no screening, finding that Shield is cost-effective. With about one-third of the U.S. population not up to date on CRC screening, Shield's noninvasive approach offers a promising, cost-effective solution to increase adherence and reduce CRC mortality. Economic outcomes of Shield against no screening using CAN-SCREEN model. Intervention Test Unit Cost QALYs/Person Cost ($)/Person Cost ($)/QALY Gained vs No screening No Intervention - 15.269 $6,312.18 - Shield $1,495 15.423 $13,786.72 $48,662 Shield $3,241 15.423 $21,672.34 $100,000.00 Shield $4,942 15.423 $29,352.42 $150,000.00

The presenting symptoms of patients with appendiceal malignant tumors.

824 Background: Timely detection of appendiceal malignant tumors is a clinical priority because of the propensity for this malignancy to metastasize to the peritoneal cavity. Up to one in every 2 patients with this rare tumor type will present with distant metastatic disease, owing to there being no standardized screening tests for early detection of primary appendiceal cancers. Case reports have pointed to broad/non-specific symptoms of patients diagnosed with appendiceal malignant tumors, yet information is needed from large cohorts to support prompt/accurate clinical diagnoses. Methods: We analyzed data from patients with a pathologically-confirmed first primary appendiceal malignant tumor (AC) who prospectively enrolled in the nation-wide Genetics of Appendix Cancer [GAP] clinical cohort study (Clinicaltrials.gov, NCT05734430) between November 2022 and May 2024. The primary outcome was presenting symptoms that led to AC diagnosis. Symptom effects and interactions with diagnosis age/year, sex, body mass index (BMI), and tumor histology, were quantified with negative binomial regression models and presented as incidence rate ratios (IRRs) and 95% confidence intervals. Results: Of the 352 patients included in our analyses (median [IQR] age, 51.0 [42-59] yr), 77.6% were female and 96.6% had an adenocarcinoma histology. Seventy-seven percent of patients (n=270) reported one or more presenting symptoms, of whom 55.2% (n=149) experienced these symptoms for 3+ months prior to diagnosis. On average, patients reported 3 symptoms (mean: 2.9, SD 3.0). The most prevalent symptoms among males and females were abdominal pain (57.1%), bloating/distension (32.1%), pelvic pain (18.5%), and abdominal/pelvic mass (18.2%). Overall, patients with early-onset AC [age<50] more commonly presented with symptoms versus cases with late-onset AC (82.9% vs 71.7%, p =0.01). This finding persisted in adjusted models—the number of symptoms was highest among younger patients, rapidly decreased and plateaued around age 50 (IRR 0.97, 95%CI 0.95-0.99, p =0.002), and slowly increased again with older age (IRR 1.03, 95%CI 1.00-1.05, p =0.037). Patient sex was also significantly associated with symptom number, as males had a lower rate of symptoms versus females (IRR 0.63, 95%CI 0.48-0.83, p =0.001). In contrast, histology (IRR 1.03, 95%CI 0.53-2.02), diagnosis year (IRR 1.01, 95%CI 0.99-1.04, p =0.35) and BMI (IRR 1.01, 95%CI 0.99-1.02) were not associated with symptom number in adjusted models. Conclusions: In a large nation-wide cohort, three of every 4 patients were symptomatic prior to primary AC diagnosis. Compared to the rapid time course of acute appendicitis, over 40% of this population presented with symptoms for 3+ months prior to AC diagnosis. The higher symptom burden among young patients and females supports the need for clinical providers to keep occult appendiceal tumors in the differential diagnosis of patients presenting in this manner.

Development and validation of high-performance thin layer chromatographic screening test for the determination of Rhodamine B in snacks, cosmetics and festive and ceremonial colours

Development and validation of high-performance thin layer chromatographic screening test for the determination of Rhodamine B in snacks, cosmetics and festive and ceremonial colours

Accuracy of Alternative PHQ-9 Scoring Algorithms to Screen for Depression in People Living With HIV in Sub-Saharan Africa.

Screening for depression remains a priority for people living with HIV (PLWH) accessing care. The 9-item Patient Health Questionnaire (PHQ-9) is a widely used depression screening tool, but has limited accuracy when applied across various cultural contexts. We aimed to evaluate the performance of alternative PHQ-9 scoring algorithms in sub-Saharan African PLWH. Five HIV programs in Cameroon, Côte d'Ivoire, Kenya, Senegal, and the Republic of Congo. Adult PLWH were screened for depression during the 2018-2022 period. Diagnosis confirmation was done by psychiatrist blinded clinical evaluation (gold standard). Diagnostic performances, including sensitivity and area under the curve (AUC) of the traditional PHQ-9 scoring (positive screening - score ≥ 10), were compared to alternative scoring algorithms including (1) the presence of ≥1 mood symptom (PHQ-9 items 1 and 2) combined with ≥2 other symptoms listed in the PHQ-9, and (2) a simplified recoding of each 4-response item into 2 categories (absence/presence). A total of 735 participants were included [54% women, median age 42 years (interquartile range 34-50)]. Depression was diagnosed by a psychiatrist in 95 (13%) participants. Alternative scoring sensitivities (0.59-0.74) were higher than that of the traditional score's (0.39). Compared to traditional scoring, AUC was significantly higher for PHQ-9 alternative scoring. Across settings, alternative scoring algorithms increased sensitivity and reduced variability. As a primary screening test, new scoring algorithms seemed to improve the PHQ-9 sensitivity in identifying depression and reducing heterogeneity across settings. This alternative might be considered to identify PLWH in need of referral for further diagnostic evaluations.

Shifting the paradigm: Early identification of colorectal cancer with C the Signs clinical decision support.

54 Background: The incidence of colorectal cancer is increasing rapidly, particularly amongst younger people. Despite a screening program being widely available, most patients are diagnosed with cancer through symptomatic presentation. Leveraging electronic medical records (EMRs) through clinical decision support platforms offers potential for identifying high-risk individuals before clinical suspicion develops. This study aims to explore the challenges associated with early colorectal cancer diagnosis and evaluate the effectiveness of the cancer case finding feature of a cancer management platform called C the Signs. Methods: A retrospective analysis was conducted using data from the Mayo Data Platform, comprising records of 894,275 patients, including 7,348 diagnosed with colorectal cancer. C the Signs was employed to identify patients at risk of colorectal cancer based on EMR data. Sensitivity and specificity analyses were performed to assess the platform's performance in identifying high-risk patients. Additionally, the study evaluated the temporal discrepancy in colorectal cancer diagnoses between those flagged by C the Signs and those detected by primary care physicians. Results: The C the Signs screening platform had a sensitivity of 93.8% and a specificity of 19.7% in identifying patients at risk of colorectal cancer. Notably, 29.4% of patients with colorectal cancer were identified as being at risk up to 5 years earlier by C the Signs compared to diagnoses made by primary care physicians, highlighting the platform's potential for early detection. Conclusions: Early identification of high-risk individuals holds promise for improving patient outcomes and reducing the burden of colorectal cancer. Whilst the specificity of the C the Signs platform for colorectal cancer is relatively low, the sensitivity is comparable to the most favorable rates reported for colonoscopy. In addition, if C the Signs was used in conjunction with a relatively cheap screening test such as Faecal Immunochemical Testing, this would significantly drive up the specificity whilst maintaining the sensitivity. Further studies are needed to assess its efficacy in conjunction with tests available in primary care.

Associations between non-verbal cognitive assessment and stroke recovery via screening test for aphasia and dysarthria

Associations between non-verbal cognitive assessment and stroke recovery via screening test for aphasia and dysarthria

Psychometric Properties of the Persian Version of PID5BF + M in Iranian Drug Users.

This study aimed to adapt and evaluate the psychometric properties of the PID5BF + M as a brief measure for assessing DSM-5 and ICD-11 personality disorder traits in Iranian drug users. The sample consisted of 380 participants, including both clinical (28.68%) and nonclinical (71.32%) groups, with 43.7% female participants. All participants completed the Personality Inventory for DSM-5 and ICD-11 Brief Form-Modified (PID5BF + M), the Symptom Checklist-25 (SCL-25), the Brief Five-Factor Inventory (BFI-10), the Level of Personality Functioning Scale-Brief Form (LPFS-BF 2.0), and the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). The findings revealed that the PID5BF + M demonstrates strong psychometric properties, with a six-factor structure that is culturally appropriate for the Iranian population. Significant associations were found between the ICD-11/DSM-5 traits and both internalizing and externalizing symptoms, as well as with normal personality factors. The PID5BF + M appears to be a valid and reliable tool for assessing DSM-5 and ICD-11 personality disorder traits in Iranian drug users, showing promising potential for use in clinical and research settings within this cultural context.

Performance of a blood-based screening test for the early detection of colorectal cancer.

232 Background: While the clinical benefit of highly sensitive screening tools for colorectal cancer (CRC) has been established, adherence rates remain low. The convenience and familiarity of blood-based testing may reduce disease burden through greater access and compliance to regular and recommended asymptomatic screening. We report on preliminary findings from a minimally invasive blood-based early cancer detection (ECD) screening test for CRC. Methods: Plasma samples from healthy individuals and CRC patients sourced from biobanks were included. A targeted panel composed of differentially methylated genomic regions was developed. Using an independent cohort of plasma samples, a machine-learning model was trained to classify patient samples into cancer-free and CRC based on observed differential methylation patterns in circulating cell-free DNA (cfDNA). The assay performance was calculated based on concordance with clinical diagnosis (CRC, cancer-free). Results: The test set included 440 individuals: 127 with a confirmed CRC diagnosis (47% stage I/II, mean age 65±12 years, male 46%) and 313 without cancer (mean age 56±10 years, male 41%). Overall sensitivity was 95% (95% CI: 88-100%), and specificity was 91% (95% CI: 84-98%). Among patients with stage I disease, sensitivity was 92% overall, and 88% in screen-detected individuals. Sensitivity was 100% (n=14/14) in microsatellite-high tumors and 95% (n=107/113) in microsatellite-stable tumors. Multivariate analysis demonstrated associations between methylation signal and tumor size, cancer stage, and sex. Compared with a tumor-informed, variant-based circulating tumor DNA (ctDNA) test (Signatera), we observed a PPA (positive percent agreement) of 100%. Moreover, the differentially methylated allele fraction (DMAF) across target regions strongly correlated with variant allele frequencies (VAFs) from the tumor-informed test (Spearman’s correlation coefficient, 0.85). Conclusions: Using epigenetic markers specific for CRC, we developed a sensitive and specific blood-based test to detect cfDNA from early-stage and asymptomatic disease. The methylation signal strongly correlated with ctDNA VAFs from a clinically validated tumor-informed test and increased with cancer stage and disease burden. This test could serve as a means to increase patient adherence rates for CRC screening, thereby improving patient outcomes.

Ptosis in human immunodeficiency virus-infected patients under long-term antiretroviral treatment.

To present cases of ptosis in HIV-1 patients on long-term antiretroviral therapy (ART) and review the existing literature. Five HIV-1-positive patients with slowly progressive bilateral ptosis underwent a comprehensive diagnostic evaluation, including imaging studies, neurophysiological testing, muscle biopsy, and genetic analysis. A literature review was conducted. On clinical examination, all patients presented with bilateral symmetrical non-fatigable ptosis, three exhibited facial lipoatrophy and two also had mild multidirectional ophthalmoparesis and all had ocular abnormalities in Hess screen test. Additionally, one patient displayed proptosis, three had floppy lower eyelids, and four presented with exotropia. Anti-acetylcholine receptor antibodies were negative in all patients. Brain magnetic resonance imaging (MRI), motor unit potential analysis, and single-fiber electromyography were unremarkable. Orbital MRI revealed introrbital fat expansion in one patient, and limb muscle biopsies were inconclusive in two cases. Blood genetic testing for chronic progressive external ophthalmoplegia was negative in all patients. A total of 30 similar cases have been documented in the literature, with some studies reporting key findings such as muscle histology indicative of mitochondrial myopathy, MRI revealing patchy extraocular muscle hyperintensity, and muscle genetic testing identifying mitochondrial deoxyribonucleic acid (DNA) deletions. Ptosis surgical repair appears to be the most effective treatment. HIV patients on long-term ART may develop ocular muscle involvement due to mitochondrial dysfunction, with bilateral ptosis being the primary manifestation. Diagnosis is challenging and requires the exclusion of other conditions. Ptosis surgery can significantly improve quality of life.

The Turkish validity and reliability of Addenbrooke's Cognitive Examination III.

Addenbrooke's Cognitive Examination III (ACE-III) was developed as a screening tool for cognitive disorders. Many countries have proven the cultural adaptation, reliability and validity of ACE-III. To make cultural adaptations of ACE-III for the Turkish population and to examine its validity and reliability. First, ACE-III was translated and adapted into Turkish (ACE-III-TR), then its validity and reliability were examined. The study included 234 people: 93 with dementia (78 Alzheimer's disease (AD) and 15 frontotemporal dementia (FTD)), 46 with mild cognitive impairment (MCI) and 95 healthy. Two blinded speech and language therapists rated the ACE-III-TR simultaneously for interrater validity. The same practitioner retested the same participants 2 weeks later for test-retest reliability. The construct validity of the culturally adapted test was assessed by analysing subsection correlations with the ACE-III-TR total score. The association between the Mini-Mental State Examination (MMSE) total score, relevant subsections and ACE-III-TR total score was examined for criterion validity. Intergroup differences for healthy, MCI and dementia were studied for ACE-III-TR subsections and total score, and cut-off scores were calculated for total score with sensitivity and specificity in differential diagnosis. Attention, memory and ACE-III-TR total scores showed a statistically significant difference between the three groups of dementia, MCI and healthy (p<0.001). Statistically significant positive correlations ranging from 0.571 to 0.929 were found between ACE-III-TR subsections and total scores (p<0.05). A highly significant positive correlation was found between MMSE total score and ACE-III-TR total score (r=0.870). Between the second and first measurements, positive, moderately significant correlations were found for all subsections and ACE-III-TR total (ICC=0.508-0.784, r=0.477-0.646). A high level of agreement was found between two raters for all ACE-III-TR subsections and the ACE-III-TR total score (alpha=0.9296-0.99995). The total ACE-III-TR cut-off score was 79.5 for healthy and MCI and 69.5 for MCI and mild stage dementia. This study found that ACE-III-TR is a sensitive and specific screening test for the diagnosis of MCI and dementia that has high validity and reliability. ACE-III-TR was found to be a valid and reliable tool in dementia, including AD and FTD, and in mild, moderate and advanced dementia. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes. What is already known on the subject ACE was used as a screening tool to detect MCI and to differentiate AD from FTD. ACE was revised by Hsieh etal. in 2013 and updated as ACE-III, which has the advantages of assessing five cognitive domains, not requiring the use of additional materials, and providing an effective and sensitive measurement in a short time. However, the validity and reliability study of the ACE-III in Turkish has not been conducted. What this study adds to the existing knowledge This study demonstrates the validity and reliability of the Turkish ACE-III (ACE-III-TR), which is a sensitive and specific screening test for the diagnosis of MCI and dementia. What are the practical and clinical implications of this work? The ACE-III-TR can provide clinicians and patients with a quick and brief general cognitive screening, indicating both the patient's overall cognitive profile and the measures of each of the assessed domains. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes.

Dysmenorrhea, Premenstrual Syndrome, and Lifestyle Habits in Young University Students in Spain: A Cross-Sectional Study.

Menstruation is a physiological process that may be accompanied by pain, headache, edema, emotional changes, and other symptoms, all of which affect quality of life. Although the results of some studies indicate lifestyle habits can affect the menstrual cycle and associated symptoms, few have investigated this issue, and even fewer have explored the impact of these symptoms on quality of life, in Spanish women. The objectives of this study were to determine the prevalence of dysmenorrhea and premenstrual syndrome (PMS) among students at a Spanish university, assess the impact of these conditions on quality of life, and analyze the relationship among lifestyle habits, dysmenorrhea, and PMS. A cross-sectional study was carried out on 743 women enrolled at the University of Extremadura in the 2021-2022 academic year. Data related to the menstrual cycle, pain, and PMS-related physical and emotional symptoms were collected. Quality of life related to menstruation was evaluated using the CVM-22 scale. Lifestyle data collected included adherence to a Mediterranean diet (PREDIMED [Prevención con Dieta Mediterránea] questionnaire), level of physical activity (International Physical Activity Questionnaire), and alcohol and tobacco consumption (Alcohol, Smoking, and Substance Involvement Screening Test Version 3). Also, other clinical data were recorded. In terms of the sample, the median age was 21 (19-23) years, the prevalence of dysmenorrhea was 57.9%, 92.7% reported premenstrual physical symptoms, and 55.6% reported experiencing premenstrual emotional changes. Having a low level of adherence to a Mediterranean diet was associated with the presence of dysmenorrhea, with an adjusted odds ratio (aOR) of 1.47 (95% CI [1.06, 2.03]). Having a low level of physical activity was strongly associated with the presence of premenstrual physical symptoms, with an aOR of 5.89 (95% CI [1.71, 20.26]). Also, an association was found between tobacco use and premenstrual emotional changes, with an aOR of 2.02 (95% CI [1.25, 3.25]). Furthermore, dysmenorrhea and PMS were both associated with a low quality of life, with pain and emotional changes being the most significantly associated factors, with ORs of 16.25 (95% CI [10.36, 25.47]) and 26.73 (95% CI [16.46, 43.40]), respectively. Similar to previous studies, the findings of this study indicate a high prevalence of dysmenorrhea and PMS among young university students in western Spain, with both of these symptoms impacting quality of life significantly and negatively. In addition, lifestyle habits, diet, physical activity, and tobacco use seem to influence the occurrence of these symptoms. Promoting lifestyle changes may be an effective strategy to reduce the incidence of dysmenorrhea and PMS and improve the quality of life of young women.

Trends in utilization of colorectal cancer screening modalities among patients with average risk in the United States from 2017 to 2023.

98 Background: Colorectal cancer (CRC) is the second leading cause of cancer mortality in the US. The national CRC screening rate (58%) is still below 80%, which is the goal set by the National Colorectal Cancer Roundtable. National guidelines recommend multiple strategies for CRC screening including colonoscopy, sigmoidoscopy, CT colonography, fecal occult blood test (FOBT), fecal immunochemical tests (FIT), or multi-target stool DNA (mt-sDNA) test. To provide updated insights regarding proportional utilization of different CRC screening strategies, we analyzed modality-specific CRC screening rates across demographic subgroups between 2017 and 2023. Methods: A retrospective review was conducted using a large national claims database that covers over 165 million lives and is representative of the US population for the study period from 2017 to 2023. Individuals were included if they were aged 45-75 years, at average CRC risk in the baseline period of 1 year before the index date and continuously enrolled in a health plan for at least 1 year after the index date. The index date was defined as date of the first claim for a CRC screening test. CRC screening uptake by modality and newly screened individuals each calendar year were examined among the entire eligible population and across demographic subgroups. Results: Overall rates of CRC screening were relatively stable across the study years (approximately 20%) with the lowest annual proportion of screen eligible patients in 2020 (16.6%) and highest in 2023 (24.4%). For CRC-screened individuals, colonoscopy was the most commonly used screening modality, increasing from 1,943,733 (53%) in 2017 to 2,319,695 (58.7%) in 2023. The mt-sDNA test use increased significantly from 87,769 (2.4%) in 2017 to 807,227 (20.4%) in 2023; while FIT/FOBT use declined from 1,611,730 (44%) in 2017 to 805,150 (20.4%) in 2023. Utilization of colonoscopy and mt-sDNA tests increased notably among the 45–49 age group starting in 2021, while FIT/FOBT use simultaneously declined in this age group. Observed trends were similar to the above findings across additional subgroups defined by gender, race/ethnicity, payer type, and geographic region. Conclusions: Data from this large study of national claims data provides updated results for overall and proportional utilization of guideline-endorsed CRC screening strategies. While colonoscopy usage remained stable , the use of the non-invasive mt-sDNA test has increased significantly as FIT/FOBT usage declined over time, reflecting growing interest in this noninvasive, home-based option.

Comparison of screening outcomes associated with advanced precancerous lesion versus colorectal cancer sensitivity for a blood-based test: A simulation study.

89 Background: With estimates of over 150,000 incident and 50,000 fatal colorectal cancer (CRC) cases in 2024, efforts are ongoing to improve the national screening performance and engagement in the US. The Centers for Medicare &amp; Medicaid Services (CMS) have established criteria for covering new blood-based CRC screening tests if minimum CRC sensitivity and specificity thresholds are met. However, the current blood-based tests are challenged by their relative inability to detect advanced precancerous lesions (APLs). At present, the importance of APL versus CRC sensitivity on screening outcomes remains undetermined. To address this knowledge gap, we conducted a simulation study to compare the screening effectiveness and outcomes of a hypothetical blood-based test across a range of sensitivities for CRC and APL detection. Methods: Outcomes were simulated using the CRC-AIM microsimulation model, which has been previously calibrated and validated. Predicted outcomes were calculated for average-risk individuals screened triennially with a blood-based test between ages 45-75 years, assuming perfect adherence. Base-case screening sensitivity and specificity inputs were based on CMS minimum thresholds (74% CRC sensitivity, 90% specificity) with assumed 10% APL sensitivity. Additional scenarios considered an increase in either APL or CRC sensitivity. Outcomes of interest included life years-gained (LYG), CRC incidence, and mortality reductions. Results: Compared to the CMS minimum performance (Table), increasing APL sensitivity by 1% (from 10% to 11%) resulted in a similar increase in LYG as compared to increasing CRC sensitivity by 11% (from 74% to 85%). Additionally, increasing APL sensitivity by 1% resulted in greater reductions in CRC cases and deaths (3% decrease) as compared to increasing CRC sensitivity by 11% (0% and 1% reductions, respectively). Conclusions: Data from this study show that increased APL sensitivity is a key determinant of screening-related outcomes, such as LYG, derived from a blood-based strategy, and that similar results would require much larger increases in CRC sensitivity. With the current CMS minimum performance threshold, blood-based tests that are designed to have high APL sensitivity can outperform tests with higher CRC sensitivity and little to no APL sensitivity. Comparison of CRC screening health outcomes with CMS proposed minimum threshold blood-test versus hypothetical tests with either increased APL and CRC sensitivity. APL Sensitivity CRC Sensitivity CRC Specificity Follow-up Colonoscopies CRC Cases (% reduction) CRC Deaths (% reduction) Life-Years Gained (LYG) (% increase) 10% 74% 90% 809 50 (ref) 18 (ref) 220 (ref) 11% 74% 90% 813 48 (-3%) 17 (-3%) 226 (3%) 10% 85% 90% 809 50 (0%) 18 (-1%) 227 (3%) APL: Advanced precancerous lesions; CRC: Colorectal cancer.

Evaluating systemic immune-inflammation indices as predictive markers for endometriosis diagnosis: A retrospective observational study.

Endometriosis is a chronic inflammatory disease for which there is currently no accurate screening test to identify or predict the probability of the disease in individuals. This can often lead to delays in diagnosis. Several systemic immune-inflammation indices are currently used as predictive or supportive markers for several inflammation-associated diseases. In this study, we investigated whether these immune-inflammation indices, such as systemic immune inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and pan-immune inflammation value (PIV) could serve as predictive or supplementary markers for diagnosing endometriosis. A total of 434 women with confirmed endometriosis and 517 controls were included in this study. Data on peripheral blood tests, including total counts of white cells, neutrophils, monocytes, lymphocytes, and platelets, were collected, and systemic immune-inflammation indices were calculated. SII, SIRI, NLR, and PIV values were significantly higher in women diagnosed with endometriosis compared to controls. Using the cut-off values of 538 for SII, 0.814 for SIRI, 2.03 for NLR, and 210 for PIV, we achieved 76 % sensitivity and 70 % specificity. When the four indices were combined, the area under the ROC curve (AUC) was 0.796 (95 % CI: 0.766, 0.827), with 76 % sensitivity and 70 % specificity. In conclusion, while ultrasonography or MRI remains the gold standard for visualizing the lesions in diagnosing endometriosis, followed by laparoscopy and histologic verification, routine peripheral blood tests in combination with clinical symptoms, could provide additional clinical diagnostic value for endometriosis as a non-invasive and cost-effective test.