Window Of Opportunity For Screening Research Articles

The Natural Disease Course of Pancreatic Cyst–Associated Neoplasia, Dysplasia, and Ductal Adenocarcinoma: Results of a Microsimulation Model

Estimates on the progression of precursor lesions to pancreatic cancer (PC) are scarce. We used microsimulation modeling to gain insight into the natural disease course of PC and its precursors. This information is pivotal to explore the efficacy of PC screening. A Microsimulation Screening Analysis model was developed in which pancreatic intraepithelial neoplasms and cysts can evolve from low-grade dysplasia (LGD) to high-grade dysplasia (HGD) to PC. The model was calibrated to Dutch PC incidence data and Japanese precursor prevalence data (autopsy cases without PC) and provides estimates of PC progression (precursor lesion onset and stage duration). Mean LGD state durations of cysts and pancreatic intraepithelial neoplasms were 15.8 years and 17.1 years, respectively. Mean HGD state duration was 5.8 years. For lesions that progress to PC, the mean duration was 4.8-4.9 years for LGD lesions and 4.0-4.1 years for HGD lesions. In 13.7% of individuals who developed PC, the HGD state lasted less than 1 year. The probability that an individual at age 50 years developed PC in the next 20 years was estimated to be 1.8% in the presence of any cyst and 6.1% in case of an LGD mucinous cyst. This 20-year PC risk was estimated to be 5.1% for individuals with an LGD pancreatic intraepithelial neoplasm. Mean duration of HGD lesions before development of PC was estimated to be 4.0 years. This implies a window of opportunity for screening, presuming the availability of a reliable diagnostic test. The probability that an LGD cyst will progress to cancer was predicted to be low.

PREECLAMPSIA: Long-term Prognosis in Mother and their Children

Abstract: Pre-eclampsia is a type of hypertension that affects several organs during pregnancy. Preeclampsia, on the other hand, does not go away once the baby is born, but it can harm the mother and her children for years. A pre-eclamptic woman is at risk for cerebrovascular disease, cardiovascular disease, renal disease, and metabolic abnormalities later in life if she has pre-eclampsia. In research, children born to pre-eclamptic moms have had a variety of issues. These conditions are associated with cardiovascular, respiratory, neurological, and gastrointestinal issues later in life. The purpose of this study is to learn more about the long-term impact of pre-eclampsia on both mothers and children. Pregnancy and postpartum offer a unique window of opportunity for screening and intervention for both mother and child in the interests of health maintenance and disease prevention.

Exploring barriers to domestic violence screening among culturally and linguistically diverse and migrant women in a regional midwifery setting

BackgroundWomen are at an increased risk of experiencing domestic violence (DV) from an intimate partner during the antenatal and post-partum period, contributing to poorer health outcomes for mother and baby. The antenatal period presents a critical window of opportunity for screening and intervention. In Australia, screening guidelines vary across state and territory health departments. NSW Health has introduced compulsory antenatal DV screening, however, screening appears to be more commonly deferred for women of CALD and non-English speaking backgrounds suggesting barriers to screening. AimTo identify barriers to undertaking DV screening of culturally and linguistically diverse (CALD) and migrant women in a regional setting MethodsQualitative semi-structured interviews were conducted with midwives who undertook antenatal DV assessment at a regional hospital in rural New South Wales serving a high CALD and migrant population. FindingsEleven midwives participated in the interviews. Four emergent themes were apparent as barriers to DV screening: communications challenges, including literacy and use of interpreters, issues with maternity services including lack of flexibility and continuity, a woman's family issues and cultural difficulties. ConclusionThe antenatal period presents a critical window for screening and intervention for those living with intimate partner violence from CALD and migrant groups. While it is acknowledged that there are complex language, maternity service, family and cultural barriers that impact on the ability to undertake screening in a regional setting, recognising these is the first step in addressing them and being able to intervene to break the DV cycle.

Amphetamine-type stimulant use among patients admitted to the emergency department behavioural assessment unit: Screening and referral outcomes.

Amphetamine-type stimulant use, including methamphetamine, amphetamine, and 3,4-methylenedioxymethamphetamine, is associated with a range of behavioural symptoms. Screening for amphetamine-type stimulant use among people presenting to the emergency department with behavioural disturbance and referral to treatment has not been evaluated. The objective of this study was to determine the prevalence of amphetamine-type stimulant use among patients admitted to a behavioural assessment unit and report referral outcomes. A prospective observational design was used. Individuals who tested positive or self-reported amphetamine-type stimulant use were referred to the alcohol and other drug clinician. We measured the prevalence of amphetamine-type stimulant use in saliva and by self-report along with rates of referral. The setting was a behavioural assessment unit located within an Australian emergency department. Admitted adults were enrolled from July to December 2017. Those who tested positive or self-reported amphetamine-type stimulant use were provided with harm reduction advice and offered referral. Four hundred and seventy-two tests were performed. Fifteen were excluded due to invalid results or redundant enrolment. Of the 457 individuals, 59% were male, with a mean age of 35years (SD 13). Fifty-three (11.6%, 95% CI: 8.9-15.0) tested positive for amphetamine-type stimulants. Of those with a negative test, 44 (9.6%, 95% CI: 7.3-12.7) self-reported amphetamine-type stimulant use in the previous 24hours. The prevalence of amphetamine-type stimulant use was 21.2% (95% CI: 17.7-25.2). Most accepted referral to the alcohol and other drug clinician (85.6%, 95% CI 77.2-91.2). The emergency visit represents a window of opportunity for screening for amphetamine-type stimulant use and initiating referrals.

Intimate Partner Violence and Women's Health.

Intimate partner violence affects 15-71% of women over their lifetime, resulting in significant stress, negative health effects, and negative economic effects. Features include physical and sexual abuse as well as psychological abuse and controlling behaviors such as reproductive coercion or stalking. Intimate partner violence can occur in both heterosexual and same-sex relationships, though the risk may be higher in lesbian, gay, bisexual, transgender, queer, or questioning couples. Pregnancy remains an especially risky time for escalating abuse and also provides a window of opportunity for screening and intervention. Victims experience many consequences of abuse, including physical injuries, traumatic brain injury, and chronic conditions such as headaches, insomnia, pelvic pain, depression, anxiety, and posttraumatic stress disorder. Homicide is an especially devastating consequence, with 40-45% of female victims killed by an intimate partner, and homicide remains an important cause of pregnancy-related death. Routine screening is recommended by the American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force, and obstetrician-gynecologists (ob-gyns) should remain vigilant for signs of abuse in their patients. Often the cycle of abuse makes it difficult for women to break free, and ob-gyns should continue to provide supportive care regardless of a woman's readiness to leave an abusive relationship.

OP 10 Longitudinal assessment of cardiovascular risk factors after hypertensive disorders of pregnancy – Towards identifying a window of opportunity for screening and prevention

Introduction Accumulating evidence consistently demonstrates an increased risk and accelerated development of cardiovascular disease (CVD) risk in women with a history of a hypertensive disorder of pregnancy (HDP). Guidelines emphasize the emerging need for the prevention of CVD in these women, but fail to provide uniform recommendations on commencement and time interval in screening these patients. Objective The aim of this study is to investigate development of blood pressure, lipids and fasting glucose levels over time in women with a history of HDP in order to identify a window of opportunity for screening and prevention. Methods We identified women with self-reported normotensive pregnancy and HDP (NP, n = 1811; HDP, n = 1005) within the PREVEND study, a Dutch population-based cohort with a follow-up of maximum of 5 visits with 3-year intervals. Development of blood pressure, lipids, fasting glucose and Framingham 10-years CVD scores was longitudinally assed using generalized estimating equations. Results HDP”s present with overall higher and faster increasing prevalence of hypertension (p = 0.005), dyslipidemia (p = 0.009) and glucose disturbances (p = 0.002), reflecting in the use of medication (p Conclusion Women with a history of HDP show early development of hypertension, dyslipidemia and glucose homeostasis disturbances. Based on this cohort study, calculated 10-years CVD risk and NNS indicate commencing CVRM screening in these women at age 45 would be feasible. Download : Download high-res image (385KB) Download : Download full-size image

Molecular markers and the future of colorectal cancer screening

1Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands 2Department of Pathology, GROW – School for Oncology & Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands *Author for correspondence: ga.meijer@vumc.nl The problem of colorectal cancer Cancer of the large intestine, or colorectal cancer (CRC), is one of the most com‐ mon types of cancer in the western world, from which almost half of the patients die, giving rise to more than 600,000 deaths worldwide every year [1]. This clearly require improvement and is the reason why options to reduce death from CRC are under active research. These options (interventions) range from healthier diets to prevent the onset of CRC (i.e., primary prevention) to sophisticated drugs that specifically target the molecular circuitry disrupted in individual tumors (i.e., per‐ sonalized therapies). However, one par‐ ticular intervention stands out in terms of effectiveness, and that is early detection or screening [2,3]. The principle is that by detecting the tumor in an early or even premalignant stage, an individual can be cured with limited intervention, and death from CRC is therefore prevented. Since it takes on average 8–12 years for a colorectal tumor to transform from a benign polyp, or adenoma, through a curable cancer stage into an incurable disease [4], there is an excellent window of opportunity for screening. The next question then is whether suitable screening tests are avail‐ able? The answer is yes, and they essen‐ tially come in two forms. One is visual inspection of the large intestine; the other is by using a laboratory test. Visual inspection can be performed by introducing a flexible scope into the large intestine (i.e., colonoscopy). Such an endoscopy requires the intestine to be empty and clean, which is achieved by drinking liters of laxation fluids, referred to as bowel preparation. In fact, most people undergoing colonoscopy regard this bowel preparation to be the most bothersome part of the whole procedure. A major benefit of endoscopy is that during this procedure biopsies can be taken from any suspicious EDITORIAL

Screening of Gynaecological Surgical Patients for HIV-1 Infection in Nigeria

Background : HIV infection in gynaecological surgical diseases (GSDs) is associated with higher complications but epidemiological data in Nigeria is scarce. Objective : To determine the proportion, pattern and factors associated with HIV-1 infections among GSDs patients and early linkage to HIV care and treatment. Materials and Method : This one-year prospective study enrolled consecutive volunteers admitted January 1 through December 31, 2007 for gynaecological surgeries in a tertiary Nigerian hospital. The women were pre- and post-test counselled and screened for HIV-1 antibodies using Abbott Determine for HIV- 1 and 2 (Abbott Laboratories, Illinois, USA) and Uni-Gold Recombigen HIV (Trinity Biotech, Wicklow, Ireland) in a serial test algorithm. Repeatedly reactive samples were considered positive. Discordant results were confirmed using HIV-1/2 Stat-Pak (Chembio, Medford, NY) as tie-breaker. The patients’ socio-demographic characteristics and associated factors were obtained using structured questionnaire. Seropositive women were linked to care. The outcome measures were proportion of women with HIV positive results, associated factors and mortality rate over a one year follow up period. Results : The overall proportion of HIV positive result was 6.3% (26/413) with women aged ≥ 45 years having the highest proportion (8.45%). Only 9.4 % (39/413) were aware of their HIV status prior to testing. Of the HIV positive patients, 7.7% (2/26) knew their status and were on antiretroviral drugs. They had not been sexually active in the last six months. Multiple sexual partners (p<0.000), STIs (p<0.000), traditional medications (p<0.003), pelvic abscess (p=0.008), cervical cancer (p<0.003), induced abortions (p<0.001) were HIV-associated factors. Previous blood transfusion, surgeries, benign tumors, non-cervical gynaecological malignancies were not. There were no mortalities over a one year follow up period. Conclusion : The proportion of HIV infection among women admitted for GSDs was high but prior knowledge of HIV status was low. The study has provided a window of opportunity for screening, diagnosis and early treatment. Integration of HIV counselling and testing into gynecological services would be desirable.

Timing of progression from Chlamydia trachomatisinfection to pelvic inflammatory disease: a mathematical modelling study

BackgroundPelvic inflammatory disease (PID) results from the ascending spread of microorganisms from the vagina and endocervix to the upper genital tract. PID can lead to infertility, ectopic pregnancy and chronic pelvic pain. The timing of development of PID after the sexually transmitted bacterial infection Chlamydia trachomatis (chlamydia) might affect the impact of screening interventions, but is currently unknown. This study investigates three hypothetical processes for the timing of progression: at the start, at the end, or throughout the duration of chlamydia infection.MethodsWe develop a compartmental model that describes the trial structure of a published randomised controlled trial (RCT) and allows each of the three processes to be examined using the same model structure. The RCT estimated the effect of a single chlamydia screening test on the cumulative incidence of PID up to one year later. The fraction of chlamydia infected women who progress to PID is obtained for each hypothetical process by the maximum likelihood method using the results of the RCT.ResultsThe predicted cumulative incidence of PID cases from all causes after one year depends on the fraction of chlamydia infected women that progresses to PID and on the type of progression. Progression at a constant rate from a chlamydia infection to PID or at the end of the infection was compatible with the findings of the RCT. The corresponding estimated fraction of chlamydia infected women that develops PID is 10% (95% confidence interval 7-13%) in both processes.ConclusionsThe findings of this study suggest that clinical PID can occur throughout the course of a chlamydia infection, which will leave a window of opportunity for screening to prevent PID.

Alcohol and drug use among patients presenting to an inner-city emergency department: A latent class analysis

The inner city Emergency Department (ED) provides a window of opportunity for screening for alcohol and other drug misuse and substance use disorders (SUDs), in order to facilitate linkage for individuals who are in need of services targeting such issues. The majority of prior work in this area has focused on alcohol use. This study used latent class analyses to characterize substance use/SUDs among adults presenting to the ED for medical complaints or injuries. Participants (n=14,557; 77% participation; 45% male; 54% African–American) completed a computerized survey assessing demographics, health functioning, and substance use/SUDs. Although injured patients were significantly more likely to use tobacco, alcohol, and marijuana, and were more likely to have an alcohol use disorder, presenting complaint was not related to other drug use/diagnoses. Five latent classes were identified: (1) low users/SUDs (65.9%) (2) binge drinkers (24.3%), (3) marijuana users/SUD (3.5%), (4) cocaine users/SUD (2.9%), and (5) poly-drug users (3.3%). Compared to class 1, participants in the other classes were younger, male, without health insurance, with poor mental health functioning, tobacco users, and had prior substance use treatment. African–Americans were most likely to be in classes 3 or 4 and employed participants were most likely to be in class 2. In comparison to class 1, classes 2 and 3 reported better physical health; class 2 was more likely to present for injury whereas class 5 was more likely to present for a medical complaint. ED-based screening and interventions approaches need to address the co-occurrence of alcohol, illicit drug, and psychoactive prescription drug use.

Intervention Attendance Among Emergency Department Patients With Alcohol- and Drug-Use Disorders

The emergency department (ED) visit provides a window of opportunity for screening and linkage to services for inner-city adults with substance-use disorders (SUDs). This article examines predictors of intervention attendance among ED patients who screen positive for an SUD (alcohol or other drug). As part of a large randomized control trial, medical and injured patients (ages 19-60) in an inner-city ED completed a computerized screening survey. Based on random assignment, those screening positive for an SUD either were scheduled to attend a post-discharge intervention or received a referral brochure. Interventions (brief motivational intervention vs. case management intervention) focused on linking participants to substance-use treatment. Independent variables assessed included demographics, ED visit reason, health functioning, readiness to change, self-efficacy, and substance use. Intervention attendance (yes/no) was the dependent variable. Overall, 957 (62.3% male; 58.3% African-American; M(age) = 33.2 years) were randomized to interventions (brief motivational intervention/case management intervention) and are the focus of subsequent analyses. There were no differences in the pattern of predictors of intervention attendance for brief motivational intervention versus case management intervention. Bivariate analyses compared those who attended the post-ED intervention with those who did not attend. Participants who attended the intervention (50%) were significantly more likely to be older, unmarried, insured, unemployed, and in the "action" stage of change. The present findings highlight the relative importance of assessing and attending to readiness to change as well as demographic factors such as insurance and employment (and potentially associated barriers) in ED-based screening, brief intervention, and referral to treatment protocols.

Changes in Substance Use Associated with Emergency Room and Primary Care Services Utilization in the United States General Population: 1995–2000

Objective: The purpose of this study was to compare changes in the prevalence of heavy problem drinking and drug use among those obtaining emergency room (ER), primary care, and other health care services between 1995 and 2000 in the U.S. general population. Method: Data analyzed are from the Alcohol Research Group's 1995 (n = 4925) and 2000 (n = 7612) National Alcohol Surveys. Data for the 1995 survey was based on face‐to‐face interviews in respondents' homes in the 48 contiguous states, while the 2000 interview was a random‐digit dialing computer‐assisted telephone interview of the household population in all 50 states. Results: Those reporting any health services utilization were less likely to report heavy drinking, two or more alcohol problems, and symptoms of alcohol dependence during the previous year in 2000 compared with 1995, but heavy or problem drinking was not predictive of health services utilization at either time. Controlling for demographic characteristics and health insurance coverage, illicit drug users were almost twice as likely [odds ratio (OR) = 1.85] compared with nonusers, to report ER utilization, and one and a half times more likely (OR = 1.55) to report primary care utilization during the past year in the 2000 survey, but drug use was not significantly predictive of health services utilization in 1995. Conclusions: These data suggest that while those alcohol‐involved individuals were no more likely than others to use ER and primary care services in either 1995 or 2000, those drug‐involved individuals were more likely to do so in 2000, perhaps related to the fact that these individuals may be incurring more health problems associated with their drug use that require medical attention. While identification and intervention with problem drinkers in clinical settings has received a great deal of attention, drug users may be overrepresented in health service settings, and such settings also may provide a window of opportunity for screening and intervention for a reduction in drug‐related problems.