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preventive screening - Top 30 Publications

Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis.

Advances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis. We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs.

Effect of the Apolipoprotein E Genotype on Cognitive Change During a Multidomain Lifestyle Intervention: A Subgroup Analysis of a Randomized Clinical Trial.

The role of the apolipoprotein E (APOE) ε4 allele as an effect modifier in lifestyle interventions to prevent cognitive impairment is still unclear.

Knowledge, availability, and use of ambulatory and home blood pressure monitoring in primary care in Spain: the MAMPA study.

To examine the degree of knowledge and management of automated devices for office blood pressure measurement (AD), home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) in primary care in Spain.

Non-invasive, quantitative assessment of liver fat by MRI-PDFF as an endpoint in NASH trials.

Nonalcoholic fatty liver disease (NAFLD) is now the most common cause of chronic liver disease worldwide, and the progressive form of this condition, nonalcoholic steatohepatitis (NASH), has become one of the leading indications for liver transplant. Despite intensive investigations, there are currently no FDA approved therapies for treating NASH. A major barrier for drug development in NASH is that treatment response assessment continues to require liver biopsy, which is invasive and interpreted subjectively. Therefore, there is a major unmet need for developing non-invasive, objective and quantitative biomarkers for diagnosis and assessment of treatment response. Emerging data support the use of magnetic resonance imaging derived proton density fat fraction (MRI-PDFF) as a non-invasive, quantitative, and accurate measure of liver fat content to assess treatment response in early-phase of NASH trials. In this review, we will discuss the role and utility, including potential sample-size reduction, of using MRI-PDFF as a quantitative and non-invasive imaging-based biomarker in early-phase NASH trials. This article is protected by copyright. All rights reserved.

Diagnostic Accuracy of the Veteran Affairs' Traumatic Brain Injury Screen.

To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) TBI Clinical Reminder Screen (TCRS).

Improving Follow-up and Reducing Barriers for Eye Screenings in Communities: the SToP Glaucoma Study.

To evaluate factors associated with attendance to follow-up ophthalmic care, and to assess the impact of strategies to improve follow-up.

Prediction of venous thromboembolism using semantic and sentiment analyses of clinical narratives.

Venous thromboembolism (VTE) is the third most common cardiovascular disorder. It affects people of both genders at ages as young as 20 years. The increased number of VTE cases with a high fatality rate of 25% at first occurrence makes preventive measures essential. Clinical narratives are a rich source of knowledge and should be included in the diagnosis and treatment processes, as they may contain critical information on risk factors. It is very important to make such narrative blocks of information usable for searching, health analytics, and decision-making. This paper proposes a Semantic Extraction and Sentiment Assessment of Risk Factors (SESARF) framework. Unlike traditional machine-learning approaches, SESARF, which consists of two main algorithms, namely, ExtractRiskFactor and FindSeverity, prepares a feature vector as the input to a support vector machine (SVM) classifier to make a diagnosis. SESARF matches and maps the concepts of VTE risk factors and finds adjectives and adverbs that reflect their levels of severity. SESARF uses a semantic- and sentiment-based approach to analyze clinical narratives of electronic health records (EHR) and then predict a diagnosis of VTE. We use a dataset of 150 clinical narratives, 80% of which are used to train our prediction classifier support vector machine, with the remaining 20% used for testing. Semantic extraction and sentiment analysis results yielded precisions of 81% and 70%, respectively. Using a support vector machine, prediction of patients with VTE yielded precision and recall values of 54.5% and 85.7%, respectively.

Age, age at diagnosis and diabetes duration are all associated with vascular complications in type 2 diabetes.

Type 2 diabetes (T2DM) is increasingly diagnosed in younger patients. The trajectory of complications in patients diagnosed at a younger or older age is not well understood. We examine the associations between age, age at diagnosis and diabetes duration and vascular complications in patients with T2DM.

Prediction of psychosis across protocols and risk cohorts using automated language analysis.

Language and speech are the primary source of data for psychiatrists to diagnose and treat mental disorders. In psychosis, the very structure of language can be disturbed, including semantic coherence (e.g., derailment and tangentiality) and syntactic complexity (e.g., concreteness). Subtle disturbances in language are evident in schizophrenia even prior to first psychosis onset, during prodromal stages. Using computer-based natural language processing analyses, we previously showed that, among English-speaking clinical (e.g., ultra) high-risk youths, baseline reduction in semantic coherence (the flow of meaning in speech) and in syntactic complexity could predict subsequent psychosis onset with high accuracy. Herein, we aimed to cross-validate these automated linguistic analytic methods in a second larger risk cohort, also English-speaking, and to discriminate speech in psychosis from normal speech. We identified an automated machine-learning speech classifier - comprising decreased semantic coherence, greater variance in that coherence, and reduced usage of possessive pronouns - that had an 83% accuracy in predicting psychosis onset (intra-protocol), a cross-validated accuracy of 79% of psychosis onset prediction in the original risk cohort (cross-protocol), and a 72% accuracy in discriminating the speech of recent-onset psychosis patients from that of healthy individuals. The classifier was highly correlated with previously identified manual linguistic predictors. Our findings support the utility and validity of automated natural language processing methods to characterize disturbances in semantics and syntax across stages of psychotic disorder. The next steps will be to apply these methods in larger risk cohorts to further test reproducibility, also in languages other than English, and identify sources of variability. This technology has the potential to improve prediction of psychosis outcome among at-risk youths and identify linguistic targets for remediation and preventive intervention. More broadly, automated linguistic analysis can be a powerful tool for diagnosis and treatment across neuropsychiatry.

ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis.

Multiple sclerosis (MS) is a complex disease of the central nervous system. As new drugs are becoming available, knowledge on diagnosis and treatment must continuously evolve. There is therefore a need for a reference tool compiling current data on benefit and safety, to aid professionals in treatment decisions and use of resources across Europe. The European Committee of Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Academy of Neurology (EAN) have joined forces to meet this need. The objective was to develop an evidence-based clinical practice guideline for the pharmacological treatment of people with MS to guide healthcare professionals in the decision-making process.

Sex and Race Differences in Lifetime Risk of Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction.

Background -Lifetime risk of heart failure has been estimated to range from 20% to 46% in diverse sex and race groups. However, lifetime risk estimates for the two HF phenotypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), is not known. Methods -Participant-level data from 2 large prospective cohort studies, the Cardiovascular Health Study (CHS) and the Multiethnic Study of Atherosclerosis (MESA), were pooled excluding individuals with prevalent HF at baseline. Remaining lifetime risk estimates for HFpEF (Ejection Fraction ≥ 45%) and HFrEF (Ejection Fraction < 45%) were determined at different index ages using a modified Kaplan-Meier method with mortality and the other HF subtype as competing risks. Results -We included 12,417 participants older than 45 years (22.2% blacks, 44.8% men) who were followed for median duration of 11.6 years with 2,178 overall incident HF events with 561 HFrEF events and 726 HFpEF events. At index age of 45 years, the lifetime risk for any HF through age 90 was higher in men than women (27.4% vs. 23.8%). Among HF subtypes, the lifetime risk for HFrEF was higher in men than women (10.6% vs. 5.8%). In contrast, the lifetime risk for HFpEF was similar in men and women. In race-stratified analyses, lifetime risk for overall HF was higher in non-blacks than blacks (25.9% vs. 22.4%). Among HF subtypes, the lifetime risk for HFpEF was higher in non-blacks than blacks (11.2% vs. 7.7%) while that for HFrEF was similar across the two groups. Among participants with antecedent myocardial infarction (MI) prior to HF diagnosis, the remaining lifetime risks for HFpEF and HFrEF were 2.5-fold and 4-fold higher, respectively, as compared with those without antecedent MI. Conclusions -Lifetime risks for HFpEF and HFrEF vary by sex, race, and history of antecedent MI. These insights into the distribution of HF risk and its subtypes could inform development of targeted strategies to improve population level HF prevention and control.

Smoking status and survival among a national cohort of lung and colorectal cancer patients.

The purpose of this study was to explore the association of smoking status and clinically relevant duration of smoking cessation with long-term survival after lung cancer (LC) or colorectal cancer (CRC) diagnosis. We compared survival of patients with LC and CRC who were never-smokers, long-term, medium-term, and short-term quitters, and current smokers around diagnosis.

Reliability and Validity of the Atopic Dermatitis Symptom Score.

We have developed the Atopic Dermatitis Symptom Score (ADSS) by which patients or parents can easily assess and record AD symptoms on a daily basis in a smartphone application. The aim of the present study was to evaluate the reliability and validity of the ADSS.

Molecular allergen profiling in horses by microarray reveals Fag e 2 from buckwheat as a frequent sensitizer.

Companion animals are also affected by IgE-mediated allergies, but the eliciting molecules are largely unknown. We aimed at refining an allergen microarray to explore sensitization in horses and compare it to the human IgE reactivity profiles.

Serum MMP-9 Diagnostics, Prognostics, and Activation in Acute Coronary Syndrome and Its Recurrence.

Matrix metalloproteinase (MMP)-9 is crucial in atherosclerotic plaque rupture and tissue remodeling after a cardiac event. The balance between MMP-9 and endogenous inhibitor, tissue inhibitors of matrix metalloproteinase 1 (TIMP-1), is important in acute coronary syndrome (ACS). This is an age- and gender-matched case-control study of ACS (N = 669). Patients (45.7%) were resampled after recovery, and all were followed up for 6 years. The molecular forms of MMP-9 were investigated by gelatin zymography. Diagnostically, MMP-9 and the MMP-9/TIMP-1 molar ratio were associated with ACS (OR 5.81, 95% CI 2.65-12.76, and 4.96, 2.37-10.38). The MMP-9 concentrations decreased 49% during recovery (p < 0.001). The largest decrease of these biomarkers between acute and recovery phase (ΔMMP-9) protected the patients from major adverse cardiac events, especially the non-fatal events. The fatal events were associated with in vitro activatable MMP-9 levels (p = 0.028). Serum MMP-9 and the MMP-9/TIMP-1 molar ratio may be valuable in ACS diagnosis and prognosis. High serum MMP-9 activation potential is associated with poor cardiovascular outcome.

Resilience and protective factors among people with a history of child maltreatment: a systematic review.

To provide an overview of resilience and protective factors associated with a better life following child maltreatment exposure, to compare protective factors across specific subtypes of maltreatment, and to explore existing issues in the current state of the literature.

The tyranny of the averages and the indiscriminate use of risk factors in public health: The case of coronary heart disease.

Modern medicine is overwhelmed by a plethora of both established risk factors and novel biomarkers for diseases. The majority of this information is expressed by probabilistic measures of association such as the odds ratio (OR) obtained by calculating differences in average "risk" between exposed and unexposed groups. However, recent research demonstrates that even ORs of considerable magnitude are insufficient for assessing the ability of risk factors or biomarkers to distinguish the individuals who will develop the disease from those who will not. In regards to coronary heart disease (CHD), we already know that novel biomarkers add very little to the discriminatory accuracy (DA) of traditional risk factors. However, the value added by traditional risk factors alongside simple demographic variables such as age and sex has been the subject of less discussion. Moreover, in public health, we use the OR to calculate the population attributable fraction (PAF), although this measure fails to consider the DA of the risk factor it represents. Therefore, focusing on CHD and applying measures of DA, we re-examine the role of individual demographic characteristics, risk factors, novel biomarkers and PAFs in public health and epidemiology. In so doing, we also raise a more general criticism of the traditional risk factors' epidemiology. We investigated a cohort of 6103 men and women who participated in the baseline (1991-1996) of the Malmö Diet and Cancer study and were followed for 18 years. We found that neither traditional risk factors nor biomarkers substantially improved the DA obtained by models considering only age and sex. We concluded that the PAF measure provided insufficient information for the planning of preventive strategies in the population. We need a better understanding of the individual heterogeneity around the averages and, thereby, a fundamental change in the way we interpret risk factors in public health and epidemiology.

Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR).

Severe and uncontrolled asthma is associated with increased risk of exacerbations and death. A substantial proportion of asthma patients have poor asthma control, and a concurrent COPD diagnosis often increases disease burden. The objective of the study was to describe the prevalence and managemant of severe asthma in a Swedish asthma popuöation.

Factors Influencing Suicidal Tendencies of Patients with Diagnosis of Attempted Suicide in Medical History and Potential Prevention of Relapse Prevention.

The authors researched the incidence of suicidal thoughts and related factors in 123 patients of the psychiatric ward of the Hospital of České Budějovice with diagnosed attempted suicide in their medical history for the period from January 2013 – June 2015.

Timed Up and Go Test and Future Dementia Occurrence.

This study evaluated whether baseline results of the Timed Up and Go (TUG) test is associated with future dementia occurrence.

Use of Single-Nucleotide Polymorphisms and Mammographic Density Plus Classic Risk Factors for Breast Cancer Risk Prediction.

Single-nucleotide polymorphisms (SNPs) have demonstrated an association with breast cancer susceptibility, but there is limited evidence on how to incorporate them into current breast cancer risk prediction models.

The Ethics of General Population Preventive Genomic Sequencing: Rights and Social Justice.

Advances in DNA sequencing technology open new possibilities for public health genomics, especially in the form of general population preventive genomic sequencing (PGS). Such screening programs would sit at the intersection of public health and preventive health care, and thereby at once invite and resist the use of clinical ethics and public health ethics frameworks. Despite their differences, these ethics frameworks traditionally share a central concern for individual rights. We examine two putative individual rights-the right not to know, and the child's right to an open future-frequently invoked in discussions of predictive genetic testing, in order to explore their potential contribution to evaluating this new practice. Ultimately, we conclude that traditional clinical and public health ethics frameworks, and these two rights in particular, should be complemented by a social justice perspective in order adequately to characterize the ethical dimensions of general population PGS programs.

Comparison of diagnostic methods to detect Histoplasma capsulatum in serum and blood samples from AIDS patients.

Although early and rapid detection of histoplasmosis is essential to prevent morbidity and mortality, few diagnostic tools are available in resource-limited areas, especially where it is endemic and HIV/AIDS is also epidemic. Thus, we compared conventional and molecular methods to detect Histoplasma capsulatum in sera and blood from HIV/AIDS patients.

Eurogin Roadmap 2017: Triage strategies for the management of HPV-positive women in cervical screening programmes.

Cervical cancer screening will rely, increasingly, on HPV testing as a primary screen. The requirement for triage tests which can delineate clinically significant infection is thus prescient. In this EUROGIN 2017 roadmap, justification behind the most evidenced triages is outlined, as are challenges for implementation. Cytology is the triage with the most follow-up data; the existence of an HR-HPV positive, cytology negative group presents a challenge and re-testing intervals for this group (and choice of re-test) require careful consideration. Furthermore, cytology relies on subjective skills and while adjunctive dual-staining with p16/Ki67 can mitigate inter-operator/site disparities, clinician-taken samples are required. Comparatively, genotyping and methylation markers are objective and are applicable to self-taken samples, offering logistical advantages including in low and middle income settings. However, genotyping may have diminishing returns in immunised populations and type(s) included must balance absolute risk for disease to avoid low specificity. While viral and cellular methylation markers show promise, more prospective data are needed in addition to refinements in automation. Looking forward, systems that detect multiple targets concurrently such as next generation sequencing platforms will inform the development of triage tools. Multi-step triage strategies may be beneficial provided they do not create complex, unmanageable pathways. Inevitably, the balance of risk to cost(s) will be key in decision making, although defining an acceptable risk will likely differ between settings. Finally, given the significant changes to cervical screening and the variety of triage strategies, appropriate education of both health care providers and the public is essential. This article is protected by copyright. All rights reserved.

Screening program for cervical cancer: public policies and experiences of actors who implement the program in the state of Veracruz, Mexico.

The aim of this article is to analyze the way in which the Screening Program for Cervical Cancer is carried out in a dysplasia clinic and related health centers in the state of Veracruz, through the representations and practices of the social actors who implement the program. In order to do so, in-depth interviews and observations of the practices of health service providers were carried out during different periods over the course of three years, from 2009 to 2011. Through the information obtained, the article explores the difficulties, achievements and results of this program as part of a public policy. Although a priority of public health policy is to see the whole population benefit from preventive and curative health care services, evidence shows that marginalized populations are not benefitted by such programs; such information does not however seem to permeate popular and medical knowledge.

Life Expectancy for Patients From the Southeastern United States With IgA Nephropathy.

Although end-stage renal disease (ESRD) and surrogate markers for renal dysfunction are frequently used as outcome markers for IgA nephropathy, the clinical course after reaching ESRD is not well documented. This study examined outcomes of progression to ESRD and age at death in a cohort of adults with IgA nephropathy with a long duration of follow-up.

Review of the History of Non-traumatic Spinal Cord Dysfunction.

Background: The incidence of non-traumatic spinal cord dysfunction (SCDys) is reported to be higher than traumatic spinal cord injury (SCI) in many countries. No formal review of the history of SCDys has been published. Objective: This article aims to identify key highlights in the history of SCDys. Method: An electronic literature search was conducted (January 2017) using MEDLINE (1946-2016) and Embase (1974-2016) databases for publications regarding the history of SCDys. Publications on the history of SCI and a selection of neurology textbooks and books on the history of neurology were reviewed for potentially relevant references. The focus of the literature search was on identifying publications that detail key highlights regarding the history of the diagnosis and management of the most common SCDys conditions, as well as those of historical significance. Results: The electronic search of MEDLINE and Embase identified 11 relevant publications. The majority of publications included were identified from the authors' libraries and a selection of books on neurology and the history of neurology. Conclusions: This review outlines the history of SCDys, taking a broader historical perspective and covering the increasing awareness of the role of the spinal cord and knowledge of neuroanatomy. Key milestones in the history of the diagnosis and management of the most common SCDys conditions are presented. An appreciation of the history of SCDys increases our understanding of the large number of people who contributed to our current knowledge of these conditions and in some situations helps guide efforts regarding prevention of SCDys.

Updates on the molecular epidemiology of Enterovirus D68 after installation of screening test among acute flaccid paralysis patients in Taiwan.

In respond to acute flaccid paralysis (AFP) in association with Enterovirus D68 (EV-D68) infection, Taiwan Centers for Disease Control began to screen EV-D68 infection among each AFP patient since July 2015 and detected the first case in August 2016. This article updated the molecular epidemiology trends of EV-D68 from the national surveillance data.

Menstrual and reproductive factors and risk of breast cancer: A case-control study in the Fez region, Morocco.

Breast cancer is the most common cancer in women worldwide. In the Moroccan context, the role of well-known reproductive factors in breast cancer remains poorly documented. The aim of this study was to explore the relationship between menstrual and reproductive factors and breast cancer risk in Moroccan women in the Fez region.

Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study.

Gestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease.