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Population screening for liver fibrosis: Toward early diagnosis and intervention for chronic liver diseases.
Ginès, P, Castera, L, Lammert, F, Graupera, I, Serra-Burriel, M, Allen, AM, Wong, VW, Hartmann, P, Thiele, M, Caballeria, L, et al
Hepatology (Baltimore, Md.). 2022;(1):219-228
Abstract
Cirrhosis, highly prevalent worldwide, develops after years of hepatic inflammation triggering progressive fibrosis. Currently, the main etiologies of cirrhosis are non-alcoholic fatty liver disease and alcohol-related liver disease, although chronic hepatitis B and C infections are still major etiological factors in some areas of the world. Recent studies have shown that liver fibrosis can be assessed with relatively high accuracy noninvasively by serological tests, transient elastography, and radiological methods. These modalities may be utilized for screening for liver fibrosis in at-risk populations. Thus far, a limited number of population-based studies using noninvasive tests in different areas of the world indicate that a significant percentage of subjects without known liver disease (around 5% in general populations and a higher rate -18% to 27%-in populations with risk factors for liver disease) have significant undetected liver fibrosis or established cirrhosis. Larger international studies are required to show the harms and benefits before concluding that screening for liver fibrosis should be applied to populations at risk for chronic liver diseases. Screening for liver fibrosis has the potential for changing the current approach from diagnosing chronic liver diseases late when patients have already developed complications of cirrhosis to diagnosing liver fibrosis in asymptomatic subjects providing the opportunity of preventing disease progression.
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Risk-based breast cancer screening strategies in women.
Harkness, EF, Astley, SM, Evans, DG
Best practice & research. Clinical obstetrics & gynaecology. 2020;:3-17
Abstract
The incidence of breast cancer continues to increase worldwide. Population-based screening is available in many countries but may not be the most efficient use of resources, thus interest in risk-based/stratified screening has grown significantly in recent years. An important part of risk-based screening is the incorporation of mammographic density (MD) and single nucleotide polymorphisms (SNPs) into risk prediction models to be combined with classical risk factors. In this article, we discuss different measures of MD and risk prediction models that are available. Risk-stratified screening options including supplemental or alternative screening modalities including digital breast tomosynthesis (DBT), automated ultrasound (ABUS) and magnetic resonance imaging (MRI) are discussed, as well as potential risk-based interventions (diet and lifestyle, chemoprevention and risk-reducing surgery). Furthermore, we look at risk feedback in practice and the cost-effectiveness and acceptability of risk-based screening, highlighting some of the current challenges.
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3.
A Review of Capture-recapture Methods and Its Possibilities in Ophthalmology and Vision Sciences.
Ramos, PL, Sousa, I, Santana, R, Morgan, WH, Gordon, K, Crewe, J, Rocha-Sousa, A, Macedo, AF
Ophthalmic epidemiology. 2020;(4):310-324
Abstract
Epidemiological information is expected to be used to develop key aspects of eye care such as to control and minimise the impact of diseases, to allocate resources, to monitor public health actions, to determine the best treatment options and to forecast the consequence of diseases in populations. Epidemiological studies are expected to provide information about the prevalence and/or incidence of eye diseases or conditions. To determine prevalence is necessary to perform a cross-sectional screening of the population at risk to ascertain the number of cases. The aim of this review is to describe and evaluate capture-recapture methods (or models) to ascertaining the number of individuals with a disease (e.g. diabetic retinopathy) or condition (e.g. vision impairment) in the population. The review covers the fundamental aspects of capture-recapture methods that would enable non-experts in epidemiology to use it in ophthalmic studies. The review provides information about theoretical aspects of the method with examples of studies in ophthalmology in which it has been used. We also provide a problem/solution approach for limitations arising from the lists obtained from registers or other reliable sources. We concluded that capture-recapture models can be considered reliable to estimate the total number of cases with eye conditions using incomplete information from registers. Accordingly, the method may be used to maintain updated epidemiological information about eye conditions helping to tackle the lack of surveillance information in many regions of the globe.
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Pediatric screening tools for malnutrition: an update.
Hulst, JM, Huysentruyt, K, Joosten, KF
Current opinion in clinical nutrition and metabolic care. 2020;(3):203-209
Abstract
PURPOSE OF REVIEW There is ongoing interest in nutritional screening tools in pediatrics to facilitate the identification of children at risk for malnutrition who need further assessment and possible nutritional intervention. The choice for a specific tool depends on various factors. This review aims to provide an overview of recent progress in pediatric nutritional screening methods. RECENT FINDINGS We present recent studies about newly developed or adjusted tools, the applicability of nutritional screening tools in specific populations, and how to implement screening in the overall process of improving nutritional care in the pediatric hospital setting. SUMMARY Three new screening tools have been developed for use on admission to hospital: two for the mixed pediatric hospitalized population and one for infants. A simple weekly rescreening tool to identify hospital-acquired nutritional deterioration was developed for use in children with prolonged hospital stay. Different from most previous studies that only assessed the relationship between the nutritional risk score and anthropometric parameters of malnutrition, new studies in children with cancer, burns, and biliary atresia show significant associations between high nutritional risk and short-term outcome measures such as increased complication rate and weight loss. For implementation of a nutritional care process incorporating nutritional screening in daily practice, simplicity seems to be of great importance.
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Epidemiology and Mechanisms of the Increasing Incidence of Colon and Rectal Cancers in Young Adults.
Stoffel, EM, Murphy, CC
Gastroenterology. 2020;(2):341-353
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Abstract
In contrast to the decreasing incidence of colorectal cancer (CRC) in older populations, the incidence has nearly doubled in younger adults since the early 1990s. Approximately 1 in 10 new diagnoses of CRC are now made in individuals 50 years or younger. Patients' risk of CRC has been calculated largely by age and family history, yet 3 of 4 patients with early-onset CRC have no family history of the disease. Rapidly increasing incidence rates in younger people could result from generational differences in diet, environmental exposures, and lifestyle factors. We review epidemiologic trends in CRC, data on genetic and nongenetic risk factors, and new approaches for determining CRC risk. These may identify individuals likely to benefit from early screening and specialized surveillance.
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Diagnosis of Diabetes Mellitus in Older Adults.
Reddy, SSK
Clinics in geriatric medicine. 2020;(3):379-384
Abstract
In the United States, 4 out of 10 adults with diabetes are ≥65 years of age. The older adult with diabetes is very likely to be asymptomatic and also at higher risk of vascular disease. New concerns include new diagnosis of diabetes for older adults admitted to hospital and older adults in long-term care facilities. The pathophysiology for increased incidence of diabetes in older adults is multifactorial, but dominant features are increased likelihood of metabolic syndrome, dysfunctional insulin secretion, and peripheral insulin resistance. Society in general benefits from more cost-effective care of older adults with diabetes.
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Nutritional Aspects in Inflammatory Bowel Diseases.
Balestrieri, P, Ribolsi, M, Guarino, MPL, Emerenziani, S, Altomare, A, Cicala, M
Nutrients. 2020;(2)
Abstract
Crohn's disease (CD) and ulcerative colitis (UC) are chronic, relapsing, inflammatory disorders of the digestive tract that characteristically develop in adolescence and early adulthood. The reported prevalence of malnutrition in inflammatory bowel disease (IBD) patients ranges between 20% and 85%. Several factors, including reduced oral food intake, malabsorption, chronic blood and proteins loss, and intestinal bacterial overgrowth, contribute to malnutrition in IBD patients. Poor nutritional status, as well as selective malnutrition or sarcopenia, is associated with poor clinical outcomes, response to therapy and, therefore, quality of life. The nutritional assessment should include a dietetic evaluation with the assessment of daily caloric intake and energy expenditure, radiological assessment, and measurement of functional capacity.
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Early Detection of Mild Cognitive Impairment (MCI) in Primary Care.
Sabbagh, MN, Boada, M, Borson, S, Chilukuri, M, Dubois, B, Ingram, J, Iwata, A, Porsteinsson, AP, Possin, KL, Rabinovici, GD, et al
The journal of prevention of Alzheimer's disease. 2020;(3):165-170
Abstract
Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to multi-dimensional frictions and barriers associated with evaluating individuals' cognitive performance. To move toward large-scale cognitive screening, a global panel of clinicians and cognitive neuroscientists convened to elaborate on current challenges that hamper widespread cognitive performance assessment. This report summarizes a conceptual framework and provides guidance to clinical researchers and test developers and suppliers to inform ongoing refinement of cognitive evaluation. This perspective builds upon a previous article in this series, which outlined the rationale for and potentially against efforts to promote widespread detection of MCI. This working group acknowledges that cognitive screening by default is not recommended and proposes large-scale evaluation of individuals with a concern or interest in their cognitive performance. Such a strategy can increase the likelihood to timely and effective identification and management of MCI. The rising global incidence of AD demands innovation that will help alleviate the burden to healthcare systems when coupled with the potentially near-term approval of disease-modifying therapies. Additionally, we argue that adequate infrastructure, equipment, and resources urgently should be integrated in the primary care setting to optimize the patient journey and accommodate widespread cognitive evaluation.
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Artificial Intelligence in the assessment of diabetic retinopathy from fundus photographs.
Gilbert, MJ, Sun, JK
Seminars in ophthalmology. 2020;(7-8):325-332
Abstract
Background: Over the next 25 years, the global prevalence of diabetes is expected to grow to affect 700 million individuals. Consequently, an unprecedented number of patients will be at risk for vision loss from diabetic eye disease. This demand will almost certainly exceed the supply of eye care professionals to individually evaluate each patient on an annual basis, signaling the need for 21st century tools to assist our profession in meeting this challenge. Methods: Review of available literature on artificial intelligence (AI) as applied to diabetic retinopathy (DR) detection and predictionResults: The field of AI has seen exponential growth in evaluating fundus photographs for DR. AI systems employ machine learning and artificial neural networks to teach themselves how to grade DR from libraries of tens of thousands of images and may be able to predict future DR progression based on baseline fundus photographs. Conclusions: AI algorithms are highly promising for the purposes of DR detection and will likely be able to reliably predict DR worsening in the future. A deeper understanding of these systems and how they interpret images is critical as they transition from the bench into the clinic.
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Screening for Atherosclerotic Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus: Controversies and Guidelines.
Raggi, P
Canadian journal of diabetes. 2020;(1):86-92
Abstract
If a disease state is highly prevalent and its consequences are severe, it may be appropriate to seek methods to identify it early to forestall its development and complications. Diabetes mellitus is a proven risk factor for the development of atherosclerosis, although its face and outcome are changing, as shown in contemporary clinical trials. In fact, decompensated heart failure seems to drive the hospitalization rate in patients with diabetes, and mortality from heart failure is reduced with modern hypoglycemic treatments. Nonetheless, atherosclerotic complications continue to be a major health concern in this segment of the population and cardiovascular imaging has been employed in an attempt to achieve a more accurate risk stratification. Although imaging for detection of obstructive coronary artery disease failed to reach such a goal, imaging for preclinical atherosclerosis may be more successful. In this review, we discuss the use of computed tomography and positron emission tomography to detect preclinical coronary atherosclerosis in asymptomatic patients with diabetes. Despite recent advances in the field, several questions remain to be answered as to the ultimate benefit of imaging for prevention in diabetes mellitus.