-
1.
A position statement on screening and management of prediabetes in adults in primary care in Australia.
Bell, K, Shaw, JE, Maple-Brown, L, Ferris, W, Gray, S, Murfet, G, Flavel, R, Maynard, B, Ryrie, H, Pritchard, B, et al
Diabetes research and clinical practice. 2020;:108188
Abstract
Prediabetes has a high prevalence, with early detection essential to facilitate optimal management to prevent the development of conditions such as type 2 diabetes and cardiovascular disease. Prediabetes can include impaired fasting glucose, impaired glucose tolerance and elevated HbA1c. This position statement outlines the approaches to screening and management of prediabetes in primary care. There is good evidence to implement intensive, structured lifestyle interventions for individuals with impaired glucose tolerance. The evidence for those with impaired fasting glucose or elevated HbA1c is less clear, but individuals should still be provided with generalised healthy lifestyle strategies. A multidisciplinary approach is recommended to implement healthy lifestyle changes through education, nutrition and physical activity. Individuals should aim to lose weight (5-10% of body mass) using realistic and sustainable dietary approaches supported by an accredited practising dietitian, where possible. Physical activity and exercise should be used to facilitate weight maintenance and reduce blood glucose. Moderate-vigorous intensity aerobic exercise and resistance training should be prescribed by an accredited exercise physiologist, where possible. When indicated, pharmacotherapy, metabolic surgery and psychosocial care should be considered, in order to enhance the outcomes associated with lifestyle change. Individuals with prediabetes should generally be evaluated annually for their diabetes status.
-
2.
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.
-
3.
Epidemiology and Mechanisms of the Increasing Incidence of Colon and Rectal Cancers in Young Adults.
Stoffel, EM, Murphy, CC
Gastroenterology. 2020;(2):341-353
-
-
Free full text
-
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.
-
4.
Strategies to Tackle the Global Burden of Diabetic Retinopathy: From Epidemiology to Artificial Intelligence.
Wong, TY, Sabanayagam, C
Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde. 2020;(1):9-20
Abstract
Diabetes is a global public health disease projected to affect 642 million adults by 2040, with about 75% residing in low- and middle-income countries. Diabetic retinopathy (DR) affects 1 in 3 people with diabetes and remains the leading cause of blindness in working-aged adults. There are 3 broad strategic imperatives to prevent blindness caused by DR. Primary prevention requires preventing or delaying the onset of DR in those with diabetes by systems-level lifestyle modifications such as increasing physical activity or dietary modifications, pharmacological interventions for glycaemic and blood pressure control, and systematic screening for the onset of DR. Secondary prevention requires preventing the progression of DR in patients with DR by continuing systemic risk factor control, regular screening to monitor for the progression of mild DR to vision-threatening stages, and the development and implementation of evidence-based guidelines for managing DR. In this aspect, telemedicine-based DR screening incorporating artificial intelligence technology has the potential to facilitate more widespread and cost-effective screening, particularly in low- and middle-income countries. Tertiary prevention of DR blindness has been the main focus of the clinical ophthalmology community, classically based on laser photocoagulation treatment and ocular surgery but with an increasing use of anti-vascular endothelial growth factor (anti-VEGF) for vision-threatening DR. Evidence from serial epidemiological studies shows blindness due to DR has declined in high-income countries (e.g., the USA and UK) due to coordinated public health education efforts, increased awareness, early detection by DR screening, sustained systemic risk factor control, and the availability of effective tertiary level treatment. However, the progress made in reducing DR blindness in high-income countries may be overwhelmed by the increasing numbers of patients with diabetes and DR in low- and middle-income countries (e.g., China, India, Indonesia, etc.). Thus, to tackle DR at a global level, a paradigm shift in strategic focus from tertiary towards secondary and primary prevention measures with a multi-pronged whole-of-society approach at regional and national levels is urgently needed.
-
5.
The Impact of the International Cooperation On Familial Hypercholesterolemia Screening and Treatment: Results from the ScreenPro FH Project.
Ceska, R, Latkovskis, G, Ezhov, MV, Freiberger, T, Lalic, K, Mitchenko, O, Paragh, G, Petrulioniene, Z, Pojskic, B, Raslova, K, et al
Current atherosclerosis reports. 2019;(9):36
-
-
Free full text
-
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia (FH) is often perceived and described as underdiagnosed and undertreated, though effective treatment of FH is available. Owing to the mentioned facts, it is ever more imperative to screen and treat FH patients. Subsequent to the identification of patients, the project focuses on the improvement of their prognoses. The ScreenPro FH project was established as a functional international network for the diagnosis, screening, and treatment of FH. Individual countries were assigned goals, e.g., to define the actual situation and available treatment. With "central support," more centers and countries participated in the project. Subsequently, individual countries reported the results at the beginning and end of the project. Collected data were statistically evaluated. RECENT FINDINGS The increasing number of patients in databases, from 7500 in 2014 to 25,347 in 2018, demonstrates the improvement in overall effectiveness, as well as an increase in the number of centers from 70 to 252. Before all, LDL-C decreased by 41.5% and total cholesterol by 32.3%. As data from all countries and patients were not available at the time of the analysis, only those results from 10 countries and 5585 patients at the beginning of the project and at the time of writing are included. Our data are quite positive. However, our results have only limited validity. Our patients are far from the target levels of LDL-C. The situation can be improved with the introduction of new therapy, PCSK9-i, evolocumab, and alirocumab. International cooperation improved the screening of FH and finally led to an improvement in cardiovascular risk.
-
6.
Update on Screening for Sight-Threatening Diabetic Retinopathy.
Scanlon, PH
Ophthalmic research. 2019;(4):218-224
Abstract
PURPOSE The aim of this article was to describe recent advances in the use of new technology in diabetic retinopathy screening by looking at studies that assessed the effectiveness and cost-effectiveness of these technologies. METHODS The author conducts an ongoing search for articles relating to screening or management of diabetic retinopathy utilising Zetoc with keywords and contents page lists from relevant journals. RESULTS The areas discussed in this article are reference standards, alternatives to digital photography, area of retina covered by the screening method, size of the device and hand-held cameras, mydriasis versus non-mydriasis or a combination, measurement of distance visual acuity, grading of images, use of automated grading analysis and cost-effectiveness of the new technologies. CONCLUSIONS There have been many recent advances in technology that may be adopted in the future by screening programmes for sight-threatening diabetic retinopathy but each device will need to demonstrate effectiveness and cost-effectiveness before more widespread adoption.
-
7.
Colorectal Cancer in Brunei Darussalam: An Overview and Rationale for National Screening Programme.
Lim, MA, Chong, VH, Ong, SK, Lim, YC
Asian Pacific journal of cancer prevention : APJCP. 2019;(12):3571-3580
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide after lung and breast cancers, and ranks second in terms of cancer mortality globally. Brunei Darussalam reports high incidence of CRC in the Southeast Asian region and has no formal national screening programme for CRC. Screening for CRC in Brunei Darussalam is offered in an opportunistic fashion for individuals with average or above average risks for CRC, that is, the individual has a positive family history of CRC or neoplasms and is more than 50 years old. Opportunistic screening is widely practiced but this is not standardised. The Ministry of Health in Brunei Darussalam is currently in the process of implementing a CRC screening programme as part of a larger national health screening based on the increasing incidence of non-communicable diseases (NCDs). This review article assesses the situation of CRC in Brunei Darussalam from the 1980s to present day, including incidence of CRC in different age groups, ethnicities and genders; relevant non-modifiable and modifiable risk factors of CRC in Brunei Darussalam setting; and common CRC screening techniques used in Brunei Darussalam as well as other Asia-Pacific countries. The review also discusses the merits of a national CRC screening programme. With the increasing incidence of CRC worldwide and in Brunei Darussalam, national screening for CRC in Brunei Darussalam is an important strategy to lower morbidity and mortality rates. A review of the progress and outcome of the national screening programme will be available a few years after rollout.
-
8.
Malnutrition Screening and Assessment in Hospitalised Older People: a Review.
Dent, E, Hoogendijk, EO, Visvanathan, R, Wright, ORL
The journal of nutrition, health & aging. 2019;(5):431-441
-
-
Free full text
-
Abstract
Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.
-
9.
Screening, diagnosis and treatment of iron deficiency in chronic heart failure: putting the 2016 European Society of Cardiology heart failure guidelines into clinical practice.
McDonagh, T, Damy, T, Doehner, W, Lam, CSP, Sindone, A, van der Meer, P, Cohen-Solal, A, Kindermann, I, Manito, N, Pfister, O, et al
European journal of heart failure. 2018;(12):1664-1672
Abstract
Iron deficiency is common in patients with chronic heart failure (CHF) and is associated with reduced exercise performance, impaired health-related quality of life and an increased risk of mortality, irrespective of whether or not anaemia is present. Iron deficiency is a serious but treatable condition. Several randomized controlled clinical trials have demonstrated the ability of intravenous (IV) iron, primarily IV ferric carboxymaltose (FCM), to correct iron deficiency in patients with heart failure with reduced ejection fraction (HFrEF), resulting in improvements in exercise performance, CHF symptoms and health-related quality of life. The importance of addressing the issue of iron deficiency in patients with CHF is reflected in the 2016 European Society of Cardiology (ESC) heart failure guidelines, which recognize iron deficiency as an important co-morbidity, independent of anaemia. These guidelines recommend that all newly diagnosed heart failure patients are routinely tested for iron deficiency and that IV FCM should be considered as a treatment option in symptomatic patients with HFrEF and iron deficiency (serum ferritin < 100 µg/L, or ferritin 100-299 µg/L and transferrin saturation < 20%). Despite these specific recommendations, there is still a lack of practical, easy-to-follow advice on how to diagnose and treat iron deficiency in clinical practice. This article is intended to complement the current 2016 ESC heart failure guidelines by providing practical guidance to all health care professionals relating to the procedures for screening, diagnosis and treatment of iron deficiency in patients with CHF.
-
10.
Automated Screening for Diabetic Retinopathy - A Systematic Review.
Nørgaard, MF, Grauslund, J
Ophthalmic research. 2018;(1):9-17
Abstract
PURPOSE Worldwide ophthalmologists are challenged by the rapid rise in the prevalence of diabetes. Diabetic retinopathy (DR) is the most common complication in diabetes, and possible consequences range from mild visual impairment to blindness. Repetitive screening for DR is cost-effective, but it is also a costly and strenuous affair. Several studies have examined the application of automated image analysis to solve this problem. Large populations are needed to assess the efficacy of such programs, and a standardized and rigorous methodology is important to give an indication of system performance in actual clinical settings. METHODS In a systematic review, we aimed to identify studies with methodology and design that are similar or replicate actual screening scenarios. A total of 1,231 publications were identified through PubMed, Cochrane Library, and Embase searches. Three manual search strategies were carried out to identify publications missed in the primary search. Four levels of screening identified 7 studies applicable for inclusion. RESULTS Seven studies were included. The detection of DR had high sensitivities (87.0-95.2%) but lower specificities (49.6-68.8%). False-negative results were related to mild DR with a low risk of progression within 1 year. Several studies reported missed cases of diabetic macular edema. A meta-analysis was not conducted as studies were not suitable for direct comparison or statistical analysis. CONCLUSION The study demonstrates that despite limited specificity, automated retinal image analysis may potentially be valuable in different DR screening scenarios with a relatively high sensitivity and a substantial workload reduction.