Tuberculosis Knowledge, Attitudes, and Practice in Middle- and Low-Income Countries: A Systematic Review

Tuberculosis (TB) is the leading cause of death from an infectious agent in the world. Most tuberculosis cases are concentrated in low- and middle-income countries. The aim of this study is to better understand tuberculosis-related knowledge about TB disease, prevention, treatment and sources of information, attitudes towards TB patients and their stigmatization and prevention, diagnosis and treatment practices in the general population of middle- and low-income countries, with a high tuberculosis burden, and provide evidence for policy development and decision-making. A systematic review of 30 studies was performed. Studies reporting on knowledge, attitudes, and practices surveys were selected for systematic review through database searching. Population knowledge about TB signs and symptoms, prevention practices, and treatment means was found inadequate. Stigmatization is frequent, and the reactions to possible diagnoses are negative. Access to health services is limited due to difficulties in transportation, distance, and economic cost. Deficiencies in knowledge and TB health-seeking practices were present regardless of the living area, gender, or country; however, it seems that there is a frequent association between less knowledge about TB and a lower socioeconomic and educational level. This study revealed gaps in knowledge, attitude, and practices in focused in middle- and low-income countries. Policymakers could take into account the evidence provided by the KAP surveys and adapt their strategies based on the identified gaps, promoting innovative approaches and empowering the communities as key stakeholders. It is necessary to develop education programs on symptoms, preventive practices, and treatment for TB, to reduce transmission and stigmatization. It becomes also necessary to provide communities with innovative healthcare solutions to reduce their barriers to access to diagnosis and treatment.Tuberculosis (TB) is the leading cause of death from an infectious agent in the world. Most tuberculosis cases are concentrated in low- and middle-income countries. The aim of this study is to better understand tuberculosis-related knowledge about TB disease, prevention, treatment and sources of information, attitudes towards TB patients and their stigmatization and prevention, diagnosis and treatment practices in the general population of middle- and low-income countries, with a high tuberculosis burden, and provide evidence for policy development and decision-making. A systematic review of 30 studies was performed. Studies reporting on knowledge, attitudes, and practices surveys were selected for systematic review through database searching. Population knowledge about TB signs and symptoms, prevention practices, and treatment means was found inadequate. Stigmatization is frequent, and the reactions to possible diagnoses are negative. Access to health services is limited due to difficulties in transportation, distance, and economic cost. Deficiencies in knowledge and TB health-seeking practices were present regardless of the living area, gender, or country; however, it seems that there is a frequent association between less knowledge about TB and a lower socioeconomic and educational level. This study revealed gaps in knowledge, attitude, and practices in focused in middle- and low-income countries. Policymakers could take into account the evidence provided by the KAP surveys and adapt their strategies based on the identified gaps, promoting innovative approaches and empowering the communities as key stakeholders. It is necessary to develop education programs on symptoms, preventive practices, and treatment for TB, to reduce transmission and stigmatization. It becomes also necessary to provide communities with innovative healthcare solutions to reduce their barriers to access to diagnosis and treatment.S

Radiocirugía giroscópica para el tratamiento de lesiones cerebrales, y del área de cabeza y cuello

La radiocirugía estereotáctica (SRS, del inglés stereotactic radiosurgery) es una forma de radioterapia no invasiva, no quirúrgica, de gran precisión, indicada principalmente para el tratamiento de lesiones cerebrales o intracraneales. La SRS cerebral permite la administración, en una única sesión, de altas dosis de radiación sobre zonas pequeñas del cerebro con el objetivo de alterar la función de estructuras craneales anormales que son difíciles de alcanzar con otros métodos.N

A New Hierarchy of Research Evidence for Tumor Pathology: A Delphi Study to Define Levels of Evidence in Tumor Pathology

The hierarchy of evidence is a fundamental concept in evidence-based medicine, but existing models can be challenging to apply in laboratory-based health care disciplines, such as pathology, where the types of evidence and contexts are significantly different from interventional medicine. This project aimed to define a comprehensive and complementary framework of new levels of evidence for evaluating research in tumor pathology-introducing a novel Hierarchy of Research Evidence for Tumor Pathology collaboratively designed by pathologists with help from epidemiologists, public health professionals, oncologists, and scientists, specifically tailored for use by pathologists-and to aid in the production of the World Health Organization Classification of Tumors (WCT) evidence gap maps. To achieve this, we adopted a modified Delphi approach, encompassing iterative online surveys, expert oversight, and external peer review, to establish the criteria for evidence in tumor pathology, determine the optimal structure for the new hierarchy, and ascertain the levels of confidence for each type of evidence. Over a span of 4 months and 3 survey rounds, we collected 1104 survey responses, culminating in a 3-day hybrid meeting in 2023, where a new hierarchy was unanimously agreed upon. The hierarchy is organized into 5 research theme groupings closely aligned with the subheadings of the WCT, and it consists of 5 levels of evidence-level P1 representing evidence types that merit the greatest level of confidence and level P5 reflecting the greatest risk of bias. For the first time, an international collaboration of pathology experts, supported by the International Agency for Research on Cancer, has successfully united to establish a standardized approach for evaluating evidence in tumor pathology. We intend to implement this novel Hierarchy of Research Evidence for Tumor Pathology to map the available evidence, thereby enriching and informing the WCT effectively.The overall project, International Agency for Research on Cancer, and beneficiaries (German Heart Centre Munich, Maria Sklodowska-Curie National Research Institute of Oncology, and Instituto de Salud Carlos III) are funded by the European Commission (HORIZON grant no. 101057127). R.C. and F.C. are funded by UK Research and Innovation. S.H. has received research funding or honoraria from Roche, BMS, Merck, Sysmex, Thermo, Volition, Trillium, Medica, and Instand and is a founder of SFZ BioCoDE and CEBIO. P.H.T. has received honoraria from AstraZeneca.S

Cómo poner puertas al campo : tres revisiones panorámicas sobre el uso de biomarcadores en prevención personalizada de enfermedades crónicas

Se incluye PDF de la presentación y vídeo del seminario.El seminario trata de dar respuesta a qué biomarcadores hay disponibles o en desarrollo para la prevención personalizada de enfermedades crónicas en la población general. Las revisiones realizadas resumen las principales características y conclusiones de la bibliografía sobre este tema. Abarca los tres principales grupos de enfermedades crónicas:11 tipos de cáncer, 9 enfermedades cardiovasculares y 7 enfermedades neurodegenerativas.N

Use of hyaluronic acid dermal fillers for the treatment of periocular pathology associated with facial paralysis and other causes of eyelid malposition

Pdf y Epub del documento[ES] Las patologías perioculares son alteraciones de la zona periorbicular que comprende párpados inferior y superior, ceja, músculos y estructuras que las conforman. Una de las causas más frecuentes de estas patologías es la parálisis facial periférica que consiste en una disminución o ausencia completa de movimiento en algunos o en todos los músculos inervados por el VII par craneal. Las malposiciones palpebrales pueden deberse a múltiples causas que incluyen traumatismos, causas iatrogénicas, malposiciones involutivas a causa de la edad, la orbitopatía tiroidea y enfermedades congénitas. Las alternativas para el tratamiento de la patología periocular en pacientes con parálisis facial y otras malposiciones incluyen la cirugía, el tratamiento con agentes farmacológicos y las inyecciones con rellenadores de ácido hialurónico (AH). El uso de rellenadores de AH puede ser de utilidad en algunas situaciones clínicas en pacientes seleccionados, permitiendo realizar re-intervenciones hasta conseguir el resultado deseado y un manejo flexible en el caso de pacientes con una condición que cambie o evolucione con el tiempo. También puede resultar útil en pacientes que rechazan la cirugía o que no son elegibles para la misma. [EN] Periocular pathologies are alterations of the periorbicular area that includes the lower and upper eyelids, eyebrow, muscles and structures that make them up. One of the most frequent causes of these pathologies is peripheral facial paralysis, which consists of a decrease or complete absence of movement in some or all of the muscles innervated by the seventh cranial nerve. Eyelid malpositions can be due to multiple causes including trauma, iatrogenic causes, aging related involu tional malpositions, thyroid orbitopathy and congenital diseases.Alternatives for the treatment of periocular pathology in patients with facial paralysis and other malpositions include surgery, treatment with pharmacological agents and injections with hyaluronic acid (HA) fillers. The use of HA fillers can be useful in some clinical situations in selected patients, it allows for re-interventions until the desired result is achieved and it facilitates flexible management in the case of patients with a condition that changes or evolves over time. It may also be useful in patients who refuse surgery or who are not eligible for it.N

How to stem the tide? Development of three scoping reviews in biomarkers and personalized prevention

XLI Reunión anual de la Sociedad Española de Epidemiología (SEE) y XVIII Congresso da Associação Portuguesa de Epidemiología (APE). Porto (Portugal), del 5 al 8 de septiembre de 2023.The “PeRsOnalized Prevention roadmap for the future HEalThcare” (PROPHET) project, seeks to assess the effectiveness, clinical utility and existing gaps in current personalized preventive approaches, and to develop a Strategy Research and Innovation Agenda (SRIA) for the European Union. The first draft of the SRIA concept paper needs to incorporate the state of the art of personalized prevention carried out through scoping reviews. Among them, our work aimed to answer whether there is any biomarker or combination of biomarkers that can help to better identify subgroups of individuals with different risks of developing a particular disease for primary or secondary prevention. These results were needed at early stage of the project; despite covering such a broad topic, it had to be carried out in record time (4 months) by a geographically dispersed team (Granada, Madrid, United Kingdom). Our challenge has been to maintain effective coordination and speed without losing scientific rigor. Between Feb-June 2023, our team conducted three independent scoping reviews (for cardiovascular diseases, neurodegenerative diseases and cancer, respectively) that involved quick and difficult decisions to narrow down the inclusion criteria, study populations, biomarkers included, and types of prevention. To maintain consistency, we created different glossaries and had multiple meetings and constant contact between team members. As a first step, we identified key terms on the topics of interest, helped by expert consultations, identification of significant publications and several specific tools (SR-Accelerator, etc.). A pilot study was conducted to refine the search matrix and to initiate coordination among reviewers. However, in order to shorten timeframes, we limited peer review to 10% of the records in all phases. The protocol, published in OSF, served as a guide for the report. All phases, when possible, overlapped to deliver the report on time. In addition, we made interactive evidence maps to show the results graphically, thanks to the creation of a script, using R and Python, to allow the input of the datasheet extraction file into the mapping application. Despite these challenges, we successfully met the project deadlines.Funding: HE No 10105772. UKRI No 10040946.N

Biomarkers for personalised prevention of chronic diseases: a common protocol for three rapid scoping reviews

Dataset disponible en: http://hdl.handle.net/20.500.12105/19630Introduction: Personalised prevention aims to delay or avoid disease occurrence, progression, and recurrence of disease through the adoption of targeted interventions that consider the individual biological, including genetic data, environmental and behavioural characteristics, as well as the socio-cultural context. This protocol summarises the main features of a rapid scoping review to show the research landscape on biomarkers or a combination of biomarkers that may help to better identify subgroups of individuals with different risks of developing specific diseases in which specific preventive strategies could have an impact on clinical outcomes. This review is part of the "Personalised Prevention Roadmap for the future HEalThcare" (PROPHET) project, which seeks to highlight the gaps in current personalised preventive approaches, in order to develop a Strategic Research and Innovation Agenda for the European Union. Objective: To systematically map and review the evidence of biomarkers that are available or under development in cancer, cardiovascular and neurodegenerative diseases that are or can be used for personalised prevention in the general population, in clinical or public health settings. Methods: Three rapid scoping reviews are being conducted in parallel (February-June 2023), based on a common framework with some adjustments to suit each specific condition (cancer, cardiovascular or neurodegenerative diseases). Medline and Embase will be searched to identify publications between 2020 and 2023. To shorten the time frames, 10% of the papers will undergo screening by two reviewers and only English-language papers will be considered. The following information will be extracted by two reviewers from all the publications selected for inclusion: source type, citation details, country, inclusion/exclusion criteria (population, concept, context, type of evidence source), study methods, and key findings relevant to the review question/s. The selection criteria and the extraction sheet will be pre-tested. Relevant biomarkers for risk prediction and stratification will be recorded. Results will be presented graphically using an evidence map. Inclusion criteria: Population: general adult populations or adults from specific pre-defined high-risk subgroups; concept: all studies focusing on molecular, cellular, physiological, or imaging biomarkers used for individualised primary or secondary prevention of the diseases of interest; context: clinical or public health settings. Systematic review registration: https://doi.org/10.17605/OSF.IO/7JRWD (OSF registration DOI).The PROPHET project has received funding from the European Union’s Horizon Europe research and innovation program under grant agreement no. 101057721. UK participation in Horizon Europe Project PROPHET is supported by UKRI grant number 10040946 (Foundation for Genomics & Population Health).S

Interactive Gap Maps on Available Biomarkers for Risk Prediction and Stratification in Cancer, Cardiovascular, and Neurodegenerative Diseases (PROPHET Project)

Web del proyecto: https://biodama.isciii.es/prophet/ | Material: “Biomarkers for personalized prevention of chronic diseases”: https://osf.io/wg62b/ - "Interactive Evidence Gap Maps": https://osf.io/48g5p/Artículo disponible en: http://hdl.handle.net/20.500.12105/19654[EN] The PROPHET project (“PeRsOnalized Prevention roadmap for the future HEalThcare”), funded by the European Union's Horizon Europe research and innovation program, aims to assess the effectiveness, clinical utility, key success factors, and gaps in personalised preventive approaches for healthcare settings. One of the main task focuses on biomarkers for personalised prevention in the general adult population and their integration with digital technologies. The objective of the task is to highlight gaps in biomarkers research for primary and secondary prevention for cancer, cardiovascular, and neurodegenerative diseases. Three rapid scoping reviews were conducted in parallel by three research teams, one for each group of diseases: cancer, cardiovascular and neurodegenerative diseases. The reviews used a common protocol and framework for searching, data extraction and the representation of results, with disease specific corresponding information and specifications. The following evidence and gap map is a product of these scoping reviews. [ES] El proyecto PROPHET (“PeRsOnalized Prevention roadmap for the future HEalThcare”), financiado por el programa de investigación e innovación Horizonte Europa de la Unión Europea, tiene como objetivo evaluar la eficacia, la utilidad clínica, los factores clave de éxito y las lagunas en los enfoques preventivos personalizados para entornos sanitarios. Una de las principales tareas se centra en los biomarcadores para la prevención personalizada en la población adulta general y su integración con las tecnologías digitales. El objetivo de la tarea es resaltar las lagunas en la investigación de biomarcadores para la prevención primaria y secundaria del cáncer, enfermedades cardiovasculares y neurodegenerativas. Tres equipos de investigación llevaron a cabo en paralelo tres revisiones rápidas de alcance, una para cada grupo de enfermedades: cáncer, enfermedades cardiovasculares y neurodegenerativas. Las revisiones utilizaron un protocolo y un marco común para la búsqueda, la extracción de datos y la representación de los resultados, con la información y especificaciones correspondientes específicas de la enfermedad. La siguiente evidencia y mapa de brechas es producto de estas revisiones de alcance.Co-funded by the European Union. UK participant in Horizon Europe Project PROPHET is supported by UKRI grant number 10040946 (Foundation for Genomics & Population Health)