Effectiveness of systematic screening for the detection of atrial fibrillation

© 2013 The Cochrane Collaboration. Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is a leading cause of morbidity and mortality. Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy prior to the onset of symptoms. However, for screening to be an effective intervention it must improve the detection of AF and provide benefit for those who are detected earlier as a result of screening. Objectives: The primary objective of this review was to examine whether screening programmes increase the detection of new cases of AF compared to routine practice. The secondary objectives were to identify which combination of screening strategy and patient population is most effective, as well as assessing any safety issues associated with screening, its acceptability within the target population and the costs involved. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE (Ovid) and EMBASE (Ovid) up to March 2012. Other relevant research databases, trials registries and websites were searched up to June 2012. Reference lists of identified studies were also searched for potentially relevant studies and we contacted corresponding authors for information about additional published or unpublished studies that may be relevant. No language restrictions were applied. Selection criteria: Randomised controlled trials, controlled before and after studies and interrupted time series studies comparing screening for AF with routine practice in people aged 40 years and over were eligible. Two authors (PM, CT or MF) independently selected the trials for inclusion. Data collection and analysis: Assessment of risk of bias and data extraction were performed independently by two authors (PM, CT). Odds ratios (OR) and 95% confidence intervals (CI) were used to present the results for the primary outcome, which is a dichotomous variable. Since only one included study was identified, no meta-analysis was performed. Main results: One cluster randomised controlled trial met the inclusion criteria for this review. This study compared systematic screening (by invitation to have an electrocardiogram (ECG)) and opportunistic screening (pulse palpation during a general practitioner (GP) consultation for any reason followed by an ECG if pulse was irregular) to routine practice (normal case finding on the basis of clinical presentation) in people aged 65 years or older. The risk of bias in the included study was judged to be low. Both systematic and opportunistic screening of people over the age of 65 years are more effective than routine practice (OR 1.57, 95% CI 1.08 to 2.26 and OR 1.58, 95% CI 1.10 to 2.29, respectively). The number needed to screen in order to detect one additional case compared to routine practice was 172 (95% CI 94 to 927) for systematic screening and 167 (95% CI 92 to 806) for opportunistic screening. Both systematic and opportunistic screening were more effective in men (OR 2.68, 95% CI 1.51 to 4.76 and OR 2.33, 95% CI 1.29 to 4.19, respectively) than in women (OR 0.98, 95% CI 0.59 to 1.62 and OR 1.2, 95% CI 0.74 to 1.93, respectively). No data on the effectiveness of screening in different ethnic or socioeconomic groups were available. There were insufficient data to compare the effectiveness of screening programmes in different healthcare settings. Systematic screening was associated with a better overall uptake rate than opportunistic screening (53% versus 46%) except in the ≥ 75 years age group where uptake rates were similar (43% versus 42%). In both screening programmes men were more likely to participate than women (57% versus 50% in systematic screening, 49% versus 41% in opportunistic screening) and younger people (65 to 74 years) were more likely to participate than people aged 75 years and over (61% versus 43% systematic, 49% versus 42% opportunistic). No adverse events associated with screening were reported. The incremental cost per additional case detected by opportunistic screening was GBP 337, compared to GBP 1514 for systematic screening. All cost estimates were based on data from the single included trial, which was conducted in the UK between 2001 and 2003. Authors' conclusions: Systematic and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice. While both approaches have a comparable effect on the overall AF diagnosis rate, the cost of systematic screening is significantly more than that of opportunistic screening from the perspective of the health service provider. The lack of studies investigating the effect of screening in other health systems and younger age groups means that caution needs to be exercised in relation to the transferability of these results beyond the setting and population in which the included study was conducted. Additional research is needed to examine the effectiveness of alternative screening strategies and to investigate the effect of the intervention on the risk of stroke for screened versus non-screened populations

Knowledge and attitudes of primary healthcare patients regarding population-based screening for colorectal cancer

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to assess the extent of knowledge of primary health care (PHC) patients about colorectal cancer (CRC), their attitudes toward population-based screening for this disease and gender differences in these respects.</p> <p>Methods</p> <p>A questionnaire-based survey of PHC patients in the Balearic Islands and some districts of the metropolitan area of Barcelona was conducted. Individuals between 50 and 69 years of age with no history of CRC were interviewed at their PHC centers.</p> <p>Results</p> <p>We analyzed the results of 625 questionnaires, 58% of which were completed by women. Most patients believed that cancer diagnosis before symptom onset improved the chance of survival. More women than men knew the main symptoms of CRC. A total of 88.8% of patients reported that they would perform the fecal occult blood test (FOBT) for CRC screening if so requested by PHC doctors or nurses. If the FOBT was positive and a colonoscopy was offered, 84.9% of participants indicated that they would undergo the procedure, and no significant difference by gender was apparent. Fear of having cancer was the main reason for performance of an FOBT, and also for not performing the FOBT, especially in women. Fear of pain was the main reason for not wishing to undergo colonoscopy. Factors associated with reluctance to perform the FOBT were: <b><it>(i) </it></b>the idea that that many forms of cancer can be prevented by exercise and, <b><it>(ii) </it></b>a reluctance to undergo colonoscopy if an FOBT was positive. Factors associated with reluctance to undergo colonoscopy were: <b><it>(i) </it></b>residence in Barcelona, <b><it>(ii) </it></b>ignorance of the fact that early diagnosis of CRC is associated with better prognosis, <b><it>(iii) </it></b>no previous history of colonoscopy, and <b><it>(iv) </it></b>no intention to perform the FOBT for CRC screening.</p> <p>Conclusion</p> <p>We identified gaps in knowledge about CRC and prevention thereof in PHC patients from the Balearic Islands and the Barcelona region of Spain. If fears about CRC screening, and CRC per se, are addressed, and if it is emphasized that CRC is preventable, participation in CRC screening programs may improve.</p

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

La saga del negro: presencia africana en Colombia

Nina S. de Friedemann estudia en este libro a la diáspora africana: los orígenes de las comunidades negras en Colombia; los asuntos relacionados con castas, mestizaje y blanqueamiento; la historia de los palenques y su importancia para el movimiento libertario, y la inserción de las comunidades negras en la economía actual. Con este estudio, señala la autora, se reconoce la historia de la africanía, deuda histórica que la academia y cultura colombiana no habían atendido con suficiente atención.Finalmente, menciona Nicolás Del Castillo Mathieu que: “En este libro puede confirmarse la facilidad con que Nina de Friedemann se mueve en el tema de los negros en las minas de oro de la costa Pacífica, su organización social (cuadrillas y troncos), sus métodos de trabajo y la vida cotidiana del minero, sus anhelos y necesidades. Y también en otros muchos temas como el aporte cultural africano en Colombia, en su música, arte e instituciones”.Tomado del prólogo de este documento.Agradecimientos;Prólogo;Introducción;África y américa;Negros, esclavos y cronistas de indias;Los africanos: cifras y origen;La diáspora africana y el péndulo de las cifras;Los orígenes y el predominio étnico;Regiones y procedencias;El negro en la sociedad colonial;De sol a sol: negros y códigos;Castas, mestizaje y blanqueamiento;Palenques o la temprana epopeya libertaria;Inserción y arraigo del negro;Minas y troncos en ríos de oro;Haciendas y linajes en tierras nuevas;Aportes del negro a la cultura colombiana;Raíces africanas y visiones culturales;Huellas de africanía y emblemas de nacionalidad;Hacia el siglo XX

Criele criele son. Del Pacífico negro

En “Criele criele son”, se hace un ejercicio de memoria cultural que vela por la autenticidad del vínculo entre la cultura afrocolombiana y los remotos orígenes africanos. Para realizar este examen, la autora explora la interacción entre significados de los actos litúrgicos, míticos y teológicos; así como los cambios físicos y sociohistóricos de las comunidades negras en el pacífico colombiano.Como objetivo de esta indagación, Nina S. de Friedemann propone hacer especial énfasis en “las transacciones étnicas, estratificación social, patrones de cortejo, guerras entre dioses, y diálogos entre aquellos que viven en el cielo y los habitantes de esta tierra”, desde una serie de narraciones que integran la voz de los protagonistas al relato científico. Así, se construye una visión particular del proceso etnográfico: riqueza iconográfica y objetividad científica integrada a las emociones de la autora como observadora.Biografía;Agradecimientos;Palabras e imágenes;Humor, amor y objetividad;Sentidos y contornos;Aprender, repasar y olvidar;No olvidar;Partituras pictográficas;Fotos y cine;La presencia;La identidad;Las explicaciones;Las manifestaciones;Las posibilidades;El equipaje;Por agua en una voladora;En la ruta del oro y del platino;La negra de las piñas;Del embil a la vela;La cachaloa de los franceses;Una ombligada de tapir;Cuando los canaletes roncan;Cagüingas, susungas y chancacas;Rocío Colorado en Las Flores;De cómo William Villa aprendió a mirar al santo;Un fraile que sí sabe;Un inmenso mar de luces;Yo conversé con la luna y hablé con todos los santos;En un taller de música;Bibliografía General;Glosari

Ma Ngombe: guerreros y ganaderos en Palenque

En este libro, se recogen los trabajos realizados por la investigadora Nina S. de Friedemann dentro de sus estudios sobre las comunidades negras en la costa atlántica colombiana. Destaca el relato en primera persona de la antropóloga que, con una narrativa ágil, introduce las anécdotas de sus viajes y procesos de inmersión en San Basilio de Palenque. Dentro de su investigación, Friedemann se enfoca en los procesos de blanqueamiento, adaptación evolutiva y supervivencia que han experimentado las comunidades negras a través del análisis de los elementos más auténticos de las mismas: su lengua, rituales litúrgicos, luchas sociales, organización social y circunstancias propias de la historia afrocolombiana desde la Colonia hasta el presente