Prevalence and clinical characteristics of polymyositis in a Chinese cohort / 中华风湿病学杂志

Objective:To analyze the frequency and characteristics of polymyositis (PM) in idiopathic inflammatory myopathy (IIM), and to investigate whether PM is over-diagnosed.Methods:Patients diagnosed as IIM according to the Bohan & Peter criteria of IIM hospitalized in the Department of Rheumatology of China-Japan Friendship Hospital from 2008 to 2019 were involved in the study. Definite PM (dPM) was defined as typical clinical and pathological features including elevated creatine kinase (CK) level, muscle weakness and muscle biopsy findings with endomysial CD8 + T cell infiltration and expression of MHC-1 on sarcolemma. Meanwhile, dermatomyositis (DM), anti-synthase syndrome(ASS), immune-mediated necrotic myopathy(IMNM), sporadic inclusion body myositis(sIBM) and other myopathies were excluded according to the new classification criteria of IIM subtypes respectively. Statistical analysis was performed using SPSS software 24.0. The Kruskal-Wallis test and χ2 test were used to compare the clinical characteristics between the dPM group and other IIM subtypes. Results:A total of 1 259 patients with IIM including 1 015 (80.6%) DM and 244(19.4%) PM were enrolled in this study. According to the strict definition of PM criteria, only 0.5% of patients (6/1 259) in IIM could be diagnosed as dPM. Most PM patients were IMNM and ASS according to the new IIM subtypes criteria, of which 48.0% (117/244) were IMNM and 32.0% (78/244) were ASS. 66.7%(4/6) of dPM patients were women. One complicated with RA, and one was dPM overlaped with systemic sclerosis. All of them had muscle weakness, mild elevation of CK level [611(391,1 451) U/L], and were myositis-specific autoantibodies negative. Except one dPM patients who did not receive immunoregulatory therapy due to chronic obstructive pulmonary disease, the others were administrated with low or medium dose prednisone combined with or without immunosuppressive agents. After a median follow-up of (38±26) months, the muscle strength of dPM patients were improved.Conclusion:dPM is a very rare clinical subtype of IIM. PM is an over-diagnosed entity in clinical practice. Patients with dPM have mild symptoms and good outcome.

Sobrediagnóstico: prejudicando pacientes em nome da saúde / Sobrediagnóstico: daño a las personas en nombre da la salud / Overdiagnosis: harming people in the name of health

À medida que os avanços médico-tecnológicos continuam a se tornar mais facilmente disponíveis, o diagnóstico de pseudo-doenças atingiu o cerne dos sistemas de saúde e tornou-se uma das atividades mais prejudiciais da medicina moderna, tanto individual quanto coletivamente, pois ameaça a sustentabilidade dos sistemas de saúde. Aqui descrevemos um caso hipotético, mas baseado em casos reais, de uma jovem de 36 anos diagnosticada com um carcinoma papilífero de tireoide após ter sido submetida a um check-up excessivo e desnecessário solicitado por um ginecologista em uma consulta de rotina. (AU)

As medical technological advances continue to become more readily available, diagnosis of pseudo-disease has hit the heart of medicine and has become one of the most harmful activities in modern medicine, both individually and collectively speaking as it threatens the sustainability of health systems. Here we describe a hypothetical case (but based on many similar real ones) of a young adult woman in her middle 30's that has been diagnosed with a papillary thyroid cancer after she had been submitted to an excessive and unnecessary check-up elicited by a gynaecologist in a routine medical consultation. (AU)

Revisión de los criterios diagnósticos para el síndrome de ovario poliquístico / Review of diagnostic criteria for polycystic ovary syndrome

Resumen El síndrome de ovario poliquístico, es la alteración endocrina metabólica más frecuente en mujeres en edad fértil, teniendo implicaciones a nivel reproductivo, metabólico, cardiovascular y psicosocial. Actualmente, su sobrediagnóstico corresponde a una problemática común derivada de la heterogeneidad en la aplicación de los criterios actualmente avalados para su hallazgo, lo que ha contribuido en el incremento de tratamientos innecesarios, así como los efectos negativos en la calidad de vida y el bienestar de las pacientes falsamente calificadas con este trastorno. Se realizó una búsqueda en PubMed-MENDELEY y Ovid entre los meses de Febrero a Abril del 2020, obteniendo 43 artículos relacionados con el tema, publicados en los últimos 10 años. El conocimiento por parte del personal médico capacitado sobre los consensos actuales para la correcta evaluación del síndrome y el estudio individualizado de cada caso, corresponden las medidas más apropiadas para la reducción del sobrediagnóstico. MÉD.UIS.2020;33(3):21-28

Abstract Polycystic ovary syndrome is the most frequent metabolic endocrine disorder in women of childbearing age, having implications at both the reproductive, metabolic, cardiovascular and psychosocial levels. Currently, its overdiagnosis corresponds to a common problem derived from the heterogeneity in the application of the criteria currently endorsed for its discovery, which has contributed to the increase in unnecessary treatments, as well as the negative effects on the quality of life and well-being of falsely rated patients with this disorder. A search was made in PubMed-MENDELEY and Ovid between the months of February to April of 2020, obtaining 43 articles related to the topic, published in the last 10 years. The knowledge on the part of the trained medical personnel about the current consensuses for the correct evaluation of the syndrome and the individualized study of each case, correspond to the most appropriate measures for the reduction of this event. MÉD.UIS.2020;33(3):21-28

Evidencia de sobrediagnóstico en el TDAH en base a evaluación neuropsicológica: un estudio en escolares chilenos / Evidence of overdiagnosis in Attention Deficit Hyperactivity Disorder (ADHD) based on neuropsychological evaluation: a study in Chilean students

Resumen Objetivo: El Trastorno por Déficit de Atención con Hiperactividad/impulsividad (TDAH) es una de las dificultades de aprendizaje más comunes en las escuelas chilenas. Se caracteriza por un patrón de funcionamiento atípico en atención e inhibición, con fuerte compromiso de otras funciones ejecutivas. Uno de los desafíos que plantea este trastorno está referido al proceso de diagnosis, el cual no suele ser suficientemente preciso. Se pretende explorar las diferencias en la distribución de dos muestras de estudiantes con y sin TDAH diagnosticadas con una escala de observación conductual a través de la evaluación de las funciones ejecutivas de atención, inhibición y flexibilidad cognitiva. Método: En este estudio se evaluó a 132 escolares, 66 con TDAH y 66 sin TDAH, en las variables de atención, inhibición y flexibilidad cognitiva de un colegio de la ciudad de Concepción en Chile. Se contrastó el rendimiento cognitivo con los diagnósticos y se reagrupó a los estudiantes en los subtipos conocidos del trastorno. Resultados: La evaluación neuropsicológica mostró que en el grupo con TDAH había alumnos que no cumplían los criterios diagnósticos para estar incluidos en él. En el grupo sin TDAH se observó un fenómeno semejante. En ambos grupos la evaluación neuropsicológica de la atención y la inhibición resultaron útiles para diagnosticar con mayor certeza y para determinar el subtipo al que pertenecía cada estudiante con TDAH detectado. La flexibilidad cognitiva solo permitió diferenciar a los sujetos con y sin TDAH. Conclusiones: En ambos grupos estudiados fue posible encontrar sujetos mal diagnosticados; el sobrediagnóstico fue de 43,93 % en el grupo con TDAH, mientras que el infradiagnóstico fue de 42,42 % en el grupo sin TDAH.

Abstract Objective: Attention Deficit Hyperactivity/Impulsivity Disorder (ADHD) is one of the most common learning difficulties in Chilean schools. It is characterized by an atypical functioning pattern in attention and inhibition, strongly compromising other executive functions. One of the challenges posed by this disorder is the diagnosis process, which is often not sufficiently accurate. The intention is to study the distribution of two students samples, with and without ADHD, diagnosed by a behavioral observation scale through the evaluation of attention, inhibition, and cognitive flexibility executive functions. Method: This study evaluated 132 students, 66 with ADHD and 66 without ADHD, considering the attention, inhibition, and cognitive flexibility variables of a school in the city of Concepción in Chile. Cognitive performance was contrasted with the diagnoses, and students were regrouped in the disorder known subtypes. Results: The neuropsychological evaluation showed that in the ADHD group, there were students who did not meet the diagnostic criteria to be included in the group. A similar phenomenon was observed in the group without ADHD. In both the groups, the neuropsychological evaluation of attention and inhibition was useful in providing a more certain dignosis and in determining the subtype to which each student detected with ADHD belonged. Cognitive flexibility was only useful in differentiating betwen the subjects with and without ADHD. Conclusions: In both the groups studied, it was possible to find misdiagnosed subjects; the overdiagnosis was 43,93 % in the ADHD group, while the under-diagnosis was 42,42 % in the group without ADHD.

Evidence of National Lung Cancer Screening Program in Korea

Lung cancer is a leading cause of cancer death worldwide. The effectiveness of lung cancer targeted high-risk population using low dose chest computed tomography has been reported several randomized controlled trials. Thus, recently, lung cancer screening to high-risk group is recommended internationally. National Cancer Center reported a lung cancer screening guideline by evidence-based methods in 2015. Korean national lung cancer screening program started from 2019 after evaluation of Korean lung cancer screening demonstration project (K-LUCAS) nationwide. K-LUCAS obtained comparable high early lung cancer detection rate, lower false positive rate and lower complication rate compared with clinical trials conducted in other countries. Also psychological anxiety of screening participants had been low, but willingness of smoking cessation had been increased after screening. This paper will review the evidence of lung cancer screening from clinical trials, also, evaluate the benefits and harms of screening based on K-LUCAS.

Sobrediagnóstico: "Un mal que daña a nuestros niños" / First do no harm: overdiagnosis in Pediatrics

Pueden cometerse muchos errores en el momento de hacer un diagnóstico: subdiagnosticar, hacer un diagnóstico equivocado y sobrediagnosticar. Mientras que el subdiagnóstico y el diagnóstico equivocado son errores obvios, cuando se sobrediagnostica se descubre una anomalía real, pero la detección no beneficia al paciente. El daño ocurre cuando se continúa evaluando al paciente y se lo trata innecesariamente por una afección que, de no haberse diagnosticado, nunca lo habría afectado. Son varios los fenómenos que apuntan a un posible sobrediagnóstico: que la demora u omisión de un diagnóstico no ocasione daños; que aumente la detección de una enfermedad, pero no haya cambios en los resultados, y que los estudios aleatorizados no muestren ningún beneficio con el diagnóstico.Hay quienes dirían que el saber siempre reporta beneficios, pero los efectos adversos del sobrediagnóstico están bien documentados. Tendremos que adquirir más conocimientos sobre el daño que puede generar el sobrediagnóstico y transmitirlos a nuestros colegas, y deberemos aprender a encontrar el equilibrio entre el posible beneficio de un diagnóstico y el riesgo del sobrediagnóstico.

Many errors can be made in diagnosis: underdiagnosis, misdiagnosis, and overdiagnosis. While underdiagnosis and misdiagnosis are clear errors, in overdiagnosis, a true abnormality is discovered, but detection does not benefit the patient. Harm occurs when patients are further evaluated and treated unnecessarily as a result of making a diagnosis that would never have affected the patient if the diagnosis had not been made. Several phenomena point to potential overdiagnosis: when delayed or missed diagnoses do not result in harm; when there is increased detection of a disease, but no change in the outcome; and when randomized trials show no benefit from the diagnosis. Some might say that there is always benefit in knowing, but the adverse effects of overdiagnosis are well documented. We will need to educate ourselves and our colleagues about the potential for harm from overdiagnosis, and learn how to balance the potential benefit of a diagnosis against the risk of overdiagnosis.

Thyroid cancer burden and economic impact on the Brazilian public health system

ABSTRACT Objective: Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. Materials and methods: Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. Results: A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. Conclusion: The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.

Prevención cuaternaria: como hacer, como ensiñar / Quaternary prevention: how to do, how to teach / Prevenção quaternária: como fazer, como ensinar

La prevención cuaternaria o P4 se define como las acciones que disminuyen los efectos de las intervenciones innecesarias, generadas por el contacto de las personas con los sistemas de salud. Se planteó como objetivo general desarrollar una estrategia para promover y difundir P4 em Iberoamérica; para cumplir dicha meta se realizó una investigación bibliográfica sobre los conceptos relacionados con P4; se aplicó una encuesta exploratoria para indagar sobre el conocimiento que tenían los participantes en la Cumbre y el Congreso respecto a P4. Existe múltiple literatura que define los términos relacionados con P4, lo que facilita su delimitación. Respecto a la encuesta, de las 309 personas que contestaron; 34% tenían entre 36 y 45 años; 88% eran profesionales en medicina; 69% conocía sobre P4 y más del 50% afirmó estar informado sobre los conceptos relacionados a P4; 92% consideró que P4 no es exclusiva de medicina familiar; 15% aseguró que después de la VI Cumbre se hicieron publicaciones sobre P4 en sus países; menos del 20% consideró que los políticos conocen sobre P4; 27% afirmó que los médicos de familia educan a los pacientes sobre P4. Se recomienda ampliar las campañas de educación sobre P4; facilitar el acceso a la información sobre P4 para profesionales del campo de la salud; incluir P4 en los programas académicos de pregrado y postgrado de las profesiones de la salud; crear alianzas con las entidades políticas de cada país para incluir P4 en políticas públicas.

Quaternary prevention or P4 is defined as any action taken to diminish the effects of unnecessary interventions generated when people interact with a health system. Methodology.The general objective was to develop a strategy to promote and spread P4 in Iberoamerica; to fulfill this goal a literature research was carried out, on the concepts related to P4; an exploratory survey was applied to inquire about the knowledge of the participates in the Summit and Congress, regarding P4 Results. There multiple literature sources that define the terms related to P4, which facilitated its delimitation. Regarding the survey, 69% knew about P4 and more that 50% declared that they where informed about the concepts related to P4; 92% considered that P4 is not only limited to family medicine; 15% assured that after the VI Summit publication regarding P4 where published in their countries; less than 20% stated that politicians knew about P4; 27% affirmed that family medicine doctors educate their patients about P4 Conclusions. It is recommended to expand the educational campaigns about P4; facilitate the access to information about P4 for professionals in the health field; include P4 in the academic programs of health professional for both graduate and post-graduate students; create alliances with political entities of each country to include P4 in public health policies.

A prevenção quaternária ou P4 é definida como ações que reduzem os efeitos de intervenções desnecessárias, geradas pelo contato das pessoas com os sistemas de saúde. O objetivo geral foi desenvolver uma estratégia para promover e disseminar o P4 na Ibero-América; Para atingir este objetivo, foi realizada uma pesquisa bibliográfica sobre os conceitos relacionados a P4; Uma pesquisa exploratória foi aplicada para indagar sobre o conhecimento que os participantes da Cúpula e do Congresso tinham sobre P4. Há uma diversidade de literatura que define os termos relacionados a P4, o que facilita sua delimitação. Em relação à pesquisa, das 309 pessoas que responderam; 34% tinham entre 36 e 45 anos; 88% eram profissionais de medicina; 69% conheciam o P4 e mais de 50% disseram que estavam informados sobre os conceitos relacionados ao P4; 92% consideraram que P4 não é exclusivo de medicina de família; 15% disseram que, após a VI Cúpula, foram feitas publicações sobre P4 em seus países; menos de 20% considerou que os políticos conhecem o P4; 27% disseram que os médicos de família educam os pacientes sobre o P4. Recomenda-se expandir as campanhas de educação sobre P4; facilitar o acesso à informação sobre P4 para profissionais da área da saúde; incluir P4 nos programas acadêmicos de graduação e pós-graduação das profissões de saúde; criar parceiras com as entidades políticas de cada país para incluir P4 nas políticas públicas

Preoperative ultrasonography of thyroid cancers:is it overdiagnosis or underdiagnosis? / 中华超声影像学杂志

Objective To investigate the accuracy and missed diagnosis rate of preoperative ultrasound in the diagnosis of thyroid carcinoma . Methods With the method of natural language recognition ,816 solitary thyroid nodules which received thyroidectomy were enrolled for the analysis of preoperative ultrasound examination and post-operative pathology results . The accuracy and the rate of missed diagnosis of ultrasonography for the diagnosis of thyroid carcinoma and lymph node metastasis were evaluated with the pathological results as the gold standard . Results There were 783 ( 96 .0％ ) malignant thyroid tumors ,6 ( 0 .7％ ) follicular tumor with uncertain malignant potential ,and 27 ( 3 .3％ ) benign thyroid tumors . Ultrasonography yielded an accuracy of 96 .1％ in the differential diagnosis between benign and malignant thyroid nodules and an accuracy of 94 .5％ in the quantification of nodule numbers . 5 .5％ of solitary nodules reported by ultrasound were proved to be 2 or more malignant nodules after the surgery . Regarding the diagnosis of central lymph node ,the preoperative ultrasound yielded an accuracy of 73 .0％and a misdiagnosis rate of 38 .7％ . For the lateral neck lymph node ,the accuracy was 88 .3％ ,and the misdiagnosis rate was 3 .4％ . Conclusions Natural language recognition method can assist clinical research . Ultrasonography is valuable in the diagnosis of thyroid carcinomas and neck lymph nodes . However , ultrasonography has a certain rate of misdiagnosis for the quantification of nodule numbers ,and for the diagnosis of lymph nodes in central and lateral necks .

Indispensability of cohort study in tumor prevention and prognosis assessment / 中华预防医学杂志

Cancer is one of the major causes of human death. Early diagnosis and treatment are widely believed to be important in decreasing cancer mortality rate. However, biological factors (such as tumor heterogeneity) and social factors (such as profits driving), over-diagnosis and over-treatment exist in the practice of cancer diagnosis and treatment. The keys to avoid such issues are to identify what kinds of precancerous lesions are more likely to progress into malignant tumors, what kind of early cancer are prone to invading surrounding tissues, and what kinds of prophylactic and therapeutic options are of benefit to effective survival of patients. All above need to be accurately evaluated by cohort studies. Cohort study is the most reliable method to crystallize causal relationship of the exposures (interventions) with the development and recurrence of cancers and define the directions of cancer screening and therapy. Cohort studies shed light on the prediction, screening, and active prophylaxis for the occurrence and recurrence of cancers with specific types. Moreover, the prognostic effects of a given clinical treatment can be precisely evaluated in cohort study, rather than experience-directed clinical activity. Therefore, cohort study is indispensable for cancer research.

Rastreamento populacional para o câncer de próstata: mais riscos que benefícios / Population screening for prostate cancer: more risks than benefits

Resumo Recentemente, inúmeras campanhas nacionais promovidas por hospitais, sociedades médicas e outras organizações têm estimulado o rastreamento do câncer de próstata, em consonância com iniciativas mundiais conhecidas como Novembro Azul. Essas campanhas aconselham a utilização do toque retal acompanhado da dosagem sérica do antígeno prostático específico em faixas etárias definidas. A motivação seria a detecção precoce da neoplasia, com redução de sua mortalidade e das complicações e impactos associados ao seu tratamento. A dosagem do PSA para fins de rastreamento é alvo de grande controvérsia, visto que a maioria dos tumores detectados pelo rastreamento é de evolução lenta e não interfeririam na sobrevida ou na qualidade de vida do paciente. O rastreamento de base populacional não é a indicação de inúmeras instituições estrangeiras e, no Brasil, o Instituto Nacional de Câncer também não recomenda à organização programas de rastreamento desse tipo. O artigo discute os riscos e benefícios associados a esse tipo de estratégia e reforça a preocupação com o uso inadequado e indiscriminado do rastreamento para o câncer de próstata.

Abstract Recently, numerous national campaigns promoted by hospitals, medical societies and other organizations have stimulated prostate cancer screening, in line with worldwide initiatives known as Blue November. These campaigns advise the use of rectal examination accompanied by dosage of serum prostate specific antigen (PSA) levels in defined age groups. The motivation would be the early detection of neoplasia, with reduction of mortality and complications and impacts associated with its treatment. The PSA dosage for screening purposes is highly controversial, since most of such tumors detected by screening are of slow progression and would not interfere with patient survival or quality of life. Population-based screening for prostate cancer is not recommended by numerous foreign institutions, including the National Cancer Institute in Brazil. The article discusses the risks and benefits associated with this type of strategy and reinforces concern about the inappropriate and indiscriminate use of screening for prostate cancer.

Overdiagnosis in mammography screening for breast cancer / 中华流行病学杂志

Screening has been always considered as a double-edged sword. Cancer screening could save lives in some cases, however, in other cases, it might also turn people into overdiagnosis. Overdiagnosis is the diagnosis of cancer that will never cause symptoms or death during a patient's lifetime. Therefore, overdiagnosis might lead to unnecessary treatments and lifetime surveillance, and then increase economic burden and psychological burden. In this review, we focus on how to correctly evaluate the overdiagnosis rate, and how to avoid or reduce the harms caused by overdiagnosis in the future according to the reasons associated with overdiagnosis. After systematically reviewing the previous studies, we will try to identify the potential reasons associated with overdiagnosis in breast cancer screening with mammography, address how to correctly evaluate the overdiagnosis rate, and finally provide some suggestions to reduce the overdiagnosis.

Scintigraphic Evidence for Overdiagnosis of Small PE on CT Pulmonary Angiography / 대한핵의학회잡지

A 68-year-old man with recent history of a fall presented with dyspnea on exertion, and underwent computed tomography pulmonary angiography (CTPA) for possible pulmonary embolism (PE). The CTPA was first read by the radiology resident as nondiagnostic for segmental PE. Subsequent planar perfusion (Q) images were normal; meanwhile, the attending radiologist revised the CTPA results as subsegmental PE in the left upper lobe. Further Q-SPECT images were obtained and fused with CTPA for clarification, which showed normal perfusion in the region of PE. The patient was monitored without anticoagulation treatment and remained uneventful for 12 months. This case illustrates that CTPA can lead to overdiagnosis and overtreatment of nonocclusive subsegmental PE.

Analysis of Diagnostic Differences between Colposcopy Beginner and Pathologic Report in Cervical Disease / 实用妇产科杂志

Objective:To evaluate the consistency of colposcopy diagnosis performed by a single examiner with pathologic diagnosis and to analyze the factors related with colposcopy over-and under diagnosis.Methods:A retrospective study was performed.The initial 200 cases diagnosed by a single colposcopy beginner at Peking University first Hospital out-patient clinic from March 2015 to October 2015 were included in this study.The consistency rate and bias rate of colposcopy diagnosis versus pathologic diagnosis as well as the causes of such differences were analyzed.Results:Of 174 cases with pathologic diagnosis,the consistency rate was 59.2％.The underdiagnosis rate and overdiagnosis rate were 18.4％ and 22.4％ separately.Of HSIL underdiagnosis group,the rate of TCT NILM was 78.6％ which was higher than 18.1％ in HSIL consistency group,P ＜ 0.05.Re-evaluation of the colposcopy pictures revealed that acetowhite epithelium were present in all 14 cased of HSIL underdiagnosis group.The rate of post-menopausal women was higher in HSIL underdiagnosis group than in HSIL consistency group(21.4％ vs 0％),P ＜0.05.The medium numbers of biopsy were higher in HSIL consistency group when compared with HSIL underdiagnosis group,P ＜0.05.The medium numbers of biopsy was higher in overdiagnosis group when compared with consistency group,P ＜ 0.05.Conclusions:Underdiagnosis of colposcopy was related with TCT-overdependent,insufficient understanding of acetowhite epithelium and post-menopausal women.Increasing biopsy numbers may improve the consistency rate of colposcopy and pathologic diagnosis.However,the increasing numbers of biopsy often results from overdiagnosis.

The impact of broadened diagnostic criteria on the prevalence of hypertension, hyperlipidemia and diabetes mellitus in China / 中华预防医学杂志

Objective@#The burden of chronic disease has been continuously increasing in China since the early 1980s. Besides the worsening of risk factors, the change in diagnostic criteria is very likely an important explanation for the increase in the prevalence of hypertension, hyperlipidemia and diabetes mellitus, three commonest, major chronic conditions that can lead to major vascular events and deaths. This study aims to estimate the contribution of changes in diagnostic criteria to the increase in the prevalence of the three conditions in China.@*Methods@#The data from two representative nation-wide surveys in China in 2002 and 2009, with 145 254 and 8 813 adults included respectively, were used to estimate the prevalence rate of the three conditions and the proportion attributable to the change in diagnostic criteria around year 2000. The new and old cutoff values for hypertension, hyperlipidemia, and hyperglycemia were 140/90 and 160/95 mmHg (1 mmHg=0.133 kPa), 5.7 and 6.2 mmol/L, and 7.0 and 7.8 mmol/L, respectively. The prevalence was standardized according to the distribution of age, sex and rural-urban residence of the 2000 national census of the country so as to compare between the old and new diagnostic criteria and project the situation for the entire country.@*Results@#The standardized prevalence of hypertension, hyperlipidemia, and diabetes mellitus for the entire Chinese adult population in 2002 was 8.21%, 1.71% and 1.43% according to the immediate previous diagnostic criteria, and 19.18%, 3.53% and 2.66% according to the new criteria. In 2009, the prevalence was 11.89%, 9.34% and 4.29% according to the old criteria, and 24.78%, 18.36% and 6.55% according to the new criteria. The total cumulative prevalence of the three conditions was increased by 124% in 2002 and 95% in 2009 as a result of change in diagnostic criteria. Put it differently, the change in diagnostic criteria increased the number of the three conditions from 2002 to 2009 by approximately 359 million and could increase the annual drug costs by some 271 billion RMB if all the conditions are treated. The drug costs alone of treating all the three conditions could consume 56% of the total health budget of the Government in 2010.@*Conclusion@#About half of the number of the three conditions is a result of the change in diagnostic criteria. These criteria were adopted from western populations, which are designed to meet the population need and suit healthcare resources available in these countries. It is important for China to consider the resources available and needs and values of the population in addition to the benefits, harms and costs of treatment in determining the cutoff values for defining these conditions for drug interventions.

Papillary thyroid microcarcinoma in adults may initiate from childhood / 中华内分泌代谢杂志

A total of 298577 children aged<18 years old in Fukuaka in Japan were screened for thyroid cancer after less than 3 years after nuclear accident. 110 children were diagnosed as thyroid cancer by fine needle aspiration cytology ( FNAC) and 87 cases received thyroid operation. The prevalence of thyroid cancer was 36. 8 / 100000 in population of<18 year old and 120 / 100000 at age of 16-18 years old. The 5th international expert symposium in Fukushima on radiation and health concluded that the high prevalence of thyroid cancer was not related with nuclear accident but to the screening. According to the findings, Willimas propsed a hypothesis: thyroid cancer in adults might originate from childhood. They had three stages for initiation and development of thyroid cancer: initial mutation stage, constraint growth stage, and non-constraint growth stage. The growth of thyroid cancer were stopped in the constraint stage, which was thyroid microcarcinoma.

Papillary thyroid microcarcinoma in adults may initiate from childhood / 中华内分泌代谢杂志

A total of 298577 children aged<18 years old in Fukuaka in Japan were screened for thyroid cancer after less than 3 years after nuclear accident. 110 children were diagnosed as thyroid cancer by fine needle aspiration cytology ( FNAC) and 87 cases received thyroid operation. The prevalence of thyroid cancer was 36. 8 / 100000 in population of<18 year old and 120 / 100000 at age of 16-18 years old. The 5th international expert symposium in Fukushima on radiation and health concluded that the high prevalence of thyroid cancer was not related with nuclear accident but to the screening. According to the findings, Willimas propsed a hypothesis: thyroid cancer in adults might originate from childhood. They had three stages for initiation and development of thyroid cancer: initial mutation stage, constraint growth stage, and non-constraint growth stage. The growth of thyroid cancer were stopped in the constraint stage, which was thyroid microcarcinoma.

Overdiagnosis in mammography screening for breast cancer / 中华流行病学杂志

Screening has been always considered as a double-edged sword. Cancer screening could save lives in some cases, however, in other cases, it might also turn people into overdiagnosis. Overdiagnosis is the diagnosis of cancer that will never cause symptoms or death during a patient's lifetime. Therefore, overdiagnosis might lead to unnecessary treatments and lifetime surveillance, and then increase economic burden and psychological burden. In this review, we focus on how to correctly evaluate the overdiagnosis rate, and how to avoid or reduce the harms caused by overdiagnosis in the future according to the reasons associated with overdiagnosis. After systematically reviewing the previous studies, we will try to identify the potential reasons associated with overdiagnosis in breast cancer screening with mammography, address how to correctly evaluate the overdiagnosis rate, and finally provide some suggestions to reduce the overdiagnosis.

Overdiagnosis in health care: impact of cancer screening

While overtreatment in medical services has for a long time been a topic of interest among the medical community, the concept of overdiagnosis has recently attracted interest because of the increasing scientific evidence supporting it; there are numerous academic papers investigating ‘overdiagnosis’ which have been published. Overdiagnosis is the phenomenon of a disease being diagnosed that will never progress to the point of causing symptoms or death. In certain individuals, even despite the detection of cancer cells, the person will die of other disease before the cancer can progress. It is known that overdiagnosis occurs in various diseases, such as high blood pressure, diabetes, and various psychiatric disorders. In cancer, there exist slow growing cancers in which symptoms and death often occur late and thus the patient will ultimately die of another cause before they are affected by the cancer. Through this, there is a potential of overdiagnosis due to early cancer screening. Overdiagnosed patients are harmed by the diagnosis and treatment which in no way benefit them. The general public as well as health care professionals should be informed of the balance between the benefits and harms. This article will analyze the problems related to overdiagnosis with a focus on early screening in cancer.

Prevención Cuaternaria: Ética Médica, Evaluación y Eficiencia en los Sistemas de Salud / Quaternary Prevention: Medical Ethics, Evaluation and Efficiency in the Health Systems / Prevenção Quaternária: Ética Médica, Avaliação e Eficiência nos Sistemas de Saúde

La prevención Cuaternaria consiste en desarrollar cuidados de salud y de ejercer la medicina, priorizando los cuidados centrados en la persona. Su marco conceptual se sustenta en aspectos éticos y filosóficos centrales en el ejercicio de la medicina, en aspectos epistemológicos y de carácter social. Su objeto es proteger fundamentalmente a los pacientes, pero también a los integrantes del equipo de salud, de los excesos de la medicalización y de los excesos o prácticas innecesarias o dañinas. El presente artículo es el resultado de la síntesis de los documentos de trabajo, discusión y propuestas llevadas adelante por un amplio grupo de comprometidos profesionales de CIMF, con interés particular sobre la Prevención Cuaternaria. Los materiales se produjeron en forma colaborativa por medio de un largo y complejo proceso de trabajo a distancia, realizado durante los foros preparatorios de la VI Cumbre Iberoamericana de Medicina Familiar y Comunitaria. A estos materiales se sumaron los documentos de trabajo elaborados durante la misma cumbre en San José de Costa Rica, en el mes de abril de 2016. El cometido de este artículo es difundir el estado de desarrollo y de compromiso actual con este enfoque y el destacado impulso que ha tenido en Iberoamérica en los últimos cinco años. Por su relevancia, se pretende estimular una mayor difusión del concepto: la implementación de contenidos relacionados con él en la formación y en el nivel académico. A nivel político promover su consideración en la toma de decisión, en políticas de salud pública. Difundir a nivel poblacional y promover la elaboración de contenidos de calidad. Ofrecer pistas de reflexión y herramientas concretas para su aplicación.

Quaternary Prevention as main focus and practice, promotes changes in developing health care and practicing medicine, prioritizing the person centred care.Their conceptual framework is sustained on ethical and philosophical aspects essential to medicine practice, in epistemological aspects of social and others related to political nature. Its objective is to protect fundamentally the patients, but also the members of the health group from excessive medicalization and unnecessary and hurtful practices. The present article is the result of the synthesis of the work documents, discussion and proposals carried forward by a large group of committed professionals from CIMF, with particular interest in Quaternary Prevention. The materials were produced in collaboration through a complex long distance work process, done during preparatory forums of the VI Ibero-American Summit of Family And Community Medicine. The work documents made during the same summit in San José of Costa Rica, in April 2016 were added to this material. The purpose of this document is to spread the state of development and current commitment to this approach and the outstanding initiative that it has had in Ibero America in the last five years. Due to its relevance, the intention is to stimulate greater dissemination of the concept; the implementation of content related to at in the training and academic levels. At a political level, to promote its consideration on decision making and public health issues so as to broadcast to demographic levels and promote the making of quality content. Finally to offer reflection clues to consider and concrete application tools.

A Prevenção Quaternária consiste em desenvolver cuidados de saúde e exercer a medicina priorizando o cuidado centrado na pessoa. Seu arcabouço conceitual se sustenta em aspectos éticos e filosóficos fundamentais ao exercício da prática médica, também em aspectos epistemológicos e de caráter social. O seu objetivo é proteger os pacientes, mas também os membros da equipe de saúde, dos excessos da medicalização e das práticas excessivas ou desnecessárias ou prejudiciais. Este artigo é o resultado da síntese dos documentos de trabalho, discussão e propostas levada a cabo por um numeroso grupo de profissionais comprometidos com a CIMF, com particular interesse na Prevenção Quaternária. Os materiais foram produzidos de forma colaborativa através de um extenso e complexo processo de trabalho a distancia, realizado durante as reuniões preparatórias da VI Cúpula Ibero-Americana de Medicina de Família e Comunidade. A estes materiais se somaram os documentos de trabalho preparados durante a mesma cúpula em San Jose, Costa Rica, em abril de 2016. O objetivo deste artigo é o de difundir o estado de desenvolvimento e de compromisso atual com esta abordagem e o impulso notável que tem havido na Iberoamerica nos últimos cinco anos. Por sua relevância, pretende-se estimular uma maior difusão do conceito, bem como a implementação de conteúdos relacionados a ele na formação e em nível acadêmico; a nível político, promover sua consideração na tomada de decisões de políticas públicas de saúde; difundir a nível da população e promover o desenvolvimento de conteúdo de qualidade; oferecer pistas de reflexão e ferramentas práticas para sua implementação.