GADA testing: preparation for adult general population screening.

Non-ulcer Dyspepsia and Duodenal Eosinophilia: An Adult Endoscopic Population-Based Case-Control Study

Epidemic of Childhood Obesity: Implications for Kidney Disease

Background: Upper oesophagogastroduodenoscopy is considered to be the gold standard for upper gastrointestinal disease assessment, but is currently seldom used in epidemiological studies. One concern is that the procedure may bias sampling among volunteers in a general adult population. The aim of this study was to explore whether the procedure affects symptom reporting. Methods: A random sample of 3000 adults aged 20-81 years (mean age 50.4), from two Swedish municipalities (n = 21,610) was surveyed using a validated postal questionnaire (the Abdominal Symptom Questionnaire) assessing gastrointestinal symptoms. A subsample of the responders was invited, in random order, to undergo an upper endoscopy and repeated symptom reporting using the same questionnaire, as well as a serology test for Helicobacter pylori. Results: The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n = 1001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, with the exception of an excess of symptom reporters among the youngest subjects. The prevalence of reflux symptoms, dyspeptic symptoms and irritable bowel symptoms was 40%, 37.6% and 29.6%, respectively, which is relatively high, but in no way extreme. Conclusions: The upper endoscopy survey strategy was successful. The response rate was high and there was no major selection bias of clinical relevance. The cohort selected for this study appears to be representative of the general Swedish adult population.

Stroke is a major contributor to long-term disability worldwide. In Saudi Arabia, it ranks as the 3rd leading cause of mortality, necessitating prompt recognition of symptoms and risk factors for timely treatment. This study aims to comprehensively assess stroke knowledge and awareness among the general adult population in the southern region of Saudi Arabia to inform targeted public health interventions for better prevention and care. A cross-sectional study was conducted from June to August 2024, targeting the general adult Saudi population aged 18 years and older residing in the Aseer region. A total of 586 responses were collected through an online questionnaire hosted on Google Forms. The questionnaire included demographic questions and assessed knowledge of stroke symptoms, risk factors, and consequences. Among the 586 participants, 75.6% demonstrated strong general knowledge of stroke. The sample comprised predominantly educated individuals (78.5% with university degrees) and a significant majority of females (74.7%). Recognition of early stroke symptoms was strong, with 65.5% able to identify 5 or more symptoms. Females were significantly more likely than males to identify stroke consequences (P = .028). Notably, age (50–70 years) was associated with recognizing symptoms (P = .032). However, knowledge gaps were identified regarding risk factors and consequences. Overall knowledge of stroke and its symptoms in the Aseer region is robust. However, targeted public health campaigns are essential to enhance awareness of risk factors and consequences, which may help reduce prehospital delays and improve treatment outcomes.

Background:-Esophageal cancer (EC) is one of the most common cancers in Saudi Arabia and sixth of the most common cancer killers worldwide However, no pervasive study assessing EC awareness among the general adult population in the western region of Saudi Arabia has been conducted. Therefore, in this study, we aimed to assess the level of EC awareness among the general adult population in the western region of Saudi Arabia. Methods:-Between September and November 2023, we conducted a cross-sectional study including 628 adults aged >18 years who resided in the western region of Saudi Arabia during the study period. Data was collected using a previously validated questionnaire, distributed via a Google Form survey. Of these, 118 (18.8%) had a secondary level of education,456 (72.6%) had an undergraduate degree, and 38 (6.1%) had a postgraduate degree. Results:-Good awareness regarding EC risk factors was observed in 87.5% of lower-educated participants compared to 57.9% of those with postgraduate degrees, with a recorded statistical significance (P = .048). Personal characteristics had no significant association with awareness level. Conclusion:-The findings of this study indicated a good level of EC awareness among the Saudi Arabian adult population in the western region. And the awareness regarding risk factors, smoking was the most known, followed by alcohol consumption, and the symptoms awareness, swallowing difficulty was the most known, followed by voice hoarseness. And personal characteristics were not significantly related to overall awareness.

Autoantibodies can predict clinical type 1 diabetes, impacting early diagnosis, prevention, and management. While integrating antibody testing into routine practice is debated globally, ethical considerations are often overlooked. This paper explores these ethical concerns through qualitative analysis based on a literature review.A PubMed literature search provided the foundation for a qualitative ethical analysis. Arguments regarding type 1 diabetes screening were extracted from 92 eligible articles and categorized using Beauchamp and Childress's four ethical principles. A thematic and principle-oriented ethical analysis was conducted.Key ethical concerns include decision-making for children, risk determination, screening timepoints, psychological aspects, DKA rates, treatment options, and monetary and personnel aspects. Addressing these issues ensures general population screening aligns with autonomy, beneficence, nonmaleficence, and justice.Conclusions;General population antibody screening for type 1 diabetes presents ethical challenges requiring careful consideration. While early detection offers benefits, risks such as psychological distress, stigmatization, and resource diversion must be taken into consideration. Further research should assess feasibility, including human resource demands, parental and child anxiety, optimal screening timepoints, development of educational material, children's involvement in screening, and expanding options for prevention, including teplizumab approval in the EU. What is Known: • Autoantibodies can identify individuals at risk for Type 1 Diabetes before symptom onset, and population screening is increasingly discussed as a strategy to reduce complications such as diabetic ketoacidosis at diagnosis. What is New: • This study provides a structured ethical analysis of general population antibody screening for Type 1 Diabetes using the four-principle framework of Beauchamp and Childress (autonomy, beneficence, nonmaleficence, justice) • It identifies key ethical domains, including decision-making for children, psychological impact, screening timing, resource allocation, and emerging preventive options such as Teplizumab, that should guide future implementation and research on population screening programs.

Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by destruction of insulin-producing β cells in the pancreas. The incidence of T1D is increasing dramatically, and the prevalence has doubled in the last 2 decades, further increasing the morbidity and mortality associated with the disease. T1D is now predictable with the measurement of antibodies directed against β cell proteins. Islet autoantibodies (IAs) are detectable from the peripheral blood months to years before clinical diagnosis. With the presence of two or more antibodies, the risk for developing T1D is nearly 100 % given enough time. Targeted screening for T1D risk has been carried out in first-degree relatives and those with a significant genetic risk. However, more than 85 % of individuals who are diagnosed with T1D do not have a family history. In light of the predictability of T1D and recent advances in IA measurement, general population screening is on the horizon. We provide an overview of the history of general population screening and discuss the rationale for and arguments against screening the general population for T1D risk.

County-Level Estimates of Need for Mental Health Professionals in the United States

Query a single institution computed tomography (CT) database to assess the prevalence of aortic arch anomalies in general adult population and their potential association with thoracic aortopathies. CT chest scan reports of patients aged 50-85 years old performed for any indication at a single health system between 2013 and 2016 were included in the analysis. Characteristics of patients with and without aortic arch anomalies were compared by t test and Fisher exact tests. Logistic regression analysis was performed to assess for independent risk factors of thoracic aortic aneurysm (TAA). Of 21,336 CT scans, 603 (2.8%) described arch anomalies. Bovine arch (n = 354, 58.7%) was the most common diagnosis. Patients with arch anomalies were more likely to be female (p < .001), non-Caucasian(p < .001), and hypertensive (p < .001). Prevalence of TAA in arch anomalies group was 10.8% (n = 65) compared to 4.1% (n = 844) in the nonarch anomaly cohort (p < .001). The highest prevalence of thoracic aneurysm was associated with right-sided arch combined with aberrant left subclavian configuration (33%), followed by bovine arch (13%), and aberrant right subclavian artery (8.2%). On binary logistic regression, arch anomaly (OR = 2.85 [2.16-3.75]), aortic valve pathology (OR 2.93 [2.31-3.73]), male sex (OR 2.38 [2.01-2.80]), and hypertension (OR 1.47 [1.25-1.73]) were significantly associated with increased risk of thoracic aneurysm disease. Reported prevalence of aortic arch anomalies by CT imaging in the older adult population is approximately 3%, with high association of TAA (OR = 2.85) incidence in this subgroup. This may warrant a more tailored surveillance strategy for aneurysm disease in this subpopulation.

Background: Type 1 diabetes (T1D), a major chronic autoimmune disease starting mostly from childhood, is now predictable with the measurement of four major islet autoantibodies (IAbs) including IAA, GADA, IA-2A and ZnT8A. Currently, there are approximately 1.4 million people affected with T1D in the United States and the incidence has doubled in the last 20 years, especially in young children. Mass screening for eligible subjects and the general population remains inefficiency and laborious bottleneck. Methods: With the platform of our extensively validated high affinity electrochemiluminescence (ECL) assay, we have developed a simple multiplexed ECL assay to combine all four major IAb assays in a single well. Two cohorts were studied including 80 samples from newly diagnosed patients with T1D and 1,140 from Autoimmunity Screening for Kids (ASK) study. Both multiplex ECL assay and standard radio-binding assay (RBA) were performed in parallel. Results: With &amp;gt;99th percentile of specificity for both assays in over 1,000 samples from general population, sensitivity of multiplex ECL assay in new onset patients with T1D were similar to RBA, GADA 75% vs. 71%; IA-2A 91% vs. 90%; IAA 61% vs. 65%; ZnT8A 90% vs. 87%. In ASK cohort, multiplex ECL assay was concordant with RBA among children with multiple IAbs (42/44, 96%). In contrast, only 39% (21/54, p&amp;lt;0.0001) of children with single IAb by RBA were positive by multiplex ECL assay. Conclusion: Multiplex ECL assay illustrated its high sensitivity/specificity as RBA in T1D patients. In general population screening, multiplex ECL assay, similar to single ECL assay, is capable to discriminate high risk IAbs from low risk IAbs generated by RBA. With a multiplexing feature, it provides a high throughput tool with low cost and low sample volume for large scale of population screening for T1D. Disclosure L. He: None. X. Jia: None. D. Miao: None. C. Geno rasmussen: None. M. Rewers: Advisory Panel; Self; Provention Bio, Inc., Consultant; Self; RTI, Research Support; Self; Janssen Research &amp; Development, LLC, JDRF. L. Yu: None. Funding JDRF (2-SRA-2018-533-S-B, 1-SRA-2016-208-S-B); National Institutes of Health (DK32083); Diabetes Research Center (P30DK116073)

Background/Introduction Type 2 diabetes mellitus (T2DM) is a well-established risk factor for cardiovascular disease (CVD). However, evidence is scarce on the difference in burden of T2DM as a cardiovascular risk factor in adult cancer survivors compared to the general population without history of cancer. This evidence gap needs to be addressed as increased risk for CVD in adult cancer survivors compared to the general population has been consistently reported from observational studies. Purpose To investigate the association of T2DM with CVD in adult cancer survivors and general population without history of cancer and compare the magnitude of associations for each population using propensity score-matched analyses Methods For this population-based cohort study, we used the National Health Insurance Service-National Sample Cohort (NHIS-NSC) established in the Republic of Korea (2002–2015) to identity adult cancer survivors who were aged 18 years or older and survived more than 12 months after the first-ever cancer diagnosis and general population without history of cancer matched for age and sex in a 1:1 ratio. In both cohorts, those with history of CVD prior to the index date were excluded. We used Cox proportional hazards model to compute hazard ratios (HR) and 95% confidence intervals (95% CI) for incident CVD in those with T2DM compared to those without T2DM in both adult cancer survivors and the general population after adjusting for shared confounding factors (income status, cigarette smoking, alcohol consumption, physical inactivity, body mass index, blood pressure, lipid abnormalities, family history of CVD, and aspirin use). Furthermore, we used Q statistic to compare the magnitude of association between T2DM and CVD in this matched cohort. Results The overall age and sex matched cohort in the NHIS-NSC comprised of 5,163 adult cancer survivors and the equivalent number of participants categorized as general population without history of cancer. The adjusted HR for CVD among adult cancer survivors with T2DM, as compared to without T2DM was 2.27 (95% CI: 1.25–4.11). Similarly, T2DM was associated with an increased risk of CVD in the general population without cancer (HR=1.88; 95% CI: 1.03–3.42). However, no strong statistical evidence was found for difference in contribution of T2DM to CVD risk between adult cancer survivors and general population without history of cancer (Pheterogeneity = 0.662). Conclusions In this population-based cohort study, T2DM was associated with an increased risk for CVD in both adult cancer survivors and those without history of cancer. Difference in magnitude of T2DM-CVD associations between adult cancer survivors and the general population without history of cancer was not substantial from a statistical standpoint. However, adult cancer survivor with T2DM may still need additional clinical attention for CVD prevention compared to those without history of cancer. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Cancer Center (Republic of Korea)

The negative health effects of cigarette smoking and HIV infection are synergistic. To compare the prevalence of current cigarette smoking and smoking cessation between adults with HIV receiving medical care and adults in the general population. Nationally representative cross-sectional surveys. United States. 4217 adults with HIV who participated in the Medical Monitoring Project and 27 731 U.S. adults who participated in the National Health Interview Survey in 2009. The main exposure was cigarette smoking. The outcome measures were weighted prevalence of cigarette smoking and quit ratio (ratio of former smokers to the sum of former and current smokers). Of the estimated 419 945 adults with HIV receiving medical care, 42.4% (95% CI, 39.7% to 45.1%) were current cigarette smokers, 20.3% (CI, 18.6% to 22.1%) were former smokers, and 37.3% (CI, 34.9% to 39.6%) had never smoked. Compared with the U.S. adult population, in which an estimated 20.6% of adults smoked cigarettes in 2009, adults with HIV were nearly twice as likely to smoke (adjusted prevalence difference, 17.0 percentage points [CI, 14.0 to 20.1 percentage points]) but were less likely to quit smoking (quit ratio, 32.4% vs. 51.7%). Among adults with HIV, factors independently associated with greater smoking prevalence were older age, non-Hispanic white or non-Hispanic black race, lower educational level, poverty, homelessness, incarceration, substance use, binge alcohol use, depression, and not achieving a suppressed HIV viral load. Cross-sectional design with some generalizability limitations. Adults with HIV were more likely to smoke and less likely to quit smoking than the general adult population. Tobacco screening and cessation strategies are important considerations as part of routine HIV care.

Type 1 hereditary hemochromatosis is a common disorder of iron overload occurring in individuals homozygous for the C282Y HFE gene mutation. It can be a progressive and fatal condition. Early detection and phlebotomy prior to the onset of cirrhosis can reduce morbidity and normalize life expectancy. It is readily identified through biochemical testing for iron overload using serum transferrin saturation and genetic testing for C282Y homozygosity. General population screening has been waived in preference to targeting high-risk groups such as first-degree relatives of affected individuals and those with clinical features suggestive of iron loading. This screening strategy is likely to continue until uncertainties regarding the natural history of the disease, age-related penetrance, and management of asymptomatic individuals are clarified. Potential ethical, legal, and psychosocial issues arising through application of genetic screening programs also must be resolved prior to implementation of general population screening programs.

To discover Pakistani adult population's perception about their general health, immune status and knowledge regarding immunity, and to highlight their efforts to improve it. The knowledge-attitude-practice study was conducted from January to May 2021, after approval ethics review committee of the Islamic International Medical College, Rawalpindi, Pakistan, and comprised individuals of either gender from the community aged 18 years or more and not suffering from any physical disability or mental illness. Data was collected using a pre-tested, self-administered questionnaire that was disseminated through online platforms. The collected data was analysed using SPSS 25. All the 455(100%) individuals approached responded to the questionnaire. The mean age of the subjects was 22.6±7.579 years. There were 256(56.3%) female respondents, 283(62.2%) were aged 20-21 years, and 359(78.9%) hailed from the Sindh province. Most participants perceived their general health as 'good' 197(43.3%). The immune system function was reported 'good' by 200(44%), and the perception of general knowledge of immunity was reported 'good' by 189(41.5%) subjects. Inverse relationships were identified between stress levels and self-perceived health, and between receiving effective homeopathic treatment and 'very good' self-perceived immune status (p<0.05). People willing to take non-obligatory vaccines had a positive opinion about their self-perceived knowledge on immunity that produced a direct relationship (p<0.05). The findings provide a framework of practices that should be promoted to improve health status of adult population in Pakistan.

Hypertension (HTN) is the leading cause of cardiovascular diseases. Nevertheless, most individuals in developing countries are unaware of their blood pressure status. We determined the prevalence of unrecognized hypertension and its association with lifestyle factors and new obesity indices among the adult population. This community-based study was conducted among 1288 apparently healthy adults aged 18-80 years in the Ablekuma North Municipality, Ghana. Sociodemographic, lifestyle characteristics, blood pressure and anthropometric indices were obtained. The prevalence of unrecognized HTN was 18.4% (237 / 1288). The age groups 45-54 years [aOR = 2.29, 95% CI (1.33-3.95), p = 0.003] and 55-79 years [aOR = 3.25, 95% CI (1.61-6.54), p = 0.001], being divorced [aOR = 3.02 95% CI (1.33-6.90), p = 0.008], weekly [aOR = 4.10, 95% CI (1.77-9.51), p = 0.001] and daily alcohol intake [aOR = 5.62, 95% CI (1.26-12.236), p = 0.028] and no exercise or at most once a week [aOR = 2.25, 95% CI (1.56-3.66), p = 0.001] were independently associated with HTN. Among males, the fourth quartile (Q4) of both body roundness index (BRI) and waist to height ratio (WHtR) [aOR = 5.19, 95% CI (1.05-25.50), p = 0.043] were independent determinants of unrecognized HTN. Among females, the third quartile (Q3) [aOR = 7.96, 95% CI (1.51-42.52), p = 0.015] and Q4 [aOR = 9.87 95% CI (1.92-53.31), p = 0.007] of abdominal volume index (AVI), the Q3 of both BRI and WHtR [aOR = 6.07, 95% CI (1.05-34.94), p = 0.044] and Q4 of both BRI and WHtR [aOR = 9.76, 95% CI (1.74-54.96), p = 0.010] were independent risk factors of HTN. Overall, BRI (AUC = 0.724) and WHtR (AUC = 0.724) for males and AVI (AUC = 0.728), WHtR (AUC = 0.703) and BRI (AUC = 0.703) for females yielded a better discriminatory power for predicting unrecognized HTN. Unrecognized hypertension is common among the apparently healthy adults. Increased awareness of its risk factors, screening, and promoting lifestyle modification is needed to prevent the onset of hypertension.