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Age ranges in breast cancer screening: simulated scenarios and analysis of benefits and harms

Abstract Background The Valencia Region Breast Cancer Screening Programme (VR-BCSP) (Spain) invites women aged 45-69 for mammography every 2 years (y). The aim is to evaluate benefits and harms of 3 age range scenarios of the VR-BCSP according to different adherence rates. Methods Long-term impact simulation study (2020-2050) of 3 age range screening scenarios (S) for women ≥40y of the VR in 2020 (n = 1487000): S1, 45-69y (current VR-BCSP scenario); S2, 50-69y (excluding 45-49y) and S3, 45-74y (including 70-74y). A biennial screening interval was considered. The simulations were performed for 4 participation rates: A=current adherence (72.7%), B = +5%, C = +10% and D = +20%. Benefit indicators were: nº of BC in situ and invasive (screened vs. clinically detected), nº of BC deaths and % of BC mortality reduction. Harms indicators were: nº of false positives (FP) and % of overdiagnosis. Screening scenarios were simulated using the EUTOPIA evaluation tool. Results Considering the current adherence, a reduction of BC mortality was observed in all scenarios (S1A=30.6%, S2A=27.9%, S3A=32.2%). In S2A the harms decreased vs. S1A: nº of FP (236vs423 x1000) and overdiagnosis (4.9%vs5.0%), but also the benefits: BC mortality reduction (27.9%vs30.6%) and nº of invasive BC screen detected (15/28vs18/25). In S3A vs S1A, an increase of benefits was observed: BC mortality reduction (32.2%vs30.6%) and nº of in situ BC screen detected (5/2vs4/3). On the other hand the nº of FP increased (460vs423 x1000), but overdiagnosis decreased (4.8%vs5.0%). All the results with an increased adherence had similar trend as the previous scenarios, showing a gradual increment in BC mortality reduction. Nevertheless overdiagnosis increase significantly in S3 (5.8% in all adherence increments), being higher than S1 (S1B=5.0%, S1C=4.9%, S1D=5.0%) and S2 (S2B=4.9%, S2C=4.9%, S2D=4.9%). Conclusions The wider age range, the greater reduction in BC mortality but also the probability of FP and overdiagnosis. Key messages • The wider age range, the greater reduction in BC mortality but also the probability of FP and overdiagnosis. • This study provides a balance between benefits and harms of different screening scenarios allowing evidence-based decision making.


Background:
Hospitals falls are an important challenge for healthcare systems. An early identification of patients at risk is critical, but no assessing tool has proven to be sufficiently predictive. This review aims at identifying factors associated with an increased risk of falls in hospitalized adults and at mapping them according to main international classification systems.

Methods:
We carried out a systematic literature review and metanalysis to detect risk factors positively associated with the increase of falls in hospitals, searching litterature from January 2015 to March 2022. We included studies investigating falling risk factors in patients older than 16 years. Researchers independently assessed records' eligibility and the methodological quality of included studies was assessed. When possible, data was processed using a random effects model and odds ratio (OR) with 95% confidence interval to quantify the effect. Risk factors were than classified according to ICF, ICD, and ATC classifications.

Results:
We included 40 observational studies, enrolling 3,495,552 patients. Considering ICF-factors, mental and sensory functions-pain have a strong association with falls (OR = 3.311 and 2.149, respectively). ICD-factors associated with falls were mental and behavioural disorders (OR = 2.219), diseases of the nervous system (OR = 2.974), and symptoms, signs, and abnormal clinical and laboratory findings (OR = 2.665). Considering ATC-related factors, medications for alimentary tract and metabolism (OR = 1.978), and nervous system (OR = 1.779), showed a strong association with falls. Other factors were also associated with a moderately increased risk.

Conclusions:
The comprehensive evidence-based assessment achieved with this meta-analysis alongside with the classification according to ICF, ICD and ATC systems provides a new standardized identification of the risk factors associated with an increase of falls in hospital.

Key messages:
Falls occurring in hospital are an important challenge for health care systems. Therefore the identification of risk factors associated to patients increased risk of fall is fundamental. The comprehensive evidence-based assessment achieved with this meta-analysis provides a new standardized identification of the risk factors associated with an increase of falls for hospital.

Background:
Health care and social services are industries with special challenges: Constant emotional demands, the shortage of skilled workers is noticeable (in Germany) and special organizational stresses, not only since the Corona pandemic. This study evaluates the Working out Loud (WOL) program for healthcare, which aims to create a learning culture for interdisciplinary collaboration and network-oriented learning and increases growth-oriented thinking at organizational level.

Methods:
The sample consists of 51 participants. From 16 persons data could be analyzed in the pre-post-design of the 10-week intervention accompanied by individual coaching. All respondents work in the health care system in Germany. Dependent variables were collected with validated scales for psychological safety, psychological flexibility, cooperative learning, emotional energy, engagement and voice behavior. Correlations are shown for psychological safety with emotional energy (r = .426, p = .012) and job satisfaction (r = .612, p = .000).

Conclusions:
The 10-week WOL Healthcare program can strengthen employees in the important area of health promotion and care. The program serves as behavioral prevention and, by empowering individuals, brings about job crafting structural prevention in the workplace. The intervention follows a bottom-up principle, it is an approach for health promotion in the healthcare sector, that can strengthen patient's safety. Key messages: Evidence for the effectiveness of a health promotion intervention for health care workers.
Organizational learning promotes workers health.

Background:
The Valencia Region Breast Cancer Screening Programme (VR-BCSP) (Spain) invites women aged 45-69 for mammography every 2 years (y). The aim is to evaluate benefits and harms of 3 age range scenarios of the VR-BCSP according to different adherence rates.

Conclusions:
The wider age range, the greater reduction in BC mortality but also the probability of FP and overdiagnosis. Key messages: The wider age range, the greater reduction in BC mortality but also the probability of FP and overdiagnosis. This study provides a balance between benefits and harms of different screening scenarios allowing evidence-based decision making.

Background:
Demographic changes have occurred worldwide during the recent decades, with an increasing proportion of the elderly in the society, leading to higher average age of the population. Older people are more likely to suffer from different chronic diseases, and higher consumption of healthcare services and, thus, posing additional burden and challenges to the healthcare system.

Methods:
The descriptive analysis relied on the longitudinal study of Health, Ageing and Retirement (SHARE). The target population included people aged 50 years or older, a total of 782 residents living in Latvia. We used the data from wave 8, collected from 2019-2020.

Results:
The mean age in the study population was 69 years, and 62.5 % of the respondents were women. Results show that 14.7 % of all respondents were hospitalised in the last 12 months. The average length of stay at hospital was 10.9 days (range 1 -71, SD 10.5). In 36.7 % of the cases hospitalisation was planned, but in 42.9 % it was due to an emergency. More than a half had visited hospital only once, but 19.1 % four times or more. The most common diseases among the hospitalised patients were high blood pressure/hypertension (60 %), heart attack (

Background:
Even if total knee replacement has revolutionized the treatment of degenerative knee diseases, the definition of an ideal rehabilitation protocol is still in progress. The aim of this study is to identify the factors that influence the outcomes after early, intensive, hospitalized treatment.

Methods:
A retrospective study was conducted in 2019 on 545 patients admitted to a northern Italy private clinic specialized in postsurgery rehabilitation, which applies a bio-psycho-socialenvironmental model and individual rehabilitation plans. Data regarding each patient were collected from medical records: age, numeric pain rating scale (NPRS) at admission, days between surgery and the beginning of rehabilitation (DBS). The outcomes were measured as the difference (Á) between the values at discharge and admission of the Barthel scale (ÁBS), Tinetti scale (ÁTS), passive flexion (ÁPF) and active flexion (ÁAF). We performed a univariate linear regression through STATA, to determine which factors influence the outcomes. A p < 0.05 was considered statistically significant.