BMC Proceedings最新文献

Population screening for breast cancer (BC) is currently offered in the UK for women aged 50 to 71 with the aim of reducing mortality. There is additional screening within the national programme for women identified as having a very high risk of BC. There is growing interest in further risk stratification in breast screening, which would require a whole population risk assessment and the subsequent offer of screening tailored to the individual's risk. Some women would be offered more intensive screening than others or no screening. This might provide a better balance of screening benefits and harms for each individual than the current population age-based programme alone. The UK National Screening Committee (UK NSC) is considering using decision-analytic and other models to evaluate different risk stratification screening strategies and identify remaining gaps in evidence. This paper reports the proceedings of a UK NSC workshop where experts in the field discussed both risk prediction models, as well as decision-analytic models providing a benefit-harm analysis/economic evaluation of risk-stratified screening programmes (see Table 1). The aim of the meeting was to present and discuss the current work of experts, including some data which had not been published at the time of the meeting, to inform the UK NSC. The workshop was not intended to present a balanced evaluation of how to deliver screening in future. Areas for further work identified included methods for comparing models to assess accuracy, the optimum risk assessment tools, the digital screening infrastructure, acceptability of stratification, choice of screening test and reducing inequalities. A move to risk stratification of the whole programme would require a careful phased introduction with continuing assessment of real-world evidence during deployment.

Recent advances in artificial intelligence (AI) created powerful tools for research, particularly for extracting meaningful insights from extremely large data sets. These developments increase research benefits of big data and risks posed to individual privacy, forcing a re-examination of ethics in research which is of particular importance to the Military Health System. To advance discussion of research ethics in this context, the Forum on Health and National Security: Ethical Use of Big Data for Healthy Communities and a Strong Nation was held in December 2018. The workshop was designed to identify ethical questions relevant to population and health research studies using difficult to access, health-related data in the Department of Defense (DoD). Discussions explored researchers' ethical obligations to research subjects, particularly in the areas of privacy, trust, and consent, as well as potential methods to improve researchers' ability to collect, access, and share data while protecting privacy and potential risks to national security. These include creating risk management frameworks and data governance policies, improving education and workplace training, and increasing community involvement in research design and practice. While the workshop was conducted in 2018, the discussion of data ethics is still relevant today. The research agenda of the nation is best served by building ethics into the research ecosystem. There are substantial challenges to fully realizing this goal including commitments of time and funding to address the ethical complexities, train others to understand them, and create appropriate ethical frameworks before research begins.

Background: In line with the WHO Global Action Plan's objective to achieve a 30% relative reduction in the mean population intake of sodium by 2025, the Nigeria Sodium Study (NaSS) team, which aimed to evaluate the implementation and scale-up of national sodium reduction programme, hosted a policy meeting May 22, 2023, in Abuja, the Federal Capital Territory of Nigeria. The aim was to deliberate on strategies for translating data on salt levels in food and dietary patterns, intending to strengthen sodium policies in Nigeria, with the ultimate goal of producing evidence-based information that can effectively guide strategies and policies for sodium reduction.

Methods: Policymakers from federal, state, and local government levels attended, as well as representatives from national and international universities and non-governmental organizations. Topics presented and discussed included retail survey data from the NaSS to inform front-of-package labeling, salt targets for packaged food, and best practices for supporting stakeholders in implementing best-practice evidence-informed policymaking.

Results: The meeting brought together 72 participants from 38 organizations, including government ministries and agencies (n = 21), international and non-governmental organizations (n = 6), and international health organizations and institutes (n = 2). Participants took decisive policy actions, including stringent national-level food system monitoring by relevant government agencies, implementing front-of-package labeling for healthier choices, establishing mandatory sodium limits for both packaged and unpackaged foods and school meals, launching diverse sector-wide educational campaigns to reduce salt use, conducting mass mobilization campaigns for awareness, and advocating for salt reduction in fast food outlets. Salt substitutes were also recognized as integral to the comprehensive sodium reduction approach.

Conclusion: To advance policy action, stakeholders should prioritize establishing robust monitoring systems, engage in public awareness campaigns, and collaborate with international organizations for insights. Exploring partnerships, addressing funding challenges, and implementing innovative strategies like low-sodium substitutes are crucial steps toward effective sodium reduction policies in Nigeria.

It is estimated that up to 1 in 20 people in the United States may have a fetal alcohol spectrum disorder (FASD), or the array of physical, cognitive, emotional, and social disorders caused by exposure to alcohol during prenatal development (May et al., JAMA 319:474-82, 2018). While this condition is present in a broad range of individuals and families, it has not previously been examined in the military community, where cultural factors including an increased prevalence of alcohol misuse may pose a unique set of challenges (Health.mil, Alcohol misuse, 2024).The Uniformed Services University of the Health Sciences (USUHS), in conjunction with FASD United, hosted the second annual Workshop on Fetal Alcohol Spectrum Disorders Prevention and Clinical Guidelines Research on 20 September 2023 in Washington, DC. Organized as part of a four-year, federally-funded health services research initiative on FASD in the U.S. Department of Defense (DoD) Military Health System (MHS), the workshop provided a forum for exploring the initiative's focus and progress; examining current knowledge and practice in the research and clinical spheres; and identifying potential strategies to further improve prevention, screening, diagnosis, interventions, and family support. Building off of the 2022 workshop that covered the state of the science surrounding prenatal alcohol exposure and FASD, the 2023 focused primarily on FASD and efforts aimed at identification and management (Koehlmoos et al., BMC Proc 17 Suppl 12:19, 2023). One hundred and thirty attendees from academia, healthcare, federal agencies, and patient advocacy organizations gathered to share research findings; learn from lived experiences; and discuss initiatives to advance research, screening, and services for at-risk pregnant women as well as families and caregivers supporting individuals with FASD.