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Background Improving the quality of information and communication is a priority in organised breast cancer screening and an ethical duty. Programmes must offer the information each woman is looking for, promoting informed decision-making. This study aimed to develop and evaluate a web-based dynamic decision aid (DA). Methods A pragmatic randomised trial carried out in six regional organised screening programmes recruited women at the first invitation receiving DA or a web-based standard brochure (SB). The primary outcome was informed choice measured on knowledge, attitudes, and intentions. Follow-up period: 7–10 days. Secondary outcomes included participation rate, satisfaction, decisional conflict, and acceptability of DA. Results Two thousand one hundred and nineteen women were randomised and 1001 completed the study. Respectively, 43.9% and 36.9% in the DA and SB reached the informed choice. The DA gave a 13-point higher proportion of women aware about overdiagnosis compared to SB (38.3% versus 25.2%, p  < 0.0001). The percentage of women attending screening was the same: 84% versus 83%. Decisional conflict was significantly lower in the DA group (14.4%) than in the SB group (19.3%). Conclusion DA increases informed choice. Complete information including the pros, cons, controversies, and overdiagnosis–overtreatment issues boost a woman’s knowledge without reducing the rate of actual screening participation. Clinical trial registration ClinicalTrials.gov number NCT 03097653.

BackgroundSingle-session high-dose stereotactic radiotherapy (radiosurgery) is a new treatment option for otherwise untreatable patients suffering from refractory ventricular tachycardia (VT). In the initial single-center case studies and feasibility trials, cardiac radiosurgery has led to significant reductions of VT burden with limited toxicities. However, the full safety profile remains largely unknown.Methods/designIn this multi-center, multi-platform clinical feasibility trial which we plan is to assess the initial safety profile of radiosurgery for ventricular tachycardia (RAVENTA). High-precision image-guided single-session radiosurgery with 25 Gy will be delivered to the VT substrate determined by high-definition endocardial electrophysiological mapping. The primary endpoint is safety in terms of successful dose delivery without severe treatment-related side effects in the first 30 days after radiosurgery. Secondary endpoints are the assessment of VT burden, reduction of implantable cardioverter defibrillator (ICD) interventions [shock, anti-tachycardia pacing (ATP)], mid-term side effects and quality-of-life (QoL) in the first year after radiosurgery. The planned sample size is 20 patients with the goal of demonstrating safety and feasibility of cardiac radiosurgery in ≥ 70% of the patients. Quality assurance is provided by initial contouring and planning benchmark studies, joint multi-center treatment decisions, sequential patient safety evaluations, interim analyses, independent monitoring, and a dedicated data and safety monitoring board.DiscussionRAVENTA will be the first study to provide the initial robust multi-center multi-platform prospective data on the therapeutic value of cardiac radiosurgery for ventricular tachycardia.Trial registration numberNCT03867747 (clinicaltrials.gov). Registered March 8, 2019. The study was initiated on November 18th, 2019, and is currently recruiting patients.Graphic abstract

Background Conditional cash transfers (CCTs) have been shown to improve retention in HIV care while they are provided, but their long-term effectiveness remains uncertain and effects may be time-limited, with cessation resulting in HIV care engagement deterioration. We explored CCT experiences, perceptions, and effects after cessation to investigate potential mechanisms of this observation and better understand the psychological mechanisms behind CCTs. Methods This qualitative study was nested within a larger trial, AdaPT-R (NCT02338739), focused on HIV care engagement in western Kenya. A subset of participants were purposively sampled from AdaPT-R participants: adults with HIV who had recently started ART, received CCTs for one year, completed one year of follow-up without missing a clinic visit, and were randomized to either continue or discontinue CCTs for one more year of follow-up. In-depth interviews were conducted by an experienced qualitative researcher using a semi-structed guide within a month of randomization. Interviews were conducted in the participants’ preferred language (Dholuo, Kiswahili, English). Data on patient characteristics, randomization dates, and clinic visit dates to determine care lapses were extracted from the AdaPT-R database. A codebook was developed deductively based on the guide and inductively refined based on initial transcripts. Transcripts were coded using Dedoose software, and thematic saturation was identified. Results Of 38 participants, 15 (39%) continued receiving incentives, while 23 (61%) were discontinued from receiving incentives. Half were female ( N  = 19), median age was 30 years (range: 19–48), and about three-quarters were married or living with partners. Both groups expressed high intrinsic motivation to engage in care, prioritized clinic attendance regardless of CCTs,and felt the incentives expanded their decision-making options. Despite high motivation, some participants reported that cessation of the CCTs affected their ability to access care, especially those with constrained financial situations. Participants also expressed concerns that incentives might foster dependency. Conclusions CCTs do not appear to exert their effects through motivation, but instead act through creating opportunities for better care engagement. This study helps us better understand the durability of financial incentives for HIV care engagement and support the idea that careful consideration be exercised when implementing incentives for sustainable engagement effects.

Over the past decade, growing evidence indicates that the tumor microenvironment (TME) contributes with genomic/epigenomic aberrations of malignant cells to enhance cancer cells survival, invasion, and dissemination. Many factors, produced or de novo synthesized by immune, stromal, or malignant cells, acting in a paracrine and autocrine fashion, remodel TME and the adaptive immune response culminating in metastasis. Taking into account the recent accomplishments in the field of immune oncology and using metastatic colorectal cancer (mCRC) as a model, we propose that the evasion of the immune surveillance and metastatic spread can be achieved through a number of mechanisms that include (a) intrinsic plasticity and adaptability of immune and malignant cells to paracrine and autocrine stimuli or genotoxic stresses; (b) alteration of positional schemes of myeloid-lineage cells, produced by factors controlling the balance between tumour-suppressing and tumour-promoting activities; (c) acquisition by cancer cells of aberrant immune-phenotypic traits (NT5E/CD73, CD68, and CD163) that enhance the interactions among TME components through the production of immune-suppressive mediators. These properties may represent the driving force of metastatic progression and thus clinically exploitable for cancer prevention and therapy. In this review we summarize results and suggest new hypotheses that favour the growing impact of tumor-infiltrating immune cells on tumour progression, metastasis, and therapy resistance.

Furthermore, even if the case fatality rate in imported severe malaria cases is usually lower than in endemic countries, mainly due to the wider access to high-level intensive care [ 5, 6], the relative rarity of this pathology and the little experience the local health staff has on malaria, often cause a delayed diagnosis [ 1, 7, 8]. [...]the limited availability of some first-line antimalarial treatments [ 1, 9, 10] possibly results in a variety of treatment approaches. [...]although WHO malaria guidelines use a 10 % parasitaemia threshold as a severe malaria definition criterion [ 1, 11], regardless of patient characteristics and epidemiologic setting, robust evidence indicates that levels above 2 % are associated with an increased risk of complications, longer hospital stays and increased mortality, especially in non-immune individuals [ 1, 11–13]. [...]given that the study concerned an acute imported infectious disease, we anticipated enrolling a high proportion of nonresident travelers. Variables with p < 0.10 at univariate analysis were considered for the multivariate model and tested for multicollinearity, using the Variance Inflation Factor (VIF). [...]continuous variables were checked for the linearity assumption.

Background: Cervical cancer places a significant burden on low- and middle-income countries (LMICs). The EuroMed Cancer Network (EuMedCN) brings together cancer experts and stakeholders from the Mediterranean countries to promote sustainable cancer screening and support implementation of the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. Aim: To highlight the constructive role of EuMedCN in mitigating inequalities in access to cervical cancer prevention and screening across the Mediterranean LMICs. Methods: Through its workshops and meetings, EuMedCN members discussed new developments in cancer prevention and control, and how best to translate the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem into public health policies in the Mediterranean LMICs. This led to targeted actions in the selected countries. Results: Seven priority actions were implemented to improve cervical cancer screening in the Mediterranean LMICs. EuMedCN supported organized screening, new pilot technologies and enhancement of evaluation systems. Integrating cervical cancer screening into other disease programmes and fostering multidisciplinary networks were promoted as key to achieving targets of the WHO global strategy. Conclusion: International networks, such as EuMedCN, have the potential to bring together experts and stakeholders to share experiences and catalyse resource mobilization. They can support affordable and synergistic solutions for cervical cancer prevention. Keywords: Cervical cancer, screening, prevention, World Health Organization, Mediterranean, low- and middle-income countries, networking, EuroMed Cancer Network Contexte : Le cancer du col de l'uterus represente un lourd fardeau pour les pays a revenu faible et intermediaire. L'EuroMed Cancer Network (EuMedCN) reunit des experts du cancer et des parties prenantes des pays mediterraneens afin de promouvoir un depistage durable du cancer et de soutenir la mise en oeuvre de la Strategie mondiale de l'OMS en vue d'accelerer l'elimination du cancer du col de l'uterus en tant que probleme de sante publique. Objectifs : Mettre en evidence le role constructif de l'EuMedCN dans l'attenuation des inegalites en matiere d'acces a la prevention et au depistage du cancer du col de l'uterus dans les pays a revenu faible et intermediaire de la Mediterranee. Methodes : Par le biais de ses ateliers et reunions, les membres de l'EuMedCN ont discute des nouvelles avancees en matiere de prevention et de lutte anticancereuse, et de la meilleure facon de traduire la Strategie mondiale de l'OMS en vue d'accelerer l'elimination du cancer du col de l'uterus en tant que probleme de sante publique pour son application pratique dans les politiques de sante publique dans les pays susmentionnes. Cela a conduit a des actions ciblees dans les pays selectionnes. Resultats : Sept actions prioritaires ont ete mises en oeuvre pour ameliorer le depistage du cancer du col de l'uterus dans les pays a revenu faible ou intermediaire de la Mediterranee. L'EuMedCN a soutenu la mise en oeuvre d'un depistage organise, la creation de nouvelles technologies pilotes et l'amelioration des systemes d'evaluation. L'integration du depistage du cancer du col de l'uterus dans des programmes de lutte contre d'autres maladies et la promotion de reseaux multidisciplinaires ont ete jugees essentielles pour realiser les objectifs de la strategie mondiale de l'OMS. Conclusions : Les reseaux internationaux, tels que l'EuMedCN, ont le potentiel de rassembler des experts et des parties prenantes pour echanger des donnees d'experience et catalyser la mobilisation des ressources. Ils peuvent soutenir des solutions abordables et synergiques pour la prevention du cancer du col de l'uterus. [phrase omitted]

Background: Cervical cancer places a significant burden on low- and middle-income countries (LMICs). The EuroMed Cancer Network (EuMedCN) brings together cancer experts and stakeholders from the Mediterranean countries to promote sustainable cancer screening and support implementation of the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. Aim: To highlight the constructive role of EuMedCN in mitigating inequalities in access to cervical cancer prevention and screening across the Mediterranean LMICs. Methods: Through its workshops and meetings, EuMedCN members discussed new developments in cancer prevention and control, and how best to translate the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem into public health policies in the Mediterranean LMICs. This led to targeted actions in the selected countries. Results: Seven priority actions were implemented to improve cervical cancer screening in the Mediterranean LMICs. EuMedCN supported organized screening, new pilot technologies and enhancement of evaluation systems. Integrating cervical cancer screening into other disease programmes and fostering multidisciplinary networks were promoted as key to achieving targets of the WHO global strategy. Conclusion: International networks, such as EuMedCN, have the potential to bring together experts and stakeholders to share experiences and catalyse resource mobilization. They can support affordable and synergistic solutions for cervical cancer prevention.