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Broadening risk factor or disease definition as a driver for overdiagnosis: a narrative review

2022Artigo científico Acesso aberto
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dc.contributor.authorBandovas, João Pedro
dc.contributor.authorLeal, Beatriz
dc.contributor.authorReis-de-Carvalho, Catarina
dc.contributor.authorSousa, David Cordeiro
dc.contributor.authorAraújo, João Cruz
dc.contributor.authorPeixoto, Pedro
dc.contributor.authorHenriques, Susana Oliveira
dc.contributor.authorCarneiro, António Vaz
dc.contributor.authorChoosing Wisely Working Group of the European Federation of Internal Medicinept_PT
dc.date.accessioned2022-03-21T12:12:17Z
dc.date.available2022-03-21T12:12:17Z
dc.date.issued2022
dc.description© 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.pt_PT
dc.description.abstractMedical overuse—defined as the provision of health services for which potential harms exceed potential benefits—constitutes a paradigm of low-value care and is seen as a threat to the quality of care. Value in healthcare implies a precise definition of disease. However, defining a disease may not be straightforward since clinical data do not show discrete boundaries, calling for some clinical judgment. And, if in time a redefinition of disease is needed, it is important to recognize that it can induce overdiagnosis, the identification of medical conditions that would, otherwise, never cause any significant symptoms or lead to clinical harm. A classic example is the impact of recommendations from professional societies in the late 1990s, lowering the threshold for abnormal total cholesterol from 240 mg/dl to 200 mg/dl. Due to these changes in risk factor definition, literally overnight there were 42 million new cases eligible for treatment in the United States. The same happened with hypertension—using either the 2019 NICE guidelines or the 2018 ESC/ECC guidelines criteria for arterial hypertension, the proportion of people overdiagnosed with hypertension was calculated to be between 14% and 33%. In this review, we will start by discussing resource overuse. We then present the basis for disease definition and its conceptual problems. Finally, we will discuss the impact of changing risk factor/disease definitions in the prevalence of disease and its consequences in overdiagnosis and overtreatment (a problem particularly relevant when definitions are widened to include earlier or milder disease).pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJournal of Internal Medicine, 2022, 291; 426–437pt_PT
dc.identifier.doi10.1111/joim.13465pt_PT
dc.identifier.eissn1365-2796
dc.identifier.issn0954-6820
dc.identifier.urihttp://hdl.handle.net/10451/51854
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.relation.publisherversionhttps://onlinelibrary.wiley.com/journal/13652796pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectChanging risk factorpt_PT
dc.subjectDisease definitionpt_PT
dc.subjectLow-value carept_PT
dc.subjectOverdiagnosispt_PT
dc.subjectOvertreatmentpt_PT
dc.subjectResource overusept_PT
dc.titleBroadening risk factor or disease definition as a driver for overdiagnosis: a narrative reviewpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage437pt_PT
oaire.citation.issue4pt_PT
oaire.citation.startPage426pt_PT
oaire.citation.titleJournal of Internal Medicinept_PT
oaire.citation.volume291pt_PT
person.familyNameReis-de-Carvalho
person.familyNameSousa
person.familyNameOliveira Henriques
person.familyNameVaz Carneiro
person.givenNameCatarina
person.givenNameDavid Cordeiro
person.givenNameSusana
person.givenNameAntónio
person.identifier707480
person.identifier.ciencia-idDF1D-9635-8FC4
person.identifier.ciencia-idB712-B9A2-C85F
person.identifier.orcid0000-0002-5962-1560
person.identifier.orcid0000-0002-7680-0325
person.identifier.orcid0000-0002-0947-5083
person.identifier.orcid0000-0002-2783-0544
person.identifier.ridA-6192-2015
person.identifier.ridL-8026-2013
person.identifier.scopus-author-id57188627862
person.identifier.scopus-author-id57204519284
person.identifier.scopus-author-id7006837792
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication471dcd48-a81d-48e7-9272-e2de818abdbe
relation.isAuthorOfPublicationea222ec3-f323-4645-843f-3cd7ddc200ab
relation.isAuthorOfPublication0afcf51e-1496-42ad-84d3-e92e202464a4
relation.isAuthorOfPublication376d157f-1127-4663-9d99-038dac28f37d
relation.isAuthorOfPublication.latestForDiscoveryea222ec3-f323-4645-843f-3cd7ddc200ab

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