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PubMed2006

Detection rates of high-grade prostate cancer during subsequent screening visits. Results of the European Randomized Screening Study for Prostate Cancer.

Screening for prostate cancer using prostate-specific antigen (PSA) tests has led to a stage and grade shift as compared to the pre-PSA era. Effectiveness of screening for prostate cancer should be manifested by a reduction in detection rate of aggressive cancers during subsequent screening. In 6 centers of the European Randomized Screening study for Prostate Cancer, a total of 58,710 men were tested for prostate cancer. Screening centers differed with regard to age-range, screening interval and biopsy indications. During the 2nd visit, the proportion of Gleason score 6 cancers increased from 62.5 to 75%, mainly at the expense of Gleason score 7 cancers. High-grade (Gleason score 8-10) cancer detection rates varied per screening center during the 1st visit from 5.1 to 41.1, and during the 2nd visit from 6.4 to 29.3/10,000 men. The overall detection rate of high-grade cancers showed a reduction during the 2nd visit from 26 to 12/10,000 men, an effect mainly attributable to the screening center with the highest cancer detection rate (i.e. 507/10,000 men). Variations in detection rates among screening centers related among others to biopsy compliance and age range.

Age Factors↗

PubMed2005

Validity of a modified Parkinson's disease screening questionnaire in India: effects of literacy of participants and medical training of screeners and implications for screening efforts in developing countries.

The prevalence of Parkinson's disease (PD) is low among Indians, except in the Parsis. Data for Indians come from studies using different screening tools and criteria to detect PD. An epidemiological study in India, which has nearly a billion people, more than 18 spoken languages, and varying levels of literacy, requires development and validation of a screening tool for PD. The objectives of this study are to (1) validate a modified version of a widely used screening questionnaire for PD to suit the needs of the Indian population; (2) compare the use of a nonmedical assistant (NMA) with the use of a medical person during screening; and (3) compare the effect of literacy of participants on the validity of the screening tool. The validity of the questionnaire was tested on 125 participants from a home for the elderly. NMAs of similar background and medical personnel administered the modified screening questionnaire. A movement disorder neurologist blind to the responses on the questionnaire, examined participants independently and diagnosed if participants had PD. The questionnaire was validated in the movement disorders clinic, on known PD patients and their family members without PD. In the movement disorders clinic, sensitivity and specificity of the questionnaire were 100% and 89%, respectively. Fifty-seven participants were included for analysis. The questionnaire had a higher sensitivity when NMAs (75%) rather than the medical personnel (61%) administered it, and its specificity was higher with the medical personnel (61%) than with NMAs (55% and 25%). The questionnaire had a higher specificity in literates than illiterates, whereas sensitivity varied considerably. The modified questionnaire translated in a local Indian language had reasonable sensitivity and can be used to screen individuals for PD in epidemiological studies in India. This questionnaire can be administered by NMAs to screen PD and this strategy would reduce manpower costs. Literacy may influence epidemiological estimates when screening PD.

Aged↗

PubMed2003

Do women prefer to have screening tests for Down syndrome that have the lowest screen-positive rate or the highest detection rate?

OBJECTIVE: To assess whether women have a preference for Down syndrome screening test performance. METHODS: A structured questionnaire exploring women's preferences for screening test performance was administered to women attending their first prenatal visit who wished to have Down syndrome screening performed. RESULTS: One hundred and twenty women were interviewed. The majority of women (n=80) chose a screening test with a low screen-positive rate rather than the highest detection rate. The reasons given for this preference were a desire to minimise the risk of miscarriage of a normal baby and a belief that a detection rate of 80 to 90% was acceptable. However, older women (>37 years) chose a test with the highest detection rate possible, regardless of the higher screen-positive rate, preferring to miscarry a normal baby as a result of a diagnostic test rather than miss the detection of a baby with Down syndrome. Preferences were not influenced by previous screening experience. CONCLUSIONS: Women express different preferences for screening test performance. Maternal age rather than previous screening experiences appears to be the major influence in these choices.

Abortion, Spontaneous↗

PubMed2006

Biochemical progression rates in the screen arm compared to the control arm of the Rotterdam Section of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

BACKGROUND: The European Randomized study of Screening for Prostate Cancer (ERSPC) investigates the feasibility of population-based screening. This report compares the preliminary outcome of cancers detected in the screen and the control arm of its Rotterdam section, by means of biochemical progression rates. METHODS: In the screen arm of this study (21,210 men), screening was applied according to well-established protocols, and a 4-year screen interval was chosen. Widely accepted biochemical progression-criteria were used to evaluate the diagnosed cancers over time. RESULTS: Although more cancers were detected in the screen than in the control arm (1,339 vs. 298, P < 0.001), their clinico-pathological features were more favorable. Furthermore, screened men had higher 5-year survival rates for biochemical progression after surgery (84.4% vs. 58.9% in controls), radiotherapy (71.0% vs. 58.0%), and endocrine therapy (40.5% vs. 16.3%). CONCLUSIONS: The higher biochemical progression-free survival can at least in part be explained by lead and length-time. How screening will effect the mortality remains unclear.

Aged↗

PubMed2006

Do centralised skin screening clinics increase participation in melanoma screening (Australia)?

OBJECTIVE: To compare during the first 12 months of a 3-year randomised community-based trial of population screening for melanoma three methods of screening delivery: skin screening within day-to-day primary care (Group A); screening in dedicated skin screening clinics either organised privately by local physicians (Group B); or organised centrally with participants referred back to their physicians for definitive diagnosis and management (Group C). METHODS: The trial involved 18 regional communities in Queensland, Australia. Of the nine communities randomised to the intervention group, three communities were allocated to each of the Groups A, B or C. All intervention communities received a community education programme and an education and support programme for primary care physicians. The self-reported prevalence of clinical skin examination was assessed by surveying 3,110 residents (66.9% participation rate) aged > or = 30 years by telephone at baseline, and 14,060 residents (70.9% participation rate) by self-administered mailed questionnaire at 12-month follow-up. RESULTS: At baseline the prevalence of skin screening did not differ between intervention and control communities. At 12-month follow-up, participants within intervention communities reported skin screening significantly more frequently (20.9% versus 10.9%; p < 0.001). Within intervention communities, the prevalence of clinical skin examinations in Group A was similar to that of control communities (12.6% and 10.9%; p = 0.33). Communities in Group B (16.5%; p = 0.001) and Group C (27.1%; p < 0.001) reported significantly higher prevalence of clinical examinations than the control group. CONCLUSIONS: The provision of centrally organised skin screening clinics significantly increases skin screening rates and may have relevance for future melanoma control programmes.

Adult↗

PubMed2005

To screen or not to screen for adult malnutrition?

BACKGROUND: There is some controversy about whether all adults receiving healthcare should be routinely screened for nutritional problems. METHODS: (i) A systematic review examined the proposition that malnutrition is under-recognised and under-treated, and that nutritional interventions in malnourished patients, identified through a screening procedure produce clinical benefits (assessed using randomised controlled trials, RCTs). (ii) A systematic review of nutritional screening interventions in populations of malnourished and well-nourished subjects (RCTs and non-RCTs). RESULTS: (i) The prevalence of malnutrition varies according to the criteria used, but is estimated to affect 10-60% of patients in hospital and nursing homes, 10% or more of older free-living subjects, and less than 5% of younger adults. In the absence of formal screening procedures, more than half the patients at risk of malnutrition in various settings do not appear to be recognised and/or are not referred for treatment. RCTs show that nutritional interventions in malnourished patients produce various clinical benefits. (ii) Interventions with nutritional screening in different care settings also generally suggest clinical benefits, but some are limited by small sample sizes and inadequate methodology. Factors that influence outcomes include validity, reliability and ease of using the screening procedure, the 'care gap' that exists between routine and desirable care and the need for other resources, which may increase or decrease following screening. CONCLUSIONS: The frequent failure to recognise and treat malnutrition, especially where it is common, is unacceptable. In such circumstances, the routine use of a simple screening procedure is recommended. Each health care setting should have a transparent policy about nutritional screening, which may vary according to the 'care gap', available resources, and specific populations of patients, in which the prevalence of malnutrition may vary widely.

Humans↗

PubMed2006

Radiological findings of screen-detected cancers in a multi-centre randomized, controlled trial of mammographic screening in women from age 40 to 48 years.

AIM: To elucidate the mammographic findings of screen-detected cancers in women screened between 40-48 years, and to establish the frequency and nature of abnormal findings on previous mammograms in women with screen-detected cancers. METHODS: A radiology review panel consisting of three experienced breast radiologists viewed the screening mammograms in chronological order, confirming that any abnormalities detected corresponded to the cancers detected at later screens. An analysis correlating mammographic features with median invasive size and the proportion measuring less than 10 and 15mm was performed. RESULTS: Two hundred and thirty-two women had screen-detected invasive cancers with mammograms available for review. The most frequent features seen at diagnosis were spiculate mass, ill-defined mass, granular calcification, deformity and comedo calcification. Thirty-four percent of mammograms showed calcification. The mammographic sign associated with smallest median size was calcification. Calcification was also the mammographic abnormality most frequently associated with cancers <10mm in size. In total there were 147 abnormal previous screens of 87 women. The most commonly missed features were granular microcalcification, deformity and ill-defined mass. Of the missed abnormalities 20% were classified as malignant, 43% as subtle change and 32% as non-specific. CONCLUSION: Compared with older women, screen-detected cancer in younger women more commonly manifests as calcification and less frequently a spiculate mass. Calcification is the sign most frequently associated with invasive cancers <10mm in size. Calcification and deformity are the signs most frequently seen on the previous mammograms of women with screen-detected cancer.

Adult↗

PubMed2005

Factors affecting the uptake of screening: a randomised controlled non-inferiority trial comparing a genotypic and a phenotypic strategy for screening for haemochromatosis.

BACKGROUND/AIMS: Haemochromatosis provides an example where a novel pragmatic genotypic screening strategy may be compared with a phenotypic strategy assessing factors affecting uptake, feasibility and cost. METHODS: A randomised controlled 'non-inferiority' trial testing the hypothesis that the uptake of testing in the genotypic strategy would not be inferior to the uptake in a phenotypic screening strategy. Three thousand individuals aged 30-70 were randomly selected and randomly allocated (stratified by age and sex) to one of two screening strategies. Phenotypic-transferrin saturation on blood sample taken at GP surgery or genotypic-saliva sample taken at home; followed in screen positive individuals with assessment of iron status and genotyping. RESULTS: The difference in uptake between the two strategies was 3.4% (95% CI=0.5-6.8). Uptake was low (32%) and least in young men from socially deprived areas. Phenotypic screening was least costly. CONCLUSIONS: In this study, investigating the uptake of screening for a treatable disease in primary care, the uptake of screening with the genotypic strategy was not inferior to that in the phenotypic strategy. The poor uptake in younger men would further limit the effectiveness of screening for haemochromatosis and may have implications for other screening programmes targeted to this group.

Adult↗

PubMed1996

Screening for common problems in ambulatory elderly: clinical confirmation of a screening instrument.

PURPOSE: To develop a test that will be administered by nonphysician office staff to screen elderly persons seen in ambulatory settings for problems commonly contributing to functional disability. METHODS: We reviewed the literature to identify problems that reduce function and screening measures appropriate for use in office settings. Using this information, we developed an instrument including screening items for malnutrition/weight loss, visual impairment, hearing loss, cognitive impairment, urinary incontinence, depression, physical disability, and reduced leg mobility. This instrument was tested on 109 new patients at a university-based ambulatory geriatrics medicine clinic and validated using two standards: blinded and unblinded geriatricians' assessments. For each of the individual items on the screening instrument, we calculated sensitivity and specificity using both the blinded and unblinded geriatricians' evaluations as the reference standards, prevalence of the disorders, positive and negative predictive values, inter-rater reliability, and the direct annual costs of administering the test for an individual physician's office. RESULTS: The screen was administered in 8 to 12 minutes. Inter-rater agreement varied by item from 77% to 100%. The sensitivities of the items varied between 0.65 to 0.93 (blinded) and 0.70 to 0.95 (unblinded). Specificities ranged between 0.50 to 0.95 (blinded) and 0.64 to 0.95 (unblinded). Problem prevalences varied from 21% to 72%. Positive and negative predictive values were 0.60 to 0.91 and 0.77 to 0.96, respectively. Direct annual costs for a clinical practice include a one-time $530 fee for equipment and, depending on the screening administrator's salary, between $1 to $7 per patient screened. CONCLUSIONS: The screening instrument is relatively inexpensive and brief and easy to use in the ambulatory setting. It is good validity and reliability when compared to the assessment of a geriatrician. We are currently conducting a randomized trial to assess the effectiveness of the screen among older persons seen in community physicians' offices.

Aged↗

PubMed1998

Diagnostic effectiveness of TSH screening and of T4 with secondary TSH screening for newborn congenital hypothyroidism.

We used a receiver operating characteristic (ROC) plot to evaluate the diagnostic accuracy of primary thyrotropin (TSH) screening, and compared it to the primary thyroxine (T4) with secondary TSH screening (T4/TSH) on a certain percentage of the lowest T4 value for newborn congenital hypothyroidism (CH). There were 2198 normal and 117 abnormal CH cases evaluated using both the Wallac Delfia neonatal TSH and neonatal T4 kits. The ROC areas of the primary TSH screening and T4/TSH screening were 0.9841 and 0.9557, respectively. Nine cases (out of 117 cases) of CH would have been misclassified if T4/TSH screening were used. These nine cases, however, were identified using primary TSH screening. We conclude that using primary TSH screening is more effective for mass screening in reducing false-positive and false-negative cases than the combined T4/TSH screening method.

Congenital Hypothyroidism↗

PubMed2004

Prospective evaluation of screening colonoscopy: who is being screened?

BACKGROUND: Universal access to medical procedures is deemed an advantage of the Canadian health care system. The purposes of this prospective study were to determine the degree to which the practice of colon cancer screening by colonoscopy differed among socioeconomic classes and to assess adherence to screening guidelines. METHODS: Consecutive patients scheduled to undergo colonoscopy at a single center between August 2000 and August 2002 completed a questionnaire that determined patient characteristics and indications for the procedure. The patients were divided into two groups: screening patients, defined as individuals who indicated they were undergoing colonoscopy for screening purposes and were asymptomatic, and a control group, which comprised patients undergoing colonoscopy because of symptoms. Statistical analysis was performed to determine if patients in the screening group had different characteristics with respect to socioeconomic class, compared with the control group. RESULTS: A total of 1088 patients completed the questionnaire: 707 (65%) had colonoscopy because of symptoms, compared with 381 (35%) who underwent a screening examination. Mean age and marital status were similar in both groups. Of all colonoscopy procedures, there was a significantly greater proportion of men undergoing colonoscopy for screening purposes: 199 (52.2%) vs. 294 (41.6%) in the symptomatic group ( p = 0.001). Based on the Cochran-Armitage test, patients in the screening group had significantly higher education levels ( p = 0.004) and household incomes ( p = 0.001). CONCLUSIONS: Income and education level, two indices of socioeconomic status, are statistically significantly higher in patients undergoing screening colonoscopy compared with those having colonoscopy for any other reason.

Adenoma, Villous↗

PubMed1998

Follow-up of newborns with low thyroxine and nonelevated thyroid-stimulating hormone-screening concentrations: results of the 20-year experience in the Northwest Regional Newborn Screening Program.

OBJECTIVES: To determine the type and frequency of thyroid disorders detected in infants with low thyroxine (T4) and nonelevated thyroid-stimulating hormone (TSH) screening test results in the Northwest Regional Newborn Screening Program (NWRNSP) over the 20-year period from May 1975 to May 1995 and to determine the effect of follow-up of these infants on the overall recall rate. STUDY DESIGN: The NWRNSP requests a serum specimen in infants with an absolute T4 level < 38.6 nmol/L (< 3 mg/dl) and in infants with two filter paper T4 concentrations less than the 3%, regardless of the TSH concentration. We conducted a retrospective analysis of infants who were followed up because of low T4 and nonelevated TSH concentrations on newborn screening. To determine the effect of follow-up of infants with low T4 levels, nonelevated TSH concentrations on the recall rate, we selected 1 year (1994) for review. Serum sample requests were evaluated to determine the reason for the request. RESULTS: Over this 20-year period, the NWRNSP detected 450 infants with primary hypothyroidism among 1,747,805 infants screened (1:3,884). Of these, 416 were detected on the basis of low T4 levels and nonelevated TSH screening test results, whereas an additional 34 infants with primary hypothyroidism and 29 infants with hypopituitary hypothyroidism were detected as a result of follow-up of low T4 levels and nonelevated TSH screening test results. This included 25 infants with delayed TSH rise (1:67,226), 9 infants with mild hypothyroidism (TSH levels < 25 mU/L) (1:194,212), 29 infants with hypopituitary hypothyroidism (1:60,269), and 434 infants with T4-binding globulin deficiency (1:4,027). Excluding those with T4-binding globulin deficiency, the false-positive rate was 43.5:1. This compares with an overall false-positive rate of 12:1 for our screening program. CONCLUSION: Follow-up of infants with low T4 and nonelevated TSH concentration on screening led to the detection of 63 additional infants with hypothyroidism, for an overall frequency of 1:27,743. We believe this yield justifies continued follow-up of infants with low T4 levels, nonelevated (TSH) screening test results in our program.

False Positive Reactions↗

PubMed2005

[Prenatal screening of cytomegalovirus in France: an increasing frequency practices of screening from 2000 to 2003 despite no recommendation in favor].

BACKGROUND: Screening cytomegalovirus infection in pregnant women is still controversial in 2004 in France. In this context, we evaluated the interest of such a screening in 2004 in France. This paper was designed to describe trends in CMV prenatal screening practices in 2000-2003 in France. METHODS: This retrospective study, describes the prescription of CMV screening in HIV-negative pregnant women giving birth in the private care sector, according to their occupational category and geographical area. Data were provided by the "Caisse d'Assurance-maladie des Travailleurs Indépendants" (independent workers health insurance fund). RESULTS: The study included 34.347 women, delivering in 2001-2004 (beginning of pregnancy in 2000-2003). The number of pregnant women screened for CMV increased significantly between 2000 (5.8%, 301/5.177), 2001 (11.1%, 1.130/10.139) and 2002 (22.1%, 2.701/12.223), (p<0.001), then was stable in 2003 (22.0%, 1.496/6.808). The percentage of women screened for CMV, at least once during pregnancy, doubled between 2001 and 2002 (p<0.001) in each occupational category and geographical area. It was significantly different between occupational categories (p<0.01), with a higher percentage of women in the self-employed and commercial agent occupational categories than in the craftsman category. There was also a significant difference between geographical areas (p<0.001), with a higher rate in Paris. CONCLUSION: This study providing baseline information on CMV practices showed: 1- a significant increase in the frequency of CMV screening among pregnant women over the period 2000-2002 with a stabilization in 2003; 2- a similar trend observed in each occupation category and geographical area but with a markedly higher frequency of screening practices in the Paris area and among self-employed women. A study measuring the effect of the 2004 ANAES recommendation suggesting not to screen for CMV during pregnancy should be conducted.

Adult↗

PubMed2000

Utilization of screening mammography as a preventive practice prior to initiating a population-based breast cancer screening program.

Factors associated with the level of utilization of screening mammography as a preventive practice were analyzed prior to initiating a population-based breast cancer screening program. A questionnaire was used to collect information about screening mammography utilization during the last 4 years among women invited to enroll in the program. Sociodemographic and health factors, and health services utilization were studied. A screening mammography in the last 4 years had been performed on 59.3% of the 8867 women interviewed. The utilization of mammography was higher among women who were younger, had a higher education level, or had previous visits to a physician (P < 0.001). The variables more strongly associated with use of screening mammography were: visit to a gynecologist and performance of a pap smear. Also associated with the utilization of screening mammography were: personal history of breast pathology, family history of breast cancer, breast self-examination, and recent visit to a general practitioner. Self-perceived health presented an inverse relation with screening mammography use (P < 0.001). The use of screening mammography appears to have increased in recent years, although inequalities persist which the breast cancer screening programs help to modulate. Mammographic frequency only would be deemed appropriate by the European guidelines in fewer than one-half of the cases.

Breast Neoplasms↗

PubMed2002

Evaluation of Legs For Life National Screening and Awareness Program for Peripheral Vascular Disease: results of a follow-up survey of screening participants.

PURPOSE: The Legs For Life(R) National Screening and Awareness Program for Peripheral Vascular Disease (PVD) was launched in 1999. A critical component of the screening program was an independent evaluation to provide additional information about the results of the program. This evaluation considers the health education impacts of the screening program; participants' knowledge about appropriate providers; and some of the outcomes associated with the program. MATERIALS AND METHODS: The evaluation is based on a representative sample of 700 individuals who participated in the screening program and responded to a six-page closed-ended mail questionnaire 6 months after the screening. The sample was drawn in a two-stage cluster. A sample of 1,000 individuals was drawn using random selection of low-risk participants and oversampling of all high- and medium-risk participants from 22 sites. RESULTS: More than 80% of the respondents remembered the name of the test (ankle-brachial index) given during the screening program. More than half the respondents reported being informed during the screening that leg pain when walking was a symptom of PVD, and 40% reported being told that numbness in the leg was a symptom. The majority of respondents were able to identify ways to prevent or slow the progression of PVD, whereas just under 50% were able to identify those individuals that would be at higher risk for PVD. Respondents most frequently identified vascular surgeons (42%), family or primary care physicians (22%), and cardiologists (19%) as the type of doctor to see for PVD treatment, whereas only 4.8% of screening participants recognized interventional radiologists as specialists appropriate to dealing with PVD. CONCLUSION: Evidence from participants in the Legs For Life(R) National Screening Program suggests that the program has met its initial goals of education, identification, and treatment for those identified with PVD. While many specialties manage this condition, the evaluation indicates there is much to be done in increasing the awareness of interventional radiologists and their role in the diagnosis and treatment of PVD.

Aged↗

PubMed2001

Health technology assessment and screening in The Netherlands: case studies of mammography in breast cancer, PSA screening in prostate cancer, and ultrasound in normal pregnancy.

OBJECTIVE: To review the assessment and implementation of three screening methods: mammography for breast cancer, screening for prostate cancer, and routine use of ultrasound in pregnancy. METHODS: To review policy documents and published papers dealing with prevention and screening in the Netherlands, focusing on the three screening methods specified. RESULTS: The results indicate that the Netherlands has an active establishment devoted to health technology assessment (HTA). The Netherlands government has also made prevention a high priority in the health services system. Within prevention policy, HTA is given an important place. The general policy is that prevention programs should meet high standards of effectiveness and efficiency, as well as ethical, legal, and social acceptability. In addition, the Netherlands may be unique in the world in having a specific law requiring that proposals for population screening must be carefully assessed before they are implemented. CONCLUSIONS: The three cases examined in this paper have all been assessed, and the conclusions are similar to those presented in the synthesis published in this issue (33). In the case of mammography, the assessment was followed by a rational implementation of a national screening program for breast cancer. In the other two cases, however, despite negative conclusions from assessment, the tests are frequently carried out, especially in what has been termed opportunistic screening. Prostate cancer screening seems to be spreading rapidly. Use of ultrasound in pregnancy is frequent, not necessarily for medical reasons but because parents wish to have a picture of their fetus. The conclusion is that HTA is well established in the Netherlands, as illustrated in these three cases, and policy is based on the assessments done. However, practice is not in accord with the assessment in the cases of prostate cancer and routine ultrasound. Policies to deal effectively with opportunistic screening are difficult to imagine.

Adult↗

PubMed2003

The Norwegian Breast Cancer Screening Program: re-attendance related to the women's experiences, intentions and previous screening result.

OBJECTIVE: To survey factors of importance for attendance in the Norwegian Breast Cancer Screening Program (NBCSP). METHODS: Simple forced choice questionnaires were sent to 1221 women, in four categories: not attended, screened negative, false positive, and breast cancer cases. The response rate was 80.7%. RESULTS: Women who were invited to the NBCSP reported positive opinions about being invited and the provided information. This response was independent of attendance and screening result. An experience of pain during screening examination was reported in the same proportion among women who were screened negative and false positive (p = 0.27). Unsatisfactory care was reported in a significantly lower rate among women who were screened negative, compared to the false positive (p = 0.02) and breast cancer cases (p < 0.01). Re-attendance was significantly higher among women who were screened negative (91.8%), compared to the false positive (83.9%, p < 0.01). Experienced pain seemed to influence re-attendance among the false positive, while care seemed to influence re-attendance among women who were screened negative. Intention to re-attend was significantly associated with the rate of re-attendance (p < 0.01) and it was the only significant predictor for re-attendance (OR = 5.4, 95% CI: 1.8-16.7) in a multiple logistic regression analysis with intention, age, experienced pain, experienced care and waiting time included in the model. Age did not have much influence on results. CONCLUSION: Women, who were invited to the NBCSP, reported positive opinions about the program. Re-attendance was related to previous screening results, partly by, experienced pain and care.

Aged↗

PubMed2006

The effectiveness of school dental screening: dental attendance and treatment of those screened positive.

OBJECTIVE: To determine dental attendance and treatment outcomes following two models of dental screening. DESIGN: An observational prospective cohort study. SETTING: Infant, primary and junior schools in the North West of England. SUBJECTS: Children aged six to nine years at the start of the study. INTERVENTIONS: Subjects received a screening examination according to either a 'Traditional model' or 'New model' of school dental screening. MAIN OUTCOME MEASURES: Attendance at a dentist within four months of the intervention and treatment received by children referred via the 'New model' with caries in their permanent teeth. RESULTS: In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment. CONCLUSION: School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services.

Child↗