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This paper has described a hypertension screening program at the Medical College of Virginia School of Dentistry. The program, which has been in operation for over two years, incorporates referral to a physician and a system of repeated follow-ups. The results indicate that the program has been successful in that 134 of a total of 141 patients with suspected hypertension have been successfully referred.
OBJECTIVES: The purpose of this study was to determine the acceptability, effectiveness, and cost of a face-to-face educational outreach intervention in the context of a program aimed at increasing cervical screening in Victoria, Australia. METHODS: All identified general practitioners in a specified intervention area were offered a visit by a general practitioner educator. Practitioners completed a questionnaire evaluating the acceptability of the visit. Odds ratios for a woman being screened in the 3 months following the visits were determined. RESULTS: Fifty-nine general practitioners (69.4%) accepted the offer of a visit. Most found both the process and the content of the intervention to be acceptable. The intervention and nonintervention regions did not differ either before or after the intervention. In both regions, there was a statistically significant increase in number of Pap tests performed. There was no difference in the change in screening between the two regions. Costs were estimated at Au$34 per general practitioner visited. CONCLUSIONS: This strategy cannot be recommended for widespread use in a cervical screening program.
PURPOSE: The purpose of this study was to investigate sensitivity of Klyce-Maeda and Smolek-Klyce methods in detection of early or suspect keratoconus by using AutoTopographer TMS-3 (Tomey). MATERIAL AND METHODS: At the First Department and Clinique of Ophthalmology, Silesian Medical School in Katowice, 175 eyes underwent ophthalmological examinations. There were 67 eyes with irregular astigmatism, 39 eyes with PRK decentration and 69 eyes with early or suspected keratoconus. The procedure was performed with the TMS-3 AutoTopographer (Tomey). During the study we investigated index definitions included in Keratoconus Screening Program. RESULTS: The examination showed the false positive results: in irregular astigmatism (KSI index in 31.3%, KPI index in 10.4%), in PRK decentration (KSI and KPS index in 18%). The results of analysis of keratoconus detection by Keratoconus Screening Program in early or suspected keratoconus were false negative (it means there were no keratoconus symptoms) in KCI index--24.6%, in KSI index--11.6% and KPI index--21.7%. CONCLUSION: To sum up, we can say that Keratoconus Screening Program is a good program for confirming diagnosis of early keratoconus in 80%, but it has to be assisted by a clinical examination.
We designed a randomized clinical trial to examine effectiveness of a follow-up educational mailing to improve referral completion following a workplace cholesterol screening program. Of 836 employees who participated in a cholesterol screening program at Blue Cross and Blue Shield of Maryland, 313 (37%) had a total cholesterol greater than or equal to 200 mg/dL and were referred to their physician for remeasurement and evaluation. Individuals with elevated cholesterol who agreed to a telephone interview two months after screening (n = 272) were randomized to a control or intervention group. The intervention consisted of a booster mailing two weeks after screening designed to encourage further physician follow-up and to increase knowledge about cholesterol and its dietary control and about risk factors for coronary heart disease (CHD). No statistically significant differences appeared between the control and intervention groups in rate of referral completion. However, a blood cholesterol level of greater than or equal to 240 mg/dL at the time of screening was the most significant predictor of referral completion (P less than .0001). Of those randomized, the association between the number of other additional risk factors for CHD and referral completion was not statistically significant. There was, however, a trend toward reported changes in lifestyle behavior as a result of screening, particularly in diet modification.
BACKGROUND: Tuberculosis is an important public health concern among migrant farmworkers in the United States; providing appropriate screening and treatment is difficult due to their highly mobile existence. PURPOSE: To analyze the relationship between variables (susceptibility, severity, barriers, benefits, cues to action, normative beliefs, subjective norm, attitude, and intention) from the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA) and participation by Mexican migrant farmworkers in a tuberculosis screening program. METHOD: A convenience sample of 206 migrant farmworkers were recruited after a presentation of a tuberculosis education program and were tracked during the administration and reading of the tuberculosis skin test. Participants were interviewed in Spanish by the principal investigator using the Tuberculosis Interview Instrument (TII) developed for this study. RESULTS: Most subjects were male, aged 18-27 years, and had less than a sixth-grade education. Of the 206 subjects, 152 (73.4%) received the skin test, 149 (98%) had the skin test read, and 44 (29.5%) had positive skin tests. Based on logistic regression analysis, the model that best predicted intention included cues to action, subjective norm, susceptibility, and attitude. Participation in screening was best predicted by a model containing only two variables: intention and susceptibility. CONCLUSIONS: In this study, logistic regression analysis revealed that a more parsimonious model than the full HBM and TRA model accurately predicted both intention and behavior. The findings may be helpful in developing tuberculosis education and screening programs for Mexican migrant farmworkers.
A rural CMHC screening program significantly reduced admission rates to a state hospital compared with hospital-based screening. Personnel from CMHCs in three counties evaluated each potential admission to the hospital to evaluate their need for hospitalization. Hospital staff screened admissions from the remaining counties of the state. Both community and hospital screening resulted in significant reductions in admissions with community screening producing larger declines. Additional possible advantages of community screening for improved treatment outcomes, efficient utilization of community resources, and reduced costs are discussed.
To clarify the differences in characteristics between participants and non-participants in the screening program for stomach cancer, life-style and medical histories were compared among 20, 169 subjects who lived in an urban area (Sendai) and a rural area (Wakuya and Tajiri) in Miyagi Prefecture, Japan. All subjects were classified into three groups according to the frequency of participation in the screening program during the last 5 years; i.e., frequent participating group (FPG) for 4 or 5 times, reference group (RG) for 1-3 times and non-participating group (NPG) for 0 times. Subjects in the FPG consumed more milk and green-yellow vegetable whereas those in the NPG consumed less these foods. The age-adjusted proportions of present smokers were higher in the NPG but lower in the FPG significantly. The proportions of subjects who had parental histories of all cancers and stomach cancer and past history of gastro-duodenal ulcer were higher in the FPG and lower in the NPG. To control influences among the variables a stepwise multiple regression analysis was done, and it revealed that smoking and parental history of cancers were strong predictors to explain the frequency of participation.
The American Thoracic Society and the Centers for Disease Control recommend that each hospital has a tuberculosis screening program. As the incidence of active tuberculosis in the United States has been decreasing during the last 30 yr, the necessity for continuing this screening program may be questioned. This prospective study evaluates whether screening hospital employees is still useful. In the state of Washington from January 1, 1982, through December 31, 1984, tuberculosis was diagnosed in 747 patients, of whom 387 (52%) were hospitalized. One hundred seventy-one of the hospitalized patients (44%) were sputum-smear-positive. Data were collected from each of the 114 hospitals in the state. During the 3-yr period, 50 hospitals admitted no patients known to have M. tuberculosis, 48 admitted 1 or more sputum-smear-positive patients, and 16 others admitted 1 or more smear-negative patients. The number of employees at each hospital ranged from 10 to 6,289 (539 +/- 757, mean +/- SD). Skin testing was performed on 13.7 to 100% (median, 84.2%) of employees. In the 3-yr period, 126,493 skin tests were placed by trained personnel; 501 employees were reported as being converters, but only 129 were found to be true converters. The conversion rates of employees in hospitals to which patients with smear-positive and smear-negative disease were admitted were 1.05 and 1.09 per 1,000, respectively. The conversion rate in hospitals where no patients with M. tuberculosis were admitted was 0.8 per 1,000. These conversion rates were no greater than that predicted for the general population.(ABSTRACT TRUNCATED AT 250 WORDS)
STUDY OBJECTIVE: To assess the feasibility and effectiveness of an emergency department-based, risk-targeted voluntary HIV screening program. METHODS: We prospectively enrolled consenting adult i.v. drug users (IDUs) not known to have HIV infection in the ED of a large inner-city hospital with a high rate of HIV infection among patients during a 10-week trial. Study patients were given confidential HIV pretest and risk-reduction counseling, with 10- to 14-day on-site ED follow-up. Follow-up included posttest counseling, reinforcement of risk-reduction practices, and a +10 incentive to cover transportation costs. HIV seropositive patients were referred to the hospital HIV clinic for further evaluation and treatment. RESULTS: Of 200 eligible IDUs, 168 (84%) consented to HIV testing. Of the 104 (62%) who returned for follow-up, 17 (16%) tested positive for HIV. Of these patients, 6 (35%) kept their initial hospital HIV clinic referral appointment, a rate consistent with the experience of the hospital HIV clinic. Of nine patients in whom CD4+ counts were performed at time of the visit, three (33%) had counts less than 200. At 3-month follow-up, 4 of 20 active IDUs (20%) had reportedly ceased drug use because of the program. The complete program costs was an estimated $16,659, $99 per enrolled patient and $521 per HIV-positive patient. CONCLUSION: An ED-based, risk-targeted HIV screening program is feasible and over time could detect a significant number of asymptomatic HIV-infected individuals, including those who should receive antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia therapy (CD4+ count less than 200). An additional benefit of ED-based HIV screening in high-prevalence EDs is the opportunity to conduct successful risk-reduction counseling in some high-risk individuals.
PURPOSE: To determine the relationship between annual screening volume and radiologist performance in the Screening Mammography Program of British Columbia, Canada. MATERIALS AND METHODS: Standardized abnormal interpretation ratios and standardized cancer detection ratios were constructed for 35 readers with at least 3 years of experience with the Screening Mammography Program of British Columbia. The ratios were used to compare individual reader performance with the mean program performance after adjustment for the age and screening history (first versus subsequent screening examinations) of the women who underwent screening. RESULTS: The mean standardized abnormal interpretation ratio was better for readers of 2,000-2,999 (n = 8) and 3,000-3,999 (n = 9) screening mammograms per year than for those of less than 2,000 (n = 9) and 4, 000-5,199 (n = 9) screening mammograms per year. Differences in the mean standardized abnormal interpretation ratios were significant (P <.05) between the readers of less than 2,000 and of 2,000-2,999 screening mammograms per year, between readers of less than 2,000 and of 3,000-3,999 screening mammograms per year and between readers of 3,000-3,999 and of 4,000-5,199 screening mammograms per year. The mean standardized cancer detection ratio improved gradually with increasing annual volume, but the differences between groups were not statistically significant. Five of the eight readers of 2,000-2, 999 mammograms were reading 2,475 or more screening mammograms per year. CONCLUSION: Standardized abnormal interpretation ratios and standardized cancer detection ratios provide a method of comparing two important performance measures in a screening program. A minimum of 2,500 interpretations per year is associated with lower abnormal interpretation rates and average or better cancer detection rates.
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.
In the introduction the results of previous retrospective study (1975-79) including 312,259 newborns and of preliminary screening program including 31,780 newborns are briefly summarized. After January 1st, 1985 a compulsory screening of congenital hypothyroidism (CH) was started in the whole territory of Slovakia using the estimation of thyroxine in dry blood spot obtained from a heel prick on 5th day after birth. In suspected cases a complete clinical and laboratory examination was made including TSH estimation by RIA and after January 1st, 1988 by IRMA. The organization of screening program is described in detail. During three and half year period 286,469 newborns were examined which represented almost 100 percent of all newborns. A total of 44 cases of CH was found out of them 13 cases of athyreosis, 3 cases of ectopic thyroid and 28 cases of dyshormonogenesis (among them 5 cases with goiter and 23 cases without goiter). The average incidence of CH was 1:6874. Until January 1st, 1988 (when only T4 estimation was used as a first step) the recall rate was 2.32% and the treatment was started before 25th day after birth, while after the use of TSH by IRMA from dry blood spot in suspected cases (i.e. after January 1st, 1988) the recall rate decreased to 0.82% and the treatment was started before 14th day of life. In addition, the data on 39 cases of TBG deficiency and on regional differences in their incidence are reported. Some remarkable differences in the incidence of total CH and of its individual variants between West, Central and East Slovakia with different historical, cultural, economical and genetical background as well as in some ethnic groups (Gypsies) are also presented.
Otological, ophthalmological and genetic studies were performed in 46 patients with Usher syndrome, identified through a screening program in Colombia. Of them, 69.6% had Usher syndrome type I, 26.1% type II, and 4.3% type III. Thirty-three patients showed profound deafness (71.7%), while 13 (28.3%) had moderate to severe hearing loss. The ophthalmologic manifestations showed marked variability. Although the majority of the patients had serious ocular impairment before age 20, 32.6% had good central visual acuity. The prevalence of Usher syndrome in Colombia, estimated at 3.2/100,000, warrants the implementation of screening programs in schools for the deaf and for the blind. Our study confirms that Usher syndrome shows no geographic or racial variation and that the disorder has a wide variability of expression and genetic heterogeneity. The large size of the families we have detected may provide important opportunities for further genetic studies, particularly in terms of the assignment of the locus and gene mapping.
TSH data from the congenital hypothyroidism screening program were analyzed in a mild to moderate iodine deficiency region. Neonatal TSH levels were measured at day 4-5 of life in 22,384 infants (99% coverage; 51.1% males, 48.9% females). The cut off TSH value for recall was established at 20 microUl/ml whole blood. TSH values > 20 microUl/ml were excluded from further analysis of the data. The frequency distribution analysis showed that the median neonatal TSH level was 2 microUl/ml and the mode (28% of newborns) corresponded to neonatal TSH values < 1 microUl/ml. TSH levels above 5 microUl/ml were observed in 14.4% children and the 97% cut off was 11 microUl/ml. When examined in relation to the areas of newborn origin, the individual 97% cut off values varied from 8 to 14 microUl/ml. Accordingly, the frequency of TSH levels above the 97% cut off value calculated for the entire newborn series (> 11 microUl/ml) ranged from 2.1% to 4.6%. A significant correlation was found between the frequency of neonatal TSH levels > 11 microUl/ml and both goiter prevalence (r2 = 0.88; p = 0.0019) and median urinary iodine excretion (r2 = 0.86; p = 0.0077) observed in those areas for which epidemiological data were available (n = 7). The results indicate that neonatal TSH data from the congenital hypothyroidism screening programs can be used for monitoring mild to moderate iodine deficiency regions.
OBJECTIVE: To evaluate the efficacy of combining hCG and alpha-fetoprotein (AFP) with maternal age in a two-analyte maternal serum screening program for Down syndrome. METHODS: A prospective study involved the screening of 12,170 maternal sera from patients at 14-25 weeks of gestation. The risk for Down syndrome at term was calculated from maternal serum hCG and AFP, and maternal age. For women 36 years of age and younger, a risk of 1:307 or greater was considered screen-positive. For women over 36, a risk greater than that a priori was considered screen-positive. False-positive rates and detection rates were compared with those resulting from a screening protocol using only AFP and age. RESULTS: Seven hundred eighty-two sera were initially screen-positive (6.4%). Subsequent sonography decreased this total to 687 (5.6%), and 467 (3.8%) of these patients accepted amniocentesis. Ten cases of Down syndrome and seven other chromosomal abnormalities were detected. Follow-up investigations revealed eight additional Down syndrome cases that were missed by screening. The identification of 18 Down syndrome cases in 12,170 pregnancies corresponds closely with the prediction of 14.1 Down syndrome births (18.2 second-trimester fetuses) in this population calculated from age-dependent risks. The detection rate for Down syndrome was 56% (ten of 18 expected cases). Only five of 18 (28%) would have been detected by AFP and age alone. CONCLUSION: These results support the mathematical model that hCG is the major contributor to the increased sensitivity of multi-analyte screening and demonstrate that screening programs can attain substantial improvement in detection of second-trimester Down syndrome by adding hCG to AFP and age.
In order to evaluate the effectiveness of a mass screening program for stomach cancer, a case-control study was conducted in Nose town in Osaka, Japan. The case series consisted of all deaths from stomach cancer during the period 1969-1981 (54 in males and 37 in females). For each case, 3 controls of the same sex and from the same precinct as the case, and born within 5 years of the case birth-year, were selected at random from Nose town residents alive at the date of death of the relevant case. We then investigated whether each case and corresponding controls had ever had screening tests before the date of diagnosis of the case. From the matched analysis of the distribution of screening in case-control combination, the odds ratio of screened vs. unscreened among those who died from stomach cancer compared to those who did not was calculated as 0.595 (90% confidence interval: 0.338-1.045) among males and 0.382 (0.185-0.785) among females. When the screening tests conducted within 12 months of diagnosis were ignored on the presumption that they were symptom-related, the odds ratio was calculated as 0.519 (0.297-0.905) among males and 0.486 (0.239-0.986) among females. These data strongly suggest that the mass screening program is effective in reducing stomach cancer mortality.
BACKGROUND: The objective of this study was to compare the response received by a population-based breast cancer screening program, according to three different invitation strategies: letters sent by mail from the program (program group), letters sent by mail from the Primary Health Care Team (PHT group), and direct contact through a trained professional (direct contact group). METHODS: We used a cluster-randomized controlled trial with assignment to invitation group using home address. Nine hundred eighty-six women of Barcelona (Spain), ages 50 to 64 years, were invited to participate in the program. The main outcome used was the response rate after the first invitation. RESULTS: Five hundred sixty-four women accepted the invitation (57.2%). The highest response rate was achieved in the direct contact group (63.5%), followed by the PHT group (55.6%), the program group being the one that attained the lowest response rate (52.1%). The direct contact group had a higher probability of participating than the PHT group (RR = 1.14, P = 0.037) or the program group (RR = 1.22, P = 0.003). The response rate in the direct contact group was 72.1% when the letter was received by the subject herself. The increase in response occurred particularly among women of lower educational level. CONCLUSIONS: Inviting women to participate in a breast cancer screening program through direct contact by trained personnel increased participation rate compared with mailed-letter methods. The positive effect appeared restricted to women with lower educational levels.
BACKGROUND: This study was designed to evaluate the distribution of prostate-specific antigen (PSA) levels of men in a mass screening program for prostatic disease. METHODS: A total of 763 men over 40 years of age underwent mass screening for prostatic disease in a Japanese prefecture using the highly sensitive Eiken kit and the Hybritech (Tandem-R) kit. The screening tests consisted of serum PSA determination, digital rectal examination, a questionnaire on symptoms, evaluation of prostate volume, and determination of the obesity rate. RESULTS: Serum PSA levels of all subjects were measured with both kits. The correlation between the values obtained by the Eiken kit and those of the Tandem-R kit was high (r = 0.990), but the values of the former were slightly higher than those of the latter. Serum PSA weakly correlated with age, however, when estimated within decade age brackets, the levels of PSA showed significant differences among only 1 pair of groups stratified by age. In contrast, the levels of PSA showed significant differences among 9 pairs of groups stratified by prostate volume. CONCLUSION: A highly sensitive assay kit is useful to evaluate both the distribution of PSA levels and the relationship of PSA values to age and prostate volume of men in mass screening programs for prostatic disease, since approximately 40% of the subjects who underwent the present mass screening showed PSA values under 1.0 ng/mL, which have been the the lower limit of detection of many PSA kits.