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PubMed1997

Know your numbers: comparing participants and nonparticipants in a university health screening program.

University faculty and staff members were offered the opportunity to participate in a worksite health screening program. Both the participants and the nonparticipants responded to a questionnaire concerning their dietary and health practices. Participants' values for total serum cholesterol, blood pressure, and percentage of body fat were measured. No significant differences between the two groups were observed for the parameters of self-reported total serum cholesterol or blood pressure, and the participants' self-reported and measured serum cholesterol values were not significantly different from those of the nonparticipants. However, the measured and self-reported percentages of body fat of participants were significantly different from reported percentages of body fat of those who did not participate. Further exploration of the motivation of participants in health screening programs is called for.

Adult↗

PubMed1984

[Problems in mass screening program for prostatic diseases].

We developed transrectal ultrasonotomography for practical use in 1967 and started a model trial mass screening program for prostatic diseases with the method in 1975. A mobile unit "Dolphin" for mass screening, in which two sets of special chair-type scanner for the method was loaded, was developed successfully in 1980. Up to March, 1983, 2394 males over the age of 55 were submitted to the primary study. Among them, 12 cases (0.5%) of prostatic cancer (PC) and 755 cases (31.5%) of benign prostatic hypertrophy (BPH) were finally detected in the secondary study. Thus the prevalence of BPH was significant and even the detection rate of PC was still remarkably higher than that in mass screening for other malignancies. The diagnostic accuracy in transrectal ultrasonotomography in PC was calculated from the results of patients visiting our out-patient clinic during 7 years until March, 1983. The sensitivity was 96.5% and the specificity was 84.6%. On the other hand, the sensitivity of digital examination in the same series was 80.7%. We concluded from this study that the efficacy of digital examination was thought to be insufficient for the screening of PC. The cost-benefit balance in our mass screening system was estimated from the above mentioned results. We needed yen 2,000,000 to find out each case of early PC in the system. In our clinic, patients with early PC paid yen 2,000,000 in average for treatments including radical surgery and were cured. On the contrary, patients with advanced PC paid yen 5,000,000 approximately yen 8,000,000 and died eventually. The minimum difference of treatment fee between early and advanced PC was yen 3,000,000, accordingly. Since the cost of detecting each early PC in mass screening was yen 2,000,000, we are contributing approximately yen 1,000,000 to the national finance on each time when we pick up one case of early PC. This doesn't include benefits from detecting BPH and from life prolongation. Thus the balance seems to be sufficiently positive. In conclusion, a mass screening program for prostatic diseases is promising because it can detect the diseases accurately by transrectal ultrasonotomography with a good cost-benefit balance. The only remaining problem is how to transfer this to national political measures.

Aged↗

PubMedDate not supplied

Effects of intervention on compliance to referral and lifestyle recommendations given at cholesterol screening programs.

To enhance compliance to physician referral as well as dietary and other lifestyle recommendations given at blood cholesterol (BC) screening programs, we randomized Pawtucket Heart Health Program SCORE (screening, counseling, referral event) participants with elevated BC levels into one of four groups: usual care group; a participant intervention group (mailed reminder letter and refrigerator magnet); a physician intervention group (mailed packet to participant's physician including letter, National Cholesterol Education Program [NCEP] guidelines, and preaddressed postcard to mail to patient); and a group that received both interventions. Beginning four months after the screening, we surveyed study subjects by phone. The participant intervention increased recall of physician referral and dietary recommendations; however, neither intervention successfully improved compliance to referral or dietary and lifestyle recommendations. Overall, 58%, 67% and 34% of subjects reported complying to physician referral, dietary recommendations, and lifestyle recommendations, respectively. Referral compliance was associated with a longer time interval between screening and survey (relative risk [RR] = 1.3, 95% confidence interval [CI[ = 1.0, 1.7), possession of medical insurance that covered physician visits (RR = 2.1, 95% CI = 0.98, 4.4), and history of hypertension (RR = 2.6, 95% CI = 1.1, 5.8). Dietary compliance was positively associated with baseline BC levels > or = 240 mg/dL (RR = 3.3, 95% CI = 1.4, 7.3) and negatively associated with increasing age; each one year increase in age corresponded to a 3% decrease in compliance (RR = 0.97, 95% CI = 0.9. 1.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗

PubMed1980

An improved electrophoretic method for a screening program for haemoglobinopathies.

A method for a screening program for haemoglobinopathies in a starch agar gel mixed with saponin is presented. Normal and abnormal blood containing haemoglobins S, C, I, M Boston, D Punjab, beta thalassaemia major and beta thalassaemia minor, were applied, in a tray with the capacity for 100 samples. The electrophoresis was performed in 45 min using 300 V. This method offers special advantages for the examination of a large number of samples, using a small amount of whole blood and without the previous preparation of haemoglobin solution.

Electrophoresis, Agar Gel↗

PubMedDate not supplied

Familial thyroxine-binding globulin deficiency detected in a pilot screening program for congenital hypothyroidism.

During a pilot screening program for congenital hypothyroidism, performed in Italy over a three years period on 38,000 newborns, seven cases (1/5,400) of thyroxine-binding globulin (TBG) deficiency, have been detected. None of these infants was affected by any pathology or had been treated with drugs which could explain TBG deficiency as an acquired condition. Familial studies pointed out that the transmission of the defect is consistent or compatible with X-chromosome linkage.

Congenital Hypothyroidism↗

PubMed1976

A dental school hypertension screening program.

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.

Blood Pressure↗

PubMed1997

An evaluation of educational outreach to general practitioners as part of a statewide cervical screening program.

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.

Adult↗

PubMed2000

[Use of AutoTopograf TMS-3 keratoconus screening program for keratoconus detection].

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.

Astigmatism↗

PubMedDate not supplied

Evaluation of referral completion after a workplace cholesterol screening program.

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.

Adult↗

PubMedDate not supplied

Factors associated with participation by Mexican migrant farmworkers in a tuberculosis screening program.

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.

Adolescent↗

PubMed1978

The impact of a community screening program on psychiatric hospital admissions.

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.

Commitment of Persons with Psychiatric Disorders↗

PubMed1992

Comparison of characteristics between frequent participants and non-participants in screening program for stomach cancer.

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.

Adult↗

PubMed1987

Is the tuberculosis screening program of hospital employees still required?

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)

Adult↗

PubMed1996

Feasibility of an emergency department-based, risk-targeted voluntary HIV screening program.

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.

AIDS Serodiagnosis↗

PubMed2000

Standardized abnormal interpretation and cancer detection ratios to assess reading volume and reader performance in a breast screening program.

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.

Adult↗

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↗

PubMed1989

Studies on congenital hypothyroidism and results of three and half years of compulsory screening program in Slovak Socialist Republic.

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.

Congenital Hypothyroidism↗

PubMed2002

[The hearing screening program for newborns with otoacoustic emission for early detection of hearing loss].

The importance of early detection of hearing loss is well known and screening programs for newborns are becoming more common throughout the world. The Hadassah hearing screening program for newborns using the Transient Evoked Otoacoustic Emission (TEOAE) test began in October 1999. All newborns are tested before discharge from the hospital. In case of inadequate results, the infant is scheduled for follow-up in 4 weeks in the Speech and Hearing Center, and according to results, a full audiological evaluation is performed. The high-risk population is also scheduled for follow-up. The preliminary results from 8,982 newborns show that 93.5% passed the screening in the maternity ward, 4.2% failed unilaterally, and 2.2% failed bilaterally. The follow-up rate was low in the beginning, and improved due to proceeding letters and phone calls. The follow-up results show that we were able to detect 6 infants with a hearing loss under the age of 3 months, 4 of these infants belong to the high-risk group. We believe that TEOAE hearing screening for newborns is feasible and can help to detect hard of hearing children earlier than in the past. Undoubtedly, cost effectiveness considerations will be involved in implementation decisions.

Deafness↗