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PubMed2005

Diabetes-related symptoms and negative mood in participants of a targeted population-screening program for type 2 diabetes: The Hoorn Screening Study.

OBJECTIVE: To determine the level of diabetes-related symptom distress and its association with negative mood in subjects participating in a targeted population-screening program, comparing those identified as having type 2 diabetes vs. those who did not. RESEARCH DESIGN AND METHODS: This study was conducted within the framework of a targeted screening project for type 2 diabetes in a general Dutch population (age 50-75 years). The study sample consisted of 246 subjects, pre-selected on the basis of a high-risk profile; 116 of whom were subsequently identified as having type 2 diabetes, and 130 who were non-diabetic subjects. Diabetes-related symptom distress and negative mood was assessed approximately 2 weeks, 6 months, and 12 months after the diagnosis of type 2 diabetes, with the Type 2 Diabetes Symptom Checklist and the Negative well-being sub scale of the Well-being Questionnaire (W-BQ12), respectively. RESULTS: Screening-detected diabetic patients reported significantly greater burden of hyperglycemic (F = 6.0, df = 1, p = 0.015) and of fatigue (F = 5.3, df = 1, p = 0.023) symptoms in the first year following diagnosis type 2 diabetes compared to non-diabetic subjects. These outcomes did not change over time. The total symptom distress (range 0-4) was relatively low for both screening-detected diabetic patients (median at approximately 2 weeks, 6 months, and 12 months; 0.24, 0.24, 0.29) and non-diabetic subjects (0.15, 0.15, 0.18), and not significantly different. No average difference and change over time in negative well-being was found between screening-detected diabetic patients and non-diabetic subjects. Negative well-being was significantly positive related with the total symptom distress score (regression coefficient beta = 2.86, 95% CI 2.15-3.58). CONCLUSIONS: The screening-detected diabetic patients were bothered more by symptoms of hyperglycemia and fatigue in the first year following diagnosis type 2 diabetes than non-diabetic subjects. More symptom distress is associated with increased negative mood in both screening-detected diabetic patients and non-diabetic subjects.

Affect↗

PubMed1990

Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy. The Helsinki Ultrasound Trial.

During a 19-month period, 95% of all pregnant women in the greater Helsinki area, Finland, entered a study to compare one-stage ultrasonography screening with selective screening according to antenatal hospital use, obstetric procedures, and fetal outcomes. Of 9310 women who entered the trial, 4691 were randomly allocated to ultrasound screening between the 16th and 20th gestational weeks and 4619 to follow-up only. Screened and control groups otherwise had the same antenatal care, which included ultrasonography according to usual practice. Screened women made fewer visits to the antenatal outpatient clinic than did women in the control group (2.3 vs 2.6). There were no differences in the number of labour inductions or mean birthweights in the two groups. Perinatal mortality was significantly lower in the screened than in the control group (4.6/1000 vs 9.0/1000); this 49.2% reduction was mainly due to improved early detection of major malformations which led to induced abortion. All twin pregnancies were detected before the 21st gestational week in the screening group compared with 76.3% in the control group; perinatal mortality in the small series of twins was 27.8/1000 vs 65.8/1000, respectively.

Evaluation Studies as Topic↗

PubMed2005

Health information system for community-based multiple screening in Keelung, Taiwan (Keelung Community-based Integrated Screening No. 3).

BACKGROUND: Community-based multiple screening for common cancers and chronic diseases has increasingly gained attention. However, as infrastructure and evaluation system are more diversified and complicated compared with single screening, the development of a novel health information system is paramount. METHODS: The main goal of our health information system was to support the multiple screening program not only from technical aspect but also from a broad range of perspectives including quality assurance system, organized features appertaining to screening, economic evaluation (cost-effectiveness or cost-utility analysis), epidemiological applications, behavior risk factor surveillance system, and social impact due to the introduction of the Keelung Community-Based Integrated Screening (KCIS) program. RESULTS: Health information system was designed and programmed on the basis of the demand derived from KCIS within which five cancers and three chronic diseases were included. In addition to the detailed description of infrastructure and process, design, relevant database and security involved in health information system, an innovative and extensive evaluation system in accordance with the main goals was included in our health information system. CONCLUSION: Our information system proposed several aspects regarding organized screening system that has never been addressed in computerized system supporting for single screening. These included quality assurance system, organization features, co-morbidity profiles, epidemiological applications and social and economic considerations.

Community Health Services↗

PubMed2005

Clinical outcomes from skin screening clinics within a community-based melanoma screening program.

BACKGROUND: Within a randomized trial of population screening for melanoma, primary care physicians conducted whole-body skin examinations and referred all patients with suspect lesions to their own doctor for further treatment. OBJECTIVE: Our aim was to describe characteristics of skin screening participants, clinical screening diagnoses, management following referral, and specificity and yield of screening examinations. METHODS: Information collected from consent forms, referral forms, and histopathological reports of lesions that had been excised or undergone biopsy was analyzed by means of descriptive statistics. RESULTS: A total of 16,383 whole-body skin examinations resulted in 2302 referrals (14.1% overall; 15.5% men, 18.2% > or = 50 years of age) for 4129 suspect lesions (including 222 suspected melanoma, 1101 suspected basal cell carcinomas [BCCs], 265 suspected squamous cell carcinomas [SCCs]). Histopathologic results were available for 94.8% of 1417 lesions excised and confirmed 33 melanomas (23 in men; 24 in participants > or = 50 years of age), 259 BCCs, and 97 SCCs. The probability of detecting skin cancer of any type within the program was 2.4%. The estimated specificity of whole-body skin examinations for melanoma was 86.1% (95% confidence interval = 85.6-86.6). The positive predictive value (number of confirmed/number of lesions excised or biopsied x 100) for melanoma was 2.5%, 19.3% for BCC, and 7.2% for SCC (overall positive predictive value for skin cancer, 28.9%). LIMITATIONS: Follow-up of participants with a negative screening examination has not been conducted for the present investigation. CONCLUSIONS: The rate of skin cancer detected per 100 patients screened was higher than previously reported and men and attendees older than 50 years more frequently received a referral and diagnosis of melanoma. The specificity for detection of melanoma through whole-body skin examination by a primary care physician was comparable to that of other screening tests, including mammography.

Adult↗

PubMed2005

Understanding newborn screening system issues with emphasis on cystic fibrosis screening.

Newborn screening (NBS) includes biochemical testing for certain medical conditions that can cause devastating consequences if left undetected and untreated. Mandated screening requires a complex support system to ensure its effectiveness. There are 51 separate NBS programs in the United States, all with different administrative structures and screening panels. Only 8 states mandate screening for cystic fibrosis (CF) and 2 of these are just beginning. Optional NBS for CF reaches significant numbers of newborns in 3 other states but the CF screens are only projected to reach about 20% of the newborn population in 2005. Forthcoming recommendations for NBS screening from the federal Advisory Committee on Heritable Diseases and Genetic Disorders in Newborns and Children (ACHDGDNC) will impact decisions about NBS panels and professional and consumer advocacy will play an important role in deciding the directions in which NBS programs move. For effective CF NBS, CF care centers will need to partner with NBS programs to ensure optimal health benefits, and programs will need to continually evaluate diagnostic and outcome data in order to refine their screening protocols.

Advisory Committees↗

PubMed2004

Increasing screening uptake amongst those intending to be screened: the use of action plans.

This experimental study investigates an intervention designed to increase rates of antenatal screening uptake in those intending to undergo antenatal screening. Eighty-eight pregnant women intending to undergo prenatal screening were alternately allocated to standard care or asked to write a simple plan for attending or making an appointment. Twenty-five (63%) in the intervention group made an action plan. There was no difference in uptake of screening between the intervention group and the control group, nor between those making an action plan and the control group. Within the intervention group, those making an action plan had higher screening uptake (21/25, 84%) than those not making one (7/15, 47%; CI(95) difference = 8-66%, P = 0.017). Asking women who intend to undergo screening to make an action plan does not increase screening uptake. This result raises doubts about introducing simple action plans in a clinical situation as an effective means of changing behaviour.

Adult↗

PubMed1994

Prostate cancer screening in the prostate, lung, colorectal and ovarian cancer screening trial of the National Cancer Institute.

Screening for prostate cancer and subsequent treatment is of unknown benefit but carries known treatment related morbidity and mortality risks. The recent enthusiasm for screening in the United States contrasts sharply with the more cautious attitudes of the European and Canadian medical communities. Current data from screening series without randomization and controls are inadequate to determine screening benefit. The prostate, lung, colorectal and ovarian cancer (randomized, controlled) screening trial of the National Cancer Institute, to include 74,000 men (and 74,000 women) 60 to 74 years old, has a design power of 90% to determine a 20% reduction of prostate cancer mortality from a baseline and 3 subsequent annual screens using prostate specific antigen and digital rectal examination. Randomization of participants into this trial began on November 16, 1993. Ten screening centers nationwide, a coordinating center, a laboratory and a biorepository are participating under contract.

Aged↗

PubMed1990

Congenital toxoplasmosis: to screen or not to screen?

We have reviewed the present day quantifiable cost to society of the 73 cases of congenital toxoplasmosis which are estimated to occur annually in Scotland with the cost of preventing the disease by screening and treatment. Our analysis includes advances in laboratory techniques. The cost of screening would depend on its scale and if in-house or commercial tests are used. If only 2 specimens were screened, at booking and at delivery, the screening costs are estimated to be between 0.5-0.9 times the preventable costs. If a third specimen were tested in the second trimester, to maximise scope for remedial action during pregnancy, the screening costs are 0.7-1.2 times preventable costs. As likely screening costs in most of the schemes we consider are now less than the preventable costs, a screening programme should be adopted.

Cost-Benefit Analysis↗

PubMed2001

Assessing efficiency in the UK breast screening programme: does size of screening unit make a difference?

The UK breast screening programme (UK BSP) is organised into a large number of individual screening units. Decision makers need to ensure these units are producing efficiently, particularly as the programme is anticipated to expand. Data envelopment analysis (DEA) was applied to investigate: the relative efficiency of screening units; the impact of screening unit size on efficiency; and how individual units could improve. Sixty-four screening units were categorised into 33 large and 31 small. Data were collected using a national survey and routinely collected data. The overall median efficiency score was 91%, 39 units were inefficient. Variation in efficiency scores was wide. Large units had a median efficiency score of 100% and 12 units were inefficient. Smaller units had a median efficiency score of 95% and 19 were inefficient. This difference was not statistically significant (Mann-Whitney, P=0.076). Forty-two percent of large units and 21% of small units were operating at constant returns to scale (mean difference 0.20, 95% CI: 0.15-0.43). Although there is no systematic difference in efficiency by size of screening unit there are inefficiencies in both large and small units and there is scope for many individual units to improve their use of current resources. It will be necessary for decision-makers to examine the practices of individual screening units before considering options for how best to improve their resource use. DEA can help to identify feasible options.

Breast Neoplasms↗

PubMed1996

Screening for neuroblastoma in late infancy by use of EIA (enzyme-linked immunoassay) method: 115000 screened infants in Austria.

The aim of this study was to investigate the feasibility of a neuroblastoma screening programme for children in late infancy, based on collaboration of general paediatricians and practitioners in Austria, using the technique of enzyme-linked immunoassay (EIA) for biochemical analyses. Analysis of catecholamine metabolites in spot urine samples by EIA with high performance liquid chromatography as a backup was undertaken. Austrian infants (median age 8.7 months) were screened. Overall compliance was 30%. The EIA method had a high rate (6.7%) of false-positive results. 28 infants were admitted to hospital. In 15 cases, neuroblastoma was found (four stage 1, five stage 2B, six stage 3). The EIA method can be used for neuroblastoma screening, but requires a backup analytical technique in order to avoid unnecessary hospital admissions. The stage distribution and biological features of neuroblastomas diagnosed by screening at a later age are different from those detected by earlier screening. Screening in late infancy might be of more benefit than early screening.

Austria↗

PubMed1998

10 years' neuroblastoma screening in Europe: preliminary results of a clinical and biological review from the Study Group for Evaluation of Neuroblastoma Screening in Europe (SENSE).

Between January 1986 and May 1996, 870,313 children were tested in European neuroblastoma (NB) screening programmes. Among these children, 82 cases of NB (age range 4-24 months, median 11 months) were detected by screening. 83% of the patients had localised NB and 17% were diagnosed with generalised NB (stage 4, 10%; stage 4s, 7%). Unfavourable biological markers (MYCN amplification, loss of heterozygosity (LOH) 1p36, DNA di/tetraploidy) were observed in 14% of 76 biologically examined cases. The median follow-up time of all the patients was 21.5 months (range 1-101 months). To date, 69 patients are in complete remission (CR) and 2 patients have died due to therapy (stage 4, 1 patient; stage 3, 1 patient with unfavourable markers). Apart from screened patients, 16 other patients with NB were found who had previously had a normal screening test, i.e. 'false negative' patients (age range 10-41 months, median 31.5 months). The median interval between screening and diagnosis was 24.5 months (range 6-35 months). 11 of the 'false negative' patients suffered from generalised NB (stage 4) and 5 had localised NB at diagnosis. Unfavourable biological markers were observed in 7/12 patients. 5 patients have died, 2 achieved partial remission and 9 CR. 9 of the 11 patients with unfavourable biological markers diagnosed due to NB screening are currently in CR. It is very likely that, among the patients without unfavourable biological markers, we detected tumours which may have regressed spontaneously. These children may have undergone 'unnecessary,' but unavoidable, diagnostic procedures and therapy. To reduce the number of 'false negative' patients, a later screening could be helpful and should be evaluated.

Age Distribution↗

PubMed1998

Organised cervical cancer screening still leads to higher coverage than spontaneous screening in The Netherlands.

In The Netherlands, early detection of cervical cancer by programme and spontaneous screening has been common practice for more than two decades. Both types of screening are mainly performed by general practitioners. Therefore, the question is raised of whether programme screening still enhances screening uptake. To answer this question, we analysed the national health interview survey in the years 1992-1996. The coverage rate, defined as the percentage of women with at least one smear taken in the previous 5 years, was 91% for women invited for programme screening compared with 68% for women not invited. The performance of the organised programme in reducing excessive screening, i.e. smears taken in excess of the recommended age and interval range, was not clear and the effect seemed small. Furthermore, we found that half the non-attenders were 'protected' by a recent smear or a hysterectomy, and of the unprotected women, 72% showed a positive attitude towards the programme. We conclude that even after a long history of cervical cancer screening, an organised programme is still required to ensure a high coverage.

Adult↗

PubMed1997

Mass-screening of neuroblastoma using urine from infants by high-performance liquid chromatographic method: results of first (6th month) and second (14th month) screening.

To detect neuroblastoma in early stages, mass-screening of this tumor was carried out by HPLC method using the urine of six-month-old infants. Screening began in April, 1981, and a total of 42 cases were detected by December, 1994. The incidence of detection was about 1:5,000 babies tested. All of these patients have survived without relapses except one, who died of surgical complications. Nevertheless, tumors developed at later stages in 14 cases from the group which resulted negative at the 6-month screening. To determine whether such tumors could be detected by a second check, a 14-month screening was carried out, beginning in April, 1991. By December, 1994, 3 patients with neuroblastoma were found among 41,809 babies tested, and were subsequently treated. While one of these three patients was not screened at 6 months, the other two had shown approximate cut-off values in urinary VMA as well as HVA at their 6-month screening. Therefore, if the tumors had already existed at the 6-month screening, and had grown gradually until the second check at 14 months, at least some of these tumors were of the late-onset variety and could have been detected at an earlier stage.

Chromatography, High Pressure Liquid↗

PubMed2006

Feasibility of familial PSA screening: psychosocial issues and screening adherence.

This study examined factors that predict psychological morbidity and screening adherence in first-degree relatives (FDRs) taking part in a familial PSA screening study. Prostate cancer patients (index cases - ICs) who gave consent for their FDRs to be contacted for a familial PSA screening study to contact their FDRs were also asked permission to invite these FDRs into a linked psychosocial study. Participants were assessed on measures of psychological morbidity (including the General Health Questionnaire; Cancer Worry Scale; Health Anxiety Questionnaire; Impact of Events Scale); and perceived benefits and barriers, knowledge; perceived risk/susceptibility; family history; and socio-demographics. Of 255 ICs, 155 (61%) consented to their FDRs being contacted. Of 207 FDRs approached, 128 (62%) consented and completed questionnaires. Multivariate logistic regression revealed that health anxiety, perceived risk and subjective stress predicted higher cancer worry (P = 0.05). Measures of psychological morbidity did not predict screening adherence. Only past screening behaviour reliably predicted adherence to familial screening (P = 0.05). First-degree relatives entering the linked familial PSA screening programme do not, in general, have high levels of psychological morbidity. However, a small number of men exhibited psychological distress.

Aged↗

PubMed2002

Screening for Alzheimer's disease: the memory impairment screen versus the conventional three-word memory test.

OBJECTIVES: To improve screening for Alzheimer's disease (AD) with the Memory Impairment Screen (MIS), a 4-minute, four-item delayed free and cued recall memory test with controlled learning and high discriminative validity. To assess the discriminative validity of the MIS for AD and to compare it with the conventional three-word memory test, a delayed free recall task, widely recommended as a dementia-screening test in clinical practice. DESIGN: Cross-sectional validation study nested within a longitudinal study of aging and dementia. The MIS and the standard three-word memory task were administered as part of a comprehensive neurological and neuropsychological evaluation. SETTING: Einstein Aging Study at the Albert Einstein College of Medicine, Bronx, New York. PARTICIPANTS: Two hundred forty community-dwelling older adults. MEASUREMENTS: Sensitivity, specificity, and positive predictive value (PPV) were calculated for the MIS and three-word memory test as screening tests for AD. RESULTS: In comparison with the three-word memory task, the MIS had higher sensitivity (.86 vs.65), higher specificity (.97 vs.85), and greater PPV (.80 vs.37) as a screen for AD. CONCLUSIONS: The MIS had high discriminative validity as a screening test for AD and substantially outperformed the three-word memory task. Given its validity and brevity, the MIS has important advantages as an AD screen for use in primary care.

Aged↗

PubMed2006

The effects of promoting colorectal cancer screening on screening utilisation: evaluation of the German Campaign "Aktiv gegen Darmkrebs" (Action against Colorectal Cancer).

BACKGROUND: Although colorectal cancer is the second leading cause of cancer death in Germany, screening rates remain low. It is unknown whether local approaches to promoting colorectal cancer screening are effective. This study evaluates the effectiveness of a regional awareness campaign consisting of public information sessions and leaflet distribution, upon the use of colorectal cancer screening by faecal occult blood test (FOBT) and colonoscopy. METHODS: Data on FOBT and colonoscopy were collected by doctors for 12 months following the campaign, including reason for and result of the testing. 37 % (n = 43) of all physicians and practitioners in two administrative districts (249 632 inhabitants) that were exposed to the campaign participated in the study. It was recorded whether the individuals requesting colorectal cancer screening had been prompted by the campaign, so the number and outcome of campaign-related tests was determined. RESULTS: 3398 individuals (male: 54.6 %, female: 45.4 %, age: 64.3 +/- 8.3 years) underwent 3551 screening tests (2446 FOBT, 819 colonoscopy, 133 both). 141 additional diagnostic colonoscopies were performed because of a positive result in the FOBT. Adenomas were detected in 279 individuals, malignancies in 11 individuals. 225 FOBT (8.7 %) and 176 colonoscopies (18.5 %) were performed due to the campaign; among these individuals, 49 had adenoma(s), 1 had carcinoma. The effect could be attributed both to leaflets and to information sessions. The proportion of campaign-related screening tests declined over time. CONCLUSION: The regional information campaign could reach target individuals and motivate them to utilise colorectal cancer screening. The combination of mass media and personal communicative elements seems useful.

Colonoscopy↗

PubMed1988

School screening for scoliosis by the Chiba University Medical School screening program. Results of 1.24 million students over an 8-year period.

The screening program for scoliosis started by Chiba University in 1979 consists of using moiré topography, low-dose roentgenography and a final ordinary x-ray examination. The number of children screened through this Chiba University Medical School (CUMS) screening program to 1986 amounted to 1,246,798. The incidence of scoliosis of more than 15 degrees increased linearly according to age from the fifth grade primary school children (0.07% in boys, 0.44% in girls) to the second grade junior high school students (0.25% in boys, 1.77% in girls). The female predominance of scoliosis cases with curvatures of more than 20 degrees detected during the total period was 10:1 and this female predominance was the same for primary school children and junior high school students. According to a study of the incidence of scoliosis by districts, (areas were divided according to population density and urbanization) there were no significant differences in the fifth grade primary school children between the sparsely and densely populated areas. In the cases of children beyond the fifth grade primary school level, however, the incidence in the densely populated areas were significantly higher than those in the sparsely populated districts. The incidence of scoliosis of more than 20 degrees decreased significantly every year among junior high school students, because they were screened periodically in school and the scoliotic students who had already been detected were left out of the next screening. This study establishes that screening for scoliosis by the CUMS screening program is cost-effective with a low risk of radiation hazards.

Adolescent↗

PubMed1996

Newborn screening for sickle cell disease: 4 years of experience from California's newborn screening program.

PURPOSE: In this article we describe the success of a unique newborn screening program for sickle cell disease and other hemoglobinopathies. We will present and discuss 4 years of experience from the California Newborn Hemoglobinopathy Screening Program. METHODS: Several aspects that ensure the success of the program will be reviewed. These aspects include (a) the use of high-pressure liquid chromatography as the initial screening technique, (b) a confirmatory testing laboratory that incorporates DNA technology and innovative protein analysis using electrospray mass spectrometry, and (c) a complex follow-up strategy that employs regional nurses to track positive results and ensure timely enrollment of infants into treatment systems. RESULTS: Of these 2 million infants screened, 492 were diagnosed with some form of sickle cell disease; 290 (58.9%) were diagnosed with hemoglobin SS, 143 (29.0%) were diagnosed with hemoglobin SC, and 47 (9.5%) were diagnosed with S beta+thalassemia. CONCLUSION: The prevalence and ethnicity data presented here demonstrate the ineffectiveness of targeted screening and justify universal screening. Had targeted screening been performed in California during the past 4 years, 58 nonblack infants with sickle cell disease would have gone undiagnosed, and 6,921 nonblack infants with sickle cell trait would not have been identified.

Anemia, Sickle Cell↗