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Results for “Screening programs”

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PubMed2004

Prostate-specific antigen doubling time among Japanese men in an annual health screening program.

BACKGROUND: Prostate-specific antigen doubling time (PSA-DT) has been studied as a parameter reflecting the biological doubling rate of clinically localized prostate cancer treated expectantly. With the use of PSA-DT, we studied the natural history of PSA changes among Japanese men in a health screening program. METHODS: Between July 1994 and December 2002, a cohort of 1995 men aged 40-79 years underwent a total of 5700 PSA measurements in an annual multiphasic health screening program. Prostate-specific antigen doubling time was calculated using a log-linear regression model for 994 (49.8%) men who had three or more serial PSA measurements with a mean follow-up of 46.2 months. RESULTS: Of the 994 men, 192 (19.3%) had a PSA-DT of less than 10 years and 12 (1.2%) had a PSA-DT of less than 2 years. Median PSA-DT in 14 men with a subsequent diagnosis of prostate cancer was 41.6 months (range, 12.2 to stable). A log-linear model statistically fitted 65 of 180 non-cancer patients with a PSA-DT of less than 10 years. The percentages of statistically fit cases increased with higher baseline PSA (5.3%, 7.7% and 8.7% among men with <1.0, 1.0-1.99 and 2.0-3.99 ng/mL, respectively) and older baseline age (3.7%, 8.5% and 6.9% among ages 40-49, 50-59 and 60 or older, respectively). CONCLUSION: In a small but significant portion of men, PSA increases exponentially when it is still less than 4.0 ng/mL, with a PSA-DT of less than 10 years. The clinical significance of this finding should be evaluated by a prospective screening including biopsy.

Adult↗

PubMed2001

Risk factors for benign breast biopsies: a nested case-control study in the Alberta breast screening program.

A nested case-control study was conducted to identify risk factors for benign breast biopsies in 382 cases (women with a benign biopsy result) and 399 controls (women who had not undergone a biopsy) who were sampled from the Alberta breast cancer screening program. The breast biopsy specimens of the cases were reviewed by a panel of pathologists, and percent fibroglandular tissue density was assessed. The multivariable odds ratios for the risk of open benign breast biopsy associated with current cigarette smoking was 2.04 (95% CI 1.32-3.13), for ever regular smoking was 1.61 (1.20-2.16), and for passive smoking was 1.41 (0.99-2.02). A risk reduction was found for ever alcohol consumption (0.61 [0.44-0.85]). Some risk reductions were found when the highest and the lowest quintiles of total aerobic recreational activity were compared (0.71 [0.42-1.20]), stair climbing (0.61 [0.37-1.01]) and walking pace (0.13 [0.02-0.741). Lifestyle risk factors may be implicated in the continuum between detection of an abnormality on a screening mammogram and a breast biopsy specimen. By considering these risk factors, breast screening programs may be better able to identify those women who require a breast biopsy and reduce the number of benign breast biopsies.

Aged↗

PubMed1998

Who gets missed: coverage in a provincial newborn screening program for metabolic disease.

OBJECTIVE: To determine coverage of the newborn screening program (NSP) for metabolic disease in Alberta, Canada, and to determine reasons for not being screened. STUDY DESIGN: Coverage was estimated by deterministic matching of live birth registration data with newborn screening data for the year 1992. Demographic characteristics of not-matched infants were compared with good-match infants using logistic regression. RESULTS: For 42 392 live births, there were 41 553 screening records, of which 40 593 infants were very good matches to NSP records. Another 960 were possible matches. A total of 839 infants were not matched at all, and coverage was estimated at 98.0%. Determinants of infant not-matched status were death in week 1 (adjusted odds ratio [OR]: 383); birth weight of <1500 g (adjusted OR: 18.9) or between 1500 and 2500 g (adjusted OR: 3.2); having a mother who was single (adjusted OR: 2.7) or formerly married (adjusted OR: 12.9); or being born out of hospital (OR: 19. 2). The calculated 98% coverage is close to an estimate of 98.3% made by the NSP comparing total births with initial screenings. CONCLUSION: The matched data give insight as to who was missed and point to the need for closer attention for infants at greater risk of not being screened for metabolic disease.

Alberta↗

PubMed2003

The first 15 years of the American Academy of Dermatology skin cancer screening programs: 1985-1999.

BACKGROUND: In response to the precipitous increase of melanoma, the American Academy of Dermatology (AAD) has coupled melanoma/skin cancer education with free skin cancer screening programs throughout the United States since 1985. The purpose of this analysis is to investigate the risk factors, access to dermatologic services, and screening results of participants in AAD-sponsored programs during the first 15 years that this service was available to the US public. METHODS: Before screening, participants completed a standardized AAD screening form. Screening forms were counted in the AAD central office and recorded in annual summaries. Forms were sent for keypunching and returned to the AAD on a computer disk annually. In 1999, disks were sent to Boston University and a master file was created. RESULTS: Computerized records were available for 819,019 screening forms and 639,835 individuals. In all, 65% of screenees had at least 1 risk factor and 33% had at least 2 risk factors. Of screenees, 33% reported a changing mole and 37% had skin type I or II. Among all screenees, nearly 80% did not have a regular dermatologist, 78% reported no prior AAD skin cancer screening, 60% had never had their skin checked by any doctor, and 51% would not have seen a doctor for skin cancer without the free screening. Nearly 30% of screenees had a presumptive diagnosis of skin cancer or a precursor lesion. Melanomas confirmed by postscreening biopsy were more likely than those in population-based registries to be less than 1.50 mm in thickness. CONCLUSIONS: AAD national screening and educational programs have expanded to all 50 states, provided educational messages about sun protection and early detection to millions, and served many US citizens with an above average risk for skin cancer and suboptimal access to dermatologic care. Screenees had a disturbingly high point prevalence of malignant and premalignant skin lesions. Sustained commitment by the AAD leadership and membership to the screening program is critical to reducing the morbidity and mortality of skin cancer.

Adolescent↗

PubMed1992

Issues in human immunodeficiency virus (HIV) screening programs.

Unlike test sensitivity and specificity, the false positive and negative predictive values (probabilities of mislabeling an individual being tested) depend heavily on the prevalence of the infection of the human immunodeficiency virus (HIV) as well as the quality of the kit. A consequence of this dependence is that the false positive predictive value can reach a high magnitude such as 0.9; that is, 90% of the positive tests are false. This raises many important issues pertaining to the current practice of HIV screening such as to how to control these misclassification errors, how to interpret test results, and how to estimate prevalence using test results. These issues are examined in detail here by considering the factors that dictate the quality of a screening program. Some real data examples are used to illustrate the importance of this consideration in designing programs to achieve the desired goals. The rationale behind the common two-step sequential protocol in HIV screening is examined to point out its limitations under practical situations. Finally, the use of entropy in evaluating the informativeness of a screening program is discussed.

AIDS Serodiagnosis↗

PubMedDate not supplied

[Congenital hypothyroidism screening program: preliminary results].

OBJECTIVE: The authors report early results of a screening program for Congenital Hypothyroidism in Santa Catarina, Brazil. METHODS: All the assays (82.709) analysed by Laboratório Central (LACEN) between July 1993 and December 1994 were studied. A blood sample was collected on filter paper for serum Thyroid Stimulating Hormone (TSH) measurement by fluoroimmunoassay, in triplicate. All children who had persistent abnormal TSH values (cord blood: TSH > 30 micro U/ml; from 2 to 7 days: >20 micro U/ml; older than 7 days: > 10 micro U/ml) were recalled for clinical evaluation. RESULTS: Out of 82.709 infants aged from 0 to 60 days (40% of the deliveries in this period), 304 presented abnormal results of TSH and 34 were confirmed as Congenital Hypothyroidism. The mean age of beginning the treatment was 45 days of life. CONCLUSIONS: The prevalence (1:2500) was higher than that observed in other countries, probably because some children had Transient Congenital Hypothyroidism. Nevertheless, sex prevalence was similar to that described in the literature. Clinical manifestations were inespecific which reinforces the importance of this kind of screening. Efforts have been done to improve the program in order to begin earlier treatment.

English Abstract↗

PubMed1990

Comprehensive pediculosis screening programs for elementary schools.

Pediculosis (head lice) is a major school and community health problem with an estimated 6-12 million cases annually resulting in $367 million a year in consumer costs, lost parental wages, and school system expenses. The greatest incidence is seen in children ages 5-12; however, the incidence in the 24-36 year old group is increasing due to their exposure to infested children. Developing comprehensive pediculosis screening programs in elementary schools provides an effective method for preventing epidemics from occurring by accomplishing early detection. These programs also promote primary health care and education among elementary schoolchildren, school officials, educators, and parents. An effective program includes screening the entire school three times a year: mid-September, December, and near spring vacation, and enforcing a "No Nit" policy. Establishing a successful approach to control pediculosis results in decreased incidence and transmission, reduced absenteeism, and financial savings for parents and school districts.

Child↗

PubMed1978

Experience with a community screening program for hypertension: results on 24,462 individuals.

A hypertension screening program was conducted by means of mobile units generally used for detection of tuberculosis and chest diseases. From 1st October 1973 to 31st July 1976, 24, 462 individuals aged 35 and over were examined. 10.7% were found to have elevated blood pressure (greater than 160/95 mm Hg). Among these subjects, 43% of the male and 24% of the female had never been told they were hypertensive. 5.6% of the men and 7% of the women had a diastolic reading of 105 mm Hg or more. Undetected hypertension decreased with age and was less frequent in women than in men. Young male hypertensives were frequently aware of their disease. When known, hypertension remained untreated in 14.5% of cases and badly controlled in 26%. One yr after screening, 400 patients who had been found to have undetected hypertension were contacted; 358 (89.5%) had seen their family doctor and 42% of them were under continuous medical treatment. These results further underline the challenge of undetected, untreated and uncontrolled hypertension.

Adult↗

PubMedDate not supplied

Early results of the screening program for radioprotectors.

Although WR-2721, S-2-(3-aminopropylamino)ethylphosphorothioc acid, is the most widely studied and most effective radioprotective drug at present, it is nevertheless clear from animal studies that it has important shortcomings as the ideal radioprotector in clinical radiotherapy. More effective and less toxic radioprotective drugs are needed. For this reason, a chemical radioprotector screening program has been initiated at the Fox Chase Cancer Center under a contract with the National Cancer Institute. Most of the 20 compounds that have now entered the screening program provide good protection of the mouse hematopoietic system as indicated by 30 day survival following the radiation LD100/30. Administration of a radioprotector dose equal to one half of the maximum tolerated dose (MTD/2) gave hematopoietic dose reduction factors (DRF's) as high as 2.3. No radioprotector appeared to be superior to WR-2721, although four others gave DRF's exceeding 1.8.

Animals↗

PubMed1991

The effectiveness of screening programs based on high-risk characteristics in early identification of hearing impairment.

Prompt identification of educationally significant hearing loss is yet an unattained goal. However, there is some evidence that the ability to identify and diagnose hearing loss at an early age has been significantly improved through the use of carefully designed screening protocols such as birth certificate-based high-risk registries. To evaluate the efficiency of birth certificate-based screening programs, 70 parents and guardians of 6- to 9-yr-old children with significant sensorineural losses were surveyed regarding their child's identification history. Each of these children was born in the state during the time a birth certificate-based screening program was in full operation. Results indicate that children with at least one risk factor for hearing impairment were identified an average of 7.7 mo earlier than children with no risk history. However, only 50% of the children with sensorineural hearing losses exhibited any of the risk factors and a significant number of children with risk factors were missed by the system. Had admission to a neonatal intensive care unit been considered a risk factor, 63% of the children would have exhibited at least one risk factor. More extensive implementation of high-risk registries in conjunction with more widespread education of parents and primary care providers regarding early behavioral indicators of hearing loss, procedures for referral, and appropriate intervention and management services needs to be considered.

Age Factors↗

PubMed1994

Voluntary screening program for prostate cancer: detection rate and cost.

In a community-wide screening program conducted in Jacksonville, Florida, 564 participants received free screening for prostate cancer. Frequency of positive results of prostate-specific antigen measurement and digital rectal examination was comparable to that found in similar programs in other communities. The estimated cost for each participant was $231, and the cost to discover each cancer was $7,240. If one also includes initial therapy in cost estimates, then the cost per participant was $520, and the cost to find and treat each patient was $16,300. The value of screening for prostate cancer must be judged by treatment outcome and underlying costs.

Aged↗

PubMed2004

Relation between intervention exposures, changes in attitudes, and mammography use in the North Carolina Breast Cancer Screening Program.

OBJECTIVE: Many past interventions have been based on the assumption that improving attitudes about mammography can increase mammography use. We studied changes in breast cancer and mammography attitudes over time in mediating the effect of intervention exposures on mammography use in the North Carolina Breast Cancer Screening Program. Data came from interviews with a cohort of 331 black women who said they had heard of mammography at baseline interview. METHODS: We created scores and score changes for mammography (7 items) and breast cancer (11 items) attitudes at baseline (1993-1994) and follow-up interviews (1996-1997). We modeled intervention exposures, attitude changes, and mammography use in linear risk and logistic regression. Intervention exposures were defined for mammography discussion with a project lay health advisor ("LHA advice"), mammography discussion with anyone besides a doctor or nurse, and project awareness. RESULTS: Positive change in mammography attitudes was associated with intervention exposures and mammography use and appeared to account for a large percentage (34-98%) of the effect of mammography discussion variables on increased mammography use. Greatest effect of attitude improvement was found for women without a recent mammogram at baseline and with the least positive baseline attitude scores. CONCLUSION: Using cohort data enabled us to examine the role of attitude change over time on mammography use. Breast cancer screening programs should target women with the most negative mammography attitudes and the least mammography use to start with and concentrate their messages on improving attitudes specific to mammography rather than improving attitudes about breast cancer risk.

Adult↗

PubMed2004

Cost-effectiveness analysis of the genetic screening program for familial hypercholesterolemia in The Netherlands.

Familial hypercholesterolemia (FH) is associated with pronounced atherosclerosis leading to premature cardiovascular disease and untimely death. Despite the availability of effective preventative drug treatments, many affected individuals remain undiagnosed and untreated until they become symptomatic with cardiovascular disease. To assess the cost-effectiveness of systematic genetic screening of family members of persons diagnosed with FH, an analysis was conducted using data from a nationwide screening program for the identification of individuals with FH, instituted in The Netherlands in 1994, and from other sources. There was DNA testing of families with a known genetic defect to identify new cases of FH in the presymptomatic stage of the disease. After identification, most newly identified patients were started on cholesterol-lowering statin treatment. On average, new cases diagnosed by the screening program gained 3.3 years of life each. Twenty-six myocardial infarctions would be avoided for every 100 persons treated with statins between the ages of 18 and 60 years. The average total lifetime incremental costs, over all age ranges and both sexes, including costs for screening and testing, lifetime drug treatment, and treatment of cardiovascular events, was US dollars 7500 per new case identified. Cost per life-year gained was US dollars 8700. Therefore, systematic genetic screening of family members of persons diagnosed with FH is cost-effective in The Netherlands and should be considered for other settings.

Adolescent↗

PubMed1977

Thyrotoxicosis detected in a mass-screening program for neonatal hypothyroidism: demonstration of placental transfer of an immunoglobulin with marked lipolytic activity.

A female infant born to a mother with active Graves disease and a strongly positive LATS developed neonatal thyrotoxicosis. The diagnosis was confirmed rapidly by the markedly elevated filter paper spot T4 (5.45 ng/40 microliter) taken on the fifth day of life as part of the Quebec Screening Program for Neonatal Hypothyroidism. Although the infant's serum was negative for LATS, it reacted strongly (as did the maternal serum) in the lipolytic assay for LATS. This case illustrates the ability of screening programs for neonatal hypothyroidism to detect cases of neonatal thyrotoxicosis and supports the hypothesis that this condition is secondary to the placental transfer of a thyroid-stimulating immunoglobulin.

Female↗

PubMed2006

Effectiveness of a screening program for hepatitis C.

We sought to determine the outcomes of a screening program for hepatitis C virus (HCV) infection. Of 536 veterans initially screened between July 2000 and June 2001 for risk factors and then tested positive for antibody for HCV, only 260 (48.5%) kept their initial appointments for further evaluation; 51 were not viremic and only 19 (9.1%) were treatment eligible. Of the 276 who did not keep their initial appointments, 92 were subsequently evaluated over the next 2 years and 23 (25%) were treatment eligible, along with another 15 from the first group. Thus, with appropriate intervention and long-term follow-up, there were 57 treatment candidates. In conclusion, most veterans who tested positive either failed to keep their appointment or were ineligible for treatment when first evaluated. Over the following 2 years, some were lost to follow-up, many continued to have contraindication(s) to antiviral therapy, and relatively few were treatment candidates.

Adult↗

PubMed1993

Referral adherence in an inner city breast and cervical cancer screening program.

BACKGROUND: Early detection and immediate follow-up treatment for cancer of the breast and cervix can reduce morbidity and mortality. This report describes adherence to follow-up appointments for suspected breast and cervical malignancies in a population of low-income black women who participated in a community-based nurse-managed screening program. METHODS: Components of the program that were part of the intervention included the following: a consistent referral mechanism augmented by a computerized tickler system; education of women about the importance of follow-up; and active nurse assistance in the follow-up process. Referral for follow-up of suspected malignancies or for other questionable findings was made to the public sector hospital clinics (86%) or to other providers of the women's choice (14%). RESULTS: Follow-up rates for suspected malignancies of the breast were high (92%) in this population of women, sometimes described as less likely to adhere to recommendations for continued care. In contrast, adherence rates for gynecologic conditions were lower (70%). CONCLUSIONS: This screening program and follow-up system has relevance to systems that serve similar groups of low-income women.

Adult↗

PubMedDate not supplied

Female employee participation in a worksite mammography screening program.

We conducted a survey of 1,184 women 35 years of age or older who were employees of a company in Los Angeles County, California, to determine why some women participated in a worksite mammography screening program whereas others did not. Of the 111 who accepted a mammogram, 90 responded to the survey; of the 1,073 who declined mammography, 620 responded. The women were predominantly white, were well educated, and had health insurance. Of the 111 women who received mammograms, one was diagnosed with carcinoma. Seventy-three percent of the respondents to the survey 40 years of age or older who declined mammograms had already fulfilled American Cancer Society (ACS) guidelines for mammography screening at the time of the program. Women who accepted a mammogram were more likely to have had at least one previous mammogram than were women who had not met ACS guidelines yet who declined screening. We conclude that many female employees who are white, are well educated, and have health insurance may not participate in a worksite mammography screening program because they have been screened elsewhere. Companies providing worksite mammography screening should target education to women who have not met ACS guidelines, especially those who have never had a mammogram.

Adult↗

PubMed1990

Pancreatic function in infants identified as having cystic fibrosis in a neonatal screening program.

The use of the dried-blood immunoreactive-trypsin assay for the detection of cystic fibrosis in newborns has been questioned on the grounds that it may fail to identify patients with enough pancreatic function to have normal fat absorption. To investigate this possibility, we assessed pancreatic function in 78 patients identified in a neonatal screening program as having cystic fibrosis. The diagnosis of cystic fibrosis was confirmed by abnormal results on a sweat chloride test. The results of measurements of fecal fat excretion, pancreatic-stimulation tests, and estimations of the serum level of pancreatic isoamylase indicated that 29 of the 78 children (37 percent) had substantial preservation of pancreatic function. These children (median age, four years) had growth that was close to normal and comparable to growth in children with severe pancreatic insufficiency who received oral enzyme therapy. Pancreatic insufficiency subsequently developed in 6 of the 29 patients, at 3 to 36 months of age. We conclude that the serum immunoreactive-trypsin assay used in neonatal screening programs identifies patients with cystic fibrosis who have sufficient pancreatic function to have normal fat absorption and that a substantial proportion of infants identified as having cystic fibrosis are in this category.

Child, Preschool↗