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PubMed1995

[Evaluation of the costs of mammographic screening program in the city of Florence].

This paper investigated differential direct costs determined by the difference between implementation of mammographic screening program for breast cancer detection in the city of Florence (PFD) and the "absence" of the PFD. The involved resources have been identified, quantified and evaluated. The results of the I round (1991/92) of the PFD involve the following different phases: invitations, mass screening, diagnostic assessment. Differential net costs aumonted to 780 million for total cost, and to 53,000 per screened woman. The PFD invited 27,325 women per year; at the I round, the PFD registered an attendance rate of 53.9% and a recall rate of 4.3%, with a total cost of about one thousand million and a cost per screened woman of about L. 64,000. Instead, economic results of alternative "absence" of screening registered a total cost of 170 million and a cost per screened woman of about L. 100,000. Costs for detected cancer amount about to 8.2 million for PFD and 5.7 million for "absence" of the Program. Sensitivity analysis has been performed texting the fundamental parameters of the PFD: attendance rate, recall rate and life time average of the investiments. The sensitivity analysis, performed on the PFD, registered a variation of total cost from 859 million to 1,216 million and a variation of the total cost per woman screened from L. 43,500 to L. 80,000. Sensitivity analysis results highlighted the fundamental role played by women's attendance and by the percentage of women recalled for diagnostic assessment.

Breast Neoplasms↗
PubMed2003

Prevalence of transaminase abnormalities in asymptomatic, healthy subjects participating in an executive health-screening program.

The objective of this study was to characterize the prevalence of asymptomatic liver transminase (LT) abnormalities in a healthy, low-risk adult population and identify associated risk factors. We reviewed 2340 completed medical records of participants in our Executive Health Program, which provided screening medical evaluations for executives. LT (alanine aminotransferase and aspartate aminotransferase) were considered abnormal if they above normal range for our laboratory. Subjects were excluded if they had a history of viral hepatitis, nonviral liver disease, or an identifiable cause of LT elevation. Of the 2340 subjects 2294 met inclusion criteria and all had AST recorded, but only 1309 had ALT recorded. In all, 341 subjects (14.9%) were found to have abnormal LT and in those who had less than 3 drinks per day, 13.9% had elevated LT and 3.6% had LT twice the upper limit of normal. Of the 1309 subjects in whom both AST and ALT were measured, 20.8% had abnormal LT and 6.3% had LT twice the upper limit of normal. On univariate analysis age < 60 (P = 0.005), male sex (P < 0.0001), body mass index > or = 30 (P < 0.0001), cholesterol > or = 200 mg/dl (P = 0.018), and triglycerides > or = 200 mg/dl (P < 0.0001) were associated with abnormal LT; all these variables except cholesterol were significant by logistic regression analysis. The odds ratio of abnormal LT and LT 2 times normal was 1.79 (CI 1.20-2.68) and 2.50 (CI 1.04-6), respectively, in subjects with one risk factor, and 2.80 (CI 1.07-7.34) and 4.73 (CI 0.91-24.5), respectively, in subjects with four risk factors. In conclusion, there is a high prevalence of LT abnormalities in this healthy population. Subjects with multiple risk factors should be considered for screening.

Adult↗
PubMed2000

Inhibitors of farnesylation of Ras from a microbial natural products screening program.

Mutant ras oncogenes are associated with various human tumors such as pancreas, colon, lung, thyroid, bladder and several types of leukemia. Prenylation of Ras proteins plays a major role in cell proliferation of both normal and cancerous cells. Normal and oncogenic Ras proteins are posttranslationally modified by a farnesyl group that promotes membrane binding. Inhibitors of farnesyl protein transferase (FPTase), the enzyme that catalyzes the prenylation of Ras proteins, inhibit growth of tumor cells. In an effort to identify structurally diverse and unique inhibitors of FPTase, a program devoted to screening of natural products was initiated. This effort led to the identification of 10 different families of compounds, all of which selectively inhibit FPTase with a variety of mechanisms that are reviewed in this manuscript. These compounds originated from the fermentations of a number of microorganisms, either actinomycetes or fungi, isolated from different substrates collected in tropical and temperate areas. A chemotaxonomic discussion on the distribution of each compound among single or different types of microorganisms, either phylogenetically related or unrelated species, is included.

Journal Article↗
PubMed2002

Differences between screening sites in a glaucoma screening program.

OBJECTIVE: To determine the differences in demographic variables, glaucoma risk factors, and visual acuity by type of screening site. METHODS: We conducted glaucoma screenings throughout the city of Baltimore. A questionnaire collected information about age, race, and risk factors: having a relative with glaucoma, having diabetes, having a past eye injury or surgery, and not having an eye examination within two years. We also tested visual acuity and visual fields. We categorized screening sites into work places, senior centers, health fairs, and church groups, and created age-race groups by combining age and race categories. RESULTS: This study is based on 1,366 people screened at 42 different sites. The majority of people screened were African-American (65%) and female (58%), with a mean age of 48 years. We found significant age and race differences between the screening sites. After stratifying by age-race groups, we found statistically significant associations between screening sites and not having a recent eye examination (P =.009) and visual acuity (P =.001). Health fairs had the largest percentage of people not having a recent eye examination, and senior centers had the largest percentage of people with poor visual acuity. CONCLUSIONS: Our data showed differences in age and race between screening sites. After conducting stratified analysis, differences between screening sites and recent eye examinations and visual acuity persisted. These differences in screening sites, as well as objectives of the vision screening, should be considered when planning a screening program to help focus the program on appropriate high-risk subgroups of the population.

Adolescent↗
PubMed1981

Ventilation-perfusion lung scanning in patients detected by a screening program for early lung carcinoma.

Ventilation-perfusion (V-P) lung scans obtained in 114 patients in screening program for the early detection of lung cancer were reviewed, and abnormalities were correlated with radiographic and surgical findings. Eighty-seven patients eventually had a tissue diagnosis of carcinoma; 65 (75%) had a perfusion defect and 56 (67%) had a ventilation abnormality at the tumor site. Lobar or segmental perfusion abnormalities were present at the tumor site in two of 13 patients whose lung cancer could not be localized by chest radiographs. However, 12 of these 13 patients and 54% of those with radiographically visible lesions had perfusion abnormalities in other lung regions. Twenty-seven patients with suspected carcinoma who were subsequently proved to have benign lesions had V-P abnormalities similar to those in patients with lung cancer. Thus, no pattern of V-P abnormalities similar to those in patients with lung cancer. Thus, no pattern of V-P abnormalities allowed lung cancer in this screened population to be reliably distinguished from coexisting airway disease or non-malignant pulmonary masses. V-P lung studies have a limited role in the early detection of lung cancer.

Aged↗
PubMed1995

Referral rates and cost efficiency in a universal newborn hearing screening program using transient evoked otoacoustic emissions.

Recently, a National Institutes of Health Consensus Statement recommended that all infants be screened for hearing prior leaving the birthing hospital using a two-stage screening process based on transient evoked otoacoustic emissions (TEOAEs). Although the value of identifying hearing loss before 1 year of age is widely recognized, the feasibility of universal newborn hearing screening using TEOAE is sometimes questioned because it is presumed that the technique has a high false positive rate and is not cost efficient. This paper presents new data for 4253 infants from an operational universal newborn hearing screening program using a TEOAE procedure that answers those arguments.

Acoustic Stimulation↗
PubMed1996

Hb Uxbridge [beta 20 (B2)Val-->Gly]: a new variant with mild increase in oxygen affinity found during a neonatal screening program.

Hb Uxbridge [beta 20(B2)Val-->Gly] was found in an English family during a neonatal hemoglobinopathy screening program. In both the child and the parent carrying this hemoglobin variant, the red cell parameters were normal. By isoelectrofocusing Hb Uxbridge appeared to have an isoelectric point slightly higher than Hb A but was silent on cellulose acetate and acid gel electrophoresis. Structural modifications affecting position beta 20(B2) have been demonstrated to be responsible for a high oxygen affinity and polycythemia in Hb Olympia (Val-->Met) and Hb Trölhattan (Val-->Glu). In the case of Hb Uxbridge, despite an alteration of the same site, the oxygen binding parameters of the patient's hemolysate showed only a mild (ca. 20%) increase in oxygen affinity.

Female↗
PubMed1992

Quality control for colposcopy in the Florence screening program for cervical cancer.

The authors report on the quality control for colposcopy adopted in the Florence District screening program. The sensitivity of colposcopy was determined on all cases of CIN III recorded in the local cancer registry in a four-year period. However although this showed that a centralized colposcopic clinic employing a limited number of expert operators is superior to the performance of colposcopy in private practice, such a parameter was impractical for further routine quality control since differences among operators were too small and statistically insignificant. Other parameters for quality control were chosen, namely a) the rate of colposcopically directed biopsies performed, b) the detection rate of CIN II or more severe lesions, and c) the positive predictive value of a directed biopsy for CIN II or more severe lesions. Analysis of these indicators after stratification by cytologic report allows the identification of those operators who need additional training and provides useful information for colposcopists to optimize their diagnostic and operative criteria.

Adult↗
PubMed2006

Challenges in implementing a cervical screening program in South Africa.

BACKGROUND: The Cervical Health Implementation Project was initiated with the aim of developing and evaluating health system interventions for improving public sector cervical screening services. The project was conducted between January 2001 and May 2003 in three districts in South Africa. This paper describes the districts, interventions and their evaluation, and discusses the implications of these findings for the roll out of a national cervical screening program. METHODS: A pretest/post-test study design was employed. The following interventions were developed and implemented: health worker training workshops, health system tools and protocols and a community awareness program. Pre- and post-intervention facility audits, key informant interviews, staff knowledge, attitude and practice (KAP) surveys and client KAP surveys were conducted. Clinic records and cytology laboratory data were reviewed. RESULTS: Service organization, availability of screening equipment and education and communication materials improved. The proportion of staff who knew the screening policy increased from 43% to 82%; and 68% of staff agreed with the screening policy after, as opposed to 23% before the intervention. In two of the districts, cytology turnaround times continued to be long. Only 50% of women with a high-grade squamous intraepithelial lesion had a colposcopy and biopsy within 6 months of a Pap smear. Although the number of new smears performed in the three districts increased from 1544 in 2001 to 2801 in 2002, overall the coverage remained less than 4%. CONCLUSION: This project highlights the considerable challenges that need to be addressed to effectively implement the national screening policy.

Adult↗
PubMed1989

Review of a health fair screening program in Mid-Michigan.

Using sociodemographic data and findings from an evaluation survey, a Mid-Michigan health fair screening program is reviewed over a seven year period (1981-1987). Most participants were older adults, and nearly two-thirds were women. Very few participants named the media as a reason for attending the health fairs at which the screenings were given. Many had seen a physician within the past two years, yet very few reported that they had had a complete check-up. The implications of these findings and a rationale for health fairs as a mechanism for screening are discussed.

Adult↗
PubMed2002

Stage-specific incidence of breast cancer before the beginning of organized screening programs in Italy.

OBJECTIVE: To measure stage-specific geographic and time variability of breast cancer in seven Italian areas before the onset of organized screening programs. METHODS: All invasive cancers (8689 cases) arising in women aged 40-79 years during the pre-screening period 1985-1997, were considered. Multiple Poisson regression analysis was performed. RESULTS: About 39% of the cases were classified as "early," 52% as "advanced," and 9% as "unspecified" stage. Age-adjusted incidence rates showed a significant geographic variation for early but not for advanced cancers (range: 58-103 cases/100,000 and 104-125 cases/100,000, respectively). The result was confirmed in the multiple regression analysis after adjustment for year of diagnosis and age. Early breast cancer risk adjusted for age and registry showed a significant increase over time (+3.9% per year for all ages, and +6.2% per year for age category 50-79). In contrast, a decreasing time trend was observed for advanced cancer of 3 cm or over in women aged less than 60. CONCLUSIONS: In our study, early breast cancer incidence varied both by geographic area and time before the commencement of screening. The differences in early-stage incidence may well be related to differences in availability of "spontaneous" mammography. Late-stage incidence decreased over time in younger women and for very advanced cases, but not in the older ones, nor for cancers less than 3 cm. Early detection outside organized screening was only partially efficient in reducing advanced breast cancer incidence. The trend of incidence of advanced disease, as previously proposed, is confirmed to be a valid early indicator of effectiveness of screening.

Adult↗
PubMedDate not supplied

A school-based screening program for fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) is a common cause of birth defects and neuropsychiatric impairment. Identification of affected people is crucial for early entry into intervention programs and for the development of prevalence estimates. The objective of this project was to determine if screening for FAS in a community elementary school-based setting was feasible, to estimate prevalence in the screened population, and to determine if a screening program for FAS can be implemented using available personnel from the community. The FAS Screen was used to screen kindergarten students enrolled in a school system. Students with scores on the FAS Screen above the cutoff for a positive screen (20) were referred to one of several diagnostic clinics for evaluation. Over a 9-year period, 1384 students were screened and 69 (5%) had a positive screen (20 or above). These 69 children were then seen in a genetics/dysmorphology diagnostic clinic and 7 (10%) were found to have FAS (n=6) or partial FAS (n=1). The prevalence of affected children (FAS and partial FAS) was 1 per 198 students or 4.3 per 1000. The FAS Screen was completed annually by school staff, teachers, social workers, and psychologists. The test has acceptable epidemiologic performance characteristics in a community setting. The screening takes about 8-10 min. The procedure was well accepted in the community. This screening strategy was inexpensive to implement (less than US8.00 dollars per student), and can be easily included with the other screens completed at kindergarten entry.

Child↗
PubMed1993

Results of a rubella screening program for hospital employees: a five-year review (1986-1990).

The Barnes Hospital Employee Health Service (St. Louis, Missouri) rubella screening program was evaluated over the 5-year period between January 1, 1986, and December 31, 1990. A total of 6,969 new employees were hired, and 6,115 (87.7%) were screened for evidence of rubella immunity by the Employee Health Service. Rubella serology was performed on 5,893 (96.4%) of the screened employees, while 222 (3.6%) had documentation of prior rubella vaccination or rubella infection. The absence of immunity was identified in 325 employees or 5.3% of all those screened. Women were more frequently screened by the Employee Health Service than were men (p < 0.0001), and blacks were more frequently screened than were non-Hispanic Caucasians (p < 0.0001). Physicians were less frequently screened than were other departmental groups (p < 0.0001). The rate of seronegativity for each year of hire varied from 4.45 to 6.76%, but these differences were not significant. Logistic regression analysis demonstrated that 5-year birth cohorts correlated significantly with serologic status. Employees born in 1960-1964 were least likely to be seronegative, and employees born in 1970 or later were most likely to be seronegative. Sex, race, and department group were not predictive of serologic status, although significant differences in results from different rubella assays were detected. Only 13.8% of seronegative employees were subsequently vaccinated by the Employee Health Service. This study demonstrates a lower seronegativity rate than did previous studies. It identifies groups of employees likely to escape rubella screening and low vaccination rates. It finds increasing seronegativity among employees born after 1964 that correlates with the reported increasing rates of rubella in the United States.

Adolescent↗
PubMed1983

Lead time estimation in a controlled screening program.

A method is presented for estimating a discrete form of the lead time distribution of cases detected in a single-shot screening program. The procedure is based upon a three-state progressive disease model of disease natural history and screening which focuses on the age at entry into the preclinical disease state, the duration of the preclinical state, and the age at screening or observation. Estimation is accomplished by comparing observed incidence rates of the disease between a screened group and a randomized control group in successive follow-up intervals after the screen. No assumptions concerning the false negative rate of the screening test or the distribution of the duration of time spent in the preclinical disease state are required. An example is presented by means of breast cancer screening data.

Adult↗
PubMed2005

Follow-up evaluation of a high school eating disorders screening program: knowledge, awareness and self-referral.

PURPOSE: To conduct a regional, follow-up evaluation to assess the implementation and effectiveness of the National Eating Disorders Screening Program (NEDSP), conducted in high schools nationwide in the spring of 2000. METHODS: Four New England high schools participated in a postscreen evaluation 1 to 2 months after implementation of NEDSP. A 35-item, self-report postscreen survey was administered to students in classrooms with assistance from school health staff and teachers. School staff involved in the screening were also interviewed. Logistic regression was used to estimate the odds that students talked to an adult or peers about their screening score. RESULTS: Data from 592 girls and 435 boys were included in the analysis in the four high schools participating in the program evaluation. NEDSP helped to identify students at risk and encouraged students to speak to others about their screening score and eating disorder symptoms. One-quarter of girls and one-fifth of boys reported talking with at least one adult about their EAT-26 screening score. Girls felt more strongly than boys that the program helped them learn about eating disorders, change their thinking related to eating disorders and body image, and talk to friends about eating disorders. Overall, the students felt that the program was helpful and would recommend it to their friends. CONCLUSIONS: Early detection of eating disorders in adolescents may shorten the interval between onset of symptoms and treatment, which has the potential to reduce the length of illness and morbidity associated with untreated eating disorders. Our findings suggest that high-school-based screening may be an effective way to facilitate early detection of eating disorder symptoms in adolescents.

Adolescent↗
PubMed1975

Evaluation of mortality data for cervical cancer with special reference to mass screening programs, Denmark, 1961-1971.

During the years 1961-1971, a total of 3696 women died in Denmark from cervical cancer. The annual mortality per 1000 was 0.23 and was constant in this period. The mortality was 0.30 in the Capital where a mass screening program has existed since 1968; in the Provinces, where screening was negligible, the rate was 0.21; the time trend was also constant. The mortality was low in youth, reaching a level of 0.30 around 45 years. Single women had the lowest mortality; among married women it was double, among widows 2-4 times higher, among divorcees 4 times. Within the marital groups, the Capital had higher or the same rates as the Provinces, except for divorcees in the Provinces who had higher rates. The lowest socioeconomic groups had the highest death rates at young ages. The effects of a total vs. an age-specific case-finding program have been estimated under three circumstances, namely that mass screening could reduce the cervical cancer mortality by 10%, by 50%, or by 100%. The impact on the public's health has been evaluated by relating the hypothetically prevented cervical cancer deaths to all cancer deaths and to deaths from all causes. The general population was subdivided by age, marital status and residence and ranked according to cervical cancer mortality. These data were used to design programs which would minimize the number of examinees and maximize the number of prvented deaths.

Adult↗
PubMedDate not supplied

Update on newborn hearing screening programs.

As a result of legislation supporting the position statement of the American Academy of Pediatrics (AAP) Joint Committee on Hearing, newborn hearing screening programs have become a protocol of care in hospital nurseries throughout the United States. The current goals are to screen all infants by 1 month of age, confirm hearing loss with audiologic examination by 3 months of age, and treat with comprehensive early intervention services before 6 months of age. This article will review the development of the Joint Committee on Infant Hearing position statements, examine legislation and health policy initiatives for universal newborn hearing screening, and determine nursing's role in meeting the goals.

Early Intervention, Educational↗