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PubMed2004

[Bavarian mammography screening: results of consistency tests in X-ray units over three months].

PURPOSE: To find out whether the quality requirements in daily, weekly or monthly tests of the "European protocol for the quality control of the physical and technical aspects of mammographic screening (EPQC)" can be maintained when screening the population of a large area. Furthermore, to check the specific tolerances of different test positions given by the EPQC for redundancy and statistical correlation. MATERIALS AND METHODS: Daily test images were obtained with an additional exposition of a sensitometric step wedge according DIN 6868 - 2. Weekly densitometry and visual inspection were performed at the University of Applied Sciences, Cologne. RESULTS: All units were able to maintain basic requirements on image quality as long as films of the same batch number were used. Some tolerance requirements of the EPQC are inconsistent and redundant. CONCLUSION: The occasionally considerable fluctuations of film processing require a daily check on the processing conditions. Daily test images of the units are only obligatory in the first 4 to 5 weeks of a new operation. All test results should be analyzed retrospectively in an independent test laboratory with emphasis on the statistical behavior of the unit. The tolerances prescribed by the EPQC are not always consistent and should be adapted to today's scientific standard when applied in mammography screening centers.

Female↗

PubMed1999

Population-based mammographic screening: does 'informed choice' require any less than full disclosure to individuals of benefits, harms, limitations and consequences?

Mammographic screening is a public health intervention with benefits, harms and consequences. Assuming technical excellence and at least 70% participation, mammographic screening of women aged 50 years or over will reduce breast cancer mortality by 24%. Before the introduction of mammographic screening in Australia, the mortality rate from breast cancer for women in the target age group was 69.0 per 100,000. On the basis of this relative risk reduction, breast cancer mortality would be reduced to 46 per 100,000. However, for every breast cancer death averted, 10 additional cases of breast cancer will be diagnosed. As it is unknowable who will benefit from mammographic screening, it is unethical to claim that any given individual has been 'saved' through participation, especially in the absence of evidence that all-cause mortality will change. As women misunderstand their risks of breast cancer and the benefits and limitations of mammographic screening, public education is needed. As an individual's choice about screening is affected by the way benefits are framed, our public messages must be carefully scrutinised. It is impossible otherwise to assert that women are making an 'informed choice'. The decision of women who decline to participate must be respected. Public health expertise is crucial to ensure the rhetoric of 'informed choice' in cancer screening is realised.

Aged↗

PubMed2000

Cervical cancer screening in Belgium.

A description is given of the burden of cervical cancer and the status of screening in Belgium until 1998. Screening is essentially opportunistic and generally performed at yearly intervals. A programme for organised screening - promoting one cervical smear every 3 years for women aged between 25 and 64 years - is being set up in the Flemish Region alone. Important progress has been made concerning the development of technical guidelines on the collection of an adequate Papanicolaou (Pap) smear, uniform terminology for the cytological report and the follow-up of positive tests. The implementation of the programme is confined to the provinces that are instructed to make women and physicians aware of the screening policy. The establishment of a screening register, allowing for individualised invitation of women, was hampered by strict privacy laws and by the heterogeneity of software used for data entry in cytological laboratories. The impact of the Flemish programme was further limited since the reimbursement of smear taking by a gynaecologist or a general practitioner (GP) and the cytological reading are not conditioned by the respect of guidelines. This is due to the fact that the organisation of preventive healthcare and the financing of medical activities concerns distinct authorities. The coverage of the target population is good in Flanders (82.3% according to certain estimates), but is achieved at the expense of an important amount of over-screening. The coverage is lower in the Walloon and the Capital Region. Rationalisation of the policy regarding cancer screening involving all concerned authorities of the country is necessary.

Adult↗

PubMed2002

[The scientific basis for population screening for breast cancer in the Netherlands].

A recent Cochrane review stated that there was a lack of evidence for a decrease in mortality as a result of population breast-cancer screening. The principal data were drawn from five Swedish randomized controlled trials and one Canadian trial. However, the studies cannot be so easily combined because there were important differences in the attendance rate, detection rate, technical quality, referral rate, clinical baseline situation and screening interval. For example, in one of the studies the women from the control arm underwent an annual clinical palpation carried out by a trained nurse or physician, which could have led to an underestimation of the screening effect. Further breast-cancer mortality might not be a good outcome measure because this was not reliably determined; only total mortality was to be observed. This is clinically and methodologically incorrect because breast-cancer mortality was meticulously studied, documented and validated. In the Cochrane review it is suggested that the randomisation was inadequate, but evidence for this was not supplied. The discussion about age differences as a marker for incorrect randomisation is out of date and has been revealed to be unjust. It seems likely that an important part of the decreasing trend in breast-cancer mortality in several countries (including the Netherlands) is due to screening programmes. However, the evaluation of breast-cancer mortality over the next five years is crucial, if greater certainty is to be gained about this.

Breast Neoplasms↗

PubMed2003

Screening for ability to complete a questionnaire: a preliminary evaluation of the AbilityQ and ShoulderQ for assessing shoulder pain in stroke patients.

OBJECTIVES: To assess the repeatability of the AbilityQ--a screening tool to assess technical ability to complete a questionnaire--in patients with complex disabilities following stroke. To evaluate the validity of the AbilityQ in predicting repeatability and consistency of response to verbal and visual analogue scale questions in the ShoulderQ in those with shoulder pain. DESIGN: In a cross-sectional study, the AbilityQ and 'ShoulderQ' were administered on two consecutive days by a single investigator. SETTING: Six regional rehabilitation centres in the UK managing patients with severe complex neurological disability. SUBJECTS: Forty-nine patients with anterior or posterior circulation strokes: 13 (63%) had cognitive deficits and 28 (57%) had communicative deficits. RESULTS: Thirty-one (63.3%) patients required some degree of help in completing the AbilityQ. Percentage agreement for individual questions between day 1 and day 2 ranged from 55 to 88% with kappa values from 0.07 to 0.79. Repeatability of ShoulderQ responses was 36-72% for the verbal questions (kappa values 0.16-0.56). For visual analogue scale (VAS) questions, agreement +/- 1 on a 10-point scale was 36-59% with intraclass correlation coefficients 0.50-0.60 (p < 0.01). High verbal (> or = 3/4) and VAS scores (3/3) on the AbilityQ had positive predictive values for good repeatability in the ShoulderQ of 80% and 58% respectively. Mismatched AbilityQ responses to verbal and VAS questions showed a positive predictive value of 92% for similar inconsistency in the ShoulderQ and a negative predictive value of 90%. CONCLUSIONS: In this preliminary evaluation the AbilityQ and the ShoulderQ each demonstrated a moderate level of repeatability in a group of patients expected to have difficulty in completing questionnaires. The AbilityQ appears to have some clinical usefulness in identifying those able to respond to the ShoulderQ and, where responses to verbal and VAS questions conflict, may offer some guidance as to which are most likely to be accurate in that individual. Further development is underway.

Adult↗

PubMed1998

A pilot survey of radiation doses received in the United Kingdom Breast Screening Programme.

A survey of radiation dose and compressed breast thickness was conducted in samples of women undergoing mammography in the United Kingdom National Health Service breast screening programme. The aims were to determine the average value and distribution of dose and thickness, and to identify technical difficulties in carrying out such a survey. Values of breast thickness and mean glandular dose, calculated from exposure factors and measured X-ray beam parameters, were collected for 4633 women in 92 screening units in 1994 and 1995. The median (lower quartile, upper quartile) dose per film was 1.7 (1.2, 2.4) mGy for the mediolateral oblique view (mean thickness 57 mm) and 1.4 (1.1, 2.0) mGy for the craniocaudal view (mean thickness 52 mm). The median dose per woman was 1.8 (1.3, 2.5) mGy for a one-view examination and 3.3 (2.3, 4.6) mGy for a two-view examination. The dose per film showed an exponential relationship to breast thickness, but no relationship was found between median dose and median breast thickness in the different screening units, possibly because of errors in breast thickness measurement. The values of breast thickness and dose were generally consistent with those in other published surveys, allowing for differences in radiographic technique. No relationship between breast dose and standard optical density was demonstrated. Some recommendations for the conduct of future surveys of breast dose in the UK are proposed.

Breast↗

PubMedDate not supplied

[Evaluation of technics used to define type 'A' pattern, in the Belgian Prevention Project of cardiovascular diseases (author's transl)].

In order to define the Rosenman and Friedman type A pattern three technics where used: the Bortner scale, the Jenkins Acitivity Survey (J.A.S.) and the interview. These are part of the base-line data recorded during the screening of a belgian male population aged 40 to 59 at entry of a controlled trial for the multifactorial prevention of cardiovascular diseases. The J.A.S. and the Bortner scale are evaluated in relation to the interview. Extremes of type A and B are less prevalent in our study compared to the Western Collaborative Group Study. Both the J.A.S. and the Bortner scale are very satisfactory in predicting type A and B pattern. The Bortner scale predicts the pattern in 78% of the subjects, by the method of weighted scores. The validation of this classification method, on a second sample, gives an accurate classification in 75% of the subjects. The J.A.S. predicts, the pattern in relation to the interview in 78% of the subjects; again the validation of the classification method, on a second sample, gives a correct classification in 70% of the subjects.

Behavior↗

PubMed1994

Comparative results in detection of HCV antibodies by using a rapid HCV test, ELISA and immunoblot.

Viral hepatitis C is a major problem of post-transfusion hepatitis. The best measure for preventing hepatitis C infection in transfusion is blood donor screening. There are many methods for detecting hepatitis C virus antibodies. ELISA is one of the sensitive screening methods. However it needs equipment, technical skills and it is time consuming. The Genelabs Diagnostics HCV-SPOT is a simple, rapid test for the detection of anti-HCV. This paper reports comparative results in detection of HCV antibodies by using GLD HCV-SPOT, ELISA and GLD/DBL HCV BLOT. One hundred and ninety-two specimens from blood donors patients with chronic hepatitis, cirrhosis, hepatoma and miscellaneous chronic liver diseases were tested by HCV-spot assay and HCV ELISA. The positive specimens were confirmed by the immunoblot assay. Only one of 140 samples negative by HCV-SPOT was positive by ELISA. The sensitivity and specificity of HCV-SPOT assays were 97.6% and 92.6% respectively. The positive predictive value was 78.8%, negative predictive value was 99.3%, accuracy was 93.6%. The rapid HCV-SPOT assay can be used in the management of transplantation graft procedures or emergency blood screening for transfusion. In addition, it can be used in small, local hospitals without any expensive equipment.

Blood Donors↗

PubMed2005

Implementation of national diabetes retinal screening programme is associated with a lower proportion of patients referred to ophthalmology.

AIMS: To examine the impact of a new national retinal screening programme on screening attendance, technical quality of images, and referrals to the ophthalmology clinic. METHODS: Results from the previous ad hoc retinal screening service were compared with data from the first year of the new Scottish Diabetes Retinal Screening Programme in Dundee, which was administered according to criteria recommended by the Health Technology Board Scotland. RESULTS: Of 5150 patients invited for screening, 10.3% of patients did not attend. Overall, 4574 patients underwent single-field digital retinal photography and 25.4% required mydriasis for an adequate image. After screening, 1.9 and 90.5% were recalled for repeat photography at 6 months and 1 year, respectively, whilst 4.6% were ungradable and 3.0% were referred to the ophthalmology clinic. Compared with the last 18 months of the previous scheme, with the new programme a smaller proportion of patients were referred to ophthalmology (3.0 vs. 5.9%; P < 0.001, difference 2.9%: 95% confidence interval 2.1-3.7%). Moreover, the attendance was higher (89 vs. 82%; P < 0.01) and there were fewer ungradable images (4.6 vs. 7.1%; P < 0.001). CONCLUSIONS: Introduction of a systematic retinal screening programme can reduce the proportion of patients referred to the ophthalmology clinic, and use ophthalmology services more efficiently.

Adult↗

PubMedDate not supplied

PAPNET Testing System. Technical update.

OBJECTIVE: To extensively test the functional integrity of the PAPNET Testing System, a computer-assisted cervical smear rescreening device, to ensure performance and reliability. STUDY DESIGN: Various system and subsystem testing methodologies were used to verify that the PAPNET Scanning Station performed according to specifications. Using synthetic and biologic slides, proper operation of the system in its intended use environment was verified. An automated system test was employed to demonstrate the ability of the system to detect cytologic abnormality. Several tests were performed throughout the production process and normal operation to ensure subsystem operations. RESULTS: The testing methodologies were shown to provide accurate measurements of scanning performance. CONCLUSION: Methodical testing and implementation of technologic enhancements ensure system performance and reliability. When used with microscopy, PAPNET testing provides the means to improve the accuracy of cervical cytology.

Automation↗

PubMed1985

Intervention strategies for children: a research agenda.

This background review has attempted to pinpoint problems and issues of intervention strategies to promote health among children. Some traditional interventions as they are now provided in preventive service packages, for example, are critically assessed; new interventions like neonatal intensive care, prenatal diagnosis, periconceptional vitamin supplementation, and nutritional supplementation during later pregnancy are welcome; supportive outreach services through nurse home visitors to bring proved technologies to those in greatest need, while they may not be new have shown renewed effectiveness. Recently recognized problems like the "new morbidity," and newly recognized prevention potentials like the great prospects for accident prevention, adequate school health programs, and special adolescent care programs are promising areas for preventive services effectiveness. We do not claim that a comprehensive list has been presented. Rather, an attempt has been made to challenge some traditional preventive techniques, e.g., preoperative x-rays, to stimulate thinking about new organizational forms of care delivery, and to keep an open agenda. As a result, the reader will feel a "lack of closure"--challenges without definitive answers. The general assertion is that personal preventive care is only weakly related to health and that preventive care delivery is not a simple technical problem. Let me summarize the main points. First, the lack of evidence and comprehensiveness. Other reviews of preventive care packages could have been discussed. The presentation by Fielding [164] in the Institute of Medicine's background papers to Healthy People also includes service listings for pregnant women, normal infants, preschool children, schoolchildren, and adolescents. The Lifetime Health-Monitoring program by Breslow and Somers [165] set goals and services that have already become practice patterns for large parts of the country. Many more cost-effectiveness studies of immunizations and screenings could have been cited. The point, however, is not whether technologies with the potential for prevention exist, but whether these technologies have been used and are now used effectively for that purpose, and whether their performance in the real world represents the best use of scarce and expensive resources. Scientific evidence of organized delivery effectiveness is rare.(ABSTRACT TRUNCATED AT 400 WORDS)

Accident Prevention↗

PubMedDate not supplied

Sampling, sampling errors and specimen preparation.

To obtain an adequate cervical smear for making a correct cytologic diagnosis, smear taking, laboratory handling and interpretation must be optimal. Many people are involved, and only by a combined effort of all links can this target be seriously approached: the smear takers will have to be open minded about technical improvements and read the morphologic descriptions cautiously; in the laboratory, cytotechnicians and physicians will have to challenge themselves and each other. It is mandatory to discard specimens that do not meet general standards of adequacy. At present a host of new techniques are being implemented. It is not feasible for all laboratories to be engaged in testing these new methods, but we are all requested to follow the development the best we can and switch to new ways when justified. Our working conditions are very different; therefore, it is our professional responsibility and plight to respond at the right time. So far the conclusion is that the conventional Pap smear is the international standard of care for the diagnosis of cervical cancer precursers in cancer screening programs. Certainly, this may change within a very short time. Liquid-based techniques, and in particular HPV technologies, are just around the corner.

Cell Biology↗

PubMed1999

Risk and protective factors associated with screening for complications of diabetes in a health maintenance organization setting.

OBJECTIVE: To identify risk and protective factors associated with screening for complications of diabetes, we performed a cross-sectional study of 3,612 diabetic members enrolled in CaliforniaCare, a large network-model health maintenance organization (HMO). RESEARCH DESIGN AND METHODS: We used the Health Plan and Employer Data Information Set (HEDIS) 3.0 technical definition to identify all members (aged > or = 31 years) receiving any diabetes medication(s) during a 12-month period. Using a telephone survey instrument, identified members were interviewed about their diabetes care and screening, patient, and provider history. Survey data were supplemented with HMO claims and demographic information. Multivariate analysis was performed to identify demographic, clinical, and utilization characteristics that affect the odds of diabetic members receiving annual retinal examination, foot examination, and HbA1c testing. RESULTS: While results varied by screening category, the odds of obtaining screening were higher for diabetic members who were older, spoke English, received diabetes nutrition counseling, visited a diabetes specialist physician, belonged to a diabetes association or support group, used insulin, performed glycemic level self-examination at least once a day, and had higher overall prescription drug use (suggesting higher comorbidity). Since this study is a cross-sectional review, these results do not imply a cause-and-effect relationship between dependent and independent variables. CONCLUSIONS: Results of this study suggest barriers, risks, and protective factors associated with screening for complications of diabetes. Diabetic members who do not possess these characteristics may be at increased risk.

Adult↗

PubMed2003

Prevention of sexually transmitted diseases (STDs) in female sex workers: prospective evaluation of condom promotion and strengthened STD services.

BACKGROUND: In Perú, a previous study of government-sponsored periodic examinations of female sex workers (FSWs) found no significant impact on rates of sexually transmitted diseases (STDs). GOAL: This study assessed the impact of technically improved periodic STD services on STD prevalence and on consistent condom use (CCU). STUDY DESIGN: The study involved monthly follow-up of 917 FSWs at two STD clinics, with evaluations before and during implementation of strengthened STD services, which included periodic screening and treatment for gonorrhea, chlamydial infection, trichomoniasis, bacterial vaginosis (BV), and syphilis; counseling; and supply of condoms. Outcome analyses were adjusted for participation bias. RESULTS: During 7908 person-months of observation, the prevalences of gonorrhea, chlamydial infection, trichomoniasis, and BV declined significantly and CCU increased significantly, with similar trends in both clinics. During follow-up, gonorrhea, chlamydial infection, trichomoniasis, and BV were negatively associated with follow-up after screening. BV also was positively associated with use of an intrauterine device and negatively with douching. CCU during follow-up was associated with significantly decreased risk of gonorrhea, chlamydial infection, and trichomoniasis. CONCLUSIONS: Strengthened periodic screening for and treatment of confirmed STD, in addition to condom promotion and provision, represent feasible, effective interventions in commercial sex, and time series analyses can provide a useful approach to evaluating new interventions.

Adolescent↗

PubMed1984

Four years of British audiology.

The last four years have, as envisaged by Dr Watson, seen a rapid growth in 'Audiology in the Community'. The high prevalence of hearing loss in the community, especially in the elderly, has been indicated by the pilot epidemiological study of the Institute of Hearing Research. This and other studies suggest that in the over-seventies as many as three out of five have a hearing loss sufficient to impair ordinary communication. However, the numbers having and using hearing aids falls far short of this. The range of hearing aids available through the National Health Service has increased substantially, and support services have improved with more and better qualified technical, scientific and therapeutical staff, and with the growth of rehabilitation schemes involving both professional and voluntary workers. Much still remains to be done in educating the community and the profession of the need for earlier referral and treatment of hearing loss. Assistance for the profoundly deaf will, it is hoped, come through the research studies on electrical stimulation of the cochlea. In the meantime Vistel , television captioning and similar exercises in exploiting advances in technology enhance the quality of life of those with profound loss. Help for those suffering from tinnitus has improved greatly in the last four years, partly through recognition that the difficulties are real, and partly through the increasing use of hearing aids and maskers to overcome the debilitating consequences of this condition. Preventative measures progress steadily, as do efforts towards the earlier detection of hearing loss in infants and children.

Aged↗

PubMed2025

Multi-Omics and Integrative Analytics in Natural Products Discovery.

Natural products (NPs) have long been an essential source of new bioactive compounds for drug discovery; however, traditional methods for screening and isolating these compounds can be slow and often yield diminishing returns. Fortunately, advanced multi-omics and computational approaches present powerful solutions to these challenges. This review highlights innovative methodologies that integrate metabolomics, genomics, transcriptomics, and proteomics with bioinformatics and analytical chemistry to accelerate NP discovery. For instance, untargeted metabolomics platforms like high-resolution liquid chromatography-tandem mass spectrometry (LC-MS/MS) and Global Natural Products Social (GNPS) molecular networking allow for comprehensive profiling of new compounds, while targeted isotope-labeling strategies enhance this process. Additionally, genome and metagenome mining tools such as antibiotics and secondary metabolite analysis shell (antiSMASH), Deep Biosynthetic Gene Cluster (DeepBGC), and Pipeline for Reconstructing Integrated Syntheses of Metabolites (PRISM) quickly identify biosynthetic gene clusters (BGCs) in both cultured and uncultured organisms, often using heterologous expression to validate products. Transcriptomic analyses, including RNA sequencing (RNA-seq), co-expression networks, and fluxomics, help clarify how pathways are regulated, while quantitative proteomics techniques like tandem mass tags/isobaric tags for relative and absolute quantitation (TMT/iTRAQ) and label-free methods, along with chemoproteomics approaches such as cellular thermal shift assay and thermal proteome profiling (TPP), uncover molecular targets and their mechanisms of action. This review also places significant emphasis on the role of artificial intelligence (AI) and machine learning (ML) in integrating multi-omics data, spanning activities from constructing gene-metabolite correlation networks to leveraging knowledge graphs and graph neural networks for data fusion and functional prediction. Finally, this review concludes by discussing the synergistic benefits of multi-omics for natural-product discovery, addressing current technical challenges, and exploring future directions toward high-throughput, intelligent data integration for next-generation NP research.

Biological Products↗

PubMed2005

Pharmacist-provided quantitative heel ultrasound screening for rural women at risk of osteoporosis.

BACKGROUND: Osteoporosis is underdiagnosed, and rural communities often have limited technical resources for the assessment of osteoporosis. OBJECTIVE: To evaluate the impact of a pharmacist, trained in the use of a portable heel ultrasound device, in screening elderly rural women for risk of osteoporosis and determine whether those found to be at risk seek further help and treatment from their general practitioner (GP) following screening. METHODS: Following promotion of the service, 345 women were recruited from 6 rural community pharmacies in Tasmania, Australia, and underwent quantitative heel ultrasound screening. Women were comprehensively educated on risk factors for osteoporosis and completed a calcium intake questionnaire. Results were forwarded to each woman's GP, and the participants were followed up 3 months later to assess outcomes from the screening procedure. RESULTS: Approximately 20% of women were shown to be at high risk for osteoporosis; 201 (58%) of these were referred to their GP for further assessment. Sixty-eight percent of women who were screened discussed their results with their GP, and 11% underwent further investigation. Over one-third of women screened began medication (30% calcium, 6% bisphosphonate, 6% vitamin D) for osteoporosis. CONCLUSIONS: Pharmacist-provided screening for osteoporosis in rural areas is a potentially useful method to identify women at risk for fracture and a convenient time point for discussion of preventive therapy.

Absorptiometry, Photon↗

PubMed1996

[Chlamydia trachomatis infection: risk factors].

UNLABELLED: Genital Chlamydia Trachomatis (CT) infections are the most common cause of tubal infertility. Its prevalence is variable between the authors, but seems to be more frequent in the young population. OBJECTIVE: Evaluate the CT genital infection rate in a population consulting either in a sexually transmitted disease center (STD) or in a family planning unit (FPU). --Judge the interest of a routine screening, and by which technic. --Estimate the information level of population about STD and their prevention. METHODS: 270 men and 331 women were detected by uretral or endocervix sample with an immunofluorescence method (Syva Microtrack). CT serology were also realised. RESULTS: 18.5% of man samples, 20% of woman samples in the STD center and 17.9% of woman samples in the FPU were positive for CT. There is a strong correlation between CT positivity and cervical discharge or cervicitis (RR = 4.64, p < 0.01). Serology was positive in 45.5%, 32.5% and 21.2% respectively for STD center's men, STD center's women and PFU's women. The correlation between samples and serology was 62%. Positive samples were more frequent in the 15-30 years old population and positive serology in the over 30 years old population (RR = 3.57, p < 0.01). There is a correlation between CT positive samples and nulliparity, multiple sexual partner and history of genital infection. CONCLUSION: The high prevalence of CT genital infection observed in our centers justify a routine screening especially in the young population.

Adolescent↗