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PubMed2001

Predictors of early rescreening in the National Cervical Screening Program, Australia.

OBJECTIVE: To identify variables that predict early rescreening after a negative Pap smear report. METHODS: Cohort study using the records of a statewide Cervical Cytology Registry in Victoria, Australia. The cohort comprised 31,082 women who had a negative Pap smear report during the first half of 1996 and who were rescreened within the subsequent 36 months. Early rescreening was defined as a further Pap smear within 21 months. RESULTS: The strongest predictor of early rescreening was a recommendation at the time of issuing the negative Pap smear report by the laboratory for retesting before two years (adjusted odds ratio = 3.81, 95% confidence interval (CI) 3.58-4.05). Mention of reactive or inflammatory change as part of the negative Pap smear report was also a powerful predictor (adjusted odds ratio = 1.67, 95% CI 1.50-1.85). Significant predictors associated with the women were young age, high socio-economic status and residence in the capital city. Significant predictors associated with the practitioner were if either the index or subsequent smear was collected by an obstetrician/ gynaecologist or a hospital-based clinic, or if the practitioner collecting the index smear was a female. The population-attributable risk per cent associated with the laboratory recommendation was 27%. CONCLUSIONS: This data suggests that a multifaceted strategy targeting pathology laboratories, practitioners and women may be needed to reduce early rescreening. IMPLICATIONS: Early rescreening is wasteful of health resources. New screening programs should be designed to avoid this problem.

Adult↗

PubMed2006

The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program.

BACKGROUND: Approximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the 11 September 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders, such as firefighters and police, and a diverse population of construction, utility, and public sector workers. METHODS: To characterize WTCrelated health effects, the WTC Worker and Volunteer Medical Screening Program was established. This multicenter clinical program provides free standardized examinations to responders. Examinations include medical, mental health, and exposure assessment questionnaires; physical examinations; spirometry; and chest X rays. RESULTS: Of 9,442 responders examined between July 2002 and April 2004, 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. Among those who had been asymptomatic before September 11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry; forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 27% had abnormal spirometry compared with 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site. CONCLUSION: WTC responders had exposure-related increases in respiratory symptoms and pulmonary function test abnormalities that persisted up to 2.5 years after the attacks. Longterm medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters.

Adolescent↗

PubMed1991

Establishing a screening program for abused women.

Estimates are that 1.8 million women are physically abused each year by their husband. Abused women are seen daily in emergency rooms, prenatal clinics, primary care centers, and inpatient units. To prevent abuse and the adverse health and economic consequences, routine assessment is essential. The authors offer a step-by-step plan to establish a successful abuse screening program.

Crisis Intervention↗

PubMed2004

Can case management be used to facilitate diagnostic testing in publicly funded breast cancer screening programs?

The earlier breast cancer can be diagnosed and treated, the better the odds for survival. The literature has shown many of the barriers to timely diagnosis are not individual behaviors but problems in delivery of health care. Case management has been suggested to facilitate diagnostic testing and treatment. Models of case management exist in other practice settings but have not always been rigorously described or evaluated. Determining optimal models for case management has been established federally as a research priority to ensure medically underserved women are promptly diagnosed and treated. One model has been developed and pilot-tested in this setting. This article will describe elements of case management and the characteristics of a publicly funded screening program that make use of case management to facilitate timeliness of diagnostic testing different from case management in other settings. These differences have implications for successfully implementing case management in public programs.

Breast Neoplasms↗

PubMed2006

Transgenerational effects of betel-quid chewing on the development of the metabolic syndrome in the Keelung Community-based Integrated Screening Program.

BACKGROUND: The transgenerational metabolic effects of betel-quid chewing have been reported in mice but not in humans. OBJECTIVE: This study aimed to determine whether exposure to paternal chewing of betel nut quids led to an increased risk of early manifestation of the metabolic syndrome (MetS) in human offspring. DESIGN: The subjects were selected from 66,971 residents aged >19 y who attended a community-based Integrated Screening Program in Taiwan and who were identified as parent-child trios (n = 5037). Using a population-based, parent-child study design, we compared the mean ages of offspring with MetS at entry between those who were exposed and those who were unexposed to paternal chewing of quids containing betel nut. Cox proportional hazards regression models were used to estimate adjusted hazard ratios and to assess dose-response relations for paternal betel-quid exposure. RESULTS: The offspring who were exposed to paternal betel-quid chewing were younger than those who were not exposed, regardless of MetS status; they also had a 2.14-fold increase in the risk of early manifestation of MetS (adjusted hazard ratio = 2.14; 95% CI: 1.25, 3.66) after control for environmental and other risk factors, including personal betel chewing. Significant dose-response relations were found between the risk of early MetS and the quantity and duration of paternal exposure to betel quids. In the absence of MetS in either parent and of betel-quid consumption by the offspring, paternal exposure to betel quids increased the risk of early manifestation of MetS in offspring 2.53-fold (95% CI: 1.03, 2.64) compared with paternal nonexposure. CONCLUSION: Our findings suggest that exposure to paternal betel-quid chewing increases the risk of early manifestation of MetS in human offspring in a dose-dependent manner.

Adult↗

PubMed1964

BLOOD PHENYLALANINE LEVELS OF NEWBORN INFANTS. A ROUTINE SCREENING PROGRAM FOR THE HOSPITAL NEWBORN NURSERY.

If phenylketonuria is diagnosed during the first few weeks of life, a special diet can be given to prevent the brain damage that otherwise will occur.A simple, cheap, accurate laboratory test has been developed to diagnose the condition in infants two to four days old before they leave the hospital. At the Donald N. Sharp Memorial Community Hospital in San Diego routine testing of all newborn infants has been done with this technique since August 26, 1963. Mass screening programs in the newborn nursery are already being carried out by large numbers of hospitals across the United States.

Blood↗

PubMedDate not supplied

A nurse-managed universal newborn hearing screen program.

Hearing loss is one of the most common major birth defects, yet the average age for identifying significant hearing loss in children in the United States is 30 months. Hearing loss directly affects a child's ability to develop normal language skills, impairs his or her ability to communicate with others in the environment, and has been shown to correlate with poor academic performance. However, if hearing loss is detected early and interventions are begun before 6 months of age, children with hearing loss develop language, cognitive, and speech skills comparable to their non-hearing-impaired peers. Only 38 states mandate universal newborn hearing screening before discharge from the hospital. This article describes an institutional universal hearing screening program developed by nursing, which collaborated with physicians, audiologists, and otolaryngologists. Careful planning, including a thorough literature review, networking with area hospitals, and dialoging with experts in the field led to a successful program.The outcomes from this program compare favorably to nationally published data.

Developmental Disabilities↗

PubMed2003

Evaluation of a mass screening program for lysinuric protein intolerance in the northern part of Japan.

Lysinuric protein intolerance (LPI:MIM 222700) is an autosomal recessive disease characterized by defective transport of the dibasic amino acids. We recently reported a local cluster of LPI in the northern part of Japan (Koizumi et al., 2000). Mutational analysis of the LPI patients in this local cluster revealed they were exclusively homozygous for the R410X mutation. The effectiveness of early intervention with citrulline therapy (200 mg/kg per day) and protein restriction (1.5 g/kg per day) was confirmed in these patients. Mass screening was conducted in 4,568 newborn babies between 1999 and 2002, which was estimated to cover 100% of almost all newborns delivered in the screened area. Forty heterozygous newborns were found (0.88%), leading to an estimated incidence of LPI of 1:51,984. The number of people that required screening to detect one case was 51,984, and the cost for mass screening was 30 cents/person (a total of dollars 15,600). This is comparable to, or even less than, the cost of currently screened diseases in Japan. Therefore, we conclude that a mass screening program for LPI can be introduced effectively and economically into an area where an LPI cluster is located as the result of a founder mutation.

Adolescent↗

PubMed1975

Some influences on public participation in a genetic screening program.

To identify the psychosocial factors associated with voluntary cooperation in mass genetic testing, stratified random samples of 500 participants and 500 nonparticipants were drawn from an identified at-risk population for Tay-Sachs disease. Participants were relatively younger and better educated, reported higher levels of perceived susceptibility to being a carrier, and also stated more often that the impact of learning of being a carrier would be low. Participants were also more likely to indicate they would not alter plans for future progeny. Recommendations are made for enhancing participation in future genetic screening programs of this type.

Adolescent↗

PubMed1989

Biologic variation of urinary albumin: consequences for analysis, specimen collection, interpretation of results, and screening programs.

Studies on the analytic and biologic variability of albumin concentration, albumin/creatinine ratio, and albumin excretion rate in first morning, random, and 24-hour urine specimens from healthy subjects suggest that (1) first morning specimens are preferred, (2) results should be expressed as albumin concentration, (3) assay of creatinine confers little advantage, (4) an analytical precision of coefficient of variation (CV) less than 18% is satisfactory, and (5) semiquantitative or qualitative analyses are suitable for screening programs. The intraindividual variation of albumin concentration in first morning specimens from diabetics is such that no threshold value gives the desired 100% nosological sensitivity. However, a threshold value of 30 mg/L confers 100% specificity, and a single abnormal result therefore requires initiation of therapy. Patients with negative results should continue to be monitored regularly.

Adolescent↗

PubMed2005

NIH pre-clinical screening program: overview and current status.

The increase in the number of cases of Mycobacterium tuberculosis around the world has lead to a greater need for a more efficacious vaccine than the currently used M. bovis BCG. Despite the relative success of this attenuated vaccine there are multiple examples where alternative strategies are desperately needed. In 1996, the National Institutes of Health published a request calling for applications to test newly developed vaccines against tuberculosis. The current screening program at Colorado State University has tested a wide range of novel vaccine candidates.

Adjuvants, Immunologic↗

PubMedDate not supplied

Evaluation of community pharmacists' experiences with cholesterol screening programs.

OBJECTIVE: To assess the cholesterol screening experiences of Nebraska community pharmacists. DESIGN: A mail survey was used to assess pharmacists' experiences with and involvement in cholesterol screening and patient follow-up based on National Cholesterol Education Program guidelines. SETTING: A college of pharmacy in an academic health center. PATIENTS OR OTHER PARTICIPANTS: Pharmacists-in-charge of all Nebraska community pharmacies. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Participants' responses to survey items. RESULTS: Of 308 respondents, 83 indicated that cholesterol screenings had been held in their pharmacies. Whereas 95% felt that the screenings had been conducted appropriately, only 61% had actually monitored the screening process. Pharmacists were somewhat aware of the types of information being provided to patients being screened, although few were aware of the specific procedures used to identify high-risk patients. Eight of 80 pharmacists indicated that they obtained a list of patients who were told to contact their physicians based on their cholesterol screening results. Only 3 of 30 pharmacists responding to a question asking whether they contacted such patients to remind them to contact their physician reported actually doing so. CONCLUSION: Pharmacists were relatively uninvolved in both the screening process and the provision of information to the patients who were screened. Few pharmacists initiated-up contact with patients who were referred for physician evaluation.

Community Pharmacy Services↗

PubMed1992

Cooperation of hearing-impaired elderly subjects for participation in a hearing screening program.

Presbyacusis, the auditory disorder which accompanies the aging process, is well known. However, the practical assistance available to alleviate the breakdown in the communication ability of the older person is unsatisfactory, and provision for public awareness of a rehabilitation strategy has not yet been established in many countries. Four hundred and ninety-eight elderly subjects, aged 65-94 years, were hearing tested in different setups, a geriatric nursing home and in the community. It was found that the need for rehabilitation was high and the willingness to participate in a hearing screening program was low even though the rehabilitation treatment was provided without charge.

Age Factors↗

PubMed1999

A simple multiplex FRAXA, FRAXE, and FRAXF PCR assay convenient for wide screening programs.

FRAXA, FRAXE, and FRAXF are folate-sensitive fragile sites originally discovered in patients with X-linked mental retardation. The FMR1 gene, whose first exon includes the FRAXA site on Xq27.3, accounts for 15-20% of all X-linked forms of mental retardation. Loss of expression of FMR2, a gene adjacent to the FRAXE site on Xq28, is correlated with FRAXE expansion in some mild mentally retarded patients. FRAXF is a fragile site whose expression has not been associated with any pathological phenotype. The fragility in all three sites is caused by expansions of CGG repeats adjacent to hypermethylated CpG islands. The prevalence of FRAXA, FRAXE, and FRAXF remains uncertain because of the lack of a simple and cost-effective test allowing wide screening programs. For the same reason, the real phenotype-genotype correlations in FRAXE and FRAXF are uncertain as well. We have developed a rapid multiplex polymerase chain reaction (PCR) assay in which hypermethylated CpG islands adjacent to FRAXA, FRAXE, and FRAXF are displayed. The test is very simple and cost-effective, requires only 30 microl of peripheral blood, and can be used for performing diagnoses, postnatal and prenatal, and for screening large groups of control and mentally retarded males and newborn boys.

CpG Islands↗

PubMed2003

Long-term developmental outcomes of children identified through a newborn screening program with a metabolic or endocrine disorder: a population-based approach.

OBJECTIVE: To conduct surveillance of the developmental status of children who screen positive and are diagnosed with a metabolic or endocrine disorder. STUDY DESIGN: The Centers for Disease Control and Prevention linked three data sources in Georgia: (1) Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP), (2) Special Education Database of Metropolitan Atlanta (SEDMA), and (3) State of Georgia Newborn Blood-Spot Screening Program (NBSP). RESULTS: When MADDSP and NBSP were linked (birth cohorts 1981-1991), of an estimated 147 infants who screened positive for a metabolic or endocrine disorder and were at risk for mental retardation if left untreated, only three children were identified with mental retardation. When SEDMA and NBSP were linked (birth cohorts 1981-1995), of an estimated 216 children who screened positive for a metabolic or endocrine disorder, nine children were identified as having a developmental disability less severe than mental retardation, eg, speech and language impairments. CONCLUSIONS: Although children found in MADDSP or SEDMA have a low occurrence of developmental disabilities attributable to these metabolic or endocrine disorders, our finding of cases of developmental disabilities of varying severity attributable to a metabolic or endocrine disorder suggests a need for ongoing population-based monitoring of the long-term developmental outcomes of children identified through newborn screening programs.

Data Collection↗

PubMed1996

Management of gastric remnant carcinoma based on the results of a 15-year endoscopic screening program.

SUMMARY BACKGROUND DATA: Partial gastrectomy for benign peptic ulcer disease is associated with an increased risk of adenocarcinoma of the gastric remnant, especially in patients who are at least 15 years' postgastrectomy. Increasing evidence of mucosal dysplasia is noted on random gastric biopsy and may serve as a histologic marker in the identification of early cancer of the gastric stump. METHODS: From an initial group of 233 patients who underwent gastrectomy for benign peptic ulcer disease between 1960 and 1975, 163 patients began yearly flexible gastroscopy and random mucosal biopsy. Routine histologic studies identified either normal or dysplastic epithelium as well as adenocarcinoma. An average of eight biopsies were taken per endoscopic study. All endoscopic studies were performed by surgical residents under the supervision of one surgical attending. RESULTS: From July 1980 to June 1995, 145 patients completed annual gastroscopy and random biopsy. A total of 2287 endoscopic studies were performed. Fifteen patients were found to have severe dysplasia. Nine (60%) had associated microscopic evidence of adenocarcinoma. Four additional patients had macroscopic adenocarcinoma on endoscopic examination. All 13 patients with cancer were asymptomatic. Six patients continue surveillance who display moderate-to-severe dysplasia alone. The 13 patients with carcinoma underwent completion gastrectomy (R2 nodal dissection) with no evidence of cancer found beyond the gastric wall. These patients averaged 29 years since their original partial gastrectomy. OBJECTIVE: A prospective screening program for gastric remnant cancer was begun to assess the ability to discover early neoplastic changes on random biopsy and to make treatment decisions regarding the efficacy of completion gastrectomy after discovery of carcinoma. CONCLUSIONS: Aggressive annual screening using flexible endoscopy and multiple random biopsy may discover cancer in the gastric remnant and can lead to completion curative gastrectomy in asymptomatic people. Patients who are at least 20 years postpartial gastrectomy for benign disease should be considered for annual endoscopic surveillance.

Adenocarcinoma↗

PubMed2006

[Alpha1-antitrypsin deficiency: situation in Spain and development of a screening program].

Studies undertaken in Spain indicate that 9% of the general population aged between 40 and 70 years is affected by chronic obstructive pulmonary disease (COPD). Although tobacco smoke is the causative factor in more than 90% of cases, it is estimated that only 10% to 20% of smokers develop COPD. This may be explained by the existence of genetic or environmental factors that modulate the toxic effects of tobacco. The best known genetic factor is alpha1-antitrypsin deficiency, which is associated with an increased risk of developing pulmonary emphysema in smokers. The most recent guidelines from both the World Health Organization and the American Thoracic Society/European Respiratory Society recommend the establishment of screening programs for the detection of alpha1-antitrypsin deficiency in patients with COPD. This strategy is crucial in Spain, where the disease is under diagnosed, mainly due to a low index of suspicion among doctors.

Humans↗

PubMed2004

Community-based newborn hearing screening program in Taiwan.

OBJECTIVE: Congenital bilateral hearing impairment occurs in approximately 1 in every 1000 live births. Universal newborn hearing screening (UNHS) programs are the most effective method for early diagnosis. Previously, newborn hearing screenings in Taiwan were often hospital-based. Our study is a community-based program designed to test the feasibility of performing neonatal hearing screening with a pay-for-test model, and to evaluate its acceptability to parents. METHODS: From March 2000 to December 2002, two hospitals and four obstetric clinics in Tainan city participated in this study. The subjects were healthy newborns whose parents agreed to pay for otoacoustic emissions (OAE) hearing screening. They were tested in the newborn nursery before discharge. The protocol used an initial transient evoked otoacoustic emissions screening followed by a diagnostic auditory brainstem response (ABR) test. RESULTS: A total of 10,008 healthy neonates were recruited, and 5938 newborns (59.3%) were tested. Prior to hospital discharge, 5403 of the newborns (91.0%) had passed the transient evoked otoacoustic emissions test. Referral for further testing was made in 9.0% of cases (535/5938). There were 140 babies lost to 1-month follow up. Only 395 infants (73.8%) of the infants that failed their first otoacoustic emissions tests underwent a second session at the outpatient clinic, and 91 babies failed. They were referred for further auditory brainstem response testing. Ultimately, nine babies were diagnosed with sensorineural hearing loss (SNHL). CONCLUSIONS: There are difficulties in performing universal newborn hearing screening within Taiwan's health insurance system. This study was performed with the cooperation of hospitals and obstetric clinics, and was undertaken with a pay-for-screening model. Our program, with a pay-for-test model, of newborn hearing screening is feasible and was well regarded by parents in Tainan city. It could be run without the government's financial support.

Community Health Services↗