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PubMed1999

Technical aspects of neonatal screening using tandem mass spectrometry. Report from the 4th meeting of the International Society for Neonatal Screening.

Quantitative analysis of amino acids (AA) and acylcarnitines using tandem mass spectrometry is an emerging technology used to screen neonatal dried blood spot samples for disorders in the metabolism of AA, organic acids and fatty acids. This paper provides a brief review of some of the technically oriented issues which emerged at the 4th meeting of the International Society for Neonatal Screening in Stockholm, 1999. The information covers sample preparation, instrumentation, data acquistion modes, internal standards, interpretation, confounding factors and practical screening experience.

Amino Acid Metabolism, Inborn Errors↗

PubMed1993

Screening a state middle school for asthma using the free running asthma screening test.

The free running asthma screening test (FRAST) was used to screen children in a state middle school during a normal physical education lesson. The test was conducted by the teachers with a general practitioner available via a radiopager. Of the 249 children attending the school, aged 8-12 years, 237 (95%) were tested. Twenty two (9%) children were known to have asthma, of whom 18 were tested. Thirty one children had a significant decrease (> 15%) in their peak expiratory flow rate (PEFR) after exercise. Six of these children were known to have asthma, indicating that their asthma treatment may be suboptimal. A further six children assessed clinically had false positive results. The 31 children with significant decreases in their PEFR were matched for age and sex with a control group of 30 children who were considered to have a normal result. Of the control group, one child had clinical asthma. In total, 19 (8%) new cases of asthma were identified, giving an overall prevalence of asthma in the school of 16%. These results indicate that it is feasible to screen schools for asthma using the FRAST. Children with undiagnosed asthma can be identified and the control of children with known asthma monitored.

Asthma↗

PubMed1993

Portable chest imaging: comparison of storage phosphor digital, asymmetric screen-film, and conventional screen-film systems.

The quality of chest images obtained with portable radiography was evaluated for a conventional screen-film system, a new asymmetric screen-film chest system, and computed radiography (CR). Sixty chest images were obtained in 20 patients in an intensive care unit. The CR system was ranked by all three evaluating radiologists as substantially better in overall diagnostic quality, interpretability of the lungs, and musculoskeletal detail and by two of the three observers as better for the visibility of catheters and lines. In the upper abdomen and mediastinum, there was not a clear preference. Standard deviations of film density were +/- 0.12, +/- 0.41, and +/- 0.39 for the CR, conventional, and asymmetric systems, respectively. For the same systems, phantom results indicated the relative lung contrast values were 1.2, 1.0, and 0.89, respectively. Similarly, the limiting resolution values in the lung were 2.0, 4.2, and 6.3 line pairs per millimeter. The CR system had twice the root-mean-square noise of the screen-film systems. Overall, the preferred system for portable chest imaging was the CR system.

Electricity↗

PubMed1997

Prostate cancer: to screen or not to screen?

Screening of prostate cancer in asymptomatic men over 50 years is subject to discussion. A review of the medical and economical arguments in favor and against screening is given. It is concluded that widespread screening should not be undertaken but that correct information of the population is necessary with an adapted response to individual demands.

Humans↗

PubMedDate not supplied

Frequency and timing of symptoms in infants screened for sepsis: effectiveness of a sepsis-screening pathway.

To determine the frequency and timing of symptoms and to evaluate the effectiveness of a sepsis-screening pathway in term and near-term infants, data were collected prospectively for a period of 1 year from December 1, 2000, to November 30, 2001. Results confirmed that a sepsis-screening pathway using a combination of at least 2 serial complete blood cell count and C-reactive protein measurements in both symptomatic and asymptomatic infants is a safe, simple strategy that prevents unnecessary treatment of infants with risk factors with antibiotics. However, most infants with presumed or suspected early-onset sepsis are symptomatic. Routine treatment of asymptomatic infants with risk factors or prior treatment with intrapartum antibiotics is unnecessary. A combined approach of screening in the presence of risk factors and /or symptoms of sepsis and adequate follow-up for infants discharged at less than 72 hours of age may help reduce unnecessary treatment of infants with antibiotics.

Bacteremia↗

PubMedDate not supplied

Data assessing the usefulness of screening obstetrical ultrasonography for detecting fetal and placental abnormalities in uncomplicated pregnancy: effects of screening a low-risk population.

To investigate the usefulness of screening in low-risk populations, the authors evaluated the yield of ultrasonography for detecting abnormalities in 678 clinically uncomplicated pregnancies. The yield of ultrasonography in high-risk women who were referred for amniocentesis was remarkably similar to the yield in other women. All four diagnoses of twins were correct, but overall only six of 12 initial ultrasound diagnoses of fetal demise or fetal anomalies were confirmed at delivery. Of the eight major fetal anomalies present at delivery, including two cases of Down's syndrome, three had been detected by ultrasonography; none of the nine minor anomalies had been detected, usually because they were too small or might be detectable only at a later gestational age. Although ultrasonography may have a nearly perfect predictive value for certain anomalies, on average, in this study, positive ultrasonography increased the probability of an adverse outcome of pregnancy from 5.3% to 36%, while a normal ultrasound examination decreased the probability to 4.4%. These data, which emphasize the implications of screening a low-risk population, suggest that recommendations regarding routine screening obstetrical ultrasonography should await sufficiently large controlled trials demonstrating consistent clinical benefit, in terms of reassurance or of providing a baseline for future comparison or in terms of improved outcome at a reasonable cost.

Abnormalities, Multiple↗

PubMedDate not supplied

Quality control of the autopap screening system employed as a primary screening device: rapid review of smears coded as no further review.

AIMS AND BACKGROUND: Automated reading of smears is increasingly used in cervical screening, and quality control procedures to check its performance are required. The aim of the present study was to evaluate the usefulness of rapid review of all smears coded as "no further review" (NFR) by the AutoPap system as a quality control procedure. METHODS: From 2002-2005, 153,269 smears were processed by AutoPap at the Centro per lo Studio e la Prevenzione Oncologica of Florence, Italy, and 24,503 (15.9%) were coded as NFR. All NFR smears underwent immediate rapid review by expert readers. RESULTS: Sixty-five of 118 NFR cases reviewed as ASCUS-R complied to recommended 6 months cytology, and 25 of 30 NFR cases reviewed as ASCUS-SIL or more severe accepted immediate colposcopy. As a result of such assessment, one single case of microinvasive carcinoma was detected in a woman aged 34 years: NFR smear had been reviewed as AGCUS, was followed by repeat AGCUS cytology and repeat negative colposcopy, and finally underwent conization. CONCLUSIONS: NFR report at AutoPap was associated with an extremely high negative predictive value, which might suggest using AutoPap as a primary screening tool, with NFR report prompting a "return to screening" recommendation. Rapid review of NFR smears is not recommended as a quality control measure for the negligible yield of high-grade lesions detected.

Adult↗

PubMed1990

Rome women's screening study: knowledge, attitudes and practices of women regarding screening for breast and cervical cancer.

A survey on knowledge, attitudes, and practice regarding breast and cervical cancer screening was conducted in Rome on a sample of women aged 18-64 years. Of the 793 interviewees, 31.9% had undergone at least one breast imaging examination; examinations were more frequent in women over 35 and in those familiar with breast self-examination and female pathophysiology. Seventy percent of the women had had at least one Pap smear. Women were classified as Pap smear underusers (26.0%), appropriate users (28.8%), and overusers (45.2%) as compared to standard screening recommendations, according to their age and their lifetime number of smears. Age over 35 was associated with both underuse and overuse. Such inappropriate screening patterns could be related in part to the fact that the women reported that their physicians recommendations for Pap smear frequency were once a year or more in 62%, and once every two or three years in only 2%.

Adult↗

PubMed1995

United Kingdom community growth screening 1994: a survey of current practice. "Screening for Growth Towards 2000" Scientific Organising Committee.

OBJECTIVE: To determine current policies, resources, and attitudes to community growth screening in the United Kingdom. METHODS: A postal survey of community paediatricians and paediatric endocrinologists. RESULTS: 164 replies were received-most from senior clinical medical officers or community paediatricians-covering between 68 and 78% of the United Kingdom population. One hundred and thirty three (81%) trusts or districts had a written growth policy. Preschool and school age height screening took place in 75% and 81% of districts respectively, but most children were only measured once before school or at school. Policies for the age at which measurements were made and their frequency varied enormously. Seventy three per cent used standard equipment, the most popular being the Minimetre. A wide variety of charts were used, of which 23% were decimal age charts. A large number of referral criteria were used, including height, height velocity, and weight. Most children were referred to hospital outpatient clinics rather than specialist growth clinics. CONCLUSIONS: Over 90% of respondents felt that growth screening was either extremely valuable or useful depending on resources. The survey showed a widespread lack of standardisation of equipment, charts, and policies. Referral criteria and objectives need to be clarified by research and audit, and growth monitoring integrated into a systematic programme of child health surveillance.

Adolescent↗

PubMed2003

Is the promise of cancer-screening programs being compromised? Quality of follow-up care after abnormal screening results.

Cancer screening has increased dramatically in the United States, yet in some populations, particularly racial minorities or the poor, advanced disease at diagnosis remains high. One potential explanation is that follow-up of abnormal tests is suboptimal, and the benefits of screening are not being realized. The authors used a conceptual model of access to care and integrated constructs from models of provider and patient health behaviors to review published literature on follow-up care. Most studies reported that fewer than 75 percent of patients received some follow-up care, indicating that the promise of screening may be compromised. They identified pervasive barriers to follow-up at the provider, patient, and health care system levels. Interventions that address these barriers appear to be effective. Improvement of data infrastructure and reporting will be important objectives for policy makers, and further use of conceptual models by researchers may improve intervention development and, ultimately, cancer control.

Breast Neoplasms↗

PubMed2006

Does the 'inverse screening law' apply to oral cancer screening and regular dental check-ups?

OBJECTIVE: Early detection through regular screening is a measure used in certain cancer prevention strategies. This approach has been advocated for the prevention of oral cancers in the UK. The objective of this study was to assess whether people at higher risk of oral cancer in the UK visit dentists on a regular basis, and thereby afford opportunities for oral cancer screening. METHODS: Data from two large national surveys were used. Firstly, data from the Health Survey for England, 2001, were used to assess the relationship between dental attendance (the outcome measure) and recognized oral cancer risk factors; there were 13,784 participants with complete data. We used known risk factors for oral cancer (age >40 years, male sex, alcohol intake >28 units per week, cigarettes >20 per day, and fruit and vegetables <5 times a day) to generate a risk score for oral cancer. Logistic regression was used to compute the odds ratios for regular dental attendance according to risk score. All analyses used education and social class as covariates. We also used data from the British Household Panel Survey to assess whether dental attendance behaviour is sustained over a set period of time (5,547 participants with complete data). RESULTS: In persons in the higher risk category (as defined above) of the five risk factors, age, sex, alcohol, smoking, and fruit/vegetables, 68%, 56%, 52%, 43% and 60%, respectively reported regular dental check-ups. In persons with 0, 1, 2, 3, 4 and 5 of these risk factors, the odds ratio for regular dental check-ups was 1.00, 0.93, 0.81, 0.64, 0.50 and 0.28, respectively. The probability of regular dental attendance was low in all groups with a higher risk of oral cancer. In the longitudinal sample, the low probability of visiting a dentist regularly was stable over time. CONCLUSION: Opportunistic screening for oral cancer in general dental practice in the UK is unlikely to be an effective preventive strategy.

Adult↗

PubMed1997

Comparison of an asymmetric screen-film combination with a conventional screen-film combination for chest radiography in 51 patients.

Comparison is made between a new asymmetric screen-film combination and a conventional screen-film combination for use in chest radiography. Seven anatomical features were assessed by three consultant radiologists in each of 51 film pairs. A preference was indicated if one system better demonstrated a particular feature. Alternatively, no preference was indicated if the feature was equally demonstrated by both systems or not demonstrated at all. Any pathology incidentally noted which remained unchanged between the two films was localized to lung, mediastinum or bone and marked in the same way. The asymmetric high contrast system scored higher than the conventional system for demonstration of anatomy in both mediastinum and lungs, but no difference emerged between the two systems in the demonstration of pathology. The asymmetric screen-film system showed improved mediastinal and, to a lesser degree, improved lung detail. Further assessment in necessary to define any associated improvement in diagnostic yield.

Decision Making↗

PubMed2001

Racial differences in breast cancer screening among women from 65 to 74 years of age: trends from 1987-1993 and barriers to screening.

Breast cancer mortality is decreasing for elderly white women but increasing for elderly black women. National surveys were used to study racial differences in breast cancer screening and effects of Medicare funding for mammography and to examine explanatory fac- tors. A total of 13,545 women, aged 65-74, from the Health Care Finance Administration's Master Beneficiary File participated. After Medicare funding for screening mammography, the percent reporting a mammogram increased for white women, but not for black women. Clinical breast examination and breast self-examination decreased. Physician's recommendation, geographic area, education level and health status were the variables significantly affecting mammography usage for both races. Physicians recommended mammography more often if women were white, married, educated beyond high school and had an annual income greater than $20,000. These results support the need to design and test strategies specifically for black women and interventions to emphasize physician recommendations for breast cancer screening.

Black or African American↗

PubMed1986

[Neonatal screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency. 1. Enzyme immunoassay of dried blood 17 alpha-hydroxyprogesterone and its application to neonatal screening for congenital adrenal hyperplasia].

An enzyme immunoassay for measuring 17 alpha-hydroxyprogesterone (17-OHP) in dried blood collected on filter paper has been developed. The method is easy and rapid and has specificity, accuracy and precision. 17-OHP values of neonates with congenital adrenal hyperplasia (CAH, 40 ng/ml) were extremely high compared with normal neonates (1.1 +/- 0.7 ng/ml). There was a negative correlation between the 17-OHP value and birth weight. The method has been applied to neonatal screening for CAH due to 21-hydroxylase deficiency. During 38 months, 67,392 neonates were screened. The recall rate and the medical evaluation rate were 1.16% and 0.09%, respectively. A third of recalled neonates were low birth weight infants. 5 neonates were proven to have CAH, and its incidence was 1:13,478. The present study demonstrates the feasibility of a neonatal screening for CAH and indicates that the frequency of CAH may be greater than previously reported by case assessment method in Japan.

17-alpha-Hydroxyprogesterone↗

PubMedDate not supplied

Newborn screening for congenital hypothyroidism, Victoria, Australia, 1977-1997. Part 1: The screening programme, demography, baseline perinatal data and diagnostic classification.

Clinical, demographic and laboratory data from infants with congenital hypothyroidism (CH) born in the Australian state of Victoria from the commencement of neonatal screening in mid-1977 until December 1988 are reported. These provide a baseline for a 12-year prospective longitudinal study on physical and neuro-psychological outcome until mid-1997, the subject of a second paper. Infants with CH were detected using a primary TT4 screening test. Demographic data were collected prospectively using a clinical assessment protocol. Nearly all affected infants underwent 99mTc pertechnetate scanning at the initial assessment to determine the underlying aetiology of their hypothyroidism. 704,723 infants were screened and 199 with permanent primary hypothyroidism (one in 3,541) were identified. The most common aetiologies were thyroid ectopia (46%), thyroid aplasia (33%), and 'dyshormonogenesis' (11%). The clinical abnormalities classically described in CH were more evident in infants with aplasia, and the striking female preponderance in infants with thyroid dysplasia (syn. dysgenesis) was confirmed. Other features included increased frequencies of 'dyshormonogenesis' in infants of parents of Middle-Eastern origin and of labour induction in infants with dysplasia. A closed posterior fontanelle was not found in any infant with thyroid aplasia.

Age Determination by Skeleton↗

PubMed2005

Lung cancer screening experience: a retrospective review of PET in 22 non-small cell lung carcinomas detected on screening chest CT in a high-risk population.

OBJECTIVE: The objective of our study was to retrospectively review the PET results of non-small cell lung carcinomas detected on screening chest CT in a high-risk population. CONCLUSION: PET findings were negative in 32% of the cases of non-small cell carcinomas that were detected on screening CT in a high-risk patient population. These tumors were small, low-grade, or both. The most common histology was bronchioloalveolar cell carcinoma. The role of PET in evaluating screening-detected indeterminate nodules in a high-risk population may be more limited than in a general population.

Carcinoma, Non-Small-Cell Lung↗

PubMed2003

Costs of screening for pre-diabetes among US adults: a comparison of different screening strategies.

OBJECTIVE: We evaluated various strategies to identify individuals aged 45-74 years with pre-diabetes (either impaired glucose tolerance or impaired fasting glucose). RESEARCH DESIGN AND METHODS: We conducted a cost analysis to evaluate the effectiveness (proportion of cases identified), total costs, and efficiency (cost per case identified) of five detection strategies: an oral glucose tolerance test (OGTT), a fasting plasma glucose (FPG) test, an HbA(1c) test, a capillary blood glucose (CBG) test, and a risk assessment questionnaire. For the first strategy, all individuals received an OGTT. For the last four strategies, only those with a positive screening test received an OGTT. Data were from the Third U.S. National Health and Nutrition Examination Survey, 2000 census, Medicare, and published literature. One-time screening costs were estimated from both a single-payer perspective and a societal perspective. RESULTS: The proportion of pre-diabetes and undiagnosed diabetes identified ranged from 69% to 100% (12.1-17.5 million). The cost per case identified ranged from US dollars 176 to US dollars 236 from a single-payer perspective and from US dollars 247 to US dollars 332 from a societal perspective. Testing all with OGTT was the most effective strategy, but the CBG test and risk assessment questionnaire were the most efficient. If people are substantially less willing to take an OGTT than a FPG test, then the FPG testing strategy was the most effective strategy. CONCLUSIONS: There is a tradeoff between effectiveness and efficiency in choosing a strategy. The most favorable strategy depends on if the goal of the screening program is to identify more cases or to pursue the lowest cost per case. The expected percentage of the population willing to take an OGTT is also a consideration.

Aged↗

PubMed2003

Clinical relevance of microalbuminuria screening in self-reported non-diabetic/non-hypertensive persons identified in a large health screening--the Nord-Trøndelag Health Study (HUNT), Norway.

AIM: The aim of this study was to investigate the clinical relevance and consequences of screening for microalbuminuria (MA) in a randomly selected, apparently healthy population sample. MATERIAL AND METHODS: A total of 2,113 individuals (> or = 20 years) without known diabetes and treated hypertension, all identified in the large population-based Nord-Trøndelag Health Study (HUNT) 1995-1997, (n = 65,258), delivered 3 morning urine samples for MA analysis. Those with MA, defined as at least 2 out of 3 urine samples with albumin-to-creatinine ratio (ACR) > or = 2.5 mg/mmol, were invited to a second clinical examination. RESULTS: In total, 54 men and 54 women had MA, and 42 men (84%) and 42 women (78%) attended the second examination. All with MA had 1 or more cardiovascular risk factors, like elevated cholesterol, c-peptides and blood pressure, and they were older than those without MA. Ten men (25%) and 19 women (46%), who were defined as MA-positive at the screening, had normal albumin excretion in the overnight collected urine sample in the second clinical examination. Five men (12%) and 2 women (5%) were still followed-up at the hospital out-patient clinic 3 years later. CONCLUSIONS: Several individuals in the second examination had cardiovascular risk factors and other pathology, but the clinical benefit of discovering this was not obvious. Due to low positive predictive value and reduced reliability and validity, MA did not satisfy the criteria for a good screening test in this apparently healthy population.

Adult↗