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Education, consent, and counseling in sickle cell screening programs: report of a survey.

In 1980, we surveyed screening facilities to determine the extent of sickle cell screening and to assess compliance with Maryland regulations. Approximately 52,000 persons were screened per year in Maryland by local health departments, hospitals, primary care centers, correctional facilities, and units dedicated entirely to screening. Thirteen thousand persons were screened without informed consent. Many facilities were deficient in providing education and counseling as well as in obtaining informed consent. Units dedicated entirely to screening were most compliant with the state regulations.

Anemia, Sickle Cell↗

[The results of screening program for cervical cancer in Lodz].

OBJECTIVES: Despite effective screening methods, most often tumor of the urogenital tract is still cancer of the uterine cervix. Proven in many countries the value of widespread screening of the precancerous lesions and cervical cancer justifies carrying out such prophylactic tests in Poland. DESIGN: Assessment of results of screening as a method of early detection of cancer of the uterine cervix among inhabitants of Łódź area. MATERIAL AND METHODS: Study was done between 1.07.2000 and 31.12.2000 among 5,000 women aged from 30 to 59 years, inhabitants of Łódź area. Smears were evaluated in five-grade Papanicolaou scale and according to TBS system. In cases of detection of erosion of the uterine cervix or abnormal results of cytological test (> or = III degree) biopsies were taken to make pathological diagnosis. RESULTS: 459 smears were qualified to group I according to Papanicolaou (9.18%), 4435 smears to group II (88.7%), 38 smears to II/III (0.76%), 65 smears to group III (1.3%), 2 smears to IV (0.04%) and 1 smear to V (0.02%). Due to histopathological verification of the cytological results 53 low grade cervical dysplasia (1.06%) were diagnosed, 8 dysplasia of medium grade (0.16%), 7 high grade dysplasia (0.14%), 3 pre-invasive cancers (0.06%) and 3 invasive cancers (0.06%). CONCLUSIONS: Population of inhabitants of Łódź area aged 30 to 59 years old is characterised by a high frequency of incidence of pre-cancerous conditions and invasive cervical cancer. Number of detected pathologies of the uterine cervix proves purposefulness of this project.

Adult↗

[The parents' opinions on screening program regarding newborn hearing].

OBJECTIVE: To investigate opinions on screening of newborn hearing from parent's and its influence to parents and their families. METHODS: Parents were divided into two groups and were given the same questionnaire. Those parents whose babies had passed the first test were in the first group, and those parents whose babies failed the test were in the second group. RESULTS: Most of the parents showed their ignorance to hearing screening with about 97.5% of parents admitted they had little knowledge of hearing screening. 93.06% of the parents showed positive attitude to the screening after being informed of the test. 59.73% of the parents thought the test results were reliable. 73.12% of the parents whose babies showed negative result at the first-test, thought the results were accurate. There were only 38.19% of the parents whose babies failed the first test held the same opinion. We also found that there were some disagreement among 78% of the parents who believed that the positive screening results might cause additional psychological stress on them and therefore affecting their normal family life. CONCLUSIONS: Being informed of the screening, parents showed awareness of the test and were willing to cooperate. They believed the test was beneficial to their babies. Some parents whose babies did not pass the first screening test were often doubtful to the results and refused to be followed up. Therefore, we should improve our diagnostic technology to reduce the negative effects of the test. The results of our investigation suggested that the newborn hearing screening was applicable in our country.

China↗

Massachusetts Metabolic Disorders Screening Program: III. Sarcosinemia.

Sarcosinemia has been detected by routine screening of urine for metabolic and transport disorders in Massachusetts. Three infants who had sarcosinemia were detected through the neonatal urine specimen, an observed incidence of 1:350,000. A fourth child had sarcosinemia detected through family screening after his brother was found to have Hartnup disease by neonatal urine screening. These four children with sarcosinemia have plasma sarcosine concentrations ranging from 80 to 603 mumol/L and urine sarcosine from 2.1 to 9.4 mumol/mg of creatinine, findings similar to those reported for persons with sarcosinemia. No treatment has been given. At 3.8 to 15 years of age, the children had normal findings on physical examination and had no specific illnesses. Their full-scale IQ scores ranged from 89 to 111. The oldest child had a learning and emotional disorder, and one other child was emotionally unstable. It was concluded that sarcosinemia as a specific disorder is probably benign and that the mental retardation and dysmorphic features described in some affected persons are likely coincidental with the biochemical defect. The emotional disturbances that were encountered in two children are also probably coincidental but need further attention in this disorder.

Adolescent↗

BOEL-a screening program to enlarge the concept of infant health.

Infant screening should cover the need for general information regarding the child's development of attention functions important for communication with surroundings, as well as for the acquistion of language and speech. BOEL is a screening method applied by child health centers in Sweden, Finland, The Netherlands, Denmark and Italy. With the help of two visual stimuli, the "gripper" and the "spinner", and four sound sources, ranging in frequency between 4,000 and 12,500 Hz, the child's capacity to give adequate response to signals is checked, preferably within the frame of routine health check-ups, by one tester.

Child Development↗

Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program.

OBJECTIVE: The prevalence of gestational diabetes mellitus (GDM) varies in direct proportion with the prevalence of type 2 diabetes in a given population or ethnic group. Given that the number of people with diabetes worldwide is expected to increase at record levels through 2030, we examined temporal trends in GDM among diverse ethnic groups. RESEARCH DESIGN AND METHODS: Kaiser Permanente of Colorado (KPCO) has used a standard protocol to universally screen for GDM since 1994. This report is based on 36,403 KPCO singleton pregnancies occurring between 1994 and 2002 and examines trends in GDM prevalence among women with diverse ethnic backgrounds. RESULTS: The prevalence of GDM among KPCO members doubled from 1994 to 2002 (2.1-4.1%, P < 0.001), with significant increases in all racial/ethnic groups. In logistic regression, year of diagnosis (odds ratio [OR] and 95% CI per 1 year = 1.12 [1.09-1.14]), mother's age (OR per 5 years = 1.7 [1.6-1.8]) and ethnicity other than non-Hispanic white (OR = 2.1 [1.9-2.4]) were all significantly associated with GDM. Birth year remained significant (OR = 1.06, P = 0.006), even after adjusting for prior GDM history. CONCLUSIONS: This study shows that the prevalence of GDM is increasing in a universally screened multiethnic population. The increasing GDM prevalence suggests that the vicious cycle of diabetes in pregnancy initially described among Pima Indians may also be occurring among other U.S. ethnic groups.

Adult↗

Use of an interrupted time-series design to evaluate a cancer screening program.

An alternative approach to intervention-control designs to evaluate community health education studies is to use a quasi-experimental design in which the outcomes of interest are examined over time in the intervention unit. The Forsyth County Cancer Screening Project (FoCaS) was a comprehensive clinic- and community-based education program to increase screening for cervical cancer and breast cancer among low-income women. This paper reports the use of piecewise regression accounting for potential effects of auto-correlation in the data to evaluate the effectiveness of the project in increasing mammography screening. Data for the evaluation of trends in screening consisted of all mammograms performed during the period of May 1992 through June 1995 at the Reynolds Health Center in Forsyth County, North Carolina. The results suggested that the FoCaS project was effective in increasing mammography screening among women age 40 or older in the study population. Analysis of the trends by age indicated that the program had differential effects on women age 40-49 and 50 or older. The results demonstrate that analyses of the type presented here can either complement or serve as an alternative to more traditional intervention-control analyses.

Aged↗

The accuracy of portable cholesterol analyzers in public screening programs.

To determine the accuracy of portable cholesterol analyzers in public settings, four screening organizations were accompanied to cholesterol screenings where consenting participants completed the finger-stick procedure and provided a blood sample by venipuncture. The finger-stick values were compared later with the participants' blood cholesterol values obtained in a reference laboratory. The results indicated that only one of the organizations produced cholesterol measurements entirely within the acceptable range (+/- 14.2%), while the accuracy of the other three organizations ranged from 76.5% to 96.4%. Those finger-stick values that did not fall within the acceptable range tended to underestimate the laboratory cholesterol values. Additionally, classification of the persons screened based on the National Cholesterol Education Program risk categories indicated that the finger-stick values primarily tended to produce false-negative results. The variability of the results across organizations was caused partially by insufficient operator training. However, inadequate quality-control procedures for field settings and dilution of capillary blood by tissue fluid also may have contributed to the inaccurate finger-stick results.

Adolescent↗

A microcomputer data base system for maternal serum alpha fetoprotein screening programmed in BASIC.

A computer program was developed for the IBM PC computer to be used for maternal serum alpha fetoprotein screening (MSAFP). This program, written in BASIC, 1) maintains a data base for patients tested, 2) allows input and storage of MSAFP results, 3) calculates the gestational age dependent result in multiple of the median (MOM), 4) makes an individualized interpretation of the result based on maternal age, weight and diabetes, 5) makes an appropriate recommendation for subsequent action based on the result, and 6) prints a report containing the above information. In addition, the program will print a daily log of patients tested, provides a follow-up sheet to assist in tracking abnormal results to term, converts the data files into files which can be easily intergrated into more powerful data base programs, and generates a monthly statement for billing purposes. The program can be easily modified by someone with minimal training in the BASIC programming language.

Female↗

A cost-effectiveness evaluation of a jail-based chlamydia screening program for men and its impact on their partners in the community.

BACKGROUND: Few cost-effectiveness evaluations of screening men in jails for chlamydia have been published, and none have evaluated the cost-effectiveness of providing partner notification services to the partners of chlamydia-infected inmates. GOAL: The goal of this study was to evaluate the cost-effectiveness of the chlamydia screening and partner notification programs for men conducted by a Massachusetts jail compared with 3 hypothetical alternatives. STUDY DESIGN: Using jail cost and testing data, we used decision analyses to compare the cost and effectiveness of universal screening, age-based screening with 2 age cutoffs, and testing of symptomatic inmates at intake using treated cases of chlamydia and gonorrhea as the primary outcome. We also evaluated the cost-effectiveness of adding partner notification to these alternatives. RESULTS: Universal screening was the most effective and expensive alternative. Age-based screening would have identified slightly fewer cases at half the cost of universal screening. The net cost of partner notification was low. Assuming high sequelae costs in female partners made partner notification a cost-saving intervention. CONCLUSIONS: Age-based screening could lower costs without substantially sacrificing effectiveness. Notifying partners of infected inmates was a cost-effective adjunct to screening inmates.

Adult↗

Sensitivity of the screening program for cervical cancer in the Florence District.

Cervical cancer screening has been ongoing in the Florence district since 1966. All invasive cervical cancers occurring from 1975 to 1985 in the district have been considered and their screening histories have been investigated to estimate screening sensitivity. In the years 1975-1984, 236,045 women were screened initially. In this population all interval cancers have been recorded to estimate first screening sensitivity values according to the length of the interval since the first Pap test: 0.90 at 1 year, 0.78 at 3 years, and 0.68 at 5 years. Sensitivity values for subsequent screenings were lower than those for the first screening (0.68 at 1 year, 0.43 at 3 years), probably due to a lower number of prevalent cancers and to a progressive selection of cancers which are difficult to detect. The high sensitivity values confirm our choice of a screening frequency of 3 years.

Adolescent↗

Upper gastrointestinal cancer in a population-based screening program with fecal occult blood test for colorectal cancer.

BACKGROUND: Screening with Hemoccult-II (H-II) followed by colonoscopy, when fecal occult blood is demonstrated, reduces mortality from colorectal cancer. Whether upper gastrointestinal investigation is necessary when colonoscopy does not reveal any significant colorectal lesion is doubtful, and is the subject of this study. MATERIAL: In 1985, 30,967 persons from the general population register of Funen were randomized to biennial H-II screening. A positive test was followed by colonoscopy and no attempt was made to evaluate the upper gastrointestinal tract. Based on the information from the Funen Patient Database, the National Board of Health's Register of Death Causes, the Cancer Register and the National Register of Patients, all persons with malignancy of the gastrointestinal tract were identified. RESULTS: During 15 years and 8 screening rounds, 1,767 tests were positive; 1,536 complete colonic investigations detected colorectal cancer in 182 persons, adenoma > or = 10 mm in 440 persons, and in 879 investigations no colorectal lesion was found. Upper GI cancers were diagnosed in 209 persons within 2 years of the H-II test (199 after a negative H-II and no more than 10 persons within 2 years of a positive test). Among the 10, two were diagnosed as a consequence of symptoms at the time of screening. CONCLUSION: It is unjustified to perform upper gastrointestinal investigation in asymptomatic persons with a positive H-II in a Danish population screening for colorectal cancer.

Adenoma↗

The effects of health information in a worksite hypertension screening program.

Two studies assessed the potential impact of health education messages at worksite blood pressure screenings. The messages sought to: motivate hypertensives to enter or return to treatment, motivate normotensives to improve health habits and discourage inappropriate use of blood pressure screening by normotensives. A total of 473 participants in the two studies viewed slide/tape shows about blood pressure and/or health promotion. Individuals with elevated readings at screening viewed either a show containing standard blood pressure information or an experimental show which emphasized the asymptomatic nature of high blood pressure and which described some concrete strategies for coping with high blood pressure. In both studies, individuals with normal readings at screening viewed a standard show or an experimental show which emphasized coping strategies for preventing high blood pressure. In addition, in Study 2, some normotensive individuals viewed one of several experimental shows which focused on health promotion. Results indicate that the experimental programs were significantly more effective than the standard programs in achieving appropriate followup of screening results for both normotensives and hypertensives. Implications for worksite blood pressure screenings are discussed.

Adult↗

A molecular epidemiologic study of thalassemia using newborns' cord blood in a multiracial Asian population in Singapore: results and recommendations for a population screening program.

DNA technology provides a new avenue to perform neonatal screening tests for single-gene diseases in populations of high frequency. Thalassemia is one of the high-frequency single-gene disorders affecting Singapore and many countries in the malaria belt. The authors explored the feasibility of using PCR-based diagnostic screening on 1,116 unselected sequential cord blood samples for neonatal screening. The cord blood samples were screened for the most common reported alpha- and beta-thalassemia mutations in each ethnic group (Chinese, Malays, and Indians) in a multiracial population. The carrier frequency for alpha-thalassemia mutations was about 6.4% in the Chinese (alpha deletions = 3.9%, alpha deletions = 2.5%), 4.8% in Malays, and 5.2% in Indians. Only alpha deletions were observed in the Chinese. The carrier frequency for beta-thalassemia mutations was 2.7% in the Chinese, 6.3% in Malays, and 0.7% in Indians. Extrapolating to the population distribution of Singapore, the authors found a higher overall expected carrier frequency for alpha- and beta-thalassemia mutations of 9% compared with a previous population study of 6% by phenotype. The highly accurate results make this molecular epidemiologic screening an ideal method to screen for and prevent severe thalassemia in high-risk populations.

China↗

[Evaluation of screening programs].

This paper discusses the specific aspects involved in the assessment of screening programmes, compared to the assessment of other types of public health interventions. Screening programmes are aimed at healthy asymptomatic individuals, who, in case of a positive test, will be exposed to subsequent investigations or treatments. This paper stresses upon the several aspects to be taken into consideration when assessing the potential benefits and hazards of a screening programme, especially in order to limit hazards linked to false positive results: predictive value of the test according to its diagnostic value and the disease prevalence, existence of effective "treatments" in case of positive test. It underlines the need for adequate methods to evaluate positive and negative health effects, and psychological and social consequences.

Anxiety↗