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PubMed2005

[Two-tier screening process (TEOAE/AABR) reduces recall rates in newborn hearing screening].

BACKGROUND: 1-2/1,000 newborns are affected by connatal permanent hearing impairment. Clinical diagnosis is often delayed. This demands newborn hearing screening (NHS). Some questions regarding the optimal method remain unsolved. METHODS: The newborns in the obstetrical department (low-risk group) are tested by automated transitory evoked otoacustic emissions (TEOAE). TEOAE-fail is followed by automated auditory brainstem response (AABR) examination. All sick newborns admitted to the pediatric department (high-risk group) are primarily tested using AABR. Pathological AABR-testing leads to pedaudiological diagnostic work-up. RESULTS: In the low-risk group, 82 out of 1,584 newborns failed TEOAE-testing (recall 5.18%). Only 5 of these patients failed consecutive AABR examination (recall 0.32%). Permanent hearing loss was finally confirmed in 3 children (0.13%). 10 out of 755 newborns in the high-risk group failed AABR-testing (1.32%). In 6 of these children, hearing loss was confirmed (0.79%). CONCLUSION: A two-tier screening process as described is able to reduce recall rate, overall expenses and parental anxiety.

Audiometry, Evoked Response↗

PubMed2002

[Screening for neuropsychological deficits--a screening test also for dementias?].

To assess further the psychometric features of neuropsychological deficit screening (NDS), three groups of patients (41 demented, 23 not demented but cognitively impaired, and 50 controls) were examined and the results compared with two older tests, the Mattis dementia rating scale (MDRS) and the mini mental status test (MMST). As a result, the discriminating ability of NDS (modified for this study) was comparable to both other tests without surpassing them in either demented or cognitively impaired groups. An abbreviated version allowed for an improvement in economy without sacrificing discriminating properties. The advantage of NDS thus lies in the diversity of functions assessed, while its screening power is comparable to the two other tests used for comparison.

Aged↗

PubMedDate not supplied

A multivariate evaluation of the Michigan Alcoholism Screening Test and the Drug Abuse Screening Test in a female offender population.

The Michigan Alcoholism Screening Test (MAST) and the Drug Abuse Screening Test (DAST) are instruments designed to detect alcohol and drug abuse, respectively. Short versions (20 self-report items) of each instrument were administered to a sample of 615 women who were in jail or on probation. Principal-components analysis (PCA) was applied to the items of each instrument. Four factors similar to those found in previous research were identified, however the instruments were essentially found to be unidimensional. Subjecting pooled MAST and DAST items to PCA did not result in the identification of an underlying factor.

Adolescent↗

PubMed1994

Consistency of histopathological reporting of breast lesions detected by screening: findings of the U.K. National External Quality Assessment (EQA) Scheme. U. K. National Coordinating Group for Breast Screening Pathology.

The aim of the scheme was to determine consistency of histopathological reporting in the United Kingdom National Breast Screening Programme. This external quality assessment scheme involved 51 sets of 12 slides which were circulated to 186-251 pathologists at intervals of 6 months for 3 years. Participants recorded their diagnoses on standard reporting forms, which were submitted to the U.K. National Cancer Screening Evaluation Unit for analysis. A high level of consistency was achieved in diagnosing major categories of breast disease including invasive carcinoma and the important borderline lesions, radial scar and ductal carcinoma in situ (DCIS), the latter exceeding a national target set prior to the onset of the scheme. Atypical hyperplasia (AH) was reported with much less consistency although, where it was the majority opinion, over 86% of diagnoses were of benign disorders and only 14% were of DCIS. Inconsistency was encountered in subtyping and measuring DCIS, the former apparently due to current uncertainties about classification and the latter to poor circumscription, variation in size in different sections and merging with zones of AH. Reporting prognostic features of invasive carcinomas was variable. Measurement of size was achieved with adequate consistency except in a small number of very poorly circumscribed tumours. Grading and subtyping were inconsistent although the latter was not specifically tested and will be the subject of future study. Members of the National Coordinating Group achieved greater uniformity than the remainder of the participants in all diagnostic categories, but both groups experienced similar types of problem. Our findings suggest that participation in the scheme improves diagnostic consistency. In conclusion, consistency in diagnosing invasive carcinoma and radial scar is excellent, and good in DCIS, but improvements are desirable in diagnosing atypical hyperplasia, classifying DCIS and reporting certain prognostic features of invasive tumours. Such improvements will require further research, the development of improved diagnostic criteria and the dissemination of clearer guidelines.

Breast↗

PubMed2004

Factor structure of the Psychiatric Diagnostic Screening Questionnaire (PDSQ), a screening questionnaire for DSM-IV axis I disorders.

We examined the factor structure of the Psychiatric Diagnostic Screening Questionnaire (PDSQ), a 125-item self-report scale that screens for 15 of the most common Axis I psychiatric disorders for which patients seek treatment in outpatient settings. The sample consisted of 2440 psychiatric outpatients. Thirteen factors were extracted. Ten mapped directly onto the DSM-IV diagnosis for which they were designed and one represented suicidal ideation. The remaining two factors reflected closely related disorders: Panic Disorder/Agoraphobia, and Somatization/Hypochondriasis. A psychosis factor was not extracted. Overall, the factor structure of the PDSQ was consistent with the DSM-IV nosology upon which it was developed.

Adolescent↗

PubMed1998

Which cutoff level should be used in screening for glucose intolerance in pregnancy? Definition of Screening Methods for Gestational Diabetes Study Group of the Lombardy Section of the Italian Society of Diabetology.

OBJECTIVE: Our purpose was to examine the validity of 140 mg/dL cutoff value in oral glucose challenge test screening for gestational diabetes mellitus when including in the group to be identified women fulfilling more inclusive Carpenter and Coustan criteria for 100-g oral glucose tolerance testing interpretation and gravid women with borderline glucose intolerance. STUDY DESIGN: We reanalyzed data of a multicenter study performed on 704 pregnant women screened at the twenty-fourth to twenty-eighth week with a 50-g oral glucose challenge test followed by a universal 100-g oral glucose tolerance test. We used receiver-operator characteristic curve analysis, assembling positive and negative groups according to the different criteria adopted in oral glucose tolerance test interpretation (National Diabetes Data Group or Carpenter-Coustan) and in assignment of women with borderline glucose intolerance. Besides the statistical cutoff value, defined by the Youden index (Sensitivity + Specificity - 1), we also selected a "high-sensitivity" cutoff value, identified by the maximal sensitivity associated with >70% specificity. RESULTS: With use of National Diabetes Data Group criteria, the statistical and high-sensitivity cutoff values were set at 142 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance. With use of Carpenter-Coustan criteria, the statistical cutoff value was set at 141 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance; the high-sensitivity cutoff value was set at 140 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 136 mg/dL when it also included subjects with borderline glucose intolerance. CONCLUSIONS: We suggest maintaining the 140 mg/dL oral glucose challenge test threshold if the diagnostic target is to recognize only women with positive results of the oral glucose tolerance test. To prevent perinatal risks in pregnancies complicated by borderline glucose intolerance, with Carpenter-Coustan criteria a lower cutoff value (136 mg/dL) could be hypothesized to improve test sensitivity, allowing more extensive diagnosis of "borderline" subjects; however, the higher economic costs resulting from the increased false-positive rate and the limited improvement obtainable in sensitivity currently do not justify its generalized use.

Administration, Oral↗

PubMed2000

Magnetic resonance imaging screening in women at genetic risk of breast cancer: imaging and analysis protocol for the UK multicentre study. UK MRI Breast Screening Study Advisory Group.

The imaging and analysis protocol of the UK multicentre study of magnetic resonance imaging (MRI) as a method of screening for breast cancer in women at genetic risk is described. The study will compare the sensitivity and specificity of contrast-enhanced MRI with two-view x-ray mammography. Approximately 500 women below the age of 50 at high genetic risk of breast cancer will be recruited per year for three years, with annual MRI and x-ray mammography continuing for up to 5 years. A symptomatic cohort will be measured in the first year to ensure consistent reporting between centres. The MRI examination comprises a high-sensitivity three-dimensional contrast-enhanced assessment, followed by a high-specificity contrast-enhanced study in equivocal cases. Multiparametric analysis will encompass morphological assessment, the kinetics of contrast agent uptake and determination of quantitative pharmacokinetic parameters. Retrospective analysis will identify the most specific indicators of malignancy. Sensitivity and specificity, together with diagnostic performance, diagnostic impact and therapeutic impact will be assessed with reference to pathology, follow-up and changes in diagnostic certainty and therapeutic decisions. Mammography, lesion localisation, pathology and cytology will be performed in accordance with the UK NHS Breast Screening Programme quality assurance standards. Similar standards of quality assurance will be applied for MR measurements and evaluation.

Adult↗

PubMed1999

The substance abuse subtle screening inventory minimizes the need for toxicology screening of prenatal patients.

Multiple authors have reported attempts to effectively address the discovery of substance abuse in pregnancy using various mechanisms to encourage positive self-reports and urine toxicology to augment identification. In this study, we evaluated 1,251 patients with (a) self-report, (b) the Substance Abuse Subtle Screening Inventory (SASSI), and (c) urine toxicology screening to determine which modality or combination would yield the most cost-effective discovery. Combining the SASSI with the self-report was the most clinically effective and cost effective mode of discovery. This led to the development of a clinical protocol using the SASSI and self-report with limited use of urine toxicology for specific patient subgroups. Alcohol abuse, which is missed by toxicology and self-report, is detected by the SASSI.

Adult↗

PubMed1996

Costs and benefits of cervical screening. II. Is it worthwhile reducing the screening interval from 5 to 3 years?

A reduction in screening interval from 5 years to 3 years would greatly increase the cost of the programme, but would save few extra lives. The cost per life saved would be around 250,000 Pounds at 1995 prices, or around 8000 Pounds per life per year saved. There would in addition be human costs for the women screened. The opportunity cost of reducing the interval may be too great, since it is likely that the Health Service would achieve greater health benefits by investing the funds in other health care activities.

Adult↗

PubMed1999

Screening of diabetic patients for microalbuminuria in primary care--The PROSIT-Project. Proteinuria Screening and Intervention.

The PROSIT (Proteinuria Screening and Intervention) Project started in 1993 in order to obtain data on the prevalence of micro- and macroalbuminuria in diabetic patients treated in primary care, to establish an easy screening programme for microalbuminuria, in which also diabetic patients can participate in self-responsibility, and to implement a specific intervention programme for incipient nephropathy. In 58 representative doctor's offices 647 diabetic patients were included, who performed at home self-tests for microalbuminuria on three days within one week using the early morning urine and a newly developed qualitative immunologic test-strip for microalbuminuria. After storage they returned the same urine samples to their doctors' offices for semiquantitative retesting with the immunologic test-strip Micral-Test II. In case of positive results the proteinuria dipstick Combur-9-Test was applied in order to exclude other causes of positive microalbuminuria (e.g. urinary tract infection). Data of 569 patients (6% Type 1, 88% Type 2 and 6% secondary diabetes) could be analysed. Both qualitative self-testing for microalbuminuria at home and semiquantitative retesting in doctors' offices were found to be feasible. Based on semiquantitative retesting the prevalences of microalbuminuria (macroalbuminuria) were 19.6% (0%) in Type 1 diabetes, 17.2% (10.8%) in Type 2 diabetes and 11.7% (7.8%) in secondary diabetes. Type 2 diabetic patients showed a clear correlation between albuminuria and diabetes duration, HbA1c, serum creatinine, triglycerides as well as micro- and macrovascular complications. 227 patients with micro- or macroalbuminuria were included into the ongoing PROSIT intervention programme.

Adult↗

PubMed2005

Group B streptococcus disease in neonates: to screen or not to screen?

An audit was undertaken of the prevention of early-onset Group B streptococcus (EOGBS) disease in neonates. The prevention strategy in use involved offering Intra-partum Antibiotic Prophylaxis (IAP) to mothers with identified risk factors, which include maternal fever in labour > 38 degrees C, previous baby with GBS disease, prolonged rupture of membranes > 18 h, pre-term labour, GBS urinary tract infection and known GBS carriage. The most common risk factor identified was GBS carriage (41%) which was known ante-partum but logistical problems prevented these mothers from receiving adequate prophylaxis 4 h before delivery and so were classified as at risk of GBS disease. We found an incidence of GBS in our unit of 0.55 per 1,000 births over the study period. One neonate developed EOGBS disease and the mother had no identifiable risk factor ante-partum/intra-partum. Recent recommendations from the Royal College of Obstetricians and Gynaecologists (RCOG) could reduce the number of babies having sepsis screens performed as the time interval from beginning IAP to delivery has been shortened to 2 h and routine surface cultures or blood cultures are not recommended in well newborns. The evidence is lacking at this point to recommend universal screening for GBS in all pregnant women but patients are increasingly aware of this option and may request anogenital swabs to assess GBS carriage.

Adolescent↗

PubMed2005

Initial screening transferrin saturation values, serum ferritin concentrations, and HFE genotypes in whites and blacks in the Hemochromatosis and Iron Overload Screening Study.

We compared initial screening data of 44,082 white and 27,124 black Hemochromatosis and Iron Overload Screening (HEIRS) Study participants. Each underwent serum transferrin saturation (TfSat) and ferritin (SF) measurements without regard to fasting, and HFE C282Y and H63D genotyping. Elevated measurements were defined as: TfSat more than 50% (men), more than 45% (women); and SF more than 300 ng/ml (men), more than 200 ng/ml (women). Mean TfSat and percentages of participants with elevated TfSat were significantly greater in whites than in blacks. Mean SF and percentages of participants with elevated SF were significantly greater in blacks than in whites. TfSat and SF varied by gender and age in whites and blacks. Prevalences of genotypes that included either C282Y or H63D were significantly greater in whites than in blacks. The prevalence of elevated TfSat and SF plus genotypes C282Y/C282Y, C282Y/H63D, or H63D/H63D was 0.006 in whites and 0.0003 in blacks. Among whites with HFE C282Y homozygosity, 76.8% of men and 46.9% of women had elevated TfSat and SF values. Three black participants had HFE C282Y homozygosity; one had elevated TfSat and SF values. Possible explanations for differences in TfSat and SF in whites and blacks and pertinence to the detection of hemochromatosis, iron overload, and other disorders with similar phenotypes are discussed.

Adult↗

PubMed1986

False positive results in screening tests: experiences of parents of children screened for congenital hypothyroidism.

In The Netherlands more than 99% of newborn babies (around 170 000 per annum) undergo a blood test screening for congenital hypothyroidism (combined with a test for phenylketonuria). In 1982 around 1 000 children were referred to a paediatrician after a positive screening result which was later shown to be false. In this study 31 parents of children suspected (falsely) of having congenital hypothyroidism were interviewed about their experiences. The survey showed that the suspicion of thyroid deficiency was a great strain on parents; this adversely affected the parent-child relationship. The communication and information processes between medical staff and parents were often unsatisfactory. Even after the news that congenital hypothyroidism was not present some of the parents were still bothered by questions and insecurities.

Adult↗

PubMed2006

What predicts a Cypriot woman's decision to obtain or not obtain a screening mammogram? Implications for the promotion of screening mammography in Cyprus.

BACKGROUND: Breast cancer is an important public health issue in Cyprus. The purpose of the study was to assess: (a) the differences in motivational beliefs between women who decided to obtain a mammogram and women who did not; and (b) which beliefs predict the decision to get a mammogram. METHODS: Data were collected through face-to-face interviews from 293 women (mean age = 52) at the outpatient clinics of the General Hospital of Nicosia. Variables of interests include demographics, other preventive behaviours, and cognitions. T-tests for independent samples and multiple logistic regression were the primary analytic techniques. RESULTS: One hundred and eight women decided to obtain their first mammogram within the next 6 months. Deciders were more motivated to obtain a mammogram than non-deciders. Significant statistical differences were found regarding women's attitude, perceived social pressure, perceived control over environmental factors, and self-efficacy towards obtaining a mammogram. The self-efficacy beliefs as well as the physician recommendation were the most predictive factors in the decision to obtain a mammogram. CONCLUSIONS: In the planning of successful educational campaigns promoting breast cancer screening in Cyprus, practitioners could focus on the following: (a) enhancing self-efficacy, (b) promoting a clinical environment conducive to mammography screening, and (c) encouraging physician recommendation.

Attitude to Health↗

PubMed2003

Comparison of the detectability of high- and low-contrast details on a TFT screen and a CRT screen designed for radiologic diagnosis.

RATIONALE AND OBJECTIVES: To evaluate the detection rate of fine details of a new thin-film transistor (TFT) grayscale monitor designed for radiologic diagnosis, compared with a type of cathode ray tube (CRT) screen used routinely for diagnostic radiology. METHODS: Fifteen radiographs of a statistical phantom presenting low- and high-contrast details were obtained and read out with an Agfa ADC compact storage phosphor system. Each radiograph presented 60 high-density (high-contrast) and 60 low-density (low-contrast) test bodies. Approximately half the test bodies contained holes with different diameters. Observers were asked to detect the presence or absence of a hole in the test body on a 5-point confidence range. The total of 1800 test bodies was reviewed by 5 radiologists on the TFT monitor (20.8 inches; 1536 x 2048 pixels; maximum luminance, 650 cd/m2; contrast, 600:1) and the CRT monitor (21 inches; P45 Phosphor; 2048 x 2560 pixels operated at 1728 x 2304 pixels; maximum luminance, 600 cd/m2; contrast, 300:1). The data were analyzed by receiver-operator characteristic analysis. RESULTS: For high-contrast details, the mean area under the curve rated 0.9336 for the TFT monitor and 0.9312 for the CRT monitor. For low-contrast details, the mean area under the curve rated 0.9189 for the TFT monitor and 0.9224 for the CRT monitor. At P <or= 0.05, no statistically significant difference could be detected between the 2 observational modalities for both (holes in high- and low-contrast disks) types of artifacts. CONCLUSIONS: The TFT screen performs as well as CRT monitors for the detection of fine details in both high- and low-contrast environments. Further studies with images derived from clinical routine are necessary before safely using TFT monitors in clinical practice.

Phantoms, Imaging↗

PubMed1990

How complete can cervical screening be? The outcome of a call screening programme for women aged 20-60 years in Perth and Kinross.

In this paper a computer system for cervical screening call and recall based on the Community Health Index (CHI) population data-base is described. It allows the unscreened population to be identified and located on an individual general practice basis. The results of the call programme on 9517 women aged 20-60 years listed on the CHI and with no record of a cervical smear is described. There was a 24% smear uptake in the call programme which meant that after the call programme the total population cover had risen from 71% to 78%. In addition, if women with a valid reason are excluded, and the data-base corrected for women no longer in the area, the true cover rises to 88%. An analysis of the percentage cover in each GP practice is described with the implications for implementation of screening targets for primary care.

Adult↗

PubMed2006

Cytology is useful in breast screening: results and long-term follow-up of the Singapore Breast Screening Pilot Project.

OBJECTIVE: The Singapore Breast Screening Pilot Project (SBSPP) was embarked upon (1994-1997) to determine if mammography was useful in early breast cancer detection among Asian women. PATIENTS AND MEASUREMENTS: Of 28 231 women screened, fine needle aspiration cytology (FNAC) was performed in 232 individuals as part of the triple assessment. RESULTS: Absolute and complete sensitivities for the diagnosis of carcinoma were 46.7% and 82.2%, respectively, based on the results of FNAC. Specificity was 63.3%. The inadequate rate was 31%. Five women who were considered cancer-free on triple assessment and, in two cases open diagnostic biopsy during the SBSPP, subsequently developed breast cancer after a median follow-up of 6 years. CONCLUSION: Although our FNAC results compared relatively well with international standards, they reflect a small cohort, and may face additional difficulties in a larger programme.

Biopsy, Fine-Needle↗

PubMed1992

Screening for diabetic retinopathy in a widely spaced population using non-mydriatic fundus photography in a mobile unit. Tayside Mobile Eye Screening Unit.

A screening project was established to assess the prevalence and severity of retinopathy in diabetic patients in Tayside (area: 3000 square miles, population: 390,000). A questionnaire was used to examine patient acceptability. Of 2112 patients photographed during the first year, 32% had abnormal photographs; 20.2% had diabetic retinopathy; 7.4% cataracts; 4.6% non-diabetic eye disease. Among this patient population, 73% were registered at a hospital diabetic clinic. The overall prevalence of diabetic retinopathy was similar between the two groups (hospital 23% vs non-hospital 20%). The prevalence of severe diabetic retinopathy was also similar (hospital 8.5% vs non-hospital 10%). This had been previously unrecognized or incorrectly defined in 6.5% of those not attending a hospital diabetic clinic, compared to 3.7% attending the hospital clinic (p less than 0.01). A favourable response to the service was indicated by 40% of patients with 7% unfavourable and 41% uncommitted. Non-mydriatic fundal photography housed in a mobile unit is a practical and effective method of assessing diabetic retinopathy. It is particularly suitable for screening in a widely spread population.

Diabetic Retinopathy↗