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A critical review of the literature on screening for and treating Chlamydia trachomatis during pregnancy suggests that all pregnant women at high risk of chlamydial infection, or from a population where infection is prevalent, should be screened and treated. This will help reduce chlamydial infections in infants and may decrease adverse outcomes of pregnancy.
This paper reviews and summarises the requirements and criteria for the screening of childhood disabilities. It reviews recent advances in research carried out in Jamaica and outlines available techniques for the screening of cognitive, motor, speech, hearing and visual disabilities and fits. The availability of validated, simple, low-cost techniques that can be used by community workers facilitates the conduct of surveys for the planning of programmes and the identification of cases for rehabilitation.
BACKGROUND: Because latex is a common allergen, the rate of latex sensitization may be high in the general population. A major issue would then be to determine whether a systematic preoperative screening in the general population should be recommended. OBJECTIVE: The purpose of the study was to evaluate the prevalence of latex sensitization in a sample of the general population and to assess the role of possible risk factors. METHODS: The subjects were 258 people, aged from 20 to 40 yr, visiting a health care centre for a check-up. The protocol included: a questionnaire (occupation, symptoms of atopy, use of latex goods and possible reactions, history of previous surgery), a skin-prick test, and a CAP RAST to latex. Atopy was evaluated by a skin-prick test to common allergens and a Phadiatop test. RESULTS: Some 6.6% of the study group had either a positive skin test or a positive RAST to latex. These subjects had a four-fold higher prevalence of symptoms when wearing gloves. The rate of latex sensitization was higher by fivefold in subjects with a history of reactions to latex goods and by fourfold in atopic subjects. CONCLUSIONS: Because the rate of latex sensitization is much higher than the anticipated rate of perioperative reactions due to latex allergy, a systematic preoperative screening for latex allergy should not be recommended for adults.
To compare Fourier-transform infrared (FTIR) spectroscopy in screening cervical cytology and standard Papanicolaou (Pap) screening with colposcopic directed biopsy as a "gold standard," we prospectively gathered FTIR samples and Pap smears of all patients attending our program's colposcopy clinics, from February to October 1995. We recorded demographic data for each patient including colposcopy, cytology, treatment follow-up, and histology. Using the colposcopically directed biopsy as the gold standard, exfoliated cervical cells from 301 patients were collected to compare cytology and FTIR spectroscopy. Based on previously established criteria, we provided distinctive definitions of both negative/positive FTIR, cytology, and histology. Results of 301 cases showed 196 positive and 105 negative cytologies. The sensitivity, specificity, false-negative rate, and false-positive rate for the Pap test were 86.6, 90.5, 13.4, and 9.5%, respectively. However, FTIR results versus histology showed 215 positive and 86 negative with a sensitivity of 98.6% and specificity of 98.8%. False-negative and false-positive rates were 1.4 and 1.2%, respectively. In the 12 cervical cancers there were no false-negative FTIR results but 3 false-negative Pap smears. The positive and negative predictive values for FTIR were 99.5 and 96.5% while the Pap values were 95.9 and 72.3%. Compared to standard Pap smears, FTIR has a better false-negative rate and negative predictive value in this preliminary study. Further work, to establish the range of each of the spectral criteria for different grades of dysplasia and that among various infectious effects, needs to be conducted before applying this research tool to a population-based study.
BACKGROUND: In older women covered by Medicare, relationships among physician recommendation, mammography in the past 2 years, and clinical breast examination (CBE) in the past year were systematically explored with a variety of predisposing, enabling, and situational factors identified in the Systems Model of Clinical Preventive Care. METHODS: A population-based survey of women age 65 years and older was conducted in five National Cancer Institute's Breast Cancer Screening Consortium geographic areas. Analyses focused on women with a regular physician and site of care (n = 5318). RESULTS: Physician recommendation and mammography use declined with women's increasing age and increased with income, education, and insurance. CBE and mammography increased with number of physicians and breast cancer family history; mammography use decreased with worsening health status. Recommendations were higher among physicians who were younger, female, and internists. Family practitioners were older and male; women who saw family practitioners reported characteristics associated with decreased screening-lower income, education, and insurance-and seeing only one physician. CONCLUSIONS: Public policy and health system changes that create a uniform system of finance and service performance expectations may reduce the persistent discrepancy in physician recommendation and mammography use due to sociodemographics and physician specialty.
The Mini Nutritional Assessment (MNA), the Subjective Global Assessment (SGA) and the Nutritional Risk Screening (NRS) are screening and assessment tools aimed at detecting malnourished individuals and those at risk for malnutrition. In our study we tested their applicability in geriatric hospital patients and compared the results of the three tools. We examined prospectively all patients of two acute geriatric wards by the MNA, the SGA and the NRS. 121 patients were included in the study. The MNA could be completed in 66.1% of all patients, the SGA in 99.2% and the NRS in 98.3%. There was a significant association of all three tools with the BMI (p<0.01). With regard to serum albumin and to length of hospital stay (p<0.05), only a significant association could be shown for the MNA (p<0.05). Although the categories of the results were not completely identical for the three tools there were more patients at risk or malnourished according to the MNA (70%) than according to the SGA (45%) or the NRS (40.3%). The direct comparison of the NRS with the MNA and the SGA demonstrated significant differences, especially for the latter (p<0.001). In a relevant percentage of those tested, MNA, SGA, and NRS identify different individuals as malnourished or at risk for malnutrition. Because of its association with relevant prognostic parameters, the MNA is still the first choice for geriatric hospital patients. For those patients to whom the MNA cannot be applied, the NRS is recommended.
OBJECTIVE: To evaluate whether the strategy of maternal serum screening for Down syndrome, using alpha-fetoprotein (AFP) and free beta-hCG in combination with maternal age, a technique developed in western countries, is applicable to an Asian population. METHODS: Alpha-fetoprotein and beta-hCG were measured in serum samples from 23 Down syndrome pregnancies and 1748 unaffected singleton Taiwanese (ethnically Chinese) pregnancies at 14-22 weeks' gestation. Gestational age-specific medians and a maternal weight correction formula were established for our own population. Likelihood ratio for Down syndrome pregnancies in relation to multiples of the median (MoM) levels of these analytes were derived from the overlapping gaussian frequency distribution curves for Down syndrome and unaffected pregnancies. RESULTS: The serum AFP and free beta-hCG median MoM values of Down syndrome pregnancies were significantly abnormal in Asian subjects (0.77 and 2.91, respectively), and similar to those of affected pregnancies in white women. The median value of free beta-hCG:AFP MoM ratio (2.97) in Down syndrome pregnancies was significantly higher than that of unaffected pregnancies (1.09). The mean maternal weight during the second trimester in pregnant Asian women (55.2 kg) was markedly lighter than that of white women. At a 5.8% false-positive rate, free beta-hCG identified 47.8% of Down syndrome pregnancies (likelihood ratio 8.2), AFP detected only 13% of the cases (likelihood ratio 2.2), and free beta-hCG:AFP MoM ratio detected 43.5% of the cases (likelihood ratio 7.4). By using a multivariate risk algorithm involving the combination of AFP, free beta-hCG, and maternal age, 56.5% of Down syndrome cases could be detected with a 5.3% false-positive rate (likelihood ratio 10.7). CONCLUSION: Maternal serum screening strategy using AFP and free beta-hCG in combination with maternal age is feasible in the detection of fetal Down syndrome among Asian women.
Maternal screening--either selective or universal--is an accepted component of a number of strategies for prevention of congenital and perinatal infections. Using the results of maternal screening at prenatal visits and the presence of perinatal risk factors during labour, neonatal group B streptococcal (GBS) early-onset disease can be prevented by selective intrapartum chemoprophylaxis. Possible variations on this strategy may employ semiquantitative tests for GBS colonization at prenatal visits or, possibly, rapid bacterial diagnosis intrapartum. Based on the incidence and economic impact of GBS disease, selective intrapartum chemoprophylaxis appears cost-effective in United States populations, but may not be so in countries with lower incidence rates.
The use of a semi-automated solid-phase extraction system (ASPEC) for the screening of drugs in plasma and urine on a single mixed-mode column (Clean Screen DAU) is described. The processes of column preconditioning, sample application, column wash, pH adjustment and elution of the drugs were accomplished by the ASPEC. After off-line evaporation, the residues were injected into a wide-bore capillary gas chromatograph. The recoveries of the tested drugs were in the range of 73-96%, with relative standard deviations less than 5% at a concentration level of 2 micrograms/ml.
The use of optical biosensors for compound screening was first demonstrated in the mid-1990s, but there has been limited uptake in the market owing to issues of limited throughput and a lack of applications for key receptor classes. Recently, several start-up and established tools companies have exploited non-optical detection modalities that seek to address the shortcomings of more established optical approaches. Platforms based on acoustic resonance, electrical impedance, microcantilevers, nanowires and differential calorimetry are beginning to appear with commercially available products targeted at post-high-throughput screening hit confirmation and mode-of-action studies. This article highlights key advances in commercial label-free analysis platforms, which complement more traditional optical system and which also allow novel assay formats for the analysis of previously intractable targets.
We have evaluated a flow cytometric screening method for identification of HPA la negative individuals, using a commercially available monoclonal anti-CD61 antibody specific for the HPA 1a allotype, and compared the method with an ELISA based method for HPA la phenotyping and two methods for PCR genotyping. HPA 1a phenotyping by fluorochrome conjugated monoclonal anti-HPA la and analysis by flow cytometry is a rapid, reliable and inexpensive technique, suitable for screening purposes.
OBJECTIVE: This study was undertaken to compare long-term recall of the meaning of test results after a negative result of 2-step or couple antenatal screening. STUDY DESIGN: In a randomized controlled trial a subject-completed questionnaire was sent to 275 women who had undergone couple testing 3 years earlier and 83 women who had undergone 2-step testing 3 years earlier (n = 263/358 for a response rate of 73%). The main outcome measure was understanding of test results. RESULTS: Three years after testing women who had undergone couple testing were 4.5 times (95% confidence interval 2.4-8.4 times) more likely than those who had undergone 2-step testing to accurately recall that the test result meant that they were unlikely to be carriers for cystic fibrosis (80%, 95% confidence interval 74%-86%, versus 49%, 95% confidence interval 36%-61%). Anxiety level, plans to have more children, and age were unrelated to recall. CONCLUSION: The results of this study, together with those from other evaluations, suggest that not only does couple testing avoid the high levels of anxiety associated with 2-step testing but it also results in greater awareness of the residual risk inherent in a negative screening test result.
The Brazilian translation of the Drug Use Screening Inventory (DUSI) was applied to 213 Brazilian teenagers who were classified according to their alcohol and/or drug dependence level (DSM-III-R) as: 71 nondrug users (Group 1), 71 with light/moderate dependence (Group 2) and 71 with severe dependence (Group 3). The DUSI was applied and the absolute density in each of 10 areas was calculated. The three groups presented statistically significant differences (p < .001) in the "substance use" area, with the following values (medians +/- interquartile range): Group 1: 0+/-7; Group 2: 20+/-33 and Group 3: 80+/-33. The groups also presented significant differences in behavior pattern, social competency, family system, work adjustment, peer relationships and leisure/recreation. Other differences detected among the groups indicated an important relationship between drug use and school delay. A good Spearman rank correlation (0.86, p < .0001) was observed between Composite International Diagnostic Interview (CIDI) diagnosis and DUSI, indicating that this instrument can be useful in the screening of substance use among Brazilian teenagers.
Peptide deformylase (PDF) has been identified as a promising antibacterial and herbicide target. A structurally novel class of inhibitors containing a 2-thioxo-thiazolidin-4-one heterocycle substituted by an arylidene group at the 5-position and a hexanoic acid side chain at the 3-position was discovered independently via high-throughput screening and virtual ligand screening. Data mining and analogue synthesis established a structure--activity relationship for the side chain region that is consistent with the docked structure.
An industrial film was compared with four commercially available screen-film combinations with respect to dose, definition and signal to noise ratio. The demanded minimum resolving power requires definition of an object of 100 micrometer size. However, the defined minimum object sizes are approx. 180 micrometer with close-distance projection and approx. 240 micrometer with greater distance. In this study, therefore, the signal to noise ratios were measured at defined object sizes of 5 lp/mm and 2 lp/mm. The screen-film combinations have approximately the same values as the industrial film for a size of 250 micrometer (2 lp/mm) or are definitely higher. The signal to noise ratio of the Alpha M combination is superior by 50%, although the sensitivity of the combination is 4 to 6 times greater. The signal to noise ratio of the MinR system in 25% higher than that of the industrial film, the required dose being lower by a factor of 8. This results in skin doses of 0.7 rads instead of 6 rads with tissue layers of 4.8 cm thickness.
Two postal questionnaires were sent to Belgian gynaecologists in order to have information on their current policy of antenatal HIV screening. Of the 815 contacted, 446 (54.7%) completed the first questionnaire. 91.0% offers HIV testing in pregnancy; 49.1% to all pregnant women and 41.9% only to those with behavioural risks. Only 6.5% never offers HIV testing during pregnancy. The majority of these gynaecologists (79.8%) never had to deal with the problem of HIV-seropositivity in a pregnant woman. A second questionnaire with more detailed questions about HIV testing was sent to the identified respondents of the first survey. 237 of 340 (69.7%) responded. Of those, 48.9% perform HIV testing without informing the patient, whereas 43.4% always inform their patients before HIV testing. The majority performs the test at the first antenatal consultation (73.5%; 14.9% offers the test twice. These findings let us conclude that there is a need for recommendations concerning the policy of antenatal screening and information of patients.
End-of-life care has benefited from the recognition that multiple dimensions exist to patient care needs. However, well-designed clinical tools to evaluate these multiple dimensions are few. Such tools are available for evaluations of pain and other specific areas, but clinicians need a sensitive and reliable set of bedside questions to assess and screen individual patients' overall care. We set out to develop a practical tool that we called the Needs at the End-of-Life Screening Tool (NEST). As part of a larger study, we conducted a series of focus groups and interviews with patients, family caregivers, and professionals followed by a survey of a nationally representative sample of 988 patients with a terminal diagnosis. From the former we derived a frame-work with a full range of identified dimensions that are important in end-of-life care. Dimensions were empirically tested using factor analysis of the patients' survey responses. We developed criteria for selecting questions within the dimensions. Modifications were made to the questions to suit the clinical context. Finally, to assist in their ready use at the bedside, we assigned questions to four core themes of palliative care. Thirteen questions resulted and were assigned themes corresponding, for mnemonic purposes, to each letter of NEST: for Needs (social), for Existential matters, for Symptoms and for Therapeutic matters. NEST is the first data-driven, comprehensive tool designed from an empirically validated framework and tested survey questions for clinical use in end-of-life care. Evaluation of its performance in another population is needed to complete NEST's fuller evaluation.
OBJECTIVE: To provide additional normative and validity data on the TBSI, especially to examine differences in clinical and nonclinical samples. METHODS: The sample included 312 nonclinical and 50 clinical mothers of toddlers. Clinical participants consisted of mothers of toddlers who had been referred for outpatient psychological services. Mothers completed the TBSI, a 40-item behavioral screening measure for children 12 to 41 months old. The measure assesses frequency in which the behaviors occur and whether the mothers perceived the behaviors as problematic. In addition to the TBSI, mothers also completed several measures of maternal distress and social support. RESULTS: The findings support the reliability and validity of the TBSL. In addition, the study found that TBSI scores effectively discriminated clinical from nonclinical participants. CONCLUSIONS: The TBSI is a promising behavioral screening instrument that can be easily incorporated into a medical practice.