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Healthy Lifestyle Check. A computerized health screening program.

The Healthy Lifestyle Check program is a computerized tool used to survey current health status and risk factors for potential ill health as well as to promote a healthy lifestyle. The program is an innovative teaching tool for student nurses, facilitating the integration of practice, education, and research. The program required self-report answers to questions relating to health history and current health-related behaviors with results of cholesterol, blood pressure, height, and weight assessment. Feedback to participants was provided by use of on-screen displays and printed reports containing public health messages, as well as counseling by the nurses. Results indicated that participants had not been screened for testicular, prostatic, and cervical cancers, or breast self-examination and medical checkups, and that they indulged in high levels of risk-taking behaviors such as high levels of alcohol consumption and low levels of exercise. The Healthy Lifestyle Check program is a valuable research tool that collects data and provides health information to participants, and has been used to teach nursing students the application of education and research to nursing practice.

Adolescent↗
PubMed2003

Potential health and economic impact of adding a human papillomavirus vaccine to screening programs.

CONTEXT: Recently published results suggest that effective vaccines against cervical cancer-associated human papillomavirus (HPV) may become available within the next decade. OBJECTIVE: To examine the potential health and economic effects of an HPV vaccine in a setting of existing screening. DESIGN, SETTING, AND POPULATION: A Markov model was used to estimate the lifetime (age 12-85 years) costs and life expectancy of a hypothetical cohort of women screened for cervical cancer in the United States. Three strategies were compared: (1) vaccination only; (2) conventional cytological screening only; and (3) vaccination followed by screening. Two of the strategies incorporated a vaccine targeted against a defined proportion of high-risk (oncogenic) HPV types. Screening intervals of 1, 2, 3, and 5 years and starting ages for screening of 18, 22, 24, 26, and 30 years were chosen for 2 of the strategies (conventional cytological screening only and vaccination followed by screening). MAIN OUTCOME MEASURES: Incremental cost per life-year gained. RESULTS: Vaccination only or adding vaccination to screening conducted every 3 and 5 years was not cost-effective. However, at more frequent screening intervals, strategies combining vaccination and screening were preferred. Vaccination plus biennial screening delayed until age 24 years had the most attractive cost-effectiveness ratio (44 889 dollars) compared with screening only beginning at age 18 years and conducted every 3 years. However, the strategy of vaccination with annual screening beginning at age 18 years had the largest overall reduction in cancer incidence and mortality at a cost of 236 250 dollars per life-year gained compared with vaccination and annual screening beginning at age 22 years. The cost-effectiveness of vaccination plus delayed screening was highly sensitive to age of vaccination, duration of vaccine efficacy, and cost of vaccination. CONCLUSIONS: Vaccination for HPV in combination with screening can be a cost-effective health intervention, but it depends on maintaining effectiveness during the ages of peak oncogenic HPV incidence. Identifying the optimal age for vaccination should be a top research priority.

Adolescent↗
PubMed2005

Determinants of false positive recall in an Australian mammographic screening program.

We conducted a case-control study (n=30128) to assess the importance of clinical (e.g., family history, age, hormone replacement therapy (HRT) use and duration) and service-related characteristics (e.g., time since introduction of Kodak MINR2000 film, year of screen) for false positive (FP) recall at BreastScreen Victoria, Australia. There was an age-adjusted upward trend in FP recall rates with year of screen at first (odds ratio (OR) 1.11, 95% confidence interval (95% CI) 1.08-1.13) and subsequent rounds (OR 1.04, 95% CI 1.01-1.06). In the multivariate analysis, the upward trend only remained for first round and age and family history also remained statistically significant at first round. At subsequent rounds the time since introduction of MINR2000, age, strong family history of breast cancer, use of HRT, recall at previous screen and previous screen at more than 27 months were all important predictors of FP recall. The rise in FP rates with year of screen at first round screening is of concern and may require further training of radiologists to improve confidence when viewing films when there a no films for comparison.

Age Factors↗
PubMed2006

One fracture is enough! Experience with a prospective and consecutive osteoporosis screening program with 239 fracture patients.

BACKGROUND: Fracture and low bone mineral density both have strong predictive value for future fractures. The risk of future fractures can be reduced by medi-cal treatment if patients with osteoporosis are identified, for example by screening fracture patients for low bone mineral density. We suggest that these screening routines be organized at orthopedics departments and we report our experience with such a screening system. PATIENTS AND METHODS: We screened all patients between 50-75 years of age with a wrist, vertebral, proximal humerus, or hip fracture visiting our orthopedics department by measuring bone mineral density (BMD) using DEXA scans. After diagnosis, the patients were referred to their primary care physician for treatment. RESULTS: Between November 1, 2002, and October 31, 2003, 239 patients were investigated and only 13% had normal BMD values. 45% of the patients were diagnosed with osteopenia and 42% with osteoporosis. INTERPRETATION: Screening of fracture patients who visit an orthopedics department appears to be an effective way of identifying individuals with low bone mineral density. The screening routines can be organized as an osteoporosis team consisting of a doctor, a nurse and a secretary at each department. Today, these patients are largely undetected and untreated--at least in our region. In our series, only 13 patients had been DEXA-scanned and were treated by antiresorptive drugs at the time of fracture.

Aged↗
PubMed2002

[Ultrasound screening program for neonates and infants in Hungary].

INTRODUCTION: A children's hospital in Budapest (The Madarász Street Children's Hospital) and two children's department of two county hospitals (Toldy Ferenc Hospital, Cegléd and Zala County Hospital, Zalaegerszeg) started a common ultrasound screening programme for children in 1990. OBJECTIVES: This three screening centres agreed which illnesses, pathological states and developmental disorders will be screened. In neonatological departments this screening was carried out usually in the first week of life. In the children's hospital, the majority of measurements was performed between 2 weeks and 3 months of the infants life time. The ratio between this two age group was 43.6 and 56.4%. The authors compared and analysed the results of screenings in neonates and those in infants. Another important objective of the programme was to compare the results of prae- and postnatal screening. METHODS: Examinations were carried out by up-to-date instruments corresponding to the given period. Data for neonates were compared with those for infants and with clinical findings, analysed, stored in computers and yearly evaluated. Screenings were performed by neonatologists, pediatric radiologists or pediatricians with appropriate practice. RESULTS: The three centres examined altogether 51,688 children during their 10-years activity, and found 4758 pathological cases. The majority of pathological cases (3447) was renal and urinary tract disorders, in 1224 cases intracranial occurrences were diagnosed, whereas the remaining cases were mainly tumours or cysts in the liver, spleen or ovarium. CONCLUSION: Numerous pathological changes can be detected by ultrasound screening postnatally, which have great therapeutic significance and are very important for differential diagnostics. By comparing the results for neonates and infants, it can be established that screening in infancy is usually important if no screening was carried out in the neonate age, but control examinations should be performed as well, when it is justified by some physiological or pathological reason. In case of slight deviations, when the first examination cannot provide unambiguous diagnosis, later, repeated examinations can support an accurate diagnosis. Documentation of the results from neonate age and infancy facilitates the correct judgment in later pathological states.

Brain Diseases↗
PubMed2006

Prenatal diagnosis in human immunodeficiency virus-infected women: a new screening program for chromosomal anomalies.

OBJECTIVE: This study was undertaken to describe a new prenatal diagnosis program among human immunodeficiency virus (HIV)-infected women, and the perinatal outcome of this program's application over a more than 2-year period. STUDY DESIGN: From June 2000 to December 2003, all HIV-infected women who were booked into the antenatal clinic before 20 weeks were offered a screening for chromosomal anomalies, with midtrimester amniocentesis in the tests that were positive. RESULTS: A total of 116 pregnancies (including 3 sets of twins) were seen: 96 women were offered and accepted screening for chromosomal anomalies. Thirteen pregnancies had a positive screening test and amniocentesis was performed in 10 at median 16.5 gestational weeks: a trisomy 21 and a monosomy X were diagnosed. No vertical transmissions were documented by age 6 months in the 6 liveborn infants who underwent amniocentesis. CONCLUSION: A program of prenatal diagnosis for chromosomal anomalies appears to be effective when applied to HIV-infected women, although safety remains to be proven.

Adult↗