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PubMed1988

Comprehensive vision screening program: Illinois' approach.

This article discusses a statewide vision screening program that utilizes trained and certified vision screening technicians under the auspices of the Department of Public Health. Public Act 81-174, the Child Vision and Hearing Test Act, mandates periodic vision screening of children using accepted and approved instruments and standards. The program receives consultation from the Children's Vision Services Advisory Committee, consisting of optometrists, ophthalmologists and others in health and education programs. Topics addressed include: training and certification of technicians; screening, referral and follow-up; program summary of statewide screening statistics of 1.2 million children for fiscal year 1985, etc.

Adolescent↗
PubMed1994

Benefit of independent double reading in a population-based mammography screening program.

PURPOSE: To evaluate independent double reading in mammography screening and, specifically, the effect on breast cancer detection. MATERIALS AND METHODS: Mammographic studies of 11,343 women, aged 41-75 years, who participated in a population-based screening program were independently screened by two experienced radiologists. A retrospective analysis also was performed from notations made for patient recalls. RESULTS: Including follow-up of recalled women, 131 surgical biopsies were performed, which resulted in 76 histologically proved breast cancers. Fifty-six cancerous lesions were detected by both screeners. One screener detected 14 cancerous lesions alone, and the other detected six alone. Of the cancerous lesions detected by only one screener, 85% were stage 0 or 1, compared with 59% of those detected by both screeners. Double reading detected 15% (95% confidence interval, +/- 7%) more cancer cases with an almost unchanged positive predictive value of 0.6. CONCLUSION: Independent double reading does significantly increase sensitivity of mammography screening.

Adult↗
PubMed1978

Mammographic parenchymal patterns as risk indicators for incident cancer in a screening program: an extended analysis.

In a screening program of self-referred women, different mammographic parenchymal patterns were related to significantly different rates for developing breast cancer. The risk of cancer detection subsequent to a negative mammographic examination was 7.6 times greater for women in the highest parenchymal risk class compared with the lowest, an increase in risk comparable to that of a personal history of breast cancer and greater than that reported for any other combination of historical risk factors. These differences are qualitatively similar to, but of a lesser magnitude than, those in previous reports which were based on symptomatic women with previous negative mammograms. Data suggest this difference in risk is inherent between parenchymal patterns, rather than indicating difficulty in identifying small cancers in dense breasts. Findings of differential parenchymal risk, coupled with other risk factors, may lead to concentrating mammographic screening on a smaller segment of the population, thus improving the benefit-to-cost ratio.

Adult↗
PubMedDate not supplied

Survey of departments of health about PKU screening programs.

Mailed questionnaires were used to examine the success of PKU (phenylketonuria) screening programs that were operated by departments of health and to examine differences between these programs. Of 55 departments, 44 were returned and 42 departments reported they had a PKU detection program. Thirty-eight respondents considered the PKU detection program to be effective, and 31 respondents indicated that the entire program cost $60,000 or less per year. The answers and comments on the questionnaires showed a generally positive view of the effectiveness about the value of the treatment program in general were also positive. However, a few departments indicated that more clinical evidence and experience were needed to fully evaluate the overall merits of PKU detection and screening programs.

Costs and Cost Analysis↗
PubMed1995

Alcohol abuse screening instruments: normative test data collected from a first DWI offender screening program.

OBJECTIVE: A variety of instruments are used by Driving While Impaired (DWI) screening programs nationwide to assess offenders for alcohol- or drug-related problems. This study presents normative data from five standardized instruments administered by a DWI screening program: the MAC scale of the MMPI, the Alcohol Use Inventory (AUI), the Michigan Alcoholism Screening Test (MAST), the Drug Abuse Screening Test (DAST) and the Skinner's Trauma Scale (STS). METHOD: The population under study were 2,317 first DWI offenders who completed screening evaluations in 1989-91. The sample included 24% women; the racial distribution was 46% Hispanic, 43% non-Hispanic white, 8% Native American and 3% other races. A statistical model was developed to determine associations among scores on the various instruments and age, gender, ethnicity, education, blood alcohol concentration (BAC) and validity measures on the MMPI-2 (L and K scale scores) RESULTS: There were significant differences in test scores among the ethnic- and gender-specific client groups. Test scores were significantly higher among men than women for the MAST, the D1 and D2 scales of the AUI, the MAC, and the STS. Correlations among the instruments were generally low, and the percentage of persons who scored above instrument cut-points varied significantly. The MAST identified the highest percentage of persons as alcoholic. MMPI profile validity was the most significant independent variable associated with test scores. Persons with scores in the valid range had higher mean scores on each of the instruments. CONCLUSIONS: The choice of instruments used in the DWI assessment can greatly influence the percentage of offenders assessed as having alcohol-related problems.

Accidents, Traffic↗
PubMed1988

Pharmacy-based screening program for tardive dyskinesia.

An ongoing screening program using pharmacists to detect tardive dyskinesia (TD) was developed, and a pharmacy-based prevalence survey of TD in chronic hospitalized psychiatric patients was undertaken to determine the extent of abnormal involuntary movements. The results show that older patients and women in particular are at higher risk for developing abnormal movements. Higher doses of neuroleptics were used in non-TD patients, indicating a possible masking effect caused by these drugs. By using a standardized rating method such as the Abnormal Involuntary Movement Scale, pharmacists can and should be utilized in the surveillance of TD.

Adolescent↗
PubMedDate not supplied

[Automatic perimetry in screening programs].

This work has studied the use of automatic perimetry in glaucoma screening programs. Subjects with suspicious glaucoma were selected on the basis of tonometry and direct ophthalmoscopy. Visual fields were analyzed using the G1 program of the Octopus 500 E automatic perimeter. A prevalence of 3.49% of glaucoma was observed in persons above 40 years old. This represents a higher incidence in comparison to other studies. The inclusion only of those subjects with suspicious glaucoma for automatic perimetry has resulted in a more precise and earlier diagnosis of glaucoma without unduly prolonging the duration of the study. Undoubtedly, automatic perimetry can improve both the reliability of the diagnosis and incidence of glaucoma in screening programs. Moreover, this does not necessarily mean more prolonged or costly studies.

Adult↗
PubMedDate not supplied

A first survey of organized cervical cancer screening programs in Italy. GISCi working group on organization and evaluation. Gruppo Italiano Screening Citologico.

In Italy, where no national screening program for cervical cancer exists, organized programs have developed on a local basis. We performed the first survey of existing organized programs by mailing a standard questionnaire to a large network of possibly involved services. For the present survey, a program was defined as organized if personal invitations were sent. We identified 29 already active organized programs and 4 others in a starting phase. The target population of active programs included 2,074,820 women in the age range 25-64 years, corresponding to 13.5% of the Italian female population of the same age. The situation is rapidly evolving since many regional programs are being implemented. Most programs followed Italian and European recommendations as regards the age limits, interval between screening rounds, presence of a fail-safe system for women referred for colposcopy, presence of protocols for diagnostic workup and treatment, and presence of referral centers for such phases. However, many programs did not meet national guidelines as regards the size of laboratories interpreting smears, which were frequently small. Second-level referral centers also frequently had a very small activity. The average (weighted for size of the invited population) compliance to invitation and coverage (proportion of women with at least one test in the last 3 years) was 32.6% and 66.0%, respectively, therefore needing to be improved. Compliance to colposcopy (weighted for number of referred women) was 81.4%. We found a very high variability in the proportion of women referred for colposcopy that could only be partly explained by different referral protocols and could depend on different criteria of smear interpretation: the average (weighted for number of tested women) was 2.01%. A need for improvement in the process of evaluation and for homogenization of criteria of cytology interpretation was identified: work in this regard is on-going.

Adult↗
PubMed1985

What participants understand about a maternal serum alpha-fetoprotein screening program.

We investigated the knowledge of pregnant women participating in a maternal serum alphafetoprotein (MSAFP) screening program for the detection of neural tube defects (NTDs) in the fetus. Women participating in the screening program scored higher on two knowledge tests than a comparison group of pregnant women who were not offered screening. However, there were substantial gaps in the knowledge base of women in the program, as measured by one of the tests. Women did not misinterpret a negative test result to mean that the test had identified a potential problem with the fetus; instead, there is a suggestion that they tended to interpret a negative result too positively, as an assurance that the baby was healthy in all respects.

Adult↗
PubMedDate not supplied

Developing a breast cancer screening program for Chinese-American women.

The Chinese, like other minority groups, often underuse cancer screening services because of language, cultural, and economic barriers. Nonattendance reduces the probability that cancer will be detected in its earliest and often most curable form. To improve use of cancer screening services among Chinese-Americans, a community-based coalition organized a one-day demonstration cancer awareness and screening program--the Breast Cancer Screening Day for Chinese Women. More than 100 women, many of whom did not speak English, attended the program. Six abnormal mammograms required follow-up and one breast cancer was detected. The planning process used to develop this successful project is described as are suggestions to improve future screening programs for ethnic minorities.

Adolescent↗
PubMed1998

Cost-benefit analysis of first-void urine Chlamydia trachomatis screening program.

OBJECTIVE: To perform a cost-benefit analysis of a Chlamydia trachomatis screening program based on first-void urine testing of asymptomatic women using a polymerase chain reaction (PCR) test. METHODS: A decision tree was developed. Selected variables based on assumptions were subjected to sensitivity analyses to make the model accurate and defensible. RESULTS: Screening for chlamydial infections using the PCR test was shown to be cost-effective even in low-prevalence populations. Compared with a symptom-driven no-screening situation, a universal C trachomatis screening program using the PCR test would save money, in terms of direct cost, when the baseline prevalence of C trachomatis infection exceeds 3.9%. CONCLUSION: Cost analyses are still rare among trials that compare pharmacologic or procedural health care interventions. Socioeconomic studies linking secondary prevention of C trachomatis infection and infertility and adverse pregnancy outcome are needed to convince public health authorities of the need for and the benefit of such programs.

Adolescent↗
PubMed1997

Results of a screening program for Chlamydia trachomatis infection in men attending a sexually transmitted diseases clinic.

BACKGROUND: Screening programs for Chlamydia trachomatis infection in men are uncommon. GOAL: To report the results of a screening program using the Syva MicroTrak direct fluorescent antibody (DFA) test (Palo Alto, CA) for diagnosis of C. trachomatis infection in men attending a sexually transmitted diseases (STD) clinic. STUDY DESIGN: DFA testing was performed on an additional urethral specimen obtained during male new patient or new complaint visits between July 1, 1994 and June 30, 1996. Positive and negative test results were compared according to patient demographic characteristics, symptoms, diagnoses, and treatments received. RESULTS: 474 of 9,662 (4.9%) DFA tests were positive. Men with chlamydial infection were more likely to be African-American (p < 10(-7)) and less than 24 years of age (p < 10(-7)). C. trachomatis infection was present in 10.7% of those with gonorrhea and 10.0% of those with nongonococcal urethritis. Forty percent of chlamydia cases were asymptomatic, and 97% were treated at the visit owing to existing clinic protocols. CONCLUSIONS: C. trachomatis infection is common and often asymptomatic in men attending STD Clinics. Infected men are likely to be young and African-American. Routine screening with the Syva MicroTrak DFA test will detect unsuspected cases of chlamydial infection; however, in the clinic in this report, most cases were already treated according to standard clinic protocols.

Adolescent↗
PubMed1991

Results of a prenatal screening program for the human immunodeficiency virus in a cross-sectional population.

A prenatal screening program for antibody to the human immunodeficiency virus (HIV) was examined prospectively in a cross-sectional population. Routine screening was performed on 3,241 women during the first trimester. Serum samples yielding repeatedly positive results on an enzyme-linked immunosorbent assay (ELISA) (n = 6) were subjected to confirmatory Western blot testing. All the specimens were determined to be false positive with atypical banding regions not consistent with HIV-1 infection. This false-positive rate was higher than in previous reports of screening programs in low-risk populations (P less than .005). Since antibody to HIV may not be detectable for several months after infection, we serially tested 984 of the women in different trimesters of pregnancy to determine whether repeat testing would yield seroconversion undetected at the first screening. No patient who initially tested negative on the ELISA tested positive later in gestation. We therefore recommend that routine screening be performed only once during pregnancy, preferably in the first or early second trimester, in the general population.

Adolescent↗
PubMed1992

A successful breast cancer screening program.

A private, low-cost mammography screening program in Charlotte, North Carolina, has grown from one to four fixed sites in the past 6 years and now screens more than 25,000 women annually. An ongoing medical audit of the program shows that the percentage of patients with breast cancer with positive lymph nodes has decreased from 29% to 13%, and the percentage of minimal cancers found has increased from 31% to 52%. Compliance for regular screening has remained at approximately 50% for the past 2 years. Means of increasing compliance to desired levels are discussed.

Breast Neoplasms↗
PubMed1999

Clinical impact of quality assurance in an organized cervical screening program.

BACKGROUND: We have studied whether clinical monitoring of an established population register based cervical screening program could reduce the number of cervical cancer cases and if drawbacks in the coverage could be detected. METHOD: A total of 123 consecutive cervical cancer cases were studied. A retrospective study of five years was followed by five prospective years after the introduction of increased efforts to find previously neglected low-grade positive smears. Cervical cancer incidence, histology, stage, and early mortality were related to smear history. RESULTS: The absence of cancer cases with neglected positive smears was a major reason for a 50 percent lower incidence of squamous cancers in the prospective period. Rapid onset interval cancers were few. Older women, never invited to the program, accounted for the majority of the advanced or aggressive cases in the former period. However, serious post-screening cancers remained common among women who had not had smears taken regularly up to the age of sixty, whereas there was little morbidity in women who had a regular smear to that age. CONCLUSION: This organized screening program is a versatile tool in identifying women at risk. To attain effectiveness it needs, however, active monitoring of the smear history and a mechanism to ascertain that all women have participated well beyond the age of fifty before being left out of the program.

Adult↗
PubMed1990

Survey of performance of cervical cytopathology laboratories and of screening programs in Italy. National Working Group for Quality Assurance in Cytohistopathology.

Structure, performance, management, quality control and participation in screening programs of cervical cytology laboratories have been evaluated through a questionnaire sent to all public Italian hospitals, relevant university departments and senior members of relevant scientific associations. Completed questionnaires were received from 276 centers, which gives a response rate of 73%. In this report we concentrate on the need for improvement, but there are a number of centers who have all or almost all the features traditionally associated with good or excellent practice. The main results of the survey are the following. Most of the centers examine relatively few cervical smears, so their workload could be considered too low for maintaining a good level of practice. Six centers examine 3 specimens per woman, about 25% examine 2 specimens, and the rest only 1 specimen. There is a marked variability in filing and storing practices of positive and negative smears and results. Internal quality control is inadequate in most centers, and external quality control is limited to voluntary exchange of dubious or interesting smears. Only half of the centers are involved in screening programs. In 75% of the programs the suggested screening interval is 1 year or even 6 months; only 7 (4.5%) agree with the UICC/IARC recommended interval of 3 years. The target population coverage varies from 10% to 85%, and it is less than 50% in 78% of the programs. Only 6 programs have an active women's call system. The survey has confirmed the need for launching a national program of internal and external quality control. Almost all centers have expressed their interest to take part.

Adult↗
PubMed1997

Mass screening programs for breast cancer in France--average values of assessment criteria.

Breast cancer is the most common cancer in women worldwide. Many studies have been performed worldwide to assess the effectiveness of screening in terms of reduced mortality due to breast cancer. Since the end of 1989, 10 breast cancer mass screening programs using mammography have been carried out in France under the sponsorship of the National Fund for Health Prevention, Education, and Information (FNPEIS) from the National Health Insurance of Salaried Workers (CNAMTS). These 10 campaigns, which are on a district scale, are organized according to variable methods and are assessed using a common procedure. Four groups of criteria are measured in this procedure, which investigates the impact, quality, effectiveness, and costs of screening programs. The average and extreme values of each criterion as calculated from the campaigns are presented in this paper. In order to enlighten the judgment on the French results, a comparison with the international standards in force and with the results of foreign screening programs is proposed.

Aged↗