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Universal Screening (universal + screening)
Selected AbstractsDefining the patient at high risk for melanomaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2010Estee L. Psaty BA In this practical review, we aim to help clinicians identify patients who are at significant risk of developing malignant melanoma. Universal screening is challenging, thus it is important to effectively single out patients who have a high risk of developing the disease. We provide a summary of pertinent questions to review when taking the patient's history, point out the phenotypic features to note during skin examination, and suggest risk stratification as a means to plan initial and long-term surveillance strategy. We mention personal and family history of melanoma as prime risk factors for melanoma, yet the review also focuses on the patient who has no history of melanoma, either in himself or his family, and the proper ways to evaluate his likelihood of developing the disease. [source] Ten Years' Experience of Antenatal Mean Corpuscular Volume Screening and Prenatal Diagnosis for Thalassaemias in Hong KongJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2000Dr. S. Y. Sin Abstract Objective: To determine the prevalence of thalassaemia carriers in Hong Kong. Subjects and Methods: From 1988 to 1997, 25834 (53.7%) of 48089 mothers were screened for thalassaemias by mean corpuscular volume (MCV) at the first antenatal visit. Results: In the screened population of 25834, 2229 (8.6%) had MCV , 75 fl. Of these, 1121 (4.3%) were ,-thal, 715 (2.8%) were ,-thal, 23 (0.1%) were ,,-thal, 57 (0.2%) were other haemoglobin variants, and 281 (1.1%) had either iron deficiency or uncertain causes. Out of 200 pregnancies at risk for homozygous ,-thal-1 and 32 at risk for ,-thal major, 27 homozygous ,-thal-1 and 7 ,-thal major were identified, compared favourably with the expected figures of 23 and 9. Conclusion: Antenatal screening for thalassaemias by MCV is simple, effective and reliable. Universal screening has a different impact as bone marrow or cord blood stem cell transplant provides cure for ,-thal major. At risk couples have, as an alternative to termination of pregnancy, the option of early detection and treatment for their affected newborns or fetuses. [source] Identifying Children with Dental Care Needs: Evaluation of a Targeted School-based Dental Screening ProgramJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2004David Locker BDS Abstract Objectives: It has been suggested that changes in the distribution of dental caries mean that targeting high-risk groups can maximize the cost effectiveness of dental health programs. This study aimed to assess the effectiveness of a targeted school-based dental screening program in terms of the proportion of children with dental care needs it identified. Methods: The target population was all children in junior and senior kindergarten and grades 2, 4, 6, and 8 who attended schools in four Ontario communities. The study was conducted in a random sample of 38 schools stratified according to caries risk. Universal screening was implemented in these schools. The parents of all children identified as having dental care needs were sent a short questionnaire to document the sociodemographic and family characteristics of these children. Children with needs were divided into two groups: those who would and who would not have been identified had the targeted program been implemented. The characteristics of the two groups were compared. Results: Overall, 21.0 percent of the target population were identified as needing dental care, with 7.4 percent needing urgent care. The targeted program would have identified 43.5 percent of those with dental care needs and 58.0 percent of those with urgent needs. There were substantial differences across the four communities in the proportions identified by the targeted program. Identification rates were lowest when the difference in prevalence of need between the high- and low-risk groups was small and where the low-risk group was large in relation to the high-risk group. The targeted program was more effective at identifying children from disadvantaged backgrounds. Of those with needs who lived in households receiving government income support, 59.0 percent of those with needs and 80.1 percent of those with urgent needs would be identified. Conclusions: The targeted program was most effective at identifying children with dental care needs from disadvantaged backgrounds. However, any improvements in cost effectiveness achieved by targeting must be balanced against inequities in access to public health care resources. [source] Learning and behavioural difficulties but not microcephaly in three brothers resulting from undiagnosed maternal phenylketonuriaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2004C. Shaw-Smith Abstract Universal screening introduced in the 1960s has reduced the incidence of learning disability resulting from phenylketonuria (PKU), which is a treatable condition. Nonetheless, PKU may still be having an impact on the paediatric-age population. We report a woman with previously undiagnosed PKU who was born before the onset of universal screening. She is of normal intelligence, and so the diagnosis was not suspected until after the birth of her three children. Her serum phenylalanine concentration was found to be in excess of 1 mmol/L, well into the toxic range. She has had three sons, all of whom have a significant degree of learning disability resulting from intrauterine exposure to toxic levels of phenylalanine. None of the sons had microcephaly, a physical sign that, if present, might have helped to point towards the correct diagnosis. We suggest that maternal PKU should be suspected where there is sibling recurrence of cognitive impairment, particularly where the mother was born before the initiation of the neonatal screening programme for PKU. [source] Gestational diabetes: fasting capillary glucose as a screening test in a multi-ethnic, high-risk populationDIABETIC MEDICINE, Issue 8 2009M. M. Agarwal Abstract Aims, In populations at high risk of gestational diabetes mellitus (GDM), screening every pregnant woman by an oral glucose tolerance test (OGTT) is very demanding. The aim of this study was to determine the value of the fasting capillary glucose (FCG) as a screening test for GDM. Methods, FCG was measured by a plasma-correlated glucometer in 1465 pregnant women who underwent a one-step diagnostic 75-g OGTT for universal screening of GDM. Results, One hundred and ninety-six (13.4%) women had GDM as defined by the criteria of the American Diabetes Association. The area under the receiver operating characteristic curve (AUC) of the FCG was 0.83 (95% confidence interval 0.80,0.86). A FCG threshold of 4.7 mmol/l (at an acceptable sensitivity of 86.0%) independently could rule-out GDM in 731 (49.9%) women, while the FCG could rule-in GDM (100% specificity) in 16 (1.1%) additional women; therefore, approximately half of the women would not need to continue with the cumbersome OGTT. Conclusions, Screening using a FCG significantly reduces the number of OGTTs needed for the diagnosis of GDM. Wider assessment, particularly in low-risk populations, would confirm the potential value of the FCG as a screening test for GDM. [source] A Qualitative Study of Intimate Partner Violence Universal Screening by Family Therapy Interns: Implications for Practice, Research, Training, and SupervisionJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 1 2008Jeffrey L. Todahl Although a few family therapy researchers and clinicians have urged universal screening for intimate partner violence (IPV), how screening is implemented,and, in particular, client and therapist response to screening,is vaguely defined and largely untested. This qualitative study examined the dilemmas experienced by couples and family therapy interns when implementing universal screening for IPV in an outpatient clinic setting. Twenty-two graduate students in a COAMFTE-accredited program were interviewed using qualitative research methods grounded in phenomenology. Three domains, 7 main themes, and 26 subthemes were identified. The three domains that emerged in this study include (a) therapist practice of universal screening, (b) client response to universal screening, and (c) therapist response to universal screening. Implications for practice, research, training, and supervision are discussed. [source] Communication of positive newborn screening results for sickle cell disease and sickle cell trait: Variation across states,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2008Patricia L. Kavanagh Abstract In the US, all states and the District of Columbia have universal newborn screening (NBS) programs for sickle cell disease (SCD), which also identify sickle cell trait (trait). In this project, we surveyed follow-up coordinators, including one in the District of Columbia and two in Georgia, about protocols for stakeholder notification for SCD and trait. The primary outcomes were total number and type of stakeholder informed of a positive screen. We received 52 completed surveys (100% response). Primary care providers (PCPs) (100%), hematologists (81%), hospitals (73%), and families (40%) were the most commonly notified stakeholders of positive SCD screens, while PCPs (88%), hospitals (63%), and families (37%) were most commonly notified for trait. On average, 3.4 stakeholders were notified for a positive screening for SCD, compared to 2.4 stakeholders for sickle cell trait (P,<,0.001). In multivariate analyses for SCD, we found a 2.9% increase in stakeholders notified for each additional year of universal screening mandated in a state (95% CI: 1.4,4.4%). For trait, we found an 8.5% increase in stakeholders notified for each additional follow-up staff (95% CI: 1.3,15.7%), and a 1.3% increase for each additional percent of black births in the state (95% CI: 0.1,2.5%). Wide variation exists in stakeholder notification by NBS programs of positive screenings for SCD and trait. This variation may alter the effectiveness of NBS programs by location of birth. © 2008 Wiley-Liss, Inc. [source] The prevention science of reading research within a Response-to-Intervention modelPSYCHOLOGY IN THE SCHOOLS, Issue 1 2010Erica S. Lembke The purpose of this article is to describe research-based reading intervention within a Response-to-Intervention (RTI) model, using prevention science as a context. First, RTI is defined and a rationale is provided for its use in improving the reading performance of all students, particularly those students identified as at risk for reading-related learning disabilities. Next, reading risk is defined and discussed, including prevalence, antecedents, and how risk is assessed through universal screening and progress monitoring. Existing literature on the use of RTI models in reading is summarized, including small- and large-scale implementation studies. Finally, future research directions in the area of reading within an RTI model are discussed. © 2009 Wiley Periodicals, Inc. [source] Learning and behavioural difficulties but not microcephaly in three brothers resulting from undiagnosed maternal phenylketonuriaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2004C. Shaw-Smith Abstract Universal screening introduced in the 1960s has reduced the incidence of learning disability resulting from phenylketonuria (PKU), which is a treatable condition. Nonetheless, PKU may still be having an impact on the paediatric-age population. We report a woman with previously undiagnosed PKU who was born before the onset of universal screening. She is of normal intelligence, and so the diagnosis was not suspected until after the birth of her three children. Her serum phenylalanine concentration was found to be in excess of 1 mmol/L, well into the toxic range. She has had three sons, all of whom have a significant degree of learning disability resulting from intrauterine exposure to toxic levels of phenylalanine. None of the sons had microcephaly, a physical sign that, if present, might have helped to point towards the correct diagnosis. We suggest that maternal PKU should be suspected where there is sibling recurrence of cognitive impairment, particularly where the mother was born before the initiation of the neonatal screening programme for PKU. [source] | |||||||||||||