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PloS One 2022We sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin.
OBJECTIVES
We sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin.
DESIGN
Mixed-methods, cross-sectional study with a cost assessment.
SETTING
Eight participating health facilities in Cotonou, Benin.
PARTICIPANTS
Consecutive pregnant women presenting for antenatal care at any participating site who were not in labor or currently being treated for TB from April 2017 to April 2018.
INTERVENTIONS
Screening for the presence of TB symptoms by midwives and Xpert MTB/RIF for those with cough for at least two weeks. Semi-structured interviews with 14 midwives and 16 pregnant women about experiences with TB screening.
PRIMARY AND SECONDARY OUTCOME MEASURES
Proportion of pregnant women with cough of at least two weeks and/or microbiologically confirmed TB. The cost per pregnant woman screened and per TB case diagnosed in 2019 USD from the health system perspective.
RESULTS
Out of 4,070 pregnant women enrolled in the study, 94 (2.3%) had a cough for at least two weeks at the time of screening. The average (standard deviation) age of symptomatic women was 26 ± 5 years and 5 (5.3%) had HIV. Among the 94 symptomatic women, 2 (2.3%) had microbiologically confirmed TB for a TB prevalence of 49 per 100,000 (95% CI: 6 to 177 per 100,000) among pregnant women enrolled in the study. The average cost to screen one pregnant woman for TB was $1.12 USD and the cost per TB case diagnosed was $2271 USD. Thematic analysis suggested knowledge of TB complications in pregnancy was low, but that routine TB screening was acceptable to both midwives and pregnant women.
CONCLUSION
Enhanced screening for TB among pregnant women is feasible, acceptable, and inexpensive per woman screened, however in this setting has suboptimal yield even if it can contribute to enhance TB case finding.
Topics: Adolescent; Adult; Benin; Costs and Cost Analysis; Female; Humans; Mass Screening; Middle Aged; Pregnancy; Pregnancy Complications; Pregnant Women; Prevalence; Tuberculosis, Pulmonary
PubMed: 35192665
DOI: 10.1371/journal.pone.0264206 -
The Journal of Prevention of... 2020
Topics: Alzheimer Disease; Cognitive Dysfunction; Early Diagnosis; Humans; Mass Screening; Mental Status and Dementia Tests; Primary Health Care
PubMed: 32463065
DOI: 10.14283/jpad.2020.16 -
Tidsskrift For Den Norske Laegeforening... Jan 2017
Topics: False Positive Reactions; Female; Humans; Mammography; Mass Screening
PubMed: 28127062
DOI: 10.4045/tidsskr.17.0051 -
Cancer Oct 2014Breast cancer screening holds a prominent place in public health, health care delivery, policy, and women's health care decisions. Several factors are driving shifts in... (Review)
Review
Breast cancer screening in an era of personalized regimens: a conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level.
Breast cancer screening holds a prominent place in public health, health care delivery, policy, and women's health care decisions. Several factors are driving shifts in how population-based breast cancer screening is approached, including advanced imaging technologies, health system performance measures, health care reform, concern for "overdiagnosis," and improved understanding of risk. Maximizing benefits while minimizing the harms of screening requires moving from a "1-size-fits-all" guideline paradigm to more personalized strategies. A refined conceptual model for breast cancer screening is needed to align women's risks and preferences with screening regimens. A conceptual model of personalized breast cancer screening is presented herein that emphasizes key domains and transitions throughout the screening process, as well as multilevel perspectives. The key domains of screening awareness, detection, diagnosis, and treatment and survivorship are conceptualized to function at the level of the patient, provider, facility, health care system, and population/policy arena. Personalized breast cancer screening can be assessed across these domains with both process and outcome measures. Identifying, evaluating, and monitoring process measures in screening is a focus of a National Cancer Institute initiative entitled PROSPR (Population-based Research Optimizing Screening through Personalized Regimens), which will provide generalizable evidence for a risk-based model of breast cancer screening, The model presented builds on prior breast cancer screening models and may serve to identify new measures to optimize benefits-to-harms tradeoffs in population-based screening, which is a timely goal in the era of health care reform.
Topics: Adult; Aged; Breast Neoplasms; Decision Making; Early Detection of Cancer; Evidence-Based Medicine; False Positive Reactions; Female; Humans; Magnetic Resonance Imaging; Mammography; Mass Screening; Middle Aged; National Cancer Institute (U.S.); Practice Guidelines as Topic; Precision Medicine; Risk Assessment; United States
PubMed: 24830599
DOI: 10.1002/cncr.28771 -
Value in Health : the Journal of the... Jan 2011Screening for colorectal cancer (CRC) has become established to varying degrees in several Western countries for the past 30 years. Because of its effectiveness,... (Review)
Review
Screening for colorectal cancer (CRC) has become established to varying degrees in several Western countries for the past 30 years. Because of its effectiveness, screening has been adopted or is planned in a number of other countries. In most countries, the screening method (e.g., fecal occult blood test [FOBT], sigmoidoscopy) is followed by colonoscopy, for verification. In other countries (e.g., United States, Germany), colonoscopy is the preferred first-line investigation method. However, because colonoscopy is considered to be invasive, might be poorly tolerated, and can be associated with complications, the idea of adopting colonoscopy as the primary screening method suffers. Negative effects of screening methods can reduce participation in programs and thereby negate the desired effect on individual and societal health. At present, there is no generally accepted method either to assess the perception and satisfaction of patients screened or the outcome of the screening procedures in CRC. In this review, we discuss the past development and present availability of instruments to measure health-related quality of life (HRQoL), the scarce studies in which such instruments have been used in screening campaigns, and the findings. We suggest the creation of a specific instrument for the assessment of HRQoL in CRC screening.
Topics: Colorectal Neoplasms; Humans; Mass Screening; Patient Acceptance of Health Care; Patient Preference; Quality of Life; Surveys and Questionnaires
PubMed: 21211497
DOI: 10.1016/j.jval.2010.10.018 -
American Family Physician Sep 2018The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during...
The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.
Topics: Child; Child Welfare; Child, Preschool; Growth and Development; Humans; Infant; Mass Screening; Pediatrics; Physical Examination; Psychosocial Support Systems
PubMed: 30215922
DOI: No ID Found -
American Family Physician Jan 2015
Topics: Family Practice; Humans; Mass Screening; Medical Overuse; Practice Guidelines as Topic; Quality Improvement; United States
PubMed: 25591195
DOI: No ID Found -
Journal of Women's Health (2002) Sep 2014Despite ongoing awareness, educational campaigns, and advances in technology, breast cancer screening remains a complex topic for women and for the health care system.... (Review)
Review
Despite ongoing awareness, educational campaigns, and advances in technology, breast cancer screening remains a complex topic for women and for the health care system. Lack of consensus among organizations developing screening guidelines has caused confusion for patients and providers. The psychosocial factors related to breast cancer screening are not well understood. The prevailing algorithm for screening results in significant rates of patient recall for further diagnostic imaging or procedures, the majority of which rule out breast cancer rather than confirming it. For women, the consequences of the status quo range from unnecessary stress to additional out-of-pocket expenses to indirect costs that are more difficult to quantify. A more thoughtful approach to breast cancer screening, coupled with a research agenda that recognizes the indirect and intangible costs that women bear, is needed to improve cost and quality outcomes in this area.
Topics: Breast Neoplasms; Cost of Illness; Delivery of Health Care; Early Detection of Cancer; Female; Health Care Costs; Humans; Mammography; Mass Screening
PubMed: 25247383
DOI: 10.1089/jwh.2014.1510 -
American Family Physician Apr 2015
Topics: Aortic Aneurysm, Abdominal; Communication; Direct-To-Consumer Screening and Testing; Evidence-Based Practice; Humans; Insurance Benefits; Insurance, Health; Mass Screening; Physician-Patient Relations; Practice Guidelines as Topic
PubMed: 25884857
DOI: No ID Found -
Annals of Internal Medicine Nov 2008In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended colorectal cancer screening for adults 50 years of age or older but concluded that evidence was... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended colorectal cancer screening for adults 50 years of age or older but concluded that evidence was insufficient to prioritize among screening tests or evaluate newer tests, such as computed tomographic (CT) colonography.
PURPOSE
To review evidence related to knowledge gaps identified by the 2002 recommendation and to consider community performance of screening endoscopy, including harms.
DATA SOURCES
MEDLINE, Cochrane Library, expert suggestions, and bibliographic reviews.
STUDY SELECTION
Eligible studies reported performance of colorectal cancer screening tests or health outcomes in average-risk populations and were at least of fair quality according to design-specific USPSTF criteria, as determined by 2 reviewers.
DATA EXTRACTION
Two reviewers verified extracted data.
DATA SYNTHESIS
Four fecal immunochemical tests have superior sensitivity (range, 61% to 91%), and some have similar specificity (97% to 98%), to the Hemoccult II fecal occult blood test (Beckman Coulter, Fullerton, California). Tradeoffs between superior sensitivity and reduced specificity occur with high-sensitivity guaiac tests and fecal DNA, with other important uncertainties for fecal DNA. In settings with sufficient quality control, CT colonography is as sensitive as colonoscopy for large adenomas and colorectal cancer. Uncertainties remain for smaller polyps and frequency of colonoscopy referral. We did not find good estimates of community endoscopy accuracy; serious harms occur in 2.8 per 1000 screening colonoscopies and are 10-fold less common with flexible sigmoidoscopy.
LIMITATION
The accuracy and harms of screening tests were reviewed after only a single application.
CONCLUSION
Fecal tests with better sensitivity and similar specificity are reasonable substitutes for traditional fecal occult blood testing, although modeling may be needed to determine all tradeoffs. Computed tomographic colonography seems as likely as colonoscopy to detect lesions 10 mm or greater but may be less sensitive for smaller adenomas. Potential radiation-related harms, the effect of extracolonic findings, and the accuracy of test performance of CT colonography in community settings remain uncertain. Emphasis on quality standards is important for implementing any operator-dependent colorectal cancer screening test.
Topics: Age Factors; Aged; Colorectal Neoplasms; Decision Support Techniques; Early Diagnosis; Female; Humans; Male; Mass Screening; Middle Aged; Time Factors
PubMed: 18838718
DOI: 10.7326/0003-4819-149-9-200811040-00245