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PRESENTER:
DEFINITION OF SCREENING
The search for unrecognized disease or defect by means of
rapidly applied tests, examinations or other procedures in
apparently healthy individuals.*
The presumptive identification of unrecognized disease or defect
by the application of tests, exams or other procedures which can
be applied rapidly to sort out apparently well persons who probably
have a disease from those who probably do not.*
Tests done in individuals with no symptom or sign of an illness are
referred to as screening tests.*
(* K. Park Textbook of PSM 21st edition;
* J M Last Dictionary of Epidemiology 4th edition, WHO Public Health
Papers 1968;
* J H Abramson and Z H Abramson Survey methods in Community
Medicine 5th edition)
BASIS OF SCREENING
Iceberg phenomenon
of disease
tip of the iceberg
CLINICAL DISEASE
submerged portion
HIDDEN
BURDEN
DISEASE
OF
BASIS OF SCREENING
LEAD TIME
BASIS OF SCREENING
Screening is a form of secondary prevention.
It detects disease in its early asymptomatic phase
whereby early treatment can be given and disease
can be cured or its progression can be delayed.
It has both
components.
diagnostic
(?)
and
therapeutic
Diagnostic test
1. Done on sick or ill
individuals
2. Applied
on
single
patient
3. Diagnosis is not final
4. Based on evaluation of
a no. of signs/symptoms
& lab findings
5. More accurate
6. More expensive
7. Used as a basis for
treatment
8. Initiative comes from a
patient
TYPES OF SCREENING
1. MASS SCREENING
Application of screening test to large, unselected
population. Everyone in the group is screened
regardless of the probability of having the disease
or condition.
Example: a) visual defects in school children
b) mammography in women aged 40 years or
less
c) newborn screening program in Japan
3. MULTIPURPOSE SCREENING
The screening of a population by more than one test
done simultaneously to detect more than one disease
Example: a) screening of pregnant women for VDRL,
HIV,
HBV by serological tests
4. MULTIPHASIC SCREENING
The screening in which various diagnostic procedures
are employed during the same screening program.
Example: a) DM FBS, Glucose tolerance test
b) Sickle cell anemia CBC, Hb electrophoresis
a) RHD in children
USES OF SCREENING
1. CASE DETECTION prescriptive screening, people are
screened for their own benefit
(cancer, diabetes, hypertension)
2. CONTROL OF DISEASE prospective screening, people
are screened for the benefit of others
(HIV, STI)
3. RESEARCH to know the natural history of a disease
4. EDUCATION public awareness
2. SCREENING TEST
a) Inexpensive
b) Acceptable
c) Valid
d) Reliable
e) Yielding
GOLD STANDARD
GOLD STANDARD: an external source of truth
regarding the disease status of each individual in
the population. Gold standard is a benchmark and
its results are considered definitive.
Infections CULTURE
Cancers BIOPSY
Drug testing RANDOMIZED CONTROLLED TRIAL
Cause of death AUTOPSY
VALIDITY
An expression of the degree to which a test measures what it
purports to measure.
How to understand validity?
ESTIMATE: a measurement or statement about the value of a
quantity under study.
An epidemiological estimate is the end product of the study
design, the study conduct and the data analysis.
Error is a false or mistaken result obtained in a study or
experiment.
Systematic error is one sided variation of measurements from
the true value. It has a recognizable source.
A study that has little systematic error is described as
VALID.
COMPONENTS OF VALIDITY
Ds present
Test positive
Test negative
Ds absent
SENSITIVITY
The ability of a test to correctly identify those who
have the disease. TP
a/ (a + c) expressed as percentage.
Problem of FP.
Ds present
Test positive
Test negative
Ds absent
SPECIFICITY
The ability of a test to correctly identify those who
do not have the disease. TN
d/ (b + d) expressed as percentage.
Problem of FN.
Ds present
Test positive
Test negative
Ds absent
ACCURACY
ACCURACY = TP + TN / TP + FP + TN + FN
+
(SPECIFICITY) X (1 - PREVALENCE)
PROBLEM OF FN AND FP
FN: false reassurance
ignoring of disease signs and symptoms
postponement of treatment
detrimental to overall health
FP: further testing
discomfort, inconvenience, anxiety
burden on health facilities
emotional trauma
difficulty in de-labeling