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SCREENING
IRWIN ARAS
Community Medicine Department
FMUH
DEFINITION
WHO-Regional Committee for Europe, 1957:
Attempts to identify a disease that is clinically
unclear using certain examinations or other
procedures which can be used to quickly
distinguish those who appeared healthy but
have the nature of really sick or healthy.
healthy
5/22/2014
DEFINITION
Mc Keown, 1968:
Medical investigations carried out not by the
patient preference in getting advice for
specific complaints
Detection of emerging diseases in a healthy
population
Application of the test to people who are
asymptomatic with the aim to group them into
groups which may suffer from certain diseases
5/22/2014
Death
Cronic
Clinical horizon
Carrier
Agent
entered
into the
Host
Heal
defects
Incubation
periode
Perfect
heal
Early diease
periode
Late diease
periode
End of
Illness
period
Pathogenesis phase
PREPATOGENESIS
PATHOGENESIS
CLINIC
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Aims of Screening
General
Detect the disease as early as possible so as to reduce morbidity
and mortality and improve quality of life
Specific
Research / survey
Protection of public health
Prescriptive (for the advice / instructions given)
Lowering morbidity and mortality
Improving quality of life
Given the scale of the problem
Disease Criterias
1. Prevalence quite "high".
"high"
2. Morbidity and / or mortality meaningful if
untreated.
3. There are effective therapies,
therapies
4. Beneficial early treatment outweigh further
cases.
example;
1. TB with tuberculin test; feasible
2. Ca lung with chest X-ray; not feasible
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CONDITION OF SCREENING
1. Sufficiently sensitive and specific test
test,,
2. Tests can be accepted by society, safe,
harmless, inexpensive and simple,
3. Diseases or problems that will be
screened is a serious public health
problem.
problem
TYPES OF SCREENING
1.
2.
3.
4.
5.
Mass screening
Selective screening
Single disease screening
Multiphasic screening
Case finding
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Screening is
TYPES OF SCREENING
performed on the
1.
2.
3.
4.
5.
Mass screening
Selective screening
Single disease screening
Multiphasic screening
Case finding
entire population
Ex: mass x-ray
surveys or blood
pressure screening on
the entire community
who visit the health
services
TYPES OF SCREENING
1.
2.
3.
4.
5.
Mass screening
Selective screening
Single disease screening
Multiphasic screening
Case finding
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TYPES OF SCREENING
1.
2.
3.
4.
5.
Mass screening
Selective screening
Single disease screening
Multiphasic screening
Case finding
Only performed on
one disease
Ex: Screening
against tuberculosis
So it is more
focused on the
disease
TYPES OF SCREENING
1.
2.
3.
4.
5.
Mass screening
Selective screening
Single disease screening
Multiphasic screening
Case finding
particular visit
Very simple, easy,
cheap, widely accepted
Objective: health
evaluation (insurance )
Ex: Ca examination,
with checks BP, blood
sugar, choles, etc
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TYPES OF SCREENING
1.
2.
3.
4.
5.
Mass screening
Selective screening
Single disease screening
Multiphasic screening
one step in coping with the outbreak
Case finding
of where to find the source of
infection and the presence or seeking
new cases in the community
TYPES OF SCREENING
The main objective is to find a
source of transmission by
collecting data about the people
The main objective is to find a
who had contact with the
new case by collecting data
patient BEFORE the patient fell ill
about the people who had
contact with the patient AFTER
the patient fell ill
Backward tracing
Forward tracing
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STAGES OF SCREENING
Stage of define problem
Stage of define method of data collection
Stage of define population
Stage of apply screening
Stage of streghten screening
Stage of preparation and follow-up reports
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Illustration table
Measurement of the
Gold Standard
Positive
Measure
ment of
screening
tool
Negative
Total
Positive
TP
FP
TP + FP
FN
TN
FN + TN
TP + FN
FP + TN
Negative
Validity Value
Criterias for assess a Screening Test;
Validity: the ability of a test to determine where people who
have a disease and
arepredict
not perfectly/
T who
The
test can
Valid if:
completely;
Where is all that + based on
ST is really sick
Where is all that - based on
ST is really not sick
Components of validity:
Sensitivity
Specifity
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Validity Value
Measurement of the
Gold Standard
Positive
Sensitivity:
= TP/(TP + FN)
Specifity:
Measure
ment of
screening
tool
Negative
Total
Positive
TP
FP
TP + FP
FN
TN
FN + TN
TP + FN
FP + TN
Negative
= TN/(TN + FP)
A tool is stated to have a high validity value if:
sensitivity and specificity close to 100%
PREDICTIVE VALUE
Definition: The probability of illness to a medical
examination.
Disease Prevalence
Depend on:
Specifity of ST
Type of PV :
1. Positive Predictive Value (PPV): percentage of
those with positive test results who are really sick
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PREDICTIVE VALUE
Measurement of
the Gold Standard
Positive
Measure Positive
ment of
screenin
g tool
Negative
Negative Total
TP
FP
TP + FP
FN
TN
FN + TN
TP + FN FP + TN
Reliability
Reliability: the ability of a tool to deliver consistent results,
when the examination is done more then once, in the same
individuals and the same conditions.
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Example;
Biopsy
Positive
Paps
Smear
Negative Total
Positive
69
131
200
2.049
2.050
70
2.180
2.250
Negative
THANK YOU
Telp; 08124262546
Email; irwinaras@gmail.com
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