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5/22/2014

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

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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

THE NATURE OF SCREENING


1. An early detection of the disease, namely the
detection of early stage disease and see the
magnitude of health problems in the
community,
2. Not a diagnostic tool
tool,
3. Positive test will be followed by a diagnostic
test or procedure to ensure disease.

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Natural History of Disease


Agent has not
entered into the
body of the
host, but it
comes in
contact
between the
two. If there is a
disruption in the
equilibrium
state, then the
agent can enter
Pre
Pre-pathogenesis
phase

Death

Agent already in the host body


Symptoms can be
observed

Cronic

Clinical horizon
Carrier
Agent
entered
into the
Host

Heal
defects

Symptoms can not be


observed

Incubation
periode

Perfect
heal
Early diease
periode

Late diease
periode

End of
Illness
period

Pathogenesis phase

Natural History of Disease

PREPATOGENESIS

PATHOGENESIS

SUSCEPTIBILITY ADAPTATION EARLY DISEASE

CLINIC

EARLY PROTECTION OF DISEASE

Screening should be performed here

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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

Only done at certain


proportions, with a target
population based on
certain ratios
Objective: To reduce the
negative impact of
screening
Ex:
Pap's smear in women
aged> 40 yr for the
detection of cervical Ca;
Mammography screening
for women who have a
family history of suffering
Ca.

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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

For some diseases on a

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

1. Active case findings

Backward tracing
Forward tracing

2. Passive Case Findings

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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

Conditions of Screening Tool


In determining the type of examination tool for
screening test, we should consider to:
1. Validity value
2. Predictive value

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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

2. Negative Predictive Value (NPV): percentage of


those with negative test results who are really not sick

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PREDICTIVE VALUE
Measurement of
the Gold Standard
Positive

PPV = TP/(TP + FP)


NPV = TN/(TN + FN)

Measure Positive
ment of
screenin
g tool
Negative

Negative Total

TP

FP

TP + FP

FN

TN

FN + TN

TP + FN FP + TN

A tool is stated to have a high predictive value


if: PPV and NPV close to 100%

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.

Factors affecting the consistent results:


Variation in examination
methods (eg. Sit or lay position in
1. Method Variation
BP measurement)
Variations within the subject
2. Observer Variation itself
(eg, measurement
of abody
Inter-observer
variability:
temperature
is different
mismatch
between
the between
day and night)results of a different
measurement
observer
Intra-observer variability: one
observer to read the results
differently within a different time

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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

Determine the prevalence, sensitivity,


specifity, PPV & NPV!

THANK YOU
Telp; 08124262546
Email; irwinaras@gmail.com

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