scholarly journals Implementing a Large-Scale Systematic Tuberculosis Screening Program in Correctional Facilities in South Africa

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Vincent Zishiri ◽  
Salome Charalambous ◽  
Maunank R. Shah ◽  
Violet Chihota ◽  
Liesl Page-Shipp ◽  
...  
Keyword(s):  
South African ◽  
Large Scale ◽  
Screening Program ◽  
High Volume ◽  
Treatment Costs ◽  
Correctional Facilities ◽  
Tuberculosis Screening ◽  
Pulmonary Tb ◽  
Screening Programs ◽  
The Cost

Abstract Background.  Tuberculosis (TB) prevalence is high in correctional facilities in southern Africa. With support from local South African nongovernmental organizations, the South African Department of Correctional Services initiated a program of systematically screening newly admitted and current inmates for symptoms followed by GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (Rif) for microbiologic testing of symptomatic inmates. Methods.  We conducted a program evaluation during a 5-month window describing program reach, effectiveness, adoption within the facilities, cost, and opportunities for sustainability. This evaluation included 4 facilities (2 large and 2 smaller) with a total daily census of 20 700 inmates. Results.  During the 5-month evaluation window from May to September 2013, 7426 inmates were screened at the 4 facilities. This represents screening 87% of all new admits (the remaining new admits were screened by correctional staff only and are not included in these statistics) and 23% of the daily inmate census, reaching 55% of the overall screening target as calculated per annum. The reach ranged from 57% screened during these 5 months at one of the smaller facilities to 13% at the largest facility. Two hundred one cases of pulmonary TB were diagnosed, representing 2.1% of the screened population; 93% had documented initiation of TB treatment. The cost per TB case identified was $1513, excluding treatment costs (with treatment costs it was $1880). Conclusions.  We reached a large number of inmates with high-volume screening and effectively used GeneXpert MTB/Rif to diagnose pulmonary TB and rapidly initiate treatment. The cost was comparable to other screening programs.

Cost of Annual Tuberculosis Screening of Healthcare Workers with Negative Tuberculin Skin Test Results

2013 ◽  
Vol 34 (6) ◽  
pp. 642-643
Author(s):  
J. Brooks Jackson ◽  
Xuguang Tao ◽  
Laurie Sneed ◽  
Frances Humphrey-Carothers ◽  
Edward Bernacki
Keyword(s):  
Medical School ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Screening Program ◽  
Healthcare Providers ◽  
Johns Hopkins Hospital ◽  
Tuberculosis Screening ◽  
Screening Programs ◽  
Screening Cost ◽  
The Cost

The Centers for Disease Control and Prevention (CDC) recommends annual screening for Mycobacterium tuberculosis infection using the tuberculin skin test (TST) for individuals working in hospitals with 200 or more inpatient beds that have at least 6 documented cases of active tuberculosis (TB) per year. The cost of annual TB screening programs is significant, but the cost per individual with TST conversion is unknown. Therefore, we evaluated the annual TB screening program at the Johns Hopkins Hospital and Medical School to determine (1) the proportion of individuals with TST conversion among individuals in the annual TB screening program with patient care exposure at the Johns Hopkins Hospital and Medical School, (2) which employment and demographic factors are associated with TST conversion, (3) the prevalence of active TB disease among those with TST conversion, and (4) the annual cost of subsequent screening of individuals with initial negative TST results and the screening cost per individual with TST conversion.TST results were reviewed for individuals participating in the annual TB screening program during the previous 4 years (2007–2010) at the Johns Hopkins Hospital and Medical School, which has experienced an average of 12 documented cases of active TB per year. TST was performed before employment and then annually for healthcare providers according to CDC guidelines and the manufacturer's directions. Individuals in the testing program included anyone who had patient contact, such as physicians, nurses, technologists, students, phlebotomists, nutritionists, pharmacists, and clerks. All initial testing was 2-step testing if the individual was initially reactive.

scholarly journals DNA-based carrier screening in primary healthcare: screening for aspartylglucosaminuria mutations in maternity health offices

1996 ◽  
Vol 42 (9) ◽  
pp. 1398-1404 ◽  
Author(s):  
M Hietala ◽  
P Aula ◽  
A C Syvänen ◽  
A Isoniemi ◽  
L Peltonen ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Large Scale ◽  
Solid Phase ◽  
Screening Program ◽  
Low Cost ◽  
Carrier Screening ◽  
Screening Programs ◽  
One Step ◽  
Laboratory Technology ◽  
Maternity Health

Abstract Large-scale genetic screening programs are complex enterprises in which ethical, technical, medical, and socioeconomic aspects have to be handled with professional expertise. Establishment of automated, relatively robust, and inexpensive laboratory techniques is one step of this path. Here a pilot carrier-screening program for the mutations causing aspartylglucosaminuria was carried out for pregnant women in primary care maternity health offices. Women (1975) were tested before their 12th week of pregnancy, and 31 heterozygotes were detected. The sampling was based on dried blood strips, facilitating convenient handling and inexpensive mailing to the laboratory. The mutation detection technique, solid-phase mini-sequencing simplified by the use of scintillation microplates and automated equipment, proved to be rapid, simple, inexpensive, and reliable, with a low repeat rate (2.5%). In conclusion, we found that good collaboration between the primary healthcare unit, the laboratory, and counseling experts, combined with modern laboratory technology, facilitate reliable low-cost genetic testing.

Simulated Lifetime Costs of Three Types of Employer-Based, Periodic, Breast Cancer Screening Programs for Working-Age Women

1994 ◽  
Vol 9 (2) ◽  
pp. 137-146 ◽  
Author(s):  
Robert I. Griffiths ◽  
Claudia B. Griffiths ◽  
Neil R. Powe
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Screening Program ◽  
Lifetime Cost ◽  
Decision Analysis Model ◽  
Screening Programs ◽  
Mean Lifetime ◽  
Lifetime Costs ◽  
The Cost

Purpose. To estimate the lifetime cost of three types of employer-sponsored breast cancer screening programs and to identify factors influencing cost. Design. A computerized decision analysis model was constructed to compare lifetime costs of providing breast cancer screening in each of three screening programs: on-site within an employer, mobile unit visiting the employer, and off-site. Subjects. Three hypothetical cohorts of 10,000 female employees 38 years of age at time of first screening. Intervention. A cohort was enrolled in each screening program and received screening from age 38 through age 64. Employees continued to receive benefits related to breast cancer until age 100 or death. Measures. Costs in the model included those for screening, workup for a suspicious mammogram, treatment for breast cancer, short-term losses in employee productivity, and disability due to breast cancer. Approach. The model was used to estimate the mean lifetime cost per employee, to the employer, of the On-Site program. This cost was compared to the cost of the other programs. Results. Mean lifetime cost per employee was $5,485 for the On-Site screening program. This cost was significantly (P<.0001) lower than in the Off-Site program (by $311) or the Mobile program (by $212). The baseline results for the On-Site program were quite sensitive to the cost of screening, the sensitivity and specificity of screening, age at initiation of screening, and the underlying incidence of breast cancer in the population. Conclusion. Employers and other entities should consider these factors such as location and content in selecting the most efficient and effective breast cancer screening program.

scholarly journals How to Choose Diseases for Newborn Screening by Tandem Mass Spectrometry Under the Nationally Recommended Program in Shenzhen, China Evidence From a Cost-Effectiveness Analysis

2021 ◽  
Author(s):  
Mingren Yu ◽  
Juan Xu ◽  
Xiaohong Song ◽  
Jiayue Du
Keyword(s):  
Mass Spectrometry ◽  
Cost Effectiveness ◽  
Tandem Mass Spectrometry ◽  
Newborn Screening ◽  
Screening Program ◽  
Cost Effective ◽  
Tandem Mass ◽  
National Program ◽  
Screening Programs ◽  
The Cost

Abstract Background: Newborn screening (NBS) can prevent inborn errors of metabolism (IEMs), which may cause long-term disability and even death in newborns. However, in China, tandem mass spectrometry (MS/MS) screening has just started. This study is to determine the cost-effectiveness of NBS using MS/MS in Shenzhen under the nationally recommended program, and determine IEMs for detection.Methods: A Markov model was built to estimate the cost and quality-adjusted life-years (QALYs) of different screening programs. The current screening program and nationally recommended program were compared and we also compared the programs detecting different numbers of IEMs, which are chosen from the national program. A sensitivity analysis and budget impact analysis (BIA) were performed.Results: The incremental cost-effectiveness ratio (ICER) of detecting all 12 IEMs in the national program is 277,823 RMB per QALY, below three times per capita GDP in Shenzhen. MS/MS screening in Shenzhen can be cost-effective only if at least three diseases (PKU, PCD and MMA) are covered and when the screening program covers five diseases (PKU, PCD, MMA, MSUD, IVA), the ICER closely approaches its critical value. The BIA indicated the implementation cost of the national program to be around 580 million RMB over 10 years and showed no difference in budget between programs detecting different numbers of IEMs. Conclusions: We conclude that the newborn screening using MS/MS in Shenzhen is cost-effective, and the budget affordable for the Shenzhen government. Two concepts for selecting the IEMs to be detected, which we label the “ICER maximization idea” and the “ICER validation idea” are also presented.

scholarly journals Edith Wharton's Resource Aesthetics and the Dawn of the American Energy Crisis

2018 ◽  
Vol 53 (4) ◽  
pp. 925-952
Author(s):  
ALAN ACKERMAN
Keyword(s):  
World War I ◽  
Moral Agency ◽  
Large Scale ◽  
Continuous Production ◽  
High Volume ◽  
World War ◽  
Power Stations ◽  
History Of ◽  
The Cost ◽  
Modes Of Thought

Situating Edith Wharton in the context of America's accelerating petro-culture, this essay argues that her novels critique a society that takes for granted high-volume, nonrenewable energy, and specifically revolutionary new kinds of energy: petroleum, natural gas, and the fossil-fueled power stations necessary for the large-scale, continuous production of electricity. Attention to the idiom of energy inThe House of Mirthand its mirror text,The Custom of the Country, along with Ida Tarbell'sHistory of Standard Oiland Theodore Roosevelt's conservationism, sheds new light on assumptions about moral agency, personal freedom, changing modes of thought, and the environment between 1880 and World War I. The essay shows how Wharton's allegorical treatment of Lily Bart and Undine Spragg anticipates the notion of externalities or consequences of industrial activities that affect outside parties but are not reflected in the cost of production.

Prevalence and risk factors of tuberculosis disease in South African correctional facilities in 2015

2019 ◽  
Vol 23 (11) ◽  
pp. 1198-1204
Author(s):  
A. M. Jordan ◽  
L. J. Podewils ◽  
K. G. Castro ◽  
V. Zishiri ◽  
S. Charalambous
Keyword(s):  
Risk Factors ◽  
South African ◽  
Screening Program ◽  
Computer Assisted ◽  
Correctional Facilities ◽  
Prevalence Estimates ◽  
Screening Coverage ◽  
Digital Chest ◽  
Chest X Ray ◽  
Using Data

SETTING: Sixteen South African correctional facilities.OBJECTIVE: To determine the prevalence of and risk factors for tuberculosis (TB) in South African correctional facilities using data collected during a TB screening program in South African correctional facilities in 2015.DESIGN: Inmates in 16 South African correctional facilities were screened for TB from January to December 2015. Inmates reporting ≥1 TB symptom or having an abnormal computer-assisted digital chest X-ray (CXR) provided sputum. Abnormal CXRs were interpreted by a radiologist. Sputum was tested for Mycobacterium tuberculosis using Xpert® MTB/RIF. Data from 16 South African correctional facilities were used in regression analysis, and prevalence estimates calculated for 12 South African correctional facilities with >30% screening coverage.RESULTS: In 12 South African correctional facilities included in the prevalence estimates, 837 inmates had TB disease (2653/100 000) as indicated by current TB treatment or screening-identified TB by radiologist or Xpert. Previous TB was associated with increased odds of screening-identified TB in HIV-positive inmates (OR 4.3, 95%CI 2.5–7.3). For HIV-negative inmates, previous TB (adjusted OR [aOR] 4.9, 95%CI 1.7–14.1) and self-reported symptoms vs. none (1 symptom, aOR 8.8, 95%CI 1.2–67.7; >2 symptoms, aOR 21.7, 95%CI 3.0–158.8) were independently associated with increased odds of screening-identified TB.CONCLUSIONS: Routine TB screening, including CXR, is needed in South African correctional facilities to identify and refer inmates with active TB.

scholarly journals Faecal immunochemical test-based colorectal cancer screening in Mexico: an initial experience

2020 ◽  
Vol 37 (3) ◽  
pp. 321-324 ◽  
Author(s):  
José María Remes-Troche ◽  
Gabriela Hinojosa-Garza ◽  
Priscilla Espinosa-Tamez ◽  
Arturo Meixueiro-Daza ◽  
Peter Grube-Pagola ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Potential Benefit ◽  
Large Scale ◽  
Screening Program ◽  
Preliminary Evidence ◽  
Premalignant Lesions ◽  
Middle Income ◽  
Screening Programs ◽  
Crc Screening ◽  
Middle Income Countries

Abstract Background In middle-income countries, the burden of colorectal cancer (CRC) is increasing in parallel with resources for diagnosis and treatment. There is a potential benefit of CRC screening programs in Mexico. Objective Since there are no organized screening programs in the country, we explored the willingness of individuals to complete a faecal immunochemical testing (FIT) based CRC screening program and its potential benefit in Mexico. Methods We conducted a CRC screening program pilot in Veracruz, Mexico, during 2015–16 using FIT. Individuals with FIT results &gt;100 ng of haemoglobin/ml buffer were referred for diagnostic colonoscopy. Results Of 473 FIT kits distributed to adults aged 50–75, 85.8% (406) were completed by participants and analysed in the laboratory. Of these, 5.9% (24/406) of test results showed &gt;100 ng haemoglobin/ml. Twenty-one participants completed colonoscopy. The positive predictive value of FIT &gt;100 ng haemoglobin/ml for premalignant lesions was 33%. Conclusion These results provide preliminary evidence of the willingness of individuals to complete FIT-based CRC screening program in Mexico. However, further evaluation of health systems resources will be needed prior to large-scale implementation of CRC screening programs.

scholarly journals Implementation of Ultraportable Echocardiography in an Adolescent Sudden Cardiac Arrest Screening Program

2014 ◽  
Vol 8 ◽  
pp. CMC.S15779 ◽  
Author(s):  
Thomas E. Vanhecke ◽  
James E. Weber ◽  
Matthew Ebinger ◽  
Kimberly Bonzheim ◽  
Frank Tilli ◽  
...  
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Large Scale ◽  
Screening Program ◽  
Sudden Cardiac Arrest ◽  
Structural Abnormality ◽  
Screening Programs ◽  
Structural Abnormalities ◽  
Echocardiographic Examination ◽  
Medical History Questionnaire

Background Over a 12-month period, adolescent heart-screening programs were performed for identifying at-risk adolescents for sudden cardiac death (SCD) in our community. Novel to our study, all adolescents received an abbreviated, ultraportable echocardiography (UPE). In this report, we describe the use of UPE in this screening program. Methods and Results Four hundred thirty-two adolescents underwent cardiac screening with medical history questionnaire, physical examination, 12-lead electrocardiogram (ECG), and an abbreviated transthoracic echocardiographic examination. There were 11 abnormalities identified with uncertain/varying clinical risk significance. In this population, 75 adolescents had a murmur or high ECG voltage, of which only three had subsequent structural abnormalities on echocardiography that may pose risk. Conversely, UPE discovered four adolescents who had a cardiovascular structural abnormality that was not signaled by the 12-lead ECG, medical history questionnaire, and/or physical examination. Conclusions The utilization of ultraportable, handheld echocardiography is feasible in large-scale adolescent cardiovascular screening programs. UPE appears to be useful for finding additional structural abnormalities and for risk-stratifying abnormalities of uncertain potential of adolescents’ sudden death.

Comparing two Modalities of Management of Women with Cytologic Evidence of Squamous Or Glandular Atypia: Early Repeat Cytology or Colposcopy

1997 ◽  
Vol 83 (4) ◽  
pp. 732-734 ◽  
Author(s):  
Silvia Cecchini ◽  
Anna lossa ◽  
Rita Bonardi ◽  
Stefano Ciatto ◽  
Paola Cariaggi
Keyword(s):  
Screening Program ◽  
Cost Effective ◽  
Punch Biopsy ◽  
Easy Access ◽  
Squamous Cells ◽  
Screening Programs ◽  
Large Loop ◽  
Intraepithelial Lesion ◽  
A Prospective Study ◽  
The Cost

Early repeat cytology is recommended in most screening programs for cervical cancer in subjects with squamous or glandular abnormalities not amounting to neoplasia (atypical squamous cells of undetermined significance, ASCUS), but immediate colposcopy is also recommended in some countries, especially those where there is easy access to colposcopic facilities. We evaluated the cost-effectiveness of the two procedures in a prospective study of women with cytologic ASCUS, invited to cytocolposcopic assessment after 6 months. Colposcopy-directed biopsy was assumed as the gold standard, and the accuracy of colposcopy at 6 months was assumed to be equal to that of immediate colposcopy. Out of 874 compilers, punch biopsy was performed in 303 cases (34.7%), and 19 CIN2+ lesions were detected (CIN2 = 12, CIN3 = 6, microinvasive carcinoma = 1). Detecting 13 CIN2+ lesions at colposcopy required 874 colposcopies and 303 directed biopsies: the cost per CIN2+ lesion detected with the procedure was 2,749 US$. Detecting 15 CIN2+ lesions at repeat cytology required 874 cytologic examinations, 137 colposcopies, 64 directed biopsies, and 6 diagnostic large-loop resections, the latter being performed in subjects with high-grade squamous intraepithelial lesion and less severe lesions at punch biopsy: the cost per CIN2+ lesion detected with the procedure was 1,961 US$. The policy of repeat smear was more cost-effective than immediate colposcopy. According to such results, the protocol of the Florence screening program has been modified since October 1996.

Unrecognized Cardiovascular Abnormalities Detected Through a Community Cardiovascular Screening Program

2020 ◽  
Vol 36 (3) ◽  
pp. 234-242
Author(s):  
S. Michelle Bierig ◽  
Anita Arnold ◽  
Lynne C. Einbinder ◽  
Eric Armbrecht ◽  
Thomas Burroughs
Keyword(s):  
Large Scale ◽  
Screening Program ◽  
Ankle Brachial Index ◽  
Positive Test ◽  
Screening Tests ◽  
Early Detection Of Disease ◽  
Screening Programs ◽  
Cardiovascular Screening ◽  
Subclinical Disease ◽  
Screening Protocol

Objective: Self-referral community cardiovascular screening programs (CCSPs) have a potential to reduce outcome events through early detection of disease. This study evaluated the characteristics of a population that could predict a positive test. Materials and Methods: Participants who completed a cardiovascular screening protocol were compared. The screening protocol included a blood pressure (BP), Doppler ankle brachial index (ABI) testing, a limited carotid sonogram, a limited aortic sonogram, electrocardiogram (ECG), and limited transthoracic echocardiogram (TTE). Results: Screenings were performed on 205 participants (58% female, 68 ± 9 years of age). Sixty-seven (34%) participants were abnormal in at least one of the following screening tests: ABI (2%), carotid sonogram (6%), aortic sonogram (3%), ECG (11%), and TTE (22%). Although 60.5% of the participants reported recent symptoms, there were no differences in normal or abnormal results of participants presenting with or without symptoms ( P = .06). Income was not a predictor of abnormal test results (odds ratio, 0.76; 95% confidence interval, 0.55–0.97; P = .19). Multivariate analysis demonstrated, when controlling for age greater than 75 years, that participants taking BP medication was the only variable that predicted a positive test result. Conclusion: One-third of patient results were abnormal, regardless of symptoms or lack thereof, suggestive of subclinical disease. Further large-scale studies would demonstrate the role of CCSPs in risk stratifying participants.

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