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‫بسم الله الرحمن الرحيم‬

‫رب اشرح لى صدرى ويسر‬ ‫لى أمرى‬

Contents of the session:

SCREENING

 Definitions, Rationale  Objectives of screening  Types of screening  Characteristics of a screening test  Validity: Sensitivity & Specificity  Reliability; Predictive Values  Criteria for Conducting a screening program

SCREENING
s What are the levels of prevention

of disease?
s What is secondary prevention? s How are you going to apply

secondary prevention?

SCREENING
s Definition :
s

The presumptive identification of unrecognized disease or defect by the application of tests, examinations or other procedures which can be applied rapidly to sort apparently well persons who probably have the disease from those who probably do not.

‫‪s‬التعريف :‬ ‫التعرف الظ ن ع لى حالت الرض أو‬ ‫العطب غي الظاهر عن طريق إجراء‬ ‫اختبارات أو فحوص أو استخدام أية‬ ‫وسائل أخرى سهلة الستعمال .‬

‫الفرز (التقصي،‬ ‫الكتشاف المبكر‬ ‫للمراض)‬

Why are we concerned about screening for disease?
s Early

diagnosis: s Early treatment with better outcome s Reduce morbidity s Reduce mortality s Prevent complications s Improve survival s Stop spread of infectious diseases

Types of screening
(1) Mass screening: s Large, unselective (2)Selective screening: a. High risk groups e.g.: s With family history of disease s Obese patients (or persons) s Elderly patients s Hospital patients

Types of screening )Cont.(
b. Special risk groups: s Occupational groups s Infants & young children s Pregnant mothers (3) Multiphasic (Multiple) screening: screening for more than one condition in the same screening session (4) Opportunistic screening (case finding)

Objectives of screening
(1) To identify individuals who already have the disease in the sub-clinical stage, e.g.
s Hypertension, Diabetes Mellitus, s Ca. cervix uteri, Ca. breast, s Schistosomiasis

(2) To identify individuals at high risk of developing disease, e.g.:
s s

Objectives of screening )Cont.(
CHD

High BP

High serum cholesterol

CHD

(3) To prevent disease & protect the health of the public, e.g.: serological tests for: AIDS, HBV, HCV

(1)Validity: (1)

Characteristics of a screening test

a) Sensitivity b- Specificity c- False positives d- False negatives

(2) Reliability : (3 ) Predictive value:
s

pv of a +ve test; pv of a –ve test

Validity
The ability of the test to measure what it is supposed to measure a- Sensitivity: the ability of the test to detect correctly those who probably have the disease )true positives( b- Specificity: the ability of the test to detect correctly those who probably do not have the disease )true negatives(
s

Screening 2X2 Table
Diagnostic Test present absent a b Total a+b

Sc. +ve Screening Test Sc -ve Total

c d c+d -----------------------------------a+c b+d a+b+c+d

Screening 2X2 Table
Sc. +ve Screening Test Sc -ve Total Diagnostic Test present absent TP FP Total a+b

FN TN c+d ----------------------------------------TP+FN FP+TN a+b+c+d

Screening 2X2 Table
s Calculate:

sensitivity = a/a+c = TP TP+FN specificity = d/b+d = TN TN+FP pv of +ve test = a/a+b pv of –ve test = d/c+d

Screening Example
coronary arteriography
present absent 65 7 +ve postexercise ECG -ve 39 84 123 ------------------------------Total 104 91 195 Total 72

Screening Example
s Calculate:

sensitivity = specificity = pv of +ve test = pv of –ve test =

2- Reliability (precision) ‫الموثوقية - المعولية‬ s

A test that gives consistent results when performed more than once on the same individual under the same conditions s Factors affecting reliability: (1 ) Inter—observer variation: s differences among observers (2) Intra—observer variation: s variation in readings by the same observer on separate occasions

s Predictive value of a screening test: s The

Predictive Value

ability to predict the presence or absence of disease given the results of a screening test. It depends on: (1) Prevalence of the disease in the population tested (2) Sensitivity & specificity of the test

pv of a +ve test
pv of a +ve test: the probability that a person with a positive test has the disease (True +ve). True Positive s pv +ve test = ------------------------Total +ve by screening
s

a +ve pv of 60% = there is a 60% chance that the subjects who tested +ve will have the disease.

pv of a -ve test
(b) pv of -ve test = the probability that a person with a negative test has not got the disease. True negatives pv of -ve test = ---------------------------Total -ve by screening s A -ve pv of 98% = there is a 98% chance that the subjects who tested -ve will not have the disease.

The requirements of a screening program
1. The condition should be an important health problem 2. Natural history of the condition should be adequately understood 3. A recognizable latent or early asymptomatic stage of disease 4. Accepted treatment for patients detected

The requirements of a screening program
5. Facilities for diagnosis and treatment should be provided 6. A suitable test or examination 7. The test should be acceptable to the population 8. Cost of case-finding should be economical 9. Case-finding should be a continuous process

Conditions for which screening is conducted
1 ) Prenatal screening: s Blood grouping & Rh; s Anaemia; s Syphilis; rubella (German measles); s Diabetes mellitus; s HBV

Conditions for which screening is conducted
2 ) Neonatal screening: s Congenital dislocation of the hip; s Inborn errors of metabolism; s G-6-P-D deficiency 3) Pre-school Children: s Growth & development; s Speech, vision & hearing

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