Universal Screening for Infant Hearing Impairment: Not Simple, Not Risk-Free, Not Necessarily Beneficial, and Not Presently Justified

PEDIATRICS ◽  
1994 ◽  
Vol 93 (2) ◽  
pp. 330-334 ◽  
Author(s):  
Fred H. Bess ◽  
Jack L. Paradise
Keyword(s):  
Hearing Impairment ◽  
Early Identification ◽  
Universal Screening ◽  
Screening Program ◽  
Cost Effective ◽  
Screening Methods ◽  
Controlled Trials ◽  
Validity And Reliability ◽  
Young Infants ◽  
Cost Effective Approach

In our judgment, before any societal decision is made as to whether to institute a universal screening program for hearing impairment in young infants, many questions for which answers are not now available must be answered. To answer those questions will require extensive research. Clearly, the authors of the Consensus Statement were not unmindful of the scope of the problem, for they included in the Statement a listing of proposed future studies they considened important. Among these were: "controlled trials of screening by audiologists versus trained non-professionals on volunteers; controlled trials of the influence of different settings...on the effectiveness of screening procedures; comparison of early intervention with later intervention...; evaluate the validity and reliability of screening instruments...; test the feasibility of screening methods...in infant populations...in remote satellite clinics...; determine whether a two-tier screening system...wonks better than [a single scneen]...study the cost-effectiveness of universal screening for infant hearing impairment." We heartily agree that these studies, and other studies, are important—indeed, crucial. So crucial, in fact, that, until they have been conducted and their results tabulated, no rational decision on undertaking universal screening for infant hearing loss is possible. We, too, believe that early identification is important; however, the precipitate launching of mass screening could work to deter the eventual development of an effective early identification program. In the meantime, to identify infants at risk for hearing impairment, continued reliance on the high-risk register as recommended by the Joint Committee on Infant Hearing,4 but in combination with an automated rather than conventional ABR screen, seems to be a more practical, cost-effective approach.

scholarly journals Reliability of PCR based screening for identification and quantification of GMOs

2010 ◽  
Vol 28 (No. 2) ◽  
pp. 133-138 ◽  
Author(s):  
J. Ovesná ◽  
L. Kučera ◽  
J. Hodek ◽  
K. Demnerová
Keyword(s):  
Genetically Modified Organisms ◽  
Emergency Situation ◽  
Cost Effective ◽  
Cauliflower Mosaic Virus ◽  
Pcr Analysis ◽  
Screening Methods ◽  
Cost Effective Approach ◽  
Nos Terminator ◽  
Polymerase Chain ◽  
Food Commodities

Handling with genetically modified organisms (GMOs) is regulated namely in EC. Laboratories often use polymerase chain reaction (PCR) based screening methods to monitor the presence of GM particles in food commodities as a cost effective approach. The reliability was tested of such screening using 35S CaMV promoter as the target sequences. Soya grown from non-GM cultivar as declared by a seed company was investigated after the harvest, transport to the silo, and before processing. The results based on PCR and real-time PCR analysis clearly showed that, the contamination with debris of other species, dust during transport, storage, and other kind of handling led to contamination with detectable amounts of Cauliflower mosaic virus (CaMV). Impurities are allowed by EC regulations but may, as we have shown, interfere with the analytical procedures based on PCR. The identification of 35S CaMV promoter and NOS terminator in food with uncertain history and no approved specific events may indicate unknown GMOs and perhaps emergency situation.

Letter to the Editor

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 949-949
Author(s):  
James W. Hall
Keyword(s):  
Hearing Impairment ◽  
Auditory Brainstem Response ◽  
Early Identification ◽  
Universal Screening ◽  
Auditory Brainstem ◽  
National Institutes Of Health ◽  
Screening Procedure ◽  
Evoked Responses ◽  
Auditory Evoked Responses ◽  
Brainstem Response

In their recent Pediatrics artide entitled "Universal Screening for Infant Hearing Impairment: Not Simple, Not Risk-Free, Not Necessarily Beneficial, and Not Presently Justified," Bess and Paradise comment on the performance of the auditory brainstem response (ABR) as a screening procedure, and quote an estimate from the 1993 National Institutes of Health Conference Statement on Early Identification of Hearing Impairment that "for every child with significant hearing impairment, more than 100 babies are referred." Bess and Paradise then comment that "the same concerns necessarily apply to a recently devised, automated ABR instrument," and reference my Handbook of Auditory Evoked Responses in support of their contention.

scholarly journals Enhancing Genetic Medicine: Rapid and Cost-Effective Molecular Diagnosis for a GJB2 Founder Mutation for Hearing Impairment in Ghana

Genes ◽  
2020 ◽  
Vol 11 (2) ◽  
pp. 132 ◽  
Author(s):  
Samuel M. Adadey ◽  
Edmond Tingang Wonkam ◽  
Elvis Twumasi Aboagye ◽  
Darius Quansah ◽  
Adwoa Asante-Poku ◽  
...  
Keyword(s):  
Hearing Impairment ◽  
Restriction Enzyme ◽  
Sanger Sequencing ◽  
Screening Program ◽  
Cost Effective ◽  
Normal Hearing ◽  
Hearing Impaired ◽  
Practical Case ◽  
Junction Protein ◽  
Genetic Medicine

In Ghana, gap-junction protein β 2 (GJB2) variants account for about 25.9% of familial hearing impairment (HI) cases. The GJB2-p.Arg143Trp (NM_004004.6:c.427C>T/OMIM: 121011.0009/rs80338948) variant remains the most frequent variant associated with congenital HI in Ghana, but has not yet been investigated in clinical practice. We therefore sought to design a rapid and cost-effective test to detect this variant. We sampled 20 hearing-impaired and 10 normal hearing family members from 8 families segregating autosomal recessive non syndromic HI. In addition, a total of 111 unrelated isolated individuals with HI were selected, as well as 50 normal hearing control participants. A restriction fragment length polymorphism (RFLP) test was designed, using the restriction enzyme NciI optimized and validated with Sanger sequencing, for rapid genotyping of the common GJB2-p.Arg143Trp variant. All hearing-impaired participants from 7/8 families were homozygous positive for the GJB2-p.Arg143Trp mutation using the NciI-RFLP test, which was confirmed with Sanger sequencing. The investigation of 111 individuals with isolated non-syndromic HI that were previously Sanger sequenced found that the sensitivity of the GJB2-p.Arg143Trp NciI-RFLP testing was 100%. All the 50 control subjects with normal hearing were found to be negative for the variant. Although the test is extremely valuable, it is not 100% specific because it cannot differentiate between other mutations at the recognition site of the restriction enzyme. The GJB2-p.Arg143Trp NciI-RFLP-based diagnostic test had a high sensitivity for genotyping the most common GJB2 pathogenic and founder variant (p.Arg143Trp) within the Ghanaian populations. We recommend the adoption and implementation of this test for hearing impairment genetic clinical investigations to complement the newborn hearing screening program in Ghana. The present study is a practical case scenario of enhancing genetic medicine in Africa.

Universal screening of newborns for biliary atresia: Cost-effectiveness of alternative strategies

2019 ◽  
Vol 26 (3) ◽  
pp. 113-119 ◽  
Author(s):  
Lisa Masucci ◽  
Richard A Schreiber ◽  
Janusz Kaczorowski ◽  
JP Collet ◽  
Stirling Bryan
Keyword(s):  
Cost Effectiveness ◽  
Biliary Atresia ◽  
Universal Screening ◽  
Screening Program ◽  
Unit Cost ◽  
Cost Effective ◽  
Distribution Strategy ◽  
Home Based ◽  
Life Years ◽  
Conjugated Bilirubin

Objective Biliary atresia, a rare newborn liver disease, is the most common cause of liver-related death in children and the main indication for paediatric liver transplantation. Early detection and surgical intervention with a Kasai portoenterostomy offers the best chance for long-term patient survival. We conducted a cost-effectiveness analysis to compare no universal screening with screening using either a home-based infant stool colour card with passive card distribution strategy, or conjugated bilirubin testing. Methods A Markov model was developed, with structure, costs, and probabilities informed by the literature and clinical expert opinion, to simulate a newborn cohort over a 10-year time horizon. Health benefits were expressed as life-years gained. This analysis was conducted from the perspective of the Canadian publicly funded health care system (all costs in Canadian dollars). Both deterministic and probabilistic analyses were conducted. Results Screening using a home-based colour card with passive card distribution was a cost-effective option. For a population of 392,902 annual births in Canada, this strategy cost approximately $192,000 more than no universal screening but led to eight life-years gained (incremental cost-effectiveness ratio (ICER) = $24,065 per life-year gained). Screening using conjugated bilirubin testing versus the colour card cost $2,369,199 more and led to five more life-years gained (ICER= $473,840 per life year gained), and so was not cost-effective. Conclusions A home-based screening program using infant stool colour cards with a passive distribution strategy could be highly cost-effective when administered at a low unit cost and with a reasonable screening performance.

scholarly journals KNOW Candida auris: Prevention of another outbreak through screening and early identification

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Zubaria Altaf ◽  
Omar Al Hasanat ◽  
Jenalyn Castro ◽  
Ubaid Ummer ◽  
Mohamed Safwat Gomaa Amr ◽  
...  
Keyword(s):  
Early Identification ◽  
Screening Program ◽  
Preventive Measure ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Public Healthcare ◽  
Candida Auris ◽  
Safe Patient Care ◽  
Contact Precautions ◽  
Screening Protocol

Background: Candida auris, within the last decade, has emerged as a multidrug resistant public health threat that can lead to hospital outbreaks. It is an invasive fungal yeast resistant to multiple antifungal agents. The mode of transmission is through contaminated hospital items (including clothes and furniture) and interventions by staff. Two Candida auris outbreaks occurred in Qatar. The first outbreak was in Al Wakra Hospital (AWH), which is a facility of Hamad Medical Corporation (HMC), the principal public healthcare provider in the State of Qatar. As concluded by Eyre DW, et al. (2018), a series of interventions and environmental screening program may reduce the Candida auris outbreak. A screening toolkit that includes a checklist based on an existing protocol and operationally defined criteria is a key preventive measure for Candida auris identification. We aim to attain 100% compliance with screening suspected patients and preventing further outbreaks. Methods: A screening protocol toolkit was created for eligible patients that allowed early identification and prompt intervention therefore enhancing the provision of high-quality, efficient, cost effective, and safe patient care. Furthermore, implementation of an Outbreak Prevention Bundle had been proven effective in preventing the spread and comprised: (1) prophylactic contact precautions, (2) blanket screening of at risk/exposed patients, (3) environmental sampling, and (4) hydrogen peroxide disinfection. Results/Findings/Recommendations: In 2020, continuous screening was maintained for patients fitting the HMC criteria. The protocol for the management of outbreaks was implemented. The number of COVID-19 positive cases peaked during July - August 2020 when COVID-19 patients were transferred to AWH . Overall, AWH reached 407 cumulative days without Candida auris outbreak . Conclusion: Candida auris outbreak is preventable through early identification via screening and implementation of an Outbreak Prevention Bundle. This method has led to no active outbreak in AWH since August 2019 until October 2020.

Letter to the Editor

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 954-954
Author(s):  
J. Michael Dennis ◽  
James W. Hall ◽  
John T. Jacobson ◽  
Paul R. Kileny ◽  
Roger A. Ruth
Keyword(s):  
Early Intervention ◽  
Hearing Impairment ◽  
Early Identification ◽  
Universal Screening ◽  
Consensus Statement ◽  
National Institutes Of Health ◽  
Screening Tests ◽  
Letter To The Editor ◽  
Infant Screening

In their recent Pediatrics commentary entitled "Universal Screening for Infant Hearing Impairment: Not Simple, Not Risk-Free, Not Necessarily Beneficial, and Not Presently Justified," Bess and Paradise argue that "universal screening is ill-considered and at this time ill-advised." Bess and Paradise state their general objections to the National Institutes of Health (NIH) Consensus Statement on Early Identification of Hearing Impairment, and then express their concerns about the rationale for early intervention for infant hearing impairment and about current infant screening tests.

scholarly journals Perspectives of primary healthcare providers on implementing cancer screening services in tribal block of Maharashtra, India

2019 ◽  
Vol 08 (03) ◽  
pp. 145-149
Author(s):  
Anushree D. Patil ◽  
Neha R. Salvi ◽  
Begum Shahina ◽  
A. Sharmila Pimple ◽  
A. Gauravi Mishra ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Screening Program ◽  
Hpv Vaccination ◽  
Healthcare Providers ◽  
Cost Effective ◽  
Continuous Medical Education ◽  
Screening Methods ◽  
Screening Programs ◽  
Oral Cancers ◽  
Tribal Areas

Abstract Background: Breast, cervical, and oral cancers contribute to majority of cancer deaths among women in India. However, there is poor implementation of screening programs at primary health care (PHC). There is a need to understand the perspectives of healthcare providers at PHC level for feasibility of implementation of a cost-effective cancer screening program, particularly in the rural and tribal areas that are under served by cancer services. Materials and Methods: A continuous medical education (CME) program on “Prevention and early detection of common cancers” was held for all Medical Officers of Palghar District, Maharashtra. A self-administered questionnaire was used to assess the knowledge, attitude, practices, perspectives regarding common cancers, screening methods, and human papilloma virus (HPV) vaccination. A pre- and post-assessment was carried out before the commencement and on completion of the CME among 76 participants. Results: Knowledge about etiology of common cancers was high; however, awareness of risk factors was low. There were knowledge gaps about HPV vaccination. There was overall improvement about the available screening methods and knowledge of HPV vaccine and dosages after the CME (pretest 65% to posttest 95%). Providers had no experience in performing cervical cancer screening on a routine basis. While the majority of the providers (97%) indicated that screening for cancer was essential and feasible at PHC level; however, training (52%) and resources (53%) would be needed. Conclusion: Healthcare providers though from the underserved tribal areas, were optimistic to implement screening for common cancers and were willing to take training for the same. This emphasizes the need for educating and training the healthcare providers with simple techniques for effective implementation of cancer screening programs in underserved areas.

scholarly journals Study of Factors Influence to Poor Attendance for the Second Diagnostic Visit to the Pen Program of Early Detection of Diabetes and Hypertension in PHCCs in Kirkuk, Iraq

2020 ◽  
Vol 3 (2) ◽  
pp. 218-228
Author(s):  
Suha Tahir ◽  
Suhaila Tahir
Keyword(s):  
Early Detection ◽  
Screening Program ◽  
Cost Effective ◽  
Health District ◽  
Limited Resources ◽  
Preclinical Stage ◽  
Primary Health ◽  
Cost Effective Approach ◽  
And Control

PEN was held in PHCs in Kirkuk city by WHO. To prevent and control the NCD and to provide a cost-effective approach for early detection of D.M and hypertension by recognition the preclinical stage of the disease. With selecting 5 random chosen PHCCs in first primary health district, for the month between (January to end of July) 2018. With using very simple techniques, in very limited resources for PHCs, The results showed the highest percentages of attending the NCD unit was in Tareeq – Baghdad, while the lowest in Tissin, and the females are more than the males. The highest percentage registered for hypertension was in Baglar , while the highest positive screened was in Tissin. For D.M. the highest no. of visitor registered for first and second visit was in Baglar. This gives as a conclusion that there was a defect in screening program regarding the second visit in NCD unit in PHCs.

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