2/20/2023 0 Comments Define screenie![]() ![]() Raffle and Gray saw “lifestyle checks and fitness testing” as part of health promotion, not screening. For example, some public health and medical screening authors excluded tests for fitness for employment. Ĭommon characteristics – what screening is, and is not: For the most part, both public health and clinical explanations of screening had the following aspects in common: i) one or more observations (procedures, tests, examinations) offered to presumptively healthy (asymptomatic) people ii) to detect something putatively prognostic (risk factor, precursor, or occult pathology) iii) under the assumption that early detection will be followed by prompt efficacious intervention iv) that will alter natural history and improve the screened individual’s outcome (e.g., longer survival, fewer complications, higher quality of life) relative to not having been screened.īeyond the above, we found that the definitions, and, especially, the examples and explanations of what screening is and is not, differed considerably. ![]() What screening is, and is not, depended on: whether screening is seen as a program or as a test the setting or context in which it is done eligibility criteria who requests or initiates the screening who is expected to benefit whether the entity screened for is a chronic disease, a communicable disease, or an elevated risk state, and the level of prevention/stage of natural history at which screening is performed. The search located seven journal articles and ten textbooks, and one dictionary. Our aim was to identify common usages and concepts, sources of potential misunderstanding, and the fundamentals of screening about which the public deserves to receive clear explanations. The purpose of this paper is to understand the different concepts about screening by reviewing definitions and examples of screening in selected public health and epidemiology textbooks, dictionaries, and relevant journal publications. But, paradoxically, every time our guidelines are updated to reflect the latest evidence, the public’s confidence that we know what we are doing, may be eroded. Clearly, it is appropriate for us to change screening recommendations in the face of newer, better evidence. While screening-as-early-detection seems widely understood and intuitive, communicating the complexities of evaluating the full range of risks and benefits of screening is difficult. Breast cancer screening guidelines seem especially prone to regular revision, resulting in conflicting recommendations across jurisdictions and even between governmental agencies and cancer agencies. Over-promotion of mammography may have led to unrealistic expectations, which may now be causing fears of vexatious litigation among some clinicians. For example, regarding cancer screening, people typically overestimate the positive effects, and underestimates the potential for harm. Avoiding confusion is also essential because the methodologies involved in determining whether screening does more good than harm are quite complex and prone to misunderstanding by members of the public. Because screening is voluntary and cannot work without volunteers, avoiding suspicion should be a high priority both for clinical and public health professionals. Twenty years ago, Nicholas Wald, founding editor of the Journal of Medical Screening, advocated the careful usage of screening-related terms to “avoid confusion and suspicion”. Our present understanding is further impeded because distinct public health concepts such as ‘surveillance’ are defined as a type of screening in some clinical texts. The problem of terminological confusion was noted over 40 years ago. Authors list several different definitions and examples of ‘types’ of screening. Verbs and nouns mingle freely: people called ‘screeners’, using things called ‘screeners’, ‘screening tests’, or ‘screens’, look for gene mutations, the presence of antibodies or extreme physiological values, they might validate diagnostic and prognostic indicators, they may seek to uncover unhealthy domestic environments, or they might replace long versions of questionnaires with shorter ones. When textbooks are included, current usage of ‘screening’ now spans the detection of entities across the entire bio-psycho-social continuum, and from the primordial to the quaternary levels of prevention. It is a very popular publication subject: a 2016 search of PubMed for ‘screening program’ by the authors retrieved over 120,000 references a search for ‘screening test’ returned over 590,000 hits. Screening is a fundamental concept that links clinical practice in individuals, with public health practice in populations. ![]()
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