Categories of Screening
Screening is defined as the intervention used for the betterment of the health of a targeted population. The population in which the screening is done, all of the population is thought to be at risk. The health condition is a generalized problem of the population and screening is considered important for this population. It is being anticipated that the health condition is a generalized problem and the population is thought to be benefitted from the screening process. The screening is performed by conducting simple diagnostic tests of a large number of individuals by the paramedical staff (Dekker & Rex, 2018). It helps in getting the possibility or chances of getting affected by the health condition and getting the idea of the percentage of people affected. Although it is not a final diagnostic process, it shall not be taken casually. According to the Conference on Preventive Aspects of Chronic Disease, 1951, screening is a discovery of a disease or health condition that is not recognized through a series of tests and examinations that can be done quickly. It helps in sorting individuals who have more chances of having a disease than those who don’t have it. Individuals who have chances of being positive are referred for the screening through some quick diagnostic procedures (Raffle & Gray, 2019).
The types of screening are categorized according to their purpose according to Raffle and Gray which can be case finding screening, multiphase screening, mass screening, periodical health screening, targeted screening, opportunistic screening, and prescriptive screening.
This type of screening involves the combination of individual screening assessment and it is the coherent outcome of mass screening (Webb, Bain & Page, 2019). This screening is described by many authors as the screening that is done by performing more than one test at the same time of screening. Performing two or more diagnostic procedures at the same time will help in preventing efforts and time of the health personnel and is economical also.
This type of screening involves screening a large population together. The selection of a particular group of individuals is not done. For example, essential dental screening or essential yearly health checkups of all the individuals.
This type of screening is done to a particular group of populations that are at higher risk of a particular disease. The example that can be used for explaining case finding screening is the screening of middle-aged women for breast cancer as they are at higher risk of the same. Another example is dental health screening of school children for finding the case of fluorosis and caries.
This type of screening involves screening a particular group of the population who are at higher risk of getting infected because of their profession or occupation. For instance, asbestosis was found in most of the factory workers employed in the industry. Thus screening for lung diseases of the workers will help in getting the targeted cases. This can also be explained by screening for Hepatitis B being performed to all the health professionals as they are at higher risk of the same disease.
Multiphase Screening
There are many forms of screening for the early detection of many life-threatening diseases. Pieces of literature have shown that routine pap smear screening of all women of age 21 years or elder than that and those of sexually active women being performed regularly in 1 to three years helps in early detection of cervical cancer and can help in saving lives of many of them (Speechley & et al., 2017). Early detection of diabetes is done by performing routine fasting blood sugar tests of all the individuals who are at risk like, obese individuals, having a family history, pregnant females. This helps in the prevention of diabetic emergencies and can help in saving the lives of many people and help them in modifying their lifestyle at the right time. Osteoporosis can be detected in adults with age 50 or more if they have an eating disorder or metabolic disorder (Webb, Bain & Page, 2019). Regular checkup of blood pressure during the primary examination helps in the detection of hypertension and can help in getting treatment and lifestyle modifications on time. For detection of tuberculosis, a particular TB skin test is performed through the PPD test (purified protein derivative test). Likewise, early detection of breast cancer helps in saving many lives through regular mammography being performed on women aged 40 years or more or for women with a family history of breast cancer. Thus screening at regular intervals of different groups helps in the early detection of many diseases. It is a type of secondary prevention and helps in decreasing the mortality rate through particular health conditions.
According to WHO, surveillance is defined as a continuous collection of data, examination of data and scrutinizing it, and then broadcasting the outcomes or information to the organization that is required to take action on them (Thacker, Parrish & Trowbridge, 1988). US Centres of Disease Control and Prevention defines surveillance as enduring collection, scrutinizing, and then getting the outcome of the health-related data that is required and important for further planning, implementing, and evaluating a health practice of the public. It helps by closely studying the data and then sharing it with required authorities that work on the betterment of public health (Thacker & et al., 2012).
Surveillance is done as it helps in following the trends of the status of health in a particular frame of time. It also helps in determining the healthcare priorities and planning the future programs according to the group who need interventions on a priority basis. Surveillance also helps in detecting the epidemics and responding well to tackle the epidemics. Lastly, it helps in evaluating the efficiency of the health care programs and public health services. It is better than surveys as the information that is got in surveillance is more accurate and timely and thus helps in easy monitoring of trends also. Steps involved in surveillance are reporting, accumulation of data, analysis of data, and getting the judgment and action. The reporting includes, recording of data by health care professionals or health care provides like nurses, clinic officers, doctors, etc. the data is recorded through the filling of forms and then reporting them accordingly. The second step is the accumulation of data, in which all the reported data is collected and accumulated at one place. This is usually done by the health ministry, and surveillance authorities. Thirdly, the collected data is analyzed through calculation of rates, changes in the rates, mortality, etc. This work is performed through epidemiologists who are specialized and professionals in epidemiology. Lastly, the public health systems at different levels like local, state-level, or national level, study the results and decide the course of action required accordingly. This judgment is done stepwise like from local, to state, and then to the national level. In case of emergencies, the judgment is taken through the coordination of organizations of all levels (Vitale & et al., 2020). Not a single step must be missed as all the need to be taken care of during the surveillance.
Mass Screening
There are two types of surveillance, passive surveillance and active surveillance.
In passive surveillance, the data of the disease is gathered from all the health care providers and health care workers. In this surveillance, the health care workers are not provided with any stimulus for the reporting, or they are not reminded continuously for collecting the data. An easy example to understand passive surveillance is getting the number of road accidents happening in a particular year. For this, the health care authority does not stimulate the hospitals to collect any data. Instead, the authorities just collect the number of trauma cases treated in a hospital (Webb, Bain & Page, 2019). It is a commonly used surveillance method. Most of the communicable diseases are calculated through passive surveillance. Training is provided to the health care providers for collecting the data and filling the forms given to them. These forms are then collected at regular intervals and are then analyzed and calculated.
In active surveillance, the health care providers are given stimulus in the form of rewards or incentives for collecting the data and reporting them correctly. They are being monitored regularly and have also been given feedback on their reporting. The feedback helps them in getting their mistakes and improving accordingly. More time is needed in performing active surveillance and thus it is not an appropriate choice in emergencies but the results obtained are better than passive as it is more accurate and complete (Gervasi & et al., 2020). It is indicated during the beginning of an outbreak. An example of active surveillance is the polio vaccination drive initiated to eradicate polio. In this drive, health care providers are given extra incentives for getting the children vaccinated and collecting the data of who is vaccinated and who is left. This way the workers work more efficiently and give an extra effort in getting the reports.
References
Dekker, E., & Rex, D. K. (2018). Advances in CRC prevention: screening and surveillance. Gastroenterology, 154(7), 1970-1984. https://doi.org/10.1053/j.gastro.2018.01.069
Evans, M. I., Galen, R. S., & Britt, D. W. (2005). Principles of screening. Seminars in perinatology, 29(6), 364–366. https://doi.org/10.1053/j.semperi.2005.12.002
Gervasi, V., Marcon, A., Bellini, S., & Guberti, V. (2020). Evaluation of the efficiency of active and passive surveillance in the detection of African swine fever in wild boar. Veterinary sciences, 7(1), 5. https://doi.org/10.3390/vetsci7010005
Hirai, A. H., Kogan, M. D., Kandasamy, V., Reuland, C., & Bethell, C. (2018). Prevalence and variation of developmental screening and surveillance in early childhood. JAMA pediatrics, 172(9), 857-866. doi:10.1001/jamapediatrics.2018.1524
Raffle, A. E., & Gray, J. M. (2019). Screening: evidence and practice. Oxford University Press, USA.
Scheinberg I. H. (1970). Screening in medical care: Reviewing the evidence, a collection of essays. American Journal of Human Genetics, 22(3), 358–360.
Speechley, M., Kunnilathu, A., Aluckal, E., Balakrishna, M. S., Mathew, B., & George, E. K. (2017). Screening in Public Health and Clinical Care: Similarities and Differences in Definitions, Types, and Aims – A Systematic Review. Journal of clinical and diagnostic research : JCDR, 11(3), LE01–LE04. https://doi.org/10.7860/JCDR/2017/24811.9419
Thacker, S. B., Qualters, J. R., Lee, L. M., & Centers for Disease Control and Prevention. (2012). Public health surveillance in the United States: evolution and challenges. MMWR Surveill Summ, 61(3), 3-9.
Vitale, M., Lupone, C. D., Kenneson-Adams, A., Ochoa, R. J., Ordoñez, T., Beltran-Ayala, E., … & Stewart-Ibarra, A. M. (2020). A comparison of passive surveillance and active cluster-based surveillance for dengue fever in southern coastal Ecuador. BMC Public Health, 20(1), 1-10. https://doi.org/10.1186/s12889-020-09168-5
Webb, P., Bain, C., & Page, A. (2019). Essential epidemiology: An introduction for students and health professionals (4th ed.). Cambridge University Press.
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