selective screening. This gap between national recom- mendation and the actual practice invites policy makers to re-evaluate the current situation and decide whether a stricter selective screening or formal move to universal screening is appropriate in Israel. Until a formal change in the national policy (which might take quite a long time), we suggest a number of steps that might be taken: refreshment of guidelines in tandem with discussions of uncertainty and other clinical and organizational issues; distribution of personal referral patterns among prac- ticing physicians; and redefinition of referral patterns in the form of organizational quality measures while setting annual targets.
This study highlights the necessity for universal screening for GDM. Using selective screening for GDM, only 3.7% of our patients were screened and only 3.3% of our patients were diagnosed using the new WHO criteria. In contrast, in our 2014 prospective study, using the new WHO Criteria, 15.2 % of our patients were diagnosed with GDM . This is the corollary of selective screening as the norm. Pregnancy provides a unique opportunity to screen for, diagnose and manage certain clinical conditions. Gestational Diabetes Mellitus (GDM) is one such condition wherein exists an opportunity to educate the women and promote lifestyle modifications for enhanced health of the entire family. Selective risk based screening of pregnant women for GDM miss a lot of cases thus missing the opportunity for early therapeutic intervention . These women are thus never properly managed
Universal screening is the rec- ommended approach in nearly 80% of the reviewed guidelines, with only two recommending selective screening. Although settings with weak health systems might struggle to implement a universal screening approach, selective screening would risk missing up to 43% of cases (21), and selection would be com- plicated given the nature of some of the most common risk factors used to determine the need for screening. For example, in settings that do not perform routine screening, women’s history of previous GDM is likely to be underreported. Likewise, eth- nicity as a risk factor would qualify all patients in African, Asian, and Latin American settings as high risk. Situations such as these underscore the importance of universal screening in such populations. Furthermore, studies have shown that there is low compliance to risk factor–based screening guidelines, which has resulted in 70% of pregnant women with existing risk factors not being screened for GDM (22).
The prevalence of hyperglycaemia first detected in preg- nancy was 31.9 with 95% of them being diagnosed with GDM and 5% DM in pregnancy. Selective screening of women with only risk factors may miss up to 23.8% women with the condition in our setting. Despite treat- ment, women with hyperglycaemia still gave birth to bigger babies. Clinicians should be more vigilant to screen mothers with hyperglycaemia. The hospital should consider universal screening of hyperglycae- mia first detected in pregnancy. However cost/benefit implications of screening strategies and the recent 2013, WHO diagnostic criteria and classification of hypergly- caemia first detected in pregnancy need to be studied in our setting.
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RESULTS. A good-quality retrospective study of children with hearing loss indicates that those who had early versus late confirmation and those who had undergone uni- versal newborn screening versus none had better receptive language at 8 years of age but not better expressive language or speech. A good-quality nonrandomized trial of a large birth cohort indicates that infants identified with hearing loss through universal newborn screening have earlier referral, diagnosis, and treatment than those not screened. These findings are corroborated by multiple descriptive studies of ages of referral, diagnosis, and treatment. Usual parental reactions to an initial nonpass on a hearing screen include worry, questioning, and distress that resolve for most parents. Cochlear implants have been associated with higher risks for bacterial meningitis in young children.
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RESULTS: Usable responses from 254 of 574 eligible respondents (44%) were received. Respondents were 54% male and 84% white. Almost half were aware of the NCAA policy, with highest awareness in members of COSMF (P ⬍ .001). Only 40% supported universal screen- ing, whereas 70% supported targeted screening of athletes in all NCAA divisions and would focus on black student-athletes more than on Hispanic or white-Mediterranean student-athletes (no differences among AAP sections/council). More than 75% of all respondents sup- port allowing athletes or their parents to waive screening. A majority expressed some concern that athletes with SCT might experience dis- crimination in sports participation and/or insurance. Members of COSMF were least concerned about discrimination.
babies with risk factors. A study from Ghirri et al.  reported a prevalence of 6.1% in the Pisa hospital; Molini  reported a prevalence of 3.8% in Umbria. Data from the literature describe a prevalence between 3% and 5% of neonatal risk factors for hearing loss in the general population. In the Lazio region, the number of children with neonatal or maternal risk factors was not tracked at a central level, and therefore this data was not included in the present study. Secondarily, but not less important, age of patients included in third stage evaluation is un- known. Data for this stage were received directly from Level III facilities and were collected using different methodologies. Taken into account that all patients in Level III facilities followed the entire screening protocol, it could be assumed that diagnoses were performed within the first year of life. However, missing age data did not allow us to exactly evaluate the mean age of diagnosis. Moreover, no information about the beginning of audiological treatment was received.
There are 2 principal drawbacks to the cohort de- sign. The first is the potential bias created by com- paring populations that may differ with respect to a number of variables in addition to the variable in question (screening). State populations may differ with respect to factors such as socioeconomic status, racial mixture, disease prevalence, health care ser- vices, insurance coverage, and efficacy of the NBS programs. If differences in morbidity or mortality rates are found between cohorts, there may be resid- ual concern that the explanation does not depend on screening. The second problem inherent in the cohort design in this context involves the ability to identify and to monitor affected individuals in the un- screened cohort. A screening program establishes the population prevalence at an individual level and creates the infrastructure for tracking. Without a screening program, there is unlikely to be a compre- hensive registry of affected children. Furthermore, children who might have died at a young age as a result of the condition might not have been identified as affected or their condition might not have been recorded in a retrievable manner. Many affected chil- dren may be known to subspecialty physicians in regional referral centers, but these are likely to be more severely affected children.
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We conducted an anonymous, self-administered, cross- sectional survey of outpatients at five clinics at Harbor- view Medical Center, a public urban hospital and regio- nal trauma center in Seattle, WA, to define the importance that patients place on testing for HCV, com- pared to HIV and diabetes mellitus. We included HIV as testing requires special consent procedures, thus uni- versal screening for HIV might raise additional concerns relative to HCV. We included diabetes because a man- ner of universal screening is already de facto present in every chemistry panel with a glucose result, but consent is not consistently obtained and normal results may be inconsistently discussed with patients (even abnormal results are only discussed with patients 66-88% of the time). This study was approved by the Human Sub- jects Division of the University of Washington.
The difference in proportion of children who were treated between age groups is heralded, at least in part, by the difference in numbers of children who were tested successfully. Specifically, the rate of successful screening for the 3-year-old children was 80%, whereas the rate of successful screening for the 4-year-old chil- dren was 94%. These success rates need to be considered as revised guidelines for vision screening in the medical home are developed. It is possible that universal pre- school vision screening can be achieved by focusing on a quality program with 4-year-old children. In fact, there is no adequate evidence that treatment for amblyopia at 3 years produces significantly better outcome than treat- ment at 4 years. Furthermore, the evidence from Scan- dinavia shows that screening at age 4 is effective in reducing the prevalence of amblyopia. 21
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The study was conducted as a survey to collect retro- spective data on children who were born in Austria and received a diagnosis of a PCHI at an Austrian ENT De- partment. Of a total of 35 institutions that are engaged in the diagnosis and habilitation of childhood hearing im- pairment, 15 participated. Using a standardized form, they submitted anonymized data on all children who had PCHI and were registered with them since 1990. The form asked for the child’s date of birth, date of diagnosis of hearing loss, degree and type of hearing loss (at iden- tification), and whether the child had undergone new- born hearing screening. When yes, the result of the screen (pass/fail/unknown) was to be specified. When the reason for referral to hearing assessment was other than a failed screen, it was to be indicated (eg, menin- gitis, parental concern). Data collection started in August 2003, after the study had received approval by the Ex- ecutive Board of the Austrian ENT Society, and ran until the end of December 2004.
The effective prevention programs were structured as self-help programs with either a self-help book, an online website or guided self-help with practitioner support or a mix of these delivery forms. Further, the only possible moderators or mediators identified in these studies were the mechanism of experiential avoidance in an acceptance and commitment- based indicated approach and scores on the neuroticism scale of the Big Five in a positive psychological universal approach (Schotanus-Dijkstra et al., 2017; Bohlmeijer et al., 2010). This turned out to be rather surprising due to the fact that the identification of risk- and vulnerability factors are essential in defining the target group for a selective prevention. However, the predictive power of experiential avoidance for individuals with generalized anxiety disorder was also supported elsewhere (Eustis, Hayes-Skelton, Roemer, & Orsillo, 2016), as well as supporting evidence for the association of anxiety with neuroticism (Paulus, Vanwoerden, Norton, & Sharp, 2016). According to Paulus et al. (2016), neuroticism and anxiety are associated via the factor of shame, and the universal prevention program identified in this review stated that low neuroticism scores accounted for more positive results on anxiety outcomes (Schotanus-Dijkstra et al., 2017). The positive effects of this intervention were therefore found in individuals that were not ashamed to participate, which was a big part of the included population. This means that a positive psychological approach may be promising with regard to the solution of the problem of stigma in prevention and treatment interventions.
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Recently, the Health Technology Assessment launched a call for an RCT assessing the effectiveness of GBS screening, which may address the uncertainty on the clinical benefits of screening. This should be complemented by research assessing the potential harms before we can be confident that universal screening is a safe undertaking. Additionally, research to more accurately identify the women at most risk of having a neonate with EOGBS could reduce the amount of overtreatment. Alternatively, advances are underway in the development of a GBS vaccine, which could avoid the concerns around screening and have the potential to prevent early and late onset GBS. 91
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The study also attempted to estimate the long-term economic effect of the NHS program in China. As the available data and evidence is limited and this is a very preliminary approach, only costs saving in rehabilitation and special education up to 15 years of age (at which children finish their compulsory education) were counted, potentially leading to an underestimate of the economic effect. Even so, the results showed that at the baseline, the costs saved already exceeded the imple- mentation costs in the targeted strategies; as the propor- tion of the benefit population expends, the economic effect would be more and more significant, especially in relation to universal strategies. Such results strongly support the implementation of the NHS program and suggest potentially greater benefits of adopting universal strategies in China.
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Follow up services are crucial for babies whose initial screening indicate hearing loss. It is important that children and families have access to 'habilitation' and intervention services as soon as possible after the diagnosis of permanent hearing loss. Delays to fitting amplification may occur due to problems with scheduling, the need for repeat tests, suspicion of auditory neuropathy/ dys-synchrony, and the cost of hearing aids. Delays in fittings are also likely for babies who are medically fragile. In our hospital set up, we provide intervention services such as hearing monitoring, hearing aid fitting, cochlear implant and referral to other professionals if required.
The Learning Disability Screening Questionnaire (LDSQ) was developed primarily to provide a short and effective screening instrument to indicate possible intellectual disability amongst per- sons who come in contact with the service system. This study examined the validity of the Norwe- gian version of LDSQ in a sample of 35 subjects. All participants were outpatients referred for neuropsychological examinations. WAIS-III full-scale score was used for criterion validity. At a stated cut-off score of 46.6%, LDSQ showed several false negatives and false positives but no true positives. This raises the question of whether this test represents a valid screening instrument for learning disabilities in a clinical sample.
Ascertainment o f ethnic status and explanation of the concept o f high risk groups is required for all antenatal women in a selective programme to determine who would qualify for screening on ethnic grounds*. The main distinction relevant for screening is between women o f non-North European and North European ethnic origin, the former indicating an increased risk o f Hb-pathy carrier status"^’^®. However, more refined classifications o f some groups at risk for trait, namely Chinese, South East Asian, and Eastern Meditarraneans, are necessary to guide interpretation and further investigations o f certain ambiguous screening results (section 126.96.36.199). Ethnic ascertainment in the context o f selective Hb-pathy screening could be linked to routine NHS ethnic monitoring, which is currently mandatory for admitted patients in England’*^, as most women are in hospital for the delivery o f their babies. However, the standard format currently used for NHS ethnic monitoring**^ would have to be adjusted to allow distinction between North European and several Mediterranean and other groups at risk for Hb disorders; and the importance o f ancestry would have to be emphasised if measurement were primarily based on self-definition"*. For the purpose o f the baseline analysis we have assumed no additional professional time required for ethnic ascertainment. However, in a sensitivity analysis we have relaxed this assumption and allowed additional midwifery time, guided by the average time found to be necessary for ethnic monitoring o f most patients in a primary care setting**^.
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Any child who received the TST as a screening assessment was eligible to participate in the survey portion of the study. Universal screening continued during most of the study and included: 1) 12-month-old infants seen at well-baby visits; 2) day care and kindergarten entrants; and 3) adolescents seen at routine health checks. During the final year of the study, most KPNC medical offices ceased to routinely test 12-month-old infants. Children were excluded from the study if: 1) the skin testing was performed because of illness; 2) corticosteroid agents had recently been used systemically; or 3) measles-containing or varicella vaccine was given within 3 weeks before the study began. We did not test for human immunodeficiency virus (HIV) status, but no children known to be infected with HIV were enrolled. We were unable to verify these criteria for the control children.
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Dr Grosse and colleagues, which involved a total of 53 781 new- borns, 70% (37/53) of the infants eventually identified as having moderate to profound bilateral sensorineural hearing loss had high-risk factors and/or were in special/ICNs. I stand by my statement that most of the infants with sensorineural hearing impairment detectable in the newborn period will be found by screening only newborns who meet HRR criteria and/or are ad- mitted to an ICN. 12
AABR was used to screen a large newborn popu- lation for bilateral hearing loss. The incidence of congenital bilateral loss in a large population of well infants has not previously been reported. Hearing loss identified in the well-infant population was re- mediable by amplification. The cost of identifying infants’ hearing loss at birth was a fraction of the anticipated cost of providing educational and com- munity services to people whose hearing loss is found later. We recommend a two-stage universal newborn screening protocol, amplification before age 6 months, and regular attendance of infants at aural habilitation sessions. We feel that further re- search is warranted for infants who have transient and fluctuating hearing losses because this group may benefit from temporary amplification. 73– 84
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