Effectiveness and efficiency of selective vs universal screening for chlamydial infection in sexually active young women.
Effectiveness and efficiency of selective vs universal screening for chlamydial infection in sexually active young women.
复制标题
性活跃的年轻女性衣原体感染选择性与普遍筛查的有效性和效率。
DOI：
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复制
发表时间：
1992
影响因子：
--
通讯作者：
Max Chernesky
中科院分区：
文献类型：
--
作者：
J. Sellors;Laura Pickard;Amiram Gafni;Charles H. Goldsmith;D. Jang;Jim Mahony;Max Chernesky
背景
由于衣原体宫颈炎与特定的投诉无关，筛查无症状的妇女是预防盆腔炎及其后遗症的重要举措。与普遍筛查相比，选择性筛查成本较低，但效果较差，因此需要仔细权衡节省的成本与遗漏感染妇女的后果。
方法
在两个计划生育诊所，1002名妇女进行了调查，衣原体感染（患病率，7%），其预测因素，以确定是否普遍或选择性筛查是最有效的策略。两个规则的选择患者的logistic回归模型和增量成本效益和敏感性分析比较其相对效率。在191名学生参加大学健康诊所的筛选规则的有效性进行了测试。
结果
如果对宫颈脆弱、可疑分泌物、尿频或经间期出血的妇女进行检测，55.3%的妇女将接受筛查，83.3%的病例将被发现。如果那些在前一年报告有新性伴侣的人也接受了检测，那么75.4%的人会接受筛查，从而确定了所有病例的93.3%。选择规则的预测能力和实用性进行了验证，在大学卫生诊所样本。敏感性分析显示，如果衣原体感染的患病率为16%或更低，11%或更低，或5%或更低，则使用宫颈酶免疫分析与阻断确认进行选择性筛查是有效的，这取决于是否分别使用基础分析，高估成本或最差性能方案。
结论
选择性筛查的基础上，四个或五个预测和确认宫颈酶免疫测定是一个有效和高效的战略，在低患病率的设置。
BACKGROUND
Since chlamydial cervicitis is not associated with specific complaints, screening asymptomatic women is an important initiative to prevent pelvic inflammatory disease and its sequelae. Compared with universal screening, selective screening is less costly but less effective so the cost savings vs the consequences of missing infected women need to be weighed carefully.
METHODS
In two family planning clinics, 1002 women were surveyed for chlamydial infection (prevalence, 7%) and its predictors to determine whether universal or selective screening is the most efficient strategy. Two rules for the selection of patients were determined by logistic regression modeling and their relative efficiencies were compared by incremental cost-effectiveness and sensitivity analysis. The validity of the screening rules was tested in 191 students attending a university health clinic.
RESULTS
If those with cervical friability, suspicious discharge, urinary frequency, or intermenstrual bleeding had been tested, 55.3% of all women would have been screened and 83.3% of all cases would have been detected. If those reporting a new sex partner in the preceding year had also been tested, 75.4% would have been screened, identifying 93.3% of all cases. The predictive power and practicality of the selection rules were validated in the university health clinic sample. Sensitivity analyses showed selective screening using cervical enzyme immunoassay with blocking confirmation was efficient if the prevalence of chlamydial infection was 16% or less, 11% or less, or 5% or less depending on whether base analyses, overestimated costs, or worst performance scenarios, respectively, were used.
CONCLUSIONS
Selective screening based on four or five predictors and confirmed cervical enzyme immunoassay is an effective and efficient strategy in low prevalence settings.
荧光素偶联单克隆抗体测试检测青春期女孩沙眼衣原体宫颈内感染的评估。
DOI：
10.1016/s0022-3476(86)81068-x
发表时间：
1986
期刊：
The Journal of pediatrics
影响因子：
--
作者：
Shafer,MA;Vaughan,E;Lipkin,ES;Moscicki,BA;Schachter,J
通讯作者：
Schachter,J
对到计划生育诊所就诊的妇女进行衣原体感染筛查。
DOI：
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发表时间：
1983
期刊：
The Western journal of medicine
影响因子：
--
作者：
Schachter,J;Stoner,E;Moncada,J
通讯作者：
Moncada,J
对沙眼衣原体引起的生殖器感染中等风险的女性进行筛查的成本效益。
DOI：
--
发表时间：
1988
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
Nettleman,MD;Jones,RB
通讯作者：
Jones,RB