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Aim: Selective screening for gestational diabetes is still a subject of debate. The aim of this study was to determine the effectiveness of a selective screening strategy for diagnosing gestational diabetes in our setting. This strategy rests on a scoring system that assigns women to different risk categories according to the presence of risk factors such as overweight, older age and ethnicity. Methods: We compared the rate of diagnosed gestational diabetes according to universal screening and selective screening between two periods of time. Results: The selective screening strategy allowed only 15% of women to avoid screening and was associated with a 50% decrease in diagnosed gestational diabetes. Conclusion: The two-threshold approach did not detect similar proportions of women with gestational diabetes compared with universal screening. Half the cases were missed and most women still needed to be screened. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background. There is no worldwide agreement on the best way to screen for gestational diabetes mellitus (GDM), and different diagnostic methods have been developed in order to identify women at risk. The aim of this study was to evaluate the prevalence and predictive value of the traditional risk indicators for GDM in a large group of Caucasian women. Methods. We evaluated the frequency distribution of age, body mass index (BMI), prior macrosomia, prior GDM, and family history of diabetes of 1,414 pregnant women with GDM and 1,011 healthy pregnant women. Results. The distribution of risk factors in both groups was different and significantly higher in GDM women. The cut-off value for age was 28years, and 23kg/m2 for BMI. The accumulation of two or more risk factors was frequent in GDM, but not in healthy women. By multiple logistic regression, there were significant interactions between independent variables of interest and GDM (OR: 3.19; p<0.001; sensitivity: 57.9%, specificity: 69.8%). The strongest predictors were prior GDM (OR: 4.35; 95% CI: 2.42-7.82) and a family history of diabetes (OR: 3.03; 95% CI: 2.47-3.72); less predictive were age (OR: 1.69; 95% CI: 1.44-1.99), BMI (OR: 1.50; 95% CI: 1.28-1.77), and prior macrosomia (OR: 1.64; 95% CI: 1.19-2.26). Conclusions. Selective screening based on traditional risk factors for GDM had relatively low sensitivity, and identified <60% of Caucasian women at risk. The cut-off value for BMI as a risk indicator (23kg/m2) was lower than that proposed by guidelines about screening for GDM. [ABSTRACT FROM AUTHOR]

Abstract: Objective. – Screening strategies for gestational diabetes mellitus are controversial. Thus, we sought to determine the benefits of universal screening. Patients and methods. – Prospective study with 2121 women involved but 1610 really screened (75.9%). According to WHO''s recommendations, the strategy implemented was one-step, universal screening with a 75g oral glucose tolerance test. Screening was performed between 24 and 28 weeks of gestation or earlier if risk factors were identified. Results were compared to previous year (2001) then only a selective screening was done. Results. – Application of universal screening increased the prevalence of gestational diabetes mellitus (8.39% to 15.65%). Out of the 252 patients with gestational diabetes, 66 did not display any identified risk factor (26.19%). Some new risk factors have been identified: age>30, Asian, Indian or Pakistan ethnies. If these new risk factors were applied, this super selective screening would have a sensibility of 96%. Discussion and conclusion. – Universal screening seems to be the most appropriate routine screening strategy because it is difficult to know exactly the specific risk factors of a population to do a super selective screening. [Copyright &y& Elsevier]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We assessed if selective screening for gestational diabetes mellitus (GDM) as recommended by the Fourth Workshop on GDM is worthwhile in our centre. Detection is performed using universal screening in three pregnancy periods using the tests recommended by the first three Workshops. We have analysed the prevalence of low-risk characteristics for GDM in the 917 women delivering in the centre in 1992 and in the whole cohort of 1635 women with GDM delivering between 1986 and 1998. The rate of women with all low risk characteristics was 7.0% among the general pregnant population and 1.3% in the cohort of women with GDM (p<0.001). We conclude that in our population, selective screening of GDM is reliable in identifying women at low risk of GDM, but since only a negligible subset of the pregnant population would not need to be screened, adherence to these guidelines would make the screening policy unnecessarily complicated. [ABSTRACT FROM AUTHOR]

Objective : To evaluate the incidence of gestational diabetes in our population and verify costs of universal screening. To assess neonatal and obstetrical outcomes with respect to maternal epidemiological characteristics. Methods : Eight hundred and fifty-six pregnant women between 24th and 28th weeks of gestation were examined in this observational study. Universal screening with glucose challenge test was used to screen the group for gestational diabetes. History, obstetrical and neonatal outcomes were collected and then analyzed. Results : Gestational diabetes was diagnosed in 6.6% of cases. Patients with at least one risk factor had a cesarean section in 50% of cases and a spontaneous vaginal delivery in 23.59% of cases ( p < 0.001). The absence of any risk factor was found in 73.7% of positive glucose tolerance test and in 62.5% of affected patients. The cost of universal screening in our study, was 57,60 € per case identified. Conclusions : Given the high prevalence of diabetes, the high proportion of patients potentially not identified with a selective screening in this study and the relatively low cost, universal screening for gestational diabetes seems the best way to identify patients and prevent adverse obstetrical and neonatal outcomes. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of a population-based risk factor scoring to decrease unnecessary testing for the diagnosis of gestational diabetes mellitus (GDM). We formed a risk factor scoring over five, which questions maternal age, body mass index and first-degree relatives with a diagnosis of diabetes mellitus, a prior macrosomic fetus and adverse outcome during the previous pregnancies. All participants underwent a 50-g glucose challenge test (GCT) followed by a 100-g oral glucose tolerence test (OGTT). We opened the 50-g GCT envelope if the participant had a risk score ≥ 1 and opened the 100-g OGTT envelope if the 50-g GCT value was ≥ 7.2 mmol/l. After all patients delivered we also built other strategies and tested their detection rates. Fourteen patients (3.3%) were diagnosed as having gestational diabetes mellitus via a 100-g OGTT. None of the patients with a score of zero had gestational diabetes mellitus. Logistic regression analysis revealed that an increase in the score by one caused a three times increase in gestational diabetes mellitus risk (OR = 3, CI = 1.9–5). Compared with the universal screening, our strategy to screen if the risk score was ≥ 1, followed by a 50-g GCT with a 7.2-mmol/l cut-off value, decreased the number of women to be screened by 30% and diagnosed all cases with GDM. Screening the patients with a score ≥ 2 would have decreased the number of women to be screened by 63%, still diagnosing 85% of cases with GDM. Also, risk factor-based screening strategies cause a 50% and 53% reduction in the number of OGTT applied, respectively. A well integrated, population-based scoring will decrease the number of unnecessary testing but still diagnose 85–100% of GDM cases. [ABSTRACT FROM AUTHOR]

Objective: To test whether information simply obtained from adults can identify those who are likely to have blood cholesterol levels higher than 6.5 mmol/L (250 mg/dl).Design: Cross-sectional study.Setting: Seven general practices in the lower Hunter Region of Australia.Participants: Of 693 men and women 25 to 65 years old attending the general practices, 616 (89%) participated. Twelve pregnant women and four without blood samples were excluded, leaving 600 subjects (208 men, 392 women).Measurements and Main Results: Twenty-two percent of subjects had blood cholesterol higher than 6.5 mmol/L (250 mg/dl). In women, high cholesterol was mainly found among those over 40 years of age, but in men high cholesterol was more evenly spread across the different age groups. Stepwise logistic regression identified age, history of hypertension, and a past history of heart attack as significant independent predictors of high cholesterol. A simple model developed from these variables identified 81% of men and women (95% CI = 72-90%) with high cholesterol while testing only 49% of the population (95% CI = 44-54%). This model was developed in a random subset of 331 of the 600 subjects, and when applied to the remaining 269 subjects, it identified 77% of those with high cholesterol (95% CI = 67-87%) after testing 48% (95% CI = 42-54%).Conclusions: Selective screening using this simple model can identify adults who are likely to have high blood cholesterol and could complement case-finding or provide an alternative high-risk strategy for communities that cannot afford to screen all individuals. [ABSTRACT FROM AUTHOR]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: Atrial fibrillation (AF) is associated with higher risk of stroke. While the prevalence of AF is low in the general population, risk prediction models might identify individuals for selective screening of AF. We aimed to systematically identify and compare the utility of established models to predict prevalent AF., Methods and Results: Systematic search of PubMed and EMBASE for risk prediction models for AF. We adapted established risk prediction models and assessed their predictive performance using data from 2.5M individuals who attended vascular screening clinics in the USA and the UK and in the subset of 1.2M individuals with CHA2DS2-VASc ≥2. We assessed discrimination using area under the receiver operating characteristic (AUROC) curves and agreement between observed and predicted cases using calibration plots. After screening 6959 studies, 14 risk prediction models were identified. In our cohort, 10 464 (0.41%) participants had AF. For discrimination, six prediction model had AUROC curves of 0.70 or above in all individuals and those with CHA2DS2-VASc ≥2. In these models, calibration plots showed very good concordance between predicted and observed risks of AF. The two models with the highest observed prevalence in the highest decile of predicted risk, CHARGE-AF and MHS, showed an observed prevalence of AF of 1.6% with a number needed to screen of 63. Selective screening of the 10% highest risk identified 39% of cases with AF., Conclusion: Prediction models can reliably identify individuals at high risk of AF. The best performing models showed an almost fourfold higher prevalence of AF by selective screening of individuals in the highest decile of risk compared with systematic screening of all cases., Registration: This systematic review was registered (PROSPERO CRD42019123847)., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Combined oral contraceptives (COCs) increase the risk of venous thromboembolism (VTE), particularly among women with inherited clotting disorders. The World Health Organization classifies combined hormonal contraception as an "unacceptable health risk" for women with thrombogenic mutations but advises against universal thrombophilia screening before prescribing COCs given the low prevalence of thrombophilia and high screening costs., Objective: Through the lens of lifetime costs and benefits, this paper systematically and critically reviews all published economic evaluations of thrombophilia screening prior to prescribing COCs., Methods: We searched relevant databases for economic evaluations of thrombophilia screening before prescribing COCs. After extracting the key study characteristics and economic variables, we evaluated each article using the Quality of Health Economic Studies (QHES) and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) instruments., Results: Seven economic evaluations of thrombophilia screening before prescribing COCs met our inclusion criteria. Only the two economic evaluations focusing exclusively on selective screening exceeded the 75-point threshold for high-quality economic studies based on the QHES instrument, whereas only one of these exceeded the 85% CHEERS threshold. Only three of the seven economic evaluations performed sensitivity analysis on key parameters. Most studies underestimated the benefits of thrombophilia screening by comparing one-time costs of genetic screening against benefits per person-year, thus implicitly assuming a 1-year duration of COC use, neglecting the long-term implications of VTE and/or neglecting the lifetime benefits of awareness of inherited thrombophilia., Conclusion: Our review highlights the lack of methodologically rigorous economic evaluations of universal thrombophilia screening before prescribing COCs.

Background: Inborn errors of metabolism (IEM) are disorders with a block in the metabolic pathway caused by a genetic defect of a specific enzyme. Although each of these diseases is quite rare, as a group they account for a significant proportion of newborn and childhood morbidity and mortality. Early diagnosis is important to prevent complications or even death of the child. Selective screening is an important diagnostic tool for the diagnosis of IEM., Methods: In Slovenia, symptomatic patients with suspected IEM are referred to the University Children's Hospital Ljubljana. Techniques used for selective screening are gas chromatography-mass spectrometry, ion exchange chromatography-post-column derivatization, liquid chromatography-tandem mass spectrometry and isoelectric focusing. Fluorimetric method is used for enzyme activity measurement., Results: There are 168 patients with amino and organic acidemias, 5 patients with disorders in fatty acids metabolism, 1 patient with a congenital disorder of glycosylation, 42 patients with Fabry disease (of which 37 are adult) and 20 patients with Gaucher disease (of which 18 are adult) in the Slovenian Register for Rare Diseases., Conclusions: In Slovenia, management of patients with IEM is centralized at the University Children's Hospital, with the exception of adult patients with Fabry and Gaucher disease. The team work is well organized with close cooperation between the laboratory and pediatricians specialized in metabolic disorders. According to the known frequencies of IEM from the literature, we would expect more positive results than obtained. To evaluate these results, we are planning to perform a pilot study on expanded newborn screening.

Issues related to selective screening are discussed. The distinction between test accuracy and program accuracy is presented in the context of impact on cost/true case detection, which in turn reflects the gain in specificity and loss in sensitivity for the total target population. When two or more risk factors are combined to define high-risk subjects, a gain in program accuracy and a relative reduction in cost/true case found ensue if there is additive interaction between these risk factors. The author also discusses periodicity of screening and emphasizes the inappropriateness of using the notion of risk for disease occurrence as a criterion to define periodicity. [ABSTRACT FROM AUTHOR]