Document Detail


Development and evaluation of tuberculosis screening scores in Brazilian prisons.
MedLine Citation:
PMID:  16965796     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Tuberculosis (TB) is highly endemic in Rio de Janeiro State prisons. In addition to TB screening at entry and passive case detection, active case identification may be warranted. OBJECTIVES: To develop and evaluate performances of scores aimed at identifying "tuberculosis suspects" in order to target TB screening among inmates. METHODS: Systematic chest X-ray screening was carried out in two prisons (n=1910). TB was diagnosed among individuals with X-ray abnormalities by sputum microscopic examination and culture or, if bacteriological results were negative, by response to TB treatment. Using this strategy as a reference, the clinical score proposed in WHO guidelines "TB Control in Prisons" was evaluated. Using the same variables in a logistic regression comparing TB and non-TB cases, another score was developed and evaluated. Finally, a 'new score', based on socio-demographic and clinical variables was developed and evaluated. RESULTS: When applied to our study population (prevalence of active TB: 4.6%), these scores missed many TB cases (sensitivities: 56%, 72%, 74%, respectively). Among the "TB suspects", the probability of finding TB cases was low (positive predictive value: 10%). The scores had high negative predictive values (>97%); specificities (75%, 60%, 67%) were low. Performances were similarly poor for smear-negative and smear-positive cases. CONCLUSION: The scores investigated performed poorly and would be unhelpful to target TB screening. Therefore, systematic X-ray screening may be considered, at least during the initial stages of the reinforced TB programme, in order to reduce the impressive burden of TB.
Authors:
N Fournet; A Sanchez; V Massari; L Penna; S Natal; E Biondi; B Larouzé
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2006-09-11
Journal Detail:
Title:  Public health     Volume:  120     ISSN:  0033-3506     ISO Abbreviation:  Public Health     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-09     Completed Date:  2006-12-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376507     Medline TA:  Public Health     Country:  England    
Other Details:
Languages:  eng     Pagination:  976-83     Citation Subset:  IM    
Affiliation:
INSERM, UMR-S 707, Université Pierre et Marie Curie, Paris 6, Paris F-75012, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Distribution
Brazil / epidemiology
Endemic Diseases
Humans
Logistic Models
Male
Mass Chest X-Ray / utilization
Mass Screening / methods*,  standards
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prevalence
Prisoners / statistics & numerical data*
Prisons
Sputum / microbiology
Tuberculosis / diagnosis*,  epidemiology*,  radiography
World Health Organization

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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