BACKGROUND: The colorectal cancer (CRC) screening program B-PREDICT is a population based invited two stage screening project using a faecal immunochemical test (FIT) for initial screening followed by a colonoscopy for those with a positive FIT. B-PREDICT was compared with the opportunistic screening colonoscopy (OPP-COL), performed in course of the nationwide screening program.
METHODS: Within B-PREDICT all residents of the Austrian federal state Burgenland, aged between 40 and 80 are annually invited to FIT testing. All individuals who underwent initial colonoscopy in Burgenland between 01/2003 and 12/2014, were included in this study. Individuals from the FIT-triggered invited screening program B-PREDICT were compared with those from the non-FIT triggered OPP-COL.
RESULTS: 15 133 individuals from B-PREDICT were compared to 10 045 individuals with OPP-COL. CRC detection rates were 1.34% (CI-95%, [1.15; 1.52]) in B-PREDICT compared to 0.54% in OPP-COL (95%-CI, [0.39; 0.68] p < 0.001). The decrease in the age standardized incidence rates of CRC was more pronounced in the population screened with FIT than in the general population screened with colonoscopy. Changes in incidence rates per year were -4.4% (95%-CI, [-5.1; -3.7]) vs. -1.8% (95%-CI, [-1.9; -1.6] p < 0.001).
CONCLUSIONS: B-PREDICT shows a two-fold higher detection rate of CRC as well as HRA compared to OPP-COL.

Two-stage screening, involving a self-rating report, followed by a structured interview, has been proposed for identifying clinical high risk of psychosis (CHR) for nearly two decades. This study used PRIME Screen-Revised (PS-R) and Structured Interview for Prodromal Syndromes (SIPS) to investigate the predictive validity of the two-stage screening. Of 566 participants who completed two-stage screening in this study, 192 were PS-R(-) and 374 were PS-R(+). After being interviewed with SIPS, 112 were rated as CHR(+), 109 were diagnosed with psychosis, and the other 345 individuals were CHR(-). Those who were rated through SIPS as CHR(+) and CHR(-) were followed up within 2 years to observe their clinical outcome. Ninety one (81.3%) CHR(+) and 171 (49.6%) CHR(-) individuals completed the investigation at baseline and the two-year follow-up. The cumulative conversion rate to psychosis was 27.5% in CHR(+) group, but only 1.7% in CHR(-) group, with a significant difference between the two groups (log-rank test, χ2 = 30.07, p < 0.001). In terms of two-stage screening, PS-R(-)/CHR(-), PS-R(-)/CHR(+), and PS-R(+)/CHR(-) groups were viewed as expected negative (EN), and the PS-R(+)/CHR(+) group as expected positive (EP), and the sensitivity and specificity was 64.3% and 79.1%, respectively. Furthermore, Kaplan-Meyer survival analysis showed that EP group were more likely to convert to psychosis than EN group (log-rank test, χ2 = 16.702, p < 0.001). Two-stage screening indeed saves much time and alleviates the workload, but may exclude some target individuals. Optimizing self-report scale, and forming a nurse-doctor-interviewer coalition are likely to improve the use of self-rating report and structured interview.

BACKGROUND: This study examined the operating characteristics of two-stage case finding to identify memory impairment and very mild dementia.
METHODS: Primary care patients underwent two-stage testing and a subsequent diagnostic assessment to assess outcomes. Patients who screen positive for subjective cognitive decline on the Informant Questionnaire on Cognitive Decline in the Elderly undergo memory testing with the Free and Cued Selective Reminding Test with Immediate Recall. Outcomes were determined without access to these data. A split-half design with discovery and confirmatory samples was used.
RESULTS: One hundred seventeen of 563 (21%) patients had dementia and 68 (12%) had memory impairment but not dementia. Operating characteristics were similar in the discovery and confirmatory samples. In the pooled sample, combined, patients with memory impairment or dementia were identified with good sensitivity (72%) and high specificity (90%). Differences in ethnicity, educational level, or age (≤75, >75) did not affect classification accuracy.
CONCLUSIONS: Two-stage screening facilitates the efficient identification of older adults with memory impairment or dementia.

Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded \"Saving and Empowering Young Lives in Europe\" (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE\'s two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician\'s motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and negative life events (35%) were the main reasons for referrals. Thus, not only the classical psychopathological symptoms, such as depression, anxiety, and suicidal behaviours, but also negative life events and poor social relationships (especially isolation) motivate referrals for treatment.