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The sensitivity of the programme remained low, however, at 37.5% overall, similar in both sexes.
At the population level the sensitivity of the programme was 37.5%.
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STRATEGY AND IMPLEMENTATION Findings from the assessment led to capacity building of CFS staff and a re-design of activities to improve the quality and gender-sensitivity of the programme.
The sensitivity of the surveillance programme can be simulated to range from 50%to100%0%.
The mean grading sensitivity of the DRS programme in 2010 was 91.1% (SD 4.3) [ 24].
Thus, the comparative sensitivity of the screening programme under the two approaches is not known, and empirical data will be needed in order to estimate this.
The various approaches and related biases probably explain much of the variability in the estimates of overdiagnosis, although we cannot quantify the contribution of heterogeneity in the sensitivity of the screening programme and baseline characteristics of the population.
A numerical example (Table 4) shows that given the number of samples examined with tests A, F and G in Estonia (4092) and in Lithuania (1933) the probability that no case is detected (given the assumed "design prevalence" of 0.65), even with a perfect sensitivity of the surveillance programme (Se = 100%) is higher than 5% (respectively 7% and 30%).
Assuming that the detection of an AS case is a Bernoulli variable that follows a binomial distribution (cases are assumed to be independent), the probability to detect no case of AS among n tests is: P (X = 0 ) = C n 0 × (p × S e ) 0 × (1 − p × S e ) n = (1 − p × S e ) n Where p is the prevalence of AS and Se the diagnostic sensitivity of the surveillance programme.
Data are lacking, however, on the sensitivity of the monitoring programmes, as designed under the EU Drinking Water Directive.
This is probably due to a low overall sensitivity of the surveillance programmes.
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