Disease Screening Program Research Articles

Age-stratified comparative analysis of the differences of gut microbiota associated with blood glucose level

BackgroundGut bacteria are an important component of the microbiota ecosystem in humans and other animals, and they play important roles in human health. The aim of this study was to investigate the relationship between gut microbiota and multiple demographical-, behavioral-, or biochemical-related factors in subjects with chronic disease. Subjects with a very wide age range who participated in community-based chronic disease prevention and screening programs in China were enrolled. We analyzed the intestinal microbiota composition using 16S rRNA-based high-throughput sequencing of fecal samples, analyzed the association between gut microbiota structure and multiple demographical, behavioral, and biochemical factors, and compared the differences in microbiota composition in age-stratified groups with different blood glucose levels.ResultsOur results showed that both age and blood glucose levels had a significant impact on the gut microbiota structure. We also identified several taxa showed distinct abundance in groups with different glucose levels. Lactobacillus and Bifidobacterium at genus level and their related taxa were more abundant in the GLU high group comparing with GLU normal group and in NGR group comparing with DM group. Further analysis using the age-stratified data showed that blood glucose levels had a more significant impact on the gut microbiota in the ≥76 y age group than in the ≤75 y age group, which indicated that it is necessary to take age into account when conducting such studies. Moreover, we identified several taxa that were highly associated with blood glucose levels in the ≥76 y age group but not in the ≤75 y age group. Within the ≥76 y age group, Lachnospiraceae incertae sedis and Bacteroides were more abundant in the GLU normal group, whereas Lactobacillus and Bifidobacterium at genus level were more abundant in the GLU high group.ConclusionsThis result suggested that taxa that are capable of differentiating blood glucose levels might differ significantly in different age groups.

Promoting health and well-being in prisons: an analysis of one year’s prison inspection reports

ABSTRACT There is renewed optimism about the development of policy and practices related to promoting health in prison settings, driven by the epidemiological data which suggests that the health of people in prison remains very poor. In England and Wales, the focus of this paper, independent prison inspections, conducted by Her Majesty’s Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. This includes efforts within prisons to promote health and well-being. This paper, using content and thematic analysis, analyses one year (2018) of inspection reports in 38 male prisons. Analysis demonstrates that a ‘whole-prison approach’ to promoting health and well-being is poorly understood, with only 41% of prisons showing characteristics of this approach. Of the male prisons inspected in 2018, there was good availability of disease prevention activities and screening programmes (88%) and smoking cessation support (94%). The provision of peer support mechanisms, access to condoms and access to health information was highly variable across prisons. The paper makes several conclusions about the state of health promotion in prison and moreover the current criteria adopted by HMIP to assess health and well-being which seems to offer a very narrow biomedical perspective.

Asymptomatic Inflammatory Bowel Disease and Colorectal Cancer Screening Programs: How Common Is It and What Should be Done About It?

The growing international popularity of screening programs for the early detection of pre-cancerous changes or early cancer in the colon has brought to the fore the issue of people with asymptomatic inflammatory bowel disease. What are the legal and clinical responsibilities for endoscopists and managers of screening programs towards such patients? This review assesses the magnitude of the problem and discusses the legal responsibilities, including human rights issues. In addition, it discusses whether such patients who do not have symptoms should be given active treatment.

409 Degree of Proteinuria and Hematuria, as Well as Ethnicity are the Factors Predicting Awareness of Proteinuria in the Community: Results from Kidney Disease Screening and Awareness Program (KDSAP)

409 Degree of Proteinuria and Hematuria, as Well as Ethnicity are the Factors Predicting Awareness of Proteinuria in the Community: Results from Kidney Disease Screening and Awareness Program (KDSAP)

410 High Prevalence, Low Awareness and Poor Control of Hypertension in the Community Setting: Lessons from the Kidney Disease Screening and Awareness Program (KDSAP)

410 High Prevalence, Low Awareness and Poor Control of Hypertension in the Community Setting: Lessons from the Kidney Disease Screening and Awareness Program (KDSAP)

The role of medical registries, potential applications and limitations.

Medical registries provide highly reliable data, challenged hierarchically only by randomized controlled trials. Although registries have been used in several fields of medicine for more than a century and a half, their key role is frequently overlooked and poorly recognized. Medical registries have evolved from calculating basic epidemiological data (incidence, prevalence, mortality) to diverse applications in disease prevention, early diagnosis and screening programs, treatment response, health care planning, decision making and disease control programs. Implementing, maintaining and running a medical registry requires substantial effort. Developing the registry represents a complex task and is one of the major barriers in widespread use of registries. Medical registries have potential to evolve to a next generation by taking benefit from recent semantic web technology developments. This paper is aimed at providing a summary of the basic information available on medical registries and to highlight the progress and potential applications in this field.

Clinical and other specialty services offered by pharmacists in the community: the international arena and Israel

The community pharmacy setting is a venue that is readily accessible to the public. In addition, it is staffed by a pharmacist, who is a healthcare provider, trained and capable of delivering comprehensive pharmaceutical care. As such, community pharmacists have a colossal opportunity to serve as key contributors to patients’ health by ensuring appropriate use of medications, preventing medication misadventures, identifying drug-therapy needs, as well as by being involved in disease management, screening, and prevention programs. This unique position gives the pharmacist the privilege and duty to serve patients in roles other than solely that of the stereotypical drug dispenser.Worldwide, as well as in Israel, pharmacists already offer a variety of pharmaceutical services and tend to patients’ and the healthcare system’s needs. This article provides examples of professional, clinical or other specialty services offered by community pharmacists around the world and in Israel and describes these interventions as well as the evidence for their efficacy. Examples of such activities which were recently introduced to the Israeli pharmacy landscape due to legislative changes which expanded the pharmacist’s scope of practice include emergency supply of medications, pharmacists prescribing, and influenza vaccination. Despite the progress already made, further expansion of these opportunities is warranted but challenging. Independent prescribing, as practiced in the United Kingdom or collaborative drug therapy management programs, as practiced in the United States, expansion of vaccination programs, or wide-spread recognition and reimbursement for medication therapy management (MTM) programs are unrealized opportunities. Obstacles such as time constraints, lack of financial incentives, inadequate facilities and technology, and lack of professional buy-in, and suggested means for overcoming these challenges are also discussed.

Building a sickle cell disease screening program in the Republic of Uganda: the Uganda Sickle Surveillance Study (US3) with 3 years of follow-up screening results

The prevalence of sickle cell disease (SCD) in the Republic of Uganda is higher than in the United States, but there are no accurate countrywide data and no newborn screening program has been established. The Early Infant Diagnosis (EID) program is well established to analyze dried blood spots (DBSs

Examining determinants of health service utilisation among Filipino older people: A cross-sectional study.

This study was done to study, using Andersen's Behavioral Model, factors affecting health service utilisation among older Filipinos. A total of 237 older people from Marikina City, Philippines, were randomly selected and surveyed face-to-face on factors affecting health service utilisation, specifically age, civil status, educational level, employment status, sex, health insurance coverage, household income, chronic disease status and perceived health status. Seventy-nine per cent had used health services in the past year (mean: 5.7 visits per year). Female sex and having a chronic disease were significantly associated with health service utilisation. The odds of using health services was 3.1 times higher for those who had a chronic disease and 2.2 times higher for female sex, assuming all other variables are held constant. Findings of this study support targeting men in health promotion campaigns and implementing population-based, chronic disease screening programs to improve the reach of health services among Filipino older people.

Prevalences and trends of chronic diseases in Shaanxi Province, China: Evidence from representative cross-sectional surveys in 2003, 2008 and 2013.

ObjectivesNon-communicable diseases, which can refer to chronic diseases that are not caused by infectious agents and can endure for a long time, are currently regarded as a critical public health problem in China. This study aimed to estimate the prevalences of self-reported physician-diagnosed chronic diseases among urban and rural populations aged 15 years and older in Shaanxi Province, China, during 2003−2013 and explore how these changes differ by subpopulation.MethodsThree independent cross-sectional surveys were implemented in 2003, 2008 and 2013 in Shaanxi Province. A multistage stratified cluster random sampling method was used in each wave to collect representative samples. In total, 10,568 residents in 2003, 15,453 in 2008 and 48,808 in 2013 were included in this analysis. Information on self-reported physician-diagnosed chronic diseases was collected using face-to-face interviews in each survey. Multilevel Poisson regression with robust error variance was employed to calculate the adjusted prevalence ratios to estimate the relative change in chronic conditions in 2008 and 2013, compared to that in 2003.ResultsIn 2013, 23.9%/22.1% of urban/rural residents, respectively, reported having at least one chronic condition, which represents an increase from 17.0%/15.1%, respectively, in 2008 and 12.8%/10.9%, respectively, in 2003. Adjusted for socio-demographic characteristics, the prevalence of chronic diseases was significantly higher in 2013 than that in 2003. Among the chronic diseases studied, the prevalence of hypertension and diabetes has increased dramatically over a decade. The increase in chronic diseases occurred mainly among the middle-aged and elderly.ConclusionsChronic diseases are highly prevalent and continuously increasing in the adult population in Shaanxi Province from 2003 to 2013. Given its large aging population, China may face a greater chronic disease burden. A national chronic disease surveillance system and screening program should be established to acquire comprehensive information regarding the distribution and trends of chronic diseases.

Senile eye disease screening program in downtown Wenzhou: intraocular pressure

Objective: To investigate the distribution and related factors of intraocular pressure (IOP) in the screened population aged over 50 years in Wenzhou. Methods: This study included 31 170 community residents aged 50 years or older in Wenzhou undergoing screening from March 2014 to January 2016. Participants underwent a complete ocular examination, including visual acuity, eye-ground photography, slit lamp and standardized measurement of IOP by non-contact tonometry. Subjects who had undergone ocular operation or laser peripheral iridectomy, had glaucoma, corneal or other ocular diseases that could possibly affect the IOP, had an IOP lower than 6 mmHg(1 mmHg=0.133 kPa) and visual acuity less than 0.3, or had monocular IOP values were excluded. The relationship between IOP and various parameters were analyzed. Results: A total of 20 875 subjects (6 902 males and 13 973 females) were enrolled in the current analysis, including 18 677 healthy persons and 2 125 glaucoma suspects, with an average age of (67.3±8.7) years old. The mean IOP (mean±standard deviation) of the healthy population was (13.5±3.0) mmHg (13.4±3.2) mmHg in right eyes and (13.6±3.3) mmHg in left eyes; 2.04% of the left eyes, 1.51% of the right eyes and 2.92% of either eyes of healthy population had an IOP >21 mmHg. The mean IOP in glaucoma suspects was significantly higher than that in the healthy population (P<0.001); 6.78% of the left eyes, 6.16% of the right eyes and 9.65% of either eyes of glaucoma suspects had an IOP >21 mmHg. Men had lower IOPs than women [healthy population: (12.9±3.2) mmHg versus (13.7±3.2) mmHg; P<0.05]. The linear function of IOP (Y) with age (X(1)) and the vertical cup disc ratio (X(2)) was ^Y=15.962-0.043X(1)+0.837X(2)(P<0.05) in the healthy population. Conclusion: The IOP among healthy persons aged over 50 years living in downtown Wenzhou was decreased with age but increased with the vertical cup disc ratio. The IOP in females was higher than that in males. About 3% of the healthy population had an IOP greater than 21 mmHg. (Chin J Ophthalmol, 2018, 54: 586-592).

In This Issue

https://doi.org/10.1038/s41436-018-0087-4 Prenatal exome sequencing can enable molecular diagnoses when standard genetic testing yields no diagnosis to families searching for answers. In their review article, Vora and Hui cover the landscape of advanced prenatal ’omics—both its promise and pitfalls. The authors cover both genomic and transcriptomic technologies, which have both revealed new insights into human development. The technologies have begun to assist in fetal diagnosis and have advanced to the point that placental function can be noninvasively sampled through maternal plasma cell-free RNA. Excitement surrounds the possibilities, but the authors point out that variant interpretation and pre- and posttest counseling remain highly challenging for clinicians. While the American College of Medical Genetics and Genomics and other professional organizations do not recommend exome sequencing for routine use in prenatal diagnosis, in select prenatal cases in which standard approaches have failed to offer an informative finding, exome sequencing can be offered as another option. When a fetus has structural abnormalities or homozygosity indicates consanguinity (or closer parental relatedness) on microarray, exome sequencing can also play a role. In addition, the technique can be more cost effective than sequencing individual genes using a targeted molecular panel. The authors argue that, given the rate of discovery, it would be useful to the research community to have a shared prenatal database with genotype and phenotype information. A shared database would enable researchers to search for similar phenotypes and increase the confidence in pursuing novel gene discovery functional studies if there are multiple families with genotype/phenotype correlation. The review also covers transcriptomics and the use of RNA sequencing to study pre- and postimplantation embryology, stem cell biology, organogenesis, fetal maturation, and placental physiology. —Karyn Hede, News Editor https://doi.org/10.1038/gim.2017.199 When children born with metabolic disorders receive early treatment, their health outcomes are often much better than those of children who don’t receive early diagnosis and treatment. But demonstrating that benefit at the population level has been a challenge for state-run newborn-screening programs. Investigators in California are now reporting five-year follow-up data for infants born between 7 July 2005 and 31 December 2009. Their long-term data reveal the success of screening for health outcomes and provide a model for other states seeking resources for their own follow-up programs. The California Department of Public Health’s Genetic Disease Screening Program has tracked all newborns with initial screen-positive test results for 1 of 20 primary metabolic disorders and documented treatment received through a network of metabolic specialty care centers. The cohort reported in this issue represents an extension of the 3-year data reported in GIM (Genet Med 2014;16:484–490) in 2014. By age 5, more than half (n=235; 55.2%) of the original 426 patients remained in active care compared with 82.6% (n=352) in active care at age 1. Over the cumulative 5 years, 20.4% (n=87) of the 426 patients were lost to follow-up, 8.7% (n=37) moved out of state, 6.3% (n=27) were determined to require no further follow-up, 4.7% (n=20) refused follow-up, and 4.7% (n=20) died, with most (n=13; 65%) dying within two months of birth. The results for patients and families who stayed in active care versus those who dropped out of care were not influenced by demographic characteristics or ability to pay. Some of the data suggest that barriers to care exist for families that have transportation challenges or language barriers. The cost of collecting follow-up data is covered by revenue from the screening fees for approximately 500,000 newborns each year. The authors suggest that other states may wish to consider raising their test fees to cover collection of long-term follow-up data. —Karyn Hede, News Editor

Multiple Endocrine Neoplasia in Children and the Importance of Screening: Part 2

VHL is another type of multiple endocrine neoplasia, and is inherited in an autosomal dominant manner like MEN1. Some families may have the VHL diagnosis without genetic testing, due to two or more clinical manifestations having been noted. The gene mutation is located at 3q26–25, so the long arm of chromosome 3, locus 26–25. The most common tumours identified within this syndrome are retinal and central nervous haemangioblastomas, renal cancers, renal, pancreatic and epididymal cysts, phaeochromocytomas and paragangliomas (Maher, Neumann, & Richard, 2011). VHL disease can be classified into subtypes, relating to whether there are phaeochromocytomas present. Clinical presentation can manifest usually in adulthood (Prasad et al., 2011), but can also present much earlier in childhood, resulting in the need for a screening protocol as seen in Table 1.

Abstract 3241: Children with acute lymphoblastic leukemia have increased arginase 2 at birth, implicating immunosuppression in leukemogenesis

Abstract Background: Epidemiologic evidence points to a role for infection and immune development in childhood acute lymphoblastic leukemia (ALL). Emerging evidence suggests that in utero immunosuppressive processes, along with immaturity at birth, cause immune hyporesponsiveness to commensal microbes and susceptibility to early childhood infections. A key regulator of active immunosuppression within the neonatal environment is arginase 2, which is produced by CD71+ erythroid cells and myeloid-derived suppressor cells. Arginase-dependent arginine depletion is suspected to aggravate both infections and tumor growth (the latter in adult settings) due to suppressed T-cell function by downregulation of TCR-CD3ζ. Studies have shown that immune vulnerability of the preterm neonate is critically related to arginase-dependent arginine depletion, but none have investigated this neonatal immunosuppression in relation to ALL. Methods: Children were identified via California Cancer and Vital Statistics Registries, and their neonatal dried bloodspots derived from the California Genetic Disease Screening Program. Children were born in California between 1999 and 2009, with ALL cases being 0-15 years of age at diagnosis. 137 ALL cases and 500 controls (frequency matched on birthdate, gender, and ethnicity) were analyzed. Arginase 2 levels were measured using enzyme-linked immunosorbent assay (ELISA), with total serum-protein levels measured using the Pierce BCA protein assay. Arginase 2 levels in the analyses were adjusted for total serum protein and analyzed both as a continuous variable and as quartiles based on the distribution among controls. Adjusted unconditional logistic regression was used to estimate odds ratios (OR) for the association between neonatal arginase 2 and ALL with assay plate variance structure accounted for using cluster methods. Results: Arginase 2 levels in neonatal dried blood spots were significantly higher among cases with ALL than controls (OR = 1.36, 95% CI: 1.02-1.80, p = 0.03). The highest quartile of arginase 2 levels differed significantly from the lowest (OR = 1.81, 95% CI: 1.04-3.41, p = 0.03), while the intermediate quartiles had a trend towards higher arginase 2 levels (p for trend: 0.02). Conclusions: Our findings suggest that children with ALL have significantly higher immunosuppression at birth due to increased arginase 2. A high neonatal level of this enzyme, an important downregulator of T-cell activity, may lead to altered immune responses to antigenic stimulation and infection during early childhood and potentially impact the immune system's capability to react against nascent cancer. In addition to previously discovered prenatal mutations, this new finding of an immunosuppressed environment at birth contributes to our understanding of early events in the development of ALL. Citation Format: Amalie B. Nielsen, Mi Zhou, Adam de Smith, Lucie McCoy, Helen Hansen, Paige Bracci, Libby Morimoto, Scott Kogan, Catherine Metayer, Xiaomei Ma, Joseph Wiemels. Children with acute lymphoblastic leukemia have increased arginase 2 at birth, implicating immunosuppression in leukemogenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3241.

A Deep Learning-Based Algorithm Identifies Glaucomatous Discs Using Monoscopic Fundus Photographs

To develop and test the performance of a deep learning-based algorithm for glaucomatous disc identification using monoscopic fundus photographs. Fundus photograph database study. Four thousand three hundred ninety-four fundus photographs, including 3768 images from previous Sydney-based clinical studies and 626 images from publicly available online RIM-ONE and High-Resolution Fundus (HRF) databases with definitive diagnoses. We merged all databases except the HRF database, and then partitioned the dataset into a training set (80% of all cases) and a testing set (20% of all cases). We used the HRF images as an additional testing set. We compared the performance of the artificial intelligence (AI) system against a panel of practicing ophthalmologists including glaucoma subspecialists from Australia, New Zealand, Canada, and the United Kingdom. The sensitivity and specificity of the AI system in detecting glaucomatous optic discs. By using monoscopic fundus photographs, the AI system demonstrated a high accuracy rate in glaucomatous disc identification (92.7%; 95% confidence interval [CI], 91.2%-94.2%), achieving 89.3% sensitivity (95% CI, 86.8%-91.7%) and 97.1% specificity (95% CI, 96.1%-98.1%), with an area under the receiver operating characteristic curve of 0.97 (95% CI, 0.96-0.98). Using the independent online HRF database (30 images), the AI system again accomplished high accuracy, with 86.7% in both sensitivity and specificity (for ophthalmologists, 75.6% sensitivity and 77.8% specificity) and an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.76-1.00). This study demonstrated that a deep learning-based algorithm can identify glaucomatous discs at high accuracy level using monoscopic fundus images. Given that it is far easier to obtain monoscopic disc images than high-quality stereoscopic images, this study highlights the algorithm's potential application in large population-based disease screening or telemedicine programs.

The benefits of the thyroid disease screening program in pregnant women in Slovakia

The benefits of the thyroid disease screening program in pregnant women in Slovakia

Electronic health record with computerized decision support tools for the purposes of a pediatric cardiovascular heart disease screening program in Crete

Background and ObjectiveEarly detection of cardiovascular (CV) disease or associated risk factors during childhood is of paramount importance, allowing for early treatment or lifestyle modifications, respectively.The objective of this study was to describe the development of an electronic health record (EHR), with integrated computerized decision support system (CDSS), specifically designed for supporting the needs of a pilot pediatric CV disease screening program applied on primary school students of a Mediterranean island. MethodsEvidence-based knowledge, national and international practice guidelines regarding sport preparticipation CV screening of children and young athletes has been used for the design of the designated EHR. A CDSS, capable for providing alerts for further cardiology evaluation need, has been incorporated into the EHR, based on normative anthropometric and electrocardiographic data as well as predefined positive history responses. ResultsWe developed a designated EHR with integrated CDSS supporting pediatric CV disease screening, capable for documenting CV-related personal and family history responses, physical evaluation data (weight, height, blood pressure), allowing for entering electrocardiogam (ECG) measurements and for uploading of multimedia files (including ECG images and digital phonocardiogram audio files). The EHR incorporates clinical calculators and referral alerts for the presence (and degree) of adiposity, hypertension, ECG abnormalities and positive history responses indicative of high CV disease risk. In a preliminary EHR validation, performed by entering data from 53 previously available paper-based health records, the EHR was proven to be fully functional. ConclusionsThe pediatric cardiology EHR with CDSS features which we developed might serve as a model for EHR for primary health care purposes, capable to document and early detect CV disease and associated risk factors in pediatric populations.

Implementation of a Non-Communicable Disease (NCD) Screening Programme in a Rural African HIV Clinic

Implementation of a Non-Communicable Disease (NCD) Screening Programme in a Rural African HIV Clinic

Feasibility and effectiveness of a health examination center-based opportunistic eye diseases screening

Background Blindness and low vision represent significant public health issues in China.Late diagnosis is the major reason for the irreversible vision impairment.A feasible, cost-effective screening and referral program is very important for the eye health care, prevention and treatment of blindness in China. Objective This study was to evaluate the feasibility and effectiveness of a health examination center-based opportunistic eye disease screening program. Methods This was a cross-sectional study.Subjects undergoing a routine physical examination at the health examination center of the Fourth People's Hospital of Shenyang were invited to attend this program.Presenting visual acuity, intraocular pressure, and nonmydriatic fundus photography were obtained.Optic disc photographs were evaluated independently by two ophthalmologists.Blindness and moderate to severe vision impairment were defined based on the criteria of World Health Organization Visual Impairment Classification in 2009.Glaucoma, diabetic retinopathy(DR) and other suspected eye diseases were diagnosed according to the fundus photography and intraocular pressure.This study was approved by Ethic Committe of the Fourth People's Hospital of Shenyang, the informed consent of each subject was obtained. Results Totally, 15 303 subjects were enrolled and 15 197 of them finished the exanimations, giving a response rate of 99.3%.The overall percentage of blindness and moderate to severe visual impairment was 0.08% (12/15 197) and 2.34% (355/15 197). Two hundred and twenty-eight (1.50%) subjects were defined as glaucoma suspects and 80 individuals (0.53%) were diagnosed as epimacular membrane.Other suspected eye diseases included DR (0.41%), branchial retinal vessel occlusion (0.24%), macular degeneration (0.09%), and macular hole (0.06%). More than 95% of the eye disease suspects have never been previously diagnosed or treated.A total of 358 subjects (2.36%) were defined as ocular hypertension suspects. Conclusions This health examination center-based opportunistic eye disease screening shows a good efficiency and feasibility.It may become an optional program in the national eye health care project, as well as the work of prevention and treatment of blindness. Key words: Opportunistic eye disease screening; Prevention and treatment of blindness; Eye health care

Screening of Different Hevea brasiliensis Clones Based on the Reaction to Phytophthora Bark Rot

Disease conditions caused by Phytophthora species are common on rubber (Hevea brasiliensis) in all rubber-growing countries. Bark rot is the most economically damaging disease of the tapping panel of the rubber tree, leading to the cessation of tapping during the monsoon months in rubber plantations. To overcome this situation, the disease screening programs aiming disease resistant/tolerant clones are continually carried out. The current study attempted to evaluate the reaction of different clones of H. brasiliensis against the Phytophthora bark rot in order to recommend a suitable planting material for the industry. Forty clones of H. brasiliensis were screened at the bud wood nursery of Kuruwita substation of Rubber Research Institute of Sri Lanka during South West monsoon, 2014. Each clone consisted ten bud wood plants and in each bud wood plant, three branches were used for the inoculation. These plants of different clones were artificially inoculated with a standard spore suspension of Phytophthora meadii. This was prepared by scraping the sporangia on the surface of culture plates into sterile distilled water and the final concentration was adjusted to 1x104 spores per ml. At the inoculation, the bark of the selected branches was removed with a cork borer and the wood was exposed. A sterile absorbent cotton wool plug saturated with 2 ml of the zoospore suspension was placed on the exposed wood of the plant. The cotton wool plugs were taken in sterile Petri dishes to the experimental site and a freshly-prepared zoospore suspension was used. As the control, in each of the bud wood plant tested, one branch was inoculated with a cotton wool plug with sterile distill water. After the inoculation, the inoculated portions of the branch were sealed off with budding tape in such a manner to ensure aeration. Four weeks after the inoculation, the exposed lesions were traced on to tracing papers, after removing the bark and the area under the lesions were measured with a plannimeter. The area under the lesion was assumed to be inversely proportional to the resistance level of the relevant rubber clones towards the P. meadii infection. The area of the lesion resulted after each treatment was subjected to analysis of variance in SAS statistical software. The results of the trial carried out suggest the possibility of categorizing the screened clones into three clusters. The clones RRISL 222, RRISL 220, RRISL 208, RRISL 219, RRIM 600, RRIC 102, RRIM 717 and PB 235 are among the most resistant clones while the clones, PB 255, RRISL 206, RRISL 225, RRISL 201, RRIC 130, RRISL 211, RRISL 205 and RRIC 131 are among the most susceptible clones against Phytophthora bark rot. Therefore, it can be concluded that, the screened clones were showing differential reaction to the Phytophthora bark rot under bud wood nursery conditions. Keywords: Phytophthora bark rot, Hevea brasiliensis, Clonal screening