Showing papers on "Mass screening published in 1976"

A comparison of two psychiatric screening tests.

Abstract: A comparison is made between the General Health Questionnaire (GHQ) and the Symptom Checklist (SCL) as psychiatric screening tests in community-based research projects. Both are shown to correlate equally well with independent clinical assessment, and the differences between them mainly reside in the form of their response scales. The GHQ works best as a screening test, since it has fewer false positives associated with its use, but it may miss those with long-standing disorders. The SCL tends not to miss long-standing disorders and furnishes diagnostic sub-scales if these are required. Both tests function better with men than with women and with whites than with blacks, but neither is affected by social class or age of the respondent. The study revealed high correlations between the symptoms of anxiety and depression, and indicated some possible differences between the symptom clusters seen in whites and in blacks.

Enzyme immunoassays for parasitic diseases.

Abstract: It is only in recent years that serology has come to play a major role in parasitic diseases. At first complement fixation was most used but gradually more convenient and sensitive techniques such as gel precipitation (DRAPER, 1976), and agglutination methods (KAGAN, 1974) were introduced. Probably the serological test most used by parasitologists has been immunofluorescence, particularly the indirect fluorescent antibody method (KAGAN, 1974; AMBROISE-THOMAS, 1976). Certain factors must be taken into consideration when assessing the usefulness of serological methods for parasitic diseases. The major parasitoses such as malaria, schistosomiasis, trypanosomiasis, infect millions of people in poor areas of the world where technical expertise is, at present, very limited. In these areas serological methods can be of most use in establishing epidemiological indices and for monitoring disease control programmes. Tests for use in such areas should be suitable for mass screening, should be simple and cheap, and .the results should be available quickly. Under these conditions some degree of precision may have to be sacrificed in the interests of practicability. There is also a place for more sophisticated methods suitable for individual diagnosis of parasitic infections especially in the more privileged areas of the world. We feel that enzyme-immunoassays, especially the enzyme-linked immunosorbent assay, have a part to play in both the above situations.

Mammography: a contrary view.

Abstract: Experimental and clinical data on mammography as a tool for population screening are reviewed. The conclusions are that [1] there is good evidence that annual history, physical examination, and mammography can reduce short-term and midrange breast cancer mortality by about one third; [2] the evidence that mammography alone plays a significant role in this reduction is weak and indirect; [4] data on long-term effects of mammography are lacking; [4] no satisfactory investigations of associated radiation hazards have been published; and [5] the possible benefits of mammography have received more emphasis in the clinical literature than have its defects. Promotion of mammography as a general public health measure is premature.

PREDICTIVE VALUE OF HIGH IgE LEVELS IN CHILDREN

Abstract: A group of 207 healthy non-atopic children 0-14 years of age without any known family history of atopic disease was selected for a study of the relation between serum IgE levels and the occurrence of atopic manifestations during an observation period of 18 months; 206 fullfilled the study. Serum IgE was measured by a direct radioimmunological sandwich technique (PRIST). At the follow-up 28 of 32 with an initial IgE level greater than one standard deviation above the mean for the age continued to show a high level (87.5%). The total concordance was 81.1%. Atopic or probable atopic diseases had developed in 75.0% of children 0-1 year of age with an initial IgE above +1 S.D., but in only 6.4% of those from the same age group with a lower initial IgE. Even among children 2-14 years old, it was noticement of atopic disease. Otitis media was more frequent among children with an initially elevated IgE level than among the rest of the children. Determination of serum IgE with the PRIST-technique has been shown to provide a valuable means for predicting future atopic manifestations and may be used as a screening procedure especially in children of atopic parents.

Drugs Spotlight Program: The Management of Hyperlipidemia: Whether, Rather than How

Abstract: The premise that measures used to lower the plasma lipids in patients with hyperlipidemia will lead to reductions in new events of coronary heart disease (the Lipid Hypothesis) should be reconsidered today as a result of several recent reports of large-scale double-blind drug trials in the United Kingdom and in the United States. To that end, the published evidence that bears on tests of the hypothesis by dietary and drug interventions is reviewed, and the conclusion reached that the hypothesis has not yet been adequately tested. A phased program is described that will prepare the ground for a fuller and more definitive trial of the premise in the future: the first steps must be to establish that a combined diet/drug regimen in large numbers of adult male hyperlipidemic patients is acceptable and essentially harmless and that during an observation period of several years a high rate of adherence to the regimen can be attained. Any advice to the general public to make large dietary changes now is considered premature.

Effect of a mass screening program on the risk of cervical cancer

Abstract: In Finland, the organized mass screening program for the early detection of cervical cancer covers, with few exceptions, all women between the ages of 30 and 55 every fifth year. On the basis of material originating from the Finnish Cancer Registry it was estimated that the probability for a woman aged 30-59 to experience frankly invasive cervical cancer was 0.010 before the screening program, and 0.002 after the first screening. The corresponding probability estimate was 0.022 for pre-invasive lesions subjected to operative treatment. On the assumption that the same relationship applies beyond this age group it was estimated that from 28-39% of the pre-invasive cases progress to invasive cervical cancer, and that 21% of the frankly invasive cases are preceded by a pre-invasive stage of shorter duration than the time period between the screenings, or have no preclinical stage.

Lack of efficacy of thermography as a screening tool for minimal and stage I breast cancer.

Abstract: In a study of thermograms of 42 patients with Stage 1 or smaller carcinomas of the breast, 44 confounding cases and 64 randomly selected subjects being screened, we found that the ability of expert thermographers to identify the patients with carcinoma correctly (true positive = 0.238) varied little from the ability of untrained readers (true positive = 0.301). Furthermore, in the expert group, the indexes of suspicion were so high (0.436) and the true-positive levels were so relatively low (0.238, P = 0.0005) that thermography may well have a very limited role as a screening or pre-screening modality for the detection of minimal or Stage 1 breast cancers.

A New Culture Model Facilitating Rapid Quantitative Testing of Mitotic Spindle Inhibition in Mammalian Cells

Abstract: A new culture model, which facilitated both mass screening of potential anticancer drugs acting on microtubules and quantitative experiments with known "antitubulins," was found to have the following advantages: use of mammalian cells (either transformed or not), simplicity of the techniques (phase-contrast microscopy or simple microscopy after Giemsa staining), and ease with which it lent itself to quantification. The model was based on the uniform multimicronucleation response induced by antitubulins in MO cells. The specificity (towards antitubulins) of this response was ascertained by the use of many substances, including most of the known antitubulins and a number of nonrelated cytostatic or cytotoxic compounds. The uniformity of the response was established with the use of time-lapse observation of large numbers of cells and quantitative approaches. The results obtained in this model with the standard antitubulins (colchicine, vinblastine, vincristine) showed similar effects. The major difference between colchicine and the Vinca alkaloids was that colchicine was less reversible, which might be an indication of stronger intracellular binding. The Vinca alkaloids acted synergistically with colchicine when threshold subactive doses were combined, although it is known that they bind at a different site on tubulins. A number of substances that have been claimed or were suspected to interfere with microtubules were tested. The results showed that the following substances were indeed active with MO cells: colchicine, vinblastine, vincristine, podophyllotoxin, rotenone, griseofulvin, mercaptoethanol, benomyl, methyl benzimidazol-2-yl carbamate, and R 17934. Compounds that were inactive on these mammalian cells in culture included isopropyl carbanilate and melatonin, both of which have been shown to be active in other systems.

Ultrasonic fan beam scanner for computerized time-of-flight tomography

Abstract: A fast ultrasonic scanner for soft tissue imaging and/or characterization has a transmitter with a divergent beam pattern and an arcuate array of receivers. The propagation delay time of a short acoustic pulse traversing a water bath and immersed specimen depends on the velocity distribution and is detected at each receiver. Digital data is derived from the receiver signals at many angular positions of the scan apparatus and is used to compute a reconstruction of the velocity distribution in the specimen. The instrument provides quantitative measurements of bulk tissue and has application in breast examination and mass screening for breast cancer.

A study of comparative blood pressure measures in predicting risk of coronary heart disease.

Abstract: The Western Collaborative Group Study is a prospective study of 3,154 employed men, aged 39-59 years. Coronary heart disease (CHD) occurred in 257 subjects during 8.5 years of follow-up. The multiple logistic risk model was used to assess the comparative strength of systolic, diastolic, mean arterial and pulse pressure for the prediction of CHD in two age decades after adjustment for age, serum cholesterol, cigarette smoking, behavior pattern and weight. The risk of CHD was more strongly associated with the systolic than the diastolic pressure. The general practice of assessing the importance of blood pressure based only on the diastolic component should be reassessed.

Screening for spina bifida cystica. A cost-benefit analysis.

Abstract: The costs and economic benefits are examined of introducing a programme for the mass-screening of pregnancies for the detection and abortion of fetuses with spina bifida cystica. A benefit-cost index is derived, and the possible effects on it of making different input assumptions are discussed. It is considered that, on economic grounds, screening may be worthwhile only in populations in which the incidence of spina bifida is high.

Tay-Sachs screening: social and psychological impact.

Abstract: Participants in two Tay-Sachs screening programs were generally satisifed with the organization of the tests and the results. There was no evidence of adverse impact on reproductive plans or interpersonal relations, and the respondents professed to believe in the value of screening. While the carriers discussed their condition freely with others and were no less favorable to the idea of screening than the noncarriers, about one-half of their number expressed discomfort in being told they were heterozygotes. These feelings were allayed by counseling, but there was evidence of some residual unease. It is suggested that this anxiety would be less prominent and more easily reduced if screening were done under conditions of ordinary primary medical care rather than outside the conventional system.

Convenient method for detecting 14CO2 in multiple samples: application to rapid screening for mutants.

Abstract: A procedure is presented for the rapid screening of bacterial colonies to detect mutants unable to produce 14CO2 from a labeled precursor. The method is especially useful for mass screening for mutants that cannot be easily detected by their phenotypic characteristics.

Detection of drugs of abuse by radioimmunoassay: a summary of published data and some new information.

Abstract: We review the status of radioimmunoassays for detection of abused drugs. Individual assays with use of 125I-labeled antigens are all performed in an identical manner and can be completed in 30 min to 1 h. Combined assays for simultaneous detection of two or more such drugs or assays in which a tritium-labeled antigen is used require 1-2 h for completion. All tests can be performed with 0.1 ml or less of specimen. The assays involving 125I reliably detect urinary concentrations of, per liter, 40-100 mug of morphine, 100 mug of barbiturates, methadone, methaqualone, or benzoylecgonine, and 1000 mug of amphetamine. The assay for morphine involving 3H detects 60 mug/liter. Each assay is capable of providing a qualitative and quantitative estimate of the drugs sought. The 125I-labeled antigens have a usable shelf life of at least two to four months after the antigen is iodinated; the tritium assay is stable for six months. The assays can be performed with use of paper discs that have been suspended in urine and then dried, in place of the liquid specimen. The assays appear to be equally applicable to detection of drugs in urine, blood, saliva, and tissues. All of them are done at ambient temperature and can be used equally well for emergency (stat) tests or mass screening. Except for the benzoylecgonine assay, the clinical reliability of these tests has been demonstrated.

Results of mass screening for breast cancer in 50,000 examinations.

Abstract: Detection of earlier breast cancer, especially in its preclinical stage, offers the only method available today for reducing mortality from this disease. The Health Insurance Plan study, conducted since 1963 under contract with the National Institutes of Health, has achieved a one-third reduction in death rate in a study group compared to a matched control which has persisted in 7 years of follow-up. The Guttman Institute, founded in 1968 to develop practical methods for large scale screening, is operating a tandem approach using interview, clinical examination, improved mammography, and thermography for greatest yield. Emphasis is placed on motivation to accept the examination, teaching and encouragement of breast self-examination, and emphasis on periodic reexaminations. At the present time, almost 300 women receive this complete examination per day at the Institute's fixed facility. Periodic examinations leads to marked increase in number of cancers detected free of axillary nodal involvement. The tandem approach emphasizes substantial percentage of cancers detected on only one modality, two-thirds of which are without nodal involvement. Breast self-examination is necessary to detect "interval" cancers in more localized stage.

Estimation of prevalence of bacillary tuberculosis on the basis of chest X-ray and/or symptomatic screening.

Abstract: The study was undertaken among 22,957 persons belonging to 55 randomly selected villages of Nelamangala taluk of Bangalore district in 1975, to find out precise estimates of prevalence of bacillary disease. Symptom screening was done by well experienced social investigators, according to a brief interview schedule. Sputum was collected from all above the age of 5 years reporting chest symptoms for seven or more number of days during the previous two months. Within two weeks after symptom questioning, all were tuberculin tested and all 5 years and above were X-rayed. Additional sputum collection was done for those asymptomatics who had abnormal shadows in their chest X-rays. The overall prevalence rate of culture confirmed bacillary cases by symptom and/or X-ray screening was 0.32 percent. Same prevalence was seen with X-ray alone also. But the overall prevalence rate based on symptom screening alone was 0.21 percent which is significantly lower than that of symptom and/or X-ray screening, or X-ray screening alone. The prevalence rates by age and sex based on symptom screening were about two-thirds that of rate based on X-ray and/or symptom screening. Hence to obtain prevalence rate according to X-ray and/or symptom screening, a correction factor of 1.52 should be applied to the prevalence rates obtained by symptom screening alone. This correction factor is fairly good for most of the age groups. It was also estimated that the cost of surveying the population by symptom screening alone is about half that of surveying the population by X-ray screening.

Erythrocyte porphyrin analysis in the detection of lead poisoning in children: evaluation of four micromethods.

Abstract: We evaluated four procedures for determination of erythrocyte porphyrin: double extraction with ethyl acetate/acetic acid-HCl, single extraction with ethanol, single extraction with acetone, and direct solubilization with detergent-buffer. The ethyl acetate procedure, when used with two portions of HCl, apparently gives complete recovery of porphyrin and is suitable for reference as a comparison method. The ethanol procedure gives a high and consistent recovery and is technically simpler. The acetone procedure gives low and variable recovery of porphyrin, and the detergent-buffer method is subject to serious hemoglobin interference; neither of these two procedures offers any technical advantage. Stability of samples and methods for standardization were explored. A procedure for expressing results in terms of erythrocyte Zn-protoporphyrin content is given. Because of its stability, coproporphyrin is useful as a daily working standard. The ethyl acetate and ethanol methods are about equally efficient for detecting lead intoxication. Because of its simplicity, the ethanol method seems to be the best for use in screening.

Community control of hypertension.

Abstract: The adequacy of treatment of hypertension in a community was monitored at triennial mass health examinations. Hypertensives were not adequately retained on treatment until a disease register was developed and a practice nurse given responsibility for maintaining contact with patients on the register. The advent of newer therapeutic agents and intensification of the interest of both doctor and patient in the results of treatment were associated with progressive improvement in the adequacy of control of blood pressure.

Neonatal screening for cystic fibrosis

Abstract: Reliable screening of neonates for cystic fibrosis has been available for about 15 years1 and it has been used in a number of communities. Soon after its introduction questions were raised about its value and possible adverse effects.2 In particular, it was suggested that telling parents of an apparently healthy 4-6 week old infant that it had a life-limiting condition may have negative effects on the parent-child interaction. Several papers have now been published which have evaluated the effects of neonatal screening and in Victoria, Australia, a state with approximately 65 000 births a year, neonatal screening has been undertaken for the last six years. In this issue of Thorax (pp 712-718) Dankert-Roelse and te Meerman3 produce some evidence to indicate that neonatal screening may improve the long term prognosis of the disease. Their study does, however, have some limitations. The screening method used was based on the determination of the albumin content of meconium. This is known to have poor sensitivity as was well demonstrated in that study.4 The population studied by Dankert-Roelse and te Meerman was born between 1973 and 1979 and may not represent the likely course of cystic fibrosis in children born in 1 990s. The survival of their symptomatically diagnosed patients was significantly inferior to that reported at about the same time from elsewhere.5 The survival of their post-screened population was perhaps more compatible with that expected by a major clinic and was virtually identical to that in their screened population. The median age at diagnosis in their non-screened and post-screened population was substantially higher than that of eight months seen in Victoria, Australia over an equivalent period.6 There are no other long term studies of the effects of screening on survival. A study from Melboume of siblings diagnosed at less than six months by routine sweat tests because of a family history failed to show any long term advantage for this group7 and there was some similarity to a screened population. With major clinics including our own (Wohlers, Hibbert and Phelan, unpublished data) showing a survival to 15 years of about 80% and to 25 years of at least 50% of patients managed over the last 10 years, it will probably now be very difficult to show any benefit of neonatal screening on long term survival.

Tay-Sachs screening: motives for participating and knowledge of genetics and probability.

Abstract: A highly-educated, socially aware group of persons presented themselves for Tay-Sachs screening having learned about it mainly from friends, newspapers, radio, and television but not from physicians or rabbis. After learning that screening was possible and deciding that it is in principle a good idea, and after discussing it with relatives and friends but not with physicians and rabbis, they presented themselves for the test. Although the participants knew that Tay-Sachs is a serious disease and that Jews are vulnerable, few of them knew much about the genetics of the disease, its frequency, or the incidence of the carrier state. This experience of screening for Tay-Sachs carriers suggests the need for physicians to learn the relation of genetics to preventive medicine, and for the public to learn more about the biology of man.

Cervical Cancer in Women Belonging to a Cytologically Screened Population

Abstract: Women belonging to the cytologically screened population of Stockholm in 1968 to 1974 and developing cervical cancer of stage I to IV were studied. The purpose was to find out the number of women, in whom the cancer or its preclinical stage was not detected at routine screening, and the reasons for this fact. It was found that 34 out of 177 women had never been cytologically screened. The remaining 143 women had been checked at mass screening and/or at private specialists or hospitals. In 51 screened women the cancer was not detected until the women themselves attended a doctor because of symptoms. Thus in 85 women, or 48% of the series, the cancer escaped detection at an asymptomatic stage. Errors causing a delay or interruption of the follow-up of patients with suspicious smears or colposcopic atypia were observed in 25 cases. Sixty-four patients, or 45% of all screened women, had had at least one negative smear within 4.5 years prior to discovery of the malignancy. Out of these, 53 patients had got a n...

Control of Breast Cancer Through Mass Screening

Abstract: MASS screening for detection of earlier breast cancer by palpation and mammography is the only method that has produced a notable reduction in mortality from this disease. A onethird reduction in death rate has been achieved in a seven-year follow-up in the mass-screening program conducted by the Health Insurance Plan of Greater New York under contract with the National Cancer Institute. This has led to the creation of the Guttman Breast Diagnostic Institute in New York City, whose major objective has been to develop practical methods for mass screening. In this program, a higher proportion of localized breast cancer with no nodal involvement than is the case in general medical practice has been found. These findings point up the potential of mass screening not only in increasing survival from the disease, but in increasing salvage. BACKGROUND Mass-screening programs for breast cancer detection were conducted in the 1940s and 1950s by

alpha1-Fetoprotein measurement in blood spotted on paper: discriminating test for hereditary tyrosinemia in neonatal mass screening.

Abstract: We describe an electroimmunodiffusion technique for measuring alpha1-fetoprotein in blood spotted on chromatography paper. The system is being used as a complementary test in a neonatal mass-screening program for detection of inborn metabolic diseases in the Province of Quebec. In a series of 102 cases of neonatal hypertyrosinemia, the test has proven to be highly discriminative for hereditary tyrosinemia. It has permitted early detection of eight cases of this disease, including two that would have been missed by the previously used screening procedure, tyrosine measurement only. The test not only virtually eliminates the risk of misdiagnosis or missed diagnosis, but also permits earlier diagnosis of hereditary tyrosinemia and considerably reduces the follow-up work required for newborns with transitory tyrosinemia. The AFP test is simple, fast, practical, and inexpensive. Combined with tyrosine determination, it constitutes an optimal device for mass screening of hereditary tyrosinemia.