Showing papers on "Mass screening published in 1978"
TL;DR: A common use of tests is to estimate prevalence of disease; frequency of positive tests is shown to be a bad estimate, and the necessary adjustmants are given.
Abstract: This paper deals with some basis properties of screening tests. Such tests purport to separate people with disease from people without. Minimal criteria for such a process to be a test are discussed. Various ways of judging the goodness of a test are examined. A common use of tests is to estimate prevalence of disease; frequency of positive tests is shown to be a bad estimate, and the necessary adjustmants are given.
843 citations
TL;DR: This study confirms, in the largest group surveyed to date, similar findings in previous cross-sectional surveys, and is consistent with data from longitudinal and intervention studies on the importance of overweight in relation to hypertension.
Abstract: In the nationwide Community Hypertension Evaluation Clinic screening of more than 1 million people, the group classifying itself as overweight had prevalence rates of hypertension 50% to 300% higher than other screenees. Frequency of hypertension in overweight persons aged 20 to 39 years was double that of normal weight and triple that of underweight persons. Among those aged 40 to 64 years, the overweight group had a 50% higher hypertension prevalence rate than the normal-weight group and 100% higher than the underweight group. With each higher degree of blood pressure elevation, relative frequency of hypertension with overweight was larger. Thus this study confirms, in the largest group surveyed to date, similar findings in previous cross-sectional surveys. It is also consistent with data from longitudinal and intervention studies on the importance of overweight in relation to hypertension. ( JAMA 240:1607-1610, 1978)
643 citations
TL;DR: Theoretical models and epidemiologic data showed that the prevalence of gonorrhea adjusts rapidly to changes in social behavior, medical treatment, and control programs, and prevalence oscillates seasonally around an equilibrium state determined by the current social and medical conditions.
Abstract: Calculations revealed that approximately a third of the reported cases of gonorrhea in women during 1973-1975 were discoveries of the screening program. Theoretical models and epidemiologic data showed that the prevalence of gonorrhea adjusts rapidly to changes in social behavior, medical treatment, and control programs, that prevalence oscillates seasonally around an equilibrium state determined by the current social and medical conditions, and that this equilibrium moves as epidemiologic conditions change. The incidence of gonorrhea is theoretically limited by saturation in a sexually active core population, and this core causes gonorrhea to remain endemic.
404 citations
TL;DR: Among the 6 per cent of men in this study with patterns suggesting ischaemia, the subsequent coronary heart disease mortality was little more than 1 per cent per year; and among those who were symptom free it was even less.
Abstract: A screening examination including an electrocardiogram (limb leads only) coded by the Minnesota Code, using rigorous quality control was done on 18 403 male civil servants aged 40 to 64. The association of the findings with coronary heart disease has been tested in relation to age trends, symptomatic history, and coronary heart disease mortality rates in the ensuing five years. The results were positive for Q waves, left axis deviation, ST depression, and T wave changes (including minor T wave items as an isolated finding), ventricular conduction defects, and atrial fibrillation; but they were generally unimpressive for increased R amplitude and for lengthening or shortening of the PR interval, QT interval duration, premature beats, and extremes of heart rate. The prognosis of specific electrocardiographic findings discovered at screening is quite different from when they arise in clinical practice. Among the 6 per cent of men in this study with patterns suggesting ischaemia, the subsequent coronary heart disease mortality was little more than 1 per cent per year; and among those who were symptom free it was even less.
255 citations
TL;DR: Children's blood pressures should be assessed during their continuing care where pressures can be measured over a period of time to identify those with fixed blood pressure elevations.
Abstract: This study describes the seated blood pressure distributions of 6,622 predominantly white schoolchildren in Muscatine, Iowa. Subjects with seated pressures equal to or greater than the 95th percentile for age and sex or 140 mm Hg systolic or 90 mm Hg diastolic were examined on repeated occasions. Approximately 13% of subjects were found to have blood pressures at these levels when first examined, but less than 1% were found to have persistent blood pressure elevations. Of 41 subjects found to have persistent blood pressure elevations, 23 were obese with relative weights in excess of 120%. Of the 18 lean subjects, 5 had secondary hypertension and 13 were considered to have essential hypertension. Mass screening of school-age children identifies many children with transient elevation of blood pressure and few with fixed high blood pressures. Children9s blood pressures should be assessed during their continuing care where pressures can be measured over a period of time to identify those with fixed blood pressure elevations.
198 citations
TL;DR: A more than two‐fold reduction in mortality has been observed among women aged 25–59 and there has been a similar decrease in incidence of tumours of stages II, III and IV.
Abstract: A clinic for early detection of cancer of the uterine cervix has been in operation in Iceland since 1964, aimed until recently at the age-group 25-59 More than 85% of women in this age group have been screened at least once Mortality from cancer of the cervix had been rising in Iceland, and continued to rise during the first few years of operation of the screening clinic Since 1970, however, a more than two-fold reduction in mortality has been observed among women aged 25-59 There has been a similar decrease in incidence of tumours of stages II, III and IV Both deaths and advanced tumours are largely confined to women who have never been screened Alternative explanations are considered, but the only tenable explanation of the reduction in mortality is that it is a consequence of the introduction of a comprehensive screening programme
179 citations
TL;DR: Early detection in combination with clinical measures was associated with a decrease in the incidence of twins born preterm, and the perinatal mortality rate of twins fell from 6 to 0.6 % after the introduction of this programme.
Abstract: The present study describes the evolution over a 5-year period of an ultrasonic routine screening programme of a pregnant population with participation of approximately 90 % of the pregnant women. One obvious result obtained in the screening programme is the pronounced improvement of early detection of twins, the incidence now approaching 95 % with the mean gestational age for the detection being 20 (median 19) weeks. Early detection in combination with clinical measures was associated with a decrease in the incidence of twins born preterm (before week 37) from 33 % to 10 %. The perinatal mortality rate of twins fell from 6 to 0.6 % after the introduction of this programme.The power of an early measurement of the fetal biparietal diameter (BPD) to predict the date of confinement was high. Of 848 pregnant women with an early BPD measurement (96.5 % were measured before the 21st gestational week), 95 % were delivered spontaneously within 12 days according to the estimates from the BPD, only 1.5 % being deli...
128 citations
TL;DR: Newborn screening for alpha 1 -antitrypsin deficiency is not warranted at this time in view of the low frequency of significant pulmonary or hepatic involvement in childhood and the absence of specific therapy for this condition.
119 citations
TL;DR: The data strengthen the impression that blacks normally have a concentration of hemoglobin averaging about 0.5 g/dl less than in whites, and about 10% of normal blacks will be mistakenly designated anemic, if the same norms are applied.
109 citations
TL;DR: The view that mass screening of newborns for congenital hypothyroidism has to be introduced in Sweden is supported, however, the beneficial effects of such a program cannot be fully elucidated until it has been considered whether earlier instituted treatment would have improved the outcome of children in whom a diagnosis was made after 3 months of age.
Abstract: A total number of 112 children with congenital hypothyroidism were diagnosed in all Children's Hospitals and Pediatric Wards in Sweden during the 7-year period 1969-1975. Since it may be assumed that all cases of congenital hypothyroidism, which were diagnosed during that period were seen in one of these hospitals, the incidence of congenital hypothyroidism in Sweden can be calculated to be 1:6900 live births. In spite of an efficient National Health Care Program for infants the diagnosis was delayed until after an age of three months in 52% of the cases. This fact supports the view that mass screening of newborns for congenital hypothyroidism has to be introduced in Sweden. However, the beneficial effects of such a program cannot be fully elucidated until it has been considered whether earlier instituted treatment would have improved the outcome of children in whom a diagnosis was made after 3 months of age.
93 citations
TL;DR: Routine newborn screening is necessary for the effective diagnosis of galactosemia, a disorder with definite and severe complications, but one in which the complications can be prevented with simple and inexpensive treatment.
TL;DR: Routine newborn screening for maple syrup urine disease has been conducted since 1964, and more than 9 1/2 million newborns throughout the world have been tested with use of a bacterial inhibition assay (BIA) for leucine on dried filter paper blood specimens.
Abstract: Maple syrup urine disease (MSUD), also known as branched-chain ketoaciduria, was first described by Menkes et al. (1954). Patients with the classic form of the disease appear normal at birth, but by the 1st week of life have feeding difficulties, vomiting, and hypertonicity. If untreated, the course is usually rapid with development of neurologic manifestations, convulsions, coma, and death. Untreated or improperly treated infants who survive will generally have severe mental and motor retardation.
TL;DR: The outcome of a given chronic disease is of much interest to the individual patient and his physicians, and knowledge of the natural history of untreated disease becomes particularly important in decisions regarding initiation of treatment and assessing the effect of various modes of therapy.
Abstract: The outcome of a given chronic disease is of much interest to the individual patient and his physicians. Knowledge of the natural history of untreated disease becomes particularly important in decisions regarding initiation of treatment and assessing the effect of various modes of therapy on the course of a given disease. A bias in most published data regarding prognosis and natural history of chronic disease suggests worse outcomes than actually apply. Inappropriate therapeutic decisions may result. Many chronic diseases have a wide range of clinical manifestations. Patients with more severe symptoms are more likely to find their way to physicians. . . .
TL;DR: A blood pressure measurement was part of a cardiovascular screening examination of 8397 middle-aged men taking part in the intervention section of the United Kingdom Heart Disease Prevention Project, revealing a poor degree of blood pressure control in the community at the time of screening.
Abstract: A blood pressure measurement was part of a cardiovascular screening examination of 8397 middle-aged men taking part in the intervention section of the United Kingdom Heart Disease Prevention Project. Standardised training techniques reduced observer bias to acceptable limits in four out of a total of five observers. The time of day and room temperature both made significant differences to the blood pressure measurement. High room temperatures in particular apparently had a marked effect in reducing the level of blood pressure. There were consistent and large positive associations with increasing age and overweight. The survey revealed a poor degree of blood pressure control in the community at the time of screening--only 7% of the "hypertensive" population had their diastolic pressure controlled to below 100 mm Hg.
TL;DR: An analysis of visual defects among 310 children referred from a vision screening of 2178 7‐year‐old children revealed a 50% frequency of significant eye defects among the referrals, indicating the need for continuation of the present vision screening program of pre‐school children.
Abstract: An analysis of visual defects among 310 children referred from a vision screening of 2 178 7-year-old children revealed a 50% frequency of significant eye defects among the referrals (7% of screened children). Of the screened children, one group (1 530 children) had previous visual screening three years earlier. The other group (648 children) had no previous vision screening until the age of seven. A comparison between the two groups showed that the risk of finding a new significant eye disorder in a school entrant was more than 6 times greater for a child who was not examined in his preschool years, and the risk of finding an amblyopic child was more than 10 times greater. The results do indicate the need for continuation of the present vision screening program of pre-school children.
TL;DR: A broader survey provides useful insights into the role of occupational hazards in the overall public health problem of cancer and is not a substitute for intensive investigation of specific occupation-site relationships, but can provide guidance on which relationships are likely to be of public health significance, and what directions the deeper investigations might take.
Abstract: Data using a series of approximately 14,000 patients admitted to Roswell Park Memorial Institute for Cancer Research between 1956 and 1965 have been analyzed for occupations cancer risks. A detailed epidemiological schedule involving occupational history, smoking, drinking, and various other etiological factors was taken prior to interview. A mass screening of these data for about 20 different sites of cancer and 50 suspect occupations was conducted, using age-adjusted relative risks. A number of relationships was found between particular occupations and cancers. This report gives a survey of these relationships for men in a subset of the occupations screened, i.e., those occupations where exposure to dust would be suspected. Unlike most previous occupational studies, this one has a broad focus on a set of occupations and cancer sites rather than a narrow focus on one specific occupation or cancer site. This broader survey provides useful insights into the role of occupational hazards in the overall public health problem of cancer and is not a substitute for intensive investigation of specific occupation-site relationships (which cannot be done here). It can, however, provide guidance on which relationships are likely to be of public health significance, and what directions the deeper investigations might take. This kind of perspective is provided for the 22 occupation-cancer-site combinations where the age-adjusted relative risk is significant at the 5% probability level.
TL;DR: After more than 30 years of routine use, the Pap test fails to meet most of the generally accepted criteria for a mass screening program, but the policy persists because the nation's ideology supports the maximum utilization of new technologies; and special interest groups have promoted the test as the major weapon in the "War on Cancer".
Abstract: The annual Pap test became a recommended standard for American women without ever having been subjected to controlled trials to estimate its efficacy and effectiveness. After more than 30 years of routine use, the Pap test fails to meet most of the generally accepted criteria for a mass screening program. The policy persists, however, because the nation's ideology supports the maximum utilization of new technologies; and special interest groups have promoted the test as the major weapon in the "War on Cancer." With some exceptions, this is a questionable allocation of public and private health resources.
TL;DR: From the experience in the screening of 212,000 newborn infants, a flow chart for processing T4 and TSH measurements obtained from initial filter paper blood spots is devised, which indicates that about 1.84% require a spot TSH determination, and 1.1% require repeat determinations of T4.
TL;DR: The results of four screening examinations at approximately one-year intervals and the long-term follow-up of all screened individuals support the usefulness of capture-recapture methods in the evaluation of a screening program.
Abstract: In a medical screening program for early detection of disease, one or more screening modes are administered to an apparently healthy population Knowledge of the true disease status for all screened individuals would allow estimation of the false negative and false positive rates for each mode of detection and for the program as a whole This paper develops capture-recapture methods applicable to programs as a whole This paper develops capture-recapture methods applicable to programs when follow-up of individuals negative on screening is not performed or is incomplete The methods require at least two independent modes of detection Data from a breast cancer screening program illustrate the procedure The results of four screening examinations at approximately one-year intervals and the long-term follow-up of all screened individuals support the usefulness of these methods in the evaluation of a screening program
Journal Article•
TL;DR: Statistical analysis of the data obtained from the study indicated that the Letter-Matching-Test was significantly better in terms of testability rates, group and individual instruction time, and performance time than the E-Test.
Abstract: The purpose of the study was to evaluate the relative merits of two screening tests used for visual acuity assessment of preschool children. The tests that were compared were the Good-Lite Company versions of the E-Test and of the STYCAR (Screening Test for Young Children and Retardates). The former is the most popular method for evaluating central acuity in young children in this nation; the STYCAR is a relatively new letter-matching-test developed in England, where it is widely employed. The E-Test poses left-right orientation problems which are eliminated by the symmetrical letters H, T, O and V utilized in the Letter-Matching-Test. Both visual acuity tests were administered on two separate occasions by personnel from the Prevention of Blindness Society of Metropolitan Washington to 633 preschool children in Washington, D.C. By random selection, 150 of the children received the E-Test at both sessions, 162 children received the Letter-Matching-Test at both sessions, 160 chilt athe the second session, and 161 children received the Letter-Matching-Test at the first session and the E-Test at the second session. The author medically examined the eyes of 408 of the 633 children without knowledge of which test had been initially administered. Statistical analysis of the data obtained from the study indicated that the Letter-Matching-Test was significantly better in terms of testability rates, group and individual instruction time, and performance time. The E-Test was more reliable in terms of test-retest acuity scores and was also more valid in terms of agreement between pass-fail results obtained at the first screening session and two levels of pass-fail refraction criteria.
TL;DR: Findings of differential parenchymal risk, coupled with other risk factors, may lead to concentrating mammographic screening on a smaller segment of the population, thus improving the benefit-to-cost ratio.
Abstract: In a screening program of self-referred women, different mammographic parenchymal patterns were related to significantly different rates for developing breast cancer. The risk of cancer detection subsequent to a negative mammographic examination was 7.6 times greater for women in the highest parenchymal risk class compared with the lowest, an increase in risk comparable to that of a personal history of breast cancer and greater than that reported for any other combination of historical risk factors. These differences are qualitatively similar to, but of a lesser magnitude than, those in previous reports which were based on symptomatic women with previous negative mammograms. Data suggest this difference in risk is inherent between parenchymal patterns, rather than indicating difficulty in identifying small cancers in dense breasts. Findings of differential parenchymal risk, coupled with other risk factors, may lead to concentrating mammographic screening on a smaller segment of the population, thus improving the benefit-to-cost ratio.
TL;DR: A study group of originally 623 employed women of Northwestern Switzerland who were aged 30 to 49 yr and showing objective evidence of intake of phenacetin-containing analgesics and one showing low-intake showed significantly higher rates of bacteriuria than the controls, and was higher than expected in a comparative population in Switzerland.
TL;DR: The results clearly indicate the importance of regular vision screening during the school years and the need for comprehensive but flexible back-up services.
Abstract: Distant vision screenings of a national sample of children were performed at the ages of 7, 11, and 16. Many children with normal vision at one screening showed defects at later screenings, and altogether 18% of children with normal vision at the age of 7 had defects by the time they were 16. Twelve per cent of those with normal vision at 7 and 11 had developed a visual defect by the age of 16. Apparent improvements between screenings probably resulted largely from technical difficulties inherent in testing young children. The results clearly indicate the importance of regular vision screening during the school years and the need for comprehensive but flexible back-up services.
TL;DR: It is concluded that the Isaacs endometrial cell sampler is safe, quick, comfortable, and reliable for assessingendometrial state and should prove valuable for screening, particularly in the management of menopausal women requiring oestrogen treatment.
Abstract: The value of the Isaacs endometrial cell sampler in the cytologic assessment of the endometrium was studied in 121 unanaesthetised patients aged over 40. Satisfactory aspirates for cytological diagnosis of endometrial state were obtained in 111 patients (91%) whereas endometrial specimens for histological diagnosis were obtained in only 89 patients (79%). In only four out of 83 cases were there diagnostic discrepancies between the aspirates and the curettings. It is concluded that the technique is safe, quick, comfortable, and reliable for assessing endometrial state. It should therefore prove valuable for screening, particularly in the management of menopausal women requiring oestrogen treatment.
TL;DR: Until the aetiology of the disease is established no lower age limit should be set for cervical screening; all young women should be entitled and encouraged to have cervical cytology tests.
TL;DR: Preliminary information suggests that the early diagnosis and screening of newborn infants for congenital hypothyroidism does in fact prevent mental retardation.
TL;DR: A significant but low-level association was observed between the occurrence of breast cancer and the use of rauwolfia derivatives for 5 or more years in the study of 481 breast cancer cases and 1,268 controls from a joint national mammography screening project of the National Cancer Institute and the American Cancer Society.
Abstract: A significant but low-level association (relative odds, 2.0; P less than 0.05) was observed between the occurrence of breast cancer and the use of rauwolfia derivatives for 5 or more years in the study of 481 breast cancer cases and 1,268 controls from a joint national mammography screening project of the National Cancer Institute and the American Cancer Society. This association was confined to women over age 50 years who were also heavier than average. No confounding effects could be held responsible for this association after adjustment was made for variables such as presence of hypertension, weight, age at first pregnancy, and other breast cancer risk factors. Other antihypertensive and diuretic drugs as well as multiple drug use also exhibited some suggestive associations with breast cancer. Another group of 421 women with benign lesions at breast biopsy were also compared to the 1,268 controls. They showed a significant association between benign lesions and use of thiazides for 5 or more years (relative odds, 2.4; P less than 0.001) whether employed to treat edema or hypertension. Other antihypertensive and diuretic agents also seemed to show this association, but most of them were being used together with thiazides.
TL;DR: Recent experimental data strongly suggest that the inhibitory effects of lead in the biosynthetic pathway for heme formation can be modified in animals by altering the concentrations of other essential and nonessential trace metals.
Abstract: Publisher Summary Lead causes partial inhibition at several enzymatic steps in the biosynthesis of heme, reduces the bioavailability of iron and, in erythroid cells, impairs globin synthesis. In humans, the combination is pathognomonic for lead: inhibition of δ-aminolevulinate dehydratase (ALAD) activity, as assayed in vitro in circulating erythrocytes; increased excretion of δ-aminolevulinic acid in urine (ALAU); increased excretion of Type III coproporphyrin in urine (CPU); and accumulation of zinc protoporphyrin (ZnP) in erythrocytes. In most methods of analysis of lead poisoning, ZnP is measured as “free” erythrocyte protoporphyrin (FEP). Recently developed microscale fluorometric methods permit quantitative determination of FEP in 20 μl of whole blood or less. Microtests for FEP and ZnP, referred to generically as erythrocyte protoporphyrin (EP) tests, are now in wide use in screening for prevention of pediatric plumbism. Microscale methods for measurement of in erythrocytes ALAD activity are also in wide use in epidemiological studies. Recent experimental data strongly suggest that the inhibitory effects of lead in the biosynthetic pathway for heme formation can be modified in animals by altering the concentrations of other essential and nonessential trace metals. Although intralaboratory precision is often satisfactory, interlaboratory comparisons reveal substantial differences between laboratories in the measurement of blood lead, δ-aminolevulinate dehydratase (ALAD), δ-aminolevulinic acid (ALAU), and free erythrocyte protoporphyrin (FEP).