Showing papers on "Mass screening published in 1979"

A scaled version of the General Health Questionnaire

Abstract: This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.

Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population.

Abstract: • Major medical illnesses remain undiagnosed and patients' ailments are being labeled "psychosomatic" at an alarming rate. A careful screening of 2,090 psychiatric clinic patients showed that 43% of this population suffered from one or several physical illnesses. Almost half of the physical illnesses (46%), remained undiagnosed by the referring source. Morbidity in the psychiatric clinic patients far surpassed the expected rate found in the general population. Among others, diabetes mellitus was a frequently overlooked diagnosis and proved, particularly, to produce emotional disturbances. Physicians other than psychiatrists missed one third and psychiatrists one half of the major medical illnesses in patients they referred. Self-referred and social agency-referred patients almost always had undiagnosed physical illnesses. The causes for failing to recognize medical illnesses are discussed. Based on the obtained data, the necessity for a medical orientation on the part of the psychiatrist in evaluating all patients is stressed.

Breast cancer missed by mammography.

Abstract: Because a "negative" mammogram that is followed by a biopsy diagnostic of cancer is a matter of deep concern, a retrospective review was conducted of 48 such missed diagnoses at four Breast Cancer Detection Centers. The study group comprised 40,000 women participating in breast cancer screening examinations. From 3,271 biopsies during screening, 499 cancers had been found. Biopsies in the interval between screening examinations totaled 630 and yielded 48 malignancies. These 48 interval cancers were studied in an attempt to discover why they were not found on the preceding mammographic examination. Three major categories of error were disclosed and each is discussed: (1) poor radiographic technique; (2) absence of radiographic criteria of cancer; (3a) obvious oversight by the radiologist; and (3b) lack of recognition of subtle radiographic signs. This last reason is discussed in detail in the belief that better recognition of these indirect radiographic signs will lead to more accurate diagnoses, particularly in early cancers.

Brain Stem Evoked Response Audiometry in Newborn Hearing Screening

Abstract: Brain stem evoked response audiometry (BERA) has been used as an auditory screening procedure in three groups of newborn infants. Group 1 consisted of 220 normal-term infants who were tested within 72 hours of birth; no hearing abnormalities were uncovered (386 ears), and their threshold responses (for clicks) lay between a 10- and 20-dB hearing level (re: adult). Group 2 consisted of 75 newborns who were treated in an intensive care unit for one to 14 weeks; four were found to have severe sensorineural hearing loss (seven ears) at the time of discharge. Group 3 consisted of a group of 325 infants, 1 year or older, who had previously been discharged from the same intensive care unit; of these infants, an additional four showed severe sensorineural hearing loss. All abnormalities that were identified by BERA were subsequently confirmed by conventional audiometric measures. The estimate of an incidence of severe hearing loss in one of 50 infants who required intensive care in the neonatal period calls for careful testing of this population.

A randomized controlled trial of geriatric screening and surveillance in general practice

Abstract: A randomized controlled trial of geriatric screening and surveillance was undertaken on a practice population of 295 patients aged 70 years or more over a two-year period In the screened group (145 patients) many social problems were found and a total of 380 medical conditions were reported during the study period, 144 (38 per cent) of which were previously undetected Conditions found most frequently involved the circulatory, musculoskeletal and nervous systems; 67 per cent of the conditions found were manageable, half being improved and the remainder resolved completely The screening programme was found to increase the use of social and health services but it did also decrease the expected duration of stay in hospital Independent assessment of patients in the study and control groups at the end of the two-year period showed that the screening programme had made no significant impact on the prevalence of socio-economic, functional, and medical disorders affecting health We formed the firm impression that the study patients were made more comfortable (by control of pain) and less disabled, although there was no unequivocal objective evidence of this They were, however, kept independent for longer The findings are discussed and a model of geriatric care is suggested combining conventional management on demand with comprehensive screening to identify the high-risk patients on whom care might need to be focussed

Hypertension screening in schools: results of the Dallas study.

Abstract: The purpose of this study was to determine the prevalence of persistent blood pressure elevations in an eighth-grade population composed of three ethnic groups, and to determine the feasibility of using school health facilities for hypertension screening. Blood pressure was recorded in 10,641 subjects (90% of the total eighth-grade population) in the Dallas Independent School District. Blacks made up 46% of the population; non-Latin whites, 40.1%; and Latin-Americans, 13.9%. On the first blood pressure screening, 8.9% had systolic or diastolic pressures or both at or above the 95th percentile. Of those whose blood pressures were elevated on the first examination, 98.3% were reexamined. After the third examination, 1.2% continued to have systolic hypertension, and 0.37% diastolic hypertension. No student had diastolic pressure above 90 mm Hg on all three examinations. The prevalence of persistent hypertension was similar for the three ethnic groups. Analysis of variation in blood pressure measurements revealed that the school nurses introduced a relatively small increase in variability. These data indicate that although school screening initially identifies large numbers of students as having inconstant pressure elevations, subsequent follow-up examinations show that less than 2% have persistent hypertension.

Epicuticular Wax and Cuticular Resistance in Rice

Abstract: High leaf cuticular resistance has been reported as a component adaptation of plants to drought prone regions, Experiments were conducted to evaluate and characterize the role of epicuticular wax as a component of cuticular resistance to water vapor loss from rice (Oryza sativa L.) leaves. This information is necessary to determine the applicability of including higher cuticular resistance in an upland rice breeding program and to evaluate potential selection methods. Diffusion porometry, electron microscopy, and gas liquid chromatography were employed. Measurement of cuticular resistance by leaf diffusive resistance porometry after stomatal closure by exposure of rice leaves to pure CO2 for 15 min was found sufficient to induce complete stomatal closure regardless of light level, and was superior to dark acclimation for this purpose. Removal of epicuticular wax from rice leaves by chloroform dip significantly reduced the cuticular resistance. Stressed plants were observed to increase cuticular resistance, illustrating the responsive nature of this characteristic. Gas liquid chromatography (GLC) of the chloroform leaf dip proved to be an expedient method of characterizing both quantitative and qualitative differences in the epicuticular wax of rice cullivars. The porometry and GLC techniques may be useful in selecting parents, spot checking in a pedigree program, or checking lines reaching the yield testing stage, but ate not well suited lor mass screening early generation progeny. Significant differences were found in the two rice cultivurs, ‘63–83′, an upland adapted rice from West Africa, and “IR20′, bred and selected in submerged paddy culture in ihc Philippines, by tlie above methods of characterizing cuticular resistance and epicuticular wax. These results are of ecological significance to plant breeders.

Occupational lead exposure in Denmark: screening with the haematofluorometer.

Abstract: The zinc protoporphyrin/haemoglobin (ZPP/Hb) ratio was measured in the field with a haematofluorometer. A significant increase in ZPP/Hb ratio with advancing age was found in 1295 men who denied any excess exposure to lead. Ninety-seven per cent of the results were below 110 mumol ZPP/mol Hb(Fe) (4.4 microgram ZPP/g Hb). The ZPP/Hb ratio was determined in a lead-exposed population of 2275 men, and in 305 a blood lead analysis was also performed. A blood lead limit of 2.9 mumol/l (60 microgram/100 ml) corresponds to about 500 mumol ZPP/mol Hb(Fe) (20 microgram/g). This limit was exceeded in workers engaged in secondary lead smelting, storage battery manufacture, car radiator repair, crystal glass manufacture, storage battery repair, ship breaking, metal foundries, the ceramic industry, scrap metal handling, and PVC plastic manufacture. Other occupations caused lower lead exposures with ZPP/Hb ratios between 110 and 500 mumol ZPP/mol Hb(Fe): such ratios were found in men from shooting ranges, in leaded pane manufacturers, gunsmiths, car paint sprayers, type setters, steel rolling mill workers, shipbuilders and welders, car mechanics, lead pigment handlers, and solderers. Increased ZPP/Hb ratios and blood lead levels in 210 workers were associated with a decrease in haemoglobin concentration in the blood. Thus, the haematofluorometer has proved to be very useful for screening purposes. A blood lead determination should be performed if the ZPP/Hb ratio exceeds 300 microgram ZPP/mol Hb(Fe) (12 microgram/g).

Diagnosis of alcoholism: the Munich Alcoholism Test (MALT).

Abstract: The purpose of our project was to develop and empirically test a diagnostic instrument which would permit sufficiently reliable differentiation between alcoholics and healthy as well as sick persons and which would also be easy and economical to administer. For this purpose, roughly 250 diagnostically relevant items were selected from the extensive literature on alcoholism and, with a total of 1335 patients (661 of these were alcoholics), were evaluated in three separate phases for their ability to differentiate. The best items were selected on the basis of various statistical criteria and then cross-validated. The result is the Munich Alcoholism Test (MAT) which consists of two complementary parts: a 7-item physician's assessment part and a 24-item self-assessment part. In a cross-validation study on 675 unselected in- and outpatients a validity of r = 0.94 was obtained. The reliability of the self-assessment part was r = 0.84.

Otitis Media and Child Development: Design Factors in the Identification and Assessment of Hearing Loss

Abstract: Otitis media with effusion (OME) is the major cause of auditory dysfunction in preschool and early-grade schoolchildren. At especially high risk are children with cleft palate/lip; some groups of mentally retarded children; children from underprivileged communities and children with severe or profound sensorineural hearing loss. In neonates the major concern is to identify those with severe sensorineural hearing loss but awareness of the likelihood of OME is also vital. The hearing loss associated with OME in its early stages may be as small as 10--15 dB and in consequence conventional hearing tests employing pure tones are inadequate is screening procedures. Acoustic impedance testing has proved to be a practicable, acceptable, sensitive and efficient method of identification of OME in infants and children. Impedance measurement cannot, as yet, provide accurate assessment of hearing loss, but this is probably not a serious drawback. The primary requirement is to detect OME in order that swift and effective treatment can be instituted.

Resting heart rate in apparently healthy middle-aged men.

Abstract: Resting heart rate (fcrest) was measured by a standardized technique in 2,014 men aged 40–59 years during a cardiovascular survey. All men were thought to be healthy prior to the survey examination. According to the survey findings, the material was subdivided into 5 clinical subgroups, according to survey findings of coronary heart disease (CHD), or suspect symptoms, or signs. Coronary angiography was performed in 105 subjects with particularly strong suspicions of CHD. Fcrest varied between 61–63 among the 5 groups (p>0.10). In 1832/2014 defined as “normals” the following findings were made: 1. Mean fcrest 61 (SD 9.7), and almost identical values obtained by auscultation and from resting ECGs in the same persons. 2. Linear drop in fcrest by age (−0.126 beats/year, p<0.001). 3. Increase in fcrest with increasing systolic blood pressure.

A comparison of enzyme-linked immunosorbent assay and indirect fluorescent antibody test in the sero-diagnosis of cutaneous and visceral leishmaniasis in Iran.

Abstract: ELISA AND IFAT have been applied to the sero-diagnosis of cutaneous and visceral leishmaniasis and the levels of leishmanial antibody detected by Leishmania donovani antigens in both tests have been compared. From the results it appears that ELISA is a little more sensitive than IFAT, but IFAT seems to be more specific in detecting leishmanial antibodies. In both tests reactions between leishmanial antigen and some other infections, such as malaria and typhoid, were observed. These non-specific reactions reduce the validity of both tests, especially ELISA, in the sero-diagnosis of cutaneous leishmaniasis but, in visceral leishmaniasis, the leishmanial antibody levels were high enough to be unaffected by non-specific reactions. In general, ELISA is as good as IFAT and more practical in the sero-diagnosis and mass screening surveys for kala-azar.

School screening for scoliosis in Athens

Abstract: A randomly selected sample of 3494 children evenly representing a total population of 37 391 schoolchildren aged between eleven and twelve was screened for idiopathic scoliosis by the bending test. Ten per cent of the children showed clinical evidence of scoliosis and 6.4 per cent had positive radiological findings. Small curves were equally distributed between the two sexes, while large ones were more common in girls. Children with fair hair and blue eyes showed a higher percentage of positive findings than children with a dark complexion. A group of 112 children with curves between 7 and 16 degrees were followed up for an average of nineteen months. The pattern and evolution of these curves showed their close relationship to established scoliosis. Potential factors of instability and deterioration of the curves were evaluated.

Screening for alcoholism.

Abstract: ALCOHOLISM is one of the most prevalent conditions to confront the primary care physician. In six different hospital studies, 1-3 alcoholism was found in 3.7% to 9.9% of women and in 15.3% to 29% of men. We believe that all general medical patients should be screened for alcoholism and think that this can be done simply and reliably. In general, one must have a high index of suspicion, ask the proper questions, gather the evidence, and understand the condition. We suggest the following approach. The Right Questions Two commonly asked questions should be avoided. "How much do you drink?" and "Are you an alcoholic?" usually bring guarded replies and produce little useful information. We think that four simple screening questions can go a long way toward alerting the clinician to alcoholism. "Do you drink?" obviously must begin the screening process. The patient who denies drinking at all should then be

Creatine phosphokinase levels in the newborn and their use in screening for Duchenne muscular dystrophy.

Abstract: The PKU sample, if taken after the 3rd day, is suitable for Duchenne muscular dystrophy screening using creatine phosphokinase (CPK) levels. 101 babies (53 girls and 48 boys) had CPK levels measured on filter paper blood specimens taken by heel prick on the 1st and 4th days of life. The method used was that described by Zellweger and Antonik (1975). The CPK levels were markedly raised on the 1st day of life but by the 4th they had reduced to within 3 times the upper limit of the normal range for adults. 10,000 boys were then screened for Duchenne muscular dystrophy using the PKU sample, and 2 cases were found.

Results of a regional cord blood screening programme for detecting neonatal hypothyroidism.

Abstract: Our regional cord blood screening programme for detecting neonatal hypothyroidism using initial cord blood thyroxine (T4) determinations, with supplemental thyrotropin (TSH), and triiodothyronine resin uptake (T3U) measurements, gave an incidence of thyroid abnormalities of 1/3000 births, with 1/5000 infants having severe primary hypothyroidism. No hypothyroid infant detected in the programme had been suspected clinically before the screening and, in retrospect, only a few babies had any signs of hypothyroidism. Supplemental TSH and T3U determinations were required on 8-12% of the population screened initially with a T4 test to avoid missing affected cases. With an initial T4 and supplementary TSH and T3U testing on cord blood serum, recalls to exclude primary hypothyroidism were reduced to 0.16% of the screened population. The incidence of abnormalities detected in this cord blood screening programme was comparable with that reported by others using neonatal dried blood screening methods, indicating that cord blood screening can be effective provided the appropriate recall criteria and transport conditions are used. Nevertheless, for several practical reasons, neonatal dried blood methods are recommended as the screening test of choice for surveying large populations over extensive geographical areas.

Breast cancer incidence among atomic bomb survivors: implications for radiobiologic risk at low doses.

Abstract: Supplemental dose--response analyses of breast cancer incidence data for Japanese A-bomb survivors during the period 1950 to 1969 were presented. The first analysis led to an unpublished result cited in a report on risks associated with mammography in mass screening for breast cancer, namely, that the inference for a radiation among the A-bomb survivors did not depend solely on interpolation between values at 0 and high doses. In the second analysis, a theoretical form suggested by radiobiologic principles was used to investigate the extent to which linear interpolation may overestimate or underestimate breast cancer risk at low doses. The functional form, I(D) = (..cap alpha../sub 0/+..cap alpha../sub 1/D+..cap alpha../sub 2/D/sup 2/)2/sup /sup -/..beta../sub 1/D/sup -/..beta../sub 2/D/, where I(D) denoted breast cancer incidence at dose D and where all parameters were constrained to be positive, was treated as a basically linear form for description of the risk at low doses, with additional parameters to allow for upward curvature over the low-to-intermediate range and downward curvature at high doses. The analysis provided direct evidence of a radiation breast carcinogenesis effect at doses under 49 rads kerma (< 40 rads to breast tissue). Evidence for an effect was contributed by the data frommore » both Hiroshima and Nagasaki. The incidence data were too sparse to express all the subtleties of the above functional form for the dose response, and the form was simplified by the elimination of some parameters. The risk estimate obtained with the use of a simple linear model was not greater than estimates obtained with more general models that fit the data more closely.« less

Screening for hyperlipoproteinemia in 10,000 Danish newborns. Follow-up studies in 522 children with elevated cord serum VLDL-LDL-cholesterol.

Abstract: Among 10 440 newborns, 522 with upper 5 percentile values for very low-low density lipoprotein cholesterol in cord serum were selected for follow-up studies. Follow-up was possible in 446 of these 522 families (85%) and familial hypercholesterolemia (FH) was diagnosed in 11. In 273 of the 522 children, serum lipids were determined between the ages of 1 and 2 years and were now found to be normal, except in the 11 children with FH. Furthermore the serum lipids were compared in subgroups of these 273 children divided according to obstetric complications (i.e. low birth-weight, perinatal asphyxia and antepartum betamethasone treatment), which may cause a rise in serum lipids at birth. No differences were found between these subgroups at the age of 1--2 years.

Breast cancer screening with mammography: a population-based, randomized trial with mammography as the only screening mode.

Abstract: A population-based, randomized breast cancer screening project was undertaken using mammography alone. Of 17,447 invited women aged 50-69, 12,765 (73%) attended the screening. On the basis of the screening films, malignancy was suspected in 405 women (3.2%) who were recalled for complete mammography. Additional films showed that the suspicion of malignancy was false in 194 women. The remaining 211 women (1.7%) were referred for clinical and cytological examination. Of these, 159 had surgery. Breast cancer was proved in 97 women, corresponding to a prevalence rate of 7.6/1000. Fifty-three (55%) of the carcinomas were either in situ or invasive with a diameter of less than or equal to 1 cm. Axillary metastases were found in 19 patients (19.6%). Cancers detected at screening were significantly less advanced than those in the control group. There was a remarkably high frequency of tubular carcinoma among cancers detected at screening.

Measurement of 4-hydroxyphenylacetic aciduria as a screening test for small-bowel disease.

Abstract: We evaluted measurement of urinary 4-hydroxyphenyl acetic acid as a potential screening method for small-bowel disease and bacterial overgrowth syndromes in 360 unselected acutely ill infants and children. Control data were obtained on 120 healthy children, ages 1.5 to 15 years, from a general medical practice, 48 healthy infants, ages one to five years, from local day nurseries, and 150 healthy babies, ages less than one to eight days. Comparative data were from 300 acutely ill hospitalized babies and children, ranging in age from less than one day to 15 years and without clinical evidence for small-bowel disease and bacterial overgrowth syndrome. No false-negative results and only 2% false-positive results were observed. Among the 10 patients whose urinary excretion of the analyte was considered to be abnormal were patients with Giardia lamblia infestation, ileal resection with blind loop, and other diseases of the small intestine associated with bacterial overgrowth. We conclude that measurement of 4-hydroxyphenylacetic acid excretion is useful in screening for such diseases.

Beta 0 thalassemia trait in Sardinia.

Abstract: The red cell indices and results of globin chain synthesis in peripheral blood of obligate beta 0 thalassemia (beta 0 thal) carriers (parents of homozygous beta 0 thal children) and beta thalassemia (beta thal) carriers identified during mass screening are reported. Red cell indices were similar in obligate beta 0 carriers and in carriers diagnosed during mass screening. However there was a higher incidence of anemia in female obligate beta 0 thal carriers. In Sardinia the beta 0 thal carrier showed the usual hematological characteristics of the high Hb A2 beta thal carrier with microcytosis, hypochromia, reduced osmotic fragility; Hb F greater than 1% was found in 30% of the carriers. With MCV, MCH, osmotic fragility test (OFT) and Shine and Lal discriminant function we found 3.5%, 1.5%, 3.5% and 4.0% respectively false negatives in carrier identification. A part from one subject, all obligate carriers had elevated Hb A2 levels. The alpha/beta ratio in obligate carriers (mean +/- SD) was 1.83 +/- 0.26 (N = 30).

Evaluation of a mass screening program for stomach cancer.

Abstract: To evaluate a mass screening program for stomach cancer, we followed 32,789 subjects for 6.1 years by means of a record linkage to a population-based cancer registry. The results show that the mortality from stomach cancer among those studied decreased by 9% as compared with the expected number calculated on the basis of the sex- and age-specific rates among the general population. When the study subjects were limited to those aged 40-59 years, the decrease in stomach cancer deaths became more marked, i.e., a 26% decrease was observed. Because this study is not a controlled trial, the results must be interpreted with the reservation that some biases were present in the study subjects.

The significance of drug analysis of sweat in respect to rapid screening for drug abuse

Abstract: Morphine and methamphetamine, which are excreted in the sweat, are detected by the use of routine serological and physicochemical techniques for urinary examinations. Screening for drug abuse can be done with the same accuracy of that of urine. Rapid excretion of the drug via kidney (within one day) is followed by a slow but steady excretion of the sweat gland. Methamphetamine given orally in a dose of 10 mg is excreted in the sweat at a constant rate (1.4 microgram/ml). No significant difference of the amount excreted by both systems is found. Alveolar lining seems to prevent the elimination of the volatile methamphetamine via respiration. Not only narcotics and stimulants, but also many alkaloids and barbituarates are excreted in the sweat and detected quantitatively by the same principles. The toxicological analysis of the sweat promises a new scope of forensic investigation.

Prevalence of fibrillopathia epitheliocapsularis (pseudoexfoliation) and capsular glaucoma.

Abstract: A mass screening of 8,537 persons above the age of 40 years in Bergen revealed fibrillopathia epitheliocapsularis (pseudoexfoliation) in 75 persons (i.e. 0.9%) and an increased prevalence with increasing age. Comparable geriatric groups in Birmingham, Bonn, and Bergen showed a prevalence of fibrillopathy of 4.0, 4.7, and 6.3% respectively. These differences are not statistically significant. The proportion of capsular glaucoma among patients with open angle glaucoma is higher in groups representing more severe cases of glaucoma than in groups of patients with more easily treatable glaucoma.

Impedance Screening for Preschool Children: State of the Art

Abstract: As a test for detecting middle ear disease among preschool children, tympanometry -- as opposed to audiometry -- has three advantageous attributes: a high degree of sensitivity, minimal need for subject cooperation, and total objectivity. For these reasons interest has arisen in tympanometry as a method for screening, i.e., identifying children with previously undetected middle ear disease. However, uncertainty persists concerning the importance of detecting apparently asymptomatic middle ear effusions, and concerning optimal methods, or even the advisability, of treating them. Further, the sensitivity and specificity of tympanometry depend on how the pass-fail cutoff point is defined. Defining this cutoff point so as to achieve high sensitivity may result in excessively low specificity, with the production of large numbers of false-positives who then become overreferrals. Data are presented to show how the validity of the test may be increased to some extent by attention to the gradient of "negative-pressure" tympanograms. At the present time, given the various aforementioned uncertainties, and with adequate validation as to the presence or absence of disease often lacking in reported studies of impedance screening in preschool populations, the cumulative results of these studies do not warrant embarking on large-scale screening programs. What is needed instead is additional research to explore the issue further.

A comparison of three tests for rubella antibody screening.

Abstract: Sera from 1000 women attending antenatal clinics were screened for the presence of rubella antibody by haemagglutination inhibition (HI), single radial haemolysis (SRH), and enzyme-linked immunosorbent assay (ELISA). With 925 sera concordant results were obtained with all three tests. There were 46 false-negative HI tests due to the necessity of allowing for residual non-specific inhibitors. With SRH there was one false positive and three that were negative by SRH but HI- and ELISA-positive. By ELISA 14 sera gave a false-positive result (OD 405 nm greater than or equal to 0.2). Ten of these could be eliminated by taking an OD 405 nm of 0.5 as the threshold but then another 10 sera became false negatives.

A sensitive single reverse passive haemagglutination test for detecting both HBsAg and anti-HBs.

Abstract: A trial of a modified reverse passive haemagglutination test for HBsAg using a 0.1% cell suspension instead of the recommended 1% showed an approximately eight-fold increase in detection sensitivity. The test can be performed within 30 minutes and lends itself to mass screening techniques. Confirmation tests can be done using the 0.1% method. In addition, the same serological plates and cells used for HBsAg screening can then be used to screen for high-titre anti-HBs. This makes the overall screening for both HBsAg and high-titre anti-HBs donors cheap and convenient.