Showing papers on "Mass screening published in 1980"

Northwestern Syntax Screening Test: a short form.

Abstract: The NSST was administered to 900 children aged three years to seven years, 11 months. Using a step-wise multiple regression model, the test was shortened from 20 to 11 test items receptively and expressively, while accounting for 95% of total test score variance. This shortened form, taking approximately 10 minutes to administer, was normed in six-month intervals as opposed to the one-year intervals of the original NSST. A cross validation sample of 301 children was used to demonstrate that comparable clinical decisions are made employing either form.

Ophthalmic Screening of 38,000 Children, Age 1 to 2 1/2 Years, in Child Welfare Clinics

Abstract: Screening of 38,000 infants, age 1 to 2 1/2 years, showed a prevalence of 1.3% of strabismus and 0.5% of strabismic amblyopia. Esotropia was more than three times as frequent as exotropia. Approximately half of the cases with esotropia were amblyopic. Eighty-one percent of the cases with exotropia were intermittent, and in 29% the V-pattern was found. Significant ametropia was found in over 50% of the cases with strabismus. Although hypermetropia was the most frequent refraction in children with esotropia, myopia was a frequent finding in both esotropia and exotropia. Anisometroia was particularly frequent in constant unilateral esotropia. Accommodative strabismus was found in 7% of cases with infantile esotropia. In cases with paralytic strabismus, the most frequent muscle involved was the lateral rectus. Significant organic pathology, other than strabismus or amblyopia, was revealed in 0.2% of the series. "Rapid retinoscopy" through undilated pupils is an efficient method in detecting high refractive errors and candidates for nonstrabismic amblyopia in childhood. Since this method of examination is easy to perform, its adoption as a part of screening projects in childhood is recommended. "Rapid retinoscopy" performed by a trained orthoptist is also a useful method for detecting opacities in the ocular media.

A postal screening questionnaire in preventive geriatric care.

Abstract: A postal questionnaire was introduced as a screening procedure for a comprehensive geriatric assessment programme in general practice. It had a response rate of 81 per cent, a sensitivity of 0·95, a specificity of 0·68, and a predictive value of 0·91. The use of this screening procedure could reduce the workload of an assessment programme by one fifth.

Neonatal screening for inborn errors of metabolism

Abstract: Rationale of Neonatal Screening for Inborn Errors of Metabolism.- Screening for Hereditary Metabolic Disorders.- Screening for Phenylketonuria.- Newborn Screening for Maple Syrup Urine Disease (Branched-Chain Ketoaciduria).- Homocystinuria and Other Methioninemias.- Screening for Disorders of Tyrosine Metabolism.- Neonatal Screening for Histidinemia.- Newborn Screening for Inherited Disorders of Galactose Metabolism.- Neonatal Screening for Cystic Fibrosis.- Newborn Urine Screening.- Neonatal Screening for Organic Acidurias.- Significance and Need of Screening for Hyperlipidemia in Childhood.- Screening for Hemoglobinopathies (Thalassemias and Other Abnormal Hemoglobins).- Screening for Glucose-6-Phosphate Dehydrogenase Deficiency and Other Erythrocyte Enzyme Defects.- Neonatal Screening for Muscular Dystrophy.- Neonatal Screening for Congenital Hypothyroidism.- Screening for Congenital Hypothyroidism: 4 Years of Experience.- Neonatal Screening for Hypothyroidism by TSH Determination in Dried Blood.- Experience with Primary Thyrotropin (TSH) Screening for Congenital Hypothyroidism in Pittsburgh (Pa.).- Neonatal Screening for Hypothyroidism in Brussels.- Results of the Toronto Regionalized Screening Program for Detecting Neonatal Hypothyroidism.- Experience with the Application of a Dried Blood Thyrotropin (TSH) Method for Neonatal Hypothyroidism Screening: Comparative Studies Between Double-Antibody and Solid Phase Radioimmunoassays.- Methodologie Limitations on the Measurement of Thyroxine from Small Dried Blood Discs: Comparison of Double-Antibody and Solid Phase Radioimmunoassays.- Summary of the Northwest Regional Hypothyroidism Screening Program.- Mass Screening for Neonatal Hypothyroidism in Japan.- Addendum.- Neonatal Screening Programs: Organization, Legislation, Methodologie Pitfalls, and Quality Control.- Introductory Remarks.- Organization of a Regional Newborn Screening Laboratory.- Medical Backup Needed for Newborn Metabolic Screening Programs.- Regionalization of Metabolic Screening Laboratories.- Structure of the System Required to Handle Problems in the European Community Related to Inborn Errors of Metabolism.- Organization and Legislative of Screening in Belgium.- Organization of Screening Laboratories.- Pitfalls in the Microbiologic Assay of Amino Acids in Screening Laboratories.- Quality Control Trial in a Screening Laboratory.- System of Neonatal Screening for Inbom Errors of Metabolism in Japan.- Organization of Screening Data on Computer.- Use of a Computer in a Screening Program.- Recommendations for and Future Aspects of Screening.- Recommendations for Newborn Screening.- Predictive Medicine: a Goal for Genetic Screening.

Acceptors and rejectors of an invitation to undergo breast screening compared with those who referred themselves.

Abstract: All women aged 50--79 were invited by two group practices to undergo screening and 57% accepted. Women of the same age range in other practices, who referred themselves, were also screened. Interview with random samples of 100 invited screened women (acceptors), 100 invited unscreened women (rejectors), and 50 self-referred women enabled comparisons to be made of personal and social characteristics, previous health behaviour, and beliefs about cancer in the three groups. Self-referral was associated with lower age, higher social class, and higher educational levels. Women accepting invitations included more who had previously used other screening procedures, for example, cervical smears and chest x rays, than those rejecting invitations. Previous use of screening was even more among self-referred women. Acceptance of screening was associated with belief in the possibilities of curing cancer.

Outcome of diabetes screening in pregnancy and perinatal morbidity in infants of mothers with mild impairment in glucose tolerance.

Abstract: Pregnant women attending the regular prenatal clinic at Los Angeles County (LAC)/Women9s Hospital received a 3-h oral glucose tolerance test (GTT). Upper limits for the test are a fasting blood glucose of 100 mg/dl (serum glucose 110 mg/dl), 1 h 170 mg/dl (200 mg/dl), 2 h 130 mg/dl (150 mg/dl), and 3 h 120 mg/dl (130 mg/dl). The incidence of overt diabetes (fasting hyperglycemia) was 3.5% and of Class A diabetic women (abnormal test but normal fasting glucose value) it was 8.8%. The incidence of abnormal tests is greater in obese patients, potential diabetic patients (family history of diabetes or abnormal obstetrical history), and with increasing age. However, it was 3.4% in a group of patients below age 20 yr and without an abnormal medical or obstetrical history. The perinatal mortality in uncomplicated Class A diabetic women is as low as in the general population. Patients with Complicated Class A (previous stillbirth or who develop preeclampsia) and those patients who develop fasting hyperglycemia should have medical and obstetrical surveillance. Twenty-five percent of the infants of Class A diabetic mothers experience some morbidity. Long-term follow-up of mothers with abnormal tests in pregnancy is indicated, since the incidence of subsequent carbohydrate abnormality is 40%. As a screening procedure, pregnant women should have a 2-h serum glucose following the administration of 100 g of a glucose solution. In patients with a value of over 140 mg/dl, a GTT should be performed. In patients with a screening value of less than 140 mg/dl, it should be repeated by 34 wk gestation.

A mass screening program for colorectal cancer using chemical testing for occult blood in the stool.

Abstract: Following five promotional and educational programs on CBS-TV news in Chicago, 54,101 Hemoccult® kits were requested by the public and distributed by seven cancer detection facilities. Only 14,074 individuals completed the test. Six hundred and seventeen or 4.38% were positive. Two hundred and fifteen test positive persons failed to respond to repeated notification. In 123 positives, diagnostic tests by the private physician were considered incomplete. In 33 positives, the private physician did no further testing at all. In 152 positives, no abnormality could be found, but work-up was variable. One hundred and eighty-seven had abnormalities other than cancer, including 40 with polyps. Twenty-seven asymptomatic and two symptomatic cancers were found. Nearly two-thirds had Dukes A or B lesions, while one-third had Dukes C tumors. Public compliance in both completing kits and following through with positive results was low. Physician evaluation of positives was often incomplete. Chemical testing for occult fecal blood, when properly combined with other tests such as proctoscopy, has the potential for lowering mortality from colorectal cancer. Continued public and professional education is needed.

Application of an immunoenzymatic method and an immunoautoradiographic method for a mass survey of nasopharyngeal carcinoma.

Abstract: The frequency of IgA antibody to virus capsid antigen (VCA) of EB virus was tested by an immunoenzymatic method among adults in a mass serological screening of the general population of 6 communes in

A Pilot Community'Based Screening Program for Gestational Diabetes

Abstract: A pilot community-based screening program for gestational diabetes has been in operation in Cleveland, Ohio, since April 1, 1977. A socioeconomic and racially heterogeneous group of pregnant women are being routinely tested at approximately 24-28 wk of gestation by a capillary whole blood glucose determination, 2-h after a 75-g oral challenge. The results of the first 2225 screenings are analyzed in terms of the variables of maternal race, age, and stage of gestation. The overall incidence of positive screenings (greater than or equal to 120 mg/dl) is shown to be 11.5%, with significantly more positive tests among the whites than the nonwhites. Follow-up oral glucose tolerance testing results in an overall detection rate for abnormal carbohydrate metabolism of 3.1%. The data suggest that a 2-h screening procedure is more efficient than a 1-h procedure in that fewer confirmatory glucose tolerance tests need to be performed in order to yield this rate of detection. It may soon be feasible to introduce such a program on a wider community basis in concert with regionalized perinatal care.

Population screening for congenital hypothyroidism.

Abstract: A pilot screening programme for congenital hypothyroidism covering most of North London, Essex, Bedfordshire, and Hertfordshire entailed carrying out an assay of thyroid-stimulating hormone on single Guthrie dried blood spots. During one year 87 444 babies were screened and 26 cases of primary congenital hypothyroidism detected, giving an incidence of 1:3363. Only two cases (7.7%) had already been diagnosed on clinical grounds before the results of screening became available. In two other babies the diagnosis was delayed. The programme thus resulted in the early treatment of 22 babies, eight of whom already had pronounced features of hypothyroidism that had not been detected on routine clinical examinations. Although definitive evidence will not be available for some years, the results suggest that the prognosis for most of these babies is likely to be improved by early diagnosis; thus the introduction of national screening should be delayed no longer.

Alveolar echinococcosis of the liver. Studies on 60 operated cases.

Abstract: During the years 1936 through 1978, 60 cases received surgical intervention for alveolar echinococcosis of the liver. The resectability and operative mortality rate were 64.0% (16/25) and 43.8% (7/16) before 1968, but 54.3% (19/35) and zero (0/19) thereafter. Establishment of clinical staging and criteria for justifying radical resection of a given lesion, combined with systematic evaluation of all hepatic vasculatures, contributed to improvement of the result. The long-term prognosis of the disease, unless resected, has been exclusively poor. A mass screening program, which became possible by the development of serologic tests, has covered a population of over 140,000 in the endemic area and been of value in detecting the disease in its early developmental stage. The disease should be recognized even in currently unaffected areas since the cestode has a fairly wide geographic distribution including the United States.

School screening for scoliosis: cohort study of clinical course.

Abstract: A visual examination of 1764 Oxford schoolchildren for scoliosis was followed by low-dose radiography of the spine in those who showed evidence of asymmetric body topography; radiography was repeated a year later to assess progression. Forty-four children had curves of 10 degrees or more. Two had a congenital abnormality and the remaining 42 were classified according to the type of curve: sacral tilt (compensatory), spinal (idiopathic), or combined (sacral tilt and spinal). Progression occurred in 6 (14%) children, none of whom had only a sacral tilt. These results suggest that only by measuring sacral tilt can benign compensatory curves be differentiated from true idiopathic scoliosis.

Alcohol consumption and premature death in middle-aged men.

Abstract: All the men living in Malmo born in 1926-9 were invited for a screening examination which included an assessment of alcohol consumption and measurement of gamma-glutamyltransferase (GGT) activity. They were followed for up to four years (median 2) and their mortality assessed. Sixty-two deaths occurred, 41 (0.9%) among the 4571 men who attended the screening investigation and 21 (1.3%) among the 1609 who did not respond to the invitation. Evidence of alcohol abuse or an alcohol-related cause of death was present in 25 (61%) of the deaths among the attenders and 13 (62%) of those among the non-responders. GGT values at the screening investigation were significantly increased in 19 (46%) of those who died, but established risk factors, such as cholesterol and triglyceride concentrations and blood pressure, had little predictive value. Measurement of GGT provided an objective index of alcohol consumption, though the full clinical importance of a raised value needs further assessment. The finding that heavy alcohol consumption was the single most important factor associated with premature death in these middle-aged men has important implications for prevention.

Screening for colorectal cancer: an overview.

Abstract: The critical issue of whether to screen asymptomatic patients for colorectal cancer is related to expected benefits, the population at risk, sensitivity and specificity of available screening and diagnostic tests, cost-effectiveness, and patient compliance. Current screening programs in progress strongly suggest a survival benefit to those patients with a positive screening test but longer follow-up is necessary. Risk factors within the population have been defined, but further work is needed to identify more completely the high-risk subgroups for selective screening. Selective screening of high risk groups would be more productive than mass screening of standard risk patients. Screening and diagnostic tests in current use appear to be sensitive and specific, but more data will have to be examined. Screening with fecal occult testing has been shown to be feasible and productive, but cost-effectiveness must be demonstrated. Patient compliance has been high in well-motivated patients entering studies, but factors involved in health belief must be evaluated as a basis for patient orientation toward screening. Our goal for colorectal cancer is primary prevention--identification and elimination of environmental factors. Until then, secondary prevention may be a realistic achievement--the identification and eradication of precursor lesions and the diagnosis of early colon cancer.

Identification of sources of resistance to the beanfly and two other agromyzid flies in soybean and mungbean.

Abstract: A total of 6775 soybean and 3713 mungbean accessions was screened for resistance to the beanfly, Ophiomyia phaseoli (Tryon), and 2 other agromyzids, O. centrosematis (de Meijere), and Melanagromyza sojae (Zehntner), in mass screening trials during 2 yr. Since no immune accessions were found in the preliminary screening, we did a directional selection and screened the least affected entries a 2nd and 3rd time. We selected 16 soybean and 28 mungbean accessions that were least affected. When tested at 6 locations around Taiwan, 4 soybean and 3 mungbean accessions were least affected at all locations. These soybean accessions were highly resistant and mungbean accessions were moderately resistant to all 3 species. These accessions are now being used to breed resistance into high yield potential commercial varieties of these crops.

Racial differences in intraocular tension and glaucoma surgery

Abstract: A total of 4678 persons participated in an Allegheny County, Pennsylvania glaucoma screening program in 1977. Black participants had higher mean intraocular pressures, more frequent pathologic disc changes and more new cases of glaucoma discovered than a sample of white participants matched for sex and age. The same year, in a younger population of 2127 health center employees, the higher prevalence of pathologic disc changes was confirmed, although differences in mean intraocular pressures were variable. Blacks accounted for 23% of hospitalizations for chronic open-angle glaucoma during a three-year period (1975-1977) in 10 Pennsylvania counties, rather than the expected 6.3%. Among those hospitalized for open-angle glaucoma or having anterior chamber surgery, blacks were younger than whites.

Estimates of lead time and length bias in a breast cancer screening program.

Abstract: Assume that the benefit of screening for breast cancer with a combination of mammography and a clinical examination is measured by comparing the five-year survival rate of women detected by screening to the five-year survival rate of women surface clinically with breast cancer, e.g., to the survival rate of women reported in End Results In Cancer. In this paper a mathematical model is used to estimate the percentage of the observed difference in five-year survival rates between women in these two groups that is due to lead time and length bias. For women detected at an initial screen, the best estimate is that about 50% of the observed difference is due to bias and 50% to earlier detection. However, the percent due to bias may be as low as 20% and as high as 72%. These estimates are relatively insensitive to the age of the women screened. For women detected at a second screen given one year later, the estimated percentage of the observed difference in survival rates between women detected at the screen and a control group that is due to bias is between 33 and 42%.

Double one-dimensional electrophoresis of human serum transferrin: a new high-resolution screening method for genetically determined variation.

Abstract: With one-dimensional electrophoresis or electrofocusing the selective demonstration of proteins and their genetically determined variants from complex compositions like the physiological body fluids often is possible only with specific staining techniques or immunofixation. By the method described here samples are separated by. PAG electrophoresis and a selected detail of the electropherogram is further resolved by PAG electrofocusing. The resulting pattern of bands after a usual protein stain can easily be interpreted due to the reduction of the number of bands. Informative bands hidden in a one-dimensional pherogram by overlapping with one or more other bands can be selectively visualized by the one-dimensional combination of two electrophoretic methods. With the double one-dimensional technique several hundred samples can be analyzed per person day. Thus the application in electrophoretic screening studies appears to be of special interest. The method is demonstrated by using the polymorphism of human serum transferrin as an example. A new variant of Tf-C with a high incidence in the German population is demonstrated.

Uro- and angiographic findings in a "normal" population: screening of 151 symptom-free potential transplant donors for renal disease

Abstract: Potentially significant renal abnormalities were encountered in 7.3% of 151 symptom-free renal transplant donors and included renal cysts, cortical adenoma, ectopic and solitary kidney, and vascular abnormalities. Findings as they relat to donation of a kidney were important in 2.1% of patients and included solitary kidney and certain rare vascular variants rejected for technical reasons and danger of distal ureteral necrosis after transplantation.

Health screening for occupational dermatoses in house painters

Abstract: During 1976-77 a field investigation was carried out into skin diseases among house painters in Stockholm, Sweden. The study was divided into three stages: I. questionnaires investigation, II. examination of painters who reported skin diseases, and III. patch testing and final classification. Of the 2,622 painters registered on 30 November 1976, 2239 (85.4%) answered the questionnaire. Current dermatoses were reported by 373 painters (16.7%) and of these, 227 were examined by us, 40 had recently been examined, and 106 did not attend. Occupational contact eczemas were diagnosed in 87 cases, and it was doubtful if the dermatoses were occupational in an additional 56 cases. A prevalence of 3.9% was suggested, but this represents a minimum figure. Chloracetamide was found to be an important cause of occupational contact eczema. A personal and/or family history of atopy was common among the affected painters. Solvents were widely used for skin cleansing; there is a great need for continuous information on protective measurements, and on skin cleansing and care. It is concluded that field investigation give higher and probably more reliable prevalence figures for occupational dermatoses than data compiled from outpatient clinics.

Clinical impedance audiometry

Abstract: Preface to the Second EditionAlmost five years have passed since the publication of the first edition of this handbook, years that have seen continuing growth in the clinical applications of impedance audiometry. Progess has been particularly noteworthy in three areas: 1) The use of impedance measures in the mass screening of children for hearing disorders 2) Refinement of acoustic reflex measures to predict degree of sensori-neural loss 3) Exploitation of ipsi-contralateral relations in exploring disorders of the central reflex arc.The first area, use of impedance measures in mass screening, has created considerable, and we believe, healthy controversy. Advocates of the concept point to the widespread prevalence of midddle ear disorder in children, to the sensitivity of impedance measures in detecting such disorders, to the shortcomings of conventional pure-tone screening in this regard, and to the documented effects of even minor sensitivity loss on the acquisition of language skills during critical periods of language learning. Critics, however, emphasize the typically high false positive rates associated with impedance screening procedures, the fluctuating nature of middle ear disorder in children, and the lack, in any event, of a rational treatment regimen for the problem. Whatever its ultimate outcome may be, this controversy has had a positive educational effect in areas beyond impedance audiometry, per se. All parties to the debate have learned a good deal about the concepts of sensitivity (how well does the test identify what it seeks to identify) and specificity (how well does it exclude what it does not seek to identify). They have also learned the hard lesson that you can't have one without the other. As sensitivity increases, specificity decreases and vice versa. The better the test works to identify a particular disorder, the more likely it is to give a false-positive result. Similarly, a test without false alarms is typically a test with poor sensitivity. Advocates of mass impedance screening who point to its remarkable sensitivity to middle ear disorder have had to learn a bitter lesson about the price one must, inevitably, pay to achieve this high degree of sensitivity. Critics and advocates alike, moreover, have learned a great deal about the general concept of screening. They have had to learn, from the hard lesson of over-referral, that failing a screening procedure means follow-up examination rather than immediate referral to a physician. They have learned the difficult lesson that, because of the inevitable false alarm problem encountered in any screening technique of adequate sensitivity, screening must always be a three-step procedure. If the child fails the screen, he must be subjected to careful follow-up examination. Only if he fails the latter should he be referred for medical evaluation.In summary, the controversy surrounding mass impedance screening will probably continue for several years. In the meantime, advocates and critics alike are, of necessity, learning some valuable lessons about cost-effectiveness in screening the hearing of large populations of children.Interest in the use of acoustic reflex measures to predict degree of sensori-neural loss has expanded so rapidly during the past five years that we devote a separate chapter to the topic. The early promise of this technique has been only partially realized. It seems clear, at this writing, that prediction can be quite accurate in children, but encounters serious problems in adults, especially the elderly. At least two problems have been clearly identified: 1) The confounding effects of even very mild middle ear disorder on relations among reflex thresholds; and 2) an age effect, itself, on acoustic reflex thresholds. Here, again, we find healthy controversy. Critics of the technique point to its lack of precision and to the possibility of substantial predictive error in individual cases. Supporters, on the other hand, emphasize its relative accuracy in children, where such prediction has more practical value than in the elderly, and emphasize that, in any event, such predictions can be useful as crosschecks on other predicions as part of a total pediatric battery.This controversy, too, has had a positive educational effect. Critics of the technique have, in their discourse with clinicians, learned something of the real-life problems of pediatric evaluation and of the inevitable compromises with laboratory precision often involved in this challenging area of clinical evaluation. Proponents of the technique, on the other hand, have been encouraged (prodded?) to seek the underlying bases of predictive error, and to catalogue and scrutinize all possible variable relevant to the technique. In the process, we have all learned a good deal more about the acoustic reflex in normal and impaired ears.The third area in which great strides have been made during the past five years is the diagnostic application of ipsilateral (uncrossed) versus contralateral (crossed) reflexes in the analysis of retrocochlear, and especially brain stem, disorders. Here, again, progress has been so great that we devote an entire chapter to developments in this rapidly unfolding area. Measuring and recording the ipsilateral acoustic reflex is still, to a certain extent, a technologic challenge. Interaction between the probe and reflex-eliciting signals in the external ear canal yields an omnipresent acoustic artifact of varying degree. Although this ipsilateral artifact is often disconcerting, it can always be differentiated from the true ipsilateral reflex activity on the basis of differences in temporal pattern. Evaluating the latter is greatly facilitated by computer averaging techniques, but a simple recording of the reflex on a strip chart, with synchronous signal markers, is usually sufficient for adequate analysis. With proper precaution for artifact analysis, the ipsilateral acoustic reflex adds immeasureably to the diagnostic significance of acoustic reflex measures.n

beta-Lipoprotein quantitation in cord blood spotted on filter paper: a screening test.

Abstract: We describe an electroimmunodiffusion technique for measuring beta-lipoprotein in cord blood spotted on filter paper. A series of cord-blood samples, taken from 916 consecutive live-birth infants, was spotted directly onto filter paper and assayed for beta-lipoprotein. Eleven had above-normal beta-lipoprotein. Of these 11, seven were tested two to six months later, along with their parents, for total cholesterol and triglyceride concentrations. Five infants had increased cholesterol values, and four parents of these infants had either increased cholesterol or triglyceride values. We also measured beta-lipoprotein concentrations in 63 paired samples of dried cord-blood and three-day post-delivery blood specimens, routinely collected for phenylketonuria screening. We saw a significant correlation between results for the specimens, but detected no cases of increased beta-lipoprotein. beta-Lipoprotein assay in dried specimens of cord blood is simple, inexpensive, and potentially is useful in mass screening of newborns for familial type II and combined hyperlipidemia.