Showing papers on "Mass screening published in 1981"

A comparison of the frisby, random-dot e, tno, and randot circles stereotests in screening and office use

Abstract: • Three random-dot stereogram (RDS) tests, the Frisby, Random-Dot E (RDE), and TNO tests, and a stereotest with monocularly visible contours, the Randot circles test, were administered to two populations of 3- to 5-year-old children in vision screening settings and to a sample of patients with strabismus and amblyopia. The Frisby test missed (underreferred) cases of binocular dysfunction detected by the RDE and TNO tests, using a 250 seconds of arc (250") (Frisby and RDE) or 240" (TNO) threshold as the pass-fail breakpoint. The TNO underreferred cases at 240" relative to the RDE, but underreferred none if the TNO's breakpoint was lowered to 120". The Randot circles test produced better-indicated stereoacuities than the RDS tests and was found able to reliably grade stereoacuity in patients with stereopsis too poor to be graded by RDS tests.

Alcohol consumption in a healthy population. Relationship to gamma-glutamyl transferase activity and mean corpuscular volume.

Abstract: We analyzed the multivariate relationship between alcohol consumption and γ-glutamyl-transferase (GGT), mean corpuscular volume (MCV), and tobacco consumption. A group of 995 healthy outpatients (604 men and 391 women, 18 to 76 years old) were systematically examined. Daily alcohol consumption was established after an interview regarding complete dietary habits. Significant correlations have been found between daily alcohol intake and corresponding GGT and MCV values, 35 and 34, respectively, in men and 24 and 21 in women. Multiple regression analyses confirm the superiority of GGT over MCV as a laboratory marker of alcohol intake and show the advantage of using them together. A rough estimation of alcohol consumption is proposed as a first step in mass screening of heavy drinkers. ( JAMA 1981;245:1748-1751)

Cancer Stage‐to‐Age Relationship: Implications for Cancer Screening in the Elderly*

Abstract: In a study specifically addressing the age-stage relationship, the authors examined the distribution of 30,991 cancers by disease-stage versus patient-age at the time of diagnosis. For cancer of the bladder, breast, cervix, ovary and uterus (endometrium), a highly significant positive relationship was found between advancing stage and advancing age (P less than 0.001). For cancer of the kidney and stomach, the relationship held but was less significant (P less than 0.05). For colorectal cancer, no relationship was evident. For bronchial cancer there was a highly significant inverse relationship (P less than 0.001). After the site of origin of the cancer, the stage at the time of diagnosis was the next most important determinant for treatment and survival. These data emphasize the importance of periodic pelvic examination as a means of screening for asymptomatic cervical, ovarian, or other uterine (endometrial) cancer in elderly women. Also, the data support the importance of breast self-examination and mammography in screening for breast cancer in older women. The inverse relationship of age to stage in bronchial cancer suggests that screening by periodic chest roentgenograms and cytologic sputum examinations may be more appropriate for elderly than for younger populations in whom these screening methods have proved disappointing.

Failure to identify venereal disease in a lesbian population.

Abstract: Venereal disease in the male homosexual population has been well studied, but little information is available about venereal disease in lesbians. A screening of 148 sexually active lesbians revealed no cases of syphilis, cervical gonorrhea, herpes simplex virus, or Chlamydia trachomatis infections. Cervical atypia, ranging from mild dysplasia to carcinoma in situ, was detected in four women (2.7%). This group of lesbians had a longer mean interval between routine Papanicolau smears (21 months) than did other women using the same clinic facility (eight months). Results indicate that routine screening for venereal disease may not be cost-effective in a lesbian population, but routine Papanicolau smears should be encouraged.

Estimation of very-low-density lipoprotein cholesterol from data on triglyceride concentration in plasma.

Abstract: We examined the relationship in a large-living population between the concentration of triglycerides in plasma from fasting persons and the concentration of very-low-density lipoprotein cholesterol (VLDL-C) as determined after preparative ultracentrifugation. Data from individuals in the Framingham Heart Study who were free of coronary heart disease, did not have Fredrickson Type I, III, or V hyperlipoproteinemia, and whose plasma-triglyceride values were less than 4000 mg/L were considered in the analyses. A total of 4100 Framingham Offspring, ages 20-49 years, met these criteria, as did 2284 participants in the original Framingham Cohort, aged 50-79 years. We estimated a linear regression model with an intercept and slope coefficient, using VLDL-C (units, mg/L) as the dependent variable and triglycerides as the dependent variable. The intercept was approximately 30.0 mg/L, and the slope coefficient for triglycerides was about 0.20 when all age and sex groups were combined. However, when the analysis was performed by age group, the slope coefficient for triglycerides increased with each age group only for women. The model, in which a different intercept and slope is used for each age and sex group was statistically better than a previously developed simpler model. On the other hand, the older model, in which VLDL-C is easily estimated by multiplying the triglyceride value by 0.20, is reasonably accurate and is very simple to use. The generalizability of the model is discussed in the light of results from other population studies.

Neonatal mass screening for metabolic disorders

Abstract: The present situation of neonatal mass screening for metabolic disorders in eleven European countries is presented. The only disease screened for on a population wide basis in almost all countries is phenylketonuria. Screening for congenital hypothyroidism has been started in most countries or is under active consideration. A priority list of disorders that should be screened for routinely in all newborns comprises congenital hypothyroidism, hyperphenylalaninaemia, galactosaemia and maple syrup urine disease. Other disorders, like adrenogenital syndrome, cystic fibrosis. Duchenne's muscular dystrophy, histidinaemia, or tyrosinaemia cannot be recommended for mass screening at present because of an unsatisfactory test procedure or lack of effective treatment.

Cytologic evidence of the association of condylomatous lesions with dysplastic and neoplastic changes in the uterine cervix.

Abstract: Cytologic smears were obtained from 272 women shown, during a mass screening program, to have histologically proven severe dysplasia, carcinoma in situ or invasive squamous cell carcinoma of the uterine cervix. These smears were scrutinized with special attention to the detection of the cytologic pattern recently established as diagnostic of condyloma virus infection in the genital tract. The results disclosed positive cytologic findings in a considerable percentage of the smears studied, in contrast to an absolute failure to demonstrate any cytologic evidence of the presence of genital herpesvirus infection. The frequency figures of the positive findings were in accordance with the previously established frequency figures of histologically verified condylomatous lesions, thus confirming the applicability of the cytologic criteria used. The significance of the findings is discussed in the light of cervical carcinogenesis, and the conclusion is drawn that one should seriously consider the possibility that the virus behind the condylomatous lesions is the agent responsible for, or contributing to, the development of uterine cervical carcinoma.

Application of micro-ELISA in serodiagnosis of Human paragonimiasis

Abstract: To observed whether the specific IgG antibody test using ELISA was useful in diagnosis of presently ill patients of paragonimiasis, a total of 95 sera were tested. The sera were collected from 21 egg positive cases, 8 from positive reactors of intradermal test, 7 from Clonorchis infected, 9 from other parasitic diseases and 50 from apparently non-infected cases. By the result, the sensitivity of the test was 86% and the specificity was 100%. There were no cross reactions between Paragonimus antigen and other parastic infections. Specific IgG antibody test by micro-ELISA was concluded to be useful for mass screening of the presently ill paragonimiasis in the field.

The value of screening.

Abstract: While it seems obvious that diagnosis of cancers by screening early in their asymptomatic stages should result in improved outcomes, for most cancers proof in clinical practice is elusive. Various characteristics of cancers themselves, screening tests, and screening programs, are critical in estimating the potential value of particular screening efforts. Cancer favorable for screening are those with a high prevalence in the patients screening (high-risk patients), a long detectable preclinical phase, and conditions in which early treatment beneficially alters the natural history. A good screening test is one with high sensitivity and specificity, as the test is commonly performed and interpreted, and minimal financial and other costs or risks. Favorable evaluation of a screening program includes demonstrated reduction in morbidity and mortality, preferably in a randomized controlled trial. Interpretation of experimental and nonexperimental results of screening programs in complex. Evaluation of the multidimensional costs of screening depends on the value system of the observer: patient, physician, or public health official. Comparison of costs and benefits with those of other activities is helpful in decision making and in assessing the value of screening.

Congenital hypothyroidism: Clinical and laboratory characteristics in infants detected by neonatal screening

Abstract: The clinical and laboratory characteristics of infants with neonatal hypothyroidism, and the age at which treatment was started are reviewed. The incidence of primary hypothyroidism was 1 in 3488 live births. Most of these cases were detected in a cord blood screening programme which was carried out between October 1973 and May 1980 in the Toronto region. Forty-eight infants with primary persistent hypothyroidism were classified by technetium scintiscanning as follows: 12 with athyrosis (non-visualised thyroid glands), 14 with ectopic thyroid glands, and 14 with goitrous thyroid glands. The remaining 8 infants comprised 4 with hypoplasia and 4 with transient hypothyroidism (2 idiopathic and 2 iodide induced). Although infants with athyrosis had a lower mean thyroxine value, their values overall were not significantly different from those of the other groups. Some infants, particularly those who were goitrous or ectopic, initially had normal thyroxine values. Skeletal maturation was more often delayed in athyrotic infants than in the ectopic or goitrous group. Radioactive iodine uptakes were appreciably higher in the goitrous group, and there was no significant difference between athyrotic and ectopic groups. The mean age at which treatment was started for all patients was 25 (range 6-120) days. The average age for starting treatment using initial thyroxine and secondary thyrotrophin testing in the initial stages of the cord blood screening was 36 days. The use of initial cord serum or dried blood thyrotrophin reduced the start of treatment to 14 days. It is concluded that: (1) It is important to determine the precise anatomical diagnosis, the biochemical severity, and the age at which treatment is started in order to assess the benefits of regional screening programmes in the detection of neonatal hypothyroidism. (2) Routine technetium scintiscanning before the start of treatment helps to determine the diagnosis. (3) Radioactive 131-I thyroid uptake studies are no longer routinely recommended; this is because of the radiation hazard and the lack of specificity in differentiating between the various anatomical types. (4) The feasibility of cord blood screening to detect the various causes of neonatal hypothyroidism is confirmed. (5) The time between final diagnosis and the institution of treatment can be reduced by 2 or 3 weeks if a thyrotrophin test is used initially from cord blood serum or, preferably, from dried blood spotted on filter paper; the latter is easier to post to a screening laboratory.

Frequency of transient hypothyroxinaemia in low birthweight infants. Potential pitfall for neonatal screening programmes.

Abstract: Thyroid function was studied in 54 low birthweight infants during a 3-week period. Each infant was placed in one of three groups. Group 1 (n = 21), infants who were well and appropriately grown fro gestational age; group 2 (n = 23), infants who were appropriately grown but who had hyaline membrane disease; group 3 (n = 10), infants who were small-for-gestational-age. In group 1, 5 (24%) infants had at least one serum thyroxine value less than 3.0 micrograms/100 ml (39 nmol/l). There were 8 (35%) infants in group 2 who had similarly low serum thyroxine values as did 5 (50%) of the 10 infants in group 3. Serum thyrotropin levels and serum binding of the thyroid hormones, as measured by a T3-charcoal uptake test, were normal in all infants. In all instances but 2, serum thyroxine values were at least 4.0 micrograms/100 ml (51 nmol/l) by the end of the 3-week period. There is thus a high incidence of transient 'hypothyroxinaemia' in low birthweight infants, particularly if such infants have hyaline membrane disease or are small-for-gestational-age. These findings must be considered when interpreting results of screening programmes for congenital hypothyroidism and they lend further support to the use of a combination of serum thyroxine and thyrotropin determinations for optimum screening of such infants.

An assessment of efficiency in potential screening for Wilson's disease.

Abstract: The efficiency of screening for Wilson's disease by serum caeruloplasmin determination was assessed by analysing the epidemiologic data of 289 affected families in Japan. The estimated gene frequency was 5.2 x 10(-3). The sensitivity of the screening test was 93% at a proposed cut-off level of 120 mg/l and the specificity was 99.83%. In Japan 1 500 000 children are born every year of whom 50 would be expected to have Wilson's disease. The present analysis of potential screening for all children would grade three of them as false-negatives and identify 2621 as false-positives. An analysis for children only from consanguineous marriages produced a more efficient result, with a much higher predictive value of the positive and case-finding rate. Although the number of patients identified in this latter high-risk screening group was small, it is worth considering as a pilot study.

Scoliosis Screening: Results of a Community Project

Abstract: From 1973 to 1977, 7,642 girls and 751 boys were screened for spinal deformity in a Wisconsin County with a population of approximately 100,000. Of 243 girls and 30 boys found to have scoliosis, 155 girls and 13 boys had curves 10 degrees or greater. The most common location and curve direction was right thoracic; 98% of those with scoliosis were classified as idiopathic. Eighteen girls required treatment when initially seen: ten with a Milwaukee brace and eight with spine fusion. Of those not treated and followed for six months or longer, 24 girls and one boy had a decrease in their curve of at least 5 degrees, and 21 girls and one boy had an increase in their curve of at least 5 degrees. Determination of which curves would progress was unpredictable and identification of progression was possible only by repeated examinations.

Heat tolerance and heat hardening in crop plants measured by chlorophyll fluorescence

Abstract: Variable chlorophyll fluorescence (Fv), indicative of the capacity for electron flow through photosystem II, decreased as leaves became heat injured. In leaves heated at a rate of 1°C per minute, Fv became undetectable above 43.3°C in barley, 44.2°C in pea, 45.2°C in bean, 45.3°C in tomato, 49.5°C in maize and 51.0°C in papaya. In heat hardened barley this temperature was increased by 6 to 9°C compared with unhardened barley. Measurement of Fv in vivo provides a rapid method to monitor the onset of cellular heat injury, to rank plants in order of heat resistance and to follow heat hardening. It appears to be suitable for developing a mass screening test for heat tolerance.

Screening for disability in the inner city.

Abstract: A 10% sample of private households on the electoral register of the London borough of Lambeth was screened for disable persons aged 16 and over, using a postal questionnaire. After three mailings and individual follow-up of non-responders, 87% of the sample households returned questionnaires. Disability was defined in the screening questionnaire as functional limitations or activity restrictions consequent upon disease or impairment. The overall point prevalence of disability was estimated at 15.4% and the most frequently reported impairments were those of the sense organs, bones, central nervous, circulatory, and respiratory systems. Hearing difficulties were the single most frequently reported functional limitation. A log-linear modelling procedure identified age, marital status, and working status as the factors most strongly associated with disability for both men and women. In addition, men aged 50-64 and not working, and men in manual occupations and living alone, were more likely to report disability. These findings indicate that some population groups are disable by functional limitations and activity restrictions not included in office criteria of identification and assessment. These criteria might be broadened, and serves planned for those population groups with higher rates of reported disability.

Clinical Follow‐up and Parental Attitudes Towards Neonatal Screening

Abstract: Two hundred thousand infants born in Sweden between November 1972 and September 1974 were screened at birth for alpha 1-antitrypsin (alpha 1 AT) deficiency. At age 4 years 172 of 183 children with alpha 1 AT deficiency were examined and compared with 80 randomly selected control children. The children with alpha 1 AT deficiency had the following Pi types: 118 PiZ, 50 PiSZ, 2 PiZ-, 1 PiS-, 1 PiFZ. Two PiZ children have severe liver cirrhosis and 1 PiZ boy had died of aplastic anemia. Abnormal levels of serum alanine aminotransferase (S-ALAT) were found in one PiSZ and 47 PiZ children. Upper and lower respiratory infections, otitis, eczema, urinary infections or complications of child diseases did not occur more often in children with alpha 1 AT deficiency than in controls. More parents of alpha 1 AT deficient children had stopped smoking and their fathers smoked significantly less. Forty parents of children with alpha AT deficiency PiZ answered a questionnaire concerning their reaction to, knowledge about and attitudes towards neonatal screening for alpha 1 AT deficiency. Many parents reported having reacted with lack of understanding, shock or depression upon learning that the child had alpha 1 AT deficiency. About 4 years later 44% reported still lack of understanding, and 18% depression or feelings of guilt. About two-thirds had not fully understood why alpha 1 AT deficiency had been identified, despite the fact that they had seen their doctor 3--4 times for check-ups and counselling since birth.

Use of a dried blood spot in immunoreactive-trypsin assay for detection of cystic fibrosis in infants.

Abstract: We assayed more than 5000 blood spots dried on filter paper and approximately 1000 serum samples for immunoreactive trypsin, with commercial reagents (Behring and Sorin). The assay procedures were modified so that newborn screening is technically feasible. Both kits are satisfactory for serum assay, but the Sorin materials are better adapted for blood spot analysis. Immunoreactive trypsin in blood spots rapidly decreases with specimen age, but is stable in frozen serum. Values for premature infants do not differ significantly from those for full-term babies. Children with cystic fibrosis were readily distinguished from those without, up to at least one year of age.

Procedure and apparatus for noncontacting measurement of subcutaneous temperature distributions

Abstract: A method and apparatus for noncontacting measurement and imaging of subcutaneous temperature distributions for the early detection of tumors. The (black-body) thermal electromagnetic radiation emitted by hyperthermic tumorous tissues is collected, focussed and detected within several frequency bands from 8 GHz to 36 GHz using a specially designed light-weight elliptical reflector and a highly sensitive broadband radiometer which are scanned in a raster type fashion over the supine patient. Direct indication of subcutaneous temperatures, microcomputer-aided data processing, and color or grey scale image display provide clinically usable subcutaneous thermograms at several depths which, together with conventional cutaneous infrared thermograms, can be utilized for the early detection and mass screening of tumors such as breast cancer.

The Arden grating acuity: effect of age and optical factors in the normal patient, with prediction of the false negative rate in screening for glaucoma.

Abstract: The Arden contrast sensitivity was investigated in normal persons, cataract eyes, and glaucoma patients with only plates 6 and 7 of the Arden grating set. The mean score of 90 normal eyes on plate 6 was 9.50 +/- 2.29 and on plate 7 it was 9.44 +/- 2.32. The mean scores of patients with early cataract were 14.51 +/- 2.99 on plate 6 and 13.74 +/- 3.26 on plate 7. Several patients with cataract missed the grating on plate 7. Mydriasis and miosis did not affect contrast sensitivity in normal eyes. Mydriasis significantly improved contrast sensitivity in patients with early cataract. In patients with glaucoma enlargement of the pupil from a miotic state to near normal size significantly improved contrast sensitivity. It is predicted that if plate 6 and 7 are used in mass screening for glaucoma in the elderly, there will be a false negative rate of 83% for plate 6 and 52% for plate 7. A false positive rate of 17% is predicted.

Maternal alpha-fetoprotein screening: two years' experience in a low-risk district.

Abstract: Over a two-year period, 3479 pregnant women in the Kings' Lynn Health District were screened for neural tube defects by estimation of maternal serum alpha-fetoprotein. Most pregnancies were scanned by sonar for fetal maturity. Eight women had fetuses with open neural tube defects; four with anencephaly were associated with very high alpha-fetoprotein values. Of the four with open neural tube defects without anencephaly, only one was detected by screening and confirmed after amniocentesis. One other had a raised serum alpha-fetoprotein but a normal amniotic fluid value. The other two affected fetuses were missed. This disappointing outcome was attributed to the poor predictive value of alpha-fetoprotein in detecting open neural tube defects (anencephaly apart) rather than to errors in its estimation or in assessment of fetal maturity by sonar scan. We question the validity of screening, particularly in areas of intermediate or low incidence.