Showing papers on "Mass screening published in 1991"

Psychological side effects of breast cancer screening.

Abstract: Evaluated the impact of receiving abnormal mammogram results on women's anxiety and breast cancer worries and on their breast self-examination (BSE) frequency and intentions to obtain subsequent mammograms. A telephone survey was conducted with 308 women 50 years old and older approximately 3 months following a screening mammogram. Subjects included women with suspicious abnormal mammograms, nonsuspicious abnormal mammograms, and normal mammograms. Women with suspicious abnormal mammograms exhibited significantly elevated levels of mammography-related anxiety and breast cancer worries that interfered with their moods and functioning, despite the fact that diagnostic work-ups had ruled out breast cancer. Women with moderate levels of impairment in mood or functioning were more likely to practice monthly BSE than women with either high or low levels of impairment. Breast cancer worries, perceived susceptibility to breast cancer, and physician encouragement to get mammograms all exhibited independent positive relationships to mammogram intentions.

Hepatitis B: evolving epidemiology and implications for control.

Abstract: Control and the possible elimination of transmission of HBV infection is possible with the appropriate use of hepatitis B vaccines. The prevention of chronic HBV infection has the potential of reducing the association burden of chronic liver disease and primary hepatocellular carcinoma. Worldwide, strategies for the effective use of hepatitis B vaccine have been developed and are being implemented in those areas where childhood transmission is the predominant source of chronic HBV infections. However, in the United States and other areas with "low" rates of HBV infection, current vaccination strategies have not been effective and have not fully taken into account the multifaceted epidemiology of HBV infection in those areas. Unfortunately, the majority of infections occur among adults who have been the most difficult to access, who acquire infection before they realize they are at risk, and where the changing epidemiology of HBV infections among the various risk groups only emphasizes the problems of vaccine delivery. In addition, the majority of persons receiving vaccine as a result of the current strategy to immunize adult high-risk groups have been persons who acquire HBV infection through occupational exposure, a group that accounted for no more than 5% of cases even before vaccine was introduced. The failure of the current immunization strategy to prevent a disease with significant health care and economic consequences is beginning to cause a reevaluation of this approach. A comprehensive approach to eliminating HBV transmission must address infections acquired during early childhood as well as those acquired by teenagers and adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Screening for lung cancer. A critique of the Mayo Lung Project.

Abstract: The National Cancer Institute of the United States recently sponsored three large-scale, randomized controlled trials of screening for early lung cancer. The trials were conducted at the Johns Hopkins Medical Institutions, the Memorial Sloan-Kettering Cancer Center, and the Mayo Clinic. Participants were middle-aged and older men who were chronic heavy cigarette smokers and thus at high risk of developing lung cancer. Screening procedures were chest radiography and sputum cytology, the only screening tests of established value for detecting early stage, asymptomatic lung cancer. In the Hopkins and Memorial trials the study population was offered yearly chest radiography plus sputum cytology every 4 months. The control population was offered yearly chest radiography only. In these trials the addition of sputum cytology appeared to confer no lung cancer mortality rate advantage. The Mayo Clinic trial compared offering chest radiography and sputum cytology every 4 months to offering advice that the two tests be obtained once a year. This trial demonstrated significantly increased lung cancer detection, resectability, and survivorship in the group offered screening every 4 months compared with the control group. However, there was no significant difference in lung cancer mortality rate between the two groups. The statistical power of these trials was somewhat limited. Nevertheless, results do not justify recommending large-scale radiologic or cytologic screening for early lung cancer at this time.

Screening for alcohol abuse using CAGE scores and likelihood ratios.

Abstract: ▪Objective:To assess the performance of the CAGE (acronym referring to four questions, see below) questionnaire in discriminating between medicine outpatients with and without an alcohol a...

Where is the wisdom...

Abstract: К ВОПРОСУ О ПРОСТРАНСТВЕННЫХ ПРИЗНАКАХ КОНЦЕПТОВ МУДРОСТЬ И WISDOM В данной статье представлен сопоставительный анализ пространственных признаков концептов МУДРОСТЬ и WISDOM. В структурах обоих концептов выявленные признаки формируют группу локативных признаков. Установлено, что в русской языковой картине мира феномен мудрости ассоциируется с мифологическим, воображаемым пространством, в английской – с пространством реально существующим и обозреваемым. Адрес статьи: www.gramota.net/materials/2/2013/6-2/14.html

Effectiveness of routine ultrasonography in detecting fetal structural abnormalities in a low risk population.

Abstract: OBJECTIVE--To review the efficacy of routine prenatal ultrasonography for detecting fetal structural abnormalities. DESIGN--Retrospective study of the ultrasonographic findings and outcome of all pregnancies in women scanned in 1988-9. SETTING--Maternity ultrasonography department of a district general hospital. SUBJECTS--8785 fetuses. MAIN OUTCOME MEASURES--Correlation of prenatal ultrasonographic findings with outcome in the neonate. RESULTS--8733 babies were born during 1988-9, and 52 pregnancies were terminated after a fetal malformation was identified. 8432 (95%) of the fetuses were examined by ultrasonography in the second trimester. 130 fetuses (1.5%) were found to have an abnormality at birth or after termination of pregnancy, 125 of which had been examined in the second trimester. In 93 cases the abnormality was detected before 24 weeks (sensitivity 74.4%, 95% confidence interval to 66.7% to 82.1%. Two false positive diagnoses occurred, in both cases the pregnancies were not terminated and apparently normal infants were born. This gives a specificity of 99.98% (99.9% to 99.99%). The positive predictive value of ultrasonography in the second trimester was 97.9% (92.6% to 99.7%). Of the 125 abnormalities, 87 were lethal or severely disabling; 72 of the 87 were detected by the routine screening programme (sensitivity 82.8%, 73.2% to 90.0%). CONCLUSION--Routine fetal examination by ultrasonography in a low risk population detects many fetal structural abnormalities but can present several dilemmas in counselling.

Randomized study of mammography screening--preliminary report on mortality in the Stockholm trial.

Abstract: In March 1981, 40,318 women in Stockholm, aged 40–64, entered a randomized trial of breast cancer screening by single-view mammography alone versus no intervention in a control group of 20,000 women. The attendance rate during the first screening round was 81 per cent and the cancer detection rate was 4.0 per 1000 women. The detection the rate fell to 3.1 per 1000 in the second round, which was completed in October 1985. During 1986 the controlled design of the study was broken and the contro women were invited once to screening which was completed the same year. A total of 428 cases of breast cancer were thus diagnosed in the study group and 439 in the adjusted control group. After a mean follow-up of 7.4 years the number of breast cancer deaths in the study and control groups was 39 and 30 respectively. The relative risk of breast cancer death (screening versus control) was 0.71 (95 per cent confidence interval: 0.4–1.2). Among women older than 50 years at entry the relative risk was 0.57 (95 per cent confidence interval: 0.3–1.1). Cancer deaths among women under 50 were few and perhaps because of this no mortality reduction was seen in this age group. The estimate of mortality reduction lies between the results from two earlier Swedish randomized controlled trials.

Computerized detection of masses in digital mammograms: analysis of bilateral subtraction images.

Abstract: A computerized scheme is being developed for the detection of masses in digital mammograms. Based on the deviation from the normal architectural symmetry of the right and left breasts, a bilateral subtraction technique is used to enhance the conspicuity of possible masses. The scheme employs two pairs of conventional screen-film mammograms (the right and left mediolateral oblique views and craniocaudal views), which are digitized by a TV camera/Gould digitizer. The right and left breast images in each pair are aligned manually during digitization. A nonlinear bilateral subtraction technique that involves linking multiple subtracted images has been investigated and compared to a simple linear subtraction method. Various feature-extraction techniques are used to reduce false-positive detections resulting from the bilateral subtraction. The scheme has been evaluated using 46 pairs of clinical mammograms and was found to yield a 95% true-positive rate at an average of three false-positive detections per image. This preliminary study indicates that the scheme is potentially useful as an aid to radiologists in the interpretation of screening mammograms.

Clinical applications of serum tumor markers.

Abstract: The pursuit of the ideal tumor marker has generated many tests for use in the diagnosis and management of cancer, several of which are now widely available. Tumor markers have five potential uses in patient care: They can be used for screening, for diagnosis, for establishing prognosis, for monitoring treatment, and for detecting relapse. The value of a marker in a given setting depends on two marker-related characteristics--sensitivity and specificity. The value of a marker in a particular malignancy also depends on the effectiveness of therapy for the malignancy. Tumor markers have been used to screen for occult cancer but have proved to be valuable only in selected cancers. As diagnostic tools, tumor markers have limitations: Nearly all markers can be elevated in benign disorders, and most markers are not elevated in the early stages of malignancy. Extreme marker elevation often indicates a poor prognosis and in some malignancies can indicate the need for more aggressive treatment. Tumor markers have their greatest value when used to monitor therapy in patients with widespread cancer. Nearly all markers show some correlation with the clinical course of disease, with marker elevation in any stage declining to normal after a curative intervention. Recurrent disease can be accompanied by increased marker levels, but markers can detect an occult recurrence in only a few diseases, thereby facilitating a second attempt at cure. Although it seems unlikely that an ideal tumor marker will be identified for every malignancy, several workable markers are already available. Increasing our knowledge about the capabilities and limitations of existing markers will enable us to use them judiciously in the treatment of cancer.

Prevalence of primary fibromyalgia in the Finnish population.

Abstract: OBJECTIVE--To obtain descriptive epidemiological data on fibromyalgia and its components in a representative sample of the Finnish population. DESIGN--Cross sectional study of 8000 Finns aged 30 or more invited for screening and a main examination for musculoskeletal disorders and other major disorders. SETTING--A mobile clinic. POPULATION--7217 subjects who attended the screening phase; 3434 subjects positive on screening who attended the main examination for musculoskeletal disorders. MAIN OUTCOME MEASURES--Musculoskeletal, mental, and other symptoms detected by interview and questionnaire; results of standardised clinical examination of the musculoskeletal system; operational definition of fibromyalgia; mortality at 10 years. RESULTS--The prevalence of fibromyalgia was low (54 cases; 0.75%) and related to age (peak prevalence at 55-64 years), female sex (twice as prevalent in women), occupation (no cases among 1596 white collar professionals), level of education (strong inverse gradient), and high levels of physical stress at work. No significant associations were found with body mass index, smoking, or mental stress at work. The prevalence of fibromyalgia was sensitive to even minor modifications of the definition. Fibromyalgia was strongly coincident with many other disorders, especially musculoskeletal conditions. Fibromyalgia did not predict mortality. CONCLUSION--Descriptive epidemiological data offer little support for the concept of fibromyalgia.

Epidemiological evidence for age-dependent regression of pre-invasive cervical cancer.

Abstract: Data from the screening programme in British Columbia are used to test hypotheses about the natural history of cervical cancer, especially about progression and regression of preclinical lesions (dysplasia and carcinoma in situ). Three models are considered. A model without regression does not give an adequate fit of the data (P less than 0.001), and results in an implausible estimate of 33 years for the mean duration of pre-invasive lesions. A model with an equal regression rate at all ages still does not result in a good reproduction of the data. A good fit is achieved for a model with different regression rates in lesions that develop under and over age 34. Under age 34, 84% of the new lesions will regress spontaneously, with a 95% confidence interval of 76-92% regression. Over age 34, we estimate that 40% of the new lesions will regress. The average duration of dysplasia + CIS is 11.8 years, and the sensitivity of the Pap-smear is 80%. It is concluded that a considerable proportion of pre-invasive lesions in young women do not progress. The findings about progression and duration of pre-invasive lesions do not support the still prevailing tendency of frequently making Pap smears in young women.

Breast screening, prognostic factors and survival--results from the Swedish two county study.

Abstract: The results of the Swedish two-county study are analysed with respect to tumour size, nodal status and malignancy grade, and the relationship of these prognostic factors to screening and to survival. It is shown that these factors can account for much of the differences in survival between incidence screen detected, interval and control group cancers but to a lesser extent for cancers detected at the prevalence screen where length bias is greatest. Furthermore, examination of the relationships among the prognostic factors and mode of detection indicates that malignancy grade, as a measure of inherent malignant capacity, evolves as a tumour grows. The proportion of cancers with poor malignancy grade is several fold lower for cancers of diameter less than 15 cm than for cancers greater than 30 cm, independent of the length bias of screening. The implications of these findings for screening frequency are briefly discussed.

Interval adherence to mammography screening guidelines.

Abstract: The objectives of this research were to document adherence to mammography screening guidelines among women over 50 years of age and to investigate factors related to adherence. Selected sociodemographic variables—personal breast health history, provider-related variables, and medical care utilizatio

Ovarian cancer screening in asymptomatic postmenopausal women by transvaginal sonography.

Abstract: From November 1987 to January 1991, 1300 postmenopausal women underwent screening with transvaginal sonography (TVS). Women eligible for screening were all asymptomatic with no known ovarian tumors. Ovarian volume was calculated using the prolate ellipsoid formula, and a value in excess of 8.0 cm3 was considered abnormal. Ovarian abnormalities were detected in 33 women (2.5%), and 27 underwent exploratory laparotomy. Ovarian tumors were noted in all 27 patients, including 2 primary carcinomas and 14 serous cystadenomas. The two women with ovarian carcinomas had normal results of pelvic examinations and normal serum CA-125 levels. Both women had Stage I disease, and are alive and well after conventional therapy. TVS was time efficient, easy to perform, and well-accepted by patients. Currently, there are more than 3000 patient years of follow-up in the screened population, and there have been no deaths due to ovarian cancer. A multi-institutional trial to determine the efficacy of TVS as a screening method for ovarian cancer is indicated.

Serodiagnosis of hepatitis C virus (HCV) infection with an HCV core protein molecularly expressed by a recombinant baculovirus.

Abstract: An enzyme-linked immunosorbent assay (ELISA) was developed for serological diagnosis of hepatitis C virus (HCV) infection, using HCV core protein (p22) synthesized by a recombinant baculovirus. Among 58 clinically well-defined chronic non-A, non-B hepatitis (NANBH) patients, 49 (84.5%) were positive for p22 antibody (anti-p22), whereas 42 (72.4%) were positive for C100-3 antibody (anti-C100-3), as measured by the present assay using the HCV nonstructural protein as antigen. Thirty-nine patients (67.2%) had both antibodies. No significant level of anti-p22 was detected in sera of chronic hepatitis B patients or normal blood donors. In typical post-transfusion NANBH patients, anti-p22 could be detected at, or even before, the first alanine aminotransferase peak. Anti-p22 was also detected in blood donors who were previously shown to be involved in transmitting HCV but in whose serum anti-C100-3 was not detectable. The ELISA detecting antibody to the HCV core protein expressed and properly processed in animal cells will be useful for mass screening of donor blood as well as for early diagnosis of hepatitis C.

Normative data for a brief neuropsychological screening battery. Multicenter AIDS Cohort Study.

Abstract: This study reports normative data for a group of 733 homosexual/bisexual men stratified by age (range 25 to 54 years) and by education on the following six neuropsychological tests: (1) Digit Span (WAIS-R), (2) Rey Auditory Verbal Learning Test, (3) Symbol Digit Modalities Test, (4) Controlled Oral Word Association Test, (5) Grooved Pegboard, and (6) The Trail Making Test. Analysis demonstrates that both age and education are important determinants of performance for several of these measures.

Screening for vertebral osteoporosis using individual risk factors. The Multicentre Vertebral Fracture Study Group.

Abstract: Osteoporosis is a major cause of ill health in postmenopausal women. Several risk factors for osteoporosis have been identified, and they have been widely recommended as a means of identifying subgroups of postmenopausal women who might benefit from prophylaxis and therapy. Evidence to support this use of risk factors is currently lacking, however. We have constructed and evaluated a profile of putative risk factors as a means of identifying women attending general practitioners who have sustained vertebral fractures. The overall prevalence of vertebral fractures in the 1012 women (mean age 64.4 years) studied was 7.8%. Women who had sustained vertebral fractures in this population were significantly (p<0.05) older and shorter than those without fractures. They reported a significantly (p<0.05) earlier menopause, lower parity and a greater prevalence of hyperthyroidism. However, the best screening instrument devised was not sufficiently predictive to warrant widespread use.

Identification of the second common Jewish Gaucher disease mutation makes possible population-based screening for the heterozygous state

Abstract: Gaucher disease is an autosomal recessive glycolipid storage disease characterized by a deficiency of glucocerebrosidase. The disease is most common in persons of Ashkenazi Jewish ancestry and the most common mutation, accounting for about 75% of the mutant alleles in this population, is known to be an A----G substitution at cDNA nucleotide (nt) 1226. Screening for this disease has not been possible because nearly 25% of the mutant alleles had not been identified, but linkage analysis led to the suggestion that most of these could be accounted for by a single mutation. We now report the discovery of this mutation. The insertion of a single nucleotide, a second guanine at cDNA nt 84 (the 84GG mutation), has been detected in the 5' coding region of the glucocerebrosidase gene. The amount of mRNA produced is shown to be normal but since the frameshift produced early termination, no translation product is seen. This finding is consistent with the virtual absence of antigen found in patients carrying this mutation. The 84GG mutation accounts for most of the previously unidentified Gaucher disease mutations in Jewish patients. The common Jewish mutation at nt 1226, the 84GG mutation, and the less-common mutation at nt 1448 accounted for 95% of all of the Gaucher disease-producing alleles in 71 Jewish patients. This now makes it possible to screen for heterozygotes on a DNA level with a relatively low risk of missing couples at risk for producing infants with Gaucher disease.

The impact of a breast cancer screening programme on quality‐adjusted life‐years

Abstract: Trials have shown that breast cancer screening is effective in reducing breast cancer mortality and gaining life-years. The question is whether taking into account the impact of a screening programme on quality of life would lead to a less positive view. Screening may have effects on quality of life in the short run for women participating and effects in the long run as a result of the expected shift in the number of women experiencing early and advanced phases of the disease, after the initiation of the programme. In this study 4 steps have been taken: (I) published studies on quality of life and breast cancer (screening) up to 1989 have been reviewed and summarized and, based on these data, the consequences of breast cancer and treatment have been described; (2) values have been assigned to the disease and treatment phases by experts in breast cancer and public health (N = 31, response 87%); (3) these values have been inserted in the MISCAN model predicting the prevalence of disease/treatment phases with and without a 2-yearly screening programme for women aged 50-70 and multiplied by the duration of these phases; (4) analyses have been done to establish the sensitivity of the results for the values inserted. The programme of 2-yearly mammographic screening for women aged 50-70 is predicted to be 8% "less effective" (range -19.7 to +3.2%) when computing quality-adjusted life-years. We conclude that this adjustment is too small to attribute a major role to quality of life in the decision to undertake a large-scale breast cancer screening programme.

Screening for microalbuminuria: which measurement?

Abstract: It now seems worth while to identify Type 1 diabetic patients with microalbuminuria, as improved blood glucose control and reduction of arterial blood pressure will slow if not prevent the progression to persistent proteinuria. Measurement of albumin excretion rate (AER) in a timed urine sample remains the gold standard for the definition of microalbuminuria, but is not a practical screening procedure. Thus attempts have been made to relate the albumin concentration of albumin:creatinine ratio in random or first morning urine samples to AER. There is a weak correlation of albumin concentration (r = 0.32 to 0.68) and albumin:creatinine ratio (r = 0.43 to 0.54) in a random urine sample with AER, and low sensitivity and specificity of a variety of different albumin concentrations and albumin:creatinine ratios to predict microalbuminuria. The correlation of albumin concentration (r = 0.86 to 0.90) and albumin:creatinine ratio (r = 0.74 to 0.91) in an early morning urine sample with AER is stronger. Measurement of albumin:creatinine ratio in an early morning urine sample appears to be the most reliable method of screening for microalbuminuria, with sensitivity of 88 to 100% and specificity 81 to 100% depending on the cut-off ratio chosen and the definition of microalbuminuria used. If the albumin:creatinine ratio in an early morning urine sample is less than or equal to 3.5 mg mmol-1, the patient can be classed as normoalbuminuric and re-screened annually. If the ratio is greater than or equal to 10.0 mg mmol-1, confirmation of microalbuminuria should be sought in a timed urine collection and appropriate therapy begun.(ABSTRACT TRUNCATED AT 250 WORDS)

A study guided by the health belief model of the predictors of breast cancer screening of women ages 40 and older

Abstract: In late 1987, a total of 852 Rhode Island women ages 40 and older were interviewed by telephone (78 percent response rate) to measure their use of breast cancer screening and to investigate potential predictors of use. Predictors included the women's socioeconomic status, use of medical care, a provider's reported recommendations for screening, and the women's health beliefs about breast cancer and mammography. The Health Belief Model guided the construction of the interview questions and data analysis. Logistic regression was used to identify leading independent predictors of breast cancer screening according to contemporary recommendations: reporting that a medical provider had ever recommended a screening mammogram (odds ratio [OR] = 18.77), having received gynecological care in the previous year (OR = 4.92), having a regular source of gynecological care (OR = 2.63), having ever had a diagnostic mammogram (OR = 2.32), and perceiving mammography as safe enough to have annually (OR = 1.93). The findings suggest that programs intended to increase the use of breast cancer screening should include "inreach" and "outreach" elements; inreach to patients with established patient-provider relationships, by assuring that physicians recommend screening to all eligible patients, and outreach to all eligible women, by helping them overcome barriers to effective primary care, and by promoting mammography, emphasizing its effectiveness and safety. The findings also suggest that socioeconomically disadvantaged women, who are less likely to be screened than other women, should become special targets of inreach and outreach interventions.

Urinary screening of elementary and junior high-school children over a 13-year period in Tokyo.

Abstract: The School Health Law of Japan was passed in 1974 mandating urine screening of elementary and junior high-school students for the detection of renal disease. A first morning urine was obtained on an annual basis for each individual student for the time period 1974–1986. The prevalence of proteinuria and haematuria among elementary school children was 0.08% and 0.54%, respectively, while junior high-school students demonstrated corresponding prevalences of 0.37% and 0.94%. The theoretical merits of this screening programme include the detection of glomerulonephritis with possible early therapeutic intervention. However, a limitation to this approach is its over-sensitivity where asymptomatic urine abnormalities is found to be 10 times greater in frequency than glomerulonephritis histologically.

Group B streptococcus (GBS) and neonatal infections: the case for intrapartum chemoprophylaxis.

Abstract: At the Royal Women's Hospital, Melbourne over an 8-year period (1981-1988) all public antenatal patients were screened at 32 weeks' gestation for group B streptococcus (GBS). In a total of 30,197 livebirths there were no early onset neonatal GBS infections in infants of treated asymptomatic carrier mothers. By contrast there were 27 infections with 8 deaths in an unscreened control group of private patients (total livebirths 26,915). It is recommended that GBS screening occur antenatally at 28 weeks and that intrapartum chemoprophylaxis be offered at least to those carriers with obstetric risk factors.

Use of the CAGE scale in a population survey of drinking.

Abstract: This article examines the use of the CAGE scale, a 4-item self-report screening test designed to identify problem drinkers, among 703 drinkers aged 18 and over interviewed in a general population survey. The results showed that 10.9% of drinkers reported two or more items affirmatively, the suggested cut-off indicative of problem drinking. This rate is similar to the percentage of drinkers who consume four or more standard drinks daily, derived from aggregate per capita consumption estimates. Factor analysis of the items showed a unidimensional scale with good psychometric properties. Other cut-offs are also compared with other alcoholism estimates. In general, the results indicated some utility of the CAGE in general population surveys.

A three-sample test of a masked alcohol screening questionnaire.

Abstract: The study tested an expanded version of a masked alcohol screening instrument developed by Wallace and Haines [Use of a questionnaire in general practice to increase recognition of patients with excessive alcohol consumption. British Medical Journal 290, 1949-1953 (1985)]. The alcohol subscales include the CAGE, consumption, trauma, medical advice, past problems, and present problems with alcohol. There is preliminary evidence of the construct validity and reliability of the Health Screening Survey (HSS). As expected the HSS was sensitive in known populations of alcoholics (0.96; 0.95) correctly identifying at least 95% of the alcoholic patients recruited from two treatment centers. Specificity was adequate with identified nonalcoholics (0.80; 0.70). It was also sensitive in a community primary care sample, correctly classifying 78% of the subjects meeting DSM-III criteria for alcohol abuse and/or dependence. There were gender differences in the validity of the subscales in the community sample with alcoholic males more likely to report problems on the questionnaire than alcoholic females. Based on results, the HSS was revised to improve validity.