Showing papers on "Mass screening published in 1993"
TL;DR: The AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
Abstract: The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
11,042 citations
TL;DR: Screening based on PSA identifies some men with prostate cancer who have a significantly increased proportion of organ-confined tumors compared with those detected through evaluation for an abnormal digital rectal examination alone.
Abstract: Objective. —To determine whether prostate-specific antigen (PSA)—based screening alters the proportion of organ-confined prostate cancers detected. Design. —A prospective, nonrandomized, serial PSA-based screening trial (follow-up from 6 to 37 months), and a concurrent comparison group. Setting. —Genera community outpatient screening program based at a university center. Patients. —The study group consisted of 10251 men aged 50 years and older (mean and median age, 63 years; mean and median age of patients who underwent biopsies, 66 years) who presented to a prostate cancer screening program and consented to phlebotomy. The comparison group consisted of 266 concurrently studied private patients in the same age range (mean and median age, 68 years) who were referred for prostatic ultrasonography and biopsy because of an abnormal digital rectal examination (DRE). Main Outcome Measure. —Proportion detected with clinically or pathologically advanced prostate cancer. Results. —The men were divided into three groups: the comparison group, the initial PSA-based screening group, and the serial PSA-based screening group. The proportions of prostate cancers detected that were clinically or pathologically advanced were as follows: comparison group, 57% (27/47); initial PSA-based screening group, 37% (91/244); and serial PSA-based screening group, 29% (37/ 129). Screened patients had a lower proportion of advanced cancers than the comparison group (χ 2 [2]=12.3; P =.002); this advantage was observed principally in patients younger than 70 years. Surgical staging revealed that the cancer was microscopically focal and well differentiated (possibly latent cancer) in 2.5% (1/40) of the nonscreened group, 2.9% (7/244) of the initially screened group, and 7.8% (10/129) of the serially screened group (generalized Fisher's Exact Test, P =.08). Conclusion. —Screening based on PSA identifies some men with prostate cancer who have a significantly increased proportion of organ-confined tumors compared with those detected through evaluation for an abnormal DRE alone. ( JAMA . 1993;270:948-954)
999 citations
TL;DR: There was a consistent risk reduction associated with screening in all studies, although the point estimate of the relative risk for all ages varied non-significantly between 0.68 and 0.84.
831 citations
TL;DR: No significant difference in the point prevalence of depression at six months was found between the postnatal and control women, nor in the six-month period prevalence, but a threefold higher rate of onset of depression was found within five weeks of childbirth.
Abstract: In a two-stage screening procedure using the Edinburgh Postnatal Depression Scale and Goldberg's Standardised Psychiatric Interview, 232 women six months after delivery were compared with control women individually matched for age, marital status and number of children, obtained from general practitioner lists, who were not pregnant nor had had a baby in the previous 12 months. No significant difference in the point prevalence of depression at six months was found between the postnatal (9.1%) and control women (8.2%) nor in the six-month period prevalence (13.8% postnatal, 13.4% controls), but a threefold higher rate of onset of depression was found within five weeks of childbirth. The possible explanations relate to the long duration of depression in women with young children, and the stressful effect of childbirth and its psychosocial sequelae.
776 citations
TL;DR: Because gastric cancer is unusual in the United States, screening and treatment of H. pylori in the general population are unwarranted; Chemoprevention in high-risk populations, however, could potentially be used to decrease risk for adenocarcinomas distal to the cardia.
707 citations
TL;DR: Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems.
Abstract: This WHO collaborative project is the first phase of a programme of work aimed at developing techniques for early identification and treatment of persons with hazardous and harmful alcohol consumption. The aim of the present study was to determine the prevalence of hazardous and harmful alcohol use among patients attending primary health care facilities in several countries, and to examine the correlates of drinking behaviour and alcohol-related problems in these culturally diverse populations. The broader purpose was to determine whether there was justification for developing alcohol screening instruments for cross-national use. One thousand, eight hundred and eighty-eight subjects in Australia, Bulgaria, Kenya, Mexico, Norway and the USA underwent a comprehensive assessment of their medical history, alcohol intake, drinking practices, and any physical or psychosocial problems related to alcohol. After non-drinkers and known alcoholics had been excluded, 18% of subjects had a hazardous level of alcohol intake and 23% had experienced at least one alcohol-related problem in the previous year. Intrascale reliability coefficients were uniformly high for the drinking behaviour (dependence) and adverse psychological reactions scales, and moderately high for the alcohol-related problems scales. There were strong correlations between the various alcohol-specific scales, and between these scales and measures of alcohol intake. Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems. These findings strengthen the case for developing international screening instruments for hazardous and harmful alcohol consumption.
487 citations
TL;DR: An instrument to measure the Health Belief Model concepts of susceptibility, seriousness, benefits, barriers, health motivation, and confidence, using the context of breast cancer and breast self-examination is refined.
Abstract: The purpose of this study was to refine an instrument to measure the Health Belief Model concepts of susceptibility, seriousness, benefits, barriers, health motivation, and confidence, using the context of breast cancer and breast self-examination. A Likert format was used for attitudinal scales. A random sample (N = 581) of women 35 years and over was included. Items were subjected to content analysis by national experts. Construct validity was established using exploratory factor analysis. Predictive validity was established by relating breast self-examination behavior to breast self-examination attitudes, using simultaneous multiple regression and bivariate correlations. Cronbach alpha reliability coefficients for the revised scales ranged from .80 to .93. Test-retest correlations ranged from .45 to .70.
411 citations
TL;DR: This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion of cases at a preclinical stage and further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality.
Abstract: OBJECTIVE--To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer. DESIGN--The serum CA 125 concentration of each subject was determined and those with a concentration > or = 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire. SETTING--General practice, occupational health departments, ovarian cancer screening clinic. SUBJECTS--22,000 women volunteers who were postmenopausal and aged over 45 years. MAIN OUTCOME MEASURES--Apparent sensitivity, specificity, positive predictive value, years of cancer detected. RESULTS--41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21,959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21,951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 1.4 years. CONCLUSIONS--This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion of cases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.
357 citations
TL;DR: The HADS was an easily administered tool that identified a large proportion of cancer patients as having high levels of anxiety or depression, however, clinical psychiatric interviews were not performed, so it is not possible to determine what proportion of patients would benefit from treatment.
333 citations
TL;DR: No evidence is found that the depressogenic effect of marital disruption can be explained by increased financial pressures or other secondary changes in roles, but increased emotional reactivity to these changes is shown to play a powerful role in promoting depression among the recently divorced.
Abstract: The extent to which marital disruption causes poor mental health is not well characterized even after 20 years of research. This is due in large part to the fact that previous research has ignored the possibility of selection. The present analysis is based on a representative community sample and was designed to take a step toward correcting these problems and to explore a number of specifications overlooked in previous research. The aggregate results show that marital disruption is associated with an increase of approximately one-third of a standard deviation on a screening scale of depression over a three-year interval between waves of data collection. The effect is more pronounced among women than men and is confined to people other than those who are escaping marriages with serious long-term problems. No evidence is found that the depressogenic effect of marital disruption can be explained by increased financial pressures or other secondary changes in roles. However, increased emotional reactivity to these changes is shown to play a powerful role in promoting depression among the recently divorced. The implications and limitations of these results are discussed.
Journal Article•
TL;DR: The literature on adherence and psychological adjustment in women who are at increased risk for breast cancer because of a positive family history of disease is reviewed to provide the basis for a discussion of potential intervention strategies designed to increase adherence and reduce psychological distress.
Abstract: Increasingly, women with a positive family history of breast cancer are being targeted for cancer prevention and control efforts. Two findings have been demonstrated consistently across studies of this high risk population. First, these women often have high levels of psychological distress, as well as persistent and intrusive worries about developing breast cancer. Second, despite their increased risk for developing breast cancer, a substantial proportion of these women do not adhere to recommended breast cancer screening guidelines. There is growing evidence that psychological distress is an important barrier to adherence among high risk women. Despite this, little is known about how to intervene to improve psychological adjustment and adherence in this population. In the present paper, we review the literature on adherence and psychological adjustment in women who are at increased risk for breast cancer because of a positive family history of disease. This review provides the basis for a discussion of potential intervention strategies designed to increase adherence and reduce psychological distress in this population. Finally, we present some of the psychological implications of recent developments in genetic testing for breast cancer susceptibility.
TL;DR: Transvaginal ultrasonography with colour flow imaging can effectively detect early ovarian cancer in women with a family history of the disease and the screening interval should be less than two years.
Abstract: OBJECTIVE--To assess the value of transvaginal ultrasonography with colour blood flow imaging in detecting early ovarian cancer in women with a family history of the disease. DESIGN--Study of self referred symptomless women with a close relative who had developed the disease. Each woman was screened to detect persistent lesions and defined changes in ovarian volume. Morphological score and pulsatility index were recorded. SETTING--Ovarian screening clinic. SUBJECTS--1601 self referred women. INTERVENTIONS--Women with a positive screening result were recommended to have further investigations. MAIN OUTCOME MEASURES--Findings at surgery and histology of abnormal ovaries. Morphological score > or = 5 and pulsatility index < 1.0 at last scan. RESULTS--Women were aged 17 to 79 (mean 47) years; 959 (60%) were premenopausal, 469 (29%) were naturally postmenopausal, and 173 (11%) had had a hysterectomy. 157 women had a pedigree suggestive of the site specific ovarian cancer syndrome and 288 of multiple site cancers. 61 women had a positive screening result (3.8%, 95% confidence interval 2.9 to 4.9%), six of whom had primary ovarian cancer detected at surgery (five stage Ia, one stage III). Use of a high morphological score or a low pulsatility index increased the odds of finding ovarian cancer from 1:9 to about 2:5 (1:1 in the highest risk groups). Five interval cancers were reported (three ovarian and two peritoneal). Eight of the 11 cancers developed in women with pedigrees suggestive of inherited cancer. CONCLUSIONS--Transvaginal ultrasonography with colour flow imaging can effectively detect early ovarian cancer in women with a family history of the disease. The screening interval should be less than two years.
TL;DR: The results indicate that the PCR assay is a highly sensitive and specific assay for the detection of C. trachomatis in male urine specimens and provides a noninvasive technique for routine screening of chlamydia infection in both symptomatic and asymptomatic men.
Abstract: Screening for Chlamydia trachomatis infection in men has traditionally been limited to men who present with urethral symptoms, thereby limiting the detection of asymptomatic chlamydia infection in men. In order to effectively screen both symptomatic and asymptomatic men, we evaluated a newly developed polymerase chain reaction (PCR) assay, Amplicor C. trachomatis, from Roche Molecular Systems for the detection of C. trachomatis in urine specimens in comparison with urethral culture. A total of 530 male urine specimens were collected from 322 symptomatic and 208 asymptomatic men attending two sexually transmitted disease clinics in Baltimore, Md. The prevalence of C. trachomatis by culture was 9.8% (10.6% in symptomatic men and 8.2% in asymptomatic men). Compared with culture, the sensitivity of the PCR was 92.8%, the specificity was 94.7%, the positive predictive value was 68.4%, and the negative predictive value was 99.1%. Discrepant results between culture and PCR were further analyzed by direct fluorescent-antibody staining of elementary bodies in urine sediment and in culture transport vials and by major outer membrane protein PCR of transport media for specimens with negative culture. The revised sensitivity and specificity of PCR for urine were 95.0 and 99.8%, respectively, and the positive and negative predictive values were 98.7 and 99.1%, respectively. The sensitivity of culture compared with PCR and/or direct fluorescent-antibody staining was 68.4%. These results indicate that the PCR assay is a highly sensitive and specific assay for the detection of C. trachomatis in male urine specimens and provides a noninvasive technique for routine screening of chlamydia infection in both symptomatic and asymptomatic men.
TL;DR: Multivariate analysis found age, emotional distress, and physical illness to be independent predictors of memory complaint; age, functional disability, education, andPhysical illnesses proved to be independently associated with poor memory performance.
Abstract: This study examined the prevalence of memory complaint and poor memory performance on brief screening measures within a community sample of 810 adults. All individuals received an extensive household interview and a clinical psychiatric evaluation. Overall, 22% indicated that they currently had trouble with their memory. This percentage increased with age, rising to 43% for those 65 to 74 years old, 51% for those 75 to 84 years old, and 88% for those 85 years of age and older; the percentage indicating memory problems decreased with educational attainment. The prevalence of poor memory performance was 11%, also increasing with less education and increased age, rising to 26% for those 65 to 74 years old and to 40% for those older then 75. Those who complained of memory trouble were twice as likely to show poor memory performance (29%) compared with those who did not complain (15%). Multivariate analysis found age, emotional distress, and physical illness to be independent predictors of memory complaint; age, functional disability, education, and physical illnesses proved to be independently associated with poor memory performance. A higher prevalence of complaints of memory trouble was found not only for those with affective disorders, as might be expected, but also among those with schizophrenic, cognitive, anxiety, and adjustment disorders. However, only individuals with cognitive disorders showed a higher prevalence of poor memory performance.
TL;DR: Only one person developed unequivocal epilepsy out of a group of 43 examined, and the chance of healthy individuals with EEG abnormalities of this type subsequently developing epilepsy is 2-3%.
TL;DR: The methods developed in this study for PCR screening could be applied routinely to prevent transfusion of B19 in blood and blood products and could play an important role in the prevention of iatrogenic transmission of infection.
Abstract: A highly sensitive and rapid method for routinely screening large numbers of donated blood units for parvovirus B19 by the polymerase chain reaction (PCR) was developed. Over a 3-month trial period in Edinburgh, B19 DNA was detected in 6 of 20,000 consecutive units of blood (0.03%), in concentrations ranging from 2.4 x 10(4) to 5 x 10(10) copies of viral DNA per ml. Seroconversion for B19-specific immunoglobulin M and immunoglobulin G and disappearance of circulating B19 DNA occurred in the interval between donation and recall in four of the five implicated donors who could be recalled. B19 DNA was detected in 18 of 27 separate batches of non-heat-treated factor VIII and IX concentrate manufactured from donated plasma unscreened for B19 DNA. Dry-heat treatment at 80 degrees C for 72 h reduced but did not always eliminate detectable B19 from factor VIII concentrates, consistent with recent observations that current methods for virus inactivation during blood product manufacture are insufficient to entirely eliminate B19 infectivity. The methods developed in this study for PCR screening could be applied routinely to prevent transfusion of B19 in blood and blood products and could play an important role in the prevention of iatrogenic transmission of infection. PCR screening could also be used for detection and exclusion of a range of other transmission-associated viruses for which current serological detection methods are only partially effective.
TL;DR: To establish population‐based data, with special emphasis on the effects of age, gender, and education, for eight, widely used neuropsychological tests in a community‐dwelling cohort of normal and cognitively impaired older adults.
Abstract: Objective: To establish population-based data, with special emphasis on the effects of age, gender, and education, for eight, widely used neuropsychological tests in a community-dwelling cohort of normal and cognitively impaired older adults.
Design: A population-based observational study.
Setting: Examinations were performed in a research clinic by specially trained staff during a 1988–1992 evaluation for osteoporosis.
Participants: 1,692 community-dwelling subjects, aged 55 to 94 years, who were members of the Rancho Bernardo Heart and Chronic Disease Study initiated in 1972. The mean age for men was 73.9 years (SD 9.3) and for women, 73.5 (SD 9.1).
Outcome measures: Eight neuropsychological tests were used to measure cognitive functions. Analysis of variance and post hoc contrasts were performed to determine the effects of age, gender, education, and their interactions on performance on these tests.
Results: Performance on all tests decreased progressively, without leveling off, from the youngest, age 55, to the oldest, age 94. Women performed better on verbal tasks and men on tests of visuospatial, visuoconceptual, and mental control functions. Performances of men on several tests declined more rapidly with advancing age than those of women. Both men and women with some college education performed better on most tests than men and women with high school educations, and the rate of decline with age was sometimes slower in the college-educated group. Only the savings score from the Visual Reproduction Test, which is a measure of rate of forgetting, and the scores of short-term recall derived from the Selective Reminding Test (Buschke-Fuld) were unaffected by educational attainment.
Conclusions: In a community-dwelling cohort, including normal and cognitively impaired elderly men and women, advancing age is accompanied by decline in cognitive functions as measured by neuropsychological tests. This decline is slower in women and in college-educated subjects. Two cognitive indices were unaffected by education, and these may be especially useful in cross-cultural studies.
TL;DR: Home blood pressure increased gradually with increasing age in both men and women, although blood pressure was significantly higher in men until 50 years of age, and day-to-day variation of home systolic blood pressure also increased with age.
Abstract: Objective To evaluate the distribution, reference values and day-to-day variation of blood pressure of untreated subjects measured at home. Design Cross-sectional study of a cohort. Setting General community in northern Japan. Subjects Blood pressure was measured in 871 subjects (mean +/- SD age 46.0 +/- 19.5 years, range 7-98, constituting 38.7% of the local population of Uchikawama region, Ohasama) who were not receiving antihypertensive medication. Methods Subjects measured their own blood pressure at home at least three times (mean +/- SD 19.7 +/- 8.4) each morning using a semi-automatic oscillometric blood pressure measuring device. Screening blood pressure was measured once. Main outcome measures Distribution of home blood pressure in the study population as a whole and with respect to age and sex, and the distribution of day-to-day variation of home blood pressure were determined. Results Mean home blood pressure was 117.3 +/- 13.4/69.3 +/- 9.7 mmHg (95% confidence interval 116.4-118.2/68.7-70.0). The 95th centile value was 143/85 mmHg, mean+SD 131/79 mmHg and mean + 2SD 144/89 mmHg. Mean screening blood pressure was 126.2 +/- 18.9/72.1 +/- 11.7 mmHg (95th centile 159/92 mmHg). Age- and sex-specific 95th centile values as well as mean +/- SD were obtained. Mean+SD, mean + 2SD and the 95th centile values obtained as reference upper limits of home blood pressure from subjects identified as normotensive by screening blood pressure (n = 707) were 125/77, 137/86 and 134/83 mmHg, respectively. Home blood pressure increased gradually with increasing age in both men and women, although blood pressure was significantly higher in men until 50 years of age. Day-to-day variation of home systolic blood pressure also increased with age. Conclusion Since the distribution of home blood pressure values was affected by age and sex, age- and sex-matched reference values for home blood pressure should be established. Home blood pressure values in elderly subjects should be evaluated carefully, since these exhibit greater day-to-day variation.
TL;DR: The Nijmegen screening project with patients recently diagnosed as having interval cancer or screen‐detected cancer and the previous screening mammograms of patients with an interval cancer were reviewed to identify the reasons for the “missed diagnosis”.
Abstract: Background. The occurrence of an interval cancer in a mammographic screening program is indicative of a suboptimum effect on mortality, because the very aim of the screening is to detect as many cancers as possible and at their earliest possible stage. In several studies, the previous screening mammograms of patients with an interval cancer were reviewed and the reasons for the “missed diagnosis” were classified into four categories: “screening error” (20–29%), “minimal sign present” (30–40%), “radiographically occult” (33–58%), or “radiographically occult at diagnosis” (occult both at previous screening and diagnosis; 7–16%). A similar procedure was followed in the Nijmegen screening project with patients recently diagnosed as having interval cancer or screen-detected cancer.
Methods. The previous screening mammograms of 40 interval and 44 screen-detected cases from the breast cancer screening program in Nijmegen were reviewed and categorized as specified above. These breast cancers were diagnosed clinically before the patient was invited to the eighth screening round (interval cancer) or were detected at the eighth screening round (screen-detected cancer). All these patients had been screened in the seventh round (1987–88).
Results. Thirteen percent of all cases were classified as “screening error,” 38% as “minimal sign present,” 43% as “radiographically occult.” and 6% as “radiographically occult at diagnosis.” In nearly half of the screen-detected cancers, minimal signs appeared to be present on the previous screening mammogram 2 years before the diagnosis.
Conclusions. Annual instead of biennial screening may advance detection in most of the “screening error” cases as well as in some in the categories “minimal sign present” and “radiographically occult” at the previous screening. Meticulous analysis of the radiologic characteristics of the “minimal sign present” cases may very well lead to results showing that earlier detection is possible without a significant decrease in the specificity of the screening test.
TL;DR: These four IADLs could be useful for screening subjects at high risk of incident dementia, according to their performance on a four Instrumental Activities of Daily Living (IADL) score.
Abstract: The purpose of the study was to estimate the risk of one-year incident dementia in elderly community dwellers, according to their performance on a four Instrumental Activities of Daily Living (IADL) score. From a random sample of 2792 French elderly community dwellers included in the PAQUID study, 1804 non-demented subjects were interviewed by specifically trained psychologists about their performance on telephone use, use of transport, responsibility for medication intake, and budget management, and then followed up. One year later 21 of these subjects had a diagnosis of incident dementia, according to DSM-IIIR criteria and confirmed by a neurologist. The odds ratio for incident dementia, adjusted for age, increased from 10.6 for subjects dependent in one IADL to 318.4 for those dependent in the four IADLs (p < 0.0001), compared with independent subjects. These four IADLs could be useful for screening subjects at high risk of incident dementia.
Journal Article•
TL;DR: This study confirmed the findings of others that rural African groups have extremely low rates of RA and HLA genes containing the RA associated "shared epitope" are also relatively infrequent and might explain this reduction in RA prevalence.
Abstract: A 2-stage population screening survey of 2,000 inhabitants of 2 rural townships in southern Nigeria was undertaken. No case of rheumatoid arthritis (RA) was discovered in those responding, although 3 cases of inflammatory polyarthritis were found. One of these individuals satisfied the modification of the American College of Rheumatology classification tree criteria that allows for missing radiographic data. Simultaneous monitoring, during a 4-month period, of the local health clinic serving the townships also failed to reveal a case of RA. Three (5.5%) of 55 individuals tested were positive for rheumatoid factor, a rate lower than in previous surveys of rural West African populations. Further immunogenetic investigation of that subsample from this population, using HLA oligonucleotide typing, suggested that HLA-DR4 was rare (1/55). Further, although HLA-DR1 was present in 7 (13%), 6 had the DRB1*0102 variant seen in black populations and not thought to be associated with RA. Our study confirmed the findings of others that rural African groups have extremely low rates of RA. In addition HLA genes containing the RA associated "shared epitope" are also relatively infrequent and might explain this reduction in RA prevalence.
TL;DR: It is indicated that serum pepsinogen screening provides a valuable method for detecting gastric cancers and appears to be especially useful for screening of younger generations.
Abstract: A considerable number of gastric cancers derive from stomach mucosa where chronic atrophic gastritis is severe and extensive. Based on the fact that the serum pepsinogen levels provide a precise measure of the extent of chronic atrophic gastritis, we have devised a mass screening method involving serum pepsinogen measurement to identify subjects at high risk of gastric cancer. In 1991, we screened 4,647 workers (male: 4,113, female: 534, mean age: 49.0 years) at a Japanese company using this method. Out of 875 subjects (18.8%) with a serum pepsinogen I level of less than 50 micrograms/liter and a pepsinogen I/II ratio of less than 3.0, 676 subjects (14.5%) were selected for further investigation by endoscopy. This led to the detection of four subjects (0.086%) with gastric cancer (three in an early stage) and four subjects with adenoma. The cancer detection rate of this new screening method was comparable, and in some respects superior, to that of the traditional barium X-ray screening. Since the incidence of test-positive subjects was as low as 10% amongst subjects aged less than 40, this screening method appears to be especially useful for screening of younger generations. The new method is less expensive than the traditional barium X-ray and subjects experience little discomfort. Further, many serum samples can be quickly measured simultaneously. The results of this study have indicated that serum pepsinogen screening provides a valuable method for detecting gastric cancers.
TL;DR: The results suggest that autoantibodies to oxidized low-density lipoprotein are relatively frequent in both symptomatic and asymptomatic individuals, and the investigation of their potential role as a risk factor will require mass screening and long-term follow-up.
Abstract: We have developed a solid-phase enzyme immunoassay for anti-oxidized low-density lipoprotein antibodies. Most sera showed some degree of non-specific binding to plates coated with oxidized low-density lipoprotein and the autoantibodies to oxidized low-density lipoprotein often appeared to have a relatively low affinity. To differentiate between specific and non-specific binding each sample was tested untreated and after absorption with oxidized low-density lipoprotein. The optical densities obtained with dilutions of the absorbed sample were considered to reflect non-specific binding and were subtracted from values obtained with identical dilutions of the unabsorbed sample, to yield corrected values from which the concentrations of anti-oxidized low-density lipoprotein antibody were calculated. Similar absorptions with native low-density lipoprotein and oxidized human serum albumin failed to induce a significant reduction in binding to immobilized oxidized low-density lipoprotein proving that the antibodies measured by this assay are primarily specific for oxidized low-density lipoprotein. We studied sera from two groups of individuals: (1) 33 subjects submitted to coronary angiography and split into two subgroups depending on the degree of coronary stenosis and (2) 64 healthy individuals also split into two subgroups according to lipid levels. Anti-oxidized low-density lipoprotein antibodies were detected both in patients and healthy individuals. Higher levels were detected in patients with moderate coronary disease and hyperlipemic healthy individuals, but the differences between patients and healthy volunteers or between their respective subgroups did not reach statistical significance. Our results suggest that autoantibodies to oxidized low-density lipoprotein are relatively frequent in both symptomatic and asymptomatic individuals. The investigation of their potential role as a risk factor will require mass screening and long-term follow-up.
TL;DR: Screening and intervention programmes are likely to have life saving effects and lead to considerable economic savings.
Abstract: OBJECTIVE--To analyse the cost-benefit of screening for and antihypertensive treatment of early renal disease indicated by microalbuminuria in patients with insulin dependent diabetes mellitus. DESIGN--Previously published data were used to estimate transition probabilities for each step from normoalbuminuria until death. The effect of intervention on urinary albumin excretion rate by antihypertensive treatment was arbitrarily set at three different levels. All direct costs (screening, antihypertensive treatment, treatment of end stage renal failure) were included in the cost-benefit analysis by using real discount rates of 2.5% and 6%. SETTING--Computer simulation. SUBJECTS--Simulated cohort of 8000 patients. MAIN OUTCOME MEASURES--Mortality, incidence of diabetic nephropathy, incidence of end stage renal failure, and costs versus savings. RESULTS--Assuming treatment effects of 33% and 67% median life expectancy increased by four to 14 years, respectively, and the need for dialysis or transplantation decreased by 21% to 63%. Costs and savings would balance if the annual rate of increase of albuminuria was decreased from 20% to 18% a year. CONCLUSIONS--Screening and intervention programmes are likely to have life saving effects and lead to considerable economic savings.
TL;DR: Scoring systems that incorporate risk markers as well as symptoms and signs may represent affordable alternative methods of screening for gonococcal and/or chlamydial infections among women in resource-poor settings.
Abstract: A substantial proportion of women with gonococcal and/or chlamydial infection are asymptomatic. Thus active case detection is problematical, particularly in developing countries, where facilities and materials for laboratory testing are limited. We assessed the diagnostic validity of the hierarchical clinical algorithms recommended by the World Health Organization as well as that of a nonhierarchical scoring system, using data for 1,160 pregnant women (a low-prevalence group) and 1,222 prostitutes (a high-prevalence group) in Kinshasa, Zaire. Neisseria gonorrhoeae and/or Chlamydia trachomatis was detected in 6.5% and 31.0% of pregnant women and prostitutes, respectively. No single variable that was both sensitive (> 60%) and specific (> 60%) was associated with infection. A simple hierarchical algorithm based only on reported symptoms had a sensitivity of 48.0% and 54.9% and a specificity of 75.2% and 52.2% for the screening of pregnant women and prostitutes, respectively. A second algorithm that included a speculum examination had a sensitivity of only 29.3% but a specificity of 85.3% in pregnant women. When a nonhierarchical scoring system was used, the sensitivity was 72.0% and 71.0% and the specificity was 73.5% and 55.8% for pregnant women and prostitutes, respectively. Scoring systems that incorporate risk markers as well as symptoms and signs may represent affordable alternative methods of screening for gonococcal and/or chlamydial infections among women in resource-poor settings.
TL;DR: An effecient, reproducible and simple mass screening technique for the selection of salt tolerant rice lines has been developed in this article, where fourteen-day old seedlings raised in silica gravel culture were transplanted to foam-plugged holes in polystyrene (thermopal) sheets floated over 100 dm3 of nutrient solution in painted galvanised-iron growth tanks lined with plastic.
Abstract: An effecient, reproducible and simple mass screening technique for the selection of salt tolerant rice lines has been developed. Fourteen-day old seedlings raised in silica gravel culture were transplanted to foam-plugged holes in polystyrene (thermopal) sheets floated over 100 dm3 of nutrient solution in painted galvanised-iron growth tanks lined with plastic (120×90×30cm). Three days after transplanting, NaCl was added to salinize the medium in increments, at the rate of 25 mol m-3 per 24 hours, up to the desired salinity levels which ranged from 50–200 mol m-3 NaCl. Six plants of each line were transplanted and allowed to grow for 15 days after the maximum desired stress level was achieved in each case. Absolute shoot fresh and dry weights, as well as percent mortality, were used as criteria for assessing relative salt tolerance. Related studies were also conducted to standardize the technique. The validity of this technique was tested by conducting experiments in salinised soil (pot culture) and in salt-affected field where 9 rice lines were grown up to maturity and absolute paddy yield was considered as the criterion for salt tolerance. Salt tolerance behaviour of cultivars based on different selection criteria was compared. Good reproducibility of results among the three solution culture experiments and their close association with the results of pot culture and of salt-affected field study, authenticated the validity of this technique for practical purposes.
TL;DR: The incidence of abnormal results increases with age beginning in the early 30s, occurs with a higher frequency in patients who would otherwise be diagnosed with unexplained infertility, and prognosticates decreased long‐term pregnancy rates.
TL;DR: Although BUA is a poor predictor of spinal and hip bone mineral density, it may provide additional structural information important in fracture prediction.
Abstract: This paper compares dual-energy X-ray absorptiometry (DXA) of the spine and hip and broadband ultrasound attenuation (BUA) of the os calcis in 1000 perimenopausal women aged between 45 and 49 years who attended a randomized Osteoporosis Screening Programme. Significant correlations were found between all DXA results and BUA, with the trochanter giving the best numerical correlation with BUA (r=0.354,p<0.0001). BUA was not successful in predicting women with low DXA measurements, with only 44.0% of the women whose spinal DXA falls within the lowest quartile being in the lowest quartile of BUA. Although BUA is a poor predictor of spinal and hip bone mineral density it may provide additional structural information important in fracture prediction.