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Results for “MASS SCREENING TECHNICS”

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PubMed1991

Leprosy in the WHO African region.

The African Region has the second largest prevalence of leprosy among the WHO regions with about 1 per 1,000 population affected. With a very uneven distribution among countries, the region currently has a total of about 480,000 registered cases. The number of new cases detected per year is reported to be about 37,000. A high proportion (25-40%) of the registered cases are estimated to have significant physical disabilities. In spite of the introduction of multidrug therapy (MDT) in the early 1980s, currently only about 20% of the patients are benefiting from this improved treatment. The major problem in the low MDT coverage appears to be operational, against the background of a difficult socioeconomic situation. However, there have been favourable trends towards increased political commitment in several countries in recent years. The operational and technical constraints were discussed at an interregional conference in Brazzaville in 1989 which emphasized the need to make use of the opportunities to reduce disease prevalence through MDT; to coordinate various internal and external resources available for leprosy control; to increase political commitment and develop plans of action to build national capabilities for leprosy control; to integrate leprosy control within general health services; and to promote health education.

Africa↗

PubMed2003

MaryPODS revisited: updated crash analysis and implications for screening program implementation.

PROBLEM: Due to the relative scarcity of crashes, there has consistently been a problem with analyses that use crashes as a criterion measure in their analyses. METHOD: Previous analyses of the relationships between functional capacity measures and at-fault crash involvement for older drivers as reported in the NHTSA Model Driver Screening and Evaluation Program Final Technical Report have been updated to include one additional year of driving experience. Eighteen new at-fault crashes involving drivers who previously had no crash involvement were recorded for the Maryland Motor Vehicle Administration (MVA) test sample during this interval. The method of odds ratio (OR) calculation was used to examine the relationships between functional status predictors and the most salient among the safety outcome measures identified in the Maryland research. Peak valid OR values for the prior and current analyses were contrasted, and the stability of candidate pass-fail cut-points for each predictor relative to values identified in the Final Technical Report was examined. RESULTS: Results indicate that the predictive value of functional tests appears to decrease over time, particularly for the perceptual-cognitive measures. IMPACT ON INDUSTRY: The impact of these findings on programs and policies is to underscore a need for periodic reevaluation, spaced at the shortest practical intervals but not more than 2 years apart, in order for functional capacity screening to be applied effectively by licensing authorities, health care professionals, and others to reduce personal risk and enhance public safety.

Accidents, Traffic↗

PubMed1990

Groningen Hypertension Service: ten years experience in detecting and treating hypertension in a population of 23,340 persons in rural and urban districts in Holland with a special hypertension service.

The Groningen Hypertension Service (GHS) has demonstrated that provision of training for volunteers, technical assistance and the services of the General Practitioner Laboratory (a private foundation offering laboratory and diagnostic facilities) have enabled large rural and urban districts to be screened for hypertension within a short period of time at low cost. The GHS trained volunteers and paramedics, who assisted with the treatment for six months. The General Practitioner Laboratory evaluated treatment in nearly 600 hypertensive patients, leading to the institution of low-dose therapy and careful investigation of side-effects.

Adult↗

PubMed2002

Nonpalpable breast lesions: biopsy methods and patient management.

Mammography has become a major, if not the best available, diagnostic tool for the early detection of breast cancer. Screening has progressed substantially from the anecdotes of physicians in the early 1970s, that is, the assumption that "if I can't feel it, it's not there." Although controversy continues regarding the earliest age at which screening mammography truly lowers the death rate from breast cancer, the fact that mammography detects breast cancer years before it might be discovered as a mass in the breast cannot be challenged. Mammographic techniques have improved to the point at which smaller and smaller areas of suspicion can be identified, and mammographers have gained greater experience in the interpretation of these minute radiographic abnormalities. The ability to detect these changes has inevitably led to an increase in procedures designed to explain them. The incurred costs, both emotional and economic, of patient recalls for positive mammographic findings are considerable. Regardless of whether the physician practices medicine as a patient advocate or exercises politically correct and cost-effective mandates, the management of nonpalpable breast lesions requires the correlation of cognitive and procedural skills and cooperation among physicians and reflects the technical achievements of contemporary medicine.

Biopsy↗

PubMed1995

A review of the technical features of breast cancer screening illustrated by a specific model using South Australian cancer registry data.

This paper illustrates many of the concepts and issues relating to breast cancer screening by reference to a case study of screening in South Australia and by a survey of the mathematical screening models. This work is motivated by the observation that, for some women, the prospects for a breast cancer cure appear to be enhanced if the disease is detected early. We use data from the South Australian Cancer Registry to estimate some of the parameters which describe the pattern of this disease in the South Australian female population, and the underlying model is then used to estimate the impact of various screening designs on the efficacy of a variety of breast cancer screening programmes.

Breast Neoplasms↗

PubMed1989

The imperative character of medical technology and the meaning of "anticipated decision regret".

Medical-technical possibilities are often experienced as being strongly compelling. This imperative character of medical technology not only applies to the medical profession, but also to patients who frequently find it very difficult to refuse medical examinations or treatments. This article discusses the technological imperative with regard to patients. It attempts to discover relationships with decision theory, particularly concerning "anticipated decision regret." The fact that prevention of regret plays an important role in the use of medical technology is illustrated through a number of examples: liver transplantation, prenatal diagnosis, screening, and in vitro fertilization.

Decision Theory↗

PubMed2000

In vitro and in vivo assessment of the effect of impurities and chirality on methamidophos-induced neuropathy target esterase aging.

In vitro and in vivo studies evaluated neuropathy target esterase (NTE) inhibition and aging (i.e., loss of reactivation potential) by analytical and technical grade racemic and resolved L-(-) and D-(+) isomers of methamidophos (O,S-dimethyl phosphoramidothioate). For studies in vitro, microsomal protein from phenobarbital-induced livers was isolated from chick embryos and NTE inhibition assays were performed using chick embryo brain homogenate treated with 1 or 5 mM methamidophos (with and without metabolic enzymes); for studies in vivo, hens received 30 to 35 mg/kg methamidophos injected into the pectoral muscle. NTE aging in hens was assessed 24 h later or after 30 min to 1 h incubation in vitro using solutions of potassium fluoride (KF) reactivator. Technical methamidophos produced significantly higher levels of aged-inhibited NTE than analytical methamidophos or isolated optical isomers. In vivo, technical methamidophos produced 61% total NTE inhibition with 18% aged and 43% unaged NTE; hens receiving analytical grade averaged 6% aged, 52% unaged, and 58% total NTE inhibition. Results for 1 mM analytical methamidophos in vitro were 5% aged, 54% unaged, and 59% total inhibition; for 1 mM technical methamidophos, values averaged 11% aged, 50% unaged, and 60% total NTE inhibition. The degree of NTE aging obtained both in vivo and in vitro for the isolated D-(+) and L-(-) isomers never exceeded that obtained using analytical grade. These data indicate that impurities in methamidophos could contribute to OPIDN potential. The in vitro methodology described could be applied to first tier screening for detection of NTE inhibition and aging, thus reducing the need for whole-animal testing for OPIDN.

Animals↗

PubMed2002

Lung cancer. 2: screening and early diagnosis of lung cancer.

Technical developments in spiral CT scanning mean that considerably smaller lung cancers can now be identified than with previous methods of detection. Only time will tell whether this enhanced capability will result in a reduction in the number of deaths from lung cancer. The implications and problems of screening for lung cancer are discussed. Screening implies a careful refinement of a range of clinical activities that must be routinely delivered in a carefully coordinated fashion to allow for the possibility of improved outcome. Critical analyses of the nuances of this process are essential if the field is to move forward.

Decision Making↗

PubMed2004

Multidetector computed tomography of the coronary arteries.

Over the past decades, the feasibility of non-invasive coronary imaging has been explored using different modalities, such as magnetic resonance and electron beam computed tomography. Despite encouraging initial results, neither technique is yet considered suitable for routine clinical use. Recent developments in multidetector computed tomography have expanded the potential of contrast-enhanced spiral computed tomography coronary angiography. Promising results have been published with the use of 4-slice spiral computed tomography; however, cardiac motion and calcium deposits in the artery wall rendered a substantial number of scans inadequate for interpretation. Recently, a new generation of scanners, equipped with more and thinner detector rows (8 and 16 detectors) and an increased rotation speed, have been introduced. These technical advances will have a significant impact on cardiac imaging: at an increased gantry rotation rate, up to 32 slices can be acquired in 1 s. The improved spatial and temporal resolutions have led to the opportunity of acquiring high-quality images of the entire heart within a single breath-hold.

Calcinosis↗

PubMed1995

ACOG technical bulletin. Health maintenance for perimenopausal women. Number 210--August 1995. American College of Obstetricians and Gynecologists.

Perimenopausal women are assuming increasing importance in the practice of obstetrics and gynecology. While continuing to have reproductive concerns, such as attaining or preventing pregnancy, these women are confronted with a decline in estrogen levels and the inherent protection estrogen provides against osteoporosis and cardiovascular disease. Preventive care, life style modification, and early diagnosis and intervention can play a valuable role in maintaining patients' overall health and quality of life.

Delivery of Health Care↗

PubMed1983

[Automatic screening tympanometry in school medicine].

The authors have tested 1690 ears of kindergarten and schoolchildren aged between 2 1/2 and 13 with a completely automatic tympanometer Model 85 AR American Electromedics whose most interesting characteristic is a supple eartip which adjusts to the concha without penetrating the external earduct. That technical advantage makes it a very non-aggressive instrument, easy to use for school medical screening. The results obtained are quite the same as those mentioned in the literature: 23% of the children tested have a pathological tympanogram. Three to 6 weeks later, 50% of these tympanograms remain abnormal. The breakdown by age group analysis shows a larger frequency of middle ear pathology between the ages of 2 1/2 and 6. The use of an automatic tympanometer for the screening of suspect cases seems to not only be highly suitable but needed for kindergarten children before beginning primary school.

Acoustic Impedance Tests↗

PubMed1996

Vitamin B1, B2 and B6 deficiency in primary school children infected with hookworm.

One thousand and seven hundred thirty-six school children from two districts in Nakhon Si Thammarat Province were screened for hookworm infection using the Kato-Katz stool examination technic. Two hundred students who have at least 2,000 eggs per g of stool were recruited into the program. The students were divided into six groups: groups 1, 2 and 3 were from Tha Sala district while groups 4, 5 and 6 were from Ronpibul district. Three milliliter blood samples were obtained from the cubital vein of each subject and were evaluated for erythrocyte transketolase activity (ETK) for vitamin B1, erythrocyte glutathione oxidoreductase activity (EGR) for vitamin B2, and erythrocyte aspartate aminotransferase activity (EAST) for vitamin B6. The school children were divided into three groups: those infected only with hookworm, those with both hookworm and Trichuris trichiura, and those whose stools show no parasite eggs. The results show that 10-20% of the school children are vitamin B1 deficient, about 40% to 80% are vitamin B2 deficient, and about 14% to 23% are vitamin B6 deficient. No correlation could be made between vitamin deficiencies and parasitic infection.

Causality↗

PubMed1982

Immunoassay of blood spot TSH; development of a rapid two-site immunoradiometric assay and comparison with radioimmunoassay as a screening method for neonatal hypothyroidism.

The development of a two-site immunoradiometric assay (IRMA) for thyrotropin (TSH) eluted from dried blood filter paper discs is described and compared with a conventional TSH radioimmunoassay (RIA) as a screening procedure for neonatal hypothyroidism. The iodinated antibody for the IRMA is prepared by a reproducible four step procedure. Specific antibody is selected from whole TSH antiserum with TSH covalently linked to microparticulate cellulose, iodinated as the solid phase antigen-antibody complex, and eluted by repeated changes in pH from 3 to 10. The pooled eluted material is finally purified by Sepharose 6-B gel chromatography to recover labelled monomeric anti-TSH IgG. Solid phase antibody for the IRMA is prepared by covalently linking a partially purified IgG fraction of TSH antiserum to carbonyldiimidazole-activated microparticulate cellulose. Typically yields of 2-3 mg protein per 100 mg cellulose (2-3%, w/w) are obtained. The two-site IRMA involves a primary incubation of excess labelled TSH antibody and the blood disc for 16-18 h at pH 8 and a secondary 3 h incubation under agitation, with solid phase TSH antibody. Bound and free fractions are separated by a semi-automated washing procedure. Compared with the conventional RIA, the two-site IRMA is quicker (results available within 24 h compared to 3 days for RIA), more precise at clinically important TSH levels (25-30 mU TSH/l), and more sensitive (detection limit less than w mU/l compared to 6 mU/l for RIA). The two-site IRMA is technically simpler than RIA and has proved rugged in routine practice. TSH levels in filter paper blood spots prepared from whole blood with levels of standard TSH (MRC 68/38) within the range 6 to 200 mU/l, correlated well in both assays (r = 0.969). Recoveries of 98% and 104% were demonstrated for the two-site IRMA and RIA, respectively. It is concluded that the two-site TSH IRMA has advantages over conventional RIA in speed, sensitivity, precision and ruggedness and can be recommended as an efficient screening procedure for neonatal hypothyroidism.

Autoanalysis↗

PubMed1994

Preoperative ultrasound to predict technical difficulties and complications of laparoscopic cholecystectomy.

Thirty-five patients with symptomatic gallbladder disease were prospectively evaluated by ultrasound the day before laparoscopic cholecystectomy. Diminished gallbladder function and wall thickening were significantly associated with increased technical difficulty of the operation (Student's t-test, P < 0.001). There was no association between gallbladder volume or number of calculi and operative difficulty. Dilated common bile ducts were detected by ultrasound in five patients (14%) and bile duct calculi in two patients (6%). Ultrasound findings can be used as predictors of potential operative difficulties when selecting patients for laparoscopic cholecystectomy. Ultrasound should be used as an initial screening investigation to detect common bile duct dilatation and calculi.

Adult↗

PubMedDate not supplied

[Sensitivity and specificity of test results in HIV].

In HIV tests, the sensitivity is important, but even more so is the specificity, i.e., the reliability of positive tests results. A third parameter, the positive predictive value, is connected with these test characteristics; but even more it depends to a high degree on the prevalence of the infection. To solve these general problems, highly purified virus antigens as well as step testing are used in HIV diagnosis. Initially, screenings test (ELISA, IFA, various so-called quick tests) are used to filter out those suspected of being infected from the mass of non-infected persons. For this population with an increased HIV prevalence, confirmation tests are performed. With the indirect immunofluorescence assay, it is possible to distinguish antiviral from anticellular antibody reactions. With the so-called immunoblot, the immune response against individual virus proteins can be determined. The sensitivity of HIV tests is approximately 99-100%. As for the specificity, only 1 false positive result per 50,000-100,000 tests is expected. AIDS infections before seroconversion can be diagnosed only by detecting the virus or compounds of it. This is hardly possible with virus Antigen-ELISA and virus cultivation. On principle, nucleic acid hybridisation after DNA multiplication by polymerase chain reaction would be suitable. However, there are still some technical problems and questions of interpretation of results with this method. It is also very complicated and thus out of the question for routine examination.

AIDS Serodiagnosis↗

PubMed1992

Preemployment drug screening. The epidemiologic issues.

Deciding to test applicants for employment for drugs raises complex, legal, moral, economic, and technical issues. However, we focus here on three epidemiologic issues germane to this decision. In one industry, the United States Postal Service, two recent studies suggest associations between positive preemployment drug screens and turnover, absenteeism, accidents, injuries, and discipline, but these associations are weaker than had been assumed. Cost-benefit analyses show that whether drug screening saves money depends both on the costs associated with adverse outcomes such as accidents and on the prevalence of drug use in the population screened. Finally, the predictive value of a positive drug screen also depends crucially on the prevalence of drug use. In populations with low prevalence of drug use, a large proportion of the positives may be false positives.

Absenteeism↗

PubMed1987

Diagnosis of murine mycoplasmal infections by enzyme-linked immunosorbent assay (ELISA).

ELISA is the currently accepted method for screening rodent colonies for Mycoplasma pulmonis infection. While this assay has greatly improved mycoplasmal detection, it suffers from major defects. Cross-reactions with M. arthritidis are the major technical problem, and prevent definitive diagnosis. Current methods for obtaining a definitive diagnosis are accurate in about 80% of cases, and include ELISA testing for both organisms, immunoblot analysis, and blocking of the murine reaction with heterologous serum. Another technical difficulty is the inherent variability in the assay, which can be overcome by rigid quality control measures and careful attention to detail. The difficulties that arise from the natural history of mycoplasmal infection in barrier-maintained colonies, i.e., low incidence of infected animals and delayed antibody response in animals infected with low numbers of organisms, seriously limit the usefulness of the ELISA. While the assay can be extremely useful in screening breeding colonies and in eliminating mycoplasmas from such colonies, it cannot easily be used to screen potential sources of weanling animals for experimental use.

Animals↗

PubMed2003

[Cholesterol measurement as a screening test: a category error].

The measurement of cholesterol levels is a routinely used test which, is claimed to be also a screening test. However, true screening for familial hypercholesterolemia in young people must be distinguished from the so-called risk factor screening among adults, which in Germany is performed both systematically in the whole population and even more so incidentally. This risk factor approach to the measurement of cholesterol is neither a screening test nor does it aim to detect a disease early, but the rationale is a risk factor medicine approach, which has to be evaluated according to its own requirements. The technical efficiency of cholesterol measurement as a screening test is so low, that the notion of screening represents a misnomer and a category error. The measurement of risk factors in a screening context and as a method of individual primary preventive medicine has led to unsolvable problems. A consensus has been achieved, that only a multiple risk factor approach is worthwhile, though the individual and the community approach are both only marginally effective in primary prevention, as has been shown in meta-analyses. Prescription for chemoprophylaxis with statins has shown a relevant risk reduction, but has only been evaluated as a high-risk approach with a cardiovascular risk of 2-3% per year.

Adult↗