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PubMed2004

Further examination of infants referred from newborn hearing screening.

OBJECTIVES: Universal newborn hearing screening (UNHS) is considered beneficial and is accepted worldwide. However, some problems remain, and administrative systematization has yet to be established in many countries. This study assessed the hearing screening of referred newborn infants and discusses the problems that remain. MATERIALS AND METHODS: Over the two years from July 2001 to June 2003, 98 ears of 49 infants were judged as a "referral" from a newborn hearing screening program, and were subsequently referred to our hospital for further examination using conventional ABR and other audiological tests. The methodology used for hearing screening varied between practitioners and hospitals that utilized both different recording apparatus for AABR and/or automated DPOAEs and independent protocols. RESULTS: Conventional ABR identified 21 infants with bilateral normal hearing, 12 with unilateral hearing loss, and 16 with bilateral hearing loss, and a total correspondence rate of 40.8% (20 out of 49 infants). In a comparative analysis, 26 ears out of 98 (26.5%) were determined as false-positive, seven out of 98 as false-negative (7.1%), and there was a total correspondence rate of 66.3% (65 out of 98 ears). Five of the seven false-negative cases who were referred with unilateral hearing loss exhibited moderate to profound bilateral hearing loss (moderate; one infant, severe to profound; four infants). Of the 16 infants with bilateral hearing loss, nine with more than moderate loss had hearing aids fitted at our hospital or related educational institution before most were six months old. CONCLUSIONS: Our results suggest the accuracy of newborn hearing screening remains an issue, but may be improved by an experienced examiner and better protocols including a two-stage process and altered timing of screening. Other ongoing health care programs need to monitor for signs of hearing loss even in the "passed" infants because of possible false-negatives and delayed-onset hearing loss. Improvement is needed in both the intervention systems and diagnostic follow-up of hospitals. Early public support is also required for infants with either severe to profound or moderate hearing loss. From the viewpoint of test conditions and puerperal parental psychological problems, it is considered that the timing of screening needs further discussion. Here it is suggested that screening should be performed within the first three months of infant's life but not be limited to before hospital discharge, and incorporated into the routine health care program for one-month-old infants without reducing efficiency.

Acoustic Impedance Tests↗
PubMed2001

Protection against cold air and exercise-induced bronchoconstriction while on regular treatment with Oxis.

This study aimed to compare the duration of protection against exercise-induced bronchoconstriction (EIB) after inhalation of formoterol (Oxis) Turbuhaler with that of terbutaline Turbuhaler and placebo Turbuhaler in asthmatic patients treated regularly with formoterol Turbuhaler 9 microg b.i.d. and inhaled steroids. The study. performed at three centres (Göteborg and Lund, Sweden, and Trondheim, Norway), consisted of an open-label part with formoterol Turbuhaler 9 microg b.i.d. and a randomized, double-blind, cross-over part with a single dose (on top of the regular treatment) of either formoterol Turbuhaler 9 microg, terbutaline Turbuhaler 0.5 mg or placebo Turbuhaler. The patients attended the clinic six times: twice for screening visits, three times for randomized treatment and once for a follow-up visit. Patients received regular b.i.d. treatment with formoterol 9 microg for a mean period of 16 days. Formoterol gave a post-exercise fall of 12, 10, 15 and 17% in forced expiratory volume in 1 sec (FEV1) 15 min, 4, 8 and 12 h after inhalation. The differences compared with placebo (falls of 26, 22, 23 and 22%) and terbutaline (falls of 17, 18, 22 and 22%) were all statistically significant (P<0.05 for all comparisons). Patients on regular treatment with formoterol Turbuhaler 9 microg b.i.d. have a significant protection against EIB up to 12 h after inhalation of formoterol 9 microg. The protection was also significantly better than that of terbutaline Turbuhaler 0.5 mg.

Adult↗
PubMed2005

Beyond screening: identifying new barriers to early onset group B streptococcal disease prevention.

BACKGROUND: Group B streptococcal infections remain an important cause of morbidity and mortality in newborns. METHODS: Neonatal group B streptococcal cases were identified by active surveillance in 4 urban Tennessee counties. Medical records of mothers of cases and a sample of other pregnant women with live births from the same population were reviewed to determine whether the screening or risk-based approach was used for prevention of early onset group B streptococcal disease and to assess other factors affecting preventability of cases. RESULTS: During 1998 and 1999, 43% of women underwent prenatal group B streptococcal screening. County of residence was the only factor independently associated with not being screened [odds ratio, 7.85; 95% confidence interval (4.69, 13.16)]. Ten affected babies were born to screened mothers (0.40 per 1000). In 9 of these 10, problems were identified: mothers had positive screening cultures but did not receive optimal intrapartum antibiotics (n = 3 of 4); mothers had negative screening cultures (n = 4); and mothers were screened, but the results were unknown, and intrapartum antibiotics were not given (n = 2). CONCLUSIONS: Challenges to implementation of group B streptococcal screening and prophylaxis include insufficient screening, suboptimal intrapartum antibiotics, disease despite negative screening cultures and timely communication of screening results at delivery. An awareness of such problems may lead to supplemental measures to further reduce group B streptococcal disease.

Adult↗
PubMed2001

Predictors of carotid endarterectomy in middle-aged individuals.

The objective was to investigate which screening variables in a population study predicted carotid endarterectomy. Among 793 carotid endarterectomies performed at Malmö University Hospital between 1991 and 1998, 85 patients (14 females) were identified that had participated in a population screening between 1974 and 1991. Median time from screening to operation was 16 years (range 6-26 years). Screening variables were compared with corresponding values from the background screening population (n = 33261). As operated patients were older than the background population at screening (49 [37-60] vs. 46 [26-61] years; p < 0.0001), comparisons were age-adjusted. Operated patients had higher systolic blood pressure (SBP; 130 [126-133] vs. 125 [125-125] mmHg; p < 0.01), serum total cholesterol (6.1 [5.9-6.3] vs. 5.7 [5.7-5.7] mmol/l; p < 0.0001), serum triglyceride (1.4 [1.3-1.6] vs. 1.1 [1.1-1.1] mmol/l; p < 0.0001), serum glutamic acid transferase (0.46 [0.40-0.53] vs. 0.40 [0.40-0.41] microkat/l; p < 0.05), and plasma fibrinogen (3.77 [3.42-4.16] vs. 3.35 [3.30-3.41] mmol/l; p < 0.05) levels, a lower 120-min insulin/glucose ratio at an oral glucose tolerance test (OGTT; 0.48 [0.38-0.58] vs. 0.60 [0.59-0.61]; p < 0.05) and forced vital lung capacity (3.7 [3.6-3.9] vs. 3.9 [3.9-4.0] l/min; p < 0.05), and a higher prevalence of smoking at screening (68% vs. 45%; p < 0.0001). Smoking, SBP, serum total cholesterol, and the 120-min insulin/glucose ratio remained independent predictors for carotid surgery in multivariate analysis. No differences existed among patients operated on because of symptomatic and asymptomatic stenosis. In conclusion, increased SBP and total cholesterol, lower 2-h insulin/glucose ratio at an OGTT, and smoking predict carotid surgery at long-term follow-up.

Acyltransferases↗
PubMed1998

[Strain of screening high toxin--producing from Corynebacterium diphtheria PW8-weissensee].

Corynebacterium diphtheria PW8-weissensee was grown on different media for screening high toxin produce. Through six times of screening (selecting butyrous brilliant smooth small colonies and testing their toxin production capacity) from original strain producing toxin 160 Lf/ml, a high toxin--producing descendand culture was obtained, which produced 79% more toxin than the original strain did.

Corynebacterium diphtheriae↗
PubMed1998

[The 1st case in Spain of detection of occult squamous carcinoma using LIFE system].

LIFE system (lung imaging fluorescence endoscope) is a new system of detection for early lung cancer using a He-Cd laser through a conventional fiberoptic bronchoscope. This system is able to capture and processing the autofluorescence from the bronchial mucosa and to show it in a video screen in real time. In the screen the normal tissue appears in green colour and the neoplastic tissue in brown colour. The first studies performed with LIFE system show the same specificity of the conventional bronchoscopy but the sensibility is 50% higher. In this paper we present the first case of detection of a occult squamous cell carcinoma with sputum and bronchial aspiration cytology positive for carcinoma but chest X ray, CT scanner and bronchoscopy negative for lung cancer. The LIFE system was able to detect carcinoma in the carina.

Bronchoscopy↗
PubMed1983

Lead time estimation in a controlled screening program.

A method is presented for estimating a discrete form of the lead time distribution of cases detected in a single-shot screening program. The procedure is based upon a three-state progressive disease model of disease natural history and screening which focuses on the age at entry into the preclinical disease state, the duration of the preclinical state, and the age at screening or observation. Estimation is accomplished by comparing observed incidence rates of the disease between a screened group and a randomized control group in successive follow-up intervals after the screen. No assumptions concerning the false negative rate of the screening test or the distribution of the duration of time spent in the preclinical disease state are required. An example is presented by means of breast cancer screening data.

Adult↗
PubMed1991

Early dropouts from psychotherapy.

Ninety-six patients requesting psychotherapy were studied prospectively at the time of screening interview by four senior psychiatrists using a variation on Luborsky's Helping Alliance questionnaire and the Osgood Semantic Differential. Significant differences were found at the time of screening between early dropouts and continuers, among screeners' rate of early dropouts, and among patients' perceptions of screeners. The screener with a high early dropout rate was seen as being more passive and less potent, and offering less new understanding than other screeners. Patients who dropped out early experienced a less strong helping alliance, felt they gained less new understanding, liked the clinician less well, felt less well liked and less respected, and saw the interviewer as more passive and psychotherapy as less potent than did continuers.

Attitude to Health↗
PubMed2003

[Spiral CT: is it time for lung cancer screening?].

Recent studies have benefited from the progress of the scanner in order to relaunch the debate on the opportunity of screening lung cancer. Even if these initial studies have succeeded in showing that the practise of helical scan allows the screening of a considerable proportion of cases at an early stage which may have 5-year survivals of up to 70%, there is no specific indication of the diminution of lung cancer-specific mortality. Studies of cohorts of several dozen millions subjects during a period of 8 to 10 years are to be realised and an international pool will be charged of the harmonization of the protocols in order to realize the analyse of the collected information. An experimental study of 1000 subjects financed by a grant have started recently in France.

Aged↗
PubMed2003

Is increased surveillance for asymptomatic syphilis in an HIV outpatient department worthwhile?

OBJECTIVES: Syphilis outbreaks have recently been reported in the United Kingdom, some of which have included cohorts of HIV positive individuals. As a result we commenced 3 monthly screening of syphilis serology (STS) for HIV positive patients having routine follow up blood tests. We assessed if there was an increased number of individuals being screened and also whether the screening programme was diagnosing early cases of syphilis. METHODS: Data from a 1 year period following introduction of screening (May 2001) were analysed and compared with data from the same period last year. The case notes of patients with a positive VDRL were reviewed to establish, firstly, whether these represented new diagnoses and, secondly, whether patients were asymptomatic at the time of screening. RESULTS: 2670 patients had at least one CD4 count measured in the period (surrogate for patients having routine bloods). Of these, 2266 patients had STS performed (85%). 38 patients had a positive VDRL. Of these, 20 were confirmed as having early syphilis which was asymptomatic at the time of screening. Six asymptomatic cases were also confirmed with newly positive TPPAs and a negative VDRL. These 26 asymptomatic cases represent 29% of all cases of early syphilis diagnosed in our department and 50% of cases in the HIV positive cohort. CONCLUSION: With intensive surveillance significant numbers of cases of asymptomatic early syphilis are being identified in a group of HIV individuals under routine follow up, at an earlier stage than would otherwise have been the case. This presents an opportunity to intervene not only to prevent clinical illness but also to institute infection control measures.

AIDS-Related Opportunistic Infections↗