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[A computer simulation of outcome in early screening studies of cancers of the mouth cavity].

The purpose of the simulation was to design a specific cancer screening programme for squamous cell carcinomas of the head and neck to make detailed estimates of the outcomes of different screening programme options. Therefore, a mathematical model of screening (Eddy) was transformed and simulated with a computer programme. The model is designed as a Markov chain with 7 states and filled with clinical and epidemiological data. The results of the simulation are interpreted as representative for cancer of the oral cavity. Basing on the different system model outputs, mortality with and without screening, effect on life expectancy of the individual and the entire screened population, are discussed. For a screening interval of 6 months the increase in life expectancy for a person with cancer of the oral cavity is 5.3 years, for the entire population (men older than 40 years), however, life expectancy increases only by 9.8 days. The proportion of patients saved from tumour-associated death rose to 65%. The simulation showed a rapidly decreasing effect of the screening programme with longer screening intervals. Therefore, a public cancer screening programme is only useful with a screening interval of 6 months, and the effect on life expectancy is limited. For oropharynx and hypopharynx the possibilities of early stage detection of carcinomas are limited and nearly 60% of the cases with carcinoma of the larynx are already being treated at an early stage. The importance of public health education is emphasised.

Adult↗

Limitations of 3-phenylpropionylglycine in early screening for medium-chain acyl-coenzyme A dehydrogenase deficiency.

Screening for medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency by urinary 3-phenylpropionylglycine may not be reliable in early infancy because young infants are not colonized with adult-type colonic flora. In this study we delineated the microbes that produce 3-phenylpropionic acid, the precursor of 3-phenylpropionylglycine. We found that the use of some antibiotics may alter gut flora, thereby confounding this method of screening for MCAD deficiency.

Acyl-CoA Dehydrogenase↗

Early screening for ectopic pregnancy in high-risk symptom-free women.

We screened 225 symptom-free pregnant women at increased risk for ectopic pregnancy with transvaginal sonography and human chorionic gonadotropin (hCG) assays. Among 55 (24.4%), who proved to have an ectopic pregnancy, 46 (84%) cases were diagnosed at the initial screening at a median of 37 days of gestation, and the rest at repeated scans. The false-positive rate was 1.2%. Early diagnosis prevented tubal rupture, substantial haemorrhage, and the need for emergency care, allowing elective treatment. Such early surveillance reduced the risk of complications and facilitated treatment, and should be offered to at-risk women.

Adolescent↗

[Early screening of cerebral palsy during infancy using 'Infant Motor Malfunction Profile' in the communities of two cities].

OBJECTIVE: To evaluate the prospective validity and predictive value of cerebral palsy during infancy, using 'Infant Motor Malfunction Profile'. METHODS: Items of motor milestone in the profile was used as the first step to screen cerebral palsy on 8137 infants who were screened at 3, 6, 9, 12 months of age. The positive cases who had one of 7 developmental abnormal motor milestone items were examined using the items of primitive reflexes or postural reaction as the secondary step of cerebral palsy screening. The cases who had at least one abnormal item of primitive reflex or postural reaction received neurological examination by doctors to diagnose cerebral palsy. RESULTS: According to our data, sensitivity, specificity, positive prospective value, positive and negative likelihood ratio of the profile in screening cerebral during infancy were 94.1%, 99.8%, 48.5%, 449.6 and 0.06, respectively. CONCLUSION: The profile seemed to be an acceptable instrument for early identification of cerebral palsy.

Cerebral Palsy↗

Delirium in terminal cancer: a prospective study using daily screening, early diagnosis, and continuous monitoring.

A pilot prospective cohort study was conducted to determine delirium frequency and outcome in cancer patients consecutively hospitalized for terminal care (median stay: 12 days). Screening for delirium symptoms was performed daily, using the Confusion Rating Scale. Patients positive on screening had a diagnostic assessment within 24 hours using the Confusion Assessment Method. Monitoring of symptoms was continued until death. Eighteen (20%) of the 89 study patients were positive on screening at admission. Among the 71 patients free of delirium at admission, the incidence of confirmed delirium was 32. 8% (95% CI, 21.3-44.3%). Patients positive on screening received a higher mean equivalent parenteral daily dose of morphine than other patients (72 mg vs. 41 mg, p = 0.08). Significant symptom improvement occurred in 16 (50%) of the 32 delirious cases. Delirium is a serious and frequent complication in terminal cancer whose outcome may not be as poor as previously considered.

Aged↗

Diverse small-molecule modulators of SMN expression found by high-throughput compound screening: early leads towards a therapeutic for spinal muscular atrophy.

We have exploited the existence of a second copy of the human SMN gene (SMN2) to develop a high-throughput screening strategy to identify potential small molecule therapeutics for the genetic disease spinal muscular atrophy (SMA), which is caused by the loss of the SMN1 gene. Our screening process was designed to identify synthetic compounds that increase the total amount of full-length SMN messenger RNA and protein arising from the SMN2 gene, thereby suppressing the deleterious effects of losing SMN1. A cell-based bioassay was generated that detects SMN2 promoter activity, on which greater than 550,000 compounds was tested. This resulted in the identification of 17 distinct compounds with confirmed biological activity on the cellular primary assay, belonging to nine different structural families. Six of the nine scaffolds were chosen on the basis of their drug-like features to be tested for their ability to modulate SMN gene expression in SMA patient-derived fibroblasts. Five of the six compound classes altered SMN mRNA levels or mRNA splicing patterns in SMA patient-derived fibroblasts. Two of the compound classes, a quinazoline compound series and an indole compound, also increased SMN protein levels and nuclear gem/Cajal body numbers in patient-derived cells. In addition, these two distinct scaffolds showed additive effects when used in combination, suggesting that they may act on different molecular targets. The work described here has provided the foundation for a successful medicinal chemistry effort to further advance these compounds as potential small molecule therapeutics for SMA.

Base Sequence↗

Early screening for dyslexia--a collaborative pilot project.

An ongoing collaborative project, currently being piloted in 12 Wiltshire primary schools, is described. The aim is to provide a means of identifying potentially dyslexic children by the end of Key Stage 1 (Year 2) with a view to early intervention. The causal links identified by research between phonological skills and literacy development are taken as the theoretical basis of an initial screening procedure, and an intervention package is implemented for identified children. Those demonstrating persistent difficulties one year later are further assessed over a school term using an assessment package designed to identify those children showing a dyslexic profile. Further intervention is then planned and implemented.

Child, Preschool↗

Pathways upstream: risks and realities of early screening efforts.

The need for basic societal institutions to foster growth-enhancing and ego-strengthening experiences is highlighted. The ascendancy of Asklepios--as representative of the remedial, medical model--over Hygeia--symbolizing the preventive, public health approach--is traced from Hellenic mythology to present reality. The Hygeian merits of current early identification programs are considered, and means for moving them closer to the Hygeian ideal are suggested.

Adolescent↗

Fibrosing alveolitis in systemic sclerosis: the need for early screening and treatment.

Abnormalities in lung function occur in 70% of patients with systemic sclerosis (SSc). Fibrosing alveolitis in SSc (FASSc) is more commonly seen in the diffuse cutaneous form of SSc, particularly in the presence of antitopoisomerase antibodies (Scl70), and with the decreasing incidence of scleroderma renal crisis it is now the major cause of mortality in this patient population. Screening of patients recently diagnosed with SSc by pulmonary function tests and the performance of high resolution computed tomography when physiological abnormalities are identified has resulted in the identification of significant numbers of patients with early, asymptomatic FASSc. Whether these patients should be further investigated with a surgical lung biopsy or receive immunosuppression is unclear, because it cannot yet be reliably predicted who will develop progressive disease and the evidence to support the efficacy of treatment is not strong. The objective of the present article was to review the evidence to support the use of immunosuppressive therapy in FASSc and, based on these data, to propose an algorithm for the investigation and management of this difficult clinical problem.

Bronchoalveolar Lavage Fluid↗

Breast cancer screening: early recognition.

The epidemic of breast cancer and the availability of tools to increase early detection and decrease mortality require care and diligence on the part of every physician directly caring for patients. With the widespread implementation of managed care, primary care physicians are in the best position to recommend breast cancer screening. Educational programs to emphasize the primary care physician's role in breast cancer prevention and detection, to improve physical examination skills, and to implement office systems to facilitate screening should be available to primary care physicians, and may have a major impact on breast cancer mortality in the future.

Adult↗

Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.

Pulmonary arterial hypertension (PAH) occurs as an idiopathic process or as a component of a variety of disease processes, including chronic thromboembolic disease, connective tissue diseases, congenital heart disease, and exposure to exogenous factors including appetite suppressants or infectious agents such as HIV. This article reviews evidence for screening in susceptible patient groups and the approach to diagnosing PAH when it is suspected, and provides specific recommendations for applying this evidence to clinical practice.

Echocardiography↗

Qualitative assessment of uteroplacental blood flow: early screening test for high-risk pregnancies.

A pulsed Doppler apparatus was used to assess the blood flow velocity profiles in uterine vessels (arcuate arteries) at 16 to 18 weeks' gestation to determine if complications associated with impaired trophoblastic invasion of the placental bed (ie, pregnancy-induced hypertension, intrauterine growth retardation, and fetal asphyxia) could be predicted by this measurement. Thirty-one of 126 consecutive pregnancies developed one or more of the above complications. The sensitivity was 68% and the specificity 69%; the predictive value of a positive test was 42% and that of a negative test 87%. These results seem to represent an improvement over existing predictive techniques. Early identification of such a high-risk group might allow more discerning use of antenatal resources and may lead to new therapeutic measures.

Blood Flow Velocity↗

Testicular versus breast and colorectal cancer screening: early detection practices of primary care physicians.

Testicular cancer is the most common solid tumor among men 20 to 34 years old, and it accounts for one of every seven deaths in late adolescent and young adult men. However, studies during the past 20 years continue to show that a majority of men in the most vulnerable ages are unaware of their risk for testicular cancer, deny having had testicular examinations as a part of their routine physical assessments, and lack knowledge of testicular self-examination techniques. This descriptive study used a mailed questionnaire and evaluated self-reported testicular cancer detection behaviors among primary care physicians (N = 116). Breast exams and colorectal screening were included for masking and comparative purposes. Forty-nine percent of the physicians reported routinely performing age-appropriate testicular exams on patients, in contrast to performing breast (83%) and colorectal exams (68%). Instructing male patients to perform testicular self-examination was reported as a routine procedure by 29%, and breast exams were taught routinely by 86% of the physicians. Providing an opportunity for patients to give a return demonstration of the technique was reported 16% of the time for breast self-examination and 4% of the time for testicular self-examination. Teaching patients to do appropriate self-examinations can enhance the provider-client partnership in the provision of healthcare. When providers do not teach the patient to perform self-examinations, a valuable opportunity is missed.

Adolescent↗

CSF 5-HIAA concentration as an early screening tool for predicting significant life history outcomes in female specific-pathogen-free (SPF) rhesus macaques (Macaca mulatta) maintained in captive breeding groups.

We examined relationships among cerebrospinal fluid (CSF) concentrations of the major serotonin metabolite (5-HIAA, 5-hydroxyindoleacetic acid) and significant medical and behavioral outcomes for female rhesus macaques. Based on earlier findings with males we predicted that low CSF 5-HIAA concentrations would be associated with a range of negative life history outcomes in our captive specific-pathogen-free (SPF) breeding colony. We found that the mean CSF 5-HIAA concentration among animals that died over the course of the study period was significantly lower than among animals that survived. Further examination indicated an inverse relationship between CSF 5-HIAA concentration and number of treatments for illness, further suggesting a link between serotonergic functioning and overall animal health. Examination of behavioral data indicated that individuals with low CSF 5-HIAA concentrations were more often the targets of aggressive bouts than were individuals with high CSF 5-HIAA concentrations. Finally, we found a positive relationship between CSF 5-HIAA concentration and infant survivorship. These results suggest negative life history consequences of impaired serotonergic functioning in captive female rhesus macaques, and indicate that CSF 5-HIAA concentration sampled early in life may provide a useful tool in facilitating colony management decisions concerning utilization of scarce and increasingly valuable non-human primate resources.

Aggression↗

[Colorectal carcinoma: screening--early detection].

Colorectal cancer is the second leading cancer disease in Germany. The mortality is still 60%. 75% of the patients have no risk factors for colorectal cancer, 18% have a positive family history for the disease. In these patients colorectal cancer arise from benign adenomatous polyps. A 76-90% reduction in colorectal cancer incidence can be achieved by endoscopic polypectomy. Tumor stage is an important determinant of outcome. In Dukes stage A the overall survival rate is over 90%. By annual fecal occult blood test the incidence and mortality rate of colorectal cancer can be reduced significantly. The combination of fecal occult blood test and flexible sigmoidoscopy seems to be more effective. An alternative strategy is a colonoscopy every ten years. But the important problem in Germany is the very low compliance of the patients. Only 16% of the men and 34% of the women are participating in cancer surveillance program.

Cause of Death↗