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PubMed1984

Screening blood glucose values: effects of season and time of day.

Blood glucose screening results, obtained using two different screening procedures, are reported from two occupational groups. Post-prandial blood glucose levels were measured in 3346 subjects aged 45 years or more employed by the Greater London Council/Inner London Education Authority. In women, mean blood glucose levels were higher in the afternoon than the morning (p less than 0.05). Ninety-fifth centile levels were substantially higher in the afternoon in both sexes, though the differences were not constant in all age and sex sub-groups. In both sexes mean glucose levels were highest in the winter (December-February, inclusive), but seasonal variation did not significantly affect the proportion exceeding the ninety-fifth centile for the total population. In the Whitehall study, the blood glucose was measured in men, in the morning, 2h after a 50-g glucose load. Significant seasonal variation in mean blood glucose values occurred, with highest values in winter and lowest in spring (March-May, inclusive). However, there was no significant difference by season in the proportions exceeding the arbitrary cut-off levels of 7.8 and 11.1 mmol/l.

Adult↗

PubMed2004

Needle localization for excisional biopsy of breast lesions: comparison of effect of use of full-field digital versus screen-film mammographic guidance on procedure time.

The time required to perform needle localization with full-field digital (FFD) mammography was compared with the time required to perform it with screen-film (SF) mammography in 158 women with breast lesions. The time needed to position the patient before the first image was acquired, needle placement time, and total procedure time were compared between techniques. Regression modeling was performed to assess the effect of mammographic guidance method while simultaneously adjusting for other significant covariates. By using the backward selection technique, statistically nonsignificant variables were removed one at a time to produce a final model for which all statistically significant effects were defined as those with P <.10. Total procedure time for all lesions was shorter with FFD than with SF mammography. The time needed to position the patient and needle placement time were also significantly shorter with FFD than with SF mammography. Procedure time for needle localization of breast lesions is significantly shorter with FFD than with SF mammographic guidance.

Adult↗

PubMedDate not supplied

Hepatitis B prenatal screening survey, Nova Scotia, 1990-1991.

We conducted a study in which 5,754 pregnant women who delivered at the Grace Maternity Hospital in Halifax were screened for HBsAg. There were five who were found to be seropositive for the first time (a screening yield for seropositivity of 8.7/10,000). Overall six were seropositive for a prevalence rate of 10.4/10,000. These rates are above the 6.0/10,000 level at which routine prenatal screening is considered to be cost-effective. Screening based upon risk factors would have identified only two of the five women who were found for the first time to be HBsAg seropositive. Based upon the results of this study, we recommend that routine screening for HBsAg be performed on all prenatal women in Nova Scotia.

Female↗

PubMed2001

Computer modelling of the Swedish two county trial of mammographic screening and trade offs between participation and screening interval.

OBJECTIVES: A computerised model of the Swedish two county trial of mammographic screening was built to explore the applicability of deterministic group modelling for health policy analysis and to examine trade offs between screening interval and population coverage on breast cancer mortality. METHODS: Powersim system dynamics modelling software running on a PC was used. Model inputs were published data on the populations and screening regimens used in the trial, a Swedish female population life table, incidence of breast cancer in Sweden, 95% confidence intervals (95% CIs) for mean sojourn time and screening sensitivity, and survival after diagnosis. RESULTS: The model's output--cumulative mortality from breast cancer--agreed closely with trial results. This was robust to uncertainties in key input variables. Furthermore, with hypothetical screening regimes that had a fixed total number of mammograms over a fixed period a positive association was found between more even distribution of mammograms among a population and reduction in breast cancer mortality. For example, screening 50% of a hypothetical population annually produced a 33% reduction in breast cancer mortality, whereas screening 100% of the population every 2 years produced a 48% reduction. CONCLUSIONS: Deterministic group simulation modelling can be used to build reliable, evidence based quantitative models for policy analysis. This opens health policy simulation modelling to epidemiological researchers and will assist them in identifying important information needs--such as breast cancer survival according to sojourn time (the time between cancer being detectable by screening and becoming symptomatic). Scenarios examining reductions in mortality for a given number of mammograms showed that the more equitable the distribution of screening mammograms, the greater the reduction in deaths from breast cancer.

Adult↗

PubMed2003

A case-control follow-up study for disease-specific mortality.

Case-control studies often rely on subjects to report their own screening or exposure information: this information is often obtained from cases after the event of interest has occurred. This is problematic for mortality outcomes, because dead subjects cannot report the desired information. To avoid this problem, Weiss and Lazovich (1996, American Journal of Epidemiology 143, 319-322) proposed obtaining exposure or screening information from potential cases, i.e., subjects diagnosed with disease, at the time of disease diagnosis, and also from a referent series. The design is best viewed as a new scheme for sampling from a cohort. I review estimation of the effects of time-varying screening or exposure in cohort studies, using a new factorization. I then show how this factorization, together with ignorability assumptions, allows valid estimation from these new designs. Even when the sampling fraction of nondiseased subjects is unknown, causal risk ratios are estimable if diagnosis is rare in the cohort. I illustrate and compare conventional and new methods with data from the Health Insurance Plan study.

Adult↗

PubMed1990

The preventive value of audiometric screening of preschool and young school-children.

The routine to screen 4- and 7-year-old children with audiometry has been studied with regard to its preventive value. Out of 2,330 4-year-olds, 27 children with secretory otitis media (SOM) were treated with myringotomy and 9 of these with grommets as a consequence of identification by screening. One child with unilateral, sensorineural impairment received special teacher's assistance 2 h per week as a consequence of identification by screening. When the same children were screened at the age of 7, 6 children with SOM were treated with myringotomy after identification by screening audiometry. Children with SOM at the age of 4 had impaired hearing at the age of 7, identified by screening, 4 times more frequently than other children. The study suggests that audiometric screening in Sweden does not have important preventive effects on hearing impairments or on sequelae of auditory deprivation.

Acoustic Impedance Tests↗

PubMed2005

[Obstetrical forceps: yesterday, today and tomorrow. Toward a new classification of obstetrical forceps].

OBJECTIVE: Obstetrical forceps are used worldwide since more than 400 years. In 2003 forceps deliveries accounted for 6.3% of all deliveries of the AURORE Grand-Lyon perinatal network. Although more than 400 different forceps have been described, obstetrics handbooks neither describe experimental forceps nor provide any chapter dedicated to instrumental delivery training. Our aim was to provide junior obstetricians with information that will allow them to select the best instrument and to let them know about experimental as well as pedagogic forceps. PATIENTS AND METHODS: International literature review using the terms "forceps" and "delivery" and a four year experimental work involving a close collaboration between obstetricians and biomechanics of the INSA engineering school. RESULTS: Two instruments are presented as well as a new forceps classification. DISCUSSION AND CONCLUSION: This classification distinguishes between three types of forceps: operational forceps designed to delivers neonates, experimental forceps designed to study biomechanics and training forceps designed for resident training. For the first time the classic blind forceps procedure is transformed in a full screen real time procedure.

Equipment Design↗

PubMed2000

True HIV seroprevalence in Indian blood donors.

The National AIDS Control Organization (NACO), the apex body for controlling AIDS in India, projected that HIV seroprevalence would increase from 7/1000 in 1995 to 21.2/1000 in 1997. A high incidence (8.2%) of HIV was observed in blood donors. This study was carried out to find out the true HIV positivity in Indian blood donors. Blood donors from our centre were followed for more than 5 years to determine the true HIV seroprevalence and our result was compared with similar studies from India. Voluntary and relative blood donors who visited the SGPGIMS, Lucknow, since 1993 to June 1998 were included. They were screened for HIV 1/2 by ELISA kits (WHO approved). First-time HIV-positive samples were preserved frozen for further study (stage-I). They were repeated in duplicate and retested with other kits. If found positive, the sample was labelled as ELISA positive (stage-II). ELISA-positive samples were confirmed by Western Blot (WB) at stage-III. A total of 65 288 donors were included and 834 (12.8/1000) were reactive at stage-I. But 1.1/1000 donors were found to be ELISA positive at stage-II, and 0.28/1000 donors were positive by WB at stage-III. The 'seropositivity' rate from the NACO was significantly (P < 0.001) higher than our study. There were five similar Indian studies and seropositivity rate varied from 0.72/1000 (using ELISA and WB) to 5.5/1000 (using ELISA alone). The 'seropositivity' rate from the NACO was significantly (P < 0.001) higher than all these studies. HIV seroprevalence in the present study is lower (P < 0.001) than other Indian figures. The present and other studies confirmed that the projected HIV seroprevalence (82/1000) in Indian blood donors was high. The NACO result was based on one-time ELISA screening reports from zonal blood testing centres which also receive samples from paid donors donating in commercial blood banks. The HIV prevalence of blood donors (and national prevalence) is to be reassessed.

AIDS Serodiagnosis↗

PubMed2005

Should all children be screened for celiac disease?

To address the issue of screening children for celiac disease, current evidence has been summarized and placed within the context of 8 established criteria for childhood screening. Screening all children for celiac disease is not recommended at this time. Areas with gaps in knowledge are identified as areas in need of further study. These include the timing of screening, defining the natural history of screening-identified celiac disease, developing tools to predict disease onset and disease remission, and the risks of screening.

Age Factors↗

PubMed2006

Computer-based real-time analysis in mobile ocular screening.

Mobile ocular telemedicine is potentially an effective method to provide service in medically underserved areas and to screen large populations for abnormalities. Currently, digital images are acquired, stored, and transferred to readers for evaluation, after which the results are provided to the subjects. The transfer of large image files and the timeliness of the subsequent reading of images are significant factors for practical implementation of effective telemedicine screening. This work examines the feasibility of in situ real-time computer analysis of digital images to determine and classify the image results as normal and abnormal. This retrospective study used a photoscreening database of 360 patients ranging in ages from 6 months to 18 years. Computer analysis automatically classified the binocular photorefraction (PR) images, and these PR results were compared to those of the subjective clinical eye examinations provided. With an average processing time of approximately 15 seconds per examinee, the analysis found that the PR results can be categorized as: a positive group that requires referral (186 cases) with a predictive value of 98.9% (2 false-positives); a negative group (144 cases) with a predictive value of 89.6% (15 false-negatives); and an uncertain group (30 cases or 8.3%) that required resolution by readers. The real-time analysis code reduces by approximately 92% the manpower for image grading and electronic transmission at this stage of ocular evaluation. These results indicate the feasibility of this approach.

Algorithms↗

PubMedDate not supplied

FMR1 and the fragile X syndrome: human genome epidemiology review.

The fragile X syndrome, an X-linked dominant disorder with reduced penetrance, is one of the most common forms of inherited mental retardation. The cognitive, behavioral, and physical phenotype varies by sex, with males being more severely affected because of the X-linked inheritance of the mutation. The disorder-causing mutation is the amplification of a CGG repeat in the 5' untranslated region of FMR1 located at Xq27.3. The fragile X CGG repeat has four forms: common (6-40 repeats), intermediate (41-60 repeats), premutation (61-200 repeats), and full mutation (>200-230 repeats). Population-based studies suggest that the prevalence of the full mutation, the disorder-causing form of the repeat, ranges from 1/3,717 to 1/8,918 Caucasian males in the general population. The full mutation is also found in other racial/ethnic populations; however, few population-based studies exist for these populations. No population-based studies exist for the full mutation in a general female population. In contrast, several large, population-based studies exist for the premutation or carrier form of the disorder, with prevalence estimates ranging from 1/246 to 1/468 Caucasian females in the general population. For Caucasian males, the prevalence of the premutation is approximately 1/1,000. Like the full mutation, little information exists for the premutation in other populations. Although no effective cure or treatment exists for the fragile X syndrome, all persons affected with the syndrome are eligible for early intervention services. The relatively high prevalence of the premutation and full mutation genotypes coupled with technological advances in genetic testing make the fragile X syndrome amenable to screening. The timing as well as benefits and harms associated with the different screening strategies are the subject of current research and discussion.

Female↗

PubMed2003

Primary congenital hypothyroidism, newborn thyroid function, and environmental perchlorate exposure among residents of a Southern California community.

The objectives of this study were to evaluate whether there were higher rates of primary congenital hypothyroidism (PCH) or elevated concentrations of thyroid-stimulating hormone (TSH) in a community where perchlorate was detected in groundwater wells. The adjusted PCH prevalence ratio and 95% confidence interval (CI) comparing the study community to San Bernardino and Riverside counties combined was 0.45 (95% CI=0.06-1.64). The odds ratios for elevated TSH concentration were 1.24 (95% CI=0.89-1.68) among all newborns screened and 0.69 (95% CI=0.27-1.45) for newborns whose age at screening was 18 hours or greater. Age of the newborn at time of screening was the most important predictor of the TSH level. These findings suggest that residence in a community with potential perchlorate exposure has not impacted PCH rates or newborn thyroid function.

California↗

PubMed2006

Smokers with airway obstruction are more likely to quit smoking.

BACKGROUND: Chronic obstructive pulmonary disease (COPD), usually caused by tobacco smoking, is one of the leading causes of morbidity and mortality. Smoking cessation at an early stage of the disease usually stops further progression. A study was undertaken to determine if diagnosis of airway obstruction was associated with subsequent success in smoking cessation, as advised by a physician. METHODS: 4494 current smokers (57.4% men) with a history of at least 10 pack-years of smoking were recruited from 100 000 subjects screened by spirometric testing for signs of airway obstruction. At the time of screening all received simple smoking cessation advice. 1177 (26.2%) subjects had airway obstruction and were told that they had COPD and that smoking cessation would halt rapid progression of their lung disease. No pharmacological treatment was proposed. After 1 year all subjects were invited for a follow up visit. Smoking status was assessed by history and validated by exhaled carbon monoxide level. RESULTS: Nearly 70% attended a follow up visit (n = 3077): 61% were men, mean (SD) age was 52 (10) years, mean (SD) tobacco exposure 30 (17) pack-years, and 33.3% had airway obstruction during the baseline examination. The validated smoking cessation rate in those with airway obstruction was 16.3% compared with 12.0% in those with normal spirometric parameters (p = 0.0003). After correction for age, sex, nicotine dependence, number of cigarettes smoked daily, and lung function, success in smoking cessation was predicted by lower lung function, lower nicotine dependence, and lower tobacco exposure. CONCLUSIONS: Simple smoking cessation advice combined with spirometric testing resulted in good 1 year cessation rates, especially in subjects with airway obstruction.

Counseling↗

PubMedDate not supplied

Screening the over-75s:1.

The contractual requirement to offer health assessment for older people prompts many questions. We need to ask what screening is and whether it differs from case findings. We need to define who should be screened and whether it is a wasteful use of limited resources to impose universal domiciliary screening on an annual basis when most older people are reasonably healthy and content. We must decide whether support should be targeted to those with the greatest need. We need to ascertain who should carry out screening, since time constraints alone will make delegation inevitable. We must decide where screening should take place and whether it should be opportunistic or consultation based.

Aged↗

PubMed1992

Geriatric nutrition assessment: comparison of a screening tool to a dietitian assessment.

A priority in nutrition care is early identification of patients at risk of developing nutrition disorders. Simple identification measures such as nutrition screening on admission must be demonstrated to be as effective as the more lengthy traditional nutrition assessment. This study compares a nutrition screen to a clinical assessment in a geriatric setting. Seventy-two consecutive admissions to a geriatric assessment unit were both screened and individually assessed by different staff dietitians. Results of the assessment and the screen corresponded in classifying those at nutrition risk 92% of the time and those not at nutrition risk 77% of the time. The screen was found to be highly sensitive (88%) and specific (83%). A geriatric nutrition screen that has a high degree of agreement with a lengthier assessment may be a useful tool for the clinical practitioner in early identification of patients at nutritional risk.

Aged↗

PubMed1993

Time of hospital presentation in patients with acute stroke.

BACKGROUND: Stroke is a leading cause of death and disability in the United States. Although new treatments are being studied, most must be given early in the course of stroke to be effective. This study was performed to identify factors associated with early hospital arrival in patients with stroke. METHODS: As part of the National Institute of Neurologic Disorders and Stroke Tissue-Type Plasminogen Activator Pilot Study, information from patients, patients' families, or, most commonly, the medical record was gathered on all patients presenting to the hospital within 24 hours of the onset of stroke. A total of 14 hospitals participated. Three were university hospitals, and 11 were community hospitals with and without university affiliation. The main outcome measure was the time from stroke onset to hospital arrival. RESULTS: Of 2099 patients screened, adequate time data were available in 1159. Thirty-nine percent presented to the hospital 90 minutes or less after symptom onset and 59% within 3 hours. Early hospital arrival after stroke was greatly influenced by the type of first medical contact and, to a lesser degree, by the patient's location at the time of the stroke and the time of the day at which the stroke occurred. Hospital arrival was fastest in patients using 911 as their first medical contact (mean, 155 minutes; median, 84 minutes) vs their personal physician (mean, 379 minutes; median, 270 minutes; P < .0001) or a study hospital (mean, 333 minutes; median, 212 minutes; P < .0001). Time from symptom onset to arrival was longer for patients having the stroke at night compared with patients having a stroke in the morning (P < .05), in the afternoon (P < .01), or in the evening (P < .0001). Time to hospital arrival was significantly longer for patients having the stroke at home than for patients having the stroke at work (P < .01) or in an unknown place (P < .05). Gender, age, race, and presence of brain hemorrhage had no significant effect. CONCLUSIONS: As many as 50% of patients with stroke arrive at the hospital within 3 hours of symptom onset. Our data indicate that strategies to increase the use of 911 systems may have a high yield with regard to recruitment into urgent treatment protocols for stroke.

Acute Disease↗

PubMed1995

[Pepsinogen].

It is generally accepted that extensive chronic atrophic gastritis is a precursor to gastric cancer in populations at high risk for this tumor. To improve the effectiveness of gastric cancer screening, we have devised a new screening method that investigates the serum pepsinogen levels and applied a serum pepsinogen test to mass screening for gastric cancer at a certain workplace for the first time. This screening system (named "stomach dry dock") is based on the findings that many gastric cancer develop in the stomach mucosa affected by severe and extensive chronic atrophic gastritis. Using the serum tests (Pepsinogen I/II RIA BEAD Kit: Dainabot Co., LTD. Japan) we have screened 14,862 employees of a certain company in 1991-93 and 25 cases (0.17%) of gastric cancer including 21 cases (84%) of early gastric cancer and 10 cases (0.07%) with gastric adenoma; precancerous lesion. The results are better than that of the traditional barium X-ray screening (incidence of gastric cancer is 0.07%) in the same company. In conclusion the best sensitivity for detecting gastric cancer is achieved by the mass screening with serum pepsinogen tests in combination with X-ray or endoscopy.

Chronic Disease↗

PubMed2006

Barriers to routine gynecological cancer screening for White and African-American obese women.

BACKGROUND: Obese women are reported to be at higher risk from gynecological cancers than nonobese women, yet these women are less likely to get cancer-screening tests. The specific factors that contribute to obese women not obtaining timely cancer screening have not been identified. OBJECTIVE: To investigate the factors that contribute to lower rates of gynecological cancer screening as related to women's body size. DESIGN: A purposeful sample of 498 White and African-American women with body mass index (BMI) from 25 to 122 kg/m(2), including 60 women with BMI > 55 kg/m(2), was surveyed concerning access to gynecological cancer screening and potential barriers that could cause delay. Health care providers (N = 129) were surveyed concerning their education, practices, and attitudes about providing care and gynecological cancer-screening tests for obese women. RESULTS: Obese women reported that they delay cancer-screening tests and perceive that their weight is a barrier to obtaining appropriate health care. The percent of women reporting these statements increased significantly as the women's BMI increased. Women with BMI > 55 kg/m(2) had a significantly lower rate (68%) of Papanicolaou (Pap) tests compared to others (86%). The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women's BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were 'moderately' or 'very concerned' about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them. CONCLUSION: Since the goal of preventive cancer screening is to improve health outcomes for all women and since obese women are at greater risk, strategies must be designed to reduce the weight barriers to these tests and improve the quality of the health care experience. Providers should receive specific training related to care of large women.

Adult↗