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PubMed2003

["Screening" in special situations. Assessing predictive genetic screening for hereditary breast and colorectal cancer].

AIMS AND METHODS: The aim of this health technology assessment was to analyse the current scientific and genetic counselling on predictive genetic testing for hereditary breast and colorectal cancer. Predictive genetic testing will be available for several common diseases in the future and questions related to financial issues and quality standards will be raised. This report is based on a systematic/nonsystematic literature search in several databases (e.g. EmBase, Medline, Cochrane Library) and on a specific health technology assessment report (CCOHTA) and review (American Gastroenterological Ass.), respectively. Laboratory test methods, early detection methods and the benefit from prophylactic interventions were analysed and social consequences interpreted. BACKGROUND: Breast and colorectal cancer are counted among the most frequently cancer diseases. Most of them are based on random accumulation of risk factors, 5-10% show a familial determination. A hereditary modified gene is responsible for the increased cancer risk. In these families, high tumour frequency, young age at diagnosis and multiple primary tumours are remarkable. RESULTS AND REFLECTION: GENETIC DIAGNOSIS: Sequence analysis is the gold standard. Denaturing high performance liquid chromatography is a quick alternative method. The identification of the responsible gene defect in an affected family member is important. If the test result is positive there is an uncertainty whether the disease will develop or not, when and in which degree, which is founded in the geno-/phenotype correlation. The individual risk estimation is based upon empirical evidence. The test results affect the whole family. PREVENTION/EARLY DETECTION: Currently, primary prevention is possible for familial adenomatous polyposis (celecoxib, prophylactic colectomy) and for hereditary mamma carcinoma (prophylactic mastectomy). The so-called preventive medical check-ups are early detection examinations. The evidence about early detection methods for colorectal cancer is better than for breast cancer. PROPHYLACTIC SURGICAL INTERVENTIONS: Prophylactic mastectomy (PM) reduces the relative breast cancer risk by approximately 90%. The question is if PM has an impact on mortality. The acceptance of PM is culture-dependent. Colectomy can be used as a prophylactic (FAP) and therapeutic method. After surgery, the cancer risk remains high and so early detection examinations are still necessary. EVIDENCE-BASED STATEMENTS: The evidence is often fragmentary and of limited quality. For objective test result presentation information about sensitivity, specificity, positive predictive value, and number needed to screen and treat, respectively, are necessary. REFLECTIONS: New identification of mutations and demand will lead to an increase of predictive genetic counselling and testing. There is a gap between predictive genetic diagnosis and prediction, prevention, early detection and surgical interventions. These circumstances require a basic strategy. Since predictive genetic diagnosis is a very sensitive issue it is important to deal with it carefully in order to avoid inappropriate hopes. Thus, media, experts and politicians need to consider opportunities and limitations in their daily decision-making processes.

Breast Neoplasms↗

PubMed1992

Screening for toxoplasmosis in pregnant women: presentation of a screening programme in the former "East"-Germany, and the present status in Germany.

The results of the screening programme (including the examination of fetal IgM) in East-Germany, related to the efficiency of therapy (pyrimethamine/sulfonamid) of the fetal infection risk are presented. For comparison the results of a prospective study of toxoplasmosis in pregnancy (n = 1697) without therapy, and follow up of the connatal infected infants to the age of 9/10 years old are shown. Recommendations for the diagnostic and therapeutical management in Germany for the future are presented.

Drug Therapy, Combination↗

PubMed1992

Screening to save lives. The Gloucestershire aneurysm screening project.

Aortic aneurysms can rupture without warning, and cause 10,000 deaths a year in Britain. They are most common in men over 65, and can be repaired if identified before rupture. This article describes the first year of a project to screen for aneurysms.

Aged↗

PubMed1991

[Diabetes screening among women who gave birth to heavy infants. The result of 128 glucose tolerance tests during puerperium in women who gave birth to infants weighing 4,500 gram or more, and establishing the screening procedures in Danish maternity clinics].

Experience gained from glucose tolerance tests during the puerperium carried out during a period of two years on 129 non-diabetic mothers who had given birth to infants with birth weights of over 4,500 g is presented. Out of 128 completed investigations, only one new case of diabetes was diagnosed. Seven glucose tolerance tests revealed intolerance and six of these were normal on control. No fasting blood sugar levels were over 6.0 mmol/l. These findings correspond to the frequencies of reduced glucose tolerance in a previously published Danish article. In Denmark as a whole, approximately 60% of these women undergo glucose tolerance tests and further 20% are submitted to fasting blood sugar determinations. Glucose tolerance tests during the puerperium based on postprandial blood sugar measurements for two hours is not considered to be suitable as a screening method for diabetes mellitus.

Denmark↗

PubMed1986

Medical screening and biological monitoring for the effects of exposure in the workplace. Review of 30 years of screening practices.

Increasingly larger proportions of our population are insured against health care costs through negotiated or mandated contracts involving active and retired workers and their dependents. Seeking to control and contain the dramatically rising costs, employers have begun ti demand full accountability from their third-party payers, in response to which the health care services delivery system is evolving health maintenance organizations, preferred provider organizations, independent practice associations, and variant aggregates of participants with more homogeneously predictable utilization rates and cost estimates. The resultant information base generates employer-specific data leading to earlier detection and identification of work-related and total premorbidity and morbidity, causing renewed emphasis on prevention through total, including work-site related, risk-factors reduction. The screening technology required for the implementation and evaluation of health risks assessment and reduction programs is reviewed. The technology has matured significantly over the past 30 years. Problem areas and action needs are identified.

Health Benefit Plans, Employee↗

PubMed1975

[Organization of mass-screening for early detection of cervical cancer and its precancerous conditions. II. report: Practical experience with a computer assisted mass-screening program (Model Rostock) (author's transl)].

Two years experiences with a computerassisted program for early detection of prestages and early cervical cancer in Rostock-city are reported. From 43.000 women invited to take part in the examination, 27.028 = 65% finally cooperated. Pathological Pap-smears were found in 134 cases (= 0,52%). Histological examination in 51 cases (= 0,2%) showed 1 Erosio vera (false positive), 9 severe dysplasia, 30 carcinomata in situ, 3 early invasions (microinvasive cancer), 3 microcarcinoma and 5 macrocarcinoma. Accessory findings were seen in 10,2%. A good organized mass-screening-system with unique nomenclature, diagnostic and treatment of cervical cancer and its prestages gives the best supposition to cut down its rate of incidence.

Adult↗

PubMed1993

[Studies on screening for hard-of-hearing children by questionnaire. 2. Comparison of response rates to individual questions in 1-year-6-month-old children with normal hearing and hearing loss using a health screening questionnaire].

We report the results of studies on responses to questions on hearing impairment, comparing 165 school children whose hearing was diagnosed as normal at the time of admission to primary school and 37 children with hearing loss attending facilities for children with this disability. These children had been covered by similar surveys as part of the health screening for 1-year-6-month-old infants conducted by municipal authorities. Significant differences between the two groups were noted in the response rates to all questions on hearing. Similar differences were noted in the responses to questions on family history of hearing impairment. There were no significant differences in the incidences of asphyxia and jaundice at birth. The most striking differences were noted in the response rates to questions 6, 7, 8, 10, 11, 16, and 18. Most useful and universally valid in this survey were questions 8, 10 and 18 in addition to the question on whether or not parents suspected infantile hearing loss.

Child, Preschool↗

PubMed1997

Accuracy of routine ultrasonography in screening heart disease prenatally. Gruppo Piemontese for Prenatal Screening of Congenital Heart Disease.

The aim of the present study was to assess the accuracy of the four-chamber view as a screening test for detection of congenital heart disease (CHD) prenatally in a low-risk population. A prospective observational study was conducted in 17 ultrasound units of the Piemonte Region, Italy, in pregnancies with no risk factors for CHD. At each routine scan, from 18 weeks of gestational age, the four-chamber view of the heart was looked for. When an anomaly was suspected, the patients were referred to a specialized unit. Follow-up of the babies until discharge from the hospital was obtained. 11,232 sonograms were performed on 8299 pregnancies. Cardiac malformations were diagnosed in 40 newborns (4.8/1000). Six of them (15 per cent) had been recognized in utero. The sensitivity, specificity, and positive and negative predictive values were 15, 99.9, 50, and 99.6 per cent, respectively. When malformations that are not associated with an abnormal four-chamber view were excluded from the analysis, the sensitivity increased to 35.3 per cent. The sensitivity found in this study is low, but it is probably realistic since it is comparable to that reported in other multicentric studies. This type of study should reflect the state of the art of the method applied in the field. Although the sensitivity is low, it would be nil if the test were not performed. Moreover, it will probably increase with better training of the operators and by extending the examination to the ventriculo-arterial connections.

Female↗

PubMed1997

[Speed S sensitivity of film-screen systems and mode of action of different automatic illumination in general practice. I: Film-screen systems].

A new test procedure is presented to check the correspondence between various screen-film systems (SFS) with the specification of the manufacturer in respect to the speed S according to DIN 6867-1 or rather which dose K is required for the SFS in dependence on the X-ray tube voltage (kV) to give the net density Dn = 1.00, it is based on measurements of dose and density using on X-ray equipment with water as an absorber and scatter test tool. The characteristic curves of the automatic exposure control (AEC) can be recorded and compared with those of SFS, i.e., how is the dose K in the image-receptor-plane regulated by the AEC in dependence on different radiation qualities. It is also possible to check the modes of operation of SFS and AEC with sufficient accuracy but lower time and energy requirements. The consequences of finding the right values to test the X-ray equipment under DIN 6868-50/-3 and for constancy-testing according to DIN 6868-3 are discussed.

Calibration↗

PubMed1996

Insulin-dependent diabetes mellitus and prenatal screening results: current experience from a regional screening programme.

From around 91,000 women having routine prenatal screening for Down's syndrome and neural tube defects between July 1992 and October 1995, 261 women were identified as having insulin-dependent diabetes mellitus (IDDM). Alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG) levels were reduced in these women, with median levels of 0.89 and 0.91 multiples of the median (MOM), respectively. The IDDM patients had a median weight which was 6 kg heavier than that of non-IDDM women. After correction for maternal weight, the AFP and hCG levels in the IDDM patients were 0.98 and 0.92 MOM, respectively. In routine practice, using results which were not weight-corrected, the IDDM women were neither over- nor under-represented in the high-risk group for Down's syndrome, but showed a tendency to be under-represented in the high-risk group for neural tube defects.

Adolescent↗

PubMed2002

Screening for chromosomal anomalies in the first trimester: does repeat maternal serum screening improve detection rates?

OBJECTIVE: To assess the within person biological variability of first trimester maternal serum biochemical markers of trisomy 21 across the 10-14 week gestational period. To evaluate whether repeat sampling and testing of free beta-hCG and PAPP-A during this period would result in an improved detection rate. METHODS: Women presenting at the first trimester OSCAR clinic have blood collected prior to ultrasound dating and nuchal translucency measurement. All samples are analysed for free beta-hCG and PAPP-A before an accurate estimate of gestation is available. In 10% of cases the gestation is prior to the minimum time for NT measurement (11 weeks) and these women are rebooked for a repeat visit to the clinic at the appropriate time. Our fetal database was interrogated to obtain cases in which two maternal blood samples had been collected and analysed in the 10-14 week period. Using data from the marker correlations and statistical modelling, the impact of repeat testing on detection rate for trisomy 21 at a fixed 5% false positive rate, was assessed. RESULTS: 261 pairs of data were available for analysis collected over a 3 year period. The correlation between free beta-hCG in sample 1 and sample 2 was 0.890 and that for PAPP-A was 0.827. The average within person biological variation for free beta-hCG was 21% and 32% for PAPP-A. The increase in detection rate when using both sets of marker data was 3.5% when using serum biochemistry and maternal age, and 1.3% when using nuchal translucency, serum biochemistry and maternal age. CONCLUSION: Repeat sampling and testing of maternal serum biochemical markers is unlikely to substantially improve first trimester screening performance.

Chorionic Gonadotropin, beta Subunit, Human↗

PubMed1990

Genetic screening with exfoliated cervicovaginal cells collected by a noninvasive lavage technique performed during routine gynecologic cancer screening.

We have investigated and established the feasibility of the use of exfoliated cervicovaginal cells as an abundant source of genetic material. We routinely use this material for the detection by molecular hybridization of human papillomavirus infection of the cervix. We have analyzed deoxyribonucleic acid isolated from cervicovaginal cells by Southern blot hybridization to detect a common restriction fragment length polymorphism on chromosome 13. We suggest that in the near future most, if not all, major human genetic disease loci will be cloned and their mutations will be identified. With this knowledge and innovative methods, such as the polymerase chain reaction, it will be possible to distinguish normal individuals who harbor a variety of recessive genetic mutations that may place them at risk to produce offspring with serious genetic diseases. We propose that both genetic and cancer screening can be performed during the same office visit. Such testing offers the advantage of identification of women at risk for genetic disease with a noninvasive procedure before or concurrent with childbearing. Easily accessible genetic material extracted from exfoliated cervicovaginal cells can also be used for population genetic studies.

Adult↗

PubMed1984

Screening Kit of Language Development: a preschool language screening instrument.

The Screening Kit of Language Development ( SKOLD ) was designed to meet the following criteria: Validity for 2.5-4 year old children, standardization for speakers of standard and Black English, and appropriateness for paraprofessional screeners . This paper describes the development, content, administration, scoring, reliability, and validity of SKOLD .

Child, Preschool↗

PubMed1985

Simultaneous screening for two different antibodies in ELISA by combining two solid phases: microtiter plate and Falcon assay screening test system lid.

An enzyme-linked immunosorbent assay (ELISA) is described that used a combination of 2 solid phases: a microtiter plate covered with a Falcon assay screening test (F.A.S.T.) system lid. By coating each solid phase with a different antigen, it was possible to simultaneously detect 2 different antibodies. The results of the combined test were compared and found similar to those obtained in separate assays on the same solid phases by the usual ELISA method. Further, the combined test was more economical in time, work and materials than 2 separate tests for the 2 antibodies. This method was used in a serological survey for 2 turkey viral infections: hemorrhagic enteritis and paramyxovirus type 3.

Antibodies↗

PubMed2004

To screen or not to screen: prevalence of C. trachomatis among sexually active asymptomatic male adolescents attending health maintenance pediatric visits.

This study estimated the prevalence of Chlamydia trachomatis (CT) among sexually active, asymptomatic, multiethnic adolescent males attending preventive health maintenance visits at pediatric clinics within a large health maintenance organization. First-void urines of sexually active 14-18-year-old males were screened for CT. The CT infection rate was 4% (27/711), 95% CI = 2.5%, 5.5%.

Adolescent↗

PubMed1996

Portable chest radiology in intensive care: a comparison of a new dual characteristic film-screen system (Insight) incorporating a flexible grid with a standard film-screen system.

Insight (Insight, Kodak, UK) is a new dual image receptor system which utilizes an asymmetric film screen combination. Conventional radiography was compared with the Insight system, in combination with a cassette incorporating a flexible grid, in fifty patients on the intensive care unit. Radiographs were analysed by intensive care junior medical staff, nursing staff and two groups of radiologists. Insight provided better visualization of lung parenchyma, mediastinal detail and position of endotracheal tubes than conventional radiography. Central venous catheters were generally seen better on conventional radiographs than on Insight. Insight system produces a significant improvement in plain chest radiography in the intensive care unit. In the absence of digital radiography it is a suitable technique for routine radiography in the intensive care unit.

Aged↗

PubMed2000

Pap smear screening in an equal-access health care system. Yield of screening and predictors of squamous intraepithelial lesions and atypical squamous cells of undetermined significance.

PURPOSE: The purpose of this study was to examine predictors of squamous intraepithelial lesions (SIL) and atypical squamous cells of undetermined significance (ASCUS) in an equal access health care setting.METHODS: A cohort of 10,713 active-duty United States Air Force women who provided one cervical/vaginal smear (CVS) as part of routine medical care between January 1, 1994 and December 31, 1996 were selected for this study. Each of the specimens was characterized by a "Bethesda System" diagnosis: within normal limits, repair/reactive, ASCUS, low grade SIL, high grade SIL, invasive carcinoma, infectious disease or unsatisfactory.RESULTS: Significant disease was associated with age younger than 30 years, enlisted rank, Hispanic ethnicity and the presence of genital warts on examination. SIL was associated with age 21-25 and Hispanic ethnicity in the logistic regression model. A diagnosis of ASCUS was associated with age younger than 30, marital status as single/never married, presence of genital warts on physical examination, and a history of previous abnormal CVS since entering military service. Age younger than 30, a marital status of single/never married and a previous abnormal CVS were associated with ASCUS in the logistic regression model.CONCLUSIONS: The disparity noted between women of low and high socioeconomic status was not seen here; those with the lowest income and education were not significantly more likely to have SIL or ASCUS when age was considered in the model. The significant association between Hispanic ethnicity and SIL, which should be further explored, may indicate the need for increased screening in this population.

Journal Article↗

PubMed2000

Diversity screening versus focussed screening in drug discovery.

Which strategy is best for hit identification? Making the right choices in the capital-intensive world of modern drug discovery can make the difference between success and expensive failure. Keeping an open mind to all the options is essential. Two well-established strategies are diversity-based and focussed screening. This review will provide contrasting viewpoints highlighting the strengths and deficiencies of each approach, as well as some insights into why both strategies are likely to have a place in the research armoury of a successful drug company.

Journal Article↗