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PubMed2004

Prevalence of abdominal aortic aneurysms--a screening program in São Paulo, Brazil.

CONTEXT: Abdominal aortic aneurysm is an asymptomatic but potentially fatal condition. Elective surgery can prevent death from rupture, and is indicated for aneurysms larger than 45 mm. Because aneurysms tend to grow with time, detection of small ones (> 29 mm) may lead to a closer follow-up of patients at risk. OBJECTIVE: To determine the prevalence of abdominal aortic aneurysms in São Paulo, Brazil. DESIGN: Prospective, descriptive. SETTING: University Hospital. PARTICIPANTS: Persons aged 50 years or more were offered, through the press, the opportunity to be screened for abdominal aortic aneurysm. The total number screened was 2,756. PROCEDURE: All were submitted to abdominal palpation and ultrasound examination. PARAMETER STUDIED: A maximum diameter of 30 mm or more was considered to be an aneurysm. RESULTS: Sixty-four aneurysms were detected, nine of which measuring more than 49 mm. Palpation detected 60 aneurysms, but only 20 of these were confirmed by the ultrasound. Conversely, 41 of the ultrasound-detected aneurysms were not palpable. The percentages of abdominal aortic aneurysms found in the subgroups via ultrasound examination (with 95% confidence interval) were as follows: total group, 2.3 (1.8-3); men, 4.6 (3.5-5.9); women, 0.6 (0.3-1.1); men aged 60 or more, 6 (4.3-8); women aged 60 or more, 0.9 (0.4-1.8). CONCLUSION: In Sao Paulo, Brazil, 1.8 to 3 % of persons aged 50 years or more are expected to have abdominal aortic aneurysms. In the subgroup of men aged 60 or more, the expected prevalence is between 4.3 and 8%.

Age Distribution↗
PubMed2005

Multidisciplinary vascular screening program modestly improves the medical treatment of vascular risk factors.

PURPOSE: This study investigated whether recommendations given to the treating vascular specialist and the GP by a multidisciplinary team of vascular specialists concerning the medical treatment of risk factors, based on international guidelines, led to an increased medication use in a high-risk population. METHODS: Data were obtained from 618 patients enrolled in the SMART study, an ongoing single-center prospective cohort study of patients referred to the University Medical Center Utrecht for atherosclerotic vascular diseases. All patients underwent a vascular screening and their physicians received recommendations concerning the medical treatment of newly detected or not yet sufficiently treated vascular risk factors. After a median follow-up of 29 months, questionnaires about medication use were sent to 618 patients; 534 (86%) questionnaires were returned. Actual use of medication was compared with medical treatment recommendation given at baseline. RESULTS: The proportion of patients on antihypertensive medication with hypertension (> or =140/90 mmHg) and not diagnosed with coronary heart disease increased from 56% to 68% (95% confidence interval (95% CI) 2 - 23). The frequency of lipid-lowering medication use increased substantially from 47% to 69% (95% CI 17 - 28). The frequency of glucose-lowering medication use increased slightly from 11% to 14% (95% CI 1 - 7). The use of folic acid increased from 2% to 14% (95% CI 9 - 15) in patients with hyperhomocysteinaemia. CONCLUSIONS: Medical treatment recommendations, formulated by a multidisciplinary team, led to a significant increase in medication use. The increase is marginal compared with trends in medication use without this intervention in usual care.

Adolescent↗
PubMed2000

Risk estimation and value-of-information analysis for three proposed genetic screening programs for chronic beryllium disease prevention.

Genetic differences (polymorphisms) among members of a population are thought to influence susceptibility to various environmental exposures. In practice, however, this information is rarely incorporated into quantitative risk assessment and risk management. We describe an analytic framework for predicting the risk reduction and value-of-information (VOI) resulting from specific risk management applications of genetic biomarkers, and we apply the framework to the example of occupational chronic beryllium disease (CBD), an immune-mediated pulmonary granulomatous disease. One described Human Leukocyte Antigen gene variant, HLA-DP beta 1*0201, contains a substitution of glutamate for lysine at position 69 that appears to have high sensitivity (approximately 94%) but low specificity (approximately 70%) with respect to CBD among individuals occupationally exposed to respirable beryllium. The expected postintervention CBD prevalence rates for using the genetic variant (1) as a required job placement screen, (2) as a medical screen for semiannual in place of annual lymphocyte proliferation testing, or (3) as a voluntary job placement screen are 0.08%, 0.8%, and 0.6%, respectively, in a hypothetical cohort with 1% baseline CBD prevalence. VOI analysis is used to examine the reduction in total social cost, calculated as the net value of disease reduction and financial expenditures, expected for proposed CBD intervention programs based on the genetic susceptibility test. For the example cohort, the expected net VOI per beryllium worker for genetically based testing and intervention is $13,000, $1,800, and $5,100, respectively, based on a health valuation of $1.45 million per CBD case avoided. VOI results for alternative CBD evaluations are also presented. Despite large parameter uncertainty, probabilistic analysis predicts generally positive utility for each of the three evaluated programs when avoidance of a CBD case is valued at $1 million or higher. Although the utility of a proposed risk management program may be evaluated solely in terms of risk reduction and financial costs, decisions about genetic testing and program implementation must also consider serious social, legal, and ethical factors.

Berylliosis↗
PubMed2002

Models of screening program for colorectal cancer.

Colorectal cancer is one of the most frequent neoplasms in western countries, with an estimated 400,000 deaths per year throughout the world. The results of treatment vary widely, depending on the extent of the disease. In particular, the disease stage at diagnosis by the Dukes' modified classification is significantly correlated with prognosis. Colonoscopic polypectomy substantially reduces CRC incidence in comparison to that expected in the general population. These results are of particular relevance considering that people with adenomas are at increased risk for CRC. These observations strengthen the concept of effective population screening in view of the fact that adenomatous polyps are the most frequent neoplastic outcome of screening. Today we have new opportunities for CRC secondary prevention and it is time to start public awareness campaigns and involve gastroenterologists and general practitioners in a common effort.

Colonic Polyps↗
PubMedDate not supplied

Colorectal cancer detection in a Community Hospital Screening Program.

In its first 4 1/2 years of operation in the Long Beach Community Hospital Cancer Detection Center, among the 5,595 persons examined, 16 cases of colorectal cancer were discovered. Fourteen of the 16 had symptoms referable to neoplasms. Eight had lesions found on proctosigmoidoscopic examination. Nine had positive findings for occult blood in stool samples, a 7.5% cancer detection rate among the 120 with positive stool sample findings. Six patients with cancer submitted one to four stool specimens that showed negative findings on occult blood testing, and one patient submitted no specimen. Although valuable in screening, stool testing for occult blood will not detect all colonic neoplasms. The complaints of pain, altered bowel habits, or tenesmus warrant sigmoidoscopic examination, barium enema studies, or both, whether findings in stool samples are positive or negative.

Adult↗
PubMed2004

[Skin cancer screening program in the population of Bydgoszcz].

The results of prophylactic medical skin examinations in inhabitants of Bydgoszcz were estimated. A prophylactic skin examination in asymptomatic patients was performed, and the most suspicion lesions were selected to excision. 750 persons were examined (age 15-93 years). 133 persons were operated. 173 skin lesions were removed. 32 skin cancers (18.53%), 3 melanomas (1.73%) and 34 skin lesions (which are base for melanoma) were confirmed. Detected carcinomas and melanomas were in early state of development. Prophylactic medical skin examination enable the detection of skin neoplasms in early state of development. Percent of detected carcinomas and melanomas of skin justify continuation this kinds of screening.

Adolescent↗
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↗
PubMed1994

[Consequences of incorrect interpretation of vaginal smear tests in a screening program].

A nested case-control study was undertaken in the Maribo County cohort of 27,811 women with negative cervical smears. Fifty-three women who later developed invasive cervical cancer constituted the cases, and five matched controls were selected from the cohort for each case. A total of 633 previous negative smears for the cases and controls were reviewed independently by two pathologists. The review showed misclassification to be frequent in these smears, which were collected in the period 1966-82, and the odds ratio for patients compared with controls for having at least one positive smear was 22.12 (95% CI 7.54-64.94). The study thus shows that more cancer cases could have been prevented by the screening programme were the test to have been more sensitive. The study also shows, however, that the participating women would have to pay a considerable price in the form of unnecessary extra tests if the sensitivity was too high.

Case-Control Studies↗
PubMed1997

Using focus group methodology to develop breast cancer screening programs that recruit African American women.

Public communication campaigns are designed to increase the number of women who receive mammograms, breast examinations, and cervical exams. However, these campaigns have failed to recruit sufficient numbers of African American women. Focus group techniques were used to provide data to develop a communication campaign that would increase the knowledge, assess the attitudes, and change behaviors of African American women, aged 40-65, about the aforementioned preventive health practices. The discussions revealed that participants distrusted "clinics" and preferred being examined by "their own" or a private physician. Results further revealed that the personal influence of opinion leaders, combined with interpersonal contacts that encourage preventive care, help influence women to participate in mammography and cervical cancer screening.

Adult↗
PubMed1992

The relationship between age and incidence of breast cancer. Population and screening program data.

Despite extensive study of breast cancer incidence, including specific studies of the relationship between age and breast cancer incidence, the picture remains confusing. This article examines not only the relationship between age and breast cancer, but also trends over time related to this relationship to discern the underlying true age-incidence pattern. The age-incidence curve changes around the menopausal period, most likely due to hormonal changes 10 to 15 years earlier, flattens out in the 40 to 50 year old age range, and then increases as age increases. Recent data showing decreased risk of breast cancer incidence at older ages, e.g., older than 75 years of age, relative to younger ages, are likely an artifact of recent increases in breast cancer screening in the United States. This picture is consistent with increases in screening and with notions of lead time created by increased screening. The increase in screening that has changed the age-incidence relationship may eventually deliver benefits to United States women in terms of mortality deficits, but this is not guaranteed unless screening becomes routine practice and high-quality therapeutic intervention and follow-up occurs as well.

Age Factors↗
PubMed1995

Is there a pathology of prevention? The implications of visualizing the invisible in screening programs.

The preventive orientation that has been gaining ground in Sweden is indicative of ways in which our society is organized to sustain values like "a healthy life," "a healthy body," and "a healthy society." Search for health dangers and risks shows how medical technology has been integrated with our thinking about health. Preventive language, like all language of medicine, besides describing a pre-existing biological reality, creates in the process its own objects of analysis. This also has an impact and influences how lay people experience their bodies. The study presented focuses on one form of prevention in an attempt to describe how the ambition to secure a healthy society, through the detection of early disease, may have the opposite effect. Medical health-care ambitions in screening for cholesterolaemia will be related to implications for a group of men in whom cholesterol was found to be elevated. The men feel healthy yet are in some sense diseased. This raises the issue of visualizing the invisible in health care and the implications of such a process for the patients concerned.

Adult↗
PubMed2005

Neonatal thyrotropin as measured in a congenital hypothyroidism screening program: influence of the mode of delivery.

CONTEXT: Many developed countries are reexperiencing iodine deficiency. One World Health Organization index of iodine deficiency in populations is the percentage of neonates with TSH levels greater than 5 mIU/liter 72 h after delivery. Measured TSH levels vary with methodology and are influenced by external factors including iodine exposure at time of delivery. OBJECTIVE: We wished to determine whether babies delivered by cesarean section have higher levels of TSH than babies delivered vaginally because this factor could influence determination of iodine deficiency. DESIGN AND SETTING: This was a cohort study of mothers delivering at a teaching hospital in 2002-2003 and their babies. PATIENTS AND METHODS: Women delivering a live infant were eligible for the study. Demographic data, mode of delivery, and subsequent routine newborn screening TSH levels were recorded. RESULTS: Of 2031 infants, 31.2% were delivered by cesarean section; 1864 babies were born after 37 wk, with blood samples collected by d 5 (>91% on d 3). Significant predictors of TSH concentration were the day TSH was measured and type of delivery. The distribution curve of TSH values was right shifted in infants born by cesarean section. The percentage of neonates born by cesarean with at TSH value greater than 5 was 7.1%. The figure for those born vaginally was 4.3%. CONCLUSIONS: Babies delivered by cesarean section are significantly more likely to have TSH levels greater than 5 mIU/liter on d 3 than those delivered vaginally. With the rise in the rate of births by cesarean, this could be an important factor in assessing population iodine deficiency using neonatal TSH levels.

Cesarean Section↗
PubMed1977

Evaluation of cancer screening programs: parallels with clinical trials.

The methodologic limitations of available observational evidence for the evaluation of ongoing cancer control programs is reviewed. The specific example of Control Programs for Cervical Cancer is chosen to illustrate these limitations. These limitations pertain to the special features of the natural history of this disease, to the types of data available as well as to problems in the interpretation of these data. Given the unacceptability of conducting a rigorous randomized clinical trial of an ongoing and accepted cancer control procedure, an alternative experimental approach is proposed. This approach consists in the random allocation of census tracts with a high risk population to either of two groups: 1) an experimental group in which active and repeated screening activities will attempt to reach virtually all susceptible women, 2) a comparable control group which will only benefit from regularly available services.

Adult↗
PubMed2001

[Arguments in favor of hearing loss screening programs].

In recent years criteria for the cochlear implant candidacy have been widened to childhood, therefore we are compelled to look for the earlier possible diagnosis of deafness. With this aim the AA. have reviewed the diagnostic process of hearing loss made during the last two decades and, consequently, be aware of the problems and planning solutions to avoid unnecesary delays in the treatment.

Child, Preschool↗
PubMed1996

Results of treatment of amblyopia with a screening program for early detection.

The Swedish program for early intervention in children with visual dysfunction, was evaluated with respect to the results of treatment of amblyopia. One hundred and seventy-two amblyopic children were examined before and at 6, 12 and 18 months after the beginning of treatment. The mean visual acuity of the amblyopic eye was 0.76 and the mean ratio of visual acuity between the two eyes was 0.75 or better in all types of amblyopia. Children with strabismic amblyopia showed slightly poorer treatment results than the other types, in spite of the fact that their amblyopia had been detected earlier than the others. The results attest to the importance of careful screening of monocular visual acuity in all children, which in Sweden occurs at 4 years of age. This provides a good basis for detection and treatment of amblyopia. Only one child in the group had a visual acuity at 0.2 and may therefore be at risk for visual handicap if the better eye should be lost later in life.

Amblyopia↗