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PubMed2001

Risk group assessment of oral precancer attached to X-ray lung-screening examinations.

The mortality rate of oral tumours in Hungary, as in some other countries, is increasing. In order to assess risk groups for oral cancer and precancer, oral examinations were carried out as part of the X-ray screenings for lung cancer in the 3rd district of Budapest, Hungary. There were 5,034 adults who participated voluntarily in these investigations. After completing a questionnaire with 23 questions, a short oral examination was performed. Males comprised 57.7% of the group, and the age-distribution among men and women was similar. Oral precancerous lesions were found in 3.7% of the whole group, in 3.3% of those with leukoplakia, and in 0.4% of those with oral lichen planus. The prevalence of leukoplakia in men was 5.8%, and in women 1.5%, with significantly higher prevalences in men and women over 40. Among the examined persons there were 31% who were smokers, and 6% reported that they were regular consumers of alcohol. Fifty-four percent of those examined reported that they did not visit the dentist regularly. Oral complaints came mostly from those with lichen planus. The described model, where the oral screening examinations are done in conjunction with other examinations, in a so-called multiphasic screening system, seems to be a worthwhile approach for early diagnosis of oral cancer and precancer.

Adolescent↗
PubMedDate not supplied

Findings in pre-employment examinations.

Results of comprehensive pre-employment examinations of about 8,600 persons were analyzed. The most frequent findings are those related to the more prevalent risk factors and morbidity (of adults) in industrialized countries. Of special interest were the associations found between low level of education (or socioeconomic status), exposure to various occupational hazards, and poor life-style habits. These findings attest to the need for providing preventive follow-up (intervention) services to complement any large-scale screening program. Such services could be developed, relatively simply, based on existing occupational medicine units. The advantages and pitfalls of utilizing multiphasic screening technology in general and in occupational health settings are discussed.

Adult↗
PubMed1989

[Results of a multiphase oncology population screening program in the community of Becej 1986-1987. I. The Hemoccult Program].

In the framework of a multiphase oncologic population screening-program performed in persons above 40 years of age according to the census in the community of Becej during 1986-1987, Hemoccult screening program, together with the fluorographic action involved 16.895 (83.80%) persons out of 20.160 predicted ones which was far less than the involvement of persons through the distribution and gathering of the screening material by a specialized nurse. In 907 (5.37%) Hemoccult positive persons out of which 121 (13.34%) persons rejected to cooperate or did not respond to the invitation for further investigation 16 malignant neoplasms in the lower part of the colon (anus 1, rectum 11, sigma 4) were detected as well as 53 polyposes of the rectum and the anus. Besides, 4 malignant neoplasms of the skin were found and 29 benign tumours (27 adenomas of the prostate gland, 1 fibrolipoma glutei and 1 cysta renis). Apart from these diseases 569 other previously not treated pathologic states were found, i.e. new pathologic states were detected in 85.37% of Hemoccult-positive persons. Previously known pathologic states were confirmed in 22.52% of Hemoccult-positive persons. Diagnostic was performed by the rigid rectoscope and in Hemoccult-positive persons with the negative rectoscopis finding radiologic and fiberoscopic investigations were carried out in the less scope due to the deficiency of financial resources. The number of detected malignant neoplasms of the colon surpassed the three-fold value of the average Vojvodina incidence of these localizations of malignant neoplasms at this age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

[Early diagnosis of diabetes mellitus--studies on the effectiveness and value of diabetes screening actions].

Actions to found out cases of diabetes, which exclusively worked with a proof of glucosuria using the biophan-test stripe, were always loaded by a high percentage of falsely pathologic, but also by a not insignificant number of falsely negative investigation results. -- Therefore a multiphasic screening was carried out in 5,424 persons at the age of 20 and more years, which tested the problems mentioned and judged the possibilities of an improved diagnosis.

Adult↗
PubMed1987

An evaluation of fecal occult blood screening in automated multiphasic health testing and services.

In the present paper, the efficacy of fecal occult blood screening in automated multiphasic health testing and services (AMHTS) is evaluated, and some problems with it are also discussed. A total of 54,735 subjects were screened for occult blood by the Shionogi slide 1-day method. According to a follow-up survey of the 715 subjects judged (+ +), 42 cases of colorectal polyp and 13 of colorectal cancer were confirmed. Eight of the 12 cases of primary colorectal cancer, excluding a case of metastatic transverse colon cancer, were located in the colon's right-side. The result may have arisen from the fact that most subjects in AMHTS are relatively young and free of symptoms. This suggests that fecal occult blood testing in AMHTS may be useful for detecting colon cancers of the right side as well as of the left. Of the nine cases of primary colorectal cancer previously screened, five had been judged (+) in previous testing. This fact indicates an especially rigorous examination of subjects judge (+) to be necessary in AMHTS. Meanwhile, of the 45 cases of gastric cancer detected by enhanced X-ray testing, only eight (17.8%) subjects were judged (+) or (+ +). It is suggested that fecal occult blood testing may not, therefore, be too effective in screening for gastric cancer.

Adult↗
PubMed1989

Passive smoking and cardiorespiratory health in a general population in the west of Scotland.

UNLABELLED: OBJECTIVE-To assess the risk of cardiorespiratory symptoms and mortality in non-smokers who were passively exposed to environmental smoke. DESIGN: Prospective study of cohort from general population first screened between 1972 and 1976 and followed up for an average of 11.5 years, with linkage of data from participants in the same household. SETTING: Renfrew and Paisely, adjacent burghs in urban west Scotland. SUBJECTS: 15,399 Men and women (80% of all those aged 45-64 resident in Renfrew or Paisley) comprised the original cohort; 7997 attended for multiphasic screening with a cohabitee. Passive smoking and control groups were defined on the basis of a lifelong non-smoking index case and whether the cohabitee had ever smoked or never smoked. MAIN OUTCOME MEASURE: Cardiorespiratory signs and symptoms and mortality. RESULTS: Each of the cardiorespiratory symptoms examined produced relative risks greater than 1.0 (though none were significant) for passive smokers compared with controls. Adjusted forced expiratory volume in one second was significantly lower in passive smokers than controls. All cause mortality was higher in passive smokers than controls (rate ratio 1.27 (95% confidence interval 0.95 to 1.70)), as were all causes of death related to smoking (rate ratio 1.30 (0.91 to 1.85] and mortality from lung cancer (rate ratio 2.41 (0.45 to 12.83)) and ischaemic heart disease (rate ratio 2.01 (1.21 to 3.35)). When passive smokers were divided into high and low exposure groups on the basis of the amount smoked by their cohabitees those highly exposed had higher rates of symptoms and death. CONCLUSION: Exposure to environmental tobacco smoke cannot be regarded as a safe involuntary habit.

Age Factors↗
PubMed1984

Dipstick chemical urinalysis: an accurate cost-effective screening test.

In a double-blind prospective study of 200 sequential urine specimens the sediment count of leukocytes in the centrifuged urine (white blood cells per high power field) was compared to a chamber count of leukocytes in uncentrifuged urine (white blood cells per microliter.). There was good correlation (coefficient of correlation 0.783, sensitivity 91.9 per cent, specificity 97.6 per cent and efficiency 96.6 per cent) between the more precise chamber count and the more commonly performed sediment count if the methodology of the sediment count was standardized. In a double-blind prospective study the results of the sediment count for leukocytes and erythrocytes were compared to the leukocyte esterase and hemoglobin dipstick results of urine specimens from 1,346 adults who underwent multiphasic screening. The dipsticks were found to be sensitive to physiologic limits for leukocytes and erythrocytes, with only 0.9 per cent false negative results for each. Formed elements in the urine not detectable by dipstick, such as casts and crystals, were present in 3 per cent of the specimens. Among patients who had significant pyuria, hematuria or formed elements not detectable by dipstick chemical urinalysis, no significant pathological condition was detected upon retrospective review. Because the chemical dipstick is not quantitative and because the sensitivity of the dipsticks resulted in many false positive findings compared to the sediment count (red and white blood cells 16.4 and 13.2 per cent, respectively) a protocol is offered in which results of screening urine specimens that are positive on dipstick culture would be confirmed by a properly performed microscopic urinalysis. This protocol as applied to an adult screening population would be an accurate, cost-effective method of urine testing.

Adolescent↗
PubMed2005

Long-term impact of elevated cardiovascular risk detected by screening. A qualitative interview study.

OBJECTIVE: To explore how persons with an elevated cardiovascular risk score (CRS) balanced health-related advice against the life they wanted to live or were able to live. SETTING: 2000 Danes aged 30-50 were invited to participate in a health-screening project in general practice. Screenings were conducted at baseline and after one and five years, and included among other screening procedures a calculation of CRS (see Figure 1). DESIGN: Participants with an elevated CRS were asked to participate in a qualitative semi-structured interview. They were selected by stratified purposeful sampling reflecting variations in age, sex. and perceived health. SUBJECTS: Nine men and five women aged 33-50 years. THEORETICAL FRAMES OF REFERENCE: Bandura's theory of self-efficacy and the Health Belief Model's consideration of individuals' cues to act against a health threat supported analysis. RESULTS: Being informed about an elevated CRS had a considerable impact on the informants. They initiated significant lifestyle changes, though only to a limited degree when such changes would affect their quality of life adversely. In cases where other results of the multiphasic screening were normal, interpreted as such, or if there were stressful circumstances in the informant's life, the elevated CRS receded into the background. INTERPRETATION: Doctors, who inform individuals about the impact of risk factors, need to know that the consequences and health advice are not always interpreted by laypeople as supposed by the medical culture.

Adult↗
PubMed2006

Detection and treatment of depressive and anxiety disorders among cancer patients: feasibility and preliminary findings from a liaison service in an oncology division.

Our aim in this observational study was to evaluate the feasibility of a multiphasic screening project for the detection and treatment of mood and anxiety disorders among cancer patients in a natural setting. One hundred sixty-five patients with cancer, consecutively admitted to the Oncology Division of San Camillo-Forlanini Hospital, were recruited to the study. All patients had solid tumors; the majority of them were colon, breast, and lung cancers. All patients completed the Hospital Anxiety and Depression Scale (HADS). Patients screened as positive were administered the following instruments by a psychiatrist: the Structured Clinical Interview for DSM-IV (SCID-I), the Beck Depression Inventory (BDI), the Hamilton Anxiety Rating Scale (HARS), and a validated scale for the rapid dimensional assessment of psychopathology (SVARAD). The BDI, HARS, and SVARAD were administered again at 4 and 10 weeks to all treated patients. Out of 45 patients administered the SCID-I, 37 had a mood or anxiety disorder. Adjustment disorders were identified in 20 patients, depressive disorders in 14, and anxiety disorders in three patients. Most patients were prescribed psychotropic medications: mirtazapine was prescribed to 15 patients, citalopram to 13 patients, and escitalopram to four patients. A significant improvement in symptoms of depression and anxiety was observed on all measures (P<.001). Although the design of the study prevents any firm conclusions about effectiveness, this study suggests that including psychiatric expertise in an oncology division is feasible and may lead to improved detection and treatment of psychiatric disorders among cancer patients. Further randomized trials are needed to elaborate on our findings.

Adult↗
PubMed1976

Cell-mediated immune responsiveness of patients with acute lymphocytic leukemia in remission.

Children with acute lymphocytic leukemia (ALL) in remission and undergoing either chemotherapy or immunotherapy were tested for general cell-mediated immunocompetence and cell-mediated reactivity to tumor-associated antigens (TAA) using the following parameters: skin tests with recall antigens and extracts of lymphoblastoid cell lines; primary sensitization to dinitrofluorobenzene and picryl chloride; in vitro tranformation by mitogens and PPD; and lymphocyte-mediated cytotoxicity against a lymphoblastoid cell line and a panel of cryopreserved leukemic blasts. Reactivity in all assays of children on continuous chemotherapy was significantly depressed compared to similar patients later in the study. Patients on intermittent chemotherapy demonstrated much less immunodepression. The groups tested early during immunotherapy with BCG and allogeneic leukemic blasts were hyper-responsive (compared to published data) to primary sensitization with picryl chloride. Skin test reactivity to recall antigens and to tumor-derived lymphoblastoid cell lines was suppressed (as analyzed serial comparison) in this hyperimmunized group, possibly due to antigenic competition, and reactivity in all other assays was normal. The patients tested after 2-8 years of immunotherapy showed significantly higher positive skin-test responses to extracts of tumor-derived lymphoblastoid cell lines as compared to the other groups. The results of this multiphasic screen support the known effects of chemotherapy on immunocompetence. Moreover, they document the prompt return of immunocompetence with intermittent chemotherapy and during immuno-therapy. These results do not, however, indicate a striking augmentation of the immune response during immunotherapy as measured by these parameters.

Antigens, Bacterial↗
PubMed1990

Impaired glucose tolerance in a middle-aged male urban population: a new approach for identifying high-risk cases.

From an urban population (n = 9,033) of 47-49-year-old males, 6,956 participated in a multiphase screening programme, of whom 1.5% were already registered as diabetic patients, 1.7% were then found to be diabetic; of 6,325 subjects given oral glucose tolerance tests, 6.6% were found to have impaired glucose tolerance (WHO criteria, 1985). In 889 asymptomatic cases with initial capillary whole blood glucose values greater than or equal to 6.6 mmol/l fasting and/or 2 h post-load, fluctuation in oral glucose tolerance was studied at repeat tests within one month; the mean differences in glucose values between the first and second test were less than -1% (fasting) and -15% (2 h post-load); there were no differences in body weight, and 62% of those with initially impaired glucose tolerance had normalised by the repeat test. Only in 109 cases (1.7%) were 2 h post-load values in the 7.8-11.0 mmol/l range both at the first and the repeat test; these cases were comparable vis-à-vis body mass index, triceps skin fold, blood pressure and initial glucose and insulin values, but had significantly lower oxygen uptake (2.34 +/- 0.54 l/min vs 2.63 +/- 0.68 l/min; p less than 0.003), as compared with subjects with initially impaired glucose tolerance but normal repeat test outcome. However, subjects with high normal first test results (2 h value in the 7.0-7.7 mmol/l range) and second test results in the 7.0-11.0 mmol/l range, resembled those with persistent impairment of glucose tolerance in all respects (including oxygen uptake). The repeat test procedure (including ergometry), is therefore to be recommended in selecting true risk cases.

Blood Glucose↗
PubMed2002

Screening for the early detection of disease, the need for evidence.

BACKGROUND: Screening for the early detection of disease has had a spotted history. Structured approaches to the process of gathering and evaluating evidence, with the emphasis on well-controlled randomized studies, have greatly improved the beneficial potential of appropriate and effective screening. Good quality evidence will contribute to quality health care. ISSUES: The volunteer participants in screening programs must give fully informed consent. This means that they must be presented with clear and accurate statements of the advantages and disadvantages of the screening program. Among the screening programs that have been conducted include hyperhomocysteinemia and coronary artery disease, Down's syndrome, Neonatal Group B streptococcal disease, Type 2 diabetes mellitus and endometrial cancer. The evidence in these studies has strengths and weaknesses as to how they support or oppose a particular intervention. The laboratory has a major role to play in establishing and validating standards of accuracy for diagnostic tests. Agreement on standards and their application does not mean the end of different interpretation and controversy. CONCLUSIONS: Laboratory physicians and scientists will be very effective consultants if they have the best available, high quality evidence for the appropriate use of laboratory tests.

Canada↗
PubMed2002

Some ethical and design challenges of screening programs and screening tests.

BACKGROUND: There are many examples of inadequate screening studies because of design faults and consent problems. ISSUES: Informed consent is the right of each person engaged in a clinical interaction, including service and research involvement in presymptomatic screening. Any screening approach must answer questions of efficacy, effectiveness, availability and efficiency. Accurate information, presented in clear language, must state a realistic assessment of the limitations, harms and benefits of the screening, including the consequences of false positive and false negative tests. There must be no coercive element in obtaining consent. Written and oral information should be presented. It is also important to recognize cultural differences between societies that emphasize individual autonomy and those in which autonomy derives from membership of a family, group or community, thus requiring different strategies to protect the vulnerable. Testing for genetic disorders presents additional challenges, partly due to the presence of relatively small numbers of affected individuals in the population, but also because of the complexity of counseling, confidentiality issues and the potential for social, insurance or employment discrimination. CONCLUSIONS: It is becoming increasingly difficult to present the data for many screening procedures in ways that can be understood by possible participants, and at the same time deal clearly with the costs to society and the efficacy and efficiency of the tests.

Anemia, Sickle Cell↗
PubMed1982

Renal calculi in association with hyperparathyroidism: a changing entity.

Hyperparathyroidism as a cause of renal calculous disease has decreased considerably during the last 50 years. From 1972 to 1977, 5,034 cases of calculous disease were seen in 5 major hospitals in South Carolina and only 9 patients had hyperparathyroidism as the underlying etiology. There is a 0.178 per cent incidence of hyperparathyroidism as a cause of renal calculous disease in this series, or between 1 and 2 patients per 1,000 cases of stone disease. This finding is compared to a high incidence of 8 per cent in 1934. This change probably is owing to the large-scale use of multiphasic screening blood tests.

Humans↗