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PubMed2006

A rapid method for mass screening for parkinsonism.

Epidemiology studies of parkinsonism employ a variety of techniques for unbiased sampling of populations. No current method permits mass screening of all subjects in a population for parkinsonism by movement disorders specialists. We developed and piloted a new approach to facilitate accurate and efficient screening of large populations for diagnosis of parkinsonism and provide data on sensitivity and specificity. We evaluated 2081 welders referred for medical-legal screening. Subjects were video taped using a standardized protocol, and videos were rated on the Unified Parkinson's Disease Rating Scale motor subsection 3 (UPDRS3). A "video rater" viewed video tapes and entered ratings through a web-based database. An "in-person" examiner performed a UPDRS3 examination in a randomly selected subgroup of 48 workers drawn from the 2081. We developed quantitative diagnostic criteria for parkinsonism that established minimum diagnostic thresholds based upon UPDRS3 scores and compared these criteria with diagnosis by an in-person examiner. Specificity of these criteria compared to in-person examination was 91-100% but sensitivity was 56%. A threshold UPDRS3 score greater than nine provided 100% sensitivity and 81% specificity. Liberal criteria identified 266 (13.1%) subjects with probable parkinsonism and 220 (10.8%) subjects with definite parkinsonism. Conservative criteria identified 260 (12.8%) with probable parkinsonism and 122 (6%) with definite parkinsonism. Our screening method permits rapid assessment of parkinsonian signs. An absolute UPDRS3 score greater than nine provided the best combination of sensitivity and specificity for the diagnosis of parkinsonism, while quantitative exam-based criteria for cardinal parkinsonian signs maximized specificity. Parkinsonism as diagnosed by our criteria was common in this group of welders.

Female↗
PubMed1990

[Mass screening of prostate in Shiribeshi area in Hokkaido--incidence and clinical symptoms of benign prostatic hypertrophy and prostatic carcinoma].

A prostate mass screening was performed in 6 towns in Shiribeshi area in Hokkaido Prefecture on 384 males who were over 50 years old. The screening included digital palpation, uroflowmetry, blood sampling for tumor markers, questionnaire for voiding disturbances and transrectal sonography. Prostatic carcinoma was found in 9 (2.3%) of 384 males. An incidence of benign prostatic hypertrophy was 15.6% in 384 males. Atypical hyperplasia was found in 4 among 35 biopsied cases. Incidence of voiding disturbance such as retardation, prolongation and nocturia significantly increased with age as well as prostate size.

Aged↗
PubMed1994

Mass screening for cystic fibrosis heterozygotes: two assay systems compared.

Two different assay systems were used to detect mutant cystic fibrosis alleles in mouthwash samples from pregnant women attending antenatal clinics. In the first phase of the study, comprising 3110 consecutive samples, we compared the performance of an in-house system and a commercial amplification refractory mutation system (ARMS). Successful analyses were completed at first attempt in approximately 90% of samples, and the patient resampling rate was 1.1%. There were no false positives and only one detected false negative. In the second phase, comprising 3333 consecutive samples, only ARMS was used. Again, there were no false positives and the patient resampling rate dropped to 0.5%. On the basis of convenience and reduced operator time, we have elected to use ARMS for further screening for cystic fibrosis heterozygotes.

Cystic Fibrosis↗
PubMed1993

Mass screening for prostate cancer and the bias relating to survival rate.

Since 1981 we have been studying prostate cancer (Pca) by mass screening (MS) in the Gunma Prefecture, Japan. From 1981 to 1990, 9,067 subjects (total 15,451) were examined in connection with this project and 121 subjects were diagnosed as having Pca. The presence of Pca in 87 cases was confirmed at their initial MS (initial group); 34 cases were confirmed either the year after or several years after the first MS (repeat group). To evaluate the significance of MS for Pca, in this group of patients, the effects of 'lead time bias', 'self-selection bias' and 'length bias' on the survival rate were compared to Pca patients detected in the hospitals of the Gunma Prefecture during the same period. The survival curves of MS cases for each stage of the disease were better than those of the controls. Only in stage D was there a significant difference between the two groups. However, this MS curve decreased from the 4th year in the same manner as the control curve from the start. The clinical characteristics (age, pathological differentiation, prostatic acid phosphatase, gait disturbance, erythrocyte sedimentation rate, chronic disease, and pain in the patients with stage D disease) were compared between both groups. All characteristics studied, except age, in the MS group were clinically more favorable compared to those of the controls for each stage or in total. Moreover, the relative survival rate of subjects examined by MS was greater than 1.0. No significant difference was found in stage distribution between the initial group and the repeat group.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗
PubMed1994

How to deal with advanced cases of neuroblastoma detected by mass screening: a report from the Pediatric Oncology Study Group of the Kyushu area of Japan.

Since 1985, a nationwide program of mass screening (MS) for neuroblastoma has been underway for 6-month-old infants throughout Japan. As a result, the number of patients with stage I or II disease has obviously increased, and this has resulted in overall improvement of the prognosis for neuroblastoma. Some cases detected by MS were already in an advanced stage and have also had a good prognosis. In such cases, no definitive treatment protocol has been developed. Therefore, the authors investigated (1) the clinical and biological features of the advanced neuroblastoma cases detected by MS and (2) the best way to deal with such cases. The authors analyzed 94 cases of advanced-stage neuroblastoma registered in the Kyushu area (population, 15 million) between 1985 and 1990. Eighteen cases (16 stage III, 2 stage IV) were found by MS, and the others (23 stage III, 53 stage IV) were diagnosed clinically. The following results were obtained: (1) No N-myc amplifications were observed in cases detected by MS, whereas 16 of the 45 examined patients in the non-MS group had high amplifications of N-myc. (2) With regard to Shimada's classification, DNA content, and S-100 protein positivity, most of the advanced tumors found by MS showed characteristics indicating a good prognosis. (3) The 5-year survival rate for the non-MS group is less than 25%, whereas all of the patients whose tumors were detected by MS are alive, even after undergoing mild chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1980

Mass screening of glaucoma and other eye disease using the Arden grating test.

The Arden grating test of visual function has been used for mass screening for glaucoma in Western Australia over the past year. A brief description of the test is given. Comparison is made between the Arden grating test scores, tonometry and optic disc cupping. Other eye diseases detected with this method of screening are outlined. An attempt is made to establish the proportions of false positives and negatives using this method.

Adult↗
PubMed1997

[Mass screening programs for breast cancer in France. Comparative evaluation].

OBJECTIVE: The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers. MATERIAL AND METHODS: The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program). RESULTS: The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force. CONCLUSION: The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.

Breast Neoplasms↗
PubMed1987

[Diagnostic value of a card agglutination test (Testryp CATT) in the mass screening of human trypanosomiasis in the Congo].

A field serological study using the Testryp CATT on whole blood was performed during a mass screening of sleeping sickness in a congolese focus (3,530 patients). This test which presented a good specificity (94.8%), revealed on the other hand a low positive predictive value (26.9%). The sensitivity (68.8%) confirms the previous results obtained in Congo. Association of immunoserological tests (CATT and Indirect Immunofluorescent Antibody Test) and clinical diagnosis (examination of lymph nodes) was usefulness for specify an efficient and rapid control of the human reservoir. The improvement of the CATT diagnostic value was discussed.

Agglutination Tests↗
PubMed1995

Mass screening for prostate carcinoma: a study in Hokkaido, Japan.

Although there has been controversy about the early detection of prostate carcinoma by mass screening, we carried out an investigational study of such screening, using digital rectal examination (DRE) and serum prostate-specific antigen (PSA) determination in Hokkaido, Japan. We determined the detection rate and some profiles of the carcinoma detected by screening in Japanese men 50 years old and older. The detection rate of carcinoma was 1.10% in 1,639 participants. The rate linearly increased with aging from 0.25% for men in their fifties to 2.29% for those in their seventies. Two thirds of the carcinomas were T1(c) or T2, the frequency of which seemed to be higher than that of patients who visited medical institutions. The simultaneous use of both DRE and serum PSA determination showed a higher positive predictive value than either alone. Our current results indicated that the detection rate of carcinoma was higher than we previously anticipated for Japanese men, and that simultaneous use of DRE and serum PSA determination yielded a higher positive predictive value than either alone.

Aged↗
PubMedDate not supplied

Management delays for early gastric cancer in a country without mass screening.

BACKGROUND/AIMS: To examine the symptoms of early gastric cancer and the time scale of management delays in a country without a mass screening program. METHODOLOGY: Retrospective review of 44 patients with early gastric cancer. RESULTS: Epigastric pain (63.3%) and gastrointestinal hemorrhage (27.3%) were the main symptoms found. Total delay was made up of patient delay (48.6%), doctor delay (25.5%) and treatment delay (25.9%). Median patient delay (from symptom onset to medical consult) was 30 days (inter-quartile range 2 to 365). Patient delay of more than 6 months was associated with patients aged 50 and younger (P = 0.04) and those presenting with pain (P = 0.05). Median doctor delay (consult to diagnosis) was 21 days (1 to 35) and median treatment delay (diagnosis to surgery) was 8 days (2 to 21). Doctor delay of more than 6 months was associated with a negative gastroscopy or barium meal in the previous 12 months (P = 0.03). CONCLUSIONS: The detection of early gastric cancer at the symptomatic-detectable stage is possible and this potential window for diagnosis can be more than 1 year for up to one third of cases. Efforts to reduce management delays should be aimed at public education and improving the quality and accessibility of endoscopic evaluation.

Adult↗
PubMed1994

Effects of mass screening for neuroblastoma and the presumptive natural history of this tumor.

1) By March 1992, 166,959 infants were screened in Sapporo City, and 35 patients were found to have this tumor. Incidence of this tumor in our screening was one among 5,059 babies examined. 2) Eleven infants among the group with negative screening at 6 months developed neuroblastoma later. The patients developed tumors one to several years after mass screening, and 2/3 of these cases showed high urinary HVA compared to VMA. 3) We postulate that some of the adrenal steroids, possibly cortisol, may play a role for the malignant progression of this tumor.

Adolescent↗
PubMedDate not supplied

[Aspects of providing the equipment for mass screening systems for the early detection of oncological diseases].

An optimal modification of the patients flow arrangement is offered for more convenient form and methods of the population screening for malignant tumours and precancerous diseases, aided by medical and computer techniques. A scheme of the mass-screening system and principal aspects of technical provision particularly for oncological screening are presented.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

Summer spores of birch rust fungus in Papanicolaou smears from healthy mass screening participants.

OBJECTIVE: To evaluate the origin and identification of mysterious particles in Papanicolaou smears from healthy, asymptomatic women participating in a local mass screening program. STUDY DESIGN: The material consisted of 16,000 cerricovaginal smears studied at the cytology laboratory of Pathology Laboratory of South-Western Finland Ltd. Unidentified particles were found in four apparently independent smears. All the slides were rescreened, but no further positive cases were found. RESULTS: Several swab samples were collected from the investigation room, but all were negative. Attempts at identification included numerous consultations. A telepathology consultation with the Cellular Division, Armed Forces Institute of Pathology, Washington, D.C., U.S.A., was conducted. Another teleconsultation with the reference laboratoryfor intestinal parasites in Iceland was conducted. Finally, the Aerobiology Unit, University of Turku, was consulted. The aerobiologist suggested that the particles were most probably summer spores of birch rust fungus (Melampsoridium betulinum). To confirm this we obtained a reference specimen of the fungus from the herbarium at the University of Turku. The morphology of the spore particles was identical to that in the cervicovaginal smears, proving that the smears were contaminated with birch rust fungus spores. CONCLUSION: Birch rust is ubiqutitous in Finland. Outside the hospital window there is a wide lawn behind which, at a distance of 70 m, there is a forest of birch trees. It is most likely that the rust spores flew in through the open window, to settle down on the surface of material that was used in sample taking. Airborne dust may cause misleading and surprising artefacts. Protection of specimens and instruments against dust should minimize the problem.

Basidiomycota↗
PubMedDate not supplied

[Evidence-based planning: the case of mass screening for colorectal cancer in the Lazio region of Italy].

Several population-based trials have shown the efficacy of colorectal cancer mass-screening based on guaiac faecal blood testing in a generic risk population. SCCR represents a very complex and resource-demanding public health intervention and, for this reason, its planning requires actual efficacy as a main goal. Since evidence of efficacy demonstrated by population-based trials may not actually generate effectiveness, the Regional Government of Latium Region decided to implement some experimental studies before introducing a screening programme, in order to define an evidence-based organisational model of SCCR and a feasibility evaluation of the real needs for screening. The aims of the pilot studies were to define an evidence-based organisational model, to evaluate the necessary resources and the actual quality standard of clinical examination, treatment and surgery. The aim of the feasibility study is to test the organisational model for SCCR for about 300,000 citizens residing in the Latium region. The present article illustrates the scheduling path set out, which is based on the involvement of experts, GP representatives and specialists from scientific societies and it is planned by the following actions: Definition of evidence-based recommendations; identification of further investigations; realization of experimental studies; definition of an evidence-based organisational model. The main research areas have been dealt with using randomised trials, in order to evaluate the efficacy of the involvement of GPs and the kind of test for RSOF Our work has produced evidences which were sometimes in contrast with information in the literature, demonstrating that guaiac RSOF testing is less reproducible and determines lower uptake than immunochemical testing. Our work also shows that the involvement of GPs should be based on their personal skills rather than on their role. Such evidences are fundamental to the definition of the organisational model and confirm the need of basing an evidence-based planning not only on evidences found in the literature. The necessity of this approach is strengthened by the level of organisational complexity and by the amount of resources needed to put a public health intervention into practice.

Aged↗
PubMed2001

[Doctors are increasingly held liable for missed diagnosis of cancer in mass screening].

Radiologists and pathologists are increasingly subjected to litigation for alleged faults in diagnosing cancer. An important cause of this appears to be the introduction of mass screening for cancer. According to liability law, the judge must assess whether the person making the diagnosis effected his/her duty with due care. The distinction between error and incompetence cannot be judged solely on the basis of the individual case, but requires an estimation of the accuracy of the diagnosis on a population level. The traditional role of the expert witness, who is asked to judge the individual cases, needs to be reconsidered. A re-examination of slides or radiograms with prior knowledge of the outcome obtained does no justice to the original situation and an alternative procedure is therefore needed. Since the government initiates and controls population screening and the professional organisations involved in screening have committed themselves to monitoring the process and the results obtained, the general public must be better informed about the limitations of screening. Unrealistic expectations as to the benefits of screening appear to be an important motive for legal actions. It is questionable whether screening quality can be enhanced by means of the preventive effect of professional liability. Doctors and lawyers should analyse and solve this problem together.

Diagnostic Errors↗
PubMed1985

Mass screening for glucose-6-phosphate dehydrogenase deficiency: improved fluorescent spot test.

New data on the reliability of the fluorescent spot test are presented. Improvements in the assay were established. Newborn mass screening for glucose-6-phosphate dehydrogenase (G-6-PD, EC 1.1.1.49) deficiency was performed with dried blood samples on filter paper (Guthrie-cards). Females, known to be heterozygote for G-6-PD deficiency were detected at a rate of approximately 30-70%, depending on the storage conditions of the samples. False positive results in male hemizygotes were eliminated.

Clinical Enzyme Tests↗
PubMed1997

Mass screening programs for breast cancer in France--average values of assessment criteria.

Breast cancer is the most common cancer in women worldwide. Many studies have been performed worldwide to assess the effectiveness of screening in terms of reduced mortality due to breast cancer. Since the end of 1989, 10 breast cancer mass screening programs using mammography have been carried out in France under the sponsorship of the National Fund for Health Prevention, Education, and Information (FNPEIS) from the National Health Insurance of Salaried Workers (CNAMTS). These 10 campaigns, which are on a district scale, are organized according to variable methods and are assessed using a common procedure. Four groups of criteria are measured in this procedure, which investigates the impact, quality, effectiveness, and costs of screening programs. The average and extreme values of each criterion as calculated from the campaigns are presented in this paper. In order to enlighten the judgment on the French results, a comparison with the international standards in force and with the results of foreign screening programs is proposed.

Aged↗