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[Prenatal detection of open neural tube defects in a mass screening program by determination of alpha-fetoprotein concentration in maternal serum].

A partially automatized ultramicroencymimmunoassay developed by the GDR and Cuba should be tested in a mass screening for the prenatal detection of open neural tube defects by measurement of maternal alphafetoprotein concentration (MS-AFP). In the screening program 24,271 pregnant women were included (Berlin/District of Schwerin). In 18,144 patients AFP-concentration in maternal serum was measured as a routine procedure in the care for all pregnant women of the district of Schwerin. The time of MS-AFP determination in this connection was limited from 15th to 18th completed gestational week. 1986 already in 84.9 per cent of all pregnant women of the district of Schwerin MS-AFP concentration could be measured in early pregnancy. The detective rate of open neural tube defects among 24,271 tested pregnant women was 86.1 per cent. AFP concentration was expressed in ng/ml and the "cut off" was set at 2.0 MOM. Infants born with open neural tube defects were reduced by 75 per cent under the conditions of MS-AFP screening. Better results are possible in connection with a progress in the qualification of the following diagnostic steps, if MS-AFP-levels are elevated. Not unexpected and unspecific MS-AFP-elevation was found in connection with twin pregnancies and a higher risk of abortion and the delivery of infants with very low birth-weight less than 1,500 g. A general MS-AFP-screening is recommended for prenatal detection of open neural tube defects all over the country.

Anencephaly↗

Thyroid cancer detected by mass screening over a period of 16 years at a health care center in Japan.

PURPOSE: I studied the incidence and characteristics of thyroid cancers detected during mass screening over a period of 16 years at a health care center. METHODS: The subjects were 88 160 people (48 232 men and 39 928 women) who visited Kochi Kenshin Clinic between January 1989 and March 2005. Each person was initially examined by inspection and manipulation of the thyroid glands, then by ultrasonography if there were abnormal thyroid findings. They were referred to a surgeon specializing in thyroid surgery, depending on the ultrasonographic findings. RESULTS: Malignant thyroid tumors were detected in 204 subjects (62 men and 142 women), resulting in a detection rate of 0.44% (men 0.24%: women 0.69%) for absolute subjects (25,797 men: 20,636 women). This was considered favorable compared with other reported results of thyroid examinations using ultrasonography. The rates of cancer in nodular lesions and metastasis were higher in men than in women. CONCLUSION: Manipulation is adequate as an initial screening method for thyroid examination, and ultrasonography may not always be required. Moreover, it is necessary to consider gender when referring a patient to a specialist and when deciding on the indications for surgery to remove a thyroid tumor.

Adult↗

Mass screening models for contagious diseases with no latent period.

In this paper, a simplified model describing the stochastic process underlying the etiology of contagious and noncontagious diseases with mass screening is developed. Typical examples might include screening of tuberculosis in urban ghetto areas, venereal diseases in the sexually active, or AIDS in high risk population groups. The model is addressed to diseases which have zero or negligible latent periods. In the model, it is assumed that the reliabilities of the screening tests are constant, and independent of how long the population unit has the disease. Both tests with perfect and imperfect reliabilities are considered. It is shown that most of the results of a 1978 study by W.P. Pierskalla and J.A. Voelker for noncontagious diseases can be generalized for contagious diseases. A mathematical program for computing the optimal test choice and screening periods is presented. It is shown that the optimal screening schedule is equally spaced for tests with perfect reliability. Other properties relating to the managerial problems of screening frequencies, test selection, and resource allocation are also presented.

Communicable Diseases↗

The familial incidence of symptoms of scotopic sensitivity/Irlen syndrome: comparison of referred and mass-screened groups.

The familial incidence of Scotopic Sensitivity/Irlen Syndrome was investigated in two samples. One sample involved parents and siblings of 126 children identified with symptoms who had been referred for screening. The other sample involved parents and siblings of 33 children who had been identified with symptoms through mass screening of all children in Grades 3 to 6 at two local schools. Two different samples were taken to investigate the possibility of parental referral bias. Familial incidence may be inflated in a referred sample because some parents may be aware of their own symptoms and actively seek assistance. For the sample of children referred for screening, there was an 81% chance of either one or both parents showing similar symptoms and a 76% chance of siblings being similarly affected. For the sample of children identified through school screening, there was an 85%, chance of either one or both parents showing similar symptoms and a 54% chance of siblings being similarly affected. The data confirm previous estimates of incidence and suggest that Scotopic Sensitivity/Irlen Syndrome may be a genetically-based deficit in visual processing.

Adult↗

[Early detection of hepatobiliary cancer in mass health screening].

Mass health screening (MHS) for detecting early cancer of hepatobiliary diseases is not common. However, as high risk factors for developing hepatocellular carcinoma (HCC) has been established in Japan, MHS for HCC is available, especially in high endemic areas of hepatitis C. Intrahepatic bile duct cancer often occur in patients with Thorotrastosis. Cohort study for detection of early cancer of intrahepatic bile duct has been conducting by the Japanese Government. Early detection of bile duct cancer in health screening is very rare. It will be helpful for perform MHS to clarify the high risk factors for bile duct cancers.

Adult↗

Long term follow-up of mass screening for prostate carcinoma in men with initial prostate specific antigen levels of 4.0 ng/ml or less.

BACKGROUND: Long term follow-up for subjects whose initial prostate specific antigen (PSA) levels were 4.0 ng/mL or lower was conducted to investigate the proper interval for PSA screening. METHODS: Eight thousand five hundred ninety-five men aged 50 years or older with an initial PSA level of 4.0 ng/mL or lower were screened with tumor marker measurement and/or digital rectal examination (DRE) and/or transrectal ultrasonography as a first step in the mass screening, and a prostate biopsy was performed for individuals with abnormal findings. RESULTS: Cancer was detected in 0.18% (8 of 4526), 1.0% (27 of 2724), and 3.6% (49 of 1345) of men whose initial PSA levels were lower than 1.0, 1.0-1.9, and 2.0-4.0 ng/mL, respectively. Among these prostate carcinoma cases, 25% (6 of 8), 56% (15 of 27), and 63% (31 of 49) were detected by abnormal PSA in patients with initial PSA levels lower than 1.0, 1.0-1.9, and 2.0-4.0 ng/mL, respectively. The detection rates of prostate carcinoma within 3 years after the initial visit were 0.07%, 0.24%, and 1.2% in cases with initial PSA levels lower than 1.0, 1.0-1.9, and 2.0-4.0 ng/mL, respectively. CONCLUSIONS: It is recommended that DRE and PSA measurements should be performed once every 3 years in individuals with initial PSA levels of less than 1.0 ng/mL. The prostate carcinoma detection rate increased over time in individuals with initial PSA levels of 1.0 to 4.0 ng/mL, especially in cases with 2.0-4.0 ng/mL, and annual measurement of PSA was more useful than DRE. Therefore, it is recommended that PSA screening should be performed once every year for individuals with initial PSA levels of 1.0 to 4.0 ng/mL.

Aged↗

[Use of electrical impedance tomography in detection of latent diseases during mass screening].

The paper deals with the use of the present-day highly effective method of introscopy electric impedance tomography (EIT) for diagnosis latent abnormalities during mass screening. EIT images viscera and tissues on the basis of their electric conductivity differences. Reconstruction of the images reflecting the distribution of electric conductivity values in the body is made from the recording potentials onto the body's surface while passing currents through the electrodes located along the circumference of the body's part under study. The 16-electrode EIT system developed by Dipol (Moscow) was used to examine the distribution of electric conductivity values in the extremities and chest organs in healthy volunteers of both sexes and in patients with various pulmonary diseases.

Animals↗

Progress report on experimental use of CYBEST model 2 for practical gynecologic mass screening. Alterations of the specimen rejection threshold and specimen preparation.

In order to maintain an acceptable performance of CYBEST model 2 in the field of gynecologic mass screening, the algorithm of rejection for the CYBEST assessment of inadequately oligocellular samples was reviewed, and the mean number of detected cells per square millimeter for passing rejection was raised from two cells to four. The results of field tests obtained after the modification showed a false-positive rate of 28.3% for 9,010 samples as compared with 41.8% for 10,549 samples before the modification while the rejection rate showed a moderate yet acceptable increase after the modification from 4.7% to 7.0%. Some modifications of the specimen preparation routine were also introduced to improve the performance of the system.

False Positive Reactions↗

[Mass screening against cervical cancer--what are the viewpoints of female general practitioners?].

Female general practitioners play a central role in the national programme for organized cervical mass screening. The article presents results from a study among Norwegian female general practitioners (n = 720) on their view of the benefit of the screening programme and about the recommendations they give their patients regarding routine Pap-smear. The response rate was 95%. 93% found that the national programme was of great or some benefit. 70% gave recommendations in accordance with the programme. Only 14 physicians recommended longer intervals for routine Pap-smears than those recommended in the programme. However, a considerable proportion reported that Pap-smears are taken more often than recommended by the programme, usually among young women who are considered to be at risk, or who express a wish to have a smear taken. We identify possible misunderstandings and misleading expectations which should be approached by means of strategies for quality assurance of the national programme.

Attitude of Health Personnel↗

Discovering asymptomatic non-precancerous lesions with cervical cytologic mass-screening campaigns: is it a benefit or a cost?

A total of 3357 women (88.1% married, 82.0% parous) were examined at least once in the mass-screening program carried out by the Legnano Hospital Screening Center in Nerviano (a small town near Milan with 15,600 inhabitants) in 1974, 1977 and 1980. Married women with visible portio and adequate smear were 2758: a visibly healthy cervix was found only in 1143 subjects (41.4%). A total of 1516 married women were examined at least in 2 consecutive campaigns: 1279 (84.4%) reported "no gynecologic treatment in the previous 5 years" at the first campaign, and 899 (59.3%) reported "no gynecologic treatment in the previous 3 years" at their second one. Of 350 women with "medical lesions" and 525 with "surgical lesions" recorded at the first visit, 111 (31.7%) and 232 (44.2%) reported, respectively, a "medical treatment" or a "surgical treatment" at the second visit. In women with "medical lesions" at the first visit, at the second visit a healthy cervix was found in 66.2% of the treated women and in 72.6% of the untreated patients. In those with "surgical lesions" a healthy cervix was successively found in 91.6% of treated and in 40.7% of the untreated patients.

Adolescent↗

[The Charlottenburg Allergy Prevention Program 90. Early detection and prevention of allergic diseases by modifying mass screening of 3d grade students].

On the one hand, the Charlottenburg allergy prevention programme showed the spread of allergic diseases among the pupils of the third form of public schools, and on the other hand it familiarized parents, teachers and pupils with health promotion schemes under the slogan These who are informed well in time will suffer less. For the first time within the area of Berlin, the Charlottenburg district developed a quality standard in respect of screening and health promotion connected with allergy. This new focal point of attention was set up by means of mass screenings of pupils while at the same time critically reviewing previous routine methods, weeding out unnecessary procedures and emphasizing the essential. The difficult tasks confronting Public Health services in this regard could not be managed without outside help. This was forthcoming from partners recruited from the university, the sickness insurance bodies and self-help groups. The cooperation that developed in this manner was exemplary and might serve as a model for future on-target health prevention programmes.

Berlin↗

Surgery and outcome of alveolar echinococcosis of the liver: historical comparison of mass screening systems in Japan.

The prognosis of patients with alveolar echinococcosis of the liver (AEL) is excellent when the lesions were completely resected, suggesting the significance of mass screening systems. We investigated resectability and prognosis of the disease with historical comparison of screening systems. The patients were classified into three groups: Group A (n = 63) detected by the current screening system, enzyme-linked immunosorbent assay and ultrasonography, since December 1984; Group B (n = 39), detected by a serological screening system performed between 1974 and 1984; and Group C (n = 64), non-screened patients accidentally discovered. The lesions at an early stage were most frequently found in group A, and the complete resection was performed at 74.6% in A, 41.0% in B, and 18.8% in C (p < 0.0008). Five-year survival rate was 100% in A, 74.0% in B, and 69.5% in C, with a significant intergroup difference (p < 0.05). The current system facilitates early diagnosis of the disease, contributing to its resectability and to a better outcome.

Analysis of Variance↗

[Neonatal mass-screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency. I. Microfilter paper methods for radioimmunoassay of 17 alpha-hydroxyprogesterone].

In order to perform neonatal mass-screening for 21-hydroxylase deficiency (21-OHD), two simplified radioimmunoassay (RIA) methods to estimate 17 alpha-hydroxyprogesterone (17-OHP) were devised, using discs 3 mm in diameter cut from filter paper impregnated with whole blood. One was a direct method to use assay buffer eluent as a sample, and the other was an extraction method to use diethyl ether extract. One disc in the direct method and one-fourth to four discs in the extraction method were used. We used [1, 2, 6, 7-3H(N)]-17-OHP as a tracer, anti-17-OHP-3-carboxymethyloxime-BSA serum as an antiserum and saturated ammonium sulfate to separate the bound from free 17-OHP. The specificity of the antiserum was nearly satisfactory, except for an unnegligible cross-reactivity with 17 alpha-hydroxypregnenolone (17-OH-delta 5P). Both methods were practically easy and rapid, and had satisfactory accuracy and precision. A significant correlation (p less than 0.005) was observed between "Disc-17-OHP" values by both methods and plasma 17-OHP concentrations measured by highly specific RIA, although the values obtained by the direct method were significantly higher (p less than 0.005) than plasma 17-OHP concentrations, which presumably resulted from the cross-reactivity of the antiserum with 17-OH-delta 5P-sulfate. "Disc-17-OHP" values of the untreated or poorly controlled patients with 21-OHD were extremely high compared with normal neonates and children. However, as most premature infants also showed high values, the possibility of giving false-positive results had to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

17-alpha-Hydroxyprogesterone↗

Mass screening of blood pressure in school children: results of the Karatsu Study.

The purpose of this study was to determine the prevalence of persistent blood pressure elevation in school children. Mass screening of blood pressure was performed simultaneously with a cardiovascular health check in school children. Forty four hundred and eighty school children were selected as subjects for this study, consisting of 2289 first grade primary school students aged six and seven (group A), and 2191 second grade junior high school students aged thirteen and fourteen (group B). Of the 4480 students, 4031 were examined at the initial blood pressure screening. Three hundred and sixty students whose systolic and/or diastolic pressures were above the 95th percentile were recalled for a second examination. Three hundred and thirty one students were studied at the 2nd examination, and 69 students were listed for a third survey. 1.7% of the original subjects were examined at the final survey. At the first screening, mean blood pressures were 101.5 +/- 8.5/61.2 +/- 6.6 mmHg (mean +/- SD) for males and 100.3 +/- 8.3/60.9 +/- 6.5 for females in group A. In group B, blood pressures were 120.2 +/- 11.3/66.6 +/- 7.4 mmHg for males and 117.4 +/- 11.2/66.9 +/- 7.8 mmHg for females. This screening system, if incorporated into the school health program, is an effective and efficient method of screening for persistent blood pressure elevation in school children in Japan.

Adolescent↗

Mass screening program for prostatic diseases with transrectal ultrasonotomography.

A special chair-type apparatus for transrectal ultrasonotomography was developed in our laboratory 3 years ago. We did a mass screening program for prostatic disease, using this equipment as the primary study in the system. The 132 apparently normal men evaluated ranged in age from 40 to 76 years (mean 55.0). The 48 patients suspected of having prostatic disease underwent secondary studies, consisting of the usual urological examinations. Prostatic disease was detected in 24 cases, including 18 cases of benign prostatic hyperplasia. Thus, the model program revealed an extraordinarily high prevalence of latent prostatic disease among apparently normal older men.

Adult↗

MYCN gene amplification is a powerful prognostic factor even in infantile neuroblastoma detected by mass screening.

MYCN is the most powerful prognostic factor in cases of older children. However, how MYCN is related to the prognosis of infantile cases is not clear. A mass screening program was carried out by measuring urinary catecholamine metabolites (VMA and HVA) from 6-month-old infants. Of 2084 cases detected by the screening program, MYCN amplification (MNA) was examined by Southern blot analyses in 1533 cases from 1987 to 2000. Of the 1533 cases examined, 1500 (97.8%) showed no MNA, 20 cases (1.3%) showed MNA from three to nine copies, and 13 (0.8%) cases showed more than 10 copies. The 4-year overall survival rates of these three groups (99, 89 and 53%, respectively) were significantly different (P<0.001), indicating that MYCN copy number correlates with the prognosis. Cases with MNA more than 10 copies were more advanced than those without amplification (stage III, IV vs I, II, IVs; P<0.001). Patients with MNA more than 10 copies had significantly higher serum levels of neuron-specific-enolase (NSE) and ferritin than non-amplified patients (P=0.049, P=0.025, respectively). MYCN amplification was strongly correlated with a poor prognosis in infantile neuroblastoma cases. Therefore, for the selection of appropriate treatment, an accurate determination of MNA is indispensable.

Biomarkers, Tumor↗