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PubMed1996

[Application of oculokinetic perimetry in examination of the eye].

Oculokinetic perimetry was performed using the same protocol at four health screening facilities to determine its usefulness for identifying visual field abnormalities including glaucoma during complete physical screenings in Japan. Ophthalmoscopy of the optic disc, 26-point oculokinetic perimetry (OKP), and applanation tonometry were performed in 2,768 eyes. If any one of the tests yielded an abnormal result, the eye was then examined with a Humphrey visual field analyzer (HVFA, program 30-2). After the tests were completed, the results were evaluated by ophthalmologists for evidence of primary open-angle glaucoma and normal tension glaucoma and were classified into one of 3 groups: confirmed glaucoma, suspected glaucoma, and no glaucoma. OKP detected abnormalities in the visual field in 96 eyes (3.5%). Of these 96 eyes, 29 eyes had confirmed glaucoma, 52 eyes were suspected of having glaucoma and 15 eyes had no glaucoma. The remaining 15 eyes had no glaucoma, but in 7 of them other ophthalmological disease was diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value of OKP for detecting glaucomatous visual field defect were 0.46, 0.99, 0.84 and 0.96, respectively. The high specificity and negative predictive value show that OKP is unlikely to produce false positive results, but its low sensitivity suggests that it is not suitable for the early detection of glaucoma. However, OKP identified advanced glaucoma and other ophthalmological diseases associated with visual field abnormalities, suggesting that it is a useful screening test.

Adult↗
PubMed1982

Interactive computer program for self-distributed medical questionnaire in a population health screening.

The questionnaire is an important element of a medical screening investigation, just as important as the biometrical screening tests. There are several difficulties in realizing interactive computer programs for such tasks. In the present report, we describe the design, operation and results of an interactive computer program for self-distributed medical questionnaire in which the screening subjects are informed and instructed on the terminal routines, and answer, check, confirm and record the questions direct in the computer terminals by means of simple keyboard functions. This program was possible to construct as an integrated component of the interactive computer system monitoring our multiphasic health screening in a standard minicomputer environment.

Computers↗
PubMed1976

Screening high-risk populations: a challenge to primary medical care.

The organizational, educational, and policy implications of screening high-risk populations are considered for five selected conditions: (a) the role of pregnancy-risk indices for the identification of high-risk women as it relates to the efficient use of perinatal and neonatal intensive care centers; (b) screening school-age children for conductive hearing loss, with emphasis on the role of complete otologic examination, threshold testing, and tympanometry in children with a history of recent or recurrent middle ear disease; (c) the efficacy of Pap smears in reducing mortality from cervical cancer; (d) the current status of clinical examination and mammography for detecting breast cancer; and (e) the problems inherent in diagnosing and treating hypertension. Because of the increasing costs of new technology that have not yet been adequately tested, health professionals bear an increasing obligation to require scientific evidence of the efficacy of the screening procedures before instituting large-scale programs.

Adult↗
PubMed1978

The emergence of the concept of screening for disease.

Public health officials, industrial leaders, and insurance companies early in this century optimistically advocated the potential for improved health and productivity through regular physical examinations. Doctors and the public, fed both by the exigencies of war and the experience of new technology, later joined the pursuit of protection from hazard--physical, social, and economic. But these very technologies--newer and more "mechanistic"--changed interest in the annual checkup into a fervor for "mass screening." By the 1970's the quarrel shifted from affective questions to matters of effectiveness and efficiency. Has progress been real?

History, 19th Century↗
PubMedDate not supplied

[Ambulatory geriatric screening--an overview. I: Concept and methodologic development].

Scientific literature reveals different levels of efficiency in geriatric screening in the primary care setting. Part I of our review deals with the development of geriatric screening up to the implementation of regular health checks in Great Britain. Studies in primary care show that through screening 1-2 previously unknown conditions per patient can be detected, with a particularly high prevalence of unknown problems in the following areas: vision and hearing, continence, mobility, cognitive function, mood, isolation, and lack of help. Further research is still required to transfer the results of screening studies into primary care, particularly in validating instruments of geriatric assessments and selecting risk groups.

Aged↗
PubMed1998

[Characteristics of screening-detected prostate cancer on health checkup].

Prostate cancer has the highest incidence and the second most common cause of death in U.S. men. In Japanese men, prostate cancer is not so common but is the most increasing neoplasm. Detection of early-stage cancer and early curative treatment are the most effective ways to reduce mortality from this disease. Therefore the mass screening system for prostate cancer to reduce mortality has become an important issue in recent years in Japan. The screening project for prostate cancer was conducted using only the prostate specific antigen (PSA) levels of primary screening with the cut off level of 4.0 ng/ml for candidates undergoing a medical checkup every 2 years. Totally, 20,338 men had health checkups every 2 years and 899 men requested the screening checkup for prostate cancer and their serum PSA level. Fifty (5.6%) men showed abnormal PSA level, 41 men had a second screening, 27 men underwent needle biopsy of prostate, and finally 14 cases of prostate cancer were detected. The detection rate calculated for prostate cancer was 1.56%. Thirteen cases out of 14 (92.9%) were clinically diagnosed as localized cancer. In 10 cases, total prostatectomy was performed and the pathological findings showed none of them to be clinically insignificant cancers. In conclusion, from our result the screening of prostate cancer using PSA only is considered to be very useful to detect early clinically significant prostate cancer.

Adult↗
PubMed1993

Health program for VIP's.

The question about special health program for VIP's has been discussed several times. A definition of VIP is a key person either in top management or a person with unique competence in an organization. In small companies you find 5-10 VIP's, in bigger companies up to 50. Our customers indicated a positive interest in a new type of program. They were not satisfied with just a standard screening. They wanted more from screening than just dealing with symptoms of not wellbeing. Most of them had earlier joined different personal development programs. They find those programs useful with well-motivated reasons for change in life patterns. Therefore as a top management consultant, but also certified to work with lifestyle, stress and axiological profile, I was at that time training top management both as individuals and as a team. It was therefore easy for me to combine a personal development program with lifestyle-health screening. In our new program for VIP's we therefore work with both individuals and teams and with both health and personal development.

Diagnostic Tests, Routine↗
PubMed1990

Hemoccult screening in detecting colorectal neoplasm: sensitivity, specificity, and predictive value. Long-term follow-up in a large group practice setting.

STUDY OBJECTIVE: To determine the sensitivity, specificity, and predictive value of Hemoccult II tests for detecting colorectal neoplasm (colorectal carcinoma or polyp or both). STUDY DESIGN: Prospective analyses of asymptomatic patients (greater than or equal to 45 years) followed for 4 years after screening with Hemoccult II testing and retrospective analyses of patients, with known colorectal carcinoma or polyps or both who had Hemoccult II testing within 2 years of diagnosis. SETTING: A large, health maintenance organization practice. MEASUREMENTS AND MAIN RESULTS: In the prospective analysis, the sensitivity of Hemoccult II was 50% for colorectal carcinoma diagnosed within 1 year of testing, 43% within 2 years, and 25% within 4 years. For polyps, sensitivity was 36% at 1 year, 28% at 2 years, and 17% at 4 years. Specificity was 99%. The predictive value of a positive test for colorectal carcinoma was 8% at 1 year, 10% at 2 years, and 11% at 4 years. On the basis of the retrospective analyses, the sensitivity of Hemoccult II for colorectal carcinoma diagnosed within 1 year of testing was 66% and was 61% within 2 years. Many of these patients had symptoms when tested. CONCLUSIONS: An asymptomatic patient age 45 or older with a positive Hemoccult II test has about a chance of 1 in 10 for having colorectal carcinoma and a 1-in-3 chance of having either a colorectal carcinoma or polyp: The same patient with a negative Hemoccult test has a 0.2% chance of having a colorectal carcinoma diagnosed within 2 years of testing and a 0.7% chance of having a polyp. Within 4 years of testing the chance increases to 0.5% for colorectal carcinoma and 1.5% for polyps. If Hemoccult II slides are the only screening method used for detecting asymptomatic colorectal neoplasms, 50% to 60% of lesions will remain undetected. Clinical interpretation of Hemoccult screening requires appreciation of its limits as well as its benefits.

Aged↗
PubMed1975

A critical review of periodic health screening using specific screening criteria. Part 2: Selected endocrine, metabolic and gastrointestinal diseases.

Despite the increasing interest in recent years in prevention and early recognition of asymptomatic disease, there has been a lag in development of a sound scientific basis for efforts in this area. No objectively based program for periodic health screening of asymptomatic adults has yet been proposed for the primary care physician. This is the second in a series of four articles which will critically examine the feasibility of screening procedures for 36 selected diseases. Six basic criteria are adopted as necessary to justify periodic screening. Specific screening recommendations are made for each disease, and a longitudinal screening program for asymptomatic adults will be proposed in the concluding article of this series.

Adult↗
PubMed1991

[Infection screening in pregnancy].

The aim of screening for infectious diseases in pregnancy is to identify subjects who are at risk of a specific infection, which lends itself to effective intervention. The value of routine screening is determined by the validity of the test and the prevalence of the disorder in the population. During pregnancy, serological screening for rubella, syphilis, toxoplasmosis, HIV, hepatitis B and bacteriological screening for asymptomatic bacteriuria and gonorrhea is recommended. The search for additional infections is reserved for patients presenting special risk factors or clinical symptoms.

Female↗
PubMedDate not supplied

Vision screening requirements under 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) Programs.

A 1979 survey of vision screening requirements in 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) programs revealed that 17 percent of the programs had no requirements, and 17 percent required only distance visual acuity testing. An additional 25 percent required distance vision and ocular muscle-fusion tests only, and the remaining programs required various combinations of three or more tests. Fewer than two-thirds of the programs with requirements had referral criteria for the tests. The ages at which initial testing was required also varied among the programs. The differences in requirements were not related to the demographic, socioeconomic, and other variables analyzed in this study. Programs with specific referral criteria, however, had a higher percentage of referrals for vision screening than those without such criteria. Because of the variability in vision screening standards and referral criteria observed among the programs, the authors conclude that national standards are needed.

Adolescent↗
PubMed1982

RAST and skin test screening in the investigation of asthma.

We studied 72 adult asthmatics prospectively for the purpose of detecting atopy by the use of screening methods employing total serum IgE, RAST and prick tests. Fifty-one of the patients were considered to be atopic on the basis of prick test reactivity or a positive RAST. Although the total IgE values of the atopic and nonatopic individuals demonstrated some overlap, values over 150 U/mL were found only in atopics. We determined that 89% of the atopic individuals could be detected by a combination of total IgE greater than 150 U/mL and the use of five specific IgE determinations from the frequency of positive RAST to 20 environmental antigens. Ninety percent of the atopics were detected by four prick tests. Regional data are required to develop and effective set of screening tests. The use of such tests can reduce costs and technical time in the investigation of atopy.

Adult↗
PubMed2006

Should high sensitive C-reactive protein measurement be included in health screening packages?

INTRODUCTION: The Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA) have endorsed the optional use of high sensitive C-reactive protein (hsCRP) to identify patients without known coronary heart disease but who may be at higher absolute risk than estimated by major risk factors. This study assessed the potential value of hsCRP measurement in addition to routine lipid and risk factor assessment on patient management for individuals undergoing multiphasic health screening. METHODS: hsCRP was measured on fasting lipid samples on patients attending the Health Enrichment Clinic at Tan Tock Seng Hospital between January and April 2004. These results were then compared with the outcome of individual patient risk assessment (using the 2001 Singapore Ministry of Heath Clinical Practice Guidelines on Lipids), the patient's lipid results and whether the patient was already on anti-lipid treatment. RESULTS: 212 samples were analysed for hsCRP. Seven patients were already on anti-lipid drugs. Using the AHA/CDC guidelines, hsCRP measurement would be of value in deciding management in 12.7 percent of all patients. Of this group, 11 percent had hsCRP concentrations in the high risk category. Restricting hsCRP measurement to only those patients with two or more cardiac risk factors and not on anti-lipid drugs would increase the proportion of patients where hsCRP could be useful in deciding management, to 81.8 percent. CONCLUSION: For clinicians prepared to consider treatment in patients with elevated hsCRP levels, hsCRP measurement should be included as part of health screening packages to selected patients based on individual cardiac risk assessment.

Adult↗
PubMed1975

An overview of research in cancer diagnosis.

The diagnostic research program of the National Cancer Institute encompasses detection or screening, methods of diagnosis, and prognosis. The present objective of this program is diagnosis of 75% of all cancers at a time when 90% of these have not metastasized. The Institute's Divison of Cancer Biology and Diagnosis has directed its attention toward general diagnostic methods (immunologic, chemical, cytologic, imaging, and endoscopic) and organ site programs (breast, lung, cervix, bowel, bladder, and pancreas). The organ site programs usually involve multiple diagnostic techniques applied to a specific organ. Screening for asymptomatic cancer seems an important immediate objective. Optimum frequency of screening should be established for individual organ sites and for combinations of sites, to determine whether multi-site screening programs can significantly reduce mortality from cancer.

Breast Neoplasms↗