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Use of environmental as well as developmental measures in screening high-risk children is suggested as a solution to some of the problems of EPSDT and similar programs. Defects of present developmental screening instruments are discussed, and recent efforts to refine environmental measurement techniques are reviewed. The need for further research on the impact of environmental variables is stressed.
Since 1990, due to political and legislative changes, immigration from the former Soviet Union to the United States has increased significantly. Population reports from 1988 indicate that there were approximately 406,000 Soviet immigrants in the United States at that time. This number is expected to increase due to the Immigration Reform Act of 1990, which raised the Soviet refugee ceiling to 50,000 per year. Currently, very little is known about the health status and health practices of this population, although some published data indicate that life expectancy and infant mortality rates compare poorly with those of the general population in the United States. Although the former Soviet republics experienced universal health care coverage, there was little emphasis on promoting a healthy lifestyle. Heavy cigarette use, high alcohol intake, poor dietary intake, little attention to physical fitness, and crowded living conditions have been described. Environmental pollution and poor occupational safety are common and have contributed to the health problems of the population. As the influx of immigrants continues, the consequences of these health conditions will impose a burden on health care services in this country. As with any immigrant group, an understanding of the potential health conditions and cultural values can facilitate appropriate medical care. This research was conducted to explore these issues. Interviews and a physical assessment were conducted with 30 adults from the former Soviet Union. The major health problems identified included various dental conditions requiring treatment, obesity, and the absence of basic health screening measures such as cholesterol testing, high blood pressure screening, Pap smears, and mammograms. The authors also identified a need for translators and for education regarding preventative self-care, such as breast self-examinations.
A study was undertaken to assess the types of cardiac diseases and dysrhythmias in a healthy population of 651,794 school children who underwent general health screening between January 1981 to December 1986. Congenital heart lesions were diagnosed in 1159 (0.18 per cent), the majority being mitral valve prolapse (MVP; 0.08 per cent), small ventricular septal defects (VSD; 0.04 per cent), mild pulmonary stenosis (PS; 0.03 per cent), and small atrial septal defects (ASD; 0.02 per cent). Other lesions detected were patent ductus arteriosus (PDA), coarctation of aorta (CoA), Fallot's Tetralogy (FT) and total anomalous pulmonary venous drainage (TAPVD). Of these, five had surgical closure of ASD, eight and ligation of PDA, and one had correction for TAPVD. Cardiac dysrhythmias were seen in 350 patients; consisting of premature ventricular contractions (PVC) in 186, right bundle branch block (RBBB) in 132, atrial ectopics (AE) in 17, sinus node dysfunction in five, atrioventricular (AV) block in seven, Wolff-Parkinson-White (WPW) syndrome in two, and paroxysmal atrial tachycardia (PAT) in one boy. Associated congenital heart lesions were found in 110 patients. The cardiac screening programme has resulted in a significant detection of cardiac abnormalities among apparently healthy school children. Early detection of cardiac disease has resulted in early remedial measures to be taken and thus improved cardiological care.
PURPOSE: Primary symptoms were reviewed retrospectively in patients with prostate cancer diagnosed in our hospital with the aim of promoting early detection. MATERIALS AND METHODS: The subjects included 301 cases with prostate cancer diagnosed histologically in Nagoya Urology Hospital from August, 1988 to December, 2001. The mean age was 72.7 years, and the median PSA was 20.0 ng/ml. Primary symptoms were classified according to the General Rule for Clinical and Pathological Studies on Prostate Cancer (The 3rd Edition). RESULTS: Out of 301 cases, 274 (91%) visited our hospital with clinical symptoms. Of them, 272 had primary urological symptoms. In these 272 cases, 250 (92%) and 19 (7%) had lower urinary tract symptoms (LUTS) and macroscopic or microscopic hematuria, respectively. The majority of patients (82%) referred from other urologists had already undergone PSA measurement, compared to 50% in those referred from physicians other than urologists (p < 0.0005). CONCLUSION: The present data revealed that LUTS were important primary symptoms for the detection of prostate cancer, particularly in an area like Nagoya where the mass screening for prostate cancer is still unavailable. In terms of the early detection of prostate cancer, PSA has to be measured in patients with LUTS even when they visit physicians who are not urologists.
In our hospital, ultrasonography is performed for patients who come for thyroid cancer screening. Seventy-eight patients with thyroid cancer which was found by such screening were operated on from 1989 to 1998, while 287 patients with thyroid cancer found by other methods were operated on during the same period in our department. The age of the patients at surgery in the screening group was younger than that of the contrast group. In the screening group, 41 (52.6%) patients had small thyroid cancer, a higher rate that in the contrast group. Invasion of surrounding organs by the primary cancer was observed in only one patient (1.3%) in the screening group, a rate of invasion that was statistically lower than that in the contrast group. Twenty-six patients with benign thyroid disease detected in our screening were operated on during the same period. Careful selection of patients who need fine-needle aspiration cytology is demanded of head and neck surgeons, and careful evaluation of indicators is necessary to avoid surgery in the case of benign thyroid disease.
The recommended program of Child Health Care in Austria needs some additions: The first routine visit should be done between the 3rd and 5th week of life because of the insecurity of the young mother. The orthopedic examination must comprise the ultrasonographic examination of the hip. At 7-9 months of age the urinary screening for neuroblastoma must be incorporated into the existing program. The vaccination against haemophilus influenzae Type B must be added to the existing vaccination recommendations. During school age three additional examinations are recommended at 6, 10 and 15 years respectively.
Multiple other tests have been suggested for screening healthy patients. Hopefully, the above illustrations give a perspective with regards to the incidence of disease versus other causes that would lead to abnormal test results. The most frequent cause of an abnormal test result is physiologic variation, laboratory variation, or both. Even in laboratories with excellent quality assurance programs, the results falling outside the reference ranges most likely indicate physiologic variation, laboratory variation, or both. The physician will obtain more meaningful data from the laboratory when testing is ordered to confirm diagnostic suspicions that were raised during the history and physical examination of the patient. When a physician receives abnormal test results that were ordered as screening tests without any diagnostic suspicion, a search should be made for signs and symptoms that would correlate with that abnormal test. In the absence of any evidence that would indicate underlying disease, it would usually be unnecessary to pursue follow-up testing.
This article reviews the history of screening in the elderly, the conditions that should be considered, whether or not screening in the elderly is of benefit, whether we should look for disability or diseases and where screening should take place. Thirteen conditions are discussed: hearing loss and anaemia in some detail. Both disability and precise diagnostic criteria are considered. The place where screening is best carried out depends on the mobility of the subject and the nature of the particular screening tests selected for the 13 conditions. The desirability of screening was assessed on the following criteria: prevalence of the condition, severity of the problem, acceptability by the patient of the screening test, false positive rate, consequences of making a false positive diagnosis, the false negative rate and the consequences of this error, the effect of treatment, the cost of the screening test and the burden on the health services produced by the screening test. The criteria were scored 1-5 on a scale defined for each assessment, with higher scores favouring screening. We provide evidence that screening may be worthwhile for: need for chiropody, varicose veins/ulcer, hearing loss, obesity, visual impairment, hypothyroidism, hypertension, anaemia and diabetes mellitus. However, the assessments discussed in this paper need to be tested prospectively in randomised controlled trials.
BACKGROUND: Although the need for early identification and interventions of disabilities is evident, the current state of routine screening practice in Kenya needs intensive training of screeners before more rigorous techniques are introduced. OBJECTIVE: To compare the precision and practical utility of the 'ten questions' and EARC screens among the 2- 9 year olds in a community setting. METHOD: In this analytical comparative cross-sectional survey of two disabilities screening methods. multiphase sampling and multistage data collection procedures were employed. Quantitative research utilizing structured interview checklist was used for data collection. It described the prevalence rates of different types of disabilities using both methods. It analyzed the precision and practical utility of the two methods in a community setting. RESULTS: 64 of the 399 children under study were disabled (50.5% male and 49.5% female). The 'ten questions' picks up only those problems that are of great concern to families. EARC services are a more definite case defining process of measuring the existence and degree of disability in children. It screens the children who are severely disabled leaving out the mildly disabled and medical conditions which, when left untreated, could lead to possible disablement. CONCLUSION: Parents need to be sensitized about symptoms requiring the ten questions that can be used to screen out the potentially disabled children and the Education Assessment and Resource Centres (EARC) be used to diagnose the type and degree of the disability and refer the ill children for treatment. The basic needs of disabled children could be met in the community and do not require highly specialized personnel. They need to be localized and accessible.
The adverse effects of screening are not commonly studied. False-positive tests lead to discomfort, costs, and risks from additional diagnostic and therapeutic procedures. False-negative tests lead to a sense of security and delays in seeking medical help when symptoms develop. Labeling an individual with a false-positive test, or with a true-positive test for which there is no evidence that intervention makes a difference, e.g., intervention on an 80-year-old asymptomatic woman with hypercholesterolemia, can have a markedly negative impact on the quality of life. Interpreting statistical abnormalities out of clinical context, e.g., lending importance to a multiphasic blood screen showing "high" alkaline phosphatase in a teenager, leads to unnecessary costs and anxiety. The cost of screening programs that may not have been shown to do more good than harm is already having an impact on the resources available to diagnose and treatment symptomatic persons. Premature implementation of unproved screening programs will continue to decrease physician and public confidence in prevention.
The need for basic societal institutions to foster growth-enhancing and ego-strengthening experiences is highlighted. The ascendancy of Asklepios--as representative of the remedial, medical model--over Hygeia--symbolizing the preventive, public health approach--is traced from Hellenic mythology to present reality. The Hygeian merits of current early identification programs are considered, and means for moving them closer to the Hygeian ideal are suggested.
Fabry disease is an X-linked lysosomal disorder caused by the deficiency of the lysosomal enzyme alpha-galactosidase A (alpha-Gal A). In males, the laboratory diagnosis is based on the demonstration of decreased levels of alpha-Gal A activity, while in females, the disease is diagnosed by the identification of a mutation in alpha-Gal A gene. Fabry disease in Argentina is underdiagnosed. To date, no comprehensive screening study of Fabry disease in our country has been reported. The present study aimed at developing a targeted screening for the detection of Fabry patients from Argentina based on the set of typical signs and symptoms. We received 121 blood samples from probable Fabry patients for enzymatic and genetic assay. We diagnosed six Fabry patients from six unrelated families, representing a yield of detection of 4.96%. The mutations detected in five of the families analysed were missense mutations: p.Leu243Trp, p.Asp155His, p.Leu415Pro, p.Cys94Tyr and p.Leu191Pro. After the detection of a Fabry patient, his/her relatives were also screened. In the course of these family studies, other 64 Fabry patients, 29 males and 35 females, were detected. To our knowledge, this is the first comprehensive screening of Fabry disease in Argentina. We detected 70 patients in a period of 2.5 years. The development of targeted protocols and the constitution of interdisciplinary groups for the identification of patients with Fabry disease are recommended to obtain a higher yield in the process.
Chronic infection with Strongyloides stercoralis presents a diagnostic problem because of the low recovery of the organism from stools and the insensitivity of current serological tests. Of 150 former Far East POWs, 26 (17%) had S. stercoralis in stools. The clinical features in 18 stool-positive patients were compared to those in 24 stool-negative patients and showed that strongyloidiasis was associated with a higher frequency of alteration in bowel habit, upper abdominal discomfort, rash and eosinophilia. On the basis of these features, a screening index was devised which largely separated stool-positive and stool-negative patients and led to helpful therapy in three of four patients with compatible symptoms who lacked a definitive diagnosis. Treatment with thiabendazole appeared to be superior to treatment with mebendazole.
Health screening, health counselling, promotion of pupils and health reporting are the principal marks of school doctor's precautionary health care examinations. The appropriate documentation form must meet the basic requirements of the pupil, of the medical officer and of the evaluation programme. The general concept is realized in three steps: first, definition of the contents, second, operationalisation of the individual items and third, the definition of conventional documenting.
BACKGROUND: Transabdominal ultrasonography (US) has been widely accepted as a diagnostic method with which to examine multiple organs simultaneously. This study was designed to evaluate the efficacy of trans-abdominal US to screen for urogenital malignancies. METHODS: From 1993 through 1997 109,077 men and 28,023 women underwent abdominal US to screen for abdominal and pelvic diseases as part of a regular health check-up program at the Tokyu Medical Health Center. RESULTS: Twelve renal cell cancers (RCCs), 7 bladder tumors (BTs), 4 prostatic cancers (PCs), and 1 testicular tumor (TT) were detected. All cancers were diagnosed pathologically and treated surgically except for one PC. Surgical pathological examination and conventional imaging revealed that all 12 RCCa and 6 of the 7 BTs were of less advanced stage than pT1N0M0. However, all 3 PCs and the TT were pT3N0-1M0 and pT1N3M0, respectively. The stage and grade of these 12 RCCs were significantly lower than those of 29 symptomatic RCCs. All 12 patients with RCC patients and 6 of the 7 patients with BT had no urological symptom, whereas 3 of the 4 patients with PC and the patient with TT had urogenital symptoms. Microscopic examination of the urine revealed both red blood cells and tumors cells in two of the seven patients with BT. All four patients with PC had serum levels of prostatic-specific antigen greater than 4 ng/ml. CONCLUSION: These results indicate that screening by transabdominal US as part of regular health check-ups can detect many types of urogenital malignancy. In particular, US is useful for detecting low-grade and low-stage RCCs and superficial BTs but is less sensitive for early-stage PCs and TTs.
OBJECTIVE: In clinical settings, transvaginal ultrasound has been used to evaluate abnormal vaginal bleeding. Because the endometrium responds to estrogens, endometrial thickness may constitute a biomarker of estrogen status in postmenopausal women. This study aimed to validate the transvaginal ultrasonographic measurement of endometrial thickness as an estrogen biomarker in asymptomatic, postmenopausal women by demonstrating an association between endometrial thickness and risk factors known to be associated with estrogen exposure. METHOD: Endometrial thickness was measured in 1,271 women ages 55 to 74 years who underwent transvaginal ultrasound screening as part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. A questionnaire, completed before screening, provided risk factor information, including reproductive and hormone use histories. RESULTS: Endometrial thickness measurements ranged from 1 to 32 mm (median 3.0 mm). The frequencies of thicker endometrium (> or =3.0 mm), according to body mass index (BMI) quartile, were 55.2%, 66.1%, 69.7%, and 76.7% (P < 0.0001). The frequencies of thicker endometrium were 57.8%, 58.3%, and 82.6% among never users, ex-users, and current users of hormone replacement therapy (HRT), respectively (P < 0.0001). Other factors associated with thicker endometrium included age, marital status, history of uterine fibroids, years since menopause, and history of hypertension. Statistically significant associations were not seen in analyses limited to current HRT users (n = 461). In multiple variable analysis (R2 = 0.08), current HRT use (P < 0.0001) and higher BMI (P < 0.0001) were independently associated with thicker endometrium. CONCLUSION: In postmenopausal women, factors reflecting exogenous (current HRT use) and endogenous (BMI) estrogen exposure were associated with increased endometrial thickness as measured during screening transvaginal ultrasound. Practical limitations related to screening transvaginal ultrasound include measurement variability, lack of information regarding type or dose of HRT, and problems of differentiating true endometrial thickening from unrecognized endometrial polyps or fluid accumulations. Constrained by these limitations, these results partially validate a transvaginal ultrasound measurement of endometrial thickness as a potential biomarker related to estrogen status.
Employing 19 criteria the authors have elaborated simple formal diagnostic rules in tabulated and automated modes which help detect cerebrovascular diseases in the course of prophylactic check-ups of the population. The automated diagnostic variant includes the assessment of the questionnaire data, rheoencephalography and electrocardiography. The application of this variant has allowed the diagnosis of the disease in 95.4%. The system of automated diagnosis makes it possible to significantly increase the quality and efficacy of wide-scale prophylactic check-ups of the population.
The workplace has evolved as a venue for health promotion programs that attempt to reduce employees' risk behaviors and encourage positive health practices. There is little information about the efficacy of such programs for selected subpopulations of employees. Questionnaires designed to measure health practices were administered before and 10 weeks after a work-site health screening. Results indicated that subpopulations had distinctly different patterns of health behaviors both before and after the health screening, and the pattern of variability was inconsistent across various health practices. In general, females and salaried employees had healthier practices than males and hourly employees, respectively. Several interesting interactions between participation status and gender and occupational status need further investigation. Understanding health behaviors of subpopulations may provide insights for implementation of work-site programs that will enhance health-promoting behaviors of all employees.