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PubMed2002

Preliminary findings of adult health screening under national health insurance in Taiwan.

OBJECTIVES: To provide baseline values of health elated parameters for the Taiwanese population. METHODS: A systematic sample of 9016 out of 692,311 persons undergoing health check-ups is analyzed and described, and compared to a similar survey undertaken ten years ago. Some physical indices and lab tests exhibited significant age and sex related differences. RESULTS: The prevalence of groups of diseases, and the distribution of test results by age and sex are reported and compared to other studies. CONCLUSIONS: Compared to the survey conducted ten years ago, Taiwanese adults are taller and heavier, but not necessarily healthier.

Adult↗
PubMed2005

[Renal hemangiopericytoma discovered at a health screening: a case report].

We report a case of renal hemangiopericytoma which was incidentally discovered by ultrasonography at a health screening. A 58-year-old man was admitted to our hospital for close examination of the renal tumor. Computed tomography revealed the left renal tumor, 60 x 50 mm in size, which was well enhanced with contrast medium. Magnetic resonance imaging revealed an isointensity mass (T1-weighted) and high-intensity mass (T2-weighted) at the left kidney. Radical nephrectomy was performed on suspicion of left renal cell carcinoma. Histopathological examination revealed renal hemangiopericytoma. The present case is the 7th in the Japanese literature.

Hemangiopericytoma↗
PubMed1998

Urine-based screening of adolescents in detention to guide treatment for gonococcal and chlamydial infections. Translating research into intervention.

OBJECTIVES: To determine the utility of urine-based ligase chain reaction assays for Neisseria gonorrhoeae and Chlamydia trachomatis in (1) the acceptability of such testing to adolescent detainees, (2) the potential use of these tests for identifying asymptomatic infections, and (3) the effectiveness of this approach for ensuring treatment of infected adolescents. DESIGN: Cross-sectional screening and verification of treatment for infected cases. SUBJECTS: Adolescents admitted to a short-term juvenile detention center. MAIN OUTCOME MEASURES: Neisseria gonorrhoeae and C trachomatis infection rates, and timing and location of treatment for infected patients. RESULTS: Refusal rate was 1.5%. Of 263 participants, 46 (17.5%) were female subjects. Chlamydia trachomatis infections were identified in 28.3% of the female and 8.8% of the male subjects. Neisseria gonorrhoeae infections were present in 13.1% of the female and 2.8% of the male subjects. Overall, 37 participants (14%) were positive for N gonorrhoeae, C trachomatis, or both, only one of whom had symptoms. Almost 70% (25/36) of asymptomatic infected subjects were treated within 28 days of screening. A treatment was documented in 36 of the 37 infected youth, including 20 who were followed up and treated after release from the detention center, by 6 months after testing. CONCLUSION: Urine ligase chain reaction tests were effective for identifying and guiding treatment of unsuspected N gonorrhoeae and C trachomatis infections in teenagers admitted to a short-term detention center where traditional swab specimens may be difficult to obtain.

Adolescent↗
PubMed1990

The sixth stool guaiac test: $47 million that never was.

In a 1975 paper, Neuhauser and Lewicki analysed a colorectal cancer screening policy approved by the American Cancer Society. Their analysis yielded an incremental cost per case detected in excess of $47 million. This vivid demonstration of the impact of marginal analysis is frequently cited by health economists and is often used for pedagogic purposes. The analysis is incorrect because of two fundamental errors. We have reanalysed the protocol in two stages. After correction for these errors, the $47 million disappears, the marginal cost is quite modest and the policy appears to be defensible on economic grounds.

American Cancer Society↗
PubMedDate not supplied

Medical screening in the emergency department for psychiatric admissions: a procedural analysis.

Patients who are admitted to psychiatric inpatient wards often undergo a medical screening examination in the emergency department to rule out serious or underlying medical conditions that may be better treated elsewhere. Unfortunately, prior research has been conflicting on the relative merits of various screening procedures, making it difficult to implement guidelines. A systematic review of the literature was undertaken to research the current state of knowledge in medical screening procedures. Electronic searches were conducted in PubMed, MEDLINE, and the Cochrane Library for publication years 1966-2003. No restrictions were placed on language or on quality of publications. Twelve studies were found that reported specific yields of various screening procedures. Results indicate that medical history, physical examination, review of systems, and tests for orientation have relatively high yields for detecting active medical problems in patients presenting with psychiatric complaints. Routine laboratory investigations generally have a low yield for clinically significant findings. However, these should be added selectively for four groups at higher risk of serious medical conditions, i.e., the elderly, substance users, patients with no prior psychiatric history, and patients with preexisting medical disorders and/or concurrent medical complaints.

Acute Disease↗
PubMed1989

Physical illness in chronic psychiatric patients from a community psychiatric unit. The implications for daily practice.

The prevalence and significance of physical diseases, and health-care-seeking behaviour, were examined in a sample of 218 chronic psychiatric patients from an urban community psychiatric unit. Only 14% declined medical screening. Of the respondents, 53% had one or more probable or certain physical diseases warranting further medical attention. The majority of the diseases found were minor and typical of primary care problems. A severe (i.e. life-threatening) disease was present in 7% of respondents. Of the patients, 87% visited their GP at least once a year. The implications are that frequent consultation with primary care specialists and health-care-seeking behaviour should be noted, and included in any evaluation of the medical needs of chronic patients in community psychiatric care.

Community Mental Health Centers↗
PubMed2004

You can't prevent everything anyway: a qualitative study of beliefs and attitudes about refusing health screening in general practice.

OBJECTIVE: The aim of this study was to explore beliefs and attitudes about refusing health screening in general practice. METHODS: In 1991, in Ebeltoft, Denmark people aged between 30 and 50 years were invited to participate in a 5-year randomized, controlled, population-based project testing the value of health screenings and health discussions in general practice. In 1994, non-participants who declined the offered health screening but expressed willingness to be contacted in the future were asked to participate in a qualitative interview. They were drawn by stratified purposeful sampling which reflected variation in perceived health, body mass index, age and sex. The sample comprised six men and 12 women RESULTS: Some had not participated because they were busy, felt healthy or had recently been examined. The non-participants emphasized the limitations of health screening and did not want possible risk factors to be revealed, or their feeling of good health to be disturbed. They stressed the individual's own responsibility for maintaining good health and believed that a positive attitude promoted health. They would contact their GP if they had symptoms. CONCLUSION: Non-participants have rational views on risk factor testing and on their own responsibility for maintaining health. Non-attendance was due to a conscious choice which included consulting their own GP.

Adult↗
PubMed1998

The level of preventive health care in an internal medicine residency clinic: still only an ounce of prevention?

BACKGROUND: Clinical prevention is a critical component of primary care residency training. How well residents do preventive services is one measure of the adequacy of their training. METHODS: To assess the level of preventive health care in a university internal medicine residency clinic, we conducted a randomized retrospective review of 225 patient records. RESULTS: We documented preventive services in only 39% of potentially appropriate instances. Cholesterol screening occurred in 53% of eligible cases, breast examination in 41%, mammogram in 69%, Papanicolaou's smear in 53%, estrogen replacement therapy (ERT) in 41%, fecal occult blood testing in 30%, flexible sigmoidoscopy in 18%, influenza vaccination in 65%, pneumococcal vaccination in 44%, and tetanus immunization in only 9%. Male residents were significantly less likely than females to order mammograms or offer ERT. CONCLUSIONS: Compared to earlier studies of similar design, we found that the level of preventive health care has improved during residency training, but remains unacceptably low.

Adult↗
PubMed1970

Experience with a hospital laboratory admission screen.

A comprehensive laboratory admission screen can be instituted in any large laboratory but only in one in command of conventional technology and with the co-operation of the laboratory, medical, nursing and admitting staff.The capital equipment required is costly and subject to early obsolescence. The operating costs are initially high, but the influence of the screen on the general work load indicates that the total overall procedures ordered by the physician will be reduced in number and that over a three-year period, in an economy subject to continuous inflationary pressure, the total cost will approach what might have been expected had the screen not been instituted.By presenting, shortly after admission, a truly comprehensive laboratory profile, the total number of procedures ordered will be reduced and this reduction bears no relationship to whether or not the data supplied are medically useful.The equipment more recently available for a large admission screen is far superior, from the point of view of speed of assay and cost of maintenance and production, to the equipment that has been available to us in this study.It is believed that the unit cost of assay will continue to decline and that the principle of unsolicited testing will be expanded in the future to include procedures not presently in the profile.It is predicted that in the relatively near future almost all of the laboratory procedures that a clinician could conceivably request will have been done prior to his examination of the patient.

Autoanalysis↗
PubMed1998

Somali refugee health screening in Hennepin County.

Somalis are one of the newest refugee groups to settle in Minnesota, first arriving in 1993. The largest number of Somali refugees in Minnesota live in Hennepin County, which received 85% of the state's Somali refugees in 1996. In this population, tuberculosis, parasitic diseases, and malaria are of particular concern. In 1996 Somalis accounted for 27% of the foreign-born cases of tuberculosis in Minnesota. Before entering the United States, all refugees are given an overseas health assessment, which focuses on identifying conditions that might be contagious. The examination is limited and is valid for one year. Domestic refugee health assessment is very important, since it provides a comprehensive medical evaluation and treatment plan for health conditions that may interfere with successful resettlement.

Communicable Disease Control↗
PubMed2002

[Prevalence of emphysematous changes as shown by low-dose spiral CT screening images in 6144 healthy subjects].

We assessed the prevalence of emphysematous changes among healthy workers and retired persons, using subjective evaluations of low-dose spiral CT images obtained during thoracic CT screenings for lung cancer. Among 6144 male participants (50-69 years old; mean age, 57), we detected 686 cases (11.2%) with emphysematous changes. The majority (95.3%) of CT-detected emphysema cases were in current or former smokers, and 169 cases (24.6%) showed significant obstructive impairment. Of 236 cases with emphysematous changes in the internal region (more than 20 mm from the costal margin), 98(41.5%) had significant obstructive impairment. Smoking was found to be the major risk factor for CT-detected emphysema. Longitudinal observation of the emphysema cases, as well as health care support for cessation of smoking, is very important.

Aged↗
PubMed2004

[Health situation of and health service provided for adult migrants--a survey conducted during school admittance examinations].

BACKGROUND: In spite of the increasing numbers of migrants in Germany, only few epidemiological studies have been carried out to investigate the health status of ethnic minorities in Germany. Results from national and international studies on the health of immigrants are inconsistent showing either increased or decreased morbidity in relation to native inhabitants. A survey was undertaken to study the self-reported health status, help-seeking behaviour, and health care utilization among immigrants and Germans. METHODS: 565 adults (276 immigrants and 289 Germans, 97% parents) in Bielefeld, Germany, were interviewed while they accompanied children who attended the pre-school medical examinations. In the analysis descriptive statistics and logistic regression models were used. RESULTS: The self-reported general health status of the study population was good for Germans and immigrants. Germans utilized health care facilities and preventive programmes (e. g. screening programmes) more frequently than immigrants. Furthermore, Germans reported higher levels of satisfaction with health care and a higher level of knowledge about several diseases as compared to immigrants. Logistic regression models indicate that neither migration itself (OR = 0.7, 95% CI = 0.4 - 1.1) nor socio-economic factors (OR for low vs. high social level = 1.2, 95% CI = 0.6 - 2.4) were significantly associated with physical diseases among the study population. CONCLUSIONS: We found no indications that immigrants are less healthy compared to Germans. Further investigations are needed to clarify the differences in patterns of health care utilisation and participation in preventive programmes among Germans and ethnic minorities.

Adult↗
PubMed1991

[A prospective trial of the mass survey for pancreatic cancer using serum markers and ultrasonography].

We designed a prospective trial of the mass survey for pancreatic disease, especially pancreatic cancer in consecutive 2576 subjects undergoing periodical health examination during 1989. In order to detect abnormality of the pancreas we measured serum amylase, elastase-1 and SPan-1 as serum markers and used ultrasonography (US). When abnormal elevation of serum markers or abnormal findings of US were obtained at the first screening, re-examination or further examination using ERCP, CT and endoscopic US were performed. Frequencies of elevated amylase, elastase-1 or SPan-1 were 0.9%, 3.4% or 1.7%, respectively. However, no pancreatic diseases were detected among the cases of elevated serum markers after subsequent further examination. Frequency of abnormal US findings of pancreas were 2.3% (59/2576), including dilatation of main pancreatic duct, cystic lesion, space occupying lesion and calcification. Subsequent further examinations on subjects with abnormal US revealed 8 cases of pancreatic diseases including one small pancreatic cancer. US may be an efficient tool of mass survey for pancreatic cancer in the health examination at present.

Adult↗
PubMed2003

[Analysis of dot-like hemosiderin spots using brain dock system].

BACKGROUND AND PURPOSE: Dot-like low intensity spots (a dot-like hemosiderin spot: dotHS) on T2*-weighted MR images (T2*WI), which is regarded as a sensitive method for hemosiderin detection, have been histologically diagnosed as old microbleeds associated with microangiopathies. The clinical significance of the dotHS, however, is still under debate. Therefore, we investigated the factors associated with dotHS. METHODS: We investigated 209 healthy volunteers in our hospital (sex: 106 males, 103 females; age: 38 to 78 years old, mean age: 56.4 +/- 8.3 years old) using "Brain Dock", a formalized screening system for asymptomatic brain diseases. The Odds ratio (OR) was estimated from multiple logistic regression analyses using the dotHS and variables. RESULTS: T2*WI demonstrated dotHS in 7.7% of volunteers, and the mean number of dotHS was 0.16 +/- 0.78. The hemosiderin was preferentially deposited in the basal ganglia and thalamus. Age > or = 65 years old (OR: 5.9; 95% confidence interval [CI]: 1.4-25.9; p = 0.02), hypertension (OR: 7.0; 95% CI: 1.4-34.7; p = 0.02), and headache (OR: 5.8; 95% CI: 1.4-24.6; p = 0.02) were all found to be independently associated with dotHS. CONCLUSIONS: The dotHS was significantly associated with several factors, including age, hypertension and headache.

Adult↗
PubMed2004

[Cardiovascular risk stratification in general practice].

CONCLUSION: The ESC risk charts are helpful to identify high risk patients in general practice who are candidates for preventive treatment. The use of the ESC charts is one important step to initiate "evidence based medicine" in the daily practice of preventive cardiology.Cardiovascular diseases are the most important causes of premature disability and death in Germany. High risk patients however are frequently not recognized. A systematic risk stratification in general practice could identify high risk persons and allow a cost effective treatment approach. The goal of the CAD-scoring week was to identify high risk persons with the use of the ESC risk charts and to evaluate the treatment resulting from risk stratification. In addition the feasibility of the risk charts in daily office routine was to be evaluated. A total of 1122 of 20 000 (5.6%) contacted general physicians agreed to participate in the screening procedure. More than 27 000 patients (> 50 yrs) were evaluated using the ESC risk charts. 21.6% of women (n = 15 018) vs 22.2%* of men (n = 12 361) had markedly elevated blood pressure (> 150 mmHg), 29 vs. 24%* had a total cholesterol > 250 mg/dl (6.5 mmol/l), 25.5 vs 29.9%* smoked and 28.4 vs. 31.9%* had diabetes (*female vs male: p < 0.0003). Altogether 19.4% of women vs. 53% of men were newly identified as high risk patients (risk > 20% in 10 years). More than 40% of these high risk patients received drug treatment for prevention (ASA, lipid lowering drugs or ACE inhibitors). More than 70% of the participating physicians judged the risk charts to be helpful in patient management.

Adult↗
PubMed1995

[Clinical course of a HIV-seropositive patient with thrombocytopenia and hypergammaglobulinemia who was initially screened by annual complete physical examination].

A 57-year-old man was admitted because of hypergammaglobulinemia which was initially pointed out by annual complete physical examination. No significant abnormal findings were observed except polyclonal hypergammaglobulinemia at that time (IgG; 2,662 mg/dl, IgA; 422 mg/dl). Seven months later, he has progressed to show thrombocytopenia. The laboratory data showing the reduction of peripheral CD 4-positive T cells (CD 4; 0.2 x 10(9)/l, CD 4/8 ratio; 0.19) and positive serum HIV antibody revealed that his hypergammaglobulinemia and thrombocytopenia were resulted from HIV infection. The peripheral platelet count decreased to 28 x 10(9)/l at minimal point, however, it recovered to 160 x 10(9)/l within 7 months without treatment. His good performance status has been still maintained over 4 years. His whole clinical course suggests that there is no significant correlation between peripheral platelet counts, serum gammaglobulin levels or the amounts of PAIgG in this case. This case proposes that we should also consider a possibility of HIV infection for the patients showing hypergammaglobulinemia.

HIV Seropositivity↗
PubMed1982

Main principles of a selective (single-disease) screening and scoring system for prematurity.

The main principles for preparation of both a simple screening and of the more complex scoring systems are demonstrated by means of comparison of papers performing the prediction of the risk of premature delivery in different ways. The reliability of prediction, that is different for the risk of an individual and of a group, depends on the adherence to these principles. The mode of use of some of these principles is demonstrated by means to data obtained from the own epidemiologic study. The histograms document an objective possibility of assessment of the borderline of risk for the risk factors characterized by a numerical joint sequence. On the basis of calculation of the actual risk of some risk factors together with assessment of their frequency in the population and of their treatability it is possible to differentiate objectively to which of them the intervention strategy has to be focussed primarily in order to decrease the frequency of prematurity.

Adolescent↗
PubMed1989

A medical algorithm for detecting physical disease in psychiatric patients.

An algorithm for screening psychiatric patients for physical disease was empirically derived from a comprehensive assessment of 509 patients in California's mental health system. The first 343 patients were used to develop the algorithm, and the remaining 166 were used as a test group. Calculations were made for several versions of the algorithm, and the data were compared with the diagnoses listed in the patients' admission mental health record. The algorithmic procedure was more accurate and more cost-effective than the medical evaluation procedures used by the state mental health system. When applied to the test group, the algorithm detected up to 90 percent of patients who had an active, important physical disease at a cost of $156 per patient. The mental health system had detected 58 percent of test-group patients with a disease at a cost of $230 per patient.

Algorithms↗