Vision screening at 8 and 18 months. Steering Committee of Oxford Region Child Development Project.

OBJECTIVE--To determine the effectiveness of an existing screening programme based in the community for ocular and vision defects in infants considered at increased risk of such defects. DESIGN--Children with ocular or vision defect by the age of 2 were ascertained by searching records. Those from populations at high risk were matched with their results from screening tests. The characteristics of the cases among this population were compared with those of the cases in the remainder of the population. Patterns of referral and age at referral were studied in both groups. SETTING--The study was conducted within Oxfordshire Health District. SUBJECTS--433 Children at high risk born in 1984 to mothers living in the health district at delivery and who either weighed less than 2000 g or weighed 2000 g and over and required admission to a special care nursery for longer than 24 hours. The low risk population (6254) were infants without these characteristics who were resident in the health district at the time of referral. INTERVENTIONS--Screening tests for vision or ocular defects already routinely used were applied by health visitors at 8 and 18 months to the children at high risk. MAIN OUTCOME MEASURE--Comparison of results of screening tests with vision and ocular defects detected by the age of 2. RESULTS--Screening tests in current use for vision loss and squint in this age group were insensitive and had a low positive predictive value when applied to a high risk population. Defects that were not apparent on direct inspection were unlikely to be detected by these tests. In the high risk group the relative risk of having a defect was 2.8 (95% confidence interval 1.8 to 4.5) but 85% of all cases detected by the age of 2 were in children at low risk. Referral patterns and age of referral differed in the two groups. CONCLUSIONS--Screening by health visitors of high risk populations contributes little to the detection of vision and ocular defects. This type of evaluation needs to be applied also to low risk populations, who have different referral patterns and contribute most of the cases.     

Experimental design issues for the early detection of disease: novel designs

This paper investigates two experimental designs which have been used to evaluate the benefit of the early detection of breast cancer. They have some advantages over a classical design (the screening program versus usual medical care) in that subjects in a control group may benefit by participating in the study. We refer to the two experimental designs as the up-front (UFD) and close-out (COD) designs. The UFD consists of offering an initial exam to all participants. Then they can be randomized to a usual care group or a screening group receiving one or more special examinations. If the outcome of the initial examination is included in the analysis, then the study can answer the question of the benefit of an additional screening program after an initial examination. If the analysis excludes all the cases diagnosed at the initial examination, then the analysis evaluates the benefit of a screening program after elimination of the prevalent cases. These prevalent cases are most likely to be affected by length bias sampling and consequently will tend to have less aggressive disease and live longer. As a result, the UFD can answer two scientific questions. The COD consists of randomizing subjects to a usual care group and a screened group. However, the usual care group receives an examination which coincides at the time of the last exam in the study group. In this paper the power of these two designs have been evaluated. In both cases the power is severely reduced compared to the usual control group receiving no special exams. The power is a function of the sensitivity of the exam, the number and spacings of the exams given to the screened group as well as the sample size, disease incidence of the population and the survival distribution. The theoretical results on power are applied to the Canadian National Breast Cancer Study (ages 40-49) which used an UFD and the Stockholm Mammography Breast Cancer Screening Trial which utilized a COD.     

Target product profile for a dengue pre-vaccination screening test

With increasing geographic spread, frequency, and magnitude of outbreaks, dengue continues to pose a major public health threat worldwide. Dengvaxia, a dengue live-attenuated tetravalent vaccine, was licensed in 2015, but post hoc analyses of long-term data showed serostatus-dependent vaccine performance with an excess risk of hospitalized and severe dengue in seronegative vaccine recipients. The World Health Organization (WHO) recommended that only persons with evidence of past dengue infection should receive the vaccine. A test for pre-vaccination screening for dengue serostatus is needed. To develop the target product profile (TPP) for a dengue pre-vaccination screening test, face-to-face consultative meetings were organized with follow-up regional consultations. A technical working group was formed to develop consensus on a reference test against which candidate pre-vaccination screening tests could be compared. The group also reviewed current diagnostic landscape and the need to accelerate the evaluation, regulatory approval, and policy development of tests that can identify seropositive individuals and maximize public health impact of vaccination while avoiding the risk of hospitalization in dengue-naive individuals. Pre-vaccination screening strategies will benefit from rapid diagnostic tests (RDTs) that are affordable, sensitive, and specific and can be used at the point of care (POC). The TPP described the minimum and ideal characteristics of a dengue pre-vaccination screening RDT with an emphasis on high specificity. The group also made suggestions for accelerating access to these RDTs through streamlining regulatory approval and policy development. Risk and benefit based on what can be achieved with RDTs meeting minimal and optimal characteristics in the TPP across a range of seroprevalences were defined. The final choice of RDTs in each country will depend on the performance of the RDT, dengue seroprevalence in the target population, tolerance of risk, and cost-effectiveness.     

Screening for ovarian,prostatic, and testicular cancers.

Screening for cancer should not be offered routinely to a symptomatic people on a population basis unless it has been shown to be effective in reducing mortality in randomised controlled trials. A suitable screening test should have high sensitivity and specificity and a high positive predictive value. There is an ethical imperative to ensure that the benefit to each person from screening is likely to outweight the possible harm. Preliminary studies have identified suitable screening tests for ovarian cancer, and a randomised controlled trail is about to start. There is considerable controversy about whether to screen for prostatic cancer. Likewise, there is uncertainty about the best means of treating localised prostatic cancer. Screening for prostatic cancer raises important ethical considerations which should not be ignored. Testicular self examination is of unproved benefit. Although there is a need for education about the early signs and symptoms of testicular cancer to reduce delay at presentation, a case cannot be made for screening.     

Influence of non-steroidal anti-inflammatory drugs on the outcome of faecal occult blood tests in screening for colorectal cancer.

Non-steroidal anti-inflammatory drugs have been accused of causing false positive results in faecal occult blood tests for colorectal cancer. A study was therefore performed in 10,931 people undergoing faecal occult blood screening tests to assess the effect of these drugs on the predictive value of a positive test result. Those with a positive result were interviewed and a full drug history was taken before they underwent a full colorectal examination. Of the 455 people with a positive result, 50 were taking non-steroidal anti-inflammatory drugs: 10 (20%) had colonic neoplasia. Of the 405 who were not taking non-steroidal anti-inflammatory drugs, 129 (32%) had colonic neoplasia. These detection rates were not significantly different, and the predictive value of a positive result for an adenoma larger than 1 cm was 14% in the group not taking anti-inflammatory drugs and 26% in the group taking them (not significant). These results suggest that a finding of occult faecal blood cannot be attributed to upper gastrointestinal tract bleeding caused by non-steroidal anti-inflammatory drugs and should be followed by a thorough colorectal examination.     

Contact in context: does intergroup contact function (better) in high-threat contexts?

Are interpersonal contacts effective in reducing group threat and prejudice in all contexts? Studies have found that the contact effect is stronger in regions and countries where large immigrant populations contribute to high levels of contextual group threat This paper tests the robustness of the observed positive association between contextual-level group threat and contact effects by identifying three methodological reasons for why the association might be spurious: (1) a potential omitted variable bias; (2) a potential self-selection effect; and (3) a potential ceiling effect. Using the 2002 European Social Survey, we find that the positive association is indeed robust. We interpret this as evidence that contact effects are strongest in those European contexts where the need for improved intergroup relations between immigrants and natives is most dire.     

An age dependent stochastic model of periodic screening: Length bias at a prevalence screen

An age dependent stochastic model for the periodic screening of a progressive chronic disease is used to investigate the length bias phenomenon for the case of a single screen. The preclinical state sojourn time distribution is obtained for control group cases, cases detected at the screen, and interval cases which surface after the screen in the screened group within an evaluation trial setting. Properties of these distributions are compared among themselves and with those of the underlying population to investigate the magnitude and direction of the length bias. The effect upon length bias of the magnitude of the false negative probability, the length of followup, the age at screening, the variance of the preclinical state sojourn time, and the correlation between the sojourn times in the disease free and preclinical disease states are investigated. Numerical results indicate that certain combinations of correlation and age at screening can result in substantial length bias in either the positive or the negative direction. It is also apparent that use of the randomized trial design and a suitable age range for screening can help to eliminate most of the extreme or negative length bias effects.     

Group Music Training and Children's Prosocial Skills

We investigated if group music training in childhood is associated with prosocial skills. Children in 3^rd or 4^th grade who attended 10 months of music lessons taught in groups were compared to a control group of children matched for socio-economic status. All children were administered tests of prosocial skills near the beginning and end of the 10-month period. Compared to the control group, children in the music group had larger increases in sympathy and prosocial behavior, but this effect was limited to children who had poor prosocial skills before the lessons began. The effect was evident even when the lessons were compulsory, which minimized the role of self-selection. The results suggest that group music training facilitates the development of prosocial skills.     

360例肺癌患者血清TSGH检测的临床分析

目的探讨肿瘤特异性生长因子(TSGF)在肺癌患者中检测的诊断价值。方法采用TSGF检测试剂对360例确诊肺癌患者、170例肺部良性病患者和30例正常人的血清进行TSGF检测分析。结果360例肺癌患者,检出恶性TSGF,阳性315例,占87.5%;170例肺部良性疾病,阳性24例,占14.1%;30例正常人,阳性0例。其中,肺癌组与各组相比较,差异具有统计学意义。肺癌组的TSGF阳性率明显高于其他各组(P0.01)。结论检测血清TSGF可辅助肺癌的诊断,在正常人体检筛查肺癌中具有一定的价值。     

Cytogenetic analysis of peripheral blood lymphocytes in workers exposed to benzene

In the present study, the method of cytogenetic analysis of peripheral blood lymphocytes was used to investigate 66 workers exposed to benzene, and 20 individuals selected from general population from the same locality, not exposed to particular mutagenic or carcinogenic agents (control group). Altogether, 8,600 metaphases were analysed. Frequencies of aberrant cells, including chromatide and chromosomal breaks, and chromatide and chromosomal exchanges, were scored in both groups. A very slight increase in aberrant cell frequencies (2.152% aberrant cells) was observed in the professional exposure group as compared to the control group (1.6% aberrant cells). Increased frequencies of aberrant cells were found in smokers of both the benzene-exposed and the control group. The differences were however not significant. In addition to cytogenetic examination, the workers underwent a general examination of their health condition (preventive examination). Benzene exposure seemed to have no injurious effect on the state of health of exposed workers. Biochemical and haematological tests gave normal values.     

Further Observations on the Diurnal Variation in Oral Glucose Tolerance

Diurnal variation in oral glucose tolerance was studied in 122 male volunteers aged 40 yearsand over who participated in a screening health examination. In those with screening blood sugar levels exceeding 110 mg./100 ml. the degree of diurnal variation was least in those with the highest morning glycaemia; the latter also tended to have lower afternoon fasting bloodsugar levels.In a group of 40 control subjects, afternoon glucose tolerance tests yielded significantly higher post-glucose blood sugar levels. The degree of diurnal variation was significantly and inversely related to the degree of obesity.     

Risk-Specific Optimal Cancer Screening Schedules: An Application to Breast Cancer Early Detection

The optimal schedules for breast cancer screening in terms of examination frequency and ages at examination are of practical interest. A decision-theoretic approach is explored to search for optimal cancer screening programs which should achieve maximum survival benefit while balancing the associated cost to the health care system. We propose a class of utility functions that account for costs associated with screening examinations and value of survival benefit under a non-stable disease model. We consider two different optimization criteria: optimize the number of screening examinations with equal screening intervals between exams but without a prefixed total cost; and optimize the ages at which screening should be given for a fixed total cost. We show that an optimal solution exists under each of the two frameworks. The proposed methods may consider women at different levels of risk for breast cancer so that the optimal screening strategies will be tailored according to a woman’s risk of developing the disease. Results of a numerical study are presented and the proposed models are illustrated with various data inputs. We also use the data inputs from the Health Insurance Plan of New York (HIP) and Canadian National Breast Screening Study (CNBSS) to illustrate the proposed models and to compare the utility values between the optimal schedules and the actual schedules in the HIP and CNBSS trials. Here, the utility is defined as the difference in cure rates between cases found at screening examinations and cases found between screening examinations while accounting for the cost of examinations, under a given screening schedule.     

Clinical examination,xeromammography, and fine-needle aspiration cytology in diagnosis of breast tumours.

The diagnostic accuracy of clinical examination, xeromammography, and fine-needle aspiration cytology was compared with definitive histological findings in 255 breast lumps excised during one year. When suitable aspirates were obtained for cytological examination the diagnostic accuracy of aspiration cytology was higher than clinical examination or xeromammography. A diagnostic accuracy of 99% was achieved when all three screening tests were in agreement. As well as confirming a clinical diagnosis of malignancy, cytology is useful in identifying malignancy when clinical findings suggest that the tumour is benign. The availability of accurate cytology has affected patient management in many ways. Xeromammography did not enhance the diagnostic accuracy of clinical examination and aspiration cytology in patients presenting with a breast lump and, as a procedure with potential hazard, the benefit of routine xeromammography is questionable when an efficient cytological service is available.     

Human papillomavirus DNA and liquid-based cervical cytology cotesting in screening and follow-up patient groups

OBJECTIVE: To compare the use of human papillomavirus (HPV) DNA and cervical cytology cotesting in screening and follow-up of patients with previous cervical abnormalities and to assess the significance of a positive HPV DNA test result in re-screening of cytologically normal cases. STUDY DESIGN: Cellular samples collected in liquid-based fixative were used for both cervical cytology and HPV DNA testing. The cervical cytology slides were manually screened by cytotechnologists followed by rapid re-screening by pathologists. The HPV DNA tests were performed using hybrid capture test kits. Statistical analyses of cervical cytology results and HPV DNA tests for high- and low-risk HPV from both patient groups were carried out. RESULTS: The prevalence of HPV DNA-positive cases was higher in younger patients. There was a poor correlation between cervical cytology results and HPV DNA tests for the screening group (kappa = 0.23), but a fair to good correlation was obtained for the follow-up group (kappa = 0.51). The false negative fraction of cytology negative/HPV DNA positive cases (0.1317), as compared with cytology negative/HPV DNA negative cases (0.0056), was statistically significant (p = 0.000001). CONCLUSION: The prevalence of HPV DNA decreased with increasing age in both the screening and follow-up patient groups. Virus clearance was delayed in the follow-up group as compared with the screening group. There was a poor correlation between cervical cytology and HPV DNA tests in the screening group but a fair to good correlation in the follow-up patient group. Cotesting of HPV DNA and cervical cytology increases the sensitivity and decreases the false negative fraction, suggesting that cotesting could be used to increase the interval of screening.     

血清学指标检验在脂肪肝患者临床诊断中的应用价值研究

目的:探讨血清学指标检验在脂肪肝患者临床诊断中的应用价值。方法:收集2013年3月-2014年3月于我院接受治疗的脂肪肝患者42例,作为观察组;选取同一时间我院体检科健康查体者42例,作为对照组。比较两组血清学指标检验结果,并分析其在脂肪肝临床诊断中的价值。结果:观察组患者丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)水平明显高于对照组健康查体者,两组比较差异均具有统计学意义(t=11.42、13.17,P0.05);观察组患者血清甘油三酯(TG)、总胆固醇(TC)水平明显高于对照组健康查体者,两组比较差异均具有统计学意义(t=7.35、8.02,P0.05)。结论:血清ALT、AST、TG、TC指标在脂肪肝患者临床诊断中存在重要的临床应用价值,可作为临床监测脂肪肝的重要方法,值得推广。     

Testing the Independence of Two Diagnostic Tests

Consider two diagnostic procedures having binary outcomes. If one of the tests results in a positive finding, a more definitive diagnostic procedure will be administered to establish the presence or absence of a disease. The use of both tests will improve the overall screening sensitivity when the two tests are independent, compared with employing two tests that are positively correlated. We estimate the correlation coefficient of the two tests and derive statistical methods for testing the independence of the two diagnostic procedures conditional on disease status. The statistical tests are used to investigate the independence of mammography and clinical breast exams aimed at establishing the benefit of early detection of breast cancer. The data used in the analysis are obtained from periodic screening examinations of three randomized clinical trials of breast cancer screening. Analysis of each of these trials confirms the independence of the clinical breast and mammography examinations. Based on these three large clinical trials, we conclude that a clinical breast exam considerably increases the overall sensitivity relative to screening with mammography alone and should be routinely included in early breast cancer detection programs.     

Mortality modeling of early detection programs

Summary .   Consider a group of subjects who are offered an opportunity to receive a sequence of periodic special examinations for the purpose of diagnosing a chronic disease earlier relative to usual care. The mortality for the early detection group is to be compared with a group receiving usual care. Benefit is reflected in a potential reduction in mortality. This article develops a general probability model that can be used to predict cumulative mortality for each of these groups. The elements of the model assume (i) a four-state progressive disease model in which a subject may be in a disease-free state (or a disease state that cannot be detected), preclinical disease state (capable of being diagnosed by a special exam), clinical state (diagnosis by usual care), and a death state; (ii) age-dependent transitions into the states; (iii) age-dependent examination sensitivity; (iv) age-dependent sojourn time in each state; and (v) the distribution of disease stages on diagnosis conditional on modality of detection. The model may be used to (i) compare mortality rates for different screening schedules; (ii) explore potential benefit of subpopulations; and (iii) compare relative reductions in disease-specific mortality due to advances and dissemination of both treatment and early detection screening programs.     

Point-of-care salivary microbial tests for detection of cariogenic species — Clinical relevance thereof — <Emphasis Type="Italic">review</Emphasis>

Dental caries is a highly prevalent multifactorial disease that can result in serious health impairment. It was shown that oral bacteria play a significant role in caries development. Point-of-care (POC) salivary microbial tests for detection of cariogenic species have been investigated as a potential tool for caries risk assessment. This review aims to evaluate clinical relevance of these tests in the light of recent scientific evidence. Methodology involved PubMed search using key words salivary microbial tests, cariogenic bacteria and caries risk prediction. Articles obtained by the search were cross-referenced to obtain further sources. Specificity and negative-predictive value of these tests are higher than their sensitivity and positive value. Predictive power of the POC salivary microbial tests as a single predictor is generally weak, although it increases when included in multifactorial models for caries prediction. Literature findings support the use of these tests for screening of at-risk individuals in a population of young preschool children without visible caries and for motivation of subjects on individual level. POC salivary microbial tests are simple and inexpensive and, therefore, may be advantageous from public health perspective.     

Brucellosis and veterinary surgeons.

Forty-six veterinary surgeons were given a full clinical examination, serological examinations with estimates of immunoglobulins, and supplementary haematological and radiological investigations. Thirty-five complained of one or more symptoms, and eight had abnormal physical signs which might have been caused by infection with Brucella abortus, but neither sereological tests results nor immunoglobulin estimates bore any special relation to the clinical features. The soundest way of assessing ill health which had possibly been caused by brucellosis seemed to be thorough clinical examination and disregard of serologican findings. Interpreting results by the usual serological tests in the absence of a clinical examination is probably of doubtful value and may even be misleading.     

Assessing recreational benefits as an economic indicator for an industrial harbour report card

Industrial harbours are a complex interface between environmental, economic and social systems. Trying to manage the social and economic needs of the community while maintaining the integrity of environmental ecosystems is complicated, as is the identification and evaluation of the various factors that underpin the drivers of economic, community and resource condition. An increasingly popular strategy to deal with the identification and evaluation challenges in complex human-environmental systems is to use a report card system which can be used as a summary assessment tool to monitor the health of aquatic ecosystems. To date though these have largely focused on environmental factors, and it is only very recently that attempts are being made to include social, cultural and economic indicators. There has been limited consensus in the selection of social and economic indicators applied in different aquatic report cards but as recreation is such an important activity, typically some measure of recreation benefit is included. However, there has been no commonality in the measures applied to assess its performance as an economic indicator.This paper is focused on the assessment of recreational benefits as an indicator of economic value in the report card for Gladstone Harbour in Queensland, Australia. It is the first aquatic health report card to include an assessment of the nonmarket value of recreation which makes it a more comprehensive indicator of economic value compared to other report cards based on measures of employment, participation or expenditure. There have now been three consecutive years of reporting (2014–2016) of the Gladstone Harbour report card, and the results indicate that the recreation index appears to be effective in monitoring changes over time.