Changes In Diagnostic Methods Research Articles

The effect of changing diagnostic method from culture to PCR on the number of episodes of human campylobacteriosis in Denmark: a retrospective study (2015-2022).

This study is important because it shows the potential epidemiological silence associated with the use of culture as the primary diagnostic method for the laboratory identification of human campylobacteriosis. Also, we show how polymerase chain reaction methods are associated with a systematic increase in the number of human campylobacteriosis episodes as reported by routine disease surveillance. These findings are operationally relevant and have public health implications because they tell how crucial it is to consider changes in diagnostic methods, e.g., in the epidemiological analysis of historical data and in the interpretation of future data in light of the past. We also believe that this study highlights how the synergy between microbiology and epidemiology is essential for disease surveillance.

Healthcare spaces for autism spectrum disorder - removing barriers for mental disability

Abstract Mental impairments diagnoses are increasing, due to changes in incidence and prevalence and increased changes in diagnostic methods. Among them, Autism Spectrum Disorder (ASD) is now diagnosed in one child on fifty- nine during scholar and pre-scholar age: this will make them frequently visitors of healthcare and therapeutic structures since childhood. Sensorial hypo- or hyper-activation is one of the principal features that can affect the wellbeing of people with ASD, causing discomfort. Sounds, lights, colours, smells, shapes and surfaces should be carefully chosen in order to design as much as possible an “Autism-friendly space”, that could be also a healing space that helps handling sensorial stimuli inside stressful healthcare environments. At the moment, among literature there are just few contributions that analyse the impact of built environment on ASD users, and there are no insights about healthcare spaces. Despite these gaps, there are still no guidelines provided by institutions to set design standards and guide designers, architects or caregivers in the project phase. The goal of the research is to provide a specific evaluation tool for healthcare spaces and best practices formulation, validated in collaboration with stakeholders and ASD users through a co-design approach. These design strategies will be subsequently applied, improving two study-case environments, in order to compare the different outcomes on user's wellbeing and compliance.

Do changes in STEC diagnostics mislead interpretation of disease surveillance data in Switzerland? Time trends in positivity, 2007 to 2016.

BackgroundLaboratory-confirmed cases of Shiga toxin-producing Escherichia coli (STEC) have been notifiable to the National Notification System for Infectious Diseases in Switzerland since 1999. Since 2015, a large increase in case numbers has been observed. Around the same time, syndromic multiplex PCR started to replace other diagnostic methods in standard laboratory practice for gastrointestinal pathogen testing, suggesting that the increase in notified cases is due to a change in test practices and numbers.AimThis study examined the impact of changes in diagnostic methods, in particular the introduction of multiplex PCR panels, on routine STEC surveillance data in Switzerland.MethodsWe analysed routine laboratory data from 11 laboratories, which reported 61.9% of all STEC cases from 2007 to 2016 to calculate the positivity, i.e. the rate of the number of positive STEC tests divided by the total number of tests performed.ResultsThe introduction of multiplex PCR had a strong impact on STEC test frequency and identified cases, with the number of tests performed increasing sevenfold from 2007 to 2016. Still, age- and sex-standardised positivity increased from 0.8% in 2007 to 1.7% in 2016.ConclusionIncreasing positivity suggests that the increase in case notifications cannot be attributed to an increase in test numbers alone. Therefore, we cannot exclude a real epidemiological trend for the observed increase. Modernising the notification system to address current gaps in information availability, e.g. diagnostic methods, and improved triangulation of clinical presentation, diagnostic and serotype information are needed to deal with emerging disease and technological advances.

Multiple sclerosis - a review.

Multiple sclerosis (MS) is the commonest non-traumatic disabling disease to affect young adults. The incidence of MS is increasing worldwide, together with the socioeconomic impact of the disease. The underlying cause of MS and mechanisms behind this increase remain opaque, although complex gene-environment interactions almost certainly play a significant role. The epidemiology of MS indicates that low serum levels of vitamin D, smoking, childhood obesity and infection with the Epstein-Barr virus are likely to play a role in disease development. Changes in diagnostic methods and criteria mean that people with MS can be diagnosed increasingly early in their disease trajectory. Alongside this, treatments for MS have increased exponentially in number, efficacy and risk. There is now the possibility of a diagnosis of 'pre-symptomatic MS' being made; as a result potentially preventive strategies could be studied. In this comprehensive review, MS epidemiology, potential aetiological factors and pathology are discussed, before moving on to clinical aspects of MS diagnosis and management.

An evaluation of the diagnostic methods in head and neck cancer of unknown primary site

Background: Various detection methods to identify the primary in head and neck cancer of unknown primary (HN-CUP) require evaluation to improve and standardize management.Objectives: To evaluate the use of different diagnostic methods, which aim at decreasing the incidence of HN-CUP.Material and methods: We conducted a retrospective analysis of patients with HN-CUP at the Helsinki University Hospital during 1995–2011. We evaluated clinical assessment, definitive treatment, histopathology, and follow up. We analyzed the success in identifying the primary site to show any changes in diagnostic methods over time.Results: Frequency of HN-CUP and success in identifying the primary site have remained constant despite the addition of PET-CT and determination of human papilloma virus (HPV) status in diagnostics. Among 133 patients, the diagnostic work up identified the primary site in 53% and the oropharynx predominated (69%). This left 85 patients with HN-CUP and 5-year overall and disease-free survival rates were 71 and 69%, respectively.Conclusions: Panendoscopy including tonsillectomy should not be omitted in the work up.Significance: We demonstrate a steady frequency of HN-CUP and constant success in identifying the primary site. Detection of a primary later in the follow up did not impact the survival.

Temporal trends in incidence and outcome of hydatidiform mole: a retrospective cohort study

Background: Reported incidence rates of hydatidiform mole (HM) show wide geographic and temporal variations, making reliable international comparisons difficult. The aim of the current study was to examine temporal trends in the incidence of HM and post-molar gestational trophoblastic neoplasia (GTN) in Stockholm County.Material and methods: Data of all women with a diagnosis of HM in Stockholm County 1991–2010 was collected. The incidence of HM was assessed both in relation to number of births and viable conceptions (births and pregnancy terminations). The risk of post-molar GTN was analysed for all HM, as well as for the subtypes complete (CHM) and partial hydatidiform mole (PHM). Temporal trends were analysed by stratifying the study period into five-year intervals.Results: The overall incidence rate of HM was 2.08/1000 deliveries and 1.48/1000 viable conceptions. A significant temporal increase in the incidence rate of HM, as well as in the total number and proportion of PHM, was seen. Among 956 women with HM, 77 (8%) progressed into post-molar GTN. There was evidence of a slight, but non-significant increase in the risk of malignancy in the two last five-year periods under study.Conclusions: We found evidence of a significant temporal increase in the incidence rate of HM, which could not fully be explained by an increase in maternal age over time. Changes in diagnostic methods probably contributed to the increased incidence rate of PHM. The risk of post-molar GTN remained constant over time.

The Rise of Imported Dengue Infections in Victoria, Australia, 2010–2016

Dengue notifications have increased dramatically over the past seven years in Victoria, Australia—a trend which has been seen nationally and reflects increased cases internationally. We reviewed the epidemiology of dengue among Victorian travellers, changes in diagnostic methods and describe the burden placed on local health systems resulting from this disease of public health importance. Cases of dengue notified to the Department of Health and Human Services in Victoria, Australia, between 1 January 2010 and 31 December 2016 were included in this review. Demographic, clinical, diagnostic methods, and risk factor data were examined using descriptive epidemiological analyses. Cases of dengue increased on average by 22% per year, with a total of 2187 cases (5.5 cases/100,000 population) notified over the 7-year reporting period. The most frequently reported country of acquisition was Indonesia (45%) followed by Thailand (14%). The use of multiple diagnostic methods, including the non-structural protein 1 antigen (NS1Ag) detection test, increased over time. The median time between onset of illness and diagnosis diminished from 9 days (IQR: 2–15) in 2010 to 4 days (IQR: 2–7) in 2016. Proportionally more cases were discharged directly from emergency departments in recent years (10% in 2010 to 28% in 2016, p < 0.001).The increasing incidence of dengue in Australia is reflective of its growing prominence as a travel medicine problem in western countries. For travellers with non-severe dengue, the improved timeliness of dengue diagnostics allows for consideration of best practice ambulatory management approaches as used in endemic areas.

National trends in incidence and survival of chronic lymphocytic leukemia in Norway for 1953-2012: a systematic analysis of population-based data.

Chronic lymphocytic leukemia is a disease of the elderly, and despite major advances in treatment, remains incurable. The Cancer Registry of Norway has registered data on patients with chronic lymphocytic leukemia since 1953. We aimed to analyze trends in incidence and survival of chronic lymphocytic leukemia in Norway. We identified 7664 patients reported with chronic lymphocytic leukemia to the registry between 1953 and 2012. We gathered information on sex, age at diagnosis, date of death and basis for diagnosis. The age‐standardized incidence increased from 0.6/100.000 person‐years in 1953 to 3.1/100,000 person‐years in 2012. We found a significant decrease in median age between 1993–2002 and 2003–2012 (75 vs. 72 years, 95%CI: 2.52–3.98, P < 0.001). Men were diagnosed at a significantly younger age than women. Immunophenotyping has become the most important diagnostic method after 2002. Median observed survival increased from 3 years in 1952–1963 to 8.5 years in 2003–2012. Five‐ and 10‐year age‐standardized net survival increased throughout the whole period across age groups and reached 79% and 57%, respectively. Median observed survival was significantly shorter in men than in women in 1993–2002 (4.9 vs. 6.1 years, P < 0.001). The gap between survival rates for men and women was diminishing in 2003–2012 in patients younger than 60 years while it remained considerable in older patients. Despite an aging Norwegian population, chronic lymphocytic leukemia (CLL) patients become younger at diagnosis. A fourfold increase in incidence, a prolonged survival, and major changes in diagnostic methods in Norway were observed.

Surveillance of Infectious Diseases by the Sentinel Laboratory Network in Belgium: 30 Years of Continuous Improvement.

In 1983 the sentinel laboratory network was established because of the need to describe the epidemiological evolution of infectious diseases. During the study period of 30 years (1983–2013), microbiology laboratories reported on weekly basis the laboratory diagnosed cases for a selection of infectious diseases. This resulted in a large longitudinal laboratory based database allowing to provide trends over time and distribution by person and place. During this period, adaptations to data collection were made due to changes in diagnostic methods and public health priorities, introduction and application of digital revolution, and multiple reorganizations of the laboratories. Since the surveillance network is dynamic, it necessitates a continuous evaluation to ensure that, over time, it continues to be representative of the general epidemiological trends in the country. Secondly the aim is to examine the robustness and stability of this surveillance system. Here we demonstrated that the flexibility of the data collection methodology by the sentinel laboratory network is unique and that adaptations do not affect the capacity of the system to follow trends. Therefore, the surveillance by this network is representative of the current epidemiological situation in Belgium. To our knowledge, no such surveillance network with such a long-term follow-up and demonstrated stability for multiple infectious diseases in the general population was earlier described. Furthermore, expected trends due to the implementation of vaccination or other events were accurately detected. The collected data obtained from this network allows interesting comparisons with other national and international information sources.

Forty Years of Dengue Surveillance at a Tertiary Pediatric Hospital in Bangkok, Thailand, 1973-2012.

Long-term observational studies can provide valuable insights into overall dengue epidemiology. Here, we present analysis of dengue cases at a pediatric hospital in Bangkok, Thailand, during a 40-year period from 1973 to 2012. Data were analyzed from 25,715 hospitalized patients with laboratory-confirmed dengue virus (DENV) infection. Several long-term trends in dengue disease were identified including an increase in mean age of hospitalized cases from an average of 7-8 years, an increase after 1990 in the proportion of post-primary cases for DENV-1 and DENV-3, and a decrease in the proportion of dengue hemorrhagic fever and dengue shock syndrome cases in primary and post-primary cases over time. Exploratory mechanistic analysis of these observed trends considered changes in diagnostic methods, demography, force of infection, and Japanese encephalitis vaccination as possible explanations. Thailand is an important setting for studying DENV transmission as it has a "mature" dengue epidemiology with a strong surveillance system in place since the early 1970s. We characterized changes in dengue epidemiology over four decades, and possible impact of demographic and other changes in the human population. These results may inform other countries where similar changes in transmission and population demographics may now or may soon be occurring.

Changes in Diagnostic Methods for Pulmonary Tuberculosis between 2005 and 2013.

BackgroundDiagnostic methods for pulmonary tuberculosis (TB) have recently advanced. The aim of this study was to evaluate the changes in TB diagnostic tests that prompted the initiation of anti-TB treatment over time in South Korea, an industrialized country with an intermediate TB burden.MethodsPatients diagnosed with pulmonary TB in the first halves of 2005 and 2013 at a tertiary referral hospital were included. Diagnostic methods that prompted the initiation of anti-TB treatment were compared between the 2 groups of patients.ResultsA greater proportion of patients were diagnosed with pulmonary TB using bronchoscopy in 2013 than in 2005 (26.7% vs. 6.6%, respectively; p<0.001), while the proportion of patients clinically diagnosed with pulmonary TB was lower in 2013 than in 2005 (24.7% vs. 49.0%, respectively; p<0.001). Additionally, more patients started anti-TB treatment based on positive polymerase chain reaction (PCR) results for Mycobacterium tuberculosis DNA in 2013 than in 2005 (47.3% vs. 7.9%, respectively; p<0.001).ConclusionThe initiation of treatment for pulmonary TB in South Korea has become more frequently based on PCR and the use of bronchoscopic specimens.

Improving Diagnostic Pathology Capacity for Global Cancer Care

In this issue of the Journal , Dayal and colleagues1 report their findings on benign uterine tumors removed from women in north India. The study they conducted was straightforward: determine the type and incidence of a set of tumors from one geographic area at one point in time. As an observational study, it was designed and conducted well. The underlying question, however, was far more important and highlights one of the most vexing issues facing global health: how to diagnose and treat cancer. For those of us trained in America, Europe, or former Commonwealth countries, we often forget that much of what we know, what we do, and how we affect patient care simply does not exist in many parts of the world. At the most fundamental level, many regions and countries lack health statistics and epidemiologic data to such a degree that it is not possible for governments to rationally allocate resources and develop large-scale cancer diagnosis and treatment programs. This is particularly true for cancer epidemiology: there just are no data for many areas, and where data exist, the findings are often patchy in distribution, based on older classification schemes, and do not take into account substantial changes in demographics, movement of populations, emergence of new diseases, and changes in diagnostic methods. For too many regions and countries we do not know what cancers occur there, the relative prevalence of each cancer type, how these malignancies behave clinically and pathologically, how they affect morbidity and mortality for populations living in those areas, response to treatment, or prognosis. The effect of cancer on populations as a whole is even less well understood in terms of …

Time trends of cancer incidence in European children (1978–1997): Report from the Automated Childhood Cancer Information System project

Within the framework of the Automated Childhood Cancer Information System (ACCIS), time trend analyses for childhood cancer were performed using data from 33 population-based cancer registries in 15 European countries for the period 1978–1997. The overall incidence rate based on 77,111 cases has increased significantly ( P < 0.0001), with an average annual percentage change (AAPC) of 1.1%. The rising trend was observed in all five geographical regions and in the majority of the disease groups (in order of AAPC): soft tissue sarcomas (1.8%), brain tumours, tumours of the sympathetic nervous system, germ-cell tumours, carcinomas, lymphomas, renal tumours, and leukaemias (0.6%). No change was seen in incidence of bone tumours, hepatic tumours and retinoblastoma. The increased incidence can only partly be explained by changes in diagnostic methods and by registration artefacts. The patterns and magnitude of these increases suggest that other factors, e.g. changes in lifestyle and in exposure to a variety of agents, have contributed to the increase in childhood cancer in the recent decades.

Robust Multipoint Identical-by-Descent Mapping for Affected Relative Pairs

The genetic mapping of complex traits has been challenging and has required new statistical methods that are robust to misspecified models. Liang et al. proposed a robust multipoint method that can be used to simultaneously estimate, on the basis of sib-pair linkage data, both the position of a trait locus on a chromosome and its effect on disease status. The advantage of their method is that it does not require specification of an underlying genetic model, so estimation of the position of a trait locus on a specified chromosome and of its standard error is robust to a wide variety of genetic mechanisms. If multiple loci influence the trait, the method models the marginal effect of a locus on a specified chromosome. The main critical assumption is that there is only one trait locus on the chromosome of interest. We extend this method to different types of affected relative pairs (ARPs) by two approaches. One approach is to estimate the position of a trait locus yet allow unconstrained trait-locus effects across different types of ARPs. This robust approach allows for differences in sharing alleles identical-by-descent across different types of ARPs. Some examples for which an unconstrained model would apply are differences due to secular changes in diagnostic methods that can change the frequency of phenocopies among different types of relative pairs, environmental factors that modify the genetic effect, epistasis, and variation in marker-information content. However, this unconstrained model requires a parameter for each type of relative pair. To reduce the number of parameters, we propose a second approach that models the marginal effect of a susceptibility locus. This constrained model is robust for a trait caused by either a single locus or by multiple loci without epistasis. To evaluate the adequacy of the constrained model, we developed a robust score statistic. These methods are applied to a prostate cancer-linkage study, which emphasizes their potential advantages and limitations.

Changes in Diagnostic Methods of Non-palpable Breast Lesions: Analysis for 5 Years

Purpose: To describe the changes in diagnostic methods and reassess the role of core biopsy compared with needle localization biopsy (NLB) in the evaluation of non-palpable breast lesions. Materials and Methods: We retrospectively analyzed 930 non-palpable breast lesions which underwent either core biopsy or NLB between January 1996 and December 2000. NLB involved 511 lesions in 482 patients, and core biopsy, 419 lesions in 365 patients. For a given lesion, NLB was guided by either mammography (n=213) or ultrasonography (US) (n=298), but only US was used to guide a core biopsy. Over the five-year period, we calculated the total number of biopsies per year relating to non-palpable breast lesions, also determining the mammographic findings in cases involving NLB and the percentage of malignancies seen at histopathology. Results: The total number of biopsies increased with time: 1996: n=91, 1997: n=118, 1998: n=144, 1999: n=245, 2000: n=332. The implementation of core biopsy, however, led to a decrease in the proportion of NLB (1996: 97.8%, 1997: 84.7%, 1998: 75.7%, 1999: 47.8%, 2000: 28.9%). Among nonpalpable lesions which underwent mammography-guided NLB, 46.5% (20/43) were a mass or density in 1996, while in 2000 the proportion was 5.7% (2/35). During this period, however, the finding of calcification without a mass increased from 48.8% in 1996 to 94.3% in 2000. The proportion of cases in which NLB demonstrated malignancy increased from 13.5% in 1996 to 49% in 2000; where US-guided NLB was used, the increase was remarkable: from 15.2% in 1996 to 65.6% in 2000. Conclusion: In the evaluation of non-palpable breast lesions, the appropriate use of core biopsy can decrease the need for a more invasive method such as NLB. Furthermore, because most benign lesions diagnosed by core biopsy do not also undergo NLB, the use of the latter increases the yield of malignancies.

Increase in incidence of disease due to diagnostic drift: primary liver cancer in Denmark, 1943-85.

To examine the extent to which changes in diagnostic methods and classification are responsible for the striking increase in incidence of primary liver cancer in Denmark since 1943. Analysis of the time trends in sex specific, age standardised incidence of primary liver cancer and unspecified liver cancer (either secondary without known primary cancer or not specified as primary cancer) in the entire population from 1943 to 1985. By review of the 727 notifications from three periods of 5 years (1948-52, 1963-7, and 1978-82) the changes in histological diagnosis and classification were assessed. Denmark. Notifications of liver cancer to the Danish cancer registry. Concomitant with the increase in primary liver cancer, the incidence of the unspecified liver cancer declined. The proportion of histologically diagnosed primary liver cancer rose from 85% to 98%, whereas the proportion for unspecified liver cancer rose from 12% to 51%. When the proportion of primary versus unspecified liver cancer obtained by histological diagnosis was extrapolated to all cases, the annual incidence of primary liver cancer was 4.4 rather than 1.6 per 100,000 population in 1948-52 and 6.0 rather than 5.5 per 100,000 in 1978-82. The increase in the incidence of primary liver cancer may be much smaller than the numbers of registered cases indicate. This example emphasises the need to consider diagnostic drift in time trend studies of disease incidence.

The role of socio-behavioural scientists in health care practice

This paper attempts to analyse some of the complex problems that face primary health care practice in the developed world today. These are shown to be a degree of depersonalisation, that has come with greater efficiency, and a reduction in the quality of the doctor-patient relationship, which has accompanied increased medical effectiveness. These changes are in turn related to changes in diagnostic methods in primary care, to changes in the organisation of primary care and to change in the stress laid on interventive, preventive and rehabilitative care. All these inter-related problems have to be viewed against a background of shortage of resource which demand a far more stringent system of accountability than has been common until now. A possible solution lies in redefining the traditional medical role and the philosophical basis which underlies that role at a time when primary health care is confronted by thespecial problems of the AIDS pandemic. This would require major alterations in medical attitudes and in established medical education which may be impossible for the doctors to achieve by themselves. It is suggested that a most important role of socio-behavioural scientists lies in helping the medical profession to remove the attitudinal and educational barriers which prevent the realisation of the concept of a new sort of doctor who may cope with the demands of primary health care as we approach 2000.

The location and size of gastric ulcers: radiologic and endoscopic evaluation.

The location and size of 132 gastric ulcers were evaluated radiologically and endoscopically. Results suggest that the classically noted concentration of ulcers along the lesser curvature and in the distal stomach remains valid despite changes in diagnostic methods. It was also found that proximally located ulcers tend to be larger than those elsewhere, whereas those in the distal stomach are smaller. Concentration of ulcers in the proximal stomach in elderly patients, as suggested by previous authors, could not be confirmed.

Secular trends in mortality for cerebrovascular diseases in Japan, 1960 to 1979.

In Japan the age-adjusted death rate from cerebrovascular diseases has decreased for both males and females since 1965. This downward trend accelerated in 1971. This is not due to artifacts such as changes in diagnostic methods of stroke and in rules for coding cause of death on death certificates. The progress and spread of detection, treatment and control of hypertension appears to have been the greatest contributing factor. Furthermore, improvement in the dietary habits, that is, a decrease in salt intake and an appropriate increase in the amount of animal fat and protein taken are also considered to have contributed to the decline in stroke mortality. The regional difference in the standardized mortality ratio for stroke markedly observed in 1960 was still seen even in the 1970's, but the difference became smaller. Mechanization of farming works may be partly accountable for the decrease in the regional difference.

Changing social-class distribution of heart disease.

Analysis of mortality trends over 40 years in England and Wales showed that mortality from coronary heart disease had become progressively more common in working-class men and women than in those from the middle and upper classes. The change was most noticeable for men. Whereas in 1931 and 1951 heart disease was more common in men of social classes I and II, by 1961 it was more common in men of classes IV and V. This change in social-class distribution can only partly be explained by changes in diagnostic methods. The worsening mortality of classes IV and V correlated with relatively more smoking, a higher consumption of sugar, and a lower consumption of wholemeal bread in these classes. There was no correlation between change in heart disease and change in the social-class pattern of fat consumption.