Dai S, Marti B, Tschopp A, Bodenmann A, Gutzwiller F
Institut für Sozial- und Präventivmedizin, Universität Zürich.
Schweiz Rundsch Med Prax. 1991 Aug 27;80(35):874-8.
The attitude towards mass screening of serum cholesterol is controversial. In order to characterize the volunteers of such screenings and to test the representativity of its findings, we compared the data of 1686 adult health-screening participants collected during a trade fair in the city of Basel, Switzerland, with the results of two population-based studies, the Basel City Risk Factor Survey and the MONICA Project in Western Switzerland. Among those screened, there was an over-representation of women and older persons. The age-specific medians of blood cholesterol and proportions of hypercholesterolemic persons were consistently higher in female screenees--and marginally so in males--than in the reference populations, whereas higher proportions of persons with ideal cholesterol level in those screened were also observed, especially in younger males. Higher systolic blood pressure, lower relative body weight and less regular smoking were found consistently among the screenees. This cross-sectional study shows that the participants of such mass screening actions are a selective group of older, more frequently female health-conscious persons with a specific risk-factor pattern. Mass screenings of self-selected volunteers can, therefore, not be used for a reliable prediction of risk-factor distributions in the general population. Moreover, suggested further steps for those screenees with both health-conscious behavior and elevated biological risk-factor levels, such as second measurement, medical consultation and counselling, cannot be assured in the setting of a trade fair. The objectives and intentions of such mass screening activities should be reconsidered and discussed.
对血清胆固醇进行大规模筛查的态度存在争议。为了描述此类筛查志愿者的特征并检验其结果的代表性，我们将在瑞士巴塞尔市一次贸易展览期间收集的1686名成年健康筛查参与者的数据，与两项基于人群的研究结果进行了比较，这两项研究分别是巴塞尔市危险因素调查和瑞士西部的莫尼卡项目。在接受筛查的人群中，女性和老年人的比例过高。女性受检者的血胆固醇年龄特异性中位数和高胆固醇血症患者比例一直高于参考人群，男性受检者略高于参考人群，而在受检者中也观察到理想胆固醇水平的人群比例较高，尤其是年轻男性。在受检者中，始终发现收缩压较高、相对体重较低和吸烟不太规律。这项横断面研究表明，此类大规模筛查行动的参与者是一个经过挑选的群体，由年龄较大、女性居多、有健康意识且具有特定危险因素模式的人组成。因此，自我选择的志愿者的大规模筛查不能用于可靠预测一般人群中的危险因素分布。此外，对于那些既有健康意识行为又有生物学危险因素水平升高的受检者所建议的进一步措施，如再次测量、医疗咨询和辅导，在贸易展览的环境中无法得到保证。此类大规模筛查活动的目标和意图应重新考虑和讨论。
