STATE OF NEW MEXICO, Hon. MAURINE B. NEUBERGER, Santa Fe, August 30, 1966. Chairman, Subcommittee on Health of the Elderly, Washington, D.C. MY DEAR SENATOR NEUBERGER: Thank you for your letter of August 18, 1966, requesting our viewpoints and information on health screening methods for chronic disease. The New Mexico Department of Public Health and the New Mexico Department of Public Welfare have contributed to the answers to your questions that follow. 1. Have any health screening programs within your State been particularly helpful in detecting diseases that may become acute in later years? May we have brief description of the program and the results? New Mexico has conducted several screening programs in the past few years: (a) The division of dental health has conducted an oral cytology project in their itinerant dental clinics and through practicing dentists during the past 2 years. Sixty cytology smears have been performed with one case discovered. (b) Veneral disease case finding is active in the State with contact, jail, premarital, and pregnancy screening. (c) Screening methods for tuberculosis are being analyzed by a project administered by the Division of Preventive Medicine. This involves contact followup and screening of school children by skin testing. (d) Papanicolaou smears for cervical cancer are performed on selected indigent patients in local health departments. A recent U.S. Public Health Service Community Health Grant to the Department of Pathology of the University of New Mexico School of Medicine will increase this service to Albuquerque residents and Indian patients. (e) In 1959-60 the New Mexico Department of Public Health conducted a diabetic screening program through its local health departments. Screening tests were performed on 13,884 persons. Patients saw their family physicians for followup. Fifteen new cases of diabetes were diagnosed and 121 cases were potential diabetics on whom adequate followup information was not available. (f) A multiphasic screening program was conducted by the New Mexico Department of Public Health at an agricultural extension service course for women in June 1966. The 268 women participants had height, weight, blood pressure, urine sugar, urine protein, and blood sugar determinations performed. The electrocardiogram was abandoned early in the program as it was evident that it was a poor screening technique. Excluding overweight, 93 abnormalities were found. Followup evaluation is now underway on this group. (g) Dr. Marian Hotopp, District I Health Officer is planning an adult health maintenance program for a low income rural area of northern New Mexico. Medical care is not readily accessible in this remote four-county area. The program is being funded by a contract from the Gerontology Branch of the Division of Chronic Diseases of the U.S. Public Health Service. Itinerant clinics will be established for health screening of elderly residents. The clinics will include a nutritional and medical history, laboratory tests, and a limited physical examination. Counseling, physician referral, and followup are planned. The project will attempt to study the most effective techniques and personnel, and the feasibility of this type of program. 2. Can you give us information about the prevalence of chronic disease within your State in age groups from 40 to 50, 50 to 60, and 60 and beyond? New Mexico mortality dáta are available from death certificates. This is best summarized in, "Vital Statistics of the United States," which is published by the National Center for Health Statistics of the Public Health Service, U.S. Department of Health, Education, and Welfare. Further comparative data are analyzed in the President's Commission on Heart Disease, Cancer, and Stroke "Report to the President a National Program to Conquer Heart Disease, Cancer, and Stroke," volume II, February 1965. Morbidity data are not generally available for nonreportable diseases. The discharge diagnoses of patients hospitalized during fiscal year 1965 under the New Mexico Department of Public Welfare old age assistance program (all patients over age 65) are shown on the enclosed chart. 3. Do you have any suggestions for effective screening or other health maintenance programs for persons below age 60? Above age 60? Suggestions are discussed under question No. 5. 4. May we have names and addresses of any individuals who may have special knowledge of, or interest in, our subject? (1) New Mexico Department of Public Health, 408 Galisteo Street, Santa Fe, N. Mex. 87501; Edwin O. Wicks, M.D., D.P.H., director; Leo D. O'Kane, M.D., chief, division of preventive medicine; Leonard J. Voelker, D.D.S., M.P.H., chief, division of dental health; Marion Hotopp, M.D., M.P.H., District I health officer. (2) New Mexico Department of Public Welfare (State agency on aging), 408 Galisteo Street, Santa Fe, N. Mex. 87501; Leo T. Murphy, director; Mrs. K. Rose Wood, supervisor, State program on aging, (3) New Mexico State Special Hospitals' Board (for geriatric and tuberculosis facilities) Fort Bayard, N. Mex. 88036; George W. Bryan, executive director. (4) New Mexico Medical Society, 3010 Monte Vista Boulevard, NE., Albuquerque, N. Mex.; Ralph R. Marshall, executive secretary; Thomas L. Carr, M.D., president; R. C. Derbyshire, M.D., chairman, public health committee. (5) New Mexico regional medical program for heart disease, cancer, stroke, and related diseases, 900 Stanford Drive, NE., Albuquerque, N. Mex.; Reginald H. Fitz, M.D., project director. (6) University of New Mexico School of Medicine, 900 Stanford Drive, NE., Albuquerque, N. Mex.; Reginald H. Fitz, M.D., dean; Solomon Papper, M.D., chairman, department of medicine (7) Albuquerque Area Office, Division of Indian Health, U.S. Public Health Service (Includes New Mexico and parts of Colorado and Arizona) 502 Gold, SW., Albuquerque, N. Mex.; Robert L. Zobel, M.D., Rrea Medical Director. 5. Is there a need for a multiphasic health screening program? Are there any particular impediments to the acceptance of such a program by the public or by the medical profession? The New Mexico Department of Public Health and the New Mexico Department of Public Welfare feel that there is a need for such preventive services. However, any such programs should be well planned, and studied, for feasibility prior to initiation. Our past experiences of acceptance by the medical profession bring the following precautions to mind: (a) We must be certain that early diagnosis of a disease may lead to prevention of complications. Screening should be limited to discases for which unequivocal preventive or therapeutic treatment is available. (b) Screening tests must be both sensitive and specific so that they would not falsely reassure nor falsely alarm the populace. (c) Cost feasibility must be closely examined. For example, diabetes screening of persons less than age 25 yields only two cases per 1,000 persons screened with current methods. The natural history of diabetes in this age group would probably cause most of these diabetics to seek medical care within a short time. (d) Adequate followup must be insured. Initial programs should be designed to study this aspect of multiphasic screening. With attention to the above precautions and close cooperation with involved parties, I think the impediments to acceptance of such a program would be markedly diminished. Thank you for this opportunity to express our viewpoints. EDWIN O. WICKS, M.D., D.P.H., Director. In-patient hospital care: Number of hospital discharges, by admission diagnosis of the disease or injury for which the person was being cared for in the hospital, July 1, 1964, to June 30, 1965 Source: Medical care program, 1964-65, New Mexico Department of Public Welfare. Hon. MAURINE B. NEUBERGER, Chairman, Subcommittee on Health of the Elderly, Special Committee on Aging, U.S. Senate, Washington, D.C. DEAR SENATOR NEUBERGER: I am really pleased to learn of the study of modern health screening methods being undertaken by the Subcommittee on Health of the Elderly of the U.S. Senate Special Committee on Aging and wish to express my support for any program which will promote the development of illness detection programs for our older adult population. There is no doubt in our minds that community programs directed at the detection of those chronic illnesses for which reliable screening methods are available and for which something can be done, when detected, is our best approach toward curtailing the morbidity and disability processes so common among the aged today and thereby reducing the cost of medical care. In addition, research directed at the improvement of detection methods needs more financial support than has been available to date. I will answer your specific questions as they were presented: 1. The three major health screening programs in this State have been as follows: (a) Multiphasic health screening for State employees in the Albany area. During the past year approximately 6,000 employees have received a battery of screening tests, primarily for cardivascular and respiratory disease. It is planned to expand this group during the next several years to offer repeat examinations at 3-year intervals. Additional screening tests will be added as the program develops. (b) A well aging conference is being carried out by the Erie County Department of Health in Buffalo. This is now in the last year of a 3-year demonstration and it is expected that it will be absorbed by the department of health on a continuing basis next year. (c) The New York City Department of Health has been operating four continuing screening programs for diabetes and glaucoma. We are collecting the results on these three programs and will forward them to you as soon as they are available. In addition, we have numerous programs throughout the State in diabetes and glaucoma detection, some on a continuing basis, others on a more periodic or irregular scheduling. Some of these programs are offered primarily for educational purposes such as those conducted at the annual meetings of the State medical society, the Association of County & Town Officers, and the Association of Mayors. A major program is conducted as part of the State exposition each year and reaches several thousands of individuals. 2. While several surveys of chronic disease in New York State give figures for disease prevalence by age group, we find the estimates of the national health survey more reliable. 3. It is our opinion that the Kaiser Foundation program in California, to which your letter refers, represents the ultimate in screening programs today. The program should be available to persons of all ages although the tests would vary according to age group. 69-803 0-66- -30 |