Showing papers on "Mass screening published in 1995"

The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings.

Abstract: Objective: The concurrent, construct, and discriminant validity of the Alcohol Use Disorders Identification Test (AUDIT) were evaluated. AUDIT consists of a 10-item Core questionnaire and an 8-item Clinical procedure. AUDIT was designed to identify hazardous drinkers (whose drinking increases their risk of alcohol-related problems, though alcohol-associated harm has not yet occurred); harmful drinkers (who have had recent physical or mental harm from their drinking, but who are not alcohol-dependent); and people with alcohol dependence. Method: Known alcoholics (n = 65) and general medical patients (n = 187) completed self-report questionnaires and underwent a diagnostic interview, physical examination and laboratory testing. Results: AUDIT scores correlated significantly with scores on the MAST and MacAndrew alcoholism screening tests, and with ALAT, ASAT, GGT and MCV levels, which reflect recent heavy drinking. AUDIT scores were correlated with measures of alcoholism vulnerability (e.g., familial alcoho...

Total plasma homocysteine and cardiovascular risk profile. The Hordaland Homocysteine Study.

Abstract: Objective. —To estimate the relations between established cardiovascular risk factors and total homocysteine (tHcy) in plasma. Design. —Health examination survey by the Norwegian Health Screening Service in 1992 and 1993. Setting. —General community, Hordaland County of Western Norway. Participants. —A total of 7591 men and 8585 women, 40 to 67 years of age, with no history of hypertension, diabetes, coronary heart disease, or cerebrovascular disease were included. Main Outcome Measure. —Plasma tHcy level. Results. —The level of plasma tHcy was higher in men than in women and increased with age. In subjects 40 to 42 years old, geometric means were 10.8 μmol/L for 5918 men and 9.1 μmol/L for 6348 women. At age 65 to 67 years, the corresponding tHcy values were 12.3 μmol/L (1386 men) and 11.0 μmol/L (1932 women). Plasma tHcy level increased markedly with the daily number of cigarettes smoked in all age groups. Its relation to smoking was particularly strong in women. The combined effect of age, sex, and smoking was striking. Heavy-smoking men aged 65 to 67 years had a mean tHcy level 4.8 μmol/L higher than never-smoking women aged 40 to 42 years. Plasma tHcy level also was positively related to total cholesterol level, blood pressure, and heart rate and inversely related to physical activity. The relations were not substantially changed by multivariate adjustment, including intake of vitamin supplements, fruits, and vegetables. Conclusions. —Elevated plasma tHcy level was associated with major components of the cardiovascular risk profile, ie, male sex, old age, smoking, high blood pressure, elevated cholesterol level, and lack of exercise. These findings should influence future studies on the etiology and pathogenesis of cardiovascular disease. ( JAMA . 1995;274:1526-1533)

Efficacy of screening mammography. A meta-analysis.

Abstract: Objective. —To determine the efficacy of screening mammography by age, number of mammographic views per screen, screening interval, and duration of follow-up. Design. —Literature review and meta-analysis. Data Identification and Analysis. —Literature search of English-language studies reported from January 1966 to October 31, 1993, using MEDLINE, manual literature review, and consultation with experts. A total of 13 studies were selected, and their results were combined using meta-analytic techniques based on the assumption of fixed effects. Main Results. —The overall summary relative risk (RR) estimate for breast cancer mortality for women aged 50 to 74 years undergoing screening mammography compared with those who did not was 0.74 (95% confidence interval [CI], 0.66 to 0.83). The magnitude of the benefit in this age group was similar regardless of number of mammographic views per screen, screening interval, or duration of follow-up. In contrast, none of the summary RR estimates for women aged 40 to 49 years was significantly less than 1.0, irrespective of screening intervention or duration of follow-up. The overall summary RR estimate in women aged 40 to 49 years was 0.93 (95% CI, 0.76 to 1.13); the summary RR estimate for those studies that used two-view mammography was 0.87 (95% CI, 0.68 to 1.12) compared with 1.02 (95% CI, 0.73 to 1.44) for those studies that used one-view mammography, and for those studies with 7 to 9 years of follow-up, the summary RR estimate was 1.02 (95% CI, 0.82 to 1.27) compared with 0.83 (95% CI, 0.65 to 1.06) for those studies with 10 to 12 years of follow-up. Conclusion. —Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up, regardless of screening interval or number of mammographic views per screen. There is no reduction in breast cancer mortality in women aged 40 to 49 years after 7 to 9 years of follow-up. Screening mammography may be effective in reducing breast cancer mortality in women aged 40 to 49 years after 10 to 12 years of follow-up, but the same benefit could probably be achieved by beginning screening at menopause or 50 years of age. (JAMA. 1995;273:149-154)

Progress with gene‐product mapping of the Mollicutes: Mycoplasma genitalium

Abstract: A protein map of the smallest known self-replicating organism, Mycoplasma genitalium (Class: Mollicutes), revealed a high proportion of acidic proteins. Amino acid composition was used to putatively identify, or provide unique parameters, for 50 gene products separated by two-dimensional gel electrophoresis. A further 19 proteins were subjected to peptide-mass fingerprinting using matrix-assisted laser desorption ionisation-time of flight (MALDI-TOF) mass spectrometry and 4 were subjected to N-terminal Edman degradation. The majority of M. genitalium proteins remain uncharacterised. However, the combined approach of amino acid analysis and peptide-mass fingerprinting allowed gene products to be linked to homologous genes in a variety of organisms. This has allowed proteins to be identified prior to detection of their respective genes via the M. genitalium sequencing initiative. The principle of ‘hierarchical’ analysis for the mass screening of proteins and the analysis of microbial genomes via their protein complement or ‘proteome’ is detailed. Here, characterisation of gene products depends upon the quickest and most economical technologies being employed initially, so as to determine if a large number of proteins are already present in both homologous and heterologous species databases. Initial screening, which lends itself to automation and robotics, can then be followed by more time and cost intensive procedures, when necessary.

Mammographic Features and Breast Cancer Risk: Effects With Time, Age, and Menopause Status

Abstract: Background : Mammographic images from women with a high proportion of epithelial and stromal breast tissues are described as showing high-density parenchymal patterns. Most past studies that noted an increase in breast cancer risk associated with mammographic parenchymal patterns showing high density either 1) lacked information on other breast cancer risk factors, 2) were too small, or 3) included insufficient follow-up time to adequately resolve persisting doubts whether mammographic features are independent measures of breast cancer risk and not a detection artifact. Purpose : The purpose of this study was twofold : 1) to evaluate the associations between mammographic features and other breast cancer risk factors and 2) to assess effects of mammographic features on breast cancer risk by time, age, and menopause status. Methods : To address these questions, we analyzed detailed information from a large, nested case-control study with 16 years of follow-up. This study used information from both screening and follow-up phases of the Breast Cancer Detection Demonstration Project, a nationwide program that offered annual breast cancer screening for more than 280 000 women from 1973 to 1980. Mammographic features were assessed from the base-line screening mammographic examination for 1880 incident case subjects and 2152 control subjects. Control subjects were randomly selected from women of the same age and race as each case subject. Control subjects attended the same screening center as the case subject and were free of breast cancer at the case subject's date of diagnosis. Odds ratios (ORs) with 95% confidence intervals (CIs) provided estimates of the relative risk of breast cancer. Results : Mammographic features were associated with known breast cancer risk factors. However, the high-density parenchymal pattern effects were independent of family history, age at first birth, alcohol consumption, and benign breast disease. The increased risk for women with Wolfe's two high-density parenchymal patterns, P2 (OR = 3.2 ; 95% CI = 2.5-4.0) and Dy (OR = 2.9 ; 95% CI = 2.2-3.9), was explained primarily by measured percent of the breast with dense mammographic appearance. Compared with women with no visible breast density, women who had a breast density of 75% or greater had an almost fivefold increased risk of breast cancer (95% CI = 3.6-7.1). These effects persisted for 10 or more years and were noted for both premenopausal and postmenopausal women of all ages. Conclusions : Of the breast cancer risk factors assessed in the participants, high-density mammographic parenchymal patterns, as measured by the proportion of breast area composed of epithelial and stromal tissue, had the greatest impact on breast cancer risk. Of the breast cancers in this study, 28% were attributable to having 50% or greater breast density.

Expanding access to cancer screening and clinical follow-up among the medically underserved

Abstract: Blacks have the highest cancer incidences and mortality rates in the United States. Higher mortality rates appear due to higher incidence in some sites and to later-stage diagnoses in others. To address these problems, expanded cancer screening in an inner-city public hospital and a patient navigator intervention were proposed. Patient navigators acted as patient advocates for patients with abnormal screening findings. One thousand thirty-four females and 102 males were screened from July 1990 through November 1992; seven breast cancers and one cervical cancer were found. Patient navigators were significantly more likely to have seen patients with suspicious findings than patients with non-suspicious findings. However, even among those with suspicious findings, almost 70% were not seen by a patient navigator. Of those navigated, 87.5% completed recommended breast biopsies, compared with 56.6% of the non-navigated patients. Among those with a biopsy, navigated patients did so in significantly less time than those not navigated. Navigation is one of three phases proposed to reduce cancer mortality among medically underserved populations.

Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice.

Abstract: The US Preventive Services Task Force recommended that physicians use the CAGE questions to screen patients for alcohol abuse. A similarly brief screening instrument for abuse of other drugs is needed. Two conjoint screening questionnaires for alcohol and other drug abuse were adapted from the CAGE questions and the Short Michigan Alcoholism Screening Test (SMAST). For 124 patients of an academic, community family practice, the conjoint questionnaires and their forerunners were compared with DSM-III-R diagnoses of substance use disorders as measured by the Diagnostic Interview Schedule-Revised (DIS-R). The SMAST and its conjoint analog exhibited low sensitivity. The CAGE Adapted to Include Drugs (CAGE-AID) was more sensitive but less specific for substance abuse than the CAGE, especially when a reduced criterion score was employed. The CAGE-AID was more sensitive than the CAGE for subjects of varying sex, income, and level of education, as well as most patterns of substance use disorders. The diminished specificity of the CAGE-AID may have been, at least in part, artifactual. The CAGE-AID holds promise for identifying primary care patients with alcohol and drug disorders.

Perceptions of Breast Cancer Risk and Screening Effectiveness in Women Younger Than 50 Years of Age

Abstract: Background : The National Cancer Institute has recently changed its approach and has substituted summary-of-evidence statements for specific recommendations for breast cancer screening in women 40-50 years of age, leaving these women with a greater share of decision-making responsibility. To make an informed decision about breast cancer screening, women need accurate information about their breast cancer risk and the benefit of screening. Although it has been suggested that women younger than 50 years of age overestimate this risk and benefit, their estimates have not been quantified. Purpose : The purpose of this study was to determine how women 40-50 years of age perceive their risk of breast cancer and the effectiveness of screening and how these perceptions compare with estimates derived from epidemiologic studies of breast cancer incidence and randomized clinical trials of screening. Methods : We mailed a questionnaire to 200 women, identified through the computerized medical records of Dartmouth-Hitchcock Medical Center, who were between 40 and 50 years of age and had no history of breast cancer. Each woman was asked about her risk factors for breast cancer and asked to estimate her probabilities of developing breast cancer and dying of it within 10 years, with and without screening. The women's answers were compared with individual probabilities derived from the Gail et al. model, age-specific probabilities of developing and dying of breast cancer in the United States, and the results of randomized clinical trials of screening. Results : The mailed questionnaire was completed and returned by 145 (73%) of the 200 women. Respondents overestimated their probability of dying of breast cancer within 10 years by more than 20-fold (median, 22.3 ; interquartile range, 11.1-74.2). Assuming a 10% relative risk reduction from screening, respondents overestimated the relative risk reduction by sixfold (median, 6.0 ; interquartile range, 5.0-7.5) and the absolute risk reduction more than 100-fold (median, 127.5 ; interquartile range, 47.1-399.6). The median perceived estimate of absolute risk reduction was 6.0 breast cancer deaths per 100 women ; the median calculated estimate was only 0.04 per 100 women. Conclusion : These findings suggest that many women younger than 50 years of age substantially overestimate their breast cancer risk and the effectiveness of screening. Implications : A balanced presentation of information about breast cancer risk and screening effectiveness may improve decision making for women younger than 50 years of age and reduce their anxiety about breast cancer, regardless of whether they choose to be screened. [J Natl Cancer Inst 87 :720-731, 1995]

Frequency of Thyroid Dysfunction in Diabetic Patients: Value of Annual Screening

Abstract: A randomly selected group of 1310 adult diabetic patients attending a diabetic outpatient clinic received annual screening for thyroid disease, by estimating serum free thyroxine and TSH concentrations. The overall prevalence of thyroid disease was found to be 13.4%, and was highest (31.4%) in Type 1 diabetic females, and lowest in Type 2 diabetic males (6.9%). As a direct result of screening, new thyroid disease was diagnosed in 6.8% (89 patients) of the population screened; the commonest diagnosis was subclinical hypothyroidism (4.8%), followed by hypothyroidism (0.9%), hyperthyroidism 0.5%), and subclinical hyperthyroidism (0.5%). Female patients with Type 1 diabetes had the highest annual risk of developing thyroid disease (12.3%), but all patient groups had a higher incidence of thyroid dysfunction, compared to that reported in the general population. This study suggests that thyroid function should be screened annually in diabetic patients to detect asymptomatic thyroid dysfunction which is increased in frequency in a diabetic population.

Effective field theory approach to high temperature thermodynamics

Abstract: An effective field theory approach is developed for calculating the thermodynamic properties of a field theory at high temperature T and weak coupling g. The effective theory is the three-dimensional field theory obtained by dimensional reduction to the bosonic zero-frequency modes. The parameters of the effective theory can be calculated as a perturbation series in the running coupling constant ${\mathit{g}}^{2}$(T). The free energy is separated into the contributions from the momentum scales T and gT, respectively. The first term can be written as a perturbation series in ${\mathit{g}}^{2}$(T). If all forces are screened at the scale gT, the second term can be calculated as a perturbation series in g(T) beginning at order ${\mathit{g}}^{3}$. The parameters of the effective theory satisfy renormalization group equations that can be used to sum up leading logarithms of T/(gT). We apply this method to a massless scalar field with a ${\mathrm{\ensuremath{\Phi}}}^{4}$ interaction, calculating the free energy to order ${\mathit{g}}^{6}$lng and the screening mass to order ${\mathit{g}}^{5}$lng.

Predictive capacity of the AUDIT questionnaire for alcohol-related harm

Abstract: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item questionnaire designed to screen for hazardous and harmful alcohol consumption. We examined its ability to predict alcohol-related illness and social problems, hospital admission and mortality over a 2-3-year period. At initial interview, 330 ambulatory care patients were assessed using a detailed interview including the AUDIT questions and laboratory tests. After 2-3 years, 250 (76%) subjects were reassessed and their experience of alcohol-related harm determined. Of those who scored eight or more on AUDIT at initial interview, 61% experienced alcohol-related social problems compared with 10% of those with lower scores (p < 0.0001); they also had a significantly greater experience of alcohol-related medical disorders and hospitalization. AUDIT score was a better predictor of social problems and of hypertension than laboratory markers. Its ability to predict other alcohol-related illnesses was similar to the laboratory tests. However, gamma glutamyltransferase was the only significant predictor of mortality. We conclude that AUDIT should prove a valuable tool in screening for hazardous and harmful alcohol consumption so that intervention can be provided to those at particular risk of adverse consequences.

Preparticipation cardiovascular evaluation of the competitive athlete: perspectives from the 30-year Italian experience.

Abstract: R ecently, issues related to the identification of cardiovascular disease in competitive athletes have become highly visible to the lay public and medical community in the United States, promoted largely by the occurrence of sudden and premature cardiac deaths in elite athletes.’ These catastrophies have raised our consciousness regarding preparticipation screening in competitive athletic populations?,’ as well as the criteria for sports eligibility.4.5 In this regard, we thought it an opportune time to take note of a unique experience with such issues impacting on competitive athletes in Italy over the past 3 decades. It is our expectation that this discussion may prove informative by virtue of offering a different perspective. and in the process afford a measure of clarity to controversies surrounding sudden cardiac death and preparticipation screening in competitive athletes.

A New and Simple Questionnaire to Identify People at Increased Risk for Undiagnosed Diabetes

Abstract: OBJECTIVE To develop a simple questionnaire to prospectively identify individuals at increased risk for undiagnosed diabetes. RESEARCH DESIGN AND METHODS People with newly diagnosed diabetes ( n = 164) identified in the Second National Health and Nutrition Examination Survey and those with neither newly diagnosed diabetes nor a history of physician-diagnosed diabetes ( n = 3,220) were studied. Major historical risk factors for undiagnosed non-insulin-dependent diabetes were defined, and classification trees were developed to identify people at higher risk for previously undiagnosed diabetes. The sensitivity, specificity, and predictive value of the classification trees were described and compared with those of an existing questionnaire. RESULTS The selected classification tree incorporated age, sex, history of delivery of a macrosomic infant, obesity, sedentary lifestyle, and family history of diabetes. In a representative sample of the U.S. population, the sensitivity of the tree was 79%, the specificity was 65%, and the predictive value positive was 10%. CONCLUSIONS This classification tree performed significantly better than an existing questionnaire and should serve as a simple, noninvasive, and potentially cost-effective tool for diagnosing diabetes in the U.S.

Antiphospholipid antibodies and beta 2-glycoprotein-I in 500 women with recurrent miscarriage: results of a comprehensive screening approach.

Abstract: Five hundred consecutive women (median age 33 years; range 19-45) with a history of recurrent miscarriage (median 4; range 3-16) were screened for the presence of antiphospholipid antibodies (APA)-lupus anticoagulant (LA) and/or anticardiolipin antibodies (ACA). The prevalence of persistently positive tests for LA was 9.6% and for immunoglobulin G (IgG) and immunoglobulin M (IgM) ACA was 3.3 and 2.2% respectively. Only seven women (1.4%) were LA and ACA positive. Repeat testing, after an interval of at least 8 weeks, demonstrated that only 65.7% of LA positive, 36.6% IgG ACA positive and 36.0% IgM ACA positive women on initial testing had a second positive test result. The dilute Russell's viper venom time detected the LA significantly more often than either the activated partial thromboplastin time or the kaolin clotting time (P < 0.001). There was no difference in the gestation of previous miscarriages between APA positive and APA negative women. There was no difference in the plasma beta 2-glycoprotein-I concentrations between APA positive and APA negative women with miscarriages and normal women. All women with a history of recurrent miscarriage should be tested for the presence of both LA and ACA. A second confirmatory test should be performed in those with an initial positive test result.

Familial dilated cardiomyopathy in the United Kingdom.

Abstract: OBJECTIVES--To determine the frequency and mode of inheritance of familial dilated cardiomyopathy in the United Kingdom. BACKGROUND--Two recent prospective studies have suggested that familial forms of dilated cardiomyopathy are common but have been limited by selective screening methods, inadequate diagnostic criteria, and low rates of ascertainment. METHODS--Prospective screening study of 236 relatives from 40 families of patients with dilated cardiomyopathy. Screening consisted of clinical examination, 12 lead electrocardiogram, and two-dimensional Doppler echocardiography. Relatives with systemic hypertension and other cardiac diseases were excluded from the study. All echocardiograms were performed by an experienced echocardiographer who was blinded to clinical information. Relatives were classified as having dilated cardiomyopathy, left ventricular enlargement (method of Henry), depressed fractional shortening, or as being normal. Relatives with abnormal investigations underwent further evaluation as appropriate. RESULTS--Twenty five cases of dilated cardiomyopathy were identified and came from 10 (25%) of the 40 families screened. Pedigree analysis was most consistent with autosomal dominant inheritance and variable penetrance (65-95%). Of the remaining apparently healthy relatives, 37 (18%) were found to have left ventricular enlargement and nine (4%) depressed fractional shortening; these values were significantly higher than those observed in 239 healthy controls (24 (10%), P = 0.02 and one (0.4%), P = 0.01, respectively). CONCLUSIONS--Patients with dilated cardiomyopathy commonly have an affected family member and a high proportion of apparently healthy relatives with minor echocardiographic abnormalities. Segregation analysis suggests that familial dilated cardiomyopathy is the result of the transmission of a rare autosomal dominant gene. Further studies are currently underway to characterise the molecular basis of familial dilated cardiomyopathy and identify early disease within these families.

Screening for depression in primary care. Development and validation of the Depression Scale, a screening instrument for depression.

Abstract: Depression is a common mental disorder; effective methods for treating it are also available. Its recognition and diagnosis are prerequisite to effective treatment. A majority of depressed patients are generally managed in the primary care setting; only a half of the cases, however, are identified at their first visit. Screening instruments to improve recognition of depression have therefore been developed. The Depression Scale (DEPS), consisting of 10 items, was developed and tested in primary care patients aged 18 to 64 years. Clinical assessments were made on the basis of Present State Examination interviews with 436 patients. The DEPS proved to be satisfactory. Increasing age and poor education had an adverse effect on the screening process, however. The sensitivity of the DEPS for clinical depression was 74% and the specificity for non-depression 85%. The sensitivity for severe depression was 84% and the specificity for symptom-free patients 93%. The DEPS seems to improve the recognition of depression in primary care and may also be suitable for screening depression in the general population and for identifying high-risk groups.

The evaluation of screening for gastric cancer in Miyagi Prefecture, Japan: a population-based case-control study

Abstract: Although a screening program for gastric cancer, using barium X-ray examination, has been carried out widely in Japan for the past 3 decades, there is insufficient evidence to confirm its effectiveness in terms of reducing mortality. To evaluate the effectiveness of the screening, a population-based case-control study was carried out in Miyagi Prefecture, Japan. Case subjects, who had died from gastric cancer (198) and control subjects matched in age, sex and residence (577) were selected from among members of the National Health Insurance. Their screening histories during 5 years before the cases were diagnosed were surveyed on the basis of records of the regional cancer registry and the cancer-detection center. The odds ratio (OR) of death from gastric cancer for the persons who participated in the screening at least once during 5 years was 0.41. For those who participated only once during 5 years the OR was 0.43, and for those whose last participation was 5 years earlier it was 0.30. Our data suggest that screening for gastric cancer at 5-year intervals might reduce mortality by 60%, and that the effect might remain for at least 5 years.

Quantitative Interpretation of Age-Specific Mortality Reductions From the Swedish Breast Cancer-Screening Trials

Abstract: Background : Results from five Swedish randomized trials may provide the most conclusive evidence on the effect of mammographic screening and have been used to forecast the expected reduction in breast cancer mortality in other programs. However, those trials demonstrated different degrees of reduction. The interpretation of observed mortality reduction after long follow-up for women aged 40-49 years at trial entry is both important and controversial. Purpose: We estimated what percentage of the observed mortality reduction for women aged 40-49 years at entry into the five Swedish screening trials might be attributable to screening these women at 50 years of age or older. Moreover, we calculated the most likely percentage mortality reduction for specific screening programs if the Swedish results were generalized and analyzed whether characteristics of each trial might at least partly explain the observed differences in reductions among the trials. Methods : Each Swedish trial was simulated with one underlying computer simulation model (MISCAN-MIcrosimulation SCreening ANalysis) of the natural history of the disease and the performance of screening, taking into account nine important trial characteristics. Improvement in prognosis for screen-detected case patients was estimated with age-specific reduction for all trials and each trial design as a reference. Results : An expected 7% reduction in breast cancer mortality for women aged 40-49 years at trial entry (relative risk [RR] = 0.93) was determined by computer modeling, assuming no improvement in prognosis for cancers that are screen detected before 50 years of age. This result indicates that, of the overall 10% observed reduction (RR = 0.90) in the five Swedish trials analyzed, most (70%) of this reduction might be attributable to screening these women in later rounds after their 50th birthday. Using additional trial information, predictions of breast cancer mortality reduction in women 50 years or older might be 11% larger than previously expected, assuming that high-quality mammographic screening can be achieved in nationwide programs. For women aged 50-69 years at trial entry, the differences in expected versus observed mortality reduction among the trials are estimated to be relatively small. (Expected mortality reductions range from 24% to 32%.) Conclusions : Results from the Swedish randomized breast cancer-screening trials should be seen as more favorable regarding the effect of mammographic screening in reducing breast cancer mortality for women aged 50-69 years than was estimated earlier. Our analyses also suggest that the improvement in prognosis due to screening for women aged 40-49 years is much smaller than that for women aged 50 years or older. Approximately, 70% of the 10% observed reduction in breast cancer mortality (i.e., 7%) for women aged 40-49 years at trial entry might be attributable to a reduction due to screening these women after they reach age 50. Implications : Detailed screening data for the 40- to 49-year age group of all Swedish trials should be analyzed to specifically estimate the natural history and performance of screening in this age group.

Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS Cardiac Echo and Cohort Study)

Abstract: An elevated serum level of lipoprotein(a) (Lp[a]) may be an independent risk factor for atherosclerotic disease, but the relation of Lp(a) to aortic valve (AV) sclerosis has not been determined. We measured serum concentrations of Lp(a) and investigated their relation to the presence of echocardiographic AV sclerosis in residents of a rural village in Japan. We measured serum Lp(a) levels in 347 men ana 437 women aged 35 to 90 years (mean ± SD: 62 ± 11 years) who participated in mass screening examinations in Wara village, Gifu, Japan. AV sclerosis was assessed by longand short-axis 2-dimensional echocardiographic views and continuous-wave Doppler echocardiography. AV sclerosis was graded as follows: 0 = normal AV; 1 = increased echo density; 2 = thickening or calcific deposits ≥3 mm; and 3 = same as 2 with mildly restricted motion (pressure gradient

Alcohol interventions in trauma centers. Current practice and future directions.

Abstract: Nearly half of all trauma beds are occupied by patients who were injured while under the influence of alcohol. Alcoholism plays such a significant role in trauma that efforts to reduce injury recurrence are unlikely to be successful if it remains untreated. An injury requiring hospitalization creates a unique opportunity to intervene and to motivate patients to alter their drinking behavior, thereby making trauma centers ideal sites to implement an alcohol screening, intervention, and referral program. However, despite emphasis on injury control and prevention, little has been done to incorporate alcohol intervention programs into care of the injured patient. Effective means of intervention exist that are consistent with the time, financial, and staffing constraints of trauma centers, and they should be implemented.

Screening for post-partum depression in a community sample.

Abstract: ObjectiveThis study undertook to estimate the prevalence of post-partum depression in the community by means of telephone screening. Demographic correlates of post-partum depression were also inves...

Incidence of clinically diagnosed subtypes of dementia in an elderly population. Cambridge Project for Later Life.

Abstract: BACKGROUND In developed countries, most dementia appears to be due to Alzheimer's disease and vascular dementia. We report rates for incidence of subtypes of dementia based on clinical diagnosis. METHOD This study was a 2.4-year (s.d. 2.6 months) follow-up of a cohort aged 75 years and over, seen initially in a prevalence study of dementia. A screening interview in 1173 survivors was followed in a subsample of 461 respondents by a diagnostic interview 1.8 months after screening (s.d. 1.5 months). This comprised a standardised interview with respondent and informant, with venepuncture where possible. Clinical diagnoses of subtypes were made by specified criteria. RESULTS The incidence of Alzheimer's disease of mild and greater severity was 2.7/1000 person-years at risk (1.6-4.4); in men 1.5 (0.8-2.7) and in women 3.3 (1.8-5.9). The incidence of vascular dementia was 1.2/100 person-years at risk (0.7-1.9); in men 1.1 (0.4-2.8) and in women 1.2 (0.7-2.0). Alzheimer's disease, but not vascular dementia, showed a marked increase with age, particularly in women. Rates for minimal dementia of different subtypes showed similar age and sex effects, but were much higher for Alzheimer's disease than vascular dementia. CONCLUSIONS The striking rise in incidence rates of dementia in the very old appear to be due to Alzheimer's disease, while rates for vascular dementia remain relatively constant. These trends are particularly marked for minimal dementia, but emphasise the importance of Alzheimer's disease in the community as a cause of cognitive decline of all degrees.

UKCCCR multicentre randomised controlled trial of one and two view mammography in breast cancer screening

Abstract: Objective: To compare one view (oblique) and two view (oblique and craniocaudal) mammography in breast cancer screening. Design: Randomised controlled trial. Setting: Nine breast screening centres in England. Subjects: 40163 women aged 50-64 attending their first breast screening examination. Interventions: Women were randomised to have one view mammography, two view mammography, or two view mammography in which one view was read by one reader and both views were read by another. Main outcome measures: Prevalence of cancer detected, recall rates, cost per cancer detected, and marginal cost per extra cancer detected. Results: Two view mammography detected 24% more women with breast cancer (95% confidence interval 16% to 31%) than one view mammography. Prevalence of detected cancer was 6.84 with two view mammography and 5.52 per 1000 women with one view. The proportion of women recalled for assessment was 15% lower (95% confidence interval 6% to 23%) with two view (6.97%) than with one view (8.16%) mammography. The cost of two view screening was higher (pounds sterling26.46 compared with pounds sterling22.00 per examination) but the average cost per cancer detected was similar (pounds sterling5330 compared with pounds sterling5310) and the marginal cost per extra cancer detected with two views was similar to the average cost (pounds sterling5400). Conclusion: Two view mammography is medically more effective than one view; it detects more cancers and reduces recall rates; it is also similarly cost effective financially.

The informant questionnaire on cognitive decline in the elderly (iqcode) as a screening tool for dementia for a predominantly illiterate chinese population

Abstract: The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) provides ratings of an individual's changes in everyday cognitive functions during the previous 10 years. Original studies conducted in Australia showed that its score was not influenced by the subjects' educational backgrounds and that it performed at least as well as the Mini-Mental State Examination (MMSE) as a screening instrument for dementia. The subjects of the present study were Chinese and included 399 community residents and 61 dementia patients. Their ages ranged from 50 to 92 years; their education levels ranged from 0 to 19 years, and 63% of them had never attended school. We administered the IQCODE to informants and the Cognitive Abilities Screening Instrument (CASI), from which a CASI-estimated score of the MMSE (MMSE-CE) can be obtained, to the subjects. The diagnosis of dementia was made independently by physicians according to the DSM-III-R criteria based on semistructured interview and testing, neurologic examination, and standardized assessments of cerebral vascular disease, Parkinson's disease, and depression. The Chinese IQCODE showed no association with the subjects' education level or gender, low association with their age, and moderately high association with their MMSE-CE score. The area under the receiver operating characteristic curve of the IQCODE was significantly larger than that of the MMSE-CE for the whole group and for the subgroup with 1 to 19 years of education but not for the subgroup with 0 years of education. Nine of the 26 items of the IQCODE could be deleted without appreciable reduction in sensitivity and specificity. The IQCODE (1) can be shortened to 17 items, (2) had good cross-cultural applicability, and (3) was better than the MMSE-CE as a screening tool for dementia in a population with large variation in educational backgrounds.