Showing papers on "Mass screening published in 1998"
TL;DR: A parent-to-child version of the Conflict Tactics Scales, the CTSPC is better suited to measuring child maltreatment than the original CTS and is practical for epidemiological research on child malt treatment and for clinical screening.
2,093 citations
TL;DR: Over 10 years, one third of women screened had an abnormal test result that required additional evaluation, even though no breast cancer was present, and Physicians should educate women about the risk of a false positive result from a screening test for breast cancer.
Abstract: Background The cumulative risk of a false positive result of a breast-cancer screening test is unknown. Methods We performed a 10-year retrospective cohort study of breast-cancer screening and diagnostic evaluations among 2400 women who were 40 to 69 years old at study entry. Mammograms or clinical breast examinations that were interpreted as indeterminate, aroused a suspicion of cancer, or prompted recommendations for additional workup in women in whom breast cancer was not diagnosed within the next year were considered to be false positive tests. Results A total of 9762 screening mammograms and 10,905 screening clinical breast examinations were performed, for a median of 4 mammograms and 5 clinical breast examinations per woman over the 10-year period. Of the women who were screened, 23.8 percent had at least one false positive mammogram, 13.4 percent had at least one false positive breast examination, and 31.7 percent had at least one false positive result for either test. The estimated cumulative risk...
1,056 citations
TL;DR: The results show that hypertrophic cardiomyopathy was an uncommon cause of death in young competitive athletes and suggest that the identification and disqualification of affected athletes at screening before participation in competitive sports may have prevented sudden death.
Abstract: Background For more than 20 years in Italy, young athletes have been screened before participating in competitive sports. We assessed whether this strategy results in the prevention of sudden death from hypertrophic cardiomyopathy, a common cardiovascular cause of death in young athletes. Methods We prospectively studied sudden deaths among athletes and nonathletes (35 years of age or less) in the Veneto region of Italy from 1979 to 1996. The causes of sudden death in both populations were compared, and the pathological findings in the athletes were related to their clinical histories and electrocardiograms. Cardiovascular reasons for disqualification from participation in sports were investigated and follow-up was performed in a consecutive series of 33,735 young athletes who underwent preparticipation screening in Padua, Italy, during the same period. Results Of 269 sudden deaths in young people, 49 occurred in competitive athletes (44 male and 5 female athletes; mean [±SD] age, 23±7 years). The most co...
943 citations
TL;DR: In this paper, a mass screening with a spiral computed tomography scanner could contribute substantially to detection of smaller cancers, and decrease mortality, and the lung cancer detection rate with CT was significantly higher than the 0·03-0·05% for standard mass assessments done previously in the same area.
885 citations
TL;DR: Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.
Abstract: This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.
881 citations
TL;DR: Although benefits of screening are likely to outweigh harms for populations at high risk of colorectal cancer, more information is needed about the harmful effects of screening, the community's responses to screening, and costs of screening for different healthcare systems before widespread screening can be recommended.
Abstract: Objective : To review effectiveness of screening for colorectal cancer with faecal occult blood test, Hemoccult, and to consider benefits and harms of screening. Design : Systematic review of trials of Hemoccult screening, with meta-analysis of results from the randomised controlled trials. Subjects : Four randomised controlled trials and two non-randomised trials of about 330 000 and 113 000 people respectively aged ≥ years in five countries. Main outcome measures : Meta-analysis of effects of screening on mortality from colorectal cancer. Results : Quality of trial design was generally high, and screening resulted in a favourable shift in the stage distribution of colorectal cancers in the screening groups. Meta-analysis of mortality results from the four randomised controlled trials showed that those allocated to screening had a reduction in mortality from colorectal cancer of 16% (relative risk 0.84 (95% confidence interval 0.77 to 0.93)). When adjusted for attendance for screening, this reduction was 23% (relative risk 0.77 (0.57 to 0.89)) for people actually screened. If a biennial Hemoccult screening programme were offered to 10 000 people and about two thirds attended for at least one Hemoccult test, 8.5 (3.6 to 13.5) deaths from colorectal cancer would be prevented over a period of 10 years. Conclusion : Although benefits of screening are likely to outweigh harms for populations at high risk of colorectal cancer, more information is needed about the harmful effects of screening, the community9s responses to screening, and costs of screening for different healthcare systems before widespread screening can be recommended.
855 citations
TL;DR: Based on the available molecular, clinical and epidemiologic data, a subset of HPVs are unequivocally the etiologic agents for cervical cancers and their precursors and caution in clinical implementation of HPV testing is warranted.
Abstract: ISSUES Cervical squamous cell carcinomas, adenocarcinomas and their precursors are caused by the human papillomavirus (HPV). Although HPV appears to be essential to the transformation of these epithelial cells, it is not sufficient, and a variety of cofactors and molecular events must take place between when an HPV infection occurs and a cervical cancer or its precursor develops. This review examines the data supporting these contentions, briefly outlines the molecular events that occur, considers the epidemiology and natural history of the disease, and details the implications of using HPV detection and typing in both clinical management and population-based screening programs. CONSENSUS POSITION 1. Based on the available molecular, clinical and epidemiologic data, a subset of HPVs are unequivocally the etiologic agents for cervical cancers and their precursors. 2. Different mucosotropic HPVs have varying neoplastic potential. However, the great majority of cervical HPVs have oncogenic potential. Since oncogenic HPV-induced epithelial transformation to a high grade lesion or cancer is rare relative to the rate of infection, the term high risk is discouraged. 3. HPV's interaction with host cells has two principal biologic consequences: a) All anogenital HPVs induce low grade squamous lesions, which are the morphologic correlate of a productive infection. b) Rarely, HPVs induce a proliferative epithelial phenotype that pathologists recognize as a high grade lesion and that is the proximate cytohistologic precursor of invasive cervical carcinoma. 4. HPV biology and issues of practical clinical management should be reflected in the classification systems used for cytologic and histologic diagnosis. ONGOING ISSUES The molecular identification of HPVs (HPV testing) potentially may be very useful for primary screening or secondary triage of patients with certain lesions. However, the technology available to the practicing clinician is still evolving. Optimization of type spectrum, sensitivity, specificity and ease of use is under development. Data regarding these factors as well as a clear cost benefit analysis are sparse or pending in several large trials. Until such data are available, caution in clinical implementation of HPV testing is warranted.
636 citations
03 Apr 1998
527 citations
TL;DR: PTSD can be precipitated by diagnosis and treatment of breast cancer, and the PCL-C can be a cost-effective screening tool for this disorder.
Abstract: The presence of a posttraumatic stress disorder (PTSD) diagnosis in women (n = 82) diagnosed with Stage 0-IIIA breast cancer was assessed 6 to 72 months after cancer therapy. The PTSD Checklist-Civilian Version (PCL-C) and the PTSD module for the Structured Clinical Interview for DSM-IV, Nonpatient Version, PTSD module (SCID-NP-PTSD) were administered in a telephone interview. SCID-NP-PTSD results indicated prevalence rates of 6% and 4% for current and lifetime PTSD, respectively. Use of the recommended cutoff score of 50 on the PCL-C to determine diagnosis of current cancer-related PTSD resulted in a sensitivity of .60 and a specificity of .99 with 2 false-negative diagnoses. In conclusion, PTSD can be precipitated by diagnosis and treatment of breast cancer, and the PCL-C can be a cost-effective screening tool for this disorder.
440 citations
TL;DR: Neuropathy, foot deformity, high plantar pressures, and a history of amputation are significantly associated with the presence of foot ulceration.
Abstract: years), foot deformities (hallux rigidus or hammer toes), male sex, poor diabetes control (glycosylated hemoglobin .9%), 1 or more subjective symptoms of neuropathy, and an elevated vibration perception threshold (.25 V) were significantly associated with foot ulceration. In addition, 59 patients (78%) with ulceration had a rigid deformity directly associated with the site of ulceration. No significant associations were noted between vascular disease, level of formal education, nephropathy, retinopathy, impaired vision, or obesity and foot ulceration on multivariate analysis. Conclusions: Neuropathy, foot deformity, high plantar pressures, and a history of amputation are significantly associated with the presence of foot ulceration. Although vascular and renal disease may result in delayed wound healing and subsequent amputation, they are not significant risk factors for the development of diabetic foot ulceration. Arch Intern Med. 1998;158:157-162
432 citations
Journal Article•
TL;DR: This document contains numerous detailed recommendations pertaining to all aspects of ambulatory diabetes care, ranging from service delivery to prevention and treatment of diabetes-related complications.
Abstract: Objective To revise and expand the 1992 edition of the clinical practice guidelines for the management of diabetes in Canada incorporating recent advances in diagnosis and outpatient management of diabetes mellitus and to identify and assess the evidence supporting these recommendations Options All aspects of ambulatory diabetes care, including organization, responsibilities, classification, diagnosis, management of metabolic disorders, and methods for screening, prevention and treatment of complications in all forms of diabetes were reviewed, revised as required and expressed as a set of recommendations Outcomes Reclassification of types of diabetes based on pathogenesis; increased sensitivity of diagnostic criteria; recommendations for screening for diabetes; improved delivery of care; recommendations for tighter metabolic control; and optimal methods for screening, prevention and treatment of complications of diabetes Evidence All recommendations were developed using a justifiable and reproducible process involving an explicit method for the citation and evaluation of the supporting evidence Values All recommendations were reviewed by an expert committee that included people with diabetes, family physicians, dietitians, nurses, diabetologists, as well as other subspecialists and methodologists from across Canada Benefits, harm and costs More aggressive screening strategies and more sensitive testing and diagnostic procedures will allow earlier detection and management of diabetes Cost-effectiveness analyses suggest that this will lead to savings in health care costs relating to diabetes care by reducing the incidence of complications of diabetes Similarly, tighter metabolic control in most people with diabetes, through intensive diabetes management, seeks to reduce the incidence of complications and, hence, their associated social and economic burdens Recommendations This document contains numerous detailed recommendations pertaining to all aspects of ambulatory diabetes care, ranging from service delivery to prevention and treatment of diabetes-related complications The terms "insulin-dependent diabetes mellitus" and "non-insulin-dependent diabetes mellitus" should be replaced by the terms "type 1" and "type 2" diabetes Testing for diabetes using fasting plasma glucose (FPG) level should be performed every 3 years in those over 45 years of age More frequent or earlier testing should be considered for people with additional specific risk factors for diabetes The FPG level at which diabetes is diagnosed should be reduced from 78 to 70 mmol/L to improve the sensitivity of the main diagnostic criterion and reduce the number of missed diagnoses Depending on the type of diabetes and the therapy required to achieve euglycemia, people with diabetes should generally strive for close metabolic control to achieve optimal glucose levels This entails receiving appropriate diabetes education through a diabetes health care team, diligent self-monitoring of blood glucose, attention to lifestyle and adjustments in diet and physical activity, and the appropriate and stepwise use of oral agents and insulin therapies needed to maintain glycemic control Also highlighted is the need for appropriate surveillance programs for complications and management options Validation All recommendations were graded according to the strength of the evidence and consensus of all relevant stakeholders Collateral efforts of the American Diabetes Association and the World Health Organization and the input of international experts were also considered throughout the revision process
TL;DR: This analysis indicates that 14.9% of US children have low-frequency or high-frequency hearing loss of at least 16-dB hearing level in 1 or both ears, and among children in elementary, middle, and high school, audiometric screening should include low- frequencies and high- frequencies to detect hearing loss.
Abstract: Context.—Hearing loss in children influences the development of communication
and behavioral skills, but few studies in the United States have used pure-tone
audiometry to derive hearing loss prevalence estimates for children.Objective.—To describe the prevalence of hearing loss among US children by sociodemographic
characteristics, reported hearing loss, and audiometric screening factors.Design.—National population-based cross-sectional survey with an in-person interview
and audiometric testing at 0.5 to 8 kHz.Setting/Participants.—A total of 6166 children aged 6 to 19 years completed audiometry in
the mobile examination center of the Third National Health and Nutrition Examination
Survey conducted between 1988 and 1994.Main Outcome Measure.—Hearing loss, defined as audiometric threshold values of at least 16-dB
hearing level based on a low or high pure-tone average.Results.—A total of 14.9% of children had low-frequency or high-frequency hearing
loss of at least 16-dB hearing level, 7.1% had low-frequency hearing loss
of at least 16-dB hearing level, and 12.7% had high-frequency hearing loss
of at least 16-dB hearing level. Most hearing loss was unilateral and slight
in severity (16- to 25-dB hearing level). Of those with measured hearing loss,
10.8% were reported to have current hearing loss during the interview.Conclusions.—This analysis indicates that 14.9% of US children have low-frequency
or high-frequency hearing loss of at least 16-dB hearing level in 1 or both
ears. Among children in elementary, middle, and high school, audiometric screening
should include low-frequency and high-frequency testing to detect hearing
loss.
TL;DR: Using affinity-purified antibodies against human proteins that regulate DNA replication can reduce the high false-negative rate of the Pap smear test and may facilitate mass automated screening.
Abstract: Carcinoma of the cervix is one of the most common malignancies. Papanicolaou (Pap) smear tests have reduced mortality by up to 70%. Nevertheless their interpretation is notoriously difficult with high false-negative rates and frequently fatal consequences. We have addressed this problem by using affinity-purified antibodies against human proteins that regulate DNA replication, namely Cdc6 and Mcm5. These antibodies were applied to sections and smears of normal and diseased uterine cervix by using immunoperoxidase or immunofluorescence to detect abnormal precursor malignant cells. Antibodies against Cdc6 and Mcm5 stain abnormal cells in cervical smears and sections with remarkably high specificity and sensitivity. Proliferation markers Ki-67 and proliferating cell nuclear antigen are much less effective. The majority of abnormal precursor malignant cells are stained in both low-grade and high-grade squamous intraepithelial lesions. Immunostaining of cervical smears can be combined with the conventional Pap stain so that all the morphological information from the conventional method is conserved. Thus antibodies against proteins that regulate DNA replication can reduce the high false-negative rate of the Pap smear test and may facilitate mass automated screening.
TL;DR: Of the screening strategies evaluated, screening for, and treatment of, dyslipidaemia and hypertension seem to produce the largest clinical benefit.
Abstract: Objectives: To develop the number needed to screen, a new statistic to overcome inappropriate national strategies for disease screening.Number needed to screen is defined as the number of people that need to be screened for a given duration to prevent one death or adverse event. Design: Number needed to screen was calculated from clinical trials that directly measured the effect of a screening strategy. From clinical trials that measured treatment benefit, the number needed to screen was estimated as the number needed to treat from the trial divided by the prevalence of heretofore unrecognised or untreated disease. Directly calculated values were then compared with estimate number needed to screen values. Subjects: Standard literature review. Results: For prevention of total mortality the most effective screening test was a lipid profile. The estimated number needed to screen for dyslipidaemia (low density lipoprotein cholesterol concentration >4.14 mmol/1) was 418 if detection was followed by pravastatin treatment for 5 years. This indicates that one death in 5 years could be prevented by screening 418 people. The estimated number needed to screen for hypertension was between 274 and 1307 for 5 years (for 10 mm Hg and 6 mm Hg diastolic blood pressure reduction respectively) if detection was followed by treatment based on a diuretic. Screening with haemoccult testing and mammography significantly decreased cancer specific, but not total, mortality. The number needed to screen for haemoccult screening to prevent a death from colon cancer was 1374 for 5 years, and the number needed to screen for mammography to prevent a death from breast cancer was 2451 for 5 years for women aged 50-59. Conclusion: These data allow the clinician to prioritise screening strategies. Of the screening strategies evaluated, screening for, and treatment of, dyslipidaemia and hypertension seem to produce the largest clinical benefit.
TL;DR: There is considerable scope for improving the treatment and control of hypertension in the English adult population.
Abstract: ObjectiveTo assess the current levels of awareness, treatment and control of hypertension in England and to determine the number and type of drugs prescribed.DesignA cross-sectional household-based survey of English adults.SubjectsA random sample from the adult English population of 12 116 adults wh
TL;DR: Considerable variability in interpretation of mammographic examinations exists; this variability and the accuracy of mammography are neither improved nor diminished with use of BI-RADS.
Abstract: Background: Several studies, which were limited by their small sample size and selection of difficult cases for review, have reported substantial variability among radiologists in interpretation of mammographic examinations. We have determined, in the largest study to date, intraobserver and interobserver agreement in interpreting screening mammography and accuracy of mammography by use of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). Methods: The mammographic examinations were randomly selected on the basis of original mammographic interpretation and cancer outcome from 71 713 screening examinations performed by the Mobile Mammography Screening Program of the University of California, San Francisco, during the period from April 1985 through February 1995. The final sample included 786 abnormal examinations with no cancer detected, 267 abnormal examinations with cancer detected, and 1563 normal examinations. Films were read separately by two radiologists according to BI-RADS. Cancer status was determined by contacting women’s physicians and by linkage to the regional Surveillance, Epidemiology, and End Results Program. Results: There was moderate agreement between radiologists in reporting the presence of a finding when cancer was present (k = 0.54) and substantial agreement when cancer was not present (k = 0.62). Agreement was moderate in assigning one of the five assessment categories but was statistically significantly lower when cancer was present relative to when cancer was not present (k = 0.46 versus 0.56; two-sided P = .02). Agreement for reporting the presence of a finding and mammographic assessment was twofold more likely for examinations with less dense breasts. Agreement was higher on repeat readings by the same radiologists than between radiologists. The sensitivity of mammography was lower with BI-RADS than with the original system for mammographic interpretation, but the positive predictive value of mammography was higher. Conclusion: Considerable variability in interpretation of mammographic examinations exists; this variability and the accuracy of mammography are neither improved nor diminished with use of BI-RADS. [J Natl Cancer Inst 1998;90: 1801‐9]
TL;DR: In this article, a Monte Carlo program for solving the Boltzmann equation for partons via the cascade method is presented, where only gluon-gluon elastic scattering is included.
TL;DR: A high prevalence and incidence of C trachomatis infection were found among adolescent females and all sexually active adolescent females are recommended to be screened for chlamydia infection every 6 months, regardless of symptoms, prior infections, condom use, or multiple partner risks.
Abstract: Context Adolescents are at highest risk for infection with Chlamydia trachomatis, an important preventable cause of pelvic inflammatory disease and subsequent tubal factor infertility in US women Current guidelines for delivery of adolescent primary care services recommend yearly chlamydia screening for those adolescent females considered to be at risk Objectives To describe the epidemiology of prevalent and incident chlamydia infection among adolescent females to assess the appropriate interval for chlamydia screening and to define risk factors that would identify adolescent females to target for screening Design Prospective longitudinal study Patients A consecutive sample of 3202 sexually active females 12 through 19 years old making 5360 patient visits over a 33-month period, January 1994 through September 1996 Setting Baltimore, Md, family planning, sexually transmitted disease, and school-based clinics Intervention Testing for C trachomatis by polymerase chain reaction Main outcome measures Prevalence and incidence of C trachomatis infections; predictors of positive test result for C trachomatis Results Chlamydia infection was found in 771 first visits (241%) and 299 repeat visits (139%); 933 adolescent females (291%) had at least 1 positive test result Females who were 14 years old had the highest age-specific chlamydia prevalence rate (63 [275%] of 229 cases; P=01) The chlamydia incidence rate was 280 cases per 1000 person-months (95% confidence interval, 249-315 cases) The median time was 72 months to a first positive chlamydia test result and 63 months to a repeat positive test result among those with repeat visits Independent predictors of chlamydia infection--reason for clinic visit, clinic type, prior sexually transmitted diseases, multiple or new partners, or inconsistent condom use-failed to identify a subset of adolescent females with the majority of infections Conclusions A high prevalence and incidence of C trachomatis infection were found among adolescent females We, therefore, recommend screening all sexually active adolescent females for chlamydia infection every 6 months, regardless of symptoms, prior infections, condom use, or multiple partner risks
TL;DR: Eugenic aspects of the practice of genetics, particularly surrounding the role of professionals and the notion of consent, are explored and recommendations on a disability equality approach to genetics and obstetrics are made.
Abstract: Pre-natal screening is a highly contentious ethical and political issue. The paper discusses aspects of the debate, and focuses on the context in which reproductive decisions are taken and the lack of a disabled voice in genetic policy. Eugenic aspects of the practice of genetics, particularly surrounding the role of professionals and the notion of consent, are explored. The paper concludes with recommendations on a disability equality approach to genetics and obstetrics.
TL;DR: Screening in the nursery with low false-positive rates can be achieved when three elements are present: audiology involvement, hospital support, and automated data and information management.
Abstract: Background. Early detection of hearing loss coupled with appropriate early intervention is critical to speech, language, and cognitive development. These competencies serve as the foundation for later academic skills. For these reasons, many states are undertaking aggressive efforts to screen all newborns before hospital discharge. Universal detection of hearing loss in newborns is a three-stage process composed of 1) the birth admission screen, 2) follow-up and diagnosis, and 3) intervention services. Breakdown at any stage jeopardizes the entire effort. The goals of this research are to examine the birth admission screen by reviewing outcome measurements for 54 228 Texas newborns and to evaluate factors that impact outcomes positively or negatively. Methodology. All newborns were screened for hearing loss using a physiologic test of auditory function; either screening auditory brainstem responses or transient evoked otoacoustic emissions. Screening occurred in the newborn and intensive care nurseries, before hospital discharge in 9 sites as part of the nursery protocol. Patients. A total of 54 228 newborns were available for screening. Outcome Measures. Four measures were evaluated and are reported: the number of births screened, the number of newborns who passed the screen before discharge, the number of infants who returned for follow-up, and the number of infants identified with hearing loss. A Birth Screening Performance Index is also calculated. Results. Results are reported for calendar years 1994, 1995, 1996, and through June 1997. A total of 54 228 newborns were available for screening; 52 508 were screened before hospital discharge during their birth admission and 50 721 passed this screen. Infants returning for follow-up screen as outpatients numbered 1224. Over this 3½-year span, 113 infants who failed the birth admission screening had hearing loss that was sensorineural in nature. From these data, the estimated incidence of hearing loss is 3.14/1000 infants. Conclusions. Screening in the nursery with low false-positive rates can be achieved when three elements are present: audiology involvement, hospital support, and automated data and information management. Follow-up measures need improvement. Better tracking methods may help assure that at-risk newborns are connected to services.
TL;DR: It will be necessary to identify the key mechanism(s) of tolerance in a particular field environment before initiating mass screening for a specific tolerance mechanism in light of the diverse plant responses to nutrient-deficient soils.
Journal Article•
TL;DR: The psychological consequences of receiving an abnormal cervical smear result and of secondary screening and treatment are reviewed, and methods of increasing participation, of improving the quality of the service, and of reducing women's anxiety are suggested.
Abstract: The United Kingdom (UK) cervical screening programme has been successful in securing participation of a high proportion of targeted women, and has seen a fall in mortality rates of those suffering from cervical cancer. There remains, however, a significant proportion of unscreened women and, of women in whom an abnormality is detected, many will not attend for colposcopy. The present work reviews the psychological consequences of receiving an abnormal cervical smear result and of secondary screening and treatment, and examines reasons for women's non-participation in the screening programme. Psychological theories of screening behavior are used to elucidate women's reactions and to suggest methods of increasing participation, of improving the quality of the service, and of reducing women's anxiety. A literature search identified studies that examine factors influencing women's participation in the screening programme, their psychological reaction to the receipt of an abnormal cervical smear result, and experiences of colposcopy. Reasons for non-participation include administrative failures, unavailability of a female screener, inconvenient clinic times, lack of awareness of the test's indications and benefits, considering oneself not to be at risk of developing cervical cancer, and fear of embarrassment, pain, or the detection of cancer. The receipt of an abnormal result and referral for colposcopy cause high levels of distress owing to limited understanding of the meaning of the smear test; many women believe the test aims to detect existing cervical cancer. The quality of the cervical screening service can be enhanced by the provision of additional information, by improved quality of communication, and by consideration of women's health beliefs. This may result in increased participation in, and satisfaction with, the service.
TL;DR: The finding that mammography with or without clinical breast examination can reduce breast cancer mortality by 25-30% has prompted several countries to introduce routine screening on a population basis.
Abstract: The finding that mammography with or without clinical breast examination can reduce breast cancer mortality by 25-30% has prompted several countries to introduce routine screening on a population basis. The International Breast Cancer Screening Network (IBSN) conducted surveys in 1990 and 1995 to yield international data on the policies funding and administration of national regional or pilot population-based screening programs. Comparison of the results of the two surveys revealed several changes from 1990 to 1995. The number of countries (primarily European) that have established or plan to launch breast cancer screening programs increased from 9 to 22. There has been a trend toward raising the lower age limit for mammography screening from 40 to 50 years with a 2-year interval between screenings. Also noted was more widespread use of the clinical breast examination and breast self-examination as additional detection methods. Countries with centralized systems for policy funding and administration were more likely to have achieved complete population coverage than those with decentralized systems. The IBSN is shifting its focus from generating an international database to developing methodologies for the evaluation of mammography screening outcomes.
TL;DR: Stage-matched, tailored materials may be a means to encourage screening mammography in women aged 40-74 and differ from the Stage-Matched group in multivariate analysis.
TL;DR: Renal disease in this population is multifactorial, with risk factors related to whole-of-life nutrition, metabolic and hemodynamic profiles, infections, health behaviors, and possibly a family predisposition, suggesting that renal disease is a component of Syndrome X.
TL;DR: It is found that education has a modest impact on the development of early childhood caries, and education should be promoted especially in high risk communities and population groups (low-income families and native populations).
Abstract: This paper reviews the methods used for the prevention of early childhood caries (ECC). The education of mothers or caregivers to promote healthy dietary habits in infants has been the main strategy used for the prevention of ECC. This review found that education has a modest impact on the development of ECC. While education should be promoted especially in high risk communities and population groups (low-income families and native populations), it should not be the only preventive strategy of ECC. Early screening for signs of caries development, starting from the first year of life, could identify infants and toddlers who are at risk of developing ECC and assist in providing information to parents about how to promote oral health and prevent the development of tooth decay. High risk children include those with early signs of ECC, poor oral hygiene, limited exposure to fluorides, and frequent exposure to sugary snacks and drinks. These children should be targeted with a professional preventive program that includes fluoride varnish application, fluoridated dentifrices, fluoride supplements, sealants, diet counseling, and chlorhexidine. Prevention of ECC also requires addressing the social and economic factors that face many families where ECC is endemic.
TL;DR: Among women who sought outpatient care, screening rates decreased as comorbidity increased, and whether clinicians and patients are making appropriate decisions about screening is not known.
Abstract: OBJECTIVE: To assess whether chronic disease is a barrier to screening for breast and cervical cancer.
TL;DR: Comparison of results to historical data within a cohort population reinforced earlier data and lent further support to the claim that the ThinPrep Pap Test is "significantly more effective" than the conventional smear in clinical practice.
Abstract: OBJECTIVE: To compare the cytologic diagnoses and specimen adequacy of the ThinPrep Pap Test with historical data within a distinct patient population to assess test performance and its impact on clinical practice. STUDY DESIGN: A total of 16,314 ThinPrep Pap tests were processed and evaluated at Fletcher Allen Health Care over a seven-month period. A subset of 8,574 tests from a selected provider group (cohort) was compared to the historical conventional cervical cytologic smear data from the cohort population for both cytologic diagnoses and specimen adequacy. The cohort consisted of 12 practice groups, including 60 physicians and providers, utilizing the ThinPrep Pap Test as their primary cervical cancer screening sampling technique. Cytologic diagnoses and specimen adequacy were classified using the Bethesda system. RESULTS: Using a three-tiered diagnostic system similar to the Cytyc clinical trials (within normal limits [WNL], atypical squamous cells of undetermined significance [ASCUS]/atypical glandular cells of undetermined significance [AGUS] and low grade squamous intraepithelial lesion and higher [LSIL]+), the ThinPrep method increased the percentage of cases that could be definitively diagnosed as WNL by 1.71%, lowered the percentage of ambiguous or borderline cases diagnosed as ASCUS/AGUS by 26.59% and increased the percentage of cases diagnostic of LSIL+ by 52.15% in the cohort population. Further subdivision by the Bethesda classification showed that the identification of infectious agents increased 25.51% and the detection of high grade squamous intraepithelial lesion/carcinoma increased 55.14%. Concurrently, cases reported as benign cellular changes (reactive/reparative) decreased 23.1%, and the percentage of cases reported as unsatisfactory/limited by was reduced 52.71%. Histologic correlation of cases reported as squamous intraepithelial lesion revealed that the percentage of patients with subsequent benign biopsies was reduced by 31.7% utilizing the ThinPrep technique. Further, the percentage of ThinPrep patients with histologically confirmed cervical intraepithelial neoplasia (CIN) 1 and CIN 2/3 increased by 16.3% and 9.3%, respectively. CONCLUSION: Implementation of the ThinPrep Pap Test resulted in statistically significant improvements in both diagnostic yield and specimen adequacy, as seen by others in clinical trials. Comparison of results to historical data within a cohort population reinforced earlier data and lent further support to the claim that the ThinPrep Pap Test is significantly more effective than the conventional smear in clinical practice.
TL;DR: The results suggest that regression of screened neuroblastoma is not a rare phenomenon, and it seems reasonable to adopt a wait-and-see strategy, with careful observation, for selected stage I or II tumors identified in infants screened at 6 months of age.
Abstract: PURPOSETo clarify whether and when neuroblastomas identified through screening do regress, and to ascertain how to treat them appropriately, we observed screened patients who had localized tumors, without any therapeutic intervention.PATIENTS AND METHODSThe criteria for the observation program were as follows: disease stage I or II; tumor less than 5 cm in diameter; no invasion to the intraspinal canal or growth to the great vessels; urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) less than 50 microg/mg creatinine; and informed consent. Of 25 patients identified through screening for 6-month-old infants in Saitama Prefecture, Japan between April 1994 and March 1996, 11 patients who met the criteria and one other patient with stage III tumor were enrolled onto the program. They were examined by abdominal ultrasonography (US) and their urinary VMA and HVA levels were assessed approximately once per month. The observation periods ranged from 4 to 27 months.RESULTSThe 11 tumors decreased in si...