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PubMed2005

Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries.

BACKGROUND: Despite its effectiveness in reducing mortality, colorectal cancer (CRC) screening rates are low, especially among low-income and minority groups; however, physician recommendation can increase screening rates. METHODS: We performed a multilevel analysis of the Medicare Current Beneficiary Survey data linked to Medicare claims and the Area Resource File to identify determinants of racial and socioeconomic disparities in CRC screening among 9985 Medicare Parts A and B beneficiaries with a usual physician. Recent CRC screening was defined as receipt of either a home fecal occult blood test, flexible sigmoidoscopy, or colonoscopy at recommended intervals. RESULTS: Unadjusted rates of screening were 48% for white and 39% for black beneficiaries (P<.001). Racial differences in CRC screening receipt were eliminated after adjustment for socioeconomic status as measured by income and education. Socioeconomic status disparities decreased but remained significant after adjustment for personal and health system factors. Awareness of CRC (adjusted odds ratio, 2.76; 95% confidence interval, 2.29-3.33) and having a primary care generalist (vs another specialist) as one's usual physician (adjusted odds ratio, 1.31; 95% confidence interval, 1.12-1.53) were associated with higher odds of screening, controlling for other factors. The odds of screening were also higher among those whose usual physician was rated more highly on information-giving skills. CONCLUSIONS: Racial differences in CRC screening rates among Medicare beneficiaries with a usual physician are explained by differences in socioeconomic status. Beneficiaries with a primary care generalist as their usual physician had higher rates of CRC screening receipt. Increased efforts to make Medicare beneficiaries aware of the benefits of CRC screening may capitalize on the associations found in this study between CRC knowledge, physician information giving, and timely screening.

Aged↗

PubMed2003

Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer.

BACKGROUND: Colonoscopic screening for colorectal cancer has been suggested because sigmoidoscopy misses nearly half of persons with advanced proximal neoplasia. OBJECTIVE: To create a clinical index to stratify risk for advanced proximal neoplasia and to identify a subgroup with very low risk in which screening sigmoidoscopy alone might suffice. DESIGN: Cross-sectional study. SETTING: A company-based program of screening colonoscopy for colorectal cancer. PATIENTS: Consecutive persons 50 years of age or older undergoing first-time screening colonoscopy between September 1995 and June 2001. MEASUREMENTS: A clinical index with 3 variables was created from information on the first 1994 persons. Points were assigned to categories of age, sex, and distal findings. Risk for advanced proximal neoplasia (defined as an adenoma 1 cm or larger or one with villous histology, severe dysplasia, or cancer) was measured for each score. The index was tested on the next 1031 persons from the same screening program. RESULTS: Of 1994 persons, 67 (3.4%) had advanced proximal neoplasia. A low-risk subgroup comprising 37% of the cohort had scores of 0 or 1 and a risk of 0.68% (95% CI, 0.22% to 1.57%). Among the validation group of 1031 persons, risk for advanced proximal neoplasia in the low-risk subgroup (comprising 47% of the cohort) was 0.4% (upper confidence limit of 1.49%). Application of this index detected 92% of persons with advanced proximal neoplasms and, if applied following screening sigmoidoscopy, could reduce the need for colonoscopy by 40%. The marginal benefit of colonoscopy among low-risk persons was small: To detect 7 additional persons with advanced proximal neoplasia, 1217 additional colonoscopies would be required. CONCLUSIONS: This clinical index stratifies the risk for advanced proximal neoplasia and identifies a subgroup at very low risk. If it is validated in other cohorts or groups, the index could be used to tailor endoscopic screening for colorectal cancer.

Age Distribution↗

PubMed2002

Use of mammographic screening by HIV-infected women in the Women's Interagency HIV Study (WIHS).

BACKGROUND: Although HIV-positive women may be less likely than women in general to receive mammography due to socioeconomic disadvantage, HIV diagnosis may increase opportunities for medical interactions which encourage mammography. METHODS: HIV-positive (2,059) and HIV-negative (569) Women's Interagency HIV Study (WIHS) participants reported ever/never history of mammography at baseline (in 1994, 1995) and, at each 6-month follow-up visit, if they had been screened since their last visit. National Health Interview Survey (NHIS) data for 1994 were used to compare WIHS participants to U.S. women. Factors independently related to mammography were determined using logistic regression for baseline data and proportional hazards for follow-up data. Results were adjusted for age. RESULTS: Among women > or =40, fewer WIHS women, regardless of HIV status, reported screening than U.S. women (67% HIV-positive, 62% HIV-negative, 79% NHIS; P < 0.0001). First-time screening while on study was associated with being HIV-positive [rate ratio (95% confidence interval) = 1.6 (1.1, 2.3)]. Factors independently associated with screening were related to health care access and usage. CONCLUSIONS: WIHS women, a disadvantaged population, reported less mammography than the general population. HIV-positive women reported more screening than HIV-negative women, possibly because of greater opportunity to interact with the health care system.

Adult↗

PubMedDate not supplied

Micro-X-ray fluorescence as a general high-throughput screening method for catalyst discovery and small molecule recognition.

A powerful high-throughput screening technique is described for the rapid screening of bead-based libraries for catalyst discovery and molecular recognition. Micro-X-ray fluorescence (MXRF) screens materials for elemental composition with mesoscale analysis. This method is nondestructive and requires minimal sample preparation and no special tags for analysis, and the screening time is dependent on the desired sensitivity. The speed, sensitivity, and simplicity of MXRF as a high-throughput screening technique were applied to screen bead-based libraries of oligopeptides for phosphate hydrolysis catalysts and molecular recognition of selective receptors for the degradation products and analogues of chemical warfare agents. This paper demonstrates the analytical or HTS capability of MXRF for combinatorial screening. It is meant only to show the capabilities of MXRF and is not meant as an exhaustive study of the catalyst and molecular recognition systems presented.

Catalysis↗

PubMed2006

Accelerating the transit time of barium sulphate suspensions in small bowel examinations.

PURPOSE: To determine whether hyperosmolar and effervescent agents proven individually to accelerate transit time in the barium small bowel examination have an additive effect when combined, surpassing that of either agent alone. MATERIALS AND METHODS: One hundred and forty-nine patients were randomised to four groups. Three hundred milliliters of barium sulphate alone was given to the first group. Fifteen milliliters of iodinated hyperosmolar contrast agent (Gastrografin, meglumine/sodium diatrizoate, Schering) was given in addition to barium sulphate to the second group while six packets of effervescent granules (Carbex, Ferring) were added for the third group. The final group was given a combination of both additives and barium sulphate. The time taken following ingestion for the contrast column to reach the caecum, as assessed by frequent interval fluoroscopy, was recorded. A subgroup of 32 patients were selected randomly from the four groups, 8 from each and assessed for quality of examination. Statistical assessments were made using Kruskal-Wallis and Mann-Whitney tests. RESULTS: One hundred and nineteen patients were analysed after exclusions. The addition of accelerant to barium sulphate, both individually and in combination significantly reduced the small bowel transit time (p<0.001). No significant difference existed between the additives when used with barium alone. The combined group had significantly faster transit times compared to the hyperosmolar group (p=0.02). Differences between combined and effervescent groups tended towards significance (p=0.09). No significant difference existed between groups when examination quality was assessed. CONCLUSION: These results suggest that the addition of combined effervescent and hyperosmolar agents to the barium suspension may significantly shorten the small bowel transit time without adversely affecting examination quality. This has implications for patient acceptability of the examination as well as potentially reducing screening time and therefore radiation dose.

Adult↗

PubMed1988

An integrated microcomputer system using immobilized cellular electrodes for drug screening.

Biosensors based on immobilized microbial cells were developed for drug screening in our laboratory. Compared with the conventional methods such as diffusion and dilution tests, biosensors have been demonstrated to be superior in sensitivity and require much shorter screening time. An integrated microcomputer system has been developed for data acquisition, database management, and mode of action estimation, which automates the screening processes and reduces the labor requirements significantly.

Anti-Bacterial Agents↗

PubMed1981

Evaluation of a nation-wide neonatal metabolic screening programme in Sweden 1965-1979.

In Sweden, neonatal screening for phenylketonuria was started in 1965 and a total of 1 326 000 infants were studied up to 1979. During various periods of time, screening was also carried out for galactosaemia, hereditary tyrosinaemia, histidinaemia, and homocystinuria. In screening for phenylketonuria and galactosaemia no false-negative results were obtained and the incidences were 1/30 850 and 1/81 100, respectively. In screening for hereditary tyrosinaemia only 1 out of 6 patients was identified by screening and the incidence was 1/106 710. Two cases of histidinaemia were detected, which corresponds to an incidence of 1/36 840. Both children developed normally without any treatment. No child with homocystinuria was detected in the screened population of more than 300 000 newborn infants. A screening programme involving phenylketonuria and galactosaemia was considered to be optimal among the tested disorders.

Evaluation Studies as Topic↗

PubMed1996

Screening for coeliac disease--has the time come for mass screening?

Several recent studies, in particular the Italian SIGEP study, have demonstrated that mass screening for coeliac disease using gliadin and endomysial antibody testing is now a realistic possibility. If mass screening is to receive serious consideration then it must be shown to be (i) effective, (ii) acceptable, and (iii) worthwhile (cost-effective). At present there is insufficient evidence as to the health benefits from treating screen-detected disease and as to the size of the risks associated with having undetected coeliac disease. It is also unclear whether truly asymptomatic screen-detected coeliacs will accept long-term dietary restriction. To answer these questions randomized trials of screening are needed. On current evidence, mass screening cannot be justified. Efficient case-finding may prove as effective and more acceptable.

Adolescent↗

PubMed2000

Prenatal genetic screening.

This article presents a discussion of screening principles and techniques available to screen for common birth defects during pregnancy. Sixty-five to 70% of women have serum screening and /or ultrasound during pregnancy to evaluate the health and well-being of the developing fetus. The most common birth defects identified by screening include neural tube defects and chromosome abnormalities. Nurses employed in prenatal care settings need to have accurate information they can provide to women so they understand the benefits and limitations of screening. Timely presentation of information and identification of available resources will help nurses minimize confusion and provide support for women as they proceed with pregnancy screening.

Adult↗

PubMed1988

Screening: potential for cancer prevention.

Cancer screening is the application of a test in large numbers of asymptomatic persons for the early detection of cancer. The objective is to reduce deaths among the population screened. Prerequisites for implementation of cancer screening are sufficient knowledge of the biology of the cancer, an appropriate screening test, an effective intervention, either by removal or with curative treatment, and the decision that the costs are worth the benefits. At this time, screening asymptomatic women for early detection of cancers of the cervix using the Pap test and breast using mammography has the greatest potential for the control of these common cancers.

Breast Neoplasms↗

PubMed2003

Costs of screening for pre-diabetes among US adults: a comparison of different screening strategies.

OBJECTIVE: We evaluated various strategies to identify individuals aged 45-74 years with pre-diabetes (either impaired glucose tolerance or impaired fasting glucose). RESEARCH DESIGN AND METHODS: We conducted a cost analysis to evaluate the effectiveness (proportion of cases identified), total costs, and efficiency (cost per case identified) of five detection strategies: an oral glucose tolerance test (OGTT), a fasting plasma glucose (FPG) test, an HbA(1c) test, a capillary blood glucose (CBG) test, and a risk assessment questionnaire. For the first strategy, all individuals received an OGTT. For the last four strategies, only those with a positive screening test received an OGTT. Data were from the Third U.S. National Health and Nutrition Examination Survey, 2000 census, Medicare, and published literature. One-time screening costs were estimated from both a single-payer perspective and a societal perspective. RESULTS: The proportion of pre-diabetes and undiagnosed diabetes identified ranged from 69% to 100% (12.1-17.5 million). The cost per case identified ranged from US dollars 176 to US dollars 236 from a single-payer perspective and from US dollars 247 to US dollars 332 from a societal perspective. Testing all with OGTT was the most effective strategy, but the CBG test and risk assessment questionnaire were the most efficient. If people are substantially less willing to take an OGTT than a FPG test, then the FPG testing strategy was the most effective strategy. CONCLUSIONS: There is a tradeoff between effectiveness and efficiency in choosing a strategy. The most favorable strategy depends on if the goal of the screening program is to identify more cases or to pursue the lowest cost per case. The expected percentage of the population willing to take an OGTT is also a consideration.

Aged↗

PubMed1999

Large-scale HCV RNA screening in first-time blood donors: the first step towards genomic screening of blood donations. HCV RNA Screening Study Group.

BACKGROUND AND OBJECTIVES: Individual genomic screening for viruses in blood donations is becoming increasingly pressing as an alternative to pool testing to improve the safety of the blood supply. MATERIALS AND METHODS: To determine the feasibility and, possibly, efficacy of genomic screening for hepatitis C virus (HCV) in the blood service setting, a representative population of first-time blood donors was screened individually with a semi-automated genomic amplification assay for HCV RNA. First-time blood donors in two blood centres in the United Kingdom were screened in parallel for anti-HCV and HCV RNA by RT-PCR. RESULTS: 8, 417 serum samples were screened. A 99.95% specificity was observed and one anti-HCV-positive, HCV-RNA-positive donation was found. No seronegative HCV-RNA-positive donations were detected. CONCLUSIONS: These results are consistent with the low prevalence of HCV infection in blood donors from the London area and demonstrate the high level of performance of the individual genomic screening method used in this study. When fully automated, such a method would be a highly suitable candidate for routine, automated genomic screening of HCV and, subsequently, of other pathogenic blood-borne viruses.

Autoanalysis↗

PubMed1996

Intertrochanteric fractures of the femur: a randomized prospective comparison of the Gamma nail and the Ambi hip screw.

BACKGROUND: The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented. METHODS: A prospective randomized study was used to compare the Ambi hip screw and the Gamma nail for the treatment of 69 patients over the age of 50 years with intertrochanteric femoral fractures. The groups were similar with respect to age, sex, prefracture mobility and abode, anaesthetic risk grade, CT measured bone density and fracture pattern. RESULTS: Those treated with the Gamma nail had a significantly longer image intensifier screening time (P < 0.05), greater blood loss (P < 0.01) and more operative complications. There was no difference in the length of hospital stay but the level of mobility recovered was significantly better in the Ambi group at 6 months follow up. Urine retention was the most frequent complication but did not correlate with the implant or method of anaesthesia. Two implants cut out, one in each group. Limb shortening was similar in both groups and was not affected by leaving the Gamma nail unlocked distally in unstable fractures. Thirteen patients died from pre-existing medical conditions. CONCLUSIONS: The Gamma nail proved technically more demanding with higher intra-operative complications and inferior return of mobility.

Aged↗

PubMed1991

Design of an automated temperature mapping system for ultrasound or microwave hyperthermia.

An automated temperature mapping system was designed to accomplish the following goals: remote control mapping; a maximum position error of 0.5 mm; mapping simultaneously on several channels; real-time screen display on a dedicated computer; to be inexpensive, and have a simple patient interface and set up. A four channel, microstepper system was fabricated for less than $1000 and controlled by an IBM-AT computer. The system utilizes direct drive of Luxtron fibre-optic probes fed through thin flexible Teflon tubing which allows for patient movement. The driving and control software were written in the programming language "C". Mapping parameters for each independent channel include start and stop positions and map increment. The software permits the user to automatically find the maximum temperature along a track in three passes of 2.0, 1.0 and 0.5 mm steps. The latter two passes take five or seven readings centred about the maximum of the previous pass. A high resolution monitor plots the temperatures in real time, overlaying the previous map in a new colour. A screen dump was written to drive a colour printer with the plot information. The computer evaluates each plot to safeguard against any shift in the maximum location. Visualization of orthogonal pullbacks provides rapid feedback and aids in the repositioning of superficial hyperthermia transducers. The time saved over the previous manual mapping methods easily justifies the additional set up time.

Animals↗

PubMed2006

Overweight and obesity among children and youth.

OBJECTIVES: This article describes the prevalence of overweight and obesity among Canadian children and youth aged 2 to 17, based on direct measurements of their height and weight. Data from 1978/79 and 2004 are compared, and trends by sex and age groups are presented. DATA SOURCES: Data based on direct measurements are from the 2004 Canadian Community Health Survey (CCHS): Nutrition. Other information is from the 1978/79 Canada Health Survey and the 1999-2002 National Health and Nutrition Examination Survey, conducted in the US. ANALYTICAL TECHNIQUES: The estimated prevalence of overweight and of obesity, including an overall rate reflecting both, was based on 2004 CCHS data for 8,661 children and youth whose height and weight were measured. MAIN RESULTS: In 2004, 26% of Canadian children and adolescents aged 2 to 17 were overweight or obese, and 8% were obese. Over the past 25 years, the prevalence of overweight and obesity combined has more than doubled among youth aged 12 to 17, while the prevalence of obesity alone has tripled. Children and youth who ate fruit and vegetables at least five times a day were substantially less likely to be overweight or obese than were those who ate these foods less often. The likelihood of being overweight/obese rose as "screen time" (watching TV, playing video games or using a computer) increased.

Adolescent↗

PubMed1989

Health maintenance update: guidelines for the physician and patient.

In summary, we have gathered information from current sources in order to provide practicing physicians up-to-date health maintenance recommendations. We have also provided sample forms that can be used for recording information and ensuring that timely screening is accomplished. These same forms could also be given to the patient who has a desire to be involved in his/her medical care. Although some of the recommendations will remain stable over a period of time, there will certainly be new developments in medicine that will alter today's advice. Our concept is that each physician should develop and keep up to date a plan of health maintenance and screening and have some method of ensuring that appropriate screening is accomplished.

Health Promotion↗

PubMed1996

Patient dose measurements from femoral angiography.

Investigation of patient dose from femoral angiography requires detailed logging of dose-area product (DAP) measurements, which is time-consuming and only possible on small numbers of patients. A simple model for the femoral angiogram study consists of two regions; lower limbs and torso. The experimental phantom was the abdominal and pelvic sections of a Rando phantom, and two 10 cm diameter water filled cylinders to represent a lower limb. DAP rate during screening, and the DAP per spot film exposure were obtained in two rooms. Total DAP values were measured on 100 patients in each room. The median screening time and number of spot film exposures were divided between the two regions. The DAP from screening and spot films for each region was estimated by combining the phantom and patient data. The total DAP predicted by the model agreed to within 7% of the median DAP from the patient studies Conversion to effective dose gave 9.0 mSv for the newer room compared with 2.8 mSv for the older room. In the newer room it was estimated that digital spot film exposure contributed 88% of the total effective dose. In the same room, exposure of the torso contributed 98% of the total effective dose. The model will enable interpretation of total DAP measurements made from femoral angiogram studies without the need for detailed DAP measurements on every patient. Attempts to reduce patient dose from femoral angiography must concentrate on reduction of the number and dose per exposure from abdominal and pelvic digital spot films.

Femoral Artery↗

PubMed2005

Self-medication of mental health problems: new evidence from a national survey.

OBJECTIVE: To evaluate the association between past 30-day use of alcohol, marijuana, and other illicit drugs and past year unmet need for and use of mental health care. DATA SOURCE: A subsample of 18,849 respondents from the 2001 National Household Survey on Drug Abuse and the 2002 National Survey on Drug Use and Health. Subjects were between the ages of 18 and 65 years and had least one past year mental disorder symptom and no past year substance dependency. STUDY DESIGN: Logistic regressions of past 30-day substance use on past 12-month unmet need for mental health care and past 12-month use of mental health services controlling for clinical and sociodemographic characteristics. Predicted probabilities and corresponding standard errors are reported. PRINCIPAL FINDINGS: Use of illicit drugs other than marijuana increased with unmet need for mental health care (4.4 versus 3.2 percent, p=.046) but was not reduced with mental health-care use. Heavy alcohol use was not associated with increased unmet need for mental health care, but was higher among individuals with no mental health care use (4.4 percent versus 2.7 percent, p<.001). By contrast, marijuana use did not appear associated with either unmet need or mental health care use. CONCLUSIONS: Substance use varies with past year unmet need for mental health care and mental health care use in ways consistent with the self-medication hypothesis. Results suggest that timely screening and treatment of mental health problems may prevent the development of substance-use disorders among those with mental disorders. Further research should identify subgroups of individuals for whom timely and appropriate mental health treatment would prevent the development of substance-use disorders.

Adult↗