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Cost-effectiveness of diagnostic tests for toenail onychomycosis: a repeated-measure, single-blinded, cross-sectional evaluation of 7 diagnostic tests.

OBJECTIVE: Our purpose was to estimate and compare the cost-effectiveness of the most commonly used diagnostic tests for onychomycosis: potassium hydroxide preparation (KOH), interpreted both by a dermatologist (KOH-CLINIC) and a laboratory technician (KOH-LAB); KOH with dimethyl sulfoxide (KOH-DMSO) and with chlorazol black E (KOH-CBE), interpreted by a dermatologist; culture using dermatophyte test medium, culture with Mycobiotic and Inhibitory Mold Agar (Cx); and histopathologic analysis using periodic acid-Schiff stain (PAS). METHODS: This was a repeated-measure, blinded, cross-sectional study conducted at the Minneapolis Veterans Affairs Medical Center. Inclusion criteria included: at least one toenail with 25% or more clinical disease, which was defined as subungual debris with onycholysis and/or onychauxis. Exclusion criteria included other nail dystrophies, use of oral antifungal medication for 2 months or longer within the past year, or topical ciclopirox lacquer within 6 weeks of enrollment. The main outcome measure was the cost-effectiveness (Medicare and non-Medicare costs) of 7 diagnostic tests. Sensitivity (at least 3 positive tests) was the unit of effectiveness. RESULTS: Two hundred four participants were enrolled; their average age was 69.5 years and 95.5% were male. PAS was the most sensitive test (98.8%); it was statistically significantly more sensitive than all other diagnostic tests except KOH-CBE (94.3%). Dermatophye test medium was the least sensitive test (57.3%). KOH-CBE was statistically significantly more cost effective than any other test, with the exception of KOH-CLINIC and KOH-LAB. PAS was the least cost effective. LIMITATIONS: Test specificities were not evaluated. CONCLUSION: KOH-CBE should be the test of choice for practitioners confident in interpreting KOH preparations because of its combination of high sensitivity and cost-effectiveness.

Aged↗

Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests.

Previous research indicates that physical examination cannot diagnose sacroiliac joint (SIJ) pathology. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard. In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. The tests were evaluated singly and in various combinations (composites) for diagnostic power. All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Receiver operator characteristic curves and areas under the curve were constructed for various composites. The greatest area under the curve for any two of the best four tests was 0.842. In conclusion, composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ. Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP.

Adult↗

Follow-up testing of rodent carcinogens not positive in the standard genotoxicity testing battery: IWGT workgroup report.

At the Plymouth Third International Workshop on Genotoxicity Testing in June 2002, a new expert group started a working process to provide guidance on a common strategy for genotoxicity testing beyond the current standard battery. The group identified amongst others "Follow-up testing of tumorigenic agents not positive in the standard genotoxicity test battery" as one subject for further consideration [L. Müller, D. Blakey, K.L. Dearfield, S. Galloway, P. Guzzie, M. Hayashi, P. Kasper, D. Kirkland, J.T. MacGregor, J.M. Parry, L. Schechtman, A. Smith, N. Tanaka, D. Tweats, H. Yamasaki, Strategy for genotoxicity testing and stratification of genotoxicity test results-report on initial activities of the IWGT Expert Group, Mutat. Res. 540 (2003) 177-181]. A workgroup devoted to this topic was formed and met on September 9-10, 2005, in San Francisco. This workgroup was devoted to the discussion of when it would be appropriate to conduct additional genetic toxicology studies, as well as what type of studies, if the initial standard battery of tests was negative, but tumor formation was observed in the rodent carcinogenicity assessment. The important role of the standard genetic toxicology testing to determine the mode of action (MOA) for carcinogenesis (genotoxic versus non-genotoxic) was discussed, but the limitations of the standard testing were also reviewed. The workgroup also acknowledged that the entire toxicological profile (e.g. structure-activity relationships, the nature of the tumor finding and metabolic profiles) of a compound needed to be taken into consideration before the conduct of any additional testing. As part of the meeting, case studies were discussed to understand the practical application of additional testing as well as to form a decision tree. Finally, suitable additional genetic toxicology assays to help determine the carcinogenic MOA or establish a weight of evidence (WOE) argument were discussed and formulated into a decision tree.

Acetamides↗

Treadmill testing for evaluation of claudication: comparison of constant-load and graded-exercise tests.

OBJECTIVES: To compare the correlation and practicability of single-stage vs. graded treadmill protocols in the assessment of the absolute claudication distance (ACD). DESIGN: Randomized open study. MATERIAL AND METHODS: In 52 patients with peripheral arterial occlusive disease, the ACD on treadmill at 3 km/h and 12% grade (constant-load test = C-test) ranged form 50 to 400 m. The C-test and the graded-exercise test (walking on the treadmill at 3 km/h and 0% gradient for 3 min, with subsequent increase in gradient of 3.5% every 3 min = G-test) were carried out at random on the same day under standardized conditions. RESULTS: The ACD was higher in the G-test than in the C-test (360.4 +/- 208.8m vs. 166.5 +/- 93.6m; p < 0.001). The coefficients of variation were very similar (57.9% and 56.2%, respectively). In the subgroup of patients with an ACD of between 100 m and 150 m, a large difference was found both for the coefficient of variation (58.6% G-test, 9.6% C-test) and for the standard deviation (339.8 +/- 199.0m and 133.1 +/- 12.8m, respectively). CONCLUSIONS: For the assessment of the ACD in patients with severe claudication the C-test would seem to be more suitable than the G-test.

Exercise Test↗

Comparison of two disposable plastic skin test devices with the bifurcated needle for epicutaneous allergy testing.

BACKGROUND: The Greer DermaPIK and the Lincoln Diagnostics Duotip-Test are frequently used plastic, disposable, allergy skin testing devices. OBJECTIVES: To compare the prick method of using the bifurcated needle and DermaPIK with the Duotip-Test using both the scratch (rotation) and prick methods for sensitivity, precision, and level of discomfort. METHODS: Skin-testing was done with histamine and saline on the back in triplicate on 24 volunteers (mean age 32.8, seven males). Wheal and erythema were measured and a photograph was taken. Discomfort was rated on an analog scale. RESULTS: The bifurcated needle and the Duotip-Test prick technique had significantly smaller histamine wheal and erythema responses than either the DermaPIK prick or Duotip-Test scratch techniques (P < .05). The Duotip-Test scratch produced significantly larger wheals (mean 1.1 mm, P < .001) to saline than the other three methods. Erythema to saline by Duotip-Test scratch (mean 3.16 mm) was significantly larger than the bifurcated needle (mean 1.2 mm, P < .001) and Duotip-Test prick method (mean 1.6 mm, P < .01). There was no statistical difference in the histamine coefficient of variation among the four methods. The Duotip-Test scratch method was rated significantly higher in patient discomfort (mean 21.6, P < .05) than the bifurcated needle (mean 7.8). No differences in discomfort were noted between the other methods. CONCLUSIONS: The Duotip-Test scratch method had the largest mean wheal/erythema to histamine and the lowest CV. It had the most dermatographism and was more uncomfortable than the other methods. The other devices and methods were very similar in response to histamine and saline, and to precision and discomfort.

Adolescent↗

Positive nickel patch tests do not intensify positive reactions to adjacent patch tests with dichromate. Results from a double-blind multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe, DKG).

The possible interference of neighbouring allergic patch-test reactions is still an open question. In this study, we investigated whether there is a distance-related mutual modification of neighbouring allergic patch-test reactions to nickel sulfate and potassium dichromate. We used a double-blind multicentre study design with randomized attachment of special TRUE Tests with 1, 3 and 7 cm distance between nickel sulfate and potassium dichromate patches. 589 patients with a history of nickel allergy (523 female, 66 male) were tested, with a mean age of 35 years. A log-linear modelling approach was used for statistical assessment of the relation between the distance separating neighbouring patch tests with nickel and dichromate and the reactions to the allergens. Non-reproducibility coefficients were compared by the generalized version of Fisher's exact test for arbitrary 2-dimensional contingency tables. For the left side of the back, virtually no differences (p=0.70) were found in the reaction patterns obtained for the 3 distances separating nickel and dichromate patch tests. On the right side of the back, the number of reactions to dichromate patches with only 1 cm distance from moderate/strong nickel reactions was lower than the number of positive dichromate tests at larger distances from nickel tests (on the border of statistical significance: p= 0.05). Corresponding side-related results were obtained for subgroups of patients with and without a history of atopic dermatitis. The non-reproducibility of reactions to dichromate was not significantly related to the distance between neighbouring tests. Our data argue against a "spillover" effect of strong/moderate nickel reactions, but indicate that such reactions may, under certain conditions, attenuate adjacent reactions to an unrelated allergen. In the case of future verification, this will have implications for the interpretation of patch tests.

Adolescent↗

Evaluation of a new, rapid, qualitative, one-step PSA Test for prostate cancer screening: the PSA RapidScreen test.

To increase the acceptance rate and reduce the cost of the screening programme for prostate cancer, a new qualitative and one-step test for prostate-specific antigen (PSA), called PSA RapidScreen, has been evaluated. PSA RapidScreen test is a chromatographic lateral flow immunoassay, which generates a positive or negative result for PSA values >or=or <4 ng/ml, respectively. Capillary blood samples from 188 men were evaluated. Two independent observers interpreted the test at 10, 15, 20 and 25 min. A total of 10 women were tested as controls. Parallel serum samples were simultaneously collected and tested with an ordinary quantitative assay (Elecsys 2010, Roche). Sensitivity, specificity, accuracy, negative and positive predictive values of the test were 97.6, 90.4, 94, 98 and 89%, respectively. PSA RapidScreen tests on female capillary samples were negative. Reproducibility of the test was 99.5%, while interobserver variation was 5%. Specificity of the test was altered by variations in the reading time. Quantitative assessment of the intensity of the band correlated with the PSA value (r=0.87; t=23.97; P<0.001). PSA RapidScreen is a rapid, simple and reproducible one-step test. The low cost and the speed of the test make it a powerful and convenient tool for prostate cancer screening programmes.

Adult↗

A sensitive guaiac faecal occult blood test is less useful than an immunochemical test for colorectal cancer screening in a Chinese population.

BACKGROUND: Colorectal cancer screening by guaiac faecal occult blood test has been shown to reduce the incidence and mortality of colorectal cancer in Western populations. The optimal faecal occult blood test, whether guaiac or immunochemical, for colorectal cancer screening in the Chinese population remains to be defined. AIM: To compare the performance characteristics of a sensitive guaiac-based faecal occult blood test (Hemoccult SENSA) and an immunochemical faecal occult blood test (FlexSure OBT) in a Chinese population referred for colonoscopy. METHODS: One hundred and thirty-five consecutive patients who were referred for colonoscopy and who met the study inclusion criteria took samples for the two faecal occult blood tests simultaneously from three successive stool specimens, with no dietary restrictions. All tests were developed and interpreted by a single experienced technician who was blind to the clinical diagnosis. The sensitivity, specificity and positive predictive value for the detection of colorectal adenomas and cancers were estimated for the two tests. RESULTS: The sensitivity, specificity and positive predictive value for the detection of significant colorectal neoplasia (adenomas > or = 1.0 cm and cancers) were 91%, 70% and 18% for Hemoccult SENSA and 82%, 94% and 47% for FlexSure OBT. The specificity and positive predictive value were significantly higher for FlexSure OBT than for Hemoccult SENSA (P < 0.001 and P = 0.016, respectively). Combining the positive results from both faecal occult blood tests did not improve the accuracy. CONCLUSION: The positive predictive value of the immunochemical faecal occult blood test for the detection of significant colorectal neoplasia was 29% better than that of the sensitive guaiac-based test. This may relate to the Chinese diet and requires further study. The poor specificity of the sensitive guaiac-based test, without dietary restriction, makes it less useful for colorectal cancer screening in a Chinese population.

Adult↗

Skin reaction and recovery: a repeated sodium lauryl sulphate patch test vs. a 24-h patch test and tape stripping.

BACKGROUND: Little is known of the predictive value of methods to test an individual's susceptibility to acquiring occupational contact dermatitis. Recently, the recovery rate after induced irritation was suggested for this purpose. Although it is likely that repeated exposure to sodium lauryl sulphate (SLS) is preferable to a single application, there is little evidence to support this idea. Similarly, little is known about whether the outcome of a repeated SLS test can be predicted by a brief test. OBJECTIVES: We studied the relationship between the skin reaction after a repeated SLS test and two brief tests, devoting special attention to the recovery rate. METHODS: In 29 healthy volunteers, we measured transepidermal water loss (TEWL) and erythema after applying 0.03, 0.1 and 0.3% SLS for 6 h, 3 days per week, over a course of 3 weeks. The data were compared with the effects after applying 0.1, 0.3 and 1.0% SLS for 24 h and with 10 and 15 repetitions of tape stripping. RESULTS: A poor correlation was found between the repeated test and the brief SLS test, or tape stripping, when using an increase in TEWL (r = 0.04 and 0.26, respectively) or its recovery rate (r = - 0.01 and 0.42, respectively). CONCLUSIONS: We presume that in a repeated test of sufficient duration, additional mechanisms come into play that are absent in a brief test, e.g. an alteration in the thickness of the epidermis, with a resulting change in the permeability of SLS. When such an effect differs between subjects it could explain the lack of agreement between the acute and the repeated tests. At present, a brief irritation test will, in all likelihood, be unable to assess an individual's susceptibility to occupational contact dermatitis.

Adult↗

Evaluation of the World Health Organization standard tourniquet test and a modified tourniquet test in the diagnosis of dengue infection in Viet Nam.

OBJECTIVES: A positive tourniquet test is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue haemorrhagic fever, but no formal evaluation of the test has been undertaken. As many doctors remain unconvinced of its usefulness, this study was designed to assess the diagnostic utility of both the standard test and a commonly employed modified test. METHODS: A prospective evaluation of the standard sphygmomanometer cuff tourniquet test, compared with a simple elastic cuff tourniquet test, was carried out in 1136 children with suspected dengue infection admitted to a provincial paediatric hospital in southern Viet Nam. RESULTS: There was good agreement between independent observers for both techniques, but the sphygmomanometer method resulted in consistently greater numbers of petechiae. This standard method had a sensitivity of 41.6% for dengue infection, with a specificity of 94.4%, positive predictive value of 98.3% and negative predictive value of 17.3%. The test differentiated poorly between dengue haemorrhagic fever (45% positive) and dengue fever (38% positive). The simple elastic tourniquet was less sensitive than the sphygmomanometer cuff, but at a threshold of 10 petechiae (compared with the WHO recommendation of 20) per 2.5 cm2 the sensitivity for the elastic tourniquet rose to 45% (specificity 85%). Other evidence of bleeding was frequently present and the tourniquet test provided additional information to aid diagnosis in only 5% of cases. CONCLUSION: The conventional tourniquet test adds little to the diagnosis of dengue in hospitalized children. The simple, cheap elastic tourniquet may be useful in diagnosing dengue infection in busy rural health stations in dengue endemic areas of the tropics. A positive test should prompt close observation or early hospital referral, but a negative test does not exclude dengue infection.

Adolescent↗

Calibration of the disk diffusion test for trovafloxacin susceptibility testing of four anaerobic species.

OBJECTIVES: To study trovafloxacin susceptibility among clinical isolates of four anaerobic bacterial species using minimum inhibitory concentrations (MIC) determinations, E test assays and disk diffusion test results and to calibrate the disk diffusion method for these species using single strain regression analysis (SRA). METHODS: One-hundred and eighty-seven clinical isolates of four anaerobic bacterial species were included. Trovafloxacin MIC determinations were performed using the agar dilution technique and MIC estimations using the E test. The disk diffusion test was performed according to Swedish Reference Group for Antibiotics standardization. NCCLS limits for susceptibility categories were applied. SRA was performed using 1, 3, 10, 30, and 100 microg trovafloxacin disk contents and ATCC control strains. The regression lines obtained permitted the calculation of zone equivalents to MIC limits as well as an evaluation of various disk potencies. RESULTS: Trovafloxacin susceptibility (S + I) was noted in 98.9, 100, 100, and 97% of Bacteroides fragilis, Bacteroides thetaiotaomicron, Clostridium perfringens, and Peptostreptococcus magnus strains, respectively, as judged by MIC determinations. Agar dilution and E test estimations gave the same results, but E test values were consistently lower than MIC values by the reference method. Regression lines calculated for the four species using SRA showed different equation constants indicating species-related differences. Interpretive zone diameter breakpoints were calculated for the four species and used for the interpretation of susceptibility. CONCLUSIONS: The disk diffusion test was successfully calibrated for trovafloxacin susceptibility testing of four anaerobic species using single strain regression analysis, SRA. There was a good agreement between the results of MIC-tests and disk testing. Interpretive errors of type I are prone to occur among Bacteroides isolates and might require species-related MIC limits. SRA calculations permitted the testing of the effect of different disk potencies on inhibition zones produced at the interpretive MIC limits. Criteria for the selection of a minimal disk content showed that 5 microg trovafloxacin is sufficient, but a 10 microg disk will safeguard against residual laboratory variation without producing too large inhibition zones for very susceptible strains.

Anti-Infective Agents↗

Laboratory running test vs. field roller skiing test in cross-country skiers: a longitudinal study.

Laboratory treadmill running tests are commonly used to assess the effect of training programs and to prescribe training intensity for cross-country skiers. The present study compared the physiological parameters during a treadmill running (R) test and a field roller skiing (RS) test both at the beginning (Beg) and at the end (End) of a 6-month specific training program in seven competitive cross-country skiers. Oxygen uptake (VO2) and blood lactate concentration ([La]) were assessed for exercise intensity corresponding to 70%, 80%, 90% of maximal heart rate (HRmax) and to HRmax.VO2 was lower for the RS test compared to the R test at any HR levels at Beg only (p<0.05). Maximal VO2 increased from Beg to End for the RS test only (+23.7+/-10.4; p<0.05). [La] was lower for the R test compared to the RS test during both testing periods at 90% HRmax (p<0.05), and no significant modification in [La] from Beg to End at any HR levels was observed (p>0.05). The [La]/V.O2 curve shifted toward the right from Beg to End to a greater extent for the RS test compared to the R test. The present study emphasised the importance of exercise specificity in order to assess the effect of specific training program in competitive cross-country skiers.

Adolescent↗

Test-re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study.

PRIMARY OBJECTIVE: Assess the test-re-test reliability of walking speed, step length and step width measurement in people with traumatic brain injury (TBI). RESEARCH DESIGN: Repeated measures (two test occasions). METHODS: Thirteen people with TBI completed four comfortable and four fast-paced walking trials of the 10 m walk test and two trials of the 6-minute walk test (6MWT). Walking speed, step length and step width were measured during the 10 m walk test and walking distance and average speed were measured during the 6MWT. The tests were repeated 1-week later. MAIN RESULTS: Walking speed and distance showed excellent test-re-test reliability, with an intra-class correlation coefficient (ICC) of 0.95-0.96. Reliability was also high for step length and width measurement (ICC 0.91-0.98). CONCLUSIONS: This test-re-test reliability means that walking speed and distance and step length and width can be used by physiotherapists to monitor improvements in walking after TBI.

Adult↗

False-positive gonorrhea test results with a nucleic acid amplification test: the impact of low prevalence on positive predictive value.

Five false-positive gonorrhea test results from a private laboratory using a nucleic acid amplification test led to an investigation by the Hawaii State Department of Health. No unexplained increase or variation in the laboratory's positive gonorrhea test results was detected. The proportion of positive gonorrhea test results among tests performed in the population was 1.06%. The calculated positive predictive value (PPV) of the test in this setting was 60%. Documentation of sexual histories was lacking for all cases. It is imperative to obtain a sexual history for both assessing sexually transmitted disease (STD) risk and interpreting STD test results. The possibility that positive test results may be false should be considered when patients have unanticipated positive test results. Clinicians who perform STD screening tests should know the approximate prevalence of STDs in the population being screened and have a conceptual understanding of PPV and the impact of low prevalence on screening tests with imperfect specificity.

Adult↗

A physico-chemical screening test for chemical carcinogens: the ke test.

A pulse-conductivity technique was used to measure the rate at which excess electrons in liquid cyclohexane attach to carcinogens and non-carcinogens in order to determine if the electron attachment rate constant, ke, could be used to screen potential carcinogens. The keS of 114 chemicals are reported; these chemicals are among 182 that had previously been tested in a validation study of several short-term carcinogen-screening bioassays. The remaining 68 chemicals for which keS were not measured include chemicals that were unavailable, were not sufficiently stable or soluble in cyclohexane, or did not have a well-defined mol. wt. For the 114 chemicals that were tested, 35 are carcinogens, 50 are putative non-carcinogens and 29 have not been adequately tested or yielded equivocal responses in animal-test studies. Diffusion-controlled keS were measured for 27 of the 35 carcinogens tested whereas the keS of 45 of the 50 non-carcinogens were less than diffusion controlled. From these results, several measures of the predictive performance of using a diffusion-controlled ke to indicate a positive response to a carcinogen were calculated and compared with the Ames-test predictiveness in screening the same chemicals. The predictive criteria calculated were sensitivity, specificity, accuracy and predictive value, all of which were greater for the ke test than for the Ames test. Comparisons of the chemicals that yielded false-negative responses in the ke and Ames tests indicate a high degree of independence between the two which implies that the tests could be efficaciously used in a battery of short-term tests. Rationales are offered concerning the observed ke--carcinogenicity correlation and the apparent lack of the need for procarcinogens to be metabolically activated to yield a positive ke response.

Carcinogens↗

Defining measurement precision for effort dependent tests: the case of three neurobehavioural tests.

For effort dependent tests, the estimation of measurement precision (reproducibility) is complicated by learning effects and submaximal efforts which inflate the variance of repeated trials. To illustrate an approach to the estimation problem, precision was evaluated for three neurobehavioural tests based on the responses of 76 boatbuilders tested on four separate test occasions within a one-week period. The average Coefficient of Variation (CV) for repeated trials within a test session was 6%, 16% and 13% for the Continuous Performance Test (CPT), Symbol-Digit substitution test (SDS) and the Hand-Eye motor-coordination test (HEM), respectively. In order to adjust for the effects of learning, the first trial(s) of a session were excluded from the calculation of performance level and its precision. This adjustment for learning significantly improved the precision for SDS and HEM to a CV of 8%. Inspection of the distributions of best efforts by trial number indicated that dropping the early trial(s) eliminated the best efforts of 34%, 22% and 7% of the subjects on the three tests respectively. When the worst two trials were excluded regardless of order, precision improved significantly to less than 5% for all three tests. On the basis of these results, a 5% precision rule for CPT and a 10% precision rule for SDS and HEM are provisionally recommended. The test results of subjects unable to meet this criterion should be identified, but in order to avoid selection bias, they should be analysed separately rather than excluded.

Adult↗

Attitudes about genetic testing and genetic testing intentions in African American women at increased risk for hereditary breast cancer.

PURPOSE: To evaluate attitudes about the benefits, limitations, and risks of genetic testing for BRCA1 and BRCA2 (BRCA1/2) mutations and explore testing intentions in African American women at increased risk for hereditary breast cancer. METHODS: Attitudes and intentions were evaluated by telephone in African American women (n = 74) at moderate and high risk for having a BRCA1/2 mutation. RESULTS: Attitudes about the benefits of genetic testing were endorsed at a higher rate relative to limitations and risks; however, only 30% of respondents indicated that they would definitely have testing. In regression analysis, women most likely to be considering testing were those with fatalistic beliefs about cancer and those who believed they had a BRCA1/2 mutation. Women who had two or more affected relatives were also most likely to be considering testing. Women who had a personal history of cancer and those who believed they were at high risk for developing breast cancer were most likely to report greater limitations and risks. Pros scores were higher among women older than age 50 and those who were unemployed. CONCLUSION: Although African American women at moderate and high risk for BRCA1/2 mutations report favorable attitudes about genetic testing, interest in testing may be limited. Women affected with cancer and those who believe they are at a higher risk for developing breast cancer may be most concerned about the negative consequences of testing. Increased attention may need to be given to beliefs about genetic testing and testing motivations during genetic counseling with African American women.

Black or African American↗

The folic acid absorption test compared with other laboratory tests for malabsorption.

In 25 patients with malabsorption, the folic acid urinary excretion (TRIFA) test was compared with the degree of steatorrhoea, the Schilling test, and the D-xylose test. No correlation was found between the faecal lipid excretion, the Schilling test, and the TRIFA test, whereas the TRIFA test did correlate fairly well with the D-xylose test. It is concluded that the TRIFA test does not replace estimations of faecal lipid excretions in the diagnosis of intestinal malabsorption. As it mainly supplies information about absorptional capacity in the upper small bowel, it is complementary to the Schilling test, which chiefly measures the absorption in the lower intestine. Finally, the TRIFA test has several advantages over the D-xylose test in practical clinical use.

Adolescent↗