Maternal serum triple analyte screening in pregnancy.
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Cost-Benefit Analysis↗
Biomedical subjects
S Cate
Publications and source records attributed to S Cate.
Feasibility of an epidemiologic study of thyroid neoplasia in persons exposed to radionuclides from the Hanford nuclear facility between 1944 and 1956.
Between 1944 and 1956, approximately 19.6 PBq (530,000 Ci) of 131I were released to the atmosphere during Pu reprocessing for nuclear weapons at the Hanford nuclear facility in southeastern Washington state. For these years, we summarized historical records of quarterly 131I atmospheric releases and vegetation concentrations measured in nearby communities. We used these data and other reported environmental measurements to make preliminary estimates of maximum doses to the thyroid for the general public. We also computed the statistical power for an epidemiologic study of thyroid neoplasia in birth cohorts of children born in two counties near Hanford during the years of highest exposure. These estimates suggest that an epidemiologic study would be feasible if the actual average radiation doses in the exposed population were no less than one-tenth the preliminary maximum doses. Our analyses also suggest that it may be more appropriate to stratify the exposed population by cumulative dose in order to examine the relation between radiation exposure and thyroid neoplasia.
Adolescent↗
Multiple marker screening for Down syndrome--whom should we screen?
BACKGROUND: The multiple marker test highlights the complexities of an expanding number of genetic tests that family physicians can offer to their patients. Many concerns surround the use of the multiple marker test, including a poor understanding of the test by physicians and patients, limited sensitivity, increased anxiety among women, and the risks of amniocentesis in patients who have false-positive results. METHODS: An online search of the medical literature was used to select English-language articles addressing the burden of suffering from Down syndrome, and efficacy, cost-effectiveness, and psychological effects of screening. RESULTS AND CONCLUSIONS: Down syndrome occurs in 0.99 per 1000 births, and the risk increases with age. Between 10% and 20% of infants die in the first year, predominantly from heart defects. Special education, the move away from institutionalization, and more employment opportunities have improved the outlook for these persons. The multiple marker test has an overall detection rate for Down syndrome of 56% with a 7% false-positive rate. A laboratory cutoff ratio of 1:190 is the most efficient for optimizing the detection rate and minimizing the false-positive rate. Limited screening to women older than 30 years appears most cost-effective, reducing losses of normal fetuses secondary to amniocentesis and the number of pregnant patients requiring pretest counseling. The family physician needs to inform the patient of the nature, purpose, and risks of screening including the psychological effects. Pretest counseling should be nondirective.
Adolescent↗