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PubMedDate not supplied

Screening for cancer: state of the art and prospects for the future.

Effectiveness of screening has been established for two cancer sites: breast and cervix uteri. Only for these, therefore, are national policies applicable. The degree of effectiveness of such programs will depend on the coverage of the eligible population; organized programs are, therefore, essential. For cancer of the cervix, nearly maximal efficacy will be obtained by screening sexually active women from 25 to 60 years of age every 3 years. For cancer of the breast, current evidence only justifies screening from 50 years of age; most programs will stop at 70 years of age. Mammography every 2 years will provide nearly maximal efficacy. The place of breast self-examination and physical examination of the breasts is under investigation. In Japan, screening for stomach cancer is justifiable, although strict evidence of effectiveness is lacking. Screening for other cancers must still be regarded as experimental, including the use of sigmoidoscopy and fecal occult blood tests for colorectal cancer, and visual examination of the mouth for oral cancer. Because of organizational and other difficulties, screening seems unlikely to make a major contribution to reduction in overall cancer mortality by the year 2000. However, if organizational problems can be overcome, screening has the potential to control invasive cancer of the cervix, and to make a major contribution to reduction in breast cancer mortality.

Humans↗
PubMed2026

Fecal immunochemical tests from population-based colorectal cancer screening programs support prospective microbiome cohorts.

BACKGROUND: Large, prospective cohorts are needed to research the gut microbiome's role in colorectal cancer (CRC) risk. We evaluated the gut microbiome leveraging residual fecal immunochemical tests (FIT) from a CRC screening program in Turin, Italy, and conducted one of the largest population-based case-control studies across the adenoma-carcinoma sequence to date. METHODS: We extracted DNA from residual FIT stool, used whole-genome shotgun sequencing, and included those with CRC (N = 44), advanced adenomas (N = 269), early adenomas (N = 134), and FIT-negative controls (N = 478). Alpha diversity, beta diversity, and species, gene, and pathway relative abundances were estimated. Multivariable logistic regression models were used to estimate associations of these metrics with colorectal neoplasms. RESULTS: Alpha diversity was mostly inversely associated with colorectal neoplasms, particularly early adenomas (OR: 0.45, 95% CI: 0.25-0.80; P = 0.01). Presence of oral pathogens, including Parvimonas micra, was associated with higher odds of CRC. Furthermore, Escherichia coli and Bacteroides fragilis were strongly associated with higher odds of all colorectal neoplasms. Several genes and pathways were associated with colorectal neoplasms. CONCLUSIONS: Our findings align with smaller studies of the gut microbiome and colorectal neoplasms, supporting that CRC screening programs provide opportunities to prospectively study the gut microbiome's association with cancer risk in large populations.

Humans↗
PubMed1982

Health education program effects on the management of hypertension in the elderly.

Because the elderly are viewed as having more difficulty in complying with therapy, this analysis was directed at the effects of a health education program on their control of primary hypertension when compared with a younger population. The program consisted of three sequential interventions introduced in a randomized factorial design. Depsite the fact that elderly patients had more chronic disease, more complications from hypertension, and were receiving more complex drug therapies than younger patients exposed to the same experimental interventions, they demonstrated significantly higher levels of compliance with drug therapy, significantly higher levels of appointment keeping, and no difference in the proportion having their BP under control at two-year-follow-up. Longitudinal data collected at five-year follow-up indicate no decay effect. These results indicate such programs can be successfully implemented and equally effective for an elderly population.

Aged↗
PubMed1989

Hypertension studies in the Soviet Union.

Arterial hypertension control trials conducted during the last decade in the Soviet Union are reviewed. Epidemiologic data illustrating a considerable prevalence of arterial hypertension in various regions are presented. The results of population hypertension control programs are discussed, and the feasibility of reducing total mortality in the intervention vs reference groups at the community level is demonstrated, with the mortality and morbidity due to stroke showing a two-fold decrease. An outline is given of the major approaches used in population programs started in recent years, which are geared at improving drug and nondrug prevention and altering approaches to hypertension control in public health care.

Adult↗
PubMed1980

Common methods, different populations. The Lipid Research Clinics Program Prevalence Study.

The salient characteristics of the Lipid Research Clinics (LRC) Program Prevalence Study are presented, including an overview of its structure, the populations included and the common procedures used. Highlighted are the two sequential screening examinations that included 68,317 participants in 12 LRCs in the U.S. Canada and the U.S.S.R. for the first examination and 15,816 for the second. Several thousand more will be added as the thirteenth LRC completes its screening in Israel. Major data items are described briefly, as are data quality enhancement procedures. Procedures for plasma lipid determination, lipoprotein cholesterol, other clinical chemistries, nutritional intake assessment, and resting and stress electrocardiography are discussed. A discussion of the methodologic strengths and weaknesses of the findings of the LRC Program Prevalence Study is also included. This paper provides a frame of reference for the individual papers in this volume.

Adolescent↗
PubMedDate not supplied

Preschool vision screening for amblyopia and strabismus. Programs, methods, guidelines, 1983.

Amblyopia and strabismus, which afflict at least 5% of children, require treatment early in life for best visual results. At present, many such children are treated late or not at all. Mass screening at preschool age, and perhaps ultimately of infants, appears the only viable solution to this problem. To ascertain the present status of preschool screening in the United States, on-site visits, mail questionnaires and telephone interviews were used to study existing preschool vision screening programs at the federal, state and private organization levels. We estimate that, at most, 21% of preschool children receive any form of vision screening. Only two states, Michigan and Minnesota, have legislated requirements for such screening. Several organizations have attempted to establish screening guidelines, with suggestions of specific test and referral criteria. These guidelines are reviewed. The guidelines are of particular interest because screening programs following them typically indicate far lower prevalence rates than most studies indicate actually exist, suggesting that the guidelines result in underreferrals. In order to assess this matter, vision screening methods appropriate for preschoolers or infants, based on current evidence, are reviewed. Stereoscopic testing, utilizing a random dot stereogram format, appears the best instrument available for amblyopia and strabismus screening, but large scale comparative studies of the different test methods are needed to arrive at a final determination. Suggestions are made for the physician interested in initiating preschool vision screening programs.

Amblyopia↗
PubMedDate not supplied

Preventing out-of-home placement for high-risk children.

Preventing the removal of high-risk children from their families is investigated through two community-based programs. One program followed a day treatment model; the other used a home-based approach. These programs treated populations that shared common features but also had important differences. In both programs, a high percentage of children were maintained in the home and were still at home one year after discharge. It is suggested that such community-based intervention programs enhance the likelihood that high-risk children can remain with their families.

Adolescent↗
PubMed1986

Patterns of dyslipoproteinemia in selected North American populations. The Lipid Research Clinics Program Prevalence Study.

This article describes the assignment of dyslipoproteinemia (DLP) in several free-living North American populations and presents mean lipid and lipoprotein levels for each type. Dyslipoproteinemic phenotypes were assigned by a modified version of the National Institutes of Health (Fredrickson) phenotyping system. Criteria for assigning phenotypes included age- and sex-specific 5th and 95th percentiles for low-density lipoprotein and high-density lipoprotein cholesterol and total triglyceride, as well as other qualitative and quantitative criteria. Phenotypes IIb, III, I, and V were uncommon, confirming clinical impressions of their frequency. Lipid and lipoprotein levels in specific phenotypes were generally as expected. In the type III phenotype, however, mean cholesterol and triglyceride levels were surprisingly low. Gonadal hormone use, in the form of both oral contraceptives and postmenopausal estrogens, was reported in approximately 30% of women in these populations and was associated with dramatic differences in the frequency of DLP when compared with women not taking hormones. In general, these differences reflected the previously described effects of estrogen and progestins on lipoprotein levels. These data gathered in free-living populations: confirm clinical impressions of the rarity of some phenotypes, focus attention on those phenotypes in which diminished rather than elevated lipoproteins are found, and provide further evidence of the effect of hormones on lipid and lipoprotein levels.

Adolescent↗
PubMed1986

Poverty and social welfare: an agenda for change.

Actions to reduce the federal deficit in recent years threaten to strand the economically and socially disadvantaged while maintaining generous subsidy programs for populations with little or no financial need. This situation has been brought about in large part because of government's inherent reluctance to scale down programs that are politically popular even if no longer affordable or, in the long run, appropriate. The authors suggest that realistic and responsible social welfare policy reform requires that no sector of the federal budget be exempt from review or change. In the area of health, the importance of reshaping programs such as Medicare and Medicaid and disaggregating trends to focus more on populations with legitimate unmet needs is underscored. The authors make a number of suggestions on how existing social welfare programs can be better targeted.

Adolescent↗
PubMedDate not supplied

HRSA's collaborative efforts with national organizations to expand primary care for the medically underserved.

As the Federal agency that provides leadership in expanding access to primary health care, the Health Resources and Services Administration (HRSA) manages some 50 programs directed toward the delivery of services and strengthening the base of national health resources. An enabling element of the agency's strategy is the expansion of partnerships with national associations, private foundations, and other entities that share a concern for the health care of the medically underserved. Cooperative efforts with national organizations are intended to promote the integration of public and private resources and encourage adoption of efficient approaches to organizing and financing health care. Medical education in the primary care specialties, State programs for women and children, involvement of managed care organizations with low-income populations, and programs concerning the uninsured are the foci of some of these collaborative relationships.

Child↗
PubMed1982

Evaluating the rehabilitation process: an example with the blind.

The research methods presented here were developed for the evaluation of the CBRC (Central Blind Rehabilitation Center) at Hines. These methods are applicable to the evaluation of other blind rehabilitation programs. In addition, most of the strategies are applicable to other kinds of rehabilitation programs. The process of defining goals and of determining outcome variables is a necessary step in effective evaluation regardless of the population and program in question. It is essential to measure the influence of patient variables on treatment outcomes for all populations undergoing rehabilitation. The measures to evaluate these out-come and patient variables must be demonstrably reliable and valid. The methods used to identify and define variables, the research design and methods to produce reliable measures all can be used to evaluate a variety of programs as well as individual treatments and devices.

Blindness↗
PubMed1980

Evaluation of an oral disease control program administered to a clinic population at a suburban dental school.

This study included 99 patients. Seventy-four of these participated in the Oral Disease Control program at Emory University School of Dentistry and 25 control patients did not. Those who completed the Oral Disease Control program were examined and scored from 2 to 24 months afterward. The Patient Hygiene Performance Scoring was used. It was found that there was no significant difference in levels of plaque between subjects who completed the Oral Disease Program and those who did not participate. Also, the patient's knowledge of the causes of dental caries and gingival disease bore no significant relationship to the amount of plaque present. Further, certain selected hygiene habits had no significant effect on plaque level. The patients studied were enthusiastic about the control program and developed an increased awareness of oral disease control. However, this study confirms others that demonstrate the need for repeated professional reinforcement in any effective oral disease control program.

Adolescent↗
PubMedDate not supplied

Data-based planning for educational interventions through hypertension control programs for urban and rural populations in Maryland.

As part of a statewide effort to coordinate existing resources for high blood pressure (HBP) control, a public health HPB control program was planned and implemented in two high-risk communities in Maryland. The selection of the two communities was based on epidemiologic data. The planning of the educational intervention program in these communities (urban and rural) was guided by organizational theory and health education principles. The framework for development, implementation, and evaluation of the program utilizes an educational assessment model which identified factors that predispose, reinforce, and enable individual persons to practice positive health behavior. Multiple data sources were used in assessing the extent of the problem and relevant approaches in the development of the coordinated HPB control program. These include statewide vital statistics and a random statewide household survey to assess the prevalence rates of awareness, treatment, and control of HPB. To supplement these data, telephone surveys were carried out in the two communities to assess knowledge, beliefs, and practices related to HPB control. Medical record reviews provided baseline information on appointment keeping behavior and BP correlates of hypertensive patients. The planning and implementation of the program was carried out under the direction of representatives of the health care systems, community leaders, and residents, and representatives of communitywide organizations involved in HPB control.

Adolescent↗