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PubMed1996

Recruitment and enrollment for Project HeartBeat! Achieving the goals of minority inclusion.

OBJECTIVE: The inclusion of women and minorities in health research supported by the National Institutes of Health (NIH) has received increasing attention since the adoption of related guidelines by NIH in 1990. Investigators in population-based and clinical research may need to identify and recruit research participants from community settings in which little is known by investigators of the dynamics and day-to-day needs of the community. This was the case at the start of Project HeartBeat!, an intensive longitudinal study of the development of cardiovascular risk factors against the background of growth and maturation. This paper identifies those elements found essential when recruiting and enrolling minority participants for Project HeartBeat! METHODS: No prior experience had existed in the community from which the majority of Black participants were recruited to the Project. Therefore, recruitment methods were based on previous experience of the investigators as well as on the published reports of others. RESULTS: Immediate costs were substantially greater than projected, and the recruitment period was two years rather than one-a circumstance with longer-term implications as well. However, with the support of a community-based advisory committee, the school district, and a local recruitment staff, the recruitment goal was obtained. CONCLUSIONS: Recruitment and enrollment of minority participants can be especially challenging; however, many of those challenges are common to any target population. Elements that need to be adequately addressed include the researchers' involvement with the community in which the participants live, a tracking system to assess recruitment efforts, flexibility in the methods of recruitment, and adequate resources in time, money and personnel.

Adolescent↗
PubMed1986

A community-based program of colorectal screening in an asymptomatic population: evaluation of screening tests and compliance.

The incidence of colorectal cancer in Ashkenazi Jews is two to three times higher than in non-Ashkenazis. For a community colorectal screening program 1339 asymptomatic Ashkenazis over 40 yr old were asked to participate. Of these 1012 (75%) took Hemoccult II kits [fecal occult blood tests (FOBT)], and 614 (46%) personally returned them. Screenees were interviewed regarding family and personal medical history. Fourteen persons (2.3%) had positive tests, in whom colonoscopy revealed two with cancer (Dukes' B,C) and two with a greater than 2 cm polyp. The remaining 600 persons were invited for flexible sigmoidoscopy (FS) but only 287 (48%) appeared. The mean depth of insertion of the instrument was 50.3 cm (range 30-120), but was poorer for women. FS identified lesions in 28 (9.7%) persons: three had Dukes' A carcinomas and 25 had less than 2 cm adenomatous polyps. Significantly more women than men accepted FOBT, but among those completing FOBT, there was no difference by sex for use of FS. Middle-aged persons (50-69 yr) found screening more acceptable than young or older persons. Among screenees who agreed to undergo FS, a significantly larger fraction had a first relative with colon cancer, or a personal history of colon or female genital neoplasia, compared to those not agreeing to FS. There were no differences in screenees with relatives with noncolon cancer. Eighty-eight couples completed FOBT and were invited for FS. The decision whether or not to participate was made for both members in 81 (92%) couples. In conclusion, effective screening programs have to take into consideration compliance patterns of the target population.

Adult↗
PubMed2005

Factors explaining the intention to give blood among the general population.

BACKGROUND AND OBJECTIVES: The aim of this study was to identify factors explaining the intention to donate blood. MATERIALS AND METHODS: A random sample of 4000 respondents drawn from the general population received a questionnaire by mail. This questionnaire assessed variables as defined by the most prominent social cognitive theories. RESULTS: Overall, the respondents expressed a neutral mean level of intention to give blood in the next 6 months (2.84 on a five-point scale); 56.2% had never given blood in the past. The variables explaining 74% of the variance of intention were: perceived behavioural control (beta = 0.39; P < 0.001); factors facilitating taking action (beta = 0.25; P < 0.001); anticipated regret (beta = 0.16; P < 0.001); moral norm (beta = 0.11; P < 0.001); attitude (beta = 0.08; P < 0.01); level of education (beta = -0.03; P < 0.05); and past experience in giving blood (beta = 0.09; P < 0.001). Nonetheless, the predictive power of perceived behavioural control and moral norm was higher among the ever donors (both at P < 0.01) compared to the never donors, whereas the reverse was observed for attitude (P < 0.05). CONCLUSIONS: People's intentions are mainly determined by perceived barriers and obstacles regarding blood donations. This suggests that promotional strategies should focus on the elimination of barriers to action as well as the development of a higher perception of control. Also, messages should be adapted to the targeted population, based on their previous blood donation behaviour (i.e. never donors vs. ever donors).

Adolescent↗
PubMed2001

Sociodemographic and clinical factors associated with low quality of life one year after coronary bypass operations: the Israeli coronary artery bypass study (ISCAB).

OBJECTIVES: We sought to examine the effect of sociodemographic characteristics and perioperative clinical factors 1 year after coronary bypass operations on low health-related quality of life. We also sought to assess the usefulness of an additional single question on overall health for identifying patients with low health-related quality of life. METHODS: This report is part of the Israeli coronary artery bypass study of 1994, in which every patient undergoing isolated coronary bypass grafting in Israel was included. The target population for this report comprised all survivors beyond 1 year who were 45 to 65 years of age. Patients were interviewed before the operations. Self-administered questionnaires regarding health-related quality of life (SF-36) were sent to 1724 patients who were successfully located 1 year postoperatively, and 1270 questionnaires were completed. Low health-related quality of life was defined as the lowest tertile of the distribution of scores for the 2 summary components of the SF-36 and the single question on overall health. Logistic models were constructed for each of the 3 outcomes. RESULTS: Female sex and low socioeconomic background were associated with low health-related quality of life in the logistic models. Other significant factors were symptoms of angina, sleep disturbances, hypertension, high severity of illness scores, hospital readmission, no rehabilitation, and hospitals with high perioperative mortality. Of the 3 study outcomes, the model for the single question on overall health was the most discriminating (C statistic = 0.76 vs 0.70 and 0.70, respectively). CONCLUSIONS: The study identifies patients who would most benefit from posthospitalization community support after bypass operations. Under circumstances of limited resources, these disadvantaged groups should be targeted as a priority. Encouraging participation in existing rehabilitation programs or introducing telephone hotlines could improve health-related quality of life after coronary bypass grafting without large investments.

Aged↗
PubMed2004

Predictors of smoking behavior of first year university students: questionnaire survey.

AIM: To assess the prevalence of smoking and sociodemographic factors related to smoking behavior of first year university students in Adana, Turkey. METHODS: The sample was selected from two faculties (Faculty of Engineering and Architecture and Faculty of Agriculture) using the method of simple cluster sampling, representing the university student population. The students filled out an anonymous questionnaire comprising 17 questions related to their sociodemographic characteristics and smoking behavior. The response rate was 73.5% (471 out of 640 students). RESULTS: The prevalence of daily smoking among the first year students was 21.4%, with the predominance of men (25.0%) over women (12.9%). Most students (89.1%) had positive expectations about quitting smoking in the next 5 years ("I will quit smoking", "I will decrease the number of cigarettes I smoke", and "I will continue to be a non-smoker"). The smoking behavior was significantly related to student's sex (p=0.026, Pearson's chi-square test), mother's education (p=0.029, Pearson's chi-square test), number of failed grades (p=0.011, ANOVA), student's monthly income (p<0.001, Pearson's chi-square test), and having friends who smoke (p<0.0001, Pearson's chi-square test). CONCLUSION: The main determinants of regular smoking behavior for university students in Turkey were male sex, low academic performance, having smoking friends, high level of income, and a mother with high education level. These findings call for making anti smoking policies more specific in regard to the targeted population.

Adult↗
PubMed2003

The St-Louis du Parc Heart Health Project: a critical analysis of the reverse effects on smoking.

OBJECTIVES: Although some school based smoking prevention programmes have shown positive impacts, others have had only short term effects, no effects, and in some cases reverse effects. The St-Louis du Parc Heart Health Project was a five year heart health promotion programme targeting children in eight elementary schools aged 9-12 years in disadvantaged multiethnic neighbourhoods in Montreal. In a controlled, longitudinal evaluation, the programme produced reverse effects on smoking--children exposed to the programme were more likely to initiate and to continue smoking than control children. This article explores hypotheses to explain the reverse effects. DESIGN: Following work by an in-house committee, a consensus workshop with international experts was conducted to develop hypotheses to explain the reverse effects. This was complemented by an analysis of the programme's concordance with the standard guidelines on the school based prevention of tobacco use, and discussions with experts at the Centers for Disease Control and Prevention. RESULTS: The programme respected most standard guidelines for smoking prevention programmes with respect to content and mode of delivery. Hypotheses to explain the reverse effects include: an unfavourable environment characterised by strong pro-smoking models and resistance to environmental interventions; heightened sensitivity to smoking among children most exposed to the programme; defence mechanisms among children stimulated by cognitive dissonance or anxiety; unanticipated effects associated with the health educator who delivered the programme; inadequate attention in programme development to the diverse cultural origins of the population targeted; and intervention content inappropriately targeted to children's stages of cognitive development. CONCLUSION: Elementary school based interventions should aim to develop a clear and coherent social norm about the non-use of tobacco, as a precursor to or in close conjunction with having children as their primary target. Programme design should take key student characteristics into consideration and ensure that the modes of communication are adapted to the targeted group's characteristics. Neighbourhood level interventions should be orchestrated to complement regional, provincial, and national programmes.

Child↗
PubMed2003

Systematic review and economic decision modelling for the prevention and treatment of influenza A and B.

OBJECTIVES: To establish the clinical and cost-effectiveness of amantadine, oseltamivir and zanamivir compared to standard care for the treatment and prevention of influenza. DATA SOURCES: Electronic databases. Reference lists of identified articles and key publications. Relevant trials. REVIEW METHODS: A systematic review and meta-analysis of the randomised evidence was undertaken to investigate the effectiveness of oseltamivir and zanamivir compared to standard care for treatment and prophylaxis use for influenza A and B. An additional systematic review of the effectiveness of amantadine for treatment and prophylaxis use for influenza A in children and the elderly was also undertaken. Economic decision models were constructed to examine the cost-effectiveness and cost-utility of the alternative strategies for treating and preventing influenza A and/or B. This was informed by the systematic reviews outlined above and additional sources of information where required. RESULTS: The systematic review of the treatment of influenza found that oseltamivir reduced the median duration of symptoms in the influenza positive group by 1.38 days for the otherwise healthy adult population, 0.5 day for the high-risk population, and 1.5 days for the children population. This compared to 1.26 days, 1.99 days, and 1.3 for the similar groups for inhaled zanamivir. The systematic review of the prevention of influenza found that the relative risk reduction for oseltamivir was between approximately 75 and 90% and approximately 70 and 90% for inhaled zanamivir depending on the strategy adopted and the population under consideration. For the economic model a base case was constructed that focussed primarily on the health benefits generated by shortening the period of influenza illness. This base case found that, compared to standard care, the estimated cost per quality-adjusted life year ranged from pound 6190 to pound 31,529 for healthy adults, from pound 4535 to pound 22,502 for the 'high-risk' group, from pound 6117 to pound 30,825 for children, and from pound 5057 to pound 21,781 for the residential care elderly population. The base case model included valuations of the health effects of pneumonia (and otitis media in the children's model) based on observed rates in the trials. However it does not include the cost of hospitalisations as only very limited data was available for the effects of antivirals on hospitalisation rates. As for mortality rates, deaths from influenza were rare in trials of neuraminidase inhibitors (NIs). Therefore, suitable data on mortality were not available from these sources. As avoided hospitalisation costs and avoided mortality are potentially important we also carried out sensitivity analysis that involved extrapolating the observed reductions in pneumonias in the NI trials to hospitalisations and deaths. In all four models the cost-effectiveness of NIs is substantially improved by this extrapolation. For prophylaxis, antiviral drugs were compared with vaccination as preventative strategies. In all cases the cost-effectiveness ratios for vaccination were either low or cost-saving. In the base case the cost-effectiveness of antivirals was relatively unfavourable, there were scenarios relating to the elderly residential care model where antivirals as an additional strategy could be cost-effective. CONCLUSIONS: The cost-effectiveness varies markedly between the intervention strategies and target populations. The estimate of cost effectiveness is also sensitive to variations in certain key parameters of the model, for example the proportion of all influenza-like illnesses that are influenza. The effectiveness literature that was used to inform the economic decision model spans many decades and hence great caution should be exercised when interpreting the results of indirect intervention comparisons from the model. Further randomised trials making direct comparisons would be valuable to verify the model's findings.

Antiviral Agents↗
PubMed1984

Beta-thalassemia disease prevention: genetic medicine applied.

We report here an evaluation of a program for thalassemia-disease prevention, comprising education, population screening for heterozygotes, and reproductive counseling; the evaluation includes cost analysis. A preprogram survey in 1978 of 3,247 citizens in the high-risk communities (85% were high-school students) showed that 88% favored a program but that only 31% considered fetal diagnosis as an acceptable option. Screening in high school or before marriage was preferred by 56%. In a 25-month period (December 1979-December 1982), we screened 6,748 persons, including 5,117 senior high-school students, using MCV/HbA2 indices. The participation rate was 80% in the high-school group. The frequency for beta-thalassemia heterozygosity was 4.7% with 10-fold variation among ethnic groups at risk; the overall frequency for all variants found was 5.4%. We surveyed 60 carriers and 120 noncarriers after screening high-school students (response rate 77%): most carriers told parents (95%) and friends (67%) the test result; and 38% of the carriers' parents (vs. 18% of the noncarriers' parents) were also screened. Carriers would ascertain their spouses' genotype (91%) and approved uniformly (95%) the high-school screening experience and its goal. We performed 11 fetal diagnoses in a 25-month interval (greater than 75% participation in target population) either by fetoscopy and globin-chain analysis or by amniocentesis and genomic DNA analysis; two of three affected fetuses were aborted at parental request, there was one spontaneous abortion (after fetoscopy), and seven live births. The at-risk couples claimed pregnancy would not be contemplated without the fetal-diagnosis option. We analyzed economic costs of the program: cost per case prevented is approximately equal to $ 6,700, slightly less than cost-per-patient-treatment-year or about 4% of undiscounted treatment cost incurred in the first 25 years of life for an affected individual. These findings indicate: collective acceptance of the program, appropriate attitudes among carriers, general acceptance and efficacy of fetal diagnosis, and global cost-effectiveness.

Adolescent↗
PubMed2005

Labeling--stereotype--discrimination. An investigation of the stigma process.

AIM: Using Link and Phelan's concept of the stigma process, public attitudes towards people with schizophrenia are examined. METHOD: In the spring of 2001, a representative population survey was conducted in Germany (n=5025). A fully structured personal interview was carried out, beginning with the presentation of a case vignette. RESULTS: Labeling as mental illness increased the likelihood that someone suffering from schizophrenia was considered as being unpredictable and dangerous. This, in turn, led to an increase of the preference for social distance. Although much weaker, labeling also had a positive effect on public attitudes insofar as it was associated with a decrease of the tendency to attribute the responsibility for the occurrence of the disorder to the afflicted person. However, this had no significant impact on the desire for social distance. There was no significant association between labeling and the anticipation of poor prognosis. There were some differences between respondents who are familiar with mental illness and those who are not. CONCLUSION: Our findings have some implications for the planning of interventions aimed at reducing stigma and discrimination because of schizophrenia. These interventions should primarily address the stereotypes of unpredictability and dangerousness since they are most likely to have a negative impact on the public's willingness to engage in social relationships with those suffering from this disorder. The interventions should also be tailored according to whether the target population is familiar with mental illness or not.

Adolescent↗
PubMed2006

Mountain biking injuries requiring trauma center admission: a 10-year regional trauma system experience.

BACKGROUND: Mountain biking has become an increasingly popular recreational and competitive sport with increasingly recognized risks. The purpose of this study was to review a population based approach to serious injuries requiring trauma center admission related to mountain biking, identify trends and develop directions for related injury prevention programs. METHODS: Three trauma centers in the Greater Vancouver area exclusively serve a major mountain bike park and the North Shore Mountains biking trails. The Trauma Registries and the patient charts were reviewed for mountain bike injuries from 1992 to 2002. The data were analyzed according to demographics, distribution, and severity of injuries, and need for operative intervention. Findings were reviewed with injury prevention experts and regional and national mountain-biking stakeholders to provide direction to injury prevention programs. RESULTS: A total of 1,037 patients were identified as having bicycling-related injuries. Of these, 399 patients sustained 1,092 injuries while mountain biking. There was a threefold increase in the incidence of mountain biking injuries over a 10-year period. Young males were most commonly affected. Orthopedic injuries were most common (46.5%) followed by head (12.2%), spine (12%), chest (10.3%), facial (10.2%), abdominal (5.4%), genitourinary (2.2%), and neck injuries (1%). High operative rate was observed: 38% of injuries and 66% of patients required surgery. One patient died from his injuries. Injury prevention programs were developed and successfully engaged the target population. CONCLUSION: Mountain biking is a growing cause of serious injuries. Young males are principally at risk and serious injuries result from intended activity and despite protective equipment. Injury prevention programs were developed to address these concerns.

Abbreviated Injury Scale↗
PubMed2005

Clustering of risk behaviours for oral and general health.

UNLABELLED: While it is recognised that risk behaviours for general health tend to cluster among individuals, it is less clear whether risk behaviours for oral health co-occur among these same individuals. OBJECTIVES: To describe the distribution of health-relevant behaviours in a population sample, to examine whether oral and general risk behaviours cluster among individuals and to identify population groups with a shared risk profile. METHODS: Self-reported data were obtained from a stratified random sample of adults aged 18+ who participated in the 2002 National Dental Telephone Interview Survey and completed a subsequent mailed questionnaire (n = 3,132). Data were weighted to represent a simple random sample of Australian adults and analysis was limited to dentate adults. RESULTS: Four oral health behaviours (toothbrushing frequency, interdental cleaning, exposure to non-milk extrinsic sugars, usual reason for a dental visit) and four general health behaviours (smoking, alcohol consumption, physical activity, Body Mass Index) were dichotomised. K-means cluster analysis identified two readily interpretable groups that differed significantly on each behaviour apart from alcohol consumption (ANOVA; p = 0.77). A significant relationship emerged between cluster memberships and sociodemographic characteristics. Over-represented in the risk behaviour group (40.7% of the sample) were males, young adults, Australian born, those who did not live in a major city, adults who rented their housing and those adults with lower levels of education and household income (Chi square; p < 0.05). CONCLUSION: The interrelatedness of oral and general risk behaviours and their sociodemographic associations supports the tailoring of integrated oral and general health promotion messages and services to targeted population groups.

Adolescent↗
PubMed1998

The cost-effectiveness of screening for type 2 diabetes. CDC Diabetes Cost-Effectiveness Study Group, Centers for Disease Control and Prevention.

CONTEXT: Type 2 diabetes mellitus is a common and serious disease in the United States, but one third of those affected are unaware they have it. OBJECTIVE: To estimate the cost-effectiveness of early detection and treatment of type 2 diabetes. DESIGN: A Monte Carlo computer simulation model was developed to estimate the lifetime costs and benefits of 1-time opportunistic screening (ie, performed during routine contact with the medical care system) for type 2 diabetes and to compare them with current clinical practice. Cost-effectiveness was estimated for all persons aged 25 years or older, for age-specific subgroups, and for African Americans. Data were obtained from clinical trials, epidemiologic studies, and population surveys, and a single-payer perspective was assumed. Costs and benefits are discounted at 3% and costs are expressed in 1995 US dollars. SETTING: Single-payer health care system. PARTICIPANTS: Hypothetical cohort of 10000 persons with newly diagnosed diabetes from the general US population. MAIN OUTCOME MEASURES: Cost per additional life-year gained and cost per quality-adjusted life-year (QALY) gained. RESULTS: The incremental cost of opportunistic screening among all persons aged 25 years or older is estimated at $236449 per life-year gained and $56649 per QALY gained. Screening is more cost-effective among younger people and among African Americans. The benefits of early detection and treatment accrue more from postponement of complications and the resulting improvement in quality of life than from additional life-years. CONCLUSIONS: Early diagnosis and treatment through opportunistic screening of type 2 diabetes may reduce the lifetime incidence of major microvascular complications and result in gains in both life-years and QALYs. Incremental increases in costs attributable to screening and earlier treatment are incurred but may well be in the range of acceptable cost-effectiveness for US health care systems, especially for younger adults and for some subpopulations (eg, minorities) who are at relatively high risk of developing the major complications of type 2 diabetes. Although current recommendations are that screening begin at age 45 years, these results suggest that screening is more cost-effective at younger ages. The selection of appropriate target populations for screening should consider factors in addition to the prevalence of diabetes.

Adult↗
PubMed2000

Results of the health survey of a population living in a vicinity of a large waste site (Warsaw, Poland).

Although attracting rapidly increasing attention from the public, the health impact of environmental exposures related to the operation of waste dumping sites is a relatively new issue in Poland. However, the problem cannot be neglected in light of the fact that environmental impact assessment in selected sites revealed the lack of sufficient documentation concerning quantity and quality of dumped materials and poor technological management of the sites. The paper describes the results of health survey performed in a vicinity of a country's largest municipal waste site. Although the study came across methodological obstacles involving low participation and difficult to estimate representativeness of the examined group its findings obtained in 393 adults and 188 children and the results of internal comparisons revealed some interesting observations. Three "exposure-classification" variables were used in data analysis (geographical location, distance, "waste traffic" intensity) and health status was examined by means of self- and physician-administered questionnaire, physical examination and routine laboratory analyses. Relationship, although weak, of subjective symptoms and objective findings with the place of residence vis-a-vis the waste site location suggests that potential health effects of waste site-related environmental exposures might include psychological problems, digestive tract disorders and respiratory disorders as well as allergic symptoms. An intriguing observation concerning pregnancy-related health outcomes was made. The exact role of environmental determinants in this respect remains unclear and should be addressed by specific environmental epidemiological and toxicological studies. The findings as well as subjects' concern about health consequences of exposures to waste-related pollution (paralleled by subjective perception of impaired health) justify further investigations and public health initiatives including environmental impact assessment and health monitoring activities targeting populations living in a vicinity of waste sites in Poland.

Abortion, Spontaneous↗
PubMed1992

The impact of tailored self-help smoking cessation guides on young mothers.

It has been suggested that tailoring self-help materials for specific target populations will increase their effectiveness. This study tested the value of a self-help guide tailored specifically for women with young children. These women were recruited through a media campaign that encouraged smokers to call the Cancer Information Service (CIS) for assistance in stopping smoking. Women smokers with young children (under the age of 6) who called the CIS were given telephone counseling on quitting and were mailed one of three stop smoking guides. One third of callers received Quitting Times, a guide written specifically for women with young children; one third received the American Lung Association guide, Freedom from Smoking for You and Your Family; and one third received Clearing the Air, a guide developed by the National Cancer Institute. Six months after calling the CIS, these women were contacted by telephone to assess changes in smoking behavior. Overall, 12.5% of the women reported not smoking for at least 1 week at the time of the 6-month follow-up interview. There were no significant differences between subjects in the three groups in use of the self-help guides, methods used to attempt quitting, and quitting behavior. Findings from this study do not support the hypothesis that using a tailored stop smoking guide increases the targeted audience's cessation rate or affects quitting-related behavior. However, it should be noted that the smokers who called were predominantly in the contemplation or action stages.

Adult↗
PubMed1992

Epidemiology and control of Japanese encephalitis.

Japanese encephalitis (JE) remains endemo-epidemic in several countries in East, South-East and South Asia. The disease has been under control in Japan since the 1970s owing to mass immunization using mouse-brain-derived inactivated vaccine and to reduced vector mosquito populations. The vector density which was once reduced by wide spraying of insecticides in rice fields showed an increasing trend after the 1980s as a result of mosquito resistance. In the Republic of Korea, the number of JE cases showed a significant decrease after 1983 also because of mass immunization using mouse-brain-derived vaccine. On the other hand, large outbreaks of JE continued to occur in China, Viet Nam, Thailand, India, Nepal and Sri Lanka. In China, a hamster-kidney cell-derived vaccine was developed and used for human immunization. Besides human JE, the fatal outcome of equine JE is an economic problem in China. Current JE vaccine derived from mouse brain is highly purified and its safety and efficacy have been proved by field-tests as well as laboratory experiments. In spite of slight antigenic differences among JE virus isolates, JE vaccine produced by a classical Nakayama strain was effective in preventing overt JE in a field study in Thailand. The technology of mouse-brain-derived inactivated JE vaccine production was transferred from Japan to India, Thailand and Viet Nam. The production of JE vaccine in these countries is still on a pilot scale and insufficient for mass-immunization of susceptible target populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Encephalitis Virus, Japanese↗
PubMed2004

Low all-cause mortality in the volunteer-based Rotterdam section of the European randomised study of screening for prostate cancer: self-selection bias?

OBJECTIVES: The likelihood of self-selection bias in a cohort of men that entered the volunteer-based randomised prostate cancer screening trial was assessed. In addition, the accuracy of the randomisation was evaluated by comparison amongst the trial arms. SETTING: The Rotterdam section of the European Randomised Study of Screening for Prostate Cancer (ERSPC). Participants were recruited from population registries and randomised after receipt of written informed consent (49% participation rate). METHODS: Data from 37,614 men who entered the Rotterdam trial between June 1994 and July 1999 were linked to the Causes of Death Registry of Statistics Netherlands. For the assessment of self-selection bias, mortality in the trial cohort and the area of Rotterdam was compared by calculating standardised mortality ratios (SMRs, 95% confidence interval [CI]). Comparisons between the screening and the control arm were made by means of relative risk (RR). RESULTS: There were a total of 1661 deaths (4.4%) in the trial cohort, during an average follow-up time of 2.8 years. The observed number of deaths in the two arms combined was lower than expected (SMR 86.7%, 95% CI 81.6-92.1), which was reflected in the major cause of death categories, especially in all malignant neoplasms. No difference was observed in the all-cause mortality rate among the screening and control arm, aged 55-69 years at entry (RR 1.00, 95% CI 0.89-1.12), nor when all causes, excluding prostate cancer mortality, were considered. CONCLUSIONS: The preliminary results show that the screening and the control arm were comparable, but men recruited for the trial seemed healthier than men in the target population.

Aged↗
PubMed2000

Screening for abdominal aortic aneurysm: lessons from a population-based study.

OBJECTIVES: To test the acceptability of screening and to identify modifiable risk factors for abdominal aortic aneurysm (AAA) in men. DESIGN: A trial of ultrasound screening for AAA in a population-based random sample of men aged 65-83 years, and a cross-sectional case-control comparison of men in the same sample. PARTICIPANTS: 12,203 men who had an ultrasound examination of their abdominal aorta, and completed a questionnaire covering demographic, behavioural and medical factors. MAIN OUTCOME MEASURES: Prevalence of AAA, and independent associations of AAA with demographic, medical and lifestyle factors. RESULTS: Invitations to screening produced a corrected response of 70.5%. The prevalence of AAAs (> 30 mm) rose from 4.8% in men aged 65-69 years to 10.8% in those aged 80-83 years. The overall prevalence of large (> 50 mm) aneurysms was 0.69%. In a multivariate logistic model Mediterranean-born men had a 40% lower risk of AAA (> 30 mm) compared with men born in Australia (odds ratio [OR], 0.6; 95% CI, 0.4-0.8), while ex-smokers had a significantly increased risk of AAA (OR, 2.3; 95% CI, 1.9-2.8), and current smokers had even higher risks. AAA was significantly associated with established coronary and peripheral arterial disease and a waist:hip ratio greater than 0.9; men who regularly undertook vigorous exercise had a lower risk (OR, 0.8; 95% CI, 0.7-1.0). CONCLUSION: Ultrasound screening for AAA is acceptable to men in the likely target population. AAA shares some but not all of the risk factors for occlusive vascular disease, but the scope for primary prevention of AAA in later life is limited.

Aged↗
PubMed1998

The incidence of hepatocellular carcinoma in New Zealand.

AIM: To measure the incidence rate of hepatocellular carcinoma (HCC) in New Zealand, by ethnicity, sex, region and age. METHODS: Cancer Registry data for 1983-94 were used to calculate rates of primary liver cancer (ICD code 155.0) and HCC (both ICD code 155.0 and ICD-O morphology code 8170) directly standardised to Segi's world population and standardised for region. RESULTS: Rates of HCC per 100,000 person years 6.6 and 1.3 for Maori males and females, 14.7 and 4.6 for Pacific people, and 0.8 and 0.3 for Other (inclusive of Chinese). The rates for Chinese for 1989-94 were 19.9 and 5.8. These rates are likely to be underestimates due to imperfect sensitivity of ICD-O code 8170 registrations for HCC. The rates of HCC for Maori and Pacific people (sexes combined) were 7.3 and 18.0 times that for other for 1983-94; the HCC rate for Chinese was 25.8 times greater than Europeans for 1989-94. Rates of HCC tended to be higher in the north of New Zealand, compared to the south, for Maori and Other/Europeans, but there was no apparent regional gradient for Pacific people and Chinese. CONCLUSIONS: Non-Europeans have higher rates of HCC than Europeans due to variations in hepatitis B carriage. Males have higher rates than females, and Maori and Europeans living in the north of New Zealand have higher rates of HCC than those living in the south. It is estimated that any hepatitis B screening and follow-up programme will detect one incident case of HCC per year per 2000 hepatitis B carriers in the target population, or one incident case per 1000 carriers actually participating in regular follow-up.

Carcinoma, Hepatocellular↗