bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of the effects of intensive training of community based staff in the screening of children for disorders of growth and puberty
Authors: Cowan F.J. , Gregory J.W.
Published: October 2002

Introduction The effects of an intensive training programme involving screening of children for disorders of growth and puberty for community based nursing and medical staff employed by Cardiff Community Healthcare NHS Trust were audited to assess the impact of this training on referrals to the local hospital based growth clinic.

Method Referrals from community based staff to the growth clinic of patients living in the geographical area in which staff underwent training were compared with those from general practitioners in the 18 months prior to and following the training programme. Hospital notes were available for 209 of 254 (82.2%) patients identified. We excluded 112 referrals as they did not have a problem relating to growth or puberty or were inter-hospital referrals. Hence 97 referrals were included in the final audit.

Results Forty referrals occurred prior to compared with 57 following the training programme. The number of referrals from community based staff increased threefold during the six months immediately following the training programme but then returned to the previous level. There were no differences in age or height standard deviation scores at referral between groups at any time. The proportion of children referred from the community with significant abnormalities of growth or puberty (for example, hypothyroidism or precocious puberty) increased from two of 15 referrals to six of 30 referrals following the training programme.

Conclusions Intensive training in screening for disorders of growth and puberty can increase the number of referrals of children with significant pathology but at the cost of increased total number of referrals. The increase in referrals is not sustained with time, suggesting continued training is necessary.
Clinical validation of a new dimeric inhibin-A assay suitable for second trimester Down's syndrome screening
Authors: Knight G.J. , Palomaki G.E. , Neveux L.M. , Haddow J.E. , Lambert Messerlian G.M.
Published: October 2002

Objective To compare the Down's syndrome screening performance of a simplified dimeric inhibin-A assay (Diagnostic Systems Laboratories (DSL)) with an assay whose clinical utility has been established (Serotec).

Setting A case control set consisting of 51 Down's syndrome and 245 matched unaffected pregnancies collected as part of an earlier multicentre cohort study.

Methods Sera were assayed for dimeric inhibin-A using the DSL assay and Serotec reference assay. Data analysis included a method comparison of mass values, fit of data to a logarithmic Gaussian distribution, and determination of detection and false positive rates. In addition, 234 fresh sera were assayed using the simplified method.

Results The two assays showed a high correlation (r =0.93) but average concentrations of the DSL assay were 48% higher. However, the differences were basically proportional over the range of values important for screening. The detection rate was essentially equivalent for the DSL assay whether analysed univariately or in combination with other markers (for example, 79% v 75% at a 5% false positive rate for the DSL and Serotec assays for the combination of α fetoprotein, unconjugated oestriol, human chorionic gonadotrophin, and dimeric inhibin-A, respectively). The 234 dimeric inhibin-A values measured on fresh sera fitted a logarithm Gaussian distribution for the DSL assay, as indicated by the fit to a probability plot.

Conclusions The Down's syndrome screening performance of a simplified dimeric inhibin-A immunoassay was equivalent to a more labour intensive established dimeric inhibin-A assay.
Screening with breast ultrasound in a population at moderate risk due to family history
Authors: O'Driscoll D. , Warren R. , MacKay J. , Britton P. , Day N.E.
Published: October 2002

Objective To perform a pilot study to compare ultrasound and mammographic screening with particular respect to specificity, in a cohort of women at moderate family history risk of breast cancer.

Material and methods High resolution ultrasound of both breasts was undertaken in 149 women at moderate risk of breast cancer who were referred for mammographic screening. The two tests were read blind to the other. Core biopsy was undertaken for solid lesions found on ultrasound.

Results 149 Patients, mean age 42.15 years, were screened with bilateral ultrasound. 90 Examinations were normal. 46 Women had cysts, two had lesions previously biopsied and found to be benign, and one had a lymph node. 10 Focal solid lesions were biopsied on account of their ultrasound findings, 6.7% (95% confidence intervals (95% CIs) 2.7% to 10.7%). All but one of the 149 mammograms were normal. In this case both mammography and ultrasound showed a focal solid lesion that at core biopsy was found to be a fibroadenoma. Histology showed seven fibroadenomata, two areas of fibrocystic change, and one adenoid cystic carcinoma. Positive predictive value for biopsy was 10%. Mean follow up was 13.7 months. There was one interval cancer.

Conclusion Screening with breast ultrasound, in a cohort of women at moderate risk of breast cancer due to family history, has an acceptable biopsy rate. Screening with ultrasound and mammography in patients with an increased risk of breast cancer may be beneficial and a randomised study to examine issues of acceptability, reproducibility, and cost effectiveness is apt.
Multiple marker second trimester serum screening for pre-eclampsia
Authors: Wald N.J. , Morris J.K.
Published: October 2002

Objective To investigate whether an appropriate combination of maternal serum inhibin A, free &bgr;-human chorionic gonadotropin (free &bgr;-hCG), unconjugated estriol (uE 3), and alpha-fetoprotein (AFP) may be an effective means of screening for pre-eclampsia in the second trimester of pregnancy.

Setting Women who attended an antenatal clinic in Oxford, from whom serum samples were stored, 19 of whom subsequently developed pre-eclampsia.

Methods Serum inhibin A, free &bgr;-hCG, uE 3, and AFP were measured in 32 serum samples collected from the 19 women who developed pre-eclampsia and, for each sample, in three control samples collected from women with unaffected pregnancies matched for gestational age and maternal age.

Results In pregnancies that developed pre-eclampsia the median inhibin A value was raised (1.7 multiples of the median (MoM) for unaffected pregnancies (95% confidence interval (95% CI) 1.1 to 2.7 MoM), the median free &bgr;-hCG was raised (2.1, 1.4 to 3.3 MoM) and the median uE 3 was lowered (0.8, 0.6 to 0.98 MoM) after 19 completed weeks of gestation and at least 2 weeks before the onset of proteinuria. Values of AFP were similar in affected and unaffected pregnancies. Combining the values of inhibin A, free &bgr;-hCG, and uE 3 to form a screening test would detect an estimated 55% of affected pregnancies with a false positive rate of 5%.

Conclusions Inhibin A, free &bgr;-hCG, and uE 3 in combination may be a useful screening test during the second trimester for pre-eclampsia.
Prevalence and family history of colorectal cancer: implications for screening
Authors: Sandhu M.S. , Luben R. , Khaw K-T.
Published: October 2002

Objectives To estimate the current prevalence of family history and associated risk of prevalent colorectal cancer among middle aged and older British adults.

Methods Cross sectional analysis of colorectal cancer and self reported family history based on data from a large population based study in Norfolk, United Kingdom.

Results Of the 30 353 participants, 2069 (6.8%) participants had reported a family history of colorectal cancer in at least one first degree relative. The prevalence of colorectal cancer in those with a family history was 1% and 0.5% in those without. Of the 151 participants with prevalent colorectal cancer, 14.6% reported a family history of the disease. Also, a family history of colorectal cancer in first degree relatives was significantly associated with an increased risk of prevalent colorectal cancer (multivariate odds ratio (OR) 2.32 (95% confidence interval (95% CI) 1.43 to 3.76). For those with one affected relative below the age of 45, and for those with two affected relatives the multivariate ORs were 5.29 (1.63 to 17.17) and 4.93 (1.17 to 20.70), respectively.

Conclusions Although positive family history may identify a group with increased likelihood of colorectal cancer, screening strategies targeted solely at people with a family history will have limited impact on reducing mortality from colorectal cancer at the population level.
Radiological peer review of interval cancers in the East Anglian breast screening programme: what are we missing?
Authors: McCann J. , Britton P.D. , Warren R.M.L. , Hunnam G. ,   on behalf of the East Anglian Breast Screening Programme
Published: October 2002

Objective To determine whether association between classification of interval cancers (false negative, minimal sign, true interval, occult) and tumour characteristics can indicate areas for improvement in effectiveness of screening .

Setting East Anglian regional Breast Screening Programme.

Method The consensus classification of interval cases, obtained through peer review, was compared with tumour characteristics: size; grade; and nodal status, and with radiological signs. A set of 923 cancers with known tumour characteristics, presenting in unscreened women, was available for comparison.

Result In total, 385 interval cases were analysed. Prognosis of interval cancers was at least as good as that of cancers in unscreened women, with fewer node positive cases. No significant relation was found between classification of cases and age of patients. True intervals tended to present later after a negative screen, although false negatives commonly presented earlier. Occult cancers were significantly smaller than false negatives. Analysis of histological type yielded little of relevance, and mammographic appearance was similar in all classifications. At diagnosis, cancers in the low risk group were more likely to be seen as spiculate masses, whereas high risk cases more often appeared as opacities. A higher proportion of interval cases had been assessed than in the normal screened population.

Conclusion Sensitivity may be improved by reducing false negative and minimal sign cases (21% of interval cancers in East Anglia). These will include tumours in all risk groups, and with all radiological features, thus no particular age group or radiological feature may be targeted for improvement. Misdiagnosis at assessment reduces sensitivity and therefore merits particular study.
Should newborn mutation scanning for hyperphenylalaninaemia and galactosaemia be implemented? A Polish experience
Authors: Żekanowski C. , Nowacka M. , Radomyska B. , Cabalska B.
Published: October 2002

OBJECTIVE:To elucidate whether screening for mutations causing hyperphenylalaninaemia (HPA) and classic galactosaemia could provide important, additional information on a clinical phenotype. METHOD:Genotypes that cause disease at the phenylalanine hydroxylase (PAH) gene and galactose-1-phosphate uridyltransferase (GALT) gene in a group of 101 hyperphenylalaninaemic and 77 patients with classic galactosaemia were established. The PAH and GALT mutations were identified in genomic DNA extracted from whole blood leucocytes using single stranded conformational analysis and direct fluorescent sequencing of polymerase chain reaction (PCR) products. RESULTS:Mild HPA and mild phenylketonurea (PKU) were caused by divergent genotypes. In the studied group a total of 26 different mild and intermediate PAH mutations were identified, most of them being rare ones. Classic galactosaemia was caused by two frequent mutations, accounting for 82% of all mutated alleles. CONCLUSIONS:Identification of mild or intermediate mutations causing HPA could provide fast and reliable information about future clinical outcome of a newborn infant. Molecular diagnosis of HPA should be preceded by biochemical analysis and implemented to differentiate mild forms of HPA and cases of ambiguous classification. Because of multiple rare mutations scattered on all exons, scanning of the entire PAH coding sequence could be useful and cost beneficial. Routine genotyping is not proposed in classic phenylketonuria and classic galactosaemia, as it provides limited additional, prospective information on the clinical phenotype.
Screen detected ductal carcinoma in situ (DCIS): overdiagnosis or an obligate precursor of invasive disease?
Authors: Evans A.J. , Pinder S.E. , Ellis I.O. , Wilson A.R.M.
Published: October 2002

OBJECTIVES:Ductal carcinoma in situ (DCIS) represents 20%–25% of malignancy detected at mammographic screening. This study aims to clarify the value of detecting DCIS at mammographic screening by assessing its biological characteristics and by comparing screen detected DCIS with a series of symptomatic DCIS lesions. METHODS:222 Screen detected and 151 symptomatic cases of pure DCIS were identified. Their histological grade and the prevalence of necrosis were ascertained and compared. RESULTS:Of the screen detected lesions 28 (13%) were low grade, 40 (18%) intermediate grade, and 153 (69%) high grade. Of screen detected lesions 186 (87%) were necrotic and 29 (13%) were not. Of the 151 symptomatic lesions 24 (16%) were low grade, 34 (23%) intermediate grade, and 89 (61%) high grade. Of symptomatic lesions 112 (75%) were necrotic and 36 (24%) were not necrotic. Screen detected DCIS was more often necrotic (p=0.008) than symptomatic DCIS. CONCLUSIONS:As most DCIS detected at screening is high grade and necrotic, aggressive investigation of suspicious microcalcification at mammographic screening is advocated. Given the biological features of screen detected DCIS, the existence of an upper limit for the detection of DCIS by the NHS breast screening programme seems to be inappropriate. 8
Long QT syndrome in children: the value of rate corrected QT interval and DNA analysis as screening tests in the general population
Authors: Allan W.C. , Timothy K. , Vincent G.M. , Palomaki G.E. , Neveux L.M. , Haddow J.E.
Published: October 2002

OBJECTIVE:To evaluate two hypothetical screening strategies for identifying children with long QT syndrome (LQTS), a cause of sudden death in childhood. METHODS:Families with KVLQT1, HERG, or SCN5A genotypes provided electrocardiographic (ECG) data for this analysis. This is the first time such genotype-phenotype information has been available. Using the LQTS genotype, the distributions of QTc in affected and unaffected children were established and screening performance for various QTc cut off points were modelled. The detection rate for DNA mutation analysis was determined from published experience. RESULTS:The mean QTc (SD) was 0.484 seconds (0.031) in 117 affected children and 0.420 seconds (0.021) in 133 unaffected children. A QTc cut off of 0.50 seconds in a population of 1 million children would identify 61 of the 200 affected children, and 100 unaffected children. Estimates of testing costs for a screening programme in the newborn period would be $327 869/case detected and $2 222 000/death avoided. Although not presently available for routine use, DNA analysis could, theoretically, identify 100 of the 200 children with LQTS within the same population, along with an estimated 100 unaffected children. CONCLUSION:The only available screening test for LQTS is ECG measurement. If DNA technology becomes available for screening, unit costs must be very low to be competitive. There are multiple problems with screening for LQTS: only a minority of children will be detected, cost/death avoided is high, and pilot studies would need to be in place for 5–10 years to document efficacy.
Revised estimates of the maternal age specific live birth prevalence of Down's syndrome
Authors: Morris J.K. , Mutton D.E. , Alberman E.
Published: October 2002

Objectives: To revise the estimates of maternal age specific live birth prevalence of Down's syndrome in the absence of antenatal screening and selective termination using newly available data. Setting and Design: Data were used from the National Down Syndrome Cytogenetic Register (NDSCR), which contains information on nearly all antenatally or postnatally diagnosed cases of Down's syndrome in which a karyotype was confirmed between 1989 and 1998 in England and Wales. It is the largest single series of data on the prevalence of Down's syndrome. Results and conclusion: The prevalence does not continue increasing at an increasing rate with age above age 45 as has been previously assumed. Above this age the rate of increase declines with increasing age. The overall age pattern is sigmoidal. A new logit logistic model is proposed which fits the data well. The risk of a Down's syndrome live birth is given by: risk=1/(1+exp(7.330-4.211/(1+exp(-0.282x(age-37.23))))).
Interval breast cancers in New South Wales, Australia, and comparisons with trials and other mammographic screening programmes
Authors: Taylor R. , Supramaniam R. , Rickard M. , Estoesta J. , Moreira C.
Published: October 2002

Objective: To present information on 1st year interval breast cancer from the New South Wales mammographic screening programme and to compare with published results from trials and services. Setting: New South Wales data were derived from a population based biennial mammographic screening programme, which achieved statewide coverage in 1995. Women aged 50–69 years screened during 1995–7 were included. Methods: Bilateral two view mammography with reading by two radiologists is used for biennial screening examinations. Interval cancers were detected by the screening programme and by linkage with the statewide cancer registry. In situ carcinoma was excluded. Incidence of interval cancer was estimated as a proportion of the expected underlying incidence of breast cancer. Comparative data were derived from the published literature and meta-analyses were performed. Results: Although randomised trials of screening have a proportional incidence by meta-analysis of 19% (95% confidence interval (95% CI) 12% to 25%), service studies yield a proportional incidence by meta-analysis of 27% (95% CI 25% to 30%), and more than half report proportional incidences greater than 25%. In the New South Wales mammographic screening programme the proportional incidence of interval breast cancer was 33% (95% CI 29% to 38%) for ages 50–59 years, 28% (95% CI 24% to 32%) for ages 60–69 years, and 31% (95% CI 28% to 34%) for ages 50–69 years combined. Proportional incidence in the New South Wales programme for ages 50–69 years was not significantly different from the rate for service studies by meta-analysis. Conclusions: Effectiveness of mammographic screening for reducing mortality from breast cancer needs to be examined relative to rates of interval cancer from actual service situations as trials may concentrate resources and expertise in ways which may be less replicable in routine delivery of the service.
Early cervical cancer rescreening
Authors: Morrell S. , Mamoon H. , O'Callaghan J. , Taylor R. , Ross J. , Wain G.
Published: October 2002

Introduction: The extent of early cervical rescreening, defined as rescreening earlier than the recommended interval for a given initial test result, is difficult to determine mainly because the testing history of women is incomplete, especially with newer population based screening registers. Methods: Estimation of early rescreening is based on analysis of a 1 month cohort of women (February 1997) recorded on the New South Wales Pap Test Register (PTR) who initially tested negative and who had no recorded history of a positive test result. For the purposes of estimating early rescreening rates and sources of multiple screening occurring within the recommended 2 yearly screening interval for New South Wales, the cohort excluded the estimated proportion of women with an unrecorded history of a positive result. Approaches to exclusion were different for women with a history of a high grade result (CIN2 or higher) or a low grade result (CIN1 or lower). Results: Characteristic rescreening peaks occurred at 6, 12, 18, 24 and 27 months according to negative result category. The rescreening peak at 27 months illustrates the effect of the PTR late reminder system. After adjusting the cohort for estimated proportions of women with a history of a lesion, the number of women estimated to have rescreened early was ≈156 000 over 1997–8, and the early rescreening rate was estimated as 15.3% of women who have a Pap test. A feasible target for reducing rescreening through service provider interventions was estimated to be a reduction of 7.4%, based on reducing the overscreening proportion from 15.3% to 7.9% through truncating characteristic rescreening peaks to background levels of rescreening. This represents just under 200 000 screens that could be performed over 2 years on New South Wales women who are underscreened or unscreened without incurring additional costs due to screening. Conclusions: Reasonable estimates of early cervical rescreening can be derived but some assumptions in estimating the proportion of women with a positive test result history may be needed particularly if a screening programme is new and universal recording of screening data is only recent. Characteristic peaks, as departures from a background of random noise in time plots of rescreening indicate that a component of early rescreening is systemic and the chief source of such variation in screening behaviour would be service providers.
Probabilities of progression of aortic aneurysms: estimates and implications for screening policy
Authors: Couto E. , Duffy S.W. , Ashton H.A. , Walker N.M. , Myles J.P. , Scott R.A.P. , Thompson S.G.
Published: October 2002

Background: Screening for abdominal aortic aneurysm, and intervention with elective repair, can reduce the incidence of aneurysmal rupture by a half. If a screening programme is implemented, it is essential to determine appropriate follow up intervals for rescreening. This paper estimates probabilities of progression growth of aortic diameter to provide evidence for this. Methods: Data were taken from 2342 men aged 65–80 screened in the Chichester randomised control trial, who have been followed up for an average of 11 years. Aortic diameter was modelled as a Markov process with four categories: <30 mm (normal), 30–44 mm, 45–54 mm, and ≥55 mm. Estimates of the probabilities of progressing to each higher category were obtained. Results: The probabilities of progression increased with greater initial aortic diameter. The estimated rates/year were 0.018 (95% confidence interval 0.014 to 0.023), 0.16 (0.12 to 0.20), and 0.49 (0.35 to 0.70) respectively for moving up one category. The probabilities of moving from <30 mm to ≥55 mm were estimated as 1% in 5 years and 12% in 15 years, while the corresponding figures for moving from 45–54 mm to ≥55 mm were 91% and 99%. There were differences in rates of progression according to age, with men over 70 years having rates about three times those of men under 70. Conclusions: It seems unnecessary to follow up men with normal aortic diameter as they experience a low probability of reaching criteria for surgery even within 15 years. However, follow up intervals should be progressively shorter for those with greater aortic diameter, especially in those aged over 70. Active follow up, for example every 3 months, is appropriate for men with an aortic diameter of 45–54 mm.
Assigning risk for Smith-Lemli-Opitz syndrome as part of 2nd trimester screening for Down's syndrome
Authors: Palomaki G.E. , Bradley L.A. , Knight G.J. , Craig W.Y. , Haddow J.E.
Published: October 2002

Objectives: To design a reliable model in the context of prenatal screening for assigning the risk in an individual pregnancy of Smith-Lemli-Opitz syndrome (SLOS) and assess its performance. Setting: A 2nd trimester screening programme for Down's syndrome that measures unconjugated estriol (uE3) along with other serum markers. Methods: Development of individual risk estimates with a trivariate model incorporating measurements of maternal serum uE3, α-fetoprotein (AFP), and human chorionic gonadotropin (hCG) in both SLOS and unaffected pregnancies. Results: Population parameters were computed for the three analytes, as were pairwise correlation coefficients and truncation limits, based on an unbiased collection of 29 affected pregnancies. Published parameters were used for unaffected pregnancies. With a cut off level of risk of 1:50, 62% of SLOS pregnancies can be detected by initially identifying 0.34% of unaffected pregnancies as screen positive. About 1 in 90 screen positive pregnancies will be affected. Conclusions: It is possible to screen for SLOS as an add on to existing 2nd trimester maternal serum screening, if uE3 is already being measured. A large, prospective trial is necessary to determine whether diagnostic testing can be performed in maternal urine or serum rather than amniotic fluid.
Psychiatric morbidity and screening for colorectal cancer
Authors: Parker M.A. , Robinson M.H.E. , Scholefield J.H. , Hardcastle J.D.
Published: October 2002

Background: Several studies have shown that faecal occult blood (FOB) screening reduces mortality from colorectal cancer. However, concern has been expressed that health screening may have adverse psychological effects, particularly for the group returning false positive tests. Objectives: To evaluate any adverse psychological effects associated with faecal occult blood screening. Setting: Randomised controlled trial of faecal occcult blood screening for colorectal cancer. Methods: Psychiatric morbidity was measured, using the general health questionnaire (GHQ) before and 3 months after the offer of screening for colorectal cancer with FOB testing. Scores were related to acceptance of the screening test. A smaller cohort, who had returned positive FOB tests, had anxiety levels measured, using the Spielberger anxiety inventory (SAI), at different times during screening, investigation, and follow up. Results: A GHQ was sent to 2184 subjects before the offer of screening, and 1541 (70.6%) were returned. Of the 1693 subjects offered the GHQ 3 months after the offer of screening, 1303 (77%) returned it. A GHQ score of 5 or more, indicating possible psychiatric morbidity, was present in 454 subjects (29.5%) before screening and in 386 (29.6%) subjects 3 months after screening (NS). Of the 454 subjects who scored 5 or more, 241 (53.1%) accepted screening and 213 (46.9%) refused. A total of 1081 subjects scored less than 5, and of these 521 (48.2%) accepted screening and 560 (51.8%) refused (NS). Anxiety scores were measured in 100 test positive patients and were highest after notification of a positive test and before investigation by colonoscopy. In patients with false positive results, scores fell the day after colonoscopy and remained low 1 month later. Conclusions: The receipt of a screening test does not cause sustained anxiety and the existence of psychiatric morbidity is not a factor affecting a person's decision to accept or refuse a screening test for colorectal cancer.
Measurement of phenylalanine in blood on filter paper as a method of monitoring PKU treatment
Authors: Tylek-Lemañska D. , Otarzewski M. , Kostyk E.
Published: October 2002

OBJECTIVES: Phenylketonuria (PKU) is a genetic disease with autosomal recessive inheritance. In Poland the microbiological Guthrie test for this disease was replaced by an enzymatic colorimetric test. The question is whether the colorimetric test might be used in monitoring treatment of PKU. SETTING: In 80 patients with PKU on routine treatment monitoring of serum phenylalanine concentrations (SPh) was compared with phenylalanine concentrations in blood on filter paper (PhBFP). METHODS: Measurements of SPh were by a fluorimetric method (McCaman and Robins), and those of PhBFP were by an enzymatic colorimetric method. RESULTS: The regression analysis of SPh compared with PhBFP gave the equation y=0.9219x+0.2389; for the reversed ratio: it gave y=1.0220x+0.55083. The correlation was 0.97 at p<0.05. DISCUSSION: Concentrations of SPh accepted for children with PKU are not uniform. In the Cracow centre, the range of accepted SPh concentrations are 2–6 mg/dl for children and <12 mg/dl for older patients. The concentrations of PhBFP accepted are somewhat higher than SPh, range from 4 to 10 mg/dl, and are a good indicator of an appropriate diet. CONCLUSIONS: (1) The comparison indicated that colorimetric measurements of PhBFP are effective in monitoring therapeutic PKU management. Tests can be performed more often and are more comfortable both for the patients and their parents. (2) The comparative results indicated a concentration of PhBFP ranging from 4 to 10 mg/dl to be the accepted value for children treated for PKU.
Does a better grade of tumour occurring in women under hormone replacement therapy compensate for their lower probability of detection by screening mammography
Authors: Estève J. , Séradour B. , Jacquemier J. , Remontet L.
Published: October 2002

OBJECTIVE: To compare the prognostic factor of breast cancer survival between breast cancer diagnosed in subjects receiving hormone replacement therapy (HRT) before diagnosis to those without such a therapy. Subjects and methods: All breast cancers diagnosed between 1993 and 2000 within the breast cancer screening programme in Bouches du Rhône (France) were analysed for size, node status, and grade according to use, or not, of HRT. Univariate and multivariate analyses were carried out taking into account age, density of the breast, and mode of detection. RESULTS: The breast tumours diagnosed among HRT users had a lower grade whatever the mode of detection. The proportion of node positive tumours was identical in the two groups after adjustment for age. The smaller size of the tumours among HRT users is partly explained by the lower grade of these tumours Conclusion: Although tumours occurring in HRT users have a lower chance of being detected by screening, their prognostic factors, especially the grade of the tumour, are better than in non-users. More work is needed to find which part of this advantage is attributable to better surveillance of women treated with HRT
Crude open biopsy rates for benign screen detected lesions no longer reflect breast screening quality—time to change the standard
Authors: Maxwell A.J. , Pearson J.M. , Bishop H.M.
Published: October 2002

OBJECTIVES: To investigate the changing nature of the benign screen detected breast abnormalities removed at open biopsy over a seven year period and to compare this with the improving cancer detection rate and non-operative diagnosis rate. SETTING: The Bolton, Bury, and Rochdale Breast Screening Programme. METHODS: The histopathology reports of the benign lesions removed from patients undergoing open biopsy for screen detected abnormalities between 1 April 1994 and 31 March 2001 were reviewed and the lesions classified on the B1 to B5 scale. Cancer detection rates and non-operative cancer diagnosis rates were ascertained from the breast screening computer system. RESULTS: 148 benign surgical biopsies were performed in the seven year period. There was a moderate increase in the overall benign biopsy rate over the period (from 1.26 open biopsies per 1000 women screened for the three years 1994–97 to 1.63 open biopsies per 1000 women screened for the three years 1998–2001). The biopsy rate for B2 (benign) lesions decreased slightly over the study period but the biopsy rate for B3 lesions (that is, of uncertain malignant potential) more than doubled. The majority (84%) of the B3 lesions were radial scars. There was a steady improvement in the cancer detection rate and the non-operative cancer diagnosis rate over the period, similar to that seen nationally. CONCLUSIONS: Improvements in screening technique and detection ability result in an increase in the number of subtle radiologically indeterminate or suspicious lesions detected. Many of these are radial scars, which require excision. Crude benign open biopsy rates for screening programmes are no longer meaningful, and should now be refined with separate rates for B2 lesions and B3 lesions. High quality programmes can expect to have low B2 open biopsy rates and high B3 open biopsy rates. It is inappropriate to have an upper limit for the B3 open biopsy rate.
The cervical cancer screening programme in Norway, 1992–2000: changes in Pap smear coverage and incidence of cervical cancer
Authors: Nygård J.F. , Skare G.B. , Thoresen S.Ø.
Published: October 2002

OBJECTIVES: Changes in the incidence of cervical cancer were studied to assess the impact of the Norwegian coordinated cervical cancer screening programme introduced in 1995. Attention was given as to whether recommendation letters sent to women without a screen in the previous 3 years could be an alternative to a conventional screening programme that invites women irrespectively of their spontaneous screening. SETTING: A population based, nationwide, screening programme in which women of 25 to 69 are recommended to have a conventional Pap smear every 3 years. METHODS: The impact of the screening programme was assessed indirectly by comparing trends in invasive cervical cancer, changes in coverage, and changes in interval between Pap smears in the 3 year period (1992–4) before screening with the two first screening rounds (1995–7 and 1998–2000). All Pap smears taken from women of all ages were included, a total of 4 744 967 Pap smears from more than 1.4 million women. Further, the impact was assessed directly by logistic regression by comparing the screening results of women recruited for the programme with women who had regularly had Pap smears. RESULTS: In the last 2 years studied, the incidence of invasive cancer was 22% lower than in the period before the programme. The proportion of women who had a Pap smear was higher after the implementation of the coordinated screening programme. The number of smears taken was less as the interval after a normal smear was greater. The newly recruited women had a threefold risk of having a high grade precursor and a 20-fold higher risk of cancer than the women who had had regular smears. CONCLUSIONS: The coordinated screening programme provides a low cost way of increasing the coverage of the female population, and consequently has reduced the rate of invasive cervical cancer.
Reproductive outcome among female hairdressers
Authors: Rylander L , Axmon A , Torén K , Albin M
Published: October 2002

Background:Working as a hairdresser involves exposure to a variety of chemical agents.

Aims:To estimate the risk of such exposure in relation to reproductive outcome.

Methods:A cohort of hairdressers, certified in Sweden from 1970 onwards, and a referent cohort of women from the general population were established and linked to the Swedish Medical Birth Register for the period 1973 to 1994. In the cohort of hairdressers 3706 women gave birth to 6960 infants. The corresponding numbers among the referents were 3462 and 6629. Questionnaires were sent to all hairdressers to obtain individual exposure data. The response rate was 65%.

Results:Compared with the referents, the hairdressers more often gave birth to infants that were small for gestational age (SGA). In addition, a higher fraction of the infants born to a hairdresser had a major malformation (2.8%v2.1%). Frequent permanent waving and spraying tended to be associated with increased risk of having an SGA infant, whereas no clear association could be seen between the individual exposure assessments and malformation risk.

Conclusions:Results indicated that hairdressers have a slight increased risk of having intrauterine growth retarded infants and infants with major malformation compared with women from the general population. However, no clear associations were seen between individual exposure assessments and these outcomes.
Work related symptoms among sewage workers: a nationwide survey in Sweden
Authors: Thorn J , Beijer L , Rylander R
Published: October 2002

Aims:To assess the risk for work related symptoms among sewage workers in Sweden using a postal questionnaire.

Methods:All municipalities in Sweden were contacted and asked to provide addresses of sewage workers and controls. Controls were recruited among other municipal workers not exposed to sewage, such as workers in drinking water plants and gardeners. A questionnaire was sent to the subjects and after two reminders, the response rate was 74% among sewage workers and 59% among controls.

Results:Significantly increased risks for airway symptoms, chronic bronchitis, and toxic pneumonitis, as well as central nervous system symptoms such as headache, unusual tiredness, and concentration difficulties were found among the sewage workers compared with controls. Furthermore, an increased risk for non-specific work related gastrointestinal symptoms was found among the sewage workers; an increased risk for joint pains, related to pains in more than four joints but not with loading, was also found.

Conclusions:The results of this questionnaire survey show an increased risk for airway, gastrointestinal, and general symptoms such as joint pains and central nervous system symptoms among sewage workers. Clinical investigations are needed to determine the cause of the reported symptoms among sewage workers, and further field studies are required to assess the causal agents.
Multiple sclerosis and pregnancy
Authors: Lorenzi A R , Ford H L
Published: October 2002

Multiple sclerosis causes disability in young adults and, like most autoimmune diseases, affects women more commonly than men. The disease can therefore present at a time when many have, or are considering, starting a family. The effect of pregnancy on the outcome of multiple sclerosis is reviewed and the management of pregnant women who have multiple sclerosis is discussed.
Inflorescence and flower development in wild-type andsidmutantMelilotus alba, white sweetclover
Authors: Hirsch Ann M , Krupp Rebecca SN , Lin Yimei , Wang Susan S , Yang Weigang , Tucker Shirley C
Published: October 2002

White sweetclover, Melilotus alba Desr. (Fabaceae), produces white, papilionoid flowers on a simple raceme. Individual floral apices originate in the axil of a bract. Each flower consists of five alternating whorls that, from outside to inside, consist of (i) five sepals, (ii) five petals, of which two fuse along their abaxial edges to form the keel, (iii) five antesepalous stamens, (iv) five antepetalous stamens with shorter filaments, and (v) a single carpel containing two to four ovules. The development of the wild-type sweetclover inflorescence and flowers is described in detail and compared with a mutant in which secondary inflorescences, instead of individual flowers, developed in axils of the bracts, especially at the base of the inflorescence. This white sweetclover mutant, designated sid for "secondary inflorescence development", might serve as a test of the ABC model of floral development, which was based on the model plants Antirrhinum and Arabidopsis.Key words: white sweetclover, inflorescence, flower, development, sid mutant.
Genetic composition and morphological variation among populations of the invasive grass,Phalaris arundinacea
Authors: Gifford Amy LS , Ferdy Jean-Baptiste , Molofsky Jane
Published: October 2002

Species that become invasive after being introduced into a new range often experience genetic bottlenecks and strong selection to adapt to their new environment. We looked for evidence of such processes in unmanaged populations of invasive reed canary grass (Phalaris arundinacea L.). This grass species is planted as a forage crop in North America but has also invaded wetland areas. We compared isozyme variation in pasture and wetland populations of this species. We did not find any indication of a genetic bottleneck: wetland populations comprised as much diversity as pasture populations and both had as much diversity as the two cultivated varieties of reed canary grass that we sampled. We also cultivated plants from wetland and pasture populations and estimated genetic variance for several morphological traits. We did not find any significant differentiation to suggest differential selection between populations from the two habitats. In fact, we found the highest amount of genetic diversity, both isozymic and quantitative, within populations. We also found strong evidence that reed canary grass reproduces primarily clonally. The implications of these observations in terms of the origin of invasive populations of reed canary grass are discussed.Key words: invasive species, Phalaris arundinacea, reed canary grass.
Interactions between ectomycorrhizal fungi and soil saprotrophs: implications for decomposition of organic matter in soils and degradation of organic pollutants in the rhizosphere
Authors: Cairney John WG , Meharg Andrew A
Published: October 2002

Ectomycorrhizal fungi and saprotrophic microorganisms coexist and interact in the mycorrhizosphere. We review what is known regarding these interactions and how they may influence processes such as ectomycorrhiza formation, mycelial growth, and the dynamics of carbon movement to and within the rhizosphere. Particular emphasis is placed on the potential importance of interactions in decomposition of soil organic matter and degradation of persistant organic pollutants in soil. While our knowledge is currently fairly limited, it seems likely that interactions have profound effects on mycorrhizosphere processes. More extensive research is warranted to provide novel insights into mycorrhizosphere ecology and to explore the potential for manipulating the ectomycorrhizosphere environment for biotechnological purposes.Key words: ectomycorrhizal fungi, ectomycorrhizosphere, rhizosphere, rhizosphere carbon flow, decomposition, rhizosphere remediation.
Does red alder (Alnus rubra) in upland riparian forests elevate macroinvertebrate and detritus export from headwater streams to downstream habitats in southeastern Alaska?
Authors: Piccolo Jack J , Wipfli Mark S
Published: October 2002

We assessed the influence of riparian forest canopy type on macroinvertebrate and detritus export from headwater streams to downstream habitats in the Tongass National Forest, southeastern Alaska. Twenty-four fishless headwater streams were sampled monthly, from April to August 1998, across four riparian canopy types: old growth, clearcut, young-growth alder, and young-growth conifer. Young-growth alder sites exported significantly greater count (mean = 9.4 individuals·m3water, standard error (SE) = 3.7) and biomass (mean = 3.1 mg dry mass·m3water, SE = 1.2) densities of macroinvertebrates than did young-growth conifer sites (mean = 2.7 individuals·m3water, SE = 0.4, and mean = 1.0 mg dry mass·m3water, SE = 0.2), enough prey to support up to four times more fish biomass if downstream habitat is suitable. We detected no significant differences in macroinvertebrate export between other canopy types or in detritus export among different canopy types. Roughly 70% of the invertebrates were aquatic; the rest were terrestrial or could not be identified. Although we do not recommend clearcutting as a means of generating red alder, maintaining an alder component in previously harvested stands may offset other potentially negative effects of timber harvest (such as sedimentation and loss of coarse woody debris) on downstream, salmonid-bearing food webs.
Fleet dynamics of herring trawlerschange in gear size and implications for interpretation of catch per unit effort
Authors: Rahikainen Mika , Kuikka Sakari
Published: October 2002

Catch per unit effort (CPUE) is widely used as an index of stock abundance. It is as widely acknowledged that CPUE can be a misleading index of abundance owing to a multitude of factors including fish behavior, fishing fleet interaction, and the increase in catchability over time caused by improvement in fishing technology. Based on information concerning the size of herring trawls manufactured in Finland since the early 1980s, an increase in fishing power of the fleet was postulated. Because we lacked direct information about the size of trawls aboard, we applied a model to estimate the changes over time. In the analysis, an analogy between fish and trawls was created by adopting the concepts and algorithms from fish stock assessment into assessment of the trawl "population", where both the total number of trawls and the size of individual trawls were being analyzed. The results indicate that the average gear size has nearly tripled in 20 years. Accepting the assumption that larger trawls are generally more effective than smaller ones, a substantial increase in fishing power has taken place. As a result, sequential population models calibrated with CPUE data will be severely biased as well.
Relationships of channel characteristics, land ownership, and land use patterns to large woody debris in western Oregon streams
Authors: Wing Michael G , Skaugset Arne
Published: October 2002

Regression tree analysis was used to test the relationship of channel and aquatic habitat characteristics from 3793 stream reaches in western Oregon State to the abundance of large woody debris (LWD). Stream reaches were drawn from diverse ownerships and land uses  land cover types over a broad geographic extent. When all land uses  land covers were considered, ownership and land use patterns were related to LWD abundance. When nonforested land uses were excluded, however, these factors became less important. In forested streams, LWD abundance was predicted primarily by stream gradient and bankfull channel width, with the volume, frequency, and size of LWD pieces decreasing as channel size increased. Within forested lands, stand age and forest distribution were related to LWD size but had small correlations with LWD volume and abundance. The strong relationship of stream gradient and bankfull channel width with LWD suggests that in forested areas, the most significant factor related to LWD counts is the geomorphology of stream reaches and their surrounding areas. Land managers in western Oregon who want to improve aquatic habitat quality may want to direct their efforts to increasing LWD in larger streams, which typically include smaller quantities of LWD.
Altered body size distributions in a large river fish community enriched by sewage
Authors: deBruyn Adrian M.H , Marcogliese David J , Rasmussen Joseph B
Published: October 2002

We used two approaches (interspecific upper bound and normalized biomass spectrum, NBS) to study size distributions in a littoral fish community across a natural gradient of epiphytic primary production and at sites enriched by primary-treated sewage. The upper bound of the interspecific density  body size relationship supported universal energetic constraints on the regional assemblage but revealed substantial variation in size distributions at a local scale. Multivariate analysis of the modes composing the NBS suggested possible mechanisms for this local variation in size distributions. Only the largest organisms had higher densities at higher levels of productivity. Densities of smaller organisms could be explained by a combination of habitat characteristics and feeding interactions.
The accuracy of alternative stochastic growth rate estimates for salmon populations
Authors: Hinrichsen Richard A
Published: October 2002

The accuracies of four alternative estimators of stochastic growth rate for salmon populations are examined using bootstrapping. The first estimator is based on a stochastic Leslie matrix model that uses age-specific spawner counts. The other three estimators use spawner counts with limited age-structure information: a BotsfordBrittnacher model method and two diffusion approximation methods, namely, the least squares approach of Dennis and the robust approach of Holmes. Accuracy of the estimators was quantified using median bias and interquartile ranges of the stochastic growth rate estimates. The BotsfordBrittnacher estimator was found to be unreliable due to large bias. Of the remaining estimators, the stochastic Leslie approach tended to produce the most reliable estimates but had the greatest data demands. With severe lognormal measurement error, the Dennis estimators produced less biased estimates than the other methods, but precision of the stochastic growth rate was generally highest using the stochastic Leslie estimator.