bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the ICD/AIS MAP for pediatric use
Authors: Durbin D R , Localio A R , MacKenzie E J
Published: October 2002

Objective—To determine the performance of the ICD/AIS MAP (© E J MacKenzieet al) as a method of classifying injury severity for children.

Methods—Data on all children less than 16 years of age admitted to all designated trauma centers in Pennsylvania from January 1994 through October 1996 were obtained from the state trauma registry. The ICD/AIS MAP was used to convert all injury related ICD-9-CM diagnosis codes into abbreviated injury scale (AIS) score and injury severity score (ISS). Agreement between trauma registry AIS and ISS scores and MAP generated scores was assessed using the weighted κ (κw) coefficient for ordered data and the intraclass correlation coefficient for continuous data.

Results—Agreement in ISS scores was excellent, both overall (intraclass correlation coefficient = 0.86, 95% confidence interval (CI) 0.84 to 0.89)), and when grouped into three levels of severity (κw= 0.86, 95% CI 0.85 to 0.87). Agreement in AIS scores across all body regions and ages was also excellent, (κw= 0.86 (95% CI 0.83 to 0.87). Agreement increased with age (κw= 0.78 for children <2 years; κw= 0.86 for older children) and varied by body region, though was excellent across all regions.

Conclusions—The performance of the ICD/AIS MAP in assessing severity of pediatric injuries was equal to or better than previous assessments of its performance on primarily adult patients. Its performance was excellent across the pediatric age range and across nearly all body regions of injury.
Law enforcement officers' opinions about gun locks: anchors on life jackets?
Authors: Coyne-Beasley T , Johnson R M
Published: October 2002

Objectives—One way law enforcement officers support firearm safety is by promoting the use of gun locks. This investigation examined law enforcement officers' willingness to use gun locks on their own guns, as well as their opinions regarding gun locks in general.

Setting—Law enforcement officers from an urban agency in the southern region of the United States.

Methods—Free keyed cable gun locks were distributed to all law enforcement officers in one agency who wanted one, and then an anonymous questionnaire survey was conducted about their subsequent use of, and attitudes toward, these devices.

Results—About half of the 207 officers collected gun locks (n=103). Nearly three quarters (73%) completed and returned the questionnaire. Two thirds reported that they were not using the gun lock they collected (65%), and over half disagreed that gun lock use should be required (56%). Very few cited any actual or potential technical problems with the device. An important reason given for non-use of gun locks related to being able to access the weapon quickly in case of an emergency.

Conclusions—The findings highlight the need for further investigation into law enforcement officers' attitudes toward gun locks, the degree to which their attitudes affect their firearm safety counseling, and the need to develop a gun safety device that can be disengaged quickly.
Injuries among teens employed in the homebuilding industry in North Carolina
Authors: Lipscomb H J , Li L
Published: October 2002

Objective—To describe injuries of teens employed in the residential construction industry and to assess whether their injury experiences are significantly different from those of adults in this high risk industry.

Methods and setting—North Carolina homebuilders workers' compensation data for a 41 month period were analyzed. Injuries of teens were identified and described by body part injured, nature, and cause of injury. Proportionate injury ratios were used to summarize and compare the injury experience of teens with those of adult construction workers.

Results—Teens had proportionately more injuries to the eye and foot and fewer injuries to the back than adults. They had more cuts and scratches and fewer sprains and strains. They also had proportionately fewer injuries from falls from elevations and overexertion, injuries that account for a significant cost burden in construction. Consistent with these findings, teens had significantly fewer injuries resulting in medical costs or lost time costs of $1000 or more.

Conclusions—The analyses indicate that injuries of teens are less serious than those of adults. This finding may indicate that their work exposures are less dangerous than those of adults in comparable broad categories of construction. However, the data also provide documentation of injuries to teens resulting from work at heights, use of power tools, and motor vehicles with the majority of more expensive claims involving one of these exposures. Construction is dangerous work and these results add to the documentation of the need for additional measures to prevent work related injuries among all workers—teens and adults—in this industry.
Kentucky's graduated driver licensing program for young drivers: barriers to effective local implementation
Authors: Steenbergen L C , Kidd P S , Pollack S , McCoy C , Pigman J G , Agent K R
Published: October 2002

Objectives—To examine the implementation of graduated driver licensing (GDL) in Kentucky and to use the data collected to recommend actions to enhance the effectiveness of the GDL program.

Methods—Data were acquired from surveys of 700 law enforcement officers and more than 40 judges and from interviews with 100 persons who implement or are affected by Kentucky's GDL program—for example, traffic court judges, licensing clerks, law enforcement officers, insurance agents, driving instructors, parents, and employers of teens. Transcripts from interviews were analyzed using a qualitative data analysis computer program.

Results and conclusions—Participants noted a widespread lack of awareness of the night-time driving restriction and a substantial number of young drivers receiving little driving time during the learner permit phase. It appeared that specific GDL provisions can be difficult for judges and law officers to enforce and the penalty of license suspension after several traffic violations may not be a sufficient deterrent. Efforts are needed to increase parental awareness of GDL provisions, GDL purpose, and their teen's traffic violations and to increase parental enforcement of restrictions that are difficult for law enforcement agencies to monitor, such as the night-time driving restriction and the adult supervision requirement.
Controlled evaluation of a community based injury prevention program in Australia
Authors: Ozanne-Smith J , Day L , Stathakis V , Sherrard J
Published: October 2002

Objective: To evaluate the effects of a community based, all age, all injury prevention program, the Safe Living Program, on injury risk and injury rates.

Design: A quasiexperimental population based evaluation using an intervention and comparison community design.

Setting: The intervention community (Shire of Bulla, n=37 257) is an outer metropolitan area of Melbourne, Australia. The demographically matched comparison community (Shire of Melton, n=33 592) is located nearby.

Subjects and methods: The Safe Living Program in the Shire of Bulla targeted injury reduction in all settings with a focus on high risk groups. Strategies included program publicity, education and training, injury hazard reduction, and environmental change. Baseline and follow up measures of program reach, risk factors, and injury rates in both communities were used to evaluate program process, impact, and outcome.

Results: Increase in program awareness was moderate and similar to other community based programs. The program achieved injury hazard reduction on the road, in schools, and, to a more limited extent, in the home. Other changes in injury risk factors could not necessarily be attributed to the program as similar changes were observed in the comparison community. No significant changes were found in rates of injury deaths, hospitalisations, or emergency department presentations in the Shire of Bulla after six years. Self reported household injuries, mostly minor, were reduced in the intervention community, but had been higher at program launch than in the comparison community.

Conclusions: The Safe Living Program was unable to replicate the significant reductions in injuries reported in other community based interventions. Replication of apparently successful community based injury prevention programs in different settings and populations requires evidence based interventions, sustained and effective program penetration, reliable data systems to measure change, at least one control community, and sufficient budget and time for effects to be observable.
Adolescent injury morbidity in New Zealand, 1987–96
Authors: Kypri K , Chalmers D J , Langley J D , Wright C S
Published: October 2002

Objectives: Adolescents are over-represented in injury statistics. New Zealand is privileged in having a hospital discharge database allowing for analysis of non-fatal injury data at a national level. An epidemiological description of adolescent injury morbidity is provided and options for prevention are discussed.

Method: People aged 15–19 years admitted to hospital for their injuries in the period 1987–96 were identified from the New Zealand Health Information Service morbidity data files. The manner, causes, and nature of injury were examined. Injury prevention strategies were reviewed.

Results: The incidence of hospitalised injury was 1886 per 100 000 person years. The victims were predominantly male (70%). The leading causes of injury were road traffic crashes, sports injuries, and self poisoning. The most common injury diagnoses were head injuries (29%) and limb fractures (21%). Road traffic crashes produced the highest proportion of serious injuries.

Conclusions: Road traffic crashes, sports injuries, and self inflicted poisoning, stood out as areas with the greatest potential for reducing the burden of injury in late adolescence. Graduated driver licensing shows promise as an injury prevention measure but remains inadequately implemented. Policies to reduce self inflicted poisoning are of unknown efficacy, and evidence is awaited on the effectiveness of measures to reduce injury in sport.
Socioeconomic differences in injury risks in childhood and adolescence: a nation-wide study of intentional and unintentional injuries in Sweden
Authors: Engström K , Diderichsen F , Laflamme L
Published: October 2002

Study objective:To measure socioeconomic differences in injuries among different age groups of children and adolescents.

Subjects:Children under 20 living in Sweden between 1990 and 1994 (about 2.6 million).

Method:A cross sectional study based on record linkage between 15 Swedish national registers. Children were divided into four age groups and allocated to four household socioeconomic status groups. Absolute and relative risks were compiled using children of high/intermediate level salaried employees as the comparison group. Four diagnostic groups were considered: fall, traffic, interpersonal violence, and self inflicted injuries.

Results:Injury incidences were relatively low and socioeconomic differences negligible in the 0–4 year olds. Thereafter, significant socioeconomic differences were observed in all diagnostic groups except falls. The highest absolute differences were in traffic injuries, especially among 15–19 year olds, and in self inflicted injuries among 15–19 year old girls. Relative differences were highest in both categories of intentional injuries for the age group 10–14. Social circumstances in the household other than family socioeconomic status affected the social pattern of intentional but not that of unintentional injuries.

Conclusions:Socioeconomic differences in injury risks are not necessarily constant over age. Inequalities are particularly high in absolute terms among adolescents 15–19 years old for traffic injuries and in relative terms among 10–14 year olds for intentional injuries.
Risk factors associated with non-fatal adolescent firearm injuries
Authors: Paris C A , Edgerton E A , Sifuentes M , Seidel J S , Lewis R J , Gausche M
Published: October 2002

Study objective:To identify behavioral, environmental, and sociodemographic risk factors associated with non-fatal firearm injuries among inner city adolescents in the United States.

Design:A case-control study in which patients with firearm injury serve as cases and those with medical conditions serve as controls.

Setting:A level I trauma center in a metropolitan area serving a predominately lower socioeconomic status population.

Participants:Cases were 45 consecutive patients 11–18 years presenting to the emergency department with a non-fatal firearm injury; controls were 50 age and gender matched patients presenting with acute medical problems.

Outcome measure:Odds ratios (OR) and associated 95% confidence intervals (CI) as estimates of the magnitude of association between risk factors and non-fatal firearm injury.

Results:After adjusting for age, gender and socioeconomic status, multivariate analysis identified four risk factors independently associated with firearm injury: living with less than two parents (OR 3.8, 95% CI 1.2 to 12.2), skipping class (OR 7.1, 95% CI 1.7 to 28.9), previous arrest (OR 6.2, 95% CI 1.9 to 20.7), and being African-American (OR 4.2; 95% CI 1.4 to 14.9).

Conclusion:Risk factors for adolescents sustaining a non-fatal firearm injury are sociodemographic and environmental, not just behavioral. Thus interventions that foster protective and supportive environments may help prevent firearm injuries.
UNICEF's child injury league table. An analysis of legislation: more mixed messages
Authors: Towner E , Towner J
Published: October 2002

This paper presents a summary table and discussion of legislation related to child injury prevention in member countries of the Organisation for Economic Cooperation and Development. The table is an expanded version of the one which appeared in the UNICEF Report Card “Child Deaths by Injury in Rich Countries” (2001). A commentary is provided on the variations in legislation between countries in terms of range and form of measures and an estimate of degree of enforcement. As legislation is generally considered a powerful tool in injury prevention, the paper examines whether those countries with the widest range of legislation and the strongest enforcement have made the most progress in reducing child injury deaths since the 1970s. It also considers whether a commitment to extensive legislation is reflected in a country's position in the UNICEF league table of injury death. The initial conclusion to these two basic issues is that no clear picture can be seen and we thus need to know far more about the relationship between legislation and societies and cultures as they vary from place to place. This paper hopes to stimulate more widespread debate about the role of legislation in different countries.
Death with dignity
Authors: Allmark Peter
Published: October 2002

The purpose of this article is to develop a conception of death with dignity and to examine whether it is vulnerable to the sort of criticisms that have been made of other conceptions. In this conception “death” is taken to apply to the process of dying; “dignity” is taken to be something that attaches to people because of their personal qualities. In particular, someone lives with dignity if they live well (in accordance with reason, as Aristotle would see it). It follows that health care professionals cannot confer on patients either dignity or death with dignity. They can, however, attempt to ensure that the patient dies without indignity. Indignities are affronts to human dignity, and include such things as serious pain and the exclusion of patients from involvement in decisions about their lives and deaths. This fairly modest conception of death with dignity avoids the traps of being overly subjective or of viewing the sick and helpless as “undignified”.
Improving the detection of cancer in the screening of mammograms
Authors: Laming D. , Warren R.
Published: October 2002

Objective Examination of figures from screening at several different centres, and from the incidence of interval cancers in those programmes, suggests that a single radiologist reading by him/herself would miss 16 to 31% of cancers detectable in the mammograms. This study investigates how the accuracy of breast cancer screening could be improved.

Method Draw a comparison between screening for breast cancer and other inspection tasks that have been studied in the experimental psychological laboratory to suggest two low cost fixes that might improve the accuracy of breast cancer screening.

Recommendations (1) Radiologists should not work for more than half an hour at a time; (2) two radiologists double reading should inspect the same series of mammograms in inverse order; (3) there should be a clerical check to see whether the efficiency of detection decreases with time on task; and (4) a more sophisticated engineering of the screening procedure might be accomplished by assembling a library of mammograms for which the correct diagnosis is known. If these library mammograms were mixed randomly with those to be inspected in some suitable ratio, it would then be possible to provide the radiologist with immediate feedback on the accuracy of (some of) his/her diagnoses. From experimental studies of inspection tasks this should improve diagnostic accuracy. These recommendations, of course, require evaluation in field trials.
Screening for colorectal cancer by faecal occult blood test: comparison of immunochemical tests
Authors: Castiglione G. , Zappa M. , Grazzini G. , Rubeca T. , Turco P. , Sani C. , Ciatto S.
Published: October 2002

Objective To compare two immunochemical faecal occult blood tests based on reversed passive haemagglutination (RPHA) or latex agglutination (Hdia) in a population based screening setting.

Method Hdia was interpreted according to three positivity thresholds: 100, 150, or 200 ng of haemoglobin/mg of specimen solution. A total of 5844 subjects were recruited into the study, from 17 432 invited subjects aged 50–70.

Results Positivity rates were 3.3% for RPHA, Hdia100 3.5%, Hdia150 2.5%, Hdia200 2.0%. Among subjects complying with the diagnostic work up, colorectal cancer (CRC) was detected in 19 subjects (17 RPHA positive, 16 Hdia100 positive, 15 Hdia150 positive, 14 Hdia200 positive) and high risk adenoma/s in 41 subjects (28 RPHA positive, 32 Hdia100 positive, 29 Hdia150 positive, 25 Hdia200 positive). The prevalence of screen positive CRC in the population was for RPHA 2.9‰, Hdia100 2.7‰, Hdia150 2.6‰, Hdia200 2.4‰. The prevalence of screen positive high risk adenomas in the population was for RPHA 4.8‰, Hdia100 5.5‰, Hdia150 5.0‰, Hdia200 4.3‰.

Conclusion Hdia100 was as sensitive as RPHA for cancer and high risk adenomas. As Hdia is less technically complex than RPHA, it is a valid alternative to the latter, provided that full automation of the development procedure is available. Increasing the positivity threshold of Hdia up to 150 or 200 ng of haemoglobin/mg of specimen solution is not advisable as the increase in specificity is too small to justify the corresponding decrease in the detection of screen positive cancers in the population.
Strategic options for antenatal screening for syphilis in the United Kingdom: a cost effectiveness analysis
Authors: Connor N. , Roberts J. , Nicoll A.
Published: October 2002

Objective Antenatal screening for syphilis is well established in the United Kingdom. The prevalence of syphilis is now very low, prompting the question as to whether this screening programme is still necessary. This paper aims at identifying possible screening strategy options for the programme and comparing their effectiveness and cost effectiveness.

Methods The cost of the screening programme in the United Kingdom was estimated. This was based on the cost of screening tests, treatment, and follow up of infected women and their infants. This information was obtained from laboratories, antenatal clinics, and genitourinary medicine clinics. Epidemiological data from a survey of women treated for syphilis in pregnancy were analysed to identify groups at increased risk of syphilis. Strategic options for the screening programme were then identified. The effectiveness, number needed to treat, and cost effectiveness of these options were compared.

Results Antenatal screening in the United Kingdom detected at least 40 pregnant women who need treatment for syphilis every year. This means that 18 602 women are screened for every woman detected who needs treatment for syphilis. The marginal annual cost of this screening programme in the United Kingdom is £672 366. This is equivalent to 90p per woman screened, or £16 670 to detect one woman who needs treatment for syphilis. The screening programme could be targeted geographically at pregnant women in the Thames regions. This option has the potential to save £482 185. Other strategic options are to target pregnant women in non-white ethnic groups, or those born outside the United Kingdom. These targeted options would each detect between 70% and 77% of women needing treatment for syphilis. These options could potentially save £592 938 and £562 691 respectively.

Conclusions Targeting or stopping the screening programme would save relatively little money. Although selectively screening groups by country of birth or by ethnic group could detect at least 70% of cases, this would be politically and practically difficult. Targeting by region would also be effective, but would pose similar ethical and medicolegal problems. These facts and the changing international epidemiology of syphilis lead us to recommend that the current universal antenatal screening for syphilis should continue.
Recent economic evaluations of antenatal screening: a systematic review and critique
Authors: Petrou S. , Henderson J. , Roberts T. , Martin M-A.
Published: October 2002

A systematic review of recent economic evaluations of antenatal screening was conducted. Relevant studies were identified from a number of sources including computerised databases, bibliographies of economic evaluations, and searches of unpublished manuscripts. Each study identified by the literature searches was categorised on the basis of its title and abstract. Studies considered relevant to the systematic review were obtained from libraries. The methodology, results, and policy implications of studies categorised as economic evaluations upon full review were documented.A total of 566 studies were identified by the literature searches, 41 of which were categorised as economic evaluations upon full review. The economic evaluations covered a range of antenatal screening practices, aimed mainly at the prevention of infectious diseases and fetal anomalies. The review highlighted the poor methodological quality of the bulk of economic evaluations of antenatal screening. The study design, data collection methods, and analysis and interpretation of results frequently violated methodological guidelines adopted by health economists. The review also highlighted the narrow definition of benefits adopted by this body of literature, with most studies reporting outcomes in terms of cases detected, cases of particular disorders prevented or, most often, costs averted.The conclusions arrived at differed by area of antenatal screening. There appeared to be clear economic arguments in favour of some forms of antenatal screening, for example, triple test screening for Down's syndrome. Other economic evaluations pertained to specific locations, which suggests that the results may not necessarily be generalisable to different settings. For all areas of antenatal screening, an updating of published economic evaluations may be required to account for evolving economic, epidemiological, and clinical effectiveness evidence.
Usefulness of thyroxine and free thyroxine filter paper measurements in neonatal screening for congenital hypothyroidism of preterm babies
Authors: Gruñeiro-Papendieck L. , Prieto L. , Chiesa A. , Bengolea S. , Bossi G. , Bergadá C.
Published: October 2002

Introduction Low thyroxine (T4) with normal thyroid stimulating hormone (TSH) is a well known condition in preterm (PT) infants. The establishment of T4 and freeT4 (FT4) values in filter paper dried blood spots in PT could provide useful information in the neonatal period.

Objective To study T4 and FT4 levels in dried blood filter paper samples of PT and full term (FT) babies.

Methods We measured T4 by fluoroimmunoassay (FIA) DELFIA and TSH by IFMA DELFIA (Wallac Inc Turku, Finland) in 193 PT (26 to 37 weeks of gestational age (GA)) in samples from the first and second week of life and in 153 FT babies in the first week of life. In 131 PT and 31 FT we determined FT4 in filter paper blood spots using FIA (Alonso Fernandez J). Infants were grouped according to GA.

Results There was a significant difference in T4 between PT and FT (p < 0.001). The lowest T4 levels were at 26 to 29 weeks GA. T4 values were lower in the second week. FT4 in PT up to 35 weeks GA, during the first week, was significantly different with FT infants (G1 to G3 p < 0.01, G4 p < 0.05). FT4 values in the first and second weeks of life did not vary.

Conclusions T4 values were significantly lower in PT than in FT neonates, increasing with GA. PT infants had low T4 with normal FT4 values. This could suggest a decreased thyroxine binding globulin (TBG) or decreased protein binding and/or an adaptative mechanism that would not require therapeutical intervention.
Family history and risk of colorectal cancer: implications for screening programmes
Authors: Benhamiche-Bouvier A-M. , Lejeune C. , Jouve J-L. , Manfredi S. , Bonithon-Kopp C. , Faivre J.
Published: October 2002

Objective To estimate the lifetime risk of colorectal cancer in the general population and in first degree relatives of patients with sporadic colorectal cancer or adenoma.

Main outcomes measuresThe cumulative risk of colorectal cancer (0–74) in the general population combined with the relative risk of colorectal cancer and the prevalence of different groups of subjects with family history of colorectal tumour allows the calculation of cumulative risks in these groups.

Results The lifetime risk of colorectal cancer was 1 in 23 in men and 1 in 40 in women. In males, 0.5% in the 55–59 age group and 4.5% in the 70–74 age group will develop a colorectal cancer. The corresponding values in females were 0.4% and 2.5%. The cumulative risk at age 74 varied between 7.7% (one family member affected) and 25.6% (two affected) in males, and 4.3% and 14.3% respectively in females. The risk in the 40–44 year age group for individuals with one first degree relative affected before 45 years of age was 0.5%, similar to that of those aged 45–49 with one first degree relative affected with a colorectal cancer or a large adenoma (> 1 cm).

Conclusions These results suggest that screening in the general population should start at 50 or 55. The lifetime risk is high enough (over 10%) among individuals with one affected first degree relative before age 45, or with at least two affected first degree relatives, to warrant colonoscopic screening. The data provide a basis for recommendations that relatives of these patients should enter screening programmes at age 40 to 44.
Evaluation of the prenatal diagnosis of neural tube defects by fetal ultrasonographic examination in different centres across Europe
Authors: Boyd P.A. , Wellesley D.G. , de Walle H.E.K. , Tenconi R. , Garcia-Minaur S. , Zandwijken G.R.J. , Stoll C. , Clementi M.
Published: October 2002

Objective Evaluation of prenatal diagnosis of neural tube defects by ultrasound examination in unselected populations across Europe.

Setting Prenatal ultrasound units in areas that report to contributing congenital malformation registers.

Methods All cases with a suspected or confirmed neural tube defect and delivered within the 30 month study period were identified from 18 Congenital Malformation Registers from 11 European countries. Data on the pregnancy, prenatal scans, outcome of pregnancy, and information on different screening policies for each country were analysed.

Results 670 766 deliveries occurred in the area covered by the registers during the study period. A neural tube defect was diagnosed at delivery in 542 cases. In 84% of these, the lesion was isolated (166 anencephaly, 252 spina bifida, 35 encephalocele). Of the 166 isolated cases with anencephaly, 96% were correctly identified prenatally; one was missed on scan, two were wrongly diagnosed, and four were not scanned (sensitivity 98%). 84% of the prenatal diagnoses were made before 24 weeks' gestation; 86% of isolated anencephalic pregnancies were terminated. Of the 252 cases of isolated spina bifida, 171 (68%) were correctly identified prenatally; 66% of these before 24 weeks' gestation. The diagnosis was missed on scan in 60 cases and 21 were not scanned (sensitivity 75%). The mean reduction in birth prevalence because of termination of pregnancy for spina bifida was 49% (range 6–100%). There was a wide variation between centres in prenatal detection rate (33–100%), termination of pregnancy of prenatally diagnosed cases (17–100%), and gestation both at diagnosis and termination of pregnancy.

Conclusion A high prenatal detection rate for anencephaly was reported by all registers. There is a large variation in prenatal detection and termination rates for spina bifida between centres, reflecting differences both in policy and culture.
Relation of severity of maternal hypothyroidism to cognitive development of offspring
Authors: Klein R.Z. , Sargent J.D. , Larsen P.R. , Waisbren S.E. , Haddow J.E. , Mitchell M.L.
Published: October 2002

Background An association between maternal subclinical hypothyroidism and low intelligence quotient (IQ) in the offspring has recently been shown.

Objective To provide evidence for the causality of the association by testing the hypothesis that severity of maternal hypothyroidism correlates inversely with IQ of the offspring.

Methods IQ scores were compared among 8 year old offspring of 124 control mothers whose thyroid stimulating hormone (TSH) concentrations were < 98th percentile of a cohort of 25 000 mothers at 17 weeks gestation, of 28 untreated hypothyroid women whose TSH was between the 98th and 99.85th percentiles, and of 20 untreated women whose TSH concentration was ≥ 99.85th percentile.

Results Mean (SD) IQs for each group of children (in ascending order of maternal TSH concentration) were 107 (13), 102 (15), and 97 (14). The difference between the extremes was significant (p = 0.003). The percentage of children with IQs > 1 SD below the control mean was 15, 21, and 50 respectively (p = 0.003). The odds ratio of having an IQ > 1 SD below the control mean, after controlling for socioeconomic status, was 4.7 (p = 0.006) for the third group compared with the controls.

Conclusions The inverse correlation between severity of maternal hypothyroidism and IQ of the offspring supports a causal relation and makes the need to screen for and treat pregnant women for hypothyroidism even more compelling.
Hormone replacement therapy and the sensitivity and specificity of breast cancer screening: a review
Authors: Banks E.
Published: October 2002

Background The use of hormone replacement therapy (HRT) is prevalent in the age group invited to routine breast cancer screening in many countries. Previous publications have reported reduced sensitivity and specificity of mammographic breast cancer screening associated with current use of HRT.

Objectives To review the epidemiological evidence for the relation between use of HRT and the risk of having breast cancer diagnosed between screens (interval breast cancer—sensitivity) and being recalled for assessment after initial mammography with no diagnosis of breast cancer at that screen (false positive recall—specificity).

Methods Overview of published literature.

Results Eight studies were identified, providing a total of 367 interval cancers and 8878 cases of false positive recall, in women of 50 and over. Overall, the studies showed an increased risk of interval cancer and false positive recall in current users of HRT compared with non-users. Only one study accounted for the essential confounding factors of age and menopause. Furthermore, information on duration and recency of HRT use was not available for most studies.

Conclusions Studies to date indicate that women using HRT are more likely to experience reduced sensitivity and specificity of breast cancer screening, compared with women not using HRT. However, because results have not been adjusted for crucial confounding factors, the magnitude of these effects is uncertain.
Computer modelling of the Swedish two county trial of mammographic screening and trade offs between participation and screening interval
Authors: Fett M.J.
Published: October 2002

Objectives A computerised model of the Swedish two county trial of mammographic screening was built to explore the applicability of deterministic group modelling for health policy analysis and to examine trade offs between screening interval and population coverage on breast cancer mortality.

Methods Powersim system dynamics modelling software running on a PC was used. Model inputs were published data on the populations and screening regimens used in the trial, a Swedish female population life table, incidence of breast cancer in Sweden, 95% confidence intervals (95% CIs) for mean sojourn time and screening sensitivity, and survival after diagnosis.

Results The model's output—cumulative mortality from breast cancer—agreed closely with trial results. This was robust to uncertainties in key input variables. Furthermore, with hypothetical screening regimes that had a fixed total number of mammograms over a fixed period a positive association was found between more even distribution of mammograms among a population and reduction in breast cancer mortality. For example, screening 50% of a hypothetical population annually produced a 33% reduction in breast cancer mortality, whereas screening 100% of the population every 2 years produced a 48% reduction.

Conclusions Deterministic group simulation modelling can be used to build reliable, evidence based quantitative models for policy analysis. This opens health policy simulation modelling to epidemiological researchers and will assist them in identifying important information needs—such as breast cancer survival according to sojourn time (the time between cancer being detectable by screening and becoming symptomatic). Scenarios examining reductions in mortality for a given number of mammograms showed that the more equitable the distribution of screening mammograms, the greater the reduction in deaths from breast cancer.
A comparative study of the prevalence of abdominal aortic aneurysms in the United Kingdom, Denmark, and Australia
Authors:   Collaborative Aneurysm Screening Study Group (CASS Group),   Chichester Aneurysm Screening Group (UK),   Viborg Aneurysm Screening Study (Denmark),   Western Australia Abdominal Aortic Aneurysm Program (Australia),   Multicentre Aneurysm Screening Study (MASS)(UK)
Published: October 2002

Objectives To compare attendance and prevalence of abdominal aortic aneurysm (AAA) in population based randomised trials of sonographic screening in the United Kingdom, Western Australia, and Denmark.

Methods 65 290 men were randomised to screening in the four trials, and data were collected and analysed from 46 397 aortic scans for men aged between 64 and 83 years who attended one of four community screening programmes. Comparisons were made for age standardised populations (65–74 years).

Results Age standardised attendance varied between 74% and 81%, and was highest in the United Kingdom and lowest in Western Australia. Age standardised prevalence of AAAs of 3.0 cm or more varied significantly between 4.5% and 7.7%, and was highest in the United Kingdom and lowest in Denmark.

Conclusions Participation in the four programmes compares favourably with other reported screening studies. The possibility that variations may reflect the different recruitment methods used is discussed. The prevalence of AAA in central Denmark would appear to be significantly different from that in southern England and Western Australia.
Service screening with mammography of women aged 50–69 years in Sweden: effects on mortality from breast cancer
Authors: Jonsson H. , Nyström L. , Törnberg S. , Lenner P.
Published: October 2002

OBJECTIVES:To estimate the effect of the population based service screening programme in Sweden on mortality from breast cancer among women aged 50–69. SETTING:In 1986, population based service screening with mammography started in Sweden, and by 1997 screening had been introduced in all counties. Half of the counties invite women from 40 years of age whereas women 50 and older are invited in the other counties. The upper age limit was either 69 or 74. Women in the age group 50–69 years are thus invited to screening in all counties. METHODS:The counties which started with mammographic screening in 1986–87 constituted the study group and were compared with the counties which started in 1993 or later. In 1987 the mean number of women aged 50–69 was 161 986 and 98 608 in the study and control groups, respectively. Refined excess mortality (smoothed with the Lowess method) from breast cancer and refined cause specific mortality from breast cancer were used as effect measures. To adjust for geographical differences in mortality from breast cancer a reference period was used. Allowance was made for two potential biases: (a) inclusion bias implying the inclusion of cases diagnosed before invitation to screening in the first screening round, and (b) lead time bias. RESULTS:After a mean follow up time of 10.6 years since the start of screening and a mean individual follow up time of 8.4 years, a non-significant reduction in refined excess mortality for breast cancer was estimated as relative risk (RR) 0.84 (95% confidence interval (95% CI) 0.67 to 1.05). After adjustment for inclusion and lead time biases the RR was 0.80 (20% reduction). Only 27% of the deaths from breast cancer in the total mortality for women aged 50–79 at death consisted of women aged 50–69 at diagnosis who were diagnosed after the start of screening. This figure has important implications for judgement of the impact of screening on age specific national breast cancer mortalities. CONCLUSIONS:A non-significant reduction in mortality from breast cancer was found in counties performing service screening with mammography in Sweden. Adjustment for possible biases changed the result towards a larger effect of screening. The results do not contradict the effects found in the Swedish randomised mammography trials.
Screening for cystic fibrosis in newborn infants: results of a pilot programme based on a two tier protocol (IRT/DNA/IRT) in the Italian population
Authors: Corbetta C. , Seia M. , Bassotti A. , Ambrosioni A. , Giunta A. , Padoan R.
Published: October 2002

OBJECTIVE: To assess the performance of a two tier neonatal screening programme (IRT/DNA/IRT) for cystic fibrosis, based on immunoreactive trypsinogen (IRT) followed by direct cystic fibrosis transmembrane conductance regulator (CFTR) gene analysis (based on a panel of up to 31 mutations) in hypertrypsinaemic newborn infants and to compare it with a previous screening protocol. SETTING: The study comprised all the newborn infants in the period 1 October 1998 to 31 December 1999 in the Lombardia region, north western Italy. METHODS: The screening strategy consisted of an immunoreactive trypsinogen assay from dried blood spots, a polymerase chain reaction (PCR) followed by an oligonucleotide ligation assay (PCR-OLA), and a sequence code separation. RESULTS: 104 609 newborn infants were screened. 1457 hypertrypsinaemic infants (1.39%) were analysed with the PCR-OLA assay. 18 newborn homozygotes or compound heterozygotes for CFTR mutations were identified and referred to the cystic fibrosis (CF) centre at a mean age of 3 weeks. 125 infants presenting only one mutation were recalled for a sweat test: a diagnosis of CF was made in 13 infants, and parents of 112 neonates identified as carriers (1:13) received genetic counselling. The remaining 1314 hypertrypsinaemic newborn infants were recalled for IRT retesting and 177 were referred for a sweat test because the second IRT measurement was above the cut off value. Among this group a further two infants were diagnosed with CF (1.1%) leading to a CF prevalence of 1:3170. CONCLUSIONS: This strategy resulted in an early and accurate diagnosis of CF. The IRT/DNA/IRT protocol with an OLA assay was shown to be useful in an Italian population with a genetic heterogeneity, leading to the identification of 94% of infants with CF.
Screening and management of asymptomatic popliteal aneurysms
Authors: Trickett J.P. , Scott R.A.P. , Tilney H.S.
Published: October 2002

OBJECTIVES: To determine the prevalence of popliteal aneurysms in men to enable the case for screening and elective surgery to be assessed. SETTING: Scott Research Unit, St Richards Hospital, Chichester. METHODS: The popliteal arteries of 1074 men aged between 65 and 80 were scanned with ultrasound, aneurysmal vessels >1.5 cm diameter were rescanned 5 years later to assess their rate of expansion. RESULTS: 11 of 1074 patients screened had a popliteal aneurysm between 15 and 26 mm, a prevalence of 1.0%. Five years later no increase in aneurysm size had occurred and no related complications were reported. CONCLUSION: In men the low prevalence and complication rate of popliteal aneurysms in conjunction with the effective treatment of acutely thrombosed aneurysms provides evidence for conservative management but against screening asymptomatic popliteal aneurysms.
Use of bacille Calmette-Guérin in superficial bladder cancer
Authors: Meyer J-P , Persad R , Gillatt D A
Published: October 2002

Intravesical bacille Calmette-Guérin (BCG) has been used by urologists for several years after its first reported use as a cancer therapy in the 1930s. Morales in 1976 described the usage of BCG as a once weekly intravesical instillation for six weeks; this is a treatment regimen that still exists today. Its success as a treatment depends on it being used appropriately. It is employed: (1) to treat carcinoma in situ or occasionally residual papillary tumours; (2) to reduce the number and frequency of recurrent high grade superficial tumours; and (3) to prevent disease progression (although this remains a controversial point, on which there is no consensus view). Unfortunately, the more widespread use of BCG is often limited due its high side effect profile. Present research is directed towards reducing its side effect profile, improving its efficacy, and understanding its exact mechanism of action, which is not fully understood.
Acid suppression in gastro-oesophageal reflux disease: Why? How? How much and when?
Authors: Jones M P
Published: October 2002

For patients with suboptimal relief from lifestyle modifications, acid suppressive therapy remains a cornerstone of treatment for gastro-oesophageal reflux disease (GORD). While a great deal of attention is focused on complications of GORD, adequate symptom relief remains an important and practical therapeutic goal. Adequate symptom relief is an achievable and easily measurable endpoint that both restores quality of life and prevents many potential complications.
Congenital scoliosis in a neonate: can a neonatologist ignore it?
Authors: Jog S , Patole S , Whitehall J
Published: October 2002

The frequency of diagnosis of congenital scoliosis in the neonatal period is expected to rise given the increasing survival of high risk neonates in the surfactant era and their frequent exposure to x rays. Considering its significant long term implications a neonatologist cannot afford to ignore the diagnosis of congenital scoliosis in a neonate as close surveillance, early detection, and treatment may prevent/minimise the wide spectrum of potentially serious deformities that can affect the developing spine. The review provides general guidelines to help the neonatologists in counselling the parents and in planning the multidisciplinary follow up for management of congenital scoliosis.
Diversité de la végétation et du réservoir de graines du sol dans une pelouse calcicole du nord-ouest de la France
Authors: Chabrerie Olivier , Alard Didier , Touzard Blaise
Published: October 2002

In a chalk grassland of the Seine valley in northwestern France, vegetation and seed bank were compared according to their composition, diversity, and spatial structure through use of a spatial sampling design. The results show (i) that it is possible to establish a successional gradient from short grasslands to early stages of forests with vegetation data; (ii) that there is a weak correspondence between vegetation and seed bank (mean similarity 41%), which was mainly dominated by opportunistic annual or biennial species (Hypericum perforatum, Blackstonia perfoliata); (iii) that there are differences between spatial patterns of vegetation and seed bank. These spatial patterns often exhibit a time lag and represent different levels of heterogeneity. The spatial heterogeneity of the seed bank and its independence from the vegetation structure were interpreted according to the functioning of the two compartments and their type of exchanges (through seed rain and seedling recruitment).Key words: chalk grassland, biodiversity, spatial pattern, succession, seed bank, synchronic approach.
Occurrence and distribution of fungal endophytes in tropical forests across a rainfall gradient
Authors: Suryanarayanan T S , Murali T S , Venkatesan G
Published: October 2002

Fungal endophytes occur in leaves of angiosperm and gymnosperm trees. The occurrence and distribution of fungal endophytes in the leaves of trees growing in four different types of tropical forests in the Western Ghats were studied. One thousand five hundred leaf segments from five different hosts were screened for each forest type. Endophyte communities of trees of the semi-evergreen forest showed the highest species diversity. More endophyte isolates were recovered during the wet season. Although several genera of endophytes were common for different hosts growing in different forests, the dominant endophyte was different for different forest types. Our results suggest that although tropical trees individually may be endophyte rich, the overall endophyte diversity of the entire plant community is not exceptional.Key words: tropical forests, fungal endophytes, fungal diversity, foliar endophytes.