bluuebunny/crossref_metadata_2025_split huggingface dataset:
Normal growth in the short normal prepubertal child: the Wessex Growth Study
Authors: Voss L D , Mulligan J 
Published: May 2013

Objective The study aimed at defining the normal rate of growth for short, prepubertal children, and comparing their pattern of growth with those of average stature. Setting Community based. Design Observation of an unselected population of 109 very short, normal prepubertal children (<3rd height centile) and 107 controls matched for age and sex (10th to 90th centile). Main outcome measuresHeight, velocity, change in height standard deviation score, from 6 to 9 years of age. Results The absolute mean rate of growth was significantly different between groups—short normal 5.3 cm/year, controls 5.9 cm/year—corresponding to velocities on the 25th and 50th centiles, respectively. The relative growth rates, however, as shown by the changes in height standard deviation score (short normal 0.10 (SD 0.22), controls 0.10 (SD 0.24) did not differ, and each group remained close to its original 3rd and 50th centiles. Two short children showed “catch up” growth after adoption, but, otherwise, the divergence from their original height centile was the same for short normal and control children. No social or biological factors were found to predict growth rate in the short normal children, and only target height in controls. “Normal” velocity is conditional on height. Short normal children do grow more slowly than children of average stature, but they do not necessarily grow more poorly. From 6 to 9 years of age they are no more likely to fall off their height centiles than children of average stature. The value of height monitoring at this age is questioned.
Early rescreen/recall in the UK National Health Service breast screening programme: epidemiological data
Authors: Ong G J , Austoker J , Michell M 
Published: May 2013

Objective In the United Kingdom in 1994–95 about 16 500 women aged 50 to 64 were asked to come back earlier than the usual three yearly screening interval for further mammography (early rescreen (ES)) or for a range of further investigations at an assessment centre (early recall (ER)). This study aimed at providing epidemiological data on ES/ER, in particular, how often and why it is used, and what the outcome is of using it. Setting National Health Service breast screening programme in the United Kingdom. Methods All breast screening units were invited to complete a postal questionnaire. Two reminders were sent. The units were asked retrospectively to provide breast screening data about women aged 50 to 64 from their local computer systems. Women placed on ES/ER were followed up for at least one year. Results The response rate was 71% (69/97), of which 14% (10/69) were unable to provide the required data, leaving 59 completed questionnaires (61%). The rate of placing women on ES/ER was above 1.0% for 26/54 (48%) responding breast screening units and above 2.0% for 13/54 (24%) units. Women were placed on ES/ER because of ( a) previous breast cancer (21% of cases; cancer detection rate 2.4%), ( b) diagnostic uncertainty (51%; cancer detection rate 3.0%), or ( c) family history (27%; cancer detection rate 0.6%). Breast screening units with a high rate of placing women on ER were significantly more likely to have a high recall rate ( rS=0.63; n=53; p<0.0005) or a high benign surgical biopsy rate ( rS=0.33; n=49; p<0.05), or both. The cancer detection rate of ES/ER tended to decrease with increasing ES/ER rates ( rS=−0.37; n=51; p<0.01). Conclusions A relatively large number of women were placed on ES or ER for a range of reasons. If the recommendations given are followed, the number of women placed on ER may be reduced while maintaining the cancer detection rate at the required level. The option of ES should not be used.
General practitioner screening for melanoma: sensitivity, specificity, and effect of training
Authors: Burton R C , Howe C , Adamson L , Reid A L , Hersey P , Watson A , Watt G , Relic J , Holt D , Thursfield V , Clarke P , Armstrong B K 
Published: May 2013

Objective To measure the performance of trained and untrained general practitioners (GPs) in screening men and women aged 50 or more for melanomas. Methods GPs trained in melanoma diagnosis, untrained GPs, and skin cancer specialists examined groups of volunteers, each of which included a small number of subjects with prediagnosed suspicious pigmented lesions (SPLs) that were subsequently excised for histopathological examination. Results Trained and untrained GPs achieved mean sensitivities of 0.73 and 0.71, and mean predictive values of 0.40 and 0.37, respectively, for the detection of prediagnosed SPLs. When the SPLs had been excised and examined histopathologically, reanalysis showed mean sensitivities of 0.98 and 0.95, mean specificities of 0.52 and 0.49, and mean positive predictive values of 0.24 and 0.22 for the detection of subjects with melanomas by trained and untrained GPs respectively. Trained GPs were significantly better than untrained GPs at diagnosing as melanomas SPLs that subsequently proved to be melanomas (p=0.04). Conclusions GPs in this study achieved high sensitivities in screening older Australian men and women for melanomas, but at the cost of low specificities and positive predictive values. Training in melanoma diagnosis had no significant effect on sensitivity, specificity, and positive predictive value for screening. Data from the study were tested in a model of population screening for melanomas, and costs per life year saved for men aged 50–70 ranged from &dollar;A11 852 to &dollar;A40 259 depending upon the screening interval and whether the GPs excised the SPLs diagnosed, or referred all patients to skin cancer specialists; this would be as cost effective as cervical cancer screening.
Acceptance of amniocentesis by women in the state of Montana (USA) who are screen positive for Down's syndrome
Authors: Priest J H , FitzGerald J M , Haag M M , Streets K , Vanisko M , Johnson J P 
Published: May 2013

Objective To assess factors influencing uptake of amniocentesis after a positive Down's syndrome screening result. Methods Interviews of 53 Montana women with screening risks ≥1 in 300 after delivery. Results Thirty had accepted amniocentesis (“yes” group) and 23 had declined (“no” group) (57% uptake). Age at delivery was significantly higher (p=0.02) for the “no” than the “yes” group (mean 35.3 v 31.7 years). The mean risk of Down's syndrome ascertained by screening was 1 in 190 for the “no” group and 1 in 115 for the “yes” group (p=0.05). Statistically significant differences (p≤0.05) between opinions in the two groups included: ( a) desire to know if the fetus had Down's syndrome; ( b) perception of the burden of care for an affected child; ( c) support of doctor, spouse, and relatives for choice about amniocentesis; ( d) attitudes toward abortion; ( e) importance of religion; and ( f) concerns about the amniocentesis procedure. The most important factor for those choosing amniocentesis was knowing if the fetus had Down's syndrome, and for those not choosing amniocentesis, attitude about abortion. Conclusion Our results show the need for prescreening education to enable pregnant women to make informed decisions about screening for Down's syndrome and diagnostic testing.
Mammographic parenchymal patterns and mode of detection: implications for the breast screening programme
Authors: Sala E , Warren R , McCann J , Duffy S , Day N , Luben Robert 
Published: May 2013

Objectives To assess the effects of mammographic parenchymal patterns on the risk of breast cancer detected at first screen, second screen, and in the interval between these two screens. Settings A nested case-control study within a screening cohort in East Anglia was designed. The study group comprised 502 patients with cancer at the prevalence screening round, 198 patients with interval cancer, and 175 with cancer at the first incidence screen. These patients were matched with 2601 controls. Methods The mammographic parenchymal patterns of breast tissue were assessed according to Wolfe's classification. Statistical analysis was by conditional logistic regression. Results Overall, 67% of patients and 59% of controls were considered to have high risk pattern (P2+DY) mammogram. The risk associated with P2 or DY mammographic patterns compared with N1 was higher for interval cancers (odds ratios (ORs) 2.2 and 2.4 respectively) than for screen detected cancers (ORs 1.7 and 1.1 respectively). For interval cancers in the first 18 months after the last negative mammogram, the risk was particularly high (ORs 3.8 for P2 and 4.1 for DY compared with N1). The high risk associated with P2 and DY patterns was concentrated on invasive ductal grade III cancers (ORs 2.7 and 3.8) rather than grade I or II cancers (ORs 1.6 and 1.2). Conclusions The study strongly suggests that screening effectiveness is reduced for high risk parenchymal patterns which are associated with high grade cancers. Changes should aim at improving screening sensitivity for dense parenchymal patterns, and the diagnosis of high grade tumours.
Outcomes of universal antenatal screening for haemoglobinopathies
Authors: Greengross P. , Hickman M. , Gill M. , Dugan B. , Davies S.C. 
Published: May 2013

Objective To evaluate universal antenatal screening for haemoglobinopathies. Setting District general hospital serving a London borough with 45% ethnic minorities. Methods Retrospective cohort study of 1444 women referred in 1688 pregnancies and 95 tertiary referrals during 101 pregnancies. Results Unselected women at risk for sickle cell disease booked 2.7 weeks (95% confidence interval (CI) 0.14 to 5.1) later in gestation than those at risk for β thalassaemia were less likely to attend counselling (83% v93%, relative risk (RR) 0.89; 95% CI 0.85 to 0.94), their partners were less likely to be tested (77% v 95%, RR 0.81; 0.77 to 0.83), and they were less likely to accept prenatal diagnosis (22% v 90%, RR 0.37; 0.24 to 0.57). Over 99% of tertiary referrals attended counselling and had their partners tested. There were no significant differences in acceptance of prenatal diagnosis between those at risk of sickle cell disease and β thalassaemia (55% v 67%). Unselected women at risk of sickle cell disease were significantly less likely to have their partner tested or to accept prenatal diagnosis than tertiary referrals, but not those at risk of β thalassaemia. 80% of β thalassaemia and 16% of SS births were prevented. Conclusions Uptake of prenatal diagnosis among unselected women at risk of β thalassaemia is similar to that reported by tertiary centres. It is considerably lower for sickle cell disease but could increase considerably if screening occurred earlier in gestation. Acceptance of counselling is universally high, suggesting that informed choices are made, and indicating a need to measure these outcomes for cost effectiveness studies.
Reanalysis of the Mayo Lung Project data: the impact of confounding and effect modification
Authors: Marcus P.M. , Prorok P.C. 
Published: May 2013

Objectives To examine whether age at entry, history of cigarette smoking, exposure to non-tobacco lung carcinogens, or previous pulmonary illnesses were confounders or effect modifiers of the relation between screening and lung cancer mortality in the Mayo Lung Project. Setting —The Mayo Lung Project was a randomised, controlled, clinical trial conducted between 1971 and 1986 in 9211 male smokers over the age of 45 in Minnesota (USA). The group screened received chest x ray examination and sputum cytology every four months for six years. The unscreened group were recommended to obtain usual care (annual chest x ray examination and sputum cytology). After follow up, lung cancer mortality was similar in both groups. Methods —Proportional hazard models were used to analyse data. A variable was considered a confounder if its inclusion in a model changed the rate ratio for screening by more than 15%; a variable was considered an effect modifier if its stratum-specific rate ratio for screening differed by a factor of two. Results None of the four aforementioned variables changed the rate ratio associated with screening (1.07) by more than 2%. The effect of screening may have differed by years smoked (rate ratio for smoking fewer than 30 years 2.4; rate ratio for smoking 30 or more years 1.0), though we suspect that this result occurred by chance. Conclusion Adjustment for or stratification by four established lung cancer risk factors did not alter the original findings of the Mayo Lung Project.
Trends in mammography 1991–96 and the impact of nationwide screening in the Netherlands
Authors: van Leiden H.A. , van Gessel-Dabekaussen A.A.M.W. , van der Maas P.J. , de Koning H.J. 
Published: May 2013

Objectives To investigate the impact of the population based breast screening programme on total uptake of mammography in the Netherlands. Setting The Netherlands; breast screening programme for women aged 50–69; 21 820 women who participated in the 1991–96 Health Interview Survey (HIS). Methods HIS data linked to data related to the start of the screening programme in different municipalities investigating mammography use, reasons for mammography, and further assessment procedures. Results Among women aged 50–69 the percentage who had recently undergone mammography (in the year of the HIS or two years before) increased from 20% in 1991 to 70% in 1996, which was entirely due to screening. The percentage of women in this age group who had had a recent clinical mammogram (outside the screening programme) varied between 8 and 12% and did not change significantly in municipalities without screening. There was no change in the uptake of mammography among women under 50 years of age. Among women over 70 there was only a small increase in this percentage from 6 to 13%, partially due to screening mammograms. In municipalities in which screening had started, precaution is mentioned as a reason for a recent clinical mammogram among women aged less than 70 more often than in municipalities without screening. Furthermore, mammography performed because of complaints is mentioned less in all age groups after the introduction of screening. After a clinical mammogram, further assessment procedures (cytology/needle biopsies 8%, biopsies 10%) were considered necessary about 10 times more often than after a screening mammogram. Conclusions Although the screening programme has almost no impact on the frequency of mammography in women who underwent a clinical mammogram, there has been a shift in reasons for these mammograms more towards reasons of prevention. Screening mammograms lead to a much smaller percentage of additional examinations than do clinical mammograms.
A trial to study the effect on breast cancer mortality of annual mammographic screening in women starting at age 40
Authors: Moss S. 
Published: May 2013

Objective Although there is clear evidence from randomised trials of the effectiveness of mammographic screening in women over 50 in reducing mortality from breast cancer, the benefit of screening in younger women remains less certain. This paper describes a randomised controlled trial in progress to study the effect on breast cancer mortality of annual mammographic screening of women starting at age 40–41. Setting Screening centres of the NHS Breast Screening Programme. Methods In 1991 a national multicentre randomised controlled trial was set up by the United Kingdom Coordinating Committee on Cancer Research (UKCCCR). This trial (the “age” trial) aims at recruiting 195 000 women aged 40–41 such that 65 000 form a study group and the remaining 130 000 a control group. Women in the study group are invited for annual screening by mammography, and become eligible for the National Health Service Breast Screening Programme (NHSBSP) after age 50. Those in the control group are not offered any additional services, but will also join the national programme after age 50. All malignant breast histology in trial women is recorded. Analysis The principal method of evaluation will be the comparison of cumulative breast cancer mortality rates in the study and control groups; interim analyses of prognostic factors of breast cancers will also be possible. Additional NHS screening costs incurred owing to lowering the age of screening will be assessed as part of an economic evaluation. The amount of unscheduled screening occurring in the control group of the trial will also be assessed.
Proficiency test for screening mammography: results for 117 volunteer Italian radiologists
Authors: Ciatto S. , Ambrogetti D. , Catarzi S. , Morrone D. , Rosselli del Turco M. 
Published: May 2013

Objective To analyse the performance of a large sample of Italian radiologists undergoing a proficiency test for screening mammography. Design Evaluation of performance indicators according to reference standards determined by a panel of experts (sensitivity (reference standard ≥80%), recall rate (reference standard ≤15%)). Setting 117 Italian radiologists of varying experience (years of practice 0.5–18, average 5.9; mammograms read 500–51 000, average 13 000), all currently reporting clinical mammography and planning to take part in screening in the near future. Results Eighty four of 117 (72%) radiologists reached the standard for sensitivity, 88 (75%) reached the standard for recall rate, and only 59 (50%) reached both standards and passed the proficiency test. The probability of passing the test was significantly correlated with mammographic practice (p=0.015), mammograms read (p=0.024), and mammograms read/year (p=0.043). Discussion The performance of a large sample of Italian radiologists currently reporting clinical mammography was disappointing, indicating the need for proper training of at least 50% of the tested subjects. When implementing organised screening the health authority should set up a proper process for training and accrediting radiologists, and a proficiency test should be part of such a process.
Comparison of the CAPAS and Ewing tests for screening of hearing in infants
Authors: Rovers M.M. , Zielhuis G.A. , Straatman H. , Ingels K. , van der Wilt G-J. , Kauffman-de Boer M. 
Published: May 2013

Objective To study the similarities and differences between the non-automated labour intensive Ewing hearing test and the less labour intensive automated CAPAS (Compact Amsterdam Paedo-Audiometrical Screening) hearing test. Setting A multicentre study in which all the children born in the eastern part of the Netherlands between 1 January 1996 and 1 April 1997 were routinely screened for hearing impairment at 9 months of age. Methods Differences and similarities between the two methods were described for the proportion of children who failed every test, the percentage of referred children, the yield of bilateral and unilateral otitis media with effusion (OME), the positive predictive value of the third test result, and the yield of persistent OME after 4–6 months' follow up at an ENT department. Results 12 603 infants were screened with the CAPAS test and 17 496 with the Ewing test. There were differences between the CAPAS and Ewing tests respectively in the proportions of children lost to follow up (10.1% v 15.2%), the proportions of children referred diagnosed with OME (59% v 81%), the yield of bilateral otitis media with effusion (2.4% v 3.0%), and the yield of persistent OME after 4–6 months' follow up (1.1% v 1.6%). Conclusions The CAPAS test is more practical than the Ewing test, but the non-automated Ewing test seems to be more reliable and valid for detecting conductive hearing loss.
Should genetic analysis in newborn screening and a heterozygote test for hyperphenylalaninaemia be recommended? An Italian study
Authors: Rottoli A. , Gianní M.L. , Verduci E. , Biondi M.L. , Fiori L. , Giovannini M. , Riva E. 
Published: May 2013

Objective To determine whether the introduction of genetic analysis for phenylalanine hydroxylase (PAH) deficiency into regional screening programmes can be supported by the benefit-cost ratio. Method Tests for the genetic PAH locus were carried out in 151 patients with hyperphenylalaninaemia originally from all of the Italian regions. PAH mutations were identified by extraction of genomic DNA from leucocytes (whole blood in EDTA), PAH exon amplification was determined by polymerase chain reaction, restriction enzyme analysis was carried out for some recognised mutations, and DNA sequence analysis for the other mutations. Results It was found that the eight most common mutations in the population accounted for 49% of the mutant alleles, which is well below the required standard for effective population screening (90%). Conclusions Genetic screening for PAH deficiency in Italy does not increase the sensitivity of the methodology and the benefit-cost ratio, and thus provides no advantage, particularly as the correlation between genotype and the metabolic phenotype needed to optimise dietary intervention is still being studied.
The target plot: a new way of displaying the performance of a screening test
Authors: Wald N.J. , Watt H.C. 
Published: May 2013

Objectives To produce a graphical method to represent the performance of a screening test that illustrates the prevalence of the disorder being screened for, as well as its discriminatory potential. Concept A target plot was constructed in which the risk of the disorder is represented by a series of concentric circles of constant risk (isorisks) equivalent to specified false positive rates, with the highest risk in the centre and lower risks spreading outwards towards the circumference. Dots were drawn to represent cases of the disorder; these were of a size such that their total area as a proportion of the area of the whole target plot equalled the prevalence of the disorder in the screened population. The discriminatory power of the test was seen as the clustering of dots around the centre or bull's eye of the target. The detection rate could be estimated as the proportion of dots which fell within the isorisk corresponding to a specified false positive rate. Application The target plot was applied to second trimester antenatal screening for Down's syndrome using different combinations of screening markers, and also to screening for ischaemic heart disease using protein components of cholesterol (apolipoproteins A I and B and Lp(a) lipoprotein), systolic blood pressure, and smoking status. Discussion The efficacy of the different methods of screening for Down's syndrome is readily apparent using the target plot, as is the poorer performance of screening for ischaemic heart disease. Conclusions The target plot is a simple and quantitative way of displaying the performance of a screening test that may be useful in teaching and educational material.