bluuebunny/crossref_metadata_2025_split huggingface dataset:
The sensitivity, specificity, and positive predictive value of screening mammography and symptomatic status
Authors: Kavanagh A.M. , Giles G.G. , Mitchell H. , Cawson J.N. 
Published: October 2002

Objective To examine whether the accuracy of screening mammography varies according to symptomatic status reported at the time of screening. Setting Victoria, Australia, where free biennial screening is provided to women aged 40 and older. Methods We examined the sensitivity, specificity, and the positive predictive value of screening mammography by symptom status in 106 826 women from Victoria, who attended for first round mammography in 1994 and who did not have a personal history of breast cancer. Symptomatic status was divided into the following categories: asymptomatic; significant symptoms, if the woman reported a breast lump and/or blood stained or watery nipple discharge; and other symptoms, if reported. Unconditional logistic regression modelling was used to adjust for age, use of hormone replacement therapy (HRT), and family history. Results Sensitivity was lower for women with other symptoms (60.0%) than asymptomatic women (75.6%), or women with significant symptoms (80.8%). Specificity was lower for women with significant symptoms (73.7%) than asymptomatic women (94.9%), or women with other symptoms (95.4%). Among women who had invasive cancer detected during screening interval, women with other symptoms were more likely to get a false negative result (odds ratio 1.79, 95% confidence interval 1.03 to 3.04) than asymptomatic women, after adjusting for age, use of HRT, and family history. Conclusion The lower sensitivity in women with other symptoms requires further investigation. Possible explanations include increased breast density and poor image quality. The high sensitivity in women with significant symptoms is probably due to more cautious radiological practice, which has also resulted in low specificity in this group.
Predictors of attendance in the United Kingdom flexible sigmoidoscopy screening trial
Authors: Sutton S. , Wardle J. , Taylor T. , McCaffery K. , Williamson S. , Edwards R. , Cuzick J. , Hart A. , Northover J. , Atkin W. 
Published: October 2002

Objective To investigate predictors of attendance in the United Kingdom flexible sigmoidoscopy screening trial. Design Prospective design in which participants completed a postal questionnaire before being sent their invitation for screening. Setting Welwyn Garden City and Leicester, United Kingdom. Participants A total of 2758 patients aged 55 to 64, registered with general practices in the two centres, who (a) expressed interest in having the screening test, (b) completed a postal questionnaire, and (c) were subsequently invited for screening. Main resultsThe attendance rate among questionnaire responders was 76.1%. Multiple logistic regression analysis yielded a final model that included nine independent predictors of attendance. Patients with the following characteristics were more likely to attend: men; home owners; non-smokers; those who had regular check ups at the dentist; those with better subjective health; those who minded less about having medical tests; those who said they would definitely rather than probably take up the offer of sigmoidoscopy screening; and those who perceived less barriers and more benefits to having the test. Conclusions The findings are broadly consistent with previous studies of screening participation, although subjective health emerged as an important predictor in this study. There was no evidence for “reverse targeting”: attenders were not at lower (or higher) risk for colorectal cancer compared with non-attenders. The findings relating to attitudes and beliefs could be used in efforts to improve attendance, for example by developing information leaflets that address barriers to screening. Other findings could be used to target interventions to subgroups that have relatively low rates of screening participation.
Maternal thyroid deficiency and pregnancy complications: implications for population screening
Authors: Allan W.C. , Haddow J.E. , Palomaki G.E. , Williams J.R. , Mitchell M.L. , Hermos R.J. , Faix J.D. , Klein R.Z. 
Published: October 2002

Objective To examine the relation between certain pregnancy complications and thyroid stimulating hormone (TSH) measurements in a cohort of pregnant women. Methods TSH was measured in sera obtained from women during the second trimester as part of routine prenatal care. Information was then collected about vaginal bleeding, premature delivery, low birthweight, abruptio placentae, pregnancy induced hypertension, need for cesarean section, low Apgar scores, and fetal and neonatal death. Results Among 9403 women with singleton pregnancies, TSH measurements were 6 mU/l or greater in 209 (2.2%). The rate of fetal death was significantly higher in those pregnancies (3.8%) than in the women with TSH less than 6 mU/l (0.9%, odds ratio 4.4, 95% confidence interval 1.9–9.5). Other pregnancy complications did not occur more frequently Conclusion From the second trimester onward, the major adverse obstetrical outcome associated with raised TSH in the general population is an increased rate of fetal death. If thyroid replacement treatment avoided this problem this would be another reason to consider population screening.
Effect of distance and social disadvantage on the response to invitations to attend mammography screening
Authors: Hyndman J.C.G. , Holman C.D.J. , Dawes V.P. 
Published: October 2002

Study objectivesTo investigate whether public response to an invitation to attend mammography screening can be increased by strategic relocation of the clinics. Methods Women invited to attend mammography screening were classified by attendance, socioeconomic status, and distance from their screening clinic. A geographic information system was used to investigate whether the response could be increased by relocating clinics to facilitate access. Setting The metropolitan city of Perth in Western Australia with six fixed site, publicly funded, mammography screening clinics. Main resultsWomen from disadvantaged areas, not screened previously by the mammography screening programme, had a higher response to an invitation to attend screening if they lived within 3 km of their closest clinics (12%) than if they lived further away (8%). Theoretically, the response of the target population could be increased if the existing clinics were replaced by six new clinics located closer to disadvantaged areas. Conclusions Public health planners should be aware of the use of geographic information systems to model optimum locations of health care facilities, and be willing to assess the potential target population response to those locations.
Opportunistic screening for chlamydia infection in general practice: can we reach young women?
Authors: Santer M. , Warner P. , Wyke S. , Sutherland S. 
Published: October 2002

Objective To study opportunistic screening in primary care, in such a way that would include teenage women. Setting Screening for chlamydia infection was offered opportunistically in eight general practices in Edinburgh to women aged ≤ 35 years attending for cervical smear, and women aged ≤ 20 years attending for contraception. The numbers of women eligible to be offered screening were 901 in the cervical smear group, and 595 in the contraception group. Results Effective screening rate (offered test, consented, and urine sample returned) was 30% for the cervical smear group compared with 23% for the contraception group. Among those tested, chlamydia prevalence was strongly associated with young age, ranging from 11.8% in those <18 years, to 0% in those >25 years. Number of sexual partners in past year did not improve prediction of infection. Conclusion These findings raise concerns regarding the feasibility of opportunistic screening in general practice, particularly for those with highest prevalence of chlamydia—teenage women.
Oral cancer screening as an integral part of general health screening in Tokoname City, Japan
Authors: Nagao T. , Miyazaki H. , Fujiwara K. , Warnakulasuriya S. , Ikeda N. , Fukano H. 
Published: October 2002

Objectives To measure the attendance and compliance rates in oral mucosal screening (OMS) offered as part of a general health screen (GHS) undertaken as an organised programme in Japan. Methods In 1996, all adults over the age of 40 years resident in Tokoname City were invited by letter to attend a free GHS annually, conducted by the municipal cooperation and the medical and dental societies of Tokoname City. In the later years only those who attended in 1996 were reinvited. Females aged less than 39 years were also allowed to attend if they wished to participate in the GHS. The GHS consisted of completion of a self administered questionnaire to identify past and current illnesses and any medications used by the screened population coupled with a routine physical check, chest x ray, ECG, and blood and urine examination. The GHS was programmed annually during the years 1996 to 1998. All those attending the GHS were invited to participate in an OMS conducted under the same roof by a visiting dentist (n=37). A referral pathway was established for screen positives requiring follow up. Results A total of 19 305 subjects (5955 males, 13 350 females; mean age 59.2 years; 7033 in 1996, 6289 in 1997, and 5983 in 1998) attended the GHS. Of those who attended the GHS, 19 056 (98.7%) attended the OMS (1.3% refused). This rate was fairly constant over the three years. Excluding repeat examinations, new cases recruited for OMS over the three years were 8723. Of those participating in OMS, 4269 (60.7%) attended all three years. In the cohorts examined, screening dentists recorded oral mucosal lesions in 5.4% in 1996, in 4.0% in 1997, and in 2.6% in 1998. Overall, this amounted to a positive detection rate of 4.1%, or 4.9% excluding repeat examinations. A higher prevalence of oral pre-cancer was recorded among male smokers. Conclusions The overall results suggest that although compliance with attending a free GHS was low (26.2%) among Japanese subjects over 40 years of age, of those who complied 74–76% reattended annually. Hence a satisfactory participation rate can be obtained in Japan for OMS when this is coupled to a GHS conducted at the same visit.
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.
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.