Assessment of the Effectiveness of Radon Screening Programs in Reducing Lung Cancer Mortality

The present study was aimed at assessing the health consequences of the presence of radon in Quebec homes and the possible impact of various screening programs on lung cancer mortality. Lung cancer risk due to this radioactive gas was estimated according to the cancer risk model developed by the Sixth Committee on Biological Effects of Ionizing Radiations. Objective data on residential radon exposure, population mobility, and tobacco use in the study population were integrated into a Monte‐Carlo‐type model. Participation rates to radon screening programs were estimated from published data. According to the model used, approximately 10% of deaths due to lung cancer are attributable to residential radon exposure on a yearly basis in Quebec. In the long term, the promotion of a universal screening program would prevent less than one death/year on a province‐wide scale (0.8 case; IC 99%: –3.6 to 5.2 cases/year), for an overall reduction of 0.19% in radon‐related mortality. Reductions in mortality due to radon by (1) the implementation of a targeted screening program in the region with the highest concentrations, (2) the promotion of screening on a local basis with financial support, or (3) the realization of systematic investigations in primary and secondary schools would increase to 1%, 14%, and 16.4%, respectively, in the each of the populations targeted by these scenarios. Other than the battle against tobacco use, radon screening in public buildings thus currently appears as the most promising screening policy for reducing radon‐related lung cancer.     

The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study

ProblemAlthough perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain.AimTo compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA).MethodsWomen attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an ‘at-risk’ flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the ‘at-risk’ flag for PIPA than for Usual-Care. Each model’s performance was evaluated using the midwife’s agreement with the ‘at-risk’ flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach.FindingsBoth models performed well at identifying ‘at-risk’ women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying ‘at-risk’ women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted.DiscussionOverall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as ‘at-risk’ and ‘not at-risk’ of perinatal psychosocial morbidity.     

The Development of a Screening Tool for the Adult Children of Alcoholics Traits (STACAT)

In order to develop a valid tool for screening the traits of adult children of alcoholics (ACOA), this study focused on finding common characteristics among ACOA and developing a tool based on those characteristics. An item pool was generated targeting three distinct characteristics discussed in the alcohol literature related to ACOA, and the items were reviewed by a panel of experts. Using data from the sample, a confirmatory factor analysis, t -test and correlation analysis were conducted to gather various validity evidences for the screening tool. Cronbach's coefficient alpha test was used to check the internal consistency of the tool. The evidence of the reliability and validity for the ACOA traits screening tool provide the social work practice with an empirically validated method of measuring these traits in the children of alcoholics.     

Composite screener for androgen deficiency related to the aging males’ symptoms scale

Objective.?Methodological characteristics of the Aging Males’ Symptoms (AMS) scale point towards a high standard measurement and comparison of health-related quality of life (HRQoL) over time or intervention. However, the scale was neither developed nor standardized as a screening instrument for androgen deficiency.

Methods.?Data of the Austrian ANDROX study suggested to develop a composite screener for androgen deficiency based on AMS, age, and BMI, to determine sensitivity and specificity to detect low total testosterone (TT) levels. The findings were compared with those of an independent sample of urological patients with suspicion of androgen deficiency (AD) from Germany (n = 803).

Results.?A graphical solution for a composite-screening tool was proposed, with three levels of suspicion for AD: positive screening result (high suspicion), equivocal result, and negative screening result (no suspicion, AD unlikely). The percentage of TT values < 4 ng/ml were 18.7%, 40.7% and 58.8% in the three categories: negative, equivocal and positive, respectively. The findings were confirmed in the independent German sample. In both instances, neither sensitivity nor specificity was very high, i.e., between about 50% and 75%.

Conclusion.?The results of the development and initial validation of the new screener are promising. Further information, and experience from the practice, is needed to confirm or refute the hypothesis that this screener is a useful tool for medical practice.     

Improving Cancer Dose–Response Characterization by Using Physiologically Based Pharmacokinetic Modeling: An Analysis of Pooled Data for Acrylonitrile-Induced Brain Tumors to Assess Cancer Potency in the Rat

Historically, U.S. regulators have derived cancer slope factors by using applied dose and tumor response data from a single key bioassay or by averaging the cancer slope factors of several key bioassays. Recent changes in U.S. Environmental Protection Agency (EPA) guidelines for cancer risk assessment have acknowledged the value of better use of mechanistic data and better dose–response characterization. However, agency guidelines may benefit from additional considerations presented in this paper. An exploratory study was conducted by using rat brain tumor data for acrylonitrile (AN) to investigate the use of physiologically based pharmacokinetic (PBPK) modeling along with pooling of dose–response data across routes of exposure as a means for improving carcinogen risk assessment methods. In this study, two contrasting assessments were conducted for AN-induced brain tumors in the rat on the basis of (1) the EPA's approach, the dose–response relationship was characterized by using administered dose/concentration for each of the key studies assessed individually; and (2) an analysis of the pooled data, the dose–response relationship was characterized by using PBPK-derived internal dose measures for a combined database of ten bioassays. The cancer potencies predicted for AN by the contrasting assessments are remarkably different (i.e., risk-specific doses differ by as much as two to four orders of magnitude), with the pooled data assessments yielding lower values. This result suggests that current carcinogen risk assessment practices overestimate AN cancer potency. This methodology should be equally applicable to other data-rich chemicals in identifying (1) a useful dose measure, (2) an appropriate dose–response model, (3) an acceptable point of departure, and (4) an appropriate method of extrapolation from the range of observation to the range of prediction when a chemical's mode of action remains uncertain.     

Rapid Assessment for Psychopathology in a College Health Clinic: Utility of College Student Specific Questions

Abstract

Objective: The purpose of this study was to determine the utility and unique benefits of employing the College Health Questionnaire (CHQ) in a college health care setting. The CHQ is a newly designed measure to assess psychosocial issues commonly problematic among college students. Participants: One hundred nine patients participated in the study during their medical appointments. Methods: Participants completed the study questionnaires (CHQ and Patient Health Questionnaire) in the waiting room. Their provider had the opportunity to use the responses in treatment decision making. Results: A majority (66.1%) endorsed at least one CHQ item. Patients who indicated traditional mental health problems were more likely to be prescribed psychotropic medications, whereas patients who endorsed psychosocial issues commonly problematic among college students were more likely to be referred for behavioral treatment. Conclusions: Screening for behavioral problems in college primary care settings without the use of college-related questions would result in missing numerous important psychosocial problems.     

Mental Health and Substance Abuse Screening in Primary Care

ABSTRACT

An automated screening system for substance abuse and mental health problems was developed and implemented in a rural primary care clinic. Eighty-nine patients were assessed with this system. The incidence of identified problems, 35% in total, was consistent with that found in previous studies of patients in general and medical settings. Additionally, over half of the patients assessed felt at least some need for mental health or substance abuse treatment. Nonetheless, because of the staff's concerns over patient privacy, impeding patient flow, and the physician's perceived ability to adequately identify these problems without assistance, the system was not adopted.     

Errors in inspection and grading distributional aspects ofscreening and merarchal screening

Continuing the studies of Johnson et al (1980) and Johnson and Kotz (1981), further distributions arising from models of errors in inspection and grading of samples from finite, possibly stratified lots are obtained. Screening, and hierarchal screening forms of inspection are also considered, and the effects of errors on the advantages of these techniques assessed.     

上海地区干部健康体检胸部肿瘤的X线分析

目的回顾性分析1996年～2000年上海地区干部在我院健康体检胸部肿瘤的检出情况,探讨健康体检在早期发现胸部肿瘤的意义和方法。方法全部病例均经电视透视发现胸部异常阴影后,再摄取胸部正侧位片,并进一步进行各种检查初步明确诊断,经随访、手术及病理证实。结果被检出的160例胸部肿瘤中,肺恶性肿瘤87例,肺良性肿瘤23例,纵膈肿瘤45例,胸壁横膈肿瘤5例。67例周围型肺癌平均瘤体直径2.2cm,≤2cm的早期肺癌38例占56.72%。在电视透视发现的67例周围型肺癌和45例纵膈肿瘤中,分别有25例(37.31%)和21例(46.67%)在胸部平片中不能显示。结论定期胸部健康体检是早期发现胸部肿瘤的主要方法,在干部保健工作中有重要意义。胸部电视透视是健康体检早期发现胸部肿瘤的重要手段,采用肿瘤追踪筛查方法能有效地提高肺部肿瘤检出率。