Screening For Diabetic Retinopathy: Review of Current Methods

Abstract

Objective: To review the current screening methods for diabetic retinopathy, with a focus on nonmydriatic digital fundus photography. Methods: Articles from Medline were reviewed from 1976 to November 2011 for different combinations of the words “diabetic retinopathy,” “screening,” “fundus photography,” and “nonmydriasis.” Results: Because of its ease of use and cost-effectiveness, digital fundus photography is becoming the preferred method for diagnosing diabetic retinopathy. Current research has proven that pupillary dilation is not a necessary step in the fundus examination, although it reduces the number of unnecessary referrals to ophthalmologists. Automated grading systems, while saving time and reducing human error, still need refinement before they can replace manual grading by trained ophthalmologists. Conclusion: Nonmydriatic digital fundus photography with manual grading by a trained technician is an acceptable method of screening for diabetic retinopathy.     

上海市闵行区高血压社区三级管理工作现状和管理模式的探讨

目的：了解闵行区高血压的患病情况及社区三级管理工作现状，为高血压社区综合防治措施的制订和开展提供可靠的科学依据。方法：采用《心脑血管流行病学调查方法手册》的方法及标准，对我区35岁以上人群高血压患病及管理现状进行分析。结果：（1）35岁以上人群高血压患病率为13．58％，其中男性高血压患病率为12．24％，女性高血压患病率为14．91％。（2）35－44岁组患病率为3．50％，45－54岁组患病率为11．81％，55－64岁组患病率为17．75％，65－74岁组患病率为31．49％，75－84岁组患病率为37．59％，≥85岁组患病率为25．65％。（3）由于行政区划的变更及房地产开发等多方面因素的影响，原有三级网络功能削弱，高血压管理失访率达15．32％。结论：（1）女性高血压患病率高于男性；（2）随着年龄增长高血压患病危险性增加；（3）在高血压三级管理工作中三级网络的作用不容忽视，迫切需要加强网络功能建设及提高基层医务工作者的业务水平；（4）为提高高血压社区的管理率和加强高血压防治知识的宣传，建立高血压患者特证制度很有必要；（5）防制慢性病作为一项公益性的工作还埯加强政府部门多方面的投入。     

Point-of-Care Saliva Osmolarity Testing for the Screening of Hydration in Older Adults With Hypertension

ObjectivesOlder adults have an elevated risk of dehydration, a state with proven detrimental cognitive and physical effects. Furthermore, the use of diuretics by hypertensive patients further compounds this risk. This prospective study investigated the diagnostic accuracy of point-of-care (POC) salivary osmolarity (SOSM) measurement for the detection of dehydration in hypertensive adults with and without diuretic pharmacotherapy.DesignProspective diagnostic accuracy study.SettingHome visits to patients recruited from 4 community health centers in West Sulawesi, Indonesia.ParticipantsA total of 148 hypertensive older adults (57 men, 91 women). The mean ages of male and female patients were 69.4 ± 11.4 and 68.1 ± 7.8 years, respectively.MethodsHypertensive adults were divided into 2 groups based on the presence of diuretics in their pharmacotherapeutic regimen. First-morning mid-stream urine samples were used to perform urine specific gravity (USG) testing. Same-day SOSM measurements were obtained using a POC saliva testing system.ResultsBoth USG (P = .0002) and SOSM (P < .0001) were significantly elevated in hypertensive patients with diuretic pharmacotherapy. At a USG threshold of ≥1.030, 86% of diuretic users were classified as dehydrated compared with 55% of non-using participants. A strong correlation was observed between USG and SOSM measurements (r = 0.78, P < .0001). Using a USG threshold of ≥1.030 as a hydration classifier, an SOSM threshold of ≥93 mOsm had a sensitivity of 78.6% and a specificity of 91.1% for detecting dehydration.Conclusions and ImplicationsHypertensive patients on diuretics have significantly higher first-morning USG and SOSM values, indicating a higher likelihood of dehydration relative to those on other classes of antihypertensive medication. POC SOSM assessment correlates strongly with first-morning USG assessment, and represents a rapid and noninvasive alternative to urinary hydration assessment that may be applicable for routine use in populations with elevated risk of dehydration.     

Longitudinal Adherence With Fecal Occult Blood Test Screening in Community Practice

PURPOSE Although screening with fecal occult blood testing (FOBT) reduces colorectal cancer (CRC) mortality, its effectiveness may diminish if patients do not adhere with repeated screenings. Among patients who had previously engaged in FOBT screening, we assessed subsequent adherence with FOBT screening.METHODS We assessed longitudinal adherence with biennial FOBT screening (every other year) within a cohort of patients enrolled in an integrated Washington State health plan. Among 11,110 patients who participated in FOBT screening during a 2-year baseline period (2000–2001), we ascertained CRC screening use during a subsequent 2-year observation period (2002–2003). We used multinomial logistic regression to identify patient characteristics associated with higher incidence of repeat CRC screening (with or without FOBT) relative to patients who received no CRC screening.RESULTS Despite prior participation in FOBT screening, less than one-half of patients (44.4%; 95% CI, 42.9%–45.8%) completed FOBT screening during the 2-year observation period. Although 8.8% of patients (95% CI, 8.0%–9.7%) received other CRC tests without FOBT during the observation period, nearly one-half, 46.8% (95% CI, 45.3%–48.4%), received no CRC screening. After adjustment for other patient characteristics, receipt of a preventive health examination was strongly associated with FOBT adherence relative to no CRC screening (adjusted relative rate ratio = 11.16; 95% CI, 9.61–12.96).CONCLUSIONS Longitudinal adherence with FOBT screening was low in this insured population, potentially compromising its effectiveness in population CRC mortality reduction. Interventions to promote adherence may be necessary to achieve high effectiveness in population-based FOBT screening programs.     

硝苯地平控释片与氨氯地平对原发性高血压的疗效比较

目的评价硝苯地平控释片与氨氯地平在治疗原发性高血压的疗效及安全性方面的对比。方法将符合原发性高血压条件的门诊患者120例随机分为硝苯地平治疗组(60例)与氨氯地平治疗组(60例),进行8周的疗程。结果治疗过程中的前4周,硝苯地平组的疗效优于氨氯地平组,差异有统计学意义,治疗结束的后4周2组疗效无明显差异。结论在临床的治疗工作中,如果是要快速降低血压可选用硝苯地平,维持血压稳定减少药物依从性可选用氨氯地平。     

Experiences of Family Law Attorneys With Current Issues in Divorce Practice*

A survey was administered at a state bar convention to 72 family law attorneys who reported on their experiences in representing a total of 3,860 clients. Results showed that lawyers believed that (a) most losers in relocation cases do not or would not ultimately move; (b) the Family Court Masters system seems to be helpful to families; (c) lawyers' actions often raise the emotional level of the dispute; and (d) the divorce and custody system is biased against fathers.     

Potential Adult Medicaid Beneficiaries Under the Patient Protection and Affordable Care Act Compared With Current Adult Medicaid Beneficiaries

PURPOSE

Under health care reform, states will have the opportunity to expand Medicaid to millions of uninsured US adults. Information regarding this population is vital to physicians as they prepare for more patients with coverage. Our objective was to describe demographic and health characteristics of potentially eligible Medicaid beneficiaries.

METHODS

We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2007–2010) to identify and compare adult US citizens potentially eligible for Medicaid under provisions of the Patient Protection and Affordable Care Act (ACA) with current adult Medicaid beneficiaries. We compared demographic characteristics (age, sex, race/ethnicity, education) and health measures (self-reported health status; measured body mass index, hemoglobin A_1c level, systolic and diastolic blood pressure, depression screen [9-item Patient Health Questionnaire], tobacco smoking, and alcohol use).

RESULTS

Analyses were based on an estimated 13.8 million current adult non-elderly Medicaid beneficiaries and 13.6 million nonelderly adults potentially eligible for Medicaid. Potentially eligible individuals are expected to be more likely male (49.2% potentially eligible vs 33.3% current beneficiaries; P <.001), to be more likely white and less likely black (58.8% white, 20.0% black vs 49.9% white, 25.2% black; P = .02), and to be statistically indistinguishable in terms of educational attainment. Overall, potentially eligible adults are expected to have better health status (34.8% “excellent” or “very good,” 40.4% “good”) than current beneficiaries (33.5% “excellent” or “very good,” 31.6% “good”; P <.001). The proportions obese (34.5% vs 42.9%; P = .008) and with depression (15.5% vs 22.3%; P = .003) among potentially eligible individuals are significantly lower than those for current beneficiaries, while there are no significant differences in the expected prevalence of diabetes or hypertension. Current tobacco smoking (49.2% vs 38.0%; P = .002), and moderate and heavier alcohol use (21.6% vs 16.0% and 16.5% vs 9.8%; P <.001, respectively) are more common among the potentially eligible population than among current beneficiaries.

CONCLUSIONS

Under the ACA, physicians can anticipate a potentially eligible Medicaid population with equal if not better current health status and lower prevalence of obesity and depression than current Medicaid beneficiaries. Federal Medicaid expenditures for newly covered beneficiaries therefore may not be as high as anticipated in the short term. Given the higher prevalence of tobacco smoking and alcohol use, however, broad enrollment and engagement of this potentially eligible population is needed to address their higher prevalence of modifiable risk factors for future chronic disease.     

Immittance Screening For Aural Problems in School Children

The predominant aural health problem in school-age children is middle ear inflammation with effusion. The conventional hearing screening method has ineffectively detected half of those school children with middle ear problems. Acoustic immittance measurements, recently added to the audiologist's battery of tests, effectively and economically screens middle ear effusion. Unfortunately, acoustic immittance does not screen hearing sensitivity as does the conventional pure-tone sweep check. This article describes the principles of acoustic immittance and compares it with pure-tone audiometry; discusses current immittance screening practices; and outlines how acoustic immittance can be included in a school hearing conservation program.     

Screening For Language Disorders in Primary Care Settings

The acquisition of language ability is one of the most important milestones in early child development.The ability to communicate with others extends beyond the use of spoken words and includes tone of voice,facial expression,     

产前超声在胎儿畸形筛查中的临床价值

目的探讨产前超声检查在胎儿畸形筛查中的临床价值。方法采用彩色多普勒超声随机对孕18-36W 6086例孕妇产前常规检查及畸形筛查,对筛出畸形儿进行产后追踪。结果筛查出胎儿畸形117例,其中神经系统畸形49例,唇腭裂26例,泌尿系畸形11例,骨骼及肢体畸形7例,胎儿肿瘤7例,腹裂内脏外翻6例,呼吸系统异常4例,消化道畸形3例,心血管畸形2例,其他2例。结论系统超声检查对妊娠中晚期胎儿形态结构方面的明显畸形有一定的诊断价值,是产前诊断方法中不可或缺的手段之一,对于降低出生缺陷发生率,提高人口素质具有重要意义。     

The Role of Ambulatory Medical Care in Hypertension Screening

Data from the 1975-1976 National Ambulatory Medical Care Survey conducted by the National Center for Health Statistics were examined retrospectively to determine the extent to which blood pressure was measured during visits to office-based physicians in the conterminous United States. Blood pressure was more often measured for females (especially black) than for males although males (especially black) in certain age groups had a higher prevalence of hypertension and comprised the higher proportion of undiagnosed hypertensives. Blood pressure measurement increased with age, but was rarely measured for those under 15 years of age. Blood pressure was measured about 79 per cent of the time when hypertension was present but only 30 per cent of the time when hypertension was absent. When diseases shown to be frequently concomitant with hypertension were diagnosed in the absence of hypertension, blood pressure checks ranged from 24 per cent of visits diagnosed neuroses to 66 per cent diagnosed obesity. Blood pressure was measured during about 12 per cent of visits for diseases of the nervous system and sense organs as well as diseases of the skin and subcutaneous tissue; 24 per cent of visits for infective and parasitic diseases, diseases of the respiratory system, and mental disorders. Blood pressure was measured most often when diagnoses were in the categories of diseases of the circulatory system and endocrine, nutritional, and metabolic diseases. Opportunities for blood pressure measurement during routine visits did not appear to be fully utilized, nor did some specialists take frequent blood pressure measurements. (Am. J. Public Health 69:19-24, 1979.)     

Audit on Hypertension Management in General Practice

The case records of an urban teaching practice in Britain werestudied to assess the performance of the practice in the detectionand management of hypertension. The prevalence of hypertensionamong adults was 9%. The original diagnosis of hypertensionwas made by the patients' own general practitioner in two-thirdsof patients. Evidence of adequate monitoring of treatment andfollow-up by general practitioners was seen in only one-thirdof patients with hypertension. The effect of these findingson the subsequent performance of the practice is discussed.     

中国医学成像市场正吸引着全球厂商

本文简述了中国医学成像市场,它的上升趋势,需求细分,驱动因素,期望医学成像设备研发和生产企业能抓住机遇,有所作为.     

Variations of Depression Treatment Among Women With Hypertension

The objective was to examine depression treatment among non-pregnant women, aged 22 and older, with hypertension, utilizing cross-sectional data from the 2006 and 2007 Medical Expenditure Panel Survey. Depression treatment patterns by demographic, socioeconomic, health care access, and health characteristics were analyzed utilizing chi-square tests and logistic and multinomial logistic regressions. Overall, 23.9% had no depression treatment, 56.8% had antidepressant use only, and 19.3% had psychotherapy with or without antidepressants. African Americans (adjusted odds ratio [AOR] = 0.47), Latinas (AOR = 0.46), and uninsured women (AOR = 0.39) were significantly less likely to report any treatment for depression compared with Whites and those with private insurance.