Effectiveness and cost-effectiveness of colorectal cancer screening: Selecting the ideal strategy

Abstract Colorectal cancer is the second most common cancer killer of Americans. Recently developed and tested methods of screening and surveillance can effectively diagnose and treat the disease in most patients before symptoms develop when the chance of cure is high. It is also possible to prevent colorectal cancer by detecting and resecting premalignant adenomatous polyps. Evidence-based guidelines recommend that the average-risk population greater than age 50 be screened with annual faecal occult blood tests plus periodic flexible sigmoidoscopy. This approach is feasible, efficacious, affordable and cost-effective in a high-risk country such as the US. Widespread compliance with these recommendations could reduce the mortality from this malignancy by more than 50%.     

Chronic Dietary Toxicity/Oncogenicity Studies on 2,4-Dichlorophenoxyacetic Acid in Rodents

Forms of 2,4-dichlorophenoxyacetic acid (collectively knownas 2,4-D) are herbicides used to control a wide variety of broadleafand woody plants. Doses in the 2-year chronic/oncogenicity ratstudy were 0, 5, 75, and 150 mg/kg/day. The chronic toxicityparalleled subchronic findings, and a NOEL of 5 mg/kg/day wasestablished. A slight increase in astrocytomas observed (inmales only) at 45 mg/kg/day in a previously conducted chronicrat study was not confirmed in the present study at the highdose of 150 mg/kg/day. Doses in the 2-year mouse oncogenicitystudies were 0, 5, 150, and 300 mg/kg/day for females and 0,5, 62.5, and 125 mg/kg/day for males. No oncogenic effect wasnoted in the study. In summary, the findings of these studiesindicate low chronic toxicity of 2,4-D and the lack of oncogenicresponse to 2,4-D following chronic dietary exposure of 2,4-Din the rat and mouse.     

Maternal and neonatal outcomes following diabetes in pregnancy in Far North Queensland, Australia

Background: Diabetes in pregnancy (DIP) is increasing and is associated with a number of adverse consequences for both the mother and the child.
Aims: To compare local maternal and neonatal outcomes with state and national data.
Methods: Chart audit of all DIP delivered during 2004 at a regional teaching hospital and compare outcomes with national benchmark, Queensland and national Indigenous data.
Results: The local DIP frequency was 6.7%. The local compared to benchmark and state data demonstrated a higher frequency of Indigenous mothers (43.6% vs 6.8% vs 5.5%), caesarean sections (50.7% vs 26% vs 32.0%), hypoglycaemia (40.7% vs 19.5% vs 2.7%) and respiratory distress (16.6% vs 4.5% vs 2.3%) in infants, fewer normal birthweights (64.8% vs 82.6% vs 80.4%) and full-term deliveries. More local mothers compared to benchmark had type 2 diabetes mellitus (T2DM) (15.4% vs 8.7%) but fewer used insulin (31.0% vs 46.6%); compared to state data, fewer women had gestational diabetes (79.5% vs 91.2%), however, insulin use was higher (22.8%). Furthermore, Aborigines had fewer pregnancies compared to Torres Strait Islanders (3.0 vs 5.0) and less insulin use (21.9% vs 59.3%) ( P  = 0.008–0.024). In contrast, non-Indigenous versus Indigenous women showed fewer pregnancies, less T2DM (7.8% vs 23.7%), better glycaemic control, longer babies, more full-term deliveries and less severe neonatal hypoglycaemia. Comparing local and national Indigenous data, local showed poorer outcomes, however, only 11.8% had diabetes or hypertension nationally.
Conclusion: The local cohort had poorer outcomes probably reflecting a more disadvantaged. Few differences were found between local Indigenous groups.     

Child Behaviour Checklist classification of behaviour disorder

Objective : The aim of this study was to determine the applicability of the published clinical cut-off scores of the Child Behaviour Checklist (CBCL) for the classification of behaviour disorders.
Methodology : Child Behaviour Checklists were obtained for 1342 subjects newly referred to the six major mental health centres in Melbourne. The normative community sample of 1002 7-, 12- and 15-year-olds was drawn from a school-based asthma prevalence study.
Results : The mean total problem T-score for the children referred to mental health centres was 67 and was above the clinical range for all age groups. Using referral to psychiatric services as the gold standard, the sensitivity and specificity of the CBCL using a cut-off of ≥ 60, was 77.4 and 83.2%, respectively. This compares favourably with the sensitivity of 68% and specificity of 82% for the American sample. Using a cut-off score of ≥ 63, the sensitivity was 70.5% and the specificity was 88.6%. The referred and community samples differed with respect to socio-economic status, family structure and mothers' level of education. Fifty-two per cent of the clinically referred children lived with both parents, compared with 89% of the community sample.
Conclusions : While there are some limitations to this study in terms of both the clinic and community sample, support is provided for the usefulness and applicability of the recommended CBCL cut-off scores in an Australian population.     

Transfer before delivery on Mersey side: an analysis of the first 140 patients

Summary. Pregnant women (140) were transferred to the Regional Unit between May 1979 and December 1981 for delivery of preterm infants considered to be at risk. The 144 live infants and seven stillbirths that were delivered had a mean birthweight of 1.37 kg and a mean gestation of 29 weeks; there were nine abortions. In 1980 the uncorrected neonatal survival for very low birthweight infants was significantly better for those transferred before delivery (81%) than for infants born in the Region and not transferred (52%). The survival of very low birthweight infants transferred after delivery was 53%.     

The long-term learning effect of training in stage of change for smoking cessation: a three-year follow up of community pharmacy staff's knowledge and attitudes

Objective — A randomised controlled trial has already demonstrated that a training workshop on smoking cessation counselling for pharmacists and their assistants, based on the stage of change model, had a positive effect on the knowledge and attitudes of pharmacy personnel for at least a year, and was associated with increased and more useful counselling, and higher smoking cessation rates. An extension of the study aimed to monitor the duration of the training effect and so help to determine the optimum time span for refresher training. This paper reports the results of two further annual follow-ups. Method — A previously developed and validated self-completion questionnaire assessing knowledge and attitudes was re-administered to intervention and control personnel at 24 and 36 months. One hundred and thirty-four questionnaires were completed at 24 months (85 per cent response rate) and 124 (83 per cent) at 36 months. Setting — Community pharmacies in Grampian, Scotland, United Kingdom. Key findings — The training had a significant effect on knowledge for at least three years, since at both 24 and 36 months the intervention pharmacy teams had a significantly greater knowledge and understanding of the model than the controls (24 months, P=0.0001; 36 months, P=0.031). At 24 months, the intervention pharmacy teams were significantly more confident in their ability to counsel smokers (P=0.021) and were more positive about the outcome of smoking cessation counselling provided in community pharmacies (P=0.043). These attitudinal differences were no longer statistically significant at 36 months. Conclusion — This study has demonstrated the long-term benefit of the stage of change training over a three-year period, for both community pharmacists and their staff, on knowledge and attitudes.     

Disposition and Metabolism of [14C]Dibenzo[c,g]carbazole Aerosols in Rats after Inhalation

Disposition and Metabolism of [^l4C]Dibenzo[c,g]carbazole Aerosolsin Rats after Inhalation. Bond, J. A. Ayres, P. H., Medinsky,M. A., Cheng, Y. S., Hirshfield, D., and McClellan, R. O. (1986).Fundam Appl Toxicol. 7, 76-85. Dibenzo[c.£]carbazole (DBC)is a nitrogen-containing polycyclic aromatic hydrocarbon thathas been detected in tobacco tars, industrial oils, and dieselengine exhaust fumes. DBC is carcinogenic in respiratory tracttissue of hamsters and in lungs, kidneys, and livers of mice.The purpose of this research was to determine the respiratorytract deposition, distribution in tissues, metabolism, and excretionof DBC in rats after inhalation. Rats were exposed nose-onlyto 1.1 or 13 Mg [¹⁴C]DBC/liter air for 60 min. Activity medianaerodynamic diameters for the two concentrations of DBC rangedfrom 0.7 to 0.8 pm. Unne. feces, and selected tissues were collectedfor various times after exposure. The fractional depositionfor the 1.1 and 13 ug/liter exposure concentrations was similar,13 and 16%, respectively. The dominant route of excretion of¹⁴C following exposure to either concentration of DBC was thefeces, accounting for approximately 95% of the total 14C eliminated.Half-time for fecal excretion was 20 ± 6 hr (x ±SE). Gastrointestinal absorption of [I4C]DBC was 43%. Radioactivitywas widely distributed to all tissues examined, with the respiratorytract (lung, trachea, larynx, and nasal turbinates), upper gastrointestinaltract (stomach and small intestine), the liver, and the adrenalscontaining the highest concentrations of [I4C]DBC equivalentswithin 1 hr after exposure. At both concentrations of DBC tested,clearance of I4C from tissues was rapid, with approximately60 to 98% of the initial tissue burden being cleared with half-timesranging from 1 to 16 hr. The remaining 2 to 40% in the tissueswas cleared with half-times that ranged from 1.5 to 14 days.Several metabolites were detected in the urine and feces, noneof which appeared to be either glucuronide or sulfate conjugates.Small quantities of [I4C]DBC were detected in the urine, althoughquantities were less than 1% of the initial respiratory tractburden of [I4C]DBC. The results from this research indicatethat DBC was rapidly absorbed from the lungs and translocatedto many tissues. Prior to elimination, primarily in the feces,DBC was extensively metabolized There appeared to be no effectof exposure concentration on the toxicokinetics of inhaled DBC.