Periodic Health Assessments Research Articles

Patient Education for Colon Cancer Screening: A Randomized Trial of a Video Mailed before a Physical Examination

Colorectal cancer screening is underused, and primary care clinicians are challenged to provide patient education within the constraints of busy practices. To test the effect of an educational video, mailed to patients' homes before a physical examination, on performance of colorectal cancer screening, particularly sigmoidoscopy. Randomized, controlled trial. 5 primary care practices in central Massachusetts. 938 patients age 50 to 74 years who were scheduled for an upcoming physical examination, had no personal history of colorectal cancer, and were eligible for lower-endoscopy screening according to current guidelines. Participants were randomly assigned to receive usual care (n = 488) or a video about colorectal cancer, the importance of early detection, and screening options (n = 450). Baseline and 6-month follow-up telephone assessments were conducted. A dependent variable classified screening since baseline as 1) sigmoidoscopy with or without other tests, 2) another test or test combination, or 3) no tests. Overall screening rates were the same in the intervention and control groups (55%). In regression modeling, intervention participants were nonsignificantly more likely to complete sigmoidoscopy alone or in combination with another test (odds ratio, 1.22 [95% CI, 0.88 to 1.70]). Intervention dose (viewing at least half of the video) was significantly related to receiving sigmoidoscopy with or without another test (odds ratio, 2.81 [CI, 1.85 to 4.26]). Recruitment records showed that at least 23% of people coming for periodic health assessments were currently screened by a lower-endoscopy procedure and therefore were not eligible. The primary care sample studied consisted primarily of middle-class white persons who had high screening rates at baseline. The results may not be generalizable to other populations. The trial was conducted during a period of increased health insurance coverage for lower-endoscopy procedures and public media attention to colon cancer screening. A mailed video had no effect on the overall rate of colorectal cancer screening and only modestly improved sigmoidoscopy screening rates among patients in primary care practices.

NUTRITION DURING PREGNANCY AND LACTATION

Because appropriate maternal nutrition improves pregnancy outcome, improving maternal nutrition before, during, and after pregnancy is an excellent example of primary prevention. Providing assessment and intervention to encourage an optimal state of health will also benefit the many women who do not desire pregnancy. For these women, the provision of nutritional care as part of a periodic health assessment can serve not only as a way to enhance health status in preparation for a future pregnancy, but also as a mechanism for encouraging nutritional behaviors to improve health throughout life.

General approach to correction for bias in analytical performance in longitudinal studies illustrated by estimating the effect of age on gamma-glutamyltransferase activity

For studying trends in blood biochemistry analytes of an individual or a group of individuals, the outcome may be influenced by analytical changes that may have occurred during the study. An observed trend may well represent a drift in analytical performance instead of a truly biological finding. We developed a model that allows for retrospective correction of analytical changes with time. This model is based on the concept of adjustment of an individual's longitudinal blood biochemistry data by comparing the long-term results of the laboratory with those of other laboratories in an external quality-control survey program. Factors responsible for the analytical bias of our laboratory were identified by multiple regression analysis. The resulting procedure for assessing analytical bias and variability was applied to study in two mutually exclusive cohorts of employees of the Shell petrochemical complex in Rotterdam (a) the true nature of the changes (analytical or biological) in gamma-glutamyltransferase (GGT) and (b) the effect of age on GGT. The first cohort consisted of employees who attended a periodic health assessment in 1984 and in 1989; the second, employees who attended periodic health assessments in 1985 and in 1988. Thus we studied 3- and 5-year changes of GGT corrected for analytical bias. Whereas standard cross-sectional results apparently showed an increase of GGT up to age 50 years, the longitudinal findings corrected for analytical changes, as indicated above, do not support these cross-sectional results.

Monitoring occupational exposure to ethylene oxide by the determination of hemoglobin adducts.

In a study on workers in a chemical plant where ethylene oxide (EtO) is manufactured and partly used for ethylene glycol production, exposure to EtO was monitored during annual periodic health assessments in January 1988, December 1988, and March 1990 by the determination of the level of 2-hydroxyethylvaline (HOEtVal) in hemoglobin. The HOEtVal levels in workers corresponded with the potential EtO exposures. The highest level was found in December 1988, in blood samples collected 1-2 months after a shut-down, maintenance, and start-up program. The range of adduct levels found in the three examinations indicated that average EtO exposures during the 4 months preceding blood sampling were below 0.5 ppm. It was demonstrated that the method allows for the accurate monitoring of low levels of EtO exposure and provides personalized time-integrated exposure data with great discriminative power. In addition, the method may serve to identify unexpected personal exposures, which may lead to targeted exposure control measures.

Challenges in Medical Surveillance for Hazardous Waste Workers

Abstract Because of the unique nature of hazardous waste operations and as a result of federal Hazardous Waste Operations and Emergency Response (HAZWOPER) regulations, medical surveillance has become an integral component of employee health assurance programs in this industry. Considerable resources may be dedicated to achieving a variety of medical surveillance objectives, including the determination of fitness for duty, documentation of base line health status, periodic health assessment, epidemiologic research, and documentation of termination health status. However, if programs are not properly designed and administered, the data collected could prove to be not only costly but ineffective in meeting objectives or even counterproductive. There are numerous challenges in program design, data collection, and data evaluation for health and safety personnel involved in the implementation of medical surveillance. Demographics and other characteristics of the workforce; the nature of physical, chemical, and...

Children without Health Insurance

Children without Health Insurance

Opinions of Rhode Island Physicians on Automated Multiphasic Screening

A UTOMATED multiphasic screening exists today as a limited and controversial part of health care in the United States. The Rhode Island multiphasic screening (MPS) program was started in 1968 as one of four demonstration projects in health screening initiated by the Public Health Service. Its operation was based on the acceptance of two concepts: (a) that periodic health assessment does have value and (b) if chronic disease is uncovered early its subsequent course may be altered (1). Recently, automated multiphasic screening has been cited as a potentially useful technique in the delivery of health care quite apart from its original concept as a device for preventive medicine in detecting the early stages of diseases through mass screening of the population. It has been proposed as a means of combating the rising costs of medical care and the shortage of skilled medical manpower (2), functioning as an aid to private physicians in examining their patients, as a point of entry for the undoctored into the health care system, as an efficient method of prehospitalization or other required medical physical examination, and as a means of colleeting a data base for personal medical records or epidemiologic surveys (3). Whether automated multiphasic screening can prove to be of value in meeting these goals is an important question that is not easily answered. Existing automated health testing centers have not been functioning long enough, nor has the scope of their operations been extensive enough, to evaluate fully their effectiveness in detecting disease in the population and their yield in terms of cost benefits (3a). Equally as important as the scientific and economic value of multiphasic screening is the acceptance o? its concepts and application in medical care by the medical profession. A recent survey by Bates and Mulinare (4) concludes that although physicians have an unmet need for screening tests, their attitudes toward these tests appear to be highly ambivalent. In Rhode Island, physician opinion concerning the MPS center at the Rhode Island Hospital in Providence is particularly important for its operation. As the screening program is currently operated, participants are not accepted unless they have a resource (that is, a private physician or clinic) to which the test data can be sent for interpretation as part of a complete health examination. Thus the program is not an end in itself but is completely useless to the participant unless the result is interpreted to him by his physician. Physician opinion is also important when planMr. von Oeyen is with the division of biological and medical sciences, Brown University, and the department of ambulatory care and community medicine, Rhode Island Hospital. This study was supported in part by Public Health Service grant No. PH 110-68. Tearsheet requests to Paul von Oeyen, Department of Ambulatory Care and Community Medicine, Rhode Island Hospital, Providence, R.I. 02903.