(53) A general practice study. Screened 3,800 in the 25-55 age group. 221 had a raised cholesterol and invited to a life-style intervention clinic. 181 attended, 78 showing a drop in cholesterol (mean drop 0.74).
The mean of the Reflotron results was 108% higher than that of the laboratory.
Cost in manpower £10,150 Postage £520 Reflotron & strips free.
(54) 2353 patients screened in general practice. Reflotron with parallel laboratory measurements. Reflotron on average = 108% of lab.
10% men over 6.5
10% women over 7.0
2% over 8.0
(55) Follow up in one of the Anggard practices. Comparison again between lab and Reflotron (lab lower). Single estimations of cholesterol in the surgery should be treated with caution as with single blood pressure readings.
(56) Report of the Broughton & Bullock quality control
(59) Quoted in Pulse 3/2/90
The increase in the risk of myocardial infarction attributable to cigarette smoking is largely reversible within a few years.
The present data may give women a convincing motive to quit, even if they have smoked heavily for many years.
(63) Smoking responsible for 50,000 - 100,000 deaths per year. Average reduction in life expectancy of 10 yrs. Smoking related illness cost the National Health Service £370 million in 1984.
(65) A general practice study. Prospective study of 215 healthy adults invited to a screening clinic. Control group of 225 age matched controls. General health questionnaire used as an indication of psychological stress.
Significantly less subjective stress in the unscreened group.
Repeated in three months psychological stress significantly increased in screened group compared with controls who showed no increase.
(66) The data suggest that the Multiple Risk Factor InterventioTrial confers a mortality benefit in middle aged men over a period of about ten years.
Intervention = Dietary advice to lower cholesterol, Counselling to achieve smoking cessation, Stepped care drug treatment to control, hypertension, Weight reduction for the overweight.
12,000 men from 35-57yrs of age selected as high risk from 361,662 screened. Randomised into two groups, positive intervention and unintervened controls.
The 10.5 year trial mortality findings provide support for early intervention on cholesterol, smoking and BP for the primary prevention of coronary heart disease.
(68) No clear effect of screening on coronary heart disease end points.
(70) This is the paper in which the level of 5.2 is mentioned as the upper limit of normal for cholesterol. A good starting point for reading as this study is quoted in most of the later papers. It was a large prospective epidemiological study, but of men only, It concluseively established the link between serum cholesterol and deaths from coronary events and non-haemorrhagic stroke.
(71) Labelling of previously undiagnosed hypertensives detected by screening at the work place results in increased absenteeism.
(72) "We believe that the use of general practice based multiphasic screening in the middle aged can no longer be advocated on scientific, ethical or economic grounds as a desirable public health measure."
Two groups, screened/unscreened - no significant difference in mortality or morbidity after 9 years.
|The Rev Stephen Hales was one of the first to experiment with blood pressure. Select this picture if you wish to learn more about him.|
(76) Wilson's Criteria
1) The condition should be important.
2) An accepted treatment must be available for the condition.
3) The facilities for diagnosis and treatment must be available.
4) A latent or early symptomatic stage must exist.
5) A sensitive & specific screening test must be available.
6) The test must be acceptable to the population.
7) The natural history of the condition must be understood.
8) An agreed treatment policy must exist.
9) The cost must be acceptable.
10) Case finding must be a continuous process.
(80) Lifelong smoking can cut 18 years from a man's life. A 30 yr old man will live to 64 if he smokes and to 82 if not
Based on 8308 interviews in Erie Pennsylvania.
(81) Cholesterol levels disclosed to Insurance companies if recorded in general practice records - consequent rise in premiums if above 6.5.
(82) Accuracy of the Reflotron - 415 patients - follow instructions carefully.
(83) "These instruments are potentially useful for cholesterol screening and follow up when sound internal and external quality control programs are implemented."
(84) "We consider the estimation of blood cholesterol as a screening procedure is not justified hence this service will not be available in the District". (84)a - 21/12/90 Policy reiterated.
(85) "There is increasing interest in risk assessment for coronary heart disease for two distinct purposes.
1) As a means of identifying individuals at particularly high risk of the disease, to target life-style advice and, if necessary, drug treatment.
2) As a means of motivating individuals to make appropriate life-style changes and to follow prescribed courses of treatment."
"Since coronary heart disease is multifactorial in origin, prevention of coronary heart disease must not place undue emphasis on any one risk factor in isolation. In particular cholesterol testing should only be carried out in the context of an assessment of the other risk factors for coronary heart disease."
"Risk factor assessment for coronary heart disease must be accompanied by detailed practical advice about smoking cessation, healthy eating, alcohol consumption, exercise and stress. Such advice must be appropriate to the individual's level of risk and to their particular circumstances."
"Quality control of cholesterol measurement is essential."
"Risk assessment for coronary heart disease could be undertaken in other settings as well as in general practice."
"Risk assessment programmes in an occupational health setting should be developed."
(86) Paris. 435 postmenopausal women. The menopause seems to be associated with an adverse lipid profile.
(87) Authors suggest that gamma-glutamyl-transpeptidase is a misleading test and should be excluded from the repertoire.
(88) All new screening programmes should include evaluation of the psychological impact of invitation and participation. Audit should include assessment of measures taken to reduce the psychological costs. Such measures could include standardised assessments of patients understanding of the test and assessments of anxiety. "Staff training is the corner-stone of successful screening programmes"
(90) There is a strong indication that regular vigorous exercise protects against coronary attack. 9376 civil servants studied over 9 years!
(91) Females with a body mass index greater than 29 appear to have a myocardial infarction risk 3.3 times those with one of 21. (n = 115,886).
(93) This is the Pittsburgh paper that purports to show that reducing cholesterol does reduce heart attack but also increases death from violence. Statistical treatment of six published trials 119,000 person years and 1147 deaths.
(94) More from Framingham. Increase in survival of the 1970s cohort (43% reduction in coronary heart disease death) may have been primarily the result of improvement in risk factors (cholesterol, blood pressure and smoking) in the 1950s cohort.
The Framingham Heart Study In 1948, 2336 men and 2873 women from Framingham, Massachusetts attended for medical examination on recruitment to the Framingham Heart Study, the source of much of our present understanding of the epidemiology of heart disease and stroke. Both the original study group (aged 30-62; then free of cardiovascular didease) and a succeeding generation of Framingham residents were followed through much of their lives. Each surviving subject has been comprehensively interviewed and examined every two years for half a century. More than a thousand articles from the study have been published and the impressive output continues. It is the ideal epidemiological investigation - long-term follow up on a well defined but representative and cooperative population, and the systematic recording of comprehensive information.
(95) Success rate for self motivated stopping of smoking. Cold Turkey 47.5% - Organised programme 23.6%
(96) 4 organisations tested - 100% accurate at one site, up to 30% inaccurate at others. Operator training and inaccurate machines were the factors involved.
2 Reflotrons, 1 Abbott-Vision, 1 Kodak-DT60
(97) Smoking and raised cholesterol are risk factors for the 65-74 age group as well as younger people.
(98) Association between coffee drinking and raised cholesterol only significant for consumption of boiled coffee
(99) Advice in journals and from expert bodies and study groups varies substantially (concerning cholesterol screening).
(100) Many doctors and nurses would give inappropriate advice to patients with raised cholesterol. "Results of this screening point to a need for improved nutritional education and training in dietary counselling for general practitioners, nurses and primary care facillitators".
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