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High-risk Subjects (high-risk + subject)
Selected AbstractsSubthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2004P. Cuijpers Objective:, In order to examine whether the incidence of major depressive disorder (MDD) is increased in subjects with subthreshold depression, or sD (clinically relevant depressive symptoms, without meeting criteria for a full-blown MDD), we conducted a review of prospective studies examining the incidence of MDD in subjects with sD. Method:, A systematic literature search was conducted. For all studies, the relative risk of developing MDD was calculated, based on person-years. Results:, Twenty studies (23 comparisons) were found, based on community samples, general medical patients and high-risk subjects. Most comparisons showed that subjects with sD had a consistently larger chance of developing MDD. The studies differed considerably in the definition of sD, the recency (occurrence of the last sD) and the in-/exclusion of lifetime MDD. Conclusion:, The incidence of MDD in subjects with sD is larger than in subjects without sD. Otherwise, the concept of sD is too broad to be used. In future studies, some consensus should be reached regarding the definition of sD. [source] Type 2 diabetes in families and diabetes preventionEUROPEAN DIABETES NURSING, Issue 2 2008FRCP Professor of Diabetic Molecular Medicine, M Walker MD Abstract Type 2 diabetes frequently clusters in families. Non-diabetic first-degree relatives (offspring and siblings) of patients with type 2 diabetes have a three-fold increased lifetime risk of developing diabetes compared with the background population. This increased diabetes risk results from the combined effects of shared genetic and lifestyle factors. Extensive studies of non-diabetic relatives of type 2 diabetic families show that impaired insulin secretion, insulin resistance and an adverse cardiovascular risk factor profile exist well before the development of frank diabetes. Despite this well-documented adverse metabolic predisposition, patients with type 2 diabetes and their non-diabetic relatives generally have a limited understanding of the risks. Several large-scale studies, such as the Finnish Diabetes Prevention and Diabetes Prevention Program studies, indicate unequivocally that lifestyle modification through dietary change and exercise can dramatically decrease risk of progression to diabetes in high-risk subjects. However, such individuals pursue lifestyle changes only if they understand their own risk of developing diabetes. Further work is therefore needed to investigate and develop optimal ways of improving knowledge of diabetes risk in families of patients with type 2 diabetes, so that they can appreciate the potential benefits of diabetes prevention strategies. Copyright © 2008 FEND [source] Oral biofilms, periodontitis, and pulmonary infectionsORAL DISEASES, Issue 6 2007S Paju Bacteria from the oral biofilms may be aspirated into the respiratory tract to influence the initiation and progression of systemic infectious conditions such as pneumonia. Oral bacteria, poor oral hygiene, and periodontitis seem to influence the incidence of pulmonary infections, especially nosocomial pneumonia episodes in high-risk subjects. Improved oral hygiene has been shown to reduce the occurrence of nosocomial pneumonia, both in mechanically-ventilated hospital patients and non-ventilated nursing home residents. It appears that oral colonization by potential respiratory pathogens, possibly fostered by periodontitis, and possibly by bacteria specific to the oral cavity or to periodontal diseases contribute to pulmonary infections. Thus, oral hygiene will assume an even more important role in the care of high-risk subjects , patients in the hospital intensive care and the elderly. The present paper critically reviews the recent literature on the effect of oral biofilms and periodontitis on pneumonia. [source] Factors associated with cancer distress in the Asbestos Post-Exposure Survey (APEXS),AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2009Marion Maurel MSc Abstract Objectives CT-scan screening programs for lung cancer detection have been proposed in high-risk subjects, and more recently in former asbestos-exposed subjects. However, to date no data are available on psychological impact of such programs. The aim of this study is to examine the risk factors of psychological distress at baseline of a CT-scan screening program among asbestos-exposed subjects. Methods The Asbestos Post-Exposure Survey (APEXS) was carried out in France between October 2003 and December 2005 in order to screen asbestos-related diseases by CT-scan. Volunteers underwent self-administered questionnaires including an asbestos exposure assessment and, for a large sub-sample, a validated psychological distress scale. Non-exposed subjects were used as reference group. Results At baseline, a significant higher level of distress was observed in exposed subjects (n,=,3,122) relative to the reference group (n,=,486) after adjustment on age, sex, and tobacco status. This distress is associated independently with the self-perception of (i) intensity of asbestos exposure and (ii) the risk of current or future disease related to the asbestos exposure. The perception of the cancer risk related to asbestos seems to play a fundamental role in this psychological distress. Conclusion In this study, asbestos-exposed subjects experienced a higher significant cancer distress than previously described in literature. These findings may be of potential public health importance. First, the impact of such occupational exposures on quality of life of patients who suffer from cancer related to these exposures has to be appraised. Secondly, the assessment of psychological impact of CT-scan screening programs among asbestos-exposed subjects is also required. Am. J. Ind. Med. 52:288,296, 2009. © 2009 Wiley-Liss, Inc. [source] Screening programmes for the early detection and prevention of oral cancerAUSTRALIAN DENTAL JOURNAL, Issue 2 2009O Kujan Background:, Screening programmes for major cancers, such as breast and cervical cancer have effectively decreased the mortality rate and helped to reduce the incidence of these cancers. Although oral cancer is a global health problem with increasing incidence and mortality rates, no national population-based screening programmes for oral cancer have been implemented. To date there is debate on whether to employ screening methods for oral cancer in the daily routine work of health providers. Objectives:, To assess the effectiveness of current screening methods in decreasing oral cancer mortality. Search strategy:, Electronic databases (MEDLINE, CANCERLIT, EMBASE (1966 to July 2005) and CENTRAL (The Cochrane Library 2005, Issue 3), bibliographies, handsearching of specific journals and contact authors were used to identify published and unpublished data. Selection criteria:, Randomized controlled trials of screening for oral cancer or precursor oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy. Data collection and analysis:, The search found 112 citations and these have been reviewed. One randomized controlled trial of screening strategies for oral cancer was identified as meeting the review's inclusion criteria. Validity assessment, data extraction and statistics evaluation were undertaken by two independent review authors. Main results:, One 10-year randomized controlled trial has been included (n = 13 clusters: 191 873 participants). There was no difference in the age-standardized oral cancer mortality rates for the screened group (16.4/100 000 person-years) and the control group (20.7/100 000 person-years). Interestingly, a significant 34% reduction in mortality was recorded in high-risk subjects between the intervention cohort (29.9/100 000 person-years) and the control arm (45.4/100 000). However, this study has some methodological weaknesses. Additionally, the study did not provide any information related to costs, quality of life or even harms of screening from false-positive or false-negative findings. Authors' conclusions:, Given the limitation of evidence (only one included randomized controlled trial) and the potential methodological weakness of the included study, it is valid to say that there is insufficient evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest that other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Future high quality studies to assess the efficacy, effectiveness and costs of screening are required for the best use of public health resources. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed. Future studies on improved treatment modalities for oral cancer and precancer are also required. Plain language summary:, Screening programmes for the early detection and prevention of oral cancer. More evidence needed to find out whether screening programmes could detect oral cancer earlier and reduce the number of deaths from this disease. Cancer of the mouth and back of the throat (oral cancer) has a low survival rate, largely because the disease is often not diagnosed until it is advanced. Screening the general population for oral cancer might make it possible to detect cases of the disease earlier. The most common method is visual inspection by a clinician, but other techniques include the use of a special blue "dye" and an imaging technique. The review found that there is not enough evidence to decide whether screening by visual inspection reduces the death rate for oral cancer, and no evidence for other screening methods. [source] | ||||||||||