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Church T.R.,University of Minnesota | Black W.C.,Dartmouth Hitchcock Medical Center | Aberle D.R.,University of California at Los Angeles | Berg C.D.,U.S. National Cancer Institute | And 11 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: Lung cancer is the largest contributor to mortality from cancer. The National Lung Screening Trial (NLST) showed that screening with low-dose helical computed tomography (CT) rather than with chest radiography reduced mortality from lung cancer. We describe the screening, diagnosis, and limited treatment results from the initial round of screening in the NLST to inform and improve lung-cancer- screening programs. METHODS: At 33 U.S. centers, from August 2002 through April 2004, we enrolled asymptomatic participants, 55 to 74 years of age, with a history of at least 30 pack-years of smoking. The participants were randomly assigned to undergo annual screening, with the use of either low-dose CT or chest radiography, for 3 years. Nodules or other suspicious findings were classified as positive results. This article reports findings from the initial screening examination. RESULTS: A total of 53,439 eligible participants were randomly assigned to a study group (26,715 to low-dose CT and 26,724 to chest radiography); 26,309 participants (98.5%) and 26,035 (97.4%), respectively, underwent screening. A total of 7191 participants (27.3%) in the low-dose CT group and 2387 (9.2%) in the radiography group had a positive screening result; in the respective groups, 6369 participants (90.4%) and 2176 (92.7%) had at least one follow-up diagnostic procedure, including imaging in 5717 (81.1%) and 2010 (85.6%) and surgery in 297 (4.2%) and 121 (5.2%). Lung cancer was diagnosed in 292 participants (1.1%) in the low-dose CT group versus 190 (0.7%) in the radiography group (stage 1 in 158 vs. 70 participants and stage IIB to IV in 120 vs. 112). Sensitivity and specificity were 93.8% and 73.4% for low-dose CT and 73.5% and 91.3% for chest radiography, respectively. CONCLUSIONS: The NLST initial screening results are consistent with the existing literature on screening by means of low-dose CT and chest radiography, suggesting that a reduction in mortality from lung cancer is achievable at U.S. screening centers that have staff experienced in chest CT. Copyright © 2013 Massachusetts Medical Society. All rights reserved.


Cowie C.C.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases | Rust K.F.,Westat | Byrd-Holt D.D.,Social and Scientific Systems | Gregg E.W.,Centers for Disease Control and Prevention | And 4 more authors.
Diabetes Care | Year: 2010

OBJECTIVE - We examined prevalences of previously diagnosed diabetes and undiagnosed diabetes and high risk for diabetes using recently suggested A1C criteria in the U.S. during 2003-2006. We compared these prevalences to those in earlier surveys and those using glucose criteria. RESEARCH DESIGN AND METHODS - In 2003-2006, the National Health and Nutrition Examination Survey included a probability sample of 14,611 individuals aged ≥12 years. Participants were classified on glycemic status by interview for diagnosed diabetes and by A1C, fasting, and 2-h glucose challenge values measured in subsamples. RESULTS - Using A1C criteria, the crude prevalence of total diabetes in adults aged ≥20 years was 9.6% (20.4 million), of which 19.0% was undiagnosed (7.8% diagnosed, 1.8% undiagnosed using A1C ≥6.5%). Another 3.5% of adults (7.4 million) were at high risk for diabetes (A1C 6.0 to <6.5%). Prevalences were disproportionately high in the elderly. Age-/sex-standardized prevalence was more than two times higher in non-Hispanic blacks and Mexican Americans versus non-Hispanic whites for diagnosed, undiagnosed, and total diabetes (P < 0.003); standardized prevalence at high risk for diabetes was more than two times higher in non-Hispanic blacks versus non-Hispanic whites and Mexican Americans (P < 0.00001). Since 1988-1994, diagnosed diabetes generally increased, while the percent of diabetes that was undiagnosed and the percent at high risk of diabetes generally decreased. Using A1C criteria, prevalences of undiagnosed diabetes and high risk of diabetes were one-third that and one-tenth that, respectively, using glucose criteria. CONCLUSIONS - Although A1C detects much lower prevalences than glucose criteria, hyperglycemic conditions remain high in the U.S., and elderly and minority groups are disproportionately affected. © 2010 by the American Diabetes Association.


DiGaetano R.,Westat
Evaluation and the Health Professions | Year: 2013

A sample frame is the listing of the units from which a sample is to be selected. When deciding upon a file to serve as a source for a sample frame for a survey, perhaps the most important consideration is the extent to which the target population will be covered by the frame. However, other issues also come into play such as the accuracy of contact and other information appearing on the file as well as its cost. The American Medical Association Masterfile has long been considered the preferred choice for surveys of physicians, although it does have drawbacks. Here we consider two alternative files, discussing their relative advantages and disadvantages. For surveys of physician practices (or other organizations that employ physicians), there have been no files that are obvious choices to serve as the basis for a sample frame. Here we discuss data collection on physician practices from an analytic perspective and consider how sampling physicians to obtain practice level data may be a desirable approach. © The Author(s) 2013.


Karakus M.C.,650 Research Blvd | Patton L.C.,Westat
Journal of Behavioral Health Services and Research | Year: 2011

The relationship between depression and development of chronic illness among older adults is not well understood. This study uses data from the Health and Retirement Study to evaluate the relationship between depression at baseline and new onset of chronic illnesses including cancer heart problems arthritis and diabetes. Analysis controlling for demographics (age, gender, race, education) health risk indicators (BMI and smoking) functional limitations (gross motor index health limitations for work) and income show that working-age older people (ages 50-62) with depression at baseline are at significantly higher risk to develop diabetes heart problems and arthritis during the 12-year follow-up. No significant association was found between depression and cancer. Prevention efforts aimed at chronic illnesses among the elderly should recognize the mind-body interaction and focus on preventing or alleviating depression. © 2011 National Council for Community Behavioral Healthcare.


The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician and Group Adult Visit Survey enables patients to report their experiences with outpatient medical offices. To evaluate the factor structure and reliability of the CAHPS Clinician and Group (CG-CAHPS) Adult Visit Survey. Data from 21,318 patients receiving care in 450 clinical practice sites collected from March 2010 to December 2010 were analyzed from the CG-CAHPS Database. RESEARCH DESIGN AND PARTICIPANTS: Individual level and multilevel confirmatory factor analyses were used to examine CAHPS survey responses at the patient and practice site levels. We also estimated internal consistency reliability and practice site level reliability. Correlations among multi-item composites and correlations between the composites and 2 global rating items were examined. Scores on CG-CAHPS composites assessing Access to Care, Doctor Communication, Courteous/Helpful Staff, and 2 global ratings of whether one would Recommend their Doctor, and an Overall Doctor Rating. Analyses provide support for the hypothesized 3-factor model assessing Access to Care, Doctor Communication, and Courteous/Helpful Staff. In addition, the internal consistency reliabilities were ≥ 0.77 and practice site level reliabilities for sites with >4 clinicians were ≥ 0.75. All composites were positively and significantly correlated with the 2 global rating items, with Doctor Communication having the strongest relationship with the global ratings. The CG-CAHPS Adult Visit Survey has acceptable psychometric properties at the individual level and practice site level. The analyses suggest that the survey items are measuring their intended concepts and yield reliable information.

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