A comparison of fecal occult-blood tests for colorectal-cancer screening.

BACKGROUND: Hemoccult II, a widely used guaiac test for fecal occult blood, has a low sensitivity for detecting colorectal neoplasms in asymptomatic patients at average risk. In such patients, the performance characteristics of screening tests developed to improve on Hemoccult II are not known. METHODS: A set of three fecal occult-blood tests--Hemoccult II; Hemoccult II Sensa, a more sensitive guaiac test; and HemeSelect, an immunochemical test for human hemoglobin--was mailed to all patients 50 years of age or older who were scheduled for personal health appraisals at the Kaiser Permanente Medical Center in Oakland, California. The performance of each test and of a combination test (HemeSelect to confirm positive Hemoccult II Sensa results) was evaluated by identifying screened patients who had colorectal neoplasma (carcinoma or a polyp > or = 1 cm in diameter) in the two years after screening. RESULTS: Of the 10,702 eligible patients, 8104 (75.7 percent) had at least one interpretable sample and were screened on the basis of at least one test; 96 percent of these patients had complete two-year follow-up. The sensitivity of the tests for detecting carcinoma was lowest with Hemoccult II (37.1 percent; 95 percent confidence interval, 19.7 to 54.6 percent), intermediate with the combination test (65.6 percent; 95 percent confidence interval, 47.6 to 83.6 percent) and with HemeSelect (68.8 percent; 95 percent confidence interval, 51.1 to 86.4 percent), and highest with Hemoccult II Sensa (79.4 percent; 95 percent confidence interval, 64.3 to 94.5 percent). The specificity for detecting carcinoma was 86.7 percent with Hemoccult II Sensa, 94.4 percent with HemeSelect, 97.3 percent with the combination test, and 97.7 percent with Hemoccult II. HemeSelect and the combination test detected more colorectal carcinomas and polyps than Hemoccult II, with only slight increases in the number of colonoscopies needed. CONCLUSIONS: HemeSelect and a combination test in which HemeSelect is used to confirm positive Hemoccult II Sensa results improve on Hemoccult II in screening patients for colorectal carcinoma.

The effect of retirement on mental health and health behaviors: the Kaiser Permanente Retirement Study.

To assess the short-term effect of retirement on mental health and health behaviors of members of a health maintenance organization aged 60-66, questionnaires were completed in 1985 and 1987 by employed members planning to retire during the study period and those not planning to retire. Mental health and health behaviors of members who actually retired (n = 320) were compared with those members who did not retire (n = 275). Using logistic regression controlling for age, gender, marital status, and education, we found that retired members were more likely to have lower stress levels and to engage in regular exercise more often as compared to those who did not retire during the study period. Retired women were more likely to report no alcohol problems as compared to nonretired women. There were no differences between the groups on self-reported mental health status, coping, depression, smoking, alcohol consumption, and frequency of drunkenness. These findings underscore the importance of assessing positive benefits associated with retirement and call for further evaluation of whether these benefits persist over time.

Alcohol problems and sense of coherence among older adults.

The relation between alcohol problems and sense of coherence (SOC), a salutogenic model developed by Antonovsky, was assessed on a sample of 952 older members of a health maintenance organization. Data on alcohol problems (5-item index) and SOC (9-item scale) were obtained from mailed questionnaires. Multiple regression analyses indicated that SOC was a significant negative predictor of alcohol problems while controlling for alcohol consumption level, frequency of drunkenness and demographic characteristics. In addition, SOC scores were significantly higher for a subsample of lighter drinkers who reported no alcohol problems in the last year and had not been drunk in the last year (n = 419) as compared to heavier drinkers who reported at least one alcohol problem in the last year, and reported being drunk at least once in the last year (n = 107). These findings emphasize the importance of assessing factors which contribute to healthier behaviors as opposed to focusing exclusively on predictors of pathogenic outcomes.

The effect of retirement on health services utilization: the Kaiser Permanente Retirement Study.

The relationship of retirement and use of medical services was investigated among members of the Kaiser Permanente Medical Care Program in Northern California. A mailed survey of a 10 percent random sample of members 60-66 years old (N = 10,202) was followed by a telephone interview of (a) all respondents who had planned to retire in the next year, and (b) a random sample of respondents who had not planned to retire: 253 had retired (Retired group) and 238 were still working 20 hours a week or more (Not Retired group). Medical charts were reviewed for one year before and after the retirement date for the Retired group and for one year before and after a randomly assigned anchor date for the Not Retired group. With the exception of urgent care and emergency visits, no significant difference was found between the two groups in overall use of outpatient and inpatient services following retirement.

Health status, retirement plans, and retirement. The Kaiser Permanente retirement study.

The purpose of this study was to assess the stability of short-term plans to retire and to evaluate the role of self-reported health status in predicting both plans to retire and actual retirement from a sample of 1,165 older members of a prepayment, group practice model, health maintenance organization. The study sample was derived from a random sample of members 60 to 66 years of age. Mailed questionnaires were completed that obtained data on the following variables: self-reported health status, work status, demographic variables, and plans to retire in the next year. Telephone interviews were conducted throughout the study period to determine dates of retirement from both those who planned to retire and those who had not. Results indicated that retirement plans were relatively stable for this population. Logistic regression analyses revealed that poorer health status was related to both retirement plans and actual retirement for women but not for men.

Transcription and metabolism of RNA from the Drosophila melanogaster heat shock puff site 93D.

Characteristics of the major heat shock puff site 93D and the RNA transcribed from it have been investigated by hybridization to polytene chromosome preparations and to recombinant DNA. By saturation in situ hybridization, the length of the transcribed region at 93D is twice that of the mRNA coding region at the heat shock puff site 87A. From the known length of the heat shock mRNA sequence at 87A, we calculate that the minimum length of the transcribed region at 93D is 9.6 kb (kb = kilobase, i.e., 1,000 nucleotides).--The metabolism of RNA transcribed from 93D has been compared with that of RNA coding for the major heat shock protein hsp70 in cells incubated for one hour at 35 degrees C. Hsp70 mRNA sequences, assayed by hybridization to a specific recombinant DNA probe and by in situ hybridization to 87A, were found in both poly(A)+ and poly(A)- cytoplasmic RNA and were more concentrated in cytoplasmic RNA than in nuclear RNA. In contrast, sequences complementary to 93D, assayed by in situ hybridization, were more concentrated in nuclear than in cytoplasmic RNA. This implies that sequences from 93D exit from the nucleus at a lower rate and/or are turned over in the cytoplasm at a higher rate, than sequences from 87A. Site 93D is also unusual in that its transcribed region is represented in both poly(A)+ and poly(A)- nuclear RNA, even though 93D-complementary RNA in the cytoplasm is predominantly poly(A)-. Finally, only 28-58% of the length of DNA transcribed at 93D is represented in cytoplasmic RNA, indicating that only a portion of the sequences transcribed from 93D are exported from the nucleus. The transcripts from two heat shock loci, 93D and 87A, thus appear to be metabolized in significantly different ways.