Primary and secondary prevention services in clinical practice: twenty years' experience in development, implementation, and evaluation

Article Abstract:

A carefully constructed preventive medicine plan that takes a population-based approach to problem identification and develops prevention strategies for both the community and individual may be an effective way of improving overall public health. A group health cooperative in Washington state developed a program that looked at the population as a whole to identify problem areas that could be verified through medical records. Physicians and community members were then allowed to develop prevention programs that involved intervention at the individual and community levels. Such intervention stressed the role of the patient and gave physicians freedom to target underlying factors of larger health trends. Twenty years after the program began, late-stage breast cancer rates had fallen 32%, the percentage of patients who smoked fell from 25% to 17% and head injuries from bicycle accidents decreased 67% due to increased use of helmets.

Management, Evaluation, Public health, Preventive health services, Preventive medicine, Medicine, Preventive

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Multicenter trial to evaluate vascular magnetic resonance angiography of the lower extremity

Article Abstract:

Magnetic resonance angiography (MRA) and contrast arteriography (CA) appear to produce comparable rates of accuracy for diagnosing patients with lower limb atherosclerotic occlusive disease. A total of 155 patients with symptoms of peripheral vascular disease were evaluated. MRA and CA were used to pinpoint the occlusions and find normal vessels that could be used for a graft. Images for each method for 15 vessel segments of each patient were analyzed. While each imaging modality showed similar accuracy, both modalities used in combination were considered better than CA by itself. Sixty-one percent of the patients had infraingual bypass surgery, 19% did not have a surgical procedure, 6% had angioplasty, 4% had an amputation, and 8% had another surgical procedure.

Diagnosis, Magnetic resonance imaging, Atherosclerosis, Angiography

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Changes in Breast Density Associated With Initiation, Discontinuation, and Continuing Use of Hormone Replacement Therapy

Article Abstract:

Hormone therapy can increase the density of a woman's breasts, making it more difficult to detect breast cancer on a mammogram. According to a study of 5,212 postmenopausal women, the density of a woman's breast decreases when she stops using hormone therapy.

Physiological aspects, Hormone therapy, Breast

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