Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders. I. Hematuria and proteinuria

We review evidence on the value of dipstick urinalysis screening for hemoglobin and protein in asymptomatic adults. In young adults, evidence from five population-based studies indicates that fewer than 2% of those with a positive heme dipstick have a serious and treatable urinary tract disease, too few to justify screening and the risks of subsequent workup. For older populations, evidence is contradictory and no recommendation can presently be made for or against hematuria screening. A population-based randomized, controlled trial of hematuria screening in the elderly is urgently needed. Proteinuria screening is not recommended in any healthy, asymptomatic adult population, since four population-based studies have found that fewer than 1.5% of those with positive dipsticks have serious and treatable urinary tract disorders.

Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders. II. Bacteriuria

Using criteria adopted by the US Preventive Services Task Force, we evaluated use of the dipstick urinalysis to screen for bacteriuria. When the leukocyte esterase and nitrite dipstick tests are combined, the positive predictive value for detecting bacteriuria exceeded 12% in groups with a 5% or higher prevalence of bacteriuria: women who are pregnant, diabetic, or over 60 years of age and all institutionalized elderly. Conventional antimicrobial regimens for asymptomatic bacteriuria have proved efficacious only for pregnant women. We conclude that pregnant women should be screened for bacteriuria, but with the more sensitive urine culture, because treatment prevents serious fetal and maternal sequelae. Dipstick screening may be justified in women who are over 60 years of age or diabetic. The prevalence of bacteriuria in other groups is too low to justify screening.

Localized measurements of refractive turbulence using spatial filtering of scintillations

Remote measurements of refractive turbulence strength with high spatial resolution are demonstrated. The technique uses spatial and temporal filtering of scintillation from a spatially filtered incoherent optical source. Spatial resolution as fine as 4.5 m was observed at the center of a 110-m propagation path. An analytic approximation to the theory agrees very well with the data. This theory predicts the spatial resolution of a system of this type to be in the vicinity of the path length divided by the total number of cycles in the transmitter and receiver spatial filters.

Relation between age, education, and time to respond to questions in a computer-based medical interview

The time required for 458 women volunteers to respond to questions in a computer-based medical interview was related both to their age and to their formal education. When the analysis was restricted to the 220 women with a college degree, older women responded more slowly than their younger counterparts, and when the analysis was restricted to the 265 women between 18 and 30 years of age, women with less formal education took longer to respond. By contrast, the time required for the volunteers to record their responses was related only to age.

The chorioallantoic membrane in irritation testing

The chorioallantoic membrane (CAM) of the chick embryo is a fusion membrane with a blood vessel complex. It was examined as a possible means of predicting the irritant potential of chemicals for the conjunctiva, as observed in the Draize eye test. Nine chemicals of known irritancy potential for the eye in vivo were selected from published data, and each was tested at four different concentrations. The treated CAMs were examined macroscopically at 4, 24 and 48 hr after treatment, and were then prepared for histological examination. A dose response was observed for each chemical. In only four of the nine chemicals could the response in the CAM be considered to predict the in vivo activity. In another two, the correlation was poor. Three chemicals, glycerine, polyethylene glycol and Tween 80, all reported to be harmless to the eye, were embryotoxic at more than one concentration. Histological changes were degeneration or necrosis at the treated site without the chemical features of heterophil (chicken neutrophil) infiltration or significant macrophage infiltration. It is concluded that the CAM is not a suitable tissue for predicting in vivo irritant potential of substances for the conjunctiva, and that it provides no more information than could be obtained from cell cultures.

Comparing ambulatory care practices of primary care and traditional medicine residents

Although special residency programs preparing internists for primary care have been in existence for a decade, little is known about whether these tracks have achieved their goals. As part of a multicenter evaluation of ambulatory care at four university hospitals, 1,040 patient care encounters were reviewed for 16 primary-care and 41 traditional medicine residents. Using a chart-based audit, the authors examined 16 discrete items of patient care to assess resident management in the following areas: screening for colorectal carcinoma, management of hypertension, benzodiazepine drug prescribing, and management of chronic lung disease. Their hypothesis that primary care residents would score higher than traditional medicine residents in the areas of screening, prevention, and prescribing of drugs was not supported. There was no association between type of training and performance of a task with the following exception: second-year primary care residents screened for colorectal carcinoma in 86% (126) of patients whose charts were audited, while second-year traditional medicine residents did so in 77% (160) (P less than 0.025). This difference was not maintained when the residents were reaudited 1 year later. Both groups of residents scored high in all areas with the following exceptions: documentation of the amount of sedative dispensed and immunization of susceptible patients against pneumococcus and influenza. The ambulatory practices of both groups of residents exceeded expectations, probably because of the wider influence of primary care training.

Health-promoting behavior among lawyers and judges

This report compares the health-promoting behaviors of lawyers and judges and contrasts these behaviors with published data from nationwide surveys of the general population. Data were obtained from a self-administered questionnaire distributed to a random sample of Massachusetts lawyers and a group of judges attending an annual meeting of midwestern state municipal judges. Compared to the United States general population, lawyers and judges have more favorable health-promoting practices with respect to smoking, exercise, and use of seatbelts but are similar in terms of drinking habits and drinking problems, diet and weight consciousness, and the prevalence of tension, stress or pressure from their work.

Profile of women practicing breast self-examination

The monthly practice of breast self-examination (BSE) can result in the early diagnosis of breast cancer. To explore factors that influence women's habits in the practice of BSE, we interviewed 616 women using an interactive computer program. We found that these women were more likely to practice BSE on a frequent basis if they were living with their sexual partner, had been shown how to perform BSE, and were confident in their examination technique. Women with a maternal history of breast disease were also more likely to practice monthly BSE. Unlike past reports that women with formal education beyond high school practice BSE more frequently than less-educated women, our study showed no association between monthly BSE practice and formal education. Contrary to our hypothesis that BSE practice was associated with the practice of other preventive health activities, our study did not demonstrate such a relationship. These findings suggest that demonstrating BSE at the periodic health examination may help increase the number of women practicing BSE on a frequent basis.

Wind measurements by the temporal cross-correlation of the optical scintillations

Various methods of correlation analysis that have been used to deduce crosswind from a drifting scintillation pattern are briefly described and then compared with regard to their immunity to noise and their accuracy when faced with nonuniformities along the propagation path or changes in the characteristics of the turbulence. Of the techniques considered, none is ideal; but a new technique, using complete knowledge of the cross-covariance function, proves to be advantageous in a wide variety of situations.

Histopathologic observations after short-term implantation of two porous elastomers in dogs

This report describes the effects of pore size and material on soft tissue ingrowth of two medical-grade elastomers. Using the replamineform process, silicone rubber (SR) and bioelectric polyurethane (BEP) were rendered microporous with essentially the same microstructural pore configuration. Implants were prepared in each material having five pore size ranges: 18-25 microns, 30-45 microns, 75-95 microns, 60-120 microns, and 120-180 microns. Implants 1 cm X 1 cm X 1 mm were harvested at 1, 2, 4 and 12 weeks following subcutaneous implantation in mongrel dogs. Ingrowth of the 18-25 microns and 30-45 microns implants in both polymers consisted of histiocytes and dispersed fibrocytic proliferation during the first two weeks. By 12 weeks, the fibrocytic component had increased, but histiocytes remained the principal component of ingrown tissue. In contrast, initial ingrowth of the 75-95 microns, 60-120 microns and 120-180 microns implants showed increased fibrocytic proliferation and minimal histiocytic reaction. By 12 weeks, ingrowth into the larger-pore implants had progressed to broad bands of well organized collagenous stroma. Differences in the rate of tissue ingrowth were found to be related to both material and pore size. Less than 15% of the void spaces were infiltrated by 4 weeks in 18-25 microns and 30-45 microns SR implants, although this increased to approximately 50% by 12 weeks. In contrast, the 3 larger-pore SR implants and all pore sizes in the BEP implants were almost completely ingrown by 4 weeks.

Optical rain gauge using a divergent beam

We have shown that path-averaged rain rates can be obtained from the raindrop-induced amplitude scintillations of a divergent laser beam (spherical wave case). We found that the rain rate obtained from a divergent beam is less sensitive to drop-size distribution than that from a collimated beam. However, the path-weighting function is heavily weighted toward the receiving end in the spherical wave case, whereas in the plane wave case, it is almost uniformly weighted along the optical path. The theory was confirmed by observations on two optical paths, one using a collimated beam on a 200-m path, the other using a divergent beam on a 1000-m path. The results for the longer path show a saturation effect for rain rates higher than 12 mm/h.

Where have all the doctors gone? Physician choices between specialty and primary care practice

Public concern about physician manpower is becoming increasingly focused on the distribution of physicians across specialties. Although an optimal mix of physicians has not been clearly defined, most interested parties agree that more primary care doctors are needed. We examine economic, psychological, and organizational incentives that tend to induce physicians to pursue careers in subspecialties rather than primary care. The existing incentive structure needs to be examined more closely and will almost certainly have to be redesigned if efforts to redeploy physician manpower are to be successful.