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1

Royal Colleges of Physicians of the United Kingdom. Committee on Health Promotion. Population screening for pre-symptomatic disease. London: Faculty of Community Medicine of the Royal Colleges of Physicians of the United Kingdom, 1985.

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2

Kafwembe, Emmanual Musonda. Some microanalytical studies of vitamin A for use in population screening programmes. Salford: University of Salford, 1991.

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3

Michael, Paul Simon. PCR screening for human papillomavirus infections, and evaluation of the estimated infection prevalence for a population of females. Sudbury, Ont: Laurentian University, Department of Biology, 1999.

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4

Hauser, Lorenz. Microsatellite screening in Pacific halibut (Hippoglossus stenolepis) and a preliminary examination of population structure based on observed DNA variation. Seattle: International Pacific Halibut Commission, 2006.

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5

B, Hall D. M., Elliman D, and Joint Working Party on Child Health Surveillance., eds. Health for all children Party on Child Health Surveillance. 4th ed. Oxford: Oxford University Press, 2003.

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6

Moss, T. The role of genito urinary medicine cytology and colposcopy in cervical screening: Does the GU female population merita different cytology/colposcopy strategy? Oxford: NHSCervical Screening Programme, 1994.

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7

Joint Working Party on Child Health Surveillance (Great Britain). Health for all children. 4th ed. Oxford: Oxford University Press, 2003.

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8

Joint Working Party on Child Health Surveillance (Great Britain). Health for all children: Report of the third Joint Working Party on Child Health Surveillance. 3rd ed. Oxford: Oxford University Press, 1996.

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9

B, Hall David M., ed. Health for all children: A programme for child health surveillance : the report of the Joint Working Party on Child Health Surveillance. 2nd ed. Oxford: Oxford University Press, 1991.

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10

B, Hall David M., ed. Health for all children: A programme for child health surveillance : the report of the Joint Working Party on Child Health Surveillance. Oxford [England]: Oxford University Press, 1989.

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11

B, Schonfeld Alison, ed. Screening adult neurologic populations: A step-by-step instruction manual. 2nd ed. Bethesda, Md: AOTA Press, 2009.

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12

B, Schonfeld Alison, ed. Screening adult neurologic populations: A step-by step instruction manual. Bethesda, MD: AOTA Press, 2003.

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13

Ries, Peter W. Americans assess their health: United States, 1987. Hyattsville, Md: U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Health Statistics, 1990.

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14

Bachmann, Max. Screening for diabetic retinopathy: A quantitative overview of the evidence applied to the populations of health authorities and boards. Bristol): Health Care Evaluation Unit, University of Bristol, 1996.

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15

Cassidy, Jim, Donald Bissett, Roy A. J. Spence OBE, Miranda Payne, and Gareth Morris-Stiff. Population screening for cancer. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199689842.003.0012.

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This chapter addresses aetiological risk factors associated with the development of a range of different tumours, and looks at the roles of diet, chemotherapy, and surgery in preventing the development of cancer.
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16

Juengst, Eric T. Population Genetic Research and Screening: Conceptual and Ethical Issues. Oxford University Press, 2009. http://dx.doi.org/10.1093/oxfordhb/9780199562411.003.0021.

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17

Hage, Fadi G., Ayman Farag, and Gilbert J. Zoghbi. Screening Asymptomatic Subjects. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0016.

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Cardiovascular disease is the leading cause of death in the United States and accounts for more deaths than all cancers combined. Many apparently healthy adults first present to the health system with a myocardial infarction or sudden cardiac death. It is therefore imperative to assess the risk of cardiovascular events among currently asymptomatic individuals to try and intervene early in the disease process to prevent future events. Risk factors for the development of coronary artery disease in particular, and cardiovascular disease in general, have been identified from epidemiological studies and used to develop global risk scores to risk stratify populations. Although these scores work well at the level of the population, unfortunately they are imperfect at estimating risk at the level of the individual. In this Chapter we will discuss the use of exercise stress testing and other imaging modalities as screening methods for the detection of coronary disease and predicting risk in asymptomatic adults. The hope is to develop a screening program to identify cardiovascular disease early in the disease process to introduce interventions that will favorably impact outcomes in a manner similar to the current screening programs available for several cancers.
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18

Ali, Najef. Population based screening program for the prevention of ischaemic heart disease. Bradford, 1987.

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19

Schröder, Fritz H. Screening for prostate cancer. Edited by James W. F. Catto. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0062.

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Screening for a disease must be clearly defined and differentiated from early detection. ‘Screening’ refers to the application of tests to the whole population or to defined segments such as males within certain defined high risk age groups. If applied in such a fashion ‘screening’ for prostate cancer may also be described epidemiologically as ‘secondary prevention’. While high-quality randomized studies show that screening reduces prostate cancer mortality by 21–44%, there is wide agreement that the introduction of population-based screening is at present premature because harms, mainly the high rate of overdiagnosis seen currently outweighs the benefits. This chapter attempts to put current knowledge into perspective with a set of recognized prerequirements for the application of screening, established by Wilson and Jungner in 1968.
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20

Nasimudeen, Abdul. Screening for respiratory disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0352.

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Routine screening for respiratory diseases is currently not available to the general healthy population, with the exception of screening for cystic fibrosis. This chapter discusses the screening strategies in place for cystic fibrosis, TB, and other conditions, such as COPD, lung cancer, alpha-1 antitrypsin deficiency, pulmonary hypertension, pulmonary arteriovenous malformation, and obstructive sleep apnoea, for which screening can be applied. While screening has the potential to improve quality of life through early diagnosis and management, it is not an easy process and cannot offer a guarantee of protection.
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21

Cader, Sarah. Screening for neurological disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0355.

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Given the nature of some neurological diseases to become progressively disabling, early detection and treatment would be very welcome. However, screening for neurological illnesses in the general population has a number of problems. There are only a few neurological conditions that exist in a detectable asymptomatic state prior to development of clinical disease, and a small number of other conditions have early symptomatic stages before the full impact of the disease manifests. In addition, in many neurological conditions, there are no definitive treatments available. There are, of course, many genetic conditions that have neurological manifestations and could be screened, and early access to neurological assessment for some progressive conditions may enable early intervention. Potential target groups include patients with neurogenetic disorders, patients with neurodegenerative disorders, patients with inflammatory disorders, and patients with metabolic disorders.
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22

Banerjee, Amitava, and Kaleab Asrress. Screening for cardiovascular disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0351.

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Screening involves testing asymptomatic individuals who have risk factors, or individuals who are in the early stages of a disease, in order to decide whether further investigation, clinical intervention, or treatment is warranted. Therefore, screening is classically a primary prevention strategy which aims to capture disease early in its course, but it can also involve secondary prevention in individuals with established disease. In the words of Geoffrey Rose, screening is a ‘population’ strategy. Examples of screening programmes are blood pressure monitoring in primary care to screen for hypertension, and ultrasound examination to screen for abdominal aortic aneurysm. The effectiveness and feasibility of screening are influenced by several factors. First, the diagnostic accuracy of the screening test in question is crucial. For example, exercise ECG testing, although widely used, is not recommended in investigation of chest pain in current National Institute for Health and Care Excellence guidelines, due to its low sensitivity and specificity in the detection of coronary artery disease. Moreover, exercise ECG testing has even lower diagnostic accuracy in asymptomatic patients with coronary artery disease. Second, physical and financial resources influence the decision to screen. For example, the cost and the effectiveness of CT coronary angiography and other new imaging modalities to assess coronary vasculature must be weighed against the cost of existing investigations (e.g. coronary angiography) and the need for new equipment and staff training and recruitment. Finally, the safety of the investigation is an important factor, and patient preferences and physician preferences should be taken into consideration. However, while non-invasive screening examinations are preferable from the point of view of patients and clinicians, sometimes invasive screening tests may be required at a later stage in order to give a definitive diagnosis (e.g. pressure wire studies to measure fractional flow reserve in a coronary artery). The WHO’s principles of screening, first formulated in 1968, are still very relevant today. Decision analysis has led to ‘pathways’ which guide investigation and treatment within screening programmes. There is increasing recognition that there are shared risk factors and shared preventive and treatment strategies for vascular disease, regardless of arterial territory. The concept of ‘vascular medicine’ has gained credence, leading to opportunistic screening in other vascular territories if an individual presents with disease in one territory. For example, post-myocardial infarction patients have higher incidence of cerebrovascular and peripheral arterial disease, so carotid duplex scanning and measurement of the ankle–brachial pressure index may be valid screening approaches for arterial disease in other territories.
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23

Great Britain. Department of Health. Public Health Medical Liaison Division., University of Leeds. School of Public Health., University of York. Centre for Health Economics., and Royal College of Physicians of London. Research Unit., eds. Screening for osteoporosis to prevent fractures: Should population based bone screening programmes aimed at the prevention of fractures in elderly women be established?. Leeds: Consortium of the School of Public Health, University of Leeds and Centre for Health Economics, University of York and the Research Unit of the Royal College of Physicians, with the support of thePublic Health Medical Liaison Division of the Department of Health, 1992.

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24

Active Detention of Obstructive Airways Disease in the General Population: A Screening Survey (DIMCA Project). University of Nijmegen, 1997.

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25

Sorn, Nancy L. A comparison of techniques used in the screening of language processing abilities in the adolescent population. 1987.

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26

Scheuner, Maren T., Marcia Russell, Jane Peredo, Alison B. Hamilton, and Elizabeth M. Yano. Implementing Lynch Syndrome Screening in the Veterans Health Administration. Edited by David A. Chambers, Wynne E. Norton, and Cynthia A. Vinson. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190647421.003.0024.

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Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Diagnosis of LS has important clinical implications for CRC patients and their family members. LS screening in tumor tissue is possible, and screen-positive cases are referred for diagnostic testing. This case study describes how implementation science informed a population-based LS screening program in the Veterans Health Administration (VHA), the largest integrated health care delivery system in the United States. Successful implementation strategies relied on the organizational structures and processes characteristic of integrated health care systems, including data warehousing methods that leverage the electronic health record, case management, and centralized technical assistance. Challenges to sustainability of the population-based program include low prevalence of LS among veterans, limited expertise, organizational changes, and the rapidly evolving field of precision oncology. LS screening is an exemplar case study for implementation science in integrated health care delivery systems.
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27

Health for All Children: Report of the Third Working Party on Child Health Surveillance. 3rd ed. Oxford University Press, USA, 1996.

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28

Gareri, Joey Nicky. Fetal ethanol exposure and meconium analysis of fatty acid ethyl esters in neonatal screening: The first Canadian population-based study. 2006.

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29

M, Hardy Leslie, and Institute of Medicine (U.S.). Committee on Prenatal and Newborn Screening for HIV Infection., eds. HIV screening of pregnant women and newborns. Washington, D.C: National Academy Press, 1991.

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30

HIV Screening of Pregnant Women And Newborns. Natl Academy Pr, 1990.

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31

Lawrence, Paszat, and Canadian Coordinating Office for Health Technology Assessment., eds. A population-based cohort study of surveillance mammography after treatment of primary breast cancer. Ottawa: Canadian Coordinating Office for Health Technology Assessment, 2001.

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32

Screening Adult Neurologic Populations. AOTA Press, 2019.

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33

Bhopal, Raj S. Interrelated concepts in the epidemiology of disease: Natural history and incubation period, time trends in populations, spectrum, iceberg, and screening. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198739685.003.0006.

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The natural history of disease is the uninterrupted progression of disease from its initiation to either spontaneous resolution, containment by the body’s repair mechanisms, or to a clinically detectable problem. Related concepts include the changing pattern of disease in populations and levels of severity (spectrum) of disease. Often the number of cases identified is exceeded by those not discovered. An illustrative metaphor for this is the iceberg. The pyramid of disease develops this into a population concept. Screening is the application of tests to diagnose disease (or precursors) in an earlier phase of the natural history of disease, often in well people, or in a less severe part of the disease spectrum than is achieved in routine medical practice. The potential of screening is vast but there are important limitations, such as the inability to influence the natural history of many diseases.
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34

Levesque, Anna, and Edward V. Nunes. Recognizing Addiction in Older Patients. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.003.0002.

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Alcohol and substance-use disorders in older adults can present in primary care practice in subtle or confusing ways. Screening and diagnostic tools validated in younger populations may limit their recognition. The main objective of this chapter is to differentiate signs and symptoms of alcohol or substance use disorder from other medical and psychiatric comorbidities. We review normal metabolic changes associated with aging as well as clinical features of harmful drinking. The risks of combining alcohol with psychoactive prescription medications are also considered. The relevance of DSM-5 diagnostic criteria to older patients is explored, and we review the evidence for the importance of systematic screening using validated instruments in an older population. Therapeutic vs. aberrant uses of psychoactive prescription medications in the geriatric population are discussed. Finally, we review patterns of illicit substance use in older adults.
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35

Rayner, Mike, Kremlin Wickramasinghe, Julianne Williams, Karen McColl, and Shanthi Mendis, eds. An Introduction to Population-level Prevention of Non-Communicable Diseases. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198791188.001.0001.

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This book is based on the content covered during the non-communicable disease (NCD) prevention short course at the University of Oxford. It provides theoretical background and ‘real life case studies’ helping readers to apply the learnings to their day-to-day work. It covers case studies from both high-income countries and low- and middle-income countries. This book is structured around the four stages of the policy cycle: (1) problem definition; (2) solution generation; (3) resource mobilization and implementation; and (4) evaluation. Chapters 2–7 focus on problem definition, which involves understanding the burden of NCDs, its risk factors, the sociopolitical landscape, the role of advocacy, and screening and surveillance. Chapters 8–10 are about solution generation, which involves examining the evidence for potential costs and benefits of interventions, while also considering contextual factors, including the ethical and political dimensions of different solutions. Chapters 11–13 are on implementation and the mobilization of resources, both the money needed for material aspects of the interventions and the people required to plan for and carry out the interventions. Chapter 14 is about evaluation and monitoring, which may be designed to assess whether interventions met their aims and objectives. Given the cyclical nature of the policy cycle, the final chapter is about returning to the various stages. NCD prevention does not always follow the stages of the policy cycle in a strict sequence and often, NCD interventions will need revisiting in light of the experiences and lessons learned from earlier stages.
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36

Health for All Children: A Programme for Child Health Surveillance (Oxford Medical Publications). Oxford University Press, USA, 1992.

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37

Gutman, Sharon A., and Alison B. Schonfeld. Screening Adult Neurologic Populations (Rheumatologic Rehabilitation Series. Aota Press, 2003.

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38

Mathiesen, Amber, and Kali Roy. Carrier Screening. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190681098.003.0006.

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This chapter provides information on carrier screening options available, including testing based on ethnicity, targeted to the family history or clinical situation, or by use of expanded carrier testing panels. It describes who should be offered testing, the timing of testing, how to evaluate the risks of conditions being tested, and how to interpret results, in addition to providing a brief description of newborn screening. The chapter describes testing protocols for specific conditions including cystic fibrosis, spinal muscular atrophy, FMR-1–related conditions, and hemoglobinopathies. It reviews ethnicity-based screening, as in Ashkenazi Jewish and French Canadian populations, as well as screening when there is a family history. It also discusses the use, benefits, and recommendations when offering expanded carrier screening.
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39

Pirson, Yves, and Dominique Chauveau. Management of intracranial aneurysms. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0310.

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An asymptomatic intracranial aneurysm (ICA) is found by screening in about 8% of patients with autosomal dominant polycystic kidney disease (ADPKD), with a trend to cluster in some families. Though most ICAs will remain asymptomatic, a minority of them may rupture, causing subarachnoid haemorrhage (SAH). Given the grave prognosis of ICA rupture, screening and prophylactic repair of unruptured ICAs have to be considered, with the aim to identify patients with a risk of ICA rupture that exceeds the risk of a prophylactic procedure, surgical or endovascular. Relying on a decision analysis model established in the general population, widespread screening in ADPKD patients is today not recommended. However, the chapter authors advise screening in ADPKD patients with a familial history of ICA or SAH. Additional acceptable indications are high-risk occupations and patient anxiety despite adequate information. Screening is preferably performed by high-resolution, three-dimensional, time-of-flight magnetic resonance imaging. When an asymptomatic ICA is found, a recommendation for whether to intervene depends on its size, site, morphology, patient life expectancy, and general health as well as the experience of the neuroradiologist–neurosurgeon team. Since the risk of new ICAs or enlargement of an existing one is very low in those with small (< 6 mm) ICAs, conservative management is usually recommended. Elimination of tobacco use and aggressive treatment of hypertension are strongly recommended.
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40

Beattie, R. Mark, Anil Dhawan, and John W.L. Puntis. Cystic fibrosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0021.

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Gastrointestinal manifestations 156Management of gastrointestinal symptoms in children with CF 158Nutrition in CF 158Nutritional management 159Vitamins 160The incidence of cystic fibrosis (CF) is around 1 in 2500. Cases are diagnosed as a consequence of population screening or high-risk screening, or following presentation with clinical symptoms typical of the disorder. The basic defect is in the CFTR (cystic fibrosis transmembrane conductance regulator) protein which codes for a cyclic adenosine monophosphate-regulated chloride transporter in epithelial cells of exocrine organs. This is involved in salt and water balance across epithelial surfaces. The gene is on chromosome 7. There are multiple known mutations, the most common being ...
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41

Chakera, Aron, William G. Herrington, and Christopher A. O’Callaghan. Screening for kidney disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0353.

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Renal disease is common and, with routine reporting of estimated glomerular filtration rates, impairment of renal function is increasingly being recognized. As renal impairment is usually asymptomatic until very advanced, chronic kidney disease (CKD) guidelines have been developed to improve the identification and screening of at-risk populations. Target groups include patients with vascular risk factors (e.g. diabetes mellitus and hypertension); patients with certain multisystem diseases which can cause renal impairment; patients with urological conditions; patients on nephrotoxic medication; and immediate relatives of patients with established renal disease. Kidney function should also be checked during intercurrent illness and perioperatively in all patients with CKD or suspected CKD. The frequency of screening is dictated by the CKD stage.
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42

Casanova, Nancy G., Ting Wang, Eddie T. Chiang, and Joe G. N. Garcia. Genomics, Epigenetics, and Precision Medicine in Integrative Preventive Medicine. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190241254.003.0004.

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This chapter briefly reviews the use of genomewide screening for early detection, treatment, and prevention and the utility of genome-based biomarkers as a tool for precision medicine and its application to population and integrative preventive medicine. Advances in technology have made genomic screening more affordable and widely available, and both our understanding and the value of testing grow as more data is collected. Even more recently, the growing availability of epigenetic testing, methylation and ROS-associated molecular signatures are providing more insight into dynamic aspects of the human genome and how lifestyle and IPM change affect the expression of the genome. Early adoption of precision medicine in oncology offers a model that should be expanded into wider areas of treatment and prevention.
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43

Sullivan, Maria, and Frances Levin, eds. Addiction in the Older Patient. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.001.0001.

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Addictive disorders in older adults are underdiagnosed and undertreated. An important reason for this lack of recognition of a serious health problem is a paucity of clinical knowledge about how such disorders present in this population. The presentation for alcohol and substance use disorders in the elderly can be confusing, given the metabolic changes and concurrent conditions associated with aging, together with interactions between alcohol and prescribed psychoactive drugs. Further, screening instruments have not been validated for this population. Brief interventions may be effective but should take into account contextual needs such as medical conditions, cognitive decline, and mobility limitations. Treatment strategies, including detoxification regimens, need to be modified for older patients and - in the case of opioid dependence - must address the management of chronic pain in this population. Ironically, benzodiazepines are the most frequently prescribed psychoactive medication in the elderly, despite older individuals' greater sensitivity to side effects and toxicity. Older women are at particularly heightened vulnerability for iatrogenic dependence on sedatives and hypnotics. More clinical research data are needed to inform screening and referral strategies, behavioral therapies, and pharmacological treatment. At the same time, emerging technologies such as communication tools and monitoring devices offer important opportunities to advance addiction treatment and recovery management in older adults. Although research to date has been limited in this population, recent data suggest that treatment outcomes are equal or better to those seen in younger cohorts.
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44

Foley, Frederick W. Assessment and Treatment of Sexual Dysfunction in Multiple Sclerosis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199341016.003.0016.

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This chapter discusses the signs and symptoms of sexual dysfunction that are common in persons with multiple sclerosis. The epidemiology of sexual dysfunction in this patient population is presented, along with techniques and instruments for screening for sexual dysfunction. Definitions of primary, secondary, and tertiary sexual dysfunction are reviewed, and a detailed discussion of treatment strategies is presented, including pharmacologic agents, devices, and behavioral interventions.
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45

Wong, Germaine, and Angela C. Webster. Cancer after kidney transplantation. Edited by Jeremy R. Chapman. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0287.

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Cancer is a major cause of mortality and morbidity after transplantation. The overall risk of cancer among transplant recipients is at least 2.5–3-fold greater than that of the age- and gender-matched general population. The increased risk is also type specific, and is greatest among virus-related neoplasms such as Kaposi sarcoma, post-transplant lymphoproliferative disease, and vulvovaginal cancers, with an excess risk of at least 9–20 times greater than that of the general population. Cancer prognoses are also poor in transplant recipients, with less than 10% surviving 5 years after initial diagnoses. Despite the increased cancer risk, little is known about the efficacy of treatment, the screening strategies, and the outcomes of patients with cancer and kidney transplants. Uncertainties also exist as to how the various types of modern immunosuppression impact on recipients’ overall long-term survival and quality of life. This chapter discusses the incidence and prognoses of patients with de novo cancer after transplantation, the epidemiology of donor cancer transmission, the outcomes of transplanting patients with a prior history of cancer, as well as the different approaches to cancer screening and management after kidney transplantation.
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46

O’Connell, Henry, and Brian Lawlor. Alcohol and substance abuse in older people. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199644957.003.0049.

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This chapter highlights the importance of alcohol use disorders (AUDs), inappropriate medication use (IMU) and use of illicit drugs in older people. Such problems are associated with considerable morbidity and will become more important with the ageing ‘baby-boomer’ generation in coming years. AUDs are under-detected, misdiagnosed and often completely missed in older populations. However, despite ageist and pessimistic assumptions, AUDs in older people are as amenable to treatment as in younger people. IMU in older people includes abuse of prescribed medications such as benzodiazepines and opiates, unnecessary treatment of medical and psychiatric conditions and toxic drug reactions related to inappropriate polypharmacy. Screening and treatment programmes for IMU could lead to considerable improvements in individual and population health. Misuse of illicit drugs, e.g. marijuana, cocaine, opioids and stimulants, by older people is not yet a major problem, but will probably become more prevalent and be a more important clinical issue for future generations of older people.
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47

Burgard, Michael, and Robert Kohn. Substance Use Disorders in the Elderly. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199374656.003.0030.

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Substance use disorders in older adults remains lower than in younger adults; however, the prevalence is rising in the elderly population. In the United States, the lifetime prevalence of an alcohol use disorder among persons age 65 and older is 16.1%. Studies of Veteran’s Administration nursing home residents have found that 29% to 49% of those admitted have a lifetime diagnosis of alcohol use disorder. A sizable proportion of the elderly acknowledge driving under the influence. In 2013, 1.5% of the elderly had used illicit drugs. The number requiring treatment for substance abuse is expected to double by 2020. The populations with the fastest increase in opiate mortality are those age 55 and older, including those 65 and older. This chapter presents the epidemiology of substance use among older adults and discusses issues related to elders’ substance use, including use in nursing homes, impaired driving and arrests, use of non-prescription medications, screening for substance use, and treatment.
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48

Mutyambizi, Kudakwashe. Dermatologic Complications. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190493097.003.0034.

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The hallmark of HIV infection is immune dysregulation and immunosuppression. As the immune system deteriorates, inflammatory dermatoses, metabolic dysregulation, adverse drug reactions, opportunistic infections, and cutaneous malignancies become more common, atypical in presentation, and recalcitrant to therapy. Both acute and chronic skin complaints contribute significantly to reduced quality of life for HIV patients. The Centers for Disease Control and Prevention recommends that individuals between ages 13 and 64 years be tested for HIV at least once in their lifetime, with increased screening of high-risk individuals and testing based on symptoms. The presence of dermatoses uncommon in the general population but concentrated in the HIV population, or dermatoses strikingly recalcitrant to therapy, should warrant suspicion and testing for HIV.
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49

Gulliford, Martin, and Edmund Jessop, eds. Healthcare Public Health. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780198837206.001.0001.

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Healthcare public health is concerned with the application of population sciences to the design, organization, and delivery of healthcare services, with the ultimate aim of improving population health. This book provides a modern introduction to the methods and subject matter of healthcare public health, bringing together coverage of all the key areas in a single volume. Topics include healthcare needs’ assessment; access to healthcare; knowledge management; ethical issues; involvement of patients and the public; population screening; health promotion and disease prevention; new service models; programme budgeting and preparation of a business case; evaluation and outcomes; patient safety, and implementation and improvement sciences; healthcare in remote and resource-poor regions; and disasters and emergencies. Drawing on international perspectives, this volume will be relevant wherever healthcare is delivered. It will enable students, researchers, academics, practitioners, and policy makers to contribute to the goals of designing and delivering health services that improve population health, reduce inequalities, and meet the needs of individuals and communities.
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50

Chong, Ji Y., and Michael P. Lerario. A Sickle Pickle. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190495541.003.0029.

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Abstract:
Sickle cell disease may result in large vessel intracranial stenoses, which cause high rates of stroke. Screening for elevated velocities on transcranial Dopplers is a good way to stratify stroke risk. Patients at high stroke risk should participate in an exchange transfusion program indefinitely to reduce the rate of subsequent stroke. Although there is a high risk of stroke in pediatric sickle cell patients, the use of IV tPA in this population is largely unstudied and not routinely recommended due to unclear safety and efficacy.
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