In 2009, an influential panel of medical experts ignited a controversy when they recommended that most women should not begin routine mammograms to screen for breast cancer until the age of fifty, reversing guidelines they had issued just seven years before when they recommended forty as the optimal age to start getting mammograms. While some praised the new recommendation as sensible given the smaller benefit women under fifty derive from mammography, many women's groups, health care advocates, and individual women saw the guidelines as privileging financial considerations over women's health and a setback to decades-long efforts to reduce the mortality rate of breast cancer. In The Big Squeeze, Dr. Handel Reynolds, a practicing radiologist, notes that this episode was only the most recent controversy in the turbulent history of mammography since its introduction in the early 1970s. In a book written for the millions of women who face the decision about whether to get a mammogram, health professionals interested in cancer screening, and public health policymakers, Reynolds shows how pivotal decisions made during mammography's initial launch made it all but inevitable that the test would be contentious. He describes how, at several key points in its history, the emphasis on mammography screening as a fundamental aspect of women's preventive health care coincided with social and political developments, from the women's movement in the early 1970s to breast cancer activism in the 1980s and '90s. At the same time, aggressive promotion of mammography made the screening tool the cornerstone of a huge new industry. Taking a balanced approach to this much-disputed issue, Reynolds addresses both the benefits and risks of mammography, charting debates, for example, that have weighed the early detection of aggressively malignant tumors against unnecessary treatments resulting from the identification of slow-growing and non-life-threatening cancers. The Big Squeeze, ultimately, helps to evaluate the ongoing public health controversies surrounding mammography and provides a clear understanding of how mammography achieved its current primacy in cancer screening.

In 2009, an influential panel of medical experts ignited a controversy when they recommended that most women should not begin routine mammograms to screen for breast cancer until the age of fifty, reversing guidelines they had issued just seven years before when they recommended forty as the optimal age to start getting mammograms. While some praised the new recommendation as sensible given the smaller benefit women under fifty derive from mammography, many women's groups, health care advocates, and individual women saw the guidelines as privileging financial considerations over women's health and a setback to decades-long efforts to reduce the mortality rate of breast cancer.

In The Big Squeeze, Dr. Handel Reynolds, a practicing radiologist, notes that this episode was only the most recent controversy in the turbulent history of mammography since its introduction in the early 1970s. In a book written for the millions of women who face the decision about whether to get a mammogram, health professionals interested in cancer screening, and public health policymakers, Reynolds shows how pivotal decisions made during mammography s initial launch made it all but inevitable that the test would be contentious. He describes how, at several key points in its history, the emphasis on mammography screening as a fundamental aspect of women s preventive health care coincided with social and political developments, from the women s movement in the early 1970s to breast cancer activism in the 1980s and 90s.

At the same time, aggressive promotion of mammography made the screening tool the cornerstone of a huge new industry. Taking a balanced approach to this much-disputed issue, Reynolds addresses both the benefits and risks of mammography, charting debates, for example, that have weighed the early detection of aggressively malignant tumors against unnecessary treatments resulting from the identification of slow-growing and non-life-threatening cancers. The Big Squeeze, ultimately, helps to evaluate the ongoing public health controversies surrounding mammography and provides a clear understanding of how mammography achieved its current primacy in cancer screening."

No Family History presents compelling evidence of environmental links to breast cancer, ranging from everyday cosmetics to industrial waste. Sabrina McCormick weaves the story of one survivor with no family history into a powerful exploration of the big business of breast cancer. A growing number of experts argue that we should increase focus on prevention--reducing environmental exposures that have contributed to the sharp increase of breast cancer rates. But the dollars continue to pour into the search for a cure, and the companies that profit, including some pharmaceutical and cosmetics companies, may in fact contribute to the environmental causes of breast cancer. No Family History shows how profits drive our public focus on the cure rather than prevention, and suggests new ways to reduce breast cancer rates in the future.

No Family History presents compelling evidence of environmental links to breast cancer, ranging from everyday cosmetics to industrial waste. Sabrina McCormick weaves the story of one survivor with no family history into a powerful exploration of the big business of breast cancer. As drugs, pink products, and corporate sponsorships generate enormous revenue to find a cure, a growing number of experts argue that we should instead increase focus on prevention reducing environmental exposures that have contributed to the sharp increase of breast cancer rates. But the dollars continue to pour into the search for a cure, and the companies that profit, including some pharmaceutical and cosmetics companies, may in fact contribute to the environmental causes of breast cancer. No Family History shows how profits drive our public focus on the cure rather than prevention, and suggests new ways to reduce breast cancer rates in the future."

Bilder vom guten Arzt, vom aufgeklarten Patienten, von der mitfuhlenden Krankenschwester, vom guten Sterben, von zertifizierten Krankenhausern, von funktionierender Technik lassen sich besser verstehen, wenn man sie als praktikable Schemata begreift, die ein Versprechen formulieren. An ihrem Entstehungsort, den Organisationen, funktionieren sie wie ein Kredit, der uns als Betroffene abzusichern scheint, obwohl die Zukunft ungewiss bleiben muss."

The process of discovery in science and technology may require investigation of a large number of features, such as factors, genes or molecules. In Screening, designed experiments and statistical analyses of the resulting data sets are used to identify efficiently the few features that determine key properties of the system under study.

This book brings together accounts by leading international experts that are essential reading for those working in fields such as industrial quality improvement, engineering research and development, genetic and medical screening, drug discovery, and computer simulation of manufacturing systems or economic models. Our aim is to promote cross-fertilization of ideas and methods through detailed explanations, a variety of examples and extensive references.

Topics cover both physical and computer simulated experiments. They include screening methods for detecting factors that affect the value of a response or its variability, and for choosing between various different response models. Screening for disease in blood samples, for genes linked to a disease and for new compounds in the search for effective drugs are also described. Statistical techniques include Bayesian and frequentist methods of data analysis, algorithmic methods for both the design and analysis of experiments, and the construction of fractional factorial designs and orthogonal arrays.

The material is accessible to graduate and research statisticians, and to engineers and chemists with a working knowledge of statistical ideas and techniques. It will be of interest to practitioners and researchers who wish to learn about useful methodologies from within their own areaas well as methodologies that can be translated from one area to another.

In Cancer Screening: A Practical Guide for Physicians, a panel of highly experienced clinicians and researchers from around the world present their up-to-date screening techniques for a wide variety of cancers. The techniques range from screening for breast, gynecological, and gastrointestinal cancers, to testing for urogenital, dermatological, and respiratory cancers. In addition to providing the busy practitioner with quick access to guidelines for particular cancers, the epidemiology and biology of the various cancers, as well as the sensitivity and specificity of the methods, are discussed in detail. Authoritative and physician-friendly, Cancer Screening: A Practical Guide for Physicians offers to all internists, oncologists, various subspecialists, and primary care physicians a concise practical review of cancer screening designed specifically for daily use in the consulting room.

For more than 30 years the impairment standards of choice for physicians! This new edition contains the most consensus-based, scientific and clinical information from every relevant medical speciality. Enhanced coverage of chronic pain assessment and new conditions, such as HIV and latex alergy. Major enhancements to cardiology, skin, visual, respiratory and musculoskeletal systems. Standardized formatting across topics makes it more accessible than ever.

Nicotine has been developed as a medication to assist smoking cessation, and is being considered as a possible drug for long-term maintenance of non-smoking. It is also undergoing evaluation as a possible treatment for several medical disorders, including ulcerative colitis, Alzheimer's disease, Parkinson's disease, Tourette's syndrome, attention deficit disorder, spasticity, and sleep apnea. Understanding its safety and toxitity is essential for drug developers, drug regulators, and clinicians making risk/benefit decisions about long-term nicotine therapy. Research on nicotine toxicity is also relevant to ongoing research on tobacco and health aimed at understanding the role of nicotine in contributing to tobacco-induced diseases. This book reviews the current scientific understanding of the safety and toxicity of nicotine. The discussion ranges from chemistry, studies in animals and human experimental research to the results of large clinical trials. Among the topics covered are cardiovascular disease, cancer, reproductive toxicity (including fetal toxicity and Sudden Infant Death Syndrome), behavioral toxicity (including abuse liability and addiction to nicotine medication), and gastrointestinal disease. Finally, contributions explore the risks and benefits of nicotine as a medication. The authors are world-renowned experts on their respective topics. No other book addresses nicotine toxicity in the depth or breadth of this volume. A book on the cutting edge of contemporary public health discourse, Nicotine Safety is an up-to-date and lucid overview of current knowledge on the subject. It will be a necessary addition to the bookshelves of clinicians with an interest in tobacco and health, drug developers and researchers, pharmacologists and toxicologists, public health researchers and policy-makers.

This book examines mortality rates for African-Americans in selected U.S. urban areas in relation to both social class and the degree of black-white residential segregation. Mortality rates for African-American infants and young adults are shown to be especially high in certain highly-segregated areas. The findings will foster the development of the "epidemiology of American apartheid", a new field of research that has relevance to social and health policy. The intended audience includes sociologists (especially medical sociologists) who are likely to be familiar with segregation but not with its potential relevance to the health of African-Americans. Epidemiologists have recently turned to the study of racism and health, but epidemiologic studies have not dealt specifically with black-white segregation and health. Psychologists interested in racism are important potential collaborators with sociologists and epidemiologists in studies of the epidemiology of racial difference in health. Readers working in social policy and health policy areas, including urban issues, should also find relevant material. This work fits within the framework of Swedish economist Gunnar Myrdal's thesis that the American creed of equality of opportunity remains unfulfilled.

Throughout the world, injuries are the leading cause of death during more than half of the average life span. This book documents the nature and magnitude of the problem and provides basic approaches to injury prevention. Injury statistics are given for many developing countries and indigenous populations as well as industrialized nations. Important differences among countries and cultures in types and circumstances of injury are illustrated in a tables and figures that enhance the book's usefulness. The many types of injuries covered in detail include those related to traffic, occupation, disasters, drowning, falls, burns, suicide, and homicide. The cost and health impacts of injury are discussed as well as the role of health services. The authors describe surveillance methods and effective preventive measures that are applicable even in countries with limited resources. This book has been written for public health practitioners and researchers as well as policy makers. Reflecting the author's many years of injury prevention experience in a variety of countries, the book will help readers understand this major health problem, the changes that could reduce it, and the means of influencing crucial public policies.

This is a unique, in-depth discussion of the uses and conduct of cost-effectiveness analyses (CEA) as decision-making aids in the health and medical fields. The product of over two years of deiberation by a multi-disciplinary Public Health Service appointed panel that included economists, ethicists, psychometricians, and clinicians, it explores cost-effectiveness in the context of societal decision-making for resource allocation purposes. It proposes that analysts include a "reference-case" analysis in all CEA's designed to inform resource allocation and puts forth the most expicit set of guidelines (together with their rationale) ever outlined of the conduct of CEAs. Important theoretical and practical issues encountered in measuring costs and effectiveness, valuing outcomes, discounting, and dealing with uncertainty are examined in separate chapters. These discussions are complemented by additional chapters on framing and reporting of CEAs that aim to clarify the purpose of the analysis and the effective communication of its findings. Primarily intended for analysts in medicine and public health who wish to improve practice and comparability of CEAs, this book will also be of interest to decision-makers in government, managed care, and industry who wish to consider the roles and limitations of CEA and become familiar with criteria for evaluating these studies.

As screening programs for HIV, high cholesterol, high blood pressure, genetic abnormalities and other risk factors continue to proliferate, difficult questions are continually raised concerning the psychological and behavioral effects on the participants. Although members of the public health community have debated the costs and benefits of screening programs for over three decades, these questions have become especially pertinent with the current emphasis on early disease detection and prevention. While advocates argue that risk notification provides the impetus for individuals to improve their health habits and seek early treatment, skeptics contend that risk screening can have an adverse labeling effect, leading to increased anxiety, work absenteeism, and fatalism.
Now, for the first time, the widely scattered body of research on the effects of risk factor screening is comprehensively reviewed and evaluated in this volume. Here, an internationally recognized group of expert contributors summarizes and discusses current knowledge about the psychosocial consequences of risk factor testing, taking into account individual differences, gender differences, risk status, and intervention strategies. Both the public health and behavioral science viewpoints are explored through up-to-date reviews and stimulating commentary. Bridging the gap between data, theory and public health policy, this volume is essential reading for researchers, professionals and policymakers concerned with the prevention of acute and chronic disease.

Chronic diseases and premature death can often be linked to social, environmental, and behavioral factors that are subject to modification, especially during adolescence when many habits--both good and bad--are formed. In order to effectively encourage good health-related behaviors among adolescents, health providers need an integrated understanding of the many factors involved. This volume fills that need by providing the most comprehensive, up-to-date review of the pertinent issues, including in-depth discussions on adolescent sexuality, substance abuse, the future of adolescent health promotion, and the relationship between socioeconomic status and health-related behaviors. The outstanding group of contributors represents a wide variety of disciplines and offers proven techniques and approaches that can help future adults enjoy longer, safer, more productive lives. With an emphasis on practical solutions, Promoting the Health of Adolescents will be of value to health and social scientists, health care providers, educators, and administrators who plan and implement programs for adolescent health.

Todos deberian tener acceso a los servicios de salud que necesitan sin verse empobrecidos al pagar por ellos. En el presente informe se afirma que la cobertura sanitaria universal -junto con el pleno acceso a servicios de calidad en materia prevencion, tratamiento y proteccion contra los riesgos financieros- no puede alcanzarse sin los datos objetivos que proporciona la investigacion cientifica. Se sostiene que todas las naciones deberian ser productoras de investigaciones tanto como consumidoras. El proceso de descubrimiento deberia tener lugar no solo en los centros universitarios sino tambien en los programas de salud publica en los que las personas buscan atencion sanitaria y utilizan los servicios proporcionados. Las investigaciones, desde los ensayos clinicos hasta los estudios sobre politicas de salud, pueden ayudar trazar el rumbo hacia la mejora de los resultados sanitarios y la reduccion de la pobreza, pero para tener exito es preciso que cuenten con el respaldo nacional e internacional."

Proposals for screening pregnant women and newborns for HIV infection have provoked much controversy. This volume analyzes the possible goals of such screening programs and assesses whether these goals can currently be achieved. It also provides guidance to policymakers in developing and implementing sound screening policy.

It has been close to six decades since Watson and Crick discovered the structure of DNA and more than ten years since the human genome was decoded. Today, through the collection and analysis of a small blood sample, every baby born in the United States is screened for more than fifty genetic disorders. Though the early detection of these abnormalities can potentially save lives, the test also has a high percentage of false positives - inaccurate results that can take a brutal emotional toll on parents before they are corrected. Now some doctors are questioning whether the benefits of these screenings outweigh the stress and pain they sometimes produce. In "Saving Babies?" Stefan Timmermans and Mara Buchbinder evaluate the consequences and benefits of state-mandated newborn screening - and the larger policy questions they raise about the inherent inequalities in American medical care that limit the effectiveness of this potentially lifesaving technology. Drawing on observations and interviews with families, doctors, and policy actors, Timmermans and Buchbinder have given us the first ethnographic study of how parents and geneticists resolve the many uncertainties in screening newborns. Ideal for scholars of medicine, public health, and public policy, this book is destined to become a classic in its field.