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For evidence-based screening of high-risk groups, a pro grammatic approach can be recom mended, provided the quality and the cost-effectiveness of the screen ing process are assured. Two recent reviews estimated be imprecise and underestimate the For a programme to be considered that for every one or two overdiag benefts of screening, calculations of an organized screening programme, nosed cases, at least one death the mortality beneft based on precise a public cancer screening policy due to breast cancer was avoided, individual data tend to be highly ac documented in a law, or an offcial a balance between beneft and harm curate. Although many people con regulation, decision, directive, or considered to be appropriate [22,23]. The the potential for overdiagnosis death to greatly outweigh the risks policy should defne, as a minimum, is substantial when screening for of overdiagnosis and overtreatment, the screening protocol and repeat prostate cancer by determining se strict quality assurance practices interval, and determinants of eligi rum prostate-specifc antigen levels must be maintained to minimize all bility for screening. Provision of screening Randomized Study of Screening for People eligible for population-based in organized programmes is recom Prostate Cancer [26], have not indi screening are defned by age and/or mended because these include an cated a disease-specifc mortality gender, as well as the cancer bur administrative structure responsible reduction, both trials suggest that den for the relevant tumour type. The recom maintaining the requisite quality, statistical methods,all such estimates mended interval commonly varies and reporting on performance and are subject to uncertainty. Such organizational and cancer-registry-based studies tend to middle income countries, cervical managerial elements generally 326 Fig. Therefore, only a small number of people can derive a direct health beneft from attending screening. However, all participants are exposed to the risks of screening, and although these are slight, the risks add up. To achieve the beneft of cancer screening, quality must be optimal at every step in the screening process, in cluding identifcation and personal invitation of each eligible individual; performance of the screening test, examination, or procedure; diagnos tic work-up of people with detected abnormalities; and, when neces provide for supervision and monitor via mobile phones suggests that sary, treatment, surveillance, and ing of most steps in the screening such methods of communication warrant further investigation [30]. In practice, process, as well as comprehensive the process of screening is much guidelines and rules defning stan more complex than the schematic dard operating procedures. Such screening relies ing whether diagnostic work-up is on a health-care provider taking the warranted involves at least fve dif Population-based initiative to offer screening or to en ferent activities. Diagnostic work-up programmes courage individuals to participate in and clinical management of the le Population-based screening pro a screening programme, or to under sions detected in screening require grammes identify and individually take screening outside the context multidisciplinary teamwork and can invite each person in the eligible of any programme (so-called wild be complicated. Individual invitations tings, opportunistic screening has programmes follow comprehen aim to give each person in the eli been associated with lower overall sive quality assurance guidelines gible population an equal chance impact of screening and lower par with evidence-based standards, of benefting from screening and ticipation rates [32]. In addition, the procedures, and protocols of best to thereby reduce health-care total volume of resources consumed practice that are continuously being inequalities [29]. This leads Evaluation of the impact of a communication for groups with lim to overuse of screening resources screening programme on cancer ited access to screening, such as by part of the target population and mortality is a long-term objective of less-advantaged socioeconomic underuse by, or lack of coverage of, quality assurance.

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The very low coefficient of friction and ceramic bearing surfaces have been use of ceramic-on-ceramic bearings demonstrate the lowest wear rates of associated with squeaking that is audi offers many advantages in terms of any implant bearing surface. Initially wear reduction, especially for young are scratch resistant and may be com believed to occur rarely (~1%) in and active patients. Compared with the limited cera tumors, have been seen following arthroplasty dislocation rates Clin mic ball neck lengths available, oxini large-head metal-on-metal hip replace Orthop Relat Res 2006;447:34-38. Early ing), and poor fixation led to early fail poor outcome if they occur, even after complications of primary total hip re ures of many hip replacements using revision surgery. J Bone Joint Surg Am 2006; central-head bearing and minimal wear Total hip arthroplasty has become the 88:(suppl):221-233. This finding orders leading to arthritis in the adult sion minimally invasive total hip arthro led to a resurgence of interest in metal population. Orthop on-metal surface bearings, and an long-term clinical results, implant fix Clin North Am 2004;35:163-172. Metal bearings support active patients undergoing total hip patients with hip arthroplasty. A 12-year the use of a larger femoral head size, replacement, the challenge will be the radiographic review. J Bone Joint Surg Br which demonstrates better fluid-film bearing surface selection. Primary total hip arthroplasty with a binations, making metal-on-metal rates and the fewest wear-related com porous-coated acetabular component. The long with improved joint stability and a term results of the original Exeter pol reduced risk of dislocation. Sixteen-year follow-up of the cemented mium in patients with metal-on-metal hip 31. The Exeter Universal cemented femoral tures following Birmingham hip resurfac 33. J Bone ment of arthritic hips by the McKee-Far of a randomized trial and a registry. The mid-term results of a dual metal hip resurfacing versus large-diam plasty of the hip by the ring prosthesis.

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The researchers also found a correlation between higher levels of nickel and chromium and the magnitude of earthquakes. Heavy metal dispersal from abandoned Spanish mines Researchers have shown how heavy metals present in tailings from the Cabezo Rajao abandoned mining area in south east Spain are transported by surface runof and strong winds. The mine is very close to the protected environmental area, the mar menor Coastal lagoon. The area surrounding the mine is rich in carbonates, which are naturally alkaline. This alkalinity plays an important role in metal stability by balancing the pH of the acidic mine tailings and allowing more of the metals to be bound to soils and sediments, with fewer in soluble form. This means that there is no transfer of soluble heavy metals to the protected lagoon. In soils in this region, arsenic applications of arsenic include antifungal wood preservatives (e. Arsenic compounds are used in small amounts greater threat is considered to be arsenic in drinking water. Much of the evidence for the long-term efects of arsenic on human health comes from south-east Asia where there is a natural belt of However, arsenic poses serious short and long-term threats to health, arsenic-rich alluvium or sediments which were deposited millions of and so eforts to reduce exposure to arsenic from all sources are years ago in the Bramaputra and Ganges river basins. When individuals are exposed to arsenic over the long of India, Myanmar and Nepal are all afected, and mining in areas term, the frst changes are usually in skin pigmentation, followed by of Tailand has also caused arsenic contamination. The long million people may be at risk from arsenic-related disease as a result of list of other long-term exposure efects includes peripheral neuropathy, contaminated water in the region (Caussy, 2005). Even where land is contaminated, plants rarely contain much arsenic; cereals and vegetables, especially where soil is sandy, have the Sources of arsenic exposure greatest concentrations of arsenic. Initial studies show this to be the case for indigenous people in the South American Andes, who have lived with arsenic We can take in arsenic in our food, including fsh, shellfsh, meat, dairy contaminated drinking water for thousands of years (as evidenced by products and cereals. The type of arsenic found in fsh and shellfsh is samples taken from mummies), and who carry a gene that helps to usually organic, which has low toxicity. In Cornwall, Phillip et al (1984) found evidence of a cluster of malignant melanomas (skin cancers) among communities where local arsenic concentrations exceeded 30g/kg of soil.

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