高胆固醇浓度病例筛查的有效性与风险

Effectiveness and hazards of case finding for a high cholesterol concentration.

作者信息

Kinlay S, Heller R F

机构信息

Centre for Clinical Epidemiology and Biostatistics, Faculty of Medicine, University of Newcastle, Australia.

出版信息

BMJ. 1990 Jun 16;300(6739):1545-7. doi: 10.1136/bmj.300.6739.1545.

DOI:10.1136/bmj.300.6739.1545

PMID:2372619

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1663079/

Abstract

OBJECTIVE

To see whether adults with high blood cholesterol concentrations (greater than 6.5 mmol/l) detected by case finding return to their doctor, receive appropriate advice, and report changes in their diet and whether adults found not to have high cholesterol concentrations on case finding are discouraged from changing their diet.

DESIGN

Follow up study.

SETTING

Seven general practices in the lower Hunter region of Australia.

PARTICIPANTS

600 Men and women aged 25-65 who had their blood cholesterol concentrations measured three to four months earlier while attending their general practitioner. Analysis conducted on 552 (92%) who returned follow up postal questionnaires.

MEASUREMENTS AND MAIN RESULTS

Of the 125 subjects found to have blood cholesterol concentrations greater than 6.5 mmol/l, 102 (82%) returned to their doctor and 83 of these recalled receiving dietary advice. 93 (75%) Subjects with high concentrations reported changing their diet compared with 72 (46%) subjects with concentrations of greater than 5.5-6.5 mmol/l and 44 (17%) subjects with lower concentrations. Overall 333 (61%) of all respondents who answered reported not changing their diet, the most common reason (nearly half the sample; n = 266) being that their cholesterol concentration was "all right." Adults without high cholesterol concentrations who returned to their doctor were also significantly more likely to recall their doctor saying that they did not need to lower their concentrations (less than or equal to 5.5 mmol/l = 61%; greater than 5.5-6.5 mmol/l = 12%; greater than 6.5 mmol/l = 5%) and significantly less likely to recall receiving dietary advice (less than or equal to 5.5 mmol/l = 13%; greater than 5.5-6.5 mmol/l = 60%; greater than 6.5 mmol/l = 82%).

CONCLUSIONS

High risk strategies which require everyone to be tested for high cholesterol concentrations may interfere with population strategies designed to reduce everyone's dietary intake of fat.

摘要

目的

了解通过病例筛查发现血胆固醇浓度高（大于6.5 mmol/l）的成年人是否会回访医生、接受适当建议并报告其饮食变化，以及通过病例筛查发现血胆固醇浓度不高的成年人是否会被劝阻改变饮食。

设计

随访研究。

地点

澳大利亚猎人谷下游地区的7家普通诊所。

参与者

600名年龄在25 - 65岁之间的男性和女性，他们在看全科医生时于三到四个月前测量了血胆固醇浓度。对552名（92%）返回随访邮寄问卷的参与者进行了分析。

测量指标及主要结果

在125名被发现血胆固醇浓度大于6.5 mmol/l的受试者中，102名（82%）回访了医生，其中83名回忆起接受了饮食建议。93名（75%）高浓度受试者报告改变了饮食，而浓度大于5.5 - 6.5 mmol/l的受试者中有72名（46%），低浓度受试者中有44名（17%）报告改变了饮食。总体而言，所有回答问卷的受访者中有333名（61%）报告未改变饮食，最常见的原因（近一半样本；n = 266）是他们的胆固醇浓度“正常”。回访医生的血胆固醇浓度不高的成年人也更有可能回忆起医生说他们无需降低胆固醇浓度（小于或等于5.5 mmol/l = 61%；大于5.5 - 6.5 mmol/l = 12%；大于6.5 mmol/l = 5%），且明显不太可能回忆起接受过饮食建议（小于或等于5.5 mmol/l = 13%；大于5.5 - 6.5 mmol/l = 60%；大于6.5 mmol/l = 82%）。