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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The U.S. Preventive Services Task Force's "Guide to Clinical Preventive Services" summarizes the results of a critical review of the literature pertaining to the effectiveness of 169 interventions in modifying 60 risk factors or conditions. The ultimate impact of the guide depends on the diffusion into clinical practice of its recommendations. This report reviews the factors influencing the diffusion process. Three categories of behavioral influence--predisposing, enabling, and reinforcing factors--apply to this diffusion process. Predisposing factors include knowledge and attitudes, personal health behaviors, confidence, and beliefs about patients' interests in health-promotion advice. Enabling factors include competence to perform preventive services, reimbursement for preventive services, organization of the practice setting, time to provide preventive services, a reminder system, and a coherent set of guidelines that are perceived as scientific and unambiguous. Reinforcing factors include peer support, feedback, evidence of results, and an enhanced sense of self-efficacy in fulfilling one's role as a healer. Recommendations are given for using these factors to increase the diffusion of preventive services into clinical practice. [ABSTRACT FROM AUTHOR]

Discusses the 'Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions,' by the U.S. Preventive Services Task Force. Importance of personal health practices; Shifting priorities in primary care; Designing medical practice to individual risks; Timing of preventive services; Changing role of patient.

The article presents obituaries for several medical personnel including former consultant cardiac surgeon John Cleland, former general practitioner William Malcolm Ferguson and former anaesthetist Mary Ducrow.