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APPENDIX A 24 Specific Comments Page 4, Section IâAdd bullets: â¢ Addressing issue of false positive results. â¢ How positive (true positive and false positive) results will be managed. â¢ Educate population to be screened about â¢ Informed consent. â¢ Risks and benefits associated with being screened. Page 4, Section II.BâIf the goal is to improve health status, how do the grantees know that screening will help? Applicants or participants should discuss the logic supporting their decisions. Page 5, Section II.B.1ââOutreachâ: in addition to using the mass media to announce the availability of the program to eligible people, RESEP could request more active searches, such as obtaining lists of former workers from employers, unions, or tribal agencies and then contacting them. Page 5, Section II.B.2.aâInclude generally accepted screening recommendations (such as those of the US Preventive Health Services Task Force). Page 5, Section II.B.2.a.4âis it suggested that arterial blood gases would be used as a screen? That would be invasive and carry a risk of injury. Page 5, Section II.B.2.a.6âThis should include management of the results. Page 6, Section IIB.2.b.1ââMedical and Occupational Historyâ: occupational history seems to emphasize exposures at work and would apply to miners, millers, ore-haulers, and test-site workers. The section could also include information more applicable to the downwinders, such as dates of residence in the affected counties and where the family obtained foodstuffs, especially milk. It should also include family history because that may modulate the need for some screening testsâfor example, history of breast or colon cancer; genetic history might also be included. Page 6, Section II.B.2.b.2âHow does one detect on physical examination cancer of the bladder, colon, small intestine, pancreas, gall bladder, and ovary. This is insensitive and nonspecific. Page 6, Section II.B.2.b.4âWhy specialty care and not primary care, especially, in an underserved population? How could their current monitoring of care be compatible with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)? Page 7, Section II.B.3.aâBullets should be selective, not inclusive. Which radiogenic nonmalignant diseases are detected with 24-hour urine studies?