Gynecological screening or cervical screening? Conflicts between clinical and public health viewpoints

The "gynecological screening" that is composed of complex gynecological examination including colposcopy and cytological examinations has traditionally been incorporated into the gynecological protocol and practice. Over the past few decades, unfortunately, this screening practice has entrenched in the mind both of the gynecological community and the general public. As a result, the government-supported, organized cervical screening program of the population has come to a standstill. In order to adjust the cervical screening practice to the international public health recommendations in which cytology is the only screening test applied, the authors decided to involve primary care nurses and health visitors in smear taking, and to refer those with abnormal findings to a gynecologist for further clinical examination.     

A screening questionnaire for HAVS?

AIM: To define the diagnostic power of simple questions most applicable for a hand-arm vibration syndrome (HAVS) assessment screening questionnaire. METHOD: Using a binary logistic regression we analysed 365 physician led HAVS health surveillance assessments to identify which questions could form the basis of a screening questionnaire. RESULTS: Four sensorineural related questions regarding tingling and numbness in response to the cold and after using vibrating tools, and two vascular-related questions focusing on the patient's fingers going white on exposure to cold and numbness during an attack of whiteness were identified. CONCLUSIONS: Questions of high sensitivity for screening subjects for the vascular and neurosensory components of HAVS were identified, which can be used to identify those requiring further clinical investigation and functional testing.     

General practitioners’ preferences with regard to colorectal cancer screening organisation Colon cancer screening medico-legal aspects

Objective

French health authorities put general practitioners at the heart of the colorectal cancer screening. This position raises organisational issues and poses medico-legal problems for the professionals and institutions involved in these campaigns, related to the key concepts of medical decisions and suitability of standards. The objective of our study is to reveal the preferences of general practitioners related to colorectal cancer screening organisation with regard to the medico-legal risk

Cost-effectiveness analysis of neonatal hearing screening program in china: should universal screening be prioritized?

Background

Patient satisfaction is an important indicator of quality of care in hospitals. Reliable and valid instruments to measure clinical and outpatient satisfaction already exist. Recently hospitals have increasingly provided day care, i.e., admitting patients for one day without an overnight stay. This article describes the adaption of the ??Core questionnaire for the assessment of Patient Satisfaction?? (COPS) for general Day care (COPS-D), and the subsequent validation of the COPS-D.

Methods

The clinical COPS was supplemented with items to cover two new dimensions: Pre-admission visit and Operation Room. It was sent to a sample of day care patients of five general Dutch hospitals to investigate dimensionality, acceptability, reliability, construct and external validity. Construct validity was established by correlating the dimensions of the COPS-D with patients?? overall satisfaction.

Results

The COPS-D was returned by 3802 patients (response 46%). Factor analysis confirmed its?? structure: Pre-intake visit, Admission, Operation room, Nursing care, Medical care, Information, Autonomy and Discharge and aftercare (extraction communality 0.63-0.90). The internal consistency of the eight dimensions was good (???=?0.82-0.90); the item internal consistency corrected for overlap was satisfactory (>0.40); all inter-item correlations were higher than 0.45 but not too high (<0.90). The construct validity of all dimensions was good (r from 0.52-0.62, p?<?0.01). The Information dimension had the strongest correlation with overall day care satisfaction.

Conclusions

The COPS-D is a reliable and valid instrument for measuring satisfaction with day care. It complements the model of measuring patient satisfaction with clinical and outpatient care given in hospitals. It also fulfils the conditions made while developing the clinical and outpatient COPS: a short, core instrument to screen patient satisfaction.     

Does gender discrimination impact regular mammography screening? Findings from the race differences in screening mammography study

ABSTRACT Objective: To determine if gender discrimination, conceptualized as a negative life stressor, is a deterrent to adherence to mammography screening guidelines. Methods: African American and white women (1451) aged 40-79 years who obtained an index screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998 were enrolled in this study. This logistic regression analysis includes the 1229 women who completed telephone interviews at baseline and follow-up (average 29.4 months later) and for whom the study outcome, nonadherence to age-specific mammography screening guidelines, was determined. Gender discrimination was measured as lifetime experience in seven possible situations. Results: Gender discrimination, reported by nearly 38% of the study population, was significantly associated with nonadherence to mammography guidelines in women with annual family incomes of > or =$50,000 (OR 1.99, 95% CI 1.33, 2.98) and did not differ across racial/ethnic group. Conclusions: Our findings suggest that gender discrimination can adversely influence regular mammography screening in some women. With nearly half of women nonadherent to screening mammography guidelines in this study and with decreasing mammography rates nationwide, it is important to address the complexity of nonadherence across subgroups of women. Life stressors, such as experiences of gender discrimination, may have considerable consequences, potentially influencing health prevention prioritization in women.     

Is genetic screening for hemochromatosis worthwhile?

Hereditary hemochromatosis is an iron overload disorder and is the most common recessive disease in Caucasians. About 80% of hemochromatosis patients are homozygous for the C282Y mutation in the HFE gene. Since iron accumulation can be prevented by phlebotomy, there is increasing interest in screening populations for hemochromatosis. Hemochromatosis is a disease that meets all the criteria for screening as set by the World Health Organization (WHO) or the US preventive services task force criteria for a screening program. However, there is no consensus on the value of a screening program for hemochromatosis. Moreover, there is no agreement on whether this screening should be based on the phenotype i.e. biochemical levels of serum iron parameters or on the genotype i.e. based on the presence of mutations in the HFE gene. Other important concerns are the lack of important data in evaluating screening as well as the psychosocial impact of a screening program. The present review analyses the current situation from a genetic-epidemiological perspective. We conclude that general population screening may be helpful to identify high-risk groups or individuals in the early stage of the disease so that treatment can be started. We suggest a two-phase screening program based on the first instance on serum iron levels and then a genetic test to only those with elevated serum iron parameters.     

Assessing efficiency in the UK breast screening programme: does size of screening unit make a difference?

The UK breast screening programme (UK BSP) is organised into a large number of individual screening units. Decision makers need to ensure these units are producing efficiently, particularly as the programme is anticipated to expand. Data envelopment analysis (DEA) was applied to investigate: the relative efficiency of screening units; the impact of screening unit size on efficiency; and how individual units could improve. Sixty-four screening units were categorised into 33 large and 31 small. Data were collected using a national survey and routinely collected data. The overall median efficiency score was 91%, 39 units were inefficient. Variation in efficiency scores was wide. Large units had a median efficiency score of 100% and 12 units were inefficient. Smaller units had a median efficiency score of 95% and 19 were inefficient. This difference was not statistically significant (Mann-Whitney, P=0.076). Forty-two percent of large units and 21% of small units were operating at constant returns to scale (mean difference 0.20, 95% CI: 0.15-0.43). Although there is no systematic difference in efficiency by size of screening unit there are inefficiencies in both large and small units and there is scope for many individual units to improve their use of current resources. It will be necessary for decision-makers to examine the practices of individual screening units before considering options for how best to improve their resource use. DEA can help to identify feasible options.     

Who attends skin cancer screening in Western Australia? Results from the Lions Cancer Institute skin cancer screening program

OBJECTIVE: To examine the characteristics of persons attending a skin cancer screening clinic in Western Australia and compare the effectiveness of screening in different socio-demographic subgroups. METHODS: Questionnaires were completed by 5,950 self-selected participants who voluntarily attended the Western Australian Lions Cancer Institute's targeted skin cancer screening clinics during the period 1996-2003. A risk assessment technique was used to identify individuals at high risk of developing melanoma. Provisional diagnoses of suspicious lesions were given at the screening by a medical specialist. Suspicious lesions were later matched with histopathologically confirmed malignant melanomas reported to the Western Australia Cancer Registry. RESULTS: Fifty-seven per cent of attendees were female. The mean age of attendees was 53 years. The yield of suspicious malignant melanomas detected was 24.7 per 1,000 participants screened; the yield of confirmed malignant melanomas detected was 3.0 per 1,000 participants screened. Persons over 50 years of age were three times more likely to have a histopathologically confirmed malignant melanoma detected at the screening than those younger than 50 years (p = 0.049). CONCLUSIONS: The yield of confirmed melanomas detected by the Lions Cancer Institute is among the highest reported by a skin cancer screening program. This may have been attributable to the risk assessment technique used by the program. IMPLICATIONS: A free community skin cancer screening program that targets high-risk individuals can detect melanomas.     

Testing at home--the screening of the future?

Cardiovascular diseases (CVD) and diabetes mellitus (DM) aremajor public health concerns in modern society. Although mortalityfrom CVD has decreased substantially in many European countriesin the past 30 years due to better prevention (e.g. encouragingpeople to stop smoking and discouraging people from starting)and better medicinal treatment, CVD remains the category ofdiseases with the highest number of life-years lost. Due tosedentary lifestyles and unfavourable nutrition habits, obesityhas developed into a new ‘epidemic’ with adverseconsequences for CVD and DM. Type 2 diabetes is     

Development and validation of an instrument assessing women’s satisfaction with screening mammography in an organized breast cancer screening program

Background

Understanding dentists’ capacity to supply dental services over time is a key element in the process of planning for the future. The aim was to identify time trends and estimate age, period and cohort effects in patients’ visits supplied per dentist per year.

Methods

Mailed questionnaires were collected from a random sample of Australian private general practice dentists. The response rates were 73%, 75%, 74%, 71%, 76% and 67% in 1983, 1988, 1993, 1998, 2003 and 2009, respectively. The time trends in the mean number of patient visits supplied per dentist per year (PPY) was described by using a standard cohort table and age-period-cohort analyses applying a nested general linear regression models approach.

Results

The mean number of PPY decreased across most age groups of dentists over the time of study. The age-period model showed that younger dentists (20–29 years) and older dentists (65–74 and 80–84 years) had lower PPY than middle-aged dentists, and the age-cohort model showed higher PPY among earlier cohorts, and lower PPY among more recent cohorts.

Conclusion

The study found a period effect of declining PPY over the observation period. More recent cohorts of dentists provide lower numbers of PPY than earlier cohorts at similar ages, but the provision of PPY among these younger cohorts appeared to be stable as they moved into middle age.     

Tailored breast cancer screening with ultrasound and MRI?

The ACRIN 6666 trial has shown that the addition of ultrasound or MRI to mammography screening detects more breast cancers in women with dense breasts and at least one other breast cancer risk factor. This higher detection yield is accompanied by an increase in false-positive findings. Unfortunately, this study was not randomized into groups with and without the addition of ultrasound and MRI. It is therefore impossible to investigate if the improved detection rate also results in a smaller number of interval tumours which would be the best indication of the ultimate goal - a decrease in breast cancer mortality. Before any new and costly imaging is added to the breast cancer screening program, it is necessary to investigate if this will not merely increase the detection of indolent tumours. If additional imaging is implemented too hastily it will be hard to turn it back, and impossible to assess it in a randomized study.