非浸润性乳腺癌的诊疗策略

文章对非浸润性乳腺癌的诊疗策略及预后等进行介绍.     

Same-visit HIV testing in Trinidad and Tobago

Background  

The Ministry of Health (hereafter, Ministry) of Trinidad and Tobago is responsible for delivery of all health services in the country. The Ministry takes responsibility for direct delivery of care in the public sector and has initiated a process whereby those seeking HIV test results could obtain confidential reports during a single-visit to a testing location. The Ministry requested technical assistance with this process from the Caribbean Epidemiology Centre (CAREC). The United States Centers for Disease Control and Prevention (CDC) played an important role in this process through its partnership with CAREC.     

The National Prevention Strategy and Breast Cancer Screening: Scientific Evidence for Public Health Action

Mammography screening rates in the United States have remained fairly stable over the past decade, and screening rates remain low for some groups.We examined insights from recent public health research on breast cancer screening to identify promising new approaches to improve screening rates and address persistent health disparities in mammography use. We considered this research in the context of the four strategic directions of the National Prevention Strategy: elimination of health disparities, empowered people, healthy and safe community environments, and clinical and community preventive services.This research points to the value of direct outreach and case management services, interventions to support more patient-centered models of care, and more organized, population-based approaches to identify women who are eligible to be screened, encourage participation, and monitor results.OVERALL, ABOUT ONE IN FOUR women in the United States aged 50 to 74 years have not had a mammogram within the past two years, as is recommended.1 Mammography use is substantially lower for certain subgroups, such as low-income women, women without health insurance, and women without a usual source of care.1–3 In addition, breast cancer screening rates have not improved in almost a decade1,4,5 and the Healthy People 2010 target that 70% of women aged 40 to 74 years received a mammogram in the past two years was not achieved.6 The Healthy People 2020 cancer objective uses new age guidelines and calls for a 10% improvement in the proportion of women aged 50 to 74 years who received a mammogram in the previous two years, as well as a reduction in late-stage female breast cancer (an intermediate outcome of cancer screening success).7Current efforts and approaches are clearly not sufficient to meet these national goals. New approaches are needed to further increase mammography utilization to achieve Healthy People 2020 objectives. Whether a woman receives a mammogram is influenced by a range of personal, social, and economic factors, and these factors are interrelated. The use of scientific evidence from extensive research on the determinants of mammography utilization could increase effective public health practice. The National Prevention Strategy8 outlined four strategic directions to integrate recommendations across multiple settings: elimination of health disparities, empowered people, healthy and safe community environments, and clinical and community preventive services.The purpose of this analysis was to examine insights gained from recent research on breast cancer screening in the context of these four strategic directions for prevention. Integrating efforts in a coordinated public health effort may result in improved mammography utilization, reduction in breast cancer mortality, and improvement in longstanding health disparities.     

Las Mujeres Saludables: Reaching Latinas for Breast, Cervical and Colorectal Cancer Prevention and Screening

Community health advisors have effectively promoted breast and cervical cancer prevention and screening among low-income Latina women. Specific elements of such programs, such as enhanced social support, may explain successes. Promotion of colorectal cancer screening has been less studied. Promotoras de Salud (i.e., Latina health advisors) implemented a 12-week program among women recruited from community-based organizations. The program educated 366 Latinas in breast, cervical and colorectal cancer prevention and screening and emphasized social support among class members. Pre-and post-intervention assessments demonstrated significant increases for fruit and vegetable consumption (3.05 to 3.60 servings/day), and physical activity (65.15 to 122.40 minutes/week). Of women previously non-compliant, 39 percent, 31 percent and 4 percent received Pap tests, mammography, and fecal occult blood test (FOBT), respectively. A culturally aligned education program using community health advisors and emphasizing social support among participants may improve prevention and selected screening behaviors, but more intensive interventions may be required for colorectal cancer screening compliance. Supported by a grant from St. Luke’s Charitable Health Trust, Phoenix, Arizona.     

Social inequalities and children's height in Trinidad and Tobago

OBJECTIVE: The aim of the study was to report the association of socio-economic factors with child's height. DESIGN: Cross-sectional study based on a representative national sample of government schools. SETTING: Trinidad and Tobago in 1999. SUBJECTS: A total of 2608 boys and girls mean age 5.8 y, range 4.38-6.99 y and 3080 mean age 8.6 y, range 7.00-10.44 y olds. OUTCOME: Measurement of height and a questionnaire completed by parents. In the analysis height was expressed as standard deviation scores (s.d.s.) based on the British height curves (1990) or height below -1.5 s.d.s. RESULTS: Ethnicity, parental heights, birthweight, maternal age at child's birth and number of children in the family were the main factors associated with children's height. Lack of piped water supply in the home was the only socio-economic factor consistently associated with height (mean difference in s.d.s. adjusted only for age group, gender and ethnicity -0.192, 95% CI -0.257 to -0.127 and in addition adjusted for the variables listed above -0.080, 95% CI -0.141 to -0.019). Parental education, household overcrowding and employment status were weakly associated with height in the partially adjusted model only. Analysis of severe growth failure gave similar results. CONCLUSION: The impact of socio-economic factors on height is marginal in Trinidad and Tobago. As socio-economic factors may have an impact on a broad range of health indicators, height and rates of undernutrition should not be used as sole criteria for assessing progress in decreasing health differentials caused by social inequalities.     

Patient satisfaction at health centres in Trinidad and Tobago

The aim of this paper is to identify background characteristics of health centre users in Trinidad and Tobago and their perceptions of the services provided. Multi-staged sampling was used to select 1,500 health centre users throughout the country. Data were obtained using structured interviews conducted on regular clinic days.Results show that there is an overwhelmingly large percentage of unemployed persons (80.4%) and women(75.9%) among the users of health centres. The elderly is well represented, with 25.4 percent of the sample being over 60 years of age. Also, occupational status of family wage earners and educational attainment levels of respondents reflect a disproportionately higher number from lower socio-economic groupings among health centre users. On the other hand, proportions of different ethnic and religious groups among the respondents bear a striking similarity to the general population of Trinidad and Tobago.Respondents appear to be generally satisfied with the services of the health centres. When the categories for‘satisfied’ and ‘very satisfied’ were combined, results show that 73.0% of respondents were satisfied with the comfort of the health centre, 81.7% with the ease and convenience of getting to the health centre and 67.4% with the medical care received at the health centre.According to respondents' opinions, the services in greatest need of improvement are the pharmacy anddoctor services, especially through reducing the long waiting period. When the doctors, nurses and pharmacists were compared with respect to ‘courtesy and consideration’, ‘Skills and Competence’ and ‘advice provided’, results show that the generally high levels of satisfaction are remarkably similar in all three cases.     

Opportunities for Skin Cancer Prevention Education among Individuals Attending a Community Skin Cancer Screening in a High-Risk Catchment Area

Despite the highly preventable nature of skin cancer, it remains the most commonly diagnosed form of cancer in the United States. Recommendations for a complete skin cancer prevention regimen include engaging in photoprotection (e.g., sunscreen use), avoiding skin cancer risk behaviors (e.g., tanning), and receiving total body skin exams from a health care provider. The current study examined reported engagement in these behaviors among participants attending a community skin cancer screening (N?=?319) in a high-risk catchment area to assess the need for increased health education on skin cancer prevention. Participants’ responses indicate a history of suboptimal avoidance of skin cancer risk behaviors. Over half of participants (52%) reported four or more blistering sunburns before age 20, and 46% reported indoor tanning at least one during their lifetime. There is a need among this population for education regarding a complete skin cancer prevention regimen, which could improve adherence to photoprotection and avoidance of skin cancer risk behaviors, thereby reducing morbidity and mortality due to skin cancer.     

乳腺癌诊断移动应用：数字乳腺X射线成像获准支持移动乳腺癌筛选

西门子医疗系统集团的全数字乳腺X射线成像系统Mammomat Novation被批准用于移动筛查。自此，乳腺癌筛查第一次在拖挂式卡车的内置数字系统上进行。拖车与进行最终诊断的固定筛查中心连网。这种移动数字乳腺癌筛查特别适合于居住在农村地区或经常闲居在家的妇女。在德国，50到69岁的妇女有权享受每两年一次的免费乳腺X射线成像检查。     

乳腺癌的预后和预防

文章对乳腺癌的预后和预防进行介绍.     

Organophosphate resistance in Trinidad and Tobago strains of Aedes aegypti

Aedes aegypti larvae from 8 sites in Trinidad and 1 in Tobago were assayed against temephos, malathion, and fenthion using the Centers for Disease Control and Prevention time-mortality-based bioassay method. Resistance ratios (RRs) and resistance thresholds (RTs) for each insecticide were calculated in relation to the Caribbean Epidemiology Center reference susceptible strain. Results showed that the Haleland Park and Tobago strains were susceptible to fenthion and malathion, respectively (RRs < 1), while the San Fernando strain had a high RR (33.92) to malathion. All other strains had low-level resistance to fenthion and malathion. Resistance to temephos was more intense with 4 strains showing high-level resistance. The established RT was 60 min for fenthion, 75 min for bendiocarb, and 120 min for temephos and malathion. At the RTs, all Trinidad strains were resistant to temephos (11.50-74.50% mortality), 7 resistant to fenthion (21.25-78.75% mortality), and 5 resistant to malathion (56.25-77.50% mortality). The other strains were incipiently resistant (80-97% mortality). Despite the discrepancies between the RR levels and RT status, it is evident that the organophosphate insecticide resistance is prevalent in Trinidad and Tobago populations of Ae. aegypti. These results suggest that operational failure could soon occur and alternative strategies should be developed and implemented to reduce the probability of further selection pressure on resistant Ae. aegypti populations in Trinidad and Tobago.     

宫颈癌与乳腺癌筛查信息系统设计与实现

目的将现代信息技术引入宫颈癌、乳腺癌筛查工作,以提高两癌筛查工作的服务和管理水平。方法基于北京市妇幼保健信息系统二期开发建设,对两癌筛查子系统进行升级改造。结果两癌筛查信息系统可以实现从个人基本信息采集、筛查及诊断结果录入,到可疑病例确诊、治疗、随访等全过程的信息化,实现信息共享,提高了工作效率,提升了两癌筛查系统管理水平,为各级管理者提供及时有效的信息数据。结论将信息技术引入两癌筛查工作领域有其必要性,两癌筛查信息管理系统可以优化工作流程,提升妇幼保健信息管理层次,提高工作效率和质量。     

Breast Cancer Screening and Trauma History

ABSTRACT

The prevalence of mammography screening is unacceptably low. A history of trauma has been associated with poor health status, decreased health prevention behaviors, and increased mortality. We predicted that women who had a history of trauma were less likely to obtain mammography screening than women who did not report such a history. The relation between history of trauma and breast cancer screening has not been previously described.

We used a case-control design, randomly sampling women who had obtained and who had not obtained mammography within the preceding 2.25 years. There were significant differences in trauma history between women who had been screened and those who had not. Those who had not obtained mammography within the recommended breast cancer screening guidelines reported a greater overall number of traumatic events in their lifetimes, a greater prevalence of urban violence, domestic violence, sexual violence, and greater frequency of MVA.

African-American, Asian-American, and Latina-American women obtained mammography less often than white European-American women. The specific traumatic events which were associated with obtaining mammography differed between ethnic groups.

Several types of trauma were associated with lowered rates of mammography screening. The effects of different types of trauma were different for women of different ethnic groups.