A Pap test screening clinic in a South Asian community of Vancouver, British Columbia: challenges to maintaining utilization

The purpose of this article is to describe experiences and challenges in establishing a South Asian Pap Test Clinic. The specialized Pap test clinic for immigrant South Asian women was a community-initiated response to high rates of cervical cancer within this population. Efforts were made to ensure that the clinic provided health services in a sensitive and culturally appropriate manner. Although women were generally positive about their experiences at the South Asian Pap Test Clinic and often encouraged other women to attend the clinic for Pap testing, attendance patterns have not been maintained. The three most significant challenges to the clinic's ongoing success were: (1) maintaining the continued involvement of stakeholders in developing long-term strategies to enhance community awareness about cervical cancer; (2) creating mechanisms to strengthen support from physicians in the community; and (3) meeting the needs of the underserved within a specialized health service for South Asian immigrant women. These challenges provide important lessons for others to increase the participation of immigrant women in screening practices. Nurses can play a key role in mobilizing and maintaining collaborations that are essential to the continuing success of community-based programs.     

Breast Cancer Screening in Premenopausal Women: Current Recommendations and Opportunities for Research

The American Cancer Society recommends periodic mammography, clinical breast examination and breast self-examination beginning at age 40 years for asymptomatic women at average risk of breast cancer. Although there is substantial evidence from meta-analyses and non-randomized studies to support these recommendations, individual randomized clinical trials of breast cancer screening have not demonstrated mortality reduction in women aged 40-49 years. The opportunity to study this issue further in the United States has been diminished by the high prevalence of screening already being conducted in that population of younger women. The International Union Against Cancer, the American Cancer Society and the National Cancer Institute of the United States have convened a series of workshops and planning meetings to consider the available data and outline plans for future research. Plans are being developed to conduct a randomized trial of mammography in women younger than 50 years in multiple European sites. Successful completion of this trial may provide critical data on efficacy of breast cancer screening in younger women.     

癌症患者健康素养现状及其影响因素

目的了解癌症患者健康素养现状,并探讨其影响因素。方法 2014年7-11月,采用便利抽样法选取福州市某三级甲等综合性医院353例住院癌症患者为研究对象。采用一般情况调查表及慢性病患者健康素养调查量表对其进行健康素养调查。结果 39.1%癌症患者具备健康素养,其中具备信息获取能力、交流互动能力、改善健康意愿、经济支持意愿的比例分别为57.2%、47.0%、72.5%、48.0%;多因素Logistic回归分析结果显示,癌症患者健康素养的影响因素为年龄、居住地和文化程度(均P0.05)。结论癌症患者健康素养处于中等偏低水平,提示医护人员在进行健康教育时,应针对患者的不同特点,开展有针对性的教育,并着重加强对老年患者、低文化程度和农村癌症患者的健康指导,以提高其健康素养水平。     

Compliance with Recommended Cancer Screening among Emergency Department Patients: A Multicenter Survey

Objectives: The objectives were to measure compliance with, and possible sociodemographic disparities for, cancer screening among emergency department (ED) patients. Methods: This was a cross‐sectional survey in three academic EDs in Boston. The authors enrolled consecutive adult patients during two 24‐hour periods at each site. Self‐reported compliance with standard recommendations for cervical, breast, testicular, and prostate cancer screening were measured. The chi‐square test was used test to evaluate associations between demographic variables and cancer screening compliance. Results: The authors enrolled 387 patients (81% of those eligible). The participants had a mean (±standard deviation) age of 44 (±18) years and were 52% female, 16% Hispanic, and 65% white. Sixty‐seven percent (95% confidence interval [CI] = 60% to 73%) of all women reported Pap smear examinations in the past 3 years, 92% (95% CI = 85% to 96%) of women aged ≥40 years reported clinical breast examinations, and 88% (95% CI = 81% to 94%) of women aged ≥40 years reported mammography. Fifty‐one percent (95% CI = 40% to 61%) of men aged 18–39 years reported testicular self‐examinations, and among men aged ≥40 years, 79% (95% CI = 69% to 87%) reported digital rectal examinations (DREs) and 51% (95% CI = 40% to 61%) reported prostate‐specific antigen (PSA) testing. Racial and ethnic minorities reported slightly lower rates of clinical breast examinations and testicular self‐examinations. Conclusions: Most women and a majority of men in our ED‐based study were compliant with recommended measures of cervical, breast, testicular, and prostate cancer screening. No large sociodemographic disparities in our patient population were identified. Based on these data, and the many other pressing public health needs of our ED population, the authors would be reluctant to promote ED‐based cancer screening initiatives at this time.     

Asian Indian women: knowledge, attitudes and behaviors toward breast cancer early detection

Education programs have been developed to promote adherence to recommended breast cancer screening guidelines. Few studies have assessed the degree to which ethnic subgroups are perceiving and acting on the proffered information. Such assessment is vital to the creation of efficient public health interventions. This paper describes the reported breast cancer knowledge, attitudes, and screening behaviors of 194 American Asian Indian women. While monthly breast self exam adherence was low, only 40.7%, 61.3% of women 40 and older, and 70% of women 50 and older, reported having had a mammogram within the past 12 months. These rates for annual mammography screening are high relative to many other ethnic groups. While the results are encouraging, the respondents may not be representative of all Asian Indian women. The majority of these women reported that their breast cancer knowledge is inadequate. They were willing to be called upon to share with others any knowledge they gained. There is a clear opportunity for public health nurses to provide Asian Indian women with a more comprehensive understanding of breast health and disease. Those women can then share their health knowledge with other women within their ethnic group.     

长沙市肾移植受者健康素养现状及其影响因素

目的了解肾移植受者肾移植相关健康素养的现状,并分析肾移植术后患者健康素养的影响因素。方法采用方便抽样法,选择2016年8-12月长沙市3所三级甲等医院门诊随访及住院的163例肾移植术后患者为研究对象。采用自行编制的一般资料调查表、中文版成人快速健康素养评估量表对其进行调查。结果肾移植患者的健康素养得分为(62.32±8.74)分,其中128例(78.53%)患者处于健康素养充足水平,25例(15.34%)患者处于健康素养临界水平,10例(6.13%)患者处于健康素养缺乏水平。最不熟悉的10个肾移植相关词汇分别是:雷帕霉素(西罗莫司)、谷浓度、血管性疾病、不依从、延迟恢复、敏感性、器官获取、三酰甘油、环孢素和病理检查。多元线性回归分析显示,受教育程度、移植肾等待时间以及移植术后时间对肾移植相关健康素养有影响。结论肾移植术后患者的健康素养水平整体不高,受教育程度越高、移植肾等待时间越长以及移植术后时间越短,患者移植相关性健康素养水平越高。     

Preventive Care in the Emergency Department: Screening and Brief Intervention for Alcohol Problems in the Emergency Department: A Systematic Review

OBJECTIVE: To systematically review the medical literature in order to determine the strength of the recommendation for screening and brief intervention (SBI) for alcohol-related problems in the emergency department (ED) setting. METHODS: The review followed the methodology of systematic reviews and was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. The primary outcome measure was the prevention of mortality and morbidity secondary to alcohol-related illnesses/injuries. The secondary outcome measures included: decreased consumption; fewer ED/outpatient visits and hospitalizations; a decrease in social consequences; and increased referrals for follow-up and/or treatment. Three Medline searches as well as a search of the Cochrane Library were performed. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles. RESULTS: Twenty-seven articles were identified and reviewed, in addition to the 14 primary articles included in the 1996 U.S. Preventive Services Task Force Report. The study populations were diverse, including inpatient, outpatient, and college settings, with ages ranging from 12 to 70 years. Four studies were ED-based and two included EDs as one of multiple sites. Thirty-nine studies on SBI, 30 randomized controlled and nine cohort, were used to formulate the current recommendation. A positive effect of the intervention was demonstrated in 32 of these studies. CONCLUSIONS: The authors recommend that SBI for alcohol-related problems in the ED be incorporated into clinical practice.     

Nurses' knowledge of health literacy,communication techniques,and barriers to the implementation of health literacy programs: A cross‐sectional study

Nurses' health literacy knowledge and communication skills are essential for improving patients' health literacy. Yet, research on nurses' health literacy knowledge and perception is limited. The study aimed to evaluate nurses' health literacy knowledge, communication techniques, and barriers to the implementation of health literacy interventions. A cross‐sectional study was used, and a total of 1697 nurses in 104 community hospitals in Thailand completed self‐report measures. Approximately 55% of the participants had heard about the concept of health literacy; 9% had received formal training specific to interaction with patients with low health literacy. About 50% of the nurses were aware of their patients' low health literacy; therefore, they applied the recommended communication techniques for them. Delivery of effective health literacy training was hampered by a lack of assessment tools, health literacy training and specialists, educational materials, and health provider time. Hospital administrators, nurse managers, health leaders should develop strategies to create environments and resources supporting health literacy interventions.     

Promoting screening and early detection of cancer in men

Abstract Gender is a factor in the risk assessment for many diseases. It may also impact on the way in which men assess their personal health or illness status and take action to prevent illness or promote well-being. This paper is focused on three objectives: (i) to foster an understanding of gender differences in health promoting behaviors; (ii) to review three health issues affecting males for which dissemination of health education, increased personal awareness and early detection may be beneficial in the reduction of morbidity and mortality; and (iii) to offer suggestions for nurses and other health care professionals to promote positive patient–provider interactions within a health-care framework for action.     

eHealth Literacy of Medical and Health Science Students and Factors Affecting eHealth Literacy in an Ethiopian University: A Cross-Sectional Study

Background  eHealth literacy is individual''s ability to look for, understand, and evaluate health information from electronic sources. Integrating eHealth literacy to the health system could help lower health care costs and ensure health equity. Despite its importance, the eHealth literacy level in Ethiopia has not been studied on medical and health science students, who are important parties in the health system. Understanding their level of eHealth literacy augments practice of health care, efficiency in education, and use of eHealth technologies. Objective  This research study aims to determine eHealth literacy level and identify its associated factors among medical and health science students in University of Gondar (UoG). Methods  An institution-based cross-sectional study was conducted from March to May 2019 among undergraduate medical and health science students in the UoG. Stratified multistage sampling was used. The eHealth literacy scale was used to measure eHealth literacy. A binary logistic regression model was fitted to measure association between eHealth literacy and the independent variables. Results  A total of 801 students participated in this study with a 94.6% of response rate. The majority (60%) were male and previously lived-in urban areas (68%). The mean eHealth literacy score was 28.7 and 60% of the participants possessed high eHealth literacy. Using health-specific Web sites (adjusted odds ratio [AOR] = 2.84, 95% confidence interval [CI]: 1.86–4.33), having higher Internet efficacy (AOR = 2.26, 95% CI: 1.56–3.26), perceived usefulness of the Internet (AOR = 3.33, 95% CI: 1.95–5.69), medical app use (AOR = 1.70, 95% CI: 1.13–2.55), being female (AOR = 1.55, 95% CI: 1.08–2.22), and being health informatics student (AOR = 2.02, 95% CI: 1.149–3.148) affect a high eHealth literacy level. Conclusion  The level of eHealth literacy in this study was moderate. Using specific reputable health Web sites, using smartphone medical applications, and Internet efficacy determine eHealth literacy significantly.     

Benefits and Challenges of Lung Cancer Screening in Older Adults

Purpose

Lung cancer screening with low-dose computed tomography has been shown to significantly reduce lung cancer–related mortality in high-risk patients. However, patients diagnosed with lung cancer are typically older and often have multiple age- and smoking-related comorbidities. As a result, cancer screening in older adults remains a complex decision, requiring careful consideration of patients' risk characteristics and life expectancy to ensure that the benefits outweigh the risks of screening. In this review, we evaluate the evidence regarding lung cancer screening, with a focus on older patients.

广州某2所医院护士乳腺癌及早期筛查认知状况调查

目的 了解广州市三级甲等医院护士乳腺癌及早期筛查知识的认知状况和获取相关信息的来源.方法 采用乳腺癌及早期筛查知识问卷和有关信息来源的问卷对广州市某2所三级甲等医院100名护士进行调查.结果 本组护士对特殊的月经史、长期服用雌激素、高脂饮食是乳腺癌高危因素和乳腺癌的早期临床表现认知率较高,达到80%以上.但对长期主动或被动吸烟和酗酒是乳腺癌的危险因素知晓率较低;86%以上的护士认为乳腺自我检查、乳房钼靶检查、乳房临床检查能早期发现乳腺癌.文化程度较高者,相关知识认知率较高(P<0.01).目前护士获取乳腺癌相关信息的主要途径是书籍和杂志,而她们最想通过专业讲座(61%)去进一步了解相关专业知识.结论 加强护士群体对乳腺癌及其早期筛查知识的深入学习,培养护士这一特殊群体,使其充分发挥乳腺癌防治宣传者的角色.     

胃蛋白酶原联合幽门螺杆菌抗体检测在早期胃癌筛查中的可靠性研究

目的:探讨运用"ABC法"联合检测胃蛋白酶原和幽门螺杆菌抗体在早期胃癌筛查中的临床价值。方法:回顾性分析符合要求的1 200例消化内科门诊患者的临床资料,按照胃癌高危人群的年龄分界将研究对象分为40岁和≥40岁两个群体;比较两个群体中胃癌风险分层各组例数和病理构成比是否有统计学差异。结果:40岁和≥40岁2个群体中C组和D组例数相比较,差异有统计学意义(P0.05),在≥40岁人群中被要求进一步胃镜检查的例数明显增多;在≥40岁人群中,B、C、D组中萎缩性胃炎、早期胃癌、进展期胃癌的发生率与A组和40岁人群相比较,差异有统计学意义(P0.05)。结论:运用"ABC法"进行不同群体的早期胃癌筛查,可以对筛查人群进行胃癌风险分层,减少了不必要的胃镜检查人数,避免了用单一的血清检测方法对早期胃癌的漏诊,提高了早期胃癌的检出率。     

Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency Department

This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on “Public Health in the ED: Screening, Surveillance, and Intervention.” The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening—develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention—conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups—conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies—a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow‐up; and d) examine alternatives to specialized treatment referral. 5) Translation—conduct translational and cost‐effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.     

A Breast Cancer Review: Through the Eyes of the Doctor,Nurse, and Patient

Breast cancer patients endure many challenges in their journey. During the course of their treatment, they interact with several multidisciplinary teams, including radiologists, breast surgeons, and oncologists, as well as nurses, genetic counselors, social workers, and psychologists. This article aims to provide a synoptic review, including the background, causes, screening, diagnosis, and treatment options of breast cancer, by exploring the perspectives of the physician, nurse, and patient. Understanding the complexities that patients with breast cancer encounter can help aid providers address their concerns and focus on providing a more comprehensive approach to care.