Eliciting relative preferences for two methods of colorectal cancer screening

Two methods of mass population screening for colorectal cancer - faecal occult blood testing and sigmoidoscopy - have been the subject of randomized controlled trials in the UK. A national screening programme is currently under consideration and the choice of screening method remains open. To be successful, a programme will require high levels of uptake, and uptake is likely to depend upon subjects' attitudes towards the screening method introduced. Although a preferred screening method has already been identified from a questionnaire survey, we undertook a further interview study (n = 106), with a view to comparing the results of two different approaches to eliciting public preferences. In comparison with the questionnaire study, a higher proportion of interview subjects stated a preference. Interview subjects were generally more favourably disposed towards sigmoidoscopy, excepting those with previous experience. Compared with the questionnaire survey, the interviews provided richer information on the reasons for preferences offered. Individual preferences were evidently subjective and dependant on attitudes towards a variety of method characteristics, such as discomfort, convenience and perceived sophistication. Characteristics such as age and low income, which had predicted preferences in the questionnaire study, predicted preferences in the interview study also. The difference between the results obtained by the different elicitation techniques can be explained in terms of the differential provision of information and sample selection. Conclusions made about public preferences are likely to depend on the technique employed in eliciting them.     

Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.     

Advances in environmental and occupational diseases 2003

The past year has seen a welcome increase in the number of articles published in the Journal on environmental and occupational disorders. Some of the major themes have been risk factors for allergic sensitization, the measurement and containment of domestic allergens (especially cockroach but also house dust mite), and risk factors for occupational allergy and asthma. Some important articles were also presented on mechanisms of occupational and environmental asthma.     

Evidence of range bias in contingent valuation payment scales

The payment scale format has been widely used in willingness-to-pay studies in health care. Concerns have been expressed that the format is, in theory, prone to range bias, although this proposition has not been tested directly. We report the findings of a contingent valuation questionnaire study of colorectal cancer screening, wherein different subjects were provided with payment scales of two different lengths. Whilst the long-scale instrument included scale values up to pound 1000, the short-scale version extended only to pound 100. After controlling for inter-sample differences in, for example, income, education and health behaviour, it emerged that the long-scale instrument produced a mean willingness to pay more than 30% higher than that resulting from the short-scale version. We believe our findings to be strongly supportive of the likelihood of range bias in payment-scale instruments, with important consequences for the estimation of both average valuation and consumer surplus.     

Hypertension: pathophysiology and treatment

Arterial hypertension is a major cause of morbidity and mortalitybecause of its association with coronary heart disease, cerebrovasculardisease and renal disease. The extent of target organ involvement(i.e. heart, brain and kidneys) determines outcome. North Americanstudies have shown that hypertension is a major contributorto 500 000 strokes (250 000 deaths) and 1 000 000 myocardialinfarctions (500 000 deaths) per annum.     

The surgical hypertensive patient

We reviewed the pathophysiology and treatment of hypertensionin a recent edition of this journal (see key references). Inthis article, we discuss the management of the hypertensivepatient presenting for surgery and anaesthesia.