The cervical cancer screening program in Mexico: problems with access and coverage

A cross-sectional study was carried out in two geographic regions of Mexico - Oaxaca (rural area) and Mexico City (urban area) - to determine the main factors for predicting participation in Cervical Cytology Screening Programs (CCSP), in populations with high mortality due to cervical cancer. We included 4,208 women aged between 15 and 49 years, randomly selected through a national household-sample frame. Knowledge of what the Pap test is used for strongly predisposes use of CCSP in Mexico City (odds ratio [OR] = 46.1, 95 percent confidence interval [CI] = 33.1-64.1) and Oaxaca state (OR = 61.5, CI = 42.0-89.9), as well as high socioeconomic level (Mexico: OR = 2.0, CI = 1.1-7.6; Oaxaca: OR = 4.1, CI = 3.1-5.3), high education level (Mexico: OR = 3.6, CI = 1.5-8.8; Oaxaca: OR = 5.3, CI = 2.8-10.0), and access to social security (Mexico: OR = 1.7, CI = 1.4-2.2; Oaxaca: OR = 2.2, CI = 1.8-2.7). Low coverage of the CCSP is confirmed as an important problem in Mexico.     

Nasal ciliary beat frequency is age independent

Objectives: Evaluate the age-dependency of ciliary beat frequency (CBF) in biopsies after ciliogenesis in culture. Study Design: Retrospective analysis of CBF and ciliary ultrastructure in biopsies and after ciliogenesis from 203 individuals, aged 3 months to 74 years. Methods: All patients with successful culture were included. Ciliogenesis was obtained using the sequential monolayer-suspension culture technique for dissociated nasal epithelial cells. CBF was measured using computerized microscope photometry. Secondary ultrastructural abnormalities were evaluated in transmission electron microscopy. Results: There was no correlation between age and CBF, in either the biopsies (7.0 ± 2.6 Hz; n = 113) or after ciliogenesis in culture (8.1 ± 1.3 Hz; n = 203). Even in individuals older than 70 years, CBF was normal in bioptic material (6.7 ± 1.7 Hz) and after ciliogenesis in culture (7.9 ± 1.0 Hz). Also, in individuals less than 1 year of age CBF was normal in biopsies as well as after ciliogenesis. CBF correlated inversely with the percentage of secondary ultrastructural abnormalities in the biopsies as seen with transmission electron microscopy: 8.1 ± 1.8 Hz when ciliary ultrastructure was normal and 3.5 ± 3.3 Hz in cases of severe secondary ciliary dyskinesia. After ciliogenesis in culture, ciliary ultra-structure was always normal, as was CBF. Conclusion: CBF is age independent but correlates with secondary ultrastructural abnormalities. CBF after ciliogenesis in culture is the intrinsic one.     

A realist qualitative study to explore how low‐income pregnant women use Healthy Start food vouchers

Healthy Start is the UK government's food voucher programme for low‐income pregnant women and young children. It was introduced in 2006, but the impact of the programme on nutritional outcomes remains understudied. This study sought to explore potential outcomes of the Healthy Start programme (including intended and unintended outcomes) and develop explanations for how and why these outcomes might occur. A realist review preceded this study, in which programme theories were developed and tested using existing evidence. This qualitative study aimed to further refine and consolidate the programme theories from the realist review while remaining open to new and emerging theories (or hypotheses) about how low‐income pregnant women use Healthy Start vouchers. Semistructured interviews were conducted with 11 low‐income women from North West England, who received Healthy Start vouchers during pregnancy. A realist logic of analysis was applied to generate clear and transparent linkages between outcomes and explanations. The findings suggested that some women used the vouchers to improve their diets during pregnancy (intended outcome), whereas some women were diverted towards alternative or unintended outcomes. Women's circumstances, values, beliefs, and motivations influenced how they perceived and responded to the vouchers. This paper presents four evidence‐based programme theories to explain four contrasting (and potentially overlapping) outcomes: dietary improvements (theory refined from review), shared benefits (new theory), financial assistance (theory refined from review), and stockpiling formula (new theory). It considers how the Healthy Start programme could be improved, to increase the possibilities for low‐income women to experience the intended outcome of dietary improvements.     

30例45岁以上女性乳腺癌的生存分析

目的 探讨45岁以上乳腺癌患者生存状况.方法 对1992年至2000年间收治的30例45岁以上的乳腺癌患者的临床资料进行回顾性分析,1992～1996年组(A组)17例及1996～2000年组(B组)13例,探讨生存率改善的有关临床因素.结果 A、B两组患者的生存率分别为(64.7±3.8)%和(69.2±2.5)%,有统计学意义(P＜0.01).结论 年龄是乳腺癌的一个独立预后变量,但乳腺癌的临床分期、淋巴结转移、病理类型、手术方式对乳腺癌患者的生存状况的影响不容忽视.     

老年妇女妇科手术特点和围手术期管理

因妇科疾病需要手术的老年女性逐年增多,但老年人随着年龄增长器官功能逐渐衰退,且多数合并内科疾患,手术风险和围手术期并发症增高。因此了解老年妇女的妇科手术特点和加强围手术期管理至关重要。     

运用Demirjian法测量替牙早期前牙反合患者的牙龄研究

目的 评估Demirjian法测定天津地区儿童的牙龄的适用性.方法 运用Demirjian法测定天津地区替牙早期前牙反合患者治疗期间牙龄的变化量,并与实际年龄的变化量进行比较分析.结果 Demirjian法测定的牙龄变化量无论男性组还是女性组与实际年龄变化量均无显著性差异.结论 Demirjian法适用于中国天津地区替牙前期前牙反合患者牙龄的测定.     

大同地区489例变应性鼻炎并发支气管哮喘患者的相关性研究

目的:探讨本地Ⅸ变应性鼻炎(AR)并发支气管哮喘(BA)的发病率,以及AR并发BA患者在年龄、不同分型、并发症3方面的疾病相关性.方法:通过随机抽取、体格榆查、必要的实验室手段、填写调查问卷几种方法,确诊本地区489例AR,并依据BA的诊断标准,将其分为2组,I组(对照组)为仅有AR的患者298例,Ⅱ组(试验组)指AR并发BA者191例,进行2组对比分析.结果:①本组资料表明;AR并发BA者占39%;②哮喘-鼻息肉-阿司匹林过敏(ASA)三联症,2组差异有统计学意义(P<0.01);③年龄组人数分布,10～19岁及40～49岁2组差异有统计学意义(P<0.05);④疾病分型,中重度间歇性AR、轻度持续性AR、中重度持续性AR三型实验组和对照组间差异有统计学意义(P<0.05);⑤其他手要伴发病及症状2组分布情况,如变应性咽炎、鼻窦炎、结膜炎、分泌性中耳炎、肥厚性鼻炎、皮肤病、胃肠道不适症状、不明原因头痛2组差异有统计学意义(P<0.05),以上差异件都表明实验组高于对照组.结论:本地区AR并发BA者人数较高,并发BA者以10～19岁及40～49岁者较多,分型以中重度间歇性AR、轻度持续性AR、中重度持续性AR3型比较多见,并发BA者伴发疾病人数增加.     

Changes in HIV testing policies and the implications for women

The US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) together with the Joint United Nations Programme on HIV/AIDS (UNAIDS) recently released new guidelines for HIV testing in health care settings. Both sets of guidelines recommend eliminating individual informed consent in favor of an opt-out approach that requires clients to actively decline the HIV test after a pretest information session. The revised guidelines also recommend reducing the amount of counseling that accompanies the HIV test. Women are more likely than men to be affected by efforts to expand access to HIV testing in health care settings because of women's increased vulnerability to HIV and greater contact with the health care system. Women may also be more susceptible to changes to the consent and counseling process for HIV testing because of their marginalized social status in many settings. More research is needed to document women's experiences with provider-initiated, opt-out HIV testing. Understanding women's experiences will help to formulate feasible and effective strategies to support women and ensure they gain access to HIV treatment services.