The benefits and ethics of screening for breast cancer.
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Breast Neoplasms↗
Biomedical subjects
D Haran
Publications and source records attributed to D Haran.
Trends in the organization of cervical cancer screening.
Cervical cytological screening has been available in the UK for several decades, but has not achieved a significant reduction in the incidence of and mortality from cervical cancer. In this paper we describe past problems of cervical screening, discuss the impact of recent innovations to computerize call and recall, and suggest further improvements for the future.
Appointments and Schedules↗
Cervical screening: what are the communication problems?
Computer-managed call and recall schemes offer the opportunity for effective cervical screening. However, such schemes involve several different agencies, often independent of one another. As a result, problems of communication can arise. This paper discusses potential areas of difficulty and presents some suggestions for improvement.
Adult↗
Computer-managed call and recall for cervical screening: a typology of reasons for non-attendance.
Three pilot studies looked at women who had not attended for cervical screening following a computer-generated invitation to a health authority clinic. From these a typology of reasons for non-attendance for computer-managed screening has been developed, specifying inaccessibility, ineligibility, unsuitability, failure of communications, misclassification and refusal because of practical problems, inappropriate beliefs or attitudinal barriers. Underlying the typology are issues connected with the inaccuracy of the database, service organization and provision, and the characteristics of the women themselves.
Appointments and Schedules↗
Well you can come in but i'm not having it. The role of the health visitor in computer-managed cervical screening.
Health visitors called on women who had not attended for a cervical smear test, following an invitation via a computer-managed scheme. Reasons for non-attendance were identified and the study showed that health visitors can be successful in encouraging some non-attenders to be screened. However, there are problems involved in undertaking such a role, which must be acknowledged if the health visitors's time is to be used effectively.
Community Health Nursing↗
Reasons for non-attendance for computer-managed cervical screening: pilot interviews.
A pilot interview study looked at reasons why women did not attend a clinic following an invitation for a cervical smear test offered via a computer-managed scheme. Three broad issues were identified. First, the inaccuracy of the computer database (the FPC register) meant some women were inaccessible because they no longer lived at the address recorded. Other women were ineligible or unsuitable within the criteria of the scheme but had been sent invitations inappropriately because their screening records were incomplete or out of date. Second, aspects of service organisation and provision led to misclassification of some attenders as non-attenders and to various failures of communication such as non-receipt of the invitation or health education leaflet or unsuccessful attempts to rearrange appointments. In addition, the appointment or venue offered could be unsatisfactory. The third issue concerned the characteristics of the women which sometimes interacted with practical problems connected with service provision. Other women believed the test to be inappropriate for themselves while some were deterred by the prospect of the test itself. In general, embarrassment was pervasive and reflected in preferences for different types of service provision. Women who had neither attended nor been otherwise tested were particularly likely to express feelings of fear and fatalism. General attitudes to the test were favourable but this was not always applied personally. A typology of reasons for non-attendance for computer-managed cervical screening is presented.
Attitude to Health↗
Hypothesis: common bacterial toxins are a possible cause of the sudden infant death syndrome.
It is hypothesised that common toxins produced by bacteria growing in the respiratory tract following a viral infection are a cause of SIDS. This hypothesis is consistent with evidence that viral infections pre-dispose to SIDS, minimal morphological change at autopsy, maximum incidence during sleep and the age incidence of this disease. We present evidence of nasopharyngeal bacterial overgrowth in victims of SIDS and have developed a mathematical model based on the hypothesis which closely predicts the age distribution. The model predicts other age distribution patterns for less common toxins and these may apply to other diseases of childhood. The hypothesis can be tested and if sustained would offer hope of prevention.
Age Factors↗
Computer-managed cervical cytology screening: a pilot study of non-attenders.
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Cervix Uteri↗
Pregnancy following induced abortion: maternal morbidity, congenital abnormalities and neonatal death. Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists Joint Study.
In a prospective cohort study of the long-term sequelae of induced abortion, a comparison is made between a group of 6418 women who had an induced abortion (cases) and a control group of 8059 women recruited with an unplanned pregnancy which was not terminated with an induced abortion (controls). The present paper reports on 729 cases and 1754 controls who had a post-recruitment pregnancy. In general, prior induced abortion had no material effect on the rate of pregnancy-related morbidity, nor on the rate of congenital abnormalities and neonatal death in the offspring. There was, however, a significant difference in two specific conditions. In the post-index pregnancy in the cases there was an increased relative risk (RR 2.26) of the occurrence of urinary tract infection and a decreased risk (RR 0.25) of pregnancy-related anaemia.
Abortion, Induced↗
Breast self-examination: how committed are women? How committed are we?
Breast self-examination (BSE), increasingly promoted as a good health habit, is gaining recognition by surgeons as a significant factor in tumour size and staging at diagnosis. Clinically-based reports leave unanswered important behavioural questions and pay scant attention to the quality of the teaching or of the practice of BSE. This paper argues that if BSE is to be used as the coarse-screening modality of which it seems to be capable, we must apply to it the same criteria as to other screening modalities. Since BSE ipso facto must be undertaken by the women herself, it is a screening in which subject behaviour is crucial. Promotion of BSE requires not only behaviour change but also maintenance and support. Behavioural aspects are discussed in relation to a recent major study of the teaching and practice of BSE.
Behavior↗
Synthesising research findings and practical experience to formulate principles in cervical screening.
Compared particularly with Scandinavian countries, the effects of cervical screening in the United Kingdom have been disappointing, both in terms of women screened and in relation to incidence and mortality. The underlying problem is the under-representation of women most at risk of cervical cancer in the screened population. In this paper we examine two possible hypotheses for such under-representation: one concerns the behavioural aspects of women's failure to attend and the second the effect of the organisation of current screening services on their attendance. We outline the features that an effective service would need to incorporate and propose principles for the development of a screening system designed to maximise the potential of the cervical smear test.
Behavior↗
A computer-managed call and recall system for cervical screening.
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Computers↗
Living with an amputation: the helper.
One hundred and nine key helpers were interviewed in connection with a study of the psychosocial implications of amputation. They were found to carry formidable burdens. Social isolation was a major problem which increased over time and was associated with diminished capacity to express needs. The respondents discussed emotional problems readily. Social workers had little sustained contact with helpers: welfare agencies had intervened mainly to provide practical help. The Artificial Limb Centre did not routinely see helpers or communicate with General Practitioners. A more realistic approach to the support of those who implement community care policies is advocated, with particular reference to the need for respite care to be provided in the domestic setting. The dangers of the exploitation of women as carers are highlighted.
Adaptation, Psychological↗
Attendance for cervical screening--whose problem?
Despite the existence of an effective screening technique for cancer of the cervix, incidence and mortality from this disease have not declined in the United Kingdom. The basic problem is that women most at risk of the disease are under-represented in the screened population. The evidence for two different points of view to explain this situation is examined. These viewpoints are the failure of the women to attend, and the failure of the service to meet the needs of women. This paper argues that the evidence supports the view that the organisation of the existing screening service impedes the maximum participation of at-risk women. We discuss the features that an effective service needs to incorporate, and put forward principles for the development of a more effective screening system, namely, that it should be provider-initiated and user-oriented.
Attitude to Health↗