Community medicine最新文献

A survey of the knowledge of and attitudes towards cervical cytology screening in various locations in Tower Hamlets showed that 77 per cent of women in the sample reported that they had a smear test, and 86 per cent knew about them, although a small group of active elderly were unlikely to know much about the test or to have had one. Only 11 per cent of the 600 women under 65 understood that cervical cytology was to prevent cancer, whereas 71 per cent thought that it was to detect cancer. Of the 205 women who recalled their experience of the test, all had some difficulty. Two-thirds were embarrassed, and 54 per cent had pain or discomfort, which included all those women who did not feel embarrassed. Forty-three per cent had been informed of the result of their tests and about one-quarter of those took steps to get the result. Seventy-one per cent of the women had had their first test done before the age of 35, but only 9 per cent after the age of 45. A quarter of those screened had only had one test done. The women considered that more publicity about the test, the knowledge that a woman doctor would do the test, and more encouragement by health professionals would be improvements most likely to increase the uptake of screening. The possibility of a service offering immediate results should be explored by means of a pilot study.

In an attempt to improve cervical cytology screening uptake in women aged over 40, a mobile screening unit was used to make screening easily available to women at work. This service was organized jointly between the District Health Authority, the Women's National Cancer Control Campaign and the South West Thames Regional Cancer Organization, and was offered to all companies employing at least 25 women. Thirty-nine out of 82 companies accepted the offer. Among those companies which were able to supply a register of their employees aged over 40, 91 per cent of eligible women attended the mobile clinic. The clinic doctors followed District guidelines in not taking smears from women who had been screened and found negative within the previous three years, or who had had a hysterectomy for an unrelated reason. Of the 1038 women who attended the clinic, cervical smears were taken from 568 (55 per cent). Fifteen women were found to have cervical neoplasia, of whom nine had either never been screened before or had last been screened more than five years previously; a further two women (one of whom was found to have early invasive cancer) had previously had an abnormal smear for which the recommended follow-up had not been done. It was not possible to quantify the benefits of other tests (clinical breast examination, blood pressure, urinalysis and gynaecological examination) included in the screening clinic, but they were popular with the women attending. Provided that the health authority is involved in the planning and organization of workplace screening, it can be a valuable adjunct to improving screening coverage, particularly for women aged over 40.

The prevalence of antibody to hepatitis A virus (anti-HAV) in a sample of 1662 Sardinian children aged 3 to 11 years was estimated by ELISA. The overall anti-HAV prevalence was 3.8 per cent; it increased from zero among children of 3 to 7.2 per cent in children of 11 years. A slight male predominance was observed (4 versus 3.6 per cent). Anti-HAV prevalence was inversely related to the number of years of education received by the father and positively related to the number of households in the sample. Children whose fathers had received less than six years of schooling, had a 6.2-fold risk (Cl 95 per cent = 2.6-15.3) and children with five or more households under one roof had a 2.6-fold risk (Cl 95 per cent = 1.4-5.0) of previous exposure to hepatitis A virus (HAV) infection. These findings suggest that exposure of Sardinian children to hepatitis A virus is relatively low, probably because of improvements in socioeconomic conditions in recent years in the island. However, overcrowding and poor education in the father of schooling appear to be important determinants of infection.

A study of the geographical distribution of cerebrovascular disease in Scottish communities during three quinquennia between 1959 and 1983 showed a marked tendency for high SMRs to be present in the west of Scotland and low SMRs in the east. Cerebrovascular disease was significantly correlated with coronary heart disease, with bronchitis, emphysema and asthma, and to a lesser extent with other heart disease, with other circulatory disease and with indices of overcrowding. It was not associated with either urbanization or industrialization.