Uptake Of Screening Tests Research Articles

Effectiveness of workplace cancer screening interventions: a systematic review

IntroductionCancer cases are rising globally, with a noticeable rise in younger adults. Screening and early detection are effective in decreasing mortality. Workplaces can play a role in promoting cancer screening uptake. This systematic review investigated the effectiveness of workplace breast, lung, colorectal, and cervical cancer screening interventions, and the factors impacting their effectiveness.MethodologySix databases (Embase, Medline, Web of Science, CINAHL, Cochrane Library, Scopus) were searched, and cancer screening promotion and cancer screening uptake was analysed using effect direction plots. Magnitude of effectiveness (i.e., change in knowledge or screening rate) was also evaluated.ResultsIn total, 13,426 articles were identified. After screening and applying the eligibility criteria, 21 articles were included in the analysis. A positive effect direction was seen for all workplace cancer screening promotion interventions. Magnitude of effectiveness for cancer screening promotion interventions resulted in a > 30% change in knowledge or screening uptake in 4/7 of breast cancer, in 3/4 of cervical cancer and 1/3 colorectal cancer screening promotion interventions. For workplace cancer screening uptake interventions, a positive effect direction was observed for the majority (18/22). Cancer screening uptake interventions showed a > 30% change in magnitude of screening rate in 4/7 breast cancer, 5/10 colorectal cancer and in 1/5 cervical cancer workplace interventions. No studies for lung cancer were eligible. Factors positively influencing effectiveness included an interest in health and previous healthcare use, while fear of cancer and embarrassment of screening negatively influenced effectiveness.ConclusionWorkplace cancer screening promotion and uptake interventions can effectively improve cancer screening knowledge and increase uptake of screening tests.

Beliefs and Utilization of Cervical Cancer Screening by Female Health Care Workers in Saudi Arabia Using the Health Belief Model: A Nationwide Study.

Epidemiologically, cervical cancer is the fourth most commonly diagnosed cancer among females globally and the third most commonly diagnosed gynecological cancer in Saudi Arabia. Screening is an important measure to prevent it. The current study aimed to assess, epidemiologically, female healthcare workers' (HCWs) utilization of cervical cancer screening services and its association with their beliefs about cervical cancer and the screening test, as well as their personal characteristics. This cross-sectional study included female HCWs in Saudi Arabia. A predesigned, self-administered survey was used to collect data, and it included questions about sociodemographic and reproductive characteristics, self-utilization of cervical cancer screening services, and the Health Belief Model (HBM) scale. Regression analyses were conducted to identify predictors of cervical cancer screening service utilization. A total of 1857 females participated. The cervical cancer screening test uptake was 24.6% of ever-married females. However, 45% of the participants were willing to have the test. The odds of utilizing a screening were significantly higher among older participants, those with a higher level of education, and those with a higher number of pregnancies. Furthermore, HCWs with a history of HPV infection, cervical cancer in the family, hormonal contraception, or immunocompromised diseases were more likely to have the screening. An increase in the mean scores of the perceived benefits and motives subscales of HBM was associated with an increase in the uptake of screening. However, an increase in perceived barrier scores was significantly associated with a lower likelihood of cervical cancer screening uptake. Low cervical screening uptake and slightly higher intentions to have the test exist among HCWs. Certain personal factors and health beliefs significantly affect the utilization of the screening test. Approaches that target perceived benefits, health motivation, and perceived barriers to improve the screening rates of cervical cancer among HCWs are recommended.

Awareness, knowledge, and factors that influenced the uptake of screening tests for prostate cancer among men aged 40 and older in Ido-Ekiti, Ekiti State, Nigeria.

Despite being the second most common and deadliest cancer in males, prostate cancer could go unnoticed in the early stages. Prevention programs have been set in place to help in the early detection and reduction of mortality rates in developed countries. The aim of this study was to determine awareness, knowledge, and the uptake of prostate cancer screening tests. Another objective was to identify the factors that determine the uptake of prostate cancer screening among men living in Ido-Ekiti. A cross-sectional study was conducted among males aged 40 and above living in Ido-Ekiti in Ido-Osi local government area, Ekiti State, Nigeria. The sample size of 380 respondents was obtained using Leslie Fisher's formula. The study revealed that the majority of the correspondents are aware of prostate cancer (57.9%). More than two-thirds of the respondents have poor knowledge of prostate cancer and the screening test (74.4%), with a median knowledge score of 30%. The uptake of prostate cancer screening tests was very low among the respondents (18.2%). Despite the high level of awareness of prostate cancer disease among the respondents, the majority have poor knowledge of the disease and the screening test. There was a low uptake of prostate cancer screening tests among the respondents.

The impact of the COVID-19 pandemic on Italian population-based cancer screening activities and test coverage: results from national cross-sectional repeated surveys in 2020.

In Italy, regions have the mandate to implement population-based screening programs for breast, cervical, and colorectal cancer. From March to May 2020, a severe lockdown was imposed due to the COVID-19 pandemic by the Italian Ministry of Health, with the suspension of screening programs. This paper describes the impact of the pandemic on Italian screening activities and test coverage in 2020 overall and by socioeconomic characteristics. The regional number of subjects invited and of screening tests performed in 2020 were compared with those in 2019. Invitation and examination coverage were also calculated. PASSI surveillance system, through telephone interviews, collects information about screening test uptake by test provider (public screening and private opportunistic). Test coverage and test uptake in the last year were computed by educational attainment, perceived economic difficulties, and citizenship. A reduction of subjects invited and tests performed, with differences between periods and geographical macro areas, was observed in 2020 vs. 2019. The reduction in examination coverage was larger than that in invitation coverage for all screening programs. From the second half of 2020, the trend for test coverage showed a decrease in all the macro areas for all the screening programs. Compared with the pre-pandemic period, there was a greater difference according to the level of education in the odds of having had a test last year vs. never having been screened or not being up to date with screening tests. The lockdown and the ongoing COVID-19 emergency caused an important delay in screening activities. This increased the preexisting individual and geographical inequalities in access. The opportunistic screening did not mitigate the impact of the pandemic. This study was partially supported by Italian Ministry of Health - Ricerca Corrente Annual Program 2023 and by the Emilian Region DGR 839/22.

Abstract PR003: Colorectal cancer screening among Native Americans of Nebraska: A qualitative analysis of the barriers and facilitators

Abstract As a component of statewide cancer needs assessment, this study explored factors impacting colorectal cancer (CRC) screening and approaches to increase screening among Native Americans of Nebraska. Three 75-minute focus groups were conducted October-December 2021: Omaha Urban Indian clinic (n=11), Lincoln Urban Indian clinic (n=6), and Ponca Tribe (n=9). Participants were Native American cancer survivors and caregivers aged 30+ residing in Nebraska. Verbatim transcripts were inductively coded and analyzed using a directed content analysis approach. Most participants were female (88%) and caregivers (85%). Most had heard of colonoscopies (83%), but awareness of fecal tests was low with two participants unaware of any screening. Only 38% had heard of the Fecal Occult Blood Test despite tribal outreach during March incentivizing stool tests. Reasons for low uptake of screening tests included lack of awareness (“What is colorectal cancer?” and “I don't think a lot of Natives get that type of cancer, do they?”), elderly avoidance of medical care (“even when I’m real sick I have to be…near…death” before seeking care), fear (“fearing what they’re gonna find out”), and embarrassment (“perception of manhood”). The invasive and uncomfortable procedural aspect of colonoscopy and use of excreta for stool-based tests "Because I don't wanna be digging in my poop" were other deterrents. Some providers did not strongly recommend the screening. Other barriers include insurance and transportation/travel distance for colonoscopy. Suggested approaches to improve CRC screening were increasing awareness of CRC and screening options using billboards, flyers, posters, brochures, health fairs, public meetings, and social media (e.g., Facebook). Posters and educational materials in clinics were already in use. Suggested message content should portray that CRC is treatable “if they catch it in time,” emphasizing being there for family (“you’ve got kids, you want to see them graduate”), funny (“goofy…they can kinda laugh at the ad and hopefully not be so nervous”) and having community members share CRC survival stories. Engaging the community was also discussed either through 1) having nursing students provide health education outreach, 2) forming elder committees to encourage the elderly to complete screenings, and/or 3) ensuring physicians recommend and explain the importance of screenings during appointments. Community support in terms of transportation, social workers to attend appointments with the elderly, and financial counselors were discussed as important to complete screenings. Certain types of health facilities should enhance their partnership with Native Americans to share information with the community. Low awareness and wrong perception of CRC and screening tests are reasons for low utilization of screening. Participants expressed a desire for the researchers to continue building relationships with the tribal groups to address CRC. The state can use study results to prioritize interventions to reduce cancer care disparities. Citation Format: Krishtee Napit, Kendra L. Ratnapradipa, Lady Beverly Luma, Danae Dinkel, Shinobu Watanabe-Galloway. Colorectal cancer screening among Native Americans of Nebraska: A qualitative analysis of the barriers and facilitators [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR003.

Knowledge of Cervical Cancer and Uptake of Screening Test Among Women in the Region of Marrakesh, Morocco

In Morocco, cervical cancer is the leading cause of women’s cancer mortality because of the late stage diagnosis. The adherence to early screening remains insufficient. The aim of this study is to assess women’s knowledge of cervical cancer and their adherence to early screening. The study was conducted in five selected primary healthcare facilities in the region of Marrakesh, Morocco, and included 300 participants. Structured interviews were used to elicit information on demographic and reproductive life characteristics, knowledge, and uptake of screening test of cervical cancer (CC). Data was analyzed using the descriptive statistics, univariate analysis was carried out using χ2 test to compare percentages about symptoms, and risk factors for cervical cancer were poor among the participants. The human papillomavirus infection was ignored by almost 70% of women. Almost half of women never had a screening test. The urban origin, the uptake of the screening test, and the family antecedent of CC were factors that increase women’s knowledge about CC. The non-adherence to early screening is due to lack of knowledge, fear of the test result, or false beliefs. More efforts are needed to raise awareness among women by health staff to overcome negative perceptions and knowledge deficiencies about CC and to increase women’s adherence to screening.

Jordanian women’s attitudes towards cervical cancer screening: has the pattern changed?

The objective of this study was to report the current Jordanian rate of cervical smear test uptake, and study changes in women’s attitude to the smear test since the last published report in 2002. A prospective cross-sectional study of Jordanian women who at the time of the study were living in Jordan. The study period was from December 1 2018 to December 31 2018. Six hundred and twelve women were recruited, and the mean age was 36 years. Thirty-eight percent of the women in the study said they had had a smear test before. Of those who had ever had a test, 88% did so as a routine test. Of women who had never had a smear test, 61% said they had heard about the test, 50% of them did not give a ‘logical’ reason for not having a test. While the current rate is less than in 2002, more women recognised the test as being important. While the rate of cervical smear test uptake in Jordan remained low (38%), it is better than the rate in 2002 of 25.5%. Severe deficiencies in the knowledge of the test exist. Implementing a national cervical screening programme supported by media-led health education and promotion is likely to increase the test uptake and reduce incidence of cervical cancer.Impact statementWhat is already known on this subject? The incidence of cervical cancer (CC) in high income countries has reduced through the implementation of cervical screening programmes, with subsequent early detection and treatment of precancerous lesions. Globally, 85% of the CC burden is in low income countries. Furthermore, the implementation of screening programmes has not been successful due to limited resources and a lack of infrastructure. The rates of cervical screening test uptake vary widely among different countries. Jordan’s smear test uptake was 25% in 2002.What the results of this study add? The rate of cervical smear test uptake in Jordan has remained low (38%) compared to the rates in the developed countries. In addition, 12% of the cervical smears in our study were opportunistic. Our study recognised deficiencies in relation to public awareness of the importance and the details of the test.What the implications are of these findings for clinical practice and/or further research? In clinical practice and in the absence of national screening programme, health care workers are encouraged to perform more opportunistic smears. This study provides education on the test. Researchers may consider investigating the barriers to cervical screening and therefore increase cervical screening uptake.

Development of a conceptual model for interpretation of monitoring indicators of cancer screenings from the Italian National Prevention Plan

the Italian National Prevention Plan (PNP) posed the standard to be achieved by Italian Regions for the implementation of cervical, breast, and colorectal cancer screening: to invite all of the target populations and to increase the screening uptake up to 50%, 60%, and 50%, respectively, the standard defined by the Essential Levels of Care (LEA). Moreover, for cervical cancer screening, it requires the implementation of HPV-DNA test and, for breast cancer screening, the PNP demands for the definition of diagnostic and follow up pathways for high familial risk women. The PNP also set up a monitoring system to assess the impact of implemented policies. A conceptual model has been defined to facilitate interpretation of variation in outcome indicators. after a systematic review, the DPSEEA (Driving forces, Pressure, State, Exposure, Effect, Actions) was identified as the more appropriate framework to assess the results of preventive policies. Factors for each component of the model were identified and indicators that allow measuring the changing of each of these factors were defined. among the "driving forces", the trust in the health care system and the social capital were included. The presence of opportunistic screening, the competing private clinical activity, the commitment of General Practitioners and "medical" leaders, the attitude to cooperation and to patients' involvement, and the level of agreement between the positions of scientific societies and the recommendations implemented in organized screening programmes were included in the "pressures". In "state", the availability of technological and human resources, the level of management skills and of accessibility were identified. The "exposure" was defined as the coverage of active invitation of the target population and the uptake of screening tests. The "exposure" factors influence the "effect", described as the impact on anticipation of cancer diagnosis, on disease incidence (for cervical and colorectal cancer) and prognosis. The changing in screening programs performance modifies the impact of invitation coverage and test uptake ("exposure"). through the DPSEEA framework, we set up a logical conceptual model, which includes implementable actions and the mechanisms through which these actions should impact on the "exposure" (invitation coverage and screening uptake) and on the screening performance (quality).

Determinants of prostate specific antigen screening test uptake in an urban community in North-Central Nigeria.

Despite the increasing incidence of Prostate cancer, there has not been any focused screening policy or strategy in sub-Saharan Africa including Nigeria. To assess the level of awareness and uptake of PSA screening test and their determinants in a Nigerian community. A cross-sectional population survey of men with no prior history of prostate cancer was carried out. Logistic regression analysis was used to determine the effect of identified variables in predicting awareness and uptake of prostate cancer screening. Mean age was 51.5±9.8 years; a few men (31, 16.9%) had ever heard of the screening test and most got the information from health centers. A low proportion (8, 4.4%) had taken the screening test. Men with incomes above poverty line (OR = 11.7 2.8-50.1, p = .001) or those with health insurance (OR = 2.7 1.2-6.5, p = .023) were significantly more likely to be aware of the test. Only the men with higher incomes (OR = 25.6 5.8-114.2, p = .0001) were significantly more likely to have taken the test. Higher incomes and health insurance status impact screening awareness but only income status determines if men subsequently proceed to take the PSA screening test.

Interventions to increase uptake of faecal tests for colorectal cancer screening: a systematic review.

International guidelines promote screening by faecal tests in asymptomatic individuals at average risk of colorectal cancer (CRC), but uptake does not reach recommended levels in most countries. The aim of this study was to synthetize evidence on (a) interventions aiming to increase uptake of faecal tests for CRC screening, in asymptomatic individuals at average risk of CRC, (b) interventions that targeted general practitioner (GP) involvement and (c) interventions that targeted nonresponders or disadvantaged groups. A systematic review of randomized-controlled trials, searching PubMed, Embase and the Cochrane Library database, based on the Cochrane's Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guidelines was performed. The risk of bias of included trials was assessed. From 24 included RCTs, the following interventions increase uptake of faecal tests: advance notification letter (OR 1.20-1.51), postal mailing (OR 1.31-7.70), telephone contacts with an advisor (OR 1.36-7.72). Three interventions showed positive effects of GP involvement such as a GP-signed invitation letter [odds ratio (OR)=1.26], GP communication training (OR=1.22) or mailing reminders to GPs (OR=14.8). Inconclusive results were found for studies comparing different types of faecal tests and those testing the effectiveness of providing various types of written information. Advance notification letters, postal mailing of the faecal tests, written reminders and telephone contacts with an advisor increase patient uptake of faecal tests. There was only limited evidence on the effect of GP involvement on screening test uptake and a lack of studies focusing on nonresponders or disadvantaged groups.

Colon Cancer Screening Programs: Impact of an Organized Screening Strategy Assessed by the EDIFICE Surveys.

The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. Via the colorectal cancer screening program, all average-risk individuals in the 50-74-year age group are invited every 2years to do a guaiac-based or, since April 2015, an immunochemical fecal occult blood test. The fifth edition of the nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1299 individuals with no history of cancer (age, 50-74years) was interviewed between 22 November and 7 December 2016. The present analysis focuses on minimum lifetime uptake of screening tests, compliance to recommended repeat-screening intervals, and reasons for non-participation. In 2016, 64% survey participants had been screened at least once and 38% had been screened in the previous 2years, suggesting a trend towards increasing participation rates, particularly in the younger age categories and among men. The 2016 data also suggest that the newly implemented FIT-based screening program has been well perceived by the population. Up to one in four individuals cited "no risk factors" as the reason for not undergoing screening. This reveals ignorance of the fact that the colorectal cancer screening program actually targets all average-risk individuals in a given age group, without individual risk factors. We suggest the next step should be dedicated to educational approaches to explain exactly what screening involves and to persuasive messages targeting those who to date have remained unreceptive to information campaigns.

Temporal Trends in Geographic and Sociodemographic Disparities in Colorectal Cancer Among Medicare Patients, 1973-2010.

Colorectal cancer (CRC) incidence and mortality in the United States have steadily declined since the 1980s, but racial and socioeconomic disparities remain. The influence of geographic factors is poorly understood and may be affected by evolving insurance coverage and screening test uptake. We characterized temporal trends in the association between geographic and sociodemographic factors and CRC outcomes. We used the 1973-2010 SEER-Medicare files to identify patients aged ≥65 years with and without CRC. Beneficiary residential ZIP codes were used to extract local-level data. We constructed multivariable logistic regression models for CRC incidence and mortality using geographic and sociodemographic variables in 4 time periods: (1) 1973-1997; (2) 1998-2001; (3) 2002-2006; and (4) 2007-2010. We analyzed 1,093,758 records, including 336,321 CRC cases. Compared to urban residence, small rural residence was strongly associated with increased CRC incidence (OR 1.50, 95% CI: 1.43-1.57) and mortality (OR 1.35, 95% CI: 1.26-1.45) in 1973-1997, but the associations diminished by 2007-2010 (OR 1.09, 95% CI: 1.04-1.15 for incidence; OR 1.10, 95% CI: 1.01-1.20 for mortality). The disparity between blacks and whites increased over time for both incidence (OR 1.09, 95% CI: 1.05-1.13 in 1973-1997 vs OR 1.32, 95% CI: 1.27-1.37 in 2007-2010) and mortality (OR 1.22, 95% CI: 1.16-1.28 in 1973-1997 vs OR 1.34, 95% CI: 1.26-1.42 in 2007-2010). High socioeconomic status was associated with greater incidence and mortality in 1973-1997, but it became protective after 1998. Although disparities persist among Medicare beneficiaries, the relationship between geographic and sociodemographic factors and CRC incidence and mortality has evolved over time.

NH2 What effect do practice visits have upon opportunistic chlamydia screening test uptake and case detection in primary care? An audit of 81 general practices in Oxfordshire

Background/Introduction The National Chlamydia Screening Programme in England aims to reduce transmission and prevent complications through early diagnosis. The ‘Value for Money’ review proposed opportunistic screening in general practice supported by specialist services. Aims/Objectives To evaluate the effect of practice visits upon chlamydia screening coverage and case identification in young people aged 15–24 in Oxfordshire, April 2012–March 2014. Methods Quarterly counts of total screens and positive tests for general practices in Oxfordshire were linked to records of practice visits (date, attendance) and characteristics of practices (location, deprivation, practice size). Testing and positivity rates three months prior to screening officer visits (baseline) were compared to rates in the 0–3 and 4–6 months following a visit. Pre- and post-visit counts were compared using multivariate generalised estimating equation models, accounting for repeated measures by practices and confounders. Results Practice screen counts were available for 136 periods before and after visits to 81 practices. Practices reported a median of 9 tests in the 3 months prior to visits or 3% screening coverage of registered 15–24 year olds. Screen counts were significantly higher following visits (Table 1), and positively associated with higher staff attendance at those visits. Also, there is an increase in number of positive cases diagnosed immediately after visits. Conclusion Practice visits serve as a good reminder for staff in general practice to offer test opportunistically. However, there is a need for an enhanced intervention to sustain any increase in screening coverage and diagnoses following visit.

Predictors and factors related to the uptake of cervical cancer screening test among female secondary school teachers in Sagamu, Ogun State, Nigeria

Background: Cervical cancer is a cause of significant morbidity and mortality among Nigerian women. Early detection by screening has proved to be an effective preventive measure. Knowing the factors that determine and predict uptake helps to determine where more efforts need to be put to achieve better uptake of the screening test. Aim and Objective: To determine the predictors and factors related to the uptake of cervical cancer screening test among female secondary school teachers in Sagamu. Methods: A cross-sectional descriptive study was carried out among 256 secondary school teachers in Sagamu Local Government Area of Ogun State. Data were collected using semi-structured, self-administered questionnaires and analyzed using SPSS version 21. Chi-square test was used to determine factors related to the uptake of the screening test while logistic regression was done to predict which group was less likely to be screened. Results: Uptake of screening test was 17.6%. One hundred and sixty-nine (66%) respondents were willing to be screened. The most common reason for not willing to be screened was the belief of not been at risk of the disease. About 84% of the respondents had a positive attitude toward cervical cancer screening, with a mean score of 7.8 ± 1.5 while only 23.4% had good knowledge with a mean score of 7.6 ± 3.6. Teachers with lower knowledge and attitude scores who had one sexual partner were less likely to be screened. Conclusion: Adequate knowledge needs to be passed across to teachers to improve uptake of cervical cancer screening.

Health Screening Behaviour among Singaporeans

This study assessed the health screening behaviour of Singaporeans and evaluated factors associated with low uptake of screening tests. Data from the 2010 National Health Survey, which was conducted on Singapore citizens and permanent residents, was used in this analysis. Multivariate Cox regression was used to evaluate the relationship between sociodemographics and health screening behaviour for selected chronic diseases (hypertension, diabetes and hypercholesterolaemia) and cancers (cervical, breast and colorectal). National recommendations for age at which screening should be initiated and appropriate screening interval were used to define appropriate screening behaviour. More respondents have had their last chronic disease screening done within the recommended time period compared to cancer screening. A total of 77.8%, 63.4% and 54.9% of the respondents had their last hypertension, diabetes and hypercholesterolaemia done within the recommended time period respectively, while less than 50% of the respondents had their cervical (45.8%), breast (32.9%) and colorectal (20.2%) cancer screenings done within the recommended time period. Respondents with higher household income or more years of education were more likely to have undergone screening within the recommended time period. Indians, who are at higher risk of chronic diseases such as diabetes and hypercholesterolaemia, were also more likely to have been screened. A total of 69.9% and 79.5% of the respondents with previously undiagnosed diabetes and hypertension had reported to have done diabetes and hypertension screenings respectively, within the recommended time period. Sociodemographic factors that could be associated with a lower uptake of screening tests include: 1) low household income, 2) low education level, and 3) Malay ethnicity. Health promotion programmes and outreach to these groups can be enhanced to further improve screening uptake.

Strategies of testing for syphilis during pregnancy.

Strategies of testing for syphilis during pregnancy.

Test Uptake and Case Detection of Syphilis, HIV, and Hepatitis C Among Women Undergoing Prenatal Screening in British Columbia, 2007 to 2011

ObjectiveTest uptake and case detection trends for rubella, syphilis, HIV, and hepatitis C (HCV) were compared among the 2007 to 2011 cohort of women undergoing prenatal testing in British Columbia. Analysis involved linkage of provincially centralized laboratory and surveillance data to assess prenatal test uptake and rates of newly diagnosed versus prevalent infections. MethodsWe included prenatal specimens submitted from BC women aged 16 to 45years in 2007 to 2011. Laboratory records were linked to provincial surveillance systems to identify confirmed maternal syphilis and HIV cases. Previous positive status was determined for HIV and HCV if a prior confirmed case was identified from laboratory records. We determined rates of HIV and HCV newly identified at prenatal screening (new diagnoses per 100 000 per year). Prevalence for HIV and HCV was the sum of all new and prior diagnoses (prevalence per 100 000 per year). ResultsOf 233 203 women, 96.9% were screened for rubella, 93.3% for syphilis, 93.8% for HIV, and 21.5% for HCV. From 2007 to 2011, the overall rates of new diagnoses were 15.4, 5.1, and 82.8 cases per 100 000 per year for syphilis, HIV, and HCV, respectively. The overall prevalence was 45.9 and 551.5 cases per 100 000 per year for HIV and HCV, respectively (0.05% and 0.6%). From 2007 to 2011, new diagnoses of HCV decreased 40% from 106.0 to 62.1 cases per 100 000 per year. HCV prevalence did not change and increased with maternal age. ConclusionThis study links surveillance and laboratory data to provide a provincial picture of prenatal screening test uptake and case detection, with the advantage of distinguishing new from prior diagnoses. This information can help guide prenatal communicable disease screening policy.

Personalised risk communication for informed decision making about taking screening tests

There is a trend towards greater patient involvement in healthcare decisions. Although screening is usually perceived as good for the health of the population, there are risks associated with the tests involved. Achieving both adequate involvement of consumers and informed decision making are now seen as important goals for screening programmes. Personalised risk estimates have been shown to be effective methods of risk communication. To assess the effects of personalised risk communication on informed decision making by individuals taking screening tests. We also assess individual components that constitute informed decisions. Two authors searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2012), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHOST) and PsycINFO (OvidSP) without language restrictions. We searched from 2006 to March 2012. The date ranges for the previous searches were from 1989 to December 2005 for PsycINFO and from 1985 to December 2005 for other databases. For the original version of this review, we also searched CancerLit and Science Citation Index (March 2001). We also reviewed the reference lists and conducted citation searches of included studies and other systematic reviews in the field, to identify any studies missed during the initial search. Randomised controlled trials incorporating an intervention with a 'personalised risk communication element' for individuals undergoing screening procedures, and reporting measures of informed decisions and alsocognitive, affective, or behavioural outcomes addressing the decision by such individuals, of whether or not to undergo screening. Two authors independently assessed each included trial for risk of bias, and extracted data. We extracted data about the nature and setting of interventions, and relevant outcome data. We used standard statistical methods to combine data using RevMan version 5, including analysis according to different levels of detail of personalised risk communication, different conditions for screening, and studies based only on high-risk participants rather than people at 'average' risk. We included 41 studies involving 28,700 people. Nineteen new studies were identified in this update, adding to the 22 studies included in the previous two iterations of the review. Three studies measured informed decision with regard to the uptake of screening following personalised risk communication as a part of their intervention. All of these three studies were at low risk of bias and there was strong evidence that the interventions enhanced informed decision making, although with heterogeneous results. Overall 45.2% (592/1309) of participants who received personalised risk information made informed choices, compared to 20.2% (229/1135) of participants who received generic risk information. The overall odds ratios (ORs) for informed decision were 4.48 (95% confidence interval (CI) 3.62 to 5.53 for fixed effect) and 3.65 (95% CI 2.13 to 6.23 for random effects). Nine studies measured increase in knowledge, using different scales. All of these studies showed an increase in knowledge with personalised risk communication. In three studies the interventions showed a trend towards more accurate risk perception, but the evidence was of poor quality. Four out of six studies reported non-significant changes in anxiety following personalised risk communication to the participants. Overall there was a small non-significant decrease in the anxiety scores. Most studies (32/41) measured the uptake of screening tests following interventions. Our results (OR 1.15 (95% CI 1.02 to 1.29)) constitute low quality evidence, consistent with a small effect, that personalised risk communication in which a risk score was provided (6 studies) or the participants were given their categorised risk (6 studies), increases uptake of screening tests. There is strong evidence from three trials that personalised risk estimates incorporated within communication interventions for screening programmes enhance informed choices. However the evidence for increasing the uptake of such screening tests with similar interventions is weak, and it is not clear if this increase is associated with informed choices. Studies included a diverse range of screening programmes. Therefore, data from this review do not allow us to draw conclusions about the best interventions to deliver personalised risk communication for enhancing informed decisions. The results are dominated by findings from the topic area of mammography and colorectal cancer. Caution is therefore required in generalising from these results, and particularly for clinical topics other than mammography and colorectal cancer screening.

Ovarian cancer in Kenyatta National Hospital in Kenya: Characteristics and management

Background: Ovarian cancer is the third commonest cause of cancer death from gynaecologic tumors in Kenya. Early disease causes minimal, nonspecific, or no symptoms therefore, most patients are diagnosed when the disease is at an advanced stage. Overall, prognosis for these patients remains poor but has not been described in Kenya. Objectives: To describe the histological types, therapeutic methods used, therapeutic outcome and the survival rate at 2 years. Methods: This was a retrospective cross-sectional descriptive study undertaking a 10-year review of case records of patients treated for cancer of the ovary between 1998 and 2008 in Kenyatta National Hospital. Results: Majority of the patients (73.3%) presented with advanced stage of disease (stages III & IV). Epithelial tumors (86.2%) are the commonest histological type, with 45.7% of them being serous type. Chemotherapy was the most (46.0%) used therapeutic option, with vomiting and diarrhea being the leading morbidity associated with it. Survival at 2 yrs from diagnosis was 50% as per the Kaplan-Meier time survival estimate. Conclusion: There is need to improve the quality of data on cancer care and information systems in general to provide a reliable source of information to guide research and policy in oncology. Further, the late presentation to hospital calls for innovative strategies to improve ovarian cancer awareness and uptake of screening tests. There is need to lobby Governments in resource limited setting to subsidize cancer of the ovary care and invest in lower level health facilities to promote early diagnosis and decongest the referral hospital.

Evidence-based milestone ages as a framework for developmental surveillance.

Developmental surveillance is the process of monitoring child development over time to promote healthy development and to identify possible problems. Standardized developmental screeners have greater sensitivity than milestone-based history taking. Unfortunately, Canadian screening guidelines, to date, are sparse, logistical barriers to implementation have slowed uptake of screening tests and physicians continue to rely on milestones. When using clinical impression as a framework for surveillance, clinicians may not know when to consider a milestone delayed because developmental attainments exist within an age range and there is an absence of referenced percentiles on available published tables, which are particularly problematic for the cognitive and social-emotional sectors, which are less familiar to physicians. A novel, five-sector milestone framework with upper limits, referenced to the best available level of evidence, is presented. This framework may be used in teaching and may help physicians to better recognize failed milestones to facilitate early identification of children at risk for developmental disorders.