No description available.

Background Tobacco smoking is accountable for more than one in ten deaths in patients with cardiovascular disease. Thus, smoking cessation has a high priority in secondary prevention of coronary heart disease (CHD). The present study meant to assess smoking cessation patterns, identify parameters associated with smoking cessation and investigate personal reasons to change or maintain smoking habits in patients with established CHD. Methods Quality of CHD care was surveyed in 24 European countries in 2012/13 by the fourth European Survey of Cardiovascular Disease Prevention and Diabetes. Patients 18 to 79 years of age at the date of the CHD index event hospitalized due to first or recurrent diagnosis of coronary artery bypass graft, percutaneous coronary intervention, acute myocardial infarction or acute myocardial ischemia without infarction (troponin negative) were included. Smoking status and clinical parameters were iteratively obtained a) at the cardiovascular disease index event by medical record abstraction, b) during a face-to-face interview 6 to 36 months after the index event (i.e. baseline visit) and c) by telephone-based follow-up interview two years after the baseline visit. Parameters associated with smoking status at the time of follow-up interview were identified by logistic regression analysis. Personal reasons to change or maintain smoking habits were assessed in a qualitative interview and analyzed by qualitative content analysis. Results One hundred and four of 469 (22.2%) participants had been classified current smokers at the index event and were available for follow-up interview. After a median observation period of 3.5 years (quartiles 3.0, 4.1), 65 of 104 participants (62.5%) were classified quitters at the time of follow-up interview. There was a tendency of diabetes being more prevalent in quitters vs non-quitters (37.5% vs 20.5%, p=0.07). Higher education level (15.4% vs 33.3%, p=0.03) and depressed mood (17.2% vs 35.9%, p=0.03) were less frequent in quitters vs non-quitters. Quitters more frequently participated in cardiac rehabilitation programs (83.1% vs 48.7%, p<0.001). Cardiac rehabilitation appeared as factor associated with smoking cessation in multivariable logistic regression analysis (OR 5.19, 95%CI 1.87 to 14.46, p=0.002). Persistent smokers at telephone-based follow-up interview reported on addiction as wells as relaxation and pleasure as reasons to continue their habit. Those current and former smokers who relapsed at least once after a quitting attempt, stated future health hazards as their main reason to undertake quitting attempts. Prevalent factors leading to relapse were influence by their social network and stress. Successful quitters at follow-up interview referred to smoking-related harm done to their health having had been their major reason to quit. Interpretation Participating in a cardiac rehabilitation program was strongly associated with smoking cessation after a cardiovascular disease index event. Smoking cessation counseling and relapse prophylaxis may include alternatives for the pleasant aspects of smoking and incorporate effective strategies to resist relapse. / Einleitung Bei Patienten*innen mit kardiovaskulären Erkrankungen ist mehr als einer von zehn Todesfällen auf Tabakrauchen zurückzuführen. Daher ist Rauchentwöhnung ein wichtiger Aspekt der Sekundärprävention der koronaren Herzerkrankung. In dieser Studie wurde der Verlauf des Rauchverhalten von Patienten*innen mit bekannter koronarer Herzerkrankung erfasst, Einflussfaktoren für Tabakabstinenz untersucht und die persönlichen Beweggründe zur Änderung oder Beibehaltung des Rauchverhaltens analysiert. Methoden Die Güte der Behandlung der koronaren Herzerkrankung wurde in 24 Europäischen Staaten in den Jahren 2012/13 im Rahmen des vierten European Survey of Cardiovascular Disease Prevention and Diabetes erfasst. Eingeschlossen wurden Patienten*innen zwischen 18 und 79 Jahren zum Zeitpunkt des kardiovaskulären Indexereignisses. Als kardiovaskuläres Indexereignis wurde eine stationäre Behandlung aufgrund der folgenden Erst- oder Rezidiv Diagnosen definiert: Koronararterien-Bypass, perkutane Koronarintervention, akuter Myokardinfarkt und akute myokardiale Ischämie ohne Infarkt (Troponin negativ). Rauchgewohnheiten und klinische Parameter wurden bei Patienten*innen im Studienverlauf wiederholt erhoben: a) Anhand der Behandlungsunterlagen während des kardiovaskulären Indexereignis, b) während eines persönlichen Interviews 6-36 Monate nach dem Indexereignis (i.e. Baseline Untersuchung) und c) im Rahmen eines telefonischen Follow-Up Interviews zwei Jahre nach der Baseline Untersuchung. Einflussfaktoren für Tabakabstinenz zum Zeitpunkt des telefonischen Follow-Up Interviews wurden über logistische Regressionsmodelle ermittelt. Die persönlichen Beweggründe das individuelle Rauchverhalten beizubehalten oder zu ändern wurden im Rahmen eines qualitativen Interviews erhoben und mithilfe der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse 104 von 469 (22,2%) Studienteilnehmer*innen wurden zum Zeitpunkt des Indexereignisses als Raucher*innen klassifiziert und nahmen an dem Follow-Up Interview teil. 65 von 104 (62,5%) dieser Raucher*innen gaben median 3,5 Jahre (Quartilen 3,0; 4,1) nach dem kardiovaskulären Indexereignis an mit dem Rauchen aufgehört zu haben. Es gab eine Tendenz zu höheren Prävalenzen von Diabetes bei nicht mehr Rauchenden im Vergleich zu weiterhin Rauchenden (37,5% vs. 20,5%; p=0,07). Höherer Bildungsgrad (15,4% vs. 33,3%; p=0,03) und Symptome einer depressiven Verstimmung (17,2% vs. 35,9%; p=0,03) waren bei nicht mehr Rauchenden seltener als bei weiterhin Rauchenden. Nicht mehr Rauchende nahmen überdurchschnittlich häufig an einem kardialen Rehabilitationsprogramm teil (83,1% vs. 48,7%; p<0,001). Kardiale Rehabilitation war ein signifikanter Einflussfaktor auf Tabakabstinenz in der multivariaten logistischen Regression (OR 5,19; 95% Konfidenzintervall 1,87-14,46; p=0,002). Weiterhin Rauchende berichteten von Sucht sowie von Entspannung und Freude als Gründe nach wie vor zu rauchen. Diejenigen aktiven und ehemaligen Raucher*innen, welche mindestens einmal einen Rückfall nach einem Aufhörversuch erlebten, gaben Sorgen vor den gesundheitlichen Folgeschäden des Rauchens als Hauptgrund für Aufhörversuche an. Ihr soziales Umfeld und Stress waren häufige Gründe für Rückfälle. Ehemalige Raucher*innen berichteten von bereits eingetretenen gesundheitlichen Problemen, welche sie mit dem Rauchen in Verbindung gebracht hatten, als treibende Kräfte um nachhaltig abstinent sein zu können. Interpretation Die Teilnahme an einem kardialen Rehabilitationsprogramm war bei Patienten*innen mit kardiovaskulärer Erkrankung deutlich mit dem Verzicht auf Tabakrauchen assoziiert. Beratung zur Raucherentwöhnung und Rückfallprophylaxe könnten Alternativen für die, in der subjektiven Wahrnehmung, angenehmen Aspekte des Rauchens bieten und effektive Strategien zur Vermeidung von Rückfällen berücksichtigen.

Da bei Patienten mit Nebenniereninsuffizienz (NNI) trotz etablierter Substitutionstherapie eine erhöhte Mortalität nachgewiesen wurde, kommt der Prävention von Nebennierenkisen (NNK) eine starke Bedeutung zu. Mithilfe des in der vorliegenden Arbeit evaluierten Schulungsprogrammes konnte die Grundlage für eine künftig optimierte Krisenpräventionsarbeit für Patienten mit NNI in Deutschland geschaffen werden. Kern der Studie war eine standardisierte 90-120-minütige Gruppenschulung, die in acht Zentren durchgeführt wurde. Mittels Fragebogenerhebung zu drei verschiedenen Zeitpunkten (vorher, direkt nachher, 6-9 Monate nachher) wurde der Wissenstand sowie subjektive Einschätzungen der Patienten zum Umgang mit ihrer Erkrankung evaluiert. Die Patienten schnitten nach Teilnahme an einer standardisierten Schulungsveranstaltung im Wissenstest deutlich besser ab und schätzten den eigenen Informationsstatus sowie das subjektive Sicherheitsgefühl als höher ein. Außerdem stieg die Anzahl der Personen, die sich in einer Notfallsituation die Eigeninjektion von Hydrocortison zutrauen würden, signifikant. Damit zeigt das hier vorgestellte interaktive Training einen eindrucksvollen, positiven Effekt auf den Alltag von NNI-Patienten, die dieses zu jedem untersuchten Zeitpunkt in jeweils > 90 % der Fälle als Lebensqualität-verbessernd einstuften. Obwohl sich die Gesamtpunktzahlen im Wissenstest zwischen dem Zeitpunkt direkt nach einer Schulung und nach 6-9 Monaten nicht signifikant unterschieden, war zumindest in den subjektiven Einschätzungsfragen (beispielsweise bzgl. des Informationsstatus, des Sicherheitsgefühls und des Eigeninjektions-Zutrauens) ein statistisch bedeutsamer Rückgang zu verzeichnen. Dies sollte, auch in Zusammenschau mit der Literatur, als Hinweis dafür aufgefasst werden, dass eine einzelne Schulung pro Patient nicht ausreichend ist. Die zumindest jährliche Wiederholung der geschulten Inhalte wäre deshalb zu empfehlen. / Patients with adrenal insufficiency (AI) suffer from impaired quality of life and are at risk of adrenal crisis (AC) despite established replacement therapy. Patient education is regarded an important measure for prevention of AC and improvement of AI management. A standardised education programme was elaborated for patients with chronic AI in Germany. During 2h-sessions, patients were provided with basic knowledge on AI, equipped with emergency cards and sets and trained in self-injection of hydrocortisone. To evaluate the education programme, patients from eight certified centres completed questionnaires before, immediately after and 6-9 months after training. Questionnaire score-values for theoretical knowledge were significantly higher after patient education, indicating successful knowledge transfer, and remained stable over 6-9 months. Furthermore patient education lead to positive development of subjective well-being and information-status as well as confidence of self-injection of hydrocortisone in case of emergency and quality of life. Therefore patient group education represents a helpful tool fort he guidance of patients, their self-assurance and their knowledge on prevention of AC. Repeated training and adaption to specific needs is needed.

Hintergrund: An der Universität Würzburg wurde bereits im Wintersemester 2018/19 eine 90-minütige Lehrveranstaltung zur Nikotinentwöhnung als Präsenz- oder E-Learning-Seminar im 6. Semester implementiert. In 2020 wurden weitere Bausteine ergänzt: eine Kurzinfo zur Raucherberatung im 9. Semester und die Beratung realer Patienten im 10. Semester im Blockpraktikum-Allgemeinmedizin (BPA). Fragestellung: Wie wirkt sich der Besuch des Seminars langfristig auf das Beratungs-Wissen aus? Ist eine Nikotinentwöhnungsberatung im Rahmen des BPA machbar? Erhöht sich dadurch die subjektive Sicherheit der Studierenden? Methoden: Im Sommersemester 2020 wurden Studierende des 9. Semesters, die regulär das Seminar zur Raucherberatung im Wintersemester 2018/19 besucht haben sollten, online bzgl. Wissen zur Nikotinentwöhnungsberatung befragt. Es folgten vertonte PowerPoint-Folien zur Raucherberatung (Kurzinfo). Im Wintersemester 2020/21 im BPA sollten die Studierenden ein Nikotinentwöhnungsgespräch mit einem Patienten in der Lehrpraxis durchführen und ihre Erfahrungen und subjektive Sicherheit mittels Online-Befragung retrospektiv evaluieren. Ergebnisse: In der Befragung des 9. Semesters (n=54, Rücklauf: 35%) schätzten Teilnehmende der Ursprungskohorte (n=35 von ursprünglich 130) im Vergleich zu Nicht-Teilnehmenden (n=19) ihr Wissen deutlich höher ein (p=0,016). Dabei spielte die zuvor besuchte Lehrform keine Rolle (p=0,963). Im BPA führten 50% (n=57) der 114 Befragten (Rücklauf: 74%) eine Nikotinberatung mit einem Patienten durch, dabei stieg die Sicherheit, ein solches Gespräch zu führen, signifikant (p<0,001). Beratende Studierende beurteilten den Zugewinn an Fertigkeiten durch das BPA höher (p<0,001) und hielten es für wichtiger, Patienten zu ihrem Rauchverhalten zu beraten (p=0,048). Diskussion: Unabhängig von der Lehrform scheint sich ein Seminar zur Raucherberatung langfristig positiv auf das Wissen auszuwirken. Für 50% war eine Nikotinentwöhnungsberatung im BPA machbar. Als Hinderungsgründe wurden fehlende Gelegenheiten und ungeeignete Patienten angegeben. Die Beratung eines Patienten in einer realen Situation erhöht die Beratungssicherheit. / Background: To prepare students for their future role in prevention, we implemented a longitudinal smoking cessation course using the 5A schedule for students of 6th term. This follow-up study evaluated the practical feasibility of the learned smoking cessation counselling in the family medicine placement in 10th term and the changes in students’ attitudes and confidence regarding counselling. Methods: For the evaluation we used an online questionnaire with Likert-scales, multiple and single choice as well as open-end questions. Students of 10th term assessed the feasibility and obstacles of smoking counselling in the placement, their counselling confidence and professional attitudes after placement. For the examination of changes since 6th term we compared matched data sets. Data were analysed with Welch tests and paired t-test. Results: Data of 114 students were analysed and 45 data sets could be matched to 6th term. Results showed that the short-intervention was feasible under favorable conditions. Half of the students did not perform a counselling because of a lack of time or opportunity. The longitudinal course influenced attitudes in a positive way and increased counselling confidence of students. Performing the short-intervention in the placement led to a greater increase in assessment of counselling competences over time. Conclusion: The new course has closed an important gap in our medical curriculum. To prepare students well for medical practice, it is important to combine theoretical content and practical implementation. Promoting good framework conditions in general practice, such as sufficient time, is essential to give students the opportunity to practice counselling sessions. The next steps should be an objective measurement of competence and analysis of possible support points for implementation.

No description available.

Trauma is arguably the most comparative and least ambiguous of palaeopathological lesions. As such, it is an ideal vehicle for exploring the respective contributions and differences between historical and osteological approaches to health in the past. A direct comparison between historical and osteological assemblages is often impossible due to the lack of comparable data, or complicated by the very different perceptions, motivations and pre-occupations of past writers and present researchers. Nevertheless, where genuine opportunities exist to compare and contrast the alternative strands of evidence, it may lead to a much richer and more nuanced understanding of the past. This study uses trauma in the late 18^th- to early 19^th century British Royal Navy (R.N.) to explore the differences between the two disciplines, and through this process to come to a deeper understanding of the physical effects of a maritime lifestyle on the health of late 18th- to early 19th century R.N. seamen and marines. The 18^th- and early 19^th century R.N. is one of the best documented institutions of its day, with a large corpus of records accessible in the National Archives in Kew. Recent archaeological excavations in the burial grounds of the three R.N. hospitals of the 18^th century in Britain- the Royal Hospitals Haslar in Gosport, Stonehouse in Plymouth and Greenwich Hospital in South-East London- have made available over 300 skeletons of seamen and marines, who were treated but died in these institutions. This study explores the osteological evidence for fractures and joint trauma patterning in 300 of these skeletons. Eighteenth century accounts of the privations and dangers of sailing a fighting ship are well supported osteologically by the presence of 926 fractures and 14 joint dislocations. Osteological trauma patterning was compared with historical data collated from the Haslar and Plymouth Hospital musters (1792-1824) and Entry Books of Greenwich Hospital (1749-1765). The most probable aetiology of injuries was explored using insights from modern medical and forensic research, and 18^th century sea surgeons' journals. Falls accounted for a very high proportion of injuries in both datasets, as did crush injuries, and to a much lesser extent, battle trauma. Extremely high rates of nasal fractures, Bennett's fractures of the first metacarpal, and anterior rib fractures in the skeletal assemblages strongly suggest very high rates of casual interpersonal violence. Interestingly, these injuries were very seldom recorded in either sea surgeon or hospital records, possibly due to seamen's fear of punishment for transgressing official naval regulations against fighting. Several unusual fractures (such as Shepherd's fractures of the talus, and third metacarpal avulsion fractures) and bony modifications (such as shallow and unstable hip and shoulder joints, os acromiale and Eagle's syndrome) appear to be the consequences of engaging in a maritime lifestyle, often beginning in childhood or adolescence. Trauma is arguably the most comparative and least ambiguous of palaeopathological lesions. As such, it is an ideal vehicle for exploring the respective contributions and differences between historical and osteological approaches to health in the past. A direct comparison between historical and osteological assemblages is often impossible due to the lack of comparable data, or complicated by the very different perceptions, motivations and pre-occupations of past writers and present researchers. Nevertheless, where genuine opportunities exist to compare and contrast the alternative strands of evidence, it may lead to a much richer and more nuanced understanding of the past. This study uses trauma in the late 18th- to early 19th century British Royal Navy (R.N.) to explore the differences between the two disciplines, and through this process to come to a deeper understanding of the physical effects of a maritime lifestyle on the health of late 18th- to early 19th century R.N. seamen and marines. The 18th- and early 19th century R.N. is one of the best documented institutions of its day, with a large corpus of records accessible in the National Archives in Kew. Recent archaeological excavations in the burial grounds of the three R.N. hospitals of the 18th century in Britain- the Royal Hospitals Haslar in Gosport, Stonehouse in Plymouth and Greenwich Hospital in South-East London- have made available over 300 skeletons of seamen and marines, who were treated but died in these institutions. This study explores the osteological evidence for fractures and joint trauma patterning in 300 of these skeletons. Eighteenth century accounts of the privations and dangers of sailing a fighting ship are well supported osteologically by the presence of 926 fractures and 14 joint dislocations. Osteological trauma patterning was compared with historical data collated from the Haslar and Plymouth Hospital musters (1792-1824) and Entry Books of Greenwich Hospital (1749-1765). The most probable aetiology of injuries was explored using insights from modern medical and forensic research, and 18th century sea surgeons’ journals. Falls accounted for a very high proportion of injuries in both datasets, as did crush injuries, and to a much lesser extent, battle trauma. Extremely high rates of nasal fractures, Bennett’s fractures of the first metacarpal, and anterior rib fractures in the skeletal assemblages strongly suggest very high rates of casual interpersonal violence. Interestingly, these injuries were very seldom recorded in either sea surgeon or hospital records, possibly due to seamen’s fear of punishment for transgressing official naval regulations against fighting. Several unusual fractures (such as Shepherd’s fractures of the talus, and third metacarpal avulsion fractures) and bony modifications (such as shallow and unstable hip and shoulder joints, os acromiale and Eagle’s syndrome) appear to be the consequences of engaging in a maritime lifestyle, often beginning in childhood or adolescence.

Contemporary health policy and funding bodies are placing increasing emphasis on patient and public involvement (PPI) in healthcare and health research, advocating PPI in all stages of the research process. Currently, however, there is limited empirical evidence critiquing different approaches to PPI or exploring its associated benefits and challenges. Without this information researchers and patient/public representatives cannot make informed decisions about best practice. The principal aim of this thesis was to generate a detailed understanding of the implementation of PPI in health research. To accomplish this broad aim, I focused on a specific health condition, epilepsy, and the research structures underlying health research in the UK, namely, research networks. I achieved this using a multi-sited, ethnographic approach, incorporating multiple qualitative data collection methods, including 47 interviews, 35 observations, fieldnotes and document analysis. My in-depth thematic analysis of the data found that PPI is conceptualised in terms of ‘meaningful’ and ‘tokenistic’ involvement by those engaged in the process, rather than how it is depicted in the current models of involvement. Having first explored these terms I identified five components that can help to ensure that PPI is meaningful and not tokenistic. Having compared and contrasted multiple approaches to PPI I conclude that there is not one single ‘best approach’ for implementing PPI. Rather, to achieve high ‘quality’ PPI there is a need to incorporate seven methodological factors that overarch approaches and ensure that there is an alignment of approach and purpose. Both the professionals and the patient/ public representatives within my research appeared to be highly aware of the moral and political motivations of PPI, but were primarily motivated by pragmatic or consequentialist reasons. Professionals were motivated almost exclusively by the goal of improving the applicability or relevance of the research. This goal was important for representatives too but they were also motivated by a range of personal reasons, including the wish to feel they were making a difference; the opportunity to learn about epilepsy and epilepsy research; and the opportunity to interact with others. The perceived benefits of PPI were also identified and discussed in depth, and appeared to be largely congruent with those reported in the literature. However, my work has identified some challenges and barriers around PPI that have not previously been explored including: adverse emotional effects; organisational practicalities; concerns about ‘representativeness’ and ‘tokenism’; the ‘blurring’ of roles and the erosion of patient-clinician boundaries. I conclude by recommending that there should be an increased focus on appropriate, ‘meaningful’, involvement rather than endeavouring to implement PPI in all stages of the research process, as currently advocated in policy documents. The insights into the challenges of PPI that my work has provided will allow them to be addressed from the outset, improving the PPI experience and consequently the likelihood of PPI being successfully implemented.

This thesis comprises of studies based on the broad field of forensic analysis and the development of methods which can be applied to different matrices. The initial studies focus on the forensic determination of psychoactive drugs in hair matrix using newly deve1oped gas chromatography-mass spectrometry analytical methods. The second study focuses on the discrimination and matching of skid marks and rubber tyre analysis by using novel chemical analysis methods. This thesis reports the deve1opment and application of a series of innovative analytical methods: gas chromatography-mass spectrometry, inductively coupled plasma mass spectrometry, pyrolysis-gas chromatography-mass spectrometry and attenuated total reflection Fourier transform infrared spectroscopy. Gas Chromatography-Mass Spectrometric (GC-MS) methods for drug analysis routinely employ derivatising reagents. The aim of the first study was to develop a method for the analysis of two recreational drugs, delta-9-tetrahydrocannabinol (delta-9- THC) and cocaine in hair samples using GC-MS, without prior derivatisation, thus allowing the sample to be analysed in its original form. Ten hair samples, that were positive to ELISA analysis for either delta 9-THC and/or cocaine, were enzymatically digested, extracted and then analysed by gas chromatography-mass spectrometry. All samples measured contained delta 9-THC and one sample contained cocaine. The limits of detection (LOD) and quantification (LOQ) were 0.02 ng/mg & 0.05 rig/mg, respectively for cocaine and 0.015 ng/mg & 0.02 ng/mg, respectively for A9-THC. The wide detection window, ease of direct analysis by GC-MS, lower detection limits of un-derivatised samples and the stability of drugs using this technique offers an improved method of analysis. This experiment has been designed to develop an immunological screening test followed by a GC-MS confirmation method for the simultaneous analysis of delta 9- THC, THC-COOH, , OH-THC, cocaine, Benzoylecgonine (BZ), amphetamine (AP), methamphetamine (MA), in human hair, thus avoiding the significant factors responsible for drug degradation by acid and alkali hydrolysis and to obtain optimal recovery conditions. Enzymatic hair digestion was used to hydrolyse 18 Turkish samples using Proteinase K, Dithiothreitol and Tris HCl buffer. At the beginning, all 18 samples tested screened positive on ELISA, though analysis by GC-MS indicated that only 2 samples were positive for delta 9-THC and THC-COOH. Cross reaction lead to false positive results in the pre-screening step as a result of the degradation of the antibodies in the pre-coated ELISA microplate. Tyre rubber analysis Owing to an increase in the number of hit and run accidents, it is quite common for rubber traces to be left at the crime scene. The Forensic Scientist will have the task of analysing the tyre striation traces in order to identify the type of tyre involved in the accident. However, the tyre striations alone do not provide enough detail to show a high level of discrimination between different tyre manufacturers and individual models. In this study, Inductively Coupled Plasma Mass Spectrometry (ICP-MS), Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR-FI‘IR) and pyrolysis GC-MS methods were developed to enable greater discrimination between different tyre rubber samples. Seventy elements were screened for each sample by ICP-MS in both collision cell mode and reaction cell mode. ATR-FTIR analysis indicated a low intra-variability (analysis of similar tyres) which demonstrated high precision of the technique, and also showed a large inter-variability between different manufacturers and models, which supports their high potential as indicators to be used for discrimination between different tyres manufacturers and models. Principal Component Analysis (PCA) was utilised to distinguish between the different tyres.

This thesis examines issues related to cervical cancer epidemiology and prevention through screening, with the aim of informing policy regarding setting up an organised cervical screening programme in Hong Kong. There are five studies described here. The first, a case control study, indicated that screening is effective in preventing invasive cervical cancer among Chinese women. In addition, the main risk factors identified in other studies, were confirmed as risk factors in this population. Secondly, a cross-sectional study examined the pattern of cervical screening in Hong Kong. The screening system at that time achieved poor coverage, was inefficient, inequitable and potentially harmful. Thirdly, a cross-sectional study of practitioners showed the diversity in provision of services and the lack of consensus among practitioners in the management of abnormal smears. Fourthly, the use of an industrial quality management technique in monitoring quality, using inadequate smear rates as an indicator is assessed. It demonstrated that this is an efficient and useful method that can be applied to monitoring a screening programme. The last study was a randomised controlled trial showing that when women are given balanced information on cervical screening, with information on both the harms and benefits, relatively fewer chose to attend. The implications of these studies in relation to setting up a screening programme are discussed.

No description available.