Communication Between Breast Cancer Patients Who Received Inconclusive Genetic Test Results and Their Daughters and Sisters Years After Testing.

Inconclusive genetic test results including screening recommendations for the breast cancer patients and their first-degree relatives are the most common outcomes of BRCA 1/2 testing. Patients themselves should communicate these results to their relatives. Our aim was to explore communication of breast cancer genetic counseling results with daughters and sisters over a long period of time. Breast cancer patients, who had received an inconclusive DNA test result 7-14 years earlier, completed a self-report questionnaire. Additionally, in-depth interviews were conducted and analysed thematically. Of the 93 respondents, 85 (91 %) considered themselves responsible for communicating genetic test results to relatives. In-depth interviews (n = 14) showed, that counselees wanted 'to hand over' their responsibilities to communicate the test results and screening recommendations to their sisters. Although most patients had informed their daughters and sisters about the genetic test results, usually little is spoken about genetic test results and screening recommendations once the duty of informing is completed. We recommend that, similar to the procedure for BRCA1/2-mutation carriers, a separate letter for first-degree relatives of patients with an inconclusive test result should be provided. In this way information about risks and screening recommendations can be verified by family members years after genetic testing has been completed.

The reach of a hepatitis B vaccination programme among men who have sex with men.

BACKGROUND: Homosexual contact is a major risk factor for acute hepatitis B infection. This study explores how many and which men who have sex with men (MSM) are reached by the ongoing hepatitis B vaccination programme in The Netherlands (started in 2002), and investigate reasons for non-participation and non-compliance. METHODS: In this cross-sectional study, on the basis of ethnographic mapping and targeted sampling, 320 MSM were interviewed at different venues in three regions in The Netherlands. RESULTS: Of the sample, 74% reported to be aware of the opportunity to obtain free hepatitis B vaccination, and 50% reported to be vaccinated (received at least one injection). Compliance with the three-dose vaccination schedule was 84%. The most important reason for non-participation in the vaccination programme was a low perceived risk of getting infected with the virus. A personal approach by STD-prevention workers, the recruitment region and having sex with casual partners were positively associated with vaccination uptake. Being bisexual was negatively associated with, and visiting gay bars/discos was positively associated with, awareness of the opportunity to obtain free hepatitis B vaccination. CONCLUSION: This study shows a large proportion of MSM is aware that they could opt for free hepatitis B vaccination. Future vaccination programmes should focus on a personal approach, since the use of STD prevention workers was shown to be a successful tool for participation in the vaccination programme. The personal information should focus on perceived risk of infection, since this was a major reason for vaccine refusal.

The reach of a free hepatitis B vaccination programme: results of a Dutch study among drug users.

BACKGROUND: The objective of the study was to explore the reach of an ongoing hepatitis B vaccination programme in terms of awareness of the programme among drug users (DUs), vaccination uptake and compliance, as well as to investigate reasons for non-participation. METHODS: Ethnographic mapping and targeted sampling were used to recruit 309 DUs in three regions in the Netherlands. Results were based on univariate statistics (Chi-square and t-tests) and multivariate logistic regression analysis. RESULTS: Of the sample, 63% were aware of the free vaccine, and 44% said they had been vaccinated. DUs who visited drug consumption rooms were more likely to be aware of the programme than those who did not. Vaccination uptake was negatively associated with older age of onset of drug use. Uptake was positively associated with being informed personally about the free vaccination by drug service staff. A history of STD infection, and having sexual intercourse with casual partners were negatively associated with compliance with the vaccination schedule (receiving three vaccinations). CONCLUSION: Our results suggest that marginalised DUs have been reached by the programme. Attention should be paid to those at risk of hepatitis B infection through sexual contacts, since they are less likely to be fully vaccinated. Most importantly, our results suggest that immediate vaccination on location after personal communication is one of the most effective ways to increase vaccination uptake.

Vaccination uptake and awareness of a free hepatitis B vaccination program among female commercial sex workers.

OBJECTIVES: We sought to explore the reach of a free hepatitis B vaccination program among female commercial sex workers (CSWs) within a legalized prostitution setting in the Netherlands. We also investigated the reasons for nonparticipation and noncompliance. METHODS: In this cross-sectional study based on ethnographic mapping and targeted sampling, 259 CSWs were interviewed at their work in 3 regions in the Netherlands. The semistructured interviews contained questions on sociodemographics, sexual risk behavior, sex work, awareness of the opportunity to obtain free hepatitis B vaccination, vaccination uptake, and compliance with the full vaccination schedule. RESULTS: Of our sample, 79% reported awareness of the opportunity to obtain hepatitis B vaccination, and 63% reported to be vaccinated against hepatitis B (received > or =1 vaccination). A personal approach by health professionals or was associated with vaccination uptake, when specific sociodemographic variables, sexual behavior, and sex work related covariates were controlled for in the analysis. Window prostitution and the duration of working in the region were associated with awareness of the opportunity to obtain free hepatitis B vaccination. CONCLUSIONS: The results of this study suggest that outreach activities (i.e., a personal approach) within this program are beneficial. Transient CSWs are more difficult to reach within the current vaccination program. These results can be used to increase the success of future health programs among this risk group.