[Reliability of endocervical curettage after conservative treatment of intraepithelial neoplasia of the cervix]. / Fiabilité du curetage endocervical après traitement conservateur des néoplasies intraépithéliales du col utérin.

OBJECTIVE: To evaluate the reliability of endocervical curettage (ECC) in patients previously treated for CIN. PATIENTS AND METHODS: Retrospective analysis of data from 85 patients between January 1985 and December 2011 who received an ECC during monitoring after treatment of CIN. The reliability of the ECC was evaluated by comparison with the final histological analysis of the surgical specimen or the data for subsequent cyto-colpo-histological follow-up. RESULTS: Patients were referred to colposcopy either within the immediate post-treatment monitoring (n=42), meanly 9.7±5.3 months after treatment, or if cytological abnormalities were detected during long-term monitoring, meanly 78.6±52.4 months after treatment. Colposcopy was unsatisfactory in 75.3% of patients and normal colposcopic findings were found in 80% of patients. A perfect agreement between the ECC and the endocervical final diagnosis was noted in 68 patients (80%). For the diagnosis of severe cervical lesions (CIN 2+) ECC had a sensitivity of 86.2% (68.3-96.1), a specificity of 94.6% (85.1-98.9) and positive and negative predictive values of 61.4% (47.6-74.0) and 93% (83.0-98.1), respectively. CONCLUSION: The high sensitivity and negative predictive value of ECC for the diagnosis of severe post-therapeutic endocervical lesions avoid iterative treatment without increasing the risk of progression of a lesion to cancer.

A prospective randomized study of two reminding strategies: telephone versus mail in the screening of cervical cancer in women who did not initially respond.

OBJECTIVE: To compare the efficacy and cost-effectiveness of two reminding strategies addressed to women who did not respond to a first invitation to undergo cervical cancer screening. STUDY DESIGN: A randomized study was carried out by a programme created in Alsace to organize cervical cancer screening. In total, 10,662 women who did not have a smear test 1 year after a first notice was sent, were randomly allocated to receive either a new letter with a reply coupon or a telephone call. The uptake of screening was measured using routine data. Efficacy and direct costs of the two methods were compared. RESULTS: Uptake at 8 months was 6.3% [95% confidence interval (CI) 5.6-7.0%] for telephone calls and 5.8% (95% CI 5.2-6.4%) for letters. The difference was not significant. More information was collected through telephone calls than by letters, but with less reliability. Furthermore, telephone calls were more costly. CONCLUSIONS: We found that in our region, a mail reminder was as effective as, and less expensive than, a telephone call; moreover, it was applicable to the whole population, including patients without a telephone.

[Is early cervical cancer screening justified?]. / Le dépistage précoce du cancer du col est-il justifié?

Pap smear screening of women under 25 years old remains controversial. No randomized study exists on this topic. The perception of individual benefit often prevails, although there is no proof of effectiveness and no demonstrated risk-benefit ratio. A review of published studies - taking into account epidemiological data, effectiveness of screening of young women, adverse medical outcomes and costs - suggests that there are more arguments against screening before 25 than in favour of it.

A fall-off in cervical screening coverage of younger women in developed countries.

OBJECTIVES: To analyse cervical screening coverage data by age over time in a number of developed countries throughout the world, with specific emphasis on trends for younger women and on age differentials between younger and older women. METHODS: Routinely collected cervical screening statistics and survey data were collected on the proportion of women who have undergone cervical screening with cytology in seven countries in the period 1995 to 2005. RESULTS: Data for the 25-29 age group were examined. Coverage fell in most countries, in three by more than 5 percentage points. In two countries while overall coverage rose in the period, the rise was not as steep in the youngest group of women. Data for each available 5-year age group for the different countries shows a similar gradient in most, regardless of the absolute level of coverage. Although the trend is not uniform in every country, it appears that generally the gap between coverage of younger women and coverage of older women increased, sometimes dramatically, between the mid-1990s and the mid-2000s. CONCLUSIONS: There is a general trend in developed countries towards lower coverage in young women (25-29 years old). No common underlying cause has been clearly identified and there is a need for further studies to investigate the possible reasons for this phenomenon.

[EVE, a regional campaign for the screening of cervical cancer. Organization, 7-years results and perspectives]. / EVE, une campagne régionale de dépistage du cancer du col de l'utérus. Organisation, résultats à 7 ans et perspectives.

OBJECTIVE: Based on the 7-years results, assess the interest of organised cervical cancer screening on regional level (the EVE campaign). ORGANISATION AND METHOD: The screening relied on existing medical structures. The centralised data collection, with data from the cyto-pathology laboratories assessed the quality of screening and the participation of the women to the follow-up of abnormal smears. The campaign run by a local women's rights association and sponsored by National educational and health information funds (FNPEIS) and the local councils. RESULTS: To date, 814 649 smears in the Bas-Rhin and 62 227 in the Haut-Rhin have been collected. After 3 years, 72% of women aged 25 to 64 in the year 1997, in the Bas-Rhin, had had at least one smear, and 82% after 5 years. Inadequate smears represented less than 1% of all smears of the region. Pathological smears represented around 4% of the total and benefited from strict monitoring which could be improved. However this could be improved on since only 75% of women in whom a low-grade lesion was suspected underwent a second examination within the year that followed. The rate was on 80% for those with suspected high-grade lesions. Reminders made by the EVE association, in agreement with practitioners, permitted postponed follow-up and improved screening coverage. CONCLUSION: The EVE programme clearly shows that organized screening is feasible in France because the results obtained are satisfactory in terms of screening coverage and quality of smears. Centralised data collection permits detection of possible weak points and contributes to the improvement in efficacy.

Culturally congruent end-of-life care for Jewish patients and their families.

This qualitative study was conducted to determine cultural influences in end-of-life care among Jewish people. The conceptual framework for this study was drawn from Leininger's culture care theory. Informants consisted of 16 professional caregivers, family members, and rabbis who had experience with end-of-life care for Jewish patients. Interviews using open-ended and focused questions were used to gather informants' descriptions of their generic values, beliefs, and practices. Findings revealed the strong influence of religious, cultural, and historical factors in caring. Sanctity of life and life promotion are central to Judaism. Caring is a communal obligation that unites the family and community into a cohesive unit. Attitudes toward death are influenced by beliefs about afterlife and suffering. The value put on expert knowledge influences patients' and family members' expectations of professional caregivers. Similarities and differences were noted among different groups of informants.

Cervical cancer screening in France.

In France, as in other European countries the incidence and mortality rates of carcinoma of the cervix uteri indicate a clear decrease in invasive cancers. Opportunistic screening has spread and, presently, approximately 60% of the female population undergo a regular cytological test. This rate increases up to 80% in the younger age groups and decreases to 20% after the age of 60 years. In 1990, intervention procedures were defined at a consensus conference; the major recommendations were to screen all women exclusively by cervical smears, for ages 25-65 years over a 3-year period. Guidelines on the quality control of cervical smear taking and reading were published by the national agency of evaluation of health intervention (ANAES). Since 1990, four population-based, organised pilot programmes, have been implemented in Isère. Doubs, Bas-Rhin and Martinique. These programmes evaluate the participation rate (from approximately 20-80% depending upon the age and the geographical area), the rate of abnormal tests (0.2-3%), according to the laboratories, the cancer detection rate (0.04%-0.15%) and some other quality indicators. Recently (November 1998) a law was passed stipulating that the screening test will be free of charge when performed in agreement with the national recommendations. A specific organisation for cytological quality control will be implemented. An effort to better identify and to include the screening process the women in the population who are not yet participating has to be made.

[Cervical cancer screening in the Bas-Rhin. Evaluation of four and a half years of the EVE campaign]. / Le dépistage du cancer du col de l'utérus dans le Bas-Rhin. Bilan de quatre ans et demi de campagne EVE.

The cervical cancer screening campaign has been settled in 1990 in the french department of Bas-Rhin and has effectively started in 1994. The 1901 law association EVE, gathering the partners concerned by illness and screening, has been designed as responsible for organisation. In relation with the field actors, the main guidelines were to try and increase the women's participation in the screening, to insure the quality of the cytological interpretation and the follow-up of pathological smears. After a four and a health years campaign, 80.3% of 25 to 65 years old women had the benefit one smear at least. The quality of the cytological interpretation is quite good and the follow-up of pathological smears is acceptable. This experience indicates the screening by the existing medical structures is possible. Many laboratories of cytology have accepted to participate in the campaign and to respect the modalities, notably for the transfer of data and the process insurance-quality. The majority of the practioners (gynecologists and general practioners) takes part in collecting the information about the follow-up. However, there's no regulation from official texts about the screening modalities and that makes to come to an arrangement with the health professionals in order to obtain and maintain their participation.

[Can we and must we organize cervical cancer screening in France? Results of the pilot project "EVE" in the department of Bas-Rhin]. / Peut-on et faut-il organiser le dépistage du cancer du col de l'utérus en France? A propos des résultats due project pilote "EVE" dans le département du Bas-Rhin.

EVE is a pilot project for cervical cancer screening whose aim is to test the feasibility of organized screening in the French liberal health system with a consensus of medical participants. After three and a half years, 74.8% of women aged 25 to 64 had had at least one smear. Coverage varies with age, from 89% between 25 and 29 to 56% between 55 and 60. Only 8% of smears are taken by General Practitioners. There is a tendency to space out smears because only 14% of women had had a second smear within one year and 41.1% within 2 years. On the other hand more then 20% percent of women do not return after 3 years. Pathological smears represent 1.94% of all smears. For these, a questionnaire is sent to the physician in order to get information on follow-up. This enables cytologic/histologic correlation. The histologic exam reveals a pathological lesion in 95% of cytologies consistent with invasive cancer, 91% of those consistent with high grade lesions and 70% of those consistent with low grade lesions.

[Towards a decrease of myocardial infarction in the Bas-Rhin region? Results of the 6 first years of the Strasbourg MONIC Register]. / Vers une diminution de l'infarctus du myocarde dans le Bas-Rhin? Résultats des six premières années du Registre MONICA Strasbourg.

The Bas-Rhin MONICA Register shows trends in myocardial infarction and other acute ischemic events between 1984 and 1989. Coronary heart disease mortality decreased by 27% in men and 30% in women. Morbidity trends were less favourable. The annual event rate for total acute ischemic events remained stable. However, a decrease of 14% for myocardial infarction was seen in men, particularly in patients with a past history of coronary disease. Another positive point is that the 28-day mortality rate in recent infarctions decreased in men by 33% during the 5 year period.

[Evaluation of the status of access to emergency care of subjects with myocardial infarction]. / Evaluation des conditions d'accès aux soins d'urgence des sujets atteints d'infarctus du myocarde.

This study, undertaken in the Bas-Rhin area of France by the MONICA Register, presents the evaluation of the procedures followed for 323 subjects under 65 years old suffering from an acute myocardial infarction and subsequently hospitalized for this reason. We observe that 87.5% of the patients first consult a private practitioner -- for the most part a non specialist -- while 9% first contact a mobile coronary unit. 3.5% of patients go directly to hospital. Concerning delays in hospitalization, 35% of patients more than 6 hours to consult a doctor, while the median time between the onset of symptoms and the first call for medical aid is 2 hours. The median delay between the onset of symptoms and arrival at hospital is 5hrs 45 min., 28% of the subjects requiring more than 24 hours to be hospitalized.