Personal invitations for population-based breast cancer screening

Rationale and Objectives Women who are invited for breast cancer screening should get enough information about the benefits and harms of screening to make an informed decision on participation. Personal invitations are an important source of information, because all invited women receive them. The objective of this study was to evaluate the information breast cancer screening units send to women invited for screening in Finland. Materials and Methods A questionnaire was sent to all breast cancer screening units in Finland in 2005 and 2008, and the information (eg, invitations, results letters, leaflets) the units sent to women was collected. Results from 2005 were sent as feedback to the units. Data were analyzed descriptively, and results from the 2 years were compared. Results Screening units sent personal invitation letters usually providing fixed appointment times. Most units informed about participation free of charge and the benefits of detecting breast cancer early. Harm associated with screening was seldom mentioned; no unit mentioned the possibility of false-negative results or overtreatment. Conclusion The screening units provided very variable information, which often was biased toward optimizing participation. The high participation rate (approximately 88%) in Finland may be due partly to the prescriptive nature of the invitation letters. National templates for information letters would be useful

Sympathetic overactivity and arrhythmias in tetanus: electrocardiographic analysis Hiperatividade simpática e arritmias no tétano: análise eletrocardiográfica

As a result of the advances in the control of pulmonary insufficiency in tetanus, the cardiovascular system has increasingly been shown to be a determining factor in morbidity and mortality but detailed knowledge of the cardiovascular complications in tetanus is scanty. The 24h-Holter was carried out in order to detect arrhythmias and sympathetic overactivity in 38 tetanus patients admitted to an ICU. The SDNN Index (standard deviation from the normal R-to-R intervals), was useful in detecting adrenergic tonus, and ranged from 64.1 &plusmn; 27 in the more severe forms of tetanus to 125 &plusmn; 69 in the milder ones. Sympathetic overactivity occurred in 86.2% of the more severe forms of the disease, but was also detected in 33% of the milder forms. Half the patients had their sympathetic overactivity detected only by the Holter. The most frequent arrhythmias were isolated supraventricular (55.2%) and ventricular (39.4%) extrasystoles. There was no association of the arrhythmias with the clinical form of tetanus or with the presence of sympathetic overactivity. The present study demonstrated that major cardiovascular dysfunction, particularly sympathetic overactivity, occurs in all forms of tetanus, even in the milder ones. This has not been effectively detected with traditional monitoring in ICU and may not be properly treated.<br>Com os avanços no controle da insuficiência respiratória no tétano, o sistema cardiovascular tem participado de forma crescente na morbidade e mortalidade da doença, mas o conhecimento dessas complicações é escasso. No intuito de detectar arritmias e hiperatividade simpática, o holter de 24 h foi utilizado em 38 pacientes com tétano admitidos numa UTI de doenças infecciosas. O índice SDNN (desvio standard dos intervalos normais R-a-R), foi útil na detecção do tônus adrenérgico, e variou de 64,1 &plusmn; 27 nas formas mais severas de tétano a 125 &plusmn; 69 nas formas mais leves. Hiperatividade simpática ocorreu em 86,2% das formas mais severas da doença, mas também foi identificada em 33% das formas leves. Cerca da metade dos pacientes tiveram sua hiperatividade simpática detectada apenas pelo Holter. As arritmias mais freqüentes foram extrassístoles isoladas, do tipo supraventriculares (55,2%) ou ventriculares (39,4%). Não houve associação das arritmias com a forma clínica do tétano ou com a presença de hiperatividade simpática. O presente estudo demonstrou que importantes alterações cardiovasculares, particularmente a hiperatividade simpática, ocorrem em todas as formas de tétano, mesmo as mais leves. Estas alterações não estão sendo detectadas pelos métodos tradicionais de monitorização em UTI, podendo resultar em falhas na abordagem terapêutica