Evaluation of a cervical cancer screening program based on HPV testing and LLETZ excision in a low resource setting

We conducted studies in Vanuatu to evaluate potential screening and treatment strategies to assist with control of cervical cancer. In a pilot study of 496 women, visual inspection and cytology were evaluated as screening tests for detection of CIN 2 or worse (CIN2+), observed in 21 of 206 subjects biopsied on the basis of abnormal visual inspection or cytology. Sensitivity of visual inspection with Lugol's Iodine for detection of CIN2+ on biopsy was 0.63, specificity was 0.32, and the positive predictive value was 0.09. For HSIL cytology, sensitivity was 0.99, specificity was 0.77, and the positive predictive value was 0.88. HSIL cytology was significantly more sensitive and had a significantly higher PPV for CIN 2+ than visual inspection (

Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

Understanding the emerging relationship between complementary medicine and mainstream health care: A review of the literature

The history of the relationship between complementary medicine (CM) and mainstream health care has shifted from the early days of pluralism, through hostility and exclusion, to one of grudging acceptance. The current situation is one of a tacit acknowledgement and in some cases open endorsement by biomedicine for a number of forms of CM practice, largely driven by the popularity of CM to consumers in our increasingly market driven health care system. How this relationship is ultimately worked out will impact both on the practice of CM and biomedicine, and on the health care choices available to consumers. In this article we review the research and commentary literature on the current and emerging relationship between biomedicine and CM. In particular we explore the ways in which mainstream inclusion of CM is discussed in the literature, and the biomedical and CM perspectives of mainstream CM inclusion. Finally we discuss the implications of the emerging relationship for CM, and CM practitioners and consumers.Marlene Wiese, Candice Oster & Jan Pincomb

'Becoming accepted': The complementary and alternative medicine practitioners' response to the uptake and practice of traditional medicine therapies by the mainstream health sector

This Australian study sought to understand how practitioners of the traditional systems of what is now termed complementary and alternative medicine (CAM) are responding to the adoption of their traditional medicine therapies by the mainstream health care system, and the practice of these therapies by mainstream health care practitioners. A grounded theory approach was used for this study. In-depth interviews were conducted with 19 participants who were non-mainstream practitioners from five traditional systems of medicine — Traditional Chinese Medicine, Ayurveda, Naturopathy, Homeopathy and Western Herbal Medicine. Four main conceptual categories were identified: Losing Control of the CAM Occupational Domain (the participants’ main concern); Personal Positioning; Professional Positioning (the core category); and Legitimacy.These categories formed the elements of the substantive theory of ‘becoming accepted’ as a legitimate health care provider in the mainstream health system, which explained the basic social process that the study’s participants were using to resolve their main concern.Marlene Wiese, Candice Oste

'Ultrasound is an invaluable third eye, but it can't see everything' : a qualitative study with obstetricians in Australia

BACKGROUND: Obstetric ultrasound has come to play a significant role in obstetrics since its introduction in clinical care. Today, most pregnant women in the developed world are exposed to obstetric ultrasound examinations, and there is no doubt that the advantages of obstetric ultrasound technique have led to improvements in pregnancy outcomes. However, at the same time, the increasing use has also raised many ethical challenges. This study aimed to explore obstetricians' experiences of the significance of obstetric ultrasound for clinical management of complicated pregnancy and their perceptions of expectant parents' experiences. METHODS: A qualitative study was undertaken in November 2012 as part of the CROss-Country Ultrasound Study (CROCUS). Semi-structured individual interviews were held with 14 obstetricians working at two large hospitals in Victoria, Australia. Transcribed data underwent qualitative content analysis. RESULTS: An overall theme emerged during the analyses, 'Obstetric ultrasound - a third eye', reflecting the significance and meaning of ultrasound in pregnancy, and the importance of the additional information that ultrasound offers clinicians managing the surveillance of a pregnant woman and her fetus. This theme was built on four categories: I:'Everyday-tool' for pregnancy surveillance, II: Significance for managing complicated pregnancy, III: Differing perspectives on obstetric ultrasound, and IV: Counselling as a balancing act. In summary, the obstetricians viewed obstetric ultrasound as an invaluable tool in their everyday practice. More importantly however, the findings emphasise some of the clinical dilemmas that occur due to its use: the obstetricians' and expectant parents' differing perspectives and expectations of obstetric ultrasound examinations, the challenges of uncertain ultrasound findings, and how this information was conveyed and balanced by obstetricians in counselling expectant parents. CONCLUSIONS: This study highlights a range of previously rarely acknowledged clinical dilemmas that obstetricians face in relation to the use of obstetric ultrasound. Despite being a tool of considerable significance in the surveillance of pregnancy, there are limitations and uncertainties that arise with its use that make counselling expectant parents challenging. Research is needed which further investigates the effects and experiences of the continuing worldwide rapid technical advances in surveillance of pregnancies