126 research outputs found
Mammography screening: views from women and primary care physicians in Crete
Background: Breast cancer is the most commonly diagnosed cancer among women and a leading cause of death from cancer in women in Europe. Although breast cancer incidence is on the rise worldwide, breast cancer mortality over the past 25 years has been stable or decreasing in some countries and a fall in breast cancer mortality rates in most European countries in the 1990s was reported by several studies, in contrast, in Greece have not reported these favourable trends. In Greece, the age-standardised incidence and mortality rate for breast cancer per 100.000 in 2006 was 81,8 and 21,7 and although it is lower than most other countries in Europe, the fall in breast cancer mortality that observed has not been as great as in other European countries. There is no national strategy for screening in this country. This study reports on the use of mammography among middleaged women in rural Crete and investigates barriers to mammography screening encountered by women and their primary care physicians.
Methods: Design: Semi-structured individual interviews. Setting and participants: Thirty women between 45â65
years of age, with a mean age of 54,6 years, and standard deviation 6,8 from rural areas of Crete and 28 qualified
primary care physicians, with a mean age of 44,7 years and standard deviation 7,0 serving this rural population.
Main outcome measure: Qualitative thematic analysis.
Results: Most women identified several reasons for not using mammography. These included poor knowledge
of the benefits and indications for mammography screening, fear of pain during the procedure, fear of a serious
diagnosis, embarrassment, stress while anticipating the results, cost and lack of physician recommendation.
Physicians identified difficulties in scheduling an appointment as one reason women did not use mammography
and both women and physicians identified distance from the screening site, transportation problems and the
absence of symptoms as reasons for non-use.
Conclusion: Women are inhibited from participating in mammography screening in rural Crete. The provision
of more accessible screening services may improve this. However physician recommendation is important in
overcoming women's inhibitions. Primary care physicians serving rural areas need to be aware of barriers
preventing women from attending mammography screening and provide women with information and advice in a sensitive way so women can make informed decisions regarding breast caner screening
Are caregiving responsibilities associated with non-attendance at breast screening?
<p>Abstract</p> <p>Background</p> <p>Previous research showed that deprived individuals are less likely to attend breast screening and those providing intense amounts of informal care tend to be more deprived than non-caregivers. The aim of this study was to examine the relationship between informal caregiving and uptake of breast screening and to determine if socio-economic gradients in screening attendance were explained by caregiving responsibilities.</p> <p>Methods</p> <p>A database of breast screening histories was linked to the Northern Ireland Longitudinal Study, which links information from census, vital events and health registration datasets. The cohort included women aged 47 - 64 at the time of the census eligible for breast screening in a three-year follow-up period. Cohort attributes were recorded at the Census. Multivariate logistic regression was used to examine the relationship between informal caregiving and uptake of screening using STATA version 10.</p> <p>Results</p> <p>37,211 women were invited for breast screening of whom 27,909 (75%) attended; 23.9% of the cohort were caregivers. Caregivers providing <20 hours of care/week were more affluent, while those providing >50 hours/week were more deprived than non-caregivers. Deprived women were significantly less likely to attend breast screening; however, this was not explained by caregiving responsibilities as caregivers were as likely as non-caregivers to attend (Odds Ratio 0.97; 95% confidence intervals 0.88, 1.06).</p> <p>Conclusions</p> <p>While those providing the most significant amounts of care tended to be more deprived, caregiving responsibilities themselves did not explain the known socio-economic gradients in breast screening attendance. More work is required to identify why more deprived women are less likely to attend breast screening.</p
The influence of socio-economic and surveillance characteristics on breast cancer survival: a French population-based study
Survival data on female invasive breast cancer with 9-year follow-up from five French cancer registries were analysed by logistic regression for prognostic factors of cancer stage. The KaplanâMeier method and log-rank test were used to estimate and compare the overall survival probability at 5 and 7 years, and at the endpoint. The Cox regression model was used for multivariate analysis. County of residence, age group, occupational status, mammographic surveillance, gynaecological prevention consultations and the diagnosis mammography, whether within a screening framework or not, were independent prognostic factors of survival. Moreover, for the same age group, and only for cancers T2 and/or N+ (whether 1, 2 or 3) and M0, the prognosis was significantly better when the diagnosis mammography was done within the framework of screening. Socio-economic and surveillance characteristics are independent prognostic factors of both breast cancer stage at diagnosis and of survival. Screening mammography is an independent prognostic factor of survival
Estimating attendance for breast cancer screening in ethnic groups in London
BACKGROUND: Breast screening uptake in London is below the Government's target of 70% and we investigate whether ethnicity affects this. Information on the ethnicity for the individual women invited is unavailable, so we use an area-based method similar to that routinely used to derive a geographical measure for socioeconomic deprivation. METHODS: We extracted 742,786 observations on attendance for routine appointments between 2004 and 2007 collected by the London Quality Assurance Reference Centre. Each woman was assigned to a lower super output (LSOA) based on her postcode of residence. The proportions of the ethnic groups within each LSOA are known, so that the likelihood of a woman belonging to White, Black and Asian groups can be assigned. We investigated screening attendance by age group, socioeconomic deprivation using the Index of Deprivation 2004 income quintile, invitation type and breast screening service. Using logistic regression analysis we calculated odds ratios for attendance based on ethnic composition of the population, adjusting for age, socioeconomic status, the invitation type and screening service. RESULTS: The unadjusted attendance odds ratios were high for the White population (OR: 3.34 95% CI [3.26-3.42]) and low for the Black population (0.13 [0.12-0.13]) and the Asian population (0.55 [0.53-0.56]). Multivariate adjustment reduced the differences, but the Black population remained below unity (0.47 [0.44-0.50]); while the White (1.30 [1.26-1.35]) and Asian populations (1.10 [1.05-1.15]) were higher. There was little difference in the attendance between age groups. Attendance was highest for the most affluent group and fell sharply with increasing deprivation. For invitation type, the routine recall was higher than the first call. There were wide variations in the attendance for different ethnic groups between the individual screening services. CONCLUSIONS: Overall breast screening attendance is low in communities with large Black populations, suggesting the need to improve participation of Black women. Variations in attendance for the Asian population require further investigation at an individual screening service level
The material soul: Strategies for naturalising the soul in an early modern epicurean context
We usually portray the early modern period as one characterised by the âbirth of subjectivityâ with Luther and Descartes as two alternate representatives of this radical break with the past, each ushering in the new era in which âIâ am the locus of judgements about the world. A sub-narrative called âthe mind-body problemâ recounts how Cartesian dualism, responding to the new promise of a mechanistic science of nature, âsplit offâ the world of the soul/mind/self from the world of extended, physical substanceâa split which has preoccupied the philosophy of mind up until the present day. We would like to call attention to a different constellation of textsâneither a robust âtraditionâ nor an isolated âepisodeâ, somewhere in betweenâwhich have in common their indebtedness to, and promotion of an embodied, Epicurean approach to the soul. These texts follow the evocative hint given in Lucretiusâ De rerum natura that âthe soul is to the body as scent is to incenseâ (in an anonymous early modern French version). They neither assert the autonomy of the soul, nor the dualism of body and soul, nor again a sheer physicalism in which âintentionalâ properties are reduced to the basic properties of matter. Rather, to borrow the title of one of these treatises (LâĂme MatĂ©rielle), they seek to articulate the concept of a material soul. We reconstruct the intellectual development of a corporeal, mortal and ultimately material soul, in between medicine, natural philosophy and metaphysics, including discussions of Malebranche and Willis, but focusing primarily on texts including the 1675 Discours anatomiques by the Epicurean physician Guillaume Lamy; the anonymous manuscript from circa 1725 entitled LâĂme MatĂ©rielle, which is essentially a compendium of texts from the later seventeenth century (Malebranche, Bayle) along with excerpts from Lucretius; and materialist writings such Julien Offray de La Mettrieâs LâHomme-Machine (1748), in order to articulate this concept of a âmaterial soulâ with its implications for notions of embodiment, materialism and selfhood
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