Preferences for interventions designed to increase cervical screening uptake in non-attending young women: how findings from a discrete choice experiment compare with observed behaviours in a trial

Background Young women’s attendance at cervical screening in the UK is continuing to fall and the incidence of invasive cervical cancer has begun to rise. Objectives We assessed the preferences of non-attending young women for alternative ways of delivering cervical screening. Design Postal discrete choice experiment (DCE) conducted during the STRATEGIC study of interventions for increasing cervical screening uptake. Attributes included action required to arrange a test, location of the test, availability of a nurse navigator and cost to the NHS. Setting and participants Non-attending young women in two UK regions. Main outcome measures Responses were analysed using a mixed multinomial logit model. A predictive analysis identified the most preferable strategy compared to current screening. Preferences from the DCE were compared with women’s observed behaviours during the STRATEGIC trial. Results The DCE response rate was 5.5% (222/4000) and 94% of respondents agreed screening is important. Preference heterogeneity existed around all attributes with strong evidence for test location. Relative to current screening, unsolicited self-sampling kits for home use appeared most preferable. The STRATEGIC trial showed this same intervention to be most effective although many women who received it and were screened attended for conventional cytology instead. Conclusions The DCE and trial identified the unsolicited self-sampling kit as the most preferred / effective intervention. Data from the DCE suggested that the decision of some women receiving the kit in the trial to attend for conventional cytology may be due to anxieties around home testing coupled with a knowledge that ignoring the kit could potentially have life changing consequences. Keywords: cervical cancer; screening uptake; young women; preferences; discrete choice experiments; heterogeneity; United Kingdo

Internalisasi Nilai Nilai Tasawuf di Pondok Pesantren Salafi Al Afiyah Kampung Keroy Kecamatan Sukabumi Bandar Lampung

Akhlak dalam aktivitas yang diajarkan oleh tasawuf untuk mengangkat manusia ke tingkatan shafa al-tauhid. Pada tahap inilah manusia akan memiliki akhlak kepada Allah. Dan manakala seseorang dapat berperilaku dengan perilaku Allah, akan terjadi keselarasan dan keharmonisan antara kehendak manusia dengan Iradah-Nya. Penelitian ini mengambil Pondok Pesantren Salafi Al-Afiyah, karena ponpes incukup konsen dengan nilai-nilai tasawuf di dalamnya. Oleh sebab itu, peneliti berkeinginan untuk meneliti bagaimana nilai-nilai tasawuf diajarkan kepada para santrinya, sehingga para santrinya memiliki bekal untuk membentengi diri dari pengaruh-pengaruh negatif di era globalisasi Penelitian ini bertujuan untuk mengetahui, memahami dan mendeskripsikan secara rinci dan mendalam tentang internalisasi nilai-nilai tasawuf akhlaqi. Penelitian ini menggunakan metode kualitatif dengan pendekatan deskriptif; Pengumpulan data melalui wawancara sebagai metode pokok dan dokumentasi sebagai metode penunjang dalam penelitian. Uji keabsahan data yang digunakan adalah triangulasi sumber. Sumber data pada penelitian ini adalah Ketua Ponpes, wakil, pengajar dan santri di Ponpes Salafi Al-Afiyah. Berdasarkan hasil penelitian dapat disimpulkan bahwa; 1). Penanaman nilai tasawuf akhlaqi yang dilakukan di Pondok Pesantren Salafi Al-Afiyah dapat dikatakan cukup baik. Hal tersebut didasarkan bahwa penanaman nilai sudah sesuai dengan kajian teoritik yang dipaparkan oleh Mukhtar Hadi, yaitu penanaman nilai akhlaqi dilakukan melalui proses takhali, tahalli, dan tajjali. Takhalli (mengkosongkan diri dari perbuatan yang tidak baik), tahalli (menghias diri dengan jalan membiasakan diri dengan sikap, perilaku, dan akhlak yang terpuji) dan tajalli (tersingkapnya batas antara hamba dan Tuhannya). Kemudian, dalam pelaksanaan penanaman nilai akhlaqi melalui takhali, tahalli, dan tajjali, diperkuat dengan mengintegrasikan materi yang bersumber dari kitab ; (Ta‟lim alMutta‟allim, Nasoikhul Ibad, Bidayatul Hidayah, Irsyadul Ibad, Hadits Arbain Nawawi, Hadits Riyadh al-Shalihin, dan lain sebagainya). Serta, penggunaan metode seperti; (metode kedisiplinan, metode latihan dan pembiasaan, metode targhib dan tahdzib, metode keteladanan, dan metode ibrah), yang dapat menunjang dalam penanaman atau pembentukan akhlak santri. 2). Penanaman nilai tasawuf akhlaqi di Pondok Pesantren Salafi Al-Afiyah, memiliki implikasi terhadap santri, yaitu: Pertama, Menjadikan seorang santri berakhlak mulia (Meliputi sifat: zuhud, qona‟ah,rawakkal, sabar, wara‟, dan ikhlas). Kedua, menjadikan seorang santri yang bertoleransi tinggi. Ketiga, menjadikan seorang santri percaya diri. Dan keempat, menambah kecerdasan spiritual seorang santri. Dapat dilihat bahwa penanaman tasawuf memiliki implikasi yang positif terhadap kepribadian seorang santri sebagai mahluk individu, mahluk sosial dan juga sebagai hamba Allah. Tasawuf selalu mengarahkan kepada jalan kebaikan dan kebenaran, sehingga apapun problematika yang muncul pasti dapat direspon dengan baik, oleh setiap pribadi yang memiliki nilai tasawuf di dalam diri dan hatinya

Subjective experiences of compulsory treatment from a qualitative study of early implementation of the Mental Health (Care and Treatment)(Scotland) Act 2003

Compulsory psychiatric treatment is highly contested, and little research has focused specifically on direct experiences. The Mental Health (Care & Treatment) (Scotland) Act, 2003 introduced new roles and provisions including community treatment orders, and was designed to increase participation, ensure treatment was beneficial and was the ‘least restrictive’ alternative. This article draws on findings from semistructured interviews with 49 individuals who had experienced compulsion under this new legislation during 2007-08, that were part of a broader cohort study. Interviews with service users were conducted at two stages with 80% agreeing to be interviewed twice. The sample included people on a variety of compulsory orders from four Health Board areas, some of whom had been detained for the first time, while others reported ‘revolving door’ experiences. Peer researchers who were mental health service users carried out the interviews with professional researchers. The findings suggest that legislation had a limited impact on participation in the process of compulsion. Consensus was that although service users felt there was increased opportunity for their voices to be heard, this was not matched by having increased influence over professional decision-making, especially in relation to drug treatments. According to people's direct experiences, the passing of the legislation in itself had done little to change the dominant psychiatric paradigm. While providing a foundation for improving the process of compulsion, the findings suggest that as well as legislative reform, fundamental shifts in practice are needed both in terms of the nature of therapeutic relationships, and in embracing more holistic and recovery perspectives

Fatal case of sorafenib-associated idiosyncratic hepatotoxicity in the adjuvant treatment of a patient with renal cell carcinoma.

BACKGROUND: Sorafenib is an orally available kinase inhibitor with activity at Raf, PDGFβ and VEGF receptors that is licensed for the treatment of advanced renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC). Current evidence-based post-nephrectomy management of individuals with localized RCC consists of surveillance-based follow up. The SORCE trial is designed to investigate whether treatment with adjuvant sorafenib can reduce recurrence rates in this cohort. CASE PRESENTATION: Here we report an idiosyncratic reaction to sorafenib resulting in fatal hepatotoxicity and associated renal failure in a 62 year-old man treated with sorafenib within the SORCE trial. CONCLUSION: This is the first reported case of sorafenib exposure associated fatal toxicity in the adjuvant setting and highlights the unpredictable adverse effects of novel adjuvant therapies.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Informe independiente de sociedad civil de El Salvador al cuestionario correspondiente a la tercera ronda

El presente documento expresa los hallazgos, valoraciones, recomendaciones y la posición de la Sociedad Civil ante cuatro de los temas del Cuestionario de la Tercera Ronda del Mecanismo de Seguimiento de la Convención Interamericana contra la Corrupción (MESICIC). Los temas abordados en el presente informe, tienen como objetivo el de profundizar y aportar recomendaciones que coadyuven al actual proceso de construcción de la política pública de transparencia y anti-corrupción

Anticipated regret to increase uptake of colorectal cancer screening (ARTICS):a randomised controlled trial

Objective. Screening is key to early detection of colorectal cancer. Our aim was to determine whether a simple anticipated regret (AR) intervention could increase colorectal cancer screening uptake. Methods. We conducted a randomised controlled trial of a simple, questionnaire-based AR intervention, delivered alongside existing pre-notification letters. 60,000 adults aged 50-74 from the Scottish National Screening programme were randomised to: 1) no questionnaire (control), 2) Health Locus of Control questionnaire (HLOC) or 3) HLOC plus anticipated regret questionnaire (AR). Primary outcome was guaiac Faecal Occult Blood Test (FOBT) return. Secondary outcomes included intention to return test kit and perceived disgust (ICK). Results. 59,366 people were analysed as allocated (Intentionto- treat (ITT)); there were no overall differences between treatment groups on FOBT uptake (control: 57.3%, HLOC: 56.9%, AR: 57.4%). 13,645 (34.2%) people returned questionnaires. Analysis of the secondary questionnaire measures showed that AR had an indirect effect on FOBT uptake via intention, whilst ICK had a direct effect on FOBT uptake over and above intention. The effect of AR on FOBT uptake was also moderated by intention strength: for less than strong intenders only, uptake was 4.2% higher in the AR (84.6%) versus the HLOC group (80.4%) (95% CI for difference (2.0, 6.5)). Conclusion. The findings show that psychological concepts including anticipated regret and perceived disgust (ICK) are important factors in determining FOBT uptake. However, there was no simple effect of the AR intervention in the ITT. We conclude that exposure to AR in those with low intentions may be required to increase FOBT uptake. Current controlled trials: www.controlledtrials. com number: ISRCTN74986452

Are there gender differences in the geography of alcohol-related mortality in Scotland? An ecological study

<b>Background</b> There is growing concern about alcohol-related harm, particularly within Scotland which has some of the highest rates of alcohol-related death in western Europe. There are large gender differences in alcohol-related mortality rates in Scotland and in other countries, but the reasons for these differences are not clearly understood. In this paper, we aimed to address calls in the literature for further research on gender differences in the causes, contexts and consequences of alcohol-related harm. Our primary research question was whether the kind of social environment which tends to produce higher or lower rates of alcohol-related mortality is the same for both men and women across Scotland. <b>Methods</b> Cross-sectional, ecological design. A comparison was made between spatial variation in men's and women's age-standardised alcohol-related mortality rates in Scotland using maps, Moran's Index, linear regression and spatial analyses of residuals. Directly standardised mortality rates were derived from individual level records of death registration, 2000–2005 (n = 8685). <b>Results</b> As expected, men's alcohol-related mortality rate substantially exceeded women's and there was substantial spatial variation in these rates for both men and women within Scotland. However, there was little spatial variation in the relationship between men's and women's alcohol-mortality rates (r2 = 0.73); areas with relatively high rates of alcohol-related mortality for men tended also to have relatively high rates for women. In a small number of areas (8 out of 144) the relationship between men's and women's alcohol-related mortality rates was significantly different. <b>Conclusion</b> In as far as geographic location captures exposure to social and economic environment, our results suggest that the relationship between social and economic environment and alcohol-related harm is very similar for men and women. The existence of a small number of areas in which men's and women's alcohol-related mortality had an different relationship suggests that some places may have unusual drinking cultures. These might prove useful for further investigations into the factors which influence drinking behaviour in men and women

Community professionals' management of client care : a mixed-methods systematic review

This is the final draft, after peer-review, of a manuscript published in Journal of Health Services Research & Policy. The definitive version, detailed above, is available online at www.rsmjournals.com.Peer reviewedPostprin