Doing good, doing harm: adverse effects of screening and health education in perspective

Screening for rheumatic heart disease in Aboriginal and Torres Strait Islander children

Rheumatic heart disease is preventable but causes significant morbidity and mortality in Aboriginal Australian and Torres Strait Islander populations. Screening echocardiography has the potential to detect early rheumatic heart disease thereby enabling timely commencement of treatment (secondary prophylaxis) to halt disease progression. However, a number of issues prevent echocardiographic screening for rheumatic heart disease satisfying the Australian criteria for acceptable screening programs. Primarily, it is unclear what criteria should be used to define a positive screening result as questions remain regarding the significance, natural history and potential treatment of early and subclinical rheumatic heart disease. Furthermore, at present the delivery of secondary prophylaxis in Australia remains suboptimal such that the potential benefits of screening would be limited. Finally, the impact of echocardiographic screening for rheumatic heart disease on local health services and the psychosocial health of patients and families are yet to be ascertained.

Effects of a health examination programme on quality of life and subjective well-being

The effects on quality of life and psychological well-being of a health examination programme in a branch of Swedish industry were studied by means of questionnaires in 124 white-collar workers. They were asked to answer two questionnaires, one before and the other one month after the examination (the Nottingham Health Profile (NHP) and the Psychological General Well-being Schedule (PGWB)). Both are well-known and well-documented standard questionnaires used for estimating quality of life and degree of subjective well-being. The answers were compared with those of a control group comprising other white-collar workers in the same industry, of the same sex and age but who did not participate in the health examination and who were asked to complete the same questionnaires twice. The group that had participated in the health examination did not differ generally from the control group with respect to intra-individual differences as studied in the questionnaires on the two occasions. This indicates that no deterioration of quality of life or of psychological well-being was experienced by the participants in the health examination.

Psychological reactions to information about risk of ischaemic heart disease in general practice

OBJECTIVE

To examine the psychological reactions in 40-49 year old men diagnosed as having an increased risk for the development of ischaemic heart disease at a health examination in general practice.

DESIGN

A multipractice study including a questionnaire about the psychological well-being before and 6 months after a health examination aimed at finding an increased risk for ischaemic heart disease.

SETTING

General practice in the county of Aarhus, Denmark. Sixty five general practitioners.

PARTICIPANTS

123 men with and 150 men without an increased risk of ischaemic heart disease.

OUTCOME MEASURES

Psychological well-being was measured by the General Health Questionnaire (12 item version).

RESULTS

No significant change in GHQ-scores after the screening examination.

CONCLUSION

Information about increased risk of IHD in 40-49 year old men at a health examination in general practice did not change the psychological well-being as measured by a General Health Questionnaire 6 months after the examination.