Effectiveness of two educational interventions based on the theory of planned behavior on oral cancer self-examination in adults: a randomized controlled trial

BACKGROUND

The theory of planned behavior (TPB) is recognized as an effective theory for behavior change. The aim of the present study was to investigate the impact of two TPB-based educational interventions on oral self-examination (OSE) behavior and the related TPB constructs among adults in Tehran, Iran, in 2022.

METHODS

This randomized controlled trial involved 400 healthy individuals recruited from 20 urban comprehensive health centers in the southern part of Tehran, Iran. The health centers were randomly assigned to two control (PowerPoint) and intervention (WhatsApp) groups (200 individuals in each group). In the control group (the recipient of the routine care), participants received a 20-minute lecture through a PowerPoint presentation and a pamphlet. In the intervention group (the recipient of an additional intervention alongside the routine care), participants were educated through messages and images on WhatsApp along with having monthly group discussions. Data was collected at baseline, as well as at 1- and 3-month follow-ups using a structured questionnaire. The outcomes assessed included OSE behavior and the related TPB constructs: intention, attitude, subjective norm, and perceived behavioral control. Linear and logistic generalized estimating equations (GEE) regression models were used to evaluate the impact of the interventions with STATA version 17.

RESULTS

Of the total participants, 151 (37.75%) were men. The mean ± standard deviation (SD) of ages in the PowerPoint and WhatsApp groups were 39.89 ± 13.72 and 39.45 ± 13.90, respectively. OSE and the related TPB constructs showed significant differences between the groups at the 1-month post-intervention assessment. The effect of PowerPoint was more significant in the short-term (one month), while both methods showed similar effectiveness after three months, specifically in relation to OSE and the TPB constructs. At the 3-month post-intervention assessment, there were significant increases in OSE (OR = 28.63), intention (β = 1.47), attitude (β = 0.66), subjective norm (β = 2.82), and perceived behavioral control (β = 1.19) in both groups (p < 0.001).

CONCLUSIONS

The present study provides evidence of the effectiveness of both educational interventions in improving OSE and the TPB constructs after three months. Therefore, both TPB-based educational methods can be recommended for designing and implementing interventions aimed at preventing oral cancer.

TRIAL REGISTRATION

The trial protocol was registered in the Iranian Registry of Clinical Trials (IRCT) on 04/03/2022 (registration number: IRCT20220221054086N1).

Contact investigations for antibiotic-resistant bacteria: a mixed-methods study of patients' comprehension of and compliance with self-sampling requests post-discharge

BACKGROUND

Contact investigation is an important tool to identify unrecognized patients who are colonized with antibiotic-resistant bacteria. Many Dutch hospitals include already discharged contact patients by sending them a self-sampling request at home, incl. an information letter and sampling materials. Each hospital composes these information letters on their own initiative, however, whether discharged patients comprehend and comply with these requests remains unclear. Therefore, the aim was to provide insight into patients' comprehension of and self-reported compliance with self-sampling requests post-discharge.

METHODS

This mixed-methods study was performed in eight Dutch hospitals. First, the Common European Framework of Reference (CEFR) language level of self-sampling request letters was established. Second, a questionnaire about patients' comprehension of the letter, self-reported compliance, and reasons for compliance or non-compliance were sent to patients that received such a request in 2018/2019. Finally, a random selection of questionnaire respondents was interviewed between January and March 2020 to gain additional insights.

RESULTS

CEFR levels of 15 letters were established. Four letters were assigned level B1, four letters B1-B2, and seven letters B2. The majority of patients reported good comprehension of the letter they had received. Conversely, some respondents indicated that information about the bacterium (18.4%), the way in which results would be communicated (18.1%), and the self-sampling instructions (9.7%) were (partially) unclear. Furthermore, self-reported compliance was high (88.8%). Reasons to comply were personal health (84.3%), the health of others (71.9%), and general patient safety (96.1%). Compliant patients appeared to have a need for confirmation, wanted to protect family and/or friends, and felt they were providing the hospital the ability to control the transmission of antibiotic-resistant bacteria. Although a limited number of non-compliant patients responded to the questionnaire, it seemed that more patients did not comply with self-sampling requests when they received a letter in a higher CEFR-level (B2) compared to a lower CEFR-level (< B2) (9.8% vs. 2.5%, P = 0.049).

CONCLUSIONS

This study showed an overall good comprehension of and high self-reported compliance with self-sampling requests post-discharge. Providing balanced information in self-sampling request letters has the potential to reduce patient's ambiguity and concerns, and can cause increased compliance with self-sampling requests.

Testicular self-examination for early detection of testicular cancer

Testicular cancer (TCa) commonly presents as a painless scrotal mass. It has been suggested that testicular self-examination (TSE) can help in early detection and thus potentially improve treatment outcomes and prognosis. While TSE is more well established in guideline recommendations for patients with a known history of TCa, its role in healthy young men is less established and controversial. In this paper, we review contemporary data to provide an updated recommendation.

Prevalence and determinants of breast self-examination practices among women in their reproductive age in Namibia: an analysis of the 2013 Namibia demographic and Health Survey

BACKGROUND

In resource-constrained settings like Namibia, breast self-examination (BSE) is considered an important cost-effective intervention that is critical to the early detection of breast cancer, and better prognosis. Even though BSE is a simple, quick, and cost-free procedure, its practice varies across different contexts. Knowing the determinants of BSE is necessary to inform the implementation of policies and targeted interventions to improve the practice across the population. In Namibia, estimating the magnitude of BSE practice and its determinants using nationally representative data has received limited scholarly attention. Hence, the present study sought to examine the prevalence and determinants of BSE practices among women of reproductive age in Namibia.

METHODS

This study relied on the 2013 Namibia Demographic and Health Survey (NDHS), analysing data from women aged 15-49 years. Statistical analyses including bivariate and multivariate logistic regression analyses were done using Stata version 14. Adjusted odds ratio (AOR) and confidence interval (CI) are presented. We followed the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) statement.

RESULTS

Only 30.67% of the respondents practiced BSE. The odds of performing BSE were higher among those with health insurance coverage [AOR = 1.59, 95% CI: 1.34, 1.89], those who were separated from their spouses [AOR = 1.36, 95% CI: 1.03, 1.80], those within the richest wealth index [AOR = 1.69, 95% CI: 1.23, 2.33, p ≤ 0.001], and among Catholics [AOR = 0.84, 95% CI: 0.71, 0.98]. Women with secondary [AOR = 2.44, 95% CI:1.78, 3.35, p ≤ 0.001] or higher education [AOR = 3.39, 95%CI:2.24, 5.14] had higher odds of performing BSE. Women aged between 20-49 years had a significantly higher likelihood to practice BSE. Compared to women who live in Khomas, those living in Erongo, Karas, and Omaheke, were more likely to practice BSE than those in Kavango, Ohangwena, Omusati, Oshana, and Oshikoto.

CONCLUSION

We conclude that the determinants of BSE practice are age, educational level, marital status, health insurance coverage, religion, mobility in the last 12 months, early sexual debut, parity, household wealth index, and region of residence. Any policy or intervention to improve BSE practice among Namibian women of reproductive age must target adolescent girls, those with no formal education, those without health insurance coverage, multiparous women, and those in the poorest wealth index.

Awareness of testicular cancer among adult Polish men and their tendency for prophylactic self-examination: conclusions from Movember 2020 event

BACKGROUND

Testicular cancer (TC), due to its non-specific symptoms and occurrence in young men, is particularly dangerous. A critical point for early diagnosis is awareness of the disease and the willingness to perform a testicular self-examination (TSE). The main aim of the study was to assess the knowledge of 771 adult men about testicular cancer. Additionally, the sources of information on TC and TSE were analyzed and the influence of demographic factors on the willingness to join preventative programs was examined.

MATERIALS AND METHODS

The study was carried out during the Movember2020 campaign, where a testicular ultrasound was performed on participants. They were asked to complete a questionnaire with 26 questions to assess their knowledge.

RESULTS

The results obtained in the study indicate a low level of knowledge (average 3.5 points out of 18) about TC. Living in a large city (OR = 1.467; p = 0.03), as well as an earlier conversation about TC (OR = 1.639; p = 0.002), increased the awareness about the disease. Additionally it showed that many participants do not perform TSE at all (52.4%) and that only few perform TSE frequently (18.4%). Relationship status (OR = 2.832; p < 0.001) and previous conversations about TC (OR = 1.546; p = 0.02) was reported to be the main contributing factors in males deciding to have TSE.

CONCLUSIONS

Our research indicates large educational neglect in terms of knowledge about TC and reluctance in performing TSE. It is worth carrying out preventative actions periodically on an increasing scale, not only for the screening of testicular cancer, but also to expand knowledge on this subject.

Can patient-led surveillance detect subsequent new primary or recurrent melanomas and reduce the need for routinely scheduled follow-up? A protocol for the MEL-SELF randomised controlled trial

BACKGROUND

Most subsequent new primary or recurrent melanomas might be self-detected if patients are trained to systematically self-examine their skin and have access to timely medical review (patient-led surveillance). Routinely scheduled clinic visits (clinician-led surveillance) is resource-intensive and has not been shown to improve health outcomes; fewer visits may be possible if patient-led surveillance is shown to be safe and effective. The MEL-SELF trial is a randomised controlled trial comparing patient-led surveillance with clinician-led surveillance in people who have been previously treated for localised melanoma.

METHODS

Stage 0/I/II melanoma patients (n = 600) from dermatology, surgical, or general practice clinics in NSW Australia, will be randomised (1:1) to the intervention (patient-led surveillance, n = 300) or control (usual care, n = 300). Patients in the intervention will undergo a second randomisation 1:1 to polarised (n = 150) or non-polarised (n = 150) dermatoscope. Patient-led surveillance comprises an educational booklet, skin self-examination (SSE) instructional videos; 3-monthly email/SMS reminders to perform SSE; patient-performed dermoscopy with teledermatologist feedback; clinical review of positive teledermoscopy through fast-tracked unscheduled clinic visits; and routinely scheduled clinic visits following each clinician's usual practice. Clinician-led surveillance comprises an educational booklet and routinely scheduled clinic visits following each clinician's usual practice. The primary outcome, measured at 12 months, is the proportion of participants diagnosed with a subsequent new primary or recurrent melanoma at an unscheduled clinic visit. Secondary outcomes include time from randomisation to diagnosis (of a subsequent new primary or recurrent melanoma and of a new keratinocyte cancer), clinicopathological characteristics of subsequent new primary or recurrent melanomas (including AJCC stage), psychological outcomes, and healthcare use. A nested qualitative study will include interviews with patients and clinicians, and a costing study we will compare costs from a societal perspective. We will compare the technical performance of two different models of dermatoscope (polarised vs non-polarised).

DISCUSSION

The findings from this study may inform guidance on evidence-based follow-up care, that maximises early detection of subsequent new primary or recurrent melanoma and patient wellbeing, while minimising costs to patients, health systems, and society.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864 . Registered on 18 February 2021.

[Testicular and breast self-examination-a retrospective cohort study of medical students]

Hintergrund

Durch eine regelmäßige Selbstuntersuchung kann ein Malignom der Hoden oder Brust gegebenenfalls frühzeitig erkannt und kurativ behandelt werden. Ziel dieser Arbeit war es, das Selbstuntersuchungsverhalten von Medizinstudierenden zu untersuchen und Faktoren, die eine regelmäßige Selbstuntersuchung beeinflussen, zu identifizieren.

Methodik

Medizinstudierende wurden mittels Fragebogen bezüglich ihres Gesundheits- und Sexualverhaltens befragt. 98,8 % der Studierenden nahmen teil (n = 473). Die erhobenen Daten wurden mittels univariater und multivariater logistischer Regression analysiert.

Ergebnisse

Es gaben 64,2 % der männlichen Studierenden (n = 177) an, regelmäßig ihre Hoden zu untersuchen und 72,2 % der weiblichen Studierenden (n = 296) gaben an, regelmäßig ihre Brust abzutasten. Studierende, die nicht mit ihrer/ihrem PartnerIn bzw. mit ihren FreundInnen über ihre Sexualität sprechen, führten seltener eine Selbstuntersuchung durch (p < 0,05). Männliche Studierende, die in den letzten 4 Wochen vor Befragung keinen Geschlechtsverkehr hatten und weibliche Studierende, die im gleichen Zeitraum nicht masturbierten, führten seltener eine Selbstuntersuchung durch (p < 0,05).

Diskussion

Der Anteil an Medizinstudierenden, der eine regelmäßige Selbstuntersuchung durchführt, ist im Vergleich zu weniger medizinisch gebildeten jungen Erwachsenen hoch. Wissen über die Relevanz von Hoden- bzw. Brustkrebs scheint grundlegend für eine regelmäßige Selbstuntersuchung zu sein. Ein belastetes Sexualleben schränkt solch ein Gesundheitsverhalten möglicherweise ein. Eine Verbesserung der Aufklärung über Hodenkrebs und die urologische Anbindung von Jungen/junger Männer bieten daher die Möglichkeit, die Bereitschaft zur Selbstuntersuchung innerhalb dieser Altersgruppe zu steigern.

Knowledge, Attitudes, and Practices of Breast Cancer Screening Methods Among Female Patients in Primary Healthcare Centers in Najran, Saudi Arabia

The aim of the present study was to evaluate the knowledge, attitude, and practice of breast cancer screening methods among female patients attending five primary healthcare centers in Najran, Saudi Arabia. A cross-sectional survey was conducted on 500 female patients, and a direct interview questionnaire was used to collect data. Our results indicated a low knowledge about breast cancer, breast self-examination, mammogram and clinical breast examination was 54.4%, 56%, 90.4%, and 83.8%, respectively. Nineteen percent of patients demonstrated a high knowledge of breast self-examination. Breast self-examination was performed by 35% of patients, whereas 15% of patients received mammograms and 19.8% clinical breast examinations. The most common barrier for screening methods of breast cancer was that patients were unaware of half of the screening methods. A total of 20.6% of women did not perform breast self-examinations because they were not well trained, and 26.4% of women did not receive clinical breast examinations because there was no female doctor available. The main source of information among the women patients was social media (52.4%), whereas 8.8% received information through their healthcare provider. In summary, the majority of women demonstrated poor knowledge about breast cancer and screening methods. Additional effort should be put forth through women's healthcare providers to increase the awareness of breast cancer screening. That means we need to continue emphasizing the importance of primary healthcare for early detection of breast cancer in the early stages.

[Knowledge and early detection of testicular germ cell cancer among adolescents and young adults]

INTRODUCTION

Malignant testicular germ cell tumors are the most common tumor disease in young men, affecting not only the period of his reproductive phase but also creating a complex life situation. Therapy includes the risk of development of second neoplasia and sequelae. However, particularly in this age group, knowledge about this disease and risk factors is sparse, and preventive examinations are not available or are not or insufficiently used.

MATERIALS AND METHODS

In order to evaluate the state of knowledge on testicular tumors in adolescents, a knowledge survey was conducted at 6 high schools in Hamburg from January to April 2019 among pupils of grades 11 and 12. This was carried out with a questionnaire comprising 15 items, which was analyzed and also evaluated on a gender-specific basis. Only fully completed questionnaires were considered.

RESULTS

The overall proportion of correctly answered questions was 60.04%. Broken down by gender, the proportion was 60.18% for female pupils and 59.14% for male pupils, while the gender ratio was 52.2 and 47.8% for female pupils. Special questions on testicular tumors were answered correctly by 59.71% of the female students and 54.8% of the male students, while general questions on the structure and function of the male sexual organs were answered 4.51% better by the male students with 64.9%. These were statistically significant in both cases.

CONCLUSION

The survey shows a gender-specific knowledge deficit on testicular tumors, which is more pronounced among boys. As intensified knowledge transfer on this topic alone is insufficient, a preventive examination should be established especially for boys. This would enable individual, risk-commensurate and needs-adapted monitoring and early detection of testicular tumor disease, but also of other health issues in male adolescents.

Diversity of human papillomavirus typing among women population living in rural and remote areas of Brazilian territory

Objectives

Genotyping HPV from samples tested positive to careHPV™ assay in rural and remote areas of Brazilian territory.

Methods

A total of 5079 women were enrolled in an opportunistic screening from the Barretos Cancer Hospital, through mobile units or ambulatory unit. All careHPV™ hr-HPV positive samples were tested by a Luminex-based protocol in order to evaluate the HPV infecting types.

Results

Positive hr-HPV results were obtained in 10.6% (536/5068) of women. Among these cases, HPV-56 and HPV-51 were the most common types detected in 32.3% and 31.4%, respectively. HPV-53 (20.5%), HPV-18 (18.5%), HPV-58 (17.6%), HPV-52 (16.0%) and HPV-16.6%) were the other most frequent types detected. These frequencies represent prevalences of 2.35%, 2.12%, 2.02%, 1.84% and 1.80% respectively, within the population studied. Regarding low-risk HPVs, HPV-6 was detected in 12.9% of the samples. The less frequent types (<3%) were: HPV-70, HPV-11 and HPV-26.

Conclusions

The most frequent types detected were: HPV-56, HPV-51, HPV-53, HPV-18, HPV-58, HPV-52 and HPV-16 according to decreasing rates.

[Value of the BioPerfectus multiplex real time HPV assay for self-collected samples cervical cancer screening]

Objective: To evaluate the feasibility of the BioPerfectus multiplex real time (BMRT) HPV assay for self-sample cervical cancer screening. Methods: Eight hundreds and thirty-nine self-collected and physician-obtained DNA samples from the Shenzhen cervical cancer screening trial Ⅳ(SHENCCAST-Ⅳ) study collected samples for cervical cancer screening during June 2013 to September 2014 were detected by BMRT HPV assay to evaluate the screening efficacy. Results: A total of the 839 women who were screened, 804 with complete BMRT HPV data was included in the study, and average age was (46±7) years. Of the 804 women, the positive rates of 14 high-risk HPV genotypes (including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 subtype) of self-sample and physician-obtained samples were 12.2% (98/804) and 12.8% (103/804), respectively (χ(2)=0.14, P=0.71). Self-collected samples with HPV-positive had significantly more cells (median 19 901.0) than physician-obtained samples (median 1 778.4), and there was statistically significant difference (Z=-7.61, P<0.01). The degree of agreement between self-sample and physician-obtained samples of HPV 16, HPV 18 and other 12 high risk HPV genotype was 99.8%, 100.0% and 96.1%, respectively. And the consistent Kappa value was 0.95, 1.00 and 0.81, respectively. Of 804 samples, there were 6 cervical intraepithelial neoplasia (CIN)Ⅱ(+) cases. There were no missed CINⅡ(+) cases by BMRT HPV assay. Conclusion: BMRT HPV assay is feasible for self-sample cervical cancer screening.

[Survey of the acceptance status of HPV self-sampling screening in female population for cervical cancer]

Objective: To investigate the acceptance of HPV self-sampling mode in cervical cancer screening population and explore its feasibility. Methods: From March 5 to 15, 2018, researchers investigated women who participated in cervical cancer screening organized by Beijing Shunyi Women's and Children's Hospital in the form of questionnaires. Questionnaires were conducted on their acceptance status and the factors that affect the self-sampling experience. The specific contents of the questionnaires were as follows: (1) the experience of using self-sampling included operability, comfortable, sample time-consuming, bleeding or not after sampling; (2) psychological changes after self-sampling, including the willingness to accept self-sampling again, the worrying problems during self-sampling process. According to whether or not have operating video guidance, the self-sampling experience and psychological changes after self-sampling were compared. Results: (1) There were 1 375 women participated in the questionnaire survey, and 86.55% (1 190/1 375) of them thought the self-sampling was convenient, 78.40% (1 078/1 375) thought it was not uncomfortable, 88.58% (1 218/1 375) thought the sampling time was fast (less than 5 minutes), 94.04% (1 293/1 375) self-sampling without bleeding; and 83.27% (1 145/1 375) were willing to self-sampling for cervical cancer screening again, 85.82% (1 180/1 375) were afraid of inaccurate sampling. (2) Among the 1 375 women, 1 202 were in the video guidance group and 173 were in the non-guidance group. The self-sampling experience of women in video guidance group was better than those of non-guidance group in operability, comfortable, sampling time-consuming and bleeding after sampling. The proportion of women who willing to self-sampling again was higher than that of non-guidance group (86.69% vs 59.54%, respectively). The proportion of women who worried operating incorrectly was lower than that of non-guidance group (11.23% vs 32.37%, respectively). The differences were significant (all P<0.05). Conclusions: Self-sampling for HPV testing in cervical cancer screening is easy to operate and has little discomfort complaint. It is feasible in cervical cancer screening. Operational video guidance during the screening process could effectively improve the women's experience and willingness to self-sampling again in the future.

Effects of Creating Awareness Through Photographs and Posters on Skin Self-Examination in Nursing Students

Nurses can have an influence on primary and secondary prevention of skin cancer. Therefore, it is important to help them acquire knowledge and skills necessary to modify behavior in relation to skin cancers. The aim of this study was to examine effects of creating awareness through photographs and posters on knowledge and skills of skin self-examination in nursing students. The study had a quasi-experimental design with a pretest and a posttest in a single group. The study population included 249 last-year nursing students in Turkey. Non-probability sampling was used to reach the population. The study sample was composed of 201 students volunteering to participate in the study, and the response rate was 81 %. Of the students, 85.1 % (n = 171) were female and the mean age of the students was 22.18 ± 0.78 years. Of the students, 94.5 % did not know the asymmetry, border, color, diameter, evolution (ABCDE) criteria on the pretest, but this rate decreased to 20.9 % on the posttest. The mean score for knowledge of symptoms of skin cancer was 10.95 ± 1.37 on the pretest and 11.48 ± 0.90 on the posttest. There was a significant linear increase in the scores for knowledge of the symptoms (F = 7.874, p < 0.001) after the intervention with photographs and posters. The students were observed to learn the ABCDE criteria and had increased knowledge of skin cancer symptoms after the intervention using photographs and posters. Photographs and posters are effective tools which can be used to increase awareness of skin self-examination.

Evaluation of the Efficacy of Clinical Breast Examination Gloves in the Diagnosis of Breast Lumps

INTRODUCTION

Recent studies have questioned the efficacy of mammography in reducing breast cancer-related mortality. Additionally, the efficacies of commercially available gloves marketed as aiding the detection of breast lumps have not been independently verified.

AIM

To evaluate the efficacy of clinical breast examination gloves in the detection of breast lumps.

MATERIALS AND METHODS

During the period from October 2011 to June 2012, patients were submitted to clinical examination with and without gloves. This prospective study involved 202 patients who underwent conventional clinical breast examination (test 1) or clinical breast examination with Sensifemme^® gloves (test 2). All patients underwent subsequent bilateral ultrasonography (test 3) to confirm the findings of the physical examinations. The Chi-square test was used to compare values, while the kappa concordance index was used to determine the concordance between the diagnostic tests.

RESULTS

The mean age of the patients was 43 years; 298 breast lumps were detected. In the clinical examination group (test 1), sensitivity was 54%, specificity was 78%, and accuracy was 57%. These rates for clinical breast examinations with gloves (test 2) were 68%, 58%, and 66%, respectively. The glove increased the diagnosis of breast nodules by 14%; the rate of false-positives was also higher (42% for test 2 compared to 22% for test 1). The accuracy of the glove was found to be superior to clinical examination after 100 patients had been examined. The kappa indices for test 1 vs. test 3 and for test 2 vs. test 3 were 0.15 and 0.16, respectively.

CONCLUSION

Clinical examination using the glove was more effective than clinical examination with bare hands for the diagnosis of breast lumps, as it increased the sensitivity and accuracy of lump detection. However, this was at the expense of a higher false-positive rate, which can lead to further tests, unnecessary biopsies, and patient anxiety. The concordance of clinical examination results (whether performed with or without the glove) with those of ultrasonography is weak. Moreover, the glove has a steep learning curve that may discourage its use in certain circumstances.

Effect of health-belief-model-based training on performance of women in breast self-examination

Background

Breast cancer is the most common cause of cancer death among women in the world. With prevention and examinations, including breast self-examination, the death rate will be reduced.

Objective

The purpose of this study was to determine the effect of health-belief-model-based training on the performance of women in breast self-examination in the province of Fars (Iran).

Methods

An empirical study examined the effect of an eight-week training program based on the health belief model among 144 women who visited health care centers in the city of Abadeh in Fars Province (Iran) in 2015. Data gathered through researcher-made questionnaires including awareness, components of the health belief model, performance, and demographic information. IBM-SPSS software version 20, descriptive and inferential statistical tests such as T-test, chi-square, Mann–Whitney, and repeated measurements were used for data analysis.

Results

After the intervention, a significant difference was seen in average awareness, perceived susceptibility, and performance of women (p<0.05), while it was not significant in benefits constructs, perceived barriers, and perceived severity and practice guide. After intervention, the average score of awareness was increased significantly (p<0.001). Also, the average score of performance in breast self-examination showed a significant difference (p<0.001).

Conclusion

Due to the low level of awareness of women about breast self-examination, using a health belief model with an increase of the perceived susceptibility could be effective in improving their performance in breast self-examination.

Self-Optical Coherence Tomography and Angiography

Purpose

To present a new concept of self-optical coherence tomography (OCT) and self-OCT angiography.

Methods

The operator sits in the patient seat and manipulates the instrument body via the joystick with the dominant hand, while the dominant index is ready to press the capture button and while focusing on the fixation target. One senior ophthalmologist judged various OCT machines for ease of self-scan during a major ophthalmic convention. Separately, self-scans were also captured using a single OCT machine by one senior ophthalmologist and 5 junior optometrists and the scans were analyzed for both centration and image quality value (IQV), and compared to regular scans done by an operator.

Results

Ten available OCT machines were tested for their ability to allow self-OCT. Machines that had one or more features of auto-alignment, auto-focus, and auto-shoot were ideal for self-OCT or self-OCT angiography. Self-scans done by the ophthalmologist (total 27 scans of right eye, mean IQV = 32.6, and 24 left eyes, mean IQV = 37.3, done over 9 months) and 5 optometrists (total 24 scans, mean 34.8 done in one session) were comparable to scans (total 11, mean IQV = 38.1) done by an operator for image quality. Decentration was very common in self-scans of the macula (37% right eye and 46% left eye) versus 0% for scans of the right eye done by an operator.

Conclusions

Self-OCT scans of the macular region can be done with good image quality but are often decentered. Advantages include privacy, potential use by ophthalmic health professionals, airspace station officers, and possible future home self-imaging of macula.

From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening

In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a ‘D’ recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians.

In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the ‘D’ grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a ‘D’ grade were analyzed for logical reasoning and methodological rigor.

Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current ‘D’ grade for TCa screening (i.e. discourage the use of said service) should be changed to an ‘I’ statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value.

•

The USPSTF gave testicular cancer screening a ‘D’ rating, discouraging its practice.

•

We discover methodological flaws and a lack of evidence needed to grant a D rating.

•

The D rating contrasts with the widely held support of TCa screening among practitioners.

•

The question is raised if the ‘D’ rating for TCa screening should be changed to an ‘I′ statement.

Yazd Breast Cancer Project Profile; A Community Based Trial for the Evaluation of Self-Examination and Physical Examination of the Breast Cancer Disease

There is some evidence to suggest that a benefit might be derived from a program that incorporated both annual physical examination of the breast (BPx) and the teaching of breast self-examination (BSE). Current investigation presents the profile of a multicenter community based intervention for evaluating the effect of BSE+BPx on the reduction of morbidity and mortality due to breast cancer amongst women residing in urban areas of Yazd (Iran) from 2008 to 2018. There were three distinctive phases in this trial with 10 years duration: pilot phase with the duration of 1 year, active intervention phase with 4 rounds of annual screening of BPx+BSE and follow up phase with 5 years duration. Tools of enquiry included a pre-tested questionnaire, repeated annual physical examination of the breast and more importantly mammography, sonography, and fine needle aspiration (FNA). Data were analyzed using descriptive statistics such as frequencies, percent, mean (SD), tests of chi-square and student t-test with 95% confidence level. Comparison of socio-demographic and socio-economic factors such as age, age at marriage, family size, number of live births, occupation, education level, total family income and marital status showed that no significant difference was seen between the groups (P>0.05). A response rate of 84.5% was seen by participants of the experiment group visiting the health centers for the first BPx. Our results showed that except for the education and marital status, the difference in other main demographic and socio-economic factors between the groups were not significant, and the response rate of individuals in the experiment group was at an acceptable level.

[Breast self-examination in users of the Instituto Mexicano del Seguro Social from Teapa, Tabasco, Mexico]

OBJECTIVE

To establish the proportion of women of 40 years-old and more, which perform properly breast self-examination in the Family Medical Unit 18 of the Instituto Mexicano del Seguro Social from Teapa, Tabasco, Mexico, in 2011.

METHODS

Cross-sectional study in a universe of 1457 women. A random sample of 127 women was obtained and aleatorily selected. Socio-demographic and hereditary variables were included and breast self-examination technique was evaluated. The information was taken from clinical files and check lists. Descriptive statistic was obtained.

RESULTS

The mean age was 52.7 ± 9.3, with a confidence interval of 40-80 years-old. Women with a primary-school education were the largest group, representing 35.4 %. Family antecedent of breast malign tumor was found in 11 %. The mother was the most frequent parent with this background (42.9 %). Adequate breast self-examination technique was observed in 0.8 %.

CONCLUSIONS

The proportion of women that performs breast self-examination properly is very low. Associated factors were not found. Educative interventions are required in order to correct this problem.