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O pre-condicionamento isquemico (PCI) e um procedimento que consiste na aplicacao de um aparelho para a oclusao vascular (OV), alternando momentos de OV e reperfusao. O PCI e um metodo de trabalho empregado para bloquear o fluxo sanguineo de maneira remota e nao invasiva, atraves de um torniquete pneumatico antes de realizacao de um exercicio. Diversos estudos tem investigado os efeitos do PCI no desempenho esportivo e muscular. Entretanto, poucos estudos investigaram os efeitos do PCI sobre as respostas hemodinâmicas apos o exercicio. Portanto, o objetivo do presente estudo foi investigar o efeito agudo do PCI aplicado antes de testes de forca isometrica e de endurance muscular sobre a pressao arterial sistolica (PAS), pressao arterial diastolica (PAD), frequencia cardiaca (FC), duplo produto (DP), pressao arterial media (PAM) e saturacao de oxigenio (SPO 2 ) em homens treinados. A amostra foi composta por 12 individuos saudaveis, treinados recreacionalmente. O estudo foi realizado em um total de 3 visitas em dias nao consecutivos (3 a 7 dias de intervalo). Durante a primeira visita ao laboratorio foram assinalados os Termos de Consentimentos Livres e Esclarecidos (TCLE), de acordo com a declaracao de Helsinki, em seguida, respondidos os Physical Activity Readiness Questionnaire / PAR-Q, imediatamente apos foram avaliados a antropometria e em seguida uma familiarizacao com os testes e o metodo. Na segunda e terceira visita os voluntarios foram divididos aleatoriamente com entrada contrabalanceada e alternada, nos seguintes protocolos experimentais:a) PCI + testes de forca isometrica e testes de endurance muscular (PCI); b) protocolo controle (CON) testes de forca isometrica e testes de endurance muscular, logo apos os foram mensuradas as variaveis hemodinâmicas. Os resultados motraram que as respostas da PAS, PAD, FC, DP, PAM e SPO 2 nao apresentaram diferencas significativas entre os protocolos PCI e CON ( p > 0.05). A PAS foi significativamente maior no PCI comparando o momento pre vs. pos ( p= 0.01). A FC foi significativamente maior, comparando pre vs. pos, no PCI ( p= 0.01) e no CON ( p= 0.01). O DP foi significativamente maior, comparando pre vs. pos, no PCI ( p= 0.01) e no CON ( p= 0.01). A PAMnao apresentou diferencas significativas, comparando pre vs. pos, nos protocolos PCI e CON (p>0.05). A SPO 2 nao apresentou diferencas significativas, comparando pre vs. pos, nos protocolos PCI e CON (p>0.05). Em conclusao, nossos achados demonstraram que aplicacao do PCI antes de teste de forca isometrica e de endurance muscular nao alteraram significativamente as respostas hemodinâmicas (PAS, PAD, FC, DP, PAM e SPO 2 ) em homens treinados.

Current rates of opioid prescribing and consumption in the United States have resulted in deleterious consequences for both patients and society. There has been a focus on opioid consumption and overprescribing, but the utility of patient education in reducing opioid consumption has only recently been explored. This randomized trial aimed to evaluate the effectiveness of a brief patient educational intervention in reducing pain and opioid consumption in patients undergoing mastectomy and breast reconstruction. A parallel, randomized, single-center trial of women undergoing mastectomy with immediate, implant-based breast reconstruction was completed to evaluate the utility of a patient educational instrument with information on multi-modal pain control. A questionnaire was administered postoperatively to collect data on pain control and opioid consumption. Fifty participants were randomized to each group preoperatively; 46 control (92%) and 39 intervention (78%) participants completed the postoperative questionnaire. Active tobacco use was more common in the control group (p = 0.04). There was a trend towards lower pain scores in the intervention group (3.0/10, SD 1.8 vs 3.6/10, SD 1.6, p = 0.06). Both groups were prescribed a median of 32.0 5-mg oxycodone tablets postoperatively. Participants in the intervention group consumed 33% fewer opioids than the control group (16.2 tablets, SD 16.4 vs 24.3 tablets, SD 21.8, p = 0.05). The use of a brief educational intervention provided at a preoperative appointment can reduce opioid consumption. We recommend the use of an educational intervention to decrease opioid consumption among breast surgery patients.

Purpose: Current rates of opioid prescribing and consumption in the United States have resulted in deleterious consequences for both patients and society. There has been a recent focus on opioid consumption and overprescribing, but little work has been done to evaluate the utility of patient education in opioid consumption. This study aimed to decrease opioid consumption in patients undergoing mastectomy and breast reconstruction through a patient education tool. Methods: Patients undergoing consultation for mastectomy and immediate, implant-based breast reconstruction between March, 2018 and January, 2019 were prospectively enrolled in a randomized control trial. Patients were randomized to standard of care or to receive a single-paged handout which included information on the pain scale, expectations for pain control, and examples of a multi-modal approach to pain control. A survey was administered at the preoperative and postoperative appointment to collect data on pain expectations and opioid use. A chart review was performed to obtain surgical information, patient comorbidities, and opioid prescription information. Results: Of 100 patients completing the preoperative survey, 97 patients (97.0%) underwent surgery and 85 patients (85.0%) completed the postoperative survey. Half of patients were randomized preoperatively to receive the intervention. Preoperatively, 27 patients (27.0%) had a history of a chronic pain syndrome, 34 (34.0%) of a mental health comorbidity, and 9 (9.0%) of both. Reconstruction was completed following bilateral mastectomy in 70.1% of patients (n=68) and unilateral mastectomy in 29.9% (n=29). A total of 85 tissue expander (87.6%) and 12 direct-to-implant (12.4%) reconstructions were completed. Patients were prescribed an average of 36.0 5mg-oxycodone tablets postoperatively. Patients in the intervention group consumed an average of 1/3 fewer opioids than patients in the control group (16.2 tablets, 121.5 MEE (SD=122.6) vs 24.3 tablets, 182.2 MEE (SD=181.9), p=0.03). Although not statistically significant, fewer patients in the intervention group required an opioid prescription refill (15.8% vs 21.7%). There was a trend towards lower pain scores in the intervention group (3.0/10 (SD=1.8) vs 3.6/10 (SD=1.6), p=0.06). Overall, patients reported consuming an average of 20.6 tablets postoperatively (154.5 MEE, SD=148.7), or 57.0% of the average prescription amount. The majority of patients (75.3%) reported taking an opioid less than once a day at the time of survey completion, and 24 patients (28.2%) reported that they had either not filled or had not used any of their opioid prescription postoperatively. Conclusions: Consistent with other studies of postoperative opioid consumption, patients undergoing mastectomy and implant-based breast reconstruction are prescribed nearly twice as many opioid tablets as consumed, and one in three patients report not using any opioids postoperatively. The amount of opioids prescribed in this population can be safely decreased. The results of this randomized controlled trial showed that through the use of a simple educational handout provided at a preoperative appointment, opioid consumption can be reduced by an additional 30% compared to patients receiving no intervention. Patients receiving an intervention are also less likely to require a refill. We recommend implementation of protocols related to opioid prescribing and the use of a simple educational tool to decrease opioid consumption among breast surgery patients. Citation Format: Katie Egan, Elizabeth Muenks, Niaman Nazir, Michelle De Souza, Richard Korentager. A brief intervention decreases opioid consumption following mastectomy with implant-based breast reconstruction [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-15-01.

BACKGROUND Current rates of opioid prescribing have deleterious consequences on both patient and societal levels. This study aims to evaluate responsible opioid prescribing and predictors of opioid consumption in immediate implant-based breast reconstruction. METHODS Patients undergoing consultation for immediate, implant-based breast reconstruction were enrolled in a prospective, cohort survey study. A survey was administered at the preoperative and postoperative appointment to collect data on pain expectations and opioid use. A medical record review was performed. RESULTS Of 100 enrolled patients, 97 (97.0 percent) underwent surgery and 85 (85.0 percent) completed the postoperative survey. Preoperatively, 27 patients (27.0 percent) had a history of a chronic pain syndrome, 34 (34.0 percent) had a history of a mental health comorbidity, and nine (9.0 percent) had a history of active preoperative opioid use. A total of 85 tissue expander (87.6 percent) and 12 direct-to-implant (12.4 percent) reconstructions were completed. Patients were prescribed an average of 36.0 5-mg oxycodone tablets postoperatively. Patients reported consuming an average of 20.6 tablets, or 57.0 percent of the average prescription amount. The majority of patients (75.3 percent) reported taking an opioid less than once per day at the time of survey completion, and 24 patients (28.2 percent) reported that they did not use any opioids postoperatively. Preoperative opioid use (p = 0.004), inpatient opioid consumption (p < 0.0001), and patient-reported anxiety related to pain control (p < 0.05) were predictors of opioid consumption. CONCLUSIONS Patients undergoing mastectomy and implant-based breast reconstruction are prescribed nearly twice as many opioid tablets as consumed, and one in three patients report not using any opioids postoperatively. Clinical factors may help guide prescribing practices. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.

OBJECTIVES: To assess the quality of life of hospitalized pregnant women with preeclampsia (PE), and compare with a group of healthy pregnant women (HP). METHODS: This was an observational cross-sectional study conducted among 58 pregnant women; 28 of them had preeclampsia and 30 were healthy. The WHOQOL-Bref questionnaire, which was divided into four aspects: physical, psychological, social, and environmental, was applied to each subject. RESULTS: A statistically significant difference was observed regarding maternal age (PE 27.8±6.2 x HG 23.0±6.6, p

Although there has been a recent focus on decreasing opioid prescribing through alternative pain medication protocols, the patient's perception of pain related to breast reconstructive surgeries has not been well described. We sought to evaluate patient perception of pain control as it influences opioid use. We hypothesize that modifiable factors may influence patterns in pain perception and postoperative opioid use. Patients undergoing consultation for mastectomy with immediate, implant-based breast reconstruction were enrolled in a prospective, cohort survey study. A survey was administered at preoperative and postoperative appointments to collect data on pain expectations and pain control. Of 100 patients enrolled, 85% completed the postoperative survey. Over half of patients (52%) reported feeling anxious about pain control after surgery. Patients with preoperative opioid use were more likely to expect complete relief of pain postoperatively (P = .038). Patients with psychiatric comorbidity were more likely to report feeling anxious about postoperative pain (P = .012; 70% vs 42%; OR 3.0 CI 1.2-7.4). Patients who reported feeling anxious about pain control preoperatively were more likely to report trying opioids (P = .047; 67% vs 44%; OR 2.5 CI 1.0-6.1) and benzodiazepines (P = .020; 80% vs 56%; OR 3.0 CI 1.2-8.0) postoperatively. Anxiety related to pain control is common and results in an increased likelihood of trying opioid and benzodiazepine medications postoperatively. This presents an opportunity to educate patients preoperatively by addressing anxiety related to pain control to decrease controlled substance use.

No final de 2019, emergiu um grupo de casos de pneumonia associados a um novo coronavírus de RNA envelopado, espalhando-se rapidamente pelos continentes e sendo rotulado como pandemia global por COVID-19. Uma proporção considerável da população doente não necessitará de hospitalização, entretanto, alguns pacientes podem desenvolver a forma grave da doença e apresentar complicações como a síndrome do desconforto respiratório agudo (SDRA), requerendo ventilação mecânica invasiva (VMI). Pacientes com SDRA por COVID-19 podem apresentar algumas características específicas em comparação com as formas típicas da síndrome, desenvolvendo fenótipos distintos que ainda tem sido estudados. As pesquisas têm, então, se concentrado em esclarecer estratégias ventilatórias protetoras do pulmão (EPP) para estes pacientes. Esta revisão narrativa teve como objetivo investigar a experiência mundial atual em relação à EPP como manejo da SDRA associada à COVID-19 e destacar considerações para as práticas de VMI durante a pandemia. Após um processo de rastreamento de estudos nas bases de dados PubMed e BVS, foram selecionados 20 estudos a serem analisados. Na maior parte dos estudos o manejo ventilatório dos pacientes se assemelhou ao da SDRA “clássica” e, portanto, a EPP destacou-se como importante aliada na regressão da SDRA nos pacientes COVID-19. No entanto, deve ser levado em consideração a heterogeneidade fenotípica dos pacientes, principalmente quanto à mecânica pulmonar e capacidade de recrutamento. Este estudo possibilitou aprofundamento cientifico sobre as semelhanças e diferenças da SDRA por COVID-19 e por outras causas, além de permitir a formação de orientações quanto aos ajustes ventilatórios iniciais em pacientes com SDRA/COVID-19.

Plastic surgery is a broad field, including maxillofacial surgery, reconstruction after injuries, hand surgery, and skin flaps and grafts, but the most common procedures for women are liposuction and body contouring, breast surgery, and facial cosmetic procedures. Techniques of face and brow lifts, blepharoplasty, and rhinoplasty are discussed as well as botulinum toxin and filler injections, and laser and pulsed light techniques that may delay or eliminate the need for surgery. Comparison of the surgeries for breast reconstruction, reduction, augmentation, and mastopexy is discussed. New surgeries for enhancement of female genitalia are also examined.

The monitoring of resistance of cattle tick populations in Brazil to the chemical bases in use is largely limited to investigation of the phenotypic profile. There are few studies investigating the role played by the genotypic profile in acaricide resistance in the country. Therefore, the aim of the present study was to carry out molecular characterization and trace out the genetic profile of populations of Rhipicephalus microplus with respect to resistance to the organophosphate and pyrethroid chemical groups. For that purpose, larvae were genotyped belonging to 587 populations for pyrethroids and 306 for organophosphates, using the polymerase chain reaction technique. It was found that 75.49% and 97.44% of the larvae studied showed resistance to the organophosphates and pyrethroids, respectively. Among the populations resistant to pyrethroids, 91.9% were heterozygotes, showing that most of the resistant populations have only one allele responsible for resistance. Therefore, it is possible to conclude that the genotyped populations have high resistance to organophosphates, and even more so to pyrethroids. This information is fundamental for understanding the mechanisms of resistance of R. microplus to acaricides, to enable improvement of control techniques. Made available in DSpace on 2022-08-12T17:21:37Z (GMT). No. of bitstreams: 1 A-new-approach-to-characterization-of-the-resistance-of-populations-of-Rhipicephalus.pdf: 589212 bytes, checksum: 6d713c888475983bb76835b2a38e9b87 (MD5) Previous issue date: 2013

Lipodissolve is a relatively new technique of injection lipolysis. Localized areas of fat are treated with the injection of a combination of phosphatidylcholine and deoxycholate. These agents work in concert to reduce fat deposits. The article reviews the results for patients treated with Lipodissolve and other injection lipolysis treatments by Dr. Patricia Rittes, the authors, and other practitioners and researchers. They conclude that properly performed, single-stage surgery that allows the surgeon to address all anatomic levels is preferable to Lipodissolve, pending the results of current and future studies and randomized controlled trials.

In covering the Emergency Department, the Plastic Surgeon can be faced with the mandibular fracture patient. Although the timely repair of the fracture usually leads to normal function and appearance, occasionally the surgeon is faced with the untoward sequelae of the mandible fracture. Post-traumatic mandibular deformities include non-union, malunion, malocclusion, TMJ dysfuction, and facial asymmetry. The difficulty in treatment of these deformities can be compounded by edentulous mandibles, substance abuse, and approach controversies such as the timing of the repair and surgical versus non-surgical management. Knowledge of the post-traumatic mandibular deformities by the treating physician not only assists in their management but may also allow for their prevention.

Our study directly compares the performance of liquid-based (LBC) and conventional cytology for detecting high-grade cervical intraepithelial neoplasia and cancer (CIN 2+) in high-risk, previously unscreened women. As part of a larger randomized clinical trial assessing the efficacy and safety of a "screen and treat" program for cervical cancer prevention, 5,652 South African women, aged 35 to 65 years, were screened using either ThinPrep or conventional Papanicolaou cytology. The cytology method used (i.e., ThinPrep or conventional) was rotated on a 6-month basis for the duration of the study. Directly following collection of the cytology specimen, all women underwent colposcopy with endocervical curettage and biopsy of all colposcopic abnormalities. Assessment of cytology and histology results was blinded and results were compared using histology-confirmed CIN as the "gold standard." The accuracy of LBC and conventional cytology was statistically equivalent, although the sensitivity of conventional cytology was at least 5 percentage points higher at all cutoff levels. For example, at a cytology cutoff level of low-grade squamous intraepithelial lesion, the sensitivity of LBC was 60.3% for CIN2+ vs. 69.1% for conventional cytology and specificity was 94.1% and 94.5%, respectively. LBC specimens were significantly less likely to be "satisfactory-but-limited-by" (6.5% vs. 27.9%) but significantly more likely to be unsatisfactory (2.2% vs. 0.8%). Thus, in this high-risk population, the sensitivity of LBC is no greater than the sensitivity of conventional cytology. Because of the higher unit cost of LBC, low resource settings should carefully consider the potential benefits and drawbacks of LBC before adopting this new technology.

Background and Objectives: Intravaginal practices, including wiping, douching, or inserting substances into the vagina, have been hypothesized to increase women's risk of HIV infection. However, data on the prevalence of these practices, and associations with HIV and other sexually transmitted diseases (STD), are limited. Study Design: We conducted a case analyses. We interviewed 2897 women participating in a gynecologic screening study in Cape Town, South Africa, about their intravaginal practices. After clinical examination, cervical and blood samples were collected and tested for HIV and other STD. Results: ThOf the 831 (29%) women reporting some type of intravaginal practice, 48% reported using only water and cloth to clean inside the vagina, whereas 17% reported using antiseptics or detergents. Most women (53%) reported practices as part of regular hygiene. Intravaginal practices were strongly associated with behavioral risk factors, including recent sexual activity, more lifetime sexual partners, and recent multiple sexual partners. Intravaginal practices were associated with prevalent HIV infection (adjusted odds ratio, 1.74; 95% confidence interval, 1.37-2.20), but were not associated with other STDs. Conclusion: Prospective studies that include detailed measurements of correlated sexual risk behaviors are required to discern whether this association is causal in nature; if so, these behaviors could represent an important area for future HIV prevention interventions.

Management of a patient with a closed head injury is based on neurologic status and computerized tomography scan results. We hypothesized that those patients with an epidural hematoma (EDH) or subdural hematoma (SDH)1 cm in thickness could safely be treated nonoperatively.We retrospectively reviewed charts of 204 consecutive patients with either an EDH or SDH.There were 122 lesionsor =1 cm and 82 lesions1 cm. In the first group, 115 were managed nonoperatively, with 111 good outcomes (minimal deficit with a Rancho Los Amigos score [RLAS]or =3), two poor outcomes (severely disabled with RLAS3), and two deaths. Twenty-eight patients with lesions greater than 1 cm had concomitant cerebral edema (CE) with an 89% mortality rate. The mortality rate in this group without CE was 20%, demonstrating the presence of CE in this group may have adversely affected the mortality rate, regardless of intervention.This data suggests that EDH or SDH1 cm thick can be safely managed nonoperatively unless there is concomitant CE.

OBJECTIVE: To estimate the prevalence of depression and correlate clinical and demographic characteristics in pregnant women assisted by the public health system in the city of Pelotas, RS, Brazil. METHOD: We performed a cross-sectional study focused on pregnant women assisted by the public health service. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depression. RESULTS: In a sample of 1,264 pregnant women aged 12-46 years, 21.1% (n = 255) presented a depressive episode during pregnancy. The presence of depression was associated with older age, lower education, lack of a cohabiting partner, not being primiparous, planned pregnancy, abortion thoughts, psychological or psychiatric treatment, smoking and alcohol consumption during pregnancy, and stressful events. CONCLUSION: Pregnant women assisted by the Brazilian public health system presented a high prevalence of depression. Psychiatric history, lack of support, and stressful events increase the probability of antenatal depression. OBJETIVO: Estimar a prevalência de depressão, bem como fatores clínicos e características demográficas associados em grávidas assistidas por meio do sistema público de saúde da cidade de Pelotas, RS, Brasil. MÉTODO: Foi realizado um estudo transversal tendo como população-alvo as grávidas assistidas pelo sistema público de saúde. Para o rastreio da depressão foi utilizada a Edinburgh Postnatal Depression Scale. RESULTADOS: Em uma amostra de 1.264 mulheres grávidas com idade de 12 a 46 anos, 21,1% (n = 255) apresentaram episodio depressivo durante a gravidez. A presença de depressão foi associada com ter mais idade, menor grau educacional, não morar com companheiro, não ser primigesta, ter planejado a gestação, idealizar o aborto, ter feito tratamento psicológico ou psiquiátrico, consumir tabaco e/ou álcool durante a gravidez e ter sofrido algum evento estressor. CONCLUSÃO: As mulheres grávidas acompanhadas pelo sistema público de saúde apresentaram alta prevalência de depressão. História psiquiátrica, baixo suporte e eventos estressores aumentam a probabilidade de depressão no período pré-parto.

O estudo tem como objetivo mensurar a auto-estima e fatores associados em gestantes atendidas pelo Sistema Único de Saúde (SUS) na cidade de Pelotas, Rio Grande do Sul, Brasil. É do tipo transversal, tendo-se entrevistado 560 gestantes nos meses de maio a novembro de 2006, nos ambulatórios e enfermarias dos hospitais universitários e do centro de atendimento da Prefeitura Municipal. Dentre as gestantes atendidas, 62,9% receberam o diagnóstico de alto-risco. Para avaliação da auto-estima foi utilizada a escala de Rosenberg. Na amostra total a média de pontos na escala foi de 9,2 e o desvio-padrão de 4,6. As variáveis associadas positiva e significativamente com auto-estima foram idade, nível de escolaridade e nível econômico. Já as variáveis percepção de risco à saúde do bebê e número de gestações mostraram-se associadas negativamente à auto-estima. Além disso, as gestantes com condição gestacional de alto-risco têm uma auto-estima mais elevada quando comparadas com as de baixo-risco. This study analyzes self-esteem and associated factors in pregnant women treated by the Unified National Health System (SUS) in the city of Pelotas, Rio Grande do Sul State, Brazil. Using a cross-sectional design, 560 pregnant women were interviewed from May to November 2006. The interviews were held in specific locations like University outpatient clinics and hospital wards and a center run by the city government. A full 62.9% were diagnosed as high-risk pregnancies. Mean self-esteem according to the Rosenberg scale was 9.2 (SD = 4.6). Variables showing a positive, significant association with self-esteem were age, schooling, and income. Perception of risk to the unborn infant's health and parity were both negatively associated with maternal self-esteem. These high-risk pregnant women also showed higher self-esteem than low-risk pregnant women.

Bacterial vaginosis (BV) may increase women’s susceptibility to HIV infection but there are few prospective data. During follow-up for up to 36 months 86 new HIV seroconverters (case patients) were identified among 5110 women enrolled in a cervical cancer screening trial. Nonseroconverting control subjects (np324) were frequency matched to case patients by age and duration of follow-up. At enrollment case patients and control subjects were evaluated for clinical signs of BV and Gram stains of vaginal fluid were scored using Nugent criteria. BV was diagnosed on the basis of clinical criteria at enrollment in 20% of seroconverters and 16% of control subjects (summary odds ratio [OR] 1.31 [95% confidence interval {CI} 0.71–2.41]). Nugent criteria for BV were met by 74% of seroconverters and 62% of control subjects. Diagnosis of BV on the basis of Nugent criteria was significantly associated with an increased risk of HIV seroconversion after adjustment for demographic characteristics other sexually transmitted infections and sexual behaviors (adjusted OR 2.01 [95% CI 1.12–3.62]). BV may account for a substantial fraction of new HIV infections in this setting. Treatment of BV and other interventions to promote normal vaginal flora warrant attention for HIV prevention. (authors)

Background This study was designed to quantify the resources used in reestablishing contact with women who missed their scheduled cervical cancer screening visits and to assess the success of this effort in reducing loss to follow-up in a developing country setting. Methods Women were enrolled in this Cape Town, South Africa-based screening study between 2000 and 2003, and all had scheduled follow-up visits in 2003. Community health worker (CHW) time, vehicle use, maintenance, and depreciation were estimated from weekly logs and cost accounting systems. The percentage of women who attended their scheduled visit, those who attended after CHW contact(s), and those who never returned despite attempted contact(s) were determined. The number of CHW visits per woman was also estimated. Results 3,711 visits were scheduled in 2003. Of these, 2,321 (62.5%) occurred without CHW contact, 918 (24.8%) occurred after contact(s), and 472 (12.7%) did not occur despite contact(s). Loss to follow-up was reduced from 21% to 6%, 39% to 10%, and 50% to 24% for 6, 12, and 24-month visits. CHWs attempted 3,200 contacts in 530 trips. On average, 3 CHWs attempted to contact 6 participants over each 111 minute trip. The per-person cost (2003 Rand) for these activities was 12.75, 24.92, and 40.50 for 6, 12, and 24-month visits. Conclusion CHW contact with women who missed scheduled visits increased their return rate. Cost-effectiveness analyses aimed at policy decisions about cervical cancer screening in developing countries should incorporate these findings.

The Interactive Stories [IS] approach offers language students an alternative way to learn language skills, through authoring and producing their own ‘choose your own adventure’ stories using software for interactive multimedia. This paper describes an evaluation study of the InteractiveStories approach. The main focus of the study was to investigate the learning processes used by students, and how well they met the desired learning outcomes. The study also investigated how well students coped with using new technologies and ways to improve the approach. The study established that students attained skills in reading, writing, speaking and listening, even though they did not realise this at the time. Students were able to creatively use multimedia to place their language in an authentic context. Because students worked in groups, a sense of community was achieved within the class. The areas of improvement identified are mainly administrative, and do not point to any fundamental weakness in the approach. However, the IS approach seems to be most applicable to intermediate and advanced students.

Background Adherence is crucial for public health program effectiveness, though the benefits of increasing adherence must ultimately be weighed against the associated costs. We sought to determine the relationship between investment in community health worker (CHW) home visits and increased attendance at cervical cancer screening appointments in Cape Town, South Africa. Methodology/Principal Findings We conducted an observational study of 5,258 CHW home visits made in 2003–4 as part of a community-based screening program. We estimated the functional relationship between spending on these visits and increased appointment attendance (adherence). Increased adherence was noted after each subsequent CHW visit. The costs of making the CHW visits was based on resource use including both personnel time and vehicle-related expenses valued in 2004 Rand. The CHW program cost R194,018, with 1,576 additional appointments attended. Adherence increased from 74% to 90%; 55% to 87%; 48% to 77%; and 56% to 80% for 6-, 12-, 24-, and 36-month appointments. Average per-woman costs increased by R14–R47. The majority of this increase occurred with the first 2 CHW visits (90%, 83%, 74%, and 77%; additional cost: R12–R26). Conclusions/Significance We found that study data can be used for program planning, identifying spending levels that achieve adherence targets given budgetary constraints. The results, derived from a single disease program, are retrospective, and should be prospectively replicated.

ContextNon–cytology-based screen-and-treat approaches for cervical cancer prevention have been developed for low-resource settings, but few have directly addressed efficacy.ObjectiveTo determine the safety and efficacy of 2 screen-and-treat approaches for cervical cancer prevention that were designed to be more resource-appropriate than conventional cytology-based screening programs.Design, Setting, and PatientsRandomized clinical trial of 6555 nonpregnant women, aged 35 to 65 years, recruited through community outreach and conducted between June 2000 and December 2002 at ambulatory women’s health clinics in Khayelitsha, South Africa.InterventionsAll patients were screened using human papillomavirus (HPV) DNA testing and visual inspection with acetic acid (VIA). Women were subsequently randomized to 1 of 3 groups: cryotherapy if she had a positive HPV DNA test result; cryotherapy if she had a positive VIA test result; or to delayed evaluation.Main Outcome MeasuresBiopsy-confirmed high-grade cervical cancer precursor lesions and cancer at 6 and 12 months in the HPV DNA and VIA groups compared with the delayed evaluation (control) group; complications after cryotherapy.ResultsThe prevalence of high-grade cervical intraepithelial neoplasia and cancer (CIN 2+) was significantly lower in the 2 screen-and-treat groups at 6 months after randomization than in the delayed evaluation group. At 6 months, CIN 2+ was diagnosed in 0.80% (95% confidence interval [CI], 0.40%-1.20%) of the women in the HPV DNA group and 2.23% (95% CI, 1.57%-2.89%) in the VIA group compared with 3.55% (95% CI, 2.71%-4.39%) in the delayed evaluation group (P