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In eight multidisciplinary teams, 50 health care professionals participated in a case-management workshop. Pre/posttest data revealed significant changes in knowledge and more value placed on cost monitoring. These improvements did not vary by type of hospital, profession, or experience. (SK)

Physicians (n=366) described how they gained knowledge or skill to solve a recent clinical problem: 47.8% reading; 33% consultation/referral; 18.9% formal continuing medical education (CME). They were more likely to select formal CME when the problem required more technical expertise or communication ability. (SK)

Cervical cancer morbidity and mortality have decreased substantially during the last 50 years mostly due to success-ful organized or opportunistic screening with Pap cytology in high and middle income countries. In many low income countries Pap cytology screening is yet to be effectively implemented or has failed to reduce cervical cancer rates to an appreciable extent. The fact that infection with certain human papillomavirus (HPV) types is now recognized as a necessary cause of this disease has led to new research fronts on prevention of cervical cancer. Testing for HPV DNA has shown great promise as a screening tool with better sensitivity but somewhat lower specificity than Pap cytology. In combination with the latter, HPV testing has the potential to improve the negative predictive value of cytology, thus allowing for increased testing intervals, which would lower program costs with acceptable safety. Advances in cytology processing and automation have also led to new screening approaches that are increasingly gaining acceptance in high and middle income countries. For low income countries, visual inspection with acetic acid has proven to be an effective alternative to conventional Pap cytology, especially in settings where no screening programs have been implemented. Concerning primary prevention of cervical cancer, recent research on the safety and efficacy of candidate prophylactic vaccines against HPV have shown very promising results with nearly 100% efficacy in preventing persistent infections and development of cervical cancer precursors. However, policy makers are strongly cautioned to avoid deferring decisions concerning the implementation of cervical cancer screening under the expectation that a successful vaccine could obviate the need for secondary prevention strategies.

Several studies are conducted to compare the testing for DNA of human papillomaviruses (HPV) and the Papanicolaou (Pap) test for cervical-cancer screening. The results show that HPV testing is much more sensitive than the Pap testing.

Researchers provide more evidence that persistent infection with human papillomavirus is a risk factor for cervical cancer. They repeatedly tested 1,611 healthy women for papillomavirus infection and a type of precancerous cervical disease called squamous intraepithelial lesions over an eight-year period. Human papillomavirus types 16 and 18 were most likely to cause squamous intraepithelial lesions., Context: Human papillomavirus (HPV) infection is believed to be the central cause of cervical cancer, although most of the epidemiological evidence has come from retrospective, case-control studies, which do not provide information on the dynamics of cumulative or persistent exposure to HPV infection. Objective: To assess the risks of cervical neoplasia related to prior persistent HPV infections. Design and Setting: Longitudinal study of the natural history of HPV infection and cervical neoplasia in women residing in the city of Sao Paulo, Brazil, which was conducted between November 1993 and March 1997 and involved repeated measurements of HPV and lesions with follow-up until June 2000. Participants: A total of 1611 women with no cytological lesions at enrollment and HPV test results available from the first 2 visits. Main Outcome Measure: Cervical specimens taken for Papanicolaou cytology and HPV testing every 4 months in the first year and twice yearly thereafter. Incident cervical cancer precursor lesions ascertained by expert review of all cytology smears. Results: The incidence rate of squamous intraepithelial lesions (SILs) was 0.73 per 1000 women-months (95% confidence interval [CI], 0.5-0.9) among women free of HPV at the 2 initial visits and 8.68 (95% CI, 2.3-15.1) among women with HPV type 16 or 18 infections persisting over both visits. Relative to those negative for HPV oncogenic types at both initial visits, the relative risk (RR) of incident SIL was 10.19(95% CI, 5.9-17.6) for persistent infections with any known oncogenic HPV types. The equivalent RR of incident high-grade SIL was 11.67 (95% CI, 4.1-33.3). The RRs of lesions were considerably higher for persistent infections with HPV type 16 or 18. Conclusion: A strong relationship exists between persistent HPV infections and SIL incidence, particularly for HPV types 16 and 18.

Abstract Health issue Cervical cancer is one of the most common malignant diseases of women; it is diagnosed in almost half a million women every year and half as many die from it annually. In Canada and other industrialized countries, its incidence has decreased due to cytology screening. However, invasive cases still occur, particularly among immigrant groups and native Canadian women. Although incidence of squamous cell carcinomas has decreased, the proportion of adenocarcinomas has increased because Pap cytology is ineffective to detect these lesions. Key findings In Canada, cervical cancer will cause an estimated 11,000 person-years of life lost. In most Canadian provinces, early detection is dependent on opportunistic screening. Primary prevention can be achieved through health education (sexual behavior modification) and vaccination to prevent infection from Human Papillomavirus (HPV). The initial results from vaccination trials are encouraging but wide scale use is more than a decade away. Data gaps and recommendations Most cases of cervical cancer occur because the Pap smear was either false negative, was not done or not done often enough. Appropriate recommendations and guidelines exist on implementation of cytology-based programs. However, most Canadian women do not have access to organized screening. Further research is needed to 1) evaluate automated cytology systems; 2) define appropriate management of precursor lesions and 3) deliver definitive evidence of HPV testing efficacy in long-term follow-up studies with invasive cancer as an outcome and 4) provide Canadian data to justify augmenting or modifying current programs to use HPV testing in secondary triage of equivocal Pap smears.

Problem statement: Hydrogymnastics can improve older adults' functional fitness, but few studies have explored if using resistive elements during sessions would have any effect on functional fitness of middle-aged and older women. Aim: To verify strength training effects on functional fitness of middle-aged and older women while using resistive implements in hydrogymnastics. Material and methods: Experimental study, conducted with 15 women (mean=58.8, SD=8.2 years old), randomly divided into intervention and control groups. Hydrogymnastics training was held in 60-minute sessions, three times a week, for eight weeks. Besides traditional exercises, two specific exercises were incorporated in four series, 12-15 repetitions, with maximum speed and high intensity only for individuals in the intervention group. Functional fitness was assessed through gait speed, agility to sit and stand, and upper-limb strength and resistance at pre and post eight-week training. Data were analyzed with two-way ANOVA for repeated measures (group and time), proportional differences (Δ%), and effect size (Cohen's d). Results: Both groups showed an improvement in gait speed, decreasing time by five seconds (Δ%: - 16%; F: 34.3; p<0.001). Both groups showed a significant increment in the number of repetitions for the agility to sit and stand test (Δ%: ≈ 14%; F: 11.63; p<0.001), but no interaction was observed between time and group (F: 0.17; p=0.681). On the strength and upper-limb resistance, individuals from the intervention group had a mean increase of 8.6 repetitions (Δ%: 45%), while those in the control group remained the same (Δ%: 1%). Though not significant (F: 3.39; p=0.07) a difference was found between groups (F: 9.04; p<0.01). The effect size was null or small for all outcome variables (0.229-3.256). Conclusion: The training allowed for improved functional fitness in middle-aged and older women, especially in the strength and upperlimb muscular resistance component. [ABSTRACT FROM AUTHOR]