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Biomedical subjects

E M Mann

Publications and source records attributed to E M Mann.

13 recordsLinked to original sources
PubMed1994

Management of women with mild and moderate cervical dyskaryosis.

OBJECTIVE: To compare the outcomes in women with mild and moderate dyskaryosis after increasing periods of surveillance and thereby to define a rational protocol for managing such women. DESIGN: Prospective study with randomisation of women to one of four treatment groups, each with a different period of surveillance; one group in which the women were given immediate treatment and three other groups in which the women were under surveillance for six, 12, and 24 months. SETTING: A dedicated colposcopy clinic in Aberdeen, Scotland. SUBJECTS: 902 women who presented with a mildly or moderately dyskaryotic smear for the first time. INTERVENTIONS: Cytological and colposcopic examinations at intervals of six months until the allocated period of surveillance was completed, at which time biopsy was performed. Women with severe dyskaryosis were withdrawn from surveillance and a biopsy was performed. MAIN OUTCOME MEASURES: The histological findings after punch biopsy or large loop excision of the transformation zone, and the trends in cytological appearances of serial cervical smears. RESULTS: 793 women completed the study. In all, 769 women had an adequate final smear, of which 197 were normal cytologically, 328 were still mildly or moderately dyskaryotic, and 244 were severely dyskaryotic. Seventeen of the 67 (25%) women with one repeat smear showing non-dyskaryosis had cervical intraepithelial neoplasia grade III compared with only one of the 31 (3%) women with no dyskaryosis in four repeat cervical smears (P < 0.0001). None of the women had invasive cancer. Of 158 women whose index smear showed mild dyskaryosis and who were allocated to the group under surveillance for two years, only 40 had not defaulted or still had dyskaryotic smears by the end of the two years. CONCLUSION: Cytological surveillance, although safe, is not an efficient strategy for managing women with mildly abnormal smears. Women with any degree of dyskaryosis in a smear should be referred for colposcopy.

Adult↗
PubMed1994

Screening for cervical intraepithelial neoplasia in north east Scotland shows fall in incidence and mortality from invasive cancer with concomitant rise in preinvasive disease.

OBJECTIVE: To assess the effect of screening for cervical intraepithelial neoplasia on the incidence of and mortality from invasive squamous cell carcinoma of cervix in north east Scotland and to discover why cases of invasive cancer still occur. DESIGN: (a) Analysis of data on cases of cervical intraepithelial neoplasia obtained from the cytology data bank; (b) analysis of data on 612 women presenting with invasive squamous cancer during 1968-91, obtained from cancer registry and hospital records; (c) analysis of death rates obtained from the registrar general's (Scotland) annual reports, the Information Services Division of the Home and Health Department (Scotland), and local records for 1974-91; (d) case-control studies on 282 cases of invasive cancer and 108 deaths which occurred in 1982-91. Cases were matched with two controls both for age and for having a negative smear test result at the time of presentation of the case. SETTING: North east Scotland (Grampian region, Orkney, and Shetland). SUBJECTS: Women (n = 306,608) who had had cervical smear tests between 1960 and 1991. RESULTS: There had been a substantial increase in cases of cervical intraepithelial neoplasia grade III since 1982. The incidence of invasive cancer has fallen since the start of screening in 1960, the fall occurring mainly in the well screened age group 40-69 years. There was a rise in women aged under 40 and over 70. Women with invasive disease seen between 1982 and 1991 mostly presented at stage I. Of these, half were unscreened, one third were poorly screened, 11% were found in retrospect to have had abnormal cells, 3% had recurrence of disease after treatment for cervical intraepithelial neoplasia grade III, and 3% were lost to follow up. Death rates had fallen, most noticeably in women aged 45-64, who had had the opportunity to be screened and rescreened. There was a disturbing rise in deaths among women under 45. Most deaths (65%) occurred in unscreened women. Case-control studies showed that the longer the time and absence of a smear test before presentation the higher was the risk of invasive cancer and of death. CONCLUSIONS: Screening has been effective in reducing the incidence of and mortality from cervical cancer in north east Scotland. Most cases and deaths occurred in unscreened women or in those who had had few smears at long intervals. An increase in cases of cervical intraepithelial neoplasia grade III in women screened for the first time occurred during 1982-91.

Adult↗
PubMed1992

Mild and moderate dyskaryosis: can women be selected for colposcopy on the basis of social criteria?

OBJECTIVE: To describe the distribution of cervical intraepithelial neoplasia grades among women with mild and moderate dyskaryosis after a single cervical smear and to determine whether social criteria could help identify women who are at increased risk of grade II or III disease. DESIGN: Cross sectional analysis within a randomised prospective study. Subjects had a repeat smear, a colposcopic examination, and an excision biopsy of the transformation zone. In addition, women were asked to complete a social questionnaire. SETTING: Colposcopy clinic, Aberdeen. SUBJECTS: 228 women with a single smear test showing mild or moderate dyskaryosis. MAIN OUTCOME MEASURES: Histology, age, sexual and contraceptive history, cigarette smoking. RESULTS: 159 (70%) women had cervical intraepithelial neoplasia grades II or III. Among current smokers the prevalence of grade II and III disease was higher in women who smoked greater than or equal to 20 cigarettes a day (84%) than among those who smoked less (66%; p less than 0.04). Women with more than one sexual partner also had a higher prevalence (75%) than women with only one partner (50%; p = 0.0028). Use of oral contraceptives and younger age were not significantly associated. The prevalence of grade II or III disease was up to 66% in the lower risk groups. CONCLUSIONS: Because of the high prevalence of cervical intraepithelial neoplasia grades II and III in both the high and the low risk groups social factors are not useful for selecting women with mild or moderate dyskaryosis for either early referral to colposcopy or cytological surveillance.

Adult↗
PubMed1992

Conservative treatment of mild/moderate cervical dyskaryosis: long-term outcome.

There is some controversy about the management of women with mild or moderate dyskaryotic cervical smears. To assess the strategy of an established cervical cytology screening programme (Grampian region, northeast Scotland) we identified 500 women who had had mild or moderate cervical dyskaryosis in 1978 or 1979, and 500, matched by age, who had had a normal smear at that time. Follow-up smear results and any subsequent investigation by colposcopy, cone biopsy, or hysterectomy, with biopsy result were recorded. Of the 500 women who initially had an abnormal smear, 300 (60%) had a smear that was normal or inflammatory at their last visit (after seven years' median follow-up). 184 (37%) had undergone biopsy, 97 (19%) of whom were cervical intraepithelial neoplasia grade III or worse. Survival curves for time to biopsy and ten-year biopsy rates show that women with an abnormal smear before their baseline year were the most likely to have a subsequent biopsy. Older women had a biopsy less often and at biopsy were more likely to have minor abnormalities. Mild or moderate dyskaryotic smears should not be an indication for immediate referral for colposcopy, since under a conservative management policy most women return to normal without needing treatment. Nevertheless, the increased risk associated with abnormal smears justifies rigorous surveillance.

Biopsy↗
PubMed1992

Cross-cultural differences in rating hyperactive-disruptive behaviors in children.

OBJECTIVE: To determine the extent to which the reported variations across countries in the prevalence of attention-deficit hyperactivity disorder are due to cultural differences among raters, the authors examined the degree to which mental health professionals in four countries differed in their ratings of hyperactive-disruptive behaviors in children. METHOD: Mental health professionals from China (N = 8), Indonesia (N = 12), Japan (N = 9), and the United States (N = 8) rated the presence and degree of hyperactive-disruptive behaviors in standardized videotape vignettes of four 8-year-old boys participating in individual and group activities. RESULTS: Chinese and Indonesian clinicians gave significantly higher scores for hyperactive-disruptive behaviors than did their Japanese and American colleagues. CONCLUSIONS: These findings suggest that perceptions of hyperactivity vary significantly across countries even if uniform rating criteria are applied. Without correction for these perceptual differences, cross-cultural prevalence rates of hyperactivity may not be comparable.

Attention Deficit Disorder with Hyperactivity↗
PubMed1991

Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow-up protocol.

In an effort to devise a rational protocol for the follow-up of patients who have had destructive treatment for cervical intraepithelial neoplasia (CIN), an analysis has been performed of treatment failures following laser therapy in 2130 women treated between 1980-1989. Of this group, 1253 women have been followed up for 3 years or more and 380 for 6 years or more. There have been 119 treatment failures (5.6%), of which 71% of the women had the second lesion detected during the first year of follow-up, 24% during the second year, 3.3% during the third year, and 1.7% during the sixth year. In 18% of these 119, the second lesion was detected colposcopically in the presence of negative cytology. There were two cases of microinvasion and one frankly invasive lesion following laser, all diagnosed during the second year of follow-up. Our data suggest that if the first year of follow-up includes at least one colposcopic examination, some second lesions will be diagnosed in the presence of negative cytology.

Adult↗
PubMed1981

Self-reported stresses of adolescent rape victims.

This paper identifies the self-reported concerns of 122 sexually abused teenagers and compares them with their parents' reactions and the assessments made by pediatric housestaff and trained rape counselors. The predominant rape reaction reported by the teenagers was a fear for their life or safety. Second was embarrassment and self-blame. Physicians and counselors, similar to parents, emphasized anger toward the perpetrator and anxieties about future sexual relations. Physicians and counselors often missed subtle, fantasized fears of bodily damage, which were also common concerns of these teenagers. They also judged parents more often supportive of the victims than did the victims themselves. The data suggest that professionals tend to identify with parental reactions, which do not always coincide with teenager's concerns.

Adolescent↗
PubMedDate not supplied

The relationship between attitudinal and behavioral change in pediatric residents in a psychiatric liaison teaching program: a pilot study.

Two behavioral measures--chart audits and requests for psychiatric consultations--and two attitudinal measures--case conference comments and a case management questionnaire--were used to assess changes in pediatric residents' approaches to psychosocial issues over the course of liaison training. Both attitudinal measures showed changes in the residents' approaches, including an increased attention to patients' and families' feelings and an expanded awareness of the options available in dealing with psychosocial problems. These changes in attitude, however, did not result in increases in the amount of psychosocial data recorded in the charts or increases in resident-initiated consultation requests. The authors use their observations on the wards and in case conferences and interviews with pediatric residents to explain why chart contents and psychiatric consultation practices are resistant to change. Their findings indicate a gap between attitudinal and behavioral change that requires further research on how pediatric residents identify psychosocial problems, and how liaison training is integrated with the needs and expectations of nonpsychiatric physicians.

Attitude of Health Personnel↗