The challenge of eliminating cervical cancer in the United States: a story of politics, prudishness, and prevention.

Exciting strides in reducing the incidence of and mortality from cervical cancer have been made over the last century in the United States. The issues surrounding the implementation of the human papillomavirus vaccine are remarkably similar to the issues involved in the gradual adoption of the Pap test and initiation of cervical cancer screening beginning nearly a century ago. The following review of the reduction of cervical cancer morbidity and mortality demonstrates the importance of the interplay between basic science, clinical medicine, social mores, and public policy.

Ha sentido sola? Culturally competent screening for intimate partner violence in Latina women.

OBJECTIVE: Intimate partner violence (IPV), a common public health problem, affects women irrespective of ethnicity. Primary care visits provide an excellent opportunity to identify IPV survivors; however, among immigrant Latina women, language can be a barrier. Several IPV screening instruments are available in English, but few are available in Spanish. Therefore, we sought to estimate the screening characteristics of seven validated screening questions translated into Spanish. METHODS: Participants included 105 Spanish-speaking Latina women, aged 18-64 years, seen for primary care in an urban teaching hospital. Measures used were (1) screening questions: seven dichotomous response-option IPV screening questions, and (2) comparison standard: Index of Spouse Abuse (ISA), adapted for lifetime IPV. All measures were professionally translated into Spanish. Sensitivity and specificity, with 95% confidence intervals (CI), of all questions were estimated using 2 x 2 tables. Sensitivity and specificity with 95% CIs were estimated for the two questions with highest sensitivity. RESULTS: Mean age was 38.5 years (SD 11.4); 89.5% were uninsured, and 33% reported lifetime IPV. Spanish translations of the following questions: "Have you ever been in a relationship where you have felt controlled by your partner?" and "Have you ever been in a relationship where you have felt lonely?" had the highest individual sensitivity. The sensitivity of an affirmative response to either question was 94% (95% CI 86%, 100%), and the specificity of an affirmative response to both questions was 86% (95% CI 78%, 94%). CONCLUSIONS: Simple screening questions used in combination are highly sensitive for IPV detection in immigrant Latina women and may assist clinicians caring for them to identify a history of IPV.

Integrative clinical experience: an innovative program to prepare for internship.

BACKGROUND: Interns experience tremendous challenges on the transition from student to new physician. There is limited literature describing curriculum that enhances medical students' preparation for internship. DESCRIPTION: To prepare graduating medical students at our institution for the new responsibilities and stressors that they will face as interns, an elective course, Integrative Clinical Experience, was implemented. Over a 2-week period, participating medical students rotate through 1 to 3-hr modules that cover four major domains: managing acutely ill patients, teaching, communicating, and coping with stressors. EVALUATION: Participants evaluated the course qualitatively and quantitatively through verbal and written feedback. Students found the course useful and educationally valuable. They also had a statistically significant increase in perceived preparedness for internship upon completion of the course. CONCLUSIONS: A 2-week, concentrated course is a feasible and effective method for raising students' perceived preparedness for internship.

Survivors of domestic violence: demographics and disparities in visitors to an interdisciplinary specialty clinic.

Although the traditional response to domestic violence has been undertaken by legal and human service agencies, this societal issue has become increasingly recognized as a national public health concern. While identification and intervention in cases of domestic violence are widely recommended, little data exist on intervention outcomes. This retrospective study describes similarities and disparities in sociodemographic variables, health status, referral characteristics, and management strategies among patients referred to a specialty clinic for survivors of domestic violence.