Discomfort and pain during mammography: description, prediction, and prevention.

OBJECTIVE: To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated. DESIGN: Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort. SETTING: Health district in South East Thames region. SUBJECTS: 1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire. MAIN OUTCOME MEASURES: Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist. RESULTS: 35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend. CONCLUSIONS: The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicized.

Parents' attitudes to measles immunization.

A study of a cohort of children in Maidstone Health Authority examined the reasons for the failure to achieve targets for the uptake of measles immunization. Parents were interviewed before they were notified about measles immunization to determine their attitudes, beliefs and intentions regarding measles immunization and a further review was held with those whose child had no record of the immunization by the age of 20 months. The initial interview showed that most parents have a favourable attitude to measles immunization. However, many lacked knowledge, especially about valid contraindications, and claimed not to have received advice from a doctor or health visitor. The most common reasons for non-uptake of measles immunization were: the child had already had measles, concern about contraindications and delay owing to illness. This points to the importance of increasing doctors' and health visitors' knowledge of Department of Health and Social Security guidelines regarding valid contraindications and to the role of health visitors in promoting uptake. However there is also evidence that the gap between actual and target levels of uptake may be less than official figures suggest.

Breast cancer screening services in three areas: uptake and satisfaction.

The objective of our study was to test whether attendance for breast cancer screening and satisfaction with the service could be predicted from a knowledge of the woman's social and psychological characteristics. In a prospective design, demographic characteristics, self-reported health status and behaviour, expectations and attitudes were examined through postal questionnaires sent out shortly before the invitation to screening, and the measures were used to predict subsequent attendance and satisfaction. The sample was taken from three areas in the South-East Thames Regional Health Authority providing a Forrest service--one rural, one provincial and one inner city--and consisted of 3160 women aged 50-64 invited routinely for screening. The main predictors of attendance were the woman's attitude to being screened and her belief that 'salient others' wanted her to attend. The main predictors of satisfaction with the service were the behaviour of the staff and the facilities at the centre. Three implications of the findings are discussed: (a) health education should include partners, relatives and friends of the target women, as their views had as much effect on attendance as did the women's attitudes; (b) staff training and development should focus on communication with the patient; (c) further research should examine the precursors of reported discomfort and pain.

Measles immunisation: feasibility of a 90% target uptake.

A three part investigation of the factors that might influence uptake of immunisation was carried out in Maidstone Health Authority; this included studies of the computer system and attitudes of parents and professionals. Several problems with immunisation scheduling, information transfer between general practitioners and clinics and the computer centre, and validity of computer information were identified. The attitudes of parents, relatives, and friends were generally favourable, although parents reported a lack of knowledge about the disease and vaccine and lack of advice from professionals. Perceived contraindications to immunisation, particularly a history of measles, were important reasons for non-uptake. Professionals' perceptions of contraindications, however, were at variance with Department of Health and Social Security guidelines and none of the recorded contraindications was valid. Calculations of potential uptake suggest that a 90% target uptake is feasible and recommendations are made for changes in services.

Outbreak of Salmonella napoli infection caused by contaminated chocolate bars.

An outbreak of Salmonella napoli infection in England and Wales in 1982 was detected by the surveillance of routine reports of salmonella infections from hospital and public-health laboratories. Epidemiological investigation quickly identified two types of small chocolate-covered bars, imported from Italy, as the vehicles of infection, and subsequently both were found to be contaminated with the organism. The prompt recognition of this outbreak and rapid identification of the vehicle of infection enabled four-fifths of the consignment of contaminated chocolate to be withdrawn from the market. The 245 reported cases resulted from the sale of 600 000 bars; as these were presumably only a small fraction of the total number of cases, it is likely that many thousands of infections were prevented.