Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas.

BACKGROUND: Uptake of bowel cancer screening is lowest in London, in populations of lower socio-economic status, and in particular ethnic or religious groups. METHODS: We report on the evaluation of two interventions to improve uptake in an area including populations of low socio-economic status and considerable ethnic diversity. The interventions were face-to-face health promotion on bowel cancer screening at invitees' general practice and health promotion delivered by telephone only. Nine large general practices in East London were chosen at random to offer face-to-face health promotion, and nine other large practices to offer telephone health promotion, with 24 practices of similar size as comparators. Data at practice level were analysed by Mann-Whitney-Wilcoxon tests and grouped-logistic regression. RESULTS: There were 2034 invitees in the telephone intervention practices, 1852 in the face-to-face intervention practices and 5227 in the comparison practices. Median gFOBt kit uptake in the target population (aged 59-70) was 46.7% in the telephone practices, 43.8% in the face-to-face practices and 39.1% in the comparison practices. Significant improvements in the odds of uptake were observed following telephone intervention in both males (OR=1.39, 95% CI=1.20-1.61, P<0.001) and females (OR=1.49, 95% CI=1.29-1.73, P<0.001), while the face-to-face intervention mainly impacted uptake in males (OR=1.23, 95% CI=1.10-1.36), P<0.001) but did not lead to a significant increase in females (OR=1.12, 95% CI=0.96-1.29, P=0.2). CONCLUSIONS: Personally delivered health promotion improved uptake of bowel cancer screening in areas of low socio-economic status and high ethnic diversity. The intervention by telephone appears to be the most effective method.

The health of children in refuges for women victims of domestic violence: cross sectional descriptive survey.

OBJECTIVES: To describe the health and developmental status of children living in refugees for women victims of domestic violence and to investigate their access to primary healthcare services. DESIGN: Cross sectional survey. SETTING: Women's refugees in Cardiff. PARTICIPANTS: 148 resident children aged under 16 years and their mothers. MAIN OUTCOME MEASURES: Completeness of records on the child health system (register of all children that includes data on the child's health) for named health visitor, named general practitioner, and immunisation uptake; satisfactory completion of child health surveillance; Denver test results for developmental status; Rutter test scores for behavioural and emotional problems; reports of maternal concerns. RESULTS: 148/257 (58%) children living in refugee between April 1999 and January 2000 were assessed. Child health system data were incorrect (general practitioner and/or address) or unavailable for 85/148 (57%) children. Uptake of all assessments and immunisations was low. 13/68 (19%) children aged <5 years had delayed or questionable development on the Denver test, and 49/101 (49%) children aged 3-15 years had a Rutter score of >10 (indicating probable mental health problems). Concerns were expressed by mothers of 113/148 (76%) children. After leaving the refuge, 22 children were untraceable and 36 returned home to the perpetrator from whom the families had fled. CONCLUSIONS: The children had a high level of need, as well as poor access to services. Time spent in a refuge provides a window of opportunity to review health and developmental status. Specialist health visitors could facilitate and provide support, liaison, and follow up.

A comparison of metered dose inhalers with nebulizers from the delivery of ipratropium bromide in domiciliary practice.

In a randomized, double-blind, crossover study consisting of three 1-month periods, we compared the effects of ipratropium bromide (IB) 120 micrograms delivered by a metered dose inhaler (MDI) against two different doses of IB (125 micrograms and 500 micrograms) delivered by a gas driven nebulizer. Thirty-two patients (mean age 57.1 years, range 17-78) with severe airflow obstruction (mean PEFR 192 litres/min, range 75-380 litres/min) were recruited to the study. They had a maximum documented reversibility of over 20% (mean 55.2, range 25-200), and an improvement of over 13% (mean 26.3, range 13-56) in the PEFR to a test dose of 120 micrograms IB delivered by a MDI. In the 20 patients who completed the trial no significant differences were found between the treatment periods when comparisons were made of the weekly averages for the morning PEFR, evening PEFR, reversibility, diurnal variation of the PEFR, bronchodilator and steroid usage. The monthly assessments of FEV1, FVC, VC, RV/TLC ratio and the single breath transfer factor showed all three treatments to be better than the base-line assessment (P less than 0.001), but overall there was no significant difference between treatments. The 6-minute walking distance did not show any improvement over the base-line values with any of the treatments. Symptom scores also showed no overall difference between treatments except for cough which was worse on the 500 micrograms nebulizer solution (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)