Providing more balanced information on the harms and benefits of cervical cancer screening: A randomized survey among US and Norwegian women.

We aimed to identify how additional information about benefits and harms of cervical cancer (CC) screening impacted intention to participate in screening, what type of information on harms women preferred receiving, from whom, and whether it differed between two national healthcare settings. We conducted a survey that randomized screen-eligible women in the United States (n = 1084) and Norway (n = 1060) into four groups according to the timing of introducing additional information. We found that additional information did not significantly impact stated intentions-to-participate in screening or follow-up testing in either country; however, the proportion of Norwegian women stating uncertainty about seeking precancer treatment increased from 7.9% to 14.3% (p = 0.012). Women reported strong system-specific preferences for sources of information: Norwegians (59%) preferred it come from a national public health agency while Americans (59%) preferred it come from a specialist care provider. Regression models revealed having a prior Pap-test was the most important predictor of intentions-to-participate in both countries, while having lower income reduced the probabilities of intentions-to-follow-up and seek precancer treatment among U.S. women. These results suggest that additional information on harms is unlikely to reduce participation in CC screening but could increase decision uncertainty to seek treatment. Providing unbiased information would improve on the ethical principle of respect for autonomy and self-determination. However, the clinical impact of additional information on women's understanding of the trade-offs involved with CC screening should be investigated. Future studies should also consider country-specific socioeconomic barriers to screening if communication re-design initiatives aim to improve CC screening participation.

Neurotic excoriations.

Neurotic excoriations are self-inflicted skin lesions produced by repetitive scratching. Because there is no known physical problem of the skin, this is a physical manifestation of an emotional problem. The classic lesions are characterized by clean, linear erosions, scabs and scars that can be hypopigmented or hyperpigmented. The lesions are usually similar in size and shape, and are grouped on easily accessible and exposed body sites, such as extensor surfaces of the extremities, face and upper back. Psychotropic medications and appropriate counseling can be effective treatments.

Family practice center-based training in skin disorders: a photographic approach.

BACKGROUND: The majority of family practice residency programs rely on lectures and rotations in dermatologists' offices for training their residents about skin disorders. However, in a dermatologist's office, residents may not receive enough exposure to the types of skin problems typically seen in a family physician's office. METHODS: A longitudinal, family practice center-based training experience was developed in which residents photographed patients with skin conditions and presented the cases to a dermatologist at a monthly teaching conference. Fifteen residents who were exposed to two different instructional methods (the photography conference and rotations with dermatologists) were surveyed to determine their preferred instructional method for learning to diagnose and manage skin disorders. RESULTS: Over a 2-year period, a total of 232 skin lesions were photographed and presented. The distribution of the photographed skin disorders differed from the distribution of skin problems found in a national survey of dermatologists' practices. Of the residents surveyed, 93% preferred monthly photography conferences to rotations in dermatologists' offices for learning about children's skin problems. Eighty-six percent preferred using the photography conferences for learning about treatment of skin diseases. CONCLUSIONS: A longitudinal, family practice center-based experience using photographic presentations of skin lesions is a valuable adjunct for teaching family practice residents about skin disorders.