(Press-News.org) ANN ARBOR, Mich. -- It's a tale of two tests: one for early signs of cervical cancer, the other for a sexually transmitted disease. But a new study suggests that a change in the recommended schedule for one may have dramatically lowered the chances that young women would get the other.
Results published by a University of Michigan team shows the unintended consequences of changes to national health test guidelines: the potential for doctors to fall behind on ordering other tests that screen for serious health problems.
In this case, the two tests are Pap smears and screens for the most common sexually transmitted disease: chlamydia. If undiagnosed, chlamydia can leave women in pain, infertile or unable to have a successful pregnancy.
Until six years ago, recommendations for most women under age 25 called for Pap smears earlier and more often, and chlamydia screening once they were sexually active. Doctors could take samples during the same pelvic exam. But the Pap smear schedule for young women changed in 2009, removing annual tests before age 21 to reduce the chance of unneeded follow-up tests.
"With the change in screening, we wanted to see if there were other implications, and indeed a decrease in chlamydia screening occurred even though the number of visits by young women was about the same," says U-M Medical School Department of Family Medicine lecturer Allison Ursu, M.D., the lead author of the new paper in Annals of Family Medicine.
She and her colleagues looked at the tests given to sexually active young women aged 16 to 21 years with no chlamydia symptoms who came to U-M's five family medicine clinics in the year before the new Pap test guideline and two years later. Those in the earlier group were nearly 14 times more likely to get a chlamydia test than those seen later, even though there was no drop in clinic visits by such patients.
The five clinics have since added a reminder into their shared computer system to prompt doctors to order a chlamydia test once a year for sexually active, asymptomatic young women. A urine test for chlamydia is also available, so doctors don't need to perform a pelvic exam.
The sharp drop in testing at the U-M clinics suggests that the Pap smear guideline change could have had the same effect elsewhere. The team hopes their findings will prompt other primary care clinics to assess whether they need to pay attention to ensuring chlamydia testing is done on time, even if it's not paired with a Pap test.
Their results showed that a U-M family medicine clinics, the two were performed together 60 percent of the time before the guideline change, but only 10 percent of the time two years later.
Says Ursu, "The clinical framework of the visit shifts when we're not doing a pelvic exam, and the things we're thinking about are different."
Need for better attention to chlamydia testing
Annual chlamydia tests are recommended for all sexually active young women under age 25, because the disease can be silent for years and can be transmitted by partners symptoms. Early detection and treatment with antibiotics can prevent long-term effects such as pelvic inflammatory disease that can affect the fallopian tubes and lead to infertility or ectopic pregnancy.
The state of Michigan recently approved expedited partner therapy, which allows doctors to prescribe antibiotics to the partner of a patient who screens positive for chlamydia even if they're not seen in the same clinic.
National data show that only about two of every five young women nationwide get screened for chlamydia on the recommended schedule.
Guidelines for screening tests are set by national groups for particular medical specialties, based on the latest evidence from research that balances benefit and potential for harm. It can take time for doctors nationwide to begin following guidelines, and some may choose to go against them for other reasons. But insurance companies usually pay for screening tests recommended by major specialty groups.
But new computer systems increasingly in use at clinics can be set to prompt medical assistants, doctors and nurses during a visit for the tests recommended for each patient.
The new reminder in the MiChart system in use across all of the U-M Health System's primary care clinics has greatly increased chlamydia screening for teen and young adult women. Now, more than two-thirds of sexually active patients with no symptoms get screened each year. Further analysis will look at impacts on chlamydia infections, PID cases and ectopic pregnancies seen among UMHS patients.
Senior author and U-M professor of family medicine Mack Ruffin, M.D., MPH, says, "Patients are very aware of Pap tests and many still think they need one yearly. There's much less awareness of chlamydia screening. The takeaway from this study is that we have to find other opportunities to screen."
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Ruffin is a member of the U-M Institute for Healthcare Policy and Innovation and is the Max and Buena Lichter Research Professor in the Department of Family Medicine. Co-author Ananda Sen, Ph.D. is the Lee A. Green Collegiate Research Professor in Family Medicine. Both Ruffin and Sen hold joint positions in the U-M School of Public Health.
Reference: Annals of Family Medicine, http://www.annfammed.org, Vol. 13, No. 4, July/August 2015
What you're reading now secretly tells you whether your country will be skinnier or fatter in three years. After analyzing 50 years of all the food words mentioned in major newspapers like the New York Times and London Times, a new Cornell study shows that the food words trending today in 2015 will predict a country's obesity level in three years - in 2018.
"The more sweet snacks are mentioned and the fewer fruits and vegetables that are mentioned in your newspaper, the fatter your country's population is going to be in 3 years, according to trends we found from the past ...
(PHILADELPHIA) -- African American men are more likely to develop prostate cancer than European American men, and are also more than twice as likely to die from it. Although there are many reasons that contribute to this health disparity, new research shows that African American men may have a distinctly different type of prostate cancer than European American men, according to new genomic fingerprinting results.
"This study, this line of research, is about finding better and more appropriate therapies for African American men," says corresponding author of the study, ...
Both prescription and illegal drugs that are abused have been found in Canadian surface waters. New research shows that wastewater discharges flowing downstream have the potential to contaminate sources of drinking water with these drugs at relatively low concentrations.
The concentrations of cocaine, morphine, and oxycodone did not decline with distance downstream from the wastewater treatment plant discharge, and many of the drugs were not removed effectively by drinking water treatment plants.
The research is part of a special section on pharmaceuticals in the journal ...
Researchers are developing instruments and methods for measuring the ages of rocks encountered during space missions to the Moon or other planets. Many of the techniques used to date rocks on Earth are not practical in spaceflight, but a technique called laser ablation resonance ionization mass spectrometry can avoid the need for sophisticated sample preparation.
A team led by Dr. F. Scott Anderson has now demonstrated that this technique can successfully date an Earth rock--the Duluth Gabbro--that is analogous to the rocks that cover one-third of the lunar nearside. ...
In Eastern Australia, the ocean has been warming at a rate that's 4-times that of the global average. Many marine species have been appearing further south than they ever have before, while others have stayed put. A new study identifies which characteristics seem to be important for species to shift their ranges so quickly.
As expected, swimming ability is important, as fish are stretching their ranges south faster than organisms such as starfish and crustaceans. Researchers also found that animals that already have large range sizes are the most responsive and shift ...
California-grown almonds dominate the global market, providing over 80% of the world's commercial almonds. Two new articles published in the Journal of Industrial Ecology examine the environmental impacts of California's almond production, focusing on greenhouse gas emissions and energy.
Investigators noted that certain practices reduce greenhouse gas emissions and energy use substantially, including strategic utilization of co-products and the choice of water source and irrigation technology. Both of these may be influenced by regional variability in resources.
"Our ...
Studies that have assessed the effects of total knee replacement on quality of life are scarce and have been almost exclusively limited to patients with osteoarthritis, even though rheumatoid arthritis is the most common inflammatory arthritis for which the surgery is indicated.
In a new study that assessed the effects of total knee replacement in rheumatoid arthritis patients versus osteoarthritis patients, researchers found that the surgery is highly effective in reducing knee pain and also provides benefits in other subjective quality of life indices in patients with ...
Examining post-mortem tissue from the brains of people with Alzheimer's disease, Stanford University School of Medicine investigators identified what appear to be iron-containing microglia -- specialized scavenger cells that sometimes become inflammatory -- in a particular part of the hippocampus, a key brain structure whose integrity is critical to memory formation.
In post-mortem brain tissue from people not diagnosed with Alzheimer's, neither the iron deposits nor the scavenger cells engulfing them were present in that brain region.
The findings, recounted in a ...
In a new study, women considered the position and shape of the urethral opening to be the least important aspects of a penis' appearance.
They also perceived the genitals of men who underwent surgery to treat distal hypospadias--a congenital condition in which the opening of the urethra is on the underside of the penis--to be as normal-looking as nonaffected, circumcised genitals.
"The information may help prevent the development of shame or impaired genital perceptions about penile appearance," said Dr. Norma Ruppen, lead author of The Journal of Sexual Medicine study.
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In a study of 2239 individuals with chronic widespread pain, the key feature of fibromyalgia, those who regularly consumed alcohol had lower levels of disability than those who never or rarely drank.
Those who drank 21 to 35 units of alcohol per week were 67% less likely than never drinkers to experience disability. (One unit of alcohol is a half pint of average strength beer/lager, one small glass of wine, or one single measure of spirits.).
"Although we cannot say that alcohol consumption causes less disability among people with chronic widespread pain, the observed ...
