1.  Peer Reviewed Title: One-stop care for HIV-positive women [letter] Author: Barber TJ; Coyne KM; Hawkins F; Desmond N Source: International Journal of STD and AIDS. 2009 Jan;20(1):67. Abstract: Language: English Keywords: UNITED KINGDOM | CRITIQUE | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | PERSONS LIVING WITH HIV/AIDS | SCREENING | HIV INFECTIONS | PAP SMEAR | FAMILY PLANNING | SEXUALLY TRANSMITTED DISEASE PREVENTION | INTEGRATED PROGRAMS | FAMILY PLANNING EDUCATION | CONTRACEPTION | FINANCIAL ACTIVITIES | Developed Countries | Europe, Western | Europe | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Programs | Organization and Administration | Education | Economic Factors Document Number: 330713 |
| 2. Peer Reviewed Title: Family planning provider referral, facilitation behavior, and patient follow-up for abnormal Pap smears. Author: Felix HC; Bronstein J; Bursac Z; Stewart MK; Foushee HR; Klapow J Source: Public Health Reports. 2009 Sep-Oct;124(5):733-44. Abstract: OBJECTIVES: Family planning (FP) clinics are important access points for cervical cancer screening and referrals for follow-up care for abnormal Papanicolaou (Pap) smears for a substantial number of U.S. women. Because little is known about referral and facilitation practices in these clinics or client action based on referrals, we sought to determine FP provider referral and facilitation practices when seeing FP clients with abnormal Pap smear results, and FP client follow-up for abnormal Pap smears due to FP provider referrals. METHODS: We conducted a mail survey of Medicaid-enrolled FP providers in Arkansas and Alabama, and conducted a telephone survey with a sample of FP clients of those providers responding to the provider survey. RESULTS: Major provider factors associated with referral included rural location, health department and clinic institutional setting, large Title X practice/clinic size, and high FP clinic focus. Major factors associated with facilitation included rural location, non-physician specialty, health department and clinic institutional setting, and small Title X clinic size. Of women reporting abnormal results, 62.4% reported follow-up care. Of those who received follow-up care, 40.0% received some care and a referral from their FP provider. A major factor associated with clients seeking follow-up care was being told by their FP provider where to go for follow-up care. Age was a major factor associated with clients actually obtaining follow-up care. CONCLUSIONS: Where follow-up care is not available at the FP site, referrals are critical and are a major factor associated with whether women seek care for the condition. Interventions to increase follow-up rates should focus on provider and system features, rather than clients. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | REFERRAL AND CONSULTATION | FAMILY PLANNING | CERVICAL CANCER | SCREENING | PAP SMEAR | HEALTH SERVICES | QUALITY OF HEALTH CARE | Developed Countries | North America | Americas | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Health Services Evaluation | Program Evaluation Document Number: 342766 |
| 3. Title: Cytokine levels in HIV infected and uninfected Indian women: correlation with other STAs. Author: Guha D; Chatterjee R Source: Experimental and Molecular Pathology. 2009 Feb;86(1):65-8. Abstract: Host immune status is an important determinant of disease progression. Infections in the genital tract may alter the immunity in the particular site and hence affect the production of local cytokines. We performed this study to determine whether HIV in association with cervical HPV and CT/GC infections influences the production of local cytokines. Cervical secretions from 100 women with or without HIV infection were collected for measuring IL-1 beta, -6, -10 and -12 concentrations by ELISA. Cervical HPV and CT/GC DNA were detected by HCII test. Significant elevations of IL-6 and IL-10 were observed in patients having HIV infection. Although cervical HPV infection increased the concentrations of both IL-6 and IL-1 beta but HPV induced abnormal cervical smear was associated only with increased IL-6 concentrations significantly. Double infection had marked relation with IL-6 and IL-10. CT/GC had no direct effect on any of these cytokines but in association with HIV and HPV, these bacterial pathogens elevated the concentrations of IL-6 significantly. Thus, our results suggest that the presence of HIV and other STAs in the genital tract can cause imbalance of local cytokine levels which in turn may facilitate other opportunistic infections. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | GENETIC TECHNIQUES | WOMEN IN DEVELOPMENT | IMMUNOLOGICAL EFFECTS | HPV | HIV INFECTIONS | COMPLICATIONS | IMMUNITY, CELLULAR | PAP SMEAR | CHLAMYDIA | GONORRHEA | Developing Countries | Asia, Southern | Asia | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Development | Economic Factors | Immunity | Immune System | Physiology | Biology | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections Document Number: 330392 |
| 4. Title: Perspectives on sexual and reproductive health among women in an ancient mining area in Brazil. Author: Miranda AE; Mercon-de-Vargas PR; Corbett CE; Corbett JF; Reynaldo D Source: Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2009 Feb;25(2):157-161. Abstract: The purpose of this study was to describe the reproductive profile and frequency of genital in fections among women living in the Serra Pelada, a former mining village in the Pará state, Brazil. A descriptive study of women living in the mining area of Serra Pelada was performed in 2004 through interviews that gathered demographics and clinical data, and assessed risk be haviors of 209 randomly-selected women. Blood samples were collected for rapid assay for HIV; specimens were taken for Pap smears and Gram stains. Standard descriptive statistical analy ses were performed and prevalence was calculated to reflect the relative frequency of each dis ease. Of the 209 participants, the median age was 38 years, with almost 70% having less than four years of education and 77% having no income or under 1.9 times the minimum wage of Brazil. About 30% did not have access to health care services during the preceding year. Risk behaviors included: alcohol abuse, 24.4%; illicit drug abuse, 4.3%; being a sex worker, 15.8%; and domestic violence, 17.7%. Abnormal Pap smear was found in 8.6%. Prevalence rates of in fection were: HIV, 1.9%; trichomoniasis, 2.9%; bacterial vaginosis, 18.7%; candidiasis, 5.7%; Chlamydial-related cytological changes, 3.3%; and HPV-related cytological changes, 3.8%. Women living in this mining area in Brazil are economically and socially vulnerable to health problems. It is important to point out the importance of concomitant broader strategies that include reducing poverty and empowering women to make improvements regarding their health. Language: English Keywords: BRAZIL | RESEARCH REPORT | WOMEN | MINE WORKERS | REPRODUCTIVE HEALTH | HEALTH SERVICES | PROGRAM ACCESSIBILITY | PAP SMEAR | RISK BEHAVIOR | CANDIDIASIS | VAGINOSIS | SEXUALLY TRANSMITTED DISEASES | HIV INFECTIONS | PREVALENCE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Demographic Factors | Population | Labor Force | Human Resources | Economic Factors | Health | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Behavior | Bacterial and Fungal Diseases | Infections | Diseases | Vaginal Abnormalities | Reproductive Tract Infections | Viral Diseases | Measurement | Research Methodology Document Number: 341876 |
| 5. Title: Prevalence and risk factors for human papillomavirus and cervical intraepithelial neoplasia among HIV-positive women at a tertiary level hospital in India. Author: Peedicayil A; Thiyagarajan K; Gnanamony M; Pulimood SA; Jeyaseelan V; Kannangai R; Lionel J; Abraham OC; Abraham P Source: Journal of Lower Genital Tract Disease. 2009 Jul;13(3):159-64. Abstract: OBJECTIVES: The hypothesis to be tested was that the prevalence of human papillomavirus (HPV) and cervical intraepithelial neoplasia would be significantly higher in HIV seropositive women as compared with seronegative controls. Secondary aims were to determine the risk factors for HPV and cervical intraepithelial neoplasia and the HPV types in HIV-positive women. MATERIALS AND METHODS: A cross-sectional study of women 18 to 49 years old was done. Seventy-five women who were HIV seropositive and 58 seronegative women, of whom 27 had HIV-positive partners, participated in the study. A Pap smear and a cervical swab for HPV were done. Women with Pap smear abnormality underwent colposcopy and large loop excision procedures if indicated. RESULTS: Ten (13.3%) HIV-positive women had high-grade squamous intraepithelial lesion as compared with 2 (3.4%) seronegative women (odds ratio [OR] 4.3; 95% CI = 0.9-41.7; p =.048). Among the HIV-positive women, 28 (37.3%) had high-risk HPV, whereas only 9 (15.5%) had high-risk HPV among seronegative women (OR 3.2; 95% CI = 1.3-8.3; p =.009). Among women who were positive for high-risk HPV, the HIV-positive women were significantly more likely to have more than 1 HPV type (OR 7.4; 95% CI = 1.4-43.7; p =.005). Women who had coitus at less than 18 years of age were more likely to have high-risk HPV infection (OR 2.9; 95% CI = 1.2-6.2; p =.013) even after controlling for HIV status. CONCLUSIONS: HIV-positive women have a higher risk for multiple HPV infections as compared with seronegative women. Behavioral factors dominate HIV in determining HPV infections and resultant cervical neoplasia. Language: English Keywords: INDIA | RESEARCH REPORT | CONTROL GROUPS | STATISTICAL REGRESSION | PERSONS LIVING WITH HIV/AIDS | WOMEN | HPV | PREVALENCE | RISK FACTORS | CERVICAL EFFECTS | NEOPLASMS | PAP SMEAR | Asia, Southern | Asia | Developing Countries | Research Methodology | Data Analysis | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | Measurement | Health | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 342825 |
| 6. Peer Reviewed Title: Some minor female reproductive system disorders: findings in the Oxford-Family Planning Association contraceptive study. Author: Vessey M; Yeates D Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):105-10. Abstract: BACKGROUND: The Oxford-Family Planning Association (Oxford-FPA) contraceptive study has provided information on many serious diseases of the female reproductive tract. No information has been published about a number of common minor conditions. This report fills the gap with regard to uterine polyp, cervicitis, cervical erosion, and vaginitis and vulvitis. METHODS: The Oxford-FPA study includes 17 032 married women recruited at ages 25-39 years between 1968 and 1974 from clinics in England and Scotland. These women were followed up until mid-1994. Information collected during follow-up included details of contraceptive use, cervical smears taken at the clinic, pregnancies and hospital referrals. RESULTS: Oral contraceptive (OC) use was associated with a reduction in first hospital referral for uterine polyp and for vaginitis and vulvitis, which became more marked with increasing duration of use. There was a slightly increased rate of hospital referral for cervicitis in OC users. Referral for cervical erosion was markedly increased in current and recent OC users (rate ratio 2.1, 95% confidence interval 1.8-2.4). This increase in risk steadily declined after OC use was discontinued. First hospital referral for both uterine polyp and cervical erosion showed a highly significant negative association with numbers of cigarettes smoked per day. The explanation for these observations is unknown. CONCLUSIONS: It should be remembered that the OCs studied were mainly those used in the 1970s and 1980s and mostly contained 50 mug estrogen. On balance, the overall effect of OC use on the conditions considered was neutral or beneficial. The apparent protective effect of cigarette smoking against uterine polyp and cervical erosion, even if valid, counts as nothing against the overwhelming adverse effects of smoking on health. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | LONGITUDINAL STUDIES | WOMEN | CURRENTLY MARRIED | PREVALENCE | VAGINITIS | UTERUS | DISEASES | CERVICAL EFFECTS | REPRODUCTIVE TRACT INFECTIONS | CONTRACEPTIVE USAGE | PAP SMEAR | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | Marital Status | Nuptiality | Measurement | Vaginal Abnormalities | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cervix | Infections | Contraception | Family Planning | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330947 |
| 7. Peer Reviewed Title: Predictors of persistent cytologic abnormalities after treatment of cervical intraepithelial neoplasia in Soweto, South Africa: a cohort study in a HIV high prevalence population. Author: Adam Y; van Gelderen CJ; de Bruyn G; McIntyre JA; Turton DA; Martinson NA Source: BMC Cancer. 2008;8:211. Abstract: BACKGROUND: In the presence of both HIV infection and cervical intraepithelial neoplasia (CIN), the risk of cancer development despite treatment may be greater. We investigated clinical predictors of persistent cytological abnormalities in women who had had a large loop excision of the transformation zone (LLETZ). METHODS: Women with high grade squamous intraepithelial lesions or worse (HSIL), less severe abnormalities which persisted and any abnormality in women who are HIV-infected, were referred to the colposcopy clinic. HIV infection was ascertained by self-report. A LLETZ was performed on all patients with HSIL or higher on Papanicolaou (Pap) smear or colposcopy, LSIL or higher in patients who are HIV-infected, where the colposcopy is inadequate, and when there was a discrepancy between colposcopy and cytology by one or more grades. Women with abnormal follow-up smears were compared to those with normal smears. We examined the association between abnormal follow-up smears and demographic and clinical predictors using logistic regression RESULTS: The median time between LLETZ and first follow-up Pap smear was rather short at 122 days. Persistent cytological abnormalities occurred in 49% of our patients after LLETZ. Predictors of persistence included the presence of disease at both margins and HIV infection. Among the latter, disease at the excision margins and CD4+ cell count were important predictors. In these women, disease at the endocervical margin, both margins, and disease only at the ectocervical margin were associated with increased odds of persistent abnormalities on follow-up cervical smear. CONCLUSION: We showed extremely high risk of cytological abnormality at follow-up after treatment more so in patients with incomplete excision and in the presence of immunocompromise. It remains uncertain whether recurrent CIN is a surrogate marker for invasive cervical cancer. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREVALENCE | COHORT ANALYSIS | WOMEN | PERSONS LIVING WITH HIV/AIDS | CYTOLOGY | PAP SMEAR | VAGINAL ABNORMALITIES | CERVICAL CANCER | LABORATORY EXAMINATIONS AND DIAGNOSES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms Document Number: 329116 |
8.  Title: Attitudes and beliefs about cervical smear testing in ever-married Jordanian women. Author: Amarin ZO; Badria LF; Obeidat BR Source: Eastern Mediterranean Health Journal. 2008 Mar-Apr;14(2):389-397. Abstract: To investigate attitudes and beliefs that affect a woman's decision to undergo cervical smear screening, we carried out a survey of 760 women attending general obstetrics and gynaecology clinics in Irbid, Jordan between June 2004 and April 2005. Knowledge of cervical cancer and the Pap smear test was inadequate in less-educated and older patients. Of the 109 women who had previously had the test, 104 (95.4%) had opportunistic testing. Around 95% of the sample had never had the test. Major barriers to Pap smear screening included inadequate knowledge about the test, not being referred by a health professional and fear of having a bad result. The current screening programme is not effective in reaching the majority of the population. (author's) Language: English Keywords: JORDAN | RESEARCH REPORT | QUESTIONNAIRES | EVER MARRIED | WOMEN | ATTITUDES | BELIEFS | PAP SMEAR | SCREENING | CERVICAL CANCER | EDUCATIONAL STATUS | AGE FACTORS | Developing Countries | Middle East | Marital Status | Nuptiality | Demographic Factors | Population | Psychological Factors | Behavior | Culture | Sociocultural Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Population Characteristics Document Number: 326131 |
| 9. Peer Reviewed Title: [Reproductive characteristics and utilization of preventive health services by childbearing-age women: results of two cross-sectional population-based studies in the far South of Brazil] Caracteristicas reprodutivas e utilizacao de servicos preventivos em saude por Author: Carlotto K; Cesar JA; Hackenhaar AA; Ribeiro PR Source: Cadernos de Saude Publica. 2008 Sep;24(9):2054-62. Abstract: Two surveys were conducted (1995 and 2004) on women 15-49 years of age in Rio Grande, Rio Grande do Sul State, southern Brazil, assess patterns in their use of preventive health services. The sample included 1,339 women in 1995 and 1,311 in 2004. A standardized household questionnaire covered their demographic, socioeconomic, reproductive, and health care-utilization characteristics. The chi-square test was used to compare indicators in the two studies. During the study period, housing conditions, running water, sanitation, and schooling improved, but family income decreased. Mean age at sexual initiation decreased by one year, teenage pregnancy increased 33%, and clinical breast examination and Pap smears increased 48% and 30%, respectively. Overall use of contraceptive methods declined by 3%, but condom use increased from 8% to 21%. Efforts are needed to improve coverage for breast examination and Pap smears, postpone sexual initiation, and promote the use of contraceptive methods, especially condoms. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | REPRODUCTIVE AGE | PREVENTIVE HEALTH CARE | HEALTH SERVICES | UTILIZATION OF HEALTH CARE | SOCIOECONOMIC FACTORS | SANITATION | INCOME | ADOLESCENT PREGNANCY | BREAST EXAM | PAP SMEAR | CONTRACEPTIVE USAGE | PROMOTION | NEEDS ASSESSMENT | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Demographic Factors | Population | Reproduction | Delivery of Health Care | Health | Economic Factors | Public Health | Reproductive Behavior | Fertility | Population Dynamics | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Laboratory Examinations and Diagnoses | Contraception | Family Planning | Marketing | Evaluation Document Number: 331162 |
| 10. Peer Reviewed Title: Prevention of cervical cancer. Author: Denny L Source: Reproductive Health Matters. 2008 Nov;16(32):18-31. Abstract: This article reviews the burden of cervical cancer in South Africa and shows that it remains the most common cancer among South African women, particularly women with least access to cervical cancer screening. It explains the rationale behind the South African cervical cancer screening policy, which is to offer all asymptomatic women three free cervical smears in a lifetime, beginning at age 30, 10 years apart. Further, it illustrates that cervical cancer screening offers unique opportunities for prevention at both the primary and secondary levels. The causal association of human papillomavirus infection of the cervix and the possibility for vaccination against the virus is discussed. The history of screening in South Africa and why it has failed to make a major impact to date on the morbidity and mortality of cervical cancer is also discussed. Finally, possible alternative approaches to cervical cytology for the prevention of cervical cancer are briefly reviewed. Language: English Keywords: SOUTH AFRICA | CRITIQUE | LITERATURE REVIEW | CERVICAL CANCER | DISEASE PREVENTION | HEALTH POLICY | SCREENING | COST EFFECTIVENESS | PAP SMEAR | HPV | VACCINATION | CYTOLOGY | HIV INFECTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Cancer | Neoplasms | Diseases | Prevention and Control | Policy | Political Factors | Sociocultural Factors | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation Indexes | Quantitative Evaluation | Evaluation | Laboratory Examinations and Diagnoses | Viral Diseases | Immunization | Primary Health Care | Biology Document Number: 342203 |
| 11. Title: Women's preventive screening in rural health clinics. Author: Edwards JB; Tudiver F Source: Women's Health Issues. 2008 May-Jun;18(3):155-166. Abstract: Despite the strong interest in health care quality, little is known about the quality of preventive care among women in rural primary care settings. We sought to assess the quality of screening practices in Rural Health Clinics (RHCs) as measured by the rates at which female patients received screening within national guidelines. A cross-sectional, retrospective chart review of 480 charts of female patients in 12 randomly selected RHCs was conducted. Data were collected on screening activities documented in greater than 3,800 patient visits. Chart data was extracted by trained, standardized chart auditors using the Women's Primary Care Screening Form for patient data and the Revised National Rural Health Clinic Survey for RHC background data. The rates of receipt of 5 preventive screenings received by female patients in RHCs were determined using a standardized and reproducible method, and patient and clinic characteristics associated with women's receipt of these screenings were identified. Demographic characteristics of patients were similar to that of national rural comparisons. Screening rates for Pap tests (66%) and mammograms (55%) were lower than Healthy People 2010 estimates, but similar to other record audit data; screening rates for cholesterol with comorbidity (66%) were near the Healthy People 2010 estimate, and screening rates for cholesterol without comorbidity (61%) exceeded it; and rates of blood pressure screening (99%) exceeded Healthy People 2010 estimates of national rates. Screening rates for depression showed that 35% had received a formal or informal screening. Rates of screenings for insured and uninsured female RHC patients in this retrospective chart review were not significantly different. Methods to improve pap and mammogram screening rates are needed. (author's) Language: English Keywords: UNITED STATES OF AMERICA | TENNESSEE | RESEARCH REPORT | RURAL AREAS | WOMEN | CLIENTS | HEALTH FACILITIES | PRIMARY HEALTH CARE | QUALITY OF HEALTH CARE | SCREENING | NEEDS | BREAST EXAM | PAP SMEAR | Developed Countries | North America | Americas | Geographic Factors | Population | Demographic Factors | Program Activities | Programs | Organization and Administration | Delivery of Health Care | Health | Health Services | Health Services Evaluation | Program Evaluation | Examinations and Diagnoses | Medical Procedures | Medicine | Economic Factors | Physical Examinations and Diagnoses | Laboratory Examinations and Diagnoses Document Number: 326658 |
| 12. Peer Reviewed Title: Coverage of cervical cancer screening in 57 countries: Low average levels and large inequalities. Author: Gakidou E; Nordhagen S; Obermeyer Z Source: PLoS Medicine. 2008 Jun;5(6):e132. Abstract: The large declines in cervical cancer mortality in developed countries have been attributed to widespread screening, but it is unclear whether this success can be replicated in the developing world. It is generally assumed that screening coverage in the developing world is low; in this paper we substantiate this claim with evidence from 57 countries, thus contributing to the evidence base for formulation of effective policies. Our analysis of population-based surveys indicates that coverage of cervical cancer screening in developing countries is on average 19%, compared to 63% in developed countries, and ranges from 1% in Bangladesh to 73% in Brazil. Older and poor women, who are at the highest risk of developing cervical cancer, are least likely to be screened. Strategies for improving cervical cancer prevention must be adapted to meet the specific needs of individual countries: expanded screening may be a viable option where sufficient infrastructure and health system access exists, but novel strategies need to be considered in other settings. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | ESTIMATION TECHNIQUES | STATISTICAL STUDIES | WOMEN IN DEVELOPMENT | PAP SMEAR | SCREENING | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | AGE FACTORS | POVERTY | PERFORMANCE IMPROVEMENT | PELVIC EXAM | Research Methodology | Studies | Economic Development | Economic Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Health | Program Evaluation | Programs | Organization and Administration | Population Characteristics | Demographic Factors | Population | Socioeconomic Factors | Management | Physical Examinations and Diagnoses Document Number: 327414 |
| 13. Title: Enhancement of underused cervical cancer prevention services in rural Oaxaca, Mexico. Author: Givaudan M; Leenen I; Pick S; Angulo A; Poortinga YH Source: Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2008 Feb;23(2):135-43. Abstract: In this article, we discuss a health education program, named Porque me quiero, me cuido, that was implemented in rural and indigenous populations in Valles Centrales in Oaxaca, one of Mexico's poorest and most rural states. The Valles Centrales region occupies a third of the state's territory. In Oaxaca, the mortality rate due to cervical cancer is 12.4 per 100 000 women. Hence, the goal of the program was to promote the use of screening services. The program is geared toward increasing knowledge and skills, enabling women to take preventive measures against cervical cancer, and promoting Pap smear tests. A first version of the program was implemented with support from the local health authorities in the state of Oaxaca. The first question to be answered in this article is whether the Porque me quiero, me cuido program had a demonstrable impact on health behavior, especially in the form of women seeking more Pap smear tests. A further question was to examine whether there was a demonstrable increase in knowledge, attitudes, and behaviors related to cervical cancer and prevention as a consequence of the program. (excerpt) Language: English Keywords: MEXICO | RESEARCH REPORT | EVALUATION REPORT | PROGRAM EVALUATION | QUESTIONNAIRES | PRE-POST TESTS | WOMEN | RURAL POPULATION | CERVICAL CANCER | SCREENING | PAP SMEAR | KNOWLEDGE | ATTITUDES | DISEASE PREVENTION | BEHAVIOR CHANGE | PROGRAM EFFECTIVENESS | PROGRAM EFFICIENCY | North America | Americas | Developing Countries | Evaluation | Programs | Organization and Administration | Demographic Factors | Population | Population Characteristics | Cancer | Neoplasms | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Sociocultural Factors | Psychological Factors | Behavior | Prevention and Control Document Number: 325422 |
| 14. Title: Underlying pathology of women with "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" smears, in a region with a high incidence of cervical cancer. Author: Kietpeerakool C; Srisomboon J; Tantipalakorn C; Suprasert P; Khunamornpong S Source: Journal of Obstetrics and Gynaecology Research. 2008 Apr;34(2):204-209. Abstract: The aim was to evaluate the histopathology of women who had "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions" (ASC-H) on cervical cytology in a region with high incidence of cervical cancer. This study was conducted at Chiang Mai University Hospital, Chiang Mai, Thailand. All women with ASC-H, who had undergone colposcopic and histolopathologic evaluation between October 2004 and January 2007, were recruited. Similar cohorts with other squamous cell abnormalities on a Pap-smear, who had undergone colposcopy during the same period, were included as comparative groups. During the study period, 85 women who had ASC-H smears underwent colposcopic and histopathologic evaluation. The mean age was 45.3 years (range, 20-64 years). The histopathologic results of these 85 women were as follows: cervical intraepithelial neoplasia (CIN) II-III, 52 (61.2%); invasive cancer, 7 (8.2%); CIN I, 6 (7.1%); and no lesions, 20 (23.5%). The incidence of underlying CIN II or higher inan ASC-H smear (69.4%) was intermediate between atypical squamous cell of undetermined significance (22.7%), low-grade squamous intraepithelial lesion (44.7%) and high-grade squamous intraepithelial lesion (90.5%) smears. There was no statistically significant difference in the incidence of CIN II or higher between women who were 40 years old or more and those who were younger (68.7% and 71.4%, respectively, P = 0.81), or between pre-menopausal and post-menopausal women (71.4% and 63.6%, respectively, P = 0.49). Reporting ASC-H cytology in our population is strongly associated with significant cervical pathology, particularly invasive cancer that is possibly at a rate higher than previously reported. Women who have ASC-H smears should therefore be referred for immediate colposcopy regardless of age and menopausal status. (author's) Language: English Keywords: THAILAND | RESEARCH REPORT | WOMEN | PAP SMEAR | CERVICAL CANCER | CYTOLOGY | HISTOLOGY | AGE FACTORS | MENOPAUSE | Asia, Southeastern | Asia | Developing Countries | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases | Biology | Population Characteristics | Reproduction Document Number: 326140 |
| 15. Peer Reviewed Title: Measuring the gap: from Home Office to the National Health Service in the provision of a one-stop shop sexual health service in a female prison in the UK. Author: Mahto M; Zia S Source: International Journal of STD and AIDS. 2008 Sep;19(9):586-9. Abstract: The Genitourinary (GU) Medicine Service was transferred from the Home Office to the NHS from April 2006 at this female prison to give prisoners access to the same quality of health care as the general public. Medline search showed no published data on the prevalence of sexually transmitted infections (STIs) among female prisoners in the UK. The main aim was to develop a one stop sexual health shop and to determine the prevalence and risk factors for STIs, to determine the uptake rate for HIV testing, hepatitis B vaccination and cervical cytology along with requests for usage of contraceptive services. Challenges were met when introducing change to bring the services in line with the local GU medicine clinic. Review of the service at one year along with retrospective case note review from May 2006 to August 2007 was done. Of the 545 new patients seen, history of substance abuse, IVDU, sexual abuse, sex worker and past history of hepatitis C virus and chlamydia were 86%, 41%,12%, 6%, 17% and 24% respectively.The uptake rate for both STI screen and blood-borne viruses (BBVs) testing was high at 87% and 69.3% respectively. STI was diagnosed in 19.6%. Prevalence rates were: Trichomonas vaginalis (TV) 8.2%, chlamydia 5.3%, gonorrhoea 0.2%, genital warts 5.3%, HIV 0.8%, hepatitis C virus 12% and hepatitis B virus 11%. The uptake rate for 1(st) dose hepatitis B vaccination and cervical cytology were 70% and 92% respectively, 36 accessed contraceptive services. Provision of one stop shop in a female prison is feasible and practical. STIs, particularly TV, and BBVs prevalence is high among the female inmates. Prevention methods targeting this population needs to be intensified. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | KAP SURVEYS | EPIDEMIOLOGIC METHODS | WOMEN | PRISONERS | NATIONAL HEALTH SERVICES | QUALITY OF HEALTH CARE | SEXUALLY TRANSMITTED DISEASE PREVENTION | PREVALENCE | RISK FACTORS | HIV TESTING | HEPATITIS | IMMUNIZATION | PAP SMEAR | Developed Countries | Europe, Western | Europe | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Health Services | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Measurement | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Viral Diseases | Primary Health Care Document Number: 329283 |
| 16. Peer Reviewed Title: Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting. Author: Mangclaviraj S; Kerr SJ; Chaithongwongwatthana S; Ananworanich J; Hirschel B; Emery S; Cooper DA; Chotnopparatpattara P; Ruxrungtham K; Phanuphak P Source: International Journal of STD and AIDS. 2008 Aug;19(8):529-32. Abstract: We conducted a cross-sectional study with 385 HIV-positive women in Bangkok to assess the prevalence and predictors of cervical abnormalities on Papanicolaou (Pap) smear. Low-grade squamous intraepithelial lesions (LSIL), high-grade SIL (HSIL) and invasive cervical cell cancer (ICC) were assessed by cytological examination after Pap smear and logistic regression models were used to assess associations with patient characteristics. Overall prevalence of LSIL, HSIL and ICC were 11.2% (95% confidence interval [CI] 8.2-14.7%), 4.7% (95%CI 2.8-7.3%) and 0.5% (95%CI 0.06-1.9%), respectively. In multivariate models, only the nadir CD4 count and income remained significantly associated with cytological abnormalities, whereas smoking, hormonal contraceptive or antiretroviral use, condom use, parity and number of lifetime sexual partners were not associated. The odds ratio for having cytological abnormalities was 2.6 (95% CI 1.24-5.34) in those with a nadir CD4 count <200 cells/mm3 compared with those with a higher nadir CD4 count, and 1.99 (1.11-3.57) in those with an income of <125 US dollars/month compared with those with higher incomes. In settings where access to affordable treatment is improving, this study reinforces the importance of regular Pap smear screening in HIV-positive women, particularly those with low nadir CD4 counts and lower incomes. Language: English Keywords: THAILAND | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | PERSONS LIVING WITH HIV/AIDS | PAP SMEAR | WOMEN'S HEALTH | HIV INFECTIONS | TREATMENT | SCREENING | VAGINAL ABNORMALITIES | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 328620 |
| 17. Peer Reviewed Title: Cervical dysplasia and cancer: Use of hormonal contraceptives in Jamaican women. Author: McFarlane-Anderson N; Bazuaye PE; Jackson MD; Smikle M; Fletcher HM Source: BMC Women's Health. 2008 May 30;8:9. Abstract: This study was conducted to determine whether use of hormonal contraceptives is associated with cervical dysplasia and cancer in a population where there is widespread use of hormonal contraception and the rates of cervical cancer remain high at 27.5/100,000. A case-control study was conducted among women visiting the colposcopy and gynaelogical clinics at a tertiary referral hospital. Two hundred and thirty six cases CIN I (72), II (59), III (54), cancer (51) and 102 controls, consented and were interviewed on use of contraceptives using a structured questionnaire. Logistic regression was used to determine odds ratios (ORs) and 95% confidence intervals (CIs) associated with use of hormonal contraception in cases and controls and in low and high risk cases. Recruitment was carried out from 2001 -2002. Contraceptives used were: oral contraceptives - 35%, injections (depot medroxy progesterone acetate (Depo-provera) -10%, Intrauterine devices - 2%, combinations of these and tubal ligation - 30%. 23% reported use of 'other' methods, barrier contraceptives or no form of contraception. Barrier contraceptive use was not significantly different between cases and controls. Current and / or past exposure to hormonal contraceptives (HC) by use of the pill or injection, alone or in combination with other methods was significantly higher in the cases. In multivariate analysis with age and number of sexual partners as co-variates, use of hormonal contraception was associated both with disease, [OR, 1.92 (CI 1.11, 3.34; p = 0.02] and severity of the disease [OR, 2.22 (CI 1.05, 4.66) p = 0.036]. When parity and alcohol consumption were added to the model, hormonal contraception was no longer significant. The significant association with high risk disease was retained when the model was controlled for age and number of sexual partners. Depo-provera use (with age and number of sexual partners as covariates) was also associated with disease [OR, 2.43 (CI 1.39, 4.57), p = 0.006] and severity of disease [OR 2.51 (1.11, 5.64) p = 0.027]. With parity and alcohol added to this model, depo-provera use retained significance. Exposure to HC greater than 4years conferred more risk for disease and severity of disease. Hormonal contraception did confer some risk of dysplasia and women using HC should therefore be encouraged to do regular Pap smear screening. (author's) Language: English Keywords: JAMAICA | RESEARCH REPORT | CASE CONTROL STUDIES | WOMEN | CONTRACEPTIVE AGENTS, ESTROGEN | CONTRACEPTIVE AGENTS, PROGESTIN | ORAL CONTRACEPTIVES | INJECTABLES | CERVICAL EFFECTS | CERVICAL CANCER | HPV | PAP SMEAR | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cancer | Neoplasms | Diseases | Viral Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 326992 |
| 18. Title: Atypical squamous cells, cannot exclude a high-grade intraepithelial lesion and its clinical significance in postmenopausal, pregnant, postpartum, and contraceptive-use patients. Author: Patton AL; Duncan L; Bloom L; Phaneuf G; Zafar N Source: Cancer. 2008 Dec 25;114(6):481-8. Abstract: BACKGROUND: Previous studies have confirmed the low predictive value of a diagnosis of atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) in a Papanicolaou (Pap) smear for subsequent high-grade dysplasia in the postmenopausal age group. It appears plausible that the decrease in estrogen inherent in the postmenopausal state likely produces reactive cytologic atypia, which is misinterpreted as ASC-H. The change in hormone levels observed in pregnant patients, postpartum patients, and contraceptive users, as a corollary, potentially could create a similar diagnostic dilemma. In the current study, the impact of age and altered hormone status on the frequency of ASC-H was assessed to answer the following questions: Is the low predictive value of ASC-H in postmenopausal women an age-related phenomenon, and do other states that result in decreased levels of estrogen relative to progesterone have a similar association? METHODS: Pap smears that were diagnosed as ASC-H were divided into postmenopausal, pregnant, postpartum, and contraceptive-use categories. Each Pap smear slide was reviewed to assess the degree of atrophy and the character of atypical cells. The frequency of high-grade follow-up (histology and/or Digene Hybrid Capture II) in the postmenopausal group was compared with the frequency of high-grade follow-up in the pregnant, postpartum, and contraceptive-use categories using the chi-square test. The pregnant, postpartum, and contraceptive-use categories also were compared statistically among each other with the chi-square test. RESULTS: In total, 195 cases met the criteria for study inclusion. The percentage of patients who had subsequent high-grade follow-up was 22.5% in the postmenopausal group, 79.6% in the pregnant group, 66.7% in the postpartum group, and 60% in the contraceptive-use group. When these data were subjected to the chi-square test, there was a statistically significant difference (P<.0001) between the predictive value of subsequent high-grade follow-up in the postmenopausal group compared with the other patient groups. When the chi-square test was applied to the intercomparison of the pregnant, postpartum, and contraceptive-use categories, there were no significant differences (P > .05) in high-grade follow-up between any of these groups. CONCLUSIONS: The diagnosis of ASC-H in postmenopausal Pap smears has a low predictive value in the subsequent diagnosis of high-grade squamous lesions in stark contrast to the pregnant, postpartum, and contraceptive-use categories. This suggests that age rather than hormone alterations affects the capacity of ASC-H to predict subsequent high-grade squamous intraepithelial lesions. In addition, there are no definite cytomorphologic criteria that can be used to distinguish reliably between benign cellular changes and possible high-grade squamous lesions in these Pap smears. Digene Hybrid Capture II testing, although helpful, does not have 100% correlation with subsequent tissue/Pap smear follow-up and cannot be used alone to triage this group of women for colposcopy. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | EXAMINATIONS AND DIAGNOSES | WOMEN | PREGNANCY | POSTPARTUM | MENOPAUSE | CONTRACEPTION | PAP SMEAR | CANCER | Developed Countries | North America | Americas | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Demographic Factors | Population | Reproduction | Puerperium | Family Planning | Laboratory Examinations and Diagnoses | Neoplasms | Diseases Document Number: 330083 |
| 19. Peer Reviewed Title: Who is getting Pap smears in urban Peru? Author: Paz Soldan VA; Lee FH; Carcamo C; Holmes KK; Garnett GP Source: International Journal of Epidemiology. 2008 Aug;37(4):862-869. Abstract: Cervical cancer, although usually preventable by Pap smear screening, remains the leading cause of cancer-related deaths among women in Peru. The percentages and characteristics of women in Peru who have or have not had a Pap smear have not been defined. In an urban community randomized trial of sexually transmitted infection (STI)/HIV prevention in Peru, 6712 randomly selected women between the ages of 18 and 29 from 20 cities were interviewed regarding having had cervical Pap smears. Among women sampled, only 30.9% had had a Pap smear. By multivariate analysis, the main predictors of having a Pap smear were having had sex, having had children, completion of secondary education and increasing age. Regional variations were also found: women from the highlands and rainforest were less likely to have had Pap smears than women from the coast. A norm of seeking and receiving Pap smears has not been established among sexually active young Peruvian women. To improve Pap smear coverage in Peru, promotionefforts should target underserved women and regions with less coverage. (author's) Language: English Keywords: PERU | RESEARCH REPORT | INTERVIEWS | WOMEN | PAP SMEAR | CERVICAL CANCER | DISEASE PREVENTION | DEMOGRAPHICS | South America, Western | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases | Prevention and Control | Demography | Social Sciences | Science | Sociocultural Factors Document Number: 327816 |
| 20. Peer Reviewed Title: Health insurance and cervical cancer screening among older women in Latin American and Caribbean cities. Author: Reyes-Ortiz CA; Velez LF; Camacho ME; Ottenbacher KJ; Markides KS Source: International Journal of Epidemiology. 2008 Aug;37(4):870-878. Abstract: The purpose of this study is to describe the prevalence of Papanicolaou (Pap) smear use for cervical cancer screening and to estimate A cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE). The sample includes 6357 women aged 60 and older from seven cities. The outcome was reporting a Pap smear for cervical cancer screening during the previous 2 years. Main independent variable was health care insurance. Covariates were demographic or socioeconomic variables, medical conditions and functional status. Prevalence of Pap smear use across the seven cities ranged from 21% in Bridgetown to 45% in Mexico City. In a multivariate analysis of the combined sample, without Havana that has universal health care insurance, women with public insurance (OR 0.55, 95% CI 0.43-0.71) or with no insurance (OR 0.23, 95% CI 0.15-0.34) were less likely to have a Pap smear compared with women with private insurance. Also, women with no insurance were less likely to have a Pap smear (OR 0.40, 95% CI 0.30-0.54) compared with women with any health insurance. In general, the prevalence of Pap smear use was lower than that reported for Hispanic populations in the United States. Overall, lack of health insurance or having public health insurance determined lower odds for having a Pap smear for cervical cancer screening. (author's) Language: English Keywords: LATIN AMERICA | CARIBBEAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CANCER | SCREENING | HEALTH INSURANCE | PAP SMEAR | WOMEN | MIDDLE AGED ADULTS | OLDER ADULTS | Americas | Developing Countries | Research Methodology | Neoplasms | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Financial Activities | Economic Factors | Laboratory Examinations and Diagnoses | Demographic Factors | Population | Adults | Age Factors | Population Characteristics Document Number: 327853 |
| 21. Peer Reviewed Title: HPV vaccines: bring me your daughters! Author: Thomas C Source: South African Medical Journal. 2008 Apr;98(4):259-261. Abstract: Our approach to cervical cancer prevention is set to change dramatically over the next decade with the advent of human papillomavirus (HPV) DNA typing, the probable demise of the PAP smear as we know it, and the registration of two highly effective vaccines against the two main HPV types (16 and 18). The latter account for about 70% of all cervical cancer cases globally and for 63% of those in South African women. HPV-45 and HPV-31 account for another 10% of cases. Except for a minority of non-mainstream, but remarkably visible and vocal, groups and individuals the general consensus worldwide is that HPV vaccines herald a new era and a phenomenal advance in the fight against cervical cancer, the most common cancer to affect women in South Africa and sub- Saharan Africa, where the established co-factors of smoking, long-term oral contraceptive use, HIV co-infection and high parity are also operative. Lesotho has the unfortunate claim of the highest rate of cervical cancer in the world, with an age standardised incidence rate of 61.6 (versus our 37.5) per 100 000 women. Women and health care providers have had to make two paradigm shifts around cervical cancer: firstly, although most HPV infections clear naturally, persistent infection with particular genotypes of a virus are responsible for most cases of cervical cancer (including the less common adenocarcinoma), and secondly, close contact (as in both penetrative and nonpenetrative sex) is the main mode of infection. (excerpt) Language: English Keywords: SOUTH AFRICA | CRITIQUE | RECOMMENDATIONS | CLINICAL RESEARCH | ADOLESCENTS, FEMALE | WOMEN IN DEVELOPMENT | HPV | IMMUNIZATION | CERVICAL CANCER | PAP SMEAR | PRICES | PRIVATE SECTOR | PARENTAL CONSENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Viral Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Commerce | Macroeconomic Factors | Political Factors | Sociocultural Factors Document Number: 330621 |
| 22. Peer Reviewed Title: Pattern of abnormal Pap smears in developing countries: A report from a large referral hospital in Saudi Arabia using the revised 2001 Bethesda System. Author: Abdullah LS Source: Annals of Saudi Medicine. 2007 Jul-Aug;27(4):268-272. Abstract: Reports describing the frequency and pattern of abnormal Pap smears in developing countries using the revised Bethesda system for Pap smear are few. We studied the pattern of cervical intraepithelial lessions and carcinoma detected in Pap smears of Saudi females in the western region of Saudi Arabia using the revised system. All cervical Pap smears reported in the Department of Pathology of King Abdulaziz Medical City, Jeddah, from 1 January 1998 to 31 August 2005 were reclassified according to the revised system with age ranges identified. Of 5590 sufficient smears, 261 (5%) were identified as abnormal and were further classified as atypiccal squamous cells of undetermined significance (ASC-US) (103 cases, 40%), atypical squamous cells of high grade (6 cases, 2%), low-grade squamous intraepithelial lesions (LSIL) (56 cases, 22%), high-grade squamous intraepithelial lesions (HSIL) (31 cases, 12%), glandular cell abnormalities (30 cases, 11%) and invasive squammous cell carcinoma (21 cases, 9%). The ASC-US/SIL ratio was 1.9%. Invasive adenocarcinoma accounted for 14 cases (4%) with a similar age range as invasive squamous cell carcinoma. Although this study showed a lower incidence and a wider age range of cervical epithelial cell abnormalities than others published internationally, the results emphasize the need for a well-organized cerviccal screening program supplemented by larger national studies on the pattern of cervical abnormalities in this country. The information provided in this study will encourage use of the Pap smear as a screening method for cervical cancer in developing countries. (author's) Language: English Keywords: SAUDI ARABIA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | CLASSIFICATION | WOMEN IN DEVELOPMENT | PAP SMEAR | CERVICAL CANCER | PREVALENCE | Developing Countries | Middle East | Research Methodology | Economic Development | Economic Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases | Measurement Document Number: 324452 |
| 23. Peer Reviewed Title: Human papilloma virus-16 / 18 cervical infection among women attending a family medical clinic in Riyadh. Author: Al-Muammar T; Al-Ahdal MN; Hassan A; Kessie G; Dela Cruz DM Source: Annals of Saudi Medicine. 2007 Jan-Feb;27(1):1-5. Abstract: Prevalence information is lacking on human papillomavirus types 16 and 18 (HPV-16/18) infection in cervical tissues of women residing in Riyadh, Saudi Arabia. In addition, there are no observations on progression to cervical intraepithelial neoplasia (CIN). Pap smear and HPV-16/18 DNA detection by PCR followed by Southern blotting was performed on 120 subjects (Saudi and other Arab nationals) during routine gynecological examination. Some HPV-positive subjects were followed for 4 years, by Pap smear every 6 months and by HPV DNA detection at the end of 4 years. Overall HPV-16/18 prevalence was 31.6%. HPV-16 prevalence alone was 13.3%, HPV-16 as a mixed infection with HPV-18 was 15%, and all HPV-16 was 28.3%. HPV-18 alone was 3.3%, HPV-18 as a mixed infection with HPV-16 was 15%, and all HPV-18 was 18.3%. Ten subjects had cervical abnormalities with the Pap smear test, six of whom were HPV-16/18 positive, 1 with HPV-16, 1 with HPV-18, and 4 with a mixed infection of HPV-16/18. Of all 23 HPV-16/18-positive subjects, either as individual or mixed infection, followed for 4 years, 7 showed abnormal cytology, 6 at initial examination and 1 during follow-up. Of these 7, 6 reverted to normal without treatment and 1 was treated and became normal after 3 years. None of the subjects progressed to CIN-III. A high prevalence of HPV-16/18 was found, but with a low rate of progression to CIN. A significant association with abnormal cytology was found only in patients with HPV-16/18 mixed infection. (author's) Language: English Keywords: SAUDI ARABIA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | HPV | CERVICAL EFFECTS | CERVICAL CANCER | PAP SMEAR | PREVALENCE | Developing Countries | Middle East | Research Methodology | Economic Development | Economic Factors | Viral Diseases | Diseases | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cancer | Neoplasms | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement Document Number: 324450 |
| 24. Title: Clinical and histological significance of atypical glandular cell on Pap smear. Author: Behtash N; Nazari Z; Fakhrejahani F; Khafaf A; Azar EG Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2007 Feb;47(1):46-49. Abstract: Atypical glandular cell (AGC) on Pap smear is uncommon but may represent a variety of benign and malignant lesions. The aim of this study was to evaluate the association between AGC on Pap smear and significant pathological finding to tailor management protocols. Between 2002 and 2005, 60 women with AGC on Pap smears were referred to our colposcopy clinic. Forty-one women underwent colposcopy-directed biopsy, endocervical curettage, endometrial sampling and cervical conisation to determine the cytological and histological correlations of AGC on Pap smears. The mean age of the patients was 46.9 +or- 11.5 years (range, 23-80 years). Of these patients 13 patients (31.7%) were postmenopause and 28 patients (68.2%) were in reproductive age. We found eight (19.5%) significant pathological findings including four (9.7%) high-grade squamous intraepithelial lesion, one (2.4%) adenocarcinoma of uterus, one (2.4%) adenocarcinoma of cervix, one (2.4%) squamous cell carcinoma of cervix and one (2.4%) papillary serous tumour of ovary. AGC on Pap smear was associated with a clinically significant diagnosis in approximately 20% of our cases. The women with a diagnosis of AGC on cervicovaginal smear are needed to be evaluated at least with colposcopy, endocervical and endometrial curettage. Clinicians should be careful about the significance of AGC on Pap smears. (author's) Language: English Keywords: IRAN | RESEARCH REPORT | WOMEN | PAP SMEAR | LABORATORY PROCEDURES | SCREENING | CERVICAL CANCER | Middle East | Developing Countries | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases Document Number: 312072 |
| 25. Title: Evaluation of adjunctive tests for cervical cancer screening in low resource settings. Author: Bhatla N; Mukhopadhyay A; Kriplani A; Pandey RM; Gravitt PE Source: Indian Journal of Cancer. 2007 Apr-Jun;44(2):51-55. Abstract: Visual inspection of cervix after application of acetic acid (VIA) is an effective screening tool for cervical cancer in low resource settings, but its low specificity leads to high referral rates. Adjunctive testing may overcome this drawback. This pilot study was aimed to assess test performances of VIA, human papillomavirus (HPV) testing and Pap smear, individually and in simulated combinations, to determine the probable best screening option. The setting for the study was a gynecology outpatient department (OPD); the design used was a cross-sectional study. The materials and methods used were one hundred women with complaints of irregular vaginal bleeding or discharge, post coital bleeding or unhealthy cervix on examination underwent Pap smear, HPV testing, VIA, colposcopy and biopsy, if indicated, in this screening order. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each of the tests with a biopsy result of greater than or equal to HSIL taken as the gold standard. Simulated parallel and sequential combinations for VIA/Pap, VIA/HPV and HPV/Pap were calculated and compared with individual test performance. Prevalence of abnormal Pap smears was 5%, VIA positive 51% and HPV positive 16%. Sensitivity and specificity of VIA were 100% and 53.3% respectively. For HPV and Pap tests corresponding figures were 85.7%, 89.7% and 50%, 98.9% respectively. The best simulated combination with a balance of sensitivity and specificity was of VIA followed by HPV testing (sensitivity 85.7%, specificity 95.4%). Addition of HPV testing to VIA can increase the specificity of VIA, thereby reducing the referral rates without compromising the sensitivity of the test. (author's) Language: English Keywords: INDIA | DEVELOPING COUNTRIES | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PILOT PROJECTS | CERVICAL CANCER | SCREENING | HPV | TESTING | PAP SMEAR | Asia, Southern | Asia | Research Methodology | Studies | Cancer | Neoplasms | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Measurement | Laboratory Examinations and Diagnoses Document Number: 313917 |
| 26. Title: Human papillomavirus genotypes associated with cervical cytologic abnormalities and HIV infection in Ugandan women. Author: Blossom DB; Beigi RH; Farrell JJ; Mackay W; Qadadri B Source: Journal of Medical Virology. 2007;79(6):758-765. Abstract: Human papillomavirus (HPV) infection is associated with almost all cases of cervical cancer, and cervical cancer is a common malignancy in women living in developing countries. A cross-sectional study was conducted to determine the prevalence of HPV infection, human immunodeficiency virus (HIV) infection, and cervical cytologic abnormalities in women presenting to a sexually transmitted infections clinic in Kampala, Uganda. In June and July, 2002, 135 women underwent complete physical exams including Papanicolaou (Pap) smears. HIV status was evaluated by serology. Cervical and vaginal swabs were obtained by clinicians and tested for HPV genotypes by PCR/reverse blot strip assay. Of the 106 women with cervical swabs adequate for HPV testing, the HPV prevalence was 46.2% (49/106). HIV prevalence was 34.9% (37/106). High risk genotypes 52, 58, and 16 were the genotypes detected most commonly. Eighteen percent (9/49) of women infected with HPV were found to have genotypes 16 and/or 18. Seventy-three percent (27/37) of HIV-positive women versus 16% (10/63) of HIV-negative women had abnormal Pap smears (P<0.0001). Among HIV-positive women, abnormal Pap smears were associated with the presence of high risk HPV genotypes (P<0.001). The majority of women infected with HPV attending this sexually transmitted infections clinic in Uganda were infected with high risk HPV genotypes other than 16 and 18. Future studies should focus on whether current HPV vaccine formulations, that are limited to high risk genotypes 16 and 18, would be effective at decreasing the burden of cervical cancer in this population. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | HPV | HIV INFECTIONS | PREVALENCE | PAP SMEAR | GENETICS | CERVICAL CANCER | LABORATORY PROCEDURES | CYTOLOGY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Cancer | Neoplasms Document Number: 320954 |
| 27. Peer Reviewed Title: Overcoming barriers to the eradication of cervical cancer: Women's health and rights. Author: Cain J; Denny L; Ngan HY Source: International Journal of Gynecology and Obstetrics. 2007 Jun;97(3):232-234. Abstract: The number of new cases of cervical cancer worldwide is likely underestimated due to the lack of cancer registries; however, cervix cancer is the second most common cancer for women worldwide and the first for under-resourced nations and regions, where the majority of deaths occur. It is the biggest cause of years of life lost for women from cancer in the developing world. The development of this cancer requires infection of the cervix with high risk subtypes of the human papilloma virus which is virtually always acquired by sexual exposure. Declines in the rates of cervical cancer have been directly correlated with investment in screening programs for detection of pre-malignant and early cervical cancers, linked to the availability of treatment. In addition, the development of vaccines for the high risk subtypes 16 and 18 offers the opportunity to prevent initial infection by vaccination prior to exposure to these subtypes. Cervical cancer, a major cause of women's morbidity and mortality, is nowlargely preventable through vaccination for future generations (primary prevention) and screen and treat programs (secondary prevention) to prevent deaths for present generations. Lack of access to the vaccine or screening programs represents a failure to address international development goals and targets related to reproductive health, denying women their fundamental human rights. Girls and women should be an urgent priority investment for governments, and cervical cancer control should be an important part of that agenda. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | POLICYMAKERS | CERVICAL CANCER | VIRAL DISEASES | HUMAN RIGHTS | SCREENING | HEALTH POLICY | PAP SMEAR | WORKSHOPS | Economic Development | Economic Factors | Administrative Personnel | Organization and Administration | Cancer | Neoplasms | Diseases | Political Factors | Sociocultural Factors | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Policy | Laboratory Examinations and Diagnoses | Education Document Number: 316681 |
| 28. Title: Comparison of a community outreach service with opportunity screening for cervical cancer using Pap smears. Author: Chang HC; Hsiung HY; Chen SI; Yen AM; Chen TH Source: Journal of Public Health. 2007 Jun;29(2):165-172. Abstract: We sought to compare the take-up of cervical screening with Pap smears in a new outreach and pre-existing hospital-based setting (1) to assess the extent to which the two means of provision would overlap; (2) to establish how the utilization rate is influenced by demographic features and geographical distance from the point of provision; and (3) to access whether an outreach service would lead to increased utilization. We used a pre-test-post-test design and used multiple linear regression to assess the effect an outreach service has on utilization after adjusting for participants age, education and martial status. We found that the outreach service independently provided screening to 89% of eligible women and that coverage was inversely associated with distance from the pre-existing hospital provision. After controlling for age, education and martial status, there was a statistically significant increase (53%; 95% CI: 25, 80%) in utilization. There was little overlap between the outreach and hospital-based cervical screening services so that overall accessibility was enhanced, particularly for the elderly, widowed and less well educated. The outreach service also reduced inequalities due to geography. (author's) Language: English Keywords: TAIWAN | RESEARCH REPORT | PRE-POST TESTS | WOMEN | CERVICAL CANCER | SCREENING | UTILIZATION OF HEALTH CARE | PAP SMEAR | PREVENTIVE HEALTH CARE | HEALTH SERVICES | PROGRAM ACCESSIBILITY | Asia, Eastern | Asia | Developed Countries | Program Evaluation | Programs | Organization and Administration | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses Document Number: 313602 |
| 29. Title: Screening for cervical cancer among female physicians and their relatives in Taiwan: A population-based comparative study. Author: Chen LS; Huang N; Tsay JH; Wang PJ; Chou YJ Source: Preventive Medicine. 2007 Jun;44(6):531-535. Abstract: This study compares the practice of having the recommended Pap smear test every 3 years among female physicians, female relatives of physicians, and general women of similar socio-economic background. This population-based cohort study followed a total of 5,815,781 Taiwanese women from January 2001 to December 2003, who were 30 years of age or older in 2001. Of the total study population, 1950 were physicians and 27,441 were female relatives of physicians. Multiple logistical regression models were used. After adjusting for age, ethnic status, physical disability status, and place of residence, of those women whose monthly insurable income was greater than $NT40,000, female physicians (OR 0.54, 95% CI: 0.50-060) were the least likely to have undergone at least one Pap smear test during the three-year study period. The physicians' relatives (OR 0.90, 95% CI: 0.87-0.92) were also significantly less likely to take routine Pap smear tests compared to general women with equivalent socio-economic background. The female physician is a major player in disease prevention with advanced knowledge of the benefits associated with the Pap smear test, but may not adhere any better to the recommendations than the general population. (author's) Language: English Keywords: TAIWAN | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | MULTIVARIATE ANALYSIS | PHYSICIANS | WOMEN IN DEVELOPMENT | FRIENDS AND RELATIVES | PAP SMEAR | SCREENING | PREVALENCE | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Data Analysis | Health Personnel | Delivery of Health Care | Health | Economic Development | Economic Factors | Family and Household | Sociocultural Factors | Laboratory Examinations and Diagnoses | |