ABSTRACT
The aim of the study was to compare the sensitivity of self-collected with clinician-collected human papillomavirus (HPV) tests and cytology for cervical cancer. A total of 250 non-pregnant, 25-60-year-old women from Leon, Nicaragua, self-collected vaginal specimens for HPV and received a pelvic examination for cytology and reflex HPV. All participants underwent colposcopy and completed questionnaires regarding demographic and medical information. The sensitivities of self-collected brushes, self-collected swabs and clinician-collected HPV tests were 25%, 16.7%, and 16.7%, respectively, with colposcopy as the gold standard and 30%, 22.2% and 40% when cytology was the gold standard. Agreement between self-collection methods was significant (κ=0.84, p<0.001). Although utilisation of colposcopy in every participant resulted in lower sensitivities, the self-collected tests surpassed cytology and significantly agreed with the clinician-collected results. Further clarification of the sensitivity will be required to employ self-collection for cervical cancer screening in low resource areas like rural Nicaragua.
Subject(s)
Papillomaviridae/isolation & purification , Papillomavirus Infections/diagnosis , Self Care , Uterine Cervical Neoplasms/diagnosis , Vagina/virology , Adult , Colposcopy , Early Detection of Cancer/methods , Female , Humans , Middle Aged , Nicaragua , Sensitivity and Specificity , Specimen HandlingABSTRACT
The aim of this study was to compare the acceptability of self-collected vs clinician-collected human papillomavirus (HPV) tests. Utilising a cross-sectional approach, 250 non-pregnant, 25-60-year-old women from Leon, Nicaragua self-collected vaginal swabs and brushes for HPV and received a pelvic examination for liquid-based cytology and reflex HPV. Subjects underwent colposcopy, with biopsy if indicated, and completed questionnaires comparing their perceptions of HPV testing methods. Acceptability indices were significantly higher for self-collected brushes (M = 18.40, SD = 2.73) and swabs (M = 18.48, SD = 2.41) than clinician-collection (M = 17.56, SD = 2.92), p < 0.001. Multiple regression analyses revealed that age, education, and reproductive history were not significant predictors of acceptability. A total of 81.1% of subjects reported they would self-collect in the future. Self-collected HPV tests are highly acceptable in terms of pain, comfort, privacy and embarrassment, and are thus a viable method of screening in low-resource areas.
Subject(s)
Papillomavirus Infections/diagnosis , Self Care/statistics & numerical data , Specimen Handling/statistics & numerical data , Uterine Cervical Neoplasms/diagnosis , Vaginal Smears/psychology , Adult , Cross-Sectional Studies , Female , Humans , Middle Aged , Patient Acceptance of Health Care , Specimen Handling/adverse effectsABSTRACT
A retrospective review was undertaken on all pediatric and reproductive-aged females who underwent cardiac surgery and required cardiopulmonary bypass from 1958 through 1986. The purpose of this study was to define the fertility of these patients after surgery and to compare their reproductive performance with that in the general population. Analysis was complete for 208 patients. These patients make up the following cardiac surgical categories: septal defect repairs, 92; commissurotomies, 60; valve replacements, 46; tetralogy of Fallot repairs, 6; and coronary artery bypass procedures, 4. Of 208 patients, 68 (32.7%) attempted pregnancy after surgery. Infertility was defined in five women as follows: endometriosis, 3; ovulatory dysfunction, 1; unknown, 1. A total of 64 patients conceived 121 pregnancies with the following outcomes: live births, 98; spontaneous abortion, 9; ectopic pregnancy, 2; therapeutic abortion, 12. Our results suggest that infertility is not an apparent disorder after cardiac surgery and that subsequent pregnancy outcomes are similar to those in the general population.
