Cervical intraepithelial neoplasia grade 2 or worse in human immunodeficiency virus-infected women with mildly abnormal cervical cytology.

OBJECTIVE: To compare the prevalence of cervical intraepithelial neoplasia (CIN) 2 or worse in a cohort of human immunodeficiency virus (HIV)-positive and HIV-negative women with mildly abnormal cervical cytology. METHODS: A cross-sectional cohort study was done using an established database of 3,013 women who underwent colposcopic evaluation between August 1999 and May 2006. Data collected included demographic information and cervical cytologic and histologic results. Descriptive statistics and crude and adjusted odds ratios with 95% confidence intervals were calculated. RESULTS: Of 103 HIV-infected women seen for colposcopy, 72 (70%) had atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) on referral cytology. Human immunodeficiency virus-positive women with ASC-US or LSIL were then compared with a population of 360 HIV-negative women, matched by cytologic diagnosis (ASC-US or LSIL). Both populations were found to be at similar risk for CIN 2+ (11 or 72 or 15.2% of HIV-positive women compared with 48 of 360 or 13.3% of HIV-negative women; odds ratio [OR] 1.17, 95% confidence interval [CI] 0.58-2.39). After adjustment for age, race/ethnicity, insurance status, gravidity, current smoking, and sexually transmitted disease history, the odds of CIN 2+ in HIV-infected women remained unchanged (adjusted OR 0.88, 95% CI 0.35-2.18). In the HIV-infected cohort with known CD4 counts, CIN 2+ was more commonly found among women with CD4 less than 200 cells/microliter (4 of 10 or 40%) compared with women with CD4 200 or more (4 of 30 or 13%; OR 4.3, 95% CI 0.84-22.47). CONCLUSION: High-grade disease was encountered in approximately 15% of patients with ASCU-US or LSIL, irrespective of HIV status.

Factors associated with increased charges for hysterectomy.

OBJECTIVE: To evaluate factors associated with increased hospital charges for hysterectomy with specific attention to differences based on surgical approach. METHODS: We performed a retrospective cohort study of 686 patients who underwent hysterectomy between January 1997 and September 1997 using medical chart review and hospital financial information. Demographic information, surgical approach (abdominal, vaginal, or laparoscopic), and surgical and postoperative factors were extracted from the medical record. Hospital charges were obtained from the hospital billing database. Relationships between charges and various clinical and demographic variables were examined using chi(2), Fisher exact test, t tests, or analysis of variance, where appropriate. Logistic regression was used to estimate odds ratios while controlling for important confounding variables. RESULTS: In our logistic regression model, blood loss greater than 1,000 mL (odds ratio [OR] 11.8, 95% confidence interval [CI] 4.2-33.2) and operative time 105 minutes or more (OR 14.2, CI 5.8-34.5) were strongly associated with higher charges for hysterectomy. Other factors associated with higher charges included: postoperative fever (OR 2.2, CI 1.1-4.5), increasing length of hospitalization (OR 5.3, CI 3.7-7.7), the use of prophylactic antibiotics (OR 3.0, CI 1.3-6.6), and the laparoscopic surgical approach compared with vaginal hysterectomy (OR 2.7, CI 1.0-7.0). CONCLUSION: Surgical factors such as operative time and blood loss were strongly associated with increased hospital charges for hysterectomy.

Low use of skilled attendants' delivery services in rural Kenya.

The aim of the study was to estimate the use of skilled attendants' delivery services among users of antenatal care and the coverage of skilled attendants' delivery services in the general population in Kikoneni location, Kenya. Data collected from the registers at the Kikoneni Health Centre (KHC) from March 2001 through March 2003 were retrospectively reviewed. Antenatal care attendance, deliveries by skilled attendants, and the percentage of antenatal care attendees who delivered in a healthcare facility were assessed. Deliveries at the KHC were compared with expected births in the population to estimate the coverage of deliveries assisted by skilled attendants in the community. Of 994 women who attended the antenatal care clinic, 74 (7.4%) presented for delivery services. 5.4% of expected births in the population occurred in health facilities. The coverage of deliveries assisted by skilled attendants was far below the national and international goals. The use of institutional delivery services was very low even among antenatal care attendees. Targeted programmatic efforts are necessary to increase skilled attendant-assisted births, with the ultimate goal of reducing maternal mortality.

Can you handle the truth (and know it when you see it)? Understanding sensitivity, specificity, predictive values, and ROC curves.

The interpretation of diagnostic and screening tests requires a basic knowledge of sensitivity, specificity, and predictive values. This article provides an overview of these measures of test performance, a brief description of receiver operating characteristic curves, and relevant illustrations from the medical literature.