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International Journal of Cancer Mar 2022How to manage human papillomavirus (HPV)-positive women in cervical cancer screening remains debated. Our study compared different strategies to triage HPV positivity in...
How to manage human papillomavirus (HPV)-positive women in cervical cancer screening remains debated. Our study compared different strategies to triage HPV positivity in a large cohort of women participating in a population HPV-based screening program. Women were tested for HPV (Cobas 4800; Roche), and those positive were triaged with cytology; cytology-positives were referred to colposcopy, while negatives were referred to 1-year HPV retesting. All HPV-positive women were also evaluated with p16/ki67 dual staining (Roche). All lesions found within 24 months of follow-up were included in the analyses. Of the 70 146 women tested, 4757 (6.8%) were HPV-positive. Of these, 1090 were cytology-positive and were referred to colposcopy. Of the 2958 HPV-positive/cytology-negative women who presented at 1-year retesting, 1752 (59.9%) still tested positive. Cumulatively, 532 CIN2+ (including 294 CIN3+) were found. The sensitivity of cytology, HPV16/18 and p16/ki67 as triage test for CIN3+ was 67.9%, 56.0% and 85.0%, respectively. The positive predictive value (PPV) for immediate colposcopy referral was 21.0%, 15.8% and 22.9%, respectively. Combining cytology with typing increased sensitivity to 83.9% and lowered PPV to 14.8%, while combining p16/ki67 and typing increased sensitivity to 91.1%, lowering the PPV to 15.9%. Women negative to p16/ki67 triage presented a cumulative 1-year CIN3+ risk of about 1%. In conclusion, when triaging HPV positivity, p16/ki67 performed better than cytology with or without HPV16/18 genotyping. The strategies that included dual staining achieved sensitivity and low 1-year risk for CIN3+ sufficiently high enough to permit considering extending the surveillance interval to 2 to 3 years for HPV-positive/triage-negative women.
Topics: Cyclin-Dependent Kinase Inhibitor p16; Female; Genotype; Human Papillomavirus DNA Tests; Human papillomavirus 16; Human papillomavirus 18; Humans; Ki-67 Antigen; Triage; Uterine Cervical Neoplasms; Uterine Cervical Dysplasia
PubMed: 34706093
DOI: 10.1002/ijc.33858 -
PloS One 2023Zimbabwe has high cervical cancer (CC) burden of 19% and mortality rate of 64%. Zimbabwe uses Visual Inspection with Acetic Acid and Cervicography (VIAC) for CC...
Prevalence of Cervical Cancer and Clinical Management of Women Screened positive using visual inspection with acetic acid and Cervicography in selected public sector health facilities of Manicaland and Midlands provinces of Zimbabwe, 2021.
BACKGROUND
Zimbabwe has high cervical cancer (CC) burden of 19% and mortality rate of 64%. Zimbabwe uses Visual Inspection with Acetic Acid and Cervicography (VIAC) for CC screening. Manicaland and Midlands provinces recorded low VIAC positivity of 3% (target 5-25%) and treatment coverage of 78% (target = 90%) between October 2020 and September 2021.
OBJECTIVES
We explored VIAC positivity rate and clinical management of clients screening positive in Manicaland and Midlands provinces.
METHODS
We conducted a retrospective cross-sectional study using routine VIAC and CC management data for period October 2020 to September 2021. Two samples were used, 1) a sample drawn from 48,000 women VIAC screened to measure positivity rate, and 2) a sample of 1,763 VIAC positive women to assess clinical management. Kobo-based tool was used to abstract data from facility registers, and data were analyzed using STATA 15.
RESULTS
We analyzed data for 2,454 out of 48,000 women screened through VIAC. About 82% (2,007/2,454) were HIV positive, median ages were 40 and 38 years for HIV positives and negatives respectively. Most (64% and 77%) of HIV positive and negative clients respectively were married. VIAC positivity was 5.9% and 3.4% among HIV positive and negative women screened for the first time, and 3.2% and 5.6% for repeat visits respectively. Overall, 89.1% (1,571/1,763) of VIAC positive women received treatment. Most (41%) of those treated received thermocoagulation. Overall, 43.1% of clients received treatment on VIAC day, and 77.4% within 30 days. Six-month post-treatment coverage was 3.8%.
CONCLUSION
VIAC positivity among HIV positive women screening for the first time was 5.9%, within the expected 5-25%. Treatment coverage was high, and turnaround time from diagnosis to treatment met national standards. Post-treatment coverage was suboptimal. We recommend continued implementation of quality improvement initiatives, capacity building of clinicians, and optimization of post-treatment review of clients.
Topics: Humans; Female; Uterine Cervical Neoplasms; Acetic Acid; Zimbabwe; Retrospective Studies; Prevalence; Cross-Sectional Studies; Public Sector; Mass Screening; HIV Seropositivity; Early Detection of Cancer; Health Facilities; HIV Infections
PubMed: 38019889
DOI: 10.1371/journal.pone.0294115 -
Acta Psychologica May 2023The need to further our understanding of positive affect dysregulation in depression has been widely acknowledged. Two related relevant concepts in this realm, are...
The need to further our understanding of positive affect dysregulation in depression has been widely acknowledged. Two related relevant concepts in this realm, are Avoidance Of Positivity (AOP; referring to avoidance behaviour towards positivity) and Fear Of Positivity (FOP; referring to anxious or unpleasant feelings related to positivity). However, traditionally manifestations of AOP and FOP are considered in isolation, and self-report scales used to measure both concepts show considerable content overlap. Therefore, the first study aim was to examine how AOP and FOP relate to one another, depressive symptomatology and anhedonia, through new clearly delineated scales. For exploratory purposes, general and state-specific versions were developed. The second aim was to uncover beliefs that underlie the tendency towards AOP/FOP. An adult community sample (n = 197) completed online measures of AOP, FOP, depressive symptoms and anhedonia, and answered open-ended questions about reasons for AOP and FOP. Cross-sectionally, preliminary evidence was found for AOP and FOP being positively associated with one another, depressive symptomatology and anhedonia. Even after controlling for depressive symptomatology, anhedonia remained positively associated with AOP and FOP. So, AOP and FOP may be viable candidate mechanisms maintaining anhedonia that are worth further investigation and may be appropriate to target during treatment. Answers to the open-ended questions (n = 77) reflected various beliefs underlying AOP/FOP, which were broader than simply anticipating negative consequences of feeling positive and also touched on themes of unworthiness and social inappropriateness of feeling positive. Some theoretical and clinical implications of different beliefs underlying AOP/FOP are discussed.
Topics: Adult; Humans; Anhedonia; Emotions; Fear; Anxiety; Self Report
PubMed: 37018932
DOI: 10.1016/j.actpsy.2023.103901 -
Frontiers in Endocrinology 2023To explore the impact of diabetes itself and glycemic control status on tuberculosis (TB).
OBJECTIVES
To explore the impact of diabetes itself and glycemic control status on tuberculosis (TB).
METHODS
A total of 3393 patients with TB and diabetes mellitus (DM) who were hospitalized in the Public Health Clinical Center of Chengdu from January 1, 2019, to December 31, 2021, were retrospectively included and divided into three groups according to baseline glycemic control status: two groups according to glycemic status at discharge, two groups according to cavity occurrence, three groups according to sputum results, and three groups according to lesion location. The influencing factors and the differences in cavity occurrence, sputum positivity and lesion location among different glycemic control groups or between different glycemic status groups were analyzed.
RESULTS
In this TB with DM cohort, most of the subjects were male, with a male to female ratio of 4.54:1, most of them were 45-59 years old, with an average age of 57.44 ± 13.22 years old. Among them, 16.8% (569/3393) had cavities, 52.2% (1770/3393) were sputum positive, 30.4% (1030/3393) had simple intrapulmonary lesions, 68.1% (2311/3393) had both intra and extrapulmonary lesions, only 15.8% (537/3393) had good glycemic control,16.0% (542/3393) and 68.2% (2314/3393) had fair and poor glycemic control, respectively. Compared with the non-cavity group, the sputum-negative group and the extrapulmonary lesion group, the cavity group, sputum-positive group, intrapulmonary lesion group and the intra and extrapulmonary lesion group all had higher fasting plasma glucose (FPG) and glycosylated hemoglobin A 1c (HbA1c) and lower good glycemic control rates at admission (all <0.001). Another aspect, compared with the good glycemic control group, the poor glycemic control group had a higher cavity occurrence rate, sputum positive rate, and greater proportion of intrapulmonary lesions. Moreover, FPG and HbA1c levels and poor glycemic control were significantly positively correlated with cavity occurrence, sputum positivity, and intrapulmonary lesions and were the main risk factors for TB disease progression. On the other hand, cavity occurrence, sputum positivity, and intrapulmonary lesions were also main risk factors for hyperglycemia and poor glycemic control.
CONCLUSION
Diabetes itself and glycemic control status could impact TB disease. Good glycemic control throughout the whole process is necessary for patients with TB and DM to reduce cavity occurrence and promote sputum negative conversion and lesion absorption.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Glycated Hemoglobin; Retrospective Studies; Tuberculosis, Pulmonary; Glycemic Control; Diabetes Mellitus; Tuberculosis; Hyperglycemia
PubMed: 38027218
DOI: 10.3389/fendo.2023.1250001 -
Journal of the National Cancer Institute Jul 2020Some breast tumors expressing greater than 1% and less than 10% estrogen receptor (ER) positivity (ER-borderline) are clinically aggressive; others exhibit luminal...
BACKGROUND
Some breast tumors expressing greater than 1% and less than 10% estrogen receptor (ER) positivity (ER-borderline) are clinically aggressive; others exhibit luminal biology. Prior ER-borderline studies included few black participants.
METHODS
Using the Carolina Breast Cancer Study (phase I: 1993-1996; 2: 1996-2001; 3: 2008-2013), a population-based study that oversampled black women, we compared ER-borderline (n = 217) to ER-positive (n = 1885) and ER-negative (n = 757) tumors. PAM50 subtype and risk of recurrence score (ROR-PT, incorporates subtype, proliferation, tumor size) were measured. Relative frequency differences (RFD) were estimated using multivariable linear regression. Disease-free interval (DFI) was evaluated by ER category and endocrine therapy receipt, overall and by race, using Kaplan Meier and Cox models. Statistical tests were two-sided.
RESULTS
ER-borderlines were more frequently basal-like (RFD = +37.7%, 95% confidence interval [CI] = 27.1% to 48.4%) and high ROR-PT (RFD = +52.4%, 95% CI = 36.8% to 68.0%) relative to ER-positives. Having a high ROR-PT ER-borderline tumor was statistically significantly associated with black race (RFD = +26.2%, 95% CI = 9.0% to 43.3%). Compared to ER-positives, DFI of ER-borderlines treated with endocrine therapy was poorer but not statistically significantly different (hazard ratio [HR] = 2.03, 95% CI = 0.89% to 4.65%), whereas DFI was statistically significantly worse for ER-borderlines without endocrine therapy (HR = 3.33, 95% CI = 1.84% to 6.02%). However, black women with ER-borderline had worse DFI compared to ER-positives, even when treated with endocrine therapy (HR = 2.77, 95% CI = 1.09% to 7.04%).
CONCLUSIONS
ER-borderline tumors were genomically heterogeneous, with survival outcomes that differed by endocrine therapy receipt and race. Black race predicted high-risk ER-borderlines and may be associated with poorer endocrine therapy response.
Topics: Adult; Aged; Black People; Breast Neoplasms; Female; Humans; Immunohistochemistry; Middle Aged; Neoplasm Staging; North Carolina; Receptors, Estrogen; Transcriptome; White People; Young Adult
PubMed: 31742342
DOI: 10.1093/jnci/djz206 -
Behavioral Sciences (Basel, Switzerland) Mar 2023This study aimed to identify the relationship between grateful disposition and the subjective happiness of young adults; it examined a sequential double mediating effect...
Relationship between Grateful Disposition and Subjective Happiness of Korean Young Adults: Focused on Double Mediating Effect of Social Support and Positive Interpretation.
This study aimed to identify the relationship between grateful disposition and the subjective happiness of young adults; it examined a sequential double mediating effect model of social support and positive interpretation on this relationship. The study participants included 389 male and female Korean young adults. The Korean version of Gratitude Questionnaire-6, a modified subscale of the SU Mental Health Test, Iverson et al.'s scale for social support, and the Subjective Happiness Scale were used. PROCESS Macro 3.5 Model 6 was used to analyze the double mediating effect. The correlation analysis showed that grateful disposition was positively correlated with social support, positive interpretation, and subjective happiness in young adults. Moreover, social support was positively correlated with positive interpretation and subjective happiness, whereas positive interpretation was positively correlated with subjective happiness. In addition, the sequential mediating effect of social support and positive interpretation on grateful disposition and the subjective happiness of young adults was significant. This study confirmed the determinant roles of social support and positive interpretation in grateful disposition and the subjective happiness of young adults, providing useful information for planning future studies and developing education materials and interventions for cultivating grateful disposition in childhood and promoting happiness in young adults.
PubMed: 37102801
DOI: 10.3390/bs13040287 -
PloS One 2015Diagnostic clinical prediction rules (CPRs) are developed to improve diagnosis or decrease diagnostic testing. Whether, and in what situations diagnostic CPRs improve... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Diagnostic clinical prediction rules (CPRs) are developed to improve diagnosis or decrease diagnostic testing. Whether, and in what situations diagnostic CPRs improve upon clinical judgment is unclear.
METHODS AND FINDINGS
We searched MEDLINE, Embase and CINAHL, with supplementary citation and reference checking for studies comparing CPRs and clinical judgment against a current objective reference standard. We report 1) the proportion of study participants classified as not having disease who hence may avoid further testing and or treatment and 2) the proportion, among those classified as not having disease, who do (missed diagnoses) by both approaches. 31 studies of 13 medical conditions were included, with 46 comparisons between CPRs and clinical judgment. In 2 comparisons (4%), CPRs reduced the proportion of missed diagnoses, but this was offset by classifying a larger proportion of study participants as having disease (more false positives). In 36 comparisons (78%) the proportion of diagnoses missed by CPRs and clinical judgment was similar, and in 9 of these, the CPRs classified a larger proportion of participants as not having disease (fewer false positives). In 8 comparisons (17%) the proportion of diagnoses missed by the CPRs was greater. This was offset by classifying a smaller proportion of participants as having the disease (fewer false positives) in 2 comparisons. There were no comparisons where the CPR missed a smaller proportion of diagnoses than clinical judgment and classified more participants as not having the disease. The design of the included studies allows evaluation of CPRs when their results are applied independently of clinical judgment. The performance of CPRs, when implemented by clinicians as a support to their judgment may be different.
CONCLUSIONS
In the limited studies to date, CPRs are rarely superior to clinical judgment and there is generally a trade-off between the proportion classified as not having disease and the proportion of missed diagnoses. Differences between the two methods of judgment are likely the result of different diagnostic thresholds for positivity. Which is the preferred judgment method for a particular clinical condition depends on the relative benefits and harms of true positive and false positive diagnoses.
Topics: Bias; Decision Support Techniques; Disease; Humans; Judgment; Risk Factors
PubMed: 26039538
DOI: 10.1371/journal.pone.0128233 -
Frontiers in Behavioral Neuroscience 2022Dreams may contribute to psychological adaptation by aiding in mood regulation. One way it could be achieved is through a desensitization process whereby negative events...
Dreams may contribute to psychological adaptation by aiding in mood regulation. One way it could be achieved is through a desensitization process whereby negative events are replayed within the dream under lower conditions of negative emotionality. Evidence of this theory is supported by the tendency of dreamers to evaluate their emotions felt in their dreams more positively compared to an independent judge (i.e., positivity bias). Additionally, it has been observed that while dream emotions are typically more negative than pre-sleep emotions, morning emotions are more positive, suggesting that emotional regulation occurs overnight and may help improve mood in the morning. The present study aimed to examine the relationships between pre-sleep, dream, and morning mood and the potential desensitization function of remembered dreams as indicated by their effects on morning mood and stress. Participants ( = 188; Mean age = 19.2, = 3.0) recorded their dreams ( = 345 dreams) and self-reported their stress and mood at bedtime, during their dream retrospectively, and upon waking. A judge also evaluated the subjects' dream moods. Subjects' positivity bias was defined as the difference between the subjects and the judge's evaluation of the positive emotions in the dream. A MANOVA revealed that subjects perceived a higher level of positive emotions in their dreams compared to a judge. Multi-group path analysis revealed that some relationships between pre-sleep, dream, and morning emotions and stress differed in positive and negative dream nights. In both groups, the strongest predictors of morning mood and stress were pre-sleep mood and stress, respectively. The second strongest predictor of positive morning mood was the subjects' dream positivity bias. Results provide some support for the association of dreaming in mood regulation attributable to REM sleep. They also highlight that pathways implicated in mood regulation may be distinct from stress regulation.
PubMed: 36187381
DOI: 10.3389/fnbeh.2022.947396 -
Journal of Thrombosis and Haemostasis :... Sep 2020High incidence of thrombosis in COVID-19 patients indicates a hypercoagulable state. Hence, exploring the involvement of antiphospholipid antibodies (aPL) in these...
BACKGROUND
High incidence of thrombosis in COVID-19 patients indicates a hypercoagulable state. Hence, exploring the involvement of antiphospholipid antibodies (aPL) in these patients is of interest.
OBJECTIVES
To illustrate the incidence of criteria (lupus anticoagulant [LAC], anticardiolipin [aCL] immunoglobulin G [IgG]/IgM, antibeta2-glycoprotein I antibodies [aβ2GPI] IgG/IgM) and noncriteria (anti-phosphatidyl serine/prothrombin [aPS/PT], aCL, and aβ2GPI IgA) aPL in a consecutive cohort of critically ill SARS-CoV-2 patients, their association with thrombosis, antibody profile and titers of aPL.
PATIENTS/METHODS
Thirty-one consecutive confirmed COVID-19 patients admitted to the intensive care unit were included. aPL were measured at one time point, with part of the aPL-positive patients retested after 1 month.
RESULTS
Sixteen patients were single LAC-positive, two triple-positive, one double-positive, one single aCL, and three aCL IgG and LAC positive. Seven of nine thrombotic patients had at least one aPL. Sixteen of 22 patients without thrombosis were aPL positive, amongst them two triple positives. Nine of 10 retested LAC-positive patients were negative on a second occasion, as well as the double-positive patient. Seven patients were aPS/PT-positive associated to LAC. Three patients were aCL and aβ2GPI IgA-positive.
CONCLUSION
Our observations support the frequent single LAC positivity during (acute phase) observed in COVID-19 infection; however, not clearly related to thrombotic complications. Triple aPL positivity and high aCL/aβ2GPI titers are rare. Repeat testing suggests aPL to be mostly transient. Further studies and international registration of aPL should improve understanding the role of aPL in thrombotic COVID-19 patients.
Topics: Adult; Aged; Aged, 80 and over; Antibodies, Anticardiolipin; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Blood Coagulation; COVID-19; Critical Care; Critical Illness; Female; Humans; Immunoglobulin G; Immunoglobulin M; Intensive Care Units; Lupus Coagulation Inhibitor; Male; Middle Aged; Prothrombin; Thrombosis; beta 2-Glycoprotein I
PubMed: 32619328
DOI: 10.1111/jth.14994 -
Journal of Pathology Informatics 2021Human immunodeficiency virus (HIV) screening has improved significantly in the past decade as we have implemented tests that include antigen detection of p24....
BACKGROUND
Human immunodeficiency virus (HIV) screening has improved significantly in the past decade as we have implemented tests that include antigen detection of p24. Incorporation of p24 detection narrows the window from 4 to 2 weeks between infection acquisition and ability to detect infection, reducing unintentional spread of HIV. The fourth- and fifth-generation HIV (HIV5G) screening tests in low prevalence populations have high numbers of false-positive screens and it is unclear if orthogonal testing improves diagnostic and public health outcomes.
METHODS
We used a cohort of 60,587 HIV5G screening tests with molecular and clinical correlates collected from 2016 to 2018 and applied machine learning to generate a classifier that could predict likely true and false positivity.
RESULTS
The best classification was achieved by using support vector machines and transformation of results with principle component analysis. The final classifier had an accuracy of 94% for correct classification of false-positive screens and an accuracy of 92% for classification of true-positive screens.
CONCLUSIONS
Implementation of this classifier as a screening method for all HIV5G reactive screens allows for improved workflow with likely true positives reported immediately to reduce infection spread and initiate follow-up testing and treatment and likely false positives undergoing orthogonal testing utilizing the same specimen already drawn to reduce distress and follow-up visits. Application of machine learning to the clinical laboratory allows for workflow improvement and decision support to provide improved patient care and public health.
PubMed: 34934521
DOI: 10.4103/jpi.jpi_7_21