Evaluation of Follow-up Colposcopy Procedures After Abnormal Cervical Screening Result Across a Statewide Study in Mississippi

Purpose

Cervical screening is used to detect and treat precancers to prevent invasive cancers. However, successful prevention also requires adequate follow-up and treatment of individuals with abnormal screening results. The aim was to investigate demographics, clinical characteristics, and follow-up status for individuals needing colposcopy after an abnormal screening result.

Methods

The STRIDES (Studying Risk to Improve DisparitiES) cohort comprises individuals undergoing cervical cancer screening and management at a Mississippi Health Department or University of Mississippi clinic. Follow-up status, demographics, and clinical data were assessed from electronic health records and, if necessary, patient navigation on individuals identified as needing a colposcopy after an abnormal screening.

Results

Of the 1,458 individuals requiring colposcopy, 43.0% had the procedure within 4 months, 16.4% had a delayed procedure, and 39.5% had no documented follow-up, with significant predictors of follow-up identified as age and cytology diagnosis. Based on age, individuals 30 + were more likely to follow up with a colposcopy compared to individuals < 30 years (49% and 38.7%, respectively; p < .001). Individuals with cytology diagnoses of LSIL (52.9%), ASC-H (51.4%), and HSIL (62.3%) had higher percentages of adherence to follow-up colposcopy guidelines (p < .001).

Conclusion

Despite high cervical cancer screening rates among Mississippians, a substantial portion did not have adequate next-step intervention. However, it is encouraging that highest risk individuals were more likely to have a colposcopy. Regardless, continuing to understand the underlying causes for incomplete follow-up is crucial for timely secondary targeted interventions to reduce cervical cancer burden, promote awareness, and improve health outcomes.

Experiences of adults participating in infertility support groups: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to identify and synthesize the best available evidence on the experiences of adults participating in infertility support groups to understand the value of support groups for this population.

INTRODUCTION

Infertility can impact a person physically, mentally, emotionally, spiritually and financially. Infertility support groups may represent a beneficial tool that these adults can utilize to improve their quality of life. The findings may inform or promote more effective and appropriate health care and, based on the results, a change in the standard of care for the treatment of infertility.

INCLUSION CRITERIA

This review will consider studies that include infertile women, men and couples of any age, race or marital status, in any geographic region and with any co-morbidity who participate in infertility support groups. Studies published in English that focus on qualitative data, without any restriction of year of publication, will be considered. This review will consider studies that utilize any media of material for infertility support groups.

METHODS

The key information sources to be searched are: CINAHL, PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, Scopus, MedNar and ProQuest Dissertations and Theses. A three-step search strategy will be undertaken to find both published and unpublished studies and will include searching of reference lists within articles selected for critical appraisal. Each of the included studies will be assessed for methodological quality independently by two reviewers, and findings will be extracted and synthesized.

Registered nurse experiences of nursing professional identity: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to identify, appraise and synthesize the best available evidence related to registered nurses' experiences of nursing professional identity in nursing care settings.

Natural experiments: an underused tool for public health?

Policymakers and public health researchers alike have demanded better evidence of the effects of interventions on health inequalities. These calls have been repeated most recently in the UK in the final Wanless report, which spoke of the "almost complete lack of an evidence base on the cost-effectiveness of public health interventions", and pointed more generally to the limited evidence base for public health policy and practice. Wanless and others have suggested that the gaps may be partially filled by exploiting the opportunities offered by "natural experiments", such as changes in employment opportunities, housing provision, or cigarette pricing. Natural experiments have an important contributions to make within the health inequalities agenda. First, they can play an important role in investigating the determinants of health inequalities. Second, they can assist in the identification of effective interventions, an area where it is widely acknowledged that the evidence-base is currently sparsely populated. This paper discusses some of the benefits and limitations of using this type of evidence, drawing on two ongoing quasi-experimental studies as examples.

The treatment of childhood social anxiety disorder

The concept of shyness in young children is not new; however, only recently has it been recognized that childhood SAD is a prevalent and severe disorder, with both immediate and long-term implications for academic, social, and emotional functioning. With the recognition that this disorder can result in severe lifetime impairment, both pharmacologic and psychosocial interventions for youth with social phobia are now beginning to be developed, and their efficacy, to be determined. The study of efficacious pharmacologic treatments with childhood anxiety disorders is limited at this time. There has been even less research regarding pharmacotherapy samples of children with childhood social phobia or social anxiety only. Only seven clinical trials have been conducted, and among those, only three were placebo-controlled, double-blind studies. In all of the open-labeled trials, anxious children showed improvement on both SSRIs and benzodiazepines; however, two of the three double-blind studies were unable to replicate these treatment benefits compared with placebo. The inability to find treatment effects may be a manifestation of the small sample sizes used and the comorbidity of the samples used to date. Further examination of the SSRIs and benzodiazepines with placebo-controlled studies is needed to provide more conclusive support for the efficacy of pharmacologic treatment. Similar to pharmacologic studies, research has begun to accumulate that sheds light on effective psychosocial interventions for childhood social phobia. Future research investigating the relative contribution of specific treatment components will allow for greater efficiency in the delivery of these services. Currently, which components are necessary or sufficient is unknown, although, based on meta-analyses conducted with adult outcome studies, exposure in some form seems to be the key ingredient. In addition, little attention has been given to developmental considerations regarding understanding the utility of specific psychosocial treatment components. For example, Spence et al reported that younger socially phobic children (aged 7-9 years) experienced difficulty in understanding the concept of "cognitive challenging," thus necessitating a reduction of this treatment component for this group. In addition, because differences in treatment effects across age groups was not reported, is it unclear whether the addition of a cognitive challenging component is even warranted. Similarly, Beidel et al reported significant improvement rates without the inclusion of a specific cognitive restructuring component. Thus, future research is needed to clarify the exact utility of including this intervention in treatment. Investigations have begun to accumulate that focus solely on the treatment of childhood social phobia, as opposed to general anxiety symptoms. As a result, preliminary evidence supports the use of pharmacologic and psychosocial treatments. Nonetheless, further research is needed to provide a better understanding of the efficacy of different interventions and, in the case of psychosocial treatments, different treatment components for socially phobic children across different developmental periods. Moreover, controlled treatment outcome studies that include specific measures of social anxiety and functioning, in addition to DSM diagnostic criteria, should provide a better (i.e., more thorough) evaluation of specific treatment effects for socially phobic children and adolescents.

Absence of germline infection in male mice following intraventricular injection of adenovirus

The possibility of inadvertent exposure of gonadal tissue to gene therapy vectors has raised safety concerns about germline infection. We show here that the receptor for coxsackie B viruses and adenoviruses 2 and 5 (CXADR) is expressed in mouse germ cells, suggesting the possibility that these viruses could infect germ cells. To directly assess the risk of germline infection in vivo, we injected an adenovirus carrying the germ-cell-specific protamine promoter fused to the bacterial lacZ reporter gene into the left ventricular cavity of mice and then monitored expression of the reporter gene in germ cells. To differentiate between infection of stem cells and differentiating spermatogenic cells, we analyzed expression of the reporter cassette at different times after viral delivery. Under all conditions tested, mice did not express the Escherichia coli beta-galactosidase protein in developing spermatids or in mature epididymal spermatozoa. Primary germ cells cultured in vitro were also refractory to adenoviral infection. Our data suggest that the chance of vertical germline transmission and insertional mutagenesis is highly unlikely following intracoronary adenoviral delivery.

Endogenous and exogenous Na-K-Cl cotransporter expression in a low K-resistant mutant MDCK cell line

A low K-resistant mutant Madin-Darby canine kidney (MDCK) cell line, LK-C1, has been shown previously to lack functional Na-K-Cl cotransporter (NKCC) activity, indicating that it may be a useful NKCC “knockout” cell line for structure-function studies. Using immunological probes, we first characterized the defect in the endogenous NKCC protein of the LK-C1 cells and then fully restored NKCC activity in these cells by stably expressing the human secretory NKCC1 protein (hNKCC1). The endogenous NKCC protein of the LK-C1 cells was expressed at significantly lower levels than in wild-type MDCK cells and was not properly glycosylated. This latter finding indicated that the lack of functional NKCC activity in the LK-C1 cells may be due to the inability to process the protein to the plasma membrane. In contrast, exogenously expressed hNKCC1 protein was properly processed and fully functional at the plasma membrane. Significantly, the exogenous hNKCC1 protein was regulated in a manner similar to the protein in native secretory cells as it was robustly activated by cell shrinkage, calyculin A, and low-Cl incubation. Furthermore, when the LK-C1 cells formed an epithelium on permeable supports, the exogenous hNKCC1 protein was properly polarized and functional at the basolateral membrane. The low levels of endogenous NKCC protein expression, the absence of any endogenous NKCC transport activity, and the ability to form a polarized epithelium indicate that the LK-C1 cells offer an excellent expression system with which to study the molecular physiology of the cation Cl cotransporters.

Improving the quality of spirometry in an epidemiological study: The Renfrew-Paisley (Midspan) family study

Population studies in Britain and elsewhere report deficiencies in quality of pulmonary function measurements. Methods were tested to improve the standardisation of spirometry in an epidemiological study. The spirometer provided visual feedback about acceptability and reproducibility to American Thoracic Society (ATS) standards. After 14 weeks technicians (research nurses) were given feedback and further training. Measurements were repeated in a 5% sample. Participant characteristics and technical factors (technician and technician feedback) predicted unacceptable forced expiratory volume in 1 second (FEV1) and excessively variable FEV1 and forced vital capacity (FVC). Only participant characteristics predicted unacceptable FVC. Feedback to technicians reduced test failure for FEV1 by half and excessive within-session variability by one-third. In the reproducibility study, coefficients of variation for FEV1 and FVC were 3%. Epidemiological studies can achieve standards of between-session reproducibility for spirometry comparable to levels reported by pulmonary function laboratories. Performance feedback to technicians improves the level of minimally acceptable spirometry, and within-session reproducibility.

Birth weight of offspring and mortality in the Renfrew and Paisley study: prospective observational study

OBJECTIVE

To investigate the association between birth weight of offspring and mortality among fathers and mothers in the west of Scotland.

DESIGN

Prospective observational study.

PARTICIPANTS

794 married couples in Renfrew district of the west of Scotland.

MAIN OUTCOME MEASURES

Mortality from all causes and from cardiovascular disease over 15 year follow up.

RESULTS

Women who had heavier babies were taller, had higher body mass index and better lung function, and were less likely to be smokers than mothers of lighter babies. Fathers of heavier babies were taller and less likely to be smokers than fathers of lighter babies. Mortality was inversely related to offspring's birth weight for both mothers (relative rate for a 1 kg lower birth weight 1.82 (95% confidence interval 1.23 to 2.70)) and fathers (relative rate 1.35 (1.03 to 1.79)). For mortality from cardiovascular disease, inverse associations were seen for mothers (2.00 (1.18 to 3.33)) and fathers (1.52 (1.03 to 2.17)). Adjustment for blood pressure, plasma cholesterol, body mass index, height, social class, area based deprivation category, smoking, lung function, angina, bronchitis, and electrocardiographic evidence of ischaemia had little effect on these risk estimates, although levels of statistical significance were reduced.

CONCLUSIONS

Birth weight of offspring was related inversely to mortality, from all causes and cardiovascular disease, in this cohort. The strength of this association was greater than would have been expected by the degree of concordance of birth weights across generations, but an extensive range of potential confounding factors could not account for the association. Mortality is therefore influenced by a factor related to birth weight that is transmissible across generations.

Effects of immunization of heifers against estradiol on growth, reproductive traits, and carcass characteristics

An experiment was performed to evaluate the effects of active immunization of heifers against estradiol on feedlot performance (growth and efficiency), carcass characteristics, and reproductive functions. Seventy-two crossbred heifers were divided into four equal treatment groups consisting of controls, ovariectomized heifers, and heifers actively immunized against keyhole limpet-estradiol antigen and bovine serum albumin-estradiol antigen. Heifers were fed ad libitum for 170 days. Both groups of heifers immunized against estradiol had higher (P less than 0.05) average daily gains than controls. Heifers immunized against bovine serum albumin-estradiol had increased feed efficiency (P less than 0.05) over controls. Ovariectomized heifers did not perform at levels sufficient to compensate for the initial setback from surgery. No differences were noted in carcass grade, quality, or concentration of water, fat, or protein. Uterine weights were increased in estrogen-immunized animals but were not significantly greater than controls. Ovarian weights and numbers of large follicles (greater than 9 mm diam) in immunized animals were significantly greater than in controls. Twenty-eight percent of the animals (n = 5) in the bovine serum albumin-estradiol-immunized group had cystic follicles (greater than 20 mm diam) and 50% (n = 9) of this group had no detectable corpus luteum. Low titer (1:100) systemic binding of estrogens may act as a steroid reservoir in which systemic estrogen clearance is decreased and availability to target tissues is increased.