Impact of human papillomavirus-related genital diseases on quality of life and psychosocial wellbeing: results of an observational, health-related quality of life study in the UK

Background: Data on the psychosocial burden of human papillomavirus (HPV)-related diseases other than cervical cancer are scarce. The objectives of this study were to measure and compare the psychosocial burden and the impact on health-related quality of life (HRQoL) of HPV-related lower genital tract diseases and genital warts (GW) using several generic and disease-specific instruments. Methods. Overall, 842 individuals with normal cervical cytology (n = 241), borderline nuclear abnormalities and/or mild dyskaryosis (n = 23), cervical intraepithelial neoplasia (CIN)1 (n = 84), CIN2/3 (n = 203), vulval intraepithelial neoplasia (VIN)2/3 (n = 43), GW (n = 186) and a history of GW (non-current) (n = 62) were included. The generic European Quality of Life Index Version 5D (EQ-5D) questionnaire was completed by patients with GW and VIN2/3. Sexual functioning was evaluated using the Change in Sexual Functioning Questionnaire (CSFQ). Psychosocial impact was measured in women using the HPV Impact Profile (HIP) questionnaire. HRQoL was assessed using a GW-specific questionnaire, the Cuestionario Especifico en Condilomas Acuminados (CECA) (completed by patients with GW and history of GW). For each instrument, scores were compared between groups using the Student's t-test. In addition, utility loss due to GW and VIN2/3 was evaluated by comparing mean EQ-5D scores weighted by age and sex with the UK general population normal values. Results: A significant psychosocial impact was found in women diagnosed with HPV-related genital diseases, particularly in those with GW. The health state of younger adults with GW was significantly impaired compared with UK normal values (mean EQ-5D index score 0.86 vs 0.94, p < 0.001 for 18-24-year-olds; 0.87 vs 0.93, p = 0.030 for 25-34-year-olds). VIN2/3 was found to have a significant negative impact on sexual functioning, and women with VIN2/3 had a highly impaired health state compared with women in the UK general population (weighted mean EQ-5D index score 0.72 vs 0.89, p < 0.001; weighted mean Visual Analogue Scale score 62 vs 85, p < 0.001). Conclusions: HPV-related lower genital tract lesions and GW significantly impair psychosocial wellbeing and HRQoL. The psychosocial aspects of HPV-related diseases need to be considered when evaluating the potential benefit of HPV vaccination. © 2013 Dominiak-Felden et al.; licensee BioMed Central Ltd

Evaluation of flexible senior registrar training in obstetrics and gynaecology

OBJECTIVE: To evaluate part-time senior registrar training in obstetrics and gynaecology from the perspective of the trainees. DESIGN: Postal questionnaire. SUBJECTS: Past and present senior registrar trainees on the PM(79)3 scheme. RESULTS: Thirty-two questionnaires were returned (86% response rate) from 20 current trainees (100% response) and 12 (71% response) past trainees. Family commitments were the main reason for training part-time. Of these, 84% were satisfied with their training and most (81%) thought the quality as good or better than full time training. Personalised timetables were seen to be of particular benefit. Negative attitudes towards part-time training and discrimination in favour of full time trainees were seen as some of the biggest difficulties associated with part-time training. Other problems included administrative delays in organising part-time posts, time restriction, and the length of training. CONCLUSIONS: Part-time senior registrar training is effective in retaining trainees with domestic commitments within the speciality. It is regarded as being of high quality but with attendant problems, particularly those related to the negative attitudes of others. Recommendations for improvements have been made

Immunological responses to cervical neoplasia : immunological status of patients with cervical carcinoma and HPV-specific cytotoxic lymphocyte responses in women with cervical neoplasia

Half a million new cases of cervical cancer are diagnosed annually World-wide; with optimal management the five year survival is 58%. In Developing countries cervical carcinoma is the commonest female malignancy with a lifetime risk approaching 1 in 15. In the absence of adequate health care facilities, incidence and mortality figures equate. Alternate treatment modalities are therefore urgently awaited.There is a close association between Human Papilloma Virus infection (HPV) and cervical carcinogenesis; the HPV E6 and E7 proteins interacting with the cellular regulatory proteins, p53 and Rb respectively. E6 and E7 are consistently expressed by neoplastic HPV-infected cells, serving as tumour-specific markers and as targets for immunotherapy. The importance of immunological control in HPV-associated disease is inferred from histological evidence of an immune response around regressing lesions and by the increased incidence of HPV-related disease in immunosuppressed individuals. However, there are few reports of HPV-specific T cell responses in the literature. Evidence of HPV-specific cytotoxic lymphocyte (CTL) activity presented here, in patients with cervical intraepithelial neoplasia.Eight patients with late stage invasive disease were immunised with a recombinant vaccinia virus encoding HPV16 &amp; 18 E6 and E7 genes. All patients mounted a serological reaction to the vector while three patients showed a definite anti-HPV serological response. Of three evaluable patients one showed an HPV-specific CTL response nine weeks after vaccination. No serious adverse events occurred and environmental release was contained. During the vaccine study evidence of immune compromise was noted amongst patients with cervical carcinoma. Systematic investigation for different disease stages revealed a pan T cell deficit, related to tumour load. This has implications for the safety and efficacy of future immunotherapeutic intervention.</p

The prevention of cervical cancer in Africa

In this article we aim to draw attention to the burden of cervical cancer in Africa for reproductive health and review strategies for prevention, including appropriate noncytology-based cervical screening and prophylactic human papillomavirus vaccination. We consider the heavy burden of disease attributable to human papillomavirus infection borne by developing countries, particularly in Africa. Following identification of the human papillomavirus as the infectious etiological agent and elucidation of the long natural history of cervical neoplasia, cervical cancer is now one of the most preventable of all cancers. Opportunities for primary prevention by prophylactic vaccination and secondary prevention by appropriate cervical screening are discussed, together with the importance of population coverage. Qualitative work on attitudes towards cervical cancer prevention, education needs, the creation of an environment for informed choice and uptake are essential aspects of effective prevention programs. Cervical cancer poses a huge health burden in Africa. It is a disease that is eminently preventable given political will, the availability of affordable vaccines, appropriate cervical screening and access to cheap, point-of-care human papillomavirus testing. There are a number of unanswered questions for the prevention of cervical cancer and a need for demonstration projects to address these and further develop prevention strategies

transportMYpatient: an initiative to overcome the barrier of transport costs for patients accessing treatment for obstetric fistulae and cleft lip in Tanzania

Those with disabilities are often among the poorest and most vulnerable. Even when health care is provided free, transport costs may pose an insurmountable barrier to accessing treatment. This report outlines a new initiative in Tanzania which utilizes mobile phone technology to transfer funds covering transport costs for patients with obstetric fistulae or cleft lip and/or palate. The transportMYpatient initiative surpassed the set targets and saw a 65% increase in the number of fistulae repairs performed in 2010 compared with the year before and almost triple the number of cleft lip/palate repairs. Using mobile phone technology to transfer funds is an innovative way of overcoming a significant barrier to health-care access for patients in developing countries

The effect of lifestyle factors on gynaecological cancer [review]

Several lifestyle factors affect a woman's risk of gynaecological cancer and-potentially-can be modified to reduce risk. This chapter summarises the evidence for the effect of lifestyle factors on the incidence of gynaecological malignancy. The incidence of obesity is increasing in the developed world such that it now contributes as much as smoking to overall cancer deaths. Women with a body mass index (BMI)>40 have a 60% higher risk of dying from all cancers than women of normal weight. They are also at increased risk from gynaecological cancer. Dietary factors significantly influence the risk of gynaecological cancer: fruit, vegetables and antioxidants reduce risk whereas high animal fat and energy intakes increase risk. Alcohol intake adversely affects breast cancer risk, possibly accounting for 4% of all breast cancers. Physical activity protects against ovarian, endometrial and postmenopausal breast cancer, independently of BMI. The oral contraceptive pill has a substantial and long-lasting effect on the prevention of ovarian and endometrial cancer and is one of the best examples of large-scale chemoprevention in the developed world. Childbearing is protective against ovarian, endometrial and breast cancer but increases the risk of cervical cancer. Smoking acts as a cofactor in cervical carcinogenesis and increases the risk of ovarian cancer, particularly mucinous tumours

Human papillomavirus, cervical carcinogenesis and chemoprevention with Indole derivates - a review of pathomechanisms

Cervical cancer is the second most common female cancer worldwide with high risk Human Papillomavirus (HPV) infection playing an essential aetiological role. Oestrogen interacts with HPV at a cellular level causing cell growth and inhibition of apoptosis. Indole derivatives, formed during digestion of cruciferous vegetables, have been shown to have chemopreventative properties inhibiting HPV transcription and influencing oestrogen metabolism. This review describes the interactions between HPV, oestrogen and indole derivatives. Further clinical research is required to evaluate the chemopreventative properties of these agents

Vaccination against cervical cancer [review]

The link between human papillomavirus (HPV) and cervical cancer raises the question, can the burden of cervical cancer be reduced using HPV vaccination strategies? The clinical trials to date will be reviewed, along with the challenges and potential for future development