The utility of HPV DNA testing in triage of low-grade cytological abnormalities

This study evaluated the usefulness of human papillomavirus (HPV) DNA testing and repeat cytology in triage of women referred to colposcopy in St. John's, Newfoundland with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) cytology. Data were collected on the initial Pap abnormality that prompted referral, HPV test, repeat Pap test, and histology if biopsies were ordered. Of 447 women, 97 with ASCUS and 145 with LSIL had results for all tests. For ASCUS, HPV testing was 100% sensitive for detection of underlying high-grade intraepithelial lesions (HSIL) while reducing referrals to 44.3%. There would have been significant reductions in referrals among women ≥30 years of age (74.3%) compared to younger women (27.4%). Nevertheless, in restricting HPV testing to women aged ≥30 years, 8/16 women with underlying HSIL would not have been referred to colposcopy. Repeat cytology was less sensitive (75%) for triaging all women. For LSIL, any method would have referred approximately 60% or more if a good sensitivity was achieved in any age group. For ASCUS, HPV triage appears to be more useful than repeat cytology. No useful triage strategy was identified for LSIL

Infant feeding mode predicts the costs of healthcare services in one region of Canada: a data linkage pilot study

Objective: The aim is to perform a pilot study evaluating the differences in healthcare service use and its associated costs by infant feeding mode in an infant’s first year of life. Data from a prospective cohort study and administrative databases were linked to examine healthcare use in healthy full term infants (N = 160). Exposure was categorized as exclusively breastfed, mixed fed and exclusively formula fed. Outcomes included hospitalizations, emergency room and physician visits. Descriptive statistics and generalized linear modelling were performed. Results: Overall $315,235 was spent on healthcare service use for the sample of infants during their first year of life. When compared to exclusive breastfeeding, mixed feeding and exclusive formula feeding were found to be significant predictors of total healthcare service use costs (p < 0.05), driven by costs of hospital admissions. Due to the human and economic burden associated with not breastfeeding, policies and programs that support and encourage breastfeeding should be priority