16 research outputs found
Triage of HR-HPV Positive Women with Minor Cytological Abnormalities: A Comparison of mRNA Testing, HPV DNA Testing, and Repeat Cytology Using a 4-Year Follow-Up of a Population-Based Study
Peer reviewe
The role of place in shaping contraceptive use among women in Africa.
Contraceptive prevalence is low in the African region despite considerable family planning programmatic efforts. This study is the first to examine how community factors shape contraceptive use for married women in an entire region, comparing results across 21 African countries with a DHS in the last 5 years. The analysis builds on previous studies through an examination of the individual, household and community level factors that shape contraceptive use.The data used in this analysis were from nationally representative Demographic and Health Surveys completed between 2005 and 2009. A separate multi-level logistic model was fitted for the outcome of current modern contraceptive use in each country.After controlling for individual and household level factors, community level factors of demographics and fertility norms, gender norms and inequalities, and health knowledge remain significantly associated with contraceptive use, although the magnitude and direction of these community effects varied significantly across countries.The results highlight the importance of harnessing community level factors in planning interventions for increasing access to and utilization of modern contraceptive methods
Comparison of individual and household level model to community level model, sigma mu and likelihood ratio test p-value reported for 21 study countries.
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<sup>1</sup><i>Models where variables account for all the PSU level variation are bolded.</i></p><p>
<sup>2</sup><i>Two-tailed p-value was used.</i></p
Community level results of multilevel logistic model for the outcome of modern contraceptive use, community gender health knowledge and media exposure domain.
<p>Values reported as adjusted odds ratio (95% CI)*†.</p>*<p>
<i>Models controlled for the following individual and household level factors: age, age at marriage, partner age difference, number of living children, death of a child, gender composition of children, religion, residence, wealth, employment, education (respondent and partner), violence index, decision-making autonomy index, HIV knowledge index, reproductive health knowledge index, media exposure index.</i></p>†<p>
<i>Bolded figures are significant at 0.05 level.</i></p>**<p>
<i>Information about HIV not collected in the 2008 Egypt DHS – Women’s Questionnaire; information about HIV only collected in sub-sample of the Madagascar 2008–09 DHS – Women’s Questionnaire, therefore excluded from this analysis.</i></p>††<p>
<i>Information about reproductive health only collected in sub-sample of the Madagascar 2008–09 DHS – Women’s Questionnaire.</i></p
Community level results of multilevel logistic model for the outcome of modern contraceptive use, community gender norms and inequalities domain.
<p>Values reported as adjusted odds ratio (95% CI)*†.</p>*<p>Models controlled for the following individual and household level factors: age, age at marriage, partner age difference, number of living children, death of a child, gender composition of children, religion, residence, wealth, employment, education (respondent and partner), violence index, decision-making autonomy index, HIV knowledge index, reproductive health knowledge index, media exposure index.</p>†<p>Bolded figures are signpone.0040670.g001.tifificant at 0.05 level.</p>**<p>Information on decision-making autonomy not collected in the 2005 Congo DHS – Women’s Questionnaire.</p
Operational definitions for community level variables used in modeling determinants of modern contraceptive use in 21 study countries.
<p>Operational definitions for community level variables used in modeling determinants of modern contraceptive use in 21 study countries.</p
Community level results of multilevel logistic model for the outcome of modern contraceptive use, domains of community demographics and fertility norms and community economic prosperity.
<p>Values reported as adjusted odds ratio (95% CI)*†.</p>*<p>Models controlled for the following individual and household level factors: age, age at marriage, partner age difference, number of living children, death of a child, gender composition of children, religion, residence, wealth, employment, education (respondent and partner), violence index, decision-making autonomy index, HIV knowledge index, reproductive health knowledge index, media exposure index.</p>†<p>Bolded figures are significant at 0.05 level.</p>**<p>Information on age at first intercourse not collected in the 2008 Egypt DHS – Women’s Questionnaire.</p
Effectiveness of cervical screening after age 60 years according to screening history : Nationwide cohort study in Sweden
Background The relatively high incidence of cervical cancer in women at older ages is a continuing concern in countries with long-established cervical screening. Controversy remains on when and how to cease screening. Existing population-based studies on the effectiveness of cervical screening at older ages have not considered women's screening history. We performed a nationwide cohort study to investigate the incidence of cervical cancer after age 60 years and its association with cervical screening at age 61-65, stratified by screening history at age 51-60. Methods and findings Using the Total Population Register, we identified 569,132 women born between 1 January 1919 and 31 December 1945, resident in Sweden since age 51. Women's cytological screening records, cervical cancer occurrence, and FIGO stage (for those diagnosed with cancer) were retrieved from national registers and medical charts. We calculated the cumulative incidence of cervical cancer from age 61 to age 80 using a survival function considering competing risk, and estimated the hazard ratio (HR) of cervical cancer in relation to screening status at age 61-65 from Cox models, adjusted for birth cohort and level of education, conditioning on women's screening history in their 50s. In women unscreened in their 50s, the cumulative incidence up to age 80 was 5.0 per 1,000 women, and screening at age 61-65 was associated with a lower risk for cervical cancer (HR = 0.42, 95% CI 0.24-0.72), corresponding to a decrease of 3.3 cancer cases per 1,000 women. A higher cumulative incidence and similarly statistically significant risk decrease was seen for women with abnormal smears in their 50s. In women adequately or inadequately screened with only normal results between age 51 and age 60, the cumulative incidence of cervical cancer from age 61 to 80 was 1.6 and 2.5 per 1,000 women, respectively, and further screening at age 61-65 was not associated with statistically significant decreases of cervical cancer risk up to age 80, but with fewer cancer cases of advanced stages at age 61-65. Adjustment for potential lifestyle confounders was limited. Conclusions In this study, cervical screening with cytology at age 61-65 was associated with a statistically significant reduction of subsequent cervical cancer risk for women who were unscreened, or screened with abnormalities, in their 50s. In women screened with normal results in their 50s, the risk for future cancer was not sizeable, and the risk reduction associated with continued screening appeared limited. These findings should inform the current debate regarding age and criteria to discontinue cervical screening
Early assessment of the first wave of the COVID-19 pandemic on cancer screening services: The International Cancer Screening Network COVID-19 survey
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Risk of invasive cervical cancer after atypical glandular cells in cervical screening : nationwide cohort study
OBJECTIVES To investigate the risks of invasive cervical cancer after detection of atypical glandular cells (AGC) during cervical screening. DESIGN Nationwide population based cohort study. SETTING Cancer and population registries in Sweden. PARTICIPANTS 3 054 328 women living in Sweden at any time between 1 January 1980 and 1 July 2011 who had any record of cervical cytological testing at ages 23-59. Of these, 2 899 968 women had normal cytology results at the first screening record. The first recorded abnormal result was atypical glandular cells (AGC) in 14 625, high grade squamous intraepithelial lesion (HSIL) in 65 633, and low grade squamous intraepithelial lesions (LSIL) in 244 168. MAIN OUTCOME MEASURES Cumulative incidence of invasive cervical cancer over 15.5 years; proportion of invasive cervical cancer within six months of abnormality (prevalence); crude incidence rates for invasive cervical cancer over 0.5-15.5 years of follow-up; incidence rate ratios compared with women with normal cytology, estimated with Poisson regression adjusted for age and stratified by histopathology of cancer; distribution of clinical assessment within six months after the abnormality. RESULTS The prevalence of cervical cancer was 1.4% for women with AGC, which was lower than for women with HSIL (2.5%) but higher than for women with LSIL (0.2%); adenocarcinoma accounted for 73.2% of the prevalent cases associated with AGC. The incidence rate of invasive cervical cancer after AGC was significantly higher than for women with normal results on cytology for up to 15.5 years and higher than HSIL and LSIL for up to 6.5 years. The incidence rate of adenocarcinoma was 61 times higher than for women with normal results on cytology in the first screening round after AGC, and remained nine times higher for up to 15.5 years. Incidence and prevalence of invasive cervical cancer was highest when AGC was found at ages 30-39. Only 54% of women with AGC underwent histology assessment within six months, much less than after HSIL (86%). Among women with histology assessment within six months, the incidence rate of cervical cancer after AGC was significantly higher than that after HSIL for up to 6.5 years. CONCLUSIONS AGC found at cervical screening is associated with a high and persistent risk of cervical cancer for up to 15 years, particularly for cervical adenocarcinoma and women with AGC at age 30-39. Compared with the reduction in risk of cancer seen after HSIL management, management of AGC seems to have been suboptimal in preventing cervical cancer. Research to optimise management is needed, and a more aggressive assessment strategy is warranted