Long-term CIN3 risk in women with abnormal cytology; Role of hrHPV testing

Background: Many studies have examined the short-term value of high-risk human papillomavirus (hrHPV) testing in predicting cumulative risk of cervical intraepithelial neoplasia grade 3 or cancer (CIN3). This study focuses on long-term CIN3 risk after initial wait and see policy. Methods: A total of 342 women with abnormal cytology of borderline/mild dyskaryosis (BMD) or worse (>BMD), included between 1990 and 1992, were followed-up by cytology and hrHPV testing until 1996 and monitored by cytology thereafter. Primary endpoint was cumulative CIN3 risk by December 2009.Results:Women with BMD had a 5-year CIN3 risk of 22.5% (95% confidence interval (CI) 17.0-29.1) and of 0.7% (0.1-4.5) in the subsequent 5 years. High-risk human papillomavirus-negative women with BMD had a 5-year risk of <0.01% (95% CI <0.0-5.1) and of 0.01% (0.0-5.7) in the following 5 years, while for hrHPV-positive women these risks were 37.5% (29.0-46.9) and 1.6% (0.2-9.5), respectively. Women with BMD< had a 5-year risk of 45.1% (36.4-54.1) and of 3.5% (0.9-12.2) in the subsequent 5 years. High-risk human papillomavirus-negative women with < BMD had a 5-year risk of 7.3% (2.0-23.6) and hrHPV-positive women of 56.6% (46.4-66.3). Conclusion: Women with BMD have an elevated CIN3 risk for 5 years only; afterwards their risk is similar to the general population. High-risk human papillomavirus-negative women with BMD may return to regular screening directly. All other women with ≥ BMD should be referred for additional testing and/or colposcopy

Tranquil or desolate:A mixed-methods investigation of patient sound experiences, needs and emotions in single patient ICU rooms

Aims: The sound environment, or soundscape, of intensive care units (ICUs) can be stressful for patients. Soundscapes are defined as acoustic environments as perceived by people. Single-patient rooms mitigate noise, but may deprive patients of essential auditory cues. This might harm basic psychological needs, such as safety. Experiences, needs and emotions regarding soundscapes of single-patient ICU rooms remain unexplored. We aimed to understand how patients experienced these soundscapes. Methods: This mixed-methods, single-center study involved semi-structured interviews and questionnaires five days after ICU discharge. Patients experienced the soundscapes during their ICU stay, shared experiences in interviews, and selected one to rate on need fulfilment (with a researcher-developed questionnaire), and emotions (with a validated questionnaire). Using thematic analysis, we analyzed interview transcripts by labelling sound-related experiences, sounds, and emotions. Findings: We interviewed 26 patients. We labelled 259 sound-related experiences, 264 sounds, and 281 emotions, from which six themes emerged: Orientation through sound; Coping with disruptions; Human auditory presence; Monotony and variation; Associations and hallucinations; Communication behind closed doors. Eight patient-selected experiences involved positive emotions. Need fulfilment scores varied: scores were low for communication-related experiences, but relatively high for those involving human presence. Conclusions: Our findings demonstrated that experiences with single-patient ICU room soundscapes can be positive or negative. For future implementation of such rooms, three insights merit consideration: positive sounds originating from corridors may be unnecessarily removed; alarms in single-patient rooms serve key supportive functions for patients; there is a lack of accessible and appropriate auditory stimulation. We recommend that these insights are taken into consideration to ensure more positive and restorative ICU stays. Implications for Clinical Practice: In ICUs, balanced approaches that consider both positive and negative aspects of soundscapes may benefit patients in future interventions for noise mitigation. Diversifying the variety of sounds inside patient rooms could further support well-being.</p

From a Morning Forest to a Sunset Beach:Understanding Visual Experiences and the Roles of Personal Characteristics for Designing Relaxing Digital Nature

Nature experiences, especially the visual aspects of nature, have been widely used to facilitate relaxation. Fueled by digital technology, simulated visual nature experiences have gained popularity in creating healing environments that induce relaxation. However, while easily applicable, not all nature-imitating visuals lead to relaxation. How to effectively design relaxing visual nature experiences remains largely unexplored. This paper investigates how different nature qualities facilitate relaxing visual experiences and the roles of two personal characteristics (mood and nature-relatedness) play. Through an online survey and interviews, we assessed 16 nature video clips, representing eight distinctive nature qualities, and compared perceived experiences while considering the influence of personal characteristics. The results indicate four types of visual qualities (engaging, instinctive, ambient, and derivative) underlying nature-induced relaxation, and show that nature relatedness influences the degree to which nature video clips elicit relaxation. We discuss design implications for creating personalized digital nature

Polycystic ovary syndrome

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) - with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.Robert J Norman, Ruijin Wu and Marcin T Stankiewic

Listening to the patient as a possible route to cost-effective rehabilitation: a case report

<p>Abstract</p> <p>Introduction</p> <p>Adolescents with cerebral palsy often do not need a specific rehabilitative treatment; however, when specific needs are expressed, clinicians should listen and try to answer them.</p> <p>Case presentation</p> <p>We present the case of a 17-year-old Italian male patient with hemiplegia who had received standard physiotherapy and, ultimately, after a period of adapted physical activity performed in a group, was under consideration for discharge. However, due to unsatisfactory hand control, he asked for help to reach a personal goal, the ability to drive a motorbike, without surgery. Functional taping showed efficacy, but was neither cost-effective nor practical for the patient and his family; by contrast, a dynamic orthosis associated with training in a real-life environment was instead successful.</p> <p>Conclusion</p> <p>The present case underlines the importance of considering solutions involving the motivation and compliance of the patient in order to improve his activity and participation.</p

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

European Consensus Statement on Expert Colposcopy

Peer reviewedPublisher PD

Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy

Background: Optimal endocrine therapy for premenopausal breast cancer patients after chemotherapy requires accurate menopausal status assessment. Current methods for determining resumption of ovarian function after chemotherapy are suboptimal. This study aims to evaluate the predictive value of pretreatment anti-Müllerian hormone (AMH) serum levels for predicting resumption of ovarian function after chemotherapy (CT). Methods: This prospective study included premenopausal women with hormone receptor-positive breast cancer undergoing CT. AMH was measured using the picoAMH assay of Anshlabs. The primary outcome was resumption of ovarian function, defined as menstrual cycle resumption or estradiol levels above 110 pmol/L within 24 months after CT. Results: Among 109 patients, pretreatment AMH was a strong predictor of resumption of ovarian function (AUC 0.86) and an optimal cut-off of 0.62 μg/L was calculated. AMH &gt;0.62 μg/L identified women at higher risk for ovarian function resumption (sensitivity 69.9 %, specificity 88.5 %), with a false negative rate of 11.5 % and false positive rate of 30.1 %. Combining AMH and age improved predictive accuracy only slightly. No additional predictors were identified. Survival analysis confirmed that women with low pretreatment AMH (&lt;0.62 μg/L) or older age (&gt;40.2 years) experienced significantly less frequent and delayed ovarian function resumption. Conclusion: Pretreatment AMH is a valuable tool for predicting ovarian function resumption after chemotherapy in breast cancer patients, so that a GnRH agonist can be recommended appropriately. However, the predictive value of pretreatment AMH for permanent ovarian insufficiency is too limited to determine the postmenopausal status sufficiently accurately to switch upfront to another endocrine treatment, the aromatase inhibitors.</p

Detection of child abuse in emergency departments: a multi-centre study

Objective: This study examines the detection rates of suspected child abuse in the emergency departments of seven Dutch hospitals complying and not complying with screening guidelines for child abuse. Design: Data on demographics, diagnosis and suspected child abuse were collected for all children aged ≤18 years who visited the emergency departments over a 6-month period. The completion of a checklist of warning signs of child abuse in at least 10% of the emergency department visits was considered to be compliance with screening guidelines. Results: A total of 24 472 visits were analysed, 54% of which took place in an emergency department complying with screening guidelines. Child abuse was suspected in 52 children (0.2%). In 40 (77%) of these 52 cases, a checklist of warning signs had been completed compared with a completion rate of 19% in the total sample. In hospitals complying with screening guidelines for child abuse, the detection rate was higher (0.3%) than in those not complying (0.1%, p<0.001). Conclusion: During a 6-month period, emergency department staff suspected child abuse in 0.2% of all children visiting the emergency department of seven Dutch hospitals. The numbers of suspected abuse cases detected were low, but an increase is likely if uniform screening guidelines are widely implemented