Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy

Our objective was to estimate the incidence and identify the risk factors for vaginal vault prolapse repair after hysterectomy. We conducted a case control study among 6,214 women who underwent hysterectomy from 1982 to 2002. Cases (n = 32) were women who required vaginal vault suspension following the hysterectomy through December 2005. Controls (n = 236) were women, randomly selected from the same cohort, who did not require pelvic organ prolapse surgery. The incidence of vaginal vault prolapse repair was 0.36 per 1,000 women-years. The cumulative incidence was 0.5%. Risk factors included preoperative prolapse (odds ratio (OR) 6.6; 95% confidence interval (CI) 1.5-28.4) and sexual activity (OR 1.3; 95% CI 1.0-1.5). Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (OR 0.9; 95% CI 0.5-1.8).Vaginal vault prolapse repair after hysterectomy is an infrequent event and is due to preexisting weakness of pelvic tissue

Incidence and risk factors for reoperation of surgically treated pelvic organ prolapse

Introduction and hypothesis: The objective of our study was to estimate the incidence and to identify the risk factors for reoperation of surgically treated pelvic organ prolapse (POP). Methods: We conducted a nested case-control study among 1,811 women who underwent POP surgery from January 1988 to June 2007. Cases (n = 102) were women who required reoperation for POP following the first intervention through December 2008. Controls (n = 226) were women randomly selected from the same cohort who did not require reoperation. Results: The incidence of POP reoperation was 5.1 per 1,000 women-years. The cumulative incidence was 5.6%. Risk factors included preoperative prolapse in more than two vaginal compartments (adjusted OR 5.2; 95% CI 2.8-9.7), history of surgery for POP and/or urinary incontinence (adjusted OR 3.2; 95% CI 1.5-7.1), and sexual activity (adjusted OR 2.0; 95% CI 1.0-3.7). Conclusions: The risk of POP reoperation is relatively low and is associated with preexisting weakness of pelvic tissue

Litholog generation with the StratigrapheR package and signal decomposition for cyclostratigraphic purposes

To establish an astronomical time scale, it is useful to perform a visual inspection of the lithological evolution, together with proxies record. It allows to have a clear understanding of the expression of Milankovitch cyclicity. However, performing such an inspection can be challenging due to the large amount of data and high spatial resolution required to perform a sound cyclostratigraphic analysis. To address this problem we present the StratigrapheR package in the free software environment R (https://CRAN.R-project.org/package=StratigrapheR). This package is designed to generate lithologs and to deal with stratigraphical information. StratigrapheR takes advantage of the repetitive nature of sections used for cyclostratigraphic purposes to automate as much as possible the litholog generation while still allowing the visualisation of discrepancies (e.g. lateral variations of thickness and irregular stratification boundaries) and of any particular features (e.g. fossil content, sedimentary structures, stratigraphical intervals, etc.). The package furthermore allows to import vector graphics as SVG files, to export the lithologs in PDF and SVG form, to manipulate stratigraphic interval data and to visualise oriented palaeomagnetic data. The lithologs made in StratigrapheR can be plotted at high resolution directly along the results of time series filtering and/or decomposition methods. This is particularly useful for high-frequency components inspection. Empirical Mode Decomposition (EMD) in particular can be used for visual inspection. It allows to compute different components -also called modes- by iteratively subtracting from the signal the mean envelope curves, defined by local minima and maxima. In the isolated modes, each contiguous local extrema are separated by a zero-crossing. This property furthermore allows the determination of instantaneous frequency and amplitude, using for instance the Hilbert transform. EMD typically decomposes standard cyclostratigraphic time series in maximum 15 modes, which allows all the instantaneous ratios of the modes frequencies - taken two by two- to be calculated in a realistic computational time. These instantaneous ratios of frequencies can then be used to find the signature of Milankovitch cycles by identifying relatively higher ratios distributions at values characteristic of the orbital cycles. Specific ratios intervals can then be isolated and linked back to the parts of the signal that are at their source

Stratigraphical reinterpretation of Devonian strata underlying the Mons Basin based on cuttings from the Saint-Ghislain borehole, Hainaut, Belgium

peer reviewe

Awareness of HPV and cervical cancer prevention among Cameroonian healthcare workers

<p>Abstract</p> <p>Background</p> <p>Cervical cancer, although largely preventable, remains the most common cause of cancer mortality among women in low-resource countries.</p> <p>The objective of this study was to assess knowledge and awareness of cervical cancer prevention among Cameroonian healthcare workers.</p> <p>Methods</p> <p>A cross-sectional self-administered questionnaire in 5 parts with 46 items regarding cervical cancer etiology and prevention was addressed to healthcare workers in six hospitals of Yaoundé, Cameroon. The investigators enlisted heads of nursing and midwifery to distribute questionnaires to their staff, recruited doctors individually, in hospitals and during conferences and distributed questionnaires to students in Yaoundé University Hospital and Medical School. Eight hundred and fifty questionnaires were distributed, 401 collected. Data were analyzed with SPSS version 16.0. Chi-square tests were used and P-values < 0.05 were considered significant.</p> <p>Results</p> <p>Mean age of respondents was 38 years (range 20-71 years). Most participants were aware that cervical cancer is a major public health concern (86%), were able to identify the most important etiological factors (58%) and believed that screening may prevent cervical cancer (90%) and may be performed by Pap test (84%). However, less than half considered VIA or HPV tests screening tests (38 and 47%, respectively). Knowledge about cancer etiology and screening was lowest among nurse/midwives.</p> <p>Conclusion</p> <p>Knowledge of cervical cancer and prevention by screening showed several gaps and important misconceptions regarding screening methods.</p> <p>Creating awareness among healthcare workers on risk factors and current methods for cervical cancer screening is a necessary step towards implementing effective prevention programs.</p

Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up

<p>Abstract</p> <p>Backround</p> <p>The transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions.</p> <p>Methods</p> <p>It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris^®, Obtape^®, TVT-O^®). Follow-up information was available for 225 (96.6%) women.</p> <p>Results</p> <p>There were few per operative complications. Forty-eight women (21.3%) reported late complications including <it>de novo </it>or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), <it>de novo </it>dyspareunia (9%), and vaginal erosion (7.6%). The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris^®, Obtape^®and TVT-O^®respectively (P = 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05-0.38, P < 0.001).</p> <p>Conclusion</p> <p>Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.</p