Incidence and survival rate of women with cervical cancer in the Greater Amsterdam area

To evaluate the effect of population-based cervical cancer screening on the occurrence of cervical cancer in The Netherlands, we investigated the incidence and survival of cervical cancer registered by a cancer registry in the Greater Amsterdam area. The incidence rate of squamous cell carcinoma decreased significantly from 9.2/100,000 women in 1988 to 5.9/100,000 in 2000 (P<0.001). The incidence rate of adenocarcinomas remained stable. After adjustment for age, stage and lymph node involvement, the relative risk of death was 1.6 times higher for patients with adenocarcinomas than for patients with squamous cell carcinoma (95% CI 1.2-2.1). The decreased survival was related to histological type, as the effect remained significant after correction for confounding factors. Over time, the prognosis of women with squamous cell carcinoma improved significantly. No significant change was observed for women diagnosed with adenocarcinoma. These results suggest that the screening programme in The Netherlands as executed in the Greater Amsterdam area is associated with a decreased incidence and increased survival of patients with squamous cell carcinoma, but fails to detect (pre)malignant lesions of adenocarcinoma. Since more than 92% of adenocarcinomas and its precursors contain high-risk HPV, adding HPV testing to cytologic screening might improve the present screening programme in detecting adenocarcinoma and its precursor lesions

Kinetics of proton transport into influenza virions by the viral M2 channel

M2 protein of influenza A viruses is a tetrameric transmembrane proton channel, which has essential functions both early and late in the virus infectious cycle. Previous studies of proton transport by M2 have been limited to measurements outside the context of the virus particle. We have developed an in vitro fluorescence-based assay to monitor internal acidification of individual virions triggered to undergo membrane fusion. We show that rimantadine, an inhibitor of M2 proton conductance, blocks the acidification-dependent dissipation of fluorescence from a pH-sensitive virus-content probe. Fusion-pore formation usually follows internal acidification but does not require it. The rate of internal virion acidification increases with external proton concentration and saturates with a pKm of ~4.7. The rate of proton transport through a single, fully protonated M2 channel is approximately 100 to 400 protons per second. The saturating proton-concentration dependence and the low rate of internal virion acidification derived from authentic virions support a transporter model for the mechanism of proton transfer

Dual energy x-ray absorptiometry analysis contributes to the prediction of hip osteoarthritis progression

Introduction: To determine if structural bone parameters obtained from dual energy X-ray absorptiometry (DXA) contribute to the prediction of progression of hip osteoarthritis (OA) and to test if the difference between the most affected (OA) hip and the contralateral hip adds to this prediction.Methods: The study group involves a prospective cohort of 189 patients that met the American College of Rheumatology (ARC) classification criteria for hip osteoarthritis. Progression was defined as 20% joint space narrowing or total hip replacement within a two years follow up. Software was developed to calculate geometrical aspects and bone mineral density (BMD) in different regions of interest of the proximal femur. Logistic regression was used to test if Kellgren and Lawrence (K-L) scores and DXA parameters can predict progression of OA. Models were compared using -2log likelihood tests, R2Nagelkerke and areas under the Receiver Operator Characteristic curves, assessed using 10-fold cross validation.Results: The model that included the DXA variables was significantly better in predicting hip OA progression than the model with K-L score of the affected side

Long-term protective effect of high-risk human papillomavirus testing in population-based cervical screening

We prospectively evaluated the 5-year predictive values of adding high-risk human papillomavirus (hrHPV) testing to cytology for the detection of ⩾cervical intraepithelial neoplasia (CIN)3 lesions in a population-based cohort of 2810 women. At baseline, nine (0.3%) women had prevalent lesions ⩾CIN3, all being hrHPV positive. After 5 years of follow-up, four (6.5%) of the 62 hrHPV-positive women with normal cytology developed lesions ⩾CIN3, vs only one (0.05%) of the 2175 hrHPV-negative women with normal cytology. High-risk human papillomavirus testing or combined screening revealed a much higher sensitivity, at the cost of a small decrease in specificity, and a higher negative predictive value for the detection of lesions ⩾CIN3 till the next screening round (5 years) than cytology alone

Stroke patients’ motivation for home-based upper extremity rehabilitation with eHealth tools

Purpose: eHealth-based exercise therapies were developed to increase stroke patients’ adherence to home-based motor rehabilitation. However, these eHealth tools face a rapid decrease in use after a couple of weeks. This study investigates stroke patients’ motivation for home-based upper extremity rehabilitation with eHealth tools and their relation with Basic Psychological Needs. Materials and methods: This is a qualitative study using thematic analysis. We conducted semi-structured interviews with stroke patients with upper extremity motor impairments, who were discharged home from a rehabilitation centre, after they interacted with a novel eHealth coach demonstrator in their homes for five consecutive days. Results: We included ten stroke patients. Thematic analysis resulted in eight themes for home-based rehabilitation motivation: Curiosity, Rationale, Choice, Optimal challenge, Reference, Encouragement, Social Support and Trustworthiness. Those themes are embedded into three Basic Psychological Needs: “Autonomy”, “Competence”, and “Relatedness”. Conclusion: Eight motivational themes related to the three Basic Psychological Needs describe stroke patients’ motivation for home-based upper extremity rehabilitation. We recommend considering those themes when developing a home-based eHealth intervention for stroke patients to increase the alignment of eHealth tools to the patient’s needs and reduce motivational decreases in home-based rehabilitation.</p

Extended duration of the detectable stage by adding HPV test in cervical cancer screening

The human papillomavirus test (HPV) test could improve the (cost-) effectiveness of cervical screening by selecting women with a very low risk for cervical cancer during a long period. An analysis of a longitudinal study suggests that women with a negative Pap smear and a negative HPV test have a strongly reduced risk of developing cervical abnormalities in the years following the test, and that HPV testing lengthens the detectable stage by 2-5 years, compared to Pap smear detection alone

The prevalence of cleft in the Netherlands and Northern Netherlands in 1997-2007:Trend analysis of data from three Dutch registries

Objective. To investigate the prevalence of oral cleft live births in the Netherlands, we analyzed time-trends in the Netherlands and Northern Netherlands (NNL) over the period 1997-2007 and stratified these trends by cleft category (cleft lip/alveolus ± cleft palate: CL±P; cleft palate only: CP). Methods. Patients born alive with oral clefts in the Netherlands during 1997-2007 were included from three Dutch registries on congenital anomalies/oral clefts. The estimated annual percentage change (EAPC) in prevalence was calculated using Poisson regression. Results. The overall prevalence of oral clefts per 10,000 live births was 16.6 in the Netherlands and 21.4 in NNL. During 1997-2007, the live-birth prevalence of oral clefts in the Netherlands decreased significandy (EAPC -2.0%; 95% CI: -3.0% to -0.90%), as did the CL±P prevalence (EAPC -2.1%; 95% CI: -3.4% to -0.80%), while no significant trend in CP was found. The rates of the region NNL showed no significant trends. Discussion. The national decrease in prevalence may be explained by two hypotheses: 1) greater prenatal detection of congenital anomalies including oral clefts has led to more pregnancy terminations; and 2) increased periconceptional folic acid use has reduced the risk of oral clefts. Both hypotheses would mainly apply to the category CL±P, since, unlike CP, this category can be detected prenatally by 2D ultrasound and develops during the period recommended for folic acid use. Conclusion. Because the CL±P prevalence in the Netherlands decreased, that of all oral clefts decreased. Although the rates in the region NNL were higher, they showed no significant trends

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

We followed 353 women referred with abnormal cervical cytology in a non-intervention cohort study. In 91 pregnant women we compared high-risk human papilloma virus rates in the subsequent trimesters and postpartum in comparison to 262 non-pregnant women. High-risk human papilloma virus clearance was compared with 179 high-risk human papilloma virus positive non-pregnant women. Our main questions were: (1) do high-risk human papilloma virus rates change during pregnancy?; and (2) is there any difference between high-risk human papilloma virus clearance in pregnant and non-pregnant women? Women were monitored 3–4 monthly by cytology, colposcopy, and high-risk human papilloma virus testing. The median follow-up time was 33 months (range 3–74). Non-pregnant women showed prevalence rates of high-risk human papilloma virus of 64, 57, 53, and 50%, respectively, in four subsequent 3-months periods since the start of the study. These high-risk human papilloma virus rates were higher than in the three trimesters of pregnancy, and during the first 3 months postpartum, i.e. 50, 44, 45, and 31%, respectively. Postpartum only, this difference was statistically significant (P=0.004). Paired comparisons of high-risk human papilloma virus prevalence rates of the different trimesters with the postpartum rate showed (McNemar test) decreased rates: first trimester: 18% (P=0.02), second trimester: 13% (P=0.02) and third trimester: 23% (P<0.005). Such a phenomenon was not found in non-pregnant women. Pregnant women showed a trend for increased high-risk human papilloma virus clearance during the third trimester and postpartum compared to non-pregnant women (hazard ratios 3.3 (0.8–13.7) and 4.6 (1.6–12.8), respectively). These results suggest a lowered immune-response against human papilloma virus during the first two trimesters of pregnancy with a catch-up postpartum

Design strategies for promoting young children’s physical activity: A playscapes perspective

This paper develops a set of design strategies for promoting young children’s physical activity. These strategies are developed by taking the design perspective of Playscapes as a starting point. Playscapes suggests that three play qualities are key in promoting young children’s physical activity: free, bodily, and dispersed play. We present two field studies in a pediatric oncology center, in which we observed how these play qualities were reflected in children’s interactions with two Playscape designs: Stickz, a collection of branch-shaped objects, were placed in a semi-public waiting area; Fizzy, a self-propelled robotic ball, was introduced to patient rooms. Free play was analyzed according to the diversity of play activities, bodily play according to the diversity and exertion level of bodily movements, and dispersed play according to the floor area covered. Based on the findings, we discuss how Fizzy and Stickz contributed to each play quality, and derive a set of design strategies that can be applied in different contexts to stimulate young children’s physical activity. With these strategies, Playscapes offers a concrete alternative to existing approaches, supporting designers in directing interactions towards physical activity while leaving room for children’s unstructured and spontaneous play