Estimation of Pap-test coverage in an area with an organised screening program: challenges for survey methods

BACKGROUND: The cytological screening programme of Viterbo has completed the second round of invitations to the entire target population (age 25–64). From a public health perspective, it is important to know the Pap-test coverage rate and the use of opportunistic screening. The most commonly used study design is the survey, but the validity of self-reports and the assumptions made about non respondents are often questioned. METHODS: From the target population, 940 women were sampled, and responded to a telephone interview about Pap-test utilisation. The answers were compared with the screening program registry; comparing the dates of Pap-tests reported by both sources. Sensitivity analyses were performed for coverage over a 36-month period, according to various assumptions regarding non respondents. RESULTS: The response rate was 68%. The coverage over 36 months was 86.4% if we assume that non respondents had the same coverage as respondents, 66% if we assume they were not covered at all, and 74.6% if we adjust for screening compliance in the non respondents. The sensitivity and specificity of the question, "have you ever had a Pap test with the screening programme" were 84.5% and 82.2% respectively. The test dates reported in the interview tended to be more recent than those reported in the registry, but 68% were within 12 months of each other. CONCLUSION: Surveys are useful tools to understand the effectiveness of a screening programme and women's self-report was sufficiently reliable in our setting, but the coverage estimates were strongly influenced by the assumptions we made regarding non respondents

The method of mothers for non-overlapping non-matching DDM

In this paper we introduce a variant of the three-field formulation where we use only two sets of variables. Considering, to fix the ideas, the homogeneous Dirichlet problem for −∆ u = g in Ω, our variables are i) the approximations of u in each sub-domain (each on its own grid), and ii) an approximation ψ of u on the skeleton (the union of the interfaces of the sub-domains) on an independent grid (that could often be uniform). The novelty is in the way to derive, from ψ , the values of each trace of us on the boundary of each subdomain. We do it by solving an auxiliary problem that resembles the mortar method but is more flexible. Under suitable assumptions, quasi-optimal error estimates are proved, uniformly with respect to the number and size of the subdomains

Genres et avant-gardes

Après avoir longtemps négligé la présence des femmes dans l’histoire littéraire et artistique, l’historiographie s’intéresse à elles depuis déjà trois décennies, en particulier dans le cadre des études sur les avant-gardes de la première moitié du xxe siècle. De ce point de vue, ce volume ne vient pas combler un vide mais poursuivre et enrichir une recherche déjà engagée en réfléchissant aux façons dont s’articulent, dans les textes théoriques et les pratiques artistiques des avant-gardes européennes de la première moitié du xxe siècle, des questionnements sur les genres littéraires et artistiques et des questionnements liés au genre sexué (ce que l’anglais désigne par le terme de gender). Si ces mouvements d’avant-garde ont cherché à bouleverser la société, quelle place ont-ils faite en leur sein aux femmes artistes et écrivains ? Comment ont-ils pensé les relations entre les sexes ? Y-a-t-il des genres littéraires et artistiques spécifiques pratiqués par les femmes et/ou par les hommes ? Peut-on identifier dans les avant-gardes un discours genré sur les différents genres et pratiques artistiques ? Telles sont certaines des questions auxquelles ce volume cherche à apporter des réponses

HPV triage for low grade (L-SIL) cytology is appropriate for women over 35 in mass cervical cancer screening using liquid based cytology

In the experimental arm of a randomised trial, women were tested both for liquid-based cytology and human papillomavirus (HPV) DNA and referred for colposcopy if cytology was ASCUS (atypical cells of undetermined significance) or more severe. We considered those with ASCUS (757) or LSIL (low-grade squamous intraepithelial lesions) (485) and a valid HPV test who received colposcopy. We computed sensitivity, specificity and ROC curves with different values of relative light units (RLU, that are related to viral load) as cut off, using cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) at blind histology review as the endpoint. The area under the receiver operating characteristic (ROC) curve was significantly less among women aged 25–34 years than in those older, both considering ASCUS/AGUS (atypical glandular cells of undetermined significance) (p = 0.0355) and LSIL (p = 0.0009). At age 35–60 the curves for ASCUS and LSIL were similar, while at age 25–34 the area under the curve for LSIL was significantly less than for ASCUS (p = 0.0084). With LSIL cytology, specificity of Hybrid Capture 2 with 2 RLU cut-off was 35.0% (95%CI 28.4–42.1) at age 25–34 and 64.5% (95%CI 58.3–70.3) at age 35–60. In conclusion, triaging by HPV testing performed better in women aged over 35 years than those younger. For older women, HPV triaging should also be considered for managing those with LSIL cytology