Acceptability of self-sampling and human papillomavirus testing among non-attenders of cervical cancer screening programs in El Salvador

In a cross-sectional study carried out in El Salvador between February 2016 and July 2017, self-sampling and human papillomavirus (HPV) testing was found to be highly acceptable among 2019 women who had not attended a cervical cancer screening in at least 3 years. Within this population, HPV positivity rates differed according to age, marital status, number of children, and lifetime sexual partners. The proportion of women who tested HPV positive or who were diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnoses (CIN2+) was similar to the general population of the area. Among the reasons for failing to participate in previous screening programs, non-attending women described logistic concerns, but also erroneous beliefs regarding HPV and cervical cancer, misconceptions regarding the screening procedure, discomfort with male providers, and confidentiality fears. The aim of this study was to identify opportunities and challenges that emerged from the use of self-sampling and HPV testing as part of a public cervical cancer control effort in a low-resource setting.

Emergency contraception: past, present and future

Women have been using emergency contraception (EC) for decades. Population studies have not shown that increased access to EC decreases abortion rates this is likely because of inconsistent and infrequent use even when it is available. Special populations, such as adolescents, have been shown to be just as good as their adult counterparts in comprehending EC instructions, and its use does not lead to more risky sexual practices or behaviors. There is little evidence on the administration of EC to victims of sexual assault, but what is available reveals more women who are victims of sexual assault should be offered EC as an option. Methods of EC include high doses of ethinyl estradiol; DES; Danzaol; combination ethinyl estradiol with a progestin; progestin alone and copper IUDs. This review describes the history of EC as well as newer medications such as the antiprogestins (gestrinone and uliprisatal acetate) and cyclooxygenase inhibitors(meloxifam). These methods have been added to the armamentarium and may prove to be more effective than current regimens. Finding a product that is highly effective with minimal side effects is a worthy goal, for it presents a woman with her last chance to prevent an unwanted pregnancy.

Regulation of chemokine production in response to pro-inflammatory cytokines in first trimester decidual cells

OBJECTIVE

Chemokines initiate the immune response by controlling leukocyte migration and lymphocyte development. Macrophage infiltration of the decidua has been implicated in the genesis of recurrent miscarriage and preeclampsia. Therefore, we determined whether cultured human decidual cells produce monocyte/macrophage-recruiting chemokines in response to a potent pro-inflammatory cytokine, interleukin-1beta (IL-1beta), and whether decidual cell-conditioned medium contains monocyte- and macrophage-chemoattractant activity.

METHODS

Leukocyte-free first trimester decidual cells were treated for 6h with estradiol (E(2)) and medroxyprogesterone acetate (MPA) to mimic the steroidal milieu of pregnancy, or E(2) and MPA and IL-1beta (1 ng/ml) to mimic inflamed decidua. Total RNA was used for cDNA synthesis. Biotinylated cRNAs were generated and chemically fragmented for hybridization on Affymetrix HG_U133 Plus 2.0 chips followed by fluorescence labeling and optical scanning. Raw data generated from Affymetrix GCOS 1.2 (GeneChip Operating Software) were analyzed by GeneSpring 7.2 software. Subsequently microarray results were validated by real time RT-PCR and Western blotting. A functional study of monocyte migration was carried out also using conditioned media from culture.

RESULTS

Five chemokines responsible for monocyte/macrophage chemoattraction and activation, including C-C motif ligand 2 (CCL2), CCL5, C-X-C motif ligand 2 (CXCL2), CXCL3 and CXCL8, were markedly elevated from 29- to 975-fold after exposure to IL-1beta in cultured first trimester decidual cells. The results of real-time RT-PCR (up-regulation from 43- to 3069-fold) and Western blotting (up-regulation from 15- to 300-fold) confirmed the microarray findings. Monocyte migration was significantly induced by the conditioned medium from IL-1beta-treated decidual cells.

CONCLUSIONS

Treatment of first trimester decidual cells with IL-1beta induces secretion of monocyte/macrophage recruiting-chemokines and promotes monocyte migration. Extrapolation of these in vitro results to the milieu of implantation site suggests a mechanism whereby IL-1beta could mediate excessive macrophage infiltration of the decidua.

Urinary incontinence in gynecological oncology patients

The objective of this study was to investigate the prevalence and significance of urinary incontinence (UI) symptoms in gynecological oncology (GO) patients and to test the gynecologists' proficiency in eliciting these symptoms. A prospective survey using questionnaires was designed. Two faculty practice offices in the United States were chosen for the study. Forty GO patients and 40 general gynecology patients were selected from the most recent outpatient appointments of the two hospitals. We used the Urogenital Distress Inventory and the Incontinence Impact Questionnaire to elicit UI symptoms in GO patients and compared the results with their medical records. A control group, selected from a general gynecological practice, was included for comparison. The main outcome measures were to investigate the prevalence and detection rates of UI in GO patients. GO patients were significantly more likely to report UI symptoms on the questionnaire than their gynecologist was able to elicit during a consultation (P < 0.001). The survey found that 60% (24/40) of the GO patients reported at least one symptom of UI, with 23% complaining of "severe" symptoms. Of those patients who reported the symptoms on questionnaire, only 5% (2/40) were detected at the initial physician assessment (P < 0.01). Eighteen percent of the GO patients reported that the UI symptoms adversely affected their quality of life. The prevalence of symptoms was not associated with the primary cancer site. There was no difference in detection rates between the two practice settings. In a multivariate analysis, there was no factor that emerged as the best discriminator for a positive response to the questionnaire. A significant proportion of GO patients report severe UI symptoms that are not detected by gynecologic oncologists or gynecologists during routine consultations.