Long-term effectiveness of human papillomavirus vaccines among adult women: A real-world scenario.

OBJECTIVE: This study aimed to determine the real-world effectiveness of bi- or quadrivalent human papillomavirus (HPV) vaccines in Thai adult women ≥5 years post-vaccination in reducing HPV 16/18-associated low-grade squamous intraepithelial lesions or worse (LSIL+), atypical squamous cells of undetermined significance or worse (ASC-US+), and HPV 16/18 positivity. METHODS: A retrospective cohort study was conducted among Thai women aged 20-45 years in Bangkok. The vaccinated and unvaccinated groups were matched according to baseline years. HPV/Pap test results were collected from the medical records and/or obtained by cervical sample collection at the study sites. Adjusted hazard ratios were measured using multivariable Cox regression analyses. RESULTS: A total of 993 participants (493 vaccinated and 500 unvaccinated) were enrolled from 2018 to 2019. The median ages at baseline of the vaccinated and unvaccinated groups were 33 years (interquartile range [IQR] 27-38) and 34 years (IQR 30-38), respectively. The median follow-up periods were 7.3 years (IQR 6.1-8.6) and 7.2 years (IQR 5.8-8.9) for the vaccinated group and the unvaccinated group, respectively. More women in the vaccinated group were single (29.2% vs. 13.2%, P < 0.001) and university graduates (83.2% vs. 75.4%, P = 0.009). The vaccinated and unvaccinated groups had similar personal monthly incomes (>20,000 THB/month, 63.9% vs. 62.4%, respectively, P = 0.685). There were no cases of HPV 16/18-associated LSIL+ in the vaccinated group, whereas there were four cases in the unvaccinated group. HPV vaccine effectiveness was 88.0% (95% CI 2.0-98.5) in the reduction of HPV 16/18-associated ASC-US+, and 84.6% (95% CI 43.5-95.8) in the reduction of HPV 16/18 positivity. CONCLUSIONS: HPV vaccine effectiveness was high in adult women in a real-world scenario in a developing country. Free HPV vaccination in adult women in this age group should be further explored when vaccine supplies are not limited. (HPV: human papillomavirus. LSIL+: low-grade squamous intraepithelial lesion or worse. ASC-US+: atypical squamous cells of undetermined significance or worse).

Neovaginal and Anal High-Risk Human Papillomavirus DNA Among Thai Transgender Women in Gender Health Clinics.

BACKGROUND: Although human papillomavirus (HPV)-related lesions in the neovagina of transgender women have been well documented, information on high-risk HPV (hrHPV) in the neovagina has been very limited. The objective of this study was to determine hrHPV DNA detection rate in the neovagina of transgender women. METHODS: Neovaginal and anal swab were collected in liquid-based cytology fluid from transgender women visiting Gender Health Clinic and Tangerine Community Health Clinic in Bangkok, Thailand. Samples were processed for hrHPV DNA (reported as subtypes 16 and 18 or the pooled result of subtypes 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 66) by automated real-time polymerase chain reaction and for neovaginal cytology according to the Bethesda system. Demographic data and sexual history were obtained, and physical examination was conducted. HIV status was obtained from existing medical records. RESULTS: Samples were collected from 57 transgender women (mean age, 30.4 years [interquartile range, 8 years]). From 35 of 57 valid neovaginal samples, 8 (20%) tested positive for hrHPV DNA. From 30 of 57 valid anal samples, 6 (19.4%) tested positive for hrHPV DNA. HIV status was known for 52 transgender women, 1 of which were HIV infected; neovaginal hrHPV was invalid in that patient. CONCLUSIONS: One of 5 transgender women visiting sexual health clinics in Bangkok was found to have hrHPV DNA in neovaginal and anal compartments. Studies are needed to look at incidence and persistence of hrHPV infection to inform anogenital precancerous and cancerous screening programs for transgender women.

Comparison of an oncology clinical decision-support system's recommendations with actual treatment decisions.

OBJECTIVE: IBM(R) Watson for Oncology (WfO) is a clinical decision-support system (CDSS) that provides evidence-informed therapeutic options to cancer-treating clinicians. A panel of experienced oncologists compared CDSS treatment options to treatment decisions made by clinicians to characterize the quality of CDSS therapeutic options and decisions made in practice. METHODS: This study included patients treated between 1/2017 and 7/2018 for breast, colon, lung, and rectal cancers at Bumrungrad International Hospital (BIH), Thailand. Treatments selected by clinicians were paired with therapeutic options presented by the CDSS and coded to mask the origin of options presented. The panel rated the acceptability of each treatment in the pair by consensus, with acceptability defined as compliant with BIH's institutional practices. Descriptive statistics characterized the study population and treatment-decision evaluations by cancer type and stage. RESULTS: Nearly 60% (187) of 313 treatment pairs for breast, lung, colon, and rectal cancers were identical or equally acceptable, with 70% (219) of WfO therapeutic options identical to, or acceptable alternatives to, BIH therapy. In 30% of cases (94), 1 or both treatment options were rated as unacceptable. Of 32 cases where both WfO and BIH options were acceptable, WfO was preferred in 18 cases and BIH in 14 cases. Colorectal cancers exhibited the highest proportion of identical or equally acceptable treatments; stage IV cancers demonstrated the lowest. CONCLUSION: This study demonstrates that a system designed in the US to support, rather than replace, cancer-treating clinicians provides therapeutic options which are generally consistent with recommendations from oncologists outside the US.

Value and validation of RCOST and TOPF clinical practice guideline for osteoporosis treatment.

OBJECTIVE: To determine the percentage of postmenopausal women who need treatment using the various criteria as set out in clinical practice guideline published by the Royal College of Orthopaedic Surgeons of Thailand (RCOST) and the Thai Osteoporosis Foundation (TOPF). MATERIAL AND METHOD: A cross-sectional investigation conducted at five university hospitals around Thailand, evaluated three categories of criteria according to the RCOST and the TOPF guideline for treatment in postmenopausal women, (1) bone mineral density (BMID) measured by DXA, (2) combined quantitative ultrasonography (QUS) measurement and clinical risk indices (CRI), and (3) FRAX or CRI plus spine radiography. RESULTS: One thousand sixty two woman averaging 60 years of age were recruited for this study. Of those, women with osteoporosis according to DXA, osteopenia plus FRAX, or one major or two minor risk factors comprised between 1 and 22% (category I). Using the QUS T-score in combination with CRI (OSTA or KKOS score < or = -1) or nomogram criteria, between 11 and 14.4% needed treatment (category II). Using the BMI-based FRAX calculation or CRI (OSTA score of < -4 or KKOS probability of > or =80%) plus osteopenia by spine radiograph, between 2.6 and 15.7% needed treatment (category III). CONCLUSION: Using the RCOST and TOPF clinical practice guideline, only one-fifth of postmenopausal Thai women would be eligible to receive treatment.

Clinical responses to the combination of estradiol and drospirenone in symptomatic postmenopausal Thai women.

OBJECTIVES: To investigate the efficacy and tolerability of the oral hormone replacement therapy (HRT) containing 1 mg estradiol (E2) plus 2 mg drospirenone (DRSP) in Thai women with postmenopausal symptoms. MATERIAL AND METHOD: Fifty-five Thai women with postmenopausal symptoms participated in this multicenter, open-label, non-comparative Phase IV study. The primary endpoint was the reduction of hot flushes after 12 weeks of treatment. Secondary endpoints included changes infrequency and intensity of menopausal symptoms as well as safety assessments after 4, 8, and 12 weeks of treatment. RESULTS: Treatment with 1 mg E2 plus 2 mg DRSP reduced the frequency of hot flushes in 94.6% of women at the end of the 12-week treatment period. In 60% of women, the frequency of hot flushes was reduced to 10% or less, compared to baseline findings and 49.1% of women had no remaining hot flushes. Other postmenopausal symptoms such as vaginal dryness, urinary incontinence, dysuria, and dyspareunia improved The most common adverse events were vaginal bleeding or spotting and breast tenderness. CONCLUSION: The oral HRT of 1 mg E2 plus 2 mg DRSP was effective and well tolerated by Thai women suffering from postmenopausal symptoms.

Impact of women's health initiative study on attitude and acceptance of hormone replacement therapy in Thai women attending menopause clinics.

OBJECTIVE: To assess the attitude and acceptance of Thai women attending menopause clinics on hormone replacement therapy (HRT) after the Women's Health Initiative (WHI) publication. MATERIAL AND METHOD: A standardized questionnaire was used to assess attitude and acceptance of HRT in 1,206 women who visited menopause clinics in six hospitals between September 2005 and February 2006. RESULTS: Of the total respondents, 92% were in the age of 40-70 years, 75% were in their peri- and post menopause, 25% were current users and the average duration of hormone use was 5.6 +/- 5.3 years. The women's perception of hormone benefits on osteoporosis prevention, skin improvement, and hot flashes treatment were 39.1%, 31.7%, and 28.9%, respectively. The most common concern of hormone use was malignancy. Hormone side effects were found to be the most common reason for switching hormone regimen. Of all the past users, 85% stopped HRT because they changed to another treatment regimen. Only 3.7% had been aware the WHI, of which 43.5% were influenced by its results. The most common source of HRT information was from doctors. For the ever users, 72.3% had some knowledge about HRT. CONCLUSION: The present survey revealed that very few women had been aware of the WHI study. Nevertheless, the prevalence of HRT current users was lower compared to a prior survey before the WHI publication. Doctors appeared to be the important source of HRT information, which may indirectly have an influence over women's attitude and acceptance on HRT.

Randomized comparison of lower and standard dosages of transdermal estradiol on serum estradiol levels and vaginal maturation index.

OBJECTIVE: To evaluate serum estradiol (E2) in postmenopausal women who received 0.025 mg/d or 0.05 mg/d transdermal estradiol, in an equivalent trial. MATERIAL AND METHOD: One hundred and eight postmenopausal women were randomized into 0.025 mg/d and 0.05 mg/d of transdermal E2 matrix patch. After 12 weeks, serum E2 and vaginal maturation index (VMI) were checked in both groups. Adverse effects, such as breast tenderness, application site reaction, weight gain, and headache, were also assessed. RESULTS: Serum E2 in 0.025 mg/d and 0.05 mg/d groups were 42.43 +/- 35.11 and 48.41 +/- 22.36 pg/mL, respectively. There was no statistically significant difference between the groups. Equivalence was found under CI of +/- 14 pg/mL. Mean value of superficial cells and vaginal maturation index (VMI) were comparable between both groups. Adverse effects seem to be less in the lower dosage group compared to the standard dosage group. CONCLUSION: The lower dosage (0.025 mg/d) of the transdermal E2 matrix system is probably an appropriate treatment option for postmenopausal women who need minimal effective and minimal adverse effects.

Climacteric: concept, consequence and care.

Climacteric is the period of life starting from the decline in ovarian activity until after the end of ovarian function. According to the definition, the period includes peri-menopause, menopause and post-menopause. Climacteric is considered to be a natural change of life which may be accompanied by various health consequences i.e., menopausal symptoms, osteoporosis, coronary heart disease, or Alzheimer's disease. The key concept is that women enter menopause with different menopausal status for instances, natural menopause, surgical menopause, early menopause or even premature ovarian failure. Women may experience various health consequences due to the difference in genetic and environmental interaction. The prevalence and incidence of menopausal problems vary according to ethnic groups. For instance, Asian women seem to have less problems after menopause than their occidental counterparts. Nevertheless, the problems do exist and seem to be increasing due to the longer life expectancy and lifestyle changes of people in the region. Clinical decision in menopausal therapy can be determined according to health risk stratification. Appropriated menopausal therapeutic strategies include medical and non-medical modalities. The non-medical modalities are mainly focussed on lifestyle modification, while the medical modalities are classified as hormone replacement therapy (HRT) and non-HRT. Those in the high risk group will probably benefit most from medication besides lifestyle modification. There are various types, doses, routes and regimens of medication which need to be appropriately matched with the proper women's characteristics. Those who have contraindications to HRT or can not tolerate its side effects may choose other alternatives eg, selective estrogen receptor modulators, bisphosphonates, calcitonin or calcium and vitamin D. The success of menopausal therapy is to give an appropriate therapeutic option to the right woman. The future direction of research will remain focussing on the development in diagnosis and menopausal therapy particularly the main three areas of health promotion, disease prevention and treatment. The trend of research and development will probably be concentrated on new pharmaceutical agents with more specific action and high selectivity in an attempt to maximize its efficacy and safety. Attention may be paid more on the convenience of drug administration to increase its compliance. Alternative medicine and appropriated technologies are also the fields of special interest of which research is underway.