Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 172
Filtrar
Mais filtros

Base de dados
Tipo de documento
Intervalo de ano de publicação
1.
Qual Life Res ; 30(9): 2509-2520, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33792833

RESUMO

BACKGROUND: Information concerning the health-related quality-of-life (HRQoL) consequences of colposcopy is limited, particularly over time. In a longitudinal study, we investigated women's HRQoL at 4, 8 and 12 months post colposcopy and the factors associated with this. METHODS: Women attending colposcopy at two large hospitals affiliated with the national screening programme in Ireland were invited to complete questionnaires at 4, 8 and 12 months post colposcopy. HRQoL was measured using the EQ-5D-3L and compared across a range of socio-demographic, clinical and attitudinal variables. A mixed-effects logistic multivariable model was employed to investigate associations between these variables and low HRQoL. RESULTS: Of 584 women initially recruited, 429, 343 and 303 completed questionnaires at 4, 8 and 12 months, respectively. The mean overall HRQoL score for the sample across all time points was 0.90 (SD 0.16). Approximately 18% of women experienced low HRQoL at each of the three time points. In multivariable testing, over the entire 12-month follow-up period, non-Irish nationals (OR 8.99, 95% CI 2.35-34.43) and women with high-grade referral cytology (OR 2.78, 95% CI 1.08-7.13) were at higher odds of low HRQoL. Women who were past (OR 0.20, 95% CI 0.07-0.58) or never (OR 0.42, 95% CI 0.16-1.12) smokers were at lower odds of low HRQoL than current smokers. As women's satisfaction with their healthcare increased their odds of experiencing low HRQoL fell (OR per unit increase 0.51, 95% CI 0.34-0.75). CONCLUSIONS: Women's HRQoL did not change over the 12 months post colposcopy, but some subgroups of women were at higher risk of experiencing low HRQoL. These subgroups may benefit from additional support.


Assuntos
Colposcopia , Qualidade de Vida , Feminino , Humanos , Estudos Longitudinais , Gravidez , Qualidade de Vida/psicologia , Encaminhamento e Consulta , Inquéritos e Questionários
2.
AIDS Care ; 30(9): 1189-1196, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29806466

RESUMO

We aim to understand the difference in stigma and discrimination, in particular sexual rejection, experienced between gay and heterosexual men living with HIV in the UK. The People Living with HIV StigmaSurvey UK 2015 recruited a convenience sample of persons with HIV through over 120 cross sector community organisations and 46 HIV clinics to complete an online survey. 1162 men completed the survey, 969 (83%) gay men and 193 (17%) heterosexual men, 92% were on antiretroviral therapy. Compared to heterosexual men, gay men were significantly more likely to report worrying about workplace treatment in relation to their HIV (21% vs. 11%), worrying about HIV-related sexual rejection (42% vs 21%), avoiding sex because of their HIV status (37% vs. 23%), and experiencing HIV-related sexual rejection (27% vs. 9%) in the past 12 months. In a multivariate logistic regression controlling for other sociodemographic factors, being gay was a predictor of reporting HIV-related sexual rejection in the past 12 months (aOR 2.17, CI 1.16, 4.02). Both gay and heterosexual men living with HIV experienced stigma and discrimination in the past 12 months, and this was higher for gay men in terms of HIV-related sexual rejection. Due to the high proportion of men reporting sexual rejection, greater awareness and education of the low risk of transmission of HIV among people on effective treatment is needed to reduce stigma and sexual prejudice towards people living with HIV.


Assuntos
Infecções por HIV/psicologia , Heterossexualidade , Homofobia , Homossexualidade Masculina , Estigma Social , Adolescente , Adulto , Conscientização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual , Inquéritos e Questionários , Reino Unido , Adulto Jovem
3.
Anaesthesia ; 73(3): 356-364, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29437211

RESUMO

Drug errors in the anaesthetic domain remain a serious cause of iatrogenic harm. To help reduce this issue, we explored the potential safety impact of using a simple colour-coded tray for anaesthetic drug preparation and storage. Over a six-month period, three different trained researchers observed 30 cases at three NHS Trusts. Ten observations involved standard drug trays in 'normal' practice, and 20 observations, involved 'Rainbow trays' before and after their introduction. We conducted 20 semi-structured interviews immediately after completing the Rainbow tray observation with the anaesthetists involved. All discussions and detailed notes taken were transcribed, qualitatively analysed using line-by-line coding and then synthesised into narrative themes. We found that using standard, single compartment trays enabled quick, cheap, and portable drug preparation and storage, but was linked to potential or actual harmful errors, such as syringe swaps. Rainbow trays were perceived to be easy to use and effective at all three sites, aiding drug identification and separation, and hence likely to reduce drug error and increase patient safety. We have demonstrated that it is feasible to introduce a new colour-coded compartmentalised Rainbow drugs tray into clinical practice at three NHS hospitals in England. Further research is needed into their effect on the prevalence of drug error.


Assuntos
Anestésicos , Erros de Medicação/prevenção & controle , Armazenamento de Medicamentos , Estudos de Viabilidade , Humanos
4.
Artigo em Inglês | MEDLINE | ID: mdl-27271848

RESUMO

This study investigated how both caregiver and patient factors predict different aspects of burden in colorectal cancer caregivers. One hundred and fifty-three caregiver-survivor dyads separately provided information on patient disease and treatment-related factors, and perceived global health status (EORTC QLQ30), along with caregiver socio-demographic factors, health and care-related activities. Four multiple regression analyses were conducted to assess the influence of caregiver characteristics, patient characteristics and care-related activities on four dimensions of burden from the Caregiver Reaction Assessment scale. Caregiver characteristics significantly predicted health and financial burden (11%-13% of explained variance) with comorbidity and younger age increasing this risk. Patient health, in particular global health status and the presence of a stoma, predicted all burden scores, explaining 14%-22% of variance. Care-related activities was also a significant predictor of all burden scores, explaining an additional 5%-11% of variance, with time involved in caring the most consistent predictor. Results highlight that a combination of factors influence caregiver burden. These results may be used to identify those most at risk, allowing practitioners to deliver tailored effective support. In particular, efforts to alleviate the burden of caring on caregiver schedule may be merited, given that this was the domain in which the burden was greatest.


Assuntos
Cuidadores/economia , Neoplasias Colorretais/economia , Efeitos Psicossociais da Doença , Adulto , Idoso , Sobreviventes de Câncer/psicologia , Cuidadores/psicologia , Saúde da Família/economia , Feminino , Gastos em Saúde , Nível de Saúde , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Análise de Regressão , Apoio Social , Fatores Socioeconômicos , Inquéritos e Questionários
5.
Eur J Cancer Care (Engl) ; 27(2): e12520, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27271027

RESUMO

The purpose of this study was to quantify the general cancer support activities that long-term carers of head and neck cancer (HNC) survivors engage in; and the relationships between these care activities and psychological well-being. Respondents answered a survey detailing their caring activities, the amount of time that they spent on those activities and how comfortable they felt engaging in them. Psychological well-being was assessed by the Depression Anxiety Stress Scales-21. A total of 197 carers took part in the study. The majority (76%) were women, mean age 57.4. Mean time since diagnosis was 6.2 years. In the past month, 45% of carers did not spend any extra time per week helping their relative/friend with general caring activities such as cleaning the house; 31% spent 1-19 hr/week and 23% spent 20 or more hours/week doing so. Most carers were comfortable assisting their relative/friend, though more carers felt uncomfortable assisting with HNC-specific support tasks (31% uncomfortable helping with medication) compared with general support tasks (7% uncomfortable helping with appointments). Feeling uncomfortable with head and neck-specific care tasks was a significant predictor of experiencing depression and anxiety.


Assuntos
Cuidadores/psicologia , Neoplasias de Cabeça e Pescoço/enfermagem , Adulto , Idoso , Ansiedade/etiologia , Transtorno Depressivo/etiologia , Feminino , Neoplasias de Cabeça e Pescoço/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autoeficácia , Apoio Social , Estresse Psicológico/etiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-27726215

RESUMO

We identified patient and disease characteristics associated with (1) "current" physical side-effects of any severity; and (2) "severe" physical side-effects "ever" experienced by 3,348 (54%) prostate cancer (PCa) survivors in Ireland diagnosed 2-18 years previously. Postal questionnaires collected symptoms at diagnosis, post-biopsy complications, comorbidities, primary treatments and physical side-effects post-treatment (urinary incontinence, erectile dysfunction, libido loss, bowel problems, breast changes, hot flushes, and fatigue, "ever" and "current" at time of questionnaire completion). Men were grouped by "early" (localised) and "late" (locally advanced/advanced) disease at diagnosis. Multivariable logistic regression analysis identified patient and disease-related factors associated with post-treatment side-effects. Complications post-biopsy were associated with higher risk of "current" libido loss and impotence. Radical prostatectomy was associated with higher risk of "current" and "severe" incontinence, libido loss and impotence in both early and late disease. In early disease, brachytherapy was associated with lower risk of "current" fatigue and "severe" impotence. Comorbidities were associated with higher risk of "current" experience of four side-effects (incontinence, libido loss, bowel problems, fatigue). Men on active surveillance/watchful-waiting reported lower risk of sexual dysfunction. These findings could inform development of tailored information on side-effects, which, in turn, could inform treatment decision-making and post-treatment monitoring.


Assuntos
Neoplasias da Próstata/terapia , Idoso , Braquiterapia/efeitos adversos , Sobreviventes de Câncer , Disfunção Erétil/etiologia , Fadiga/etiologia , Gastroenteropatias/etiologia , Fogachos/etiologia , Humanos , Irlanda/epidemiologia , Libido , Masculino , Pessoa de Meia-Idade , Irlanda do Norte/epidemiologia , Prevalência , Prostatectomia/efeitos adversos , Neoplasias da Próstata/epidemiologia , Fatores de Risco , Autorrelato , Incontinência Urinária/etiologia , Conduta Expectante
7.
Ann Oncol ; 28(7): 1618-1624, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28383714

RESUMO

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed in late adulthood; therefore, many patients suffer or have suffered from other diseases. Identifying disease patterns associated with PDAC risk may enable a better characterization of high-risk patients. METHODS: Multimorbidity patterns (MPs) were assessed from 17 self-reported conditions using hierarchical clustering, principal component, and factor analyses in 1705 PDAC cases and 1084 controls from a European population. Their association with PDAC was evaluated using adjusted logistic regression models. Time since diagnosis of morbidities to PDAC diagnosis/recruitment was stratified into recent (<3 years) and long term (≥3 years). The MPs and PDAC genetic networks were explored with DisGeNET bioinformatics-tool which focuses on gene-diseases associations available in curated databases. RESULTS: Three MPs were observed: gastric (heartburn, acid regurgitation, Helicobacter pylori infection, and ulcer), metabolic syndrome (obesity, type-2 diabetes, hypercholesterolemia, and hypertension), and atopic (nasal allergies, skin allergies, and asthma). Strong associations with PDAC were observed for ≥2 recently diagnosed gastric conditions [odds ratio (OR), 6.13; 95% confidence interval CI 3.01-12.5)] and for ≥3 recently diagnosed metabolic syndrome conditions (OR, 1.61; 95% CI 1.11-2.35). Atopic conditions were negatively associated with PDAC (high adherence score OR for tertile III, 0.45; 95% CI, 0.36-0.55). Combining type-2 diabetes with gastric MP resulted in higher PDAC risk for recent (OR, 7.89; 95% CI 3.9-16.1) and long-term diagnosed conditions (OR, 1.86; 95% CI 1.29-2.67). A common genetic basis between MPs and PDAC was observed in the bioinformatics analysis. CONCLUSIONS: Specific multimorbidities aggregate and associate with PDAC in a time-dependent manner. A better characterization of a high-risk population for PDAC may help in the early diagnosis of this cancer. The common genetic basis between MP and PDAC points to a mechanistic link between these conditions.


Assuntos
Carcinoma Ductal Pancreático/epidemiologia , Biologia Computacional , Neoplasias Pancreáticas/epidemiologia , Análise de Sistemas , Biologia de Sistemas , Biomarcadores Tumorais/genética , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/genética , Estudos de Casos e Controles , Análise por Conglomerados , Comorbidade , Bases de Dados Genéticas , Europa (Continente)/epidemiologia , Análise Fatorial , Humanos , Modelos Logísticos , Análise Multivariada , Razão de Chances , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Análise de Componente Principal , Medição de Risco , Fatores de Risco , Fatores de Tempo
8.
Psychooncology ; 26(4): 476-483, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27297097

RESUMO

OBJECTIVE: To compare psychosocial outcomes (follow-up related worries and satisfaction with follow-up related information and support) over 30 months of two alternative management policies for women with low-grade abnormal cervical cytology. METHODS: Women aged 20-59 years with low-grade cytological abnormalities detected in the National Health Service Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. A total of 3399 women who completed psychosocial questionnaires at recruitment were invited to complete questionnaires at 12, 18, 24 and 30 months. Linear mixed models were used to investigate differences between arms in the two psychosocial outcomes. Each outcome had a maximum score of 100, and higher scores represented higher psychosocial morbidity. RESULTS: On average, over 30 months, women randomised to colposcopy scored 2.5 points (95%CI -3.6 to -1.3) lower for follow-up related worries than women randomised to cytological surveillance. Women in the colposcopy arm also scored significantly lower for follow-up related satisfaction with information and support (-2.4; -3.3 to -1.4) over 30 months. For both outcomes, the average difference between arms was greatest at 12th- and 18th-month time points. These differences remained when the analysis was stratified by post-school education. CONCLUSIONS: Women with low-grade cytology, irrespective of their management, have substantial initial psychosocial morbidity that reduces over time. Implementation of newer screening strategies, which include surveillance, such as primary HPV screening, need to consider the information and support provided to women. © 2016 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.


Assuntos
Ansiedade/psicologia , Colposcopia/psicologia , Citodiagnóstico/psicologia , Displasia do Colo do Útero/psicologia , Neoplasias do Colo do Útero/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Morbidade , Inquéritos e Questionários , Neoplasias do Colo do Útero/patologia , Adulto Jovem , Displasia do Colo do Útero/patologia
9.
BJOG ; 124(9): 1402-1410, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28374937

RESUMO

OBJECTIVE: To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress. DESIGN: Longitudinal survey. SETTING: Two hospital-based colposcopy clinics. POPULATION: Women with abnormal cytology who underwent colposcopy (±related procedures). METHODS: Questionnaires were mailed to women 4, 8 and 12 months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4 months. Colposcopy-specific distress was measured using the Process Outcome-Specific Measure at all time-points. Linear mixed-effects regression was used to identify associations between physical after-effects and distress over 12 months, adjusting for socio-demographic and clinical variables. MAIN OUTCOME MEASURES: Prevalence of post-colposcopy physical after-effects. Associations between the presence of any physical after-effects, awareness of after-effects, and number of after-effects and distress. RESULTS: Five-hundred and eighty-four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty-two percent of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects = 25%; three after-effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI: 1.10-8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up. CONCLUSIONS: The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress. TWEETABLE ABSTRACT: Experiencing multiple physical after-effects of colposcopy is associated with psychological distress.


Assuntos
Colposcopia/efeitos adversos , Hemorragia/etiologia , Dor Processual/etiologia , Estresse Psicológico/etiologia , Doenças Vaginais/etiologia , Adulto , Colposcopia/psicologia , Feminino , Hemorragia/diagnóstico , Hemorragia/epidemiologia , Hemorragia/psicologia , Humanos , Modelos Lineares , Estudos Longitudinais , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Dor Processual/diagnóstico , Dor Processual/epidemiologia , Dor Processual/psicologia , Prevalência , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Doenças Vaginais/diagnóstico , Doenças Vaginais/epidemiologia , Doenças Vaginais/psicologia
10.
Qual Life Res ; 26(11): 2885-2897, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28653217

RESUMO

PURPOSE: Cost-effectiveness analyses (CEAs) of screening can be highly sensitive to the health-related quality of life (HRQoL) effects of screen tests and subsequent treatment. Accordingly, accurate assessment of HRQoL is essential. We reviewed the literature regarding HRQoL in cervical prevention and management in order to appraise the current evidence regarding this important input to CEA. METHODS: We searched the MEDLINE, Scopus and EconLit databases for studies that estimated HRQoL in cervical cancer prevention and management published January 1995-December 2015. The primary inclusion criterion was for studies that assess HRQoL using the EQ-5D. Data were abstracted from eligible studies on setting, elicitation group, sample size, elicitation instruments, health state valuations, study design and follow-up. We assessed the quality and comparability of the studies with a particular focus on the HRQoL reported across states and groups. RESULTS: Fifteen papers met the inclusion criteria. Most used patient elicitation groups (n = 11), 2 used the general public and 2 used a mix of both. Eight studies were cross-sectional and seven were longitudinal. Six studies used both the EQ-5D-3L and the EQ-VAS together with other measures of overall HRQoL or condition-specific instruments. Extensive heterogeneity was observed across study characteristics. CONCLUSIONS: Our results reveal the challenges of sourcing reliable estimates of HRQoL for use in CEAs of cervical cancer prevention and treatment. The EQ-5D appears insufficiently sensitive for some health states. A more general problem is the paucity of HRQoL estimates for many health states and their change over time.


Assuntos
Análise Custo-Benefício/métodos , Qualidade de Vida/psicologia , Doenças do Colo do Útero , Estudos Transversais , Feminino , Humanos , Programas de Rastreamento , Projetos de Pesquisa , Inquéritos e Questionários , Doenças do Colo do Útero/diagnóstico , Doenças do Colo do Útero/patologia , Doenças do Colo do Útero/prevenção & controle , Doenças do Colo do Útero/terapia
11.
Artigo em Inglês | MEDLINE | ID: mdl-28004448

RESUMO

Head and neck cancer is a serious form of cancer that can generate substantial physical and psychosocial morbidity. Informal caregivers can help patients to manage head and neck cancer and its emotional impacts, both during and after treatment. Caregivers, however, can experience considerable stress as a result of their caring activities. Supportive relationships can protect caregivers from psychosocial strain. Thirty-one head and neck cancer caregivers were interviewed about their experiences of accessing social support from their social networks; difficulties that they experienced accessing this support; and strategies that they used to address these difficulties. Results suggest that head and neck cancer caregivers strongly value social support, but can find it difficult to obtain, and a number of them experience socially negative responses from their networks. Some carers attempt to answer or supplement support deficiencies by turning to non-human coping supports, such as pets, spiritual figures or medication. Implications for theory and practice are discussed.


Assuntos
Cuidadores/psicologia , Neoplasias de Cabeça e Pescoço/psicologia , Rede Social , Apoio Social , Adaptação Psicológica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estresse Psicológico/etiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-28786514

RESUMO

Self-employment-the so-called flexible layer of the economy-has gained importance following the 2007-2008 global economic and financial crisis. In Europe, the self-employed now comprise on average 15% of workers [Eurostat, Labour market and Labour force survey (LFS) statistics, 2016]. Around one-third of self-employed people also provide jobs for others [European Commission, Fact Sheet. 2015 Employment and Social Developments in Europe Review: frequently asked questions, 2016]. Moreover, this group of workers adapts quickly to changing circumstances. In the UK, for instance, recent growth in self-employment is considered to have made an important contribution to labour market recovery [Hatfield, Self-employment in Europe. London, Institute of Public Policy Research, 2015]. Across the European Union self-employment is viewed as a key enabler of sustainable economic growth and, reflecting this, the Europe 2020 strategy encourages member states both to promote self-employment and to remove measures that discourage it [Library of the European Parliament, Self-employment and social security. Effects on innovation and economic growth, 2013].


Assuntos
Sobreviventes de Câncer , Emprego , Neoplasias , Trabalho , Europa (Continente) , Humanos , Previdência Social
13.
BJOG ; 123(1): 24-38, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26099164

RESUMO

BACKGROUND: Although colposcopy is the leading follow-up option for women with abnormal cervical cytology, little is known about its psychological consequences. OBJECTIVES: We performed a systematic review to examine: (1) what, if any, are the adverse psychological outcomes following colposcopy and related procedures; (2) what are the predictors of adverse psychological outcomes post-colposcopy; and (3) what happens to these outcomes over time. SEARCH STRATEGY: Five electronic databases (PubMed, PsychINFO, CINAHL, Web of Science, Scopus) were searched for studies published in English between January 1986 and February 2014. SELECTION CRITERIA: Eligible studies assessed psychological wellbeing at one or more time-points post-colposcopy. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened titles and abstracts. Full texts of potentially eligible papers were reviewed. Data were abstracted from, and a quality appraisal performed of, eligible papers. MAIN RESULTS: Twenty-three papers reporting 16 studies were eligible. Colposcopy and related procedures can lead to adverse psychological outcomes, particularly anxiety. Ten studies investigated predictors of adverse psychological outcomes; management type and treatment had no impact on this. Seven studies investigated temporal trends in psychological outcomes post-colposcopy; findings were mixed, especially in relation to anxiety and distress. Studies were methodologically heterogeneous. CONCLUSIONS: Follow-up investigations and procedures for abnormal cervical cytology can cause adverse psychological outcomes among women. However, little is known about the predictors of these outcomes or how long they persist. There is a need for a more standardised approach to the examination of the psychological impact of colposcopy, especially longer-term outcomes. TWEETABLE ABSTRACT: Follow-up investigations for abnormal cervical cytology can cause adverse psychological outcome among women.


Assuntos
Ansiedade/etiologia , Colposcopia/psicologia , Detecção Precoce de Câncer/psicologia , Estresse Psicológico/etiologia , Displasia do Colo do Útero/psicologia , Neoplasias do Colo do Útero/psicologia , Detecção Precoce de Câncer/instrumentação , Feminino , Humanos , Neoplasias do Colo do Útero/patologia , Displasia do Colo do Útero/patologia
14.
Cytopathology ; 27(4): 269-76, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26932360

RESUMO

OBJECTIVE: To investigate human papillomavirus (HPV) DNA testing and p16/Ki-67 staining for detecting cervical intraepithelial grade 2 or worse (CIN2+) and CIN3 in women referred to colposcopy with minor abnormal cervical cytology low-grade squamous intraepithelial lesions (LSIL) and atypical squamous cells of undermined significance (ASC-US). The clinical performance of both tests was evaluated as stand-alone tests and combined, for detection CIN2+ and CIN3 over 2 years. METHODS: ThinPrep(®) liquid-based cytology (LBC) specimens were collected from 1349 women with repeat LSIL or ASC-US. HPV DNA was performed using Hybrid Capture. Where adequate material remained (n = 471), p16/Ki-67 overexpression was assessed. Clinical performance for detection of histologically diagnosed CIN2+ and CIN3 was calculated. RESULTS: Approximately 62.2% of the population were positive for HPV DNA, and 30.4% were positive for p16/Ki-67. p16/Ki-67 showed no significant difference in positivity between LSIL and ASC-US referrals (34.3% versus 28.6%; P = 0.189). Women under 30 years had a higher rate of p16/Ki-67 compared to those over 30 years (36.0% versus 26.6%; P = 0.029). Overall HPV DNA testing produced a high sensitivity for detection of CIN3 of 95.8% compared to 79.2% for p16/Ki-67. In contrast, p16/Ki-67 expression offered a higher specificity, 75.2% versus 40.4% for detection of CIN3. Combining p16/Ki-67 with HPV DNA improved the accuracy in distinguishing between CIN3 and

Assuntos
Inibidor p16 de Quinase Dependente de Ciclina/biossíntese , Antígeno Ki-67/biossíntese , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Displasia do Colo do Útero/diagnóstico , Adulto , Células Escamosas Atípicas do Colo do Útero/patologia , Colposcopia , Inibidor p16 de Quinase Dependente de Ciclina/genética , Citodiagnóstico , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Antígeno Ki-67/genética , Pessoa de Meia-Idade , Gradação de Tumores , Papillomaviridae/isolamento & purificação , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/genética , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Gravidez , Lesões Intraepiteliais Escamosas Cervicais/genética , Lesões Intraepiteliais Escamosas Cervicais/patologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Esfregaço Vaginal , Adulto Jovem , Displasia do Colo do Útero/genética , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/virologia
15.
BJOG ; 122(3): 380-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24947656

RESUMO

OBJECTIVES: To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up. DESIGN: Cohort study within a randomised controlled trial. SETTING: NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham. POPULATION: Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination. METHODS: Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified. MAIN OUTCOME MEASURES: Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy. RESULTS: The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95% confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative. CONCLUSION: For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.


Assuntos
Colo do Útero/patologia , Colposcopia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Ansiedade , Estudos de Coortes , Colposcopia/psicologia , Feminino , Seguimentos , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde , Encaminhamento e Consulta/organização & administração , Reino Unido , Displasia do Colo do Útero/psicologia , Esfregaço Vaginal
16.
Cytopathology ; 26(3): 178-87, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25099940

RESUMO

OBJECTIVE: Worldwide, each year, large numbers of women are referred for colposcopy following low-grade abnormal cervical cytology. Many have no visible abnormality on examination. The risk of cervical intra-epithelial neoplasia grade 2/3 (CIN2/3) in these women is low. It is unknown whether, for women, a normal colposcopy resolves the anxiety which often follows the receipt of an abnormal cytology result. We investigated the prevalence of adverse psychological outcomes over 30 months following a normal colposcopy. METHODS: This cohort study was nested within the UK TOMBOLA randomized controlled trial. Women aged 20-59 years, with recent low-grade cytology, who had a satisfactory colposcopy examination and normal transformation zone, completed the Hospital Anxiety and Depression Scale (HADS) and Process Outcome Specific Measure (POSM) at recruitment and during follow-up (12, 18, 24 and 30 months post-recruitment). Outcomes included percentages reporting significant anxiety (HADS anxiety subscale score ≥11), significant depression (HADS depression subscale score ≥8) or worries about the result of the next cytology test, cervical cancer, having sex, future fertility and general health at each time point (point prevalence) and during follow-up (cumulative prevalence). RESULTS: The study included 727 women. All psychological measures (except depression) had high prevalence at recruitment, falling substantially by 12 months. During follow-up, the cumulative prevalence of significant anxiety was 27% and significant depression was 21%. The most frequently reported worry was that the next cytology test would be abnormal (cumulative prevalence of 71%; point prevalence of ≥50% at 12 and 18 months). The cumulative prevalence values of worries about cervical cancer, having sex and future fertility were 33%, 20% and 16%, respectively. CONCLUSIONS: For some women who have low-grade cytology, a normal colposcopy does not appear to provide psychological reassurance.


Assuntos
Colposcopia/psicologia , Detecção Precoce de Câncer/psicologia , Displasia do Colo do Útero/psicologia , Adulto , Estudos de Coortes , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Uterinas/diagnóstico , Adulto Jovem
17.
Ann Oncol ; 25(1): 154-9, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24356627

RESUMO

BACKGROUND: Aspirin use has been associated with reduced mortality from cancer including prostate cancer in some studies. A number of anti-cancer mechanisms of aspirin have been proposed, including the inhibition of the cyclooxygenase enzymes, through which aspirin mediates both anti-platelet and anti-inflammatory activities. This cohort study examines associations between pre-diagnostic aspirin use (overall and by dose and dosing intensity) and mortality in men with localised prostate cancer. PATIENTS AND METHODS: Men with stage I-III prostate cancer were identified from Irish National Cancer Registry records, which have been linked to national prescribing data from the Irish General Medical Services scheme. Aspirin use in the year preceding prostate cancer diagnosis was identified from this linked prescription-claims data. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for associations between aspirin use and all-cause and prostate cancer-specific mortality. Associations between prescribed dose and dosing intensity were examined. The presence of effect modification by the type of treatment received and tumour characteristics was also assessed. RESULTS: Two thousand nine hundred and thirty-six men with a diagnosis of stage I-III prostate cancer (2001-2006) were identified (aspirin users, n = 1131). The median duration of patient follow-up was 5.5 years. In adjusted analyses, aspirin use was associated with a small, but non-significant, reduced risk of prostate cancer-specific mortality (HR = 0.88, 95% CI 0.67-1.15). In dose-response analyses, stronger associations with prostate cancer-specific mortality were observed in men with higher aspirin dosing intensity (HR = 0.73, 95% CI 0.51-1.05) and in men receiving >75 mg of aspirin (HR = 0.61, 95% CI 0.37-0.99). Analyses of effect modification by treatment type or tumour characteristics were non-significant. CONCLUSIONS: Consistent with prior studies, aspirin use was associated with a non-significant reduced risk of prostate cancer-specific mortality in men with localised prostate cancer. Men receiving higher doses of aspirin had a statistically significant reduced risk of prostate cancer-specific mortality. These findings regarding an aspirin dose require further investigation.


Assuntos
Aspirina/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Neoplasias da Próstata/mortalidade , Idoso , Aspirina/farmacologia , Estudos de Coortes , Terapia Combinada , Inibidores de Ciclo-Oxigenase/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Neoplasias da Próstata/terapia , Risco , Resultado do Tratamento
18.
Br J Dermatol ; 171(2): 324-31, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24666396

RESUMO

BACKGROUND: Nonmelanoma skin cancer (NMSC) is the most common cancer in white people, but is registered inconsistently by population-based registries. OBJECTIVES: To analyse the changing profile of NMSC in a national population, to interpret evolving patterns of sun exposure and to recommend measures to reduce risk. METHODS: We analysed trends in the demographic, clinical and socioeconomic profile of > 50 000 cases of NMSC registered between 1994 and 2011 by the Irish National Cancer Registry, which aims to register all episodes of NMSC in the Irish population to a high degree of completeness. RESULTS: The incidence of cutaneous basal cell (BCC) and squamous cell carcinoma (SCC) was stable from 1994 to 2002, but increased significantly (BCC more than SCC) in the subsequent decade. The largest relative increases in the incidence of BCC were in younger populations and in clothed body sites. The incidence of both cancers was lower in rural areas. Incidence of BCC and, to a lesser extent, of SCC, increased with increasing affluence in urban, but not in rural, areas. CONCLUSIONS: Recent increases in skin cancers on the trunk and limbs in younger people appear to be related to increasing affluence and consequent leisure-related, episodic sun exposure. This population is at high risk of subsequent skin cancers throughout life and will need active surveillance. As preventive programmes are cost-effective in lowering the incidence of NMSC, they should be targeted at leisure exposure in young people. The recording of consistent international data on NMSC should also be a priority.


Assuntos
Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Neoplasias Primárias Múltiplas/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/prevenção & controle , Carcinoma de Células Escamosas/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/prevenção & controle , Características de Residência/estatística & dados numéricos , Distribuição por Sexo , Neoplasias Cutâneas/prevenção & controle , Fatores Socioeconômicos , Saúde da População Urbana/estatística & dados numéricos , Adulto Jovem
19.
BJOG ; 121(11): 1421-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24690225

RESUMO

OBJECTIVE: To explore emotional responses, and predictors of negative reactions, among women undergoing human papillomavirus (HPV) tests in routine clinical practice. DESIGN: Exploratory qualitative interview study. SETTING: A large busy colposcopy clinic in a Dublin hospital. SAMPLE: Twenty-seven women who had had an HPV DNA test in the previous 6 months following one or more low-grade cytology tests or treatment for cervical intraepithelial neoplasia (CIN). METHODS: In-depth semi-structured interviews were conducted. Interview transcripts were analysed using a thematic approach (Framework Analysis). MAIN OUTCOME MEASURES: Women's emotional responses and predictors of negative emotional reactions. RESULTS: For most women, having a test for high-risk HPV types generated little negative or positive emotional impact. Adverse emotional responses related to HPV infection rather than testing. Factors that influenced whether women experienced negative emotional responses were: concerns over abnormal cytology or diagnosis of CIN; HPV knowledge; awareness of HPV being sexually transmitted; awareness of HPV prevalence; and HPV information needs. Women's concerns about abnormal cytology/CIN dominated all other issues. CONCLUSIONS: These qualitative data suggest that in the context of follow up of abnormal cytology or treatment for CIN, the emotional impact of HPV testing may be modest: women's primary concerns at this time relate to abnormal cytology/CIN.


Assuntos
Ansiedade , Colposcopia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/psicologia , Displasia do Colo do Útero/psicologia , Neoplasias do Colo do Útero/psicologia , Adolescente , Adulto , Colposcopia/psicologia , Aconselhamento , Emoções , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irlanda , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Lesões Pré-Cancerosas/psicologia , Valor Preditivo dos Testes , Pesquisa Qualitativa , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/métodos , Displasia do Colo do Útero/diagnóstico
20.
J Cancer Surviv ; 2024 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-38182936

RESUMO

PURPOSE: We explored survivors' experiences of chronic bowel symptoms following pelvic radiotherapy, strategies employed in living with these symptoms, effects on daily activities, and roles at home and in the workplace. METHODS: Semi-structured interviews were conducted with 28 individuals (10 gynaecological, 14 prostate, four anal/rectal cancer survivors) who had completed pelvic radiotherapy at least six months prior to data collection and who had experience of bowel symptoms during this post-treatment period. Reflexive thematic analysis was undertaken. RESULTS: We propose four themes describing a process leading from experience of symptoms to withdrawal from activities and roles. These are (1) losing control (the experience of unintended anal leakage or discharge); (2) experiencing embarrassment and fear (the experience of embarrassment or fear of embarrassment as a result of discharge becoming public); (3) managing and reacting (acting to reduce the likelihood of discharge or to prevent this becoming public); and (4) restriction and withdrawal (avoiding specific activities or situations so as to reduce or remove the risk of embarrassment). Returning to the workplace presented additional challenges across these themes. CONCLUSIONS: Impacts of chronic bowel symptoms can be severe. Survivors employ a variety of methods and strategies in living with their symptoms. Some of these support continued role fulfilment but some constitute a withdrawal from pre-treatment roles. Current healthcare provision and statutory protections fail to fully meet needs following pelvic radiotherapy. IMPLICATIONS FOR CANCER SURVIVORS: There is a need to develop and implement evidence-based services and supported self-management programmes for survivors experiencing chronic bowel problems post-radiotherapy.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA