Organised cervical cancer screening programme in the Belgrade municipality of Cukarica - Evaluation of process indicators.

PURPOSE: To evaluate the process indicators for monitoring the Organized Cervical Cancer Screening Programme (OCCSP) conducted in the Belgrade municipality of Cukarica within the first three-year interval, and to compare Pap test coverage for women aged 25 to 64 before and after implementing the organised programme. METHODS: We analyzed the coverage by invitation, compliance with invitation and coverage by Pap test for the first three-year interval of the OCCSP (20th Dec 2012 - 19th Dec 2015) as well as the results of opportunistic screening for the same period and coverage by Pap test for women aged 25 to 64 for the last three years prior to the implementation of the OCCSP. RESULTS: After the first three years of the OCCSP implementation, coverage by invitation was 42.9%, compliance to invitation 66.7% and coverage by Pap test was 28.6%. During the same period, outside of the program (opportunistic screening) coverage by Pap test was 9.4%. In the last three years prior to the implementation of the OCCSP coverage by Pap test for women aged 25 to 64 was 21.4%. CONCLUSION: After the first three-year interval of the OCCSP implementation, the overall (organised + opportunistic) Pap test coverage for women aged 25-64 has almost doubled compared to the period when we conducted exclusively opportunistic screening (38.4 vs 21.4%). However, incentive payment for the smear takers and better coordination and planning of capacity-building is needed in order to achieve the 75% Pap tests coverage recommended by the National Programme for Early Detection of Cervical Cancer.

Psychological effects of concurrent cytology and colposcopy testing in women referred to cancer counseling outpatient clinic in Belgrade.

PURPOSE: To investigate the psychological effects of PAP smear and colposcopy performed simultaneously and receipt of abnormal tests' results on women's well-being and quality of life (QoL) using different relative questionnaires. METHODS: A prospective cohort study included 324 women with abnormal PAP smear result obtained at the primary care centers, requiring repeat smear test and colposcopy in our hospital. Questionnaires regarding the patient demographic characteristics, 7-point Likert scales which indicate concern about the smear and colposcopy results and risk of developing cervical cancer, Bek Anxiety Inventory (BAI), European QoL questionnaire - Euro QoL (EQ-5D) and visual analogue scale (EQ VAS) were used. Women filled in the questionnaires at the pre-procedural assessment, and again, 7-10 days after testing, just after the reception of results. RESULTS: According to BAI scale, almost one-quarter of women (23.5%) showed mild to severe anxiety; higher level of anxiety had women with abnormal test results (p=0.008). After adjustment for age, the difference reached statistical significance in the follow up period, too (p<0.05). At the pre-procedural assessment, there was no significant difference in the concern about test results (4.09 vs 4.22) and the perceived risk of developing cervical cancer (3.99 vs 4.14) using self-assessment by the Likart scales. However, women with abnormal test results had lower quality of life compared to women with normal PAP smear and colposcopy (mean EQ-VAS score 77.35 ± 15.63 vs 81.14 ± 16.07; p=0.020). CONCLUSIONS: We conclude that referral for evaluation after a first abnormal PAP test leads to anxiety. Close and clear communication about test meaning and its consequences is needed in the organized screening test.

Mortality from cervical cancer in Serbia in the period 1991-2011.

PURPOSE: The aim of this study was to analyze trends of death rates for cervical cancer (CC) on territory of The Republic of Serbia in the period 1991-2011. METHODS: In this descriptive epidemiological study, unpublished data of the Statistical Office of the Republic of Serbia were used for the analysis of mortality due to CC among women in Serbia, from 1991 to 2011. Three different types of rates were calculated: crude, age-specific and age-adjusted rates. The age-standardized rates were calculated by the direct method of standardization using the World Standard Population as standard. The trends were assessed by joinpoint linear regression analysis. An average annual percentage change (AAPC) and the corresponding 95% confidence intervals (CI) were computed for trends. RESULTS: The average age-standardized CC mortality rate (ASCCMR) was 7.03 per 100,000. The lowest value of the ASCCMR was at the beginning of the observed period (6.05 per 100,000) and the highest was 8.17 per 100,000 in 2008. The age-adjusted CC mortality rates have been continuously and significantly increasing (AAPC=+0.7, 95% CI=0.3- 1.1, p<0.05). In all age groups we found increasing trends, except in the age group of 65-74 years. CONCLUSION: Since ASCCMR has been steadily increasing during the period observed, reducing these rates is highly warranted. To achieve this target, an organized CC screening program is essential.

Performance indicators collected from primary health centres included in organised cervical cancer screening programme in the Republic of Serbia.

PURPOSE: To present the performance indicators for monitoring the cervical cancer screening process conducted in primary health centres (PHCs) and to identify any shortcomings in the implementation of the Organized Cervical Cancer Screening Programme (OCCSP). METHODS: This study included 16 PHCs participating in the OCCSP in the Republic of Serbia. The data were analysed from the moment the methodology in the PHCs has been accurately and consistently applied in accordance with the European guidelines (earliest from 20th December 2012 until 30th November 2014). We constructed "the standardised" model (adjusted on the number of working months). Performance indicators analysed in this study were: coverage by invitation, coverage by examination, and compliance with invitation. RESULTS: According to "the standardised" model, coverage by invitation was 61.9%, coverage by examination was 35.5% and compliance to invitation was 57.3%. CONCLUSION: Social mobilization, education, effective promotion strategies and training about cervical cancer screening program-especially in women of target population-as well as better coordination and planning of capacity-building, and staff resources in PHCs, are needed in the future in order to obtain higher values for our performance indicators. Screening registration will provide additional information about demographic characteristics of the tested women.

Quality and efficacy of a telecolposcopy programme.

We tested the performance of telecolposcopy in the diagnosis of various squamous intraepithelial lesions. There were three groups of physicians: Group 1 consisted of 15 gynaecologists who were not trained in colposcopy; Group 2 consisted of six experienced colposcopists (specialists); Group 3 was a supervising team consisting of three experts (colposcopists with more than 15 years of colposcopy experience). The first group took colpophotographs during gynaecological examinations and used a Web browser to compare them with examples from a database of colposcopy findings. Group 2 made their own diagnoses independently. Then the supervising team examined the findings from all 250 patients and made diagnoses that could be considered the 'gold standard'. The findings were identical for Groups 1 and 2 in 219 cases, i.e. an inter-observer agreement of 88%; Cohen's kappa was 0.81. The findings were identical for Groups 1 and 3 in 208 cases, i.e. an inter-observer agreement of 83%; Cohen's kappa was 0.74. The findings were identical for Groups 2 and 3 in 239 cases, i.e. an inter-observer agreement of 96%; Cohen's kappa was 0.93. There was high inter-observer agreement between all participants. However, there were also significant differences in some cases. In the cases of suspected invasive carcinoma, the results showed a significant difference (chi2=4.8, P< 0.005) because gynaecologists from Group 1 were not sure of their diagnosis and they wanted to obtain a second opinion by referring the decision to a higher level.

Fetus sound stimulation: cilia memristor effect of signal transduction.

BACKGROUND: This experimental study evaluates fetal middle cerebral artery (MCA) circulation after the defined prenatal acoustical stimulation (PAS) and the role of cilia in hearing and memory and could explain signal transduction and memory according to cilia optical-acoustical properties. METHODS: PAS was performed twice on 119 no-risk term pregnancies. We analyzed fetal MCA circulation before, after first and second PAS. RESULTS: Analysis of the Pulsatility index basic (PIB) and before PAS and Pulsatility index reactive after the first PAS (PIR 1) shows high statistical difference, representing high influence on the brain circulation. Analysis of PIB and Pulsatility index reactive after the second PAS (PIR 2) shows no statistical difference. Cilia as nanoscale structure possess magnetic flux linkage that depends on the amount of charge that has passed between two-terminal variable resistors of cilia. Microtubule resistance, as a function of the current through and voltage across the structure, leads to appearance of cilia memory with the "memristor" property. CONCLUSION: Acoustical and optical cilia properties play crucial role in hearing and memory processes. We suggest that fetuses are getting used to sound, developing a kind of memory patterns, considering acoustical and electromagnetically waves and involving cilia and microtubules and try to explain signal transduction.

The influence of probiotics on the cervical malignancy diagnostics quality.

BACKGROUND/AIM: Probiotics help to provide an optimum balance in the intestines. Probiotics species competitive block toxic substances and growth of unwanted bacteria and yeast species while they compete for the space and food. Lactogyn is the first oral probiotics on Serbian market dedicated to maintaining a normal vaginal flora. Lactogyn contains two well studied probiotics strains - Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Both of them are considered as probiotic agents with therapeutic properties increase the population of beneficial lactobacillus organisms within the vagina. The aim of this study was to exam an influence of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on results of cervical smear cytological testing including detection of atypical cells, detection of false positive and false negative findings as well as on vaginal microflora content in patients with vaginal infection signs and symptoms. METHODS: Totally 250 women with signs of vaginal infection were selected to participate in the study. The study group comprised 125 patients taking studied probiotic strains along with specific anti-infective therapy. The control group comprised, also, 125 patients taking anti-infective agents, only. Probiotic preparation (Lactogyn capsules) was administered orally (one capsule daily) during 4 weeks. Before and six weeks after beginning of the therapy a cervical smear cytological test (the Papanicolaou test), as well as microbiological examination of the vaginal smear were performed. RESULTS: Number of cases of inflammation and atypical squamous cells of undeterminated significance (ASCUS) in the study group were significantly higher before administration of the probiotic preparation. The number of lactobacilli was significantly higher, and the number of pathogenic microorganisms lower in the group treated with this preparation. CONCLUSION: The application of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 concomitantly with specific anti-infective agents provides more reliable cytological diagnostics, reduces the number of false positive and false negative findings on cervical malignancy and normalizes vaginal microflora in higher percentage of patients with vaginal infections comapred with therapy including antiinfective agents only.

Condylomata gigantea in anal and perianal region: surgical and CO2 laser treatment.

CASE REPORT: We present a case of 28-year-old female patient with condylomata gigantea (Buschke-Lowenstein tumor) in anal and perianal region with propagation on vulva and vagina. The local surgical excision and CO(2) laser treatment were performed. Histological examination showed presence of HPV type 11 without malignant potential. RESULT: Three months later, there was no recurrence.