Made available in DSpace on 2017-07-24T19:22:05Z (GMT). No. of bitstreams: 1 THAYNARA BOING.pdf: 2103458 bytes, checksum: e706074b69bce3f72ba788d2a4560bc1 (MD5) Previous issue date: 2017-04-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of this systematic review was to compare the clinical effectiveness of non-carious cervical restorations with glass ionomer cement /resin-modified glass ionomer cement (GIC/RMGIC) or composite resin (CR). The following factors were analyzed: retention rates, color, surface texture, marginal adaptation, marginal discoloration and secondary caries. Methods:According to the PRISMA guidelines, systematic review was undertaken using a selection process in two phases, different references were identified and articles were included for qualitative analysis and were included in a meta-analysis. The authors searched the following electronic database: Cochrane, Lilacs, BBO, Pubmed, Scopus and Web Of Science. Additional search of grey literature was performed. Were also searched the abstracts from the IADR (1990-2015), ongoing trials in trials registries, the CAPES database for theses and the ProQuest database for theses and dissertations. We included only randomized clinical trials. Quality of the evidence for each outcome was assessed using the GRADE tool. Results: A total of 1530 articles were identified, but only 19 articles from 15 studies remained for analysis, which were all judged at “unclear” risk of bias. Ten of the 15 studies evaluated resin-modifed glass ionomer cements, (GIC/RMGIC) that showed higher retention rates in all follow-ups (1 to 3 years; p < 0.0001 and at 5 years; p< 0.00001). No difference was observed for marginal discoloration, marginal adaptation and secondary caries in all followups (p > 0.05). CR showed better color match than GIC/RMGIC only at 2 years (p = 0.03). Higher surface texture was observed in GIC/RMGIC in all follow-ups (at 1 year p= 0.0003; at 3 years p = 0.0004). Quality of evidence was graded as moderate or low due to the unclear risk of bias and imprecision in some outcomes. Conclusions: The retention rates of GIC/RMGIC were superior to composite resins in all study follow-ups, but a higher surface texture was observed in the GIC/RMGIC compared to CR. / Comparar a efetividade clínica de restaurações cervicais não cariosas com cimento de ionômero de vidro / cimento de ionômero de vidro modificado por resina (CIV/CIVMR) ou à base de resina composta (RC). Por meio de revisão sistemática da literatura, os seguintes fatores foram analisados: taxas de retenção, cor, textura de superfície, adaptação marginal, descoloração marginal e cárie secundária. Métodos: De acordo com a orientação do PRISMA, a revisão sistemática foi realizada utilizando um processo de seleção em duas fases, identificaram-se diferentes referências e os artigos foram incluídos para uma análise qualitativa e posteriormente meta– análises. Os autores pesquisaram nas seguintes bases de dados: Cochrane, Lilacs e BBO, Pubmed, Scopus e Web Of Science. Uma pesquisa adicional na literatura cinzenta foi realizada. Foram pesquisados também os resumos do IADR (1990-2015), os ensaios em andamento nos registros de ensaios clínicos, as bases de dados CAPES e ProQuest para teses e dissertações. Foram incluídos apenas ensaios clínicos randomizados. A qualidade da evidência para cada resultado foi avaliada usando a ferramenta GRADE. Resultados: Foram identificados 1530 artigos, mas apenas 19 artigos de 15 estudos (4 de acompanhamento de estudos anteriores) permaneceram para análise, os quais foram todos julgados com risco de viés "moderado". Dez dos 15 estudos avaliaram CIVMR. Os CIV/CIVMR apresentaram maiores taxas de retenção em todos os seguimentos (1 a 3 anos, p <0,0001 e 5 anos, p <0,00001). Não houve diferença para descoloração marginal, adaptação marginal e cárie secundária em todos os seguimentos (p> 0,05). A RC mostrou melhor estabilidade de cor do que CIV/CIVMR apenas aos 2 anos (p = 0,03). Observou-se maior rugosidade no CIV/CIVMR em todos os acompanhamentos (1 ano p = 0,0003, aos 3 anos p = 0,0004). A qualidade da evidência foi classificada como moderada ou baixa, devido ao risco indefinido de viés e imprecisão em alguns resultados. Conclusões: As taxas de retenção de CIV/CIVMR foram superiores às resinas compostas em todos os acompanhamentos do estudo, mas observou-se maior textura superficial nesses CIV/CIVMR em relação às RCs.

OBJETIVO: O objetivo do presente estudo é comparar o poder da medida do comprimento do colo uterino quando obtida no período de 18-21 semanas com a obtida no período de 22-25 semanas de gestação na predição do parto prematuro espontâneo em gestações gemelares e analisar o valor do encurtamento cervical observado entre essas duas medidas. MÉTODO: estudo retrospecto envolvendo 383 gestantes gemelares que foram avaliadas entre a 18ª e a 21ª semanas (GRUPO 1- 241 pacientes) e a 22ª e a 25ª semanas de gestação (GRUPO 2- 266 pacientes). Esses dois períodos foram avaliados de maneira independente e as pacientes foram incluídas em um deles ou em ambos, com ao menos 3 semanas entre os exames. Pacientes incluídas nos dois períodos (GRUPO 3- 124 pacientes) permitiram a análise do encurtamento cervical. Não foram incluídas gestações com as seguintes complicações: síndrome da transfusão feto-fetal, poliidrâmnio, malformação fetal, patologia uterina, gestações submetidas a procedimento invasivo, cerclagem uterina, parto prematuro eletivo e os casos em que não foi possível obter o desfecho da gestação. O parâmetro avaliado foi o comprimento do colo. Curvas ROC foram usadas para comparar a capacidade de predição do parto prematuro. Na determinação de sensibilidade, especificidade, VPP e VPN foi usado como ponto de corte o 5º percentil do comprimento do colo determinado por Fujita et al (2002) em nossa população. RESULTADO: GRUPO 1- o comprimento médio do colo com 19,5 semanas (IG média no grupo) foi 38,2 ±8,7 mm. A taxa de PPE (parto prematuro espontâneo) abaixo de 28, 30, 32 e 34 semanas de gestação foi 3,7%, 6,2%, 7,8% e 16,1%, respectivamente. A incidência de colo curto foi (14/241) 5,8%. Análise da curva ROC revelou área sob a curva de 0,64 (CI95% 0,53-0,75). Sensibilidade de 33,3%, 33,3%, 30% e 23% e VPN de 97,3%, 95,6%, 93,8% e 86,8% para parto abaixo de 28, 30, 32, e 34 semanas de gestação foram obtidos. GRUPO 2- o comprimento médio do colo com 23,3 semanas (IG média no grupo) foi 35,6 ±10,5 mm. A taxa de PPE abaixo de 28, 30, 32 e 34 semanas de gestação foi 2,6%, 5,2%, 7,1% e 12,8%, respectivamente. A incidência de colo curto foi (22/266) 8,2%. Análise da curva ROC revelou área sob a curva de 0,80 (CI95% 0,72-0,88), e essa área é maior do que a do GRUPO 1 (p0,001). Sensibilidade de 71,4%, 57,1%, 52,6% e 38,2% e VPN de 99,1%, 97,5%, 96,3% e 91,4% para parto abaixo de 28, 30, 32, e 34 semanas de gestação foram obtidos. GRUPO 3- Análise da curva ROC revelou área sob a curva de 0,81 (CI95% 0,73-0,89). O melhor ponto de corte para encurtamento cervical foi dado pelo joelho de curva e foi 2 mm/semana. Sensibilidade de 80%, 90%, 78,5% e 60,8% e VPN de 98,9%, 98,9%, 96,8% e 90,6% para parto abaixo de 28, 30, 32, e 34 semanas de gestação. CONCLUSÃO: nas gestações gemelares, a medida do colo uterino entre 22-25 semanas de gestação é melhor preditora do parto prematuro abaixo de 34 semanas do que a medida obtida entre 18-21 semanas. O encurtamento cervical 6mm/3 semanas entre 18 e 25 semanas de gestação é bom preditor de parto prematuro em subgrupo de alto risco. / OBJECTIVE: The aim of the present study is to compare the value of cervical assessment in twin pregnancies in predicting risk of spontaneous preterm delivery when performed at 18-21 weeks and 22-25 weeks gestation and to examine the value of cervical shortening observed between both periods. METHODS: This retrospective study involved 383 women carrying twins who were scheduled between 18-21 completed weeks (GROUP 1- 241 patients) and 22-25 completed weeks of gestation (GROUP 2- 266 patients). These two periods were assessed independently, and patients could be included in one or both with at least three weeks between the exams, whose delivery data was obtained. Patients included in both periods (GROUP 3- 124 patients) allowed the analysis of cervical shortening. Pregnancies presenting with the following complications where not included in the analyses: twin-twin transfusion syndrome, polihidramnius, fetal malformation, uterine patology; cases that underwent invasive procedures or uterine cerclage, premature delivery indicated for maternal or fetal complications and cases in which pregnancy outcome was impossible to obtain. Cervical length was the analyzed parameter. Area under the ROC curve was used to compare the predictive capacity of spontaneous preterm birth. To determine sensitivity, specificity, PPV and NPV, cervical length cut-off for short cervix was determined by Fujita et al (2002) curve, designed in our population. RESULTS: GROUP 1- The mean cervical length at 19.5 weeks (mean gestational age in the group) was 38.2 +- 8.7 mm. The rate of spontaneous preterm delivery (SPD) < 28, <30, <32 and < 34 weeks of gestation was 3.7%, 6.2%, 7.8% and 16.1%, respectively. The incidence of short cervix in the group was (14/241) 5.8%. Receiver operating characteristic curve analysis revealed area under the curve 0.64 (CI95% 0.53-0.75). Sensitivities of 33.3%, 33.3%, 30% and 23% and negative predictive values of 97.3%, 95.6%, 93.8% and 86.8% for delivery at <28, <30, <32, and <34 weeks gestation were achieved. GROUP 2- The mean cervical length at 23.3 weeks (mean gestational age in the group) was 35.6 +- 10.5 mm. The rate of SPD < 28, <30, <32 and < 34 weeks of gestation was 2.6%, 5.2%, 7.1% and 12.8%, respectively. The incidence of short cervix was (22/266) 8.2%. Receiver operating characteristic curve analysis revealed area under the curve 0.80 (CI95% 0.72-0.88), and this is larger than GROUP 1 area (p0,001). Sensitivities of 71.4%, 57.1%, 52.6% and 38.2% and negative predictive values of 99.1%, 97.5%, 96.3% and 91.4% for delivery at <28, <30, <32, and <34 weeks gestation were achieved. GROUP 3- Receiver operating characteristic curve analysis revealed area under the curve 0.81 (CI95% 0.73-0.89). The best cut-off for cervical shortening was reveled by the inflection point of the curve and was 2 mm/week. Sensitivities of 80%, 90%, 78.5% and 60.8% and negative predictive values of 98.9%, 98.9%, 96.8% and 90.6% for delivery at <28, <30, <32, and <34 weeks gestation were achieved. CONCLUSION: In twin gestations, assessment of cervical length at 22-25 weeks is better than __________________________________________________________________ assessment at 18-21 weeks to predict preterm delivery before 34 weeks. Cervical shortening of 6 mm/ 3weeks between 18 and 25 weeks gestation was a good predictor of spontaneous preterm birth in high risk population.

Submitted by Verônica Esteves (vevenesteves@gmail.com) on 2017-09-26T13:12:36Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) TESE-CAROLINE ALVES DE OLIVEIRA MARTINS.pdf: 1666399 bytes, checksum: dc894448ce671170ce04894a85e6038f (MD5) / Approved for entry into archive by Verônica Esteves (vevenesteves@gmail.com) on 2017-09-26T13:13:39Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) TESE-CAROLINE ALVES DE OLIVEIRA MARTINS.pdf: 1666399 bytes, checksum: dc894448ce671170ce04894a85e6038f (MD5) / Made available in DSpace on 2017-09-26T13:13:39Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) TESE-CAROLINE ALVES DE OLIVEIRA MARTINS.pdf: 1666399 bytes, checksum: dc894448ce671170ce04894a85e6038f (MD5) Previous issue date: 2017 / Hospital Geral de Bonsucesso / O objetivo do estudo foi analisar a relação entre os diversos fatores de risco para infecção pelo vírus do Papiloma Humano (HPV) e suas lesões, avaliar a prevalência de câncer e das lesões precursoras do trato genital inferior e da infecção por HPV em mulheres transplantadas, além dos tipos mais prevalentes de HPV. Com este fim, foi realizado um estudo transversal com uma amostra aleatória de 61 pacientes. Os resultados encontrados foram: 10 casos de lesão (16.4%), uma prevalência geral de infecção por HPV de 54.5%, e o HPV 16 como o tipo de HPV de alto risco mais encontrado, seguido pelo HPV 51/53/70. Observou-se também, através da realização de regressão logística múltipla, a associação, com significância estatística, entre o uso de hormônio e ocorrência de infecção por HPV de alto risco (p = 0.037). Não foi observada associação, com significância estatística, entre os diversos fatores e a ocorrência de lesões. A imunossupressão foi considerada fator determinante para ocorrência de lesões. O HPV 16 foi o tipo mais frequente observado nas pacientes com e sem lesão. A maior prevalência foi observada na faixa etária entre 31 e 54 anos. Desta forma, observa-se que a alta prevalência de infecção por HPV e de suas lesões precursoras, em relação à literatura, confirmam a importância do rastreio e seguimento diferenciados das pacientes transplantadas. / This study aimed to analyze the relationship between several risk factors for human papillomavirus (HPV) infection and its lesions and to assess the prevalence of lower genital tract precursor lesions, cancer, and HPV infection in female transplant recipients, besides the most prevalent HPV types. The methodology adopted was a crosssectional study with a random sample of 61 patients. The results found were: 10 cases (16.4%) of lesions, 54.5% of the overall prevalence of HPV infection, and that HPV 16 was the most common high-risk HPV type, followed by HPV 51/53/70. A multiple logistic regression was done, and hormone use presented a statistically significant association with high-risk HPV infection (p = 0.037). No statistically significant association was identified for the set of all factors with the lesions studied. Immunosuppression was considered the determining factor for the occurrence of lesions. HPV 16 was the most frequent type observed in patients with and without lesion. The highest prevalence was observed in the age group between 31 and 54 years. Therefore, it was observed the high prevalence of HPV infection and its precursor lesions confirmed the importance of differential screening and follow-up of transplanted patients.

Made available in DSpace on 2015-09-25T12:23:16Z (GMT). No. of bitstreams: 1 ValeriaRibeiroNogueiraBarbosa.pdf: 2894050 bytes, checksum: 2496af522e31ec83452db4d278903717 (MD5) Previous issue date: 2003-09-29 / Carpal Tunnel Syndrome (CTS) represents the most common entrapment neuropathy, better defined and more studied in the human being. The diagnosis is commonly presumed in patients with painful syndrome in the upper limbs, whose symptoms aggravate at night. The gold-standard for the diagnosis is the occurring of alterations in the sensitive and muscled conduction of the median nerve. Despite the CTS being well clinically characterized, when it is typical, a lot of painful factors in the upper limbs are not caused by CTS, and these patients neuralgic exam may vary from normal to serious alterations. This paper has as objectives: 1. To evaluate the profile of the painful symptoms that may presumably occur in patients with idiopatic CTS or without CTS; 2. to evaluate the profile of the neuralgic exam in patients with idiopatic CTS. Between April and December of 2002, 35 patients with idiopatic CTS (34 women and one man) with diagnosis confirmed by the clinical and electrophysiological exam were examined. They were paired according to their age and sex with 35 citzens of the general population (34 women and one man, aged between 34 and 72, average 51, +/- 9,7 years old). The frequency of paintful syndromes distribution in the two groups studied was analysed by the square test. The age average in both groups of patients was compared by the t-Student test. There was not statistical difference concerning the ages. In the group with CTS the complaints of pain were prevalent in the neck (45,7%), Phalen`s test (68,5%), and fist compression (74,3%) are common, being the last two ones prevalent ( &#945; = 0,05). The severity of the CTS was evaluated by the eletrophysiological exam. Most of the CTS cases are of light degree and occur bilaterally. Just seven patients have unilateral CTS. Concluding: 1- One must cogitate the CTS diagnosis in every case of pain of obscure origin in the lower limbs, being the location either proximal or distal; 2- Just one of patients with CTS had, clearly, signs of cervical radicular injury. One cannot establish etiological relation between these two conditions. What is told about the existence of double-crush syndrome as a nosological entity; 3- In the neurogical exam, the alteration in the sensibility to pain was the most observed sign. The discriminatitive sensibility test seems not to have value to support the CTS diagnosis; 4- the Phalen and the carpal compression tests are more useful to the CTS diagnosis than the Tinel sign, for they are more prevalent. / A Síndrome do Túnel do Carpo (STC) representa a neuropatia compressiva mais comum, melhor definida e mais estudada no ser humano. O diagnóstico é comumente presumido em pacientes com síndrome dolorosa nos membros superiores, cujos sintomas se agravam à noite. O padrão-ouro para o diagnóstico é a ocorrência de alterações na condução sensitiva e motora do nervo mediano. Apesar da STC ser bem caracterizada clinicamente, quando é típica, muitos quadros dolorosos nos membros superiores não são causados por STC, e o exame neurológico desses pacientes pode variar de normal a alterações graves. Este trabalho tem como objetivos: 1- avaliar o perfil dos sintomas dolorosos que presumivelmente possam ocorrer em pacientes com STC idiopático e sem STC; 2- avaliar o perfil do exame neurológico em pacientes com STC idiopático. Entre abril e dezembro de 2002, 35 pacientes com STC idiopático (34 mulheres e um homem, idades entre 34 e 72 anos, média 51, + 9,8 anos) com diagnóstico confirmado pelo exame clínico e eletrofisiológico foram examinados. Eles foram pareados por idade e sexo com 35 sujeitos da população geral (34 mulheres e um homem, idades entre 34 e 72 anos, média 51, + 9,7 anos). A freqüência de distribuição de síndromes dolorosas nos dois grupos estudados foi analisada pelo teste do qui-quadrado. A média de idade dos dois grupos de pacientes foi comparada pelo teste t de Student. Não houve diferença estatística quanto às idades. No grupo com STC as queixas de dor são prevalentes no pescoço (42,8%), membros superiores (36,8%) e mãos (82,8%). Nos sujeitos sem STC a localização do quadro doloroso predomina na cabeça (11,4%), região axial do corpo (37,1%) e membros inferiores (22,8%), (&#945; = 0,05). Entre os sujeitos com STC, 85,7% apresentam queixas de parestesias nos membros superiores e 74,2% destes apenas nas mãos. Os chamados testes provocativos: sinal de Tinel (45,7%), teste de Phalen (68,5%) e compressão do punho (74,3%) são comuns, sendo os dois últimos prevalentes (&#945; = 0,05). A gravidade da STC foi avaliada pelo exame eletrofisiológico. A maioria dos casos de STC são de grau leve e ocorrem bilateralmente. Apenas sete pacientes têm STC unilateral. Em conclusão: 1 - Deve-se cogitar o diagnóstico de STC em todos os casos de dor de origem obscura nos membros superiores, seja de localização proximal ou distal; 2 - apenas uma das pacientes com STC teve, claramente, sinais de lesão radicular cervical. Não se pôde estabelecer relação etiológica entre as duas condições. O que fala contra a existência de síndrome da dupla compressão como uma entidade nosológica; 3 no exame neurológico, a alteração da sensibilidade à dor foi o sinal mais observado. O teste da sensibilidade discriminativa parece não ter valor para suportar o diagnóstico de STC; 4 os testes de Phalen e da compressão carpal são mais úteis para o diagnóstico de STC do que o sinal de Tinel, pois são mais prevalentes.

A infecção pelo HPV em mulheres abaixo de 30 anos é transitória, entretanto, algumas destas mulheres progridem para Lesão Intra-Epitelial de Alto Grau (LIAG). Este estudo investigou características virais, morfológicas e variáveis sócio-comportamentais em mulheres com LIAG, entre estas a determinação dos genótipos oncogênicos do HPV, a carga viral total e específica de HPV 16, a expressão da proteína p16INK4a assim como variáveis epidemiológicas. Foram selecionadas 88 mulheres provenientes de dois serviços de oncologia ginecológica de Salvador, Bahia, a Clínica IDEM e o CICAN, entre julho de 2006 e janeiro de 2009 com diagnóstico citopatológico de LIAG. As pacientes preencheram o Termo de Consentimento Livre e Esclarecido e responderam um questionário contendo informações sócio-demográficas e clínicas. Em seguida, foi realizada a colheita de células esfoliadas do colo uterino para genotipagem através da técnica Linear Array e avaliação da carga viral do HPV por PCR em tempo real, e a biópsia para análise histopatológica. Destas 88 mulheres, apenas 41 (46,6%) tiveram o diagnóstico de LIAG confirmado através do exame histopatológico. Desta forma, as pacientes foram divididas em 3 grupos: sem LIAG (< NIC 2), com LIAG ( NIC 2) menores que 30 anos e com LIAG ( NIC 2) com idade igual ou superior a 35 anos. Dentre os co-fatores analisados, a escolaridade, o uso de anticoncepcional oral e paridade diferiram nos dois grupos de idade com LIAG. A expressão da proteína p16INK4a foi observada em todos os graus histopatológicos com LIAG, entretanto, sua intensidade não diferiu entre estes. Foi observada uma maior prevalência de LIAG em mulheres mais jovens. Os genótipos mais prevalentes nas mulheres com LIAG foram: HPV 16, HPV 35, HPV 56, HPV 45 e HPV 70; no grupo sem LIAG foram: HPV 16, HPV 31, HPV 56, HPV 61 e HPV CP6108. A carga viral total foi maior em mulheres com LIAG em relação a mulheres sem LIAG. Houve associação entre aumento da carga viral específica para HPV 16 e aumento da severidade das lesões intraepiteliais. As cargas virais total e específica do HPV 16 não diferiram entre os dois grupos de idade com LIAG, indicando não ser esta o fator que leva ao raro desenvolvimento de LIAGs em mulheres jovens. / HPV infection in young women, below 30 years old is commonly transitory. However, some women may progress to high-grade squamous intraepithelial lesion (HSIL). This study aimed to investigate viral and host factors in young women with a diagnosis of HSIL, such as viral load both total and HPV 16- specific, genotypes, p16INK4a expression and sociodemographic characteristics. Eighty-eight women with a cytological diagnosis of HSIL were recruited from 2 specialized oncoginecologyc services from Salvador, Bahia, in between July 2006 and January 2009. After providing written informed consent, cervical scrapes were obtained for DNA extraction for further molecular testing, including HPV genotyping by Linear array and viral load determination by Real-Time PCR. Biopsies were taken for confirmatory histopathologyc analysis. Forty-one out of 88 enrolled women (46,6%) had the HSIL diagnosis confirmed. Based on that they were classified into three groups: No SIL, HSIL less than 30 years old and HSIL older than 35 years old. Among co-factors studied, education, oral contraceptive use and parity significantly differed between HSIL age groups. p16INK4a expression was observed with similar intensity among all histological grades of CIN. A higher prevalence of HSIL was detected in younger women. The most prevalent genotypes in HSIL patients were HPV 16, HPV 35, HPV 56, HPV 45 and HPV 70; whereas in the No SIL group were: HPV 16, HPV 31, HPV 56, HPV 61 and HPV CP6108. Total HPV viral load was significantly higher in women bearing CIN than in the normal group. A positive association between HPV 16 viral load and increasing histological grades was observed. Total and HPV 16 viral loads were similar among young and older women with HSIL, suggesting that this is not the main factor leading to the early development of these lesions.

研究背景： / 2009年起，中國政府發起並資助了一項覆蓋全國31個省221個鄉村、針對100萬名農村婦女的細胞學及肉眼觀察宮頸癌篩查試點項目。國家及地方政府需要對可行的篩查策略進行衛生經濟學評估，為下一步擴大規模的篩查提供政策依據。 / 研究目標： / 應用人群特異性Markov模型，對巴氏塗片及肉眼觀察的宮頸癌篩查策略進行成本效果及成本效用兩方面的衛生經濟學評估，進而為中國農村婦女宮頸癌篩查政策的制定提供依據。 / 研究方法： / 本論文工作建立了Markov人群動態擬合模型，該模型能夠整合與中國農村宮頸癌流行情況相吻合的成本及健康狀況的數據，進而用於擬合20年內35-59歲中國農村婦女在有/無篩查幹預下的成本、效用和效果。本文分析的八個備選篩查策略包括：採用醋酸染色肉眼觀察（VIA）或傳統細胞學（巴氏塗片）分別進行10年，5年，3年及1年一次的篩查。 / 本文從社會學角度出發，成本數據涵蓋篩查、診斷及治療過程中產生的直接及間接成本。模型在結構上綜合了已被廣泛認可的宮頸癌自然發展史模型，以及宮頸癌及其癌前病變（CIN）在中國農村進行篩查和治療的標準臨床路徑。模型輸入參數盡可能地使用了能夠反映中國農村婦女人群特異性的數據。通過對比國家報告數據與模型預測結果，本文從全死因死亡率、宮頸癌死亡率及宮頸癌發病率三個方面驗證了模型的可信度。 / 模型的結局變量包括：累計成本、累計生命年(LYs)、累計質量調整生命年(QALYs)、預期宮頸癌死亡率及發病率降低百分比(%)、CIN 相對風險、宮頸浸潤癌相對風險，增量成本效用比(ICUR, 表述為每挽救一個質量調整生命年消耗的成本)及增量成本效果比(ICER, 表述為每挽救一個生命年消耗的成本)等。與無篩查幹預相比，我們界定ICUR及ICER小於三倍人均國內生產總值（76,824元，2009年)的優勢策略為‘具有成本效益’的選擇，並將其中ICUR和ICER最低的策略，定義為‘最具成本效益’的策略，將具有最大健康效益的策略（挽救最多質量調整生命年或生命年的策略），定義為‘最有效’的策略。同時，我們對可能影響決策的不確定因素進行了敏感性分析。 / 結果： / 與無篩查幹預相比，肉眼觀察及巴氏塗片篩查均能夠減少宮頸癌患病例數，進而顯示出一定的健康效益。較短的篩查間隔具有更高的健康效益。模型預測在不同的篩查策略幹預下，宮頸癌死亡率和發病率分別有望降低6.67-31.95%和5.12-24.71%，預期CIN發病相對風險為0.89-0.98，預期宮頸癌發病相對風險為0.73-0.95。篩查幹預對健康的保護作用在本研究中得到了證實。 / 成本效用分析顯示，10年一次的肉眼觀察策略最具成本效益，其次為5年一次、3年一次、1年一次的肉眼觀察篩查策略及1年一次的巴氏塗片篩查策略。與無篩查幹預相比，如上策略每挽救一個質量調整生命年消耗的成本為11,921至26,069元（1,892-4,138美元，2012年）。同時成本效果分析也顯示，10年一次的肉眼觀察策略最具成本效益，其次為5年一次的肉眼觀察策略及5年一次的巴氏塗片篩查策略。同樣與無篩查幹預相比，如上策略每挽救一個生命年消耗的成本為37,211至68,226元（5,906-18,830美元，2012年）。 / 對於某一既定策略，相應的ICUR和ICER受當地經濟狀況相關因素的影響最大，這些因素包括治療成本、篩查成本和成本貼現率。從檢測技術水平上看，肉眼觀察對分析結果的影響小於巴氏塗片，原因是前者敏感度範圍較小。篩查覆蓋率、初篩陽性隨訪率、診斷陽性治療率也都與相應的ICUR和ICER呈負相關性。敏感性分析結果顯示本文中模型對於健康結局的預測，及相關的衛生經濟學分析，受自然史模型中HPV感染和CIN之間轉移概率的不確定性的影響最大。HPV感染與CIN間的進展和逆轉概率是該項模型研究的核心參數。 / 結論： / 本文中成本效用和成本效果分析均顯示，相較於傳統的細胞學篩查策略，採用間隔時間較長（10年或5年）的肉眼觀察篩查策略，對一般發病地區的35-59歲的農村婦女來說，是更具‘成本效益’的選擇。對於宮頸癌高發地區，其篩查頻率可以提高到1年一次。1年一次的巴氏塗片篩查策略，是最有效的篩查策略，可以挽救最多的生命。但採用該策略時，應在財政預算允許的前提下，確保篩查技術和項目完成的質量。 / 篩查項目的高覆蓋率，對篩查陽性患者良好的隨訪和診治，初篩檢測技術平均水平以上的表現，以及較低的篩查和治療成本是確保篩查項目具備成本效益優勢的核心因素。本文完成的成本效用及成本效果分析，能夠為公共衛生決策提供重要的輔助作用。 / Background: / A Chinese government-sponsored cytology/visual inspection pilot cervical cancer screening program covered 10 million rural women in 221 counties of 31 provinces was initiated in 2009. Both the local and national governments in China need health economic evaluations of feasible strategies so as to make better policies for the next-step enlarging screening. / Objectives: / To perform health economic evaluations of Pap smear and visual inspection cervical cancer screening strategies using population-specific Markov modeling cost-utility (CUA) and cost-effectiveness (CEA) analyses, in order to assist screening policy making for women in rural China. / Methods: / Markov simulation models were developed to synthesize the evidence on costs and health outcomes related to cervical cancer epidemiology in rural China, and applied to predict the long-term utility, effectiveness and costs for hypothetical cohorts of 35-59 years old rural Chinese women, with or without the presence of screening over 20 years. The eight alternative screening strategies assessed were visual inspection with acetic acid (VIA) or traditional cytology (Pap smear) each with ten-year, five-year, three-year and one year screening intervals. / The study was conducted from the societal perspective, thus both directed and non-direct costs related to screening, diagnosis and treatment interventions were considered. The model structures incorporated with the well-accepted the natural history model of cervical cancer and the standard clinical pathway of screening and treatment interventions for precancerous lesions (CIN) and cervical cancer in real practice in rural China. Population-specific data were used as much as possible to be the model inputs. The model estimates were validated by comparison of our predictions of all-cause mortality, cervical cancer mortality and cervical cancer incidence with the national reported data. / Outcome variables included cumulative cost, life years (LYs), quality-adjusted life years (QALYs), predicted reduction(%) in cervical cancer mortality and incidence, relative risk of CIN, relative risk of cervical cancer, incremental cost-utility ratio (ICUR, presented as cost per QALY saved) and incremental cost-effectiveness ratio (ICER, presented as cost per life year saved). Compared with no screening, not-dominated strategies with ICUR and ICER less than three times China’s GDP per capita (76,824 CNY, 2009) were considered to be ‘cost-effective’ options. Among the identified ‘cost-effective’ options, the strategy with lowest ICUR or ICER was defined as the most cost-effective strategy, and the strategy with the highest health benefit (largest QALY saved or life year saved) was defined as the most effective strategy. Sensitivity analyses were conducted to test the effect of uncertainties on decision making. / Results: / All of the VIA and Pap smear screening strategies of showed certain benefits due to the decreased number of women developing cervical cancer, when compared with no screening. A trend for shorter screening interval to have greater benefit was also found. Cervical cancer mortality and incidence were expected to be reduced by 6.67-31.95% and 5.12-24.71% with different screening strategies. And the predicted relative risks of CIN and invasive cervical cancer of 0.89-0.98 and 0.73-0.95, respectively, also demonstrated the protective effect of screenings. / Modeling cost-utility analysis identified ten years VIA screening as the most cost-effective strategy followed by VIA screening with five-, three- and one year interval and Pap smear screening with a one year interval. Compared with no screening, the incremental costs per QALY saved of these strategies ranged from 11,921 to 26,069 Yuan (1,892-4,138 US dollars, 2012). In the meanwhile, modeling cost-effectiveness analysis also identified ten-years VIA screening as the most cost-effective strategy followed by VIA screening with five-year intervals and Pap smear screening with five-year intervals. Compared with no screening, the incremental costs per life year saved of these strategies ranged from 37,211 to 68,226 Yuan (5,906-18,830 US dollars, 2012). / Both ICUR and ICER of a selelected strategy were greatest influnced by factors related to variations in local economies , including treatment cost, screening cost and discounting rate of the cost. The influence of primary test performance of VIA was rather less than that of Pap smear due to the narrower ranges of the VIA sensitivities. Screening coverage, follow-up rate and treatment rate were also negatively associated with ICUR and ICER. Health outcome predictions and health economic analyses were mostly influenced by the uncertainties in HPV infection and CIN transitions in the natural history. Progression and regression probabilities between HPV infection and CIN were considered to be the key parameters of the simulation models. / Conclusions: / Baseline CUA and CEA results suggested that in comparison with traditional cytology screening strategies, organized VIA screening with long intervals (ten or five years) were more cost-effective options than for 35-59 years old women in normal incidence areas of rural China. The VIA screening interval can be shorten to one year in high incidence areas. Pap smear strategy with one year interval can be utilized as the most effective strategy with most lives saved when budget allows and the performances of program and test are ensured. / High coverage of the screening program, good management of screening positives, average or above performance of primary test, and lower screening and treatment costs are key elements for a cost-effective screening program. Cost-utility and cost-effectiveness analyses, such as the one conducted in this thesis study, can be considered important adjuncts to policy decision-making about public health objectives. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Xue. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 388-401). / Abstracts also in Chinese; appendixes includes Chinese. / Abstract of thesis --- p.i / 中文摘要 --- p.v / ACKNOWLEDGEMENTS --- p.viii / TABLE OF CONTENTS --- p.1 / LIST OF TABLES --- p.8 / LIST OF FIGURES --- p.11 / ABBREVIATIONS --- p.12 / Chapter CHAPTER 1 --- INTRODUCTION --- p.14 / Chapter 1.1 --- Epidemiological patterns and disease burden of cervical cancer --- p.14 / Chapter 1.1.1 --- Cervical cancer incidence and mortality worldwide --- p.14 / Chapter 1.1.2 --- Risk factors for cervical cancer --- p.15 / Chapter 1.1.2.1 --- Human Papillomavirus (HPV) --- p.15 / Chapter 1.1.2.2 --- Parity --- p.16 / Chapter 1.1.2.3 --- Smoking --- p.16 / Chapter 1.1.2.4 --- Human Immunodeficiency Virus (HIV) --- p.17 / Chapter 1.1.2.5 --- Contraception --- p.17 / Chapter 1.1.2.6 --- Sexual behavior, nutrition and other factors --- p.18 / Chapter 1.1.3 --- Disease burden of cervical cancer in China --- p.18 / Chapter 1.1.3.1 --- Epidemiology of Cervical Cancer in China --- p.18 / Chapter 1.1.3.2 --- Cervical cancer in different geographic areas of China --- p.20 / Chapter 1.2 --- The need for cost-effectiveness analysis of cervical screening strategies in China --- p.21 / Chapter 1.2.1 --- Cervical cancer prevention in China --- p.21 / Chapter 1.2.2 --- Why do we need a modeling cost-effectiveness analysis? --- p.23 / Chapter 1.3 --- Natural history of cervical cancer --- p.25 / Chapter 1.3.1 --- Terminology --- p.25 / Chapter 1.3.2 --- Natural history of cervical cancer --- p.27 / Chapter 1.4 --- Secondary prevention strategies of cervical cancer --- p.29 / Chapter 1.4.1 --- Screening tests --- p.29 / Chapter 1.4.1.1 --- Cervical cytology --- p.29 / Chapter 1.4.1.2 --- Visual Inspection --- p.32 / Chapter 1.4.1.3 --- HPV testing --- p.36 / Chapter 1.4.2 --- Summary of different screening strategies all over the world --- p.37 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.40 / Chapter 2.1 --- Background --- p.40 / Chapter 2.2 --- Objectives of the literature review --- p.41 / Chapter 2.3 --- Search strategies and results --- p.41 / Chapter 2.3.1 --- Search strategies --- p.41 / Chapter 2.3.2 --- Inclusion and exclusion criteria --- p.42 / Chapter 2.4 --- Literature results summary --- p.44 / Chapter 2.4.1 --- Methodology, target population and analytical perspective --- p.44 / Chapter 2.4.2 --- Screening test and program performance --- p.47 / Chapter 2.4.3 --- Cost and utility estimation --- p.49 / Chapter 2.4.4 --- Model parameter sources and validation --- p.53 / Chapter 2.4.5 --- Alternatives and identified cost-effective strategies --- p.58 / Chapter 2.5 --- Conclusions --- p.63 / Chapter CHAPTER 3 --- OBJECTIVES --- p.64 / Chapter 3.1 --- General Objectives --- p.64 / Chapter 3.2 --- Alternative cervical cancer screening strategies in this study --- p.64 / Chapter 3.3 --- Decision rules for recommended cost-effective options --- p.65 / Chapter 3.4 --- Analytical perspective and time horizon --- p.65 / Chapter 3.5 --- Objectives --- p.66 / Chapter 3.6 --- Analytical scenario in this study --- p.66 / Chapter 3.6.1 --- Patterns of cervical screening program delivery in rural China --- p.67 / Chapter 3.6.2 --- Demographic profile of the simulated hypothetical cohort --- p.67 / Chapter 3.6.3 --- Summary of model assumptions --- p.68 / Chapter 3.6.3.1 --- Assumptions related to screening performance and clinical practice --- p.68 / Chapter 3.6.3.2 --- Assumptions related to epidemiological characteristics of cervical cancer --- p.68 / Chapter 3.6.3.3 --- Assumptions related to economic evaluation --- p.69 / Chapter CHAPTER 4 --- METHODOLOGY --- p.70 / Chapter 4.1 --- Alternative strategies in this study --- p.70 / Chapter 4.2 --- Markov Model Developments and Applications --- p.72 / Chapter 4.2.1 --- General introduction of Markov Transition Model --- p.72 / Chapter 4.2.2 --- Structure of Markov models --- p.76 / Chapter 4.2.2.1 --- Natural history model of cervical cancer --- p.76 / Chapter 4.2.2.2 --- Structure of Pap smear and Visual Inspection screening models --- p.82 / Chapter 4.2.2.3 --- Structure of precancerous lesion and invasive cancer treatment models --- p.83 / Chapter 4.2.2.4 --- Interaction of the models --- p.85 / Chapter 4.2.3 --- Demographic profile of the hypothetical cohort --- p.86 / Chapter 4.2.4 --- Probabilities --- p.88 / Chapter 4.2.4.1 --- Identification and converting between rate and probability --- p.89 / Chapter 4.2.4.2 --- Initial probabilities --- p.90 / Chapter 4.2.4.3 --- Transition probabilities --- p.91 / Chapter 4.2.5 --- Screening, diagnosis and treatment characteristics --- p.101 / Chapter 4.2.5.1 --- Screening program characteristics --- p.101 / Chapter 4.2.5.2 --- Diagnosis test performance --- p.104 / Chapter 4.2.5.3 --- Precancerous lesions treatment characteristics --- p.104 / Chapter 4.2.5.4 --- Invasive cancer and treatment characteristics --- p.106 / Chapter 4.2.6 --- Model validation --- p.111 / Chapter 4.3 --- Cost data collection --- p.112 / Chapter 4.3.1 --- Perspective of study --- p.112 / Chapter 4.3.2 --- Selection of study sites --- p.113 / Chapter 4.3.3 --- Screening cost data collection --- p.113 / Chapter 4.3.4 --- Treatment cost data collection --- p.115 / Chapter 4.4 --- Cost-utility analysis and cost-effectiveness analysis --- p.117 / Chapter 4.4.1 --- General introduction of these two analyses --- p.117 / Chapter 4.4.2 --- Utility Estimates --- p.118 / Chapter 4.4.3 --- Screening utility and effectiveness evaluation --- p.120 / Chapter 4.4.4 --- Cost-effectiveness and cost-utility analysis method --- p.122 / Chapter 4.5 --- Time horizon and discounting rate --- p.125 / Chapter 4.6 --- Summary of modeling assumptions --- p.126 / Chapter 4.6.1 --- Assumptions related to screening performance and clinical practice --- p.126 / Chapter 4.6.2 --- Assumptions related to epidemiological characteristics of cervical cancer --- p.127 / Chapter 4.6.3 --- Assumptions related to economic evaluation --- p.128 / Chapter 4.7 --- Sensitivity analysis --- p.128 / Chapter 4.8 --- Ethical approval --- p.129 / Chapter CHAPTER 5 --- RESULTS --- p.130 / Chapter 5.1 --- Model validation --- p.130 / Chapter 5.2 --- Cost analysis results --- p.134 / Chapter 5.2.1 --- Screening costs results --- p.134 / Chapter 5.2.2 --- Treatment cost results --- p.136 / Chapter 5.2.3 --- The proportional costs breakdown for different screening strategies --- p.139 / Chapter 5.3 --- Utility estimation results --- p.141 / Chapter 5.4 --- Cost-utility analysis results --- p.144 / Chapter 5.4.1 --- Baseline analysis --- p.144 / Chapter 5.4.2 --- Influence of screening program performance --- p.148 / Chapter 5.4.2.1 --- Coverage of the screening program --- p.148 / Chapter 5.4.2.2 --- Follow up rate and treatment rate of positives --- p.155 / Chapter 5.4.3 --- Influence of screening test performance --- p.159 / Chapter 5.4.4 --- Influence of costs --- p.165 / Chapter 5.4.4.1 --- Influence of screening costs --- p.165 / Chapter 5.4.4.2 --- Influence of treatment costs --- p.168 / Chapter 5.4.5 --- Influence of discounting --- p.171 / Chapter 5.4.6 --- Summary of factors and their influences on the baseline CUA results --- p.174 / Chapter 5.5 --- Cost-Effectiveness analysis results --- p.180 / Chapter 5.5.1 --- Baseline analysis --- p.180 / Chapter 5.5.1.1 --- Life year saved --- p.181 / Chapter 5.5.1.2 --- Cervical cancer mortality reduction --- p.185 / Chapter 5.5.1.3 --- Cervical cancer incidence reduction --- p.187 / Chapter 5.5.1.4 --- Relative risk of CIN and cervical cancer --- p.189 / Chapter 5.5.1.5 --- Effectiveness summary of alternative screening strategies on the hypothetical 100,000 rural Chinese women --- p.191 / Chapter 5.5.2 --- Factors that influence the CEA results --- p.195 / Chapter 5.5.2.1 --- Best scenario analysis --- p.196 / Chapter 5.5.2.2 --- Worst scenario analysis --- p.201 / Chapter 5.5.2.3 --- Summary of the possible ranges of costs and effectiveness in different scenarios --- p.206 / Chapter 5.6 --- Sensitivity analysis --- p.209 / Chapter 5.6.1 --- Sensitivity analysis of Cost-Utility analysis results --- p.209 / Chapter 5.6.1.1 --- Tornado analysis --- p.209 / Chapter 5.6.1.2 --- One-way sensitivity analysis --- p.213 / Chapter 5.6.2 --- Sensitivity analysis of Cost-Effectiveness analysis results --- p.220 / Chapter 5.6.2.1 --- Tornado analysis --- p.220 / Chapter 5.6.2.2 --- One-way sensitivity --- p.224 / Chapter 5.6.3 --- Summary of sensitivity results --- p.236 / Chapter CHAPTER 6 --- SUMMARY, DISSICUSSION AND CONCLUSIONS --- p.240 / Chapter 6.1 --- Summary of Markov model development and validation --- p.240 / Chapter 6.1.1 --- Category and source summary of input parameters --- p.240 / Chapter 6.1.2 --- Model validation --- p.244 / Chapter 6.2 --- Summary of modeling results --- p.245 / Chapter 6.2.1 --- Summary of Cost-Utility Analysis --- p.245 / Chapter 6.2.1.2 --- Baseline analysis findings --- p.245 / Chapter 6.2.1.2 --- Influential factors on the cost-effective manner of alternative strategies --- p.246 / Chapter 6.2.2 --- Summary of Cost-Effectiveness Analysis --- p.250 / Chapter 6.2.2.1 --- Baseline analysis findings --- p.251 / Chapter 6.2.2.2 --- Possible ranges for cost and effectiveness of alternative strategies under different scenarios --- p.253 / Chapter 6.2.3 --- Summary of CUA and CEA findings --- p.257 / Chapter 6.2.4 --- Summary of sensitivity analysis --- p.259 / Chapter 6.2.4.1 --- Important variables on health outcome predictions --- p.259 / Chapter 6.2.4.2 --- Sensitive variables to the baseline CUA and CEA recommendations --- p.260 / Chapter 6.2.4.3 --- Overview of the sensitivity analysis --- p.263 / Chapter 6.3 --- Discussion --- p.264 / Chapter 6.3.1 --- Alternative strategies of cervical cancer screening in rural China --- p.264 / Chapter 6.3.1.1 --- Target ages --- p.265 / Chapter 6.3.1.2 --- Screening intervals --- p.266 / Chapter 6.3.1.3 --- Feasible primary screening tests --- p.267 / Chapter 6.3.1.4 --- Service delivering patterns --- p.269 / Chapter 6.3.1.5 --- Time horizon of this thesis study --- p.270 / Chapter 6.3.2 --- Transition probability estimation --- p.271 / Chapter 6.3.3 --- Screening and treatment cost estimation --- p.276 / Chapter 6.3.3.1 --- Representativeness of the selected counties --- p.276 / Chapter 6.3.3.2 --- Screening costs of VIA and Pap smear --- p.277 / Chapter 6.3.3.3 --- Treatment costs --- p.279 / Chapter 6.3.4 --- Utility estimation --- p.280 / Chapter 6.3.4.1 --- Instrument selection --- p.280 / Chapter 6.3.4.2 --- Utility estimation between studies --- p.281 / Chapter 6.3.5 --- Baseline cost-utility and cost-effectiveness analyses --- p.283 / Chapter 6.3.6 --- Sensitivity Analysis --- p.284 / Chapter 6.3.7 --- Strengths and limitations --- p.286 / Chapter 6.3.7.1 --- Limitations --- p.286 / Chapter 6.3.7.2 --- Strengths --- p.288 / Chapter 6.4 --- Policy implications --- p.289 / Chapter 6.4.1 --- How to manage a cost-effective cervical cancer screening program? --- p.289 / Chapter 6.4.2 --- How can VIA screening be adopted? --- p.290 / Chapter 6.4.3 --- How can Pap smear screening be adopted? --- p.291 / Chapter 6.4.4 --- Framework for policy decision making --- p.292 / Chapter 6.5 --- Conclusions --- p.295 / Chapter APPENDIX --- p.300 / Chapter Appendix 1-1 --- The 2001 Bethesda System* --- p.300 / Chapter Appendix 1-2 --- The FIGO Staging for cervical cancers* --- p.301 / Chapter Appendix 1-3 --- Cervical Cancer Screening Program in different countries --- p.302 / Chapter Appendix 4-1 --- WHO World Standardized Population Distribution (%) --- p.305 / Chapter Appendix 4-2 --- Summary of transition probabilities literature review --- p.306 / Chapter Appendix 4-3 --- Price Indices from 1978 to 2010 --- p.326 / Chapter Appendix 4-4 --- Screening Cost Questionnaire --- p.327 / Chapter Appendix 4-5 --- Programmatic Cost Survey Questionnaire --- p.339 / Chapter Appendix 4-6 --- Treatment Cost Survey Questionnaire --- p.342 / Chapter Appendix 4-7 --- EQ-5D Algorism (UK) --- p.344 / Chapter Appendix 4-8 --- Chinese Version of EQ5D----HQOL score questionnaire --- p.345 / Chapter Appendix 5-1 --- Calibrated variables and its final settings --- p.348 / Chapter Appendix 5-2 --- Cervical cancer new cases and deaths all over the world in 2008 --- p.349 / Chapter Appendix 5-3 --- Data distribution of CIN2-3 and cervical cancer treatment costs --- p.350 / Chapter Appendix 5-4 --- Relative risk of CIN and cervical cancer by age groups of alternative screening strategies --- p.361 / Chapter Appendix 5-5 --- Influence of discounting rate of life years on the CEA results --- p.363 / Chapter Appendix 5-6 --- Tornado analysis results based on the effect on QALYs predictions --- p.367 / Chapter Appendix 5-7 --- Tornado analysis results based on the effect on life-year predictions --- p.372 / Chapter Appendix 6-1 --- Summary of Markov Model Inputs and Sources --- p.377 / REFERENCE --- p.388

Disertacijos objektas naujas citologinio gimdos kaklelio tyrimo panaudojus Shandon PapSpin skystąsias terpes efektyvumo įvertinimas. Žinoma, kad citologinis gimdos kaklelio tepinėlio tyrimas-efektyvus gimdos kaklelio vėžio kontrolės būdas, tačiau jis pasižymi nepakankamu jautrumu sąlygotu nepakankamos tyrimo kokybės. Skystųjų terpių citologinis tyrimas buvo įvertintas dviem etapais: tiriant dalytą gimdos kaklelio medžiagą ( angl.split-sample) fazėje ir nedalytą gimdos kaklelio medžiagą (angl. direct to vial). 2950 moterims buvo atlikti citologiniai tyrimai. Gauti citologinių tyrimų rezultatai buvo palyginti su atitinkamai konizuotosios gimdos kaklelio dalies histologinio tyrimo rezultatais apskaičiuojant citologinių metodų diagnostines vertes, sutarimą tarp citologinio tepinėlio tyrimų ir skystųjų terpių tyrimų. Disertacijoje keliamas klausimas ar citologiniai gimdos kaklelio tyrimai panaudojus skystąsiais terpes yra patikimas ikinavikinės gimdos kaklelio patologijos diagnostikos metodas. Disertacijoje konstatuojama, kad citologiniai gimdos kaklelio tyrimai panaudojus skystąsias terpes yra efektyvus diagnostikos metodas diagnozuojant ikinavikinius gimdos kaklelio pakitimus. Pagrindiniai metodo privalumai –statistiškai reikšmingas netinkamų ir ASC ( atipinių plokščiojo epitelio ląstelių) tyrimų kiekio sumažėjimas. Disertacijoje taip pat daug dėmesio skiriama Žmogaus papilomos viruso nustatymui iš skystosios likusios po citologinio tyrimo terpės ir konizuotosios gimdos... [toliau žr. visą tekstą] / The study comparing the effectiveness of a novel liquid-based Pap test (the PapSpin) with the conventional Pap smear. The impetus behind the study is meritorious: although the conventional Pap smear has been highly effective in diminishing mortality from cervical cancer, it is not perfect. It suffers from inconsistency in cell thickness and occasional obscuring blood, which hinder accurate evaluation. An alternative preparation method, one that would reduce the amount of blood and provide for a more consistent, thin layer of cells would make screening easiser and more accurate. The several performance characteristics examined in the study: Rate of unsatisfactory smears, rate of "atypical" smears (smears with an interpretation of "atypical squamous cells of undetermined significance"), sensitivity, specificity, positive predicitve value (PPV), and negative predictive value (NPV), based on histologic correlation and suitability for human papillomavirus (HPV) testing. The study consists of two principal parts. In the first part, the cervical sample collected was split into two preparations ("split sample"): a conventional smear was prepared first, then the residue left on the collection device was used to prepare a PapSpin slides. In the second part ("direct to vial"), the entire cervical sample was used to prepare a PapSpin slide. In the "split sample" study a significant reduction in the proportion of unsatisfactory and "atypical" cases was found when slides were prepared... [to full text]

The study comparing the effectiveness of a novel liquid-based Pap test (the PapSpin) with the conventional Pap smear. The impetus behind the study is meritorious: although the conventional Pap smear has been highly effective in diminishing mortality from cervical cancer, it is not perfect. It suffers from inconsistency in cell thickness and occasional obscuring blood, which hinder accurate evaluation. An alternative preparation method, one that would reduce the amount of blood and provide for a more consistent, thin layer of cells would make screening easiser and more accurate. The several performance characteristics examined in the study: Rate of unsatisfactory smears, rate of "atypical" smears (smears with an interpretation of "atypical squamous cells of undetermined significance"), sensitivity, specificity, positive predicitve value (PPV), and negative predictive value (NPV), based on histologic correlation and suitability for human papillomavirus (HPV) testing. The study consists of two principal parts. In the first part, the cervical sample collected was split into two preparations ("split sample"): a conventional smear was prepared first, then the residue left on the collection device was used to prepare a PapSpin slides. In the second part ("direct to vial"), the entire cervical sample was used to prepare a PapSpin slide. In the "split sample" study a significant reduction in the proportion of unsatisfactory and "atypical" cases was found when slides were prepared... [to full text] / Disertacijos objektas naujas citologinio gimdos kaklelio tyrimo panaudojus Shandon PapSpin skystąsias terpes efektyvumo įvertinimas. Žinoma, kad citologinis gimdos kaklelio tepinėlio tyrimas-efektyvus gimdos kaklelio vėžio kontrolės būdas, tačiau jis pasižymi nepakankamu jautrumu sąlygotu nepakankamos tyrimo kokybės. Skystųjų terpių citologinis tyrimas buvo įvertintas dviem etapais: tiriant dalytą gimdos kaklelio medžiagą ( angl.split-sample) fazėje ir nedalytą gimdos kaklelio medžiagą (angl. direct to vial). 2950 moterims buvo atlikti citologiniai tyrimai. Gauti citologinių tyrimų rezultatai buvo palyginti su atitinkamai konizuotosios gimdos kaklelio dalies histologinio tyrimo rezultatais apskaičiuojant citologinių metodų diagnostines vertes, sutarimą tarp citologinio tepinėlio tyrimų ir skystųjų terpių tyrimų. Disertacijoje keliamas klausimas ar citologiniai gimdos kaklelio tyrimai panaudojus skystąsiais terpes yra patikimas ikinavikinės gimdos kaklelio patologijos diagnostikos metodas. Disertacijoje konstatuojama, kad citologiniai gimdos kaklelio tyrimai panaudojus skystąsias terpes yra efektyvus diagnostikos metodas diagnozuojant ikinavikinius gimdos kaklelio pakitimus. Pagrindiniai metodo privalumai –statistiškai reikšmingas netinkamų ir ASC ( atipinių plokščiojo epitelio ląstelių) tyrimų kiekio sumažėjimas. Disertacijoje taip pat daug dėmesio skiriama Žmogaus papilomos viruso nustatymui iš skystosios likusios po citologinio tyrimo terpės ir konizuotosios gimdos... [toliau žr. visą tekstą]

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.