Introduction: A screening program has been implemented in SA with intervals of 10 years after a normal cytological result. There are no studies which evaluate repeat screening at a shorter interval in SA. Aim: This study aims to find the incidence of cytological abnormalities on a repeat test after a report of normal cytology or an inadequate pap smear. The factors associated with an abnormal cytology on repeat testing will also be explored. Methods: This is a secondary data analysis of the information obtained in a trial investigating the use of the diaphragm in the prevention of HIV infection between 2004 and 2006. Women were offered a Papanicolaou (Pap) smear at the enrolment visit and again at the end of the trial. The incidence of abnormal cytology after a normal or inadequate cytology was obtained. Demographic factors, history, clinical findings and tests for STI were compared amongst women with a normal and abnormal Pap smear on repeat testing after a normal Pap smear. Results: The incidence of cytological abnormalities was 6.48 % per annum in women with a previously normal Pap and 11.71% per annum in women with an inadequate smear result. (Log rank test for difference significant (p=0.03)). The incidence of cytological abnormalities in women with either an inadequate Pap smear or a normal Pap smear was 7.33%. However, the incidence of a high grade lesion was less than 0.5%. Factors associated with abnormal cytology in the multivariate analysis were a history of ectopic pregnancy [OR=9.25 (CI-1.78-48.03), p=0.01], number of male partners [0R=1.12 (CI-1.03-1.22),p=0.01], number of times a women was treated for an STI [OR=6.59 (1.54-28.19), p=0.01], history of vaginal discharge [OR=13.95 (1.18-164.47), p=0.00], and HIV infection [OR=6.58 (1.14-38.16),p=0.04]. Conclusion: The incidence of significant cervical lesions is low, but it would be prudent to continue to repeat those Pap smears that are found to be inadequate with the present interval of 10 years. In women with a normal Pap smear, a repeat Pap smear after 1-2 years should only be performed if clinically indicated.

Orientadores : Anibal Faundes, Ellen E. Hardy / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-07-14T01:10:17Z (GMT). No. of bitstreams: 1 Ching_ChongYeePack_M.pdf: 1342288 bytes, checksum: a03702a4626e3367bbd4b6c53d3cbd23 (MD5) Previous issue date: 1989 / Resumo: O resumo poderá ser visualizado no texto completo da tese digital / Abstract: The abstract is available with the full electronic digital document / Mestrado / Mestre em Tocoginecologia

M.Fam.Med., Faculty of Health Sciences, University of the Witwatersrand, 2011

Currently, the leading route of new HIV-1 infection is via heterosexual transmission, in which women are disproportionately burdened. One key factor associated with a fourfold increased risk of HIV-1 acquisition is a dysbiotic vaginal microbiota (VMB). A dysbiotic VMB is characterized by a diverse mix of anaerobic species without any appreciable amounts of beneficial Lactobacillus species. Our understanding of the species-specific manner by which vaginal bacteria interact with one another and with the host to induce susceptibility remains incompletely understood. With this, this study was designed to elucidate the interactions between common vaginal bacteria and host vaginal epithelial cells. The phenotypic and metabolic characteristics of these bacteria were also examined to provide a deeper understanding about the conditions in which each species may be able to survive and thrive. Common vaginal bacteria analyzed included dysbiosis associated species Gardnerella vaginalis and Prevotella bivia, as well as Lactobacillus species L. crispatus and L. iners. The presence of P. bivia, G. vaginalis and L. iners cocultured with vaginal epithelial cells in vitro resulted in reduced viability of vaginal epithelial cells, reduced barrier integrity and the production of pro-inflammatory cytokines. Conversely, the presence of L. crispatus did not, and was able to negate these adverse effects when placed in a dual species coculture with either of the other species. Additionally, we found that L. crispatus was the only one of these four species to produce hydrogen peroxide, and its supernatant was capable of inhibiting the growth of G. vaginalis and P. bivia. While we found that all four vaginal species could use glycogen for their growth, L. crispatus was able to use the widest range of carbohydrates tested. This translated to L. crispatus significantly outcompeting the other three bacterial species when cocultured in bacterial broth media with various carbohydrates tested. Our data provides insight into the species-specific nature by which common vaginal bacteria may interact with vaginal epithelial cells to increase host susceptibility to infection through cytotoxicity, decreased barrier function, and inflammation. We importantly observed the ability of L. crispatus to largely mitigate these effects and our phenotypic characterization place L. crispatus as the species most adept to provide protection in the FRT. Together, this work contributes to a better understanding of the interactions that govern the dynamics of the VMB and can be built upon to develop more rationale therapeutic or prophylactic interventions to improve the reproductive health of many vulnerable women. / Thesis / Master of Science (MSc)

No description available.

ABSTRACT BACKGROUND: Breastfeeding is important to children’s health and development in early years. It may also have implications for health in later life as it has been associated with some chronic non-communicable diseases including hypertension, obesity, diabetes, hypercholesterolemia, and cardiovascular diseases. The prevalence of exclusive breastfeeding in the United States is estimated to be approximately 44% for a 3-month period and 24% for a 6-month period (CDC, 2008). There are many factors that influence whether or not a mother will be successful in exclusive breastfeeding, and one factor that has been identified with the success of this is delivery method. OBJECTIVE: The purpose of this study was to determine whether or not infant delivery method is associated with exclusive breastfeeding. Additionally, other environmental and personal factors examined included: intent, infant-to-breast within two hours of birth, as well as maternal race, parity, and age. METHODOLOGY: Data were obtained from the Wellstar Kennestone Hospital Lactation Department through an agreement. The information was extracted from the patients’ medical charts between March, 2011 and March, 2013 by nurses in the lactation department. Descriptive statistical tests and univariate and multivariate logistic regression analyses were conducted to examine associations between delivery method and exclusive breastfeeding with analytic consideration given to significant environmental and personal maternal characteristics. RESULTS: There was a statistically significant association between delivery method and exclusive breastfeeding (OR= .510, 95% CI= .375-.695) after adjusting for intent, whether or not baby was put to the breast within two hours of birth, maternal race, parity, and maternal age. Mothers who delivered via cesarean section were .510 times as likely to be exclusively breastfeeding at the time of hospital discharge when compared to mothers who delivered vaginally. CONCLUSION: The results of this study indicate that there is a significant association between delivery method and exclusive breastfeeding, in that vaginally delivered babies were more likely to be exclusively breastfeeding compared to babies delivered via cesarean section. This result is consistent with other research, and it further supports recommendations for healthcare professionals to promote breastfeeding for the first six months of life. As aligned with the Baby-Friendly Hospital Initiative and WHO goals, exclusive breastfeeding should be thoroughly encouraged in addition to promoting natural (vaginal) birth options whenever possible. Further research regarding post-partum factors for both types of delivery that can lead to higher rates of exclusive breastfeeding is warranted.

Introduction Bacterial vaginosis (BV) is a highly prevalent vaginal infection which poses a significant public health burden in Sub-Saharan Africa (SSA) due to its association with HIV, other STIs and several gynaecological and obstetrical complications. The aim of this study was to explore the underlying and proximate factors associated with BV and the relationships between them. Materials and Methods This study was a cross-sectional secondary analysis of the data collected during the Microbial Development Program (MDP) 301 trial. Logistic regression and structural equation modelling were used to test for the associations between BV and the explanatory variables and to test for the direct, indirect and total effects of the variables on BV. Results A total of 2 470 women were included in the analysis and of these 2 203 were aged 40 and below. The majority of them were unemployed at 72% and 51,8% were in the lowest socio-economic level. The baseline prevalence of BV was 40.5%. In the logistic regression, high socio-economic level (AOR=1.66; 95% CI 1.04-2.64) and using a condom during their last sexual encounter (AOR 0.82; 95% CI 0.69-0.97) were associated with BV infection. The STIs significantly associated with BV infection were: Herpes Simplex Virus 2 (HSV2) (AOR=1.31; 95% CI 1.10-1.56), trichomoniasis (AOR=2.68; 95% CI 1.97-3.64) and chlamydia infection (AOR 2.02; 95% CI 1.61-2.62). In the structural equation modelling (SEM) high socio-economic status had a positive direct effect on BV infection (beta=0.12, OR=1.14).Condom use during the last sex act had a negative direct effect on BV (beta=-0.043, OR=0.96). The presence of T.vaginalis, HSV2 or chlamydia infection had significant positive effects on BV infection. Conclusions Sexual behavioural factors and the presence of STIs were significantly associated with BV. The SEM analysis showed the interaction of contraceptive use and sexual behavioural factors. No interaction between the STIs and sexual behaviour could be demonstrated in this study.

Made available in DSpace on 2016-04-28T20:17:25Z (GMT). No. of bitstreams: 1 2006-Juliana Braga de Andrade.pdf: 277168 bytes, checksum: e50d423b690ca866b106dbd90d193ab4 (MD5) Previous issue date: 2006-02-20 / In this study vaginal material was collected for microbiological and cytological evaluation in 39 female domestic cats, divided into two groups. The first group consisted of 21 whole animals, and the second of 18 neutered cats. All animals were apparently healthy, with ages varying from six months to 12 years, and were of different breeds; they came from domestic and county breeding centers in Rio de Janeiro. After mechanical containment, and cleansing of vulvar area, the proceeding for the microbiological isolation begun, for this two sterile pedriatic swabs previously embedded in a 0,9% saline solution were necessary. The first swab was used for bacterial isolation and preserved in Nutrient Agar transportation medium. The second swab was used for the fungal isolation and transported in Peptonated Water 1%. Afterwards, the material of both collections was refrigerated and sent to analysis. After this, the collection for cytological analysis was performed using a small interdental brush. The smears were fixated in absolute alcohol and dyed by the quick dyeing method (Diff Quick ?). In both groups studied differences were observed as to the number and species of bacteria. The first group had a higher frequency of Edwardsiella tarda (19,04%), followed by Enterobacter spp and Streptococcus spp, both with 17 isolations (16,19%). In relation to the neutered animals of the second group there was a higher predominance of Enterobacter spp (16,88%) and of Escherichia coli and of aeroginous Pseudomonas in the same proportion ( 14,28%). In the fungal isolation and identification it was also possible to observe differences related to the isolated ones in relation to the groups. In the first group there were 30,5% of Candida spp followed by Aspergillus spp (18,64%) and Curvularia spp (11,86%). Whereas in the second group, with castrated animals, there was a higher frequency of Penicillium spp (25%), Cladosporium (18,75%) and Candida spp (16,66%). As to the association between the microbiological and colpocytological exams it was observed that there was an agreement between the two auxiliary methods of diagnostic of vaginal microbiota of female cats only in the bacterial isolation, but not in the fungal isolation. / No presente estudo foi realizada a coleta de material vaginal para as avalia??es microbiol?gicas e citol?gicas em 39 gatas dom?sticas, divididas em dois grupos, sendo o primeiro composto de 21 animais inteiros e outro com 18 f?meas castradas, aparentemente saud?veis, com idade variando de seis meses a 12 anos, de diferentes ra?as, provenientes de cria??es domiciliares e particulares do munic?pio do Rio de Janeiro. Ap?s a conten??o mec?nica das f?meas e limpeza da regi?o vulvar, iniciou-se o procedimento para o isolamento microbiol?gico, para tal foram necess?rios dois swabs pedi?tricos est?reis, previamente umedecidos com solu??o salina est?ril a 0,9%. O primeiro swab foi utilizado para o isolamento bacteriano, sendo acondicionado em meio de transporte Agar Nutriente. O segundo swab para o isolamento f?ngico, transportado em ?gua Peptonada a 1%. Ap?s a coleta, ambos foram mantidos sob refrigera??o e encaminhados para an?lise. Em seguida procedeu-se a coleta para an?lise citol?gica com a utiliza??o da escova interdental fina. Os esfrega?os foram fixados em ?lcool absoluto e corados pelo m?todo de colora??o r?pida (Diff Quick?). Em rela??o aos dois grupos estudados observou-se diferen?as quanto ao n?mero e as esp?cies bacterianas encontradas. O primeiro grupo teve maior freq??ncia de Edwardsiella tarda (19,04%) seguido de Enterobacter spp e Streptococcus spp, ambos com 17 isolados (16,19%). Em rela??o aos animais castrados do segundo grupo, houve maior predomin?ncia de Enterobacter spp (16,88%) e de Escherichia coli e Pseudomonas aeruginosa com a mesma propor??o (14,28%). No isolamento e identifica??o f?ngica, foi poss?vel tamb?m observar diferen?as quanto aos isolados em rela??o aos grupos. No primeiro grupo houve 30,5% de Candida spp, seguido de Aspergillus spp (18,64%) e Curvularia (11,86%). No segundo grupo de animais castrados, houve maior freq??ncia de Penicillium spp (25%), Cladosporium (18,75%) e Candida spp (16,66%). Sobre a associa??o entre os exames microbiol?gicos e colpocitol?gicos, observou-se uma concord?ncia entre os dois m?todos auxiliares de diagn?stico da microbiota vaginal de gatas somente em rela??o ao isolamento bacteriano, mas n?o em rela??o ? f?ngica.

acase@tulane.edu / Progress towards understanding the underlying mechanisms of pelvic organ prolapse (POP) is limited, in part, due to a lack of information on the biomechanical properties and microstructural composition of the vaginal wall. Compromised vaginal wall integrity is thought to contribute to pelvic floor disorders. In particular, disruption of the elastin metabolism within the vaginal wall extracellular matrix has been highly implicated in POP pathogenesis; however, the role of elastin within the vaginal wall is not fully understood. In addition to the information produced from uniaxial testing, biaxial extension-inflation tests performed over a range of physiological values could provide additional insights into vaginal wall mechanical behavior (i.e. axial coupling and anisotropy) while preserving in vivo tissue geometry. Thus, the objective of this study is to identify the role of elastin in vaginal wall mechanics using physiologically relevant experimental and mathematical approaches. Our specific aims are thus: 1. Develop biaxial mechanical testing methods for assessing the mechanical properties of the murine vaginal wall in a physiological manner. 2. Establish a microstructurally-motivated constitutive model capable of describing the biaxial extension-inflation response of the nonpregnant murine vaginal wall. 3. Quantify the role of elastin in murine vaginal mechanical properties through enzymatic digestion of elastin with elastase.Vaginal tissue from female C57BL/6 mice underwent pressure-diameter and force-length preconditioning and testing within a pressure myograph device before and after elastase digestion. In order to mathematically interpret biaxial data, vaginal tissue was modeled using a 2D membrane approach. Several constitutive models were evaluated on their ability to describe vaginal wall mechanical behavior. Elastase digestion induced marked changes in biaxial mechanical properties, suggesting that elastin may play an important role in vaginal wall mechanical function. Constitutive model evaluation resulted in the selection of a diagonal two-fiber family strain energy function and suggests that collagen fibers within the vaginal wall extracellular matrix (ECM) may be primarily oriented diagonally with a slight preference towards the circumferential direction. Further, our results suggest that elastin-collagen interactions may be important for vaginal wall homeostasis. The present findings may help to understand the underlying mechanisms of POP and aid in the development of growth and remodeling models for improved assessment and prediction of changes in structure-function relationships with prolapse development. / 0 / Katy Robison

Thesis (M.S.)--University of Michigan, 1996.