Self-report versus interview data of women's subjective theories of illness: Concordance and predictive validity in a psychosomatic-gynecological liaison service

Between-method comparisons of patient data from standardized self-report instruments and corresponding patient interview data frequently have poor agreement. We investigated the concordance and predictive validity of self-report measures and expert-rated interview data of women's subjective theories of illness in a psychosomatic-gynecological consultation liaison service. 31 patients completed two questionnaires (KKG, PATEF) on subjective theories of illness and were interviewed with a semistructured instrument on the same topic at the time of the initial appointment and after 1.5 years. External criteria for assessing the predictive validity of questionnaire versus interview data were: follow-up participation and psychotherapy utilization during the follow-up interval. Questionnaire and interview rating data were only modestly associated. Rater concordance on the interview data was low. Neither the initial-assessment interview nor the questionnaire data had predictive validity for patients' participation in the follow-up. None of the interview rating data but a portion of the questionnaire data, had predictive validity for patients' utilization of psychotherapy during the follow-up interval. The cognitive conceptualization of subjective theories of illness may fail in patients with psychosomatic disorders, due to their very mode of experience. A wider approach that includes assessment of nonverbal communication and countertransference might be useful.     

Hyperemesis gravidarum and patient satisfaction: a path model of patients' perceptions of the patient-physician relationship

OBJECTIVE: To examine the relationship between patients' perceptions of the patient-physician relationship and patients' satisfaction with the overall medical care received from their physicians in the treatment of hyperemesis gravidarum (HG). METHODS: This study investigated patients' beliefs and their views of their physicians' beliefs about the causal explanation of HG, the seriousness of the illness, and the impact of the illness upon patients' daily lives. Also examined were the extent to which patients' beliefs were congruent with their perception of their physicians' beliefs, and patients' ratings of the humanistic characteristics of physicians they deemed important. Ninety-six respondents who had experienced at least one hospitalization from January 1993 through April 1997 responded to interview questions focusing on their HG illness experience. Using both quantitative and qualitative methodological approaches, a path model of patient perception factors associated with patient satisfaction was tested. RESULTS: Perceived shared beliefs about the etiology of HG for a particular patient's illness were more important direct contributing factors of satisfaction than were the specific causal explanations. The length of the patient-physician relationship provided important indirect effects on patient satisfaction; three key mediating variables were patients' perceptions about physician humanism and perceived agreement about the cause and impact of HG. Pertinent qualitative findings are provided as additional sources of information to supplement the quantitative results. CONCLUSION: Knowledge of the patient-physician relationship factors that influence HG women's satisfaction can be used to enhance service delivery and may ultimately improve perinatal outcomes.     

Validity of adolescent and young adult self-report of Papanicolaou smear results

OBJECTIVE: To assess the validity of adolescent and young adult report of Papanicolaou smear results and to determine sociodemographic, cognitive, and behavioral factors associated with incorrect reporting. METHODS: We conducted a cross-sectional study of 477 female subjects aged 12 to 24 years who attended an adolescent clinic and had a previous Papanicolaou smear. Subjects completed a self-administered survey assessing self-report of Papanicolaou smear results, knowledge about Papanicolaou smears and human papillomavirus (HPV), attitudes about Papanicolaou screening and follow-up, and risk behaviors. The sensitivity, specificity, positive predictive value, and negative predictive value of self-reported results were calculated using the cytology report as the standard. Variables significantly associated with incorrect reporting were entered into logistic regression models controlling for age and race to determine independent predictors for incorrect reporting. RESULTS: Of the 477 participants, 128 (27%) had abnormal cytology reports and 66 (14%) had incorrect self-reports. Sensitivity of self-report was 0.79, specificity 0.89, positive predictive value 0.72, negative predictive value 0.92, and kappa (kappa) 0.66. The adjusted odds ratios (OR) and 95% confidence intervals (CI) of the variables comprising a logistic regression model predicting incorrect reporting were an HPV knowledge source of zero (OR 2.4, CI 1.0, 5.8), low perceived communication with the provider (OR 2.1, CI 1.1, 4.0), and no contraception at last intercourse (OR 5.5, CI 2.7, 11.0). CONCLUSION: The validity of adolescent and young adult self-reported Papanicolaou smear result is high, except among those who lack knowledge of HPV, perceive poor communication with the provider, and use contraception inconsistently.     

Intermediate-term outcome of psychiatric inpatients with major depression.

BACKGROUND/PURPOSE: A wide range of recovery rates has been reported during the 1st year of follow-up inpatients with depression, and there is a lack of consensus regarding which clinical and psychosocial variables are associated with prognosis. This study investigated the outcome of inpatients with a major depressive episode at 10-22 months (mean +/- SD = 14.0 +/- 3.4 months) of follow-up and the associated psychosocial and clinical variables. METHODS: The demographic and clinical characteristics of 67 inpatients with a DSM-IV major depressive episode were assessed at admission, discharge and 1 year after the initial assessment. A logistic regression model was used to examine the predictive factors of depressive status at follow-up. RESULTS: At the 1-year follow-up, 12 patients could not be located, one refused further interview and one had committed suicide 1 month after discharge. Eighty percent of patients had follow-up examinations. Out of 67 patients, 31 (47%) underwent a DSM-IV diagnosis (29 with major depression and two with minor depression) and 22 (33%) recovered. Low socioeconomic status (p = 0.05), long duration of illness before admission (p = 0.03) and number of previous hospitalizations (p = 0.04) were predictive factors for a depressive morbidity at 10-22 months. CONCLUSION: At follow-up, almost half of the discharged depressive patients were still depressed. Screening for predictive factors of chronic depressive morbidity facilitates better outcome by considering the heterogeneity of psychopathology that can lead to failure in the treatment plan.     

Low back pain, smoking and employment during pregnancy and after delivery - a 3-month follow-up study.

Low back pain (LBP.), smoking and employment was studied among 111 consecutive women admitted to a maternity ward over a 6-week period, 40 were primiparas and 71 multiparas. LBP was defined as any pain in the low back, irrespective of the specific cause of the pain. Two specially constructed questionnaires were utilised. The first was a, 14-item questionnaire which all participants answered before leaving the maternity ward. It included questions on employment and smoking and self-rating Visual Analogue Scales used for rating LBP. LBP was rated during the pregnancy and 3 days after delivery. The second questionnaire was used in a 90-day follow-up interview. The mean age of participants was 28 years. The prevalence of LBP during pregnancy was 58.5% among the 111 participants. Of the 111, 75% continued to have LBP postpartum and at the 90-day post-delivery follow-up, 54% of those with LBP during pregnancy were still experiencing LBP. Previous births and birth weight were not found to correlate positively with LBP. LBP during pregnancy did not affect the length of employment during pregnancy. Smokers had LBP more frequently during pregnancy and also after (P <0.002). It is concluded that smoking does seem to contribute to LBP during and after pregnancy. Birth weight does not affect LBP and LBP does not affect the length of employment during pregnancy.     

Life quality of post-myocardial infarction patients: influence of personal variables on coping

Coping in terms of physical, social, and psychological well-being and health-seeking behavior were studied by a self-reported questionnaire in 233 outpatients with myocardial infarction below 70 years of age. For most of these patients, physical limitations or discomfort were not significant, but the impacts on their emotion and social life were rather severe. As to social maladjustment, 70.3% of the patients were experiencing a deteriorated sexual life, 63.9% had not returned to their prior work status, 55.6% had decreased social participation and 45.7% had less interest in leisure activities. Physical morbidity was not the only determinant of maladaptation. Sex, educational level, existence of combined chronic disease, the time interval, and premorbid occupational characteristics all appear to be salient factors for coping. Those patients with a lower educational level were prone to the prominent threat of the disease (perceived lack of control and predictability), had higher scores of psychiatric symptoms, reported more physical symptoms, had a lower rate of work resumption and showed poorer medical compliance. Such data indicates that differences in disease-perception may be the mediators of socioenvironmental and illness-related influences. The rate of work resumption was also directly proportional to the patients' socioeconomic status and the degree of premorbid work responsibility and psychological demand reported by patients. Poorer outcomes of coping were also related to time interval since first heart attack and combined diabetes mellitus. Recovery from myocardial infarction is more than just a medical problem. Biomedical and psychosocial variables interact at many levels in the recovery process. It is of considerable practical importance to recognize the patients' coping ability, in order to obtain effective comprehensive care.     

Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery

BACKGROUND: In 1996, the Swedish National Register for Gynecological Surgery started to collect pre- and postoperative information on patients using questionnaires given out as part of routine medical care. The information is used in providing clinical care to the patient and for quality assessment. AIMS: To evaluate patients' acceptance of questionnaires as a means of collecting information, and to investigate whether the questionnaire is a suitable tool for follow-up of patients. METHODS: In 1998, evaluations of the ordinary questionnaires were done by an evaluation questionnaire mailed to 80 patients who had been recently hysterectomized. The results were triangulated with results from the register's database and data from interviews with physicians and secretaries. RESULTS: The majority of the patients appreciated the questionnaires. Patients did not report any major problems in filling in the questionnaires. Most problems were due to administrative errors of the departments. Up to 36% of the patients missed the scheduled follow-up visit 2 months after the operation. Two out of four departments regarded the follow-up visit necessary and requested by the patients. Out of 1226 patients followed up postoperatively by questionnaire, 75% stated that they did not need any medical care. Among physicians, some distrust of questionnaires was noted. CONCLUSIONS: The patients in this study preoperatively, and for short- and long-term follow-up, accepted the questionnaire as an instrument of data collection. Questionnaires provide a more complete collection of post-treatment information than follow-up visits do. A large number of unnecessary follow-up visits can be avoided through use of a questionnaire.     

Reliability and Validity of the Functional Pelvic Pain Scale: A New Measure of Pelvic Pain Severity

This study presents reliability and validity data from a small sample of pelvic pain clinic patients on a self-report rating scale, termed the Functional Pelvic Pain Scale (FPPS), designed to measure pelvic pain intensity as it relates to functions of daily living (bladder and bowel function, intercourse, walking, running, lifting, working, and sleeping).Study design: in a preliminary study, the FPPS was completed by 24 patients from a pelvic pain clinic, and 27 female medical students not having a complaint of pelvic pain. In a subsequent study of reliability and validity, 20 women attending the pelvic pain clinic completed the FPPS during their visit, and completed Daily Pain Records (DPRS) for every day of their next menstrual cycle, as well as a second FPPS at the end of their cycle.Results: preliminary results demonstrate that the FPPS shows discriminant validity between women without a complaint of pelvic pain and those with pelvic pan (p< 0.0001). Results in the second study demonstrate that the FPPS has satisfactory levels of test-retest reliability (r= 0.8048 p= 0.004) and construct validity. Functional pelvic pain scale scores showed statistically significant correlations with the highest monthly activity impairment (r= 0.5433 p= 0.007) and the average uterine pain intensity (r= 0.4436 p= 0.025).Conclusion: the FPPS is a sensitive and reliable measure of pelvic pain intensity through, time, demonstrating evidence of validity. The FPPS shows promise as a method for evaluation of pelvic pain severity. Its predictive value in research and clinical practice has yet to be determined.     

The contribution of spirituality and spiritual coping to anxiety and depression in women with a recent diagnosis of gynecological cancer

The objective of this study was to determine whether, after accounting for illness and demographic variables, spiritual involvement and beliefs and positive and negative spiritual coping could account for any of the variation in anxiety and depression among women within 1 year's diagnosis of gynecological cancer (GC). One hundred patients from outpatient GC clinics at two Melbourne-based hospitals completed a brief structured interview and self-report measures of anxiety, depression, spirituality, and spiritual coping. Using two sequential regression analyses, we found that younger women with more advanced disease, who used more negative spiritual coping, had a greater tendency towards depression and that the use of negative spiritual coping was associated with greater anxiety scores. Although not statistically significant, patients with lower levels of generalized spirituality also tended to be more depressed. The site of disease and phase of treatment were not predictive of either anxiety or depression. We conclude that spirituality and spiritual coping are important to women with GC and that health professionals in the area should consider these issues.     

Motives for having or not having Children: A Comparison between Questionnaire and Interview Methods

This study addresses validity issues in a questionnaire constructed with the aim of exploring a private and emotionally loaded topic, namely motives for having or not having children. Themes extracted by factor analysis of data from a reference population of men and women in the fertile ages were used to structure conversational interviews with a smaller sample of women and men of the same age. Of 30 persons invited, 24 agreed to participate in the interview and they completed the questionnaire before the interview. Factor scores were estimated from data obtained by means of the written questionnaire with closed questions, and the scores were compared with results from the structured interview with open questions. Thus, the questionnaire and the factor analysis were validated and a conclusion could be drawn that this method was able to provide important informatory facts even in an area where emotional factors are predominant. The findings also supported the idea that it is important to supplement questionnaire results with validity studies. The combination of the two methods in this study was fruitful and highlighted important new areas that need further research.     

A study to evaluate the use of CA125 in ovarian cancer follow-up: A change in practice led by patient preference

OBJECTIVES: To evaluate the use of CA125 in the follow-up of women with epithelial ovarian cancer in the Cambridge Gynaecologic Oncology Centre. To institute changes depending on patients' preferences. METHODS: A patient questionnaire was developed on follow-up, CA125 estimation and patient education in epithelial ovarian cancer and CA125. Initially, 100 patients were evaluated, and a change in practice was instituted. This was re-evaluated using the same patient population. RESULTS: 22/22 patients in clinic, and 68/78 patients who received the questionnaire by post, completed and returned it (n = 90). 81% wanted CA125 results available at clinic follow-up visits, with 82% willing to have the blood test done at their GP surgery before attending outpatients. CA125 follow-up practice was changed accordingly. This change was re-evaluated. A second questionnaire was sent to 35 surviving patients from the first cohort. 31/35 (90%) responses were received. Five patients were either no longer on follow-up, being > or =5 years from completing their original treatment or were being monitored elsewhere, leaving an 87% response rate (26/30). 92.3% felt that having CA125 results available in clinic had enhanced the quality of their follow-up. Patient education and basic understanding of CA125 also improved, with 88.5% aware of its role. CONCLUSIONS: The availability of CA125 results when patients attend for routine follow-up has improved their overall management in our clinics. It has reduced patient and physician anxiety and unsatisfactory out-of-clinic telephone communication. We recommend this change of practice to all Gynaecologic Oncology Centres engaged in active routine follow-up of their patients with epithelial ovarian cancer.     

The effectiveness of the interview for predicting the presence of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS), a leading cause of female infertility, occurs in approximately 4% of women of reproductive age. Multifamily studies have established that PCOS has strong inherited traits. Although diagnosis of PCOS in the relatives of affected women can readily be made by clinical and biochemical evaluations, these methods are costly and laborious. The aim of this investigation was to determine whether clinically evident PCOS could be detected by a written questionnaire, which is a significantly less expensive means of detection than direct determination. A questionnaire about the history of possible androgenic symptoms of PCOS was presented to patients and their first-degree female relatives, who were also evaluated by physical and laboratory examinations. The sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) for the detection of PCOS by interview were calculated. The NPV of the proband interview was significantly lower for sisters than for mothers (82% vs. 100%, respectively; p?<?0.05). When the family member completed the written questionnaire directly, the specificity and NPV of self-reporting were equally high (>90%) for both mothers and sisters. Thus direct interviewing of PCOS patients or their mothers and sisters reliably predicts affected status, but patient interview alone will not predict PCOS in almost 50% of the affected sisters.     

The triage-function of a psychosomatic liaison-service for gynecological patients

The psychosomatic psychotherapeutic consultation liaison (CL)-service for gynecological patients at the Vienna University has been evaluated. Research interest focused on success and failure of the initial interview, conceptualized for a specific clientele. The interview has a triage function for treatment planning. By the type of treatment that was applied, patients were divided into three groups: Group A, patients with one single contact with the unit; Group B, patients who were referred to external psychotherapy; Group C, patients who were treated with short-term psychoanalytic psychotherapy as offered by the service unit. The drop-outs figured as Group D. The questionnaires completed by the patients at the first consultation and 6 months after their final contact with the clinic covered socio-demographic data, ego functions; the motivation for psychotherapy, a complaints list and finally, at the second contact only, an individual retrospective judgement concerning personal consequences of the consultation. Patients needs in CL-seruices call for quick decisions, which therapeutic measure would be most adequate. An experienced clinician's decision is based on several circumstances: individual feeling of suffering therapy-motivation and ego-strength, as well as social and demographic facts. Comparing groups with different therapeutic recommendations showed that the psychometric tests discriminated well between these four groups and thus the validity of the clinical recommendation has been confirmed.     

Long-term impact and risk factors for hysterectomy after hysteroscopic surgery for menorrhagia

The objective of this study was to assess the long-term impact of management and establish the incidence of hysterectomy, and to identify factors predictive of failure of the procedure among women who had undergone hysteroscopic endometrial resection with or without myomectomy for menorrhagia. Clinical history and data on additional treatment and follow-up status were obtained by medical record review and postal questionnaire for 279 women who had undergone hysteroscopic surgery. Follow-up data were available for 259 (93%) cases, and the mean follow-up was 6.0 years. Subsequent hysterectomy was the primary endpoint, and its incidence was calculated by survival analysis. Univariant analysis and Cox regression model were used to identify predictors of failure. Myomas, polyps, adenomyosis, or endometrial hyperplasia were found in 40.9% of hysteroscopic procedures. Perioperative complications occurred in 5.7% and late complications in 7.7%. During the follow-up period, 97 (37.5%) of 259 women underwent at least one gynecological procedure. The incidence of hysterectomy was 23.6% (95% confidence interval: 18.8–29.1%). Positive predictive factors for hysterectomy were long uterine cavity (≥9 cm) and tubal ligation. Most (82.8%) of the 198 women who did not undergo hysterectomy had postoperative oligo- or amenorrhea. Hormone replacement therapy was common (67%) among postmenopausal women after endometrial resection. Hysteroscopic resection of the endometrium and concomitant hysteroscopic resection of fibroids for the treatment of menorrhagia is a suitable alternative to hysterectomy and offers lasting results. A large uterine cavity indicating possible uterine pathology and tubal ligation associated with hematometra increase the risk of hysterectomy.     

Performance of Pap smear and human papilloma virus testing in the follow-up of women with cervical intraepithelial neoplasia grade 1 managed conservatively

BACKGROUND: Conservative management (follow-up) of cervical intraepithelial neoplasia grade 1 (CIN1) is acceptable, but evidence on performance of follow-up tools, such as Pap smear and human papilloma virus (HPV) test, is still needed. METHODS: A cohort of 78 women with histologically confirmed CIN1, referred because of atypical squamous cell or low-grade squamous intraepithelial lesion in their Pap smear, was enrolled between August 2000 and September 2002 and was prospectively followed-up at 6 and 12 months, until September 2003. Follow-up examinations included Pap test and Hybrid Capture II (HCII) with high-risk HPV, colposcopy, and cervical biopsies in patients with persistent abnormalities. Odds ratios and performance indicators (with 95% confidence interval) were calculated for HPV and Pap test results in detecting biopsy-confirmed CIN during the follow-up. RESULTS: Thirty-seven (47%) of the women were HPV-positive at baseline. At first follow-up visit, 30 women had persistent CIN1 and one woman progressed to CIN2; 15 patients had CIN1 and one patient CIN2 at the second follow-up visit. Women with persistent CIN1 (or progression) during follow-up had a significantly higher HPV detection rate and abnormal Pap tests, compared to women with regressive disease. Cytology had a far better sensitivity in detecting CIN than HCII at the first follow-up visit (81 versus 52%, respectively), whereas both examinations had equivalent sensitivities at the second follow-up visit (69 and 56%, respectively). Cytology had a superior negative predictive value at the first follow-up visit and better positive predictive value, in addition, at the second visit. CONCLUSIONS: Because cytological abnormalities correlated generally better with the persistence of biopsy-confirmed CIN1 in this follow-up protocol, HCII test is the second-hand option to Pap test, but the use of both Pap and HCII together seems an unnecessary waste of resources.     

Do Patients Lie? An Open Interview vs. a Blind Questionnaire on Sexuality

IntroductionPostmenopausal women are often hesitant to discuss their sexual attitudes and experiences surrounding sexuality with her doctors. Sociocultural, ethnic, and medical background may affect the attitude towards menopause and the expectations regarding sexuality in these women.AimTo describe communication about sex between patients and doctors and its relation to extrinsic limiting factors.MethodsA total of 2,332 women between 45 and 64 years old were involved in this cross-sectional survey. The study used an ad hoc questionnaire covering the demographic and reproductive variables as well as the data related to sexual activity. The Cervantes questionnaire was administered to determine the impact of sexuality on health-related quality of life.Main OutcomesPatients' responses to anonymous questionnaires or direct interviews.ResultsThe percentage of women who recognized having occasional or unconventional partners was twofold higher in the anonymous questionnaire than in the clinical interview. In the medical interview only 15.2% of women recognized that sexuality was not very important compared with more than 40% in the anonymous questionnaire (P < 0.001). The highest concordance between the anonymous questionnaire and the clinical interview was in women who referred to not having any sexual relationship at all (88.07%) whereas in the other conditions concordance was significantly lower (P < 0.001).ConclusionSelf-reported data on sexuality diverge from those derived from a direct interview. The proportion of women with low interest in sexuality was higher in the blind questionnaires. Castelo-Branco C, Palacios S, Ferrer-Barriendos J, Alberich X, and The Cervantes Study Group. Do patients lie? An open interview vs. a blind questionnaire on sexuality.     

Sexual activity during late pregnancy and risk of preterm delivery

OBJECTIVE: To examine the association between sexual activity during late pregnancy and preterm delivery. METHODS: Women at least 16 years old and carrying singleton fetuses were recruited between 24 and 29 weeks' gestation from prenatal clinics in central North Carolina. They were interviewed by telephone about sexual activity before and during pregnancy. One hundred eighty-seven women delivered between 29 and 36 weeks and had a follow-up interview after delivery. Four hundred nine women who were selected randomly from the cohort served as controls and had a follow-up interview between 29 and 36 weeks (mean gestational age 39.2 weeks). RESULTS: Intercourse during late pregnancy was associated with a reduced risk of preterm delivery. The conditional odds ratio (OR) was 0.34 and 95% confidence interval (CI) 0.23, 0.51 for preterm delivery within 2 weeks after intercourse. Similar decreased risk for preterm delivery was found with recent female orgasm. Adjusting for race, age, education, and living with a partner had little effect on results. Cases were more likely than controls to report poorer health, medical reasons for reducing sexual activity, less interest in sex, and receipt of advice to restrict sexual activity during pregnancy. Results did not differ substantially according to presence or absence of bacterial vaginosis at 28 weeks. CONCLUSION: These data provide evidence against the hypothesis that sexual activity generally increases risk of preterm delivery between 29 and 36 weeks. However, we cannot exclude the possibility that a small subgroup of susceptible women might have adverse consequences of sexual activity.     

The effectiveness of outpatient Thermachoice endometrial balloon ablation: a long-term 11-year outcome study

The aim of this study was to evaluate the long-term treatment outcomes of outpatient Thermachoice balloon endometrial ablation under a direct local anaesthetic cervical block (LA-Thermachoice). This paper is a prospective cohort study and a postal questionnaire survey in a UK teaching hospital with the participation of 253 women with heavy menstrual bleeding (HMB) undergoing LA-Thermachoice over an 11-year period between 2001 and 2011. Treatment success was measured by postoperative bleeding patterns, improvement in dysmenorrhoea, patient satisfaction and post-procedure hysterectomy rates. LA-Thermachoice was completed in 98 % of women. The survey response rate was 78 %. The median follow-up interval was 71 months (SD 42). Seventy-nine percent of the responders reported significant improvement in HMB with 40 % amenorrhoea rate and 86 % improvement in dysmenorrhoea. Eighty-one percent felt that the benefit of procedure was maintained over a long period of time. Eighty-six percent of women were satisfied with the outcome of their procedure. The case notes of non-responders were examined to check if any had undergone hysterectomy since the LA-Thermachoice procedure. In total, only 16 % of women had a hysterectomy. This study represents the largest published series of local anaesthetic thermal endometrial ablation, reporting clinical outcomes with 11 years (median 71 months) of post-treatment follow-up. It demonstrates that the patient satisfaction with LA-Thermachoice is high, and is maintained over a long period of time after the procedure.     

Role of human papillomavirus (HPV) testing in the follow-up of patients after treatment for cervical precancerous lesions

OBJECTIVE: To evaluate the role of human papillomavirus (HPV) testing in post-treatment follow-up of patients after therapeutic excision of the cervix due to positive screening tests. STUDY DESIGN: A hospital-based retrospective analysis was performed with prospective collection of patient data of women screened for cervical cancer at a Gynecologic Outpatient Clinic. Patients after therapeutic excision due to positive screening results were identified and followed up with HPV testing and serial cytology. RESULTS: After 61 treatment for cervicalis intraepithelialis neoplasia (CIN), high-risk HPV infection was detected during the post-treatment follow-up at 18 cases (29.5%), 10 of them had persisting cytological atypia (positive predictive value (PPV): 56%), 5 developed CIN (PPV: 28%). When the HPV test was negative (43 patients) in the post-treatment period, neither CIN nor persisting cytological atypia developed (negative predictive value (NPV): 100%) during 1201 patient months (median 26 months). CONCLUSIONS: A negative HPV test eliminates the risk of recurrent disease after treatment for CIN.     

Late symptoms after pregnancy-related deep vein thrombosis

Thromboembolism during pregnancy is a rare complication with a potential fatal outcome. Very little is known about long-term effects and therefore 104 women with thrombosis during pregnancy or puerperium were identified and their subjective complaints were assessed in a questionnaire. All had their thrombosis diagnosed by objective methods and the median follow-up time was 11 years. In spite of anticoagulant treatment only 22% were without complaints; 4% had ulceration, all occurring in the group with thrombosis during pregnancy. Significantly more women who had had their thrombosis during pregnancy used compression bandages than those who had their thrombosis during puerperium. The severity of the symptoms increased with the increasing number of thromboses. Anticoagulant therapy of the acute episode does not appear to alter the degree of long-term handicap in the lower limbs.