Women's experiences of the gynecologic examination: factors associated with discomfort

BACKGROUND: The aim of this study was to evaluate how women experience the gynecologic examination and to assess possible factors associated with experiencing discomfort during the gynecologic examination. METHODS: Consecutive patients visiting the Department of Obstetrics and Gynecology at Glostrup County Hospital, Denmark, were invited to participate in the study, and received a postal questionnaire that included questions about the index visit, obstetric and gynecologic history and sexual abuse history. The response rate was 80% (n = 798). The degree of discomfort during the gynecologic examination was indicated on a scale from 0 to 10. Experiencing discomfort was defined as a score of 6 or more, based on the 75th percentile. RESULTS: Discomfort during the gynecologic examination was strongly associated with a negative emotional contact with the examiner and young age. Additionally, dissatisfaction with present sexual life, a history of sexual abuse and mental health problems such as depression, anxiety and insomnia were significantly associated with discomfort. CONCLUSION: The emotional contact between patient and examiner seemed to have great importance when focusing on discomfort during the gynecologic examination. Furthermore, we found that discomfort was associated with a number of factors that are seldom known to the gynecologists, such as sexual abuse history, mental health problems and patients' sexual life. Gynecologists need to focus on the emotional contact and to reevaluate issues for communication before the examination.     

Modern cleanroom clothing systems: people as a contamination source

Today, clothing and clothing systems for cleanrooms are mainly tested with regard to material properties such as particle generation, particle filtration, and resistance to wear. The dispersal chamber or "body-box" has been used for studying the protective efficacy of clothing systems in use, for example by Hoborn in 1981 (1) and Whyte and Bailey in 1985. A modified dispersal chamber has recently been installed at KTH. Tests and comparative studies have been performed in the dispersal chamber on selected clothing systems. The latest tests have been performed in two parts. In Part 1, each person performed 12 sequences dressed in new, modern cleanroom clothing systems with small variations, such as with and without goggles, different face masks, and different sizes of hoods. In Part 2, each person performed six test sequences with new, modern cleanroom clothing systems with variations in fabrics, and as a comparison, two sequences with pharmaceutical clothing system and surgical clothing system, respectively. The results are given in total number of airborne particles (> or = 0.5 microm per cubic meter) and airborne aerobic CFU per cubic meter. Statistical evaluations of the results have been performed. The source strengths of the contamination source people wearing modern cleanroom clothing systems have been estimated.     

Antiangiogenic treatment with thrombospondin-1 enhances primary tumor radiation response and prevents growth of dormant pulmonary micrometastases after curative radiation therapy in human melanoma xenografts

Thrombospondin-1 (TSP-1) is a potent antiangiogenic factor that has been shown to inhibit tumor growth by preventing endothelial cells from responding to a wide variety of angiogenic stimulators. We have demonstrated previously that D-12 primary tumors (human melanoma xenografts) suppress the growth of their spontaneous pulmonary micrometastases by secreting TSP-1 into the blood circulation. The same tumor model was used in the present work to study antitumor effects of combined radiation therapy and antiangiogenic treatment with TSP-1. Curative radiation treatment of D-12 primary tumors resulted in rapid growth of previously dormant micrometastases. Growth of dormant micrometastases could be prevented by treating the host mice with exogenous TSP-1 after the radiation treatment. Treatment with exogenous TSP-1 after subcurative radiation treatment reduced the growth rate of recurrent primary tumors in addition to suppressing metastatic growth. TSP-1 suppressed tumor growth at both primary and metastatic sites by inducing apoptosis in tumor-associated microvascular endothelial cells. Treatment with exogenous TSP-1 before radiation treatment enhanced the antitumor effect of the radiation treatment. The radiopotentiation by TSP-1 involved at least two distinctly different mechanisms, i.e., TSP-1 reduced the fraction of radiobiologically hypoxic parenchymal tumor cells and increased the radiation sensitivity of the tumor microvasculature by promoting radiation-induced endothelial cell apoptosis. In conclusion, the present preclinical study showed that TSP-1 has antiangiogenic, antimetastatic, and radiopotentiating properties that merit additional investigation in clinical studies.     

The prognostic impact of cyclin dependent kinase inhibitors p21WAF1, p27Kip1, and p16INK4/MTS1 in adenocarcinomas of the uterine cervix: an immunohistochemical evaluation of expression patterns in population-based material from 142 patients with international federation of gynecology and obstetrics stage I and II adenocarcinoma

BACKGROUND: The authors assessed the prognostic significance of abnormal cyclin dependent kinase inhibitor (CDKI) expression in adenocarcinomas of the uterine cervix. METHODS: Population-based, archival material from patients with International Federation of Gynecology and Obstetrics (FIGO) Stage I and II cervical adenocarcionmas from 2 5-year periods (1976-1980, n = 82 patients; 1986-1990, n = 142 patients) was examined for expression of p21(WAF1), p27(Kip1), and p16(INK4/MTS1) using immunohistochemical techniques. RESULTS: Rates of tumors with low levels of nuclear expression of p27 and p16 were lower during the period 1976-1980 (P < 0.01), suggesting bias due to unbuffered formalin. Analyses that were restricted to patients from 1986-1990 showed positive associations between all three CDKIs (P < 0.05). Low p16 expression was associated with higher FIGO stage (P = 0.01), age older than 55 years (P = 0.01), and deep invasion (P = 0.003). No significant associations with stage, age, or histopathologic parameters were found for p21 or p27. Significant associations with tumor differentiation were not seen for any CDKI. Kaplan-Meier plots showed diverging survival curves for p21 and p27 expression, but the differences were not significant. In multivariate analysis, low p27 expression and high p16 expression were strong predictors of a poor prognosis (p27: < 40% nuclear staining; P = 0.001; hazard ratio, 3.18; p16: < 40% nuclear staining; P < 0.001; hazard ratio, 0.16). Low p27 expression was of prognostic significance only if it was analyzed together with p16 expression. Further evaluation indicated that patients with different phenotypic p27/p16 combinations may have different outcomes. CONCLUSIONS: Aberrant expression patterns of CDKIs were predictors of prognosis for patients with FIGO Stage I or II cervical adenocarcinoma. Analysis of CDKI expression in this patient group may prove clinically useful.     

Patients with cancer and their close relatives: experiences with treatment,care, and support

This article presents findings from a study of 536 patients with cancer and 473 of their close relatives from 15 different hospitals in Norway. The study assessed the satisfaction of both groups with the help and support they received from different sources such as family and friends, health personnel, and fellow patients. The results indicate that the patients received more support and information than their close relatives. The patients also were generally more satisfied with the support. Furthermore, the relatives seemed to underestimate the help and support provided to the patients. For both the patients and their close relatives, family and friends proved to be important sources of support. Regarding the public health services, almost 90% of the patients were very satisfied with the medical treatment. On the other hand, only an approximate 13% were very satisfied with information about alternative treatment and financial issues related to the disease. For the patients, the contact with fellow patients was highly valued. For most of the patients, this contact provided hope for the future, but it also had the potential for painful and sad feelings. The study was conducted in collaboration with the Norwegian Cancer Society to provide information that can be used for the guidance of health personnel and care of patients and their relatives.     

Sixteen days

When does a human being begin to exist? We argue that it is possible, through a combination of biological fact and philosophical analysis, to provide a definitive answer to this question. We lay down a set of conditions for being a human being, and we determine when, in the course of normal fetal development, these conditions are first satisfied. Issues dealt with along the way include: modes of substance-formation, twinning, the nature of the intra-uterine environment, and the nature of the relation between fetus and mother (connection, parthood, dependence).     

Consistency of food intake factors by different dietary assessment methods and population groups

Several studies have used factor analysis to identify food intake patterns in epidemiological studies as an alternative to nutrient-based analyses, but few have validated the factors in a larger population. Our present objectives were: to compare the factor scores based on a food-frequency questionnaire (FFQ) with scores based on a 7 d diet record; to examine the consistency of the factor score correlations across strata of age, BMI, energy intake, education, physical activity and smoking and to compare factors identified in two sub-populations. In 879 men and 927 women, of the total population sample of 3785, scores on food intake factors, three for men ('green', sweet' and 'traditional') and two for women ('green' and 'sweet-traditional'), identified in data from the FFQ and the diet record, were compared. The loadings of foods on the factors were very similar and the correlations between the corresponding factor scores, based on the two dietary assessment methods, were: for men 'green' 0.61, 'sweet' 0.55, 'traditional' 0.34; for women, 'green' 0.61, 'sweet-traditional' 0.57. Stratification did not significantly modify the correlations, with a few inconsistent exceptions. Factors obtained in a different subsample of the population, for which there was only data from the FFQ, were almost identical to the factors found in the subsample, who provided both FFQ and diet record information with regard to food loadings and model fit. In conclusion, the food intake factors identified were reproducible using two different dietary assessment methods and, furthermore, independent of stratification.     

An outbreak of viral gastroenteritis in a mother-and-child health clinic

An outbreak of diarrhoeal disease in a modern mother-and-child health clinic prompted the health authorities to initiate a retrospective cohort study in order to assess the scope of the outbreak and to identify possible risk factors. The management of the clinic had been rather concerned because four similar outbreaks had occurred during the last two years. A total of 151 guests, i.e. mothers with their children, who had arrived some days before the peak of the outbreak for a three-week-stay and another 15 guests who had arrived earlier and had extended their stay were enrolled in the study which mainly focused on the possible role of treatment measures as risk factors. In addition, a total of 49 staff members were requested to provide information about symptoms, working area and attendance at work. Relevant data were available from 164 of 166 guests and 47 of 49 staff members (response rates 98.8% and 96.0%, respectively). The attack rate among guests was 44.0% (adults 27.0%, children 54.0%) and among staff 23.4%. The mean age of affected children (3.5 years) was significantly lower than that of those not affected (6.3 years). The main symptoms were diarrhoea and vomiting. The sudden start of the outbreak suggested a single source of infection which, however, remained unknown. Person-to-person transmission was supposed to be the cause of the following spread. No association between distinct treatment measures and the disease was proven by the cohort study. Norwalk-like viruses as well as astroviruses were detected by polymerase chain reaction in specimens taken from seven patients. No other enteropathogenic agents were found. Regarding the special conditions in a mother-and-child health clinic where social contacts among guests are much more frequent and intensive than among patients in a "normal" hospital, measures to prevent the spread of gastrointestinal infections should concentrate on early recognition and isolation of symptomatic individuals. Guests and staff members should be instructed to keep to the rules of personal hygiene, especially handwashing. If disinfection is required, it should be virucidal.