Vaginal self-sampling without preservative for human papillomavirus testing shows good sensitivity

BackgroundSeveral strategies have been used to reach non-attending women in organized cervical-cancer-screening programs, with varying success. Self-sampling (SS) for HPV is effective for increasing coverage in screening programs, but requires expensive commercial sampling kits.ObjectiveWe aimed to evaluate if vaginal SS, without commercial preservatives was adequate for HPV testing.Study designWomen with abnormal cervical smears as determined from the organized screening program were invited to a colposcopy clinic. The 121 women were asked to insert a cotton swab into the vagina and rotate it, put the cotton swab into a sterile cryotube, break the upper part of the stick and put the cap on. Thereafter, the gynaecologist collected a liquid based cytology (LBC) sample. The presence of HPV-types in SS and LBC samples was analysed with PCR and luminex-based typing.ResultsHigh-risk-HPV (hr-HPV) DNA was found in 65 of the tested 108 SS (60%; 95% CI 0.50–0.69), whereas LBC found hr-HPV in 64/108 samples (59%; 95% CI 0.49–0.69). The agreement between sampling with SS and LBC was good, kappa value 0.67 (95% CI; 0.53–0.81). The sensitivity for SS with hr-HPV to find HSIL was 81% (95% CI; 67–95%), specificity 49% (95% CI; 37–60%) and the sensitivity for LBC with hr-HPV to find HSIL was 90% (95% CI 80–100%), specificity53% (95% CI; 42–65%).ConclusionsThis new vaginal self-sampling method detects hr-HPV-infections with similar sensitivity as a cervical smear taken by a gynaecologist. This self-sampling method is cost-effective and well tolerated, and the kit is suitable for regular mail transport.     

A summary of the 25th International Papillomavirus Conference 2009: Vaccines,screening, epidemiology and therapeutics

The 25th International Papillomavirus Conference was held in Malmo, Sweden, on May 8–14, 2009. The conference encompassed all areas of papillomavirus (PV) research, from clinical vaccinology to molecular biology. This review highlights some of the 237 presentations and 887 abstracts which were presented and summarizes sessions on prophylactic vaccines, screening, epidemiology and therapeutics. Important advances included identification of variants in four genes associated with HPV persistence, new HPV detection are likely new infections and not latency reactivation, and development of effective DNA vaccines that targets E6/E7 genes of HPV11. Also, many studies from different countries demonstrated that HPV vaccination provided sustained protection and substantial reduction of disease burden in both women and men, and in HIV-infected neonates. All the references cited are from the abstract book of the IPV Conference. See http://www.hpv2009.org/.     

Comparative Profile of Heme Acquisition Genes in Disease-Causing and Colonizing Nontypeable Haemophilus influenzae and Haemophilus haemolyticus

Nontypeable Haemophilus influenzae (NTHI) are Gram-negative bacteria that colonize the human pharynx and can cause respiratory tract infections, such as acute otitis media (AOM). Since NTHI require iron from their hosts for aerobic growth, the heme acquisition genes may play a significant role in avoiding host nutritional immunity and determining virulence. Therefore, we employed a hybridization-based technique to compare the prevalence of five heme acquisition genes (hxuA, hxuB, hxuC, hemR, and hup) between 514 middle ear strains from children with AOM and 235 throat strains from healthy children. We also investigated their prevalences in 148 Haemophilus haemolyticus strains, a closely related species that colonizes the human pharynx and is considered to be nonpathogenic. Four out of five genes (hxuA, hxuB, hxuC, and hemR) were significantly more prevalent in the middle ear strains (96%, 100%, 100%, and 97%, respectively) than in throat strains (80%, 92%, 93%, and 85%, respectively) of NTHI, suggesting that strains possessing these genes have a virulence advantage over those lacking them. All five genes were dramatically more prevalent in NTHI strains than in H. haemolyticus, with 91% versus 9% hxuA, 98% versus 11% hxuB, 98% versus 11% hxuC, 93% versus 20% hemR, and 97% versus 34% hup, supporting their potential role in virulence and highlighting their possibility to serve as biomarkers to distinguish H. influenzae from H. haemolyticus. In summary, this study demonstrates that heme acquisition genes are more prevalent in disease-causing NTHI strains isolated from the middle ear than in colonizing NTHI strains and H. haemolyticus isolated from the pharynx.     

Never mind the spider: Late positive potentials to phobic threat at fixation are unaffected by perceptual load

Research suggests that processing of emotional stimuli may be eliminated if a concurrent task places sufficient demands on attentional resources. To test whether this holds for stimuli with strong emotional significance, pictures of spiders as well as mushrooms were presented at fixation to spider‐fearful and non‐fearful participants. Concurrently, perceptual load was manipulated in two levels with a peripheral letter discrimination task. Results of event‐related potentials showed that, compared with non‐fearful participants, spider‐fearful participants showed greater late positive potentials (LPP) to spiders than mushrooms, which provides a manipulation check that spiders were emotionally meaningful to spider‐fearful participants. Critically, this effect was not affected by level of perceptual load. These findings suggest that strong emotional stimuli at fixation may resist manipulations of perceptual load.     

Circulating syndecans during critical illness

Circulating syndecans are proposed to be markers of glycocalyx degradation and previous investigations have found higher plasma levels of syndecan‐1 among patients with different pathological conditions. We wanted to investigate if levels of other syndecans (‐2,‐3 and ‐4) are altered during critical illness and compare the levels to syndecan‐1. In 137 consecutive intensive care unit (ICU) patients with sepsis, cardiac arrest, gastrointestinal bleeding, intoxication or trauma, plasma levels of syndecan‐1, ‐2, ‐3 and ‐4 were measured using ELISA. Syndecan‐1 and syndecan‐3 levels were similar among the different ICU patient groups but higher than controls. No differences in plasma levels of syndecan‐2 or syndecan‐4 were found neither among the different ICU patient groups nor compared to controls. All syndecans showed an association with mortality and the levels of syndecan‐1 and ‐3 and correlated with each other. The results indicate that syndecan release is triggered by the physiological stress of critical illness in general and involves several subtypes such as syndecan‐1 and syndecan‐3.     

Population-based study of screening test performance indices of three human papillomavirus DNA tests

In order to evaluate three common human papillomavirus (HPV) DNA tests for key performance indices in population-based cervical screening, we sampled 12,527 women aged 32-38 years who attended invitational, population-based screening and followed them for 4 years with comprehensive registry linkages. Three different HPV DNA tests (GP5+/6+ general primer PCR (using either AmpliTaq or AmpliTaq Gold DNA polymerase), Amplicor PCR and Hybrid Capture II were evaluated using baseline samples from women who on follow-up developed cervical intraepithelial neoplasia grade 2 or worse (CINII+) (n = 197) as well as a representative subsample of the women in the cohort (n = 794). The population-based HPV prevalence, sensitivity for future cervical intraepithelial neoplasia grade 2 or worse (CINII+), and absolute risk of CINII+ was 7.1%, 87.1%, and 23.2% for AmpliTaq GP5+/6+ PCR, 11.9%, 88.9%, and 11.0% for AmpliTaq Gold GP5+/6+ PCR, 15.7%, 93.4%, and 9.8% for Amplicor, 10.0%, 92.9%, and 15.3% for Amplicor with raised cut-off, and 7.8%, 79.7%, and 16.9% for Hybrid Capture II. In conclusion, AmpliTaq GP5+/6+ PCR and Amplicor with raised cut-off value have adequate performance indices for primary screening.     

Dental hygienists and dentists as providers of brush biopsies for oral mucosa screening

Background

Oral cancer is a severe and potentially fatal disease usually starting in the squamous epithelium lining the oral cavity. Together with oropharyngeal carcinoma, it is the fifth to sixth most common malignancy worldwide. To limit the increase in the global oral cancer incidence over the past two decades, the World Health Assembly adopted a resolution urging member states to integrate preventive measures such as engagement and training of dental personnel in screening, early diagnosis, and treatment into their national cancer control programs.

Aim

The aim of this study was to investigate if dental hygienists (DHs) and dentists (Ds) in general dental practice care can be entrusted to perform brush sampling of oral potentially malignant disorders (OPMDs), and to evaluate their level of comfort in performing brush biopsies.

Methods

Participants were five DHs and five Ds who received one day of theoretical and clinical training in oral pathology to identify OPMDs (leukoplakia [LP], erythroplakia [EP], and oral lichen planus [OLP]), and perform brush sampling for PAP cytology and high-risk human papillomavirus (hrHPV) analysis.

Results

Out of 222 collected samples, 215 were adequate for morphological assessment and hrHPV analysis. All the participants agreed that sample collection can be incorporated in DHs and Ds routine clinical duties, and most of them reported that sample collection and processing was easy/quite easy.

Conclusion

Dentists and DHs are capable of collecting satisfactory material for cytology and hrHPV analysis. All the participating DHs and Ds were of the opinion that brush sampling could be handled routinely by DHs and Ds in GDP.     

Person-centred conversations in nursing and health: A theoretical analysis based on perspectives on communication

In this paper we use the concept of the person to examine person-centred dialogue and show how person-centred dialogue is different from and significantly more than transfer of information, which is the dominant notion in health care. A further motivation for the study is that although person-centredness as an idea has a strong heritage in nursing and the broader healthcare discourse, person-centred conversation is usually discussed as a distinct and unitary approach to communication, primarily related to the philosophy of dialogue—the philosophy of Martin Buber. In this paper we start with the concept of person to critically reflect on theoretical perspectives on communication to understand person-centred conversations in the context of nursing and health. We position the concept of the person through the use of Paul Ricoeur's philosophy and follow by distinguishing four theoretical perspectives on communication before reflecting on the relevance of each of these for person-centred communication. These perspectives are: a linear view of communication as transfer of information, communication as a relation in the sense of philosophy of dialogue, practice-based communication on constructionist grounds, and communication as a practice to create social community. In relation to the concept of the person, we do not find transfer of information relevant as a theoretical underpinning for person-centred conversations. From the other three perspectives that are relevant we distinguish five types of person-centred conversations pertinent to nursing and health: problem identifying conversations, instructive conversations, guiding and supportive conversations, caring and existential conversations, and therapeutic conversations. Through this analysis it is argued that person-centred communication and conversations are substantially different to transfer of information. We also discuss the significance of communication adjusted to specific situations, including emphasis on how we speak in relation to the aim or topic of a conversation.