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- Alfonzo, Emilia, et al.
(författare)
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Colposcopic assessment by Swedescore, evaluation of effectiveness in the Swedish screening programme: a cross-sectional study.
- 2022
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 129:8, s. 1261-1267
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the effectiveness and performance of Swedescore in the Swedish screening programme.Cross-sectional register study.All Swedish women aged over 18years with a colposcopic assessment linked to a biopsy in the Swedish National Cervical Screening Registry, 2015-20.Colposcopies with Swedescore were compared with the histopathological diagnosis of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). The respective influence of cytology and human papillomavirus (HPV) testing, at referral for colposcopy and concurrently with colposcopy, were investigated in regression models.CIN2+.A total of 11317 colposcopic assessments with Swedescore were included. Odds ratios for CIN2+ increased for every step in the Swedescore scale. At Swedescore ≥0-1, the proportion of CIN2+ was 9.8%. At Swedescore ≥8, the specificity was 93.3% and the positive predictive value was 60.1%, Area under the receiver operating characteristics curve (AUC) was 0.71. If the smear had been abnormal at referral, a normal colposcopy (Swedescore 0-1) was still associated with a CIN2+ risk of more than 5%. In the regression model, cytology and HPV had higher odds ratio for CIN2+ than colposcopy; the combination resulted in an AUC of 0.88.Swedescore works well in a routine clinical setting but colposcopy assessed with Swedescore was inferior to that reported in previous clinical studies. No safe cutoff level was identified for refraining from biopsy. See-and-treat at Swedescore 8-10 is feasible only if referral cytology showed high-grade squamous intraepithelial lesion.No safe cutoff level for refraining from biopsy nor for see-and-treat with Swedescore.
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| 2. |
- Thunell, Louise, et al.
(författare)
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Scientific evidence changes prescribing practice--a comparison of the management of the climacteric and use of hormone replacement therapy among Swedish gynaecologists in 1996 and 2003
- 2006
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Ingår i: Bjog. - : Wiley. ; 113:1, s. 15-20
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study changes in attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynaecologists in Sweden. DESIGN: Comparative questionnaire study. SETTING: National survey. POPULATION: Practising gynaecologists. METHODS: In 1996, gynaecologists in Sweden (n= 1323) were invited to return a postal questionnaire concerning their attitudes, knowledge and management strategies concerning HRT. They were also asked about their own use of HRT. In 2003, a similar questionnaire was sent to practising gynaecologists (n= 1320) in Sweden. MAIN OUTCOME MEASURES: Attitudes to and personal use of HRT. RESULTS: The response rate was 76% in 2003 when 11% of the gynaecologists thought that all women without contraindications should be offered HRT compared with 44% in 1996 and 89% found it difficult to evaluate pros and cons with HRT in a clinical situation (74% in 1996). More gynaecologists in 2003 believed that HRT increased the risk for breast cancer (95% vs 71%). Twenty-five percent in 2003 stated that risk factors for osteoporosis were absolute indications for HRT (60% in 1996). Current ischaemic heart disease was considered to be an indication for HRT by 7% in 2003 (60% in 1996). In 2003, current use of HRT was reported by 71% of female menopausal gynaecologists (88% in 1996). CONCLUSIONS: Swedish gynaecologists were more cautious in their management strategies concerning HRT in 2003 compared with 1996, probably influenced by results from the Heart and Estrogen/Progestin Replacement Study (HERS) and Women's Health Initiative (WHI) studies. Current use of HRT was still high among female gynaecologists, although it had decreased since 1996.
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| 3. |
- Gyhagen, Maria, et al.
(författare)
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Prevalence and risk factors for pelvic organ prolapse 20years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery.
- 2013
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 120:2, s. 152-60
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Tidskriftsartikel (refereegranskat)abstract
- Please cite this paper as: Gyhagen M, Bullarbo M, Nielsen T, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 2012; DOI : 10.1111/1471-0528.12020. Objective To investigate prevalence and risk factors for symptomatic pelvic organ prolapse (sPOP) and sPOP concomitant with urinary incontinence (UI) in women 20years after one vaginal delivery or one caesarean delivery. Design Registry-based national cohort study. Setting Women who returned a postal questionnaire in 2008 (response rate 65.2%). Population Singleton primiparae with a birth in 1985-88 and no further births (n=5236). Methods The SWEPOP study used validated questionnaires about sPOP and UI. Main outcome measures Prevalence rate and risk of sPOP with or without concomitant UI. Results Prevalence of sPOP was higher after vaginal delivery compared with caesarean section (14.6 versus 6.3%, odds ratio [OR] 2.55; 95% confidence interval [95% CI] 1.98-3.28) but was not increased after acute compared with elective caesarean section. Episiotomy, vacuum extraction and second-degree or more laceration were not associated with increased risk of sPOP compared with spontaneous vaginal delivery. Symptomatic POP increased 3% (OR 1.03; 95% CI 1.01-1.05) with each unit increase of current BMI and by 3% (OR 1.03; 95% CI 1.02-1.05) for each 100g increase of infant birthweight. Mothers ≤160cm who delivered a child with birthweight ≥4000g had a doubled prevalence of sPOP compared with short mothers who delivered an infant weighing <4000g (24.2 versus 13.4%, OR 2.06; 95% CI 1.19-3.55). Women with sPOP had UI and UI>10years more often than women without prolapse. Conclusion The prevalence of sPOP was doubled after vaginal delivery compared with caesarean section, two decades after one birth. Infant birthweight and current BMI were risk factors for sPOP after vaginal delivery.
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| 4. |
- Alfonzo, Emilia, et al.
(författare)
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Risk of vaginal cancer among hysterectomised women with cervical intraepithelial neoplasia: a population-based national cohort study.
- 2020
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 127:4, s. 448-454
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Tidskriftsartikel (refereegranskat)abstract
- To study the risk of vaginal cancer among hysterectomised women with and without CIN.Population-based national cohort study.All Swedish women, five million in total, aged 20 and up, 1987-2011 using national registries.The study cohort was subdivided into four exposure groups: hysterectomised with no previous history of CIN3 and without prevalent CIN at hysterectomy; hysterectomised with a history of CIN3/adenocarcinoma in situ (AIS); hysterectomised with prevalent CIN at hysterectomy; non-hysterectomised.Vaginal cancer.We identified 898 incident cases of vaginal cancer.Women with prevalent CIN at hysterectomy and those with CIN3/AIS history had incidence rates (IR) of vaginal cancer: 51.3 (34.3-76.5) and 17.1 (12.5-23-4) per 100000, respectively. Age-adjusted IR-ratios (IRRs) compared to hysterectomised with benign cervical history, were 21.0 (13.4-32.9) and 5.81(4.00-8.43), respectively. IR for non-hysterectomised women was 0.87 (0.81-0.93) and IRR 0.37 (0.30-0.46). In hysterectomised with prevalent CIN, the IR remained high after 15 years of follow-up: 65.7 (21.2-203.6).Our findings suggest that hysterectomised women with prevalent CIN at surgery should be offered surveillance. Hysterectomised women without the studied risk factors have a more than doubled risk of contracting vaginal cancer compared with non-hysterectomised women in the general population. Still, the incidence rate does not justify screening.
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| 10. |
- Ankardal, Maud, 1957, et al.
(författare)
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A randomised trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence
- 2004
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Ingår i: Bjog. - : Wiley. - 1470-0328. ; 111:9, s. 974-81
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence. DESIGN: Multicentre, prospective randomised trial. SETTING: Departments of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Goteborg, Boras County Hospital and Orebro University Hospital, Sweden. POPULATION: Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component were included, and were randomised to either open colposuspension (n= 120) or laparoscopic colposuspension (n= 120). METHODS: Women were randomised to open colposuspension with sutures or laparoscopic colposuspension with polypropylene mesh and staples. Anaesthesia/operation time, blood loss, complications and other related surgical parameters were compared. MAIN OUTCOME MEASURES: Objective and subjective cure rates from 48-hour frequency-volume chart, a 48-hour pad test and a subjective assessment of the woman's incontinence and quality of life performed one year after surgery. RESULTS: Objective and subjective cure rates were higher after open compared with laparoscopic colposuspension (P < 0.001). Quality of life was improved following surgery in both groups (P < 0.0001) and the improvement was significantly greater in the open colposuspension group (P < 0.05) with regard to physical activity. Performing an open colposuspension was less time consuming (P < 0.0001), resulted in more blood loss (P < 0.0001), longer catheterisation time (P < 0.01), greater risk of urinary retention (P < 0.01) and a longer hospital stay (P < 0.0001) compared with performing a laparoscopic colposuspension. The rate of serious complications was low in both groups. CONCLUSION: Open colposuspension had a higher objective and subjective cure rate one year after surgery but with a greater blood loss, greater risk of urinary retention and a longer hospital stay than laparoscopic colposuspension.
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