Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Prognostic factors for IB2-IIIB cervical cancer patients treated by radiation therapy with high-dose-rate brachytherapy in a single-institution study
Full text linkPurpose:
To evaluate the efficacy of radiotherapy in locally advanced cervical cancer, and to determine the factors affecting prognosis.
Material and methods:
Clinical data of 211 patients with cervical cancer, treated at our institution between June 2014 and February 2017 were reviewed retrospectively. All patients were treated with definitive radiotherapy and received external irradiation of 45-50.4 Gy. High-dose-rate brachytherapy (HDR-BT) of 24-36 Gy was prescribed to a high-risk clinical target volume (HR-CTV) as a local boost. All statistical analyses were performed with SPSS version 19.0 using Kaplan-Meier survival test and Cox regression analysis. Additionally, dose parameters of patients with IIIB stage treated with combined intracavitary/interstitial (IC/IS) implants were compared with IC only.
Results:
With a median follow-up time of 69 months, local control (LC), overall survival (OS), disease-free survival (DFS), and nodal control (NC) at 5 years were 89%, 78%, 67%, and 88%, respectively. In multivariate analysis, the major determinant of LC was the level of pre-treatment squamous cell carcinoma antigen (SCC-Ag). The predictors of shorter OS were adenocarcinoma, pre-treatment SCC-Ag, and FIGO stage. Worse DFS was associated with adenocarcinoma, pre-treatment SCC-Ag, and involved lymph nodes. The predictors for nodal failure were positive pelvic lymph nodes. Patients with IIIB treated with IC/IS brachytherapy tended to improve DFS compared with IC alone, and obtained similar HR-CTV D90 EQD2 (n = 10) and biological effective dose (BED), 91 ±6 Gy vs. 89 ±3 Gy, and 107 ±4.5 Gy vs. 107 ±5.6 Gy, whereas decreased organs at risk (OARs) doses, including rectum and bladder D2cm3 were 7.5 Gy and 7.2 Gy lower, respectively. Late grade 3-4 bladder and bowel toxicities were observed in 1.9% of patients.
Conclusions:
Radiation therapy carried out in our institution results in good survival, with acceptable toxicity in locally advanced cervical cancer. Different individualized therapeutic strategies should be considered for patients with high-risk factors
Immune checkpoint inhibitors in advanced and recurrent/metastatic cervical cancer
Full text linkCervical cancer (CC) poses a serious threat to women’s health. Although many early-stage patients have a good prognosis, there are still a lack of effective therapies for advanced and recurrent/metastatic CC. In this context, immunotherapy and immune checkpoint inhibitors (ICIs) are particularly likely to play a role in the treatment of cervical tumors in a variety of disease settings. Some promising immune checkpoints include programmed cell death 1 (PD-1), programmed death ligand 1 (PD-L1) and cytotoxic T lymphocyte antigen 4 (CTLA-4), which exert immunomodulatory effects as negative regulators of T-cell activation and suppress immune responses in cervical cancer through cancer cell immune evasion. Initial trials of ICIs for CC have shown encouraging results in terms of objective response rate (ORR), progression-free survival (PFS), and overall survival (OS), both monotherapy and combination strategies. Meanwhile, human papillomavirus, vaginal microecology and intestinal microenvironment play an important role in CC, which provides new treatment directions. This review analyzed a number of completed or ongoing clinical trials of ICIs in the treatment of advanced and recurrent/metastatic CC. And we also analyzed the important relationship between vaginal microecology and intestinal microecology with CC and their related immunotherapy prospects
Menstrual hygiene management and its determinants among adolescent girls in low-income urban areas of Delhi, India: a community-based study
Full text linkObjectives:
Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls, including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India.
Methods:
A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face.
Results:
In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n=1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM.
Conclusion:
More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%)
Prevalence of reproductive tract infections including sexually transmitted infections among married women in urban and peri-urban mid to low socioeconomic neighbourhoods of Delhi, North India: an observational study protocol
Full text linkIntroduction:
The Global Health Sector Strategy on sexually transmitted infections (STIs), endorsed by the World Health Assembly in 2016 aims to end STIs as public health threat by 2030. WHO conducts global estimates of prevalence to monitor progress towards achieving the same. However, limited laboratory confirmed data exist of STIs and reproductive tract infections (RTIs) apart from few prevalence surveys among key populations and clinic-based reports, including in India. Syndromic approach is the cornerstone of RTI/STI management and to maximise the diagnostic accuracy, there is a need to determine the main aetiologies of vaginal discharge. This study aims to estimate the prevalence of common STIs and RTIs and their aetiological organisms in symptomatic and asymptomatic women living in the urban and peri-urban, mid to low socioeconomic neighbourhoods of Delhi, North India.
Methods and analysis:
A cross-sectional study will be conducted among 440 married women who participated in the ‘Women and Infants Integrated Interventions for Growth Study (WINGS)’. Information on sociodemographic profile, sexual and reproductive health will be collected, followed by examination and collection of vaginal swabs for nucleic acid amplification tests to diagnose Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis and microscopy to identify bacterial vaginosis and Candida albicans. Treatment will be as per the syndromic approach recommendations in the Indian National Guidelines. Data will be analysed to estimate prevalence, presence of symptoms and signs associated with laboratory confirmed RTIs/STIs using STATA V.16.0 (StataCorp).
Ethics and dissemination:
This study protocol has been approved by the ethics review committees of the WHO and Society for Applied Studies (SAS/ERC/RHR-RTI/STI/2020). Approval has been obtained by the WINGS investigators from SAS ethics research committee to share the contact details of the participants with the investigators. The findings will be published in peer-reviewed journals and disseminated through scientific conferences
Pasifika women's knowledge and perceptions of cervical-cancer screening and the implementation of self-testing in Aotearoa New Zealand: a qualitative study
Full text linkBackground:
In Aotearoa New Zealand, Pasifika women have a higher rate of cervical cancer incidence and mortality than European/Other women and a lower screening rate. Despite actions to reduce the barriers, there has been little change in screening coverage for Pasifika women since 2007. Novel strategies are therefore required. Persistent cervical infection with oncogenic human papillomavirus (HPV) causes virtually all cervical cancers and HPV testing will be implemented in Aotearoa in 2023, with women being able to choose to self-test. We undertook a qualitative focus group (FG) study with Pasifika women to explore their perspectives on the barriers to, and facilitators of, HPV self-testing and how best to implement this in Aotearoa.
Methods:
A trained female Pasifika Research Assistant facilitated participant recruitment and the FGs. Eligible participants self-identified as Pasifika, were aged 30-69 years, in the Wellington area, who had never been screened or who were overdue (≥5 years) for cervical-cancer screening. Recruitment was predominantly through Pasifika key-informant networks and in collaboration with Pasifika primary care providers. Participants were offered face-to-face FGs but, due to occasional Covid-19 restrictions and personal preferences, FGs via Zoom were also used. The FGs were audio-recorded and transcribed verbatim. The FG transcripts were thematically analysed.
Findings:
Seven FGs were conducted with 24 participants. We identified five main themes around barriers and potential facilitators of HPV self-testing in Pasifika women: 1) perceptions and knowledge of cervical-cancer screening; 2) challenges to engaging in organised cervical screening; 3) perceptions of self-testing for HPV and challenges women face when deciding to self-test; 4) enthusiasm for an HPV self-test; and 5) information and communication. Knowledge about cervical cancer and screening varied considerably among participants, with some never having heard about cervical-cancer screening. The main challenges that were raised were personal privacy and confidentiality and time management. There was consensus around the need for adequate, consistent, and accurate accessible information to boost the confidence of women undertaking self-testing. In general, the participants were eager for self-testing to be made available soon. This was accompanied by the need for the promotion and implementation of self-testing to include a collective/community approach consistent with Pasifika worldviews.
Interpretation:
Although participants were enthusiastic about HPV self-testing, multi-level and interacting barriers exist to participation by Pasifika women in HPV self-testing. Implementation of self-testing in Aotearoa New Zealand should be accompanied by clear information about the entire process, using culturally appropriate tailored educational campaigns in different Pasifika languages.
Funding:
The study was supported by the Collaboration for Cancer Research Aotearoa New Zealand (CCR)
Clinical impact of pathologic residual tumor in locally advanced cervical cancer patients managed by chemoradiotherapy followed by radical surgery: a large, multicenter, retrospective study
Full text linkBackground:
Exclusive chemoradiation (E-CT/RT) represents the standard of treatment for locally advanced cervical cancer (LACC). Chemoradiation (CT/RT) followed by radical surgery (RS) may play a role for patients with a suboptimal response to CT/RT or in low-income countries with limited access to radiotherapy. Histologic assessment of residual tumor after CT/RT and RS allows accurate definition of prognostic categories.
Methods:
Data on patients with FIGO stages 1B2 to 4A cervical cancer managed by CT/RT and RS from June 1996 to March 2020 were retrospectively analyzed. Pathologic response on the cervix was defined as complete (pCR), microscopic (persistent tumor foci ≤ 3 mm) (pmicroR), or macroscopic (persistent tumor foci > 3 mm) (pmacroR). Lymph node (LN) residual tumor was classified as absent or present.
Results:
The 701 patients in this study underwent CT/RT and RS. Of the 701 patients, 293 (41.8%) had pCR, 188 (26.8%) had pmicroR, and 220 (31.4%) had pMacroR. Residual tumor was found in the pelvic lymph nodes of 66 (9.4%) patients and the aortic lymph nodes of 29 (4.1%) patients. The 5-year DFS and OS were respectively 86.6% and 92.5% in the pCR cases, 80.3% and 89.1% in the pmicroR cases, and 56.2% and 68.8% in the pmacroR cases. Among the patients with lymph node residual tumor, the 5-year DFS and OS were respectively 16.7% and 40% in the pCR cases, 35.4% and 53.3% in the pmicroR cases, and 31.7% and 31.1% in the pmacroR cases. Cervical residual tumor,, positive pelvic LNs, and positive aortic LNs were associated with worse DFS and OS in both the uni- and multivariate analyses.
Conclusions:
Persistence of pathologic residual tumor on the cervix and LNs after CT/RT are reliable predictors of survival for LACC patients undergoing CT/RT and adjuvant surgery
Utilization of preconception care and its associated factors among pregnant women of west Guji zone, Oromia, Ethiopia, 2021: a community-based cross-sectional study
Full text linkBackground:
Regardless of its benefit in promoting maternal health, contributing to a healthy pregnancy, little is known concerning the prevalence of utilization of preconception care and its determinant in southern Ethiopia. Hence, this study designed to determine the prevalence of utilization of preconception care and contributing factors among pregnant women in West Guji Zone, Southern Ethiopia, 2021.
Methods:
A community-based cross-sectional study was conducted among systematically selected 660 pregnant women in West Guji from June 15 to July 30, 2021. A pretested interviewer-administered structured questionnaire was used to collect the data. Data entry was done in Epidata version3.1 and exported to SPSS version 25 for analysis. Descriptive statistics were used to summarize the data. To identify the factors associated with the utilization of preconception care binary and multivariable logistic regression analysis was performed. Adjusted odds ratios (AOR) with 95% CI were estimated to assess the strength of associations and statistical significance was declared at a p-value < 0.05.
Results:
One hundred-forty seven, 22.3% [95% CI (19.2, 25.4)] of mothers utilized preconception care. Being college and above [(AOR = 5.51 95%CI 91.43-21.19)] and secondary [(AOR = 4.46 95%CI (1.38-14.39)] in educational status, rich [(AOR = 4.23 95%CI (1.32-13.55)], having good knowledge about preconception care [AOR = 2.34 95%CI (1.05-5.28)], having a positive attitude towards preconception care [(AOR = 9.99 95%CI (4.25-23.48)] and deciding with her husband regarding maternal health services [(AOR = 4.71 95%CI (1.91-11.56)] were factors positively affecting utilization of preconception care.
Conclusions:
The utilization of preconception care in the study area is low. Being college and above and secondary in educational status, rich, good knowledge, positive attitude towards preconception care, and deciding with her husband regarding maternal health services were independent factors promoting the utilization of preconception care. Information, education, and communication activities should be strengthened to increase awareness of mothers about preconception care
Hemodynamic stability during menstrual cycle in women undergoing elective surgery
Full text linkObjective: Hemodynamic changes occur in almost one-third of patients undergoing spinal anesthesia, which are likely to effect vital organ. The aim of this study is to determine the hemodynamic effect of spinal anesthesia during different phases of menstrual cycle.
Methods: This is a descriptive cross-sectional study, two hundred and seventy-three patients who underwent spinal anesthesia for elective surgery were enrolled in this study. Of all the patients, 141 patients were in the luteal phase and 132 patients were in the follicular phase of their menstrual cycle. Analytical epidemiological study was conducted using questionnaires. Blood pressure and heart rate of patients before, immediately after, and 1 h after spinal anesthesia were recorded, and the data were analyzed using SPSS software.
Results: In the follicular phase before anesthesia, systolic blood pressure (SBP) was 127.5 ± 3.9, diastolic blood pressure (DBP) was 80.3 ± 6.2 mmHg and heart rate (HR) was 82.0 ± 8.5bpm, while, immediately after the induction of anesthesia following recordings were measured; 109.7 ± 9.13, 71.8 ± 2.8 mmHg and 70.0 ± 8.10bpm, respectively. In the luteal phase, it was 126.9 ± 3.12, 81.6 ± 9.3 mmHg and 80.2 ± 4.4bpm, and 122.0 ± 9.12, 78.6 ± 8.5 mmHg and 75.9 ± 6.5bpm respectively before and immediately after anesthesia, these changes in the menstrual phase was significant (P < 0.001). In the follicular phase an hour after spinal anesthesia, the mean SBP was 100.3 ± 3.9, DBP was 71.2 ± 7.5, MAP was 87.0 ± 4.7 mmHg and HR 67.5 ± 5.7bpm and following was seen in luteal phase; 115.4 ± 1.8, 75.9 ± 2.3, 97.3 ± 3.5 mm Hg and 74.0 ± 7.4bpm, respectively. These values were significantly lower in the follicular phase (P < 0.001).
Conclusion: Spinal anesthesia in the luteal phase as compared to the follicular phase of the menstrual cycle shows less variation in hemodynamic parameters
Promoting and protecting mental health in schools and learning environments
No full textFive essential pillars for promoting and protecting mental health in schools and learning environments: a briefing note for national governments
Mental health and psychosocial well-being are fundamental to health and well-being, and influence academic, social, and economic outcomes across the lifespan. This short briefing note is intended for policy makers, national governments, mental health and education coalitions and advocates. It outlines key policy recommendations to strengthen education systems to protect and promote the mental health and psychosocial well-being of children and adolescents, including support for their teachers and caregivers
