Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Prevalence and Correlates of Sexually Transmitted Infections in Transgender People: An Italian Multicentric Cross-Sectional Study
Get PDFoai:https://srhr.dspace-express.com:20.500.14041/6182The burden of sexually transmitted infections (STIs) in the transgender population remains an underestimated issue. The aims of the present study were to evaluate the prevalence of either self-reported and serological STIs and to describe socio-demographic and clinical characteristics of transgender individuals with STIs. A consecutive series of 705 transgender individuals (assigned-male at birth, AMAB n = 377; assigned-female at birth, AFAB n = 328) referring to six Italian gender clinics were included. Sociodemographic and clinical information was collected during the first visit. In a subsample of 126 individuals prevalence of STIs (human immunodeficiency virus, HIV; hepatitis C, HCV; hepatitis B, HBV; syphilis) were evaluated through serology tests. The self-reported prevalence of HIV, HBV, HCV and syphilis infection in the total sample were 3.4%, 1.6%, 2.6% and 2.0%, respectively. In the subsample who underwent serological tests, higher rates of serological prevalence were found (9.5%, 4.0%, 5.6% and 7.9% for HIV, HBV, HCV and syphilis, respectively). When comparing transgender people with or without self-reported STIs, unemployment, previous incarceration, justice problems and sex work resulted more frequent in the first group (p< 0.03 for all). Regarding health status, we observed higher rates of lifetime substance abuse and psychiatric morbidities in trans people with at least one reported STI (p < 0.05). The prevalence of STIs exceeded that reported in general population and STIs correlates underline the importance of stigma and discrimination as determinants of transgender health
Serum human epididymis protein 4 as a prognostic marker in cervical cancer
Get PDFObjectives:
The objective is to evaluate the prognostic value of serum human epididymis protein 4 (HE4) as a tumor marker in patients with cervical cancer.
Methods:
Sixty-seven patients with cervical cancer treated at Seoul National University Bundang Hospital from September 2014 to May 2018 were retrospectively reviewed. Serum HE4 levels were measured by immunoassay before starting primary treatment. A mean serum HE4 level of 72.6 pmol/L was used to divide the patients into low and high HE4 groups. Patient characteristics, clinicopathological variables, and survival outcomes were compared between the two groups.
Results:
The low and high HE4 groups included 55 (82.1%) and 12 (17.9%) patients at diagnosis, respectively. Higher HE4 levels were significantly associated with older age at diagnosis (age <50: .0% vs age ≥50: 100.0%; P = .002), menopause (premenopause: 8.3% vs postmenopause: 91.7%; P = .009), higher FIGO stage (stage I–II: 33.3% vs III–IV: 66.7%; P = .017), large tumor size (<4.0 cm: 41.7% vs ≥4.0 cm: 58.3%; P = .029), positive lymph node metastasis (negative: 41.7% vs positive: 58.3%; P = .049), and involvement of the parametrium (negative: 25.0% vs positive: 75.0%; P = .002). Higher HE4 level was a predictive factor for worse overall survival but not for progression-free survival. Elevated HE4 levels were not independent factors for the prediction of either overall survival or progression-free survival. Subgroup analysis by histological type revealed similar results for patients with squamous cell carcinoma.
Conclusions:
High levels of HE4 expression correlated with poor overall survival, indicating that elevated HE4 levels are associated with a poor prognosis for patients with cervical cancer
Massive prolapsed cervical lumps in cervical cancer treated with three-dimensional implant brachytherapy: a case report
Get PDFBackground:
Cervical cancer is one of the most common gynecological malignancies in developing countries. But the cervical cancer patients with tumor prolapse are very rare. The treatment principle of cervical cancer has been written into the guide, while the management of cervical lumps prolapse associated with cervical cancer is not standardized. Every doctor has different opinions on treatment strategies. Herein, we describe the three-dimensional brachytherapy treatment for massive prolapsed cervical lumps.
Case Description:
A 48-year-old woman diagnosed with cervical cancer developed a huge cervical mass prolapsed after defecation on the second day of chemotherapy. The mass surface was continuously bleeding and unable to return to the vagina. Therefore, uterine artery embolization interventional hemostasis was performed and then three-dimensional brachytherapy treatment was applied. The mass was necrotic and shedding and then retracted into the vagina on the 7th day after implantation treatment. Finally, the patient successfully received radical radiotherapy [pelvic and abdominal cavity external beam radiotherapy-PCTV 50.4 Gy/28 F, pelvic metastatic lymph nodes PGTVn 61.0 Gy/28 F, plus vaginal three-dimensional brachytherapy-HRCTV (D90) 27.25 Gy/4 F].
Conclusions:
If cervical cancer combined with tumor prolapse is inoperable, three-dimensional implants brachytherapy seems to be an adequate therapeutic option
Sexual and addictive risk behaviors and sexually transmitted infections in illegal gold miners in French Guiana: A multicenter observational study
Get PDFObjectives: Common representations of the world of gold mining-especially illegal-are usually negative: the activity conjures up images of drug trafficking, human exploitation, the sex trade, environmental destruction, and infectious diseases, in particular sexually transmitted infections (STIs). The aim of the present article is to describe the levels of risk behaviors such as transactional sex, multiple sexual partners, and the frequency of condom use, addictive substance consumption, and the prevalence of STIs among the population of illegal gold miners in French Guiana (FG), a French overseas entity in Amazonia, in order to guide potential interventions.
Methods: An observational multicenter cross-sectional study was carried out from October to December 2019 along the two borders of FG with Suriname and Brazil at rest sites used by the miners.
Results: Among the 499 participants, transactional sex was very prevalent, declared by 33.5% of men and 8.4% of women. Condoms were more frequently used for transactional sex than with a non-commercial partner (93.4% versus 42.1%). More women were tested for HIV than men (91.1% versus 55.2%). Excessive alcohol consumption (57.3%%) and tobacco use (41.2%) were very frequent, but cocaine or crack consumption was low (1.2%), which refuted our initial assumption. Consumers of alcohol had more sexual partners and reported condom use more frequently. Prevalence of HIV, HCV, HBV, and syphilis was respectively 0.5% (95% CI: 0.1-2.1), 2.1% (95% CI: 0.7-3.6), 1.6% (95% CI: 0.3-2.8), and 12.4% (95% CI: 9.0-15.7), which was higher than in the local population, especially for syphilis.
Conclusion: This study documents for the first time the risk behaviors of gold miners in FG. Although the level of condom use was high, the prevalence of STIs combined with the high rate of transactional sex should encourage an increase in prevention and screening, in particular through rapid tests, given the mobility of the population concerned
Elimination of cervical cancer as a public health problem—how shorter brachytherapy could make a difference during COVID-19
Get PDFThe World Health Organization has called for elimination of cervical cancer as a public health problem and has adopted strategies in this regard. However, the estimates for achieving the goals depend on the ability to provide timely treatment in a certain proportion of cases. The coronavirus disease 2019 pandemic has had a serious impact on healthcare delivery in many low and middle income countries (LMICs) with the highest burden of cervical cancer; funds and infrastructure are being reallocated to deal with the emergency, and cancer care has been seriously affected. In the absence of clear and reliable estimates, the exact extent of disruption remains unclear. It is, therefore, essential that pragmatic approaches are adopted to save lives. There has been considerable debate regarding the use of the 9 Gy × 2 fractions high dose rate brachytherapy schedule for the treatment of locally advanced cervical carcinoma. However, in LMICs with the highest global burden of locally advanced cervical cancer cases, radiation facilities have been using this fractionation schedule in many cases to deal with the overwhelming number of patients, who would have otherwise been denied timely treatment. In view of the current pandemic, and the difficulties in accessing and delivering timely healthcare, mortality owing to delayed treatment cannot be denied in LMICs, which already have underequipped healthcare facilities. Use of the shortest available fractionation schedule to provide timely treatment would serve to save more lives in regions with high incidence and mortality from the disease
Current state of preconception care in sub-Saharan Africa: a systematic scoping review
Get PDFBackground:
Preconception care (PCC) utilisation is essential to extend and complete the health continuum. However, these services are not yet incorporated into many low-income countries’ existing maternal health services.
Aim:
This study aims to review the current literature on the knowledge, utilisation and provision of PCC.
Setting:
This included women and healthcare workers (HCWs) in Sub-Saharan African (SSA) countries.
Methods:
Arksey and O’Malley’s scoping review methodology framework is used in this study. The following databases, Google Scholar, Science Direct, PubMed, Scopus and Dissertation via ProQuest, were searched. Articles that met the eligibility criteria were included in this study.
Results:
Out of the 451 retrieved articles, 39 were relevant. In most studies, women’s utilisation and HCW’s provision of PCC were considered limited. Their knowledge, however, varies between studies, and there were a few studies conducted among women with chronic conditions. Several factors influenced women and HCWs’ knowledge, utilisation and provision of PCC, including age, level of education, employment, practice area, resources and knowledge. Preconception care interventions most commonly identified, utilised and provided were HIV testing, counselling and family planning, while preconception folic acid supplementation was the least.
Conclusion:
The estimates of knowledge and utilisation were suboptimal among women, while provision was the worst affected among HCWs. Gaps exist between the HCW knowledge and practice of PCC. There is a need to promote, prioritise, integrate and optimise the opportunistic provision of PCC in SSA. There is also a need for more studies on PCC provision and utilisation among women with chronic medical conditions
Survival impacts of perineural invasion on patients under different radical hysterectomies due to early cervical cancer
Get PDFObjective:
Cervical cancer is a common gynecological malignancy. In addition to the open radical hysterectomy (ORH) and laparoscopic radical hysterectomy (LRH), laparoscopic nerve-sparing radical hysterectomy (LNSRH) could be another treatment option since it could preserve urinary, colorectal, and sexual functions. However, LNSRH might result in early cancer metastasis and recurrence due to inadequate tumor resection. Additionally, whether LNSRH should be considered based on perineural invasion (PNI) status remains controversial. To assess different types of hysterectomy on the outcome of early cervical cancer with PIN.
Methods:
A retrospective study was performed in early cervical cancer patients who received ORH, LRH, or LNSRH between January 2012 and December 2019. Age, FIGO cancer stages, histopathological types, tumor size, histological grade, invasion depth, lymph node metastasis, lymphovascular space invasion, and PNI were documented. Disease-free survival (DFS) and overall survival (OS) were recorded.
Results:
A total of 174 patients were included, with 33, 69, and 72 patients received LRH, ORH, and LNSRH, respectively. Twenty-one patients (12.1%) had PNI. DFS (P = 0.000) and OS (P = 0.022) periods were shortened in positive PNI patients than in negative PNI patients (P = 0.000 and 0.022, respectively). In patients with positive PNI, lymph node metastasis, but not the surgery type, was an independent risk factor for DFS and OS (P = 0.000).
Conclusion:
Early cervical cancer patients with PNI had shorter postoperative DFS and OS periods. In these patients, lymph node metastasis, but not the type of hysterectomy, was independently associated with DFS and OS
Fas and Fas ligand are highly expressed in lymphocytes from cervical intraepithelial neoplasia and cervical cancer patients: a possible role for immune escaping
Get PDFObjective(s):
Infection with high-risk human papillomavirus is required to develop cervical cancer. Some viruses modulate the Fas/FasL signaling to evade the immune response; the role of these molecules in cervical cancer is not clear. In this study, we measured the expression levels of Fas and FasL mRNA, soluble proteins, and cell surface proteins in peripheral blood mononuclear cells from patients with low- and high-grade squamous intraepithelial lesions and cervical cancer in relation to healthy women, to gain new insights into the role of Fas/FasL in cervical cancer development.
Materials and Methods:
Fas/FasL mRNA expression was measured in cervical tissues and peripheral blood mononuclear cells from patients and healthy subjects; serum soluble proteins Fas/FasL were measured by ELISA, and cell-surface protein expression was detected by flow cytometry.
Results:
Varying expression levels were found for both molecules. Cervical Fas and FasL mRNA expression was decreased in low- and high-grade lesions, but it was increased in cervical cancer cases. While, systemic Fas mRNA expression increased as malignity progressed; systemic FasL mRNA expression was increased in low- and high-grade lesions, but it was decreased in cancer patients. Soluble FasL levels decreased as lesions progressed, while soluble Fas levels increased. Finally, overexpression of Fas/FasL on the surface of peripheral blood mononuclear cells was found in patients with low-grade lesion with respect to healthy donors.
Conclusion:
Fas and FasL act as negative modulators of the immune response, probably by removing specific cytotoxic T lymphocytes against papillomavirus -infected cells and tumor cells
Constraints and current practices of menstrual hygiene among Rohingya adolescent girls
Get PDFBackground:
Although half of Rohingya refugees are women and adolescent girls, the sexual and reproductive health issues of these vulnerable groups are still unexplored. The aim of this study was to review and describe menstrual hygiene management (MHM) along with the existing challenges of MHM among Rohingya adolescent girls.
Methods:
This concurrent mixed methods study was conducted among adolescents aged 13–18 years living in Kutupalong refugee camps in Ukhiya, Cox's Bazar, Bangladesh. Camp-based surveys along with focus group discussions were performed for data collection. The findings of a total of 12 FGDs and 101 survey responses were included for data analysis. Descriptive statistics were used for quantitative data analysis, and thematic analysis was considered for the qualitative data.
Observation and results:
Approximately one-fourth of the adolescent girls (28.71%) had premenstrual knowledge. Only 8% had “Good” knowledge, and 12% had a basic understanding. Half of the women used cloths during menstruation, while others (20.79%) used homemade clean pads, disposable sanitary pads (17.82%), and used only underwear without absorbance (10.89%). The frequency of changing sanitary pads varied, but the majority of respondents (48.51%) changed padding at least once daily. Common disposal places were inside the toilet (30.69%), open spaces (17.82%), dustbins (6.93%) and water sources (3.96%). An inadequate and irregular supply of sanitary napkins or absorbents leads to poor MH practices. Limited cleaning and disposal facilities, lack of privacy in camps or informal settlements, confined and crowded places and nonsupportive environments in the camp were also factors affecting the use of pads and disposal. Family and cultural beliefs, stigma, restrictions, and fear of sexual violence were also noted within typical day-to-day activities during menstruation.
Conclusions:
The provision of adolescent-friendly wash facilities, appropriate information and adequate menstrual supplies is needed to improve the MH response in an emergency context. Despite some limitations, this study could lead to future changes relative to MH for women and adolescents in Rohingya
Acceptability of text messages and knowledge change for cervical cancer screening: a Tanzanian mixed methods study
Get PDFObjectives:
To investigate the acceptability of a text message intervention and evaluate if text messages could increase knowledge of cervical cancer and screening.
Design:
This study was a substudy of a randomised controlled trial that used a mixed methods research design combining a quantitative questionnaire dataset and qualitative interview data. A before and after assessment was made of questionnaire responses. Acceptability was measured on a 6-point Likert scale and knowledge was measured through 16 binary true/false knowledge questions concerning cervical cancer and screening. Qualitative data were coded using a combined inductive–deductive approach.
Setting:
Ocean Road Cancer Institute in Dar es Salaam as well as Kilimanjaro Christian Medical Center and Mawenzi Regional hospital in the Kilimanjaro Region in Tanzania.
Participants:
Human papillomavirus (HPV) positive women who had been randomised to the intervention group and received educative and reminder messages. Qualitative interviews were conducted with a subgroup of women in the intervention group.
Interventions:
15 one-way educative and reminder text messages.
Results:
A total of 115 women in the intervention group responded to both the baseline and follow-up questionnaire. Overall, women found it highly acceptable to receive text messages, and there was a trend towards acceptability rising between baseline and follow-up (mean: 0.22; 95% CI 0.00 to 0.44; p=0.05; t-statics=1.96). A significant increase in acceptability was found among the lowest educated and those who had not previously been screened. The qualitative interviews showed that the underlying reasons for the high acceptability rate were that the women felt someone cared for them and that the text messages were for their own benefits. The text messages did not improve the women’s knowledge on cervical cancer and screening.
Conclusions:
Educative and reminder text messages are highly acceptable among HPV-positive Tanzanian women; however, they do not increase the women’s knowledge of cervical cancer and screening