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The epidemiologic determinants of seroreactivity to human papillomavirus (HPV) type 16 L1/L2 virus-like particles (VLPs) were assessed separately in HPV-16 DNA–positive and –negative women participating in a nested case-control study of incident cervical neoplasia. Seventy-four women with cervical HPV-16 DNA and 656 cytologically normal HPV-16 DNA–negative subjects were interviewed and tested at two time points for viral DNA and once (at the later time) for VLP seroreactivity. Among subjects who were currently HPV-16 DNA–negative, seroreactivity odds ratios increased from 2.9 for 2–5 male sex partners (vs. 0 or 1) to 5.4 for 6–9 partners and 14.0 for ⩾10. Thus, prior cervical infection may be a major determinant of seroreactivity in HPV-16 DNA–negative women. This trend was not observed in HPV-16 DNA-positive subjects. Seroreactivity was independently associated with oral contraceptive use, particularly in HPV-16 DNA–negative subjects with use for ⩾10 years. Consequently, a possible role for virus–steroid hormone interactions in seroconversion is suggested. [ABSTRACT FROM PUBLISHER]

An ELISA to detect serum IgG antibody response to human papillomavirus (HPV) type 16 viruslike particles (VLPs) was evaluated in a case-control study of cervical neoplasia, nested within a prospective cohort study. Subjects included 688 controls with continued normal cytology and 152 cases with confirmed incident squamous intraepithelial lesions who were tested for DNA of a broad spectrum of HPV types at cohort enrollment and follow-up. Of controls, 16.6% were seropositive compared with 30.8% and 52.4% of cases with low- and high-grade lesions, respectively. Of HPV16 DNA-negative subjects, 16.5% were seropositive. Seropositivity increased from 22.2% in subjects who were HPV-16 DNA- positive by polymerase chain reaction once only (enrollment or follow-up) to 83.3% in those who were HPV-16 DNA-positive at both time points. These data imply that serum antibody to HPV-16 VLPs is a relatively sensitive indicator of persisting cervical HPV-16 infection. [ABSTRACT FROM PUBLISHER]

Objectives: A review of the use of previously described integrated care pathways (ICPs) established for three elective vascular surgical procedures.Design: A retrospective analysis of information gathered prospectively over an initial 18 month period of use of vascular surgical ICPs.Subject: Patients admitted to a single vascular unit for "open" repair of abdominal aortic aneurysm (AAA), carotid endarterectomy, or femoropopliteal bypass grafting.Methods: An analysis of variance data, length of stay, and costings after the use of ICPs, compared with previous clinical practice.Results: Variance data were gathered for each of the three procedures. Variances of medication prescribing and delays in discharge were common to all procedures. In particular: (i) gastrointestinal complications were more specific to AAA repair and (ii) wound drains were removed a day later than originally proposed after femoropopliteal bypass. Overall, improved efficiency due to use of ICPs reduced the length of stay for all procedures, which was reflected in a potential cost saving of some 25%.Conclusion: There are clear benefits to the use of ICPs, resulting in more structured, efficient, and cost effective patient care. Recommended changes to current practice based on variance analysis will require continued audit to sustain this "evidence based" approach. [ABSTRACT FROM AUTHOR]