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Background: Cervical screening could potentially be improved by better stratifying individual risk for the development of cervical cancer or precancer, possibly even allowing follow-up of individual patients differently than proposed under current guidelines that focus primarily on recent screening test results. We explore the use of a Bayesian decision science model to quantitatively stratify individual risk for the development of cervical squamous neoplasia. Materials and Methods: We previously developed a dynamic multivariate Bayesian network model that uses cervical screening and histopathologic data collected over 13 years in our system to quantitatively estimate the risk of individuals for the development of cervical precancer or invasive cervical cancer. The database includes 1,126,048 liquid-based cytology test results belonging to 389,929 women. From-the-vial, high risk human papilloma virus (HPV) test results and follow-up gynecological surgical procedures were available on 33.6% and 12% of these results (378,896 and 134,727), respectively. Results: Historical data impacted 5-year cumulative risk for both histopathologic cervical intraepithelial neoplasia 3 (CIN3) and squamous cell carcinoma (SCC) diagnoses. The risk was highest in patients with prior high grade squamous intraepithelial lesion cytology results. Persistent abnormal cervical screening test results, either cytologic or HPV results, were associated with variable increasing risk for squamous neoplasia. Risk also increased with prior histopathologic diagnoses of precancer, including CIN2, CIN3, and adenocarcinoma in situ. Conclusions: Bayesian modeling allows for individualized quantitative risk assessments of system patients for histopathologic diagnoses of significant cervical squamous neoplasia, including very rare outcomes such as SCC.

LGBT older adults and older people living with HIV (PLWH) experience a disproportionate burden of behavioral health conditions compared to their heterosexual, cisgender, and HIV-negative peers. This study intends to systematically review the literature regarding accessing mental health care among LGBT older adults and older PLWH. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement framework. Three databases were searched using Boolean search strings, and inclusion/exclusion criteria were developed and applied to the search outcomes to appropriately narrow results. Article quality and evidence of bias were evaluated using the National Heart, Lung, and Blood Institute (NHLBI) quality-assessment tool, and the Critical Appraisal Skills Program (CASP) assessment tool, two instruments used to help reviewers in assessing for internal validity of studies. Two independent researchers coded the articles for themes, and consensus was reached on theme grouping through an iterative process. Out of 2,031 articles initially screened, 28 met all inclusion criteria and advanced to final analysis. Several key themes emerged, including a lack of provider competency in caring for LGBT patients, lower rates of insurance coverage, greater mental health burden, social and structural determinants of health, policy solutions, and technology and health literacy. There were several domains identified in the literature as barriers to accessing mental healthcare, as well as opportunities to better attend to the mental health needs of these populations. Provider training, implementing health technology solutions, and enacting public policy changes could improve mental health outcomes. [ABSTRACT FROM AUTHOR]

Background: Classical statistics is a well-established approach in the analysis of medical data. While the medical community seems to be familiar with the concept of a statistical analysis and its interpretation, the Bayesian approach, argued by many of its proponents to be superior to the classical frequentist approach, is still not well-recognized in the analysis of medical data. Aim: The goal of this study is to encourage data analysts to use the Bayesian approach, such as modeling with graphical probabilistic networks, as an insightful alternative to classical statistical analysis of medical data. Materials and Methods: This paper offers a comparison of two approaches to analysis of medical time series data: (1) classical statistical approach, such as the Kaplan-Meier estimator and the Cox proportional hazards regression model, and (2) dynamic Bayesian network modeling. Our comparison is based on time series cervical cancer screening data collected at Magee-Womens Hospital, University of Pittsburgh Medical Center over 10 years. Results: The main outcomes of our comparison are cervical cancer risk assessments produced by the three approaches. However, our analysis discusses also several aspects of the comparison, such as modeling assumptions, model building, dealing with incomplete data, individualized risk assessment, results interpretation, and model validation. Conclusion : Our study shows that the Bayesian approach is (1) much more flexible in terms of modeling effort, and (2) it offers an individualized risk assessment, which is more cumbersome for classical statistical approaches.

Rotations in HIV primary care clinics have the potential to teach trainees core competencies and influence their career pathway. We found that fund of knowledge, confidence in obtaining a sexual history, and interest in an Infectious Diseases career all increased following an HIV clinic rotation. [ABSTRACT FROM AUTHOR]

Objectives: To study the human papillomavirus (HPV) genotype distribution of cervical cancer (CxCa) and cervical intraepithelial neoplasia grade 2/3 (CIN2/3) in China and to evaluate cotesting of HPV and cytology in CxCa screening.Methods: Patients with histopathologic CxCa and CIN 2/3 diagnoses reported between January 2012 and June 2016 and extended HPV genotype testing in the prior 6 months were documented in the institute. Available prior Papanicolaou (Pap) test results were also documented. Extended HPV genotype testing was performed using two China Food and Drug Administration-approved HPV tests.Results: CxCa and CIN 2/3 diagnoses and recent prior HPV test results were documented in 370 CxCa cases and 2774 CIN 2/3 cases. The high-risk (hr) HPV-positive rate was 88.4% for CxCa and 90.1% for CIN 2/3. Among 327 HPV-positive CxCa cases, the most common HPV types were HPV 16 (70.3%), 18 (7.0%), 58 (5.7%), 33 (4.1%), and 53 and 59 (1.9% each). Among 2499 hrHPV-positive CIN 2/3 cases, the most common HPV types were HPV 16 (53.3%), 58 (21.4%), 52 (11%), 33 (10.6%), and 18 (5.1%). 161 CxCa cases and 1094 CIN 2/3 cases also had available prior cotest results. Among cotested cases hrHPV-negative results were reported in 12.4% of CxCa and 10.1% of CIN 2/3 cases compared to cytology-negative results reported in 15.5% of CxCa and 4.3% of CIN 2/3.Conclusions: HPV 16/18/59/39/45 genotypes were significantly more prevalent in CxCa cases than in CIN 2/3 cases, consistent with the more limited progressive potential of some CIN 2/3 lesions. Of CIN 2/3 and CxCa cases, 10% to 12% had recent negative hrHPV test results, pointing to a significant limitation of primary HPV screening. [ABSTRACT FROM AUTHOR]

Objectives: Cervical screening guidelines now recommend repeat cotesting of patients aged 30 years and older having a human papillomavirus (HPV)--negative low-grade squamous intraepithelial lesion (LSIL) in 1 year as preferred management. Only limited follow-up data on patients with HPV-negative LSILs are available from routine US clinical practice settings. Methods: In total, 680 patients with Hybrid Capture 2 (Qiagen, Hinden, Germany) high-risk HPV-negative LSIL ThinPrep (Hologic, Marlborough, MA) results were identified. Patients' ages and histopathologic, cytologic, and HPV follow-up results were identified. Results: Among 680 patients with HPV-negative LSILs, 468 had follow-up within 1 year. During the study period, 14 (3.0%) of 468 had follow-up high-grade squamous intraepithelial lesion (HSIL) and 184 (39.3%) LSIL findings. No diagnoses of cervical carcinoma were documented. There were no significant follow-up differences between age groups. Of the 321 patients who had follow-up HPV testing, 271 (84.4%) had negative and 50 (15.6%) had positive HPV results. Conclusions: This is the largest study documenting follow-up results for patients with HPV-negative LSIL results based on prevalent US FDA-approved cotesting methods from one collection vial. These data document that risk for follow-up HSILs in these patients is low and also that no cervical cancers were diagnosed. These findings support recent recommendations for repeat cotesting after 1 year as an appropriate option for patients with HPV-negative LSIL results. [ABSTRACT FROM AUTHOR]

BACKGROUND. The prevalence of high-risk Human Papillomavirus DNA (hrHPVDNA) in women with negative Papanicolaou (Pap) test results provides a measureof residual risk for cervical neoplasia after cytology screening. The purpose ofthis study was to document the prevalence of hrHPV DNA in several thousandwomen ages ≥30 years with negative ThinPrep Imaging System (TIS)-imaged Paptest results in a large academic hospital cytology laboratory.METHODS. All cytology-negative TIS-imaged ThinPrep Pap tests (TPPT) withhrHPV DNA tests that were performed by the United States Food and DrugAdministration (FDA)-approved Hybrid Capture 2 (HC2) method from May 1,2005 to November 20, 2006 were identified and reviewed. Imaged-negative Paptest slides associated with a positive hrHPV DNA test result were rescreenedmanually. Variation in hrHPV DNA prevalence was assessed for different age andethnic groups.RESULTS. Of 8070 imaged cytology-negative TPPT from women ages 11 to 90years, hrHPV DNA test results were also available. Among 7426 women ages ≥30years with a cytology-negative, TIS-imaged, Pap test, a significant age-associateddecline in hrHPV DNA prevalence was noted, 3.4% in 3050 women ages 30-45years, 2.4% in 7426 women ages 30-90 years, and 1.8% in 5491 women ages40-90 years. The hrHPV DNA-positive rate was 2.3% in 6012 imaged cytology-negative white women and 4.1% in 739 imaged cytology-negative black women.CONCLUSIONS. Very low HC2 hrHPV DNA rates in 7426 women ages ≥30 yearswith cytology-negative, TIS-imaged, ThinPrep, Pap tests were similar to recentlypublished data from 1 other academic center and lower than rates reported inprevious studies on cytology-negative North American or European womenscreened manually with conventional or liquid-based Pap tests. These data mayimpact assessments of how best to combine cytology and HPV testing. [ABSTRACT FROM AUTHOR]