We conducted a systematic review and meta-analysis of observational studies evaluating survival in patients with anal cancer, according to human papillomavirus (HPV) DNA, p16 INK4a , and combined HPV DNA/p16 INK4a status. We systematically searched PubMed, EMBASE, and Cochrane Library databases to identify studies published in English until July 25, 2018, directly providing or allowing estimation of survival of patients with anal cancer according to the presence of HPV DNA and/or overexpression of p16 INK4a . We estimated pooled HRs and 95% confidence intervals (CI) for overall survival (OS) using a random-effects model. We included 16 studies, comprising 1,724 patients with anal cancer tested for HPV DNA (65% positive), and 567 patients tested for p16 INK4a (87% positive). The pooled HR for OS was 0.54 (95% CI, 0.33-0.89) for HPV DNA positive versus negative, 0.37 (95% CI, 0.24-0.57) for p16 INK4a positive versus negative, and 0.36 (95% CI, 0.22-0.58) for HPV DNA positive/p16 INK4a positive versus HPV DNA positive/p16 INK4a negative patients with anal cancer. Patients with HPV DNA or p16 INK4a positive anal cancer have significantly better OS compared with HPV DNA or p16 INK4a negative. This points to the possible value of HPV DNA and/or p16 INK4a testing when planning the management and follow-up strategy for patients diagnosed with anal cancer.
Data extractionTwo authors (A. Urbute and C.L. Rasmussen) reviewed titles, abstracts, and full-texts, and extracted data independently. Any inconsistency in the evaluation of study eligibility or data extraction was
Background: In 1997, The Danish Health Authority recommended that "it is safest not to drink alcohol when you are pregnant," and in 1999 expanded recommendations. There are only a few studies evaluating the possible change of average alcohol consumption following changes in national recommendations, and no studies have been found comparing the changes in pregnant women's attitudes toward alcohol consumption during pregnancy. We aimed to evaluate the changes in drinking pattern, and knowledge about and attitudes toward alcohol consumption during pregnancy before and after the change of national recommendations.Methods: This is a cross-sectional interview study with a representative sample of 1,418 woman attending antenatal care at the beginning of their second trimester in Aarhus, Denmark, in the year 2000, and a comparable sample of 439 pregnant women from 1998 in Aarhus. Participants were interviewed about their average alcohol consumption, binge drinking, and attitudes toward and knowledge about alcohol consumption during pregnancy. Data collection procedures and questions were identical for both samples.Results: There were no differences between the 2 samples in terms of average alcohol consumption before (p = 0.19) and during (p = 0.45) pregnancy, and binge drinking in early pregnancy (p = 0.47). Attitudes toward and knowledge about alcohol in pregnancy did not change either (p > 0.5). Women's knowledge about guidelines was less precise in 2000 (p < 0.001). Worse knowledge was associated with younger age considering both samples (OR = 2.63, 95% CI: 1.63 to 4.26). Most pregnant women reported that they had not been informed or advised about alcohol consumption during pregnancy, but they would like to be advised by their healthcare professionals.Conclusions: After the changes in the national guidelines about alcohol consumption during pregnancy, there were no changes in behavior, attitudes, and knowledge of pregnant women. This would indicate that healthcare specialists should be encouraged to initiate a conversation about alcohol consumption during the first antenatal visit.
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