In a prospective cohort study 8466 women attending routine cervical cancer screening were recruited. Colposcopy was performed on women with any degree of atypia on cytology and/or a positive high-risk human papillomavirus (HPV)-DNA test (HC2; Hybrid Capture 2 r ), and for a randomly selected sample of 3.4% women with negative findings on both. Quality control included reviews of cytology, histology, colposcopy images and retesting of samples with polymerase chain reaction. Test diagnostic performances were based on 7908 women who had complete baseline and follow-up results. Routine histology identified 86 women with high-grade cervical intraepithelial neoplasia (CIN2 þ ), which was confirmed by review histology in only 46 cases. Sensitivity of routine cytology for the detection of CIN2 þ was 43.5%, with a specificity, positive predictive value (PPV), negative predictive value (NPV) of 98.0, 11.4 and 99.7%, respectively. Sensitivity of the HC2 test for the detection of CIN2 þ was 97.8%, with a specificity, PPV and NPV, of 95.3, 10.9 and 100%, respectively. No high-grade neoplasia was detected in the randomly selected control group. A negative HPVtest result, even in combination with a positive Papanicolaou (Pap) result, virtually excluded any risk of underlying high-grade disease, but this was not the case for a negative Pap result. These data show that HPV testing is of value for the detection or exclusion of prevalent CIN in a routine cervical cancer-screening setting and could be used for further risk classification of women for follow-up management.
Summary
Objective
Maintaining weight loss results in childhood obesity treatment is difficult to achieve. Self‐management techniques such as self‐monitoring are associated with increased weight loss and maintenance. This study analyzes whether self‐monitoring of lifestyle behaviours through a short message service maintenance treatment (SMSMT) via mobile phones with personalized feedback positively effects weight, lifestyle behaviours and psychological well‐being in obese children.
Methods
After 3 months of behavioural lifestyle treatment, 141 overweight and obese children (7–12 years) were randomly assigned to an intervention group receiving SMSMT for 9 months (n = 73) or to the control group (n = 68). The intervention group sent weekly self‐monitoring data on exercise and eating behaviour and their mood via mobile phones. In return, they received tailored feedback messages. Primary treatment outcomes were weight, eating behaviour and psychological well‐being, i.e. competence, self‐esteem and quality of life. Secondary outcome was adherence to the SMSMT. Data were analyzed with mixed modelling.
Results
SMSMT did not improve treatment outcomes. Controls gained temporarily in physical health scores (P = 0.01). SMSMT completers sent on average every 2 weeks an SMS. Children who had greater weight loss during the first 3 months of lifestyle treatment sent more SMSs (P = 0.04).
Conclusions
We did not find a positive effect of SMSMT on weight, eating behaviour or psychological well‐being in obese children. SMSMT seems to be a feasible method of treatment delivery. Future research should study variations of SMSMT to investigate how SMSMT can be more effective.
These results indicate that SMSMT is effective in reducing dropout rates from a pediatric lifestyle intervention. Future research should examine the effectiveness of SMSMT on weight management and related psychosocial variables.
Background: Cortisol is produced in a circadian rhythm controlled by the hypothalamus-pituitary-adrenal axis, making it cumbersome to measure long-term cortisol exposure. Hair has proven to be a reliable matrix for long-term cortisol measurement in adults and can be used as diagnostic tool for (cyclic) Cushing's syndrome. The diagnostic applicability in children has not been studied, nor have the effects of development and hair care been evaluated in children. We aimed to establish reference ranges of hair cortisol concentrations (HCC) in healthy children and to evaluate the effects of age, gender, puberty and characteristics of hair care. Methods: In 128 healthy children aged 4-14 years, HCC were measured in a small 3-cm hair lock from the back of the head. Results: HCC increased with age (p = 0.04) up to age 10 years, with a mean of 5.0, 5.8, 6.8 and 8.5 pg/mg at age 4-5, 6-7, 8-9 and 10-14 years, respectively. Children aged 4-7 years had significantly lower HCC compared to healthy adults (p = 0.007). We did not find any influence of gender, puberty or hair care characteristics on hair cortisol. Conclusion: HCC can be reliably measured in childhood, and reference ranges increase with age. HCC in children are not dependent on hair care or hair characteristics.
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