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Cervical cancer screening--"For better or worse...": women's experience of screening.

https://arctichealth.org/en/permalink/ahliterature79592
Source
Cancer Nurs. 2006 Nov-Dec;29(6):453-60
Publication Type
Article
Author
Ideström Monica
Milsom Ian
Andersson-Ellström Agneta
Athlin Elsy
Author Affiliation
Department of Obstetrics and Gynaecology, Central Hospital, SE-651 85 Karlstad, Sweden. monica.idestrom@liv.se
Source
Cancer Nurs. 2006 Nov-Dec;29(6):453-60
Language
English
Publication Type
Article
Keywords
Adult
Female
Health Knowledge, Attitudes, Practice
Humans
Mass Screening - psychology
Middle Aged
Patient Education
Sweden
Trust
Uterine Cervical Neoplasms - diagnosis - psychology
Abstract
In Sweden, the population-based cervical cancer screening program has been in progress since the 1970s and is directed toward women between 23 and 60 years of age. The aim of this study was to explore women's experience of cervical screening after being diagnosed with cancer. A qualitative study inspired by Grounded Theory was used. Eleven women were interviewed. The interviews were analyzed using the constant comparative method. "Screening-For Better or Worse..." was identified as the core category, around which the categories "Unawareness," "Trust," "Search for Understanding," and "Making the Invisible Visible" were integrated and on which the conceptual model was built. The experience of screening had both a positive and a negative dimension for the women stricken by cervical cancer. The women had a positive experience of screening as such and they believed in its benefits. However, many women felt deceived and, because of their unawareness, questions arose for which they searched for understanding. The women requested adequate and understandable information. Their trust remained because the contact with healthcare professionals involved in screening and in the follow-up program had been reassuring.
PubMed ID
17135818 View in PubMed
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The cervical cancer screening program from a midwife's perspective.

https://arctichealth.org/en/permalink/ahliterature77616
Source
Acta Obstet Gynecol Scand. 2007;86(6):742-8
Publication Type
Article
Date
2007
Author
Ideström Monica
Milsom Ian
Andersson-Ellström Agneta
Author Affiliation
Department of Obstetrics and Gynaecology, Central Hospital, Karlstad, Sweden. monica.idestrom@liv.se
Source
Acta Obstet Gynecol Scand. 2007;86(6):742-8
Date
2007
Language
English
Publication Type
Article
Abstract
BACKGROUND: Midwives in Sweden are responsible for taking Papanicolaou (Pap) smears as part of the cervical cancer screening program. The aim of this study was to investigate midwives knowledge, experience and management of the cervical cancer screening program, and their apprehension of women's knowledge about Pap-smear screening. METHODS: A postal questionnaire was sent to midwives working in primary health care in 3 different areas in Sweden. A total of 156 (77%) out of 201 midwives completed the questionnaire. RESULTS: Four of 5 midwives considered themselves to have the education they needed to manage the screening program. However, the study indicated that midwives lacked a basic structure when giving information. As many as every third midwife refrained from or had an irrelevant answer to the proposed question, what is meant by a cellular atypia? Almost all midwives saw themselves as the main informant about Pap-smear screening. At the same time, the midwives perceived that women lacked knowledge about cellular atypia, and thought it was the same as cancer. Some 38% of the midwives expressed a wish to terminate the 'assembly line-like' screening system. The remaining midwives were completely satisfied with the organisation. CONCLUSIONS: Many midwives lacked time and a structured guidance when discussing screening and cervical atypia. Improvement in the organisation and certified education for Pap-smear screening with access to recent research, could develop a more empowering exchange between the midwives and the women participating in cervical screening.
PubMed ID
17520410 View in PubMed
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Contraceptive use and pregnancy outcome in three generations of Swedish female teenagers from the same urban population.

https://arctichealth.org/en/permalink/ahliterature88348
Source
Contraception. 2009 Aug;80(2):163-9
Publication Type
Article
Date
Aug-2009
Author
Lindh Ingela
Blohm Febe
Andersson-Ellström Agneta
Milsom Ian
Author Affiliation
Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg SE-41685, Sweden.
Source
Contraception. 2009 Aug;80(2):163-9
Date
Aug-2009
Language
English
Publication Type
Article
Abstract
BACKGROUND: The primary objective of the study was to describe contraceptive use, reasons for discontinuation of contraception and pregnancy outcome in three generations of female teenagers over a period of 20 years. The secondary objective was to describe the relationship between contraception, smoking, body mass index (BMI) and socioeconomic status (SES). STUDY DESIGN: A cross-sectional comparison of 19-year-old women born in 1962, 1972 and 1982 and living in the city of Gothenburg, Sweden, in 1981, 1991 and 2001 was conducted. Contraceptive use, pregnancy outcome, smoking and weight/height were assessed by a postal questionnaire. RESULTS: Current contraceptive use was unchanged between the 62 (60%) and 72 cohorts (62%) but had increased (p
PubMed ID
19631792 View in PubMed
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Cost-effectiveness analysis of solifenacin flexible dosing in patients with overactive bladder symptoms in four Nordic countries.

https://arctichealth.org/en/permalink/ahliterature89269
Source
Acta Obstet Gynecol Scand. 2009;88(6):693-9
Publication Type
Article
Date
2009
Author
Milsom Ian
Axelsen Susanne
Kulseng-Hansen Sigurd
Mattiasson Anders
Nilsson Carl Gustaf
Wickstrøm Jannie
Author Affiliation
Department of Obstetrics & Gynecology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. ian.milsom@gu.se
Source
Acta Obstet Gynecol Scand. 2009;88(6):693-9
Date
2009
Language
English
Publication Type
Article
Keywords
Benzhydryl Compounds - administration & dosage
Cost-Benefit Analysis
Cresols - administration & dosage
Decision Support Techniques
Female
Finland
Humans
Muscarinic Antagonists - administration & dosage - economics
Phenylpropanolamine - administration & dosage
Quinuclidines - administration & dosage - economics
Randomized Controlled Trials as Topic
Scandinavia
Tetrahydroisoquinolines - administration & dosage - economics
Urinary Bladder, Overactive - drug therapy - economics
Abstract
OBJECTIVE: The purpose of the present analysis was to analyze and compare the cost-effectiveness of solifenacin flexible dosing (5-10 mg) with tolterodine 4 mg sustained release (SR) or placebo (assumed to be comparable to no treatment) for patients with overactive bladder (OAB) symptoms. DESIGN: A decision-analytic model was constructed. METHODS: Costs and effects were evaluated for the three treatment options in a one-year timeframe. Costs included were treatment costs, cost of pad use, and patients productivity loss based on data from the Nordic countries. SAMPLE: Results from two randomized controlled trials were used as input data in the cost-effectiveness analysis. MAIN OUTCOME MEASURES: Quality adjusted life years and incremental cost-effectiveness ratio. RESULTS: Solifenacin flexible dosing was more effective with respect to reducing OAB symptoms compared to both placebo and tolterodine 4 mg. Treatment with both solifenacin and tolterodine was more costly compared to placebo, but treatment with solifenacin was a less costly alternative compared to tolterodine 4 mg SR. Sensitivity analyses revealed that the conclusions were robust. CONCLUSION: Solifenacin flexible dosing was a cost-effective treatment alternative compared to tolterodine 4 mg SR.
PubMed ID
19384673 View in PubMed
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The current and future burden and cost of overactive bladder in five European countries.

https://arctichealth.org/en/permalink/ahliterature82007
Source
Eur Urol. 2006 Nov;50(5):1050-7
Publication Type
Article
Date
Nov-2006
Author
Reeves Penny
Irwin Deb
Kelleher Con
Milsom Ian
Kopp Zoe
Calvert Neill
Lloyd Adam
Author Affiliation
Fourth Hurdle Consulting Ltd, London, United Kingdom. PennyReeves@FouthHurdle.com
Source
Eur Urol. 2006 Nov;50(5):1050-7
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Costs and Cost Analysis
Europe
Female
Health Care Costs
Humans
Male
Middle Aged
Prevalence
Sensitivity and specificity
Urinary Bladder, Overactive - economics - epidemiology
Abstract
OBJECTIVE: To estimate and compare the current and future direct cost of overactive bladder (OAB) to the health care systems of five European countries. METHOD: A health economic model was created to estimate the number of people currently affected by OAB symptoms, the expected number to be affected in the future, and the resultant economic burden on health care systems in Germany, Italy, Spain, Sweden, and the United Kingdom. RESULTS: The model estimated that in 2000, 20.2 million people over age 40 in the five countries experienced the symptoms of OAB; 7 million of these had urgency with urge incontinence. This figure is expected to rise to 25.5 million by 2020, including 9 million who will have urgency with urge incontinence. Average annual direct costs of OAB management ranged from euro269 to euro706 per patient per year. The largest cost was the use of incontinence pads, accounting for an average of 63% of the annual per patient cost of OAB management. Total cost to health care systems across all five countries was estimated at euro4.2 billion in 2000, and by 2020, the expected total cost was estimated to be euro5.2 billion, an increase of euro1 billion (26%). CONCLUSION: OAB is prevalent, with a substantial direct cost that is anticipated to increase in the future in line with aging populations. The overall burden, including indirect costs, may be considerably larger, and will fall predominantly on the elderly OAB population with urge incontinence. Recommended medical treatments could help manage those costs and should be evaluated.
PubMed ID
16753252 View in PubMed
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The economic impact of overactive bladder syndrome in six Western countries.

https://arctichealth.org/en/permalink/ahliterature89696
Source
BJU Int. 2009 Jan;103(2):202-9
Publication Type
Article
Date
Jan-2009
Author
Irwin Debra E
Mungapen Laura
Milsom Ian
Kopp Zoe
Reeves Penny
Kelleher Con
Author Affiliation
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27516, USA. dirwin@email.unc.edu
Source
BJU Int. 2009 Jan;103(2):202-9
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Cross-Sectional Studies
Europe - epidemiology
Female
Health Care Costs - statistics & numerical data
Humans
Male
Middle Aged
Prevalence
Urinary Bladder, Overactive - complications - economics - epidemiology
Urinary Incontinence - complications - economics - epidemiology
Young Adult
Abstract
OBJECTIVE: To calculate up-to-date estimates of the economic impact of overactive bladder syndrome (OAB) with and without urgency urinary incontinence (UUI) on the health sector of six countries (Canada, Germany, Italy, Spain, Sweden and the UK), as OAB is a significant health concern for adults aged >18 years living in Western countries. MATERIALS AND METHODS: The prevalence data derived from the EPIC study were combined with healthcare resource-use data to derive current direct and indirect 1-year or annual cost of illness estimates for OAB including UUI in Canada, Germany, Italy, Spain, Sweden and the UK. This model estimates the direct healthcare costs attributed to OAB, as well as the impact of work absenteeism. RESULTS: The estimated average annual direct cost of OAB per patient ranged between 262 in Spain and 619 in Sweden. The estimated total direct cost burden for OAB per country ranges between 333 million in Sweden and 1.2 billion in Germany and the total annual direct cost burden of OAB in these six countries is estimated at 3.9 billion. In addition, nursing home costs were estimated at 4.7 billion per year and it was estimated that work absenteeism related to OAB costs 1.1 billion per year. CONCLUSIONS: The cost of illness for OAB is a substantial economic and human burden. This study may under-estimate the true economic burden, as not all costs for sequelae associated with OAB have been included. Cost-effective treatments and management strategies that can reduce the burden of OAB and in particular UUI have the potential to significantly reduce this economic burden.
PubMed ID
19278532 View in PubMed
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Examining lower urinary tract symptom constellations using cluster analysis.

https://arctichealth.org/en/permalink/ahliterature86652
Source
BJU Int. 2008 May;101(10):1267-73
Publication Type
Article
Date
May-2008
Author
Coyne Karin S
Matza Louis S
Kopp Zoe S
Thompson Christine
Henry David
Irwin Debra E
Artibani Walter
Herschorn Sender
Milsom Ian
Author Affiliation
Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD 20814, USA. karin.coyne@unitedbiosource.com
Source
BJU Int. 2008 May;101(10):1267-73
Date
May-2008
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Epidemiologic Methods
Europe - epidemiology
Female
Humans
Male
Middle Aged
Nocturia - epidemiology
Prostatism - epidemiology
Sex Factors
Urination Disorders - epidemiology
Abstract
OBJECTIVE: To gain a better understanding of how patients experience lower urinary tract symptoms (LUTS) and to determine whether particular symptoms cluster together, as LUTS seldom occur alone. SUBJECTS AND METHODS: A secondary analysis of a cross-sectional, population-based survey of adults in Sweden, Italy, Germany, UK and Canada was undertaken to examine the presence of LUTS groups. Of the 19,165 telephone surveys, 13,519 respondents reported at least one LUTS and were included in the analysis. All respondents were asked about the presence of 14 LUTS (International Prostate Symptom Score plus seven additional LUTS). K-means cluster analyses, a statistical method for sorting objects into groups so that similar objects are grouped together, was used to identify groups of people based on their symptoms. Men and women were analysed separately. A split-half random sample was selected from the dataset so that exploratory analyses could be conducted in one half and confirmed in the second. On model confirmation, the sample was analysed in its entirety. RESULTS: Included in this analysis were 5014 men (mean age 49.8 years; 95% white) and 8505 women (mean age 50.4 years; 96% white). Among both men and women, six distinct symptom cluster groups were identified and the symptom patterns of each cluster were examined. For both, the largest cluster consisted of respondents with minimal symptoms (i.e. reporting essentially one symptom), 56% of men and 57% of women. The remaining five clusters for men and women were labelled based on their predominant symptoms. For men, the clusters were nocturia of twice or more per night (12%); terminal dribble (11%); urgency (10%); multiple symptoms (9%); and postvoid incontinence (5%). For women, the clusters were nocturia of twice or more per night (12%); terminal dribble (10%); urgency (8%); stress incontinence (8%); and multiple symptoms (5%). The multiple-symptom groups had several and varied LUTS, were older, and had more comorbidities. Clusters of terminal dribble and male postvoid incontinence had a lower prevalence of all other LUTS, but were fairly common (11% and 5% of men). CONCLUSIONS: This analysis provides an empirical approach to examining the presentation of multiple LUTS and suggests it is possible to identify subgroups of patients with LUTS based on their symptom presentation. These analyses need to be replicated to evaluate the clinical relevance of these findings.
PubMed ID
18336611 View in PubMed
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Impact of recent studies on attitudes and use of hormone therapy among Scandinavian gynaecologists.

https://arctichealth.org/en/permalink/ahliterature84716
Source
Acta Obstet Gynecol Scand. 2007;86(12):1490-5
Publication Type
Article
Date
2007
Author
Pedersen Anette Tønnes
Iversen Ole-Erik
Løkkegaard Ellen
Mattsson Lars-Ake
Milsom Ian
Nilsen Stein Tore
Ottesen Bent
Moen Mette Haase
Author Affiliation
Department of Obstetrics and Gynecology, JMC Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. atp@dadlnet.dk
Source
Acta Obstet Gynecol Scand. 2007;86(12):1490-5
Date
2007
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cardiovascular Diseases - prevention & control
Estrogen Replacement Therapy
Female
Gynecology - methods - trends
Health Knowledge, Attitudes, Practice
Humans
Male
Menopause - physiology
Middle Aged
Osteoporosis - prevention & control
Physicians
Scandinavia
Abstract
BACKGROUND: Climacteric medicine has been in focus during the last 2 decades, and an intensive debate has been ongoing regarding the positive and negative aspects of postmenopausal hormone therapy (HT). Recent randomised controlled studies have been unable to confirm data from observational studies of primary or secondary preventive effects of HT on coronary heart disease, and other studies have indicated an increased risk of breast cancer, stroke and venous thromboembolism among HT users. In 2001, we reported on knowledge, attitudes, management strategies and use of HT among Scandinavian gynaecologists. The aim of the present study was to re-assess the same parameters concerning HT among Scandinavian gynaecologists in 2002-2003, and compare the results with the data collected in 1995-1997. METHODS: All practicing gynaecologists in Denmark, Sweden and Norway were invited by letter to complete and return a questionnaire regarding their knowledge, attitudes and management strategies concerning HT. Female gynaecologists were questioned if they were currently using HT, and the same question was posed concerning spouses of male gynaecologists. RESULTS: The questionnaire was completed and returned by 60, 76 and 72%, respectively of gynaecologists in Denmark, Sweden and Norway. Of the 1,591 physicians who responded, 13% thought that all women should be offered HT provided there were no contraindications, while 86% recommended HT only to selected women after considering the individual advantages and disadvantages of the treatment. Of the gynaecologists, 37% considered HT to be without relevance in the primary prevention of osteoporosis in healthy women. As for duration of the treatment, 40% of the gynaecologists would recommend HT for 10 years. The prevalence of HT use among the menopausal female gynaecologists varied between 71 and 74%. Among the menopausal spouses of male gynaecologists, 68-72% were current users of HT. CONCLUSION: During the last years of ongoing debate, gynaecologists from Denmark, Sweden and Norway have become more modest in their recommendations of postmenopausal HT. Scandinavian specialists are more cautious in prescribing hormones for women with symptomatic CVD or previously treated for breast cancer, however, their personal use of HT has not changed dramatically and still reflects a positive attitude.
PubMed ID
18027116 View in PubMed
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Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program : a prospective randomized study.

https://arctichealth.org/en/permalink/ahliterature83583
Source
Cancer. 2007 Oct 25;111(5):285-91
Publication Type
Article
Date
Oct-25-2007
Author
Strander Björn
Andersson-Ellström Agneta
Milsom Ian
Rådberg Thomas
Ryd Walter
Author Affiliation
Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Goteborg and Sahlgrenska University Hospital, Goteborg, Sweden.
Source
Cancer. 2007 Oct 25;111(5):285-91
Date
Oct-25-2007
Language
English
Publication Type
Article
Abstract
BACKGROUND: The objective of this study was to evaluate whether liquid-based cytology (LBC) can improve high-standard cervical cancer screening cytology further. The primary endpoint was histopathologic high-grade lesions in current and subsequent screening rounds. The secondary endpoints were cytologic diagnosis and inadequate samples. METHODS: Women were randomized to smear taking by conventional Papanicolaou (Pap) smear or LBC according to the time of appointment. Eight thousand eight hundred ten conventional Pap smears and 4674 LBC samples were included. Evaluations of atypical cytology and referral to colposcopy and treatment were performed as routine procedures. Histopathologic diagnoses were retrieved from a regional database 8 months after the study was closed. The mean follow-up was 2 years and 9 months. RESULTS: Inadequate samples were observed in 0.3% of LBC samples versus 0.7% of Pap smears (P = .002). The total fraction of nonbenign diagnoses in cytology was 4.5% versus 3.5%, respectively (P
PubMed ID
17724676 View in PubMed
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A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women.

https://arctichealth.org/en/permalink/ahliterature90344
Source
Eur Urol. 2009 Apr;55(4):783-91
Publication Type
Article
Date
Apr-2009
Author
Wennberg Anna-Lena
Molander Ulla
Fall Magnus
Edlund Christer
Peeker Ralph
Milsom Ian
Author Affiliation
Department of Obstetrics and Gynaecology, Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden.
Source
Eur Urol. 2009 Apr;55(4):783-91
Date
Apr-2009
Language
English
Publication Type
Article
Abstract
BACKGROUND: Female urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups; at present, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies. OBJECTIVE: To describe the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to assess possible progression or regression. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal population-based study was performed in one primary health care district in the city of Gothenburg, Sweden. The participants were a sample of women aged > or = 20 yr who were randomly selected from the Swedish National Population Register, assessed in 1991 (n=2911), and available for reassessment in 2007 (n=1408). METHODS: A self-administered postal questionnaire regarding UI, OAB, and other LUTS was returned by 77% of the contacted women in 1991. The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal questionnaire. RESULTS AND LIMITATIONS: In 2007, 1081 of the available 1408 women responded to the questionnaire (77%). The overall prevalence of UI, OAB, nocturia, and daytime micturition frequency of eight or more times per day increased by 13%, 9%, 20% (p
Notes
Comment In: Eur Urol. 2009 Apr;55(4):792-319178994
PubMed ID
19157689 View in PubMed
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15 records – page 1 of 2.