Identifying Pertinent Variables for Nonresponse Follow-Up Surveys : Lessons Learned from 4 Cases in Switzerland

All social surveys suffer from different types of errors, of which one of the most studied is non-response bias. Non-response bias is a systematic error that occurs because individuals differ in their accessibility and propensity to participate in a survey according to their own characteristics as well as those from the survey itself. The extent of the problem heavily depends on the correlation between response mechanisms and key survey variables. However, non-response bias is difficult to measure or to correct for due to the lack of relevant data about the whole target population or sample. In this paper, non-response follow-up surveys are considered as a possible source of information about non-respondents. Non-response follow-ups, however, suffer from two methodological issues: they themselves operate through a response mechanism that can cause potential non-response bias, and they pose a problem of comparability of measure, mostly because the survey design differs between main survey and non-response follow-up. In order to detect possible bias, the survey variables included in non-response surveys have to be related to the mechanism of participation, but not be sensitive to measurement effects due to the different designs. Based on accumulated experience of four similar non-response follow-ups, we studied the survey variables that fulfill these conditions. We differentiated socio-demographic variables that are measurement-invariant but have a lower correlation with non-response and variables that measure attitudes, such as trust, social participation, or integration in the public sphere, which are more sensitive to measurement effects but potentially more appropriate to account for the non-response mechanism. Our results show that education level, work status, and living alone, as well as political interest, satisfaction with democracy, and trust in institutions are pertinent variables to include in non-response follow-ups of general social surveys. - See more at: https://ojs.ub.uni-konstanz.de/srm/article/view/6138#sthash.u87EeaNG.dpuf

Financial stress transmission in EMU sovereign bond market volatility: a connectedness analysis

This paper measures the connectedness in EMU sovereign market volatility between April 1999 and January 2014, in order to monitor stress transmission and to identify episodes of intensive spillovers from one country to the others. To this end, we first perform a static and dynamic analysis to measure the total volatility connectedness in the entire period (the system-wide approach) using a framework recently proposed by Diebold and Yılmaz (2014). Second, we make use of a dynamic analysis to evaluate the net directional connectedness for each country and apply panel model techniques to investigate its determinants. Finally, to gain further insights, we examine the timevarying behaviour of net pair-wise directional connectedness at different stages of the recent sovereign debt crisis.

Full instability behavior of N-dimensional dynamical systems with a one-directional nonlinear vector field

We show how certain N-dimensional dynamical systems are able to exploit the full instability capabilities of their fixed points to do Hopf bifurcations and how such a behavior produces complex time evolutions based on the nonlinear combination of the oscillation modes that emerged from these bifurcations. For really different oscillation frequencies, the evolutions describe robust wave form structures, usually periodic, in which selfsimilarity with respect to both the time scale and system dimension is clearly appreciated. For closer frequencies, the evolution signals usually appear irregular but are still based on the repetition of complex wave form structures. The study is developed by considering vector fields with a scalar-valued nonlinear function of a single variable that is a linear combination of the N dynamical variables. In this case, the linear stability analysis can be used to design N-dimensional systems in which the fixed points of a saddle-node pair experience up to N21 Hopf bifurcations with preselected oscillation frequencies. The secondary processes occurring in the phase region where the variety of limit cycles appear may be rather complex and difficult to characterize, but they produce the nonlinear mixing of oscillation modes with relatively generic features

Human papillomavirus (HPV) in mothers before and after delivery – a three year follow-up study.

Human papillomavirus (HPV) infections in mothers are important to consider since pregnancy may affect the outcome of the infection and the mother may transmit HPV to the child. This thesis is part of the 3-year Finnish Family HPV Study on HPV infection dynamics within 329 families. The presence of maternal HPV antibodies and HPV DNA in placenta, umbilical cord blood and breast milk was examined. In addition, genital and oral HR-HPV carriage was studied among mothers with one or two pregnancies. At enrollment, seropositivity to HPV 6, 11, 16, 18 and 45 was recorded in 53 %, 21 %, 35 %, 21 % and 9 % of the mothers, respectively. Age at sexual debut, number of sexual partners, a history of genital warts and antibodies to LR/HR-HPV predicted HR/LR-HPV-seropositivity. During follow-up 27 %, 14 %, 17 %, 17 % and 7 % of the mothers seroconverted to the tested HPV-types, respectively. Decay of HPV-antibodies was rare. The mother’s new pregnancy was of minor impact in the outcome of oral and cervical HR-HPV infections. HPV-DNA was present in 4.2 % and 3.5 % of the placentas and umbilical cord blood samples, and in 4.5 % and 19.7 % of the breast milk samples collected at day 3 and month 2 postpartum, respectively. HPV-positivity in placenta/cord blood was related to a history of abnormal pap-smears or genital warts, and raised the risk of the neonate being HPV-positive at birth. The mode of delivery did not predict the HPVstatus of neonate, placenta, or cord blood. HPV DNA in breast milk was associated with oral HPV status of the father, but not with HPV status of the neonate. The results indicate that exposure to HPV is common and that part of the exposure might take place already early in life. Contrary to the common claim, pregnancy is not a risk factor for HPV.

Language recovery and evidence of residual deficits after nonthalamic subcortical stroke: A 1 year follow-up study

A variety of language disturbances including aphasia have been described after subcortical stroke but less is known about the factors that influence the long-term recovery of stroke-induced language dysfunction. We prospectively examined the role of the affected hemisphere and the lesion site in the occurrence and recovery of language deficits in nonthalamic subcortical stroke. Forty patients with unilateral basal gangliastroke underwent language assessment within 1 week, 3 months and 1 year after stroke. Disturbances in at least one language domain were observed in 35 patients during the first week post stroke including aphasia diagnosed in 11 patients. Importantly, the appearance of deficits after stroke onset and the improvement of language function were not determined by the site of subcortical lesion, but instead were critically influenced by the affected hemisphere. In fact, the language impairments following left and right basal ganglia stroke mirrored the language dysfunction observed after cortical lesions in the same hemisphere. A significant overall language improvement was observed at 3 months after stroke, although residual deficits in languageexecutive function were the most commonly observed impairment at 1 year follow-up. Although a substantial improvement of language function can be expected after nonthalamic subcortical stroke, our findings suggest that language recovery may not be fully achieved at 1 year post

Design and implementation of a multipurpose reactor for scale-up studies

In the theoretical part, the different polymerisation catalysts are introduced and the phenomena related to mixing in the stirred tank reactor are presented. Also the advantages and challenges related to scale-up are discussed. The aim of the applied part was to design and implement an intermediate-sized reactor useful for scale-up studies. The reactor setting was tested making one batch of Ziegler–Natta polypropylene catalyst. The catalyst preparation with a designed equipment setting succeeded and the catalyst was analysed. The analyses of the catalyst were done, because the properties of the catalyst were compared to the normal properties of Ziegler–Natta polypropylene catalyst. The total titanium content of the catalyst was slightly higher than in normal Ziegler–Natta polypropylene catalyst, but the magnesium and aluminium content of the catalyst were in the normal level. By adjusting the siphonation tube and adding one washing step the titanium content of the catalyst could be decreased. The particle size of the catalyst was small, but the activity was in a normal range. The size of the catalyst particles could be increased by decreasing the stirring speed. During the test run, it was noticed that some improvements for the designed equipment setting could be done. For example more valves for the chemical feed line need to be added to ensure inert conditions during the catalyst preparation. Also nitrogen for the reactor needs to separate from other nitrogen line. With this change the pressure in the reactor can be kept as desired during the catalyst preparation. The proposals for improvements are presented in the applied part. After these improvements are done, the equipment setting is ready for start-up. The computational fluid dynamics model for the designed reactor was provided by cooperation with Lappeenranta University of Technology. The experiments showed that for adequate mixing with one impeller, stirring speed of 600 rpm is needed. The computational fluid dynamics model with two impellers showed that there was no difference in the mixing efficiency if the upper impeller were pumping downwards or upwards.

Molecular modeling of asymmetric induction in heterogeneously catalyzed hydrogenation of the C=O bond

Modifiering av metallytor med starkt adsorberade kirala organiska molekyler är eventuellt den mest relevanta teknik man vet i dag för att skapa kirala ytor. Den kan utnyttjas i katalytisk produktion av enantiomeriskt rena kirala föreningar som behövs t.ex. som läkemedel och aromkemikalier. Trots många fördelar av asymmetrisk heterogen katalys jämfört med andra sätt för att få kirala föreningar, har den ändå inte blivit ett allmänt verktyg för storskaliga tillämpningar. Detta beror t.ex. på brist på djupare kunskaper i katalytiska reaktionsmekanismer och ursprunget för asymmetrisk induktion. I denna studie användes molekylmodelleringstekniker för att studera asymmetriska, heterogena katalytiska system, speciellt hydrering av prokirala karbonylföreningar till motsvarande kirala alkoholer på cinchona-alkaloidmodifierade Pt-katalysatorer. 1-Fenyl-1,2-propandion (PPD) och några andra föreningar, som innehåller en prokiral C=O-grupp, användes som reaktanter. Konformationer av reaktanter och cinchona-alkaloider (som kallas modifierare) samt vätebundna 1:1-komplex mellan dem studerades i gas- och lösningsfas med metoder som baserar sig på vågfunktionsteori och täthetsfunktionalteori (DFT). För beräkningen av protonaffiniteter användes också högst noggranna kombinationsmetoder såsom G2(MP2). Den relativa populationen av modifierarnas konformationer varierade som funktion av modifieraren, dess protonering och lösningsmedlet. Flera reaktant–modifierareinteraktionsgeometrier beaktades. Slutsatserna på riktning av stereoselektivitet baserade sig på den relativa termodynamiska stabiliteten av de diastereomeriska reaktant–modifierare-komplexen samt energierna hos π- och π*-orbitalerna i den reaktiva karbonylgruppen. Adsorption och reaktioner på Pt(111)-ytan betraktades med DFT. Regioselektivitet i hydreringen av PPD och 2,3-hexandion kunde förklaras med molekyl–yta-interaktioner. Storleken och formen av klustret använt för att beskriva Pt-ytan inverkade inte bara på adsorptionsenergierna utan också på de relativa stabiliteterna av olika adsorptionsstrukturer av en molekyl. Populationerna av modifierarnas konformationer i gas- och lösningsfas korrelerade inte med populationerna på Pt-ytan eller med enantioselektiviteten i hydreringen av PPD på Pt–cinchona-katalysatorer. Vissa modifierares konformationer och reaktant–modifierare-interaktionsgeometrier var stabila bara på metallytan. Teoretiskt beräknade potentialenergiprofiler för hydrering av kirala α-hydroxiketoner på Pt implicerade preferens för parvis additionsmekanism för väte och selektiviteter i harmoni med experimenten. De uppnådda resultaten ökar uppfattningen om kirala heterogena katalytiska system och kunde därför utnyttjas i utvecklingen av nya, mera aktiva och selektiva kirala katalysatorer.

Bonding of Composite Resin to Alumina and Zirconia Ceramics with Special Emphasis on Surface Conditioning and Use of Coupling Agents

Dental oxide ceramics have been inspired by their biocompability and mechanical properties which have made durable all-ceramic structures possible. Clinical longevity of the prosthetic structures is dependent on effective bonding with luting cements. As the initial shear bond strength values can be comparable with several materials and procedures, long-term durability is affected by ageing. Aims of the current study were: to measure the shear bond strength of resin composite-to-ceramics and to evaluate the longevity of the bond; to analyze factors affecting the bond, with special emphasis on: the form of silicatization of the ceramic surface; form of silanization; type of resin primer and the effect of the type of the resin composite luting cement; the effect of ageing in water was studied regarding its effect to the endurance of the bond. Ceramic substrates were alumina and yttrium stabilized zirconia. Ceramic conditioning methods included tribochemical silicatization and use of two silane couplings agents. A commercial silane primer was used as a control silane. Various combinations of conditioning methods, primers and resin cements were tested. Bond strengths were measured by shear bond strength method. The longevity of the bond was generally studied by thermocycling the materials in water. Additionally, in one of the studies thermal cycling was compared with long-term water storaging. Results were analysed statistically with ANOVA and Weibull analysis. Tribochemical treatment utilizing air pressure of 150 kPa resulted shear bond strengths of 11.2 MPa to 18.4 MPa and air pressure of 450 kPa 18.2 MPa to 30.5 MPa, respectively. Thermocycling of 8000 cycles or four years water storaging both decreased shear bond strength values to a range of 3.8 MPa to 7.2 MPa whereas initial situation varied from 16.8. Mpa to 23.0 MPa. The silane used in studies had no statistical significance. The use of primers without 10-MDP resulted spontaneous debonding during thermocycling or shear bond strengths below 5 MPa. As conclusion, the results showed superior long-term bonding with primers containing 10-MDP. Silicatization with silanizing showed improved initial shear bond strength values which considerably decreased with ageing in water. Thermal cycling and water storing for up to four years played the major role in reduction of bond strength, which could be due to thermal fatigue of the bonding interface and hydrolytic degradation of the silane coupled interface.

The effectiveness of short-term literacy skills intervention on children at risk of reading and writing difficulties in Tanzania : a study of grade one children with dynamic assessment approach

The aim of the study was to create and evaluate an intervention programme for Tanzanian children from a low-income area who are at risk of reading and writing difficulties. The learning difficulties, including reading and writing difficulties, are likely to be behind many of the common school problems in Tanzania, but they are not well understood, and research is needed. The design of the study included an identification and intervention phase with follow-up. A group based dynamic assessment approach was used in identifying children at risk of difficulties in reading and writing. The same approach was used in the intervention. The study was a randomized experiment with one experimental and two control groups. For the experimental and the control groups, a total of 96 (46 girls and 50 boys) children from grade one were screened out of 301 children from two schools in a low income urban area of Dar-es-Salaam. One third of the children, the experimental group, participated in an intensive training programme in literacy skills for five weeks, six hours per week, aimed at promoting reading and writing ability, while the children in the control groups had a mathematics and art programme. Follow-up was performed five months after the intervention. The intervention programme and the tests were based on the Zambian BASAT (Basic Skill Assessment Tool, Ketonen & Mulenga, 2003), but the content was drawn from the Kiswahili school curriculum in Tanzania. The main components of the training and testing programme were the same, only differing in content. The training process was different from traditional training in Tanzanian schools in that principles of teaching and training in dynamic assessment were followed. Feedback was the cornerstone of the training and the focus was on supporting the children in exploring knowledge and strategies in performing the tasks. The experimental group improved significantly more (p = .000) than the control groups during the intervention from pre-test to follow-up (repeated measures ANOVA). No differences between the control groups were noticed. The effect was significant on all the measures: phonological awareness, reading skills, writing skills and overall literacy skills. A transfer effect on school marks in Kiswahili and English was found. Following a discussion of the results, suggestions for further research and adaptation of the programme are presented.

Cognitive Functions After Traumatic Brain Injury. A 30-year Follow-up Study

Many cognitive deficits after TBI (traumatic brain injury) are well known, such as memory and concentration problems, as well as reduced information-processing speed. What happens to patients and cognitive functioning after immediate recovery is poorly known. Cognitive functioning is flexible and may be influenced by genetic, psychological and environmental factors decades after TBI. The general aim of this thesis was to describe the long-term cognitive course after TBI, to find variables that may contribute to it, and how the cognitive functions after TBI are associated with specific medical factors and reduced survival. The original study group consisted of 192 patients with TBI who were originally assessed with the Mild Deterioration Battery (MDB) on average two years after the injury, during the years 1966 – 1972. During a 30-year follow-up, we studied the risks for reduced survival, and the mortality of the patients was compared with the general population using the Standardized Mortality Ratio (SMR). Sixty-one patients were re-assessed during 1998-2000. These patients were evaluated with the MDB, computerized testing, and with various other neuropsychological methods for attention and executive functions. Apolipoprotein-E (ApoE) genotyping and magnetic resonance imaging (MRI) based on volumetric analysis of the hippocampus and lateral ventricles were performed. Depressive symptoms were evaluated with the short form of the Beck depression inventory. The cognitive performance at follow-up was compared with a control group that was similar to the study group in regard to age and education. The cognitive outcome of the patients with TBI varied after three decades. The majority of the patients showed a decline in their cognitive level, the rest either improved or stayed at the same level. Male gender and higher age at injury were significant risk factors for the decline. Whereas most cognitive domains declined during the follow-up, semantic memory behaved in the opposite way, showing recovery after TBI. In the follow-up assessment, the memory decline and impairments in the set-shifting domain of executive functions were associated with MRI-volumetric measures, whereas reduction in information-processing speed was not associated with the MRI measures. The presence of local contusions was only weakly associated with cognitive functions. Only few cognitive methods for attention were capable of discriminating TBI patients with and without depressive symptoms. On the other hand, most complex attentional tests were sensitive enough to discriminate TBI patients (non-depressive) from controls. This means that complex attention functions, mediated by the frontal lobes, are relatively independent of depressive symptoms post-TBI. The presence of ApoE4 was associated with different kinds of memory processes including verbal and visual episodic memory, semantic memory and verbal working memory, depending on the length of time since TBI. Many other cognitive processes were not affected by the presence of ApoE4. Age at injury and poor vocational outcome were independent risk factors for reduced survival in the multivariate analysis. Late mortality was higher among younger subjects (age < 40 years at death) compared with the general population which should be borne in mind when assessing the need for rehabilitation services and long-term follow-up after TBI.

Thermal comfort temperature update for broiler chickens up to 21 days of age

Due to changes in genetics and nutrition, as well as in acclimatization of broiler chickens to the Brazilian climate, temperature values currently accepted as optimal may be outdated. The objective of this research was to update the environment temperatures that characterize the thermal comfort for broilers chickens from one to 21 days of age, under Brazilian production conditions. This research was conducted with 600 COBB birds, which were distributed in five growth chambers maintained at different temperatures during the first three weeks of age. During the experimental period, temperature values were progressively reduced, consisting in five treatments: T2724/21, T30/27/24, T33/30/27, T36/33/30 and T39/36/33. It was observed that the birds maintained in the T30(27-24) treatment presented better performance compared to other environment conditions. Based on the obtained regression models, the environment temperature values that provide greater weighing gain for the broiler chicken growth in the initial period were 31.3, 25.5 and 21.8 ºC, respectively for the first, second and third week of age.

Longitudinal distribution of bean seeds in horizontal plate meter operating with one or two seed outlets

This study aimed to evaluate the effect of horizontal plate meter with oblong holes operating with one or two seed outlets at different speeds over the accuracy of longitudinal distribution of common bean seeds (Phaseolus vulgaris L.). The experiment was performed in laboratory using the meter with one and two seed outlet points in relation to ten tangential disk plate speeds (0.03 to 0.30 m s-1). It was used a complete randomized design with four replications, summing up 80 experimental treatments. Tangential speed quantitative factor was estimated through a 2nd order polynomial regression. There was no significant difference in the behavior of the seed meter operating with one or two outlets in the metering of bean seeds in all tested speeds, with percentage of single seeds spacing over 60% in tangential speeds below of 0.24 m s-1.

Finnish Institutional Innovation Support Policies from Russian Entrepreneurs' Perspective: Establishing Cross-Border Technology Oriented Start-Up Firm

The purpose of this thesis is to study how Russian entrepreneurs perceive Finnish institutional environment and innovation support policies provided in the country, as well as to present a practical example in form of a case study of one technology oriented start-up firm which was established in Finland by Russian entrepreneurs. The empirical research of the thesis is conducted qualitatively in two parts. First part is conducted through online questionnaire with open questions in order to review the perceptions of Russian entrepreneurs in general. Second part is based on personal interviews with case company’s founders with the focus on the process of establishing the company in Finland. In the first part of the empirical research, five Russian start-up firms were contacted, and four responses were received. All of these responses were qualified for further analysis. The findings of the first part of the research reveal that Russian entrepreneurs have rather positive attitudes towards Finnish institutional innovation support policies. However, most of the entrepreneurs stated that they are unlikely to create their presence in Finland. As an outcome of the second part of the research, the process of establishing a case company in Finland is illustrated. In order to be able to establish companies in Finland, Russian entrepreneurs who have a permanent residence outside European Economic Area (EEA) are required to apply for a permission to perform business operations in the country. In addition, the established company must engage in improving the economical stand of the country by creating new work places, raising tax revenues, develop technologies and generate innovations in the country.

Kasvatus on kasvamaan saattamista. Kasvatusfilosofinen tutkimus J. A. Hollon sivistyskasvatusajattelusta

Tutkimukseni käsittelee J. A. Hollon (1885–1967) sivistyskasvatusajattelua. Hollo oli monitoiminen kulttuurivaikuttaja, joka toimi kriitikkona, kirjailijana, suomentajana ja kasvatustieteilijänä. Häntä voidaan pitää J. V. Snellmanin rinnalla yhtenä merkittävimpänä suomalaisena kasvatusajattelijana. Hänen kasvatusajattelustaan ei ole kuitenkaan aiemmin tehty väitöskirjatason tutkimusta. Tutkimuskysymykseni ovat seuraavat: 1. Millainen on Hollon näkemys kasvatuksesta, kasvatuksen maailmasta ja kasvatuksen teoriasta? 2. Mikä on Hollon käsitys kasvattajan ja kasvatettavan merkityksestä kasvatustapahtumassa? 3. Mitä asioita sisältyy sivistyskasvatuksen eli kasvamaan saattamisen elementteihin? Tutkimukseni on kasvatusfilosofinen. Tutkimusmenetelmäni on systemaattinen analyysi ja lähestymistapani on hermeneuttinen. Tutkimukseni pääaineistona ovat Hollon kasvatusta koskevat kirjoitukset, joista tärkeimmät ovat Mielikuvitus ja sen kasvattaminen I-II (1918, 1919), Kasvatuksen maailma (1927), Kasvatuksen teoria (1927) ja Itsekasvatus ja elämisen taito (1931). Hollon mukaan kasvatuksen maailma on suhteellisen itsenäinen elämänmuoto (Lebensform), jolla on oma ontologinen erityislaatunsa, so. sui generis. Kasvatusoppia ei pidä redusoida psykologiaan tai filosofiaan, koska sillä tavoin se menettää tieteellisen itsenäisyytensä. Hollon mielestä kasvatuksen teoria on teoria käytäntöä varten. Kasvatuksen teorian luomisessa tulee ottaa huomioon kasvatuksen maailman erityispiirteenä oleva kokonaisvaltainen näkökulma ja elämän palvelemisen päämäärä. Kasvattaminen on aina myös eettistä toimintaa. Kasvatuksen tavoitteena on hyvä elämä. Hollon mukaan kasvattajan tehtävä on luoda kasvatettavalleen eheä sivistyksellinen perusta. Tämä voi tapahtua vain laaja-alaisen sivistyskasvatuksen avulla, jonka runkona on antiikin humanistinen sivistysperinne. Sivistyskasvatukseen kuuluvat älyllinen, eettinen, uskonnollinen, esteettinen ja toiminnallinen kasvatus. Mielikuvituksen avulla kasvattaja voi yhdistää kasvatuksen osa-alueet eheäksi kokonaisuudeksi. Ilman mielikuvitusta erilaiset ilmiöt olisivat pirstaleisina, toisistaan erillisinä osina ihmisen mielessä. Opettajan persoona on merkittävä tekijä kasvatuksessa. Se tulee ottaa huomioon opettajankoulutuksen eli kasvattajan kasvattamisen valinnoissa. Opettaja-kasvattajan on tärkeää opiskella laajasti humanistisia opintoja, koska kasvatuksessa on kysymys ihmisestä. Ennen kaikkea kasvattajan eettistä ja esteettistä kykyä tulee harjoituttaa. Näin hän oppii käyttämään mielikuvitustaan kasvatustapahtumassa siten, että hän tulee kasvatuksellisesti näkeväksi kasvamaan saattajaksi, joka ymmärtää sen, mikä kussakin tilanteessa vaatii erityistä huomiota. Tutkimukseni osoittaa, että Hollon henkitieteellinen ja fenomenologis-hermeneuttinen kasvatusnäkemys ei ole vain vastaparadigma empiiriselle kasvatustieteelle, vaan myös nykyajan teknis-taloudelliselle eetokselle, joka yhtäältä uhkaa välineellistää kasvatuksen ja toisaalta väärällä tavoin tieteellistää kasvatuksen tutkimuksen. Tämän takia kasvatusoppi kysymyksineen uhkaa siirtyä kasvatuskeskustelussa syrjemmälle, jopa hävitä kokonaan. Kasvatuksen ja kasvatuksen tutkimuksen vaarana on niiden liiallinen sitouttaminen tuotantoelämän jatkeeksi, minkä seurauksena on ihmisyyden toteuttamisen vaikeutuminen. Tutkimuksen lopuksi esitän ideaalikoulunäkemykseni, joka perustuu osittain Hollon kasvatusnäkemykseen. Hollon näkemys on yhä ajankohtainen ja merkittävä kontribuutio kasvatusta, sen teoriaa ja käytäntöä koskevaan keskusteluun.

Predictive Capability of HPV and Pap Tests in Screening for Cervical Cancer over a Three-Year Follow-up

Purpose To compare the predictive capability of HPV and Pap smear tests for screening pre-cancerous lesions of the cervix over a three-year follow-up, in a population of users of the Brazilian National Health System (SUS). Methods This is a retrospective cohort study of 2,032 women with satisfactory results for Pap smear and HPV tests using second-generation hybrid capture,made in a previous study. We followed them for 36 months with data obtained from medical records, the Cervix Cancer Information System (SISCOLO), and the Mortality Information System (SIM). The outcome was a histological diagnosis of cervical intraepithelial neoplasia grade 2 or more advanced lesions (CIN2ş). We constructed progression curves of the baseline test results for the period, using the Kaplan-Meier method, and estimated sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios for each test. Results A total of 1,440 women had at least one test during follow-up. Progression curves of the baseline test results indicated differences in capability to detect CIN2ş (p < 0.001) with significantly greater capability when both tests were abnormal, followed by only a positive HPV test. The HPV test was more sensitive than the Pap smear (88.7% and 73.6%, respectively; p < 0.05) and had a better negative likelihood ratio (0.13 and 0.30, respectively). Specificity and positive likelihood ratio of the tests were similar. Conclusions These findings corroborate the importance of HPV test as a primary cervical cancer screening.