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            "abstractNote": "Aim\nClinical trials have shown prophylactic human papillomavirus (HPV) vaccines to be effective against infection and disease. We examined whether HPV vaccination has the potential to be cost-effective.Methods\nA cohort model of the natural history of HPV was developed, which fits simultaneously Canadian age and type-specific data for infection, cervical intraepithelial neoplasia, cervical cancer (CC) and genital warts (GW). Quality-Adjusted Life-Years (QALYs) lost and costs were estimated using data from the literature.Results\nVaccinating 12-year-old girls (efficacy = 95%, no waning, cost/course = CAN$ 400) against HPV-16/18 and HPV-6/11/16/18 is estimated to cost the health provider CAN$ 31,000 (80%CrI: 15,000-55,000) and CAN$ 21,000 (80%CrI: 11,000-33,000) per QALY-gained, respectively. Results were most sensitive to age at vaccination, duration of vaccine protection, vaccine cost and QALY-lost due to GW, and were least sensitive to the medical costs.Conclusion\nVaccinating adolescent girls against HPV is likely to be cost-effective. The main benefit of vaccination will be in reducing CC mortality. However, unless screening is modified, the treatment costs saved through vaccination will be insignificant compared to the cost of HPV immunization.",
            "publicationTitle": "Vaccine",
            "publisher": "",
            "place": "",
            "date": "July 20, 2007",
            "volume": "25",
            "issue": "29",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "5399-5408",
            "series": "",
            "seriesTitle": "",
            "seriesText": "",
            "journalAbbreviation": "",
            "DOI": "10.1016/j.vaccine.2007.04.086",
            "citationKey": "",
            "url": "http://www.sciencedirect.com/science/article/B6TD4-4NSWTYB-1/2/d40f95c73fc6d6c0a01275d81c251657",
            "accessDate": "2010-07-14T19:06:41Z",
            "PMID": "",
            "PMCID": "",
            "ISSN": "0264-410X",
            "archive": "",
            "archiveLocation": "",
            "shortTitle": "",
            "language": "",
            "libraryCatalog": "ScienceDirect",
            "callNumber": "",
            "rights": "",
            "extra": "",
            "tags": [
                {
                    "tag": "Cost-effectiveness",
                    "type": 1
                },
                {
                    "tag": "Human papillomavirus (HPV)",
                    "type": 1
                },
                {
                    "tag": "Vaccination",
                    "type": 1
                }
            ],
            "collections": [],
            "relations": {},
            "dateAdded": "2010-07-15T18:05:53Z",
            "dateModified": "2010-07-15T18:05:53Z"
        }
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    {
        "key": "5M8EFQE4",
        "version": 1,
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            },
            "creatorSummary": "Franco et al.",
            "parsedDate": "2001-04-03",
            "numChildren": 0
        },
        "data": {
            "key": "5M8EFQE4",
            "version": 1,
            "itemType": "journalArticle",
            "title": "Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Eduardo L.",
                    "lastName": "Franco"
                },
                {
                    "creatorType": "author",
                    "firstName": "Eliane",
                    "lastName": "Duarte-Franco"
                },
                {
                    "creatorType": "author",
                    "firstName": "Alex",
                    "lastName": "Ferenczy"
                }
            ],
            "abstractNote": "ORGANIZED SCREENING HAS CONTRIBUTED TO A DECLINE in cervical cancer incidence and mortality over the past 50 years. However, women in developing countries are yet to profit extensively from the benefits of screening programs, and recent trends show a resurgence of the disease in developed countries. The past 2 decades have witnessed substantial progress in our understanding of the natural history of cervical cancer and in major treatment advances. Human papillomavirus (HPV) infection is now recognized as the main cause of cervical cancer, the role of coexisting factors is better understood, a new cytology reporting terminology has improved diagnosis and management of precursor lesions, and specific treatment protocols have increased survival among patients with early or advanced disease. Current research has focused on the determinants of infection with oncogenic HPV types, the assessment of prophylactic and therapeutic vaccines and the development of screening strategies incorporating HPV testing and other methods as adjunct to cytology. These are fundamental stepping stones for the implementation of effective public health programs aimed at the control of cervical cancer.",
            "publicationTitle": "CMAJ",
            "publisher": "",
            "place": "",
            "date": "April 3, 2001",
            "volume": "164",
            "issue": "7",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "1017-1025",
            "series": "",
            "seriesTitle": "",
            "seriesText": "",
            "journalAbbreviation": "",
            "DOI": "",
            "citationKey": "",
            "url": "http://www.cmaj.ca/cgi/content/abstract/164/7/1017",
            "accessDate": "2010-07-13T17:50:12Z",
            "PMID": "",
            "PMCID": "",
            "ISSN": "",
            "archive": "",
            "archiveLocation": "",
            "shortTitle": "Cervical cancer",
            "language": "",
            "libraryCatalog": "HighWire",
            "callNumber": "",
            "rights": "",
            "extra": "",
            "tags": [],
            "collections": [],
            "relations": {},
            "dateAdded": "2010-07-15T18:05:53Z",
            "dateModified": "2010-07-15T18:05:53Z"
        }
    },
    {
        "key": "UD8B47XB",
        "version": 1,
        "library": {
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            "id": 21867,
            "name": "UofC_FamMed",
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                }
            },
            "creatorSummary": "Tacken et al.",
            "parsedDate": "2006",
            "numChildren": 0
        },
        "data": {
            "key": "UD8B47XB",
            "version": 1,
            "itemType": "journalArticle",
            "title": "Loss to follow-up of cervical smears without endocervical columnar cells is not disturbing",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "M A J B",
                    "lastName": "Tacken"
                },
                {
                    "creatorType": "author",
                    "firstName": "J C C",
                    "lastName": "Braspenning"
                },
                {
                    "creatorType": "author",
                    "firstName": "J",
                    "lastName": "Mulder"
                },
                {
                    "creatorType": "author",
                    "firstName": "R P M G",
                    "lastName": "Hermens"
                },
                {
                    "creatorType": "author",
                    "firstName": "W L D M",
                    "lastName": "Nelen"
                },
                {
                    "creatorType": "author",
                    "firstName": "D H",
                    "lastName": "de Bakker"
                },
                {
                    "creatorType": "author",
                    "firstName": "R P T M",
                    "lastName": "Grol"
                }
            ],
            "abstractNote": "OBJECTIVE: To investigate the six-month recommended follow-up after mass screening of Pap smears because of the absence of endocervical columnar cells (ECC-) or ECC+ smears with atypical squamous or glandular cells of undetermined origin (ASCUS/AGUS) or low-grade squamous or glandular intraepithelial lesions (LSIL/LGIL) in a Dutch mass screening cervical cancer programme. METHODS: Data were extracted from computerised medical records of national representative Dutch general practices. We have studied the attendance at and the outcome of the subsequent Pap smears after a 6-month recommendation. RESULTS: The six-month follow-up was linked to 8.7% of the Pap smears (n = 1,002); 77.6% were without endocervical columnar cells (ECC-). Clear differences were found between the follow-up of ECC+ and ECC- smears; after 36 weeks of follow-up of 43.5% the women had an ECC- smear and 66.9% had other conditions. For initial ECC- Pap smears, 84.1% had no abnormalities in the subsequent Pap smear; for initial ECC+ Pap smears, in about 64% of the cases no abnormalities were found (p < 0.0001). CONCLUSIONS: Repeating ECC- smears has a low follow-up rate but also lacks evidence-based necessity. However, for the other 6-month recommended Pap smears, one in five women had still not responded within one year, so improvement is necessary.",
            "publicationTitle": "European Journal of Gynaecological Oncology",
            "publisher": "",
            "place": "",
            "date": "2006",
            "volume": "27",
            "issue": "1",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "42-46",
            "series": "",
            "seriesTitle": "",
            "seriesText": "",
            "journalAbbreviation": "Eur. J. Gynaecol. Oncol",
            "DOI": "",
            "citationKey": "",
            "url": "http://www.ncbi.nlm.nih.gov/pubmed/16550967",
            "accessDate": "2010-07-12T20:01:04Z",
            "PMID": "",
            "PMCID": "",
            "ISSN": "0392-2936",
            "archive": "",
            "archiveLocation": "",
            "shortTitle": "",
            "language": "",
            "libraryCatalog": "NCBI PubMed",
            "callNumber": "",
            "rights": "",
            "extra": "PMID: 16550967",
            "tags": [
                {
                    "tag": "Adult",
                    "type": 1
                },
                {
                    "tag": "Aged",
                    "type": 1
                },
                {
                    "tag": "Cervical Intraepithelial Neoplasia",
                    "type": 1
                },
                {
                    "tag": "Cervix Uteri",
                    "type": 1
                },
                {
                    "tag": "Cohort Studies",
                    "type": 1
                },
                {
                    "tag": "Cytodiagnosis",
                    "type": 1
                },
                {
                    "tag": "Female",
                    "type": 1
                },
                {
                    "tag": "Follow-Up Studies",
                    "type": 1
                },
                {
                    "tag": "Humans",
                    "type": 1
                },
                {
                    "tag": "Mass Screening",
                    "type": 1
                },
                {
                    "tag": "Middle Aged",
                    "type": 1
                },
                {
                    "tag": "Needs Assessment",
                    "type": 1
                },
                {
                    "tag": "Patient Compliance",
                    "type": 1
                },
                {
                    "tag": "Registries",
                    "type": 1
                },
                {
                    "tag": "Risk Assessment",
                    "type": 1
                },
                {
                    "tag": "Sensitivity and Specificity",
                    "type": 1
                },
                {
                    "tag": "Time Factors",
                    "type": 1
                },
                {
                    "tag": "Treatment Refusal",
                    "type": 1
                },
                {
                    "tag": "Uterine Cervical Neoplasms",
                    "type": 1
                },
                {
                    "tag": "Vaginal Smears",
                    "type": 1
                }
            ],
            "collections": [],
            "relations": {},
            "dateAdded": "2010-07-15T18:05:53Z",
            "dateModified": "2010-07-15T18:05:53Z"
        }
    },
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        "version": 1,
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            },
            "creatorSummary": "Giorgi Rossi et al.",
            "parsedDate": "2010-06",
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        "data": {
            "key": "ZBJAXCCP",
            "version": 1,
            "itemType": "journalArticle",
            "title": "Risk of CIN2 in women with a pap test without endocervical cells vs. those with a negative pap test with endocervical cells: a cohort study with 4.5 years of follow-up",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Paolo",
                    "lastName": "Giorgi Rossi"
                },
                {
                    "creatorType": "author",
                    "firstName": "Diego",
                    "lastName": "Baiocchi"
                },
                {
                    "creatorType": "author",
                    "firstName": "Stefano",
                    "lastName": "Ciatto"
                }
            ],
            "abstractNote": "OBJECTIVE: To measure the risk of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in the 4.5 years following a negative Pap smear with adequate endocervical cells (ECC) (+) or absent/scarce ECC (-). STUDY DESIGN: A prospective, nonconcurrent study of the archives of 11 Italian population-based screening programs was conducted. Only 25-50-year-old women with a first negative Pap test were included. RESULTS: Women were classified as ECC+ or ECC- and followed for 4.5 years. The endpoint was the occurrence of a CIN2+ histologic diagnosis. Eligible subjects with negative Pap tests ECC+ and ECC- numbered 469,694 and 20,596, respectively. At least 1 subsequent test was available during follow-up for 335,763 and 11,972 subjects, and 691 and 13 CIN2+ lesions were observed, respectively. The risk of CIN2+ was 2.06 and 1.09 per 1,000 women over 4.5 years, and age-adjusted relative risk associated with ECC--was 0.55 (95% CI 0.28-1.06). CONCLUSION: Women with a negative Pap ECC--have a lower risk of CIN2+ than women with a negative Pap ECC+ and should repeat screening with frequency (3-5 years in Europe), independent of age.",
            "publicationTitle": "Acta Cytologica",
            "publisher": "",
            "place": "",
            "date": "2010 May-Jun",
            "volume": "54",
            "issue": "3",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "265-271",
            "series": "",
            "seriesTitle": "",
            "seriesText": "",
            "journalAbbreviation": "Acta Cytol",
            "DOI": "",
            "citationKey": "",
            "url": "http://www.ncbi.nlm.nih.gov/pubmed/20518409",
            "accessDate": "2010-07-12T19:54:34Z",
            "PMID": "",
            "PMCID": "",
            "ISSN": "0001-5547",
            "archive": "",
            "archiveLocation": "",
            "shortTitle": "Risk of CIN2 in women with a pap test without endocervical cells vs. those with a negative pap test with endocervical cells",
            "language": "",
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            "callNumber": "",
            "rights": "",
            "extra": "PMID: 20518409",
            "tags": [
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                    "tag": "Adult",
                    "type": 1
                },
                {
                    "tag": "Cervical Intraepithelial Neoplasia",
                    "type": 1
                },
                {
                    "tag": "Cervix Uteri",
                    "type": 1
                },
                {
                    "tag": "Female",
                    "type": 1
                },
                {
                    "tag": "Follow-Up Studies",
                    "type": 1
                },
                {
                    "tag": "Humans",
                    "type": 1
                },
                {
                    "tag": "Italy",
                    "type": 1
                },
                {
                    "tag": "Mass Screening",
                    "type": 1
                },
                {
                    "tag": "Middle Aged",
                    "type": 1
                },
                {
                    "tag": "Professional Practice",
                    "type": 1
                },
                {
                    "tag": "Prospective Studies",
                    "type": 1
                },
                {
                    "tag": "Risk Factors",
                    "type": 1
                },
                {
                    "tag": "Specimen Handling",
                    "type": 1
                },
                {
                    "tag": "Uterine Cervical Neoplasms",
                    "type": 1
                },
                {
                    "tag": "Vaginal Smears",
                    "type": 1
                }
            ],
            "collections": [],
            "relations": {},
            "dateAdded": "2010-07-15T18:05:53Z",
            "dateModified": "2010-07-15T18:05:53Z"
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]