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This article explores the inequities experienced by individuals with disabilities when accessing obstetric and gynecologic care. The unique needs, abilities, and barriers to care are reviewed, as well as recommendations for provision of care to people with disabilities.
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Pessoas com Deficiência , Ginecologia , Obstetrícia , Feminino , Humanos , Gravidez , Atenção à SaúdeRESUMO
Objective: The purpose of this study was to develop a survey tool to capture inappropriate, disrespectful, and coercive (IDC) interactions with healthcare providers among a diverse sample of university students. Participants: Participants were university students at one large Midwestern public university. Methods: An exploratory qualitative approach was used to create a survey tool to capture IDC interactions. Results: In Phase I, 9 focus group discussions (FGDs) and 3 individual interviews were conducted with a total of 38 participants. In Phase II, 18 participants completed cognitive interviews. Themes across all FGDs included: (1) communication; (2) respect for identity; (3) institutional practices; (4) power imbalances; and (5) lack of patient education and empowerment. Queer participants discussed unique considerations of how queer identity influences one's IDC healthcare experiences. Conclusions: This study resulted in the development of a 64-70 item tool, the IDC Survey, to measure the prevalence and characteristics of IDC healthcare interactions.
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BACKGROUND: Menarche is a pivotal time in an adolescent's life but can be experienced differently by those with physical disabilities. Parents typically serve as the primary educators and support for their daughters during this time. Little is known about the parent's perspective of their daughter's experience preparing for menarche and learning to manage menses. OBJECTIVE: We sought to understand the parent's perspective of the experience of their daughter with a physical disability around menarche and their preferences for health care provider support. METHODS: Individual semi-structured interviews were conducted with 21 parents of a daughter with a physical disability ages 7-26. Interviews were coded by 2 reviewers using Grounded Theory, with disagreements resolved by consensus. RESULTS: Six themes emerged regarding the parent's perception of the experiences, including 1) variation in emotional responses to menarche, 2) parent's perception of their daughter's experience with menses and menstrual symptoms, 3) cross-section of disability and menstrual management, 4) menstrual management at school, 5) parental knowledge correlating to daughter's preparation for menarche, and 6) desires for health care provider support. CONCLUSIONS: All parents reported that their daughters faced challenges during menarche, ranging from emotional distress to dealing with the inaccessibility of hygiene products. Managing periods at schools was particularly burdensome. Parents who were better educated about what to expect were better able to prepare their daughters, but had difficulties finding informed, supportive providers. Health care providers should provide both anticipatory guidance and holistic, respectful, and equitable options for the management of menstrual symptoms.
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Pessoas com Deficiência , Menarca , Feminino , Adolescente , Humanos , Menarca/psicologia , Almoço , Conhecimentos, Atitudes e Prática em Saúde , Menstruação/psicologiaRESUMO
OBJECTIVE: Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. DATA SOURCES AND STUDY SETTING: Quantitative surveys and qualitative interviews were collected from participants living in the community. STUDY DESIGN: Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). DATA COLLECTION: Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. PRINCIPAL FINDINGS: Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial η2 [90% CI] = 0.310 [0.08, 0.46], 0.435 [0.19, 0.60], 0.134 [0, 0.29], 0.178 [0.01, 0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). CONCLUSIONS: The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care.
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Técnicas de Apoio para a Decisão , Pessoal de Saúde , Gravidez , Humanos , Feminino , Grupos Focais , Inquéritos e Questionários , Tomada de DecisõesRESUMO
Objective: Describe a model for incorporating campus-based Sexual Assault Nurse Examiner (SANE) services. Describe differences in patient satisfaction and utilization of follow-up resources between patients seeking SANE services at a university health center (UHC) compared to an emergency department (ED). Participants: Patients seeking SANE services at the UHC or ED of a large Midwestern university from January 2016-April 2018. Fifty-eight participants completed a satisfaction survey, including 28 students. Twenty-eight participants completed a follow-up survey, including 15 students. Methods: A Qualtrics survey assessed: 1) satisfaction following the SANE exam and 2) use of follow-up services 4-6 weeks later. Descriptive analyses, exact logistic regressions, and OLS regressions were calculated. Results: There were no differences in satisfaction, services received, or follow-up services accessed between patients at the UHC and ED, including between students. Conclusions: Campus-based SANE services meet the expectations of survivors and do not differ significantly from services at the ED.
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Satisfação do Paciente , Delitos Sexuais , Humanos , Universidades , Estudantes , Serviço Hospitalar de EmergênciaRESUMO
BACKGROUND: Women with physical disability (WWPD) experience more sexual dysfunction, are typically less sexually active, and engage in fewer intimate relationships than women without physical disability. Although patient-reported outcome measures can help researchers and providers to meet the needs of this population, current measures fail to reflect the relevant experiences of WWPD. The purposes of this study were to 1) understand the experiences of WWPD related to sexual wellness, 2) identify the gaps in the current Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction, and 3) develop a conceptual framework for the measurement of sexual well-being on which a new supplemental measure will be built. METHODS: WWPD (n = 59) were recruited from an online health registry through a large academic medical center and took part in semistructured focus groups and interviews exploring experiences with sexuality, intimate relationships, sexual function, and sexual and reproductive health care. Interviews were transcribed and coded using an inductive approach to thematic analysis. RESULTS: Participants expressed that their sexual well-being extends beyond simply physical function and includes aspects of their environment, society, and intrapersonal and interpersonal factors. From themes that emerged from the qualitative data, we developed a conceptual framework of sexual well-being, which includes sexual health and sexual self-efficacy. The framework is composed of five constructs that impact sexual health and sexual self-efficacy: physical factors, intrapersonal factors, environmental factors, relationships and partner opportunity, and stigma. CONCLUSIONS: This conceptual framework can be used to develop patient-reported outcome measures items relevant to the experiences of WWPD, facilitate conversations between providers and patients, and identify areas to target for sexual wellness interventions.
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Disfunções Sexuais Fisiológicas , Saúde Sexual , Feminino , Humanos , Pesquisa Qualitativa , Comportamento Sexual , Parceiros Sexuais , SexualidadeRESUMO
BACKGROUND: Angelman syndrome (AS) is a rare neurogenetic disorder present in approximately 1/12,000 individuals and characterized by developmental delay, cognitive impairment, motor dysfunction, seizures, gastrointestinal concerns, and abnormal electroencephalographic background. AS is caused by absent expression of the paternally imprinted gene UBE3A in the central nervous system. Disparities in the management of AS are a major problem in preparing for precision therapies and occur even in patients with access to experts and recognized clinics. AS patients receive care based on collective provider experience due to limited evidence-based literature. We present a consensus statement and comprehensive literature review that proposes a standard of care practices for the management of AS at a critical time when therapeutics to alter the natural history of the disease are on the horizon. METHODS: We compiled the key recognized clinical features of AS based on consensus from a team of specialists managing patients with AS. Working groups were established to address each focus area with committees comprised of providers who manage >5 individuals. Committees developed management guidelines for their area of expertise. These were compiled into a final document to provide a framework for standardizing management. Evidence from the medical literature was also comprehensively reviewed. RESULTS: Areas covered by working groups in the consensus document include genetics, developmental medicine, psychology, general health concerns, neurology (including movement disorders), sleep, psychiatry, orthopedics, ophthalmology, communication, early intervention and therapies, and caregiver health. Working groups created frameworks, including flowcharts and tables, to help with quick access for providers. Data from the literature were incorporated to ensure providers had review of experiential versus evidence-based care guidelines. CONCLUSION: Standards of care in the management of AS are keys to ensure optimal care at a critical time when new disease-modifying therapies are emerging. This document is a framework for providers of all familiarity levels.
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Síndrome de Angelman , Síndrome de Angelman/diagnóstico , Síndrome de Angelman/genética , Síndrome de Angelman/terapia , Humanos , Padrão de CuidadoRESUMO
BACKGROUND: Individuals at increased risk for cancer are ascertained at low rates of 1% to 12% in primary care (PC). Underserved populations experience disparities of ascertainment, but data are lacking. INHERET is an online personal and family history tool to facilitate the identification of individuals who are eligible, according to guidelines, to be counseled on germline genetic testing and risk management. PATIENTS AND METHODS: INHERET data entry uses cancer genetics clinic questionnaires and algorithms that process patient data through NCCN Clinical Practice Guidelines in Oncology and best practice guidelines. The tool was tested in silico on simulated and retrospective patients and prospectively in a pilot implementation trial. Patients in cancer genetics and in PC clinics were invited to participate via email or a card. Informed consent was completed online. RESULTS: INHERET aimed to integrate patient data by algorithms based on professional and best practice guidelines to elicit succinct, actionable recommendations that providers can use without affecting clinic workflow or encounter length. INHERET requires a 4th-grade reading level, has simple navigation, and produces data lists and pedigree graphs. Prospective implementation testing revealed understandability of 90% to 100%, ease of use of 85%, and completion rates of 85% to 100%. Physicians using INHERET reported no added time to their encounters when patients were identified for counseling. In a specialty genetics clinic, INHERET's data were input, on average, within 72 hours compared with 4 to 6 weeks through standard care, and the queue for scheduling patients decreased from 400 to fewer than 15 in <6 months. CONCLUSIONS: INHERET was found to be accessible for all education and age levels, except patients aged >70 years, who encountered more technical difficulties. INHERET aided providers in conveying high-risk status to patients and eliciting appropriate referrals, and, in a specialty clinic, it produced improved workflows and shortened queues.
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Testes Genéticos , Neoplasias , Idoso , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/genética , Atenção Primária à Saúde , Estudos Prospectivos , Estudos RetrospectivosRESUMO
STUDY OBJECTIVE: To characterize the patient population with cognitive or physical impairments that presents for anticipatory guidance of puberty, evaluate caregiver concerns with respect to puberty, and describe chosen management strategies and outcomes following menarche. DESIGN: Retrospective cohort study SETTING: Academic tertiary care women and children's hospital PARTICIPANTS: Eligible female patients with special needs up to age 26 years presenting for anticipatory guidance from 2009 to 2018 MAIN OUTCOME MEASURES: Primary outcomes included characterization of patients presenting for anticipatory guidance and their reasons for menstrual management. Secondary outcomes were satisfaction with menstrual management and bleeding patterns. RESULTS: A total of 61 patients presented for anticipatory guidance of puberty, on average 13.5 months prior to menarche. Compared to the overall adolescent population with special needs who presented for gynecologic care, patients who had autism spectrum disorder (ASD), were nonverbal, or had attention-deficit/hyperactivity disorder (ADD/ADHD) were more likely to present for a pre-menarchal visit to discuss anticipated pubertal development (P < .001, Pâ¯=â¯.009, and Pâ¯=â¯.04, respectively). More than half of families described potential behavioral changes as their main concern. The majority of post-menarchal patients (80%) desired hormonal management of menses, including 30% of patients who had placement of a levonorgestrel intrauterine device. In all, 96% of patients were satisfied with their final menstrual bleeding pattern; 50% achieved amenorrhea or light spotting. CONCLUSIONS: This study describes the important role of pre-menarchal reproductive counseling for girls with disabilities. Anticipation of puberty causes great anxiety in families and patients, especially those with ASD, ADD/ADHD, and non-verbal status. Providers should consider initiating these conversations early in pubertal development.
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Cuidadores/psicologia , Deficiências do Desenvolvimento/terapia , Menarca/psicologia , Menstruação/psicologia , Adolescente , Adulto , Criança , Aconselhamento , Deficiências do Desenvolvimento/psicologia , Feminino , Ginecologia/métodos , Humanos , Menarca/fisiologia , Menstruação/fisiologia , Estudos RetrospectivosRESUMO
PURPOSE: To characterize the population of adolescents and young women with special needs presenting for gynecologic care, describe usage patterns of hormonal suppression methods, and evaluate outcomes of menstrual management. METHODS: This retrospective cohort study included females with special needs up to age 26 years presenting for menstrual management from 2009 to 2018. Demographic, social, and medical histories were collected to investigate effects on bleeding pattern and satisfaction with menstrual management. RESULTS: Of 262 patients who presented for menstrual complaints, final methods of treatment included combined hormonal contraceptives (30.9%), oral progestins (19.8%), depot medroxyprogesterone acetate (8.0%), etonogestrel implant (1.9%), and levonorgestrel intrauterine device (16.8%). Eighty-five percent of patients were satisfied with their final bleeding pattern. Patients with amenorrhea or light regular periods were more likely to be satisfied than patients with heavy or irregular bleeding (p < .001). Satisfied patients tried an average of 1.4 methods, compared to 1.8 methods tried by the unsatisfied group (p = .042). By the end of the study, 26.0% were amenorrheic and 12.8% had only light spotting. Satisfaction rates were similar with each method, including 88.4% with use of combined hormonal contraceptives, 82.5% with oral progestins, 93.3% with depot medroxyprogesterone acetate, 100% with etonogestrel implant, and 83.9% with levonorgestrel intrauterine device. CONCLUSIONS: Amenorrhea or light regular bleeding led to satisfaction in most patients. No hormonal method was superior. When counseling families and patients who present for menstrual suppression, emphasis should be placed on goals of treatment and expectations for outcomes, as light regular periods may be as acceptable as amenorrhea.
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Pessoas com Deficiência , Satisfação Pessoal , Adolescente , Adulto , Feminino , Humanos , Levanogestrel , Menstruação , Estudos RetrospectivosRESUMO
BACKGROUND: While the literature on pregnancy and disability is growing, generating important knowledge of barriers to care and health risks, there is limited literature on pregnancy decision-making and informational needs. Such knowledge is critical for the development of interventions to mitigate the challenges women with disabilities and health care providers face in making this important decision. OBJECTIVE: /Hypothesis: Develop a survey of pregnancy decisional and informational needs of women with physical disabilities. METHODS: We developed a conceptual framework that guided item writing, defined the characteristics of the target population, engaged stakeholders with disabilities to collaborate with investigators, and tested the interpretability and relevance of items, and preferred mode of responding (online vs. telephone). A total of 123 women participated in cognitive interviews (N = 13), mode testing (N = 10), or survey data collection (N = 114). RESULTS: Instructions, three screening questions, and 156 items were tested in one round of 17 cognitive interviews; 25 items were deleted, 94 were revised, and 37 items were retained without changes. The final version of the survey included six sub-sections: the experience of making a decision; information about pregnancy and disability; things affecting a decision; knowing what is important; support for making a decision; and working with health care providers. CONCLUSIONS: The overall performance of the survey supported its content validity and utility as a useful way to gather information about the pregnancy decision-making experience and informational needs of women with physical disabilities.
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Pessoas com Deficiência , Feminino , Pessoal de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Gravidez , Inquéritos e QuestionáriosRESUMO
This retrospective descriptive analysis of 837 patients seeking postassault care at an academic hospital in the United States describes characteristics of sexual assault survivors from a sociocultural context, with a specific focus on describing survivors presenting for sexual assault nurse examiner (SANE) exams and confirming existing literature on assault characteristics, such as disabilities and alcohol and/or drug use. Assaults resulting in SANE exams increased over time. Drug and/or alcohol use at the time of the assault was reported in 44.8% of cases and 20.8% of survivors reported having a disability. Understanding the demographic and sexual assault characteristics of survivors is fundamental to providing sensitive and responsive care.
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Registros de Enfermagem , Estupro/psicologia , Sobreviventes/psicologia , Adulto , Serviço Hospitalar de Emergência , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto JovemRESUMO
For the first time in the 21st century, we have an emerging body of research regarding contraceptive use among adult women with disabilities in the United States. We highlight key findings from population-based analyses that found higher odds of female sterilization and lower odds of long-acting reversible contraception use among women with disabilities compared to their peers without disabilities. We consider potential reasons underlying these differences, including discriminatory attitudes and policies that restrict the sexual and reproductive autonomy of people with disabilities. We advocate for a justice-based, intersectional approach to research on contraception and disability with the aim of promoting the reproductive autonomy of people with disabilities.
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Comportamento Contraceptivo , Pessoas com Deficiência , Pesquisa , Justiça Social , Feminino , Humanos , Contracepção Reversível de Longo Prazo , Gravidez , Comportamento Sexual , Esterilização Reprodutiva , Estados UnidosRESUMO
OBJECTIVE: To assess multiple dimensions of long-acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women. STUDY DESIGN: We conducted an Internet-based study of 1982 female undergraduates at a large mid-western university. Our 55-item survey used a multi-level framework to measure young women's understanding of, experiences with intrauterine devices (IUD) and implants and their perceived barriers to LARC at individual, health systems and community levels. The survey included a 20-item knowledge scale. We estimated and compared LARC knowledge scores and barriers using descriptive, bivariate and linear regression statistics. RESULTS: Few college women had used (5%) or heard of (22%) LARC, and most self-reported "little" or "no" knowledge of IUDs (79%) and implants (88%). Women answered 50% of LARC knowledge items correctly (mean 10.4, range 0-20), and scores differed across sociodemographic groups (p values<.04). Factors associated with scores in multivariable models included race/ethnicity, program year, sorority participation, religious affiliation and service attendance, employment status, sexual orientation and contraceptive history. Perceived barriers to IUDs included the following: not wanting a foreign object in body (44%), not knowing enough about the method (42%), preferring a "controllable" method (42%), cost (27%), and not being in a long-term relationship (23%). Implant results were similar. "Not knowing enough" was women's primary reason for IUD (18%) and implant (22%) nonuse. CONCLUSION: Lack of knowledge (both perceived and actual) was the most common barrier among many perceived individual-, systems- and community-level factors precluding these college women's LARC use. Findings can inform innovative, multi-level interventions to improve understanding, acceptability and uptake of LARC on campuses. IMPLICATIONS: Lack of knowledge of IUDs and implants served as a primary barrier to highly effective contraceptive use among these college women. Comprehensive, patient-centered and multi-level educational public health strategies are needed to promote positive campus climates around LARC and improve family planning outcomes among this substantial reproductive-aged population.
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Comportamento Contraceptivo/psicologia , Anticoncepção/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Dispositivos Intrauterinos/estatística & dados numéricos , Adolescente , Anticoncepção/métodos , Feminino , Promoção da Saúde/métodos , Humanos , Modelos Lineares , Análise Multivariada , Comportamento Sexual , Inquéritos e Questionários , Estados Unidos , Universidades , Adulto JovemRESUMO
STUDY OBJECTIVE: To characterize menstrual health issues and their effect in young women with Angelman syndrome (AS). Our secondary objective was to compare them with young women with autism spectrum disorders (ASDs). DESIGN: Cross-sectional convenience sample survey. SETTING: An institutional review board-approved Web-based survey of young female members of the Angelman Syndrome Foundation. PARTICIPANTS: Caregivers of young women with AS, aged 12-25 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Symptom characterization and effect of menses on young women with AS. RESULTS: Menstrual and premenstrual symptoms were common among young women with AS, but infrequently caused problems at home or school. Less than half of the subjects used hormones to control their flow. Of those who used hormones, 75% used them continuously. Caregivers were satisfied with their method to control periods. Girls with seizures were more likely to use hormonal methods to control menses than those without seizures. Menstrual-associated morbidity in young women with ASD and AS was fairly similar, but with greater morbidity in the ASD group than in the AS group. However, girls with AS had more problems with menstrual hygiene with almost all of them requiring full assistance for managing hygiene. CONCLUSION: In this group of young women with AS, who have moderate to severe neurodevelopmental disabilities and cannot manage their own hygiene, menstruation is not associated with significant problems. Menstrual management by hormones is used by less than half. When hormonal therapy is used, it is most commonly used continuously to suppress menses.
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Síndrome de Angelman/complicações , Distúrbios Menstruais/etiologia , Adolescente , Adulto , Transtorno do Espectro Autista/complicações , Criança , Estudos Transversais , Feminino , Hormônios/uso terapêutico , Humanos , Menstruação/efeitos dos fármacos , Distúrbios Menstruais/tratamento farmacológico , Síndrome Pré-Menstrual/tratamento farmacológico , Síndrome Pré-Menstrual/etiologia , Inquéritos e Questionários , Adulto JovemAssuntos
Comportamentos Relacionados com a Saúde , Serviços de Saúde para Estudantes , Estudantes , Comportamento Perigoso , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , Estupro/diagnóstico , Estupro/estatística & dados numéricos , Comportamento Sexual , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , Violência , Adulto JovemRESUMO
OBJECTIVE: To examine human papillomavirus (HPV) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students. PARTICIPANTS: Females aged 18 to 26 attending a university health service gynecology clinic (n = 256). METHODS: Participants were randomized to receive either HPV-specific education with a mailed reminder or standard care. Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified. RESULTS: At baseline, 41% intended to undergo HPV vaccination. Participants who were currently sexually active and lacked supplemental health insurance had decreased intent. Perceived parental approval regarding HPV vaccination, perceived vulnerability to HPV infection, and belief in health benefits of HPV vaccine were associated with increased intent. HPV vaccine uptake was low (5.5%) and did not differ by study group. However, baseline intent was significantly associated with HPV vaccine uptake. CONCLUSIONS: Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination.
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Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Papillomavirus , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estudantes/psicologia , Adolescente , Feminino , Humanos , Intenção , Michigan , Vacinas contra Papillomavirus/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde para Estudantes , Estudantes/estatística & dados numéricos , Universidades , Adulto JovemRESUMO
There is a natural curiosity about how organisms give rise to offspring like themselves through a series of reproducible developmental events and how, once mature, these offspring mate and continue the process giving rise the next generation. In the mid-1800s investigators started using gametes and embryos to explore this process. Although the observations and experimental approaches changed over time, embryologists and developmental biologists after them, sought understanding of development and inheritance through the study of gametes and embryos. It is argued here that in their quests to understand these processes embryologists made major conceptual advances that were seminal to the origins of genetics and to the origins of molecular biology. Furthermore these advances derived from the distinct perspective of those investigators with focused interest on the development of the organism. In this essay fundamental discoveries that originated with the sea urchin embryo as an experimental system are used to illustrate this position. The sea urchin has a long and uninterrupted history as a model organism that helped prepare the ground for the emergence of genetics and contributed important aspects to understanding of the central dogma of molecular biology. As molecular biology came of age new concepts and technology of the discipline were transformative for developmental biology and to this day the reciprocal inductive interactions between molecular biology and developmental biology continue to revitalize each other.
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Embriologia/história , Ouriços-do-Mar/embriologia , Animais , Cromossomos/genética , DNA/genética , DNA/história , Biologia do Desenvolvimento/história , Biologia do Desenvolvimento/tendências , Embriologia/tendências , Feminino , Fertilização , História do Século XIX , História do Século XX , História do Século XXI , Masculino , Biologia Molecular/história , Biologia Molecular/tendências , Biossíntese de Proteínas , Ouriços-do-Mar/genética , Ouriços-do-Mar/fisiologiaRESUMO
OBJECTIVE: To evaluate the use of liquid cytology in Pap smears in women with developmental disabilities (DD) for endocervical cell yield and abnormalities, via speculum examination or blind technique. METHODS: We used retrospective chart review of gynecological visits by women with DD from October 2002 to November 2005. Cervical cytology screening included speculum examination or blind technique. Endocervical cell yield was analyzed via Pearson's chi-square test. RESULTS: Of 240 attempted liquid cytology Pap smears, 199 (82.9%) were completed. Of these, 193 met inclusion criteria for the study, and 120 (62.2%) contained endocervical cells. The endocervical cell yield with liquid cytology/speculum was 80.0% and was 43.6% with liquid cytology/blind (p < 0.001). Two blind smears (1.0%) were abnormal; both revealed atypical squamous cells of undetermined significance (ASCUS) with subsequent negative human papillomavirus (HPV) typing. CONCLUSIONS: Cervical screening with liquid cytology in women with DD provides an overall rate of endocervical cells of approximately 44%-80% depending on the technique used. Although this is much lower than in the general population, this compares favorably with slide Pap smear in women with DD. The 44% yield of endocervical cells and the finding of abnormal Pap smears with the blind technique suggest this is a reasonable alternative for obtaining Pap smears in women with difficult pelvic examinations who otherwise would not receive cervical screening.