Pap Smear Cancer Coverage in Brazilian Capitals including the Pandemic Period Caused by the SARS-CoV-2 Virus: Ecological Study.

INTRODUCTION: Cervical cancer develops slowly and may not manifest signs and symptoms at an early stage. It is worth mentioning the factors that can influence the onset of cervical cancer: smoking, early sexual life, multiple sexual partners, use of oral contraceptives, multiparity, low socioeconomic status, among others. An important risk factor for the onset of this disease is HPV infection, a virus associated with most cases of precursor lesions of this type of cancer. It is essential to understand the comprehensiveness of the scope and adherence to the recommended guidelines throughout the national territory. Therefore, health indicators are important management tools that make it possible to evaluate the services offered, measuring the reach of the target population, the supply and access to preventive exams. OBJECTIVE: To analyze the trend of progress in cervical cancer coverage actions in Brazilian capitals from 2016 to 2021. METHOD: This is an ecological study with temporal analysis that used secondary data referring to process indicators for cervical cancer control actions in women aged between 25 and 64 years living in Brazilian capitals between 2016 and 2021. Aspects related to the quality of care in the cervical cancer prevention program were evaluated using databases of the Cancer Information System (SISCAN), available in DATASUS. The indicators used to monitor and evaluate cervical cancer control actions were (i) cervical coverage, (ii) reason for cervical surgery, and (iii) proportion of cervical cancer every 3 years. RESULTS: In 2016, 410,000 tests were performed and notified in the SISCAN system in all Brazilian capitals, with emphasis on Curitiba, with 65,715 tests performed, and Porto Velho, with 174. In 2020, there was a reduction in exams compared to the previous year in all capitals, with the exception of Palmas, which went from 7655 exams to 9604. It was observed that all the capitals studied showed an increase in the annual percentage variation of Pap smear coverage, with the exception of Brasília, Manaus, Porto Alegre and Porto Velho, which did not show a statistically significant increase (APC = 3.01, 2.746, 3.987, 3.69, respectively). When analyzing the performance of oncotic cytology exams in the capitals according to the years 2019 and 2020, it was observed that only Manaus registered an increase in the number of procedures performed, reaching a difference of 56.5% from one year to the next. CONCLUSION: The ecological analysis revealed a worrying drop in the number of tests performed in 2020, reflecting a sharp drop in coverage actions in Brazilian capitals during the pandemic caused by the SARS-CoV-2 virus. The pandemic has exacerbated existing inequalities and highlighted the need for adaptive strategies to maintain essential screening services in times of crisis.

Incontinência Urinária e Qualidade de Vida em uma Unidade de Atenção Primária: Estudo Piloto / Urinary Incontinence and Quality of Life in a Primary Health Care Unit: a Pilot Study / Incontinencia Urinaria y Calidad de Vida en una Unidad de Atención Primaria: Estudio Piloto

Objetivo:Identificar a prevalência de incontinência urinária (IU) e avaliar a qualidade de vida de mulheres atendidas em uma Unidade Básica de Saúde (UBS) comparando a qualidade de vida geral de mulheres continentes e incontinentes. Métodos: Estudo piloto exploratório-descritivo, transversal e quantitativo. Amostra composta por mulheres acima de 18 anos que procuraram a UBS por qualquer motivo. Coleta de dados realizada no período de agosto a dezembro de 2021, por meio de um questionário padronizado com características demográficas, socioeconômicas, obstétricas, queixas urinárias e qualidade de vida. Resultados: Participaram 53 mulheres com idade média de 44,49 (± 15,38) anos. A maioria das mulheres se autodeclarou parda (62,3%), casada ou em união estável (52,8%), exercendo atividade ocupacional remunerada (64,2%); 35,8% das mulheres foram diagnosticadas como incontinentes, relatando perder urina uma vez por semana, quando tossem ou espirram, exercendo um impacto moderado na qualidade de vida. As diferenças nos valores dos domínios da qualidade de vida possuem correlação estatística significativa entre os grupos de mulheres continentes e incontinentes. Conclusão: As queixas urinárias prevalecem em uma parcela significativa das mulheres, e a IU é um fator capaz de impactar negativamente a qualidade de vida, porém se faz necessário comprovar os achados em uma amostra significante.

Objective:Characterize urinary incontinence (UI) prevalence and assess the quality of life (QoL) of women treated at a primary health care unit in order to compare the general QoL of continent and incontinent women. Methods: An exploratory-descriptive, cross-sectional pilot study with a quantitative approach. Sample composed of women over 18 years old who went to the unit for any reason. Data collection carried out from August to December 2021, through a standardized questionnaire with information on demographic, socioeconomic, obstetric, urinary habits and QoL. Results: Fifty-three women with a mean age of 44.49 (± 15.38) years participated. Most women declared themselves to be brown (62.3%), married or in a stable union (52.8%), exercising paid occupational activity (64.2%). As for urinary characteristics, 35.8% were diagnosed as incontinent, reporting that they lost urine once a week when they coughed or sneezed, and that this had a moderate impact on QoL. The differences in the values of QoL domains have a statistically significant correlation between the continent and incontinent groups. Conclusion: Urinary complaints prevail in a significant portion of women and UI is a factor capable of negatively impacting QoL, but it is necessary to prove the findings in a significant sample

Objetivo:Caracterizar la prevalencia de incontinencia urinaria (IU) y evaluar la calidad de vida de mujeres atendidas en una unidad básica de salud, comparando la calidad de vida general de mujeres continentes e incontinentes. Métodos:Estudio piloto exploratorio-descriptivo, transversal y cuantitativo. Muestra compuesta por mujeres mayores de 18 años que acudieron a la Unidad Básica de Salud por cualquier motivo. Recolección de datos realizada de agosto a diciembre de 2021, a través de un cuestionario estandarizado con características demográficas, socioeconómicas, obstétricas, urinarias y de calidad de vida. Resultados: Participaron 53 mujeres con una edad media de 44,49 (± 15,38) años. La mayoría de las mujeres se declaró parda (62,3%), casada o en unión estable (52,8%), ejerciendo actividad laboral remunerada (64,2%). El 35,8% de las mujeres fueron diagnosticadas como incontinentes, relatando que perdían orina una vez por semana al toser o estornudar, ejerciendo un impacto moderado en la calidad de vida. Las diferencias en los valores de los dominios de calidad de vida tienen una correlación estadísticamente significativa entre los grupos de mujeres continentes e incontinentes. Conclusión: Las quejas urinarias prevalecen en una porción significativa de mujeres y la IU es un factor capaz de impactar negativamente en la calidad de vida, pero es necesario comprobar los hallazgos en una muestra significativa.

Human Papillomavirus (HPV) and the quadrivalent HPV Vaccine among Brazilian adolescents and parents: Factors associated with and divergences in knowledge and acceptance.

BACKGROUND: Low national immunization coverage (44.64%) requires strengthening the vaccination campaign to improve knowledge about HPV and its vaccine among adolescents and parents/guardians. Our aim is to evaluate factors related to knowledge about HPV, its vaccine, acceptability and divergences among Brazilian adolescents and parents/guardians. METHODS: A cross-sectional study was performed at a health unit of Sao Paulo University, Brazil, from 2015 to 2016. The convenience sample comprised 1047 individuals, including 74% (n = 776) adolescents and 26% (n = 271) parents/guardians, who answered a survey (knowledge about HPV, its vaccine, barriers and acceptability). RESULTS: The main source of information for adolescents was school (39%, n = 298); for parents/guardians, it was health professionals (55%, n = 153). Parents/guardians were 2.48 times more likely than adolescents to know that HPV caused changes in the Pap smear test [RR 2.48, 95% CI 2.03-3.01 (p < 0.001)], 1.43 times likely to be aware that HPV was a sexually transmitted infection [RR 1.43, 95% CI 1.22-1.68 (p < 0.001)], and 2.77 times likely to be informed that the HPV vaccine decreased the chance of having genital warts [RR 2.77, 95% CI 2.22-2.47 (p < 0.001)]. Girls knew more about the topic than boys (RR 1.67; 95% CI 1.10-2.60); education increased parents' knowledge [(RR 3.38; 95% CI 1.71-6.69)]. CONCLUSION: Female adolescents and parents/guardians with a higher level of education are factors related to suitable knowledge about HPV and its vaccine among Brazilian respondents. There were differences between parents/guardians and adolescents in HPV awareness, clinical implications, vaccine knowledge and vaccine acceptance.

Knowledge gaps and acquisition about HPV and its vaccine among Brazilian medical students.

OBJECTIVE: To analyze factors associated with knowledge gaps and acquisition about HPV and its vaccine among medical students. METHOD: Cross-sectional and analytical study conducted at the University of São Paulo Medicine School, in 2016. A convenience sample of students completed a data collection instrument containing questions on knowledge about HPV and its vaccine, and vaccine acceptability. The level of knowledge and acceptability established as a "good level" was 80% of correct answers on the questionnaire. Internal validity was calculated with Cronbach's alpha value (α) = 0.74. Bivariate and multiple analyzes were performed using the Stata® program (Stata Corp, College Station, USA) 14.0. RESULTS: To evaluate the internal consistency of the instrument applied, the Cronbach's alpha equation was used, obtaining the alpha value (α) = 0.74 for this population. This value attests that the consistency of the answers obtained with this questionnaire is considered substantial and acceptable. Among the 518 medical students who completed the survey, the majority were men 312 (60.4%) with a mean age of 23 (± 2.8) years old; 199 (38.3%) of the students were in the final years of graduation (5th and 6th years). Students in the first, second and third year of study had a 51% higher risk of a knowledge gap when compared to students in the final years of graduation [PR 1.51 (1.3:1.8); p <0.001]. Men were at 22% higher risk of unsatisfactory knowledge than women are [PR 1.22 (1.07: 1.39). There was no knowledge acquisition during medical school in the following questions (p <0.05), indication of vaccine for individuals with HIV and contraindication in pregnant patients. CONCLUSION: Male medical students, in the first year of medical school, and those who were not vaccinated had significant knowledge gaps about HPV. The novelty of the study includes the finding of non- acquisition of knowledge during the medical school graduation on safety and vaccination schedule and vaccine administration in specific populations.

Knowledge and acceptability of the human papillomavirus vaccine among health professionals in Acre state, western Amazon.

OBJECTIVE: To evaluate the knowledge and acceptability of the human papillomavirus (HPV) vaccine among health professionals from western Amazonia. METHODS: A cross-sectional study was conducted in the Sistema Assistencial è Saúde da Mulher e da Criança (Health Care System for Women and Children; SASMC) in Acre, Brazil, in 2017. The participants comprised 196 health professionals. The data collection instrument contained 31 questions about HPV, its clinical repercussions for women, and the HPV vaccine. Quantitative variables were presented as medians and 95% confidence intervals (CIs), and p<0.05 was considered statistically significant. For the analyses, chi-square tests and Mann-Whitney tests were used. The collected data were analyzed using Stata®11.0. RESULTS: Of the 196 health professionals, 39.8% (n=76) were physicians and 61.2% (n=120) were other health professionals. The interviewees were mostly female (n=143, 73%, 95% CI 66.1 to 78.9%) who worked in the medical field (n=81, 41.3%, 95% CI 34.4 to 48.6%), and the median age was 38 years (95% CI 36.0 to 39.7). Physicians had increased knowledge regarding only the statement "cervical cancer is one of the main causes of cancer in women", with a proportion ratio of 0.88 (0.80; 0.97) and p<0.001. Regarding clinical knowledge of the HPV vaccine, a low proportion of correct answers was obtained for all the questions, and no significant differences were found between the groups. CONCLUSION: Acceptability and knowledge of HPV and its vaccine were similar among health professionals, with knowledge gaps in questions about the relation between smoking and cervical cancer and specific clinical knowledge.

Knowledge and acceptability of the human papillomavirus vaccine among health professionals in Acre state, western Amazon

OBJECTIVE: To evaluate the knowledge and acceptability of the human papillomavirus (HPV) vaccine among health professionals from western Amazonia. METHODS: A cross-sectional study was conducted in the Sistema Assistencial è Saúde da Mulher e da Criança (Health Care System for Women and Children; SASMC) in Acre, Brazil, in 2017. The participants comprised 196 health professionals. The data collection instrument contained 31 questions about HPV, its clinical repercussions for women, and the HPV vaccine. Quantitative variables were presented as medians and 95% confidence intervals (CIs), and p<0.05 was considered statistically significant. For the analyses, chi-square tests and Mann-Whitney tests were used. The collected data were analyzed using Stata®11.0. RESULTS: Of the 196 health professionals, 39.8% (n=76) were physicians and 61.2% (n=120) were other health professionals. The interviewees were mostly female (n=143, 73%, 95% CI 66.1 to 78.9%) who worked in the medical field (n=81, 41.3%, 95% CI 34.4 to 48.6%), and the median age was 38 years (95% CI 36.0 to 39.7). Physicians had increased knowledge regarding only the statement "cervical cancer is one of the main causes of cancer in women", with a proportion ratio of 0.88 (0.80; 0.97) and p<0.001. Regarding clinical knowledge of the HPV vaccine, a low proportion of correct answers was obtained for all the questions, and no significant differences were found between the groups. CONCLUSION: Acceptability and knowledge of HPV and its vaccine were similar among health professionals, with knowledge gaps in questions about the relation between smoking and cervical cancer and specific clinical knowledge.