Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol.

INTRODUCTION: Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS: Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER: NCT01881659.

Conocimiento y creencias de mujeres del estado de Morelos sobre el virus del papiloma humano / Knowledge and beliefs of women from the state of Morelos about the human papilloma virus

Introducción: una enfermedad de transmisión sexual que afecta a un alto porcentaje de mujeres jóvenes de todo el mundo es la infección producida por virus papiloma humano. La falta de información asociada a diversos factores culturales, favorece el desarrollo de creencias que dificultan la prevención y diagnóstico oportunos. Objetivo: identificar el nivel de conocimiento y las creencias que tienen las mujeres del Estado de Morelos, México, sobre la transmisión, detección y tratamiento de la infección por virus del papiloma humano de acuerdo con la edad y el grado de escolaridad. Métodos: estudio descriptivo transversal a partir de un cuestionario aplicado a 690 mujeres en el estado de Morelos. Resultados: el nivel de conocimientos entre la mayoría de la población femenina fue de nivel medio, se incrementa en mujeres jóvenes y con mayor escolaridad. La creencia de que la detección de infección implica mayor gasto económico se presenta sin distinción de edad o nivel escolar. Conclusiones: los aspectos más conocidos sobre la infección por virus papiloma humano, es que es una infección de transmisión sexual, asociada a la aparición de verrugas en genitales y causante de cáncer cérvico uterino. Los menos conocidos son: que la infección es asintomática y que no existe tratamiento para eliminarla(AU)

Introduction: A sexually transmitted disease affecting a high percentage of young women worldwide in the infection produced by the human papilloma virus (HPV). The lack of information associated with different cultural factor favors the development of beliefs that limit timely prevention and diagnosis. Objective: Identify the level of knowledge and beliefs of women from the state of Morelos, Mexico, about the transmission, detection and treatment of HPV infection in accordance with their age and school level. Methods: Cross-sectional, descriptive study with a survey conducted on 690 women on the state of Morelos. Results: The level of knowledge among most of the female population was average, increased in young women and those with higher school level. The belief that infection detection implies higher economic spends is present regardless age and school level. Conclusions: The most known aspects about HPV are that it is a sexually transmitted infection, associated to the onset of genital warts and causing cervical cancer. The least known are that the infection is asymptomatic and that there is no treatment to eliminate it(AU)

Conocimiento y creencias de mujeres del estado de Morelos sobre el virus del papiloma humano / Knowledge and beliefs of women from the state of Morelos about the human papilloma virus

Introducción: una enfermedad de transmisión sexual que afecta a un alto porcentaje de mujeres jóvenes de todo el mundo es la infección producida por virus papiloma humano. La falta de información asociada a diversos factores culturales, favorece el desarrollo de creencias que dificultan la prevención y diagnóstico oportunos. Objetivo: identificar el nivel de conocimiento y las creencias que tienen las mujeres del Estado de Morelos, México, sobre la transmisión, detección y tratamiento de la infección por virus del papiloma humano de acuerdo con la edad y el grado de escolaridad. Métodos: estudio descriptivo transversal a partir de un cuestionario aplicado a 690 mujeres en el estado de Morelos. Resultados: el nivel de conocimientos entre la mayoría de la población femenina fue de nivel medio, se incrementa en mujeres jóvenes y con mayor escolaridad. La creencia de que la detección de infección implica mayor gasto económico se presenta sin distinción de edad o nivel escolar. Conclusiones: los aspectos más conocidos sobre la infección por virus papiloma humano, es que es una infección de transmisión sexual, asociada a la aparición de verrugas en genitales y causante de cáncer cérvico uterino. Los menos conocidos son: que la infección es asintomática y que no existe tratamiento para eliminarla(AU)

Introduction: A sexually transmitted disease affecting a high percentage of young women worldwide in the infection produced by the human papilloma virus (HPV). The lack of information associated with different cultural factor favors the development of beliefs that limit timely prevention and diagnosis. Objective: Identify the level of knowledge and beliefs of women from the state of Morelos, Mexico, about the transmission, detection and treatment of HPV infection in accordance with their age and school level. Methods: Cross-sectional, descriptive study with a survey conducted on 690 women on the state of Morelos. Results: The level of knowledge among most of the female population was average, increased in young women and those with higher school level. The belief that infection detection implies higher economic spends is present regardless age and school level. Conclusions: The most known aspects about HPV are that it is a sexually transmitted infection, associated to the onset of genital warts and causing cervical cancer. The least known are that the infection is asymptomatic and that there is no treatment to eliminate it(AU)

[Predominant organizational culture in nursing at a public hospital. Morelos, Mexico]. / Cultura organizacional de enfermería dominante en un hospital de la Secretaría de Salud de Morelos, México.

OBJECTIVE: To identify dominant and preferred organizational culture models at second level nursing services in Morelos. MATERIAL AND METHODS: A cross-sectional study was conducted between April and June, 2008. Nursing caregivers from Public Health Services of Morelos State participated. We gathered and analyzed data about socioeconomic characteristics and organizational culture, and we applied the Xi² and Kappa coefficient statistical tests using Stata version 10 software. RESULTS: We interviewed 30 nurses, randomly selected from a total of 397, with at least one year of seniority. It was identified that the dominant organizational culture is one of power and the preferred culture is one of performance. A Kappa positive coefficient of 0.17 (p = 0.047) was found between the dominant model and the preferred performance model. CONCLUSIONS: Identifying said organizational culture models helps to understand performance differences in the management of nursing care services currently provided to users of the hospital and to aspire to improvements in the service itself.

Cultura organizacional de enfermería dominante en un hospital de la Secretaría de Salud de Morelos, México / Predominant organizational culture in nursing at a public hospital. Morelos, Mexico

OBJETIVO: Identificar los modelos de cultura organizacional, dominante y preferido, en enfermería en el segundo nivel de atención a la salud. MATERIAL Y MÉTODOS: Entre abril y junio de 2008 se hizo un estudio transversal con personal de enfermería de los Servicios de Salud del Estado de Morelos. Se obtuvo información sobre los datos sociodemográficos y la cultura organizacional. Se hicieron pruebas de ji² y de correlación Kappa, y se usó Stata v.10. RESULTADOS: Se entrevistó a 30 enfermeras seleccionadas aleatoriamente de un total de 397, con al menos un año de antigüedad laboral. Se identificó que la cultura organizacional dominante es la del poder y la preferida es la del desempeño. El coeficiente Kappa positivo de 0.17 (p= 0.047) entre lo que domina y el modelo del desempeño que se prefiere. CONCLUSIONES: Identificar estos modelos de la cultura organizacional permite entender los diferenciales de desempeño en la gestión del cuidado enfermero a los usuarios hospitalarios y plantearse aspiraciones de mejoras en el propio servicio.

OBJECTIVE: To identify dominant and preferred organizational culture models at second level nursing services in Morelos. MATERIAL AND METHODS: A cross-sectional study was conducted between April and June, 2008. Nursing caregivers from Public Health Services of Morelos State participated. We gathered and analyzed data about socioeconomic characteristics and organizational culture, and we applied the Xi² and Kappa coefficient statistical tests using Stata version 10 software. RESULTS: We interviewed 30 nurses, randomly selected from a total of 397, with at least one year of seniority. It was identified that the dominant organizational culture is one of power and the preferred culture is one of performance. A Kappa positive coefficient of 0.17 (p = 0.047) was found between the dominant model and the preferred performance model. CONCLUSIONS: Identifying said organizational culture models helps to understand performance differences in the management of nursing care services currently provided to users of the hospital and to aspire to improvements in the service itself.