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1.
BJOG ; 128(1): 97-100, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33021026

RESUMO

OBJECTIVE: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vaginal secretions of both reproductive-aged and postmenopausal women during acute SARS-CoV-2 infection. DESIGN: Prospective study. SETTING: A single tertiary, university-affiliated medical centre in Israel. Time period, 1 June 2020 through to 31 July 2020. POPULATION: Women who were hospitalised in a single tertiary medical centre, who were diagnosed with acute SARS-CoV-2 infection by a nasopharyngeal RT-PCR test. METHODS: Women were diagnosed with acute SARS-CoV-2 infection by a nasopharyngeal RT-PCR test. Vaginal RT-PCR swabs were obtained from all study participants after a proper cleansing of the perineum. MAIN OUTCOME MEASURES: Detection of SARS-CoV-2 in vaginal RT-PCR swabs. RESULTS: Vaginal and nasopharyngeal swabs were obtained from 35 women, aged 21-93 years. Twenty-one women (60%) were in their reproductive years, of whom, five were in their third trimester of pregnancy. Most of the participants (57%) were healthy without any underlying medical conditions. Of the 35 patients sampled, 2 (5.7%) had a positive vaginal RT-PCR for SARS-CoV-2, one was premenopausal and the other was a postmenopausal woman. Both women had mild disease. CONCLUSION: Our findings contradict most previous reports, which did not detect the presence of viral colonisation in the vagina. Although passage through the birth canal exposes neonates to the vaginal polymicrobial flora, an acquisition of pathogens does not necessarily mandate neonatal infection or clinical disease. Nevertheless, when delivering the infant of a woman with acute SARS-CoV-2 infection, a clinician should consider the possibility of vaginal colonisation, even if it is uncommon. TWEETABLE ABSTRACT: When delivering the infant of a woman with acute SARS-CoV-2 infection, a clinician should consider the possibility of vaginal colonisation.


Assuntos
Complicações Infecciosas na Gravidez , Vagina/virologia , Adulto , Idoso , /epidemiologia , /métodos , Feminino , Humanos , Recém-Nascido , Israel/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Estudos Prospectivos , Esfregaço Vaginal/métodos , Esfregaço Vaginal/estatística & dados numéricos
2.
Epidemiol Health ; 42: e2020043, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32580534

RESUMO

OBJECTIVES: This study was conducted to analyze the inequalities in Papanicolaou test (also referred to as the Pap smear) uptake according to the socio-demographic characteristics of Peruvian women 30 years to 59 years of age using information from the 2015-2017 Demographic and Family Health Survey (ENDES, acronym in Spanish). METHODS: This is an analytical, cross-sectional study based on information acquired from the 2015-2017 ENDES surveys. Socio-demographic characteristics were reported using absolute frequencies and weighted proportions with 95% confidence intervals, considering results with a p-value <0.05 as statistically significant. Concentration curves (CCs) and concentration indices (IndCs) were created based on the interaction of the wealth index and uptake of Pap smears, taking into account the different characteristics of the population studied for the measure of inequalities. RESULTS: All the CCs were distributed below the line of equality. Similarly, all the IndCs were higher than zero, indicating inequality in the uptake of Pap smears, favoring those with a higher wealth index. The highest IndC values were obtained from women aged 50-59 (IndC, 0.293), those who lived in the jungle (IndC, 0.230), and those without health insurance (IndC, 0.173). CONCLUSIONS: We found socio-demographic inequalities in the uptake of Pap smears in Peru, favoring women with a higher wealth index. More funding is needed to promote cervical cancer screening programs and to create systems that ensure equal access to healthcare in Peru.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Estudos Transversais , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Peru , Fatores Socioeconômicos
3.
Saudi Med J ; 41(6): 661-665, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518936

RESUMO

OBJECTIVES: To assess the yield of Papanicolaou tests (pap smears), including the characteristics of abnormal pap smears. Methods: In this record-based cross-sectional study, we reviewed pap smears of patients seen at the Family Medicine clinics, King Faisal Specialist Hospital and Research Center from January 2002 to January 2017. All women between the ages of 21 and 65 were included. Study-specific case report form was developed to capture patient demographics, pap smear histopathology (Bethesda III System), human papilloma virus polymerase chain reaction (HPV PCR), and the parity status. Results: A total of 3346 patients were included; 2.2% had abnormal pap smear. Most frequent abnormalities were atypical squamous cells of undetermined significance (2%), followed by glandular cell abnormalities (0.8%). Human papilloma virus infection was detected in 6.5% and all other infections were identified in 9.2% of all screened Pap smears. Conclusion: Pap smears remain an effective tool for cervical cancer screening. Low yields of pap smears compared to other developed countries could be attributed to lower risk factors for cervical cancer in Saudi Arabia. Routine screening especially among high risk women is strongly recommended.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Atenção Primária à Saúde , Arábia Saudita/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
4.
PLoS One ; 15(5): e0233354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428033

RESUMO

Cervical cancer is a health issue that disproportionately affects developing countries, where the Papanicolaou test (Pap smear) remains an important screening tool. Brazilian government recommendations have focused screening on the female population aged from 25 to 64 years old. In this study, we examined the incidence and mortality rates of invasive cervical cancer lesions and the incidence rates of in situ precancerous cervical lesions, aiming to calculate their respective statistics over time in a mid-sized Brazilian city, Aracaju. The 1996-2015 database from the Aracaju Cancer Registry and Mortality Information System was used to calculate age standardized rates for all invasive cervical tumors (International code of diseases, ICD-10: C53) and preinvasive cervical lesions (ICD-10: D06) in the following patient age ranges; ≤ 24, 25-34, 35-44, 45-54, 55-64 and ≥ 65 years old. We identified 1,030 cancer cases, 1,871 in situ lesions and 334 deaths. Using the Joinpoint Regression Program, we calculated the annual percentage incidence changes and our analyses show that cervical cancer incidence decreased up to 2008, increased up to 2012 and decreased again thereafter, a significant trend in all age groups from 25 years. The incidence of precursor lesions increased from 1996 to 2005 and has since decreased, a result significant in all age groups until 64 years. Cervical cancer mortality has decreased by 3.8% annually and trend analysis indicates that Pap smears have been effective in decreasing cancer incidence and mortality. However, recent trends shown here show a decreasing incidence of in situ lesions and may indicate either a real decrease or incomplete catchment. Thus, we suggest health policies should be re-considered and include sufficient screening and HPV vaccination strategies to avoid cervical cancer resurgence in the population.


Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Adulto , Brasil/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Sistema de Registros , Fatores de Tempo , Esfregaço Vaginal/estatística & dados numéricos
5.
Acta Cytol ; 64(5): 433-441, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396902

RESUMO

OBJECTIVE: The objective of this study was to calculate the positive rate and overall concordance rate of high-risk human papillomavirus (hrHPV) test and cytology using self-sampled and physician-sampled cervicovaginal tests and to compare both specimens. METHODS: In collaboration with 3 private hospitals in Sapporo city, 300 women visiting these organizations were enrolled in the study by previously signing an informed consent. From these women, both types of samples (self-obtained and physician-sampled) were obtained at the same time. HrHPV test and cytology were performed on both specimens, and the positive rate and overall concordance rate were calculated to compare both specimens. RESULTS: HrHPV-positive women were 13.7% in physician-sampled specimens and 14.7% in self-sampled specimens, with an overall concordance rate of 96.3% (95% confidence interval [CI]: 94-98%). On the other hand, the positive rate of the cases higher than or equal to atypical squamous cells of undetermined significance (ASCUS) on cytology was different between both groups, that is, 12.3% in physician-obtained and 5.3% in self-sampled specimens; the overall concordance rate was 90.7% (95% CI: 87-94%), indicating an apparent decrease in the positive rate of cytology in self-obtained specimens. CONCLUSION: HrHPV test and cytology were performed on parallel samples obtained by the patients with a self-sampling tool and by the physician. The positive rate of cytology was considerably different between these specimens, while almost equivalent results were obtained for hrHPV test in both specimens. It was concluded that hrHPV test may be safely and accurately performed on self-obtained cervicovaginal samples by the help of a self-sampling device in the Japanese population as a first screening tool, with equivalent results to physician-obtained specimens.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Citodiagnóstico/métodos , Detecção Precoce de Câncer/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Manejo de Espécimes/métodos , Neoplasias do Colo do Útero/epidemiologia , Adulto , Neoplasia Intraepitelial Cervical/virologia , Feminino , Humanos , Incidência , Japão/epidemiologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Manejo de Espécimes/normas , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/normas , Esfregaço Vaginal/estatística & dados numéricos , Adulto Jovem
6.
BMC Public Health ; 20(1): 654, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393218

RESUMO

BACKGROUND: Sub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work. METHODS: A systematic search of literature was conducted in PubMed, Web of Science, Embase, and CINAHL databases through May 2019. Screening and data charting were performed by two independent reviewers. Intervention studies measuring changes to uptake in screening among women in SSA were included, with no restriction to intervention type, study setting or date, or participant characteristics. Intervention type and implementation strategies were described using behavioral constructs from the IBM. RESULTS: Of the 3704 citations the search produced, 19 studies were selected for inclusion. Most studies were published between 2014 and 2019 (78.9%) and were set in Nigeria (47.4%) and South Africa (26.3%). Studies most often assessed screening with Pap smears (31.6%) and measured uptake as ever screened (42.1%) or screened during the study period (36.8%). Education-based interventions were most common (57.9%) and the IBM construct of knowledge/skills to perform screening was targeted most frequently (68.4%). Willingness to screen was high, before and after intervention. Screening coverage ranged from 1.7 to 99.2% post-intervention, with six studies (31.6%) reporting a significant improvement in screening that achieved ≥60% coverage. CONCLUSIONS: Educational interventions were largely ineffective, except those that utilized peer or community health educators and mHealth implementation strategies. Two economic incentivization interventions were moderately effective, by acting on participants' instrumental attitudes, but resulted in screening coverage less than 20%. Innovative service delivery, including community-based self-sampling, acted on environmental constraints, striving to make services more available, accessible, and appropriate to women, and were the most effective. This review demonstrates that intent to perform screening may not be the major determinant of screening behavior, suggesting other theoretical frameworks may be needed to more fully understand uptake of cervical screening in sub-Saharan Africa, particularly for health systems change interventions.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/estatística & dados numéricos , África ao Sul do Saara/epidemiologia , Ciências Biocomportamentais , Detecção Precoce de Câncer/métodos , Feminino , Acesso aos Serviços de Saúde , Humanos , Telemedicina/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia
7.
BMC Womens Health ; 20(1): 49, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138737

RESUMO

BACKGROUND: Cervical cancer is the third most common cancer that affects women worldwide. It has been and remains the leading cause of cancer mortality among women in Ghana. Despite the fact that cervical cancer is preventable through early detection and treatment of precancerous lesions, anecdotal evidence from gynaecological clinics in Ghana indicates that most patients present with a late stage of the disease. This study assesses the cervical cancer screening practices among women in Ghana. METHODS: Data from the World Health Organization's (WHO) multi-country Study on AGEing and adult health (SAGE) wave 2 conducted between 2014 and 2015 in Ghana was used. We employed binary logistic regression models to analyse data on 2711 women to examine factors associated with having pelvic examination among women aged ≥18 years. Among those who had pelvic examination, we applied binary logistic regression models to analyse factors associated with receiving Pap smear test as a subgroup analysis. RESULTS: Of the 2711 women aged 18 years or older surveyed, 225 (8.3%) had ever had a pelvic examination and only 66 (2.4%) of them reported ever having done a Pap smear test. For those who had pelvic examination, only 26.94% had Pap smear test. Ethnic group, marital status, father's educational level and difficulty with self-care were independently associated with undergoing pelvic examination. Only age and healthcare involvement were independently associated with pelvic examination within the past 5 years to the survey. Marital status, satisfaction with healthcare and healthcare involvement were independently associated with Pap smear test. CONCLUSION: Even though cervical cancer is preventable through early detection of precancerous lesions using Pap smear test, the patronage of this screening test is still very low in Ghana. Factors influencing the low patronage in Ghana include the marital status of women, their level of satisfaction with healthcare as well as their level of involvement with healthcare. These may be the consequences of a weak health system and the lack of a national policy on cervical cancer screening.


Assuntos
Envelhecimento , Detecção Precoce de Câncer/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Detecção Precoce de Câncer/métodos , Feminino , Gana/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Organização Mundial da Saúde , Adulto Jovem
8.
JAMA Intern Med ; 180(2): 274-280, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31904768

RESUMO

Importance: Pelvic examination is no longer recommended for asymptomatic, nonpregnant women and may cause harms such as false-positive test results, overdiagnosis, anxiety, and unnecessary costs. The bimanual pelvic examination (BPE) is an invasive and controversial examination component. Cervical cancer screening is not recommended for women younger than 21 years. Objectives: To estimate prevalence of potentially unnecessary BPE and Papanicolaou (Pap) tests performed among adolescent girls and women younger than 21 years (hereinafter referred to as young women) in the United States and to identify factors associated with receiving these examinations. Design, Setting, and Participants: A cross-sectional analysis of the National Survey of Family Growth from September 2011 through September 2017 focused on a population-based sample of young women aged 15 to 20 years (n = 3410). The analysis used survey weights to estimate prevalence and the number of people represented in the US population. Data were analyzed from December 21, 2018, through September 3, 2019. Main Outcomes and Measures: Receipt of a BPE or a Pap test in the last 12 months and the proportion of potentially unnecessary examinations and tests. Results: Responses from 3410 young women aged 15 to 20 years were included in the analysis with 6-year sampling weights applied. Among US young women aged 15 to 20 years represented during the 2011-2017 study period, 4.8% (95% CI, 3.9%-5.9%) were pregnant, 22.3% (95% CI, 20.1%-24.6%) had undergone STI testing, and 4.5% (95% CI, 3.6%-5.5%) received treatment or medication for an STI in the past 12 months (Table 1). Only 2.0% (95% CI, 1.4%-2.9%) reported using an IUD, and 33.5% (95% CI, 30.8%-36.4%) used at least 1 other type of hormonal contraception in the past 12 months. Among US young women aged 15 to 20 years who were surveyed in the years 2011 through 2017, approximately 2.6 million (22.9%; 95% CI, 20.7%-25.3%) reported having received a BPE in the last 12 months. Approximately half of these examinations (54.4%; 95% CI, 48.8%-59.9%) were potentially unnecessary, representing an estimated 1.4 million individuals. Receipt of a BPE was associated with having a Pap test (adjusted prevalence ratio [aPR], 7.12; 95% CI, 5.56-9.12), testing for sexually transmitted infections (aPR, 1.60; 95% CI, 1.34-1.90), and using hormonal contraception other than an intrauterine device (aPR, 1.31; 95% CI, 1.11-1.54). In addition, an estimated 2.2 million young women (19.2%; 95% CI, 17.2%-21.4%) reported having received a Pap test in the past 12 months, and 71.9% (95% CI, 66.0%-77.1%) of these tests were potentially unnecessary. Conclusions and Relevance: This analysis found that more than half of BPEs and almost three-quarters of Pap tests performed among young women aged 15 to 20 years during the years 2011 through 2017 were potentially unnecessary, exposing women to preventable harms. The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking.


Assuntos
Exame Ginecológico/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Esfregaço Vaginal/estatística & dados numéricos , Adolescente , Detecção Precoce de Câncer , Feminino , Contracepção Hormonal , Humanos , Dispositivos Intrauterinos , Guias de Prática Clínica como Assunto , Doenças Sexualmente Transmissíveis/diagnóstico , Estados Unidos , Neoplasias do Colo do Útero/diagnóstico , Adulto Jovem
9.
J Womens Health (Larchmt) ; 29(7): 996-1006, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31928405

RESUMO

Purpose: Health-related behaviors among underweight women have received less attention than overweight and obese women in the United States. Our purposes were to estimate the rate and modifiers of breast, cervical, and colorectal cancer screening adherence among underweight women and compare it to other body mass index (BMI) categories. Materials and Methods: We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System (BRFSS) of age-eligible women (breast cancer screening, n = 163,164; cervical, n = 113,883 and colorectal, n = 128,287). We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force (USPSTF) guidelines. We calculated the prevalence of screening among four BMI categories (underweight <18.5, normal weight ≥18.5 to <25, overweight ≥25 to <30, and obese ≥30). Logistic regression models assessed the independent effect of BMI on screening adherence. Results: Underweight women had significantly lower breast (62.9%), cervical (67.5%), and colorectal (62.6%) cancer screening rates compared to other BMI categories. In logistic regression models, being underweight was associated with decreased odds of breast (odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.49-0.88) and cervical (OR = 0.54, 95% CI = 0.34-0.84), but not colorectal (OR = 0.88; 95% CI = 0.66-1.18) cancer screening adherence. We did not demonstrate a significant association between obesity and screening rates for any of the three cancers. Underweight women reported higher rates of smoking and lower levels of educational attainment, income, and insurance coverage compared to all other groups. Higher rates of chronic illness and health access hardship were observed among underweight women. Conclusion: BMI variably affects cancer screening. Compared to normal-weight women, being underweight is associated with breast and cervical cancer screening nonadherence. Promoting breast and cervical cancer screening among this currently underserved population may reduce future disparities.


Assuntos
Índice de Massa Corporal , Neoplasias da Mama/prevenção & controle , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Comportamentos Relacionados com a Saúde/etnologia , Programas de Rastreamento/estatística & dados numéricos , Cooperação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etnologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/etnologia , Feminino , Humanos , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Exame Físico/estatística & dados numéricos , Fatores de Risco , Magreza/epidemiologia , Estados Unidos/etnologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Esfregaço Vaginal/estatística & dados numéricos , Saúde da Mulher
10.
Prev Med ; 130: 105902, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31730943

RESUMO

The human papillomavirus (HPV) vaccine is a powerful tool in cancer prevention. In combination with cervical cancer screening programs, this vaccine has the potential to nearly eliminate death from cervical cancer. However, this remarkable public health success can only be realized if vaccines reach those most at risk-unscreened women. Vaccinating only those already well-screened would have little impact on cervical cancer mortality, exacerbate disparities, and be a striking public health failure. We use data from the Behavioral Risk Factor Surveillance System optional Adult HPV Vaccination module between 2013 and 2016 to assess the association between HPV vaccine status and cervical cancer screening behavior. Only 27% of eligible women had received any HPV vaccination. Uninsured women were less likely to be vaccinated (aOR: 0.48, 95% CI:0.30-0.76) and less likely to be screened (aOR: 0.41, 95% CI:0.28-0.60) than insured women. Vaccinated women were more than twice as likely to be up to date on screening than unvaccinated women (aOR: 2.14, 95% CI:1.46-3.12). Younger women were 49% less likely to be up to date on screening (aOR: 0.51, 95% CI:0.37-0.71), but over 4 times more likely to be vaccinated (aOR: 4.44, 95% CI:3.20-6.17) than older women. Unvaccinated, unscreened women are at continued risk for cervical cancer. Uninsured women were most likely to be in this group. Concerted efforts should be focused on increasing vaccination and screening in this population. Cancer prevention innovations, like the HPV vaccine, must reach at-risk populations to avoid further protecting the protected and failing to reduce existing health disparities.


Assuntos
Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Vacinas contra Papillomavirus/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/estatística & dados numéricos , Adulto Jovem
11.
Cancer Causes Control ; 31(1): 43-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31720918

RESUMO

Racial/ethnic disparities in cancer outcomes have been well documented. Access to Pap testing may account for some of the variation in the racial and socioeconomic differences in cervical cancer outcomes. Literature exploring perceived access to care as it relates to women of color and low-income women is lacking. The goal of the study was to evaluate and characterize the relationship between what respondents believe about access to free/low-cost screening facilities and screening behaviors among low-income women in New Jersey. We used multivariate logistic regression to investigate belief about access to affordable screening on cancer screening behaviors using data from a cross-sectional study of low-income women in New Jersey (n = 430). Having had a Pap test in the past 3 years was inversely associated with age (OR 0.94, 95% CI 0.92-0.97) and was positively associated with having had insurance in the previous 2 years (OR 32.48. 95% CI 1.04-5.91), higher perceived risk of cervical cancer (OR 2.59, 95% CI 1.29-5.66), and knowing where to go to get a check-up that includes a cancer test (OR 1.97, 95% CI 1.11-3.49). These results suggest that insurance status continues to be a predictor of screening behavior but also that perceived risk awareness of where to go to get cancer screenings in general may influence the likelihood of utilizing screening, which can be important in developing targeted prevention strategies.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Adulto , Idoso , Grupos de Populações Continentais , Estudos Transversais , Grupos Étnicos , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Modelos Logísticos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Análise Multivariada , New Jersey/epidemiologia , Teste de Papanicolaou , Pobreza , Risco , Neoplasias do Colo do Útero/economia , Esfregaço Vaginal/estatística & dados numéricos , Adulto Jovem
13.
Rheumatology (Oxford) ; 59(3): 559-567, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31722431

RESUMO

OBJECTIVES: To compare cervical screening attendance and cytology (high- and low-grade cervical dysplasia [HGCD and LGCD]) between women with RA and the English general population and between biologic DMARD (bDMARD)-naïve and exposed women. METHODS: The British Society for Rheumatology Biologics Register for RA (BSRBR-RA), a national prospective study of RA treatment outcomes, was linked to the National Health Service Cervical Screening Programme, providing data for 12 785 women to compare with national screening data. Rates of HGCD/LGCD were compared with rates of negative smears using risk difference calculations between BSRBR-RA and national statistics. Within the BSRBR-RA, coverage was compared between those with low and high physical disability scores, while coverage and cytology results were compared between bDMARD-naïve and -exposed RA patients. RESULTS: The mean 5 year screening coverage was significantly higher in BSRBR-RA (83%) compared with the general population (79%), but lower in women with high disability (78%) compared with lesser disability (85%). Risk differences for HGCD were lower in the BSRBR-RA compared with national statistics, whereas risk differences for LGCD were higher. There was no statistically significant difference in the rates of HGCD or LGCD between bDMARD-exposed and -naïve women. CONCLUSION: This first-ever British analysis of cervical screening rates in RA has shown that women with RA have higher screening rates than the general population. Disability negatively impacts attendance, but treatment type does not. Women with RA did not have an increased risk of HGCD compared with national statistics, which was also not influenced by bDMARD exposure.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Neoplasia Intraepitelial Cervical/epidemiologia , Teste de Papanicolaou/estatística & dados numéricos , Displasia do Colo do Útero/epidemiologia , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Idoso , Artrite Reumatoide/epidemiologia , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Sistema de Registros , Resultado do Tratamento
14.
J Obstet Gynaecol ; 40(2): 240-246, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31340702

RESUMO

The purpose of this study was to develop an ideal cervical cancer screening model to reduce false-negative errors in Korea where there is a high prevalence of cervical cancer. We conducted a cross-sectional study including 33,531 women who underwent routine cervical cancer screening in Korea. Colposcopic examinations were performed after abnormal results on their screening tests. Diagnostic capacities including sensitivity, specificity, and false-negative rate of each screening scenario were analysed at the CIN1 or worse (CIN1+) threshold with colposcopic biopsy results considered the gold standard. A total of 4117 women had valid results for Papanicolaou (Pap) cytology, human papilloma virus (HPV) tests, cervicography, and colposcopically directed biopsy were included in this study. The disease prevalence of CIN1+ was 38.1%. Pap-alone resulted in the highest false-negative rate of 46.9%, followed by HPV-alone at 25.1%, cervicography-alone at 18.7%, Pap/HPV-combined at 15.0%, Pap/cervicography-combined at 6.9% and Pap/HPV/cervicography-combined at 2.9% in a sample of 1570 women with CIN1+ lesions. Therefore, cervicography demonstrated excellent performance for the detection of CIN or cervical cancer and markedly reduced false-negative errors when used in combination with Pap cytology and HPV tests.IMPACT STATEMENTWhat is already known on this subject? False-negative rate of Pap smears is as high as approximately 40-50%. Limitations of the Papanicolaou (Pap) test have led to the development of new screening programmes for cervical cancer, such as combination screenings with human papillomavirus (HPV) tests or cervicography.What do the results of this study add? Pap-alone resulted in the highest false-negative rate of 46.9%, followed by HPV-alone at 25.1%, cervicography-alone at 18.7%, Pap/HPV-combined at 15.0%, Pap/cervicography-combined at 6.9% and Pap/HPV/cervicography-combined at 2.9% in a sample of 1570 women with CIN1+ lesions.What are the implications of these findings for clinical practice and/or further research? Cervicography demonstrated excellent performance for the detection of CIN or cervical cancer and markedly reduced false negative errors when used in combination with Pap cytology and HPV tests.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Colo do Útero/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Ginecologia/métodos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/virologia , Colo do Útero/patologia , Colo do Útero/virologia , Estudos Transversais , Reações Falso-Negativas , Feminino , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Papillomaviridae , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Prevalência , República da Coreia/epidemiologia , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/estatística & dados numéricos
15.
Prev Med ; 130: 105880, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31678587

RESUMO

BACKGROUND: Large scale United States (US) surveys guide efforts to maximize the health of its population. Cervical cancer screening is an effective preventive measure with a consistent question format among surveys. The aim of this study is to describe the predictors of cervical cancer screening in older women as reported by three national surveys. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS 2016), the Health Information National Trends Survey (HINTS 2017), and the Health Center Patient Survey (HCPS 2014) were analyzed with univariate and multivariate analyses. We defined the cohort as women, without hysterectomy, who were 45-65years old. The primary outcome was cytology within the last 3years. RESULTS: Overall, Pap screening rates were 71% (BRFSS), 79% (HINTS) and 66% (HCPS), among 41,657, 740 and 1571 women, respectively. BRFSS showed that women 60-64years old (aPR=0.88, 95% CI: 0.85, 0.91), and in rural locations (aPR=0.95, 95% CI: 0.92, 0.98) were significantly less likely to report cervical cancer screening than women 45-49-years old or in urban locations. Compared to less than high school, women with more education reported more screening (aPR=1.20, 95% CI: 1.13, 1.28), and those with insurance had higher screening rates than the uninsured (aPR=1.47, 95% CI: 1.33, 1.62). HINTS and HCPS also showed these trends. CONCLUSIONS: All three surveys show that cervical cancer screening rates in women 45-65years are insufficient to reduce cervical cancer incidence. Insurance is the major positive predictor of screening, followed by younger age and more education. Race/ethnicity are variable predictors depending on the survey.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/estatística & dados numéricos , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Estados Unidos , População Urbana/estatística & dados numéricos
16.
Asian Pac J Cancer Prev ; 20(12): 3755-3762, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31870118

RESUMO

OBJECTIVE: To describe cervical cancer screening participation among women in Taiwan under its population-based screening policy and to estimate the economic burden of disease attributable to avoidable disparities in cervical cancer (CC) screening. METHODS: We identified a nationally-representative sample of females aged 30 years or above who were eligible for Pap smear testing in Taiwan from 1 January to 31 December 2013. An administrative database with detailed claims of health care utilization under the universal coverage health care system was used. Socioeconomic position of the female subjects was defined using the occupation classification, and two groups were specifically identified: general (O1) and low-income (O5) groups. Differences in screening rate, CC prevalence, and CC-attributable deaths were assessed between the two groups. Economic consequences as a result of screening inequalities were estimated using actual total health care spending (health care expenditure), monetary value per life-year and years of life lost for ill health and screening disparities (health as consumption good), and productivity losses alongside costs of social benefits (health as capital good). RESULT: A total of 301,057 enrolled females aged 30 years and older eligible for screening were identified. Overall, 3-year and 1-year screening rates among all subjects were 0.601 and 0.372, respectively. Impact of observed differences in screening translated to US$59,568 of health care spending in one year, 90.4% of which was specific to hospital admissions. When we viewed health as a consumption good and capital good, the impact of screening disparity on health losses through CC would be equivalent to US$78,095 and US$190,868, respectively. CONCLUSION: Forgone health and economic benefits associated with inequalities in CC screening uptake can be considerable in productive women.


Assuntos
Detecção Precoce de Câncer/economia , Disparidades em Assistência à Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/economia , Adulto , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , Humanos , Teste de Papanicolaou/economia , Teste de Papanicolaou/estatística & dados numéricos , Prognóstico , Taiwan/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal/economia , Esfregaço Vaginal/estatística & dados numéricos
17.
PLoS One ; 14(11): e0221546, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689301

RESUMO

Within 2021, Norway intends to complete implementation of HPV DNA-based primary screening for cervical cancer for women 34-69 years, while continue cytology-based screening for women 25-33 years. Over the recent years, the incidence of cervical cancer has increased by 30% among women younger than 40 years. In this subset of women, nearly 30% were diagnosed with a normal smear, as most recent smear, prior the cancer diagnosis. This observation demands quality control of normal smears. The aim of this study was to assess increase in program sensitivity of CIN2+ after follow-up of women with false negative Pap-smears testing positive for a 3-type (-16, -18, -45) HPV mRNA test in a cohort design over one screening interval. 521 women, aged 23-39 years, and no prior history of CIN1+ or HSIL, with an ASC-US or worse smear (ASC-US+) and 1444 women with normal screening cytology comprised the study cohorts. The positivity rate for the 3-type HPV mRNA was 1.9% (28/1444). Rescreening revealed 23 women with ASC-US, two women with LSIL, two women with ASC-H, and one woman with AGUS. If the HPV mRNA-positivity rate and histology findings from samples rescreened were applied to all women with normal cytology, an estimated increase in screening sensitivity of 16.4% (95% CI:15.3-17.5) for CIN2+ and 17.3% (95% CI:16.2-18.4) for CIN3+ were achieved. By rescreening less than 2% of women with normal cytology positive for a 3-type HPV mRNA test, we achieved a significant increase in screening program sensitivity.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/métodos , Adulto , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/virologia , Estudos de Coortes , Feminino , Ensaios de Triagem em Larga Escala/métodos , Ensaios de Triagem em Larga Escala/normas , Ensaios de Triagem em Larga Escala/estatística & dados numéricos , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Gradação de Tumores , Noruega/epidemiologia , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Prevalência , Controle de Qualidade , RNA Mensageiro/análise , RNA Mensageiro/genética , RNA Viral/análise , RNA Viral/genética , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/normas , Esfregaço Vaginal/estatística & dados numéricos , Adulto Jovem
18.
Cad Saude Publica ; 35(10): e00234618, 2019.
Artigo em Português | MEDLINE | ID: mdl-31596403

RESUMO

This article evaluates access to the Papanicolaou test in the Family Health Strategy (FHS) in municipalities in a health region. Cervical cancer control depends on a well-organized Family Health Strategy, so assessment of access to the Papanicolaou test reflects the quality of care at this level. This is a qualitative study with data produced in 10 focus groups, totaling 70 participants in four municipalities. We analyzed the organizational, symbolic, and technical dimensions of access to the Pap test, with cervical cancer control as the marker. The results indicate that living in rural areas was a barrier to access to the Papanicolaou test and exacerbated the inequalities. Nurses were the principal reference for access to the Pap test. The absence of necessary items for collecting cervical cytopathology specimens was a barrier to access in all the municipalities. There were obstacles to access for women with disabilities and lesbian women, with care that was fragmented and out of sync with individual characteristics. The numerous obstacles to access to the Papanicolaou test exposed the selectiveness of the Family Health Strategy in the health region, since it reproduced the invisibility of women with greater social vulnerability and exacerbated the existing inequalities.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Teste de Papanicolaou/estatística & dados numéricos , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal/estatística & dados numéricos , Brasil , Detecção Precoce de Câncer , Saúde da Família , Feminino , Grupos Focais , Humanos , Programas de Rastreamento , Atenção Primária à Saúde , Saúde da População Rural , Fatores Socioeconômicos , Neoplasias do Colo do Útero/prevenção & controle
19.
Asian Pac J Cancer Prev ; 20(10): 2965-2969, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31653142

RESUMO

BACKGROUND: Cervical cancer is a preventable and curable disease if early diagnosed; however, most of the cases present late; hence, there is a need to raise the awareness about cervical cancer and to establish screening programs. We aimed to assess the knowledge and attitudes toward screening and to determine the current status of awareness among women. METHODS: We conducted a cross-sectional study among 2,220 Saudi women in the Qassim region using a validated questionnaire that gathers data on socio-demographics, knowledge and attitude domains. RESULTS: Among the participants, 952 (42.9%) were between 31 and 45 years old; most were married and highly educated 1,754 (79%), and showed moderate knowledge about cervical cancer symptoms, prevention, and screening. The most reported symptom was non-cyclic bleeding by 511 (23%), while prolonged use of contraceptives 289 (13%) was the more selected risk factor by participants. We found that 1,881 (84.7%) of women had not undergone a Pap smear test, and 805 participants (42.8%) expressed their refusal to attend for it, citing various reasons; the most reported was that they do not know someone who tried pap smear. A significant negative correlation was found between the level of knowledge and acceptance to vaccinate daughters at school age against human papillomavirus. CONCLUSION: Saudi women in the Qassim region have moderate awareness of cervical cancer but negative attitudes toward screening. Awareness campaigns are needed to promote knowledge and improve pap smear attendance to eliminate negative perceptions and beliefs.


Assuntos
Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus/complicações , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/psicologia , Adolescente , Adulto , Idoso , Estudos Transversais , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/terapia , Infecções por Papillomavirus/virologia , Prognóstico , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/estatística & dados numéricos , Saúde da Mulher , Adulto Jovem
20.
BMJ Open ; 9(8): e031317, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31473624

RESUMO

BACKGROUND: Despite worldwide efforts in encouraging routine pap smears for early detection of cervical cancer, Poland's screening rate lags behind the rest of the European Union at 20.2%. Family physicians (FPs) in Poland rarely perform pap smears, and little is known about the experiences and attitudes of Polish patients regarding pap smear screening in a primary healthcare (PHC) setting. METHODS: A cross-sectional questionnaire-based survey was performed. Questionnaires were distributed among 43 FPs and 418 of their patients in one Polish region. The data from patients were associated with the doctors' characteristics. Descriptive statistics, the χ2 test and the Mann-Whitney U test were used for analysis. RESULTS: Nearly two-thirds of patients (66%) declared willingness to undergo free pap smear screening by their FPs, with the most common reason being time saved. Among those objecting to receive pap smears from their FPs, immediate specialist care provided by gynaecologists in case of adverse results was the main concern. The factors that positively influenced the patients' decision to undergo cervical cancer screening in PHC were: (1) living in a city with more than 100 000 inhabitants, (2) being single, (3) having a female FP or (4) a physician with specialty training in family medicine. CONCLUSION: There is high level of acceptance for pap smears performed in PHC offices among patients in Poland. They are more likely to comply with the screening due to easy access. Establishing a solid physician-patient relationship is also crucial in encouraging screening.


Assuntos
Teste de Papanicolaou , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Médicos de Família , Polônia/epidemiologia , Inquéritos e Questionários , Esfregaço Vaginal/estatística & dados numéricos
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