Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.008
Filtrar
1.
Medicine (Baltimore) ; 100(13): e24927, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787580

RESUMO

RATIONALE: Usual-type endocervical adenocarcinoma (ECA), high-risk HPV associated, is the most common type of glandular carcinoma in the endocervix. Mucin-depleted usual-type ECA is 1 end of morphological lineage of usual-type ECA and morphologically may show endometrioid features, which could cause diagnostic challenge with uterine endometrioid adenocarcinoma (EEC) and primary endometrioid ECA, especially in the setting of small biopsy and endocervical curettage (ECC). PATIENT CONCERNS: A 37-year-old women presented with dyspareunia for 1 year, showing atypical glandular cell on a liquid-based Pap TCT examination and positive for HPV16 detection. ECC showed EEC in another hospital based on its "endometrioid" morphology and immunohistochemical profiles (ER/PR/PAX8 strongly positive, though p16 also strongly positive). DIAGNOSES: The specimen of hysterectomy in our hospital displayed a lesion confined to the uterine cervix showing the same morphology and immunohistochemical profiles as ECC. Finally, we successfully performed HPV RNAscope and detected high-risk human papilloma virus (HPV) E6/E7 mRNA particles in tumor cells in situ, which warranted usual-type ECA with mucin-depleted feature, a rare deviation of usual-type of ECA. INTERVENTIONS: The patient underwent total hysterectomy with lymph node dissection. OUTCOMES: To date, 14 months after surgery, the patient is well without recurrence or distant metastasis, and undergoes regular reexamination. LESSONS SUBSECTIONS: We report a rare case of mucin-depleted usual-type ECA showing overlapping morphological and immunohistochemical profiles with EEC. The pathological diagnosis was confirmed by high-risk HPV RNAscope detection which is superior than immunohistochemistry to identify usual-type ECA, warranting an important role in assisting the diagnosis of morphological vague cases.


Assuntos
Adenocarcinoma/diagnóstico , Carcinoma Endometrioide/diagnóstico , Neoplasias do Endométrio/diagnóstico , Testes de DNA para Papilomavírus Humano , Imuno-Histoquímica , Neoplasias do Colo do Útero/diagnóstico , Adenocarcinoma/virologia , Adulto , Carcinoma Endometrioide/virologia , Colo do Útero/virologia , Curetagem , Diagnóstico Diferencial , Neoplasias do Endométrio/virologia , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Humanos , Teste de Papanicolaou , RNA Viral/análise , Neoplasias do Colo do Útero/virologia
2.
s.l; CONETEC; mar. 2021.
Não convencional em Espanhol | BRISA/RedTESA | ID: biblio-1150458

RESUMO

INTRODUCCIÓN: El cáncer del cuello uterino es una enfermedad prevenible, e incluso puede curarse si se detecta en una fase temprana y se trata debidamente. A pesar de ello, sigue siendo uno de los tipos de cáncer más comunes y una de las causas de muerte por cáncer entre mujeres de todo el mundo. Más del 85% de las mujeres afectadas son mujeres jóvenes y con escasa instrucción que viven en los países más pobres. Muchas de ellas también tienen hijos de corta edad cuya supervivencia se ve truncada por la muerte prematura de sus madres1 . Pocas enfermedades reflejan las desigualdades a nivel mundial como el cáncer del cuello uterino. En los países de ingresos bajos y medianos, su incidencia es de casi el doble y su tasa de mortalidad el triple que las de los países de ingresos altos. En palabras del Director General de la OMS: «Mediante intervenciones costo-eficaces y basadas en pruebas científicas, en particular la vacunación de las niñas contra el virus del papiloma humano, la detección y el tratamiento de lesiones precancerosas y la mejora del acceso al diagnóstico y el tratamiento de cánceres invasivos, podemos eliminar el cáncer del cuello uterino como problema de salud pública y lograr que se convierta en una enfermedad del pasado¼2 . Un reciente comunicado a todos los países en mayo de 2018 aboga por el fin al sufrimiento provocado por el CCU y una renovada voluntad política para hacer realidad su eliminación, instando a todas las partes interesadas a que se unieran en pos de ese objetivo común3 . Este esfuerzo mundial está en consonancia con los instrumentos que consagran la salud como derecho humano, 4 así como con la Agenda 2030 para el Desarrollo Sostenible y su principio general de no dejar a nadie atrás. Respalda el logro de varios Objetivos de Desarrollo Sostenible y metas conexas 5 y es uno de los componentes de la Estrategia Mundial del Secretario General de las Naciones Unidas para la Salud de la Mujer, el Niño y el Adolescente (2016-2030). OBJETIVO: El objetivo del presente informe será evaluar entre sí las distintas tecnologías para test de VPH disponibles en nuestro país, utilizadas en estrategias de detección precoz de CCU. Se analizarán diferencias en eficacia, seguridad, conveniencia y costos para el sistema de salud de Argentina. METODOLOGÍA: Se realizó la búsqueda bibliográfica de manera independiente por distintos investigadores. Se revisaron bases de datos y buscadores: MEDLINE, LILACS, Cochrane, Universidad de York, HTAi, OMS, Tripdatabase, Google académico, agencias de ETS, agencias reguladoras de alimentos y medicamentos, repositorios de guías de práctica clínica y productores de guías como OMS-OPS, Ministerio de Salud de la República Argentina, Royal College of Obstetricians and Gynaecologist,Faculty of Sexual and Reproductive Health Care, American College of Obstetricians and Gynecologist y Society of Obstetricians and Gynaecologist of Canada. Se realizó una búsqueda de informes en el repositorio BRISA de la OPS-RedETSA y en el repositorio de RedArets, así como otras agencias de ETS de nuestro país y del mundo. Se solicitó a través de las autoridades de CONETEC a todos los productores y vendedores de marcas y modelos de test de VPH disponibles en Argentina que acerquen evidencias sobre eficacia, seguridad y conveniencia de sus marcas y modelos. RESULTADOS: La prueba de detección del VPH ofrece máxima especificidad y tiene un sólido valor de predicción negativa, lo que significa que la mujer que obtiene un resultado negativo no necesita ser examinada de nuevo en un mínimo de cinco años. A su vez, dar a las mujeres la posibilidad de realizar por sí mismas la prueba (auto-toma) mejora la aceptabilidad y facilita el acceso a los servicios, aunque se requiere una compleja y dinámica articulación entre las capacidades de detección y atención del sistema de salud para captar la gran cantidad de casos positivos en la primera prueba, y continuar los estudios confirmatorios con PAP y las instancias terapéuticas derivadas. A diferencia de otros países, Argentina no logra reducir la mortalidad por CCU en forma significativa, pero existe desde 2011 una decisión de política sanitaria para implementar el test de VPH como prueba primaria. Como otros países, existe en Argentina una elevada inequidad en el acceso a rastreo y mortalidad por CCU, relacionándose las mismas con los determinantes sociales de la salud. CONCLUSIÓN: La detección y el tratamiento del CCU constituyen una prioridad en políticas sanitárias. Existe en Argentina una decisión de política sanitaria para implementar el test de VPH como prueba primaria en el screening de CCU (iniciada progresivamente desde 2011), que debe enfrentar de manera primordial la alta inequidad en el acceso a rastreo y mortalidad por CCU, relacionándose las mismas con los determinantes sociales de la salud. El test de VPH respecto al test de PAP: Es más sensible aunque levemente menos específico. Se recomienda en Argentina como rastreo en serie (HPV seguido de PAP). Permite la auto-toma que incrementa la tasa de realización del rastreo. Comparado con PAP, el test HPV demostró salvar vidas y ser costo-ahorrativo. En la revisión de la evidencia realizada no se identificaron diferencias en performance diagnóstica entre las diferentes marcas y modelos de tests de VPH disponibles en Argentina; algunas marcas comerciales aún no tienen validada la auto-toma y otras requieren adquirir por separado (con otro proveedor) este dispositivo. Las guías clínicas propuesta por OMS y varios países en el mundo apoyan el uso de estas metodologías como estrategia diagnóstica; su cobertura es explícita en países desarrollados y se encuentra en implementación en nuestra región Las evaluaciones económicas evaluadas de organismos de referencia avalan su utilización, demostrando ahorros de costos y mejor perfil de eficacia global en la patología, aunque consideran mandatorio un gran cambio operativo y cultural para los médicos, pacientes y laboratorios para que la implementación sea exitosa (requiriendo adecuada planificación, financiación y coordinación).


Assuntos
Humanos , Neoplasias do Colo do Útero/diagnóstico , Testes de DNA para Papilomavírus Humano/instrumentação , Teste de Papanicolaou/instrumentação , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício
3.
Acta Cytol ; 65(2): 140-149, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33535202

RESUMO

BACKGROUND: Fine needle aspiration (FNA) of renal masses can distinguish between benign and malignant neoplasms in 73-94% of cases. Previous studies suggested the correct subclassification of renal cell carcinomas (RCCs) by cytomorphology can be achieved in up to 80% of cases. However, as RCCs become increasingly subclassified by molecular signatures, correct subclassification based on cytology alone is increasingly difficult. DESIGN: Two FNA passes (2 stained with Diff-Quik® and 2 with the Papanicolaou method) were performed on all fresh nephrectomy specimens for a 1-year period. There were 30 cases in this study, with 29 primary renal tumors and 1 case of metastatic lung adenocarcinoma. Each case was assigned a random number and came with 2 slides (1 from each staining method). Eight cytopathologists were asked to provide a diagnosis and the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading if applicable. Fleiss' Kappa and Cohen's Kappa equations were used to look at inter-rater variability. RESULTS: When compared to the surgical pathology diagnosis, the average percent correct diagnosis for all cytopathologist was 35%. Chromophobe RCCs had the best average percent accuracy at 72% followed by clearcell RCC at 48%. Average accuracy for grading RCCs was 40%. Inter-rater variability among the cytopathologists for all RCC diagnoses was fair with a Fleiss' Kappa coefficient of 0.28. For the WHO/ISUP grade, the weighted coefficient for each pathologist ranged from 0.11 to 0.45, ranging from fair to moderate, respectively. CONCLUSIONS: Renal tumors are difficult to classify on cytopathology alone. Core needle biopsy and ancillary studies are necessary if diagnosis will change management.


Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Corantes Azur , Biópsia por Agulha Fina , Carcinoma de Células Renais/classificação , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/classificação , Neoplasias Renais/cirurgia , Azul de Metileno , Gradação de Tumores , Variações Dependentes do Observador , Teste de Papanicolaou , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Xantenos
4.
Ther Umsch ; 78(2): 93-98, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33615865

RESUMO

Importance of the Pap smear in the age of HPV testing Abstract. Screening for cervical cancer prevention is considered a success story. Since the introduction of the Pap test in the 1950s, the incidence and mortality of cervical carcinomas has decreased dramatically in the industrialized world. In developing countries, and especially in certain countries in Africa, cervical cancer is still one of the most common fatal cancers due to the lack of screening and therapeutic options. For decades, Pap tests and colposcopy were the basis of cervical cancer screening. In the early 1980s, it became known that almost without exception cervical carcinomas require infection with certain human papilloma viruses (HPV). Among other things, this finding also revolutionized cervical cancer screening. The quality of the Pap test is influenced by the conditions of collection and by the so-called interobserver variability. Overall, cytology shows a good specificity of 95 % with a lower sensitivity of 70 %. Additional immunohistochemical tests to determine the biomarkers p16 and Ki-67 can increase the sensitivity of the Pap test up to 94 % (analogous to the HPV test), which is why cytological tests are still considered very effective in countries with sufficient resources and expertise. In contrast, the HPV test is not subjective and has a high sensitivity of 94 %. However, the specificity is worse than for the Pap test, which is why HPV-based screening carries an increased risk of unnecessary clarification and therapy. The superiority of HPV versus cytological screening seems to be proven under defined study conditions, but only after the second or third screening round. If screening is performed opportunistically, as in Switzerland, there is a risk of so-called lost follow-up. It is precisely the failure to take advantage of screening examinations or their performance at irregular intervals that is considered the most significant risk factor for the development of cervical carcinoma. It should also be remembered that the HPV test only reflects the current viral shedding but does not provide any information about the time and duration of HPV infection. Further studies are necessary to determine long-term results and cost-effectiveness.


Assuntos
Papillomaviridae , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Detecção Precoce de Câncer , Feminino , Humanos , Programas de Rastreamento , Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Gravidez , Suíça , Neoplasias do Colo do Útero/diagnóstico
6.
Rev. bras. cancerol ; 67(1): e-081080, 2021.
Artigo em Português | LILACS | ID: biblio-1147043

RESUMO

Introdução: A Gardnerella vaginalis facilita a infecção pelo papilomavírus humano (HPV). Objetivo: Verificar a associação entre anormalidades citológicas e presença de Gardnerella vaginalis nos esfregaços cervicovaginais encaminhados ao Laboratório Clínico da Pontifícia Universidade Católica de Goiás (LAC/PUC Goiás) estratificadas por faixa etária. Método: Estudo transversal realizado no LAC/PUC Goiás entre janeiro de 2013 a dezembro de 2015. Para análises estatísticas, a variável idade foi categorizada em ≤39 anos e >40 anos, utilizando o programa IBM SPSS Statistics (Version 2.0, 2011®) para o teste de qui-quadrado (X²), com intervalo de confiança de 95% e valor p<0,05. Resultados: Foram analisados 4.558 exames citopatológicos, a maioria com presença de Lactobacillus spp. (46,97%). A prevalência dos agentes patogênicos foi a Gardnerella vaginalis (79,6%), seguida de Candida spp. (16,8%), Trichomonas vaginalis (2,2%), Herpes simplex (0,4 %) e Chlamydia trachomatis (0,1%). As anormalidades citológicas foram observadas em 9,1%, sendo atypical squamous cells of undetermined significance (ASC-US) 2,57%, low grade squamous intraepithelial lesion (LSIL) 1,78%, atypical squamous cells of undetermined significance cannot exclude high grade squamous intraepithelial lesion (ASC-H) 3,52%, high grade squamous intraepithelial lesion (HSIL) 1,08%, atypical endocervical cells, favor neoplastic (AGC-NEO) 0,22% e carcinoma 0,02%. Houve uma associação significante entre anormalidades citológicas graves e mulheres ≥40 anos, OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Mulheres ≤40 anos mostraram significância à presença de Gardnerella vaginalis (p<0,0004). Conclusão: Uma elevada prevalência de Gardnerella vaginalis foi encontrada associada com as anormalidades citológicas, principalmente em mulheres sexualmente ativas.


Introduction:Gardnerella vaginalis facilitates human papillomavirus (HPV) infection. Objective: To verify the association between cytological abnormalities and the presence of Gardnerella vaginalis in cervicovaginal smears sent to the Clinical Laboratory of the Pontifical Catholic University of Goiás (LAC/PUC Goiás) stratified by age range. Method: Cross-sectional study carried out at LAC/PUC Goiás from January 2013 to December 2015. For statistical analysis, the variable age was categorized as ≤39 years and >40 years, using the IBM SPSS Statistics program (Version 2.0, 2011®) for the chi-square test (X²), with a 95% confidence interval and p<0.05. Results:4,558 cytopathological exams were analyzed, most of them with the presence of Lactobacillus spp (46.97%). The prevalence of pathogens was Gardnerella vaginalis (79.6%), followed by Candida spp. (16.8%), Trichomonas vaginalis (2.2%), Herpes simplex (0.4%) and Chlamydia trachomatis (0.1%). Cytological abnormalities were observed in 9.1%, being atypical squamous cells of undetermined significance (ASC-US) 2.57%, low grade squamous intraepithelial lesion (LSIL) 1.78%, atypical squamous cells of undetermined significance cannot exclude high intraepithelial lesion (ASC-H) 3.52%, high grade squamous intraepithelial lesion (HSIL) 1.08%, atypical endocervical cells, neoplastic favor (AGC-NEO) 0.22% and carcinoma 0.02%. There was a significant association between severe cytological abnormalities and women >40 years old OR 3.01 (95% CI 2.0-4.58) (p<0.0001). Women ≤40 years old showed the presence of Gardnerella vaginalis (p<0.0004). Conclusion:A high prevalence of Gardnerella vaginalis was found and its association with cytological abnormalities, especially in sexually active women.


Introducción:Gardnerella vaginalis facilita la infección por el virus del papiloma humano (VPH). Objetivo: Verificar la asociación entre anormalidades citológicas y la presencia de Gardnerella vaginalis en frotis cervicovaginales enviadas al Laboratorio Clínico de la Pontificia Universidad Católica de Goiás (LAC/PUC Goiás) estratificadas por grupo de edad. Método: Estudio transversal realizado en LAC/PUC Goiás desde enero de 2013 hasta diciembre de 2015. Para el análisis estadístico, la edad variable se clasificó como ≤39 años y >40 años, utilizando el programa IBM SPSS Statistics (Versión 2.0, 2011®) para la prueba de chi-cuadrado (X²), con un intervalo de confianza del 95% y p <0,05. Resultados: Se analizaron 4.558 exámenes citopatológicos. La prevalencia de Lactobacillusspp. con 46,97%. Los patógenos como Gardnerella vaginalis fueron 79,6%, Candidaspp. 16,8%, Trichomonas vaginalis 2,2%, Herpes simplex 0,4%, y Chlamydia trachomatis 0,1%. Se observaron anormalidades citológicas en 9,1%, con células escamosas atípicas de significado indeterminado (ASC-US) 2,57%, lesión intraepitelial escamosa de bajo grado (LSIL) 1,78%, células escamosas atípicas de significación indeterminada no pueden excluir lesión intraepitelial (ASC-H) 3,52%, lesión intraepitelial escamosa de alto grado (HSIL) 1,08%, células endocervicales atípicas, favor neoplásico (AGC-NEO) 0,22% y carcinoma 0,02%. Hubo una asociación significativa entre anormalidades citológicas severas y mujeres >40 años OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Las mujeres ≤40 años mostraron la presencia de Gardnerella vaginalis (p<0,0004). Conclusión: Se encontró una alta prevalencia de Gardnerella vaginalis y su asociación con anomalías citológicas, especialmente en mujeres sexualmente activas.


Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Esfregaço Vaginal , Gardnerella vaginalis/isolamento & purificação , Vaginose Bacteriana/patologia , Infecções por Bactérias Gram-Positivas/patologia , Teste de Papanicolaou , Estudos Transversais
7.
JAMA Netw Open ; 3(12): e2030214, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337495

RESUMO

Importance: Sexual and reproductive health services are a primary reason for care seeking by female young adults, but the association of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) with insurance use for these services has not been studied to our knowledge. Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care. Objective: To evaluate the association between implementation of ACA-DCE and insurance use for confidential sexual and reproductive health services by female young adults newly eligible for parental coverage. Design, Setting, and Participants: For this cross-sectional study, a difference-in-differences analysis of a US national sample of commercial claims from January 1, 2007, to December 31, 2009, and January 1, 2011, to December 31, 2016, captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage. Data were analyzed from January 2019 to February 2020. Exposures: Eligibility for parental coverage under the ACA-DCE as of 2010. Main Outcomes and Measures: Probability of insurance use for contraception and Papanicolaou testing. Emergency department and well visits were included as control outcomes not sensitive to confidentiality concerns. Linear probability models adjusted for age, plan type, annual deductible, comorbidities, and state and year fixed effects, with SEs clustered at the state level. Results: The study sample included 4 690 699 individuals (7 268 372 person-years), with 2 898 275 in the treatment group (mean [SD] age, 23.7 [0.8] years) and 1 792 424 in the comparison group (mean [SD] age; 27.9 [0.8] years). Enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group. Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 to -2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 to -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups. Emergency department and well visits increased 0.4 (95% CI, 0.2-0.7) and 1.7 (95% CI, 1.3-2.1) percentage points, respectively. Conclusions and Relevance: The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage. Some young people who gained coverage under the expansion may not be using essential, confidential services.


Assuntos
Cobertura do Seguro/tendências , Seguro Saúde , Serviços de Saúde Reprodutiva , Saúde Sexual , Serviços de Saúde da Mulher , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Patient Protection and Affordable Care Act , Serviços de Saúde Reprodutiva/economia , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/economia , Saúde Sexual/estatística & dados numéricos , Estados Unidos , Serviços de Saúde da Mulher/economia , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-33379209

RESUMO

Using the claims data of one million insured residents in Taiwan from 1996-2013, this study identified 12,126 women in an urban city (Taichung) and 7229 women in a rural county (Yunlin), aged 20 and above. We compared Papanicolaou (Pap) test uses and cervical cancer detection rates between urban and rural women. Results showed that the Pap screening rate was slightly higher in rural women than in urban women (86.1 vs. 81.3 percent). The cervical cancer incidence was much greater for women without Pap test than women with the test (35.8 vs. 9.00 per 1000 in rural women and 20.3 vs. 7.00 per 1000 in urban women). Nested case-control analysis showed that Pap test receivers had an adjusted odds ratio (OR) of 0.35 (95% CI = 0.25-0.51) to be diagnosed with cervical cancer as compared to those who did not receive the test. The rural women had an adjusted OR of 1.46 (95% CI = 1.03-2.06) to be diagnosed with cervical cancer as compared to urban women. In conclusion, women in rural area are at higher cancer risk than city women. Women who do not undergo Pap tests deserve timely intervention of Pap test to prevent the onset of cancer, particularly in rural women with low income.


Assuntos
População Rural , População Urbana , Neoplasias do Colo do Útero , Adulto , Idoso , Detecção Precoce de Câncer , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Teste de Papanicolaou , Fatores Socioeconômicos , Taiwan/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal , Adulto Jovem
9.
Korean J Parasitol ; 58(5): 571-576, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33202510

RESUMO

Extra-enteric infections by Blastocystis spp. have rarely been documented. Here, we report a case of extra-enteric blastocystosis in a patient with minimal cervicitis symptoms. A 47-year-old Hispanic female patient was attended in a primary health centre in Michoacan state, Mexico, for her routine gynaecological medical examination. As only symptom, she referred to a slight vaginal itching. The presence of several vacuolar-stages of Blastocystis spp. were identified by Papanicolaou staining; molecular identification was attempted by culture-PCR sequencing of a region of 18S gene from cervical and faecal samples obtained 2 months after cytological examination, even when patient declared that she tried self-medicating with vaginal ovules. Blastocystis ST1 was identified only in the faecal sample. The presence of Blastocystis spp. in the cervix of a patient with scarce symptomatology, demonstrates the extraordinary flexibility of this microorganism to adapt to new environments and niches.


Assuntos
Infecções por Blastocystis/parasitologia , Blastocystis/isolamento & purificação , Colo do Útero/parasitologia , Cervicite Uterina/parasitologia , Blastocystis/genética , Fezes/parasitologia , Feminino , Genes de Protozoários , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou , Reação em Cadeia da Polimerase , RNA Ribossômico 18S
10.
Med Clin North Am ; 104(6): 1063-1078, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33099451

RESUMO

The most effective strategy for cervical cancer prevention involves vaccination to prevent human papillomavirus (HPV) infections during adolescence followed by screening to detect HPV infections during adulthood. HPV vaccination before sexual debut can prevent HPV infections, precancers, and cancers. HPV vaccination of sexually active populations does not prevent cancer. Screening with HPV testing is the most effective method of detecting precancers and cancers between ages 25 and 65. Ensuring adequate screening around the age of menopause may be the key to preventing cervical cancer among elderly women. Most cervical cancers at all ages occur among unscreened or underscreened women.


Assuntos
Neoplasias do Colo do Útero/prevenção & controle , Detecção Precoce de Câncer , Feminino , Humanos , Teste de Papanicolaou , Papillomaviridae/imunologia , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/prevenção & controle , Atenção Primária à Saúde , Estados Unidos , Neoplasias do Colo do Útero/patologia , Vacinação
11.
Value Health ; 23(9): 1246-1255, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940243

RESUMO

OBJECTIVES: Low uptake of cancer screening services is a global concern. Our aim was to understand factors that influence the screening decision, including screening and treatment subsidies and a gain-frame message designed to present screening as a win-win. METHODS: We analyzed preferences for mammography and Pap smear among women in Singapore by means of discrete choice experiments while randomly exposing half of respondents to a gain-framed public health message promoting the benefits of screening. RESULTS: Results showed that the message did not influence stated uptake, and given the levels shown, respondents were influenced more by treatment attributes, including effectiveness and out-of-pocket cost should they test positive, than by screening attributes, including the offer of a monetary incentive for screening. Respondents also underestimated the survival chances of screen-detected breast and cervical cancers. CONCLUSIONS: Combined, these findings suggest that correcting misconceptions about screen-detected cancer prognosis or providing greater financial protection for those who test positive could be more effective and more cost-effective than subsidizing screening directly in increasing screening uptakes.


Assuntos
Detecção Precoce de Câncer/psicologia , Mamografia/psicologia , Programas de Rastreamento/psicologia , Teste de Papanicolaou/psicologia , Adulto , Neoplasias da Mama/diagnóstico , Comportamento de Escolha , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Mamografia/economia , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Teste de Papanicolaou/economia , Singapura , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico
12.
PLoS One ; 15(9): e0238291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870941

RESUMO

The establishment of link between high-risk human papillomavirus (HPV) infection and occurrence of cervical cancer has resulted in development of various HPV related control strategies for the prevention of cervical cancer. The objective of the present study was to assess the cost effectiveness of various screening strategies for cervical cancer and human papilloma virus (HPV) vaccination in India. A Markov model based on societal perspective was designed to estimate the lifetime costs and consequences of screening (with either visual inspect with acetic acid (VIA), Papanicolaou test or HPV DNA test at various time intervals) in a hypothetical cohort of 30-65 years age women or vaccination among adolescent girls. Diagnostic accuracy of the screening strategies, efficacy of HPV vaccination and data on transition probabilities was based on the results of the existing meta-analyses. Primary data was collected for assessing per person cost of screening, cost of treating cervical cancer and quality of life. We found that introduction of different screening strategies leads to reduction in lifetime occurrence of cervical cancer cases caused by HPV 16/18 from 20% to 61%, and cervical cancer deaths from 28% to 70%, as compared to no screening. Among various screening strategies, screening with both VIA 5 yearly and VIA 10 yearly came out to be cost effective at 1-time per capita GDP, with VIA every 5 years providing greater health benefits as compared to VIA 10 years. Hence, screening with VIA 5 years at an incremental cost of US$ 829 (INR 54,881) per QALY gained is the recommended strategy for India. Further, with regards to HPV vaccination, it leads to 60% reduction in cancer cases and mortality caused by HPV 16/18 as compared to no vaccination. Moreover, when this vaccinated cohort of adolescent girls is also screened later in their life (with VIA every 10 years and VIA 5 years), it leads to 69%-76% reduction in cancer cases and 71%-81% reduction in cancer deaths. As compared to no vaccination and no screening, both HPV vaccination alone and vaccination plus screening (with VIA every 5 yearly and VIA 10 yearly) appears to be cost effective with ICERs in the range of US$ 86 (INR 5,693) to US$ 476 (INR 31,511) per QALY gained. In the long run, when the cohort of adolescent girls, who were immunized for HPV, reach the age of 30 years, the screening frequency using VIA should be determined based on the coverage of HPV vaccination in that cohort.


Assuntos
Análise Custo-Benefício , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Idoso , DNA Viral/análise , DNA Viral/metabolismo , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/isolamento & purificação , Humanos , Índia/epidemiologia , Cadeias de Markov , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Teste de Papanicolaou/economia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Qualidade de Vida , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/terapia , Vacinação , Adulto Jovem
13.
Acta Cytol ; 64(6): 597-606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32829336

RESUMO

BACKGROUND: The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) offers a comprehensive range of External Quality Assurance programs for all disciplines of pathology and is committed to delivering programs to advance outcomes in patient care and promote excellence in laboratory diagnostic and technical proficiency. Proficiency testing in cytopreparatory techniques became available for formal enrolment in 2018. The 2019 technical program focused on the demonstration of a laboratory to troubleshoot problems encountered during staining and processing. The exercise provided a peer comparison of a laboratory's ability to (1) identify the problem viewed from a digital image and (2) describe the troubleshooting steps to rectify the problem using assessment guidelines. METHODS: Ten troubleshooting exercises including whole-slide z-stacked virtual images, a reference slide, and an online Result Entry questionnaire were provided. Common staining and processing problems were demonstrated in these exercises. Multiple-choice responses were made available to participants for each case with 1 response requiring submission. Participants were then allowed free text to describe how they would rectify the problem. RESULTS: Of the 72 participants who participated, 62 participants (86%) achieved a satisfactory assessment, 6 participants (8%) received a borderline assessment, and 4 participants (6%) received an unsatisfactory assessment. The average mark obtained was 32.7 out of a total of 45 marks, which equates to a satisfactory assessment. The highest mark obtained for this survey was 42.5. CONCLUSIONS: Quality cytopathology preparatory techniques are integral to mitigating the risk of diagnostic error. The digital pathology platform allowed homogeneity of samples for all participants and appeared to be a satisfactory mode for demonstrating the technical problems to participants. Laboratories participating in this survey showed good performance in identifying processing and staining problems on virtual images and working through the troubleshooting steps. The exercise also identified a method for troubleshooting formalin vapour-affected slides using citrate buffer which may be useful for laboratories following in-house validation.


Assuntos
Laboratórios/normas , Teste de Papanicolaou/normas , Patologia Clínica/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Testes Diagnósticos de Rotina , Feminino , Humanos , Controle de Qualidade , Coloração e Rotulagem/métodos , Esfregaço Vaginal/métodos
14.
Cancer Causes Control ; 31(9): 839-850, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32602058

RESUMO

PURPOSE: The 2010 Affordable Care Act (ACA) provided millions of people with health insurance coverage and facilitated routine cancer screening by requiring insurers to cover preventive services without cost-sharing. Despite greater access to affordable cancer screening, Pap testing has declined over time. The aim of this study is to assess participation in Pap test and HPV vaccination, and adherence to guidelines as outlined by the American Cancer Society (ACS) from the 2010 ACA provision eliminating cost-sharing for preventive services. METHODS: Using multi-year responses from the Behavioral Risk Factor Surveillance System, we examined the association between the ACA and participation in and adherence to Pap testing and HPV vaccination behaviors as set by the ACS. The sample included women aged 21-29 who completed the survey between 2008 and 2018 (every other year) and who live in 24 US States (N = 37,893). RESULTS: Results showed significant decreases in Pap testing rates but increases in the uptake of the HPV vaccine series for all age groups and across all demographics. Post-ACA year significantly predicted increases in HPV + Pap co-testing participation and adherence. Women with health insurance coverage were more likely to engage in both behaviors. CONCLUSION: Findings raise concerns around declines in the proportion of women receiving and adhering to Pap testing guidelines. A need exists for research to examine the role of increases in HPV vaccination uptake on decreases in Pap testing. Moreover, effective strategies should target increases in cervical cancer screening uptake among women vaccinated against HPV.


Assuntos
Teste de Papanicolaou/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Custo Compartilhado de Seguro , Estudos Transversais , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Teste de Papanicolaou/economia , Teste de Papanicolaou/métodos , Vacinas contra Papillomavirus/administração & dosagem , Patient Protection and Affordable Care Act/economia , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
15.
BMC Womens Health ; 20(1): 141, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631299

RESUMO

BACKGROUND: Male spouses and partners play an important role in determining a woman's willingness to participate in cervical cancer screening. However, the attitudes and behaviors by which they influence a woman's decision to undergo Pap testing remain poorly understood. METHODS: A series of semi-structured, qualitative interviews were conducted in Spanish with 19 recent Latino immigrants in Houston, Texas. The interview format was designed to establish each individual's pattern of engagement with the United States healthcare system, assess baseline knowledge of cervical cancer screening and evaluate attitudes and patterns of communication with their female partners regarding health care. Interview questions were constructed using principles of the Theory of Reasoned Action. All interviews were conducted in Spanish. After translation, responses were coded and scored with the goal of identifying themes and key observations. RESULTS: Most subjects reported few, if any, interactions with the healthcare system since their arrival in the United States. Although most participants reported being aware that women should be seen by their doctors regularly, fewer than half could clearly indicate the purpose of a Pap test or could state with certainty the last time their female partner had undergone screening. Multiple subjects expressed a general distrust of the health care system and concern for its costs. Approximately half of subjects reported that they accompanied their female partner to the health care provider's office and none of the participants reported that they were present in examination rooms at the time their partner underwent screening. Multiple participants endorsed that there may be some concerns within their community regarding women receiving frequent gynecologic care and distrust of the healthcare system. Almost all interviewed subjects stated that while they would allow their female partners to see male physicians, they also expressed the opinion that other men might be uncomfortable with this and that women would likely be more comfortable with female physicians. CONCLUSIONS: Strategies to enhance knowledge of HPV and cancer screening and improve trust in the health care system among male spouses or partners should be explored with the goal of promoting cervical cancer screening among immigrant Latinx populations.


Assuntos
Emigrantes e Imigrantes , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Programas de Rastreamento/psicologia , Neoplasias do Colo do Útero/diagnóstico , Detecção Precoce de Câncer , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Teste de Papanicolaou , Pesquisa Qualitativa , Texas/epidemiologia , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/psicologia , Esfregaço Vaginal/psicologia
16.
PLoS One ; 15(7): e0235202, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614875

RESUMO

BACKGROUND: Cervical cancer is a highly preventable disease. To not attend an organized cervical cancer screening program increases the risk for cervical dysplasia and cervical cancer. The aim was to investigate the participation rate in three different intervention groups for non- attendees in the Swedish national program for cervical screening. The participation in the recommended follow up, and the histology found were also examined. METHOD: Population-based randomized control trial. It included10,614 women that had not participated in the cervical cancer screening programme during the last six years (ages 30-49) and the last eight years (ages 50-64) were randomised 1:1:1(telephone call from a midwife (offering the choice between a visit for a pap smear or an HPV self-sampling test); an HPV self-sampling test only; or the routine procedure with a yearly invitation). RESULTS: In the intention to treat analysis the participation rates were 25.5% (N = 803/3146) vs 34.1% (N = 1047/3068) and 7.0% (N = 250/3538) (p<0.001) for telephone, HPV self-test and control groups respectively. In the by protocol analysis including women that answered the phone call the participation rates were 31.7% (N = 565/1784) vs 26.1% (N = 788/3002) and 7.0% (N = 250/3538) (p<0.001) for telephone, HPV self-test and control groups. The corresponding results in the by protocol analysis including women that did not answer the phone call was 19.7% (N = 565/2870) vs 26.1% (N = 788/3002) and 7.0% (N = 250/3538) (p< 0.001). The majority of the women 63,4% (1131/1784) who answered the telephone wanted to participate either by booking a visit for pap smear (38,5%) or to be sent a HPV self- sampling test (24,9%) (p<0.001). Women who chose an HPV self-test were older and gave anxiety/ fear as a reason to decline participation, and they were also less likely to participate in the follow-up if found to be HPV-positive compared to the women who chose a Pap smear. The attendance to the recommended follow-up after abnormality was in total 87%. The non-attendees had a three or eight times higher risk of having a cytology result of HSIL or suspected SCC respectively, in the index sample compared to women screened as recommended (OR 3.3 CI 95% 1.9-5.2, OR 8.6 CI 1.6-30). A total of ten SCC and one adenocarcinoma were found in the histopathology results from the non-attendee group with a study intervention, while there was only one SCC in the non-attendee group without any study intervention (p = 0.02, OR 8.1 CI 95% 1.2-350). CONCLUSIONS: Our study suggests, according to intention to treat analysis, that the best intervention to get as many non-attendees as possible to participate is to send an HPV self-sampling test together with an invitation letter. Almost 90% of women in the study with an abnormal index sample attended follow-up. This is high enough to indicate that interventions to increase the participation among non-attendees are meaningful. REGISTRY: International Standard Randomised Controlled Trial Number (ISRCTN) Registration number ISRCTN78719765.


Assuntos
Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Alphapapillomavirus/isolamento & purificação , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , Humanos , Análise de Intenção de Tratamento , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Teste de Papanicolaou , Manejo de Espécimes/métodos , Suécia , Esfregaço Vaginal
17.
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
18.
BMC Womens Health ; 20(1): 119, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517800

RESUMO

BACKGROUND: Though obesity is associated with some malignancies, its association with cervical cancer is still inconclusive. This study was aimed at determining if there was an association between obesity and cervical epithelial cell abnormalities (CEA). METHODS: This was a cross-sectional comparative study of obese and non-obese women at the Cervical Cancer Screening Clinic, University of Nigeria Teaching Hospital (UNTH), Enugu between January, 2012 and June, 2013. The participants whose body mass index (BMI) were ≥ 30 kg/m2 were classified as obese (200 women) while those whose BMI were < 30 kg/m2 were classified as non-obese (200 women) and the two groups were consecutively recruited at the ratio of 1:1. Pap smear cytology, random blood sugar (RBS) and human immune-deficiency virus (HIV) screening was done for all the participants. Data was analyzed with SPSS version 20. Categorical variables were analyzed using McNemar's test and Chi-squared test. Logistic regression analysis was used to determine the influence of socio-demographic characteristics on cervical epithelial cell abnormalities. The level of significance was set at ≤0.05. RESULTS: Among the obese women, 152(76%) had negative for intra-epithelial lesion or malignancy (NILM) while 48(24%) had cervical epithelial cell abnormalities (CEA). Also 182(91%) non-obese women had NILM while the remaining 18(9%) had CEA. The prevalence of CEA among all the study participants was 16.5%. There was an association between obesity and CEA[OR (95%CI) = 1.353(1.013-1.812); P-value = 0.04].CEA were significantly more common among women who were 40 years and above and single/separated women as well as widows (P-value = < 0.05). CONCLUSION: There was an association between obesity and CEA. This underscores the need for a positive behavioural change among women in order to stem the tide of this public health problem.


Assuntos
Obesidade/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Nigéria/epidemiologia , Obesidade/complicações , Teste de Papanicolaou , Gravidez , Prevalência , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal
19.
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
20.
Public Health Rep ; 135(4): 483-491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516053

RESUMO

OBJECTIVES: Cervical cancer is the second-most common type of cancer among women aged 15-44, and racial, ethnic, and economic disparities exist in survival rates despite widely available screening tests and early treatment options. The objective of this study was to describe the association among knowledge, sociodemographic characteristics, and cervical cancer screening, with the goal of developing interventions to prevent cervical cancer in populations at risk of the disease. METHODS: In 2017, we conducted a nationwide survey of women in the United States aged ≥18 who had ever received a Papanicolaou (Pap) test (N = 630). We conducted t tests and one-way analysis of variance to determine sociodemographic differences (age, education, race, ethnicity, income, type of health insurance) in knowledge about cervical cancer screening (Pap test and human papillomavirus [HPV] test). We used logistic regressions to define significant determinants of cervical cancer screening behaviors in the previous 5 years. RESULTS: Of 629 respondents, 407 (64.7%) had an annual household income <$30 000, and 322 of 536 (60.1%) respondents had government-provided health insurance. Of 630 women who had ever had a Pap test, 425 (67.5%) had an HPV test. Hispanic and non-Hispanic white women were more likely than Hispanic and non-Hispanic black women (odds ratio [OR] = 2.49; 95% CI, 1.12-4.54; P = .02) and women with government-provided health insurance (OR = 1.91; 95% CI, 1.08-3.37; P = .03) were more likely than women with private health insurance to have received a Pap test in the previous 5 years. Knowledge of HPV was a significant predictor of having received an HPV test in the previous 5 years (OR = 1.37; 95% CI, 1.22-1.54; P < .001). CONCLUSION: Disparities in cervical cancer screening among sociodemographic groups of women suggest the need for targeted interventions to improve knowledge about Pap and HPV tests.


Assuntos
Detecção Precoce de Câncer/psicologia , Programas de Rastreamento/psicologia , Teste de Papanicolaou/psicologia , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/psicologia , Adulto , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Disparidades em Assistência à Saúde , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...