Impact of educational lectures on female adolescents knowledge about sexually transmitted diseases and cervical cancer in the city of Jundiaí, SP / Impacto das palestras educativas no conhecimento das adolescentes em relação às doenças sexualmente transmissíveis e câncer do colo uterino em Jundiaí, SP

Objective: To evaluate the knowledge of adolescents living in Vila Ana and Morada das Vinhas region, in the city of Jundiaí, State of São Paulo, Brazil, on prevention and diagnosis of the main sexually transmitted diseases (STDs) and on cervical cancer, as well as the immediate impact of educational lectures. Methods: A prospective cross-sectional study was performed to assess the knowledge of a particular group of female adolescents about STDs and cervical cancer, by means of a questionnaire applied before and after educational lectures. Results: After the lecture, there was an increased number of correct answers about sexual education, knowledge about HPV (44%), and prevention of cervical cancer (22%). Conclusion: The adolescents in our study had little knowledge about STDs and cervical cancer, but educative lectures could change this reality at a low cost to Public Health services.

Objetivo: Avaliar o conhecimento das adolescentes moradoras nas regiões abrangentes da Vila Ana e da Morada das Vinhas, na cidade de Jundiaí (SP), sobre a prevenção e diagnóstico das principais doenças sexualmente transmissíveis (DSTs) e do câncer de colo do útero, além de avaliar o impacto imediato de palestras educativas. Métodos: Foi realizado estudo prospectivo de corte transversal para avaliar o conhecimento de um determinado grupo de adolescentes sobre DSTs e câncer do colo uterino, por meio de um questionário aplicado antes e logo após a realização de palestra educativa. Resultados: Após a exposição da palestra, houve aumento de respostas corretas sobre educação sexual, conhecimento do HPV (em 44%) e sobre a prevenção do câncer de colo de útero (em 22%). Conclusão: As adolescentes que participaram do estudo têm pouco conhecimento em relação às DSTs e câncer do colo uterino, mas as palestras educativas são capazes de reverter essa realidade com baixo custo à Saúde Pública.

Active search of women as an efficacy factor for a breast and cervical cancer screening program in the city of Jundiaí, São Paulo, Brazil / Busca ativa de mulheres como fator de eficácia de programa de rastreamento de câncer de mama e colo uterino no município de Jundiaí

Objective: To compare the profile of women looking for gynecological care to the profile of women invited to participate in the program, assessing breast and cervical cancer risk factors in each group and comparing Papanicolaous test and mammography results. Methods: Medical records of 46 women participating in a breast and cervical cancer prevention program and 42 medical reports of women that regularly visited the primary healthcare unit from August to December 2006 were examined. Results: The mean interval between the last Papanicolaous tests was of approximately 19.7 months when comparing women visiting their physician and 25.3 participants in the program. There was one case (1.1%) of high grade intraepithelial lesion in one woman included in the program. Regarding breast cancer, when comparing both groups, we verified that all women above the age of 40 years that participated in the program underwent mammography; this was not verified in the group seeing a physician. This shows the efficacy of this screening, actively looking for women in the age group at risk for breast cancer. Conclusions: Active search is important to recruit women; the screening program needs improvement to show its real impact on morbidity and mortality of these cancers.

Objetivo: Comparar o perfil das mulheres que buscam atendimento ginecológico ao perfil de mulheres convidadas a participarem do programa, avaliando-se fatores de risco para câncer de mama e de colo uterino presentes em cada grupo e comparando os resultados dos exames de Papanicolaou e mamografia. Métodos: Foi realizado levantamento de 46 prontuários de mulheres de um programa de prevenção de câncer de colo do útero e mama e de 42 prontuários de pacientes que consultaram rotineiramente o médico da unidade básica de saúde entre agosto e dezembro de 2006. Resultados: Constatou-se que o intervalo médio entre os dois últimos exames de Papanicolaou foi de aproximadamente 19,7 meses entre as mulheres que consultaram o médico e 25,3 entre as participantes do programa. Houve um caso (1,1%) de lesão intraepitelial de alto grau em uma paciente incluída no programa. Com relação ao câncer de mama, comparando-se os dois grupos, observou-se que todas as mulheres acima de 40 anos do Grupo Programa realizaram mamografia, o que não ocorreu no Grupo Médico. Isso mostra a eficiência do programa de rastreamento na busca ativa de mulheres que se encontram na faixa etária de risco para o câncer de mama. Conclusões: A busca ativa é importante para o recrutamento de mulheres, havendo necessidade de aprimorar o programa de rastreamento para evidenciar seu impacto na morbiletalidade das doenças.

Impact of educational lectures on female adolescents' knowledge about sexually transmitted diseases and cervical cancer in the city of Jundiaí, SP.

OBJECTIVE: To evaluate the knowledge of adolescents living in Vila Ana and Morada das Vinhas region, in the city of Jundiaí, State of São Paulo, Brazil, on prevention and diagnosis of the main sexually transmitted diseases (STDs) and on cervical cancer, as well as the immediate impact of educational lectures. METHODS: A prospective cross-sectional study was performed to assess the knowledge of a particular group of female adolescents about STDs and cervical cancer, by means of a questionnaire applied before and after educational lectures. RESULTS: After the lecture, there was an increased number of correct answers about sexual education, knowledge about HPV (44%), and prevention of cervical cancer (22%). CONCLUSION: The adolescents in our study had little knowledge about STDs and cervical cancer, but educative lectures could change this reality at a low cost to Public Health services.

Active search of women as an efficacy factor for a breast and cervical cancer screening program in the city of Jundiaí, São Paulo, Brazil.

OBJECTIVE: To compare the profile of women looking for gynecological care to the profile of women invited to participate in the program, assessing breast and cervical cancer risk factors in each group and comparing Papanicolaou's test and mammography results. METHODS: Medical records of 46 women participating in a breast and cervical cancer prevention program and 42 medical reports of women that regularly visited the primary healthcare unit from August to December 2006 were examined. RESULTS: The mean interval between the last Papanicolaou's tests was of approximately 19.7 months when comparing women visiting their physician and 25.3 participants in the program. There was one case (1.1%) of high grade intraepithelial lesion in one woman included in the program. Regarding breast cancer, when comparing both groups, we verified that all women above the age of 40 years that participated in the program underwent mammography; this was not verified in the group seeing a physician. This shows the efficacy of this screening, actively looking for women in the age group at risk for breast cancer. CONCLUSIONS: Active search is important to recruit women; the screening program needs improvement to show its real impact on morbidity and mortality of these cancers.

Increased risk of oncogenic human papillomavirus infections and incident high-grade cervical intraepithelial neoplasia among smokers: experience from the Latin American screening study.

BACKGROUND: The purpose of this study was to assess the effect of smoking on the prevalence and incidence of high-risk human papillomavirus (hr-HPV) infection and cervical intraepithelial neoplasia (CIN) in a large sample of Latin American women. METHODS: The study examines baseline data on over 12,000 women included in the Latin American Screening Study (Brazil and Argentina), and over 1000 women followed-up for a period of 36 months. Three groups were formed: never smokers, current, and past smokers. The prevalence of hr-HPV infection and CIN were compared between the study groups. In the prospective analysis, women were controlled at 6-month intervals to assess the cumulative risk of incident hr-HPV infection, smear abnormalities, and CIN. RESULTS: A higher prevalence (21.7%) of hr-HPV infection was found among current smokers as compared to never smokers (16.5%) or past smokers (13.5%). Being current smoker was significantly (P <0.01) associated with hr-HPV detection (OR = 1.6; 95% CI = 1.2-2.1). Being a current smoker was a significant predictor of incident hr-HPV during the follow-up [Hazards ratio (HR) = 1.4; 95% CI 1.0-1.9]. For incident CIN2+, being a past smoker (HR = 3.6; 95% CI 1.6-9.8) or current smoker (HR = 3.6; 95% CI 1.5-8.6) were the significant independent predictors. Current and past smokers had a significantly increased risk of incident CIN2+ (P <0.01). CONCLUSIONS: Smoking increases the risk of contracting hr-HPV infection and modifies the effect of a persistent hr-HPV infection by further increasing the risk of developing CIN2+. It seems that this effect modification persists over several years after smoking cessation.

Smoking worsens the prognosis of mild abnormalities in cervical cytology.

OBJECTIVE: To examine the effect of smoking on the incidence of low- and high-grade cervical intraepithelial neoplasia (CIN) in women with a baseline Pap smear of atypical squamous cells (ASC) or a low-grade squamous intraepithelial lesion (LSIL). DESIGN: Prospective study in which a cohort of women with normal colposcopy and ASC/LSIL at baseline were followed at 6-month intervals of up to 36 months. Women were grouped in post-hoc analysis according to their smoking behavior: never (or past) smokers and current smokers. SETTING: This report was based on data from the Latin American Screening Study, conducted in Sao Paulo, Campinas, Porto Alegre (Brazil) and Buenos Aires (Argentina). POPULATION: A subset of 150 women derived from a cohort of 1,011 women. METHODS: Multivariate Cox analysis and Kaplan-Meier curves were used. MAIN OUTCOME MEASURES: Low- and high-grade CIN during follow-up. RESULTS: The only factor related to an increased risk of developing CIN was the positive high-risk (hr) HPV status (hazard ratio (HR) = 3.42; 95% CI: 1.11-9.43). A total of 21 cases of incident CIN were detected during follow-up. Of these, 11 appeared in the group of 67 smokers and 10 among the 83 non-smoker women (log-rank, p=0.33). Smoking status was not associated with the risk of developing CIN (HR = 0.73; 95% CI: 0.40-1.33). However, when restricting the analysis to high-grade CIN only (11 cases), the probability of developing the disease was significantly higher among smokers (p=0.04). CONCLUSIONS: Smoking contributes additional risk for developing high-grade CIN in women with ASC or LSIL cytology but normal colposcopy.

Anorexia nervosa: repercussões endócrinas de interesse para o ginecologista / The endocrine consequences of anorexia nervosa of interest to the gynecologist

Os autores fazem revisão acerca das repercussões da anorexia nervosa (AN) nos sistemas genital e reprodutivo feminino, do ponto de vista endócrino. Analisam, ainda, as alterações ocorridas no eixo hipotála-mo-hipófise-gônadas que trazem como consequência a amenorréia e atualizam teorias sobre o seu mecanismo...

Rastreamento, diagnóstico e tratamento das lesões precursoras e do câncer invasor de colo uterino no Município de Franco da Rocha, SP / Sreening, diagnosis and treatment of precursory lesions and invasive cervical cancer in the city of Franco da Rocha, São Paulo, Brazil

O objetivo deste estudo do tipo transversal foi avaliar a gravidade da lesão cervical entre mulheres com biópsia decolo uterino compatível com lesão precursora ou câncer e os principais fatores associados ao diagnóstico histológico,bem como os procedimentos e materiais disponíveis para rastreamento, diagnóstico e tratamento. Foram revisadosos prontuários de todas as mulheres com biópsia de colo uterino alterada atendidas no Hospital Regional deFranco da Rocha, entre janeiro de 1998 e dezembro de 2002. Os recursos existentes no hospital e nos postos desaúde do Município foram avaliados através de entrevista com um funcionário de cada local. A cobertura doexame de citologia (CO) foi calculada embasada nos dados do Datasus. Para a análise da associação entre asvariáveis e o diagnóstico histológico foram calculados os Odds Ratio com intervalo de confiança de 95 por cento. Foramidentificados 87 prontuários: 52 por cento HPV/ NIC 1, 27 por cento NIC 2/ NIC 3, e 21 por cento câncer invasor. As variáveisassociadas ao diagnóstico de NIC 2/ NIC 3 foram procura de atendimento por CO ou biópsia alterada, idade de35 a 49 anos e ter tido cinco partos ou mais. Por outro lado, procura de atendimento espontaneamente e porsintoma específico de câncer e, idade de 35 a 49 anos e 50 anos ou mais, ter tido cinco partos ou mais, ou oprimeiro parto com 18 anos ou mais, não usar anticoncepcional hormonal e não possuir CO prévia foram variáveisassociadas ao câncer invasor. A cobertura do exame citológico foi menor que 25 por cento em todos os anos.

The objective of this cross-sectional study was to evaluate the severity of cervical lesion among women withpreneoplasic or invasive cervical biopsy, the characterisitics of these women, as well as the procedure and resourcesavailable to screen, diagnose and treat them. The files of all women with abnormal cervical histologicaldiagnosis, who attended the Franco da Rocha Regional Hospital between 1998 and 2002, were reviewed. Toevaluate the resources available in the hospital and in the primary healthcare units, an interview was carried outwith one employee from each facility. The Pap test coverage was estimated using data from Datasus. Odds Ratios,with a confidence interval of 95%, were estimated for the analysis of the association between the variables and the histological diagnosis. Eighty-seven files were identified - 52% with a diagnosis of HPV / CIN 1, 28% of CIN 2/ CIN 3, and 21% of invasive cervical cancer. Presenting to the hospital because of abnormal cytology and/orbiopsy results, being between 35 and 49 years old and having had five or more deliveries were factors associatedwith CIN 2 / CIN 3. Presenting for a specific symptom of cancer, attending the hospital spontaneously, being 50or more years old, or 35 to 49 years of age, having had five or more deliveries, not having used contraceptive pillsand not having had a previous Pap smear were factors positively associated with a diagnosis of invasive neoplasia. The Pap smear coverage was below 25% for every year studied.

Fatores associados às alteraçöes da colpocitologia oncológica, à inspeçäo visual com ácido acético e à detecçäo de DNA-HPV de alto risco oncológico em mulheres de uma unidade básica de saúde em Campinas / Factors associated with pap smear and visual inspection alterations and oncogenic high-risk DNA-HPV

Objetiva avaliar fatores associados às alteraçöes da colpocitologia oncológica - CO -, à inspeçäo visual com ácido acético - IVA - e à detecçäo de DNA-HPV em mulheres de uma unidade de saúde de Campinas