HPV Vaccination in Female Children with Special Health Care Needs

Study ObjectivePotential barriers between parents of children with special health needs (CSHCN) and their health care providers in regards to the patient receiving a full course of the human papillomavirus (HPV) immunization are explored in this study.Study DesignParents of female CSHCN between ages of 9-26 years completed a questionnaire asking about personal receptivity of vaccines and potential barriers to vaccinating their child against HPV. A separate survey was completed by members of the Wisconsin and Illinois chapters of the American Academy of Pediatrics about HPV vaccination practices provided to patients with special health care needs.SettingOutpatient urban health clinic and the Children’s Hospital of Wisconsin’s Adolescent Medicine and Neurology clinics from January 2009-2010.ResultsSeventeen parents completed the survey. Forty-seven percent of parents answered that their child’s pediatrician had offered the HPV vaccine; 17% reported that their child was vaccinated against HPV. Most parents knew that HPV is a sexually transmitted infection, causes genital warts, and can cause abnormal pap smears. For the provider survey, 77 out of 130 respondents offer HPV vaccine as part of their practice and see CSHCN. Ninety percent have vaccinated CSHCN against HPV.ConclusionsThis study suggests that acceptability of the HPV vaccine is high for health care providers, but acceptability in parents of CSHCN is lower than in the general population. This study raises awareness that health care providers need to be aware of the possibility that parents of CSHCN may not perceive their child as needing or being offered the HPV vaccine.     

Association between Maternal Preventive Care Utilization and Adolescent Vaccination: It's Not Just About Pap Testing

Study ObjectiveTo examine the association between maternal preventive care utilization and human papillomavirus (HPV) vaccine uptake by their adolescent daughters.DesignA cross-sectional study using immunization records from administrative claims and the state health department's immunization information system from June 2006 through May 2011.ParticipantsCommercially-insured Michigan females aged 13-17 in May 2011 and their mothers. Mothers were identified using relationship information on the insurance contract.Main Outcome MeasuresUsing logistic regression, we investigated whether initiating and/or completing the HPV vaccine series were associated with maternal preventive care utilization (Papaniculou testing, mammograms, primary care office visits) independently and using a combined maternal preventive care utilization index.ResultsAmong 38,604 mother-daughter pairs, 36% of daughters initiated and 22% completed the HPV vaccine series. Maternal utilization of each recommended service was modestly associated with both daughter's initiation and completion of the HPV vaccine. Effect estimates for receipt of Papaniculou test on vaccine initiation (OR = 1.07, 95% CI = 1.06-1.08) were not any higher than for mammograms (OR = 1.10, 95% CI = 1.08-1.11) or primary care office visits (OR = 1.07, 95% CI = 1.06-1.09). Using a maternal preventive care utilization index, vaccine uptake increased with an increasing number of received services.ConclusionsMaternal receipt of recommended preventive care, which may reflect general attitudes toward prevention, is as or more predictive of daughter's vaccination status than cervical cancer screening alone. Engaging women in broad routine preventive care practices may have additional positive effects on adolescent HPV vaccination beyond those achieved through cervical cancer prevention efforts alone.     

HPV Vaccination Recommendation Practices among Adolescent Health Care Providers in 5 Countries

Study Objective

To assess adolescent health care providers’ recommendations for, and attitudes towards human papillomavirus (HPV) vaccination in 5 countries.

Gynecologic Care for Transgender Adults

Purpose of the Review

Transgender people need both routine gynecological and reproductive health care and services specific to gender-affirming processes. However, there is little evidence to guide their routine gynecological and reproductive health care, and data suggests that 33% of transgender people avoid routine health care due to persistent discrimination and disrespect. Here we systematically approach the care of transmasculine and transfeminine people for practicing obstetrician-gynecologists (OBGYNs) with an eye towards enhancing knowledge and enhancing respectful care.

Recent Findings

Though hampered by a paucity of high-quality data specific to transgender people, topics covered in the review include routine health care maintenance; including cancer screening, assessment of sexually transmitted infections, and contraception; as well as issues specific to transgender individuals such as to use of gender-affirming hormones and care surrounding gender-affirming surgeries. Additionally, we incorporate perspectives to support cultural humility and provider preparedness towards promoting patient comfort in seeking and obtaining care.

Summary

We aim to demonstrate that though there are some clinical topics specific to transgender people and their health care that warrant enhanced training and resources, obstetrician-gynecologists (OBGYNs) are actually well-poised to support the care of this population. Bringing awareness of the needs of transgender people to OBGYNs will help decrease the well-documented care gap for this underserved population.

     

Primary HPV screening for cervical cancer

Cytology-based cervical screening had unequivocal success in reducing the incidence and mortality of cervical cancer in the last century. The recognition of the role of human papillomavirus (HPV) as a necessary cause of cervical cancer led to the development of HPV testing. Gradually, there has been a shift from reflex HPV testing for mild cytological abnormalities, to co-testing with cytology and HPV, and lately to primary HPV screening, based on evidence from well-designed large randomized controlled trials and meta-analyses. Advantages of primary HPV screening include higher sensitivity to detect pre-neoplastic lesions, better re-assurance with a negative test, and safe prolongation of screening intervals. However, clinicians and policy makers must ensure the availability of clinically validated HPV assays and triage protocols of screen positive cases prior to implementation of primary HPV screening. This is likely to reduce potential harm from over-treatment as well as extra burden on the health care system.     

Répartition des génotypes de papillomavirus humain dans les frottis ASC-US de patientes infectées ou non par le VIH-1. Résultats préliminaires d’une enquête rétrospective locale

ObjectivesAnalysis of the distribution of human papillomavirus (HPV) genotypes amongst HIV-negative and HIV-positive women diagnosed with atypical squamous cells of undetermined significance (ASC-US).Patients and methodsWe performed a retrospective study of HPV genotype distribution in 313 ASC-US Pap smears from women who consulted at the University Hospital of Nice between 2008 and 2012. HPV genotyping results, conducted on PapilloCheck^® HPV DNA Chip, and information on the status of HIV patients were retrospectively collected. The odds ratio were calculated by logistic regression.ResultsIn co-infected HIV/HPV women we observed a low prevalence of HPV16, a high prevalence of oncogenic HPV low risk and a high prevalence of HPV 68 compared to non-co-infected women. By grouping HPV HR based on their prevalence in cervical cancer of the uterus and their genetic proximity we observe that HPV 18, 45, 68 (the “alpha-7”) are 7.4 times more represented (CI95 [2.48 to 22.35]) than HPV 16, 31, 33, 52, 58 (the “alpha-9”) in the population of women co-infected with HIV.Discussion and conclusionGiven that HPV “alpha-7” are responsible for 46.3% of adenocarcinomas, the high prevalence of these HPV found in ASC-US Pap smears of co-infected women should be put in relation with the highest prevalence of glandular abnormalities found in this population. HPV genotyping could become an essential tool for gynecological care for HIV positive women.     

Guidelines for Perinatal Care

The health care system should be oriented toward providing family centered care, the underlying assumption of which is that the family is the primary source of support for anyone receiving health care services. Family-centered health care professionals engage parents as caregivers and partners and seek to ensure that every encounter builds on the family's strengths, preserves their dignity, and enhances their confidence and competence. These health care professionals strive to understand each family's priorities and needs, incorporating the family's perspective into an individualized plan of care for each infant. Such an approach offers families real choices and respects the decisions they make for themselves and their children. In family-centered perinatal services, women and their families are involved in all aspects of planning, delivering, and evaluating health care services. This approach creates a climate in which decisions at all levels throughout the perinatal program and hospital are based not only on the expertise and assumptions of health care professionals, but also on the needs, values, and strengths of the newborns and their families.     

The Care of Adolescents by Obstetrician-Gynecologists: A First Look

Study ObjectiveTo determine whether obstetrician-gynecologists who typically care for adolescent patients, what this care entails, and the adequacy of training opportunities in adolescent health care.DesignA questionnaire designed to elicit information regarding practice patterns of obstetrician-gynecologists mailed to the American College of Obstetricians and Gynecologists Collaborative Ambulatory Practice Network.ParticipantsObstetrician-gynecologists whose patient populations included girls under the age of 18.Main Outcome MeasuresItems in the questionnaire were generated to determine what care obstetrician-gynecologists are providing to adolescents, whether this care meets practice guidelines of major medical organizations, and whether obstetrician-gynecologists are receiving adequate training to provide this care.ResultsObstetrician-gynecologists frequently care for adolescent patients, with 72.6% seeing adolescents either monthly or weekly. The most frequently cited service needs pertained to reproductive health. Obstetrician-gynecologists also provide primary care, with 55.2% currently providing immunizations to adolescent patients. Nearly all (96.5%) plan to provide HPV immunizations. Most (80% or more) considered their residency training in obstetrics-gynecology on reproductive health to be adequate, but many reported inadequate or no training on primary care.ConclusionsObstetrician-gynecologists are an important part of the health care team caring for female adolescent patients. There is a lack of training during residency in obstetrics-gynecology in adolescent primary care issues. Increased training of obstetrician-gynecologists in all aspects of adolescent health care may increase the pool of health care providers who care for adolescents adequately. Collaborative efforts among all adolescent health care providers can improve access to quality health care for adolescents and the health of this population.     

Knowledge and attitudes about human papillomavirus, Pap smears, and cervical cancer among young women in Brazil: implications for health education and prevention

The objective of the study was to assess knowledge and attitudes about human papillomavirus (HPV), cervical cancer, and Papanicolaou (Pap) smears among young women. A questionnaire was administered to 204 women aged 16-23 years, attending a public clinic. Data were gathered on sociodemographic characteristics, knowledge, and attitudes related to HPV. Overall, 92% of women reported current/previous sexual activity, 42% perceived themselves at high risk of acquiring a sexually transmitted disease, 67% did not know that HPV can cause cervical cancer/warts, and only 10% acknowledged that HPV might lead to cervical cancer. In general, women had a poor knowledge on HPV diagnosis/treatment, condyloma signs, and Pap smear test. The main reasons for not having a Pap smear test done before were embarrassment (63%) and fear of pain (61%). Knowledge of HPV infection and cervical cancer was low in this urban young population. Our findings recommend for greater HPV education of the public and health care practitioners.     

The HPV vaccine mandate controversy

In this editorial we address the controversies surrounding human papillomavirus (HPV) vaccine school-entry mandate legislation, but differentiate between the mandate debate and issues specific to the vaccine itself. Our goal is not to take a stand in favor of or opposed to mandates, but rather to critically examine the issues. We discuss the following arguments against HPV vaccine school-entry requirements: 1. The public health benefit of mandated HPV vaccination is not sufficient to warrant the intrusion on parental autonomy; 2. A vaccine that prevents a non-casually transmitted infection should not be mandated; 3. Opt-out provisions are inherently unfair to parents who oppose HPV vaccination; 4. Limited health care dollars should not be directed toward cervical cancer prevention; and 5. The vaccine is expensive and potential problems with supply suggest that mandates should not be implemented until insurance coverage and supply issues are resolved. Next, we critically evaluate the following critiques of HPV vaccination itself: 1. Giving girls HPV vaccine implies tacit consent to engage in sexual activity; 2. Giving girls this vaccine will confer a false sense of protection from sexually transmitted infections and will lead to sexual disinhibition; 3. Children already have too many vaccinations on the immunization schedule; 4. Long-term side effects of HPV vaccine are unknown; 5. The vaccine's enduring effectiveness is unknown and booster shots may be required; and 6. It is wrong to only target girls with HPV vaccine; boys should be vaccinated as well.     

Forced and Coerced Sterilization of Indigenous Peoples: Considerations for Health Care Providers

Forced and coerced sterilization refers to the provision of permanent contraception without true informed consent. In Canada, this topic is particularly relevant to Indigenous Peoples because of this country's history of racialized eugenics programs. In this commentary, we briefly review the history of forced and coerced sterilization in Canada, describe the clinical considerations for health care providers who work with Indigenous patients in this context, and outline calls to action for health care providers and organizations to support the provision of culturally appropriate reproductive health care to Indigenous people.     

Comparison of urine and self-collected vaginal samples for detecting human papillomavirus DNA in pregnant women

Objective

To investigate the utility of urine sampling for detecting human papillomavirus (HPV) DNA among pregnant women and to compare HPV DNA detection in urine with detection in vaginal samples.

Methods

In a cross-sectional study, urine and vaginal samples were self-collected from pregnant women attending prenatal care at Hospital Divina Providencia, Frederico Westphalen, Brazil, between October 2006 and August 2007. Part of the L1 region of the HPV genome was amplified via GP5⁺/bioGP6⁺ primers. Positive urine was genotyped for high-risk HPV genotypes (HPV16, HPV18, HPV31, HPV33, HPV39, HPV45, and HPV59).

Results

During the study period, urine samples were obtained from 133 pregnant women, 63 of whom also self-collected vaginal samples. HPV DNA was detected in 54.0% (34/63) and 61.9% (39/63) of urine and vaginal samples, respectively. HPV infection was significantly associated with first intercourse at younger than 20 years of age (P = 0.008). There was substantial agreement in HPV DNA test results between the urine and vaginal samples (κ value, 77.3%; P < 0.0001). HPV31 and HPV16 accounted for 80.7% of the oncogenic types identified.

Conclusion

Detection of HPV DNA in urine showed good agreement with detection in self-collected vaginal samples, indicating that urine might be a reliable sample for HPV testing among pregnant women.     

Prevalence and Clinical Utility of Human Papilloma Virus Genotyping in Patients with Cervical Lesions

Objective

Cervical cancer is the commonest cancer among Indian women. High-risk human papilloma virus (HPV) detection holds the potential to be used as a tool to identify women, at risk of subsequent development of cervical cancer. There is a pressing need to identify prevalence of asymptomatic cervical HPV infection in local population. In our study, we explored the prevalence of HPV genotypes and their distribution in women with cervical lesions.

Methods

Scrape specimens were obtained from 100 women (study group) with cervical abnormalities. HPV was detected with amplicor HPV tests, and the individual genotypes in these specimens were identified by Hybribio Genoarray test kit. Fifty specimens were also collected from females with healthy cervix (control group). The present study also aimed to determine the status of HPV prevalence and its association with different sociodemographic factors.

Results

Out of the total number of 100 samples, 10 (10 %) women tested positive for HPV DNA. Among them, HPV 18 was observed in 6, HPV 16 in 2, HPV 52 and HPV 39 in one each. Fifty specimens collected from patients with healthy cervix were not infected with any of the HPV genotype.

Conclusions

Our study generates data of HPV prevalence in patients with cervical lesions visiting tertiary care institute. The data generated will be useful for laying guidelines for mass screening of HPV detection, treatment, and prophylaxis.     

Lesbian Health Care Issues: A Guide for Gynaecologists

Lesbian women make up six to ten percent of females. There is a paucity of research about the health care concerns of this group of women. There appear to be difficulties in the physician-patient interaction when the patient is a lesbian. As gynaecologists, we need to be aware of any health care issues unique to these women. We need to create a positive climate for health care because presently, many lesbian patients avoid health care interactions because of fear.     

Case Report of Nursing Care for a Pregnant Woman With Cystic Fibrosis

Life expectancy for individuals with cystic fibrosis (CF) has significantly increased during the last few decades, and subsequently, more women with CF are considering pregnancy. A detailed understanding of the management of pregnancy, specific pulmonary treatments, and necessary medications is essential to provide specialized care for women with CF. In this article, we present the physical and psychosocial aspects of care for pregnant women with CF and describe a case involving the planned pregnancy of a nulliparous woman with CF. We suggest vigilant monitoring for adequate nutrition, weight gain, and pulmonary function throughout pregnancy as implications for nursing care.     

HOME BIRTH AND SHORT-STAY DELIVERY: Lessons in Health Care Financing for Providers of Health Care for Women

The current restructuring of the U.S. health care delivery system is driven primarily by economic forces. Although primary care providers may understand the roles of technology and advocacy in fostering fundamental change, they may not be familiar with the issues related to financing of health care and, thus, may not fully appreciate the extent to which economic factors influence the character of their professional lives and the services they provide. Analysis of the loss of the home birth option in the 1950s provides a method for understanding and influencing the factors driving health care restructuring today. In examining short-stay delivery in the 1990s, this article also addresses ways in which managed health care systems may improve or restrict women's access to a variety of primary care services.     

Risk of Cervical Dysplasia After Colposcopy Care and Risk-Informed Return to Population-Based Screening: A Systematic Review

This systematic review examined the risk of cervical dysplasia among women who have undergone a colposcopy episode of care to inform their return to population-based cervical screening. PubMed, Embase, and grey literature were searched between January 2000 and 2018. One reviewer screened citations against pre-defined eligibility criteria. A second reviewer verified 10% and 100% of exclusions at title and abstract and at full-text screening, respectively. One reviewer extracted data and assessed methodological quality of included articles; a second reviewer verified these in full. The primary outcome was incidence of cervical intraepithelial neoplasia grade 2 or greater (CIN2+) subsequent to initial colposcopy evaluation. Secondary outcomes included incidence of CIN2+ after negative follow-up test results and performance of follow-up strategies. Results were synthesized narratively. A total of 48 studies were included. The 1- to 5-year CIN2+ risks after colposcopy evaluation ranged from 2.4% to 16.5% among women treated for CIN2+ and from 0.7% to 16.8% among women untreated for CIN grade 1 or less (≤CIN1). Follow-up strategies included single or repeat cytology, human papillomavirus (HPV) testing, or combined HPV/cytology co-testing at various intervals. After negative follow-up test results, risk varied by follow-up strategy for both groups and by referral cytology severity for untreated women. Performance of follow-up strategies varied among treated women. Among untreated women, co-testing demonstrated greater sensitivity than cytology alone. In conclusion, women treated during colposcopy for CIN2+ and women with ≤CIN1 who were referred to colposcopy for low-grade cytology and who did not receive treatment may be able to return to population-based screening after negative co-testing results. Current evidence does not suggest that women untreated for ≤CIN1 who are referred for high-grade cytology be returned to screening at an average risk interval. The optimal strategy for colposcopy discharge needs ongoing evaluation as implementation of HPV testing evolves.     

Human papillomavirus type 18 and other risk factors for cervical cancer in Jakarta, Indonesia

Infection with human papillomavirus (HPV) has now been established as a necessary cause of cervical cancer. Indonesia is a country with a high cervical cancer incidence and with the world's highest prevalence of HPV 18 in cervical cancer. No information exists about the prevalence of HPV 18 or other HPV types in the Indonesian population. We conducted a hospital-based case-control study in Jakarta, Indonesia. A total of 74 cervical carcinoma cases and 209 control women, recruited from the gynecological outpatient clinic of the same hospital, were included. All women were HPV typed by the line probe assay, and interviews were obtained regarding possible risk factors for cervical cancer. HPV was detected in 95.9% of the cases and in 25.4% of the controls. In the control group, 13.4% was infected with a high-risk HPV type. HPV 16 was detected in 35% of the case group and in 1.9% of the control group and HPV 18 was identified in 28% of the case group and in 2.4% of the control group, suggesting that the oncogenic potentials of HPV 16 and HPV 18 in Indonesia are similar. In addition to HPV infection, young age at first intercourse, having a history of more than one sexual partner, and high parity were significant risk factors for cervical cancer. Within the control group, we did not identify determinants of HPV infection. We hypothesize that the high prevalence of HPV 18 in cervical cancer in Indonesia is caused by the high prevalence of HPV 18 in the Indonesian population.     

Health Care Decision Making by Mothers for their Adolescent Daughters Regarding the Quadrivalent HPV Vaccine

Study ObjectiveIn this study we sought to understand the predictors of a mother's decision (behavior) to vaccinate her daughter with the initial dose of the HPV vaccine.DesignThis prospective, cross sectional study involved a convenience sample of 68 mother-daughter dyads recruited to test the hypothesis that the Theory of Planned Behavior (TPB) variables (attitudes toward vaccine, perception of others' opinions, and perceived difficulty in obtaining vaccine) would explain a mother's decision to consent for her daughter to receive the first dose of the HPV vaccine.Main Outcome MeasuresMothers and daughters independently completed survey instruments that measure the variables of the TPB (attitude, subjective norms, and perceived behavioral control). Instruments also included measures of parenting style and conflict.ResultsThe mother's intention to vaccinate was predicted by her attitude (β = .41, P < .001), subjective norms (β = .33, P = .002), and perceived behavioral control (β = .24, P = .005). The pathway connecting intention to the decision (yes or no) to vaccinate was significant (β = .41, P < .001). Squared multiple correlations for intention and decision, respectively, were .68 and .12. The mothers who chose to vaccinate their daughter did not differ on any of the demographic variables from those who chose not to vaccinate but had significantly different scores on attitude, subjective norms, and intention but not perceived behavioral control.ConclusionsThe TPB model demonstrates potential influences on a mother's intention to choose to initiate the HPV vaccination series for her daughter. Influences of attitude, subjective norms and perceived control are potential targets for interventions and tailored social marketing to improve vaccine acceptance.