Knowledge about cervical cancer screening among family physicians: cross-sectional survey

Background  Cervical cancer (CC) is an important public health problem worldwide. In Mexico, there has been a National Cervical Cancer Screening Program (NCCSP) since 1974. Mexican Social Security Institute attended Mexican workers and family physicians are responsible of the primary care of patients.
Objective  To evaluate knowledge about the aetiology and prevention of CC among family physicians working in Yucatan, Mexico, at Mexican Social Security Institute.
Methods  A questionnaire was applied to 187 family doctors. Self-administer questionnaire with 10 item previously used by ours and other researchers, was used for the evaluation. Each correctly answered item was given a point. The maximum grade was 10 and the minimum 0.
Results  The knowledge mean was 6.93 points. Fewer than 50% knew what to do with women who are human papillomavirus (HPV) positive without a precancerous cervical lesion and the appropriate age range for Pap smears. A total of 61.1% identified CC as an important health problem in Mexico; however, 95.1% identified CC as a preventive cause of deaths among Mexican women and recognized that HPV is the main CC aetiological agent, and 90.3% mentioned the Pap smear as the main method of diagnosis of CC.
Conclusion  The family doctors need to have an adequate knowledge of the practical elements of the NCCSP to give an efficient attention to their patients.     

Evidence for practice: oral contraception and risk of cervical cancer

PURPOSE: The issue of continued oral contraceptive use among women with abnormal Pap smears may be controversial due to reported evidence of an increased risk of cervical cancer among long term oral contraceptive users. This article reviews the evidence concerning oral contraception and cervical cancer risk. The role of Human Papilloma virus (HPV) and proposed mechanisms for the development of cervical cancer are explained. Evidence from World Health Organization (WHO) studies and additional research evidence are discussed. Implications for clinical practice are included. DATA SOURCES: WHO commissioned studies, additional relevant studies searchable from an EBSCO database, and texts that describe the natural history of HPV. CONCLUSIONS: Epidemiological studies and biomedical research suggest a role for steroid hormones, such as oral contraceptives, in facilitating the action of HPV. However, a majority of HPV infections resolve spontaneously, despite widespread use of oral contraception. Oral contraception does not appear to increase incident HPV infection or persistence of HPV infection. The benefits of oral contraceptives appear to outweigh the risks associated with HPV facilitation. IMPLICATIONS FOR PRACTICE: NPs inform patients of abnormal Pap smears, manage the clinical care of women at risk of cervical cancer, and provide educational counseling regarding contraceptive choices. Ethical considerations include clear disclosure of potential risk. However, a risk-benefit analysis supports continued use of oral contraception among women who have abnormal Pap smears but also have access to clinical surveillance.     

Interactive model of client health behavior and cervical cancer screening of African-American women

ABSTRACT Objective: Explore inductively African American women's use of Pap smear screening services and consider how well the data did or did not affirm the usefulness of the interaction model of client health behavior (IMCHB). Design and Sample: The IMCHB guided this qualitative study designed to explore women's social influence and previous health care experience and their influence on the women's cognitive appraisal associated with Pap smears and cervical cancer. Interviews were conducted with 24 women, resulting in 2 groups: routine‐use (n=11) (Pap smears every 1–3 years) and non‐routine‐use (n=13). Measures: Content analysis approach to data analysis was used, where interview data were considered in relation to elements of IMCHB. Results: Analysis revealed that the IMCHB was useful for framing cervical cancer screening health behavior research. Both groups' data fit well onto the framework. The routine‐use group fit the entire model, with iterative (repeat) behavior in cervical cancer screening. The non‐routine‐use group also fit the model, but their iterative behavior in cervical cancer screening was intermittent due to negative personal influences. Conclusions: This model can provide a focus to the delivery of gynecological care based on a client's unique characteristics that can be addressed with individualized nursing interventions designed to promote positive health outcomes.     

高危型人乳头瘤病毒E2在宫颈癌中的表达及其生物学意义

目的探讨高危型人乳头瘤病毒(HPV)E2在宫颈癌中的表达及其生物学意义。方法采用基因芯片技术对56例宫颈炎性组织、55例宫颈上皮内瘤变(CIN)组织、58例宫颈鳞癌组织进行HPV分型检测;免疫印迹技术对宫颈组织中高危型HPV E2蛋白表达水平的检测;流式细胞技术进行宫颈癌细胞凋亡的检测及Transwell试验进行细胞侵袭能力的检测。结果基因芯片技术结果显示,与宫颈炎性组比较,宫颈鳞癌组的HPV16、HPV18感染阳性率明显增高,而CIN组的HPV16、HPV18感染阳性率无明显变化。免疫印迹结果显示,与宫颈炎性组比较,宫颈鳞癌组高危型HPV E2蛋白的水平明显降低,而CIN组中HPV E2蛋白水平无明显变化。与空载体组比较,高危型HPV E2质粒组宫颈癌细胞凋亡率明显增加,宫颈癌细胞侵袭能力明显下降。结论高危型HPV E2蛋白具有诱导宫颈鳞癌细胞凋亡的作用,有望成为宫颈癌防治的有效靶标。     

女大学生HPV疫苗的接种意愿及影响因素分析——基于健康信念模式

目的了解浙江省女大学生自费接种人乳头状瘤病毒疫苗的意愿,以健康信念模式为框架分析女大学生自费接种人乳头状瘤病毒疫苗的影响因素,为今后开展健康教育活动及制订干预措施提供参考依据。方法采用自行设计的关于女大学生人乳头状瘤病毒的认知及人乳头状瘤病毒疫苗自费接种意愿调查问卷对302名女大学生进行调查,并采用单因素及多重线性回归分析。结果302名女大学生接种人乳头状瘤病毒疫苗行为意图得分(3.39±0.79)分,人乳头状瘤病毒疫苗的评价、知觉易感性、知觉到障碍、自我效能及行动线索是影响人乳头状瘤病毒疫苗接种行为意图的因素。结论浙江省女大学生自费接种人乳头状瘤病毒疫苗的意愿一般,受多种因素影响。     

The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS

The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety.

KEY MESSAGES

• The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.
• Collaborations have been established between researchers in North America and East African countries for these studies.
• Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.

     

The effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening

Purpose of the research

The aim of this study was to investigate the effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening.

Methods and sample

In this pretest-posttest longitudinal study, Turkish men over 40 years of age were given an interactive educational session on prostate cancer and prostate cancer screening, and were then given related web-assisted education and consultation for a period of 6 months. As well as the Internet, reminders such as desk calendar, booklets, e-mails and cell phone messages were used in the study. Changes in the screening behaviors, the health belief and knowledge level of patients were examined 3 and 6 months after the interventions.

Key results

During the study, participants’ prostate examination rate increased from 9.3% to 19.1% and PSA measurement rate increased from 6.7% to 31.4%. The interventions raised the susceptibility perception on prostate cancer and prostate cancer screening while decreasing the barrier perception (p < 0.05). No change was observed in other health belief components and the level of knowledge.

Conclusion

Web-assisted education and reminders provided positive changes in the barrier and susceptibility perceptions of individuals. Participation in the screening also increased.     

社区高血压患者预防脑卒中知识、信念与行为的相关性研究

目的：描述社区高血压患者脑卒中预防知识、健康信念和健康行为水平,探讨三者间的相关性。方法采.用脑卒中预防知识问卷（stroke-prevention knowledge questionnaire,SPKQ）、Champion健康信念量表（champion±39;s health belief model scale,CHBMS）、健康促进生活方式量表Ⅱ（health promoting lifestyle profile Ⅱ,HPLP Ⅱ）对广州市某社区94例高血压患者进行调查。结果社区高血压患者的SPKQ总分标准分为（62.70±177;18.39）分,CHBMS均分为（3.51±177;0.24）分,HPLPⅡ均分为（2.48±177;0.37）分。健康知识与健康信念、健康动力及自我效能维度呈正相关（r值分别为0.289、0.246及0.350,P＜0.01或P＜0.05）;健康信念的健康动力与健康行为呈正相关（r值为0.304,P＜0.01）;健康信念的感知严重性与健康行为呈负相关（r值为-0.279,P＜0.01）。结论医护人员应重视社区高血压患者对预防脑卒中相关知识的教育,促进其建立预防脑卒中的健康动力及自我效能,让患者认识到脑卒中的严重性,建立和维持健康的生活方式。     

高危型人乳头状病毒和IL-17在宫颈病变患者宫颈脱落细胞中表达的相关性和临床意义

目的 探讨高危人乳头状病毒和白细胞介素17(interleukin,IL-17)在宫颈病变中的表达及临床意义.方法 应用多重PCR技术和流式细胞技术对来我院就诊的66例妇女宫颈病变患者进行HPV-DNA、IL-17含量检测.结果 HPV阴性患者29例、HPV阳性患者20例、宫颈癌患者17例.三组所表达的IL-17的含量分别为(2.37±2.03)%、(27.99±11.28)%、(35.4±11.59)%.HPV阳性患者、宫颈癌患者的IL-17的含量比HPV阴性患者显著增高(P＜0.01),HPV阳性患者与宫颈癌患者之间无明显差别(P＞0.05).结论 IL-17与宫颈癌的发生发展相关,检测IL-17含量对宫颈癌诊断和病情变化有重要意义.     

女性肺癌易感因素、围术期护理及疗效调查

目的探讨女性肺癌患者易感因素、围术期注意事项及疗效。方法了解女性患肺癌的影响因素,对115例女性肺癌患者及同期手术的123例男性肺癌患者术后近期并发症进行分析,了解哪些因素是围术期护理的重点,电话随访统计5年生存率有无差异。结果女性肺癌患者有其特殊的易感分子因素,术后女性相对男性肺部感染、肺不张并发症较少,切口脂肪液化较男性多见,对疼痛的耐受程度较男性差,女性肺癌患者术后5年生存率高于男性患者。结论女性肺癌和男性肺癌发病有着不同的生物学基础,女性患者围术期护理尤其是术后护理有不同之处,女性肺癌患者术后5年生存率较高。     

A cross-sectional survey of calcium intake in relation to knowledge of osteoporosis and beliefs in young adult women

This investigation found that young adult women (n = 265) were very likely (80.6%) to have accurate knowledge about osteoporosis but also typically had a low calcium intake (454 mg/day). The women in this study believed that they were at risk of osteoporosis but felt that prevention was difficult. Meanwhile, they held the opinion that osteoporosis is not serious and that taking preventative measures would not be worthwhile. The factors that most strongly affected the intake of calcium by women were, in order, knowledge, number of children, self-rated health score, Body Mass Index, graduation from high school, experience of bone density examination and family history. These seven items accounted for 31.8% of the variation in calcium intake.     

组氨酸三联体及肺癌抑制因子1基因表达与宫颈癌发生及人乳头瘤病毒感染的相关性

目的探讨肺癌抑制因子1(TSLC1)及组氨酸三联体(FHIT)在正常宫颈组织、宫颈鳞状上皮内病变及宫颈癌组织中的表达及其与人乳头瘤病毒(HPV)的关系。方法采用细胞免疫组化法测定35例正常子宫组织、40例低度鳞状上皮内病变(LSIL)、38例高度鳞状上皮内病变(HSIL)及35例子宫癌组织中TSLC1及FHIT的表达情况。采用HC2基因杂交捕获仪(HC-Ⅱ)检测各组HPV感染情况。结果 HSIL、宫颈癌组织中FHIT、TSLC1阳性表达率显著低于正常宫颈组织及LSIL,而HPV阳性率则高于正常宫颈组织及LSIL(P0.05)。FHIT表达与病理分级、临床分期及淋巴结转移相关(P0.05)。TSLC1表达与临床分期及淋巴结转移相关(P0.05)。在正常宫颈组织、LSIL、HSIL及宫颈癌组织中,FHIT、TSLC1表达与HPV感染呈负相关(P0.05)。结论 FHIT、TSLC1表达缺失发生在HSIL阶段,FHIT、TSLC1表达缺失与HPV感染参与宫颈鳞状上皮细胞内病变、宫颈癌发生、侵袭及转移具有密切的关系。     

Use of a simulation intervention to examine differences in nursing students' hand hygiene knowledge,beliefs, and behaviors

BackgroundAlthough hand hygiene remains an essential aspect of quality care, adherence to best patient safety practices continues to pose major challenges.ObjectivesThe objectives of this study are to examine hand hygiene knowledge, beliefs, practices, perceived importance and behaviors using Social Cognitive Theory and simulation-based intervention.DesignParticipants were taken from a convenience sample of 131 undergraduate nursing students enrolled in a nursing fundamentals course at an urban university in the midwestern United States, and then randomly assigned to their respective groups. Using an experimental pretest-posttest design, control and intervention groups received the same lecture pertaining to hand hygiene and 3 data collection points where van de Mortel's Hand Hygiene Questionnaire (HHQ) was administered. In addition, the intervention group viewed a 6.5 min video related to healthcare acquired infection and participated in 4 simulated situations requiring hand hygiene, based on World Health Organization guidelines. For all students, the hand hygiene technique was assessed through the use of Glo Germ, followed by handwashing and photography under ultraviolet light (posttest only). Image illumination was analyzed using image processing software. Microbiological sampling plates (pretest-posttest) were assessed quantitatively by colony counting.ResultsStudy findings did not support differences in the intervention group for the 5 hypothesized relationships. Social desirability responding and negative item confusion were found to occur with the HHQ in the student population. There was a significant difference in the UV hand photographs, with students in the afternoon having lower values than students in the morning.ConclusionsGiven the study results, there were no definitive educational recommendations to teach hand hygiene to nursing students. Future research should continue to further examine multi-focal modalities to enhance adherence to hand hygiene practices, as well as control for extraneous mediating or moderating variables found in educational settings.     

人乳头状瘤病毒核酸检测试剂盒用于宫颈癌及癌前病变筛查的临床价值

目的分析人乳头状瘤病毒(HPV)杂交捕获-化学发光法核酸检测试剂盒(DH3)用于宫颈癌及癌前病变筛查的临床价值。方法收集480例妇科门诊妇女宫颈脱落细胞样本,分别采用DH3、TCT和HPV-PCR检测,对TCT≥ASC-US者行阴道镜下病理检测,以病理学结果为金标准,分析DH3诊断价值。结果病理学结果显示,正常者370例(77.08%),良性病变者(≤CINⅠ)59例(12.29%),高危者(≥CINⅡ)51例(10.63%);TCT、HPV-PCR和DH3诊断阳性率分别为26.04%、32.08%和27.08%;DH3与TCT检测一致率为94.79%(P0.01),与HPV-PCR检测一致率为93.13%(P0.01);DH3灵敏度98.18%,特异度87.57%,阳性预测值70.13%,阴性预测值99.39%,准确率为90%,检出高危型(≥CINⅡ)的ROC曲线面积Z=0.887(95%CI为0.785~0.918,P0.01)。结论 DH3试剂盒与TCT、HPV-PCR在检出HPV宫颈癌及癌前病变具有高度一致性,灵敏度、特异度和准确率高,操作便捷,临床筛查意义显著。     

Integrative review of cervical cancer screening in Western Asian and Middle Eastern Arab countries

Population‐based screening programs have resulted in minimizing mortality and morbidity from cervical cancer. The aim of this integrative review was to explore the factors influencing access of women from Western Asian and Middle Eastern Arab countries to cervical cancer screening. A systematic search for studies conducted in Arab countries in those regions, and published in English between January 2002 and January 2017, was undertaken. Thirteen papers were selected and subjected to quality appraisal. A three step analysis was used, which involved a summary of the evidence, analysis of both quantitative and qualitative data, and integration of the results in narrative form. Few population‐based cervical cancer screening programs had been implemented in the relevant countries, with low knowledge of, and perceptions about, cervical screening among Arab women, the majority of whom are Muslim. Factors affecting the uptake of cervical cancer screening practices were the absence of organized, systematic programs, low screening knowledge among women, healthcare professionals’ attitudes toward screening, pain and embarrassment, stigma, and sociocultural beliefs. Policy changes are urgently needed to promote population‐based screening programs. Future research should address the promotion of culturally‐sensitive strategies to enable better access of Arab Muslim women to cervical cancer screening.     

Women with learning disabilities: risk behaviours and experiences of the cervical smear test

This paper reports the findings of a study on the views and experiences of women with learning disabilities regarding the cervical smear test. The experience and opinions of the carers were also taken into account. The study was carried out between 1997 and 1999 in Cambridgeshire. The factors that influenced whether women with a learning disability had a smear test included: sexual activity; number of sexual partners; pregnancy; and a past history of smoking. Women with a learning disability who had a cervical smear test most often experienced pain and difficulty with the procedure. Factors that enable women with a learning disability to undergo a cervical smear test, according to their experiences, will be discussed in this paper. These include: the importance of prolonged preparation; issues surrounding communication; the giving of information; and support from the carers. The implications of these findings for collaborative working between learning disability nurses and primary healthcare professionals in clinical practice are highlighted.     

子宫颈癌合并糖尿病围术期的护理

目的：探讨子宫颈癌合并糖尿病围术期的护理方法。方法：对42例子宫颈癌合并2型糖尿病患者的临床资料和护理结果进行总结。结果：住院18～28d,术前治疗5—7d,均顺利完成手术治疗计划,无一例发生糖尿病并发症,切口1期愈合。结论：恶性肿瘤伴发其他合并症的患者,手术前正规治疗并发症,围术期加强护理,可以使患者顺利完成手术。