Type-Specific HPV Prevalence in Cervical Cancer and High-Grade Lesions in Latin America and the Caribbean: Systematic Review and Meta-Analysis

BACKGROUND: Cervical cancer is a major public health problem in Latin America and the Caribbean (LA&C), showing some of the highest incidence and mortality rates worldwide. Information on HPV type distribution in high-grade cervical lesions (HSIL) and invasive cervical cancer (ICC) is crucial to predict the future impact of HPV16/18 vaccines and screening programmes, and to establish an appropriate post-vaccinal virologic surveillance. The aim was to assess the prevalence of HPV types in HSIL and ICC in studies in LA&C. METHODS AND FINDINGS: We performed a systematic review, following the MOOSE guidelines for systematic reviews of observational studies, and the PRISMA statement for reporting systematic reviews and meta-analyses. Inclusion criteria were at least ten cases of HSIL/ICC, and HPV-type elicitation. The search, without language restrictions, was performed in MEDLINE, Cochrane Library, EMBASE, LILACS from inception date to December 2009, proceedings, reference lists and consulting experts. A meta-analysis was performed using arc-sine transformations to stabilize the variance of simple proportions. Seventy-nine studies from 18 countries were identified, including 2446 cases of HSIL and 5540 of ICC. Overall, 46.5% of HSIL cases harbored HPV 16 and 8.9% HPV18; in ICC, 53.2% of cases harbored HPV 16 and 13.2% HPV 18. The next five most common types, in decreasing frequency, were HPV 31, 58, 33, 45, and 52. Study's limitations comprise the cross-sectional design of most included studies and their inherent risk of bias, the lack of representativeness, and variations in the HPV type-specific sensitivity of different PCR protocols. CONCLUSIONS: This study is the broadest summary of HPV type distribution in HSIL and ICC in LA&C to date. These data are essential for local decision makers regarding HPV screening and vaccination policies. Continued HPV surveillance would be useful, to assess the potential for changing type-specific HPV prevalence in the post-vaccination era in Latin America

La distribution des bols moulés monochromes hellénistiques et augustéens sur le territoire français, état de la documentation

XXIIe rencontres de l'AFAV, Renne

Auto-exame de mama: conhecimento de usuárias atendidas no ambulatório de uma maternidade escola Auto-examen de la mama: conocimiento de las usuarias atendidas en el ambulatorio de un hospital universitario Breast self-examination: the knowledge of users assisted in the outpatient unit of a university maternity hospital

Estudo descritivo desenvolvido no ambulatório de uma Maternidade Escola em, Natal/RN. Objetivou-se identificar o conhecimento e as alterações encontradas no auto-exame de mama e descrever como as mulheres se auto-examinam. A população foi constituída por mulheres referenciadas de outros serviços de saúde, e a amostra constou de 109 mulheres que tinham entre 15 a 83 anos de idade. O instrumento para a coleta de dados foi um formulário de entrevista contendo dados de identificação e acerca do auto-exame de mama. A partir dos dados coletados, identificamos que, das 109 participantes do estudo, 36 (33%) estavam entre 15 a 39 anos de idade; 58 (53%) entre 40 a 58 anos, e 15 (14%), na faixa entre 60 a 83 anos. 75% referem se auto-examinarem e, ao detectarem alguma alteração nas mamas durante o auto-exame, procuraram o médico para o tratamento correto.<br>Estudio descriptivo desarrollado en el Servicio de Consulta Externa de un Hospital Universitario de la ciudad de Natal/RN. Tuvo como objetivo identificar el conocimiento y las alteraciones encontradas en el auto-examen de mama y describir con esas mujeres si se autoexaminan. La población estuvo constituida por mujeres remitidas de otros servicios de salud y la muestra constó de 109 mujeres que tenían entre de 15 y 83 años de edad. El instrumento utilizado para la recolección de datos fue un formulario de entrevista contiendo datos de la identificación acerca de el auto-examen de mama. A partir de los datos recolectados identificamos que de las 109 participantes del estudio, 36 (33%) estaban entre 15 y 39 años de la edad; 58 (53%) entre 40 y 58 años y 15 (14%) entre 60 y 83 años. 75% informaron que se autoexaminan y al detectar alguna alteración en las mamas durante el auto-examen, procuran el médico para el tratamiento correcto.<br>This is a descriptive study developed in the outpatient unit of a university maternity hospital in the city of Natal/RN. It aimed at identifying the knowledge about and alterations found during breast self-examination as well as at describing how women examine themselves. The population was formed by patients sent by other health services and the sample consisted of 109 women with age varying from 15 to 83 years. In order to collect data, the authors used a form containing identification information as well as about breast self-examination. Based on the collected data, they identified that among the 109 participants, the age of 36 (33%) of them varied from 15 to 39 years; of 58 (53%) of them from 40 to 58 years and of 15 (14%) of them from 60 to 83 years. 75% reported that they examined themselves and that they attended a health care service for correct treatment in case any alterations were detected during self-examination