HPV vaccine: knowledge and acceptance to ensure effectiveness

The new Vaccine technologies against transmissible and non-transmissible diseases, such as cancer, have had an impact on international public health. The human papillomavirus (HPV) vaccine is used on a large scale in immunization programs in more than 58 countries, with resultant efficacy and safety for precursor lesions of cervical cancer, in addition to anogenital lesions. After the introduction of quadrivalent HPV vaccine (6,11,16 and 18) in Brazil in 2014, monitoring the vaccination coverage and the development of HPV prevalence incidence of cervical abnormalities and precancerous lesions must be observed, as well as morbidity and mortality trends from in situ and invasive cancer. Encouraging information, counseling and continuing education is recommended as a strategy to broaden vaccine acceptance in order to sediment its implementation and ensure effectiveness in reducing new cases of cervical cancer in the future

Concepts and movements in health promotion to guide educational practices

Introduction: in health promotion, practices are necessary to trigger mechanisms aimed at the creation or recreation of a new mode of enhancing health, in order to overcome the still-oriented actions of the biological approach. Prevailing actions oh health care, although important to the sector, do not advance toward a positive concept. Objective: to analyse the historical process of health as a concept and care models in the search for a new model of health promotion. Methods: This is a refl ective review designed to understand and appraise the international and national literature from Medline/PubMed, Lilacs and the Scientifi c Electronic Library (Scielo). For the organization of data, articles were separated by themes, and the process of categorisation was conducted based on content analysis.Results: Despite having the knowledge that consistent actions with the assumptions of health promotion are of great importance to quality of life and equity in health, implementing them remains a challenge due to the predominance of curative practices and an individualistic approach. These practices, in turn, are revealed to be a refl ection of the concept of health that has passed from the absence of disease to a process related to social, political, economic and cultural factors. Conclusion: The concept of health has been transformed from historical ideas, refl ecting the emergence of new formulations about thinking and doing and, consequently, new proposals for changes in welfare models of health. Therefore, although the new model of healthcare has been structured from a health promotion perspective; there are still features of hegemonic models with the predominance of curative practices

Knowledge and acceptance of HPV vaccine among adolescents, parents and health professionals: construct development for collection and database composition

Introduction: The human papillomavirus (HPV) is a prevalent viral infection in the sexually active population, which can be oncogenic and non-oncogenic. Educational efforts by health professionals, aimed at adolescents and their parents, help decision-making on human papillomavirus vaccination, benefiting the implantation process and vaccine coverage. Objective: To describe the data collection constructs about knowledge and acceptability of HPV vaccine among adolescents, parents and health professionals. Methods: Study of construct elaboration based on an empirical review of the literature with a qualitative focus on PubMed database, from 2007 to 2014, using the following keywords: Papillomaviridae AND Papillomavirus Vaccines AND Knowledge AND Community Health Services. A total of 31 questions were divided into six categories. In the internal validation, the final construct was applied in 390 subjects (adolescents, parents/guardians and health professionals) in the period of 2014. The proportion of assertive responses and respective 95% confidence interval (CI) were used to describe each question. Results: Three articles on the subject were found in the databases consulted that served as the basis for the elaboration of the questionnaire. There was a lower proportion of correct answers among adolescents about knowledge of HPV. Adolescents, parents, and carers showed a low proportion of correctness about the safety and efficacy of the vaccine. The three groups did not show any barriers to vaccine acceptability. Conclusion: The instrument was adequate to measure knowledge about HPV, its repercussions and its vaccine among adolescents, parents/guardians and health professionals, as well as measuring the acceptability of the human papillomavirus vaccine

The acceptability of vaginal smear self-collection for screening for cervical cancer: a systematic review

Cervical cancer is a major cause of death in adult women. However, many women do not undergo cervical cancer screening for the following reasons: fear, shame, physical limitations, cultural or religious considerations and lack of access to health care services. Self-collected vaginal smears maybe an alternative means of including more women in cervical cancer screening programs. The objective of this systematic review was to evaluate the acceptability of vaginal smear self-collection for cervical cancer screening. We selected articles from PubMed, the Cochrane Library and Embase that were published between January 1995 and April 2016. Studies written in English, French, Italian, Portuguese or Spanish that involved women between 18 and 69 years of age who had engaged in sexual intercourse were included in this review. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Nineteen studies were ultimately evaluated in this review. Most of the included studies (n=17) demonstrated that the self-collection method exhibited outstanding acceptability among women with respect to cervical cancer screening, and only two studies indicated that self-collection exhibited low acceptability among women in this context. The acceptability of self-collection was determined subjectively (without standardized questionnaires) in 10 studies (53%) and via structured and validated questionnaires in the remaining studies. The results of our review suggest that the self-collection method is well-accepted and may therefore encourage greater participation in cervical cancer screening programs. However, additional studies are required to verify these results

Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study

Background: Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD. Objective: To evaluate the effects of group CBT on women with HSDD. Method: Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. Main Outcome Measures: demographics, education, sexual history, FSQQ and its domains for sexual function assessment. Results: Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001). Conclusion: Group CBT was shown to be an effective tool for treating HSDD

Perceptions of learning among the students of the League of Gynecology

Introdução: A Liga de Ginecologia atualmente conta com 8 membros, 4 diretores, 2 médicos assistentes e 1 residente, para o desenvolvimento de educação, pesquisa e extensão, para a disseminação de aprendizado na educação médica. Objetivo: Identificar as percepções de aprendizado dos acadêmicos da Liga de Ginecologia. Método: Trata-se de estudo transversal, realizado em agosto de 2017, na Faculdade de Medicina da Universidade de São Paulo. Foi utilizado um questionário respondido por membros da Liga de Ginecologia entre os anos de 2015 e 2017. Resultados: O principal motivo de ingresso na Liga é aprender o exame físico ginecológico, o principal aprendizado é a semiologia ginecológica, o principal ponto positivo é o atendimento ambulatorial supervisionado e o principal ponto negativo é a ausência de aulas teóricas. Além disso, 70% referiu influência da Liga na possibilidade de realizar residência médica em Ginecologia. Conclusão: As percepções de aprendizado entre os participantes da Liga de Ginecologia revelaram aquisições de competências em semiologia ginecológica e atendimento ambulatorial, lacuna de aulas teóricas na Liga e incentivo à pós-graduação.Background: The League of Gynecology currently has 8 members, 4 directors, 2 assistant physicians and 1 resident, for the development of education, research and extension, for the dissemination of learning in medical education. Objective: To identify the perceptions of learning among the academics of the League of Gynecology. Method: This is a cross-sectional study, carried out in August 2017 at the Faculty of Medicine of the University of São Paulo. A questionnaire answered by members of the League of Gynecology between the years of 2015 and 2017 was used. Results: The main reason to join the League is to learn the gynecological physical examination, the main learning is the gynecological semiology, the main positive point is supervised outpatient care and the main negative point is the absence of theoretical classes. In addition, 70% mentioned the influence of the League in the possibility of performing medical residency in Gynecology. Conclusion: Learning perceptions among the participants of the Gynecology League revealed the acquisition of skills in gynecological semiology and outpatient care, a gap in theoretical classes in the League and encouragement to post-graduation

Knowledge and acceptability of the human papillomavirus vaccine among health professionals in Acre state, western Amazon

OBJECTIVE: To evaluate the knowledge and acceptability of the human papillomavirus (HPV) vaccine among health professionals from western Amazonia. METHODS: A cross-sectional study was conducted in the Sistema Assistencial a` Sau´ de da Mulher e da Crianc¸a (Health Care System for Women and Children; SASMC) in Acre, Brazil, in 2017. The participants comprised 196 health professionals. The data collection instrument contained 31 questions about HPV, its clinical repercussions for women, and the HPV vaccine. Quantitative variables were presented as medians and 95% confidence intervals (CIs), and po0.05 was considered statistically significant. For the analyses, chi-square tests and Mann-Whitney tests were used. The collected data were analyzed using Statas11.0. RESULTS: Of the 196 health professionals, 39.8% (n=76) were physicians and 61.2% (n=120) were other health professionals. The interviewees were mostly female (n=143, 73%, 95% CI 66.1 to 78.9%) who worked in the medical field (n=81, 41.3%, 95% CI 34.4 to 48.6%), and the median age was 38 years (95% CI 36.0 to 39.7). Physicians had increased knowledge regarding only the statement "cervical cancer is one of the main causes of cancer in women", with a proportion ratio of 0.88 (0.80; 0.97) and po0.001. Regarding clinical knowledge of the HPV vaccine, a low proportion of correct answers was obtained for all the questions, and no significant differences were found between the groups. CONCLUSION: Acceptability and knowledge of HPV and its vaccine were similar among health professionals, with knowledge gaps in questions about the relation between smoking and cervical cancer and specific clinical knowledge

Vulnerability in adolescence: a case report of attempted abortion and sexual violence

Background: Abortion, even when provided by law in cases of sexual violence, continues to be practiced in an insecure way, since women who suffer violence are not reported or guarded by social, institutional or age vulnerability, as in adolescence. Objective: Describe the clinical consequences of unsafe abortion, report this experience as well as sexual violence in situations of social and age vulnerability. Methods: It is a clinical case report, with the consent of the patient, in the year 2016, of a 16-year-old female adolescent with a personal history of sexual violence by an intimate aggressor. Admitted to the health service with diagnosis of acute abdomen and induced abortion using antibiotic therapy. Results: Laboratory tests revealed altered C reactive protein and presence of leukocytosis, ultrasound showed heterogenic mass, computed tomography showed presence of cylindrical foreign body in vaginal cavity, surgical interventions, sepsis, clinical complications (pulmonary thromboembolism) and prolonged hospitalization. Conclusion: The history of violence portrayed in this study reveals an attempt of abortion with self harm, revealing negative clinical repercussions and the health problems of the adolescent. This person has committed an abortion that does not fit into the abortion criteria provided by law. It also revealed the need for further discussion on the topic, highlighting health promotion practices against unsafe abortion