A exposição ao fumo de cigarros em lesões do colo uterino : um estudo de caso-controle

A infecção do colo uterino por tipos oncogênicos do HPV é a causa principal para desenvolvimento de lesões cervicais de baixo (LSIL) e alto grau (HSIL), bem como do câncer invasivo. No entanto, considerando que um grande número de mulheres infectadas por HPVs oncogênicos não desenvolve o câncer cervical, torna-se necessário verificar o papel de outros potencias fatores de risco, como o tabagismo, no desenvolvimento desse tipo de câncer. Este estudo de caso-controle tem como objetivo verificar a associação da exposição ativa ao tabagismo com a infecção genital pelo Papilomavírus humano e com o grau de lesões em colo uterino. Para tal, utilizamos uma amostra de 306 mulheres. O grupo caso foi composto por 84 mulheres com infecção genital pelo HPV e com alteração no exame histopatológico do colo uterino. O grupo controle corresponde a 222 mulheres HPV-DNA negativas e sem alteração ao exame citopatológico da cérvice uterina. A detecção e a genotipagem do HPV foram feitas por PCR, utilizando os primers GP5+/GP6+ e primers específicos para os HPVs 16, 18 e 31. Foi utilizada Regressão Logística Múltipla para verificar a associação das variáveis estudadas com os desfechos (i) infecção genital pelo HPV e (ii) grau de lesões cervicais. As variáveis independentemente associadas à infecção pelo HPV foram grupo etário inferior a 35 anos (OR 4,83; IC95% 2,28-10,20) e fumo de cigarros (OR 2,80; IC95% 1,55-5,08). O fumo também mostrou-se associado ao grau de lesão cervical - HSIL (OR 14,5; IC95% 3,07-66,7; p=0,001). A baixa escolaridade (p=0,06) e histórico de DSIs (p=0,07) apresentaram associação limítrofe com este desfecho. Os resultados sugerem associação entre o fumo de cigarros com infecção genital pelo HPV e com lesões cervicais de alto grau. Esses achados relevam a importância do controle da exposição ao fumo em medidas de prevenção do câncer de colo uterino.The infection of the cervix by oncogenic HPV is the main cause for developing low grade cervical lesions (LSIL), high grade cervical lesions (HSIL) and invasive cancer. However, considering that a large number of women infected with oncogenic HPVs do not develop cervical cancer, it is necessary to examine the role of other potencial risk factors, such as cigarette smoking, in the development of this type of cancer. This case-control study aims to investigate the association of exposure to active smoking and genital infection with human papillomavirus and the degree of lesions in the cervix. To this end, a sample of 306 women was used. The case group comprised 84 women with genital HPV infection and with abnormal histopathology of the cervix. The control group consists of 222 HPV-DNA negative women with no alterations in the cytological examination of the uterine cervix. The HPV detection and genotyping were performed by PCR, using primers GP5 + / GP6 + and specific primers for HPV 16, 18 and 31. Multiple logistic regression was used to verify the association of variables with the outcomes (i) genital HPV infection and (ii) degree of cervical lesions. Variables independently associated with HPV infection were age <35 years old (OR 4.83; 95% CI 2.28-10.2) and cigarette smoking (OR 2.8; 95%CI 1.55-5.08). Smoking also was associated with the degree of cervical lesions - HSIL (OR 14.5; 95% CI 3.07-66.7; p= 0.001). Low education level (p=0.06) and STIs history (p=0.07) showed borderline association with this outcome. The results suggest an association between cigarette smoking and genital HPV infection and high-grade cervical lesions. These findings emphasize the importance of controlling exposure to cigarette smoking on measures to prevent cervical cancer

2010 A(H1N1) vaccination in pregnant women in Brazil: identifying coverage and associated factors

We studied vaccination coverage and its associated factors in the 2010 pandemic influenza vaccination of Brazilian pregnant women. A cross-sectional study of pregnant women who had given birth was performed in a municipality in southern Brazil, in 2010. Data about vaccination against A(H1N1) and sociodemographic characteristics, morbidities and prenatal care were collected. Statistical analysis was performed using a Poisson regression. Coverage was 77.4%. Most were vaccinated in the public sector (97.6%) and in the second trimester (47%). Associated factors that increased vaccination were marriage, older age, first income quartile, prenatal care and influenza before pregnancy. Education and skin color were not significantly associated with vaccination. The vaccination campaign was extensive and exhibited no inequality. Prenatal care was the factor that most affected vaccination coverage, reflecting its importance for vaccination campaign success