nÃo hà / O cÃncer do colo uterino à caracterizado pelo aumento desordenado do epitÃlio que reveste o ÃrgÃo, afetando todo o tecido subjacente conhecido como estroma. Embora as mulheres busquem mais os serviÃos de saÃde, no Brasil ainda hà uma grande incidÃncia de morte relacionada a esse tipo de patologia, sendo um dos tipos de cÃncer que mais acomete a populaÃÃo feminina. O exame citopatolÃgico, realizado nas Unidades BÃsicas de SaÃde, à utilizado como um mÃtodo de rastreamento das lesÃes precursoras desse cÃncer e sinaliza o direcionamento de algumas aÃÃes de saÃde. Frente a esse contexto este estudo objetivou verificar o conhecimento, atitude e prÃtica das mulheres sobre o exame de prevenÃÃo do cÃncer do colo uterino, em mulheres de um municÃpio do CearÃ. Tratou-se de um estudo exploratÃrio com abordagem quantitativa desenvolvido nas salas de espera das unidades de saÃde do municÃpio de IcÃ. A amostra do estudo foi aleatÃria e composta de 379 mulheres. Foi aplicado o inquÃrito CAP (Conhecimento, Atitude e PrÃtica) previamente utilizado (MALTA, 2014), composto por 46 perguntas. O teste realizado para responder aos objetivos do estudo foi o qui-quadrado. As variÃveis sociodemogrÃficas estudadas como potenciais variÃveis associadas ao conhecimento, atitude e prÃtica, foram: idade, estado civil, escolaridade, religiÃo, ocupaÃÃo, trabalho e renda familiar. Na histÃria sexual e reprodutiva foi pesquisada vida sexual e tempo do inÃcio da mesma, parceiro fixo, laqueadura, uso de camisinha, mÃtodo contraceptivo, filhos, idade que teve o primeiro filho, aborto, DST, problema no Ãtero, histerectomia, gravidez e cÃncer na famÃlia. Os dados evidenciaram que em 49,9% das mulheres o conhecimento foi avaliado como inadequado. A atitude inadequada foi em 46,2% das mulheres e a prÃtica inadequada em 40,1%. As seguintes variÃveis apresentaram significÃncia estatÃstica para o conhecimento inadequado: estado civil (p=0,016, maior entre solteiras), escolaridade (p < 0,001, maior entre analfabetas ou com ensino fundamental incompleto), renda (p=0,004,maior nas com renda menor de um salÃrio mÃnimo, nÃo possuir parceiro fixo (p<0,017) e ter DST (p=0,039). A escolaridade das mulheres foi a Ãnica variÃvel associada a atitude inadequada (p=0,003). As variÃveis estatisticamente associadas a prÃtica inadequada foram: estado civil, faixa etÃria, trabalho fora de casa, renda familiar, nÃo ter vida sexual ativa, ser laqueada e ter tido o primeiro filho com idade de 25 anos ou mais. Quanto as dificuldades para realizar o exame Papanicolaou na ESF e receber o resultado teve grande destaque a demora do resultado. Percebeu-se a partir desta pesquisa, a importÃncia da educaÃÃo em saÃde acerca da problemÃtica relacionada ao CCU e sua prevenÃÃo, como tambÃm a necessidade do apoio por parte dos gestores. Tivemos alguns grupos de mulheres com maior risco ao problema estudado, devendo portanto serem priorizadas por os profissionais de saÃde e gestores, realizando-se a busca ativa desse grupo para realizaÃÃo de rodas de conversas. Espera-se que os resultados encontrados possam contribuir para a melhoria do atendimento Ãs mulheres e realizaÃÃo de uma maior vigilÃncia quanto a frequÃncia ao exame, visando uma maior abrangÃncia das mulheres, satisfazendo suas necessidades de conhecimento atravÃs da troca de saberes. / Cancer of the cervix is characterized by the disordered enlargement of the epithelium that lines the organ, affecting all the underlying tissue known as stroma. Although women seek more health services, in Brazil there is still a high incidence of death related to this type of pathology, being one of the types of cancer that affects the female population the most. The cytopathological examination, performed at the Basic Health Units, is used as a screening method for the precursor lesions of this cancer and indicates the direction of some health actions. Against this background, this study aimed to verify the knowledge, attitude and practice of women on the cervical cancer prevention exam in women from a municipality of CearÃ. It was an exploratory study with a quantitative approach developed in the waiting rooms of the health units of the municipality of IcÃ. The study sample was random and composed of 379 women. The KAP (Knowledge, Attitude and Practice) survey previously used (MALTA, 2014), composed of 46 questions, was applied. The test performed to answer the study objectives was chi-square. The sociodemographic variables studied as potential variables associated with knowledge, attitude and practice were: age, marital status, schooling, religion, occupation, work and family income. In the sexual and reproductive history, the sexual life and the time of the beginning of the sexual intercourse were investigated, fixed partner, tubal ligation, condom use, contraceptive method, children, age of first child, abortion, Sexually Transmitted Disease, hysterectomy, pregnancy and cancer in the family. The data showed that in 49.9% of the women the knowledge was evaluated as inadequate. The inadequate attitude was in 46.2% of the women and the inadequate practice in 40.1%. (p = 0.016, higher among single women), schooling (p <0.001, higher among illiterates or incomplete primary education), income (p = 0.004, higher in the lower income group) Of a minimum wage, did not have a fixed partner (p <0.017) and had STD (p = 0.039). The education of women was the only variable associated with an inappropriate attitude (p = 0.003). The variables statistically associated with inappropriate practice were: marital status, age, work away from home, family income, no active sex life, lactation and having had the first child aged 25 years or more. As for the difficulties to perform the Papanicolaou exam at the HSF and receive the result had great prominence the delay of the result. From this research, the importance of health education about the problems related to cervical cancer and its prevention, as well as the need for the support of the managers, was perceived. We had some groups of women with greater risk to the problem studied, and should therefore be prioritized by health professionals and managers, with the active search of this group for the realization of conversation wheels. It is hoped that the results found may contribute to the improvement of the attendance of women and greater vigilance regarding the frequency of the examination, aiming at a greater comprehension of the women, satisfying their knowledge needs through the exchange of knowledge.

Thesis (M. Med. Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 66-67).

Thesis (M. Med. Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 48-53).

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

This thesis provides a social history of the introduction the Pap smear and the expansion of population-based cervical screening programs in Australia throughout the latter decades of the twentieth century. By placing cervical screening in a broad social context, this history helps to reveal the complex interrelationship between developments in scientific medicine, social, political and economic concerns, changing beliefs and attitudes, and the growing influence of commercialisation and consumerism. It also highlights the tendency for public health strategies to serve as a means of social and moral control. Furthermore, the thesis examines the conflict between the population-based approach of public health and the concern of clinicians for the welfare of individual patients. This conflict has emerged in other areas of medicine. In casting light on such conflict, the thesis will provide historical insight into reasons for why medicine is often perceived to be in a state of crisis today.

Thesis (M.Med.Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 66-67). Also available in print.

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 48-53). Also available in print.

Thesis (M. Med. Sc.)--University of Hong Kong, 2005.

The purpose of this study was to understand how clinicians manage asymptomatic women after Trichomonas has been reported on Papanicolaou (Pap) smears. Clinical information was obtained from questionnaires sent to healthcare providers whenever Trichomonas was identified during the study period. Trichomonas was identified in 173 (1.4%) of 12.547 Pap smears examined. Completed questionnaires were returned on 95 (55%) patients, and 92 patients were included in this study. Sixty-three (68%) patients were asymptomatic, 16 (18%) had symptoms characteristic of infection, and 13 (14%) had nonspecific symptoms. Twenty-six (28%) patients received treatment during the original clinic visits. After the Pap smear reported Trichomonas, 49 (81%) of the 66 patients were contacted and treated. 7 (12%) were contacted and scheduled for further evaluation, and no action was taken on the remaining 10 (17%) patients. There was a significant association between presenting with symptoms and receiving treatment at the time of the original visit (P < 0.001), but not with receiving subsequent treatment. Clinical suspicion of infection was also associated with receiving treatment at the time of the original visit only (P < 0.001). Clinical suspicion of infection correlated with symptoms and results of wet amount smears (P < 0.001). In conclusion, the Pap smear report of Trichomonas identification directly impacted the management of 61% of patients and served as confirmation for clinical management in another 28% who had received treatment at the time of original visit. Despite the fact that most patients were asymptomatic, the majority received treatment and/or evaluation after the Pap smear report was received.

Ziel dieser Arbeit war es, die psychische Belastung bei Patientinnen mit auffälligen PAP-Abstrichen oder dysplastischen Veränderungen der Zervix uteri im Rahmen der Dysplasie-Sprechstunde zu erheben. Durch Auswertung und Analyse der Daten im Rahmen des Qualitätsmanagements sollte eine Grundlage für eine verbesserte und angepasste Versorgung geschaffen werden. In dem erhobenen Fragebogen waren vier Fragen von besonderer Bedeutung - die Informationslage bei Vorstellung, die Art der Informationsbeschaffung, der mögliche Wunsch nach mehr Information und der Bildungsstand. In der Auswertung des ausgeteilten Fragebogens konnte erhoben werden, dass 56,9% der Patientinnen bei der Erstvorstellung psychisch belastet waren. Das ist ein großer Anteil in Anbetracht der Tatsache, dass das PAP-Screening eine jährliche Vorsorgeuntersuchung für über 15 Millionen Frauen darstellt [19]. Der Großteil der in der Dysplasie-Sprechstunde erhobenen PAP-Abstriche waren auffällig und somit weiter abklärungsbedürftig. Über 70% der HPV-Tests waren „high risk“ positiv. Der Mittelwert der Verteilung des Alters lag bei 44 Jahren, was bedeutet, dass viele junge Frauen mit potenziell bestehendem Kinderwunsch oder jungen Familien betroffen sind. Die jungen Frauen sind durchschnittlich besser gebildet und psychisch belasteter als die Kohorte der älteren Patientinnen. Ein Blick auf die Verteilung der Bildung zeigt, dass bei Betrachtung der gesamten Kohorte, schlechter gebildete Frauen verunsicherter sind. Viele der Patientinnen, 40,9%, fühlten sich vor der Erstvorstellung nicht ausreichend informiert und mehr als 53,8% der Patientinnen hätten sich mehr Informationen gewünscht. Sieht man sich die Antworten auf die Frage nach der Quelle der Informationsbeschaffung an, fällt auf, dass mit 68,5% weiterhin der/die betreuende Arzt/Ärztin die wichtigste Informationsquelle darstellt. Zusammenfassend lässt sich sagen, dass trotz des 2020 deutschlandweit begonnenen organisierten Screenings die betroffenen Frauen anhaltend belastet sind und sich mehr Informationen wünschen. Ein wichtiger Schritt zur Vorbeugung psychischer Belastung wäre eine verbesserte Vermittlung von Information seitens der behandelnden Ärzte/Ärztinnen, auch unter Hinweis auf die online zur Verfügung stehenden Informationen des Bundesministeriums für Gesundheit. / The aim of this work was to assess the psychological stress of patients with conspicuous PAP smears or dysplastic changes of the cervical uteri during the consultation in the “Dysplasie-Sprechstunde”. By evaluating and analyzing the data within the framework of quality management, a basis for improved and adapted care should be created. In the questionnaire four questions were of particular importance - the information situation at the time of presentation, the way in which information was obtained, the possible desire for more information and the level of education. In the evaluation of the distributed questionnaire it could be found that 56.9% of the patients were psychologically stressed at the first presentation. This is a large proportion considering that PAP screening is an annual screening for over 15 million women [19]. The majority of the PAP smears taken during the dysplasia consultation were conspicuous and therefore in need of further clarification. Over 70% of HPV tests were "high risk" positive. The mean distribution of the age was 44 years, which means that many young women with a potential desire to have children or young families are affected. On average, the young women are better educated and more psychologically stressed than the cohort of older patients. A look at the distribution of education shows that if you look at the whole cohort, less educated women are more insecure. Many of the patients, 40.9%, did not feel sufficiently informed before the first presentation and more than 53.8% of the patients would have liked more information. If one looks at the answers to the question about the source of information, it is striking that with 68.5% the attending physician continues to be the most important source of information. In summary, it can be said that despite the organized screening that began throughout Germany in 2020, the affected women are still burdened and would like more information. An important step towards the prevention of psychological stress would be an improved communication of information on the part of the treating physicians, also with reference to the information available online from the Federal Ministry of Health.