Orientador: Márcia Rita Fernandes Machado / Banca: Paulo Henrique Franceschini / Banca: Cláudio Alvarenga de Oliveira / Resumo: Objetivou-se com este estudo determinar o perfil preliminar das progestinas, estrógenos e corticosteróides, da paca, segundo maior roedor da fauna brasileira, mediante a técnica de enzimaimunoensaio no extrato fecal de cinco fêmeas adultas, não nulíparas, diagnosticadas nao prenhes por meio de exame ultrassonográfico e alojadas individualmente; também, verificaram-se os aspectos morfológicos, por meio da colpocitologia desses mesmos animais. Mediante as condicões e exigências em que o experimento foi conduzido pôde-se verificar alteracões na morfologia das cêlulas da mucosa vaginal, observando tipos celulares característicos das fases de proestro, estro e diestro, embora nao se tenha verificado sinais de anestro. No periodo em que se realizaram as análises colpocitológicas nao foi possivel caracterizar episódio de um ciclo estral completo. Dessa forma, para a obtencão de resultados mais consistentes, outros estudos referentes a análises hormonais e colpocitologia, corn delineamentos experimentais mais bem elaborados, devem ser realizados / Abstract: The aim of this study was to determine the preliminary profile of fecal progestin, estrogen and corticosteroids of the Agouti paca, the second biggest Brazilian rodent, through enzynneimmuneassay in five adults female paca, diagnosed non-pregnant by ultrasonograph exam and housed individually; also verify the morphological aspects of colpocytology in this animals. Thus, in the conditions and requirements in which the experiment was conduced, morphological changes in vaginal cells could be verified, observing cellular types proper of proestrus, estrus and diestrus, thought signs of anestrous could not be verified. In the period of colpocytology analysis it was not possible to determine the occurrence of a complete estrous cycle episode. To obtain consistent results, other studies concerning the fecal hormone analysis and colpocytology should be conducted with more elaborated experimental outlines / Mestre

MALTA, Elainy Fabrícia Galdino Dantas. Fatores relacionados à prática inadequada do exame Papanicolau por mulheres do interior do Ceará. 2014. 83 f. Dissertação (Mestrado em Saúde da Família) - Universidade Federal do Ceará. Faculdade de Farmácia, Odontologia e Enfermagem, Fortaleza, 2014. / Submitted by denise santos (denise.santos@ufc.br) on 2014-08-28T15:57:05Z No. of bitstreams: 1 2014_dis_efgdmalta.pdf: 1683808 bytes, checksum: 8643dc0c9d527f6e9a8bc17929692555 (MD5) / Approved for entry into archive by denise santos(denise.santos@ufc.br) on 2014-08-28T15:59:32Z (GMT) No. of bitstreams: 1 2014_dis_efgdmalta.pdf: 1683808 bytes, checksum: 8643dc0c9d527f6e9a8bc17929692555 (MD5) / Made available in DSpace on 2014-08-28T15:59:32Z (GMT). No. of bitstreams: 1 2014_dis_efgdmalta.pdf: 1683808 bytes, checksum: 8643dc0c9d527f6e9a8bc17929692555 (MD5) Previous issue date: 2014 / In Brazil, the Pap test is the primary recommended strategy for the prevention of cervical cancer (CCU) cancer, targeted at women 25-64 years old, held every three years after two consecutive normal tests performed a interval of one year. This research aimed to identify the factors related to inadequate practice of Pap smear for women examination on a city in the interior of Ceará. Thus, a cross-sectional study was conducted using a quantitative approach. The collection was from June to October 2013 in the health district V of Juazeiro do Norte-CE. The sample was calculated using the formula for finite populations, totaling a value of 240 women who were included based on the following criteria: age between 20 and 59 years; have initiated sexual life and accepting participate. Excluded were those who were not in full physical or mental condition and were not at the clinic at the time of data collection. Was used as an instrument of data collection, the household survey-type Knowledge, Attitude, Practice, and subsequently applied by the researcher classified according to criteria of adequacy. Data were stored and analyzed using STATA software, version 12.0. The data showed that all respondents reported having heard of the Pap smear, but in 72.9% of the knowledge was assessed as inappropriate. Improper attitude also showed high percentage (73.3%). The practice was classified as inadequate in 39.2% of the sample, in which 13.3% reported never having undergone the examination, and 23.6% have done it for over three years. After the adjusted Odds Ratio test, the following variables showed statistical significance for appropriate practice: age between 20 and 29 years (OR (CI) = 2.25), single marital status (OR (CI) = 3.18) and inadequate knowledge (OR (CI) = 2.90). The difficulties encountered in the realization of the Pap smear in the health unit, the variables of higher percentages for inadequate practice were lack of material (68.1%), shame the professional (27.6%) and not like the professional who performs the examination (20.8%). It was realized from this research, the importance of clarifying the population and effective communication among professionals of the teams of the Family Health Strategy about the issues related to cervical cancer and its prevention, as well as warranty and support continuity of care by managers. / No Brasil, o exame citológico de Papanicolaou é a principal estratégia recomendada para a prevenção do câncer de colo do útero (CCU), orientado para as mulheres de 25 a 64 anos, realizado a cada três anos, após dois exames normais consecutivos realizados com um intervalo de um ano. Esta pesquisa objetivou identificar os fatores relacionados com a prática inadequada do exame Papanicolaou pelas mulheres em um município do interior do Ceará. Para tanto, foi realizado um estudo transversal com abordagem quantitativa. A coleta foi no período de junho à outubro de 2013 no distrito sanitário V do município de Juazeiro do Norte-CE. A amostra foi calculada através da fórmula para populações finitas, perfazendo um valor de 240 mulheres, as quais foram inclusas a partir dos seguintes critérios: ter idade compreendida entre 20 e 59 anos; ter iniciado vida sexual e aceitar participar da pesquisa. Eram excluídas aquelas que não estavam em plena condição física ou mental e não estavam na unidade de saúde no momento da coleta de dados. Utilizou-se como instrumento de coleta de dados, o inquérito domiciliar do tipo Conhecimento, Atitude e Prática, aplicado e posteriormente classificado pela pesquisadora segundo critérios de adequação. Os dados obtidos foram armazenados e analisados pelo software STATA, versão 12.0. Os dados evidenciaram que todas as entrevistadas informaram ter ouvido falar do exame Papanicolaou, mas em 72,9% destas o conhecimento foi avaliado como inadequado. A atitude inadequada também apresentou percentuais elevados (73,3%). A prática foi classificada como inadequada em 39,2% da amostra, na qual 13,3% afirmaram nunca ter se submetido ao exame, e 23,6% o realizaram há mais de três anos. Após o teste de Odds Ratio ajustado, as seguintes variáveis revelaram relevância estatística para a prática inadequada: idade entre 20 e 29 anos (OR(IC)=2.25), estado civil solteira (OR(IC)=3.18) e conhecimento inadequado (OR(IC)=2.90). As dificuldades encontradas para a realização do exame Papanicolaou na unidade de saúde, as variáveis de maiores percentuais para a prática inadequada foram: falta de material (68,1%), vergonha do profissional (27,6%) e não gostar do profissional que realiza o exame (20,8%). Percebeu-se a partir desta pesquisa, a importância do esclarecimento à população e a comunicação efetiva por parte dos profissionais das equipes da Estratégia Saúde da Família acerca da problemática relacionada ao CCU e sua prevenção, assim como a garantia e apoio à continuidade do cuidado por parte dos gestores.

OBJETIVO: Determinar el grado de satisfacción sobre el proceso de despistaje de cáncer de cuello uterino (Papanicolaou) en las usuarias que acuden al Centro de Salud “Leonor Saavedra”. San Juan de Miraflores durante el año 2015. METODOLOGÍA: Estudio observacional, descriptivo, prospectivo de corte transversal, que tuvo en cuenta a una muestra de 80 usuarias que acudían al Centro de Salud “Leonor Saavedra” durante el año 2015 para la realización de la toma de Papanicolaou, a las que se les aplicó una ficha de recolección de datos y un cuestionario sobre el Grado de Satisfacción de la atención de Papanicolaou. Para el análisis descriptivo o univariado, las variables cuantitativas se estimaron mediante medidas de tendencia central (media) y medidas de dispersión (desviación estándar) y en las variables cualitativas se estimaron frecuencias y porcentajes. RESULTADOS: Las usuarias tienen una edad promedio de 33.8 años, viven con su pareja (65%) y tienen grado de instrucción secundaria (46.3%). Respecto al grado de satisfacción del proceso de despistaje de cáncer de cuello uterino (Papanicolaou), el 78.8% de las usuarias se encuentra “muy satisfecha” sobre la infraestructura del consultorio y equipos; el 52.5% se encuentra “medianamente satisfecha” sobre el tiempo de espera para la atención de la toma de Papanicolaou; el 80.0% se encuentra “muy satisfecha” sobre la información recibida en la toma de Papanicolaou; y el 91.3% se encuentra “muy satisfecha” sobre el proceso de atención para la toma de Papanicolaou. CONCLUSIÓN: El 81.3% de las usuarias que acuden al Centro de Salud “Leonor Saavedra” de San Juan de Miraflores durante el año 2015 se encuentran “Muy satisfechas” sobre el proceso de despistaje de cáncer de cuello uterino (Papanicolaou) el 2.4% poco satisfechas. PALABRAS CLAVES: Satisfacción, despistaje, cáncer de cuello uterino, Papanicolaou. / --- OBJECTIVE: To determine the degree of satisfaction with the process of screening for cervical cancer (Pap) in users who come to the health center "Leonor Saavedra" cancer. San Juan de Miraflores in 2015. METHODOLOGY: Observational, descriptive, cross-sectional prospective study that took into account a sample of 80 users who flocked to the health center "Leonor Saavedra" during 2015 for the realization of Pap decision, which were given a data collection sheet and a questionnaire about satisfaction attention Pap. For descriptive and univariate analysis, quantitative variables were estimated using measures of central tendency (mean) and dispersion measures (standard deviation) and qualitative variables, frequencies and percentages were estimated. RESULTS: The users have an average age of 33.8 years, living with a partner (65%) and have high school degree (46.3%). Regarding the degree of satisfaction from the process of screening for cervical cancer (Pap), 78.8% of users is located "very satisfied" on infrastructure and office equipment; 52.5% are "moderately satisfied" about the waiting time for taking care of Pap; 80.0% are "very satisfied" on the information received in taking Pap; and 91.3% are "very satisfied" about the care process for taking Pap. CONCLUSIONS: 81.3% of users who come to the health center "Leonor Saavedra" San Juan de Miraflores in 2015 are "very satisfied" about the process of screening for cervical cancer (Pap) 2.4% little satisfied. KEYWORDS: Satisfaction, screening, cervical cancer, Pap smear. / Tesis

Objective: To detect the most prevalent human papillomavirus (HPV) genotypes samples of asymptomatic Peruvian women by analyzing the correlation betwe ienn c Pearvpiacnailc somlaeoaur (PAP)-stained cervical tests and PCR-sequencing. Methods: A total of 254 women attending routine gynecological examinations were included in pthaitsh ostluogdiys.t Tahned scalmaspsliefise dw ebrye tahnea Blyeztehde sbdya PsAysPt etmec.h HnPiqVu ea manpdli feicxaatmioinn ewda su nddoenre au msinicgr othsceo pprei mbeyr as specific for E1 region and positive specimens were confirmed by direct sequencing. Results: The prevalence of HPV was investigated in 254 cervical scrape samples by PCR. PAP smear showed that 94.9% cases had normal morphology and 5.1% had an inflammatory pattern; 2p0r.e5v%a lwenert eg efonuontydp teo ibne c ionrfreeclatetido nw iwthit hH PchVa, ncgoems pinri scienrgv i2c0a dl icfyfetorelongt yg.enotypes. HPV16 was the most Conclusions: Our results suggest the HPV is very frequent even in women with negative PAP, eannddo PceCrRvi csaele smasm tpol ebs.e Itdheen tbifeicsat toiopnt ioofn t htoe HdePtVe rgmeinnoety tphee inc aaussyamtipvteo magateinc tw oofm HePnV m ianyf eaclltoiown t hine nimatpulreaml henisttaotriyo no fo tfh ea pdpisroepasreia aten dp rthope hsyulbascetqicu emnet adseuvreelso pwmheicnht omf acye rhviacvael ma adliirgencatn icmy.pact / jdelvall@upc.edu.pe / This work has been partially supported by Universidad Peruana de Ciencias Aplicadas (UPC), Instituto de Investigación Nutricional and Instituto de Investigación de Efrnomfe rtmheed pardoegsr aImnf ecciosas, Lima, Peru. JR has a fellowship I3, of the ISCIII (Grant No. CES11/012), and LJDV from the Generalitat de Catalunya (2009SGR1208). / Revisión por pares

Made available in DSpace on 2014-06-12T23:04:08Z (GMT). No. of bitstreams: 2 arquivo8842_1.pdf: 1513602 bytes, checksum: 2d02aa51371164a9f81e60ccd258a07c (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2004 / O impacto do exame citológico cérvico-vaginal de Papanicolaou na redução das taxas de carcinoma escamocelular invasor obscureceu o papel desse exame no diagnóstico das cervico-vaginites, com reflexos sobre o Sistema Bethesia (TBS). Os aperfeiçoamentos do TBS no terreno das lesões infra-epiteliais escamosas não foram alcançados no que diz respeito as infecções, apesar dos avanços da pesquisa microbiológica. A autora estudou, a partir de uma amostra de 10.064 exames citopatológicos, dos quais 86% apresentavam inflamação (12,34% leve, 66,22% moderada e 7,44% intensa0. 2169 casos em que foram solicitados exames microbiológicos a critério clínico. O exame microbiológico, representado pela cultura em 94,85% dos casos, revelou freqüência relativa semelhante entre os três tipos de floras mais encontradas no exame citopatológico e microbiológico (p 0,001), as de Lactobacillus sp, Cândida sp., Gardnerella vaginalis, esta última diagnosticada pela ocorrência de célula-guia. Confirmou-se a possibilidade de diagnóstico pelo método de Papanicolaou, dos Lactobacillus sp., Cândida SP., Leptotnix vaginalis, Trichomonas vaginalis. O diagnóstico de Gardnerella vaginalis é seguro, quando se identifica a célula guia. São ainda diagnosticáveis o Actinomyces spp. Chlamydia trachomatis, streptococus sp, e provavelmente, Mobiluncus spp. Confirmamos que a codificação das floras F1 a F11 não deve ser utilizada. Como conseqüência do estudo, propomos as seguintes modificações no sub-item ?infecções? do TBS, em relação as especificações dos microorganismos. 1) Manutenção do item Lactobacillus sp 2) Substituição de ?Alteração da flora vaginal compatível com vaginose? por ?Gardnerella vaginalis com presença de célula-guia. 3) Inclusão do tópico ?Alteração da flora a esclarecer com exame microbiológico?. Esta última observação permitirá ao citopatologista, comunicar ao clínico, a necessidade de investigar os casos suspeitos de infecção ao exame citológico

Wits School of Public Health May 2015 / Background and objectives: Cervical cancer is a major cause of cancer-related deaths in many developing countries yet it is a preventable and treatable in early disease. Recent research has seen increasing morbidity and mortality due to cancer of the cervix attributed to the advent of the human immunodeficiency virus (HIV) epidemic worldwide. Papanicolaou smears (Pap smears) to detect cervical abnormalities are currently the best known form of early detection and prevention of invasive cervical cancer (ICC). Knowledge and awareness about cervical cancer and associated risk factors, and cervical screening is very important in determining appropriate health seeking behaviours with the aim to reduce morbidity and mortality. This study examines awareness, perceived risk and practices related to cervical cancer screening among HIV-positive women in an urban HIV clinic in Johannesburg, South Africa. This will be useful in making recommendations with regards to designing and planning of screening programmes, and addressing cervical cancer education and awareness. Materials and methods: This study analysed secondary data collected from an ongoing cervical cancer study undertaken by Right to Care in partnership with the Clinical HIV Research Unit (CHRU) among HIV-positive adult (18 years and older), female patients enrolled in the Themba Lethu Clinic HIV care and treatment programme in Johannesburg, South Africa from November 2009 to December 2012. Clinical data for all respondents was extracted from TherapyEdge-HIVTM, the electronic medical database system used for patient management at the facility. Descriptive statistics were used to summarise baseline characteristics. Models using logistic regression were developed to estimate odds ratios (OR) to further identify baseline sociodemographic factors and clinical characteristics associated with behaviours studied (awareness, perceived risk and practice related to cervical cancer and Pap smear testing) and to identify the association between these factors and the prevalence and severity of cervical disease. Awareness of the Pap smear test and the human papillomavirus (HPV) was assessed based on whether the women report knowing what a Pap smear test is, and whether they have ever heard about HPV. Perceived risk about getting cervical cancer was assessed based on how worried the study participants were about getting cervical cancer. Previous Pap screening practice was assessed using reported screening history of the study participants. In addition to this, a subanalysis was conducted to see how these responses compare to 1) the recommended practice according to the South African national cervical cancer screening guidelines based on the age of participants, and 2) the latest HIV treatment guidelines based on year of HIV diagnosis. Analysis of attrition of study participants at 12 months of study participation was conducted using different time to event analysis techniques including Kaplan Meier, Log-rank test and Cox proportional hazards model. Cox proportional hazards models were fitted to investigate associations between baseline covariate and attrition. A sub-analysis was also carried out using descriptive statistics and chi-square tests to compare the cohort of patients that were included in the study (the VICAR1 cohort) and the rest of the larger Themba Lethu Clinic (TLC) population that was not included in the study to see if there were any significant differences noted between the two groups. In addition, a sensitivity analysis of the of 12 month follow up study visit was conducted using descriptive statistics and chi-square tests to determine if there were any significant differences between study participants that came for their 12 month study visit and those that did not come for their 12 month study visit. Results: Eight hundred and fifty seven (71.30%) participants reported to be aware of Pap smear screening, with only 18.15% reporting to be aware of HPV. Of the 1192 participant who had data to ascertain perceived risk regarding cervical cancer disease, 662 (55.54%) of the women were very worried, 250 (20.97%) were somewhat worried, 280 (23.49%) were not worried about getting cervical cancer. A total of 381 (36.46%) women had adequate practice according to the national cervical cancer screening guidelines. While 304 (28.57%) had adequate practice according to the national HIV treatment guidelines. Factors associated with Pap smear screening awareness were being in the 50+ age group (aOR=4.70, 95% CI 1.63-13.55) as compared to the 18-29 age group, being of non-South African nationality (aOR=0.41, 95% CI 0.20-0.83), having a grade 10 to matric level education (aOR=2.12, 95%CI 1.28-3.52), and a tertiary level education (aOR=2.62, 95%CI 1.07-6.41) as compared to having a less than a grade 10 level education. None of the factors assessed were found to be significantly associated with awareness regarding HPV. Factors associated with perceived risk regarding cervical cancer disease were having a tertiary education (aOR=3.74, 95%CI 1.13-12.38) as compared to having less than a grade 10 level, taking snuff (aOR=0.55, 95%CI 0.33-0.92) and drinking alcohol (aOR=2.53, 95% CI 1.24- 5.17). Being in the 30-39 age group (aOR=12.23, 95%CI 4.00-37.35) as compared to being in 18-29 age group, cohabiting with a partner (aOR=0.36, 95%CI 0.17-0.75) as compared to being single, being self-employed (aOR=2.95, 95%CI 0.82-10.66) as compared to those in full time employment, and being initiated on highly active antiretroviral therapy (aOR=0.17, 95%CI 0.06-0.55) were associated with Pap smear screening practices according to the national cervical cancer guidelines. None of the factors proved to be significantly associated with the practice according to the national HIV treatment guidelines, this is mainly because the HIV treatment guidelines have stricter screening requirements for HIV positive women. Those that had a moderate to severe baseline study Pap smear at enrolment into the study were 92% less likely to have disease progression at their 12 month Pap smear screening (aOR=0.08, 95%CI 0.05-0.13) compared to those that had a negative baseline Pap smear at study enrolment. This is mostly because they would have had a treatment intervention based on their baseline study Pap screening result therefore they would mostly likely not have disease progression at a follow up screening. Only seven women enrolled in the study died of non-cervical cancer related causes during the study period. In the analysis on all-cause attrition (deceased or lost to follow up) those that are initiated on highly active antiretroviral therapy were 92% less likely to be deceased or lost to follow up than those that were not initiated on highly active antiretroviral therapy (aOR=0.08, 95% CI 0.05-0.13). The global test for the overall model showed that the proportional hazard assumption had not been violated, p=0.684. Conclusions: Results for our study showed high levels of Pap smear screening awareness amongst the study participants. However, low levels of Pap screening uptake was observed for study participants. These results and results shown in previous studies show that awareness is only the first hurdle in the challenges related to cervical cancer prevention and treatment. Adequate practice is the factor that will have the most positive influence on the disease morbidity and mortality. Rates of screening practices have been found to be worse in populations with less than 70% Pap smear screening awareness. Findings from this study and similar findings from other studies highlight that more research needs to be done into effective health education programmes to address the gaps in adequate screening practice. These efforts should not only target the clients but also the health providers as they also have an important role to play in improving awareness, knowledge and practices related to cervical cancer and Pap smear screening amongst their clients.

OBJETIVO: determinar la relación entre los conocimientos y las actitudes sobre cáncer de cuello uterino con la toma de Papanicolaou en las usuarias que acuden al Centro de Salud San Fernando durante el periodo de Julio- Agosto del 2014. METODOLOGÍA: estudio observacional, analítico-correlacional, prospectivo de corte transversal. Se entrevistó un total de 148 usuarias atendidas en el Centro de Salud San Fernando-Agustino, evaluando en ellas el nivel de conocimientos y actitudes sobre el cáncer de cuello uterino y si esto influye en la toma de Papanicolaou durante el año 2014. Los datos obtenidos se registraron en el programa Statistics SPSS v.21. Para evaluar el grado de asociación, se utilizó la prueba Chi-cuadrado, con un nivel de confianza (IC) del 95%, considerándose significativo un valor p≤ 0.05. RESULTADOS: de 148 usuarias con edades comprendidas entre 20-59 años, el 62.8% se realizó examen de Papanicolaou en los tres últimos años, mientras que el 37.2% refiere que no se lo realizó en más de tres años o nunca lo hizo, siendo los motivos por falta de tiempo (41.9%) o por temor (25.8%). Respecto al nivel de conocimiento sobre cáncer de cuello uterino en la población total fue: el 58.8% alcanzó un nivel “Medio” y el 20.9% “Bajo” y frente a las actitudes el 83.8% tuvo un actitud “Negativa” y el 16.2% “Positiva”. El nivel de conocimientos sobre cáncer de cuello uterino en las usuarias que si se realizaron el Papanicolaou fue “Medio” en un 50.5% y “Alto” en 25.8% comparado con las usuarias que no se realizaron el Papanicolaou que obtuvieron un nivel “Medio” en un 72.7% y “Alto” en un 10.9%, existiendo una diferencia estadísticamente significativa (p=0.023). Las actitudes frente al cáncer de cuello uterino en las usuarias que si se realizaron el Papanicolaou fueron “Negativas” en el 81.7% comparado con las usuarias que no se realizaron el Papanicolaou que fueron “Negativas” en un 87.3%, no existiendo una diferencia estadísticamente significativa (p=0.376). Las usuarias con una actitud “Positiva” frente al cáncer de cuello uterino, tuvieron un nivel de conocimientos “Medio” en el 70.8% y “Alto” en el 25% comparado con las usuarias con actitud “Negativa” que tuvieron un nivel “Medio” en el 56.5% y “Bajo” en el 19.4%, existiendo entre estos valores cierta significancia (p=0.087). CONCLUSIÓN: existe relación significativa entre los conocimientos sobre cáncer de cuello uterino y la toma de Papanicolaou (p=0.023), sin embargo no se determinó relación entre las actitudes sobre el cáncer de cuello uterino y la toma de Papanicolaou (p=0.376), observándose una actitud negativa tanto en el grupo de pacientes que se tomaron y no se tomaron el Papanicolaou. PALABRAS CLAVES: Cáncer de cuello uterino, Nivel de conocimiento, Actitudes, Papanicolaou. / OBJECTIVE: to determine the relationship between knowledge and attitudes about cervical cancer with the takes of Papanicolau in users attending the San Fernando Health Center during the July-August 2014. METHODOLOGY: Observational study, analytic-correlational, prospective of crosssectional. A total of 148 clients attended the San Fernando Health Center-Augustino were interviewed, evaluating them, the level of knowledge and attitudes about cervical cancer and if it influences in the decision of PAP during 2014. The data were recorded in the Statistic program SPSS v.21. To evaluate the degree of association, the Chisquare test was used, with a confidence level (CI) of 95%, being considered significant a p ≤ 0.05 value. RESULTS: Of 148 users with ages between 20-59 years, 62.8% was realized Pap test in the last three years, while 37.2% reported that it was not done in over three years and never did, being the motives lack of time (41.9%) or out of fear (25.8%). Regarding the level of knowledge about cervical cancer in the total population was: 58.8% got a level of "Medium" and 20.9% "Low" and address the attitudes 83.8% had a "negative" attitude and 16.2% "Positive". The level of knowledge about cervical cancer in users that was performed the Pap smear was "Medium" 50.5% and "High" at 25.8% compared to the Pap the users who obtained a level "Medium" were not performed in 72.7%, and "High" by 10.9%, being statistically significant difference (p=0.023). Attitudes toward cervical cancer in users that if were performed the Pap smear was "Negative" in 81.7% compared with the Pap the users who were "Negative" in a 87.3% were not performed, noteing a statistically significant (p = 0.376). The users with a "positive" attitude to cervical cancer, had a level of knowledge "Medium" in 70.8%, and "High" at 25% compared to the users with attitude "Negative" that had a level "Medium "at 56.5% and" Low "at 19.4%, with some significance between these values (p=0.087). CONCLUSIONS: There is significant relationship between knowledge about cervical cancer and taking Papanicolaou (p = 0.023), but was not found relationship between attitudes about cervical cancer and taking Papanicolaou (p=0.376), showing a negative attitude both in the group of patients who were taken and not taken the Pap. KEYWORDS: Cervical cancer, level of knowledge, attitudes, Papanicolaou.

Objetivo: Determinar la prevalencia de las lesiones premalignas de cáncer de cuello uterino en los resultados de Papanicolau en las mujeres atendidas en el Hospital II Cañete en el periodo Julio 2014 a Julio del 2015. Métodos: Se realizó un estudio observacional, de tipo descriptivo, retrospectivo. La población, y muestra fue de 3061 resultados de Papanicolau, y fue recolectado por medio de una ficha simple de recolección de datos. Resultados: El estudio obtuvo 136 resultados de Papanicolau positivos, de los cuales 104 presentaron algún grado de alteración citológica, lo cual representó una prevalencia de 3.39%. De las citologías positivas presentaron ASCUS, 43.3%; LIE Bajo Grado, 37.5%; LIE Alto Grado, 18.3% y Carcinoma de cérvix, 1%. Las muestras insatisfactorias corresponden a un total de 32 resultados, lo cual es 1.04% Conclusiones: La prevalencia de anormalidades citológicas, y de muestras insatisfactorias fue bajo en el grupo estudiado, respecto a estudios Latinoamericanos, y según los indicadores nacionales. Además se encontró un mayor número de alteraciones citológicas hacia el grupo de 25 a 34 años.

OBJETIVO: Evaluar el conocimiento, actitudes y práctica sobre el examen de Papanicolaou en pacientes mayores de 15 años que asisten a la consulta externa de Ginecología del Hospital San José en el mes de junio a agosto del 2015. METODOS: estudio observacional, analítico, prospectivo y transversal en el cual se evaluó a pacientes mayores de 15 años que asisten a la consulta externa de Ginecología del Hospital San José en el mes de julio a agosto del 2015. Se realizaron encuestas estructuradas. El tamaño de la muestra fue de 368 mujeres mayores de 15 años. La información obtenida se realizó en tabulaciones para el procesamiento estadístico de los datos en el programa de Excel 2013 y SPSS 23. Se utilizó la estadística descriptiva como: frecuencia, porcentaje, media aritmética y desviación estándar. La estadística inferencial determinó la relación existente entre variables a través de la prueba chi-cuadrado con un nivel de significancia < 0,05. RESULTADOS: El 45.11% de las mujeres mayores de 15 años encuestadas, oscilan entre 30-44 años. De todas las mujeres encuestadas, el 60.05% conocen que el Papanicolaou se realiza para la detección del cáncer del cuello uterino; el 45.11% piensan que el presentar molestias en la vagina es el indicador más importante para realizarse el examen del Papanicolaou; Así mismo, el 54.62% presentaron un nivel de conocimiento alto con respecto al Papanicolaou; el 55.70% presentaron una actitud favorable frente al examen del Papanicolaou; el 58.97% mostraron una práctica adecuada frente al examen del Papanicolaou. Del mismo modo se encontró que, existe relación estadísticamente significativa entre el nivel de conocimiento alto y la actitud favorable, y entre el nivel de conocimiento alto y la práctica adecuada frente al examen de Papanicolaou (p<0,05); y existe relación estadísticamente significativa relación estadísticamente significativa entre el nivel de conocimiento alto y la actitud favorable, y entre el nivel de conocimiento alto y la práctica adecuada frente al examen de Papanicolaou (p<0,05). CONCLUSIONES: Se concluye, que las mujeres mayores de 15 años que acudieron al consultorio de Ginecología presentan un nivel de conocimiento alto, una actitud favorable y una práctica adecuada frente al examen del Papanicolaou. Otra conclusión importante es que existe relación estadísticamente significativa entre el nivel de conocimiento alto y la actitud favorable; entre el nivel de conocimiento alto y la práctica adecuada y relación estadísticamente significativa entre el nivel de conocimiento alto y la actitud favorable, y entre el nivel de conocimiento alto y la práctica adecuada frente al examen de Papanicolaou.

La mortalidad debido al cáncer de cuello uterino (CCU) es uno de los grandes problemas de salud pública que confrontan las mujeres en todo el mundo, especialmente en los países menos desarrollados donde ocurre el 80% de las muertes relacionadas a este tipo de cáncer. A diferencia de otros tipos de cáncer, el de cuello uterino, puede prevenirse exitosamente mediante la identificación oportuna por medio de la prueba de PAP y el tratamiento a las mujeres que presentan lesiones pre-neoplasicas. Esas lesiones demorarán diez años o más en progresar hacia el cáncer. En Bolivia, el CCU es una de las principales causas de muerte en mujeres, especialmente en el grupo de 35 a 64 años de edad. Los Programas de prevención del CCU en países como Bolivia no han logrado un impacto considerable sobre la incidencia de este cáncer ni en las tasas de mortalidad, debido a que no cuentan con la compleja estructura requerida para obtener una cobertura de tamizaje adecuada. A nivel nacional en Bolivia en la gestión 1998 se realizaron 57.826 exámenes de Papanicolaou para una población de mujeres en edad fértil de 1.932.321 representando una cobertura de 2,9%. El 21 de noviembre de 2002, se lanza como política de estado, la estrategia de reducción a la pobreza y cumplimiento de las metas de desarrollo del milenio, promulgándose la Ley No. 2426 “Seguro Universal Materno Infantil” (SUMI), con el propósito de disminuir la morbi-mortalidad materna infantil. Entra en vigencia el 1 de enero del 2003.