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Original Article
Association between Hormonal Contraception and Injuries Induced by Human Papillomavirus in the Uterine Cervix
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):196-202
04-01-2018
Summary
Original ArticleAssociation between Hormonal Contraception and Injuries Induced by Human Papillomavirus in the Uterine Cervix
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):196-202
04-01-2018Views111See moreAbstract
Objective
To evaluate the association between hormonal contraception and the appearance of human papillomavirus HPV-induced lesions in the uterine cervix of patients assisted at a school outpatient clinic - ObGyn outpatient service of the Universidade do Sul de Santa Catarina.
Methods
A case-control study, with women in fertile age, performed between 2012 and 2015. A total of 101 patients with cervical lesions secondary to HPV were included in the case group, and 101 patients with normal oncotic colpocytology, in the control group. The data were analyzed through the Statistical Package for the Social Sciences (SPSS, IBM Corp. Armonk, NY, US) software, version 24.0, using the 95% confidence interval. To test the homogeneity of the proportions, the chi-square (χ2) test was used for the qualitative variables, and the Student t-test, for the quantitative variables.
Results
When comparing the occurrence of HPV lesions in users and non-users of combined oral contraceptives (COCs), the association with doses of 0.03 mg or higher of ethinylestradiol (EE) was observed. Thus, a higher probability of developing cervical lesions induced by HPV was identified (odds ratio [OR]: 1.9 p = 0.039); and when these cases were separated by the degree of the lesion, the probability of these patients presentingwith lowgrade squamous intraepithelial lesion was 2.1 times higher (p = 0.036), but with no impact on high-grade squamous intraepithelial lesions and the occurrence of invasive cancer. No significant differences were found in the other variables analyzed.
Conclusion
Although the results found in the present study suggest a higher probability of the users of combined hormonal contraceptives with a concentration higher than 0.03 mg of EE to develop low-grade intraepithelial lesions, more studies are needed to conclude causality.
Views111
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleAssociation between Hormonal Contraception and Injuries Induced by Human Papillomavirus in the Uterine Cervix
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):196-202
04-01-2018Views111See moreAbstract
Objective
To evaluate the association between hormonal contraception and the appearance of human papillomavirus HPV-induced lesions in the uterine cervix of patients assisted at a school outpatient clinic - ObGyn outpatient service of the Universidade do Sul de Santa Catarina.
Methods
A case-control study, with women in fertile age, performed between 2012 and 2015. A total of 101 patients with cervical lesions secondary to HPV were included in the case group, and 101 patients with normal oncotic colpocytology, in the control group. The data were analyzed through the Statistical Package for the Social Sciences (SPSS, IBM Corp. Armonk, NY, US) software, version 24.0, using the 95% confidence interval. To test the homogeneity of the proportions, the chi-square (χ2) test was used for the qualitative variables, and the Student t-test, for the quantitative variables.
Results
When comparing the occurrence of HPV lesions in users and non-users of combined oral contraceptives (COCs), the association with doses of 0.03 mg or higher of ethinylestradiol (EE) was observed. Thus, a higher probability of developing cervical lesions induced by HPV was identified (odds ratio [OR]: 1.9 p = 0.039); and when these cases were separated by the degree of the lesion, the probability of these patients presentingwith lowgrade squamous intraepithelial lesion was 2.1 times higher (p = 0.036), but with no impact on high-grade squamous intraepithelial lesions and the occurrence of invasive cancer. No significant differences were found in the other variables analyzed.
Conclusion
Although the results found in the present study suggest a higher probability of the users of combined hormonal contraceptives with a concentration higher than 0.03 mg of EE to develop low-grade intraepithelial lesions, more studies are needed to conclude causality.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Does Knowing Someone with Breast Cancer Influence the Prevalence of Adherence to Breast and Cervical Cancer Screening?
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):203-208
04-01-2018
Summary
Original ArticleDoes Knowing Someone with Breast Cancer Influence the Prevalence of Adherence to Breast and Cervical Cancer Screening?
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):203-208
04-01-2018Views92Abstract
Objective
To evaluate the prevalence of adherence to screening methods for breast and cervical cancer in patients attended at a university hospital and to investigate whether knowing someone with breast cancer, moreover belonging to the patient’s family, affects the adherence to the screening recommendations.
Methods
This was a cross-sectional and quantitative study. A structured interview was applied to a sample of 820 women, between 20 and 69 years old, who attended a university hospital in the city of Juiz de for a, MG, Brazil. For the analysis, the chi-square test was used to assess possible associations between the variables, and the significance level was set at p-value ≤ 0.05 for a confidence interval (CI) of 95%.
Results
More than 95.0% of the sample performed mammography and cervical cytology exam; 62.9% reported knowing someone who has or had breast cancer, and this group was more likely to perform breast self-examination (64.9%; odds ratio [OR] 1.5; 95% CI 1.12-2.00), clinical breast examination (91.5%; OR 2.11; 95% CI 1.37-3.36), breast ultrasound (32.9%; OR 1.81, 95% CI 1.30-2.51), and to have had an appointment with a breast specialist (28.5%; OR 1.98, 95% CI 1.38-2.82).Women with family history of breast cancer showed higher propensity to perform breast self-examination (71.0%; OR 1.53 95% CI 1.04-2.26).
Conclusion
There was high adherence to the recommended screening practices; knowing someone with breast cancer might make women more sensitive to this issue as they were more likely to undergo methods which are not recommended for the screening of the general population, such as breast ultrasound and specialist consultation; family history is possibly an additional cause of concern.
Key-words Breast neoplasmsbreast selfexaminationMass screeningPublic healthUterine cervical neoplasmsSee moreViews92This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleDoes Knowing Someone with Breast Cancer Influence the Prevalence of Adherence to Breast and Cervical Cancer Screening?
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):203-208
04-01-2018Views92Abstract
Objective
To evaluate the prevalence of adherence to screening methods for breast and cervical cancer in patients attended at a university hospital and to investigate whether knowing someone with breast cancer, moreover belonging to the patient’s family, affects the adherence to the screening recommendations.
Methods
This was a cross-sectional and quantitative study. A structured interview was applied to a sample of 820 women, between 20 and 69 years old, who attended a university hospital in the city of Juiz de for a, MG, Brazil. For the analysis, the chi-square test was used to assess possible associations between the variables, and the significance level was set at p-value ≤ 0.05 for a confidence interval (CI) of 95%.
Results
More than 95.0% of the sample performed mammography and cervical cytology exam; 62.9% reported knowing someone who has or had breast cancer, and this group was more likely to perform breast self-examination (64.9%; odds ratio [OR] 1.5; 95% CI 1.12-2.00), clinical breast examination (91.5%; OR 2.11; 95% CI 1.37-3.36), breast ultrasound (32.9%; OR 1.81, 95% CI 1.30-2.51), and to have had an appointment with a breast specialist (28.5%; OR 1.98, 95% CI 1.38-2.82).Women with family history of breast cancer showed higher propensity to perform breast self-examination (71.0%; OR 1.53 95% CI 1.04-2.26).
Conclusion
There was high adherence to the recommended screening practices; knowing someone with breast cancer might make women more sensitive to this issue as they were more likely to undergo methods which are not recommended for the screening of the general population, such as breast ultrasound and specialist consultation; family history is possibly an additional cause of concern.
Key-words Breast neoplasmsbreast selfexaminationMass screeningPublic healthUterine cervical neoplasmsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
The Burden of Indirect Causes of Maternal Morbidity and Mortality in the Processof Obstetric Transition: A Cross-Sectional Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):106-114
03-01-2018
Summary
Original ArticleThe Burden of Indirect Causes of Maternal Morbidity and Mortality in the Processof Obstetric Transition: A Cross-Sectional Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):106-114
03-01-2018Views154See moreAbstract
Objective
The aim of this study is to evaluate the burden of indirect causes of maternal morbidity/mortality in Brazil.
Methods
Secondary analysis of a multicenter cross-sectional study conducted in 27 referral obstetric units within the Brazilian Network for Surveillance of Severe Maternal Morbidity.
Results
A total of 82,388 women were surveilled: 9,555 women with severe maternal morbidity were included, and 942 (9.9%) of them had indirect causes of morbidity/ mortality. There was an increased risk of higher severity among the indirect causes group, which presented 7.56 times increased risk of maternal death (prevalence ratio [PR]: 7.56; 95% confidence interval [95%CI]: 4.99-11.45). The main indirect causes of maternal death were H1N1 influenza, sepsis, cancer and cardiovascular disease. Non-public antenatal care (PR: 2.52; 95%CI: 1.70-3.74), diabetes (PR: 1.90; 95%CI: 1.24-2.90), neoplasia (PR: 1.98; 95%CI: 1.25-3.14), kidney diseases (PR: 1.99; 95%CI: 1.14-3.49), sickle cell anemia (PR: 2.50; 95%CI: 1.16-5.41) and drug addiction (PR: 1.98; 95%CI: 1.03-3.80) were independentlyassociatedwithworseresultsintheindirectcausesgroup.Someprocedures for the management of severity were more common for the indirect causes group.
Conclusion
Indirect causes were present in less than 10% of the overall cases, but they represented over 40% of maternal deaths in the current study. Indirect causes of maternal morbidity/mortality were also responsible for an increased risk of higher severity, and they were associated with worse maternal and perinatal outcomes. In middle-income countries there is a mix of indirect causes of maternal morbidity/ mortality that points to some advances in the scale of obstetric transition, but also reveals the fragility of health systems.
Views154This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleThe Burden of Indirect Causes of Maternal Morbidity and Mortality in the Processof Obstetric Transition: A Cross-Sectional Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):106-114
03-01-2018Views154See moreAbstract
Objective
The aim of this study is to evaluate the burden of indirect causes of maternal morbidity/mortality in Brazil.
Methods
Secondary analysis of a multicenter cross-sectional study conducted in 27 referral obstetric units within the Brazilian Network for Surveillance of Severe Maternal Morbidity.
Results
A total of 82,388 women were surveilled: 9,555 women with severe maternal morbidity were included, and 942 (9.9%) of them had indirect causes of morbidity/ mortality. There was an increased risk of higher severity among the indirect causes group, which presented 7.56 times increased risk of maternal death (prevalence ratio [PR]: 7.56; 95% confidence interval [95%CI]: 4.99-11.45). The main indirect causes of maternal death were H1N1 influenza, sepsis, cancer and cardiovascular disease. Non-public antenatal care (PR: 2.52; 95%CI: 1.70-3.74), diabetes (PR: 1.90; 95%CI: 1.24-2.90), neoplasia (PR: 1.98; 95%CI: 1.25-3.14), kidney diseases (PR: 1.99; 95%CI: 1.14-3.49), sickle cell anemia (PR: 2.50; 95%CI: 1.16-5.41) and drug addiction (PR: 1.98; 95%CI: 1.03-3.80) were independentlyassociatedwithworseresultsintheindirectcausesgroup.Someprocedures for the management of severity were more common for the indirect causes group.
Conclusion
Indirect causes were present in less than 10% of the overall cases, but they represented over 40% of maternal deaths in the current study. Indirect causes of maternal morbidity/mortality were also responsible for an increased risk of higher severity, and they were associated with worse maternal and perinatal outcomes. In middle-income countries there is a mix of indirect causes of maternal morbidity/ mortality that points to some advances in the scale of obstetric transition, but also reveals the fragility of health systems.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Female Sexual Function in Women with Suspected Deep Infiltrating Endometriosis
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):115-120
03-01-2018
Summary
Original ArticleFemale Sexual Function in Women with Suspected Deep Infiltrating Endometriosis
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):115-120
03-01-2018Views158See moreAbstract
Objective
To evaluate the quality of the sexual function of women with suspected deep infiltrating endometriosis.
Methods
A cross-sectional, observational and prospective study was conducted between May 2015 and August 2016, in which 67 patients with deep infiltrating endometriosis, suspected or diagnosed, were assessed for epidemiological and clinical characteristics, such as pain level through a visual analog scale (VAS), features of deep infiltrating endometriosis lesions and score on the Female Sexual Function Index (FSFI) before the onset of treatment. The statistical analysis was performed using the software STATA version 12.0 (StataCorp LLC, College Station, TX, USA) to compare the variables through multiple regression analysis.
Results
The average age of the patients was 39.2 years old; most patients were symptomatic (92.5%); and the predominant location of the deep infiltrating lesions was on the rectosigmoid colon (50%), closely followed by the retrocervical region (48.3%). The medianoverallscoreontheFSFIwas23.4;in67.2%of thecasesthescorewas26.5(cutoff point for sexualdysfunction). Deepdyspareunia(p = 0.000,confidenceinterval [CI]:0.64- 0.83) and rectosigmoid endometriosis lesions (p = 0.008, CI: 0.72-0.95) showed significant correlation with lower FSFI scores, adjusted by bladder lesion, patients’ ageand size of lesions. Deep dyspareunia (p = 0.003, CI: 0.49-0.86) also exhibited significant correlation with FSFI pain domain, adjusted by cyclic bowel pain, vaginal lesion and use of gonadotropin-releasing hormone (GnRH) analog. These results reflect the influence of deep dyspareunia on the sexual dysfunction of the analyzed population.
Conclusion
Most patients exhibited sexual dysfunction, and deep dyspareunia was the pelvic painful symptom that showed correlation with sexual dysfunction.
Views158This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleFemale Sexual Function in Women with Suspected Deep Infiltrating Endometriosis
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):115-120
03-01-2018Views158See moreAbstract
Objective
To evaluate the quality of the sexual function of women with suspected deep infiltrating endometriosis.
Methods
A cross-sectional, observational and prospective study was conducted between May 2015 and August 2016, in which 67 patients with deep infiltrating endometriosis, suspected or diagnosed, were assessed for epidemiological and clinical characteristics, such as pain level through a visual analog scale (VAS), features of deep infiltrating endometriosis lesions and score on the Female Sexual Function Index (FSFI) before the onset of treatment. The statistical analysis was performed using the software STATA version 12.0 (StataCorp LLC, College Station, TX, USA) to compare the variables through multiple regression analysis.
Results
The average age of the patients was 39.2 years old; most patients were symptomatic (92.5%); and the predominant location of the deep infiltrating lesions was on the rectosigmoid colon (50%), closely followed by the retrocervical region (48.3%). The medianoverallscoreontheFSFIwas23.4;in67.2%of thecasesthescorewas26.5(cutoff point for sexualdysfunction). Deepdyspareunia(p = 0.000,confidenceinterval [CI]:0.64- 0.83) and rectosigmoid endometriosis lesions (p = 0.008, CI: 0.72-0.95) showed significant correlation with lower FSFI scores, adjusted by bladder lesion, patients’ ageand size of lesions. Deep dyspareunia (p = 0.003, CI: 0.49-0.86) also exhibited significant correlation with FSFI pain domain, adjusted by cyclic bowel pain, vaginal lesion and use of gonadotropin-releasing hormone (GnRH) analog. These results reflect the influence of deep dyspareunia on the sexual dysfunction of the analyzed population.
Conclusion
Most patients exhibited sexual dysfunction, and deep dyspareunia was the pelvic painful symptom that showed correlation with sexual dysfunction.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Management of Atypical Squamous Cell Cases: A Prospective Study of Women seen at a Private Health Service in Northeastern Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):121-126
03-01-2018
Summary
Original ArticleManagement of Atypical Squamous Cell Cases: A Prospective Study of Women seen at a Private Health Service in Northeastern Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):121-126
03-01-2018Views125Abstract
Objective
To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women.
Methods
A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H).
Results
In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p< 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p< 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p< 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075).
Conclusion
The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.
Key-words atypical squamous cells of the cervixdisease managementHuman papillomavirusPapanicolaou testUterine cervical neoplasmSee moreViews125This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleManagement of Atypical Squamous Cell Cases: A Prospective Study of Women seen at a Private Health Service in Northeastern Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):121-126
03-01-2018Views125Abstract
Objective
To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women.
Methods
A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H).
Results
In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p< 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p< 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p< 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075).
Conclusion
The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.
Key-words atypical squamous cells of the cervixdisease managementHuman papillomavirusPapanicolaou testUterine cervical neoplasmSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Late-Stage Diagnosis of Breast Cancer in Brazil: Analysis of Data from Hospital-Based Cancer Registries (2000-2012)
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):127-136
03-01-2018
Summary
Original ArticleLate-Stage Diagnosis of Breast Cancer in Brazil: Analysis of Data from Hospital-Based Cancer Registries (2000-2012)
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):127-136
03-01-2018Views112Abstract
Objective
To analyze the time trend and the factors regarding the diagnosis of latestage breast cancer in Brazil from 2000 to 2012.
Methods
We conducted a retrospective cohort study using data from hospital-based cancer registries. Joinpoint regression was used to analyze the time trends of stage at diagnosis. The risk of late-stage presentation was estimated using multinomial logistic regression.
Results
A total of 170,757 cases were analyzed. The median time from diagnosis to treatment was of 43 days (range: 0-182 days). The percentage of cases with late-stage diagnosis decreased from2000 to 2002, with an annual percent change (APC) of -6.6%(95%confidence interval [95%CI]: -7.6--5.5%); it increased from 2002 until 2009, with an APC of 1.1% (95% CI: 0.9-1.3%), and remained stable up to 2012.Women with college education (compared with illiterate women) had less chance of having a late-stage diagnosis (odds ratio [OR]: 0.32; 95%CI: 0.29-0.35). The odds were greater among brown women (OR: 1.30; 95%CI: 1.21-1.41) and black women (OR: 1.63; 95%CI: 1.47-1.82), compared with white women. The odds were also higher for women treated in facilities located and in the Northern region of Brazil (OR: 1.23; 95%CI: 1.04-1.45) and in the Midwest (OR: 1.61;95%CI: 1.34-1.94), compared with those treated in the southern region of the country. Age, histological type, and marital status were some of the other factors that were positively related to staging at the diagnosis.
Conclusion
Access to diagnosis of breast cancer is uneven in Brazil, and women with lower socioeconomic status present a greater probability of having an advanced stage at diagnosis.
Key-words Breast neoplasmsdisease registriesHealth services accessibilityoncologywomen’s health serviceSee moreViews112This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleLate-Stage Diagnosis of Breast Cancer in Brazil: Analysis of Data from Hospital-Based Cancer Registries (2000-2012)
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):127-136
03-01-2018Views112Abstract
Objective
To analyze the time trend and the factors regarding the diagnosis of latestage breast cancer in Brazil from 2000 to 2012.
Methods
We conducted a retrospective cohort study using data from hospital-based cancer registries. Joinpoint regression was used to analyze the time trends of stage at diagnosis. The risk of late-stage presentation was estimated using multinomial logistic regression.
Results
A total of 170,757 cases were analyzed. The median time from diagnosis to treatment was of 43 days (range: 0-182 days). The percentage of cases with late-stage diagnosis decreased from2000 to 2002, with an annual percent change (APC) of -6.6%(95%confidence interval [95%CI]: -7.6--5.5%); it increased from 2002 until 2009, with an APC of 1.1% (95% CI: 0.9-1.3%), and remained stable up to 2012.Women with college education (compared with illiterate women) had less chance of having a late-stage diagnosis (odds ratio [OR]: 0.32; 95%CI: 0.29-0.35). The odds were greater among brown women (OR: 1.30; 95%CI: 1.21-1.41) and black women (OR: 1.63; 95%CI: 1.47-1.82), compared with white women. The odds were also higher for women treated in facilities located and in the Northern region of Brazil (OR: 1.23; 95%CI: 1.04-1.45) and in the Midwest (OR: 1.61;95%CI: 1.34-1.94), compared with those treated in the southern region of the country. Age, histological type, and marital status were some of the other factors that were positively related to staging at the diagnosis.
Conclusion
Access to diagnosis of breast cancer is uneven in Brazil, and women with lower socioeconomic status present a greater probability of having an advanced stage at diagnosis.
Key-words Breast neoplasmsdisease registriesHealth services accessibilityoncologywomen’s health serviceSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Improving Perinatology Residents’ Skills in Breaking Bad News: A Randomized Intervention Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):137-146
03-01-2018
Summary
Original ArticleImproving Perinatology Residents’ Skills in Breaking Bad News: A Randomized Intervention Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):137-146
03-01-2018Views166Abstract
Objective
Breaking bad news (BBN) is particularly difficult in perinatology. Previous research has shown that BBN skills can be learned and improved when taught and practiced. This project evaluated whether a structured training session would enhance perinatology residents’ skills in BBN.
Methods
This was a randomized controlled intervention study with year 1 to 4 Perinatology residents from a medical school in Brazil, during the 2014/15 school year. A total of 61 out of 100 (61%) eligible residents volunteered to a structured training program involving communicating a perinatal loss to a simulated patient (SP) portraying the mother followed by the SP’s immediatefeedback,bothvideo recorded. Later, residents were randomly assigned to BBN training based on a setting, perception, invitation, knowledge, emotion and summary (SPIKES) strategy with video reviews (intervention) or no training (control group). All residents returned for a second simulation with the same SP blinded to the intervention and portraying a similar case. Residents’ performances were then evaluated by the SP with a checklist. The statistical analysis included a repeated measures analysis of covariance (RM-ANCOVA). Complementarily, the residents provided their perceptions about the simulation with feedback activities.
Results
Fifty-eight residents completed the program. The simulations lasted on average 12 minutes, feedback 5 minutes and SPIKES training between 1h and 2h30m. There was no significant difference in the residents’ performances according to the SPs’ evaluations (p = 0.55). The participants rated the simulation with feedback exercises highly. These educational activities might have offset SPIKES training impact. Conclusion The SPIKES training did not significantly impact the residents’ performance. The residents endorsed the simulation with feedback as a useful training modality. Further research is needed to determine which modality is more effective.
Key-words educationHealth communicationinternship and residencymedicalpatient simulationperinatologySee moreViews166This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleImproving Perinatology Residents’ Skills in Breaking Bad News: A Randomized Intervention Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):137-146
03-01-2018Views166Abstract
Objective
Breaking bad news (BBN) is particularly difficult in perinatology. Previous research has shown that BBN skills can be learned and improved when taught and practiced. This project evaluated whether a structured training session would enhance perinatology residents’ skills in BBN.
Methods
This was a randomized controlled intervention study with year 1 to 4 Perinatology residents from a medical school in Brazil, during the 2014/15 school year. A total of 61 out of 100 (61%) eligible residents volunteered to a structured training program involving communicating a perinatal loss to a simulated patient (SP) portraying the mother followed by the SP’s immediatefeedback,bothvideo recorded. Later, residents were randomly assigned to BBN training based on a setting, perception, invitation, knowledge, emotion and summary (SPIKES) strategy with video reviews (intervention) or no training (control group). All residents returned for a second simulation with the same SP blinded to the intervention and portraying a similar case. Residents’ performances were then evaluated by the SP with a checklist. The statistical analysis included a repeated measures analysis of covariance (RM-ANCOVA). Complementarily, the residents provided their perceptions about the simulation with feedback activities.
Results
Fifty-eight residents completed the program. The simulations lasted on average 12 minutes, feedback 5 minutes and SPIKES training between 1h and 2h30m. There was no significant difference in the residents’ performances according to the SPs’ evaluations (p = 0.55). The participants rated the simulation with feedback exercises highly. These educational activities might have offset SPIKES training impact. Conclusion The SPIKES training did not significantly impact the residents’ performance. The residents endorsed the simulation with feedback as a useful training modality. Further research is needed to determine which modality is more effective.
Key-words educationHealth communicationinternship and residencymedicalpatient simulationperinatologySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Distance Education Course about Sexuality for Obstetrics and Gynecology Residents
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(12):670-675
12-01-2017
Summary
Original ArticleDistance Education Course about Sexuality for Obstetrics and Gynecology Residents
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(12):670-675
12-01-2017Views134See moreAbstract
Purpose
To describe the experience of a distance education course on sexual issues during pregnancy and after birth for residents.
Methods
This prospective educational intervention study was conducted by investigators from the Universidade Federal de São Paulo, Brazil, between April and September 2014. The participants were 219 physicians (residents from the 1st to the 6th years). The duration of the course was of 24 hours (10 video lectures and online chats). At baseline, the participants answered questions about their training, attitude and experience regarding sexual issues during pregnancy and after birth; before and after the course, they answered questions to assess their knowledge about the topic; at the end of the course, they answered questions on the quality of the course. The Student t-test was used to compare the before and after scores of the knowledge tests; values of p < 0.05 were considered statistically significant.
Results
A total of 143 residents concluded the course; most were in their 1st (27.2%) or 3rd (29.4%) years of residency. There was a significant increase in themean scores of the questionnaires that assessed the knowledge of the topic: 4.4 (1.6) versus 6.0 (1.3; maximum score: 10), before and after the course respectively (p < 0.0001). Most of the participants (74.1%) declared that the quality of the course as a whole reached their expectations, and 81.1% would recommend the course to a friend.
Conclusions
The online Sexology course for Obstetrics and Gynecology residents increased their knowledge about the sexual issues during pregnancy and after birth, and fulfilled the participants’ expectations. The experience described heremay serve as a model for other sexuality courses targeting similar audiences.
Views134This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleDistance Education Course about Sexuality for Obstetrics and Gynecology Residents
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(12):670-675
12-01-2017Views134See moreAbstract
Purpose
To describe the experience of a distance education course on sexual issues during pregnancy and after birth for residents.
Methods
This prospective educational intervention study was conducted by investigators from the Universidade Federal de São Paulo, Brazil, between April and September 2014. The participants were 219 physicians (residents from the 1st to the 6th years). The duration of the course was of 24 hours (10 video lectures and online chats). At baseline, the participants answered questions about their training, attitude and experience regarding sexual issues during pregnancy and after birth; before and after the course, they answered questions to assess their knowledge about the topic; at the end of the course, they answered questions on the quality of the course. The Student t-test was used to compare the before and after scores of the knowledge tests; values of p < 0.05 were considered statistically significant.
Results
A total of 143 residents concluded the course; most were in their 1st (27.2%) or 3rd (29.4%) years of residency. There was a significant increase in themean scores of the questionnaires that assessed the knowledge of the topic: 4.4 (1.6) versus 6.0 (1.3; maximum score: 10), before and after the course respectively (p < 0.0001). Most of the participants (74.1%) declared that the quality of the course as a whole reached their expectations, and 81.1% would recommend the course to a friend.
Conclusions
The online Sexology course for Obstetrics and Gynecology residents increased their knowledge about the sexual issues during pregnancy and after birth, and fulfilled the participants’ expectations. The experience described heremay serve as a model for other sexuality courses targeting similar audiences.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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