The impact of specimen adequacy on the diagnosis of cervical cytology is not fully understood. Virtually, the greatest impact of smear quality limitation factors is on the diagnosis of atypical squamous cells of undetermined significance (ASCUS) because this category is more susceptible to interpretation mistake due to its criteria subjectivity. This study aims to evaluate the impact of smear quality impairing factors on the diagnosis of ASCUS. The 1,507 cases of ASCUS studied were obtained from the Cervical Cancer Screening Program of Paraná (CCSPP). The cases were reviewed by expert cytopathologists and the results were correlated to the specimen adequacy. The results showed that the presence of obscuring blood impairs the correct diagnosis and leads the pathologist to overdiagnose negative smears as ASCUS. The presence of adequate endocervical sampling contributes to a higher rate of correct ASCUS diagnoses but did not influence the pathologist to over- or underestimate the cytological findings.
Introduction: Ethnic and cultural diversity in Portugal has reinforced the importance of adjusting healthcare services to the health needs of different populations. This study aims to analyse longitudinally the factors associated with health care use by native Portuguese and African hypersive patients. Methods: Longitudinal study including treated hypertensive patients followed-up in primary care in the Lisbon region, between September 2010 and March 2012. For this analysis, 233 native Caucasians and 170 African immigrants were included. We applied three face-to-face questionnaires (0, 6 and 12 months) and two by telephone (3 and 9 months). The measure of service use was the number of encounters due to hypertension, in the three months preceding the interview. For the identification of the factors, a longitudinal generalised linear mixed model was estimated for each group. Results: More natives than immigrants consulted the GP in the last year (76.0% vs 64.7%, p=0.019), however, more immigrants used urgent health care (12.4% vs 5.2%, p=0.016). The proportion of patients with at least one medical encounter was not different between groups (46.5% vs 41.6%, p=0.387). After adjusting for all variables, the use of medical care among natives was associated with age (e β =1.036; p=0.021), diabetes (e β =1.898; p=0.006), hypertension control (e β =1.036; p=0.007), uncontrolled self-assessed hypertension status (e β =0.596; p=0.033), and follow-up time. (e β =0.771; p=0.001). Among immigrants, the use of health services was associated with marital status (e β =2.228; p=0.025), uncontrolled self-assessed hypertension status (e β =0.580; p=0.013), time since diagnosis of hypertension (e β =1.021; p=0.016) and follow-up time (e β =0.689; p<0.001). Conclusions: There is a need to better understand the differences in the factors associated with the use of hypertension-related health care among natives and immigrants, in order to develop health promotion strategies adapted to target populations.
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