The LAMS study failed to reproduce the performance figures obtained with VIA and VILI (as stand-alone tests) in some other settings, where the prevalence of cervical disease was higher. However, a combined use of VIA or VILI with the Pap test or HCII allowed specific detection of cervical abnormalities.

Resumo: Introdução: Com a suspensão das atividades presenciais e a implementação do ensino remoto do curso de Medicina da Unicamp, foi necessária a elaboração de estratégias para identificar as necessidades dos estudantes para continuidade das aulas nessa nova modalidade. Objetivo: Demonstrar as estratégias desenvolvidas e as soluções encontradas para permitir a equidade de acesso ao ensino remoto no curso de medicina da FCM-Unicamp. Método: São apresentados dados do relatório institucional, elaborado a partir de questionários aplicados para os estudantes do curso de Medicina sobre as dificuldades referentes ao acesso ao ensino remoto emergencial e as ações realizadas para solucionar as principais dificuldades encontradas. Resultados: Constatamos que os anos iniciais do curso apresentam a maior proporção de alunos com dificuldades, embora, em todos os anos, os discentes tenham relatado alguma dificuldade. Os principais problemas identificados foram internet instável e/ou apenas acesso por redes móveis. Verificou-se ainda que os alunos tinham maior dificuldade em acompanhar as atividades síncronas. A maior parte dos alunos mencionou que acompanhava as aulas por computadores e notebooks, mas, muitas vezes, estes eram compartilhados com outros membros da família. Alguns estudantes apontaram também que muitas vezes, não conseguiam acompanhar o curso por falta de aparelhos ou acesso à internet. Nesse caso, computadores e chips de celular e para uso em tablets eram emprestados aos alunos. Houve orientação aos professores para adequação das ferramentas pedagógicas utilizadas. Conclusão: Garantir a equidade de acesso é fundamental para permitir a continuidade dos estudos na transformação do estudo presencial em remoto emergencial. O ato de escutar os alunos sobre as dificuldades em relação ao ensino remoto e a realização de suporte material são ferramentas essenciais para o sucesso dessa estratégia pedagógica. A orientação do corpo docente em relação às dificuldades dos alunos foi importante para adequação do ensino remoto. Essas ações auxiliaram os estudantes na mudança do ensino imposta pelo distanciamento social.

Hybrid capture II (HC II) test for oncogenic human papillomaviruses (HPV) was carried out in a cohort of 4284 women at their first clinical visit. Overall prevalence of HPV was 17.1%, decreasing with age from 33.9% among women below 20 years to only 11.0% among those older than 41 years. HPV prevalence was significantly higher among current smokers (odds ratio [OR] = 1.31; 95% CI 1.1-1.6), in women with two or more lifetime sexual partners (OR = 1.9; 95% CI 1.6-2.4), and those women with two or more sexual partners during the past 12 months prior to examination (OR = 1.6; 95% CI 1.2-2.2). HPV detection increased in parallel with increasing cytologic abnormality, being highest in women with high-grade squamous intraepithelial lesion (P= 0.001). Specificity of the HPV test in detecting histologically confirmed cervical disease was 85% (95% CI 83.9-86.1). Sensitivity of the HPV test in detecting histologic abnormalities increased in parallel with disease severity, ranging from 51.5% for cervical intraepithelial neoplasia (CIN) 1 to 96.5% for CIN 3 and 100.0% for cancer, with respective decline of positive predictive value. These data suggest that HPV testing with HC II assay might be a viable screening tool among this population with relatively high prevalence of cervical disease.

In 2018, WHO called for global action to eliminate cervical cancer. The complexity of the processes involved in terms of prevention is often underestimated. Low‐ and middle‐income countries do not have a robust healthcare framework to ensure high‐quality programs. The present article discusses how fragile healthcare systems are barriers to eliminating cervical cancer, and also reports the experience of a Brazilian prevention program. The article considers how cervical cancer can be interpreted as an indicator of inequality: how women's attitudes and access to care determine an early or late diagnosis, and how strategies combining vaccine and DNA‐HPV tests are crucial. New vaccine schemes, the critical analysis of local data, strengthening communication, managing sentinel events, and integrating vaccination and screening data for the health information system are some of the key activities to sustainable improvement in both access and quality of care.

Patients with positive margins in cone biopsy specimens have an increased risk of residual disease at radical hysterectomy and require careful evaluation before conservative surgery. Pelvic lymph node evaluation is essential because lymph node metastasis may occur even in early stages. The lack of parametrial invasion in this study reinforces the knowledge that the select group of patients with microinvasive cervical carcinoma stages IA1 LVSI and stage IA2 have a very low risk of parametrial infiltration. Less radical surgery can be carefully considered for these patients.

Hybrid capture II (HC II) test for oncogenic human papillomaviruses (HPV) was carried out in a cohort of 4284 women at their first clinical visit. Overall prevalence of HPV was 17.1%, decreasing with age from 33.9% among women below 20 years to only 11.0% among those older than 41 years. HPV prevalence was significantly higher among current smokers (odds ratio [OR] = 1.31; 95% CI 1.1–1.6), in women with two or more lifetime sexual partners (OR = 1.9; 95% CI 1.6–2.4), and those women with two or more sexual partners during the past 12 months prior to examination (OR = 1.6; 95% CI 1.2–2.2). HPV detection increased in parallel with increasing cytologic abnormality, being highest in women with high-grade squamous intraepithelial lesion (P = 0.001). Specificity of the HPV test in detecting histologically confirmed cervical disease was 85% (95% CI 83.9–86.1). Sensitivity of the HPV test in detecting histologic abnormalities increased in parallel with disease severity, ranging from 51.5% for cervical intraepithelial neoplasia (CIN) 1 to 96.5% for CIN 3 and 100.0% for cancer, with respective decline of positive predictive value. These data suggest that HPV testing with HC II assay might be a viable screening tool among this population with relatively high prevalence of cervical disease.

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BackgroundA Brazilian guideline on cervical cancer screening was released in 2011. The objective was to verify changes in screening indicators around this period.MethodsAn audit study which sample was all screening tests performed by the public health system of Campinas city from 2010 to 2016. Variables were absolute tests numbers, excess tests, intervals and results, by age. For trend analysis was used Cochran-Armitage × 2 and linear regression.ResultsWere carried out 62,925 tests in 2010 and 43,523 tests in 2016, a tendency at a reduction (P = 0.001). Excess tests were higher than 50% over the years, with a tendency at a reduction (P < 0.001). Tests performed on women under 25 ranged from 20.2 to 15.4% in the period (P < 0.001), while in the 25–64 years age-group, it ranged from 75.1 to 80.2% (P < 0.001). In 2010 the most frequent interval was annual (47.5%) and in 2016 biennial (34.7%). There was a tendency at a reduction in the proportion of tests performed at the first time and those with an annual interval (P < 0.001), and also a tendency at an increase in tests with intervals equal to or greater than biannual (P < 0.001). We observed a tendency at a reduction in LSIL and HSIL-CIN2 results (P = 0.04 and P = 0.001, respectively), and a tendency at an increase in HSIL-CIN3 result (P = 0.02).ConclusionThe proportion of cervical cancer screening tests performed out of the recommendation showed a significant reduction in the period. This indicates a tendency to align cervical cancer screening in Campinas with the standards recommended.