Bacterial vaginosis (BV) is characterized by a polymicrobial proliferation of anaerobic bacteria and depletion of lactobacilli, which are components of natural vaginal microbiota. Currently, there are limited conventional methods for BV diagnosis, and these methods are time-consuming, expensive, and rarely allow for the detection of more than one agent simultaneously. Therefore, we conceived and validated a multiplex polymerase chain reaction (M-PCR) assay for the simultaneous screening of thirteen bacterial vaginosis-associated agents (BV-AAs) related to symptomatic BV: Gardnerella vaginalis, Mobiluncus curtisii, Mobiluncus mulieris, Bacteroides fragilis, Mycoplasma hominis, Atopobium vaginae, Ureaplasma urealyticum, Megasphaera type I, Clostridia-like bacteria vaginosis-associated bacteria (BVABs) 1, 2, and 3, Sneathia sanguinegens, and Mycoplasma genitalium. The overall validation parameters of M-PCR compared to single PCR (sPCR) were extremely high, including agreement of 99.1% and sensitivity, specificity, and positive predictive values of 100.0%, negative predictive value of 97.0%, accuracy of 99.3%, and agreement with Nugent results of 100.0%. The prevalence of BV-AAs was very high (72.6%), and simultaneous agents were detected in 53.0%, which demonstrates the effectiveness of the M-PCR assay. Therefore, the M-PCR assay has great potential to impact BV diagnostic methods in vaginal samples and diminish associated complications in the near future.

Abstract. The question of whether Chlamydia trachomatis (Ct) is a cofactor for human Papillomavirus (HPV) in cervical carcinogenesis is still controversial. We conducted a molecular detection study of both infections in 622 Brazilian women, including 252 women with different grades of abnormal cervical cytology and cervical cancer (CC; cases) and 370 women with normal cytology (controls). Although Ct infection did not seem related to CC carcinogenicity, women with abnormal cytology had a significant high rate of Ct infection. Therefore, it is important to adopt protocols for diagnosis and treatment of this bacterium in conjunction with screening for CC in this population.At present, cervical cancer (CC) is the second leading cause of cancer affecting women, 1,2 preceded only by breast cancer; it develops over a long period through precursor lesions that can be detected by cytological screening.3 Its frequency varies in different regions of the world, and it is much higher in underdeveloped or developing than developed countries.1 In Brazil, CC is the third most common cancer among women, with 17,000-18,000 new cases annually. 4 It is well-established that persistent infection by high-risk (HR) human Papillomavirus (HPV) is a necessary but not sufficient cause of CC.5 Considering that a small proportion of HR-HPV-infected women actually develop CC, 6 additional risk factors that may be involved in the development of the disease have been investigated.Among other sexually transmitted infections (STIs) that can increase the risk of CC, Chlamydia trachomatis (Ct) is among the leading factors. Some investigators have proposed that Ct infection could affect HPV acquisition and persistence, increase the rate of transformation to early precursor lesions, and also increase the likelihood that precursor lesions lead to CC.7 However, the association of Ct as a cofactor for HPV in cervical carcinogenesis is still controversial. 8 This information directly affects the adoption of efforts to control CC, because a Ct-HPV association would require not only HPV vaccination but also adoption of protocols for diagnosis and treatment of the bacteria. Considering that, in Brazil and Latin America in general, few studies have examined this possibility, we conducted a molecular detection study of HPV and Ct infections in Brazilian women with different grades of abnormal cervical cytology and CC in an attempt to contribute to elucidating the involvement of Ct in cervical carcinogenesis.Six hundred twenty-two women of low socioeconomic status, ages 15-83 years, were recruited between August 1, 2009 and March 31, 2012 in three cities of the state of Paraná , southern Brazil: Maringá , Paiçandú , and Uniã o da Vitó ria. The epidemiological characteristics were obtained through the analysis of data from a standard registration form for each woman. Each woman involved signed the authorization, and the execution of this project was approved by the Committee for Ethics in Research Involving Humans at the State University of Maringá /Paraná , ...

Most cervical cancers occur in women who do not participate in cervical-cancer screening. We therefore evaluated adherence to screening for clinic-based Pap testing, self-collected sampling for HPV testing, and choice of the 2 among 483 unscreened/underscreened women in Brazil. Three public Basic Health Units (BHU) were each randomly assigned to three arms: (i) Pap testing at the BHU (N ¼ 160), (ii) "Self&HPV" (self-collection for HPV testing) (N ¼ 161), and (iii) "Choice" between self-collection and HPV testing and Pap test at the local BHU (N ¼ 162). The theory-based (PEN-3 and Health Belief Model) intervention in all three arms was implemented by trained Community Health Workers (CHW) at participants' home. With the first invitation, 60.0% in the Pap arm, 95.1% [154 of 161 (95.7%) who selected Self&HPV and 0 of 1 (0.0%) a Two-sided, Fisher exact test; bolded values highlight statistical significance (P < 0.05). b Among women ages 50 and older. c Women had undergone screening in <4 years were ineligible for the study.Castle et al.

This is an observational quantitative and analytical study aimed at verifying the knowledge, acceptability and use of natural family planning (NFP) by patients in a university hospital from July to November, 2008. The data were collected using a structured questionnaire and analyzed with the softwares Excel and Statistica 8.0. Of the 113s women interviewed, 70 (62%) accepted the method and 1 (0.9%) used it routinely. Acceptance was higher among those who wished to become pregnant in the future compared to those who did not wish it. Acceptability was statistically significant (p = 0.0147) among the 28 (80%) non-contraceptive users compared to 42 (53.8%) who used some contraceptive method. Factors such as age, education, number of living children and religion were not statiscally associated with the acceptability of NFP. The Billings ovulation method has an adequate acceptability, but has a low actual use because of the lack of information by health professionals of its real effectiveness and applicability.

Objetivo: avaliar os métodos contraceptivos adotados e o perfil das usuárias da rede pública de saúde do município de Maringá-PR, em relação às orientações para o seu uso, indicações, contra-indicações e razões para interrupção dos métodos. Métodos: estudo transversal, descritivo, obtido por 284 entrevistas domiciliares de mulheres selecionadas das 62 equipes do Programa de Saúde da Família, mediante consentimento livre e esclarecido. O questionário foi aprovado pelo Comitê de Ética em Pesquisa envolvendo seres humanos da Universidade Estadual de Maringá. Os questionários utilizados foram pré-testados e então aplicados, interessando para este estudo as seguintes seções: caracterização da entrevistada; indicadores socioeconômicos; métodos contraceptivos. Análise estatística das distribuições de freqüências, pelo Statistical Package for the Social Sciences, versão 12.0. Resultados: a maioria das mulheres eram de etnia branca, casadas, tinham idade entre 35 e 49 anos, escolaridade em nível médio, exerciam trabalho não remunerado e foram classificadas na classe econômica D e E. Quanto aos hábitos, 22,5% eram fumantes e 4,9% usuárias de bebida alcoólica. A pílula foi adotada em 50,3%, preservativo em 28,1% e laqueadura em 32%. A orientação quanto ao uso de métodos anticoncepcionais geralmente foi dos profissionais da área de saúde. Os motivos de interrupção dos métodos foram: desejo de engravidar, preferência por método definitivo e efeitos colaterais da pílula. O fator de risco mais prevalente para uso de pílula foi o tabagismo. Apenas 35,9% das entrevistadas iniciaram o uso da pílula após consulta prévia e quase a mesma proporção, 33,6%, não a fizeram antes do início de seu uso. Conclusões: observou-se que as indicações do uso do método contraceptivo e as orientações realizadas por profissionais da área de saúde foram satisfatórias, apesar das elevadas taxas de laqueadura e de detecção de usuárias de pílulas com contra-indicações relativas, com mais de cinco anos de uso. PALAVRAS-CHAVE:Anticoncepção; Saúde da mulher; Medicina reprodutiva; Serviços de planejamento familiar ABSTRACT Purpose: to evaluate the contraceptive methods adopted by the public health system of Maringá County, Paraná, regarding the orientations for using them, indications, contraindications and reasons for interrupting these methods, as well as the profile of the female users. Methods: transversal descriptive study, performed through 284 home interviews with women selected from the 62 groups of the Family Health Program, after their free and informed consent, and after the questionnaire had been approved by the Ethics in Research Committee involving human beings of the State University of Maringá (Universidade Estadual de Maringá -UEM). Before applying the questionnaires, they were pretested, focusing on the following sections: characterization of the interviewee, socioeconomical factors and contraceptive methods. Results were analyzed using the Statistical Package for the Social Sciences software 12.0 version. Results: most women were white, m...

ObjectiveTo assess the rates of co-infections between human papillomavirus (HPV) and 13 key markers of bacterial vaginosis in cervical samples by multiplex polymerase chain reaction in a population with a high rate of abnormal cytology and a positive HPV test.MethodsThe study included a total of 213 women aged 18–72 years screened using Papanicolaou smears for determining cervical abnormalities and for HPV and bacterial vaginosis by single-target and multiplex polymerase chain reaction.ResultsA total of 83 (39%) women were negative for intraepithelial lesion or malignancy cytology and 130 (61%) had abnormal cytology. HPV-DNA prevalence was 69.9% and bacterial vaginosis was 72.7 %. Co-infections between bacterial vaginosis with HPV-DNA and high-risk HPV were associated with an increased risk for squamous intraepithelial lesions of low-grade cytology and high-grade squamous intraepithelial lesions plus cervical cancer. The most frequent bacterial vaginosis agent was Gardnerella vaginalis (33.8%), and co-infection with HPV-DNA and high-risk HPV increased the risk for squamous intraepithelial lesions of low grade cytology and high-grade squamous intraepithelial lesions plus cervical cancer. Co-infection between Megasphaera type I and high-risk HPV increased the risk for high-grade squamous intraepithelial lesions plus cervical cancer.ConclusionsOur results reinforce the hypothesis that some bacterial vaginosis agents may play a role as co-factors in HPV-mediated cervical carcinogenesis, at least in some populations.

Objective.To estimate prevalence rates and analyze the quality and performance of Pap smears carried out on the Cervical Cancer Screening Program in Maringá, Paraná, Brazil. MethOds. A retrospective search was run on the Brazilian Ministry of Health SIS-Colo database. Variables such as age, cervical cytology result and district of residence were analyzed. Ages were divided into bands; residence was classified according to the five regional healthcare districts of the city of Maringá. Cervical cytology results were categorized according to the Bethesda System. Cervical screening coverage was calculated by dividing the number of tests within the population aged 25 to 59 by the number of women in that age range. Results. The 17.664 cervical cytology specimens collected during 2005 by the public health system were distributed across women aged from 12 to 82 years, with 12,961 (73.4%) of these tests being on women in the 25 to 59 range, who are considered at higher risk of cancer. A total of 17,458 (98.84%) cytological examinations were negative for malignancy, and there were 206 (1.16%) atypical results (ASCUS/AGUS, LSIL, HSIL and invasive cancer). The study found a prevalence of 0.85% (151) for ASCUS/AGUS and of 1.14% (203/17,664) for atypical cells, and a ASCUS/atypical cells ratio of 2.75 (151/55). cOnclusiOns. The lower than expected prevalence of abnormal cervical cytology results and low proportion of ASCUS, the elevated ASCUS/atypical cells ratio, the insufficient population coverage of that cervical cytology and the elevated cervical cancer mortality rate all compromise the performance of the cervical cancer prevention program. The population with low socioeconomic status need special attention and the more privileged must be better informed about the need for regular tests and which age group is at greatest risk.

Objective: To evaluate primary care prophylactic post-exposure anti-rabies treatment.Methods: This was a cross-sectional, descriptive and analytical study, with data from the Information System for Notification of Diseases. It analyzed 39,087 visits, excluding 1,091 (2.79%) cases of re-exposure and pre-exposure, resulting in 37,996 post-exposure visits. A logistic regression analysis was performed for adjustment of the treatment. Results: A predominance of Caucasians (83.93%), male (54.58%), primary school educational level (66.13%), ages between 20-59 years (45.0%) , followed by 0 to 12 years (32.88%), and residents in the urban area (91.97%) was observed. Among the visits, 15,500 (41.56%) were considered inadequate, 10,587 (28.11%) were deficient or the patient did not receive the necessary treatment, and 5,013 (13.44%) patients received more than what was necessary for rabies prophylaxis. Conclusion: The post-exposure prophylaxis for rabies was considered inadequate and requires a better approach on admission, and attention in completing the notification in the data record. ResumoObjetivo: Avaliar o tratamento profilático do primeiro atendimento anti-rábico pós-exposição. Métodos: Estudo transversal, descritivo e analítico, com dados do Sistema de Informação de Agravos de Notificação. Analisados 39.087 atendimentos, excluídos 1.091 (2,79%) casos de re-exposição e pré-exposição, resultando em 37.996 atendimentos pós-exposição. Realizada análise de regressão logística para adequação de conduta. Resultados: Observou-se predomínio da raça branca (83,93 %), sexo masculino (54,58 %), ensino fundamental (66,13%), idades entre 20-59 anos (45,0%), seguido por 0 a 12 anos (32,88%) e residentes na zona urbana (91,97%). Considerou-se 15.500 (41,56%) atendimentos inadequados 10.587 (28,11%) atendimentos deficitários, ou o paciente não recebeu o tratamento necessário, e 5.013 (13,44%) pacientes receberam atendimento mais do que o necessário para a profilaxia antirrábica. Conclusão: A profilaxia pós-exposição da raiva foi considerada inadequada necessitando de uma melhor abordagem na admissão e atenção no preenchimento dos registros de dados.