ABSTRACT Introduction: cervical cancer represents a serious public health problem despite being highly preventable. Objective: to determine the clinical and epidemiological characteristics of the participation of women in the area of influence of a Public Hospital in the prevention of cervical cancer between the months of January to December of the years 2020 to 2021. Methodology: non-experimental cross-sectional descriptive design, with a quantitative approach. The total number of women participating in the prevention of cervical cancer in the area of influence of the Public Hospital was included. Secondary data were used that were loaded into a previously prepared form. Results: 61 % of the women were of 13 years old at risk, 83 % were not pregnant and 17 % were pregnant, 53 % had a history of PAP and 47 % did not, 86 % had a negative result for lesion, 9 % inflammatory and 4 % positive. Among the positive results, the predominant one was ASCUS with 47 %. The majority women had a negative PAP result. As a conclusion among women with positive results, there was a predominance of ASCUS diagnoses and in second place CIN I LSIL. Conclusion: the features that were found to be significantly associated with the PAP result were: being part of the age group at risk and presence of pregnancy. It is suggested to continue emphasizing prevention and follow-up, to investigate the ages at risk and to include other variables of interest in future studies.

RESUMEN Introducción: el cáncer cervical representa un grave problema de salud pública a pesar de ser altamente prevenible. Objetivo: determinar las características clínicas y epidemiológicas de la participación de las mujeres del área de influencia de un Hospital Público en la prevención del cáncer de cuello uterino entre los meses de enero a diciembre de los años 2020 al 2021. Metodología: diseño no experimental de corte transversal tipo descriptivo, con enfoque cuantitativo. Se incluyó el total de mujeres participantes de la prevención de cáncer cervical en el área de influencia del Hospital Público. Se utilizaron datos secundarios que fueron cargados en una planilla elaborada previamente. Resultados: el 61 % de las mujeres estaban en edad de riesgo, 83 % no estaban embarazadas y 17 % si, 53 % tiene antecedente de PAP y 47 %, no, 86 % tuvo resultado negativo para lesión, 9 % inflamatorio y 4 % positivo. Entre los resultados positivos el preponderante fue el de ASCUS con un 47 %. Se concluye que la mayoría de las mujeres tuvieron un resultado de PAP negativo. Entre las mujeres con resultados positivos se tuvo preponderancia de diagnósticos de ASCUS y en segundo lugar CIN I LSIL. Conclusión: las características que se encontraron significativamente asociadas al resultado de PAP fueron: formar parte del grupo de edad de riesgo y presencia de embarazo. Se sugiere seguir haciendo hincapié en la prevención y seguimiento, indagar en las edades de riesgo e incluir otras variables de interés en futuros estudios.

Objetivo: comparar el número de citologías oncóticas planificadas y las realizadas en la ciudad de Río de Janeiro entre los años 2013 y 2022 . Métodos: utilizando la población femenina de Río de Janeiro, se estimó cuántas pruebas se deberían realizar si se recomienda el tamizaje. realizado por el Ministerio de Salud se realizó de manera ideal y luego se comparó con la cantidad de pruebas disponibles en la base de datos pública. Resultados: En este periodo se realizaron 1.364.325 frente a una estimación de 7.886.720. Después del ajuste por el uso de asistencia sanitaria complementaria, la pandemia y los exámenes fuera de la edad recomendada, se observó el 36% del ideal. Conclusión: la cantidad realizada está muy por debajo de lo ideal, incluso después de ajustes, lo que aumenta los costos para el servicio público de salud, haciendo necesarias nuevas políticas públicas para mejorar el seguimiento.

Objetivo: comparar a quantidade de colpocitologias oncóticas ideias e a realmente realizadas no município do Rio de Janeiro entre os anos de 2013 e 2022. Métodos: através da população feminina do Rio de Janeiro, foi feita estimativa de quantos exames deveriam ser realizados caso o rastreio preconizado pelo Ministério da Saúde fosse feito de forma ideal e posteriormente foi comparado com a quantidade de exames disponíveis na base de dados pública. Resultados: foram realizados 1.364.325 nesse período comparado a 7.886.720 estimados. Após ajuste pelo uso de saúde suplementar, pandemia e exames fora da idade recomendada, observou-se 36% do ideal. Conclusão: a quantidade realizada está muito abaixo da ideal, mesmo após os ajustes, o que aumenta custos para o serviço de saúde pública, sendo necessárias novas políticas públicas para melhorar o rastreamento.

Objective: to compare the number of planned oncotic smear tests and those actually performed in the city of Rio de Janeiro between the years 2013 and 2022 . Methods: using the female population of Rio de Janeiro, an estimate was made of how many tests should be carried out if screening recommended by the Ministry of Health was done in an ideal way and was subsequently compared with the number of tests available in the public database. Results: 1,364,325 were carried out in this period compared to an estimated 7,886,720. After adjustment for the use of supplementary healthcare, the pandemic and exams outside the recommended age, 36% of the ideal was observed. Conclusion: the quantity carried out is far below ideal, even after adjustments, which increases costs for the public health service, making new public policies necessary to improve tracking.

Abstract Objectives: To evaluate Lymph node ratio (LNR) as a predictor for survival and recurrence of laryngeal cancer with metastatic lymph nodes (pN+). Study design: This retrospective study included patients who underwent primary laryngectomy combined with bilateral neck dissection, between October/2010 and April/2023. Results: A total of 73 patients were included. Among pN+ patients (n=37;50.7%), those with disease recurrence (n=16;43.2%) exhibited a higher median LNR (0.159 versus 0.060), p=0.007. ROC curve analysis showed that LNR>0.063 predicted recurrence (sensitivity 87%;specificity 48%). Moreover, multivariate analysis confirmed LNR>0.063 as an independent predictor of disease recurrence, after controlling for potential confounders, namely age, extracapsular spread, resection margin and pathological T category, (HR=6.58; p=0.049). Finally, high LNR (>0.063) was associated with cancer-specific death (OR=8.64; p=0.008) in pN+ patients. Conclusion: Our findings highlight that patients with LNR>0.063 are more likely to have aggressive disease, suggesting LNR as a significant prognostic factor complementing TNM staging in pN+ laryngeal cancer.

Resumo Objetivo: Avaliar o Rácio de gânglios linfáticos (RGL) como preditor de sobrevida e recidiva de cancro da laringe com metastização cervical (pN+). Desenho do estudo: Estudo retrospetivo, que incluiu doentes submetidos a laringectomia total associada a esvaziamento ganglionar cervical bilateral, entre outubro/2010 e abril/2023. Resultados: Foram incluídos 73 doentes. Entre os doentes pN+ (n=37;50,7%), aqueles com evidência de recidiva tumoral (n=16;43,2%) apresentaram uma mediana de RGL superior (0,159 versus 0.060), p=0,007. Após análise da curva ROC, o RGL>0,063 indicou recidiva tumoral (sensibilidade:87%; especificidade:48%). Para além disso, o RGL>0,063 manteve-se como um preditor independente de recidiva tumoral, após análise multivariada ajustada para potenciais fatores de confundimento (idade, extensão extraganglionar, margem de resseção e estadio patológico T),(HR=6,58; p=0,049). Por último, um RGL elevado (>0,063) esteve associado à morte específica por cancro em doentes pN+ (OR=8,64; p=0,008). Conclusão: Este estudo indica que doentes com RGL>0,063 têm maior probabilidade de doença agressiva. Assim, o RGL é um parâmetro prognóstico relevante, podendo ser útil para complementar o estadiamento TNM no cancro da laringe pN+.

ABSTRACT Introduction: Worldwide, cervical cancer is the fourth-most frequent cancer in women. Objective : To describe HPV vaccination coverage and Adverse Events Following Immunizations (AEVF). Material and Methods: This was a cross-sectional, descriptive and observational study, carried out in Paraguay during 2013-2023; the variables analyzed were: HPV vaccination coverage in 10-year-old girls, according to the recommended vaccination schedule: 3 doses (2013-2016), 2 doses (2017-2023), follow-up vaccination coverage at 15 years (1st dose and Final Dose), AEVF classification during 2013-2023. Results: The coverage intervals for the 1st dose of the HPV vaccine were: 55-73% during the pre-pandemic period (2013-2019) and 33-55% during the pandemic years (2020-2023); Final HPV Vaccine dose coverage: 1-64% during the pre-pandemic period and 5-31% during the pandemic period. The average dropout was higher during the use of a 3-dose schedule: 42 vs. 25% (p value = 0.001). Follow-up vaccination coverage at 15 years for Final Dose: 66-77%. A significant catch-up was achieved from 2019-2021: 71%, 65% and 59% respectively. Regarding the safety of the vaccine the AEFV rate: 2.1 x 100,000. Conclusions: HPV Vaccination coverage at 15 years was below 90%; the AEFV rate per 100,000 dose was low.

RESUMEN Introducción: A nivel mundial, el cáncer de cuello uterino es el cuarto cáncer más frecuente en la mujer. Objetivo: Describir las coberturas anuales de vacunación contra VPH y ESAVI. Material y Métodos: Estudio observacional descriptivo transversal, realizado en Paraguay, periodo 2013-2023, variables analizadas: coberturas de vacunación contra VPH en niñas de 10 años, según esquema: 3 dosis (2013-2016), 2 dosis (2017-2023), coberturas de vacunación de seguimiento a los 15 años (1ª dosis y Dosis Final), ESAVI grave y no grave. Resultados: Los intervalos de coberturas de vacunación contra VPH 1ª dosis: 55-73% (periodo no pandémico), 33-53 % (periodo pandémico), mientras que para Dosis Final: 1-64% (periodo prepandémico) y 5-31 % (periodo pandémico). Al analizar las coberturas de vacunación contra VPH Dosis Final según esquema el promedio de deserción fue mayor en esquema de 3 dosis: 42 vs 25% (valor p= 0,001). El intervalo de coberturas de seguimiento a los 15 años Dosis Final: 66 a 77%. Hubo un recupero importante en los años 2019-2021: 71%, 65% y 59% respectivamente. La Tasa de ESAVI: 2,5 x 100.000 dosis administradas. Conclusión: Las coberturas de vacunación de seguimiento a los 15 años fueron < 90%. La tasa de ESAVI por 100.000 fue baja.

Resumen Introducción : La inspección visual con ácido acé tico (IVAA) es una alternativa primaria para mer mar la incidencia y mortalidad por cáncer de cuello uterino (CaCu). El objetivo del estudio es conocer la proporción de mujeres de 30 a 49 años que usaron el test de IVAA en los últimos dos años y los factores asociados con el uso de la prueba, en el ámbito de la atención primaria. Métodos : Estudio transversal y multicéntrico, partici paron 706 mujeres de 30 a 49 años, usuarias de centros de atención primaria en una región del Perú. La variable dependiente fue el uso del test de IVAA, en los últimos dos años y las independientes los factores sociodemo gráficos, sociosanitarios, de información y actitud. Resultados : La proporción de mujeres que usaron el test de IVAA, fue del 30.6%. Se asociaron con mayor uso de la prueba, el área de residencia urbana, haber recibido recomendación para realizarse la IVAA, sentir preocupación por adquirir CaCu, haber oído hablar del CaCu y del virus del papiloma humano, el considerar tener mayor o igual probabilidad de desarrollar CaCu respecto a mujeres de su edad y con menor uso de la prueba, el proceder de la sierra y considerar riesgoso realizarse la IVAA. Conclusión : El programa de tamizaje del CaCu, me diante IVAA no estaría logrando el impacto deseado. Se requiere fortalecer estrategias e intervenciones en atención primaria, para mejorar las conductas y tasas del cribado.

Abstract Introduction : Visual inspection with acetic acid (VIA) is a primary alternative to reduce cervical cancer (CaCu) incidence and mortality. The study aimed to determine the proportion of women aged 30-49 years who used VIA in the last two years and the factors associated with the use of the test in the primary care setting. Methods : Cross-sectional, multicenter study. Seven hundred and six women aged 30 to 49 years partici pated, users of primary health care centers in a region of Peru. The dependent variable was the use of the VIA test in the last two years and the independent variables were sociodemographic, socio-health, information and attitudinal factors. Results : The proportion of women who used the VIA test was 30.6%. The following factors were associated with greater use of the test: urban area of residence, having received a recommendation for VIA, feeling worried about acquiring CaCu, having heard about CaCu and the human papilloma virus. Also, considering having a greater or equal probability of developing CaCu compared to women of the same age, and with lower use of the test, coming from the highlands and considering it risky to undergo VIA. Conclusion : The VIA screening program for CaCu would not be achieving the desired impact. There is a need to strengthen strategies and interventions in primary care to improve screening behaviors and rates.

Resumen Las metástasis en la glándula tiroides a partir de tu mores malignos no tiroideos son raras pero significativas. A menudo son asintomáticas, lo que indica tumores primarios en etapas avanzadas y un mal pronóstico. Aunque infrecuentemente, el cáncer de mama puede metastatizar en la glándula tiroides. Presentamos el caso de una mujer de 56 años con antecedente de cáncer de mama que consultó por bocio nodular. El examen físico y las imágenes revelaron un nódulo tiroideo y ganglios linfáticos cervicales con características sospechosas. La punción aspiración con aguja fina confirmó la presencia de células epiteliales atípicas en el nódulo tiroideo y los ganglios linfáticos. Una evaluación adicional, que incluyó tomografía por emisión de positrones, biopsia histológica e inmunohistoquímica, respaldó el diagnóstico de cáncer de mama metastásico en la glándula tiroides. Debido a la extensión local de la enfermedad, no fue factible realizar una tiroidectomía total. Se inició el tratamiento con ri bociclib y letrozol, pero desafortunadamente la paciente tuvo una progresión desfavorable con el desarrollo de metástasis en el sistema nervioso. El carcinoma metas tásico en la glándula tiroides es raro, pero ha aumentado debido a las técnicas de diagnóstico mejoradas. El cáncer de mama puede metastatizar en la tiroides. El diagnóstico implica imágenes, punción aspiración con aguja fina e in munohistoquímica. Las opciones de tratamiento incluyen cirugía, radioterapia y quimioterapia, pero el pronóstico generalmente es desfavorable.

Abstract Metastases to the thyroid gland from nonthyroidal malignant tumors are rare but significant. They are often asymptomatic, indicating advanced-stage primary tumors and poor prognosis. Although infrequently, breast cancer (BC) can metastasize to the thyroid gland. We present the case of a 56-year-old woman with a history of BC who pre sented with a nodular goiter. Physical examination and im aging revealed a thyroid nodule and cervical lymph nodes with suspicious features. Fine-needle aspiration biopsy (FNAB) confirmed the presence of atypical epithelial cells in the thyroid nodule and lymph nodes. Further evaluation, including positron emission tomography, histological biop sy, and immunohistochemistry, supported the diagnosis of metastatic BC to the thyroid gland. Due to the local extent of the disease, total thyroidectomy was not feasible. The treatment with ribociclib and letrozole was initiated, but unfortunately, the patient had an unfavorable progression with the development of metastasis in the nervous system. Metastatic carcinoma to the thyroid gland is rare but has increased due to improved diagnostic techniques. BC can metastasize to the thyroid. Diagnosis involves imaging, FNAB, and immunohistochemistry. Treatment options include surgery, radiotherapy, and chemotherapy, but the prognosis is generally poor.

Abstract Background: The right to access safe and high-quality sexual and reproductive healthcare is part of the well-being of all people. There is a scarcity of clinical guidelines regarding transgender (TG) specific family planning. Objective: This synthesis of information intends to describe the approach towards the TG population’s sexual health. Methods: A comprehensive search was conducted in the MEDLINE and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. The quality of retrieved studies was assessed using the Critical Appraisal Skills Programme Qualitative Checklist for qualitative studies and an adapted version of the Quality Assessment Tool for Cross-Sectional Studies. The protocol was registered on PROSPERO (CRD42022371962). Results: From the 671 articles retrieved, 13 fulfilled the predefined inclusion and exclusion criteria, and were selected to perform the in-depth analysis. Phenomena of interest were subdivided into patient and provider-level issues, contraception, fertility preservation, and cancer screening. Contraception can have many purposes, including the prevention of pregnancy, and frequently exerts an impact on gender dysphoria. A great percentage of TG patients believe that testosterone may be used as a contraceptive method, which prevents recognition of their pregnancy risk. Providers’ lack of formal education plus the discrimination TG people face contribute to the rising of myths and misinformation among the population. Most TG people desire to be parents, but the question of whether biologically or not is mostly undefined. TG people do not routinely undertake pelvic examinations or PAP smears. Conclusion: The present review outlines the urge to develop guidelines for TG sexual and reproductive health. Primary care doctors are vital in managing TG people’s health concerns.

Resumo Introdução: O acesso a cuidados de saúde sexuais e reprodutivos seguros e de alta qualidade faz parte dos direitos e bem-estar de todas as pessoas. Há uma escassez de diretrizes clínicas específicas para a população transgénero (TG). Objetivo: Esta revisão sistemática pretende descrever a abordagem da saúde sexual da população TG. Métodos: Foi realizada uma revisão sistematizada em duas bases de dados, MEDLINE e Scopus, seguindo os Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A qualidade dos estudos foi avaliada utilizando o Critical Appraisal Skills Programme Qualitative Checklist para estudos qualitativos e uma versão adaptada do Quality Assessment Tool for Cross-Sectional Studies. O protocolo foi registado na plataforma PROSPERO (CRD42022371962). Resultados: Dos 671 artigos recuperados através da pesquisa, 13 cumpriram os critérios de inclusão e exclusão e foram selecionados para análise. Os fenómenos de interesse foram subdivididos em problemas relativos ao paciente e ao prestador de cuidados, contraceção, preservação da fertilidade e rastreio de cancro cervical. Os métodos contracetivos podem ser usados com vista à prevenção da gravidez, tendo também impacto na disforia de género. Uma percentagem significativa dos utentes TG acredita que a testosterona pode ser usada como método contracetivo, o que os impede de reconhecer o seu risco de engravidar. A escassez de educação formal dos profissionais de saúde neste tema, aliada à discriminação da população TG, contribui para o aumento dos mitos em saúde. A maioria dos TG deseja a parentalidade, não definindo preferência relativamente a filhos biológicos ou não. A realização de exame pélvico e rastreio do cancro cervical não é rotineira na população TG. Conclusão: A presente revisão reforça a relevância e necessidade de desenvolver guidelines no âmbito da saúde sexual e reprodutiva da população TG. Os cuidados de saúde primários são de vital importância na gestão dos problemas de saúde desta população.

Abstract Introduction : Little evidence exists on the impact of the COVID-19 pandemics on the compliance with cervi cal cancer treatment. Methods : We carried out a population-based, be fore-and-after retrospective cohort study of all cervical cancer patients diagnosed in the Jujuy province public health sector (n=140), Argentina, between 2017 and 2020. Patients diagnosed in 2020 were considered exposed to the COVID-19 pandemic (n=21). We used multivariable logistic regression to assess the relationship between the pandemics and compliance with treatment. We also measured treatment duration for women who were indicated brachytherapy and time to treatment initia tion by stage. Results : Compared with women diagnosed in 2017- 2019 the odds ratio of non-complying with treatment was 1.77 (95%CI 0.59-5.81; p = 0.32) for women diagnosed during 2020. An increased risk of non-compliance was found in patients with prescribed brachytherapy (OR 4.14. 95%CI 1.95-9.11; p < 0.001). Median treatment dura tion for women with prescribed brachytherapy was 12.8 and 15.7 weeks in 2017-2019 vs. 2020 (p = 0.33); median time to treatment initiation for women with early-stage disease was 9 and 5 weeks during 2017-2019 and 2020 respectively (p = 0.06), vs 7.2 and 9 weeks in 2017-2019 and 2020 respectively (p = 0.36) for patients with stages IIB+ disease. Conclusions : Low access to brachytherapy was a major determinant of non-compliance. irrespective of the effect of the pandemics.

Resumen Introducción : Hay escasa evidencia sobre el impacto de la pandemia de COVID-19 en el cumplimiento del tratamiento de cáncer cervicouterino. Métodos : Se llevó a cabo un estudio poblacional de cohorte retrospectivo. -antes/después- de las pacientes con cáncer cervicouterino diagnosticadas en estable cimientos públicos de la provincia de Jujuy (n = 140), entre 2017 y 2020. Las pacientes diagnosticadas en 2020 se consideraron expuestas a la pandemia (n = 21). Utili zamos la regresión logística multivariada para analizar la asociación entre pandemia y cumplimiento del tra tamiento de cáncer. Además, se midió la duración del tratamiento en aquellas con indicación de braquiterapia y el tiempo hasta el inicio al tratamiento según estadio. Resultados : Comparadas con las mujeres diagnosti cadas en 2017-2019 el odds ratio de incumplimiento del tratamiento fue de 1.77 (IC95% 0.59-5.81; p = 0.32) para las diagnosticadas durante 2020. Se encontró un mayor riesgo de incumplimiento en pacientes con indicación de braquiterapia (OR 4.14; IC 95%:1.95-9.11; p < 0.001). La mediana de duración del tratamiento para aquellas con indicación de braquiterapia fue de 12.8 y 15.7 sema nas en 2017-2019 y 2020 respectivamente (p = 0.33). La mediana de tiempo hasta el inicio del tratamiento para pacientes con enfermedad en estadio temprano fue de 9 y 5 semanas durante 2017-2019 y 2020 respectivamente (p = 0.06), versus una mediana de 7.2 y 9 semanas en 2017-2019 y 2020 respectivamente (p=0.36) para las pa cientes con enfermedad en estadio IIB+. Conclusiones : El bajo acceso a la braquiterapia fue un factor determinante de incumplimiento de tratamiento de cáncer cervicouterino, independientemente del efecto de la pandemia.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology. Brazil crosssectional cross sectional 1 9 years 200 2015 HCR (HCR Integrator NRHI (NRHI) System used 484 48 4 48.4% PR 1.06 106 06 1.011.10, 101110 1.01 1.10 , 01 10 1.01-1.10) black brown raceskin race skin 1.04 104 04 1.011.07, 101107 1.07 07 1.01-1.07) 1.28 128 28 1.161.40, 116140 1.16 1.40 16 40 1.16-1.40) 110 1.071.13, 107113 1.13 13 1.07-1.13) 107 1.031.11, 103111 1.03 1.11 03 11 1.03-1.11) 1.08 108 08 1.011.14. 101114 1.14 . 14 1.01-1.14) cytology 20 201 (NRHI 48.4 1.0 0 011 1.011.10 10111 101 1.1 1.01-1.10 1.011.07 10110 1.01-1.07 1.2 12 2 161 1.161.40 11614 116 140 1.4 1.16-1.40 071 1.071.13 10711 113 1.07-1.13 031 1.031.11 10311 103 111 1.03-1.11 1.011.14 114 1.01-1.14 48. 1. 1.011.1 1011 1.01-1.1 1.011.0 1.01-1.0 1.161.4 1161 1.16-1.4 1.071.1 1071 1.07-1.1 1.031.1 1031 1.03-1.1 1.011. 1.01-1. 1.161. 1.16-1. 1.071. 1.07-1. 1.031. 1.03-1. 1.011 1.01-1 1.161 1.16-1 1.071 1.07-1 1.031 1.03-1 1.01- 1.16- 1.07- 1.03-

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica. Brasil transversal 1 9 anos 200 2015 Câncer Humano Ambulatoriais Usouse Usou se aleatório 484 48 4 48,4% RP 1,06 106 06 1,011,10, 101110 1,01 1,10 , 01 10 1,01-1,10) raçacor raça cor preta 1,04 104 04 1,011,07, 101107 1,07 07 1,01-1,07) 1,28 128 28 1,161,40, 116140 1,16 1,40 16 40 1,16-1,40) 110 1,071,13, 107113 1,13 13 1,07-1,13) 107 1,031,11 103111 1,03 1,11 03 11 1,03-1,11 1,08 108 08 1,011,14. 101114 1,14 . 14 1,01-1,14) oncótica 20 201 48,4 1,0 0 011 1,011,10 10111 101 1,1 1,01-1,10 1,011,07 10110 1,01-1,07 1,2 12 2 161 1,161,40 11614 116 140 1,4 1,16-1,40 071 1,071,13 10711 113 1,07-1,13 031 1,031,1 10311 103 111 1,03-1,1 1,011,14 114 1,01-1,14 48, 1, 1,011,1 1011 1,01-1,1 1,011,0 1,01-1,0 1,161,4 1161 1,16-1,4 1,071,1 1071 1,07-1,1 1,031, 1031 1,03-1, 1,011, 1,01-1, 1,161, 1,16-1, 1,071, 1,07-1, 1,031 1,03-1 1,011 1,01-1 1,161 1,16-1 1,071 1,07-1 1,03- 1,01- 1,16- 1,07-

Abstract This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita. cuts 20102019 2010 2019 (2010-2019 framework system loglinear log linear model positive however congenital syphilis screening. screening . screening) due insurance capita 2010201 201 (2010-201 201020 20 (2010-20 20102 2 (2010-2 (2010- (2010 (201 (20 (2 (

Resumo O artigo apresenta uma análise do desempenho da APS no estado de São Paulo na última década, em contexto de crise econômica e retração dos investimentos em saúde. Utilizaram-se indicadores de desempenho, determinantes em saúde e sistema de saúde, em série temporal (2010 a 2019), a partir de matriz conceitual adaptada. Foram calculadas variações percentuais anuais (VPA) de cada indicador em modelo log-linear. Os indicadores de desempenho apresentaram, no geral, evolução favorável; no entanto, ocorreu piora em indicadores relacionados à qualidade do cuidado (sífilis congênita, partos cesáreos e rastreamento de câncer de colo uterino). Verificou-se, ainda, um potencial aumento das demandas ao SUS (envelhecimento da população e redução da cobertura da saúde suplementar) e aumento das despesas em saúde em contexto de redução do PIB per capita. década Utilizaramse Utilizaram se 2010 (201 2019, 2019 , 2019) adaptada VPA (VPA loglinear. loglinear log linear. linear log-linear apresentaram geral favorável entanto sífilis congênita uterino. uterino . uterino) Verificouse, Verificouse Verificou se, Verificou-se ainda envelhecimento suplementar capita 201 (20 20 (2 2 (

Resumo O artigo apresenta uma análise do desempenho da APS no estado de São Paulo na última década, em contexto de crise econômica e retração dos investimentos em saúde. Utilizaram-se indicadores de desempenho, determinantes em saúde e sistema de saúde, em série temporal (2010 a 2019), a partir de matriz conceitual adaptada. Foram calculadas variações percentuais anuais (VPA) de cada indicador em modelo log-linear. Os indicadores de desempenho apresentaram, no geral, evolução favorável; no entanto, ocorreu piora em indicadores relacionados à qualidade do cuidado (sífilis congênita, partos cesáreos e rastreamento de câncer de colo uterino). Verificou-se, ainda, um potencial aumento das demandas ao SUS (envelhecimento da população e redução da cobertura da saúde suplementar) e aumento das despesas em saúde em contexto de redução do PIB per capita.

Abstract This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita.

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

RESUMEN Introducción: el constante estudio de los factores incidentes en el aumento de cáncer de cuello uterino, redimensiona su importancia como herramienta de promoción y prevención en las áreas de salud para enfrentar el proceso de aumento de este cáncer. Objetivo: determinar los factores de riesgo de cáncer cervico uterino en pacientes diagnosticadas con cáncer cervicouterino en el municipio Pinar del Río. Métodos: estudio observacional, descriptivo y transversal, con un universo integrado por las 172 pacientes diagnosticadas con esa enfermedad en el municipio Pinar del Río durante los años 2021 y 2022 y una muestra aleatoria simple de 170 pacientes que cumplieron con los criterios de inclusión. Se utilizaron métodos teóricos, empíricos y estadísticos y se tuvieron en cuenta las normas éticas establecidas para este tipo de investigación. Resultados: predominaron las mujeres con edades entre 25 y 29 años de edad (35,4 %), la lesión más frecuente fue el NIC I en 98 pacientes (56,9 %) con mayor incidencia en el grupo de 25 y 29 años 40 (23,3 %). El factor de riesgo intrínseco de mayor incidencia fue la susceptibilidad inmunológica en 109 pacientes (63,3 %) y de los extrínsecos el hábito de fumar en 98 pacientes (56,9 %); el 65,6 % de la muestra tenían un alto riesgo relacionado con el cáncer cervico uterino. Conclusiones: Los factores de riesgo de cáncer cervico uterino constituyen un problema de salud en la población pinareña, por lo que se necesitan desarrollar acciones de salud que contribuyan a modificarlos.

ABSTRACT Introduction: the constant study of the factor’s incident to the increase in cervical cancer resizes its importance as a promotion and prevention tool in health areas to face the process of increase in this cancer. Objective: determine the risk factors for cervical cancer in patients diagnosed with cervical cancer in the Pinar del Río, municipality in the Cuban province of the same name. Methods: observational, descriptive and cross-sectional study, with a universe made up of the 172 patients diagnosed with this disease in the Pinar del Río municipality during the years 2021 and 2022 and a simple random sample of 170 patients who met the inclusion criteria. Theoretical, empirical and statistical methods were used and the ethical standards established for this type of research were taken into account. Results: women between 25 and 29 years of age predominated (35,4 %), the most frequent lesion was CIN I in 98 patients (56,9 %) with a higher incidence in the group of 25 and 29 years 40 (23,3 %). The intrinsic risk factor with the highest incidence was immunological susceptibility in 109 patients (63,3 %) and the extrinsic risk factor was smoking in 98 patients (56,9 %); 65,6 % of the sample had a high risk related to cervical cancer. Conclusions: The risk factors for cervical cancer constitute a health problem in the Pinar del Río population, so health actions need to be developed that contribute to modifying them.