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      Cytological screening for cervical cancer and associated factors in the penitentiary population of Peru Translated title: Cribado citológico de cáncer de cuello uterino y factores asociados en la población penitenciaria del Perú

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          ABSTRACT

          Objective

          To determine the prevalence and factors associated with the screening of cervical cancer by Papanicolaou in the penitentiary population of Peru.

          Method

          A cross-sectional study was conducted using data from the 2016 National Penitentiary Population Census of Peru.

          The dependent variable was the cytological screening of cervical cancer during the last year. The independent variables were classified as facilitators, sociodemographic predisposers, and generators of need for the use of health services.

          The multivariate association was estimated through adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI), using Poisson regression and using the variables with p <0.05 in the bivariate.

          Results

          A total of 4515 women incarcerated in the 67 prisons of Peru entered the study. 69% (95% CI: 67.81-70.5) performed cytological screening during the last year and this is associated with having public health insurance (aPR 1.28 , 95% CI: 1.21-1.36), go to prison health services (aPR 1.18 , 95% CI: 1.12-1.24) and have a history of cancer (aPR 1.14, 95% CI: 1.02-1.26). Age, number of children, sports activities and the type of prison were also associated with cytological screening.

          Discussion

          There is an association between cytological screening and access to health services, sociodemographic predispositions and pathological backgrounds of women incarcerated in Peru. More research should be promoted on health prevention behaviors in this population.

          RESUMEN

          Objetivo

          Determinar la prevalencia y los factores asociados al cribado de cáncer de cuello uterino por Papanicolaou en la población penitenciaria del Perú.

          Métodos

          Se realizó un estudio transversal que utilizó los datos del Censo Nacional de Población Penitenciaria del Perú de 2016.

          La variable dependiente fue la realización de un cribado citológico del cáncer de cuello uterino durante el último año. Las variables independientes se clasificaron en facilitadores, predisponentes sociodemográficos, y generadores de necesidad para el uso de los servicios de salud.

          La asociación multivariada se estimó a través de razones de prevalencia ajustadas (RPa) e intervalos de confianza al 95% (IC 95%), mediante la regresión de Poisson y utilizando las variables con p <0,05 en el bivariado.

          Resultados

          En el estudio participaron un total de 4.515 mujeres encarceladas en los 67 establecimientos penitenciarios del Perú. El 69% (con un intervalo de confianza o IC 95%: 67,81-70,5) realizó un cribado citológico durante el último año, y está asociado con poseer un seguro de salud público (RPa: 1,28; IC 95%: 1,21-1,36), acudir a los servicios de salud del establecimiento penitenciario (RPa: 1,18; IC 95%: 1,12-1,24) y tener antecedentes de cáncer (RPa: 1,14; IC 95%: 1,02-1,26). La edad, el número de hijos, la práctica de actividades deportivas y el tipo de establecimiento penitenciario también son factores que estuvieron asociados al cribado citológico.

          Discusión

          Existe una asociación entre el cribado citológico y el acceso a los servicios de salud, predisponentes sociodemográficos y antecedentes patológicos de las mujeres encarceladas en el Perú. Se deben impulsar más investigaciones sobre las conductas de prevención de salud en esta población.

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          Most cited references26

          • Record: found
          • Abstract: found
          • Article: not found

          Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.

          Estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. We review the sources and methods used in compiling the national cancer incidence and mortality estimates, and briefly describe the key results by cancer site and in 20 large "areas" of the world. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung (1.82 million), breast (1.67 million), and colorectal (1.36 million); the most common causes of cancer death were lung cancer (1.6 million deaths), liver cancer (745,000 deaths), and stomach cancer (723,000 deaths). © 2014 UICC.
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            Screening for cancer in low- and middle-income countries.

            Screening programs involve testing asymptomatic individuals with an accurate screening test to identify those likely to have the disease of interest and to further investigate them to confirm or exclude the disease. The aim of cancer screening is to prevent cancer deaths and improve quality of life by finding cancers early and by effectively treating them. A decision to introduce a screening program in public health services depends on the evidence that the benefits outweigh the harms of screening, disease burden, availability of suitable screening test, effective treatment, adequate resources, and efficient health services. Screening programs should achieve high participation for testing, diagnosis, and treatment to be effective and efficient.
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              • Record: found
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              Structural barriers to screening for and treatment of cervical cancer in Peru.

              Through in-depth interviews with 30 key informants from 19 institutions in the health care system in four regions of Peru, this study identifies multiple barriers to obtaining cervical cancer screening, follow-up, and treatment. Some facilities outside Lima do not have the capacity to take Pap smear samples; others cannot do so on a continuing basis. Variation in procedures used by facilities and between regions, differences in women's ability to pay, as well as varying levels of training of laboratory personnel, all affect the quality and timing of service delivery and outcomes. In some settings, perverse incentives to accrue overtime payments increase the lag time between sample collection and reporting back of results. Some patients with abnormal results are lost to follow-up; others find needed treatment to be out of their financial or geographic reach. To increase coverage for cervical cancer screening and follow-up, interventions are needed at all levels, including an institutional overhaul to ensure that referral mechanisms are appropriate and that treatment is accessible and affordable. Training for midwives and gynaecologists is needed in good sample collection and fixing, and quality control of samples. Training of additional cytotechnologists, especially in the provinces, and incentives for processing Pap smears in an appropriate, timely manner is also required.
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                Author and article information

                Journal
                Rev Esp Sanid Penit
                Rev Esp Sanid Penit
                sanipe
                Revista Española de Sanidad Penitenciaria
                Sociedad Española de Sanidad Penitenciaria
                1575-0620
                2013-6463
                Sep-Dec 2018
                Sep-Dec 2018
                : 20
                : 3
                : 103-110
                Affiliations
                [1] originalSociedad Científica de San Fernando. Universidad Nacional Mayor de San Marcos. Lima. Perú. normalizedUniversidad Nacional Mayor de San Marcos orgdiv1Sociedad Científica de San Fernando orgnameUniversidad Nacional Mayor de San Marcos Lima, Peru
                Author notes
                Correspondence: Juan C. Ruiz-Maza. Universidad Nacional Mayor de San Marcos. Lima, Perú. E-mail: juancarlo.ruizmaza@ 123456gmail.com
                Article
                00005
                6463325
                30908565
                47b2e5f7-9405-4375-a9ad-39b6175b7596

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 16 January 2018
                : 06 March 2018
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 24, Pages: 08
                Categories
                Artículos Originales

                uterine cervical neoplasms,papanicolaou test,early detection of cancer,women’s health,public health,prisoners,vaginal smear,risk groups,neoplasias del cuello uterino,prueba de papanicolaou,detección precoz del cáncer,salud de las mujeres,salud pública,prisioneros,frotis vaginal,grupos de riesgo

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