Análisis de los motivos del abandono del proceso de seguimiento y tratamiento por parte de mujeres con lesiones precursoras de cáncer de cuello uterino en la provincia de Jujuy: implicancias para la gestión  <span class="so-article-trans-title" dir="auto"> Translated title: Analysis of the reasons for abandoning the follow-up and treatment process in women with pre-cancerous cervical lesions in the province of Jujuy: implications for health management </span>

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

El adecuado seguimiento y tratamiento de las mujeres con lesiones escamosas intraepiteliales de alto grado (HSIL, por sus siglas en ingles) y carcinoma es un aspecto clave para la reducción de la mortalidad por cáncer de cuello uterino. El objetivo de esta investigación es analizar la magnitud y los motivos del abandono en el proceso de seguimiento y tratamiento por parte de las mujeres con diagnóstico de HSIL y carcinoma atendidas en el sistema público de la provincia de Jujuy durante 2010. Se realizó el análisis de fuentes secundarias y entrevistas domiciliarias a las mujeres. El porcentaje de abandono en la población de estudio fue del 23,5%. Entre estas mujeres, el 40,5% mencionó motivos de abandono relacionados con la organización del sistema de salud y el 30,9% mencionó motivos subjetivos. Los resultados han sido utilizados como insumos para la reorganización del proceso de seguimiento y tratamiento que se está llevando a cabo en la provincia.

Translated abstract

Adequate follow-up and treatment of women with high-grade squamous intraepithelial lesion (HSIL) and cancer is key in reducing cervical cancer mortality. This research study aims to analyze the magnitude of abandonment in the follow-up and treatment process, as well as the reasons for this abandonment, in women with HSIL who received care in public health services in the province of Jujuy in 2010. Secondary sources were analyzed and women were interviewed in their homes. The abandonment rate within the study population was 23.5%. Among these women, 40.5% mentioned organizational problems in the health care system as a reason for abandoning and 30.9% mentioned subjective reasons. Our results have been used in the reorganization of the follow-up and treatment process being carried out in the province.

Related collections

Most cited references 49

Record: found
Abstract: found
Article: not found

Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries.

Jack Cuzick, Marc Arbyn, Rengaswamy Sankaranarayanan … (2008)

Screening for cervical cancer precursors by cytology has been very successful in countries where adequate resources exist to ensure high quality and good coverage of the population at risk. Mortality reductions in excess of 50% have been achieved in many developed countries; however the procedure is generally inefficient and unworkable in many parts of the world where the appropriate infrastructure is not achievable. A summary and update of recently published meta-analyses and systematic reviews on four possible clinical applications of human papillomavirus (HPV) DNA testing is provided in this article: (1) triage of women with equivocal or low-grade cytological abnormalities; (2) follow-up of women with abnormal screening results who are negative at colposcopy/biopsy; (3) prediction of the therapeutic outcome after treatment of cervical intraepithelial neoplasia (CIN), and most importantly (4) primary screening HPV DNA test, solely or in combination with Pap smear to detect cervical cancer precursors. There are clear benefits for the use of HPV DNA testing in the triage of equivocal smears, low-grade smears in older women and in the post-treatment surveillance of women after treatment for CIN. However, there are still issues regarding how best to use HPV DNA testing in primary screening. Primary screening with Hybrid Capture((R)) 2 (HC2) generally detects more than 90% of all CIN2, CIN3 or cancer cases, and is 25% (95% CI): 15-36%) relatively more sensitive than cytology at a cut-off of abnormal squamous cells of undetermined significance (ASC-US) (or low-grade squamous intraepithelial lesions (LSIL) if ASC-US unavailable), but is 6% (95% CI: 4-7%) relatively less specific. Several approaches are currently under evaluation to deal with the lower specificity of HPV DNA testing as associated with transient infection. These include HPV typing for HPV-16 and -18/45, markers of proliferative lesions such as p16 and mRNA coding for the viral E6 and/or E7 proteins, with a potential clinical use recommending more aggressive management in those who are positive. In countries where cytology is of good quality, the most attractive option for primary screening is to use HPV DNA testing as the sole screening modality with cytology reserved for triage of HPV-positive women. Established cytology-based programmes should also be gradually moving towards a greater use of HPV DNA testing to improve their efficacy and safely lengthen the screening interval. The greater sensitivity of HPV DNA testing compared to cytology argues strongly for using HPV DNA testing as the primary screening test in newly implemented programmes, except where resources are extremely limited and only programmes based on visual inspection are affordable. In such countries, use of a simple HPV DNA test followed by immediate 'screen and treat' algorithms based on visual inspection in those who are HPV-positive are needed to minimise the number of visits and make best use of limited resources. A review of studies for visual inspection methods is presented. The fact that HPV is a sexually transmitted infection may lead to anxiety and concerns about sexual relationships. These psychosocial aspects and the need for more information and educational programmes about HPV are also discussed in this article.

0 comments Cited 155 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Cervical cancer in women with comprehensive health care access: attributable factors in the screening process.

Judy Mouchawar, Marianne Yood, W Leyden … (2005)

Invasive cervical cancer is highly preventable, yet it continues to occur, even among women who have access to cancer screening and treatment services. To reduce cervical cancer among such women, reasons for its occurrence must be better understood. We examined factors associated with the diagnosis of cervical cancer among women enrolled in health plans. We identified all cases of invasive cervical cancer (n = 833) diagnosed from January 1, 1995, through December 31, 2000, among women who were long-term members of seven prepaid comprehensive health plans and reviewed each woman's medical records for the 3 years prior to her cancer diagnosis. Women were classified into one of three categories based on Pap test histories 4-36 months before diagnosis: failure to screen with a Pap test, failure in detection by a Pap test, or failure in follow-up of an abnormal test result. The majority of cases (n = 464; 56%) were in women who had no Pap tests during the period 4-36 months prior to diagnosis. Of the remaining cases, 263 (32%) were attributed to Pap test detection failure and 106 (13%) to follow-up failure. Being older (odds ratio [OR] = 6.48, 95% confidence interval [CI] = 3.89 to 10.79) or living in an area of higher poverty (OR = 1.72, 95% CI = 1.11 to 2.67) or having a lower education level (OR= 1.52; 95% CI = 1.07 to 2.16) was associated with the likelihood of being assigned to the failure to screen category versus either of the other two categories. A total of 375 (81%) of the 464 patients who had not had Pap screening had had at least one outpatient visit 4-36 months prior to cancer diagnosis. The cancer diagnostic process was triggered by a routine screening examination in 44% of patients, whereas 53% of the patients presented with symptoms consistent with cervical cancer; the remaining 3% were identified fortuitously during the course of receiving noncervical care. To reduce the incidence of invasive cervical cancer among women with access to screening and treatment, Pap screening adherence should be increased. In addition, strategies to improve the accuracy of Pap screening could afford earlier detection of cervical cancer.

0 comments Cited 83 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Indicadores de calidad y eficiencia de los servicios hospitalarios: Una mirada actual

Rosa E Jiménez Paneque (2004)

La definición de buena calidad de los servicios de salud es difícil y ha sido objeto de muchos acercamientos. Desde el punto de vista de los gestores o administradores de la atención médica, la calidad con que se brinda un servicio de salud no puede separarse de la eficiencia puesto que si no se tienen en cuenta el ahorro necesario de los recursos disponibles, el alcance de los servicios será menor que el supuestamente posible. La medición de la calidad y la eficiencia de un servicio de salud es una tarea de complejidad intrínseca ya que a la medición de conceptos abstractos se añade la variedad de intereses que pueden influir en las evaluaciones subsecuentes. Calidad y eficiencia son nociones abstractas, la necesidad de medirlas es obvia pero es siempre un desafío debido en parte a que los indicadores deben separar la parte de ellos que se debe a las características de los pacientes, de la que se relaciona con la atención prestada. La atención hospitalaria juega un papel preponderante en la atención sanitaria; tiene un alto significado social, pues los hospitales albergan a las personas con los problemas de salud más serios y son los centros más costosos del sistema de salud por la atención especializada y tecnológicamente avanzada que deben brindar, además del servicio hotelero que lógicamente ofrecen. La evaluación continua de la calidad y la eficiencia de la atención hospitalaria con sus implicaciones sociales y económicas es un imperativo para el sector de la salud. El presente trabajo comienza por una visión actualizada de los conceptos de calidad y eficiencia de la atención sanitaria y de la relación entre ellos. Profundiza entonces en los indicadores tradicionales y actualmente utilizados para medir ambos atributos en los servicios hospitalarios. Incluye las formas en que tales indicadores se clasifican y las distintas maneras en que se aborda la difícil tarea de realizar los ajustes necesarios para separar la parte de su valor que se debe a las características de los pacientes de la que realmente se debe a la calidad y eficiencia de la gestión hospitalaria

0 comments Cited 74 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (publisher-id): scol

Title: Salud Colectiva

Abbreviated Title: Salud Colectiva

Publisher: Universidad Nacional de Lanús (Lanús, Buenos Aires, Argentina )

ISSN (Print): 1669-2381

ISSN (Electronic): 1851-8265

Publication date (Print and electronic): December 2012

Volume: 8

Issue: 3

Pages: 247-261

Affiliations

[03] orgnameConsejo Nacional de Investigaciones Científicas y Técnicas

[01] orgnameConsejo Nacional de Investigaciones Científicas y Técnicas

[02] Buenos Aires orgnameCentro de Estudios de Estado y Sociedad Argentina

[04] Buenos Aires orgnameCentro de Estudios de Estado y Sociedad Argentina

Article

Publisher ID: S1851-82652012000400003 Publisher ID: S1851-8265(12)00800303

DOI: 10.1590/s1851-82652012000400003

PubMed ID: 23681458

SO-VID: 084c7541-9d7e-494f-9fcd-f764f59cced3

License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date received : 08 May 2012

Date revision received : 28 August 2012

Date accepted : 28 October 2012

Page count

Figures: 0, Tables: 0, Equations: 0, References: 46, Pages: 15

Product

SciELO Argentina

Self URI: Texto completo solamente en formato PDF (ES)

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

Read this article at

Abstract

Translated abstract

Related collections

SciELO Argentina

Most cited references 49

Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries.

Cervical cancer in women with comprehensive health care access: attributable factors in the screening process.

Indicadores de calidad y eficiencia de los servicios hospitalarios: Una mirada actual

Author and article information

Journal

Affiliations

Article

History

Page count

Product

Categories

Comments

Comment on this article

Similar content 250

Cited by 16

Most referenced authors 653