Background: Low national immunization coverage (44.64%) requires strengthening the vaccination campaign to improve knowledge about HPV and its vaccine among adolescents and parents/guardians. Our aim is to evaluate factors related to knowledge about HPV, its vaccine, acceptability and divergences among Brazilian adolescents and parents/guardians. Methods: A cross-sectional study was performed at a health unit of Sao Paulo University, Brazil, from 2015 to 2016. The convenience sample comprised 1047 individuals, including 74% (n = 776) adolescents and 26% (n = 271) parents/guardians, who answered a survey (knowledge about HPV, its vaccine, barriers and acceptability). Results: The main source of information for adolescents was school (39%, n = 298); for parents/guardians, it was health professionals (55%, n = 153). Parents/guardians were 2.48 times more likely than adolescents to know that HPV caused changes in the Pap smear test [RR 2.48, 95% CI 2.03–3.01 (p < 0.001)], 1.43 times likely to be aware that HPV was a sexually transmitted infection [RR 1.43, 95% CI 1.22–1.68 (p < 0.001)], and 2.77 times likely to be informed that the HPV vaccine decreased the chance of having genital warts [RR 2.77, 95% CI 2.22–2.47 (p < 0.001)]. Girls knew more about the topic than boys (RR 1.67; 95% CI 1.10–2.60); education increased parents’ knowledge [(RR 3.38; 95% CI 1.71–6.69)]. Conclusion: Female adolescents and parents/guardians with a higher level of education are factors related to suitable knowledge about HPV and its vaccine among Brazilian respondents. There were differences between parents/guardians and adolescents in HPV awareness, clinical implications, vaccine knowledge and vaccine acceptance.

To estimate the gastroschisis seasonality and trend of prevalence in recent years, stratified by maternal age and geographical clusters of São Paulo state, a population–based study was designed. We used data from the Live Births Information System (SINASC) in São Paulo state, Brazil, from 2005 to 2016. Trends of prevalence were evaluated for the specific subgroups using the Prais–Winsten regression model, and the Durbin–Watson test was used, to estimate the regression coefficient, the annual percent change (APC), and 95% confidence interval (CI). We observed 1576 cases of gastroschisis among 7,317,657 live births (LB), a prevalence of 2.154 (95% CI: 2.047–2.260) per 10,000 LB which included, 50.6% males, 67.4% Caucasians, 53.4% preterm births, and 80.9% caesarean births. The prevalence of gastroschisis significantly increased by 2.6% (95% CI: 0.0–5.2) per year, and this trend was higher in mothers aged 30–34 years (APC: 10.2, 95% CI: 1.4–19.4) than in mothers of other age groups. Between 2011 and 2016, we identified the existence of seasonality based on the date of conception in the middle months of the year (p = 0.002). This is the first and largest population–based study summarizing current epidemiology and identifying trend of prevalence of gastroschisis in São Paulo state.

Purpose: To analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon. Patients and methods: Cross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20–24 years), and young women (25–30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient’s medical records. Results: In total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents’ group compared with the young women’s group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14–2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02–3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11–3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36–14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49–2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47–2.98; PFDI, PR = 2.12, 95% CI 1.47–2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04–3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03–5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21–13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60–2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61–3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68–3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section. Conclusion: Adolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.

This study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from 2003 to 2015 according to education level. This is a cross-sectional population-based study conducted with data from the 2003, 2008, and 2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios. The proportion of Pap smears remained stationary at a high level (>89%) throughout the study period, while access to mammography and PSA tests significantly increased in the 2003‒2015 period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period 2003‒2015. The inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group.

The association between gynecological diagnoses and their distribution in the health sectors provides benefits in the field of women’s health promotion and in medical and interdisciplinary education, along with rationalization according to level of care complexity. Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services. This is a research project of retrospective audit study design with a chart review of data from 428 women treated at University Ambulatory Clinic of Women’s Health, the facility in gynecology and training for Family and Community Medical Residents, São Paulo, Brazil, from 2012 to 2014. Clinical and demographic information, gynecological diagnoses (International Classification of Diseases), and distribution of health services (primary, secondary, and tertiary) were described. The female patients present non-inflammatory disorders of the female genital tract (81.07%, n = 347) and diseases of the urinary system (22.66%, n = 97) among the gynecological diagnoses. The chances of having benign breast disease and non-inflammatory disorders of the female genital tract during the reproductive period corresponds to being 3.61 (CI 1.00–16.29) and 2.56 times (CI 1.58–4.16) higher, respectively, than during the non-reproductive period. The non-inflammatory disorders of the female genital tract (93.33%, n = 28) are most related to the tertiary sector. The distribution in health services was the following: 71.30% (n = 305) in the primary sector, 21.70% (n = 93) in the secondary sector and 7% (n = 30) in the tertiary sector. The studied women presented non-inflammatory disorders of the female genital tract and diseases of the urinary system as determined by gynecological diagnoses. Low-assistance complexity followed in most cases.

To evaluate the knowledge and acceptability of the human papillomavirus (HPV) vaccine among health professionals from western Amazonia. A cross-sectional study was conducted in the Sistema Assistencial è Saúde da Mulher e da Criança (Health Care System for Women and Children; SASMC) in Acre, Brazil, in 2017. The participants comprised 196 health professionals. The data collection instrument contained 31 questions about HPV, its clinical repercussions for women, and the HPV vaccine. Quantitative variables were presented as medians and 95% confidence intervals (CIs), and p<0.05 was considered statistically significant. For the analyses, chi-square tests and Mann-Whitney tests were used. The collected data were analyzed using Stata®11.0. Of the 196 health professionals, 39.8% (n=76) were physicians and 61.2% (n=120) were other health professionals. The interviewees were mostly female (n=143, 73%, 95% CI 66.1 to 78.9%) who worked in the medical field (n=81, 41.3%, 95% CI 34.4 to 48.6%), and the median age was 38 years (95% CI 36.0 to 39.7). Physicians had increased knowledge regarding only the statement "cervical cancer is one of the main causes of cancer in women", with a proportion ratio of 0.88 (0.80; 0.97) and p<0.001. Regarding clinical knowledge of the HPV vaccine, a low proportion of correct answers was obtained for all the questions, and no significant differences were found between the groups. Acceptability and knowledge of HPV and its vaccine were similar among health professionals, with knowledge gaps in questions about the relation between smoking and cervical cancer and specific clinical knowledge.