Background: HPV primary screening has shown effectiveness for cancer prevention; however, gynaecological examination is considered uncomfortable. Self-sampling methods increase the acceptance of screening. The aim of this study is to compare the sensitivity and specificity of clinician sampling versus vaginal and urine self-sampling for HPV diagnosis. Methods: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer’s instructions. Results: Characteristics of the participants were: median age 35 years; 40.8% married; 46.7% had a primary level of education; and median age of sexual onset, 17.6 years. The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2–99.9), and specificity 92.1% (IC 85.2–95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2–96.9). The negative predictive value was 98.9% (IC 94.2–99.8) for vaginal self-sampling and 97.6% (IC 92.6–99.4) for urine sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory.

A door-to-door survey was organised in Cuenca, Ecuador, to determine the prevalence of COVID-19 infection and adherence of the population to COVID-19 preventive measures. A total of 2457 persons participated in the study; 584 (23.7%) reported having experienced at least one flu-like symptom since the onset of the pandemic. The maximum SARS-CoV-2 seroprevalence in Cuenca was 13.2% (CI: 12–14.6%) (IgM or IgG positive). Considering PCR confirmed infections, the prevalence was 11% (CI: 10–12.4%). There was no significant difference in seroprevalence between rural and urban areas. Participants aged 35–49 years old, living with a COVID-19 positive person, at least six people in a household, physical contact with someone outside the household, a contact with a person outside the home with flu-like symptoms, using public transport, and not having enough resources for living, significantly increased the odds for SARS-CoV-2 seropositivity. Overall, there was good adherence to COVID-19 preventive measures. Having known someone who tested positive for COVID-19, having a primary or secondary level of education, and having enough resources for living, significantly increased the odds for higher adherence. In conclusion, despite good overall adherence of the population of Cuenca with COVID-19 preventive measures, our study suggests high ongoing COVID-19 transmission in Cuenca, particularly in certain parishes. Prevention should not only focus on behavioural change, but on intensified testing strategies in demographical risk groups.

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67–52.8), and urine sampling, OR 16.63 (6.79–40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44–18.93), and urine sampling, OR 19.5 (5.83–65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03–0.16), and urine sampling, OR 0.01 (0–0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07–0.34), and urine sampling, OR 0.05 (0.01–0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71–9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods.

Castillo C, et al. Endocrinol Metab. 2018 Dec;33(4):466-472. https://doi.org/10.3803/EnM.2018.33.4.466

Objective: To examine the effect of birth weight and subsequent weight gain on children being overweight and obese in serial assessments of Uruguayan children living at urban areas. Methods: We used secondary data of pediatric anthropometric measurements and health and socioeconomic characteristics of families that were included in a longitudinal and prospective nationally representative survey (“Encuesta de Nutrición, Desarrollo Infantil y Salud”). The associations of conditional weight gain, being overweight and obesity were tested through correlation coefficients. Multivariate binary logistic regression models were performed to calculate the effect of birth weight on childhood obesity and were adjusted for covariates. Results: For macrosomic babies, there was an increase in the prevalence of overweight and obesity in 70% compared with non-macrosomic babies, when we adjusted for sex, exclusive breastfeeding duration, and household income. The correlation between weight gain and the body mass index for age indicated that the greatest (positive) difference in Z score between measurements increased the obesity levels. Conclusions: Our findings suggest that ensuring optimal birth weight and monitoring and controlling posterior weight gain represent the first steps toward primary prevention of childhood obesity.