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Knowledge of the Human Papillomavirus by Social Stratification Factors

imageBackground Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection. Objectives The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women. Methods A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015–2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose–response associations were estimated based on p-trend. Results Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified “promiscuity” as a risk factor of HPV infection and “the use of condoms” as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose–response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine. Discussion In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine.

Clinical practice outcomes and differential results in maternal and neonatal morbidity among pregnant women in Spain who are candidates for a normal birth: a cross-sectional study

Por: Casteleiro · A. · Santibanez · M. · Paras-Bravo · P. · Pellico-Lopez · A. · Paz-Zulueta · M.
Objective

To determine the percentage of pregnant women who are potential candidates for a normal birth in the region of Cantabria, Spain. Also, to compare the main clinical practice outcome indicators and the rates of maternal and neonatal morbidity among the group of candidate women versus non-candidates.

Design

A cross-sectional study.

Setting

A tertiary Hospital in Cantabria (Northern region of Spain).

Participants

The study population comprised the total number of hospital births that took place between 1 January 2014 and 31 December 2014 (n=3315).

Results

Secondary registers were accessed to review the main indicators of care and the outcome of births. The 2 test or the Student’s t-test were used to compare both groups for the categorical and continuous variables, respectively. In total, 1863 births (56.20%) were candidates for applying the strategy of care for a normal birth. In 50.86% of these candidate births, an episiotomy was performed, compared with 60.96% in the group of non-candidates (p

Conclusions

Our results suggest a differential clinical practice, in line with the recommendations of the Clinical Practice Guidelines for Care of Normal Birth. Nonetheless, improvements are necessary regarding the care provided to women and infants, as the percentages of episiotomies and caesarean sections are still high when compared with current standards and compared with other reports.

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