Transcript 1,0 - Medicina

3rd Presentation
12th April ‘10
Introdução à Medicina II
Class 16 - 2009/2010
I. Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. Preliminary Results
VI. References
Why are we developing this study?
 Cervical cancer has a high incidence and mortality.
 A lack of knowledge about the disease is shown in
articles previously consulted.
 Knowledge is a key first step to health education
intervention and appropriate decision-making.
 Medical students will play a major role in the future
public healthcare and education.
 We believe there is potential for better results on
prevention of cervical cancer.
What is cervical cancer?
 A slow developing malignant cancer that starts in the
tissues of the cervix.
 Human papillomavirus (HPV) is implicated in more than
99% of these cancers. (Kaplan-Myrth N, 2007, Family Physicians of Canada)
Normal
Cervix
HPV Infection
HPV Clearance
Infected
Cervix
HPV infection
must persist for
more than one year
Progression
Regression
CIN
Invasion
Cancer
How aware are people of cervical cancer?
 1st grade college students’ knowledge was uncertain
about forms of HPV transmission. There were no major
differences between genders, except for the
knowledge about the link between HPV and genital
warts (4,2%-males; 11,6%-females). (Baer H. et al, 2000, J
Community Health)
Awareness among young university students is low.
How aware are people of cervical cancer?
 “Health professionals and women had better
knowledge about HPV than other participants (…)
Overall, the knowledge of the general public about
HPV infection is poor.” (Klug SJ et al, 2008, Prev. Med.)
 “In a population sample of British women (…) only
2.5% cited HPV as the cause of cervical cancer
without prompting (…) Public education is urgently
needed.” (Marlow LA et al, 2007, Br J Cancer)
How common is cervical cancer?
 Portugal is the
country with the
greatest incidence
of cervical cancer
among the Western
Europe.
 It is also one of
the countries with
higher
mortality
rate.
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. Preliminary Results
VI. References
Major and minor aims
Are medical students well informed about
cervical cancer? And how do they behave?
Major aim:
•
To assess medical students’ knowledge on
cervical cancer...
•
Link between cervical cancer and HPV infection
•
Methods of prevention and detection
•
(...)
Major and minor aims
... and their behaviour in regard to this problem.
•
•
•
•
Number of sexual partners
Age of sexual activity initiation
Vaccine
Others
Secondary aims:
• To compare the results between male and female medical
students’.
• To confront differences involving basic and clinical grades.
• To associate the students’ behaviour with the level of
knowledge shown.
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. Provisory Results
VI. References
Study design
•
Observational
•
Analytic
•
Cross sectional
•
Unit of analysis: individual
Inclusion & exclusion criteria
Inclusion Criteria:
•
FMUP’s student, available population of the 1st and
5th grades
Exclusion criteria:
•
No questionnaire obtained (no response or no
contact with the subject, after two attempts);
•
Classes 10, 15 and 16 of the 1stgrade
Study participants & sampling methods
Target Population:
•
Medical students
Sampling Methods:
1. Stratification of the sample, according to the
students’ grades
2. Questionnaire’s application to all students of 1st
and 5th grades.
Study participants & sampling methods
Questionnaire’s application method
Selection of date and schedule
to apply the questionnaire to
each class
Selection of other date
and schedule to apply the
questionnaire to the
missing students
Application of the
questionnaire to the students
of the class
no
All the students
are present?
yes
End
Data collection methods. Questionnaire.
Main objectives in the design (Leung WC, 2001, StudentBMJ)
•
•
To maximize the response rate
•
Simplicity, shortness and clearness
•
Close-ended questions only
•
Sensitive questions last
To obtain accurate and relevant information for our survey
•
Different types of questions
•
Reversed coded questions
•
Good question quality
Data collection methods. Questionnaire.
Characteristics of the questionnaire:
•
Self-administered, 4-pages; to be applied in groups
(classes), during obligatory practical sessions.
•
Two sections:
•
Section A – Knowledge
•
Section B – Personal data and behaviour
•
Each question has a “Comments” area.
•
We piloted for clarity in class 10.
•
Questions are coded for an easier analysis.
Data collection methods. Questionnaire.
‘Introduction’
Title and logo
Objective
Anonymity
Confidentiality
Instructions
Data collection methods. Questionnaire.
‘Questions’
Variables description
•
Each question generates one or more variables.
•
Analysed variables:
•
Global knowledge of cervical cancer (using a scale); degree of
preoccupation of being infected; degree of self-evaluated knowledge;
frequency of pap smearing  ordinal variables; outcomes in scales
•
Knowledge of specific subjects – questions 2 to 5 (e.g, of the causal link
between HPV and cervical cancer)  nominal variables; outcomes: yes/no
•
Age of initiation of sexual activity; number of sexual partners in lifetime
and in the last 12 months  quantitative variables; outcomes will be
categorized
•
Having started sexual activity; use of condom; being vaccinated; having
done a pap smear  nominal variables; outcomes = yes/no
•
Independent variables:
age, gender
Planned statistical analysis
•
Analysis of each question according to their
previously determined codes.
•
Treatment of the results will be made in SPSS ©
(Statistical Package for Social Sciences).
•
Descriptive statistics
•
Comparative statistics, according to several
interest groups: gender, grade, having or not
started sexual activity, using or not using
condom, etc.
•
Results in tables and graphs.
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. Preliminary Results
VI. References
Basic grades vs clinical grades
 Knowledge and behaviour of students from the 5th
grade will be better than those of students in the 1st

Awareness should increase with the grades.
Males vs females
 Comparing the female subjects with male ones it
should be noticed a slight difference in knowledge
and alertness on this matter.
 However, concerning to genders, the difference
between men and women may be more evident in the
undergraduate years than in the post-graduate ones.
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. Preliminary Results
VI. References
1st grade students
Section A – Knowledge: Question 1
‘Have you ever heard about cervical cancer?’
Have heard of cervical cancer
Frequency
Valid
Missing
Total
Yes and know what it is
Yes but don't know what it is
Total
193
5
198
1
199
Percent
97,0
2,5
99,5
,5
100,0
Valid Percent
97,5
2,5
100,0
Cumulative
Percent
97,5
100,0
 No statistically significant differences were found
between age, gender and sexual activity groups (χ2 tests)
1st grade students
Section A – Knowledge: Question 2
‘What do you think it is the main cause of cervical cancer?’
Think the main cause of cervical cancer is:
Frequency Percent
Valid
Missing
Total
Infection by some types of HIV
Infection by some types of herpes virus
It's hereditary
Infection by some types of HPV
No opinion
Total
2
1,0
3
3
181
7
196
3
199
1,5
1,5
91,0
3,5
98,5
1,5
100,0
Valid
Cumulative
Percent
Percent
1,0
1,0
1,5
1,5
92,3
3,6
100,0
2,6
4,1
96,4
100,0
 No statistically significant differences were found
between age, gender and sexual activity groups (χ2 tests)
the
students who already
started sexual activity
had a significantly higher
% of correct answers
(p=0,036).
0
Correct
Incorrect
No opinion
True
30
False
40
"The mortality rate
by cervical cancer in
Portugal is very low."
True
True
60
"Cervical cancer is more
frequently diagnosed in
women between 35 and
55 years old."
10
False
70
False
False
True
80
"HPV infection is
always
symptomatic."
20
False
90
"Not all HPV types
are potentially
oncogenic."
always
True
infection
is
symptomatic”,
In the question “HPV
"HPV infection is
uncommon in
young women."

Percent
1st grade students
Section A – Knowledge: Question 3 (True/False)
Questions were most subjects chose the correct option
50
1st grade students
Section A – Knowledge: Question 3 (True/False)
False
80
False
70
60
50
30
20
10
True
True
40
False
Correct
Incorrect
No opinion
"An abnormal cytological
smear indicates cervical
cancer."
0
"Vaccination is especially
recommended for women
who have already started
sexual activity."
female
students
had %a
significantly
higher
significantly
% of
of correct higher
answers
correct
answers
than
than male
students.
male
students.
(p=0,046).
(p<0,001).
90
True
"Vaccination
especially

In the is question
recommended
for
“HPV
is
mainly
women
who havefemale
already
symptomatic”,
started
sexual had
activity."a ,
students
100
"HPV is mainly
sexually transmitted."
question
True
the
“After vaccination, there's
no need to continue with
Papanicolaou smear
screening."
In
Percent

False
Questions were most subjects chose the correct option
1st grade students
Section A – Knowledge: Question 3 (True/False)
90
False
True
Questions were most subjects chose the wrong option
False
50
40
Correct
Incorrect
No opinion
True
True
"Some HPV infections
frequently disappear
without treatment."
0
"HPV is transmitted
through skin."
10
True
20
"HPV infection has no
known impact in
pregnancy."
30
False
students
had
a
significantly higher % of
incorrect answers than
male
students.
(p<0,001).
60
"HPV infection affects
mainly women."
“HPV infection affects
mainly women”, female
70
True
question,
False
the
"Condoms are the most
effective way to prevent
HPV infection."
In
Percent

False
80
1st grade students
Section A – Knowledge: Question 3 (True/False)
Questions were most subjects had no opinion
90
In the question “The
10
True
False
20
False
30
True
40
False
50
"The HPV types 16 and 18
are the highest-risk types
for cervical cancer."
Correct
Incorrect
No opinion
"The incidence of cervical
cancer in Portugal is the
highest in Western
Europe."
0
"HPV types 6 and 11
are oncogenic."
who have already started
sexual activity had a
significantly higher % of
correct
answers
(p=0,039).
60
True
HPV types 16 and 18 are
the highest-risk types for
cervical cancer.“, students
70
Percent

80
1st grade students
Section A – Knowledge: Question 3 (True/False)
30
True
True
False
40
10
False
False
20
Correct
Incorrect
No opinion
"There is a virological HPV
test that identifies an
infection through detection
of viral DNA."
0
"Some types of HPV cause
genital warts."
who
have
already
significantly
higher
significantly
higher
started
sexual
activity
(p=0,045)
than
the
(p=0,012)
than
the
had
significantly
femalea ones.
younger
ones
(<=21
higher
years). % of correct
answers (p=0,039).
50
"The Papanicolaou smear
is used to detect the
presence of HPV."
“There
a virological
“Some is
types
of HPV
HPV
test
that

Also,
in the
same
cause
genital
warts.”,
identifies
an infection
question,
male
older
students
(>21
through
detection
students
hada a %% of
of
years)
had
of
viral
DNA.“, students
correct
answers
correct
answers
60
True
In
the question,
question
In the
Percent

Remaining questions
1st grade students
Section A – Knowledge: Question 4: Likert scale
Gender **Self-assessed
Self-assesseddegree
degreeof
ofpreocupation
preocupationof
ofgetting
gettinginfected
infectedby
byHPV
HPVCrosstabulation
Crosstabulation
Male Count
Female
Count
% within
Gender
% within
Gender
% within
Self-assessed
degree
of of
% within
Self-assessed
degree
preocupation
of getting
infected
by by
preocupation
of getting
infected
HPVHPV
% of Total
% of Total
Self-assessed
Self-assesseddegree
degreeof
ofpreocupation
preocupationof
of
getting
infected
by
HPV
getting infected by HPV
Very
Very
Very
Low
Medium High
High Very
Low
Medium
low
high
low
high
Total
Total
72
120
19
3513
376
22
297
23
1
100,0%
40,3%
31,9% 29,2%
18,1% 30,8%
8,3% 18,3%
1,4% 100,0%
5,8% 15,8%
37,5%
62,5%
19,4% 45,2%
80,6%
54,8%
72,9%
27,1% 86,0%
14,0% 95,7%
4,3%
3,6% 12,0%
9,9%
15,1%
18,2%
6,8% 19,3%
3,1% 11,5%
,5%
62,5%
37,5%
 Female students were significantly more worried
in getting infected by HPV than male ones (p<0,001)
(Mann-Whitney test)
1st grade students
Section A – Knowledge: Question 4: Likert scale
Gender * Self-assessed degree of knowledge about cervical cancer Crosstabulation
Gender * Self-assessed degree of knowledge about cervical cancer Crosstabulation
Self-assessed degree of knowledge about
cervical
cancer
Self-assessed
degree
of knowledge about Total
Very
Very low Low cervical
Mediumcancer
High
Total
high
Very
Very4 low 22
Low
Medium
High
Male Count
38
6
72
high2
within Gender
5,6% 30,6%
G
Female % Count
2
25 52,8% 73 8,3%20 2,8%0100,0%
120
%
within
Self-assessed
degree
of
e
100,0
% within Gender
1,7%
20,8% 34,2%
60,8%23,1%
16,7%100,0%
,0% 37,5%
66,7%
46,8%
knowledge
about
cervical
cancer
n
%
d
% within Self-assessed degree of
% of Total
2,1%
11,5%
33,3%
53,2% 19,8%
65,8% 3,1%
76,9% 1,0%
,0% 37,5%
62,5%
e
knowledge about cervical cancer
% of Total
1,0% 13,0%
38,0% 10,4%
,0% 62,5%
r
 The mean rank of the self-assessed degree of
knowledge is significantly higher among female than
male students (p=0,039) (Mann-Whitney test)
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. Preliminary Results
VI.References
Baer H, Allen S, Braun L. Knowledge of human papillomavirus infection among young adult men and
women: implications for health education and research. J Community Health. 2000 Feb;25(1):67-78.
Gerhardt CA, Pong K, Kollar LM, Hillard PJ, Rosenthal SL. Adolescents’ Knowledge of Human
Papillomavirus and Cervical Dysplasia. J Pediatr Adolesc Gynecol. 2000 Feb;13(1):15-20.
Holcomb B, Bailey JM, Crawford K, Ruffin MT 4th. Adults' knowledge and behaviors related to human
papillomavirus infection. J Am Board Fam Pract. 2004 Jan-Feb;17(1):26-31.
Kaplan-Myrth N, Dollin J. Cervical cancer awareness and HPV prevention in Canada. Can Fam
Physician. 2007 Apr;53(4):693-6, 697.
Klug SJ, Hukelmann M, Blettner M. Knowledge about infection with human papillomavirus: a
systematic review. Prev Med. 2008 Feb;46(2):87-98. Epub 2007 Sep 14.
Lambert EC. College students' knowledge of human papillomavirus and effectiveness of a brief
educational intervention. J Am Board Fam Pract. 2001 May-Jun;14(3):178-83.
Leung WC. How to design a questionnaire. studentBMJ (2001);09:171-216
Marlow LA, Waller J, Wardle J. Public awareness that HPV is a risk factor for cervical cancer.
Br J Cancer. 2007 Sep 3;97(5):691-4. Epub 2007 Aug 7.
Pitts M, Clarke T. Human papillomavirus infections and risks of cervical cancer: what do
women know? Health Educ Res. 2002 Dec;17(6):706-14.
Tiro JA, Meissner HI, Kobrin S, Chollette V. What do women in the U.S. know about human
papillomavirus and cervical cancer? Cancer Epidemiol Biomarkers Prev. 2007 Feb;16(2):28894.
Yacobi E, Tennant C, Ferrante J, Pal N, Roetzheim R. University students' knowledge and
awareness of HPV. Prev Med. 1999 Jun;28(6):535-41.