RESUMO
The United States-Mexico border is a region comprised of a country with one of the highest rates of invasive cervical cancer (Mexico) and a country with one of the lowest rates (United States). Recent evidence clearly indicates that human papillomavirus (HPV) infection is the cause of cervical cancer. The distribution of specific types of HPV is known to vary in different regions of the world, as do the cofactors that may inhibit or promote HPV carcinogenesis. Estimating the prevalence of oncogenic HPV is needed for guiding vaccine development. The purpose of this study was to determine the prevalence of oncogenic and nononcogenic HPV types and risk factors for HPV among women residing along the United States-Mexico border. A cross-sectional study of 2319 women, ages 15-79 years, self-referring for gynecological care was conducted between 1997 and 1998. HPV was detected by PCR using the PYGMY 09/11 L1 consensus primer, and HPV genotyping was conducted using the reverse line blot method. Overall, the HPV prevalence was 14.4% with no significant differences observed by country after adjustment for age. HPV 16 was the most commonly detected HPV type in both the United States and Mexico. Among women with high-grade squamous intraepithelial lesions, HPV types 58, 45, 51, 31, 35, 55, and 73 were most common in Mexico, and HPV types 18, 31, 35, 51, 52, and 58 were most common in the United States. In both countries, HPV prevalence declined linearly with age from 25% among women ages 15-19 years to 5.3% among women 56-65 years. Factors significantly independently associated with HPV infection were older age [adjusted odds ratio (AOR) = 0.15 for ages 56-65 years compared with those 15-19 years], a marital status other than married (AOR = 1.58-3.29), increased numbers of lifetime male partners (AOR = 3.8 for > or =10 partners compared with 1 partner), concurrent infection with Chlamydia trachomatis (AOR = 1.79), ever use of Norplant (AOR = 2.69), and current use of injectable contraceptives (AOR = 2.29). Risk factors for HPV infection did not differ by country. Results from this study suggest that in addition to HPV 16 and 18, HPV types 31, 45, 51, and 58 should be considered for inclusion in an HPV prevention vaccine for distribution in Mexico.
Assuntos
Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Genótipo , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Fatores de Risco , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/prevenção & controleRESUMO
This longitudinal study of older Anglo and Mexican-American widows provides data on coping strategies and coping effectiveness as measured by perceived physical and psychological health. Previous health levels were the best predictors of later physical and psychological symptoms. Contrary to expectations, both ethnic groups preferred nonconfrontational strategies for widowhood problems, with the Mexican Americans using more confrontational strategies. Ways of coping with problems during the first months of widowhood had significant long-term effects upon the widow's health. The most effective coping methods over the first year involved combinations of independent action and emotional release. Over a longer period, more effective strategies included being able to ignore problems, accept the situation, and release tensions, or to actively seek advice about general problems. Contradictory findings over the two time periods for those Mexican Americans using independent action and emotional release strategies appear to be related to cultural patterns of familial support after a death occurs.