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      <title>Az alapellátás szerepe a népegészségügyi méhnyakszűrésben</title>
      <subTitle>Következtetések egy hazai nagy kockázatú humán papillomavírus prevalencia felmérés adataiból</subTitle>
      <altTitles>Emerging role of primary care health visitors in population-based cervical screening : Further conclusions of a high-risk human papillomavirus prevalence survey in Hungary</altTitles>
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      <abstractText>Bevezetés: A humán papillomavírus kimutatásán alapuló hatékonyabb méhnyakszűrés hazai bevezetésének tervezésekor a szakorvoshoz nem vagy ritkán eljutó nők közvetlen megszólítása, elérése is fontos. A védőnők képzése közel egy évtizede kiegészült a népegészségügyi célú méhnyakszűrés kompetenciájával. Célkitűzés: Egy korábbi hazai reprezentatív humán papillomavírus prevalencia felmérés adatai alapján elemeztük a védőnők által elért populáció jellemzőit és az általuk levett minták (n = 905) eredményeit, összehasonlítva a szakorvosok által szűrt populációval és eredményekkel (n = 3826). Módszer: Anonim kérdőíves felmérést és méhnyaki mintavételt végeztünk megyénként véletlenszerűen kiválasztott, összesen 169 szülész-nőgyógyász szakorvos és 40 védőnő segítségével ThinPrep edényzetbe Rovers Cervex-Brush Combi eszközzel. A laboratóriumi feldolgozás Neumann Confidence és Roche Linear Array klinikailag validált genotipizáló tesztekkel történt. Eredmények: A védőnői szűrésen részt vettek körében a páciensek átlagéletkora, az érettségivel nem rendelkezők és azok aránya, akiknél 3 évnél régebben vagy soha nem történt kenetcitológiai méhnyakszűrés, szignifikánsan magasabb volt, mint a szakorvosi szűrésen részt vevők körében. Az 55 év feletti korcsoportokban a védőnők mintája lényegesen közelebb állt a célcsoport populációs részarányához, mint a szakorvosoknál megjelenteké. Az eredménytelen minták aránya nem tért el szignifikánsan attól függően, hogy védőnő vagy szakorvos vette a mintát. A szakorvosok pácienseinél a pozitivitási arány szignifikánsan nagyobb volt, bár nagyobb arányban kaptak korábban humán papillomavírus elleni védőoltást. Megbeszélés: A községi mintákban az életkori hatás statisztikai kiküszöbölése után is látott alacsonyabb vírusprevalenciának mediátora lehetett a mintavételt végző szakember is, hiszen kóros előzményekkel rendelkező páciens nagyobb eséllyel fordulhat szakorvoshoz, mintsem hogy megvárja a védőnői megkeresést. Következtetés: Az iskolai oltási program elindulását, valamint a méhnyakrák előfordulásának korosztályi eloszlását figyelembe véve a szűrés szerepe sikeres oltási program mellett is legalább 20–30 évig jelentős marad. Az 50 év feletti, községben élő, alacsonyabb iskolázottságú célcsoport bevonása védőnőkön keresztül hatékonyabbnak bizonyult, mint szakorvosi rendelésen. Az erre képzett védőnők bizonyítottan eredményes mintavétellel, a nők egyéni felkeresésével, a szűréssel kapcsolatos kétségeik megválaszolásával egyedülálló szerepet játszhatnak a prevenciós célok megvalósulásában. | Introduction: Cervical screening policy update with primary human papillomavirus detection should cover women
who rarely visit gynecologists. Education of registered health visitors in Hungary has incorporated cervical sampling
since 2015.
Objective: Analysis of data from a geographically representative high-risk human papillomavirus prevalence survey to
explore target population characteristics and results of samples collected by health visitors (n = 905) compared to
gynecologists (n = 3826). Method: Cervical sampling with Rovers Cervex-Brush Combi device into ThinPrep containers followed by an anonymous questionnaire of demographic and anamnestic data by randomly appointed competent 40 health visitors and
169 gynecologists all over Hungary. Laboratory detection of high-risk human papillomavirus genotypes with Neumann Confidence and Roche Linear Array clinically validated tests.
Results: Women enrolled by health visitors were significantly less educated, older, and last screened a longer time ago
on average than those who visited gynecologists. Age distribution of women screened by health visitors matched
more proportionally the target population above 55 years. Rate of invalid samples was similar by health visitors and
gynecologists. Patients of gynecologists showed higher virus prevalence despite higher human papillomavirus vaccination rate.
Discussion: Lower age-standardized virus prevalence in rural samples was potentially mediated by the health professional who performed the screening because a patient with pathological anamnesis may prefer going to gynecologists
rather than waiting for health visitor contact.
Conclusion: Calculating with the onset and beneficial coverage of school vaccination program and the age distribution of cervical, vulvar and vaginal cancer incidence, screening keeps its importance for another 20–30 years minimum. Inclusion of risk target group of women with lower education, rural residence, 50+ years of age in the screening was more effective through health visitors than through gynecologists. Health visitors are comparable in sampling
competence and have a practice in actively approaching and involving women, playing a unique part in achieving
prevention objectives.</abstractText>
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      <label>Fogarasi István András et al. Az alapellátás szerepe a népegészségügyi méhnyakszűrésben: Következtetések egy hazai nagy kockázatú humán papillomavírus prevalencia felmérés adataiból. 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