Mother and Daughter Perspectives on Genetic Counseling and Testing of Adolescents for Hereditary Breast Cancer Risk.

OBJECTIVE: To evaluate the risks, benefits, and utility of testing for adult-onset hereditary breast and ovarian cancer (HBOC) in adolescents and young adults. STUDY DESIGN: We evaluated interest in genetic testing of adolescents for adult-onset HBOC genes through semistructured interviews with mothers and adolescents who had previously participated in breast cancer research or had pursued (mothers) clinical testing for HBOC. RESULTS: The majority of mothers (73%) and daughters (75%) were interested in the daughter having genetic testing and were motivated by the future medical utility and current social utility of relieving anxiety and allowing them to prepare. Mothers and daughters both reported that approximately 3 years in the future was the best time to test the daughter regardless of the current age of the daughter. Overall, both mothers and daughters expressed the importance of the involvement of the mother to provide educational and emotional support but ultimately it was the daughter's decision to test. Balancing the independence and maturity of the daughter while reinforcing communication and support within the dyad was a prominent theme throughout the interviews. CONCLUSIONS: There is interest among some high-risk adolescents and young adults to engage in genetic counseling and undergo testing. Providing pretest and posttest genetic counseling, assessing preferences for parent involvement, and offering psychosocial support may be important if genetic testing for HBOC is offered to adolescents and young adults before age 25 years.

Prepubertal Internalizing Symptoms and Timing of Puberty Onset in Girls.

Stressful environments have been associated with earlier menarche. We hypothesized that anxiety, and possibly other internalizing symptoms, are also associated with earlier puberty in girls. The Lessons in Epidemiology and Genetics of Adult Cancer From Youth (LEGACY) Girls Study (2011-2016) included 1,040 girls aged 6-13 years at recruitment whose growth and development were assessed every 6 months. Prepubertal maternal reports of daughter's internalizing symptoms were available for breast onset (n = 447), pubic hair onset (n = 456), and menarche (n = 681). Using Cox proportional hazard regression, we estimated prospective hazard ratios and 95% confidence intervals for the relationship between 1 standard deviation of the percentiles of prepubertal anxiety, depression, and somatization symptoms and the timing of each pubertal outcome. Multivariable models included age, race/ethnicity, study center, maternal education, body mass index percentile, and family history of breast cancer. Additional models included maternal self-reported anxiety. A 1-standard deviation increase in maternally reported anxiety in girls at baseline was associated with earlier subsequent onset of breast (hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.09, 1.36) and pubic hair (HR = 1.15, 95% CI: 1.01, 1.30) development, but not menarche (HR = 0.94, 95% CI: 0.83, 1.07). The association of anxiety with earlier breast development persisted after adjustment for maternal anxiety. Increased anxiety in young girls may indicate risk for earlier pubertal onset.

Non-invasive optical spectroscopic monitoring of breast development during puberty.

BACKGROUND: Tanner staging (TS), a five-stage classification indicating no breast tissue (TS1) to full breast development (TS5), is used both in health research and clinical care to assess the onset of breast development (TS2) and duration in each stage. Currently, TS is measured both visually and through palpation but non-invasive methods will improve comparisons across settings. METHODS: We used optical spectroscopy (OS) measures from 102 girls at the Ontario site of the LEGACY girls study (average age 12 years, range 10.0-15.4 years) to determine whether breast tissue optical properties map to each TS. We further examined whether these properties differed by age, body mass index (BMI), and breast cancer risk score (BCRS) by examining the major principal components (PC). RESULTS: Age and BMI increased linearly with increasing TS. Eight PCs explained 99.9% of the variation in OS data. Unlike the linear increase with age and BMI, OS components had distinct patterns by TS: the onset of breast development (TS1 to TS2) was marked by elevation of PC3 scores indicating an increase in adipose tissue and decrease in signal from the pectoral muscle; transition to TS3 was marked by elevation of PC6 and PC7 and decline of PC2 scores indicating an increase in glandular or dense tissue; and transition to TS4+ by decline of PC2 scores representing a further increase in glandular tissue relative to adipose tissue. Of the eight PCs, three component scores (PC4, PC5, and PC8) remained in the best-fitting model of BCRS, suggesting different levels of collagen in the breast tissue by BCRS. CONCLUSIONS: Our results suggest that serial measures of OS, a non-invasive assessment of breast tissue characteristics, can be used as an objective outcome that does not rely on visual inspection or palpation, for studying drivers of breast development.

A qualitative study evaluating parental attitudes towards the creation of a female youth cohort (LEGACY) in the Breast Cancer Family Registry.

OBJECTIVES: Expanding the existing Breast Cancer Family Registry (BCFR) to enrol daughters aged 6-17 years in a prospective cohort study named LEGACY (Lessons in Epidemiology and Genetics of Adult Cancer from Youth) offers the opportunity to study the effects of genetic and environmental exposures in youth on adult breast cancer risk. Few studies have assessed parents' willingness to enroll their daughters in genetic epidemiological cohort studies. Since BCFR parents are the gatekeepers of their daughters' future enrollment, it is important to explore their interests and attitudes towards LEGACY. METHODS: Semi-structured telephone interviews were conducted with 85 BCFR participant parents at 3 BCFR sites in Ontario, Canada, and in Utah and Northern California. We explored parents' thoughts and feelings (interests and attitudes) regarding their daughters' enrollment in LEGACY and different data collection modalities. Qualitative analysis of audiotaped interviews was carried out utilizing an inductive content analysis. RESULTS: Parents' acceptance of three data collection modalities were 92% (78/85) for questionnaire data, 87% (74/85) for biological samples and 63% (46/73) for physical examination for pubertal staging. The parents' primary motivation for participation was altruistic. Their concerns regarding their daughters' participation centered on exacerbating awkward pubertal feelings, increasing cancer anxiety, respecting autonomy and maturity, privacy and future use of data and logistical impediments. CONCLUSION: Parents demonstrated a high level of interest in the creation of LEGACY. Their motivation to participate was balanced by their desire to protect daughters from undue harm. These interviews contributed valuable information for the design of LEGACY.

The use of preventive measures among healthy women who carry a BRCA1 or BRCA2 mutation.

PURPOSE: The purpose of this study was to assess women's knowledge about tamoxifen, to examine the frequency of tamoxifen usage and other preventive measures in BRCA1/2 mutation carriers, and to document women's concerns about taking tamoxifen for chemoprevention. METHODS: One hundred and twenty five women with known BRCA1 or BRCA2 mutation and with no prior diagnosis of breast or ovarian cancer were identified through the records of two large cancer genetics clinics. These women had been counseled about their cancer risk and various preventive options were discussed. At a time from two to 110 months following disclosure session, a questionnaire was sent by mail. Women were asked about their current and past use of tamoxifen, their knowledge of risks and benefits, their desire for additional information, and their experience with other preventive measures. RESULTS: Eighty-one of 125 eligible women returned the questionnaire (64.8%). Ten women (12.3%) had used tamoxifen and eight women had used raloxifene (9.9%). Twenty-two women (27.2%) had undergone prophylactic mastectomy and 54 women (66.7%) had had an oophorectomy. Twelve women (14.8%) did not recall discussing tamoxifen. Thirty-five women (58.3%) said that their doctors had not provided them with sufficient information about tamoxifen to consider its use. Fear of side-effects was the most common reason for not taking tamoxifen. CONCLUSION: Although tamoxifen appears to be effective in preventing breast cancer in women with a BRCA1 or BRCA2 mutation, few women now take the drug compared to those who choose other preventive measures including surgery. Health care providers should provide accurate information about the risks and benefits of tamoxifen to allow women to make informed decisions.

A low frequency of non-founder BRCA1 mutations in Ashkenazi Jewish breast-ovarian cancer families.

The 185delAG and 5382insC founder mutations account for the majority of mutations identified in BRCA1 in Ashkenazi Jewish breast and breast-ovarian cancer families. Few non-founder BRCA1 mutations have been identified to date in these families. We initially screened a panel of 245 Ashkenazi Jewish breast-ovarian cancer families with an affected proband and at least one other case of breast or ovarian cancer for founder mutations in BRCA1 and BRCA2. Founder mutations were identified in 85 families (185delAG in 44 families, 5382insC in 16 families, and the BRCA2 6174delT in 25 families). The 160 negative families were then screened for the entire BRCA1 gene by a combination of DGGE and PTT. We identified one novel frameshift mutation in BRCA1 in exon 14 (4572del22) that truncated the protein at codon 1485. The family contained three cases of early-onset ovarian cancer (41 years, 43 years, and 52 years) and one case of breast cancer (at age 54 years subsequent to an ovarian cancer). In addition, three missense variants of unknown significance (exon 11 C3832T (P1238L), exon 15 G4654T (S1512I), and exon 15 G4755A (D1546N)) were found in single families. These missense variants have been previously identified in other families [BIC Database] and are considered to be "unclassified variants, favoring polymorphism." Non-founder BRCA1 mutations are rare in Ashkenazi Jewish breast/ovarian cancer families.

All in the family: evaluation of the process and content of sisters' communication about BRCA1 and BRCA2 genetic test results.

Despite the potential importance of family communication, little is known about the process and content of communicating BRCA1/2 test results to relatives. The objectives of this observational study were to describe the process and content of communicating BRCA1/2 test results to sisters, and to evaluate whether the proband's carrier status influenced communication outcomes. Participants were 43 women who were the first family member to have genetic testing (probands). Probands reported on communication outcomes for 81 sisters. Process and content variables were evaluated 1-month after receipt of BRCA1/2 test results using the Family Communication Questionnaire (FCQ). Overall, BRCA1/2 test results were communicated to 85% of sisters, and carriers communicated their results to significantly more sisters compared to uninformative (96% vs. 76%, FET = 0.02). The most important reason for communicating results was to provide genetic risk information; however, compared to uninformatives, carriers communicated their results to significantly more sisters to obtain emotional support (74%) and to get advice about medical decisions (42%) (FET = 0.001). Carriers also discussed the possibility of discrimination and recommendations for cancer management with significantly more sisters. Among sisters to whom BRCA1/2 test results were not communicated, the most important reason for not sharing test results was because of emotionally distant relationships. The results of this study suggest that probands are likely to quickly communicate their BRCA1/2 test results to relatives and that although needs for social support may motivate family communication, emotionally distant relationships may be a barrier to communication with relatives.

Avaliação da percepção de dor em recém-nascidos por profissionais de saúde de unidade neonatal / Evaluation of pain perception in newborns by neonatal health professionals

Resumo Introdução A crescente utilização de recursos de terapia intensiva neonatal para manter a vida dos recém-nascidos enfermos pode gerar estímulos dolorosos, causando sofrimento a eles. Porém, nem sempre essa dor é percebida pelos profissionais envolvidos no cuidado, embora já exista um interesse crescente por parte deles nesse sentido. Objetivo Avaliar a percepção de dor do recém-nascido por profissionais de saúde que atuam em unidade neonatal. Método Pesquisa qualitativa do tipo exploratória, realizada em um hospital de referência em cuidado neonatal de uma capital do Nordeste. Foram realizadas entrevistas semiestruturadas com todos os profissionais que atuavam na Unidade de Terapia Intensiva Neonatal e/ou na Unidade de Cuidados Intermediários em cuidado direto com o recém-nascido. Utilizou-se da análise de conteúdo na modalidade temática, e os resultados foram agrupados em categorias. Resultados Foram realizadas 36 entrevistas. Os profissionais entrevistados reconheceram que a dor neonatal foi historicamente negligenciada e que hoje as evidências científicas comprovam sua existência. Foram identificadas carência na formação no tema e fragilidade na aplicação do conhecimento na prática. Conclusão Os profissionais têm conhecimento sobre a dor neonatal, entretanto quase não utilizam os parâmetros fisiológicos e possuem pouco conhecimento sobre a literatura científica atual. O principal desafio diz respeito à necessidade de uso sistemático de escalas que garantam a avaliação da dor.

Abstract Background The increasing use of neonatal intensive care resources to maintain the lives of sick infants can generate painful stimuli and cause distress for them. However, this pain is not always perceived by the professionals involved in the care, although there is already an increasing interest on the part of the professionals involved in care. Objective To evaluate the perception of health professionals, who works in a neonatal unit related to newborn pain. Method Qualitative research of the exploratory type was carried out in a reference hospital in neonatal care of a capital of the Northeast. Semi-structured interviews were conducted with all professionals working in the Neonatal Intensive Care Unit and / or Intermediate Care Unit in direct care of the newborn. Content Analysis was used in the thematic modality and the results were grouped into categories. Results 36 interviews were conducted. The professionals interviewed acknowledged that neonatal pain was historically neglected and that scientific evidence today confirms its existence. It was identified lack in the training in the theme and fragility in the application of the knowledge in the practice. Conclusion The professionals have knowledge about neonatal pain; however they still use little physiological parameters and have little knowledge of current scientific literature. The main challenge is the need for systematic use of scales that guarantee the evaluation of pain.

Principais mecanismos de gestão participativa

Os processos participativos de gestão fazem parte da dinâmica de diferentes instituições e órgãos do SUS nas três instâncias do governo. Por outro lado, as mesas de negociação entre gestores públicos tem se consolidado como um importante instrumento na prática da gestão participativa. As instâncias de pactuação entre gestores se constituem como espaço de ações compartilhadas, estratégicas e operacionais na gestão do SUS. Enquanto os processos de educação popular em saúde se desenvolvem por meio do diálogo entre movimentos sociais, entidades formadoras e grupos sociais, a fim de fortalecer a participação social no SUS.

Saúde da mulher: saúde sexual e reprodutiva

Material da unidade 2 que compõe o módulo 11 "Saúde da mulher" do Curso de Especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Aborda a assistência médica frente à saúde sexual e reprodutiva da mulher, apresentando algumas peculiaridades que envolvem essa assistência, tais como ações específicas para cada etapa do seu ciclo natural, alterações relacionadas à gravidez, câncer de mama e colo de útero, planejamento reprodutivo e métodos contraceptivos.

Enfermagem gerontológica e suas intervenções nas grandes síndromes geriátricas

Texto que compõe a unidade 2 do módulo eletivo "Cuidado de Enfermagem em Gerontologia" do curso de especialização em Saúde da Pessoa Idoso produzido pela UNA-SUS/UFMA. Aborda a funcionalidade e os desafios na Atenção Básica, os cuidados da Enfermagem em diversos cenários de atenção ao idoso (síndromes geriátricas) e os conceitos elementares de gestão do cuidado prestado por cuidadores informais e profissionais de nível médio na Atenção Básica.

Avaliação antropométrica: peso de crianças menores de 2 anos em balaça mecânica

Material utilizado na unidade 2 do módulo de Alimentação e Nutrição do curso de especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Trata-se de adaptação de material do Ministério da Saúde que apresenta os passos para aferir o peso de crianças menores de 2 anos em balança pediátrica mecânica.

Avaliação antropométrica: peso de crianças menores de 2 anos em balança digital

Material utilizado na unidade 2 do módulo de Alimentação e Nutrição do curso de especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Material adaptado do Ministério da Saúde que apresenta os passos para aferir o peso de crianças menores de 2 anos em balança pediátrica digital eletrônica.

Avaliação antropométrica: peso de crianças maiores de 2 anos, adolescentes e adultos em balança mecânica

Material utilizado na unidade 2 do módulo de Alimentação e Nutrição do curso de especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Material adaptado do Ministério da Saúde que apresenta os passos para aferir o peso de crianças maiores de 2 anos, adolescentes e adultos em balança mecânica de plataforma.

Avaliação antropométrica: comprimento de crianças menores de 2 anos

Material utilizado na unidade 2 do módulo de Alimentação e Nutrição do curso de especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Material adaptado do Ministério da Saúde que apresenta os passos para aferir a estatura/altura de crianças menores de 2 anos.

Avaliação antropométrica: comprimento de crianças maiores de 2 anos, adolescentes e adultos

Material utilizado na unidade 2 do módulo de Alimentação e Nutrição do curso de especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Material adaptado do Ministério da Saúde que apresenta os passos para aferir a altura de crianças maiores de 2 anos, adolescentes e adultos.

Avaliação antropométrica: medida da circunferência da cintura

Material utilizado na unidade 2 do módulo de Alimentação e Nutrição do curso de especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Material adaptado do Ministério da Saúde que apresenta os passos para aferir a circunferênca da cintura de adultos utilizando fita inelástica.

Avaliação antropométrica: medida da circunferência da panturrilha

Material utilizado na unidade 2 do módulo de Alimentação e Nutrição do curso de especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Material adaptado do Ministério da Saúde que apresenta os passos para aferir a circunferênca da panturrilha de adultos utilizando fita inelástica.

Saúde da mulher

Módulo do Curso de Especialização em Saúde da Família produzido pela UNA-SUS/UFMA destinado aos alunos participantes do programa Mais Médicos. Apresenta questões multiprofissionais e da prática assistencial de médicos atuantes na Atenção Básica no que tange peculiaridades relacionadas à saúde da mulher, tais como o planejamento reprodutivo, rastreio de câncer de colo de útero, mama e prevenção de DSTs, aborda ainda as atribuições dos profissionais da atenção primária à saúde na saúde da mulher.

Saúde da mulher: atenção humanizada em saúde da mulher

Material da unidade 3, que compõe o módulo 11 "Saúde da mulher", do Curso de Especialização em Saúde da Família produzido pela UNA-SUS/UFMA, com apresentação visual trabalhada para atender aos alunos participantes do programa Mais Médicos. Apresenta as particularidades da gestação e seu acompanhamento, tais como os fatores de risco tanto para a mãe quanto para o bebê, o diagnóstico e as consultas, o preparo para a amamentação e a melhoria de cuidados com a saúde do bebê.