Temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service between 2008 and 2017.

BACKGROUND: In Brazil, 70% of the population depends on the public healthcare system. Since early detection is considered crucial, this study aimed to evaluate temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service (SUS) according to the different regions of the country between 2008 and 2017. METHODS: This ecological study analyzed data on breast cancer screening within the SUS for women aged 50-69 years. Coverage was calculated from the ratio between the number of screening tests conducted and the expected number for the target population. Joinpoint regression analysis was used to calculate annual percent changes (APC) in coverage. RESULTS: Around 19 million mammograms were performed in 50-69-year old women within the SUS between 2008 and 2016. The estimated APC indicates that breast cancer screening coverage increased by 14.5% annually in Brazil between 2008 and 2012 (p < 0.01), with figures stabilizing between 2012 and 2017 as shown by an APC of - 0.4% (p = 0.3). In the five geographic regions of the country, the APC initially increased, then stabilized in the north, northeast and southeast and decreased in the south and Midwest. Of the 26 states, coverage increased in seven and remained stable in six. In the other 13, there was an initial increase followed by stabilization in 11, and a reduction in coverage in two. In the Federal District, coverage remained stable throughout the study period. CONCLUSION: Evaluation of the temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service revealed an initial increase, confirming that public policies were effective, although insufficient to ensure organized screening. There appears to be a lack of uniformity between the different regions and states and this situation is highlighted in the final 5-year period, with the APC reflecting stabilization of breast cancer screening coverage.

Mean glandular dose in digital mamography in women with breast implants.

PURPOSE: Mean Glandular Dose (MGD) is the quantity related to the risk of radiation-induced breast cancer. This study aimed to evaluate the MGD in screening mammography for women with breast implants. METHODS: This retrospective study used data of 2680 mammographies of 335 asymptomatic women with mammary implants examined in a digital direct x-ray unit. Each woman had a total of eight images: four in standard views and four with posterior displacement of the implant (ID). Data on kV, mAs, target/filter combination, compressed breast thickness and MGD were obtained from the DICOM header of the stored images. Quantitative variables were presented through descriptive statistics for median (5th-95th percentiles); and the qualitative variables were presented by numbers and percentages. Mean glandular doses of standard views and ID views were compared and statistical analysis was used to assess the influence of implant position, breast glandularity and thickness on mean glandular doses. RESULTS: Median MGD for standard views were 3.30 (2.60-4.00) mGy for CC and 3.31 (2.70-4.20) mGy for MLO. For ID views, median were 1.20 (0.90-2.20) mGy and 1.40 (0.97-3.74) mGy for CC and MLO views, respectively. Median MGD for the whole examination of women with breast implants was 9.60 (7.92-12.07) mGy, ranging from 6.25 to 21.50 mGy. When comparing MGD median for standard and ID views it was found a statistically significant difference (p < 0.05), with higher doses for the standard views due to the greater compressed breast thickness in these views. It was observed that, in the standard views, MGD decreases with increasing breast thickness due to the manual radiographic techniques used to expose the women. It was also observed that implant position does not affect MGD in breast augmentation mammography. CONCLUSION: Mammography of women with mammary implants gives higher radiation doses when compared with those without implants. For more accurate dose assessment in augmented breast mammography, it is necessary that specific conversion factors for the calculation of MGD based on air kerma at entrance of breasts with implants are made available.

Are All Views with and without Displacement Maneuver Necessary in Augmentation Mammography? Putting Numbers Into Perspective.

OBJECTIVE: Augmentation implants pose a challenge for radiologists. Displacing the implant allows slightly more breast tissue to be visualized than the standard compression views. The objective of this study was to verify the agreement between craniocaudal (CC) views and CC with implant displacement (CC-ID), mediolateral oblique (MLO) and MLO-ID and the inter- and intraobserver agreement of mammographic images for finding abnormal images. METHODS: The main outcomes [BI-RADS® normal=1,2; abnormal=3,4,5)] were analysed by 3 readers (reader1; reader 2, 1st round, reader 2, 2nd round) in 360 women with breast implants. Comparison between CC/CC-ID and MLO/MLO-ID, and degree of agreement for mammographic images between researchers were made using Kappa index. Proportions were calculated using a 95% confidence interval (95%CI). RESULTS: A total of 87 abnormal findings were identified by reader 2, 2nd round. Abnormal findings were observed in CC-ID=18.8% (68 out of 360; 95%CI=15.1%-23.2%) compared to CC=10.8% (39 out of 360; 95%CI=8%-14.4%, k=0.49); in MLO=10.5% (38 out of 360; 95%CI=7.7%-14.1%) compared to MLO-ID=15.8% (57 out of 360; 95%CI=12.4%-19.9%, k=0.55). The CC-ID was the view that singly identified more abnormal findings (20 out of 87; 23%; 95%CI=15.4% to 32.8%) and the CC was the view that least detected abnormal findings (1 out 87; 95%CI=0.2% to 6.2%). The inter- and intraobserver agreement between readers views was 0.67 and 0.74 respectively. CONCLUSIONS: In women with breast augmentation implants, all views are necessary to identify breast tissue abnormalities. In our sample, the inter- and intraobserver agreement were "substantial".

Evaluation of ionizing radiation as a risk factor for the incidence of breast cancer: long-term analysis after the cesium-137 accident in Goiânia, Brazil. An ecological study.

BACKGROUND: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. OBJECTIVE: To evaluate the association between breast cancer incidence and ionizing radiation levels. DESIGN AND SETTING: Ecological study among residents of the city of Goiânia, Brazil. METHODS: The central region of Goiânia, with seven major sources of contamination from cesium-137, was defined as the study area. The addresses of women diagnosed with breast cancer were identified between 2001 and 2010. The data were geographically referenced and, using census data, the annual averages of crude incidence rates were estimated. The existence of clusters of new cases was ascertained by means of the Moran index. Correlations of radiometric measurements with the incidence were assessed using unconditional linear regression. RESULTS: A total of 4,105 new cases were identified, of which 2,233 were in the study area, and of these, 1,286 (57.59%) were georeferenced. The gross rates of total and referenced cases were 102.91 and 71.86/100,000 women, respectively. These were close to the average for Brazilian state capitals, which is 79.37/100,000 women. The cluster analysis showed slight correlations in three small sets of census tracts, but these were far from the sources of contamination. The scatter plot of points and the R2 value close to zero indicated that there was no association between the variables. CONCLUSION: This study reinforces the hypothesis that the ionizing radiation levels to which women living in Goiânia are now exposed to are not associated with the onset of new cases of breast cancer.

RELATIONSHIP OF FEMALE BREASTS TO PHYSICAL ACTIVITY, EXERCISE AND SPORT - Part 1 / RELAÇÃO DAS MAMAS FEMININAS COM A ATIVIDADE FÍSICA, EXERCÍCIO E ESPORTE - Parte 1 / Relación de las mamas femeninas con la actividad física, el ejercicio y el deporte - parte 1

ABSTRACT Introduction: The women are increasingly seeking to be physically active or even choose sports as their professional activity as in the years, the number of Summer Olympic athletes has equaled that of men. Due to this growing female participation in sports, the study of female and male differences has become increasingly relevant in the involvement of the academic world. Objective: A review on this subject, stimulating more research, and making knowledge reach more women is a major objective of this literature review. We understand that more studies are needed to understand pathophysiology, prevention, and treatment. Methods: The study design was a retrospective narrative review of the relationship between breasts and physical activity, exercise, and sports. Results: Several anthropometric and physiological differences have been established; however, the volume and shape of the female breast is peculiar but still little studied. The specificity of female breasts are conditions that can exert sports performance and contribute to distancing women from physical activity practice. Conclusion: Possible conditions of female breasts in sports are exercise-induced mastalgia, breast injury, nipple injury, pregnancy, and many others. We understand that more studies are needed to understand pathophysiology, prevention, and treatment. Level of Evidence II; Retrospective Narrative Review.

RESUMEN Introducción: Cada vez son más las mujeres que buscan ser físicamente activas e incluso eligen el deporte como actividad profesional, ya que en los últimos años el número de atletas olímpicas de verano ha igualado al de los hombres. Debido a esta creciente participación femenina en el deporte, el estudio de las diferencias entre hombres y mujeres se ha vuelto cada vez más relevante en el ámbito académico. Objetivo: Realizar una revisión sobre este tema, estimular nuevas investigaciones y hacer que el conocimiento llegue a más mujeres constituye el principal objetivo de esta revisión bibliográfica. Métodos: El diseño del estudio fue una revisión narrativa retrospectiva de la relación entre mamas y actividad física, ejercicio y deporte. Resultados: Se han establecido varias diferencias antropométricas y fisiológicas; sin embargo, el volumen y la forma de la mama femenina son peculiares, pero aún poco estudiados. La especificidad de las mamas femeninas es un factor que puede perjudicar el rendimiento deportivo y contribuir a alejar a las mujeres de la actividad física. Conclusión: Las posibles afecciones de las mamas femeninas en el deporte son la mastalgia inducida por el ejercicio, las lesiones mamarias, las lesiones del pezón, el embarazo y muchas otras. Entendemos que se necesitan más estudios para comprender la fisiopatología, la prevención y el tratamiento. Nivel de Evidencia II; Revisión Narrativa Retrospectiva.

RESUMO Introdução: As mulheres estão cada vez mais buscando ser fisicamente ativas e até escolhendo o esporte como sua atividade profissional, pois, nos últimos anos, o número de atletas olímpicas de verão equiparou-se ao dos homens. Devido a essa crescente participação feminina nos esportes, o estudo sobre as diferenças entre homens e mulheres tem se tornado cada vez mais relevante no âmbito acadêmico. Objetivo: Uma revisão sobre esse assunto, estimulando mais pesquisas e fazendo com que o conhecimento chegue a mais mulheres constitui o principal objetivo desta revisão da literatura. Métodos: O desenho do estudo foi uma revisão narrativa retrospectiva da relação entre mamas e atividade física, exercícios e esportes. Resultados: Várias diferenças antropométricas e fisiológicas foram estabelecidas; entretanto, o volume e a forma da mama feminina são peculiares, mas ainda pouco estudados. A especificidade das mamas femininas é um fator que pode prejudicar o desempenho esportivo e contribuir para afastar as mulheres da prática de atividade física. Conclusão: As possíveis condições das mamas femininas no esporte são mastalgia induzida pelo exercício, lesão mamária, lesão do mamilo, gravidez e muitas outras. Entendemos que são necessários mais estudos para compreender a fisiopatologia, a prevenção e o tratamento. Nível de Evidência II; Revisão Narrativa Retrospectiva.

Trends in the Incidence of Breast Cancer Following the Radiological Accident in Goiânia: A 25-Year Analysis.

BACKGROUND: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. One major concern regarding deleterious effects in the population was a possible increase in the breast cancer incidence. This study analyzed trends in the incidence of breast cancer over the 25-year period following the radiological accident. METHODS: This ecological, population-based study was conducted to determine the incidence of breast cancer in female residents of Goiânia, Goiás, Brazil, between 1988 and 2012. The data were collected from the Goiânia population-based cancer registry. Crude and age-standardized incidence rates were calculated. The Joinpoint software program was used to calculate annual percent changes (APC) in the incidence of breast cancer. RESULTS: Overall, 7,365 new cases of breast cancer were identified, with an annual crude incidence rate of 23.09/100,000 women in 1988 and of 71.65/100,000 women in 2012. The age-standardized incidence rate was 35.63/100,000 women in 1988 and 65.63/100,000 women in 2012. Analysis of the APC showed a significant annual increase of 4.8% in the incidence between 1988 and 2005 (p<0.0001) followed by stabilization in 2005-2012, with an APC of -3.5% (p=0.1). CONCLUSION: There was an increase in the incidence of breast cancer in the female residents of Goiânia, Goiás in the first 17 years of evaluation (1988-2004) followed by a period of stabilization until 2012. However, the trends in the incidence suggest a lack of association with the radiological accident.

Difficult Access and Poor Productivity: Mammography Screening in Brazil.

Background: Factors that may hamper access to mammographic screening in any given region include socioeconomic limitations and the geographical distribution and quality of the mammography machines. This study evaluated access to breast cancer screening within the Brazilian National Health Service (SUS), the geographical distribution of mammography equipment and the number of mammograms performed in Brazil. Methods: This ecological study evaluated the availability of mammography machines within the SUS, those available for Brazil as a whole, its macroregions, states and the Federal District in 2016. The number of mammography machines required for breast cancer screening was calculated and compared to the number of machines available. The expected number of mammograms was compared with the actual number performed. Machines were georeferenced based on their location and the municipal seat, according to healthcare region, with 60 km being defined as the maximum distance for an individual to travel for a mammogram. Results: In 2016, there were 4,628 mammography machines in Brazil. Of these, 4,492 were in use and 2,113 (47%) were available to the SUS. Considering the number of mammograms required as a function of the number clinically indicated, 2,068 machines would be required for breast cancer screening in Brazil. The network of machines available would be capable of producing 14,279,654 exams; however, only 4,073,079 exams were performed, representing 29% of the total capacity of production in the country in 2016. Regarding the maximum distance of 60 km to access a mammogram, only relatively small areas of Brazil were found not to meet this indicator. Conclusion: These results suggest that the difficulty of the Brazilian population in accessing breast cancer screening through the SUS is not associated with the number of machines available or with the geographical location of the equipment but rather with the insufficient number of mammograms performed.

14C content in vegetation in the vicinities of Brazilian nuclear power reactors.

(14)C specific activities were measured in grass samples collected around Brazilian nuclear power reactors. The specific activity values varied between 227 and 299 Bq/kg C. Except for two samples which showed (14)C specific activities 22% above background values, half of the samples showed background specific activities, and the other half had a (14)C excess of 1-18%. The highest specific activities were found close to the nuclear power plants and along the main wind directions (NE and NNE). The activity values were found to decrease with increasing distance from the reactors. The unexpectedly high (14)C excess values found in two samples were related to the local topography, which favors (14)C accumulation and limits the dispersion of the plume. The results indicate a clear (14)C anthropogenic signal within 5 km around the nuclear power plants which is most prominent along northeastwards, the prevailing wind direction.

Clinical quality assurance in breast cancer screening and diagnosis: a warning regarding mammographic positioning

This study aimed to evaluate the clinical image quality of mammograms performed in users of the Brazilian Unified Health System (SUS) referred to a tertiary hospital. Methods: A prospective study assessed mammograms from women referred to a specialist breast center in Goiânia, Goiás, Brazil, between May and October 2017. Scans performed in the preceding 6 months, either screening or diagnostic, were included in the study. Clinical quality was determined from 40 variables related to patient identification, technical performance, the equipment, radiological findings, reporting of results, and breast positioning. Scans performed in the public and private healthcare networks were compared regarding mammographic positioning. Results: Overall, 4,560 variables associated with the clinical quality of the images were evaluated in scans from 114 women with a mean age of 50.6 years. A total of 660 (14.47%) inadequacies were found, 443 (67.12%) of which were related to breast positioning. The most common errors were as follows: pectoral muscle could not be seen in 86.8% of scans in the craniocaudal view and inframammary angle could not be seen in 79.8% of scans in the mediolateral oblique view. Considering the breast-positioning criteria evaluated in the mediolateral oblique view, there was a greater risk of the breast not being centrally positioned with the nipple in profile (RR 4.66; 95%CI 1.05−20.62; p=0.02) and of nonvisualization of the retro-areolar area (RR 4.14; 95%CI 0.92−18.66; p=0.04) in the exams performed in the private compared to the public network.

Implementation of a national metrology network of radionuclides used in nuclear medicine.

The Nuclear Medicine Services (NMS) in Brazil routinely use dose calibrators to measure the activity of solutions containing radiopharmaceuticals. These solutions are administered to patients with the intention to diagnose or treat illnesses. However, for optimal results, the activity of these radiopharmaceuticals must be determined as accurately as possible. The National Laboratory for Ionizing Radiation Metrology (LNMRI) led, since 1998, a comparison program for activity measurements of radiopharmaceuticals administered to patients in the NMS with the purpose promoting quality control. This program has been carried out successfully in Rio de Janeiro, but there is a need to implement it around the country. This can be resolved through the implementation of a network of regional laboratories at various locations throughout the national territory. Currently, such a network is active at a second site, located in Brasília, covering the needs of the Center-West Region, and at a third site, located in Porto Alegre, in the South Region. This work presents the results of comparisons for the radiopharmaceuticals nuclides 131I and 99Tcm and proves that the implementation of a radionuclide metrology network is feasible and viable.

Contribution of the Unified Health Care System to mammography screening in Brazil, 2013.

OBJECTIVE: To estimate the coverage of opportunistic mammography screening performed via the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System), at the state and regional level, in 2013. MATERIALS AND METHODS: This was an ecological study in which coverage was estimated by determining the ratio between the number of mammograms performed and the expected number of mammograms among the population of females between 50 and 69 years of age. The number of mammograms performed in the target population was obtained from the Outpatient Database of the Information Technology Department of the SUS. To calculate the expected number of mammograms, we considered 58.9% of the target population, the proportion that would be expected on the basis of the recommendations of the Brazilian National Cancer Institute. RESULTS: In 2013, the estimated national coverage of mammography screening via the SUS was 24.8%. The mammography rate ranged from 12.0% in the northern region to 31.3% in the southern region. When stratified by state, coverage was lowest in the state of Pará and highest in the state of Santa Catarina (7.5% and 35.7%, respectively). CONCLUSION: The coverage of mammography screening performed via the SUS is low. There is a significant disparity among the Brazilian states (including the Federal District of Brasília) and among regions, being higher in the south/southeast and lower in the north/northeast.

OBJETIVO: Estimar a cobertura mamográfica em rastreamento oportunista realizado pelo Sistema Único de Saúde (SUS) no Brasil, nas suas regiões e nas Unidades da Federação, no ano de 2013. MATERIAIS E MÉTODOS: Estudo ecológico, em que a estimativa da cobertura foi a proporção entre o número de exames realizados e o número de exames esperados na população feminina na faixa etária de 50 a 69 anos. O número de exames realizados refere-se aos dados da produção mamográfica da população alvo, disponíveis no Sistema de Informações Ambulatoriais do Departamento de Informática do SUS. Para o cálculo do número de exames esperados considerou-se 58,9% da população alvo, tendo em vista as recomendações do Instituto Nacional de Câncer. RESULTADOS: A estimativa da cobertura mamográfica no rastreamento realizado pelo SUS no Brasil, em 2013, foi 24,8%. A prevalência de mamografias variou de 12,0% na Região Norte a 31,3% na Região Sul. Ao estratificar por Unidades da Federação, a menor cobertura foi no Pará (7,5%) e a maior cobertura foi em Santa Catarina (35,7%). CONCLUSÃO: A cobertura mamográfica do SUS no Brasil é baixa. Existe uma desigualdade significativa entre as Unidades da Federação, sendo maior nas regiões Sul e Sudeste e menor nas regiões Norte e Nordeste do país.

Knowledge of basic attention professionals about prevention and early detection of breast cancer in the state of Goiás

The role of Basic Health Care (BHC) professionals is essential in the primary and secondary prevention of breast cancer. The aim of this study was to characterize BHC professionals in the Health Regions of a federative unit and to assess their knowledge about breast cancer. This was a prospective study carried out with BHC professionals from the state of Goiás. Phase 1 ­ Preparation of material and training of the team. Phase 2 ­ Agreement of actions between executing team and coordination of health regions. Phase 3 ­ Presentation of project at the collegiate meeting. Phase 4 ­ Qualification of BHC professionals with different learning methods and application of questionnaires, evaluating the contribution of the action. A total of 1,133 professionals were included; mean age was 36.3 years, and they were predominantly women (87.6%), working as community health agents (59.2%) and at public service (76.3%). Only 53.8% of professionals identified the female sex as a risk factor for breast cancer, while 90% identified family history as an important factor for the development of the disease. Important changes in physical examination that can occur in patients with the disease, such as skin retraction, skin bulging and nipple injury, were mentioned as a risk factor only by 35.3%, 31.3% and 39.7%, respectively. BHC professionals who participated in the project had less than ten years of professional experience and significant restrictions of knowledge about primary and secondary prevention of breast cancer. They still experience difficulties in accessing mammography and specialized care.

Opportunistic mammography screening by the Brazilian Unified Health System in 2019

Introduction: Mammography screening has been the best method for detecting early tumors and reducing breast cancer mortality according to different studies. In Brazil, the number of women who undergo mammography tests by the Brazilian Unified Health System (SUS) has been far below international recommendations. Objective: To describe the number of mammographies, mammography coverage, and the amount spent on this exam during 2019 by SUS, in Brazil. Method: Ecological study with data from the Department of Informatics of the Brazilian Unified Health System and the Brazilian Institute for Geography and Statistics in order to verify the number of mammographies performed by the SUS concerning the Brazilian female population in Brazil, in the age group of 50 to 69 years, in the states and in macro-regions during 2019. Results: In 2019, 2,660,469 mammographies were performed in the country out of the expected total of 12,154,979, accounting for a 21.9% mammography coverage by SUS at the cost of BRL 117,841,231.97. The lowest coverage rates were verified in the states of Amapá (0.6%) and the Federal District (4.9%), whereas the best rates were found in the states of Paraná (29.7%) and Alagoas (29.6%). Conclusions: The number of mammographies performed in Brazil in 2019 by SUS corresponded to almost » of the country's need, with mammography coverage far below the target and being widely different among the many Brazilian states.

Evaluation of ionizing radiation as a risk factor for the incidence of breast cancer: long-term analysis after the cesium-137 accident in Goiânia, Brazil. An ecological study

ABSTRACT BACKGROUND: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. OBJECTIVE: To evaluate the association between breast cancer incidence and ionizing radiation levels. DESIGN AND SETTING: Ecological study among residents of the city of Goiânia, Brazil. METHODS: The central region of Goiânia, with seven major sources of contamination from cesium-137, was defined as the study area. The addresses of women diagnosed with breast cancer were identified between 2001 and 2010. The data were geographically referenced and, using census data, the annual averages of crude incidence rates were estimated. The existence of clusters of new cases was ascertained by means of the Moran index. Correlations of radiometric measurements with the incidence were assessed using unconditional linear regression. RESULTS: A total of 4,105 new cases were identified, of which 2,233 were in the study area, and of these, 1,286 (57.59%) were georeferenced. The gross rates of total and referenced cases were 102.91 and 71.86/100,000 women, respectively. These were close to the average for Brazilian state capitals, which is 79.37/100,000 women. The cluster analysis showed slight correlations in three small sets of census tracts, but these were far from the sources of contamination. The scatter plot of points and the R2 value close to zero indicated that there was no association between the variables. CONCLUSION: This study reinforces the hypothesis that the ionizing radiation levels to which women living in Goiânia are now exposed to are not associated with the onset of new cases of breast cancer.

[Effectiveness of a quality control program in mammography for the Brazilian National Health System]. / Efetividade de programa de controle de qualidade em mamografia para o Sistema Único de Saúde.

OBJECTIVE: To assess the effectiveness of a quality control program in mammography services of the Brazilian National Health System (SUS). METHODS: A prospective study using temporal analysis of a health surveillance action was conducted. A total of 35 service providers that had mammography equipment in operation and regularly performed exams between 2007 and 2009 in the state of Goiás, Central-Western Brazil, participated in this study. Services were assessed during three site visits by performance testing of mammography equipment, film processors, and other materials, and image quality and entrance surface dose in a phantom were also assessed. Each service was scored according to the percentage of tests that conformed to standards. RESULTS: The mean percentage for compliance among the participating service providers were 64.1% (± 13.3%) in the first visit, 68.4% (± 15.9%) in the second, and 77.1% (± 13.3%) in the third (p < 0.001). The main improvements resulted from adjustments to the breast compression force, the automatic exposure control system, and the alignment of the compression paddle. The doses measured were within the conformity range in 80% of the services assessed. CONCLUSIONS: The implementation of this program in the mammography services was effective at improving the operational parameters of the mammography machines, although 40% of the services did not reach the acceptable level of 70%. This result indicates the need to continue this health surveillance action.

Analytical results and effective dose estimation of the operational Environmental Monitoring Program for the radioactive waste repository in Abadia de Goiás from 1998 to 2008.

This paper presents the results of the Environmental Monitoring Program for the Radioactive waste repository of Abadia de Goiás, which was originated from the accident of Goiania, conducted by the Regional Center of Nuclear Sciences (CRCN-CO) of the National Commission on Nuclear Energy (CNEN), from 1998 to 2008. The results are related to the determination of (137)Cs activity per unit of mass or volume of samples from surface water, ground water, depth sediments of the river, soil and vegetation, and also the air-kerma rate estimation for gamma exposure in the monitored site. In the phase of operational Environmental Monitoring Program, the values of the geometric mean and standard deviation obtained for (137)Cs activity per unit of mass or volume in the analyzed samples were (0.08 ± 1.16) Bq.L(-1) for surface and underground water, (0.22 ± 2.79) Bq.kg(-1) for soil, and (0.19 ± 2.72) Bq.kg(-1) for sediment, and (0.19 ± 2.30) Bq.kg(-1) for vegetation. These results were similar to the values of the pre-operational Environmental Monitoring Program. With these data, estimations for effective dose were evaluated for public individuals in the neighborhood of the waste repository, considering the main possible way of exposure of this population group. The annual effective dose obtained from the analysis of these results were lower than 0.3 mSv.y(-1), which is the limit established by CNEN for environmental impact in the public individuals indicating that the facility is operating safely, without any radiological impact to the surrounding environment.

Competências profissionais para enfermeiros: a visão de discentes de graduação em enfermagem / Professional competences for nurses: the view of undergraduate nursing students

Objetivo: caracterizar as competências profissionais para os enfermeiros na visão de discentes de graduação emenfermagem, bem como as estratégias mobilizadas para aquisição dessas competências. Método: estudo qualitativoque utilizou a entrevista semiestruturada na coleta de dados ocorrida de janeiro a julho de 2015. Para análisedos dados foi utilizado o método de análise temática indutiva. Resultados: participaram da pesquisa 54 discentes,sendo 87% do sexo feminino e 13% do sexo masculino, na faixa etária entre 21 e 46 anos, 27,77% possuíamformação técnica em enfermagem. Quanto à procedência dos participantes, a maior parte (64,81%) era da regiãode Ribeirão Preto. Conclusão: na visão dos discentes, as competências profissionais para os enfermeiros foramconhecimento teórico-prático, liderança, comunicação, gerenciamento, relacionamento interpessoal e trabalhoem equipe e competências pedagógicas. As estratégias mobilizadas para aquisição dessas competências foramexperiência prática, aprimoramento profissional, grupos de estudo e apoio dos docentes.

Objective: characterize the professional competences for nurses in students view nursing graduation, as well as thestrategies mobilized to acquire these competences. Method: qualitative study, which was attended by 54 studentsof nursing in the last year of a public higher education institution of a municipality of São Paulo. The data werecollected through semi-structured interviews from January to July 2015 and data analysis was used the method ofinductive thematic analysis. Results: the results showed competences as theoretical-practical knowledge, leadership,communication, management, interpersonal skills and teamwork, and teaching skills, as well as strategies to develop them. Conclusion: this study should cause reflection of managers on the competences of nursing students in training,since the analysis of competences is an important factor to achieve results in effective professional practice.

Objetivo: caracterizar las competencias profesionales para las enfermeras en los estudiantes de enfermería ver lagraduación, así como las estrategias movilizadas para adquirir estas habilidades. Método: estudio cualitativo, a laque asistieron 54 estudiantes de enfermería el último año de una institución de educación superior pública de unmunicipio de Sao Paulo. Los datos fueron recolectados a través de entrevistas semiestructuradas de enero a julio2015 y se utilizó el análisis de datos del método de análisis temático inductivo. Resultados: los resultados mostraroncompetencias como el conocimiento teórico-práctico, el liderazgo, la comunicación, la gestión, habilidadesinterpersonales y de trabajo en equipo y habilidades de enseñanza, así como las estrategias para desarrollarlas.Conclusión: este estudio debería provocar la reflexión de los directivos sobre las competencias de los estudiantes deenfermería en formación, ya que el análisis de las competencias es un factor importante para lograr resultados enla práctica profesional efectiva.

[Estimated mammogram coverage in Goiás State, Brazil]. / Estimativas da cobertura mamográfica no Estado de Goiás, Brasil.

This cross-sectional study aimed to estimate mammogram coverage in the State of Goiás, Brazil, describing the supply, demand, and variations in different age groups, evaluating 98 mammography services as observational units. We estimated the mammogram rates by age group and type of health service, as well as the number of tests required to cover 70% and 100% of the target population. We assessed the association between mammograms, geographical distribution of mammography machines, type of service, and age group. Full coverage estimates, considering 100% of women in the 40-69 and 50-69-year age brackets, were 61% and 66%, of which the Brazilian Unified National Health System provided 13% and 14%, respectively. To achieve 70% coverage, 43,424 additional mammograms would be needed. All the associations showed statistically significant differences (p < 0.001). We conclude that mammogram coverage is unevenly distributed in the State of Goiás and that fewer tests are performed than required.

Contribution of the Unified Health Care System to mammography screening in Brazil, 2013 / Contribuição do Sistema Único de Saúde no rastreamento mamográfico no Brasil, 2013

Abstract Objective: To estimate the coverage of opportunistic mammography screening performed via the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System), at the state and regional level, in 2013. Materials and Methods: This was an ecological study in which coverage was estimated by determining the ratio between the number of mammograms performed and the expected number of mammograms among the population of females between 50 and 69 years of age. The number of mammograms performed in the target population was obtained from the Outpatient Database of the Information Technology Department of the SUS. To calculate the expected number of mammograms, we considered 58.9% of the target population, the proportion that would be expected on the basis of the recommendations of the Brazilian National Cancer Institute. Results: In 2013, the estimated national coverage of mammography screening via the SUS was 24.8%. The mammography rate ranged from 12.0% in the northern region to 31.3% in the southern region. When stratified by state, coverage was lowest in the state of Pará and highest in the state of Santa Catarina (7.5% and 35.7%, respectively). Conclusion: The coverage of mammography screening performed via the SUS is low. There is a significant disparity among the Brazilian states (including the Federal District of Brasília) and among regions, being higher in the south/southeast and lower in the north/northeast.

Resumo Objetivo: Estimar a cobertura mamográfica em rastreamento oportunista realizado pelo Sistema Único de Saúde (SUS) no Brasil, nas suas regiões e nas Unidades da Federação, no ano de 2013. Materiais e Métodos: Estudo ecológico, em que a estimativa da cobertura foi a proporção entre o número de exames realizados e o número de exames esperados na população feminina na faixa etária de 50 a 69 anos. O número de exames realizados refere-se aos dados da produção mamográfica da população alvo, disponíveis no Sistema de Informações Ambulatoriais do Departamento de Informática do SUS. Para o cálculo do número de exames esperados considerou-se 58,9% da população alvo, tendo em vista as recomendações do Instituto Nacional de Câncer. Resultados: A estimativa da cobertura mamográfica no rastreamento realizado pelo SUS no Brasil, em 2013, foi 24,8%. A prevalência de mamografias variou de 12,0% na Região Norte a 31,3% na Região Sul. Ao estratificar por Unidades da Federação, a menor cobertura foi no Pará (7,5%) e a maior cobertura foi em Santa Catarina (35,7%). Conclusão: A cobertura mamográfica do SUS no Brasil é baixa. Existe uma desigualdade significativa entre as Unidades da Federação, sendo maior nas regiões Sul e Sudeste e menor nas regiões Norte e Nordeste do país.

(14)C, delta(13)C and total C content in soils around a Brazilian PWR nuclear power plant.

Nuclear power plants release (14)C during routine operation mainly as airborne gaseous effluents. Because of the long half-life (5730 years) and biological importance of this radionuclide (it is incorporated in plant tissue by photosynthesis), several countries have monitoring programs in order to quantify and control these emissions. This paper compares the activity of (14)C in soils taken within 1km from a Brazilian nuclear power plant with soils taken within a reference area located 50km away from the reactor site. Analyses of total carbon, delta(13)C and (137)Cs were also performed in order to understand the local soil dynamics. Except for one of the profiles, the isotopic composition of soil organic carbon reflected the actual forest vegetation present in both areas. The (137)Cs data show that the soils from the base of hills are probably allocthonous. The (14)C measurements showed that there is no accumulation due to the operation of the nuclear facility, although excess (14)C was found in the litter taken in the area close to power plant. This indicates that the anthropogenic signal observed in the litter fall has not been transferred yet to the soil. This study is part of an extensive research programme in which other samples including air, vegetation and gaseous effluents (taken in the vent stack of the Brazilian nuclear power reactors Angra I and II) were also analyzed. The present paper aimed to evaluate how (14)C emissions from the nuclear power plant are transferred and stored by soils present in the surroundings of the reactor site. This is the first study concerning anthropogenic (14)C in soils in Brazil.