Breast Cancer Stage at Diagnosis in a Nigerian Hospital: Trend over a Decade.

BACKGROUND: Breast cancer outcomes are poor in Nigeria, partly due to late-stage diagnosis. To assess the impact of past and present interventions, a review of an institutional data base was performed to determine the trend with respect to stage at diagnosis over a decade. METHODS: A retrospective analysis of an institutional data base was performed over a decade. The review period was divided into segments (2013-2015, 2016-2018 and 2019-2022). The latter period (2019-2022), corresponds to a time of more intense community interventions aimed at promoting early diagnosis and treatment around the locality of the teaching hospital. The stage at diagnosis within these periods were compared. The relationship between stage and sociodemographic variables (age, religion, marital status, menopausal status, and level of education) was assessed. RESULTS: There were 910 patients, 144 within the first period (2013-2015), 318 in the second (2016-2018) and 454 in the third period (2019-2022). The majority presented with stage 3 disease (73.8%). There was a significant decline in the proportion of metastatic cases and a concomitant increase in early cases in the latter part of the review. The proportion of metastatic cases reduced from 23.6% (2013-2015), to 15.7% (2016-2018) and 9.3% (2019-2022) (p=0.001). Level of education was significantly associated with stage (p=0.001). CONCLUSION: This study shows a trend towards downstaging of breast cancer in our locality. This trend corresponds to the period of more intense community interventions, justifying the need to further interrogate the direct impact of each of the interventions. This will provide a firm basis for sustaining or improving on current efforts to achieve more robust gains.

CONTEXTE: Les résultats du cancer du sein sont médiocres au Nigeria, en partie en raison d'un diagnostic tardif. Pour évaluer l'impact des interventions passées et actuelles, une revue d'une base de données institutionnelle a été réalisée pour déterminer la tendance en ce qui concerne le stade au moment du diagnostic sur une décennie. MÉTHODES: Une analyse rétrospective d'une base de données institutionnelle a été effectuée sur une décennie. La période de revue a été divisée en segments (2013-2015, 2016-2018 et 2019-2022). La dernière période (2019-2022) correspond à une période d'interventions communautaires plus intensives visant à promouvoir un diagnostic précoce et un traitement autour de la localité de l'hôpital universitaire. Les stades au moment du diagnostic au cours de ces périodes ont été comparés. La relation entre le stade et les variables sociodémographiques (âge, religion, état matrimonial, statut ménopausique et niveau d'éducation) a été évaluée. RÉSULTATS: Il y avait 910 patients, 144 dans la première période (2013-2015), 318 dans la deuxième (2016-2018) et 454 dans la troisième période (2019-2022). La majorité présentait une maladie de stade 3 (73,8 %). On a observé une diminution significative de la proportion de cas métastatiques et une augmentation concomitante des cas précoces dans la dernière partie de la revue. La proportion de cas métastatiques est passée de 23,6 % (2013-2015) à 15,7 % (2016- 2018) et 9,3 % (2019-2022) (p=0,001). Le niveau d'éducation était significativement associé au stade (p=0,001). CONCLUSION: Cette étude montre une tendance à la réduction du stade du cancer du sein dans notre localité. Cette tendance correspond à la période d'interventions communautaires plus intenses, justifiant la nécessité d'interroger davantage l'impact direct de chacune des interventions. Cela fournira une base solide pour soutenir ou améliorer les efforts actuels afin d'obtenir des gains plus robustes. Mots-clés: Sein, Cancer, Stade, Nigéria.

Extensión universitaria y universidad médica cubana revolucionaria: impacto de una reforma / University extension and cuban revolutionary medical university: a reforms´ impact

El movimiento de la Reforma Universitaria de Córdoba en Argentina, a un siglo de su proclamación, constituye un referente obligado al abordar el tema de la función y proyección social de las Universidades y en especial la cubana. El propósito del presente trabajo es realizar un análisis crítico del significado, trascendencia y vigencia del mismo en el contexto de la Universidad cubana contemporánea, con énfasis en el proceso de Extensión Universitaria en la Educación Médica cubana revolucionaria. Se realizó una exhaustiva revisión bibliográfica y documental, con énfasis en el análisis de artículos y documentos sobre el tema en cuestión a partir del uso del método histórico-lógico, el cual permitió discurrir entre los hitos fundamentales del devenir histórico de dicho proceso reformista. La autora considera que este movimiento posee una connotación especial en el contexto que se refiere, el cual marcó cambios esenciales en los aspectos teórico-conceptuales, prácticos y de valores en la formación de los profesionales de la salud cubanos a partir del modelo de formación, así como la proyección social y humanística que caracterizó la etapa revolucionaria, por lo que amerita significar en el devenir histórico sus aportes como un digno homenaje en su centenario (AU).

The movement of the Cordova University Reform in Argentina, after a century of its proclamation, is an unavoidable reference when approaching the theme of the function and social projection of the Universities, specially the Cuban one. The purpose of the current work is carrying out a critical analysis of that movement's significance, transcendence and force in the context of Cuban contemporary university, emphasizing in the university extension process in the Cuban revolutionary medical education. An exhaustive bibliographic and documental review on the treated theme was carried out using the historical-logical method that allowed discussing the main landmarks of the historical development of that reforming process. The author considers that movement has an special connotation in the referred context, which led to essential changes in theoretical-conceptual, practical and values training of Cuban health professionals, beginning with the training model, and also the social and humanistic projection characterizing the revolutionary period; therefore, it deserves explaining the meaning of its contributions in the historical development as a worthy homage in its centenary (AU).

"Learning, Education, Awareness, Prevention (L.E.A.P.) Young Adult Cancer": An Education and Outreach Program.

Delayed diagnosis due to lack of education may contribute to lack of improvement in adolescent and young adult (AYA) cancer survival. This program sought to educate trainees and AYAs in the community. The "Learning, Education, Awareness, Prevention (L.E.A.P) Young Adult Cancer" outreach program was developed to teach the most common AYA cancers, signs and symptoms associated with them, and prevention. A total of 150 trainees were educated and presented to 1000 high school students in Columbus. Pre- and post-testing demonstrated increases in AYA cancer knowledge of both groups. Empowering medical professionals with AYA knowledge early in their learning may impact the way they examine and educate patients throughout their medical career.

Community-Informed Health Promotion to Improve Health Behaviors in Honduras.

BACKGROUND: Honduras is the second poorest country in Central America. The already high burden of disease is disproportionately worse among individuals with less education and limited access to health care. Community engagement is needed to bridge the gap in health care resources with the need for health promotion and education. Culturally relevant health promotion activities can foster transcultural partnerships. PURPOSE: The purpose of this study was to partner nursing students with village leaders to assess a community's health needs and implement health promotion activities in Honduras. DESIGN: Participatory action research was used in the study. METHOD: U.S. nursing students ( n = 4) partnered with a nonprofit organization and community partners in Villa Soleada to interview mothers in Villa Soleada, a Honduran village of 44 families, and implement health promotion activities targeted to the health priorities of their families. RESULTS: Structured interviews with 24 mothers identified gastrointestinal issues, health care access and quality, and malaria as the top three priorities. Ninety-two percent of respondents were interested in nurse-led health promotion. Activities engaged new community partners. DISCUSSION: This partnership and learning model was well received and sustainable. The U.S. nurses involved in the partnership gained exposure to Honduran health issues and led locally tailored health promotions in Villa Soleada. The community's response to health promotion were positive and future activities were planned. IMPLICATIONS: Nursing student's immersion experiences to support population-based health activities in low-resource settings are a replicable model that can help build healthier communities with a sustainable local infrastructure. Transcultural nursing experiences enhance students' perspectives, increase personal and professional development, strengthen nursing students' critical thinking skills, and for some students, confirm their desire to practice in an international arena.

Sobre a história viva do Instituto de Medicina Social / On the living history of the Institute of Social Medicine

Fruto de uma pesquisa de corpo no Instituto de Medicina Social, esta tese trata de uma performance analítica sobre a trajetória daquela instituição. Está expressada nela o cotidiano institucional, o passado e o futuro que o atravessam e que pude colecionar. Tem como "base empírica" a experiência de um corpo em contato com memórias e imagens performadas. Um corpo que teve acesso à história viva de uma comunidade afetiva. Sendo uma performance composta por diferentes performances, aposta na fusão de formas literárias como possibilidade de permitir o acesso a quem a lê àquele cotidiano institucional. Ao longo dela, estão registros produzidos por um corpo que é produto daquele espaço e tempo, daquele coletivo, e o produz. A tese tem duas aberturas e pode ter os capítulos lidos na ordem corrente das folhas ou no inverso. Para quem parte da abertura, que é a introdução, será apresentado ao Instituto através de uma visitante misteriosa, a mulher. Após a ambientação física e cotidiana, há um capítulo que é de ambientação à tese e às perspectivas ético-política-epistemológica-estéticas do corpo que a produz. A seguir, um capítulo sobre as imagens perseguidas nas cinco décadas de instituição, os sonhos diurnos que a construíram. A esse, segue o capítulo de integração desta performance analítica, que tem a ambivalência como elemento estruturante. Silvia Cusicanqui, nele, nos oferece categorias para ler o mundo de outra maneira. Sobre o mote da ambivalência, o capítulo seguinte trata do elemento pertencido que decide confrontar o elemento estranho ao Instituto; o corpo no qual se produz o confronto, tenta traduzi-lo na forma de uma auto entrevista. O último capítulo é de encerramento que pode ser abertura, para quem vier na ordem inversa dos capítulos. Aqueles que a lerem, encontrarão afetos, ambivalência, desejo, imagens, performances, espaço e tempo produzidos e produtores, corpos e coletivos em movimento. Encontrarão algo sobre a história viva do Instituto de Medicina Social

As a result of a body research conducted at the Institute of Social Medicine, this thesis delves into the analytical performance of the Institute's own trajectory. It encompasses the daily life of the Institute, its past and future, and whatever else that I was able to assemble. Its "empirical base" is the experience of a body in touch with memories and performed images. A body that had access to the living history of an affective community. Being the performance an ensemble of different performances, it gambles on the fusion of literary forms as a mean to enable the access to those who reads the Institution's daily life. Throughout this performance, there are records by a body that is the very product and also the producer of that space and time and the collectiveness as well. This thesis has two starting points: it can either be read following the natural flow of its chapters or in reverse. For those who wish to start from the opening, which is the introduction, will be presented to the Institute by a mysterious visitor, the woman. Following the backdrop of the physical and daily settings, there is a chapter that corresponds to the general ambiance of the thesis, contextualising the ethical-political-epistemological-aesthetic perspectives of the body that produces it. The following chapter is around the images that were persecuted during the five decades of the Institution and the daydream that constructed and keep on constructing it. This is followed by the subsequent chapter concerning the integration of this analytic performance, which has ambivalence as its core structural element. In this section, Silvia Cusicanqui presents categories to support reading the world in another way. Under the same ambivalent premise, the succeeding chapter deals with the very element that confronts the alien one to the Institute; the body in which the confrontation takes place tries to translate it into the form of a self-interview. The last chapter is of closure, but also of opening for those who began reading backwards from the last chapter. Those who read this research will find affections, ambivalence, desire, images, performances, space and time produced and producers, bodies and the collectiveness in motion. One will find something about the very living history of the Institute of Social Medicine

Implementation of the Street Outreach Office in the perspective of health care / La implantación del Consultorio en la Calle en la perspectiva del cuidado en salud / A implantação do Consultório na Rua na perspectiva do cuidado em saúde

ABSTRACT Objective: To report the experience of implementation of a clinical equipment of health care production to homeless people, denominated Street Outreach Office. Method: Experience report in the city of Rio de Janeiro, Brazil. Results: The Street Outreach Office implementation resulted from a demand for health care practices for homeless people. This implementation had intersectoral articulations, causing health professionals to carry out street care practices, which led them to strive for public policies, to rethink their actions in order to increase the resolution of care to this population. Conclusion: We should emphasize the importance of health professionals to reinvent their practices, daily, seeking partnerships and acquisition of new knowledge in order to achieve results that can reduce the demands of these individuals throughout their life routes.

RESUMEN Objetivo: Informar la experiencia de la implantación de un equipo clínico de producción de cuidado en salud a la población en situación de calle, denominado Consultorio en la Calle. Método: Relato de experiencia ocurrido en el municipio del Rio de Janeiro, Brasil. Resultado: La implantación del Consultorio en la Calle partió de una demanda de prácticas de cuidado en salud para personas en situación de calle que se encontraban abrigadas. Esta implantación contó con articulaciones intersectoriales, haciendo que los profesionales de salud, en la realización de prácticas de cuidado a la población en situación de calle, hecho que los llevan a anhelar por políticas públicas, repensaran sus acciones para que amplían la resolutividad de la asistencia a esa población. Conclusión: Se destaca la importancia de los profesionales de la salud reinventaren sus prácticas, cotidianamente, buscando alianzas y la adquisición de nuevos saberes a fin de lograr resultados que puedan minimizar las demandas de estos individuos a lo largo de sus trayectorias de vida.

RESUMO Objetivo: Relatar a experiência da implantação de um equipamento clínico de produção de cuidado em saúde à População em Situação de Rua, denominado Consultório na Rua. Método: Relato de experiência ocorrido no município do Rio de Janeiro, Brasil. Resultado: A implantação do Consultório na Rua partiu de uma demanda de práticas de cuidado em saúde para pessoas em situação de rua que se encontravam desabrigadas. Esta implantação contou com articulações intersetoriais, fazendo com que os profissionais de saúde, na realização de práticas de cuidado à População em Situação de Rua, fato que os levam a almejar por políticas públicas, repensassem suas ações para que ampliassem a resolutividade da assistência a essa população. Conclusão: Salienta-se a importância dos profissionais de saúde reinventar suas práticas, cotidianamente, buscando parcerias e aquisição de novos saberes a fim de lograrem resultados que possam minimizar as demandas destes indivíduos ao longo de suas trajetórias de vida.

"Community projects" in Modena (Italy): promote regular physical activity and healthy nutrition habits since childhood.

Lack of exercise and unhealthy diets are two of the most important risk factors to develop overweight, obesity and other chronic diseases. The school plays a key role in the promotion of lifelong healthy habits in children and their families. Every intervention at school level will need to be matched by changes in the social and cultural context so that the benefits can be sustained and enhanced in the community. We promoted healthy nutrition and a regular physical activity in schools and in local communities, through multifaceted interventions, which involved more than 10,000 children and about 100,000 adults.

Regular provision of outreach increases acceptance of cataract surgery in South India.

OBJECTIVES: The prevalence of visual loss and blindness from cataract remains high in India. Marginalized communities are frequently reached through outreach clinics. The aim of this study was to explore the hypothesis that regular outreach, held in the same location by the same provider, leads to greater acceptance of cataract surgery than outreach clinics that are irregular in terms of timing and location. METHODS: The study was integrated into outreach clinics run in two districts by Sankara Eye Centre, Coimbatore, Southern India. A semi-structured questionnaire was administered to patients who had attended outreach eye clinics and either accepted or not accepted the offer of cataract surgery. RESULTS: Overall acceptance of surgery was high (91.7%), being higher in the district with regular outreach (94.6%vs. 82.3%, P < 0.001). A total of 398 participants (240, 60% acceptors) were interviewed. Acceptors were more likely to live in smaller households and in supportive families than non-acceptors who lived in larger families which could not provide support and where transport and distance were also barriers (P .001). Attending regular outreach and having had first eye cataract surgery were independent predictors of acceptance in a logistic regression model. CONCLUSION: The findings indicate the importance of providers building trust by organizing regular outreach in the same location. Previous eye surgery was also a strong predictor of accepting cataract surgery. To promote universal access to health care, marginalized rural communities will continue to need outreach for some time to come.

Extensão comunitária: um caminho para a formação médica / Communitarian extension: a path for medical formation

O artigo objetiva relatar a experiência do projeto Parceiro Sanitário desenvolvida pela Universidade doPlanalto Catarinense (UNIPLAC), Lages SC, tendo por base uma extensão comunitária. Tal processo envolve aconstrução coletiva do enfrentamento de questões relacionadas à saúde da população, estimulando a formaçãode parcerias institucionais, favorecendo o controle social através da participação da população no planejamentoe execução de ações relacionadas à saúde e a medicina comunitária.

Relating counselor attributes to client engagement in England.

Client functioning and treatment engagement were examined in relation to staff attributes and organizational climate across a diverse sample of drug treatment and outreach programs in England. Self-rating assessments were obtained from 1,539 clients and 439 counselors representing 44 programs, and results were interpreted using comparable data from studies of treatment programs in the United States. Client scores on treatment participation and counseling rapport in England were directly related to their higher levels of motivation and psychosocial functioning, as well as to staff ratings of professional attributes and program atmosphere. By linking records from English clients with their counselors in each program, findings also indicate these relationships are rooted in the personal interactions between clients and their counselor. Standardized assessments of treatment structure, process, and performance used across therapeutic settings and national boundaries show there is generalizability in the pattern of clinical dynamics, including the relationships between organizational functioning and quality of services.

Saúde mental, mudança social e discurso bioético: uma face da desinstitucionalização revelada em uma notícia de jornal / Mental health, social change and bioethical discourse: a view of deinstitutionalization revealed in a newspaper

Na contemporaneidade, desafios e dilemas bioéticos em saúde mental estão exigindo estudos e reflexões. Este trabalho pretende contribuir com a discussão sobre a atual política de saúde mental, especialmente a questão da reinserção social de portadores de transtornos mentais. É importante que essa construção na comunidade e na cultura avance em sintonia com uma "rede" de saúde mental que possa responder por essa assistência e, assim, afrontar o risco de uma mera desospitalização irresponsável, pois, caso contrário, estaremos diante de um quadro de desassistência. Por acreditar que o discurso jornalístico possibilita uma compreensão mais abrangente de certos aspectos acerca dos significados, recursos e práticas que vêm sendo utilizadas no cotidiano, propõe-se aqui analisar um texto jornalístico, tendo como referencial a Análise do Discurso Crítico que, juntamente com os conceitos bioéticos, permitirá o entendimento da forma pela qual esse processo vem ocorrendo.

Nowadays, challenges and bioethical dilemmas in mental health are demanding studies and reflections. This paper aims to contribute to the discussion on the current mental health policy, especially the issue of social reintegration of people with mental disorders. It is important that this construction in community and culture go in line with a mental health "network" able to account for such assistance and thus face the risk of a mere irresponsible dehospitalization; otherwise, we will face a situation of lack of assistance. Believing that media discourse provides a more comprehensive understanding of certain aspects about the meanings, practices and resources that have been used in everyday life, it is proposed here to analyze a journalistic text, taking in consideration the Critical Discourse Analysis which, together with the bioethical concepts, would allow the understanding of the way in which this process is occurring.

The promise of outreach for engaging and retaining out-of-care persons in HIV medical care.

From the beginning of the HIV/AIDS epidemic, outreach workers have been on the frontlines of HIV prevention, working in community venues to increase knowledge and promote behaviors to reduce HIV transmission. As demographics of the HIV-infected population have changed, the need has grown to locate out-of-care individuals and learn how to engage and retain them in HIV care. Through the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Outreach Initiative, 10 sites across the United States implemented and evaluated enhanced outreach models designed to increase engagement and retention in HIV care for underserved, disadvantaged HIV-infected individuals. Although the models differed in response to local needs and organizational characteristics, all made use of a common conceptual framework, and all used the same data collection and reporting protocols. Study teams enrolled and provided behavioral interventions to HIV-infected individuals who have been noticeably absent from research and from practice. Their interventions incorporated coaching, skills-building, and education, and were successful in reducing or removing structural, financial, and personal/cultural barriers that interfered with equitable access to HIV care. Desired outcomes of increased engagement and retention in HIV health care were achieved. Results demonstrate that interventions to promote equitable access to HIV care for disadvantaged population groups can be built from outreach models. Qualitative and quantitative analysis of the multisite data indicates that further development and evaluation of outreach-based interventions will result in effective tools for reaching HIV-infected individuals who would otherwise remain without needed care.

Mitigación de la pobreza: el desarrollo de la comunidad como estrategia / Mitigation of the poverty: the development of the community as strategy

Trata de uno de los temas mas acusiantes en nuestro país actualmente, la pobreza, y desarrolla una estrategia de intervención a fin de ir mitigándola gradualmente. Gran parte de la población paraguaya está sumida en la pobreza, un elevado porcentaje (17%) en la pobreza extrema o absoluta, urge, definir una estrategia de intervención en la realidad nacional, donde se cosidere en primer lugar la participación activa, deliberada y consciente de este segmento tan importante y olvidado de lapoblación el proceso de desarrrollo del país.

J. H. Louw Memorial Lecture. Outreach, origins and a hedgehog.

Professor J. H. Louw is honoured in this lecture for the major contribution he made to the development of paediatric surgery in South Africa as a specialty in its own right. Although he is perhaps best known internationally for his contribution to our understanding of the aetiology of small-bowel atresias, it may be that his greatest legacy lies in those he taught, many of whom are in the audience. He was a man who demanded the highest standards, both of himself and of his colleagues, and despite many other leadership roles and responsibilities in surgery generally, always considered that his first responsibility was to paediatric surgery. It may be fitting, therefore, that this lecture deals with two aspects that were dear to Professor Louw, namely the provision of specialist care for children with surgical conditions, and recent research into the causes of congenital structural abnormalities.

Organización y movilización comunitaria / Desarrollo Comunitario / Organization and community mobilization

El desarrollo comunitario está dedicado a asegurar la sustentabilidad de los servicios de agua y saneamiento a través de un proceso de capacitación en administración, operación y mantenimiento: educación sanitaria y ambiental para lograr el uso efectivo de los servicios; establecer un sistema de apoyo técnico a largo plazo en base al fortalecimiento de los municipios y organizaciones comunales