Feasibility and Colonoscopy Yield Using the Fecal Immunochemical Test (FIT)-Based Colorectal Cancer Screening in a Latin America Country.

BACKGROUND & AIMS: Organized colorectal cancer (CRC) screening is not widely practiced in Latin America and the results of regional studies may help overcome barriers for implementation of national screening programs. We aimed to describe the implementation and findings of a fecal immunochemical test (FIT)-based program in Brazil. METHODS: In a prospective population-based study, asymptomatic individuals (50-75 years old) from Sao Paulo city were invited to undergo FIT for CRC screening. Participants with positive FIT (≥10 µg Hb/g feces) were referred for colonoscopy. Subjects were classified into groups according to the presence of CRC, precursor lesions, and other benign findings, possibly related to bleeding. RESULTS: Of a total of 9881 subjects, 7.8% had positive FIT and colonoscopy compliance was 68.9% (n = 535). Boston scale was considered adequate in 99% and cecal intubation rate was 99.4%. CRC was diagnosed in 5.9% of the cases, adenoma in 63.2%, advanced adenoma in 31.4%, and advanced neoplasia in 33.0%. Age was positively associated with CRC (P = .03). Higher FIT concentrations were associated with increased detection of CRC (P < .008), advanced adenoma (P < .001), and advanced neoplasia (P < .001). CONCLUSIONS: Implementation of a FIT-based CRC screening program was feasible in a low-resource setting, and there was a high yield for neoplasia in individuals with a positive FIT. This approach could be used as a model to plan and disseminate organized CRC screening more broadly in Brazil and Latin America.

High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, São Paulo, Brazil.

Every year there are approximately 16,000 new cases of cervical cancer in Brazil. Novel screening technologies may reduce this number by expanding the population coverage but also by improving the detection rate of precursor lesions. We aimed to evaluate human papillomaviruses (HPV)-DNA testing in the context of routine cervical cancer screening in the public health system of the city of São Paulo, Brazil. Women participating in the primary screening program were invited to enroll. Liquid-based cytology samples were collected and cytology and Hr-HPV DNA testing were performed in parallel. Cytologists were blind to HPV results. Women older than 24 years with a positive high-risk HPV test and/or cytology class ≥ ASC-US were referred to colposcopy. From December 2014 to December 2016, 16,102 women joined the study. High-risk human papillomavirus (HR HPV) DNA prevalence was 14.9%, whereas cytologic abnormalities were found in 7.2% of the women. Per protocol, 1,592 Hr-HPV+ women, in addition to 72 patients with cytologic classification > low-grade squamous intraepithelial lesion (LSIL) were referred. A total of 80 cervical intraepithelial neoplasia (CIN2+) cases were diagnosed, 79 were Hr-HPV DNA+ and 18 had normal cytology. Hr-HPV DNA detected a significant number of patients with premalignant lesions missed by cytology and all 16 CIN3+ cases were Hr-HPV DNA+ HPV genotyping may be useful in the management of Hr-HPV+ women, reducing the burden of colposcopic referral for those harboring genotypes with a weaker association to CIN3+ Use of HPV-DNA testing was shown to be feasible and advantageous over current cytologic screening in the public health system.

Penetração da perspectiva de gênero e análise crítica do desenvolvimento do conceito na produção científica da Saúde Coletiva / Penetration of the gender perspective and critical analysis on the development of this concept within scientific production on public health / La penetración de la perspectiva de género y análisis crítico de la evolución del concepto en la producción científica en Salud Pública

Estudou-se a produção científica brasileira baseada em gênero na Saúde Coletiva, entre 1990-2008. Um total de 1.343 resumos de trabalhos de congressos e 251 artigos publicados foi examinado segundo: distribuição temporal, autoria, abordagem metodológica, áreas de conhecimento e temáticas abordadas. Os artigos foram também analisados quanto à coerência epistemológica entre a intenção e o uso efetivo de gênero ao longo do estudo e quanto à consistência metodológica de aplicação do conceito em termos do sentido completo ou parcial dado a gênero de acordo com sua construção teórica. Resultados mostraram que, embora com penetração crescente, 25,1 por cento dos estudos reduzem gênero a sexo, uso considerado não coerente; 37,8 por cento possuem uso coerente de gênero, mas lhe atribuíram um sentido parcial, e apenas 37,1 por cento deram-lhe o sentido completo. Conclui-se que gênero tem importante presença no campo, mas é trabalhado de modo pouco preciso metodologicamente e inferior a seu potencial analítico.

Gender-based scientific production within public health from 1990 to 2008 was studied. A total of 1343 congress abstracts and 251 published articles was examined regarding their distribution in time, authorship, methodological approach, fields of knowledge and topics covered. The articles were also analyzed regarding epistemological coherence between the intention to use gender and actually doing so over the study, and regarding methodological consistency in applying the concept in terms of complete or partial meaning given to gender in accordance with its theoretical construction. The results showed that, despite its increasing penetration, 25.1 percent of the studies reduced gender to sex, what was considered to be non-coherent use; 37.8 percent had coherent gender use but gave it partial meaning; and only 37.1 percent gave it the complete meaning. In conclusion, gender has an important presence within the field, but is worked up in a methodologically imprecise manner that is lower than its analytical potential.

Se estudia la producción científica brasileña basada en género en Salud Colectiva entre 1990-2008. Un total de 1.343 resúmenes de conferencias y 251 artículos publicados fueron examinados según distribución temporal, autoría, enfoque metodológico, áreas de conocimiento y temas planteados. Los artículos fueron también analizados por la coherencia epistemológica entre la intención y el uso real de género en el estudio de la coherencia y la aplicación metodológica del concepto en términos de sentido total o parcial dado a género por su construcción teórica. Los resultados muestran que, aun que com la penetración cada vez mayor, 25,1 por ciento de los estudios de género se reducen a sexo, un uso considerado no coherente, 37,8 por ciento tienen uso coherente de género, pero con sentido parcial, y sólo 37,1 por ciento ledierón sentido completo. Se concluye que el género tiene una presencia significativa enel campo, pero su utilización es poco precisa metodológicamente y abajo de su potencial analítico.

Metodologia de avaliaçäo do trabalho na atençäo primária à saúde / Methodology for assessment of activities in primary health care

Realiza-se um estudo de caso, no qual se analisa o processo de avaliaçäo de açöes assistenciais em uma unidade básica de saúde, no sentido de contribuir para o desenvolvimento de metodologias de avaliaçäo do trabalho assistencial e de proposiçäo de categorias orientadoras desses processos de avaliaçäo, tendo como base o processo de trabalho. Foi desenvolvido no Centro de Saúde Escola da Faculdade de Medicina da Universidade de Säo Paulo, tomando como seu material empírico as avaliaçöes das açöes assistenciais dirigidas ao pronto-atendimento e ao atendimento programático de pacientes crônicos (hipertensos e diabéticos). A análise dessas avaliaçöes, que apreenderam diferentes momentos constituintes do processo de trabalho (objetos do trabalho, atuaçäo dos agentes, análise dos meios de trabalho, produto do trabalho), sugerem a necessidade da elaboraçäo de categorias analíticas que operacionalizem a apreensäo desse processo, articulando cada momento à sua totalidade. As categorias analíticas propostas säo: 1) operacionalidade, como medida da efetivaçäo das açöes propostas; 2) efetividade estratégica, como medida do alcance dos resultados apreensíveis nos usuários e/ou na populaçäo, atribuuíveis às açöes realizadas.