Origen y evolución del control de salud / Origin and evolution of periodic health check-ups

Los controles periódicos de salud son aquellos cuidados médicos realizados a intervalos regulares, motivados por la necesidad de evaluar la salud en general y prevenir enfermedades a futuro. Se presume que comenzaron a ponerse en práctica durante el siglo XIX para la detección precoz de la tuberculosis y otras enfermedades contagiosas. A principios del siglo XX fueron difundidos los programas de examinación médica en el contexto de la estimación del riesgo de enfermedad y/o muerte previo a la contratación de seguros de vida. El desarrollo tecnológico posterior a la Segunda Guerra mundial fomentó el interés en estas examinaciones periódicas con la implementación de pruebas masivas de rastreo, lo que aumentó de manera considerable de la mano de los servicios de medicina prepaga. En los últimos años se han realizado múltiples esfuerzos por cuantificar los beneficios de estos controles. Si bien existen diversas opiniones respecto a su utilidad, pareciera ser que el enfoque actual del control periódico de salud implica tener en cuenta las necesidades de las personas, el riesgo individual y la relación médico-paciente como eje de la discusión. (AU)

Periodic health check-ups are medical care performed at regular intervals, motivated by the need to assess general health and prevent future diseases. It is presumed that they began to be implemented in the 19thcentury for the early detection of tuberculosis and other contagious diseases, and later spread in the early 20thcentury in the context of estimating the risk of illness and/or death prior to taking out life insurance. The technological development after the World War II encouraged interest in these periodic examinations with the implementation of mass screening tests, which increased considerably with the introductionof prepaid medical services. In recent years, multiple efforts have been made to quantify the benefits of such controls. While there are varying opinionsas to their usefulness, it appears that the current approach to periodic health check-ups is to take into account the needs of individuals, their individual risk, and the doctor-patient relationship at the core of the discussion. (AU)

Factors associated with delay in seeking care by tuberculosis patients / Factores asociados a demoras en la búsqueda de atención del enfermo de tuberculosis / Fatores associados ao atraso na procura por atendimento pelo doente de tuberculose

ABSTRACT Objective: To identify social, clinical and behavioral factors of tuberculosis patients that are associated with delay in the search for primary health care. Method: This is a cross-sectional, quantitative study conducted with 56 people on treatment for pulmonary tuberculosis in the city of Natal, in the state of Rio Grande do Norte, Brazil. The data were collected through a structured instrument. The Chi-square and Fisher tests were applied to test the association between independent and dependent variables (search time). A value of p <0.05 was set as statistically significant. Results: No social or clinical variables were statistically associated with patient delays in the search for primary health care. Among the behavioral variables, self-medication and the first health service sought had a statistically significant association with the time for seeking care (p = 0.020, and p = 0.033, respectively). Conclusion: Self-medication contributes to the delay in the search for primary health care by tuberculosis patients.

RESUMEN Objetivo: Identificar factores sociales, clínicos y conductuales de enfermos de tuberculosis, asociados a la demora por buscar la primera atención de salud. Método: Estudio transversal, cuantitativo, realizado con 56 personas en tratamiento de tuberculosis pulmonar, en Natal/RN, Brasil. Datos recolectados mediante instrumento estructurado. Se aplicaron los tests de Chi-cuadrado y de Fisher para probar la asociación entre las variables dependientes e independientes (tiempo de búsqueda). Se estableció un valor de p < 0,05 como estadísticamente significativo. Resultados: Ninguna variable social o clínica mostró asociación estadística a la demora del enfermo en la búsqueda de la primera atención de salud. Entre las variables conductuales, la automedicación y el primer servicio de salud buscado presentaron asociación estadísticamente significativa con el tiempo de búsqueda (p = 0,020 y p = 0,033, respectivamente). Conclusión: La automedicación contribuye a la demora en la búsqueda de la primera atención de salud en el enfermo de tuberculosis.

RESUMO Objetivo: Identificar fatores sociais, clínicos e comportamentais dos doentes de tuberculose que estejam associados ao atraso na procura pelo primeiro atendimento à saúde. Método: Estudo transversal, quantitativo, conduzido com 56 pessoas em tratamento da tuberculose pulmonar em Natal/RN, Brasil. Os dados foram coletados por meio de instrumento estruturado. Aplicaram-se os testes de Qui-quadrado e Fisher para testar a associação entre as variáveis independentes e dependentes (tempo de procura). Fixou-se valor de p < 0,05 como estatisticamente significativo. Resultados: Nenhuma variável social ou clínica se mostrou estatisticamente associada ao atraso do doente na procura pelo primeiro serviço de saúde. Dentre as variáveis comportamentais, a automedicação e o primeiro serviço de saúde procurado apresentaram associação estatística significativa com o tempo de procura (p = 0,020 e p = 0,033, respectivamente). Conclusão: A automedicação contribui para o atraso na procura pelo primeiro atendimento à saúde pelo doente de tuberculose.

Rastreamento e diagnóstico do câncer de ovário / Screening and diagnosis of ovarian cancer

O câncer de ovário apresenta a maior taxa de mortalidade entre as neoplasias ginecológicas, sendo a maioria dos casos diagnosticados em estágio avançado. O diagnóstico precoce é passo fundamental no manejo e controle da doença. No entanto, estratégias de rastreamento populacional não têm se mostrado efetivas para a redução de mortalidade. O rastreamento em população de alto risco (história familiar), por outro lado, é recomendado por comitês especializados. A associação entre a dosagem sérica de CA 125 e a US transvaginal, feita de forma periódica e sequencial, é o método mais utilizado em programas de rastreamento.

Ovarian cancer has the highest mortality rate among gynecological neoplasias, most of the cases being diagnosed at advanced stage. Early diagnosis is crucial for management and control of the disease. Population screening strategies, however, have not been effective in reducing mortality. On the other hand, the screening in high risk populations (family history) is recommended by expert committees. The combination of serum CA 125 measurement and transvaginal ultrasound, performed in periodical and sequential fashion, is the most common method used in screening programs.

Socioeconomic Disparities in Breast Cancer Screening among US Women: Trends from 2000 to 2005 / 예방의학회지

OBJECTIVES: This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. RESULTS: Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. CONCLUSIONS: These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. ontinued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.

Trends in the uptake of antenatal voluntary counselling and testing for HIV and HIV prevalence among childbearing women in Barbados, 1993-2004: evidence to gauge the effectiveness of HIV prevention measures / Tendencias en el interés por el asesoramiento y prueba voluntarios prenatales para el vih, y prevalencia del vih entre las embarazadas de barbados, 1993­2004: evidencia para evaluar la efectividad de las medidas para prevenir el vih

OBJECTIVES: To describe the long term trends on the uptake of antenatal voluntary counselling and testing (VCT) for Human Immunodeficiency Virus (HIV) and on the HIV prevalence among pregnant women. These data were used to gauge the impact of the National Acquired Immunodeficiency Syndrome (AIDS) Intervention Programme on preventing mother-to-child transmission (PMTCT) in Barbados. METHODS: This was a population based study. Data for this report were drawn from the HIV Surveillance Programme for the mother-to-child transmission of HIV The study population comprised all pregnant women who attended the various antenatal care clinics throughout Barbados during the period between 1993 and 2004. RESULT: The uptake of the VCT for HIV among the pregnant women in Barbados has increased from 39.9in 1993 to over 89.7in 2004 (p < 0.0001). Mean annual HIV prevalence decreased from 10.53 per thousand women screened in 1993-1996 to 8.23 during 2001-2004 (p = 0.121). Mean annual incidence rate of newly diagnosed HIV infection among the pregnant women declined from 8.83 per thousand women screened during 1993-1996 to 4.53 per thousand pregnant women screened during 2001-2004 (p = 0.004). Mean annual incidence rate of newly diagnosed HIV infection among the pregnant women aged less than 25 years during the corresponding period declined from 10.17 per thousand women aged less than 25 years screened to 4.75 per thousand women screened (p = 0.003). CONCLUSION: There has been a significant decline in the prevalence and incidence of HIV since the late-1990s. Although new infections are still occurring, the numbers are small. The decline may partly be explained by the impact of PMTCT and the general preventive measures on the spread of HIV among this population.

Objetivos. Describir las tendencias a largo plazo en relación con el interés en el asesoramiento y prueba voluntarios (APV) prenatales para el virus de la inmunodeficiencia humana VIH, así como en relación con la prevalencia del VIH entre las embarazadas. Estos datos fueron usados para evaluar el impacto del Programa Nacional de Intervención del Síndrome de Inmunodeficiencia Adquirida (SIDA) en la prevención de la transmisión de madre a hijo (PTMH) en Barbados. Métodos. Se trató de un estudio poblacional. Los datos para este reporte fueron tomados del Programa de Vigilancia del VIH para la transmisión madre a hijo del VIH. El estudio poblacional abarcó a todas las embarazadas que asistieron a las distintas clínicas de atención prenatal en todo Barbados durante el período comprendido entre 1993 y 2004. Resultado. El interés mostrado por el APV del VIH entre las embarazadas de Barbados, ha aumentado de 39.9% en 1993 a más de 89.7% en 2004 (p < 0.0001). La media anual de prevalencia del VIH disminuyó de 10.53 por cada mil mujeres sometidas a pesquisaje en 1993­1996 a 8.23 durante 2001­2004 (p = 0.121). La tasa de incidencia anual media de infección por VIH de diagnóstico reciente entre las embarazadas descendió de 8.83 por cada mil mujeres embarazadas sometidas a pesquisaje durante 1993­1999 a 4.53 por cada mil mujeres sometidas a pesquisaje durante 2001­2004 (p = 0.004). La tasa de incidencia anual media de infección por VIH de diagnóstico reciente entre las embarazadas menores de 25 años de edad durante el periodo correspondiente disminuyó de 10.17 por cada mil mujeres menores de 25 años de edad sometidas a pesquisaje, a 4.75 por cada mil mujeres sometidas a pesquisaje (p = 0.003). Conclusión. Ha habido un descenso significativo en la prevalencia e incidencia del VIH desde los finales de 1990. Aunque todavía se están produciendo nuevas infecciones, su número es pequeño. El descenso puede explicarse en parte por el impacto del PTMH y las medidas generales de prevención de la difusión del VIH entre esta población

Evaluation of a hypertension screening programme in Independence, Belize / Evaluación de Programa de Pesquizaje de la Hipertensión en Independencia, Belice

This study assesses the effectiveness of a hypertension-screening programme in Independence, Belize. Forty-nine of the 101 patients screened were found to have elevated blood pressure readings and were advised to seek medical care. Four months later, interviews with 35 of the 49 patients from the hypertensive group revealed that 85.7 of the patients had sought medical care. Women, elderly patients and patients with a previous history of hypertension were more likely than men, younger patients and those without a history of hypertension to seek follow-up medical care. The screening programme successfully directed a high proportion of patients with elevated blood pressure to seek appropriate medical care

Este estudio evalúa la efectividad de un programa de pesquizaje de la hipertensión en Independencia, Belice. Se halló que 49 de 101pacientes sometidos al pesquizaje produjeron lecturas de alta presión sanguínea y tensión arterial, y se les aconsejó buscar atención médica. Cuatro meses después, entrevistas con 35 de los 49 pacientes del grupo hipertenso revelaron que el 85.7% de los pacientes habían buscado atención médica. Las mujeres, los pacientes mayores y los pacientes con una historia previa de hipertensión presentaban una probabilidad mayor a buscar atención médica de seguimiento, que los hombres, los pacientes más jóvenes y aquéllos sin una historia de hipertensión. El programa de pesquizaje tuvo éxito en hacer que una alta proporción de pacientes con presión sanguínea alta buscaran adecuada atención médica.

Cancer screening literature in the period 2000-2002: pointers to future research avenues.

In order to determine which areas of cancer screening are currently receiving greatest emphasis in different parts of the world a Medline search of the literature for the period 2000-2002 was performed, concentrating attention on research into all aspects of efforts for early detection of tumours, with especial attention to methodology, motivation (including awareness of utility in the general populace and in minority groups), and intervention (professional training and general education). Focus on the skin, lung, cervix, breast, ovary + endometrium, oral cavity-oesophagus, gastric, colorectal, kidney + urinary tract and prostate, demonstrated large numbers of journals to be publishing papers in the field, with 10, 33, 130, 53, 24, 21, 6, 81, 12 and 58, respectively, in the period investigated, the grand total being 259. The average numbers of papers/journal ranged from 1.0-2.4 with only 15-35% appearing in journals with wide coverage. With the exception of oral, oesophageal and gastric cancer screening, an approximately 50% contribution in all areas was made by scientists in the US, followed by Europe (31% overall,) Asia (11%) then Australasia, Central and South America and Africa (3%, 2% and 1%, respectively). Clear differences were evident with the organ regarding specific topics receiving attention, most publications concerning the lung, ovary and urological tract dealing with detection methods. With the cervix and colorectum this topic accounted for half of the papers with especial attention to the relative advantages of the PAP smear, HPV testing and direct visual acetic acid (DVA) in the one, and FOBT and endoscopy in the other. Another major focus was found to be minority attitudes to breast, prostate and cervical screening in the US, whereas only few papers were found dealing with practical intervention, targeting professionals or screenees to increase participation in screening programs. The present approach suggested a number of areas requiring more attention, not least being the need for more comprehensive reviews across organs to allow the general reader a better understanding of the overall picture, and which avenues might best reward exploration in the future.

Protocolos de rastreamento para o diagnóstico precoce do câncer de pulmão: passado, presente e futuro / Screening for lung cancer: past, present and future

O carcinoma brônquico é, de todos, o de maior letalidade, responsabilizando-se, anualmente, por maior número de óbitos do que aqueles decorrentes do câncer do cólon, mama e próstata juntos. Seguindo seu curso natural, mais de 50 por cento dos pacientes têm metástases a distância e somente 20 a 25 por cento são potencialmente ressecáveis no momento do diagnóstico, com perspectiva de sobrevida em cinco anos de apenas 14 por cento. Os protocolos de rastreamento, baseados em radiografias do tórax e citologia do escarro, realizados há 30 anos com o intuito de estabelecer o diagnóstico precoce, mostraram maior índice de ressecabilidade e melhores taxas de sobrevida, porém sem causar impacto na redução da mortalidade específica. Nos últimos anos, com o advento da tomografia computadorizada helicoidal de baixa dose e de novas técnicas para análise das secreções respiratórias e da mucosa brônquica, com o potencial para identificar casos de câncer de pulmão em fases mais precoces de sua evolução natural, os protocolos de rastreamento voltam a despertar o interesse. Os autores revisam os protocolos de rastreamento realizados no passado, assim como analisam os estudos prospectivos mais recentes e discutem as perspectivas futuras, destacando suas principais limitações, os problemas metodológicos no seu delineamento e principais vieses que comprometem a interpretação dos resultados

Screening of early detection of lung cancer.

Methods for detecting early lung cancers, carcinoma in situ, and dysplastic lesions of the tracheobronchial tree ultimately aim to eradicate them before they become invasive. This approach is being developed to detect early stage lung cancer, when treatment is more likely to be curative. This review describes the recent developments in lung cancer screening and the possible impact on management of lung cancer.

Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica. Part 2: Assessment

This paper summarise the requirements and criteria for assessment of childhood disabilities. It reviews recent research carried out in Jamaica and outlines procedures for medical and psychological assessment used in the International Epidemiological Study of Childhood and Disability as well as local experience in community-based rehabilitation. While the medical assessment procedures were considered to be validated, there is an urgent need for local research and development in psychological assessment. These approaches, while not perfect as yet, bring the possibility of local community capability closer. They will require changes in professional attitudes, training of health and educational personnel, and changes in the service systems, so that screening and assessment can be integrated into existing services. However, although this will obviate the need for new, specialised administrations, improved linkages and lines of referral will be necessary.