Instrumentos de vigilância e rastreio do desenvolvimento infantil e tecnologia móvel: revisão / Child development monitoring and screening instruments and mobile technology: review / Instrumentos de vigilancia y detección del desarrollo infantil y tecnología móvil: revisión

Este estudo é uma revisão de literatura desenvolvida para investigar o uso de instrumentos de vigilância e rastreio para atraso do desenvolvimento infantil por meio de tecnologia móvel. Além disso, objetivou-se caracterizar as metodologias utilizadas, amostras de participantes, se clínicas ou não, contexto de pesquisa, bem como a finalidade do uso instrumento. Foi realizada a busca de artigos, por três juízes, nas bases de dados indexadas na BVS, PUBMED/MEDLINE e APA PsyNET. Utilizaram-se as recomendações do PRISMA para essa revisão. A partir de critérios de inclusão/exclusão, foram recuperados e analisados cinco artigos. As duas modalidades de instrumentos: vigilância e rastreio, apresentaram-se em três categorias de estudo: 1) descritivo 2) viabilidade/usabilidade 3) validade. Conclui-se que mais estudos sejam necessários, especialmente para avaliar o impacto e eficácia do uso de instrumentos de vigilância e rastreio para atraso no desenvolvimento infantil em formato de tecnologia móvel. (AU)

This study is a literature review designed to investigate the use of monitoring and screening instruments for child developmental delay using mobile technology. In addition, the aim was to characterize the methodologies used, samples of participants, whether clinical or not, the research context and the purpose of the instrument use. Articles were searched by three judges in the databases indexed in the BVS, PUBMED/MEDLINE and APA PsyNET. The PRISMA recommendations were used for this review. After applying the inclusion/exclusion criteria, five articles were retrieved and analyzed. The two types of instruments: monitoring and screening, were presented in three study categories: 1) descriptive 2) viability/usability 3) validity. Further studies are needed to assess the impact and effectiveness of the use of mobile format instruments for the monitoring and screening for childhood developmental delays. (AU)

Este estudio es una revisión de la literatura desarrollada para investigar el uso de instrumentos de vigilancia y rastreo del retraso del desarrollo infantil a través de la tecnología móvil. Asimismo, el objetivo fue caracterizar las metodologías utilizadas, muestras de participantes, ya sean clínicas o no; además del contexto de investigación y la finalidad del uso del instrumento. Tres jueces realizaron una búsqueda de artículos en las bases de datos indexadas en la BVS, PUBMED/MEDLINE y APA PsyNET. Las recomendaciones de PRISMA se utilizaron para esta revisión. Según los criterios de inclusión/exclusión, cinco artículos fueron recuperados y analizados. Los dos tipos de instrumentos fueron: vigilancia y detección, se presentaron en tres categorías de estudio: 1) descriptivo 2) viabilidad/usabilidad 3) validez. Se concluyó que son necesarios más estudios, especialmente para evaluar el impacto y la efectividad del uso de instrumentos de vigilancia y rastreo del retraso en el desarrollo infantil en formato de tecnología móvil. (AU)

Psychiatric disorders in adolescents with type 1 diabetes: a case-control study

Objectives: To study the prevalence of psychiatric disorders in adolescents with and without type 1 diabetes, the factors associated with its presence, and to test the reliability of a screening tool for use in clinical settings. Methods: Eighty-one adolescents were enrolled in this case-control study, including 36 diabetic participants and 45 controls. Clinical and sociodemographic data were collected and psychiatric symptoms and diagnoses were obtained from adolescents and their parents using a screening tool (Strengths & Difficulties Questionnaire) and a semi-structured interview (Development and Well-Being Assessment). Results: Psychiatric disorders were identified in 22.2% of the sample (30.56% among diabetic adolescents vs. 15.56% of controls: OR = 2.39, 95%CI 0.82-6.99; p = 0.11). Overweight (body mass index percentile ≥ 85) was the only factor associated with psychiatric disorder (OR = 3.07; 95%CI 1.03-9.14; p = 0.04). Compared to the semi-structured interview, the screening instrument showed 80% sensitivity, 96% specificity, 88.9% positive predictive value and 92.3% negative predictive value for the presence of psychiatric diagnoses in adolescents. Conclusion: Psychiatric morbidity was high in this sample of adolescents, especially among those with diabetes. Routine use of the Strengths and Difficulties Questionnaire can help with early detection of psychiatric disorders in this at-risk group.

Social determinants of health related to adhesion to mammography screening / Levantamiento de determinantes sociales de salud relacionados a la adhesión al examen mamógrafo / Levantamento de determinantes sociais de saúde relacionados à adesão ao exame mamográfico

ABSTRACT Objective: To identify proximal, intermediary and individual social determinants related to mammography adherence, according to the Social Determinants of Health model proposed by Dahlgren and Whitehead. Method: Correlational cross-sectional study, carried out with a sociodemographic and clinical data questionnaire and the Champion's Health Belief Model Scale, translated and adapted for use in Brazil. Data analyzed by multiple linear regression, from the domains scale, and sociodemographic and clinical variables were used as predictors. Results: The age group of 60-64 years (55.0%) was highlighted, 22 (55.0%) women had a stable partner; and 14 (65.0%) completed higher education. The domain with the greatest influence on adhesion to mammography was perceived barriers. Conclusion: The social determinants of health are directly related to the levels of adherence to the exam among women, as well as the perceived benefits, susceptibilities and barriers.

RESUMEN Objetivo: identificar determinantes sociales proximales, intermediarios y distales relacionados a la adhesión a la mamografía, según el modelo de determinantes sociales de salud, propuesto por Dahlgren y Whitehead. Método: estudio transversal correlacionado, realizado con la aplicación de un cuestionario de datos socio demográficos y clínicos y de Champion's Health BeliefModelScale, traducida y adaptada para el uso en Brasil. Datos analizados por regresión linear múltipla, a partir de los dominios de la escala, y usadas, como predictores, las variables socio demográficas y clínicas. Resultados: Se destacó el grupo de edad de 60-64 años (55,0%), 22 (55,0%) mujeres poseían pareja estable; y 14 (65,0%) concluyeron la enseñanza superior. El dominio con mayor influencia en la adhesión a la mamografía fue barreras notadas. Conclusión: Los determinantes sociales de salud tiene relación directa con los niveles de adhesión examen entre las mujeres, así como con los beneficios, las susceptibilidades y las barreras notadas.

RESUMO Objetivo: identificar determinantes sociais proximais, intermediários e distais relacionados à adesão à mamografia, segundo o modelo de determinantes sociais de saúde, proposto por Dahlgren e Whitehead. Método: estudo transversal correlacional, realizado com a aplicação de um questionário de dados sociodemográficos e clínicos e da Champion's Health Belief Model Scale, traduzida e adaptada para o uso no Brasil. Dados analisados por regressão linear múltipla, a partir dos domínios da escala, e usadas, como preditores, as variáveis sociodemográficas e clínicas. Resultados: destacou-se a faixa etária de 60-64 anos (55,0%), 22 (55,0%) mulheres possuíam companheiro fixo; e 14 (65,0%) concluíram o ensino superior. O domínio com maior influência na adesão à mamografia foi barreiras percebidas. Conclusão: os determinantes sociais de saúde têm relação direta com os níveis de adesão ao exame entre as mulheres, bem como com os benefícios, as suscetibilidades e as barreiras percebidas.

Screening and Brief Intervention for the use of alcohol and other drugs / Rastreo e intervención breve para uso de alcohol y otras drogas / Rastreamento e Intervenção Breve para uso de álcool e outras drogas

ABSTRACT Objective: to identify the lifetime use of alcohol and other drugs among users of the Family Health Strategy and apply Brief Intervention to problems related to the use of these substances. Method: a descriptive cross-sectional study where 1,031 users of the Family Health Strategy of the city of Rio de Janeiro answered a form with socio-demographic information and the Alcohol, Smoking and Substance Involvement Screening Test. Statistical analysis with simple frequency distribution was performed. Results: the most commonly used drugs in lifetime were alcohol and tobacco; among the illegal drugs, marijuana, hypnotics and cocaine/crack stood out. Those who received most Brief Intervention were users of tobacco, hypnotics, marijuana, cocaine/crack and alcohol. Conclusion: it is important to detect early problems associated with the use of alcohol and other drugs in Primary Care, since it has the promotion/protection of health and the prevention of diseases as priority health practices.

RESUMEN Objetivo: identificar el uso en la vida de alcohol y otras drogas entre usuarios de la Estrategia Salud de la Familia y aplicar una intervención breve para problemas relacionados al uso de esas sustancias. Método: el estudio descriptivo del tipo transversal donde 1031 usuarios de la Estrategia Salud de la Familia de la ciudad de Rio de Janeiro respondieron a un formulario con informaciones sociodemográficas y a el Alcohol, Smoking and Substance Involvement Screening Test. Se realizó un análisis estadístico con distribución de frecuencias simple. Resultados: las drogas más usadas en la vida fueron el alcohol y el tabaco; entre las drogas ilícitas, se destacaron marihuana, hipnóticos y cocaína/crack. Los que más recibieron intervención breve fueron los usuarios de tabaco, hipnóticos, marihuana, cocaína/crack y alcohol. Conclusión: es importante detectar precozmente problemas asociados al uso de alcohol y otras drogas en la atención básica, pues ella tiene la promoción/protección de la salud y la prevención de agravios como prácticas sanitarias prioritarias.

RESUMO Objetivo: identificar o uso, na vida, de álcool e outras drogas entre usuários da Estratégia Saúde da Família e aplicar Intervenção Breve para problemas relacionados ao uso dessas substâncias. Método: estudo descritivo do tipo transversal onde 1031 usuários da Estratégia Saúde da Família da cidade do Rio de Janeiro responderam um formulário com informações sociodemográficas e o Alcohol, Smoking and Substance Involvement Screening Test. Análise estatística com distribuição de frequências simples foi realizada. Resultados: as drogas mais usadas na vida foram álcool e tabaco; entre as drogas ilícitas, destacaram-se maconha, hipnóticos e cocaína/crack. Os que mais receberam Intervenção Breve foram os usuários de tabaco, hipnóticos, maconha, cocaína/crack e álcool. Conclusão: é importante detectar precocemente problemas associados ao uso de álcool e outras drogas na Atenção Básica, pois ela tem a promoção/proteção da saúde e a prevenção de agravos como práticas sanitárias prioritárias.

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.

Perception of nurses who perform rapid tests in Health Centers / Percepción de enfermeros ejecutores de prueba rápida en Centros de Salud / Percepção de enfermeiros executores de teste rápido em Unidades Básicas de Saúde

ABSTRACT Objective: Learn about the perception of health professionals who perform rapid tests in Health Centers (HCs). Method: This is a descriptive and qualitative study conducted in nine HCs in Recife. Data were collected through individual interviews and evaluated using Bardin's content analysis, in its thematic category. Results: Challenges were observed in rapid tests related to the supply of products, physical structure, training for pre- and post-test counseling, and the need for improvements in permanent education actions. Final considerations: These issues can be resolved with management improvements, systematization of permanent education activities, and definition of care flows that enable early diagnosis. Besides the diagnosis, care lines should be created for people living with HIV and AIDS who use the HCs for early health care process.

RESUMEN Objetivo: conocer la percepción de profesionales de salud ejecutores de prueba rápida en Centros de Salud (CS). Método: estudio descriptivo y cualitativo realizado en nueve UBS en Recife. Los datos fueron recogidos a través de encuesta individual y evaluados por medio del análisis de contenido de Bardin, en su modalidad temática. Resultados: se certifican fragilidades para la realización de las pruebas rápidas, relacionadas a la logística de materiales e insumos, estructura física, capacitación para la realización del asesoramiento pre y pos-prueba, y la necesidad de mejoras en las acciones de educación permanente. Consideraciones finales: esas dificultades pueden ser puestas en ecuación con la mejora de la gestión, sistematización de las actividades de educación permanente y definición de flujos de atención que posibiliten el diagnóstico precoz. Además del diagnóstico, es necesario establecer líneas de cuidado para personas viviendo con VIH y sida que tengan como inicio del proceso de asistencia a la salud las UBS.

RESUMO Objetivo: conhecer a percepção de profissionais de saúde executores de teste rápido em Unidades Básicas de Saúde (UBS). Método: estudo descritivo e qualitativo realizado em nove UBS em Recife. Os dados foram coletados através de entrevista individual e avaliados por meio da análise de conteúdo de Bardin, em sua modalidade temática. Resultados: verificam-se fragilidades para realização dos testes rápidos, relacionadas à logística de materiais e insumos, estrutura física, capacitação para realização do aconselhamento pré e pós-teste, e a necessidade de melhorias nas ações de educação permanente. Considerações finais: essas dificuldades podem ser equacionadas com a melhoria da gestão, sistematização das atividades de educação permanente e definição de fluxos de atendimento que possibilitem o diagnóstico precoce. Além do diagnóstico, é necessário estabelecer linhas de cuidado para pessoas vivendo com HIV e aids que tenham como início do processo de assistência à saúde as UBS.

Creencias sobre el cancer cervicouterino y papanicolaou y su relación con la adherencia al tamizaje / Beliefs about cervical cancer and Pap smear and their relationship with adherence to screening

INTRODUCCIÓN Y OBJETIVO: Actualmente, las tasas de mortalidad por cáncer cérvicouterino (CC) en Latinoamérica y el Caribe son mayores comparadas con otros países, a pesar de ser altamente prevenible. El objetivo de este trabajo es identificar la relación entre la adherencia al tamizaje de cáncer cérvicouterino y las creencias sobre el CC y el Papanicolaou (PAP) en mujeres chilenas. MÉTODOS: Estudio realizado en una muestra probabilística de 969 mujeres entre 25 y 64 años de edad, beneficiarias del sistema de salud público y pertenecientes a la comuna de Puente Alto en Santiago, Chile. El reclutamiento y recolección de datos fue entre Marzo 2014 y Octubre 2015. Se midieron variables sociodemográficas, adherencia al PAP y creencias en relación al PAP y CC. RESULTADOS: La mayor adherencia al tamizaje de CC tiene relación significativa con el sentimiento de bienestar al estar cuidando la salud, la percepción de menor cantidad de barreras para tomarse el PAP particularmente en mujeres que adhieren en el sistema privado, el conocimiento de la radio o quimioterapia como tratamiento para el CC, la percepción del riesgo personal de desarrollar la enfermedad, saber que los síntomas no son un requisito para el PAP, y la motivación dada por profesionales de salud o la madre. CONCLUSIONES: La adherencia al PAP es multifactorial y las creencias de las mujeres deben ser consideradas para el éxito de un programa de tamizaje eficaz.

INTRODUCTION AND OBJECTIVES: Currently, cervical cancer's mortality rates in Latin America and the Caribbean are higher compared to other countries, despite being highly preventable. The aim of this study is to identify the relationship between beliefs on CC and PAP test and adherence to screening in Chilean women. MATERIAL AND METHOD: This study was carried out in a probabilistic sample of 969 women aged between 25 and 64 years old, belonging to public health care system and enrolled in any of the four selected primary healthcare centers in Puente Alto, Santiago, Chile. Data collection was carried out between March 2014 and October 2015. Socio-demographic variables, adherence to screening and beliefs regarding CC and PAP test were measured. RESULTS: Greater adherence to CC screening has a significant relationship with the feeling of well-being while taking care of one's health, the perception of fewer barriers to the test particularly in women who adhere in the private health care system, knowledge of radio or chemotherapy as a treatment for CC, the perception of the personal risk of developing the disease, knowing that symptoms are not a requirement for the test, and the motivation given by health care professionals or the mother. CONCLUSION: Adherence to screening is multifactorial and women's' beliefs should be considered for the success of an effective screening program.

Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel / Avaliação da qualidade de vida de pacientes com carcinoma pulmonar de células não pequenas em estágio avançado, tratados com carboplatina associada a paclitaxel

OBJECTIVE: Non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. Most patients are diagnosed at an advanced stage, palliative chemotherapy therefore being the only treatment option. This study was aimed at evaluating the health-related quality of life (HRQoL) of advanced-stage NSCLC patients receiving palliative chemotherapy with carboplatin and paclitaxel. METHODS: This was a multiple case study of advanced-stage NSCLC outpatients receiving chemotherapy at a public hospital in Rio de Janeiro, Brazil. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire was used in conjunction with its supplemental lung cancer-specific module in order to assess HRQoL. RESULTS: Physical and cognitive functioning scale scores differed significantly among chemotherapy cycles, indicating improved and worsened HRQoL, respectively. The differences regarding the scores for pain, loss of appetite, chest pain, and arm/shoulder pain indicated improved HRQoL. CONCLUSIONS: Chemotherapy was found to improve certain aspects of HRQoL in patients with advanced-stage NSCLC. .

OBJETIVO: O carcinoma pulmonar de células não pequenas (CPCNP) é tipo mais comum de câncer de pulmão. Como a maioria dos pacientes é diagnosticada em estágio avançado, a quimioterapia paliativa é a única opção de tratamento. Este estudo avaliou a qualidade de vida relacionada à saúde (QVRS) de pacientes com CPCNP avançado no decorrer da quimioterapia paliativa com carboplatina e paclitaxel. MÉTODOS: Trata-se de um estudo de casos múltiplos de pacientes ambulatoriais com CPCNP em estágio avançado recebendo quimioterapia em um hospital público no Rio de Janeiro (RJ). Para a avaliação da QVRS, foram usados o European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire e seu módulo específico para câncer de pulmão. RESULTADOS: Houve diferenças significativas na pontuação nas escalas de capacidade física e cognitiva durante a quimioterapia, indicando melhora e piora da QVRS, respectivamente. As diferenças na pontuação nos itens dor, perda de apetite, dor no tórax e dor no braço ou ombro indicaram melhora da QVRS. CONCLUSÕES: Observou-se que a quimioterapia melhora alguns aspectos da QVRS de pacientes com CPCNP avançado. .

Saúde geral: evidências de diferenças relacionadas ao sexo / General Health: evidences of sex related individual diferences

Objetivou-se verificar a existência de diferenças relacionadas ao sexo com base nos indicadores de saúde mental providos pelo Questionário de Saúde Geral (QSG) e avaliar a pertinência de normas diferenciadas por sexo. Participou voluntariamente do estudo uma amostra aleatória de 146 adultos da cidade de Divinópolis, MG. Os dados foram analisados por meio de testes t para amostras independentes, análise de variância simples com correção de Bonferroni e correlações de Pearson. Mulheres apresentaram médias superiores às dos homens em todos os escores do QSG, entretanto diferenças significantes com magnitude de efeito moderada foram encontradas nas escalas de Estresse Psíquico, Autoeficácia, Distúrbios Psicossomáticos e Gravidade de Doença Mental. Nossos achados são congruentes com os do estudo de adaptação e validação do QSG para o Brasil, indicando a presença de diferenças moderadas relacionadas ao sexo em saúde geral e a pertinência de normas diferenciadas para homens e mulheres. Ajustes normativos mostram-se necessários.

The current study aimed to verify the existence of sex related differences in the mental health indicators provided by the General Health Questionnaire (GHQ) and to evaluate the pertinence of sex differentiated norms. Participated in this study voluntarily a random sample of 146 adults from the city of Divinópolis, MG. Data were analyzed using t-Tests for independent samples, one-way analysis of variance with Bonferroni correction and Pearson correlations. Women had a higher means than men in all the scores produced by the GHQ, but significant differences with moderate effect sizes were found only in the scales of Psychological Stress, Self-efficacy, Psychosomatic Disorders and Severity of Mental Illness. Our findings are consistent with GHQ Brazilian adaptation and validation study, indicating the existence of moderate sex differences in general health and the pertinence of differentiated norms for men and women. Normative adjustments are, however, required.

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.

Rastreamento e diagnóstico de câncer de próstata / Screening and diagnosis of prostate cancer

Não existem até o momento provas contundentes que a população coberta pelo plano de saúde UNIMED-POA deva ser submetida ao rastreamento sistemático do câncer de próstata com o intuito de reduzir a mortalidade decorrente deste tipo de câncer, uma vez que não existem estudos desenhados no Estado do Rio Grande do Sul que contemplem este aspecto. Recentemente, dois grandes estudos randomizados que visavam a esclarecer se o rastreamento populacional poderia reduzir a mortalidade por câncer de próstata concluíram: em estudo realizado nos Estados Unidos (prostate, lung, colorectal and ovary trial), não houve diferença na mortalidade da população rastreada ou não; no estudo europeu (European randomized of screening for prostate cancer), houve uma redução de 20 por cento da mortalidade da população rastreada em relação à não rastreada. Cabe ressaltar que ambos os estudos apresentaram, entre outros problemas, viés de seleção dos pacientes, onde mais de 50 por cento do grupo teoricamente não rastreado efetivamente realizou exames antes ou durante o estudo. Sendo assim, permanece recomendada realização de rastreamento nas diretrizes da Associação Americana de Urologia, Associação Europeia de Urologia e Sociedade Brasileira de Urologia.

So far, there is no compelling evidence that the local population covered by the health plan UNIMED-POA should be submitted to systematic screening for prostate cancer in order to reduce mortality resulting from this type of cancer, as no studies in Rio Grande do Sul have been performed to address this particular issue. In other countries, two large randomized studies aimed at clarifying whether such screening could reduce mortality from prostate cancer were conducted recently: the prostate, lung, colorectal and ovary trial in the United States, and the European randomized screening for prostate cancer. In the former, there was no difference in mortality between screened and non-screened groups; in the latter there was a 20 percent reduction in mortality in the screened as compared to the non-screened group. It should be highlighted that both studies had many design problems including biased selection of patients, as more than 50 percent of the supposedly non-screened group was in fact submitted to medical tests either before or during the trial. Therefore, screening still should be performed according to the guidelines of the American Association of Urology, European Association of Urology and the Brazilian Society of Urology.

Rastreo del cáncer colorrectal: Conocimiento y actitud de la población / Screening colorectal cancer: Perception and behavior of the population

El rastreo de cáncer colorrectal (CCR) cuenta con fuertes evidencias en su favor. Datos preliminares indican que a pesar de ello no se lleva a cabo con la frecuencia adecuada. Se intenta aquí determinar, dentro de un Sistema de Salud que cuenta con los recursos necesarios, los elementos que facilitan o generan barreras para concretar esta práctica preventiva, cuántos individuos lo ponen en práctica y qué predice esta conducta. Se realizó una encuesta telefónica a los afiliados de una Obra Social de empleados de la Universidad de Buenos Aires, de los que 132 completaron el cuestionario (tasa de respuesta 70%). Los elementos considerados facilitadores del rastreo obtuvieron respuestas afirmativas en el 64 a 97%, mientras que los que definían barreras un 11 a 27%. En este último grupo, una categoría diferenciada la constituía el miedo a los efectos adversos: 39%, y el sentimiento de vergüenza relacionado con los procedimientos: 30%. Un 33% de los encuestados tenían hecho un método de rastreo, mayoritariamente de sangre oculta (27), sigmoideoscopía (11) y colonoscopía (20). Una mayoría afirmó que "se haría el procedimiento si el médico se lo recomendara" (95%), o "no se lo haría excepto que su médico se lo aconseje" (87%). Contestar afirmativamente que "los médicos hacen lo mejor para los pacientes" se asoció con haberse hecho un método de rastreo de CCR, OR 1.55 (IC 95%: 1.02-2.37) p: 0.04. El grupo de individuos estudiado parece bien predispuesto para el rastreo del CCR, la recomendación médica sería aquí un determinante prominente para ponerlo en práctica.

There is strong evidence favoring colorectal cancer screening. Preliminary data suggests that it is not included in routine practice with the adequate frequency. We intended to recognize in a Health Care System (HCS) that provides the needed resources, the facilitators and barriers related with the implementation of this preventive practice, how many individuals have carried out one procedure and what this preventive activity predicts. A telephone survey was administered to a sample of affiliates from an HCS that serves employees of the University of Buenos Aires; 132 completed the questionnaire (70% response rate). Facilitators obtained an affirmative response in a 64 to 97%, and barriers from 11 to 27%. In the latter category a special subgroup (39%) was afraid of adverse events, and there was a feeling of embarrassment in others (30%); 33% of respondents had carried out a screening procedure, mainly FOBT 27, sigmoidoscopy 11 and colonoscopy 20. A majority (95%) stated that they "would do the procedure if doctors recommend it", or "not do it unless my doctor advises to do it" (87%). Answering affirmatively that "physicians will do the best for their patients" was associated with having had a CRC screening test, OR 1.55 (95% CI: 1.02-2.37) p: 0.04. Studied individuals showed good predisposition for colorectal cancer screening, but to put it into practice, medical advice seems to be a prominent determinant.

Sociocultural deterrents to mammographic screening in Jamaica / Elementos socioculturales de disuasión en el pesquisaje mamográfico en Jamaica

OBJECTIVE: Less than five per cent of eligible Jamaican women had mammograms in 2003. The sociocultural determinants and the perceptual barriers modulating screening behaviour in Jamaican women are unclear. We sought to investigate sociocultural effects, in particular, knowledge and fear of the procedure on mammographic screening behaviour in Jamaican women. METHOD: One hundred and forty-seven women attending the breast imaging units at the University Hospital of the West Indies and 127 attending Radiology West were interviewed to determine the factors relating to participation in mammographic screening. Knowledge level, deterring factors as well as the experience during mammography were recorded. RESULTS: The mean age ± SD of participants was 51 ± 10.4 years. Eighty-eight of the 274 women (32%) were having a mammogram for the first time. Of these, the major determinants of the mammographic experience were the expectation that the procedure would be painful (OR = 0.08, p < 0.001) and the pain intensity (OR = 1.4, p < 0.030) experienced during mammography. There were 188 women who had repeat mammograms. Seventy-five of these women had delayed mammography for greater than one year. There was a significant association between being late for mammography and the perception that a doctor's referral was necessary (p < 0.001). The factors associated with improved mammographic experience were pain intensity (OR = 0.84, p < 0.04), interval status of previous mammography (OR = 2.24, p = 0.059) and knowing someone with breast cancer (OR = 0.35, p < 0.04). Although 97% of all women found mammography painful, only seven (2.5%) said pain would prevent a repeat mammogram. CONCLUSIONS: Fear, pain during mammography, subjective indifference, inertia and reliance on physician referrals were identified as barriers to complying with mammographic screening guidelines.

OBJETIVO: Menos del cinco por ciento de las mujeres jamaicanas elegibles recibieron mamogramas en 2003. No están claras las determinantes socioculturales y las barreras preceptuales que modulan el comportamiento de pesquisaje en la mujer jamaicana. Buscamos investigar los efectos socioculturales - en particular, el conocimiento y el miedo al procedimiento - sobre la conducta ante el pesquisaje mamográfico en las mujeres jamaicanas. MÉTODO: Ciento cuarenta y siete mujeres que asistían a las unidades de imágenes de mamas en el Hospital Universitario de West Indies, y 127 que asistían a Radiology West, fueron entrevistadas a fin de determinar los factores relacionados con su participación en el pesquisaje mamográfico. Se registraron el nivel de conocimientos, los factores de disuasión así como la experiencia durante la mamografía. RESULTADOS: La edad promedio ± SD de los participantes fue 51 ± 10.4 años. Ochenta y ocho de las 274 mujeres (32%) recibían un mamograma por primera vez. De estas, las mayores determinantes de la experiencia mamográfico fueron la expectativa de que el procedimiento sería doloroso (OR = 0.08, p < 0.001) y la intensidad del dolor (OR = 1.4, p < 0.030) experimentado durante la mamografía. Hubo 188 mujeres que tuvieron mamografías repetidas. Setenta y siete de estas mujeres tuvieron sus mamografías retrasadas por más de un año. Hubo una asociación significativa entre estar tarde para la mamografía y la percepción de que era necesaria una remisión médica (p < 0.001). Los factores asociados con el mejoramiento de la experiencia mamográfica fueron: la intensidad del dolor (OR = 0.84, p < 0.04), el estatus del intervalo de la mamografía previa (OR = 2.24, p = 0.059), y el conocer a alguien con cáncer de mamas (OR = 0.35, p < 0.04). Aunque el 97% de todas las mujeres encontraron la mamografía dolorosa, sólo siete de ellas (2.5%) dijeron que el dolor sería un impedimento para hacerse una nueva mamografía. CONCLUSIONES: El miedo, el dolor durante la mamografía, la indiferencia subjetiva, la inercia, y la dependencia de las remisiones médicas, fueron identificadas como los obstáculos que impiden el cumplimiento de las guías para el pesquisaje mamográfico.

The Factors Associated with Changes in the Stage of Breast Cancer Screening Behavior among the Woman who are Eligible for the Korean National Cancer Screening Program / 예방의학회지

OBJECTIVES: This study was performed to evaluate the relationships between psychosocial characteristics and changes in the stage of breast cancer screening behavior. METHODS: The 474 study subjects were randomly sampled from 21,459 women (age range, 40-70 years) who were eligible for the Korean National Cancer Screening Program in 2006 in Jinju, Gyeongsangnam-do. The information, including behaviors and sociodemographic characteristics, attitudes, subjective norms and self-efficacy, was collected by trained interviewers via home visits. The breast cancer screening stages were grouped as precontemplation, contemplation, action, maintenance and relapse, according to Rakowski. RESULTS: Of the 474 women, 18.8% were in the precontemplation stage, 23.3% were in the contemplation stage, 13.1% were in the action stage, 36.6% were in the maintenance stage, and 8.2% were in the relapse stage. The distribution of stages was associated with attitude, subjective norms and self-efficacy (p for trend<0.01). To investigate the overall relationship between the variables, we conducted a linear structural equation model analysis based on the theory of planned behavior. The subjective norms and self-efficacy influenced the stage of the women's screening behavior. CONCLUSIONS: We should target on self-efficacy about the screening behavior of women by performing timely, thoughtful interventions. The support from family members, friends and other people is crucial for women to undergo breast cancer screening and to improve the breast cancer screening rate.

The relationship between women's health beliefs and their participation in screening mammography.

Breast cancer is the most common type of cancer in women. Early diagnosis of this disease can reduce mortality significantly and will promote women's quality of life. Changes in the women's beliefs and attitudes are necessary to encourage them to undergo screening mammography. To make this change happen, understanding their health beliefs is important. This attempt is to determine the relationship between women's health belief of city of Kerman with their participation in mammography on the basis of health belief model in the year 2005-2006. This study was an experimental-control one in which the main independent variable was health belief including different dimensions such as perceived sensitivity, perceived intensity, perceived barriers, perceived benefits, "cues to actions" and self-efficacy. Participation in the mammography was taken as the dependent variable. Two samples consisting of 148 women who had and 148 women who had not underwent mammography were selected. Data were collected through questionnaires and were analyzed by SPSS=12 software. The result of this study showed that women's health belief in some dimensions of health belief model such as perceived benefits of mammography use, the presence of cues to action in mammography use is associated with having mammography. Moreover the total score of mammography group was more than the score of the group without the mammography. When the two groups were compared in terms of demographic data, experimental group showed significant statistical differences with regard to age, benign breast mass and family history of breast cancer. (P, 0001)Understanding the benefits and advantages of mammography and cues to action will increase women's adherence toward doing it. It is of great importance to better realize breast cancer screening behaviors and factors influencing it. It is also necessary to recognize the factors affecting health professionals' and particularly nurses' use of mammography.

Barriers for breast cancer screening among Asian women: a mini literature review.

Breast cancer is the most commonly diagnosed cancer among Asian women. Breast cancer is detected in advanced stages and among younger age group women in Asia. The delay in presentation is attributed mainly to the social-cultural perception of the disease, poverty, and the strong influence of traditional medicine. Many of Asian women are not aware of the importance of regular screening. Cultural attitudes toward breast cancer screening tests, modesty, lack of encouragement by family members and physicians are the major inhibitors to women's participation in breast cancer screening. Health education using media and community health programs to create awareness of the advantages of earlier presentation and diagnosis of breast cancer in Asian women can motivate participation in breast cancer screening programs.

Estudio endoscópico en familiares de primer grado de pacientes operados por cáncer colorrectal / Screening colonoscopy among first degree relatives of patients with colorectal carcinoma

Background: First degree relatives of patients with colorectal carcinoma are at a higher risk of having the disease than the general population. Therefore, they should be subjected to screening colonoscopy. Aim: To assess the effectiveness of colonoscopy among first degree relatives of patients with colorectal carcinoma. Material and methods: A free colonoscopy was offered to first degree relatives of patients operated on for colorectal cancer between 1998 and 2000. As inclusion criteria, subjects had to be asymptomatic, older than 40 years or less than 10 years younger than the index case. Each subject was contacted twice, inviting him/her to have a colonoscopy performed. Results: Two hundred forty three relatives were contacted for the study and in 76, a colonoscopy was performed. Among the latter, a neoplasm was found in 13 (17 percent): One adenocarcinoma and 12 adenomas. Three of these lesions were located in the right colon. The main reason given by the 176 subjects that did not agree to have a colonoscopy was lack of interest. Conclusions: Screening colonoscopy is effective to detect adenoma and adenocarcinomaamong first degree relatives of patients with colorectal carcinoma, however only 31 percent of all potential relatives agreed to undergo a colonoscopy.

Korean Immigrant Women's Meanings of Breast, Breast Cancer, and Breast Cancer Screenings / 간호학회지

PURPOSE: Koreans are one of the fastest growing Asian populations in the U.S. since 1960s. In Korean immigrant women (KIW), breast cancer was reported as the most frequently diagnosed cancer. However, their screening rates for breast cancer are lower than national guidelines; it is assumed that underlying cultural schemas of breast, breast cancer, and its screening modalities exist and need to be studied. This study was aimed to investigate cultural meanings of breast, breast cancer, and breast cancer screenings in KIW. METHODS: Using cultural models theory from cognitive anthropology, naturalistic qualitative methodology was utilized. Three focus group interviews with fifteen KIW were conducted. Thematic analysis with constant comparison technique was performed eliciting units of meaning, categories, and themes. RESULTS: The cultural schema of the meaning of breast is "mother who is breast-feeding her baby," with two themes of "balance in size," and "shyness." Regarding breast cancer, three themes, i.e., "indifference," "fear," and "uncertainty" are emerged. "Lack of information about screening modalities" is the overarching schema with reference to breast cancer screenings. CONCLUSIONS: The findings of this study demonstrate unique cultural models of KIW related to breast cancer and its screenings, which are critical to understand and penetrate their barriers to breast cancer screening.

Cervical Cancer Screening in Korean American Women : Findings from Focus Group Interviews / 간호학회지

PURPOSE: Korean American women have twice the rate of cervical cancer than white women and demonstrate low rates in participation in cervical cancer screening. This study was to describe the perceptions about cervical cancer and factors related to cervical cancer screening among Korean American women. METHOD: Focus group methods. RESULT: Five themes emerged. First, knowledge about cervical cancer; misconceptions about cervical cancer, its causes, reproductive anatomy and the treatment Second, perceived meanings of having cervical cancer; most of the women felt that cervical cancer represented a loss of femininity and existential value of womanhood. Third, knowledge about cervical cancer screening ; regular medical check-ups were necessary for early detection and prevention of cervical cancer. Forth, experiences and perceived meanings of cervical cancer screening; the participants expressed their feelings; embarrassment, fear, shame and shyness. Fifth, practices of cervical cancer screening; various intervals in participating in cervical cancer screening. But they mentioned several deterrents, language, insurance, time constraint, embarrassment, fear of the screening results, misbelief about susceptibility, lack of health prevention behavior, and lack of information written in Korean. CONCLUSION: Results emphasize the critical need for culturally appropriate health education to encourage participation of Korean American women in cervical cancer screening.