Autoria, subjetividade e poder: devolução de dados em um centro de saúde na Guariroba (Ceilândia/DF) / Authority, subjectivity and power: data devolution at a primary care unit in Guariroba (Ceilândia/Federal District/Brazil)

ResumoA devolução, restituição ou compartilhamento pode significar, dentre outras possibilidades, entregar produtos aos partícipes de um empreendimento de pesquisa/extensão. A entrega de resultados não é uma prática nova na antropologia, embora ainda seja pouco usual, sistematizada e valorizada. Neste artigo, relato e discuto uma experiência de devolução de materiais de um projeto de extensão da antropologia, que foi desenvolvido dentro de um centro de saúde, na região periférica do Distrito Federal. As reações aos materiais foram muito diferentes do esperado pela equipe do projeto, mas ainda assim permitiu fazer avançar o diálogo entre os envolvidos e, mais do que isso, permitiu que o conhecimento sobre as relações de trabalho dentro dessa instituição de saúde fosse aprofundado. Não é somente porque foi logrado o aval de comitês de ética que as negociações sobre a entrada e permanência em projetos acadêmicos estão garantidas continuamente. As relações de subjetividade, poder e autoria permeiam qualquer iniciativa antropológica, antes de começá-la e muito depois de, supostamente, terminá-la.

AbstractDevolution, restitution or sharing can mean, within other possibilities, to offer products to participants of a research or an extension project. Far from a new practice in Anthropology, returning results is still unusual, little organized and valued. This paper presents and discusses a devolution experience by an extension project in Anthropology that was developed in a primary care unit in the outskirts of Distrito Federal (Brazil). Local reactions were very different from what was expected by the project's staff, but still permitted dialogue with the health professionals and, more important, deepened our knowledge about work relations in this health institution. Even though IRB approval has been granted, negotiations about starting and continuing academic projects have to be negotiated continuously. Subjectivity, power and authority permeate any anthropological initiative from its beginning and much after it supposedly has been concluded.

Prevalência de relação sexual e fatores associados em adolescentes escolares de Goiânia, Goiás, Brasil / Prevalence of sexual intercourse and associated factors among adolescents attending schools in Goiânia in the state of Goiás, Brazil

Objetivou-se investigar a prevalência de relação sexual em adolescentes de um município brasileiro e sua associação com fatores sociodemográficos, comportamentos de risco à saúde e percepção da imagem corporal. Estudo transversal utilizando dados da Pesquisa Nacional de Saúde do Escolar - PeNSE realizada em 2009. A amostra foi composta por escolares do 9° ano de Goiânia, Goiás (n = 3.099), com predomínio das idades de 13 a 15 anos. A variável dependente foi o relato de relação sexual alguma vez. Para identificação das variáveis associadas foi realizada análise de regressão de Poisson. A prevalência de relação sexual alguma vez foi de 26,5% (IC95% = 23,8-29,4). Este comportamento foi mais prevalente em adolescentes do sexo masculino, com idade de 14 anos ou mais, que não moravam com a mãe ou com o pai, estudavam em escolas públicas, relataram ter experimentado álcool, tabaco e outras drogas, e envolvimento em brigas e agressão familiar. Conclui-se que a prevalência de relação sexual alguma vez foi elevada e associada a condições sociodemográficas mais precárias, comportamentos de risco à saúde e violência. Estes fatores devem ser considerados nas estratégias de promoção de saúde, visando comportamentos sexuais seguros e saudáveis na adolescência.

This study sought to investigate the prevalence of sexual intercourse among adolescents in a Brazilian city and its association with sociodemographic factors, health-risk behaviors, and body image perception. A cross-sectional study was conducted using data from the National Adolescent School-based Health Survey (PeNSE), carried out in 2009. The sample comprised schoolchildren enrolled in the 9th year in the city of Goiânia, Goiás (n= 3,099), mostly aged between 13 and 15. The dependent variable was the reporting of sexual intercourse at least once. To identify variables associated with sexual activity, Poisson regression analysis was used. The prevalence of sexual intercourse at least once in the adolescents' lifetime was 26.5% (95% CI= 23.8-29.4). Prevalence was higher among males, those aged 14 years or older, who reported not living with their mother or with their father, who attended public schools, reported alcohol, tobacco or other drug use, and were involved in fights and family violence. The conclusion reached was that the prevalence of sexual intercourse was high and associated with poor sociodemographic conditions, health-risk behaviors and violence. These factors should be considered in the health promotion strategies seeking more safe and healthy sexual behavior during adolescence.

Is San Francisco's “The Shaking Man” an urban depiction of parkinsonism? / Seria o “Shaking Man” de São Francisco, Califórnia, uma representação urbana de parkinsonismo?

Art and Medicine often mingle in the most unexpected ways. One can often find in pictorial art the representation of many medical conditions. The same can happen with sculptures; however, the finding of an urban sculpture in a public space with features of parkinsonism is unique. We reported how “The Shaking Man”, an urban sculpture located in the Yerba Buena Gardens in San Francisco, USA, is a contemporary representation of parkinsonism and compared it with other art works in different media that also present such thing to laymen.

Arte e Medicina frequentemente interagem das mais inusitadas maneiras. Muitas condições médicas podem ser encontradas em pinturas acadêmicas. O mesmo pode ocorrer com esculturas; no entanto, encontrar uma escultura em um espaço público exibindo sinais clínicos de parkinsonismo é um achado único. Relatou-se como “The Shaking Man”, que é uma estátua urbana localizada no Yerba Buena Gardens em São Francisco, EUA, pode ser uma representação contemporânea de parkinsonismo e foram realizadas comparações com outras obras de arte em diferentes mídias, as quais também demonstram parkinsonismo para o público leigo.

External Validation of the Cancer of the Prostate Risk Assessment-S Score in Koreans Undergoing Radical Prostatectomy

PURPOSE: To evaluate the validity of the University of California San Francisco Cancer of the Prostate Risk Assessment-S score (CAPRA-S score), a biochemical indicator of recurrent prostate cancer that uses histopathologic data, in Korean prostate cancer patients. MATERIALS AND METHODS: A total of 203 prostate cancer patients who underwent radical prostatectomy between February 1997 and November 2010 were observed for longer than 6 months. The CAPRA-S score of 134 patients for whom records were available for preoperative prostate-specific antigen (PSA), pathologic specimen Gleason score, surgical margin, seminal vesicle invasion, extracapsular extension, and lymph node invasion were calculated. Biochemical recurrence was defined as repetitive measurement of PSA > or =0.2 ng/mL at least 6 months after surgery with at least a 4-week interval. The Cox proportional hazard model and Kaplan-Meier analysis were used for the statistical testing. RESULTS: The CAPRA-S scores were divided into nine groups. The 5-year disease-free survival rate was reduced as the CAPRA-S score increased compared with the group with a CAPRA-S score of 0-1. The CAPRA-S score in this study was more sensitive to biochemical recurrence than was the CAPRA score conducted at this institution (CAPRA-S concordance index, 0.776; CAPRA concordance index, 0.728). CONCLUSIONS: The CAPRA-S score is judged to be a useful tool for predicting the disease-free survival rate of Korean prostate cancer patients and is thought to assist in establishing postoperative management.

A Case of Severe Vaso-Occlusive Retinopathy as the First Manifestation Associated with Systemic Lupus Erythematosus

PURPOSE: To report a case of severe vaso-occlusive retinopathy with significant decrease of bilateral visual acuity as the first manifestation associated with systemic lupus erythematosus (SLE). CASE SUMMARY: A 23-year-old man was referred to our clinic with bilateral visual impairment of hand motion (HH). Fundus examination revealed severe retinal hemorrhage, cotton-wool patch, occlusive retinal vasculitis with vascular engorgement, and diffuse retinal edema in both eyes. Because of a malar rash on both cheeks, generalized edema was observed on initial examination with hypertension, azotemia, anemia, and thrombocytopenia, The patient was diagnosed with SLE, strongly positive to antinuclear antibody (ANA), and received an intravitreal injection of Bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) in the left eye in addition to hemodialysis, transfusion, systemic corticosteroid and immunosuppressant treatment due to lupus nephritis. Eighteen months later, the retinal edema, cotton-wool patch and hemorrhage resolved, leaving epiretinal membrane without traction in his left eye and diffuse degeneration of the right eye. Final visual acuity was HM in the right eye and 20/100 in the left eye. CONCLUSIONS: Vaso-occlusive retinopathy in SLE can result in permanent visual impairment. In a patient with a high possibility of SLE retinopathy, a periodic fundus examination and intensive management of systemic disease should be considered.

Hepatitis B Screening and Vaccination Practices in Asian American Primary Care

BACKGROUND/AIMS: Screening for hepatitis B virus (HBV) is recommended in populations with anticipated prevalence > or =2%. This study surveyed HBV screening and vaccination practices of Asian American primary care providers (PCPs). METHODS: Approximately 15,000 PCPs with Asian surnames in the New York, Los Angeles, San Francisco, Houston, and Chicago areas were invited to participate in a web-based survey. Asian American PCPs with > or =25% Asian patients in their practice were eligible. RESULTS: Of 430 (2.9%) survey respondents, 217 completed the survey. Greater than 50% followed > or =200 Asian patients. Although 95% of PCPs claimed to have screened patients for HBV, 41% estimated that < or =25% of their adult Asian patients had ever been screened, and 50% did not routinely screen all Asian patients. In a multivariable analysis, the proportion of Asian patients in the practice, provider geographic origin and the number of liver cancers diagnosed in the preceding 12 months were significantly associated with a higher likelihood of screening for HBV. Over 80% of respondents reported that < or =50% of their adult Asian patients had received the HBV vaccine. CONCLUSIONS: Screening and vaccination for HBV in Asian American patients is inadequate. Measures to improve HBV knowledge and care by primary-care physicians are critically needed.

Retrospective Validation of the San Francisco Syncope Rule for Predicting Serious Outcomes in a Korean Emergency Department

PURPOSE: Syncope in a common condition that is typically benign but is occasionally associated with mortality. We conducted a retrospective validation of the San Francisco Syncope Rule (SFSR) for use in identifying emergency department (ED) syncope patients with short-term serious outcomes. METHODS: We studied 131 syncope patients who were admitted to or visited the out-patient department within 1 month of an ED visit related to syncope from January to December 2010. Patients meeting the inclusion criteria as defined in the SFSR derivation were evaluated for 5 previously derived predictor variables: abnormal electrocardiography (ECG), shortness of breath, hematocrit <30%, triage systolic blood pressure <90 mm Hg, and a history of congestive heart failure. Predetermined outcome measures as defined by the SFSR included death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing or likely to cause a return ED visit and hospitalization, or related event. RESULTS: The patient group consisted of 63 males and 68 females with an average age of 56 years. 35(26.7%) patients met the predetermined criteria for serious outcome. 10 of 35(28.6%) patients with a serious outcome were not identified as high risk using the rule. The rule performance for predicting serious outcomes included a sensitivity of 71.4% (95% confidence interval (CI), 56% to 86%), specificity of 69.8% (95% confidence interval (CI), 69% to 70%) and positive predictive value of 47.3%. CONCLUSION: In this retrospective validation study in Korea, the SFSR performed with comparable specificity but with significantly lower sensitivity than reported in the original study. Implementing the rule would significantly increase admission rates.

The Present of Fetal Therapy and Future Prospect / 대한주산의학회잡지

Advances in prenatal diagnosis have led to the prenatal management of a variety of congenital diseases. Fetal surgery was born of clinical necessity. Observations by pediatric surgeons and neonatologists of neonates that were born with irreversible organ damage led to the conclusion that one possible approach to prevent this alteration of developmental physiology, was fetal surgical intervention. The demonstration in animal models that the correction of an anatomical defect could reverse the associated pathophysiology led to the first systematic application of fetal surgery at the University of California, San Francisco, in the early 1980s . There has been a dramatic improvement in our ability to diagnose, select and safely operate on an expanding number of fetal anomalies. Many fetal interventions remain investigational but for a number of conditions randomized trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programs. Although prenatal stem cell and gene therapy await clinical application, they offer tremendous potential for the treatment of many genetic disorders. Here we review the prenatal evaluation, current status and future potential of various prenatal operative approaches, such as open hysterotomy, fetoscopy, and percutaneous, including tissue engineering, and prenatal cellular and genetic therapy.

Corneal Endothelial Change After Intravitreal Bevacizumab Injection

PURPOSE: To evaluate the in vivo corneal endothelial changes after intravitreal bevacizumab (Avastin(R); Genentech Inc., San Francisco, California, USA) injection. METHODS: A total of 30 eyes of 28 patients who received intravitreal bevacizumab injections were included in the present study. Before injection and one and three months after injection, specular microscopy was performed to analyze the corneal endothelial cell changes. In order to compare the differences in the changes of corneal endothelial cells, the eyes were divided into two groups, a single injection group and a multiple injection group. RESULTS: The mean endothelial cell count decreased from 2,497.4 +/- 427.8 at baseline to 2,421.2 +/- 430.5 at one month and to 2,362.7 +/- 366.2 at three months after the injection in all patients. However, the change in endothelial cell count was not statistically significant. In addition, the postoperative change in endothelial cell count was more prominent in the multiple injection group than in the single injection group, although the difference was again not significant. No significant changes in preoperative or postoperative coefficients of variation for cell area or hexagonalities were observed in either patient group or within each group. CONCLUSIONS: There was no significant change in corneal endothelial cells after intravitreal bevacizumab injection. In addition, there was no significant difference in the changes in corneal endothelial cells according to the number of bevacizumab injections.

The Effect of Intravitreal Bevacizumab Injection in Eales' Disease

PURPOSE: To report on 2 cases of Eales' disease that were successfully regressed with laser photocoagulation and intravitreal bevacizumab (Avastin; Genetech, Inc, San Francisco, California, USA) injection. CASE SUMMARY: Two male patients (30 years and, 40 years of age,) with a history of recurrent vitreous hemorrhage were diagnosed with Eales' disease. The 2 patients had peripheral retina neovascularization and active phlebitis in fundus fluorescein angiography. No other findings were observed in their eyes in the general examination. Scatter laser photocoagulation and intravitreal bevacizumab injection were performed. After 1 month follow-up, neovascularization completely regressed. There was no complication or recurrent vitreous hemorrhage at the 1 year follow up. CONCLUSIONS: Intravitreal bevacizumab injection, as combination treatment of laser photocoagulation, may be helpful in the regression of neovascularization due to Eales' disease.

Effectiveness of Preoperative Intravitreal Bevacizumab Injections in Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of preoperative intravitreal bevacizumab (Avastin(R); Genetech, San Francisco, CA, USA) injections of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: Thirty patients (30 eyes) who underwent PPV for treatment of PDR and received a preoperative intravitreal bevacizumab injection of 1.25 mg were retrospectively analyzed. The study group (group 1, 30 patients, 30 eyes) was compared with a control group (group 2, 29 patients, 30 eyes and matched with the study group for preoperative parameters) who underwent PPV without preoperative intravitreal bevacizumab injection. RESULTS: In both groups, visual acuity improved but there was no statistical significance. Intraoperative vitreous hemorrhage occurred in 14 eyes (46.7%) from group 1 and 11 eyes (36.7%) from group 2. There was no statistical significance of intraoperative bleeding occurrence (p=0.3). Postoperative vitreous hemorrhage occurred in 4 eyes from group 1 and 14 eyes from group 2. The group 1 had a lower incidence of postoperative hemorrhage than group 2 (p=0.005). CONCLUSIONS: Preoperative intravitreal bevacizumab injection appears effective in decreasing early postoperative vitreous hemorrhage and maybe technically helpful in PPV for PDR.

Effectiveness of Preoperative Intravitreal Bevacizumab Injections in Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of preoperative intravitreal bevacizumab (Avastin(R); Genetech, San Francisco, CA, USA) injections of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: Thirty patients (30 eyes) who underwent PPV for treatment of PDR and received a preoperative intravitreal bevacizumab injection of 1.25 mg were retrospectively analyzed. The study group (group 1, 30 patients, 30 eyes) was compared with a control group (group 2, 29 patients, 30 eyes and matched with the study group for preoperative parameters) who underwent PPV without preoperative intravitreal bevacizumab injection. RESULTS: In both groups, visual acuity improved but there was no statistical significance. Intraoperative vitreous hemorrhage occurred in 14 eyes (46.7%) from group 1 and 11 eyes (36.7%) from group 2. There was no statistical significance of intraoperative bleeding occurrence (p=0.3). Postoperative vitreous hemorrhage occurred in 4 eyes from group 1 and 14 eyes from group 2. The group 1 had a lower incidence of postoperative hemorrhage than group 2 (p=0.005). CONCLUSIONS: Preoperative intravitreal bevacizumab injection appears effective in decreasing early postoperative vitreous hemorrhage and maybe technically helpful in PPV for PDR.

Stomach cancer incidence in Metro Manila and Rizal province: 1980-1992

Incidence was derived from published data from 2 population-based registries - the Philippine Cancer Society - Manila Cancer Registry and the Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1,674 square kilometer area that comprises Metro Manila and Rizal province. Thirteen registry clerks actively sought new cancer cases in 96 hospitals and 30 Civil Registry offices. Both registries are members of the International Association of Cancer Registries and received continuing professional assistance from the International Agency for Research on Cancer (IARC). For the period 1988-1992 the combined age-standardized incidence rate (ASR) was 9.9 per 100,000 for male stomach cancer (ranked fifth, 4.5% of all male cancers), and 5.9 per 100,000 among females (ranked ninth, 2.8% of all female cancers). Stomach cancer among Philippine residents had lower ASRs and age-specific rates compared to Japanese, Korean, Chinese, Singaporean Chinese and Vietnamese populations. Age-specific rates among Filipinos reached 10 per 100,000 or higher at age-group 50-54 years among males, and 55-59 years among females. Significant differences in incidence were observed in only few cities and municipalities. There were little differences in ASRs between 2 populations during 3 time periods between 1980-1992, in both males and females with an indication of a slight decrease. Incidence of male Philippine migrants to Hawaii, San Francisco and Los Angeles were comparable to those of white residents covered by the Manila registry. Among females, stomach cancer incidence of Philippine residents and Filipina migrants to Hawaii were similar, and were slightly higher than those of white residents in Hawaii and both migrants and white residents in San Francisco and Los Angeles

The role of Hispanic race/ethnicity and poverty in breast cancer survival

The association of Hispanic race/ethnicity and poverty with general survival time and breast cancer survival time was examined for a total of 14,896 breast cancer patients (14,035 White and 861 Hispanic) included in the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER) program in New Mexico and San Francisco between 1975 and 1984. Variables examined included: age, marital status, stage at diagnosis, tumor histology, delay, treatment, period of diagnosis (1975-79 vs. 1980-84), and poverty. Univariate analysis of 14,896 patients indicated that a greater proportion of Hispanics (vs. Whites) with breast cancer were: younger than age 50, married, diagnosed at a later stage, diagnosed in New Mexico, lived in greater poverty, were diagnosed between 1980-84, and died from breast cancer. Univariate Cox Proportion Hazards analysis indicated that poverty was a significant predictor for reduced general survival time. Being diagnosed in the 1980-84 period was a predictor for improved general survival time. Poverty and Hispanic race/ethnicity were significant predictors of reduced breast cancer survival time. Multivariate Cox Proportional Hazards models indicated that Hispanic race/ethnicity was a significant risk factor for breast cancer survival time for women aged 50 and older. For White women: state, marital status, poverty, surgery, radiation/hormonal treatments, and histology were significant risk factors for breast cancer survival time. For Hispanic women: stage, surgery, hormonal treatment and period of diagnosis were significant risk factors for breast cancer survival time. For White breast cancer patients, period of diagnosis was not a significant risk factor for reduced breast cancer survival time; but for Hispanics, it was a significant risk factor. In the age and race/ethnicity-stratified models of breast cancer survival time, similar risk factors emerged for both Whites and Hispanics. For both younger and older Hispanics, being diagnosed in the early 1980's (vs. the late 1970's) was associated with reduced breast cancer survival time--vs. Whites, who experienced no significant change in breast cancer survival time in the same time period. Poverty was not a predictor for Hispanic survival time in any of the models; however, it was a predictor for younger Whites for breast cancer survival time. These results fueled discussion in three areas targeting breast cancer in underserved women: the development of racial/ethnic-specific cancer control guidelines, the development of a breast cancer integrated delivery system, and population management

Evaluación del centro de salud San Francisco de Asis: Informe final / Evaluation of the health center San Francisco de Asis: Final report

El centro de salud "San Francisco de Asis", viene prestando servicios de salud a la población de Villa el Carmen desde hace 15 años, en principio como centro de primer nivel y desde junio de 1994 es considerado centro de salud de segundo nivel (hspital de referncia) del distrito norte. Teniebdo en cuenta que a fines del año 1994 concluye el financiamiento a cargo de Medicus Mundi Navarra, esta institución conjuntamente con la de nuestro centro de salud, se han propuesto desarrollar un proceso conjunto de evaluacion-programación de las acciones desarrolladas...