ABSTRACT
INTRODUCCIÓN Fuertes desigualdades sociales atraviesan la prevención del cáncer de cuello uterino (CCU) y del cáncer de mama (CM). En los servicios públicos de atención primaria no funcionan programas preventivos de esas enfermedades. Las prácticas preventivas de las mujeres que asisten a esos servicios son menos frecuentes que las de las mujeres que se atienden en el subsistema privado y de la seguridad social. OBJETIVOS Indagar las opiniones de las mujeres acerca del CCU, el CM, el Pap y la mamografía, describir las prácticas preventivas y las experiencias de atención en las consultas ginecológicas y analizar los factores demográficos, socioculturales, económicos, políticos e institucionales que inciden en el acceso a las consultas ginecológicas, al Pap y a la mamografía. MÉTODOS Se realizó un estudio cualitativo basado en el análisis de fuentes primarias entrevistas semiestructuradas a mujeres de 18 años o más, pertenecientes a estratos socioeconómicos bajos y atendidas en los centros de salud y acción comunitaria (CESAC) de la Ciudad Autónoma de Buenos Aires. RESULTADOS Las mujeres tienen conocimientos abstractos acerca de la utilidad del Pap, y varias desconocen cómo se realiza la mamografía. Ninguna efectúa consultas ginecológicas preventivas. Demandan atención cuando están embarazadas o tienen algún problema de salud, ocasión en que se les realiza el Pap o un examen físico de mamas. El vínculo de confianza con los profesionales de salud y las redes de apoyo familiares intervienen también como facilitadores del acceso a las consultas ginecológicas, al Pap y a la mamografía. Los principales obstáculos son las dificultades para conseguir turnos y los prolongados tiempos de espera para la atención, entre otros factores. DISCUSIÓN Es necesario fortalecer la comunicación entre los profesionales y las mujeres para instalar la noción de prevención, implementar acciones para promover la demanda de consultas ginecológicas preventivas, mejorar los sistemas de acceso a los turnos y reducir los tiempos de espera para la atención.
Subject(s)
Breast Neoplasms , Uterine Cervical Neoplasms , Ambulatory Care FacilitiesABSTRACT
Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.â They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.
Subject(s)
Colorectal Neoplasms/diagnosis , Mass Screening/standards , Quality Assurance, Health Care , Early Detection of Cancer , Europe , Evidence-Based Medicine , HumansABSTRACT
INTRODUCCIÓN El cáncer cervicouterino (CC) es un grave problema de salud en Argentina, en parte debido a la baja participación de las mujeres en los programas de prevención. Los conocimientos sobre virus de papiloma humano (VPH) y CC de la población son limitados, y los significados atribuidos a la infección por VPH conllevan una carga estigmatizante, asociada a la promiscuidad y la infidelidad. Estos significados están atravesados por las desigualdades de género. La mujer suele ser culpabilizada, y la pareja puede constituirse en un factor obstaculizador para el acceso al tamizaje. OBJETIVOS Describir los conocimientos y significados asociados al VPH y al CC en un grupo de varones del barrio INTA de la Ciudad Autónoma de Buenos Aires (CABA). MÉTODOS Se realizó un estudio cualitativo con entrevistas semiestructuradas a una muestra intencional de 20 varones. Las entrevistas fueron sometidas al método de análisis de contenido. RESULTADOS De acuerdo con lo observado en el estudio, los varones suelen no involucrarse en temas relacionados con los controles de salud de las mujeres, adoptando una actitud de indiferencia; consideran que las mujeres son vulnerables ante las enfermedades ginecológicas y que padecen más riesgo las que llevan una vida sexual promiscua (prostitución, infidelidades). El Papanicolaou es un estudio medianamente divulgado entre los varones, pero la información que poseen continúa siendo vaga e imprecisa. El CC está asociado a la muerte y la fatalidad. Con respecto a las Infecciones de Transmisión Sexual, se considera a las mujeres como responsables de su transmisión. Por último, existe un desconocimiento generalizado sobre el VPH, que suele confundirse con el VIH. DISCUSIÓN os resultados de este trabajo concuerdan con la bibliografía previa, que revela una falta de conocimiento sobre el tema y una estigmatización de las mujeres, que puede actuar como obstaculizador del cuidado de su salud.
Subject(s)
Sexually Transmitted Diseases , Uterine Cervical Diseases , Health Knowledge, Attitudes, Practice , Papillomaviridae , MenABSTRACT
BACKGROUND: This study examines socio-demographic determinants of participation in a population-based randomized controlled trial that proved that oral visual inspection was effective in reducing oral cancer mortality in high-risk individuals in India. METHODS: Multivariate logistic regression was used to establish socio-demographic characteristics of participants versus non-participants in the intervention arm. Compliance with referral was analysed according to the socio-demographic characteristics of screen-positives. RESULTS: Of 96,517 eligible subjects, 87,655 were screened, 8688 individuals never received the invitation and 174 refused screening. Compared to the non-screened, a higher proportion of screened individuals were women (OR=4.51; CI: 4.28-4.75), lived in better housing (OR=1.35; CI: 1.25-1.41), had television/radio (OR=1.50; CI: 1.43-1.58) and were tobacco and alcohol users (OR=2.75; CI: 2.57-2.95). Being 65 and older decreased the chances of screening (OR=0.39; CI: 0.37-0.42), as well as living in high-size households (OR=0.73; CI: 0.68-0.78). Sixty-three percent of 5143 screen-positives complied with referral. Controlling for all other factors, individuals older than 44, and those with more advanced lesions were more likely to comply with referral (p<0.001). Individuals living in better housing were less likely to comply with referral (OR=0.79; CI: 0.65-0.95). CONCLUSIONS: In summary, adequate coverage can be obtained in population-based oral screening in developing countries. The study underscores the important role of patient-provider communication in assuring high compliance with referral.
Subject(s)
Developing Countries/statistics & numerical data , Mass Screening , Mouth Neoplasms/prevention & control , Patient Participation/statistics & numerical data , Adult , Age Factors , Aged , Demography , Female , Humans , India , Male , Middle Aged , Patient Compliance/statistics & numerical data , Referral and Consultation , Sex Factors , Socioeconomic FactorsABSTRACT
Underutilization of cervical cancer prevention services by women in the high-risk age group of 30-60 years can be attributed to health service factors (such as poor availability, poor accessibility, and poor quality of care provided), to women's lack of information, and to cultural and behavioral barriers. The Alliance for Cervical Cancer Prevention (ACCP) partners have been working to identify effective ways to increase women's voluntary participation in prevention programs by testing strategies of community involvement in developing countries. The ACCP experiences include developing community partnerships to listen to and learn from the community, thereby enhancing appropriateness of services; developing culturally appropriate messages and educational materials; making access to high-quality screening services easier; and identifying effective ways to encourage women and their partners to complete diagnosis and treatment regimens. Cervical cancer prevention programs that use these strategies are more likely to increase demand, ensure follow-through for treatment, and ultimately reduce disease burden.
Subject(s)
Community Health Services/statistics & numerical data , Uterine Cervical Dysplasia/prevention & control , Uterine Cervical Neoplasms/prevention & control , Women's Health Services/statistics & numerical data , Ambulatory Care , Female , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Humans , Kenya , Patient Compliance , TeachingABSTRACT
Cervical cancer is a significant health problem among women in developing countries. Contributing to the cervical cancer health burden in many countries is a lack of understanding and political will to address the problem. Broad-based advocacy efforts that draw on research and program findings from developing-country settings are key to gaining program and policy support, as are cost-effectiveness analyses based on these findings. The Alliance for Cervical Cancer Prevention (ACCP) has undertaken advocacy efforts at the international, regional, national, and local levels to raise awareness and understanding of the problem (and workable solutions), galvanize funders and governments to take action, and engage local stakeholders in ensuring program success. ACCP experience demonstrates the role that evidence-based advocacy efforts play in the ultimate success of cervical cancer prevention programs, particularly when new screening and treatment approaches-and, ultimately, radically new approaches such as a human papillomavirus vaccine-are available.