Mastectomized women's perception of breast cancer early detection.

BACKGROUND: A third of new cases of breast cancer could be detected early, which would prevent more serious consequences, such as mastectomy and death. Access to the subjectivity of mastectomized patients becomes relevant to elucidate failures in early detection of breast cancer and thus improve the cancer care network. Given that, the present study aimed to identify mastectomized women's perception of the quality of care provided by the cancer care network for the early detection and diagnosis of breast cancer. METHODS: Qualitative study carried out at a public outpatient cancer center in the city of Fortaleza, Ceará, Northeastern Brazil, to analyze the perceptions of 26 women who had undergone mastectomy after breast cancer based on Symbolic Interactionism. RESULTS: The thematic analysis showed how women (re)structure their lives in the face of the structural and social aspects of coping with breast. Two essential themes emerged: "Contradictions regarding access to primary health care services and obstacles to the organization of SUS formal care network services" and "The informal and private health care network increase quality care coverage". CONCLUSIONS: The absence of effective measures in Primary Health Care and patients' 'pilgrimage' in the formal health care network have delayed early detection breast cancer.

Subjective well-being and oral discomfort in older people.

ABSTRACTBackground:The study aims to assess the relationship between oral discomfort and subjective well-being (SWB) in older people. METHODS: A quantitative cross-sectional study was conducted in four Reference Centers for Social Welfare in Fortaleza, Northeastern Brazil. A census was held and individual interviews were carried out with all the older people (n = 246) enrolled in the centers. A questionnaire addressing sociodemographic data (age, gender, marital status, income, and education) and oral discomfort (dry mouth, difficulty in chewing and swallowing food, problems with the taste of food, burning mouth sensation, pain for no apparent reason, and mouth swelling) and the 62-item SWB scale were used. RESULTS: Participants were 246 people aged 60-89 years (mean of 69 ± 6.9 years). The majority were women (n = 199; 80.9%), had incomplete primary education (n = 161; 65.4%), had an income of up to one minimum wage (n = 182; 74%), were retired (n = 169; 68.7%), were white (n = 100; 40.7%), and had no partner (n = 177; 72%). The mean SWB score (subscale 1) was associated with age (p = 0.010), gender (p = 0.019), health in the previous year (p = 0.027), systemic diseases (p = 0.007), speech problems (p = 0.016), vision problems (p = 0.006), number of teeth (p = 0.010), and dry mouth (p = 0.044). SWB (subscale 2) was associated with gender (p = 0.029), skin color (p = 0.023), general health (p < 0.001), health in the previous year (p < 0.001), systemic diseases (p = 0.001), drinking (p = 0.022), soft tissue problems (p = 0.001), and pain for no apparent reason (p = 0.025). CONCLUSION: The relationship between oral discomfort and SWB reveals that older people's poor oral health leads to physical, psychological, and/or social problems that directly interfere with their well-being.

Tools, strategies and qualitative approach in relation to suicidal attempts and ideation in the elderly.

The article analyses the quality and consistency of a comprehensive interview guide, adapted to study attempted suicide and its ideation among the elderly, and imparts the method followed in applying this tool. The objective is to show how the use of a semi-structured interview and the organization and data analysis set-up were tested and perfected by a network of researchers from twelve universities or research centers in Brazil, Uruguay and Colombia. The method involved application and evaluation of the tool and joint production of an instruction manual on data collection, systematization and analysis. The methodology was followed in 67 interviews with elderly people of 60 or older and in 34 interviews with health professionals in thirteen Brazilian municipalities and in Montevideo and Bogotá, allowing the consistency of the tool and the applicability of the method to be checked, during the process and at the end. The enhanced guide and the instructions for reproducing it are presented herein. The results indicate the suitability and credibility of this methodological approach, tested and certified in interdisciplinary and interinstitutional terms.

The influence of family problems and conflicts on suicidal ideation and suicide attempts in elderly people.

Family conflicts and problems involve meanings that are constructed during the course of an existence, and become associated with other factors in manifestations of suicidal thoughts and suicide attempts in elderly people. These questions are analyzed in a qualitative study of interviews with elderly people in four different locations in Brazil. A total of 63 men and women took part, and the interviews were held in 2013 and 2014. The field data showed the following factors - in order of the importance that the interviewees gave to them: significant family losses; family and inter-generation conflicts; and explicit and veiled violence. The speech of the subjects showed, as elements that led them to try to end their lives: sadness; feelings of abandonment; isolation, incomprehension of their desires by their family members, and absence of manifestations of affection and/or respect. When telling their stories, they also gave clues about what they expect from their families: welcome, acceptance, comprehension and freedom to carry out their minor wishes; to end their lives in a dignified manner without suffering; to find help and protection for the progressive reduction of their capacities; to continue to participate in family decisions, and to prolong to the maximum their social achievements and prerogatives, such as property, authority and respect.

Is it possible to overcome suicidal ideation and suicide attempts? A study of the elderly.

This study presents a qualitative analysis of how older people who had attempted suicide began to overcome the desire and the urge to take their own life. This article is based on a survey of 87 Brazilian men and women aged 60 and over, living in different regions of Brazil, who have demonstrated suicidal behaviour; twenty of whom gave important information about their coping strategies. The analysis in this article only refers to the aforementioned twenty participants. All the participants were heard through semi-structured interviews, which included questions about the process of overcoming suicidal ideation and suicide attempts. The central focus of the analysis - overcoming suicidal ideation and suicide attempts - was based on the following concepts: coping strategies, autonomy, and emotional balance. Irrespective of the gender of the respondents, five centers of meaning emerged from the discourses of the elderly, which highlighted the effectiveness of the following factors: religiosity and religious practices; social and family support; the support of health services; contact with pets; and the recovery of the autonomy to manage their own lives. This study can help to support the primary and secondary prevention of suicidal behavior in older people.

Factors associated to the imposition of types of violence against women informed in sentry services.

OBJECTIVE: to identify the prevalence and the factors associated to the imposition of the different types of violence against women informed in sentry services. METHOD: transversal study accomplished through 939 notification forms of cases of violence against women, referring to the three years from 2006 to 2008 in Fortaleza, Ceará. Univariate and multiple analyses by logistic regression were realized. RESULT: the results showed a positive association between the imposition of types of violence against women with a schooling varying from illiterate to basic education and the aggression which had occurred other times. CONCLUSION: this knowledge contributes to the delineation of specific actions that aim at facing this problem, as well as generates subsidies for adequate attendance proposals and guidance for the victims who call on health services.

Prevalence and factors associated with syphilis in parturient women in Northeast, Brazil.

BACKGROUND: Congenital syphilis is a major public health concern, even after the implementation of intervention protocols in several countries. This study aimed to analyze the prevalence and socio-demographic, behavioral and institutional factors associated with syphilis in parturient women attending public maternity hospitals in Northeast, Brazil. METHODS: A cross-sectional study was conducted from June to September 2010 with a proportionate stratified sampling of 222 parturient women using a structured questionnaire. The study analyzed socio-demographic, behavioral and institutional variables. The structured questionnaire was conducted with parturient women and complementary information was obtained through hospitals records, admission forms and prenatal cards. Data were stored using the Statistical Package SPSS version 18. A descriptive statistical analysis was performed using frequency distribution, central tendency and measures of spread for the variables. A bivariate analysis was done using chi square test and Fisher's exact test, with a significance level of 5% and a 95% confidence interval, in order to analyze the relation between the variables and risk factors for syphilis. The multivariate logistic regression analysis was done in the statistical package STATA, version 11.0. RESULTS: The prevalence of syphilis in parturient women was 7.7%. The bivariate analyses showed that the rate was higher among women who: were from Fortaleza (p = 0.019), studied for less than nine years (p = 0.044), had more than one sexual partner in life (p = 0.021), did not live with partner (p = 0.022), used illegal drugs (p < 0.0001), whose partner used illegal drugs and had diagnosis of syphilis (p = 0.001 and p < 0.0001 respectively). The non-adjusted analysis found significant positive association between syphilis and the following variable: being from Fortaleza (OR = 7.26; CI 95% = 1.49-100.20), having studied for less than nine years (OR = 7.97; CI 95% = 0.87-12.89), having more than one sexual partner in life (OR = 3.75; CI 95% = 1.59-107.11), not living with partner (OR = 3.75; CI95% = 1.03-12.15), and parturient women and partner used illegal drugs (OR = 7.34; CI95% = 1.69-27.57; OR = 4.93; CI95% = 1.58-16.05), respectively. The adjusted multiple logistic regression analysis showed that none of the variables remained significant. CONCLUSION: This study enabled to identify a high prevalence of syphilis in parturient women and that this situation is associated with socio-demographic, behavioral and institutional variables.

[The family planning of women with mental disorders: what CAPS professionals have to say]. / Planejamento familiar de mulheres com transtorno mental: o que profissionais do CAPS têm a dizer.

The objective of this study was to explore the family planning demands that occur at the Psychosocial Care Center (Centro de Atendimento Psicossocial - CAPS) and investigate the contributions of this service to women with mental disorders. This qualitative study was performed with eight workers from a CAPS located in Fortaleza-CE. Data collection was performed through interviews, and the data were submitted to content analysis. The following demands were identified: relatives' request for information on how to cope with a sexually active patient; patients susceptible to sexual violence and pregnancy; and women with depression taking lithium carbonate. Contributions identified were: the need for an integrated network (primary healthcare/CAPS) with professionals who understand the complexities regarding these women's family planning; supportive care should be provided in the primary healthcare setting, emphasizing matrix organization as a strategy to make both centers co-responsible, thus avoiding unnecessary patient referrals to the CAPS by strengthening the ability to deal with these cases in the primary healthcare setting.

Sexually transmitted infections associated syndromes assisted in the primary health care in Northeast, Brazil.

BACKGROUND: The lack of information on the care for sexually transmitted infections (STI) associated syndromes may contribute for its non-inclusion as prevention and control strategy for STI in Brazil. This study aims to analyze the cases of STI - Associated Syndromes assisted in primary health care center in a city in Northeast Brazil associating them with socio-demographic and behavioral variables. METHODS: This is a retrospective study that analyzed 5148 consultation forms and medical records of patients assisted in a primary health care center who presented at least one genital syndrome from 1999 to 2008. Was considered as dependent variables the genital syndromes and serologies for syphilis and HIV and as independent variables the socio-demographic and behavioral aspects. It was used Pearson's chi-square test to analyze the differences between the categorical variables, with a significance level of 5%. It was performed a multivariate analysis through the multivariate logistic regression model with the variables with p <0.05. We used odds ratio with a confidence interval of 95%. RESULTS: The most frequent syndromes were vaginal discharge and/or cervicitis (44%) and genital wart (42.2%). Most people were between 20 and 39 years old (70%) and women (74.2%). Genital ulcer was most prevalent among men (OR = 2.67; CI 95% 1.99-3.58) and people who studied more than eight years (OR = 1.33; CI 95% 1.00-1.75) and wart prevailed among men (OR = 3.92; IC 95% 3.36-4.57), people under 29 years old (OR = 1.81; CI 95% 1.59-2.07) and who studied more than eight years (OR = 1.75; CI 95% 1.54-1.99). The Venereal Disease Research Laboratory (VDRL) was positive in 7.3% of men and in 7.1% of women and the Anti-HIV in 3.1% of men and 0.7% of women. CONCLUSION: Vaginal discharge was the most frequent syndrome assisted in primary health care, followed by genital wart. The high prevalence of genital wart justifies the greater effort for the proper follow-up of these cases. Men presented more genital wart and ulcer and reported having more sexual partners, showing their need for a greater access and inclusion in health activities developed in primary health care in Brazil.

[Family planning: significance for women of reproductive age]. / Planejamento familiar: significado para mulheres em idade reprodutiva.

The study sought to comprehend the significance of family planning from the standpoint of women of reproductive age and identify their perceptions about the care received and the partner's participation in the decisions about the use of contraceptive methods. It is a descriptive study using a qualitative approach, conducted with 24 women who participated in the Family Planning program in a Basic Family Health Unit in Fortaleza, State of Ceará, Brazil, between August and October 2007. The information gleaned from interviews was recorded, organized into themes and analyzed on the basis of the concept of significance of symbolic interactionism. The results revealed three significant themes: the significance of family planning from the viewpoint of women of fertile age; interactions of women of fertile age in a family planning service; and male participation in family planning in terms of female significance. It was revealed that the significance of family planning for these women is related to avoiding pregnancy and according to values pertaining to their cultural, economic and social reality. The care is received in an isolated manner, without prioritizing women's needs and without input of an educational or empowerment stamp.

[Lactational amenorrhea: nurses experience and the promotion of this alternative method of contraception]. / Lactação com amenorréia: experiência de enfermeiros e a promoção dessa opção contraceptiva.

This is a cross-sectional, field study that used a quantitative approach with the objectives to identify nurses' personal experiences with breastfeeding and with the Lactactional Amenorrhea Method (LAM); learn the reasons for not adhering to breastfeeding or adhering to mixed feeding; establish the relationship between nurses' personal experience with the LAM and their giving orientations about this contraceptive method to users of the Primary Health Care Center. Participants were 137 nurses with the Family Health Strategy in Fortaleza, Ceará, Brazil, and data collection was performed through interviews. Most participants were female; i.e., 121 participants (88.3%). The age range was 26 to 59 years, with an average of 38.3 years. Sixty-six participants (94.2%) had a previous experience with breastfeeding, 61 (92.4%) of which adhered to Exclusive Breastfeeding (EB), 5 (7.6%) to Mixed Feeding (MF); and 4 (5.8%) did not breastfeed. The time of EB ranged from one to six months, with an average 4.31 months. Twelve nurses (19.6%) followed the LAM. The study showed that the nurses' personal experience with the LAM did not affect the promotion of this method to the clientele that they assist.

[Understanding the user's health behavior change through their participation in the Family Health Program]. / Compreensão das mudanças comportamentais do usuário no Programa Saúde da Família por meio da participação habilitadora.

This study aimed to understand how users from Family Health Program (FHP) make their decision about health-illness. It was used the Stages of Change Model from Prochaska and DiClemente to identify the level of change of FHP users. It was a qualitative research developed with users and FHP health professionals from Crato, Ceará State, Brazil. The data were collected by semi-structured interviews, focal group and observation from May to September in 2005. They were organized by means of content analysis and analyzed in the light of theoretical reference. The changes of the FHP users are depicted as following: in the pre-contemplation stage the emphasis is on disease and care itself. In the contemplation stage, the care is on the family. It is centred in the cure and treatment of diseases. In the determination stage, we have some improvement concerning prevention in the family, with registers of looking around. In the action stage, behaviour from the user to reach autonomy and emancipation is registered. These results seem to indicate ascendency in FHP users' learning and participation towards health promotion.

Nursing communication in nursing care to mastectomized women: a grounded theory study.

The goal was to understand the nurse/patient communication process, emphasizing nursing care to mastectomized women. Symbolic Interactionism and Grounded Theory were used to interview eight nurses from a referral institution in cancer treatment, using the guiding question: how do nurses perceive their communication process with mastectomized women? Data analysis allowed for the creation of a central theory: the meaning of communication in nursing care to women, constituted by three distinct but inter-related phenomena: perceiving communication, the relationship nurse/mastectomized woman and rethinking the communication nurse/mastectomized woman. With a view to satisfactory communication, professionals need to get involved and believe that their presence is as important as the performance of technical procedures that relieve situations of stress.

Symbolic violence experienced by men who have sex with men in the primary health service in Fortaleza, Ceará, Brazil: negotiating identity under stigma.

In Brazil, the inclusion of minorities and the most vulnerable members of the population in the health service is still a challenge for health planners. This study analyzed the perception of men who have sex with men (MSM) treated in health units with the onset of a sexually transmitted disease (STD). It consists of qualitative research involving 21 MSM, contacted in a non-governmental organization (NGO) and in the Testing and Counseling Center (TCC) in Fortaleza, Ceará, Brazil. The data were collected during two periods: from February until May 2007 and from September until October 2008 by using focused interview, and were organized by subject matter according to the content analysis technique of Bardin. The references to the theoretical concepts of the symbolic violence by Bourdieu and stigma by Goffman were the foundation for the analysis. The results indicate that MSM experienced situations of symbolic violence and avoided seeking primary health care service fearing prejudice and being stigmatized. Even when they sought these services, they tended to demonstrate masculine behavior in order to not be indentified as to their sexual orientation. We concluded that MSM feel excluded and discriminated against in the primary health care service. More studies related to this subject matter are needed to help implement health care policies facilitating the inclusion of and to welcome this group of the population into the general health care service.

[Breast self-examination by nursing professionals]. / Realização do auto-exame das mamas por profissionais de enfermagem.

Most breast tumors are detected by women, not health professionals, therefore breast self-examination (BSE) continues to be an efficacious strategy. The study objective was to analyze BSE performed by nursing professionals and factors that hinder their perseverance in this practice. This descriptive study was performed with 159 professionals: 40 nurses, 48 nurses aides, and 71 health agents from 19 Basic Health Units located in Fortaleza (Ceará, Brazil). Data collection was performed using a self-administered questionnaire, and the analysis was based on the Self Care Theory. Of the 159 professionals, 86 (54%) performed BSE on a monthly basis. Of the 73 professionals who did not perform BSE, 60 (82%) reported the reason for that was forgetting, 38 (52%) for not trusting the technique/did not know the correct technique, and 35 (48%) due to lack of health care. It was found that although most women reported performing BSE, the professionals felt insecure and would like to learn better about this technique.

[Quality of life in the perception of women participating in educative workshops about back pain]. / Percepção sobre qualidade de vida de mulheres participantes de oficinas educativas para dor na coluna.

The aim of this study was to analyze how women with back pain perceived their quality of life after having attended educational workshops on back pain directed to self-care and prevention. This qualitative study was conducted in a Higher Education Institution in Fortaleza, Ceará, Brazil, during the months April and May 2005, using a sample of nine women who had concluded eight workshops. The focal group method was selected for data collection, and the sessions were filmed and recorded. Data were grouped into categories and sequentially analyzed. All women thought they had a good quality of life, independently of having a poor health, no money and no a job. All this was overcome by their faith in God. All women reported that, before the workshops, the pain had interfered in their daily and social lives and that, after the intervention, the pain had calmed down or disappeared. The awareness of self-care provided physical, intellectual and emotional well being, improved mobility and decision-making and allowed them to return to their activities. Besides, it helped to eliminate or reduce pain medication. The study made us realize the importance of evaluating the quality of life in order to guide us in the choice of the most effective therapeutic measures.

Participating in a support group: experience lived by women with breast cancer.

The goal of the study was to understand the meaning of support groups in the life of women with breast cancer. It is a qualitative study with 30 mastectomized women who belonged to six support groups in the city of Fortaleza, Ceará. Data were collected with semi-structured interviews, organized and analyzed based on the interactionism concept. The results characterized the support groups as a mechanism to cope with the situation and to overcome the suffering derived from the diagnosis and treatment of the breast carcinoma. The socialization of the experiences facilitated the search for assistance in the support groups, since sharing the problems with mastectomized women was a way to preserve a high self-esteem, have faith and overcome some difficulties. Participating in the group provided well-being and a differentiated care, since it was considered a way to know, accept and understand the disease and its cure, facilitating the socialization of ideas.

[Common sense, science and philosophy: the links of knowledge necessary for promoting health care]. / Senso comum, ciência e filosofia: elo dos saberes necessários à promoção da saúde.

In its evolution, humanity has accumulated data which were systematized as knowledge. Philosophy through self examination helps us in its practical and theoretical functions to reach a concept of the universe. Common sense helps science evolve. People's daily difficulties stir up the need for research, for deepening data interpretation and to propose solutions to overcome the population's problems. Science exists to explain difficult aspects of common sense, to support questions, as well as to substantiate knowledge produced as a response to demands. Thus, knowledge involved in this reflection sets out to foster an articulation between basic forms of knowledge and to develop a satisfactory understanding of the health care process, through a shared and critically consciousness view of the changes in the health system's paradigm. We understand that health education is an essential component within this process, provided that it is focused primarily on an individual belonging to a community with its multiple relationships, especially between the community context and the subjective dimension, which can provide citizenship empowerment redemption.

[Self-care practice lived by hypertensive woman: analysis on the health education focus]. / Prática do autocuidado vivenciada pela mulher hipertensa: um análise no âmbito da edução em saúde.

This study approached the practice of self care lived by the women that suffer with high blood pressure. Descriptive-exploratory study which was inspired on the Orem's self-care theory and developed with 200 women who presented high blood pressure at a Public Health Agency, located in Fortaleza, Ceará, Brazil. The data were collected during nursing encounters, organized in categories, and analyzed according to the fundaments of the referred Theory. In this surveyed sample, about 172 (86%) women found out that they had high blood pressure problems by means of signs and symptoms related to the "climateric". It was evidenced on the women interviewed, that they presented knowledge knowledge about this syndrome, partial adherence to the treatment, and consequently inefficient practice of self-care, related to this deficit. In this way, it is possible to conclude that the self-care practice was influenced by the age, by disease stage development, and by the social, economic and health problems.

[Breast cancer: how women think and what they do]. / Câncer de mama: o pensar e o fazer das mulheres.

Changes brought about by the diagnosis and treatment of cancer always cause psychological, social, cultural, economic and spiritual disorders. We have tried to understand the significance of breast cancer for women and to find out what they do in order to detect it in an early stage. We have randomly chosen thirty-four women who went to a cancer prevention centre in the town of Fortaleza. We have carried out clinical examinations of the breasts, taught the circular self-examination technique and observed how the technique was learnt. We have analysed the results by means of an interactionist approach, and they have been organised according to their significance and to the development of early detection actions. We have concluded that women perceive cancer as a possibility of loss and death and make associations between people or past events and real or imaginary causes. Some of them perform early detection procedures, but the lack of information on the disease is evident, which makes it unfeasible to control breast cancer.