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- ItemSomente MetadadadosAções para o controle do câncer de mama entre usuárias da atenção primária em dois municípios da Amazônia ocidental(Universidade Federal de São Paulo (UNIFESP), 2020-03-05) Silva, Maria Susana Barboza Da [UNIFESP]; Gabrielloni, Maria Cristina [UNIFESP]; Universidade Federal de São PauloObjective: Evaluate the implementation of actions for early detection of breast cancer in Primary Health Care (PHC) by users of Basic Health Units (UBS) in two municipalities of Western Amazon. Method: Cross-sectional study. The sample consisted of 736 women from 35 to 69 years old, eligible UBS users. The collection took place in Family Health Strategy UBS from September / 2017 to March 2018, using a structured questionnaire, based on national protocols and guidelines published until 2015 as references. Statistical analysis was performed using the R® Core Team (2018) software, applying Chi-square or Fisher Exact tests, with a significance level of 5%. Results: Among the 736 women, 82.3% lived in the urban area, 40.1% were married, 76.4% of mixed race / brown color, 48.2% were illiterate or had not completed elementary school and 63.9% were from the city. class of. The frequency of breast examination in women at high risk and standard risk was 39.7% and mammography 42%. The adequacy of clinical breast examination reached 21% of women at risk for breast cancer. Proper mammography was performed in 66.7% in high-risk women and 5.8% in standard-risk women. Most women were instructed to have mammography after 40 years, consequently, the prevalence of annual mammographic examination was higher in women from 40 to 49 years. There was greater adequacy in the clinical examination of breasts and mammography in women with standard risk for breast cancer in Cruzeiro do Sul than in Rodrigues Alves, but this is much lower than recommended. Conclusion: In the socio-demographic characterization of the age groups, it was found that low education and income are more frequent in women from 50 to 69 years old than in women from 35 to 39 years old and from 40 to 49 years old, making them more vulnerable. socially. The early detection actions implemented are in disagreement with national recommendations, which may pose a higher risk to women. Given this, it is necessary to create strategies to increase the adherence of health professionals to government proposals, as well as continuous evaluation of actions performed in PHC services.
- ItemSomente MetadadadosAções para o controle do câncer de mama na atenção primária à saúde na perspectiva das usuárias(Universidade Federal de São Paulo (UNIFESP), 2019-09-28) Goncalves, Valterli Conceicao Sanches [UNIFESP]; Gutierrez, Maria Gaby Rivero De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Cancer is considered an important public health problem, due to its epidemiological, social and economic relevance, in both developed and developing countries. For early detection of this condition, the Ministry of Health recommends diagnostic and screening actions, making clear the need for the tripod: population warned of signs and symptoms; health professionals trained to evaluate suspected cases and health systems, and services prepared to ensure timely diagnostic confirmation, with quality and guarantee of comprehensive care throughout the care line. It is relevant to know preventive practices related to early detection and diagnosis, since this information can support the planning of effective strategies in Primary Health Care. Objective: To evaluate the implementation of opportunistic screening actions for breast cancer control, proposed by the Ministry of Health, in Primary Health Care, through information from users. Method: Cross-sectional study conducted in 18 BHUs in the municipality of Diadema, with 675 users, aged 35-69 years, from November 2014 to March 2015. It is linked to the multicenter project entitled “Actions on Breast Cancer Control: identification of practices in Primary Care” developed by the Nursing Schools of the Federal University of São Paulo (Paulista School of Nursing / UNIFESP) and the University of São Paulo - Ribeirão Preto College of Nursing (EERP-USP), which purpose is to portray the implementation of the actions recommended by the Ministry of Health for the screening of breast cancer among users of Primary Health Care. Used a validated questionnaire which was applied after approval of the UNIFESP Research Ethics Committee. The project was approved under CAAE No. 20021714.5.0000.5505. The collected data were analyzed descriptively and analytically. Results: Of the users, 50.5% declared to be white; 44.3% married; 32.2% said they were illiterate or had completed Elementary School. 61.6% belonged to social class C and 62.1% do not perform any paid activity. Most (83.8%) used exclusively Unified Health Care System services and only 16.2% had health insurance, using it for consultations and exams. As for the risk for breast cancer, 4.7% reported having family risk factor for the neoplasm and 63.1% said the health professional asked about family risk for breast cancer; 37.5% of users at high risk for breast cancer reported having undergone breast clinical examination annually; 20.9% of users aged 50 to 69 years and at population risk performed mammography. Only 8.7% of users reported having attended an educational meeting on breast cancer. Regarding the adequacy of the parameters established by the Consensus for mammography and clinical breast examination, rates of 8.9%, 10.6% and 7.7% were found for age groups 35 to 39, 40 to 49 and 50. to 60 years, respectively. Conclusion: the opportunistic screening actions for breast cancer, carried out by Primary Health Care, need to be adjusted to comply with the guidelines proposed by the Ministry of Health in all age groups studied.
- ItemSomente MetadadadosA prevalência da junção escamocolunar em laudos citopatológicos realizados em serviços de atenção primária à saúde(Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Tochetto, Liane De Oliveira Serra [UNIFESP]; Domenico, Edvane Birelo Lopes De [UNIFESP]; Universidade Federal de São PauloIntroduction: Cervical cancer is one of the tumors with the highest incidence in women, being the fourth more common worldwide and the third in Brazil. A considerable number of cases results from infections with the Human Papillomavirus, mostly located at the squamocolumnar junction (SCJ). Papanicolaou test is still the most accessible and one of the most efficient tests to obtain an accurate diagnosis, as long as epithelial samples, collected by means of a smear procedure, are satisfactory. Objectives: To identify the quality of the material collected for cancer cytology test by analyzing the prevalence of SCJ cells described in cervix cytopathological reports and verify the association between the prevalence of SCJ cells in cytopathological reports and the following variables: age, gestational status, inflammation, atrophy or atrophy with inflammation, microbiology, other cellular alterations, and professional who collected the sample. Methods: cross-sectional, descriptive, and quantitative study based on analysis of 1,251 reports of gynecological cancer cytology tests carried out at 16 Basic Health Units that offered services to the population in 51 neighborhoods in the Sapopemba administrative district of São Paulo, state of São Paulo, Brazil. The period for data collection was six months, from August 2018 to January 2019.Data were organized on the Visual Basic for Applications implementation and analyzed with the SPSS statistical software, version 20.0. The chi-squared test was used to analyze the association between two or more variables, and the test for equality of two proportions was used to compare answers for the same variable. The adopted level of significance was < 5%. Results: The epithelia that had more representativeness were the squamous (n=636; 50.8%) and the squamousglandular ones (n=368; 29.4%). The presence of SCJ was observed in 48.6% of the samples. The highest prevalence of SCJ was found in women between 25 and 39 years old (n=274; 56.1%; p<0.001). A statistically significant association was found between samples with the presence of SCJ and the fact that the material was collected by a nurse (n=510; 83.9%; p=0.022). Presence of SCJ was also associated with presence of inflammation (p=0.023), absence of atrophy (p<0.001), absence of atrophy/inflammation (p<0.001), presence of bacilli (p<0.001), absence of scarce flora (p=0.002), and presence of atypical cytology (p<0.001). Although cytological atypias were observed in only 4.8% of the reports with SCJ, there was a positive association between presence of these atypias and presence of SCJ (p<0.001). The association of presence of SCJ with moderate cytolysis (n=578; 95.1%; p<0.001) and with hypoestrogenism (n=594; 97.7%; p=0.02) was found, in addition to absence of SCJ and karyomegaly (n=640; 99.5%; p=0.014) and presence of erythrocytes (n=630; 98.0%; p<0.001). These data cannot be ignored, because these atypias can evolve into more serious alterations, and accurate diagnosis and preventive treatment could hinder the development of cervical cancer. Conclusion: The most important indicators in the determination of sample adequacy in cytopathological reports, representation of SCJ cells and presence of atypias, were found in numbers lower than expected, including in the group of women between 40 and 59 years old, which stressed the unsatisfactory quality of the performed cervical cancer screening.