Differentiated thyroid cancer clinical trends in Quito, Ecuador / Tendencias clínicas del cáncer diferenciado de tiroides en Quito, Ecuador

Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found. Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found.

Introducción. El cáncer de tiroides es actualmente el cáncer más frecuente en la mujer en Ecuador. El presente estudio ha tenido como objetivo evaluar los cambios en la presentación clínica y el diagnóstico del cáncer diferenciado de tiroides en un hospital de tercer nivel de Quito, Ecuador. Material y Métodos. El presente es un estudio retrospectivo de casos realizado en tres períodos consecutivos desde 1990 a 2019 en un hospital del tercer nivel en Quito, Ecuador. Los expedientes clínicos de 875 pacientes tratados quirúrgicamente por un cáncer diferenciado de tiroides fueron revisados. Los datos demográficos, clínicos, de imagen y patología fueron extraídos y analizados. Resultados. Se encontraron tendencias significativas hacia una edad más avanzada, nivel educativo más alto, menos tumores palpables, menos adenopatías regionales palpables, menos metástasis a distancia, más exámenes de ultrasonido y tomografía, más estudios de citología, más tumores pequeños y pacientes con estadío I y más descripciones de las variantes histológicas. Conclusiones. El cáncer de tiroides no sólo que ha aumentado continuamente en su frecuencia en los años recientes, sino que la presentación clínica, el manejo diagnóstico y terapéutico ha cambiado significativamente en las tres últimas décadas.

Frecuencia de la mamografía, ecografía, examen clínico y autoexamen de mama en población general / Frequency of mammography, ultrasound, clinical breast exam and self-exam in the general population

Introducción. El cáncer de mama es el cáncer que más afecta a las mujeres. Se estima que 1 en 8 mujeres desarrollarán cáncer de mama eventualmente. Una de las herramientas contra el cáncer de mama es crear estrategias de detección temprana de la enfermedad, y la mamografía ha demostrado ser de mucha utilidad. El objetivo del estudio fue determinar la frecuencia de la mamografía, ecografía, examen clínico y autoexamen mamario, y evaluar su uso como pruebas de tamización para cáncer de mama en una cohorte de pacientes atendidas en la Clínica del Prado en Medellín, Colombia. Metodología. Estudio descriptivo, transversal, efectuado a través de encuesta en 318 usuarias atendidas entre junio y diciembre de 2018. Se estimó la frecuencia de los diferentes métodos de tamización y se evaluaron las características sociodemográficas, antecedentes personales y antecedentes familiares. Adicionalmente, se buscó si había asociación significativa entre la práctica de la mamografía como prueba de tamización y las variables de estudio. Resultados. La media de la edad fue de 44,2 años. El método de tamización más usado fue el autoexamen (70,1%), en su mayoría mensual (76,7%), seguido por la mamografía (56%), en su mayoría ocasional (46%). El examen clínico de mama (ECM) se utilizó en el 45,9% de las pacientes, con una frecuencia anual en el 50% de ellas. Por último, la ecografía de mama se practicó en el 43,1% de las encuestadas, con una frecuencia en su mayoría ocasional (39,4%). Se realizó un análisis independiente para mujeres entre los 50 y 69 años, y aunque el 93,8% se habían realizado la mamografía, solo el 9,3% lo hizo bienal, como lo recomienda el Ministerio de Salud y Protección Social. No se hallaron diferencias estadísticamente significativas entre las variables de estudio y la realización de la mamografía como método de tamización. Conclusión. En la población estudiada, el autoexamen de mama es realizado por la mayoría de las mujeres con una frecuencia mensual. La frecuencia de la mamografía, el ECM y la ecografía de mama fue muy similar, y se esperaba encontrar un mayor porcentaje de mamografías realizadas como prueba de tamización. Se requiere fortalecer esta estrategia efectiva para la detección temprana de cáncer de mama, teniendo en consideración la situación particular de cada paciente, la efectividad y beneficio de la técnica, así como los costos asociados

Breast cancer is the most frequent cancer that affects women. It is estimated that 1 in 8 women will eventually develop breast cancer. One of the tools against breast cancer is to create early detection strategies, and mammography has proven to be very useful. The aim of this study was to determine the frequency of mammography, ultrasound, clinical breast exam and self-exam, and to evaluate their use as screening tests for breast cancer in a cohort of patients that attended at the Clinica del Prado in Medellin, Colombia. Methodology. Descriptive, cross-sectional study, carried out through a survey in 318 women between June and December 2018. The frequency of the different screening methods was estimated and the sociodemographic characteristics, personal history and family history were evaluated. Additionally, a possible association between the practice of mammography as a screening test and the different variables was analyzed. Results. Mean age was 44.2 years. The most used screening method was the self-exam (70.1%), mostly monthly (76.7%), followed by mammography (56%), mostly occasional (46%). The clinical breast exam was used in 45.9% of the patients, with an annual frequency in 50% of them. Lastly, breast ultrasound was performed in 43.1% of those surveyed, mostly occasional (39.4%). An independent analysis was carried out for women between 50 and 69 years old, and although 93.8% had mammograms, only 9.3% had them every 2 years, as recommended by the Ministry of Health and Social Protection guidelines. No statistically significant differences were found between the study variables and the use of mammography as a screening method. Conclusion. In the studied population, breast self-exam is performed by most women on a monthly basis. The frequency of mammography, clinical breast exam and ultrasound was very similar. A higher percentage of mammograms performed as a screening test was expected. It is necessary to strengthen this effective strategy for the early detection of breast cancer, taking into consideration the particular situation of each patient, the effectiveness and advantages of the technique, and the associated costs

Factores de riesgo, conocimiento y práctica de tamizaje para cáncer de mama en consulta externa / Risk factors, knowledge and practice of screening for breast cancer in outpatient clinic

Introducción. El cáncer de mama es el segundo cáncer más frecuente a nivel mundial. En Honduras sigue siendo la principal causa de cáncer en las mujeres. Hay factores de riesgo modificables y no modificables. Las pruebas de tamizaje disponibles para detectarlo son: mamografía, ultrasonido, re- sonancia magnética, tomo síntesis y autoexamen de mama. Objetivo. Describir los factores de riesgo y evaluar el conocimiento sobre práctica de tamizaje para la detección del cáncer de mama de las mujeres que asisten a la consulta externa del Hospital Nacional Mario Catarino Rivas (HMCR) de di- ciembre 2019 a enero 2020. Pacientes y métodos. Estudio cuantitativo, descriptivo y transversal con una muestra por conveniencia de 100 mujeres que asistieron a la consulta externa el 19 de diciembre del 2019 y 16 de enero 2020 entre las 8 a.m. y 12m en el HMCR. Se aplicó un cuestionario antes y después de una charla educativa sobre conocimiento y pruebas de tamizaje para cáncer de mama. Se procesaron los datos en Excel® 2013 y SPSS® V.22. Resultados. El 55% tenía entre 41-60 años. El 79% tenía un índice de masa corporal mayor a 25. El 45% refirió consumo de anticonceptivos orales alguna vez en su vida. El 41% conocía menos o igual a 3 métodos de tamizaje. El 65% se había reali- zado el autoexamen de mama, pero sólo el 29% se lo hacía una vez al mes. Conclusión. La mayoría de la población encuestada tenía más de 3 factores de riesgo para cáncer de mama. Las pruebas de tamizaje más conocidas fueron la mamografía y autoexame...(AU)

Educação em saúde e prevenção do câncer de mama no município de Itaúna, Minas Gerais / Health education and breast cancer prevention in the city of Itaúna, Minas Gerais / Educación en salud y prevención del cáncer de mama en la ciudad de Itaúna, Minas Gerais

Objetivo: Relatar a experiência de ações educativas realizadas com profissionais da Estratégia de Saúde da Família, sobre a prevenção do câncer de mama e o incentivo ao autoexame. Métodos: Trata- se de um estudo descritivo, do tipo relato de experiência, realizado com 28 profissionais da saúde no município de Itaúna, Minas Gerais, entre setembro à outubro de 2019. Foi utilizado um questionário de pré e pós-intervenção para comparar conhecimentos prévios e adquiridos, além de uma atividade prática de palpação em próteses de mamas. Resultados: Houve predominância de participantes com idade entre 31 a 38 anos (35,71%), seguida de profissionais entre 23 a 30 anos (32,14%). Os resultados mostraram que 60,71% dos participantes relataram ter conhecimento sobre o assunto, 28,57% afirmaram não saber do que se trata e 10,72% não responderam a essa questão. Conclusão: A intervenção aplicada serve de base para que estes profissionais disseminem os novos saberes para população.(AU)

Objective: To report the experience of educational actions carried out with professionals from the Family Health Strategy, on the prevention of breast cancer and the encouragement of self-examination. Methods: This is a descriptive, experience report type study conducted with 28 health professionals in the city of Itaúna, Minas Gerais, between September and October 2019. A pre- and post-intervention questionnaire was used to compare knowledge and acquired, in addition to a practical palpation activity on breast prostheses. Results: There was a predominance of participants aged between 31 and 38 years old (35.71%), followed by professionals between 23 and 30 years old (32.14%). The results showed that 60.71% of the participants reported having knowledge about the subject, 28.57% said they did not know what it was about and 10.72% did not answer this question. Conclusion: The applied intervention serves as a basis for these professionals to disseminate new knowledge to the population.(AU)

Objetivo: Informar sobre la experiencia de las acciones educativas llevadas a cabo con profesionales de la Estrategia de Salud de la Familia, sobre la prevención del cáncer de mama y el fomento del autoexamen. Métodos: Este es un estudio descriptivo tipo informe de experiencia realizado con 28 profesionales de la salud en la ciudad de Itaúna, Minas Gerais, entre septiembre y octubre de 2019. Se utilizó un cuestionario previo y posterior a la intervención para comparar el conocimiento. y adquirido, además de una práctica actividad de palpación en prótesis mamarias. Resultados: predominaron los participantes de edades comprendidas entre 31 y 38 años (35,71%), seguidos por profesionales de entre 23 y 30 años (32,14%). Los resultados mostraron que el 60.71% de los participantes informaron tener conocimiento sobre el tema, el 28.57% dijo que no sabían de qué se trataba y el 10.72% no respondió a esta pregunta. Conclusión: La intervención aplicada sirve como base para que estos profesionales difundan nuevos conocimientos a la población.(AU)

Caso Clínico: Enfermedad de Paget del Pezón / Clinical Case Report: Paget's Disease of the Nipple

INTRODUCCIÓN: La enfermedad de Paget del pezón es infrecuente y representa del 1 al 3 % de las neoplasias de mama. Está asociada con un carcinoma invasivo o in situ en el 82 al 94 % de los casos. Se presenta entre los 55 a 64 años de edad. CASO CLÍNICO: Se presenta el caso de una mujer de 58 años con zona de descamación de 1 cm2 indolora en pezón derecho y tumor de 4 cm2 en mama izquierda, ecografía y mamografía BI-RADS III. Biopsia incisional de pezón derecho que reportó enfermedad de Paget, con ampliación de márgenes. Se completó estudios de extensión con resonancia magnética que reportó lesión retro-areolar sospechosa en mama derecha y lesión nodular maligna en mama izquierda. EVOLUCIÓN: Se realizó cuadrantectomía central más neo-pezón en mama derecha, y en mama izquierda cuadrantectomía superoexterna con vaciamiento ganglionar axilar bilateral, el reporte de patología fue mama derecha negativa para malignidad, mama izquierda hiperplasia intraductal atípica con focos de carcinoma intraductal. Se administró 25 sesiones radioterapia, tras un año de seguimiento se mantiene sin recurrencia. CONCLUSIÓN: La enfermedad de Paget es poco frecuente, pero debe considerarse como diagnóstico diferencial en pacientes sobre los 55 años, su tratamiento estandarizado es quirúrgico, la adyuvancia con radioterapia aún es motivo de discusión. El autoexamen de mama, el acudir a controles periódicos a partir de los 40 años además de realizar una ecografía y mamografía nos lleva a diagnósticos tempranos con un elevado porcentaje de cirugías más conservadoras.(au)

BACKGROUND: Paget's disease of the nipple is uncommon and represents 1 to 3% of breast malignancies. It is associated with invasive or in situ carcinoma in 82 to 94% of cases. It occurs between 55 to 64 years old. CASE REPORT: We present the case of a 58 year old woman with a painless 1cm2 scaling skin lesion in the right nipple and a 4cm2 tumor in the left breast, ultrasound and mammograghy classified as BIRADS III. Incisional biopsy of the right nipple that reported Paget's¬ disease, with extension of surgical margins of resection. MRI extension studies were made; they reported suspicious retroaereolar lesion in the right breast and malignant nodular lesion in the left breast. EVOLUTION: We performed central quadrantectomy with nipple reconstruction in the right breast, and superoexternal quadrantectomy in the left breast, with bilateral axillary lymph node dissection, the pathology report was negative for malignancy in the right breast, in the left breast atypical intraductal hiperplasia with foci of intraductal carcinoma. The patient received 25 radiotherapy sessions. After one year of follow-up there is no recurrence. CONCLUSIONS: Paget's disease is rare, but should be considered as a differential diagnosis in patients over 55 years, its standardized treatment is surgery, adjuvant treatment with radiotherapy is still a matter of discussion. Breast self-exam, regular checkups in people over 40 years old, ultrasound and mammogram lead to early diagnosis with a higher percentage of conservative surgeries.(au)

Design and Validation of a Computer Application for Diagnosis of Shoulder Locomotor System Pathology / 대한의료정보학회지

OBJECTIVES: To design and validate a computer application for the diagnosis of shoulder locomotor system pathology. METHODS: The first phase involved the construction of the application using the Delphi method. In the second phase, the application was validated with a sample of 250 patients with shoulder pathology. Validity was measured for each diagnostic group using sensitivity, specificity, and positive and negative likelihood ratio (LR(+) and LR(−)). The correct classification ratio (CCR) for each patient and the factors related to worse classification were calculated using multivariate binary logistic regression (odds ratio, 95% confidence interval). RESULTS: The mean time to complete the application was 15 ± 7 minutes. The validity values were the following: LR(+) 7.8 and LR(−) 0.1 for cervical radiculopathy, LR(+) 4.1 and LR(−) 0.4 for glenohumeral arthrosis, LR(+) 15.5 and LR(−) 0.2 for glenohumeral instability, LR(+) 17.2 and LR(−) 0.2 for massive rotator cuff tear, LR(+) 6.2 and LR(−) 0.2 for capsular syndrome, LR(+) 4.0 and LR(−) 0.3 for subacromial impingement/rotator cuff tendinopathy, and LR(+) 2.5 and LR(−) 0.6 for acromioclavicular arthropathy. A total of 70% of the patients had a CCR greater than 85%. Factors that negatively affected accuracy were massive rotator cuff tear, acromioclavicular arthropathy, age over 55 years, and high pain intensity (p < 0.05). CONCLUSIONS: The developed application achieved an acceptable validity for most pathologies. Because the tool had a limited capacity to identify the full clinical picture in the same patient, improvements and new studies applied to other groups of patients are required.

Factors Affecting Breast Self-examination Behavior Among Female Healthcare Workers in Iran: The Role of Social Support Theory / 예방의학회지

OBJECTIVES: In women, breast cancer is the most common cancer and the leading cause of cancer death. Screening tests are the basis for early diagnosis. In Iranian women, the mortality rate of breast cancer is high due to insufficient screening examinations and delayed visits for care. Therefore, this study aimed to determine the factors affecting breast self-examinations among Iranian women employed in medical careers. METHODS: This cross-sectional study included 501 women working in the medical professions at Hamadan University of Medical Sciences in western Iran in 2018. The subjects were selected by stratified random sampling. Data were collected using a researcher-developed, self-report questionnaire that contained demographic information and questions based on protection motivation theory and social support theory. Descriptive data analysis was conducted using SPSS version 23 and model fitting with PLS version 2. RESULTS: The mean age of the participants was 37.1±8.3 years, and most of the women (80.4%) were married. Most women had a bachelor's degree (67.5%). The findings of this study showed that the coping appraisal construct was a predictor of protection motivation (β=0.380, p<0.05), and protection motivation (β=0.604, p<0.05) was a predictor of breast self-examination behavior. Additionally, social support theory (β=0.202, p<0.05) had a significant positive effect on breast self-examination behavior. CONCLUSIONS: The frequency of practicing self-examinations among women employees in the medical sector was low; considering the influence of social support as a factor promoting screening, it is necessary to pay attention to influential people in women's lives when designing educational interventions.

Adopción e implementación del ofrecimiento de la autotoma VPH por agentes sanitarios en Jujuy, Argentina / Adoption and implementation of HPV self-collection sampling by CHWs in Jujuy, Argentina

Resumen: Objetivo: Evaluar la adopción e implementación en escala de la estrategia orientada a ofrecer puerta a puerta la autotoma de la prueba del virus del papiloma humano (AT-VPH), por parte de agentes sanitarios (AS), en Jujuy, Argentina. Material y métodos: Se aplicó una encuesta autoadministrada a 478 AS. Las dimensiones de adopción e implementación fueron evaluadas con el modelo RE-AIM. Resultados: Adopción: 81.8% de los AS ofreció la AT-VPH y 86.4% expresó gratificación con la estrategia. Implementación: los problemas encontrados fueron la demora en la entrega de tubos (61.3%) y resultados (70.0%); falta de recursos humanos (28.3%), y dificultades al obtener turnos para realizar el triage (26.1%). El principal obstáculo fue la sobrecarga de trabajo (50.2%), mientras que la capacitación (38.0%) y el listado de mujeres a contactar (28.7%) fueron los elementos facilitadores. Conclusiones: La adopción de la AT-VPH fue alta entre los AS. Deben reforzarse las estrategias programáticas para motivar a los AS y reducir su carga de trabajo al implementar la AT-VPH.

Abstract: Objective: To evaluate adoption and implementation of scaling up of HPV self-collection (SC) strategy offered door-to-door by Community Health Workers (CHWs) in Jujuy, Argentina. Materials and methods: A self-administered questionnaire was applied to 478 CHWs. RE-AIM model was used to evaluate adoption and implementation dimensions. Results: Adoption: 81.8% offered SC and 86.4% were satisfied with the strategy. Implementation: main problems were delays in the delivery of tubes (61.3%) and results (70.0%), lack of human resources (28.3%) and difficulties in obtaining an appointment for triage (26.1%). The main obstacle was the excessive workload of CHWs (50.2%). Training (38.0%) and the list of women to be offered the test (28.7%) were identified as facilitators. Conclusions: The adoption of SC strategy was high among CHWs. Program strategies should be strengthened to motivate and reduce the excessive workload of CHWs when implementing SC strategy.

Nuevas estrategias de prevención y control de cáncer de cuello uterino en Chile / New strategies for the prevention and control of cervical cancer in Chile

Resumen: Objetivos: Discutir el cáncer cervicouterino (CC), el virus del papiloma humano (VPH), el programa de control del CC y proponer alternativas para Chile. Material y métodos: Se analiza el programa nacional del CC 1966-2015 y la guía clínica 2015-2020, la prevalencia de VPH en mujeres y en casos de CC; la infección y serología de VPH; la autotoma; la precisión y rentabilidad del tamizaje con VPH contra el Papanicolaou y las opciones de triaje en VPH AR positivas. Resultados: En Chile mueren 600 mujeres (principalmente de bajos recursos) al año por CC. La cobertura del Papanicolaou es < 70%, sensibilidad muy inferior al test de VPH, por lo que el cambio es rentable. Desde 2015 se vacuna contra VPH a niñas menores de 13 años. Conclusiones: Las condiciones técnicas y económicas existen en Chile para lograr una mejoría sustancial del CC: se sugiere el reemplazo del Papanicolaou por el examen de VPH; tamizaje cada cinco años con opción de autotoma; triaje con base en la tipificación de VPH 16/18 o Papanicolaou.

Abstract: Objective: To discuss cervical cancer (CC), Human Papilloma Virus (HPV), CC control program and propose alternatives for Chile. Materials and methods: We analyzed the national program of CC 1966-2015 and the clinical CC guideline 2015-2020; HPV prevalence in women and in cases of CC; HPV infection and serology; the self-vaginal sample; the accuracy and cost-effectiveness of screening with HPV versus Papanicolaou, and triage options among HPV-AR positives. Results: 600 women die of CC each year in Chile, mainly from low resources. Papanicolaou coverage is <70%; Papanicolaou sensitivity is much lower than HPV test. Change from Papanicolaou to HPV test is cost-effective. Since 2015, girls under 13 have been vaccinated against HPV. Conclusions: There are the technical and economic conditions for a substantial improvement of CC in Chile: replacement of the Papanicolaou by HPV; screening every five years, with the option of self-sampling, and triage based on HPV 16/18 or Papanicolaou typing.

Evaluation of the usefulness of a device for Human Papilloma Virus DNA collection and reservation in self-collected cervicovaginal samples stored dry in women with cervical dysplasia, Bogotá, Colombia / Evaluación de la utilidad de un dispositivo para toma y preservación del ADN del virus del papiloma humano de muestras cérvico-vaginales autorrecolectadas y almacenadas en seco en mujeres con displasia cervical, Bogotá, Colombia

ABSTRACT Objective: To evaluate the usefulness of a device for collecting and preserving human papilloma virus (HPV) DNA in self-collected vaginal samples stored dry during 14 days. Materials and methods: Diagnostic concordance pilot study that included non-pregnant women over 25 years of age with a biopsy-confirmed result of cervical intraepithelial neoplasia (CIN) grade 1 or more, coming to two referral centres in Bogotá, Colombia. Women with a history of total hysterectomy were excluded. Convenience sampling was used. The device uses real-time PCR (polymerase chain reaction) for DNA detection. Sociodemographic and clinical variables were measured, as well as the results of the test when the sample was collected by the patient and when it was collected by the physician, and the amount of DNA in the samples taken and processed on day 1, and in those processed on day 14, using Ct thresholds. Descriptive statistics were applied. Overall concordance was estimated by means of the kappa coefficient and mean differences in DNA amount. Materials and methods: Diagnostic concordance pilot study that included non-pregnant women over 25 years of age with a biopsy-confirmed result of cervical intraepithelial neoplasia (CIN) grade 1 or more, coming to two referral centres in Bogotá, Colombia. Women with a history of total hysterectomy were excluded. Convenience sampling was used. The device uses real-time PCR (polymerase chain reaction) for DNA detection. Sociodemographic and clinical variables were measured, as well as the results of the test when the sample was collected by the patient and when it was collected by the physician, and the amount of DNA in the samples taken and processed on day 1, and in those processed on day 14, using Ct thresholds. Descriptive statistics were applied. Overall concordance was estimated by means of the kappa coefficient and mean differences in DNA amount. Results: A kappa coefficient of 0.84 (95% CI: 0.71-0.96) was found for concordance in high-risk HPV detection between the self-collected cervicovaginal sample and the sample taken by the clinician. There were no differences in terms of the amount of viral DNA between day 1 and day 14 (DM -0.34 cycles; 95% CI: - 2.29 to 1.61). Conclusion: Self-collected vaginal samples using the storage device are reliable for high-risk HPV detection in patients with cervical dysplasia, and preserve viral DNA for 14 days if stored dry at room temperature. Confirmation studies in the general population are required.

RESUMEN Objetivo: Evaluar la utilidad de un dispositivo para toma y preservación del DNA del virus del papiloma humano (VPH) de muestras vaginales recolectadas por autotoma y almacenadas en seco durante 14 días. Materiales y métodos: Estudio piloto de concordancia diagnóstica. Se incluyeron mujeres mayores de 24 años no gestantes con un resultado de neoplasia intraepitelial cervical (NIC) grado 1 o más, confirmado por biopsia en dos instituciones de referencia en Bogotá, Colombia. Se excluyeron mujeres con antecedente de histerectomía total. Se realizó un muestreo por conveniencia. El dispositivo utiliza PCR (reacción en cadena de la polimerasa) en tiempo real para detección del ADN. Se midieron variables sociodemográficas y clínicas, así como el resultado de la prueba por autotoma y tomada por el médico, y la cantidad de ADN de las muestras tomadas el día 1 procesadas ese día, y el día 14, por medio del Ct umbral. Se realizó estadística descriptiva. Se calculó la concordancia global por medio del índice de kappa ponderado y la diferencia de medias de la cantidad de ADN. Resultados: La concordancia en la detección de VPH de alto riesgo mostró un kappa = 0,84 (IC 95 %: 0,71-0,96) entre la muestra cervicovaginal recolectada por autotoma frente a la muestra cervical recolectada por el médico. No hubo diferencias en la cantidad de ADN viral entre el día 1 y el 14 (DM -0,34 ciclos; IC 95 %: -2,29 a 1,61). Conclusión: Las muestras vaginales recolectadas por autotoma usando el dispositivo de almacenamiento son confiables para la detección de VPH de alto riesgo en pacientes con displasia cervical, y preservan el ADN viral por 14 días si se almacenan en seco a temperatura ambiente. Se requieren estudios en población general para poder confirmar.

Perceptions of Iranian women regarding breast cancer screening behaviour

Background: Breast cancer is the leading cause of death among women aged 20–59 years worldwide, with 58% of deaths occurring in less-developed countries. In the Islamic Republic of Iran, breast cancer constitutes 21% of all cancers, with an incidence rate of 22 per 100 000 women.

Aims: Since research into breast cancer screening among Iranian women is scarce and results are contradictory, we aimed to explore women's' perceptions regarding breast cancer screening behaviour and provide insights into how breast cancer is perceived and approached. This could aid policy-makers in drafting effective interventions to stimulate women to perform regular screening.

Methods: We used the Health Belief Model as a theoretical framework. In-depth interviews with 22 women in Tehran were performed, based on a topic-list exploring the 6 constructs of the Health Belief Model: perceived barriers, perceived severity, perceived susceptibility, perceived benefits, self-efficacy and cues to action. Data-analysis was based on the Constructive Grounded Theory Method.

Results: The main barriers were fear, low priority and cultural values. Perceived severity was low for the majority of women, while perceived susceptibility was high for about half of them. Perceived benefit of screening was high for all women. Women's' self-efficacy was low when it came to breast self-examination. Talking about breast cancer screening and having somebody in their environment adopting screening behaviour were important cues for taking up breast cancer screening.

Conclusions: Interventions should focus on diminishing barriers and increasing women's' self-efficacy and interpersonal communication about breast cancer screening

Evaluation of the self-eye examination method for health promotion / Avaliação do método de autoexame ocular para a promoção da saúde / Evaluación del método de autoexamen ocular para promoción de la salud

ABSTRACT Objective To evaluate the self-eye examination practice as a tool to promote the ocular self-evaluation. Method Quasi-experimental study developed in a university of Piauí with sample of 324 students between January and May 2014. A team of thirteen researchers made observations during the self-examination followed by an ocular screening. Results There was no agreement on the hypothesis of defense that the ocular exam could help to observe the eyes health, p-value>0.3. However, the exam was considered as easy to accomplish (99.7%) and that not only the physician can perform the eye exam (99.4%). The awareness about eye care is identified as the main purpose of this booklet (97.6%), (χ2= 186.01; p=0.001). The results highlight the booklet can be used in the teaching process of self-eye examination (84.6%). Although the defense that its fulfilment can replace the consultation with the ophthalmologist (23.8%%) cannot be accepted (χ2= 46.34), the self-exam must be done routinely (82.4%). Conclusion The results prove that the learning through virtual booklet is possible and supports self-care with the eyes by performing the self-exam.

RESUMO Objetivo Avaliar a prática do autoexame como uma ferramenta para promover a autoavaliação ocular. Método Estudo quase-experimental, desenvolvido em uma universidade do Piauí, com uma amostra de 324 estudantes, entre janeiro e maio de 2014, por uma equipe de 13 pesquisadores, os quais fizeram observações durante o autoexame seguido de uma triagem ocular. Resultados Não houve concordância sobre a hipótese de que o exame ocular poderia ajudar a observar a saúde do olho (p-valor> 0,3), no entanto, foi considerado de fácil realização (99,7%), e que não só o médico pode realizá-lo (99,4%). A conscientização do cuidado com os olhos é identificada como o principal objetivo do uso da cartilha (97,6%), (χ2 = 186,01; p = 0,001). O resultado destaca que o material educativo pode ser utilizado no processo de ensino do autoexame ocular (84,6%). Embora a realização do autoexame não possa substituir a consulta com o oftalmologista (23,8%), (χ2 = 46,34), ele deve ser feito rotineiramente (82,4%). Conclusão Os resultados comprovam que o aprendizado por meio de uma cartilha virtual é possível, apoiando o autocuidado com os olhos através da realização do autoexame.

RESUMEN Objetivo Evaluar la práctica del autoexamen como herramienta para promocionar la autoevaluación ocular. Método Estudio cuasi-experimental, desarrollado en una universidad de Piauí, con una muestra de 324 estudiantes, entre enero y mayo de 2014, por un equipo de trece investigadores, quienes hicieron observaciones durante el autoexamen seguido de un cribado ocular. Resultados No hubo concordancia acerca del supuesto de que el examen ocular podría ayudar a observar la salud ocular (valor-p >; 0,3). Sin embargo, se consideró como de fácil realización (99,7%) y que no solo el médico puede llevar a cabo el examen ocular (99,4%). Se identifica la concienciación acerca del cuidado ocular como la razón principal para el empleo de la cartilla (97,6%), (χ2 = 186,01; p =0,001). El resultado subraya que el método educativo se puede utilizar en el proceso de enseñanza del autoexamen ocular (84,6%). Aunque la realización del autoexamen no pueda reemplazar la consulta con el oftalmólogo (23,8%), (χ2= 46,34), se debe hacerlo de rutina (82,4%). Conclusión Los resultados comprueban que el aprendizaje mediante una cartilla virtual es posible, sosteniendo el autocuidado con los ojos mediante la realización del autoexamen.

Knowledge and practices of primary care providers on skin cancer and skin self-examination / Conhecimento e práticas dos provedores de cuidados primários sobre o câncer de pele e o autoexame da pele / Conocimiento y prácticas de los proveedores de cuidados primarios acerca del cáncer de piel y el autoexamen de la piel

ABSTRACT Objective To determine the knowledge and practices related to skin cancer and skin self-examination of primary care providers. Method This cross-sectional descriptive study was conducted in Turkey. The study was carried out in primary health centers such as family health centers, community health centers, early cancer detection centers and family planning centers in 2016-2017. Participants' socio-demographic characteristics, their knowledge and practices related to skin cancer, skin cancer risk factors and skin self-examination were determined. Results The study population included 94 primary care providers. The symptoms of which the participants were most aware were changes in the color of moles or skin spots (95.71%), and of which participants were the least aware was the itching of a mole (71.43%). Among participants, the most recognized risk factor was having fair skin (97.14%), whereas the least known was the presence of birthmarks (24.29%). The mean scores the participants obtained from the questionnaire were as follows: 5.39±1.61 for skin cancer risk factors and 10.47±2.73 for skin cancer symptoms. Of the participants, 14.29% received training on skin self-examination, 38.57% knew how to perform skin self-examination, and 67.14% did not perform skin self-examination. Of the participants, 61.7% did not perform skin self-examination because they did not know what to look for. Of the participants, 85.71% did not have continuing education/workshop about skin self-examination after graduation. Conclusion Although the primary care providers' knowledge of skin cancer symptoms was adequate, their knowledge of skin cancer risk factors was not sufficient. Primary care providers' knowledge of skin self-examination was good, but they did not perform skin self-examination adequately.

RESUMO Objetivo Determinar o conhecimento dos provedores de cuidados primários e suas práticas relacionadas com o câncer de pele e o autoexame da pele. Método Este estudo descritivo transversal foi conduzido na Turquia. O estudo foi realizado em centros de saúde primários, tais como centros de saúde da família, centros de saúde comunitários, centros de detecção precoce do câncer e centros de planejamento familiar em 2016-2017. As características sociodemográficas dos participantes, seu conhecimento e práticas relacionados com o câncer de pele, fatores de risco para o câncer de pele e o autoexame da pele foram determinados. Resultados A população do estudo incluiu 94 provedores de cuidados primários. Os sintomas dos quais os participantes estiveram mais conscientes foram mudanças na cor das pintas ou manchas na pele (95,71%) e dos quais os participantes estiveram menos conscientes foi a coceira em uma pinta (71,43%). Entre os participantes, o fator de risco mais reconhecido foi ter pele clara (97,14%), ao passo que o menos conhecido foi a presença de marcas de nascença (24,29%). Os principais scores que os participantes obtiveram do questionário foram os seguintes: 5,39±1,61 para fatores de risco para câncer de pele e 10,47±2,73 para sintomas de câncer de pele. Dos participantes, 14,29% receberam treinamento sobre autoexame, 38,57% sabiam como realizar o autoexame e 67,14% não realizavam autoexame de pele. Dos participantes, 61,7% não realizavam autoexame porque não sabiam o que procurar. Dos participantes, 85,71% não tiveram educação continuada/workshop sobre autoexame de pele após a graduação. Conclusão Embora o conhecimento dos provedores de cuidados primários sobre os sintomas do câncer de pele foi adequado, seu conhecimento dos fatores de risco para o câncer de pele não foi suficiente. O conhecimento dos provedores de cuidados primários sobre o autoexame da pele foi bom, mas eles não realizaram o autoexame da pele adequadamente.

RESUMEN Objetivo Conocimiento y prácticas de los proveedores de cuidados primarios y sus prácticas relacionadas con el cáncer de piel y el autoexamen de la piel. Método Este estudio descriptivo transversal fue conducido en Turquía. El estudio fue llevado a cabo en centros de salud primaria, tales como centros de salud de la familia, centros de salud comunitarios, centros de detección precoz del cáncer y centros de planificación familiar en 2016-2017. Las características sociodemográficas de los participantes, su conocimiento y prácticas relacionadas con el cáncer de piel, factores de riesgo para el cáncer de piel y el autoexamen de la piel fueron determinados. Resultados La población del estudio incluyó a 94 proveedores de cuidados primarios. Los síntomas de los que los participantes estuvieron más enterados fueron los cambios en el color de los lunares o manchas en la piel (95,71%) y de los que los participantes estuvieron menos enterados fue la picazón en un lunar (71,43%). Entre los participantes, el factor de riesgo más reconocido fue tener piel clara (97,14%), mientras que el menos conocido fue la presencia de marcas de nacimiento (24,29%). Los principales scores que los participantes obtuvieron del cuestionario fueron los siguientes: 5,39±1,61 para factores de riesgo para cáncer de piel y 10,47±2,73 para síntomas de cáncer de piel. De los participantes, el 14,29% recibieron entrenamiento acerca del autoexamen, el 38,57% sabían cómo realizar el autoexamen y el 67,14% no realizaban el autoexamen de la piel. De los participantes, el 61,7% no realizaban el autoexamen porque no sabían qué buscar. De los participantes, el 85,71% no tuvieron educación continuada/taller sobre autoexamen de la piel después del grado académico. Conclusión Aunque el conocimiento de los proveedores de cuidados primarios acerca de los síntomas del cáncer de piel fue adecuado, su conocimiento de los factores de riesgo para el cáncer de piel no fue suficiente. El conocimiento de los proveedores de cuidados primarios acerca del autoexamen de la piel fue bueno, pero ellos no llevaron a cabo el autoexamen de la piel adecuadamente.

Tecnologia para realização do autoexame ocular: comparação entre cartilha impressa e virtual / Tecnología para la realización del autoexamen ocular: comparación entre cartilla impresa y virtual / Technology for performing ocular self-examination: comparison between printed and virtual booklets

RESUMO Objetivo: Comparar os resultados do autoexame ocular realizado com auxílio das versões impressa e virtual de cartilha educativa. Método: Estudo quase-experimental realizado em escola estadual de capital do nordeste brasileiro, com 100 estudantes divididos igualmente em grupo controle e intervenção, mediante pareamento quanto à idade, ao sexo, à escolaridade e à situação econômica. Foram aplicados Testes Qui-quadrado de Pearson e Exato de Fisher, com nível significância de 5%. Resultados: Os resultados do autoexame obtidos pelas cartilhas virtual e impressa foram estatisticamente semelhantes, exceto no item Alterações do reflexo pupilar, no qual a cartilha virtual foi mais eficaz para sua identificação (p=0,049). Conclusão: As versões impressa e virtual da cartilha educativa ocular possuem eficácia semelhante para a realização do autoexame ocular.

RESUMEN Objetivo: Comparar los resultados del autoexamen ocular realizado con auxilio de las versiones impresa y virtual de cartilla educativa. Método: Estudio cuasi-experimental llevado a cabo en escuela estadual de capital del nordeste brasileño, con 100 estudiantes divididos igualmente en grupo control e intervención, mediante pareamiento en cuanto a la edad, el sexo, la sexualidad y situación económica. Fueron aplicadas Pruebas de Chi cuadrado de Pearson y Exacta de Fisher, con nivel de significación del 5%. Resultados: Los resultados del autoexamen obtenidos por las cartillas virtual e impresa fueron estadísticamente semejantes, excepto por el punto Modificaciones del reflejo pupilar, en el que la cartilla virtual fue más eficaz para su identificación (p=0,049). Conclusión: Las versiones impresa y virtual de cartilla educativa ocular tienen efectividad semejante para la realización del autoexamen ocular.

ABSTRACT Objective: Comparing the results of the ocular self-examination performed with the aid of printed and virtual versions of an educational booklet. Method: A quasi-experimental study carried out in a state (public) school of a capital in northeast Brazil, with 100 students equally divided into control and intervention groups according to age, gender, schooling and economic status. Pearson's Chi-square test and Fisher's exact test were applied with a significance level of 5%. Results: The results of the self-examination obtained by the virtual and printed booklets were statistically similar, except for the item 'Alterations of the pupillary reflex', in which the virtual booklet was more effective for its identification (p=0.049). Conclusion: The printed and virtual versions of the ocular educational booklet have similar efficacy for performing ocular self-examination.

Elaboração e desenvolvimento de aplicativo móvel para autocuidado e automonitoramento do pé diabético / Development of a mobile application for self-care and self-monitoring of diabetic foot

Diabetes mellitus é uma síndrome crônica complexa, que exige assistência contínua e uso de estratégias que visem à redução de suas complicações. É reconhecido como um severo problema de saúde pública e configura-se como uma epidemia em todo o mundo. Embora existam sérias complicações decorrentes da doença as que acometem os pés representam a maior parte. Nesse contexto o pé diabético representa um problema de saúde pública relevante já que 40 a 70% de todas as amputações de extremidades inferiores estão relacionadas a essa doença. Acrescido a esses números alarmantes é reconhecido que ainda é insignificante o número de pacientes que recebe regularmente cuidados em seus pés por profissionais de saúde, além de ser baixa a adesão às atividades de autocuidado por esses pacientes, indicando tais fatos como possíveis fatores responsáveis pelo grande número de complicações e mortes. Dessa forma é de suma importância o desenvolvimento e a implementação de estratégias que aprimorem o manejo do pé diabético, buscando sua prevenção e a promoção do autocuidado, já que este é responsável por 95% do sucesso do tratamento das doenças crônicas. Desse modo frente à presença do diabetes, do potencial de risco para o desenvolvimento do pé diabético e do fato deste ser uma complicação incapacitante, porém prevenível, e ainda, entendendo a importância e necessidade de um olhar mais atento aos pés e como as ferramentas computacionais podem oportunizar um melhor cuidado em saúde, auxiliando o autocuidado, acreditamos que o desenvolvimento de um aplicativo para dispositivos móveis seja uma estratégia para auxiliar na prevenção e promoção à saúde das pessoas com diabetes. Para tal o presente estudo descritivo e de desenvolvimento experimental, teve como objetivo a elaboração do aplicativo móvel “Pé Diabético” visando oferecer subsídios as pessoas com diabetes para o autocuidado e automonitoramento de seus pés. Assim, o estudo foi conduzido em 3 etapas: revisão sistemática ...

Diabetes mellitus is a complex chronic syndrome that requires a lot of time and strategy use aimed at reducing its complications. It is recognized as a public health problem and is set up as an epidemic around the world. Although there are serious for a majority of parties. In this context, diabetic foot represents a relevant public health problem since 40 to 70% of all lower extremity amputations are related to this disease. In addition to these alarming and recognized numbers, the number of patients receiving health care at their feet by health professionals is still insignificant, as well as being low adherence to self-care activities by these patients, indicating such facts as please number complications and deaths. Thus, it is of paramount importance to develop and implement strategies that improve the management of diabetic foot, seeking its prevention and a promotion of self-care, since it is responsible for 95% of the success of the treatment of chronic diseases. Thus, in the presence of diabetes, the potential risk for the development of diabetic foot and the fact that this is a disabling but preventable complication, and also understanding the importance and necessity of a closer look at the feet and how the tools The best health care, helping self care, we believe in all the development of a mobile application is a strategy to assist in prevention and health in people with diabetes. For the present descriptive study and experimental development, the objective was the elaboration of the mobile application "Diabetic Foot" aiming to offer subsidies such as people with diabetes for self-care and self-monitoring of their feet. Thus, the study was conducted in three stages: systematic review of the literature, elaboration of the prototype and pre-test. A systematic review was developed according to Cochrane methodology, and the prototype was constructed using a software programming methodology Extreme Programming, JavaScript language ...

Comparing Interrater reliability between eye examination and eye self-examination / Comparação de confiabilidade interobservador do exame ocular versus autoexame / Comparación de confiabilidad interobservadorvdel examen ocular versus el autoexamen

Reume Objective: to compare Interrater reliability concerning two eye assessment methods. Method: quasi-experimental study conducted with 324 college students including eye self-examination and eye assessment performed by the researchers in a public university. Kappa coefficient was used to verify agreement. Results: reliability coefficients between Interraters ranged from 0.85 to 0.95, with statistical significance at 0.05. The exams to check for near acuity and peripheral vision presented a reasonable kappa >0.2. The remaining coefficients were higher, ranging from very to totally reliable. Conclusion: comparatively, the results of both methods were similar. The virtual manual on eye self-examination can be used to screen for eye conditions.

Resumo Objetivo: comparar a confiabilidade interobservador de dois métodos de avaliação ocular. Método: estudo quase experimental, realizado com 324 alunos universitários, por meio do autoexame ocular e da avaliação ocular feita por pesquisadores em uma universidade pública. Para análise de concordância, utilizou-se o índice Kappa. Resultados: os valores obtidos para confiabilidade interobservadores variaram entre 0,85 e 0,95, tendo como significância estatística 0,05. Nos exames da acuidade visual para perto e visão periférica, observou-se índice de concordância considerado razoável, com Kappa >0,2. Os demais índices foram superiores, com variação entre muito e totalmente confiável. Conclusão: comparativamente, os dois resultados dos exames mostraram-se similares. A cartilha virtual sobre autoexame ocular pode ser utilizada para rastrear problemas na visão.

Resumen Objetivo: comparar la confiabilidad interobservador de dos métodos de evaluación ocular. Método: estudio casi experimental, realizado con 324 alumnos universitarios, por medio del autoexamen ocular y de la evaluación ocular hecha por investigadores en una universidad pública. Para el análisis de concordancia, se utilizó el índice Kappa. Resultados: los valores obtenidos para confiabilidad interobservadores variaron entre 0,85 y 0,95, teniendo como significación estadística 0,05. En los exámenes de acuidad visual para cerca y visión periférica, se observó índice de concordancia considerado razonable, con Kappa >0,2. Los demás índices fueron superiores, con variación entre mucho y totalmente confiable. Conclusión: comparativamente, los dos resultados de los exámenes se mostraron similares. La cartilla virtual sobre autoexamen ocular puede ser utilizada para rastrear problemas de visión.

Equidade no uso de serviços odontológicos provenientes do SUS entre idosos: estudo de base populacional / Equity inthe use of dental services provided by the Brazilian Unified Health System (SUS) among the elderly: a population-based study

Resumo Propõe-se caracterizar os idosos usuários de serviços odontológicos ofertados pelo Sistema Único de Saúde, considerando o princípio da equidade. Trata-se de um estudo transversal analítico com modelagem hierarquizada, conduzido a partir de uma amostra probabilística, complexa, por conglomerados de idosos (65-74 anos) residentes em um município brasileiro de grande porte populacional. Foram incluídas variáveis independentes referentes a: características sociodemográficas, acesso a informações em saúde, comportamentos/sistema de atenção à saúde e desfechos em saúde. Realizou-se análises descritivas, bivariadas e múltiplas hierarquizadas. Dos 480 idosos incluídos, 138 (31,2%) utilizaram serviços odontológicos provenientes do SUS. O uso desses serviços foi maior à medida que diminuíam a renda per capita e a escolaridade dos idosos, menor entre os que não haviam realizado o autoexame da boca e maior entre os que usavam os serviços odontológicos para procedimentos que não fossem rotina. Além disso, verificou-se que utilizaram mais o SUS pessoas que tiveram o relacionamento afetado pela saúde bucal e uma autopercepção negativa da sua aparência. Conclui-se que o uso dos serviços odontológicos no SUS foi predominante entre os idosos que vivem sob condições de vulnerabilidade.

Abstract The scope of this study is to establish the profile of elderly users of dental services provided by the Brazilian Unified Health System(SUS) and associated factors from the standpoint of equity. It involves an analytical cross-sectional study with hierarchical modeling conducted on the basis of a complex probabilistic sample of groups of the elderly (65-74 years of age) living in a densely populated Brazilian city. Independent variables were included relating to: socio-demographic characteristics, access to information on health, behaviors/health-care system and health outcomes. Descriptive, bivariate and multiple hierarchical analysis was performed. Of the 480 elderly persons included, 138 (31.2%) used dental services from the SUS. Use of these services was greater as per capita income and level of schooling decreased. It was lower among those who had not conducted exams of their own mouths (oral self-examinations) and higher among those individuals who used dental services for non-routine procedures. In addition, people whose relationship had been affected by oral health issues and a negative perception of their appearance used the SUS more frequently. The conclusion drawn is that the use of dental services of the SUS was most prevalent among the elderly living in precarious conditions.

Conductas de autoexamen cutáneo en dermatólogos chilenos / Cutaneous self-examination behaviors in Chilean dermatologistc

La incidencia de cáncer de piel ha aumentado, por lo que la detección precoz puede ser beneficiosa. Se ha sugerido que los dermatólogos son una población de alto riesgo para desarrollar cáncer de piel. El objetivo de este estudio es evaluar la frecuencia de autoexamen, consulta dermatológica y cáncer de piel en un grupo de dermatólogos chilenos. Pacientes y métodos: Se confeccionó una encuesta de 8 preguntas, hecha personalmente, durante 4 meses, a 143 dermatólogos de la Sociedad Chilena de Dermatología (46,7%). Las variables analizadas fueron: sexo, edad, fototipo de Fitzpatrick, frecuencia de autoexamen, consulta a otro dermatólogo, antecedente de melanoma maligno (MM), carcinoma basocelular (CBC), carcinoma espinocelular (CEC) y queratosis actínica (QA), y razones para no realizarse examen cutáneo en forma regular. Resultados: El 60% de encuestados se hacía autoexamen, pero 48% afirmó hacerlo sólo ocasionalmente. Con respecto a si solicitan ser evaluados por otro dermatólogo, el 81% no lo hace, del 19% que si lo hace, un 69% consultaba sólo ante una lesión llamativa. Finalmente, el 17% de encuestados refirió haber tenido neoplasias cutáneas. Entre ellas 12% para QA, 5% para CBC, 2% para CEC y ningún melanoma. Conclusión: La mayoría de los dermatólogos encuestados se realiza autoexamen, pero no regularmente, y raramente hacen consultas de chequeo a sus colegas, la mayoría solicita evaluación por otro dermatólogo ante una lesión sospechosa.

Abstract: Skin cancer incidence has increased worldwide; early detection may be beneficial. Some evidence suggests dermatologists as a high-risk population for developing skin cancer. The aim of this study was to assess how often Chilean dermatologists consult with colleagues for check ups, to evaluate the frequency of self-skin examination and the frequency of skin cancer in this group. Patients and methods: A sample of 143 members (46,7%) of the Chilean Society of Dermatology responded an eight items questionnaire, in a face-to-face manner. Evaluated variables were: sex, age, Fitzpatrick phototype, self-skin examination frequency, frequency for consult s with another dermatologist, previous history of malignant melanoma, basal cell carcinoma, squamous cell carcinoma and actinic keratosis, and reasons to perform or not in themselves regular skin examination. Results: 60% performed regular self-skin examination, but only 48% did it regularly. Concerning whether they consulted another dermatologist, 81% didn´t, and between the 19% who do consult, 69% of them consulted only in case of a suspicious lesion. Finally, 17% of the surveyed people referred history of skin cancer. 12% were actinic keratosis, 5% basal cell carcinoma, 2% squamous cell carcinoma and no melanoma was declared. Conclusion: Most of surveyed dermatologists perform occasional self-skin examination, and rarely do regular check ups with colleagues, most of them consulted another dermatologist only if a suspicious lesion was found.

Caracterización de adultos mayores con lesiones bucales premalignas y malignas / Characterization of aged adults with premalignant and malignant oral lesions

Se realizó un estudio descriptivo y transversal de 43 adultos mayores con lesiones bucales premalignas y malignas, pertenecientes al área de salud del Policlínico Universitario "Julián Grimau García" de Santiago de Cuba, durante el 2013, con vistas a caracterizarles según variables seleccionadas. Predominaron los afectados de la séptima década de la vida con lesiones provocadas por la presencia de factores de riesgo, tales como tabaquismo, higiene bucal deficiente y prótesis desajustadas; el paladar duro como la localización anatómica más afectada y la no realización del autoexamen bucal. El uso prolongado de la prótesis influyó negativamente en la aparición de escasas lesiones y la estomatitis subprótesis fue el estado precanceroso más frecuente. Estos resultados mostraron la ineficacia de las acciones de promoción de salud, puesto que no se logró la elevación de la calidad de vida de los ancianos.

A descriptive and cross sectional study of 43 aged adults with premalignant and malignant oral lesions, belonging to the area of "Julián Grimau García" University Polyclinic in Santiago de Cuba was carried out during the 2013, aimed at characterizing them according to selected variables. Those affected of the seventh decade of life with lesions caused by the presence of risk factors, such as tabaquism, scarce oral hygiene and maladjusted prosthesis, the hard palate as the affected anatomical site and the no practice of the oral self-exam prevailed. The prolonged use of prosthesis influenced negatively in the emergence of scarce lesions and the subprosthesis was the most frequent premalignant state. These results showed the inefficacy of the health promotion actions, since the increase of the patients life quality was not achieved.