Intervención educativa para perfeccionar la ejecución del Programa de Detección Precoz del Cáncer Bucal

Introducción: las lesiones premalignas y malignas del complejo bucal se incrementan en la población, lo que demanda una correcta ejecución del Programa de Detección Precoz del Cáncer Bucal (PDCB). En el trabajo se exponen las transformaciones en el nivel de conocimientos de pacientes y estomatólogos acerca de las afecciones concernientes al PDCB para perfeccionar su ejecución. Método: se realizó una intervención educativa en el área de salud Julio Antonio Mella del municipio Camagüey desde mayo de 2022 hasta junio de 2023, con la participación de 36 pacientes y 30 estomatólogos. Las fuentes de información fueron la historia clínica, un cuestionario y una prueba de entrada y salida, aplicados a pacientes y estomatólogos respectivamente, antes y después de la intervención; para constatar las transformaciones. Resultados: antes de la intervención los pacientes estaban mal informados sobre las consecuencias nocivas de hábitos tóxicos, higiénicos y dietéticos, así como desconocimiento de la importancia del correcto autoexamen bucal; los que alcanzaron en su mayoría un alto nivel de conocimientos con la intervención. Los estomatólogos mejoraron sus conocimientos sobre diagnóstico y seguimiento de lesiones pre malignas y malignas del complejo maxilofacial. Discusión: la adecuada ejecución del PDCB descansa tanto en pacientes como en estomatólogos y aunque las investigaciones se enfocan a los primeros por los beneficios reportados; la superación de posgrado constituye una vía para sistematizar conocimientos y fortalecer competencias profesionales que impacten de manera positiva en el PDCB. La intervención educativa se considera satisfactoria al elevar el nivel de conocimientos de pacientes y estomatólogos, lo que demuestra sus potencialidades para perfeccionar la ejecución del PDCB.

Introduction: premalignant and malignant lesions of de oral area increase in the population which demands a correct implementation of the Early Detection of Oral Cancer Program. In this work transformations are exposed knowledge level of both patients and dentists regarding lesions concerning the Early Detection of Oral Cancer Program (EDOCP). Method: educational intervention was carried out in Julio Antonio Mella health area of Camaguey municipality from May 2022 to June 2023 which 36 patients and 30 Deontologists. Information sources were the Clinical History, a questionnaire and a test applied to patients and Deontologists respectively, before and after the intervention, to confirm the transformations in the sample. Results: Prior to intervention patients were poorly informed about consequences of toxic, hygienic and dietetic habits combined with lack of knowledge regarding importance of a correct oral self-examination whose knowledge improved to reach a high level in most of them after the intervention. Deontologists improved their knowledge on diagnosis and follow-up of premalignant and malignant lesions affecting the maxillofacial complex. Discussion: correct application of the EDOCP depends on both patients and deontologists, however reserchers focus on the former due to the reported benefits; the postgraduate training is a way to systematize knowledge and strengthen professional competences with positive impact on EDOCP. The educational intervention was satisfactory since it improved the level of knowledge of both patients and dentists which shows its potential on a correct implementation of the Early Detection of Oral Cancer Program.

Concordancia inter- e intraobservador del puntaje PI-RADS 2.1 del Colegio Americano de Radiología / Intraobserver and interobserver agreement of the American College of Radiology PI-RADS 2.1 score

Resumen Antecedentes: La resonancia magnética (RM) de próstata es uno de los métodos diagnósticos para la identificación del carcinoma de próstata. La escala PI-RADS (Prostate Imaging and Reporting Data System) es el sistema usado para la interpretación de estas imágenes. Es importante, para su reproducibilidad, la estandarización y la evaluación de dicha escala. Objetivo: Determinar la concordancia inter- e intraobservador de la versión 2.1 del PI-RADS. Material y métodos: Estudio observacional retrospectivo, evaluando 129 RM de pacientes con sospecha de cáncer de próstata por tres radiólogos con diferentes años de experiencia y en dos momentos del tiempo, usando el puntaje PI-RADS 2.1. Se evaluó la concordancia intra- e interobservador. Resultados: La concordancia interobservador fue sustancial (kappa > 0,6) en todos los observadores, siendo la categoría 5 la de mayor acuerdo interobservador. Se observó una alta reproducibilidad intraobservardor, con la mayor kappa siendo de 0,856. Cuando se realizó el análisis según años de experiencia de los radiólogos, la concordancia interobservador fue significativa en todos los casos. Conclusiones: El sistema de clasificación PI-RADS 2.1 es reproducible para las diferentes categorías y aumenta la concordancia cuando se trata de lesiones con mayor probabilidad de cáncer clínicamente significativo.

Abstract Background: Magnetic Resonance Imaging (MRI) of the prostate is a key diagnostic tool for identifying prostate carcinoma. The Prostate Imaging-Reporting and Data System (PI-RADS) scale is the standard system for interpreting these images. Standardizing and evaluating this scale is crucial for ensuring consistent and reproducible results. Objective: This study aims to assess both the interobserver and intraobserver agreement of the PI-RADS version 2.1. Material and methods: In this retrospective observational study, 129 prostate MRI scans from patients with suspected prostate cancer were evaluated. Three radiologists, each with different levels of experience, analyzed these scans at two separate times using the PI-RADS 2.1 scoring system. Both intraobserver and interobserver agreements were measured. Results: The study found substantial interobserver agreement (kappa > 0.6) across all categories, with category 5 showing the highest level of agreement. Intraobserver reproducibility was also high, with the highest kappa value reaching 0.856. Further analysis based on the radiologists’ years of experience revealed significant interobserver agreement in all instances. Conclusions: The PI-RADS 2.1 classification system demonstrates high reproducibility across different categories, particularly for lesions more likely to be clinically significant cancers. This underscores its reliability in varied diagnostic scenarios.

Developing a breast cancer screening decision aid in Spanish for average-risk women: a mixed methods study / Estudios originales Publicado el 14 de marzo de 2024 | http://doi.org/10.5867/medwave.2024.02.2726 Developing a breast cancer screening decision aid in Spanish for average-risk women: a mixed methods study Desarrollo de una herramienta en español para ayudar en la toma de decisiones del cribado de cáncer de mama para mujeres de riesgo promedio: un estudio de métodos mixtos

Introduction We aimed to develop a decision aid to support shared-decision making between physicians and women with average breast cancer risk when deciding whether to participate in breast cancer screening. Methods We included women at average risk of breast cancer and physicians involved in supporting the decision of breast cancer screening from an Academic Hospital in Buenos Aires, Argentina. We followed the International Patient Decision Aid Standards to develop our decision aid. Guided by a steering group and a multidisciplinary consultancy group including a patient advocate, we reviewed the evidence about breast cancer screening and previous decision aids, explored the patients' information needs on this topic from the patients' and physicians' perspective using semi-structured interviews, and we alpha-tested the prototype to determine its usability, comprehensibility and applicability. Results We developed the first prototype of a web-based decision aid to use during the clinical encounter with women aged 40 to 69 with average breast cancer risk. After a meeting with our consultancy group, we developed a second prototype that underwent alpha-testing. Physicians and patients agreed that the tool was clear, useful and applicable during a clinical encounter. We refined our final prototype according to their feedback. Conclusion We developed the first decision aid in our region and language on this topic, developed with end-users' input and informed by the best available evidence. We expect this decision aid to help women and physicians make shared decisions during the clinical encounter when talking about breast cancer screening.

Expert consensus on the molecular diagnosis of early-stage pancreatic cancer （2023 edition） / 临床肝胆病杂志

Pancreatic cancer is a relatively common tumor of the digestive system， with difficulties in early-stage diagnosis and an extremely high degree of malignancy. Molecular diagnostic technology based on tumor biomarkers， combined with the existing gold standard in clinical practice， is of great clinical significance to achieve early accurate identification， timely treatment and intervention， and reduction in mortality. Previous studies have shown that miRNAs show high specificity in terms of types and expression levels in different pathological stages of pancreatic cancer and can thus be used in monitoring the development and progression of pancreatic cancer. Since a single miRNA has a limited diagnostic potential， the combination of different miRNAs may effectively improve the diagnostic efficiency of early-stage pancreas carcinogenesis. Based on related research advances in recent years， this consensus document aims to fill the gap in molecular diagnostic technology in the guidelines for the clinical diagnosis and treatment of pancreatic cancer and provide expert guidance and recommendations.

Impact of Mobile Application Intervention: DETAK in Early Detection and Early Treatment of Acute Coronary Syndrome

@#Introduction: Acute Coronary Syndrome (ACS) is still a major cause of mortality and morbidity globally. One of the factors that cause a prehospital delay is the delay in early detection and inaccuracy of early treatment of ACS. The Internet of Things, which is supported by the high use of smartphones with the DETAK application, can be an opportunity to facilitate ACS education programs so that ACS can be detected early. Method: This study has used a quantitative research design with a quasi-experimental approach which pretest and posttest, in which both the experimental and control groups participate. The inclusion criteria of this study were age >45 years; obesity; smoker; Respondents with a history of: hypertension/diabetes mellitus/hyperlipidemia/hypercholesterolemia/CVD/families with cardiovascular disease. 252 respondents who met the inclusion criteria were randomly divided into control (n=126) and intervention groups (n=126). The intervention group was given education through the DETAK application and the control group was given leaflet about ACS. Results: The results of the study showed that there was an increased in early treatment ability was only found in the intervention group (p<.001). Mean differences of the ability of early detection (p<.001) and early treatment (p=.019)between intervention and control groups were both significance. Conclusion: There is potential for DETAK applications to improve the early detection and treatment capabilities of ACS.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging / Recomendações da Sociedade Brasileira de Cirurgia Torácica, Sociedade Brasileira de Pneumologia e Tisiologia e Colégio Brasileiro de Radiologia e Diagnóstico por Imagem para o rastreamento do câncer de pulmão no Brasil

ABSTRACT Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

RESUMO O câncer de pulmão (CP) é uma das neoplasias mais comuns e letais no Brasil, e apenas 15% dos pacientes são diagnosticados nos estágios iniciais. O tabagismo persiste como o responsável por mais de 85% de todos os casos. O rastreamento do CP (RCP) por meio da TC de baixa dosagem de radiação (TCBD) reduz a mortalidade do CP em 20%, e, quando combinado com a cessação do tabagismo, essa redução chega a 38%. Na última década, diversos países adotaram o RCP como recomendação de saúde populacional. No Brasil, embora ainda incipiente, a discussão sobre o tema é cada vez mais ampla e necessária. Com o intuito de aumentar o conhecimento e estimular o debate sobre o RCP, a Sociedade Brasileira de Cirurgia Torácica, a Sociedade Brasileira de Pneumologia e Tisiologia e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem constituíram um painel de especialistas para elaborar as recomendações para o RCP. As recomendações aqui apresentadas foram baseadas em revisão narrativa da literatura, com ênfase em grandes estudos populacionais, em revisões sistemáticas e em recomendações de diretrizes internacionais, sendo construídas após ampla discussão pelo grupo de especialistas. Os temas revisados foram os seguintes: porque rastrear, considerações gerais sobre tabagismo, epidemiologia do CP, critérios de elegibilidade, achados incidentais, lesões granulomatosas, modelos probabilísticos, requisitos mínimos da TCBD, aquisições volumétricas, riscos do rastreamento, estrutura mínima e papel da equipe multidisciplinar, conduta segundo o Lung CT Screening Reporting and Data System (Lung-RADS), custos vs. benefícios e perspectivas do rastreamento.

Adequação da oferta de procedimentos para a detecção precoce do câncer de mama no Sistema Único de Saúde: um estudo transversal, Brasil e regiões, 2019 / Adequacy of provision of procedures for early detection of breast cancer in the Brazilian Unified National Health System: a cross-sectional study conducted in Brazil and its regions, 2019 / Adecuación de la oferta de procedimientos para la detección precoz del cáncer de mama en el Sistema Único de Salud: un estudio transversal, Brasil y regiones, 2019

Resumo: A detecção precoce é uma das estratégias para o controle do câncer de mama e, para tanto, é fundamental garantir o acesso à investigação dos casos suspeitos para continuidade do cuidado e tratamento oportuno. Este estudo tem por objetivo estimar a necessidade de procedimentos para detecção precoce dessa neoplasia e avaliar a sua adequação no atendimento às mulheres rastreadas e sintomáticas no Sistema Único de Saúde (SUS), no ano de 2019. Foi realizado um estudo descritivo transversal para analisar a oferta de exames de detecção precoce do câncer de mama, comparando a necessidade estimada com os procedimentos realizados no SUS. Foram utilizados os parâmetros disponibilizados pelo Instituto Nacional de Câncer para estimar a população e a necessidade de exames para a detecção precoce. No Sistema de Informações Ambulatoriais do SUS, obteve-se o número de procedimentos realizados em 2019. Observou-se um déficit de mamografias de rastreamento no país (-45,1%), variando entre -31,4% na Região Sul a -70,5% na Região Norte. Se a oferta desse exame fosse direcionada para a população-alvo do rastreamento, o déficit no país reduziria para -14,8% e haveria sobreoferta no Sul (6,2%). Os procedimentos de investigação diagnóstica apresentaram variações entre as regiões, com maiores déficits de punção por agulha grossa (-90,8%) e biópsia/exérese de nódulo da mama (-80,6%) observados no Centro-oeste, e o maior déficit de exames anatomopatológicos no Norte (-88,5%). A comparação entre a produção e a necessidade de procedimentos para detecção precoce do câncer de mama no Brasil identificou déficits e inadequações que devem ser melhor conhecidos e equacionados em nível estadual e municipal.

Abstract: Early detection is a major strategy in breast cancer control and, for this reason, it is important to ensure access to investigation of suspected cases for care continuity and timely treatment. This study aimed to estimate the need for procedures of breast cancer early detection and assess their adequacy for providing care to screened and symptomatic women in the Brazilian Unified National Health System (SUS) in 2019. A descriptive cross-sectional study was conducted to analyze the provision of tests for breast cancer early detection, comparing the estimated need with the procedures performed in the SUS. Parameters provided by the Brazilian National Cancer Institute were used to estimate the population and the need for early detection tests. The number of procedures performed in 2019 was obtained from the Outpatient Information System of the SUS. A deficit in screening mammograms was observed in the country (-45.1%), ranging from -31.4% in the South Region to -70.5 % in the North Region. If this test was offered to the target population, the deficit in the country would reduce to -14.8% and there would be an oversupply in the South Region (6.2%). Diagnostic investigation procedures varied between the regions, with higher deficits in coarse needle biopsy (-90.8%) and breast lump biopsy/excision (-80.6%) observed in the Central-West Region, and the highest deficit in anatomopathological exams in the North Region (-88.5%). The comparison between the production and need for procedures of breast cancer early detection in Brazil and its regions identified deficits and inadequacies that must be better understood and addressed at the state and municipal levels.

Resumen: La detección temprana es una de las estrategias para el control del cáncer de mama y, para ello, es fundamental garantizar el acceso a la investigación de los casos sospechosos para la continuidad del cuidado y el tratamiento oportuno. El presente estudio tiene como objetivo estimar la necesidad de procedimientos para la detección temprana de esta neoplasia y evaluar su adecuación en la atención a las mujeres rastreadas y sintomáticas en el Sistema Único de Salud (SUS) brasileño, en el año 2019. Se realizó un estudio descriptivo transversal para analizar la oferta de pruebas para la detección temprana del cáncer de mama, comparando la necesidad estimada con los procedimientos realizados en el SUS. Se utilizaron los parámetros proporcionados por el Instituto Nacional del Cáncer para estimar la población y la necesidad de pruebas para la detección temprana. El número de procedimientos realizados en el 2019 se obtuvo del Sistema de Información Ambulatoria del SUS. Se observó un déficit de mamografías de tamizaje en el país (-45,1%), oscilando entre el -31,4% en la Región Sur y el -70,5% en la Región Norte. Si la oferta de esta prueba se dirigiera a la población objetivo del rastreo, el déficit en el país se reduciría al -14,8% y habría una sobreoferta en el Sur (6,2%). Los procedimientos de investigación diagnóstica presentaron variaciones entre regiones, observándose mayores déficits en punción con aguja gruesa (-90,8%) y biopsia/escisión de nódulo mamario (-80,6%) en el Centro-Oeste, y el mayor déficit de pruebas anatomopatológicas en el Norte (-88,5%). La comparación entre la producción y la necesidad de procedimientos para la detección temprana del cáncer de mama en Brasil y en las regiones identificó déficits e insuficiencias que deben ser mejor conocidos y abordados a nivel estatal y municipal.

Analysis of the indications for and results of breast cancer screening by magnetic resonance imaging at a cancer center in Brazil / Análise das indicações e resultados da ressonância magnética para rastreamento de câncer de mama em um centro oncológico brasileiro

Abstract Objective: To evaluate the indications for and results of magnetic resonance imaging (MRI) examinations for breast cancer screening at a cancer center in Brazil. Materials and Methods: This was a retrospective observational study, based on electronic medical records, of patients undergoing MRI for breast cancer screening at a cancer center in Brazil. Results: We included 597 patients between 19 and 82 years of age. The main indications for MRI screening were a personal history of breast cancer, in 354 patients (59.3%), a family history of breast cancer, in 102 (17.1%), and a confirmed genetic mutation, in 67 (11.2%). The MRI result was classified, in accordance with the categories defined in the Breast Imaging Reporting and Data System, as benign (category 1 or 2), in 425 patients (71.2%), probably benign (category 3), in 143 (24.0%), or suspicious (category 4 or 5), in 29 (4.9%). On MRI, 11 malignant tumors were identified, all of which were invasive carcinomas. Among those 11 carcinomas, six (54.5%) were categorized as minimal cancers (< 1 cm), and the axillary lymph nodes were negative in 10 (90.9%). The cancer detection rate was 18.4/1,000 examinations, and the positive predictive value for suspicious lesions submitted to biopsy was 37.9%. Conclusion: In our sample, the main indication for breast MRI screening was a personal history of breast cancer. The results indicate that MRI is a highly accurate method for the early detection of breast neoplasms in this population.

Resumo Objetivo: Avaliar as indicações e resultados de exames de ressonância magnética (RM) para rastreamento de câncer de mama em um centro oncológico no Brasil. Materiais e Métodos: Estudo observacional, realizado mediante análise retrospectiva de pacientes submetidos a RM das mamas para rastreamento de câncer de mama, por meio de revisão do prontuário eletrônico em um centro oncológico. Resultados: Foram incluídas 597 pacientes com idade variando de 19 a 82 anos. As principais indicações para rastreamento foram história pessoal de câncer de mama em 354 (59,3%) pacientes, história familiar em 102 (17,1%) e mutação genética confirmada em 67 (11,2%). O resultado da RM foi benigno (BI-RADS 1 ou 2) em 425 (71,2%) pacientes, provavelmente benigno (BI-RADS 3) em 143 (24,0%) e suspeito (BI-RADS 4 ou 5) em 29 (4,9%). Foram identificados 11 tumores malignos na RM, todos carcinomas invasivos, porcentagem de cânceres "mínimos" (< 1 cm) de 54,5% e porcentagem de axila negativa de 90,9%. A taxa de detecção de câncer na RM foi 18,4/1000 exames e o valor preditivo positivo para as lesões suspeitas submetidas a biópsia foi 37,9%. Conclusão: A principal indicação para RM de rastreamento na nossa população foi história pessoal de câncer de mama. Os resultados mostraram que a RM constitui um método com alta acurácia para detecção precoce de neoplasias da mama nessa população.

Caracterización de adultos mayores con cáncer colorrectal en la comunidad

Fundamento: el cáncer colorrectal es la neoplasia más frecuente del sistema digestivo en los adultos mayores. En Cuba es un problema de salud de primer orden por su elevada incidencia y mortalidad, constituye la tercera causa de muerte en la población general. Objetivo: caracterizar a los adultos mayores con cáncer colorrectal en el Policlínico Sur Rudesindo García del Rijo de la provincia Sancti Spíritus. Métodos: se realizó una investigación de tipo descriptiva en el Policlínico Sur Rudesindo García del Rijo del municipio y provincia Sancti Spíritus, de enero a marzo del 2019. Se trabajó con una muestra intencional de 127 adultos mayores, pertenecientes a consultorios urbanos. Las variables analizadas fueron: edad, sexo, nivel de escolaridad, estadio del cáncer colorrectal al diagnóstico, estado de salud, comorbilidades, capacidad y percepción del autocuidado y supervivencia. Para el estadio al diagnóstico se utilizó la clasificación anatomoclínica, la comorbilidad, se midió mediante el índice de Charlson y el Test de Capacidad y Percepción de Autocuidado del Adulto Mayor. La información se procesó mediante el análisis porcentual. Los resultados alcanzados se interpretaron los números con sus porcientos. Resultados: en la caracterización de la muestra predominaron las féminas, el grupo de edad entre 70 y 79 años y el nivel de escolaridad de secundaria básica. El estadio II con un mal estado de salud y la inadecuada percepción de autocuidado fue mayoritario. La comorbilidad fue moderada con una supervivencia entre 40 a 60 meses. Conclusiones: predominaron las mujeres entre los 70 y los 79 años y como nivel de escolaridad, la secundaria básica; además prevaleció el estadio II y la inadecuada percepción de autocuidado.

Foundation: colorectal cancer is the most common neoplasm of the digestive system in older adults. In Cuba it is a major health problem due to its high incidence and mortality; it is the third cause of death in the general population. Objective: to characterize older adults with colorectal cancer at the Rudesindo García del Rijo Sur Polyclinic in the Sancti Spíritus province. Methods a descriptive research was carried out at the Sur Rudesindo García del Rijo Polyclinic in the municipality and province of Sancti Spíritus, from January to March 2019. We worked with an intentional sample of 127 older adults, belonging to urban clinics. The variables analyzed were: age, sex, educational level, stage of colorectal cancer at diagnosis, health status, comorbidities, capacity and perception of self-care and survival. For the stage at diagnosis, the anatomoclinical classification was used, comorbidity was measured using the Charlson index and the Self-Care Capacity and Perception Test for the Elderly. The information was processed through percentage analysis. The results achieved were interpreted as numbers with their percentages. Results: in the characterization of the sample, females, the age group between 70 and 79 years and the level of lower secondary education predominated. Stage II with a poor state of health and inadequate perception of self-care was the majority. Comorbidity was moderate with survival between 40 to 60 months. Conclusions: women between 70 and 79 years of age and lower secondary education level predominated, stage II and inadequate perception of self-care also prevailed.

Desarrollo infantil y sus principales desafíos en los primeros años de vida: lugar e importancia de los centros de educación y protección del Instituto del Niño y Adolescente del Uruguay / Child development and its main challenges in the first years of life: place and importance of the education and protection centers of the Children and Adolescents Institute of Uruguay

Existe un aumento progresivo de los problemas del neuropsicodesarrollo. Las intervenciones psicoeducativas y sociales oportunas con soporte en evidencias mejoran la evolución a lo largo de la vida de los niños. Los Centros Educativos en Primera Infancia tienen el potencial de identificar precozmente a niños con riesgos de alteraciones en el neuropsicodesarrollo. El Centro de Formación y Estudios del Instituto del Niño y Adolescente del Uruguay convoca a la Unidad Académica de Psiquiatría Pediátrica para la formación y actualización en esta problemática. El objetivo del trabajo es implementar un Programa de Capacitación en desarrollo normal, sus variaciones y desafíos; oportunidades de estimulación, identificación precoz de alteraciones e intervenciones en Centros Educativos en Primera Infancia; simultáneamente capacitar en habilidades de comunicación y trabajo interdisciplinario a posgrados de psiquiatría pediátrica y otras disciplinas de salud mental. Está dirigido a trabajadores del Instituto del Niño y Adolescente del Uruguay que trabajan con niños de 0 a 3 años. La implementación se realiza a través de tres modalidades articuladas, escalando progresivamente en contenidos: 1) Conferencias abiertas. 2) Curso introductorio a través de talleres virtuales sincrónicos. 3) Instancias docentes de profundización con equipos de Centros Educativos en Primera Infancia. Resultados: 2800 inscriptos. Se realizaron dos conferencias (4500 participantes en total), ocho cursos introductorios y se está implementando la modalidad 3 para el año 2024. Las encuestas de satisfacción han sido entre muy buenas-excelente. Se concluye que la implementación de este Programa de Capacitación permite la difusión de conocimientos y el intercambio interdisciplinario, por lo que es necesario continuar la cooperación entre Unidades Académicas, explorar otras modalidades pedagógicas y estudiar el impacto de la capacitación.

A progressive increase in neuro-psycho- developmental problems has taken place; timely evidence-based psycho-educational and social interventions improve children's lifelong development. Early Childhood Educational Centers have the potential for early identification of children at risk for neurodevelopmental disorders. The Training and Studies Center of the Institute of Childhood and Adolescence of Uruguay convenes the Academic Unit of Pediatric Psychiatry for training and updating on this issue. The objective is to implement a Training Program on normal development, its variations and challenges; stimulation opportunities, early identification of changes and interventions in Early Childhood Educational Centers, while training pediatric psychiatry postgraduates and other mental health disciplines in communication skills and interdisciplinary work. Methodology: Aimed at workers of the Institute of Childhood and Adolescence of Uruguay, working with children from 0 to 3 years old. Three articulated modalities, progressively increasing in content: 1) Open lectures. 2) Introductory course: synchronous virtual workshops. 3) Teaching instances with teams from Early Childhood Educational Centers. Results: 2800 participants. Two conferences (4500 participants) and eight introductory courses were held. Modality 3 is being organized for 2024. Satisfaction surveys show very good to excellent results. It is concluded that the implementation of this training Program makes knowledge dissemination and interdisciplinary exchange possible, so it is necessary to continue cooperation between academic units, explore other pedagogical modalities and study training impact.

Current Insights on Neoplasms and Adequate Dental Care for Patients with Oral Cancer / Actualización sobre Neoplasmas y su Correcta Atención Odontológica en Pacientes con Cancer Oral

The present study aimed to review the literature on the main complications of antineoplastic therapies and the degree of knowledge of dental surgeons about these complications. A bibliographic search was conducted in the main health databases PUBMED (www.pubmed.gov) and Scholar Google (www.scholar.google.com.br), in which studies published from 1987 to 2023 were collected. Laboratory studies, case reports, systematic and literature reviews, which were developed in living individuals, about the main neoplastic genes and their relationship with the cells of individuals affected by neoplasms in the head and neck region, and studies on the care with this group of patients, were included. Therefore, articles that did not deal with neoplasm and the main complications of antineoplastic therapies were excluded. Neoplasm is a clonal disorder, caused by mutations, resulting from changes in the genetic structure of cells. Each healthy cell has instructions on how to grow and divi de. In the presence of any error in these instructions (mutation), it can result in a diseased cell that, when proliferating, may cause a tumor. Countless knowledge has been accumulated over the years on the main characteristics of neoplasms, whether they are cancer cell biology, carcinogenesis mechanism, neoplasms of the maxillofacial system and sequels of antineoplastic treatments. In this context, methods have been developed that offer a better quality of life for patients diagnosed with this pathology, as well as preventive vaccine models that may, in the not too distant future, contribute to this goal to be successfully achieved.

El presente estudio tuvo como objetivo revisar la literatura sobre las principales complicaciones de las terapias antineoplásicas y el grado de conocimiento de los odontólogos sobre este abordaje. Se realizó una búsqueda bibliográfica en las principales bases de datos de salud PUBMED (www.pubmed.gov) y Scholar Google (www.scholar.google.com.br), en la que se recopilaron estudios publicados entre 1987 y 2023. Fueron incluidos estudios de laboratorio, relatos de casos, revisiones de la literatura y revisiones sistemáticas, desarrolladas en individuos vivos, que incluyeran los principales genes neoplásicos y su relación con las células de individuos afectados por neoplasias en la cabeza y el cuello. También, se tuvieron en cuenta estudios relacionados con la atención a este grupo de pacientes. La neoplasia es un trastorno clonal, causado por mutaciones, como resultado de cambios en la estructura genética de las células. Cada célula sana tiene instrucciones sobre cómo crecer y dividirse. En presencia de cualquier error en estas instrucciones (mutación), puede provocar una célula alterada que, al proliferar, puede causar un tumor. Se han acumulado innumerables conocimientos a lo largo de los años sobre las principales características de las neoplasias, ya sea sobre biología de células cancerosas, el mecanismo de la carcinogénesis, la neoplasias del sistema maxilofacial y las diferentes secuelas de tratamientos antineoplásicos. En este contexto, se han desarrollado métodos que ofrecen una mejor calidad de vida para los pacientes diagnosticados con esta patología, así como modelos de vacunas preventivas que, en un futuro no muy lejano, pueden contribuir a alcanzar este objetivo con éxito.

Desarrollo de la habilidad en el diagnóstico precoz del cáncer bucal durante las prácticas preprofesionales de Estomatología / Development of the competence in oral cancer early diagnosis during pre-professional training in Dentistry i: en

Introducción: La creciente aparición del cáncer bucal en etapas avanzadas revela la necesidad de egresar profesionales preparados que contribuyan a su prevención y diagnóstico precoz. Objetivo: Evaluar un sistema de tareas docentes para el desarrollo de la habilidad en el diagnóstico precoz del cáncer bucal. Métodos: Se realizó un preexperimento en 32 estudiantes y 10 profesores vinculados al proceso de enseñanza-aprendizaje de la asignatura Atención Integral a la Población de la carrera de Estomatología en la Universidad de Ciencias Médicas de Guantánamo, en el curso escolar 2022-2023. A tal efecto, se determinó la variable el desarrollo de la habilidad para el diagnóstico precoz del cáncer bucal, con sus dimensiones e indicadores, y se comprobó la significación de un sistema de tareas docentes para este fin a través de la prueba de Wilcoxon. Resultados: De acuerdo con los rangos de Wilcoxon, el sistema de tareas docentes resultó confiable para contribuir al desarrollo de la habilidad objeto de estudio (p<0,05). Los estudiantes consideraron que dicho sistema constituye la vía idónea para su preparación en el tema; de igual forma, todos los profesores coincidieron en cuanto a su pertinencia, factibilidad, efectividad, utilidad práctica y relevancia. Conclusiones: El sistema de tareas docentes aplicado durante la práctica preprofesional de los estudiantes de estomatología demostró ser factible para el desarrollo de la habilidad en el diagnóstico precoz del cáncer bucal.

Introduction: The increasing appearance of advanced oral cancer reveals the need of graduating professionals, prepared to contribute to its prevention and early diagnosis. Objective: To evaluate a system of teaching tasks for the development of competence in oral cancer early diagnosis. Methods: A pre-experiment was carried out with 32 students and 10 professors, who were involved in the teaching-learning process of the subject Comprehensive Dental Care for the Population of Dentistry degree in the University of Medical Sciences from Guantánamo, in the 2022-2023 academic year. For this purpose, the development of competence in oral cancer early diagnosis was determined as the variable, with its dimensions and indicators, and the significance of a system of teaching tasks for this objective was verified through the Wilcoxon test. Results: According to the Wilcoxon ranks, the teaching task system was reliable in contributing to the development of the competence under study (p<0.05). The students considered that this system is the ideal way for their training on the subject; in the same way, all teachers agreed regarding the relevance, feasibility, effectiveness, and practical utility of the teaching task system. Conclusions: The teaching task system applied during pre-professional practice of dentistry students proved to be feasible for the development of competence in oral cancer early diagnosis.

A New Brazilian Device for Cervical Cancer Screening: Acceptability and Accuracy of Self-sampling / Um Novo Dispositivo Brasileiro para Diagnóstico de Câncer Cervical: Aceitabilidade e Precisão da Autoamostragem

Abstract Objective To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix® - for detecting HPV-DNA. Methods A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling. Results HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling. Conclusion Self-sampling using the new Brazilian device SelfCervix® is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.

Resumo Objetivo Avaliar a acurácia e aceitabilidade da auto-coleta utilizando um novo coletor - SelfCervix® - para a detecção de DNA de HPV. Métodos Foram incluídas no estudo 73 mulheres com idade entre 25-65 anos que realizaram seu rastreamento regular do câncer de colo do útero entre Março e Outubro de 2016. Estas mulheres realizaram a auto-coleta, seguida de coleta profissional e as amostras foram analisadas paraa presença de DNA de HPV. Após, elas responderam um questionário sobre a experiência da auto-coleta. Resultados As taxas de detecção de DNA de HPV por auto-coleta foram altas e similares as da coleta profissional. Sessenta e quatro (87,7%) pacientes responderam o questionário de experiência. A maioria (89%) considerou a auto-coleta confortável, e 82,5% preferiram o método comparado a coleta profissional. As razões citadas foram economia de tempo e conveniência. Cinquenta e uma (79,7%) mulheres confirmaram que recomendariam a auto-coleta. Conclusão Auto-coleta utilizando o novo coletor desenvolvido no Brasil não é inferior na detecção de DNA de HPV quando comparada a coleta profissional, e apresenta uma boa aceitabilidade pelas mulheres. Desta maneira, pode ser uma opção para alcançar populações que não realizam o rastreamento padrão.

Computer-aided diagnosis system versus conventional reading system in low-dose (< 2 mSv) computed tomography: comparative study for patients at risk of lung cancer

ABSTRACT BACKGROUND: Computer-aided diagnosis in low-dose (≤ 3 mSv) computed tomography (CT) is a potential screening tool for lung nodules, with quality interpretation and less inter-observer variability among readers. Therefore, we aimed to determine the screening potential of CT using a radiation dose that does not exceed 2 mSv. OBJECTIVE: We aimed to compare the diagnostic parameters of low-dose (< 2 mSv) CT interpretation results using a computer-aided diagnosis system for lung cancer screening with those of a conventional reading system used by radiologists. DESIGN AND SETTING: We conducted a comparative study of chest CT images for lung cancer screening at three private institutions. METHODS: A database of low-dose (< 2 mSv) chest CT images of patients at risk of lung cancer was viewed with the conventional reading system (301 patients and 226 nodules) or computer-aided diagnosis system without any subsequent radiologist review (944 patients and 1,048 nodules). RESULTS: The numbers of detected and solid nodules per patient (both P < 0.0001) were higher using the computer-aided diagnosis system than those using the conventional reading system. The nodule size was reported as the maximum size in any plane in the computer-aided diagnosis system. Higher numbers of patients (102 [11%] versus 20 [7%], P = 0.0345) and nodules (154 [15%] versus 17 [8%], P = 0.0035) were diagnosed with cancer using the computer-aided diagnosis system. CONCLUSIONS: The computer-aided diagnosis system facilitates the diagnosis of cancerous nodules, especially solid nodules, in low-dose (< 2 mSv) CT among patients at risk for lung cancer.

Infarto agudo do miocárdio: Tempo é músculo / Acute myocardial infarction: Time is muscle

Objetivo: descrever a impotância de uma detecção precoce do Infarto Agudo do Miocárdio (IAM) por meio da equipe multidisciplinar de saúde e expor se o tempo interfere ou não na piora da lesão miocárdica. Método:Trata-se de uma revisão integrativa da literatura com artigos de 2015 e 2020. As bases utilizadas foram LILACS, MEDLINE, SCIELO, BDEFN e Google Acadêmico. Resulatdos: O tempo porta-balão <90 minutos é eficiente no manejo do paciente com IAM, pois quanto mais rápido atendimento melhor o prognóstico, mas ainda existem muitas dificuldades na realização desse manejo, pois muitos sintomas não são detectados precocemente, a busca pelo atendimento é demorada e as instituições não seguem os protocolos corretamente. Conclusão: Diante deste cenário a telemedicina surge como um aliado no prevenção, diagnóstico e tratamento e principalmente o menor tempo para o atendimento, pois trará mais saúde para o miocárdio e consequentemente para o paciente.(AU)

Objetivo: describir la importancia de la detección precoz del Infarto Agudo de Miocardio (IAM) a través del equipo multidisciplinario de salud y exponer si el tiempo interfiere o no en el empeoramiento de la lesión miocárdica. Método: Se trata de una revisión integrativa de la literatura con artículos de 2015 y 2020. Las bases de datos utilizadas fueron LILACS, MEDLINE, SCIELO, BDEFN y Google Scholar. Resultados: El tiempo puerta-balón < 90 minutos es eficiente en el manejo de los pacientes con IAM, pues cuanto más rápido el tratamiento, mejor el pronóstico, pero aún existen muchas dificultades para realizar este manejo, ya que muchos síntomas no se resuelven. detectada a tiempo, la búsqueda de atención lleva mucho tiempo y las instituciones no siguen correctamente los protocolos. Conclusión: Ante este escenario, la telemedicina surge como un aliado en la prevención, diagnóstico y tratamiento y sobre todo en el menor tiempo de atención, ya que traerá más salud al miocardio y consecuentemente al paciente.(AU)

Objective: to describe the importance of an early detection of Acute Myocardial Infarction (AMI) through the multidisciplinary health team and expose whether or not time interferes in the worsening of the myocardial injury. Method: This is an integrative literature review with articles from 2015 and 2020. The databases used were LILACS, MEDLINE, SCIELO, BDEFN and Google Scholar. Results: The door- to-balloon time <90 minutes is efficient in the management of patients with AMI, because the faster the treatment, the better the prognosis, but there are still many difficulties in carrying out this management, since many symptoms are not detected early, the search for care it is time consuming and institutions do not follow protocols correctly. Conclusion: Given this scenario, telemedicine emerges as an ally in prevention, diagnosis and treatment and especially the shortest time for care, as it will bring more health to the myocardium and consequently to the patient.(AU)

Accuracy of visual inspection, cytology and colposcopy in the diagnosis of high-grade cervical intraepithelial neoplasia / Acurácia da inspeção visual, citologia e colposcopia no diagnóstico da neoplasia intraepitelial cervical de alto grau

Cervical cancer is still one of the leading causes of cancer and mortality in women, especially in low- and middle-income countries. Normally, the prevention of its occurrence is done through efficient screening and treatment programs for high-grade epithelial lesions, which are pre-malignant lesions. Cheaper diagnostic techniques ensure greater access to women, which can prevent a large number of cancer cases worldwide. Objective: The aim of the study was to evaluate the accuracy of visual inspection either with acetic acid or with Lugol's iodine, cervical cytology and colposcopy in the diagnosis of cervical intraepithelial neoplasia 2 and 3. Methods: This is a study of diagnostic accuracy. We evaluated 115 women with high-grade squamous intraepithelial lesion confirmed by biopsy, 54 with cervical intraepithelial neoplasia 2 and 61 with cervical intraepithelial neoplasia 3, from January 2016 to December 2018 at the Lower Genital Tract Pathology and Colposcopy Service of the Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. A comparative analysis of the visual inspection, Pap smear and colposcopy diagnostic methods was performed. Results: The average age was 33.1 years (standard deviation=9.83) for cervical intraepithelial neoplasia 2 cases and 35.2 years (standard deviation=7.97) for cervical intraepithelial neoplasia 3. In the cervical intraepithelial neoplasia 2 group, visual inspection tests were positive for high-grade squamous intraepithelial lesion in 98.1% of the cases with acetic acid and 94.4% with Lugol's iodine. Colposcopy identified a probable high-grade squamous intraepithelial lesion in 94.4% of the cases, while cytology only in 42.6%. In the cervical intraepithelial neoplasia 3 group, the visual inspection tests were positive for high-grade squamous intraepithelial lesion in 91.8% of the cases with acetic acid and 95.1% with Lugol's iodine. Colposcopy identified a probable high-grade squamous intraepithelial lesion in 93.5% of the cases, while cytology in 65.6%. Conclusion: Visual inspection with acetic acid and Lugol's iodine, and colposcopy test were more accurate for the diagnosis of cervical intraepithelial neoplasia 2 and 3 than through cytopathology. (AU)

Introdução: O câncer do colo de útero ainda é uma das principais causas de câncer e mortalidade em mulheres, especialmente em países de baixa e média renda. Normalmente, a prevenção de sua ocorrência é feita por meio de programas eficientes de triagem e tratamento de lesões epiteliais de alto grau, que são as lesões pré-malignas. Técnicas diagnósticas mais baratas garantem maior acesso às mulheres, podendo evitar um grande número de casos de câncer no mundo inteiro. Objetivo: O objetivo deste estudo foi avaliar a acurácia da inspeção visual (com ácido acético e com solução de lugol), da citologia cervical e da colposcopia no diagnóstico de neoplasias intraepiteliais cervicais 2/3. Métodos: Trata-se de um estudo de acurácia diagnóstica. Foram avaliadas 115 mulheres com lesão intraepitelial escamosa de alto grau confirmada por biópsia, 54 com neoplasias intraepiteliais cervicais 2 e 61 com neoplasias intraepiteliais cervicais 3, no período de janeiro de 2016 a dezembro de 2018 no Serviço de Patologia e Colposcopia do Trato Genital Inferior do Hospital de Clínicas de Porto Alegre, em Porto Alegre, Brasil. Foi realizada análise comparativa dos métodos de diagnóstico Inspeção visual com ácido acético, Inspeção visual com Solução de Lugol, colpocitologia oncótica e colposcopia. Resultados: A média de idade foi de 33,11 anos (DP 9,83) para os casos de neoplasias intraepiteliais cervicais 2 e de 35,28 anos (DP 7,97) para neoplasias intraepiteliais cervicais 3. No grupo de neoplasias intraepiteliais cervicais 2, os testes de inspeção visual foram positivos para tratamento de lesões epiteliais de alto grau em 98,1% dos casos com Inspeção visual com ácido acético e em 94,4% daqueles com Inspeção visual com Solução de Lugol. A colposcopia identificou provável tratamento de lesões epiteliais de alto grau em 94,4% dos casos, enquanto a citologia apenas 42,6%. No grupo neoplasias intraepiteliais cervicais 3, os testes de inspeção visual foram positivos para tratamento de lesões epiteliais de alto grau em 91,8% dos casos com Inspeção visual com ácido acético e em 95,1% daqueles com Inspeção visual com Solução de Lugol. A colposcopia identificou provável tratamento de lesões epiteliais de alto grau em 93,5% dos casos, enquanto a citologia em 65,6%. Conclusão: A inspeção visual (com ácido acético e com Solução de Lugol) e a colposcopia foram mais precisas para o diagnóstico de neoplasias intraepiteliais cervicais 2/3 do que a citopatologia. (AU)

Are sociodemographic and anthropometric variables effective in screening probable and confirmed sarcopenia in community-dwelling older adults? A cross-sectional study

ABSTRACT BACKGROUND: Screening for probable and confirmed sarcopenia using sociodemographic and anthropometric indicators can be a practical, cheap, and effective strategy to identify and treat older people susceptible to this condition. OBJECTIVES: To identify cutoff points for sociodemographic and anthropometric variables in screening probable and confirmed sarcopenia in community-dwelling older adults. DESIGN AND SETTING: This was a cross-sectional study of community-dwelling older adults in Araranguá, Santa Catarina, Brazil. METHODS: Sociodemographic (age, education) and anthropometric (weight, height, body mass index [BMI], waist circumference [WC], and dominant calf circumference [DCC]) factors were considered as predictors. The outcomes were probable sarcopenia (reduction in muscle strength assessed by time ≥ 15 s in the five-time sit-to-stand test) and confirmed sarcopenia (reduction in strength and muscle mass). Receiver operating characteristic curve analysis was used to analyze the ability to track sociodemographic and anthropometric variables for sarcopenia. RESULTS: In 308 older adults, WC > 91 cm in women and age > 69 years in men were useful in screening for probable sarcopenia. The variables age, weight, BMI, WC, and DCC can be used to screen for sarcopenia in older women and men. CONCLUSION: Sociodemographic and anthropometric variables are simple and accessible tools for sarcopenia screening in older adults.

Citopatológico do colo uterino e adequabilidade da amostra: ensaio clínico randomizado controlado / Cervical cytopathology and sample suitability: a randomized controlled clinical trial

Resumo Objetivo Avaliar duas técnicas de coleta cervicovaginal à adequabilidade da amostra e aos demais achados do laudo colpocitopatológico. Métodos O estudo foi realizado no período de setembro de 2018 a julho de 2019, em um centro de saúde-escola, localizado no município de Fortaleza - Ceará. A amostra foi composta por 365 mulheres divididas aleatoriamente, sendo 184 participantes no Grupo Controle (técnica na qual o esfregaço da ectocérvice foi disposto na lâmina antes da coleta do material da endocérvice) e 181 no Grupo Comparação (no qual o esfregaço da ectocérvice vaginal foi disposto na lâmina apenas após a coleta do material da endocérvice). Utilizou-se um instrumento contendo variáveis sociodemográficas, clínicas, sexuais, reprodutivas e referentes aos achados no laudo citopatológico. Incluíram-se mulheres na faixa etária de 18 a 64 anos, que já tinham iniciado vida sexual e que realizaram o exame de prevenção do câncer de colo uterino no período da coleta de dados. Os testes do qui-quadrado, Fisher e Kruskal-Wallis foram utilizados. Resultados Não houve associação estatística entre a adequabilidade da amostra citopatológica às duas técnicas de coleta cervicovaginal empregadas e às demais variáveis clínicas, sexuais, reprodutivas e referentes aos demais achados no laudo citopatológico, obtendo-se valor de p>5% em todas as associações realizadas. Conclusão As duas técnicas de coleta de células cervicais descritas em manuais oficiais não diferiram para a obtenção de uma amostra celular adequada, sendo igualmente eficazes e propiciando a garantia de um laudo colpocitopatológico preciso e oportuno. Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-2H4MPN.

Resumen Objetivo Evaluar dos técnicas de toma de muestra cervicovaginal con la adecuación de la muestra y con los demás resultados del informe colpocitológico. Métodos El estudio fue realizado durante el período de septiembre de 2018 a julio de 2019, en un centro de salud-escuela, ubicado en el municipio de Fortaleza, estado de Ceará. La muestra estaba compuesta por 365 mujeres divididas aleatoriamente, de las cuales 184 participantes estaban en el Grupo Control (técnica por la que el frotis del ectocérvix fue colocado en la lámina antes de la toma del material del endocérvix) y 181 en el Grupo Comparación (en el que el frotis del ectocérvix vaginal fue colocado sobre la lámina únicamente después de la toma del material del endocérvix). Se utilizó un instrumento con variables sociodemográficas, clínicas, sexuales, reproductivas y relativas a los resultados del informe citológico. Fueron incluidas mujeres del grupo de edad de 18 a 64 años, que ya habían empezado su vida sexual y que realizaron la prueba de prevención de cáncer de cuello uterino durante el período de la recopilación de datos. Se utilizaron las pruebas χ2 de Pearson, Fisher y Kruskal-Wallis. Resultados No hubo asociación estadística entre la adecuación de la muestra citológica con las dos técnicas de toma cervicovaginal utilizadas y con las demás variables clínicas, sexuales, reproductivas y referentes a los demás resultados del informe citológico, y se obtuvo un valor de p>5 % en todas las asociaciones realizadas. Conclusión Las dos técnicas de toma de células cervicales que se describen en manuales oficiales no difirieron en la obtención de una muestra celular adecuada y son igualmente eficaces y favorecen la garantía de un informe colpocitológico preciso y oportuno.

Abstract Objective To assess two cervicovaginal collection techniques to sample suitability and the other findings of Pap smear. Methods The study was conducted from September 2018 to July 2019, in a school health center located in the city of Fortaleza - Ceará. The sample consisted of 365 women randomly divided, with 184 participants in the Control Group (technique in which the ectocervix smear was placed on the slide before endocervical material was collected) and 181 in the Comparison Group (in which the vaginal ectocervix smear was placed on the slide only after collecting the material from the endocervix). An instrument containing sociodemographic, clinical, sexual, reproductive and findings in cytopathological report was used. Women aged between 18 and 64 years, who had already started their sexual life and who underwent the cervical cancer prevention test during the data collection period, were included. Chi-square, Fisher and Kruskal-Wallis tests were used. Results There was no statistical association between cytopathological sample suitability for the two cervicovaginal collection techniques used and for the other clinical, sexual, reproductive and other variables related to the other findings in cytopathological report, obtaining a value of p>5% in all associations performed. Conclusion The two techniques for collecting cervical cells described in official manuals did not differ for obtaining an adequate cell sample, being equally effective and providing the guarantee of an accurate and timely Pap smear. Brazilian Clinical Trial Registry (ReBEC): RBR-2H4MPN.

Social inequalities in access to cancer screening and early detection: A population-based study in the city of São Paulo, Brazil

Abstract Objective: This study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from 2003 to 2015 according to education level. Method: This is a cross-sectional population-based study conducted with data from the 2003, 2008, and 2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios. Results: The proportion of Pap smears remained stationary at a high level (>89%) throughout the study period, while access to mammography and PSA tests significantly increased in the 2003-2015 period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period 2003-2015. Conclusions: The inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group.

Análise de custo-efetividade do rastreamento com tomografia computadorizada de baixa dose para detecção precoce de câncer de pulmão sob a perspectiva do Sistema Único de Saúde / Cost-effectiveness analysis of low-dose computed tomography screening for early detection of lung cancer from the perspective of the Unified Health System

O câncer de pulmão é reconhecidamente um dos mais agressivos dentre os tumores, com alta letalidade. A detecção precoce do câncer de pulmão com tomografia computadorizada de baixa dose tem sido avaliada em diversos países e implementada em alguns. Entretanto, a implementação do rastreamento com uso dessa tecnologia para detecção precoce de novos casos, permanece questionado no mundo, e no Brasil não está recomendado. Por esse motivo, foi elaborada uma avaliação de custo-efetividade do uso da tomografia computadorizada de baixa dose como estratégia de rastreamento para detecção precoce do câncer de pulmão em população de risco sob a perspectiva do Sistema Único de Saúde como órgão financiador. Inicialmente uma revisão sistemática foi elaborada e descrita uma síntese das diferentes abordagens disponíveis nas avaliações econômicas. Os 30 estudos selecionados e incluídos na revisão mostraram qualidade global, com bom padrão metodológico, que atendeu a mais de 80% dos critérios estabelecidos pelo formulário (Consensus Health Economic Criteria list). A análise da eficiência comparativa entre duas alternativas (anual e bianual) para o diagnóstico precoce de câncer de pulmão, considerando a estratégia de rastreamento com tomografia computadorizada de baixa dose e a conduta clínica sem rastreio, como cenário de referência, teve por base uma coorte hipotética de 100.000 indivíduos assintomáticos, e tabagistas de alto risco. O horizonte temporal considerou a expectativa de vida dos indivíduos, e a perspectiva foi o Sistema Único de Saúde como financiador da assistência à saúde. Apenas os custos médicos diretos dos itens relacionados ao processo de diagnóstico e tratamento foram estimados. O desfecho foi medido em anos de vida ganhos. O desconto de 5% foi aplicado aos custos e benefícios. E realizadas análises de sensibilidade determinística univariada e probabilística. A razão de custo-efetividade incremental da estratégia de rastreamento anual com a tomografia computadorizada de baixa dose para a detecção precoce de câncer de pulmão foi estimada em R$ 97.583,52 por cada ano de vida ganho e de R$ 56.642,20 por ano de vida ganho, com o rastreio a cada dois anos. A análise determinística mostrou que o impacto da redução da incidência de câncer de pulmão, em ambas as alternativas (anual e bianual), chega a gerar quase o triplo dos gastos estimados para a razão de custo-efetividade incremental. Para o anual esse aumento chega a R$ 176.834,47, fora do limiar de R$105.000,00, enquanto o rastreamento bianual, mesmo dobrando os gastos, ainda se manteria dentro do limiar de custo-efetividade atualmente definido para o país. Os demais parâmetros de relevância (sensibilidade do rastreamento para detecção de câncer e a proporção de diagnósticos em estadio I/II com o rastreamento) não impactaram nos resultados finais. A análise probabilística das alternativas de rastreamento mostrou para o rastreamento anual 52% das simulações dentro do limiar estabelecido e 94,2% referente ao bianual. O resultado do modelo econômico mostrou resultados favoráveis com a adoção da estratégia de rastreamento de câncer de pulmão com uso de tomografia computadorizada de baixa dose comparada a condução clínica, realizada a cada dois anos em população de alto risco, sob a perspectiva do SUS. (AU)

Lung cancer is one of the most aggressive tumors, with high lethality. Early detection of lung cancer with low-dose computed tomography has been evaluated in several countries and implemented in some. However, the implementation of screening using this technology for early detection of new cases remains questioned worldwide, but in Brazil, it has not been recommended. Thus, a cost-effectiveness assessment of a screening strategy with low-dose computed tomography for early lung cancer detection in a high-risk population under the Unified Health System perspective as a funding body. First, a systematic review was performed and synthesized the different approaches available in economic evaluations. Thirty studies selected and included in the review showed overall quality, with a well-designed methodological standard, which met more than 80% of the criteria established by the Consensus Health Economic Criteria (CHEC) list form. The analysis of the comparative efficiency between two alternatives (annual and biannual) for the early diagnosis of lung cancer, considering the screening strategy with low-dose computed tomography and the clinical management, without screening, as a reference scenario, was based on a cohort hypothetical 100,000 asymptomatic individuals, and high-risk smokers. The time horizon considered the individuals' life expectancy, and the perspective was the Brazilian Unified Health System as the funder of health care. Only the direct medical costs of items related to the diagnosis and treatment process were estimated. The outcome measure was life years gained. A discount of 5% has been applied to costs and benefits. A deterministic and probabilistic sensitivity analysis has been performed. The incremental cost-effectiveness ratio of the annual screening strategy for early lung cancer detection has been estimated at BRL 97,583.52 for each life-year gained and BRL 56,642.20 per year of life gained, with screening every two years. The deterministic analysis showed that the impact of reducing the incidence of lung cancer, in both alternatives (annual and biannual) generated almost three times the estimated expenses for the incremental cost-effectiveness ratio. For the annual survey, this increase reaches BRL 176,834.47, outside the BRL 105,000.00 threshold, while biannual screening, even doubling the expenses, would remain within the cost-effectiveness threshold currently defined for the country. The other relevant parameters (screening sensitivity for cancer detection and the proportion of stage I/II diagnoses with screening) have no impact on the final results. The probabilistic analysis showed that 52% of simulations within the established threshold correspond to the annual screening, and 94.2% to the biannual. The economic model designed to evaluate the cost-effectiveness of lung cancer screening using low-dose computed tomography compared to clinical care showed favorable results from the strategy performed every two years in a high-risk population, under the SUS perspective. (AU)