Apoio social à mulher mastectomizada: um estudo de revisão / Social support to women after mastectomy: a review study

Para fundamentar as ações de cuidado integralizado em saúde da mulher é necessário compreender de que modo o apoio social pode contribuir para minimizar as repercussões do diagnóstico e do tratamento da neoplasia mamária. O objetivo deste estudo é analisar a contribuição da produção científica nacional e internacional acerca do apoio social percebido por mulheres diagnosticadas com câncer de mama. A amostra foi constituída de 12 publicações, obtidas a partir de critérios de inclusão preestabelecidos, nas bases de dados MedLine, Lilacs e PsycINFO, na última década (2000-2010). Os resultados foram sistematizados em categorias temáticas: percepção do apoio familiar, apoio social percebido, percepção do apoio educacional, necessidade de aprimoramento da pesquisa e assistência às mastectomizadas e suas famílias. Os estudos dedicados à dimensão subjetiva do apoio social ainda são incipientes. As evidências disponíveis sugerem que a literatura é circunscrita a temas de interesse das profissões tradicionais da área da saúde, como Enfermagem e Medicina, privilegiando construtos que podem ser diretamente quantificados. A preocupação com o apoio social deve estar presente desde a fase de diagnóstico até a reabilitação psicossocial, como parte do processo de enfrentamento.

It is necessary to understand how social support can contribute to minimize the impact of the diagnosis and treatment of mammary tumors in order to underpin the actions of comprehensive women's health care. This study seeks to analyze the contribution of the national and international literature regarding the perceived social support by women diagnosed with breast cancer. Twelve studies were selected from the MedLine, Lilacs and PsycINFO databases over a 10-year period (2000-2010) with pre-defined criteria for inclusion. The results were organized into thematic categories: the perception of family support; perceived social support; the perception of educational support; the need to improve the research and the assistance given to women after mastectomy and their families. The studies dedicated to the subjective dimension of social support are still incipient. The available evidence suggests that the literature is limited to topics of interest to the traditional health professions, such as Nursing and Medicine, focusing on constructs that can be directly quantified. The concern with social support must be present from the time of diagnosis to psychosocial rehabilitation, as part of the process of tackling the situation.

Waiting times for surgical and diagnostic procedures in public hospitals in Mexico / Tiempos de espera para procedimientos quirúrgicos y diagnósticos en hospitales públicos de México

Objective. A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. Materials and methods. We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. Results. Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). Conclusion. Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.

Objetivo. Se llevó a cabo una evaluación retrospectiva de los tiempos de espera para procedimientos electivos en una muestra de hospitales públicos en México de las siguientes instituciones: Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) y Secretaría de Salud (SS). El propósito era describir la situación actual en materia de tiempos de espera e identificar oportunidades de redistribución de la demanda de servicios entre instituciones públicas. Material y métodos. Se analizaron los tiempos de espera y la productividad para siete procedimientos quirúrgicos y cuatro procedimientos diagnósticos seleccionados sobre la base de su frecuencia relativa y comparabilidad con otros sistemas de salud nacionales. Resultados. El tiempo de espera promedio para los siete procedimientos quirúrgicos en las tres instituciones fue de 14 semanas. Los hospitales del IMSS y el ISSSTE mostraron un mejor desempeño (12 y 13 semanas) frente a los hospitales de la SS (15 semanas). El tiempo de espera promedio para los cuatro procedimientos diagnósticos fue de 11 semanas. Los hospitales del IMSS mostraron un tiempo de espera promedio mejor (10 semanas) que los hospitales del ISSSTE (12 semanas) y la SS (11 semanas). Conclusión. Se identificaron variaciones importantes no sólo entre instituciones sino también al interior de cada una de ellas. Estas variaciones deben atenderse para así mejorar la satisfacción de los usuarios de los servicios.

Neoadjuvant capecitabine-based chemoradiotherapy followed by total mesorectal excision for locally advanced resectable rectal cancer

Twenty three patients with respectable clinical stages II and III cancer rectum entered the study. All patients received concurrent chemoradiotherapy [CRT] based on capecitabine orally at a dose of 825 mg/m2 twice a day throughout the concurrent radiotherapy [RT] course. A radiation dose of 45 Gy was given to the posterior part of the pelvis to include the tumor, the mesorectum, followed by a boost of 5.4 Gy limited to the tumor and corresponding mesorectum with a 2 cm margin. A total mesorectal excision [TME] surgery was performed after a rest period of 6-7 weeks from completion of the preoperative chemo-irradiation. Acute toxicities of concurrent chemo-radiotherapy were reversible and controllable. Grade 3 leucopenia was noted in one patient only. Acute cystitis, moderate grade, was developed in 3 patients. Neurological symptoms were noted in 3 patients. Bleeding during operation occurred in 8.7% of patients. One patient who showed clinical leakage failed conservative management and required surgical re-intervention. Downstaging rate for T-stage was 69.5% [16/23 patients]. This rate was higher for N-stage constituting 84.2% [16/ 19 patients as 4 patients were NO]. There was no increase in T- and/or N-stage [upstaging] recorded in this study. Complete pathological response was recorded in 2 patients only [8.7%]. Sphincter-conserving surgery was successfully performed in 2 of 7 patients who were considered for abdomino-perineal resection before chemo-irradiation [28.6%]. After a median follow up period of 24 months, overall survival rate was 90.9% [20/22]. Distant failure was higher than local recurrence [13.6% Vs 9.1% respectively]. In conclusion; preoperative concurrent capecitabine and radiotherapy is considered to be a safe procedure and well-tolerated in patients with clinical stages II and III resectable rectal cancer treated with TME surgery. Successful high rate of sphincter-sparing procedure to some patients with low cancer rectum is possible after preoperative concurrent capecitabine and radiotherapy. Preoperative concurrent capecitabine and radiotherapy may reduce recurrence and improve survival rates