Primeiro rastreamento organizado regional no Brasil: barreiras relacionadas á realidade do exame de mamografia

A mamografia constitui o método populacional mais eficaz na redução da mortalidade por câncer de mama, visto a elevação do diagnóstico de lesões precoces. Países em desenvolvimento apresentam uma elevação na incidência e mortalidade por câncer de mama, decorrente da limitação do exame de mamografia e de programas efetivos de rastreamento. Há inúmeras barreiras relacionadas a não realização do exame de mamografia, podendo estar relacionadas ao sistema de saúde, à educação e à adesão da paciente. Iniciou-se em 2003 na DRS-V um rastreamento mamográfico, controlando as variáveis relacionadas ao sistema de saúde e educação. Na região da DRS/V do Estado de São Paulo, constituída por 19 cidades, iniciou-se um rastreamento mamográfico organizado, a mulheres na faixa etária dos 40-69 anos, através de uma Unidade Móvel de Prevenção (UMP) contendo um mamógrafo, ou em uma unidade fixa, em local onde havia limitação prévia a realização deste exame. Avaliou-se as características de 17.964 mulheres atendidas nos dois primeiros anos do projeto, sendo avaliado as características desta população; e após a cobertura populacional de 50,3% das mulheres, foram entrevistadas 550 mulheres que nunca haviam realizado o exame de mamografia anteriormente. Nas mulheres refratárias foi aplicado questionário avaliando o conhecimento sobre o auto-exame da mama, a importância da mamografia, bem como estratégias para identificação desta população refratária ao exame. No início do projeto o Programa de Saúde da Família foi o principal fator motivador a realização do exame de mamografia (46,8%) e a maioria dos exames foi realizada em UMP (63,7). Cerca de 42,1% das mulheres nunca havia realizado o exame de mamografia na vida, sendo que as mulheres que não haviam realizado o exame previamente constituído principalmente de mulheres da faixa etária 40-69 anos, baixa...Mammography breast screening is related to early breast cancer diagnosis and the reduction of breast mortality is related to the increase in early breast cancer diagnosis. Developing countries have an increase in incidence and mortality for breast cancer is related to low income of mammography and the absence of organized screening. There are barriers related to the low adherence to mammography exam, and the main reasons are related to health system, education and adherence to guidelines. In 2003 started in DRS-V a mammography screening controlling the factors related to health system and knowledge. We began a mammographic screening in São Paulo state DRS/5 region, consisted with 19 cities, a mammographic breast cancer screening in women between 40-69 years old using a Mobile Unit with a mammography or in a fixed unit. We evaluated the characteristics of 17.964 women screened from the first two years of the project. When 50,3% of women had been screened we found 550 women non adherent to the project and applied questions related to the knowledge about breast clinical examination or reasons related to non adherence to mammography exam, and we analyze the strategies used to find these women. The “Programa de Saúde da Família” was the main factor related to adherence to mammography (46,8%) and the main local related to exams was the Mobile Unit (63,7%). There were 42,1% of the women who hadn’t done de mammography in their life’s and these women were principally between 40-49 years old, low socio-economic status and low income. There was an inverse relation in mammography previously and years of schooling and income. There was 39,2% early breast cancer diagnosis. The 550 women had low years of schooling (84,7%), low income (66,8%) and were between 42-49 years old (43,8%). The clinical frequently doesn’t realize breast examination (14,9%), and low women know how to do this exam... (Complete abstract click electronic access below

Barreiras no rastreamento do câncer de mama e o papel da enfermagem: revisão integrativa

O rastreamento para o câncer de mama ou a realização regular do exame de mamografia é uma realidade em países desenvolvidos. A enfermagem atua de diferentes maneiras neste processo, tendo importante papel no enfrentamento das barreiras relacionadas com a não adesão ao rastreamento; porém, sua efetividade é pouco comprovada, havendo limitado número de estudos clínicos sobre o tema. Realizou-se revisão integrativa sobre o tema na PubMed e na literatura latino-americana LILACS, avaliando estudos clínicos controlados que comprovassem a efetividade das ações de enfermagem, utilizando as palavras-chave rastreamento para o câncer de mama, enfermagem e estudos clínicos. Na PubMed foram identificadas 110 publicações sobre o tema, das quais 18 estudos clínicos apresentando as ações de enfermagem. Não se identificou nenhum estudo na LILACS. A presente revisão mostrou a efetividade da enfermagem no contexto do rastreamento do câncer de mama, apresentando novas perspectivas de atuação profissional, dentro de um contexto multidisciplinar de qualificação de ações relacionadas à saúde da mulher

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil

Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40-69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn't done de mammography in their lives and these women were principally from low socio-economic status (OR=2.99), low education (OR=3.00). The best strategies to include these women were mobile unit (OR=1.43) and Family Health Program (OR=1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora