Outcomes and quality of life following breast cancer treatment in older women: When, why, how much, and what do women want?

BACKGROUND: There are few comprehensive reviews of breast cancer outcomes in older women. We synthesize data to describe key findings and gaps in knowledge about the outcomes of breast cancer in this population. METHODS: We reviewed research published between 1995 and June 2003 on breast cancer quality of life and outcomes among women aged 65 and older treated for breast cancer. Outcomes included communication, satisfaction, and multiple quality of life domains. RESULTS: Few randomized trials or cohort studies that measured quality of life after treatment focused exclusively on older women. Studies from older women generally noted that, with the exception of axillary dissection, type of surgical treatment generally had no effect on long-term outcomes. In contrast, the processes of care, such as choosing therapy, good patient-physician communication, receiving treatment concordant with preferences about body image, and low perceptions of bias, were associated with better quality of life and satisfaction. CONCLUSIONS: With the exception of axillary dissection, the processes of care, and not the therapy itself, seem to be the most important determinants of long-term quality of life in older women

Políticas públicas, (des)igualdade de oportunidades e ampliação da cidadania no Brasil: o caso da educação de surdos (1990-2014)

TeseEste trabalho objetiva avaliar a relação entre as metas expressas nos textos das políticas públicas que, no Brasil do século XXI, incidem sobre os alunos surdos e as implicações da implementação dessas políticas nas nossas escolas. Com esse escopo, procura-se apurar até que ponto o Estado brasileiro está sendo capaz de garantir e respeitar os direitos de cidadania dessa parcela da população, assegurando aos estudantes surdos educação que atenda às suas especificidades e propicie acesso e apropriação do conhecimento escolar em condições de equidade face aos alunos ouvintes. Para tanto, analisam-se documentos relativos à questão, contextualiza-se sua construção, focalizam-se os discursos neles contidos e em que se constituíram, examinam-se dados censitários e busca-se, na observação das práticas escolares, verificar como, por que e com quais derivações e consequências as ações propostas estão, atualmente, traduzidas no cotidiano que caracteriza o ensino desses aprendizes. Ancorada na dimensão política e sócio-antropológica da surdez como diferença, na perspectiva sócio-histórico-cultural do desenvolvimento humano e nos estudos, por parte da Sociologia da Educação, da relação do sistema escolar com as desigualdades sociais, a moldura teórica, de base política, interage e se complementa com aportes da Educação de Surdos. Na teia construída com esses elementos, e trabalhando-se a partir da Abordagem do Ciclo de Políticas, investigam-se os processos macro e micropolíticos, observando-se a trajetória das políticas elaboradas, destacando-se progressos e conquistas alcançadas e apresentando-se sugestões para lidar com eventuais desigualdades reproduzidas, criadas ou desencadeadas pelas ações desenvolvidas. Verificada forte divergência entre a política de educação inclusiva adotada pela maioria dos governos estaduais e municipais e os anseios por uma educação bilíngue, defendida por grande parte da comunidade surda brasileira, delineiam-se algumas diretrizes para melhor enfrentamento dos temas aqui pesquisados e recomenda-se a coexistência de escolas bilíngues ao lado das escolas inclusivas, ensejando à parcela surda da população brasileira a experiência democrática da opção entre uma e outra modalidade de ensino

Comparison of recommendations for screening mammography using CISNET models

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138386/1/cncr30842.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138386/2/cncr30842_am.pd

Where only ghosts and tourists come to dine : the Creole and Cajun cuisines of Southern Louisiana and the commodification of history

This thesis interrogates the ways that the material biographies of the Creole and Cajun cuisines of southern Louisiana undermine and ultimately betray the discursive fictions that they are typically required to perform in popular culinary discourse. The thesis begins with an investigation of the contemporary literature concerning the commodity, commodity fetishism and consumption, particularly in the arena of cuisine, in order to better understand how the commodification of cuisine enables specific fantasies regarding American colonial history related to race and ethnicity. After elaborating the concept of the biography of the object, the thesis studies six specific recipes in detail. The historical trajectories of key ingredients in the recipes are traced in order to explore the ways the development of cuisine in 18 th -century Louisiana related to the violent interaction between French and Spanish colonists, Native American peoples, and the enslaved West African labour force. The thesis concludes by reconceptualizing the cuisines of Louisiana as diasporic cuisines

Health care professionals' preferences for extending mammographic breast screening to the over 70s

Background Breast screening improves survival in women aged 50–70. The relative benefits of screening in women over 70 are reduced but women up to age 80 may still benefit. In the UK the National Health Service provides screening by self referral to women >70. This research has investigated health care professionals' (HCPs') preferences for extending screening to older women and factors they consider when advising about screening. Materials and methods UK HCPs for breast or elderly care were recruited. A questionnaire relating to screening in the >70s was administered. A sample of respondents were also interviewed to give added insight. Results Questionnaires were distributed to 488 HCPs and 139 replies received, (29%). A total of 26 professionals were also interviewed. Most felt the current system of self referral was under-utilized due to poor user awareness. Predicted life expectancy, co-morbidity and patient preference were viewed as important factors influencing screening recommendation. Chronological age was thought less important. The present system was thought flawed, but there was little enthusiasm for extending screening due to perceived risks and reduced cost efficacy. Some form of selectivity for fitter women was advocated. Conclusions There was acceptance that fitter older women may benefit from screening whilst the less fit may be harmed suggesting that some form of selective invitation would be preferable to the present system but would be practically difficult and costly to administer. The present system of self referral was felt to be inadequate due to low levels of awareness and uptake

A expansão e o registro do léxico terminológico em LIBRAS: a contribuição do manuário acadêmico do INES

A presença cada vez mais numerosa de estudantes surdos em todos os níveis e modalidades da educação brasileira tem feito crescer, substancialmente, nos últimos anos, a demanda pela criação de sinais-termo para nomear conceitos referentes às diferentes áreas do conhecimento, bem como a demanda por obras lexicográficas para registro e divulgação desses novos itens lexicais. Entre os trabalhos com esse objetivo, localiza-se o Manuário Acadêmico e Escolar, resultante da investigação de um grupo de pesquisa do Departamento de Ensino Superior (DESU) do Instituto Nacional de Educação de Surdos (INES), composto de docentes, discentes e intérpretes da instituição, além de colaboradores externos. O produto, definido como um dicionário terminológico bilíngue da área da Pedagogia e das disciplinas do Ensino Básico, em processo de elaboração e aprimoramento, conta atualmente com um acervo de aproximadamente mil sinais, dos quais uma centena já com seus verbetes apresentados num formato moderno, dinâmico e original. Este artigo tem como objetivos situar o Manuário no processo de dicionarização da Língua Brasileira de Sinais, expor e discorrer sobre o processo de pesquisa e validação dos sinais divulgados por meio desse instrumento pedagógico de registro linguístico e consulta, e sugerir, em diálogo com outros autores, possíveis contribuições para a Lexicografia Terminológica da Libras.</div

Benefits and Costs of Interventions to Improve Breast Cancer Outcomes in African American Women

Purpose Historically, African American women have experienced higher breast cancer mortality than white women, despite lower incidence. Our objective was to evaluate whether costs of increasing rates of screening or application of intensive treatment will be off-set by survival benefits for African American women. Methods We use a stochastic simulation model of the natural history of breast cancer to evaluate the incremental societal costs and benefits of status quo versus targeted biennial screening or treatment improvements among African Americans 40 years of age and older. Main outcome measures were number of mammograms, stage, all-cause mortality, and discounted costs per life year saved (LYS). Results At the current screening rate of 76%, there is little incremental benefit associated with further increasing screening, and the costs are high: $124,053 and$124,217 per LYS for lay health worker and patient reminder interventions, respectively, compared with the status quo. Using reminders would cost $51,537 per LYS if targeted to virtually unscreened women or$78,130 per LYS if targeted to women with a two-fold increase in baseline risk. If all patients received the most intensive treatment recommended, costs increase but deaths decrease, for a cost of $52,678 per LYS. Investments of up to$6,000 per breast cancer patient could be used to enhance treatment and still yield cost-effectiveness ratios of less than $75,000 per LYS. Conclusion Except in pockets of unscreened or high-risk women, further investments in interventions to increase screening are unlikely to be an efficient use of resources. Ensuring that African American women receive intensive treatment seems to be the most cost-effective approach to decreasing the disproportionate mortality experienced by this population

Determinants of Breast Conservation Rates: Reasons for Mastectomy at a Comprehensive Cancer Center

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75345/1/j.1524-4741.2008.00668.x.pd

A survey of breast cancer physicians regarding patient involvement in breast cancer treatment decisions

Purpose: Shared breast cancer treatment decision-making between patients and physicians increases patient treatment satisfaction and compliance and is influenced by physician-related factors. Attitudes and behaviors about patient involvement in breast cancer treatment decisions and treatment-related communication were assessed by specialty among breast cancer physicians of women enrolled in the Breast Cancer Quality of Care Study (BQUAL). Results: Of 275 BQUAL physicians identified, 50.0% responded to the survey. Most physicians spend 46-60 min with the patient during the initial consult visit and 51.5% report that the treatment decision is made in one visit. Oncologists spend more time with new breast cancer patients during the initial consult (p = 0.021), and find it more difficult to handle their own feelings than breast surgeons (p = less than 0.001). Conclusion: Breast surgeons and oncologists share similar attitudes and behaviors related to patient involvement in treatment decision-making, yet oncologists report more difficulty managing their own feelings during the decision-making process