O presente artigo tem o objetivo de identificar dificuldades da participação social na Atenção Primária à Saúde, compreendendo e problematizando suas principais vertentes conforme a atual literatura. Foi feita uma revisão sistemática qualitativa considerando um intervalo de 4 anos e meio (2014 a 2018). Foram empregados os descritores “participação popular”, “participação comunitária” e “participação social” na base de dados SciELO, e, em seguida, foram aplicados os filtros “Brasil” e “Saúde”. A partir da leitura dos resumos foram selecionados os artigos que se concentravam na dimensão da Atenção Primária à Saúde, totalizando 59 artigos. Extraiu-se as ideias principais acerca do tema em cada artigo e fez-se duas sistematizações. Seis dificuldades principais foram encontradas: a) tímido conhecimento da população sobre o Sistema Único de Saúde e sobre a saúde como um direito constitucional; b) limites quanto à cultura política participativa da população; c) fragilidade quanto ao conhecimento da população sobre os espaços de participação; d) obstáculos no funcionamento dos conselhos de saúde; e) fragilidades quanto ao compromisso de gestores e trabalhadores em colocar em prática as deliberações e pactuações das instâncias participativas; f) as determinações sociais do processo saúde-doença gerando obstáculos significativos para a participação social. Constatou-se que na literatura a dimensão das dificuldades é pouco explorada, de modo que o presente estudo contribui com o aprofundamento desse debate. O tímido conhecimento da população sobre a participação social e o frágil envolvimento nesses espaços promove um distanciamento, o que fomenta ainda mais a ideia da ineficiência desses ambientes. Essas barreiras podem se tornar transponíveis por meio da educação popular em saúde.

Diante do contexto do Sistema Único de Saúde e das Diretrizes Curriculares Nacionais para os Cursos de Medicina, o Módulo Horizontal A-2 traz uma proposta de conectar os aprendizados teóricos e a prática na rede de saúde. Com objetivos de construção de conhecimentos em práticas educativas em saúde, foram realizados dois cursos de Práticas Integrativas centrados em princípios da educação popular e em uma construção horizontal do conhecimento. Esses cursos foram realizados na Unidade de Saúde da Família - Vila Saúde e a sua construção deu-se em conjunto com a equipe e usuários da mesma. Os participantes entraram em contato com diversas práticas como a fitoterapia, terapia floral, biodança e vivências teatrais. Nesse contexto, foi possível identificar muitas potencialidades e dificuldades no desenvolvimento desses cursos, como a importância do interesse dos participantes e os problemas de infraestrutura na Unidade. Durante os cursos, o conhecimento construído permitiu um contato maior dos participantes com as práticas integrativas e uma visão ampliada sobre o cuidado. Além disso, os profissionais puderam se capacitar e conhecer novas práticas, o que possibilita uma melhoria no atendimento realizado. Para os estudantes, o curso trouxe uma visão ampla do sistema e da importância da educação em saúde no Sistema Único de Saúde.

Introduction: Breast cancer is the main cancer in women in Brazil and worldwide, it and is the leading cause of death among women in Brazil. Although it is more common in women over 40 years, when it occurs in younger women, it generally has a worse prognosis, thus leading to more aggressive treatments and generating more long-term sequelae. Objective: The aim of this research was to analyze the quality of life of women breast cancer survivors under 40 years of age. Methods: This is an observational, cross-sectional study that was carried out at the Hospital Napoleão Laureano, which is the reference for the treatment of breast cancer in Paraíba. The project was submitted to the Research Ethics Committee of the Centro de Ciências Médicas of the Universidade Federal da Paraíba, and the patients signed an informed consent form. Data collection was performed between September 2020 and February 2021. We had to conduct most of the interviews by telephone, because the COVID-19 pandemic decreased the flow of patients to the outpatient clinic. Results: In this time period, we identified 76 patients who fit the inclusion criteria for the survey, and from these, we obtained 47 responses to the quality of life questionnaire. Among those who answered the survey, only four had not yet had any surgical procedure on their breasts. Of the 43 women who had undergone surgery, most still suffer from pain (27.6%) or discomfort (63.8%) in the area of the breasts and upper limbs, and 63.8% also feel a decrease in the strength of this homolateral upper limb. This is very important data, because pain is responsible for a great decrease in quality of life, so much so that chronic pain can lead to symptoms of depression in breast cancer survivors. In the second part of the questionnaire, we asked about body image, since the breast region is generally a very important area of women’s bodies. More than 70% of the interviewees feel beautiful and satisfied with their sex life; often related to the support they are receiving, be it from family, friends, health professionals, or even from social media. Even so, they have noticed a drop in libido, which is a common side effect of chemotherapy, a topic not usually addressed in medical consultations. They were asked about their desire to have children, since many cancer treatments can lead to premature ovarian failure, early menopause, and infertility; 36% of them said that the diagnosis changed their desire to get pregnant, demonstrating that the issue of fertility is not being properly addressed among these women, since fertility preservation options are not even available in the Brazilian public health service. Another issue addressed was the socioeconomic issues related to the diagnosis and treatment of the disease, considering that in Brazil, women are responsible for the family income in more than half of the households. Although cancer treatment in Brazil is free of charge, 68% of the women had to stop work or take a medical leave, and about 78% of them said that their financial conditions worsened during the treatment, increasing their worries in this already extremely stressful period. Conclusion: The evolution of therapies in the treatment of breast cancer has allowed a considerable survival rate for this disease. Thus, the management of the sequelae of the disease and treatment, and the quality of life of these women survivors, also becomes the responsibility of the health team, so that studies on this are fundamental to provide better assistance.

O presente artigo analisou as principais conquistas e oportunidades construídas a partir dos espaços de participação social na atenção primária à saúde a partir do olhar de usuários, trabalhadores e gestores. Foram realizadas entrevistas semiestruturadas com 33 pessoas relacionadas a cinco Unidades de Saúde da Família no município de João Pessoa, Paraíba. Como caminho metodológico, foram realizadas leituras das transcrições das entrevistas, seguidas de esforços interpretativos e aproximação de ideias similares que foram levantadas por diferentes entrevistados, as quais foram agrupadas em dimensões. Assim, foram sumarizadas quatro dimensões principais: potencialização da participação ativa e crítica da comunidade na definição e na construção das ações de saúde; aprimoramento das formas de cuidar e de organizar o serviço e o processo de trabalho na unidade; criação de novos espaços sociais, experiências e projetos para a promoção da saúde no território; e potencialização da qualidade de vida das pessoas envolvidas nos espaços de participação. A participação social ativa é fundamental para que os espaços possam gerar ações devolutivas de acordo com a demanda da população. Só assim eles poderão exercer sua função de modificadores da realidade local e de empoderamento desses atores sociais.

Introduction: Breast cancer is the most common malignant neoplasm in the world and is the leading cause of cancer mortality in women. It is relatively uncommon in young women under 40 years old, but they have more aggressive tumors with high mortality rates. Objectives: The aim of this study was to analyze the clinical and histopathological profiles of young women affected by breast cancer in a reference hospital in Paraíba. Methods: This is an observational, cross-sectional, and retrospective study to identify clinical data, tumor characteristics, and therapeutic modalities used. The data were collected in a reference hospital in Paraíba. The sample was nonprobabilistic by convenience of women in the followup of the disease during September 2020 and February 2021. Interviews were conducted with patients who met the inclusion and exclusion criteria, as well as a review of medical records in order to complement the information provided by patients. The project was approved by the Research Ethics Committee of the Centro de Ciências Médicas of the Universidade Federal da Paraíba. Results: Of the 76 patients, 2 had bilateral tumors, totaling 78 tumors. The mean time between diagnosis and biopsy was 60.23 days, the fastest time being 1 day and the longest being 450 days. Regarding histological type, invasive ductal carcinoma was found in 66 (84.2%) tumors, followed by carcinoma in situ in 6 (7.69%) cases, and invasive lobular in 1 (1.28%). The remaining five tumors were of five other different histological types. In all, 74 tumors were evaluated for staging, 6 (8.11%) tumors were Tis, 13 (17.57%) T1 tumors, 30 (40.54%) T2 tumors, 12 (16.22%) T3 tumors, and 13 (17.56%) T4 tumors. There was information on only 69 tumors regarding lymph node involvement; of these, 34 (49.28%) were N0, 19 (27.53%) were N1; and 16 (23.19%) were N2. In only 44 cases, it was possible to evaluate distant metastasis, with 38 (86.36%) without metastasis and 6 (13.64%) with metastasis. The histological grade of 70 tumors was evaluated, and only 1 (1.43%) had histological grade I, 34 (48.57%) with grade II, and 35 (50%) with grade III; and regarding the nuclear grade in 73 tumors, 29 (39.73%) tumors classified as nuclear grade 2 and 44 (60.27%) as grade 3. Of 72 tumors analyzed, 14% were triple negative; nevertheless, more than 60% of tumors expressed estrogen and progesterone receptor. The cell proliferation index from the Ki-67 antigen was evaluated in 73 tumors, with 14 (19.18%) tumors equal or less than 10%, 11 (15.07%) tumors between 15% and 25%, and 48 (65.75%) equal or above 30%. Vascular invasion was present in 20 (29.41%) of the 68 tumors evaluated, and perineural invasion was present in 20 (31.75%) of the 63 tumors analyzed. Of the 76 patients, only 6 did not undergo chemotherapy and 5 had missing information; 23 (35.38%) patients with adjuvant and 42 (64.62%) with neoadjuvant. The mean time of treatment was 6 months and 5 days, the minimum time was 4 months, and the maximum was 11 months. Radiotherapy was performed in 50 (89.29%) of the 56 patients evaluated, 90% adjuvant; 73% (19) of HER2-positive patients used trastuzumab; and 95% of patients underwent surgery, being radical mastectomy with axillary lymphadenectomy the most prevalent, performed in more than 50% of women. Conclusion: Invasive ductal carcinoma was identified as the most common subtype, 74.32% of diagnosed women had tumors larger than 2 cm, and 50.72% had lymph node involvement in the homolateral axilla. High histological and nuclear grades and high cell proliferation index were observed in immunohistochemistry. Regarding the therapeutic modalities, surgery and chemotherapy had a fundamental role in most cases, as well as radiotherapy. Targeted therapy and hormone therapy had a limited participation.

With the emergence of Molecular Targeted Therapy, the interest in studying immunogenetic components that act in carcinogenesis has grown. The role of the estrogen receptor (ER) in initiation and progression of breast cancer is well documented and the estrogen treatment may affect expression of proteins described as tumor stem cell biomarkers in estrogen-sensitive breast cancer. The aim of this study is to analyze the expression of CD44 and CD326 on MCF-7 (ER+) and MDA-MB-231 (ER-) cell lines treated with 17β-estradiol for different periods. Our results indicate that 17β-estradiol can modulate CD44 and CD326 expression in breast cancer cells that have functional estrogen receptors in a time dependent manner. To our knowledge, this is the first study to investigate the influence of 17β-estradiol on CD44 and CD326 expression in MCF-7 and MDA-MB-231 cell lines. Further investigations with primary patient samples and their cultures will enhance our knowledge on the effect of hormones on breast cancer.