Objective: Identify the actions for early detection of breast cancer performed by nurses from basic health units; compare the compliance of these actions with the recommendations from the Ministry of Health; analyze the availability of documents to check these recommendations and analyze the association of variables "training," "lato sensu training," and "years of activity" of these professionals with the actions performed. Method: A cross-sectional study conducted with 133 nurses from 38 basic health units in the Southeast region of the municipality of São Paulo, interviewed with a validated questionnaire. Result: Most nurses reported actions to detect this neoplasm. Guidance on the first mammogram age was significantly associated with training, years of activity and availability of Basic Attention Book nº 13. Conclusion: This study observed a positive influence of training and years of activity on the actions for early detection of breast cancer and the need for adjustments in national guidelines. Descriptors: Breast Neoplasms; Screening Programs; Primary Healthcare; Nursing Professional Role; Oncology Nursing. RESUMO Objetivo: Identificar as ações de detecção precoce do câncer de mama desenvolvidas por enfermeiros de Unidades Básicas de Saúde; comparar a conformidade dessas ações com as recomendações do Ministério da Saúde; verificar a disponibilidade de documentos para consulta dessas recomendações e analisar a associação das variáveis capacitação, formação lato sensu e tempo de atuação desses profissionais com as ações desenvolvidas. Método: Estudo transversal, realizado com 133 enfermeiros de 38 unidades básicas de saúde da região Sudeste do município de São Paulo, entrevistados utilizando questionário validado. Resultado: A maioria dos enfermeiros referiu realizar as ações para detecção desta neoplasia. A orientação da idade da primeira mamografia associou-se significativamente com capacitação, tempo de atuação e disponibilidade do Caderno de Atenção Básica nº13. Conclusão: Destaca-se a influência positiva da capacitação e tempo de atuação na realização das ações de detecção precoce do câncer de mama e a necessidade de ajustes para adequá-las às diretrizes nacionais. Descritores: Neoplasias da Mama; Programas de Rastreamento; Atenção Primária à Saúde; Papel do Profissional de Enfermagem; Enfermagem Oncológica. RESUMENObjetivo: Identificar las prácticas de enfermeros en la detección temprana del cáncer de mama en las unidades básicas de salud; compararlas con las recomendaciones del Ministerio de Salud brasileño; verificar la disponibilidad para consulta de dichas recomendaciones y evaluar la relación de las variables capacitación, formación lato sensu y tiempo de trabajo de estos profesionales con las prácticas empleadas por ellos. Método: Estudio transversal con 133 enfermeros de 38 unidades básicas de salud del municipio de São Paulo, región Sudeste, entrevistados mediante el cuestionario validado. Resultado: La mayoría de los enfermeros afirmaron realizar prácticas para detectar esta neoplasia...
Controle do câncer mamário no Brasil Artigo de Revisão Review Article Artículo de Revisión Recebido em: 04/01/2015-Aprovado em: 25/02/2015 RESUMO: Objetivou-se descrever as ações de saúde pública para o controle do câncer de mama no Brasil. Revisão narrativa, sem restrição temporal, foi realizada em sites governamentais e analisada com base nas políticas de saúde vigentes no País. São resultados foram identificadas 48 publicações, constatando-se que o tratamento dessa neoplasia passou a ser considerado no cenário da saúde pública a partir de 1984 e que só em 1996 iniciou-se um programa específico para esse agravo. As ações, recursos, público-alvo e indicadores de rastreio foram definidos em 2004, mas o monitoramento destas práticas por sistema informatizado ocorreu após dois anos de sua implantação. Em conclusão, evidenciou-se, pela documentação analisada, que houve um aumento considerável de intervenções públicas para o controle do câncer de mama a partir de 1998 e, que o direcionamento para as ações de rastreio e detecção precoce se deu a partir de 2004. Palavras-Chave: Neoplasias da mama; atenção primária à saúde; programas de rastreamento; políticas públicas de saúde. ABSTRACT: This study described public healthcare measures for breast cancer control in Brazil. A narrative review of official government websites was performed, with no time restriction, and analyzed against current health policies in place in Brazil. As a result, 48 publications were detected, revealing that cancer treatment has been considered in public health circles since 1984, but not until 1996 was a specific program started for this disease. In 2004, the measures, resources, target public and screening and early detection indicators were defined, but computerized monitoring of these practices started two years after implementation. In conclusion, the documentation reviewed showed that public health interventions for breast cancer control have increased considerably since 1998, and that more policies have been directed to screening and early detection since 2004.
Over the past few decades, there has been growing support for the idea that cancer needs an interdisciplinary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health Assembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treatment, and palliative care. This paper highlights experiences/ideas in cancer control for international collaborations between low, middle, and high income countries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the Eastern Mediterranean countries. These proposals are presented within the context of the global vision on cancer control set forth by WHO in partnership with the International Union Against Cancer (UICC), in addition to issues that should be considered for collaborations at the global level: cancer survival (similar to the project CONCORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is given lower priority on the health agenda of low and middle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focusing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Control Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new international collaborations to promote cancer control actions in low and middle income countries. The development of supranational collaborations has been hindered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MGGs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.
Objective: To develop and validate a questionnaire to identify the actions performed in screening and detection of breast cancer in Brazil, and to determine its applicability. Methods: A methodological study, with the participation of three experts and a pilot test with 85 users of four primary health care services, with a descriptive data analysis. Results: Of the 132 questions formulated and organized in the structure and process dimensions undergoing validation, there was a 96.7% and 78.8% agreement of the evaluators in the first and second rounds, respectively. Most of the questions were understood by those involved in the investigation. The absence of the medical record resulted in the exclusion of 40 questions, resulting in 83 questions in the final version. Conclusion: The content of the instrument was adequate to evaluate actions to control breast cancer in primary care. The pilot test confirmed its applicability, and the need for improvements in documenting information. ResumoObjetivo: Construir e validar um questionário para identificar as ações realizadas no rastreio e diagnóstico do câncer de mama no Brasil e determinar sua aplicabilidade. Método: Estudo metodológico, com participação de três especialistas e teste piloto junto a 85 usuárias de quatro serviços de saúde, com análise descritiva dos dados. Resultados: Das 132 questões formuladas e organizadas nas dimensões de estrutura e processo submetidas à validação, houve 96,7% e 78,8% de concordância dos avaliadores na 1ª e 2ª rodadas respectivamente. A maioria das questões foi compreendida pelos envolvidos na investigação. A ausência de registro no prontuário resultou no descarte de 40 questões, ficando 83 na versão final. Conclusão: O conteúdo do instrumento mostrou-se adequado para avaliar as ações para controle do câncer de mama na atenção básica. O teste piloto confirmou sua aplicabilidade e a necessidade de melhorias no registro das informações.
RESUMOObjetivo: analisar as ações dos enfermeiros de unidades básicas de saúde (UBS) para a detecção precoce do câncer de mama, bem como a estrutura desses serviços. Método: estudo transversal em 2011, aprovado por Comitê de Ética (nº 0185.0162.162-09). Aplicados questionários validados a 13 enfermeiros, quatro gestores e 85 usuárias de quatro UBS paulistanas. Analisaram-se descritivamente os recursos e capacitações ofertados, a frequência com que ocorreram o exame clínico das mamas (ECM) e as reuniões educativas sobre o tema. Resultados: 61,5% dos enfermeiros possuíam protocolo; 23% foram capacitados; 46,2% faziam reuniões educativas; 92,3% realizavam ECM com indicação anual (66,7%) sem idade-alvo (58,5%). Existiam 22 consultórios para 25 médicos e outros sete consultórios para 15 enfermeiros. Enfermeiros capacitados alcançaram maior conformidade prática à recomendação ministerial que os demais. Conclusão: os enfermeiros realizam ações de detecção do câncer de mama, mas constam algumas inconformidades em relação ao preconizado pelo governo, sendo a capacitação e a estrutura da UBS preditoras de maior alcance ao recomendado. Palavras-chave: Enfermagem; neoplasias da mama; atenção primária à saúde; programas de rastreamento. ABSTRACTObjective: to examine the actions of nurses towards early detection of breast cancer in primary health care (PHC) services, as well as the structure of such services. Method: in this cross-sectional study (with ethics committee approval No. 0185.0162.162-09), validated questionnaires were applied to 13 nurses, 4 managers and 85 users from 4 PHC facilities in São Paulo State in 2011. The resources and training offered and the frequency of clinical breast examinations (CBE) and breast cancer education meetings were analyzed descriptively. Results: 61.5% nurses had screening guidelines; 23% had been trained; 46.2% held educational meetings; 92.3% performed CBE, 66.7% with annual indication and 58.5% with no target age. There were 22 offices for 25 physicians and another 7 offices for 15 nurses. There were 22 consulting rooms for 25 physicians and only 7 for 15 nurses. Trained nurses attained better compliance with ministry of health recommendations that other nurses. Conclusion: nurses perform breast cancer detection actions, but there is some noncompliance with governmental guidelines, while training and PHC facility structure were predictors of better compliance with recommendations. Keywords: Nursing; breast neoplasm; primary health care; mass screening. RESUMEN Objetivo: analizar las acciones de los enfermeros de atención primaria de salud (APS) para la detección temprana del cáncer de mama, así como la estructura de estos servicios. Método: estudio transversal en 2011, aprobado por el Comité de Ética (nº 0185.0162.162-09). Se aplicaron cuestionarios validados a 13 enfermeros, 4 gestores y 85 usuarias de 4 servicios de APS de la ciudad de São Paulo. Se analizaron descriptivamente los recursos y capacitaciones ofertadas, la frecuencia del examen clínico de las mamas (ECM) y reuniones ...
Objectives: to measure the frequency and compliance of breast cancer screening, according to the risk for this disease. Methods: a cross-sectional study with 950 female users of 38 public Primary Health Care services in São Paulo, between October and December 2013. According to UHS criteria, participants were grouped into high risk and standard risk, and frequency, association (p≤0.05), and screening compliance were measured. Results: 6.7% had high risk and 93.3% standard risk, respectively; in these groups, the frequency and compliance of clinical breast examination were 40.3% and 37.1%, and 43.5% and 43.0% (frequency p=0.631, compliance p=0.290). Mammograms were 67.7% and 35.5% for participants at high risk, and 57.4% and 25.4% for those at standard risk (frequency p=0.090, compliance p=0.000). Conclusions: in the groups, attendance and conformity of the clinical breast exam were similar; for mammography, it was higher in those at high risk, with assertiveness lower than the 70% set in UHS.
Objective: To evaluate the functional capacity of women with breast neoplasm undergoing palliative chemotherapy. Method: Cross-sectional study with an analysis of medical records of women with breast cancer undergoing palliative chemotherapy. Results: Out of one hundred evaluated records, most registered 50 years or older (66%), primary education (53%), an income of 1 to 2 minimum wages (87%), invasive ductal carcinoma (95%), positive hormone receptor (64%), and histological grade 1 and 2 (57%). Performance status 0 (49%), 1 (39%), and 2 (12%) were prevalent; these imply, respectively, active patients, with mild and moderate activity restriction. One to four chemotherapy schemes were associated with the inappetence (p =0.00) and weight loss (p =0.001) symptoms. The main complications were neuropathy (31%), medullary compression syndrome (21%), neutropenia (9%), and death (28%). Conclusion: Out of the analyzed women, 88% presented functional capacity 0 and 1, had no or mild restriction of daily activities, were multiply treated, and manifested manageable symptoms. Others, however, presented moderate to severe clinical complications during the treatment, progressing to exclusive palliative care or death.
Introdução: Programas e Politicas de Saúde para o controle do câncer de mama tem enfatizado o atendimento multiprofissional e determinado ações específicas a serem desenvolvidas pelos diferentes profissionais de saúde. Objetivo: Identificar os estudos referentes às ações realizadas pelo enfermeiro na atenção primária para o rastreamento e diagnóstico precoce do câncer de mama no Brasil. Método: Revisão integrativa de literatura, de artigos indexados nas bases de dados Lilacs e PubMed, sem restrição de data. Os artigos selecionados foram organizados em ordem cronológica e analisados de forma descritiva, à luz das políticas públicas para o controle desse agravo. Resultados: Dos 83 artigos localizados nas diversas buscas, apenas cinco foram selecionados, e as ações destacadas foram: autoexame das mamas, consulta de enfermagem e exame clínico das mamas. Em relação a essa ação, os autores referem que a baixa execução decorre do excesso de atividades e da falta de capacitação dos enfermeiros. Conclusão: A análise dos artigos possibilitou observar, além da carência de publicações referentes às ações do enfermeiro para o controle do câncer de mama na atenção básica, a existência de lacunas no conhecimento desse profissional para a realização da consulta de enfermagem e do exame clínico das mamas, o que implica na necessidade de desenvolver programas de educação permanente, de modo a garantir uma atenção de qualidade às usuárias dos serviços de saúde.
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