Achievements that have been accomplished and strategies that are in place reflect a high level of organization and unity among Portuguese pharmacies. From a global perspective, pharmacies are reorganizing to be able to compete against other possible agents and are preparing to expand their scope of intervention.
Background
This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients’ socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis.
Methods
Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients’ perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis.
Results
Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This “churning” required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients’ narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost.
Conclusions
Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania’s policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care.
The care taken by the nursing team before mastectomized clients is the object of a study of paramount importance for the care of these patients. The objective of this study was to identify, in the literature, the care taken by the nursing team vis-à-vis mastectomized clients. An electronic survey was carried out through the Virtual Health Library Research Portal (VHL), in the databases: Medline, Lilacs, Ibecs, Scielo, BDEnf, Cochrane Library, among other bases of this portal, using the following keywords: nursing, nursing care, mastectomy, breast neoplasms, coping, rehabilitation, self care, published from 2009 to 2013. The sample consisted of seven articles. Of the articles selected 100% report the importance of women receiving information regarding perioperative care that is divided into preoperative, transoperative and postoperative periods; 90% approached nursing care for women diagnosed with breast cancer and probable evolution to mastectomy; and 40% of the articles address the psychological, social and physical impact as well as acceptance of mutilation. The articles emphasize the educator role of the nurse in the care given to these women, since the lack or inaccuracy in the information provided favors the occurrence of complications. The nurse is the professional prepared to play this role of educator,
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