Carmen Justina Gamarra

Conhecimentos, atitudes e prática do exame de Papanicolaou entre mulheres argentinas

OBJECTIVES: To evaluate the knowledge, attitudes, and practice regarding the Papanicolaou test in an Argentinean community. METHODS: Two hundred women were interviewed at their homes in Puerto Leoni, Misiones, Argentina. Women were selected by simple random sampling. Answers were described in terms of knowledge, attitudes, and practice, ant their respective adequacies with respect to the Papanicolaou test, as previously defined. Adequacy was compared between the categories of the control variables by c2 test with a 5% significance level. RESULTS: Knowledge and practice of the Papanicolaou test were adequate in 49.5% and 30.5% of subjects, respectively, although the attitude towards the test was considered adequate in 80.5% of subjects. Another important finding was that women reported as the main reason for not undergoing the test the lack of a request by a physician or healthcare professional. CONCLUSIONS: Our results show a need for increasing the information provided to the public, especially by healthcare services and professionals, thus generating knowledge among the population of the advantages and benefits of Papanicolaou testing.

Tendência da mortalidade por câncer nas capitais e interior do Brasil entre 1980 e 2006

OBJECTIVE To analyze the corrected trend of overall cancer mortality and leading sites in the state capitals and other municipalities of Brazil between 1980 and 2006. METHODS Data on deaths (n = 2,585,012) caused by cancer between 1980 and 2006 were obtained from Sistema de Informações sobre Mortalidade (Mortality Information System), and demographic data were provided by Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). The rates of overall cancer mortality and major types were corrected by proportionally redistributing 50% of ill-defined causes of death and standardizing them by age according to the standard world population. Trend curves for Brazil and its major regions were calculated for state capitals and other municipalities according to sex, and were evaluated by means of simple linear regression. RESULTS Among men, ascending mortality rates were observed for lung, prostate and colorectal cancer; declining rates for stomach cancer; and stable rates for esophagus cancer. Among women, mortality from breast, lung and colorectal cancer increased, and the rates for cervical and stomach cancer declined. Mortality evolution varied across the regions of Brazil, with distinct patterns between state capitals and other municipalities. CONCLUSIONS The correction of mortality rates based on redistribution of ill-defined causes of death increased the magnitude of the overall cancer mortality in Brazil by approximately 10% in 1980 and 5% in 2006. In the inland municipalities no decrease or stability was identified, differently from what was observed in the state capitals. Limited scope of prevention actions and lower access to services of cancer diagnosis and treatment for the population living away from large urban centers may partly explain these differences.OBJETIVO: Analizar la tendencia corregida de la mortalidad general por cancer y principales tipos en las capitales y demas municipios de Brasil entre 1980 a 2006. METODOS: Los datos sobre obitos (n= 2.585.012) originados por cancer entre 1980 y 2006 fueron obtenidos en el Sistema de Informaciones sobre Mortalidad, y los demograficos, en el Instituto Brasileno de Geografia y Estadistica. Las tasas de mortalidad general por cancer y principales tipos fueron corregidas redistribuyendo proporcionalmente 50% de las muertes mal definidas y estandarizandolas por edad segun poblacion patron mundial. Las curvas de tendencia para Brasil y grandes regiones fueron calculadas para capitales y demas municipios segun sexo y evaluadas por medio de regresion linear simple. RESULTADOS: Entre los hombres, las tasas de mortalidad para los canceres de pulmon, prostata y colorrectal fueron ascendentes; declinantes para el de estomago y estables para el de esofago. Entre las mujeres, hubo aumento de la mortalidad por cancer de mama, pulmon y colorrectal; y disminucion de las tasas para los canceres de cuello uterino y de estomago. La evolucion de la mortalidad vario entre las regiones del Pais, con patrones distintos entre las capitales y demas municipios. CONCLUSIONES: La correccion de las tasas de mortalidad con redistribucion de los obitos mal definidos aumento la magnitud de la mortalidad general por cancer en Brasil en cerca de 10% en 1980 y 5% en 2006. En los municipios del interior no se observo tendencia de disminucion o estabilidad como en las capitales. Menor alcance de las acciones de prevencion y la dificultad de acceso a servicios diagnostico y tratamiento para cancer para la poblacion residente fuera de los grandes centros urbanos pueden explicar, en parte, estas diferencias.

Social support and cervical and breast cancer screening in Argentinean women from a rural population.

OBJECTIVE To examine whether emotional social support influences the use of 3 cancer screening tests in females. DESIGN Cross-sectional study. SAMPLE Data were collected via a household survey of a random sample of 200 Argentinean women. MEASUREMENTS The questionnaire included self-reported data about the cancer screening tests (Papanicolaou [Pap] test for cervical cancer, breast self-examination, and clinical examination for breast cancer), and socioeconomic background information. Social support was measured by the Duke-UNC-11 questionnaire. ANALYSIS Logistic models were used to investigate the association between social support and cancer screening tests. RESULTS Emotional social support was associated with having participated in Pap screening within 3 years before this study, but a link between social support and self or clinical breast examination was not supported. CONCLUSION Emotional social support may play a role in early cervical cancer detection among Argentinean females, specifically by encouraging performance of the Pap test. The educational practices accomplished by nurses should include actions that involve the family and community; therefore, emphasizing the importance of social ties on health and promoting interactions between target women and existent social groups in the community.

Correção da magnitude da mortalidade por câncer do colo do útero no Brasil, 1996-2005

OBJECTIVE To develop a methodology for correction of reported cervical cancer deaths in Brazil. METHODS Data on 9,607,177 cancer deaths were obtained from the Brazilian National Mortality Database for the period between 1996 and 2005. For correction of underreporting of deaths, factors generated by the Global Burden of Disease Study in Brazil-1998 were used. Proportional distribution was used in order to correct the categories of unknown, incomplete or ill-defined death diagnosis. The corrections were applied to each Brazilian state and the results were presented for Brazil nationwide, macroregions, and geographical areas (capital, other cities of metropolitan areas and interior cities) as percent variability of cervical mortality rates before and after correction. Corrections were analyzed by multivariate linear regression with interaction terms between macroregion and geographical area. RESULTS After correction, cervical cancer mortality rates showed an increment of 103% nationwide, ranging between 35% (Southern region capitals) and 339% (Northeastern region interior cities). The reallocation of cervical cancer deaths not otherwise specified resulted in greater mortality rate increments. The percent correction by year of death revealed steady trends nationwide. CONCLUSIONS The study results showed that the proposed methodology was appropriate for the correction of cervical cancer mortality rates in Brazil. It evidenced that cervical cancer mortality is even higher than that reported.OBJETIVO: Desenvolver uma metodologia para correcao da magnitude dos obitos por câncer do colo do utero no Brasil. METODOS: Os dados sobre os 9.607.177 obitos foram obtidos do Sistema de Informacao sobre Mortalidade, para o periodo de 1996 a 2005. Para a correcao do sub-registro, foram utilizados os fatores de expansao gerados pelo Projeto Carga Global de Doenca no Brasil - 1998. Para correcao das categorias de diagnosticos desconhecidos, incompletos ou mal definidos de obitos, foi aplicada redistribuicao proporcional. Os dados ausentes de idade foram corrigidos por imputacao. As correcoes foram aplicadas por Unidade Federativa e os resultados apresentados para o Brasil, regiao e areas geograficas (capital, demais municipios das regioes metropolitanas e interior) por meio do percentual de variabilidade da magnitude das taxas, antes e apos a correcao dos obitos. O comportamento das correcoes foi analisado por modelo de regressao linear multivariada com termos de interacao entre regiao do Pais e area geografica. RESULTADOS: As taxas corrigidas de mortalidade por câncer do colo do utero no Brasil mostraram um acrescimo de 103,4%, variando de 35% para as capitais da regiao Sul a 339% para o interior da regiao Nordeste. A redistribuicao dos obitos por câncer de utero sem especificacao de localizacao anatomica promoveu os maiores acrescimos na magnitude das taxas. Os percentuais de correcao, segundo ano de ocorrencia do obito, mostraram tendencia estacionaria no Brasil. CONCLUSOES: Os resultados permitem concluir que a metodologia proposta foi adequada para corrigir a magnitude das taxas de mortalidade por câncer do colo do utero no Pais, mostrando que a mortalidade por esse câncer e ainda maior do que o observado nos informes oficiais.

Magnitude da mortalidade por câncer do colo do útero na Região Nordeste do Brasil e fatores socioeconômicos

OBJETIVO: Analisar a tendencia temporal da mortalidade por câncer do colo do utero segundo dados de obito corrigidos ou nao e verificar a associacao entre essas informacoes e indicadores socioeconomicos selecionados em mulheres com 20 anos ou mais residentes no Nordeste do Brasil (capital e interior) no periodo de 1996 a 2005. METODOS: Foram incluidos no estudo os obitos por câncer do colo do utero captados do Sistema de Informacoes sobre Mortalidade (SIM) e aqueles identificados como sendo decorrentes dessa neoplasia apos processo de correcao. Atraves de regressao linear simples, foram analisadas as tendencias temporais da mortalidade e as correlacoes com os indicadores socioeconomicos selecionados atraves de correlacao de Pearson (r). RESULTADOS: As maiores taxas de mortalidade por câncer do colo do utero sem correcao corresponderam as capitais e as menores foram observados no interior dos estados. Por outro lado, os maiores coeficientes de mortalidade corrigidos foram observados para o interior dos estados e os menores para as capitais, invertendo o quadro. Da mesma forma, as menores taxas de mortalidade sem correcao foram observadas nos estados com maior pobreza, analfabetismo, fecundidade e mortalidade infantil, enquanto as maiores taxas de mortalidade sem correcao foram observadas nas regioes com melhores indicadores sociais. As taxas corrigidas mostraram associacao negativa com os indicadores que assinalam melhores condicoes de vida, e positiva com os indicadores que descrevem piores condicoes de vida. CONCLUSOES: A utilizacao de dados nao corrigidos de mortalidade pode levar a subestimacao do câncer do colo de utero e comprometer as interpretacoes de analises comparativas sobre a magnitude, distribuicao e fatores associados a essa doenca. A magnitude desse câncer merece ser reavaliada, pelo menos no Nordeste do Brasil. Contudo, os resultados demonstram que ja ha resultados positivos da deteccao precoce na regiao.

Correction for reported cervical cancer mortality data in Brazil, 1996-2005.

OBJECTIVE To develop a methodology for correction of reported cervical cancer deaths in Brazil. METHODS Data on 9,607,177 cancer deaths were obtained from the Brazilian National Mortality Database for the period between 1996 and 2005. For correction of underreporting of deaths, factors generated by the Global Burden of Disease Study in Brazil-1998 were used. Proportional distribution was used in order to correct the categories of unknown, incomplete or ill-defined death diagnosis. The corrections were applied to each Brazilian state and the results were presented for Brazil nationwide, macroregions, and geographical areas (capital, other cities of metropolitan areas and interior cities) as percent variability of cervical mortality rates before and after correction. Corrections were analyzed by multivariate linear regression with interaction terms between macroregion and geographical area. RESULTS After correction, cervical cancer mortality rates showed an increment of 103% nationwide, ranging between 35% (Southern region capitals) and 339% (Northeastern region interior cities). The reallocation of cervical cancer deaths not otherwise specified resulted in greater mortality rate increments. The percent correction by year of death revealed steady trends nationwide. CONCLUSIONS The study results showed that the proposed methodology was appropriate for the correction of cervical cancer mortality rates in Brazil. It evidenced that cervical cancer mortality is even higher than that reported.OBJETIVO: Desenvolver uma metodologia para correcao da magnitude dos obitos por câncer do colo do utero no Brasil. METODOS: Os dados sobre os 9.607.177 obitos foram obtidos do Sistema de Informacao sobre Mortalidade, para o periodo de 1996 a 2005. Para a correcao do sub-registro, foram utilizados os fatores de expansao gerados pelo Projeto Carga Global de Doenca no Brasil - 1998. Para correcao das categorias de diagnosticos desconhecidos, incompletos ou mal definidos de obitos, foi aplicada redistribuicao proporcional. Os dados ausentes de idade foram corrigidos por imputacao. As correcoes foram aplicadas por Unidade Federativa e os resultados apresentados para o Brasil, regiao e areas geograficas (capital, demais municipios das regioes metropolitanas e interior) por meio do percentual de variabilidade da magnitude das taxas, antes e apos a correcao dos obitos. O comportamento das correcoes foi analisado por modelo de regressao linear multivariada com termos de interacao entre regiao do Pais e area geografica. RESULTADOS: As taxas corrigidas de mortalidade por câncer do colo do utero no Brasil mostraram um acrescimo de 103,4%, variando de 35% para as capitais da regiao Sul a 339% para o interior da regiao Nordeste. A redistribuicao dos obitos por câncer de utero sem especificacao de localizacao anatomica promoveu os maiores acrescimos na magnitude das taxas. Os percentuais de correcao, segundo ano de ocorrencia do obito, mostraram tendencia estacionaria no Brasil. CONCLUSOES: Os resultados permitem concluir que a metodologia proposta foi adequada para corrigir a magnitude das taxas de mortalidade por câncer do colo do utero no Pais, mostrando que a mortalidade por esse câncer e ainda maior do que o observado nos informes oficiais.

Cancer mortality trends in Brazilian state capitals and other municipalities between 1980 and 2006

OBJECTIVE To analyze the corrected trend of overall cancer mortality and leading sites in the state capitals and other municipalities of Brazil between 1980 and 2006. METHODS Data on deaths (n = 2,585,012) caused by cancer between 1980 and 2006 were obtained from Sistema de Informações sobre Mortalidade (Mortality Information System), and demographic data were provided by Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). The rates of overall cancer mortality and major types were corrected by proportionally redistributing 50% of ill-defined causes of death and standardizing them by age according to the standard world population. Trend curves for Brazil and its major regions were calculated for state capitals and other municipalities according to sex, and were evaluated by means of simple linear regression. RESULTS Among men, ascending mortality rates were observed for lung, prostate and colorectal cancer; declining rates for stomach cancer; and stable rates for esophagus cancer. Among women, mortality from breast, lung and colorectal cancer increased, and the rates for cervical and stomach cancer declined. Mortality evolution varied across the regions of Brazil, with distinct patterns between state capitals and other municipalities. CONCLUSIONS The correction of mortality rates based on redistribution of ill-defined causes of death increased the magnitude of the overall cancer mortality in Brazil by approximately 10% in 1980 and 5% in 2006. In the inland municipalities no decrease or stability was identified, differently from what was observed in the state capitals. Limited scope of prevention actions and lower access to services of cancer diagnosis and treatment for the population living away from large urban centers may partly explain these differences.OBJETIVO: Analizar la tendencia corregida de la mortalidad general por cancer y principales tipos en las capitales y demas municipios de Brasil entre 1980 a 2006. METODOS: Los datos sobre obitos (n= 2.585.012) originados por cancer entre 1980 y 2006 fueron obtenidos en el Sistema de Informaciones sobre Mortalidad, y los demograficos, en el Instituto Brasileno de Geografia y Estadistica. Las tasas de mortalidad general por cancer y principales tipos fueron corregidas redistribuyendo proporcionalmente 50% de las muertes mal definidas y estandarizandolas por edad segun poblacion patron mundial. Las curvas de tendencia para Brasil y grandes regiones fueron calculadas para capitales y demas municipios segun sexo y evaluadas por medio de regresion linear simple. RESULTADOS: Entre los hombres, las tasas de mortalidad para los canceres de pulmon, prostata y colorrectal fueron ascendentes; declinantes para el de estomago y estables para el de esofago. Entre las mujeres, hubo aumento de la mortalidad por cancer de mama, pulmon y colorrectal; y disminucion de las tasas para los canceres de cuello uterino y de estomago. La evolucion de la mortalidad vario entre las regiones del Pais, con patrones distintos entre las capitales y demas municipios. CONCLUSIONES: La correccion de las tasas de mortalidad con redistribucion de los obitos mal definidos aumento la magnitud de la mortalidad general por cancer en Brasil en cerca de 10% en 1980 y 5% en 2006. En los municipios del interior no se observo tendencia de disminucion o estabilidad como en las capitales. Menor alcance de las acciones de prevencion y la dificultad de acceso a servicios diagnostico y tratamiento para cancer para la poblacion residente fuera de los grandes centros urbanos pueden explicar, en parte, estas diferencias.

Infecção por HPV em mulheres atendidas pela Estratégia Saúde da Família

ABSTRACT OBJECTIVE Estimate the prevalence of cervical HPV infection among women assisted by the Family Health Strategy and identify the factors related to the infection. METHODS A cross-sectional study involving 2,076 women aged 20–59 years old residing in Juiz de Fora, State of Minas Gerais, who were asked to participate in an organized screening carried out in units were the Family Health Strategy had been implemented. Participants answered the standardized questionnaire and underwent a conventional cervical cytology test and HPV test for high oncogenic risk. Estimates of HPV infection prevalence were calculated according to selected characteristics referenced in the literature and related to socioeconomic status, reproductive health and lifestyle. RESULTS The overall prevalence of HPV infection was 12.6% (95%CI 11.16–14.05). The prevalence for the pooled primer contained 12 oncogenic HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) was 8.6% (95%CI 7.3–9.77). In the multivariate analysis, it was observed that the following variables were significantly associated with a higher prevalence of HPV infection: marital status (single: adjusted PR = 1.40, 95%CI 1.07–1.8), alcohol consumption (any lifetime frequency: adjusted PR = 1.44, 95%CI 1.11–1.86) and number of lifetime sexual partners (≥ 3: adjusted PR = 1.35, 95%CI 1.04–1.74). CONCLUSIONS The prevalence of HPV infection in the study population ranges from average to particularly high among young women. The prevalence of HPV16 and HPV18 infection is similar to the worldwide prevalence. Homogeneous distribution among the pooled primer types would precede the isolated infection by HPV18 in magnitude, which may be a difference greater than the one observed. The identification of high-risk oncogenic HPV prevalence may help identify women at higher risk of developing preneoplastic lesions.OBJETIVO Estimar a prevalencia de infeccao do colo do utero pelo HPV entre mulheres assistidas pela Estrategia Saude da Familia e identificar os fatores relacionados a infeccao. METODOS Trata-se de estudo transversal, no qual participaram 2.076 mulheres de 20 a 59 anos, residentes em Juiz de Fora, MG, convocadas para rastreamento organizado, realizado em unidades […]

Tendencia de la mortalidad por cáncer en las capitales e interior de Brasil entre 1980 y 2006

OBJECTIVE To analyze the corrected trend of overall cancer mortality and leading sites in the state capitals and other municipalities of Brazil between 1980 and 2006. METHODS Data on deaths (n = 2,585,012) caused by cancer between 1980 and 2006 were obtained from Sistema de Informações sobre Mortalidade (Mortality Information System), and demographic data were provided by Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). The rates of overall cancer mortality and major types were corrected by proportionally redistributing 50% of ill-defined causes of death and standardizing them by age according to the standard world population. Trend curves for Brazil and its major regions were calculated for state capitals and other municipalities according to sex, and were evaluated by means of simple linear regression. RESULTS Among men, ascending mortality rates were observed for lung, prostate and colorectal cancer; declining rates for stomach cancer; and stable rates for esophagus cancer. Among women, mortality from breast, lung and colorectal cancer increased, and the rates for cervical and stomach cancer declined. Mortality evolution varied across the regions of Brazil, with distinct patterns between state capitals and other municipalities. CONCLUSIONS The correction of mortality rates based on redistribution of ill-defined causes of death increased the magnitude of the overall cancer mortality in Brazil by approximately 10% in 1980 and 5% in 2006. In the inland municipalities no decrease or stability was identified, differently from what was observed in the state capitals. Limited scope of prevention actions and lower access to services of cancer diagnosis and treatment for the population living away from large urban centers may partly explain these differences.OBJETIVO: Analizar la tendencia corregida de la mortalidad general por cancer y principales tipos en las capitales y demas municipios de Brasil entre 1980 a 2006. METODOS: Los datos sobre obitos (n= 2.585.012) originados por cancer entre 1980 y 2006 fueron obtenidos en el Sistema de Informaciones sobre Mortalidad, y los demograficos, en el Instituto Brasileno de Geografia y Estadistica. Las tasas de mortalidad general por cancer y principales tipos fueron corregidas redistribuyendo proporcionalmente 50% de las muertes mal definidas y estandarizandolas por edad segun poblacion patron mundial. Las curvas de tendencia para Brasil y grandes regiones fueron calculadas para capitales y demas municipios segun sexo y evaluadas por medio de regresion linear simple. RESULTADOS: Entre los hombres, las tasas de mortalidad para los canceres de pulmon, prostata y colorrectal fueron ascendentes; declinantes para el de estomago y estables para el de esofago. Entre las mujeres, hubo aumento de la mortalidad por cancer de mama, pulmon y colorrectal; y disminucion de las tasas para los canceres de cuello uterino y de estomago. La evolucion de la mortalidad vario entre las regiones del Pais, con patrones distintos entre las capitales y demas municipios. CONCLUSIONES: La correccion de las tasas de mortalidad con redistribucion de los obitos mal definidos aumento la magnitud de la mortalidad general por cancer en Brasil en cerca de 10% en 1980 y 5% en 2006. En los municipios del interior no se observo tendencia de disminucion o estabilidad como en las capitales. Menor alcance de las acciones de prevencion y la dificultad de acceso a servicios diagnostico y tratamiento para cancer para la poblacion residente fuera de los grandes centros urbanos pueden explicar, en parte, estas diferencias.

Corrección de la magnitud de la mortalidad por cáncer de colón uterino en Brasil, 1996-2005

OBJECTIVE To develop a methodology for correction of reported cervical cancer deaths in Brazil. METHODS Data on 9,607,177 cancer deaths were obtained from the Brazilian National Mortality Database for the period between 1996 and 2005. For correction of underreporting of deaths, factors generated by the Global Burden of Disease Study in Brazil-1998 were used. Proportional distribution was used in order to correct the categories of unknown, incomplete or ill-defined death diagnosis. The corrections were applied to each Brazilian state and the results were presented for Brazil nationwide, macroregions, and geographical areas (capital, other cities of metropolitan areas and interior cities) as percent variability of cervical mortality rates before and after correction. Corrections were analyzed by multivariate linear regression with interaction terms between macroregion and geographical area. RESULTS After correction, cervical cancer mortality rates showed an increment of 103% nationwide, ranging between 35% (Southern region capitals) and 339% (Northeastern region interior cities). The reallocation of cervical cancer deaths not otherwise specified resulted in greater mortality rate increments. The percent correction by year of death revealed steady trends nationwide. CONCLUSIONS The study results showed that the proposed methodology was appropriate for the correction of cervical cancer mortality rates in Brazil. It evidenced that cervical cancer mortality is even higher than that reported.OBJETIVO: Desenvolver uma metodologia para correcao da magnitude dos obitos por câncer do colo do utero no Brasil. METODOS: Os dados sobre os 9.607.177 obitos foram obtidos do Sistema de Informacao sobre Mortalidade, para o periodo de 1996 a 2005. Para a correcao do sub-registro, foram utilizados os fatores de expansao gerados pelo Projeto Carga Global de Doenca no Brasil - 1998. Para correcao das categorias de diagnosticos desconhecidos, incompletos ou mal definidos de obitos, foi aplicada redistribuicao proporcional. Os dados ausentes de idade foram corrigidos por imputacao. As correcoes foram aplicadas por Unidade Federativa e os resultados apresentados para o Brasil, regiao e areas geograficas (capital, demais municipios das regioes metropolitanas e interior) por meio do percentual de variabilidade da magnitude das taxas, antes e apos a correcao dos obitos. O comportamento das correcoes foi analisado por modelo de regressao linear multivariada com termos de interacao entre regiao do Pais e area geografica. RESULTADOS: As taxas corrigidas de mortalidade por câncer do colo do utero no Brasil mostraram um acrescimo de 103,4%, variando de 35% para as capitais da regiao Sul a 339% para o interior da regiao Nordeste. A redistribuicao dos obitos por câncer de utero sem especificacao de localizacao anatomica promoveu os maiores acrescimos na magnitude das taxas. Os percentuais de correcao, segundo ano de ocorrencia do obito, mostraram tendencia estacionaria no Brasil. CONCLUSOES: Os resultados permitem concluir que a metodologia proposta foi adequada para corrigir a magnitude das taxas de mortalidade por câncer do colo do utero no Pais, mostrando que a mortalidade por esse câncer e ainda maior do que o observado nos informes oficiais.