Maria Helena Costa Amorim

Avaliação da completude das variáveis epidemiológicas do Sistema de Informação sobre Mortalidade em mulheres com óbitos por câncer de mama na Região Sudeste: Brasil (1998 a 2007)

The study evaluates the data from the Mortality Information System in Espírito Santo, southeastern Brazil in the period from 1998 to 2007. It is a descriptive analytic study based on secondary data. The variables of sex, age, race/color, level of education and marital status in women who died of breast cancer were evaluated. The scores used were excellent (variable shows less than 5% of incomplete coverage), good (5% to 10%), fair (10% to 20%), poor (20% to 50%) and very poor (50% or higher). The linear trend equations were calculated using SPSS, version 15.0 for non-plenitude over time. It is essential to include in the education of health professionals, especially in undergraduate and postgraduate studies in medicine, content that develops skills and competencies for systematic registration of epidemiological data, so they can be included in the health information systems.O estudo avalia a completude dos dados do Sistema de Informacao sobre Mortalidade no Espirito Santo, Regiao Sudeste e Brasil no periodo de 1998 a 2007. Trata-se de um estudo descritivo analitico baseado em dados secundarios. Avaliou-se as variaveis de sexo, idade, raca/cor, escolaridade e estado civil em mulheres com obito por câncer de mama. Utilizou-se os escores excelente (variavel apresenta menos de 5% de preenchimento incompleto), bom (5% a 10%), regular (10% a 20%), ruim (20% a 50%) e muito ruim (50% ou mais). Calculou-se as equacoes de tendencia linear para a nao completude ao longo do tempo. Os resultados para as variaveis sexo e idade foram excelentes para o Espirito Santo, o Sudeste e o Brasil. Enquanto no Sudeste e no Brasil as variaveis raca/cor e escolaridade tem tendencia decrescente para a nao completude, no Espirito Santo se mantem estavel, mas inadequadas. Para a variavel estado civil, a nao completude tem tendencia crescente no Espirito Santo, e inadequada. Conclui-se que, as declaracoes de obito com câncer de mama neste estado apresentam inconsistencias, e sugere-se que na formacao dos profissionais de saude, em especial nos cursos de medicina, sejam desenvolvidas habilidades e competencias no registro de dados epidemiologicos, para poderem fundamentar os sistemas de informacao em saude.

Adequação do processo de assistência pré-natal segundo critérios do Programa de Humanização do Pré-natal e Nascimento e da Organização Mundial de Saúde

The scope of this article is to assess the adequacy of the process of prenatal care provided to users of the Unified Health System in the city of Vitoria, in accordance with criteria established by the Humanization of Prenatal and Birth Program (PHPN) and the World Health Organization (WHO). The information on the prenatal care records of 360 pregnant women interned in public hospitals in the city at the time of delivery were assessed. The information was collected, processed and submitted to descriptive statistical analysis for calculations of absolute and relative frequencies and confidence intervals. None of the pregnant women were given entirely appropriate prenatal care in accordance with WHO criteria, and only 5% of pregnant women received prenatal care in line with PHPN. 44.7% of the women did not begin prenatal care until the 4th month. With respect to conducting technical procedures in the appointments, the main emphasis was on checking maternal weight (95.0%) and blood pressure (95.6%). The results indicate the need for a review of the number of prenatal appointments in the municipality and the adoption of strategies to meet the minimum criteria that need to be performed during prenatal care in public health services.

Survival analysis of women with cervical cancer treated at a referral hospital for oncology in Espírito Santo State, Brazil, 2000-2005

O câncer do colo do utero corresponde a uma das principais causas de morte por neoplasias na populacao feminina mundial. O objetivo deste estudo foi analisar a sobrevida de mulheres com câncer do colo do utero atendidas no Hospital Santa Rita de Cassia/Associacao Feminina de Educacao e Combate ao Câncer (HSRC/AFECC) durante o periodo de 2000 a 2005 e descrever os fatores prognosticos associados. Trata-se de um estudo de coorte com utilizacao de dados secundarios retrospectivos, com amostra de 964 casos. Foram utilizados a curva de Kaplan-Meier e o modelo de Cox para avaliacao da sobrevida e para analise logistica multipla. Ocorreram 421 (43,6%) obitos no periodo minimo de 5 anos de seguimento, com sobrevida global de 58,8% em 5 anos. Identificaram-se como risco a procedencia Regiao Serrana (1,94 vez, IC95%: 1,09-3,45) e estadiamento crescente. As mulheres com estadiamento III e IV apresentaram risco de 4,33 (IC95%: 3,00-6,24) e 15,40 (IC95%: 9,72-24,39) vezes maior, respectivamente, de terem menor sobrevida quando comparadas ao estadio I. Os resultados demonstram que o diagnostico e tratamento precoces sao fundamentais na reducao da mortalidade por câncer do colo do utero.Uterine cervical cancer is a leading cause of death from cancer in the female population worldwide. The aim of this study was to analyze survival of women with cervical cancer treated at the Santa Rita de Cássia Hospital/Womens Association for Cancer Education and Control (HSRC/AFECC) in Espírito Santo State, Brazil, from 2000 to 2005 and to describe associated prognostic factors. This was a cohort study using retrospective secondary data with a sample of 964 cases. The Kaplan-Meier curve and Cox model were used to evaluate survival and for multiple logistic analysis. There were 421 deaths (43.6%) during the minimum 5-year follow-up, with an overall 5-year survival of 58.8%. Risk factors were place of residence in the Serrana Region of the State (HR: 1.94; 95%CI: 1.09-3.45) and advanced staging. Women with stages III and IV at diagnosis showed an increased risk of 4.33 (95%CI: 3.00-6.24) and 15.40 (95%CI: 9.72-24.39), respectively, for lower survival when compared to stage I. The results show that early diagnosis and treatment are essential for reducing mortality from cervical cancer.

Avaliação da postura corporal em mulheres com câncer de mama

OBJETIVO: Avaliar a postura corporal de mulheres submetidas ao tratamento por câncer de mama, identificar as alteracoes posturais nos tres primeiros meses apos a cirurgia e investigar a correlacao desses achados com a idade da mulher, o tipo e o lado da cirurgia. METODOS: Estudo longitudinal que acompanhou a evolucao postural de 39 mulheres submetidas a mastectomia e quadrantectomia. A avaliacao postural foi realizada nas vistas anterior e posterior com uso da biofotogrametria antes da cirurgia, apos a retirada do dreno e tres meses depois da cirurgia. A analise estatistica foi realizada atraves de testes parametricos e nao parametricos, considerando nivel de significância p<0,05. RESULTADOS: A media de idade das mulheres foi 50±10,5 anos; 48,8% foram tratadas com mastectomia sendo que em 61,5% a neoplasia era na mama esquerda. Nao houve diferenca significante nos ângulos posturais medidos nas mulheres no periodo estudado. Porem, a pelve e o tronco das mulheres tratadas com quadrantectomia mostraram mais alinhamento (90°) quando comparados aos das mastectomizadas (91,3°); mulheres com cirurgia na mama esquerda apresentaram elevacao do ombro e inclinacao do tronco homolateral a cirurgia em curto prazo. CONCLUSAO: As alteracoes posturais apresentaram correlacao com o tipo e o lado da cirurgia. O seguimento desse grupo, apos termino do tratamento, e necessario para esclarecer alteracoes posturais a longo prazo.

Efeitos da intervenção Hatha-Yoga nos níveis de estresse e ansiedade em mulheres mastectomizadas

This article seeks to evaluate the effects of hatha yoga on stress and anxiety levels in mastectomized women. It also investigates the relationship between these levels with the following variables: age; marital status; religion; instruction; profession; smoke addiction; elitism; staging of the disease; and treatment phase. This involved controlled random clinical trial sampling of 45 mastectomized women treated at the Ilza Bianco outpatient service of Santa Rita de Cassia Hospital in the Brazilian state of Espirito Santo from March to November 2010. The experimental group participated in 6 individually-applied sessions with incentive for ongoing home practice and was re-evaluated after the period, whereas the control group was re-evaluated after a proportional period. For the study of the variables, the interview and recording on a form technique was used, along with the Anxiety Trait and State Test, and the Stress Symptoms and Signs Test. For statistical treatment, the Statistical Pack for Social Sciences was used. The data are statistically significant and have shown that hatha yoga exercises decrease stress and anxiety in the experimental group. No connection between confounding variables and anxiety and stress levels was found.

Uso da Classificação Internacional para as Práticas de Enfermagem na assistência a mulheres mastectomizadas

RESUMO Objetivo: Caracterizar o perfil de mulheres submetidas a mastectomia participantes de um Programa de Reabilitacao; identificar os diagnosticos de enfermagem mais comuns e elaborar as intervencoes para cada diagnostico, utilizando a Classificacao Internacional para as Praticas de Enfermagem - CIPE/versao1.0. Metodos: Estudo descritivo realizado em hospital de referencia para Oncologia em Vitoria – ES. A amostra abrangeu 239 prontuarios sorteados aleatoriamente e os dados, coletados em maio de 2008, focaram os registros das consultas de enfermagem as mulheres mastectomizadas. Resultados: Dentre as 239 participantes, 64,8% tinham entre 40 e 59 anos, 55%, eram casadas, 48,2% cursaram o ensino fundamental incompleto, 60,7% eram da regiao metropolitana do Estado do ES e 34,3% exerciam atividades do lar. Os diagnosticos registrados nao possuiam relacao exclusiva com o câncer de mama e podem ser verificados em clientes com outras alteracoes de saude. Conclusao: A CIPE utiliza metodos praticos para elaboracao do diagnostico e selecao das intervencoes que facilitam a sistematizacao da assistencia de enfermagem. Descritores: Diagnostico de enfermagem; Neoplasias mamarias; Processos de enfermagem; MastectomiaObjective: To characterize the profile of women that underwent mastectomy and participated in a rehabilitation program, to identify the most common nursing diagnoses and interventions for each diagnosis, using the International Classification for Nursing Practice (ICNP), version1.0. Methods: It was a descriptive study conducted in a referral hospital for Oncology in the city of Vitoria, ES. The sample consisted of 239 randomly selected records and the data was collected in May 2008; the research focused on the records of nursing visits to women with mastectomies. Results: Among the 239 participants, 64.8% were between 40 and 59 years, 55% were married, 48.2% finished the elementary school, 60.7% were from the metropolitan region of the ES state, and 34.3 % were housewives. The diagnoses recorded did not have exclusive relationship with breast cancer and may be found in clients with other health alterations. Conclusion: The ICNP uses practical methods for making the diagnosis and selection of interventions that facilitate the systematization of nursing care.

Efeitos do relaxamento na ansiedade e nos níveis de IgA salivar de puérperas

This experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espirito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearson’s correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety. DESCRIPTORS: postpartum depression; anxiety; relaxation techniques; immunoglobulin A; psychoneuroimmunology; pregnancy; postpartum periodThis experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espírito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearsons correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety.This experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espirito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearsons correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety.

Avaliação da qualidade dos dados do Sistema de Informações sobre Nascidos Vivos e do Sistema de Informações sobre Mortalidade no período neonatal, Espírito Santo, Brasil, de 2007 a 2009

Health information systems make it possible to be aware of health problems and often represent the sole source of information, thereby making it essential to assess their quality. The scope of this paper was to evaluate the quality of data about live births and deaths in the neonatal period in the Live Births Information System (SINASC) and Mortality Information System (SIM) in the state of Espirito Santo during the period from 2007 to 2009. Descriptive methodology with secondary data obtained from the electronic address of the Informatics Department of the Unified Health System was used to analyze the dimensions of quality of information, namely accessibility, timeliness and completeness. The results indicate that the information is accessible and timely, with a lag of three years compared to the beginning of the study. The completeness of the variables analyzed in SINASC was predominantly classified as excellent. SIM revealed a high percentage of missing data on the number of the Live Birth Declaration, mothers education, age and reproductive history. The conclusion reached is that SINASC is an excellent source of information about births, though SIM reveals a marked need for improvements in the completeness of its information.

Factors associated with the incidence of local recurrences of breast cancer in women who underwent conservative surgery.

Conservative surgery is considered the procedure of choice for women who are affected by early stage tumours. The local recurrence of cancer as a consequence of breast tissue conservation is a growing concern. This study aimed to describe the sociodemographic and clinical profiles of women who had local recurrences of breast cancer after conservative surgery and to examine the associations between sociodemographic and clinical variables and the incidence of tumour recurrence in these women. The retrospective cohort included 880 women who were diagnosed with breast cancer and underwent conservative surgery between January 2000 and December 2010. Recurrences occurred in 60 patients, and the mean age of the women at diagnosis was 48.8 years. Predictive factors for local recurrence were young age (<39 years) (P = 0.028 and OR = 10.93), surgical margin involvement (P = 0.001 and OR = 3.66), and Her-2 overexpression (P = 0.045 and OR = 1.94). The establishment of sociodemographic and clinical characteristics might help to select optimum treatments, which is a crucial challenge for public health in Brazil, especially with regard to reductions of surgery and hospitalisation expenditures in the Unified Health System (Sistema Único de Saúde—SUS).

Breast cancer mortality among patients attending a cancer hospital, Vitoria, ES

This study aimed to investigate the association between mortality of breast cancer women and the social-demographic and clinical characteristics. During the mortality study of 1,086 women diagnosed with breast cancer and treated from 2000 to 2005 at a cancer hospital in the city of Vitória, Espírito Santo, medical records and tumor registration cards were controlled. The Mortality Information System and the Reclink program were used to identify 280 deaths. Patients were classified under death and non-death, and variables percentages were calculated. For variables that showed statistical significance, considering the level of 0.10, the crude and adjusted odds ratio (OR) were calculated by logistic regression model. There was a correlation between mortality and the following variables: women coming from the Unified Health System (p = 0.014; OR = 2.38), negative c-erb B-2 tumor marker (p = 0.027; OR = 2.03), advanced (III and IV) staging (p = 0.001; OR = 6.89 and OR = 17.13, respectively), presence of metastasis (p = 0.001; OR = 18.23) and recurrence (p = 0.010; OR = 3.53). Mortality associated with staging underlines the necessity of warning the population about the benefits of early diagnosis of the disease of cancer.