RESUMO Trata-se de um relato de experiência sobre a incorporação do tema da violência contra a mulher no ensino médico. O objetivo do estudo foi descrever as correntes teóricas explicativas da violência contra a mulher e as formas de intervenção apreendidas pelos estudantes. Foram realizados dez encontros semanais com um grupo de 12 estudantes e desenvolvidas as seguintes atividades: (a) leitura de um caso de uma mulher em situação de violência, busca na literatura científica; (b) visitas a serviços de atenção primária à saúde e ao Centro de Referência Especializado de Assistência Social; (c) sistematização dos dados teóricos e práticos para construção do planejamento estratégico; (d) apresentação das atividades realizadas aos demais grupos de alunos. Ao final do módulo, destacou-se o aprendizado de quatro aspectos importantes das implicações do tema para a saúde das mulheres: (a) influência dos fenômenos socioculturais e psicossociais no processo saúde-doença; (b) importância da integralidade no atendimento; (c) a estratégia de saúde da família como facilitadora na detecção e acompanhamento dos casos; (d) violência contra a mulher como um problema de saúde pública pertinente na formação médica.
ABSTRACT The following article is an experience report on the incorporation of the theme of violence against women in the medical curriculum. The objectives of this study were to describe the theoretical framework of the theme of violence against women and to identify the learning activities acquired by students. The module activities were developed throughout 10 weekly meetings with groups of 12 students, and are as follows: (a) read a study case of a woman in a violent situation and perform a literature review; (b) conduct visits to Primary Health Care Services and a Specialized Reference Center for Social Assistance; (c) systematize theoretical and practical data for strategic planning; and (d) present the activities developed to other student groups. At the end of the module, four relevant learning activities were identified in terms of women’s health: (a) the influence of socio-cultural and psychosocial phenomena in the health-disease process; (b) the importance of comprehensive care; (c) the Family Health Strategy as a facilitator in detecting and monitoring cases; and (d) violence against women as a relevant public health problem in the medical curriculum and training.
Introduction: colorectal cancer is one of the most common malignancies in developed countries. Data on specific and 10-year survival are scarce. This study analyzes overall and disease-specific survival for patients with colorectal cancer and assesses the value of clinical factors on disease-specific survival. Methods: a retrospective cohort study of newly diagnosed invasive colorectal cancer cases diagnosed from 1992 to 2007 were identified through the Hospital del Mar Cancer Registry. Five- and 10-year survival functions were estimated using Kaplan-Meier method. Cox proportional hazard models were used to assess prognostic factors. Results: a total of 2,080 patients with colorectal cancer were identified. The median age at diagnosis was 72 years and 58.5% were men. By the end of the follow-up period (December 2008), 1,225 patients had died and 68.4% of deaths were due to colorectal cancer. The 5- and 10-year cancer-specific survival rates were 55.5% (95%CI 53.9-57.9%) and 48.5% (95%CI 45.6-51.3%), respectively. The 5-year specific survival rate improved in the last period (2003-2007) (60.4%, 95%CI 55.4-65.0) compared with 1992-1997 (53.4%; 95%CI 49.2-57.4) and 1998-2002 (52.0%; 95%CI 47.8-56.2). Various factors were independently associated with excess CRC mortality: male sex (HR 1.21), age at diagnosis > 75 years (HR 1.97), rectal location (HR 1.33), more advanced stages (stage IV: HR 18.54), poorly differentiated/undifferentiated tumors (HR 1.80), and admission through the emergency department (HR 1.52). Conclusions: cancer-specific survival improved from 1992 to 2007. This improvement could be due to more effective treatment, since changes in stage distribution or age at diagnosis were not observed during the study period. Overall survival rates should notably improve with the implementation of a population-based colorectal cancer screening program in Spain.
OBJECTIVE: To ascertain the extent to which screening procedures (with and without evidence of effectiveness) are practiced among health care workers at a tertiary-care hospital in Sao Paulo, Brazil. METHODS: From February 2001 to September 2003, a cross-sectional study involving physicians, nurses and nursing assistants (aged 40 to 69 years) was carried out at a tertiary-care hospital in the city of Sao Paulo, Brazil. Subjects were interviewed using a questionnaire that addresses 17 procedures with grades of recommendation of A, B, C, D or E, in accordance with the 1996 United States Preventive Services Task Force guidelines for routine screening. RESULTS: Of the 333 health care workers included, 228 (68.5%) were female. The mean age was 48.8 (SD 6.6 years). Most subjects had undergone screening for hypertension (blood pressure measurement) and lipid abnormalities (cholesterol testing). Screening for breast and cervical cancer was common among females. Resting electrocardiography, serum glucose testing, urine tests, chest X-rays and serum prostate-specific antigen testing were also quite common. However, only 6 (1.8%) of the subjects had undergone screening for colorectal cancer (fecal occult blood test or sigmoidoscopy). CONCLUSIONS: A sizeable proportion of health care workers underwent screening procedures that are not recommended or for which there was insufficient evidence of a benefit. Conversely, certain recommended procedures were performed on a small proportion of such workers. These results indicate that the Brazilian National Ministry of Health must develop nationwide evidence-based screening recommendations and disseminate such recommendations among health care professionals in Brazil.
O objetivo deste artigo é evidenciar em que sentido as mudanças espaciais (físicas e simbólicas) transformaram as estratégias de gestores da economia informal, quando estes foram retirados das ruas e passaram a atuar como lojistas no Shopping Popular Oiapoque, o primeiro da cidade de Belo Horizonte/MG. Com base na abordagem da estratégia como prática social e à luz das categorias sociológicas "casa" e "rua" de DaMatta (1991) acerca da sociedade brasileira, assume-se que, no estudo em questão, o significado simbólico atribuído ao espaço é fator fundamental à análise das estratégias como prática social. Os dados foram coletados por meio de entrevistas semi-estruturadas, realizadas no ano de 2006, e examinados por meio da análise de conteúdo. Como conclusão, observou-se que, no locus do estudo, o espaço simbólico do shopping como "rua" e da rua como "casa" coexiste com o espaço simbólico do shopping como "casa" e da rua como "rua". Os dois espaços simbólicos envolvem o fazer estratégia dos sujeitos que atuam no shopping. Os sujeitos alinhados com o primeiro buscam resgatar práticas anteriores perdidas ao entrar no shopping. Os sujeitos alinhados com o segundo buscam novas práticas: para eles o shopping não é apenas uma "casa", mas uma nova "casa", na qual se situam com novas práticas sociais.
It is intended through this article to enlighten how the spatial changes (symbolic and geographical) transformed the business strategies of the informal economic organizations, when they were moved from the streets to a popular shopping named Oiapoque, the first of this kind at Belo Horizonte/MG. Trough the perspective of strategy as a social construction and based on the sociological categories of "rua" (street) and "casa" (home) of DaMatta (1991), about the Brazilian society, it is assumed that the symbolical meaning of the shopping is a fundamental factor on the building strategy process as a social construction. Primaries data were collected trough semi-structured interview and the technique of subject analysis was used. In conclusion, it was perceived that the locus of this research is understood both as "rua" (street) and "casa" (home) by the respondents. The first group tried to sustain their former strategic practice on the new geographical place, the shopping Oiapoque, because they didn't feel it as their "casa" (home). The second group, otherwise, built new strategies practices, based upon the conception as the shopping as a new "casa" (home).