RESUMO
Introduction: Prostate cancer is one of the most frequent cancers in Chile, with 8157 new cases in 2020. Worldwide, 5 to 10% of men have metastatic disease at diagnosis, and androgen deprivation therapy with or without chemotherapy is the standard of care for these patients. The use of local treatment in this setting has no formal recommendation due to the lack of high-quality evidence. Some retrospective studies have sought to elucidate the benefit of surgery on the primary tumor in the setting of metastatic disease since it has been proven to be an effective local treatment for other metastatic malignant diseases. Despite these efforts, the benefit of cytoreductive radical prostatectomy as local treatment in these patients remains unclear. Methods: We searched Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, and Cochrane, among others. We extracted data from systematic reviews, reanalyzed data from primary studies, conducted a meta-analysis, and generated a summary results table using the GRADE approach. Results and conclusions: We identified 12 systematic reviews, including seven studies in total, none of which was a trial. Only six of those seven primary studies were used in the results summary. Despite the lack of high-quality evidence, the results summary shows the benefits of performing surgery on the primary tumor in terms of all-cause mortality, cancer-specific mortality, and disease progression. There was also a potential benefit in local complications related to the progression of the primary tumor, supporting the implementation of this intervention in patients with metastatic disease. The absence of formal recommendations highlights the need to evaluate the benefits of surgery on a case-by-case basis, presenting the available evidence to patients for a shared decision-making process and considering future local complications that could be difficult to manage.
Assuntos
Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Procedimentos Cirúrgicos de Citorredução , Antagonistas de Androgênios/uso terapêutico , Revisões Sistemáticas como Assunto , Prostatectomia/métodosRESUMO
Introducción El cáncer de próstata es uno de los cánceres más frecuentes en Chile, con 8157 nuevos casos en 2020. A nivel mundial, 5 a 10% de los hombres presentan metástasis al diagnóstico, y la terapia de deprivación androgénica con o sin quimioterapia es el estándar de cuidado para estos pacientes. El uso de tratamiento local en este contexto tiene una recomendación formal debido a la falta de evi-dencia de alta calidad. Algunos estudios retrospectivos han intentado dilucidar el beneficio de la cirugía sobre el tumor primario en el contexto de la enfermedad metastásica, ya que se ha demostrado que es un tratamiento local eficaz para otras neoplasias metastá-sicas. A pesar de estos esfuerzos, el beneficio de la prostatectomía radical citorreductora como tratamiento local en estos pacientes sigue sin estar claro. Métodos Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, que se mantiene mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE y Cochrane, entre otras. Se extrajeron los datos de las revisiones sistemáticas, se volvieron a analizar los datos de los estudios primarios, se realizó un metanálisis y se generó una tabla de resumen de resultados utilizando el enfoque GRADE. Resultados y conclusiones Se identificaron 12 revisiones sistemáticas, que incluían siete estudios primarios en total, ninguno de los cuales era un ensayo alea-torizado controlado. Sólo seis de esos siete estudios primarios se utilizaron en el resumen de resultados. A pesar de la falta de evi-dencia de alta calidad, los resultados de este resumen muestran los beneficios de realizar la cirugía en el tumor primario en términos de mortalidad por cualquier causas, mortalidad específica por cáncer y progresión de la enfermedad. También se observó un bene-ficio potencial en las complicaciones locales relacionadas con la progresión del tumor primario, lo que apoya la realización de esta intervención en pacientes con enfermedad metastásica. La ausencia de recomendaciones formales subraya la necesidad de evaluar los beneficios de la cirugía caso por caso, presentando la evidencia disponibles a los pacientes para un proceso de toma de decisiones compartido, teniendo en cuenta las futuras complicaciones locales que podrían ser difíciles de manejar.
Introduction Prostate cancer is one of the most frequent cancers in Chile, with 8157 new cases in 2020. Worldwide, 5 to 10% of men have metastatic disease at diagnosis, and androgen deprivation therapy with or without chemotherapy is the standard of care for these patients. The use of local treatment in this setting has no formal recommendation due to the lack of high- quality evidence. Some retrospective studies have sought to elucidate the benefit of surgery on the primary tumor in the setting of metastatic disease since it has been proven to be an effective local treatment for other metastatic malignant diseases. Despite these efforts, the benefit of cytoreductive radical prostatectomy as local treatment in these patients remains unclear. Methods We searched Epistemonikos, the largest database of systematic reviews in health, which is main-tained by screening multiple information sources, including MEDLINE, EMBASE, and Cochrane, among others. We extracted data from systematic reviews, reanalyzed data from primary studies, conducted a meta- analysis, and generated a summary results table using the GRADE approach. Results and conclusions We identified 12 systematic reviews, including seven studies in total, none of which was a trial. Only six of those seven primary studies were used in the results summary. Despite the lack of high- quality evidence, the results summary shows the benefits of performing surgery on the primary tumor in terms of all- cause mortality, cancer- specific mortality, and disease progression. There was also a potential benefit in local complications related to the progression of the prima-ry tumor, supporting the implementation of this intervention in patients with metastatic disease. The absence of formal recommendations highlights the need to evaluate the benefits of surgery on a case- by- case basis, presenting the available evidence to patients for a shared decision- making process and considering future local complications that could be difficult to manage.
RESUMO
BACKGROUND: In Bolivia the incidence and mortality rates of uterine cervix cancer are the highest in America. The main factor contributing to this situation is the difficulty of establishing and maintaining quality prevention programs based on cytology. We aimed to evaluate the effectiveness of HR-HPV testing on self-collected samples to detect cervical intra-epithelial neoplasia and identify the best combination of screening tests. METHODS: A total of 469 women, divided in two groups, were included in this study. The first group included 362 women that underwent three consecutively primary screening tests: self-collected sampling for HR-HPV detection, conventional cervical cytology and visual inspection under acetic acid (VIA). The second group included 107 women referred with a positive HR-HPV test that underwent conventional cervical cytology and VIA. The presence of high grade intraepithelial lesion (CIN 2+) or invasive cancer was verified by colposcopy and biopsy. RESULT: In the screening group the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer were 100, 76, 44% for the VIA, HR-HPV test and cytology, respectively. In the referred group, the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer by VIA and cytology were 100 and 81%, respectively. CONCLUSIONS: VIA and HR-HPV self-sampling were the best combination to detect CIN2+ lesions. Cytology analysis gave the poorest performance.
Assuntos
Programas de Rastreamento/métodos , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Adulto , Bolívia/epidemiologia , Colposcopia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Teste de Papanicolaou/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase/métodos , Prognóstico , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/virologia , Esfregaço VaginalRESUMO
En Chile, la atención de salud para usuarios/as transexuales se desarrolla en un contexto marcado por la desigualdad territorial en cuanto al acceso a servicios trans específicos del proceso de adecuación corporal. Por otro lado, las circulares sanitarias que regulan su trato en relación a la identidad de género no se cumplen a cabalidad, lo que favorece la discriminación y la transfobia. Las experiencias de salud de estos/as usuarios/as aún permanecen poco abordadas, por lo tanto también los impactos que esta tiene en su calidad de vida y bienestar. Objetivo: Conocer las experiencias de vida y el significado que un grupo de usuarios/as transexuales le otorga a sus experiencias derivadas del proceso de atención en el sistema de salud chileno, en relación al respeto que reciben por su identidad de genero. Material y método: Estudio cualitativo interpretativista de tipo exploratorio con enfoque fenomenológico. Entrevistas semi-estructuradas fueron llevadas a cabo con 8 personas transexuales, una muestra determinada por la saturación del discurso. El análisis fue hermenéutico del discurso. Resultados: Las personas transexuales en Chile suelen recibir una atención en el sistema de salud poco respetuosa de su identidad de género; sin embargo, participantes reportan que los cuidados que reciben en el Hospital Las Higueras de Talcahuano mejoran su calidad de vida. Conclusión: El modelo de atención de salud respetuoso de la identidad de género tiene un impacto positivo en la dignidad de las personas transexuales, por lo que es indispensable replicar este modelo de atención.
In Chile, health care for transsexual users is offered in a context marked by territorial inequality in terms of access to trans-specific services in the process of corporal adaptation. At the same time, sanitary norms that regulate the treatment of transsexual users in relation to their gender identity are not fully complied with, which facilitates discrimination and transphobia. These health care experiences, and their subsequent impact on the users' quality of life and well-being, still remain poorly addressed. Objective: To explore the experiences of transsexual users in the Chilean health care system and the meaning the users assign to those experiences, in relation to the respect shown for their gender identity. Materials: Exploratory, interpretative qualitative study with a phenomenological approach. Semi-structured interviews were conducted with 8 transsexual individuals; this sample size was determined by the data saturation point. The Hermeneutic Content Analysis method was used. Results: The Chilean health care system tends to not respect the gender identity of transsexual individuals; nevertheless, participants reported that the care they receive at Las Higueras Hospital of Talcahuano improves their quality of life. Conclusion: Gender-respectful health care has a positive impact on the dignity of transsexual individuals, which is why it is essential to replicate this model of care.
Assuntos
Humanos , Masculino , Feminino , Atenção à Saúde , Pessoas Transgênero/psicologia , Transexualidade , Chile , Entrevistas como Assunto , Pesquisa Qualitativa , Identidade de Gênero , Acessibilidade aos Serviços de SaúdeRESUMO
El objetivo de este estudio es analizar el conocimiento y la percepción de los y las adolescentes sobre el Programa de Planificación Familiar. Se realizó un estudio transversal a través de metodologías cuantitativa (encuesta semiestructurada) y cualitativa (técnica de grupo focal y entrevistas individuales), con una muestra de 277 adolescentes (15 a 19 años) usuarios del Hospital de El Carmen, en el año 2010. El 12% de varones y mujeres habían iniciado su vida sexual (el 42% de los varones y el 22% de las mujeres, antes de los 15 años). Aunque todos reconocían que la responsabilidad es de ambos, las mujeres consultaron más el Programa que los varones (el 40% y el 13,5% respectivamente) y reconocían haber recibido más información sobre métodos anticonceptivos antes de iniciar su vida sexual que sus pares varones. Los adolescentes de ambos sexos siguen teniendo concepciones erradas sobre el uso de métodos anticonceptivos. Por lo tanto, es necesario intensificar las actividades de difusión de los Programas de Planificación Familiar entre los y las adolescentes.(AU)
The objective of this study is to analyze adolescentsÆ knowledge and perceptions of ChileÆs Family Planning Program. A cross-sectional study using both quantitative (semi-structured surveys) and qualitative (focus group technique and individual surveys) research methods was conducted with a sample of 277 adolescents aged 15-19 years who were users of the Hospital de El Carmen, in the year 2010. The study results showed that 12% of the participants had initiated sexual activity (of this group, 42% of males and 22% of females had done so before the age of 15). Although all participants recognized that both partners should take responsibility, women consulted the program more frequently than men (13.5% of males and 40% of females had consulted the program). Women also acknowledged receiving more information on birth control methods before initiating sexual activity than their male peers. Adolescents of both sexes continue to have misconceptions about birth control. Therefore, it is necessary to enhance activities aimed at heightening awareness of the program among adolescents.(AU)
RESUMO
El objetivo de este estudio es analizar el conocimiento y la percepción de los y las adolescentes sobre el Programa de Planificación Familiar. Se realizó un estudio transversal a través de metodologías cuantitativa (encuesta semiestructurada) y cualitativa (técnica de grupo focal y entrevistas individuales), con una muestra de 277 adolescentes (15 a 19 años) usuarios del Hospital de El Carmen, en el año 2010. El 12% de varones y mujeres habían iniciado su vida sexual (el 42% de los varones y el 22% de las mujeres, antes de los 15 años). Aunque todos reconocían que la responsabilidad es de ambos, las mujeres consultaron más el Programa que los varones (el 40% y el 13,5% respectivamente) y reconocían haber recibido más información sobre métodos anticonceptivos antes de iniciar su vida sexual que sus pares varones. Los adolescentes de ambos sexos siguen teniendo concepciones erradas sobre el uso de métodos anticonceptivos. Por lo tanto, es necesario intensificar las actividades de difusión de los Programas de Planificación Familiar entre los y las adolescentes.
The objective of this study is to analyze adolescents knowledge and perceptions of Chiles Family Planning Program. A cross-sectional study using both quantitative (semi-structured surveys) and qualitative (focus group technique and individual surveys) research methods was conducted with a sample of 277 adolescents aged 15-19 years who were users of the Hospital de El Carmen, in the year 2010. The study results showed that 12% of the participants had initiated sexual activity (of this group, 42% of males and 22% of females had done so before the age of 15). Although all participants recognized that both partners should take responsibility, women consulted the program more frequently than men (13.5% of males and 40% of females had consulted the program). Women also acknowledged receiving more information on birth control methods before initiating sexual activity than their male peers. Adolescents of both sexes continue to have misconceptions about birth control. Therefore, it is necessary to enhance activities aimed at heightening awareness of the program among adolescents.
Assuntos
Adolescente , Feminino , Humanos , Masculino , Adulto Jovem , Serviços de Planejamento Familiar , Conhecimentos, Atitudes e Prática em Saúde , Chile , Estudos Transversais , Entrevistas como AssuntoRESUMO
The objective of this study is to analyze adolescents' knowledge and perceptions of Chile's Family Planning Program. A cross-sectional study using both quantitative (semi-structured surveys) and qualitative (focus group technique and individual surveys) research methods was conducted with a sample of 277 adolescents aged 15-19 years who were users of the Hospital de El Carmen, in the year 2010. The study results showed that 12% of the participants had initiated sexual activity (of this group, 42% of males and 22% of females had done so before the age of 15). Although all participants recognized that both partners should take responsibility, women consulted the program more frequently than men (13.5% of males and 40% of females had consulted the program). Women also acknowledged receiving more information on birth control methods before initiating sexual activity than their male peers. Adolescents of both sexes continue to have misconceptions about birth control. Therefore, it is necessary to enhance activities aimed at heightening awareness of the program among adolescents.
Assuntos
Serviços de Planejamento Familiar , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Chile , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Adulto JovemRESUMO
The objective of this study is to analyze adolescents knowledge and perceptions of Chiles Family Planning Program. A cross-sectional study using both quantitative (semi-structured surveys) and qualitative (focus group technique and individual surveys) research methods was conducted with a sample of 277 adolescents aged 15-19 years who were users of the Hospital de El Carmen, in the year 2010. The study results showed that 12
of the participants had initiated sexual activity (of this group, 42
of males and 22
of females had done so before the age of 15). Although all participants recognized that both partners should take responsibility, women consulted the program more frequently than men (13.5
of males and 40
of females had consulted the program). Women also acknowledged receiving more information on birth control methods before initiating sexual activity than their male peers. Adolescents of both sexes continue to have misconceptions about birth control. Therefore, it is necessary to enhance activities aimed at heightening awareness of the program among adolescents.
RESUMO
Objetivo: analizar la relación entre vulnerabilidad social y conductas sexuales de riesgo en un grupo de adolescentes chilenos. Materiales y métodos: estudio transversal en adolescentes de la comuna Chiguayante, región del Bío-Bío, Chile, año 2009. La muestra fue de 297 adolescentes, 154 mujeres y 143 varones. Se utilizó la ficha CLAP OPS/OMS y un instrumento de vulnerabilidad social y conducta sexual. Se aplicó t-Student y Ji 2 (p < 0,05). Resultados: la edad promedio fue 16,5 ± 1,5 años en varones y 16,4 ± 1,5 mujeres. El 63% vive con ambos padres. El 74% describe sus relaciones familiares como buenas y excelentes. El 44% de los adolescentes que han iniciado actividad sexual definen sus relaciones familiares como regulares, malas o sin relación frente al 20% que no ha iniciado actividad sexual (p = 0,033); el 62% de los adolescentes que han iniciado actividad sexual percibe escaso o nulo apoyo familiar frente al 42% de los adolescentes que no han iniciado actividad sexual (p = 0,0031). El 51% señala que hay delincuencia en su entorno social próximo. No hubo diferencias significativas al asociar variables de vulnerabilidad social con uso de métodos anticonceptivos y el número de parejas sexuales. Las relaciones sexuales asociadas al consumo de alcohol y drogas fueron superiores en varones (21%) que en mujeres (10%) (p = 0,019); las relaciones sexuales sin protección fueron superiores en mujeres (35%) que en varones (20%) (p = 0,05).Conclusión: se reconoce la importancia de la familia en el proceso de formación de la conducta sexual de las y los adolescentes.
Objective: Analyzing the relationship between social vulnerability and risky sexual conduct in a group of Chilean adolescents. Materials and methods: This was a crosssectional study of adolescents living in the Chiguayante commune in the Bío-Bío region of Chile, during 2009. The sample consisted of 297 adolescents (154 female, 143 male). PAHO/WHO Latin-American Perinatology Centre record cards and a social vulnerability and sexual conduct instrument were used. Students t-test and the chi-square test (p < 0.05) were used for analyzing the data. Results: Average age was 16.5 ± 1.5 years for males and 16.4 ± 1.5 for females; 63% lived with both parents, 74% described their family relationships as being good and/or excellent. 44% of the adolescents in the study who had begun sexual activity defined their family relationships as regular, poor or lacking compared to 20% who had not begun sexual activity (p = 0.033). 62% of the adolescents who had begun sexual activity perceived very limited or no family support compared to 42% of them who had not initiated sexual activity stating the same (p = 0.0031). 51% stated that there was delinquency in their close social setting. There were no significant differences when associating social vulnerability with using conceptive methods and number of sexual partners. Sexual relationships associated with drinking alcohol and taking drugs was greater in males (21%) than in females (10%) (p = 0.019). Engaging in unprotected sexual relationships was greater in females (35%) than in males (20%), (p = 0.05).Conclusion: It was recognized that the family played an important role in forming adolescents' sexual conduct.
Assuntos
Masculino , Feminino , Adolescente , Adolescente , Sexualidade , Vulnerabilidade SocialRESUMO
El epitelio escamoso presenta un aumento de la queratinización, acantosis y disqueratosis a partir de la fecha de la exodoncia. La primera conclusión puede resumirse asi: a mayor tiempo de efectuada la exodoncia hay mayor queratinización. El tejido conectivo presenta un aumento de los fibroblastos a partir de la fecha de la exodoncia. Esta conclusión puede resumirse asi: a mayor cantidad de fibroblastos. El tejido conectivo presenta un aumento de sustancia colagena a partir de la fecha de la exodoncia. A mayor tiempo de efectuada la exodoncia hay mayor cantidad de fibras colagenas con disposición abigarrada, esta disposición le permite tener mayor resistencia. La mucosa de la zona desdentada adquiere mayor resistencia a medida que pasa el tiempo. Referente a la hipótesis podemos decir que si bien no se ha confirmado que se trata de una mucosa intermedia, se trata mas bien de una mucosa de mayor resistencia. Finalmente, sugerimos que la zona motivo de nuestro trabajo sea denominada mucosa adaptada