Increase in skin cancer screening during a community-based randomized intervention trial

Survival from cutaneous melanoma is mainly dependent on the thickness of the lesion at diagnosis. Skin screening may increase detection of thin lesions and hence improve survival. Within a community-based randomized controlled trial of a population screening program for melanoma in Queensland, Australia, 9 communities were randomly assigned to the 3-year intervention and 9 communities to the control group. Skin screening prevalence was monitored by cross-sectional surveys at baseline, 1, 2 and 3 years into the intervention and 2 years later. At baseline, prevalence of whole-body clinical skin examination was similar in intervention and control communities. In intervention communities, the prevalence of whole-body skin examinations increased to 29.2%, an absolute difference of 18% from baseline, with a peak of 34.8% 2 years after baseline, and began to decline again at the end of the intervention period. The largest increases were seen in men and women ≥50 years. Uptake of screening did not differ according to melanoma risk factors; however, the decline in screening was less in participants who reported a number of melanoma risk factors. The prevalence of skin self-examination remained stable during the intervention program. No changes were observed in the control communities. These results indicate that the intervention program significantly increased the prevalence of whole-body clinical skin examinations in intervention communities. Once the intervention program ceased, and particularly after skin clinics ceased, levels of skin screening began to decline. The provision of specialized skin screening clinics may be needed to achieve sufficient screening rates should population based screening for skin cancer be considered. © 2005 Wiley-Liss, Inc.

Detección temprana del cáncer de mama mediante la termografía en Ecuador

En los últimos reportes de Quito-Ecuador ocupa el primer lugar en diagnósticos de cáncer en las mujeres. Las campañas de concienciación y las investigaciones han permitido mejorar el diagnóstico y su tratamiento, pero en países de recursos bajos y medios aun es un problema sin resolver, debido a varios factores: diagnóstico en fases avanzadas y recursos insuficientes que ayuden en su pronta detección. Se conoce que en Ecuador por ejemplo, cerca de cuatro de cada diez mujeres diagnosticadas de cáncer de mama lo son en estadios avanzados (III y IV) cuyo tratamiento es costoso y complejo. Actualmente, según la OMS el reto para todos los países es detectar tempranamente la enfermedad. Por tanto, se debe abordar nuevos retos, tales como la búsqueda de nuevas herramientas y tecnologías costo efectivas que ofrezcan ventajas al actual método, que está basado en mamografías y auto examen. El uso de nuevas tecnologías permitirá identificar la enfermedad en estadios tempranos, lo que dará lugar a que la sobrevida libre de enfermedad aumente, los costos de la atención disminuyan y el pronóstico vital sea mayor. Este trabajo propone incorporar el uso de la termografía como complementaria al diagnóstico precoz de bajo coste y no invasiva.

„Ob Wahrheit oder nicht, ich glaube die Geschichte“. Unbequeme Bildung zu demokratischer Mündigkeit

Vor dem Hintergrund der Flüchtlingsthematik illustriert die Autorin als Auftakt, wie sehr sich die Demokratie in westlichen Gesellschaften, die schon immer Frauen ausschloss, dem Abgrund nähert. Bildung, ob sie es will oder nicht, bildet indirekt oder direkt immer auch politisch-soziale Bedingungen und Verhältnisse ab, bildet in diese hinein, kann nicht unpolitisch sein. Demokratie und Politik finden nicht im Menschen statt, sondern entstehen zwischen den Menschen. Wie kann Bildung nun zum Demokratie lernen oder - um es mit Gayatri Chakravorty Spivak auszudrücken - Demokratie verlernen beitragen? Indem sich jede Bildung immer wieder prozessual einer Selbstprüfung aussetzt, um den Anspruch auf "Erziehung" mündiger BürgerInnen nicht durch die eigene Praxis zu verhindern, lautet die Antwort in diesem kritisch-feministischen und essayistischen Beitrag. Zudem brauche es Bildungsorte, wo es möglich ist, ein BürgerInnensein durch Erfahrung und politische Ideengeschichte zu lernen. (DIPF/Orig.)

Simulador radiográfico antropomórfico de mama humana

Mammography is a diagnostic imaging method in which interpretation depends on knowledge of radiological aspects as well as the clinical exam and pathophysiology of breast diseases. In this work a mammography phantom was developed to be used for training in the operation of mammographic x-ray equipment, image quality evaluation, self-examination and clinical examination of palpation. Polyurethane was used for the production of the phantoms for its physical and chemical properties and because it is one of the components normally used in prostheses. According to the range of flexibility of the polyurethane, it was possible to simulate breasts with higher or lower amount of adipose tissue. Pathologies such as areolar necrosis and tissue rejection due to surgery reconstruction after partial mastectomy were also simulated. Calcifications and nodules were simulated using the following materials: polyethylene, poly (methyl methacrylate), polyamide, polyurethane and poly (dimethyl silicone). Among these, polyethylene was able to simulate characteristics of calcification as well as breast nodules. The results from mammographic techniques used in this paper for the evaluation of the phantoms are in agreement with data found in the literature. The image analyses of four phantoms indicated significant similarities with the human skin texture and the female breast parenchyma. It was possible to detect in the radiographic images produced regions of high and low radiographic optical density, which are characteristic of breasts with regions of different amount of adipose tissue. The stiffnesses of breast phantoms were adjusted according to the formulation of the polyurethane which enabled the production of phantoms with distinct radiographic features and texture similar to human female breast parenchyma. Clinical palpation exam of the phantoms developed in this work indicated characteristics similar to human breast in skin texture, areolar region and parenchyma

Estímulos, barreiras e experiências na procura de ajuda para a disfunção sexual : estudo com utentes dos cuidados de saúde primários

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

A measure of skin familiarity and its role in the early detection of skin cancer

Skin self-examination (SSE) is promoted widely so that individuals will become familiar with their skin and be better able to identify suspicious changes earlier. However, individuals can also become familiar with their skin other than through purposeful SSE. In this article, we develop a measure of skin familiarity based on the density of spots on 14 different areas of the body. A factor analysis of the 14 body-area scores revealed that they could be grouped into four broad body regions (shoulders and back, front of legs, back of legs, and feet). Each total body score and body-region score has high internal consistency (Cronbach's alpha coefficients ranging from 0.79 to 0.93). Moreover, the scores correlate as expected with skin self-examination behaviors and other personal characteristics, indicating high construct validity. We consider the advantages that skin familiarity measures offer over the exclusive use of SSE measures in the assessment of early detection activities and discuss the direction of future research in this area

Community perceptions about the important signs of early melanoma

Detecting melanoma early often relies on patient concern about a particular pigmented lesion. However, it is not clear what specific features the public views as being important.Our purpose was to explore the importance persons place on various features of skin lesions when looking for early signs of melanoma.This study comprised 1148 respondents (participation rate, 78%) from 60 rural communities in Queensland, Australia, who participated in a telephone interview.The following features were considered important and are listed in order of importance: change in the lesion (clearly identified as the most important), more than one color, uneven edges, elevation, large size (the last three of equal importance), and hairiness of the lesion. Age, sex, education, self-efficacy, perceived knowledge, and recent self-examination influenced importance levels, but having a recent skin examination by a family physician did not.To increase the skin self-examination skills of the community, guidelines may have to become more specific and all opportunities fully utilized to educate the public. Article in Journal of the American Academy of Dermatology 36(1):33-9 · February 1997

Life design counseling: A study on client's operations for meaning construction

This study evaluated the adequacy of the micro-theory of client operations to explain meaning construction during Life Design Counseling. Four adolescents were interviewed about their second counseling session. Their recollections were stimulated through the replay of counseling videotapes. The resulting transcribed interviews were qualitatively analyzed. Results confirmed a sequence of client operations evolving from the symbolic representation of experience and reflexive self-examination towards making new realizations and revisioning self. Moreover, clients reported negative and positive session moments evidencing that clients' attention and activity during the session was not restricted to meaning construction operations. Practical implications for life design counseling are derived from the results and discussed.

Efectos de una intervención educativa en los conocimientos y prácticas de los estilos de vida saludables para la prevención del cáncer de seno en estudiantes mujeres de un colegio público de la localidad de Ciudad Bolívar en Bogotá, Colombia

Objetivo: Evaluar los efectos de una intervención educativa en la práctica del autoexamen de seno, los conocimientos y práctica de los estilos de vida saludables para la prevención del cáncer de seno en estudiantes mujeres de un colegio público de la localidad de Ciudad Bolívar en Bogotá, Colombia. Materiales y métodos: Estudio de intervención, antes y después, no controlado en un periodo de seis meses con la participación de mujeres jóvenes estudiantes entre 10 y 20 años de edad. Se contemplaron cinco momentos metodológicos ejecutados en los meses de febrero en el cual se realizó la aplicación del cuestionario auto-diligenciado; de marzo en el cual las estudiantes recibieron una sesión educativa de 90 minutos y una de 60 minutos, soportadas con material audiovisual y folletos informativos. Se realizó el seguimiento prospectivo para la toma de datos en uno, tres y seis meses post-intervención. Conclusiones: 155 estudiantes fueron encuestadas. La prevalencia de práctica del autoexamen de seno fue de 78,1% (n=121). Se evidenció un cambio significativo en el conocimiento de la técnica y la práctica del autoexamen de seno, así como aumentos significativos en los conocimientos de los principales factores de riesgo para el cáncer de mama (p<,0001). En cuanto a los estilos de vida, las estudiantes mejoraron de manera significativa la práctica regular de actividad física con más de 150 minutos semanales a los 6 meses post-intervención. Conclusión: Una intervención educativa puede mejorar los conocimientos acerca de los factores de riesgo para cáncer de mama, la práctica del autoexamen de seno y los estilos de vida en mujeres jóvenes estudiantes de una localidad de bajo nivel socio-económico en Bogotá, Colombia. Estudios experimentales de alta calidad son requeridos.

Prevalencia y factores asociados al síndrome de agotamiento profesional en residentes de diferentes especialidades médicas : una revisión de la literatura de los últimos 15 años

El Síndrome de Agotamiento Profesional (SAP), es común en los trabajadores de la salud, particularmente en los expuestos a altos niveles de estrés en el trabajo e incluye el agotamiento emocional, despersonalización y baja realización personal. Se considera que los médicos residentes presentan una mayor prevalencia del síndrome que los médicos debido a que se encuentran en entrenamiento, período en el cual están sometidos a alta carga laboral debido a las largas horas de trabajo, horarios irregulares, privación de sueño, intensas demandas emocionales, así como la presión de dominar un gran conocimiento clínico. Objetivo. Determinar la prevalencia del Síndrome de Agotamiento Profesional o Burnout en la población de médicos residentes. Metodología. Se realizó una búsqueda de artículos en la base de datos electrónica Pubmed, seleccionando aquellos publicados entre los años 2001 al 2016, tanto en idioma inglés como en español, a texto completo y enfocados en estudios en médicos residentes. Resultados. Los hallazgos sugieren que el Síndrome de Agotamiento Profesional o Burnout es altamente prevalente, que varía de acuerdo a la residencia que se esté realizando, encontrando un promedio del 50% con un rango de 27% a 75% entre las diferentes especialidades de la población estudiada y, en consecuencia, puede constituir un problema de salud que amerita atención en cada Institución, esto a pesar de que la prevalencia pueda variar de un lugar a otro y en las diferentes especialidades. Conclusiones. El SAP o Burnout constituye un problema de salud entre la población de médicos residentes, lo que sugiere la conveniencia de diseñar medidas para su prevención como informar en la inducción al programa de residencia sobre el riesgo de la aparición del síndrome y sus síntomas, consultar tempranamente ante signos de alarma, adecuar el sistema de vigilancia epidemiológica para que incluya esta condición específica y ajustar o disminuir la carga laboral entre otras.

Life Design Counseling: A study on client's operations for meaning construction

This study evaluates the adequacy of the micro-theory of client operations to explain meaning construction in Life Design Counseling. Four adolescents were interviewed on their second counseling session. Their recollections were stimulated through the replay of counseling videotapes and the resulting transcribed interviews were qualitatively analyzed. Results confirmed a sequence of client operations evolving from the symbolic representation of experience and reflexive self-examination towards making new realizations and revisioning self. Moreover, clients reported negative and positive session moments evidencing that clients’ attention and activity during the session was not restricted to meaning construction operations. Practical implications for life design counseling are derived from the results and discussed.

Medical advice, diabetes self-management, and health outcomes of a multi-ethnic population from the National Health and Nutrition Examination Survey 2007--2008

Diabetes self-management, an essential component of diabetes care, includes weight control practices and requires guidance from providers. Minorities are likely to have less access to quality health care than White non-Hispanics (WNH) (American College of Physicians-American Society of Internal Medicine, 2000). Medical advice received and understood may differ by race/ethnicity as a consequence of the patient-provider communication process; and, may affect diabetes self-management. ^ This study examined the relationships among participants’ report of: (1) medical advice given; (2) diabetes self-management, and; (3) health outcomes for Mexican-Americans (MA) and Black non-Hispanics (BNH) as compared to WNH (reference group) using data available through the National Health and Nutrition Examination Survey (NHANES) for the years 2007–2008. This study was a secondary, single point analysis. Approximately 30 datasets were merged; and, the quality and integrity was assured by analysis of frequency, range and quartiles. The subjects were extracted based on the following inclusion criteria: belonging to either the MA, BNH or WNH categories; 21 years or older; responded yes to being diagnosed with diabetes. A final sample size of 654 adults [MA (131); BNH (223); WNH (300)] was used for the analyses. The findings revealed significant statistical differences in medical advice reported given. BNH [OR = 1.83 (1.16, 2.88), p = 0.013] were more likely than WNH to report being told to reduce fat or calories. Similarly, BNH [OR = 2.84 (1.45, 5.59), p = 0.005] were more likely than WNH to report that they were told to increase their physical activity. Mexican-Americans were less likely to self-monitor their blood glucose than WNH [OR = 2.70 (1.66, 4.38), p<0.001]. There were differences among ethnicities for reporting receiving recent diabetes education. Black, non-Hispanics were twice as likely to report receiving diabetes education than WNH [OR = 2.29 (1.36, 3.85), p = 0.004]. Medical advice reported given and ethnicity/race, together, predicted several health outcomes. Having recent diabetes education increased the likelihood of performing several diabetes self-management behaviors, independent of race. ^ These findings indicate a need for patient-provider communication and care to be assessed for effectiveness and, the importance of ongoing diabetes education for persons with diabetes.^

Further concerns about self-assessment: are medical students aware of their progress in clinical skills during clerkship

Background: Medical students do not accurately self-assess their competence. However, little is known about the awareness of change of competence over time. The aim of this study was to evaluate if students are aware of their progress. Summary of work: Twenty-two fourth year medical students had self- and expert-assessments of their clinical skills in musculoskeletal medicine in an OSCE like station (4 point Likert scale) at the beginning (t0) and end (t1) of their eight weeks clerkship in internal medicine. Thirteen students were assigned to the intervention of a 6x1 hour practical examination course; nine took part in the regular clinical clerkship activities only and served as controls. Summary of results/Conclusions: The intervention students significantly improved their skills (from 2.78 ± 0.36 to 3.30 ± 0.36, p<0.05) in contrast to the control students (from 3.11 ± 0.58 to 2.83 ± 0.49, n.s.). At t0, 19 students, at t1 21 out of 22 students underestimated their competence. Correlations between the change of self- and expert-assessment were r=0.43, p<0.05 (all), r=0.47, n.s. (control) and r=-0.12, n.s. (intervention), respectively. Take-home message: Medical students improving their clinical skills by an interactive course in addition to their regular clerkship activities are not aware of their progress

An examination of spirituality, self efficacy, and smoking cessation among adults in Houston, Texas

Over the past decade there has been a growing interest in the association between spirituality and health outcomes. Little is known about the role of spirituality among adult smokers who are motivated to stop smoking. The purpose of this dissertation is to examine the relations among immutable individual differences, spirituality, and self efficacy among adults motivated to stop smoking. The first paper of this dissertation systematically reviewed literature to measure the concordance between spirituality and smoking status among adults in the United States. The second paper of this dissertation explored the association between spirituality and smoking cessation. We hypothesized that higher levels of spirituality were positively associated with smoking cessation. The third paper of this dissertation examined the association between perceived self efficacy and spirituality. We hypothesized that both high levels of self efficacy and spirituality were positively associated with smoking cessation.^ A total of 152 citations were identified based on the preliminary search of databases and reference lists. After a preliminary title- and abstract-based review, 17 full text articles were retrieved for further assessment. Of these, eight met the criteria for inclusion. Results of the systematic review suggest that there is inconsistent evidence to support or refute an association between spirituality and smoking status among adults.^ Smokers (N = 200) at least 18 years of age enrolled in a minimal contact smoking cessation intervention in Houston, Texas completed questionnaires. To examine our hypotheses we conducted cross-sectional analyses of responses to questions included in selected baseline questions and the final in-person visit three weeks post-quit day. Results of the logistic regression analyses indicated that individuals with higher levels of spirituality and self efficacy were significantly more likely to abstain from smoking. The positive association is also evident when controlling for employment, income, race, education, and nicotine dependence. The interaction between self efficacy and spirituality was not statistically significant in predicting smoking abstinence.^ Recommendations for future research and implications for smoking cessation interventions are discussed. Further research in this area would benefit from using standard measures of abstinence, recruiting larger and more diverse populations, and using longitudinal study designs.^