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Rastreamento do câncer do colo do útero: adequabilidade da amostra

O Câncer do colo do útero, apesar de prevenível e tratável, ainda é o responsável pela morte de cerca de 5 mil mulheres por ano no Brasil.

O leite ideal para o recém-nascido pré-termo e a transição da sonda para a peito

Encontro com as especialistas Eremita Val Rafael, enfermeira neonatologista da Universidade Federal do Maranhão (UFMA),  e Andrea Penha Spinola Fernandes, médica neonatologista, coordenadora do Banco de Leite do Hospital e Maternidade Leonor Mendes de Barros de São Paulo/SP, 19/07/2018, às 15h. Inscreva-se já para enviar suas dúvidas! Elas serão respondidas pelo Especialista durante o Encontro.

Prevenção do Câncer de Mama

Encontro com as especialistas Viviane Ferreira Esteves de Mattos e Maria Julia Gregorio Calas, médicas mastologistas, 26/07/2018, às 15h.

Planejamento Reprodutivo: o que há de novo e além do planejamento familiar?

O profissional de saúde é quem acolhe mulheres e homens em suas demandas relacionadas ao planejamento reprodutivo, que tem o potencial de ampliar a autonomia das mulheres, reduzir em um terço as mortes maternas e em até 20% as mortes infantis.

Screening interval and risk of invasive squamous cell cervical cancer

To compare the risks of developing invasive squamous cell cervical cancer associated with screening intervals of 1, 2, and 3 years after a negative cervical smear. We conducted a matched case-control study of invasive squamous cell cervical cancer patients (n = 482) diagnosed between 1983 and 1995 among long-term members of a large health maintenance organization. Controls were matched for age, length of membership, and race (n = 934). Screening interval was time between the last negative cervical smear and the case diagnosis date. The main outcome measure was the relative odds of invasive disease associated with 1-year, 2-year, and 3-year intervals. The odds ratio for a 2-year versus a 1-year interval was 1.72 (95% confidence interval 1.12, 2.64, P =.013) and for a 3-year versus a 1-year interval was 2.06 (95% confidence interval 1.21, 3.50, P =.007). The odds ratio for a 3-year versus a 2-year interval was 1.20 (95% confidence interval 0.65, 2.21, P =.561). Controlling for ever having had an abnormal cervical smear or a previous consecutive negative smear did not substantially change these results. In this large health plan, the relative risks of invasive squamous cell cervical cancer were significantly greater for 2-year and 3-year cervical cancer screening intervals compared with a 1-year interval, but not for a 3-year interval compared with a 2-year interval. Our findings need to be placed in the context of the low absolute risks of developing invasive cervical cancer during the first 3 years after a negative cervical smear before making policy recommendation.

What is the right age for cervical cancer screening?

The question as to what the right age is for beginning cervical screening has received much attention in recent months following the tragic death of Jade Goody from cervical cancer at the age of 28 years, and the consequential campaigning by national newspapers for the age at which women are first invited to screening in England to be lowered from 25 to 20 years. Far less attention has been given to the age at which cervical screening could reasonably stop, although it is an equally important question.When considering the benefits and harms of screening, it is useful to consider what would happen to 10,000 people participating in screening. Investigating relative risks alone is insufficient since it does not take into account how common (or rare) the cancer is for a particular group. Consider three possible scenarios involving 10,000 women. For one scenario, there is no screening and 100 women get cancer; in another scenario, there is 3-yearly screening and ten cancers; and in a third scenario, there is 5-yearly screening and 20 cancers. Comparing 3- yearly with 5-yearly screening, one might say that 3-yearly screening halves the risk of cervical cancer. The added benefit, however, is ten cancers prevented, and, compared with no screening, this is an additional reduction of 10%.

The impact of a two- versus three-yearly cervical screening interval recommendation on…

To assess the impact of cervical screening interval recommendations on cervical cancer incidence and mortality during periods of organized and opportunistic screening in Australia (2-yearly screening interval for organized screening), New Zealand (3 yearly interval for organized screening), and England (3/5 yearly interval for organized screening).In the era of opportunistic screening, some reductions were observed in cervical cancer mortality rates, but these were relatively modest and seen inconsistently between countries. After the introduction of organized cervical screening, cervical cancer mortality rates fell by a similar amount (~40 % or more) in all countries, and incidence fell by more than a third in Australia and New Zealand and by approximately one-fifth in England. Although several factors are likely to have influenced these observed reductions in cervical cancer rates, these findings do not support the more frequent 2-yearly cervical screening interval recommendation in Australia.

Risk of cervical cancer associated with extending the interval between cervical cancer…

Although contemporary guidelines suggest that the intervals between Papanicolaou tests can be extended to three years among low-risk women with previous negative tests, the excess risk of cervical cancer associated with less frequent than annual screening is uncertain. Among 31,728 women 30 to 64 years of age who had had three or more consecutive negative tests, the prevalence of biopsy-proven cervical intraepithelial neoplasia of grade 2 was 0.028 percent and the prevalence of grade 3 neoplasia was 0.019 percent; none of the women had invasive cervical cancer. According to our model, the estimated risk of cancer with annual Papanicolaou tests for three years was 2 in 100,000 among women 30 to 44 years of age, 1 in 100,000 among women 45 to 59 years of age, and 1 in 100,000 among women 60 to 64 years of age; these risks would be 5 in 100,000, 2 in 100,000, and 1 in 100,000, respectively, if screening were performed once three years after the last negative test. To avert one additional case of cancer by screening 100,000 women annually for three years rather than once three years after the last negative test, an average of 69,665 additional Papanicolaou tests and 3861 colposcopic examinations would be needed in women 30 to 44 years of age and an average of 209,324 additional Papanicolaou tests and 11,502 colposcopic examinations in women 45 to 59 years of age. As compared with annual screening for three years, screening performed once three years after the last negative test in women 30 to 64 years of age who have had three or more consecutive negative Papanicolaou tests is associated with an average excess risk of cervical cancer of approximately 3 in 100,000.

Epidemiological data on cervical carcinoma relevant to cytopathology

Epidemiological studies based on cervical cytopathology have aroused widespread interest since it was realized that they could be a useful tool for measuring the effectiveness of screening programs and defining practical measures for the prevention of invasive neoplasms and deaths. In the present article, published evidence from screening programs, cohort investigations and case-control studies is reviewed, and possibilities for further analyses and applications are discussed. In particular, when estimates of the relative protections conveyed by Pap smear from various case-control studies conducted on different populations and using different criteria of selection were pooled, a surprisingly close concordance emerged, with overall risk estimates of invasive cervical cancer of 0.42 for women reporting one smear, and of 0.20 for two or more smears in the past. This protection appeared to be long-lasting in a considerable proportion of cases, since the major determinant of invasive cancer risk was the number of previous smears rather than the interval since last smear, and a noticeable residual effect was evident even more than 10 years after the last smear. Besides providing a measure of the effectiveness of cytological screening and helping define the optimal frequency of screening using the limited resources available, case-control studies should permit accurate estimates of the sensitivity of the test and quantify the probability of transition and the duration of various stages of the neoplastic process, i.e., permit a better understanding of the natural history of the disease.

Principais questões sobre Persistência do Canal Arterial em Recém-nascidos Pré-termo

A persistência do canal arterial em recém-nascidos pré-termo é um dos temas mais controversos em Neonatologia atualmente. Seguem as principais questões abordadas durante Encontro com o Especialista sobre esse tema.

Resumo do Programa de Ação da Conferência Internacional sobre População e Desenvolvimento

A Conferência Internacional sobre População e Desenvolvimento das Nações Unidas (CIPD) foi realizada no Cairo, Egito, de 5 a 13 de setembro de 1994 e reuniu 179 países. A CIPD é considerada um marco histórico, sendo o primeiro encontro global no qual todos os aspectos da vida humana foram abordados de forma abrangente. O resultado da Conferência foi um Plano de Ação, uma agenda de compromissos comuns para melhorar a vida de todas as pessoas por meio da promoção dos direitos humanos e da dignidade, apoio ao planejamento familiar, saúde sexual e reprodutiva e direitos, promoção da igualdade de gênero, promoção da igualdade de acesso à educação para as meninas, eliminação da violência contra as mulheres, além de questões relativas à população e proteção do meio ambiente. O Plano de Ação da CIPD está completando 20 anos e passa atualmente por um processo global de revisão, envolvendo governos e sociedade civil, que vai definir o futuro da agenda de população e desenvolvimento para além de 2014; clique aqui para saber mais.

Portaria GM/MS Nº 426 de 22 de março de 2005

O MINISTRO DE ESTADO DA SAÚDE, no uso de suas atribuições, e Considerando a necessidade de estruturar no Sistema Único de Saúde - SUS uma rede de serviços regionalizada e hierarquizada que permita atenção integral em reprodução humana assistida e melhoria do acesso a esse atendimento especializado; Considerando que a assistência em planejamento familiar deve incluir a oferta de todos os métodos e técnicas para a concepção e a anticoncepção, cientificamente aceitos, de acordo com a Lei nº 9.263, de 12 de janeiro de 1996, que regula o § 7º do art. 226 da Constituição Federal, que trata do planejamento familiar; Considerando que, segundo a Organização Mundial da Saúde- OMS e sociedades científicas, aproximadamente, 8% a 15% dos casais têm algum problema de infertilidade durante sua vida fértil, sendo que a infertilidade se define como a ausência de gravidez após 12 (doze) meses de relações sexuais regulares, sem uso de contracepção; Considerando que as técnicas de reprodução humana assistida contribuem para a diminuição da transmissão vertical e/ou horizontal de doenças infectocontagiosas, genéticas, entre outras; Considerando a necessidade de estabelecer mecanismos de regulação, fiscalização, controle e avaliação da assistência prestada aos usuários; e Considerando a necessidade de estabelecer os critérios mínimos para o credenciamento e a habilitação dos serviços de referência de Média e Alta Complexidade em reprodução humana assistida na rede SUS