Made available in DSpace on 2014-07-29T15:29:16Z (GMT). No. of bitstreams: 1 Dissertacao Diego R M e Silva.pdf: 1206544 bytes, checksum: 5bc8723bf521bdb4a4651301fc032ff8 (MD5) Previous issue date: 2012-10-02 / Introduction: Esophageal cancer is a malignancy of high mortality worldwide. Studies on Population-based of this neoplasm in Brazil are scarce. In the central-western of Brazil there are population-based cancer registries to monitor the impact of cancer. However there are no studies describing the profile of this tumor in the central-western of Brasil. Another reason for this study is the large-scale of internal migration happened in the 70's from Porto Alegre to the central-western. Such migration may have influenced the incidence and mortality rates of esophageal cancer in the region. Objective: To evaluate the performance of the Population-Based Cancer Registry of Goiânia (PBCR of Goiânia) in the collecting of basic variables and recommended variable (clinical staging) of incident cases of esophageal cancer. To describe the epidemiological profile of the incidence, mortality and trends esophageal cancer in central-western Brazil. Methods: From the PBCR of Goiânia it was analyzed the completeness of variables related to the patient, tumor and clinical staging of esophageal cancer cases for incidence analysis the period were: Cuiabá (2000-2005), Brasília (1999-2002) and Goiânia (1995-2008). Mortality data were obtained from DATASUS (2010) for the period 1980-2008 for all capitals of central western region. For statistical analysis we used version 15.0 of SPSS for Windows ®, the X2 test and odds ratios were calculated by applying significance at p<0.05 and Joinpoint Regression Program for trend analysis. Results: In the period from 1988 to 2008 were reported 827 cases of esophageal cancer in Goiania in a 3:1 ratio (men/women). Most cases were diagnosed in advanced stages. The analysis of variables collected by RCBP Goiânia identified indices of good completeness of the basic variables related to the patient and tumor, whereas for clinical staging was low (5%). The highest incidence of esophageal cancer in the center-western of Brazil was observed in Cuiabá and lowest in Goiania, while rates in women were similar in Brasilia and Cuiaba. The mortality rates have a heterogeneous increase trend among men in Cuiaba and Campo Grande and among women in Goiania. Conclusions: The RCPB Goiânia had a good performance in collecting of basic variables of esophageal cancer, and low for clinical staging. The profile of incidence of esophageal cancer in the central-western of Brazil was higher in Brasilia and Cuiaba, with incidence rates for men similar to those of Porto Alleger in some periods. There was an increased in mortality in men in Cuiaba and Campo Grande and among women in Goiania. Long-term studies may confirm the influence of migration on the incidence rates of esophageal cancer in this region. / Introdução: O câncer de esôfago é uma neoplasia de alta mortalidade em todo mundo. Estudos de base populacional no Brasil sobre essa neoplasia são escassos. No centro-oeste do Brasil existem registros de câncer de base populacional que monitoram o impacto do câncer, entretanto, não existem estudos avaliando o perfil epidemiológico desse tumor na região. Outra razão para esse estudo é a migração interna em grande escala que houve na década de 70 da população do sul (Porto Alegre) para o centro-oeste. Tal migração pode ter influenciado nas taxas de incidência do câncer de esôfago na região.Objetivo: Avaliar o desempenho do Registro de Câncer de Base Populacional de Goiânia (RCBP de Goiânia) na coleta de variáveis básicas e uma variável recomendada (estadiamento clínico) nos casos incidentes de câncer de esôfago. Determinar a incidência, a mortalidade e as tendências do câncer de esôfago nas capitais do centro-oeste brasileiro (Goiânia, Brasília, Cuiabá e Campo Grande). Metodologia: Para o desempenho do RCBP de Goiânia no período de 1988-2008 avaliou-se os casos de câncer de esôfago quanto à exaustividade das variáveis referentes ao paciente, tumor e o estadiamento clínico. A análise do perfil epidemiológico de incidência e mortalidade abrangeu os seguintes períodos: Cuiabá (2000-2005), Brasília (1999-2002) e Goiânia (1995-2008). Dados da mortalidade foram obtidos do DATASUS (2010) no período 1980-2008. Na análise estatística utilizou-se o software SPSS versão 15.0 para Windows®, o teste X2 e Odds Ratio foram calculados, com nível de p<0,05; utilizou-se o Joinpoint Regression Program para análise de tendência. Resultados: No período de 1988 a 2008 foram notificados 827 casos do câncer de esôfago em Goiânia na proporção de 3:1 (homem/mulher). A maioria dos casos foram diagnosticado em estádio avançado. Na análise do RCBP de Goiânia identificaram-se índices bons de exaustividade das variáveis básicas referentes ao paciente e tumor, para o estadiamento clínico o índice foi ruim (5%). Em relação ao impacto da incidência do câncer de esôfago no centro-oeste do Brasil foi maior em Cuiabá e menor em Goiânia, sendo que as taxas em mulheres foram semelhantes em Brasília e Cuiabá. A mortalidade apresentou padrões heterogêneos com tendência crescente entre os homens em Cuiabá e Campo Grande e entre mulheres em Goiânia. Conclusões: O RCPB de Goiânia apresentou bom desempenho na coleta das variáveis básicas do câncer de esôfago, e ruim para o estadiamento clínico. O perfil da incidência do câncer de esôfago no centro-oeste do Brasil mostrou taxas elevadas em Cuiabá e Brasília, sendo estas taxas de incidência em homens semelhantes às taxas de Porto Alegre em alguns períodos. A mortalidade aumentou em homens em Cuiabá e Campo Grande, e em mulheres em Goiânia. Estudos a longo prazo poderão confirmar a influência da migração nas taxas de incidência do câncer de esôfago nessa região.

AIM The purpose of this study was to explore and describe factors that contribute to the non-initiation of Antiretroviral Therapy (ART) amongst Pre-Antiretroviral Therapy eligible patients and to make recommendations for health care workers to enhance early initiation of pre-ART-eligible patients for primary health care facilities in Swaziland. METHOD A qualitative design was applied in rural primary health care (PHC) facilities in the Hhohho region of Swaziland. The target population for this study included nurses who have successfully completed the National Nurse Led Antiretroviral Therapy Initiation in Swaziland (NARTIS) training, and who actively initiated ART to eligible patients in rural PHC facilities. Data was collected through semi-structured interviews and field notes. Purposive, convenient sampling was applied. Eleven respondents were interviewed for the study, and data was collected until data saturation was reached. Data from transcripts and field notes was analysed and categorised with thematic analysis through Tesch’s open coding process. RESULTS The study identified the following three predominant themes: 1) systematic enablers of prompt ART initiation, 2) barriers to prompt ART initiation, 3) sources of support. Categories included public health care (PHC) factors, community level factors, the interdependence of the health care system, patient centred barriers, individual patient agency, and NARTIS nurse support. CONCLUSION The recommendations for health care workers that emerged from the study included continued HIV treatment scale-up and decentralisation to grass roots levels, aggressive treatment prioritisation among pre-ART patients, building the capacity of the local health care system and continued research initiatives. It is hoped that recommendations emerging from the findings of this study will have positive implications for programming and practice regarding the initiation of ART for eligible pre-ART patients in Swaziland. / Health Studies / M. PH.