Made available in DSpace on 2015-07-22T20:50:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: No Brasil, o Instituto Nacional do Câncer (INCA) estima que haverá 14.120 novos casos de câncer bucal em 2010, sendo 10.330 em homens e 3.790 em mulheres. A maioria dos cânceres de boca infelizmente só é diagnosticada em fase tardia. O autoexame bucal, por representar uma estratégia simples e eficaz na identificação precoce das lesões cancerizáveis e do câncer bucal, deveria ser feito periodicamente, sobretudo por indivíduos do grupo de risco. Objetivo: Desenvolver e avaliar um website educacional no intuito de promover a prevenção e a identificação precoce das lesões cancerizáveis e do câncer bucal. Método: Foram desenvolvidos um website com conteúdo educacional sobre o câncer bucal, um questionário de conhecimento e um vídeo do autoexame bucal. A avaliação do website baseou-se em uma amostra n=100 dividida em dois grupos. O grupo G1 foi avaliado pré e pós navegação no website, e o grupo G2 não teve acesso ao conteúdo do website. Ambos os grupos executaram o autoexame bucal e registraram seus achados clínicos, que foram comparados com os achados clínicos dos dentistas. Resultados: O website desenvolvido foi intitulado “Website Educacional da Prevenção do Câncer Bucal”. A análise estatística mostrou que os grupos G1 e G2 eram homogêneos quanto ao conhecimento prévio sobre o câncer bucal. Entretanto, o G1 mostrou diferença significante (p<0,01) sobre o conhecimento pós navegação no website. Já a análise de concordância entre os grupos versus dentistas apresentou alta concordância para o G1 e fraca concordância para o G2. Conclusões: O website desenvolvido mostrou-se uma eficiente ferramenta educacional quanto ao ganho de conhecimento sobre o câncer bucal e propiciou eficaz reprodutibilidade do autoexame bucal. / Introduction: In Brazil, the National Cancer Institute (INCA) estimates there will be 14,120 new cases of oral cancer in 2010, with 10,330 men and 3,790 women. Unfortunately, most mouth cancers are only diagnosed in late stage. The oral self-examination represents a simple and effective strategy for early identification of precancerous lesions and oral cancer, and should be done periodically, especially for individuals in risk groups. Objective: To develop and evaluate an educational website aimed at promoting prevention and early detection of cancerous lesions and oral cancer. Method: A website with educational content on oral cancer, a survey of knowledge and a video of oral self-examination have been developed. The website evaluation was based on a sample n = 100, divided into two groups. Group 1(G1) was evaluated before and after browsing the website, and the group 2(G2) did not have access to the website content. Both groups performed the oral self-examination and recorded their clinical findings, which were compared with dentists clinical findings. Results: The developed website was named "Educational Website for Oral Cancer Prevention." Statistical analysis showed that G1 and G2 were homogeneous with respect to prior knowledge about oral cancer. However, G1 showed a significant difference (p <0.01) on knowledge after browsing the website. However, analyzing the agreement between the groups versus dentists, it was found high concordance for G1 and poor agreement for G2. Conclusions: The website proved to be an effective educational tool for gain of knowledge about oral cancer and provided effective reliability of oral self-examination. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: A infecção genital pelo papilomavírus humano (HPV) é um fator necessário para o desenvolvimento do câncer cervical. Vacinas para prevenir a infecção pelos tipos de alto risco HPV 16 e 18 foram desenvolvidas e idealmente devem ser administradas antes da exposição ao HPV através do contato sexual. As variações na prevalência do HPV e na de seus tipos específicos em diferentes populações podem influenciar as recomendações da vacina contra o HPV em diferentes locais. A vacinação após o primeiro parto poderia ser uma estratégia em potencial para atingir mulheres jovens e saudáveis, dependendo da proporção de mulheres desse grupo ainda não infectadas pelos tipos de alto risco, HPV 16 e 18. Objetivos: O objetivo principal deste estudo foi determinar a prevalência genital do DNA de tipos específicos do HPV e avaliar a associação dessa infecção com fatores de risco selecionados em mulheres após o primeiro parto, usuárias de uma maternidade pública. Métodos: Esse estudo transversal foi realizado no Hospital Maternidade Leonor Mendes de Barros (HMLMB), uma das maiores maternidades públicas da cidade de São Paulo. Durante junho de 2006 até fevereiro de 2007, 301 primíparas de 15-24 anos, cujos partos ocorreram no referido Hospital, foram incluídas no estudo entre 43 e 60 dias após o parto. Na detecção de DNA do HPV extraído das células cervicais esfoliadas foi utilizado protocolo padrão da Reação em Cadeia por Polimerase (PCR), utilizando primers PGMY09/11. Para estimar a associação da infecção por HPV com fatores de risco selecionados, foi calculada a Razão de Prevalência (RP) e o intervalo de 95% de confiança [IC]; o ajuste foi realizado utilizando-se o Modelo Linear Generalizado (MLG) com distribuição binomial e função de ligação logarítmica. Resultados: O DNA do HPV foi detectado em 58,5% (IC 95% 52,7%-64,0%) das jovens mulheres. Os tipos de HPV mais comumente encontrados foram: HPV 16, HPV 51, HPV 52, HPV 58 e HPV 71. A prevalência dos tipos de HPV incluídos nas vacinas profiláticas foi: HPV 16 - 12,0%, HPV 18 - 2,3% e HPV 6+11 - 4,3%. Os tipos de alto risco de HPV foram encontrados em 133 (44,2%) mulheres, enquanto 43 delas (14,3%) apresentaram somente tipos de HPV de baixo risco. Cento e duas mulheres (33,9%) foram positivas para apenas um tipo de HPV; entretanto, 43 (14,3%) apresentaram dois tipos, e 31 (10,3%) apresentaram três ou mais tipos virais. A análise multivariada revelou que somente a idade (p=0,020) e o hábito de fumar (p <0,001) foram fatores de risco independentemente associados com a infecção por HPV. Conclusões: Essas adolescentes e jovens primíparas apresentaram elevada prevalência de infecção genital por tipos de alto risco do HPV, mostrando que constituem um grupo de risco para o desenvolvimento de câncer cervical. Contudo, apenas 17,3% apresentaram pelo menos um dos quatro tipos virais presentes na vacina quadrivalente (HPV 6, 11, 16 ou 18), 13,3% apresentaram infecção pelos tipos HPV 16 ou 18, e somente 1,0% apresentou concomitantemente infecção por esses dois tipos virais de alto risco presentes nas vacinas. Portanto, esse estudo indica que a grande maioria dessas jovens primíparas poderia ainda se beneficiar da imunização (catch-up) contra o HPV e constitui um grupo que deve ser alvo de programas efetivos de prevenção primária e secundária para o câncer cervical / Introdution: Genital infection by human papillomavirus (HPV) is a necessary factor in the development of cervical cancer. Vaccines to prevent infection by high risk HPV genotypes 16 and 18 were developed and ideally should be administered before exposure to HPV through sexual contact. Variations in HPV prevalence in different populations and of specific HPV types could affect vaccine recommendations in different settings. Vaccination after first delivery could be a potential strategy for reaching healthy young women depending on the baseline prevalence of high risk genotypes 16 and 18 in this target group. Objectives: The main objective of this study was to determine genital type specific HPV DNA prevalence and selected risk factors associated with HPV infection after the delivery of the first child among young women in a public maternity. Methods: This cross-sectional study was carried out at Hospital Maternidade Leonor Mendes de Barros (HMLMB), one of the largest public maternity hospitals in Sao Paulo. During June 2006 to February 2007, 301 primiparous women aged 15-24 years, who gave birth at that hospital, were included in the study between 43 and 60 days after delivery. Detection of HPV DNA in cervical specimens was performed using a standardized polymerase chain reaction (PCR) protocol with PGMY09/11 primers. To estimate the association of HPV infection with selected risk factors, prevalence ratios (PR) and 95% confidence interval [CI] were estimated using a Generalized Linear Model (GLM) with binomial distribution and log link function. Results: Any HPV DNA was detected in 58.5% (95% CI 52.7%-64.0%) of the enrolled young women. Most common types of HPV found were: HPV16, HPV51, HPV52, HPV58 and HPV71. The overall prevalence of HPV types targeted by the HPV prophylactic vaccines was: HPV16 - 12.0%, HPV18 -2.3% and HPV 6+11- 4.3%. High-risk HPV types were found in 133 (44.2%) women, whereas 43 women (14.3%) had only low-risk HPV types. One hundred and two women (33.9%) were positive for one HPV type only; however, 43 (14.3%) had two types, and 31 (10.3%) had three or more types detected. The multivariate analysis revealed that only age (p for trend =0.020) and smoking habits (p <0.001) were risk factors independently associated with HPV infection. Conclusions: These adolescents and young primiparous women had high cervical HPV prevalence, suggesting that this is a high risk group for cervical cancer development. Nevertheless, 17.3% were positive to any of the four HPV types included in HPV vaccines (HPV6, 11, 16 or 18), with 13.3% positive for HPV 16 or 18, and only 1.0% of them had both vaccine related oncogenic HPV types. Thus, this study supports that the most part of young primiparous women could benefit from catch-up HPV vaccination, and represents a target group for effective primary and secondary cervical cancer prevention programs

No description available.

A model was developed in this study to understand women's cervical screening behaviour. It revealed that the interaction among institutional factors, risk appraisal, coping appraisal, and health beliefs and cultural factors contributed to the complex nature of screening behaviour among Chinese women. The institutional component provided the contextual factors within which women perceived the risk of cervical cancer, perceived the practice of cervical screening, and decided to take or not to take cervical screening. Risk appraisal provided the premise factor that induces women to seek coping strategies to reduce or remove the risk. During the process of coping appraisal, women's motivation to have cervical screening could be increased or decreased as the perceived benefits and costs of screening interacted with each other. The importance of the women's health beliefs and cultural factors was reflected in the way that they were affected by their notions of health behaviour and their cultural beliefs about cervical cancer risk and cervical screening participation. Commitment to participate in screening was a reinforcing factor inducing women to take up an offer of cervical screening. / Aim: To explore the knowledge and the perception of the risk of cervical cancer, identify the factors determining cervical screening behaviour, and develop a model to understand cervical screening behaviour among women in mainland China. / Background: Cervical cancer is the most common type of cancer, and is the second most common cause of cancer death in women in mainland China. Cervical screening is the most important intervention for the secondary prevention of cervical cancer. Theories of health behaviour and empirical research highlight risk perception as a significant factor motivating people to opt for cancer screening. However, little is known about the risk perception of cervical cancer and the factors influencing the screening participation of women in mainland China. / Conclusion: This study provides evidence of the complex factors influencing cervical screening behaviour and contributes new knowledge to the understanding of cervical screening behaviour within the Chinese cultural context. It further informs programmes for the promotion of cervical screening among this population. / Methods: A mixed method design consisting of two phases was used, employing both quantitative and qualitative methods of data collection. First, a cross-sectional survey was conducted to collect a baseline assessment of women's knowledge of cervical cancer and screening, their perceptions of the risk of cervical cancer, and the relationship between these factors and their cervical screening behaviour. Findings from this phase also guided the purposive sampling of participants in phase two. / Results: The findings from phase one demonstrated that the availability of an organized screening programme was a major motivator for women to opt for cervical screening. Multivariate analysis shows that having children (OR=2.57, p=0.026), a perception that visiting doctors regularly is important for health (OR-2.66, p=0.025), average (OR-4.84, 1)=0.006) and high levels of knowledge about cervical screening (OR-9.66, p=0.001) were significantly associated with having been screened in the previous three years. / Then in phase two, qualitative research was conducted using semi-structured interviews of 27 women, 16 of whom had been screened and 11 had not. The interview structure was based on an initial analysis of the data from phase one and from a review of the related literature. The data from the interviews were analyzed using latent content analysis, involving an interpretative reading of the symbolism underlying the surface structure in the text. The audio recordings of the interviews were transcribed verbatim in Chinese, and then the key phrases which were important for the objectives of the study were identified. The key phrases and words were grouped according to their commonality of meaning. Then, these groups of data were sorted and classified to create categories and sub-categories, which were mutually exclusive, explicit and accurate without overlapping. / Two themes emerged from the qualitative data from phase two. Theme I was that perceptions of cervical cancer and cervical screening included five categories: the perceived effects of suffering from cervical cancer; the perception of cervical screening; a lack of understanding about cervical cancer and screening; the perceived risk of cervical cancer; and factors related to the cultural beliefs system. Theme II was that the institutional and health care practitioner system included two categories: availability of an organised physical examination programme and the role of the health care practitioner in encouraging cervical screening utilization. / Gu, Can. / Adviser: Chan, Carmen. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 244-267). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Diversos estudos epidemiológicos têm demonstrado que isoprenóides presentes em frutas e hortaliças possuem ação protetora contra o desenvolvimento de câncer. Objetivou-se, no presente trabalho, avaliar as eventuais atividades quimiopreventivas dos isoprenóides geraniol (GO) e beta-ionona (BI) quando administrados a ratos Wistar, isoladamente ou em associação, continuamente durante as etapas de iniciação e pós-iniciação de modelo de carcinogênese de cólon induzida por dimetilhidrazina. A atividade quimiopreventiva desses compostos foi observada microscopicamente por meio da análise de Focos de Criptas Aberrantes (FCAs) em cólons corados com azul de metileno (0,02%). Verificou-se que, em comparação ao grupo controle apenas os ratos tratados com GO, mas não com BI, apresentaram redução (p&#8804;0,05) do número de lesões pré-neoplásicas (FCAs), no cólon distal, tanto em relação ao número de focos totais quanto aqueles com número maior ou igual do que quatro criptas. Por outro lado, somente tratamento com BI foi capaz de reduzir a concentração de colesterol plasmático total. Posteriormente, raspagem da mucosa colônica foi utilizada para a avaliação de danos no DNA pelo método do \"Cometa\". Em comparação ao grupo controle, tratamentos com GO, BI e GO+BI reduziram (p&#8804;O,05) o comprimento dos cometas indicando, dessa forma, diminuição de danos no DNA. Avaliou-se, ainda, a expressão de Bcl-2, em nível de proteína, em mucosas colônicas dos animais dos diferentes grupos pela técnica Western Blot. Foi possível notar uma redução nos valores da expressão pelos tratamentos com GO (p&#8804;0,05). Embora somente o tratamento com GO tenha inibido a formação de FCAs, tratamentos com BI e GO+BI podem ter apresentado efeitos protetores por inibirem os danos do DNA que não foram suficiente para a inibição da formação e crescimento de lesões pré-neoplásicas. / Several epidemiologic studies have shown consistently that isoprenoids presents in fruits and vegetables have a protective action against cancer. The objective of this study was to evaluate the chemopreventive effects of isoprenoids geraniol (GO) and beta-ionone (BI) during the initiation and pós-initiation phases of in rats submitted to model of chemical colon carcinogenesis induced by dimethylhydrazine (DMH). Aberrant Crypt Focus (ACFs) were detected using a light microscope in colons stained with 0,02% methylene blue. Treatment with GO significantly suppressed the total number of ACF and ACFs &#8805; 4 crypts per colon compared with the control group com oil (p&#8804;0,05), mainly in the distal colon. In other hand, only treatment with BI reduced total plasma cholesterol levels compared with the control group (p&#8804;0,05). Subsequently colonic mucosa scraping was used for asses DNA damage through comet assay and expressed as comet length. DNA damage was inhibited in our study by all treatments (p&#8804;0,05). Analysis of Bcl-2 protein from colonic mucosa scraping by Western Blot showed that treatment with GO reduced the values of expression de Bcl-2 (p&#8804;0,05). Although the results of this study suggest that treatment with GO has chemopreventive effects, treatments with BI and GO+BI has initial protective action that maybe wasn\'t sufficient to reduce formation ACF.

A breast cancer cell line stably transfected with the CYP19 gene had been employed for aromatase inhibition. Among the phytochemicals tested, the major dietary flavonoids, such as genistein and daidzein, produced very weak inhibition. On the other hand, the red clover isoflavone biochanin A, the hydroxychalcone butein and the red grape phytoalexin resveratrol were found to be effective aromatase inhibitors. Cell proliferation assay had shown that they could inhibit ER-positive cell proliferation induced by testosterone, and the inhibitory effect was specifically attributed to the reduction of estrogen synthesis. In another breast cancer cell line SK-BR-3, resveratrol, biochanin A and genistein inhibited CYP19 both in enzyme and promoter I.3/II transcriptional levels. The element responsible for the inhibition of aromatase by these phytoestrogens should fall within the region between -556 to -446 by upstream of exon II. / Breast cancer is one of the most common cancers affecting women. Estrogen plays an important role in breast cancer initiation and development. The majority of breast tumors are initially dependent upon estrogen to support their growth. Most breast cancers occur in the postmenopausal period. However, the intra-tumoral estradiol (E2) is maintained at a high level equivalent to the pre-menopausal status. High intra-tumoral E2 level in postmenopausal women is sustained by the biosynthesis of estrogens in the tumorous tissue. / Genistein and Biochanin A, ranged from 0.1 to 10 muM, might act as estrogen agonist and induced aromatase activity and promoter I.1 transactivation in ERalpha-transfected SK-BR-3 cells. (Abstract shortened by UMI.) / The aromatase enzyme, CYP19, belongs to a family of P450 enzyme. As a final rate-limiting step in estrogen biosynthesis, it catalyzes the conversion of C 19 steroids to estrogens. The expression of CYP19 is tissue-specific, and is regulated by alternate promoter usage. The use of aromatase inhibitors for breast cancer treatment has become a major therapeutic approach. / The consumption of some phytochemicals protects against breast cancer. Yet the mechanisms are far from clear. In my present study, various phytochemicals, including phytoestrogens, monoterpenes and carotenoids, were evaluated for their effect on aromatase. / Wang Yun. / "July 2005." / Adviser: Lai-Kwok Leung. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3716. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 145-169). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Made available in DSpace on 2015-07-22T20:49:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-10-28 / Em 2002, o Estado de Mato Grosso aderiu à segunda fase de intensificação Programa Nacional de Controle do Câncer do Colo do Útero (PNCCU) como medida de enfrentamento das altas taxas da doença e de morte por neoplasia cervical. Com o objetivo de analisar os principais resultados do PNCCU, foi feito um estudo em duas partes. A primeira parte teve como objetivo levantar o perfil da doença e a cobertura do exame rastreamento pelo PNCCU no Estado. Os objetivos da segunda parte foram: analisar o seguimento clínico da população rastreada, analisar as diferentes características evolutivas da doença associadas aos fatores sócio-demográficos e clínicos, bem como analisar o risco de óbito e a taxa de sobrevida estratificada pelas variáveis sócio-demográficas e clínicas das mulheres que apresentaram carcinoma invasivo. Na primeira parte, foi utilizado estudo do tipo transversal e na segunda parte, foi realizado um estudo de coorte. O período do estudo compreendeu de 2002 a 2007 e abrangeu todos os municípios do Estado de Mato Grosso. A população estudada na primeira fase do estudo correspondeu todas as mulheres que fizeram o exame de rastreamento no ano de 2002. Na segunda parte do estudo, a população correspondeu a uma amostra aleatória representativa das mulheres que apresentaram alterações citológicas na primeira fase do estudo, totalizando 323 mulheres. A fonte de dados utilizada foi o sistema de informação oficial de saúde, dentre eles o SISCOLO, SIM, APAC, além de dados oficiais da Secretaria Estadual de Saúde/MT (SES/MT), dados disponíveis no site do INCA e do DATASUS e prontuários clínicos. Para análise estatística dos dados foram utilizadas técnicas descritivas e inferenciais. Na parte descritiva foram utilizados tabelas, gráficos e medidas de posição e de dispersão. Para avaliar a o risco de adoecer por carcinoma cervical invasor foi utilizado regressão logística univariada e multivariada. Para analisar a taxa de sobrevida global foi utilizado o estimador de Kaplan-Meier e para analisar os fatores prognósticos, foi utilizado o modelo de riscos proporcionais de Cox. Dentre os principais resultados, destaca-se que no período estudado, Mato Grosso apresentou taxas de incidência elevadas, acima da média nacional. Os dados do seguimento clínico mostraram os diferentes desfechos, dentre eles, destaca-se que: entre as 323 mulheres, 18 (6,2%) foram a óbito tendo o câncer do colo do útero como causa básica da morte. Foi analisado o risco de a doença evoluir para o carcinoma invasor, segundo as variáveis sócio-demográficas e clínicas, sendo que as variáveis: faixa etária, estado civil, tabagismo, menarca e município foram as que apresentaram forte associação com a doença na fase invasora. Já na análise de sobrevivência, a taxa de sobrevida global em 60 meses, estimada pelo método de Kaplan-Meier, foi de 66,7%. No modelo final de risco proporcional de Cox, as variáveis com maior risco de óbito foi o estágio avançado da doença e a raça/cor. Estes dados levam a concluir que a doença no Estado de Mato Grosso tem uma determinação social muito grande, considerando a dificuldade de acesso aos serviços de saúde da população desfavorecida pelas condições raciais, sócio-econômicas, e chegam aos serviços com a doença em fase adiantada, quando a chance de sobrevivência é muito pequena. Conclui-se que para o efetivo combate a doença são necessárias políticas governamentais, como o PNCCU, que garantam a universalidade da assistência, principalmente da população desfavorecida socialmente. / In 2002, the State joined the second phase of intensification of the National Program for the Control of Cervical Cancer (PNCCU) as a measure to deal with the high rates of the disease and of death by cervical neoplasia. With the aim of analyzing the main PNCCU results, a two-stage study was carried out. The first phase aimed at presenting the disease profile and the coverage of the screening exam by the PNCCU in the State. The aims of the second phase were to analyze the clinical follow-up of the population that was screened, analyze the different evolutionary characteristics of the disease associated to socio-demographic and clinic factors, as well as analyze the factors associated to death risk and the stratified survival rate by the socio-demographic and clinical variables of women that presented invasive carcinoma. In the first part, the cross-sectional study was used and a cohort study was used in the second phase. The period of study was from 2002 to 2007 and comprised all the municipalities of the State of Mato Grosso. The population studied in the first phase of the study was all the women who had undergone the screening test in 2002. The population used in the second phase of the study was a representative random sample of those that presented cytological alterations in the first phase of the study, a total of 323 women. The source of data used was the official health information system, among them the SISCOLO, SIM, APAC, and also the official data of the State Health Department/MT (SES/MT), data available in the INCA and DATASUS sites and medical records. For the statistical analysis of the data, descriptive and inferential techniques were used. In the descriptive part, tables, graphics and position and dispersion measures were used. In order to evaluate the risk of being sick due to invasive cervical carcinoma, the univariate and multivariate logistic regression analysis was used. The Kaplan-Meier estimator was used to analyze the survival rate and to analyze the prognostic factors, the Cox proportional hazards model was used. Among the main results it is highlighted that in 2002, Mato Grosso presented high incidence rates, above the national average. The data of the clinical follow up showed the different clinical outcomes, among the 323 women, 18 (6,2%) died having as the basic cause of death the cervical cancer. The risk of the disease developing into the invasive carcinoma was analyzed according to the socio-demographic and clinical variables, and the variables: age group, marital status, smoking history, menopause and municipality were those that presented a strong association with the disease in the invasive phase. However, in the survival analysis, the global survival rate in 60 months, estimated by the Kaplan-Meier method, was of 66,7%. In the final Cox proportional hazards model, the variables with higher death risk was the advanced stage of the disease and the race/color. These data lead to a conclusion that the disease in the State of Mato Grosso has a very large social determination, considering the difficulties in the access to the health services by the population affected by racial, socio-economic conditions that arrive in the health services with the disease in an advanced stage, when the survival probability is very small. The conclusion is that for the effective fight against the disease governmental policies such as the PNCCU are necessary, and that the universality of the assistance be guaranteed, mainly to the socially disadvantaged population. / TEDE / BV UNIFESP: Teses e dissertações

Diversos estudos epidemiológicos têm demonstrado que isoprenóides presentes em frutas e hortaliças possuem ação protetora contra o desenvolvimento de câncer. Objetivou-se, no presente trabalho, avaliar as eventuais atividades quimiopreventivas dos isoprenóides geraniol (GO) e beta-ionona (BI) quando administrados a ratos Wistar, isoladamente ou em associação, continuamente durante as etapas de iniciação e pós-iniciação de modelo de carcinogênese de cólon induzida por dimetilhidrazina. A atividade quimiopreventiva desses compostos foi observada microscopicamente por meio da análise de Focos de Criptas Aberrantes (FCAs) em cólons corados com azul de metileno (0,02%). Verificou-se que, em comparação ao grupo controle apenas os ratos tratados com GO, mas não com BI, apresentaram redução (p&#8804;0,05) do número de lesões pré-neoplásicas (FCAs), no cólon distal, tanto em relação ao número de focos totais quanto aqueles com número maior ou igual do que quatro criptas. Por outro lado, somente tratamento com BI foi capaz de reduzir a concentração de colesterol plasmático total. Posteriormente, raspagem da mucosa colônica foi utilizada para a avaliação de danos no DNA pelo método do \"Cometa\". Em comparação ao grupo controle, tratamentos com GO, BI e GO+BI reduziram (p&#8804;O,05) o comprimento dos cometas indicando, dessa forma, diminuição de danos no DNA. Avaliou-se, ainda, a expressão de Bcl-2, em nível de proteína, em mucosas colônicas dos animais dos diferentes grupos pela técnica Western Blot. Foi possível notar uma redução nos valores da expressão pelos tratamentos com GO (p&#8804;0,05). Embora somente o tratamento com GO tenha inibido a formação de FCAs, tratamentos com BI e GO+BI podem ter apresentado efeitos protetores por inibirem os danos do DNA que não foram suficiente para a inibição da formação e crescimento de lesões pré-neoplásicas. / Several epidemiologic studies have shown consistently that isoprenoids presents in fruits and vegetables have a protective action against cancer. The objective of this study was to evaluate the chemopreventive effects of isoprenoids geraniol (GO) and beta-ionone (BI) during the initiation and pós-initiation phases of in rats submitted to model of chemical colon carcinogenesis induced by dimethylhydrazine (DMH). Aberrant Crypt Focus (ACFs) were detected using a light microscope in colons stained with 0,02% methylene blue. Treatment with GO significantly suppressed the total number of ACF and ACFs &#8805; 4 crypts per colon compared with the control group com oil (p&#8804;0,05), mainly in the distal colon. In other hand, only treatment with BI reduced total plasma cholesterol levels compared with the control group (p&#8804;0,05). Subsequently colonic mucosa scraping was used for asses DNA damage through comet assay and expressed as comet length. DNA damage was inhibited in our study by all treatments (p&#8804;0,05). Analysis of Bcl-2 protein from colonic mucosa scraping by Western Blot showed that treatment with GO reduced the values of expression de Bcl-2 (p&#8804;0,05). Although the results of this study suggest that treatment with GO has chemopreventive effects, treatments with BI and GO+BI has initial protective action that maybe wasn\'t sufficient to reduce formation ACF.

The comprehensive cancer control approach is used by state, tribes, tribal organizations, territorial and Pacific Island Jurisdiction cancer coalitions to spur local implementation of cancer plans to reduce the burden of cancer in jurisdictions across the country. There is a rich diversity of models and approaches to the development of relationships and scope of planning for cancer control activities between coalitions and advocates in local communities. The national comprehensive cancer control philosophy provides an operational framework while support from the Centers for Disease Control and Prevention enables coalitions to act as catalysts to bring local partners together to combat cancer in communities. This manuscript describes multiple characteristics of cancer coalitions and how they are organized. Two models of how coalitions and local partners collaborate are described. A case study method was used to identify how five different state and tribal coalitions use the two models to organize their collaborations with local communities that result in local implementation of cancer plan priorities. Conclusions support the use of multiple organizing models to ensure involvement of diverse interests and sensitivity to local cancer issues that encourages implementation of cancer control activities.

This review summarizes the principles of cancer chemoprevention and discusses the evidence from epidemiologic and experimental studies and preclinical and clinical trials of potential colorectal chemopreventive agents. The putative mechanisms of action of the drugs in chemoprevention and their potential to reduce the incidence and mortality rate of colorectal neoplasms are discussed. The future of colorectal chemoprevention will depend on important new insights into molecular carcinogenesis of colorectal cancer, application of molecular markers as surrogate endpoints, and ultimately on therapeutic targets of prevention in clinical trials.