Introdução: O câncer do colo do útero é um problema de saúde publica, é uma importante causa de morbidade e mortalidade em mulheres de todo mundo. O rastreamento com a citologia de Papanicolaou, quando realizado periodicamente demonstrou ser eficaz na redução de incidência e mortalidade em países desenvolvidos. O rastreamento com unidade móvel de prevenção é uma estratégia para o diagnóstico precoce do câncer do colo do útero. Objetivo: Avaliar os resultados do programa de rastreamento com busca ativa e unidade móvel na detecção precoce do câncer do colo do útero na população das zonas urbana e rural de Barretos. Casuística e Métodos: Estudo retrospectivo, descritivo, com 16.849 mulheres na zona urbana e 1.055 na zona rural de Barretos. O projeto inclui visitas domiciliares repetidas de um profissional de saúde da unidade móvel do Hospital de Câncer de Barretos (HCB), entrevista e coleta de Papanicolaou. Mulheres com diagnóstico citológico de ASC-US, ASC-H, lesões intraepiteliais e carcinoma invasivo, foram convocadas para colposcopia e todas as mulheres com histopatológico de carcinoma foram tratadas e permanecem em seguimento no HCB. Os resultados deste programa foram comparados com dados do registro sobre câncer do colo do útero do Departamento Regional de Saúde V (DRS-V) e da Fundação Oncocentro de São Paulo (FOSP), do mesmo período. Resultados: Na zona urbana 10.350 (61,4%) mulheres foram examinadas e realizaram o exame de Papanicolaou, com taxa de cobertura de 62,9% nas mulheres em idade alvo (25 a 60 anos) do programa brasileiro. Foram identificados 35 casos de carcinoma, sendo 77,1% de carcinoma espinocelular in situ. A idade média foi 41,9 anos, 81,4% das mulheres examinadas eram das classes socioeconômicas D e E, e 88,6% apresentavam exame prévio de Papanicolaou. Na zona rural, 1.055 (100%) mulheres foram entrevistadas, examinadas e realizaram o exame de Papanicolaou, com taxa de cobertura de 74,4% na idade alvo. Foram identificados 6 casos de carcinoma, sendo 83,3% de carcinoma espinocelular in situ. A idade média foi de 39,8 anos, 86,7% nas classes socioeconômicas D e E, e 81,0% das mulheres apresentavam exame de Papanicolaou prévio. Analisamos os dados do programa de rastreamento do HCB e comparamos com os dados, em relação ao estadiamento, da DRS-V e FOSP, no mesmo período. Está análise mostrou que houve uma prevalência de lesões in situ em relação às invasivas no programa de rastreamento do HCB quando comparado à DRS-V (p=0,005) e à FOSP (p<0,001). Conclusões: O rastreamento com busca ativa e unidade móvel é um método efetivo no diagnóstico precoce do câncer do colo do útero / Introduction: Uterine cervical cancer is a public health problem and an important cause of morbidity and mortality among women worldwide. Screening using the Papanicolaou cytological test, when done repeatedly, has been shown to be effective for reducing the incidence and mortality of this disease in developed countries. Screening with an active search using a mobile unit is a strategy for early diagnosis of uterine cervical cancer. Objective: To evaluate the results from a screening program with an active search using a mobile unit for early detection of uterine cervical cancer among the populations in the urban and rural zones of Barretos. Sample and Methods: This was a retrospective descriptive study on 16,849 women in the urban zone and 1,055 in the rural zone of Barretos. The project included repeated home visits by a healthcare professional from the mobile unit of Barretos Cancer Hospital (HCB), interviews and collection of Papanicolaou smears. Women with a cytological diagnosis of ASC-US, ASC-H, intraepithelial lesions and invasive carcinoma were called in for colposcopy examinations. All the women with a histopathological diagnosis of carcinoma were treated and remained under follow-up by HCB. The results were compared with data from the uterine cervical cancer records of the Fifth Regional Health Department (DRS-V) and the Oncocenter Foundation of São Paulo (FOSP), covering the same period. Results: From the urban zone, 10,350 Papanicolaou smears (61.4%) were collected, with a coverage rate of 62.9% of the women at the target age for the Brazilian program. There were 35 cases of carcinoma, of which 77.1% were in situ squamous cell carcinoma. The womens mean age was 41.9 years; 81.4% were in socioeconomic classes D and E; and 88.6% had had a previous Papanicolaou examination. In the rural zone, 1,055 Papanicolaou smears (100.0%) were collected, with a coverage rate of 74.4% of the women at the target age. There were six cases of carcinoma, of which 83.3% were in situ squamous cell carcinoma. The womens mean age was 39.8 years; 86.7% were in socioeconomic classes D and E; and 81.0% had had a previous Papanicolaou examination. We analyzed the data from the HCB screening program in comparison with the staging data from DRS-V and FOSP, over the same period. There were statistically significant differences in the proportions of in situ and invasive carcinoma found in the HCB screening program in relation to DRS-V (p = 0.0046) and in relation to FOSP (p < 0.001). This analysis showed that there was higher prevalence of in situ lesions than of invasive lesions in the HCB screening program. Conclusions: Screening with an active search using a mobile unit is an effective method for early diagnosis of uterine cervical cancer

Introdução: A identificação do uso de risco de álcool na Atenção Primária à Saúde é fundamental para prevenir danos individuais e prejuízos sociais. Nesse contexto, é imprescindível o emprego de instrumentos de rastreamento que sejam de fácil aplicação, de baixo custo, compreensível por leigos e que ocupe pouco tempo profissional para avaliação. No Brasil, encontram-se disponíveis alguns instrumentos, no entanto nenhum deles contempla todas as características citadas, o que dificulta sua utilização na Atenção Primária à Saúde. Logo, é relevante disponibilizar um instrumento para uso nesse local. Objetivo: Traduzir, adaptar culturalmente e validar para o idioma português a Questão-Chave (Single-Question) original do idioma inglês. Método: Estudo metodológico cujas etapas realizadas foram tradução, retrotradução, adaptação cultural, avaliação pelo Comitê de Juízes, estudo piloto e validação de critério. Resultados: Estão apresentados em três artigos. Artigo 1: A versão traduzida e adaptada da Questão-Chave teve seu conteúdo validado por um Comitê de Juízes especializados na área de uso de álcool e fluentes no idioma inglês. O Índice de Validade de Conteúdo quanto à clareza da sentença e emprego correto de termos técnicos foi 1, para adaptação e preservação do sentido original foi 0.8.O Índice de Kappa para a concordância entre os juízes foi de 0.83. Após ajuste sugerido pelos juízes originou-se a versão final da Questão-Chave. Artigo 2: Realizou-se a validação de critério da Questão-Chave, aplicando-a em 518 usuários de uma Unidade Básica de Saúde na cidade de São Paulo concomitantemente com o AUDIT e AUDIT-C. A Questão-Chave apresentou sensibilidade de 99 % e 54% de especificidade em relação ao AUDIT e 59% de especificidade e 99% de sensibilidade em relação ao AUDIT-C. A acurácia foi de 77% para o AUDIT e 81% para o AUDIT-C. Essas propriedades não sofreram influência de gênero ou de outras características sóciodemográficas. Os resultados indicam que a Questão-Chave está adequada do ponto de vista psicométrico e é tão útil e eficiente para o rastreamento do uso de risco de álcool quanto suas medidas-critério. Artigo 3: Identificou-se o padrão de uso de álcool de usuários de uma Unidade Básica de Saúde na cidade de São Paulo. O AUDIT foi aplicado a 859 usuários conjuntamente com um questionário sociodemográfico. Observou-se que 68.9% dos usuários faziam uso de baixo risco de álcool e 31.1% faziam uso problemático do álcool, dos quais 49.8% uso de risco, 38.7% uso nocivo e 11.5% provável dependência. As características associadas ao uso problemático foram sexo masculino, estado civil divorciado ou separado e quanto mais jovem maior a chance de pontuar acima da Zona I do AUDIT. Conclusão: A Questão-Chave apresentou boa concordância entre os Juízes sobre seu conteúdo e bom desempenho psicométrico atendendo os critérios para testes de instrumentos de rastreamento. Observou-se uma parcela considerável de usuários da Atenção Primária à Saúde que fazem uso de risco de álcool, a qual não pode ser menosprezada pelos profissionais de saúde. Os achados desse estudo subsidiam o emprego da Questão-Chave na Atenção Primária à Saúde para identificação do uso de risco de álcool. / Introduction: The identification of the hazardous alcohol use in Primary Health Care is important to prevent individual harm and social damages. In this context, is essential to use screening instruments that are easy to apply, inexpensive, understandable by lay people and take few time for professional evaluation. In Brazil, there are some instruments available, but none of them include all the mentioned characteristics, which becomes it difficult to use in Primary Health Care. Therefore, it is relevant to provide an instrument for use in this area. Objective: To translate, adapt culturally and validate to Portuguese language the Single-Question original English language. Method: Methodological study whose stages were translation, back translation, cultural adaptation, evaluation by the Judges Committee, pilot study and criteria validation. Results: These are presented in three articles. Article 1: The translated and adapted version of the Key-Question had its contents validated by a Committee of Judges specialized in alcohol use and fluent in the English language. The Content Validity Index for clarity of sentence and correct use of technical terms was 1, for adaptation and preservation of the original meaning was 0.8. The Kappa index for concordance between the judges was 0.83. After adjustment suggested by the judges the final version of the Key-Question was established. Article 2: Achieved Key-Question criteria validation, applying it to 518 users of Health Unit in the city of São Paulo concomitantly with the AUDIT and AUDIT-C. The Key-Question presented sensitivity of 99% and 54% of specificity in relation to AUDIT and 59% of specificity and 99% of sensitivity in relation to AUDIT-C. The accuracy was 77% to the AUDIT and 81% to the AUDIT-C. These properties were not influenced by gender or others sociodemographic characteristics. The results indicate that the Key-Question is psychometrically adequate and is as useful and efficient to screen alcohol hazardous use as its criteria measures. Article 3: Alcohol use patterns among users of a Health Unit in the city of São Paulo was identified. The AUDIT was applied to 859 users with a sociodemographic questionnaire. It was observed that 68.9% of users were low risk and 31.1% had problematic use, of which 49.8% were risk case, 38.7% were harmful case and 11.5% probable dependence. The characteristics associated with the problematic use were male, divorced or separated marital status and younger user had more chance of scoring above Zone I of the AUDIT. Conclusion: The Key-Question presented a good concordance among judges about it content and good psychometric performance, matching the criteria for screening tools. A significant proportion of users of Primary Health Care showed patterns problematic use of alcohol, which cannot be overlooked by health professionals. The findings of this study subsidize the use of the Key-Question in Primary Health Care to identify risk alcohol use.

The aim of this thesis is to map regional variability in the intensity of mortality using methods avoidable mortality and a few selected characteristics of health care. The thesis describes the development of the concept of avoidable mortality, which is then used for the Czech Republic for the period 2006-2010 and to individual districts for the period 2006-2010. Furthermore, this thesis focuses on the relationship between expenditures of General Health Insurance Company and the level of mortality in the regions. For showing regional differences depending on the health care intensity of mortality from ischemic heart disease (both acute and chronic forms) was also selected, depending on the distance of specialized medical care. The last chapter focuses on National screening programs and cancer mortality, which are integrated in a comparison of the percentage of people examine in this program for districts. The relationship between spending per insured and intensity of mortality and outcomes related to the intensity of mortality, depending on the availability of specialized health care has been confirmed by statistical methods - correlation (Pearson correlation coefficient). Relationship between the intensity of mortality in cancer within screening programs and the percentage of people who passed...

Screening programs for cervical cancer are performed to diagnose the early stage of cancer and prevent its development. Historically, the screening test was taken every three years, but it gradually varied due to continuous changes in technology, guidelines, and a new type of test. These changes made the screening participants uncertain and worried about understanding and interpreting the meaning of various test results and frequent follow-ups. These test results are manual and time-consuming to date. The participants seek it as digital, allowing easy and fast access to information. The primary research challenge of the proposed study is to present simple and complex test history data to the participants in an easily understandable way. The proposed research helped to design an artifact (prototype) that can be utilized to develop a digital service that does not cause any uncertain worry for the participants in understanding the complex test history data. For this, the proposed thesis study used state-of-the-art visualization techniques following the guidelines of design science research.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.