Practical Considerations and Challenges for Germline Genetic Testing in Patients With Prostate Cancer: Recommendations From the Germline Genetics Working Group of the PCCTC

Germline genetic testing is now routinely recommended for patients with prostate cancer (PCa) because of expanded guidelines and options for targeted treatments. However, integrating genetic testing into oncology and urology clinical workflows remains a challenge because of the increased number of patients with PCa requiring testing and the limited access to genetics providers. This suggests a critical unmet need for genetic services outside of historical models. This review addresses current guidelines, considerations, and challenges for PCa genetic testing and offers a practical guide for genetic counseling and testing delivery, with solutions to help address potential barriers and challenges for both providers and patients. As genetic and genomic testing become integral to PCa care, developing standardized systems for implementation in the clinic is essential for delivering precision oncology to patients with PCa and realizing the full scope and impact of genetic testing.

Self-learning Courses EaD to qualify clinical practice

Background

Health service evaluation studies point to the low quality of care, however the permanent education of health professionals is a major challenge. Within the scope of the Open University for the Unified Health System (SUS), the Department of Social Medicine of the Federal University of Pelotas produced open access self-learning courses, for primary health care, based on interactive clinical cases, through distance learning.

Methods

The courses, with 45 hours, provides interactive clinical cases, medical calculators and textual materials for use by the professional or with the community. The cases are presented and followed by multiple choice questions, focusing diagnosis and treatment. The feedback is automatic. An expanded theoretical content ('learn more') that privileges the use of illustrations, images, infographics and flowcharts useful for professional practice can be accessed. Bibliographical references on the subject are also available. The courses are available in a responsive web client app, for various types of devices, providing control of progress and automatic certification. The app allows the work offline, enabling the permanent education of professionals working in remote areas.

Results

Six courses were produced for doctors, nurses and dentists, more than 30,000 users were certified.

Conclusions

This problem-based learning initiative allows the student to have a menu of cases, providing a choice of the subject, decision on the time allocated to the activity, repetition according to its need, access to a large bibliography and reading in the quantity and depth chosen by the student. In addition, the format is challenging and develops clinical reasoning. The proposition of questions promotes the reflection of the student in relation to his knowledge on the subject. Automatic feedback, 'learn more' and selected bibliographies provide formative assessment and subsidize students to define their study needs in each subject.

Key messages

Distance learning expands the possibility of qualifying the clinical practice of health professionals, especially those in remote areas. Interactive clinical cases provide the development of clinical reasoning, content review and promote formative assessment.

Availability of family planning supplies in the Brazilian Primary Health Care Units

Background

The availability of contraceptive methods is a main determinant of their use and diversification is necessary to meet the reproductive health needs of women at different stages of life, in a universal and equitable way. The study aims to evaluate the availability of family planning supplies in Primary Care Units (PCU) in Brazil that adhered to the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB) in three evaluation cycles (2012, 2014, 2018), as well as, its distribution according to the Human Development Index (HDI), population size, Family Health Strategy (FHS) coverage and geographic region.

Methods

A descriptive cross-sectional study, of the more than 10.000 UBS included in the external evaluation of the PMAQ-AB. Availability was assessed by the physical presence of the following supplies: ethinyl estradiol + levonorgestrel, norethisterone, norethisterone + estradiol, levonorgestrel, medroxyprogesterone, male and female condom, IUD and rapid pregnancy test. The availability of all supplies at the PCU was considered adequate availability.

Results

The availability of supplies increased in the evaluated period. The lowest availabilities were IUD, 34.4% and rapid pregnancy test, 41.8%; the greatest were male condoms, 96.9%, and ethinyl estradiol + levonorgestrel, 85.2%. In Cycle III, adequate availability was 10.9%. The North had the worst results, followed by the Midwest region. HDI had little effect and population size had no effect on adequate availability, while FHS coverage was associated with greater availability. The PCUs of municipalities with a lower HDI had the largest increases in adequate availability. Adequate availability was greater in the PCUs that participated in all PMAQ-AB cycles.

Conclusions

Policies aimed at strengthening PHC increased the availability of supplies evaluated with equity promotion, however, regional inequities remain. The availability of a rapid pregnancy test and an IUD should be increased.

Key messages

Policies aimed at strengthening PHC, focusing infrastructure, provision and training professionals and quality monitoring increased the availability of family planning supplies with equity promotion. Monitoring the availability family planning supplies is essential for detecting failures, as the low availability of rapid pregnancy test, an essential supply for the early start of prenatal care.

Child labor and health: problems and perspectives

Child labor remains a widespread problem. Although it can have positive effects, in some situations it has negative effects on health and development of the children. Although mainly a problem in developing countries, it is also possible to find child workers, some working in hazardous activities, in developed countries. The authors describe the child labor profiles in developed and developing countries, the principal occupations of children, and their concomitant hazards. They summarize the epidemiologic evidence for a greater impact of some occupational exposures on the health of children as compared with adults, and the theoretical concerns about the impact of child labor on health, and suggest policies that can be used to combat harmful child labor.

[The rural labor process and health in the Southern Brazilian mountains: a descriptive study]

This cross-sectional study among rural workers in the mountainous region of the southernmost Brazilian State of Rio Grande do Sul was designed to identify the characteristics of work performed on family farms. The research focused on the socio-demographic profiles of rural workers, identifying the characteristics of rural labor and describing the prevalence of some disease entities in such populations. Some 1479 rural workers from 495 farms were interviewed. In this sample, 87% of the individuals were members of the farm-owning family, mean age was 41 years, 56% were males, and mean schooling was 5 years. Farms had a mean area of 37 hectares, 50% had at least one type of farm machinery, and fruits constituted the main crop. About 75% of workers handled several types of pesticides, while 12% reported at least one lifetime episode of pesticide poisoning. Prevalence of minor psychiatric disorders was 36%, and annual frequency of occupational injuries was 10%. There was a wide variety of activities and occupational risks. The high prevalence of health problems identified in the study calls attention to the need for measures to promote and protect rural workers' health.

[A cross-sectional study about mental health of farm-workers from Serra Gaucha (Brazil)]

OBJECTIVE

In view of the shortage of population-based rural studies, this research project evaluated the associations between the characteristics of rural work and the occurrence of minor psychiatric disorders (MPD).

METHODS

A cross sectional study was carried out on the 1,282 farm workers of 446 farms. Information about the farms (land extension, agricultural activities, technology and pesticide use) was collected. Demographic and socioeconomic data, characteristics of the work process and mental health indicators were obtained from the workers.

RESULTS

MPD were found in 37.5% of the farm workers. The risk was higher on farms with a land extension of from 26 to 50 hectares, and lower where there was an increased level of job technology and schooling. The prevalence of MPD was higher among bean producers and lower among apple producers. Despite the impossibility of defining the direction of the causal link, pesticide poisoning was strongly associated with MPD.

CONCLUSION

The results call attention to the dimension of the problem and to the importance of adopting new policies for the protection of farm workers' mental health.

[Workers' perception of exposure to workload and risks of accidents in a southern Brazilian city]

OBJECTIVE

The study of the association between workers' perceptions of occupational hazards and the risk of occupational accidents.

DESIGN

Case control study.

POPULATION

The cases were 264 workers who presented a "typical" occupational accident, registered at the National Institute of Social Security in the city of Pelotas, between January and July, 1996. Fatal accidents (two) were excluded, as were those leading to an absence of less than seven days from work. The cases were interviewed in their homes with a standard questionnaire. For each case, three controls were chosen: a fellow-work, a neighbor and a population control. Controls were matched to the cases by age (+/- 5 years) and sex; workers who had suffered an occupational accident in the preceding month were excluded from the control group. All cases and controls were formally employed and lived in the urban area. The data were analyzed using conditional logistic regression.

RESULTS AND CONCLUSIONS

The risk of occupational accidents was found to double among workers who reported having faced emergency situations at work, working in high places, facing constant danger or noisy environments. Working in uncomfortable positions or intense physical activities were associated with a 50% increase in risk. The remaining occupational hazards under study were not significantly associated with the risk of accidents. All of the above results were adjusted for confounding factors.

The Brazilian cohort of pulp and paper workers: the logistic of a cancer mortality study

The International Agency for Research on Cancer (IARC) proposed this international historical cohort study trying to solve the controversy about the increased risk of cancer in the workers of the Pulp and Paper Industry. One of the most important aspects presented by this study in Brazil was the strategies used to overcome the methodological challenges, such as: data access, data accuracy, data availability, multiple data sources, and the large follow-up period. Through multiple strategies it was possible to build a Brazilian cohort of 3,622 workers, to follow them with a 93 percent success rate and to identify in 99 percent of the cases the cause of death. This paper, has evaluated the data access, data accuracy and the effectiveness of the strategies used and the different sources of data.

[Use of outpatient services in an urban area of Southern Brazil: place and frequency]

OBJECTIVE

The objective was determine the use of health services by the adult population in Pelotas, RS, Brazil.

METHODS

A cross-sectional study was made on the basis of a population sample. One thousand six hundred and fifty-seven persons we interviewed during the months of March and June, 1992. A percentage of 9.7 of the sample was lost.

RESULTS

Two dependents variables. One the type of service as determined by type of payment. The other the number of medical visits made during the previous year. The type of service was seen to be associated with the following social variables: social class, level of schooling and place of residence. The frequency of medical visits was associated with sex, risk factors and reasons for the visit.

CONCLUSION

It was concluded that choice of the type of service depends more heavily in social class than other variables associated with the severity of the disease in question.

Medindo o impacto da promoção do aleitamento materno em serviços de atenção primária à saúde em Pelotas, Rio Grande do Sul, Brasil

Através da aplicação de um questionário padronizado a todas as mães que procuraram os serviços de puericultura das unidades sanitárias (US) da Universidade Federal de Pelotas (UFPel), RS, em setembro de 1990, buscou-se conhecer o impacto dos grupos de gestantes na promoção do aleitamento materno. Os resultados obtidos para 347 crianças revelaram que quase metade delas pertencia a famílias com renda inferior a dois salários mínimos mensais; 1/4 de suas mães apresentavam escolaridade inferior a quatro anos, sendo estas as que mais frequentaram os grupos. Apesar da maioria das mães ter feito pré-natal e pouco menos da metade ter participado dos grupos de gestantes, 1/3 das crianças estavam desmamadas aos três meses de idade e cerca de 80% delas haviam recebido chás nos primeiros meses. Os dados obtidos revelam um serviço com sérias deficiências em incentivar o aleitamento e em retardar a introdução de outros alimentos na dieta infantil. Espera-se, a partir dos dados obtidos, poder contribuir para a reestruturação dos programas existentes, bem como poder demonstrar que, a partir de recursos mínimos e de uma metodologia relativamente simples, é possível avaliar a qualidade dos serviços oferecidos à população.

[The worker model and perception of occupational and environmental risks: the optimal use of a descriptive study]

An attempt was made to identify the risks resulting from exposure to the chemicals to which workers are exposed as well as from the poor working conditions to which they are subject in a chemical and pharmaceutical factory. A descriptive study based on the "workers model"--a methodological approach developed in Italy in the 60's, was carried out. Such a study requires direct contact with the workers and has the advantage of overcoming the difficulty of gaining access to their work-place. The activities of the different departments of the plant were reconstructed and the main chemicals used, the main physical complaints, the potential harms and the main environmental risks identified. The report on the harmful working conditions produced was used by the workers as a means of pressing the authorities into carrying out an inspection of the plant concerned to verify its accuracy. The report's findings have been confirmed and demonstrate the usefulness of the methodological approach adopted. The workers' publicizing of the study's findings through the means of mass communication have helped to build up greater public awareness of the occupational and environmental risks of that particular industrial activity.

[Operationalization of the concept of social class in epidemiologic studies]

Procura-se demonstrar que é possível operacionalizar o conceito de classe social de forma a utilizá-lo em estudos epidemiológicos. Foi adaptado às características da formação social de Pelotas, RS (Brasil), modelo de classificação desenvolvido para o México e comparado com o desenvolvido para Ribeirão Preto, SP (Brasil). Mediu-se o poder discriminatório das duas classificações em termos do processo saúde-doença, tendo como variável dependente o crescimento de 5.384 crianças nascidas em 1982. As duas classificações estão associadas com diferenças significativas (P<0,001) no crescimento infantil, mas o modelo do México mostra melhor poder discriminatório do que a classificação de Ribeirão Preto. Quando ambas foram incluídas em uma análise multivariada do peso e da altura das crianças, o efeito do modelo do México foi altamente significativo (P<0,001), ao contrário do efeito da classificação, modelo Ribeirão Preto.

Drug usage in southern Brazilian hospitals

A drug usage survey was carried out in 14 hospitals in the southernmost region of Brazil in the year 1979. The average number of drugs prescribed per patient was 8.6, and antimicrobials, followed by analgesics, vitamins and sedatives-tranquilizers were the most often employed drug categories. Among the antimicrobials, ampicillin was the first, followed by chloramphenicol, but the overall leading drug was an analgesic-antipyretic, dipyrone. Some possible distortions in drug usage are discussed.