To determine the anthropometric indicators of obesity in the prediction of highbody fat in adolescents from a Brazilian State. The study included 1,197 adolescents (15-17 years old). The followinganthropometric measurements were collected: body mass (weight and height), waistcircumference and skinfolds . The anthropometricindicators analyzed were: body mass index (BMI), waist circumference (WC),waist-to-height ratio (WHtR) and conicity index (C-Index). Body fat percentage,estimated by the Slaughter et al equation, was used as the reference method.Descriptive statistics, U Mann-Whitney test, and ROC curve were used for dataanalysis.  Of the four anthropometric indicators studied, BMI, WHtR and WC had the largestareas under the ROC curve in relation to relative high body fat in both genders.The cutoffs for boys and girls, respectively, associated with high body fat wereBMI 22.7 and 20.1kg/m², WHtR 0.43 and 0.41, WC 75.7 and 67.7cm and C-Index 1.12and 1.06. Anthropometric indicators can be used in screening for identification of body fatin adolescents, because they are simple, have low cost and are non-invasive. Overweight has been considered an important public health problem worldwide.Numerous methods have been used to assess body composition.Many anthropometric indicators have been proposed to diagnose the health risks takinginto account the increased body fat.-,Some studies have been conducted with children and adolescents in order to analyze theperformance of anthropometric indicators  in the diagnosis of excess bodyfat.This cross-sectional epidemiological study included schoolchildren aged 15-17 yearsenrolled in public schools  in the Brazilian state of Santa Catarina.The study was approved by the Ethics Committee on Human Research of the FederalUniversity of Santa Catarina (protocol number 372/2006) and University of Western SantaCatarina (protocol number 079/08). 19 The western region of Santa Catarina hasan HDI of 0.807.20 Among the top 20 cities in quality of life in Brazil, fiveare from the western region of Santa Catarina, which has an estimated population of25,322 inhabitants.19To conduct the survey, two regions were considered: 1) a survey was conducted in 2007 inFlorianópolis, capital of the state of Santa Catarina, located in southern Brazil.Florianópolis has a population of approximately 420,000 inhabitants,The sample was calculated separately for each region. The following parameters wereused: prevalence for the outcome of 50% , tolerable error of fivepercentage points, confidence level of 95%, and a delimitation effect of 1.5, adding 10%for possible losses/refusals. Thus, 634 adolescents in each region were evaluated,composing a total sample of 1,268 adolescents. In Florianópolis, the sampling process was determined in two stages: stratified bygeographic region and conglomerate groups. In the first stage, the city was divided intofive geographical regions: center, continent, east, north and south. The school with thelargest number of students from each region was selected, and in each school, classeswere randomly selected to represent a sample representative of the geographic area. Inthe second stage, all adolescents who were present in classroom on the day of datacollection were invited to participate in the study.In the Midwestern region of Santa Catarina, the sampling process was determined in twostages: stratified by public high schools and classes conglomerates. In the first stage,only schools with over 150 students were considered. Moreover, in cities with more thanone teaching unit, we chose the one with the highest number of students. In the secondstage, all adolescents who were present in classroom on the day of data collection wereinvited to participate in the study. For this investigation, we defined as eligible the students enrolled in public stateschools, those present in the classroom on the day of data collection and those aged15-17 years. The exclusion criteria were: (a) students either <15 or >17 yearsold; (b) students who did not bring the Free and Informed Consent Form (FICF) signed byparents and/or guardian; (c) students who refused to participate; (d) students who didnot perform anthropometric measurements. Fieldwork was conducted by Physical Education teachers and students, trained to carryout all the necessary procedures in order to standardize data collection. Schoolstudents were instructed on evaluations at least five days in advance. At that time, theFICF was presented and they were informed about the procedures for the tests. The datacollection team was trained in order to standardize the anthropometric measurements. Thetechnical error of measurement was not calculated, but the researcher responsible forthe survey had extensive experience in anthropometric measurements and routinelyperformed the quality control of the team of evaluators.Anthropometric body mass data - weight and height, waist circumference, triceps skinfoldthickness (TSFT) and medial calf skinfold thickness (MCST) were measured according tostandardized procedures.Body fat was verified by the relative body fat - % BF,The cutoff points used for the classification of body fat were those recommended byLohman,p<0.05. Analyses wereperformed using SPSS  20.0 version andMedCalc.Mean and standard deviation were used in the descriptive analysis of variables. TheKolmogorov-Smirnov test was used to verify data normality. Differences in the averagesof variables between genders were analyzed by the Mann Whitney test. Association betweenanthropometric indicators and gender was assessed by the chi-square test. To evaluatethe diagnostic performance of BMI, WHtR and C-Index in detecting excess body fat, theROC curve analysis was applied. The diagnostic accuracy refers to the ability of BMI,WHtR and C-Index to discriminate adolescents with excess body fat from those withoutexcess body fat. Areas under the ROC curve and confidence intervals were determined. Tobetter determine the optimal critical values of anthropometric indicators with greateraccuracy in the overweight detection, sensitivity and specificity were considered foreach gender. The significance level was set at p<0.05). The study showed a response rate of 94.4% , with 478 male and 719 femaleadolescents aged 15-17 years. The sample characteristics are presented in The values of the area under the ROC curve, cutoff points, sensitivity and specificityare presented  for all p<0,05). The areas under the ROC curve of anthropometric indicators in the prediction of body fatin adolescents can be observed in All anthropometric indicators were able to diagnose excess body fat, as they showed thelowest limit of 95% of the area under the ROC curve up to 0.50. However, BMI, WHtR andWC had greater ability to discriminate body fat in both genders compared to the C-Index.These results show that not only indicators of general obesity (BMI), but alsoindicators of central obesity  can be used in adolescents to diagnose highbody fat.These results were similar to those presented by Brazilian adults in relation to theC-Index, which is an anthropometric indicator with low discriminatory power for healthproblems compared to other anthropometric indicators.10WC and WHtR had enough similarity to discriminate body fat in this study. A studyconducted in southern Brazil also revealed that these anthropometric indicators showedsimilarity to predict blood hypertension..The findings of this study have vital implications for the assessment of obesity amongadolescents, since it reinforces the use of anthropometric indicators of obesity, whichare relatively simple to be evaluated, as a discriminator of body fat. There is no doubtthat the assessment of body composition by skinfold is more accurate than usinganthropometric indicators, as shown by Nooyens et alResearch conducted with Spanish children and adolescents revealed that BMI, tricepsskinfold thickness and WC were good anthropometric indicators in the diagnosis of totalbody fat assessed by the doubly labeled water method.,22,31Moreover, the cutoff point for BMI in this study for females is below those found inliterature to detect overweight. One possible explanation for these discrepancies may berelated to ethnic and cultural differences in Brazilian adolescents that may influenceBMI. The best cutoff point for BMI to detect the emergence of high body fat was 22.7kg/m² forboys and 20.1kg/m² for girls. Usually, the cutoff points for BMI in adolescents varyaccording to gender and age.32 Evidence shows that, among theanthropometric indicators, WC had the best performance in the diagnosis of obesity inchildren and adolescents.,As for WC, it was observed that the best cutoff point to detect the emergence of highbody fat was 75.7cm and 67.7cm for boys and girls, respectively. Fernandez et al,Regarding WHtR, the best cutoff point to detect the emergence of high body fat was0.43cm and 0.41cm for males and females, respectively. Studies conducted withItalianThe best cutoff point for the C-Index was 1.12 for boys and 1.06 for girls. Publicationson the prediction of high body fat through the C-Index were not found, which makes itdifficult to compare the results found in this study. However, cutoff points for theC-Index were developed to detect high blood pressure (boys=1.13 and girls=1.14), highlevels of total cholesterol (boys=1.10) and low levels of HDL-c (girls=1.10).Among the limitations of the study, the use of double indirect measures (skinfold) toestablish the criterion measure of body fat can be highlighted; however, in theassessment of nutritional status and body composition in children and adolescents, suchmeasures are commonly used and recommended by health agencies.According to the findings of this study, it could be concluded that anthropometricindicators can be used in screening to identify high body fat in adolescents for being asimple, inexpensive and non-invasive method. These findings reinforce the possibility ofusing anthropometric indicators as an alternative to evaluate adolescents, throughsimple, replicable and reliable criteria, with high sensitivity and specificity at lowcost, which allows greater range in the scope of monitoring nutritional and healthstatus among adolescents. O excesso de peso tem sido considerado um importante problema de saúde pública emtodo o mundo.Diversos métodos têm sido usados para avaliar a composição corporal.Muitos indicadores antropométricos têm sido propostos para diagnosticar os riscospara a saúde levando em consideração o aumento da gordura corporal.,,  and  and Alguns estudos têm sido feitos em crianças e adolescentes a fim de analisar odesempenho de indicadores antropométricos  no diagnóstico do excesso degordura corporal.Este estudo epidemiológico transversal incluiu escolares de 15-17 anos matriculadosem escolas públicas (estaduais e federais) no estado brasileiro de Santa Catarina. Oestudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos daUniversidade Federal de Santa Catarina (número de protocolo 372/2006) e daUniversidade do Oeste de Santa Catarina (número de protocolo 079/08).Para fazer a pesquisa, duas regiões foram consideradas: 1) uma pesquisa foi feita em2007, em Florianópolis, capital do Estado de Santa Catarina, localizado no sul doBrasil. Florianópolis tem uma população de 420.000 habitantesA amostra foi calculada separadamente para cada região. Foram usados os seguintesparâmetros: prevalência para o desfecho de 50% , errotolerável de cinco pontos percentuais, nível de confiança de 95% e um efeito dedelimitação de 1,5, com a adição de 10% para possíveis perdas/recusas. Assim, foramavaliados 634 adolescentes em cada região, que compuseram uma amostra total de 1.268adolescentes.Em Florianópolis, o processo de amostragem foi feito em duas etapas: estratificadopor regiões geográficas e grupos de conglomerados. Na primeira etapa, a cidade foidividida em cinco regiões geográficas: Centro, Continente, Leste, Norte e Sul. Aescola com o maior número de estudantes de cada região foi selecionada e, em cadaescola, as classes foram escolhidas aleatoriamente para representar uma amostrasignificativa da área geográfica. Na segunda etapa, todos os adolescentes que estavampresentes em sala de aula no dia da coleta de dados foram convidados a participar doestudo.Na Região Centro-Oeste de Santa Catarina, o processo de amostragem foi determinado emduas etapas: estratificado por colégios públicos e conglomerados de classes. Naprimeira etapa, foram consideradas apenas as escolas com mais de 150 alunos. Alémdisso, em cidades com mais de uma unidade de ensino, escolhemos aquela com o maiornúmero de alunos. Na segunda etapa, todos os adolescentes que estavam presentes emsala de aula no dia da coleta de dados foram convidados a participar do estudo.Para essa pesquisa, foram definidos como elegíveis os alunos matriculados em escolaspúblicas estaduais, aqueles presentes na sala de aula no dia da coleta de dados eaqueles entre 15-17 anos. Os critérios de exclusão foram: (a) os alunos com <15 ou>17 anos; (b) os alunos que não trouxeram o Termo de Consentimento Livre eEsclarecido (TCLE) assinado pelos pais e/ou responsável; (c) os alunos que serecusaram a participar; (d) os alunos que não fizeram medidas antropométricas.O trabalho de campo foi feito por professores e alunos de educação física, treinadospara fazer todos os procedimentos necessários, com o objetivo de padronizar a coletade dados. Os estudantes das escolas foram instruídos sobre as avaliações com pelomenos cinco dias de antecedência. Nesse momento, o TCLE foi apresentado e eles foraminformados sobre os procedimentos para os testes. A equipe de coleta de dados foitreinada a fim de padronizar as medidas antropométricas. O erro técnico da medida nãofoi calculado, mas o pesquisador responsável pelo levantamento tinha vastaexperiência em medidas antropométricas e fez o controle de qualidade da equipe deavaliadores rotineiramente.Os dados antropométricos de massa corporal - peso e altura, perímetro da cintura,dobra cutânea tricipital (DCT) e dobra cutânea da panturrilha medial (DCPM) forammedidos de acordo com procedimentos padronizados.A gordura corporal foi verificada pela gordura corporal relativa -%GC,Os pontos de corte usados para a classificação da gordura corporal foram osrecomendados por Lohman,p<0,05. As análisesforam feitas com o programa SPSS  versão20.0 e o MedCalc.A média e o desvio-padrão foram usados na análise descritiva das variáveis. O testede Kolmogorov-Smirnov foi usado para verificar a normalidade dos dados. As diferençasnas médias das variáveis entre os sexos foram analisadas pelo teste de Mann-Whitney.A associação entre os indicadores antropométricos e sexo foi avaliada pelo teste doqui-quadrado. Para avaliar o desempenho diagnóstico do IMC, RCE e IC na detecção deexcesso de gordura corporal, foi aplicada a análise da curva ROC. A precisão dodiagnóstico refere-se à capacidade de IMC, RCE e IC de discriminar os adolescentescom excesso daqueles sem excesso de gordura corporal. Foram determinadas as áreas sobas curvas ROC, bem como os intervalos de confiança. Para melhor determinar os valorescríticos ideais dos indicadores antropométricos com maior acurácia na detecção doexcesso de peso, a sensibilidade e especificidade foram consideradas para cada sexo.O nível de significância foi estabelecido em p<0,05).O estudo mostrou uma taxa de resposta de 94,4% (n=1197), com 478 adolescentes do sexomasculino e 719 do feminino entre 15-17 anos. As características da amostra sãoapresentadas na Os valores da área sob a curva ROC, os pontos de corte, a sensibilidade eespecificidade são apresentados para todp<0,05).As áreas sob a curva ROC dos indicadores antropométricos na predição de gorduracorporal em adolescentes podem ser observadas na Todos os indicadores antropométricos foram capazes de diagnosticar o excesso degordura corporal, uma vez que mostraram o limite mais baixo de 95% da área sob acurva ROC até 0,50. Entretanto, IMC, RCE e PC tiveram maior capacidade de discriminara gordura corporal em ambos os sexos, em comparação com o IC. Esses resultadosmostram que não apenas os indicadores de obesidade generalizada (IMC), mas tambémindicadores de obesidade central , podem ser usados para diagnosticar agordura corporal elevada em adolescentes.Esses resultados foram semelhantes aos apresentados por adultos brasileiros emrelação ao IC, que é um indicador antropométrico com baixo poder discriminatório paraproblemas de saúde em comparação com outros indicadores antropométricos.O PC e a RCE apresentaram similaridade suficiente para discriminar a gordura corporalneste estudo. Um estudo feito no sul do Brasil também revelou que esses indicadoresantropométricos apresentavam similaridade para prever hipertensão arterial..Os resultados deste estudo têm implicações importantes para a avaliação da obesidadeentre os adolescentes, uma vez que reforçam o uso de indicadores antropométricos deobesidade, relativamente simples de serem avaliados, como um discriminador de gorduracorporal. Não há dúvida de que a avaliação da composição corporal por dobras cutâneasé mais precisa do que o uso de indicadores antropométricos, como mostrado por Nooyenset alPesquisa feita com crianças e adolescentes espanhóis revelou que o IMC, a pregacutânea tricipital e o PC foram bons indicadores antropométricos no diagnóstico dagordura corporal total avaliada pelo método da água duplamente marcada.2 para os meninos e 20,1 kg/m2 para asmeninas. Normalmente, os pontos de corte para IMC em adolescentes variam de acordocom sexo e idade. and 2 a 23,6kg/m2 para homens e de 22,8 kg/m2 a 24,8 kg/m2para mulheres. Para a obesidade, o estudo mencionado relatou que no sexo masculino oponto de corte para o IMC variou de 27,5 kg/m2 a 28,7 kg/m2 epara as mulheres de 27,5 kg/m2 a 29,6 kg/m2. No estudo de Coleet al.,2 a 24,5 kg/m2 para o sexo masculino e 23,3kg/m2 a 24,7 kg/m2 para o feminino. Para a obesidade, oponto de corte para o IMC foi de 27,6 kg/m2 a 29,4 kg/m2 paraos homens e o ponto de corte para as mulheres variou de 28,6 kg/m2 a 29,7kg/m2. Observou-se que o ponto de corte do IMC para o sexo masculinoneste estudo está na faixa de sobrepeso de outros estudos. and O melhor ponto de corte de IMC para detectar o aparecimento de gordura corporalelevada foi de 22,7 kg/m and Quanto ao PC, observou-se que o melhor ponto de corte para detectar o aparecimento degordura corporal elevada foi 75,7 cm e 67,7 cm para meninos e meninas,respectivamente. Fernandez et al.,Em relação à RCE, o melhor ponto de corte para detectar o aparecimento de gorduracorporal elevada foi 0,43 cm e 0,41 cm para homens e mulheres, respectivamente.Estudos feitos com adolescentes italianosO melhor ponto de corte para o IC foi de 1,12 para meninos e 1,06 para meninas. Nãoforam encontradas publicações sobre a predição de gordura corporal elevada por meiodo IC, o que torna difícil a comparação com os resultados encontrados neste estudo.No entanto, os pontos de corte para o IC foram desenvolvidos para detectar a pressãoarterial elevada , níveis elevados de colesteroltotal  e baixos níveis de HDL-c .Entre as limitações do estudo, pode-se destacar o uso de medidas indiretas duplas(dobras cutâneas) para estabelecer o critério de medida de gordura corporal; noentanto, na avaliação do estado nutricional e da composição corporal em crianças eadolescentes, tais medidas são comumente usadas e recomendadas por agências desaúde.De acordo com os resultados deste estudo, pode-se concluir que os indicadoresantropométricos podem ser usados na triagem para identificar a gordura corporalelevada em adolescentes por ser um método simples, barato e não invasivo. Essesachados reforçam a possibilidade do uso de indicadores antropométricos como uma opçãopara avaliar adolescentes, por meio de critérios simples, reprodutíveis e confiáveis,com alta sensibilidade e especificidade, a um baixo custo, o que permite maioralcance no âmbito da monitoração do estado nutricional e de saúde entre osadolescentes.


To analyze HIV/AIDS positive individual’s perception and attitudes regarding dental services. One hundred and thirty-four subjects (30.0% of women and 70.0% of men) from Nuevo León, Mexico, took part in the study (2014). They filled out structured, analytical, self-administered, anonymous questionnaires. Besides the sociodemographic variables, the perception regarding public and private dental services and related professionals was evaluated, as well as the perceived stigma associated with HIV/AIDS, through a Likert-type scale. The statistical evaluation included a factorial and a non-hierarchical cluster analysis. Social inequalities were found regarding the search for public and private dental professionals and services. Most subjects reported omitting their HIV serodiagnosis and agreed that dentists must be trained and qualified to treat patients with HIV/AIDS. The factorial analysis revealed two elements: experiences of stigma and discrimination in dental appointments and feelings of concern regarding the attitudes of professionals or their teams concerning patients’ HIV serodiagnosis. The cluster analysis identified three groups: users who have not experienced stigma or discrimination (85.0%); the ones who have not had those experiences, but feel somewhat concerned (12.7%); and the ones who underwent stigma and discrimination and feel concerned (2.3%). We observed a low percentage of stigma and discrimination in dental appointments; however, most HIV/AIDS patients do not reveal their serodiagnosis to dentists out of fear of being rejected. Such fact implies a workplace hazard to dental professionals, but especially to the very own health of HIV/AIDS patients, as dentists will not be able to provide them a proper clinical and pharmaceutical treatment. It is considered a relevant public health care problem worldwide, regardless of antiretroviral therapy advances, which has made of this infection a chronic illness. Life quality and expectancy rates of people living with HIV/AIDS (PLWHA) may be compared to those of the general population.9 Stigmatization is the social process by which such evaluations or labels and the consequent negative emotional and behavioral responses are generated and sustained. Therefore, originating and shaping social exclusion.4Stigma is a degrading social evaluation or label that is attached to people that exhibits socially undesirable characteristics.20Stigma is sustained by a complex set of factors difficult to address. An existing duality is observed between the social rejection and approval of attitudes and behaviors of people with certain characteristics. In addition, factors such as beliefs and the environment in which stigma is developed, impose the intensity of the rejection or the acceptance of individuals in a certain context.19HIV/AIDS related stigma and discrimination have multiple consequences that affect HIV epidemic development and reinforce existing social inequalities, especially those related to gender roles, sexuality, and ethnicity. The stigma PLWHA go by is an obstacle in their access to health care services and their engagement into the “HIV continuum of care”.25 This study intends to analyze HIV/AIDS positive individual’s perception and attitudes towards the received oral health care.Evidence-based scientific research shows PLWHA’s needs in oral health care, due to the high incidence of HIV-related oral problems that diminish their quality of life.One hundred and thirty-four subjects (30.0% of women and 70.0% of men) from Nuevo León, Mexico, took part in the study (2014). They filled out a written or online format questionnaire at the non-governmental and community-based organizations members of Nuevo Leon’s Multisector Response Board to HIV, AIDS, and other sexually-transmitted infections (MEMUREIVH). A non-probabilistic and convenience sample including HIV-positive men and women was adopted.The data collection process lasted 60 days. Prior to the data collection, collaboration was requested to the different non-governmental and community-based organizations members of the MEMUREIVH, to implement the survey in their office location and to their HIV/AIDS positive affiliates. Four properly qualified surveyors visited all sites and applied the written or on-line surveys on the previously agreed dates and time with the aforementioned organizations. There were no cancellations.3 The following topics were covered: sociodemographic characteristics, perception regarding public and private dental professionals and services, and that regarding the received HIV-related oral health care. Perception of HIV-AIDS-related stigma in the dental office was analyzed through a Likert-type scale.15 Following the procedure recommended by Lynn,17 a group of reviewers assessed how well the 11 items evaluated the concepts of stigma and discrimination in terms of their accuracy and relevance for both concepts. Such scale consisted of five alternatives that ranged from “never” to “very often”.An analytical-type structured questionnaire was used  in either written or online formats. Self-administered questionnaires have been shown to be proper methods to collect several data, since they are fully anonymous and, unlike interviews, do not involve a face-to-face confrontation, which could possibly lead to false answers.A digital survey database was created and submitted to a double-quality control to assure reliability of information. The subjects accessed the survey website (www.encuestas.no-ip.org) to answer the online questionnaire. No log-in data  were stored in the electronic access. After survey was completed (average of 25 minutes), and as a benefit to all participants, voluntarily, informed, and consented oral examination and oral prophylaxis were offered free by qualified, certified and sensitized dentists.24 Principal components analysis was used to extract core factors. Prior to the extraction Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s test of sphericity were used to assess the suitability of the respondent data for factor analysis. A Varimax rotation method with Kaiser Normalization were performed to facilitate the interpretation of the factor loadings. A k-means clustering procedure was performed after the factor analysis. Once those clusters had been outlined, each of the factors that were used in their differentiation was proven to be statistically significant by an analysis of variance (ANOVA).An exploratory factor analysis was performed to empirically synthesize the variables concerning the perception of HIV/AIDS-related stigma and discrimination. In this analysis, the inclusion of variables was conditioned by a matrix that validates the presence of marked correlations among all of them and ensures that their application is fitting. Items with no statistical significance were disregarded. The analytical criterion to determine the number of covered factors included the ones whose values were shown to have proper internal consistency index through Cronbach’s alpha.All data were analyzed using SPSS software, version 20.0.The study protocol was approved by the Ethics Committee at the Tecnologico de Monterrey (BIO-ELB-2012-01). Participants signed informed consent forms. The anonymity and confidentiality of written or electronic data were guaranteed.The sample consisted of 134 PLWHA (30.0% of women and 70.0% of men). The mean age of women was 41.7 years . Median time of HIV diagnosis was five years.. The average education level was 8.4 (SD = 4.1) and all female subjects reported being heterosexual. The mean age of male participants was 34.9 years , and their median time of HIV diagnosis was two years. In regards to men’s education levels, the average was 14 years (SD = 3.5), and most of them (88.4%) reported being homosexual .Forty percent of the women included reported working full time, and the remaining ones were unemployed. However, regardless of their job statuses, their monthly incomes exceeded the minimum wage in northeastern Mexico  In the case of men, 81.9% of them reported working full time, whereas 10.6% reported working part-time and the remaining 7.4% were unemployed. Out of the total, 69.2% men earned a monthly income of ≤ 15,000 MXN .Out of all women, 44.7% reported having had dental appointments at least once a year. On the other hand, half of the men reported having them once a year and the remaining half reported having them two times or more a year. .In regards to the modalities of services, 39.5% of women used public dental services and 74.5% of men reported using private ones. Whilst 37.1% of women reported not knowing whether they received a general or specialist oral health care service, 40.4% of the men reported having the general one and 33.0%, the specialist oral health service.The main reasons the women pointed out for choosing a certain dentist were their professional knowledge (32.4%) and good chairside manner (18.9%). Conversely, most men (29.8%) based their choices on the professionals’ length of experience, followed by their knowledge (26.6%).Regarding the women, 72.5% of them reported they considered the dental offices they went to as being neither safe, clean, nor complying with infection control rules required by health care authorities. The perception from most men (91.5%) regarding their elected offices was another one entirely. Besides that, 84.6% of the women and 91.5% of the men considered that dentist have to be specifically trained to deal with PLWHA .In 58.3% of the cases involving women and in 68.1% of cases involving men, dentists were said to be reliable concerning the confidentiality of the information in their dental records. However, only 48.7% of the women and 30.9% of the men reported disclosing their HIV serodiagnosis to dental professionals. Despite PLWHA (61.5% of the women and 78.7% of the men) considered it was important that their dentists were aware of their HIV-positive condition, they did not disclose it, since they (63.5% of women and 68.1% of men) were concerned they would be denied oral health care or that inconveniences would arise during dental appointment . In turn, 65.0% of the women and 70.3% of the men believed they were entitled to keep from disclosing their HIV/AIDS serodiagnosis to their dentists .Most women (54.1%) considered that their dentists do not take professional ethics into account, and that is why they thought they would not receive the same care a non-HIV patient would receive. Such perception regarding the dental professionals ran contrary to the women’s by most men (80.9%).Most PLWHA (66.7% of women and 54.3% of men) do not believe HIV can be transmitted in dental office environments; 85.0% of the women and 83.0% of the men do not believe the dental professionals can transmit the virus to their patients, or vice versa (74.4% of women and 53.2% of men) during appointments. Most PLWHA (77.5% of the women and 79.7% of the men) does not believe they can transmit HIV to other people going to the same office or clinic. The same way, 61.5% of the women and 77.7% of the men do not find it necessary for them to go to specific dental offices or clinics due to their HIV-positive status.In spite of most PLWHA (71.8% of the women and 42.6% of the men) considering they have good oral and dental health, they do not believed (61.5% of the women and 60.7% of the men) they can come down with a secondary infection during or after dental care, due to the fact they are infected with HIV. Nonetheless, they stated (87.5% of the women and 67.0% of the men) that their general state of health could be affected by the lack of dental care if they will suffer from any HIV-related oral manifestations.Most PLWHA (69.4% of the women and 84.0% of the men) reported never had experienced any discrimination from dentists, nor that dental professionals had denied them care due to their HIV-positive status (79.5% of the women and 90.4% of the men). Most subjects (76.9% of the women and 83.0% of the men) were never given excuses to denied their oral health care service, nor did most of them (69.2% of the women and 86.2% of the men) had their oral care purposefully delayed due to their PLWHA condition, as compared to the other patients .Most subjects (81.6% of the women and 83.0% of the men) never felt being the target of whispers, glances, or laughter during their dental appointments. The majority of them (81.6% of the women and 88.2% of the men) have never received negative opinions about their lifestyles or sexual behaviors either, nor have they been belittled by their dentists or by their staff (74.4% of the women and 87.2% of the men).Among the subjects, 78.4% of the women and 89.4% of the men reported that never had noticed that dentists or their staff avoided direct contact with them, neither have most of them (74.4% of the women and 87.2% of the men) noticed fear or insecurity by dental professionals during their appointments. Finally, 76.3% of the women and 88.3% of the men reported never had heard any request to discard materials used in their appointments under the argument that they are highly risky patients due to HIV.24 as none of them were discarded. A Cronbach’s alpha of 0.942 was obtained. The first factor consisted of variables related to stigma and discrimination experiences perceived by participants during dental appointments; the second one, for variables related to participants’ concern towards dentists or their staff attitudes regarding their HIV serodiagnosis. After factor analysis, a non-hierarchical clustering analysis was conducted. The first group included subjects identified as “users who have not experienced HIV-related stigma and discrimination in dental appointments” (85.0%). The second group was characterized by a group of subjects referred to as “users who have not experienced stigma and discrimination, but feel slightly concerned about dentists or their staffs’ reaction if they knew about their HIV-positive status” (12.7%). The third group comprised “users who had experienced stigma and discrimination, and feel concerned about dentists or their staffs’ reaction if they knew about their HIV-positive status” (2.3%)  .16 The women who took part in this study tended to seek general and public dental health care services, whereas male participants in this study, as they were observed to have a higher income, tended to seek for dental private and specialized services.Most PLWHA went to a dental office once or more times a year in search of oral health care, as they recognize that oral diseases affect their overall state of health. The socioeconomic and education-related determinants revealed social inequalities in HIV care.9Even though, men and women agreed that (i) dentists must be qualified to treat PLWHA; (ii) it is important to inform dental professionals about one’s HIV-positive diagnose; and (iii) that dentists are believed to keep their patient’s dental record information confidential. At the end, both men and women decline to disclose their HIV-positive status to dental professionals. Stigma is a social process or personal experience which influences all aspects in one’s life. Thus, the HIV/AIDS diagnose is omitted by people suffering from it, in order to avoid being excluded socially. That is what Goffman calls “concealment”.22 with different population groups affected by HIV/AIDS pandemic, among the main reasons why PLWHA do not disclose their HIV status to dentists are fear of being shunned, inconveniences that may arise in the dentist-patient relationship, and one’s right not to disclose their diagnose.Similar to what was shown globally in other studies14 Nonetheless, the obtained results provide an overview of opinions and problems that PLWHA have undergone concerning their dentists.One of the limitations of this study – typically found in other HIV-related studies – is the fact that it was conducted with a small sample, as most patients do not disclose their HIV-positive status.8 Likewise, such fact jeopardizes the very health of PLWHA, as dental professionals will not be able to provide proper clinical care,13 and might prescribe a drug that could enhance or antagonize with antiretroviral therapy.11Although the results from this study have shown a low percentage of perceived stigma and discrimination in dental appointments, most PLWHA reported (through their answers to the questionnaire) not disclosing their HIV status to dental professionals, whether because of previous experiences of stigma and discrimination these people were submitted to in other situations or due to their social collective identity within a given context. Such omission may lead to workplace hazards for dentists and their staff, not only in the case of HIV transmission (and the provision of post-exposure prophylaxis), but also in the case of infection with other blood-borne pathogens, such as hepatitis B and C viruses.According to the Global Report 2013 of the Joint United Nations Programme on HIV/AIDS, 61.0% of the countries reported the existence of laws against discrimination that protect PLWHA. In Mexico – based on the provisions in the first article of its federal constitution and on the first article, second paragraph, section II of the federal law for preventing and eliminating discrimination – it is illegal to stigmatize and deny rights that are afforded to all other citizens. Consequently, denying oral health care to PLWHA and other patients with infectious diseases is considered to be discrimination, as it violates the Universal Declaration of Human Rights, such as the right to adequate health. Nonetheless, the lack of accessible legal services leads to the frequent neglect of many HIV-related discrimination cases.Both realities  do not ensure that dental professionals or their patients avoid being exposed to HIV and other pathogens, as individuals living with HIV or other infectious diseases may not be aware of being infected. For that reason, dentists and all health care professionals are responsible for and ethically bound to seek training concerning the treatment of HIV and other diseases in its category. They also have to keep up-to-date regarding gender studies, diversity, and human rights, to keep high professional standards and to ensure all patients are provided dignified and egalitarian care. 23 A pesar de esto, la percepción social hacia quienes viven con VIH continua negativa.12 Sus vías de transmisión, sus implicaciones respecto a los mandatos de género más tradicionales y su asociación con el imaginario social a grupos socialmente excluidos causan estigma y discriminación en distintos ámbitos.12La epidemia de VIH entra en su cuarta década. Es considerado un importante problema de salud pública en todo el mundo, independientemente de los avances en la terapia antirretroviral que ha hecho de esta infección una enfermedad crónica. La calidad y la esperanza de vida de las personas que viven con VIH/sida (PVVS) podrían equipararse a la del resto de la población.9 La estigmatización es el proceso social por el cual las evaluaciones o etiquetas degradantes y las consecuentes respuestas emocionales y conductuales negativas se generan y se mantienen, dando origen y forma a la exclusión social.4El estigma es una evaluación o etiqueta social degradante que se adjunta a quienes exhiben características socialmente indeseables.20El estigma se sustenta en un complejo conjunto de factores que no son fáciles de resolver. Hay dualidad entre el rechazo y la aprobación social de las actitudes y los comportamientos de las personas con determinadas características. Además, factores como las creencias y el medio ambiente en donde se desarrolla el estigma precisan la magnitud del rechazo o la aprobación de los individuos en determinado contexto social.19El estigma y la discriminación relacionados con el VIH/sida tienen múltiples consecuencias que afectan al desarrollo de la epidemia y refuerzan las desigualdades sociales existentes, en especial las relacionadas con el género, la sexualidad y la etnia. El estigma que sufren las PVVS es un obstáculo para el acceso a los servicios de salud y al modelo del “Continuo del tratamiento del VIH”.25 El objetivo del presente estudio fue analizar la percepción y las actitudes de las personas que viven con VIH/sida hacia la asistencia odontológica recibida.La investigación científica basada en evidencia muestra la necesidad de las PVVS en recibir atención buco-dental, debido a la alta incidencia de padecimientos orales asociados al VIH que afectan su calidad de vida.on-line, en las organizaciones no gubernamentales y de base comunitaria, pertenecientes a la Mesa Multisectorial de Respuesta al VIH, el sida y otras Infecciones de Transmisión Sexual (ITS) en Nuevo León, México (MEMUREVIH). Se realizó un muestreo no probabilístico, incidental y la muestra estudio la conformaron mujeres y hombres con serodiagnóstico positivo para VIH.En este estudio transversal, participaron 134 PVVS (30.0% mujeres e 70.0% hombres) de Nuevo León, México (2014), los cuales contestaron una encuesta impresa u La recogida de datos ocurrió durante 60 días. Para contactar con las PVVS que frecuentaron alguna de las organizaciones no gubernamentales y de base comunitaria pertenecientes a la MEMUREVIH, se solicitó autorización a los directivos así como su colaboración para aplicar las encuestas en sus oficinas. Cuatro encuestadores debidamente capacitados visitaron todas las organizaciones en día y hora previamente pactados con los directivos de las organizaciones para la aplicación de las encuestas. No hubo pérdidas o rechazos.on-line. El cuestionario auto-administrado ha demostrado ser un medio adecuado para recopilar información diversa, dado que es totalmente anónimo y a diferencia de las entrevistas, no implica una confrontación cara a cara, lo que eventualmente podría conducir a respuestas falsas.3 Los temas explorados fueron: características sociodemográficas, percepción hacia los prestadores y servicios odontológicos públicos y privados, y hacia recibir atención y tratamiento odontológico integral del VIH. Se exploraron la percepción del estigma y discriminación asociados al VIH/sida en la consulta odontológica mediante una escala tipo Likert.15 Siguiendo el procedimiento recomendado por Lynn,17 un grupo de revisores valoró qué tan bien los 11 ítems evaluaban el concepto de estigma y discriminación en términos de la claridad del ítem y de su relevancia para ambos conceptos. Esta escala constaba de cinco alternativas en gradiente desde “nunca” hasta “muy a menudo”.Se utilizó un cuestionario estructurado analítico  con formato impreso u on-line. No se almacenó ningún registro de datos  en el caso del acceso electrónico. Después de la encuesta (duración media de 25 min), se les ofreció como beneficio a las PVVS participantes la realización de una exploración y profilaxis oral de forma voluntaria, informada, consentida y gratuita, realizado por odontólogos capacitados, sensibilizados y certificados.Se creó una base de datos digital de la encuesta, que fue sometida a un doble control de calidad para asegurar la fiabilidad en el ingreso de la información. Los participantes accedían a la página web de la encuesta (www.encuestas.no-ip.org) para responder el cuestionario 24 El método de extracción de los factores fue el de los componentes principales. Se calculó la medida de adecuación muestral de Kaiser, Meyer y Olkin (KMO) y se realizó la prueba de esfericidad de Barlett para comprobar la conveniencia de este análisis. Se realizó una rotación por el método Varimax con Kaiser para facilitar la interpretación de los resultados. Después del análisis factorial, se realizó un análisis de clusters no jerárquico (K-Means Cluster). Una vez delimitados estos grupos o clusters, se comprobó que cada uno de los factores utilizados en la diferenciación de los grupos fuera estadísticamente significativo mediante el análisis de la varianza (ANOVA).Se realizó análisis factorial exploratorio para sintetizar empíricamente las variables relacionadas con la percepción del estigma y discriminación asociados al VIH/sida. En este análisis, la inclusión de las variables fue condicionada por una matriz que convalida la presencia de una notable correlación entre todas las variables y garantiza la idoneidad de la aplicación de un análisis factorial. Ítems sin significación estadística no se incluyeron en el análisis factorial. El criterio analítico para determinar el número de los factores conservados en el análisis fueron aquellos cuyos valores mostraran índices adecuados de consistencia interna mediante la estimación del coeficiente alfa de Cronbach.® versión 20.0.Se analizaron los datos del programa de análisis estadístico SPSSEl estudio fue aprobado por el Comité de Ética del Tecnológico de Monterrey (BIO-ELB-2012-01). Los participantes firmaron consentimiento informado. Se garantizó el anonimato y la confidencialidad de los datos escritos o electrónicos.La muestra estudio la conformaron 134 PVVS (30.0% mujeres y 70.0% hombres). La edad media de las mujeres encuestadas fue de 41.7 años . La mediana de tiempo del diagnóstico del VIH fue cinco años. La edad media de escolarización fue 8.4 años (DE = 4.1) y todas se definieron como heterosexuales. Los hombres encuestados presentaron edad media de 34.9 años , mediana de tiempo del diagnóstico del VIH, dos años. La edad media de escolarización fue 14 (DE = 3.5) y la mayoría (88.3%) se definió como homosexual .El 40.0% de las mujeres contaba con empleo a tiempo completo y el 60.0% no trabajaba. Sin embargo, independientemente de su situación laboral, recibían un ingreso económico mensual superior al salario mínimo, en el noreste de México, de ≤ 15,000 MXN . El 81.9% de los hombres trabajaba a tiempo completo, mientras el 10.6% lo hacía a tiempo parcial y el 7.4% no trabajaba. El 69.2% de los hombres recibía un ingreso económico mensual de ≤ 15,000 MXN .El 44.7% de las mujeres acudió a la consulta odontológica al menos una vez al año. Por otro lado, el 50.0% de los hombres declaró asistir al menos una vez al año y el 50.0% restante asistió dos o más veces al año .El 39.5% de las mujeres acudió a los servicios odontológicos públicos y el 74.5% de los hombres a los servicios privados. El 37.1% de las mujeres desconocía si la atención odontológica que recibía era general o de especialidad. El 40.4% de los hombres recibía atención odontológica general y el 33.0%, especialidad.Las razones principales por la que las mujeres elegían un determinado odontólogo fueron los conocimientos del profesional (32.4%) y el trato amable (18.9%). Por el contrario, la mayoría de los hombres (29.8%) basaba su elección en la experiencia del odontólogo, seguido por los conocimientos de éste (26.6%).El 72.5% de las mujeres consideraba que el consultorio al que acudían no era seguro ni limpio y no contaba con las normas de control de infección requeridas por las instancias de salud pública. La percepción del consultorio o clínica dental al que acudían la mayoría de los hombres (91.5%) era totalmente opuesta. Además, el 84.6% de las mujeres y el 91.5% de los hombres creían que era necesario que el odontólogo estuviese capacitado para brindar atención a las PVVS .El 58.3% de las mujeres y el 68.1% de los hombres creían en la confidencialidad del expediente odontológico, sin embargo, solo el 48.7% de las mujeres y el 30.9% de los hombres le informaban al odontólogo su serodiagnóstico al VIH. A pesar de que las PVVS (61.5% de las mujeres y 78.7% de los hombres) consideraban importante que el profesional estuviese enterado de que viven con VIH, no lo referían, dado que (62.5% de las mujeres y 68.1% de los hombres) les preocupaba que se les negase la atención o que surgieran inconvenientes durante la consulta odontológica (62.5% de las mujeres y 43.6% de los hombres). A su vez, el 65.0% de las mujeres y el 70.3% de los hombres creían estar en su derecho de no revelar su condición de PVVS al odontólogo .La mayoría de las mujeres (54.1%) consideraba que los odontólogos no se rigen por la ética profesional y, por consiguiente, no serían atendidas como cualquier otra usuaria que no viva con VIH. La percepción hacia los odontólogos, por la mayoría de los hombres (80.9%) fue contraria a la de las mujeres.La mayor parte de las PVVS (66.7% de las mujeres y 54.3% de los hombres) no creían que el VIH se pudiese transmitir en el consultorio odontológico. El 85.0% de las mujeres y el 83.0% de los hombres no creía que los odontólogos pudiesen trasmitirles a sus usuarios el VIH, o viceversa (74.4% de las mujeres y 53.2% de los hombres), durante la atención odontológica. La mayoría de las PVVS (77.5% de las mujeres y 79.7% de los hombres) no creían que pudiesen transmitirles el VIH a terceras personas que acudieran al mismo consultorio o clínica odontológica. De la misma forma, el 61.5% de las mujeres y el 77.7% de los hombres no creían que por vivir con VIH debieran atenderse en consultorios o clínicas odontológicas donde únicamente se atiendan a las PVVS.A pesar que la mayoría de las PVVS (71.8% de las mujeres y 42.6% de los hombres) considera tener un buen estado de salud buco-dental, no creían (61.5% de las mujeres y 60.7% de los hombres) que por vivir con VIH pudiesen adquirir una infección secundaria durante o después de la atención en el consultorio o clínica odontológica. Sin embargo, dijeron (87.5% de las mujeres y 67.0% de los hombres) que su estado de salud general resultaría afectado de no recibir atención o tratamiento odontológico al presentarse alguna comorbilidad buco-dental asociada al VIH.La mayoría de las PVVS (69.4% de las mujeres y 84.0% de los hombres) señalaron que nunca han experimentado alguna situación de discriminación por parte de algún odontólogo. Tampoco el odontólogo les ha negado la atención odontológica debido a que viven con VIH (79.5% de las mujeres y 90.4% de los hombres). A la mayoría de los participantes (76.9% de las mujeres y 83.0% de los hombres) nunca le han dado excusas para negarles la atención, ni tampoco a la mayor parte  nunca le han demorado el servicio odontológico por vivir con VIH, con relación al resto de los usuarios .La mayoría (81.6% de las mujeres y 83.0% de los hombres) nunca ha experimentado murmullos, miradas o risas hacia su persona, igualmente a la mayoría (81.6% de las mujeres y 88.2% de los hombres), en la consulta odontológica, nunca se les ha culpabilizado o descalificado por vivir con VIH. La mayor parte (78.9% de las mujeres y 87.2% de los hombres) nunca ha recibido opiniones negativas sobre su vida y comportamientos sexuales ni han recibido un trato despectivo por parte del odontólogo o su personal (74.4% de las mujeres y 87.2% de los hombres).El 78.4% de las mujeres y el 89.4% de los hombres nunca han percibido que el odontólogo o su personal evita el contacto directo, o la mayoría (74.4% de las mujeres y 87.2% de los hombres), nunca ha percibido temor o inseguridad al momento de brindárseles la atención odontológica. El 76.3% de las mujeres y el 88.3% de los hombres nunca han escuchado que se hubiese solicitado desechar el material empleado durante su atención bajo el argumento de alto riesgo debido al VIH.24 por lo que ninguno fue eliminado, obteniéndose el valor del coeficiente alfa de Cronbach de 0.942. El primer factor estuvo compuesto por aquellas variables relacionadas con las experiencias de estigma y discriminación percibidas por los usuarios en la consulta odontológica; y el segundo, por aquellas relacionadas con la preocupación de los usuarios por la actitud del odontólogo o su personal hacia su serodiagnóstico. Tras el análisis factorial, se realizó un análisis de clusters no jerárquico. En el primer grupo, se identificó a los individuos como “usuarios que no han experimentado estigma ni discriminación asociados al VIH en la consulta odontológica” (85.0%). El segundo grupo se caracterizó por el conglomerado de individuos denominados “usuarios que no han experimentado estigma ni discriminación, pero sienten una ligera preocupación hacia la reacción del odontólogo o su personal al enterarse de su serodiagnóstico de VIH” (12.7%). El tercer grupo se caracterizó como “usuarios que han experimentado algún tipo de estigma y discriminación, y sienten preocupación por la reacción del odontólogo o su personal al enterarse de su serodiagnóstico de VIH” (2.3%)  .16 Las mujeres que participaron en el presente estudio se inclinaron hacia los servicios dentales públicos y la atención odontológica de práctica general, mientras que los hombres que viven con VIH, y con mayor ingreso mensual que las mujeres, en este estudio, se inclinaron por los servicios dentales privados y de especialización.La mayor parte de las PVVS visitan una o más veces al año al odontólogo en busca de atención odontológica, pues tienen claro que las enfermedades buco-dentales afectan el estado de su salud general. Los determinantes socioeconómicos y educativos denotaron desigualdades sociales en la atención y tratamiento del VIH.9Pese a que, las mujeres y los hombres concordaron (i) que el odontólogo debe capacitarse en la atención de las PVVS, (ii) que es importante notificar al odontólogo de su serodiagnóstico al VIH y (iii) que existe la confianza en la confidencialidad del expediente odontológico; finalmente, ambos desistieron en notificar al odontólogo su serodiagnóstico al VIH. El estigma es un proceso social o una experiencia personal conexa que influye sobre todos los aspectos sociales del afectado. De esta forma, el diagnostico de VIH/sida es ocultado por la persona que lo padece para tratar de evitar el rechazo social que este le pueda generar; es lo que Goffman llama “encubrimiento”.22 alrededor del globo y con distintos grupos poblaciones afectados por la pandemia del VIH/sida, entre las razones principales por las cuales las PVVS no le informan al odontólogo la infección por el VIH, perpetúan, el temor al rechazo, inconvenientes que puedan surgir en la relación odontólogo-paciente y el derecho a no revelar el serodiagnóstico.Al igual que en otras investigaciones14 Sin embargo, los resultados obtenidos ofrecen un panorama de las opiniones y los problemas que las PVVS han experimentado con los odontólogos.Una de las limitaciones de este estudio, común con otros relacionados con el VIH, es el empleo de una muestra relativamente pequeña, debido a que la mayoría no revela su estado serológico.8 De igual forma, este hecho plantea un riesgo para la propia salud de las PVVS, dado que el odontólogo no podrá proporcionar un tratamiento clínico adecuado13 y pudiere prescribir algún fármaco que potencie o antagonice con la terapia antirretroviral.11Aun cuando los resultados del presente estudio revelaron bajo porcentaje de estigma y discriminación percibidos en la consulta odontológica, no debemos olvidar que la mayoría de las PVVS encuestadas no comunican al odontólogo que viven con VIH, ya sea por las experiencias de estigma y discriminación vividas por las PVVS participantes o por la identidad social colectiva de éstas en su contexto. Lo anterior plantea un riesgo laboral para el odontólogo y el resto del personal que colabora en la clínica o consultorio odontológico, no sólo para el VIH (y la provisión de la profilaxis post-exposición), sino igualmente para otros patógenos transmitidos por vía sanguínea, como los virus de la hepatitis B y C.De acuerdo con el Informe Global 2013 del Programa Conjunto de las Naciones Unidas sobre el VIH/sida, 61.0% de los países informaron de la existencia de leyes contra la discriminación que protegen a las PVVS. En México, con base en lo establecido en el artículo primero constitucional federal y el artículo 1, párrafo segundo, fracción III de la ley federal para prevenir y eliminar la discriminación, se considera un acto contrario a derecho estigmatizar y negar derechos a las PVVS. Por consiguiente, se considera discriminatorio y antiético negar la atención odontológica a las PVVS y a otros usuarios con enfermedades infectocontagiosas puesto que ello vulnera garantías primordiales de los seres humanos como lo es la atención médica eficiente. Sin embargo, con frecuencia, la falta de servicios legales accesibles resulta en que muchos casos de discriminación, relacionados con el VIH, nunca se aborden.Ambas realidades  no garantizan que los odontólogos o sus usuarios eviten la exposición al VIH y a otros patógenos, ya que los individuos que viven con VIH o con alguna otra enfermedad infectocontagiosa pueden no ser conscientes de estar infectados. Por tal motivo, los odontólogos y todos los profesionales de la salud tienen la responsabilidad profesional y ética de capacitarse, sensibilizarse y certificarse en el manejo del VIH y otras enfermedades infectocontagiosas, así como en estudios de género, diversidad y derechos humanos, para mantener altos estándares profesionales y asegurar que todos los usuarios reciban un trato digno y equitativo.


To describe the waiting time for radiotherapy for patients with cervical cancer. This descriptive study was conducted with 342 cervical cancer cases that were referred to primary radiotherapy, in the Baixada Fluminense region, RJ, Southeastern Brazil, from October 1995 to August 2010. The waiting time was calculated using the recommended 60-day deadline as a parameter to obtaining the first cancer treatment and considering the date at which the diagnosis was confirmed, the date of first oncological consultation and date when the radiotherapy began. Median and proportional comparisons were made using the Kruskal Wallis and Chi-square tests. Most of the women (72.2%) began their radiotherapy within 60 days from the diagnostic confirmation date. The median of this total waiting time was 41 days. This median worsened over the time period, going from 11 days (1995-1996) to 64 days (2009-2010). The median interval between the diagnostic confirmation and the first oncological consultation was 33 days, and between the first oncological consultation and the first radiotherapy session was four days. The median waiting time differed significantly (p = 0.003) according to different stages of the tumor, reaching 56 days, 35 days and 30 days for women whose cancers were classified up to IIA; from IIB to IIIB, and IVA-IVB, respectively. Despite most of the women having had access to radiotherapy within the recommended 60 days, the implementation of procedures to define the stage of the tumor and to reestablish clinical conditions took a large part of this time, showing that at least one of these intervals needs to be improved. Even though the waiting times were ideal for all patients, the most advanced cases were quickly treated, which suggests that access to radiotherapy by women with cervical cancer has been reached with equity. Tribunal de Contas da União  in Brazil showed that 65.9% of the demand for radiotherapy, in 2010, was met and that the average waiting time for the beginning the first session of treatment was 113.4 days.Radiotherapy is used to cure and provide palliative treatment for almost all types of cancer. Around 58.0% of all cervical-type cancer cases receive this treatment.The International Agency for Research on Cancer (IARC) estimated 14 million new cases of cancer around the world in 2012.Instituto Nacional de Câncer , between 1999 and 2004.In Brazil, 45.5% of cervical cancer cases diagnosed between 1995 and 2002 were in their advanced stages,Improving access to cancer treatment is a matter of great concern in Brazil, which is evidenced by targeted measures for organizing the network of services and providing greater technological resources. In 2012, a law that regulates an acceptable waiting time of up to 60 days for beginning the treatment of new cases of cancer was passed.The objective of this study was to describe the radiotherapy waiting time for cervical cancer sufferers.Serviço Isolado  – a specialized unit, accredited by SUS, for Radiotherapy and Chemotherapy, in the Baixada Fluminense region.This descriptive study presents data from a cohort of women with cervical cancer, who were identified between October 1995 and August 2010 from anatomical pathology or cervical pathology records at a university hospital in Brazil . The HGNI is integrated into the Brazilian Unified Health System (SUS), and is located in the Baixada Fluminense region, which is within the Metropolitan Region of Rio de Janeiro State, Brazil. This hospital is home to a colposcopy unit which is designed for clarifying and treating lesions, which are the precursor to cancer of the lower genital tract, as well as for diagnosing cervical cancer. After initial diagnosis and care, patients with the invasive cervical disease are forwarded for treatment at specialized public units in the city of Rio de Janeiro or to the The 667 new cases of cervical cancer with no treatment were identified upon diagnosis at the HGNI during the period. 51 of these individuals had died before starting cancer treatment, 109 were selected for primary surgical treatment and 26 did not have sufficient information to allow the following identification. Thus, 481 patients who had been recommended for exclusive radiotherapy were eligible for the study. 128 of these cases with treatment only at oncology units in the capital were excluded, where a much more comprehensive network of establishments enabled by the SUS for radiotherapy exists,The average age of these patients was 51.7 years old . The morphological analysis showed a higher frequency of squamous tumors (90.9%), followed by adenocarcinoma (5.8%), adenosquamous (1.5%) and other types (1.8%). The clinical staging showed that the disease had spread further than the cervical structure in most cases (90.4%).The analyzed information were obtained from the records of patients who had received care at the HGNI and at the Specialized Unit as well as from computer files at the Cancer Hospital Registry at the Specialized Unit. The mortality databaseInterval between the diagnostic confirmation and the beginning of radiotherapy : time (in days) elapsed between registration of the histopathological diagnosis in the patient’s medical chart at the HGNI and the first session of radiotherapy at the Specialized Unit.Interval between the diagnostic confirmation and the first oncological consultation at the Specialized Unit: time (in days) elapsed between registration of the histopathological diagnosis in the patient’s medical chart at the HGNI and the first oncological consultation at the Specialized Unit.Interval between the first oncological consultation at the Specialized Unit and the first radiotherapy session: time (in days) elapsed between the first oncological consultation at the Specialized Unit and the first radiotherapy session.versus > 15 days; ≤ 30 days versus 30 days >; ≤ 60 days versus > 60 days; ≤ 90 days versus > 90 days; ≤ 120 days versus > 120 days.Analyzing the total waiting time was done according to the following categories: ≤ 15 days ≥ 50 years versus < 50 years), clinical staging , established according to criteria set out by the International Federation of Gynecology and Obstetrics (FIGO).The other analyzed variables were: age at diagnosis , median, interquartile range (IQR), absolute and relative frequencies. Nonparametric tests were applied to compare the continuous variables  and categorical variables (Chi-square test), considering a 5% significance level.This study was approved by the Committee of Ethics in Research at the HGNI .All 342 women received treatment by external specialized radiotherapy or combined with complementary therapies, at the Specialized Unit of Radiotherapy and Chemotherapy, which resulted in eight different treatment schemes .Waiting time for radiotherapy, which was evaluated using the median of the interval between the diagnostic confirmation and the first radiotherapy session  over the period (1995 to 2010), was 41 days (IQR: 50 days). The variation was almost six fold, from 11 days in the initial biennium (1995 to 1996) to 64 days in the final biennium (2009 to 2010). The median of the interval between the diagnostic confirmation and the first oncological consultation at the Specialized Unit and between the first oncological consultation and the first radiotherapy session was 33 days (IQR: 50 days) and four days (IQR: seven days), respectively. With the exception of the 1995-1996 biennium, for the interval between the first oncological consultation and beginning radiotherapy, the extension of the averages of the analyzed time components was systematically greater than the extension of the medians, over all the periods. This finding pointed to the presence of extreme values on the right, which represents cases that, despite having had access to radiotherapy, were subject to long delays in some cases .The clinical staging analysis showed that 16.1% of women were in the earlier stages (up to IIA); 78.9% were classified in the intermediate stages (IIB-IIIB) and 5.0% had the disease at more advanced stages (stages IVA-IVB). These conditions were shown to have a statistically significant relationship (p = 0.003) with the total waiting time, with medians of 56 days, 35 days and 30 days for cases classified within groups up to IIA, from IIB to IIIB, and IVA-IVB, respectively.The schematic representation of the different components of the waiting time showed that the increase in the interval between the diagnostic confirmation and the radiation first session was slighter between the biennia 1997 to 1998 and 1999 to 2000, which then deteriorated more sharply from 2001 and 2002. Throughout the period, the interval between the first oncological consultation and beginning radiotherapy remained constant, it did not exceed 10 days .In regards to the total waiting time, the proportion of cases with access to treatment was 30.4%, 43.8%, 72.2%, 88.3% and 94.1% within up to 15 days, 30 days, 60 days, 90 days and up to 120 days, respectively. At the end of the first three biennia, over half of the cases began their radiotherapy within 15 days. This proportion fell from 44.9% (2001 to 2002) to zero (2005 to 2006 and 2009 to 2010) .Access to radiotherapy within 60 days was achieved by a relatively high proportion of women (72.2%), considering the entire period. The proportion reached 90.0% in the first two biennia. However, access to radiotherapy up to 60 days gradually decreased from 2001 to 2002 (87.3%) up to 2009 to 2010, while 39.5% of patients with cervical cancer started radiotherapy, within the aforementioned time limit.Regardless of the cut-off points used for defining the time intervals , the proportion of women with the disease at stages IIB-IIIB and IVA-IVB, who receive radiotherapy more swiftly, was greater than those classified as being in the earlier stages, namely up to IIA.Access to radiotherapy for women younger than 50 years of age was similar for those aged 50 years or more, which was true for all of the analyzed waiting time cutoff points.This study provides unprecedented information regarding the time that women diagnosed with cervical cancer at this university hospital waits before starting radiotherapy at the Specialized Unit. Most (72.2%) of the women with the disease were given access to radiotherapy within 60 days after their diagnostic confirmation, according to information recorded in the patient chart. Despite the median waiting time being 41 days, their component intervals influenced differently the time spent waiting for radiotherapy differently. While the interval between the diagnostic confirmation and the first oncological consultation at the Specialized Isolated Service increased from five to 53 days from the first biennium (1995 to 1996) to the last biennium (2009 to 2010), the interval between the first oncological consultation and effective administration of oncologic treatment remained stable, being less than 10 days throughout the period.Studies on cancer treatment waiting times for are not common around the world, the fact that they differ on the definition for intervals used and types of tumors and therapy administered makes comparing them difficult. One of the few studies on the subject to have been developed in Brazil had the date of the first consultation at the Department of head and neck surgery at the Hospital of Heliopolis, Sao Paulo, SP, Southeastern Brazil, as an initial reference.In Ontario, Canada, the median was of 5.7 weeks from surgery or biopsy to the first radiotherapy session for cervical cancer diagnosed in 2001 and 2002.In the United Kingdom, studies that followed the introduction of the ‘NHS Cancer Plan’Thus, by critically analyzing this situation it is possible to help planning actions designed to shorten waiting times for cancer treatments. These results indicate that the interval between the diagnostic confirmation and the first oncological consultation was the longest before radiotherapy. This interval involves the implementation of measures with varying degrees of complexity that are not only for establishing the stage of the tumor, but mainly for keeping patients alive who arrive in poor medical conditions when diagnosed.The line of care for cervical cancer involves numerous services and depends on the availability of different technologies,Since 2012, the problem of time spent waiting to begin cancer treatment has understandably been given special attention by government authorities in Brazil. Following the passing of the lawAlmost 86.0% of cases in this study were at stages II or III upon diagnosis, which is a higher proportion than what was reported during analysis conducted in the cities of VitoriaThe issue raised in this study was to investigate if the waiting time for treating tumors, referred to potentially curative radiotherapy and for palliative radiotherapy, were be the same. While patients who have an earlier-stage of the disease, classified up to IIA, began treatment with a median of 56 days, those at more advanced stages received treatment with a median of 35 days (IIB to IIIB) or a median of 30 days (IVA-IVB). During a population-based study performed in Poland, which was restricted to patients with breast cancer, found an greater average waiting time to begin treatment in cases of localized disease.This study has some limitations. It was developed with retrospective data, which were recorded with a purpose that was basically administrative and supportive in nature. However, this study carefully collected the data with relentless adherence to the timeframes, which helped minimize the possible inconsistencies. Despite the waiting time for beginning radiotherapy being an important indicator for cancer treatment, this study remained quantitative in nature and did not evaluate the technical conditions for implementing radiotherapy or the comprehensiveness of the programmed regime. The significant number of cases who had only undergone treatment in oncology units in the capital led to the exclusion of more than 1/4 of patients who had been recommended to receive radiotherapy. Although the impact of such a decision is undeniable, the results are in line the purposes of the study and express an indicator for cancer care that is offered in the Baixada Fluminense region, which has a single unit that is enabled by the SUS for radiotherapy. Faced with the current situation that sees there being great interest on the part of governmental authorities regarding cancer, evaluation of implementation of brachytherapy, which was not done here, can bring about important contributions on the approach to cervical cancer, especially if the interval from the end of the external irradiation is duly taken into account.On the other hand, focusing on a single type of cancer and cases for which radiation treatment is exclusively recommended, along with the formation of a homogeneous cohort, made it possible to reach a better interpretation of the results. Defining waiting time is in accordance with the newly enacted legislation, which is more in keeping with the Brazilian situation. The study period covers almost 16 years, which provides a suitable interpretation of the trends of the indicators over this time.The waiting time for radiotherapy increased over this period; this increase came at the expense of the interval between recording the diagnosis on the medical chart and the first consultation at the Specialized Unit. Therefore, efforts directed towards improving the supply of resources used for tumor staging and for the re-establishment of the clinical conditions of the patients can assist in reducing waiting times. Despite actions regarding screening the Brazilian population being at the forefront of the public health sphere, most women are already at the advanced stages when diagnosed. This study showed that treatment for those that needed it most happened more swiftly, which suggests a certain equality regarding access to radiotherapy, even though the waiting time was not ideal for all. A radioterapia contribui para a cura e tratamento paliativo de quase todos os tipos de câncer e cerca de 58,0% dos casos de câncer originados no colo do útero recebem esse tratamento.A Agência Internacional de Pesquisa em Câncer (IARC) estimou a ocorrência de 14 milhões de casos novos de câncer no mundo em 2012.No País, 45,5% dos casos de câncer do colo do útero diagnosticados entre 1995 e 2002 encontravam-se em estádios avançados,Há grande preocupação em melhorar o acesso ao tratamento do câncer no Brasil, com medidas direcionadas para a organização da rede de serviços e maior disponibilização de recursos tecnológicos. Em 2012, foi promulgada a lei que regulamenta a tempestividade aceitável de até 60 dias para se estabelecer o primeiro tratamento de novos casos de câncer.O objetivo do estudo foi descrever o tempo de espera para realização de radioterapia em casos de câncer do colo do útero.Este estudo descritivo apresenta dados de uma coorte de mulheres com câncer do colo do útero, identificadas entre outubro de 1995 e agosto de 2010 nos registros dos setores de anatomia patológica ou patologia cervical de um hospital escola . O HGNI integra a rede do Sistema Único de Saúde (SUS) e está localizado na Baixada Fluminense, parte da Região Metropolitana I do Estado do Rio de Janeiro. O hospital abriga um polo para colposcopia com habilitação para esclarecimento e tratamento de lesões precursoras de câncer do trato genital inferior e para diagnóstico do câncer do colo do útero. Após o diagnóstico e os cuidados iniciais, as pacientes com doença invasora cervical são encaminhadas para tratamento em unidades públicas especializadas da cidade do Rio de Janeiro ou para o Serviço Isolado, credenciado pelo SUS, para Radioterapia e Quimioterapia, na Baixada Fluminense.Foram identificados 667 casos novos de câncer do colo do útero livres de tratamento no momento diagnóstico no HGNI, no período. Entre eles, 51 evoluíram para óbito antes de iniciar o tratamento do câncer, 109 foram eleitos para tratamento cirúrgico primário e para 26 não se dispunha de informações suficientes que permitissem a identificação no seguimento. Assim, 481 pacientes com indicação de radioterapia exclusiva eram elegíveis para o estudo. Destes, foram excluídos 128 casos com tratamento apenas em unidades oncológicas da capital, onde se conta com rede muito mais abrangente de estabelecimentos habilitados pelo SUS para radioterapiaA média de idade das pacientes foi de 51,7 anos . A análise morfológica mostrou maior frequência de tumores do tipo escamoso , seguida de adenocarcinoma , adenoescamoso  e outros tipos . O estadiamento clínico mostrou que grande parte dos casos apresentava extensão de doença para além da estrutura cervical .As informações analisadas foram obtidas dos prontuários de pacientes atendidas no HGNI e no Serviço Isolado, bem como dos arquivos eletrônicos do Registro Hospitalar de Câncer instalado no Serviço Isolado. Também foi consultada a base de óbitos do Sistema de Informação sobre MortalidadeIntervalo entre a confirmação diagnóstica e o início da radioterapia : tempo (em dias) transcorrido entre a data do registro do diagnóstico histopatológico no prontuário da paciente no HGNI e a data da primeira sessão de radioterapia no Serviço Isolado.Intervalo entre a confirmação diagnóstica e a primeira consulta oncológica no Serviço Isolado: tempo (em dias) transcorrido entre a data do registro do diagnóstico histopatológico no prontuário da paciente no HGNI e a data da primeira consulta oncológica no Serviço Isolado.Intervalo entre a primeira consulta oncológica no Serviço Isolado e a primeira sessão de radioterapia: tempo (em dias) transcorrido entre a data da primeira consulta oncológica no Serviço Isolado e a data da primeira sessão de radioterapia.versus > 15 dias; ≤ 30 dias versus > 30 dias; ≤ 60 dias versus > 60 dias; ≤ 90 dias versus > 90 dias; ≤ 120 dias versus > 120 dias.A análise do tempo de espera total foi feita segundo as seguintes categorias: ≤ 15 dias versus < 50 anos), estadiamento clínico , estabelecido segundo critérios da Federação Internacional de Ginecologia e Obstetrícia (FIGO).As demais variáveis analisadas foram: idade ao diagnóstico , mediana, intervalo interquartil (IRQ), frequências absolutas e relativas. Foram aplicados testes não paramétricos para comparar as variáveis contínuas  e variáveis categóricas (teste Qui-quadrado), considerando nível de significância de 5%.O estudo foi aprovado pelo Comitê de Ética em Pesquisa do HGNI .Todas as 342 mulheres receberam tratamento por radioterapia externa isolada ou combinada a terapias complementares, no Serviço Isolado de Radioterapia e Quimioterapia, resultando em oito diferentes esquemas de tratamento .A espera pela radioterapia, avaliada pela mediana do intervalo entre a confirmação diagnóstica e a primeira sessão de radioterapia  ao longo do período (1995 a 2010), foi de 41 dias (IRQ: 50 dias). A variação foi de quase seis vezes, passando de 11 dias no biênio inicial (1995 a 1996) para 64 dias no biênio final (2009 a 2010). A mediana do intervalo entre a confirmação diagnóstica e a primeira consulta oncológica no Serviço Isolado e da primeira consulta oncológica à primeira sessão de radioterapia foi de 33 dias (IRQ: 50 dias) e quatro dias (IRQ: sete dias), respectivamente. Com exceção do biênio 1995-1996, para o intervalo entre a primeira consulta oncológica e o início da radioterapia, a extensão das médias dos componentes de tempo analisados foi sistematicamente maior que a extensão das medianas, ao longo de todos os períodos. Esse achado apontou para a presença de valores extremos à direita, representativos de casos que, embora tenham tido acesso à radioterapia, isso ocorreu, para alguns, de modo muito postergado .A análise do estadiamento clínico mostrou que 16,1% das mulheres encontravam-se em estádios mais precoces (até IIA); 78,9% foram classificadas em estágios intermediários (IIB-IIIB) e 5,0% tinham doença mais avançada (estágios IVA-IVB). Tais condições mostraram relação estatisticamente significativa  com o tempo de espera total, obtendo-se medianas de 56 dias, 35 dias e 30 dias para os casos classificados nos grupos até IIA, de IIB a IIIB, e IVA-IVB, respectivamente.A representação esquemática dos diferentes componentes do tempo de espera mostrou que o aumento do intervalo entre a confirmação diagnóstica e a primeira sessão de radioterapia foi mais discreto entre o biênio 1997 a 1998 e 1999 a 2000, deteriorando mais acentuadamente a partir de 2001 e 2002. Durante todo o período, o intervalo entre a primeira consulta oncológica e o início da radioterapia manteve-se constante, não ultrapassando 10 dias .Em relação ao tempo de espera total, a proporção de casos com acesso ao tratamento foi de 30,4%, 43,8%, 72,2%, 88,3% e 94,1% dentro de até 15 dias, 30 dias, 60 dias, 90 dias e até 120 dias, respectivamente. Até finalizar os três primeiros biênios, mais da metade dos casos iniciaram a radioterapia com até 15 dias. Essa proporção caiu de 44,9% (2001 a 2002) para zero (2005 a 2006 e 2009 a 2010) .O acesso à radioterapia com até 60 dias foi alcançado por proporção relativamente alta de mulheres , considerando todo o período. A proporção atingiu a casa dos 90,0% nos dois primeiros biênios. Entretanto, o acesso à radioterapia até 60 dias veio diminuindo gradativamente de 2001 a 2002  até 2009 a 2010, quando 39,5% das pacientes com câncer do colo do útero tinham iniciado a radioterapia, dentro do referido prazo.Independentemente do ponto de corte definidor dos intervalos , a proporção de mulheres com doença nos estádios IIB-IIIB e IVA-IVB que chegaram mais rápido à radioterapia foi maior do que aquelas classificadas nos estádios mais precoces até IIA.O acesso à radioterapia para mulheres com menos de 50 anos foi semelhante ao daquelas com 50 anos ou mais, em todos os pontos de corte de espera analisados.Este estudo fornece informações inéditas sobre o tempo esperado pelas mulheres diagnosticadas com câncer do colo do útero em hospital de ensino até iniciar a radioterapia em Serviço Isolado. Grande parte  das mulheres com a doença teve acesso à radioterapia dentro do prazo de 60 dias a contar da confirmação diagnóstica, registrada no prontuário. Ainda que a mediana do tempo de espera tenha sido de 41 dias, seus intervalos componentes influenciaram de modo diferente a espera pela radioterapia. Enquanto o intervalo entre a confirmação diagnóstica e a primeira consulta oncológica no serviço isolado aumentou de cinco para 53 dias do biênio inicial (1995 a 1996) para o final (2009 a 2010), o intervalo entre a primeira consulta oncológica e a efetiva administração do tratamento manteve-se estável com menos de 10 dias ao longo de todo o período.Estudos sobre tempo de espera para tratamento de câncer são escassos em todo o mundo e diferem nas definições dos intervalos utilizados e tipos de tumores e de terapêutica administrada, dificultando a comparabilidade. Um dos poucos estudos no tema desenvolvidos no Brasil teve a data da primeira consulta no Departamento de Cirurgia de Cabeça e Pescoço do Hospital de Heliópolis, São Paulo, SP, como referência inicial.Canadian Institute for Health Information estabeleceu como padrão o prazo de 28 dias para o tratamento do câncer por radioterapia.Em Ontário, Canadá, obteve-se mediana de 5,7 semanas da cirurgia ou biópsia até a primeira sessão de radioterapia no câncer do colo do útero diagnosticado em 2001 e 2002.NHS Cancer PlanAddenbrooke’s Hospital, Cambridge, UK, em um grupo de pacientes com câncer do colo do útero. Os autores detectaram aumento da mediana de 14 dias (1996) para 18 dias (1998) e depois para 35 dias (2001). A opção por regimes de radioterapia mais fracionados, de maior complexidade, acompanhado de falta de aceleradores lineares e de equipe treinada pode explicar parcialmente tais achados.No Reino Unido, estudos que sucederam a implantação do Assim, a análise crítica da situação pode ajudar no direcionamento das ações para encurtar o tempo de espera para o tratamento do câncer. Os atuais resultados indicam que o intervalo entre a confirmação diagnóstica e a primeira consulta oncológica consumiu a maior parte do tempo que antecedeu a radioterapia. Esse intervalo comporta a implementação de medidas com diferentes graus de complexidade não só para o estabelecimento do estadiamento do tumor, mas principalmente para a manutenção da vida das pacientes que chegam em condições clínicas precárias no momento do diagnóstico.A linha de cuidado do câncer do colo do útero percorre inúmeros serviços e depende da disponibilidade de diferentes tecnologias,European Cancer Health Indicador Project (EUROCHIP)Desde 2012, o problema do tempo esperado para iniciar o tratamento do câncer tem merecido atenção especial das autoridades governamentais. Depois de sancionada a leiNo presente estudo, quase 86,0% dos casos encontravam-se nos estádios II ou III no momento do diagnóstico, proporção superior à relatada em análises conduzidas na cidade de VitóriaQuestão levantada no presente estudo foi se o tempo de espera para tratamento de tumores, encaminhados para radioterapia potencialmente curativa e para radioterapia paliativa, seria o mesmo. Enquanto as pacientes com doença em estádios mais precoces, classificados em até IIA, iniciaram o tratamento com mediana de 56 dias, aquelas em situações mais avançadas chegaram ao tratamento dentro de 35 dias (tumores IIB até IIIB) ou de 30 dias de mediana (tumores IVA/IVB). Estudo de base populacional desenvolvido na Polônia, restrito a pacientes com câncer de mama, encontrou média de tempo de espera para iniciar o tratamento maior nos casos de doença localizada.Este estudo tem algumas limitações. Foi desenvolvido com dados retrospectivos, registrados com finalidade basicamente assistencial e administrativa. Entretanto, a coleta cuidadosa dos dados com busca incessante aos marcos temporais, aqui utilizados, contribuiu para minimizar as possíveis inconsistências. Embora o tempo de espera para iniciar a radioterapia seja importante indicador para o tratamento do câncer, o estudo se manteve no plano quantitativo e não avaliou as condições técnicas de implementação da radioterapia e a completude do regime programado. O expressivo número de casos com tratamento apenas em unidades oncológicas da capital motivou a exclusão de mais de 1/4 das pacientes com indicação de radioterapia. Ainda que o impacto de tal decisão seja inegável, os resultados alinham-se aos propósitos do estudo e expressam um indicador da atenção oncológica ofertada na Baixada Fluminense, região que conta com um único serviço habilitado pelo SUS para radioterapia. Diante do panorama atual de grande interesse das autoridades governamentais para o câncer, avaliações da implementação da braquiterapia, que não foi feita aqui, poderão trazer importantes contribuições na abordagem do câncer do colo do útero, principalmente se o intervalo contado a partir do término da irradiação externa for devidamente contemplado.Por outro lado, o foco em um tipo único de câncer indicado para tratamento radioterápico exclusivo, com formação de coorte homogênea, permitiu melhor interpretação dos resultados. A definição do tempo de espera está de acordo com a legislação recém promulgada, conferindo maior sintonia com o cenário brasileiro. O período do estudo estendeu-se por quase 16 anos, fornecendo interpretação adequada de tendência dos indicadores ao longo do tempo.O tempo de espera para radioterapia aumentou ao longo do período e o incremento deu-se à custa do intervalo entre o registro do diagnóstico no prontuário e a primeira consulta no Serviço Isolado. Nesse contexto, os esforços direcionados ao suprimento de recursos usados para o estadiamento tumoral e para o restabelecimento das condições clínicas das pacientes podem auxiliar na redução do tempo de espera. Em que pese as ações de rastreamento populacional em voga no Brasil para o âmbito da saúde pública, a maioria das mulheres chega ao diagnóstico em estádio avançado de doença. Este estudo mostrou que o tratamento das que mais dele necessitavam começou mais rápido, sugerindo acesso à radioterapia com equidade, ainda que o tempo de espera não tenha sido o ideal para todas.