Changes in childhood stroke mortality from 1990 to 2019 in Brazil and its federative units

This research analyzed the temporal trend of stroke mortality in children aged 0-14 years, from 1990 to 2019, in Brazil and its federative units. This ecological study used data from the Global Burden of Disease, a study led by the Institute for Health Metrics and Evaluation. Stroke definition considered the International Classification of Diseases according to codes G45, G46, and I60-I69. Age-standardized mortality rates and the mean annual percentage change (APC) in mortality rates were estimated. Stroke mortality trends decreased, with an APC of - 3.9% (95% CI - 4.5; - 3.3; p < 0.001). Reducing trends were found in all but two states, where they were stationary. Maranhão (- 6.5%; 95% CI - 7.6; - 5.4; p < 0.001) had the greatest reduction and Rondônia, the smallest (- 1.2%; 95% CI - 2.3; - 0.1, p = 0.027). Decrease was more important in children < 5 (- 5.8%; 95% CI - 6.3; - 5.2; p < 0.001) compared to 5-14 years old (- 2.1%; 95% CI - 2.9; - 1.3; p < 0.001); additionally, it was greater in girls (- 4.1%; 95% CI - 4.6; - 3.5; p < 0.001) than in boys (- 3.8%; 95% IC - 4.5; - 3.1; p < 0.001). Ischemic stroke had the highest APC (- 6.1%; 95% CI - 6.8; - 5.3; p < 0.001), followed by intracranial hemorrhage (- 5.3%; 95% CI - 6.1; - 4.5; p < 0.001) and subarachnoid hemorrhage (- 2.7%; 95% CI - 3.3; - 2.1; p < 0.001). Largest reductions were seen in states with more vulnerable socioeconomic contexts. The stationary trends and lowest APCs were concentrated in the northern region, which had greater impact of diseases and less favorable outcomes.

Analyzing households' food insecurity during the COVID-19 pandemic and the role of public policies to mitigate it: evidence from Ceará, Brazil

OBJECTIVE

To evaluate the association of conditional cash transfer policies to mitigate the food insecurity (FI) among families living in poverty during the COVID-19 pandemic in Ceará, Brazil.

METHODS

An analytical cross-sectional study was carried out through telephone contact during the period of May-July 2021, during the second wave of the COVID-19 pandemic in Ceará. Families in a situation of high social and economic vulnerability participated in this study (monthly per capita income of less than US$16.50). FI was assessed using the EBIA, a Brazilian validated questionnaire. The participation of families in government programs and public policies was also investigated. Logistic regression models were used to assess the association of the several factors assessed with food insecurity.

RESULTS

The prevalence of any food insecurity in this sample was 89.1% (95% Confidence interval (95% CI: 86.2 - 92.1) and of severe food insecurity, 30.3% (95% CI: 26.0 - 34.6). The Mais Infância card program, adopted as a cash transfer supplement in the state of Ceará, was significantly associated with food insecurity (OR 4.2 (95% CI: 1.7 - 10.2), with a p-value of 0.002. In addition, families affected by job losses due to the COVID-19 pandemic presented higher odds of FI.

CONCLUSIONS

In this study, 89% of evaluated families presented food insecurity. Conditional cash transfer programs were associated with FI. We highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on food insecurity. Such policies can adopt appropriate criteria for defining the participants, as well as connect the participants to an appropriate set of broader social protection measures.

Time trends and projected obesity epidemic in Brazilian adults between 2006 and 2030

We examined time trends and projected obesity epidemic in Brazilian adults between 2006 and 2030 by sex, race/skin color, educational attainment, and state capitals. Self-reported body weight and height of 730,309 adults (≥ 18 years) from the Vigitel study were collected by telephone interview between 2006 and 2019. A multinomial logistic regression model was used to predict the prevalence of body mass index (BMI) categories as a function of time by 2030. The prevalence of obesity increased from 11.8% in 2006 to 20.3% in 2019. The projected prevalences by 2030 are estimated to be 68.1% for overweight, 29.6% for obesity, and 9.3% for obesity classes II and III. Women, black and other minority ethnicities, middle-aged adults, adults with ≤ 7 years of education, and in Northern and Midwestern capitals are estimated to have higher obesity prevalence by 2030. Our findings indicate a sustained increase in the obesity epidemic in all sociodemographic subgroups and across the country. Obesity may reach three out of 10 adults by 2030.

Ovarian cancer mortality: implications of income-inequality and availability of medical doctors in Brazil

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Background: Ovarian cancer mortality varies by region and age group in Brazil. However, it is still unknown if socioeconomic inequalities may affect its outcome even if indirectly as it happens for other gynecologic neoplasms in the country. Methods: Ecological study conducted with secondary data from 2016-2018 to examine the relationship between income-inequality and the amount of doctors per inhabitant on ovarian cancer mortality in Brazil. All data were gathered from Brazil’s public health system. Mortality was analyzed by sex and age, which was standardized according to the World Health Organization’s population. Income-Inequality was measured using the Gini index, obtained from the United Nations Development Programme. The number of doctors was obtained from the Unified Health System and was also calculated as the rate per 100,000 inhabitants. Linear regression was performed using stepwise selection/backward elimination. Results: Despite income inequality as measured by the Gini index not having any statistically significant relationship with ovarian cancer mortality rates, we found that the amount of doctors per inhabitant was positively associated with ovarian cancer mortality rates (β 0.037, IC95% 0.028;0.045), whereas the amount of clinical oncologists (β-0.426, IC95% -0.805; -0.047) and higher income (β -0.004, IC95% -0.005; -0.003) were all negatively associated with those rates (p < 0.05), meaning that the higher those variables, the lower the mortality. Conclusions: Ovarian cancer mortality differs among federative units in Brazil. Higher mortality is associated with a greater amount of doctors per inhabitant, whereas lower mortality rates were found to be associated with higher income and more clinical oncologists available.

Colorectal cancer mortality rates and socioeconomic factors in Brazil: Association with income inequality and availability of medical doctors

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Background: Colorectal cancer mortality is expected to rise in the upcoming years in Brazil, especially in less developed regions. It is also known that socioeconomic factors play a role not only in the development, but also in the outcome of this disease. Methods: Ecological study that analyzed secondary data from 2016-2018 to examine the relationship between both income-inequality and the amount of doctors per inhabitant on colorectal cancer mortality in Brazil and its Federative Units. All data were gathered from Brazil’s public health system. Mortality was standardized by the World Health Organization’s population and analyzed by sex and age. Income-Inequality was measured using the Gini index, obtained from the United Nations Development Programme. The number of doctors was obtained from the Unified Health System and also calculated as the rate per 100,000 inhabitants. For this study, linear regression was performed using stepwise selection/backward elimination. Results: In the present study, we found that female sex (β -0.616, IC95% -1.308;0.075), the number of gastroenterologists (β -2.506, IC95% -3.702;-1.309), clinicians (β -0.107, IC95% -0.155; -0.0600), and the number of general surgeons (β -0.845, IC95% -1.188; -0.501) were negatively associated with colorectal cancer mortality, whereas higher income (β 0.02, IC95% 0.001;0.003), the amount of doctors in the public health system as a whole (β 0.090, IC95% 0.064;0.116), generalists (β 1.760, IC95% 0.987; 2.533) and oncology surgeons (β 14.252, IC95% 3.937; 24.566), were positively associated with cancer mortality. Conclusions: Colorectal cancer presents different mortality rates depending on sex, socioeconomic status and availability of medical doctors and specialists, whether for diagnosis and higher notifications or treatment and lesser deaths form the disease.

Temporal Trend of the Prevalence of Modifiable Risk Factors of Stroke: An Ecological Study of Brazilians between 2006 and 2012

Stroke is one of the leading causes of death worldwide, including in Brazil. This study aimed to analyze the temporal trend of the prevalence of modifiable risk factors of stroke from 2006 to 2012. This ecological study was conducted by secondary analysis in May 2018, using data from the surveillance of risk factors and protection for chronic diseases by telephone inquiry (VIGITEL) available in the Department of Informatics of the Unified Health System (DATASUS). The modifiable risk factors of stroke in Brazilians were systemic arterial hypertension, diabetes mellitus, abusive alcohol consumption, overweight, and obesity. Overall, there was a significant increase in the risk factors of diabetes (β = 0.30, P = 0.001, r2 = 0.99), overweight (β = 0.50, P = 0.002, r2 = 0.98), and obesity (β = 0.88, P < 0.001, r2 = 0.96). However, there was a stability in the prevalence of hypertension (β = 0.25, P = 0.320, r2 = 0.88) and alcohol abuse (β = 0.32, P = 0.116, r2 = 0.49). There was an increase in the prevalence of diabetes mellitus, overweight, and obesity, but stability in systemic arterial hypertension and abusive alcohol consumption in the Brazilian population.

Physical inactivity level and lipid profile in traditional communities in the Legal Amazon: a cross-sectional study : Physical inactivity level in the Legal Amazon

BACKGROUND

The practice of regular physical activity can alter the lipid profile in populations according to diverse demographic characteristics.

OBJECTIVE

To evaluate the association of physical inactivity with the lipid profile among vulnerable populations.

METHODS

A cross-sectional study was conducted among 349 vulnerable individuals from Tocantins state, northern Brazil. The International Physical Activity Questionnaire 7 Day short form was used to measure self-reported physical activity levels. Venous blood samples were drawn to evaluate lipid profile. Logistic regression adjusted by the socioeconomic variables was used to analyse the effects of physical inactivity on the lipidic profile. The level of significance was 5% and Stata® (StataCorp, LC) version 11 was used.

RESULTS

We observe an inverse relationship between physical inactivity and HDL-C-that is, those who were sedentary or below the WHO Recommendations for physical activity were at 2.6 greater odds (IC95% 1.21, 5.67; p = 0.015) of having a lower HDL compared with those meeting or exceeding WHO physical activity recommendations.

CONCLUSION

On the vulnerable populations studied, the insufficiently active or sedentary individuals (called the physical inactivity individuals) have more risk of the altered HDL-C.

Stroke Hospital Admissions during the COVID-19 Outbreak in São Paulo, Brazil

Background

Globally, stroke remains an important cause of death and long-term disability, and the impact of coronavirus disease (COVID-19) on the health system may have impaired stroke care. Previous studies suggest significant reduction in hospital admissions for stroke after COVID-19 onset as patients may hesitate seeking medical help due to fear of exposure.

Methods

This cross-sectional study included cases of hospital admissions for stroke, identified from the Hospital Information System of the Unified Health System (Sistema Único de Saúde), which contains official and public data in Brazil. Data were collected in duplicate, then categorized according to the International Classification of Diseases, tenth revision (ICD-10), considering codes I60–I69. Linear regression was used to estimate the variation in hospital admissions for stroke in the city of São Paulo (SP) − the largest and most populous city in Brazil and Latin America, between January and June of each analyzed year (2017–2020). The percentage variation between June and January 2020 was also compared. The level of significance was set at 5%, and the statistical program used was Stata, version 14.0.

Results

In the city of SP, during the first wave of COVID-19, from January to June 2020, there were registered decreases in absolute numbers and mean monthly admissions for stroke. Compared to January 2020, data from June 2020 showed 17% reduction in hospitalizations for intracerebral hemorrhage, 32% for cerebral infarction, 26% for stroke unspecified, and 47% for other cerebrovascular diseases.

Conclusion

We argue for policies aimed at improving stroke care and developing awareness campaigns regarding the importance of early diagnosis and treatment, as even in less severe presentations, stroke can trigger an increase in mortality, cost, and long-term disability.

Expression of DNA repair genes in association with ionizing radiation

BACKGROUND AND AIM

DNA repair systems are functionally essential for the maintenance of life and among these, we can highlight the MutS system, subdivided into MutSα (hMSH2 and hMSH6) and MutSβ (hMSH2 and hMSH3). The objective of this study was to analyze the expression of hMSH2 and hMSH6 repair genes in radiology technicians exposed to low radiation doses.

METHODS

Thirty workers occupationally exposed to ionizing radiation and twenty-five non-exposed were included in this study. Gene expression was analyzed by qPCR. Peripheral blood samples were collected from both groups for total RNA isolation.

RESULTS

It was observed a five-fold increase (p=0.006) in the hMSH2 repair gene expression in those exposed to radiation and a weak but significant correlation (p=0.041) with the hMSH6 genes when we associated the number of hours of exposure with gene expression.

CONCLUSIONS

The longer the exposure time, the greater the activation of this component of the repair system.

APPLICATION TO PRACTICE

Blood count parameters could did not alter with radiation exposure. X-rays used by radiology technicians in imaging tests can damage the DNA to the point of activating the MutS repair system and that there is a greater tendency of expression of this system in professionals that had undergone longer exposure.

Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017

This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais-Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother's age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00-P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20-P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.

Assessment of the median ages at sexual maturation stages of Brazilian schoolchildren according to overweight status and type of school over a 5-year period: 2007-2012/2013

OBJECTIVES

A secular trend of earlier puberty has been observed in girls, and, although more uncertain in boys, is associated with an increasing trend in the prevalence of overweight and obesity. We aimed to compare the median ages of sexual maturation stages in schoolchildren from a city in southern Brazil over a 5-year period, according to weight status and type of school.

METHODS

Two cross-sectional studies were performed in 2007 and 2012/2013, including 2215 and 1614 schoolchildren, respectively. Body mass index z-scores were calculated and categorized as either nonoverweight or overweight (including obesity). The type of school was categorized as either public or private. Sexual maturation was self-assessed according to the Tanner stages. Mann-Whitney and Kruskal-Wallis tests were performed to compare the median ages of sexual maturation stages.

RESULTS

The median age decreased for almost all stages over the 5-year period in both sexes. In boys, the decrease ranged from 0.3 to 1.0 years (stages 2, 3, 4, and 5 for genitalia, and stages 2 and 4 for pubic hair), and from 0.3 to 0.7 years (stages 2, 3, and 4 for breast, and stages 3, 4, and 5 for pubic hair). In 2012, overweight students had lower median ages for most stages compared to those in 2007, especially in girls. Differences by type of school were balanced across years.

CONCLUSIONS

The median age of Tanner's stages after 5 years was reduced in both sexes. In overweight girls, the reduction was more pronounced. The results by type of school were inconsistent.

Noncoding RNAs and Colorectal Cancer: A General Overview

Colorectal cancer (CRC) is the second most prevalent cancer in the world in which nonmelanoma skin cases are not considered. Different epigenetic mechanisms play a role in the development of cancer. Noncoding RNAs (ncRNAs) are RNA molecules transcribed from noncoding regions of the genome. These are divided into sncRNAs (small noncoding RNAs: <200 nucleotides - including miRNAs [microRNAs], siRNAs [small interfering RNAs], piRNAs [piwi-interacting RNAs], snoRNAs [small nucleolar RNAs]) and lncRNAs (long noncoding RNAs: >200 nucleotides - includingcircular RNAs [circRNAs]). NcRNAs can act as oncogenes or as tumor suppressor genes in CRC and are potential biomarkers of diagnosis, with possible clinical implications. This article aims to conduct a general review of all types of non-coding RNAs and their influence in colorectal cancer, focus on biomarkers of CRC and their possible applications in clinical practice, as well as review their biogenesis and functions. Furthermore, we seek to summarize possible databases available for new searches and studies that require sequence annotation, comparison sequences and target prediction for ncRNAs with the hope of gathering information that can aid in the process of understanding and translating the use of ncRNAs into clinical practice.

Income-inequality and rate of doctors per inhabitant and their influence on esophageal cancer mortality in Brazil

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Background: There are substantial disparities in esophageal cancer mortality across different social groups, including sex, race/ethnicity, geographical location and socio-economic status. Methods: This is an ecological study with secondary data from 2016 to 2018 that evaluated the effects of income-inequality and number of doctors per inhabitant on esophageal cancer mortality in Brazil and its Federative Units. The amount of deaths and the overall number of doctors were obtained from the Department of Informatics of the Unified Health System. Mortality was estimated per 100,000 individuals and age-standardized through the World Health Organization’s population, whereas the rate of doctor per inhabitant was calculated per 1,000 inhabitants. Income-Inequality was measured by the Gini index, obtained from the United Nations Development Programme. Linear regression was performed by the stepwise backward method. Results: Sex, Gini index values and oncology surgeons were all related to lower mortality rates (p < 0.05), whereas clinical oncologists and general surgeons were both associated with higher mortality (p < 0.05). Conclusions: Esophageal cancer mortality rates were influenced by both the type and amount of doctors per inhabitant of any given administrative region in Brazil, however there was no association found with regards to income inequality.[Table: see text]

Impact of COVID-19 pandemic in hospitalizations due to brain tumors from the epicenter of Latin America

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Background: The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. In Brazil, the disease had its first case in the city of São Paulo, thus being the starting point and epicenter of this disease in Latin America. Neurological features are currently well recognized in COVID-19 indicating the neurotropic nature of the virus and include anosmia, myalgia, myositis, encephalitis, meningitis, cerebrovascular disease, Guillain–Barré syndrome, and post-infectious myelitis. CNS tumors though relatively rare (> 2% of all cancers) are a relevant source of cancer-related morbi-mortality worldwide. Although studies have reported higher COVID-19 severity in cancer patients, the consequences of the pandemic on health care for CNS tumors remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the hospital admissions (HA) due to CNS tumors in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to CNS tumors in the city of São Paulo comparing the outbreak period (January-June 2020) and a pre-pandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD-10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to CNS tumors was observed during the outbreak period (January-June 2020). Benign neoplasm of brain and other parts of CNS (-2, CI -2 to -1) and malignant neoplasm of brain (-5, CI -7 to -3) showed to be remarkably affected (see table). To our knowledge, this is the first scientific report of significant reduction of HAs due to CNS tumors during COVID-19 era. Conclusions: Our findings seem to be associated to delayed oncological diagnose and care to CNS tumor patients during the lockdown and health system collapse. A rebound help-seeking effect as well as more severe complications may present in the post‐pandemic. Further studies are needed to evaluate the impact of the ongoing pandemic in CNS neoplasms in order to strategically corroborate public health actions for short- and long-term implications of COVID-19 pandemic. [Table: see text]

Reduction in prostate cancer hospitalizations in the COVID-19 pandemic epicenter of Latin America

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Background: The novel SARS-CoV-2 coronavirus disease 2019 (COVID-19) has disrupted health care systems worldwide since December 2019 causing atypical pneumonia and affecting multiple body organs. In Latin America, COVID-19 had its first case in the megacity of São Paulo, Brazil, thus being the starting point and epicenter of this disease. In this context, prostate cancer (PC) is the most common non-skin cancer among men and its preventive healthcare is substantial to public health surveillance. Additionally, PC raises particular interest during COVID-19 outbreak as PC androgen-deprivation therapies have shown to mitigate SARS-CoV-2 infection, which suggests an association between SARS-CoV-2 and PC cells. Thus, the consequences of the COVID-19 outbreak on male genital cancers care remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the incidence of hospital admissions (HA) due to malignant neoplasms of male genital organs in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to malignant neoplasms of male genital organs in the city of São Paulo comparing the outbreak period (January-June 2020) and a pre-pandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD-10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to malignant neoplasms of male genital organs was observed in PC, but not other malignant neoplasms of male genital organs during the outbreak period (January-June 2020). PC (-19, CI -36 to -1) showed to be remarkably affected while other male genital cancers (-1, CI -5 to 3) did not (Table). Conclusions: Our findings seem to be associated to delayed oncological care delivery to PC during the lockdown and health system disruption. Further studies are required to evaluate the impact of the ongoing pandemic in malignant neoplasm of male genital organs, particularly PC, in order to strategically corroborate public health actions for implications of COVID-19 pandemic. Linear regression of hospital admissions for the years 2017-2020 (January until June) due to malignant neoplasms of male genital organs (chapter II of the ICD-10). Municipality of São Paulo, São Paulo, Brazil.[Table: see text]

Hospital Admissions Associated With Noncommunicable Diseases During the COVID-19 Outbreak in Brazil

This cross-sectional study uses data from the Brazilian Unified Health System to compare the number of hospital admissions for treatment of noncommunicable diseases from January to June 2020 with that during the corresponding period in each of the previous 3 years in São Paulo, Brazil.

Collision of Fundamental Human Rights and the Right to Health Access During the Novel Coronavirus Pandemic

Introduction: COVID-19 requires governmental measures to protect healthcare system access for people. In this process, the collision of fundamental rights emerges as a crucial challenge for decision-making.

Policy Options and Implications: This policy review analyzes selected articles by the PubMed searcher about extreme measures taken in several countries during precedent pandemics and the current pandemic, and selects hard decisions relating to the exceptional measures taken by judicial departments in Brazil, connecting them to the “collision of fundamental rights and law principles.” The collision of rights and principles imposed on decision makers a duty to provide balanced rights, and to adopt the enforcement of some rights prioritization. Ethical concerns were also verified in this field involving rights limitations. During a pandemic, the importance of extreme measures to protect health rights and healthcare systems is instrumental for focused, fast, and correct decision making to avoid loss of life and the collapse of healthcare systems. The main goals of this research are to discuss the implications and guidelines for public health decision making, the indispensable ethical and legal aspects for safeguarding health systems and the lives of people, and the respect of the Justice principle and of fundamental health and dignity rights. We conclude that COVID-19 justifies the prioritization of collective and individual health access rights. Acceptable standards of fundamental rights restrictions are established at the constitutional and international levels and must be enforced by rules and governmental action, to ensure fast and accurate decision making during a pandemic. Freedom rights exercises must be linked to solidarity for the realization of social welfare, for the health rights of all individuals and for health systems to function well during a pandemic.

Actionable Recommendations: All individuals are free and equal, therefore social exclusion is prohibited. Institutions must consider social inequalities when discussing public health measures and be guided by ethical standards, by law principles, and rules recognized by constitutional and international law for the benefit of all during a health pandemic.

Conclusions: Collective and individual health rights prevail over the collision of rights when facing pandemic occurrences, case by case, in health systems protection, based on the literature, on precedent pandemics and on legitimate Public Health efforts.

Prevalência e fator associado à fragilidade em idosos brasileiros atendidos nas Unidades Básicas de Saúde: um estudo transversal

Introdução: A fragilidade é uma síndrome multidimensional que aumenta a vulnerabilidade em idosos, causando diminuição das reservas fisiológicas, aumento do declínio funcional e está associada a inúmeras alterações físicas, determinando maiores riscos à saúde do idoso. Objetivo: Analisar a associação entre fragilidade e condições sociodemográficas de idosos atendidos em Unidades Básicas de Saúde da cidade de Cajazeiras, nordeste do Brasil. Métodos: Estudo transversal, realizado em julho de 2015, com 823 idosos, por meio de questionário semiestruturado contendo os critérios de fragilidade propostos por Linda Fried e analisado pelo SPSS versão 21. Utilizou-se o teste qui-quadrado para verificar a associação entre as variáveis, considerando-se estatisticamente significativo p<0,05. Coletaram-se os dados sociodemográficos por meio de instrumento elaborado pelos autores. Resultados: A prevalência de fragilidade foi de 23,8% e está associada a faixa etária mais velha (70-90 anos), idosos que não frequentaram a escola (25,5%), e a principal característica de fragilidade encontrada entre os idosos era "lenta" (71,7%). Conclusão: A fragilidade em idosos do Nordeste Brasileiro está associada à idade e ao analfabetismo.

Incidence of hospitalization and mortality due to stroke in young adults, residents of developed regions in Brazil, 2008-2018

Introduction

We evaluated trends in hospitalization incidence and mortality due to hemorrhagic and ischemic stroke in young adults, according to gender and developed regions in Brazil.

Methods

Between 2008–2018, we performed a population-based time-series study using official hospitalization and death data due to stroke, in individuals aged 10–49 years, from Southeast and South, Brazil. Data were based on reports from the Unified Health System of Hospital Information System and Mortality Information System. Stroke was defined by the International Classification of Diseases, 10^th revision (I60–I63). A Prais-Winsten regression model was performed and the Annual Percentage Change was calculated.

Results

In total, 78,123 hospitalizations of individuals aged 10–49 years were recorded, of which 59,448 (76%) resulted from hemorrhagic stroke (HS). The hospitalizations for HS was significantly decreased (- 4.37%) among men and women in both regions. The hospitalizations for ischemic stroke (IS) was flat, except between 2011 and 2018, when IS hospitalization rates increased. In the analysis by states, HS hospitalizations declined across all states, except for Espírito Santo, where it remained unchanged (p > 0.05). IS flat hospitalizations were observed in all states, except Espírito Santo, where it increased by 24.93%. In terms of mortality, 28,625 deaths were recorded, of which 26,548 (92.7%) resulted from HS. HS mortality decreased significantly by -3.48%and IS mortality by -3.84%. Decreases also occurred in all Southeast and South states (p < 0.05). IS remained unchanged across all states, except Minas Gerais, where it decreased by -14.95%.

Conclusions

We identified a decline in the hospitalizations and mortality of HS and a flat trend for IS in developed regions of Brazil. The recent period (2011–2018) demonstrated increasing rates in the hospitalizations of IS in both regions and genders. The mortality rates for HS and IS decreased between 2008–2018 in Southeast and South Brazil for both genders.

Diagnosis and referral flow in the single health system for climacteric women

OBJECTIVE

The association between gynecological diagnoses and their distribution across healthcare sectors benefits health promotion and the identification of topics for continued education of gynecological care. This study aimed to identify healthcare diagnoses and referral flow in climacteric women.

METHODS

This is a cross-sectional study conducted at the Women's Health Clinic of the University Hospital, University of São Paulo, with a reference to gynecology and training for Residents of Family and Community Medicine, between 2017 and 2018. The medical records of 242 women whose sociodemographic and clinical information, gynecological diagnoses, and distribution of healthcare services (primary, secondary, and tertiary) had been processed were collected. Statistical analysis included the chi-square test and odds ratio.

RESULTS

Smoking (OR = 2.27, 95% CI 1.05-4.89; p = 0.035) was associated with the referral of climacteric women to higher complexity services. Considering the distribution of non-oncological diagnoses in climacteric patients, the chance of women being referred to medium- and high-complexity health services presented a 2-fold increase in cases of breast diseases, a 2.35-fold increase in cases of noninflammatory disorders of the female genital tract, and a 3-fold increase in cases of inflammatory diseases of the pelvic organs.

CONCLUSION

Climacteric women aged over 55 years, postmenopausal women, and smoking women were most frequently referred to medium- and high-complexity outpatient surgery.

Health Services, Socioeconomic Indicators, and Primary Care Coverage in Mortality by Lower Genital Tract and Breast Neoplasias in Brazilian Women during Reproductive and Non-Reproductive Periods

Women's health assistance at the low-complexity level is focused on the most common diseases and can be affected by primary health care coverage, particularly in areas far away from large urban centers. Thus, in this work, we aim to analyze the relationship between socioeconomic status, health care indicators, and primary care coverage in mortality from neoplasms of the lower genital tract and breast in Brazilian women during reproductive and non-reproductive periods. We conducted an ecological study at the Gynecology Discipline, Medicine School, University of São Paulo. Secondary data were collected from women according to reproductive periods and mortality data from the Mortality Information System based on International Classification of Disease-10th edition regarding breast and lower genital tract neoplasms in 2017. The health service and socioeconomic indicators were obtained from the Informatics Department of the Unified Health System and Brazilian Institute of Geography and Statistics. Our results showed that primary care coverage and health service indicators were not associated with mortality from breast cancer and the female lower genital tract, both in reproductive and non-reproductive periods. Sociodemographic indicators were found to be associated with mortality from breast cancer and the female lower genital tract, with income being associated with reproductive period (β = -0.4; 95% CI, -0.8 to -0.03) and educational level in the non-reproductive period (β = 9.7; 95% CI, 1.5 to 18.0).

Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 2004 and 2014

Background

Access to the diagnosis and treatment of breast cancer in Brazil is marked by immense inequalities in the provision of specialized assistance, which leads patients to seek treatment outside the place of residence. To evaluate the variations between 2004 and 2014 in the distribution of flow between place of residence and care, and the average distance traveled for treatment of breast cancer in the administrative regions and federal states of Brazil.

Method

Analysis of secondary data from the years 2004 and 2014, extracted from the Department of Informatics of the Unified Health System through the Hospital Information System. Data from Hospitalization Release Authorizations were collected, and the maps were created with TabWin 3.6 software. Descriptive analysis was performed on Stata® (StataCorp, LC) 11.0.

Results

In the total flow, it was observed that there was a decrease in referrals between 2004 and 2014 in most regions. In 2004 the main direction of flow was in the Midwest and Southeast regions. In 2014, however, the intensity of these admissions was centralized in the Southeast region. In relation to the average distance traveled, the North, Northeast, and Midwest regions had the highest values of displacement. Of the 27 federative units, 17 presented an increase in average distance between these periods.

Conclusion

Despite the improvement in the hospitalization of residents, in most regions and federal units, Brazilians still travel great distances when they require treatment for breast cancer.

Pharmacogenetics findings in Brazilian cancer patients

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Background: Pharmacogenetic is the study of genetic modifications influence on drugs action. Recent studies have suggested that some genetic polymorphisms may have an influence on patient outcomes. Thus, the objective of this thesis is to evaluate the frequency of genetic polymorphisms in cancer patients. Methods: Cross-sectional study at the Oncology Center of São Paulo. The reports presented a SNP evaluation (saliva - PCR-Multiplex, PCR-RFLP or capillary sequencing - Genotypic variants: 1 allele, 2 alleles and no allelic alteration). Polymorphs were validated according to the localized gene and its relationship to drugs using PharmGKB, NCBI SNP Database, NCBI Gene Database and DrugBank Database. Results: Sample mean aging was 49.92 years (SD = 22.73), with breast cancer (n = 26 /% = 26.3) and stage IV (n = 51 /% = 51.6). Among the evaluated platinum components, it is possible to verify that the presence of polymorphisms was more frequent. Of these, all had the highest frequency of polymorphisms in only 1 allele (xpc__rs2228001 = 25.4%; ercc1_rs11615 = 21.2%; xrcc3_rs861539 = 22.2%; mthfr_rs1801133 = 44.4%). This was repeated when evaluating the Cyclophosphamide, Fluoropyrimidines, Taxanes, Anastrozole and Epirubicin-related polymorphisms. When we evaluated the Tamoxifen-related genes, the polymorphisms absence was more frequent (cyp2d6_rs3892097 = 26.3%; cyp3a4_rs2740574 = 61.6%). Evaluating all medications the highest frequency was polymorphism in only 1 allele. Consequently, for the irinotecan drug evaluation, two polymorphisms were evaluated and presence of polymorphism (xrcc3_rs861539 = 58%), mostly in only 1 allele (44%). Conclusions: Therefore we can evaluate that the allelic frequency variability of the polymorphs observed, despite the great variability, shows most evaluated individuals present some type of genotypic modification, being the majority in only 1 allele.

Effects of Intravitreal Bevacizumab Therapy in Patients with Proliferative Diabetic Retinopathy

INTRODUCTION

Diabetes mellitus (DM) stands out as one of the chronic diseases with the highest morbidity and mortality rates worldwide. Among the many complications of DM, diabetic retinopathy (DR) is one of the causes of blindness in patients aged between 20 and 64 years. At least 90% of the new cases showed to have the retinal structure and function restored when proper treatment was provided.

AIM

To evaluate the efficacy of the antiangiogenic bevacizumab in the treatment of DR according not only to the clinical laboratory parameters for glycated hemoglobin (HbA1C) and capillary glycemia but also to the ophthalmological parameters for optical coherence tomography (OCT) and best-corrected visual acuity (BCVA).

PATIENTS AND METHODS

A total of 11 individuals were included and followed up for 12 months after 3 administrations of bevacizumab.

RESULTS

Upon associating the ophthalmological and laboratory variables throughout the treatment, no significant alterations could be seen regarding the analyzed variables. However, it was observed that HbA1c values and the total leukocyte count negatively interfered with the treatment response.

CONCLUSION

The current study showed that HbA1c values and the amount of leukocytes negatively interfere with the therapeutic response. Therefore, laboratory analyses of these parameters are recommended for diabetic patients undergoing the above-mentioned treatment.

The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy

The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Factors associated with perceived quality of life in artisanal fishermen: a cross-sectional study

Objective

To analyze a combination of socioeconomic and demographic characteristics, chronotype, stress perception and level of physical activity with the perception of quality of life in artisanal fishermen.

Results

Several variables were associated with lower scores of quality of life domains: workload (P = 0.047), age (P = 0.01), economic class D–E (P = 0.04) and perceived stress scores (P = 0.01) for scores physical domain; workload (P = 0.03) and perceived stress (P < 0.001) for scores psychological domain; Perceived stress (P < 0.001) and age (P = 0.01) for social domain scores; economic class D–E (P = 0.03) and perceived stress (P = 0.01) for environment domain scores; perceived stress (P = 0.01) and age (P = 0.01) for general quality of life scores and; female sex (P = 0.04) and age (P = 0.02) for the score of satisfaction with quality of life.

Factors associated with blood pressure disorders in Afro-descendant children and adolescents

BACKGROUND

Hypertension (AH) is an emerging disease that has rapidly increased in the last decades throughout the world. The increase in blood pressure (BP) is observed with growth and development and, although the manifestation of the disease is rare in childhood and adolescence, its occurrence is increasing and the causes are likely to be from different combinations of factors. Afrodescendants have been consistently observed in many populations, including Brazil, which has the largest population of Afrodescendants outside Africa; nevertheless, data is scarce on the disease in children and adolescents. In this study, we investigated BP disorders in children and adolescents of "Quilombola" populations of the state of Tocantins, northern Brazil, and determined the disease occurrence with some factors, namely food consumption, body composition, anthropometric measures, and biochemical data.

METHODS

We carried out a cross-sectional study with 67 children aged 10-17 years, comparing the variables studied between the normotensive and non-normotensive groups, using the Chi-square test for qualitative variables and the appropriate tests, according to data adherence to the Gaussian distribution for the quantitative variables. High blood pressure was defined as mean systolic or diastolic blood pressure ≥ 90 percentile for age, height, gender.

RESULTS

The rate of adolescents with BP disorders was 19.4% (prehypertension 14.9% and hypertension 4.5%). There were no significant differences between the sexes for high blood pressure. In the Poisson regression analysis, the high fat percentage was associated with elevated blood pressure (p = 0.021) for adolescents. Similar associations were observed for non-HDL-c (p < 0.001) and low calcium intake (p = 0.015).

CONCLUSION

Most children and adolescents in "Quilombola" communities had normal blood pressure. However, higher levels of dyslipidemia and low calcium intake are factors associated with prehypertension in the population studied with high BP.

Evaluation of the impact of single-nucleotide polymorphisms on treatment response, survival and toxicity with cytarabine and anthracyclines in patients with acute myeloid leukaemia: a systematic review protocol

INTRODUCTION

Acute myeloid leukaemia is the most common type of acute leukaemia in the world. Thus, the study of genetic alterations, such as single-nucleotide polymorphisms (SNPs), has contributed to a better understanding of the mechanisms underlying leukaemogenesis, to improve the prognosis and to increase the survival of these patients. However, there is no synthesis of evidence in the literature evaluating the quality of evidence and the risk of bias in the studies such that the results can be translated. Thus, this systematic review protocol aims to assess the impact of SNPs on genes involved in the metabolism of cytarabine and anthracyclines with respect to survival, treatment response and toxicity in patients with AML.

METHODS

This systematic review protocol is based on PRISMA guidelines and includes searches in six electronic databases, contact with authors, repositories of clinical trials, and cancer research. Studies published in peer-reviewed journals will be included if they meet the eligibility criteria: (a) samples composed of individuals of any age, of both sexes, with a diagnosis of AML, regardless of the time of diagnosis of disease; (b) participants who have undergone or are undergoing cytarabine- and anthracycline-associated chemotherapy or cytarabine-only chemotherapy; and (c) in vivo studies. Studies that include patients with promyelocytic leukaemia (Fab type 3) will be excluded because this disease has different treatment. The process of study selection, data extraction, and evaluation/synthesis will be performed in duplicate. Assessment of methodological quality and risk of bias will be performed using the Cochrane Risk of Bias Tool for randomized clinical studies and the Downs-Black Checklist for cohort and case-control studies. The synthesis of evidence will include the level of evidence based on the GRADE protocol. A meta-analysis of the association between SNPs and outcomes may be performed based on Cochrane guidelines.

DISCUSSION

It is expected that clinical decisions for AML patients will consider evidence-based practices to contribute to better patient management. In this way, we will be able to define how to treat patients with AML to improve their survival and quality of life.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018100750.

Prevalence of and Factors Associated with Metabolic Syndrome in Afro-Descendant Communities in a Situation of Vulnerability in Northern Brazil: A Cross-Sectional Study

Background: Quilombos are Brazilian communities developed by survivor groups following fight against slavery. They are found in the whole of the Brazilian territory, far from urban centers, living in vulnerable and poor socioeconomic situations and continuously suffering from influence of occidentalization. Based on the hypothesis that the way Quilombolas live may be associated with metabolic syndrome (MS), the objective of this study was to estimate the prevalence of MS and to analyze the associated factors in adult residents of Quilombola communities in the northern region of Brazil. Methods: A cross-sectional study was conducted according to the guidelines of the STROBE Statement in five communities of Tocantins. Results: The study investigated 193 individuals who lived for at least 1 year in the communities. The prevalence of MS in this population was 32.12%. There was a higher prevalence of MS or metabolic disorders in women, as well as metabolic profiles related to low high-density lipoprotein and obesity among participants with MS. Conclusion: The prevalence of MS is higher compared with other Quilombola and African communities, indicating an opportunity to improve or develop new programs to reduce MS and metabolic disorders, by making changes in some habits, such as physical activities, because there were differences in metabolic disorders related to the presence of MS.

Effects of the high-inequality of income on the breast cancer mortality in Brazil

As well as breast cancer mortality, the income inequality in Brazil is different between Federative units, including between units of the same region. To assess the effects of the high-inequality of income on breast cancer mortality in Brazilian Federative Units, in the 2010 year. This is an ecologic study. Deaths from breast cancer in Brazilian women according to Federative units were obtained from the Department of Informatics of the Unified Health System. Mortality by breast cancer was estimated per 100,000 women and age-standardized by the direct method according to World Health Organization population. Income inequality was measured by the Gini index obtained from the United Nations Development Programme. The High-inequality of income was classified by the third tercile of the distribution from the Gini index of the Federative units. Univariate analysis was performed according to data normality. Linear regressions were performed by the stepwise backward method. The confidence level was 5%. Stata® (Stata Corp, LC) 11.0. was used. The High-inequality of income was associated with worse social and demographic indicators. The age-standardized breast cancer mortality was larger in the high-inequality of income Federative units. In the adjusted analysis, these Federative units presented a mean of 2 more deaths (ranging from the 0.4 to 3.7 deaths, r² = 0.79; p = 0.018) by breast cancer per 100,000 women when compared to the Federative units without high-inequality of income. In the Brazilian Federative units, the high-inequality of income was associated with age-standardized breast cancer mortality more.

Time trend of breast cancer mortality in BRAZILIAN men: 10-year data analysis from 2005 to 2015

Background

Male Breast Cancer (MBC) is rare, which makes its understanding and treatment be extrapolated from what is known about the occurrence in women, with few epidemiological studies, with few epidemiological studies. Therefore, the aim of the present paper was to study breast cancer mortality in adult males in Brazil and its administrative regions between 2005 and 2015.

Methods

Ecological study with data on MBC mortality in adults between 2005 and 2015. Data were obtained from the Mortality Information System of the Department of Informatics of SUS (the Unified Health System of the country). Descriptive statistics were used for MBC mortality and linear regression to analyze the relationship between mortality and the country’s administrative regions. Percentage Change (PC) and Annual Percentage Change (APC) were the trend measures used for MBC mortality for the period.

Results

Between 2005 and 2015, there were 1521 deaths due to MBC in adults in Brazil. Regarding mortality by region, there was great oscillation in the rates of the country as a whole (PC = 113,87; β = 0,009 (IC95% 0,000 – 0,018); r² = 0,381; P = 0,043). The highest increase in MBC mortality occurred in patients aged 80 years or older (PC = 161,04; β = 0,201 (IC95% 0,640 - 0,339); r² = 0,550; P = 0,009) and there was significant increase in deaths for the 50–54-year age group (PC = 224,01; β = 0,135 (CI95% 0,052; 0,218); r² = 0,601; P = 0,005).

Conclusion

Mortality in adults due to MBC increased in Brazil during the study period with the highest percentage increase occurring for individuals aged 80 years or older.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5261-1) contains supplementary material, which is available to authorized users.

Knowledge and acceptability of the human papillomavirus vaccine among health professionals in Acre state, western Amazon

OBJECTIVE

To evaluate the knowledge and acceptability of the human papillomavirus (HPV) vaccine among health professionals from western Amazonia.

METHODS

A cross-sectional study was conducted in the Sistema Assistencial è Saúde da Mulher e da Criança (Health Care System for Women and Children; SASMC) in Acre, Brazil, in 2017. The participants comprised 196 health professionals. The data collection instrument contained 31 questions about HPV, its clinical repercussions for women, and the HPV vaccine. Quantitative variables were presented as medians and 95% confidence intervals (CIs), and p<0.05 was considered statistically significant. For the analyses, chi-square tests and Mann-Whitney tests were used. The collected data were analyzed using Stata®11.0.

RESULTS

Of the 196 health professionals, 39.8% (n=76) were physicians and 61.2% (n=120) were other health professionals. The interviewees were mostly female (n=143, 73%, 95% CI 66.1 to 78.9%) who worked in the medical field (n=81, 41.3%, 95% CI 34.4 to 48.6%), and the median age was 38 years (95% CI 36.0 to 39.7). Physicians had increased knowledge regarding only the statement "cervical cancer is one of the main causes of cancer in women", with a proportion ratio of 0.88 (0.80; 0.97) and p<0.001. Regarding clinical knowledge of the HPV vaccine, a low proportion of correct answers was obtained for all the questions, and no significant differences were found between the groups.

CONCLUSION

Acceptability and knowledge of HPV and its vaccine were similar among health professionals, with knowledge gaps in questions about the relation between smoking and cervical cancer and specific clinical knowledge.

The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings

Objective

To analyze the epidemiological stroke data of Brazil according to the Global Burden of Disease (GBD) study in 2016 and secondary data from the GBD database.

Results

The highest percentage of deaths due to stroke in general occurred in individuals aged 70 years or over (60.2%; 95% confidence interval [CI] 59.9–60.5%) followed by that in men (52.9%; 95% CI 52.6–53.2%). Ischemic stroke was the most common type, accounting for 61.8% (95% CI 61.5–62.1%) of deaths due to stroke in 2016. Most of the epidemiological indicators (incidence, prevalence, mortality-to-incidence ratio, mortality, disability-adjusted life years, years lost due to disability, and years of life lost) of stroke in general or either type of stroke were higher in men and those aged 70 years or over. Stroke data in Brazil are a major concern and represent a real health challenge for the coming decades. Men and individuals aged 70 years or older appear to represent the groups with the highest epidemiological parameters and risk for the various stroke outcomes. However, this does not mean the female data are irrelevant, which, although representing a lower risk than the male data, also raise the need for policies aimed at prevention and improvement in the treatment of stroke and its sequelae.

Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access

Background

Adequate flow through a newly created arteriovenous fistula depends on multiple characteristics of the vessels and patient comorbidities. Several studies have related preoperative findings to failure, but few have analyzed the influence of intraoperative findings.

Objectives

To evaluate the predictive value of intraoperative findings on the immediate outcome of radial-cephalic arteriovenous wrist fistulas (RCAVF) by collecting data that are easily measured intraoperatively.

Methods

We designed a cross-sectional study, in which a single surgeon performed 101 RCAVF in 100 patients at a single center. We analyzed the immediate postoperative flow, assessed by thrill intensity immediately after fistula creation, against patient demographics and intraoperative data. The following variables were analyzed: age, sex, comorbidities, length of vein visible at preoperative examination, macroscopic arterial calcification, maximum vein diameter, and length of stenosis-free vein, measured by cannulation with a urethral catheter during the procedure. The chi-square test was used both to eliminate possible bias introduced by side of venous access (left or right), and to determine predictive values of immediate thrill.

Results

Side of access was not associated with any significant differences in variables. Absence of macroscopic arterial calcification, successful venous catheterization using a 6 French catheter or larger, and ability to advance it more than 10 centimeters along the lumen of the proximal vein were correlated with adequate immediate postoperative thrill (p = 0.004, p < 0.001, and p = 0.005, respectively).

Conclusions

In this series of 101 RCAVF, both the diameter of the catheter and its progress through the proximal vein and also absence of arterial calcification had positive predictive value for achieving adequate immediate thrill after vascular access construction.

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

PURPOSE

To analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon.

PATIENTS AND METHODS

Cross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20-24 years), and young women (25-30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient's medical records.

RESULTS

In total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents' group compared with the young women's group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14-2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02-3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11-3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36-14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49-2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47-2.98; PFDI, PR = 2.12, 95% CI 1.47-2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04-3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03-5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21-13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60-2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61-3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68-3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section.

CONCLUSION

Adolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.

Association between primary care coverage and breast cancer mortality in Brazil

Breast cancer early detection is the major strategy for mortality rates reduction. In Brazil, Primary Health Care is an important strategy for public health promotion. To analyse the association between breast cancer mortality and primary health care indicators in Brazilian municipalities, data on breast cancer mortality and primary healthcare coverage of the 5,700 Brazilian municipalities were collected from the Department of Informatics of the Brazilian Unified Health System. We collected data on the deaths of women living in Brazil in 2010 with breast cancer. Breast cancer mortality was calculated by 100,000 women and age-standardised from the World Health Organisation population. We studied the coverage of primary health care, family health team and community health agents. We found that increase of both primary care indexes was related to increasing of the breast cancer mortality. Additionally, improving the scholarly and reducing the income inequality was related to reducing the breast cancer mortality. Strategies to improve the quality of primary care, reduce the income inequality and improve elementary scholarly should be taken into account in the development of public policies in the Brazilian municipalities to reduce breast cancer in Brazilian municipalities.

Nurses' knowledge and practices in the face of the challenge of using the systematization of nursing care as an instrument of assistance in a first aid in Brazil

To analyze the performance of nurses in the implementation of nursing care systematization (NCS). This study is a descriptive research developed from a qualitative approach. The content analysis (CA) must be developed through 3 chronological poles allowing the researcher to construct an analysis structure that corresponds to the needs of the research and the objectives of the proposed research; The chronological poles of CA are described as: Phase 1-preanalysis, phase 2-exploration of the material: phase 3-treatment of the results obtained and interpretation. Only a semistructured interview will be conducted with the research subjects who meet the inclusion criteria of the study, preserving the identity of the individuals and guaranteeing the right to quit the research at any time during the interview. The Research Ethics Committee of Hospital of the clinics of Acre, Brazil (Amazon region) under the opinion no. 1.460.960 approved this protocol. The clinical protocol was registered in the "Brazilian Registry of Clinical Trials" validated by the World Health Organization, and received clinical trials "RBR-882rg2."

Correlation between municipal human development index and stroke mortality: a study of Brazilian capitals

Objective

To analyze the correlation between municipal human development indices (MHDIs) and stroke mortality in residents of Brazilian state capitals in 2010. A secondary data analysis was conducted in 2015 using data for the MHDI and the following dimensions: income, longevity and education which were obtained from the United Nations Development Program. Additionally, we analyzed age-standardized stroke mortality data from the Department of System Information Unified Health of Brazil.

Results

We observed a correlation between stroke mortality and MHDIs overall (Pearson r = − 0.563; p = 0.002) and within the following dimensions: income (Spearman’s ρ = − 0.479; p = 0.011), longevity (Pearson r = − 0.510; p = 0.006) and education (Pearson r = − 0.592; p = 0.001). We identified moderate but significant negative correlations between MHDI overall and in its individual dimensions (income, longevity, and age) and stroke mortality in Brazilian capitals. Stroke is the second leading cause of death in industrialized countries and the leading cause of death in Brazil. Therefore, the discovery of factors that may influence the epidemiology of stroke is important for the construction of adequate policies considering to the socioeconomic status in these places and with an emphasis in lower socioeconomic status places.

Associaton between violence and drug consumption with suicide in lesbians, gays, bisexuals, transvestites, and transsexuals: cross-sectional study

Introduction. Lesbian, gay, bisexual, transvestite, and transgender (LGBT) people are affected by prejudice and psychological, physical, and/or sexual violence due to their sexual orientation. Objective. To analyze the association between violence, drug use, and suicide in LGBT people. Method. We interviewed 316 LGBT people from two cities of the Brazilian Northeast by means of a structured instrument. This included questions about sociodemographic data, sexual orientation, type of violence, type and quantity of drugs consumed, and suicide. Results. There was a positive association between physical violence and anabolic consumption (p = .001) and tranquilizers (p = .012). In relation to psychological and verbal violence, there was a positive association with the use of tranquilizers (p = .021) and negative with the use of amphetamines (p = .027). Suicide attempts were associated with having experienced physical (p = .03) and sexual (p = .037) violence. Drug use, especially ecstasy, cocaine, marijuana, and tranquilizers, was also associated with suicide attempts (p = .002, p = .031, p < .001, p < .001, respectively). The participants who had already attempted suicide were more vulnerable to experience violence and consume drugs within 30 days prior to the interview (p < .001). Discussion and conclusion. Psychological/verbal violence showed to be associated with the use of amphetamines, while physical violence was associated with a higher consumption of tranquilizers and anabolic steroids. Suicide attempts were more common among participants who had suffered physical violence and who were users of substances such as ecstasy, cocaine, marijuana, and tranquilizers.