Minimum acceptable diet in a cohort of children aged between 6 and 15 months: Complementary feeding assessment and associated factors in the Brazilian western Amazon.

OBJECTIVE: The goal of the article was to assess complementary feeding patterns, and associated factors, of children between 6 and 15-month old in Rio Branco-Acre, Brazil, based on the minimum acceptable diet indicator. METHODS: This study was cross-sectional, including 857 children between ages 6 and 15 mo, from a 2015 birth cohort of Rio Branco, Brazil. The prevalence of complementary feeding indicators, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was estimated based on the recommendations of the World Health Organization. Sociodemographic characteristics, infant and maternal habits, prenatal information, birth characteristics, breastfeeding, and complementary feeding were evaluated. Differences between the proportions were evaluated by the χ2 test and univariate and multiple logistic regression analyses, to determine associated factors with child minimum acceptable diet. RESULTS: The minimum frequencies of meals and dietary diversity were observed in 81.0% and 51.8% of the children, respectively. The minimum acceptable diet prevalence was 47.1%. Also, minimum acceptable diet was inversely associated with C, D, and E social classes (adjusted odds ratio = 0.49; 95% CI, 0.33-0.72), number of living siblings (adjusted odds ratio for two or three children = 0.69; 95% CI, 0.48-0.98, and adjusted odds ratio for ≥ 4 children = 0.56; 95% CI, 0.37-0.84). Maternal regular consumption of fruits, vegetables, and legumes (adjusted odds ratio = 2.62; 95% CI, 1.69-4.05), child age from 12 to 15 mo (adjusted odds ratio = 2.05; 95% CI, 1.32-3.18), and receiving guidance regarding complementary feeding during postnatal consultations (adjusted odds ratio = 1.38; 95% CI, 1.03-1.86) were directly associated with minimum acceptable diet. CONCLUSIONS: Fewer than 50% of the children received adequate food with adequate frequency and diversity. Low socioeconomic status and having ≥ 2 living siblings reduced the chance of minimum acceptable diet, whereas maternal healthy diet, child age (12-15 mo), and complementary feeding counseling during postnatal appointments increased the chance of minimum acceptable diet.

Delays in treatment initiation and conclusion in women with stage IA to IIIB cervical cancer: A survival study in a hospital-based cohort from a developing country.

AIM: To evaluate the effect of delays in stage IA to IIIB cervical cancer treatment initiation and conclusion on hospital-based survival among Brazilian women. METHODS: A retrospective follow-up study was conducted in a stage IA to IIIB cervical cancer cohort treated from 2012 and 2014 and followed until December 31, 2017 in Rio de Janeiro. Delay in treatment initiation definition was defined based on the Brazilian law of 60 days for treatment initiation after diagnosis. Delay in treatment conclusion was defined based on the literature and sample distributions: < 120/121-200/> 200 days. The endpoint was death(from all causes or cervical cancer). Death causes and dates were obtained by a record linkage procedure between the hospital cancer registry and the Mortality Information System. Global 36-month survival and HRs were estimated by the KaplanMeier method and proportional Cox regression models, respectively. RESULTS: From 865 patients, 269(31.1%) died over the median follow-up time of 27 months. Delay on treatment initiation(>60-days) was 92.8%, while the delay in treatment conclusion(>120 days) was 87.5%. Overall survival was 61.3% (<60-days:62.6%; 61-90 days:63.5%). Among stage IIB-IIIB, women treated < 60-days presented 40.1% survival, while 61-90-days had 52.5%, and > 90-days had 53.3%. Delays in treatment conclusion significantly reduced survival[72.2%(<120-days) to 60.7%(>200-days)]. Multivariate analysis showed that delays in treatment initiation did not affect 36-month death risk. Compared to women concluding treatment in < 120-days, those taking 121-200-days or > 200-days showed increases in death risk of 89%(95%CI:1.10-3.24) and 111%(95%CI:1.31-3.39), respectively, regardless of age, stage, treatment protocol, and time to treatment initiation. CONCLUSION: Delays in cervical cancer treatment conclusion (but not treatment initiation) affected 36-month survival and death risk among Brazilians.

Effect of prenatal care quality on the risk of low birth weight, preterm birth and vertical transmission of HIV, syphilis, and hepatitis.

BACKGROUND: Averse birth-outcomes still affect newborns worldwide. Although high-quality prenatal care is the main strategy to prevent these outcomes, the effect of prenatal care based on Kotelchuck index combined with consultation contents is still unclear. Thus, this article to evaluate the effect of the quality of prenatal care (PC) process on birth indicators in a cohort of puerperaes who attended maternity hospitals in Brazilian western Amazon, city of Rio Branco, in the state of Acre, Brazil, in 2015. METHODS: This research was a hospital-based cohort study. The sample consisted of 1,030 women who gave birth in maternity hospitals in the city between April 6 and June 30, 2015. This research was a hospital-based cohort study. The sample consisted of 1,030 women who gave birth in maternity hospitals in Rio Branco between April 6th. and June 30th., 2015. Prenatal care was classified as fully adequate when started ≤4th month; ≥80.0-109% expected consultations for GA according to the Kotelchuck Index; ≥5 records of blood pressure, weight, GA, fundal height, ≥4 records of fetal heart rate, fetal movements or equivalent to 75% of the number of consultations; in addition to recording ABO/RH, hemoglobin, VDRL, urine, glucose, anti-HIV and anti-toxoplamosis during the 1st trimester. The evaluated outcomes were low birth weight (LBW), preterm birth and vertical transmission of human immunodeficiency virus (HIV)/hepatitis/syphilis. Differences between proportions were assessed using the X² test, and the crude and adjusted odds ratios (OR) (95% CI) were estimated using unconditional logistic regression. RESULTS: Overall cohort, the outcomes incidences were 8.8% for LBW, 9.2% for preterm birth, and 1.1% for vertical transmission (syphilis/HIV/hepatitis). Crude and adjusted OR showed that inadequate PC increased the risk statistically significant of LBW (ORcrude: 1.84; 95%CI: 0.99-3.44; ORadjusted: 1.87; 95%CI: 1.00-3.52), and preterm birth (ORcrude: 1.79; 95%CI: 1.00-3.29; ORadjusted: 3.98; 95%CI: 1.40-11.29). CONCLUSION: The results draw attention to the importance of quality PC in reducing the risks of LBW, preterm birth, and vertical transmission of syphilis/HIV/hepatitis. Moreover, using this proposed quality prenatal care indicator based on Kotelchuck index combined with consultations contents adjusted by GA may accurately predict unfavorable outcomes.

Cancer incidence in indigenous populations of Western Amazon, Brazil.

OBJECTIVES: This study aims to estimate a population-based cancer incidence among indigenous populations in the State of Acre, Brazilian Western Amazon, to provide knowledge about cancer epidemiological profiles contributing to healthcare policies and service planning. Although cancer epidemiology in Brazil is well described through incidence and mortality estimate in the general population, cancer estimates among indigenous peoples are still unknown. DESIGN: This is a descriptive study of cancer incidence among the indigenous population (2000-2012) in the State of Acre, Brazil. The sources used were population-based cancer registries of Goiânia, hospital-based cancer registry of Acre, São Paulo, and Porto Velho; Special Indigenous Health Districts databases of Acre, Goiânia, and São Paulo; Mortality Information System, and Rio Branco's public and private laboratories' reports. Standardized Incidence Ratio (SIR) was calculated using cancer incidence rates of Goiânia as reference. RESULTS: From 137 cancer cases, 51.8% occurred in women and 32.1% in people aged 70 + . Among men, the most frequent cancer sites were stomach (25.8%), liver (15.1%), colorectal (7.6%), leukemia (7.6%), and prostate (6.1%). Among women, the most frequent were cervical (50.7%), stomach (8.5%), leukemia (5.6%), liver (4.3%), and breast (4.3%). Among men, there was an excess of cancer cases for stomach (SIR=1.75; 95%CI:1.67-1.83), liver (SIR=1.77; 95%CI:1.66-1.88), and leukemia (SIR=1.64; 95%CI:1.49-1.78). In women, an excess of cancer cases was observed for cervical (SIR=4.49; 95%CI:4.34-4.64) and liver (SIR=2.11; 95%CI:1.88-2.34). A lower cancer incidence for prostate (SIR=0.06; 95%CI:0.05-0.07) and female breast (SIR=0.12; 95%CI:0.11-0.14) was observed. CONCLUSIONS: Cervical, stomach, and liver cancers corresponded to 52% of the cases and were highly incident among the Brazilian indigenous population of Western Amazon compared to non-indigenous counterparts. Despite the low frequency of breast and prostate cancer, the fact they were present among indigenous peoples suggests a complex epidemiological transition framework in these populations.

Biomonitoring of Exposure to Metals in a Population Residing in an Industrial Area in Brazil: A Feasibility Study.

BACKGROUND: Industries are sources of environmental pollutants. However, there are few human biomonitoring (HBM) studies in the vicinity of industrial areas. Thus, we evaluate the feasibility of conducting an HBM study to assess exposure to metals in an industrial area in Rio de Janeiro, Brazil. METHODOLOGY: A cross-sectional survey was conducted near a steel factory. Adults (exposed = 775; controls = 775) were randomly selected and sex-matched. Subjects were interviewed using a questionnaire and a 24 h dietary recall. Blood samples were collected to analyze metal concentrations, blood count, biochemical parameters, and thyroid hormones. The feasibility of the survey was assessed following guidelines. The descriptive analysis was performed for the first 250 participants (pilot study). RESULTS: Adjustments were made to the survey execution, including age-matching, fieldwork team, questionnaire, blood collection, and research awareness. The complete questionnaire was answered by ≥97% of participants; metals were measured in ≥98% and clinical parameters in ≥89%, except thyroid hormones (13-44%). The average age and family income were of 50 years and USD 575/month, respectively. The participants had equal distribution among sexes: 50% had a medium education level, and 59% were nonwhite. CONCLUSION: This preliminary HBM study demonstrates feasibility for the total population, with results indicating representativeness of the target population.

Concentration of heavy metals in UHT dairy milk available in the markets of São Luís, Brazil, and potential health risk to children.

OBJECTIVE: To assess the levels of heavy metals and their antagonists in dairy products available in the markets of São Luís, northeastern Brazil. METHODS: Chemical analysis of the heavy metals copper(Cu), lead(Pb), mercury(Hg), and nickel(Ni) and their antagonists iron(Fe), zinc(Zn), calcium(Ca), selenium(Se), and cobalt(Co) contained in dairy products using inductively coupled plasma optical emission spectrometry (ICP-OES). RESULTS: The main heavy metal observed in dairy products were Hg; Pb; Se and Ni. A significant negative correlation was observed between the concentrations of Cu and Fe (rho = -0.634, p = 0.001), Cu and Zn (rho = -0.794, p = 0.000) in whole milk. A non-significant positive correlation was observed between Pb and Ca (rho = 0.387, p = 0.056), and Hg and Se (rho = 0.055, p = 0.795). CONCLUSIONS: Dairy product brands available in the markets of São Luís could be considered a source of heavy metal contamination (Hg, Pb, Se, Cu, Ni) with weak correlations with their antagonists.

Incidence of Colorectal Cancer in Selected Countries of Latin America: Age-Period-Cohort Effect.

OBJECTIVE: To estimate Age-Period-Cohort effects on colorectal, colon and rectal cancer incidence rates in Latin American countries covered by high quality population-based cancer registries. METHODS: A trend study was performed using data from Cancer Incidence in Five Continents. Age-Period-Cohort effects were estimated by Poisson regression for individuals aged between 20 and 79 years with colorectal, colon and rectal cancers informed by Population-Based Cancer Registries from 1983 to 2012 in Cali (Colombia); from 1983 to 2007 in Costa Rica; and from 1988 to 2012 for both Goiânia (Brazil) and Quito (Ecuador). Goodness of fit model was tested using the deviance of the models. RESULTS: Age effect was statistically significant for both sexes in all Population-Based Cancer Registries areas and the curves slope reached peaks in the older age groups. There were cohort effects on the incidence rates for colorectal, colon and rectal cancers in all Population-Based Cancer Registries areas, except for women in Quito. Regarding the period effect, an increased ratio rate was observed in men (1.26, 95%CI 1.17 to 1.35) and women (1.23, 95%CI, 1.15 to 1.32) in Goiânia, between 2003 and 2007. CONCLUSIONS: In Latin America, age effect was observed on incidence rates for colorectal, colon and rectal cancers. Besides, birth cohort effect was identified for recent cohorts in both genders for colorectal, colon and rectal cancers in Cali and Goiânia, and cohort effect for colorectal and colon cancers in both genders in Costa Rica; while in Quito a cohort effect was only observed for rectal cancer among men. Period effect was observed in Goiânia with increased ratio rate in 2003-2007.
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Axillary surgery in breast cancer: acute postoperative complications in a hospital cohort of women of Rio de Janeiro, Brazil / Abordagem cirúrgica axilar no câncer de mama: complicações pós-operatórias agudas em uma coorte hospitalar de mulheres do Rio de Janeiro

Objective: To analyze the incidence of early postoperative complications in women with breast cancer according to the axillary surgery. Methods: An observational study of a cohort of women diagnosed with T1-T2N0M0 clinical stage breast cancer attended at the Brazilian National Cancer Institute from January 2007 to December 2009. The outcome was defined as postsurgical complications in the affected upper limb, such as: axillary web syndrome, winged scapula, paraesthesia and surgical wound, seroma and wound infection. The incidence of simple complications was estimated. The crude and adjusted Odds Ratios, with their respective 95% confidence intervals, were estimated by Multiple Logistic Regression analysis. Results: The incidence of postoperative complications was significantly lower in sentinel lymph node biopsy (axillary web syndrome: 6.0%; paraesthesia: 45.2%; winged scapula: 9.1%; seroma: 28.5%; wound infection: 3.8%) than in axillary lymphadenectomy (axillary web syndrome: 22.5%; paraesthesia: 89.8%; winged scapula: 50.0%; seroma: 69.4%; wound infection: 12.9%). Compared to those who underwent axillary lymphadenectomy, the risk of postoperative complications in those in whom sentinel lymph node biopsy was performed was significantly lower. Conclusion: The sentinel lymph node biopsy technique was an independent protective factor for acute postoperative complications when compared to axillary lymphadenectomy

Objetivo: Analisar a incidência de complicações pós-operatórias precoces em mulheres com câncer de mama de acordo com a cirurgia axilar. Métodos: Estudo observacional de uma coorte de mulheres diagnosticadas com câncer de mama em estágio clínico T1-T2N0M0 atendidas no Instituto Nacional de Câncer do Brasil de janeiro de 2007 a dezembro de 2009. O desfecho foi definido como complicações pós-cirúrgicas no membro superior afetado, tais como: síndrome da rede axilar, escápula alada, parestesia e ferida cirúrgica, seroma e infecção da ferida. A incidência de complicações simples foi estimada. Os Odds Ratios bruto e ajustado, com seus respectivos intervalos de confiança de 95%, foram estimados por análise de Regressão Logística Múltipla. Resultados: A incidência de complicações pós-operatórias foi significativamente menor na biópsia de linfonodo sentinela (síndrome da rede axilar: 6,0%; parestesia: 45,2%; escápula alada: 9,1%; seroma: 28,5%; infecção da ferida: 3,8%) do que na linfadenectomia axilar (síndrome da rede axilar: 22,5%; parestesia: 89,8%; escápula alada: 50,0%; seroma: 69,4%; infecção da ferida: 12,9%). Em comparação com aqueles que foram submetidos a linfadenectomia axilar, o risco de complicações pós-operatórias naqueles nos quais a biópsia de linfonodo sentinela foi realizada foi significativamente menor. Conclusão: A técnica de biópsia de linfonodo sentinela foi um fator de proteção independente para complicações pós-operatórias quando comparadas à linfadenectomia axilar

Epidemiological characteristics related to treatment failure of preinvasive cervical intraepithelial neoplasia among Brazilian women.

OBJECTIVE: To evaluate cervical intraepithelial neoplasia (CIN) treatment failure among women with an altered Papanicolaou test and treated at a public cervical pathology center in Rio de Janeiro, Brazil. METHODS: An exploratory study was carried out in a cohort of women treated for preinvasive cervical cancer, from 1998 to 2000. Epidemiological, clinical, and sociodemographic data were obtained from medical records. Information related to cytological and histological examinations, classified according to the Bethesda System, were cross-tabulated with reports from the main cervical pathology laboratory at the Brazilian Cancer Institute. Conditional probability for treatment failure (12 and 24 months) and hazard ratios were estimated through Kaplan-Meier (log-rank test, 95%) and Cox regression (entry, or=0.10). RESULTS: Mean (SD) follow-up period was 20.75 (20.53) months, and 449 women were treated for CIN-1 or CIN-2/3. There was an increased probability of treatment failure according to age group (37.19% and 57.44% in 12 and 24 months for women >50 years). Women who smoked for more than 10 years were more likely to present treatment failure compared with those who smoked for up to 10 years (33.56% and 22.01% in 12 months; 53.15% and 42.59% in 24 months, respectively). Women older than 50 years showed an independent risk for treatment failure (adjusted hazard ratio, 1.59; 95% confidence interval, 1.04-2.41) compared with women aged between 10 and 29 years. CONCLUSIONS: Age (>50 years) was statistically associated with treatment failure. Duration of tobacco use (>10 years), CIN-2/3 cytology at treatment, glandular involvement, and having more than 4 sexual partners in a lifetime were also associated with failure, reducing statistical significance after adjustment.