Exposure to Organochlorine Pesticides and Female Breast Cancer Risk According to Molecular Receptors Expression: a Systematic Review and Meta-analysis of Epidemiological Evidence.

PURPOSE OF REVIEW: Organochlorine pesticides (OCP) have been proposed as potential mammary carcinogens since they interact with steroid signaling pathways. However, the epidemiological results are not conclusive. Most studies have evaluated breast cancer (BC) as a single entity without considering the different molecular expressions, including estrogen receptor (ER), progesterone receptor (PR), and HER2, that could differ in their association with these contaminants. Hence, we assessed the association between biological concentration of OCP and BC, according to its molecular receptor expression, based on a systematic review and meta-analysis. RECENT FINDINGS: Of the 141 articles eligible for full-text review, nine met the inclusion criteria. The way in which molecular expression was reported was heterogeneous; therefore, the inclusion of studies in the meta-analysis was limited to eight articles. A negative association was identified for ß-hexachlorocyclohexane and trans-nonachlor with ER + tumors and between hexachlorobenzene and ER - tumors. No associations were observed for p,p'-dichlorodiphenyldichloroethylene, cis-nonachlor, and dieldrin, and it was not possible to evaluate the associations between OCP with HER2 expression or triple-negative tumors due to lack of data. The results suggest that some OCP might be associated with BC depending on the expression of ER. However, the evidence is not conclusive due to the scarce data. We identified several methodological aspects to fill the gaps in knowledge and increase the comparability among studies.

NAT2 global landscape: Genetic diversity and acetylation statuses from a systematic review.

Arylamine N-acetyltransferase 2 has been related to drug side effects and cancer susceptibility; its protein structure and acetylation capacity results from the polymorphism's arrays on the NAT2 gene. Absorption, distribution, metabolism, and excretion, cornerstones of the pharmacological effects, have shown diversity patterns across populations, ethnic groups, and even interethnic variation. Although the 1000 Genomes Project database has portrayed the global diversity of the NAT2 polymorphisms, several populations and ethnicities remain underrepresented, limiting the comprehensive picture of its variation. The NAT2 clinical entails require a detailed landscape of its striking diversity. This systematic review spans the genetic and acetylation patterns from 164 articles from October 1992 to October 2020. Descriptive studies and controls from observational studies expanded the NAT2 diversity landscape. Our study included 243 different populations and 101 ethnic minorities, and, for the first time, we presented the global patterns in the Middle Eastern populations. Europeans, including its derived populations, and East Asians have been the most studied genetic backgrounds. Contrary to the popular perception, Africans, Latinos and Native Americans have been significantly represented in recent years. NAT2*4, *5B, and *6A were the most frequent haplotypes globally. Nonetheless, the distribution of *5B and *7B were less and more frequent in Asians, respectively. Regarding the acetylator status, East Asians and Native Americans harboured the highest frequencies of the fast phenotype, followed by South Europeans. Central Asia, the Middle East, and West European populations were the major carriers of the slow acetylator status. The detailed panorama presented herein, expands the knowledge about the diversity patterns to genetic and acetylation levels. These data could help clarify the controversial findings between acetylator states and the susceptibility to diseases and reinforce the utility of NAT2 in precision medicine.

Prenatal Exposure to Potentially Toxic Metals and Their Effects on Genetic Material in Offspring: a Systematic Review.

In recent years, the background level of environmental pollutants, including metals, has increased. Pollutant exposure during the earliest stages of life may determine chronic disease susceptibility in adulthood because of genetic or epigenetic changes. The objective of this review was to identify the association between prenatal and early postnatal exposure to potentially toxic metals (PTMs) and their adverse effects on the genetic material of offspring. A systematic review was carried out following the Cochrane methodology in four databases: PubMed, Scopus, Web of Science, and the Cochrane Library. Eligible papers were those conducted in humans and published in English between 2010/01/01 and 2021/04/30. A total of 57 articles were included, most of which evaluated prenatal exposure. Most commonly evaluated PTMs were As, Cd, and Pb. Main adverse effects on the genetic material of newborns associated with PTM prenatal exposure were alterations in telomere length, gene or protein expression, mitochondrial DNA content, metabolomics, DNA damage, and epigenetic modifications. Many of these effects were sex-specific, being predominant in boys. One article reported a synergistic interaction between As and Hg, and two articles observed antagonistic interactions between PTMs and essential metals, such as Cu, Se, and Zn. The findings in this review highlight that the problem of PTM exposure persists, affecting the most susceptible populations, such as newborns. Some of these associations were observed at low concentrations of PTMs. Most of the studies have focused on single exposures; however, three interactions between essential and nonessential metals were observed, highlighting that metal mixtures need more attention.

Systematic literature review of instruments that measure the healthfulness of food and beverages sold in informal food outlets.

BACKGROUND: Informal food outlets, defined as vendors who rarely have access to water and toilets, much less shelter and electricity, are a common component of the food environment, particularly in many non-Western countries. The purpose of this study was to review available instruments that measure the quality and particularly the healthfulness of food and beverages sold within informal food outlets. METHODS: PubMed, LILACS, Web of Science, and Scopus databases were used. Articles were included if they reported instruments that measured the availability or type of healthy and unhealthy foods and beverages by informal food outlets, were written in English or Spanish, and published between January 1, 2010, and July 31, 2020. Two trained researchers reviewed the title, abstract and full text of selected articles; discrepancies were solved by two independent researchers. In addition, the list of references for selected articles was reviewed for any additional articles of relevance. The quality of published articles and documents was evaluated using JBI Critical appraisal checklist for analytical cross-sectional studies. RESULTS: We identified 1078 articles of which 14 were included after applying the selection criteria. Three additional articles were considered after reviewing the references from the selected articles. From the final 17 articles, 13 measurement tools were identified. Most of the instruments were used in low- and middle-income countries (LMIC). Products were classified as healthy/unhealthy or produce/non-produce or processed/unprocessed based on availability and type. Six studies reported psychometric tests, whereas one was tested within the informal food sector. CONCLUSIONS: Few instruments can measure the healthfulness of food and beverages sold in informal food outlets, of which the most valid and reliable have been used to measure formal food outlets as well. Therefore, it is necessary to develop an instrument that manages to measure, specifically, the elements available within an informal one. These actions are extremely important to better understand the food environment that is a central contributor to poor diets that are increasingly associated with the obesity and Non-communicable disease (NCD) pandemic.

Intervenciones no farmacológicas para reducir síntomas depresivos en mujeres con cáncer de mama / Non-pharmacological interventions to reduce depressive symptoms in women with breast cancer

Resumen: Objetivo: Describir y discutir los resultados de las intervenciones no farmacológicas (INF) adyuvantes en el tratamiento de los síntomas depresivos entre mujeres con cáncer de mama (CaMa). Material y métodos: Se realizó una revisión sistemática sobre INF, aplicadas a pacientes con cáncer y síntomas depresivos en siete bases de datos. La revisión se limitó del 1 de enero de 2006 al 31 de diciembre de 2017 y a los idiomas inglés, español y portugués. Los descriptores médicos empleados fueron "breast neoplasm" y "depression". Resultados: Existen diversas INF que pueden estimular principalmente las dimensiones físicas o psicosociales. En este artículo se propone una clasificación basada en nueve estrategias terapéuticas identificadas, entre las que sobresalen el ejercicio, la psicoterapia y el yoga con meditación. Conclusiones: Con base en la evidencia disponible, se concluye que la psicoterapia y yoga con meditación reducen los síntomas depresivos en pacientes con CaMa. Se requiere mayor investigación para determinar la magnitud de la reducción de los síntomas depresivos, de acuerdo con su gravedad, presencia de comorbilidades y diversidad de INF.

Abstract: Objective: To describe and discuss the results of non-pharmacological interventions (NPI) adjuvants in the treatment of depressive symptoms among women with breast cancer (BC). Materials and methods: A systematic review on NPI was performed, which was applied to patients with cancer and depressive symptoms in seven databases. The review was limited from January 1, 2006 to December 31, 2017 and to English, Spanish and Portuguese languages. The medical descriptors used were "breast neoplasm" and "depression". Results: There are several NPI that are able stimulate the physical or psychosocial dimensions. In this article we propose a classification based on nine identified therapeutic strategies, among which exercise, psychotherapy and yoga with meditation stand out. Conclusions: Based on the available evidence, we concluded that psychotherapy and yoga with meditation reduce depressive symptoms in patients with CaMa. More research is needed to determine the magnitude of the reduction of depressive symptoms, according to their severity, presence of comorbidities and diversity of INF.

[Non-pharmacological interventions to reduce depressive symptoms in women with breast cancer]. / Intervenciones no farmacológicas para reducir síntomas depresivos en mujeres con cáncer de mama.

OBJECTIVE: To describe and discuss the results of non-pharmacological interventions (NPI) adjuvants in the treatment of depressive symptoms among women with breast cancer (BC). MATERIALS AND METHODS: A systematic review on NPI was performed, which was applied to patients with cancer and depressive symptoms in seven databases. The review was limited from January 1, 2006 to December 31, 2017 and to English, Spanish and Portuguese languages. The medical descriptors used were "breast neoplasm" and "depression". RESULTS: There are several NPI that are able stimulate the physical or psychosocial dimensions. In this article we propose a classification based on nine identified therapeutic strategies, among which exercise, psychotherapy and yoga with meditation stand out. CONCLUSIONS: Based on the available evidence, we concluded that psychotherapy and yoga with meditation reduce depressive symptoms in patients with CaMa. More research is needed to determine the magnitude of the reduction of depressive symptoms, according to their severity, presence of comorbidities and diversity of INF.

OBJECTIVE: Describir y discutir los resultados de las intervenciones no farmacológicas (INF) adyuvantes en el tratamiento de los síntomas depresivos entre mujeres con cáncer de mama (CaMa). MATERIALS AND METHODS: Se realizó una revisión sistemática sobre INF, aplicadas a pacientes con cáncer y síntomas depresivos en siete bases de datos. La revisión se limitó del 1 de enero de 2006 al 31 de diciembre de 2017 y a los idiomas inglés, español y portugués. Los descriptores médicos empleados fueron "breast neoplasm" y "depression". RESULTS: Existen diversas INF que pueden estimular principalmente las dimensiones físicas o psicosociales. En este artículo se propone una clasificación basada en nueve estrategias terapéuticas identificadas, entre las que sobresalen el ejercicio, la psicoterapia y el yoga con meditación. CONCLUSIONS: Con base en la evidencia disponible, se concluye que la psicoterapia y yoga con meditación reducen los síntomas depresivos en pacientes con CaMa. Se requiere mayor investigación para determinar la magnitud de la reducción de los síntomas depresivos, de acuerdo con su gravedad, presencia de comorbilidades y diversidad de INF.

[Disrespect and abuse during childbirth and abortion in Latin America: systematic review and meta-analysisDesrespeito e maus-tratos durante o parto e o aborto na América Latina: revisão sistemática e meta-análise]. / Irrespeto y maltrato durante el parto y el aborto en América Latina: revisión sistemática y metaanálisis.

OBJECTIVE: This review synthesizes the evidence (quantitative, general, and by typological categories) of disrespect and abuse during childbirth and abortion in health facilities in Latin America and the Caribbean. METHODS: Systematic searches identified 18 primary studies. Q and I2 were calculated, meta-analyses and meta-regressions were performed, and subgroups were analyzed using a DerSimonian and Laird random-effects model grouped by inverse variance and the Freeman-Tukey double arcsine transformation. RESULTS: Studies conducted in five Latin American countries were identified. No studies from the Caribbean were found. The aggregate prevalence of disrespect and abuse during childbirth and abortion was 39%. The aggregated prevalence of the phenomenon in childbirth was 43% and 29% during abortion. The high heterogeneity made it impossible to generate aggregate measures according to typological categories. Nevertheless, the frequencies of specific forms of the phenomenon were grouped typologically. CONCLUSIONS: The evidence suggests that disrespect and abuse during childbirth and abortion care are human-rights and public-health problems that are prevalent in some countries of the Region. It is necessary to reach international consensus on the definition and operationalization of this problem and to develop standardized methods for its measurement. Doing so is essential in order to achieve the targets of the 2030 Agenda related to reducing maternal and newborn morbidity and mortality and eliminating all forms of violence and discrimination against women.

OBJETIVO: Esta revisão sintetiza as evidências quantitativas, gerais e desagregadas por categorias tipológicas do desrespeito e maus-tratos na atenção institucional ao parto e ao aborto na América Latina e Caribe. MÉTODOS: Dezoito estudos primários foram identificados por meio de buscas sistemáticas. Foi feito o cálculo de Q e I2 e realizadas meta-análises, metarregressões e análises de subgrupos com um modelo de DerSimonian e Laird de efeitos aleatórios agrupados com variância inversa e transformação de Freeman-Tukey (duplo arco-seno). RESULTADOS: Foram identificados estudos realizados em cinco países da América Latina. Não foi identificado nenhum estudo no Caribe. Observou-se uma prevalência agregada de 39% de desrespeito e maus-tratos durante o parto e o aborto. A medida agregada para este fenômeno durante o parto foi 43% e a medida agregada nos casos de aborto foi 29%. Devido à alta heterogeneidade, não foi possível gerar medidas agregadas segundo categorias tipológicas. No entanto, são descritas as frequências de formas específicas do fenômeno agrupadas tipologicamente. CONCLUSÕES: As evidências indicam que o desrespeito e os maus-tratos na atenção ao parto e ao aborto são uma questão de direitos humanos e de saúde pública prevalente em alguns países da Região. É preciso chegar a um consenso internacional sobre a definição e a operacionalização deste problema e elaborar métodos padronizados para mensurá-lo. Isso é imprescindível para o alcance das metas da Agenda 2030 relativas à redução da morbidade e mortalidade materna e perinatal e à eliminação de todas as formas de violência e discriminação contra a mulher.

Non-pharmacological therapies for depressive symptoms in breast cancer patients: Systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE: Depressive symptoms are common comorbidities among breast cancer (BC) patients. Non-pharmacological therapies (NPTs) such as exercise and psychotherapy may reduce depressive symptoms; however, the evidence is inconclusive. The objective of this study is to evaluate if NPTs reduce depressive symptoms among BC patients. METHODS: A systematic review and meta-analysis of randomized clinical trials (RCTs) of NPTs for BC patients were performed. A literature search was conducted from eight databases in English, Portuguese and Spanish from 2006 to 2017. Inclusion criteria were: RCTs that evaluated depressive symptoms as a primary or secondary outcome that did not include pharmacological interventions and did include a non-intervened control group, with at least 30 participants in non-terminal BC stage with no current psychiatric illness. A meta-analysis for each NPT was performed with DerSimonian and Laird's method for the random effects model. Sensitivity analyses were conducted. Heterogeneity and publication bias were assessed. RESULTS: A total of 41 eligible RCTs were identified. Overall, NPTs significantly reduced depressive symptoms (Summary standardized mean difference (SMD) = -0.516; 95%CI: -0.814, -0.218; I2 = 96.2). Of the types of NPTs, psychotherapy significantly reduced depressive symptoms (Summary SMD = -0.819; 95% CI: -1.608, -0.030; I2 = 91.53). A significant difference emerged for Mindfulness (Summary SMD = -0.241; 95% CI: -0.412, -0.070; I2 = 28.6%) and yoga (Summary SMD = -0.305; 95% CI: -0.602, -0.007; I2 = 41.0%) when the heterogeneity was reduced. No evidence of publication bias was observed. CONCLUSIONS: Psychotherapy and mind-body therapies may reduce depressive symptoms in women with BC. Laughter and couples therapy warrant attention in future studies.

State of Children Environmental Health Research in Latin America.

BACKGROUND: Promotion of biomedical research along with the development of evidence-based prevention policies have been suggested as an effective way to reduce environmental risks for children's health in Latin America. However, there is little information on the current state of childhood environmental health research, which might help identify its strengths and limitations, as well as to design a strategy to improve the future of child environmental health research in the region. OBJECTIVE: To describe the current state of environmental health research on children exposed to environmental pollutants in Latin America. METHODOLOGY: We performed a comprehensive search of published peer-reviewed environmental health articles (1994-2014), dealing with the exposure of Latin American children to chemical compounds. We described the type of studies and their research topics, and identified networks of co-authors. We also analyzed the relationship between research funding sources and the impact factor (IF) of the journal where research was published. RESULTS: The average number of publications was about 20 per year. Mexico and Brazil produced almost 70% of the 409 identified papers. The most studied contaminant was lead, but research on this element has declined since 2005. Retrospective studies were the most frequent, and also showed a decreasing trend. Most studies did not assess health effects. Four groups of leading investigators and two collaboration models for scientific production were identified. Except for Mexico, there was very little collaboration with North American and European countries. Compared to articles that did not report financial support, those that received international funding had on average an IF around 7, and those with national funding reached a mean IF near 3. CONCLUSION: There is a limited number of publications and insufficient collaboration between Latin-American scientists. It is necessary to identify strategies to stimulate South-South-North alliances and strengthen the scarce research on the environmental health of children in the region.

Epidemiological Characteristics of Dengue Disease in Latin America and in the Caribbean: A Systematic Review of the Literature.

Dengue, an important mosquito-borne virus transmitted mainly by Aedes aegypti, is a major public health issue in Latin America and the Caribbean. National epidemiological surveillance systems, usually based on passive detection of symptomatic cases, while underestimating the true burden of dengue disease, can provide valuable insight into disease trends and excess reporting and potential outbreaks. We carried out a systematic review of the literature to characterize the recent epidemiology of dengue disease in Latin America and the English-speaking and Hispanic Caribbean Islands. We identified 530 articles, 60 of which met criteria for inclusion. In general, dengue seropositivity across the region was high and increased with age. All four virus serotypes were reported to circulate in the region. These observations varied considerably between and within countries and over time, potentially due to climatic factors (temperature, rainfall, and relative humidity) and their effect on mosquito densities and differences in socioeconomic factors. This review provides important insight into the major epidemiological characteristics of dengue in distinct regions of Latin America and the Caribbean, allowing gaps in current knowledge and future research needs to be identified.

Identification of biomedical journals in Spain and Latin America.

OBJECTIVES: Journals in languages other than English that publish original clinical research are often not well covered in the main biomedical databases and therefore often not included in systematic reviews. This study aimed to identify Spanish language biomedical journals from Spain and Latin America and to describe their main features. METHODS: Journals were identified in electronic databases, publishers' catalogues and local registries. Eligibility was determined by assessing data from these sources or the journals' websites, when available. FINDINGS: A total of 2457 journals were initially identified; 1498 met inclusion criteria. Spain (27.3%), Mexico (16.0%), Argentina (15.1%) and Chile (11.9%) had the highest number of journals. Most (85.8%) are currently active; 87.8% have an ISSN. The median and mean length of publication were 22 and 29 years, respectively. A total of 66.0% were indexed in at least one database; 3.0% had an impact factor in 2012. A total of 845 journals had websites (56.4%), of which 700 (82.8%) were searchable and 681 (80.6%) free of charge. CONCLUSIONS: Most of the identified journals have no impact factor or are not indexed in any of the major databases. The list of identified biomedical journals can be a useful resource when conducting hand searching activities and identifying clinical trials that otherwise would not be retrieved.

Aportes y desafíos del enfoque de género en el estudio de las enfermedades transmitidas por vector / Challenges and inputs of the gender perspective to the study of vector borne diseases

Los determinantes sociales y el enfoque de género son un imperativo para comprender la vulnerabilidad de las poblaciones, sus riesgos de exposición, las condicionantes de su atención, y su organización y participación en la prevención y control de las enfermedades. El enfoque ecosistémico incorpora el estudio de los determinantes sociales y la perspectiva de género, debido a que la emergencia de las enfermedades transmitidas por vector está ligada a la urbanización, a la infraestructura sanitaria y a las condiciones materiales de las viviendas (domicilio). El género emerge como un elemento explicativo de los roles que hombres y mujeres desempeñan en los diferentes ámbitos (doméstico, comunitario y social), y que moldean los riesgos de exposición a los vectores y abren perspectivas de éxito a las estrategias de prevención, control y atención de la enfermedad. El objetivo es contribuir a la reflexión sobre el enfoque de género en el análisis de los riesgos a través de un modelo y marco conceptual propio.

The analysis of social determinants and gender within the health-disease-care process is an imperative to understand the variables that define the vulnerability of populations, their exposure risks, the determinants of their care, and the organization and participation in prevention and control programs. Ecohealth incorporates the study of the social determinants and gender perspectives because the emergency of dengue, malaria and Chagas disease are bound to unplanned urbanization, deficient sanitary infrastructure, and poor housing conditions. Gender emerges as an explanatory element of the roles played by men and women in the different scenarios (domestic, communitarian and social) that shape exposure risks to vectors and offer a better perspective of success for the prevention, control and care strategies. The objective is to contribute to the understanding on the gender perspective in the analysis of health risks through a conceptual framework.

[Challenges and inputs of the gender perspective to the study of vector borne diseases]. / Aportes y desafíos del enfoque de género en el estudio de las enfermedades transmitidas por vector.

The analysis of social determinants and gender within the health-disease-care process is an imperative to understand the variables that define the vulnerability of populations, their exposure risks, the determinants of their care, and the organization and participation in prevention and control programs. Ecohealth incorporates the study of the social determinants and gender perspectives because the emergency of dengue, malaria and Chagas disease are bound to unplanned urbanization, deficient sanitary infrastructure, and poor housing conditions. Gender emerges as an explanatory element of the roles played by men and women in the different scenarios (domestic, communitarian and social) that shape exposure risks to vectors and offer a better perspective of success for the prevention, control and care strategies. The objective is to contribute to the understanding on the gender perspective in the analysis of health risks through a conceptual framework.

A systematic review of rubella vaccination strategies implemented in the Americas: impact on the incidence and seroprevalence rates of rubella and congenital rubella syndrome.

OBJECTIVE: To evaluate the impact of rubella vaccination strategies on the rates of acquired rubella and congenital rubella syndrome in the Americas. METHODS: We conducted a systematic review of the literature (MEDLINE, PubMed, EMBASE, Cochrane Library, Artemisa Database, LILACS Database, Evidence Portal, VHL-PAHO Portal, Scielo, and Grey-Literature sources) that was published from 1969-2010. We included studies on rubella incidence and seroprevalence rates that were associated with rubella vaccination. The quality of the studies was evaluated according to international guidelines. RESULTS: A total of 14 studies were identified: 2 clinical trials, 2 cohort studies, 3 transversal studies, 5 ecological studies, and 2 mathematical models. Childhood vaccination reduced the incidence of rubella by 23.6% to 99.6%, increased the occurrence of epidemic cycles in Argentina and in the United States, and shifted the illness to susceptible adults. Vaccination strategies that focused on women and children in Brazil were associated with a 5.5-fold greater incidence of rubella in men leading to new outbreaks and CRS. A combined vaccination strategy with a universal approach that included routine vaccination for boys, girls, women, and men in Mexico and in Costa Rica reduced the incidence of rubella by more than 98% and led to absence of CRS since 2008. A medium and a low risk of bias were found in 3 and 4 articles, respectively. CONCLUSION: The results of this review demonstrate that the combined vaccination strategy with a universal approach was the most effective strategy as evidenced by a drastic reduction in the number of cases and the interruption of endemic transmission of rubella in the Americas.