Basal Cell Carcinoma: Incidence and Trends in Valencia, Spain. / Carcinoma basocelular: incidencia y tendencias en Valencia (España).

BACKGROUND: There is a need for epidemiological and incidence data on the occurrence of basal cell carcinoma (BCC) in Spain. OBJECTIVES: Our study was designed to retrospectively retrieve cases from our computer databases from 2010 through 2016 to provide updated data on the actual incidence of BCC in Valencia, eastern Spain. MATERIAL AND METHODS: This was an epidemiological study on basal cell carcinoma conducted in Valencia, eastern Spain. We analyzed a total of 2171 patients and 4047 tumors, and gathered data to estimate the actual incidence of BBC in our region. RESULTS AND CONCLUSIONS: Our study confirmed that the incidence of BCC is much higher than previously reported. We calculated a crude incidence of 410.38 BCCs/100 000 person-years, an adjusted rate for the European population of 256.98 BCCs/100 000 person-years, and an adjusted rate for the world population of 196.26 BCCs/100 000 person-years. Risk is up to 29.49% higher for men (464.07 cases/100 000 person-years vs 358.40 cases/100 000 person-years for women). Incidence also increases by an annual 3.91% (a significantly higher annual incidence of 8.28% in women vs a 0.92% annual incidence in men). Overall, the lifetime risk for developing a BCC is 5.8% (5.02% in women and 7% in men).

Epidemiology of Primary Cutaneous Melanoma in the Migjorn Health Sector of Mallorca, Spain From 2003 Through 2021. / Epidemiología del melanoma cutáneo primario en el sector Migjorn en la isla de Mallorca entre los años 2003-2021.

The study of the increasing incidence of melanoma over the past few decades is essential regarding prevention and optimization of health resources. We collected cases of melanoma from Hospital son Llàtzer from the Migjorn health sector of Mallorca, Spain from 2003 through 2021, and calculated the incidence of melanoma adjusted to the standard European population. In addition, other demographic and clinicopathological data were descriptively analyzed too. A total of 690 new cases of melanoma were detected with a progressive increase in the age-standardized incidence from 7.47 cases per 100,000 inhabitants/year in 2003 up to 23.84 in 2021 mainly due to early stages of the disease. The incidence of melanoma has increased significantly in Mallorca probably due to the increasing population coming from northern Europe (low phototypes), sun exposure habits (tourism, fishing, agriculture), and improved early diagnosis.

[Translated article] Epidemiology of Primary Cutaneous Melanoma in the Migjorn Health Sector of Mallorca, Spain From 2003 Through 2021.

The study of the increasing incidence of melanoma over the past few decades is essential regarding prevention and optimization of health resources. We collected cases of melanoma from Hospital son Llàtzer from the Migjorn health sector of Mallorca, Spain from 2003 through 2021, and calculated the incidence of melanoma adjusted to the standard European population. In addition, other demographic and clinicopathological data were descriptively analyzed too. A total of 690 new cases of melanoma were detected with a progressive increase in the age-standardized incidence from 7.47 cases per 100,000 inhabitants/year in 2003 up to 23.84 in 2021 mainly due to early stages of the disease. The incidence of melanoma has increased significantly in Mallorca probably due to the increasing population coming from northern Europe (low phototypes), sun exposure habits (tourism, fishing, agriculture), and improved early diagnosis.

Effects of age, period, and cohort on the incidence of psoriasis in Spain: a 30-year review (1990-2019).

AIM: This study aimed to investigate the effects of age, period, and cohort on the incidence of psoriasis in Spain from 1990 through 2019 using the Global Burden of Disease (GBD) database and age-period-cohort (A-P-C) analysis. METHODS: We conducted an ecological trend study to analyze the incidence rates of psoriasis in Spain from 1990 through 2019. Joinpoint software and National Cancer Institute A-P-C tools were used to identify trends and assess the effects of age, period, and cohort. RESULTS: From 1990 through 2019, an estimated 2.99 million cases of psoriasis were diagnosed in Spain, with a mean annual increase of 0.49%. Significant decreases in age-standardized incidence rates (ASIR) were reported for both sexes, with women consistently maintaining a slightly higher ASIR. Joinpoint analysis revealed multiple turning points in the downward trend, indicating periods of stabilization. A-P-C analysis demonstrated significant declines in both net (overall trend) and local drift (age-specific trends), indicating a broad decrease in the incidence of psoriasis across most age groups. While the risk of psoriasis increased with age, peaking in the 50-54 age group, it declined thereafter. Furthermore, the analysis revealed a continuous decline in risk from 1990 through 2019 for both sexes, with individuals born in the early 21st century exhibiting a significantly lower risk vs those born in the early 20th century. CONCLUSION: This study observed a slight decline in the reported psoriasis ASIR in Spain, potentially due to reduced exposure to risk factors. However, limitations in data and the complexity of factors influencing the incidence of psoriasis require further research.

The effect of different definitions of hepatic injury on incidence and mortality rates in the ICU patient population with secondary hepatic injury.

OBJECTIVE: The aim was to investigate how different hepatic injury (HI) definitions used in the same study population change incidence and mortality rates and which would best diagnose secondary HI. DESIGN: Single-centre retrospective observational cohort study. SETTING: Tertiary hospital ICU, ANKARA, Turkey. PATIENTS: Four hundred seventy-eight adult patients were included in the study. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Three definitions of HI were compared. Taking the SOFA hepatic criteria (SOFA: Total bilirubin (TBL) > 1.2 mg/dl) as the gold standard, sensitivity, specificity, positive and negative predictive values, and accuracy of the modified 2017 definition by the American College of Gastroenterology (ACG) and the 2019 European Association for the Study of the Liver (EASL) were calculated. RESULTS: Incidence rates ranged from 10% to 45% according to the definition (p < 0.005), while mortality rates ranged from 38% to 57%. When the SOFA1.2 (TBL > 1.2 definition was taken as the gold standard, the diagnostic value of the ACG definition was high, and HI was found to be an independent risk factor that increased mortality four times. CONCLUSIONS: According to this study's results, the incidence and mortality rates of secondary HI vary greatly depending on the definition used. A definition that includes minimal increases in ALT, AST, and TBL predicts mortality with reasonable incidence rates.

Sex-specific Difference for Small Cell Lung Cancer from Immunotherapy Advancement.

BACKGROUND: The treatment of lung cancer has witnessed significant progress, leading to improved survival rates among patients. It is important to assess the individual contributions of non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) to overall lung-cancer incidence and mortality trends based population, especially sex difference. METHODS: We analyzed lung cancer mortality based on subtype, gender, and calendar year. The Joinpoint software was used to identify any changes in incidence and trends in mortality. RESULTS: Incidence and incidence-based mortality declined from 2001 to 2019 both NSCLC and SCLC annually. The most significant decrease occurred between 2016 and 2019 with annual percent change of 5.71%. From 2012 to 2016, the incidence-based mortality of SCLC in women changed by 2.7% in tandem with incidence decreased 2.84%. Remarkably, the incidence-based mortality for women declined notably by 5.23% between 2016 and 2019, even as the incidence showed a less extent of decreasing (-2.59%). The survival rate for women was 15.2% in 2001, 19.3% in 2016, it had increased to 21.3% in 2018 but similar trends not in men. The survival curve showed the change in survival outcomes over time among men and women (median overall survival: 13 vs 23months) receiving immunotherapy for SCLC. CONCLUSION: Population-level mortality from NSCLC and SCLC in the United States fell sharply from 2016 to 2019 as incidence deceased, and survival improved substantially. Our analysis suggests that approval for and use of immunotherapy may explain the mortality reduction observed during this period, with significant benefits especially for SCLC patient in women.

The association between pre-existing heart failure and cancer incidence: A systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: Cardiovascular diseases (CVD) and cancer are some of the most recognized causes of mortality and morbidity worldwide. Cancer is the second leading cause of death in heart failure (HF) populations. Recent studies have hypothesized that HF might promote the development and progression of cancer. We aim to analyze and discuss the most recent evidence on the relationship between HF and cancer development. METHODS: From inception to November 2022, we searched PubMed, Web of Science and ClinicalTrials.gov for relevant articles on patients with HF and a subsequent cancer diagnosis that reported outcomes of overall and site-specific cancer incidence, or mortality. RESULTS: Of 2401 articles identified in our original search, 13 articles met our criteria. Studies reporting risk rate estimates were summarized qualitatively. Studies reporting hazard ratios (HRs), or relative risks were combined in a meta-analysis and revealed that HF was associated with an increased overall cancer incidence with a HR=1.30 (95% CI: 1.04-1.62) compared with individuals without HF. Subgroup analyses by cancer type revealed increased risk for lung cancer (HR=1.87; 95% CI: 1.28-2.73), gastrointestinal cancer (HR=1.22; 95% CI: 1.03-1.45), hematologic cancer (HR=1.60; 95% CI: 1.23-2.08) and female reproductive cancer (HR=1.67; 95% CI: 1.27-2.21). Mortality from cancer was higher in HF patients compared with non-HF subjects with a HR=2.17 (95% CI: 1.23-3.84). CONCLUSIONS: Our systematic review and meta-analysis revealed that HF may result in a subsequent increase in cancer incidence as well as in cancer-related mortality. The most common cancer subtypes in HF patients were lung, female reproductive system, and hematologic cancers. Further research is needed to understand this association better and to provide the best cardiological and oncological care.

The influence of age, period, and cohort factors on the incidence of kidney cancer in Spain 1990-2019: Evidence from the global burden of disease study.

OBJECTIVE: This study aimed to assess the influence of age, period, and cohort (A-P-C) factors on kidney cancer (KC) incidence trends in Spain from 1990 to 2019. METHODS: Employing data from the Global Burden of Disease Study 2019, we employed joinpoint analysis to determine long-term patterns and A-P-C modelling to quantify net drift, local drift, longitudinal age curves, and rate ratios (RRs) of period and cohort effects. RESULTS: Over the period 1990-2019, an estimated 142,811 cases of KC were diagnosed in Spain. A consistent upward trend in KC incidence was observed for both men and women, with the male-to-female ratio remaining stable at 2.6. Joinpoint analysis identified three distinct periods for men: An initial period (1990-1995) characterised by a significant increase in rates, a subsequent period (1995-2016) characterised by a slowdown in the rate of increase, and a final period (2016-2019) in which rates have plateaued. In women, 2 time periods were observed: an initial period (1990-2007) in which rates increased significantly, followed by a period of stabilization (2007-2019). Men born in the early-mid 20th century had a rising KC risk, peaking in the 1960s. Women's risk rose steadily, peaking in the late 1990s. CONCLUSION: A-P-C analysis reveals steady KC incidence increase in both genders over three decades. This highlights the need for targeted public health policies and effective prevention strategies.

[Retrospective estimation of initial COVID-19 infections in the Santiago Metropolitan Region in Chile]. / Estimación retrospectiva de los casos iniciales de COVID-19 en Santiago Región Metropolitana en Chile.

OBJECTIVE: Estimate daily infections of COVID-19 during the first year of the pandemic in the Santiago Metropolitan Region (SRM) in Chile and Chile that are more realistic than those officially registered. METHOD: Retrospective estimate of daily infections from daily data on COVID-19 deaths, a seroprevalence study, and the REMEDID (Retrospective Methodology to Estimate Daily Infections from Deaths) algorithm. RESULTS: In SRM, it is observed that: 1) the maximum peak of infections was more than double that registered in the official statistics; 2) such peak was reached on May 22 (95% CI: 20-24 May), 2022, that is, 24 days before the official date of the peak of infections; and 3) the first estimated contagion took place on January 28, 2020 (95% CI: January 21 to February 16), that is, 36 days before the official date. In Chile, the situation is similar. During the first wave SRM accounted for 70%-76% of those infected in Chile, while from August 2020 onwards it accounted for 36%-39%. CONCLUSIONS: The official records of COVID-19 infections in SRM and Chile underestimated the real number of positives and showed a delay of about a month in the dynamics of infections. This is not an isolated situation, as it is known to have been the case in other countries as well. However, it is important to have reliable estimates for a correct modeling of the spread of the virus.

Incidence of incontinence-associated dermatitis in hospitalised neonates. Adaptation and validation of a severity scale.

INTRODUCTION: Up to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates. METHODS: Cross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals. RESULTS: We obtained a content validity index of 0.869 for the total scale (95% CI, 0.742-0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD. CONCLUSION: The Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants.

Rising testicular cancer incidence in Spain despite declining mortality: an age-period-cohort analysis.

BACKGROUND: Testicular cancer, primarily affecting young men, has seen an alarming rise globally. This study delves into incidence and mortality trends in Spain from 1990 to 2019 using the Global Burden of Disease (GBD) database and the Age-Period-Cohort (A-P-C) model. METHODS: We analyzed GBD data on testicular cancer cases and deaths in Spain, calculating age-standardized rates (ASIR and ASMR) and employing Joinpoint regression to identify significant shifts. The A-P-C model further dissected the effects of age, period, and birth cohort on these trends. RESULTS: A striking doubling in testicular cancer incidence was observed, from 3.09 to 5.40 per 100,000 men (1.9% annual increase), while mortality rates remained stable and even decreased in younger age groups (0.34 to 0.26 per 100,000, 0.8% annual decrease). Joinpoint analysis revealed four distinct periods of increasing incidence, with a recent slowdown. The A-P-C model highlighted a consistent rise in incidence risk with each successive generation born after 1935, contrasting with a progressive decline in mortality risk across cohorts, particularly marked for those born since the 1960s. CONCLUSION: While mortality rates are encouraging, Spain reflects the global trend of escalating testicular cancer incidence. The A-P-C analysis suggests a generational influence, but the underlying causes remain elusive. Further research is crucial to understand these trends and implement effective prevention strategies to combat this growing health concern.

Incidence of confusional syndrome (delirium) in a Latin American university hospital.

BACKGROUND: Little is known about the incidence of delirium and its subtypes in patients admitted to different departments of university hospitals in Latin America. OBJECTIVE: To determine the incidence of delirium and the frequency of its subtypes, as well as its associated factors, in patients admitted to different departments of a university hospital in Bogotá, Colombia. METHODS: A cohort of patients over 18 years of age admitted to the internal medicine (IM), geriatrics (GU), general surgery (GSU), orthopaedics (OU) and intensive care unit (ICU) services of a university hospital was followed up between January and June 2018. To detect the presence of delirium, we used the CAM (Confusion Assessment Method) and the CAM-ICU if the patient had decreased communication skills. The delirium subtype was characterised using the RASS (Richmond Agitation and Sedation Scale). Patients were assessed on their admission date and then every two days until discharged from the hospital. Those in whom delirium was identified were referred for specialised intra-institutional interdisciplinary management. RESULTS: A total of 531 patients admitted during the period were assessed. The overall incidence of delirium was 12% (95% CI, 0.3-14.8). They represented 31.8% of patients in the GU, 15.6% in the ICU, 8.7% in IM, 5.1% in the OU, and 3.9% in the GSU. The most frequent clinical display was the mixed subtype, at 60.9%, followed by the normoactive subtype (34.4%) and the hypoactive subtype (4.7%). The factors most associated with delirium were age (adjusted RR = 1.07; 95% CI, 1.05-1.09), the presence of four or more comorbidities (adjusted RR = 2.04; 95% CI, 1.31-3.20), and being a patient in the ICU (adjusted RR = 2.02; 95% CI, 1.22-3.35). CONCLUSIONS: The incidence of delirium is heterogeneous in the different departments of the university hospital. The highest incidence occurred in patients that were admitted to the GU. The mixed subtype was the most frequent one, and the main associated factors were age, the presence of four or more comorbidities, and being an ICU patient.

Bronchiolitis trends in out-of-hospital urgent care services in the Community of Madrid: Observational study, 2016-2023.

INTRODUCTION: Bronchiolitis poses a considerable challenge during its seasonal peak, overwhelming the material and human resources available to care for affected patients. As a result, interhospital transfers increase exponentially. We did not find any studies analysing the characteristics of patients with bronchiolitis managed in out-of-hospital urgent care (OHUC) services and the impact of the COVID-19 pandemic on the epidemiology of bronchiolitis. OBJECTIVE: To establish the characteristics of paediatric and neonatal patients with acute bronchiolitis (AB) managed in OHUC services in the Community of Madrid and to analyse the impact of the COVID-19 pandemic on the epidemiology of bronchiolitis. METHODS: Retrospective cross-sectional observational and descriptive study carried out in OHUC settings in the Community of Madrid between 2016 and 2023. We included patients with a diagnosis of acute bronchiolitis based on the ICD-10 codes documented in the electronic records of urgent care visits and interhospital transports. We collected data on sociodemographic, clinical and treatment (ventilation and medication) variables. RESULTS: The sample included 630 patients with AB: 343 managed in non-neonatal OHUC (non-neo) services and 287 by the mobile neonatal intensive care unit transport team (NTT). The median age was 3.7 months (IQR, 2.8-4.7) in patients in the non-neo OHUC group and 19 days (IQR, 14.2-23.7) in the NTT group. There was a statistically significant increase in age in the 2020/2021 season in the non-neo OHUC group. The severity score was significantly higher in the NTT group. There was an unusual peak in bronchiolitis cases in June 2021, coinciding with the end of the 4th wave of the COVID-19 pandemic. The incidence of bronchiolitis was highest after the 6th wave of the pandemic (13.5 cases per 10 000 children aged < 2 years). CONCLUSIONS: The median age of paediatric patients with AB managed in OHUC services increased following the end of the lockdown imposed due to the COVID-19 pandemic, which was probably associated with the lack of exposure to the viruses that cause it. This also may explain why the incidence of bronchiolitis was highest in the season following the 6th wave of the pandemic. The severity score was higher in neonatal patients. Epidemiological surveillance, the introduction of protocols and the implementation of an ongoing training programme for non-specialized health care staff involved in the transport of these patients could improve their management.

Prevalência, incidência e caracterização sociodemográfica e clínica das pessoas com estoma de eliminação em Portugal / Prevalence, incidence, and sociodemographic and clinical characterization of individuals with an intestinal or urinary stoma in Portugal / Prevalencia, incidencia y caracterización sociodemográfica y clínica de las personas con ostomía de eliminación en Portugal

Resumo Enquadramento: Dados que caracterizam as pessoas com estoma em Portugal são escassos. Estabelecer estimativas epidemiológicas pode melhorar o conhecimento sobre esta população e adaptar modelos de cuidados de saúde. Objetivos: Estimar a prevalência e incidência de pessoas com estoma de eliminação em Portugal em 2021. Metodologia: Estudo observacional, longitudinal e retrospetivo, a partir de uma base de dados de dispensa de dispositivos para ostomia. Resultados: Em 2021, o número estimado de pessoas com pelo menos um estoma foi de 22.045. Entre estes, 19.793 [IC95%:19.599;19.994] tinham um estoma de eliminação. Na sua maioria eram homens (61,4%), em média tinham 70,5 anos e residiam preferencialmente na região interior do país. O tipo de estoma de eliminação mais prevalente foi a colostomia (48,8%). A incidência estimada de novos casos foi de 6.622, sendo 5.834 [IC95%:5.680;5.984] referentes a estomas de eliminação. Conclusão: Estes resultados permitiram caracterizar o perfil das pessoas com estoma de eliminação em Portugal. Poderão ser úteis para ajustar os programas de prevenção/acompanhamento em saúde desta população e ainda alocar recursos especializados.

Abstract Background: Data characterizing individuals with a stoma in Portugal is limited. Establishing epidemiological estimates can enhance understanding of this population and facilitate the adaptation of healthcare models. Objectives: To estimate the prevalence and incidence of individuals in Portugal who have undergone intestinal or urinary ostomy in 2021. Methodology: Observational, longitudinal, and retrospective study using a stoma appliance dispensing database. Results: In 2021, an estimated 22,045 individuals had at least one stoma, with 19,793 [95%CI:19,599;19,994] having an intestinal/urinary stoma. Most of these individuals were men (61.4%) with a mean age of 70.5 years and resided in the inland region of Portugal. Colostomy was the most prevalent type of intestinal/urinary stoma (48.8%). The estimated incidence of new cases was 6,622, of which 5,834 [95%CI:5,680;5,984] were intestinal/urinary stomas. Conclusion: These results characterize the profile of individuals with intestinal and urinary stomas in Portugal. They may be useful in adjusting prevention and health monitoring programs for this population and allocating specialized resources.

Resumen Marco contextual: Los datos que caracterizan a las personas con estomas en Portugal son escasos. Establecer estimaciones epidemiológicas puede mejorar el conocimiento sobre esta población y adaptar modelos sanitarios. Objetivos: Estimar la prevalencia y la incidencia de personas con estoma de eliminación en Portugal en 2021. Metodología: Estudio observacional, longitudinal y retrospectivo, basado en una base de datos de dispensaciones de dispositivos de ostomía. Resultados: En 2021, el número estimado de personas con al menos un estoma era de 22.045, de las cuales 19.793 [IC95%:19.599;19.994] tenían un estoma de eliminación. La mayoría de ellos eran hombres (61,4%), tenían una edad media de 70,5 años y vivían principalmente en el interior del país. El tipo de estoma de eliminación más frecuente era la colostomía (48,8%). La incidencia estimada de nuevos casos fue de 6.622, de los cuales 5.834 [IC95%:5.680;5.984] eran estomas de eliminación. Conclusión: Estos resultados han permitido caracterizar el perfil de las personas con estoma de eliminación en Portugal. Podrían ser útiles para ajustar los programas de prevención/seguimiento de la salud de esta población y para asignar recursos especializados.

Incidencia de diabetes gestacional en Chile durante el periodo 2001-2022 / Incidence of gestational diabetes in Chile during the period 2001-2022

Introducción: La diabetes mellitus gestacional (DG) se define como una hiperglucemia que se diagnostica por primera vez durante la gestación. Objetivo: Describir la incidencia de diabetes gestacional (DG) durante el periodo 2001-2022 en Chile. Método: Estudio observacional, descriptivo, ecológico y longitudinal. Se incluyeron los egresos hospitalarios consignados como diabetes durante el embarazo y DG en el periodo 2001-2022, de la base de datos del Departamento de Estadística e Información en Salud. Se determinó la incidencia de DG por la cantidad de partos institucionalizados, para cada año. Se analizaron la tendencia en el periodo y las diferencias entre regiones. Resultados: Se determinó un aumento de 2,615 casos de DG por 1000 partos atendidos por año en el periodo 2001-2022. En particular, en el periodo 2016-2022 la incidencia aumentó hasta 6,746 casos de DG por 1000 partos por año. En el año 2022, la región de La Araucanía presentó una incidencia de 284,4 casos por 1000 partos, lo que representa un aumento del 503% en relación con la incidencia media nacional (56,5 casos por 1000 partos). Conclusiones: Se demuestra un aumento significativo de la DG, en especial desde 2016. La situación en La Araucanía podría relacionarse con los niveles de pobreza multidimensional.

Introduction: Gestational diabetes mellitus (GDM) is defined as hyperglycemia first diagnosed during pregnancy. Objetive: To describe the incidence of gestational diabetes (GD) during the period 2001-2022 in Chile. Method: Observational, descriptive, ecological, longitudinal study. Hospital records of diabetes during pregnancy and GD in the period 2001-2022 were included, from the database of the Department of Statistics and Health Information. The incidence of GD was determined by the number of births, for each year. Trends in the period and differences between regions were analysed. Results: The results show an increase of 2.615 GD cases per 1000 births per year in the period 2001-2022. Particularly, in the period 2016-2022 the incidence increased to 6.746 cases of GD per 1000 births per year. In 2022, La Araucanía region presented an incidence of 284.4 cases per 1000 births, which represents an increase of 503% in relation to the mean national incidence (56.5 cases per 1000 births). Conclusions: A significant increase in DG is demonstrated, especially since 2016. The situation in La Araucanía could be related to the levels of multidimensional poverty.

Efeitos do lockdown na incidência da COVID-19 na fase de emergência sanitária da pandemia / Effects of lockdown on COVID-19 incidence in the health emergency phase of the pandemic

RESUMO Objetivo avaliar os efeitos do lockdown na incidência da COVID-19 na fase de emergência sanitária da pandemia. Métodos trata-se de um estudo ecológico transversal. Os dados foram coletados nas páginas da Fundação Sistema Estadual de Análise de Dados e da Prefeitura Municipal de Araraquara. Para analisar a incidência da COVID-19 foram considerados os casos notificados no referido município. Para comparar os períodos em relação aos casos diários, foi utilizado o modelo de regressão com distribuição binomial-negativa com função de ligação logarítmica. Resultados para todas as faixas etárias, com exceção de menores de 20 anos, verificou-se diferença estatística nos coeficientes de incidência. Para o sexo feminino o declínio na incidência da doença foi mais expressivo. Considerando ambos os sexos e todas as faixas etárias, observou-se uma redução de 49% na incidência de casos. Conclusão houve uma redução significativa na incidência da doença considerando a população geral do município. Contribuições para a prática: a disponibilidade e adoção de medidas tradicionais de saúde pública, como o lockdown, mostraram-se essenciais para reduzir casos e óbitos de doenças de vírus respiratórios emergentes sem tratamento e vacina.

ABSTRACT Objective to assess the effects of lockdown on the incidence of COVID-19 during the health emergency phase of the pandemic. Methods this is a cross-sectional ecological study. Data was collected from the websites of the State Data Analysis System Foundation and Araraquara City Hall. To analyze the incidence of COVID-19, cases reported in the municipality were considered. A regression model with a negative binomial distribution and a logarithmic link function was used to compare the periods in terms of daily cases. Results for all age groups except those under 20, there was a statistical difference in the incidence coefficients. For females, the decline in the incidence of the disease was more significant. Considering both sexes and all age groups, there was a 49% reduction in the incidence of cases. Conclusion there was a significant reduction in the incidence of the disease in the general population of the municipality. Contributions to practice: the availability and adoption of traditional public health measures, such as lockdown, proved essential to reducing cases and deaths from emerging respiratory virus diseases without treatment or vaccine.

Incidência de sífilis no estado do Rio de Janeiro e nomunicípio de Seropédica nos anos de 2010 a 2022 / Incidence of syphilis in the state of Rio de Janeiro andmunicipality of Seropédica in the years 2010 to 2022

Sífilis é uma infecção sexualmente transmissível (IST) que sinaliza a necessidade de efetivas políticas públicas devido ao aumento de casos na última década. Dessa forma, o objetivo do trabalho é descrever a incidência de sífilis no estado do Rio de Janeiro e no município de Seropédica. Métodos: foi realizado um estudo descritivo, com abordagem quantitativa. A coleta dos dados foi realizada por meio do Sistema de Informação de Agravos de Notificação (Sinan), referentes ao município de Seropédica e ao estado do Rio de Janeiro, no período de 2010 a 2022. Resultados: foram identificados 105.138, 79.609 e 42.819 casos de sífilis adquirida, em gestantes e congênita, respectivamente, no estado do Rio de Janeiro e 187, 140 e 79 casos de sífilis adquirida, em gestantes e congênita, respectivamente, no município de Seropédica. Foi observado uma incidência maior para sífilis adquirida entre homens em comparação com mulheres tanto no estado do Rio de Janeiro (62.719 versus 42.346) quanto no município de Seropédica (110 versus 77). Houve um aumento nas taxas de incidência de sífilis no estado do Rio de Janeiro e no município de Seropédica ao longo dos anos. Conclusão: a sífilis segue sendo uma doença com alta incidência no território do Rio de Janeiro. Nesse sentido, é importante elaborar estratégias em saúde pública mais efetivas às pessoas acometidas por tal infecção.

Syphilis is a sexually transmitted infection (STI) that signals the need for effective public policies due to the increase in cases in the last decade. Thus, the aim of this study is to describe the incidence of syphilis in the state of Rio de Janeiro and in the municipality of Seropédica. Methods: a descriptive study with a quantitative approach was carried out. Data collection was performed through the Sistema de Informação de Agravos de Notificação (Sinan), referring to the municipality of Seropédica and the state of Rio de Janeiro, from 2010 to 2022. Results: overall, 105.138, 79.609 and 42.819 cases of acquired syphilis, in pregnant women, and congenital syphilis, respectively, were identified in the state of Rio de Janeiro, and 187, 140, and 79 cases of acquired syphilis, in pregnant women, and congenital syphilis, respectively, were identified in the municipality of Seropédica. A higher incidence of acquired syphilis was observed among men compared to women both in the state of Rio de Janeiro (62.719 versus 42.346) and in the municipality of Seropédica (110 versus 77). There has been an increase in the incidence rates of syphilis in the state of Rio de Janeiro and the municipality of Seropédica over the years. Conclusion: syphilis continues to be a disease with a high incidence in the territory of Rio de Janeiro. In this sense, it is important to develop more effective public health strategies for people affected by this infection.

Estadio, perfil biológico y tendencias de incidencia y mortalidad de cáncer de mama en Uruguay: análisis por franjas etarias / Stage, biological profile and trends in the incidence and mortality of breast cancer in Uruguay: analysis by age groups / Estágio, perfil biológico e tendências da incidência e mortalidade por cáncer de mama no Uruguai: análise por faixa etária

Introducción: el cáncer de mama es el tumor maligno más frecuente y la primera causa de muerte por cáncer en mujeres en Uruguay y en el mundo. La evidencia epidemiológica sugiere que el cáncer de mama en diferentes grupos de edades se comportaría como patologías distintas. El objetivo de este trabajo es caracterizar el cáncer de mama en Uruguay para diferentes estratos de edades. Material y método: se analizaron las tendencias temporales de la incidencia de cáncer de mama en mujeres en Uruguay en el período 2002-2019, y de la mortalidad por esta causa en 1990-2020. Para el quinquenio 2015-2019, se analiza además la distribución de estadios al diagnóstico y de perfiles biológicos (luminales, triple negativos y HER2 positivos). Se analizan tres segmentos de edades: mujeres de 20 a 44 años, de 45 a 69 y de 70 y más años. Resultados: las tasas de incidencia para el conjunto de edades se presentaron estables en el período 2002-2019, mientras que la mortalidad presenta una tendencia decreciente en el período 1990-2020. En las mujeres menores de 45 años se encuentra un aumento en la incidencia, con mortalidad que decrece hasta el 2010, seguido de una estabilización de las tasas; en las mujeres de 45 a 69 años la incidencia se mantiene estable y la mortalidad decrece; en las mayores de 70 años, la incidencia decrece mientras la mortalidad se mantiene estable. Más del 70% de los casos se diagnostican en estadios I y II. Los tumores luminales (receptores hormonales positivos, HER2 negativos) son el subtipo más frecuente para todos los grupos, la proporción de tumores con estas características aumenta con la edad, mientras decrece la proporción de HER2 positivo y triple negativo. Conclusión: en las mujeres uruguayas el cáncer de mama presenta características diferenciales para las tres franjas de edades analizadas.

Introduction: Breast cancer is the most common malignant tumor and the leading cause of cancer death in women in Uruguay and worldwide. Epidemiological evidence suggests that breast cancer in different age groups behaves as distinct pathologies. The objective of this work is to characterize breast cancer in Uruguay for different age groups. Method: Temporal trends in the incidence of breast cancer in women in Uruguay are analyzed for the period 2002-2019, along with mortality trends for this cause from 1990 to 2020. For the five-year period 2015-2019, the distribution of stages at diagnosis and biological profiles (Luminal, Triple-negative, and Her2 positive) is also analyzed. Three age segments are analyzed: women aged 20 to 44 years, 45 to 69 years, and 70 years and older. Results: The incidence rates for all age groups remained stable during the period 2002-2019, while mortality showed a decreasing trend in the period 1990-2020. In women under 45, there is an increase in incidence, with mortality decreasing until 2010, followed by a stabilization of rates; in women aged 45 to 69, incidence remains stable and mortality decreases; in those over 70, incidence decreases while mortality remains stable. More than 70% of cases are diagnosed at stages I and II. Luminal tumors (hormone receptor positive, Her2 negative) are the most frequent subtype for all age groups. The proportion of tumors with these characteristics increases with age, while the proportion of Her2 positive and triple-negative tumors decreases. Conclusions: In Uruguayan women, breast cancer presents differential characteristics for the three age groups analyzed.

Introdução: O câncer de mama é o tumor maligno mais comum e a principal causa de morte por câncer em mulheres no Uruguai e no mundo. Evidências epidemiológicas sugerem que o câncer de mama se comportaria como patologias distintas em diferentes faixas etárias. O objetivo deste trabalho é caracterizar o câncer de mama no Uruguai para diferentes faixas etárias. Materiais e Métodos: São analisadas as tendências temporais da incidência de câncer de mama em mulheres no Uruguai no período 2002-2019 e a mortalidade por esta causa no período 1990-2020. Para o quinquénio 2015-2019 são também analisadas a distribuição dos estádios ao diagnóstico e os perfis biológicos (Luminal, Triplo negativo e Her2 positivo). São analisados três segmentos etários: mulheres dos 20 aos 44 anos, dos 45 aos 69 anos e dos 70 anos ou mais. Resultados: As taxas de incidência para todas as idades permaneceram estáveis no período 2002-2019 enquanto a mortalidade apresentou tendência decrescente no período 1990-2020. Nas mulheres com menos de 45 anos verifica-se um aumento da incidência, com uma redução da mortalidade até 2010, seguida de uma estabilização das taxas; nas mulheres de 45 a 69 anos, a incidência permanece estável e a mortalidade diminui; nas pessoas com mais de 70 anos, a incidência diminui enquanto a mortalidade permanece estável. Mais de 70% dos casos são diagnosticados nos estágios I e II. Os tumores luminais (receptor hormonal positivo, Her2 negativo) são o subtipo mais comum para todos os grupos sem do que a proporção de tumores com essas características aumenta com a idade, enquanto a proporção de (Her2 positivo e triplo negativo) diminui. Conclusão: Nas mulheres uruguaias, o câncer de mama apresenta características diferenciadas para as três faixas etárias analisadas.

Lições de Justiça Reprodutiva para catalisar estratégias de incidência durante a crise do Zika no Brasil / Reproductive Justice Lessons for Catalyzing Advocacy Strategies during Zika Crisis in Brazil

Resumo Revisitaremos uma constelação de respostas para garantir justiça reprodutiva para mulheres e meninas durante a crise do Zika no Brasil. As ações relatadas foram conduzidas pela Anis - Instituto de Bioética, uma ONG feminista. Argumentamos que, durante as emergências sanitárias, é necessário o uso de lentes feministas interseccionais para construir respostas efetivas e sensíveis às questões de gênero, em favor de mulheres e meninas. Apresentamos três táticas de incidência utilizadas na luta por justiça reprodutiva durante a crise do Zika: 1) construir narrativas baseadas em histórias de vida que retratem os efeitos desproporcionais da crise em mulheres e meninas; 2) produzir dados baseados em evidências para catalisar estratégias de incidência para revisão legal e de políticas públicas; 3) promover oportunidades para o fortalecimento de alianças e movimentos, bem como o compartilhamento de poder por meio de atividades de mobilização comunitária. Reconhecemos a importância de responder às necessidades das populações em tempo real, e para isso torna-se fundamental que as evidências sobre os impactos das emergências em saúde pública sejam produzidas e compartilhadas de maneira ágil. Os esforços em incidência não são estratégias fragmentadas, pois garantir a justiça reprodutiva exige uma estrutura abrangente e transformadora, incluindo soluções que envolvam o cotidiano das pessoas comuns e suas experiências de vida.

Abstract This article aims to revisit a constellation of responses to guarantee reproductive justice for women and girls during the Zika crisis in Brazil, that were conducted by Anis - Institute of Bioethics, a Brazilian feminist NGO. We argue that intersectional feminist lenses and gender-sensitive responses are necessary to build effective efforts for women and girls during a public health emergency. As such, we present three concomitant and intersectional learned tactics we used to fight for reproductive justice during the Zika crises, but also in its aftermath: 1. To build storytelling narratives that portray the disproportional effects of the crisis on women and girls; 2. To produce evidence-based data to catalyze advocacy strategies for legal and policy review; 3. To promote movement building opportunities and sharing power through community mobilization activities. We assume the importance of providing immediate evidence and gender sensitive framings to inform real-time public health responses. Advocacy efforts should not be seen as fragmented strategies, since ensuring reproductive justice demands a comprehensive and transformative framework that include solutions for multiple aspects of real-life experiences.

Tuberculosis incidence in Brazil: time series analysis between 2001 and 2021 and projection until 2030 / Incidência de tuberculose no Brasil: análise de série temporal entre 2001 e 2021 e projeção até 2030

ABSTRACT Objective: To assess the incidence of tuberculosis in Brazil between 2001 and 2022 and estimate the monthly incidence forecast until 2030. Methods: This is a time-series study based on monthly tuberculosis records from the Notifiable Diseases Information System and official projections of the Brazilian population. The monthly incidence of tuberculosis from 2001 to 2022 was evaluated using segmented linear regression to identify trend breaks. Seasonal autoregressive integrated moving average (Sarima) was used to predict the monthly incidence from 2023 to 2030, deadline for achieving the sustainable development goals (SDGs). Results: There was a decrease in incidence between January/2001 and December/2014 (4.60 to 3.19 cases-month/100,000 inhabitants; β=-0.005; p<0.001), followed by an increase between January/2015 and March /2020 (β=0.013; p<0.001). There was a sharp drop in cases in April/2020, with the onset of the pandemic, and acceleration of the increase in cases since then (β=0.025; p<0.001). A projection of 124,245 cases in 2030 was made, with an estimated incidence of 4.64 cases-month/100,000 inhabitants, levels similar to those in the 2000s. The Sarima model proved to be robust, with error of 4.1% when removing the pandemic period. Conclusion: The decreasing trend in tuberculosis cases was reversed from 2015 onwards, a period of economic crisis, and was also impacted by the pandemic when there was a reduction in records. The Sarima model can be a useful forecasting tool for epidemiological surveillance. Greater investments in prevention and control need to be made to reduce the occurrence of tuberculosis, in line with the SDGs.

RESUMO Objetivo: Avaliar a incidência de tuberculose no Brasil entre 2001 e 2022 e estimar a previsão de incidência mensal até 2030. Métodos: Trata-se de estudo de série temporal que partiu de registros mensais de tuberculose do Sistema de Informação de Agravos de Notificação e projeções oficiais da população brasileira. Avaliou-se a incidência mensal de tuberculose entre 2001 e 2022 por meio de regressão linear segmentada para identificar quebras de tendências. Utilizou-se o modelo autorregressivo integrado de médias móveis sazonais (Sarima) para prever a incidência mensal de 2023 a 2030, prazo para alcançar os objetivos de desenvolvimento sustentável (ODS). Resultados: Observou-se diminuição da incidência entre janeiro/2001 e dezembro/2014 (de 4,60 para 3,19 casos-mês/100 mil habitantes; β=-0,005; p<0,001), seguida de aumento entre janeiro/2015 e março/2020 (β=0,013; p<0,001). Houve queda abrupta de casos em abril/2020, com início da pandemia e aceleração do aumento de casos desde então (β=0,025; p<0,001). Projetaram-se 124.245 casos de tuberculose em 2030, com incidência estimada em 4,64 casos-mês/100 mil habitantes, patamares da década de 2000. O modelo Sarima mostrou-se robusto, com erro de 4,1% ao remover o período pandêmico. Conclusão: A tendência decrescente nos casos de tuberculose foi revertida a partir de 2015, período de crises econômicas, e foi também impactada pela pandemia quando houve redução nos registros. O modelo Sarima pode ser uma ferramenta de previsão útil para a vigilância epidemiológica. Maiores investimentos na prevenção e controle precisam ser aportados para reduzir a ocorrência de tuberculose, em linha com os ODS.