Homicídios dolosos, tráfico de drogas e indicadores sociais em Salvador, Bahia, Brasil / Intentional homicide, drug trafficking and social indicators in Salvador, Bahia, Brazil

Resumo O objetivo deste artigo é verificar a associação entre homicídio doloso, tráfico de drogas e indicadores sociais em Salvador, Bahia, Brasil, no ano de 2010. Trata-se de estudo ecológico a partir dos casos de homicídios dolosos e de tráfico de drogas registrados pela Polícia Civil da Bahia com indicadores sociais. A análise entre o coeficiente de homicídio doloso, tráfico de drogas e proporção de homens negros de 15 a 49 anos foi feita através do modelo de regressão binomial negativa, com software R versão 2.13.0. Foram registrados 1.391 homicídios dolosos em 2010, gerando coeficiente de 108,5 homicídios por 100mil habitantes. Na associação foi observado que nos bairros com proporção de homens negros de 15 a 49 anos acima de 60%, esse coeficiente aumentou 89% (≥ 60% e ≤ 80%) e 87% (> 80%), comparado com bairros com proporção menor que 60%. Quanto ao tráfico de drogas, houve aumento médio de 40% estatisticamente significante nesse coeficiente nos bairros com 5 ou mais casos, comparado com bairros com menos de 5. As evidências empíricas observadas poderão contribuir para o conhecimento sobre o fenômeno dos óbitos por homicídios dolosos nas grandes cidades e poderá auxiliar gestores, segurança pública e sociedade civil organizada no enfrentamento desse problema.

Abstract To study the association between intentional homicide, drug trafficking and social indicators in Salvador, Bahia, Brazil in 2010. This is an ecological study, based on cases of intentional homicides and drug trafficking registered by the Civil Police of Bahia, as well as social indicators. A negative binomial regression model, utilizing R software (version 2.13.0), was used to verify the association between the homicide rate, drug trafficking and the proportion of black males aged 15 - 49. There were 1391 homicides in 2010, giving a rate of 108.5 homicides per 100,000 people. It was observed that in neighborhoods with a proportion of black males aged 15 - 49 over 60%, this rate increased by 89% (≥ 60% and ≤ 80%) and 87% (> 80%), compared to neighborhoods with less than 60% of black males aged 15 - 49. Regarding the factor of drug trafficking, there was a statistically significant average increase of 40% in terms of this coefficient in neighborhoods with five or more cases of drug trafficking, compared to neighborhoods with less than five of such cases. The empirical evidence that was observed can help to contribute to the existing knowledge about the phenomenon of deaths due to homicide in large cities, and it will also help managers, public security and organized civil society to face this problem.

Excesso de peso e fatores associados em quilomboras do médio São Francisco baiano, Brasil / Overweight and associated factors in Quilombolas from the middle San Francisco, Bahia, Brazil

Resumo O objetivo deste artigo é analisar a prevalência do excesso de peso e os fatores associados em adultos de comunidade quilombola do médio São Francisco baiano. Estudo transversal com amostra de 112 adultos. O excesso de peso foi avaliado pelo índice de massa corporal (IMC). A regressão linear foi usada para testar as associações, conforme modelo hierárquico de análise. A prevalência de excesso de peso foi de 27,7% (Intervalo de Confiança de 95% - IC95%: 19,3;36,1), com IMC médio de 23,1(± 3,8) Kg/m2, na análise múltipla permaneceram associados (p < 0,05) o sexo feminino, autoavaliação negativa de saúde e aumento da pressão arterial média (R2 ajustado 0,326). O aumento do IMC entre os quilombolas se associou com sexo feminino, autoavaliação negativa de saúde e maiores níveis pressóricos médios.

Abstract The aim of this article was to analyze the prevalence of overweight and associated factors in adult quilombolas (inhabitants of black communities) from the Middle San Francisco, Bahia. Cross-sectional study with a sample of 112 adults. Overweight was evaluated by body mass index (BMI). Linear regression was used to test associations. The mean age of the participants was 42.1 (standard deviation 18.5) years and there was a predominance of females (55.4%). The prevalence of overweight was 27.7% (95% confidence interval: 19.3;36.1), with a mean BMI of 23.1 (± 3.8) kg/m2. Factors that remained associated in multiple linear regression analysis (p < 0.05) were female gender, negative self-assessment of health, and increased mean arterial pressure (adjusted R2 0.326). The increase in BMI among quilombolas was associated with female gender, negative self-assessment of health and higher mean blood pressure levels.

High-Sensitivity C-Reactive Protein and Cardiovascular Disease Across Countries and Ethnicities

Despite substantial differences in ethnicities, habits, cultures, the prevalence of traditional cardiovascular risk factors and affordable therapies, atherosclerosis remains the major cause of death in developing and developed countries. However, irrespective of these differences, inflammation is currently recognized as the common pathway for the major complications of atherosclerosis, stroke, and ischemic heart disease. A PubMed search was conducted for “high-sensitivity C-reactive protein” (hs-CRP) in combination with the terms race, ethnicity, gender, prevalence, geographic, epidemiology, cardiovascular, obesity, diabetes, hypertension, cholesterol, smoking, ischemic heart disease, stroke, and mortality. This review includes the articles that pertained to the topic and additional articles identified from the reference lists of relevant publications. This review describes the marked differences in cardiovascular mortality across countries and ethnicities, which may be attributed to inequalities in the prevalence of the classic risk factors and the stage of cardiovascular epidemiological transition. However, hs-CRP appears to contribute to the prognostic information regarding cardiovascular risk and mortality even after multiple adjustments. Considering the perception of cardiovascular disease as an inflammatory disease, the more widespread use of hs-CRP appears to represent a valid tool to identify people at risk, independent of their ancestry or geographic region. In conclusion, this review reports that the complications associated with vulnerable atherosclerotic plaques are triggered by the major mechanisms of dyslipidemia and inflammation; whereas both mechanisms are influenced by classic risk factors, hs-CRP contributes additional information regarding cardiovascular events and mortality.

The impact of combined radiation and chemotherapy on outcome in uterine papillary serous carcinoma compared to chemotherapy alone / 부인종양

OBJECTIVE: To investigate the impact of pelvic radiation on survival in patients with uterine serous carcinoma (USC) who received adjuvant chemotherapy. METHODS: Patients with stage I-IV USC were identified from the Surveillance, Epidemiology, and End Results program 2000 to 2009. Patients were included if treated with surgery and chemotherapy. Patients were divided into two groups: those who received chemotherapy and pelvic radiation therapy (CT_RT) and those who received chemotherapy only (CT). Kaplan-Meier curves and Cox regression proportional hazard models were used. RESULTS: Of the 1,838 included patients, 1,272 (69%) were CT and 566 (31%) were CT_RT. Adjuvant radiation was associated with significant improvement in overall survival (OS; p<0.001) and disease-specific survival (DSS; p<0.001) for entire cohort. These findings were consistent for the impact of radiation on OS (p<0.001) and DSS (p<0.001) in advanced stage (III-IV) disease but not for early stage (I-II) disease (p=0.21 for OS and p=0.82 for DSS). In multivariable analysis adjusting for age, stage, race and extent of lymphadenectomy, adjuvant radiation was a significant predictor of OS and DSS for entire cohort (p=0.003 and p=0.05) and in subset of patients with stage III (p=0.02 and p=0.07) but not for patients with stage I (p=0.59 and p=0.49), II (p=0.83 and p=0.82), and IV USC (p=0.50 and p=0.96). Other predictors were stage, positive cytology, African American race and extent of lymphadenectomy. CONCLUSION: In USC patients who received adjuvant chemotherapy, adjuvant radiation was associated with significantly improved outcome in stage III disease but not for other stages. Positive cytology, extent of lymphadenectomy and African race were significant predictors of outcome.

Morphologic Variability of the Shoulder between the Populations of North American and East Asian

BACKGROUND: The aim of this study was to determine if there were significant differences in glenohumeral joint morphology between North American and East Asian populations that may influence sizing and selection of shoulder arthroplasty systems. METHODS: Computed tomography reconstructions of 92 North American and 58 East Asian patients were used to perform 3-dimensional measurements. The proximal humeral position was normalized in all patients by aligning it with the scapular plane utilizing anatomic landmarks. Measurements were performed on the humerus and scapula and included coronal and axial humeral head radius, humeral neck shaft and articular arc angles, glenoid height and width, and critical shoulder angle. Glenohumeral relationships were also measured and included lateral distance to the greater tuberosity and acromion, abduction lever arm, and acromial index. Parametric and nonparametric statistical analyses were used to compare population metrics. RESULTS: East Asian glenohumeral measurements were significantly smaller for all linear metrics (p < 0.05), with the exception of acromial length, which was greater than in the North American cohort (p < 0.001). The increase in acromial length affected all measurements involving the acromion including abduction lever arms. No difference was found between the neck shaft and articular angular measurements. CONCLUSIONS: The East Asian population exhibited smaller shoulder morphometrics than their North American cohort, with the exception of an extended acromial overhang. The morphologic data can provide some additional factors to consider when choosing an optimal shoulder implant for the East Asian population, in addition to creating future designs that may better accommodate this population.

Responsabilidad sanitaria en odontólogos: Casuística de casos evaluados en el Servicio Médico Legal de Chile / Professional liability claims against dentists

Background: The frequency and features of malpractice lawsuits against dentists in Chile are not well known. Aim: To determine the magnitude and frequency of professional liability claims against dentists. Material and Methods: A retrospective analysis of the Medical Liability Unit of the Legal Medical Service of Chile database. This public organization deals with most professional liability claims in Chile. Results: Between 2007 and 2012, 3,990 expert opinions about liability of health care professionals were requested. Odontology was the fifth specialty most commonly sued and dentists, the second most frequently sued professionals. Sixty nine percent of cases originated in private clinics, which is coincident with a higher frequency of dentists working in private practice. Most petitioners were adult women and most claims originated from surgical interventions and infections. In 35% of claims against dentists, a violation of Lex Artis was confirmed, compared with 9% of all expert opinions that generated in the unit. Conclusions: Claims against dentists are more common than previously thought and these professionals should adopt preventive measures to avoid them.

Screening Colonoscopy among Uninsured and Underinsured Urban Minorities

BACKGROUND/AIMS: Uninsured individuals have lower rates of screening colonoscopy (SC), and little is known regarding the pathology results obtained when they undergo colonoscopies. Since 2004, we have participated in a program that offers SC to uninsured New Yorkers; herein, we report our findings. METHODS: Uninsured, average-risk patients who were at least 50 years of age underwent SC at our institution between April 2004 and June 2011. We analyzed polyp pathology, location, size, incidence of adenomas, and incidence of adenomas with advanced pathology (AAP) with respect to ethnicity, gender, and age. RESULTS: Out of 493 referrals, 222 patients completed the colonoscopies. Polyps were identified in 21.2% of all patients; 14% had adenomas, and 4.5% had AAP. The rates of adenomas among African-Americans, Hispanics, and Whites were 24.3%, 12.1%, and 11.6%, respectively, and the corresponding rates of AAP were 10.8%, 3.5%, and 2.3%. Differences in the polyp type, location, and AAP did not reach statistical significance with respect to ethnicity or gender. Patients aged 60 and older were found to have a higher rate of advanced adenomas compared with younger patients (8.6% vs 2.6%, p=0.047). CONCLUSIONS: Further efforts to fund screening colonoscopies for uninsured individuals will likely result in the identification of advanced lesions of the colon before they progress to colorectal cancer.

An evaluation of treatment strategies for head and neck cancer in an African American population / Evaluación de las estrategias del tratamiento para el cáncer de cabeza y cuello en una población afroamericana

OBJECTIVE: This study evaluated treatment strategies for head and neck cancers in a predominantly African American population. METHODS: Data were collected utilizing medical records and the tumour registry at the Howard University Hospital. Kaplan-Meier method was used for survival analysis and Cox proportional hazards regression analysis predicted the hazard of death. RESULTS: Analysis revealed that the main treatment strategy was radiation combined with platinum for all stages except stage I. Cetuximab was employed in only 1% of cases. Kaplan-Meier analysis revealed stage II patients had poorer outcome than stage IV while Cox proportional hazard regression analysis (p = 0.4662) showed that stage I had a significantly lower hazard of death than stage IV (HR = 0.314; p = 0.0272). Contributory factors included tobacco and alcohol but body mass index (BMI) was inversely related to hazard of death. CONCLUSIONS: There was no difference in survival using any treatment modality for African Americans.

OBJETIVO: Este estudio evaluó las estrategias del tratamiento para los cánceres de cabeza y cuello en una población predominantemente afroamericana. MÉTODOS: Se recopilaron datos utilizando historias clínicas y el registro de tumores del Hospital Universitario Howard. Se utilizó el método de Kaplan-Meier para el análisis de supervivencia, y el análisis de regresión de riesgos proporcionales de Cox para predecir los riesgos de muerte. RESULTADOS: El análisis reveló que la estrategia principal para el tratamiento fue la radiación combinada con platino para todas las etapas, excepto la etapa I. Se empleó cetuximab en sólo 1% de los casos. El análisis de Kaplan-Meier reveló que los pacientes de etapa II tuvieron resultados más pobres que los de la etapa IV, mientras que el análisis de regresión de riesgos proporcionales de Cox (p = 0.4662) mostró que la etapa I tenía un riesgo de muerte significativamente menor que la etapa IV (HR = 0.314; p = 0.0272). Los factores contribuyentes incluyeron el tabaco y el alcohol, pero el índice de masa (IMC) fue inversamente proporcional al riesgo de muerte. CONCLUSIONES: No hubo diferencias en la supervivencia con ninguna de las modalidades de tratamiento para los afroamericanos.

Effect of exercise dosages on adiposity indices in overweight girls / Efecto de programas de ejercicio en los índices de adiposidad en niñas con sobrepeso

Objective. The primary purpose of this study was to determine the impact of two exercise dosages on reducing adiposity in minority girls. Materials and methods. Sixty-two overweight Hispanic and African-American girls participated in one of two intense summer interventions in Houston, TX: Intervention A (exposure to about 40 hours physical activities) or Intervention B (exposure to 60 hours of physical activities). Adiposity indices (percent body fat, waist circumference, body mass index) were taken pre- and post-intervention. Results. Intervention B had a significantly greater decrease in adiposity indicators (p= 0.006) when compared to Intervention A. Waist circumference displayed the most significant decrease (p = 0.001). Both interventions significantly increased daily minutes of moderate-to-vigorous physical activity (p= 0.020). Conclusions. Intense physical activity interventions may effectively reduce abdominal fat in minority girls.

Objetivo. Determinar el impacto de dos programas de ejercicio en la reducción de los índices de adiposidad en niñas de grupos minoritarios. Material y métodos. Sesenta y dos niñas latinas y africano-americanas participaron en una de dos intervenciones intensivas durante el verano: la intervención A (exposición a aproximadamente 40 horas de actividad física) o la intervención B (exposición a 60 horas de actividad física) en Houston, TX. Los indicadores de adiposidad (índice de masa corporal, porcentaje de grasa corporal y grasa abdominal) se midieron antes y después de cada intervención. Resultados. La intervención B tuvo una disminución más significativa en el nivel de adiposidad (p=0.006) comparado con la intervención A. La circunferencia abdominal fue la que más disminuyó (p=0.001). Ambas intervenciones aumentaron significativamente la actividad física moderada a intensa (p=0.020). Conclusiones. Las intervenciones cortas e intensas pueden ser efectivas en la reducción de la grasa abdominal en niñas de grupos minoritarios.

Ethnic and health correlates of diabetes-related amputations at the Texas-Mexico border / Correlatos étnicos y de salud de las amputaciones relacionadas con la diabetes en la frontera entre Texas y México

OBJECTIVE: To examine the association between diabetes-related lower-extremity amputation (LEA) and ethnicity, age, source of payment, geographic location, diabetes severity, and health condition in adults with diabetes mellitus type 2 living in border and non-border counties in Texas, United States of America, and to assess intra-border region geographic differences in post-LEA treatment. METHODS: This correlational study was based on secondary data from the 2003 Texas Inpatient Hospital Discharge Data. The sample consisted of individuals 45 years of age and older with type 2 diabetes who had undergone a nontraumatic LEA (n = 5 865). Descriptive statistics and logistic regression analyses were applied. RESULTS: The following characteristics were predictors of LEA: being Hispanic or African American, male, > 55 years old, and a Medicare or Medicaid user, and living in a border county. Persons with moderate diabetes and those who suffered from cardiovascular disease or stroke also had higher odds of undergoing an LEA. Post-LEA occupational therapy was significantly less prevalent among border residents (9.5 percent) than non-border residents (15.3 percent) (P < 0.001). CONCLUSION: Understanding the factors that influence diabetes-related LEA may lead to early detection and effective treatment of this disabling consequence of diabetes along the U.S.-Mexico border.

OBJETIVO: Analizar la asociación entre las amputaciones de extremidades inferiores (AEI) relacionadas con la diabetes y el grupo étnico, la edad, la procedencia del pago, la ubicación geográfica, la gravedad de la diabetes y el estado de salud de los adultos que padecen diabetes tipo 2 residentes en los condados fronterizos y no fronterizos de Texas (Estados Unidos de América), y evaluar la diferencias geográficas dentro de la zona fronteriza en cuanto al tratamiento posterior a la amputación. MÉTODOS: Este estudio correlacional se basó en datos secundarios procedentes de la información de egreso de pacientes hospitalizados en Texas durante el año 2003. La muestra estuvo integrada por personas de 45 años o mayores con diabetes tipo 2, que habían sido sometidas a la amputación no traumática de una extremidad inferior (n = 5 865). Se aplicaron estadística descriptiva y análisis de regresión logística. RESULTADOS: Las siguientes características constituyeron factores predictivos de AEI: ser hispano o afroestadounidense, hombre, de 55 años o mayor, beneficiario de Medicare o Medicaid, y residente en un condado fronterizo. Las personas con diabetes moderada que padecían enfermedades cardiovasculares o habían sufrido un accidente cerebrovascular también tenían una mayor probabilidad de ser sometidas a una AEI. La terapia ocupacional posterior a la amputación fue significativamente menos prevalente entre los residentes fronterizos (9,5 por ciento) que entre los no fronterizos (15,3 por ciento) (P < 0,001). CONCLUSIONES: La comprensión de los factores que influyen en las AEI relacionadas con la diabetes puede conducir a la detección temprana y el tratamiento eficaz de esta secuela discapacitante en la zona fronteriza entre los Estados Unidos y México.

Do cross-registry comparisons of Black and White Americans provide support for N-acetylation as an important determinant for urinary bladder and other tobacco-related cancers?

Tobacco smoking is an unequivocal risk factor for cancers of the larynx, lung, pancreas and urinary bladder. Whereas African-Americans demonstrate higher laryngeal, lung and pancreatic cancer rates than their Caucasian-American counterparts, they paradoxically have only approximately half of the urinary bladder incidences. One possible explanation is their N-acetyltransferase (NAT) status, since this enzyme is responsible for metabolism of arylamines in smoke and blacks are reported to have a higher rate for rapid acetylation than whites. However, other tobacco-related cancers are also linked to slow acetylation so that African-Americans might therefore also be expected to have lower incidences of other tobacco-related cancers. The present investigation was conducted with data from Cancer Incidence in Five Continents Vol VIII to assess whether there might be correlations between incidence rates for four major cancers across registries in the United States. Cluster analysis demonstrated clear separation of the white and black populations for all states, and significant correlations were observed between bladder and laryngeal cancers, and also for lung and laryngeal cancers, for both Blacks and Whites. Striking similarities in the plots for urinary bladder incidence against all three of the other cancers suggests the existence of a factor specific to the bladder. A review of black-white ratios for cancer incidences in all major body sites in both sexes and the published literature for NAT polymorphisms provided evidence that this might indeed be arylamine exposure, although other factors could also be involved.