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OBJECTIVE: Although Brazil became the first country worldwide to ban the sale of all tobacco products with any additive that could alter their flavours and tastes in 2012, its implementation was effectively halted by tobacco industry lawsuits, including a constitutional challenge filed in the Federal Supreme Court in 2013. This study aimed at examining, for the first time in the country, the evolution over time of the new registrations of tobacco products with additives that would have been banned if not for the tobacco industry's interference ('counterfactual scenario'). METHODS: We used the newly available public database on the registration of tobacco products developed by the Health Regulatory Agency (from 2008 onwards). All types of tobacco products intended for the domestic market that contained 'banned additives in a counterfactual scenario' and were registered between January 1 and December 31 of each year were selected. RESULTS: Between 2012 and 2023, a total of 1112 new registrations of tobacco products with 'banned additives' were recorded. The spread of hookah tobacco registrations started in 2014, and by 2023, the cumulative incidence of registrations containing 'banned additives' was 641. Both manufactured cigarettes and hookah products reached their peaks in new registrations in 2020. CONCLUSIONS: After 12 years since the resolution intended to ban all additives that change the aroma and taste of tobacco products in Brazil, primarily to prevent smoking initiation, the tobacco industry's interference continues to successfully block its implementation. Countries facing similar challenges in tobacco control could consider generating comparable national data that might help expose the adverse impacts of tobacco industry interference on public health.
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OBJECTIVES: This study aimed to: i) perform an ultrasonographic (US) evaluation of the lacrimal glands (LGs) in healthy subjects in order to define the sonographic elementary lesions which could be identified in the LGs and describe their frequencies in healthy subjects; ii) test the intra and inter-rater agreement between four rheumatologists; iii) preliminary assess whether the elementary lesions of the LGs let us differentiate healthy subjects from primary Sjögren's syndrome (pSS) patients. METHODS: A consensus meeting was held to define the sonographic lesions to be evaluated. Healthy subjects and pSS patients underwent lacrimal glands ultrasound (LGUS) examinations in two Italian Rheumatology Clinics. A web-based reliability exercise was performed on healthy subjects' images by four rheumatologists. Afterward, images of pSS patients were evaluated for the presence of the sonographic lesions previously defined and compared to the US findings in healthy subjects. RESULTS: Fifty-seven healthy subjects and 17 pSS patients were evaluated. The intra and inter-rater reliability score was good-excellent for almost all the agreed US features assessed (glandular parenchyma visibility, size, homogeneity, hypoechoic areas, hyperechoic spots, fibrous gland appearance, fatty deposition). Among the LGUS elementary lesions in pSS patients compared with healthy subjects, we detected a significantly difference in glandular inhomogeneity [13/33 (39.4%) vs. 9/63 (14.3%), p=0.01], and in fibrous gland appearance [3/33 (9.1%) vs. 0/63 (0%), p=0.04]. CONCLUSIONS: In this preliminary study, LGUS proved to have a good-excellent intra and inter-rater reliability. The glandular parenchyma inhomogeneity and the fibrous gland appearance could help differentiate pSS patients from healthy subjects.
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Aparato Lagrimal , Síndrome de Sjögren , Estudios Transversales , Voluntarios Sanos , Humanos , Aparato Lagrimal/diagnóstico por imagen , Reproducibilidad de los Resultados , Síndrome de Sjögren/diagnóstico por imagenRESUMEN
Families share behavioral risk factors that can increase the risk of cancer development. We examined whether having a positive family breast cancer history is associated with health behaviors/screening practices. Analyses were based on a cross-sectional sample of 545 Brazilian National Cancer Institute Hospital patients with newly diagnosed breast cancer in 2013/2014. Women were categorized according to their breast cancer family history. Age-adjusted Poisson regressions with robust variance were performed to estimate the association between breast cancer family history and selected health-related behaviors and screening practices. About one fourth of women reported a positive family history of breast cancer. Contrary to expectation, we found that women with a family history of breast cancer did not report healthier behaviors more often than those without a family history. However, those with a family history were more likely to report a mammographic exam prior to the mammographic diagnosis. Our study suggests that having a family history of cancer is not sufficient to change women's behaviors about physical activity, weight control and diet, smoking, and drinking, but it seems to influence their breast cancer screening behavior. Our results suggest the need to increase women's information and/or understanding that healthier lifestyles contribute to cancer prevention.
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Neoplasias de la Mama/epidemiología , Conductas Relacionadas con la Salud , Tamizaje Masivo/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Dieta , Detección Precoz del Cáncer/métodos , Ejercicio Físico , Femenino , Humanos , Persona de Mediana Edad , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVES: To estimate the proportions of illicit cigarette consumption in Brazil from 2012 to 2016, a period of sharp increases in cigarette taxes. METHODS: We used an approach based on legal sales provided by the Secretariat of Federal Revenues and self-reported consumption data from an annually conducted telephone survey (VIGITEL) to estimate the changes over time in illegal cigarette use in Brazil. For that purpose, we also used available information on the proportion of illegal cigarette consumption from a nationwide household survey conducted in 2013 to calculate a constant proportion of underreporting from VIGITEL in relation to total consumption and sales in Brazil. RESULTS: There was an increase in the estimated proportion of illicit cigarette use from 2012 to 2013 (from 28.6% to 32.3%), then a decrease from 2013 to 2014 (32.3% to 28.8%), and then a sustained trend of increase from 2014 to 2016 (28.8% to 42.8%). CONCLUSIONS: Novel and feasible approaches to estimate changes over time in the illegal market are important for helping the effective implementation of tobacco excise tax policy.
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Fumar Cigarrillos/epidemiología , Comercio/estadística & datos numéricos , Crimen/estadística & datos numéricos , Adulto , Brasil , Fumar Cigarrillos/economía , Fumar Cigarrillos/tendencias , Comercio/economía , Crimen/tendencias , Femenino , Humanos , Masculino , Prevalencia , Encuestas y Cuestionarios , Impuestos/economíaRESUMEN
Brazil has experienced a large decline in cigarette consumption in the last 25years. However, the most recent annual reports from the tobacco industry market leader in Brazil did not show a decrease in its gross profits. This is particularly important because tobacco industry donations/sponsorships come directly from the industry's reported gross-profits and are used to subvert health policies. The aim of the present study was to estimate (i) tobacco industry's gross-profit from legal cigarettes sales, and (ii) all-cause smoking-attributable deaths (SADs) among current Brazilian smokers who consumed legal cigarettes in 2013. We collected information on prevalence of legal cigarette use, cigarette consumption, price per cigarette pack among individuals aged ≥35years from the Global Adult Tobacco Survey, legal cigarettes sales (e.g., average costs and total volume of sales) provided by the Federal Secretariat of Revenues, and population mortality from the available vital statistics. With a gross-profit of US$1.378 billion (1.307-1.434) from sales of 54.6 billion sticks of cigarettes (53.4-55.5) to 8,424,510 smokers aged 35years and older in Brazil in 2013, cumulative SADs were estimated at 96,012 (85,647-107,654) (around 34% of cumulative SADs also including current smoking of illegal cigarettes and past smoking), i.e., one SAD was equivalent to a gross-profit of US$14,352 (12,140-16,743). Our results revealed the association between sales of cigarettes, gross-profits, and deaths in Brazil. As tobacco industry donations/sponsorships originate from industry's gross profits, which, in turn, depend on cigarette sales, our findings may be useful for increasing "moral pressure" on individuals and institutions and help countries in stopping tobacco industry interference in health policies.
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Comercio/economía , Fumar/mortalidad , Industria del Tabaco/economía , Productos de Tabaco/economía , Adulto , Brasil , Costos y Análisis de Costo , Femenino , Política de Salud/legislación & jurisprudencia , Humanos , Masculino , Persona de Mediana Edad , Fumar/epidemiología , Industria del Tabaco/legislación & jurisprudenciaRESUMEN
These findings suggest that there are no "fixed" racial patterns of tobacco use around the globe. Cross-country differences in tobacco use among races could be modified by cultural influences, domestic tobacco control, or socioeconomic factors. There is need for enhanced efforts to monitor tobacco use by race/ethnicity to identify existing and emerging patterns in tobacco use by race, as well as identify opportunities for interventions. Tailored interventions to reduce tobacco use within different settings and countries may help reduce tobacco use among racial/ethnic minorities. Implementation of comprehensive tobacco control measures could be facilitated by community-based efforts, ensuring that disadvantaged populations are engaged as partners to adapt tobacco control policies and interventions to local contexts and health equity issues.
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Salud Global/estadística & datos numéricos , Fumar/etnología , Características Culturales , Disparidades en el Estado de Salud , Humanos , Cese del Hábito de Fumar/etnología , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Prevención del Hábito de Fumar , Factores Socioeconómicos , Uso de Tabaco/etnología , Uso de Tabaco/prevención & controlRESUMEN
BACKGROUND: Brazil has experienced a large decline in smoking prevalence due to several tobacco control policies that were implemented in the past 25â years. Previous population-wide studies found a consistent reduction over time in daily cigarette consumption among all socioeconomic groups. OBJECTIVE: To examine changes between 2008 and 2013 in tobacco behaviours and health-related conditions of smokers. METHODS: We used data obtained from two nationally-representative surveys conducted in 2008 and 2013 to estimate the prevalence of self-reported psychological and physical morbidity, and nicotine dependence markers, stratified by gender and sociodemographic groups. Generalised linear models were used to understand whether absolute differences in prevalence rates over time differed by categories of selected variables. RESULTS: For both genders, as smoking prevalence declined in Brazil, there has been an increase in the proportion of ever smokers who have quit. In addition, remaining smokers seem to be making more quitting attempts. Among men with low educational level or younger than 25â years-old, as compared to their counterparts, cessation rate showed an even greater increase over time. Moreover, the proportion of light smokers, which represent the vast majority of smokers, did not decrease. The percentage of poor health-conditions among remaining smokers nevertheless increased, particularly among women, which can make future cessation more challenging. CONCLUSIONS: In Brazil, quitting rate is increasing, thus suggesting that tobacco control interventions implemented in Brazil in the past years seem to be effectively reaching the smoking population. This is strong evidence against the 'hardening hypothesis', which posits that remaining smokers decrease their willingness and ability to quit.
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Fumadores/estadística & datos numéricos , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Tabaquismo/epidemiología , Adolescente , Adulto , Factores de Edad , Brasil/epidemiología , Escolaridad , Femenino , Estado de Salud , Humanos , Modelos Lineales , Masculino , Prevalencia , Factores Sexuales , Prevención del Hábito de Fumar/legislación & jurisprudencia , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Although case studies indicate that indigenous peoples in Brazil often suffer from higher morbidity and mortality rates than the national population, they were not included systematically in any previous national health survey. Reported here for the first time, the First National Survey of Indigenous People's Health and Nutrition in Brazil was conducted in 2008-2009 to obtain baseline information based on a nationwide representative sample. This paper presents the study's rationale, design and methods, and selected results. METHODS: The survey sought to characterize nutritional status and other health measures in indigenous children less than 5 years of age and indigenous women from 14 to 49 years of age on the basis of a survey employing a representative probabilistic sample of the indigenous population residing in villages in Brazil, according to four major regions (North, Northeast, Central-West, and South/Southeast). Interviews, clinical measurements, and secondary data collection in the field addressed the major topics: nutritional status, prevalence of hypertension and diabetes mellitus in women, child hospitalization, prevalence of tuberculosis and malaria in women, access to health services and programs, and characteristics of the domestic economy and diet. RESULTS: The study obtained data for 113 villages (91.9% of the planned sample), 5,305 households (93.5%), 6,692 women (101.3%), and 6,128 children (93.1%). Multiple household variables followed a pattern of greater economic autonomy and lower socioeconomic status in the North as compared to other regions. For non-pregnant women, elevated prevalence rates were encountered for overweight (30.3%), obesity (15.8%), anemia (32.7%), and hypertension (13.2%). Among children, elevated prevalence rates were observed for height-for-age deficit (25.7%), anemia (51.2%), hospitalizations during the prior 12 months (19.3%), and diarrhea during the prior week (23.6%). CONCLUSIONS: The clinical-epidemiological parameters evaluated for indigenous women point to the accentuated occurrence of nutrition transition in all regions of Brazil. Many outcomes also reflected a pattern whereby indigenous women's and children's health indicators were worse than those documented for the national Brazilian population, with important regional variations. Observed disparities in health indicators underscore that basic healthcare and sanitation services are not yet as widely available in Brazil's indigenous communities as they are in the rest of the country.
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Estado de Salud , Encuestas Epidemiológicas , Encuestas Nutricionales , Estado Nutricional , Grupos de Población/estadística & datos numéricos , Adolescente , Adulto , Brasil , Preescolar , Femenino , Encuestas Epidemiológicas/métodos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Encuestas Nutricionales/métodos , Embarazo , Proyectos de Investigación , Adulto JovenRESUMEN
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of anti-epidermal growth factor receptor (cetuximab and panitumumab) or anti-vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy (CT) (fluorouracil and leucovorin with irinotecan) as a first-line treatment for unresectable metastatic colorectal cancer. METHODS: A partitioned survival analysis model was adopted to simulate direct health costs and benefits comparing therapeutic options in a 10 years' time horizon. Model data were extracted from the literature and costs were obtained from Brazilian official government databases. The analysis considered the perspective of the Brazilian Public Health System; costs were measured in local currency (BRL) and benefits in quality-adjusted life-years (QALY). A 5% discount rate was applied to costs and benefits. Alternative willingness-to-pay scenarios, varying from 3 to 5 times the cost-effectiveness threshold established in Brazil, were estimated. The results were presented incremental cost-effectiveness ratio (ICER), and both deterministic and probabilistic sensitivity analyses were performed. RESULTS: The most cost-effective choice would be the association of CT with panitumumab, with an ICER of $58 330.15/QALY compared with isolated CT. The second-best option was CT with bevacizumab and panitumumab, with an ICER of $71 195.40/QALY compared with panitumumab alone. Although having higher costs, the second-best option was the most effective. Both strategies were cost-effective in part of the Monte Carlo iterations, considering the 3× threshold. CONCLUSIONS: The therapeutic option CT + panitumumab + bevacizumab represents the most significant effectiveness gain in our study. It is the second-lowest cost-effectiveness, and this option includes monoclonal antibodies association for patients with and without KRAS mutation.
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Anticuerpos Monoclonales , Neoplasias Colorrectales , Humanos , Anticuerpos Monoclonales/uso terapéutico , Panitumumab/uso terapéutico , Bevacizumab/uso terapéutico , Análisis de Costo-Efectividad , Neoplasias Colorrectales/tratamiento farmacológico , Análisis Costo-BeneficioRESUMEN
Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status â¦Ì¸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher's exact tests and the OS by Kaplan-Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.
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INTRODUCTION: The use of e-cigarettes has been the subject of a public health debate on their possibility of undermining efforts for tobacco control. The aim of this study was to synthesize the risk of smoking relapse with the use of e-cigarettes by former smokers. METHODS: MEDLINE, EMBASE, PsycInfo and LILACS were searched without restriction to language or date of publication. Longitudinal observational studies evaluating the association between e-cigarette use and smoking relapse were selected by two independent reviewers, and disagreements solved by discussion with a third researcher. Data extraction and risk of bias assessment were also carried out by two independent reviewers. The meta-analysis was performed using the random effect Mantel-Haenszel model. RESULTS: From 632 retrieved records, six studies were eligible and described, while three were included in the quantitative synthesis. The studies were conducted in the USA, UK and France, with final sample size varying from 374 to 4094 former smokers. Risk of relapse was 2.03 (95% CI: 1.39-2.96) among former smoker users than non-users of e-cigarettes, and 1.38 (95% CI: 1.11-1.65) when pooling the adjusted association measures. Long-term former smokers were the main contributors for the higher relapse risk, while the impact of frequency of exposure to e-cigarettes (past, non-daily, daily) was uncertain. CONCLUSIONS: Considering the growing popularity of e-cigarettes among former smokers, our results point to the great potential for an increase in the frequency of relapse to conventional smoking and vaping for those who move to regular use of e-cigarettes.
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INTRODUCTION: Spondyloarthropathies (SpA) represent a heterogeneous group of inflammatory arthritides with autoimmune pathogenesis that can affect both adults and children with peculiar features such as enthesitis, sacroiliac joint, and axial involvement. Since juvenile onset of SpA (JSpA) is not well codified by the current juvenile idiopathic arthritis classification, studies in this field are restricted to single categories and therefore cannot be exhaustive. This review aims to report recent advances in the treatment of JSpA. AREAS COVERED: In order to assess the available therapies for JSpA, the authors have analyzed data obtained from retrospective and prospective studies, case reports, and case series, as well as from controlled trials. EXPERT OPINION: Given the challenging classification of JSpA, research in this field has been restricted to single subcategories. Little is known of which patients are more likely to develop axial involvement leading to severe spinal damage. Whether TNF inhibitors are capable to prevent or stop disease progression, once started, is yet to be ascertained with structural damage still a matter for research. Therefore, trials on the efficacy of TNF inhibitors in JSpA are strongly advocated since they may help to elucidate their place as a treatment option.
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Antirreumáticos/uso terapéutico , Artritis Juvenil/tratamiento farmacológico , Metotrexato/uso terapéutico , Espondiloartropatías/tratamiento farmacológico , Sulfasalazina/uso terapéutico , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Adulto , Artritis Juvenil/inmunología , Niño , Ensayos Clínicos como Asunto , Humanos , Estudios Prospectivos , Estudios Retrospectivos , Espondiloartropatías/inmunologíaRESUMEN
BACKGROUND: Cervical cancer (CC) is a common preventable and curable disease that may lead to death. Our aim was to describe the patterns of time trends in CC mortality rates among women in Brazil from 1980 to 2017, and identify the influence of age, period and birth cohort (APC) stratified by region (North NR, Northeast NER, Southeast SER, South SR, Center-Western region CWR). METHODS: We performed a time-series analysis using secondary data bases. Crude (MR) and WHO age-standardized CC mortality rates (aMR) were estimated per 100,000 women. We evaluated time trends using permutation joinpoint regression models (JP) and APC models to estimate the effect of APC on MR. RESULTS: The JP analysis showed a temporal decrease in all regions, except the NR, which had an annual percentage increase of 0.44 (95%CI 0.2 - 0.7). MR in the NR was 2 to 4 times higher than in the other regions. We observed steady increases in MR with age in the NR and NER. A plateau after age 40 was observed in SER, SR, and CWR. The NR and NER MR ratio stabilized around the year 2000. Birth cohort effect showed decreasing MR ratio from 1900 to 1970 for all regions, except the NR, which showed increasing MR rate from older to more recent cohorts. CONCLUSION: We showed relevant differences in cervical MR by region, which may reflect inequality in access to primary and secondary prevention as well as treatment, particularly in the NR.
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The purpose of this study is to review the current literature on the use of hyaluronic acid (HA) specifically applied to the treatment of osteoarthritis (OA) secondary to primary inflammatory rheumatic diseases. Osteoarthritis should be carefully considered because it has potentially devastating effects on health-related quality of life. Locally injected HA seems to be an effective treatment for OA but it is not clear how to place this treatment in the context of inflammatory rheumatic disorders. To retrieve relevant articles, we conducted the search through MEDLINE, EMBASE and Cochrane Databases performing the PICO strategy. We finally selected four randomized clinical trials and six observational studies and grouped them in accordance with its main objective within three focuses: the clinical effect of HA therapy in joints without any signs of inflammation, the clinical effects of HA therapy in joints with active synovitis, and the involvement and changes of synovial fluid in the treatment of secondary OA. Our qualitative analysis clearly showed that the current literature is marked by high levels of heterogeneity and therefore difficult to interpret. Therefore, our hypothesis that viscosupplementation should be considered as a treatment for chronic moderate symptomatic OA secondary to inflammatory rheumatic diseases, and not for flares with joint swelling, cannot be definitely supported. Well-designed studies are necessary to definitively clarify the range of application of intra-articular HA injections in the treatment of inflammatory rheumatic disorders.
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Ácido Hialurónico/uso terapéutico , Osteoartritis/tratamiento farmacológico , Osteoartritis/etiología , Enfermedades Reumáticas/complicaciones , Viscosuplementos/uso terapéutico , Humanos , Ácido Hialurónico/administración & dosificación , Inflamación/tratamiento farmacológico , Inyecciones Intraarticulares , Calidad de Vida , Líquido Sinovial/efectos de los fármacos , Sinovitis/tratamiento farmacológico , Resultado del Tratamiento , Viscosuplementos/administración & dosificaciónRESUMEN
BACKGROUND: Brazil experienced a robust decline in smoking prevalence rates as a consequence of public policies. Since lung cancer is strongly associated with smoking, trends in lung cancer mortality rates may be used as a delayed effectiveness indicator of smoking prevention interventions. OBJECTIVES: The aim of this study was to estimate lung cancer mortality trends from 1980 through 2017 and to predict temporal trends in lung cancer mortality rates, in Brazil from 2016 through 2040. METHODS: Time trends in lung cancer mortality rates were evaluated using data from available public databases. Crude and age-standardized mortality rates were calculated for each year sex-specific mortality predictions were made for each five-year period from 2016 to 2020 through 2036-2040 using an age-period-cohort (APC) model. Sex ratios were estimated using age-standardized lung cancer mortality rates. RESULTS: A decline in age-standardized lung cancer mortality rates has been observed for males since 2005 and for all predicted periods. It is expected that females aged 55 or younger will experience a reduction in lung cancer mortality from 2021 to 2026 onwards, but for those aged 75 or over rates are predicted to continue increasing through 2036-2040. CONCLUSION: Smoking prevention and cessation policies are essential, and it is important to commit to an ethical framework whereby equity in tobacco control activities between genders is achieved. This will avert many premature and preventable smoking-related deaths in the next decades.
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Neoplasias Pulmonares/mortalidad , Mortalidad/tendencias , Fumar/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Bases de Datos Factuales , Epidemias , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etiología , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
BACKGROUND: Female breast cancer is the most common cancer in Latin American and Caribbean (LAC) countries and is the leading cause of cancer deaths. The high mortality-to-incidence ratio in the regions is associated with mainly the high proportion of advanced stage diagnosis, and also to inadequate access to health care. In this study we aimed to systematically review the proportion of advanced stage (III-IV) at diagnosis (pas) and the five-year stage-specific survival estimates of breast cancer in LAC countries. METHODS: We searched MEDLINE, Embase, and LILACS (Latin American and Caribbean Health Science Literature) to identify studies, in any language, indexed before Nov 5, 2018. We also conducted manual search by reviewing citations of papers found. pas was summarized by random effects model meta-analysis, and meta-regression analysis to identify sources of variation. Stage-specific survival probabilities were described as provided by study authors, as it was not possible to conduct meta-analysis. PROSPERO CRD42017052493. RESULTS: For pas we included 63 studies, 13 of which population-based, from 22 countries comprising 221,255 women diagnosed from 1966 to 2017. The distribution of patients by stage varied greatly in LAC (pas 40.8%, 95%CI 37.0% to 44.6%; I2 = 99%; p<0.0001). The heterogeneity was not explained by any variable included in the meta-regression. There was no difference in pas among the Caribbean (pas 43.0%, 95%CI 33.1% to 53.6%), Central America (pas 47.0%, 95%CI 40.4% to 53.8%) and South America (pas 37.7%, 95%CI 33.1% to 42.5%) regions. For 5-year stage-specific survival we included 37 studies, comprising 28,988 women from ten countries. Seven of these studies were included also for pas. Since we were unable to adjust for age, comparability between countries and regions was hampered, and as expected, the results varied widely from study to study. CONCLUSIONS: LAC countries should look to address concerns with early detection and diagnosis of breast cancer, and wherever viable implement screening programs and to provide timely treatment.
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Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Región del Caribe/epidemiología , Femenino , Humanos , Incidencia , América Latina/epidemiología , Estadificación de Neoplasias , Análisis de SupervivenciaRESUMEN
There have been arguments about the role of breast cancer screening at the population level, and some points of controversy have arisen, such the establishment of organized screening policies and the age at which to begin screening. The real benefit of screening has been questioned because the results of this practice may increase the diagnosis of indolent lesions without decreasing mortality due to breast cancer. The authors have proposed a study of incidence and mortality trends for breast cancer in a developing setting in Brazil to monitor the effectiveness of the official recommendations that prioritize the age group from 50 to 69 years. The database of the Cancer Registry and the Mortality Information System was used to calculate age-standardized and age-specific rates, which were then used to calculate incidence and mortality trends using the Joinpoint Regression Program. The results showed stability in trends across all ages and age-specific groups in both incidence and mortality. In conclusion, we found that incidence and mortality rates are compatible with those in regions with similar human development indexes, and trends have demonstrated stabilization. Thus, we do not endorse changes in the official recommendations to conduct screening for ages other than 50 to 69 years, nor should policy makers implement organized screening strategies.
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Carcinoma de Mama in situ/epidemiología , Neoplasias de la Mama/epidemiología , Detección Precoz del Cáncer/estadística & datos numéricos , Política de Salud , Adulto , Factores de Edad , Anciano , Brasil , Países en Desarrollo/estadística & datos numéricos , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/normas , Femenino , Humanos , Persona de Mediana Edad , Mortalidad/tendencias , Guías de Práctica Clínica como AsuntoRESUMEN
Here, we analyze 248 DNA barcode sequences of 35 fly species of forensic importance in Brazil. DNA barcoding can be effectively used for specimen identification of these species, allowing the unambiguous identification of 31 species, an overall success rate of 88%. Our results show a high rate of success for molecular identification using DNA barcoding sequences and open new perspectives for immature species identification, a subject on which limited forensic investigations exist in Tropical regions. We also address the implications of building a robust forensic DNA barcode database. A geographic bias is recognized for the COI dataset available for forensically important fly species in Brazil, with concentration of sequences from specimens collected mainly in sites located in the Cerrado, Mata Atlântica, and Pampa biomes.
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Código de Barras del ADN Taxonómico , Dípteros/clasificación , Ciencias Forenses , Animales , Brasil , Dípteros/genética , Complejo IV de Transporte de Electrones/análisis , Proteínas de Insectos/análisisRESUMEN
BACKGROUND: In the 1980s, an increase in mortality rates for prostate cancer was observed in North America and developed European countries. In the 1990s, however, mortality rates decreased for these countries, an outcome related to early detection of the disease. Conversely, an upward trend in mortality rates was observed in Brazil. This study describe the trends in mortality for prostate cancer in Brazil and geographic regions (North, Northeast, South, Southeast, and Central-West) between 1980 until 2014 and analyze the influence of age, period, and cohort effects on mortality rates. METHODS: This time-series study used data from the Mortality Information System (SIM) and population data from Brazilian Institute for Geography and Statistics (IBGE). The effects on mortality rates were examined using age-period-cohort (APC) models. RESULTS: Crude and standardized mortality rates showed an upward trend for Brazil and its regions more than 2-fold the last 30 years. Age effects showed an increased risk of death in all regions. Period effects showed a higher risk of death in the finals periods for the North and Northeast. Cohort effects showed risk of death was higher for younger than older generations in Brazil and regions, mainly Northeast (RRAdjusted=3.12, 95% CI 1.29-1.41; RRAdjusted=0.28, 95% CI 0.26-0.30, respectively). CONCLUSION: The increase in prostate cancer mortality rates in Brazil and its regions was mainly due to population aging. The differences in mortality rates and APC effects between regions are related to demographic differences and access of health services across the country.
Asunto(s)
Mortalidad/tendencias , Neoplasias de la Próstata/mortalidad , Sistema de Registros/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios de Cohortes , Geografía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Neoplasias de la Próstata/epidemiología , Tasa de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVE: Annona tomentosa R.E.Fr is a species not endemic to Brazil that belongs to the phytogeographic areas of the Amazon, Cerrado and Pantanal. Popularly known as "araticum rasteiro" or "araticum de moita", A. tomentosa is edible and tea made from the leaves has been used as an anti-inflammatory by native communities. There is no scientific evidence for these uses of A. tomentosa, especially those related to the control of pain and inflammation. For this reason, in the present study we evaluated the antinociceptive and anti-inflammatory activities of partitions from the methanolic extract of A. tomentosa leaves (A. tomentosa leaf methanolic extract (ATFM) in hexane partition: ATFM-H; ATFM in dichloromethane partition: ATFM-D; ATFM in ethyl acetate partition: ATFM-Ac; ATFM in butanol partition: ATFM-B) in mice. METHODS: The antinociceptive effects of leaf extracts from A. tomentosa were evaluated by abdominal writhing and tail-flick tests, while the anti-inflammatory effects were evaluated by paw oedema and air-pouch tests. The locomotor activity was evaluated with the open-field test. Furthermore, we evaluated the possible action mechanism of A. tomentosa, using naloxone, nitro-L-arginine methyl ester, glibenclamide, atropine, naltrindole and norbinaltorphimine in tail-flick tests. The productions of tumor necrosis factor α (TNF-α) and interleukin (IL)-1ß were also evaluated. RESULTS: The chromatographic fractionation of the partitions of the methanolic extract from the leaves of A. tomentosa revealed the presence of diterpenes, flavonoids, and steroids compounds. From the analysis of the hexane partition kaurenoic acid was identified as the major component. ATFM-H and ATFM-D had a significant antinociceptive effect in acute pain models in mice. The ATFM-H showed central antinociceptive effect from the involvement of the δ opioid receptors, without causing alterations in the locomotor activity of the mice, while ATFM-D was effective in decreasing paw oedema and TNF-α and IL-1ß production. CONCLUSION: These results demonstrate that leaf extracts from A. tomentosa present antinociceptive and anti-inflammatory effects that can to be used in relieving algesic and inflammatory conditions.