Cancer incidence in indigenous populations of Western Amazon, Brazil.

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

Effects of age, period, and cohort on mortality by prostate cancer among men in the state of Acre, in the Brazilian Western Amazon. / Efeitos de idade, período e coorte na mortalidade por câncer de próstata em homens no estado do Acre, oeste Amazônico brasileiro.

The present study aimed to analyze the effects of age, time period, and birth cohort on the temporal evolution of mortality rates due to prostate cancer in men from the state of Acre, Brazil, in the period of 1990 to 2019. This is an ecological study in which the temporal trend was evaluated by the joinpoint method, estimating the annual percentage variations of the mortality rates. The age-period-birth cohort effects were calculated by using the Poisson Regression method, using estimation functions. The mortality rates showed an increase of 2.20% (95%CI: 1.00-3.33) in the period studied, tended to increase with age. A relative risk (RR) of 0.67 (95%CI: 0.59-0.76) was observed between 2005 and 2009, 0.76 (95%CI: 0.67-0.87) from 2005 on, and 1.44 (95%CI: 1.25-1.68) from 2015 on. The cohorts from 1910 to 1924 presented a risk reduction (RR < 1), when compared to the reference cohort (1935). Regarding the time period, the creation of public policies and the establishment of guidelines are suggested as factors which may have contributed to more access to diagnosis, in consonance with the cohort effect. These findings can contribute to a better understanding of the epidemiological scenario of prostate cancer in regions that are more vulnerable in terms of socioeconomic conditions.

O objetivo foi analisar os efeitos de idade, período e coorte de nascimento na evolução temporal da mortalidade por câncer de próstata em homens no estado do Acre, no período de 1990 a 2019. Trata-se de um estudo ecológico de tendência temporal, que foi avaliada pelo método de joinpoint, estimando as variações percentuais anuais das taxas de mortalidade. Os efeitos idade-período-coorte de nascimento foram calculados pelo modelo de regressão de Poisson, utilizando as funções estimáveis. A taxa de mortalidade apresentou incremento de 2,20% (IC95%: 1,00-3,33) no período estudado. A mortalidade aumentou com a idade. Foi observado risco relativo (RR) de 0,67 (IC95%: 0,59-0,76) entre 2005 e 2009, de 0,76 (IC95%: 0,67-0,87) a partir de 2005 e de 1,44 (IC95%: 1,25-1,68) a partir de 2015. As coortes de 1910 a 1924 apresentaram redução do risco (RR < 1) quando comparadas à coorte de referência (1935). Quanto ao período, sugere-se que a instituição de políticas públicas e o estabelecimento de diretrizes podem ter auxiliado para maior acesso ao diagnóstico, em consonância com o efeito de coorte. Esses achados contribuem para melhor compreensão do cenário epidemiológico do câncer de próstata em regiões com condições socioeconômicas mais vulneráveis.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life.

OBJECTIVE: To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. METHODS: Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. RESULTS: 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. CONCLUSION: There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. MAIN RESULTS: Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life. IMPLICATIONS FOR SERVICES: Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System. PERSPECTIVES: Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.

Description of vaccination coverage and hesitancy obtained by epidemiological survey of children born in 2017-2018, in Belo Horizonte and Sete Lagoas, Minas Gerais, Brazil.

OBJECTIVE: To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. METHODS: Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. RESULTS: Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. CONCLUSION: Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities. MAIN RESULTS: Vaccination coverage of children up to 4 years old was 50.2% in Belo Horizonte, and 64.9% in Sete Lagoas. Fear of severe reactions and believing that vaccination against eradicated diseases is unnecessary were the main reasons for vaccination hesitancy. IMPLICATIONS FOR SERVICES: Recovery of high vaccination coverage among children, considering public health service access conditions and socioeconomic inequities. Acting on reasons for hesitancy that can assist in targeting actions. PERSPECTIVES: The multifactorial context of vaccination hesitancy demands the development of health education strategies to raise awareness about child immunization.

[Social, demographic, and health policies history of indigenous peoples from the state of Acre, Brazil]. / Histórico social, demográfico e de saúde dos povos indígenas do estado do Acre, Brasil.

The historical trajectory experienced by Brazilian Amerindians population lead to a complex social issues, which are expressed by a lack of health service access and socioeconomic disparities. Such reality is translated into a higher level of poverty, lower education level and worse health profile, as compared to non-indigenous counterparts. The current health policies for indigenous population in Brazil could not overcome the lack of specialized care access. thus, fragmented and unplanned health care still persist, with distortions in the process of social control. Therefore, increased morbidity and mortality rates, unequal health care access, lack of continuity of care, and administrative barriers are still frequent among Brazilian Amerindians. The indigenous peoples from the State of Acre, located in the Western Brazilian Amazon, reflects the situation of greater vulnerability among all the indigenous populations from the North Region of Brazil, sharing worse health outcomes as compared to the rest of the country. Thus, the purpose of this narrative review is to characterize the history of the Indian population in Brazil and the State of Acre, according to demographic, epidemiological and health policies.

A trajetória histórica vivenciada pelos povos indígenas no Brasil coadunou numa complexa situação social que se estende com precariedade e evidentes disparidades traduzidas em pior perfil de pobreza, escolaridade e de saúde em relação a outros segmentos da sociedade nacional. As políticas de saúde direcionadas para os povos indígenas não conseguiram até a atualidade superar as lacunas do cuidado especializado, persistindo a atenção fragmentada e emergencial, manutenção de péssimo quadro de morbimortalidade, iniquidades de acesso aos serviços de saúde, elevada descontinuidade do cuidado, barreiras administrativas e distorções no processo de controle social. O Estado do Acre, localizado na Amazônia Ocidental brasileira, reflete o quadro de maior vulnerabilidade dos povos indígenas da Região Norte, que compartilham piores resultados de saúde quando comparados com o restante do país. O objetivo do presente artigo de revisão narrativa da literatura consiste em caracterizar o histórico dos povos indígenas do Acre, segundo aspectos sociodemográficos, epidemiológicos e de políticas de saúde no contexto brasileiro.

[Cancer mortality among indigenous population in Acre State, Brazil]. / Mortalidade por câncer em populações indígenas no Estado do Acre, Brasil.

The study aimed to estimate cancer mortality among indigenous peoples in Acre State, Brazil. This was a descriptive observational study based on the nominal bank of the Brazilian Mortality Information System for the period from January 1st, 2000, to December 31st, 2012. The study analyzed the distribution death frequencies by sex and age. Standardized mortality ratio (SMR) was calculated taking Goiânia (Goiás State), Acre State, and the North Region of Brazil as the references. A total of 81 deaths were identified, the majority in men (59.3%) and in individuals over 70 years of age. The five main sites in men were stomach, liver, colon and rectum, leukemia, and prostate. The five main sites in women were uterine cervix, stomach, liver, leukemia, and uterus. In indigenous men there was an excess of deaths from stomach cancer compared to the populations of Goiânia (SMR = 2.72; 2.58-2.87), Acre State (SMR = 2.05; 1.94-2.16) and North region (SMR = 3.10; 2.93-3.27). The same was observed for deaths from hepatic cell carcinomas referenced against Goiânia (SMR = 3.89; 3.66-4.14), Acre State (SMR = 1.79; 1.68-1.91), and the North of Brazil (SMR = 4.04; 3.77-4.30). Among indigenous women, there was an excess of cervical cancer in comparison to Goiânia (SMR = 4.67; 4.41-4.93), Acre State (SMR = 2.12; 2.00-2.24), and the North (SMR = 2.60; 2.45-2.75). The estimates show that preventable neoplasms such as cervical cancer and those linked to underdevelopment, such as stomach and liver cancer, account for 49.4% of deaths among indigenous peoples. Compared to the reference population, mortality from liver, stomach, and colorectal cancer and leukemias was more than twice as high in indigenous men; among indigenous women, cervical, stomach, and liver cancer and leukemias were 30% higher.

O objetivo do estudo foi estimar a mortalidade por câncer em povos indígenas no Estado do Acre, Brasil. Trata-se de estudo observacional descritivo, com base no banco nominal do SIM (Sistema de Informações sobre Mortalidade), referente ao período de 1º de janeiro de 2000 a 31 de dezembro de 2012. Foi analisada a distribuição de frequência de óbitos, por sexo e faixa etária, e calculada a RMP (razão de mortalidade padronizada), tendo como referência Goiânia (Goiás), Acre e Região Norte. Foram identificados 81 óbitos, a maioria de homens (59,3%) e acima de 70 anos. As cinco principais localizações em homens foram estômago, fígado, cólon e reto, leucemia e próstata. Nas mulheres, câncer cervical, estômago, fígado, leucemia e útero. Nos homens indígenas houve excesso de óbitos por câncer de estômago quando comparados às populações de Goiânia (RMP = 2,72; 2,58-2,87), Acre (RMP = 2,05; 1,94-2,16) e Região Norte (RMP = 3,10; 2,93-3,27). O mesmo foi observado para óbitos por hepatocarcinomas, tendo por referência Goiânia (RMP = 3,89; 3,66-4,14), Acre (RMP = 1,79; 1,68-1,91) e Região Norte (RMP = 4,04; 3,77-4,30). Dentre as mulheres indígenas, destaca-se o excesso de câncer cervical em relação à Goiânia (RMP = 4,67; 4,41-4,93), Acre (RMP = 2,12; 2,00-2,24) e Região Norte (RMP = 2,60; 2,45-2,75). As estimativas apontam que neoplasias passíveis de prevenção, como câncer cervical, e ligadas ao subdesenvolvimento, como estômago e fígado, corresponderam a cerca de 49,4% dos óbitos entre indígenas. Comparados à população de referência, a mortalidade por câncer de fígado, estômago, colorretal e leucemias foi maior que o dobro entre os homens indígenas; por câncer cervical, estômago, fígado e leucemias esteve acima de 30% entre as mulheres indígenas.

El objetivo del estudio fue estimar la mortalidad por cáncer en pueblos indígenas del estado de Acre. Se trata de un estudio observacional descriptivo, a partir del banco de datos nominal del SIM (Sistema de Información Sobre Mortalidad), referente al período de 01 de enero de 2000 a 31 de diciembre de 2012. Se analizó la distribución de frecuencia de óbitos, por sexo y franja de edad, y se calculó la RMP (razón de mortalidad estandarizada), teniendo como referencia Goiânia-GO, Acre y la región norte. Se identificaron 81 óbitos, la mayoría en hombres (59,3%) y por encima de los 70 años. Los cinco principales focos en hombres fueron: estómago, hígado, colon y recto, leucemia y próstata. En las mujeres, cáncer cervical, estómago, hígado, leucemia y útero. En los hombres indígenas, hubo exceso de óbitos por cáncer de estómago, comparados con las poblaciones de Goiânia (RMP = 2,72; 2,58-2,87), estado de Acre (RMP = 2,05; 1,94-2,16) y región norte (RMP = 3,10; 2,93-3,27). Lo mismo se observó en caso de óbitos por hepatocarcinomas, teniendo por referencia Goiânia (RMP = 3,89; 3,66-4,14), estado de Acre (RMP = 1,79; 1,68-1,91) y región norte (RMP = 4,04; 3,77-4,30). Entre las mujeres indígenas, se destaca el exceso de cáncer cervical, en relación con Goiânia (RMP = 4,67; 4,41-4,93), estado de Acre (RMP = 2,12; 2,00-2,24) y región norte (RMP = 2,60; 2,45-2,75). Las estimativas apuntan a que neoplasias susceptibles de prevención, como la cervical, y vinculadas al subdesarrollo, como la de estómago e hígado, correspondieron a cerca de un 49,4% de los óbitos entre indígenas. Comparados con la población de referencia, la mortalidad por cáncer de hígado, estómago, colorrectal y leucemias fue más que el doble entre los hombres indígenas; por cáncer cervical, estómago, hígado y leucemias estuvo por encima de un 30% entre las mujeres indígenas.

Beliefs about Breast Cancer among Women in the Western Amazon: A Population-Based Study

Objective: Evaluate the beliefs about the risk factors for breast cancer in a population of women from the western Amazon and determine the factors associated with the higher belief scores presented by this population. Methods: A population-based cross-sectional study included 478 women aged >40 years residing in Rio Branco, Acre, Brazil. An American Cancer Society questionnaire was applied to assess the knowledge, attitudes, and beliefs about breast cancer. Results: The main beliefs about the risk factors for breast cancer were breast trauma (95%), use of underwire bra (58.5%), and a high number of sexual partners (55.5%). Women from younger age groups presented higher belief scores (Bcoefficient: ­0.04, 95% CI: ­0.07; ­0.01) than those of women from older age groups. A strong association was noted between high knowledge scores of risk factors and signs/symptoms of the disease and high belief scores in the study group (Bcoefficient:0.33;95%CI:0.28;0.38). Conclusion: The results indicate the existence of important beliefs related to the risk factors for breast cancer. Women from younger age groups, women who have seen a gynecologist in the past 2 years, and women who had more knowledge about the risk factors and signs and symptoms of breast cancer had higher belief scores.

Efeitos de idade, período e coorte na mortalidade por câncer de próstata em homens no estado do Acre, oeste Amazônico brasileiro / Effects of age, period, and cohort on mortality by prostate cancer among men in the state of Acre, in the Brazilian Western Amazon

Resumo O objetivo foi analisar os efeitos de idade, período e coorte de nascimento na evolução temporal da mortalidade por câncer de próstata em homens no estado do Acre, no período de 1990 a 2019. Trata-se de um estudo ecológico de tendência temporal, que foi avaliada pelo método de joinpoint, estimando as variações percentuais anuais das taxas de mortalidade. Os efeitos idade-período-coorte de nascimento foram calculados pelo modelo de regressão de Poisson, utilizando as funções estimáveis. A taxa de mortalidade apresentou incremento de 2,20% (IC95%: 1,00-3,33) no período estudado. A mortalidade aumentou com a idade. Foi observado risco relativo (RR) de 0,67 (IC95%: 0,59-0,76) entre 2005 e 2009, de 0,76 (IC95%: 0,67-0,87) a partir de 2005 e de 1,44 (IC95%: 1,25-1,68) a partir de 2015. As coortes de 1910 a 1924 apresentaram redução do risco (RR < 1) quando comparadas à coorte de referência (1935). Quanto ao período, sugere-se que a instituição de políticas públicas e o estabelecimento de diretrizes podem ter auxiliado para maior acesso ao diagnóstico, em consonância com o efeito de coorte. Esses achados contribuem para melhor compreensão do cenário epidemiológico do câncer de próstata em regiões com condições socioeconômicas mais vulneráveis.

Abstract The present study aimed to analyze the effects of age, time period, and birth cohort on the temporal evolution of mortality rates due to prostate cancer in men from the state of Acre, Brazil, in the period of 1990 to 2019. This is an ecological study in which the temporal trend was evaluated by the joinpoint method, estimating the annual percentage variations of the mortality rates. The age-period-birth cohort effects were calculated by using the Poisson Regression method, using estimation functions. The mortality rates showed an increase of 2.20% (95%CI: 1.00-3.33) in the period studied, tended to increase with age. A relative risk (RR) of 0.67 (95%CI: 0.59-0.76) was observed between 2005 and 2009, 0.76 (95%CI: 0.67-0.87) from 2005 on, and 1.44 (95%CI: 1.25-1.68) from 2015 on. The cohorts from 1910 to 1924 presented a risk reduction (RR < 1), when compared to the reference cohort (1935). Regarding the time period, the creation of public policies and the establishment of guidelines are suggested as factors which may have contributed to more access to diagnosis, in consonance with the cohort effect. These findings can contribute to a better understanding of the epidemiological scenario of prostate cancer in regions that are more vulnerable in terms of socioeconomic conditions.

Description of vaccination coverage and hesitancy obtained by epidemiological survey of children born in 2017-2018, in Belo Horizonte and Sete Lagoas, Minas Gerais, Brazil / Descripción de la cobertura de vacuna y de las vacunaciones obtenidas por la encuesta epidemiológica de niños nacidos en 2017-2018, en Belo Horizonte y Sete Lagoas, Minas Gerais / Descrição da cobertura e da hesitação vacinal obtida por inquérito epidemiológico de crianças nascidas em 2017-2018, em Belo Horizonte e Sete Lagoas, Minas Gerais

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

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RESUMO Objetivo Descrever as coberturas e hesitação das vacinas do calendário básico infantil em Belo Horizonte e Sete Lagoas, Minas Gerais. Métodos Inquéritos epidemiológicos de base populacional realizados de 2020 a 2022, para estimar coberturas vacinais por tipo de imunobiológico e esquema completo (doses válidas e aplicadas) segundo estratos socioeconômicos, e os motivos de hesitação vacinal. Resultados A cobertura global com doses válidas e a hesitação vacinal de pelo menos uma vacina foram, respectivamente, de 50,2% (IC95% 44,1;56,2) e 1,6% (IC95% 0,9;2,7), em Belo Horizonte (n = 1.866), e de 64,9% (IC95% 56,9;72,1) e 1,0% (IC95% 0,3;2,8), em Sete Lagoas (n = 451), com diferenças entre os estratos. O receio de reações graves foi o principal motivo de hesitação vacinal. Conclusão Identificou-se coberturas abaixo do preconizado para a maioria das vacinas. A desinformação deve ser combatida, evitando-se a hesitação vacinal. Há necessidade premente de recuperar as coberturas, considerando acesso ao SUS e disparidades socioeconômicas.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life / Desigualdades raciales en la vacunación infantil y obstáculos para la vacunación en Brazil entre nacidos vivos en 2017 y 2018: análisis de uma cohorte retrospectiva de los dos primeros años de vida / Desigualdades raciais na vacinação infantil e nos obstáculos à vacinação no Brasil entre nascidos vivos em 2017 e 2018: análise de uma coorte retrospectiva dos dois primeiros anos de vida

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

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RESUMO Objetivo Descrever a completude vacinal em tempo oportuno nos primeiros 24 meses de vida no Brasil e os obstáculos para vacinação, testando-se associações com raça/cor da pele materna. Métodos Fez-se coleta de informações sobre os nascidos em 2017 e 2018, constantes no Inquérito Nacional de Cobertura Vacinal. Foram calculados prevalência e intervalos de confiança de 95% de obstáculos à vacinação e completude vacinal em tempo oportuno aos 5 meses, primeiro e segundo ano, segundo raça/cor da pele materna. Empregou-se regressão logística para análise de associações. Resultados Analisaram-se dados de 37.801 crianças. Do total, 7,2% (IC95% 6,3;8,2) dos responsáveis enfrentaram dificuldades para levar seus filhos para vacinação e 23,4% (IC95% 21,7;25,1) das crianças não foram vacinadas, mesmo sendo levadas. Essas proporções foram 75% (IC95% 1,25;2,45) e 97% (IC95% 1,57;2,48) mais elevadas, respectivamente, entre pretas; e 49,9% (IC95% 47,8;51,9) e 61,1% (IC95% 59,2;63,0) das crianças tiveram atraso em alguma vacina até os 5 meses e o primeiro ano, respectivamente. Tais valores foram maiores entre pardas/pretas. Conclusão Há desigualdades raciais nos obstáculos enfrentados e na vacinação no Brasil.

Breast Cancer Awareness among Women in Western Amazon: a Population Based Cross-Sectional Study

Background: A general lack of women`s awareness of breast cancer has been one of the barriers to screening and early presentation. Thus, the aim of this study was to evaluate levels of knowledge about risk factors, and early warning signs of breast cancer, and to determine factors associated with better levels of comprehension. Methods: A population-based cross-sectional study was carried out among 478 women over 40 years old, living in Rio Branco city, western Amazon. All were interviewed using the "Breast cancer knowledge, attitudes and practice scale", developed by American Cancer Society. Results: Among the respondents, only 28.6% of women were aware that advanced age highly increases the risk. Around 30% of participants recognized nipple retraction as a sign of breast cancer. Breast cancer knowledge varied according to age in such a way that the mean scores were high from 40-69 years and decreased dramatically among those aged ≥70 (ß=-0.06,p=0.031). Access to health services such as the Pap-test (ß=2.45,p=0.027) and attending a gynecologist in the past two years (ß=1.88,p=0.005) were statistically associated with the score of breast cancer knowledge. Conclusion: The findings indicate that women living in urban areas, having gynecological assessment, considering herself at high risk of developing breast cancer and thinking that breast cancer is a fatal disease are statistically associated with good knowledge of breast cancer risk factors, signs and symptoms, even adjusting for age and education.

Histórico social, demográfico e de saúde dos povos indígenas do estado do Acre, Brasil / Social, demographic, and health policies history of indigenous peoples from the state of Acre, Brazil

Resumo A trajetória histórica vivenciada pelos povos indígenas no Brasil coadunou numa complexa situação social que se estende com precariedade e evidentes disparidades traduzidas em pior perfil de pobreza, escolaridade e de saúde em relação a outros segmentos da sociedade nacional. As políticas de saúde direcionadas para os povos indígenas não conseguiram até a atualidade superar as lacunas do cuidado especializado, persistindo a atenção fragmentada e emergencial, manutenção de péssimo quadro de morbimortalidade, iniquidades de acesso aos serviços de saúde, elevada descontinuidade do cuidado, barreiras administrativas e distorções no processo de controle social. O Estado do Acre, localizado na Amazônia Ocidental brasileira, reflete o quadro de maior vulnerabilidade dos povos indígenas da Região Norte, que compartilham piores resultados de saúde quando comparados com o restante do país. O objetivo do presente artigo de revisão narrativa da literatura consiste em caracterizar o histórico dos povos indígenas do Acre, segundo aspectos sociodemográficos, epidemiológicos e de políticas de saúde no contexto brasileiro.

Abstract The historical trajectory experienced by Brazilian Amerindians population lead to a complex social issues, which are expressed by a lack of health service access and socioeconomic disparities. Such reality is translated into a higher level of poverty, lower education level and worse health profile, as compared to non-indigenous counterparts. The current health policies for indigenous population in Brazil could not overcome the lack of specialized care access. thus, fragmented and unplanned health care still persist, with distortions in the process of social control. Therefore, increased morbidity and mortality rates, unequal health care access, lack of continuity of care, and administrative barriers are still frequent among Brazilian Amerindians. The indigenous peoples from the State of Acre, located in the Western Brazilian Amazon, reflects the situation of greater vulnerability among all the indigenous populations from the North Region of Brazil, sharing worse health outcomes as compared to the rest of the country. Thus, the purpose of this narrative review is to characterize the history of the Indian population in Brazil and the State of Acre, according to demographic, epidemiological and health policies.

Mortalidade por câncer em populações indígenas no Estado do Acre, Brasil / Cancer mortality among indigenous population in Acre State, Brazil / Mortalidad por cáncer en poblaciones indígenas en el estado de Acre, Brasil

O objetivo do estudo foi estimar a mortalidade por câncer em povos indígenas no Estado do Acre, Brasil. Trata-se de estudo observacional descritivo, com base no banco nominal do SIM (Sistema de Informações sobre Mortalidade), referente ao período de 1º de janeiro de 2000 a 31 de dezembro de 2012. Foi analisada a distribuição de frequência de óbitos, por sexo e faixa etária, e calculada a RMP (razão de mortalidade padronizada), tendo como referência Goiânia (Goiás), Acre e Região Norte. Foram identificados 81 óbitos, a maioria de homens (59,3%) e acima de 70 anos. As cinco principais localizações em homens foram estômago, fígado, cólon e reto, leucemia e próstata. Nas mulheres, câncer cervical, estômago, fígado, leucemia e útero. Nos homens indígenas houve excesso de óbitos por câncer de estômago quando comparados às populações de Goiânia (RMP = 2,72; 2,58-2,87), Acre (RMP = 2,05; 1,94-2,16) e Região Norte (RMP = 3,10; 2,93-3,27). O mesmo foi observado para óbitos por hepatocarcinomas, tendo por referência Goiânia (RMP = 3,89; 3,66-4,14), Acre (RMP = 1,79; 1,68-1,91) e Região Norte (RMP = 4,04; 3,77-4,30). Dentre as mulheres indígenas, destaca-se o excesso de câncer cervical em relação à Goiânia (RMP = 4,67; 4,41-4,93), Acre (RMP = 2,12; 2,00-2,24) e Região Norte (RMP = 2,60; 2,45-2,75). As estimativas apontam que neoplasias passíveis de prevenção, como câncer cervical, e ligadas ao subdesenvolvimento, como estômago e fígado, corresponderam a cerca de 49,4% dos óbitos entre indígenas. Comparados à população de referência, a mortalidade por câncer de fígado, estômago, colorretal e leucemias foi maior que o dobro entre os homens indígenas; por câncer cervical, estômago, fígado e leucemias esteve acima de 30% entre as mulheres indígenas.

The study aimed to estimate cancer mortality among indigenous peoples in Acre State, Brazil. This was a descriptive observational study based on the nominal bank of the Brazilian Mortality Information System for the period from January 1st, 2000, to December 31st, 2012. The study analyzed the distribution death frequencies by sex and age. Standardized mortality ratio (SMR) was calculated taking Goiânia (Goiás State), Acre State, and the North Region of Brazil as the references. A total of 81 deaths were identified, the majority in men (59.3%) and in individuals over 70 years of age. The five main sites in men were stomach, liver, colon and rectum, leukemia, and prostate. The five main sites in women were uterine cervix, stomach, liver, leukemia, and uterus. In indigenous men there was an excess of deaths from stomach cancer compared to the populations of Goiânia (SMR = 2.72; 2.58-2.87), Acre State (SMR = 2.05; 1.94-2.16) and North region (SMR = 3.10; 2.93-3.27). The same was observed for deaths from hepatic cell carcinomas referenced against Goiânia (SMR = 3.89; 3.66-4.14), Acre State (SMR = 1.79; 1.68-1.91), and the North of Brazil (SMR = 4.04; 3.77-4.30). Among indigenous women, there was an excess of cervical cancer in comparison to Goiânia (SMR = 4.67; 4.41-4.93), Acre State (SMR = 2.12; 2.00-2.24), and the North (SMR = 2.60; 2.45-2.75). The estimates show that preventable neoplasms such as cervical cancer and those linked to underdevelopment, such as stomach and liver cancer, account for 49.4% of deaths among indigenous peoples. Compared to the reference population, mortality from liver, stomach, and colorectal cancer and leukemias was more than twice as high in indigenous men; among indigenous women, cervical, stomach, and liver cancer and leukemias were 30% higher.

El objetivo del estudio fue estimar la mortalidad por cáncer en pueblos indígenas del estado de Acre. Se trata de un estudio observacional descriptivo, a partir del banco de datos nominal del SIM (Sistema de Información Sobre Mortalidad), referente al período de 01 de enero de 2000 a 31 de diciembre de 2012. Se analizó la distribución de frecuencia de óbitos, por sexo y franja de edad, y se calculó la RMP (razón de mortalidad estandarizada), teniendo como referencia Goiânia-GO, Acre y la región norte. Se identificaron 81 óbitos, la mayoría en hombres (59,3%) y por encima de los 70 años. Los cinco principales focos en hombres fueron: estómago, hígado, colon y recto, leucemia y próstata. En las mujeres, cáncer cervical, estómago, hígado, leucemia y útero. En los hombres indígenas, hubo exceso de óbitos por cáncer de estómago, comparados con las poblaciones de Goiânia (RMP = 2,72; 2,58-2,87), estado de Acre (RMP = 2,05; 1,94-2,16) y región norte (RMP = 3,10; 2,93-3,27). Lo mismo se observó en caso de óbitos por hepatocarcinomas, teniendo por referencia Goiânia (RMP = 3,89; 3,66-4,14), estado de Acre (RMP = 1,79; 1,68-1,91) y región norte (RMP = 4,04; 3,77-4,30). Entre las mujeres indígenas, se destaca el exceso de cáncer cervical, en relación con Goiânia (RMP = 4,67; 4,41-4,93), estado de Acre (RMP = 2,12; 2,00-2,24) y región norte (RMP = 2,60; 2,45-2,75). Las estimativas apuntan a que neoplasias susceptibles de prevención, como la cervical, y vinculadas al subdesarrollo, como la de estómago e hígado, correspondieron a cerca de un 49,4% de los óbitos entre indígenas. Comparados con la población de referencia, la mortalidad por cáncer de hígado, estómago, colorrectal y leucemias fue más que el doble entre los hombres indígenas; por cáncer cervical, estómago, hígado y leucemias estuvo por encima de un 30% entre las mujeres indígenas.

[Prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and factors associated with non-participation in screening]. / Prevalência do exame preventivo de câncer do colo do útero em Rio Branco, Acre, Brasil, e fatores associados à não-realização do exame.

The objective of the study was to determine the self-reported prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and to analyze factors associated with non-participation in screening. A population-based cross-sectional study with a sample of 772 women 18 to 69 years of age and living in Rio Branco was conducted in 2007 and 2008. Data were analyzed with Stata 10.0, and prevalence rates were estimated with Poisson multivariate regression (95%CI). 85.3% of women reported at least one cervical cancer screening test in the previous three years. The majority of women (72.8%) were screened in the Brazilian Unified National Health System. After adjusting for selected variables, statistically significant prevalence rates for absence of screening were found in women 18-24 and 60-69 years of age, single, and with low income and low schooling. The prevalence rates were consistent with findings from other studies, highlighting the need for greater intervention in the group of women most vulnerable to cervical cancer incidence and mortality.

Percepção do trabalho docente em uma universidade da Região Norte do Brasil / Perception of the teaching profession at a university in Northern Brazil / Percepción de la labor docente en una universidad de la Región Norte de Brasil

Buscou-se conhecer a percepção da experiência do trabalho docente em cursos de saúde de uma universidade federal da região Norte do Brasil. Utilizando-se abordagem qualitativa, foram entrevistados seis docentes de cursos de saúde dessa universidade, cujos dados foram submetidos à análise de conteúdo. Predominaram mulheres na função docente, e a valorização dessa função como vínculo estável de trabalho, fonte de rendimentos e função social. No trabalho docente, a maioria se concentra no desenvolvimento de habilidades técnico-científicas dos alunos, expressando a necessidade da qualificação contínua e apoio institucional insuficiente. As relações pessoais desses docentes com alunos e outros professores e técnico-administrativos são reconhecidamente mediadoras da qualidade do processo de ensino-apren-dizagem e trabalho. Quanto à saúde, a maior parte se sente vulnerável e desgastada, principalmente em aspectos psicoemocionais, o que influencia as suas relações sociais dentro e fora do ambiente de trabalho. Embora o exercício profissional tenha sido identificado como fonte de estabilidade, realização pessoal e financeira, destacam-se a precariedade e a sobrecarga de trabalho, que tendem a induzir sofrimento e adoe-cimento. Esta reflexão entre docentes, movimentos sindicais e instituições de ensino pode subsidiar ajustes institucionais, legais, curriculares e sociais para melhorar o processo de ensino-aprendizagem e a qualidade de vida dos docentes.

An attempt was made to get to know the views professors have on the experience of teaching in health courses at a federal university located in northern Brazil. Using a qualitative approach, six professors working at the university's health courses were interviewed, and their data were subjected to content analysis. Most professors were female, and the role was valued as it represents a stable employment status, a source ofincome, and a social function. In the teaching activity, most focus on developing the students' technical and scientific skills, expressing the need for ongoing training and insufficient institutional support. Personal relationships among these professors and students and with other professors and technical administrators are known to mediate the quality of the teaching/learning and work processes. Insofar as health is concerned, most feel vulnerable and worn, particularly in psycho-emotional aspects, a fact that influences their social relations within and outside of the workplace. Although the professional practice has been identified as a source of stability and of personal and financial realization, the precariousness and work overload stand out and tend to induce suffering and illness. This reflection among professors, labor union movements, and educational institutions may support institutional, legal, curriculum and social adjustments in order to improve the process of teaching and learning and the professors' quality of life.

Se buscó conocer la percepción de la experiencia del trabajo docente en cursos de salud de una universidad federal de la región Norte de Brasil. A partir de un enfoque cualitativo, fueron entrevistados seis profesores de cursos de salud de esa universidad, cuyos datos fueron someti-dos al análisis de contenido. Predominaron las mujeres en la función docente, y la valoración de esta función como vínculo laboral estable, fuente de ingresos y función social. En el trabajo docente, la mayoría se concentra en el desarrollo de habilidades técnicas y científicas de los estu-diantes, lo que expresa la necesidad de la formación continua y un apoyo institucional insuficiente. Las relaciones personales de estos profesores con alumnos y otros docentes y con técnicos administrativos, son reconocidamente mediadoras de la calidad en el proceso de ensenanza-apren-dizaje y trabajo. En relación a la salud, la mayoría se siente vulnerable y desgastada, sobre todo en los aspectos psicoemocionales, lo que influye en sus relaciones sociales dentro y fuera del ambiente de trabajo. Aunque la práctica profesional se haya identificado como una fuente de es-tabilidad, realización personal y financiera, sobresalen la precariedad y la sobrecarga de trabajo, que tienden a provocar sufrimiento y enfermedad. Esta reflexión entre los docentes, los mo-vimientos sindicales y las instituciones educativas puede sustentar ajustes institucionales, legales, curriculares y sociales para mejorar el proceso de ensenanza-aprendizaje y la calidad de vida de los docentes.

Prevalência do exame preventivo de câncer do colo do útero em Rio Branco, Acre, Brasil, e fatores associados à não-realização do exame / Prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and factors associated with non-participation in screening

O objetivo do estudo foi determinar a prevalência autorreferida do exame preventivo de câncer do colo uterino em Rio Branco, Acre, Brasil, e avaliar fatores associados com a não realização do exame. Trata-se de estudo transversal de base populacional, composto por 772 mulheres de 18 a 69 anos residentes em Rio Branco, no período 2007 a 2008. Os dados foram analisados no programa Stata 10.0 e estimadas razões de prevalências a partir da regressão multivariada de Poisson. O percentual de mulheres na população alvo que relatou pelo menos um exame nos últimos três anos foi de 85,3%, com acentuada utilização do Sistema Único de Saúde (72,8%). Foram encontradas razões de prevalência estatisticamente significativas quanto à ausência do exame em mulheres de 18 a 24 anos, de 60 a 69 anos, solteiras, com menor renda e baixa escolaridade. As magnitudes encontradas nas razões de prevalência foram consistentes com achados de outros estudos, apontando maior necessidade de intervenção no grupo de mulheres mais vulneráveis à incidência e mortalidade por câncer do colo do útero.

The objective of the study was to determine the self-reported prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and to analyze factors associated with non-participation in screening. A population-based cross-sectional study with a sample of 772 women 18 to 69 years of age and living in Rio Branco was conducted in 2007 and 2008. Data were analyzed with Stata 10.0, and prevalence rates were estimated with Poisson multivariate regression (95%CI). 85.3% of women reported at least one cervical cancer screening test in the previous three years. The majority of women (72.8%) were screened in the Brazilian Unified National Health System. After adjusting for selected variables, statistically significant prevalence rates for absence of screening were found in women 18-24 and 60-69 years of age, single, and with low income and low schooling. The prevalence rates were consistent with findings from other studies, highlighting the need for greater intervention in the group of women most vulnerable to cervical cancer incidence and mortality.