Breast cancer and cervical cancer: a comparison of the period before and during the COVID-19 pandemic.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic impacted cancer health care in several countries, with delays in the detection and treatment of breast and cervical cancer. The objective of this study is to analyze and compare the screening, diagnosis and treatment of breast and cervical cancer in the pre-COVID period and during the COVID-19 period. METHODS: Cross-sectional study with secondary data collected from the Mortality Information System (SIM), Hospital Information System (SIH), Ambulatory Information System (SIA) and the Oncology Panel (PO) of breast cancer notifications with ICD C50.0 to C50.9 and cervix ICD C53.0 to C53.9, The analyzed period before the pandemic was from March 1 to October 1, 2019, and during the pandemic from March 1 to October 1, 2020. The period from 2013 to 2022 was also analyzed with the same information, including the number of diagnoses, treatments, and deaths from breast cancer and cervical cancer. The study population consisted of Brazilian women aged 25 to 70 years. In order to compare categorical variables between periods, the Chi-Square or Fisher's Exact tests, and Mann-Whitney U tests were applied, and the Poisson Regression model was applied to model the number of reported cases of COVID-19 and the amount of procedures. RESULTS: There was a decrease in the number of mammograms and cytopathological exams during COVID-19, as well as a decrease in cases of breast and cervical cancer. The Poisson regression showed that the increase in the number of COVID-19 cases caused a decrease in the number of breast cytopathological examinations, cervical-vaginal cytopathological examinations/microflora and screening, diagnosis, initiation of treatment for breast cancer and deaths from this disease. Meanwhile, in some regions of Brazil, as the number of Covid-19 increased, there was a significantly increase in the number of mammograms performed and cervical cancer diagnoses. CONCLUSIONS: The COVID-19 period in 2020 significantly impacted screening, diagnosis, treatment for breast and cervical cancer.

Impact of Covid-19 on Breast Cancer Screening.

OBJECTIVE: To assess the influence of the COVID-19 pandemic on breast cancer screening. METHODS: This was a cross-sectional and retrospective study, which used data extracted from "TABNET" between 2014 to 2020.  Statistical analysis was carried out using the ANOVA model. RESULT: In 2019, a total of 3,068,776 mammograms were conducted, which significantly decreased to 1,808,765 in 2020.  Since the onset of the pandemic in Brazil in March 2020, there has been a reduction in the number of mammograms performed.  Mammography coverage increased from 0.11 to 0.18 between 2014 and 2019 but sharply declined from 0.18 to 0.10 between 2019 and 2020. CONCLUSION: The COVID-19 pandemic has had a detrimental impact on breast cancer screening efforts, especially in detecting the disease in early stages.  Health services shifted their focus towards caring for COVID-19 patients, therefore neglecting routine screening programs and interventions. Additionally, the population's fear of contagion contributed to a decrease in demand for screening tests.

Factors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units.

OBJECTIVES: to evaluate the factors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units in Brazil. METHODS: this ecological study was conducted using secondary data from Brazilian pregnant women with COVID-19 hospitalized in Intensive Care Units between March 2020 and March 2022. Univariate analysis and logistic regression were employed. RESULTS: out of 3,547 pregnant women with COVID-19 hospitalized in Intensive Care Units, 811 died (22.8%). It was found that lack of COVID-19 vaccination (OR: 2.73; 95% CI: 1.83; 4.04), dyspnea (OR: 1.73; 95% CI: 1.17; 2.56), obesity (OR: 1.51; 95% CI: 1.05; 2.17), chronic cardiovascular disease (OR: 1.65; 95% CI: 1.14; 2.38), and non-white race/color (OR: 1.29; 95% CI: 1.00; 1.66) were independently and significantly associated with death. CONCLUSIONS: it is concluded that vaccination status, presence of comorbidities, and clinical and ethnic-racial characteristics are associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units in Brazil.

Relationship between Screening, Diagnostic Mammograms, Hospital Admissions, and Mortality Rates from Breast Cancer.

BACKGROUND: Breast cancer is the most common type of cancer worldwide. If diagnosed and treated early, it has a high chance of cure, and for this, screening tests are necessary, namely mammograms, which are the most commonly used. The objective of this study was to analyze the association between the number of screening and diagnostic mammograms and the number of hospitalizations and deaths from breast cancer. METHODS: This is a cross-sectional, analytical, retrospective study with secondary data made available by the Ministry of Health. Pearson correlation analysis was employed to assess whether the number of mammograms is associated with the number of deaths and hospitalizations, Poisson regression was used to assess whether an increase in the number of mammograms and hospitalizations is related to the number of deaths, and the Cox-Stuart test was used to analyze the temporal trend of the variables under study and the projection of time series. RESULTS: There was a strong positive correlation for all age groups when relating the variables hospitalizations and deaths, a moderate-to-strong correlation for the variables mammography and hospitalization, and a weak correlation for the variables mammography and death. There was no statistical significance in the relationship between the number of mammograms and deaths, whereas the hospitalization variable had a significant impact in relation to death, increasing the chance by 0.015%. There has also been a significant growth trend in the variables deaths and hospitalizations in Brazil over the years. CONCLUSIONS: A growing trend was identified from 2013 to 2021, both in hospitalizations and deaths, thus suggesting that strategies aimed at reformulating public health policies are necessary for earlier diagnosis in order to improve the treatment of breast cancer and the prognosis of the disease.

Mortality of Young Women due to Breast Cancer in Low, Middle and High-Income Countries: Systematic Literature Review and Meta-Analysis.

OBJECTIVE: To identify the difference in breast cancer mortality rates among young women according to countries' economic classification. METHODS: A systematic literature review included retrospective studies on breast cancer mortality rates in women aged 20 to 49 years. Databases used were PubMed, Web of Science, Scopus, and Virtual Health Library, with articles selected in English, Portuguese, and Spanish. The study selection and analysis were conducted by two pairs of researchers. Data from 54 countries were extracted, including 39 high-income, 12 upper-middle-income, and 3 lower-middle-income countries. A meta-analysis was performed with the quantitative data from two studies. RESULTS: Six articles met the inclusion criteria. Four were analyzed descriptively due to data diversity, and two were included in the meta-analysis. The pooled mortality rate for high-income countries was 10.2 per 100,000 women (95% CI: 9.8-10.6), while for upper-middle-income countries, it was 15.5 per 100,000 women (95% CI: 14.9-16.1). Lower-middle-income countries had a pooled mortality rate of 20.3 per 100,000 women (95% CI: 19.5-21.1). The decrease in mortality rates in high-income countries was statistically significant (p<0.05). CONCLUSION: Mortality rates for breast cancer among young women have decreased significantly in high-income countries but have increased in lower-income countries. This disparity underscores the impact of insufficient investment in preventive measures, health promotion, early diagnosis, and treatment on young women's mortality in lower-income countries.

Use of machine learning to identify protective factors for death from COVID-19 in the ICU: a retrospective study.

Background: Patients in serious condition due to COVID-19 often require special care in intensive care units (ICUs). This disease has affected over 758 million people and resulted in 6.8 million deaths worldwide. Additionally, the progression of the disease may vary from individual to individual, that is, it is essential to identify the clinical parameters that indicate a good prognosis for the patient. Machine learning (ML) algorithms have been used for analyzing complex medical data and identifying prognostic indicators. However, there is still an urgent need for a model to elucidate the predictors related to patient outcomes. Therefore, this research aimed to verify, through ML, the variables involved in the discharge of patients admitted to the ICU due to COVID-19. Methods: In this study, 126 variables were collected with information on demography, hospital length stay and outcome, chronic diseases and tumors, comorbidities and risk factors, complications and adverse events, health care, and vital indicators of patients admitted to an ICU in southern Brazil. These variables were filtered and then selected by a ML algorithm known as decision trees to identify the optimal set of variables for predicting patient discharge using logistic regression. Finally, a confusion matrix was performed to evaluate the model's performance for the selected variables. Results: Of the 532 patients evaluated, 180 were discharged: female (16.92%), with a central venous catheter (23.68%), with a bladder catheter (26.13%), and with an average of 8.46- and 23.65-days using bladder catheter and submitted to mechanical ventilation, respectively. In addition, the chances of discharge increase by 14% for each additional day in the hospital, by 136% for female patients, 716% when there is no bladder catheter, and 737% when no central venous catheter is used. However, the chances of discharge decrease by 3% for each additional year of age and by 9% for each other day of mechanical ventilation. The performance of the training data presented a balanced accuracy of 0.81, sensitivity of 0.74, specificity of 0.88, and the kappa value was 0.64. The test performance had a balanced accuracy of 0.85, sensitivity 0.75, specificity 0.95, and kappa value of 0.73. The McNemar test found that there were no significant differences in the error rates in the training and test data, suggesting good classification. This work showed that female, the absence of a central venous catheter and bladder catheter, shorter mechanical ventilation, and bladder catheter duration were associated with a greater chance of hospital discharge. These results may help develop measures that lead to a good prognosis for the patient.

Mortality in Women with Coronary Artery Disease in Paraná State, Brazil: A Bayesian Spatiotemporal Analysis.

Background: Mortality resulting from coronary artery disease (CAD) among women is a complex issue influenced by many factors that encompass not only biological distinctions but also sociocultural, economic, and healthcare-related components. Understanding these factors is crucial to enhance healthcare provisions. Therefore, this study seeks to identify the social and clinical variables related to the risk of mortality caused by CAD in women aged 50 to 79 years old in Paraná state, Brazil, between 2010 and 2019. Methods: This is an ecological study based on secondary data sourced from E-Gestor, IPARDES, and DATASUS. We developed a model that integrates both raw and standardized coronary artery disease (CAD) mortality rates, along with sociodemographic and healthcare service variables. We employed Bayesian spatiotemporal analysis with Markov Chain Monte Carlo simulations to assess the relative risk of CAD mortality, focusing specifically on women across the state of Paraná. Results: A total of 14,603 deaths from CAD occurred between 2010 and 2019. Overall, temporal analysis indicates that the risk of CAD mortality decreased by around 22.6% between 2010 (RR of 1.06) and 2019 (RR of 0.82). This decline was most prominent after 2014. The exercise stress testing rate, accessibility of cardiology centers, and IPARDES municipal performance index contributed to the reduction of CAD mortality by approximately 4%, 8%, and 34%, respectively. However, locally, regions in the Central-West, Central-South, Central-East, and Southern regions of the Central-North parts of the state exhibited risks higher-than-expected. Conclusion: In the last decade, CAD-related deaths among women in Paraná state decreased. This was influenced by more exercise stress testing, better access to cardiology centers, improved municipal performance index. Yet, elevated risks of deaths persist in certain regions due to medical disparities and varying municipal development. Therefore, prioritizing strategies to enhance women's access to cardiovascular healthcare in less developed regions is crucial.

Women Abused: Analysis of Assistance Provided by Urgency Mobile Service.

Considering that reports of violence against women must come after a victim seeks help, the subject matter transcends health-related issues. In Brazil, mobile urgency services (SAMU/SIATE) frequently provide first aid to these women and, to the best of our knowledge, no other research has specifically examined the first reaction given to these women. The present study aimed to analyze SAMU/SIATE assistance to abused women in a cross-sectional study of the assistance to assaulted women provided by SIATE and SAMU Maringá/Norte Novo between 2011 and 2020. Women between 20 and 39 years old, non-pregnant, were the main victims, and 19.52% of them have used drugs of some kind. The (ex) partner figured as the perpetrator in 17.35%, but there was no information about this variable in 73.75% of the records. The Chi-square test shows a mortality rate superior to 70% among the severely traumatized victims. This is the first research work to examine the kind of care that SAMU/SIATE offers, and it identifies several weaknesses in its "modus operandi" that may prevent the results from being applied to larger contexts. In addition, further studies on mobile urgent care services in other provinces are required in order to suggest ways to lessen this epidemic.

Factors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units / Factores relacionados al óbito por COVID-19 en mujeres embarazadas hospitalizadas en Unidad de Cuidado Intensivo / Fatores associados ao óbito por COVID-19 em gestantes hospitalizadas em Unidade de Terapia Intensiva

ABSTRACT Objectives: to evaluate the factors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units in Brazil. Methods: this ecological study was conducted using secondary data from Brazilian pregnant women with COVID-19 hospitalized in Intensive Care Units between March 2020 and March 2022. Univariate analysis and logistic regression were employed. Results: out of 3,547 pregnant women with COVID-19 hospitalized in Intensive Care Units, 811 died (22.8%). It was found that lack of COVID-19 vaccination (OR: 2.73; 95% CI: 1.83; 4.04), dyspnea (OR: 1.73; 95% CI: 1.17; 2.56), obesity (OR: 1.51; 95% CI: 1.05; 2.17), chronic cardiovascular disease (OR: 1.65; 95% CI: 1.14; 2.38), and non-white race/color (OR: 1.29; 95% CI: 1.00; 1.66) were independently and significantly associated with death. Conclusions: it is concluded that vaccination status, presence of comorbidities, and clinical and ethnic-racial characteristics are associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units in Brazil.

RESUMEN Objetivos: evaluar los factores relacionados al óbito por COVID-19 en embarazadas hospitalizadas en Unidad de Cuidados Intensivos en Brasil. Métodos: se trata de un estudio ecológico realizado con datos secundarios de embarazadas brasileñas con COVID-19 hospitalizadas en Unidad de Cuidados Intensivos, entre marzo de 2020 y marzo de 2022. Empleado análisis univariado y regresión logística. Resultados: de 3.547 embarazadas con COVID-19 hospitalizadas en Unidad de Cuidados Intensivos, 811 evolucionaron a óbito (22,8%). Evidenciado que la no vacunación contra la COVID-19 (OR: 2,73; IC95: 1,83;4,04), disnea (OR: 1,73; IC95:1,17;2,56), obesidad (OR: 1,51; IC95: 1,05;2,17), enfermedad cardiovascular crónica (OR: 1,65; IC95: 1,14;2,38) y la raza/color no blanca (OR: 1,29; IC95: 1,00;1,66) se relacionaron de manera independiente y significante al óbito. Conclusiones: concluido que el estado de vacunación, presencia de comorbilidades y características clínicas y étnico-raciales están relacionadas al óbito por COVID-19 en embarazadas hospitalizadas en Unidad de Cuidados Intensivos en Brasil.

RESUMO Objetivos: avaliar os fatores associados ao óbito por COVID-19 em gestantes hospitalizadas em Unidade de Terapia Intensiva no Brasil. Métodos: este estudo ecológico foi realizado com dados secundários de gestantes brasileiras com COVID-19 hospitalizadas em Unidade de Terapia Intensiva, entre março de 2020 e março de 2022. Empregou-se análise univariada e regressão logística. Resultados: de 3.547 gestantes com COVID-19 hospitalizadas em Unidade de Terapia Intensiva, 811 evoluíram a óbito (22,8%). Evidenciou-se que a não vacinação contra a COVID-19 (OR: 2,73; IC95: 1,83;4,04), dispneia (OR: 1,73; IC95:1,17;2,56), obesidade (OR: 1,51; IC95: 1,05;2,17), doença cardiovascular crônica (OR: 1,65; IC95: 1,14;2,38) e a raça/cor não branca (OR: 1,29; IC95: 1,00;1,66) associaram-se de forma independente e significante ao óbito. Conclusões: conclui-se que o estado vacinal, presença de comorbidades e características clínicas e étnico-raciais estão associadas ao óbito por COVID-19 em gestantes hospitalizadas em Unidade de Terapia Intensiva no Brasil.

Anaplastic lymphoma associated with breast implants-Early diagnosis and treatment.

Anaplastic large cell lymphoma associated with breast implants is a relatively new disease that deserves attention from the academic community. Brazil figures as one of the protagonists in plastic surgery, however publications are insufficient and very few cases are reported in comparison to other countries. It is a disease with excellent prognosis when diagnosed early and treated effectively, but for this to happen, it is essential that health care professionals and the patient understand its pathology. We reported two cases in a small town during a short period of time. In both cases reported by this study, the patients presented late seroma, associated with pain as a clinical presentation, at 13 and 9 years after the placement of silicone implants with textured polyurethane surfaces. After the procedure, the patients were screened for cancer. Further research with more robust samples is still needed to fully determine the risks and benefits of using textured versus smooth implants.

Maternal Risk Factors Associated with Negative COVID-19 Outcomes and Their Relation to Socioeconomic Indicators in Brazil.

BACKGROUND: This study aimed to analyze maternal risk factors associated with negative outcomes of COVID-19 and association with socioeconomic indicators in Brazil. METHODS: A cross-sectional study, with data from the Influenza Epidemiological Surveillance Information System (SIVEP-Flu) of pregnant women with COVID-19 and cases of hospitalization and death. For the analysis of risk factors and outcomes, the multiple logistic regression method was used. RESULTS: Pregnant women who had some risk factor represented 47.04%. The chance of death was 2.48 times greater when there was a risk factor, 1.55 for ICU admission and 1.43 for use of ventilatory support. The percentage of cure was 79.64%, 15.46% without any negative outcome, 4.65% death and 0.26% death from other causes. Pregnant women who did not take the vaccine represented 30.08%, 16.74% took it and 53.18% were not specified. The variables HDI, illiteracy, per capita income and urbanization did not influence the cases of COVID-19. CONCLUSIONS: Factors such as age, obesity, asthma and pregnancy were responsible for the increase in hospitalizations, respiratory complications and death. Vaccination reduced the risk of negative outcomes by 50%. There were no correlations between socioeconomic indicators and the negative outcomes of COVID-19 in pregnant women.

Exploring regional disparities in lung cancer mortality in a Brazilian state: A cross-sectional ecological study.

BACKGROUND: Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil. METHODS AND FINDINGS: We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná. CONCLUSIONS: There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.

A look through Latin America truck drivers' health, a systematic review and meta-analysis.

Heavy truck drivers represent a social group of great importance to any country's economy. Their professional activity requires a high level of dedication. Due to the irregular hours in their work routine and adopted habits, they mostly predispose them to a diversity of health problems. The purpose of this study is to perform a systematic review and meta-analysis aiming to identify the prevalence of diabetes, hypertension, and obesity in Latin American Truck Drivers. We searched the PubMed, Web of Science, Scopus and LILACS databases, for scientific publications articles, as reported by The PRISMA Statement. From 1,382, 7 studies were included according to the established criteria. The hypertension prevalence found was 34.2%, diabetes was of 9.2% and the highest prevalence found was for overweight and obesity (56%). Meta-analysis presented that drivers have a higher prevalence of overweight or obesity when compared to eutrophic individuals and that drivers with diabetes and hyperglycemia have a lower prevalence. Due to their work activity, their access to the health system is compromised limiting any type of monitoring of their health. This study showed that there is, in Latin America, an investment and assistance gap, both in the health sector and in the research section, for this professional category, which is so important to the economy of these countries. These data should help to identify the difficulties faced by this professional in health assistance, road safety, public safety, leisure and social life. This research also highlighted that they are young and already have the first sign of non-transmissible chronic diseases, which is overweight and obesity.

Uso da medicina popular na prevenção da Covid-19 / Use of folk medicine in the prevention of Covid-19 / Uso de la medicina popular en la prevención del Covid-19

A procura pela medicina popular tem sido recorrente, em que plantas medicinais são consumidas como agentes terapêuticos na prevenção de diversos sintomas e doenças. O objetivo deste estudo foi analisar a utilização de produtos naturais da medicina popular durante a pandemia, na prevenção da infecção e dos sintomas da COVID-19. Foi feito um estudo observacional transversal descritivo. Utilizou-se como processo de amostragem o método de recrutamento consecutivo de participantes (Snowball), por meio de um questionário distribuído nacionalmente pelas mídias sociais para a população acima de 18 anos de idade, no período de setembro de 2021 a março de 2022. Para as análises estatísticas foi utilizado o teste Qui-quadrado de Pearson e/ou o exato de Fisher, considerando intervalos de confiança de 95% e nível de significância de 5% (p < 0,05). Participaram do estudo 1022 pessoas. Variáveis como sexo, escolaridade, idade, área de residência e região geográfica influenciaram significativamente a busca e o consumo de produtos a base de plantas medicinais. A maioria da população utilizou produtos naturais a base de plantas medicinas no período, sentiu melhora da saúde ao consumi-los e indica o uso para a prevenção da COVID-19 e de sintomas associados. No entanto, merece atenção o risco de toxicidade proveniente do uso incorreto e de interações medicamentosas, sendo necessários mais estudos.

The demand for popular medicine has been recurrent, in which medicinal plants are consumed as therapeutic agents in the prevention of various symptoms and diseases. The objective of this study was to analyze the use of natural products from popular medicine during the pandemic, in the prevention of infection and symptoms of COVID-19. A descriptive cross-sectional observational study was carried out. The method of consecutive recruitment of participants (Snowball) was used as a sampling process, through a questionnaire distributed nationally on social media for the population over 18 years of age, from September 2021 to March 2022. Pearson's chi-square test and/or Fisher's exact test were used for statistical analysis, considering 95% confidence intervals and a significance level of 5% (p < 0.05). A total of 1022 people participated in this study. Variables such as gender, education, age, area of residence and geographic region significantly influenced the search for and consumption of products based on medicinal plants. The majority of the population used natural products based on medicinal plants in the period, felt an improvement in health when consuming them and indicated their use for the prevention of COVID-19 and associated symptoms. However, the risk of toxicity from incorrect use and drug interactions deserves attention, requiring further studies.

Ha sido recurrente la demanda de la medicina popular, en la que se consumen plantas medicinales como agentes terapéuticos en la prevención de diversos síntomas y enfermedades. El objetivo de este estudio fue analizar el uso de productos naturales de la medicina popular durante la pandemia, en la prevención de la infección y síntomas del COVID-19. Se realizó un estudio observacional descriptivo transversal. Se utilizó como proceso de muestreo el método de reclutamiento consecutivo de participantes (Bola de Nieve), a través de un cuestionario distribuido a nivel nacional en medios sociales para la población mayor de 18 años, de septiembre de 2021 a marzo de 2022. Para el análisis estadístico se utilizó la prueba de chi cuadrado de Pearson y/o la prueba exacta de Fisher, considerando intervalos de confianza del 95% y un nivel de significancia del 5% (p < 0,05). Un total de 1022 personas participaron en este estudio. Variables como el sexo, la educación, la edad, la zona de residencia y la región geográfica influyeron significativamente en la búsqueda y el consumo de productos a base de plantas medicinales. La mayoría de la población utilizó productos naturales basados en plantas medicinales en el periodo, sintió una mejora de la salud al consumirlos e indicó su uso para la prevención de la COVID-19 y los síntomas asociados. Sin embargo, el riesgo de toxicidad por el uso incorrecto y las interacciones farmacológicas merecen atención, requiriendo estudios adicionales.

Comparative Analysis of Mortality due to Breast Cancer and Mammography Uptake in the Federative Units of Brazil-2015 to 2021.

Objective: Compare the breast cancer mortality rate and the rate of mammograms with socioeconomic factors, in Brazilian´s Federative Units, during the period of 2015 to 2021. Methods: This is an ecological study, of a descriptive nature, which covers the 27 Brazilian federative units, using secondary data extracted from the DATASUS System. The information analyzed was mammography data, breast cancer mortality, demographic and economic data of the resident population and women over 20 years of age. Results: There is a direct relationship between mortality rate and mammograms rates in the Federative Units. The data obtained for Brazil presents a total of 133,048 deaths from breast cancer and 17,324,526 mammography exams in the period from 2015 to 2021. In other words, Brazil presents a standardized mortality rate value, 19.25 deaths per 100,000 women. Regarding the mammography rate, the value of the exam-specific mammography rate was 2,506.55 per 100,000 women. In relation to socioeconomic data by mortality rate group, higher mortality rates from breast cancer present higher rates in the variables: income rate by State (2,594.86), people with income (63.5), average percentage of women with more over 50 years old (29.5%), women with average years of education (6.64), white population (55.1%) and mammography exam rate (2873.20). When analysing the highest rates of mammography exam rates, higher rates are observed income rate by State (2,161.47), people with income (62.5%), average percentage of women over 50 years old (28.6%), women with an average number of years of education (5.8). Conclusion: Brazil has a high mortality rate due to breast cancer, when compared to other countries. The reasons are diverse, such as the modern, industrialized and populous lifestyle. The Federative Units with the highest mortality rate also have high rates of mammograms, that is, in the Federative Units with "better" sociodemographic conditions, the South and Southeast.

Violence against health personnel before and during the COVID-19 pandemic.

OBJECTIVE: Violence in the workplace has been an alarming phenomenon around the world. The aim of this study was to analyze the frequency of violence against health personnel in urgent and emergency departments, before and during the COVID-19 pandemic. METHODS: This is an exploratory cross-sectional study including a structured online survey with the approval of the Research Ethics Committee. The sample was composed of health personnel over 18 years old who work in urgent and emergency departments. The survey was structured with sections: sociodemographic data, detailing of occupational data, and a survey of physical, verbal, sexual, and racial violence. Descriptive statistics included absolute frequencies and percentages for categorical variables and means with standard deviation for continuous variables. RESULTS: A total of 114 participants, aged between 20 and 60 years, answered the questionnaire; 68.4% of them were women. Most of them were white (71.9%), married or living with a partner (70.2%), residing in the south or southeast regions (85.1%) of Brazil, 56.1% doctors, 11.4% nurses, and 12.3% nursing technicians. The incidence of violence before the COVID-19 pandemic was 60%. During the pandemic, the incidence suffered low variation, being 57.9%. Only 37.7% said that their workplace offers some procedure/routine to report acts of violence suffered at work. Verbal violence was the most reported among the participants. Anxiety, tiredness, fear, low self-esteem, loss of concentration, and stress are the most frequent consequences of aggression. CONCLUSION: Our results suggest that the COVID-19 pandemic did not potentiate the episodes of violence; however, episodes of violence continue to occur, and so management and prevention measures must be implemented.

Violence against health personnel before and during the COVID-19 pandemic

SUMMARY OBJECTIVE: Violence in the workplace has been an alarming phenomenon around the world. The aim of this study was to analyze the frequency of violence against health personnel in urgent and emergency departments, before and during the COVID-19 pandemic. METHODS: This is an exploratory cross-sectional study including a structured online survey with the approval of the Research Ethics Committee. The sample was composed of health personnel over 18 years old who work in urgent and emergency departments. The survey was structured with sections: sociodemographic data, detailing of occupational data, and a survey of physical, verbal, sexual, and racial violence. Descriptive statistics included absolute frequencies and percentages for categorical variables and means with standard deviation for continuous variables. RESULTS: A total of 114 participants, aged between 20 and 60 years, answered the questionnaire; 68.4% of them were women. Most of them were white (71.9%), married or living with a partner (70.2%), residing in the south or southeast regions (85.1%) of Brazil, 56.1% doctors, 11.4% nurses, and 12.3% nursing technicians. The incidence of violence before the COVID-19 pandemic was 60%. During the pandemic, the incidence suffered low variation, being 57.9%. Only 37.7% said that their workplace offers some procedure/routine to report acts of violence suffered at work. Verbal violence was the most reported among the participants. Anxiety, tiredness, fear, low self-esteem, loss of concentration, and stress are the most frequent consequences of aggression. CONCLUSION: Our results suggest that the COVID-19 pandemic did not potentiate the episodes of violence; however, episodes of violence continue to occur, and so management and prevention measures must be implemented.

Prevalence and Impact of Academic Violence in Medical Education.

Situations of mistreatment in the academic environment are prevalent worldwide, but research in this area is scarce in middle-low-income countries. This study aimed to estimate the prevalence of mistreatment inflicted against Brazilian medical students. In addition, characterize these situations and analyze their consequences. Cross-sectional study conducted with 831 medical students from public and private institutions. Absolute and relative frequencies of the analyzed variables and possible associations were determined through univariate and multivariate logistic regression. Chi-square test of association with second-order Rao-Scott adjustment was also used. The response rate was 56%. Public institution pointed to a higher prevalence of mistreatment when compared to private (59% versus 43%). Female students were the most affected. Verbal and psychological aggression was more prevalent. The aggressor usually was a faculty member. Mistreatment incidence increased over the years of training, with higher rates in the internship. About 94% of the students felt affected in anyway, with 77% feeling diminished and depressed. More than 50% reported impaired academic performance. Almost 30% sought help from experts. The reporting rate was extremely low. Adequate identification of the situations by the victims, safe reporting mechanisms and, an educational system capable of maintaining an appropriate learning environment are essential to break this destructive cycle.

Colorectal cancer mortality in women: trend analysis in Brazil and its regions and states.

OBJECTIVES: to analyze colorectal cancer mortality trends in women in Brazil and its regions and states. METHODS: ecological, time-series study with trend analysis of deaths caused by colorectal cancer in women in Brazil and its regions and states between 2008 and 2019. Polynomial regression was used to treat the data. RESULTS: 48,225 deaths of women caused by colorectal cancer were examined. There was an increasing mortality trend in Brazilian women, with regional differences that resulted from socioeconomic, political, and cultural inequalities. The South Region stood out with the highest rate (7.32) in 2008, which increased to 8.65 in 2019, followed by the Southeast Region, whose rates were 6.72 and 9.05 in 2008 and 2019, respectively. CONCLUSIONS: colorectal cancer mortality increased, which indicates the need to expand public policies oriented toward screening and early diagnosis of colorectal cancer in women.

Factors associated with vaccination against Covid-19 in pregnant and hospitalized postpartum women: A retrospective cohort study.

OBJECTIVE: To analyze the characteristics associated with vaccination against Covid-19 in pregnant and postpartum women with Severe Acute Respiratory Syndrome in Brazil and to investigate a possible association between vaccination and the clinical course and outcome of the disease. METHODS: Retrospective cohort study of hospitalized pregnant and postpartum women diagnosed with Severe Acute Respiratory Syndrome (SARS) by SARS-CoV-2, presenting onset of signs and symptoms between May and October 2021. Secondary data were used, available in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe). Data were analyzed using the SPSS statistical program, medians were applied to present continuous variables and frequencies, and proportions were calculated for categorical variables, using logistic and multivariate regression analysis. RESULTS: The final study population included 3,585 pregnant and postpartum women, of whom 596 (16.6) were vaccinated: 443 (74.3%) received one dose and 153 (25.7%) received two doses. They were factors associated with non-vaccination against Covid-19 age ≤ 19 anos (OR: 2.57; IC95% 1.40;4.71), non-white women (OR: 1.34; IC95% 1.07;1.67) and those who required ventilatory support (OR: 1.51; IC95% 1.19;1.90) and invasive ventilation (OR: 2.05; IC95% 1.37;3.08). On the other hand, vaccination was associated with advanced maternal age (OR: 0.60; IC95% 0.48;0.76), presence of comorbidities (OR: 0.57; IC95% 0.45;0.72) and loss of taste (OR: 0.63; IC95% 0.48;0.82). CONCLUSIONS: Demographic, ethnic-racial and clinical characteristics were associated with the vaccination status of pregnant and postpartum women with SARS by SARS-CoV-2 in Brazil. Vaccination against Covid-19 in the obstetric population has already shown positive results in the evolution of severe cases, which reiterates its importance. It is essential that health services advance vaccination against Covid-19 in the obstetric population, especially adolescentes and non-white women.