Minimum acceptable diet in a cohort of children aged between 6 and 15 months: Complementary feeding assessment and associated factors in the Brazilian western Amazon.

OBJECTIVE: The goal of the article was to assess complementary feeding patterns, and associated factors, of children between 6 and 15-month old in Rio Branco-Acre, Brazil, based on the minimum acceptable diet indicator. METHODS: This study was cross-sectional, including 857 children between ages 6 and 15 mo, from a 2015 birth cohort of Rio Branco, Brazil. The prevalence of complementary feeding indicators, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was estimated based on the recommendations of the World Health Organization. Sociodemographic characteristics, infant and maternal habits, prenatal information, birth characteristics, breastfeeding, and complementary feeding were evaluated. Differences between the proportions were evaluated by the χ2 test and univariate and multiple logistic regression analyses, to determine associated factors with child minimum acceptable diet. RESULTS: The minimum frequencies of meals and dietary diversity were observed in 81.0% and 51.8% of the children, respectively. The minimum acceptable diet prevalence was 47.1%. Also, minimum acceptable diet was inversely associated with C, D, and E social classes (adjusted odds ratio = 0.49; 95% CI, 0.33-0.72), number of living siblings (adjusted odds ratio for two or three children = 0.69; 95% CI, 0.48-0.98, and adjusted odds ratio for ≥ 4 children = 0.56; 95% CI, 0.37-0.84). Maternal regular consumption of fruits, vegetables, and legumes (adjusted odds ratio = 2.62; 95% CI, 1.69-4.05), child age from 12 to 15 mo (adjusted odds ratio = 2.05; 95% CI, 1.32-3.18), and receiving guidance regarding complementary feeding during postnatal consultations (adjusted odds ratio = 1.38; 95% CI, 1.03-1.86) were directly associated with minimum acceptable diet. CONCLUSIONS: Fewer than 50% of the children received adequate food with adequate frequency and diversity. Low socioeconomic status and having ≥ 2 living siblings reduced the chance of minimum acceptable diet, whereas maternal healthy diet, child age (12-15 mo), and complementary feeding counseling during postnatal appointments increased the chance of minimum acceptable diet.

Delays in treatment initiation and conclusion in women with stage IA to IIIB cervical cancer: A survival study in a hospital-based cohort from a developing country.

AIM: To evaluate the effect of delays in stage IA to IIIB cervical cancer treatment initiation and conclusion on hospital-based survival among Brazilian women. METHODS: A retrospective follow-up study was conducted in a stage IA to IIIB cervical cancer cohort treated from 2012 and 2014 and followed until December 31, 2017 in Rio de Janeiro. Delay in treatment initiation definition was defined based on the Brazilian law of 60 days for treatment initiation after diagnosis. Delay in treatment conclusion was defined based on the literature and sample distributions: < 120/121-200/> 200 days. The endpoint was death(from all causes or cervical cancer). Death causes and dates were obtained by a record linkage procedure between the hospital cancer registry and the Mortality Information System. Global 36-month survival and HRs were estimated by the KaplanMeier method and proportional Cox regression models, respectively. RESULTS: From 865 patients, 269(31.1%) died over the median follow-up time of 27 months. Delay on treatment initiation(>60-days) was 92.8%, while the delay in treatment conclusion(>120 days) was 87.5%. Overall survival was 61.3% (<60-days:62.6%; 61-90 days:63.5%). Among stage IIB-IIIB, women treated < 60-days presented 40.1% survival, while 61-90-days had 52.5%, and > 90-days had 53.3%. Delays in treatment conclusion significantly reduced survival[72.2%(<120-days) to 60.7%(>200-days)]. Multivariate analysis showed that delays in treatment initiation did not affect 36-month death risk. Compared to women concluding treatment in < 120-days, those taking 121-200-days or > 200-days showed increases in death risk of 89%(95%CI:1.10-3.24) and 111%(95%CI:1.31-3.39), respectively, regardless of age, stage, treatment protocol, and time to treatment initiation. CONCLUSION: Delays in cervical cancer treatment conclusion (but not treatment initiation) affected 36-month survival and death risk among Brazilians.

Effectiveness of mat pilates on fatigue in women with breast cancer submitted to adjuvant radiotherapy: randomized controlled clinical trial.

PURPOSE: This clinical trial aimed to evaluate the influence of Mat Pilates and time on the change in fatigue scores in women with breast cancer undergoing adjuvant radiotherapy (RT). Additionally, assess the adherence and adverse effects of Mat Pilates sessions and the association of the level of physical activity with severe fatigue symptoms. METHODS: One hundred fifty-six patients with non-metastatic breast cancer were randomized to usual care or supervised Mat Pilates exercise. Fatigue and physical activity level were measured at baseline, end of RT, 30 days, 3 and 6 months after RT. The generalized estimating equation (GEE) with intention to treat was applied. RESULTS: A significant difference in the fatigue mean between the end of RT and the baseline was found in patients of both groups. There was no adverse effect with the practice of Mat Pilates, and it was analyzed the reduction of the symptom pain after the end of RT in women of intervention group compared to the control. There was no significant effect on fatigue between the groups. Patients with severe fatigue after 3 and 6 months of RT reported a significantly lower level of physical activity in the last periods. CONCLUSION: Fatigue levels increased at the end of RT but returned to baseline values after 6 months. A lower level of physical activity was associated with severe fatigue symptoms. Mat Pilates was safe for these women and reduced the symptom pain after treatment, but it did not successfully reduce fatigue during adjuvant RT. REGISTRATION: NCT03333993. November 7, 2017.  https://clinicaltrials.gov/ct2/show/NCT03333993?term=breast+cancer&cond=pilates&draw=2&rank=1 .

Effect of prenatal care quality on the risk of low birth weight, preterm birth and vertical transmission of HIV, syphilis, and hepatitis.

BACKGROUND: Averse birth-outcomes still affect newborns worldwide. Although high-quality prenatal care is the main strategy to prevent these outcomes, the effect of prenatal care based on Kotelchuck index combined with consultation contents is still unclear. Thus, this article to evaluate the effect of the quality of prenatal care (PC) process on birth indicators in a cohort of puerperaes who attended maternity hospitals in Brazilian western Amazon, city of Rio Branco, in the state of Acre, Brazil, in 2015. METHODS: This research was a hospital-based cohort study. The sample consisted of 1,030 women who gave birth in maternity hospitals in the city between April 6 and June 30, 2015. This research was a hospital-based cohort study. The sample consisted of 1,030 women who gave birth in maternity hospitals in Rio Branco between April 6th. and June 30th., 2015. Prenatal care was classified as fully adequate when started ≤4th month; ≥80.0-109% expected consultations for GA according to the Kotelchuck Index; ≥5 records of blood pressure, weight, GA, fundal height, ≥4 records of fetal heart rate, fetal movements or equivalent to 75% of the number of consultations; in addition to recording ABO/RH, hemoglobin, VDRL, urine, glucose, anti-HIV and anti-toxoplamosis during the 1st trimester. The evaluated outcomes were low birth weight (LBW), preterm birth and vertical transmission of human immunodeficiency virus (HIV)/hepatitis/syphilis. Differences between proportions were assessed using the X² test, and the crude and adjusted odds ratios (OR) (95% CI) were estimated using unconditional logistic regression. RESULTS: Overall cohort, the outcomes incidences were 8.8% for LBW, 9.2% for preterm birth, and 1.1% for vertical transmission (syphilis/HIV/hepatitis). Crude and adjusted OR showed that inadequate PC increased the risk statistically significant of LBW (ORcrude: 1.84; 95%CI: 0.99-3.44; ORadjusted: 1.87; 95%CI: 1.00-3.52), and preterm birth (ORcrude: 1.79; 95%CI: 1.00-3.29; ORadjusted: 3.98; 95%CI: 1.40-11.29). CONCLUSION: The results draw attention to the importance of quality PC in reducing the risks of LBW, preterm birth, and vertical transmission of syphilis/HIV/hepatitis. Moreover, using this proposed quality prenatal care indicator based on Kotelchuck index combined with consultations contents adjusted by GA may accurately predict unfavorable outcomes.

Benefícios acidentários e previdenciários concedidos a portadores de câncer no Brasil, 2008-2014 / Accident and social security benefits granted to cancer patients in Brazil, 2008-2014

Resumo O objetivo deste artigo é descrever a distribuição do câncer entre os benefícios concedidos pelo Registro Geral da Previdência Social (RGPS), de 2008 a 2014, no Brasil. Estudo ecológico com dados cedidos pelo Instituto Nacional do Seguro Social (INSS). Determinou-se a proporção de benefícios acidentários (relacionados ao trabalho) e previdenciários (gerais) concedidos por câncer no Brasil, entre os benefícios concedidos por todas as causas e realizou-se uma análise espacial para avaliar a distribuição geográfica dessas proporções, tendo os estados brasileiros como unidade de análise. O câncer foi motivo de concessão de 533.438 benefícios (2,9% do total de benefícios concedidos por todas as causas), com predomínio do sexo feminino nos benefícios previdenciários (53,7%) e do sexo masculino nos benefícios acidentários (71,6%). As maiores proporções de benefícios previdenciários por câncer ocorreram nas regiões Norte e Centro-Oeste. Em 19 dos 26 estados brasileiros e no Distrito Federal não houve concessão de benefício acidentário por câncer. A análise das ocorrências de câncer que geraram concessões de benefícios do RGPS sugere uma desproporcionalidade da concessão de benefícios previdenciários em relação aos acidentários, principalmente nas regiões Norte, Nordeste e Sul do Brasil.

Abstract This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

Accident and social security benefits granted to cancer patients in Brazil, 2008-2014. / Benefícios acidentários e previdenciários concedidos a portadores de câncer no Brasil, 2008-2014.

This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

O objetivo deste artigo é descrever a distribuição do câncer entre os benefícios concedidos pelo Registro Geral da Previdência Social (RGPS), de 2008 a 2014, no Brasil. Estudo ecológico com dados cedidos pelo Instituto Nacional do Seguro Social (INSS). Determinou-se a proporção de benefícios acidentários (relacionados ao trabalho) e previdenciários (gerais) concedidos por câncer no Brasil, entre os benefícios concedidos por todas as causas e realizou-se uma análise espacial para avaliar a distribuição geográfica dessas proporções, tendo os estados brasileiros como unidade de análise. O câncer foi motivo de concessão de 533.438 benefícios (2,9% do total de benefícios concedidos por todas as causas), com predomínio do sexo feminino nos benefícios previdenciários (53,7%) e do sexo masculino nos benefícios acidentários (71,6%). As maiores proporções de benefícios previdenciários por câncer ocorreram nas regiões Norte e Centro-Oeste. Em 19 dos 26 estados brasileiros e no Distrito Federal não houve concessão de benefício acidentário por câncer. A análise das ocorrências de câncer que geraram concessões de benefícios do RGPS sugere uma desproporcionalidade da concessão de benefícios previdenciários em relação aos acidentários, principalmente nas regiões Norte, Nordeste e Sul do Brasil.

The environmental monitoring of air pollution in the Santa Cruz industrial district of Rio de Janeiro using a plant fertility model.

In 2010, a steel company was established in Santa Cruz, Rio de Janeiro. In 2012, silver rain raised concerns about human and environmental impacts. In 2013, the steel company signed an Adjustment of Conduct Term (ACT). To evaluate air pollution in the vicinity of the steel company based on a plant fertility assay before and after ACT implementation. A pollen abortion assay was implemented using flower buds of Bauhinia forficata in 2013 and Delonix regia in 2015. Sites over 5 km from the steel company, highways, and tunnels were classified as unexposed; sites 5 km from highway/tunnel were classified as exposed to other sources; and sites 5 km from the steel company were classified as exposed. Random plant collection occurred during the dry and rainy seasons (10 buds/site and 300 cells/slide). Aborted grains were analyzed using a 400-fold magnification microscope. Statistical analyses were considered significant at the 5% level. In 2013 were collected flower buds in 27 sites (2 unexposed, 18 highway/tunnel-exposed, and 7 steel company-exposed); and 34 sites in 2015 (14 unexposed, 18highway/tunnel-exposed, and 2 steel company-exposed). In both years, the mean pollen abortion was significantly higher in the dry season for sites exposed to highway/tunnel (p < 0.001) and the steel company (p = 0.005). In 2013, the mean pollen abortion was significantly higher in sites exposed to highway/tunnel compared to unexposed sites (p = 0.004) and in sites exposed to the steel company compared to sites exposed to highway/tunnel (p = 0.034). In 2015, compared to unexposed sites, the mean pollen abortion was significantly higher in sites exposed to highway/tunnel (p = 0.014) and the steel company (p < 0.001). Overall, compared to unexposed sites, the mean pollen abortion was 5.79-fold higher in sites exposed to the steel company and 4.08-fold higher in sites exposed to highway/tunnel. Compared to unexposed plants, greater air pollution effects occurred in plants exposed to the steel company before (2013) and after (2015)ACT implementation.

Questionário de Reabilitação para o Trabalho (WORQ) aplicado a trabalhadores ativos - evidências de validade de constructo e de confiabilidade / Work Rehabilitation Questionnaire (WORQ) applied to active workers - construct validity and reliability evidence

Resumo Introdução: o Questionário de Reabilitação para o Trabalho (WORQ) foi criado para avaliação da funcionalidade de trabalhadores em reabilitação. Por ser abrangente, supõe-se que sua utilização é útil para avaliar trabalhadores ativos. Objetivo: avaliar a validade de constructo e a confiabilidade da versão autorrespondida do WORQ traduzida para o português brasileiro, para uso com trabalhadores ativos. Métodos: aplicou-se o WORQ em uma amostra aleatória de trabalhadores da Universidade Federal do Acre, no Brasil. Para validação de constructo, foram levantadas hipóteses e feitas correlações entre o WORQ e os instrumentos: WHOQOL-BREF, WHODAS, PHQ-9 e GAD-7. Para confiabilidade, foi utilizada a metodologia teste-reteste em subamostra (n=50) e posterior cálculo do coeficiente de Spearman. Para consistência interna, foi calculado o alfa de Cronbach. Resultados: participaram 241 trabalhadores, 50,2% do sexo feminino. O WORQ apresentou forte correlação com o WHODAS (r=0,782), moderada com o PHQ-9 e com a GAD-7 (r=0,68 e r=0,675) e moderada correlação inversa com o WHOQOL (r=-0,671). Foi obtido alfa de Cronbach de 0,95 e coeficiente de correlação de Spearman de 0,86. Conclusão: O WORQ apresentou evidências sugestivas de validade de constructo e de confiabilidade para uso com trabalhadores ativos, podendo sua utilização ser sugerida na triagem de incapacidades nesses trabalhadores.

Abstract Introduction: the Work Rehabilitation Questionnaire (WORQ) was created to assess the functioning and disability of workers undergoing rehabilitation. Since it is comprehensive, it is assumed that its use for a population of active workers can be useful. Objective: to evaluate the construct validity and the reliability of the self-reported WORQ translation to Brazilian Portuguese, in active workers population. Methods: we applied the WORQ to a random sample of workers from the Federal University of Acre, Brazil. For construct validation, we raised hypotheses and analised correlations between the WORQ and the instruments: WHOQOL-BREF, WHODAS, PHQ-9, and GAD-7. For assess reliability, we used the test-retest methodology in a sub-sample (n=50), followed by the calculation of the Spearman coefficient. For internal consistency, we calculated the Cronbach's alpha. Results: 241 workers participated, 50.2% female. The WORQ showed a strong correlation with WHODAS (r=0.782), moderate with PHQ-9 and GAD-7 (r=0.68 and r=0.675) and a moderate inverse correlation with WHOQOL (r=−0.671). We calculated a Cronbach´s' alpha of 0.95, and a Spearman's correlation coefficient of 0.86. Conclusion: the WORQ presented suggestive evidence of construct validity and reliability for use with active workers. Its use in screening for disabilities in these workers may be suggested.

Câncer segundo a Atividade Econômica na Região Sudeste do Brasil: Benefícios Concedidos pelo Regime Geral de Previdência Social / Cancer per Economic Activity at Brazil's Southeast Region: Benefits Granted by the Brazilian Social Security System / Cáncer según Actividad Económica en la Región Sudeste del Brasil: Beneficio Concedido por el Sistema General de Seguridad Social de Brasil

Introdução: Apesar da importância econômica da Região, ainda existem poucos estudos na literatura sobre o câncer ocupacional na Região Sudeste do Brasil. Objetivo: Comparar a distribuição do câncer entre os benefícios concedidos pelo Regime Geral da Previdência Social (RGPS), por ramo de atividade econômica do segurado, no período de 2008 a 2014, na Região Sudeste do Brasil. Método: Foram calculadas as proporções de benefícios acidentários (relacionados ao trabalho) e previdenciários (geral) concedidos por câncer, segundo o ramo de atividade econômica do segurado (bancário, comerciário, transporte e carga, ferroviário, industriário, marítimo, serviço público, rural e não preenchido). Resultados: O câncer representou 3,07% (271.086) dos benefícios concedidos por todas as causas. Os ramos de atividades comerciário e rural tiveram as maiores proporções de benefícios concedidos por câncer, em todos os Estados. Para ambos, as principais localizações de câncer que motivaram a concessão de benefícios previdenciários foram mama e próstata, e as outras neoplasias malignas da pele foram a principal localização para os benefícios acidentários. Conclusão: A desproporcionalidade entre o número de benefícios previdenciários e acidentários concedidos por câncer sugere erro em muitos benefícios, desfavorecendo os acidentários. O aprimoramento das anamneses do trabalhador pelo médico perito, com a utilização de documentos complementares, pode auxiliar no estabelecimento do nexo causal entre a atividade profissional e o câncer, concedendo benefícios acidentários quando houver esse nexo. Adicionalmente, ainda são necessárias estratégias de vigilância para subsidiar a implementação de ações de prevenção do câncer ocupacional na Região Sudeste do Brasil

Introduction: Despite the economic importance of the Region, there are still few studies in the literature about occupational cancer in Brazil's Southeast Region. Objective: Compare the distribution of cancer-related benefits granted by the Brazilian Social Security System (RGPS) by economic activity of the insured individual, between 2008 and 2014, at Brazil's Southeast Region. Method: The proportions of cancer-related accidental (work-related) and social security (general) benefits granted, according to the economic activity of the insured individual (bank cashier, salesperson, transport and freight worker, railway worker, industrial worker, sailor, public servant, rural worker, and blank) were calculated. Results: Cancer represented 3.07% (271,086) of the benefits granted for all causes. Commercial and rural activities showed the largest proportions of cancer-related benefits granted in all States. For both activities, breast and prostate cancers were the main locations that justified the approval of social security benefits, and other malignant skin neoplasms were the main locations for accidental benefits. Conclusion: The disproportionality between the number of cancer-related social security and accidental benefits granted suggests an error in many benefits, disfavoring accidental benefits. The improvement of the anamneses of the worker by the medical expert, with the use of additional documents, can aid the establishment of the causal link between the professional activity and the cancer developed, granting accidental benefits when this link exists. Moreover, surveillance strategies to boost the implementation of actions to prevent occupational cancer are still necessary at that Region

Introducción: A pesar de la importancia económica de la Región, todavía hay pocos estudios en la literatura sobre el cáncer ocupacional en la Región Sudeste del Brasil. Objetivo: Comparar la distribución del cáncer entre los beneficios otorgados por el Sistema General de Seguridad Social (RGPS), según la actividad económica del asegurado, de 2008 a 2014, en la Región Sudeste del Brasil. Método: Se calcularon las proporciones de los beneficios accidentales (laborales) y previsionales (generales) otorgados por cáncer, de acuerdo con la actividad económica del asegurado (bancaria, comercial, transporte y carga, ferroviaria, industrial, marítima, servicio público, rural y no llenado). Resultados: El cáncer representó el 3,07% (271.086) de los beneficios por todas las causas. Las actividades comerciales y rurales tuvieron las mayores proporciones de beneficios otorgados por cáncer, en todos los estados. Para ambos, las principales localizaciones de cáncer que motivaron el otorgamiento de los beneficios de la seguridad social fueron las de mama y próstata, y otras neoplasias malignas de la piel fueron la principal localización de los beneficios accidentales. Conclusión: La desproporción entre el número de beneficios de seguridad social y de accidentes otorgados por cáncer sugiere un error en muchos beneficios, desfavoreciendo los por accidentes. El perfeccionamiento de las anamnesis del trabajador por parte del perito médico, con el uso de documentos complementarios, puede ayudar a establecer el nexo de causalidad entre la actividad profesional y el cáncer, otorgando beneficios accidentales cuando exista dicho nexo. Además, todavía se necesitan estrategias de vigilancia para apoyar la implementación de acciones de prevención del cáncer ocupacional en la Región Sudeste del Brasil

Polimorfismo Genético TP53 Arg72Pro e Câncer de Mama em Mulheres Jovens: Estudo Caso-Controle no Brasil / TP53 Arg72Pro Genetic Polymorphism and Young Women with Breast Cancer: Case-Control Study in Brazil / Polimorfismo Genético TP53 Arg72Pro y Cáncer de Mama en Mujeres Jóvenes: Estudio de Casos y Controles en el Brasil

Introduction: Breast cancer is the most common cancer in women and incidence and mortality rates are increasing among young women worldwide, including Brazil. TP53 Arg72Pro polymorphism (rs1042522) has been associated with breast cancer, due to its important role in cell cycle that impacts the development of cancer. Objective: To determine the magnitude of the association between TP53 Arg72Pro polymorphism and breast cancer development in young Brazilian women. Method: Hospital-based case-control study conducted in Rio de Janeiro with 268 confirmed breast cancer cases and 277 controls with women enrolled among hospitalized patients without neoplastic diseases or their companions at three public hospitals. Results: The genotype frequency was 46.57% for Arg/Pro, 35.74% for Arg/Arg, and 17.69% for Pro/Pro among healthy controls and 41.04% for Arg/Pro, 46.64% for Arg/Arg, and 12.31% for Pro/Pro among breast cancer cases. The genotypes Pro/Pro (OR=0.46; 95% CI=0.27-0.80, in comparison with Arg/Arg genotype) and Pro allele in dominant model (OR=0.65; 95% CI=0.45-0.92, in comparison with Arg/Arg genotype) were statistically associated with a protective effect for breast cancer among young Brazilian women. Also, family history of breast or ovary cancer (OR=2.18; 95% CI=1.37-3.46) and tobacco use (OR=1.74; 95% CI=1.14-2.68) were statistically associated with breast cancer. Conclusion: Further studies are necessary to confirm that Arg72Pro polymorphism can be a protective factor for breast cancer development among young women, since ethnicity can influence genotypes frequencies and the risk of developing breast cancer

Introdução: O câncer de mama é o mais comum em mulheres e as taxas de incidência e mortalidade estão aumentando entre mulheres jovens em todo o mundo, inclusive no Brasil. O polimorfismo TP53 Arg72Pro (rs1042522) tem sido associado ao câncer de mama em razão do seu importante papel no ciclo celular que pode impactar o desenvolvimento do câncer. Objetivo: Determinar a magnitude da associação entre o polimorfismo TP53 Arg72Pro e o desenvolvimento de câncer de mama em mulheres jovens brasileiras. Método: Estudo caso-controle de base hospitalar realizado no Rio de Janeiro com 268 casos confirmados de câncer de mama e 277 controles com mulheres cadastradas entre pacientes internados sem doenças neoplásicas ou seus acompanhantes em três hospitais públicos. Resultados: A frequência genotípica foi de 46,57% para Arg/Pro, 35,74% para Arg/Arg e 17,69% para Pro/Pro entre controles saudáveis e 41,04% para Arg/Pro, 46,64% para Arg/ Arg e 12,31% para Pro /Pro entre os casos de câncer de mama. Os genótipos Pro/Pro (OR=0,46; IC 95%=0,27-0,80, em comparação ao genótipo Arg/ Arg) e o alelo Pro no modelo dominante (OR=0,65; IC 95%=0,45-0,92, em comparação com o genótipo Arg/Arg) foram estatisticamente associados a um efeito protetor para o câncer de mama em mulheres jovens brasileiras. Além disso, história familiar de câncer de mama ou ovário (OR=2,18; IC 95%=1,37-3,46) e tabagismo (OR=1,74; IC 95%=1,14-2,68) foi estatisticamente associada ao câncer de mama. Conclusão: Novos estudos são necessários para confirmar que o polimorfismo Arg72Pro pode ser um fator de proteção para o desenvolvimento de câncer de mama em mulheres jovens, uma vez que a etnia pode influenciar tanto as frequências desses genótipos quanto o risco de desenvolver câncer de mama

Introducción: El cáncer de mama es el cáncer más común en la mujer y las tasas de incidencia y mortalidad están aumentando entre las mujeres jóvenes en todo el mundo, incluido Brasil. El polimorfismo TP53 Arg72Pro (rs1042522) se ha asociado con el cáncer de mama, debido a su importante papel en el ciclo celular que puede afectar el desarrollo del cáncer. Objetivo: Determinar la magnitud de la asociación entre el polimorfismo TP53 Arg72Pro y el desarrollo de cáncer de mama en mujeres jóvenes brasileñas. Método: Estudio de casos y controles de base hospitalaria realizado en Río de Janeiro con 268 casos confirmados de cáncer de mama y 277 controles con mujeres inscritas entre pacientes hospitalizadas sin enfermedades neoplásicas o sus acompañantes en tres hospitales públicos. Resultados: La frecuencia de genotipos fue del 46,57% para Arg/Pro, 35,74% para Arg/Arg y 17,69% para Pro/Pro entre controles sanos y 41,04% para Arg/Pro, 46,64% para Arg/Arg y 12,31% para Pro/Pro entre los casos de cáncer de mama. El genotipo Pro/Pro (OR=0,46; IC 95%=0,27-0,80, en comparación con el genotipo Arg/Arg) y el alelo Pro en el modelo dominante (OR=0,65; IC del 95 %=0,45-0,92, en comparación con el genotipo Arg/Arg) se asociaron estadísticamente con un efecto protector frente el cáncer de mama entre mujeres jóvenes brasileñas. Además, los antecedentes familiares de cáncer de mama o de ovario (OR=2,18; IC 95%=1,37-3,46) y el hábito del tabaquismo (OR=1,74; IC 95%=1,14-2,68) se asociaron estadísticamente con el cáncer de mama. Conclusión: Son necesarios nuevos estudios para confirmar que el polimorfismo Arg72Pro puede ser un factor de protección para el desarrollo del cáncer de mama en mujeres jóvenes, ya que la etnia puede influir r tanto en las frecuencias de estos genotipos como en el riesgo de desarrollar cáncer de mama

Chikungunya, Zika and Dengue seroprevalence rates among pregnant women in a hospital of southeastern Brazil / Soroprevalência de chikungunya, zika e dengue em gestantes de um hospital do sudeste do Brasil / Seroprevalencia de chikungunya, zika y dengue en mujeres embarazadas en un hospital del sureste de Brasil

Background and objectives: For decades, dengue outbreaks have been affecting vast territories of the Americas. In 2010's decade, Chikungunya and Zika virus (CHIKV and ZIKV) emerged as new arboviruses in the region. While several seroprevalence rates have been reported for dengue virus (DENV) infection in Brazil, serological surveys for the latest are scarce. We aimed to evaluate the seroprevalence of CHIKV, ZIKV, and DENV infections in pregnant women at admission to a public maternity hospital of Nova Iguaçu, state of Rio de Janeiro. Methods: A simple questionnaire was applied, containing limited demographic, obstetric, and clinical data, alongside with blood collection. Different commercial test kits, based on enzyme-linked immunosorbent assay (ELISA), were used. Results: Among 349 pregnant women enrolled from July to December 2017, there was a 28.4% seroreactivity for CHIKV, 47.2% for ZIKV, and 88.8% for DENV. Conclusion: These findings reflect the high dengue endemicity scenario and suggest a significant reach of the recent outbreaks of ZIKV and CHIKV infections in the region.(AU)

Justificativas e objetivos: Há décadas, surtos de dengue afetam vastos territórios das Américas. Na década de 2010, os vírus Chikungunya e Zika (CHIKV e ZIKV) surgiram como arbovírus emergentes na região. Embora diversas taxas de soroprevalência tenham sido relatadas para a infecção pelo vírus da dengue (DENV) no Brasil, pesquisas sorológicas para chikungunya e zika são escassas. Objetivou-se avaliar a soroprevalência das infecções por CHIKV, ZIKV e DENV em gestantes admitidas em uma maternidade pública de Nova Iguaçu, estado do Rio de Janeiro. Métodos: Foi aplicado um questionário simples, contendo dados demográficos, obstétricos e clínicos limitados, sendo realizada coleta de sangue na mesma visita. Diferentes kits de teste comerciais, baseados em ensaio imunoenzimático (ELISA), foram utilizados. Resultados: De 349 gestantes recrutadas de julho a dezembro de 2017, houve sororreatividade de 28,4% para CHIKV, 47,2% para ZIKV e 88,8% para DENV. Conclusão: Esses achados refletem o cenário de alta endemicidade da dengue e sugerem um alcance significativo dos surtos recentes causados por ZIKV e CHIKV na região.(AU)

Justificación y objetivos: Durante décadas, los brotes de dengue han afectado a vastos territorios de las Américas. En la década de 2010, los virus Chikungunya y Zika (CHIKV y ZIKV) surgieron como arbovirus emergentes en la región. Aunque se han reportadas varias tasas de seroprevalencia para la infección por el virus del dengue (DENV) en Brasil, la investigación serológica para el chikungunya y el Zika es escasa. Este estudio tuvo como objetivo evaluar la seroprevalencia de infecciones por CHIKV, ZIKV y DENV en mujeres embarazadas ingresadas en una maternidad pública en Nova Iguaçu, estado de Rio de Janeiro. Métodos: Se aplicó un sencillo cuestionario, que contenía datos demográficos, obstétricos y clínicos limitados, y se extrajo sangre en la misma visita. Se utilizaron diferentes kits de prueba comerciales basados en el ensayo inmunoabsorbente ligado a enzimas (ELISA). Resultados: De 349 mujeres embarazadas reclutadas de julio a diciembre de 2017, hubo serorreactividad de 28,4% para CHIKV, 47,2% para ZIKV y 88,8% para DENV. Conclusión: Estos hallazgos reflejan el escenario de alta endemicidad para el dengue y sugieren una variedad significativa de brotes recientes causados por ZIKV y CHIKV en la región.(AU)

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.

Axillary surgical approach in T1-T2N0M0 clinical breast cancer staging: Survival in a women's hospital cohort in Rio de Janeiro

The concerns regarding the prognosis and quality of life of patients with early breast cancer staging without lymph node involvement have increased, especially with regard to the axillary surgical approach. The aim of the present study was to determine overall survival and disease-free survival according to the axillary surgical approach. Methods: Retrospective cohort study of 827 women with clinical T1-T2N0M0 diagnosis attended at the Cancer Hospital III of the Brazilian National Cancer Institute, from January 2007 to December 2009, with a follow-up period of 60 months. Data were obtained from the Hospital Registry of Cancer through the medical records. Results: 683 women underwent sentinel lymph node biopsy and 144 underwent sentinel lymph node biopsy followed by axillary lymphadenectomy. After 5 years of follow-up, considering adjustment, it was observed overall survival (96.2% vs 93.6%; HR 0.98; 95%CI 0.42­2.29) and disease-free survival (93.7% vs 91.2%; HR 0.78; 95%CI 0.39­1.48) similar among patients undergoing either one or the other approach. In patients with micrometastasis, both overall (93.3%) and diseasefree survival (100%) were higher in women who underwent only sentinel lymph node biopsy compared to those who underwent this procedure followed by axillary lymphadenectomy (OS: 87.5%; DFS: 90,7%), albeit not statistically significant.

Time trends in colorectal cancer incidence in four regions of Latin America: 1983-2012.

This study aimed to assess time trends in colorectal cancer incidence from 1983 to 2012 in Latin America. This was an ecological time-series study whose population consisted of individuals aged 20 years or older diagnosed with colorectal cancer. Data from population-based cancer registries in Cali (Colombia), Costa Rica, Goiânia (Brazil), and Quito (Ecuador), were used for rates estimation, while time trends estimations were proceeded by the Joinpoint Regression Program. The study showed an increase in colorectal cancer incidence in men and women in Cali (2.8% and 3.2%, respectively), Costa Rica (3.1% and 2.1%, respectively), and Quito (2.6% and 1.2%, respectively), whereas in Goiânia, only women showed an increase in colorectal cancer rates (3.3%). For colon cancer, we observed an increasing trend in incidence rates in men and women in Cali (3.1% and 2.9%, respectively), Costa Rica (3.9% and 2.8%, respectively), and Quito (2.9% and 1.8%). For rectal cancer, we observed an increasing trend in incidence in men and women in Cali (2.5% and 2.6%, respectively), Costa Rica (2.2% and 1%, respectively), and Goiânia (5.5% and 4.6%, respectively), while in Quito only men showed an upward trend (2.8%). The study found increases in colorectal cancer, colon cancer, and rectal cancer in four Latin America regions. This findings reflect lifestyle, such as dietary changes, following the economic opening, and the prevalence variations of colorectal cancer risk factors by sex and between the four studied regions. Finally, the different strategies adopted by regions for colorectal cancer diagnosis and screening seem to influence the observed variation between anatomical sites.

Breastfeeding patterns and factors associated with early weaning in the Western Amazon.

OBJECTIVE: To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre. METHODS: This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning. RESULTS: The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06-3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59-3.94), pacifier use (HR = 6.23; 95%CI 4.52-8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25-2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10-1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34-2.90). CONCLUSION: Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

[Evaluation of missed opportunities in the control of vertical HIV transmission in Rio Branco, Acre State, Brazil]. / Avaliação das oportunidades perdidas no controle da transmissão vertical do HIV em Rio Branco, Acre, Brasil.

Vertical HIV transmission is still an important global public health problem. This study aimed to verify vertical HIV transmission in Rio Branco, Acre, Brazil, and to assess the possibility of its elimination. A cross-sectional study was conducted of HIV in pregnant women and a longitudinal study on the incidence of vertical HIV transmission in pregnant women living in the municipality (county) of Rio Branco in 2007-2015. The cohorts of pregnant women consisted of women who had liveborn children, stillbirths, or abortions. The data were obtained from the Brazilian Information System for Notificable Diseases (SINAN), Brazilian Information System on Live Births (SINASC), Brazilian Mortality Information System (SIM), and Brazilian Hospital Information Systems (SIH). Databases. Probabilistic database linkage was performed with the OpenRecLink software. The authors calculated the HIV prevalence rate in pregnant women, the vertical transmission rate, and the principal associated factors. HIV prevalence in pregnant women showed an upward trend, and the mean prevalence was 0.18%. Variables statistically associated with the occurrence of HIV in pregnant women were maternal age ≥ 20 years (p = 0.007), lower schooling (p = 0.054), and unmarried conjugal status/without partner (p = 0.001). Vertical HIV transmission was 6.9%. Use of antiretroviral therapy (ART) during prenatal care, even among pregnant women that already knew they were HIV-positive, was less than 90%. The elective cesarean rate was less than 60%, and the use of ART during delivery and by the newborn in the first 24 hours showed variations, depending on the period in which the maternal diagnosis was made. Although the strategies for the elimination of vertical HIV transmission are well established, this study's results point to important flaws in the cascade of care for HIV-infected pregnant women in Rio Branco.

A transmissão vertical do HIV ainda representa um importante problema de saúde pública no mundo. O objetivo deste estudo foi verificar a transmissão vertical do HIV em Rio Branco, Acre, Brasil, e avaliar a possibilidade de eliminação. Foi realizado estudo transversal dos casos de HIV em gestante e longitudinal sobre a incidência da transmissão vertical do HIV na base populacional de gestantes residentes no Município de Rio Branco, no período de 2007-2015. As coortes de gestantes foram formadas por mulheres que tiveram filhos nascidos vivos, mortos ou abortos. Os dados foram obtidos do Sistema de Informação de Agravos de Notificação (SINAN), Sistema de Informações sobre Nascidos Vivos (SINASC), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informações Hospitalares (SIH). Foi realizado o relacionamento entre as bases de dados utilizando o software OpenRecLink. Foram calculadas as prevalências de HIV em gestante, a taxa de transmissão vertical e os principais fatores associados. A prevalência de HIV em gestante apresentou tendência de aumento, e a prevalência média foi de 0,18%, as variáveis estatisticamente associadas à ocorrência de HIV em gestantes foram idade materna ≥ 20 anos (p = 0,007), menor escolaridade (p = 0,054) e não ter companheiro (p = 0,001). A transmissão vertical foi de 6,9%. O uso de terapia antirretroviral (TARV) no pré-natal, mesmo entre as gestantes que já sabiam ser portadoras do vírus, foi menor que 90%. A realização de cesáreas eletivas ficou abaixo de 60%, e o uso de TARV no parto e pelo recém nascido nas primeiras 24 horas apresentou variações, dependendo do período em que o diagnóstico materno foi realizado. Embora as estratégias de eliminação da transmissão vertical do HIV estejam bem estabelecidas, os resultados deste estudo ainda apontam falhas importantes na cascata de cuidados das gestantes infectadas em Rio Branco.

La transmisión vertical del VIH todavía representa un importante problema de salud pública en el mundo. El objetivo de este estudio fue verificar la transmisión vertical del VIH en Río Branco-Acre y evaluar la posibilidad de su eliminación. Se realizó un estudio transversal de los casos de VIH en gestantes y longitudinal sobre la incidencia de la transmisión vertical del VIH en la base poblacional de gestantes residentes en el municipio de Río Branco, durante el período de 2007-2015. Las cohortes de gestantes estuvieron formadas por mujeres que tuvieron hijos nacidos vivos, muertos o abortos. Los datos se obtuvieron del Sistema Brasileño de Información de Enfermedades de Notificación (SINAN), Sistema de Información sobre Nacidos Vivos (SINASC), Sistema de Información sobre Mortalidad (SIM) y Sistema de Informaciones Hospitalarias (SIH). Se realizó la relación entre las bases de datos, utilizando el software OpenRecLink. Se calcularon las prevalencias de VIH en gestantes, la tasa de transmisión vertical y sus principales factores asociados. La prevalencia de VIH en gestantes presentó una tendencia de aumento y la prevalencia media fue de 0,18%, las variables estadísticamente asociadas a la ocurrencia de VIH en gestantes fueron: edad materna ≥ 20 años (p = 0,007), menor escolaridad (p = 0,054) y no contar con compañero (p = 0,001). La transmisión vertical fue de un 6,9%. El uso de terapia antirretroviral viral (TARV) durante el período prenatal, incluso entre las gestantes que ya se sabían portadoras del virus, fue menor de un 90%. La realización de cesáreas electivas quedó por debajo de un 60% y el uso de TARV en el parto y por el recién nacido en las primeras 24 horas presentó variaciones, dependiendo del período en que el diagnóstico materno fue realizado. A pesar de que las estrategias de eliminación de la transmisión vertical del HIV estén bien establecidas, los resultados de este estudio todavía apuntan fallos importantes en la cascada de cuidados de las gestantes infectadas en Río Branco.

Avaliação das oportunidades perdidas no controle da transmissão vertical do HIV em Rio Branco, Acre, Brasil / Evaluation of missed opportunities in the control of vertical HIV transmission in Rio Branco, Acre State, Brazil / Evaluación de las oportunidades perdidas en el control de la transmisión vertical del VIH en Río Branco, Acre, Brasil

Resumo: A transmissão vertical do HIV ainda representa um importante problema de saúde pública no mundo. O objetivo deste estudo foi verificar a transmissão vertical do HIV em Rio Branco, Acre, Brasil, e avaliar a possibilidade de eliminação. Foi realizado estudo transversal dos casos de HIV em gestante e longitudinal sobre a incidência da transmissão vertical do HIV na base populacional de gestantes residentes no Município de Rio Branco, no período de 2007-2015. As coortes de gestantes foram formadas por mulheres que tiveram filhos nascidos vivos, mortos ou abortos. Os dados foram obtidos do Sistema de Informação de Agravos de Notificação (SINAN), Sistema de Informações sobre Nascidos Vivos (SINASC), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informações Hospitalares (SIH). Foi realizado o relacionamento entre as bases de dados utilizando o software OpenRecLink. Foram calculadas as prevalências de HIV em gestante, a taxa de transmissão vertical e os principais fatores associados. A prevalência de HIV em gestante apresentou tendência de aumento, e a prevalência média foi de 0,18%, as variáveis estatisticamente associadas à ocorrência de HIV em gestantes foram idade materna ≥ 20 anos (p = 0,007), menor escolaridade (p = 0,054) e não ter companheiro (p = 0,001). A transmissão vertical foi de 6,9%. O uso de terapia antirretroviral (TARV) no pré-natal, mesmo entre as gestantes que já sabiam ser portadoras do vírus, foi menor que 90%. A realização de cesáreas eletivas ficou abaixo de 60%, e o uso de TARV no parto e pelo recém nascido nas primeiras 24 horas apresentou variações, dependendo do período em que o diagnóstico materno foi realizado. Embora as estratégias de eliminação da transmissão vertical do HIV estejam bem estabelecidas, os resultados deste estudo ainda apontam falhas importantes na cascata de cuidados das gestantes infectadas em Rio Branco.

Abstract: Vertical HIV transmission is still an important global public health problem. This study aimed to verify vertical HIV transmission in Rio Branco, Acre, Brazil, and to assess the possibility of its elimination. A cross-sectional study was conducted of HIV in pregnant women and a longitudinal study on the incidence of vertical HIV transmission in pregnant women living in the municipality (county) of Rio Branco in 2007-2015. The cohorts of pregnant women consisted of women who had liveborn children, stillbirths, or abortions. The data were obtained from the Brazilian Information System for Notificable Diseases (SINAN), Brazilian Information System on Live Births (SINASC), Brazilian Mortality Information System (SIM), and Brazilian Hospital Information Systems (SIH). Databases. Probabilistic database linkage was performed with the OpenRecLink software. The authors calculated the HIV prevalence rate in pregnant women, the vertical transmission rate, and the principal associated factors. HIV prevalence in pregnant women showed an upward trend, and the mean prevalence was 0.18%. Variables statistically associated with the occurrence of HIV in pregnant women were maternal age ≥ 20 years (p = 0.007), lower schooling (p = 0.054), and unmarried conjugal status/without partner (p = 0.001). Vertical HIV transmission was 6.9%. Use of antiretroviral therapy (ART) during prenatal care, even among pregnant women that already knew they were HIV-positive, was less than 90%. The elective cesarean rate was less than 60%, and the use of ART during delivery and by the newborn in the first 24 hours showed variations, depending on the period in which the maternal diagnosis was made. Although the strategies for the elimination of vertical HIV transmission are well established, this study's results point to important flaws in the cascade of care for HIV-infected pregnant women in Rio Branco.

Resumen: La transmisión vertical del VIH todavía representa un importante problema de salud pública en el mundo. El objetivo de este estudio fue verificar la transmisión vertical del VIH en Río Branco-Acre y evaluar la posibilidad de su eliminación. Se realizó un estudio transversal de los casos de VIH en gestantes y longitudinal sobre la incidencia de la transmisión vertical del VIH en la base poblacional de gestantes residentes en el municipio de Río Branco, durante el período de 2007-2015. Las cohortes de gestantes estuvieron formadas por mujeres que tuvieron hijos nacidos vivos, muertos o abortos. Los datos se obtuvieron del Sistema Brasileño de Información de Enfermedades de Notificación (SINAN), Sistema de Información sobre Nacidos Vivos (SINASC), Sistema de Información sobre Mortalidad (SIM) y Sistema de Informaciones Hospitalarias (SIH). Se realizó la relación entre las bases de datos, utilizando el software OpenRecLink. Se calcularon las prevalencias de VIH en gestantes, la tasa de transmisión vertical y sus principales factores asociados. La prevalencia de VIH en gestantes presentó una tendencia de aumento y la prevalencia media fue de 0,18%, las variables estadísticamente asociadas a la ocurrencia de VIH en gestantes fueron: edad materna ≥ 20 años (p = 0,007), menor escolaridad (p = 0,054) y no contar con compañero (p = 0,001). La transmisión vertical fue de un 6,9%. El uso de terapia antirretroviral viral (TARV) durante el período prenatal, incluso entre las gestantes que ya se sabían portadoras del virus, fue menor de un 90%. La realización de cesáreas electivas quedó por debajo de un 60% y el uso de TARV en el parto y por el recién nacido en las primeras 24 horas presentó variaciones, dependiendo del período en que el diagnóstico materno fue realizado. A pesar de que las estrategias de eliminación de la transmisión vertical del HIV estén bien establecidas, los resultados de este estudio todavía apuntan fallos importantes en la cascada de cuidados de las gestantes infectadas en Río Branco.

Breastfeeding patterns and factors associated with early weaning in the Western Amazon / Padrões de amamentação e fatores associados ao desmame precoce na Amazônia ocidental

ABSTRACT OBJECTIVE: To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre. METHODS: This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning. RESULTS: The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06-3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59-3.94), pacifier use (HR = 6.23; 95%CI 4.52-8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25-2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10-1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34-2.90). CONCLUSION: Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

RESUMO OBJETIVO: Caracterizar os padrões de amamentação nos primeiros seis meses de vida e fatores associados ao desmame precoce numa coorte de nascidos vivos em Rio Branco, Acre. MÉTODOS: Estudo prospectivo com nascidos vivos entre abril e junho de 2015. As entrevistas com as mães ocorreram logo após o nascimento e entre 6 e 15 meses pós-parto. Na alta hospitalar, o aleitamento foi definido em exclusivo (AME) e materno (AM). No seguimento, os padrões de amamentação foram AME, aleitamento materno predominante (AMP) e AM. A interrupção da amamentação nos primeiros seis meses foi classificada como desmame precoce. Utilizou-se o método de Kaplan Meier (log-rank: 95%) para estimar a probabilidade condicional de mudança no padrão de amamentação e risco de desmame. Os fatores associados ao desmame e seus intervalos de confiança de 95% (IC95%) foram analisados pela regressão proporcional de Cox bruta e ajustada. RESULTADOS: Participaram do estudo 833 lactentes que na alta hospitalar estavam em AME (95,4%) e AM (4,6%). A probabilidade do lactente em AME na alta hospitalar permanecer em AME, ou se tornar AMP ou AM, aos seis meses, foi de 16,4%, 32,3% e 56,5% respectivamente. A probabilidade de desmame aos seis meses foi estaticamente maior para lactentes em AM na alta hospitalar (47,4%) em comparação com aqueles em AME (26%). Mostraram-se associados ao desmame precoce: o AM na alta hospitalar (HR = 1,82; IC95% 1,06-3,11), ausência de amamentação cruzada praticada pela mãe (HR = 2,50; IC95% 1,59-3,94), usar chupeta (HR = 6,23; IC95% 4,52-8,60), pretender amamentar por menos de seis meses (HR = 1,93; IC95% 1,25-2,98), não amamentar na primeira hora de vida (HR = 1,45; IC95% 1,10-1,92) e consumir álcool na gestação (HR = 1,88; IC95% 1,34-2,90). CONCLUSÃO: Comparados aos lactentes em AME, aqueles em AM, na alta hospitalar, apresentaram maior probabilidade de desmame. Esforços em saúde pública devem priorizar o AME na alta hospitalar, promover amamentação na primeira hora de vida e orientar sobre os riscos do consumo de álcool na gestação, amamentação cruzada e uso de chupeta.

Chikungunya, Zika and Dengue seroprevalence rates among pregnant women in a hospital of southeastern Brazil / Soroprevalência de chikungunya, zika e dengue em gestantes de um hospital do sudeste do Brasil

Justificativas e objetivos: Há décadas, surtos de dengue afetam vastos territórios das Américas. Na década de 2010, os vírus Chikungunya e Zika (CHIKV e ZIKV) surgiram como arbovírus emergentes na região. Embora diversas taxas de soroprevalência tenham sido relatadas para a infecção pelo vírus da dengue (DENV) no Brasil, pesquisas sorológicas para chikungunya e zika são escassas. Objetivou-se avaliar a soroprevalência das infecções por CHIKV, ZIKV e DENV em gestantes admitidas em uma maternidade pública de Nova Iguaçu, estado do Rio de Janeiro. Métodos: Foi aplicado um questionário simples, contendo dados demográficos, obstétricos e clínicos limitados, sendo realizada coleta de sangue na mesma visita. Diferentes kits de teste comerciais, baseados em ensaio imunoenzimático (ELISA), foram utilizados. Resultados: De 349 gestantes recrutadas de julho a dezembro de 2017, houve sororreatividade de 28,4% para CHIKV, 47,2% para ZIKV e 88,8% para DENV. Conclusão: Esses achados refletem o cenário de alta endemicidade da dengue e sugerem um alcance significativo dos surtos recentes causados por ZIKV e CHIKV na região.

Time trends in colorectal cancer incidence in four regions of Latin America: 1983-2012 / Tendências temporais na incidência do câncer colorretal em quatro regiões da América Latina: 1983-2012 / Tendencias temporales en la incidencia del cáncer colorrectal en cuatro regiones latinoamericanas: 1983-2012

Abstract: This study aimed to assess time trends in colorectal cancer incidence from 1983 to 2012 in Latin America. This was an ecological time-series study whose population consisted of individuals aged 20 years or older diagnosed with colorectal cancer. Data from population-based cancer registries in Cali (Colombia), Costa Rica, Goiânia (Brazil), and Quito (Ecuador), were used for rates estimation, while time trends estimations were proceeded by the Joinpoint Regression Program. The study showed an increase in colorectal cancer incidence in men and women in Cali (2.8% and 3.2%, respectively), Costa Rica (3.1% and 2.1%, respectively), and Quito (2.6% and 1.2%, respectively), whereas in Goiânia, only women showed an increase in colorectal cancer rates (3.3%). For colon cancer, we observed an increasing trend in incidence rates in men and women in Cali (3.1% and 2.9%, respectively), Costa Rica (3.9% and 2.8%, respectively), and Quito (2.9% and 1.8%). For rectal cancer, we observed an increasing trend in incidence in men and women in Cali (2.5% and 2.6%, respectively), Costa Rica (2.2% and 1%, respectively), and Goiânia (5.5% and 4.6%, respectively), while in Quito only men showed an upward trend (2.8%). The study found increases in colorectal cancer, colon cancer, and rectal cancer in four Latin America regions. This findings reflect lifestyle, such as dietary changes, following the economic opening, and the prevalence variations of colorectal cancer risk factors by sex and between the four studied regions. Finally, the different strategies adopted by regions for colorectal cancer diagnosis and screening seem to influence the observed variation between anatomical sites.

Resumo: O estudo teve como objetivo avaliar as tendências temporais na incidência do câncer colorretal entre 1983 e 2012 na América Latina. Este é um estudo ecológico de séries temporais com uma população de indivíduos com 20 anos ou mais, diagnosticados com câncer colorretal. Foram usados os dados dos registros de câncer de base populacional de Cáli (Colômbia), Costa Rica, Goiânia (Brasil) e Quito (Equador) para estimar taxas, enquanto as estimativas das tendências temporais foram realizadas com o software Joinpoint Regression Program. O estudo mostrou um aumento na incidência do câncer colorretal em homens e mulheres em Cáli (2,8% e 3,2%, respectivamente), Costa Rica (3,1% e 2,1%, respectivamente) e Quito (2,6% e 1,2%, respectivamente). Em Goiânia, somente as mulheres mostraram um aumento na incidência do câncer colorretal (3,3%). Para o câncer de cólon, houve uma tendência crescente na incidência em homens e mulheres em Cali (3,1% e 2,9%, respectivamente), Costa Rica (3,9% e 2,8%, respectivamente) e Quito (2,9% e 1,8%). Para o câncer retal, houve uma tendência crescente na incidência em homens e mulheres em Cali (2,5% e 2,6%, respectivamente), Costa Rica (2,2% e 1%, respectivamente) e Goiânia (5,5% e 4,6%, respectivamente), enquanto em Quito somente os homens mostraram tendência crescente (2,8%). O estudo encontrou aumentos no câncer colorretal, câncer de cólon e câncer retal em quatro regiões latino-americanas. Os achados refletem mudanças no estilo de vida, como mudanças de dieta, após a abertura econômica, e variações na prevalência de fatores de risco para câncer colorretal de acordo com gênero e entre as quatro regiões estudadas. Finalmente, as diferentes estratégias adotadas pelas regiões para o diagnóstico e triagem do câncer colorretal parecem influenciar a variação observada entre os sítios anatômicos.

Resumen: El objetivo fue evaluar las tendencias temporales en la incidencia del cáncer colorrectal, de 1983 a 2012, en Latinoamérica. Se trata de un estudio ecológico de series temporales, cuya población consistió en individuos con 20 años de edad, diagnosticados con cáncer colorrectal. Para las tasas de estimación se utilizaron los datos provenientes de los registros de cáncer de base poblacional en: Cali (Colombia), Costa Rica, Goiânia (Brasil), y Quito (Ecuador), mientras que las estimaciones en las tendencias temporales se obtuvieron mediante el software Joinpoint Regression Program. El estudio mostró un incremento en la incidencia de cáncer colorrectal en hombres y mujeres en Cali (2.8% y 3.2%, respectivamente), Costa Rica (3.1% y 2.1%, respectivamente), y Quito (2.6% y 1.2%, respectivamente). En Goiânia, solo las mujeres mostraron un incremento en las tasas de cáncer colorrectal (3.3%). Para el cáncer de colon, hubo una tendencia creciente en las tasas de incidencia en hombres y mujeres en Cali (3.1% y 2.9%, respectivamente), Costa Rica (3.9% y 2.8%, respectivamente), y Quito (2.9% y 1.8%). En el caso del cáner rectal, hubo una tendencia creciente en la incidencia en hombres y mujeres en Cali (2.5% y 2.6%, respectivamente), Costa Rica (2.2% y 1%, respectivamente), y Goiânia (5.5% y 4.6%, respectivamentre), mientras en Quito solo los hombres mostraron una tendencia creciente (2.8%). El estudio encontró incrementos en cáncer colorrectal, cáncer de colon, y cáncer rectal en cuatro regiones de Latinoamérica. Los resultados reflejan un estilo de vida con cambios en la dieta, que siguió a la apertura económica, así como variaciones en la prevalencia de los factores de riesgo de cancer colorrectal por sexos y entre las cuatro regiones estudiadas. Finalmente, las diferentes estrategias adoptadas por las regiones para el diagnóstico del cáncer colorrectal y su pruebas de cribado parece que influencian la variación observada entre los sitios anatómicos donde surge.