Stroke Hospital Admissions during the COVID-19 Outbreak in São Paulo, Brazil.

BACKGROUND: Globally, stroke remains an important cause of death and long-term disability, and the impact of coronavirus disease (COVID-19) on the health system may have impaired stroke care. Previous studies suggest significant reduction in hospital admissions for stroke after COVID-19 onset as patients may hesitate seeking medical help due to fear of exposure. METHODS: This cross-sectional study included cases of hospital admissions for stroke, identified from the Hospital Information System of the Unified Health System (Sistema Único de Saúde), which contains official and public data in Brazil. Data were collected in duplicate, then categorized according to the International Classification of Diseases, tenth revision (ICD-10), considering codes I60-I69. Linear regression was used to estimate the variation in hospital admissions for stroke in the city of São Paulo (SP) - the largest and most populous city in Brazil and Latin America, between January and June of each analyzed year (2017-2020). The percentage variation between June and January 2020 was also compared. The level of significance was set at 5%, and the statistical program used was Stata, version 14.0. RESULTS: In the city of SP, during the first wave of COVID-19, from January to June 2020, there were registered decreases in absolute numbers and mean monthly admissions for stroke. Compared to January 2020, data from June 2020 showed 17% reduction in hospitalizations for intracerebral hemorrhage, 32% for cerebral infarction, 26% for stroke unspecified, and 47% for other cerebrovascular diseases. CONCLUSION: We argue for policies aimed at improving stroke care and developing awareness campaigns regarding the importance of early diagnosis and treatment, as even in less severe presentations, stroke can trigger an increase in mortality, cost, and long-term disability.

Assessment of the median ages at sexual maturation stages of Brazilian schoolchildren according to overweight status and type of school over a 5-year period: 2007-2012/2013.

OBJECTIVES: A secular trend of earlier puberty has been observed in girls, and, although more uncertain in boys, is associated with an increasing trend in the prevalence of overweight and obesity. We aimed to compare the median ages of sexual maturation stages in schoolchildren from a city in southern Brazil over a 5-year period, according to weight status and type of school. METHODS: Two cross-sectional studies were performed in 2007 and 2012/2013, including 2215 and 1614 schoolchildren, respectively. Body mass index z-scores were calculated and categorized as either nonoverweight or overweight (including obesity). The type of school was categorized as either public or private. Sexual maturation was self-assessed according to the Tanner stages. Mann-Whitney and Kruskal-Wallis tests were performed to compare the median ages of sexual maturation stages. RESULTS: The median age decreased for almost all stages over the 5-year period in both sexes. In boys, the decrease ranged from 0.3 to 1.0 years (stages 2, 3, 4, and 5 for genitalia, and stages 2 and 4 for pubic hair), and from 0.3 to 0.7 years (stages 2, 3, and 4 for breast, and stages 3, 4, and 5 for pubic hair). In 2012, overweight students had lower median ages for most stages compared to those in 2007, especially in girls. Differences by type of school were balanced across years. CONCLUSIONS: The median age of Tanner's stages after 5 years was reduced in both sexes. In overweight girls, the reduction was more pronounced. The results by type of school were inconsistent.

Physical inactivity level and lipid profile in traditional communities in the Legal Amazon: a cross-sectional study : Physical inactivity level in the Legal Amazon.

BACKGROUND: The practice of regular physical activity can alter the lipid profile in populations according to diverse demographic characteristics. OBJECTIVE: To evaluate the association of physical inactivity with the lipid profile among vulnerable populations. METHODS: A cross-sectional study was conducted among 349 vulnerable individuals from Tocantins state, northern Brazil. The International Physical Activity Questionnaire 7 Day short form was used to measure self-reported physical activity levels. Venous blood samples were drawn to evaluate lipid profile. Logistic regression adjusted by the socioeconomic variables was used to analyse the effects of physical inactivity on the lipidic profile. The level of significance was 5% and Stata® (StataCorp, LC) version 11 was used. RESULTS: We observe an inverse relationship between physical inactivity and HDL-C-that is, those who were sedentary or below the WHO Recommendations for physical activity were at 2.6 greater odds (IC95% 1.21, 5.67; p = 0.015) of having a lower HDL compared with those meeting or exceeding WHO physical activity recommendations. CONCLUSION: On the vulnerable populations studied, the insufficiently active or sedentary individuals (called the physical inactivity individuals) have more risk of the altered HDL-C.

Reduction on Proinflammatory Cytokines after Application of Transcutaneous Electrical Nerve Stimulation (TENS) in Patients with a Breast Cancer: A Nonrandomized, Open, and Single-Arm Study Protocol with Paired Analysis.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) has been used as analgesic therapy in many diseases. It is already known that studies that have observed the relationship between pain and cytokines have found that patients who report less severe pain have less production of proinflammatory cytokines. However, one another accepted mechanism is that decreasing proinflammatory cytokines results in decreased pain intensity. Analyzing the literature, the authors describe that, in addition to the analgesic effect, TENS has shown systemic effects, and clinically, the reduction of proinflammatory cytokines could be a protective factor against inflammation. To test the inflammatory effect of TENS, we researched the literature for clinical conditions that suggest that proinflammatory cytokines are one of the main mediators of the disease process. Chronic inflammation is one of the risk factors mentioned for the development of a new cancer; at the same time, it is indicated as an indicator of the worst prognosis. Studies also suggest that the worst prognosis of breast cancer, one of the types with the highest incidence in the world, may be related to increased inflammatory activity. Considering that inflammation is increased in breast cancer and that TENS can reduce proinflammatory cytokines even without blocking the pain pathway, our hypothesis is that the anti-inflammatory effect of TENS can bring benefits to these patients. The aim of this study will be to evaluate the effect of TENS on blood reduction of proinflammatory cytokines in breast cancer patients. METHODS: This study will evaluate at least 59 patients, over 18 years of age, diagnosed with breast cancer, but who have not yet started any treatment. All patients will be submitted to TENS intervention (Ibramed, Model Neurodyn III, parameters: VIF-turn on, frequency-2-247 Hz, pulse size-50-500 µs, and intensity (mA)-maximum tolerated by the patient), and the data will be analyzed in the pre- and postintervention of each patient. The application has a total duration of 30 minutes, and 8 ml of blood will be collected before and after the intervention. Proinflammatory (IL-1, IL-2, IL-6, IL-7, and TNF-α) and anti-inflammatory (IL-4, IL-10, IL-13, and FTCß) cytokines will be analyzed. As a primary endpoint, we will analyze the reduction in blood concentration of proinflammatory cytokines, and as secondary endpoints, we will analyze the size of the effect according to each type of proinflammatory cytokine, describe the effect size of the reduction according to the breast cancer immunohistochemistry, and analyze the effect of TENS on anti-inflammatory cytokines. This study is approved by the Research Ethics Committee (Centro Universitário FMABC, Brazil) and registered in the Brazilian Clinical Trials (Search text: RBR-10jbwh47).

Brazilian National Policy of Comprehensive Women's Health Care and mortality during climacteric period: has anything changed?

BACKGROUND: The National Policy for Integral Attention to Women's Health Care (PNAISM) was implemented in 2004, with monitoring of potential benefits. One of the life cycles of women contemplated in this health policy was the importance of health care during the climacteric. Prevention and health promotion are actions carried out by the Brazil National Health System and enshrined in health Brazilian policies for women. Thus, our purpose was to identify climacteric women's main causes of death as well as the mortality trends of such causes, especially after implementation of PNAISM. METHODS: An ecological study was conducted from 2018 to 2020. Data were retrieved from the Brazilian Health Department by accessing the mortality information system of the National Health Information, divided into periods 1996-2004 and 2005-2016 the latter to correspond with the implementation of the National Policy. The death records of Brazilian women aged 40 to 64 years who had a designated cause of death were retrieved. Trends and differences between periods were evaluated using linear regression. The significance level was set at 5%. RESULTS: The main causes of death in women from 1996 to 2016 were circulatory system diseases (22.47%, 697,636 deaths), neoplasms (19.69%, 611,495 deaths), respiratory system diseases (5.5%, 170,716 deaths), endocrine, nutritional, and metabolic disorders (5.27%, 163,602 deaths), and digestive system diseases (3.74%, 116.280 deaths). Analyzing the changes in the major causes of death of climacteric women after implementation of the PNAISM we observed that mortality from circulatory system diseases and endocrine and nutritional diseases were significantly declined in post-PNAISM period: (ß = - 3.63; 95% CI - 4.54 to - 2.73 r2 = 0.87; p < 0.001; ß = - 0.51; 95% CI, - 0.71 to - 0.31; R2 = 0.73; p < 0.001, respectively). No changes were observed in mortality from neoplasms and respiratory system diseases in post-PNAISM period (p = 0,765; p = 0,233, respectively). CONCLUSIONS: After implementation of the PNAISM, we observed a downward trend in rates of mortality from diseases of the circulatory and digestive systems and from endocrine, nutritional, and metabolic diseases but stability in the rates of death from neoplasm and respiratory system diseases.

Association between pubertal development stages and body adiposity in children and adolescents.

BACKGROUND: The study aimed to analyze the association between pubertal development stages and adiposity in children and adolescents. METHODS: Cross-sectional study conducted in 2007 in Florianópolis, Brazil, with 2339 schoolchildren 32 aged 8 to 14 years old (1107 males). The outcome (adiposity) was evaluated using Z score and 33 percentilee values > = 85 of four skinfolds (triceps, subscapular, suprailiac and calf) and waist 34 circumference. Total body adiposity (Z score of the sum of skinfolds), central adiposity (Z score 35 of waist circumference) and peripheral adiposity (Z scores of triceps and calf skinfolds) were 36 estimated. Pubertal development stages was self-assessed according to Tanner stages of development. Thirty-seven Children and adolescents were classified according to tertiles of age for each pubertal development stages 38 stage - early, normal and late. Statistical analysis was performed using univariate and 39 multivariate Poisson regression models. RESULTS: Children and adolescent from both sexes with early pubertal development stages presented higher prevalence of central adiposity (waist circumference), with adjusted prevalence ratio (CI 95%) of 2.21 (1.12; 4.35) for males and 2.18 (1.04; 4.57) for females (reference group: normal pubertal development stages). Among females, there was a reduction in the prevalence of excess adiposity with decreased occurrence of early pubertal development stages. There was a strong relationship between adiposity and pubertal development stages. CONCLUSIONS: Excess adiposity was higher in both sexes for those with early pubertal development stages.

Correction to: Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 2004 and 2014.

An amendment to this paper has been published and can be accessed via the original article.

Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 2004 and 2014.

BACKGROUND: Access to the diagnosis and treatment of breast cancer in Brazil is marked by immense inequalities in the provision of specialized assistance, which leads patients to seek treatment outside the place of residence. To evaluate the variations between 2004 and 2014 in the distribution of flow between place of residence and care, and the average distance traveled for treatment of breast cancer in the administrative regions and federal states of Brazil. METHOD: Analysis of secondary data from the years 2004 and 2014, extracted from the Department of Informatics of the Unified Health System through the Hospital Information System. Data from Hospitalization Release Authorizations were collected, and the maps were created with TabWin 3.6 software. Descriptive analysis was performed on Stata® (StataCorp, LC) 11.0. RESULTS: In the total flow, it was observed that there was a decrease in referrals between 2004 and 2014 in most regions. In 2004 the main direction of flow was in the Midwest and Southeast regions. In 2014, however, the intensity of these admissions was centralized in the Southeast region. In relation to the average distance traveled, the North, Northeast, and Midwest regions had the highest values of displacement. Of the 27 federative units, 17 presented an increase in average distance between these periods. CONCLUSION: Despite the improvement in the hospitalization of residents, in most regions and federal units, Brazilians still travel great distances when they require treatment for breast cancer.

Time trend of breast cancer mortality in BRAZILIAN men: 10-year data analysis from 2005 to 2015.

BACKGROUND: Male Breast Cancer (MBC) is rare, which makes its understanding and treatment be extrapolated from what is known about the occurrence in women, with few epidemiological studies, with few epidemiological studies. Therefore, the aim of the present paper was to study breast cancer mortality in adult males in Brazil and its administrative regions between 2005 and 2015. METHODS: Ecological study with data on MBC mortality in adults between 2005 and 2015. Data were obtained from the Mortality Information System of the Department of Informatics of SUS (the Unified Health System of the country). Descriptive statistics were used for MBC mortality and linear regression to analyze the relationship between mortality and the country's administrative regions. Percentage Change (PC) and Annual Percentage Change (APC) were the trend measures used for MBC mortality for the period. RESULTS: Between 2005 and 2015, there were 1521 deaths due to MBC in adults in Brazil. Regarding mortality by region, there was great oscillation in the rates of the country as a whole (PC = 113,87; ß = 0,009 (IC95% 0,000 - 0,018); r2 = 0,381; P = 0,043). The highest increase in MBC mortality occurred in patients aged 80 years or older (PC = 161,04; ß = 0,201 (IC95% 0,640 - 0,339); r2 = 0,550; P = 0,009) and there was significant increase in deaths for the 50-54-year age group (PC = 224,01; ß = 0,135 (CI95% 0,052; 0,218); r2 = 0,601; P = 0,005). CONCLUSION: Mortality in adults due to MBC increased in Brazil during the study period with the highest percentage increase occurring for individuals aged 80 years or older.

Factors associated with blood pressure disorders in Afro-descendant children and adolescents.

BACKGROUND: Hypertension (AH) is an emerging disease that has rapidly increased in the last decades throughout the world. The increase in blood pressure (BP) is observed with growth and development and, although the manifestation of the disease is rare in childhood and adolescence, its occurrence is increasing and the causes are likely to be from different combinations of factors. Afrodescendants have been consistently observed in many populations, including Brazil, which has the largest population of Afrodescendants outside Africa; nevertheless, data is scarce on the disease in children and adolescents. In this study, we investigated BP disorders in children and adolescents of "Quilombola" populations of the state of Tocantins, northern Brazil, and determined the disease occurrence with some factors, namely food consumption, body composition, anthropometric measures, and biochemical data. METHODS: We carried out a cross-sectional study with 67 children aged 10-17 years, comparing the variables studied between the normotensive and non-normotensive groups, using the Chi-square test for qualitative variables and the appropriate tests, according to data adherence to the Gaussian distribution for the quantitative variables. High blood pressure was defined as mean systolic or diastolic blood pressure ≥ 90 percentile for age, height, gender. RESULTS: The rate of adolescents with BP disorders was 19.4% (prehypertension 14.9% and hypertension 4.5%). There were no significant differences between the sexes for high blood pressure. In the Poisson regression analysis, the high fat percentage was associated with elevated blood pressure (p = 0.021) for adolescents. Similar associations were observed for non-HDL-c (p < 0.001) and low calcium intake (p = 0.015). CONCLUSION: Most children and adolescents in "Quilombola" communities had normal blood pressure. However, higher levels of dyslipidemia and low calcium intake are factors associated with prehypertension in the population studied with high BP.

Characterization of Adolescent Pregnancy and Legal Abortion in Situations Involving Incest or Sexual Violence by an Unknown Aggressor.

Background and Objectives: In pregnancies resulting from incest, the adolescent maintains close family and emotional relations with the aggressor, different from what occurs when pregnancy results from sexual violence by strangers. Evidence indicates that this type of relationship with the aggressor may interfere in the dynamics of such violence and the adolescent's access to health services. Materials and Methods: The objective of this research was to describe and correlate aspects associated with pregnancy when resulting from rape of adolescents in situations of incest; rape when perpetrated by an unknown aggressor and an abortion as allowed by law was sought. Method: A cross-sectional, epidemiological study of adolescents treated at the Pérola Byington Hospital, São Paulo, Brazil, bringing an allegation of pregnancy, resulting from sexual violence and a request for abortion as allowed by law. A total of 311 adolescents, being 134 in the "pregnancy from incest group", and 174 in the group "pregnancies resulting from rape by a stranger" were considered under the study variables; relationships were investigated using the chi-squared test and Poisson regression with robust variance. Results: The study included 137 cases (44.1%) of pregnancy resulting from incest, and 174 cases (55.9%) of pregnancy from rape by a stranger. In cases of incest, a declaration of religion (92.0%) was significantly more frequent, and the adolescents were approached in spaces considered safe or private (92.7%); the aggressor taking advantage of the adolescent's legal condition of vulnerability as a function of age (83.3%). Cases of incest presented a lower median adolescent age and greater gestational development, with gestations being ≥ 13 weeks prevailing. Conclusion: Cases of pregnancy by incest presented indicators suggesting both proximity and relationship with the aggressor, and pregnancy at a very early age, which postponed the adolescent's procurement of health service, and interfered negatively with abortion assistance as allowed by law.

Time trend and regional variability of mortality rate due to ovarian cancer in Brazil: a 15-year analysis.

Introduction: Ovarian cancer (OC) is the most lethal gynecological tumor. In Brazil, there are important regional differences regarding mortality rates for the same cancer type. Objectives: To analyze the progression of OC mortality rates in Brazil and its regions, in age groups over 50 years, between 2000 and 2015. Methods: Ecological longitudinal study carried out using secondary data from DATASUS (Brazil's public health system database) regarding deaths due to OC in women living in Brazil between 2000 and 2015. We calculated gross and adjusted mortality, estimated the impact of death of OC and proportional mortality rate of all cancer types in women between the age of 50 and 79 years. Results: There were 34.335 deaths due to OC in women in the referred age interval, with a 9% increase in mortality adjusted for age, a 0.05% (P = 0.012) trend and a 24.67% increase in the proportional mortality due to all causes with a 0.02% (P < 0.001) trend. There were statistically significant increases in mortality rates due to OC in the age groups of 50-54 (28,4%, P < 0,05) and 75-79 years (25,1%, P < 0,05). Conclusion: Although there are oscillations in mortality rates of OC in Brazil and its regions over the period studied, this parameter has remained relatively stable.

Effects of Transcutaneous Electrical Nerve Stimulation on Proinflammatory Cytokines: Systematic Review and Meta-Analysis.

The mechanism of pain reduction involves bidirectional processes of pain blocking (nociception) and reductions in the levels of proinflammatory cytokines in the blood. Does transcutaneous electrical nerve stimulation (TENS) reduce blood levels of proinflammatory cytokines? For this systematic review, we searched in six databases to identify randomized controlled trials with the criteria: humans older than 18 years (adults), use of TENS in the experimental group, and having at least one pre- and postintervention blood level of at least one proinflammatory cytokine. The risk of bias and the level of evidence were assessed. Five studies were included involving 240 participants. The heterogeneity of the studies was high (I2: 85%); therefore, we used a random-effects meta-analysis. It was observed through the meta-analysis synthesis measures that there were statistically significant differences following the use of TENS to reduce the general group of cytokines. When grouped by chronic disease, by postoperative settings, or by individual studies in the case of IL-6, it was observed that the significant reduction of cytokines related to the use of TENS was maintained. The use of TENS reduced the blood levels of proinflammatory cytokines (we observed a protective factor of TENS in relation to inflammation). The protocol of the systematic review was registered in PROSPERO, CRD42017060379.

Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access.

BACKGROUND: Adequate flow through a newly created arteriovenous fistula depends on multiple characteristics of the vessels and patient comorbidities. Several studies have related preoperative findings to failure, but few have analyzed the influence of intraoperative findings. OBJECTIVES: To evaluate the predictive value of intraoperative findings on the immediate outcome of radial-cephalic arteriovenous wrist fistulas (RCAVF) by collecting data that are easily measured intraoperatively. METHODS: We designed a cross-sectional study, in which a single surgeon performed 101 RCAVF in 100 patients at a single center. We analyzed the immediate postoperative flow, assessed by thrill intensity immediately after fistula creation, against patient demographics and intraoperative data. The following variables were analyzed: age, sex, comorbidities, length of vein visible at preoperative examination, macroscopic arterial calcification, maximum vein diameter, and length of stenosis-free vein, measured by cannulation with a urethral catheter during the procedure. The chi-square test was used both to eliminate possible bias introduced by side of venous access (left or right), and to determine predictive values of immediate thrill. RESULTS: Side of access was not associated with any significant differences in variables. Absence of macroscopic arterial calcification, successful venous catheterization using a 6 French catheter or larger, and ability to advance it more than 10 centimeters along the lumen of the proximal vein were correlated with adequate immediate postoperative thrill (p = 0.004, p < 0.001, and p = 0.005, respectively). CONCLUSIONS: In this series of 101 RCAVF, both the diameter of the catheter and its progress through the proximal vein and also absence of arterial calcification had positive predictive value for achieving adequate immediate thrill after vascular access construction.

CONTEXTO: O fluxo adequado de uma fístula arteriovenosa recém-confeccionada depende de múltiplas características dos vasos, bem como de comorbidades do paciente. Diversos estudos associam achados pré-operatórios e suas relações à falha do acesso, mas poucos analisam a influência dos achados encontrados no intraoperatório. OBJETIVOS: Avaliar o valor preditivo desses achados no fluxo imediato de fístulas arteriovenosas radiocefálicas de punho (FAVRCPs) para hemodiálise através de coleta de dados facilmente mensuráveis do intraoperatório. MÉTODOS: Um único cirurgião realizou 101 FAVRCPs em 100 pacientes, em um único centro. Analisou-se o fluxo do pós-operatório imediato através da intensidade do frêmito imediatamente após a confecção do acesso, e os resultados foram comparados com dados demográficos e achados intraoperatórios. As variáveis analisadas foram sexo, idade, comorbidades, extensão da veia visível ao exame físico, presença de calcificação arterial macroscópica, diâmetro venoso máximo e extensão de veia livre de estenose, avaliadas através da cateterização venosa com sonda uretral durante o procedimento. O teste de qui-quadrado foi utilizado tanto para excluir um possível viés de confusão pelo lado do acesso como para avaliar o valor preditivo das variáveis na intensidade do frêmito. RESULTADOS: Não foi identificada diferença significativa nas variáveis segundo o lado do acesso. A ausência de calcificação arterial, a possibilidade de cateterização venosa com sonda de 6 French ou maior, e a sua progressão por mais de 10 cm através do lúmen da veia proximal tiveram correlação com frêmito imediato adequado ao fim do procedimento (p = 0,004, p < 0,001 e p = 0,005, respectivamente). CONCLUSÕES: Nesta série de 101 FAVRCPs, o diâmetro e a progressão de cateter 6 French ou maior através da veia proximal e a ausência de calcificação arterial apresentaram valor preditivo positivo na obtenção de frêmito imediato adequado de FAVRCP para hemodiálise.

The role of health policy in the burden of breast cancer in Brazil.

BACKGROUND: Breast cancer affects millions of women worldwide, particularly in Brazil, where public healthcare system is an important model in health organization and the cost of chronic disease has affected the economy in the first decade of the twenty-first century. The aim was to evaluate the role of health policy in the burden of breast cancer in Brazil between 2004 and 2014. METHODS: Secondary analysis was performed in 2017 with Brazilian Health Ministry official data, extracted from the Department of Informatics of the National Health System. Age-standardized mortality and the age-standardized incidence of hospital admission by breast cancer were calculated per 100,000 people. Public healthcare costs were converted to US dollars. Regression analysis was performed to estimate the trend of breast cancer rates and healthcare costs, and principal component analysis was performed to estimate a cost factor. Stata® 11.0 was utilized. RESULTS: Between 2004 to 2014, the age-standardized rates of breast cancer mortality and the incidence of hospital admission and public healthcare costs increased. There was a positive correlation between breast cancer and healthcare public costs, mainly influenced by governmental strategies. CONCLUSIONS: Governmental strategies are effective against the burden of breast cancer in Brazil.

Treatment delays among women with breast cancer in a low socio-economic status region in Brazil.

BACKGROUND: Considering the inequalities and the areas of low socioeconomic status in Brazil, access to health services is a challenge and the delay between diagnosis and treatment represents an important factor of worse prognosis in patients with breast cancer. Herein, we describe the clinical and epidemiological profiles of women with breast cancer and evaluate their access to health services, as well as treatment delays, at a reference centre of the Cariri region, Ceará, Brazil. METHODS: This is a retrospective study that included 473 women treated with breast cancer between 2009 and 2011 at the Oncology Centre of the Cariri. RESULTS: The majority of these patients were aged between 40 and 69 years old (65.7%), without a completed high school degree (89.2%). They were married (62.9%) and were already diagnosed but had not yet been subjected to any previous treatment (77.8%). It was observed that 91.8% were referred from the public health service, and treatment was paid for by the public health service in 92.9% of the cases. The patients whose source of referral was the public system waited longer between diagnosis and the treatment initiation (p = 0.031; Mann-Whitney's test), with a median waiting time of 71.5 days versus 39 days for those receiving referrals from private services. In addition, those with public referrals prior to diagnosis also experienced a longer waiting time between the first medical visit and treatment initiation (77 days vs. 37 days; p = 0.036; Mann-Whitney's test), with the waiting time for the biopsy being an important factor in this delay. CONCLUSIONS: Late diagnosis was often the result of inefficiency of the prevention policies coupled with difficulty accessing the public health network. It was commonly observed that, even after diagnosis, the patients needed to wait too long before entering the Oncology Service because of long waiting queues in the public health system.

Reduction of heart rate variability in hypertensive elderly.

INTRODUCTION: The elderly population grows globally every day, and along with it the incidence of high blood pressure also grows, following these data scientists seek tools to improve the health of this population, a widely used tool for assessing cardiovascular function is the heart rate variability(HRV), that is a mecanism that allows the investigation of oscillations in the intervals between consecutive heart beats (RR intervals). There are already studies on the autonomic nervous system in the elderly population, however, these studies investigated normotensive patients and there is little research in hypertensive patients. AIM: To compare the cardiac autonomic modulation between healthy elderly and hypertensive elderly. METHOD: The total sample was 80 elderly people- 40 healthy elderly and 40 elderly (HBP). Anthropometric data, HRV analysis and IPAQ questionnaire were collected. For the analysis of cardiac modulation data in the time domain (pNN50, SDNN and RMSSD) and frequency domain (LF and HF). The geometric analysis (RRtri, TINN, SD1, SD2 and SD1/SD2 ratios). RESULTS: In the time domain the MeanRR index presented a HAS increase 832.35 ± 104.46 ms vs control 782.73 ± 112.78 ms (p = 0.040). In the SDNN, there was a 58.35ms decrease vs the SAH 43.15 ms (p = 0.030). In the frequency domain, HF decreased control 247.00 ms2 vs HAS 157.00 ms2 (p = 0.002). In the geometric, the TINN and SD2 in the HAS group decreased in relation to the control from 203.38 ± 80.26 ms to 161.83 ± 53.25 ms (p = 0.018) and from 71.95 ms to 59.40 ms (p = 0.051). The mean SD1/SD2 ratio showed an increase between the Control and SAH groups from 0.22 ± 0.10 to 4.09 ± 1.18 and there was a statistical difference (p = 0.001). CONCLUSION: Hypertensive elderly patients present decreased heart rate variability and decreased parasympathetic modulation when compared to normotensive elderly.

Prevalence of active transportation among adults in Latin America and the Caribbean: a systematic review of population-based studies.

OBJECTIVE: To describe the prevalence of "active" (self-propelled, human-powered) transportation in the Latin America and Caribbean (LAC) region over the past decade. METHODS: MEDLINE, Excerpta Medica (Embase), SportDiscus, Lilacs, MediCarib, Web of Science, OVID, CINAHL, Scopus, Google Scholar, National Transportation Library, and TRIS/TRID were searched for articles on active transportation published between January 2003 and December 2014 with (at least) a title and abstract in English, Portuguese, or Spanish. Research was included in the study if the two reviewing authors agreed it 1) was conducted in an adult sample (≥ 18 years old), 2) was designed to be representative of any LAC area, and 3) reported at least one measure of active transportation. Reference lists of included papers and retrieved reviews were also checked. A total of 129 key informants (87 scientific experts and 42 government authorities) were contacted to identify additional candidate publications. Two other authors extracted the data independently. RESULTS: A total of 10 459 unique records were found; the full texts of 143 were reviewed; and a total of 45 studies were included in the study, yielding estimates for 72 LAC settings, most of which were in Argentina, Brazil, and Colombia. No eligible studies were found for the years 2003-2004, resulting in a 10-year study time frame. Estimates were available for walking, cycling, or the combination of both, with a high degree of heterogeneity (heterogeneity index (I2) ≥ 99%). The median prevalence of active transportation (combining walking and cycling) was 12.0%, ranging from 5.1% (in Palmas, Brazil) to 58.9% (in Rio Claro, Brazil). Men cycled more than women in all regions for which information was available. The opposite was true for walking. CONCLUSIONS: Prevalence of active transportation in LAC varied widely, with great heterogeneity and uneven distribution of studies across countries, indicating the need for efforts to build comprehensive surveillance systems with standardized, timely, and detailed estimates of active transportation in order to support policy planning and evaluation.

Evaluation of MCT1, MCT4 and CD147 Genes in Peripheral Blood Cells of Breast Cancer Patients and Their Potential Use as Diagnostic and Prognostic Markers.

BACKGROUND: Patients with breast cancer-the deadliest cancer among women-are at constant risk of developing metastasis. Oxidative stress and hypoxia are common feature of tumor cells that can proliferate even in a resultant metabolic acidosis. Despite the low extracellular pH, intracellular pH of tumor cells remains relatively normal, or even more alkaline due to the action of a membrane protein family known as monocarboxylate transporters (MCTs). The objective of this study was to verify the diagnostic and prognostic value of MCT1, MCT4 and CD147 in tumor and peripheral blood samples of patients with breast cancer undergoing chemotherapic treatment. METHODS: Differential expression of MCT1, MCT4 and CD147 obtained by qPCR was determined by 2-ΔΔCq method between biological samples (tumor and serial samples of peripheral) of patients (n = 125) and healthy women (n = 25). RESULTS: tumor samples with higher histological grades have shown higher expression of these markers; this higher expression was also observed in blood samples obtained at diagnosis of patients when compared to healthy women and in patients with positive progression of the disease (metastasis development). CONCLUSION: markers studied here could be a promising strategy in routine laboratory evaluations as breast cancer diagnosis and prognosis.

Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review.

BACKGROUND: The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. METHOD: A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population's access to health services and original articles with full text available online. RESULTS: The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. CONCLUSIONS: The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.