Karina Cardoso Meira

The Fraction of Cancer Attributable to Ways of Life, Infections, Occupation, and Environmental Agents in Brazil in 2020

Many human cancers develop as a result of exposure to risk factors related to the environment and ways of life. The aim of this study was to estimate attributable fractions of 25 types of cancers resulting from exposure to modifiable risk factors in Brazil. The prevalence of exposure to selected risk factors among adults was obtained from population-based surveys conducted from 2000 to 2008. Risk estimates were based on data drawn from meta-analyses or large, high quality studies. Population-attributable fractions (PAF) for a combination of risk factors, as well as the number of preventable deaths and cancer cases, were calculated for 2020. The known preventable risk factors studied will account for 34% of cancer cases among men and 35% among women in 2020, and for 46% and 39% deaths, respectively. The highest attributable fractions were estimated for tobacco smoking, infections, low consumption of fruits and vegetables, excess weight, reproductive factors, and physical inactivity. This is the first study to systematically estimate the fraction of cancer attributable to potentially modifiable risk factors in Brazil. Strategies for primary prevention of tobacco smoking and control of infection and the promotion of a healthy diet and physical activity should be the main priorities in policies for cancer prevention in the country.

Trends and predictions for gastric cancer mortality in Brazil

AIM To analyze the effect of age-period and birth cohort on gastric cancer mortality, in Brazil and across its five geographic regions, by sex, in the population over 20 years of age, as well as make projections for the period 2010-2029. METHODS An ecological study is presented herein, which distributed gastric cancer-related deaths in Brazil and its geographic regions. The effects of age-period and birth cohort were calculated by the Poisson regression model and projections were made with the age-period-cohort model in the statistical program R. RESULTS Progressive reduction of mortality rates was observed in the 1980s, and then higher and lower mortality rates were verified in the 2000s, for both sexes, in Brazil and for the South, Southeast and Midwest regions. A progressive decrease in mortality rates was observed for the Northeast (both sexes) and North (men only) regions within the period 1995-1999, followed by rising rates. CONCLUSION Regional differences were demonstrated in the mortality rates for gastric cancer in Brazil, and the least developed regions of the country will present increases in projected mortality rates.

Cervical cancer mortality in the state of Rio Grande do Norte, Brazil, 1996-2010: time trends and projections up to 2030

OBJECTIVE to analyze cervical cancer mortality trends in the state of Rio Grande do Norte and its health micro-regions from 1996 to 2010, as well as to make projections for five-year periods from 2011 to 2030. METHODS this was an ecological time series study; negative binomial regression was used to analyze trends and projections. RESULTS rates above 5.0 deaths per 100,000 women were observed in all the micro-regions, with a stationary trend in the state as a whole and an upward trend in the micro-regions with the worst socioeconomic conditions; projections indicated reduction in mortality rates in the state, from 5.95/100,000 women (2006-2010) to 3.67 (2026-2030), although a 22% increase in the absolute number of deaths is expected. CONCLUSION although a reduction in mortality rates is projected, they continue to be high, indicating the need for review and strengthening of the states cervical cancer control program.

Inequalities in esophageal cancer mortality in Brazil: Temporal trends and projections.

The main objective of the study was to analyze the effect of age, period and birth cohort on esophageal cancer mortality in Brazil and its geographic regions, per sex. An ecological study is presented herein, which evaluated the deaths by esophageal cancer and the distribution, per geographic region. Poisson Regression was utilized to calculate the effects of age, period and birth cohort, and projections were made with the statistical software R, using the age-period-cohort model. Projection of data covered the period 2015–2029. Regarding the geographic regions of Brazil, a decrease was verified, throughout time, for the mortality rates of the South and Southeast regions, for men and women. For the North, Northeast and Midwest regions, an increase was evidenced in mortality rates, mainly for men, after the 2000s. Regarding the projections, a progressive increase of mortality rates was verified for the Northeast and North regions. Divergences evidenced for observed and projected esophageal cancer mortality rates revealed inequalities among the geographic regions of Brazil.

Chagas disease mortality in Brazil: A Bayesian analysis of age-period-cohort effects and forecasts for two decades

Background Chagas disease (CD) is a neglected chronic parasitic infection and a public health problem that is preventable, and has serious complications. In this study, the effects of age, period and birth cohort (APC Effects) on the evolution of the mortality of that disease in Brazil, from 1980–2014, according to sex and geographic region of the country, were analyzed. Mortality forecasts from the years 2015 to 2034 were estimated. Methods This is an ecological cross-sectional study in which death records and population data were extracted from the DATASUS (Department of Information Technology of the National Health System) website, in age groups from 20–24 years of age to 80 years and over, from 1980 to 2014. The rates were standardized according to age and sex distributions using the direct method. The APC models were estimated using the Bayesian approach, and the INLA (Integrated Nested Laplace Approximations) method was used for parameter inference. Super dispersion of the data was considered, and we included unstructured random terms in the models. Results During the analyzed period, there were 178,823 deaths in Brazil (3.85 annual deaths per 100,000 inhabitants). It was found that temporal effects on CD mortality varied by sex and region. In general, there was an increase in mortality rates up to 30 years of age, and the mortality rates were higher between 50 and 64 years of age. On average, men died five years younger than women. Mortality rates were highest in the Central West and Southeast regions. The Central West, Southeast and Southern regions had a reduction over time in the rate of CD deaths between 2000 and 2014. The mortality rate in the Northeast was not statistically different in any period analyzed, while the North had tendency to increase; however, a significant risk increase was only observed between 1995 and 1999. The rate of mortality was high in older birth cohorts. The overall prediction for the next two decades showed a progressive decline in CD mortality, which will be highest among the young. The expected average reduction was 76.1% compared to the last observed period (2010–2014) and the last predicted (2030–2034) period. The average reduction ranged from 86% in the 20–24 age group to 50% in the 80 and over age group. Conclusions In the present study, a higher death rate was observed for ages above 30 years, especially 50 to 64 years, and in the older birth cohorts. We believe these results can be related to period effects of vector control actions and preventive and care measures by the health system of Brazil, in addition to demographic changes in the period. The differences among the regions reflect socioeconomic inequities and access to the healthcare systems in the Brazilian population.

Mortalidade por infarto agudo do miocárdio no Brasil e suas regiões geográficas: análise do efeito da idade-período-coorte

The objective of this study was to analyze the effect of age-period and cohort (APC) of birth on mortality for acute myocardial infarction in Brazil and its geographic regions, according to sex in the period from 1980 to 2009. The data was extracted from the Mortality Information System and was corrected and adjusted by means of proportional redistribution of records with sex and age ignored, ill-defined causes, and corrections were made based on the death sub-register. The APC was calculated using the Poisson regression model with estimable functions. The APC analysis on both sexes and in all regions of the country showed gradual reductions in the risk of death in birth cohorts from the decade of the 1940s, except in the Northeast. In this region, there have been progressive increases in the risk of death from the late 1940s for both sexes. This was up until the 1950s for men and the 1960s for women. It was concluded that the observed differences in the risk of death in Brazilian regions is the result of socio-economic inequalities and poor access to health services within the Brazilian territory, favoring early mortality for this cause especially in poorer areas.

Os desafios para a formulação, implantação e implementação da Política Nacional de Vigilância em Saúde

This article examines the evolution of health surveillance policies as actions, models and systems, as well as contributing to the debate about the constitution of the National Health Surveillance Policy (PNVS). The article discusses conceptual elements regarding the notion of health surveillance and its evolution in Brazil and a trajectory is provided in relation to the construction of care models, particularly after the creation of the Unified Health System (SUS). The possibility of using the framework of public policies based on evidence, and methods for analyzing health situations, such as spatial analysis and time series, are highlighted. To conclude, questions are raised regarding the effective creation of the PNVS, and the challenges that the federal executive faces in driving this process.Resumo O artigo e um ensaio com o objetivo de resgatar a evolucao da vigilância em saude como acao, modelo e sistema na historia e trazer subsidios para o debate acerca da constituicao da Politica Nacional de Vigilância em Saude (PNVS). Sao resgatados elementos conceituais sobre o conceito de vigilância em saude e sua evolucao no Brasil ao longo dos anos, e e definida uma trajetoria da construcao do modelo de atencao, principalmente apos a criacao do Sistema Unico de Saude (SUS). Pontua-se a possibilidade de utilizacao, como eixo norteador, do referencial das politicas publicas baseadas em evidencia, e do uso de metodos conhecidos pela analise de situacao de saude, como as analises espaciais e de series temporais. Ao final, sao elencados as questoes para a efetiva criacao da PNVS e os desafios colocados, principalmente, para o executivo federal na conducao deste processo.

Homicídios de mulheres nas distintas regiões brasileiras nos últimos 35 anos: análise do efeito da idade-período e coorte de nascimento

The aim of this study is to estimate the effects of age-period-birth cohort (APC) on female homicides. This is an ecological study which analyzed the violence-related death records of women aged 10 years and older, in the Brazilian geographic regions, between 1980 and 2014. Data on mortality were extracted from the Mortality Information System. The trend analysis was conducted using negative binomial regression and APC effects were analyzed using estimable functions. The average mortality rate for the period was 5.13 deaths per 100,000 women, with the highest rates observed in the Central-West (7.98 deaths), followed by the Southeast (4.78 deaths), North (4.77 deaths), Northeast (4.05 deaths) and South (3.82 deaths) regions. All regions presented a decrease in the risk of death in the period from 2010 to 2014, except for the Northeast region (RR = 1.06, 95% CI 1.02 to 1.10). There was a progressive increase in the homicide risk for women born from 1955 to 1959 in all Brazilian regions. Younger women are at higher risk of dying from homicides in all Brazilian geographic regions. The upward trend of homicide mortality rates according to birth cohort was significant and the highest risk was observed in women born between 2000 and 2004.

Nurses’ Job Market Profile in Brazil

Introduction: The expression ‘job market’ refers, in general terms, to the dynamics and behavior of the labor force available in the market. It encompasses the relations between employment and unemployment, income levels, working hours, and contractual relations, including wage, workforce distribution in the economy sectors, relations between capital and labor. Objective: Characterize nurses’ job market profile, within the period 2009-2013, in a northeastern Brazilian state. Method: Descriptive and cross-sectional study, with a quantitative approach and data obtained from two public databases: the Brazilian Social Information Annual Report (RAIS), by the Brazilian Ministry of Labor and Employment (MTE); and the number of registrations in the Regional Nursing Council in Rio Grande do Norte, Brazil (COREN/RN). Results: Regarding employment agreements, a certain stability was identified within the period, reducing the number of job positions in 2012 and 2013. When comparing data of nurses’ workforce, through records from COREN/RN, to job positions of the RAIS, since 2011, a clear mismatch between the number of job positions and the number of nurses available in the market was found. Conclusion: It is concluded there is a maintenance trend with worse unemployment, especially among young individuals, if three situations highlighted in 2013 persist: growth in nurses’ educational level, staying in Rio Grande do Norte, and stability or maintenance of a decreased number of job positions available.

Mortalidade por câncer do colo do útero no estado do Rio Grande do Norte, no período de 1996 a 2010: tendência temporal e projeções até 2030

OBJETIVO: analisar a tendencia da mortalidade por câncer do colo do utero no estado do Rio Grande do Norte e em suas microrregioes de saude, no periodo de 1996 a 2010, e realizar projecoes para os quinquenios, de 2011 a 2030. METODOS: estudo ecologico de series temporais; empregou-se regressao binomial negativa para analise das tendencias e projecoes. RESULTADOS: foram observadas taxas acima de 5,0 obitos por 100 mil mulheres em todas as microrregioes, com tendencia estacionaria para o estado e ascendente nas microrregioes com piores condicoes socioeconomicas; as projecoes indicaram reducao nas taxas de mortalidade no estado, de 5,95/100 mil mulheres (2006-2010) para 3,67 (2026-2030), embora seja previsto aumento de 22% no numero absoluto de obitos. CONCLUSAO: apesar da previsao de reducao nas taxas de mortalidade, estas ainda apresentam-se elevadas, sinalizando a necessidade de revisao e fortalecimento do programa de controle do câncer do colo do utero no estado.