Maximiliano Ribeiro Guerra

Prevalência de perda auditiva induzida por ruído em empresa metalúrgica

OBJETIVO: Analisar a prevalencia dos casos sugestivos de perda auditiva induzida por ruido em trabalhadores metalurgicos, potencialmente expostos ao ruido ocupacional (83 a 102 dB). METODOS: Estudo transversal conduzido em empresa metalurgica prestadora de servicos localizada no municipio do Rio de Janeiro, Brasil. Com o Programa de Conservacao Auditiva da empresa, foram analisados dados clinicos e ocupacionais de 182 trabalhadores, em atividade no periodo de novembro de 2001 a marco de 2002. Utilizou-se da classificacao acustica das unidades operacionais das empresas contratantes para a caracterizacao do status de exposicao ao ruido no ambiente de trabalho, em funcao da dificuldade de quantificacao em nivel individual. Foram testadas associacoes entre esses casos e variaveis tais como idade, tempo de atividade na empresa, tempo de exposicao ao ruido ocupacional e uso regular de equipamento de protecao individual, por meio de razao de prevalencia e analise de regressao logistica. RESULTADOS: A prevalencia de casos sugestivos de perda auditiva induzida por ruido foi de 15,9% e, na analise multivariada, foram identificadas associacoes significativas (p<0,05) entre esses casos e as variaveis idade e uso regular de equipamento de protecao individual. CONCLUSOES: Os resultados encontrados contribuiram para melhor compreensao do comportamento de algumas das principais caracteristicas relacionadas a perda auditiva induzida por ruido, em uma situacao particular de organizacao do trabalho, relativamente comum nas industrias brasileiras.

Sobrevida de cinco anos e fatores prognósticos em coorte de pacientes com câncer de mama assistidas em Juiz de Fora, Minas Gerais, Brasil

O objetivo deste estudo foi analisar a sobrevida de cinco anos e os fatores prognosticos em mulheres com câncer invasivo da mama, submetidas a cirurgia e assistidas em Juiz de Fora, Minas Gerais, Brasil, com diagnostico da doenca entre 1998 e 2000. As variaveis analisadas foram: idade, cor, local de residencia, variaveis relacionadas ao tumor e ao tratamento. Foram estimadas as funcoes de sobrevida pelo metodo de Kaplan-Meier, e o modelo de riscos proporcionais de Cox foi utilizado para avaliacao prognostica. A sobrevida estimada foi de 81,8%. Tamanho tumoral e comprometimento de linfonodos axilares foram os fatores prognosticos independentes mais importantes, com risco de obito aumentado para mulheres com tamanho do tumor maior que 2,0cm (HR = 1,97; IC95%: 1,26-3,07) e com metastase para gânglios axilares (HR = 4,04; IC95%: 2,55-6,39). Tais achados enfatizam a importância do diagnostico e tratamento precoces. O acesso as acoes de rastreamento nos diversos niveis de assistencia, especialmente para o grupo considerado como de maior risco, deve ser uma prioridade para os gestores de saude no pais.

Cervical cancer mortality trends in Minas Gerais State, Brazil, 1980-2005.

This study evaluated the cervical cancer mortality trend from 1980 to 2005 in the State of Minas Gerais, Brazil. The demographic and mortality data available on the website of the Statistics Department of the Unified National Health System (DATASUS) were used to estimate the mortality rate for uterine cervical cancer and unspecified uterine cancer for the State during the period. Linear regression was performed, with mortality rate as the response variable and year of diagnosis as the explanatory variable. Mortality varied from 9.18/100,000 in 1980 to 5.70/100,000 in 2005. The log-linear model showed a 1.93% annual reduction in mortality due to cervical cancer for the State during the study period (p = 0.000), and this drop was observed mainly in cases classified as unspecified uterine cancer. The downward mortality trend observed for this disease suggests improved access to timely and adequate diagnosis and treatment in Minas Gerais in recent years, although coverage of screening is still unsatisfactory.

[Non-metastatic breast cancer specific-survival of patients after treatment with adjuvant chemotherapy].

OBJECTIVE Analyze the 5-year breast cancer specific-survival rate of women diagnosed with invasive non-metastatic disease, who as part of their primary treatment underwent surgery followed by adjuvant chemotherapy. METHODS Four hundred twenty eight patients diagnosed between 1998 and 2000 were recruited from all oncology services of the municipality of Juiz de Fora, MG, Brasil. Survival time was counted from the date of the histopathological diagnosis and the date of death due to breast cancer was considered the adverse event. Women alive until December 2005, the final date of the follow-up, were censored. For those who interrupt treatment, censor date was the last follow-up in the medical records. Kaplan-Meier survival curves were estimated, with the differences assessed by the log-rank test. RESULTS Mean age was 51.2 years, and most (72.6%) were Caucasian. Clinical Stages II (47.4%) and III (38.6%) predominated. Breast cancer specific five-year survival rate was 82.0%. A worst survival was observed among women with disease diagnostic before menopause (p=0.02), with tumor size greater than 2.0 cm (p=0.05), with lymph node involvement (p=0,000), in a more advanced disease stage (p=0.000), on a full adjuvant chemotherapy regimen (p=0.03), and who used hormone therapy (p=0.05). CONCLUSION This research allowed identification of the profile and disease survival of breast cancer patients who used adjuvant chemotherapy. These results stimulated the adoption of intensive strategies by the local health authorities for disease control and prevention in this population, emphasizing the increasing need of breast cancer screening, mainly for women considered as of high risk and the availability of timely treatment for all cases diagnosed.

Perfil imuno-histoquímico e variáveis clinicopatológicas no câncer de mama

OBJECTIVE: To describe the main characteristics of women with breast cancer, according to the immunohistochemical profile. METHODS: The population comprised a hospital cohort, consisting of women diagnosed with breast cancer between 2003 and 2005 (n = 601) and treated at a referral center for cancer care in Juiz de Fora, MG, Brazil. Only 397 women who had complete immunohistochemistry analysis were selected. To define the groups according to the immunohistochemical profile, the assessment of estrogen and progesterone receptors, Ki-67 cell proliferation index, and overexpression of human epidermal growth factor receptor 2 (HER2) was chosen. According to the different phenotypes, five subtypes were defined: luminal A, luminal B HER2 negative, luminal B HER2 positive, triple negative, and HER2 overexpression. RESULTS: Most patients were white (80.7%) and post-menopausal (64.9%), with a mean age of 57.4 years (± 13.5). At diagnosis, 57.5% had tumor size > 2.0 cm, and 41.7% had lymph node involvement. The most common subtypes were luminal B - HER2 negative (41.8%) and triple negative (24.2%). In the luminal A subtype, 72.1% of patients were post-menopausal, while the highest percentage of premenopausal women were observed in the luminal B - HER2 positive and triple negative subtypes (45.2% and 44.2%, respectively). A higher frequency of tumors > 2.0 cm and lymph node involvement was observed in triple negative and HER2 positive subtypes. CONCLUSION: This study allowed the distribution assessment of the main clinical and pathological characteristics and those related to health services in a cohort of Brazilian women with breast cancer, according to the immunohistochemical tumor subtypes.

Cause-specific mortality for 249 causes in Brazil and states during 1990–2015: a systematic analysis for the global burden of disease study 2015

BackgroundReliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015.MethodsWe describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states.ResultsThere was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI.ConclusionsA widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly.

Immunohistochemical profile and clinical-pathological variables in breast cancer

OBJECTIVE To describe the main characteristics of women with breast cancer, according to the immunohistochemical profile. METHODS The population comprised a hospital cohort, consisting of women diagnosed with breast cancer between 2003 and 2005 (n = 601) and treated at a referral center for cancer care in Juiz de Fora, MG, Brazil. Only 397 women who had complete immunohistochemistry analysis were selected. To define the groups according to the immunohistochemical profile, the assessment of estrogen and progesterone receptors, Ki-67 cell proliferation index, and overexpression of human epidermal growth factor receptor 2 (HER2) was chosen. According to the different phenotypes, five subtypes were defined: luminal A, luminal B HER2 negative, luminal B HER2 positive, triple negative, and HER2 overexpression. RESULTS Most patients were white (80.7%) and post-menopausal (64.9%), with a mean age of 57.4 years (± 13.5). At diagnosis, 57.5% had tumor size > 2.0 cm, and 41.7% had lymph node involvement. The most common subtypes were luminal B - HER2 negative (41.8%) and triple negative (24.2%). In the luminal A subtype, 72.1% of patients were post-menopausal, while the highest percentage of premenopausal women were observed in the luminal B - HER2 positive and triple negative subtypes (45.2% and 44.2%, respectively). A higher frequency of tumors > 2.0 cm and lymph node involvement was observed in triple negative and HER2 positive subtypes. CONCLUSION This study allowed the distribution assessment of the main clinical and pathological characteristics and those related to health services in a cohort of Brazilian women with breast cancer, according to the immunohistochemical tumor subtypes.

Sobrevida por câncer de mama e iniquidade em saúde

O câncer de mama e a neoplasia mais frequente em mulheres e alguns estudos mostram desigualdades sociais na sua incidencia e sobrevida, o que e pouco estudado no Brasil. Para avaliar a iniquidade no seu prognostico, foi feito estudo de coorte hospitalar. O seguimento foi realizado por busca ativa nos registros medicos e Sistema de Informacao sobre Mortalidade, contato telefonico e consulta de situacao cadastral no Cadastro de Pessoas Fisicas. As funcoes de sobrevida foram estimadas pelo metodo de Kaplan-Meier e o modelo de riscos proporcionais de Cox foi utilizado para avaliacao prognostica. Foi estimada uma sobrevida especifica pela doenca de 76,3% (IC95%: 71,9-81,0) em 5 anos. As mulheres atendidas no servico publico tiveram pior prognostico (HR = 1,79; IC95%: 1,09-2,94), e tal efeito foi mediado, sobretudo, pelo estadiamento da doenca mais avancado no momento do diagnostico. Tais achados apontam para a existencia de desigualdades de acesso a acoes de rastreamento, com as mulheres de menor posicao socioeconomica tendo diagnostico mais tardio e consequentemente pior prognostico.Breast cancer is the most frequent neoplasm in women, and some studies have shown social inequalities in incidence and survival, which are poorly investigated in Brazil. To assess iniquity in prognosis, a hospital-based cohort study was carried out. Follow-up was made by active search in medical records and in the Mortality Information System, phone calls, and consultation on Individual Tax-Collection Record status. Survival functions were estimated by the Kaplan-Meier method, and the Cox proportional hazards model was employed for prognostic assessment. Disease-specific survival was estimated at 76.3% (95%CI: 71.9-81.0) in 5 years. Women seen at public facilities had worse prognosis (HR = 1.79; 95%CI: 1.09-2.94), which was particularly due to the disease being diagnosed at a more advanced stage. These findings point to inequalities of access to screening actions, as women of lower social conditions with later diagnostic and therefore with worse prognostic.

Hemophilia A in Brazil – epidemiology and treatment developments

Hemophilia A is an inherited disorder characterized by deficiency of coagulation factor VIII, which predisposes patients to bleeding events. Treatment is based on replacement of the deficient factor, in a therapeutic or prophylactic manner. Brazil is the country with the third largest population of people with hemophilia, for which the public health system provides free comprehensive care. Maintaining an updated registry of patients, documenting the prevalence of complications, and assessing the effectiveness of resource use are indispensable elements in the design of a well-coordinated national program. According to sociodemographic, clinical, and laboratory data collected by the computerized Brazilian system on coagulopathies, in June 2013, there were 9,122 registered patients with hemophilia A in Brazil, of which 36.1% had a severe form of the disease. Clotting factor inhibitors were present in 7.5%, but 25.7% of records did not provide this type of data. Around 70% of the patients belonged to the economically active population, being between 15 and 59 years old. Infection by the human immunodeficiency virus was present in 23.4% of the patients tested and infection by hepatitis C virus antibodies in 59.3%. Infection by the hepatitis B virus and human T-lymphotropic virus was also reported. The high percentage of incomplete records regarding serological data shows the fragility of the information system to date. There was also no information available on the prevalence of permanent or disabling joint damage. Although few hemophiliacs receive adequate care in developing countries, and despite Brazil exhibiting great social inequalities, the Ministry of Health has made significant advances in the treatment of hemophilia A. The gradual increase in importation of factor VIII concentrate enabled the implementation of primary and secondary modalities of prophylaxis, in addition to the induction of immune tolerance. There are also plans to set up a factory in the country, to ensure Brazilian self-sufficiency in the production of blood products.

Mortality due to cancer of the uterine cervix in the state of Minas Gerais, Brazil, 1980-2005: period and cohort analysis

This study identifies the period and cohort effects on the decreasing mortality trend of cancer of the uterine cervix and of the uterus, part unspecified, in the state of Minas Gerais, Brazil, during the period 1980-2005. 11,243 cases were included. A non-parametric method was used to calculate Z statistics and p-values. The cohorts were assessed one by one and also in blocks of three, so as to allow for a larger number of comparisons to be made. Greater than expected mortality reduction was observed for the cohort blocks of women born in 1913-1920; 1927-1936; 1937-1946; 1949-1956; 1963-1970; and 1969-1976. For the 1901-1908 and 1921-1928 cohort blocks a smaller than expected mortality decrease was found. As for period effect, we found a greater than expected reduction for the 2000-2001 period, in comparison with the previous one. The study suggests the existence of a significant cohort effect on mortality due to cancer of the uterine cervix in the study population, and such results have been placed in their social and political contexts.