Raphael Mendonça Guimarães

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

AIMnTo 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.nnnMETHODSnAn 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.nnnRESULTSnProgressive 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.nnnCONCLUSIONnRegional 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.

Trends in mortality due to myeloid leukemia in regions of Brazil and the country as a whole between 1980 and 2012

Letter to the Editor Trends in mortality due to myeloid leukemia in regions of Brazil and the country as a whole between 1980 and 2012 Dear Editor, We read with great interest the article entitled Trends in mortality of adult patients diagnosed with myeloid leukemia from 1994 to 2011 in southeastern Brazil by Callera et al. published in the Revista Brasileira de Hematologia e Hemoterapia (2015;37(1):7–11), 1 and we would like to make some comments. The subject of the article is very important for clinical oncology and cancer surveillance as it presents a time series analysis showing a declining trend in mortality from myeloid leukemia in one area of the richest region of Brazil. It is understood that this decline is a result of the improving quality of access to health services with early diagnosis of the disease and clinical management. However, Brazil is the size of a continental and, therefore, we believe it is important to observe the trend of mortality due to myeloid leukemia in other regions of Brazil and the country as a whole. In 2014, the Brazilian National Cancer Institute estimated the incidence of leukemia in Brazil to be around 5050 and 4320 new cases for men and women, respectively. Excluding non-melanoma skin tumors, leukemia is the fifth most common cancer in men in the Northern Region of the it is the eleventh most frequent. 2 This inconsistency has been observed worldwide. GLOBO-CAN estimates the global prevalence of leukemia to be 4.7/100,000 inhabitants. The same report shows, however, that there are differences in the rates when comparing medium (3.8/100,000) and under (2.5/100,000) developed countries. With regard to mortality, the global estimate is 3.4/100,000 inhabitants, 3.2/100,000 for medium and 2.4/100,000 for under development countries. 3 By using a methodology 4 similar to Callera et al., 1 we identified important differences in different Brazilian regions. Myeloid leukemia mortality rates between 1980 and 2012 are different when stratified by gender. The rates in men are which may point to important differences between the genders. In addition, the rates are consistently higher in the Southeast and South, regardless of gender, which shows regional differences in the impact of the disease (Figure 1). Regarding the trend, there is a difference related to gender and region. For males, there was a significant increase in the incidence rates in Brazil between 1980 and 2005. After 2005, there was a statistically non-significant …

Assessment of the quality of water for consumption by river-bank communities in areas exposed to urban and industrial pollutants in the municipalities of Abaetetuba and Barcarena in the state of Pará, Brazil

In spite of the great technological advances in processes for treatment of water for human consumption, water actually used for supply has become a major public health challenge. This study assesses the quality of the water consumed in two riverside communities in the Brazilian state of Pará, in an area exposed to domestic and industrial pollutants. Four campaigns of sampling were carried out in the two communities. The variables used for the calculation of the water quality index - Índice de Qualidade da Água, or IQA - were: pH, total solids, chloride, fluoride, hardness and N-Nitrate. The waters used for human consumption in the Maranhão Community, where there is no contamination by industrial pollutants, presented adequate samples, with improvement in the dry season; on the other hand the waters of the Vila do Conde, a location close to the industrial activity, had quality that was unacceptable for human consumption in both the seasonal periods. The principal parameters affected were pH and N-Nitrate, with values up to 25 times the reference level of the Brazilian legislation for water for human consumption. These results indicated greater anthropic interference in the vicinity of Vila do Conde, in Barcarena. It is concluded that this population is in need of clinical assessments by specialized professionals on the state of its health.

Deforestation and malaria incidence in the legal Amazon Region between 1996 and 2012

Malaria is a major public health problem, and Brazil is the largest contributor in America to the number of cases. In the country, the Amazon concentrates around 99.5% of the cases. This article aims to compare trends in deforestation rate and the parasite index of malaria in the Amazon region between 1996 and 2012. The annual crude rate of deforestation and the Annual Parasite Index (API) of malaria between 1996 and 2012 were estimated. The rate of deforestation has great variability among the states every year, and a similar situation is observed for malaria API over the studied period. There are important variations across the states within this period. The historical series of crude deforestation rate and malaria API have markedly similar trends; with a 1-2 years lag between them, suggesting that the occurrence of fluctuations in deforestation numbers impacts malaria numbers in a period immediately following. The mapping of deforested areas and the analysis of temporal series are therefore useful in the analysis of malaria.

Analysis of conditions sensitive to primary care in a successful experience of primary healthcare expansion in Brazil, 1998–2015

OBJECTIVEnTo analyze trends in expansion of coverage of the family health strategy and hospitalization for conditions sensitive to primary care (CSPC) in a successful experience of primary healthcare expansion in Brazil.nnnSTUDY DESIGNnEcological study with data from the Brazilian National Health Information System.nnnMETHODSnCSPC were analyzed between 1998 and 2015 in Rio de Janeiro, Brazil, by cause groups. Trends, variation, and correlation between indicators in the period were evaluated.nnnRESULTSnMost of the cause groups showed a reduction in hospitalization rate, particularly cardiovascular diseases and asthma, but an increase was seen for obstetric causes. The main causes of hospitalization were heart failure, cerebrovascular diseases, and bacterial pneumonia. The contribution of vaccine-preventable diseases, cardiovascular diseases, diabetes, nutritional deficiencies, and chronic lung diseases to the total number of hospitalizations was seen to decrease.nnnCONCLUSIONSnAnalysis demonstrates that the family health strategy, as access to the healthcare system, decreases the majority of CSPC hospitalization rates.

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.

Factors associated to the type of childbirth in public and private hospitals in Brazil

Objectives: to estimate the prevalence of cesarean sections and factors associated to the type of childbirth in Brazil. Methods: data on childbirths were collected in Brazil in 2014. Demographic characteristics, related to pregnancy and birth hospital regime (public or private) were evaluation. For each hypothesis raised, the variables were modeled by the binary logistic regression, which the outcome was considered in the type of childbirth. Results: the prevalence of the cesarean sections in Brazil in 2014 was 52.8%; that is 38.1% at public hospitals and 92.8% at private ones. The association between cesarean section and the legal regime at the hospital was highlighted in the logistic model which presented a positive association and interaction between age groups (OR = 23.26; 95% CI= 13.39 41.79 for women between 20 and 24 years old and OR = 51.04; 95% CI 31.06 84.23 for women aged 35 and over). Conclusions: the performance of childbirth in Brazil meets the routines and recommendations regarding womens health and humanized childbirth established by the Brazilian National Health System policies.

Equivalência conceitual de itens e semântica da versão brasileira do instrumento EORTC QLQ-ELD14 para avaliação de qualidade de vida em idosos com câncer

Objective: to describe the process of semantic equivalence, the first stage in the validation of the EORTC QLQ-ELD14 instrument for Brazilian Portuguese. Method: Direct and independent translations of the instrument into Portuguese were carried out and validated by a meeting of experts to generate a synthesis version. The version chosen was submitted to reverse translations into English, and the form was pre-tested with patients. At the conclusion of the process, a summary version was presented. The pre-test and the final version of the instrument were applied to a total of 28 patients at a high complexity oncology treatment center. Result: after completion of the first round of pretesting, some adjustments for the next phase of the study were necessary by the expert committee. Palavras-Chave: Idoso. Neoplasias. Qualidade de Vida. Comparação Transcultural. http://dx.doi.org/10.1590/1981-22562017020.160024

Quality index of the surface water of Amazonian rivers in industrial areas in Pará, Brazil

In this study was to evaluate the waters quality of the Murucupi River, located in urban agglomerate area and intense industrial activity in Barcarena City, Pará State. The Arapiranga River in Abaetetuba City was used as control area (Background), next to Barcarena. Was used the Water Quality Index (WQI) based on nine variables analized. Waters quality of the Arapiranga and Murucupi rivers were regular to good and bad to good, respectively. Anthropogenic influence on the Murucupi River was higher, mainly by the disposal of domestic effluents from the urban agglomerate and of the industrial waste tailing basins upstream of this river. Due to its less inhabited environment and further away from the area urban and industrial, the Arapiranga River was more preserved. Waters pollution of around these area is increasingly intense, and restricted its uses for various purposes.