Breast Cancer Mortality In Brazil: Correlation With Human Development Index

Background: Mortality from breast cancer decreased in high-income countries, while countries with middle and low incomes as Brazil still has upward trend. However, large geographical variations among the federal units are observed in the country. The aim of the study was to evaluate the trend of specific mortality from breast cancer in women over 20 years old years among different states of Brazil from 1996 to 2012.  Methods and Findings: Ecological study, using linear regression model for temporal analysis of specific mortality coefficient from malignant neoplasm of breast. We also checked the degree of its correlation with the HDI for the states of Brazil during the stated period. There was an increase in the specific mortality rate for malignant neoplasm of the breast in order of 33%, with range from 23.2 to 30.8 / 100,000 inhabitants. The states with the highest human development HDI in 2010, showed the largest specific mortality rates of breast cancer. Conclusion: Taking the trends of mortality from cancer an important role, this study confirms the need for improvements in mammography coverage, following radiological lesions suspected and access to appropriate therapy. &nbsp

Workplace Accident and Systemic Arterial Hypertension in Tobacco Farmers in São Lourenço do Sul, RS

It is little known about workplace injuries and systemic arterial hypertension (SAH) in Brazilian rural areas. The present study is part of the second stage of a major project and aimed to determine the prevalence workplace injuries and SAH and its associated factors with emphasis on the work process, especially exposure to pesticides among tobacco growers in the city of São Lourenço do Sul, RS, Brazil. A cross-sectional study was conducted in October 2010, with 492 tobacco workers who reported having applied pesticides in the year prior to the survey and worked 15 or more hours per week in tobacco farming. The interview addressed socioeconomic, demographic, behavioral variables, and broad characterization of the work process, use of pesticides and health problems. Identification cards of pesticides were used in order to facilitate the recall of the pesticides applied in the crop. The outcome characterization, the occurrence of lifetime workplace injury was referred by the interviewed and the type of injury and resulting limitations were characterized for the most serious accident. It was considered hypertensive individuals with diagnosis medical of hypertension. For the diagnosis of hypertension, a previous diagnosis of hypertension, use of antihypertensive medication, and antihypertensive medication use, physical examination, and blood pressure SBP>=140 and DBP>=90 mmHg were considered. The cumulative score of pesticides exposure was defined based on the methodology study proposed by Dosemeci et al. (2002), and the application, preparation of pesticide mixtures, equipment cleaning, transportation of pesticides, access the crop after application, washing clothes used in the application, use of personal protective equipment and time of exposure to pesticides were considered. The injury prevalence was 24,6% among the 488 individuals over 18 years old. Being male (PR 1.62; 95%CI 1.04-2.52), and tenant tobacco farmer (PR 1.87; 95%CI 1.29- 2.72), bundling tobacco leaves (PR 2.00; 95%CI 1.14-3.52) and having minor psychiatric disorders (PR 1.58; 95%CI 1.06-2.35) were positively associated with accidents. Among the injuries considered more severe, 46% were superficial lesions and 26% resulted in fractures. Among injured subjects, 12% had loss movement of one limb, 7.6% suffered amputation and 3.8% had loss of vision. The SAH prevalence was 18.5% among 482 individuals over 20 years-old. 52.5% of respondents were up to 39 years old, 10% were black, and 87% had less than eight years of education. The individuals over 40 years of age was 4.8 times more likely to be hypertensive (95% CI 1.88-12.28), compared to individuals with up to 29 years old. The black individuals have 2.4 fold of risk for SAH (IC95%1,29-4,45). The risk of presenting hypertension among those who washed the clothes worn during application were 53% (95%CI1.07-2.17), and among the ones who had medical diagnostic of acute pesticide poisoning were 62% (95%IC1.05-2.50). Overweight/ obesity conferred 1.88 fold of risk for SAH (95% CI 1.23- 2.89). There was no association of gender, alcohol consumption, smoking and physical exertion at work with SAH. The cumulative score of pesticide exposure presented a direct association with SAH among individuals under 40 years old. However, among individuals over 40 years no trend was observed. In conclusion, the high prevalence of workplace injury and SAH found, indicates the need of injury prevention policies, investment in the plantation mechanization and education about pesticides hazards, and appropriate use of personal protective equipment. Else than the known risk factors for SAH, such as age and obesity, occupational exposure to pesticides may be contributing to the early development of SAH in the rural areas. The systematic review addressed the chronic exposure to pesticides and cardiovascular disease association. Twenty-five articles were selected and positive association was found with same pesticides of organophosphorus insecticide class, chlorpyrifos and coumaphos, herbicides, fungicides, organophosphates, and carbamate with acute myocardial infarction. Diazinon, malathion, parathion, and chlorpyrifos were associated with SAH in pregnancy. Pyrethroid was associated with blood pressure increase. Environmental contamination with organochlorine pesticides and pesticides containing arsenic were associated with peripheral arterial diseases, and cardiovascular mortality. These findings point chronic effects caused by pesticides in the cardiovascular system and suggest the importance of greater rigor in global public policies on the control of pesticides use.Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPqFundação de Amparo à Pesquisa do Estado do Rio Grande do Sul - FAPERGSPouco se conhece sobre o acidente de trabalho e a hipertensão arterial sistêmica (HAS) em área rural brasileira. O presente estudo faz parte da segunda etapa de projeto maior, e objetivou determinar a prevalência e fatores associados aos acidentes de trabalho e da HAS com ênfase no processo de trabalho, principalmente à exposição aos agrotóxicos entre fumicultores no município de São Lourenço do Sul, RS. Estudo transversal foi conduzido em outubro de 2010, com 492 fumicultores que relataram ter aplicado agrotóxico no ano anterior à pesquisa e trabalharam 15 ou mais horas semanais na fumicultura. A entrevista abordou variáveis socioeconômicas, demográficas, comportamentais, e ampla caracterização do processo de trabalho, uso de agrotóxicos e de problemas de saúde. Foram utilizadas cartelas de identificação dos agrotóxicos com objetivo de facilitar o recordatório dos fumicultores em relação aos agrotóxicos aplicados na lavoura. Para o estudo de acidentes de trabalho, considerou-se a ocorrência de acidente de trabalho na vida referida pelo entrevistado, o tipo de lesão e limitações decorrentes, caracterizando para o acidente de maior gravidade. Para o estudo de HAS, o diagnóstico de foi feito por médicos treinados para o estudo, considerando o diagnostico prévio de HAS, uso de medicação anti-hipertensiva e a medida de pressão arterial (PAS>=140 e/ou PAD>=90 mmHg. Foi construído o escore acumulado de exposição aos agrotóxicos baseado no estudo de Dosemeci e cols. (2002) e considerouse a forma de aplicação, preparo da calda, limpeza dos equipamentos, transporte dos agrotóxicos, acesso a lavoura após aplicação, lavagem das roupas utilizadas na aplicação, uso de equipamento de proteção individual e tempo de exposição aos agrotóxicos. Foi utilizado a regressão de Poisson seguindo um modelo hierárquico. A prevalência de acidentes de trabalho na vida foi de 24% entre 488 indivíduos acima de 18 anos. Foi encontrada associação positiva com o sexo masculino (RP1,62IC-95%1,04- 2,52), ser arrendatário (RP1,87IC-95%1,29-2,72), realização de manocas (RP2,00IC- 95%1,14-3,52) e problemas psiquiátricos menores (RP1,58IC-95%1,06-2,35). Dentre os acidentes que a pessoa considerou o mais grave, 46% foram superficiais e 26% resultaram em fraturas. Entre os acidentados, 12% apresentaram perda de movimento de algum membro, 7,6% sofreram amputação e 3,8% tiveram perda de visão. A prevalência de HAS foi de 18,5% em 482 indivíduos com idade superior a 20 anos. 52.5% dos entrevistados tinham menos de 39 anos, 10% eram negros e 87% tinham menos de 8 anos de estudo. O risco dos indivíduos acima de 40 anos foi 4.8 vezes maior de serem hipertensos (IC95%1,88-12,28), comparados aos indivíduos com até 29 anos. A cor negra conferiu risco de 2,4 (IC95%1,30-4,46). O risco de apresentar HAS entre os que lavavam as roupas utilizadas durante a aplicação de agrotóxicos foi 53% (IC95%1,07-2,17) e entre os que apresentaram diagnóstico médico de intoxicação aguda por agrotóxicos foi de 62% (IC95% 1,05-2,50). O sobrepeso/obesidade conferiu risco de 1.89 para HAS (IC95%1,23-2,89). Não foi encontrada associação entre sexo, consumo de risco de bebida alcoólica, tabagismo e esforço físico durante o trabalho com a HAS. O escore acumulado de exposição aos agrotóxicos apresentou associação positiva com HAS entre os indivíduos abaixo de 40 anos de idade. Entre os indivíduos acima de 40 anos esta tendência não foi observada. Pode-se concluir que a alta prevalência de acidentes e de HAS encontrada, indica que são necessárias políticas de prevenção de acidentes, investimento na mecanização da cultura e educação sobre riscos do uso de agrotóxicos e no uso apropriado de equipamento de proteção individual. Observa-se que, além dos fatores de risco conhecidos para HAS, como idade e obesidade, a exposição ocupacional aos agrotóxicos pode estar contribuindo para o desenvolvimento precoce da HAS no meio rural. O foco da revisão sistemática foi a associação entre exposição crônica aos agrotóxicos e o desenvolvimento das doenças cardiovasculares (DVC). Foram selecionados 25 artigos e encontrou-se associação positiva entre alguns agrotóxicos da classe dos organofosforados, Clorpirifós e Coumafós, herbicidas, fungicidas, organofosfatos e carbamatos com o infarto agudo do miocárdio. Diazinon, matalhion parathion e clorpirifós estiveram associados com hipertensão gestacional; e os piretróides com o aumento da pressão arterial. A exposição aos poluentes orgânicos persistentes foi associada a doença arterial periférica e risco de mortalidade cardiovascular. Estes achados apontam para risco de DCV entre os expostos cronicamente aos agrotóxicos, sugerindo a necessidade de maior controle ao uso destes químicos

Prevalence and risk factors for chronic hepatitis B in HIV patients attended at a sexually-transmitted disease clinic in Vitoria, Brazil

This study assessed the prevalence of and correlated factors for chronic hepatitis B infection (HBV) among HIV patients attending the Reference Center for Sexually Transmitted Infections (STI) and AIDS in Vitória, ES, Brazil. HIV patients were studied from 1993 to 2004, using information recorded in a database of the STI Clinic. Demographic data, clinical characteristics, patterns of risk behavior and test results (ELISA-HIV, IFA-HIV, HBsAg, viral load and CD4 counts) were analyzed. We analyzed 851 HIV patients. Median age was 35.0 (interquartile range 30; 42) years and median years of education was 8.0 (IQR 5; 11). The prevalence of chronic HBV was 3.8% (95% CI 2.5-5.1). Illicit drug use was reported in 185 (21.7%) cases, alcohol abuse in 80 (9.4%) cases, men who have sex with men in 116 (13.6%) cases, and past STI in 320 (37.6%) cases. Chronic HBV was associated with intravenous drug use, male gender, STI associated with HIV diagnosis, and death. There is a need for prevention and assistance strategies to control the evolution of this infection in HIV patients