Fatores associados ao rastreamento inadequado do câncer cervical em duas capitais brasileiras

OBJECTIVE:To analyze factors associated with cervical cancer screening failure. METHODS:Population-based cross-sectional study with self-weighted two-stage cluster sampling conducted in the cities of Fortaleza (Northeastern Brazil) and Rio de Janeiro (Southeastern Brazil) in 2002. Subjects were women aged 25-59 years in the last three years prior to the study. Data were analyzed through Poisson regression using a hierarchical model. RESULTS: The proportion of women who did not undergo the Pap smear test in Fortaleza and Rio de Janeiro was 19.1% (95% CI: 16.1;22.1) and 16.5% (95% CI: 14.1;18.9), respectively. Higher prevalence ratios of cervical cancer screening failure in both cities were seen among women with low education and low per capita income, old age, unmarried, who never underwent mammography, clinical breast examination, and blood glucose and cholesterol level testing. Smokers also had lower screening rates compared to non-smoker women and this difference was only statistically significant in Rio de Janeiro. CONCLUSIONS:The study findings point to the need of intervention focusing particularly women in worse socioeconomic conditions and access to healthcare, old-aged and unmarried. Education activities must prioritize screening of asymptomatic women and early diagnosis for symptomatic women and access to adequate diagnostic methods and treatment should be provided.OBJETIVO:Analizar factores asociados a la no realización del examen de Papanicolaou. MÉTODOS: Estudio transversal, de base poblacional, con muestreo por conglomerado con dos fases de selección y autoponderación en 2002. Las participantes fueron mujeres de 25 a 59 años de edad en los tres años anteriores a la investigación, en los municipios de Fortaleza y Río de Janeiro (Noreste y Sureste de Brasil). Los datos fueron analizados por regresión de Poisson por medio de modelo jerárquico. RESULTADOS:El porcentaje de mujeres no sometidas al examen de Papanicolaou fue de 19,1% (IC 95%: 16,1;22,1) en Fortaleza y 16,5% (IC 95%: 14,1;18,9) en Río de Janeiro. Las mayores razones de prevalencia para la no realización del examen en las dos localidades fueron entre mujeres con baja escolaridad, de menor renta per capita, con edad más avanzada, no casadas y que nunca fueron sometidas a la mamografía, al examen clínico de las mamas y a los exámenes de glicemia y colesterolemia. Así mismo, las fumadoras fueron menos sometidas al examen de Papanicolaou cuando se compararon con las demás mujeres, siendo la diferencia estadísticamente significativa solamente en Río de Janeiro. CONCLUSIONES: Los resultados apuntan la necesidad de intervención principalmente en mujeres de peores condiciones socioeconómicas y de acceso a la salud, con edades más avanzadas y no casadas. Las actividades de educación para el diagnóstico precoz y para el rastreo en mujeres sintomáticas y asintomáticas deben ser priorizadas con garantía de acceso a los métodos de diagnóstico y tratamiento adecuados.OBJETIVO: Analisar fatores associados à não-realização do exame de Papanicolaou. MÉTODOS:Estudo transversal, de base populacional, com amostragem por conglomerados com dois estágios de seleção e autoponderada em 2002. As participantes foram mulheres de 25 a 59 anos de idade nos três anos anteriores à pesquisa, nos municípios de Fortaleza (CE) e Rio de Janeiro (RJ). Os dados foram analisados por regressão de Poisson por meio de modelo hierárquico. RESULTADOS: O percentual de mulheres não submetidas ao exame de Papanicolaou foi de 19,1% (IC 95%: 16,1;22,1) em Fortaleza e 16,5% (IC 95%: 14,1;18,9) no Rio de Janeiro. As maiores razões de prevalência para a não-realização do exame nas duas localidades foram entre mulheres com baixa escolaridade, de menor renda per capita, com idade mais avançada, não-casadas e que nunca foram submetidas à mamografia, ao exame clínico das mamas e aos exames de glicemia e colesterolemia. Além disso, as fumantes foram menos submetidas ao exame de Papanicolaou quando comparadas às demais mulheres, sendo a diferença estatisticamente significativa somente no Rio de Janeiro. CONCLUSÕES: Os achados apontam a necessidade de intervenção principalmente em mulheres de piores condições socioeconômicas e de acesso à saúde, com idade mais avançada e não-casadas. As atividades de educação para o diagnóstico precoce e para o rastreamento em mulheres sintomáticas e assintomáticas devem ser priorizadas com garantia de acesso aos métodos de diagnóstico e tratamento adequados

The economic impact of cancer mortality among working-age individuals in Brazil from 2001 to 2030

Background: About half of cancer deaths in Brazil occur among individuals of working-age (under 65 years for men, under 60 for women), resulting in a substantial economic impact for the country. We aimed to estimate the years of potential productive life lost (YPPLL) and value the productivity lost due to premature deaths from cancer between 2001 and 2015 and the projected to 2030. Methods: We used the Human Capital Approach to estimate the productivity losses corresponding to YPPLL for cancer deaths in working age people (15–64 years). Mortality data were obtained from the Mortality Information System from 2001 to 2015 and projected between 2016 and 2030. Economic data were obtained from the Continuous National Household Sample Survey and forecasted to 2030. Productivity lost was calculated as the monetary value arising from YPPLL in Int$(2016). Results: Between 2001 and 2030, a total of 2.3 million premature deaths from all cancers combined were observed and forecasted in Brazil (57$141.3 billion in productivity losses (men: Int$102.5 billion, women: Int$38.8 billion). Between 2001 and 2030, among men, lung (Int$12.6 billion), stomach (Int$ 10.6 billion) and colorectal (Int$9.4 billion) cancers were expected to contribute to the greatest productivity losses; and among women, it will be for breast (Int$ 10.0 billion), cervical (Int$6.4 billion) and colorectal (Int$ 3.2 billion) cancers. Conclusions: Many preventable cancers result in high lost productivity, suggesting measure to reduce smoking prevalence, alcohol consumption, physical inactivity and inadequate diet, improving screening programs and increasing vaccination coverage for human papillomavirus and hepatitis B would have a positive impact on the economy, as well as reducing morbidity and mortality from cancer.Peer reviewe

Perspectivas atuais sobre o uso de psilocibina no manejo da depressão resistente: revisão sistemática

A depressão resistente ao tratamento é um desafio global, impactando negativamente a qualidade de vida dos pacientes. Nesse contexto, a psilocibina, um composto psicodélico presente em certos cogumelos, desperta interesse como possível intervenção terapêutica. Seu potencial para influenciar positivamente o humor e a cognição, através da ativação dos receptores de serotonina no cérebro, sugere uma nova abordagem no tratamento da depressão resistente. Este estudo busca analisar as perspectivas atuais sobre o uso da psilocibina nesse contexto, destacando a necessidade de mais pesquisas sobre seus efeitos e segurança para sua integração clínica. Este estudo, baseado em uma revisão sistemática da literatura científica, abrange o período de 2016 a 2024, utilizando as bases de dados PubMed (Medline), Cochrane Library e Scientific Electronic Library Online (SciELO). No primeiro estudo, os efeitos agudos da psilocibina foram detectáveis de 30 a 60 minutos após a administração, atingindo o pico em 2 a 3 horas e diminuindo após pelo menos 6 horas. A substância foi bem tolerada, com eventos adversos leves e transitórios. Houve uma redução significativa nos sintomas depressivos, ansiedade e anedonia após o tratamento com doses altas. O segundo estudo envolveu 233 participantes distribuídos em grupos de doses diferentes. Houve uma redução significativa nos sintomas depressivos após o tratamento, com doses mais altas apresentando uma diferença estatisticamente maior em comparação com a dose mais baixa e o grupo de controle. Eventos adversos, como dor de cabeça e náusea, foram comuns entre os participantes. O terceiro estudo abordou as perspectivas futuras para o tratamento com psilocibina para depressão resistente. Recomendações incluíram equilibrar o tempo dos pacientes e terapeutas, aumentar gradualmente a intensidade das sessões e integrar a terapia sustentada ao tratamento. O envolvimento de pacientes experientes e estudos naturalísticos adicionais foi destacado como importante para abordagens mais personalizadas. Em resumo, a psilocibina mostra potencial como tratamento para a depressão resistente, com redução significativa dos sintomas depressivos e boa tolerabilidade. No entanto, são necessárias mais pesquisas para confirmar sua eficácia e segurança, destacando a importância de estudos adicionais e ensaios clínicos controlados

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Spatial distribution of advanced stage diagnosis and mortality of breast cancer: Socioeconomic and health service offer inequalities in Brazil.

Breast cancer presents high incidence and mortality rates, being considered an important public health issue. Analyze the spatial distribution pattern of late stage diagnosis and mortality for breast cancer and its correlation with socioeconomic and health service offer-related population indicators. Ecological study, developed with 161 Intermediate Region of Urban Articulation (IRUA). Mortality data were collected from the Mortality Information System (MIS). Tumor staging data were extracted from the Hospital Cancer Registry (HCR). Socioeconomic variables were obtained from the Atlas of Human Development in Brazil; data on medical density and health services were collected from the National Registry of Health Institutions (NRHI) and Supplementary National Health Agency. Global Moran's Index and Local Indicator of Spatial Association (LISA) were utilized to verify the existence of territorial clusters. Multivariate analysis used models with global spatial effects. The proportion of late stage diagnosis of breast cancer was 39.7% (IC 39.4-40.0). The mean mortality rate for breast cancer, adjusted by the standard world population was 10.65 per 100,000 women (± 3.12). The proportion of late stage diagnosis presented positive spatial correlation with Gini's Index (p = 0.001) and negative with the density of gynecologist doctors (p = 0.009). The adjusted mortality rates presented a positive spatial correlation with the Human Development Index (p<0.001) and density of gynecologist doctors (p<0.001). Socioeconomic and health service offer-related inequalities of the Brazilian territory are determinants of the spatial pattern of breast cancer morbimortality in Brazil

Factors related to inadequate cervical cancer screening in two Brazilian state capitals Factores asociados al rastreo inadecuado del cáncer cervical en dos capitales brasileras Fatores associados ao rastreamento inadequado do câncer cervical em duas capitais brasileiras

OBJECTIVE:To analyze factors associated with cervical cancer screening failure. METHODS:Population-based cross-sectional study with self-weighted two-stage cluster sampling conducted in the cities of Fortaleza (Northeastern Brazil) and Rio de Janeiro (Southeastern Brazil) in 2002. Subjects were women aged 25-59 years in the last three years prior to the study. Data were analyzed through Poisson regression using a hierarchical model. RESULTS: The proportion of women who did not undergo the Pap smear test in Fortaleza and Rio de Janeiro was 19.1% (95% CI: 16.1;22.1) and 16.5% (95% CI: 14.1;18.9), respectively. Higher prevalence ratios of cervical cancer screening failure in both cities were seen among women with low education and low per capita income, old age, unmarried, who never underwent mammography, clinical breast examination, and blood glucose and cholesterol level testing. Smokers also had lower screening rates compared to non-smoker women and this difference was only statistically significant in Rio de Janeiro. CONCLUSIONS:The study findings point to the need of intervention focusing particularly women in worse socioeconomic conditions and access to healthcare, old-aged and unmarried. Education activities must prioritize screening of asymptomatic women and early diagnosis for symptomatic women and access to adequate diagnostic methods and treatment should be provided.<br>OBJETIVO:Analizar factores asociados a la no realización del examen de Papanicolaou. MÉTODOS: Estudio transversal, de base poblacional, con muestreo por conglomerado con dos fases de selección y autoponderación en 2002. Las participantes fueron mujeres de 25 a 59 años de edad en los tres años anteriores a la investigación, en los municipios de Fortaleza y Río de Janeiro (Noreste y Sureste de Brasil). Los datos fueron analizados por regresión de Poisson por medio de modelo jerárquico. RESULTADOS:El porcentaje de mujeres no sometidas al examen de Papanicolaou fue de 19,1% (IC 95%: 16,1;22,1) en Fortaleza y 16,5% (IC 95%: 14,1;18,9) en Río de Janeiro. Las mayores razones de prevalencia para la no realización del examen en las dos localidades fueron entre mujeres con baja escolaridad, de menor renta per capita, con edad más avanzada, no casadas y que nunca fueron sometidas a la mamografía, al examen clínico de las mamas y a los exámenes de glicemia y colesterolemia. Así mismo, las fumadoras fueron menos sometidas al examen de Papanicolaou cuando se compararon con las demás mujeres, siendo la diferencia estadísticamente significativa solamente en Río de Janeiro. CONCLUSIONES: Los resultados apuntan la necesidad de intervención principalmente en mujeres de peores condiciones socioeconómicas y de acceso a la salud, con edades más avanzadas y no casadas. Las actividades de educación para el diagnóstico precoz y para el rastreo en mujeres sintomáticas y asintomáticas deben ser priorizadas con garantía de acceso a los métodos de diagnóstico y tratamiento adecuados.<br>OBJETIVO: Analisar fatores associados à não-realização do exame de Papanicolaou. MÉTODOS:Estudo transversal, de base populacional, com amostragem por conglomerados com dois estágios de seleção e autoponderada em 2002. As participantes foram mulheres de 25 a 59 anos de idade nos três anos anteriores à pesquisa, nos municípios de Fortaleza (CE) e Rio de Janeiro (RJ). Os dados foram analisados por regressão de Poisson por meio de modelo hierárquico. RESULTADOS: O percentual de mulheres não submetidas ao exame de Papanicolaou foi de 19,1% (IC 95%: 16,1;22,1) em Fortaleza e 16,5% (IC 95%: 14,1;18,9) no Rio de Janeiro. As maiores razões de prevalência para a não-realização do exame nas duas localidades foram entre mulheres com baixa escolaridade, de menor renda per capita, com idade mais avançada, não-casadas e que nunca foram submetidas à mamografia, ao exame clínico das mamas e aos exames de glicemia e colesterolemia. Além disso, as fumantes foram menos submetidas ao exame de Papanicolaou quando comparadas às demais mulheres, sendo a diferença estatisticamente significativa somente no Rio de Janeiro. CONCLUSÕES: Os achados apontam a necessidade de intervenção principalmente em mulheres de piores condições socioeconômicas e de acesso à saúde, com idade mais avançada e não-casadas. As atividades de educação para o diagnóstico precoce e para o rastreamento em mulheres sintomáticas e assintomáticas devem ser priorizadas com garantia de acesso aos métodos de diagnóstico e tratamento adequados