Country-level correlates of cervical cancer mortality in Latin America and the Caribbean.

OBJECTIVE: To identify country-level correlates of geographical variations in cervical cancer (CC) mortality in Latin America and the Caribbean (LAC). MATERIALS AND METHODS: CC mortality rates for LAC countries (n=26) were examined in relation to country-specific socio-economic indicators (n=58) and Human Papilloma Virus (HPV) prevalence using linear regression models. RESULTS: High mortality at ages <5 years, low per capita total expenditure on health, and low proportion of the population with access to sanitation were identified as the best independent predictors of CC mortality (R² =77%). In the subset of countries (n=10) with HPV prevalence estimates, these socio-economic indicators together with high-risk HPV prevalence explained almost all the between-country variability in CC mortality (R² =98%). CONCLUSION: The findings suggest that continuing socioeconomic improvements in LAC countries will be associated with further reductions in CC mortality even in the absence of organised population-based screening and vaccination programmes

Country-level correlates of cervical cancer mortality in Latin America and the Caribbean Determinantes a nivel país de la mortalidad por cáncer cervicouterino en Latinoamérica y el Caribe

OBJECTIVE: To identify country-level correlates of geographical variations in cervical cancer (CC) mortality in Latin America and the Caribbean (LAC). MATERIALS AND METHODS: CC mortality rates for LAC countries (n=26) were examined in relation to country-specific socio-economic indicators (n=58) and Human Papilloma Virus (HPV) prevalence using linear regression models. RESULTS: High mortality at ages <5 years, low per capita total expenditure on health, and low proportion of the population with access to sanitation were identified as the best independent predictors of CC mortality (R² =77%). In the subset of countries (n=10) with HPV prevalence estimates, these socio-economic indicators together with high-risk HPV prevalence explained almost all the between-country variability in CC mortality (R² =98%). CONCLUSION: The findings suggest that continuing socioeconomic improvements in LAC countries will be associated with further reductions in CC mortality even in the absence of organised population-based screening and vaccination programmes.<br>OBJETIVO: Identificar variables a nivel de país que expliquen las variaciones geográficas en la mortalidad por cáncer cervicouterino (CaCu) en América Latina y el Caribe (AL). MATERIALES Y MÉTODOS: Se examinaron las tasas de mortalidad por CaCu de cada país (n=26) mediante modelos de regresión lineal en relación con indicadores socioeconómicos (n=58) y prevalencia del virus del papiloma humano (VPH). RESULTADOS: Alta mortalidad en menores de cinco años, bajo gasto total en salud per-cápita y baja proporción de población con acceso a saneamiento básico son los mejores predictores de mortalidad por CaCu (R² =77%). En los países (n=10) con estimaciones de prevalencia de VPH, estos indicadores socioeconómicos y la prevalencia de VPH de alto riesgo explicaron el 98% de la variabilidad de CaCu en AL. CONCLUSIÓN: Las mejoras en el nivel socioeconómico en AL están asociadas con reducciones en la mortalidad por CaCu, a pesar de la ausencia de programas organizados de tamizaje e inmunización contra VPH

Present situation of hepatitis B in Chile Situación actual de la hepatitis B en Chile

Background: Hepatitis B virus infection generates carriers and 8% will evolve to a chronic phase. Aim: To perform a compilation of studies on hepatitis B in Chile and other sources of information to estimate the impact of this disease in our country. Material and methods: Published and unpublished evidence about the infection, in the general population and risk groups in our country, was compiled and reviewed critically. Informal interviews to experts, revision of the mandatory notification book of the Ministry of Health and collection of data from laboratories that study hepatitis B virus, were also carried out. Results: The seroprevalence of chronic carriers in blood donors is nearly 0.3%. Among risk groups such as health care personnel, the figure is 0.7%, among homosexuals 29%, among HIV positive patients 30%, among sexual workers 2% and among children with chronic hemodialysis, 9%. Prevalence rate according to notified cases in 2004 was 1.8 x 100,000 habitants. Detection of vira

Early BMI Gain and Later Height Growth Predicts Higher DHEAS Concentrations in 7-Year-Old Chilean Children

Background: Accelerated weight and height gain in infancy have been associated with premature adrenarche. However, the exact tempo of these events remains undefined. Thus, our goal was to assess the relationship between early BMI and height growth in different periods before 7 years of age and plasma DHEAS levels at 7 years of age. Methods: This is a longitudinal follow-up of participants of the Growth and Obesity Chilean Cohort Study (GOCS) that represents Chilean children from low- to middle-income families. The subjects were 972 children (48% girls) with birth weights of 2,500–4,500 g for whom serial weight and height measurements from birth until 7 years were available. At 7 years of age, we also measured DHEAS, IGF-I, leptin, insulin, and other metabolic markers in serum. The main outcome of interest was plasma DHEAS concentrations at 7 years of age. Results: At 7 years of age, children with DHEAS >75th percentile of the sample were taller and fatter and presented higher HOMA-IR and IGF-I than their counterparts ( p < 0.05). Children with higher DHEAS were heavier at 4 years of age and beyond compared to their counterparts (higher BMI [BMI SDS at 4 years: 1.16, 95% CI 1.02–1.29 vs. 0.83, 95% CI 0.76– 0.91, p < 0.001]) and taller at 7 years of age (height SDS at 7 years: 0.19, 95% CI –0.08 to 0.31 vs. –0.001, 95% CI –0.06 to 0.06, p < 0.005). Conclusions : We observed weight and BMI from 2 to 4 years, and height gains from 4 to 7 years were associated with higher DHEAS levels at 7 years

Metabolic Syndrome and Mammographic Density in Premenopausal Chilean Women

Background: Metabolic syndrome (MetS) has been previously associated with an increased risk of breast cancer in postmenopausal women. Mammographic density (MD) is a marker of breast cancer risk. There is little evidence of an association between MetS and MD in premenopausal women. Methods: Through a cross-sectional study, we evaluated 364 premenopausal Chilean women in which we measured anthropometric, blood pressure, and metabolic markers. MetS and its components were defined according to the National Cholesterol Education Program Adult Treatment Plan III criteria. We estimated MD by absolute dense volume (ADV, cm3), nondense volume (NDV, cm3), and percentage of dense volume (PDV, %). The relationship between MetS and MD was assessed by linear regression models. Results: After adjusting for sociodemographic and gyneco-obstetrics variables, nonsignificant association was found between MetS and ADV (log b D 0.10; 95%CI: ¡0.01, 0.21). However, abdominal obesity, high triglycerides, and number of components of MetS were directly related to higher ADV (P < 0.05). Conclusion: Our results showed no association between MetS and ADV; nevertheless, abdominal obesity and triglycerides were related to higher ADV. If MD could be modifiable through nutritional factors, it would open new perspectives for the prevention of breast cancer through obesity prevention strategies at population level

Effect of excessive gestational weight on daughters’ breast density at the end of puberty onset

The effect of excessive gestational weight gain (EGWG) is related to adverse health outcomes in the offspring; however, its effect on the daughters' breast density is unclear. We aimed to assess the association between EGWG and daughters' breast composition (% of fibroglandular volume (%FGV) and absolute fibroglandular volume (AFGV)) at Tanner stage 4 (Tanner B4)). We included 341 girls and their mothers from an ongoing cohort of low-income Chilean girls born from 2002-2003. Maternal gestational weight gain was self-reported in 2007, and breast density by digital mammography was measured in 2010. Weight, height and breast composition by dual X-ray absorptiometry (DXA) were measured in daughters at Tanner B4. Logistic regression models were run to assess the association between EGWG and the 80th percentile of %FGV and AFGV. Mean gestational weight gain was 13.7kg (SD=6.9kg). Women with pregestational overweight or obesity exceeded the recommended gestational weight gain (58.8% vs. 31.8%, respectively). Daughters of women who had EGWG had higher levels of AFGV (OR: 2.02; 95%CI 1.16-3.53) at Tanner B4, which could be explained by metabolic and hormonal exposure in utero. However, we did not observe an association with %FGV.Chilean Council for Science and Technology FONDECYT 11170670 World Cancer Research Fund International (WCRF) 2010/245 United States Department of Health & Human Services National Institutes of Health (NIH) - USA United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Cancer Institute (NCI) 5R01CA158313 PCI Proyecto REDI17006