RESUMO RACIONAL: O volume do Hospital, especialização, disponibilidade serviços oncológicos e experiência na realização de cirurgias complexas têm impacto favorável no tratamento do câncer gástrico (CG). OBJETIVOS: Comparar resultados do tratamento do CG de acordo com o tipo de Hospital oncológico no Estado de São Paulo. MÉTODOS: Pacientes diagnosticados com CG entre 2000 e 2022 foram avaliados por dados extraídos do Registro Hospitalar de Câncer, de acordo com o tipo de Unidade de tratamento: Unidade de Assistência de Alta Complexidade Oncológica (UNACON) e Centro de Assistência de Alta Complexidade Oncológica (CACON), que tem maior complexidade. RESULTADOS: Entre os 33.774 pacientes, 23.387 (69,2%) foram tratados em CACONs e 10.387 (30,8%) em UNACONs. Pacientes no CACON eram mais jovens, tinham maior nível de escolaridade e cTNM mais avançado em comparação ao UNACON (todos p<0,001). O tempo do diagnóstico ao tratamento foi superior a 60 dias em 49,8% dos pacientes do CACON e 39,4% dos do UNACON (p<0,001). O tratamento cirúrgico foi realizado em 18.314 (54,2%) pacientes. A frequência de pN0 (40,3 vs 32,4%) e pTNM I (23 vs 19,5%) foi maior no CACON. Não houve diferença na sobrevida global (SG) entre todos os casos de adenocarcinoma tratados no CACON e no UNACON (9,3 vs 10,3 meses, p=0,462, p>0.05). No entanto, considerando apenas os pacientes submetidos à cirurgia, a SG daqueles tratados no CACON foi melhor (24,4 vs 18 meses, p<0,001, p<0.05). CONCLUSÕES: Pacientes com GC submetidos à gastrectomia em CACONs apresentaram melhores resultados de sobrevida, sugerindo que a centralização de cirurgias oncológicas complexas pode ser benéfica. RACIONAL especialização CG. . (CG) OBJETIVOS Paulo MÉTODOS 200 202 Câncer (UNACON CACON, , (CACON) complexidade RESULTADOS 33774 33 774 33.77 23387 23 387 23.38 69,2% 692 69 2 (69,2% 10387 10 10.38 30,8% 308 30 8 (30,8% UNACONs jovens p<0,001. p0001 p p<0,001 0 001 p<0,001) 6 498 49 49,8 394 39 4 39,4 (p<0,001) 18314 314 18.31 54,2% 542 54 (54,2% pN 40,3 403 40 3 (40, 32,4% 324 32 (2 19,5% 195 19 5 (SG 9,3 93 9 (9, 103 10, meses p0462 462 p=0,462 p>0.05. p005 p>0.05 05 p>0.05) entanto cirurgia 24,4 244 24 (24, 1 p<0.05. p<0.05 p<0.05) CONCLUSÕES benéfica (CG 20 (CACON 3377 77 33.7 2338 38 23.3 69,2 (69,2 1038 10.3 30,8 (30,8 p000 p<0,00 00 49, 39, (p<0,001 1831 31 18.3 54,2 (54,2 40, (40 32,4 ( 19,5 9, (9 p046 46 p=0,46 p00 p>0.0 24, (24 p<0.0 337 7 33. 233 23. 69, (69, 10. 30, (30, p<0,0 (p<0,00 183 18. 54, (54, (4 32, 19, p04 p=0,4 p0 p>0. p<0. (69 (30 p<0, (p<0,0 (54 p=0, p>0 p<0 (6 (3 (p<0, (5 p=0 p> p< (p<0 p= (p< (p

ABSTRACT BACKGROUND: The hospitals’ volume, specialization, availability of all oncological services, and experience in performing complex surgeries have a favorable impact on gastric cancer (GC) treatment. AIMS: The aim of this study was to compare the results of GC treatment according to the type of oncological hospital in the State of São Paulo. METHODS: Patients diagnosed with GC between 2000 and 2022 in qualified hospitals for cancer treatment were evaluated by data extracted from the hospital cancer registry. Patients were assessed according to the type of hospital for cancer treatment: Oncology High Complexity Assistance Unit (UNACON) and Oncology High Complexity Care Center (CACON), which has greater complexity. RESULTS: Among the 33,774 patients, 23,387 (69.2%) were treated at CACONs and 10,387 (30.8%) in UNACONs. CACON patients were younger, had a higher level of education, and had a more advanced cTNM stage compared to UNACON (all p<0.001, p<0.05). The time from diagnosis to treatment was over 60 days in 49.8% of CACON’s patients and 39.4% of UNACON’s (p<0.001, p<0.05). Surgical treatment was performed in 18,314 (54.2%) patients. The frequency pN0 (40.3 vs 32.4%) and pTNM stage I (23 vs 19.5%) were higher in CACON. There was no difference in overall survival (OS) between all adenocarcinoma cases treated at CACON and UNACON (9.3 vs 10.3 months, p=0.462, p>0.05). However, considering only patients who underwent curative surgery, the OS of patients treated at CACON was better (24.4 vs 18 months, p<0.001). CONCLUSIONS: Patients with GC who underwent gastrectomy at CACONs had better survival outcomes, suggesting that the centralization of complex cancer surgery may be beneficial. BACKGROUND volume specialization services (GC AIMS Paulo METHODS 200 202 registry (UNACON CACON, , (CACON) complexity RESULTS 33774 33 774 33,77 23387 23 387 23,38 69.2% 692 69 2 (69.2% 10387 10 10,38 30.8% 308 30 8 (30.8% UNACONs younger education p0001 p 0 001 p<0.001 p<0.05. p005 p<0.05 . 05 p<0.05) 6 498 49 49.8 s 394 39 4 39.4 (p<0.001 18314 314 18,31 54.2% 542 54 (54.2% pN 40.3 403 40 3 (40. 32.4% 324 32 (2 19.5% 195 19 5 (OS 9.3 93 9 (9. 103 10. months p0462 462 p=0.462 p>0.05. p>0.05 p>0.05) However 24.4 244 24 (24. 1 p<0.001. p<0.001) CONCLUSIONS outcomes beneficial 20 (CACON 3377 77 33,7 2338 38 23,3 69.2 (69.2 1038 10,3 30.8 (30.8 p000 00 p<0.00 p00 p<0.0 49. 39. (p<0.00 1831 31 18,3 54.2 (54.2 40. (40 32.4 ( 19.5 9. (9 p046 46 p=0.46 p>0.0 24. (24 337 7 33, 233 23, 69. (69. 10, 30. (30. p0 p<0. (p<0.0 183 18, 54. (54. (4 32. 19. p04 p=0.4 p>0. (69 (30 p<0 (p<0. (54 p=0. p>0 (6 (3 p< (p<0 (5 p=0 p> (p< p= (p

RESUMO Objetivo: O objetivo deste estudo foi analisar o prognóstico de mulheres com câncer de mama de acordo com os subtipos moleculares, variáveis sociodemográficas, características clínicas e de tratamento. Métodos: Este foi um estudo de coorte retrospectivo de base hospitalar. Foram analisadas 1.654 mulheres maiores de 18 anos diagnosticadas com câncer de mama invasivo entre 2000 a 2018. Os dados foram extraídos da Fundação Oncocentro de São Paulo, Brasil. As variáveis analisadas foram idade, histologia, subtipo moleculares, estadiamento clínico, tipo de tratamento e tempo entre o diagnóstico e tratamento. A análise de regressão de Cox foi aplicada para estimar o risco de morte. Resultados: As mulheres que apresentaram os subtipos moleculares HER-2-positivo (não luminal) e triplo negativo tiveram risco de morte quase duas vezes maior respectivamente, com razão de risco ajustada — HRaj=2,30 (intervalo de confiança de 95% — 95%IC 1,34–3,94) e HRaj=2,51 (95%IC 1,61–3,92). O atraso no tratamento associado ao avanço do estadiamento clínico ao diagnóstico aumentou em quatro vezes o risco de morte (HRaj=4,20 (IC95% 2,36–7,49). Conclusão: Os fenótipos HER-2-positivo (não luminal) e triplo negativo, além da interação entre estágio clínico avançado e maior tempo entre o diagnóstico e o tratamento, associaram-se a pior prognóstico. Assim, ações para reduzir as barreiras no diagnóstico e tratamento podem proporcionar melhores resultados, mesmo em fenótipos agressivos. Objetivo sociodemográficas Métodos hospitalar 1654 1 654 1.65 200 2018 Paulo Brasil idade histologia Resultados HER2positivo HERpositivo HER 2 positivo não luminal respectivamente HRaj230 HRaj 30 HRaj=2,3 intervalo 95 95IC IC 1,34–3,94 134394 34 3 94 HRaj251 51 HRaj=2,5 1,61–3,92. 161392 1,61–3,92 . 61 92 1,61–3,92) HRaj=4,20 HRaj420 4 20 (HRaj=4,2 IC95% IC95 (IC95 2,36–7,49. 236749 2,36–7,49 36 7 49 2,36–7,49) Conclusão associaramse associaram se Assim resultados agressivos 165 65 1.6 201 HRaj23 HRaj=2, 9 1,34–3,9 13439 HRaj25 5 16139 1,61–3,9 6 HRaj=4,2 HRaj42 (HRaj=4, IC9 (IC9 23674 2,36–7,4 16 1. HRaj2 HRaj=2 1,34–3, 1343 1613 1,61–3, HRaj=4, HRaj4 (HRaj=4 (IC 2367 2,36–7, HRaj= 1,34–3 134 161 1,61–3 HRaj=4 (HRaj= 236 2,36–7 1,34– 13 1,61– (HRaj 23 2,36– 1,34 1,61 2,36 1,3 1,6 2,3 1, 2,

ABSTRACT Objective: This study aimed to analyze the prognosis of women with breast cancer by molecular subtypes, sociodemographic variables, and clinical and treatment characteristics. Methods: This hospital-based retrospective cohort study analyzed 1,654 women over 18 years of age diagnosed with invasive breast cancer from 2000 to 2018. Data were extracted from Brazil’s Oncocenter Foundation of São Paulo. The variables analyzed were age, histology, molecular subtypes, clinical staging, treatment type, and diagnosis-to-treatment time. Cox regression analysis was applied to estimate death risk. Results: Women with HER-2-positive (nonluminal) and triple-negative molecular subtypes were more than twice more likely to be at risk of death, with adjusted hazard ratio — HRadj=2.30 (95% confidence interval — 95%CI 1.34–3.94) and HRadj=2.51 (95%CI 1.61–3.92), respectively. A delayed treatment associated with an advanced clinical stage at diagnosis increased fourfold the risk of death (HRadj=4.20 (95%CI 2.36–7.49). Conclusion: In summary, besides that interaction between advanced clinical stage and longer time between diagnosis and treatment, HER-2-positive (nonluminal) and triple-negative phenotypes were associated with a worse prognosis. Therefore, actions to reduce barriers in diagnosis and treatment can provide better outcome, even in aggressive phenotypes. Objective characteristics Methods hospitalbased hospital based 1654 1 654 1,65 200 2018 Brazils Brazil s Paulo histology staging type diagnosistotreatment Results HER2positive HERpositive HER 2 positive nonluminal (nonluminal triplenegative triple negative HRadj230 HRadj 30 HRadj=2.3 95% 95 (95 95CI CI 1.34–3.94 134394 34 3 94 HRadj251 51 HRadj=2.5 1.61–3.92, 161392 1.61–3.92 , 61 92 1.61–3.92) respectively HRadj=4.20 HRadj420 4 20 (HRadj=4.2 2.36–7.49. 236749 2.36–7.49 . 36 7 49 2.36–7.49) Conclusion summary Therefore outcome 165 65 1,6 201 HRadj23 HRadj=2. 9 (9 1.34–3.9 13439 HRadj25 5 16139 1.61–3.9 6 HRadj=4.2 HRadj42 (HRadj=4. 23674 2.36–7.4 16 1, HRadj2 HRadj=2 ( 1.34–3. 1343 1613 1.61–3. HRadj=4. HRadj4 (HRadj=4 2367 2.36–7. HRadj= 1.34–3 134 161 1.61–3 HRadj=4 (HRadj= 236 2.36–7 1.34– 13 1.61– (HRadj 23 2.36– 1.34 1.61 2.36 1.3 1.6 2.3 1. 2.

Abstract Objectives Hospitalization during pregnancy and childbirth increases the risk of Venous Thromboembolism Risk (VTE). This study applied a VTE risk score to all hospitalized pregnant women to ascertain its effectiveness in preventing maternal death from VTE until 3 months after discharge. Methods In this interventional study, patients were classified as low- or high-risk according to the VTE risk score (Clinics Hospital risk score). High-risk patients (score ≥ 3) were scheduled for pharmacological Thromboprophylaxis (TPX). Interaction analysis of the main risk factors was performed using Odds Ratio (OR) and Poisson regression with robust variance. Results The data of 10694 cases (7212 patients) were analyzed; 1626 (15.2%, 1000 patients) and 9068 (84.8%, 6212 patients) cases were classified as high-risk (score ≥ 3) and low-risk (score < 3), respectively. The main risk factors (Odds Ratio, 95% Confidence Interval) for VTE were age ≥ 35 and < 40 years (1.6, 1.4-1.8), parity ≥ 3 (3.5, 3.0-4.0), age ≥ 40 years (4.8, 4.1-5.6), multiple pregnancies (2.1, 1.7-2.5), BMI ≥ 40 kg/m2 (5.1, 4.3-6.0), severe infection (4.1, 3.3-5.1), and cancer (12.3, 8.8-17.2). There were 10 cases of VTE: 7/1636 (0.4%) and 3/9068 (0.03%) in the high- and low-risk groups, respectively. No patient died of VTE. The intervention reduced the VTE risk by 87%; the number needed to treat was 3. Conclusions This VTE risk score was effective in preventing maternal deaths from VTE, with a low indication for TPX. Maternal age, multiparity, obesity, severe infections, multiple pregnancies, and cancer were the main risk factors for VTE. . (VTE) discharge highrisk high Clinics score. score) Highrisk High TPX (TPX) OR (OR variance 1069 7212 (721 analyzed 162 15.2%, 152 15 2 (15.2% 100 906 84.8%, 848 84 8 (84.8% 621 lowrisk 3, , respectively 95 Interval 4 1.6, 16 1 6 (1.6 1.41.8, 1418 1.4 1.8 1.4-1.8) 3.5, 5 (3.5 3.04.0, 3040 3.0 4.0 0 3.0-4.0) 4.8, 48 (4.8 4.15.6, 4156 4.1 5.6 4.1-5.6) 2.1, 21 (2.1 1.72.5, 1725 1.7 2.5 7 1.7-2.5) kgm2 kgm kg m2 m kg/m 5.1, 51 (5.1 4.36.0, 4360 4.3 6.0 4.3-6.0) 4.1, 41 (4.1 3.35.1, 3351 3.3 5.1 3.3-5.1) 12.3, 123 12 (12.3 8.817.2. 88172 8.8 17.2 17 8.8-17.2) 71636 1636 7/163 0.4% 04 (0.4% 39068 3/906 0.03% 003 03 (0.03% groups 87% 87 multiparity obesity infections (VTE (TPX 106 721 (72 15.2% (15.2 90 84.8% (84.8 62 9 1.6 (1. 1.41.8 141 14 1. 18 1.4-1.8 3.5 (3. 3.04.0 304 30 4. 3.0-4.0 4.8 (4. 4.15.6 415 56 5. 4.1-5.6 2.1 (2. 72 1.72.5 172 25 2. 1.7-2.5 (5. 36 4.36.0 436 43 60 6. 4.3-6.0 3.35.1 335 33 3.3-5.1 12.3 (12. 817 8.817.2 8817 88 8. 17. 8.8-17.2 7163 163 7/16 0.4 (0.4 3906 3/90 0.03 00 (0.03 (7 15.2 (15. 84.8 (84. (1 1.41. 1.4-1. (3 3.04. 3.0-4. (4 4.15. 4.1-5. (2 1.72. 1.7-2. (5 4.36. 4.3-6. 3.35. 3.3-5. 12. (12 81 8.817. 881 8.8-17. 716 7/1 0. (0. 390 3/9 0.0 (0.0 ( 15. (15 84. (84 1.41 1.4-1 3.04 3.0-4 4.15 4.1-5 1.72 1.7-2 4.36 4.3-6 3.35 3.3-5 8.817 8.8-17 71 7/ (0 39 3/ (8 1.4- 3.0- 4.1- 1.7- 4.3- 3.3- 8.81 8.8-1 8.8-

ABSTRACT Objective: This study aimed to analyze the prognosis of women with breast cancer by molecular subtypes, sociodemographic variables, and clinical and treatment characteristics. Methods: This hospital-based retrospective cohort study analyzed 1,654 women over 18 years of age diagnosed with invasive breast cancer from 2000 to 2018. Data were extracted from Brazil’s Oncocenter Foundation of São Paulo. The variables analyzed were age, histology, molecular subtypes, clinical staging, treatment type, and diagnosis-to-treatment time. Cox regression analysis was applied to estimate death risk. Results: Women with HER-2-positive (nonluminal) and triple-negative molecular subtypes were more than twice more likely to be at risk of death, with adjusted hazard ratio — HRadj=2.30 (95% confidence interval — 95%CI 1.34–3.94) and HRadj=2.51 (95%CI 1.61–3.92), respectively. A delayed treatment associated with an advanced clinical stage at diagnosis increased fourfold the risk of death (HRadj=4.20 (95%CI 2.36–7.49). Conclusion: In summary, besides that interaction between advanced clinical stage and longer time between diagnosis and treatment, HER-2-positive (nonluminal) and triple-negative phenotypes were associated with a worse prognosis. Therefore, actions to reduce barriers in diagnosis and treatment can provide better outcome, even in aggressive phenotypes.

RESUMO Objetivo: O objetivo deste estudo foi analisar o prognóstico de mulheres com câncer de mama de acordo com os subtipos moleculares, variáveis sociodemográficas, características clínicas e de tratamento. Métodos: Este foi um estudo de coorte retrospectivo de base hospitalar. Foram analisadas 1.654 mulheres maiores de 18 anos diagnosticadas com câncer de mama invasivo entre 2000 a 2018. Os dados foram extraídos da Fundação Oncocentro de São Paulo, Brasil. As variáveis analisadas foram idade, histologia, subtipo moleculares, estadiamento clínico, tipo de tratamento e tempo entre o diagnóstico e tratamento. A análise de regressão de Cox foi aplicada para estimar o risco de morte. Resultados: As mulheres que apresentaram os subtipos moleculares HER-2-positivo (não luminal) e triplo negativo tiveram risco de morte quase duas vezes maior respectivamente, com razão de risco ajustada — HRaj=2,30 (intervalo de confiança de 95% — 95%IC 1,34–3,94) e HRaj=2,51 (95%IC 1,61–3,92). O atraso no tratamento associado ao avanço do estadiamento clínico ao diagnóstico aumentou em quatro vezes o risco de morte (HRaj=4,20 (IC95% 2,36–7,49). Conclusão: Os fenótipos HER-2-positivo (não luminal) e triplo negativo, além da interação entre estágio clínico avançado e maior tempo entre o diagnóstico e o tratamento, associaram-se a pior prognóstico. Assim, ações para reduzir as barreiras no diagnóstico e tratamento podem proporcionar melhores resultados, mesmo em fenótipos agressivos.

Abstract Purpose The authors aim to carry out an investigation on the impact of cervical oncogenic Human Papillomavirus (HPV) detection in pregnant adolescents, to clarify the prevalence and risk factors, considering the importance and lack of data on this topic in Brazil. Methods A cross-sectional study was conducted with adolescents receiving prenatal care in a tertiary hospital in São Paulo, Brazil, with routine Pap smear and oncogenic HPV detection test in the uterine cervix. The authors sought to associate the results of these tests with demographic and obstetric variables. Results A total of 303 pregnant adolescents whose mean age was 15.30 ± 1.22 years comprised the study subjects. The frequency of high-risk HPV cervical detection was 50.50%. Multivariate analysis revealed that a large number of partners in their lifetime (OR = 1.27) and having a religion (OR = 2.05) were risk factors for cervical detection of oncogenic HPV, while schooling appeared as a protective factor (OR = 0.85). There was an association between this detection and colpocytological alterations, reaching almost 30% of patients, but without association with obstetric and neonatal outcomes. Conclusion The prevalence found is one of the highest in Brazil and worldwide. A greater number of partners during their lifetime and having religion were detected as possible factors associated with cervical HPV detection. Detection of cervical HPV-DNA did not influence obstetric and neonatal outcomes. The findings of this study reinforce the need to implement educational measures capable of modifying the incidence of sexually transmitted infections in this population and capable of promoting adherence to HPV vaccination programs.

Abstract Objective: To identify risk factors for Oxygen (O2) needs in pregnant and postpartum women with COVID-19. Methods: Prospective cohort involving pregnant women hospitalized with COVID-19 from April to October 2020. The oxygen need was analyzed regarding risk factors: demographic characteristics, clinical and laboratory parameters at hospital admission, and chest Computer Tomography (CT) findings. Poisson univariate analysis was used to estimate the Relative Risk (RR) and 95% Confidence Intervals. Results: 145 patients, 80 who used and 65 who did not use O2, were included. Body mass index ≥ 30, smoking, and chronic hypertension increased the risk of O2 need by 1.86 (95% CI 1.10–3.21), 1.57 (95% CI 1.16‒2.12), and 1.46 (95% CI 1.09‒1.95), respectively. Patients who were hospitalized for COVID-19 and for obstetric reasons had 8.24 (95% CI 2.8‒24.29) and 3.44 (95% CI 1.05‒11.31) times more use of O2 than those admitted for childbirth and abortion. Respiratory rate ≥ 24 breaths/min and O2 saturation < 95% presented RR for O2 requirements of 2.55 (1.82‒3.56) and 1.68 (95% CI 1.27-2.20), respectively. Ground Glass (GG) < 50% and with GG ≥ 50%, the risk of O2 use were respectively 3.41-fold and 5.33-fold higher than in patients who haven’t viral pneumonia on CT. The combination of C-reactive protein ≥ 21 mg/L, hemoglobin < 11.0 g/dL, and lymphopenia < 1500 mm3 on hospital admission increased the risk of O2 use by 4.97-times. Conclusions: In obstetric patients, clinical history, laboratory, clinical and radiological parameters at admission were identified as a risk for O2 need, selecting the population with the greatest chance of worsening. HIGHLIGHTS In unvaccinated pregnant and postpartum women, any need for oxygen supply increases the risk of invasive ventilation. Obesity, smoking and chronic arterial hypertension proved to be risk factors for the use of oxygen in pregnant and postpartum women with COVID-19. The combination of C-reactive protein ≥ 21 mg/L, hemoglobin < 11.0 g/dL, and lymphopenia < 1500 mm on hospital admission and the presence of ground glass ≥ 50% in computer tomography increased the risk of O2 use by 4.97 and 5.33 times respectively in pregnant and postpartum women with COVID-19.

Abstract Objective To evaluate objective criteria of Magnetic Resonance Imaging (MRI) of Placenta Accreta Spectrum disorder (PAS) analyzing interobserver agreement and to derive a model including imaging and clinical variables to predict PAS. Methods A retrospective review including patients submitted to MRI with suspicious findings of PAS on ultrasound. Exclusion criteria were lack of pathology or surgical information and missing or poor-quality MRI. Two radiologists analyzed six MRI features, and significant clinical data were also recorded. PAS confirmed on pathology or during intraoperative findings were considered positive for the primary outcome. Variables were tested through logistic regression models. Results Final study included 96 patients with a mean age of 33 years and 73.0% of previous C-sections. All MRI features were significantly associated with PAS for both readers. After logistic regression fit, including MRI signs with a moderate or higher interobserver agreement, intraplacental T2 dark band was the most significant radiologic criteria, and ROC analysis resulted in an AUC = 0.782. After including the most relevant clinical data (previous C-section) to the model, the ROC analysis improved to an AUC = 0.893. Conclusion Simplified objective criteria on MRI, including intraplacental T2 dark band associated with clinical information of previous C-sections, had the highest accuracy and was used for a predictive model of PAS.

Resumo O artigo discute as especificidades do processo de iniciação sexual (IS) das jovens vivendo com HIV infectadas por transmissão vertical (TV) a partir de um estudo transversal, com amostragem probabilística, conduzido no município de São Paulo entre 2013 e 2014. Foram comparadas as médias da idade da primeira relação sexual das jovens de 18 a 24 anos, segmentadas entre infectadas por TV, infectadas por outras vias e aquelas que não vivem com HIV/Aids. Observou-se associação entre o adiamento da primeira relação sexual e a infecção por TV, ter filiação religiosa, ter ao menos ensino médio completo, não ter feito uso de drogas na vida e ter tido a primeira relação com parceiro mais novo ou até dois anos mais velho. A infecção pelo HIV confere complexidade aos processos de socialização para a sexualidade e, consequentemente, de transição para a vida adulta. Os resultados indicam que diferentes vias de infecção pelo HIV aparecem associadas a modos peculiares de viver a sexualidade.

Abstract The article discusses the specificities of the sexual initiation (SI) of young women living with HIV infected by vertical transmission (VT). The empirical data comes from a transversal study, with probabilistic sampling, carried out in the city of São Paulo from 2013 to 2014. The age average of the first sexual intercourse of the 18-24-year-old women was compared among the three groups: those infected by VT, those infected by other means and those who have not been infected by HIV/Aids. The postponement of the first sexual intercourse is associated with having a religious practice, a secondary school, not having ever used drugs and having the first sexual intercourse with younger or up to two years older partners. HIV infection confers complexity to the processes of socialization for sexuality and, consequently, transition into adult life. The results indicate that different routes of HIV infection are associated with peculiar ways of experiencing sexuality.

Resumen El artículo discute las especificidades del proceso de iniciación sexual (IS) de las jóvenes viviendo con HIV infectadas por transmisión vertical (TV) a partir de un estudio transversal, con muestreo probabilístico, conducido en el municipio de São Paulo entre 2013 y 2014. Se compararon las medias de la edad de la primera relación sexual de las jóvenes de 18 a 24 años, segmentadas entre infectadas por TV, infectadas por otras vías y aquellas que no viven con HIV/SIDA. Se observó asociación entre el aplazamiento de la primera relación sexual y la infección por TV, tener filiación religiosa, tener al menos la enseñanza media completa, no haber hecho uso de drogas en la vida y haber tenido la primera relación con pareja más joven o hasta dos años más viejo. La infección por el HIV confiere complejidad a los procesos de socialización para la sexualidad y, consecuentemente, de transición a la vida adulta. Los resultados indican que diferentes vías de infección por el HIV aparecen asociadas a modos peculiares de vivir la sexualidad.

RESUMO Objetivo Avaliar o conhecimento em saúde bucal e os fatores sociodemográficos associados em gestantes. Métodos Estudo com delineamento transversal, com amostra de 195 gestantes atendidas na Unidade Básica de Saúde de Paraisópolis I, em São Paulo (SP). Para a análise estatística, utilizou-se teste χ2 ou teste exato de Fisher e a regressão logística múltipla. Assumiu-se um nível de significância de 5% para todas as análises. Resultados Escolaridade igual ou maior a 8 anos de estudo e presença de um a dois filhos estiveram associadas a conhecimento adequado sobre saúde bucal. Conclusão Estratégias de promoção de saúde bucal durante o pré-natal devem levar em consideração aspectos sociodemográficos.

ABSTRACT Objective To evaluate knowledge on oral health and associated sociodemographic factors in pregnant women. Methods A cross-sectional study with a sample of 195 pregnant women seen at the Primary Care Unit Paraisópolis I, in São Paulo (SP), Brazil. For statistical analysis, χ2 or Fisher's exact test and multiple logistic regression were used. A significance level of 5% was used in all analyses. Results Schooling level equal to or greater than 8 years and having one or two children were associated with an adequate knowledge about oral health. Conclusion Oral health promotion strategies during prenatal care should take into account sociodemographic aspects.

RESUMO Objetivo Investigar a sensibilidade e consistência interna do instrumento a partir da comparação com os resultados dos instrumentos de avaliação funcional facial, escala de House-Brackmann (HBS) e Sistema de Graduação Facial, e implicações psicossociais a partir da aplicação da Escala Hospitalar de Ansiedade e Depressão (HADS). Método Pesquisa aprovada pelo comitê de ética em pesquisa, sob o protocolo nº. 196.977 e 230.982. A avaliação da sensibilidade do questionário foi realizada por meio de entrevistas fechadas em sujeitos adultos com PFP, sendo 38 selecionados para essa etapa. A análise estatística foi realizada para cada uma das etapas deste estudo, os dados foram digitados em Excel®, analisados pelos programas SPSS versão 17.0 para Windows e AMOS versão 22.0 para Windows®. Resultados Participaram 38 sujeitos, entre 19 e 78 anos, com predominância de paralisia idiopática (44,7%). Os resultados do Alfa de Cronbach mostraram uma consistência interna forte entre os grupos temáticos e as questões, no entanto a análise fatorial confirmatória alerta para questões cuja relação de causa entre os grupos temáticos foi fraca, como nos casos das questões 5 e 6 do grupo temático Aspectos Funcionais da Face, questão 17 dos Aspectos Sociais e questão 23 dos Aspectos Emocionais. Conclusão Essa pesquisa constituiu os primeiros passos para o subsídio e respaldo de um instrumento que investiga os aspectos psicossociais associados à PFP, sendo possível a elaboração de questões e ordenação em grupos temáticos. Porém, faz-se necessária a continuidade de estudos para a efetivação dos processos de validação.

ABSTRACT Purpose To investigate the sensitivity and internal consistency of the Psychosocial Scale of Facial Appearance (PSFA) based on the comparison between its results and those from other facial functional assessment instruments: House-Brackmann scale (HBS) and Facial Grading System - and the psychosocial implications measured by the Hospital Anxiety and Depression Scale (HADS). Methods The study was approved by the Research Ethics Committee of the aforementioned Institution under protocols no. 196.977 and 230.982. Thirty-eight adult individuals with Peripheral Facial Palsy (PFP) were submitted to closed interviews in order to evaluate the sensitivity of the questionnaire. Statistical analyses were conducted for each stage of this study. Data were entered in Excel® spreadsheet and analyzed using SPSS 17.0 and AMOS 22.0 for Windows®. Results Study participants were 38 individuals with PFP aged 19-78 years with predominance of idiopathic paralysis (44.7%). Results of the Cronbach's Alpha coefficient showed strong internal consistency between the thematic groups and the questions; however, Confirmatory Factor Analysis indicated some questions with week causal relationship between thematic groups, namely, questions 5 and 6 of the group Functional Aspects of Face, question 17 of the group Social Aspects, and question 23 of the group Emotional Aspects. Conclusion This study provided the first steps for the subsidy and support of an instrument designed to investigate the psychosocial aspects associated with PFP, enabling the preparation of questions and their organization into thematic groups. However, further studies are needed to conclude the validation processes.

RESUMO: A disponibilidade de grandes bases de dados informatizadas em saúde tornou a técnica de linkage uma alternativa para diferentes tipos de estudos, proporcionando a geração de uma base de dados mais completa e de baixo custo operacional. Objetivo: Melhorar a qualidade e a completitude dos casos incidentes de câncer por meio dos linkages probabilístico e determinístico entre o Registro de Câncer de Base Populacional de São Paulo (RCBP-SP), o banco de dados de óbitos e de Autorização e Procedimentos de Alta Complexidade. Método: Foi utilizado o banco de dados do RCBP-SP, composto de 343.306 casos de câncer incidentes no município de São Paulo entre 1997 e 2005, com idades entre 1 e 106 anos, de ambos os sexos. Para o linkage foram utilizadas três bases de dados, a saber: do Programa de Aprimoramento de Mortalidade no Município de São Paulo (PRO-AIM), da Fundação SEADE e da Autorização e Procedimentos de Alta Complexidade/Custo do Sistema de Informação Ambulatorial do Sistema Único de Saúde (APAC-SIA/SUS). Foram analisadas os coeficientes brutos de incidência (CBI) e mortalidade (CBM) e a sobrevida global pela técnica de Kaplan-Meier. Resultados: Após o linkage, verificou-se um ganho de 4,3% para a CBI e 25,8% para a CBM. Na análise de sobrevida global antes do linkage havia uma subestimação da probabilidade de estar vivo para todas as variáveis analisadas (p < 0,001). Conclusão: As técnicas de linkage contribuíram para a melhora da qualidade da informação do RCBP-SP tanto na completitude das variáveis quanto na definição do status vital do paciente, refletindo a capacidade das bases de dados, quando trabalhadas de maneira conjunta, de fornecerem subsídios para diversos tipos de estudos e informações para o planejamento de ações políticas e estratégicas.

ABSTRACT: The availability of large computerized databases on health turned the record linkage technique into an alternative for different study designs. This technique provides the creation of more complete databases, at low operational costs. Objective: The aim of this study was to improve the quality of information and data completeness through probabilistic and deterministic record linkage between Population-based Cancer Registry of São Paulo (PBCR-SP) for incident cancer cases, death database and drugs/medical procedures database. Methods: We used the database of the PBCRP-SP composed of 343,306 incident cancer cases in the municipality of São Paulo in the period between 1997 and 2005 with ages raging from under 1 to 106 years old, from both sexes. Three databases were used for linkage, namely Improvement Program for Mortality Information in São Paulo city (PRO-AIM), Authorization of Procedures of High Complexity/Cost of Outpatient Information System from the Unified Health System (APAC-SIA/SUS), and Foundation State System of Data Analysis (Foundation SEADE). Crude incidence (CIR) and mortality rates (CMR) were calculated and overall survival analysis was performed using the Kaplan-Meier method. Results: After record linkage, it was possible to observe gain of 4.3% for the CIR and 25.8% for CMR. The overall survival analysis showed that before record linkage there was an underestimation of the probability of being alive for all variables (p < 0.001). Conclusion: The linkage techniques contributed with the improvement of the quality of RCBP-SP information both on completeness of data, as in defining the vital status of the patient. In addition, the results found in this study reflect the ability of databases when worked jointly, providing subsidies for various types of studies and information for planning policies and strategic actions.

RESUMO: A disponibilidade de grandes bases de dados informatizadas em saúde tornou a técnica de linkage uma alternativa para diferentes tipos de estudos, proporcionando a geração de uma base de dados mais completa e de baixo custo operacional. Objetivo: Melhorar a qualidade e a completitude dos casos incidentes de câncer por meio dos linkages probabilístico e determinístico entre o Registro de Câncer de Base Populacional de São Paulo (RCBP-SP), o banco de dados de óbitos e de Autorização e Procedimentos de Alta Complexidade. Método: Foi utilizado o banco de dados do RCBP-SP, composto de 343.306 casos de câncer incidentes no município de São Paulo entre 1997 e 2005, com idades entre 1 e 106 anos, de ambos os sexos. Para o linkage foram utilizadas três bases de dados, a saber: do Programa de Aprimoramento de Mortalidade no Município de São Paulo (PRO-AIM), da Fundação SEADE e da Autorização e Procedimentos de Alta Complexidade/Custo do Sistema de Informação Ambulatorial do Sistema Único de Saúde (APAC-SIA/SUS). Foram analisadas os coeficientes brutos de incidência (CBI) e mortalidade (CBM) e a sobrevida global pela técnica de Kaplan-Meier. Resultados: Após o linkage, verificou-se um ganho de 4,3% para a CBI e 25,8% para a CBM. Na análise de sobrevida global antes do linkage havia uma subestimação da probabilidade de estar vivo para todas as variáveis analisadas (p < 0,001). Conclusão: As técnicas de linkage contribuíram para a melhora da qualidade da informação do RCBP-SP tanto na completitude das variáveis quanto na definição do status vital do paciente, refletindo a capacidade das bases de dados, quando trabalhadas de maneira conjunta, de fornecerem subsídios para diversos tipos de estudos e informações para o planejamento de ações políticas e estratégicas.

ABSTRACT: The availability of large computerized databases on health turned the record linkage technique into an alternative for different study designs. This technique provides the creation of more complete databases, at low operational costs. Objective: The aim of this study was to improve the quality of information and data completeness through probabilistic and deterministic record linkage between Population-based Cancer Registry of São Paulo (PBCR-SP) for incident cancer cases, death database and drugs/medical procedures database. Methods: We used the database of the PBCRP-SP composed of 343,306 incident cancer cases in the municipality of São Paulo in the period between 1997 and 2005 with ages raging from under 1 to 106 years old, from both sexes. Three databases were used for linkage, namely Improvement Program for Mortality Information in São Paulo city (PRO-AIM), Authorization of Procedures of High Complexity/Cost of Outpatient Information System from the Unified Health System (APAC-SIA/SUS), and Foundation State System of Data Analysis (Foundation SEADE). Crude incidence (CIR) and mortality rates (CMR) were calculated and overall survival analysis was performed using the Kaplan-Meier method. Results: After record linkage, it was possible to observe gain of 4.3% for the CIR and 25.8% for CMR. The overall survival analysis showed that before record linkage there was an underestimation of the probability of being alive for all variables (p < 0.001). Conclusion: The linkage techniques contributed with the improvement of the quality of RCBP-SP information both on completeness of data, as in defining the vital status of the patient. In addition, the results found in this study reflect the ability of databases when worked jointly, providing subsidies for various types of studies and information for planning policies and strategic actions.

RESUMO Objetivo Aplicar a Escala Psicossocial de Aparência Facial, para verificar aplicabilidade e reprodutibilidade, por meio de estudo piloto. Métodos Casuística: seleção de oito sujeitos adultos com paralisia facial periférica, a partir de critérios estabelecidos. Procedimentos: 1. avaliação fonoaudiológica da função facial; 2. verificação da fidedignidade da Escala Psicossocial de Aparência Facial; 3. verificação da reprodutibilidade da escala; 4. aplicação da Escala Hospitalar de Ansiedade e Depressão. Foi realizada análise descritiva dos dados e aplicado o teste t-Student pareado, entre os momentos 1 e 2, e o coeficiente de correlação intraclasse (ricc). Resultados A verificação da aplicabilidade aumentou a familiaridade com o processo de coleta de dados e auxiliou nas modificações dos procedimentos. O questionário mostrou-se fidedigno para todas as escalas analisadas: Aspectos Funcionais da Face, Aspectos Sociais, Aspectos Emocionais, Geral e Nota atribuída ao rosto. O coeficiente de correlação intraclasse (ricc) demonstrou a reprodutibilidade do instrumento, tendo apresentado, neste caso, valores excelentes para todas os grupos temáticos analisados. Conclusão Esta pesquisa ofereceu subsídios para o aprimoramento e elaboração final de instrumento que investiga os aspectos psicossociais associados à paralisia facial periférica.

ABSTRACT Purpose To apply the Psychosocial Scale of Facial Appearance in order to verify its applicability and reproducibility in a pilot study. Methods Subjects: eight adult subjects with peripheral facial palsy were selected according to established criteria. Procedures: 1. speech-language assessment of the facial function; 2. verification of the reliability of the Psychosocial Scale of Facial Appearance; 3. verification of the scale’s reproducibility; 4. application of the Hospital Anxiety and Depression Scale. A descriptive analysis of the data was performed, and the paired t-Student test (between times 1 and 2) and the intraclass correlation coefficient (ricc) were applied. Results Assessing the applicability increased the familiarity with the data collection process and contributed to modifications in the procedures. The questionnaire proved to be reliable for all the scales analyzed: Functional, Social, and Emotional Aspects of Face, General, and Note Assigned to the Face. The intraclass correlation coefficient (ricc) demonstrated the reproducibility of the instrument by showing excellent values for all thematic groups analyzed. Conclusion This study provided subsides for the improvement and final elaboration of an instrument that aims to investigate the psychosocial aspects associated with peripheral facial palsy.

ResumoObjetivo:Verificar a prevalência de sedentarismo entre adolescentes com HIV/Aids e seus fatores associados.Métodos:Foram entrevistados 91 adolescentes de 10 a 19 anos, com HIV/Aids, em acompanhamento em uma unidade de infectologia universitária. Foram coletados dados antropométricos (peso, altura e circunferência da cintura) em duplicata, informações clínicas foram obtidas nos prontuários médicos e a prática de atividade física habitual foi medida por meio do questionário proposto por Florindo et al. O ponto de corte para sedentarismo foi de 300 minutos/semana.Resultados:As prevalências de altura inadequada para idade, desnutrição e sobrepeso/obesidade foram de 15,4%, 9,9% e 12,1%, respectivamente. As atividades físicas mais citadas foram: futebol (44,4%), voleibol (14,4%) e andar de bicicleta (7,8%). Os tempos medianos dispendidos com a prática de atividade física e caminhando/andando de bicicleta até a escola foram de 141 minutos e 39 minutos, respectivamente. A maioria dos adolescentes (71,4%) era sedentária, proporção maior entre as meninas (p=0,046).Conclusões:Foi observada alta prevalência de sedentarismo entre adolescentes com HIV/Aids, prevalência essa semelhante àquela observada na população geral. Promover a prática de atividade física entre adolescentes - especialmente entre meninas - com HIV/Aids, assim como monitorá-la, deve fazer parte da rotina de acompanhamento desses pacientes.

AbstractObjective:To assess the prevalence of physical inactivity among adolescents with HIV/AIDS, as well as associated factors.Methods:Ninety-one adolescents (from 10 to 19 years old) with HIV/AIDS who are patients at a university follow-up service were interviewed. Anthropometric data (weight, height, and waist circumference) were measured twice; clinical information was obtained from medical records, and habitual physical activity was assessed by a questionnaire proposed by Florindo et al. The cutoff point for sedentariness was 300 minutes/week.Results:The prevalence of inadequate height for age, malnutrition, and overweight/obesity was 15.4%, 9.9% and 12.1%, respectively. The most common physical activities were soccer (44.4%), volleyball (14.4%) and cycling (7.8%). The median times spent with physical activity and walking/bicycling to school were 141 min and 39 min, respectively. Most adolescents (71.4%) were sedentary and this proportion was higher among girls (p=0.046).Conclusions:A high prevalence of physical inactivity among adolescents with HIV/AIDS was observed, similar to the general population. Promoting physical activity among adolescents, especially among girls with HIV/AIDS, as well as monitoring it should be part of the follow-up routine of these patients.

RESUMO Objetivo: Relatar as características demográficas e a evolução de pacientes com neoplasia de pulmão de não pequenas células que receberam erlotinibe em qualquer linha de tratamento. Métodos: Coletamos retrospectivamente dados de pacientes portadores de neoplasia de pulmão de não pequenas células que receberam erlotinibe em qualquer linha de tratamento em um hospital geral de referência e em uma clínica particular de oncologia em São Paulo, no período de 2005 a 2011. Foi realizada a análise estatística e foram avaliados aspectos demográficos e resposta ao tratamento estabelecido, correlacionando os resultados dessa primeira coorte publicada no Brasil com resultados da literatura vigente. Resultados: Foram avaliados 44 pacientes, dos quais 65,9% eram portadores de adenocarcinoma e 63,6% tinham doença metastática. A média de idade foi de 63,3 anos. O seguimento mediano foi de 47,9 meses. A pesquisa de mutação do receptor do fator de crescimento epidérmico foi realizada em 22,7% dos pacientes (n=10), resultando positiva em 30% dos avaliados. A sobrevida global mediana foi de 46,3 meses, e observou-se uma probabilidade maior de sobrevida em 60 meses para o grupo feminino, quando comparado ao grupo masculino (29,4% versus 15,8%; p=0,042). As demais variáveis não apresentaram diferença estatística significativa. Conclusão: Coletamos a maior sequência de pacientes com neoplasia de pulmão de não pequenas células que fizeram uso de erlotinibe no Brasil até a data vigente e demonstramos que a evolução dos pacientes tratados no período avaliado teve resultados concordantes com os da literatura vigente em pacientes semelhantes.

ABSTRACT Objective: To report the demographic data and clinical outcomes of non-small-cell lung cancer patients exposed to erlotinib in any line of treatment. Methods: This was a retrospective cohort study of nonsmall-cell lung cancer patients from a reference general hospital and a private oncology clinic, who received erlotinib from 2005 to 2011. Statistical analysis was performed and we evaluated demographic data and response to treatment, by correlating the results of this first cohort published in Brazil with results of current literature. Results: A total of 44 patients were included; 65.9% were diagnosed with adenocarcinoma, and 63.6% had metastatic disease. The mean age was 63.3 years. The median follow-up was 47.9 months. Epidermal growth factor receptor mutation screening was performed in 22.7% of patients (n=10), with mutation present in 30% of patients. The median overall survival was 46.3 months, and there was a higher probability of survival at 60 months for females compared to males (29.4% versus 15.8%; p=0.042). The other variables did not present significant statistical difference. Conclusion: We collected the largest cohort of patients with non-small-cell lung cancer who have used erlotinib in Brazil to date, and demonstrated that outcomes of patients treated at our clinic during the study period were consistent with the results of current literature in similar patients.