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ABSTRACT Introduction. The behavior of COVID-19 is influenced by diverse social differentials that transcend demographic variables and include morbidity, the conditions of their homes, family dynamics, job performance, gender roles and stereotypes, care tasks, habits, and behaviors of life and consumption, among others. Methods. Statistical and demographic analysis and tools of metric studies of the information were used. Results and Discussion. The research showed the importance of incorporating into the analysis of the behavior of COVID-19 in Cuba the influence of social and epidemiological differentials determined by skin color, marital status, employment status, income levels, types of families, mobility, hygienic environmental conditions, access to health services, among others, which can place populations in greater or lesser conditions of vulnerability. Conclusions: The composition and dynamics of the population together with other social differentials are determinants of the behavior and expression of the pandemic. The crossing of epidemiological factors with the analysis of containment measures and the composition and structure of the affected population allows for the design of health policies that are more adjusted to the needs of the pandemic. Distance psychological counseling makes it possible to identify and deal with situations related to confinement and changes in life routines that affect the mental health of different groups of people.

RESUMEN Introducción. El comportamiento de la COVID-19 está influenciado por diferenciales sociales que trascienden las variables demográficas e incluyen la morbilidad, las condiciones de sus viviendas, las dinámicas familiares, el desempeño laboral, los roles y estereotipos de género, las tareas de cuidado, los hábitos y comportamientos de vida y consumo, entre otros. Métodos. Se empleó el análisis estadístico y demográfico y herramientas de los estudios métricos. Resultados y Discusión. La investigación mostró la importancia de incorporar a los análisis del comportamiento de la COVID-19 en Cuba la influencia de diferenciales sociales y epidemiológicos determinados por el color de la piel, el estado conyugal, la situación laboral, los niveles de ingreso, los tipos de familias, la movilidad, las condiciones higiénico ambientales, el acceso a los servicios de salud, entre otros, que pueden ubicar a las poblaciones en mayores o menores condiciones de vulnerabilidad. Conclusiones, la composición y la dinámica de la población junto a otros diferenciales sociales son determinantes del comportamiento de la pandemia. El cruzamiento de los factores epidemiológicos con el análisis de las medidas de contención y la composición y estructura de población afectada permite diseñar políticas sanitarias más ajustadas a las necesidades de la pandemia. La orientación psicológica a distancia permite identificar y atender situaciones vinculadas al confinamiento y los cambios en las rutinas de vida que afectan la salud mental de diferentes grupos de personas.

Histological and Immunohistochemical Characteristics for Hereditary Breast Cancer Risk in a Cohort of Brazilian Women
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Freitas, Renata Mendes de

; Guerra, Maximiliano Ribeiro

; Fayer, Vívian Assis

; Campos, Angélica Atala Lombelo

; Cintra, Jane Rocha Duarte

; Warren, Joan

; Ervilha, Rafaela Russi

; Paula, Camila Damasceno de

; Bustamante-Teixeira, Maria Teresa

Revista Brasileira de Ginecologia e Obstetrícia

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aug 2022, Volume 44 N. 8 Pages 761 - 770

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo O presente estudo buscou caracterizar o perfil clínico, histológico e imunohistoquímico de mulheres com câncer de mama invasivo segundo o risco para a Síndrome de Predisposição Hereditária ao Câncer de Mama e Ovário em uma população brasileira. Métodos Trata-se de um estudo retrospectivo realizado a partir de uma coorte hospitalar composta por 522 mulheres diagnosticadas com câncer de mama entre 2014 e 2016 assistidas em um centro de referência oncológica localizado na região sudeste brasileira. Resultados Entre as 430 mulheres diagnosticadas com câncer de mama invasivo que compuseram a população de estudo, 127 (29,5%) foram classificadas como de risco aumentado para a síndrome de predisposição hereditária ao câncer de mama e ovário. Verificou-se menor nível de escolaridade nas pacientes com risco aumentado (34,6%) quando comparadas àquelas consideradas como de risco habitual (46,0%). Quanto às características do tumor, as mulheres de risco aumentado apresentaram maiores percentuais de doença diagnosticada em estádio avançado (32,3%) e com tumores > 2cm (63,0%), com prevalência aumentada para ambas as características, quando comparadas àquelas de risco habitual. Ainda nas mulheres de risco aumentado, foram encontrados maiores percentuais de GH3 (43,3%) e Ki-67 ≥ 25% (64,6%), com prevalência cerca de duas vezes maior neste grupo. A presença de tumores triplo-negativos foi observada em 25,2% nas mulheres de risco aumentado e 6,0% nas mulheres de risco habitual, com prevalência de ausência de biomarcadores 2,5 vezes maior entre as mulheres do grupo de risco aumentado. Conclusão A partir dos critérios clínicos rotineiramente utilizados no diagnóstico do câncer de mama, a prática assistencial do aconselhamento genético para as pacientes com risco aumentado de câncer de mama hereditário em contextos como o do Brasil ainda é escarça.

Abstract Objective The study aimed to characterize the clinical, histological, and immunohistochemical profile of women with invasive breast cancer, according to the risk for Hereditary Predisposition Breast and Ovarian Cancer Syndrome in a Brazilian population. Methods This is a retrospective study performed from a hospital-based cohort of 522 women, diagnosed with breast cancer treated at an oncology referral center in the Southeast region of Brazil, between 2014 and 2016. Results Among the 430 women diagnosed with invasive breast cancer who composed the study population, 127 (29.5%) were classified as at increased risk for hereditary predisposition to breast and ovarian cancer syndrome. There was a lower level of education in patients at increased risk (34.6%) when compared with those at usual risk (46.0%). Regarding tumor characteristics, women at increased risk had higher percentages of the disease diagnosed at an advanced stage (32.3%), and with tumors > 2cm (63.0%), with increased prevalence for both characteristics, when compared with those at usual risk. Furthermore, we found higher percentages of HG3 (43.3%) and Ki-67 ≥ 25% (64.6%) in women at increased risk, with prevalence being about twice as high in this group. The presence of triple-negative tumors was observed as 25.2% in women at increased risk and 6.0% in women at usual risk, with the prevalence of absence of biomarkers being 2.5 times higher among women in the increased risk group. Conclusion From the clinical criteria routinely used in the diagnosis of breast cancer, the care practice of genetic counseling for patients at increased risk of hereditary breast cancer in contexts such as Brazil is still scarce.

https://doi.org/10.1055/s-0042-1743103

Misdiagnoses in a Brazilian population with amyotrophic lateral sclerosis
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Borghetti, Vinicius Stefani

; Cintra, Vívian Pedigone

; Ramos, Jean de Oliveira

; Marques, Vanessa Daccach

; Onofre, Patrícia Toscano

; Santana, Victor Augusto Souza

; Bezerra, Lua Flora Pereira

; Tomaselli, Pedro José

; Santos, André Cleriston José dos

; Sobreira, Claudia Ferreira da Rosa

; Marques Jr., Wilson

Arquivos de Neuro-Psiquiatria

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jul 2022, Volume 80 N. 7 Pages 676 - 680

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects the upper and lower motor neurons. The correct diagnosis at the onset of the disease is sometimes very difficult, due to the symptoms being very similar to those of other neurological syndromes. Objective This study aimed to analyze the initial manifestations, the specialty of the first physician visited due the initial complaint, the misdiagnoses, as well as the unnecessary surgical interventions in a new ALS Brazilian population. Methods The medical records of 173 patients with typical ALS were reviewed. Results The present study demonstrated that other symptoms, besides weakness, were very frequent as initial presentation of ALS, and orthopedics was the medical specialty most sought by patients at the onset of symptoms. Our frequency of misdiagnoses was 69.7%, and in 7.1% of them, an unnecessary surgical intervention was performed. Conclusions Amyotrophic lateral sclerosis presents a very large pool of signs and symptoms; therefore, there is an urgent need of increasing the disease awareness to other specialties due to the high frequency of misdiagnoses observed in clinical practice.

Resumo Antecedentes A esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa que afeta os neurônios motores superior e inferior. O diagnóstico correto no início da doença é, às vezes, muito difícil, pois os sintomas de início são muito semelhantes aos de outras síndromes neurológicas. Objetivo Este estudo teve como objetivo analisar as manifestações iniciais, a especialidade do primeiro médico visitado devido à queixa inicial, os diagnósticos errôneos, bem como as intervenções cirúrgicas desnecessárias em uma nova população brasileira acometida por ELA. Métodos Os prontuários médicos de 173 pacientes com ELA típica foram revisados. Resultados O presente estudo demonstrou que outros sintomas, além da fraqueza, foram muito frequentes como apresentação inicial da ELA, sendo a ortopedia a especialidade médica mais procurada pelos pacientes no início dos sintomas. Nossa frequência de diagnósticos errôneos foi de 69,7%, e em 7,1% deles foi realizada intervenção cirúrgica desnecessária. Conclusões A ELA apresenta um conjunto amplo de sinais e sintomas; portanto, há necessidade urgente de uma melhor educação de outras especialidades devido à alta frequência de diagnósticos equivocados observada na prática clínica.

https://doi.org/10.1055/s-0042-1755224

Time to diagnosis and treatment for breast cancer in public and private health services
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Campos, Angélica Atala Lombelo

; Guerra, Maximiliano Ribeiro

; Fayer, Vívian Assis

; Ervilha, Rafaela Russi

; Cintra, Jane Rocha Duarte

; Medeiros, Iara Renault de

; Silveira, Matheus Calábria da

; Bustamante-Teixeira, Maria Teresa

Revista Gaúcha de Enfermagem

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2022, Volume 43 elocation e20210103

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

RESUMO Objetivo: Analisar o tempo para o diagnóstico e tratamento do câncer de mama e os fatores associados, segundo o tipo de assistência (pública vs. privada). Métodos: Coorte retrospectiva com 477 mulheres diagnosticadas com câncer de mama entre 2014-2016. Os dados foram coletados em um serviço de oncologia de um município de Minas Gerais, entre 2018-2019. As análises foram realizadas pelo método de Kaplan-Meier e pelo modelo de regressão de Cox. Resultados: O tempo mediano para diagnóstico foi de 70 dias, sendo menor para aquelas que descobriram a doença por exames de rastreamento e diagnosticadas em estádios iniciais. O tempo mediano para o tratamento foi de 32 dias, sendo menor para as mulheres assistidas pela rede privada, com alta escolaridade e diagnosticadas em estádios iniciais. Conclusões: Assistência na rede privada e facilitadores do acesso ao cuidado do câncer de mama associaram-se a menores tempos de espera.

ABSTRACT Objective: To analyze the time to diagnosis and treatment for breast cancer and the associated factors, according to the type of care (public vs. private). Methodology: Retrospective cohort study with 477 women diagnosed with breast cancer between 2014 and 2016. Data were collected in an oncology service in a municipality in Minas Gerais, in the 2018-2019 period. Analyzes were performed using the Kaplan-Meier method and Cox's proportional regression model. Results: The median time to diagnosis was 70 days, being shorter for women who discovered the disease through screening tests and who were diagnosed in early stages of the disease. The median time for treatment was 32 days, which was shorter for women assisted by private health service, with a high level of education and who were diagnosed in early stages. Conclusions: Private care and facilitators of access to breast cancer care were associated with shorter waiting times.

RESUMEN Objetivo: Analizar el tiempo de diagnóstico y tratamiento del cáncer de mama y los factores asociados, según el tipo de assistência (pública vs. privada). Metodología: Cohorte retrospectiva con 477 mujeres diagnosticadas de cáncer de mama entre 2014-2016. Los datos fueron recolectados en un servicio de oncología de Minas Gerais, en el período 2018-2019. Los análisis se realizaron mediante el método de Kaplan-Meier y el modelo de regresión de Cox. Resultados: Mediana de tiempo para el diagnóstico fue de 70 días - menor para las que descubrieron la enfermedad mediante pruebas de detección y que fueron diagnosticadas en etapas tempranas. Mediana de tiempo para tratamiento fue de 32 días - menor para las atendidas por la red privada, con alto nivel educativo y diagnosticadas en etapas tempranas. Conclusiones: Asistencia en la red privada y facilitadores de acceso a la atención del cáncer de mama asociados a tiempos de espera más cortos.

https://doi.org/10.1590/1983-1447.2022.20210103.en

Serological survey for IgG antibodies against SARS-CoV-2 from newborns and their mothers
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Pinheiro, Gabriela Soutto Mayor Assumpção

; Azevedo, Vivian Mara Gonçalves de Oliveira

; Bentes, Aline Almeida

; Januário, Gabriela Cintra

; Januário, José Nélio

; Cintra, Mila Lemos

; Souza, Ana Beatriz Araújo de

; Pires, Laura Gregório

; Lemos, Stela Maris Aguiar

; Alves, Claudia Regina Lindgren

Cadernos de Saúde Pública

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2022, Volume 38 N. 8 elocation e00021022

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Este inquérito sorológico, realizado em cinco municípios brasileiros, avaliou o uso de sangue seco em papel filtro (DBS), obtidas de recém-nascidos e suas mães, para detectar anticorpos IgG SARS-CoV-2. DBS foram obtidas de 4.803 neonatos com até sete dias de vida e suas mães, ambos assintomáticos, em unidades de saúde pública durante a triagem neonatal. DBS foram processadas por ELISA para detectar anticorpos IgG contra o antígeno do nucleocapsídeo SARS-CoV-2. As mães de neonatos soropositivos foram entrevistadas quanto às características sociodemográficas e antecedentes clínicos e laboratoriais. Foram excluídas amostras insatisfatórias, díades com dados incompletos e mães vacinadas. Das 1.917 amostras analisadas, 14,7% dos neonatos apresentaram anticorpos IgG contra SARS-CoV-2. Entre os recém-nascidos soropositivos, 73,2% era filho de mulheres também soropositivas. Mais da metade das mães com recém-nascidos soropositivos negaram suspeita clínica ou laboratorial de COVID-19 durante a gravidez. A suspeita de COVID-19 ocorreu no terceiro trimestre para 24,6% das mães. Este estudo testou uma estratégia inovadora para melhorar a compreensão da dinâmica de anticorpos contra SARS-CoV-2 durante a gravidez e sugere a viabilidade de realização de um inquérito sorológico universal em puérperas e neonatos.

This serological survey, conducted in five Brazilian municipalities, evaluated the use of dried blood spots (DBS), obtained from newborns and their mothers, to detect SARS-CoV-2 IgG antibodies. DBS were obtained from 4,803 neonates aged up to seven days and their mothers, both asymptomatic, at public health care clinics during newborn screening. DBS were processed by ELISA to detect IgG antibodies against SARS-CoV-2 nucleocapsid antigen. Mothers of seropositive neonates were interviewed about sociodemographic characteristics and clinical and laboratory antecedents. Non-satisfactory samples, dyads with incomplete data, and vaccinated mothers were excluded. Of the 1,917 DBS dyads samples analyzed, 14.7% of neonates showed IgG antibodies against SARS-CoV-2. Among seropositive neonates, 73.2% of their mothers were also seropositive. More than half of the mothers with seropositive neonates denied clinical or laboratory suspicion of COVID-19 during pregnancy. Suspicion occurred in the third trimester for 24.6% of the mothers. This study tested an innovative strategy to improve the understanding of COVID-19 antibody dynamics during pregnancy and suggests the feasibility of a universal serological survey in puerperal women and neonates.

Esta encuesta serológica, realizada en cinco municipios brasileños, evaluó el uso de manchas de sangre seca (DBS), obtenidas de recién nacidos y sus madres, para detectar anticuerpos IgG contra el SARS-CoV-2. Se obtuvieron DBS de 4.803 recién nacidos de hasta siete días de edad y sus madres, ambos asintomáticos, en clínicas de salud pública durante el cribado neonatal. Las DBS se procesaron mediante ELISA para detectar anticuerpos IgG contra el antígeno de la nucleocápside del SARS-CoV-2. Se entrevistó a madres de recién nacidos seropositivos sobre características sociodemográficas y antecedentes clínicos y de laboratorio. Se excluyeron muestras no satisfactorias, díadas con datos incompletos y madres vacunadas. De las 1.917 muestras de díadas DBS analizadas, el 14,7 % de los recién nacidos mostró anticuerpos IgG contra el SARS-CoV-2. Entre los recién nacidos seropositivos, el 73,2% de sus madres también eran seropositivas. Más de la mitad de las madres con recién nacidos seropositivos negaron sospecha clínica o de laboratorio de COVID-19 durante el embarazo. La sospecha ocurrió en el tercer trimestre para el 24,6% de las madres. Este estudio probó una estrategia innovadora para mejorar la comprensión de la dinámica de anticuerpos de COVID-19 durante el embarazo y sugiere la viabilidad de una encuesta serológica universal en mujeres puérperas y recién nacidos.

https://doi.org/10.1590/0102-311xen021022

Serological survey for IgG antibodies against SARS-CoV-2 from newborns and their mothers
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Pinheiro, Gabriela Soutto Mayor Assumpção

; Azevedo, Vivian Mara Gonçalves de Oliveira

; Bentes, Aline Almeida

; Januário, Gabriela Cintra

; Januário, José Nélio

; Cintra, Mila Lemos

; Souza, Ana Beatriz Araújo de

; Pires, Laura Gregório

; Lemos, Stela Maris Aguiar

; Alves, Claudia Regina Lindgren

Cadernos de Saúde Pública

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2022, Volume 38 N. 8 elocation e00021022

Abstract: Pt Es En | Text: Pt Es En | PDF: Pt | PDF: Es | PDF: En

https://doi.org/10.1590/0102-311xen021022

Exome sequencing and targeted gene panels: a simulated comparison of diagnostic yield using data from 158 patients with rare diseases
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Quaio, Caio Robledo D’Angioli Costa

; Obando, María José Rivadeneira

; Perazzio, Sandro Felix

; Dutra, Aurelio Pimenta

; Chung, Christine Hsiaoyun

; Moreira, Caroline Monaco

; Novo Filho, Gil Monteiro

; Sacramento-Bobotis, Patricia Rossi

; Penna, Michele Groenner

; Souza, Rafaela Rogerio Floriano de

; Cintra, Vivian Pedigone

; Carnavalli, Juliana Emilia Prior

; Silva, Rafael Alves da

; Santos, Monize Nakamoto Provisor

; Paixão, Daniele

; Baratela, Wagner Antonio da Rosa

; Olivati, Caroline

; Spolador, Gustavo Marquezani

; Pintao, Maria Carolina

; Fornari, Alexandre Ricardo dos Santos

; Burger, Matheus

; Ramalho, Rodrigo Fernandes

; Pereira, Otavio Jose Eulalio

; Ferreira, Elisa Napolitano e

; Mitne-Neto, Miguel

; Kim, Chong Ae

Genetics and Molecular Biology

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2021, Volume 44 N. 4 elocation 20210061

Abstract: En | Text: En | PDF: En

Abstract Next-generation sequencing (NGS) has altered clinical genetic testing by widening the access to molecular diagnosis of genetically determined rare diseases. However, physicians may face difficulties selecting the best diagnostic approach. Our goal is to estimate the rate of possible molecular diagnoses missed by different targeted gene panels using data from a cohort of patients with rare genetic diseases diagnosed with exome sequencing (ES). For this purpose, we simulated a comparison between different targeted gene panels and ES: the list of genes harboring clinically relevant variants from 158 patients was used to estimate the theoretical rate of diagnoses missed by NGS panels from 53 different NGS panels from eight different laboratories. Panels presented a mean rate of missed diagnoses of 64% (range 14%-100%) compared to ES, representing an average predicted sensitivity of 36%. Metabolic abnormalities represented the group with highest mean of missed diagnoses (86%), while seizure represented the group with lowest mean (46%). Focused gene panels are restricted in covering select sets of genes implicated in specific diseases and they may miss molecular diagnoses of rare diseases compared to ES. However, their role in genetic diagnosis remains important especially for well-known genetic diseases with established genetic locus heterogeneity.

https://doi.org/10.1590/1678-4685-gmb-2021-0061 205 downloads

Genetic evidence for a species complex within the piranha Serrasalmus maculatus (Characiformes, Serrasalmidae) from three Neotropical river basins based on mitochondrial DNA sequences
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Bignotto, Thaís Souto

; Maniglia, Thiago Cintra

; Gomes, Vivian Nunes

; Oliveira, Isadora Janolio de

; Agostinho, Carlos Sérgio

; Prioli, Sônia Maria Alves Pinto

; Prioli, Alberto José

Genetics and Molecular Biology

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2020, Volume 43 N. 1 elocation e20190131

Abstract: En | Text: En | PDF: En

Abstract Mitochondrial molecular markers (DNA sequences of D-loop, cytochrome b and cytochrome c oxidase I) were employed to characterize populations of the piranha Serrasalmus maculatus from Upper Paraná, Upper Paraguay and Tocantins River basins. D-loop sequences of S. maculatus population from Paraná-Paraguay River basin exhibited tandem repeats of short motifs (12 base pairs) and variable numbers depending on specimens, accounting for length variation. Concatenated mitochondrial sequences suggested that S. maculatus encompasses different mitochondrial DNA lineages. Although sampling was restricted to three river basins, phylogenetic analysis clearly indicated that the species currently recognized as S. maculatus presents high genetic variability. Maximum likelihood and Bayesian analysis clustered S. maculatus populations according to their locations. However, the highest genetic differentiation was identified between populations from Paraná-Paraguay system and Tocantins River basin. Three species delimitation analyses (PTP, GMYC, and ABGD) suggested that there are at least two species among the analyzed populations. The analysis of the mitochondrial sequences evidenced genetic differentiation among populations corresponding to related, but different species, suggesting that at least S. maculatus from the Tocantins River and Paraná-Paraguay River basins are most likely different species. Therefore, S. maculatus should be considered a species complex with morphologically cryptic diversity. An integrative revision is suggested.

https://doi.org/10.1590/1678-4685-gmb-2018-0131 767 downloads

Disparidade racial na sobrevivência em 10 anos para o câncer de mama: uma análise de mediação usando abordagem de respostas potenciais
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Nogueira, Mário Círio

; Guerra, Maximiliano Ribeiro

; Cintra, Jane Rocha Duarte

; Corrêa, Camila Soares Lima

; Fayer, Vívian Assis

; Bustamante-Teixeira, Maria Teresa

Cadernos de Saúde Pública

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2018, Volume 34 N. 9 elocation e00211717

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Os objetivos foram investigar a associação entre raça/cor e a sobrevivência em 10 anos de mulheres com câncer de mama e o papel do estadiamento como mediador. Coorte hospitalar com 481 mulheres com câncer invasivo de mama, diagnosticadas entre 2003 e 2005. Foram feitas comparações entre mulheres brancas e negras quanto às características sociodemográficas e ao estadiamento, usando o teste qui-quadrado, e à sobrevivência em 10 anos, usando os métodos de Kaplan-Meier e regressão de Cox. Foram estimados para a variável raça/cor efeitos diretos e indiretos, mediados pelo estadiamento, com ajuste para a condição social da área de residência e idade, utilizando o modelo de respostas potenciais (contrafactual) e regressão múltipla de Cox. As mulheres negras residiam em setores censitários de menor renda, eram usuárias do setor público em maior proporção e foram diagnosticadas com estadiamentos mais avançados. A sobrevivência específica em 10 anos foi de 64,3% (IC95%: 60,0; 68,9), com diferença significativa entre brancas (69,5%; IC95%: 64,8; 74,6) e negras (44%; IC95%: 35,2; 55,1). Nos modelos múltiplos, ajustados para renda e idade, as negras tiveram pior prognóstico (HR = 2,09; IC95%: 1,76; 2,51), e a proporção mediada pelo estadiamento foi de 40% (IC95%: 37; 42). Há disparidade racial na sobrevivência do câncer de mama em 10 anos, mediada principalmente pelo estadiamento mais avançado da doença nas mulheres negras. Isso aponta para a necessidade de ampliar a cobertura e a qualidade do programa de rastreamento dessa doença e facilitar o acesso ao diagnóstico e tratamento precoces, com vistas à redução da iniquidade racial.

The study’s objectives were to investigate the association between race/color and 10-year survival in women with breast cancer and the role of staging as mediator. This was a hospital cohort with 481 women with invasive breast cancer diagnosed from 2003 to 2005. Comparisons were made between white and black women as to sociodemographic characteristics and staging, using the chi-square test, and 10-year survival, using Kaplan-Meier and Cox regression methods. For the race/color variable, direct and indirect effects were estimated, mediated by staging, with adjustment for the socioeconomic status of the woman’s area of residence and age, using the potential responses (counterfactual) model and Cox multiple regression. Black women living in low-income census tracts were more likely to use the public health care system and to be diagnosed at more advanced stages. Breast cancer-specific 10-year survival was 64.3% (95%CI: 60.0; 68.9), with a significant difference between whites (69.5%; 95%CI: 64.8; 74.6) and blacks (44; 95%CI: 35.2%; 55.1). In the multivariate models adjusted for income and age, black women had worse prognosis (HR = 2.09; 95%CI: 1.76; 2.51), and the proportion mediated by staging was 40% (95%CI: 37; 42). There is racial disparity in 10-year breast cancer survival in Brazilian women, mediated mainly by more advanced staging at diagnosis in black women. This highlights the need to expand both the coverage and the quality of breast cancer screening and to facilitate access to early diagnosis and treatment in order to reduce racial inequality.

Los objetivos fueron investigar la asociación entre raza/color y la supervivencia en 10 años de mujeres con cáncer de mama y el papel de la fase de desarrollo como mediador. Se trata de una cohorte hospitalaria de 481 mujeres, con cáncer invasivo de mama, diagnosticadas entre 2003 y 2005. Se realizaron comparaciones entre mujeres blancas y negras, en cuanto a las características sociodemográficas y a la fase del cáncer, usando el test chi-quadrado, y la supervivencia en 10 años, usando los métodos de Kaplan-Meier y regresión de Cox. Se estimaron para la variable raza/color efectos directos e indirectos, mediados por las diferentes fases, con ajuste en la condición social del área de residencia y edad, utilizando el modelo de respuestas potenciales (contrafactual) y regresión múltiple de Cox. Las mujeres negras residían en sectores censitarios de menor renta, eran usuarias del sector público en mayor proporción y fueron diagnosticadas en fases más avanzadas. La supervivencia específica en 10 años fue de un 64,3% (IC95%: 60,0; 68,9), con una diferencia significativa entre blancas (69,5%; IC95%: 64,8%-74,6%) y negras (44%; IC95%: 35,2; 55,1). En los modelos múltiples, ajustados para renta y edad, las negras tuvieron un peor pronóstico (HR = 2,09; IC95%: 1,76-2,51), y la proporción mediada por el estadio fue de un 40% (IC95%: 37; 42). Existe disparidad racial en la supervivencia del cáncer de mama en 10 años, mediada principalmente por el estadio más avanzado de la enfermedad en las mujeres negras. Esto apunta la necesidad de ampliar la cobertura y calidad del programa de rastreo de esa enfermedad y facilitar el acceso al diagnóstico y tratamiento precoces, con vistas a la reducción de la inequidad racial.

https://doi.org/10.1590/0102-311x00211717 25 downloads

10.

Disparidade racial na sobrevivência em 10 anos para o câncer de mama: uma análise de mediação usando abordagem de respostas potenciais
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Nogueira, Mário Círio

; Guerra, Maximiliano Ribeiro

; Cintra, Jane Rocha Duarte

; Corrêa, Camila Soares Lima

; Fayer, Vívian Assis

; Bustamante-Teixeira, Maria Teresa

Cadernos de Saúde Pública

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2018, Volume 34 N. 9 elocation e00211717

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0102-311x00211717 2440 downloads

11.

Sobrevida de dez anos e fatores prognósticos para o câncer de mama na região Sudeste do Brasil
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Fayer, Vívian Assis

; Guerra, Maximiliano Ribeiro

; Cintra, Jane Rocha Duarte

; Bustamante-Teixeira, Maria Teresa

Revista Brasileira de Epidemiologia

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dec 2016, Volume 19 N. 4 Pages 766 - 778

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO: Introdução: O câncer de mama é um importante problema de saúde pública em diversas partes do mundo, apresentando relevante incidência e sendo considerado uma das principais causas de óbito por câncer no sexo feminino. Objetivo: Analisar a sobrevida de dez anos e os fatores prognósticos em mulheres com câncer de mama invasivo. Métodos: A coorte foi composta de 195 mulheres assistidas em centro de referência oncológica no município de Juiz de Fora, no estado de Minas Gerais, com diagnóstico da doença em 2000 e 2001. Foram analisadas características sociodemográficas, tumorais e relacionadas à utilização do serviço de saúde e do tratamento. O método Kaplan-Meier foi utilizado para estimar as funções de sobrevida e o modelo de riscos proporcionais de Cox para avaliação dos fatores prognósticos. Resultados: A sobrevida de dez anos após o diagnóstico foi de 56,3%. Os principais fatores prognósticos independentes associados ao aumento do risco de óbito foram tamanho de tumor > 2,0 cm (razão de risco - HR = 1,9; intervalo de confiança - IC95% 1,0-3,2) e presença de linfonodos comprometidos (HR = 3,7; IC95% 2,1-5,9). Conclusão: Os achados reforçam a necessidade da adoção de medidas que assegurem o acesso da população-alvo às modalidades diagnósticas e terapêuticas preconizadas, contribuindo para que sejam alcançados diagnósticos mais precoces e maior tempo de sobrevida.

ABSTRACT: Introduction: Breast cancer is an important public health issue in many parts of the world. Thus, it shows relevant incidence and is considered one of the main causes of death from cancer among women. Objective: To analyze ten-year survival and prognostic factors in women with invasive breast cancer. Methods: The cohort was composed of 195 women assisted in an oncology referral center in the municipality of Juiz de Fora, state of Minas Gerais, Brazil, who were diagnosed with the disease in 2000 and 2001. Sociodemographic, tumoral, health service, and treatment-related characteristics were analyzed. The Kaplan-Meier method was used to estimate the survival functions and the Cox model of proportional hazards for the evaluation of prognostic factors. Results: The ten-year survival after diagnosis was of 56.3%. The major independent prognostic factors associated with increased risk of death were tumor size > 2.0 cm (hazard ratio - HR = 1.9; confidence interval - 95%CI 1.0 - 3.2) and presence of compromised lymph nodes (HR = 3.7; 95%CI 2.1 - 5.9). Conclusion: These findings reinforce the need of adopting actions that ensure access of the target population to the recommended diagnostic and therapeutic modalities, thus contributing to achieve earlier diagnosis and better survival rates.

https://doi.org/10.1590/1980-5497201600040007 1131 downloads

12.

Sobrevida de dez anos e fatores prognósticos para o câncer de mama na região Sudeste do Brasil
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Fayer, Vívian Assis

; Guerra, Maximiliano Ribeiro

; Cintra, Jane Rocha Duarte

; Bustamante-Teixeira, Maria Teresa

Revista Brasileira de Epidemiologia

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dec 2016, Volume 19 N. 4 Pages 766 - 778

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1980-5497201600040007 4812 downloads

13.

Disease-free survival in patients with non-metastatic breast cancer
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Diniz, Roberta Wolp

; Guerra, Maximiliano Ribeiro

; Cintra, Jane Rocha Duarte

; Fayer, Vívian Assis

; Teixeira, Maria Teresa Bustamante

Revista da Associação Médica Brasileira

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aug 2016, Volume 62 N. 5 Pages 407 - 413

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: o câncer de mama é o segundo mais frequente no mundo e o de maior incidência na população feminina, além de ser uma das principais causas de óbito por câncer em mulheres. Objetivo: analisar a sobrevida livre de doença (SLD) em 5 anos e fatores prognósticos em mulheres com câncer de mama invasivo não metastático tratadas em centro de referência em assistência oncológica de cidade de porte médio da região Sudeste do Brasil. Método: foram analisadas as pacientes diagnosticadas com a doença entre 2003 e 2005, identificadas por meio do registro hospitalar de câncer da instituição. O seguimento dos casos foi realizado por meio de consulta aos prontuários, complementada por busca no banco do Sistema de Informação sobre Mortalidade (SIM) e contato telefônico. As variáveis analisadas foram distribuídas nos seguintes blocos: sociodemográficas, características relativas ao tumor e características relativas ao tratamento. As funções de sobrevida foram calculadas por meio do método de Kaplan-Meier. O modelo de riscos proporcionais de Cox foi utilizado para avaliação dos fatores prognósticos. Resultados: o estudo mostrou uma SLD em 5 anos de 72% (IC95%: 67,6-75,9). As principais variáveis associadas à SLD, de forma independente, foram o comprometimento linfonodal, a realização de hormonioterapia e o nível de escolaridade. Conclusão: este estudo reforça a importância do diagnóstico precoce para a SLD, apontando para o papel de aspectos sociais. Destaca-se a relevância desta pesquisa haja vista a escassez de estudos a respeito de SLD na população brasileira.

SUMMARY Introduction: Breast cancer is the second most common malignancy in the world and the one with highest incidence in the female population; it is also a major cause of death from cancer among women. Objective: To analyze the disease-free survival (DFS) at 5 years and prognostic factors in women with non-metastatic invasive breast cancer treated at a referral center for cancer care located in a medium-sized city in the Southeast of Brazil. Method: Patients diagnosed with the disease between 2003 and 2005 and identified through the institution’s cancer hospital records were analyzed. The follow-up of cases was carried out through hospital records, and complemented by search in the database of the Mortality Information System (SIM) as well as telephone contact. The variables analyzed were distributed in the following blocks: socio-demographic data, tumor-related characteristics, and treatment-related characteristics. Survival functions were calculated using the Kaplan-Meier method and the prognostic factors were analyzed based on Cox proportional hazard model. Results: The study showed a DFS at 5 years of 72% (95CI 67.6-75.9). The main variables independently associated with DFS were lymph node involvement, use of hormone therapy, and education level. Conclusion: This study reinforces the importance of early diagnosis for DFS, pointing to the role of social aspects in this regard. The relevance of this research in the country is also highlighted, given the scarcity of studies on DFS in the Brazilian population.

https://doi.org/10.1590/1806-9282.62.05.407 4042 downloads

14.

Estrategia de gestión curricular para tecnólogos de la salud del perfil en Administración y Economía de la Salud
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Walter Sánchez, Vivian

; Izquierdo La O, José Manuel

; Burgal Cintra, Carmen Juana

; Charón Díaz, Kenia

MEDISAN

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may 2016, Volume 20 N. 5 Pages 708 - 717

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

The technologists training in Health Administration and Economy should be permanent and systematic, and pedagogic and methodological aspects should be included that contribute to the professional performance. In this work a curricular management strategy is presented to solve some problems in the comprehensive training and the graduated performance of the speciality in Santiago de Cuba. The strategy consists in 4 stages: diagnosis, projection, method and evaluation. In the first stage the process of these postgraduated technologists' training was diagnosed, the results evidenced inadequacies in the professional performance. The validation and implementation of the curricular management strategy -- elaborated in the last stage -- were carried out by means of the specialists' criteria with the previous implementation of the necessary procedures to gather the information

La preparación de los tecnólogos del perfil en Administración y Economía de la Salud debe ser permanente y sistemática, y en ella se deben incluir aspectos pedagógicos y metodológicos que contribuyan al desempeño profesional. En este trabajo se presenta una estrategia de gestión curricular para solucionar algunos problemas existentes en la formación integral y el ejercicio de los graduados de dicho perfil en la ciudad de Santiago de Cuba. La estrategia consta de 4 etapas: diagnóstico, proyección, metodológica y evaluación. En la primera fase se diagnosticó el proceso de formación posgraduada de estos tecnólogos, cuyos resultados evidenciaron insuficiencias en el desempeño profesional. La validación e implementación de la estrategia de gestión curricular -- elaborada en la última etapa -- se realizaron mediante los criterios de especialistas, previa aplicación de los procedimientos necesarios para la recolección de la información

15.

Metodología para implementar la Medicina Natural y Tradicional en la enseñanza de la Química
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Horruitiner Dominguez, Rafael Adolfo

; Burgal Cintra, Carmen Juana

; Walter Sánchez, Vivian

EDUMECENTRO

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feb 2016, Volume 8 Pages 58 - 73

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: the instrumentation of the interdisciplinary approach implies a form of methodological work that requires to differ from those traditionally used, guided to achieve a meaningful learning in the students. Objective: to design a methodology for the implementation of the Herbal and Folk Medicine (HFM) in the contents of the Chemistry subject, in Health Technology. Methods: it was carried out a development investigation from September 2012 to July 2013 in "Juan Manuel Páez Inchausti" Health Technology faculty of Santiago de Cuba. The study universe comprised all the students who received the Chemistry subject (215) and 12 professors with vast teaching experience, masters in Herbal and Folk Medicine and high teaching ranks. Theoretical, empiric and statistical methods were used which allowed to conform the proposed methodology. Results: it was verified that there are some deficiencies to relate the contents between Herbal and Folk Medicine and Chemistry: most of the students refer that in the classes they only receive knowledge of the mentioned subject, deficiencies exist in the methodological preparation of the professors to integrate both sciences and lack of knowledge about the different modalities of (HFM); That is why a methodology was elaborated that allows the integration and consolidation of both contents in the teaching-learning process. Conclusions: the implementation of the methodology was valued as pertinent by the specialists' criteria for its relevancy, accessibility and scientific and methodological treatment. It fulfills an appropriate structure according to the demands of the model of the technologist's formation and it revitalizes the Chemistry subject teaching-learning process.

Fundamento: la instrumentación del enfoque interdisciplinario implica una forma de trabajo metodológico diferente de las utilizadas tradicionalmente, encaminada a lograr aprendizajes significativos en los estudiantes. Objetivo: diseñar una metodología para la implementación de la Medicina Natural y Tradicional en los contenidos de la asignatura Química, en Tecnología de la Salud. Métodos: se realizó una investigación de desarrollo desde septiembre 2012 a julio 2013 en la Facultad de Tecnología de la Salud "Juan Manuel Páez Inchausti" de Santiago de Cuba. El universo de estudio estuvo conformado por la totalidad de estudiantes (215) que recibieron la asignatura Química y 12 profesores con vasta experiencia en la docencia, másteres en Medicina Natural y Tradicional y categoría docente principal. Se utilizaron métodos teóricos, empíricos y estadísticos que permitieron conformar la metodología propuesta. Resultados: se constató que existen algunas insuficiencias para relacionar los contenidos entre MNT y Química: la mayoría de los alumnos refieren que en las clases solo reciben conocimientos de la mencionada asignatura, existen deficiencias en la preparación metodológica de los docentes para integrar ambas ciencias y desconocimiento acerca de las diferentes modalidades de la MNT; por lo que se elaboró una metodología que permite la integración y consolidación de ambos contenidos en el proceso enseñanza aprendizaje. Conclusiones: la implementación de la metodología fue valorada como adecuada por criterio de especialistas por su pertinencia, asequibilidad y tratamiento científico y metodológico. Cumple con una estructura apropiada según las exigencias del modelo de formación del tecnólogo y dinamiza el proceso enseñanza aprendizaje de la Química.

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