RESUMEN
OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on preterm birth (PB) and low birth weight (LBW), comparing public and private healthcare systems of the National Integrated Health System in Uruguay, where the mitigation measures for the COVID-19 pandemic generated an immediate socioeconomic and psychological crisis, which caused a sharp widening of existing socioeconomic inequalities. METHODS: A national observational study was conducted comparing perinatal outcomes in the first 6 months of 2020 (period of the pandemic without pregnancy infections), which was the beginning of the pandemic, with the same period of the previous year 2019 (pre-pandemic period with no mitigation measures) among pregnant women from the public and private health systems. Data were retrieved from the national database (Informatic Perinatal System) and analyzed by healthcare system category. RESULTS: A total of 36 559 deliveries were assessed: 18 563 in the 2019 study period and 17 996 in the 2020 study period. In the public system, there was a significant increase in the risk of LBW (adjusted relative risk [aRR] 1.12, 95% confidence interval [CI] 1.05-1.36) and of the composite outcome (PB or LBW) (aRR 1.15, 95% CI 1.04-1.26). In the private system, by contrast, there was a non-statistically significant decrease of LBW and there were no changes in the incidence of PB and the composite outcome in 2020. CONCLUSION: The different evolution of birth outcomes in the public and private systems suggests an unequal impact of mitigation measures on populations of different socioeconomic levels. Given that no COVID-19 infections were identified in pregnant women during the study period, this research offers an opportunity to differentiate the biologic effects of the virus from the psychological and social impacts derived from containment measures. GOV IDENTIFIER: NCT05087160.
Asunto(s)
COVID-19 , Nacimiento Prematuro , Recién Nacido , Femenino , Embarazo , Humanos , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Pandemias , Uruguay/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/complicaciones , Recién Nacido de Bajo Peso , Atención a la Salud , Peso al NacerRESUMEN
OBJECTIVE: The present study investigates the influence of lymph node pathological features and HPV DNA status on the prognosis of vulvar invasive tumors. METHODS: This study includes 184 consecutive cases of primary invasive squamous cell carcinoma of the vulva treated by radical surgery from 1975 to 1992, in São Paulo, Brazil. Clinical follow-up data was collected from patient files and hematoxilin-eosin sections were reviewed. HPV detection and typing was done by polymerase chain reaction (PCR), using specific and generic primers, followed by dot blot hybridization (DBH) with type-specific oligonucleotide probes for 19 HPV types. Age-adjusted Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze the cancer risk associations for all DNA and pathology-related variables. RESULTS: Among 161 cases tested by PCR, 38 (23.6%) were positive for high-risk HPV types. Regional lymph nodes of 43 cases, including all those of HPV-positive tumors and a sample of the ones removed from patients with HPV negative tumors, were evaluated by the same method. HPV DNA was found in the lymph nodes of 10 cases. In every case, at least one lymph node was metastatic and the HPV detected in the lymph nodes were of the same type as those found in the primary tumor in all cases. Multivariate analysis including age, race, pattern of invasion, tumor thickness, inflammatory reaction, surgical margins, number of node metastases, presence of extracapsular growth, depth of invasion, and presence of high-risk HPV DNA was performed. Following automated selections of this model, node variables important for prognosis that remained were number of node metastases and presence of extracapsular growth. CONCLUSIONS: Patients with four or more node metastases associated with extracapsular spread were 5.6 (95%CI: 2.3-13.1) times more likely to die from cancer and 10.0 (95%CI: 4.0-24.9) times more likely to have a recurrence than patients without metastases. The HPV status in the tumor was not important as a prognostic factor.
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Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/virología , ADN Viral/análisis , Ganglios Linfáticos/patología , Papillomaviridae/genética , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/virología , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/cirugía , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Humanos , Ganglios Linfáticos/virología , Metástasis Linfática , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/virología , Infecciones por Papillomavirus/genética , Estudios Retrospectivos , Infecciones Tumorales por Virus/genética , Neoplasias de la Vulva/cirugíaRESUMEN
OBJECTIVE: To identify the predictive factors (with emphasis on diagnostic delay) associated with the diagnosis of an advanced-clinical stage head and neck cancer. DESIGN: Cross-sectional study of patients with head and neck cancer originally recruited for a case-control study. SETTING: Three referral oncological centers in metropolitan areas in southern Brazil: São Paulo, Curitiba, and Goiânia. PATIENTS: The study population comprised 679 patients recently diagnosed as having a previously untreated head and neck squamous cell carcinoma. MAIN OUTCOME MEASURE: Diagnosis of advanced disease (clinical stage III-IV) head and neck cancer. RESULTS: Patients with laryngeal and hypopharyngeal cancers were more likely to be diagnosed as having advanced disease than those with lip, oral, and oropharyngeal cancers (88.0% vs 74.6%) (P<.001). Patient delay was inversely associated with clinical stage at diagnosis in patients with the same cancers, while professional delay was directly associated with a higher risk of advanced clinical stage at diagnosis (P =.001 and P =.006, respectively). In the analysis of laryngeal and hypopharyngeal cancer, both patient and professional delays were associated with advanced disease, with patient delay being a stronger predictive factor than professional delay. CONCLUSIONS: Clinical stage at diagnosis was associated with sociodemographic characteristics, patient delay, and professional delay. Our results indicate that continued educational programs for the population and health care professionals regarding the identification of early symptoms of head and neck cancers are warranted.
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Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Laríngeas/diagnóstico , Neoplasias de los Labios/diagnóstico , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/diagnósticoRESUMEN
BACKGROUND: Most of the evidence identifying determinants of UADT cancer risk comes from hospital-based case-control studies. However, such studies are thought to be influenced by selection bias given the extent of association of tobacco smoking and alcohol drinking with other diseases in the general population. We assessed the extent of selection bias due to inclusion of controls with tobacco or alcohol related diseases in a hospital-based case-control study of upper aero-digestive tract (UADT) cancers in Brazil. METHODS: Risk factor information was obtained from 784 cases and 1568 non-cancer controls. Causes of hospitalization for controls were scored according to their likelihood of association with tobacco and alcohol. Odds ratios (OR) were calculated by conditional logistic regression with and without exclusion of controls with tobacco or alcohol related diseases. RESULTS: The OR for smoking slightly increased after exclusion of controls with tobacco-related diseases, from 15.3 (95% confidence interval [CI]: 9.7, 24.2) among heaviest smokers (pack-years > 91) to 18.6 (95%CI: 11.4, 30.2). The OR for alcohol consumption remained unchanged after exclusion of controls with alcohol related diseases. Associations of low magnitude for some dietary variables (citric fruits, carotene-rich foods, spicy foods, maté tea) and wood stove use were not appreciably affected by the exclusion of controls. CONCLUSION: The bias introduced by controls with tobacco and alcohol related diseases is small, when these exposures are investigated as determinants, and almost negligible when considered as confounders of the association between other factors and UADT cancers.
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Trastornos Relacionados con Alcohol/epidemiología , Neoplasias Laríngeas/epidemiología , Neoplasias de la Boca/epidemiología , Neoplasias Faríngeas/epidemiología , Tabaquismo/epidemiología , Trastornos Relacionados con Alcohol/complicaciones , Sesgo , Brasil/epidemiología , Estudios de Casos y Controles , Factores de Confusión Epidemiológicos , Hospitalización/estadística & datos numéricos , Humanos , Neoplasias Laríngeas/complicaciones , Neoplasias de la Boca/complicaciones , Oportunidad Relativa , Neoplasias Faríngeas/complicaciones , Factores de Riesgo , Sesgo de Selección , Tabaquismo/complicacionesRESUMEN
Introducción: El objetivo del presente trabajo fue estimar los costos de la determinación de receptores hormonales en cáncer de mama en estadios I y II en relación a los beneficios clínicos y riesgo del tratamiento con tamoxifeno en mujeres con tumores positivos para receptores estrogénicos (RE+). Metodología: Se estimaron los efectos del tratamiento adyuvante con tamoxifeno en mujeres con cáncer mamario RE+ a partir de los meta-análisis publicados en la última década. Se estimaron los costos de la determinación de RE, de hormonoterapia, quimioterapia, así como el costo promedio del tratamiento de recurrencias, a partir de los datos obtenidos del CASMU. Se compararon los efectos del tratamiento y los costos con el escenario hipotético en que el tamoxifeno no sea utilizado como adyuvante. Resultados: Se estimó que de cada 200 mujeres diagnosticadas con cáncer de mama en estadio I o II, la terapia con tamoxifeno durante cinco años (20mg/día) evitaría la aparición de 21 recurrencias en cinco años, comparando con el no uso de tamoxifeno como adyuvante(AU)
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Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Receptores de Progesterona/análisis , Tamoxifeno/uso terapéutico , Análisis Costo-EficienciaRESUMEN
Introducción: El objetivo del presente trabajo fue estimar los costos de la determinación de receptores hormonales en cáncer de mama en estadios I y II en relación a los beneficios clínicos y riesgo del tratamiento con tamoxifeno en mujeres con tumores positivos para receptores estrogénicos (RE+). Metodología: Se estimaron los efectos del tratamiento adyuvante con tamoxifeno en mujeres con cáncer mamario RE+ a partir de los meta-análisis publicados en la última década. Se estimaron los costos de la determinación de RE, de hormonoterapia, quimioterapia, así como el costo promedio del tratamiento de recurrencias, a partir de los datos obtenidos del CASMU. Se compararon los efectos del tratamiento y los costos con el escenario hipotético en que el tamoxifeno no sea utilizado como adyuvante. Resultados: Se estimó que de cada 200 mujeres diagnosticadas con cáncer de mama en estadio I o II, la terapia con tamoxifeno durante cinco años (20mg/día) evitaría la aparición de 21 recurrencias en cinco años, comparando con el no uso de tamoxifeno como adyuvante