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BACKGROUND: In Brazil, 211 thousand (16.14%) of all death certificates in 2016 identified cancer as the underlying cause of death, and it is expected that around 320 thousand will receive a cancer diagnosis in 2019. We aimed to describe trends of cancer mortality from 1996 to 2016, in 133 intermediate regions of Brazil, and to discuss macro-regional differences of trends by human development and healthcare provision. METHODS: This ecological study assessed georeferenced official data on population and mortality, health spending, and healthcare provision from Brazilian governmental agencies. The regional office of the United Nations Development Program provided data on the Human Development Index in Brazil. Deaths by misclassified or unspecified causes (garbage codes) were redistributed proportionally to known causes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed calculating trends for each region, sex and cancer type. RESULTS: Trends were predominantly on the increase in the North and Northeast, whereas they were mainly decreasing or stationary in the South, Southeast, and Center-West. Also, the variation of trends within intermediate regions was more pronounced in the North and Northeast. Intermediate regions with higher human development, government health spending, and hospital beds had more favorable trends for all cancers and many specific cancer types. CONCLUSIONS: Patterns of cancer trends in the country reflect differences in human development and the provision of health resources across the regions. Increasing trends of cancer mortality in low-income Brazilian regions can overburden their already fragile health infrastructure. Improving the healthcare provision and reducing socioeconomic disparities can prevent increasing trends of mortality by all cancers and specific cancer types in Brazilian more impoverished regions.

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Over the last 43 years, surveys of over 200,000 subjects in Jamaica have identified ß-thalassemia (ß-thal) mutations. In most, these genes were detected at birth in patients with sickle cell-ß-thal and so the prevalence and distribution would not be influenced by subsequent clinical course. There were two newborn populations, 100,000 deliveries in the corporate area between 1973-1981 and 84,940 in south and western Jamaica between 2008-2016. A third population, which derived from the Manchester Project in central Jamaica, screened 16,612 secondary school children, aged predominantly 15-19 years, and identified 150 students with the ß-thal trait and 11 with sickle cell [Hb S (HBB: c.20A>T)]- or Hb C (HBB: c.19G>A)-ß-thal. The latter patients may have been subject to symptomatic selection, but this should not have affected those with ß-thal trait. Of the 24 different molecular mutations, ß0-thal genes accounted for 10.0-27.0% of these groups and most common was IVS-II-849 (A>G) (HBB: c.316-2A>G). Of the ß+ mutations, seven subjects had severe genes with low levels of ß chain synthesis but the majority were benign mutations in the promoter region. The -29 (A>G) (HBB: c.-79A>G) mutation dominated in the newborn study in Kingston, similar to experiences in Guadeloupe and African Americans but the -88 (C>T) (HBB: c.-138C>T) mutation was more common among school students in central Jamaica. Caribbean populations are genetically heterogeneous but variations within different parts of Jamaica is of potential importance for prenatal diagnosis and genetic counseling. This information may also be useful among the large Jamaican diaspora.

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A lo largo de la historia la geografía y la medicina han compartido sus espacios, pues dentro de sus objetivos de estudio se encuentra el hombre como pilar esencial en ambas disciplinas. Analizar el desarrollo de la geografía médica o de la salud en Cuba es el propósito de este artículo. El trabajo se estructura en tres partes fundamentales: la primera aborda el surgimiento de la geografía médica o geografía de la salud, la segunda trata de la incorporación y desarrollo de los Sistemas de Información Geográfica y la tercera hace referencia a algunos de los estudios realizados sobre esta temática en Cuba. Los resultados palpables que se han consolidado a lo largo de los años demuestran que la geografía médica es una rama de la geografía que ha cobrado mayor fuerza con el surgimiento de los Sistemas de Información Geográfica. En Cuba la geografía médica fue favorablemente aceptada y un ejemplo de ello es la incorporación de geógrafos en el sistema nacional de salud, fundamentalmente en el área de higiene y epidemiología. Existen numerosos trabajos que abordan el análisis espacial dentro de la relación salud/enfermedad y causa /efecto que generan nuevos conocimientos de la situación actual de salud, facilitando la toma de decisiones a diferentes niveles(AU)

Throughout history, geography and medicine have had common objects of study, for man is the essential pillar in both disciplines. The present review is aimed at analyzing the development of medical or health geography in Cuba. The paper consists of three main sections. The first one approaches the emergence of medical or health geography, the second deals with the incorporation and development of Geographic Information Systems, and the third refers to some studies conducted on the subject in Cuba. The palpable results obtained throughout the years show that medical geography is a branch of geography which has gained greater strength with the emergence of Geographic Information Systems. Medical geography was welcomed in Cuba, an example of which is the incorporation of geographers into the national health system, mainly in the area of hygiene and epidemiology. Numerous studies address spatial analysis within health / disease and cause / effect relationships, generating new knowledge about the current health situation and facilitating decision making on various levels(AU)

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Public health data is often highly aggregated in time and space. The consequences of temporal aggregation for modeling in support of policy decisions have largely been overlooked. We examine the effects of changing temporal scale on spatial regression models of pediatric diarrhea mortality patterns, mortality rates and mortality peak timing, in Mexico. We compare annual and decadal level univariate models that incorporate known risk factors. Based on normalized sums of squared differences we compare between annual and decadal coefficients for variables that were significant in decadal models. We observed that spurious relationships might be created through aggregating time scales; obscuring interannual variation and resulting in inflated model diagnostics. In fact, variable selection and coefficient values can vary with changing temporal aggregation. Some variables that were significant at the decadal level were not significant at the annual level. Implications of such aggregation should be part of risk communication to policy makers.

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