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BACKGROUND: In the Brazilian health system, community health facilities consist of multidisciplinary teams that focus on family health, whereas health centers treat mainly illnesses of registered patients. In the present study we compared socio-economic factors and performance of mammography screening (MS) and clinical breast exam (CBE),  respectively, among women who used both types of public health service centers. METHODS: The present study included 180 women aged ≥40 years, who used different health service centers within the same municipal district. Of all 180 women, 110 (41.1%) and 70 (38.9%) used a health center and a community health facility. Logistic regression analysis was performed to calculate odds ratios (ORs) and confidence intervals (CIs) of variables. RESULTS: Regression modeling indicated that women who used the community health facility, performed annual MS 9.52 (OR= 0.105; 95%CI: 0.03- 0.36) times more often (p <0.001). In this model retirement and gynecological service use ≤ each second year, increased annual MS performance 8.16 (95%CI: 1.55- 54.32) and 7.78 (95%CI: 2.54- 23.79) times (p <0.001; p <0.001). Among 113 (62.8%) women who reported strong fear of MS, the chance of its performance was 35.71 (OR= 0.028; 95%CI: 0.02- 0.32) times decreased (p= 0.05). In a second model use of gynecological service ≤ each second year, increased chance of annual CBE performance 7.92 (95%CI: 3.25- 19.29) times (p <0.001). Women who used the community health facility performed annual and bi-annual CBE 2.90 (OR= 0.345; 95%CI: 0.14- 0.86) and 2.97 (OR= 0.337; 95%CI: 0.12- 0.92) times more often, compared to women who used the health center (p =0.030). CONCLUSIONS: Performance of MS and CBE varied both considerable among women who used different types of health service centers. Gynecological service use, fear and socioeconomic variables, additionally influenced regular performance of MS and CBE.

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INTRODUCTION: Despite the increasing incidence of breast cancer among women in Northeast Brazil, there have been no studies on the association between physical activity and attendance to mammography screening. OBJECTIVE: This study of Brazilian women addressed socio-economic variables, physical activity, and knowledge about breast cancer and their impact on attendance to mammography screening. METHODS: A cross-sectional quantitative study was conducted as an epidemiological evaluation. Data were obtained by interviewing 307 women in a public health center. Logistic regression analysis was applied to determine the odds ratio (ORs) and confidence intervals (CI) of variables. RESULTS: Mean age of women was 49.79 (SD=8.63) years and 172 (56.0%) were between 40 and 49 years old. Women aged from 40 to 49 and ≥50 years who performed physical activity, had a 2.4-fold (95% CI: 1.13-5.04) and 10.6-fold (95% CI: 2.66-41.95) increased chance to attend MS every year (p=0.040; p<0.001). Women aged between 40 and 49 years with a low and middle income, had a 10.3-fold (OR=0.097; 95% CI: 0.02-0.53) and 13.2-fold (OR=0.076; 95% CI: 0.11 0.53) decreased chance to attend MS every second year (p=0.007). The MS attendance of women aged ≥50 years with basic education level was 13.3 (OR=0.075; 95% CI: 0.09-0.66) times decreased (p=0.010). CONCLUSION: Physical activity represented an important predictor of MS attendance of all women. The impact of income and education level, in contrast, depended strongly on the age group.

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BACKGROUND: The risk factors for breast cancer (BC) among women in Brazilian populations are poorly understood. To date, few Brazilian studies have addressed the potential association between risk factors and molecular BC subtypes. This case-control study aimed to identify risk factors for BC in a population of Northeast Brazil. METHODS: Data from 313 patients with invasive BC and 321 healthy controls were obtained from medical records from two cancer treatment centres and personal interviews. Of the 313 BC patients, 224 (71.6%) had reached menopause. The following distribution of subtypes was found among 301 patients: (1) Luminal A: 54 (17.9%); (2) Luminal B: 175 (58.1%); (3) HER2/neu: 29 (9.7%); and (4) triple-negative breast cancer (TNBC): 43 (14.3%). Odds ratios (ORs) and confidence intervals (CIs) were determined using regression analysis. RESULTS: Regression modelling indicated that family history, obesity (≥ 30.0 kg/m2), alcohol consumption and contraceptive use increased the overall risk of BC 1.78 (95% CI: 1.22-2.59), 1.69 (95% CI: 1.08-2.63), 2.21 (95% CI: 1.44-3.39) and 2.99 (95% CI: 2.09-4.28) times, respectively. After stratification for menopausal status, alcohol consumption increased the risk of BC 4.15 (95% CI: 2.13-8.11) times, and obesity, as a single variable, increased the risk of BC 2.02 (95% CI: 1.22-3.37) times, only among postmenopausal women. In a case-control analysis, the risk of TNBC and Luminal B breast cancer were 4.06 (95% CI: 1.58-10.42) and 1.87 times (95% CI: 1.13-3.11) higher, respectively, in obese women than in non-obese women. Furthermore, alcohol consumption increased the risk of Luminal A and B subtypes 7.08 (3.40-14.73) and 1.77 (1.07-2.92) times, respectively. CONCLUSION: Family history, contraceptive use, obesity and alcohol consumption increased the risk of BC. Obesity and alcohol consumption differentially increased risk of TNBC and Luminal molecular subtypes.

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O câncer de mama (CM) é o tumor maligno que mais mata mulheres no mundo, sendo considerado um grave problema de saúde pública. Este artigo investiga as ações de enfermeiros atuantes na Atenção Primária à Saúde na prevenção do CM em Campina Grande-PB. Trata-se de um estudo descritivo-exploratório, de abordagem qualitativa, realizado com 10 enfermeiros que atuam em unidades básicas de saúde do referido município, por meio de entrevista semiestruturada. Os dados coletados foram analisados por meio da análise de conteúdo, com o auxílio do software Atlas.ti. Em seus resultados emergiram cinco categorias: Conhecimentos gerais sobre CM; Capacitação profissional e educação em saúde da população; Abordagem clínica do enfermeiro na prevenção do CM; Dificuldades na prevenção; Autoanálise da prática profissional. Entre estas, destacou-se a influência negativa da falta de capacitações para ajustamento das ações dos enfermeiros às diretrizes nacionais de prevenção do CM na Atenção Primária à Saúde.

Breast cancer is the malignant tumor that kills the most women worldwide, being considered a serious public health problem. This article investigates the actions of nurses working in Primary Health Care in the prevention of breast cancer in Campina Grande-PB. This is a descriptive-exploratory study, with a qualitative approach, carried out with 10 nurses who work in basic health units in that city, through semi-structured interviews. The collected data were analyzed through content analysis, with the help of the Atlas.ti software. Five categories emerged from their results: General knowledge about breast cancer; Professional training and health education for the population; Nurses' clinical approach to breast cancer prevention; Difficulties in prevention; Self-analysis of professional practice. Among these, the negative influence of the lack of training to adjust the nurses' actions to the national guidelines for the prevention of breast cancer in Primary Health Care was highlighted.

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Admixed populations have not been examined in detail in cancer genetic studies. Here, we inferred the local ancestry of cancer-associated single nucleotide polymorphisms (SNPs) and haplotypes of a highly admixed Brazilian population. SNP array was used to genotype 73 unrelated individuals aged 80-102 years. Local ancestry inference was performed by merging genotyped regions with phase three data from the 1000 Genomes Project Consortium using RFmix. The average ancestry tract length was 9.12-81.71 megabases. Strong linkage disequilibrium was detected in 48 haplotypes containing 35 SNPs in 10 cancer driver genes. All together, 19 risk and eight protective alleles were identified in 23 out of 48 haplotypes. Homozygous individuals were mainly of European ancestry, whereas heterozygotes had at least one Native American and one African ancestry tract. Native-American ancestry for homozygous individuals with risk alleles for HNF1B, CDH1, and BRCA1 was inferred for the first time. Results indicated that analysis of SNP polymorphism in the present admixed population has a high potential to identify new ancestry-associated alleles and haplotypes that modify cancer susceptibility differentially in distinct human populations. Future case-control studies with populations with a complex history of admixture could help elucidate ancestry-associated biological differences in cancer incidence and therapeutic outcomes.

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Este estudo caso-controle teve como objetivo identificar os fatores que modificam o risco de câncer de próstata em pacientes de um hospital público da Paraíba. Dados de 91 pacientes e 91 controles saudáveis pareados por idade (± 5 anos) foram obtidos de prontuários médicos e entrevistas pessoais. A razão de chance e os intervalos de confiança foram determinados por meio de análise de regressão. Pacientes e controles tinham em média 69,56 (DP = 8,31) e 68,32 (DP = 7,68) anos (p = 0,297). Afrodescendentes e homens que já fumaram, tiveram um risco 4,150 e 3,939 vezes maior (p <0,001; p <0,001). A história familiar aumentou o risco 6,967 vezes (p <0,001). Ascendência africana, tabagismo e história familiar aumentaram o risco de câncer de próstata. As recomendações das autoridades de saúde em relação ao rastreamento do câncer de próstata poderiam se concentrar mais nos homens com esses fatores de risco.

This case-control study aimed on the identification of factors that modified prostate cancer risk of patients in a public hospital of Paraíba. Data from 91 patients with prostate cancer and 91 age- matched (±5 years) healthy controls were obtained from medical records and personal interviews. Odds ratios (ORs) and confidence intervals (CIs) were determined using regression analysis. Patients and controls were on average 69.56 (SD= 8.31) and 68.32 (SD= 7.68) years old (p = 0.297). In a model of multiple regression analysis, Afrodescendants and men who ever smoked had a 4.150 and 3.939 times increased risk (p < 0.001; p < 0.001). Family history of first- degree relatives was associated with a 6.967 (p < 0.001) increased risk of prostate cancer. African ancestry, smoking and family history increased the risk of prostate cancer. Recommendations of health authorities regarding prostate cancer screening could stronger focus on men with these risk factors.

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The incidence and mortality rates of colorectal cancer (CRC) in Northeast Brazil are increasing. To study the association between CRC and diet, data were obtained from 64 patients with CRC and 123 sex- and age-matched controls. The dietary details were recorded using a validated food frequency questionnaire. Nutrient intake was calculated using Dietsys software (National Cancer Institute, Maryland, USA). In a binary logistic regression model of dietary components (model 1), the chance of CRC increased by 0.2% (odds ratio [OR] = 1.002; 95% confidence interval [CI]: 1.000-1.004) for each gram of processed meat intake per week (p < 0.010). Consumption of eggs decreased the chance by 0.1% per gram (OR = 0.999; 95% CI: 0.998-1.000; p < 0.050). The use of oil (including olive oil) for served food decreased the chance by 1.8% (OR = 0.982; 95% CI: 0.970-0.992) for each time consumed (p < 0.010). In a model of nutritional factors (model 2), intake of vitamin E decreased the chance by 16.8% (OR = 0.832; 95% CI: 0.725-0.940) for each milligram intake per week (p < 0.010). In model 1 and 2 smoking increased the chance of CRC by 10.294 (95%CI: 4.240-27.670) and 2.496 (95% CI: 1.425-3.566) times (p < 0.010; p < 0.010), respectively.

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OBJECTIVE: To evaluate the association between socioeconomic factors, health status, and Functional Capacity (FC) in the oldest senior citizens in a metropolis and a poor rural region of Brazil. METHOD: Cross-sectional study of 417 seniors aged ≥80 years, data collected through Brazil's Health, Well-being and Aging survey. FC assessed by self-reporting of difficulties in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Chi-square tests and multiple logistic regression analyses were performed using "R" statistical software. RESULTS: Socioeconomic and demographic inequalities in Brazil can influence FC in seniors aged 80 years and older. Comparatively, urban long-lived people had a higher prevalence of difficulties for ADLs and rural ones showed more difficulties for IADLs. Among urban oldest seniors, female gender and lower-income were correlated with difficulties for IADLs. Among rural oldest seniors, female gender, stroke, joint disease, and inadequate weight independently were correlated with difficulties for ADLs, while the number of chronic diseases was associated with difficulties for IADLs. CONCLUSION: Financial constraints may favor the development of functional limitations among older seniors in large urban centers. In poor rural areas, inadequate nutritional status and chronic diseases may increase their susceptibility to functional decline.

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BACKGROUND: The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies. DESIGN AND METHODS: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals. RESULTS: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050). CONCLUSION: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic- histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.

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This paper deals with the frequency and structure of first-cousin marriages, by far the most important and frequent type of consanguineous mating in human populations. Based on the analysis of large amounts of data from the world literature and from large Brazilian samples recently collected, we suggest some explanations for the asymmetry of sexes among the parental sibs of first-cousin marriages. We suggest also a simple manner to correct the method that uses population surnames to assess the different Wright fixation indexes FIS, FST and FIT taking into account not only alternative methods of surname transmission, but also the asymmetries that are almost always observed in the distribution of sexes among the parental sibs of first-cousins.

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