The study protocol for a multicenter observational headache registry: Brazilian Headache Registry - REBRACEF II

Objective: This article presents the protocol for the Brazilian Headache Registry (REBRACEF), the first national registry designed to systematically collect real-world data on patients with primary and secondary headaches at specialized centers in Brazil. The main objective is to describe the methods for patient selection, the registry infrastructure, data collection, and the standardized instruments used. Methodology: REBRACEF is a prospective, observational, multicenter cohort study conducted in real-world settings. Expected results: This protocol aims to standardize and enable the structuring of the registry, allowing its implementation in other centers across Brazil. It also ensures external feasibility by establishing a robust framework that can be replicated in other national and international healthcare institutions. Conclusion: The registry protocol provides a standardized framework for the collection of real-world data on patients with primary and secondary headaches, facilitating the improvement of headache management and research in Brazil. (AU)

Características de la mortalidad por COVID-19 durante y después de la pandemia en el Perú / Characteristics of COVID-19 mortality during and after the pandemic in Peru

RESUMEN Introducción. La emergencia de COVID-19 causó una pandemia con gran impacto en la mortalidad en Perú. Objetivo. Analizar la magnitud de la mortalidad por COVID-19 e identificar algunas características sociodemográficas. Métodos. Se realizó un estudio descriptivo de tipo ecológico, se analizaron los datos de muertes por COVID-19 durante el periodo 2020-2023, así como indicadores socioeconómicos y demográficos de acceso público. Las variables incluidas en el estudio fueron año de defunción, número de muertes, sexo, grupo etario, provincia de procedencia, región natural, macrorregión, índice de desarrollo humano (IDH), necesidades básicas insatisfechas (NBI) y densidad poblacional. Resultados. Se reportaron 220628 muertes por la COVID-19, de las cuales, 219374 (99,43%) ocurrieron durante la pandemia y 1254 (0,57%) en periodo pospandemia. La tasa de mortalidad acumulada fue de 6,76 muertes/1000 habitantes. La curva de muertes por COVID-19 muestra que entre el 2020-2023 ocurrieron cinco olas siendo la de mayor mortalidad la segunda, seguida por la primera ola. La mortalidad predominó en hombres, adultos mayores (69,77%) y adultos (28,11%). La macrorregión de Lima Metropolitana y Callao tuvo las más altas tasas de mortalidad con 9,36 muertes/1000 habitantes. Las provincias con mayores tasas de mortalidad acumulada fueron las ubicadas en la costa, en quintiles con menos NBI, en quintiles de mayor IDH y en aquellas provincias con mayor densidad poblacional. Conclusiones. La pandemia COVID-19 causó elevada mortalidad en Perú, siendo mayor en varones, adultos mayores, de ciudades de costa, de mayor densidad poblacional y mejores indicadores socioeconómicos.

ABSTRACT Introduction. The COVID-19 emergency caused a pandemic with a great impact on mortality in Peru. Objective. To analyze the magnitude of mortality due to COVID-19 and identify some sociodemographic characteristics. Methods. A descriptive ecological study was carried out, analyzing data on deaths due to COVID-19 during the period 2020-2023, as well as publicly accessible socioeconomic and demographic indicators. The variables included in the study were: year of death, number of deaths, sex, age group, province of origin, natural region, macroregion, human development index (HDI), unmet basic needs (UBN) and population density. Results. 220,628 deaths due to COVID-19 were reported, of which 219,374 (99.43%) occurred during the pandemic and 1,254 (0.57%) in the post-pandemic period; The cumulative mortality rate was 6.76 deaths/1000 inhabitants. The COVID-19 death curve shows that between 2020-2023, five waves occurred, with the second wave having the highest mortality, followed by the first wave. Mortality predominated in men, older adults (69.77%) and adults (28.11%). The macroregion of Metropolitan Lima and Callao had the highest mortality rates with 9.36 deaths/1000 inhabitants. The provinces with the highest cumulative mortality rates were those located on the coast, in quintiles with less NBI, in quintiles with a higher HDI and in those provinces with a higher population density. Conclusions. The COVID-19 pandemic caused high mortality in Peru, being higher in males, older adults, from coastal cities, with higher population density and better socioeconomic indicators.

Epidemiología de la apendicitis aguda en Colombia: Un análisis de las bases de datos administrativas del Ministerio de Salud / Epidemiology of acute appendicitis in Colombia: An Analysis of the Ministry of Health administrative databases

Introducción. La apendicitis aguda es una afección común, con un pico de incidencia entre los 10 y 20 años. La cirugía es el tratamiento preferido y la apendicectomía por laparotomía sigue siendo el estándar, aunque el abordaje laparoscópico ha mostrado menos complicaciones. El objetivo de este artículo fue caracterizar tanto la enfermedad como el tratamiento quirúrgico en Colombia, usando datos de bases oficiales. Métodos. Se accedió a la base de datos del Sistema Integrado de Información para la Protección Social (SISPRO) del Ministerio de Salud de Colombia en febrero de 2023. Se recogieron datos de los pacientes con diagnóstico de apendicitis y con procedimiento de apendicectomía entre 2017 y 2021, y se analizaron por edad, sexo y ubicación geográfica. Resultados. Entre 2017 y 2021 se diagnosticaron 345.618 casos de apendicitis (51,8 % mujeres), con pico de incidencia a los 15-20 años. Se realizaron 248.133 apendicectomías, el 16,7 % por laparoscopia. Los hospitales con más procedimientos reportados estaban en Bogotá, Yopal, Popayán y Florencia. La mortalidad fue de 0,56 % en hombres y 0,51 % en mujeres. Conclusión. La apendicitis es común, con pico a los 10-19 años. Las mujeres tienen mayor probabilidad de apendicectomía, debido a otras afecciones ginecológicas. El acceso a la apendicectomía disminuye la mortalidad; en estos pacientes, el 16 % fue laparoscópica, lo que sugiere que se necesita más entrenamiento y acceso a esta técnica. Este estudio aporta a la comprensión de la epidemiología de la apendicitis y apendicectomías en Colombia.

Introduction. Acute appendicitis is a common condition, with a peak incidence between 10 and 20 years of age. Surgery is the preferred treatment and laparotomy appendectomy remains the standard, although the laparoscopic approach has shown fewer complications. The objective of this article was to characterize both the disease and the surgical treatment in Colombia, using data from official databases. Methods. The Integrated Information System for Social Protection (SISPRO) database of the Ministry of Health was accessed in February 2023. Data with diagnosis of apendicitis and with appendectomy between 2017 and 2021 were collected. Analysis was done by age, gender, and geographic location. Results. Between 2017 and 2021, 345,618 cases of appendicitis were diagnosed (51.8% females), with peak incidence at 15-20 years of age. A total of 248,133 appendectomies were performed, 16.7% by laparoscopy. The hospitals with most reported procedures were located in Bogotá, Yopal, Popayán, and Florencia. Mortality was 0.56% in men and 0.51% in women. Conclusion. Appendicitis is common, peaking at ages 10-19. Women are more likely undergo appendectomy due to other gynecological conditions. Access to appendectomy improves mortality. In these patients, 16% were laparoscopic, suggesting that more training and access to this technique is needed. This study contributes to the understanding of the epidemiology of appendicitis and appendectomies in Colombia.

Identifying malignant mesothelioma by a pathological survey using the São Paulo state hospital cancer registry, Brazil

ABSTRACT Objective: To review the pathological diagnosis of possible cases and/or hidden cases of malignant mesothelioma (MM) between 2000 and 2012 using the Hospital-Based Cancer Registry database in the state of São Paulo, Brazil. Methods: Possible cases were retrieved by assessing the database. Inclusion criteria were being older than 30 years of age and having ICD-O-3 topography and morphology codes related to MM. A board of expert pathologists reviewed the pathology reports and requested paraffin blocks in cases that demanded revision. After staining with calretinin, D2-40, WT-1 (as positive MM markers) and Ber-EP4 and MOC31 (as negative MM markers), cases were divided and studied independently by a pair of pathologists to confirm or discard the diagnosis of MM. Results: Our sample comprised 482 cases from 25 hospitals, and 130 needed further histological revision. We received 73 paraffin blocks with adequate material. After board analysis, there were 9 cases with a definitive diagnosis of MM, improving the diagnostic rate in 12%. Two cases of previously diagnosed MM were discarded by review. Conclusions: Our results confirm that part of MM underdiagnosis and underreporting in Brazil is due to incomplete or mistaken pathological diagnosis.

Association Between Body Mass Index, Obesity, and Clinical Outcomes Following Coronary Artery Bypass Grafting in Brazil: An Analysis of One Year of Follow-up of BYPASS Registry Patients

ABSTRACT Objective: To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. Methods: A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. Results: Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ2=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. Conclusion: Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness.

Comparative effectiveness of abatacept versus TNF inhibitors in rheumatoid arthritis patients who are ACPA and shared epitope positive

Abstract Background The HLA-DRB1 shared epitope (SE) is a risk factor for the development of rheumatoid arthritis (RA) and the production of anti-citrullinated protein antibodies (ACPAs) in RA patients. Our objective was to examine the real-world effectiveness of abatacept versus tumor necrosis factor inhibitors (TNFi) in patients with RA who were SE and anti-cyclic citrullinated peptide antibody (anti-CCP3) positive. Methods Abatacept or TNFi initiators who were SE + and anti-CCP3+ (> 20 U/mL) at or prior to treatment and had moderate or high CDAI score (> 10) at initiation were identified. The primary outcome was mean change in CDAI score over six months. Analyses were conducted in propensity score (PS)-trimmed and -matched populations overall and a biologic-experienced subgroup. Mixed-effects models were used. Results In the overall PS-trimmed (abatacept, n = 170; TNFi, n = 157) and PS-matched cohorts (abatacept, n = 111; TNFi, n = 111), there were numerically greater improvements in mean change in CDAI between abatacept and TNFi but were not statistically significant. Similar trends were seen for biologic-experienced patients, except that statistical significance was reached for mean change in CDAI in the PS-trimmed cohort (abatacept, 12.22 [95% confidence interval (95%CI) 10.13 to 14.31]; TNFi, 9.28 [95%CI 7.08 to 11.48]; p = 0.045). Conclusion In this real world cohort, there were numerical improvements in efficacy outcomes with abatacept over TNFi in patients with RA who were SE + and ACPA+, similar to results from a clinical trial population The only statistically significant finding after adjusting for covariates was greater improvement in CDAI with abatacept versus TNFi in the bio-experienced PS-trimmed cohort. .

Incidence of childhood cancer in Latin America and the Caribbean: coverage, patterns, and time trends / Incidencia del cáncer infantil en América Latina y el Caribe: cobertura de los registros, patrones y tendencias a lo largo del tiempo / Incidência de câncer infantil na América Latina e no Caribe: cobertura, padrões e tendências temporais

ABSTRACT Objective. To provide a comprehensive overview of geographical patterns (2001-2010) and time trends (1993-2012) of cancer incidence in children aged 0-19 years in Latin America and the Caribbean (LAC) and interpret the findings in the context of global patterns. Methods. Geographical variations in 2001-2010 and incidence trends over 1993-2012 in the population of LAC younger than 20 years were described using the database of the third volume of the International Incidence of Childhood Cancer study containing comparable data. Age-specific incidence per million person-years (ASR) was calculated for population subgroups and age-standardized (WSR) using the world standard population. Results. Overall, 36 744 unique cases were included in this study. In 2001-2010 the overall WSR in age 0-14 years was 132.6. The most frequent were leukemia (WSR 48.7), central nervous system neoplasms (WSR 23.0), and lymphoma (WSR 16.6). The overall ASR in age group 15-19 years was 152.3 with lymphoma ranking first (ASR 30.2). Incidence was higher in males than in females, and higher in South America than in Central America and the Caribbean. Compared with global data LAC incidence was lower overall, except for leukemia and lymphoma at age 0-14 years and the other and unspecified tumors at any age. Overall incidence at age 0-19 years increased by 1.0% per year (95% CI [0.6, 1.3]) over 1993-2012. The included registries covered 16% of population aged 0-14 years and 10% of population aged 15-19 years. Conclusions. The observed patterns provide a baseline to assess the status and evolution of childhood cancer occurrence in the region. Extended and sustained support of cancer registration is required to improve representativeness and timeliness of data for childhood cancer control in LAC.

resumen está disponible en el texto completo

RESUMO Objetivo. Apresentar uma visão abrangente dos padrões geográficos (2001 a 2010) e das tendências temporais (1993 a 2012) da incidência de câncer em crianças e jovens de 0 a 19 anos na América Latina e no Caribe (ALC) e interpretar os resultados no contexto de padrões mundiais. Métodos. Foram descritas variações geográficas de 2001 a 2010 e tendências de incidência de 1993 a 2012 na população com menos de 20 anos da ALC usando informações comparáveis da base de dados do terceiro volume do estudo International Incidence of Childhood Cancer. Foram calculadas taxas de incidência específica por idade por milhão de pessoas-ano (ASR, na sigla em inglês) para subgrupos populacionais e taxas padronizadas por idade usando a população padrão mundial (WSR, na sigla em inglês). Resultados. No total, foram incluídos 36 744 casos únicos. No período de 2001 a 2010, a WSR para todos os tumores combinados na faixa etária de 0 a 14 anos foi de 132,6. Os diagnósticos mais frequentes foram leucemia (WSR de 48,7), neoplasias do sistema nervoso central (WSR de 23,0) e linfoma (WSR de 16,6). A ASR para todos os tumores combinados na faixa etária de 15 a 19 anos foi de 152,3, e a maior taxa foi a de linfoma (ASR de 30,2). A incidência foi maior no sexo masculino do que no sexo feminino e maior na América do Sul do que na América Central e no Caribe. De modo geral, em comparação com as estimativas mundiais, a incidência na ALC foi menor, exceto para leucemia e linfoma entre 0 e 14 anos e para outros tumores e tumores não especificados em qualquer idade. A taxa de incidência na faixa etária de 0 a 19 anos aumentou em 1,0% ao ano (IC de 95% [0,6, 1,3]) entre 1993 e 2012. Os registros incluídos cobriam 16% da população de 0 a 14 anos e 10% da população de 15 a 19 anos. Conclusões. Os padrões observados servem de referência para avaliar o status e a evolução da ocorrência de câncer infantil na região. É necessário garantir um apoio ampliado e consistente aos registros de câncer para aprimorar a representatividade e a disponibilidade das informações em tempo adequado para o controle do câncer infantil na ALC.

Avaliação da efetividade da intervenção para aprimoramento do Sistema de Informações sobre Mortalidade em Pernambuco, Brasil: um estudo quase-experimental / Evaluation of the effectiveness of the intervention to improve the Brazilian Mortality Information System in Pernambuco, Brazil: a quasi-experimental study / Evaluación de la efectividad de la intervención para mejorar el Sistema de Informaciones sobre la Mortalidad en Pernambuco, Brasil: un estudio cuasiexperimental

Resumo: Avaliou-se a influência da variação da implantação do Sistema de Informações sobre Mortalidade (SIM) nos resultados antes e depois da intervenção para aprimoramento do sistema em Pernambuco, Brasil. Foram explicitados o modelo lógico e a matriz de indicadores e julgamento do SIM. Coletaram-se dados primários nos 184 municípios e dados secundários na base do sistema. Obteve-se o grau de implantação (GI) a partir de indicadores de estrutura e processo, posteriormente relacionado aos de resultado, com base no modelo. A intervenção foi direcionada às falhas identificadas e se desenvolveu mediante etapas estratégicas. Foi calculado o percentual de variação anual do GI e dos resultados antes e depois da intervenção. Classificou-se o SIM como parcialmente implantado nas avaliações pré (70,6%) e pós-intervenção (73,1%), com incrementos em todos os componentes. As Regiões de Saúde seguiram a mesma classificação do âmbito estadual, excetuando-se a XII (80,3%), com escore implantado, após a intervenção. Cobertura do sistema, óbitos com causa básica definida, transferência mensal e envio oportuno de dados situaram-se acima de 90% nas duas avaliações. Houve melhora na completude das Declarações de Óbito infantil e no registro oportuno de eventos notificáveis. O fortalecimento da gestão e operacionalização do SIM por meio de intervenções aplicadas no contexto de produção dos dados pode aprimorar os resultados do sistema.

Abstract: This study evaluated the influence of the variation in the implementation of the Brazilian Mortality Information System (SIM) on the results, before and after the intervention to improve the system in Pernambuco, Brazil. The SIM logical model and matrix of indicators and assessment were described, primary data were collected from the 184 municipalities and secondary data were collected from the system database. The degree of implementation (DI) was obtained from the indicators of structure and process, and then related to result indicators, based on the model. The intervention was directed at the shortcomings identified, and developed using strategic stages. The percentage of annual variation of the DI and the results before and after the intervention were calculated. The SIM was classified as partially implemented in the pre- (70.6%) and post-intervention (73.1%) evaluations, with increments in all components. The Health Regions followed the same classification of the state level, except for XII (80.3%), regarding implemented score after the intervention. The coverage of the system; deaths with a defined underlying cause; monthly transfer; and timely submission of data were above 90% in both evaluations. There was an improvement in the completeness of infant Death Certificates and in the timely recording of notifiable events. Strengthening the management and operationalization of the SIM with interventions applied to data registration can improve the system's results.

Resumen: Se evaluó la influencia de la variación de la implantación del Sistema de Informaciones sobre la Mortalidad (SIM) en los resultados, antes y después de la intervención para mejorar el sistema en Pernambuco, Brasil. Se explicitaron el modelo lógico y la matriz de indicadores y juicio del SIM, recolectando datos primarios en los 184 municipios y datos secundarios en la base del sistema. Se obtuvo el grado de implantación (GI) a partir de indicadores de estructura y proceso, posteriormente, relacionado con los indicadores de resultado, basado en el modelo. La intervención se dirigió a los fallos identificados y se desarrolló a través de etapas estratégicas. Se calcularon el porcentaje de variación anual del GI y de los resultados antes y después de la intervención. El SIM se clasificó como parcialmente implantado en las evaluaciones previas (70,6%) y posteriores a la intervención (73,1%) con aumento en todos los componentes. Las Regiones de Salud han seguido la misma clasificación del ámbito estatal, salvo la XII (80,3%), con puntaje implantado, después de la intervención. La cobertura del sistema; óbitos debido a causa básica definida; transferencia mensual y envío oportuno de datos, estuvieron por encima del 90% en ambas evaluaciones. Hubo una mejora en la exhaustividad de los Certificados de Muerte infantiles y en el registro oportuno de eventos notificables. Fortalecer la gestión y la implementación del SIM a través de intervenciones aplicadas en el contexto de producción de datos puede mejorar los resultados del sistema.

Spatio-temporal evolution of stroke mortality in Minas Gerais, Brazil, 1980-2021 / Evolución espacio-temporal de la mortalidad por accidentes cerebrovasculares en Minas Gerais, 1980 a 2021 / Evolução espaço-temporal da mortalidade por acidente vascular cerebral em Minas Gerais, 1980 a 2021

ABSTRACT Objective To analyze spatio-temporal evolution of stroke mortality in Minas Gerais state, Brazil, 1980-2021. Methods Ecological study with aggregated data by micro-region. Segmented linear regression was used for trend analysis; maps with rates per five-year period and scan statistics were used for spatial analysis. Results There were 392,521 stroke-related deaths (rate of 52.6/100,000-year). All rates (crude, adjusted, by age group) showed a decreasing trend, less so in the crude rate (Annual Percent Change [APC] = -0.70) and a faster decrease in the 20-39 age group (APC = -4.48). A high-rate cluster was identified in the southern region (1980-1999; Relative Risk [RR] = 2.06), and a low-rate cluster in the northwest (2008-2021; RR = 0.59). The most significant decrease occurred in the south (APC = -3.64). Conclusion Stroke mortality showed a decreasing trend. Clusters and areas with higher rates identified in the northeast in recent years require attention by service managers.

RESUMEN Objetivo analizar la evolución espacio-temporal de la mortalidad por accidentes cerebrovasculares (ACV) en Minas Gerais, 1980-2021. Métodos estudio ecológico, con datos por microrregión. En el análisis de tendencia se utilizó regresión lineal segmentada, en el análisis espacial estadística scan. Resultados Hubo 392.521 muertes por ACV (tasa de 52,6/100.000-años). Todas las tasas (bruta, ajustada, grupos de edad) indicaron una tendencia decreciente, con menor velocidad en tasa bruta (Variación Porcentual Anual [VPA] = -0,70), mayor en el grupo de 20-39 años (VPA = -4,48). Se identificó un conglomerado con tasas altas en el sur (1980-1999; Riesgo Relativo [RR] = 2,06) y uno con tasas bajas en el noroeste (2008-2021; RR = 0,59). El descenso fue más intenso en el sur (VPA = -3,64). Conclusión Se observó tendencia de disminución de mortalidad. La identificación de conglomerados y áreas con mayores tasas en el noreste en los últimos años merece la atención de los gestores.

RESUMO Objetivo Analisar a evolução espaço-temporal da mortalidade por acidente vascular cerebral (AVC) em Minas Gerais, 1980 a 2021. Métodos Estudo ecológico, com dados agregados por microrregião. Na análise de tendência, foi utilizada regressão linear segmentada; na análise espacial, mapas com taxas quinquenais e estatística scan. Resultados Ocorreram 392.521 mortes por AVC (taxa de 52,6/100 mil habitantes-ano). Todas as taxas (bruta, ajustada, por faixas etárias) apresentaram tendência de diminuição, com velocidade menor na taxa bruta (variação percentual anual [VPA] = -0,70) e maior na faixa etária de 20 a 39 anos (VPA = -4,48). Foi identificado um conglomerado no sul com taxas altas (1980-1999; risco relativo [RR] = 2,06), e no noroeste, com taxas baixas (2008-2021; RR = 0,59). A diminuição foi mais intensa no sul (VPA = -3,64). Conclusão Verificou-se tendência de diminuição da mortalidade por AVC. A identificação de conglomerados e áreas com maior risco no nordeste do estado, nos últimos anos, merece atenção dos gestores.

Smoking, mortality, access to diagnosis, and treatment of lung cancer in Brazil / Tabagismo, mortalidade, acesso ao diagnóstico e tratamento de câncer de pulmão no Brasil

ABSTRACT INTRODUCTION Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019. METHOD Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM). RESULTS There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people. CONCLUSION This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies.

RESUMO INTRODUÇÃO O câncer de pulmão (CP) é um relevante problema de saúde pública no Brasil e no mundo, dada sua alta incidência e mortalidade. Assim, objetiva-se analisar a distribuição do tabagismo e da carga tabágica segundo características sociodemográficas e disparidades no acesso, no tratamento e na mortalidade por CP no Brasil, em 2013 e 2019. MÉTODO Estudo retrospectivo de triangulação de fontes de dados de abrangência nacional: a) análise da distribuição do tabagismo, baseada na Pesquisa Nacional de Saúde (PNS); b) investigação dos registros de CP, via Registros Hospitalares de Câncer (RHC); e c) distribuição da mortalidade por CP, no Sistema de Informação sobre Mortalidade (SIM). RESULTADOS Verificou-se redução do percentual de pessoas que nunca fumaram de 2013 (68,5%) para 2019 (60,2%), assim como da carga tabágica (anos-maço). Esta foi observada maior em homens em pessoas de faixas etárias mais avançadas e de menor escolaridade. Em relação aos pacientes registrados no RHC, a entrada no serviço de saúde se dá a partir de 50 anos, e apenas 19% nunca fumaram. Ao passo que os fumantes na população são majoritariamente pardos, os pacientes no RHC são em maioria brancos. Quanto ao estadiamento inicial (I e II), é mais frequente em pessoas brancas e que nunca fumaram. A taxa de mortalidade apresentou variação de 1,00, para pessoas com ensino superior, a 3,36, entre pessoas sem instrução, assim como pessoas brancas têm uma taxa de mortalidade três vezes maior que a de pessoas negras e pardas. CONCLUSÃO Este artigo apontou relevantes disparidades sociodemográficas no acesso ao diagnóstico, tratamento e mortalidade do CP. Assim, recomenda-se: fortalecer o Registro de Câncer de Base Populacional; desenvolver e implementar estratégia de screening de CP no Brasil, uma vez que a realização de estratégias de prevenção e diagnóstico precoce combinadas funcionam melhor no controle da mortalidade pela doença; e investimento contínuo nas políticas de prevenção e controle do tabagismo.

Capacidade intrínseca e mortalidade entre pessoas idosas residentes em uma microrregião de saúde de Minas Gerais / Intrinsic capacity and mortality among older adults living in a health microregion of Minas Gerais

Resumo Objetivo Analisar a capacidade intrínseca e sua capacidade preditiva sobre a mortalidade por todas as causas em pessoas idosas residentes em uma microrregião de saúde de Minas Gerais, Brasil. Método Estudo tipo inquérito domiciliar, de abordagem quantitativa. Os dados foram coletados no domicílio com instrumentos validados no país. Resultados A média do escore de capacidade intrínseca foi de 5,8 (±1,63) pontos. No período de acompanhamento, com média de tempo de seguimento de 58,0 (±13,1) meses, ocorreram 142 óbitos (16,4%). Observou-se que para cada acréscimo no escore de capacidade intrínseca, ocorreu diminuição do risco de mortalidade em 21% (p<0,001). Conclusão A capacidade intrínseca exerceu papel preditivo sobre a mortalidade das pessoas idosas.

Abstract Objective To analyze intrinsic capacity and its ability to predict all-cause mortality in older adults living in a health microregion of Minas Gerais state, Brazil. Method A household survey study with a quantitative approach was conducted. Data were collected at homes using instruments validated for use in Brazil. Results Mean intrinsic capacity score was 5.8 (±1.63) points. During the follow-up period, with a mean follow-up time of 58.0 (±13.1) months, 142 deaths (16.4%) occurred. For each 1 point increase in intrinsic capacity score, there was a 21% reduction in the risk of mortality (p<0.001). Conclusion Intrinsic capacity served as a predictor of mortality in older adults.

Evaluación de la calidad de las estadísticas vitales de niños menores de cinco años. Colombia, 2000-2018

Introducción: Las estadísticas vitales son fundamentales para conocer las condiciones de salud de la población y diseñar intervenciones. De su calidad depende la precisión y validez de las métricas derivadas y la relevancia de las decisiones de política pública. Objetivo: Evaluar la calidad de las estadísticas vitales de niños menores de cinco años en Colombia, entre 2000 y 2018. Métodos: Estudio descriptivo y exploratorio. Se analizó la calidad de los registros de nacidos vivos y defunciones publicados por el DANE, utilizando los criterios recomendados por las Naciones Unidas: exactitud (precisión), cobertura (compleción) y oportunidad. Resultados: Se encontraron registros de nacimientos y defunciones con datos perdidos en categorías que indican gradiente social. El 8,2 % de los registros de defunción tenían como causa básica de muerte códigos poco útiles para la toma de decisiones en salud pública. El 97,8 % de los nacidos vivos fueron registrados durante el mismo año de ocurrencia. El subregistro de la mortalidad infantil se estimó en un 28,9 %, con diferencias entre territorios. Conclusiones: La calidad de las estadísticas vitales en niños menores de cinco años de Colombia mejoró en los 19 años evaluados, en particular en exactitud y oportunidad. Sin embargo, persisten problemas en la asignación de la causa básica de muerte y en el subregistro, con diferencias importantes entre territorios. Mejorar la calidad del sistema de estadísticas vitales debe ser un imperativo ético, en especial para comprender las poblaciones de áreas geográficas históricamente invisibilizadas en el país.

Introduction: Vital statistics are essential to identify the health conditions of a population and design interventions. Vital statistics are essential to understand population health and design public health interventions. The accuracy and validity of the derived metrics and the relevance of public policy decisions depend on its quality. Objetive: To evaluate the quality of the vital statistics of children under five years of age in Colombia, between 2000 and 2018. Methods: A descriptive and exploratory study was carried out and the quality of records of live births and deaths published by DANE was analyzed using the criteria suggested by the United Nations: accuracy (precision), opportunity, and coverage (completeness). Results: Of the death records, 8.2% show codes useless for public health purposes as underlying cause of death. Of the live births, 97.8% were registered during the same year of occurrence. We estimated the underregistration of infant mortality at 28.9%, with differences between territories. Conclusions: The quality of vital statistics of children under five years of age has improved in Colombia in the 19 years analyzed, particularly in accuracy and opportunity. However, problems persist in assigning the underlying cause of death and in underregistration, with significant differences between territories. Improving the quality of the vital statistics system must be an ethical imperative, especially to understand the populations of geographic areas historically invisible in the country.

Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis / Controle intensivo da glicose em adultos em estado grave: um protocolo de revisão sistemática e metanálise de dados individuais de pacientes

ABSTRACT Objective: The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. Data sources: MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. Methods: Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. Primary endpoint: In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. Discussion: This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?' Protocol version 0.4 - 06/26/2023 PROSPERO registration: CRD42021278869

RESUMO Objetivo: Não está claro qual é a meta ideal de concentração de glicose no sangue em pacientes em estado grave. Realizaremos uma revisão sistemática e uma metanálise com dados agregados e de pacientes individuais de estudos controlados e randomizados, comparando o controle intensivo da glicose com o controle liberal da glicose em adultos em estado grave. Fontes de dados: MEDLINE®, Embase, Cochrane Central Register of Clinical Trials e registros de ensaios clínicos (Organização Mundial da Saúde, clinical trials.gov). Os autores dos estudos qualificados serão convidados a fornecer dados individuais de pacientes. Os dados publicados em nível de ensaio qualificado que não apresentem alto risco de viés serão incluídos em uma metanálise de dados agregados se os dados individuais de pacientes não estiverem disponíveis. Métodos: Critérios de inclusão: ensaios clínicos controlados e randomizados que recrutaram pacientes adultos, com meta de glicemia ≤ 120mg/dL (≤ 6,6mmol/L) comparada a uma meta de concentração de glicemia mais alta com insulina intravenosa em ambos os grupos. Estudos excluídos: aqueles com meta de glicemia no limite superior no grupo de intervenção > 120mg/dL (> 6,6mmol/L), ou em que o controle intensivo de glicose foi realizado apenas no período intraoperatório, e aqueles em que a perda de seguimento excedeu 10% até a alta hospitalar. Desfecho primário: Mortalidade intra-hospitalar durante a admissão hospitalar. Desfechos secundários: Mortalidade e sobrevida em outros momentos, duração da ventilação mecânica invasiva, agentes vasoativos e terapia de substituição renal. Utilizaremos metanálise bayesiana de efeito randômico e modelos bayesianos hierárquicos para dados individuais de pacientes. Discussão: Essa revisão sistemática com dados agregados e de pacientes individuais abordará a questão clínica: Qual é a melhor meta de glicose no sangue de pacientes graves em geral? Protocolo versão 0.4 - 26/06/2023 Registro PROSPERO: CRD42021278869

Evolución que ha tenido el manejo del Trauma en Chile

Introducción: El trauma continúa siendo una importante causa de mortalidad en pacientes jóvenes en todo el mundo. Representa un desafío para los sistemas sanitarios, por ser un problema de salud pública. Su manejo en Chile, tradicionalmente, ha sido realizado por cirujanos generales, en servicios de urgencia, ya que no existe la cirugía de trauma como especialidad en nuestro país. Tenemos algunos cirujanos de trauma formados en otros países, pero en un pequeño número. El objetivo de esta revisión es saber cómo funciona, actualmente, el manejo del trauma en nuestro país y qué necesitamos para hacerlo adecuadamente, acercándonos a los estándares de países más desarrollados. Para ello realizamos una breve encuesta y una revisión de la literatura. Conclusión: si bien contamos con más conocimientos y recursos que en décadas pasadas, necesitamos políticas públicas que permitan tener sistemas de trauma, registro y centros de trauma.

Introduction: Trauma continues to be an important cause of mortality among young patients across the globe. It is a challenge for health systems, as it is a Public Health issue. Its management has traditionally been undertaken by general surgeons in Chile, in emergency romos. Trauma surgery does not existe as a specialty in our country. We have some trauma surgeons trained abroad, but in a small number. The aim of this article is to learn how Trauma Surgery works in our country, and what is needed to perform better; bringing it to the standard of highly developed countries. To achieve this we have conducted a brief poll and a narrative review of literature. Conclusion: although our knowledge and resources have improved in comparison to decades ago, we need public policies that allow for trauma systems, registries and trauma centers.

Prevalence of inflammatory myopathies in Colombia: Demographic analysis from the National Health Registry 2012-2018 / Prevalencia de las miopatías inflamatorias en Colombia: análisis demográfico a partir del Registro Nacional de Salud de 2012 a 2018

ABSTRACT Introduction: Using data from the Ministry of Health of Colombia, we performed an analysis of prevalence and general demographic characteristics of patients with inflammatory myopathies, with data from 2012 to 2018. Materials and methods: A descriptive cross-sectional study based on data from the Ministry of Health of Colombia. We used as key terms the diagnostic codes of the International Manual of Diseases related to the diagnosis of inflammatory myopathies. Results: We founded 12,401 individuals with a diagnosis of inflammatory myopathy and estimated an overall prevalence of 25.7 cases per 100,000 inhabitants. This diagnosis is more common in the age group of 65-69 years, and in the female population (64%), with a female-to-male ratio 1.79:1. In addition, we calculated a prevalence of 15.1 cases per 100,000 inhabitants for dermatomyositis and 7.3 cases per 100,000 inhabitants for polymyositis (based on a total population of 48,203). There is little information on the epidemiology of myopathies in Latin America, and records are essential to know their behaviour in populations. In Colombia, the Ministry of Health collects information from the health system, which has nearly universal coverage (around 95%). This information makes it possible to carry out epidemiological studies on different diseases. For the present study we analysed the available data on inflammatory myopathies in Colombia. Conclusions: The present work describes for the first time the demographic characteristics of inflammatory myopathies in the Colombian population based on official data from the Ministry of Health, where the most frequent was dermatomyositis and a predominance in the female population was evidenced.

RESUMEN Introducción: A partir de los datos del Ministerio de Salud de Colombia, se realizó un análisis de la prevalencia y las características demográficas generales de los pacientes con miopatías inflamatorias, con los registros correspondientes a los años 2012 a 2018. Materiales y métodos: Estudio descriptivo de corte transversal en el que se tomaron los datos del Ministerio de Salud de Colombia, utilizando como términos clave los códigos diagnósticos del manual internacional de enfermedades relacionados con el diagnóstico de miopatías inflamatorias. Resultados :Se documentaron 12.401 individuos con diagnóstico de miopatía inflamatoria, con una prevalencia global estimada de 25,7 casos por 100.000 habitantes, siendo más frecuente en el grupo de 65 a 69 anos, con un predominio de afectación en población femenina (64%) y una relación mujer a hombre de 1,79:1. Adicionalmente, se calculó una prevalencia de 15,1 casos por 100.000 habitantes para dermatomiositis y de 7,3 casos por 100.000 habitantes para polimiositis (con base en una población total de 48.203.405). Conclusiones: Este trabajo describe por primera vez las características demográficas de las miopatías inflamatorias en la población colombiana, a partir de los datos oficiales del Ministerio de Salud, donde la más frecuente fue la dermatomiositis, y se evidencia un predominio en población femenina.

Automated extraction of information from free text of Spanish oncology pathology reports

Background: Pathology reports are stored as unstructured, ungrammatical, fragmented, and abbreviated free text with linguistic variability among pathologists. For this reason, tumor information extraction requires a significant human effort. Recording data in an efficient and high-quality format is essential in implementing and establishing a hospital-based-cancer registry Objective: This study aimed to describe implementing a natural language processing algorithm for oncology pathology reports. Methods: An algorithm was developed to process oncology pathology reports in Spanish to extract 20 medical descriptors. The approach is based on the successive coincidence of regular expressions. Results: The validation was performed with 140 pathological reports. The topography identification was performed manually by humans and the algorithm in all reports. The human identified morphology in 138 reports and by the algorithm in 137. The average fuzzy matching score was 68.3 for Topography and 89.5 for Morphology. Conclusions: A preliminary algorithm validation against human extraction was performed over a small set of reports with satisfactory results. This shows that a regular-expression approach can accurately and precisely extract multiple specimen attributes from free-text Spanish pathology reports. Additionally, we developed a website to facilitate collaborative validation at a larger scale which may be helpful for future research on the subject.

Introducción: Los reportes de patología están almacenados como texto libre sin estructura, gramática, fragmentados o abreviados, con variabilidad lingüística entre patólogos. Por esta razón, la extracción de información de tumores requiere un esfuerzo humano significativo. Almacenar información en un formato eficiente y de alta calidad es esencial para implementar y establecer un registro hospitalario de cáncer. Objetivo: Este estudio busca describir la implementación de un algoritmo de Procesamiento de Lenguaje Natural para reportes de patología oncológica. Métodos: Desarrollamos un algoritmo para procesar reportes de patología oncológica en Español, con el objetivo de extraer 20 descriptores médicos. El abordaje se basa en la coincidencia sucesiva de expresiones regulares. Resultados: La validación se hizo con 140 reportes de patología. La identificación topográfica se realizó por humanos y por el algoritmo en todos los reportes. La morfología fue identificada por humanos en 138 reportes y por el algoritmo en 137. El valor de coincidencias parciales (fuzzy matches) promedio fue de 68.3 para Topografía y 89.5 para Morfología. Conclusiones: Se hizo una validación preliminar del algoritmo contra extracción humana sobre un pequeño grupo de reportes, con resultados satisfactorios. Esto muestra que múltiples atributos del espécimen pueden ser extraídos de manera precisa de texto libre de reportes de patología en Español, usando un abordaje de expresiones regulares. Adicionalmente, desarrollamos una página web para facilitar la validación colaborativa a gran escala, lo que puede ser beneficioso para futuras investigaciones en el tema.

Inserção de profissionais de educação física no Sistema Único de Saúde: análise temporal (2007-2021) / Insertion of physical education professionals in the Unified Health System: temporal analysis (2007-2021)

O objetivo desta pesquisa foi descrever e analisar a série temporal da inserção de profissionais de educação física (PEF) no Sistema Único de Saúde (SUS) no período de 2007 a 2021, bem como apresentar a distribuição por regiões e estados de profissionais no território brasileiro. Trata-se de um estudo descritivo e de série temporal que utilizou dados secundários oriundos do sistema de consultas do Cadastro Nacional dos Estabelecimentos de Saúde (CNES). Analisou-se o quantitativo de PEF no SUS nas cinco regiões e nos vinte e seis estados e no Distrito Federal entre 2007 e 2021 e reali-zou-se a análise temporal para verificar a distribuição dos PEF nas regiões brasileiras. Os resultados apontam para um crescimento no número de PEF entre 2007 (n = 22) e 2020 (n = 7.560) em todo o país. Em 2021 observa-se uma redução de 2,8% no quantitativo de PEF. Entre as regiões, os maio-res quantitativos foram observados nas regiões Nordeste e Sudeste, enquanto nos estados a maior concentração foi em Minas Gerais, seguido de São Paulo, Pernambuco, Bahia e Rio Grande do Sul. Observou-se uma tendência crescente de PEF nas regiões Norte e Sul. Conclui-se que o quantitativo de PEF atuantes no SUS teve um crescimento expressivo durante o período analisado, sendo fruto das políticas públicas e programas voltados à promoção da atividade física constituídos ao longo do tempo. Apesar disso, há importantes disparidades geográficas que não devem ser desconsideradas, reforçando a necessidade de estratégias coletivas e investimentos em políticas públicas que fomentem a inserção dos PEF na rede assistencial e de fortalecimento do SUS

The aim of this study was to describe and analyze the time series of physical education professionals (PEF in Portuguese) in the Unified Health System (SUS in Portuguese) from 2007 to 2021, as well as to present their distribution by Brazilian regions and states. This is a time series study which used secondary data from the Consultation System of the National Registry of Health Establishments (CNES in Portuguese). We analyzed the number of PEF in the country, in the five Regions and in the twenty-six States and the Fed-eral District between 2007 and 2021 and the temporal analysis was carried out to verify the distribution of PEF in the Brazilian regions. The results point to an increase in the number of PEF between 2007 (n = 22) and 2020 (n = 7560). In 2021, there is a 2.8% reduction in the amount of PEF. Among the regions, the highest numbers were observed in the Northeast and Southeast regions, while in the states the highest con-centration was in Minas Gerais, followed by São Paulo, Pernambuco, Bahia and Rio Grande do Sul. There was an increasing trend in the distribution of PEF in the North and South regions. The number of PEF working in the SUS had an expressive growth during the analyzed period, being the result of public policies and programs aimed at promoting physical activity constituted over time. Despite this, there are important geographic disparities that should not be disregarded, reinforcing the need for collective strategies and financ-ing in public policies that encourage the insertion of PEFs in the care network and the strengthening of SUS

High incidences of hepatocellular carcinoma – A report from Population-Based Cancer Registry Center in Western Arunachal Pradesh

Background: Primary hepatocellular carcinoma (HCC) is a major health hazard and frequent cause of liver cancers accounting 90% of cancers of liver worldwide. It has high mortality, prevalence, and incidence rate in Sub-Saharan, South Africa, and South-east Asia. Its etiology is associated with infection, dietary habits, and lifestyle factors. Aims and Objectives: The present study was designed to discuss the various possible etiologies for high incidence of HCC in Western Arunachal Pradesh, India. Materials and Methods: Data were collected as one among 33 population-based cancer registries in India under national cancer registry program of national center for disease informatics and research, Indian Council of Medical Research between 2012 and 2014 in Tomo Riba Institute of Health and Medical Sciences, Naharlagun. Data were represented in frequency and percentage using descriptive statistics. Results: With 194 cases, HCC represented 13.5% of overall malignancies in the region. It is 3 times more common in males than in females. Age-adjusted incidence rate for men was 21.44 and for women was 7.05. Conclusion: Western Arunachal Pradesh reported high incidence of hepatocellular carcinoma in the world. This finding may be associated with high prevalence of hepatitis and alcoholism in the region and perhaps also associated with local food habits.

Seguridad de las drogas biológicas y sintéticas dirigidas utilizadas en pacientes con enfermedades reumáticas inmunomediadas. Datos del registro BIOBADASAR 3.0 / Safety of biological and targeted synthetic drugs in patients with immune-mediated rheumatic diseases. Data from the BIOBADASAR 3.0 registry

Introducción: conocer la seguridad de las drogas actualmente disponibles para el tratamiento de las enfermedades reumáticas es muy importante al momento de tomar decisiones terapéuticas objetivas e individualizadas en la consulta médica diaria. Asimismo, datos de la vida real amplían el conocimiento revelado por los ensayos clínicos. Objetivos: describir los eventos adversos (EA) reportados, estimar su frecuencia e identificar los factores relacionados con su desarrollo. Materiales y métodos: se utilizaron datos BIOBADASAR, un registro voluntario y prospectivo de seguimiento de EA de tratamientos biológicos y sintéticos dirigidos en pacientes con enfermedades reumáticas inmunomediadas. Los pacientes son seguidos hasta la muerte, pérdida de seguimiento o retiro del consentimiento informado. Para este análisis se extrajeron datos recopilados hasta el 31 de enero de 2023. Resultados: se incluyó un total de 6253 pacientes, los cuales aportaron 9533 ciclos de tratamiento, incluyendo 3647 (38,3%) ciclos sin drogas modificadoras de la enfermedad biológicas y sintéticas dirigidas (DME-b/sd) y 5886 (61,7%) con DME-b/sd. Dentro de estos últimos, los más utilizados fueron los inhibidores de TNF y abatacept. Se reportaron 5890 EA en un total de 2701 tratamientos (844 y 1857 sin y con DME-b/sd, respectivamente), con una incidencia de 53,9 eventos cada 1000 pacientes/año (IC 95% 51,9-55,9). La misma fue mayor en los ciclos con DME-b/sd (71,1 eventos cada 1000 pacientes/año, IC 95% 70,7-77,5 versus 33,7, IC 95% 31,5-36,1; p<0,001). Las infecciones, particularmente las de la vía aérea superior, fueron los EA más frecuentes en ambos grupos. El 10,9% fue serio y el 1,1% provocó la muerte del paciente. El 18,7% de los ciclos con DME-b/sd fue discontinuado a causa de un EA significativamente mayor a lo reportado en el otro grupo (11,5%; p<0,001). En el análisis ajustado, las DME-b/sd se asociaron a mayor riesgo de presentar al menos un EA (HR 1,82, IC 95% 1,64-1,96). De igual manera, la mayor edad, el mayor tiempo de evolución, el antecedente de enfermedad pulmonar obstructiva crónica, el diagnóstico de lupus eritematoso sistémico y el uso de corticoides se asociaron a mayor riesgo de EA. Conclusiones: la incidencia de EA fue significativamente superior durante los ciclos de tratamientos que incluían DME-b/sd.

Introduction: knowing the efficacy and safety of the drugs currently available for the treatment of rheumatic diseases is very important when making objective and individualized therapeutic decisions in daily medical consultation. Likewise, real-life data extends the knowledge revealed by clinical trials. Objectives: to describe the reported adverse events (AEs), estimate their frequency and identify factors associated to them. Materials and methods: BIOBADASAR data were used, which is a voluntary, prospective follow-up registry of AEs of biological and synthetic treatments in patients with immune-mediated rheumatic diseases. Patients are followed until death, loss of followup, or withdrawal of informed consent. To carry out this analysis, the data collected up to January 31, 2023 was extracted. Results: a total of 6253 patients were included, who contributed with 9533 treatment periods, including 3647 (38.3%) periods without b/ts-DMARDs and 5886 (61.7%) with b/ts-DMARDs. Among the latter, the most used were TNF inhibitors and abatacept. A total of 5890 AEs were reported in a total of 2701 treatments (844 and 1857 without and with b/ts-DMARDs, respectively), with an incidence of 53.9 events per 1000 patients/ year (95% CI 51.9-55.9). It was higher during the periods with b/ts-DMARDs (71.1 events per 1000 patients/year, 95% CI 70.7-77.5 vs 33.7, 95% CI 31.5-36.1, p<0.001). Infections, particularly those of the upper respiratory tract, were the most frequent AEs in both groups. 10.9% were severe and 1.1% were associated with the death of the patient. 18.7% of the periods with b/ts-DMARDs were discontinued due to an AE, significantly higher than that reported in the other group (11.5%; p<0.001). In the adjusted analysis, b/ts-DMARDs were associated with a higher risk of presenting at least one AE (HR 1.82, 95% CI 1.64-1.96). Similarly, older age, longer evolution time, history of chronic obstructive pulmonary disease, diagnosis of systemic lupus erythematosus, and use of corticosteroids were associated with a higher risk of AE. Conclusions: the incidence of AEs was significantly higher during those treatment periods that included DME-b/sd.

Malignant tumor incidence and mortality in Daishan county,Zhoushan,Zhejiang Province from 2014 to 2019 / 肿瘤

Objective:To provide scientific basis for prevention and control measures of island regions through analyzing the characteristics of malignant tumor incidence and mortality in eastern island areas of China and comparing the data with the national cancer mortality data in the same period. Methods:Using the incidence and mortality data of malignant tumor in Daishan county,Zhoushan collected by the Daishan Center for Disease Control and Prevention(CDC)from 2014 to 2019,which was stratified by gender,the crude incidence rates(CIR)and crude mortality rates(CMR)were calculated,and the top 10 malignant tumors with the highest incidence or mortality rates were then ranked.The Segi's world standard population was used to calculate the age-standardized incidence(ASIR)and age-standardized mortality rate(ASMR).The local data were compared with the national cancer mortality data from 2014 to 2019,and Chi-square test was used to analyze the differences between these two sets of data using the SPSS software.The difference was considered statistically significant when P<0.05. Results:There was a total of 7 305 incidence cases of malignant tumors in Daishan county,Zhoushan from 2014 to 2019.The CIR was 662.39/105 and the ASIR was 306.81/105.Notably,the CIR was the highest in the age group of 75-79 years old.The top 5 malignant tumors with the highest incidence rates were lung cancer(27.15％),gastric cancer(12.76％),liver cancer(10.95％),colorectal cancer(6.92％)and breast cancer(5.42％),whose ASIR were 75.09/105,32.06/105,31.01/105,17.81/105 and 18.36/105,respectively.There was a total of 3 412 mortality cases of malignant tumors in Daishan county,Zhoushan from 2014 to 2019.The CMR was 309.39/105 and the ASMR was 122.73/105.Notably,the CMR was the highest in the age group of 80-85 years old.The top 5 malignant tumors with the highest mortality rates were lung cancer(24.94％),liver cancer(18.64％),gastric cancer(17.00％),colorectal cancer(7.56％)and esophageal cancer(5.72％),whose ASMR were 29.65/105,24.97/105,19.01/105,8.75/105 and 6.60/105,respectively.The total ASMR of malignant tumors in Daishan county,Zhoushan was higher than national total ASMR from 2014 to 2019(100.34/105)(P<0.001).Specifically,the ASMR of gastric cancer,lung cancer and colorectal cancer in Daishan county were significantly higher than national levels(gastric cancer:12.46/105;liver cancer:16.45/105;colorectal cancer:6.63/105)(P<0.01),whereas no significant difference in the ASMR of lung cancer and esophageal cancer between Daishan county and the whole nation(lung cancer:28.06/105;esophageal cancer:7.61/105)was observed. Conclusion:Lung cancer,gastric cancer,liver cancer and colorectal cancer were malignant tumors with higher incidence and mortality rates in Daishan county,Zhoushan from 2014 to 2019.Particularly,the ASMR of gastric cancer,liver cancer and colorectal cancer were significantly higher than the national levels,and these malignant tumors should be considered as the major focus of cancer prevention and control.