Uma análise da prevenção do câncer de mama no Brasil / An analysis of breast cancer prevention in Brazil

ResumoA presente pesquisa se propõe a estudar as inter-relações entre a prevenção do câncer de mama e os fatores socioeconômicos, demográficos, comportamentais, regionais e de saúde na determinação da frequência temporal à busca por prevenção via realização de mamografias e exames de mama no Brasil. A partir das informações do suplemento de saúde da Pesquisa Nacional por Amostra de Domicílios, de 2008, foi construída uma amostra que contempla apenas mulheres com mais de 40 anos de idade. Para o atendimento do objetivo proposto, faz-se uso da estimação do modelo logit, ordenado de chances proporcionais parciais, que indicaram como principais resultados: i) melhores condições socioeconômicas, residir nas regiões mais desenvolvidas do país, uma composição familiar que inclua filhos, apresentar uma boa autoavaliação da própria saúde e já ter sido diagnosticada com algum tipo de câncer, desenham o perfil da mulher que mais se previne contra o câncer de mama, tanto em relação à procura por mamografia, como a uma maior demanda por exame de mama realizado por médico ou enfermeiro e; ii) os resultados apontam ainda para o fato de que grande parte das entrevistadas realizaram os exames em questão há pelo menos um ano, ou nunca passaram por tais procedimentos.

AbstractThis research sets out to study the interrelationship between breast cancer prevention and the socioeconomic, demographic, behavioral, regional and health factors in determining the temporal frequency of tests for prevention by performing mammograms and breast exams in Brazil. Based on the information of the health supplement of the National Sampling Survey of Domiciles of 2008, a sample that includes only women over age 40 was created. To achieve the desired goal, the estimate of the ordered logit model is used to establish partial proportional odds, which revealed the main results as follows. Women with a good socioeconomic status, living in the more developed regions of the country, family structure including children, making a good self-assessment of health and having been diagnosed with some type of cancer in the past. This is the profile of women who are best at preventing breast cancer, both in relation to the demand for mammograms and to a greater demand for breast exam performed by a doctor or a nurse. The results also point to the fact that the majority of those interviewed had either had the tests in question within the previous year, or had never been exposed to such procedures.

Deficiências minerais em vacas em lactação da bacia leiteira do município de Rondon do Pará, estado do Pará / Mineral deficiencies in lactating cows from the dairy basin of Rondon do Pará, Brazil

Realizou-se um estudo das deficiências minerais em vacas em lactação de rebanhos leiteiros pertencentes a 13 propriedades da bacia leiteira do município de Rondon do Pará, estado do Pará. Foram determinados os níveis de fósforo (P) no osso, e os níveis de cobre (Cu), cobalto (Co), selênio (Se) e zinco (Zn) no fígado de 47 vacas leiteiras no 2º terço da lactação. Estas amostras foram coletadas por meio de biópsias realizadas no terço superior da 12a costela do lado direito e no bordo caudal do lobo caudado do fígado, respectivamente. Os rebanhos eram formados por animais mestiços (Holandes x Zebu), mantidos em sistema de produção extensivo em pastos de Brachiaria brizantha cv Marandu e recebiam suplementação mineral. A mistura mineral em 12 propriedades era do tipo comercial, dita "completa", acrescida de quantidades de NaCl acima do recomendado pelos fabricantes em dez propriedades. Em sete propriedades as misturas minerais eram fornecidas em cochos sem cobertura e em oito, o fornecimento da mistura mineral não era realizado diariamente. Em 11 propriedades, havia históricos clínicos condizentes com deficiências minerais nos rebanhos. Nessas fazendas a retenção de placenta e a osteofagia foram as alterações mais relatadas. Após as análises minerais observou-se deficiência de P em cinco propriedades, de Co em três propriedades, de Se em nove propriedades e de Zn em dez propriedades. Conclui-se que ocorre a deficiência de P, Co, Se e Zn; a suplementação mineral realizada na maioria das propriedades não atendeu as exigências diárias de P, Se e Co, baseadas no consumo estimado de 30 g de NaCl/animal/dia; os cochos pouco adequados ou inadequados para a suplementação, assim como o fornecimento inconstante das misturas minerais possivelmente contribuíram para a deficiência de um ou mais minerais.

A study of mineral deficiencies was performed in lactating cows from dairy herds belonging to 13 farms of Rondon do Pará, state of Pará, Brazil. We determined the levels of phosphorus (P) in the bone and levels of copper (Cu), cobalt (Co), selenium (Se) and zinc (Zn) in the liver of 47 dairy cows in lactation 2. The samples were collected by means of biopsies taken on the top third of the 12th rib of the right side and the caudal edge of the caudate liver lobe, respectively. The herds were composed of crossbred (Holstein x Zebu) cattle, kept in extensive production system on Brachiaria brizantha cv. Marandu pasture and received mineral supplementation. The mineral mixture on 12 farms were commercial type, called "full" and the owners added a quantity of salt above the manufacturer's recommendations on ten farms. The mineral mixtures were provided in troughs without covering on seven farms and on other eight, providing of the mineral mix was not performed daily. On 11 farms there were clinical histories consistent with mineral deficiencies in livestock, and placenta retention and osteophagia were the most frequently reported ones. The results of chemical analysis showed deficiency of P on five farms, of Co on three farms, of Se on nine farms and of Zn on ten farms. It is concluded that the mineral supplementation performed on the farms do not supply the daily demands of P, Se and Co, based on the estimated daily consumption of 30g of NaCl per animal; the little adequate or inadequate troughs for proper supplementation, as well as inconstant supply of mineral mixtures contribute to the deficiency of one or more minerals.

Experimental infection with the Toxoplasma gondii ME-49 strain in the Brazilian BR-1 mini pig is a suitable animal model for human toxoplasmosis

Toxoplasma gondii causes toxoplasmosis, a worldwide disease. Experimentation with pigs is necessary for the development of new therapeutic approaches to human diseases. BR-1 mini pigs were intramuscularly infected with T. gondii with tachyzoites (RH strain) or orally infected with cysts (ME-49 strain). Haematology and serum biochemistry were analysed and buffy coat cells were inoculated in mice to determine tachyzoite circulation. No alterations were observed in erythrocyte and platelet values; however, band neutrophils increased seven days after infection with ME-49. Serology of the mice inoculated with pig blood leucocytes revealed circulating ME-49 or RH strain tachyzoites in the pigs' peripheral blood at two and seven or nine days post-infection. The tachyzoites were also directly observed in blood smears from the infected pigs outside and inside leucocytes for longer periods. Alanine-aminotransferase was high at days 21 and 32 in the RH infected pigs. After 90 days, the pigs were euthanised and their tissue samples were processed and inoculated into mice. The mice serology revealed the presence of parasites in the hearts, ileums and mesenteric lymph nodes of the pigs. Additionally, cysts in the mice were only observed after pig heart tissue inoculation. The infected pigs presented similar human outcomes with relatively low pathogenicity and the BR-1 mini pig model infected with ME-49 is suitable to monitor experimental toxoplasmosis.

Níveis de fósforo disponível em dietas para suínos dos 15 aos 30kg / Available phosphorus levels in diets for pigs from 15 to 30kg

Avaliou-se a suplementação de dietas com fósforo disponível (Pd) para suínos selecionados para deposição de carne, utilizando-se 100 leitões com média de peso inicial de 15,03±0,33kg, distribuídos em delineamento de blocos ao acaso, com cinco tratamentos, cinco repetições e quatro animais por unidade experimental. Os tratamentos foram dieta basal sem suplementação de fosfato bicálcico e outras quatro dietas obtidas pela suplementação da dieta basal com fosfato bicálcico, resultando em cinco concentrações de Pd, 0,106; 0,221; 0,310; 0,406; e 0,493%. As porcentagens de Pd influenciaram o consumo diário de ração, que aumentou de forma linear. O ganho de peso diário aumentou e a conversão alimentar melhorou de forma quadrática até a suplementação máxima de 0,450 e 0,390% de Pd, respectivamente. Não houve efeito da suplementação das dietas sobre a resistência óssea. As porcentagens de Pd influenciaram de forma quadrática os teores de cálcio e de fósforo nos ossos, que aumentaram até a adição máxima de 0,388 e 0,369% de Pd, respectivamente. Não houve efeito da porcentagem de Pd sobre o teor de cinza óssea. Suínos dos 15 aos 30kg exigem maior concentração de Pd para máximo ganho de peso (0,450% ou 5,33g/dia) e melhor conversão alimentar (0,390% ou 4,52g/dia) em relação às recomendações atuais.

The supplementation of diets with available phosphorus (aP) for pigs selected for meat deposition was evaluated, using 100 commercial hybrid piglets, 50 castrated males and 50 females, with average initial weight of 15.03±0.33kg allotted in a randomized block design with five treatments, five replicates, and four pigs, 2 males and 2 females per experimental unit. The treatments were a basal diet and other four diets obtained through basal diet supplementation with dicalcium phosphate to obtain five aP concentrations, 0.106, 0.221, 0.310, 0,406, and 0.493%. The percentages of aP influenced daily feed intake, which increased linearly. Daily weight gain increased and feed conversion improved quadratically up to 0.450 and 0.390% maximum responses. There was no effect of diet supplementation on bone strength. The percentages of aP influenced the calcium and phosphorus contents in the bones, which increased quadratically up to 0.388 and 0.369% maximum responses, respectively. There was no effect of aP percentage in the bone ashe content. Pigs from 15 to 30kg require greater amount of aP in the diet for maximal weight gain (0.450% or 5.33g/d) and greatest feed conversion (0.390% or 4.52g/d) compared to current requirements.

Evaluación de diez especies de pescado para su inclusión como parte de la dieta renal, por su contenido de proteína, fósforo y ácidos grasos

Debido a la complejidad de la enfermedad renal, su tratamiento nutrimental es complicado y muchos alimentos se encuentran restringidos, entre ellos el pescado, por su contenido de fósforo. El objetivo del presente estudio fue cuantificar en el filete de diez especies de pescado, de consumo cotidiano en México: (Cyprinus carpio carpio, Ophichthus rex, Symphurus elongatus, Eucinostomus entomelas, Chirostoma patzcuaro, Bairdiella chrysoura, Salmo salar, Oreochromis urolepis hornorum, Sphyraena guachancho, Istiophorus albicans), el contenido de fósforo (P), proteína (Pr), colesterol, sodio, potasio, vitaminas D3 y E y ácidos grasos n-3 (EPA+DHA); para identificar, aquellos pescados que podrían ser incluidos en la dieta renal. Los análisis se realizaron de acuerdo a las técnicas del AOAC. Con los resultados se calcularon las relaciones entre los nutrimentos benéficos (EPA+DHA, vitaminas) y limitantes (Pr, P, colesterol). Los valores de proteína variaron entre 16.5 y 33.5g/100g de filete; el pescado con mayor contenido de fósforo fue Salmo salar y con menor Symphurus elongatus. La cantidad de EPA+DHA varió desde 79.64mg/100g hasta 1,381.53mg/100g. Tomando en cuenta la relación P/g de Pr recomendada para pacientes renales, todas las especies analizadas exceptuando Salmo salar, Ophichthus rex y Istiophorus albicans pueden ser incluidas en la dieta dependiendo de la etapa de la enfermedad. Considerando la relación entre P/EPA+DHA, las especies recomendadas para el paciente renal son Symphurus elongatus, Bairdiella chrysoura, y Sphyraena guachancho.

Evaluation of ten fish species to be included as part of renal diet, due to their protein, phosphorus and fatty acids content. Because renal disease is highly complex, its nutritional treatment is complicated and many foods are restricted, including fish because its phosphorus content. The aim of the present study was to analyze ten fillet fish species, commonly consumed in Mexico (Cyprinus carpio carpio, Ophichthus rex, Symphurus elongatus, Eucinostomus entomelas, Chirostoma patzcuaro, Bairdiella chrysoura, Salmo salar, Oreochromis urolepis hornorum, Sphyraena guachancho, Istiophorus albicans), to determine their phosphorus (P), protein (Pr), cholesterol, sodium, potassium, vitamins D3 and E, and n-3 PUFA (EPA+DHA) according to the AOAC techniques, in order to identify which species could be included in renal diet; particularly because of their risk:benefit relations (calculated with those results). Protein values ranged from 16.5 to 33.5g/100g of fillet; the specie with the highest phosphorus contest was Salmo salar, and with the lowest, Symphurus elongatus. EPA+DHA quantity ranged from 79.64mg/100g to 1,381.53mg/100g. Considering de P/Pr relation recommended to renal patients, all analyzed species (except Salmo salar, Ophichthus rex and Istiophorus albicans) could be included in their diet. As for the P/EPA+DHA relation, the species most recommended to renal patients are Symphurus elongatus, Bairdiella chrysoura and Sphyraena guachancho.

Modelos matemáticos no estudo do fluxo biológico de fósforo em ovinos que receberam na dieta níveis crescentes do mineral / Mathematical models to study the biological phosphorus flow in sheep fed increasing levels of mineral

Dois modelos compartimentais foram aplicados e comparados para avaliar o fluxo biológico de fósforo em ovinos que receberam dietas com níveis crescentes do mineral - 0, 2, 4 e 6g por dia. Foram utilizados 24 machos, da raça Santa Inês, com média de peso de 33,6kg. Foi utilizado fosfato bicálcico como fonte de fósforo e 32P como traçador. Avaliou-se o fluxo de fósforo entre os compartimentos: trato gastrintestinal, sangue, ossos e tecidos moles, além da ingestão, excreção e balanço do mineral. O incremento na ingestão de P aumentou a perda fecal do mineral. O fluxo de fósforo entre o trato gastrintestinal e o sangue e o fluxo contrário foram influenciados de forma quadrática pelo incremento na ingestão, diminuindo após a ingestão de 5,5g/dia, sem diferença entre os modelos avaliados. Os modelos estudados mostraram diferenças em relação ao fluxo entre sangue, ossos e tecidos moles, sem efeito dos tratamentos sobre o balanço geral do mineral, porém os níveis de ingestão praticados interferiram no fluxo biológico do fósforo. A disponibilidade biológica do fósforo ingerido diminuiu quando a ingestão superou a necessidade do animal, o que aumentou as excreções no ambiente. A quantificação do fluxo biológico de fósforo diferiu quando aplicados os modelos estudados em decorrência da sua estrutura.

Two compartimental models were applied and compared to evaluate the biological flow of P in lambs fed diets containing increasing levels of P (0, 2, 4 and 6g per day). Twenty four Santa Inês lambs with liveweight of 33.6kg were used. Dicalcium phosphate was used as P source and 32P as a tracer. P flow between compartments (gastrointestinal tract, blood, bones and soft tissues), ingestion, excretion and the mineral balance were evaluated. The increase in P intake increased fecal P loss. P flow from gastrointestinal tract to blood stream and opposite flow were affected quadratically by increased P intake, decreasing after the ingestion of 5.5g/day, without a difference among models. The models studied showed differences regarding the P flow between blood, bone and soft tissues, however, the P balance was not affected by the treatments. The increased P levels interfered with the biological P flow in sheep. The bioavailability of P diet decreases when intake exceeds the animal requirement, increasing losses to the environment. The quantification of biological P flow was different between models due to the structure of each one.

effect of dietary phosphorus restriction on the production of 1, 25[OH]2 D3 [calcitriol] in patients with moderate renal insufficiency

Renal osteodystrophy is common in chronic renal failure[CRF]. The retention of phosphate, the diminished production of calcitriol, the hypocalcaemia and the increased level of parathormone[PTH] are inter-related and basic pathogenetic factors 25 patients [14 male and 11 female] with average age of 51.7 +/- 10 years, all having moderate renal failure [glomerular filtration rate between 30-70 mI/minute] were included in this study, The basal serum level of calcitriol D3PTH, calcium[ca], phosphorus [p], creatinine, urea and albumin, also the basal urinary level of p, ca and creatinine were determined. The patients were subjected to special dietary regemen with restriction of p by giving special menus for 3 months, the level of the previously mentioned parameters were re-estimated. The p/creatinine index was used to evaluate the fulfilment of the diet. The basal level of PTH was 76.4 +/- 34 pg/ml [normal range 10-65], calcitriol was 21.6 +/- 3.4 pg/ml [normal range 20-45]. After dietary p restriction the mean level of PTH descended significantly, 74% of the patients showed reduction of PTH. The mean level of calcitriol rose significantly after the diet, all the patients showed an increase in their level. A moderate restriction of p in the diet has produced an improvement of the level of serum calcitriol, obtaining a level similar to that of healthy subjects, also reduction of the level of PTH has been obtained near the normal range. This diet represent an easy therapeutic maneuver and without cost In the way of prevention of secondary hyperparathyroidism and consequent osteodystrophy in patients with CRF