Metal levels in waste pickers in Brasilia, Brazil: hair and nail as exposure matrices.

The aim of this cross-sectional study was to compare workplace conditions and metal exposures in 431 waste pickers who worked nearby at the Estrutural Dump in Brasilia utilizing hair (n = 310) and nail (n = 355) as matrices of exposure. Waste pickers were grouped according to their workplace (open waste dump: G1 and sorting plants: G2). Hair and nail samples were collected and analyzed using ICP-MS. The work duration in the facilities was significantly different between the groups with averages of 16.46 (8.48) yrs and 9.26 (6.28) yrs for hair donors in G1 and G2, and 15.92 (7.72) yrs and 8.55 (5.77) yrs for toenail donors in G1 and G2, respectively. The arithmetic means (µg/g) of cadmium, copper, lead, and manganese in hair were significantly higher in G2 (0.076 ± 0.133; 19.61 ± 18.16; 2.27 ± .56 and 3.87 ± 5.59, respectively) compared to G1 (0.069 ± 0.235; 15.72 ± 15.18; 1.72 ± 4.04 and 3.65 ± 5.5, respectively). Concentrations of arsenic, barium, cadmium, copper, cobalt, lead, manganese, and molybdenum in nail were significantly higher in G2 (0.57 ± 0.39; 22.74 ± 42.06; 0.1 ± 0.08; 22.7 ± 51.60; 0.48 ± 0.45; 4.69 ± 9.43; 19.07 ± 20.75; 1.80 ± 1.76, respectively) compared to G1 (0.40 ± 0.28; 15.32 ± 22.31; 0.08 ± 0.11; 11.91 ± 16.25; 0.37 ± 0.37; 3.94 ± 15.04; 13.01 ± 19.08; 1.16 ± 1.80, respective. Our findings suggest that the studied population was exposed to toxic metals and indicates the need for chemical exposure prevention policies to monitor chemical risk exposures in waste pickers.

Epidural analgesia and tattoos: a modified technique to minimise risks and improve safety.

A healthy young woman with a sizeable lumbar tattoo was admitted to the delivery room in active labour at full-term gestation. She was experiencing strong, painful contractions and anxiety, concerned about the possible risks of receiving an epidural through a tattoo. Although there is little published evidence to suggest complications of performing an epidural through a tattoo, some studies report 'tissue coring phenomenon'. The anaesthesiology team informed the patient of the risks inherent in a traditional epidural and the potential long-term risks of receiving an epidural through the tattoo. Upon signing the informed consent form, the modified epidural technique was performed, and its administration proceeded without complications. A healthy boy was born 3.5 hours later in a vacuum-assisted delivery. This article describes the modified epidural technique designed to minimise tissue coring, and the results of 18 months of uneventful patient follow-up.

Validity, reliability and responsiveness of the Safety Attitudes Questionnaire for Emergency Care Units.

OBJECTIVE: To evaluate the evidence of validity, reliability and responsiveness of the Brazilian version of the Safety Attitudes Questionnaire for Emergency Care Units. METHOD: Methodological study carried out in September 2020 with 46 health professionals from an Emergency Care Unit in the metropolitan region of the State of Espírito Santo. Reliability was verified through the analysis of internal consistency, stability and reproducibility. The validity and responsiveness of the instrument were tested. RESULTS: Cronbach's alpha=0.85, showing excellent internal consistency. All domains are positively and significantly correlated with each other. In the stability assessment, the domains Job Satisfaction, Management Perception and Working Conditions showed strong correlations. CONCLUSION: It is concluded that the instrument presents satisfactory values in the evaluation of psychometric properties, showing evidence of validity, reliability and responsiveness. Thus, it is validated to be reproduced in other Emergency Care Units in Brazil.

Ram Semen Cryopreservation for Portuguese Native Breeds: Season and Breed Effects on Semen Quality Variation.

The semen quality is one of the determinant factors of ram semen cryopreservation. The present retrospective study aimed to characterize the seasonal ram pattern during the year for ten Portuguese local sheep breeds, hypothesizing that the breed and season had low effects on the main spermatozoa traits. A total of 1471 ejaculates were used and evaluated (fresh semen) from 85 rams between 2004 and 2020 and re-evaluated after thawing (thawed semen). The effect of breed, season, and sperm cryopreservation on nine semen traits were evaluated. The volume per ejaculate, spermatozoa (SPZ) concentration, and total number of SPZ per ejaculate, were affected by breed (p < 0.001) but not by season (p > 0.05). As expected, the semen processing was the most significant (p < 0.001) factor of variation on seminal parameters. Moreover, breed and interactions between breed × semen processing, modulated the response of alive SPZ, abnormal morphology, head, and intermediate piece defects. In fresh semen, season only affected the intermediate piece defects due to the highest percentage observed between February and April period in some breeds. Overall, and despite the mentioned particularities, there were similarities among the ten local breeds. We also concluded that the seasonal effect on ejaculate and SPZ traits is not significant in our region. These local ram breeds have low seasonality and can be employed in natural mating as well as semen donors for cryopreservation and assisted reproductive biotechnologies during the whole year at our latitude.

The role of early functional neuroimaging in predicting neurodevelopmental outcomes in neonatal encephalopathy.

Reliably assessing the early neurodevelopmental outcomes in infants with neonatal encephalopathy (NE) is of utmost importance to advise parents and implement early and personalized interventions. We aimed to evaluate the accuracy of neuroimaging modalities, including functional magnetic resonance imaging (fMRI) in predicting neurodevelopmental outcomes in NE. Eighteen newborns with NE due to presumed perinatal asphyxia (PA) were included in the study, 16 of whom underwent therapeutic hypothermia. Structural magnetic resonance imaging (MRI), and fMRI during passive visual, auditory, and sensorimotor stimulation were acquired between the 10th and 14th day of age. Clinical follow-up protocol included visual and auditory evoked potentials and a detailed neurodevelopmental evaluation at 12 and 18 months of age. Infants were divided according to sensory and neurodevelopmental outcome: severe, moderate disability, or normal. Structural MRI findings were the best predictor of severe disability with an AUC close to 1.0. There were no good predictors to discriminate between moderate disability versus normal outcome. Nevertheless, structural MRI measures showed a significant correlation with the scores of neurodevelopmental assessments. During sensorimotor stimulation, the fMRI signal in the right hemisphere had an AUC of 0.9 to predict absence of cerebral palsy (CP). fMRI measures during auditory and visual stimulation did not predict sensorineural hearing loss or cerebral visual impairment. CONCLUSION: In addition to structural MRI, fMRI with sensorimotor stimulation may open the gate to improve the knowledge of neurodevelopmental/motor prognosis if proven in a larger cohort of newborns with NE. WHAT IS KNOWN: • Establishing an early, accurate neurodevelopmental prognosis in neonatal encephalopathy remains challenging. • Although structural MRI has a central role in neonatal encephalopathy, advanced MRI modalities are gradually being explored to optimize neurodevelopmental outcome knowledge. WHAT IS NEW: • Newborns who later developed cerebral palsy had a trend towards lower fMRI measures in the right sensorimotor area during sensorimotor stimulation. • These preliminary fMRI results may improve future early delineation of motor prognosis in neonatal encephalopathy.

Validity, reliability and responsiveness of the Safety Attitudes Questionnaire for Emergency Care Units / Validez, confiabilidad y responsabilidad del Cuestionario de Actitudes de Seguridad para las Unidades de Atención de Emergencia / Validade, confiabilidade e responsividade do Questionário Atitudes de Segurança para Unidades de Pronto Atendimento

ABSTRACT Objective: To evaluate the evidence of validity, reliability and responsiveness of the Brazilian version of the Safety Attitudes Questionnaire for Emergency Care Units. Method: Methodological study carried out in September 2020 with 46 health professionals from an Emergency Care Unit in the metropolitan region of the State of Espírito Santo. Reliability was verified through the analysis of internal consistency, stability and reproducibility. The validity and responsiveness of the instrument were tested. Results: Cronbach's alpha=0.85, showing excellent internal consistency. All domains are positively and significantly correlated with each other. In the stability assessment, the domains Job Satisfaction, Management Perception and Working Conditions showed strong correlations. Conclusion: It is concluded that the instrument presents satisfactory values in the evaluation of psychometric properties, showing evidence of validity, reliability and responsiveness. Thus, it is validated to be reproduced in other Emergency Care Units in Brazil.

RESUMEN Objetivo: Evaluar las evidencias de validez, confiabilidad, y capacidad de respuesta de la versión brasileña del Cuestionario de Actitudes de Seguridad para Unidades de Atención de Emergencia. Método: Estudio metodológico realizado en septiembre de 2020 con 46 profesionales de la salud de una Unidad de Atención de Urgencias de la región metropolitana del Estado de Espírito Santo. La confiabilidad se verificó a través del análisis de consistencia interna, estabilidad y reproducibilidad. Se probó la validez y la capacidad de respuesta del instrumento. Resultados: Alfa de Cronbach=0,85, mostrando excelente consistencia interna. Todos los dominios están positiva y significativamente correlacionados entre sí. En la evaluación de la estabilidad, los dominios Satisfacción en el Trabajo, Percepción de la Gestión y Condiciones de Trabajo presentaron fuertes correlaciones. Conclusión: Se concluye que el instrumento presenta valores satisfactorios en la evaluación de las propiedades psicométricas, mostrando evidencias de validez, confiabilidad y capacidad de respuesta. Por lo tanto, está validado para ser reproducido en otras Unidades de Atención de Emergencia en Brasil.

RESUMO Objetivo: Avaliar as evidências de validade, confiabilidade e responsividade da versão brasileira do instrumento Questionário de Atitudes de Segurança para Unidades de Pronto Atendimento. Método: Estudo metodológico realizado em setembro de 2020 com 46 profissionais de saúde de uma Unidade de Pronto Atendimento da região metropolitana do Estado do Espírito Santo. A confiabilidade foi verificada através da análise de consistência interna, estabilidade e reprodutibilidade. Foram testadas a validade e a responsividade do instrumento. Resultados: O alfa de Cronbach=0,85, evidenciando ótima consistência interna. Todos os domínios se correlacionam entre si de maneira positiva e significativa. Na avaliação da estabilidade, os domínios Satisfação no Trabalho, Percepção da Gerência e Condições de Trabalho apresentaram fortes correlações. Conclusão: Conclui-se que o instrumento apresenta valores satisfatórios na avaliação das propriedades psicométricas, mostrando evidências de validade, confiabilidade e responsividade. Dessa forma, está validado para ser reproduzido em outras Unidades de Pronto Atendimento no Brasil.

Buffy Coat Transcriptomic Analysis Reveals Alterations in Host Cell Protein Synthesis and Cell Cycle in Severe COVID-19 Patients.

Transcriptome studies have reported the dysregulation of cell cycle-related genes and the global inhibition of host mRNA translation in COVID-19 cases. However, the key genes and cellular mechanisms that are most affected by the severe outcome of this disease remain unclear. For this work, the RNA-seq approach was used to study the differential expression in buffy coat cells of two groups of people infected with SARS-CoV-2: (a) Mild, with mild symptoms; and (b) SARS (Severe Acute Respiratory Syndrome), who were admitted to the intensive care unit with the severe COVID-19 outcome. Transcriptomic analysis revealed 1009 up-regulated and 501 down-regulated genes in the SARS group, with 10% of both being composed of long non-coding RNA. Ribosome and cell cycle pathways were enriched among down-regulated genes. The most connected proteins among the differentially expressed genes involved transport dysregulation, proteasome degradation, interferon response, cytokinesis failure, and host translation inhibition. Furthermore, interactome analysis showed Fibrillarin to be one of the key genes affected by SARS-CoV-2. This protein interacts directly with the N protein and long non-coding RNAs affecting transcription, translation, and ribosomal processes. This work reveals a group of dysregulated processes, including translation and cell cycle, as key pathways altered in severe COVID-19 outcomes.

Early Post-Operative Endoscopy Is Associated with Lower Surgical Recurrence of Crohn's Disease: A Retrospective Study of Three Successive Cohorts.

Background: The severity of endoscopic recurrence during the first year after intestinal resection for Crohn's disease is predictive of clinical recurrence. The aim of our study was to assess the impact of the implementation of an ileocolonoscopy during the first year after surgery on surgical recurrence. Methods: All patients who underwent a first intestinal resection for Crohn's disease between 1992 and 2018 at the University Hospital of Liège were retrospectively included. The time to surgical recurrence was compared in three successive groups of patients operated on in the period 1992-2001 (group A), 2002-2011 (group B), and 2012-2020 (group C) using the Kaplan-Meier method and the Log-Rank test. To identify independent prognostic factors, a multivariate analysis was used via the Cox model. Results: 223 patients (group A = 69, group B = 94, group C = 60) were included. Probabilities of surgical recurrence were significantly lower in group C (2.2% and 4.7% at 3 and 5 years, respectively) compared with group B (4.2% and 7.6% at 3 and 5 years, respectively) and with group A (9% and 18.2% at 3 and 5 years, respectively) (p = 0.0089). Ileocolonoscopy during the year after surgery was associated with a significantly reduced surgical recurrence rate in univariate and multivariate analysis (HR = 0.31, p = 0.0049). Conclusion: The implementation of an early ileocolonoscopy after surgery for Crohn's disease since early 2000 has been associated with a reduced surgical recurrence over the last 30 years.

Encontro e acolhimento em territórios vivos: narrativas para repensar tecnologias de cuidado a pessoas em crise na atenção psicossocial / Meeting and welcoming in living territories: narratives to rethink care technologies for people in crisis in psychosocial care

Após um longo e acidentado percurso, perfilado pelas repercussões de um período pandêmico (uma situação de crise planetária), coloca-se à disposição essa coletânea de escritos produzidos a partir do convite para compartilhar experiências de atenção a pessoas em situação de crise, na perspectiva da Atenção Psicossocial, em territórios do semiárido nordestino, mais especificamente, no Vale do Médio São Francisco. Este livreto, chamado assim por intuito afetivo e jamais por uma avaliação de sua qualidade ou mesmo tamanho, ganhou um nome que busca expressar seu eixo de sustentação: a (re)afirmação da potência do encontro para produzir caminhos de abertura e de expansão de vida na produção do cuidado ­ Encontro e acolhimento em territórios vivos: narrativas para repensar tecnologias de cuidado a pessoas em crise na Atenção Psicossocial. Trata-se de uma produção coletiva, visceralmente polifônica, germinada a partir do desejo compartilhado de fazer circular outras narrativas e vozes em torno do cuidado a pessoas em situação de crise. Assume-se como um fruto de agenciamentos coletivos diversos, em um país em que as atualizações da colonização sofrida (e jamais devidamente reparada) são vívidas, inclusive nos modos de pensar e produzir saúde. Destaca-se, assim, sua intencionalidade de contribuir para reposicionar ou mesmo extrapolar a captura do campo da saúde pela racionalidade biomédica, reconhecendo seus limites e efeitos iatrogênicos, especialmente em um contexto contemporâneo, marcado brutalmente pela medicalização da vida. Como destacado por Sandra Fagundes, no prefácio do livreto: "No correr dos contos, como no Grande Sertão Veredas, de Guimaraes Rosa, a vida embrulha tudo. A vida é assim, esquenta e esfria, aperta e daí afrouxa, sossega e depois desinquieta. O que ela quer da gente é coragem. O cuidado em liberdade, o que requer é ancoragem: suporte para o insuportável, impensável, indizível e para a potência".

Medical Grade Honey as a Promising Treatment to Improve Ovarian Tissue Transplantation.

Ovarian tissue cryopreservation is a female fertility preservation technique that presents major challenges for the maintenance of follicular viability after transplantation. The aim of this study was to evaluate and compare the application of L-Mesitran Soft®, a product containing 40% medical grade honey (MGH), with other strategies to improve ovarian grafts' viability. For this purpose, bovine ovarian tissue was vitrified, warmed and randomly assigned to culture groups: (1) control, (2) MGH 0.2% in vitro, (3) MGH in vivo (direct application in the xenotransplantation), (4) vascular endothelial growth factor (VEGF 50 ng/mL) and (5) vitamin D (100 Nm), during a 48 h period. A sixth group (6) of fragments was thawed on transplantation day and was not cultured. The tissue was xenotransplanted into immunodeficient (Rowett nude homozygous) ovariectomized rats. Grafts were analyzed 48 h after culture, and 7 and 28 days after transplantation. The tissue was subjected to histological and immunohistochemical analysis. Treatments using MGH showed the highest angiogenic and cell proliferation stimulation, with cellular apoptosis, within a healthy cellular turnover pathway. In conclusion, MGH should be considered as a potentially effective and less expensive strategy to improve ovarian tissue transplantation.

Herpesvirus and neurological manifestations in patients with severe coronavirus disease.

BACKGROUND: Certain clinical manifestations of coronavirus disease (COVID-19) mimic those associated with human herpesvirus (HHV) infection. In this study, we estimated the prevalence of herpesvirus in patients with COVID-19 and determined if coinfection is associated with poorer outcomes and neurological symptoms. METHODS: We analyzed samples of 53 patients diagnosed with COVID-19. The samples were evaluated for the presence of alphaherpesviruses, betaherpesviruses, and gammaherpesviruses, and the viral loads were quantified using quantitative polymerase chain reaction (qPCR) method. RESULTS: Among the patients, in 79.2% had detection at least one type of herpesvirus. HHV-6 (47.2%), cytomegalovirus (43.3%), and HHV-7 (39.6%) showed the highest detection rates. Patients with a high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) load were more likely to show herpes simplex virus 1 detection (p = 0.037). Among patients coinfected with SARS-CoV-2 and HHVs, 26.4% showed central nervous system-associated neurological symptoms and herpetic manifestations. A statistically significant association was observed between neurological changes and HHV-6 detection (p = 0.034). CONCLUSIONS: The findings showed a high prevalence of herpesvirus in patients with COVID-19. Furthermore, even though SARS-CoV-2 and HHV coinfection was not associated with poorer outcomes, the findings demonstrated the association between neurological symptoms and HHV-6 detection.

Effect of a Novel Hydroxybenzoic Acid Based Mitochondria Directed Antioxidant Molecule on Bovine Sperm Function and Embryo Production.

Sperm cells are particularly vulnerable to reactive oxygen species (ROS), impairing their fertilizing ability. Our objective was to study the effect of a novel mitochondrial-directed antioxidant, AntiOxBEN2, on bovine sperm function. This antioxidant was added to the semen capacitation medium (CAP), during the swim-up process, and to the fertilization medium (FERT) during the co-incubation of matured oocytes and capacitated spermatozoa, in concentrations of 0 (control), 1, and 10 µM. After the swim-up, sperm motility (CASA and visual analysis), vitality (eosin-nigrosin), mitochondrial membrane potential (JC1), intracellular ROS, adenosine triphosphate (ATP) levels, and basal metabolism (Seahorse Xfe96) were evaluated. Embryo development and quality were also assessed. Higher cleavage rates were obtained when 1 µM AntiOxBEN2 were added to CAP and FERT media (compared to control, p < 0.04). A positive effect of AntiOxBEN2 on intracellular ROS reduction (p = 0.01), on the increment of mitochondrial membrane potential (p ≤ 0.003) and, consequently, on the sperm quality was identified. However, the highest dose impaired progressive motility, ATP production, and the number of produced embryos. The results demonstrate a beneficial effect of AntiOxBEN2 (1 µM) on sperm capacitation and fertilization processes, thus improving embryonic development. This may constitute a putative novel therapeutic strategy to improve the outcomes of assisted reproductive techniques (ART).

1,8-Cineole ameliorates right ventricle dysfunction associated with pulmonary arterial hypertension by restoring connexin43 and mitochondrial homeostasis.

For the first time, the present study unravels a cardiospecific therapeutic approach for Pulmonary Arterial Hypertension (PAH), a disease with a very poor prognosis and high mortality rates due to right ventricle (RV) dysfunction. We first established a new in vitro model of high-pressure-induced hypertrophy that closely resembles heart defects associated with PAH and validated our in vitro findings on a preclinical in vivo model of monocrotaline (MCT)-induced PAH. Our results showed the in vitro antihypertrophic effect of 1,8-cineole, a monoterpene widely found in several essential oils. Also, a decrease in RV hypertrophy and fibrosis, and an improvement in heart function in vivo was observed, when 1,8-cineole was applied topically. Furthermore, 1,8-cineole restored gap junction protein connexin43 distribution at the intercalated disks and mitochondrial functionality, suggesting it may act by preserving cardiac cell-to-cell communication and bioenergetics. Overall, our results point out a promising therapeutic compound that can be easily applied topically, thus paving the way for the development of effective cardiac-specific therapies to greatly improve PAH outcomes.

Post-transcriptional silencing of Bos taurus prion family genes and its impact on granulosa cell steroidogenesis.

Prion proteins constitute a major public health concern, which has partly overshadowed their physiological roles in several scenarios. Indeed, these proteins were implicated in male fertility but their role in female fertility is relatively less explored. This study was designed to evaluate the role of SPRN and PRNP prion family genes in bovine follicular steroidogenesis pathways. Post-transcriptional SPRN and PRNP silencing with siRNAs was established in bovine granulosa cell (GC) in vitro culture, and gene expression and progesterone and estradiol concentrations were evaluated. SPRN knockdown, led to a downregulation of CYP11A1 mRNA levels (2.1-fold), and PRNP knockdown led to an upregulation of SPRN mRNA levels (2.3-fold). CYP19A1 expression and estradiol synthesis was not detected in any experimental group. Finally, SPRN knockdown led to a mild reduction in progesterone production in GCs and this was the only experimental group that did not exhibit an increment in progesterone levels after 48 h of culture. As a conclusion, it was possible to detect the expression of the SPRN gene in bovine GCs, a potential interaction between SPRN and PRNP regulation, and the impact of SPRN expression on CYP11A1 and progesterone levels. These findings bring new insights into the role of these genes in ovarian steroidogenesis and female reproductive physiology.

New records and species of Pseudogaurax Malloch, 1915 (Diptera: Chloropidae) from the Amazon basin.

Pseudogaurax Malloch is a speciose genus of Chloropidae in the Neotropical region. The South American fauna is understudied, particularly in the Amazon basin. Here we provide a taxonomic revision of the Amazonian species of Pseudogaurax, including the description of five new species-P. flaviscutellatus sp. nov., P. infulatus sp. nov., P. longitriangularis sp. nov., P. pallidus sp. nov. and P. poseidoni sp. nov.-and a key to all Brazilian species. Including our results, Pseudogaurax is known from 19 species from Brazil, 10 of which occur in the Amazon Forest.

Breast cancer screening program for risk groups: facts and perspectives / Tamizaje Masivo de neoplasias de la mama para grupos de riesgo: hechos y perspectivas / Programa de rastreamento de neoplasias da mama para grupos de risco: fatos e perspectivas

ABSTRACT Objectives: to measure the frequency and compliance of breast cancer screening, according to the risk for this disease. Methods: a cross-sectional study with 950 female users of 38 public Primary Health Care services in São Paulo, between October and December 2013. According to UHS criteria, participants were grouped into high risk and standard risk, and frequency, association (p≤0.05), and screening compliance were measured. Results: 6.7% had high risk and 93.3% standard risk, respectively; in these groups, the frequency and compliance of clinical breast examination were 40.3% and 37.1%, and 43.5% and 43.0% (frequency p=0.631, compliance p=0.290). Mammograms were 67.7% and 35.5% for participants at high risk, and 57.4% and 25.4% for those at standard risk (frequency p=0.090, compliance p=0.000). Conclusions: in the groups, attendance and conformity of the clinical breast exam were similar; for mammography, it was higher in those at high risk, with assertiveness lower than the 70% set in UHS.

RESUMEN Objetivos: mensurar frecuencia y conformidad de rastreo del cáncer mamario, segundo riesgo para esa enfermedad. Métodos: estudio transversal con 950 usuarias de 38 servicios de Atención Primaria púbicos en São Paulo, entre octubre y diciembre de 2013. Segundo criterios del SUS, agruparon las participantes en riesgo elevado y riesgo-estándar, y mensurado frecuencia, relación (p≤0,05) y conformidad del rastreo. Resultados: 6,7% tenían riesgo elevado y 93,3% riesgo-estándar, respectivamente; en eses grupos, la frecuencia y conformidad del examen clínico mamario fueron de 40,3% y 37,1% y de 43,5% y 43,0% (frecuencia, p=0,631; conformidad, p=0,290). Realización de mamografía alcanzó porcentuales de 67,7% y 35,5% para participantes con riesgo elevado, y de 57,4% y 25,4% en con riesgo-estándar (frecuencia, p=0,090; conformidad, p=0,000). Conclusiones: En los grupos, la frecuencia y conformidad del examen clínico mamario fueron semejantes, para mamografía fue mayor en las con riesgo elevado, habiendo asertividad inferior a 70% pactados en el SUS.

RESUMO Objetivos: mensurar a frequência e conformidade de rastreio do câncer mamário segundo risco para esta doença. Métodos: estudo transversal em São Paulo, com 950 usuárias de 38 da atenção primária no SUS entre outubro a dezembro de 2013. Segundo critérios do SUS, as participantes foram agrupadas como risco elevado ou padrão e mensurou-se frequência, associação (p≤0,05) e conformidade do rastreio. Resultados: 6,7% tinha risco elevado e 93,3% risco padrão, respectivamente, nestes grupos a frequência e conformidade do exame clínico mamário foram de 40,3% e 37,1% e de 43,5% e 43,0% (frequência p=0,631, conformidade p=0,290). Realização de mamografia alcançou percentuais de 67,7 e 35,5 para as com risco elevado, e de 57,4 e 25,4 nas com risco padrão (frequência p=0,090, conformidade p=0,000). Conclusões: nos grupos, a frequência e conformidade do exame clínico mamário foram semelhantes, para mamografia foi maior nas com risco elevado, tendo assertividade inferior aos 70% pactuados no SUS.

Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies.

The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil's Unified Health System (SUS) is among the world's largest public health systems offering free cytology testing, follow-up colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community's reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.

Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city-Lessons learned from the Amazon city of Manaus, Brazil.

The World Health Organization Call to Eliminate Cervical Cancer resonates in cities like Manaus, Brazil, where the burden is among the world's highest. Manaus has offered free cytology-based screening since 1990 and HPV immunization since 2013, but the public system is constrained by many challenges and performance is not well-defined. We obtained cervical cancer prevention activities within Manaus public health records for 2019 to evaluate immunization and screening coverage, screening by region and neighborhood, and the annual Pink October screening campaign. We estimated that among girls and boys age 14-18, 85.9% and 64.9% had 1+ doses of HPV vaccine, higher than rates for age 9-13 (73.4% and 43.3%, respectively). Of the 90,209 cytology tests performed, 24.9% were outside the target age and the remaining 72,230 corresponded to 40.1% of the target population (one-third of women age 25-64). The East zone had highest screening coverage (49.1%), highest high-grade cytology rate (2.5%) and lowest estimated cancers (38.1/100,000) compared with the South zone (32.9%, 1.8% and 48.5/100,000, respectively). Largest neighborhoods had fewer per capita screening locations, resulting in lower coverage. During October, some clinics successfully achieved higher screening volumes and high-grade cytology rates (up to 15.4%). Although we found evidence of some follow-up within 10 months post-screening for 51/70 women (72.9%) with high-grade or worse cytology, only 18 had complete work-up confirmed. Manaus has successfully initiated HPV vaccination, forecasting substantial cervical cancer reductions by 2050. With concerted efforts during campaigns, some clinics improved screening coverage and reached high-risk women. Screening campaigns in community locations in high-risk neighborhoods using self-collected HPV testing can achieve widespread coverage. Simplifying triage and treatment with fewer visits closer to communities would greatly improve follow-up and program effectiveness. Achieving WHO Cervical Cancer Elimination goals in high-burden cities will require major reforms for screening and simpler follow-up and treatment.