Maternal Risk Factors Associated with Negative COVID-19 Outcomes and Their Relation to Socioeconomic Indicators in Brazil.

BACKGROUND: This study aimed to analyze maternal risk factors associated with negative outcomes of COVID-19 and association with socioeconomic indicators in Brazil. METHODS: A cross-sectional study, with data from the Influenza Epidemiological Surveillance Information System (SIVEP-Flu) of pregnant women with COVID-19 and cases of hospitalization and death. For the analysis of risk factors and outcomes, the multiple logistic regression method was used. RESULTS: Pregnant women who had some risk factor represented 47.04%. The chance of death was 2.48 times greater when there was a risk factor, 1.55 for ICU admission and 1.43 for use of ventilatory support. The percentage of cure was 79.64%, 15.46% without any negative outcome, 4.65% death and 0.26% death from other causes. Pregnant women who did not take the vaccine represented 30.08%, 16.74% took it and 53.18% were not specified. The variables HDI, illiteracy, per capita income and urbanization did not influence the cases of COVID-19. CONCLUSIONS: Factors such as age, obesity, asthma and pregnancy were responsible for the increase in hospitalizations, respiratory complications and death. Vaccination reduced the risk of negative outcomes by 50%. There were no correlations between socioeconomic indicators and the negative outcomes of COVID-19 in pregnant women.

A look through Latin America truck drivers' health, a systematic review and meta-analysis.

Heavy truck drivers represent a social group of great importance to any country's economy. Their professional activity requires a high level of dedication. Due to the irregular hours in their work routine and adopted habits, they mostly predispose them to a diversity of health problems. The purpose of this study is to perform a systematic review and meta-analysis aiming to identify the prevalence of diabetes, hypertension, and obesity in Latin American Truck Drivers. We searched the PubMed, Web of Science, Scopus and LILACS databases, for scientific publications articles, as reported by The PRISMA Statement. From 1,382, 7 studies were included according to the established criteria. The hypertension prevalence found was 34.2%, diabetes was of 9.2% and the highest prevalence found was for overweight and obesity (56%). Meta-analysis presented that drivers have a higher prevalence of overweight or obesity when compared to eutrophic individuals and that drivers with diabetes and hyperglycemia have a lower prevalence. Due to their work activity, their access to the health system is compromised limiting any type of monitoring of their health. This study showed that there is, in Latin America, an investment and assistance gap, both in the health sector and in the research section, for this professional category, which is so important to the economy of these countries. These data should help to identify the difficulties faced by this professional in health assistance, road safety, public safety, leisure and social life. This research also highlighted that they are young and already have the first sign of non-transmissible chronic diseases, which is overweight and obesity.

Use and Applicability of the Gail Model to Calculate Breast Cancer Risk: A Scoping Review.

OBJECTIVE: To perform a scoping review of the applicability of the Gail model in different countries for different ethnicities. METHODS: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and search strategies based on the PICOS approach. The reviewed articles were included if they were published between 2013 and 2018 in English, Portuguese, or Spanish; were original articles available in full online; and described the use of the Gail model. The PubMed, Embase, and Web of Science data bases were searched. RESULTS: A total of 38 articles eligible for analysis were identified, of which 16 used the Gail model to assess breast cancer risk in women, eight analyzed the applicability of this tool in their population, seven compared the tool and/or modified it according to the specific risk factors of their population, and seven cited the model in determining eligibility for chemoprevention. CONCLUSION: The Gail model has different applicabilities Greater effectiveness and breast cancer risk are found in developed countries.

Impact of the Covid-19 Pandemic on Women's Health in Brazil.

PURPOSE: The aim is to verify the impact of the Covid-19 pandemic on women's healthcare and medical assistance in Brazil. PATIENTS AND METHODS: This exploratory cross-sectional study evaluated a non-probabilistic sample of women above 20 years old, carried out between August and September of 2020, through a snowball sampling using a Google Forms application. RESULTS: From a total of 2495 women, more than 70% have not been screened for cervical cancer (77.8% of 2244 women aged for screening), and more than 80% have not been screened for breast cancer (80.2% from 1325 women aged for mammography) during the pandemic. Also, 55.2% of the women did not undergo routine blood tests during the same period. The most frequent reasons for not performing screening and routine tests were: they were up to date; fear of contracting Covid-19; they decided to postpone it until after the end of the pandemic; they were unable to schedule the appointment at the healthcare center for whatever reason; and the healthcare center was only attending Covid-19 patients. Women with no comorbidities have performed significantly more mammograms and routine blood tests than women with comorbidities. In addition, women with comorbidities who were used to perform periodic medical follow-up have done it substantially more than women with no comorbidities during the pandemic. CONCLUSION: As observed, there was a significant decrease in women's access to the healthcare system during this pandemic. Many participants reported that they had not attended any screening tests, and some reasons included fear of getting infected and due to the public measures of social distancing. The consequences are late diagnoses and a worse prognosis. It might impact the healthcare systems around the world in the next few years. Further studies should be done to follow these consequences.

Healthcare Workers in Brazil during the COVID-19 Pandemic: A Cross-Sectional Online Survey.

Brazil is in a critical situation due to the COVID-19 pandemic. Healthcare workers that are in the front line face challenges with a shortage of personal protective equipment, high risk of contamination, low adherence to the social distancing measures by the population, low coronavirus testing with underestimation of cases, and also financial concerns due to the economic crisis in a developing country. This study compared the impact of COVID-19 pandemic among three categories of healthcare workers in Brazil: physicians, nurses, and dentists, about workload, income, protection, training, feelings, behavior, and level of concern and anxiety. The sample was randomly selected and a Google Forms questionnaire was sent by WhatsApp messenger. The survey comprised questions about jobs, income, workload, PPE, training for COVID-19 patient care, behavior and feelings during the pandemic. The number of jobs reduced for all healthcare workers in Brazil during the pandemic, but significantly more for dentists. The workload and income reduced to all healthcare workers. Most healthcare workers did not receive proper training for treating COVID-19 infected patients. Physicians and nurses were feeling more tired than usual. Most of the healthcare workers in all groups reported difficulties in sleeping during the pandemic. The healthcare workers reported a significant impact of COVID-19 pandemic in their income, workload and anxiety, with differences among physicians, nurses and dentists.

Trends in Cervical Cancer Mortality in Brazilian Women who are Screened and Not Screened.

OBJECTIVE: This study aimed to analyze the trend in cervical cancer (ICD C53) mortality in Brazilian regions in women who are who are screened and not screened from 1996 to 2015. METHODS: An epidemiological study, of time series of mortality from cervical cancer performed in 90,856 women under 24 years old (343 women), between 25 and 64 years old (32,703 women), and over 65 years old (10,909 women). The data from this research were collected from the DATASUS, from the SIM Health Surveillance Secretariat files, captured through TABNET selecting the resident population by gender and age group and ICD 10 C53 from 1996 to 2015. RESULTS: Among women, 43.8% were white, and 76% had less than eight years of formal education. Polynomial regression showed an increasing trend in cervical cancer mortality in Brazil for women aged 15 - 24 years (p=0.01). Between 25 - 64 and 65 years or older it remained constant, but high (p=0.07; 0.99). The Northeast region pointed a growing trend in women aged 15 to 24 (p=0.01), 25 to 64 years (p=0.01) and 65 or older (p=0.001). The Northeast presented the highest average growth per year. In the Southeast, South and Midwest regions, decreasing trends were observed despite the high rates. The Joinpoint regression showed a 95% confidence interval, and that mortality from cervical cancer in the North region increased throughout the period analyzed. an increasing trend was observed from 1996 to 1998, whereas in the Midwest region, the trend remained stable throughout the period analyzed. The Federal District presented an upward trend from 1996 to 2015. In Brazil, an upward trend was observed throughout the whole period analyzed. CONCLUSIONS: Cervical cancer mortality in younger women is becoming more predominant, in addition to the high rate observed for women aged 65 or older. 
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Comparative Analysis between the Gail, Tyrer-Cuzick and BRCAPRO Models for Breast Cancer Screening in Brazilian Population.

OBJECTIVE: To analyze the diagnostic accuracy of predictive models of breast cancer risk for the Brazilian population. METHOD: A cross-sectional, study was conducted in a sample of 382 women aged 35-69 years who were users of the Unified Health System (SUS) residing in a municipality in southern Brazil. RESULTS: The results showed that the Tyrer-Cuzick model had the highest mean risk values and estimates (proportion) for predicting the 5-year risk of breast cancer, reaching a maximum risk of ±1.63% in the 60-64 year age group. For the 90-year risk, a maximum risk of ±12.8% was predicted for the 50-54 year age group using this model. The 5-year risk calculated by the three tools increased progressively with increasing age, where the mean risk was ±0.8% in women aged 35-39 and reached ±1.50% in women aged 65-69. The 90-year risk declined with increasing age only in the Tyrer-Cuzick model, from ±10.8% to ±9%. The BRCAPRO model presented a greater sensitivity compared to the Gail and Tyrer-Cuzick models. And, the model that presented greater specificity was Gail. CONCLUSION: The Tyrer-Cuzick model presented the highest risk estimates for 5 years and 90 years in the studied population, however, this data is not enough to validate this tool, since when analyzing the sensitivity and specificity the BRCAPRO and Gail have the highest values respectively.