Secular trends and predictors of mortality in acute lymphoblastic leukemia for children of low socioeconomic level in Northeast Brazil.

BACKGROUND: The treatment for ALL has evolved in recent decades and as a result survival rates are now close to 90% in many developed countries. However, this is not the case in developing countries where survival rates are often below 35%. More than 80% of children who are affected by ALL worldwide live in developing countries. The objective of this study was to evaluate the secular trend in mortality for children with ALL living in Sergipe, a state in northeastern Brazil, and to investigate any association with variables that relate to socioeconomic status. METHOD: This study evaluated ALL patients who were less than 20 years of age and who were treated at the Dr. Osvaldo Leite Oncology Center in the capital city, Aracaju. The sample comprised two cohorts of patients from the public health service: patients treated from 1980 to 2004 (cohort A) and from 2005 to 2014 (cohort B). The findings were compared to those of patients treated in the one private service for pediatric cancer treatment available in the region, from 2005 to 2014 (cohort C). Two categories of variables were considered in this study: biological and socioeconomic. RESULTS: We analyzed 412 patients who were divided into three cohorts (cohort A: 287 patients, cohort B: 106 patients and cohort C: 19 patients). The mortality rates for the three cohorts were significantly different: 57.5% in cohort A, 45.3% in cohort B and 26.3% in cohort C (p=0.006). Mortality during induction in cohort B was 22.6%, while in cohort C no deaths occurred during this phase (p=0.041). Patients living in rural areas had higher mortality rates (p=0.036). CONCLUSIONS: The reduction in deaths from infection during induction seems to be the starting point for improving the chances for children and adolescents with ALL anywhere in the world.

[Impact of pregnancy on female sexual function]. / Impacto da gestação na função sexual feminina.

PURPOSE: To investigate the impact of pregnancy on female sexual function. METHODS: An analytical, cross-sectional study was conducted on 181 non-pregnant and 177 pregnant women aged 18 to 45 years. The study included premenopausal, sexually active women with a steady partner and excluded those taking antidepressants or with a diagnosis of depression. Eleven of these women (6.2%) were in the first trimester, 50 (28.2%), in the second trimester and 116 (65.5%), in the third trimester of pregnancy. The evaluation consisted of an interview in which the Female Sexual Function Index (FSFI) was applied. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 16.0. The nonparametric Mann-Whitney test was used to compare the mean FSFI values of pregnant and non-pregnant women. RESULTS: Sexual dysfunction was 40.4% among pregnant women and 23.3% among non-pregnant women, with a significant difference between the scores of the studied groups (p=0.01). The difference in the mean global FSFI values between the groups was also significant (p<0.0001). There were significant differences between pregnant and non-pregnant women regarding desire (p<0.0001), excitation (p=0.003), lubrication (p=0.02), orgasm (p=0.005) and satisfaction (p=0.03). The same was not observed regarding pain. CONCLUSION: We conclude that pregnancy negatively influences female sexual function, particularly the desire and excitement domains, revealing the importance of addressing the issue by professionals dealing with pregnant women.