and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEWThe GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs).FINDINGS In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCEThe results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

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Azoospermia is defined as absence of spermatozoa and may be secondary to blocked seminal ducts, known as obstructive azoospermia. Semen quality may be impaired due to factors such as sperm cell DNA fragmentation and presence of antisperm antibodies. The objective of this article was to investigate potential differences in outcomes of in vitro fertilisation and intracytoplasmic sperm injection between groups with different obstruction aetiology, as well as between the use of different techniques and sperm cells of different origins. Retrospective, multi‐centre analysis of 621 first cycles was carried out between 2008 and 2015: Group I, congenital obstruction, 45 patients and Group 2, vasectomy, 576 patients. Sperm cell retrieval was achieved in all cases. Results were similar for Group I and II fertilisation rates, 70% versus 66.85% (p = .786); pregnancy rates, 42.5% versus 41.46% (p = .896); and live birth rates, 29.73% versus 17.69% (p = .071). According to sperm cell origin (579 epididymal vs. 42 testicular), pregnancy rates, 41.47% versus 43.9% (p = .760); and live birth rates, 18.3% versus 27.78% (p = .163) had no difference. Fertilisation, pregnancy and live birth rates did not differ according to obstruction aetiology. Outcomes did not differ between groups according to sperm cell origin.

Objective To analyze a combination of socioeconomic and demographic characteristics, chronotype, stress perception and level of physical activity with the perception of quality of life in artisanal fishermen. Results Several variables were associated with lower scores of quality of life domains: workload (P = 0.047), age (P = 0.01), economic class D–E (P = 0.04) and perceived stress scores (P = 0.01) for scores physical domain; workload (P = 0.03) and perceived stress (P < 0.001) for scores psychological domain; Perceived stress (P < 0.001) and age (P = 0.01) for social domain scores; economic class D–E (P = 0.03) and perceived stress (P = 0.01) for environment domain scores; perceived stress (P = 0.01) and age (P = 0.01) for general quality of life scores and; female sex (P = 0.04) and age (P = 0.02) for the score of satisfaction with quality of life.

The provision of care by health professionals seems to be related to cultural patterns in which these workers are inserted. The relationship between culture and care becomes a challenge for the provision of health care to homosexual and bisexual population. Thus, this study aimed to identify the perception of Gays, Lesbians, Bisexuals and Transgenders in relation to the care received from health professionals, in the light of Cross-Cultural Theory. This is a qualitative, ethnographic study, conducted with 30 members of sexual minorities in Juazeiro do Norte, Brazil. The data analysis lead to the elaboration of five categories based on of the Theory of Cultural Care Diversity and Universality. The participants emphasized the constant violation of their rights to universal and equitable access to the National Health System, stating that they have suffered from prejudice and exclusion, as result of a heteronormative culture. They highlighted that homophobia and dehumanization of care have a strong relation to sexual orientation. The transvestites are the most prone to humiliation and pejorative attitudes of professionals and such condition is a barrier to accessing services.

Introduction: Dengue fever is currently a major endemic health issue in the city of Brejo Santo, located in the Brazilian Northeast outback, due to the rising morbidity and mortality rates in the area. The mosquito Aedes aegypti, the main vector of dengue fever virus, is highly adapted to the domestic environment. Since 1981 Brazil has been living with epidemic outbreaks of dengue fever.

Background: Access to the diagnosis and treatment of breast cancer in Brazil is marked by immense inequalities in the provision of specialized assistance, which leads patients to seek treatment outside the place of residence. To evaluate the variations between 2004 and 2014 in the distribution of flow between place of residence and care, and the average distance traveled for treatment of breast cancer in the administrative regions and federal states of Brazil. Method: Analysis of secondary data from the years 2004 and 2014, extracted from the Department of Informatics of the Unified Health System through the Hospital Information System. Data from Hospitalization Release Authorizations were collected, and the maps were created with TabWin 3.6 software. Descriptive analysis was performed on Stata® (StataCorp, LC) 11.0. Results: In the total flow, it was observed that there was a decrease in referrals between 2004 and 2014 in most regions. In 2004 the main direction of flow was in the Midwest and Southeast regions. In 2014, however, the intensity of these admissions was centralized in the Southeast region. In relation to the average distance traveled, the North, Northeast, and Midwest regions had the highest values of displacement. Of the 27 federative units, 17 presented an increase in average distance between these periods. Conclusion: Despite the improvement in the hospitalization of residents, in most regions and federal units, Brazilians still travel great distances when they require treatment for breast cancer.

Background: The National Policy of Comprehensive Women’s Health Care was implemented more than two decades ago, and the monitoring of potential benefits should be explored. Menopause is a period of life for which there are prevention and health promotion actions carried out by the government’s all-encompassing sole Unify Health System (UHS) and factored into Brazilian policies. It is thus our purpose to identify menopausal women’s main causes of death, as well as the mortality trend of such causes, especially after PNAISM implementation. Methods: This is an ecological study with secondary data analysis conducted by the Setor de Atenção Primária, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo from 2018 to 2019. Data were retrieved from the Brazilian Health Department by accessing the mortality information system of the IT Department of SUS between 1996 and 2016, divided in two periods 1996 to 2004 and 2005 to 2006 according to implementation of the National Police. The data included the death records of Brazilian women aged 35 to 64 years who had a precise diagnosis (ICD-10). Trend and differences between periods were evaluated by linear regression. The significance level was set at 5%. Stata 11® (StataCorp, LCC) was used. Results: Menopausal women’s main causes of death were the circulatory system diseases (29.39%, 736,972 deaths), neoplasms (26.17%, 656,385 deaths), respiratory system diseases (7.29%, 182,812 deaths), endocrine (29.39%), nutritional, and metabolic (6.81%, 170,881 deaths) diseases, and external causes of morbidity and mortality (5.49%, 137,674 deaths). Implementation of PNAISM led to increasing reduction in mortality from circulatory system diseases (β=-0.58; 95% CI, -0.68 to -0.48; r²=0.93; p<0.001), but not to any significant changes in neoplasm mortalities (β=0.07; 95% CI, -0.01 to 0.15; r²=0.22; p=0.070). Conclusions: The leading causes of death among menopausal women are circulatory system diseases, neoplasms, respiratory system diseases, nutritional, metabolic, and endocrine diseases, and external causes of morbidity and mortality. The trend of mortality rates among menopausal women, following PNAISM implementation, was a decline in circulatory system diseases and in nutritional, metabolic, and endocrine diseases, with no changes for neoplasms and respiratory system diseases.