IntroductionBreast cancer is the most common cause of cancer death among women.ObjectiveThe objective of this study was to analyze time trends in overall mortality from breast cancer in Brazil, Brazilian regions and States.MethodsThis is an exploratory study, of the time series of deaths from breast cancer contained in the Mortality Information System (SIM), of women living in Brazil, Brazilian regions and States, from 1996 to 2013. For the trend analysis, the polynomial regression model was used, and a significant trend was considered when the estimated model obtained a p value <0.05.ResultsThere was a tendency of increased mortality from breast cancer in Brazilian women (average increase of 0.18 per year; p <0.001), with regional differences, particularly in the age group 20–49 years (0.07 per year; p <0.001). The age group 50–69 years remained constant but had high average rates (37.14).ConclusionMore effective planning is needed to focus on the different scenarios of the Brazilian regions. Screening strategies for the incidence and mortality from breast cancer must also be rethought according to age group in the country.

BackgroundHuman Papillomavirus (HPV) infection is particularly burdensome for women infected with human immunodeficiency virus (HIV), which increases their risk of developing cervical lesions and cancer (CC). We conducted a molecular study of the distribution of cervical HPV genotypes and the risk factors for this infection in HIV-infected Brazilian women.FindingsCervical and endocervical samples for Papanicolaou screening and HPV detection were collected from 178 HIV-infected women using highly active antiretroviral therapy (HAART) of Maringá city/Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding to HIV infection from medical records. HPV was detected by polymerase chain reaction (PCR), and genotyping using PCR-restriction fragment length polymorphism analysis. HIV infection was well controlled, but women with a current CD4+ T lymphocyte count between 200–350 cells/mm3 (37.6%) had a two-fold greater risk of HPV infection than those with > 350 cells/mm3 (26.4%). HPV was associated with parity ≥3, hormonal contraceptive use and current smoker. HPV infection occurred with high frequency (46.6%) but a low frequency of cervical abnormalities was detected (7.30%), mainly low-grade squamous intraephitelial cervical lesions (LSIL) (84.6%). A high frequency of multiple HPV infections was detected (23.0%), and the most frequent HPV genotype was HPV-72 (6.7%), followed by −16, -31 and -51 (6.14% each).ConclusionsWe showed that HAART use does not protect HIV-infected women from HPV, but appear to exert some protection against cervical lesions development. This study provides other important information about risk factors and cervical HPV in HIV-infected women, which can contribute to planning protocols.

IntroductionBreast cancer remains an important public health problem that is responsible for high morbidity and mortality rates, especially in developing countries.ObjectiveTo analyze the socioeconomic and access disparities related to breast cancer mortality in 399 cities in the state of Parana, Brazil.MethodsEcological, descriptive and analytical cross-sectional study based on secondary data from the Mortality Information System from 2009 to 2012 in the state of Parana. Breast cancer mortality rate was calculated considering the mortality cases and women population of each municipality, both based on women older than 20 years old. Moran global and local analyses were used to verify the presence of spatial autocorrelation and spatial regression modeling (Spatial Lag—SAR) with the purpose of analyzing the association between socioeconomic indicators, access and mortality rates for breast cancer.ResultsSignificant positive spatial autocorrelation was found for breast cancer mortality rates (I = 0.5432, p = 0.001). In the spatial regression analysis, the model explained 61% of the variance of the mortality rates for breast cancer. The mortality rate for breast cancer was negatively associated with the illiteracy rate (Coefficient = -0.0279) and positively associated with the access index (Coefficient = 12.9525).ConclusionThe lower illiteracy rate has not been sufficient to reduce the specific mortality rate by breast cancer, and the higher the score of accessibility to cancer services, the higher the specific mortality due to breast cancer. The results show that in the state of Parana, the problem is not related to a lack of education of the patients or the distance walked, but rather with the organization of services. These conclusions have important political implications on the organization and quality of the services provided for the diagnosis and treatment of breast cancer in the state of Parana.

Abstract. We determined the prevalence of seven clinically important pathogens that cause sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, herpes simplex virus 1 [HSV-1], HSV-2, and Treponema pallidum), by using a multiplex polymerase chain reaction (M-PCR) in samples from Brazilian woman infected with human immunodeficiency virus 1 (HIV-1) and uninfected Brazilian women (controls). The M-PCR assay identified all STIs tested for and surprisingly, occurred association between the control and STIs. This association was probably caused by excellent HIV infection control and regular monitoring in these women established by public health strategies in Brazil to combat HIV/acquired immunodeficiency syndrome. Studies using this M-PCR in different populations may help to better elucidate the roles of STIs in several conditions.

Buscou-se identificar o grau de adesão dos hospitais de referência ao Protocolo de atendimento às mulheres em situação de violência sexual no Paraná-Brasil, entre 2009 e 2015, associando aos perfis sociodemográficos e às categorias de adesão. Estudo observacional transversal, população composta por todas as mulheres em situação de violência sexual, atendidas por 28 Hospitais do Paraná. Analisaram-se dez itens sobre a taxa de adesão: desde o acolhimento, profilaxias, até encaminhamentos posteriores ao trauma. Encontrou-se que todos os Hospitais fizeram o atendimento agudo às mulheres: 50% aderiram às Profilaxias ISTs, AIDS e hepatites, coletas de secreção e exames sanguíneos; 63% ofereceram contracepção de emergência; 69% encaminharam para acompanhamento ambulatorial. Houve associação entre idade, etnia, escolaridade e estado civil com melhores taxas de adesão ao Protocolo. Entendeu-se que Hospitais de referência se preocupam com atendimentos agudos, mas não aderem integralmente às medidas profiláticas, multidisciplinares e continuadas.

RESUMOObjetivou-se, neste estudo, identificar a prevalência da amamentação na primeira hora de vida e seus resultados para a manutenção do aleitamento materno. Trata-se de uma pesquisa descritiva desenvolvida em uma instituição hospitalar com Iniciativa Hospital Amigo da Criança da Tríplice Fronteira, realizada no segundo e terceiro trimestres de 2015. A coleta dos dados envolveu observação da primeira mamada e após 18 horas de nascimento; e contato telefônico após 90 dias. Os dados foram analisados pela estatística simples. Observaramse 88 binômios, dos quais 79,5% mamaram na primeira hora de vida. O parto normal foi um fator protetor para a amamentação na primeira hora e boa sucção. No alojamento conjunto, os binômios que iniciaram a mamada na primeira hora demonstraram melhor adaptação da sucção, porém não melhor resposta do recém-nascido. Após 90 dias do nascimento, a maioria das crianças estava sendo amamentada, mas também recebiam leite artificial. Aponta-se para a necessidade de sensibilizar gestores e profissionais de saúde para promover a prática do aleitamento materno na primeira hora de vida como uma prioridade de cuidado.Palavras-chave: Cuidados de Enfermagem. Enfermagem Materno-Infantil. Aleitamento Materno. Promoção da saúde.

Mundialmente, entre todos os tipos de câncer, na população feminina, o câncer de colo uterino é um dos mais frequentes, ocupando o segundo lugar em incidência. O objetivo do presente trabalho é estimar a prevalência de exames colpocitológicos realizados no município de Maringá, Paraná, e sua distribuição segundo a faixa etária das mulheres e os resultados dos exames. Trata-se de um estudo descritivo, retrospectivo, de coorte, constando da análise de todos os exames colpocitológicos realizados em 24 Unidades Básicas de Saúde (UBS) do município de Maringá, no período de 2006 a 2010. Foram estudados 41.197 exames, a média de idade foi de 41,66±14,18 anos, variando de 12 a 93 anos. Cerca de 75,4% das mulheres (12.579) estavam na faixa etária dos 25 aos 59 anos; 12,7% (2.129) tinham entre 12 e 24 anos e as demais, 11,9% (1.993), possuíam acima de 60 anos de idade. Foi observado que 48,4% dos exames estavam normais; 22,7% apresentavam alterações celulares benignas e 26,7%, atipias celulares. Em 498 mulheres, o laudo citopatológico foi positivo para neoplasia. Uma melhor qualidade de informação poderá permitir avaliações de cobertura, áreas de maior acometimento, de forma a possibilitar a implementação de medidas, visando a prevenção de neoplasias intraepiteliais cervicais.

Vulvovaginal candidiasis (VVC) in HIV-infected women contributed to the impairment of their quality of life. The aim of this study was to evaluate the effect of highly active antiretroviral therapy (HAART) use on the vaginal Candida spp. isolation in HIV-infected compared to HIV-uninfected women. This cross-sectional study included 178 HIV-infected (HIV group) and 200 HIV-uninfected women (control) that were studied at the Specialized Assistance Service (SAE) for sexually transmitted diseases (STD)/AIDS of the city of Maringá, Brazil, from April 1 to October 30, 2011. The yeasts were isolated and identified by phenotypic and molecular methods. The in vitro antifungal susceptibility to fluconazole, itraconazole, nystatin and amphotericin B was tested by the reference microdilution method. Higher frequencies of total vaginal Candida spp. isolation were found in the HIV-infected group than in the control group. However, both groups showed a similar frequency of colonization and VVC. Although C. albicans was the most frequent and sensitive to azolics and polyenes in both HIV-infected and uninfected women, the emerging resistance of C. glabrata to amphotericin B in the HIV-infected women was observed. Although higher frequency of vaginal Candida spp. isolation had been observed in the HIV-infected than in HIV-uninfected women, colonization and VVC showed similar frequency in both groups, indicating that HAART appears to protect against vaginal colonization and VVC.