BackgroundBreast cancer affects millions of women worldwide, particularly in Brazil, where public healthcare system is an important model in health organization and the cost of chronic disease has affected the economy in the first decade of the twenty-first century. The aim was to evaluate the role of health policy in the burden of breast cancer in Brazil between 2004 and 2014.MethodsSecondary analysis was performed in 2017 with Brazilian Health Ministry official data, extracted from the Department of Informatics of the National Health System. Age-standardized mortality and the age-standardized incidence of hospital admission by breast cancer were calculated per 100,000 people. Public healthcare costs were converted to US dollars. Regression analysis was performed to estimate the trend of breast cancer rates and healthcare costs, and principal component analysis was performed to estimate a cost factor. Stata® 11.0 was utilized.ResultsBetween 2004 to 2014, the age-standardized rates of breast cancer mortality and the incidence of hospital admission and public healthcare costs increased. There was a positive correlation between breast cancer and healthcare public costs, mainly influenced by governmental strategies.ConclusionsGovernmental strategies are effective against the burden of breast cancer in Brazil.

Breast cancer early detection is the major strategy for mortality rates reduction. In Brazil, Primary Health Care is an important strategy for public health promotion. To analyse the association between breast cancer mortality and primary health care indicators in Brazilian municipalities, data on breast cancer mortality and primary healthcare coverage of the 5,700 Brazilian municipalities were collected from the Department of Informatics of the Brazilian Unified Health System. We collected data on the deaths of women living in Brazil in 2010 with breast cancer. Breast cancer mortality was calculated by 100,000 women and age-standardised from the World Health Organisation population. We studied the coverage of primary health care, family health team and community health agents. We found that increase of both primary care indexes was related to increasing of the breast cancer mortality. Additionally, improving the scholarly and reducing the income inequality was related to reducing the breast cancer mortality. Strategies to improve the quality of primary care, reduce the income inequality and improve elementary scholarly should be taken into account in the development of public policies in the Brazilian municipalities to reduce breast cancer in Brazilian municipalities.

ObjectiveTo analyze the correlation between municipal human development indices (MHDIs) and stroke mortality in residents of Brazilian state capitals in 2010. A secondary data analysis was conducted in 2015 using data for the MHDI and the following dimensions: income, longevity and education which were obtained from the United Nations Development Program. Additionally, we analyzed age-standardized stroke mortality data from the Department of System Information Unified Health of Brazil.ResultsWe observed a correlation between stroke mortality and MHDIs overall (Pearson r = − 0.563; p = 0.002) and within the following dimensions: income (Spearman’s ρ = − 0.479; p = 0.011), longevity (Pearson r = − 0.510; p = 0.006) and education (Pearson r = − 0.592; p = 0.001). We identified moderate but significant negative correlations between MHDI overall and in its individual dimensions (income, longevity, and age) and stroke mortality in Brazilian capitals. Stroke is the second leading cause of death in industrialized countries and the leading cause of death in Brazil. Therefore, the discovery of factors that may influence the epidemiology of stroke is important for the construction of adequate policies considering to the socioeconomic status in these places and with an emphasis in lower socioeconomic status places.

The mechanism of pain reduction involves bidirectional processes of pain blocking (nociception) and reductions in the levels of proinflammatory cytokines in the blood. Does transcutaneous electrical nerve stimulation (TENS) reduce blood levels of proinflammatory cytokines? For this systematic review, we searched in six databases to identify randomized controlled trials with the criteria: humans older than 18 years (adults), use of TENS in the experimental group, and having at least one pre- and postintervention blood level of at least one proinflammatory cytokine. The risk of bias and the level of evidence were assessed. Five studies were included involving 240 participants. The heterogeneity of the studies was high (I 2: 85%); therefore, we used a random-effects meta-analysis. It was observed through the meta-analysis synthesis measures that there were statistically significant differences following the use of TENS to reduce the general group of cytokines. When grouped by chronic disease, by postoperative settings, or by individual studies in the case of IL-6, it was observed that the significant reduction of cytokines related to the use of TENS was maintained. The use of TENS reduced the blood levels of proinflammatory cytokines (we observed a protective factor of TENS in relation to inflammation). The protocol of the systematic review was registered in PROSPERO, CRD42017060379.

BackgroundPain reduction can be achieved by lowering proinflammatory cytokine levels in the blood. Transcutaneous electrical nerve stimulation (TENS) is a non-invasive physiotherapeutic resource for pain management, but evidence on the effectiveness of this device at reducing proinflammatory cytokines in the blood is unclear. This study systematically reviews the literature on the effect of TENS on proinflammatory cytokines.MethodsA systematic review protocol was developed based on searches of articles in six electronic databases and references of retrieved articles, contact with authors, and repositories of clinical trials. Eligibility criteria: publication in peer-reviewed journals, randomized clinical trials, use of TENS in the experimental group, and pre- and post-measurements of proinflammatory cytokines in the blood. Selection of the studies and extraction of the data will be carried out by two reviewers independently. Characteristics of the study, participants, interventions and outcomes were extracted and described. Assessments were performed on the risk of bias, level of evidence and the size of the intervention effect in the studies, according to GRADE guidelines and the Cochrane Handbook for Systematic Reviews. Clinical and statistical assessments compared the effects of the interventions (meta-analysis), taking into consideration any influencing characteristics of the studies (e.g., methods and application sites).DiscussionWe anticipate that this review will strengthen evidence-based knowledge of the effect of TENS on proinflammatory cytokines and, as a result, direct new studies to benefit patients with specific pathologies.Systematic review registrationPROSPERO, CRD42017060379.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0532-5) contains supplementary material, which is available to authorized users.

Background:Stroke is the second leading cause of death and the third leading cause of physical disability in the world, with a high burden of morbidity and mortality, but it has been shown a reduction in mortality worldwide over the past two decades, especially in regions with higher income.Objective:The study analyzed the temporal trend and the factors associated with stroke-related mortality in the cities that make up the ABC region of São Paulo (Santo André, São Bernardo do Campo, São Caetano do Sul, Diadema, Mauá, Ribeirão Pires, and Rio Grande da Serra), in comparison to data from the capital city of São Paulo, in the state of São Paulo, Brazil.Method:This was an ecological study conducted in 2017 using data from 1997 to 2012. Data were collected in 2017 from the Department of Informatics of the Brazilian Unified National Health System (DATASUS), where the Mortality Information System (SIM/SUS) was accessed. Linear regression analysis was used to estimate the temporal trend of stroke-related mortality according to sex, stroke subtypes, and regions. The confidence level adopted was 95%.Results:There was a reduction in the mortality rates stratified according to sex, age groups above 15 years, and subtypes of stroke. Mortality from hemorrhagic and non-specified stroke decreased in all regions. However, a significant reduction in ischemic stroke-related mortality was observed only in the ABC region and in Brazil.Conclusion:The ABC region showed greater mortality due to stroke in males, the age group above 49 years, and non-specified stroke between 1997 and 2012.

Introduction Acute myeloid leukaemia is the most common type of acute leukaemia in the world. Thus, the study of genetic alterations, such as single-nucleotide polymorphisms (SNPs), has contributed to a better understanding of the mechanisms underlying leukaemogenesis, to improve the prognosis and to increase the survival of these patients. However, there is no synthesis of evidence in the literature evaluating the quality of evidence and the risk of bias in the studies such that the results can be translated. Thus, this systematic review protocol aims to assess the impact of SNPs on genes involved in the metabolism of cytarabine and anthracyclines with respect to survival, treatment response and toxicity in patients with AML. Methods This systematic review protocol is based on PRISMA guidelines and includes searches in six electronic databases, contact with authors, repositories of clinical trials, and cancer research. Studies published in peer-reviewed journals will be included if they meet the eligibility criteria: (a) samples composed of individuals of any age, of both sexes, with a diagnosis of AML, regardless of the time of diagnosis of disease; (b) participants who have undergone or are undergoing cytarabine- and anthracycline-associated chemotherapy or cytarabine-only chemotherapy; and (c) in vivo studies. Studies that include patients with promyelocytic leukaemia (Fab type 3) will be excluded because this disease has different treatment. The process of study selection, data extraction, and evaluation/synthesis will be performed in duplicate. Assessment of methodological quality and risk of bias will be performed using the Cochrane Risk of Bias Tool for randomized clinical studies and the Downs-Black Checklist for cohort and case-control studies. The synthesis of evidence will include the level of evidence based on the GRADE protocol. A meta-analysis of the association between SNPs and outcomes may be performed based on Cochrane guidelines. Discussion It is expected that clinical decisions for AML patients will consider evidence-based practices to contribute to better patient management. In this way, we will be able to define how to treat patients with AML to improve their survival and quality of life. Systematic review registration PROSPERO CRD42018100750 Electronic supplementary material The online version of this article (10.1186/s13643-019-1011-y) contains supplementary material, which is available to authorized users.

Breast cancer remains the leading type of cancer in women globally and accounts for 25% of all cancer cases diagnosed. It results in approximately half a million deaths and approximate loss of 15 million disability-adjusted life years. 1 In Brazil, where its incidence increases by 1.8 cases per 100 000 inhabitants per year, 2 existing socioeconomic inequality greatly influences the early diagnosis and prevention of breast cancer, 3 thereby, creating a great challenge to the public health services focusing on the disease.In addition to socioeconomic inequality, other existing forms of inequality in Brazil 4 can also influence the outcomes related to breast cancer. Moreover, all these factors contribute to increased rates of smoking, physical inactivity, excessive alcohol consumption, and overweight, which are risk factors for chronic diseases and are also related to breast cancer. 5 In this context, from a public health point of view, it is important to know which of these factors are associated with the incidence and mortality of such disease.Thus, we performed an ecological study analyzing secondary data obtained from the Department of Information Technology of SUS (DATASUS) and the United Nations Development Program (UNDP). The units of analysis were the years between 2006 and 2014. Deaths and hospital admissions for breast cancer in women were collected from the Mortality Information System and Hospital Information System (HIS), respectively. Both are available for public access in the Department of Information Technology of the Brazilian Unified Health System (SUS), maintained by the Brazilian Ministry of Health. Hospital admission and mortality rates were estimated by 100 000 women and age-standardized by age according to the World Health Organization by the direct method. After univariate analysis of the Pearson's correlation, a multiple linear regression was performed, adopting the stepwise backward strategy, using the criteria for the withdrawal of P > 0.20 model. The level of significance was 5%. The program used was Stata® (Stata Corp., College Station, TX, USA) 11.0. The main results found were that between 2006 and 2014, overweight, average cost of hospital admission, number of available SUS mammographs, and the HDI were the main factors that influenced the mortality and hospital admission rate of breast cancer in Brazil (Table 1). The model that analyzes the socioeconomic aspects presented better explanatory capacity (r 2 = 0.99) than the models related to T A B L E 1 Correlation of variables with indicators of breast cancer in Brazil Indicator Mortality a Hospital admission rate a r P b r P b Lifestyle Overweight women rate 0.927 <0.001 0.807 0.008 Rate of physically inactive women 0.422 0.257 0.317 0.405 Rate of women with alcohol abuse 0.204 0.597 0.069 0.859 Excessive smoking rate among women −0.698 0.036 −0.669 0.048 Health service Doctors c 0.979 <0.001 0.864 0.002 Beds c −0.935 0.002 −0.871 0.010 Mammographs in SUS c 0.959 <0.001 0.878 0.002 Socioeconomic Human development index 0.994 <0.001 0...