OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators.METHODS Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state.RESULTS There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities.CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment.

. The rates of overall cancer mortality and major types were corrected by proportionally redistributing 50% of ill-defi ned causes of death and standardizing them by age according to the standard world population. Trend curves for Brazil and its major regions were calculated for state capitals and other municipalities according to sex, and were evaluated by means of simple linear regression. RESULTS:Among men, ascending mortality rates were observed for lung, prostate and colorectal cancer; declining rates for stomach cancer; and stable rates for esophagus cancer. Among women, mortality from breast, lung and colorectal cancer increased, and the rates for cervical and stomach cancer declined. Mortality evolution varied across the regions of Brazil, with distinct patterns between state capitals and other municipalities. CONCLUSIONS:The correction of mortality rates based on redistribution of ill-defi ned causes of death increased the magnitude of the overall cancer mortality in Brazil by approximately 10% in 1980 and 5% in 2006. In the inland municipalities no decrease or stability was identifi ed, differently from what was observed in the state capitals. Limited scope of prevention actions and lower access to services of cancer diagnosis and treatment for the population living away from large urban centers may partly explain these differences.

Trata-se de estudo de custo-efetividade comparando o teste de Papanicolaou com as novas tecnologias de rastreamento do câncer cérvico-uterino. Foi utilizado um modelo analítico de decisão para simular os impactos econômicos e em saúde das tecnologias de rastreamento, tendo como unidade de desfecho os casos detectados de câncer de colo uterino ou lesões precursoras de alta malignidade. As estratégias de rastreamento examinadas foram: teste de Papanicolaou; citologia em meio líquido; captura híbrida para Papilomavirus (CH-HPV); CH-HPV com autocoleta; associação do teste de Papanicolaou com CH-HPV; e associação de citologia em meio líquido com CH-HPV. O universo temporal restringiu-se a um ano. A perspectiva adotada no estudo foi a do sistema de saúde, contabilizando-se apenas os custos médicos diretos de rastreamento dos casos detectados e utilizando os valores propostos pela tabela da Classificação Brasileira Hierarquizada de Procedimentos Médicos. Estimaram-se também os preços que as tecnologias não presentes na tabela de reembolso do SUS precisariam ter para que as relações de custo-efetividade fossem, no mínimo, equivalentes ao teste de Papanicolaou. Concluiu-se que, embora o teste de Papanicolaou possa ser mais custo-efetivo, as novas estratégias de rastreamento do câncer cérvico-uterino podem vir a mostrar melhor razão de custo-efetividade na dependência dos preços praticados no setor de saúde.

Abstract

overweight/obesity. Multinomial logistic regression was used to model the relationship between oral status with underweight and overweight/obesity. Results The mean age was 72.7 years and the prevalence of overweight/obesity was 41.4%. Oral status wasn't associated with underweight. Participants who reported using prostheses in both arches with self-perceived limitation in the type or amount of food intake and subjects that rated their oral health as good were less likely to be overweight/obese. Conclusions Our findings suggest that dental prosthesis use with self-perceived limitation in food intake is associated with overweight/obesity but not with underweight.

To compare the performance of human papillomavirus DNA tests (samples collected by a healthcare professional and self-collected) and liquid-based cytology with conventional cytology in the detection of cervix uteri cancer and its precursor lesions. A cross-sectional study was carried out in 1777 women living in poor communities in Rio de Janeiro State, Brazil. Eligibility criteria included ages 25-59 years and not having had a Papanicolau test within at least 3 years prior to the study. Cytology (conventional or liquid-based) and human papillomavirus DNA (collected by a healthcare professional or self-collected) tests were performed using samples collected in a single visit. Women with abnormalities in at least one test and a systematic sample of 70 women with negative test results were referred to a colposcopic examination. Test readings were double-masked, and the outcome of interest was high-grade squamous intraepithelial lesion or worse. The pathology report was used as the gold standard. The prevalence of high-grade squamous intraepithelial lesion or worse was 2.0%. Human papillomavirus DNA test collected by a health professional alone or combined with conventional cytology had the highest sensitivity (91.4 and 97.1%, respectively). The highest specificity was found for conventional cytology (91.6%) and for a human papillomavirus DNA test collected by a healthcare professional (90.2%). On the basis of only test performance, the use of human papillomavirus DNA tests, alone or combined with cytology, would seem to be recommended. Its population-wide implementation, however, is conditional on a cost-effectiveness analysis.

Resumo Introdução Os dados dos Sistemas de Informação em Saúde são muito utilizados para a produção do conhecimento. Para a sua efetiva utilização, no entanto, é essencial assegurar que sejam válidos e confiáveis. Objetivo Avaliar a qualidade das notificações de violências no estado do Rio de Janeiro, visando contribuir para o aprimoramento e melhoria da informação. Método Estudo ecológico sobre a consistência das notificações de violência registradas no Sistema de Informação de Agravos de Notificação do Estado do Rio de Janeiro, entre 2009 a 2016. A tendência temporal das proporções de inconsistências, para cada grupo de campos relacionados, foi avaliada por regressão linear simples e respectiva significância estatística (p≤0,05). Resultados No período foram notificados 103.841 casos de violência, mas 31,7% não foram identificados se interpessoal ou autoprovocada. As principais inconsistências foram: incongruência entre violência psicológica e meio da agressão, sexo e identidade de gênero, tipo de violência e idade da vítima, violência autoprovocada e características do agressor e tipo de violência; a maioria com estabilidade no período (p>0,05). Conclusão Os resultados evidenciam inconsistências expressivas nas notificações de violência que comprometem a utilização da informação.

RESUMO Este estudo é um ensaio que visou analisar de forma crítica a abordagem punitivista do sistema de justiça criminal no âmbito da violência doméstica e familiar contra a mulher e apontar caminhos alternativos, sem, contudo, descartar as contribuições de um referencial feminista. Busca uma congruência entre os pontos relativos à criminologia crítica do direito penal com o enrijecimento do sistema punitivista, a fim de averiguar se o modo de tratamento da Lei Maria da Penha é o mais adequado. O sistema de justiça percebe a mulher como objeto inserido em um esquema predeterminado de violência, e, a partir disso, nega-lhe voz. Proteger mulheres refere-se diretamente a fortalecer as mulheres e a conferir a elas papel de protagonista da própria vida. A justiça restaurativa pode ser usada como incrementadora da democracia brasileira, facilitando a chamada 'criação coletiva da justiça' e potencializando o efeito efetivamente justo das decisões e fortalecimento da cidadania, desde que bem estruturada.