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Background: In the Brazilian health system, community health facilities consist of multidisciplinary teams that focus on family health, whereas health centers treat mainly illnesses of registered patients. In the present study we compared socio-economic factors and performance of mammography screening (MS) and clinical breast exam (CBE),  respectively, among women who used both types of public health service centers., Methods: The present study included 180 women aged ≥40 years, who used different health service centers within the same municipal district. Of all 180 women, 110 (41.1%) and 70 (38.9%) used a health center and a community health facility. Logistic regression analysis was performed to calculate odds ratios (ORs) and confidence intervals (CIs) of variables., Results: Regression modeling indicated that women who used the community health facility, performed annual MS 9.52 (OR= 0.105; 95%CI: 0.03- 0.36) times more often (p <0.001). In this model retirement and gynecological service use ≤ each second year, increased annual MS performance 8.16 (95%CI: 1.55- 54.32) and 7.78 (95%CI: 2.54- 23.79) times (p <0.001; p <0.001). Among 113 (62.8%) women who reported strong fear of MS, the chance of its performance was 35.71 (OR= 0.028; 95%CI: 0.02- 0.32) times decreased (p= 0.05). In a second model use of gynecological service ≤ each second year, increased chance of annual CBE performance 7.92 (95%CI: 3.25- 19.29) times (p <0.001). Women who used the community health facility performed annual and bi-annual CBE 2.90 (OR= 0.345; 95%CI: 0.14- 0.86) and 2.97 (OR= 0.337; 95%CI: 0.12- 0.92) times more often, compared to women who used the health center (p =0.030)., Conclusions: Performance of MS and CBE varied both considerable among women who used different types of health service centers. Gynecological service use, fear and socioeconomic variables, additionally influenced regular performance of MS and CBE.

Background: The risk factors for breast cancer (BC) among women in Brazilian populations are poorly understood. To date, few Brazilian studies have addressed the potential association between risk factors and molecular BC subtypes. This case-control study aimed to identify risk factors for BC in a population of Northeast Brazil., Methods: Data from 313 patients with invasive BC and 321 healthy controls were obtained from medical records from two cancer treatment centres and personal interviews. Of the 313 BC patients, 224 (71.6%) had reached menopause. The following distribution of subtypes was found among 301 patients: (1) Luminal A: 54 (17.9%); (2) Luminal B: 175 (58.1%); (3) HER2/neu: 29 (9.7%); and (4) triple-negative breast cancer (TNBC): 43 (14.3%). Odds ratios (ORs) and confidence intervals (CIs) were determined using regression analysis., Results: Regression modelling indicated that family history, obesity (≥ 30.0 kg/m 2 ), alcohol consumption and contraceptive use increased the overall risk of BC 1.78 (95% CI: 1.22-2.59), 1.69 (95% CI: 1.08-2.63), 2.21 (95% CI: 1.44-3.39) and 2.99 (95% CI: 2.09-4.28) times, respectively. After stratification for menopausal status, alcohol consumption increased the risk of BC 4.15 (95% CI: 2.13-8.11) times, and obesity, as a single variable, increased the risk of BC 2.02 (95% CI: 1.22-3.37) times, only among postmenopausal women. In a case-control analysis, the risk of TNBC and Luminal B breast cancer were 4.06 (95% CI: 1.58-10.42) and 1.87 times (95% CI: 1.13-3.11) higher, respectively, in obese women than in non-obese women. Furthermore, alcohol consumption increased the risk of Luminal A and B subtypes 7.08 (3.40-14.73) and 1.77 (1.07-2.92) times, respectively., Conclusion: Family history, contraceptive use, obesity and alcohol consumption increased the risk of BC. Obesity and alcohol consumption differentially increased risk of TNBC and Luminal molecular subtypes., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The incidence and mortality rates of colorectal cancer (CRC) in Northeast Brazil are increasing. To study the association between CRC and diet, data were obtained from 64 patients with CRC and 123 sex- and age-matched controls. The dietary details were recorded using a validated food frequency questionnaire. Nutrient intake was calculated using Dietsys software (National Cancer Institute, Maryland, USA). In a binary logistic regression model of dietary components (model 1), the chance of CRC increased by 0.2% (odds ratio [OR] = 1.002; 95% confidence interval [CI]: 1.000-1.004) for each gram of processed meat intake per week ( p  < 0.010). Consumption of eggs decreased the chance by 0.1% per gram (OR = 0.999; 95% CI: 0.998-1.000; p  < 0.050). The use of oil (including olive oil) for served food decreased the chance by 1.8% (OR = 0.982; 95% CI: 0.970-0.992) for each time consumed ( p  < 0.010). In a model of nutritional factors (model 2), intake of vitamin E decreased the chance by 16.8% (OR = 0.832; 95% CI: 0.725-0.940) for each milligram intake per week ( p  < 0.010). In model 1 and 2 smoking increased the chance of CRC by 10.294 (95%CI: 4.240-27.670) and 2.496 (95% CI: 1.425-3.566) times ( p  < 0.010; p  < 0.010), respectively.

Objective: To evaluate the association between socioeconomic factors, health status, and Functional Capacity (FC) in the oldest senior citizens in a metropolis and a poor rural region of Brazil., Method: Cross-sectional study of 417 seniors aged ≥80 years, data collected through Brazil's Health, Well-being and Aging survey. FC assessed by self-reporting of difficulties in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Chi-square tests and multiple logistic regression analyses were performed using "R" statistical software., Results: Socioeconomic and demographic inequalities in Brazil can influence FC in seniors aged 80 years and older. Comparatively, urban long-lived people had a higher prevalence of difficulties for ADLs and rural ones showed more difficulties for IADLs. Among urban oldest seniors, female gender and lower-income were correlated with difficulties for IADLs. Among rural oldest seniors, female gender, stroke, joint disease, and inadequate weight independently were correlated with difficulties for ADLs, while the number of chronic diseases was associated with difficulties for IADLs., Conclusion: Financial constraints may favor the development of functional limitations among older seniors in large urban centers. In poor rural areas, inadequate nutritional status and chronic diseases may increase their susceptibility to functional decline.

This paper deals with the frequency and structure of first-cousin marriages, by far the most important and frequent type of consanguineous mating in human populations. Based on the analysis of large amounts of data from the world literature and from large Brazilian samples recently collected, we suggest some explanations for the asymmetry of sexes among the parental sibs of first-cousin marriages. We suggest also a simple manner to correct the method that uses population surnames to assess the different Wright fixation indexes F IS , F ST and F IT taking into account not only alternative methods of surname transmission, but also the asymmetries that are almost always observed in the distribution of sexes among the parental sibs of first-cousins.

Background: System delay (SD) is a leading cause of advanced stage of disease and poor prognosis among Brazilian breast cancer patients., Methods: Cox regression and Kaplan-Meier analysis were used to identify variables that contributed to SD among 128 breast cancer patients. Time intervals between first medical consultation and treatment initiation were compared among patients of two referral centres: Patients of a referral centre with outsourced (FAP), respectively, integrated (HNL) diagnostic services., Results: Women who used a specialized private clinic at the beginning of patient flow had an 2.32 fold increased chance (95% CI: 1.17 - 4.60; p = 0.016) of hospital admission within 90 days after first medical consultation, compared to women who used a public health care provider (HCP). Of 73 and 34 patients of the FAP hospital and the HNL, respectively, 10 (13.7%) and 11 (32.5%) used one HCP prior to hospital admission (p = 0.000). The median time between first medical consultation and treatment initiation was 150 days. The median time between first medical consultation and hospital admission was 136.0 and 52.0 days for patients of the FAP hospital, respectively the HNL (p < 0.050). The median time between first medical consultation and diagnostic mammography was 36.5 and 23.0 days for patients from the FAP hospital and the HNL (p < 0.050)., Conclusions: Usage of public diagnostic services was associated with increased SD, whereas the usage of private diagnostic services diminished it. The usage of a lower number of HCPs accelerated patient flow.

Knowledge about risk factors for breast cancer was identified as an important variable that affects women's avoidance behavior and their screening performance. The present study assessed women's knowledge about risk factors and associated socio-economic variables. Data from 417 women aged 20-86 years were obtained in Caicó, Rio Grande do Norte, Brazil. In agreement with the recognition of 26 potential risk factors and prevention behaviors, two groups with good (N = 203) and poor (N = 214) knowledge were formed, respectively. Having a close relative with cancer remained the unique significant variable in the adjusted model. Women without any close relative with cancer, were 1.54 (95% confidence interval [CI] 1.036-2.288) times as likely to have poor knowledge, compared to women who had a close relative with cancer (p = 0.033). Other socio-economic variables, including income, employment status and educational level had no significant association with knowledge (p = 0.450, p = 0.914, p = 0.639, respectively). Of 417 women, 302 (72.42%), 339 (81.29%), and 309 (74.10%), respectively, did not identify "physical inactivity," "overweight after menopause," and "no breastfeeding of children" as risk factors. Knowledge could help to avoid risk factors and motivate prevention behavior. Information about risk factors should be disseminated in health campaigns.

Background: In Brazil, little is known regarding the underlying causes of differences among populations regarding socio-economic variables that affect women’s cervical cancer screening behavior. The present study focused on socio-economic variables that affect women’s performance of the Papanicolaou test, comparing two distinct Brazilian populations. Methods: We collected data regarding performance of the Papanicolaou test and socio-economic variables from 559 women in Mato Grosso do Sul (MS), in the Central East region, and 338 women in Paraíba (PB), in the Northeast region of Brazil. Nominal logistic regression modeling was performed to identify independent variables for both groups of data. Results: Of the women interviewed from MS and PB, 116 out of 599 (19.37%) and 94 out of 338 (27.81%), respectively, had not performed the Papanicolaou test within the last three years (p = 0.025). Low educational level characterized 570 (95.16%) and 203 (60.06%) of women from MS and PB, respectively (p = 0.000). Women in PB who had a low educational level and were unemployed had a 2.96-fold (OR = 0.338; 95% CI: 0.121 - 0.939) and 2.40-fold (OR = 0.416; 95% CI: 0.199 - 0.869) lower chance, respectively, to have performed the Papanicolaou test ≥ three times, or once within the last three years (p = 0.029; p = 0.014). The chance of women in MS who did not live in a stable relationship to have performed the test ≥ three times was 1.79-fold (OR = 0.560; 95% CI: 0.348 – 0.901) lower compared to women who reported a stable relationship (p = 0.039). Conclusions: High educational level, employment, and having a stable interpersonal relationship positively associated with performance of the Papanicolaou test among women in PB and MS. Despite having predominantly a low educational level, women in MS performed the Papanicolaou test more frequently than those in PB., (Creative Commons Attribution License)

The incidence and mortality rates of breast cancer in Northeast Brazil are increasing and little is known about prevailing reproductive factors contributing to this increase. A case-control study was conducted in a public hospital of Campina Grande, state of Paraiba, including 81 women with diagnosed invasive breast cancer and 162 age matched (±5 years) controls. Binominal logistic regression analysis was applied to estimate odds ratio (OR) and confidence intervals (CI) of risk factors. In this model, age at menarche≤12 (OR=2.120; CI: 1.043-4.308; p=0.038), single parity (OR=3.748; CI: 1.459- 9.627; p=0.06) and reproductive period>10 years (OR=3.042; CI: 1.421- 6.512; p=0.04) were identified as independent variables that significantly increased breast cancer risk of parous women. Compared to parous women who never practised breastfeeding, total breastfeeding time>24 months decreased the risk of breast cancer (OR=0.258; CI: 0.084- 0.787; p=0.017). The results indicated that modifiable reproductive factors contribute to breast cancer risk in women included in the present study. Women's knowledge about factors such as the protective effect of breastfeeding could reduce the risk of breast cancer.

Background: The frequencies of molecular breast cancer subtypes vary among different human populations. The Northeastern region of Brazil has a mixed population of African, Indigenous and European ancestry. This retrospective study investigated breast cancer subtypes and applied therapies in a public hospital of Northeastern Brazil., Methods: Data of 633 patients with invasive breast cancer from 2005 to 2011 were obtained from medical records. Status of hormone receptor (HR), HER2 and Ki67 expression index of 269 out of 633 patients were used to define subtypes of Luminal A and B, HER2 and triple negative (TN) breast cancer. Expression index of Ki67 ≥ 14% was applied to distinguish Luminal A from Luminal B subtypes., Results: Overall, 185 (68.77%) and 132 (49.07%) patients showed positive hormone receptor (HR+) and positive HER2 (HER2+) tumors. The mean age ranged from 53.33 to 58.25 years for patients with tumors of Luminal B and Luminal A subtypes, respectively (p = 0.0182). In general, 67.39% of patients with TN tumors aged over 50 and 19.57% aged between 31 and 40 years (p = 0.0046). The rate of small tumors (T1: ≤ 2.0 cm) varied from 22.73% to 52.46% for TN and Luminal A subtypes (p = 0.0088). The rate of high graded (G3) tumors was increased for HER2 and TN subtypes (35.29% and 34.28%) compared to Luminal A and Luminal B subtypes (3.92% and 12.62%), respectively (p < 0.0001). The five-year survival rate ranged from 92.86% to 75.00%, for Luminal A, HER2 and TN subtypes, respectively (HR: 0.260 to 1.015; 95% CI: 0.043 to 3.594; p = 0.2589). Patients with HER2 positive (HER2+) breast tumors did not receive immunotherapy and chemotherapy application varied from 54.84% to 86.49% for Luminal A and HER2 subtypes, respectively (p = 0.0131)., Conclusions: The results of this study revealed a high percentage of HER2+ breast tumors and an increased rate of patients with TN tumors aged over 50 years. This emphasizes the need for establishing immunotherapy as an additional therapeutic option to improve clinical outcomes for patients with HER2+ tumors and to investigate the risk factors of TN breast cancer.

Background: Consanguinity of human populations can but does not have to be associated with increased fertility. A recent study involving communities of Northeast Brazil revealed increased levels of endogamy., Subjects and Methods: Data from 20 451 interviewed couples and their 74 289 children were analysed., Aim: The present study aimed to compare fertility between consanguineous and unrelated couples of these communities., Results: Consanguineous and unrelated couples of the 39 communities had an average of 4.3 (SD = 0.9) and 3.5 (SD = 0.8) children (p < 0.0001), respectively. Average offspring number of consanguineous couples varied from 3.9 (SD = 1.1) to 5.6 (SD = 3.4) for couples related at the level of third cousins and double first cousin/uncle-niece, respectively (p < 0.005). The correlation coefficient between Human Development Index and fertility was -0.38 (p = 0.0179) and -0.23 (p = 0.17) for unrelated and related couples, respectively., Conclusion: Results indicated an overall positive association between consanguinity and fertility. Fertility tended to be increased, for closely related couples, compared to those related more distantly.

Despite conceptual inaccuracies and methods of measurement, the WHO estimates that about 10% of the world population has some form of disability. In order to investigate the prevalence and etiology of disabilities and to evaluate if they could be associated with inbreeding, a cross-sectional epidemiological study was conducted using the informant method in five communities of the state Rio Grande do Norte in the Brazilian Northeast, in which consanguineous marriages frequencies varied between 9 and 32%. The average prevalence of disabilities in the five sampled communities was 4.53%, obtained by interviews that involved 37.87% of a population of 39,054 inhabitants. On average, 25% of consanguineous and 12% of non-consanguineous couples had one or more children with disabilities. The increased rate of individuals with disabilities in the Brazilian Northeast could be associated with the maintenance of the tradition of consanguineous marriages in these populations and some of these disabilities may be caused by genetic disorders.

Objectives: The aim of this study was to identify communities at high risk of transmitting recessive genetic disorders by measuring levels of endogamy and offspring's rate of disabilities., Methods: In a house-to-house population based-survey in the state of Paraíba, 20,462 couples were interviewed regarding kinship relation, number of siblings and offspring affected by mental or physical disabilities., Results: The rate of consanguineous unions in the communities ranged from 6.0% to 41.14%, showing an average value of 20.19% ± 9.13%. The overall average inbreeding coefficient (F) was 0.00602 ± 0.00253, ranging from 0.00134 to 0.01182. Communities situated on the backlands had an increased average value of F compared to those closer to the seashore (P = 0.024). The average rate of disabled offspring varied from 2.96% ± 0.68% for unrelated unions to 10.44% ± 16.86% for related couples at the level of double first cousins or uncle-niece. The Spearman correlation coefficient between the overall rate of disabled offspring from all couples together and F was 0.510 (P < 0.01)., Conclusion: Inbreeding increases the risk of disability which is unevenly distributed, varying considerably even in neighboring communities with similar Human Development Index and population density. Higher inbreeding communities are mostly located on the more economically underdeveloped backlands than on the coastal region. The identification of communities at high risk for genetic disorders could serve as basis for the establishment of Community Genetics programs., (Copyright © 2012 Wiley Periodicals, Inc.)