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Treatment delays among women with breast cancer in a low socio-economic status region in Brazil
No full textAbstract
Background
Considering the inequalities and the areas of low socioeconomic status in Brazil, access to health services is a challenge and the delay between diagnosis and treatment represents an important factor of worse prognosis in patients with breast cancer. Herein, we describe the clinical and epidemiological profiles of women with breast cancer and evaluate their access to health services, as well as treatment delays, at a reference centre of the Cariri region, Ceará, Brazil.
Methods
This is a retrospective study that included 473 women treated with breast cancer between 2009 and 2011 at the Oncology Centre of the Cariri.
Results
The majority of these patients were aged between 40 and 69 years old (65.7%), without a completed high school degree (89.2%). They were married (62.9%) and were already diagnosed but had not yet been subjected to any previous treatment (77.8%). It was observed that 91.8% were referred from the public health service, and treatment was paid for by the public health service in 92.9% of the cases. The patients whose source of referral was the public system waited longer between diagnosis and the treatment initiation (p = 0.031; Mann–Whitney’s test), with a median waiting time of 71.5 days versus 39 days for those receiving referrals from private services. In addition, those with public referrals prior to diagnosis also experienced a longer waiting time between the first medical visit and treatment initiation (77 days vs. 37 days; p = 0.036; Mann–Whitney’s test), with the waiting time for the biopsy being an important factor in this delay.
Conclusions
Late diagnosis was often the result of inefficiency of the prevention policies coupled with difficulty accessing the public health network. It was commonly observed that, even after diagnosis, the patients needed to wait too long before entering the Oncology Service because of long waiting queues in the public health system
Immune recognition of salivary proteins from the cattle tick Rhipicephalus microplus differs according to the genotype of the bovine host
No full textAbstract\ud
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Background\ud
Males of the cattle tick Rhipicephalus microplus produce salivary immunoglobulin-binding proteins and allotypic variations in IgG are associated with tick loads in bovines. These findings indicate that antibody responses may be essential to control tick infestations. Infestation loads with cattle ticks are heritable: some breeds carry high loads of reproductively successful ticks, in others, few ticks feed and they reproduce inefficiently. Different patterns of humoral immunity against tick salivary proteins may explain these phenotypes.\ud
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Methods\ud
We describe the profiles of humoral responses against tick salivary proteins elicited during repeated artificial infestations of bovines of a tick-resistant (Nelore) and a tick-susceptible (Holstein) breed. We measured serum levels of total IgG1, IgG2 and IgE immunoglobulins and of IgG1 and IgG2 antibodies specific for tick salivary proteins. With liquid chromatography followed by mass spectrometry we identified tick salivary proteins that were differentially recognized by serum antibodies from tick-resistant and tick-susceptible bovines in immunoblots of tick salivary proteins separated by two-dimensional electrophoresis.\ud
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Results\ud
Baseline levels of total IgG1 and IgG2 were significantly higher in tick-susceptible Holsteins compared with resistant Nelores. Significant increases in levels of total IgG1, but not of IgG2 accompanied successive infestations in both breeds. Resistant Nelores presented with significantly higher levels of salivary-specific antibodies before and at the first challenge with tick larvae; however, by the third challenge, tick-susceptible Holsteins presented with significantly higher levels of IgG1 and IgG2 tick salivary protein-specific antibodies. Importantly, sera from tick-resistant Nelores reacted with 39 tick salivary proteins in immunoblots of salivary proteins separated in two dimensions by electrophoresis versus only 21 spots reacting with sera from tick-susceptible Holsteins.\ud
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Conclusions\ud
Levels of tick saliva-specific antibodies were not directly correlated with infestation phenotypes. However, in spite of receiving apparently lower amounts of tick saliva, tick-resistant bovines recognized more tick salivary proteins. These reactive salivary proteins are putatively involved in several functions of parasitism and blood-feeding. Our results indicate that neutralization by host antibodies of tick salivary proteins involved in parasitism is essential to control tick infestations.This study was supported by a grant to IKFMS from the Conselho Nacional\ud
de Desenvolvimento Científico e Tecnológico (CNPq grant number 559603/\ud
2009-6) and from the Fundação de Amparo à Pesquisa do Estado de São\ud
Paulo (FAPESP grant number 2009/53645-3). GRG. was supported by\ud
scholarships from the Fundação de Amparo à Pesquisa do Estado de São\ud
Paulo (FAPESP, fellowships: 2007/51532-1, 2009/51212-2 and 2013/00382-0).\ud
SRM was supported by scholarships from FAPESP (2006/54041-6, 2007/\ud
59357-4, 2012/15464-0 and 2012/04087-0). Because JMCR, JGV and JMA are\ud
government employees and this is a government work, the work is in the\ud
public domain in the United States. Notwithstanding any other agreements,\ud
the NIH reserves the right to provide the work to PubMedCentral for display\ud
and use by the public, and PubMedCentral may tag or modify the work\ud
consistent with its customary practices. Rights can be established outside of\ud
the United States subject to a government use license
Three novel Pseudomonas phages isolated from composting provide insights into the evolution and diversity of tailed phages
No full textAbstract\ud
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Background\ud
Among viruses, bacteriophages are a group of special interest due to their capacity of infecting bacteria that are important for biotechnology and human health. Composting is a microbial-driven process in which complex organic matter is converted into humus-like substances. In thermophilic composting, the degradation activity is carried out primarily by bacteria and little is known about the presence and role of bacteriophages in this process.\ud
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Results\ud
Using Pseudomonas aeruginosa as host, we isolated three new phages from a composting operation at the Sao Paulo Zoo Park (Brazil). One of the isolated phages is similar to Pseudomonas phage Ab18 and belongs to the Siphoviridae YuA-like viral genus. The other two isolated phages are similar to each other and present genomes sharing low similarity with phage genomes in public databases; we therefore hypothesize that they belong to a new genus in the Podoviridae family. Detailed genomic descriptions and comparisons of the three phages are presented, as well as two new clusters of phage genomes in the Viral Orthologous Clusters database of large DNA viruses. We found sequences encoding homing endonucleases that disrupt a putative ribonucleotide reductase gene and an RNA polymerase subunit 2 gene in two of the phages. These findings provide insights about the evolution of two-subunits RNA polymerases and the possible role of homing endonucleases in this process. Infection tests on 30 different strains of bacteria reveal a narrow host range for the three phages, restricted to P. aeruginosa PA14 and three other P. aeruginosa clinical isolates. Biofilm dissolution assays suggest that these phages could be promising antimicrobial agents against P. aeruginosa PA14 infections. Analyses on composting metagenomic and metatranscriptomic data indicate association between abundance variations in both phage and host populations in the environment.\ud
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Conclusion\ud
The results about the newly discovered and described phages contribute to the understanding of tailed bacteriophage diversity, evolution, and role in the complex composting environment.This work was supported by grant 2011/50870-6 from the São Paulo State\ud
Research Foundation (FAPESP). DA was supported by fellowships from FAPESP\ud
(2014/16450-8 and 2015/14334-3) and from the Coordination for the\ud
Improvement of Higher Education Personnel (CAPES). AMDS, JCS and KCL\ud
received Research Fellowship Awards from the National Council for Scientific and\ud
Technological Development (CNPq). The funders had no role in study design,\ud
data collection, analysis, decision to publish or preparation of the manuscript
Can we use short rotation coppice poplar for sugar based biorefinery feedstock? Bioconversion of 2-year-old poplar grown as short rotation coppice
No full textAbstract\ud
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Background\ud
Feedstock cost is a substantial barrier to the commercialization of lignocellulosic biorefineries. Poplar grown using a short rotation coppice (SRC) system has the potential to provide a low-cost feedstock and economically viable sugar yields for fuels and chemicals production. In the coppice management regime, poplars are harvested after 2 years’ growth to develop the root system and establish the trees. The biomass from these 2-year-old trees is very heterogeneous, and includes components of leaf, bark, branch, and wood chip. This material is quite different than the samples that have been used in most poplar bioconversion research, which come from mature trees of short rotation forestry (SRF) plantations. If the coppice management regime is to be used, it is important that feedstock growers maximize their revenue from this initial harvest, but the heterogeneous nature of the biomass may be challenging for bioconversion. This work evaluates bioconversion of 2-year-old poplar coppice and compares its performance to whitewood chips from 12-year-old poplar.\ud
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Results\ud
The 2-year-old whole tree coppice (WTC) is comprised of 37% leaf, 9% bark, 12% branch, and 42% wood chip. As expected, the chemical compositions of each component were markedly different. The leaf has a low sugar content but is high in phenolics, ash, and extractives. By removing the leaves, the sugar content of the biomass increased significantly, while the phenolic, ash, and extractives contents decreased. Leaf removal improved monomeric sugar yield by 147 kg/tonne of biomass following steam pretreatment and enzymatic hydrolysis. Bioconversion of the no-leaf coppice (NLC) achieved a 67% overall sugar recovery, showing no significant difference to mature whitewood from forestry plantation (WWF, 71%). The overall sugar yield of NLC was 135 kg/tonne less than that of WWF, due to the low inherent sugar content in original biomass. An economic analysis shows the minimum ethanol selling price required to cover the operating cost of NLC bioconversion was $1.69/gallon.\ud
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Conclusions\ud
Leaf removal resulted in significant improvement in overall monomeric sugar production from SRC biomass. Leaf removal is essential to achieve good yields in bioconversion of poplar. Economic analysis suggests the NLC could be a reasonable feedstock provided it can be obtained at a discounted price.This project is supported by Agriculture and Food Research Initiative Competitive\ud
Grant No. 2011-68005-30407 from the USDA National Institute of Food\ud
and Agriculture, and we are grateful for that support. The authors would like\ud
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Arabinose Galactose Glucose Xylose Mannose Overall monomeric sugar recovery\ud
Fig. 6 Overall monomeric sugar yield (kg/tonne), expressed as monomeric sugar per unit raw biomass, and overall monomeric sugar recovery (%),\ud
expressed as monomeric sugar per unit original sugar after pretreatment and enzymatic hydrolysis, of NLC, WTC, LC, and WWF. Error bars indicate\ud
standard deviation from triplicate measurements\ud
Dou et al. Biotechnol Biofuels (2017) 10:144 Page 14 of 15\ud
to thank the Denman Professorship in Bioresource Science and Engineering at\ud
the University of Washington for funding
Spatial and temporal distribution of American cutaneous leishmaniasis in Acre state, Brazil
No full textAbstract\ud
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Background\ud
Acre has reported the highest incidence of American cutaneous leishmaniasis (ACL) in Brazil in recent years. The present study seeks to identify high and low risk agglomerations of ACL in space and space-time during the period from 2007 to 2013 in Acre, and also to characterize the occurrence of the disease in time and according to sociodemographic variables.\ud
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Methods\ud
This is an ecological study, the study population of which consisted of autochthonous ACL cases notified in the municipalities of Acre by an epidemiological surveillance system. Scan statistics of SaTScan™ software were used to identify spatial and space-time clusters. In addition, the cases were characterized by sex, age, home situation (in a rural or urban area), and temporal tendency.\ud
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Results\ud
Acre reported an incidence rate of 12.4 cases per 10 000 inhabitant-years in the study period, with the rates varied greatly (standard deviation of 21.8) among their 22 municipalities. One agglomeration of high risk and three of low risk were detected in space and space-time. Four of the five micro-regions of Acre presented a stationary temporal tendency. The profile of transmission varied according to the micro-region. Generally speaking, the disease occurred more often among young people, those of male gender, and those living in rural areas.\ud
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Conclusions\ud
Acre has stood out within the Brazilian national context due to its high rates of ACL incidence in the central region of the Acre Valley. The high rates in the micro-region of Brasiléia are related to the disease’s intra/peridomiciliary occurrence, and it would seem that the municipality of Sena Madureira is approaching a transmission pattern similar to that of Brasiléia. In other micro-regions, the profile of the disease’s transmission is mainly related to the forest/sylvatic cycle of ACL.This study had financial support from CAPES (Coordination for the Improvement of Higher Education Personnel)
The specific and combined role of domestic violence and mental health disorders during pregnancy on new-born health
No full textAbstract\ud
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Background\ud
Addressing impaired foetal growth is recognized as a public health priority. Certain risk factors for this condition, such as poor nutritional status at birth, have been found to be highly correlated with poverty. However, the role of psychosocial factors, specifically the mother’s mental health and exposure to violence during pregnancy, have yet to be further explored. Our objective was to determine if there is a measurable association between combined psychosocial factors, specifically domestic violence and mental disorders, and birth outcomes, specifically birth nutritional status and preterm delivery.\ud
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Methods\ud
We followed 775 women from an underserved, urban area, beginning their 28th week of gestation. Diagnostic interviews were performed to determine if any of the mothers had any of the following disorders: mood disorder, anxiety, obsessive–compulsive disorder (OCD), substance dependence, psychotic disorder, or anti-social personality disorder. Physical, psychological, and sexual domestic violence were also assessed.\ud
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Results\ud
Domestic violence and mental disorders were highly correlated in our sample. About 27.15% of the women in our study experienced domestic violence, and about 38.24% of them were diagnosed with mental disorders. The main association we found between combined psychosocial factors and neonate outcomes was between anxiety (IRR = 1.83; 95%CI = 1.06–3.17)/physical violence (IRR = 1.95; 95%CI = 1.11–3.42) and the rate of small-for-gestational age (SGA) in new-borns. More specifically, the combination of anxiety (beta = −0.48; 95%CI = −0.85/−0.10) and sexual violence (beta = −1.58; 95%CI = −2.61/−0.54) was also associated with birth length. Maternal risk behaviours such as smoking, drinking, inadequate prenatal care, and inadequate weight gain could not sufficiently explain these associations, suggesting that these psychosocial factors may be influencing underlying biological mechanisms.\ud
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Conclusion\ud
Domestic violence against women and mental disorders amongst pregnant women are extremely prevalent in under-resourced, urban areas and ultimately, have detrimental effects on birth outcomes. It is imperative that actions be taken to prevent violence and improve mental health during pregnancy.CNPQ - National Council for Scientific and Technological Development;\ud
FAPESP – Foundation for the Support of Research of the State of Sao\ud
Paulo, Brazil
Development of a dynamic framework to explain population patterns of leisure-time physical activity through agent-based modeling
No full textAbstract\ud
Despite the increasing body of evidences on the factors influencing leisure-time physical activity, our understanding of the mechanisms and interactions that lead to the formation and evolution of population patterns is still limited. Moreover, most frameworks in this field fail to capture dynamic processes. Our aim was to create a dynamic conceptual model depicting the interaction between key psychological attributes of individuals and main aspects of the built and social environments in which they live. This conceptual model will inform and support the development of an agent-based model aimed to explore how population patterns of LTPA in adults may emerge from the dynamic interplay between psychological traits and built and social environments. We integrated existing theories and models as well as available empirical data (both from literature reviews), and expert opinions (based on a systematic expert assessment of an intermediary version of the model). The model explicitly presents intention as the proximal determinant of leisure-time physical activity, a relationship dynamically moderated by the built environment (access, quality, and available activities) – with the strength of the moderation varying as a function of the person’s intention– and influenced both by the social environment (proximal network’s and community’s behavior) and the person’s behavior. Our conceptual model is well supported by evidence and experts’ opinions and will inform the design of our agent-based model, as well as data collection and analysis of future investigations on population patterns of leisure-time physical activity among adults.LG was supported by scholarships from the Brazilian Coordination for the\ud
Improvement of Higher Education Personnel (# 1406604 and 1207/14-8)
Circulating leptin and its muscle gene expression in Nellore cattle with divergent feed efficiency
No full textAbstract\ud
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Background\ud
Leptin has a strong relation to important traits in animal production, such as carcass composition, feed intake, and reproduction. It is mainly produced by adipose cells and acts predominantly in the hypothalamus. In this study, circulating leptin and its gene expression in muscle were evaluated in two groups of young Nellore bulls with divergent feed efficiency. Individual dry matter intake (DMI) and average daily gain (ADG) of 98 Nellore bulls were evaluated in feedlot for 70 d to determinate the residual feed intake (RFI) and select 20 animals for the high feed efficient (LRFI) and 20 for the low feed efficient (HRFI) groups. Blood samples were collected on d 56 and at slaughter (80 d) to determine circulating plasma leptin. Samples of Longissimus dorsi were taken at slaughter for leptin gene expression levels.\ud
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Results\ud
DMI and RFI were different between groups and LRFI animals showed less back fat and rump fat thickness, as well as less pelvic and kidney fat weight. Circulating leptin increased over time in all animals. Plasma leptin was greater in LRFI on 56 d and at slaughter (P = 0.0049). Gene expression of leptin were greater in LRFI animals (P = 0.0022) in accordance with the plasma levels. The animals of the LRFI group were leaner, ate less, and had more circulating leptin and its gene expression.\ud
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Conclusion\ud
These findings demonstrated that leptin plays its physiological role in young Nellore bulls, probably controlling food intake because feed efficient animals have more leptin and lower residual feed intake.This work was financially supported by “Fundação de Amparo à Pesquisa do\ud
Estado de São Paulo” (FAPESP 2010/05650–5; 2014/02493–7, 2014/07566–2
Effects of surgically assisted rapid maxillary expansion on mandibular position: a three-dimensional study
No full textAbstract\ud
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Background\ud
This study aimed to evaluate three-dimensional changes in mandibular position after surgically assisted rapid maxillary expansion (SARME).\ud
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Methods\ud
A retrospective study was carried out with tomographic records of 30 adult patients with maxillary transverse deficiency who underwent SARME. Cone beam computed tomography scans were obtained preoperatively (T1), after expansion (T2) and 6 months after expansion (T3). Mandibular landmarks were measured with respect to axial, sagittal, and coronal planes. Repeated measures ANOVA was used for statistical analysis.\ud
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Results\ud
Clockwise rotation and lateral displacement of the mandible were observed immediately after SARME. However, mandibular displacements tended to return close to their initial values at T3.\ud
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Conclusions\ud
Clockwise rotation and lateral shift of the mandible are transient effects of SARME
Evaluating the impact of a walking program in a disadvantaged area: using the RE-AIM framework by mixed methods
No full textAbstract\ud
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Background\ud
The positive health impact of physical activity (PA) is well known, yet a large proportion of the world’s population remains sedentary. General PA programs are common as health promotion initiatives. However, effectiveness evaluations of such PA programs on individual and organizational aspects, which could inform the decision-making process of public health bodies are still lacking, particularly in the most socially disadvantaged areas, where health promotion schemes are particularly needed. The aim of this study was to assess the effectiveness of a Guided Walking Program in a high social vulnerability context.\ud
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Methods\ud
A quasi-experimental, mixed methods study was conducted. The program had a duration of 6 months and a 6-month follow-up period after the intervention. Session frequency was five times a week, where sessions consisted of supervised PA combined with educational sessions. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was followed to assess the program. The International Physical Activity Questionnaire (IPAQ) and accelerometers were used to measure levels of PA. Focus groups were conducted to gain a comprehensive insight on the implementation domain.\ud
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Results\ud
Most subjects in the intervention (IG) (n = 74) and control (CG) (n = 74) groups were female (IG:90.5%; CG:95.9%), aged 18–49 years (IG:44.6%; CG:43.2%), received less than 1 minimum wage (IG:74.3%; CG:83.7%) and had 0–4 years of formal education (IG:52.1%; CG:46.1%). The reach of the intervention was 0.3%. The IG showed increased levels of PA at post-intervention and 6-month follow-up. However, the difference between groups was not statistically significant. Adoption data revealed that 89.5% of the professionals in the Primary Health Care Center (health center) team perceived the benefits of the program for the population. The program was independently promoted by the health center team for a further 4 months post-intervention. The qualitative data revealed that the program was discontinued due to participants’ low adherence and human resource limitations in the unit’s operational dynamics.\ud
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Conclusions\ud
A health promotion intervention in a socially deprived setting faces challenges but can be effective and feasible to implement. The present study informs the development of future health promotion initiatives in this context.\ud
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Trial registration\ud
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NCT02857127\ud
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. Registered: 30 July 2016 (retrospectively registered).This study was financed by the Sao Paulo Research Foundation - FAPESP\ud
(grant. Alex Antonio Florindo receives a fellowship from the Brazilian\ud
National Council for Scientific and Technological Development (CNPq) (grant\ud
306635/2016–0)