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BACKGROUND: Oral human papillomavirus (HPV) prevalence varies according to geographical occurrence, the type of lesion, and the method of diagnosis. The polymerase chain reaction method (PCR) appears to be more sensitive and can be easily applicable to epidemiologic studies. OBJECTIVES: To determine the frequency of HPV and its genotypes in oral lesions among patients attending a reference clinic of a university hospital. METHODS: PCR was performed to identify HPV DNA from samples of oral epithelial lesions in 80 patients. For HPV DNA amplification, MY09/MY11 consensus primers were used and specific genotypes were identified through restriction fragment of length polymorphism (RFLP) pattern. RESULTS: HPV DNA was present in 11.3% of patients, and the identified genotypes were 6b, MM4 (W13B), and MM9 (PAP238A). CONCLUSIONS: HPV DNA frequency in patients with oral epithelial lesions was 11.3%. The genotypes MM4 and MM9 are uncommon in oral lesions, and they are characterized as high-risk HPV types in those types of lesions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families., Method: Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected., Results: Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened., Conclusion: This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

Objectives: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil., Method: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007., Results: A total of 1,115 patients admitted to the ICU needed mechanical ventilation. The mortality rate was 51%. The mean age (± standard deviation) was 57±18 years, and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 22.6±8.3. The variables independently associated with mortality were (i) conditions present at the beginning of mechanical ventilation, age (hazard ratio: 1.01; p<0.001); the APACHE II score (hazard ratio: 1.01; p<0.005); acute lung injury/acute respiratory distress syndrome (hazard ratio: 1.38; p=0.009), sepsis (hazard ratio: 1.33; p=0.003), chronic obstructive pulmonary disease (hazard ratio: 0.58; p=0.042), and pneumonia (hazard ratio: 0.78; p=0.013) as causes of mechanical ventilation; and renal (hazard ratio: 1.29; p=0.011) and neurological (hazard ratio: 1.25; p=0.024) failure, and (ii) conditions occurring during the course of mechanical ventilation, acute lung injuri/acute respiratory distress syndrome (hazard ratio: 1.31; p<0.010); sepsis (hazard ratio: 1.53; p<0.001); and renal (hazard ratio: 1.75; p<0.001), cardiovascular (hazard ratio: 1.32; p≤0.009), and hepatic (hazard ratio: 1.67; p≤0.001) failure., Conclusions: This large cohort study provides a comprehensive profile of mechanical ventilation patients in South America. The mortality rate of patients who required mechanical ventilation was higher, which may have been related to the severity of illness of the patients admitted to our ICU. Risk factors for hospital mortality included conditions present at the start of mechanical ventilation conditions that occurred during mechanical support.

Knowledge of the epidemiological profile of cancer is a key step in planning national cancer policy. The main objective of this study was to characterize the epidemiological profile of cancer in Angola based on cases of cancer registered at the National Oncology Centre (NOC) of Luanda, the only Angolan hospital to specialize in cancer treatment and diagnosis. The study consisted of a cross-sectional historical review of cases treated at the NOC between 2007 and 2011. The following variables were analysed: tumour location, diagnostic basis, and source of referral, as well as patient age, sex, place of residence, and the stage of the disease. The NOC registered a total of 4,791 patients throughout the study period, at an annual average of 958 cases. The most commonly diagnosed cancers were breast (20.5%), cervical (16.5%), and head and neck cancer (10.6%), followed by lymphoma (7.2%), Kaposi sarcoma (6.1%), and prostate cancer (4%). A total of 76% of patients were under 60 years old, and 10% were less than 15 years old. Of the total number of patients with cancer treated at the NOC, 77.3% lived in the Luanda province. Staging data were only available for patients with breast or cervical cancer, and an analysis of this variable showed that most of these individuals were in advanced stages of the disease. In the absence of a population-based cancer registry, this study constitutes a reasonable assessment of the epidemiological profile of cancer in Angola.

Cellular cycle proteins like the p16(INK4a) and the Ki67 proliferation nuclear antigen have been used as oncogenicity cellular markers. The E6 and E7 oncoproteins interact with tumor suppressor genes p53 and pRb, culminating with the p16(INK4a) overexpression. The objective of this study was to evaluate the presence of HPV-DNA in 174 cervical biopsies and correlate the different histological grades with the p16(INK4a) and Ki67 immunohistochemical expression (IHC). A cross-sectional study that enrolled a total of 174 women who underwent uterine cervical biopsies between February 2003 and December 2006, in southern Brazil, was performed. Cervical smear samples were analyzed for the presence of HPV-DNA through polymerase chain reaction (PCR), and biopsy samples were examined for p16(INK4A) and Ki67 expression through IHC techniques. The presence of HPV-DNA was observed in 89% of the tested patients, among which 52% were positive for high-risk (HR) viral types [16, 18 and 31]. Regarding p16(INK4a), an expression of 69% was observed, being expressed in 100% of the high-grade squamous lesions (HSIL) and HR-HPV-DNA positives. Ki67 expression was associated with the lesion grade, being more expressive in the most severe lesions (p<0.001). p16(INK4A) and Ki67 markers coexpression was present in 86% of the samples (p<0.001), being 100% among those positive to HR-HPV-DNA with HSIL (p<0.001). The results suggest an association between the presence of HR-HPV infection and the p16(INK4a) and Ki67 expression and which is even stronger among women with HSIL., (Copyright © 2014 Elsevier GmbH. All rights reserved.)

Objective: To evaluate regional differences and similarities associated with drinking and driving (DUI) in the five Brazilian macro-regions., Method: A roadside survey was conducted in the 27 Brazilian state capitals. A total of 3,398 drivers were randomly selected and given a structured interview and a breathalyzer test. To determine the predictors of positive blood alcohol concentration (BAC) in each region, a MANOVA was performed, and 3 groups were used as follows: 1) North and Northeast, 2) South and Midwest, and 3) Southeast. A Poisson robust regression model was performed to assess the variables associated with positive BAC in each group., Results: Of all surveyed drivers, 2,410 had consumed alcohol in the previous 12 months. Most were male, with a median age of 36. Leisure as the reason for travel was associated with positive BAC in all 3 groups. Low schooling, being older than 30, driving cars or motorcycles and having been given a breathalyzer test at least once in their lives predicted DUI in at least two different groups., Conclusions: Factors , especially low schooling and leisure as a reason for travel, associated with drinking and driving were similar among regions, although certain region-specific features were observed. This information is important for aiming to reduce DUI in the country.

Objective: To verify the frequency of positive Blood Alcohol Concentration (BAC) among drivers and to examine associated factors in a cross-sectional study of Brazilian state capitals., Methods: 3,398 drivers were approached on highways crossing all 27 Brazilian capitals from 12 p.m. to 12 a.m. (Fridays and Saturdays). They were breathalyzed and data on their driving characteristics and alcohol consumption were collected. Multivariate logistic regression following a hierarchical conceptual framework was used to evaluate associated factors., Results: The overall weighted prevalence of positive BAC (> 0.1 mg/L) was 4.2%. The multivariate analysis showed that education up to 8 years (OR = 2.0; 95% CI: 1.4-3.0), age > 30 years (OR = 2.6; 95% CI: 1.8-3.8), type of vehicle (cars: OR = 3.0; 95% CI: 1.7-5.1; motorcycles: OR = 3.7; 95% CI: 2.1-6.4), binge drinking (OR = 1.7; 95% CI: 1.3-2.4), having been breathalyzed before (OR = 2.6; 95% CI: 1.8-3.7), and purpose of the trip (coming from a party: OR = 1.9; 95% CI: 1.3-3.0; leisure trip: OR = 1.7; 95% CI: 1.32.4; driving after 8 p.m.: OR = 1.7; 95% CI: 1.3-2.3) were independently associated with DUI., Conclusion: Study findings suggest that selected external environmental factors, such as socioeconomic and demographic characteristics as well as personal characteristics like alcohol consumption and the relationship between drinking and driving were associated with positive BAC among Brazilian drivers. Results can help to inform drinking and driving policy and preventive approaches.

The study aimed to measure use of medication and polypharmacy among the elderly in Carlos Barbosa, Rio Grande do Sul State, Brazil, and to compare socio-demographic, economic, and health characteristics in relation to area of residence (urban versus rural) in a random sample of 811 persons 60 year of age or older. Interviews were used to collect data on socio-demographic characteristics, chronic illnesses, and self-reported use of medications. The association between area of residence and medication or polypharmacy was adjusted for confounders using Poisson regression with robust variance. Prevalence rates for use of medication and polypharmacy were higher among older persons living in the urban area. Living in the urban area was positively and independently associated with use of medication (PR = 1.10; 95%CI: 1.02-1.20) and polypharmacy (PR = 1.83; 95%CI: 1.27-2.65) in this group of elderly in southern Brazil.

Objective: To identify the role of Interleukin-6, IL-10 and their epidemiological association in women with persistence of DNA-HPV., Design and Methods: A nested case-control study within a longitudinal cohort study. Cervical specimens and blood samples were collected at enrolment from asymptomatic women who looked for a service of public health in a district of Porto Alegre, Brazil. A logistic regression analysis was performed with 95% confidence intervals. The outcome was the persistence of DNA-HPV infection., Results: The analysis showed that the age of the first intercourse below 20 years old (OR = 19.65, IC 95% 2.43-68.85), four or more sexual partners during lifetime (OR = 5.67, IC 95% 1.28-24.99), women with a previous altered Pap smear (OR = 10.17, IC 95% 1.80-57.33), marital status (OR = 12.94, IC 95% 2.43-68.85) and IL6 ≤ 3.106 pg/ml were associated with persistence of HPV infection. IL-10 were not associated with the HPV persistence., Conclusion: The present study suggests that IL-6 levels may be a marker of HPV DNA persistence, although further investigation is necessary.

Objective: To investigate the prevalence of and factors associated with alcohol- or drug-related traffic crashes (TC) in a sample of TC victims who were admitted to the two emergency rooms of Porto Alegre in southern Brazil., Methods: A cross-sectional study with consecutive samples was used. Victims of non-fatal TCs (as drivers, passengers or pedestrians) who had presented at emergency rooms during the 45 days of data collection were selected. Subjects participated in a structured interview, were breathalyzed and underwent salivary drug testing. A multinomial logistic regression model was used to verify factors associated with alcohol or drug use., Results: Of the 609 victims who participated in the interview, 72% were male, and the median age was 29 years (interquartile range 23.0-40.0 years). The drivers were mostly men (p<0.001), with a higher binge drinking rate (p=0.003) and marijuana use (p=0.005) than seen in pedestrian and passengers. The prevalence of a positive blood alcohol concentration (BAC) ranged from 7.8% among the drivers to 9.2% among the pedestrians (p=0.861), and the cannabis prevalence was 13.3% among the drivers. The variables associated with an alcohol-related accident were binge drinking in the prior 12 months (OR 2.4; CI 95% 1.1-5.1) and coming from a party/bar (OR 8.7; CI 95% 2.8-26.7). Alcohol abuse or dependence increased by 5.2-fold the chance of another substance-related TC., Conclusion: The large number of individuals found in TC-related emergency room visits in a short time frame is evidence of the Brazilian epidemic of TC. The data showed that alcohol abuse or dependence also increases the risk of intoxication by other drugs, and they point to alcohol and drug use as a major problem requiring specific TC-related public policies and law enforcement., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The objective of this study was to identify the frequency of coinfection by human papillomavirus (HPV) and Chlamydia trachomatis (CT) in cervical lesions and relate it with immunohistochemical expression of p16INK4a and Ki67, both oncogenicity markers. A cross-sectional study with 86 women from primary care units in southern Brazil was conducted. Cervical swabs were collected for HPV-DNA and CT-DNA detection, through the polymerase chain reaction technique (PCR). The immunohistochemical analysis was performed on biopsy cervical tissue material to identify the expression of p16INK4a and Ki67 cell cycle markers. About 83 % were positive for HPV-DNA and 19% had coinfection with CT-DNA. Among coinfected women, 56% expressed p16INK4a. There was a statistically significant association between the histological grade of the lesion and Ki67 expression. All high-grade lesions, 50% of low-grade lesions and 31% of negative biopsies expressed Ki67 (p = 0.004). A total of 37% of coinfected women expressed both markers. In conclusion, although more than half of the coinfected patients have expressed p16INK4a and more than one third have expressed both markers, these results suggest no association between those variables. However, other studies involving larger samples are necessary to corroborate such findings.

Objective: Determining malnutrition and associated variables in the elderly., Methods: A cross-sectional study was conducted among elderly people vaccinated against influenza in order to evaluate their nutritional status. Nutritional assessment was performed with the Mini Nutritional Assessment. To verify association of studied variables with the outcome, odds ratios was estimated using multiple logistic regression., Results: A total of 236 elderly patients were recruited. The Mini Nutritional Assessment identified three patients (1.3%) with malnutrition and 59 (25%) at risk of malnutrition. Factors with a positive association to the outcome were psychological stress or acute disease in the past three months, weight loss (< 3 kg) during the last three months and sores or skin ulcers. On the other hand, consuming two or more servings of fruits or vegetables daily, eating meat, fish or poultry every day and drinking more than three cups of fluids per day were negatively associated to malnutrition and risk of malnutrition., Conclusion: The low prevalence of malnutrition found in this study may be due to the study sample of elderly individuals in good health. Some factors related to a recent health problem (psychological stress or acute disease) seem to be positively associated while regular consumption of fluids and certain foods seem to be negatively associated with malnutrition.

Human papillomavirus (HPV) types cause approximately 70% of cervical cancer worldwide. Two vaccines have been recently evaluated in randomized controlled trials: the bivalent vaccine for HPV 16 and 18 (Cervarix, GlaxoSmithKline Biologicals, Rixensart, Belgium) and the quadrivalent vaccine for HPV 6, 11, 16, and 18 (Gardasil, Merck and Co, Inc, Whitehouse Station, NJ). We have performed a systematic review of all randomized controlled trials in which vaccines against HPV were compared with placebo regarding efficacy, safety, and immunogenicity. Six studies met the inclusion criteria, which included 47,236 women. The first objective in this systematic review was to assess vaccine efficacy in the prevention of cytologically and/or histologically proven lesions. And the secondary objective was the evaluation of safety and vaccine immunogenicity. Bivalent and quadrivalent HPV vaccines significantly reduced the rate of lesions in the cervix, vulva, vagina, and anogenital region, with efficacy of 93% (95% confidence interval [CI], 87-96) and 62% (95% CI, 27-70), respectively, when compared with the control groups according to intention to treat. Regarding safety, we found more symptoms in the bivalent vaccine group (35%; 95% CI, 5-73) when compared with the control groups. In regard to vaccine immunogenicity, there was seroconversion in the group that received the vaccine when compared with the placebo group in the bivalent and quadrivalent vaccines. Prophylactic vaccination can prevent HPV infection in women aged 9 to 26 years not previously infected with the HPV subtypes covered by the vaccines. To evaluate cervical cancer incidence and mortality, a longer follow-up is necessary.

A quantitative systematic review was performed to estimate the accuracy ultrasonography with color Doppler in the diagnosis of ovarian tumors. Studies that compared color Doppler ultrasonography with paraffin-embedded sections parameters for the diagnosis of ovarian tumors were included. Twelve studies were analyzed, which included 2398 women. The pooled sensitivity was 0.87 (95% confidence interval [CI] 0.84-0.90); and the specificity was 0.92 (95%CI, 0.87-0.90). The diagnostic odds ratio for ovarian cancer and borderline lesions versus benign lesions was 125 (95%CI, 55-283). Summary receiver operating characteristic curves were constructed because of heterogeneity in the diagnostic odds ratio. For malignant ovarian cancer and borderline versus benign lesions the area under the curve was 0.9577. In conclusion, ultrasonography with color Doppler is a useful preoperative test for predicting the diagnosis of pelvic masses.

Background: Patients with early stage cervical cancer (stages IA2, IB1 or IIA) with risk factors such as lymph node metastasis, lympho vascular space invasion, depth invasion of more than 10mm, microscopic parametrial invasion, non-squamous histology and positive surgical margins have a high risk of recurrence when compared to patients with early stage cervical cancer with no risk factors for recurrence., Objectives: To evaluate the effectiveness and safety of platinum-based adjuvant chemotherapy after radical hysterectomy, radiotherapy, or both in the treatment of early stage cervical cancer (stages IA2, IB1 or IIA)., Search Strategy: We searched the Cochrane Gynaecological Cancer Group Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 1, 2009), MEDLINE, EMBASE, LILACS, BIOLOGICAL ABSTRACTS and Cancerlit, the National Research Register and Clinical Trials register, with no language restriction. Abstracts of scientific meetings and the citation lists of included studies and other relevant publications were checked through hand searching and experts in the field were contacted to identify further reports of trials., Selection Criteria: Randomised controlled trials (RCTs) comparing adjuvant radiotherapy with adjuvant radiotherapy and cisplatin-chemotherapy after radical surgery for early stage cervix cancer were included., Data Collection and Analysis: Two review authors extracted data independently to assess whether the studies met the specified inclusion criteria. Any discrepancies were solved by a third and a forth review author. Meta-analysis was performed using a random effects model, with death and disease progression as outcomes., Main Results: Three trials were included. Two trials enrolling 325 participants, of whom 297 (91%) were assessed and compared radiotherapy and chemotherapy with radiotherapy alone found that adjuvant chemotherapy significantly reduced the risk of death (hazard ratio (HR) = 0.56, 95% confidence interval (CI): 0.36 to 0.87) and disease progression (HR = 0.47, 95%CI: 0.30 to 0.74), with no heterogeneity between trials (I(2) = 0% for both meta-analyses). One trial assessing 71 participants compared chemotherapy followed by radiotherapy with radiotherapy alone and found no significant difference between the two groups (HR = 1.34; 95%CI: 0.24 to 7.66). The median follow up of patients varied from 29 to 42 months., Authors' Conclusions: The addition of platinum-based chemotherapy to radiotherapy may offer clinical benefit in the adjuvant treatment of early stage cervical cancer with risk factors for recurrence. However, the evidence is limited because the selected studies were quantitatively and qualitatively limited, with small number of patients and limited period of follow-up.

Objective: To evaluate sensitivity, specificity and positive and negative predictive values (PPV, NPV) of anti-p16(INK4a) in cervical cytology., Study Design: A case-control study was conducted in a reference center for cervical pathology. Cytology slides were collected in a standard way with Ayre spatula and Cytobrush. The slides were interpreted by 2 independent pathologists (P1, P2). The cases (n = 61) represented all cervical examinations that had resulted in a biopsy with the diagnosis of CIN 1, 2 or 3 or squamous cell carcinoma. Controls (n = 87) included all examinations with negative cytology (Papanicolaou) and negative colposcopy., Results: The sensitivity for the histologic diagnosis of CIN 2, 3 (n = 23) was 100% and 95.7% (P1, P2), respectively. The NPV for CIN 2 or worse was 100% (P1) and 98.9% (P2). The sensitivity for the diagnosis of CIN 1 was 77.8% (P1) and 58.3% (P2). The NPV for CIN 1 or worse was 90.6% (P1) and 82% (P2). The K index between the 2 pathologists was 0.74., Conclusions: Our results suggest that the antibody anti-p16(INK4a) could contribute as an adjuvant tool in the follow-up of cervical intraepithelial lesions when the cytology sample is collected in the standard way.

Background: Over the last 10 years laparoscopy and minilaparotomy have become increasingly common approaches for the surgical removal of benign ovarian tumours. However, in the event that a tumour is found to be malignant, laparotomy is the appropriate procedure. Careful preoperative assessment including transvaginal ultrasound with morphological scoring, colour doppler assessment of vascular quality, and serum cancer antigen 125 (CA 125) level is desirable., Objectives: To determine the benefits, harms, and cost of laparoscopy or minilaparotomy compared with laparotomy in women with benign ovarian tumours., Search Strategy: We searched electronic databases, trial registers, and reference lists of published trial reports. Reference lists from trials and review articles were searched., Selection Criteria: All randomised controlled trials comparing either laparoscopy or minilaparotomy with laparotomy for benign ovarian tumours., Data Collection and Analysis: Eight review authors independently assessed the eligibility and quality of each study and extracted the data., Main Results: The results of nine randomised controlled trials (N = 482 women) showed that laparoscopic surgery was associated with fewer adverse events of surgery (surgical injury or postoperative complications including fever or infection) (OR 0.3, 95% CI 0.2 to 0.5), less postoperative pain (VAS score WMD -2.4, 95% CI -2.7 to -2.0), greater likelihood of being pain free after two days (OR 7.42, 95% CI 4.86 to 11.33), and fewer days in hospital (WMD -2.88, 95% CI -3.1 to -2.7) than with laparotomy.In one study that reported costs, laparoscopy was associated with a significant reduction in costs compared to laparotomy (WMD - USD 1045, 95% CI -1348 to -742) in 1993. Very high levels of heterogeneity made it inappropriate to pool data on duration of surgery.Three RCTs compared laparoscopy versus minilaparotomy and found that laparoscopy was associated with reduced odds of any adverse event (surgical injury or postoperative complications) (OR 0.10, 95% CI 0 to 0.8) and lower VAS scores for pain (WMD -1.0, 95% CI -1.6 to -0.45). Duration of hospital stay ranged between 1 and 2.2 days, with substantial heterogeneity., Authors' Conclusions: In women undergoing surgery for benign ovarian tumours, laparoscopy was associated with a reduction in fever, urinary tract infection, postoperative complications, postoperative pain, number of days in hospital, and total cost. These findings should be interpreted with caution since only a small number of studies were identified. These included a total of only 769 women and not all of the important outcomes were reported in each study.

Background and Objective: The loss of a functional dentition imposes eating difficulties and food avoidance, which may be detrimental in terms of nutritional status and health. The objective of this study was to investigate whether tooth loss and edentulism that were not rehabilitated with dental prostheses were associated with obesity among elderly in Southern Brazil., Materials and Methods: A random sample of 872 independently living elderly was evaluated by means of a cross-sectional study. Socio-demographic, medical history and behaviour data were assessed using a standardised questionnaire. Two trained dentists assessed the number of teeth and use of prostheses in accordance with the WHO criteria. Height and weight were assessed and used to generate body mass index (BMI = weight (kilos)/height (cm)(2)) data. Participants were categorised into non-obese (BMI 30). Multivariate logistic regression was used to model the relationship between number of teeth and use of dental prostheses with obesity adjusting for confounders., Results: Multivariate logistic regression revealed that edentulous persons wearing only upper dentures (OR = 2.34, 95% CI 1.18-4.27) and dentate participants with one to eight teeth wearing 0-to-1 prosthesis (OR = 2.96, 95% CI 1.68-5.19) were more likely to be obese., Conclusion: The results show that a poorer oral status, represented by having fewer teeth that were not replaced by dental prostheses, was associated with obesity in Southern Brazil older people, suggesting a close relationship between poor oral status and systemic conditions that may have important clinical implications.

A quantitative systematic review was performed to estimate the accuracy of CA 125 assay in the diagnosis of ovarian tumors. Studies that evaluated CA 125 levels for the diagnosis of ovarian tumors and compared them with paraffin-embedded sections as the diagnostic standard were included. Seventeen studies were analyzed, which included 2374 women. The pooled sensitivity for the diagnosis of borderline tumors or ovarian cancer was 0.80 (I.C. 95% 0.76-0.82) and the specificity was 0.75 (I.C. 95% 0.73-0.77). The diagnostic odds ratio for ovarian cancer and borderline lesions vs. benign lesions was 21.2 (95% C.I., 12-37). Summary receiver operating characteristic curves were constructed due to heterogeneity in the diagnostic odds ratio. For malignant and borderline ovarian tumors vs. benign lesions the area under the curve was 0.8877. A CA 125 level of >or= 35 U/ml is a useful preoperative test for predicting the benign or malignant nature of pelvic masses. The accuracy of CA 125 in the diagnosis of ovarian tumors is high and very important in helping the surgeon to decide what kind of surgery should be performed.

Objective: The objective of the study was to identify epidemiological correlates for persistence and clearance of human papillomavirus (HPV) infection., Study Design: Cervical smears collected in a prospective cohort study to perform Papanicoloau cytology and HPV deoxyribonucleic acid (DNA) detection at baseline and during the follow-up. Outcomes analyzed were: (1) persistence of HPV DNA; (2) conversion; and (3) clearance of HPV., Results: Among 501 women the incidence of HPV was 12.3%. Thirty-four women were persistently infected with HPV, which was associated with age below 21 years at first intercourse and 4 or more sexual partners during their lifetime. In a median of 19 months, 80.7% of women had clearance of HPV, which was associated with black race, coinfection with Chlamydia trachomatis at baseline, and a history of previous Papanicoloau smear., Conclusion: Strategies for sexual orientation may modify the rates of HPV persistence. The association of HPV clearance with a history of previous Papanicolaou smear screening highlights the importance of improving cervical screening programs. Further studies on the association of gynecological infections with HPV clearance are needed.

Background: Over the past ten years laparoscopy has become an increasingly common approach for the surgical removal of early stage ovarian tumours. There remains uncertainty about the value of this intervention. This review has been undertaken to assess the available evidence of the benefits and harms of laparoscopic surgery for the management of early stage ovarian cancer compared to laparotomy., Objectives: To evaluate the benefits and harms of laparoscopy in the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic) when compared with laparotomy., Search Strategy: Trials were identified by searching the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Issue 2, 2007, MEDLINE (January 1990 to November 2007), EMBASE (1990 to November 2007), LILACS (1990 to November 2007), BIOLOGICAL ABSTRACTS (1990 to November 2007) and Cancerlit (1990 to November 2007). We also searched our own publication archives, based on prospective handsearching of relevant journals from November 2007. Reference lists of identified studies, gynaecological cancer handbooks and conference abstract were also scanned., Selection Criteria: Studies including patients with histologically proven stage I ovarian cancer according to the International Federation of Gynaecology and Obstetrics (FIGO).Studies comparing laparoscopic surgery with laparotomy for early stage ovarian cancer were only available from 1990. It was anticipated that a very small number of randomised controlled trials (RCTs) were conducted studying the management of early stage ovarian cancer. Therefore, non-randomised comparative studies, cohort studies and case-controls studies, but not studies with historical controls, were also considered., Data Collection and Analysis: Data extraction was performed independently by five review authors (LRM, DDR, MIR, MCB and MIE) who assessed study quality and quality of extracted data. Extracted data included trial characteristics, characteristics of the study participants, interventions and outcomes. The quality of non RCTs was assessed using appropriate quality evaluations tools from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and from the Newcastle-Ottawa tool for observational studies (NOS)., Main Results: No RCTs were identified. Three observational studies were identified., Authors' Conclusions: This review has found no evidence to help quantify the value of laparoscopy for the management of early stage ovarian cancer as routine clinical practice.

Background: Few studies have evaluated the relationship between depression symptoms, chronic stress or physiological measures of stress such as cortisol levels and saliva secretion., Objective: To evaluate the association of low saliva flow with chronic stress, depression symptoms and cortisol in a population aged 50 years and older., Methods: Participants (n = 227) were recruited from community clubhouses and among dementia caregivers. Stress was assessed using the Lipp's Stress Symptoms Inventory and salivary cortisol measurements. In addition, taking care of a relative with dementia was included as a proxy variable for chronic stress. Depression was assessed using the Beck Depression Inventory. Saliva flow rate was assessed by measuring unstimulated and chewing-stimulated saliva flow. Further saliva samples were collected (morning, noon, night) for cortisol analysis by means of radioimmunoassay., Results: Gender, being a dementia caregiver, self-reported diabetes and prescriptive medication intake were independently associated with a low stimulated saliva flow. Prescriptive medication intake was also associated with a low unstimulated saliva flow., Conclusion: Caregiving, a proxy of chronic stress, was associated with low stimulated saliva flow, indicating that stress may have a potential role in salivary gland hypofunction.

The detection of telomerase activity in cervix may provide information on cervical carcinogenesis and may be a marker to monitor cervical intraepithelial neoplasia transition. A quantitative systematic review was performed to estimate the accuracy of telomerase assay in cervical lesions. Studies that evaluated the telomerase test (telomerase repeated amplification protocol) for the diagnosis of cervix lesions and compared it to paraffin-embedded sections as the diagnostic standard were included. Ten studies were analyzed, which included 1069 women. The diagnostic odds ratio (DOR) for a positive telomerase test for low-grade squamous intraepithelial lesions (Lo-SIL) vs normal or benign lesions was 3.2 (95% CI, 1.9-5.6). The DOR for a positive telomerase test for high-grade squamous intraepithelial lesions (Hi-SIL) vs Lo-SIL, normal or benign lesions was 5.8 (95% CI, 3.1-10). For cervix cancer vs Hi-SIL, the DOR for a positive telomerase test was 8.1 (95% CI, 3.2-20.3) and for cervix cancer vs Lo-SIL, normal or benign lesions, it was 40.9 (95% CI, 18.2-91). Our data support the current hypothesis that telomerase may activate an early event in cervical carcinogenesis that could be associated with the initiation and progression of cervical lesions.

Breast cancer is the most prevalent form of cancer in the world. Breast cancer mortality rates are high in Brazil and show striking variations between geographic regions. A time-trend ecological study was performed in Southern Brazil from 1980 to 2002. Data were collected from the Mortality Information System (Ministry of Health) to assess age-standardized mortality rates. Linear regression for mortality time-trend analysis and multiple regression for mortality differences among three States were calculated. The highest mean mortality rate (14.45) was observed in Rio Grande do Sul, significantly greater (p < 0.001) than in Santa Catarina (8.93) and Paraná (9.95). An annual increase of 0.47 in the mortality rate was observed in the three States of Southern Brazil. According to these results, the South of Brazil and especially the State of Rio Grande do Sul showed a significant upward trend in breast cancer mortality. Continued efforts are needed to help explain these numbers and reverse the present situation.

As there was not any data on Chlamydia pneumoniae (TWAR) infections in Brazil so far, a prospective cohort study of adult patients hospitalized due to CAP was carried out for one year in a Brazilian university general hospital to detect the incidence of CAP by Chlamydophila pneumoniae (TWAR) for one year. During a whole year 645 consecutive patients hospitalized due to an initial presumptive diagnosis of respiratory diseases by ICD-10 (J00-J99), excluding upper respiratory diseases, were screened; 59 consecutive patients with CAP were diagnosed. They had determinations of serum antibodies to C. pneumoniae by microimmunofluorescence at the Infectious Diseases Laboratory of University of Louisville (KY, USA); 37 patients (63.8%) had seroreactivity to TWAR antigens, from which 23 (39.6%) had previous infection; 3 patients (5.2%) were diagnosed with CAP by TWAR and got cured. The incidence of TWAR CAP in our hospital by seroconversion was 5.2%. Our incidence of 5.2% is probably underestimated since TWAR culture was not available; we suggest that Real-Time PCR be used along with other diagnostic methods in future studies to detect the actual incidence of TWAR CAP. We propose that the serological criterion of IgM >1:16 alone to the diagnosis of acute infection by TWAR are discontinued due a lack of specificity.

The authors evaluated stress, anxiety, depression, and feelings of hopelessness in caregivers of relatives with dementia. One hundred and twenty-nine caregivers and 145 non-caregivers who lived in metropolitan Porto Alegre, Brazil completed Lipp's Inventory of Stress Symptoms for Adults, (ISSL), and Beck's Anxiety (BAI), Depression (BDI), and Hopelessness (BHS) scales. Caregivers showed higher levels of anxiety, depression, hopelessness, resistance/pre-exhaustion stress than controls. This study indicates that constant caregiving may significantly increase the risk of physical and mental health problems for caregivers in Brazil.

Background: The role of psychoneuroimmunological factors in oral hygiene has been overlooked in the dental literature. Our objective was to evaluate the effects of stress, depression, and cortisol levels in dental plaque accumulation and gingivitis in a population of individuals aged >or=50 years., Methods: In this cross-sectional study, 230 subjects, selected from caregivers of demented patient groups and from social activities groups of Porto Alegre, Brazil, were evaluated. Stress was evaluated with the Lipp stress inventory, whereas depressive symptoms were assessed using the Beck depression inventory. Three saliva samples (at 8, 12, and 20 hours) were collected for cortisol analysis by means of radioimmunoassay. Cortisol levels were expressed as the area under the curve of the three samples for each patient. Multivariate logistic regression was performed with the visible plaque index and gingival bleeding index as outcomes., Results: The mean age of subjects was 61.6 +/- 8.2 years, mean monthly income in United States dollars (US dollars) was US 668 +/- 590, and mean cortisol level was 22.1 +/- 33.7 nmol/l. A total of 51.5% of the individuals were caregivers; 9.4% were smokers, and 25.5% used interdental floss/brush. Being a caregiver (odds ratio [OR] = 3.97; 95% confidence interval [95% CI] = 2.08 to 7.54), using an interdental brush (OR = 0.23; 95% CI = 0.11 to 0.47), cortisol (OR = 2.03; 95% CI = 1.09 to 3.81), and stress (OR = 1.45; 95% CI = 1.03 to 2.02) were all significantly associated with visible plaque index >mean (43%). Being a caregiver (OR = 2.35; 95% CI = 1.13 to 4.86), using an interdental brush (OR = 0.32; 95% CI = 0.13 to 0.77), smoking (OR = 0.26; 95% CI = 0.08 to 0.89), stress (OR = 1.78; 95% CI =1.31 to 2.38), and visible plaque index (mean) (OR = 12.87; 95% CI = 6.29 to 26.31) were significantly associated with a gingival bleeding index > mean (37%)., Conclusion: Stress was a significant risk indicator of elevated levels of plaque and gingivitis, whereas cortisol was a risk indicator of plaque in the sample after controlling for confounders.

Periodontitis and its relationship with psycho-neuro-immunological variables, such as psychological stress and cortisol, have been little explored. The objective of this study was to evaluate the extent and severity of chronic periodontitis and its association with the levels of salivary cortisol and the scores obtained with a stress questionnaire in a population aged 50 years and over. We studied 235 individuals in a cross-sectional study. They answered the Lipp's Inventory of Stress Symptoms for Adults, were instructed to collect three saliva samples for cortisol analysis, and were examined for evaluation for periodontitis. Based on logistic regression, cortisol levels were positively associated with the following outcomes: means of clinical attachment level (CAL) > = 4 mm [OR = 5.1, 95%CI (1.2, 20.7)]; 30% of sites with CAL > = 5 mm [OR = 6.9, 95%CI (1.7, 27.1)]; and 26% of sites with probing depth > = 4 mm [OR = 10.7, 95%CI (1.9, 54.1)] after adjustment for confounding variables. The results suggest that cortisol levels were positively associated with the extent and severity of periodontitis.

Introduction: Apoptosis of neutrophils (polymorphonuclear neutrophils [PMNs]) may limit inflammatory injury in sepsis and acute respiratory distress syndrome (ARDS), but the relationship between the severity of sepsis and extent of PMN apoptosis and the effect of superimposed ARDS is unknown. The objective of this study was to correlate neutrophil apoptosis with the severity of sepsis and sepsis-induced ARDS., Methods: A prospective cohort study was conducted in intensive care units of three tertiary hospitals in Porto Alegre, southern Brazil. Fifty-seven patients with sepsis (uncomplicated sepsis, septic shock, and sepsis-induced ARDS) and 64 controls were enrolled. Venous peripheral blood was collected from patients with sepsis within 24 hours of diagnosis. All surgical groups, including controls, had their blood drawn 24 hours after surgery. Control patients on mechanical ventilation had blood collected within 24 hours of initiation of mechanical ventilation. Healthy controls were blood donors. Neutrophils were isolated, and incubated ex vivo, and apoptosis was determined by light microscopy on cytospun preparations. The differences among groups were assessed by analysis of variance with Tukeys., Results: In medical patients, the mean percentage of neutrophil apoptosis (+/- standard error of the mean [SEM]) was lower in sepsis-induced ARDS (28% +/- 3.3%; n = 9) when compared with uncomplicated sepsis (57% +/- 3.2%; n = 8; p < 0.001), mechanical ventilation without infection, sepsis, or ARDS (53% +/- 3.0%; n = 11; p < 0.001) and healthy controls (69% +/- 1.1%; n = 33; p < 0.001) but did not differ from septic shock (38% +/- 3.7%; n = 12; p = 0.13). In surgical patients with sepsis, the percentage of neutrophil apoptosis was lower for all groups when compared with surgical controls (52% +/- 3.6%; n = 11; p < 0.001)., Conclusion: In medical patients with sepsis, neutrophil apoptosis is inversely proportional to the severity of sepsis and thus may be a marker of the severity of sepsis in this population.

In order to better understand the exact mode and risk of vertical transmission in asymptomatic pregnant women, as well as the relationship between HPV transmission and mode of delivery, we have proposed this systematic quantitative review of prospective cohort studies. A comprehensive search was performed in the Cochrane Library, MEDLINE, LILACS, CANCERLIT, and EMBASE, as well as in the reference lists from the identified studies. Nine primary studies, which included 2,111 pregnant women and 2,113 newborns, met our selection criteria and were analyzed. A positive HPV test in the mother increased the risk of vertical HPV transmission (RR: 4.8; 95%CI: 2.2-10.4). We also observed a higher risk of HPV infection after vaginal delivery than after cesarean section (RR: 1.8; 95%CI: 1.3-2.4). The results of this meta-analysis showed the HPV DNA-positive rate only after birth, but an HPV DNA-positive neonatal sample does not necessarily indicate infection; it could merely indicate contamination (perinatal HPV contamination may have occurred). Infants born through vaginal delivery were at higher risk of exposure to HPV.

A quantitative systematic review was performed to estimate the diagnostic accuracy of frozen sections in ovarian tumors. Studies that compared frozen sections and paraffin sections within subjects for diagnosis of ovarian tumors were included. Fourteen primary studies were analyzed, which included 3 659 women. For benign ovarian vs borderline/malignant tumor cases, the occurrence of a positive frozen-section result for benignity (pooled likelihood ratio [LR], 8.7; 95% confidence interval [CI], 7.3-10.4) and posttest probability for benign diagnosis was 95% (95% CI, 94-96%). A positive frozen-section result for malignant vs benign diagnosis (pooled LR, 303; 95% CI, 101-605) increased the probability of ovarian cancer to 98% (95% CI, 97-99%). In borderline vs benign ovarian tumor cases, a positive frozen-section result (pooled LR, 69; 95% CI, 45-106) increased the probability of borderline tumors to 79% (95% CI, 71-85%). In borderline vs malignant ovarian tumor cases, a positive frozen-section result (pooled LR, 18; 95% CI, 13-26) increased the probability of borderline tumors to 51% (95% CI, 42-60%). We conclude that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.

A decrease in uterine cervical cancer (CC) mortality has been observed in developed countries. However, mortality data in Brazil suggest that CC is one of the most frequent causes of cancer death in women; it is the fourth cause of death from cancer in women in Rio Grande Sul State. A time-trend ecological study was performed to analyze CC mortality trends in Rio Grande do Sul from 1979 to 1998. Data were collected from the Mortality Information System, Brazilian Ministry of Health (DATASUS). Standardized mortality ratios were calculated and linear regression was used for time-trend analysis. The impact of cervical cancer death on life expectancy was also estimated for the study population using potential years of life lost (PYLL). Standardized mortality ratios during the study period revealed a positive linear trend of 0.17, and the mean annual mortality rate was 7.58/100,000. Cervical cancer accounted for 21.9 +/- 1.33 PYLL during the period. In conclusion, although CC is a preventable and curable disease, an increase is observed in mortality from this cause in Rio Grande do Sul State, which may suggest failure in screening programs for cervical cancer.

A population at low risk for developing cervical cancer in Southern Brazil was studied to identify the main determinants of serological response to human papillomavirus (HPV). Enzyme-linked immunosorbent assay tests were performed in 976 women to detect serum IgG antibodies against HPV 16 L1 virus-like particles (VLPs) and HPVs 16, 18, 6 and 11 L1 VLPs as a mixture of antigens. Women with four or more sexual partners were more likely to be seropositive than women with one partner (HPV 16 serology odds ratio [OR]=3.06, 95% confidence interval [CI]: 2.0-4.8; HPV 6/11/16/18 serology OR=4.64, 95% CI: 3.0-7.2). HPV DNA and both serological responses were associated. Those positives to HPV 16 serology were twice as likely to have a cytological diagnosis of squamous intraepithelial lesions (SILs) than seronegatives (OR=2.07; 95% CI: 1.0-4.5, and OR=1.73; 95% CI: 0.8-3.8). Seropositivity to HPV 16 and HPV 6/11/16/18 antigens seem to be better markers of past sexual activity than current HPV infection, and humoral response to HPV 16 or HPV 6/11/16/18 may not be a strong indicator of cervical lesions in populations at low risk for cervical lesions.

Objectives: To determine: (1) the frequency of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); (2) the mortality associated with these syndromes and (3) the influence of risk factors, comorbidities and organ system dysfunction in the mortality of ALI patients., Design: Prospective cohort study., Setting: Intensive care unit (ICU) of a general university hospital in Brazil., Patients and Participants: All patients that remained in the ICU for more than 24 h were evaluated regarding the presence/development of ALI/ARDS according to the 1994 American-European Consensus Conference., Interventions: None., Measurements and Results: One thousand three hundred and one patients were studied and analyzed regarding mortality, risk factors, comorbidities and organ system dysfunction(s). The frequency of ALI was 3.8% (50), of which ARDS was 2.3% (30) and ALI/non-ARDS 1.5% (20) (p=0.15). The ICU mortality of patients with ALI was 44.0%; in ALI/non-ARDS and ARDS patients it was 40.0% and 46.7%, respectively (p=0.43). The hospital mortality of ALI patients was 48.0%; in ALI/non-ARDS and ARDS patients it was 50.0% and 46.7%, respectively (p=0.21). A multivariate analysis demonstrated that renal (ICU and hospital: p=0.002) and hematological dysfunction (ICU: p=0.008; hospital: p=0.02) were independently associated with ICU and hospital mortality in ALI patients., Conclusions: (1) The frequency of ALI was 3.8%, of which the frequency of ARDS was 2.3% and of ALI/non-ARDS 1.5%; (2) The ICU and hospital mortality of ALI patients was 44.0% and 48.0%, respectively; mortality rates of ARDS and ALI/non-ARDS did not differ significantly; (3) Renal and hematological dysfunction were associated with mortality in ALI patients.

Objective: To evaluate whether epidemiological factors may be associated to genital human papillomavirus (HPV) infection., Methods: A cross-sectional study was carried out among 975 women seen at a public health service for cervical cancer screening in Porto Alegre, Brazil. Women were considered infected if tested positive to HPV either by Polymerase Chain Reaction (PCR) or Hybrid Capture II (HC-II) methods. Women with genital HPV infection were compared to women without infection drawn from the same population., Results: The study enrolled 975 women. The HPV prevalence (both methods combined) in this population was 27%. However, when each diagnostic method is analyzed separately, HPV prevalence was 15% and 16% for HC-II and PCR, respectively. Unconditional multiple logistic regression was used to correlate disease status to women characteristics. A positive association was found with HPV infection for the following variables: years of schooling (11 years: OR=2.05; 95%CI =1.31; 3.20), married (OR=1.69; 95%CI=0.78; 2.00), number of lifetime sexual partners (2 partners: OR=1.67; 95%CI=1.01; 2.77; 4 or +: OR=2.18; 95%CI=1.15; 4.13), age at first intercourse (15-16 years: OR=4.05; 95%CI=0.89; 18.29)., Conclusions: Various factors may contribute to genital HPV infection, especially those related to sexual behavior (young age at first intercourse, high number of lifetime sexual partners, and marital status), and those related to social and economic status (years of schooling).

Our aim was to determine the prevalence and epidemiologic correlates of atypical squamous cells of undetermined significance (ASCUS) in a population at low risk for cervical cancer in Porto Alegre, Brazil. Sociodemographic data and gynecological and obstetrical history from 977 women screened at an outpatient clinic were recorded. Specimens were collected for Papanicolaou cervical cytology, colposcopy, and biopsy (if indicated). Sixty-two (6.3%) patients presented ASCUS, 21 (2.1%) presented low-grade squamous intraepithelial lesions, and 6 (0.6%) presented high-grade lesions. Presence of human papillomavirus (HPV) DNA in cervical cells (odds ratio (OR) = 1.57; confidence interval (CI) 95% = 1.11-2.23), history of HPV infection (OR = 3.12; CI 95% = 1.22-7.96), and becoming sexually active at 18 yr or younger (OR = 1.70; CI 95% = 1.15-2.51) were independently associated with ASCUS. ASCUS patients reported HPV infections and presented HPV DNA in cervical cells more often than did patients with normal cytology; therefore, they should be carefully monitored to ensure early detection of cancer precursor lesions and prevention of cervical cancer., (Copyright 2001 Wiley-Liss, Inc.)

The authors carried out a literature review of the subject "stillbirth", with special emphasis on its conceptual and epidemiological features, aimed at highlighting its importance as a perinatal health indicator.

OBJECTIVES: To establish the profile of neonates in Caxias do Sul city, and to study early neonatal mortality, its causes and related variables.METHODS: This cohort study enrolled 5,545 newborns, which were followed up to 7 days after birth. The probability of early neonatal mortality was calculated and multiple logistic regression was performed to relate all studied variables to the outcome of early neonatal death.RESULTS: The observed probability of early neonatal mortality was 7.44 per thousand live births. The incidence of premature births and low birth weight was 9.4% and 8.1%, respectively. Fifty five percent of the neonates were born through cesarean section, which were related to socioeconomic and educational level. Previous history of neonatal mortality, maternal age > 35 years, gestational age, Apgar score < 7, male sex and low birth weight were related to early neonatal death. The main cause of death was hyaline membrane disease, followed by congenital cardiopaties, extreme preterm and abruptio placentae.CONCLUSION: Even though the observed probability of early neonatal mortality was low, some deaths may have been avoided if better prenatal and delivery care, as well as newborn assistance had been offered.

Care provided to patients in primary health services should include both a physical and a psychological assessment. In many cases treatment success depends on understanding individuals and their interactions, especially within the family; it is important for health professionals to be trained in this area. We investigated the validity of three well-known diagnostic scales of family functioning from the United States of America (FACES III, Beavers-Timberlawn, and GARF) for use in our setting in Porto Alegre, Brazil. The three scales were used with 31 families and compared to the results from clinical evaluations (semistructured family interviews), which were considered the gold standard. FACES III was also used with a sample of 102 families in the community. The Beavers-Timberlawn and GARF scales were strongly and positively correlated with the clinical evaluations. In contrast, our results suggest that FACES III is not a useful screening tool in primary care to detect the risk of psychiatric disorders. The Beavers-Timberlawn and GARF instruments showed great usefulness for formulating and classifying diagnoses of family functioning.