Who are the patients that default tuberculosis treatment? - space matters!

The goals of this article are: (i) to understand how individual characteristics affect the likelihood of patients defaulting their pulmonary tuberculosis (PTB) treatment regimens; (ii) to quantify the predictive capacity of these risk factors; and (iii) to quantify and map spatial variation in the risk of defaulting. We used logistic regression models and generalized additive models with a spatial component to determine the odds of default across continental Portugal. We focused on new PTB cases, diagnosed between 2000 and 2013, and included some individual information (sex, age, residence area, alcohol abuse, intravenous drug use, homelessness, HIV, imprisonment status). We found that the global default rate was 4·88%, higher in individuals with well-known risk profiles (males, immigrants, HIV positive, homeless, prisoners, alcohol and drug users). Of specific epidemiological interest was that our geographical analysis found that Portugal's main urban areas (the two biggest cities) and one tourist region have higher default rates compared to the rest of the country, after adjusting for the previously mentioneded risk factors. The challenge of treatment defaulting, either due to other individual non-measured characteristics, healthcare system failure or patient recalcitrance requires further analysis in the spatio-temporal domain. Our findings suggest the presence of significant within-country variation in the risk of defaulting that cannot be explained by these classical individual risk factors alone. The methods we advocate are simple to implement and could easily be applied to other diseases.

How do geometry-related parameters influence the clinical performance of orthodontic mini-implants? A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to investigate how parameters related to geometry influence the clinical performance of orthodontic mini-implants (MIs). Systematic searches were performed in electronic databases including MEDLINE, Scopus, Web of Science, Virtual Health Library, and Cochrane Library and reference lists up to March 2016. Eligibility criteria comprised clinical studies involving patients who received MIs for orthodontic anchorage, with data for categories of MI dimension, shape, and thread design and insertion site, and evaluated by assessment of primary and secondary stability. Study selection, data extraction, quality assessment, and a meta-analysis were carried out. Twenty-seven studies were included in the qualitative synthesis: five randomized, eight prospective, and 14 retrospective clinical studies. One study with a serious risk of bias was later excluded. Medium and short MIs (1.4-1.9mm diameter and 5-8mm length) presented the highest success rates (0.87, 95% CI 0.80-0.92). A maximum insertion torque of 13.28Ncm (standard error 0.34) was observed for tapered self-drilling MIs in the mandible, whereas cylindrical MIs in the maxilla presented a maximum removal torque of 10.01Ncm (standard error 0.17). Moderate evidence indicates that the clinical performance of MIs is influenced by implant geometry parameters and is also related to properties of the insertion site. However, further research is necessary to support these associations.

Influência da suplementação concentrada e da categoria animal no hemograma de ovinos da raça Morada Nova / Influence of concentrate supplementation and the animal category in the hemogram of Morada Nova sheep

Objetivou-se avaliar a influência do nível de suplementação com concentrado sobre o perfil hematológico de ovelhas Morada Nova no terço final da gestação e puerpério, bem como comparar os valores obtidos em diferentes categorias (fêmeas em gestação, puerpério e cordeiros). Utilizaram-se 11 ovelhas, aos 75 últimos dias de gestação e nos primeiros 75 dias de lactação, e oito cordeiros progênie das ovelhas, distribuídas em delineamento inteiramente casualizado em arranjo de parcelas subdivididas no tempo. Durante o período experimental, os animais permaneceram em pastagem de Andropogon gayanus, sendo recolhidos ao final da tarde, quando recebiam suplementação concentrada com 19,17% de proteína bruta. As amostras de sangue foram colhidas desde o 75º dia de gestação até o desmame, aos 75 dias de lactação, a cada quatorze dias. O sangue foi colhido sempre pela manhã, antes de os animais serem liberados para o pasto, por punção da veia jugular, para a realização do hemograma. Os diferentes níveis de suplementação não influenciaram (P>0,05) o perfil eritrocitário e leucocitário das ovelhas. A categoria animal influenciou (P<0,05) o teor de hemoglobina e o número de eritrócitos. Os valores médios de hemoglobina não difeririam (P>0,05) entre fêmeas gestantes (7,74g/dL) e puerperais (7,67g/dL), bem como a contagem total de hemácias dos cordeiros (8,14x10(6)/µL) e das fêmeas em puerpério (9,16 x 10(6)/µL). Os valores médios do hematócrito, volume corpuscular médio, concentração de hemoglobina corpuscular média e proteína total não diferiram estatisticamente (P>0,05) entre as ovelhas; no entanto, observaram-se maiores níveis para os cordeiros. O número de leucócitos totais foram superiores (P<0,05) nas ovelhas gestantes e puerperais em relação aos cordeiros. A suplementação concentrada não influenciou o perfil hematológico dos animais, porém a categoria animal exerceu influência sobre os parâmetros hematológicos eritrocitários e leucocitários.

This research was carried out to evaluate the influence of supplementation with concentrate on hematological profile of Morada Nova sheep in last third of pregnancy and postpartum, as well as comparing the values obtained in different categories (pregnant females, postpartum, and lambs). Eleven ewes it the last 75 days of pregnancy and the first 75 days of lactation and eight lambs born from the ewes allotted in completely randomized design and split-plot arrangement in time were used. During the experimental period, the animals remained in Andropogon gayanus pasture. Late in the afternoon they returned to the center of management to receive the concentrate supplementation with 19.17% of crud protein. Blood samples were collected from the 75th day of pregnancy to weaning at 75 days of lactation, every fourteen days. Blood samples were taken always in the morning, before the animals were released into the pasture, by puncturing the jugular vein, for complete blood count. Neither the erythrocyte profile nor the leukocyte profile was affected by the different levels of supplementation (P>0.05). The animal category had a significant effect (P<0.05) on hemoglobin and erythrocyte number. The mean hemoglobin values did not differ (P>0.05) between pregnant ewes (7.74 g/dL) and ones in postpartum (7.67g/dL) as well as the total count of red blood cells of the lambs (8.14 x 106/µL) did not differ (P>0.05) from females in postpartum (9.16 x 106/µl). When comparing between pregnant and postpartum ewes for the mean hematocrit values, mean corpuscular volume, mean corpuscular hemoglobin concentration and total protein did not differ (P>0.05). The highest values were observed in these animals. The total white cell count was higher (P<0.05) in pregnant and postpartum ewes than lambs. The concentrate supplementation did not affect the blood profile of animals, but the animal category exerted influence on erythrocyte and leukocyte hematological parameters.