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1.
PLoS One ; 15(3): e0229668, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160217

RESUMO

Dengue disease is a major problem for public health surveillance entities in tropical and subtropical regions having a significant impact not only epidemiological but social and economical. There are many factors involved in the dengue transmission process. We can evaluate the importance of these factors through the formulation of mathematical models. However, the majority of the models presented in the literature tend to be overparameterized, with considerable uncertainty levels and excessively complex formulations. We aim to evaluate the structure, complexity, trustworthiness, and suitability of three models, for the transmission of dengue disease, through different strategies. To achieve this goal, we perform structural and practical identifiability, sensitivity and uncertainty analyses to these models. The results showed that the simplest model was the most appropriate and reliable when the only available information to fit them is the cumulative number of reported dengue cases in an endemic municipality of Colombia.


Assuntos
Dengue/transmissão , Aedes/virologia , Animais , Número Básico de Reprodução/estatística & dados numéricos , Colômbia/epidemiologia , Simulação por Computador , Dengue/epidemiologia , Doenças Endêmicas , Fatores Epidemiológicos , Humanos , Conceitos Matemáticos , Modelos Biológicos , Mosquitos Vetores/virologia , Dinâmica Populacional/estatística & dados numéricos , Vigilância em Saúde Pública , Incerteza
2.
Am J Epidemiol ; 189(3): 243-249, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-31912138

RESUMO

A study has 2 evidence factors if it permits 2 statistically independent inferences about 1 treatment effect such that each factor is immune to some bias that would invalidate the other factor. Because the 2 factors are statistically independent, the evidence they provide can be combined using methods associated with meta-analysis for independent studies, despite using the same data twice in different ways. We illustrate evidence factors, applying them in a new way in investigations that have both an exposure biomarker and a coarse external measure of exposure to a treatment. To illustrate, we consider the possible effects of cigarette smoking on homocysteine levels, with self-reported smoking and a cotinine biomarker. We examine joint sensitivity of 2 factors to bias from confounding, a central aspect of any observational study.


Assuntos
Biomarcadores , Fatores Epidemiológicos , Metanálise como Assunto , Causalidade , Fumar Cigarros/sangue , Cotinina/sangue , Feminino , Homocisteína/sangue , Humanos , Masculino , Pessoa de Meia-Idade
3.
Health Promot Chronic Dis Prev Can ; 39(10): 281-288, 2019 Oct.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-31600041

RESUMO

The 2019 edition of the Canadian Chronic Disease Indicators (CCDI) provides recent estimates of the burden of chronic conditions and measures of general health and associated determinants in Canada. Using data from the CCDI and 2017 Canadian Community Health Survey, we explored the relationship between sociodemographic factors and selfreported mental health. Our findings suggest that sex (males vs females: adjusted odds ratio [aOR] = 1.22); age (65-79 vs 35-49 year age group: aOR = 1.48); education (postsecondary graduate vs less than high school: aOR = 1.68); household income adequacy (highest quintile [Q5] vs lowest [Q1]: aOR = 2.25); and immigrant status (recent immigrants vs nonimmigrants: aOR= 2.29) were significantly associated with higher self-reported mental health.


Assuntos
Indicadores de Doenças Crônicas , Doença Crônica , Carga Global da Doença/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Adulto , Idoso , Canadá/epidemiologia , Doença Crônica/economia , Doença Crônica/epidemiologia , Fatores Epidemiológicos , Feminino , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Fatores de Risco , Fatores Socioeconômicos
4.
Spat Spatiotemporal Epidemiol ; 30: 100289, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31421799

RESUMO

BACKGROUND: Activity spaces (AS), captured using GPS tracking devices, are measures of dynamic exposure to the built environment (BE). METHODS: Seven days of Global Positioning Systems (GPS) tracking data were obtained for 433 adult participants in the Seattle Obesity Study (SOS II). Heights and weights were measured. Dietary intakes from a food frequency questionnaire were used to calculate Healthy Eating Index (HEI 2010) scores. Linear regression analyses examined associations between AS measures: daily route length, convex hull, and radius of gyration, and diet quality and health outcomes, adjusting for covariates. RESULTS: AS measures did not vary by age, gender, race/ethnicity, or socioeconomic status. AS measures were not associated with diet quality or with self-reported obesity or diabetes. One AS measure, route length (in miles), was associated with being employed, living in the suburbs, and with distance and time commuting to work. CONCLUSION: Spatial mobility studies based on GPS tracking of environmental exposure need to demonstrate a link to relevant health outcomes.


Assuntos
Ambiente Construído , Fatores Epidemiológicos , Sistemas de Informação Geográfica/estatística & dados numéricos , Obesidade , Adulto , Antropometria/métodos , Ambiente Construído/normas , Ambiente Construído/estatística & dados numéricos , Confiabilidade dos Dados , Exposição Ambiental , Saúde Ambiental/métodos , Saúde Ambiental/normas , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/prevenção & controle , Análise Espaço-Temporal , Estados Unidos
5.
Spat Spatiotemporal Epidemiol ; 30: 100287, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31421800

RESUMO

As activity space measures are increasingly used to estimate exposure to environmental determinants of health, little is known about the stability of these measures over time. To test the stability of GPS-derived measures of activity-space footprint, size, and environmental features over time, we compared 14-day measures at baseline and six months later for 35 adults in a large city. Activity-space measures were based on convex hulls and 500 m route buffers, and included the geographic footprint (i.e. location of the activity space), size (i.e., area in square miles; (Cummins, 2007)), and environmental features including supermarket, fast-food restaurant, and parkland density. The proportion of the participants' smaller geographic footprint covered by the larger was, on average, 0.64 (SD 0.17) for the 500 m route buffer and 0.84 (SD 0.18) for the convex hull. Mean percent change in activity space size ranged from 36.3% (mean daily 500 m route buffer) to 221.3% (cumulative convex hull). Mean percent change in the density of environmental features ranged from 28.8 to 66.5%. Forty-one percent to 92.4% of the variance at one timepoint was predicted by environmental features measured within approximately six months. Activity-space size and environmental features were moderately to highly stable over six months, although there was considerable variation in stability between measures. Strategies for addressing measurement error in studies of activity space-health associations are discussed.


Assuntos
Ambiente Construído , Exposição Ambiental , Saúde Ambiental/métodos , Sistemas de Informação Geográfica/estatística & dados numéricos , Instalações Esportivas e Recreacionais/normas , Ambiente Construído/normas , Ambiente Construído/estatística & dados numéricos , Exposição Ambiental/normas , Exposição Ambiental/estatística & dados numéricos , Fatores Epidemiológicos , Serviços de Alimentação , Mapeamento Geográfico , Humanos , Parques Recreativos , Análise Espaço-Temporal , Estados Unidos
6.
Int J Mycobacteriol ; 8(2): 118-123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210152

RESUMO

Background: The Federal Ministry of Health of Ethiopia Annual performance report in 2014-2015 showed that the highest prevalence of tuberculosis (TB) case in Ethiopia was reported from Dire Dawa city which was 400/100,000 population. The aim of this study was to identify the determinants of pulmonary TB (PTB) in public health facilities of Dire Dawa city, Eastern Ethiopia. Methods: A case-control study was conducted from October to December 2017 among 95 cases and 190 controls in Dire Dawa city. Dire Dawa is one of the two chartered cities in Ethiopia like the capital city Addis Ababa. Cases and controls were identified and selected randomly from the health facilities. Data were collected using a pretested and structured questionnaire by trained data collectors. We used logistic regression to model the associations of independent variables with PTB infection. Results: PTB was associated with patients' education (no formal education vs. formal education) (adjusted odds ratio [AQR] [95% confidence interval [CI]: 3.0, [1.3, 7.1]), human immunodeficiency virus (HIV) positive status (AOR [95% CI]: 3.1: [1.1,9.1]), previous contact history with TB patient (AOR [95% CI]: 9.9 [4.3,23.0]), body mass index (BMI) of ≤18 (AOR [95% CI]: 14.9 [6.4,35.1]), and cigarette smoking history (ever vs. never) (AOR [95% CI]: 6.7 [2.3,19.5]). Conclusion: This study showed that patients' educational status, HIV status, cigarette smoking, contact history with PTB patient, and BMI were independently associated with being infected with PTB. To reduce PTB transmission, peoples should be educated on TB prevention and consequences of risky behaviors.


Assuntos
Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Cidades , Escolaridade , Fatores Epidemiológicos , Etiópia/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Instalações de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fumar , Inquéritos e Questionários , Adulto Jovem
7.
Nutrients ; 11(6)2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31195698

RESUMO

We determined which variables are predictive of normal-weight (N) Chilean 4-year-olds developing overweight/obesity when entering primary school. This study used national data of preschoolers (PK, age 4) in 2011 through 2015, and the same children in the first grade (1st G, age 6) in 2013 through 2017. We formed longitudinal cohorts considering PK as the baseline and 1st G as the follow-up and included anthropometric, socio-demographic, and health variables in PK and anthropometry in the 1st G. We report the percentage N who remained N at follow-up (N-N) or gained excessive weight (N-OW) and (N-OB), by sex. We ran univariate logistic regressions to determine for each variable, its association with gaining excessive weight (N-OW + OB), incorporating significant variables (p < 0.001) in multivariate logistic regression. A total of 483,509 (251,150 girls) of PK had anthropometry in the 1st G. In PK, 22% of the children were obese; in the 1st G (24.8% and 19.7% in boys and girls, respectively). Of normal-weight children, 30% developed OW + OB. The predictive variables were: Being born macrosomic, attending a very vulnerable school, being indigenous, the mother's low schooling, and the child being cared for by the grandmother after school. In this study, the factors predicting that normal-weight preschoolers gain excessive weight gain in a short period of time are mostly related to poverty. Prevention should focus on this population.


Assuntos
Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/etiologia , Estudantes/estatística & dados numéricos , Antropometria , Criança , Pré-Escolar , Chile/epidemiologia , Fatores Epidemiológicos , Feminino , Humanos , Peso Corporal Ideal , Modelos Logísticos , Estudos Longitudinais , Masculino , Pobreza/estatística & dados numéricos , Determinantes Sociais da Saúde , Ganho de Peso
8.
PLoS One ; 14(6): e0218678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220165

RESUMO

OBJECTIVE: Adaptation to social life changes after migration may be beneficial or detrimental to migrants' oral health outcomes and related behaviors. This systematic review aims to synthesize the scientific literature on the impact of social support on immigrants' and ethnic minorities' oral health status and/or behaviors. METHODS: A comprehensive electronic search, up to November 2018, was conducted using five electronic databases. We included cross-sectional and longitudinal quantitative studies that examine associations between social support and oral health outcomes among immigrants and ethnic minorities. Study selection, data extraction, and risk of bias assessment were completed in duplicate and the Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies. RESULTS: A total of 26 studies met the eligibility criteria. Included studies examined multiple oral health outcomes such as dental care utilization, oral health behaviors, oral health problems, self-rated oral health, oral health knowledge, and oral health-related quality of life among immigrants and ethnic minorities. The social support level is assessed either by social support indicators or by adapting certain scales. Overall, social support was found to be positively associated with dental care utilization, number of carious teeth, periodontal disease, oral health behaviors, oral health knowledge, oral health-related quality of life, and self-rated oral health. CONCLUSION: Although immigrants and ethnic minorities encounter several challenges after migration to a new country that could affect their oral health, social support from their surrounding environment in the form of structural or functional support plays an important role in improving their oral health outcomes.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Apoio Social , Estudos Transversais/estatística & dados numéricos , Fatores Epidemiológicos , Nível de Saúde , Disparidades nos Níveis de Saúde , Humanos , Estudos Longitudinais , Doenças da Boca/epidemiologia , Saúde Bucal/normas , Fatores Socioeconômicos , Migrantes/estatística & dados numéricos
9.
BMC Pregnancy Childbirth ; 19(1): 174, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096938

RESUMO

BACKGROUND: Each year, about 20 million Low Birth Weight (LBW) babies are born with very high proportion (96.5%) occuring in developing countries. In the last decade, the incidence of LBW in Ghana has not declined. Brong Ahafo Region of Ghana recorded a LBW prevalence of 11% which was higher than the the national average of 10%. This study identifed determinants of LBW delivery in the Brong Ahafo Region. METHODS: We conducted a 1:2 unmatched case control study among mothers with singleton deliveries in 3 major health facilities in the Brong Ahafo Region. A case was defined as a mother who delivered a baby weighing less than 2500g in any of the three selected health facilities between 1st December, 2015 and 30th April, 2016. A control was defined as a mother who within 24 h of delivery by a case, delivered a baby weighing at least 2500g and not exceeding 3400g in the same health facility. Deliveries that met the inclusion criteria for cases were selected and two controls were randomly selected from the pool of deliveries that meet criteria for controls within 24 h of delivery of a case. A total of 120 cases and 240 control were recruited for the study. We computed odds ratios at 95% confidence level to determine the associations between low birth weight and the dependent factors. RESULTS: After controlling for confounders such as planned pregnancy, mode of delivery, parity and previous LBW in stepwise backward logistic regression, first trimester hemoglobin < 11 g/dl (aOR 3.14; 95%CI: 1.50-6.58), delivery at 32-36 weeks gestation (aOR 13.70; 95%CI: 4.64-40.45), delivery below 32 weeks gestation (aOR 58.5; 95%CI 6.7-513.9), secondary education of mothers (aOR 4.19; 95%CI 1.45-12.07), living with extended family (aOR 2.43; 95%CI 1.15-5.10, living alone during pregnancy (aOR 3.9; 95%CI: 1.3-11.7), and not taking iron supplements during pregnancy (aOR 3.2; 95%CI: 1.1-9.5) were found to be significantly associated with LBW. CONCLUSION: Determinants of LBW were: preterm delivery, mothers with secondary education, living alone during pregnancy, not taking daily required iron supplementation and mothers with first trimester hemoglobin below 11 g/dl. Education during antenatal sessions should be tailored to address the identified risk factors in the mother and child health care services.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Mães/estatística & dados numéricos , Estudos de Casos e Controles , Fatores Epidemiológicos , Feminino , Idade Gestacional , Gana/epidemiologia , Hospitais , Humanos , Incidência , Recém-Nascido , Modelos Logísticos , Masculino , Razão de Chances , Paridade , Gravidez , Fatores de Risco
10.
BMC Nephrol ; 20(1): 68, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808313

RESUMO

BACKGROUND: Infections are the second leading cause of death and hospitalisation among haemodialysis (HD) patients. Rates of access-related bloodstream infections (AR-BSI) are influenced by patient characteristics and local protocols. We explored factors associated with AR-BSI in a contemporary cohort of HD patients at a tertiary nephrology centre. METHODS: A retrospective cohort of 235 chronic HD patients was identified from a regional dialysis programme between Jan 2015 and Dec 2016. Data on demographics, primary renal disease, comorbid conditions and dialysis access type were obtained from the Kidney Disease Clinical Patient Management System (KDCPMS). Data on blood cultures were captured from the microbiology laboratory. Poisson regression with robust variance estimates was used to compare infection rates and relative risk of AR-BSI according to the site and type of vascular access. RESULTS: The mean age was 65 (± 15) years, 77% were men, and the median follow up was 19 months (IQR: 10-24 months), accumulating 2030 catheter-months and 1831 fistula-months. Overall rates of AR-BSI were significantly higher for central venous catheter (CVC) compared to arteriovenous fistula (AVF), (2.22, 95% (CI): 1.62-2.97) versus 0.11 (0.01-0.39) per 100 patient-months respectively), with a rate ratio of 20.29 (4.92-83.66), p < 0.0001. This pattern persisted across age, gender and diabetes subgroups. Within the CVC subgroup, presence of a femoral CVC access was associated with significantly higher rates of AR-BSI (adjusted RR 4.93, 95% CI: 2.69-9.01). Older age (75+ versus < 75 years) was not associated with significant differences in rates of AR-BSI in the unadjusted or the adjusted analysis. Coagulase negative Staphylococcus (61%) and Staphylococcus aureus (23%) were the predominant culprits. AR-BSIs resulted in access loss and hospitalisation in 57 and 72% of events respectively, and two patients died with concurrent AR-BSI. CONCLUSIONS: Rates of AR-BSI are substantially higher in CVC than AVF in contemporary HD despite advances in catheter design and anti-infective protocols. This pattern was consistent in all subgroups. The policy of AVF preference over CVC should continue to minimise patient morbidity while at the same time improving anti-infective strategies through better care protocols and infection surveillance.


Assuntos
Anastomose Arteriovenosa/microbiologia , Bacteriemia , Infecções Relacionadas a Cateter , Cateteres Venosos Centrais/microbiologia , Diálise Renal , Infecções Estafilocócicas , Idoso , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateteres Venosos Centrais/efeitos adversos , Fatores Epidemiológicos , Feminino , Humanos , Irlanda/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia
11.
J Aging Health ; 31(1): 109-138, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28831864

RESUMO

OBJECTIVE: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. METHODS: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. RESULTS: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. CONCLUSIONS: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.


Assuntos
Envelhecimento , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , Qualidade de Vida , África ao Sul do Saara/epidemiologia , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Assistência à Saúde , Fatores Epidemiológicos , Feminino , Avaliação Geriátrica , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Proc Natl Acad Sci U S A ; 115(50): 12680-12685, 2018 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-30463945

RESUMO

The basic reproduction number is one of the conceptual cornerstones of mathematical epidemiology. Its classical definition as the number of secondary cases generated by a typical infected individual in a fully susceptible population finds a clear analytical expression in homogeneous and stratified mixing models. Along with the generation time (the interval between primary and secondary cases), the reproduction number allows for the characterization of the dynamics of an epidemic. A clear-cut theoretical picture, however, is hardly found in real data. Here, we infer from highly detailed sociodemographic data two multiplex contact networks representative of a subset of the Italian and Dutch populations. We then simulate an infection transmission process on these networks accounting for the natural history of influenza and calibrated on empirical epidemiological data. We explicitly measure the reproduction number and generation time, recording all individual-level transmission events. We find that the classical concept of the basic reproduction number is untenable in realistic populations, and it does not provide any conceptual understanding of the epidemic evolution. This departure from the classical theoretical picture is not due to behavioral changes and other exogenous epidemiological determinants. Rather, it can be simply explained by the (clustered) contact structure of the population. Finally, we provide evidence that methodologies aimed at estimating the instantaneous reproduction number can operationally be used to characterize the correct epidemic dynamics from incidence data.


Assuntos
Número Básico de Reprodução/estatística & dados numéricos , Busca de Comunicante/estatística & dados numéricos , Epidemias/estatística & dados numéricos , Influenza Humana/epidemiologia , Simulação por Computador , Fatores Epidemiológicos , Humanos , Influenza Humana/transmissão , Itália/epidemiologia , Modelos Estatísticos , Países Baixos/epidemiologia , Fatores de Tempo
13.
Cad Saude Publica ; 34(8): e00197216, 2018 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-30133668

RESUMO

This study aimed to identify the distribution pattern of leprosy in a hyperendemic municipality in Brazil and determine its relationship with the clinico-epidemiological situation over 11 years. The geographic information system, MapInfo, spatial scan statistics and the Moran I index were used to analyze new cases. The digital cartographic base was used to map clusters of new paucibacillary and multibacillary cases and cases in minors under 15 years old. Socioeconomic indicators are shown using the choropleth mapping technique. A reduction in the detection coefficient, increases in high-risk spatial clusters, marked changes in the distribution of high-risk and low-risk clusters, and high-risk clusters of minors under 15 years old were observed from 2006 to 2010, showing recent illness, the presence of active foci, and overlapping of high-risk clusters of multibacillary infection in minors under 15 years old. Leprosy remains a public health problem in Rondonópolis, Mato Grosso State; the high-risk areas require an intensification of control measures and active search strategies to detect new cases.


Assuntos
Doenças Endêmicas/estatística & dados numéricos , Hanseníase/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Análise por Conglomerados , Fatores Epidemiológicos , Feminino , Sistemas de Informação Geográfica , Humanos , Lactente , Masculino , Vigilância da População , Risco , Análise Espacial
14.
Int J Paediatr Dent ; 28(6): 570-577, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30019508

RESUMO

BACKGROUND: The aetiology of molar-incisor hypomineralisation (MIH) is multifactorial and may involve genetic and environmental factors. AIM: To verify the factors associated with MIH in schoolchildren from 8 to 10 years of age. DESIGN: This is a case-control study with a sample consisting of children aged 8 to 10 years, paired by gender and school type, in a ratio of 1:3. The case group included 186 children with MIH and the control included 558 children without MIH. Data were collected through a semi-structured questionnaire and clinical examination. Chi-square, linear-by-linear, Mann-Whitney, and logistic regression tests were conducted. A value of P < 0.05 was considered significant. RESULTS: The prevalence of mild MIH was 19.5%, moderate MIH 2.2% and severe MIH 3.2%. An association was observed between MIH with treatment need and a higher mean DMF-T and decayed and missing teeth (P < 0.05). According to the aetiological factors studied, mothers who presented a fever during pregnancy had a 2.54 times greater chance of having children with severe MIH than mothers who did not present a fever (P = 0.045). CONCLUSION: The presence of fever during pregnancy and the need for treatment were associated with MIH.


Assuntos
Hipoplasia do Esmalte Dentário/epidemiologia , Hipoplasia do Esmalte Dentário/etiologia , Fatores Etários , Anodontia , Brasil/epidemiologia , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Criança , Fatores Epidemiológicos , Feminino , Febre , Humanos , Incisivo/patologia , Modelos Logísticos , Dente Molar/patologia , Gravidez , Complicações na Gravidez , Prevalência , Fatores Sexuais , Estatísticas não Paramétricas , Inquéritos e Questionários
15.
J Midwifery Womens Health ; 63(6): 710-720, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29883533

RESUMO

The causal inference framework and related methods have emerged as vital within epidemiology. This framework and associated analytic approaches facilitate the conduct of valid science using observational data. These approaches have helped catalyze knowledge development using existing data and also have addressed questions for which randomized controlled trials are neither feasible nor ethical. The study of normal childbearing processes and women who are medically low risk may benefit from more direct and deliberate engagement with the process of inferring causes and the use of methods appropriate for this undertaking. This article is the second in a series of 3 that review scientific challenges encountered in researching pregnancy, labor, and birth and approaches for addressing them. This article introduces 2 methods for causal inference (g-computation and instrumental variable analysis) to an audience of clinician-scientists, including references with further details. The causal inference framework and associated methods hold promise for generating strong, broadly representative, and actionable science to improve the outcomes of women who are medically low risk and their children.


Assuntos
Causalidade , Parto Obstétrico , Métodos Epidemiológicos , Conhecimento , Parto Normal , Projetos de Pesquisa , Fatores Epidemiológicos , Feminino , Voluntários Saudáveis , Humanos , Trabalho de Parto , Observação , Parto , Gravidez , Complicações na Gravidez
16.
Am Nat ; 192(1): 23-34, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29897804

RESUMO

The transmission of many animal and plant diseases relies on the behavior of arthropod vectors. In particular, the specific preference for infected or uninfected hosts observed in many vector species is expected to affect the circulation of vector-borne diseases. Here I develop a theoretical framework to study the epidemiology and evolution of the manipulation of host choice behavior of vectors. I show that vector preference strategies have dramatic epidemiological consequences. I also explore the evolution of vector host choice under different scenarios regarding control of the vector behavior by the pathogen. This analysis yields multiple evolutionary outcomes and explains the diversity of host choice behaviors observed in a broad range of vector-borne diseases. In particular, this analysis helps us understand why several pathogens have evolved manipulation strategies that vary with the infectious status of their vector species while other pathogens seem unable to evolve such complex conditional strategies. I argue that contrasting the behavior of infected and uninfected vectors is key to revealing the mechanistic constraints acting on the evolution of the manipulation of vector behavior.


Assuntos
Vetores Artrópodes , Evolução Biológica , Comportamento de Escolha , Transmissão de Doença Infecciosa , Modelos Biológicos , Animais , Fatores Epidemiológicos
17.
PLoS Comput Biol ; 14(4): e1006106, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29698408

RESUMO

Anonymized electronic medical records are an increasingly popular source of research data. However, these datasets often lack race and ethnicity information. This creates problems for researchers modeling human disease, as race and ethnicity are powerful confounders for many health exposures and treatment outcomes; race and ethnicity are closely linked to population-specific genetic variation. We showed that deep neural networks generate more accurate estimates for missing racial and ethnic information than competing methods (e.g., logistic regression, random forest, support vector machines, and gradient-boosted decision trees). RIDDLE yielded significantly better classification performance across all metrics that were considered: accuracy, cross-entropy loss (error), precision, recall, and area under the curve for receiver operating characteristic plots (all p < 10-9). We made specific efforts to interpret the trained neural network models to identify, quantify, and visualize medical features which are predictive of race and ethnicity. We used these characterizations of informative features to perform a systematic comparison of differential disease patterns by race and ethnicity. The fact that clinical histories are informative for imputing race and ethnicity could reflect (1) a skewed distribution of blue- and white-collar professions across racial and ethnic groups, (2) uneven accessibility and subjective importance of prophylactic health, (3) possible variation in lifestyle, such as dietary habits, and (4) differences in background genetic variation which predispose to diseases.


Assuntos
Grupos de Populações Continentais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Grupos Étnicos , Biologia Computacional , Grupos de Populações Continentais/genética , Grupos de Populações Continentais/estatística & dados numéricos , Fatores Epidemiológicos , Grupos Étnicos/genética , Grupos Étnicos/estatística & dados numéricos , Predisposição Genética para Doença , Variação Genética , Genética Populacional/estatística & dados numéricos , Humanos , Redes Neurais de Computação , Aprendizado de Máquina Supervisionado
18.
Eur J Public Health ; 28(5): 916-922, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29346542

RESUMO

Background: Chronic hepatitis B (HBV) leads to an increased risk for liver cirrhosis and liver cancer. In the Netherlands, chronic HBV prevalence in the general population is 0.20%, but 3.77% in first generation immigrants. Our aim was to identify determinants associated with the intention to participate in HBV testing among first generation Moroccan immigrants, one of the two largest immigrant groups targeted for screening. Methods: Semi-structured interviews were held with first (n = 9) and second generation (n = 10) Moroccan-Dutch immigrants, since second generation immigrants frequently act as their parents' brokers in healthcare. Results: Most participants had little knowledge about hepatitis B, but had a positive attitude towards screening. Facilitators for screening intention were perceived susceptibility to and severity of disease, positive attitude regarding prevention, wishing to know their hepatitis B status and to prevent potential hepatitis B transmission to others. Additional cultural facilitators included fear (of developing cancer), and existing high health care utilization; a religious facilitator was the responsibility for one's own health and that of others. Barriers included lack of awareness and knowledge, practical issues, not having symptoms, negative attitude regarding prevention, fear about the test result and low-risk perception. A cultural barrier was shame and stigma, and a religious barrier was fatalism. Conclusion: We identified important facilitators and barriers, which we found, can be interpreted differently. Specific and accurate information should be provided, accompanied by strategies to address shame and stigma, in which Islamic religious leaders could play a role in bringing information across.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Programas de Rastreamento/psicologia , Programas de Rastreamento/estatística & dados numéricos , Adulto , Fatores Epidemiológicos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/etnologia , Países Baixos/epidemiologia , Países Baixos/etnologia , Prevalência , Pesquisa Qualitativa , Inquéritos e Questionários
19.
BMC Med Inform Decis Mak ; 17(1): 39, 2017 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-28407806

RESUMO

BACKGROUND: In previous years a substantial number of studies have identified statistically important predictors of nursing home admission (NHA). However, as far as we know, the analyses have been done at the population-level. No prior research has analysed the prediction accuracy of a NHA model for individuals. METHODS: This study is an analysis of 3056 longer-term home care customers in the city of Tampere, Finland. Data were collected from the records of social and health service usage and RAI-HC (Resident Assessment Instrument - Home Care) assessment system during January 2011 and September 2015. The aim was to find out the most efficient variable subsets to predict NHA for individuals and validate the accuracy. The variable subsets of predicting NHA were searched by sequential forward selection (SFS) method, a variable ranking metric and the classifiers of logistic regression (LR), support vector machine (SVM) and Gaussian naive Bayes (GNB). The validation of the results was guaranteed using randomly balanced data sets and cross-validation. The primary performance metrics for the classifiers were the prediction accuracy and AUC (average area under the curve). RESULTS: The LR and GNB classifiers achieved 78% accuracy for predicting NHA. The most important variables were RAI MAPLE (Method for Assigning Priority Levels), functional impairment (RAI IADL, Activities of Daily Living), cognitive impairment (RAI CPS, Cognitive Performance Scale), memory disorders (diagnoses G30-G32 and F00-F03) and the use of community-based health-service and prior hospital use (emergency visits and periods of care). CONCLUSION: The accuracy of the classifier for individuals was high enough to convince the officials of the city of Tampere to integrate the predictive model based on the findings of this study as a part of home care information system. Further work need to be done to evaluate variables that are modifiable and responsive to interventions.


Assuntos
Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Algoritmos , Fatores Epidemiológicos , Finlândia/epidemiologia , Previsões , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Modelos Estatísticos , Medição de Risco
20.
BMC Med Inform Decis Mak ; 17(1): 40, 2017 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-28407816

RESUMO

BACKGROUND: For an individual participant data (IPD) meta-analysis, multiple datasets must be transformed in a consistent format, e.g. using uniform variable names. When large numbers of datasets have to be processed, this can be a time-consuming and error-prone task. Automated or semi-automated identification of variables can help to reduce the workload and improve the data quality. For semi-automation high sensitivity in the recognition of matching variables is particularly important, because it allows creating software which for a target variable presents a choice of source variables, from which a user can choose the matching one, with only low risk of having missed a correct source variable. METHODS: For each variable in a set of target variables, a number of simple rules were manually created. With logic regression, an optimal Boolean combination of these rules was searched for every target variable, using a random subset of a large database of epidemiological and clinical cohort data (construction subset). In a second subset of this database (validation subset), this optimal combination rules were validated. RESULTS: In the construction sample, 41 target variables were allocated on average with a positive predictive value (PPV) of 34%, and a negative predictive value (NPV) of 95%. In the validation sample, PPV was 33%, whereas NPV remained at 94%. In the construction sample, PPV was 50% or less in 63% of all variables, in the validation sample in 71% of all variables. CONCLUSIONS: We demonstrated that the application of logic regression in a complex data management task in large epidemiological IPD meta-analyses is feasible. However, the performance of the algorithm is poor, which may require backup strategies.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Bases de Dados Factuais , Fatores Epidemiológicos , Modelos Logísticos , Aplicações da Informática Médica , Algoritmos , Espessura Intima-Media Carotídea , Mineração de Dados , Humanos , Metanálise como Assunto , Valor Preditivo dos Testes , Prognóstico
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