Single proxy control.

Negative control variables are sometimes used in nonexperimental studies to detect the presence of confounding by hidden factors. A negative control outcome (NCO) is an outcome that is influenced by unobserved confounders of the exposure effects on the outcome in view, but is not causally impacted by the exposure. Tchetgen Tchetgen (2013) introduced the Control Outcome Calibration Approach (COCA) as a formal NCO counterfactual method to detect and correct for residual confounding bias. For identification, COCA treats the NCO as an error-prone proxy of the treatment-free counterfactual outcome of interest, and involves regressing the NCO on the treatment-free counterfactual, together with a rank-preserving structural model, which assumes a constant individual-level causal effect. In this work, we establish nonparametric COCA identification for the average causal effect for the treated, without requiring rank-preservation, therefore accommodating unrestricted effect heterogeneity across units. This nonparametric identification result has important practical implications, as it provides single-proxy confounding control, in contrast to recently proposed proximal causal inference, which relies for identification on a pair of confounding proxies. For COCA estimation we propose 3 separate strategies: (i) an extended propensity score approach, (ii) an outcome bridge function approach, and (iii) a doubly-robust approach. Finally, we illustrate the proposed methods in an application evaluating the causal impact of a Zika virus outbreak on birth rate in Brazil.

Executive Function in Preschool Children with Congenital Heart Disease and Controls: The Role of a Cognitively Stimulating Home Environment.

OBJECTIVE: To assess the relationships between (1) environmental and demographic factors and executive function (EF) in preschool children with congenital heart disease (CHD) and controls and (2) clinical and surgical risk factors and EF in preschool children with CHD. STUDY DESIGN: At 4-6 years of age, parents of children with CHD (n = 51) and controls (n = 124) completed the Behavior Rating Inventory of Executive Function, Preschool Version questionnaire and the Cognitively Stimulating Parenting Scale (CSPS). Multivariable general linear modeling assessed the relationship between Behavior Rating Inventory of Executive Function, Preschool Version composite scores (Inhibitory Self-Control Index [ISCI], Flexibility Index [FI], and Emergent Metacognition Index [EMI]) and group (CHD/control), sex, age at assessment, gestational age, Index of Multiple Deprivation, and CSPS scores. The relationships between CHD type, surgical factors, and brain magnetic resonance imaging injury rating and ISCI, FI, and EMI scores were assessed. RESULTS: The presence of CHD, age at assessment, sex, and Index of Multiple Deprivation were not associated with EF scores. Lower gestational age was associated with greater ISCI and FI scores, and age at assessment was associated with lower FI scores. Group significantly moderated the relationship between CSPS and EF, such that CSPS significantly predicted EF in children with CHD (ISCI: P = .0004; FI: P = .0015; EMI: P = .0004) but not controls (ISCI: P = .2727; FI: P = .6185; EMI: P = .3332). There were no significant relationships between EF scores and surgical factors, CHD type, or brain magnetic resonance imaging injury rating. CONCLUSIONS: Supporting parents to provide a cognitively stimulating home environment may improve EF in children with CHD. The home and parenting environment should be considered when designing intervention studies aimed at improving EF in this patient group.

[The influence of the institutions on local health councils]. / La influencia de las instituciones en los consejos locales de salud.

OBJECTIVE: To analyze the influences of the institutions in the operation of the Local Health councils. DESIGN: qualitative, descriptive and exploratory study. STUDY SETTING: 02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil. PARTICIPANTS: twenty-four members of the Local Health Councils and 4 key informants. METHODS: Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution. RESULTS: The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces. CONCLUSIONS: The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.

Factores de riesgo relacionados con el síndrome poscovid-19 en pobladores pinareños / Risk factors related to postcovid­19 syndrome in residents from Pinar del Río i: en

Introducción: Las posibilidades de padecer el síndrome poscovid-19 crecen en la medida en que se expande la pandemia. Objetivo: Identificar los factores de riesgo relacionados con el síndrome poscovid-19 en pobladores pinareños. Métodos: Se realizó un estudio de casos y controles, que incluyó a convalecientes de covid-19, atendidos en la consulta multidisciplinaria del Policlínico Luis Augusto Turcios Lima de la provincia de Pinar del Río durante el 2022, quienes fueron incluidos de forma aleatoria en 2 grupos, a razón de 1:2 (100 casos y 200 controles). El análisis estadístico se basó en una estrategia univariada, que consistió en la determinación del odds ratio para cada factor de riesgo, así como en la estimación de los intervalos de confianza al 95 % y la prueba de la Χ2, con un nivel de significación de p<0,05. Resultados: En el estudio predominaron el sexo femenino, la diabetes mellitus, el tratamiento farmacológico, el soporte ventilatorio, la presencia de secuelas establecidas y las complicaciones. Conclusiones: A pesar de identificar los factores de riesgo más frecuentes relacionados con el síndrome poscovid-19, este continúa siendo un desafío para los profesionales de la salud.

Introduction: The possibilities to suffer from the postcovid-19 syndrome grow as the pandemic expands. Objective: To identify the risk factors related to the postcovid-19 syndrome in residents from Pinar del Río. Methods: A cases and controls study that included covid-19 convalescents was carried out. They were assisted in the multidisciplinary service of Luis Augusto Turcios Lima Polyclinic of Pinar del Rio province during 2022 that were included in 2 groups at random, at a ratio of 1:2 (100 cases and 200 controls). The statistical analysis was based on an univaried strategy, for which the odds ratio was determined for each risk factor and the confidence intervals were considered at 95 %, as well as the chi-square test, with a significance level of p<0,05. Results: In the study there was a prevalence of the female sex, diabetes mellitus, pharmacological treatment, ventilation support, the presence of established sequels and complications. Conclusions: In spite of identifying the most frequent risk factors related to the postcovid-19 syndrome, it is still a challenge for health professionals.

O Sistema CEP/Conep e as pesquisas em ciências humanas e sociais: outras éticas, outras semânticas / The CEP/Conep System and research in human and social sciences: other ethics, other semantics / El Sistema CEP/Conep y las investigaciones en ciencias humanas y sociales: otras éticas, otras semánticas

Esta nota de conjuntura tem o objetivo de evidenciar algumas questões importantes sobre como se configura o Sistema CEP/Conep e as implicações dessa regulação no campo das ciências humanas e sociais. Primeiro, explicito o que consiste esse sistema para, em seguida, esboçar as controvérsias provenientes desse controle, que tem como aspecto central, ser regido pelo que a análise do Estado e sua organização burocrática chamam de lógica cartorial

This note aims to highlight some important questions about the configuration of the CEP/CONEP System and the implications of this regulation in the field of human and social sciences. First, I will explain what is this system, and then I will outline the controversies resulting from this control, which has as central aspect, to be governed by the so-called notarial logic, according to the analysis of the State and its bureaucratic organization

Esta nota de coyuntura tiene como objetivo poner en evidencia algunas cuestiones importantes sobre como es configurado el Sistema CEP/CONEP y las implicaciones de esta normativa para el campo de las ciencias humanas y sociales. Primero explicaré en que consiste ese sistema y, en seguida, esbozaré las controversias que surgen de ese control, que tiene como aspecto central ser regido por lo que el análisis del Estado y su organización burocrática denominan lógica notarial

Differences in the Visual Performances of Patients with Strabismus, Amblyopia, and Healthy Controls.

The aim of this paper is to use the new definition of amblyopia and to define the overall visual performance of healthy controls (HCs), patients with strabismus (PS), and patients with refractive amblyopia (PRA), based on the interaction of selected visual abilities. METHOD: A total of 398 participants were divided in three groups: HCs, PRA, and PS. Variables such as visual acuity, refractive state, degree of stereopsis, phoria state, magnitude, and type of deviation were analyzed using parametric and non-parametric tests. RESULTS: Binocular visual acuity at near is the unique predictor factor for stereopsis in PRA and PS, while age relates to the amount of binocular visual acuity at near, only for PS with stereopsis. Binocular visual acuity at near and phoria states relate to each other in PRA. Binocular visual acuity at near and far in PS is better than PRA, with no differences in the degree of stereopsis. Stereoblind patients were only found among PS (36%). Only (44.9%) of PS had amblyopia. Exophoria predominated among PRA (69.72%) and HCs (78.87%), while exotropia was the predominant deviation in PS (60.54%). Hyperopia was the predominate refractive error among the groups, HCs (74.65%), PRA (79.82%), and PS (59.85%), followed by astigmatism. INTERPRETATION: HCs perform better than PS and PRA. The visual performance of PS with stereopsis and PRA is similar. Binocular visual acuity at near can predict the degree of stereopsis, and stereoblind patients are exclusively related to strabismus.

Cryptococcus neoformans- and Cryptococcus gattii-specific IgG, IgA and IgM differ among children and adults with and without cryptococcosis from Colombia.

Cryptococcus neoformans (Cn) and Cryptococcus gattii (Cg) cause cryptococcosis, a life-threatening systemic mycosis of global distribution affecting mainly immunocompromised adults. Although a humoral response occurs during cryptococcosis, the role of antibody production against this mycosis is not fully understood. We aimed to determine total and specific antibodies against cryptococcal protein antigens in sera from people with and without a diagnosis of cryptococcosis from Colombia. Using ELISA, total and specific levels of immunoglobulin (Ig)G, IgA and IgM were determined in sera from children and adults with (n = 109) and without (n = 119) cryptococcosis. Specific antibodies were those binding Cn- and Cg-protein antigens. In general, the mean of the total IgG production was higher in cryptococcosis patients than in controls (13 942.32 vs. 6459.91 µg/ml), while levels of IgA (488.13 vs. 1564.53 µg/ml) and IgM (775.69 vs. 1014.72 µg/ml) were higher in controls than in cryptococcosis patients (P ≤ .05). In patients with cryptococcosis, total IgG, IgA and IgM levels were higher in HIV + compared with HIV- (P ≤ .05). Specific antibodies tended to be higher in cryptococcosis patients than in controls and in adults than in children, with a positive correlation between antibody reactivity and age. All immunoglobulins were more reactive against Cn-proteins than Cg-proteins. Overall, a positive weak correlation between total and specific antibodies was found, although not always statistically significant. In patients with cryptococcosis from Colombia, the levels of immunoglobulins, total and specific, differ with respect to people without cryptococcosis. Variations in antibody production among adults and children with cryptococcosis and between Cn- and Cg-protein antigens were as well established. Our findings encourage further studies to determine the role of humoral immunity for host defense against cryptococcosis.

Differential IgG, IgA, and IgM production and their reactivity with cryptococcal proteins, both among children and adults with and without a diagnosis of cryptococcosis from Colombia, lead to reappraise the study of the potential role of antibody production as host defense against this fungal infection.

Diagnostic performance of the RSNA-proposed classification for COVID-19 pneumonia versus pre-pandemic controls.

OBJECTIVE: To evaluate the diagnostic accuracy of the Radiological Society of North America (RSNA) classification system for coronavirus disease 2019 (COVID-19) pneumonia compared to pre-pandemic chest computed tomography (CT) scan images to mitigate the risk of bias regarding the reference standard. MATERIALS AND METHODS: This was a retrospective, cross-sectional, diagnostic test accuracy study. Chest CT scans, carried out from May 1 to June 30, 2020, and from May 1 to July 17, 2017, were consecutively selected for the COVID-19 (positive reverse transcription-polymerase chain reaction [RT-PCR] for severe acute respiratory syndrome coronavirus 2 result) and control (pre-pandemic) groups, respectively. Four expert thoracic radiologists blindly interpreted each CT scan image. Sensitivity and specificity were calculated. RESULTS: A total of 160 chest CT scan images were included: 79 in the COVID-19 group (56 [43.5-67] years old, 41 men) and 81 in the control group (62 [52-72] years old, 44 men). Typically, an estimated specificity of 98.5% (95% confidence interval [CI] 98.1%-98.4%) was obtained. For the indeterminate classification as a diagnostic threshold, an estimated sensitivity of 88.3% (95% CI 84.7%-91.7%) and a specificity of 79.0% (95% CI 74.5%-83.4%), with an area under the curve of 0.865 (95% CI 0.838-0.895), were obtained. CONCLUSION: The RSNA classification system shows strong diagnostic accuracy for COVID-19 pneumonia, even against pre-pandemic controls. It can be an important aid in clinical decision-making, especially when a typical or indeterminate pattern is found, possibly advising retesting following an initial negative RT-PCR result and streamlining early management and isolation.

SARS-CoV-2 in eight municipalities of the Colombian tropics: high immunity, clinical and sociodemographic outcomes.

BACKGROUND: Serological evaluation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an alternative that allows us to determine the prevalence and dynamics of this infection in populations. The goal of this study was to determine the clinical and sociodemographic dynamics of SARS-CoV-2 infection in a region of the Colombian Caribbean. METHODS: Between July and November 2020, a cross-sectional observational study was carried out in Córdoba, located in northeast Colombia in the Caribbean area. Eight municipalities with the largest populations were chosen and 2564 blood samples were taken. A commercial enzyme-linked immunosorbent assay was used with the recombinant protein antigen N of SARS-CoV-2. The people included in the study were asked for sociodemographic and clinical data, which were analysed by statistical methods. RESULTS: A seroprevalence of 40.8% was obtained for SARS-CoV-2 in the Córdoba region. In the bivariate analysis, no differences were observed in seropositivity against SARS-CoV-2 for gender or age range (p>0.05). Higher seropositivity was found in low socio-economic status and symptomatic patients (p<0.0001). A total of 30.7% of the asymptomatic patients were seropositive for SARS-CoV-2, which could be linked to the spread of this infection. In the multivariate analysis, seroconversion was related to poverty and clinical manifestations such as anosmia and ageusia (p<0.05). CONCLUSIONS: The high seropositivity in Córdoba is due to widespread SARS-CoV-2 in this population. The relationship between seropositivity and socio-economic status suggests a higher exposure risk to the virus caused by informal economic activities in low-income groups. Clinical manifestations such as anosmia and ageusia could be clinical predictors of infection by the new emergent coronavirus.

Diagnostic performance of the RSNA-proposed classification for COVID-19 pneumonia versus pre-pandemic controls

Abstract Objective To evaluate the diagnostic accuracy of the Radiological Society of North America (RSNA) classification system for coronavirus disease 2019 (COVID-19) pneumonia compared to pre-pandemic chest computed tomography (CT) scan images to mitigate the risk of bias regarding the reference standard. Materials and methods This was a retrospective, cross-sectional, diagnostic test accuracy study. Chest CT scans, carried out from May 1 to June 30, 2020, and from May 1 to July 17, 2017, were consecutively selected for the COVID-19 (positive reverse transcription-polymerase chain reaction [RT-PCR] for severe acute respiratory syndrome coronavirus 2 result) and control (pre-pandemic) groups, respectively. Four expert thoracic radiologists blindly interpreted each CT scan image. Sensitivity and specificity were calculated. Results A total of 160 chest CT scan images were included: 79 in the COVID-19 group (56 [43.5-67] years old, 41 men) and 81 in the control group (62 [52-72] years old, 44 men). Typically, an estimated specificity of 98.5% (95% confidence interval [CI] 98.1%-98.4%) was obtained. For the indeterminate classification as a diagnostic threshold, an estimated sensitivity of 88.3% (95% CI 84.7%-91.7%) and a specificity of 79.0% (95% CI 74.5%-83.4%), with an area under the curve of 0.865 (95% CI 0.838-0.895), were obtained. Conclusion The RSNA classification system shows strong diagnostic accuracy for COVID-19 pneumonia, even against pre-pandemic controls. It can be an important aid in clinical decision-making, especially when a typical or indeterminate pattern is found, possibly advising retesting following an initial negative RT-PCR result and streamlining early management and isolation.

Biological and Psychosocial Factors, Risk Behaviors, and Perinatal Asphyxia in a University Hospital: Matched Case-Control Study, Cali, Colombia (2012-2014).

Introduction: Perinatal asphyxia is one of the main causes of morbidity and mortality in newborns. It generates high costs, both social and economic, and presents modifiable risk factors. Objective: To determine the biological and psychosocial factors and risk behaviors associated with the development of perinatal asphyxia (Sarnat II-III) in newborns from low socioeconomic status in a tier III university hospital in the city of Cali, Colombia. Materials and Methods: With a case and control design, 216 patients were studied (54 cases/162 controls) (1 case/3 matched controls). The cases were defined as newborns with modified or severe perinatal asphyxia (Sarnat II-III) between 2012 and 2014, with gestational age ≥ 36 weeks, with neurological signs not attributable to other causes, multiorgan compromise, advanced reanimation, and presence of a sentinel event. For the analysis, conditional logistic regression models were developed to evaluate association (OR), considering that the cases and controls had been paired by the birth and gestational age variables. Results: The final model showed that, from the group of biological variables, meconium amniotic fluid was identified as a risk factor (OR 15.28, 95%CI 2.78-83.94). Induction of labor lowered the risk of perinatal asphyxia by 97% (OR 0.03, 95%CI 0.01-0.21), and monitoring of fetal heart rate was associated with lower odds by 99% (OR 0.01, 95%CI 0.00-0.31) of developing perinatal asphyxia in the newborn. Regarding social variables, the lack of social support was identified as a risk factor for the development of perinatal asphyxia (OR 6.44, 95%CI 1.16-35.66); in contrast, secondary education lowered the odds of developing perinatal asphyxia by 85% when compared with pregnant women who only had primary school education (OR 0.15, 95%CI 0.03-0.77). Conclusion: Assessment of biological and psychosocial factors and social support is important in pregnant women to determine the risk of developing perinatal asphyxia in a low-income population.

Lower Level of Plasma 25-Hydroxyvitamin D in Children at Diagnosis of Celiac Disease Compared with Healthy Subjects: A Case-Control Study.

OBJECTIVE: To evaluate the vitamin D status of children with a new diagnosis of celiac disease compared with healthy controls. STUDY DESIGN: This was a case-control study. Cases were consecutive children with newly diagnosed celiac disease. Controls were healthy children matched for age, sex, ethnicity, and month of blood testing. Plasma 25-hydroxyvitamin D (25-OHD) was measured as the index of vitamin D nutritional status. The Student t test was used for comparisons. Differences in frequencies were evaluated with the χ2 test. Associations between variables were estimated by calculating Pearson correlation coefficients. RESULTS: There were 131 children with celiac disease enrolled (62% females; mean age 8.1 ± 1.1 years). The control group included 131 healthy children (62% females; mean age 8.2 ± 1.2). All were of European origin. Plasma 25-OHD levels were significantly lower in patients than in controls (25.3 ± 8.0 and 31.6 ± 13.7 ng/mL; P < .0001). The percentage of children with vitamin D deficiency (<20 ng/mL) was significantly higher in children with celiac diseaseas compared with controls (31% vs 12%; P < .0001). The concentration of 25-OHD was significantly lower in patients than in controls during summer (P < .01) and autumn (P < .0001). CONCLUSIONS: In this case-control study, at diagnosis, children with celiac disease showed lower levels of plasma 25-OHD compared with healthy subjects. Vitamin D status should be checked at diagnosis of celiac disease, particularly during summer and fall months.

Assessment of the impact of implementation of a zero blood alcohol concentration law in Uruguay on moderate/severe injury and fatal crashes: a quasi-experimental study.

BACKGROUND AND AIMS: Debates regarding lowering the blood alcohol concentration (BAC) limit for drivers are intensifying in the United States and other countries, and the World Health Organization recommends that the limit for adults should be 0.05%. In January 2016, Uruguay implemented a law setting a zero BAC limit for all drivers. This study aimed to assess the effect of this policy on the frequency of moderate/severe injury and fatal traffic crashes. DESIGN: A quasi-experimental study in which a synthetic control model was used with controls consisting of local areas in Chile as the counterfactual for outcomes in Uruguay, matched across population counts and pre-intervention period outcomes. Sensitivity analyses were also conducted. SETTING: Uruguay and Chile. CASES: Panel data with crash counts by outcome per locality-month (2013-2017). INTERVENTION AND COMPARATOR: A zero blood alcohol concentration law implemented on 9 January 2016 in Uruguay, alongside a continued 0.03 g/dl BAC threshold in Chile. MEASUREMENTS: Per-capita moderate/severe injury (i.e. moderate or severe), severe injury and fatal crashes (2013-2017). FINDINGS: Our base synthetic control model results suggested a reduction in fatal crashes at 12 months [20.9%; P-value = 0.018, 95% confidence interval (CI) = -0.340, -0.061]. Moderate/severe injury crashes did not decrease significantly (10.2%, P = 0.312, 95% CI = -0.282, 0.075). The estimated effect at 24 months was smaller and with larger confidence intervals for fatal crashes (14%; P = 0.048, 95% CI = -0.246, -0.026) and largely unchanged for moderate/severe injury crashes (-9.4%, P = 0.302, 95% CI = -0.248, 0.058). Difference-in-differences analyses yielded similar results. As a sensitivity test, a synthetic control model relying on an inferior treatment-control match pre-intervention (measured by mean squared error) yielded similar-sized differences that were not statistically significant. CONCLUSIONS: Implementation of a law setting a zero blood alcohol concentration threshold for all drivers in Uruguay appears to have resulted in a reduction in fatal crashes during the following 12 and 24 months.

Association of homocysteine with ankylosing spondylitis: a systematic review and meta-analysis

Abstract Background: Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). Current findings regarding plasma/serum homocysteine (HCY) levels in AS patients are inconsistent. This study aims to systematically evaluate the association between circulating HCY levels and AS. Methods: Online electronic databases (PubMed, Web of Science, Embase, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Wanfang data) were used to retrieve all relevant articles published up to May 7, 2020. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using the random-effect model, Stata16 software. Results: Nine articles containing 778 AS patients and 522 controls were included in this meta-analysis. No significant differences in HCY levels were found between AS and control groups (pooled SMD = 0.46, 95% CI = − 0.30 to 1.23, P = 0.23). However, subgroup analysis suggested that HCY levels were significantly higher (P < 0.05) in the AS group treated with methotrexate (MTX) compared with the control group. In contrast, HCY levels were significantly (P < 0.05) lower in the AS group receiving anti-TNF-α treatment compared with the control group. No significant differences were detected between HCY levels and disease activity scores (Bath AS disease activity index, BASDAI), and methylenetetrahydrofolate reductase (MTHFR) C677T genotype. Conclusion: This meta-analysis indicates that HCY levels are similar between AS and controls, and do not correlate with disease activity. However, different medical treatments cause fluctuations of circulating HCY levels in AS patients. Further and larger-scale studies are needed to confirm these findings. Trial registration: This study was registered at international prospective register of systematic reviews (PROSPERO), registration number: CRD42020184426.(AU)

Impacto del número de controles periódicos en la salud bucal de los pacientes atendidos en la Clínica de Odontopediatría / Impacto do número de controles periódicos na saúde bucal dos pacientes atendidos na Clínica de Odontologia Pediátrica / Impact of the number of periodic dental checkups on oral health at a university pediatric dentistry clinic

Resumen La Clínica de Odontopediatría desarrolla un modelo de atención con énfasis en promoción, educación y rehabilitación destacándose su control y mantenimiento. No hay información sobre el impacto de los controles periódicos. Objetivo: Evaluar la asociación del número de controles y la salud bucal de niños entre 5 y 10 años. Estudio transversal, descriptivo (2017-18) y retrospectivo (hasta 2014) en dos subpoblaciones: G1=controles y G2=primera vez, evaluando diferencias de piezas afectadas Resultados: 115 niños, 44 en G1 y 71 en G2. El 100% presentaron biopelícula. G1 presentó un valor significativamente menor del IPV>20% (p<0.001), de lesiones cavitadas (p<0.001). G1 con 2 o más controles el promedio de lesiones iniciales fue de 2,6 y G2 de 4,5 (p<0.001). Conclusiones: Los niños con dos o más controles presentaron mejor situación de salud bucal que quienes consultaron por primera vez. Se confirma la importancia del control programado para el mantenimiento de la salud bucal.

Resumo A Clínica de Odontologia Pediátrica desenvolve um modelo de cuidado com ênfase na promoção, educação em saúde e reabilitação destacando seu controle e manutenção. Não há informações que sustentem o impacto que os controles regulares. Objetivo: Avaliar a associação do número de controles anuais e da saúde bucal de crianças entre 5 e 10 anos. Estudo transversal e descritivo (2017-18) e retrospectiva (até 2014) em duas subpopulações: G1-controle e G2-primeira vez. Resultados: 115 crianzas: G1-44 e G2-71. 100% do de crianças apresentaram biofilme. G1 apresentou valor de IPV>20% e lesões cavitadas significativamente menor (p<0,001). G1 com 2 ou mais controles a média de lesões iniciais foi de 2,6 e no G2 4,5 (p <0,001). Conclusões: Crianças que assistem a 2 ou mais controles têm uma melhor situação de saúde bucal em comparação com aquelas que consultam pela primeira vez. Confirma-se a importância do controle programado para manutenção da saúde bucal.

Abstract The Pediatric Dentistry Clinic at the School of Dentistry, Universidad de la República, has a care model that focuses on promotion, health education and rehabilitation, and aims to support health control and maintenance. There is no information on the impact of periodic checkups. Objective: To evaluate the association between the number of checkups and oral health in children aged between 5 and 10. Cross-sectional, descriptive (2017-18) and retrospective (up to 2014) study in two subpopulations: G1 = checkups, and G2 = first visit. We evaluated the differences in the number of teeth affected. Results: The sample included 115 children: 44 in G1 and 71 in G2. All of them had biofilm. G1 presented significantly lower values regarding visible plaque index (VPI) (>20%) (p < 0.001) and cavitated lesions (p < 0.001). G1 members, who had attended two or more checkups, had 2.6 initial lesions on average, and G2 members, 4.5 (p < 0.001). Conclusions Children who had attended two or more checkups had better oral health than those seeking care for the first time. This confirms the importance of scheduled checkups for maintaining oral health.

A Role for GLP-1 in Treating Hyperphagia and Obesity.

Obesity is a chronic recurring disease whose prevalence has almost tripled over the past 40 years. In individuals with obesity, there is significant increased risk of morbidity and mortality, along with decreased quality of life. Increased obesity prevalence results, at least partly, from the increased global food supply that provides ubiquitous access to tasty, energy-dense foods. These hedonic foods and the nonfood cues that through association become reward predictive cues activate brain appetitive control circuits that drive hyperphagia and weight gain by enhancing food-seeking, motivation, and reward. Behavioral therapy (diet and lifestyle modifications) is the recommended initial treatment for obesity, yet it often fails to achieve meaningful weight loss. Furthermore, those who lose weight regain it over time through biological regulation. The need to effectively treat the pathophysiology of obesity thus centers on biologically based approaches such as bariatric surgery and more recently developed drug therapies. This review highlights neurobiological aspects relevant to obesity causation and treatment by emphasizing the common aspects of the feeding-inhibitory effects of multiple signals. We focus on glucagon like peptide-1 receptor (GLP-1R) signaling as a promising obesity treatment target by discussing the activation of intestinal- and brain-derived GLP-1 and GLP-1R expressing central nervous system circuits resulting from normal eating, bariatric surgery, and GLP-1R agonist drug therapy. Given the increased availability of energy-dense foods and frequent encounters with cues that drive hyperphagia, this review also describes how bariatric surgery and GLP-1R agonist therapies influence food reward and the motivational drive to overeat.

Estudios de cohortes especiales / Special cohort studies

Resumen Como se comentó en el artículo anterior (Estudios de cohortes. 1ª parte. Descripción, metodología y aplicaciones), los estudios de cohortes se caracterizan por ser observacionales, longitudinales y analíticos; y en todos ellos se debe considerar una exposición o "factor de exposición", un período de seguimiento, eventuales pérdidas de seguimiento y el desenlace de un resultado. Se han propuesto modificaciones y variantes al diseño del estudio de cohortes tradicional. Se describen de forma resumida, las características principales de los estudios de cohortes con base poblacional, de cohortes bidireccional o ambispectivo; y de otras variantes: según número de cohortes (única y múltiple), de acuerdo al tipo de reclutamiento de la población a estudio (cerrada y abierta), según el tipo de exposición (fija y dinámica); estudio de casos y controles anidado, cohorte-caso; y cohortes ocupacionales (simple con población de referencia externa, simple con grupo de referencia interna y de cohortes múltiples). Finalmente, se desarrollan algunos ejemplos de la literatura de las variantes de cohortes más frecuentes. El objetivo de este manuscrito fue generar un documento de estudio referente a las modificaciones y variantes del diseño del estudio de cohortes.

As we mentioned in a previous article (Cohort studies. 1st part. Description, methodology and applications), cohort studies are characterized by being observational, longitudinal and analytical studies; and in all of them an exposure, a follow-up period, eventual loss of follow-up; and an outcome should be considered. A number of modifications and variants to the traditional cohort study design have been proposed. A summary with the main characteristics of population-based cohort studies, bidirectional cohorts, and of other variants according: to the number of cohorts (single and multiple), to the recruitment of the study population (closed and open), to the exposure (fixed and dynamic); nested case-control study, cohort-case, and occupational cohorts (simple with external reference population, simple with internal reference group and multiple cohorts), are described. Finally, examples of the literature of the most frequent cohort variants are developed. The aim of this manuscript was to generate a study document referring to some of the modifications and variants of cohort studies.

Factors associated with low birthweight: a case-control study in a city of Minas Gerais / Fatores associados ao baixo peso ao nascer: estudo caso-controle em cidade de Minas Gerais

ABSTRACT OBJECTIVE To analyze the many factors regarding socioeconomic and healthcare-related variables linked to maternal diseases and the possible impact of the environmental disaster of Mariana, given the prenatal exposure to different water sources for human consumption that were associated with low birthweight in full-term live births in the Municipal Hospital of Governador Valadares, Minas Gerais. METHODS Case-control study, carried out with live births at the Municipal Hospital of Governador Valadares, from May 2017 to July 2018. The case group consisted of full-term live births and low birthweight, and the control group consisted of full-term live births with adequate weight, matched by gender and date of birth. For each case, two controls were selected. Data collection was performed through interviews with the puerperal women, and complementary information was obtained by analyzing the prenatal card and medical records. For data analysis, logistic regression was performed. RESULTS The study included 65 live births from the case group and 130 from the control group. After the analysis was adjusted for other factors under study, we found that the higher risks of low birthweight are associated with the first childbirth (OR = 2.033; 95%CI = 1.047-3.948; p = 0.036), smoking during pregnancy (OR = 2.850; 95%CI = 1.013-8.021; p = 0.047) and consumption of water supplied by the municipalities affected by the tailings from the Fundão dam failure (RC = 2.444; 95%CI = 1.203-4.965; p = 0.013). CONCLUSIONS The variables "water consumed during pregnancy," "previous pregnancies" and "maternal smoking" were associated with low birthweight in the population studied. The importance of epidemiological studies that assess water quality and its adverse health effects is reinforced, as well as greater prenatal control of first-time pregnant women and greater support of policies against smoking, especially during pregnancy.

RESUMO OBJETIVO Analisar os fatores socioeconômicos, demográficos, ambientais, reprodutivos, comportamentais, de assistência à saúde, doenças maternas e, sobretudo, o possível impacto do desastre ambiental ocorrido em Mariana, pela exposição pré-natal a diferentes fontes de água para consumo humano, associados ao baixo peso ao nascer em nascidos vivos a termo no Hospital Municipal de Governador Valadares, Minas Gerais. MÉTODOS Estudo caso-controle, realizado com nascidos vivos no Hospital Municipal de Governador Valadares, no período de maio de 2017 a julho de 2018. O grupo caso foi composto por nascidos vivos a termo e baixo peso ao nascer e o grupo controle, por nascidos vivos a termo e com peso adequado, pareados por sexo e data de nascimento. Para cada caso foram selecionados dois controles. A coleta de dados foi realizada por meio de entrevista com as puérperas e informações complementares foram obtidas pela análise do cartão de pré-natal e prontuários. Para análise dos dados, foi realizada regressão logística. RESULTADOS Participaram do estudo 65 nascidos vivos pertencentes ao grupo caso e 130 ao grupo controle. Após a análise ajustada para os demais fatores em estudo, verificou-se que os riscos mais elevados de baixo peso ao nascer estão associados aos primeiros filhos (RC = 2,033; IC95% = 1,047-3,948; p = 0,036) e aos nascidos vivos cujas mães utilizaram cigarro durante a gestação (RC = 2,850; IC95% = 1,013-8,021; p = 0,047) e consumiram a água fornecida pelos serviços de abastecimento dos municípios atingidos pelos rejeitos provenientes do rompimento da barragem de Fundão (RC = 2,444; IC95% = 1,203-4,965; p = 0,013). CONCLUSÕES A água consumida na gestação, primiparidade e tabagismo materno apresentaram associação com baixo peso ao nascer na população estudada. Reforça-se a importância de estudos epidemiológicos, que avaliem a qualidade da água e seus efeitos adversos na saúde, assim como maior controle no pré-natal das gestantes que terão o primeiro filho e maior apoio das políticas contra o tabagismo, especialmente durante a gravidez.

"Mão na cabeça!": abordagem policial, racismo e violência estrutural entre jovens negros de três capitais do Nordeste / "Hands up!": Police stop-and-frisk, racism and structural violence among black youth from three capitals in the Brazilian Northeast

Resumo A intersecção entre raça, classe social, pertencimento territorial e perfil etário tem sido determinante na produção dos critérios de suspeição na prática policial brasileira. Jovens negros, pobres e moradores de favelas configuram o público alvo das abordagens policiais. Propõe-se, neste artigo, apresentar os resultados do estudo que explorou experiências e percepções de jovens negros(as) pertencentes a bairros socialmente vulneráveis e/ou com altos índices de violência nas cidades de Salvador, Recife e Fortaleza, relacionadas com abordagem policial. A pesquisa foi guiada pelas seguintes questões: como jovens negros vivenciam e (re)significam a relação com a polícia e, mais especificamente, a abordagem policial? Em que medida marcadores de pertencimento social, tais como perfil racial, classe e território, influenciam no processo de abordagem? Foi realizado um estudo qualitativo através de grupos focais, rodas de conversa e entrevistas semiestruturadas com jovens negro(as) de 15 a 29 anos, moradores de bairros periféricos das três capitais referidas. Os dados revelaram que a segregação racial e o racismo, presentes na estrutura e dinâmicas relacionais da sociedade brasileira, assim como sua negação e/ou certa naturalização, influenciam a "tomada de decisão" e o modo de atuar da polícia frente à juventude negra nas três capitais investigadas.

Abstract The intersection between race, social class, territorial belonging and age profile has been decisive in producing the criteria of suspicion employed by Brazilian police. Young blacks who are poor and inhabit favelas are a prime target for police control actions such as the stop-and-frisk. This article presents the results of a study exploring the experiences and perceptions of police approach as voiced by young blacks from neighborhoods that are socially vulnerable and/or have high levels of violence. The study was carried out in the cities of Salvador, Recife and Fortaleza. The research was guided by the following questions: how do young blacks experience and (re)signify their relationship with the police and, more specifically, the police approach? To what extent do social belonging markers, such as racial profile, class and territory, influence the stop-and-frisk process? A qualitative study was carried out by means of focus groups, conversation circles and semi-structured interviews with black youths aged 15 to 29 living in peripheral neighborhoods of the three aforementioned capitals. The data revealed that racial segregation and racism present in the structure and relational dynamics of Brazilian society - as well as its denial and/or naturalization - influence the police's "decision-making" and way of dealing with black youth in the three investigated capitals.

Algunas consideraciones sobre aplicación, cálculo e interpretación de odds ratio y riesgo relativo / Some considerations on application, calculation and interpretation of odds ratio and relative risk

El riesgo relativo y el odds ratio son dos medidas de la fuerza de asociación en las investigaciones clínicas y epidemiológicas. El riesgo relativo corresponde a la razón de dos tasas de incidencia, las personas expuestas a un posible factor de riesgo y la de los no expuestos a ese factor. El odds corresponde a la razón entre dos odds y un odds. Este último es un cociente entre la probabilidad de que ocurra un evento determinado y la probabilidad de que no ocurra dicho evento. El riesgo relativo puede ser estimado en diseños prospectivos y retrospectivos, mientras que el odds ratio se puede calcular en estudios prospectivos, retrospectivos y transversales analíticos, y bajo ciertas condiciones pueden reemplazar al riesgo relativo. Por medio de algunas interrogantes y ejemplos didácticos, este artículo expone las bases metodológicas y estadísticas de manera sencilla, acerca de estas dos medidas, con el propósito de que en el ámbito de las ciencias de la salud, los investigadores puedan hacer una correcta interpretación y uso de ellos(AU)

Relative risk and odds ratio are two measures of the association strength in clinical and epidemiological investigations. The relative risk corresponds to the ratio of two incidence rates, those exposed to a possible risk factor and those not exposed to that factor. Odds correspond to the ratio of two odds to one odds. The latter is a quotient between the probability that a certain event occurs and the probability that said event does not occur. Relative risk can be estimated in prospective and retrospective designs, while odds ratio can be calculated in analytical prospective, retrospective and cross-sectional studies, and under certain conditions they can replace relative risk. Relative risk can be estimated in prospective and retrospective designs, while odds ratio can be calculated in analytical prospective, retrospective and cross-sectional studies, and under certain conditions they can replace relative risk. By means of some questions and didactic examples, this article presents the methodological and statistical bases about these two measures, in a simple way, aiming to help researchers to make a correct interpretation and use of them, in the field of health sciences(AU)