ABSTRACT
Antiretroviral therapy contributes to decreasing morbidity and mortality, and ultimately to increasing survival. In Brazil, there are regional differences in HIV epidemiology regarding pregnant women and children with HIV/AIDS. This study evaluates survival time after AIDS diagnosis in 914 children infected by mother-to-child transmission, reported between 1983 and 1998 and followed until 2002, in Brazil's five regions. Time between birth and HIV diagnosis decreased over the years, mainly in the South and Southeast Regions. There was a significant improvement in survival; more than 75% of cases were still living four years after diagnosis in the 1997-1998 group. This Brazilian study demonstrates that even with regional inequalities in health care infrastructure it is possible for a developing country to establish an effective system of universal and free access to antiretroviral therapy that produces a significant increase in survival for children with AIDS.
Subject(s)
HIV Infections/transmission , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy Complications, Infectious/mortality , Acquired Immunodeficiency Syndrome/mortality , Brazil/epidemiology , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , HIV Infections/diagnosis , Humans , Infant , Infant, Newborn , Male , National Health Programs , Pregnancy , Social Justice , Socioeconomic Factors , Survival AnalysisABSTRACT
OBJECTIVES: To estimate hypertension prevalence and identify associated socioeconomic, demographic, and anthropometric variables. METHODS: A cross-sectional study with probability sampling. TARGET POPULATION: people > or = 18 years of age living in the urban area of Formiga, Minas Gerais state, and registered with the Family Health Program (Programa Saúde da Família-PSF), which covers 94% of the population. Two hundred and eighty-five subjects (131 men and 154 women) were enrolled in the study. Criteria for the diagnosis of hypertension were the following: systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg, or current use of antihypertensive medication. A standard questionnaire was used to collect socioeconomic and demographic data, as well as information on alcohol consumption, smoking, and physical activity level. RESULTS: Overall prevalence of hypertension in the target population was estimated at 32.7% (95% CI): 28.2-37.2), 31.7% in men and 33.6% in women. Among subjects with prescribed antihypertensive drugs, 66% reported taking their medication regularly. Hypertension prevalence increased steadily with increasing age (OR = 1.07; 95% CI: 1.05-1.10) and was positively associated with waist circumference (OR = 3.05; 95% CI: 1.49-6.22) and negatively associated with the level of physical activity (OR = 0.45; 95% CI: 0.25-0.82). CONCLUSION: Hypertension prevalence was very high in the adult population registered with the PSF in Formiga, representing a major public health problem. Intervention programs that boost physical activity, promote compliance with drug treatment, and focus on hypertensive subjects unaware of their condition are needed.
Subject(s)
Hypertension/epidemiology , Adolescent , Adult , Age Factors , Aged , Alcohol Drinking/adverse effects , Alcohol Drinking/epidemiology , Antihypertensive Agents , Brazil/epidemiology , Epidemiologic Methods , Exercise , Female , Humans , Hypertension/diagnosis , Male , Middle Aged , Smoking/adverse effects , Smoking/epidemiology , Socioeconomic Factors , Urban Population , Waist-Hip Ratio/adverse effectsABSTRACT
OBJETIVOS: Estimar a prevalência de hipertensão arterial sistêmica (HAS) e identificar variáveis socioeconômicas, demográficas e antropométricas associadas. MÉTODOS: Estudo transversal com amostragem probabilística. População-alvo: pessoas com idade > 18 anos residentes na região urbana do município de Formiga, Minas Gerais, e cadastradas no Programa Saúde da Família (PSF), que tem cobertura de 94 por cento da população total do município. Participaram do estudo 285 indivíduos (131 homens e 154 mulheres). Critério para diagnóstico de HAS: pressão arterial sistólica > 140 mmHg e/ou pressão arterial diastólica > 90 mmHg, ou uso de medicação anti-hipertensiva. Utilizou-se questionário padronizado, afim de obter informações socioeconômicas e demográficas, consumo de álcool, tabagismo e nível de atividades física. RESULTADOS: A estimativa da prevalência total de HAS na população-alvo foi de 32,7 por cento (IC 95 por cento: 28,2-37,2). Entre os homens foi de 31,7 por cento e, entre as mulheres, 33,6 por cento. Dentre os hipertensos com prescrição de anti-hipertensivos, 66,7 por cento declararam fazer uso regular da medicação. A prevalência de HAS aumentou continuamente com a idade (OR = 1,07; IC 95 por cento: 1,05-1,10) e esteve positivamente associada com a medida da circunferência da cintura (OR = 3,05; IC 95 por cento: 1,49-6,22) e negativamente associada com o nível de atividade física (OR = 0,45; IC 95 por cento: 0,25-0,82). CONCLUSÃO: A prevalência de HAS na população adulta e cadastrada no PSF, foi muito elevada em Formiga, representando um grave problema de saúde pública. É preciso que os programas de intervenção promovam a prática de atividades físicas, considerem a adesão ao tratamento medicamentoso e os hipertensos que desconhecem sua condição.
OBJECTIVES: To estimate hypertension prevalence and identify associated socioeconomic, demographic, and anthropometric variables. METHODS: A cross-sectional study with probability sampling. Target population: people > 18 years of age living in the urban area of Formiga, Minas Gerais state, and registered with the Family Health Program (Programa Saúde da Família - PSF), which covers 94 percent of the population. Two hundred and eighty-five subjects (131 men and 154 women) were enrolled in the study. Criteria for the diagnosis of hypertension were the following: systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg, or current use of antihypertensive medication. A standard questionnaire was used to collect socioeconomic and demographic data, as well as information on alcohol consumption, smoking, and physical activity level. RESULTS: Overall prevalence of hypertension in the target population was estimated at 32.7 percent (95 percent CI): 28.2-37.2), 31.7 percent in men and 33.6 percent in women. Among subjects with prescribed antihypertensive drugs, 66 percent reported taking their medication regularly. Hypertension prevalence increased steadily with increasing age (OR = 1.07; 95 percent CI: 1.05-1.10) and was positively associated with waist circumference (OR = 3.05; 95 percent CI: 1.49-6.22) and negatively associated with the level of physical activity (OR = 0.45; 95 percent CI: 0.25-0.82). CONCLUSION: Hypertension prevalence was very high in the adult population registered with the PSF in Formiga, representing a major public health problem. Intervention programs that boost physical activity, promote compliance with drug treatment, and focus on hypertensive subjects unaware of their condition are needed.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Hypertension/epidemiology , Age Factors , Alcohol Drinking/adverse effects , Alcohol Drinking/epidemiology , Antihypertensive Agents , Brazil/epidemiology , Epidemiologic Methods , Exercise , Hypertension/diagnosis , Socioeconomic Factors , Smoking/adverse effects , Smoking/epidemiology , Urban Population , Waist-Hip Ratio/adverse effectsABSTRACT
Antiretroviral therapy contributes to decreasing morbidity and mortality, and ultimately to increasing survival. In Brazil, there are regional differences in HIV epidemiology regarding pregnant women and children with HIV/AIDS. This study evaluates survival time after AIDS diagnosis in 914 children infected by mother-to-child transmission, reported between 1983 and 1998 and followed until 2002, in Brazil's five regions. Time between birth and HIV diagnosis decreased over the years, mainly in the South and Southeast Regions. There was a significant improvement in survival; more than 75 percent of cases were still living four years after diagnosis in the 1997-1998 group. This Brazilian study demonstrates that even with regional inequalities in health care infrastructure it is possible for a developing country to establish an effective system of universal and free access to antiretroviral therapy that produces a significant increase in survival for children with AIDS.
A terapia anti-retroviral contribui para a diminuição da morbidade e da mortalidade, com conseqüente aumento da sobrevida. No Brasil, há diferenças regionais relativas à dinâmica da epidemia do HIV e ao seu enfrentamento no grupo das gestantes e das crianças com HIV/AIDS. Este estudo verifica o tempo de sobrevida após o diagnóstico de AIDS em 914 crianças infectadas por transmissão vertical, entre os anos de 1983 e 1998, e acompanhadas até 2002, nas cinco regiões brasileiras. O tempo do nascimento ao diagnóstico de infecção pelo HIV, ao longo dos anos, apresenta uma diminuição, principalmente nos estados das regiões Sul e Sudeste. Houve melhora significativa da sobrevivência, mais de 75 por cento dos casos ainda estavam vivendo quatro anos após o diagnóstico, no grupo de 1997 e 1998. Esta análise brasileira mostra ser possível para um país em desenvolvimento estabelecer um sistema efetivo de acesso gratuito e universal à terapia anti-retroviral, mesmo com dificuldades regionais para a organização de uma infra-estrutura ideal de saúde, tendo como resultado um aumento significativo da sobrevivência.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pregnancy , HIV Infections/transmission , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/mortality , Acquired Immunodeficiency Syndrome/mortality , Brazil/epidemiology , Cohort Studies , Follow-Up Studies , HIV Infections/diagnosis , National Health Programs , Social Justice , Socioeconomic Factors , Survival AnalysisABSTRACT
OBJECTIVE: To investigate cancer deaths among rubber industry workers according to company size. METHODS: This historical cohort study included 9,188 male workers, engaged as members of a workers' union in São Paulo, Southeastern Brazil, between 1975 and 1985, alive in January 1990 and followed until the end of 2000. Overall and specific cancer deaths were compared within the cohort, with subjects stratified according to company size and economic activity, sector of work, and worker qualification. Risk set assessment and conditional logistic regression were used to estimate relative risks, adjusted for age, time since first job, and duration of employment in the rubber industry. RESULTS: When compared to employees of larger companies, workers employed in small companies showed greater risk of death due to any type of cancer (RR=2.33, 95% CI: 0.90-6.03), stomach tumors (RR=3.47; 95% CI: 2.57-4.67), and upper aero-digestive tract tumors (RR=2.49; 95% CI: 1.78-3.48). Risk of death was greater among workers employed in maintenance (RR=2.23; 95% CI: 0.73-6.76); expedition, storage and transportation (RR=2.97; 95% CI: 0.77-11.38); and production (RR=3.51; 95% CI: 1.07-11.57), when compared to workers engaged in clerical work and support activities. CONCLUSIONS: Our results provide further evidence for an increased risk of stomach and upper aero-digestive tract tumors--and possibly of all types of cancer--among rubber industry workers employed in small companies when compared to employees of larger companies.
Subject(s)
Extraction and Processing Industry/statistics & numerical data , Neoplasms/mortality , Occupational Diseases/mortality , Occupational Exposure/adverse effects , Rubber , Adolescent , Adult , Brazil/epidemiology , Cause of Death , Cohort Studies , Humans , Male , Middle Aged , Risk FactorsABSTRACT
OBJETIVO: Avaliar as mortes por câncer em trabalhadores da indústria da borracha de acordo com o tamanho da empresa. MÉTODOS: Coorte histórica com 9.188 trabalhadores masculinos, matriculados em sindicato de trabalhadores da indústria de borracha do Estado de São Paulo entre 1975 e 1985, sobreviventes em janeiro de 1990 e acompanhados até o final de 2000. As mortes por câncer foram comparadas internamente à coorte, cujos membros foram subdivididos em estratos por porte e sub-ramo da empresa, setor de trabalho e qualificação profissional. A abordagem por conjuntos de risco e regressão logística condicional foi utilizada para o cálculo dos riscos relativos, ajustados por idade, tempo desde o primeiro emprego e tempo de trabalho na indústria da borracha. RESULTADOS: Quando comparados aos empregados de grandes empresas, trabalhadores de pequenas empresas mostraram excesso de mortes por todos tipos de câncer (RR=2,33; IC 95 por cento: 0,90-6,03); tumores de estômago (RR=3,47; IC 95 por cento: 2,57-4,67) e do trato aero-digestivo superior (RR=2,49; IC 95 por cento: 1,78-3,48). Identificou-se excesso de mortes por câncer nos trabalhadores dos setores de manutenção (RR=2,23; IC 95 por cento: 0,73-6,76); expedição, armazenamento e transporte (RR=2,97; IC 95 por cento: 0,77-11,38); e produção (RR=3,51; IC 95 por cento: 1,07-11,57), comparados aos trabalhadores dos setores administrativos. CONCLUSÕES: Os resultados mostram evidências de aumento do risco de tumores de estômago e do trato aero-digestivo superior e, possivelmente, por câncer em geral em trabalhadores de empresas de pequeno porte da indústria da borracha quando comparados aos trabalhadores das grandes empresas.
Subject(s)
Cohort Studies , Rubber Industry , Neoplasms/mortality , Risk , Occupational HealthABSTRACT
PURPOSE: To analyze the distribution and time-series trends of cancer mortality in the Northern, Northeastern, Central Western, Southern and Southeastern Brazilian geographic regions from 1980 to 1995. METHODS: Deaths according to year, age, gender and municipality of residence, were ascertained from the Ministry of Health. Age-adjusted rates were calculated for specific cancer sites by gender in the five Brazilian geographic regions. RESULTS: Lung and breast cancers were, respectively in males and females, the main causes of cancer deaths in the Brazilian population. Overall cancer mortality rates for whole country declined among males (-0.3%) and females (-4.8%). But, rates were on increase for cancers of prostate (38.3%), lung (10.5%) and, more recently, colorectal (14.5% from 1989 to 1995) in males, and for lung (26.7%), breast (9.9%) and colorectal (10.2% from 1989 to 1995) in females. Mortality rates by lung and other tobacco related cancers were higher in the Southern and Southeastern. Females in the Northern and Northeastern had more expressive mortality rates by cervical cancer than other regions, and an inverse trend was observed for breast cancer. CONCLUSIONS: Mortality rates by all cancers were heterogeneous in Brazil. The risk of death by cancer was higher in the Southern and Southeastern regions, but was decreasing in these regions, the more developed in the country. The other regions, less developed, had lower mortality rates by cancer, but the rates were on increase. From 1991 to 1995, it was observed the stability of mortality rates from tobacco related cancers, fact less perceived among females.
Subject(s)
Neoplasms/mortality , Adolescent , Adult , Aged , Brazil/epidemiology , Child , Child, Preschool , Demography , Female , Humans , Male , Middle Aged , Risk Factors , Sex Distribution , Sex FactorsABSTRACT
OBJETIVO: Analisar a distribuiçäo e a tendência temporal da mortalidade por câncer nas regiöes geográficas brasileiras entre 1980 e 1995. MÉTODOS: Foram analisados os dados de mortalidade do Ministério da Saúde por ano calendário, idade, sexo e município de residência. As taxas anuais foram padronizadas por idade e estimadas para localizaçöes específicas de câncer, gênero e regiöes. RESULTADOS: O câncer de pulmäo e o de mama foram, respectivamente em homens e mulheres, as principais causas de morte por câncer. Entre 1980 e 1995, a mortalidade por todos os cânceres apresentou variaçäo porcentual negativa nas populaçöes masculina (-0,3 por cento) e feminina (-4,8 por cento). Entretanto, a variaçäo foi positiva para próstata (38,3 por cento), pulmäo (10,5 por cento) e, mais recentemente, color-retal (14,5 por cento entre 1989 e 1995) nos homens; e pulmäo (26,7 por cento), mama (9,9 por cento) e colorretal (10,2 por cento entre 1989 e 1995) nas mulheres. As taxas de mortalidade por câncer de pulmäo e outros relacionados ao tabaco foram mais altas no Sul e Sudeste. As populaçöes femininas do Norte e Nordeste apresentaram mortalidade mais alta por câncer do colo de útero em relaçäo a de outras regiöes. O inverso ocorreu com o câncer de mama. CONCLUSÖES: O risco de morte por câncer foi maior nas regiöes Sul e Sudeste, mas está decrescendo nestas regiöes, as mais desenvolvidas do país. As demais regiöes, menos desenvolvidas, apresentaram taxas de mortalidade mais baixas, mas com tendência ascendente. Entre 1991 e 1995, observou-se no país estabilidade das taxas de mortalidade por cânceres relacionados ao tabaco, fato menos perceptível na populaçäo feminina
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Neoplasms , Brazil , Sex Factors , Demography , Risk Factors , Sex DistributionABSTRACT
CONTEXT: Around 90% of lung cancer worldwide is attributable to cigarette smoking, although less than 20% of cigarette smokers develop lung cancer. Other factors such as diet, chronic lung diseases, occupation and possibly environmental agents also contribute to this cancer. Genetic factors seem to play a role in lung cancer, but the precise characteristics influencing lung cancer susceptibility are not known, since genetic factors are easily obscured by the strong environmental determinants of lung cancer, particularly smoking. OBJECTIVE: To estimate the effect that cancer occurrence among first-degree relatives has on the risk of lung cancer. DESIGN: Hospital-based case-control study. SETTING: The metropolitan region of São Paulo, Brazil. PARTICIPANTS: 334 incident lung cancer cases and 578 controls matched by hospitals. MAIN MEASUREMENTS: By means of a structured questionnaire, cases and controls were interviewed about cancer occurrence in first-degree relatives, tobacco smoking, exposure to passive smoking, occupation, migration and socioeconomic status. Non-conditional logistic regression was used to calculate the risk of familial cancer aggregation, the effect of cancer in first-degree relatives and smoking in conjunction, and for controlling confounders. RESULTS: The adjusted odds ratio (OR) revealed a slight, but not statistically significant, excess risk of lung cancer for subjects with a history of lung cancer in relatives (OR 1.21; 95% confidence interval [CI] 0.50 - 2.92). The same was found among those with a history of other tobacco-related cancers in relatives (OR 1.36; 95% CI 0.87 - 2.14). A step gradient effect was observed regarding lung cancer risk, in accordance with increases in the number of pack-years of cigarette consumption. An interaction between familial cancer aggregation and tobacco smoking was detected. CONCLUSIONS: A mildly elevated risk of lung cancer among persons with a positive history of lung and other tobacco-related cancers was observed. The finding of an interaction between the variables of familial cancer aggregation and smoking suggests that familial cancer aggregation could be considered as a marker of susceptibility, increasing the risk of lung cancer among smokers. These results improve our knowledge of lung carcinogenesis and can guide future cancer genetic studies.
Subject(s)
Genetic Predisposition to Disease , Lung Neoplasms/genetics , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Case-Control Studies , Confidence Intervals , Female , Humans , Incidence , Logistic Models , Lung Neoplasms/epidemiology , Male , Middle Aged , Odds Ratio , Risk Factors , Smoking/adverse effects , Urban PopulationABSTRACT
CONTEXT: Around 90 percent of lung cancer worldwide is attributable to cigarette smoking, although less than 20 percent of cigarette smokers develop lung cancer. Other factors such as diet, chronic lung diseases, occupation and possibly environmental agents also contribute to this cancer. Genetic factors seem to play a role in lung cancer, but the precise characteristics influencing lung cancer susceptibility are not known, since genetic factors are easily obscured by the strong environmental determinants of lung cancer, particularly smoking. OBJECTIVE: To estimate the effect that cancer occurrence among first-degree relatives has on the risk of lung cancer. DESIGN: Hospital-based case-control study. SETTING: The metropolitan region of Säo Paulo, Brazil. PARTICIPANTS: 334 incident lung cancer cases and 578 controls matched by hospitals. MAIN MEASUREMENTS: By means of a structured questionnaire, cases and controls were interviewed about cancer occurrence in first-degree relatives, tobacco smoking, exposure to passive smoking, occupation, migration and socioeconomic status. Non-conditional logistic regression was used to calculate the risk of familial cancer aggregation, the effect of cancer in first-degree relatives and smoking in conjunction, and for controlling confounders. RESULTS: The adjusted odds ratio (OR) revealed a slight, but not statistically significant, excess risk of lung cancer for subjects with a history of lung cancer in relatives (OR 1.21; 95 percent confidence interval [CI] 0.50 -- 2.92). The same was found among those with a history of other tobacco-related cancers in relatives (OR 1.36; 95 percent CI 0.87 -- 2.14). A step gradient effect was observed regarding lung cancer risk, in accordance with increases in the number of pack-years of cigarette consumption. An interaction between familial cancer aggregation and tobacco smoking was detected. CONCLUSIONS: A mildly elevated risk of lung cancer among persons with a positive history of lung and other tobacco-related cancers was observed. The finding of an interaction between the variables of familial cancer aggregation and smoking suggests that familial cancer aggregation could be considered as a marker of susceptibility, increasing the risk of lung cancer among smokers. These results improve our knowledge of lung carcinogenesis and can guide future cancer genetic studies
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lung Neoplasms , Urban Population , Aged, 80 and over , Brazil , Smoking , Case-Control Studies , Confidence Intervals , Logistic Models , Odds Ratio , Incidence , Surveys and Questionnaires , Risk Factors , Genetic Predisposition to Disease , Lung NeoplasmsABSTRACT
To evaluate the score systems of Cassano and Sanz and suggest a new one. Design: Case series. Location: Teaching hospitals: EPM UNIFESP and Faculdade de Medicina de Botucatu. Participants: 59 patients diagnosed from 1979 to 1992. Intervention: Evaluation of clinical-laboratorial data. Measurement: Statistical comparison, uni and multivariate analysis and actuarial survival curves. Results: Cassano's system divided the patients into high and low risk (p=0.0966) while Sanz's gave high, intermediate and low risk (p=0.0108). The univariate analysis showed hemoglobin, WBC count, E/M ratio, liver size and blast percentage in BM as statistically significant. The multivariate analysis showed blast percentage in BM (p=0.004) and Hb (p=0.050) as signigicant. Our system, considering the multivariate analysis data, divided the patients into high, intermediate and low risk (p=0.0038). Conclusions: Sanz's system was more functional than Cassano's, while ours showed predictive survival value and ease of use in clinical practice.
Subject(s)
Adult , Middle Aged , Female , Humans , Adolescent , Myelodysplastic Syndromes/mortality , Prognosis , Severity of Illness Index , Aged, 80 and over , Survival Analysis , Multivariate Analysis , Retrospective Studies , Actuarial Analysis , Myelodysplastic Syndromes/bloodABSTRACT
O valor prognóstico das variáveis morfológicas constituintes da Classificaçäo de DUKES - nível de invasäo parietal e comprometimento dos linfonodos - e o padräo de crescimento da margem invasiva da neoplasia foi estudado em 320 doentes com câncer colo-retal. O padräo de crescimento expansivo associou-se significativamente à presença de linfonodos livres (90,2 por cento), ao estádio A de DUKES (70,4 por cento) e a menor número de casos metastáticos (12,5 por cento). O padräo infiltrativo associou-se a casos de neoplasias näo confinadas à parede intestinal (85,7 por cento) e a presença de metástases (87,5 por cento). A sobrevivência de cinco anos foi de 83,5 por cento para doentes com o padräo expansivo, significantemente maior que a de 49,8 por cento para os com o padräo infiltrativo. Na mesma classe de DUKES, a sobrevida mostrou-se sempre maior quando associada ao padräo expansivo de crescimento, caracterizando grupos de risco no mesmo estádio da doença
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Colorectal Neoplasms/surgery , Aged, 80 and over , Chi-Square Distribution , Colorectal Neoplasms/pathology , Follow-Up Studies , Prognosis , Disease-Free SurvivalABSTRACT
Trezentos e vinte doentes com adenocarcinoma colo-retal suvmetidos a ressecçäo curativa foram estudados com o intuito de verificar, nas peças ressecadas, o comprometimento ou näo dis linfonodos, o número dos acometidos e a área ocupada pela neoplasia. Chamou-se de linfonodos invalidos aqueles com raros focos de células neoplásicas presentes, que näo interferiram na estrutura do nodo e de destruidos áqueles que apresentavam sua estrutura em grande parte ou totalmente ocupada pelo tutmor. Os linfonodos positivos foram agrupados em subgrupos contendo 1 a 4 e em mais de 4,120 (38,6 por cento) coentes apresentaram linfonodos comprometidos, dos quais 24,2 por cento eram invadidos e 75,8 por cento destruídos. Portadores de linfonodos livres apresentaram sobrevivência de cinco anos de 71,7 por cento; a sobrevivência de doentes com nodos invadidos - 58, 6 por cento- foi significativamente maior que a dos destruídos - 29,7 por cento, mas näo diferiu estatisticamente da apresentada pelos portadores de linfonodos livres. Doentes com mais de 4 linfonodos compcrometidos sobreviveram significativamente menos (20,0 por cento) que aqueles com 1 a 4 linfonodos acometidos (43,5 por cento)...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Adenocarcinoma , Colorectal Neoplasms , Lymphatic Metastasis , Aged, 80 and over , Prognosis , Disease-Free SurvivalABSTRACT
The prognostic value of different factors upon diagnosis of CML was analysed in 45 Philadelphia (Ph1)-positive patients. The median survival was 48 months. Univariate analysis showed 5 poor prognostic factors (male sex, under 45 years-old, bone marrow blasts greater than or equal to 10 percent, blood basophils greater than or equal to 6 percent and blood eosinophilis greater than or equal to 6 percent) which provided for the development of a clinical staging system: Stage I whith none or one factor and a two-year survival rate of 100 percent; Stage II with two or three factors and two-year survival of 72.2 percent; and Stage III with four or five factors and two-year survival of 0 percent (p=0.00016). Multivariate survival analysis showed that combination of blood basophilia and bone marrow blasts had the strongest predective relationship to survival time. We conclude that a combination of pretreatment factors identifies different risk subcategories in CML patients and is helpful in assessing the overall prognosis and the treatment approach.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology , Basophils , Eosinophils , Bone Marrow , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Blast Crisis , Sex Factors , Risk , Follow-Up Studies , Neoplasm Staging , Survival Analysis , Multivariate Analysis , Chronic Disease , Age Factors , PrognosisABSTRACT
Foram avaliados no presente estudo, prospectivamente os níveis séricos de triglicerídeos, colesterol e das lipoproteínas VLDL, LDL e HDL-coleserol em 166 gestantes diabéticas do tipo II, comparando-os com os de gestantes normais (Martinez, 1984). A metodologia e os valores críticos de glicemia de jejum ou de áreas sob os TOTG de 2h ou de 3h foram os utilizados e determinados por Bertini (1983) e para os lipídios os de Martinez (1984). Para análise estatística foram utilizados os testes de análise de variância, teste de Mann-Whitney e teste t de Student para grupos independentes. Determinaram os autores que os triglicerídios e a lipoproteína VLDL-colesterol mostraram-se significativamente mais elevados entre as diabéticas, nos três trimestres, em relatçäo as gestantes normais. O colesterol total e a lipoprotefna LDL, aumentados nos três trimestres mas, significativamente, no primeiro e no segundo. A lipoprotefna HDL-colesterol, também denominada fator de proteçäo para coronariopatias, näo se elevou durante o evolver da gestaçäo entre diabéticas, contrastanto com as normais que apresentaram aumento progressivo e significativo no segundo trimestre, desta fraçäo, em relatçäo as näo-grávidas normais.
Subject(s)
Humans , Female , Pregnancy , Cholesterol/blood , Diabetes Mellitus, Type 2/blood , Triglycerides/blood , Analysis of Variance , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Cholesterol, VLDL/blood , Prospective Studies , Statistics, NonparametricABSTRACT
Discutiu-se o delineamento caso-controle, com ênfase nos esquemas de amostragem que permitem estimar diretamente razäo de densidades de incidência e risco relativo, além da razäo de odds. Diferentes maneiras de se controlar o viés de confundimento säo abordadas, especialmente o controle na análise, pela estratificaçäo. Discutimos também o conceito e detecçäo de interaçäo. Säo mostradas as bases de inferência estatística para tabelas 2x2 e 2xK. Apresentamos dois exemplos de aplicaçäo da análise estratificada em estudos caso-controle. No primeiro säo utilizados dados hipotéticos obtidos sem emparelhamento, no segundo, dados empíricos de um estudo da avaliaçäo da efetividade da vacina BCG na Regiäo Metropolitana de Säo Paulo, obtidos com emparelhamento
