ABSTRACT
Students play a key role in university social responsibility (USR), as they are the protagonists of change and the fundamental axis in the teaching-learning process. This study aims to assess the factors associated with the perception of university social responsibility among dental students from two universities in the Peruvian capital. This analytical cross-sectional study assessed 754 students from two Peruvian universities between May and July 2023. The study utilized a validated 51-item questionnaire to assess sociodemographic factors and dental students' perception of USR. A Poisson regression model with robust variance and prevalence ratio (PR) was used to assess the influence of variables such as age, sex, marital status, type of university, academic year, and awareness of taking subjects related to USR. The significance was set at p < 0.05. The perception of USR was rated as poor, fair, and good by 16%, 67%, and 17% of the participants, respectively. According to the study, dental students from public universities were 68% more likely to perceive their USR education as poor than those from private universities (APR = 1.68, 95% CI: 1.06-2.66), and those who were aware of taking MSR-related courses were 37% less likely to perceive their USR education as poor (APR = 0.63, 95% CI: 0.40-0.98). Similarly, dental students attending public universities were 2.28 times more likely to perceive poor organizational management in USR compared to their counterparts at private universities (APR = 2.28, 95% CI: 1.51-3.44). Additionally, students in their first and second academic years were 62% and 57% less likely to perceive poor organizational management in USR compared to those in their sixth year (APR = 0.38, 95% CI: 0.19-0.79 and APR = 0.43, 95% CI: 0.20-0.95; respectively). Furthermore, students from public universities were 2.31 times more likely to perceive social participation in USR poorly compared to their counterparts from private universities (APR = 2.31, 95% CI: 1.63-3.26). Lastly, it was observed that students from public universities were 2.51 times more likely to have a poor overall perception of USR compared to students from private universities (APR = 2.51, 95% CI: 1.67-3.78). Acknowledging the diverse contexts and challenges inherent in public and private institutions, it can be concluded that more than half of the dental students had a fair perception of USR. Additionally, attending a public university was found to be a risk factor for having a poor perception of USR. However, taking a course related to USR and being in the early years of the program were identified as protective factors against a poor perception of organizational training and management in USR. It is recommended that students be involved in USR activities, including the Sustainable Development Goals, from the first years of their university education, especially in public universities.
Subject(s)
Social Responsibility , Students, Dental , Humans , Students, Dental/psychology , Students, Dental/statistics & numerical data , Male , Female , Peru , Universities , Cross-Sectional Studies , Adult , Young Adult , Surveys and Questionnaires , Perception , Regression Analysis , Multivariate AnalysisABSTRACT
Genomic selection (GS) is changing plant breeding by significantly reducing the resources needed for phenotyping. However, its accuracy can be compromised by mismatches between training and testing sets, which impact efficiency when the predictive model does not adequately reflect the genetic and environmental conditions of the target population. To address this challenge, this study introduces a straightforward method using binary-Lasso regression to estimate ß coefficients. In this approach, the response variable assigns 1 to testing set inputs and 0 to training set inputs. Subsequently, Lasso, Ridge, and Elastic Net regression models use the inverse of these ß coefficients (in absolute values) as weights during training (WLasso, WRidge, and WElastic Net). This weighting method gives less importance to features that discriminate more between training and testing sets. The effectiveness of this method is evaluated across six datasets, demonstrating consistent improvements in terms of the normalized root mean square error. Importantly, the model's implementation is facilitated using the glmnet library, which supports straightforward integration for weighting ß coefficients.
Subject(s)
Genomics , Models, Genetic , Plant Breeding , Genomics/methods , Plant Breeding/methods , Genome, Plant , Selection, Genetic , Phenotype , Regression AnalysisABSTRACT
OBJECTIVE: The search for other indicators to assess the weight and nutritional status of individuals is important as it may provide more accurate information and assist in personalized medicine. This work is aimed to develop a machine learning predictions of weigh status derived from bioimpedance measurements and other physical parameters of healthy younger volunteers from Southern Cuba Region. METHODS: A pilot random study at the Pediatrics Hospital was conducted. The volunteers were selected between 2002 and 2008, ranging in age between 2 and 18 years old. In total, 776 female and male volunteers are studied. Along the age and sex in the cohort, volunteers with class I obesity, overweight, underweight and with normal weight are considered. The bioimpedance parameters are obtained by measuring standard tetrapolar whole-body configuration. The bioimpedance analyser is used, collecting fundamental bioelectrical and other parameters of interest. A classification model are performed, followed by a prediction of the body mass index. RESULTS: The results derived from the classification leaner reveal that the size, body density, phase angle, body mass index, fat-free mass, total body water volume according to Kotler, body surface area, extracellular water according to Kotler and sex largely govern the weight status of this population. In particular, the regression model shows that other bioparameters derived from impedance measurements can be associated with weight status estimation with high accuracy. CONCLUSION: The classification and regression predictive models developed in this work are of the great importance to assist the diagnosis of weigh status with high accuracy. These models can be used for prompt weight status evaluation of younger individuals at the Pediatrics Hospital in Santiago de Cuba, Cuba.
Subject(s)
Body Mass Index , Body Weight , Electric Impedance , Humans , Male , Cuba , Female , Child , Adolescent , Child, Preschool , Pilot Projects , Machine Learning , Body Composition , Nutritional Status , Thinness/diagnosis , Regression AnalysisABSTRACT
The human Ether-à-go-go-Related Gene (hERG) is a transmembrane protein that regulates cardiac action potential, and its inhibition can induce a potentially deadly cardiac syndrome. In vitro tests help identify hERG blockers at early stages; however, the high cost motivates searching for alternative, cost-effective methods. The primary goal of this study was to enhance the Pred-hERG tool for predicting hERG blockage. To achieve this, we developed new QSAR models that incorporated additional data, updated existing classificatory and multiclassificatory models, and introduced new regression models. Notably, we integrated SHAP (SHapley Additive exPlanations) values to offer a visual interpretation of these models. Utilizing the latest data from ChEMBL v30, encompassing over 14,364 compounds with hERG data, our binary and multiclassification models outperformed both the previous iteration of Pred-hERG and all publicly available models. Notably, the new version of our tool introduces a regression model for predicting hERG activity (pIC50). The optimal model demonstrated an R2 of 0.61 and an RMSE of 0.48, surpassing the only available regression model in the literature. Pred-hERG 5.0 now offers users a swift, reliable, and user-friendly platform for the early assessment of chemically induced cardiotoxicity through hERG blockage. The tool provides versatile outcomes, including (i) classificatory predictions of hERG blockage with prediction reliability, (ii) multiclassificatory predictions of hERG blockage with reliability, (iii) regression predictions with estimated pIC50 values, and (iv) probability maps illustrating the contribution of chemical fragments for each prediction. Furthermore, we implemented explainable AI analysis (XAI) to visualize SHAP values, providing insights into the contribution of each feature to binary classification predictions. A consensus prediction calculated based on the predictions of the three developed models is also present to assist the user's decision-making process. Pred-hERG 5.0 has been designed to be user-friendly, making it accessible to users without computational or programming expertise. The tool is freely available at http://predherg.labmol.com.br.
Subject(s)
Ether-A-Go-Go Potassium Channels , Quantitative Structure-Activity Relationship , Humans , Ether-A-Go-Go Potassium Channels/antagonists & inhibitors , Ether-A-Go-Go Potassium Channels/metabolism , Risk Assessment , Regression Analysis , Potassium Channel Blockers/pharmacology , Potassium Channel Blockers/chemistryABSTRACT
The aims of this study were to predict carcass and meat traits, as well as the chemical composition of the 9th to 11th rib sections of beef cattle from portable NIR spectra. The 9th to 11th rib section was obtained from 60 Nellore bulls and cull cows. NIR spectra were acquired at: P1 -center of Longissimus muscle; and P2 -subcutaneous fat cap. The models accurately estimated (P ≥ 0.083) all carcass and meat quality traits, except those for predicting red (a*) and yellow (b*) intensity from P1, and 12th-rib fat from P2. However, precision was highly variable among the models; those for the prediction of carcass pHu, 12th rib fat, toughness from P1, and those for 12th rib fat, a* and b* from P2 presented high precision (R2 ≥ 0.65 or CCC ≥ 0.63), whereas all other models evaluated presented moderate to low precision (R2 ≤ 0.39). Models built from P1 and P2 accurately estimated (P ≥ 0.066) the chemical composition of the meat plus fat, bones and, meat plus fat plus bones, except those for predicting the ether extract (EE) and crude protein (CP) of bones and the EE of Meat plus bones fraction from P2. However, precision was highly variable among the models (-0.08 ≤ R2 ≤ 0.86) of the 9th and 11th rib section. Those models for the prediction of dry matter (DM) and EE of the bones from P1; of EE from P1; and of EE, mineral matter (MM), CP from P2 of meat plus fat plus bones presented high precision (R2 ≥ 0.76 or CCC ≥ 0.62), whereas all other models evaluated presented moderate to low precision (R2 ≤ 0.45). Thus, models built from portable NIR spectra acquired at different points of the 9th to 11th rib section were recommended for predicting carcass and muscle quality traits as well as for predicting the chemical composition of this section of beef cattle. However, it is noteworthy, that the small sample size was one of the limitations of this study.
Subject(s)
Red Meat , Spectroscopy, Near-Infrared , Cattle , Animals , Spectroscopy, Near-Infrared/methods , Red Meat/analysis , Meat/analysis , Male , Regression Analysis , Female , Muscle, Skeletal/chemistryABSTRACT
This ecological study aimed to identify the factors with the greatest power to discriminate the proportion of oral and oropharyngeal cancer (OOC) records with time to treatment initiation (TTI) within 30 days of diagnosis in Brazilian municipalities. A descriptive analysis was performed on the variables grouped into five dimensions related to patient characteristics, access to health services, support for cancer diagnosis, human resources, and socioeconomic characteristics of 3,218 Brazilian municipalities that registered at least one case of OOC in 2019. The Classification and Regression Trees (CART) technique was adopted to identify the explanatory variables with greater discriminatory power for the TTI response variable. There was a higher median percentage of records in the age group of 60 years or older. The median percentage of records with stage III and IV of the disease was 46.97%, and of records with chemotherapy, radiation, or both as the first treatment was 50%. The median percentage of people with private dental and health insurance was low. Up to 75% had no cancer diagnostic support services, and up to 50% of the municipalities had no specialist dentists. Most municipalities (49.4%) started treatment after more than 30 days. In the CART analysis, treatment with chemotherapy, radiotherapy, or both explained the highest TTI in all municipalities, and it was the most relevant for predicting TTI. The final model also included anatomical sites in the oral cavity and oropharynx and the number of computed tomography services per 100,000. There is a need to expand the availability of oncology services and human resources specialized in diagnosing and treating OOC in Brazilian municipalities for a timely TTI of OOC.
Subject(s)
Mouth Neoplasms , Oropharyngeal Neoplasms , Humans , Middle Aged , Oropharyngeal Neoplasms/therapy , Regression Analysis , Time-to-TreatmentABSTRACT
INTRODUCCIÓN: En la diarrea asociada a Clostridioides dfficile (DACD) leve-moderada se recomienda tratar con vancomicina por sobre metronidazol, a pesar de su difícil acceso y poca evidencia en el medio ambulatorio. OBJETIVO: Comparar la tasa de cura clínica y recurrencia entre vancomicina y metronidazol en adultos chilenos con primer episodio leve-moderado de DACD de manejo ambulatorio. MÉTODOS: Cohorte retrospectiva entre enero 2015 y diciembre 2020 en centros de una red de salud universitaria de pacientes de ≥ 18 años con DACD tratados ambulatoriamente. RESULTADOS: Se obtuvieron 161 pacientes, 59% mujeres, edad promedio de 53 años (entre 18 y 94 años). De ellos, 109 (67,7%) usaron metronidazol y 52 (32,3%) vancomicina. En el análisis multivariado ajustado por edad y comorbilidades se obtuvo un OR 3,00 (IC 95% 1,12-9,59) para cura clínica y 0,27 (IC 95% 0,06-0,88) para recurrencia a ocho semanas, ambos a favor de vancomicina, sin diferencias en recurrencia a 12 meses, necesidad de hospitalización o mortalidad. CONCLUSIÓN: La terapia con vancomicina comparada contra metronidazol en el tratamiento ambulatorio de la infección leve-moderada por C. dfficile se asocia a mayor cura clínica y menor tasa de recurrencia a corto plazo, sin diferencias en desenlaces a largo plazo.
BACKGROUND: Recommended treatment against mild cases of Clostridioides difficile associated diarrhea is vancomycin despite the difficulties of access compared to metronidazole. AIM: To compare the effectiveness of vancomycin and metronidazole in Chilean adults with first mild-moderate episode of Clostridiodes difficile infection (CDI). METHODS: Retrospective cohort of patients with CDI between January 2015 and December 2020 treated in centers of a university health network. The patients were adults treated for C. difficile infection on an outpatient basis. Recurrent and severe cases were excluded. Outcomes included clinical cure and recurrence rate. RESULTS: Data from 161 patients was recovered. Fifty-nine percent were women and average age was 53 (18-94). One hundred and nine patients were treated with metronidazole (67.7%) and 52 (32.3%) used vancomycin. Multivariate analysis adjusted by age and comorbidities showed an Odds Ratio of 3.00 (IC 95% 1.12-9.59) for clinical cure and 0.27 (IC 95% 0.06-0.88) for 8-week recurrence rate, both in favor of vancomycin, without differences in 12-month recurrence rate, hospitalization rate nor mortality. CONCLUSIONS: Vancomycin is associated with better short-term outcomes in the treatment of outpatient mild-moderate first episode C. difficile infection, without differences in long term recurrence or mortality when compared with metronidazole.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Vancomycin/therapeutic use , Clostridium Infections/drug therapy , Diarrhea/drug therapy , Metronidazole/therapeutic use , Outpatients , Recurrence , Multivariate Analysis , Regression Analysis , Retrospective Studies , Ambulatory Care , Anti-Bacterial Agents/therapeutic useABSTRACT
SUMMARY: The identification of children and adolescents who are at risk of sarcopenic obesity development often requires specialized equipment and expensive test procedures. Therefore, the establishment of cheaper and faster methods would be greatly useful, especially if they could be applied in the field. The study's objective was to establish if identification of female adolescents who suffer the risk of developing sarcopenic obesity can be obtained through the standing-long-jump test application. To achieve the research objectives, various anthropometric and body composition measurements were performed and lower limb explosive strength was assessed using the standing long jump fitness test. The research was conducted on a sample of 535 female respondents randomly selected from 9 elementary schools in the Skopje region of the Republic of North Macedonia. The respondents were divided into quintiles according to BMI z-scores, and the arithmetic means and SD about muscle-to-fat ratio were calculated for each quintile. The cutoff was determined based on the mean and standard deviation of the muscle-to-fat ratio for the 3rd quintile of BMI and the percentage of respondents with sarcopenic obesity was examined. The optimal cut-off value of the long jump fitness test results for predicting sarcopenic obesity in an adolescent girl showed that the area under the ROC curve was 0.781 (95 % CI 0.743-0.815). The standing-long-jump test values, on grounds of odds ratio (OR 95 % CI) about the girls at risk of sarcopenic obesity development, which was identified on muscle-to-fat ratio base, were 8.76 (4.39 - 17.54, p 0.001). It can be used to predict sarcopenic obesity presence in female adolescents, which can be vital in case of health intervention.
La identificación de niños y adolescentes que corren riesgo de desarrollar obesidad sarcopénica a menudo requiere equipos especializados y procedimientos de pruebas costosos. Por lo tanto, el establecimiento de métodos más baratos y rápidos sería de gran utilidad, especialmente si pudieran aplicarse en el campo. El objetivo del estudio fue establecer si la identificación de mujeres adolescentes que sufren riesgo de desarrollar obesidad sarcopénica se puede obtener mediante la aplicación de la prueba de salto de longitud de pie. Para lograr los objetivos de la investigación, se realizaron diversas mediciones antropométricas y de composición corporal y se evaluó la fuerza explosiva de los miembros inferiores mediante la prueba de aptitud de salto de longitud de pie. La investigación se realizó con una muestra de 535 mujeres encuestadas seleccionadas al azar de 9 escuelas primarias de la región de Skopje, en la República de Macedonia del Norte. Los encuestados se dividieron en quintiles según las puntuaciones z del IMC, y se calcularon las medias aritméticas y la DE sobre la relación músculo-grasa para cada quintil. El límite se determinó en función de la media y la desviación estándar de la relación músculo-grasa para el tercer quintil del IMC y se examinó el porcentaje de encuestados con obesidad sarcopénica. El valor de corte óptimo de los resultados de la prueba de condición física de salto de longitud para predecir la obesidad sarcopénica en una adolescente mostró que el área bajo la curva ROC fue 0,781 (IC del 95 %: 0,743-0,815). Los valores de la prueba de salto de longitud de pie, sobre la base del odds ratio (OR IC del 95 %) sobre las niñas en riesgo de desarrollar obesidad sarcopénica, que se identificó sobre la base del ratio músculo-grasa, fueron 8,76 (4,39 - 17,54, p. 0,001). Puede utilizarse para predecir la presencia de obesidad sarcopénica en adolescentes, lo que puede ser vital en caso de intervención sanitaria.
Subject(s)
Humans , Female , Child , Adolescent , Exercise Test , Sarcopenia/diagnosis , Obesity/diagnosis , Body Composition , Anthropometry , Adipose Tissue , Surveys and Questionnaires , Regression Analysis , Electric Impedance , Risk Assessment , Muscle, Skeletal , Standing PositionABSTRACT
SUMMARY: The handgrip strength is used as a means of individual's health prediction during life. It is used as an indicator of the nutrition status, bone fragility, presence of sarcopenia and it correlates with certain diseases and clinical complications. The research goal was to analyze the results of the hand dynamometry test, based on the chronological and biological age, and to offer normative and referent standards about children and adolescents from the Republic of North Macedonia. The study was conducted on a sample of 4031 respondents of both sexes at the age 6-14 years. In order to achieve the research goals, the measured characteristics were of the weight, height, sitting height and handgrip strength. The body mass index and biological maturity values (APHV) were obtained by using formulas. On the basis of the obtained results, it can be concluded that statistically significant differences in handgrip strength are established between the boys and girls of all age categories. Also, statistically significant differences between boys and girls are established in the hand dynamometry test of all APHV levels. In general, the use of the APHV allows a better categorization of the performance of the studied children and adolescents. With boys, the correlation between the chronological age and test was 68 %, and with girls - 77 %. The normative referent standards of the hand dynamometry test are presented in percentiles for both sexes. Thye hand dynamometry test's results during childhood and adolescence should be analyzed and interpret on the basis of biological age, and not on the chronological age. These tools can help specialists who work with children and adolescents in ethnic and epidemiological context.
La fuerza de prensión se utiliza como medio para predecir la salud del individuo durante la vida. Se utiliza como indicador del estado nutricional, fragilidad ósea, presencia de sarcopenia y se correlaciona con determinadas enfermedades y complicaciones clínicas. El objetivo de la investigación fue analizar los resultados de la prueba de dinamometría manual, con base en la edad cronológica y biológica, y ofrecer estándares normativos y referentes sobre niños y adolescentes de la República de Macedonia del Norte. El estudio se realizó en una muestra de 4031 encuestados de ambos sexos con edades comprendidas entre 6 y 14 años. Para lograr los objetivos de la investigación, las características medidas fueron el peso, la altura, la altura al sentarse y la fuerza de prensión. El índice de masa corporal y los valores de madurez biológica (APHV) se obtuvieron mediante fórmulas. Sobre la base de los resultados obtenidos, se puede concluir que se establecen diferencias estadísticamente significativas en la fuerza de prensión manual entre niños y niñas de todas las categorías de edad. Asimismo, se establecen diferencias estadísticamente significativas entre niños y niñas en la prueba de dinamometría manual de todos los niveles APHV. En general, el uso del APHV permite una mejor categorización del desempeño de los niños y adolescentes estudiados. En los niños, la correlación entre la edad cronológica y la prueba fue del 68 %, y en las niñas, del 77 %. Los estándares normativos referentes de la prueba de dinamometría manual se presentan en percentiles para ambos sexos. Los resultados de la prueba de dinamometría manual durante la infancia y la adolescencia deben analizarse e interpretarse en función de la edad biológica y no de la edad cronológica. Estas herramientas pueden ayudar a los especialistas que trabajan con niños y adolescentes en un contexto étnico y epidemiológico.
Subject(s)
Humans , Male , Female , Child , Adolescent , Hand Strength , Pressure , Reference Standards , Body Mass Index , Anthropometry , Regression Analysis , Age Factors , Republic of North Macedonia , Manual DynamometryABSTRACT
OBJECTIVE: The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. STUDY DESIGN: Joinpoint regression and age-period-cohort effect analysis. METHODS: Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. RESULTS: From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). CONCLUSION: The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.
Subject(s)
Diabetes Mellitus , Male , Humans , Aged , Cohort Effect , Mexico/epidemiology , Cohort Studies , Regression Analysis , MortalityABSTRACT
AIMS: This study describes the spatio-temporal dynamics of new visceral leishmaniasis (VL) cases notified in Brazil between 2001 and 2020. METHODS AND RESULTS: Data on the occurrence of the disease were obtained by means of the Notifiable Diseases Information System of the Brazilian Ministry of Health. Joinpoint, temporal generalized additive models and conditional autoregressive (CAR) models were used to analyse the temporal evolution of the rates in Brazil, states and regions. Spatio-temporal generalized additive and CAR models were used to identify the distribution of annual risks of VL occurrence in the Brazilian territory in relation to variation in the spatial average. There were 63,966 VL cases in the target period (3.198 cases/year), corresponding to a mean incidence rate of 1.68 cases/100,000 inhabitants. Of these, 4451 resulted in deaths, which gives a mean mortality rate of 0.12 deaths/100,000 inhabitants and a case fatality of 6.96%. The highest incidence rate was found in the North region, followed closely by the Northeast region, which presented the second and first highest mortality rates, respectively. For all of Brazil, and in the Northeast region, there were stability in the incidence rates, while the other regions showed an increasing trend in different time segments in the period: Central-West up to 2011, North up to 2008, Southeast up to 2004, and South up to 2010. On the other hand, all regions experienced a reduction in incidence rate during the last years of the series. The Northeast region had the highest number of municipalities with statistically significant elevated relative risks. The spatio-temporal analysis showed the highest risk area predominantly in the Northeast region in the beginning of the time series. From 2002 to 2018, this area expanded to the interior of the country. CONCLUSIONS: The present study has shown that VL has expanded in Brazil. However, the North and Northeast regions continue to have the highest incidence, and the risk of infection has decreased in recent years.
Subject(s)
Leishmaniasis, Visceral , Animals , Brazil/epidemiology , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/veterinary , Spatio-Temporal Analysis , Regression Analysis , IncidenceABSTRACT
ABSTRACT Objective: To assess the impact of Molar Incisor Hypomineralization (MIH) and confounding factors on oral health-related quality of life (OHRQoL) according to the perception of 8 to 10-year-old children and their parents/caregivers. Material and Methods: A cross-sectional study including 403 students aged 8-10 years was carried out, in which OHRQoL was measured using the Child Perceptions Questionnaire administered to both children and parents/caregivers. The diagnosis of MIH was performed according to the previously proposed index. Dental caries experience, malocclusion, and sociodemographic factors were evaluated as confounders. Cluster analysis and Poisson regression with robust variance (p<0.05) were performed. Results: The prevalence of MIH was 13.4%. Parents/caregivers of children with MIH in incisors showed a higher impact prevalence in the emotional well-being domain (PR=1.92; 95%CI=1.16-3.19). Children with hypoplasia had a higher prevalence of negative impact on OHRQoL in the oral symptoms domain (PR=1.51; 95%CI=1.03-2.23). According to the perception of parents/caregivers, dental caries experience had a negative impact on the quality of life of students in the emotional well-being domain (PR=4.19; 95%CI=1.06-16.49) and in the total questionnaire score (PR=3.21; 95%CI=1.06-9.71). Conclusion: According to the perception of parents/caregivers, children with MIH in incisors showed a greater impact on OHRQoL. Additionally, the presence of hypoplasia affected the self-perception of OHRQoL in children, and caries experience influenced the OHRQoL of children, as perceived by parents/caregivers.
Subject(s)
Humans , Male , Female , Child , Quality of Life/psychology , Oral Health , Tooth Demineralization , Molar Hypomineralization , Self Concept , Cross-Sectional Studies/methods , Multivariate Analysis , Surveys and Questionnaires , Regression Analysis , Dental Caries/epidemiology , Dental Enamel Hypoplasia/diagnosis , Prevalence Ratio , Population Studies in Public Health , Sociodemographic FactorsABSTRACT
ABSTRACT Objective Evaluate the food consumption of the participants of the Cohort of Universities of Minas Gerais, according to the degree of processing, and its relationship with socioeconomic, behavioral, and individual factors. Methods A total of 4,124 individuals from the baseline of the Cohort of Universities of Minas Gerais (2016 and 2018) participated in this study. Food consumption was self-reported by completing an online Food Frequency Questionnaire. The foods were divided into 3 groups: Group 1, in natura, minimally processed foods, culinary ingredients and culinary preparations; Group 2, processed foods; Group 3, ultra-processed foods. A hierarchical multiple linear regression model was used to verify the associated factors. Results Regarding the factors associated with food consumption, it is noteworthy that Group 1 was positively associated with the practice of physical activity, female gender, age, "non-white" skin color, and the presence of diabetes Mellitus; and negatively with "not married/without stable union" marital status, alcohol abuse, tobacco use, obesity, and depression. Considering Group 2, it was positively associated with alcohol abuse, tobacco use, and age; and negatively with physical activity, female gender, and "non-white" skin color. As for Group 3 it was positively associated with a marital status of "not married/without stable union", obesity, and depression; and negatively with physical activity, age, "non-white" skin color, and presence of diabetes Mellitus. Conclusion The factors that are in at least one of the final hierarchical linear regression models stand out: marital status, physical activity, alcohol abuse, tobacco use, sex, age, skin color, obesity, diabetes mellitus, and depression.
RESUMO Objetivo Avaliar o consumo alimentar dos participantes da Coorte de Universidades Mineiras, de acordo com grau de processamento, e sua relação, com fatores socioeconômicos, comportamentais e individuais. Método Participaram desse estudo 4.124 indivíduos da linha de base da Coorte de Universidades Mineiras (2016 e 2018). O consumo alimentar foi autorrelatado por um questionário online de frequência de consumo alimentar. Os alimentos foram divididos em: Grupo 1: alimentos in natura, minimamente processados, ingredientes culinários e preparações culinárias; Grupo 2: alimentos processados; e Grupo 3: alimentos ultraprocessados. Foi utilizado modelo de regressão linear múltipla hierarquizada para verificar os fatores associados. Resultados O Grupo 1 se associou positivamente à prática de atividade física, sexo feminino, idade, cor da pele "não branca" e presença de diabetes Mellitus; e negativamente ao estado civil "não casado/sem união estável", consumo abusivo de álcool, uso do tabaco, obesidade e depressão. O Grupo 2 se associou positivamente ao consumo abusivo de álcool, uso do tabaco e idade; e negativamente à prática de atividade física, sexo feminino e cor da pele "não branca". O Grupo 3 se associou positivamente ao estado civil "não casado/sem união estável", obesidade e depressão; e negativamente à prática de atividade física, idade, cor da pele "não branca" e presença de diabetes Mellitus. Conclusão Destacam-se os fatores que estão em pelo menos um dos modelos de regressão linear hierarquizada final: estado civil, atividade física, consumo abusivo de álcool, uso do tabaco, sexo, idade, cor da pele, obesidade, diabetes mellitus e depressão.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Eating/ethnology , Social Determinants of Health/ethnology , Food Handling , Socioeconomic Factors , Universities , Brazil , Cross-Sectional Studies/methods , Regression Analysis , Minimally Processed Foods/statistics & numerical data , Food, Processed/statistics & numerical dataABSTRACT
Abstract Objective: To estimate the incidence of dental caries and associated factors in the school period from six/seven to ten years of age. Material and Methods: A longitudinal study involving 168 children was followed up between 2015 and 2019 in the municipality of Palhoça, Brazil. The dependent variable was the caries incidence rate in the mixed dentition. The independent variables included information regarding demographic and socioeconomic status. Multivariate analyzes were carried out using Poisson Regression with a robust estimator. Variables with p <0.20 in the bivariate analysis were included in the adjusted model. Relative risks were estimated, as well as 95% confidence intervals. Results: Of 168 followed schoolchildren, 32 developed the disease, providing an incidence rate of 19.0%. Female children had a 10% higher risk [RR = 1.10 (95% CI 1.03; 1.18)] of developing caries than males. Also, children born from fathers with ≤ 8 years of schooling at baseline had a 9% higher risk [RR = 1.09 (95% CI 1.01; 1.16)] of developing dental caries compared to fathers with higher education. Conclusion: The incidence of dental caries in a four-year period was 19.0%. Females and children born from fathers with a lower level of education showed higher incidence rates.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Risk Factors , Dental Caries/epidemiology , Dentition, Mixed , Socioeconomic Factors , Brazil/epidemiology , Regression Analysis , Cohort Studies , Longitudinal StudiesABSTRACT
ABSTRACT OBJECTIVE This study aims to propose a comprehensive alternative to the Bland-Altman plot method, addressing its limitations and providing a statistical framework for evaluating the equivalences of measurement techniques. This involves introducing an innovative three-step approach for assessing accuracy, precision, and agreement between techniques, which enhances objectivity in equivalence assessment. Additionally, the development of an R package that is easy to use enables researchers to efficiently analyze and interpret technique equivalences. METHODS Inferential statistics support for equivalence between measurement techniques was proposed in three nested tests. These were based on structural regressions with the goal to assess the equivalence of structural means (accuracy), the equivalence of structural variances (precision), and concordance with the structural bisector line (agreement in measurements obtained from the same subject), using analytical methods and robust approach by bootstrapping. To promote better understanding, graphical outputs following Bland and Altman's principles were also implemented. RESULTS The performance of this method was shown and confronted by five data sets from previously published articles that used Bland and Altman's method. One case demonstrated strict equivalence, three cases showed partial equivalence, and one showed poor equivalence. The developed R package containing open codes and data are available for free and with installation instructions at Harvard Dataverse at https://doi.org/10.7910/DVN/AGJPZH. CONCLUSION Although easy to communicate, the widely cited and applied Bland and Altman plot method is often misinterpreted, since it lacks suitable inferential statistical support. Common alternatives, such as Pearson's correlation or ordinal least-square linear regression, also fail to locate the weakness of each measurement technique. It may be possible to test whether two techniques have full equivalence by preserving graphical communication, in accordance with Bland and Altman's principles, but also adding robust and suitable inferential statistics. Decomposing equivalence into three features (accuracy, precision, and agreement) helps to locate the sources of the problem when fixing a new technique.
Subject(s)
Confidence Intervals , Regression Analysis , Data Interpretation, Statistical , Statistical Inference , Data AccuracyABSTRACT
Introdução: Algumas arboviroses transmitidas por vetores como Aedes aegypti e Culex spp. são consideradas de grande importância epidemiológica, entre estas, destacam-se a dengue, Zika, chikungunya, febre amarela e febre do Nilo ocidental. A transmissão dos arbovírus ocorre enquanto as fêmeas infectadas realizam a hematofagia e as atuais medidas que visam a redução dessas arboviroses na população se dão principalmente com foco na redução da população de mosquitos. Índices de vigilância entomológica fazem parte das rotinas de programas de controle. Estudos recentes têm questionado a eficácia da utilização de índices de formas imaturas do vetor para predição do risco de transmissão de arboviroses e associação com incidência de casos. Isso indica que realizar a vigilância com a forma adulta dos vetores pode ser uma alternativa de maior eficácia. Objetivos: Estimar, predizer e mapear a infestação por Ae. aegypti e o Culex spp. associadas a variáveis de uso e ocupação do solo no município de Campinas/SP no período de verão entre os anos de 2021 a 2023. Material e Métodos: Trata-se de um estudo transversal realizado por meio de coletas mensais de mosquitos adultos realizadas em 200 armadilhas BG MosquititoTM distribuídas aleatoriamente na área urbana de Campinas. Foram realizadas regressões múltiplas em um contexto bayesiano e geoestatístico utilizando a abordagem de aproximações de Laplace aninhadas e integradas e equações diferenciais parciais estocásticas. Foram consideradas como covariáveis o Índice Brasileiro de Privação (IBP) e informações sobre uso e ocupação do solo obtidas de imagens de satélite. Resultados: O melhor modelo de regressão para o número de Ae. aegypti fêmeas encontrou associação positiva com o IBP, uma medida do nível socioeconômico, e árvores. Quanto aos machos, o melhor modelo mostrou associação positiva com cimento e telha de zinco. O melhor modelo para o total de mosquitos Ae. aegypti mostrou associação positiva com o IBP, cimento e árvore e o mesmo ocorreu para Culex spp. Foram elaborados mapas com a predição da quantidade de mosquitos para cada modelo considerando a distribuição das covariáveis presentes na área de estudo. Conclusões: Com esse estudo, foi possível modelar as quantidades de fêmeas, machos e total de Ae. aegypti e total de Culex spp., com base nas informações obtidas com a partir da instalação das armadilhas de adultos, e predizer os níveis de infestação para todos os locais da área de estudo. Variáveis socioeconômicas e de uso e ocupação do solo mostraram-se associadas aos números de mosquitos coletados, com exceção do nível socioeconômico para os machos de Ae. aegypti. Os resultados mostram que a utilização dessas covariáveis nas modelagens foram úteis para melhorar as predições nos locais não amostrados. Nosso estudo mostrou ser possível identificar áreas de maior risco para infestação de forma independente dos limites administrativos da área de estudo, quer sejam bairros ou distritos. Além disso, mostrou ser viável o uso de armadilhas de adultos para realização de vigilância entomológica.
Introduction: Some arboviruses transmitted by vectors such Aedes aegypti and Culex spp. are considered of great epidemiological importance, among which dengue, Zika and chikungunya, yellow fever and West Nile fever stand out. The transmission of arboviruses occurs while infected females are carrying out hematophagy, and current measures aimed at reducing these arboviruses in the population are mainly focused on reducing the mosquito population. Entomological surveillance indices are part of the routines of control programs. Recent studies have questioned the effectiveness of using indices of immature forms of the vector to predict the risk of arbovirus transmission and association with the incidence of cases. This indicates that carrying out surveillance with the adult form of the vectors may be a more effective alternative. Objectives: Estimate, predict and map the infestation of Ae. aegypti and Culex spp. associated with land use and occupation variables in the city of Campinas (SP) in the summer period between 2021 to 2023. Material and Methods: This is a cross-sectional study carried out through monthly collections of adult mosquitoes in 200 BG MosquititoTM traps randomly distributed in the urban area of Campinas. Multiple regressions were performed in a Bayesian and geostatistical context using the approach of nested and integrated Laplace approximations and stochastic partial differential equations. The Brazilian Deprivation Index (IBP) and information on land use and occupation obtained from satellite images were considered as covariates. Results: The best regression model for the number of female Ae. aegypti found a positive association with the IBP, a measure of socioeconomic status, and trees. As for males, the best model considered showed a positive association with cement and zinc tiles. The best model for the total number of Ae. aegypti showed a positive association with IBP, cement and trees, as the same occurred for Culex spp. Conclusions: With this study, it was possible to model the numbers of females, males and total Ae. aegypti and total Culex spp., based on the information obtained from the installation of adult traps, and to predict the infestation levels for all locations in the study area. Socioeconomic and land use and occupation variables were associated with the numbers of mosquitoes collected, with the exception of the socioeconomic level for males of Ae. aegypti. The results show that the use of these covariates in the models was useful to improve predictions in the non-sampled locations. Our study showed that it is possible to identify areas of greater risk for infestation independently of the administrative boundaries of the study area, whether they are neighborhoods, districts. Furthermore, it was shown to be feasible to use adult traps to carry out entomological surveillance.
Subject(s)
Regression Analysis , Aedes/growth & development , Culex/growth & development , Spatial Analysis , Infections , BrazilABSTRACT
ABSTRACT Objective: To determine the unstimulated salivary flow, pH, and buffering capacity and their associations with systemic conditions and medication use in independently living aged. Material and Methods: This cross-sectional study included 72 participants with a minimum of 60 years recruited in Belo Horizonte, Brazil. A questionnaire was used to collect age, sex, presence of systemic diseases, and medications in continuous use. Salivary data collection was performed to determine unstimulated salivary flow, pH, and buffering capacity. Descriptive, bivariate, and multivariate analyses were performed (p<0.05). Results: Most of the sample had at least one systemic disease (81.9%) and used at least one medication (79.2%). Female participants (p=0.01), those with five or more systemic diseases (p<0.01), and hypertension (p=0.04) had reduced salivary flow. Participants with systemic diseases (p=0.02), taking any medication (p=0.04), in a polypharmacy regimen, and presenting hypertension (p=0.02) had more acidic salivary pH. Participants with diabetes had average salivary buffering capacity (p=0.02). In the adjusted multiple regression models, no explanatory variable was significantly associated with the salivary outcomes. Conclusion: Systemic alterations and medication use appear to be related to salivary changes in older adults. Integrative assessment of older adults is fundamental to identifying and controlling the factors that may modify their salivary characteristics.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Saliva , Xerostomia/pathology , Aged , Drug Utilization , Health Services for the Aged , Oral Hygiene , Cross-Sectional Studies/methods , Multivariate Analysis , Surveys and Questionnaires , Regression AnalysisABSTRACT
SUMMARY: Colon adenocarcinoma (COAD) is a prevalent disease worldwide, known for its high mortality and morbidity rates. Despite this, the extent of investigation concerning the correlation between COAD's CLCA1 expression and immune cell infiltration remains insufficient. This study seeks to examine the expression and prognosis of CLCA1 in COAD, along with its relationship to the tumor immune microenvironment. These findings will offer valuable insights for clinical practitioners and contribute to the existing knowledge in the field. In order to evaluate the prognostic significance of CLCA1 in individuals diagnosed with colorectal cancers, we conducted a comprehensive analysis using univariate and multivariate Cox regression models along with receiver operating characteristic curve (ROC) analysis. This study was performed on the patient data of COAD obtained from The Cancer Genome Atlas (TCGA) database. Nomograms were developed to anticipate CLCA1 prognostic influence. Furthermore, the CLCA1 association with tumor immune infiltration, immune checkpoints, immune checkpoint blockade (ICB) response, interaction network, and functional analysis of CLCA1-related genes was analyzed. We found that Colon adenocarcinoma tissues significantly had decreased CLCA1 expression compared to healthy tissues. Furthermore, the study revealed that the group with high expression of CLCA1 demonstrated a significantly higher overall survival rate (OS) as compared to the group with low expression. Multivariate and Univariate Cox regression analysis revealed the potential of CLCA1 as a standalone risk factor for COAD. These results were confirmed using nomograms and ROC curves. In addition, protein-protein interaction (PPI) network analysis and functional gene enrichment showed that CLCA1 may be associated with functional activities such as pancreatic secretion, estrogen signaling and cAMP signaling, as well as with specific immune cell infiltration. Therefor, as a new independent predictor and potential biomarker of COAD, CLCA1 plays a crucial role in the advancement of colon cancer.
El adenocarcinoma de colon (COAD) es una enfermedad prevalente a nivel mundial, conocida por sus altas tasas de mortalidad y morbilidad. Sin embargo, el alcance de la investigación sobre la correlación entre la expresión de CLCA1 de COAD y la infiltración de células inmunes sigue siendo insuficiente. Este estudio busca examinar la expresión y el pronóstico de CLCA1 en COAD, junto con su relación con el microambiente inmunológico del tumor. Estos hallazgos ofrecerán conocimientos valiosos para los profesionales clínicos y contribuirán al conocimiento existente en el campo. Para evaluar la importancia de pronóstico de CLCA1 en personas diagnosticadas con cáncer colorrectal, realizamos un análisis exhaustivo utilizando modelos de regresión de Cox univariados y multivariados junto con un análisis de la curva característica operativa del receptor (ROC). Este estudio se realizó con los datos de pacientes de COAD obtenidos de la base de datos The Cancer Genome Atlas (TCGA). Se desarrollaron nomogramas para anticipar la influencia pronóstica de CLCA1. Además, se analizó la asociación de CLCA1 con la infiltración inmunitaria tumoral, los puntos de control inmunitarios, la respuesta de bloqueo de los puntos de control inmunitarios (ICB), la red de interacción y el análisis funcional de genes relacionados con CLCA1. Descubrimos que los tejidos de adenocarcinoma de colon tenían una expresión significativamente menor de CLCA1 en comparación con los tejidos sanos. Además, el estudio reveló que el grupo con alta expresión de CLCA1 demostró una tasa de supervivencia general (SG) significativamente mayor en comparación con el grupo con baja expresión. El análisis de regresión de Cox multivariado y univariado reveló el potencial de CLCA1 como factor de riesgo independiente de COAD. Estos resultados se confirmaron mediante nomogramas y curvas ROC. Además, el análisis de la red de interacción proteína- proteína (PPI) y el enriquecimiento de genes funcionales mostraron que CLCA1 puede estar asociado con actividades funcionales como la secreción pancreática, la señalización de estrógenos y la señalización de AMPc, así como con la infiltración de células inmunes específicas. Por lo tanto, como nuevo predictor independiente y biomarcador potencial de COAD, CLCA1 desempeña un papel crucial en el avance del cáncer de colon.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Adenocarcinoma/immunology , Colonic Neoplasms/immunology , Chloride Channels/immunology , Prognosis , Immunohistochemistry , Adenocarcinoma/metabolism , Survival Analysis , Multivariate Analysis , Regression Analysis , Colonic Neoplasms/metabolism , Chloride Channels/metabolism , Computational BiologyABSTRACT
This research proposes: (i) analyze push and pull motivations in insular marine protected areas, and (ii) determine their effects on tourists' satisfaction, positive recommendations and loyalty in terms of returning. The study was conducted in the Galápagos Islands in Ecuador; a renowned marine protected area with a National Park being a Natural Heritage Site of Humanity by UNESCO. An exploratory (EFA) and confirmatory factor analysis (CFA), followed by a stepwise multiple regression analysis applied on a sample of 407 tourists in the Galápagos Islands showed four push and pull motivational factors in this destination: "passive marine," "active marine," "novelty and escape," and "social relations". "Passive marine" and "social relations" were the most prominent factors influencing tourist satisfaction and return intentions. Moreover, "passive marine" and "novelty and escape " highly influenced visitors' intention to recommend and give positive feedback about this place. These findings constitute action guides for the adequate management of marine protected areas.
Subject(s)
Intention , Motivation , Ecuador , Personal Satisfaction , Regression AnalysisABSTRACT
[ABSTRACT]. Objective. To analyze trends in mortality caused by cardiovascular diseases (CVD) in Chile during the period 2000–2020. Methods. Data on age-adjusted mortality rates (AAMR) from CVD per 100 000 population in Chile for 2000– 2020 were extracted from the World Health Organization Mortality Database. Joinpoint regression was used to analyze the trends and compute the average annual percent change (AAPC) in Chile. In addition, analyses were conducted by sex and type of CVD. Results. Between 2000 and 2020, the AAMR from CVD decreased in Chile from 159.5 to 94.6 per 100 000 population, with a statistically significant decrease in the AAPC of 2.6% (95% CI [–2.8, –2.4]). No joinpoints were identified. The AAMR from CVD decreased annually by 2.6% (95% CI [–2.8, –2.4]) and 2.8% (95% CI [–3.5, –2.6]) in men and women, respectively. The AAMR from ischemic heart disease reduced annually by 3.6% (95% CI [–4.6, –2.7]) with two joinpoints in 2011 and 2015. In the case of stroke, the mortality rate decreased annually by 3.7% (95% CI [–4.5, –3.0]), with two joinpoints in 2008 and 2011. Conclusions. Cardiovascular disease mortality rates have decreased significantly in Chile, in both sexes, especially in women. This decrease could be explained mainly by a significant reduction in the case fatality in recent decades. These results could be a reference for developing primary prevention and acute management of CVD policies focused on populations with higher mortality.
[RESUMEN]. Objetivo. Analizar las tendencias de la mortalidad por enfermedades cardiovasculares (ECV) en Chile durante el período 2000-2020. Métodos. Los datos sobre la tasa de mortalidad ajustada por la edad (TMAE) por ECV por 100 000 habitantes en Chile durante el período 2000-2020 se extrajeron de la base de datos de mortalidad de la Organización Mundial de la Salud. Se utilizó la regresión de tipo joinpoint (punto de cambio) para analizar las tendencias y calcular el cambio porcentual anual promedio (CPAP) en Chile. Además, se realizaron análisis por sexo y por tipo de ECV. Resultados. Entre el 2000 y el 2020, la TMAE por ECV disminuyó en Chile de 159,5 a 94,6 por 100 000 habi- tantes, con una disminución del CPAP estadísticamente significativa del 2,6% (IC del 95% [-2,8 a -2,4]). No se detectó ningún punto de cambio (joinpoint). La TMAE por ECV disminuyó anualmente un 2,6% (IC del 95% [-2,8 a -2,4]) en los hombres y un 2,8% (IC del 95% [-3,5 a -2,6]) en las mujeres. La TMAE por cardiopatía isquémica se redujo anualmente en un 3,6 % (IC del 95 % [-4,6 a -2,7]), encontrándose dos puntos de cambio en el 2011 y el 2015. En el caso de los ataques cerebrovasculares, la tasa de mortalidad disminuyó anual- mente un 3,7% (IC del 95% [-4,5 a -3,0]), encontrándose dos puntos de cambio en el 2008 y el 2011. Conclusiones. La tasa de mortalidad por ECV ha disminuido significativamente en Chile en ambos sexos, pero en especial en las mujeres. Este descenso podría explicarse principalmente por la reducción significa- tiva de la letalidad observada en las últimas décadas. Estos resultados podrían constituir una referencia para la elaboración de políticas de prevención primaria y manejo de casos agudos de ECV que estén centradas en aquellos grupos poblacionales donde la mortalidad es más alta.
[RESUMO]. Objetivo. Analisar as tendências de mortalidade causada por doenças cardiovasculares (DCV) no Chile no período de 2000 a 2020. Métodos. Taxas de mortalidade por DCV ajustadas por idade no Chile referentes ao período de 2000 a 2020 foram extraídas do Banco de Dados de Mortalidade da Organização Mundial da Saúde. Foi usado um modelo de regressão linear segmentada (joinpoint) para analisar tendências e calcular a variação percentual média anual no Chile. Além disso, foram realizadas análises por sexo e tipo de DCV. Resultados. No Chile, entre 2000 e 2020, a taxa de mortalidade por DCV ajustada por idade caiu de 159,5 para 94,6 por 100 mil habitantes, com uma redução estatisticamente significante da variação percentual média anual de 2,6% (IC de 95% [-2,8; -2,4]). Não foram identificados pontos de inflexão. Anualmente, a taxa de mortalidade por DCV ajustada por idade caiu 2,6% (IC 95% [-2,8; -2,4]) e 2,8% (IC 95% [-3,5; -2,6]) entre homens e mulheres, respectivamente. A taxa de mortalidade por doença cardíaca isquêmica ajustada por idade caiu 3,6% (95% CI [-4,6; -2,7]) por ano, com dois pontos de inflexão (em 2011 e 2015). No caso do acidente vascular cerebral, a taxa de mortalidade diminuiu 3,7% (IC de 95% [-4,5; -3,0]) por ano, com dois pontos de inflexão (em 2008 e 2011). Conclusões. As taxas de mortalidade por doenças cardiovasculares diminuíram significativamente no Chile em ambos os sexos, especialmente nas mulheres. Essa queda pode ser explicada principalmente por uma redução significativa na letalidade observada nas últimas décadas. Esses resultados podem ser uma referên- cia para o desenvolvimento de políticas de prevenção primária e manejo de casos agudos de DCV voltadas para populações com maiores taxas de mortalidade.